I'm done with my surgery rotation: one month of general surgery and one month of specialties (two weeks of transplant surgery and two weeks of plastic surgery). There was a lot to consider and write about in these past couple months, but there was little time and energy to do so. Ideally I'd like to start from the beginning, but starting from there and thinking about how much has to be rendered, is a little overwhelming for me even after 12 hours of catch-up sleep. So I'll start from the end, where it's freshest and easiest to retrieve.
In the two weeks of plastics, I never once saw the same procedure twice except for two or three minor removals of moles. Every day the variety and creativity made me think of it as plasticity, the capacity of our imaginations and skin to move and stretch. Plastics in general is a very broad entity. I'm sure there's a technical all-encompassing definition of what qualifies as plastic surgery, in the little guidebook they gave the students but I'm bad with defined definitions and technicalities. From my short experience I think of it as making molds and shifts, for any combination of structure, function and appearance. I find this an admirable endeavor, because it takes both art and empathy, in addition to the anatomy and science of surgery.
To be completely honest, my surgery rotation took a lot out of me and I'm still recovering. So I find it difficult to write in any other way than by a sort of list and free reflection, but maybe that's the best way in this case.
Day 1: Hand surgery. The first case consisted of carpel tunnel, trigger finger, and tenosynovitis all in one hand. These all follow similar pathologies of compressed tendons causing pain or dysfunction, and the procedures were simple releases of the respective tendons, placed in different areas of the hand. Hands have the most amazing anatomy in my opinion; they are so finely controlled. There are eight bones at the base of your hand--eight! Then four for each finger, three for your thumb. So many for such a small space. There are different tendons for each separate movement of each digit, and they extend from your forearm into the hand, and when the surgeon exposes them in the wrist, he can tug on one and make a finger move exactly as predicted. Besides the anatomical elegance, hands are so important in daily function; think of everything you need them for and how detrimental it would be for them to have pain or lose function.
In surgery they place sterile drapes on everything that's not being operated on, so in hand surgery the only thing you see is the person's hand. Sometimes there's such contrast between a person's hands and the rest of them. A face can be so rough and a hand so delicate, or vice versa, and it makes you think that there's so much to know about someone. In any case the capacity and shape of hands make them all pretty damn beautiful, and I can see why they take on so much importance in some cultures. That's where part of the uniqueness of plastics comes in; it remembers how deep aesthetics run below the surface.
Day 2: Cleft palate, eye reconstruction. I love the cleft lip and palate cases, as they're kids, and their smallness is made fuller by the small space of the mouth. Kids born with these defects return throughout their lives until adulthood, to fix the multiple problems arising from the incomplete fusion of their palates. It's interesting and touching to fix a "defect" of which they are too young to be aware. The eye reconstruction for an eye injured while ziplining consisted of molding plaster to place underneath the eyeball to lift it up and match the other eye. The person had lost much of the vision in this eye, but people need more from their eyes than to look out from them. As the surgeons looked from every angle to strive for symmetry, I realized eyes are also looked into.
Day 3: Melanoma removal. From these and the removals of moles, I was surprised that when a small area of your skin is removed, you can pull the surrounding areas together to cover it, as though we were designed with a bit of excess just for the possibility of mistakes and misfortune. Many of these occur on the face, and the surgeons cut them in a particular arrangement such that when the surrounding skin is used to close the wound, the result is very natural. There are natural creases in the face, and the surgeons cut as to conserve these; the creases that we inflict are then sewn with such care that the inevitable scars are underwhelming. Small changes are always felt by the bearer of them, and while these can never be completely eradicated, I appreciate the surgeons' sensitivity to the nuances.
Day 4: Resection of squamous cell (skin) cancer of the arm. This was a sad case, as the cancer penetrated much deeper than we anticipated. Originally, the skin was to be removed and covered with skin taken from another area of the body. But it turned out that the cancer went beyond the skin deep into the muscle; the surgeon removed what he thought was reasonable to take at that moment and the rest of the case was canceled, to further investigate the nature of her cancer. Instead of being closed with a skin graft, the area removed was left completely open, wrapped and covered with gauze. The sight of that made cancer visceral, something I felt in my throat more tightly than when I learned about cancer or interacted with cancer patients. And the weak cries of pain from the elderly woman with dementia, who couldn't express fight as even a child would by pulling away, made me feel there's a lot we can't cut away so easily. See Day 8 for a follow-up.
Day 5: Breast reconstruction. Most of the breast reconstructions I've seen here are for mastectomies for breast cancer. One consisted of making an entirely new nipple, by raising existing breast tissue. I did not expect to be impressed by this at all, but I was. It isn't until you see something being made from scratch that you realize how much structure it contains. With my own limited capabilities I've tried to craft things, and know it's much easier in theory than in practice to make something you make resemble something natural (which is probably why most of my Halloween costumes are abstract). It also feels important, this attempt to give back something a woman has lost that she's probably never anticipated losing. Regaining a breast is a slow process, that often requires gradually expanding the space underneath the tissue you've injured by removing the cancer, before you can place implants or other means of reconstructing the breast. In one case I watched the surgeon transfer fat from the belly to the breast--how malleable we are, how much can flow from one space to another if we only think of it. I also saw a breast reduction, which was the bloodiest surgery I've seen thus far; who knew that space encased so much red?
Day 6: I can't remember...
Day 7: Skin flap, which means taking the skin and muscle of one area of the body to cover another. This was a long day, with the surgery ending at 9:30 at night. The patient had basal cell cancer, another skin cancer that doesn't spread to other parts of the body but does invade local areas pretty aggressively. It takes years and years to do this, so sometimes people ignore it until it gets to be quite a large area. In this case, it had gotten so out of hand that the ear nose throat surgeons had to remove her ear, facial bones, and most of the left side of her face including the nerves. I didn't enter the surgery until much of this had been taken, and I couldn't recognize anything to orient me to what exactly we were working on; it wasn't until I saw her exposed neck (her jugular vein and carotid artery were completely out in the open) that I could somewhat tell. To cover this large area, the plastic surgeons took a large flap from her thigh. It took quite a bit of effort to use the thigh's surrounding skin to close this new wound, and even more to contour the flap to suit its new location on the face. In the end, it looked like a face, her face.
Day 8: Resection of skin cancer from Day 4. They decided that they could take out her entire tumor; they'd go back and take out the muscle that it had invaded. They planned to take the skin and muscle from a muscle on your side called the latissimus. They cut away at one edge of the cancer while I pulled on the other edge, and at one point they'd made enough progress that as I pulled the entire thing came away from her body. I felt then that we were doing something. Later they moved to under her arm, where the cancer had spread, and found that the cancer had wrapped itself around the vessels supplying the latissimus muscle. If we wanted to get rid of the cancer, we'd have to sacrifice the vessels, and thus sacrifice the muscle that was to replace the gaping hole the cancer left in her already fragile arm. And so that's what happened. Though her arm skin was loose enough to be able to be pulled over the wound, the inability to replace the removed muscle left her arm thinner and without much function. This was disappointing to everyone, and harder than I imagined, to see her be twice cut away...the cancer removed but likely to recur, her body and function progressively lessening in character. It made concrete the idea of fighting cancer, something that had previously seemed to mean a conceptual and mental battle but that I now know is also a physical struggle that is fully felt by the person.
Day 9: Skin graft. In this case, only the skin of an area is removed to replace another damaged area; no muscle is taken as with a skin flap. This elderly patient suffered a stroke and fell onto a heater that burned her back and knee quite badly. The surgeon razed a thin layer of skin from her thighs, and ran the skin through a little machine that places little holes into it to make a mesh with more surface area. This was originally invented for burn victims, who lost more skin than they could replace with the skin they still had. It's procedures like this that make for terms like "donor" and "recipient," both of which refer to the same person. One part gives to another, and I felt lucky to have seen this connectedness, to see things come together that I hadn't even realized had been apart.
Day 10: Nasal fracture, mandibular fracture. These reminded me of having my wisdom teeth taken out, fully awake--I didn't feel anything, but the noises of cracking and screwing together bone terrified me. The first person had broken his nose in a fight, and the other had broken both sides of his mandible and I don't know how. In addition to moving things around, plastic surgeons are good at putting things back in place, but I hope I never have anything in me knocked out of its origin.
Over the course of two weeks of seeing things rearranged and created to make things of value for people, I find myself glad that people require so many views to see them. I'm not personally equipped to do what these surgeons do, and so I feel lucky to have at the least seen a small part of their work. Sometimes it's painful to know how easily we can be damaged, but I think the plasticity that makes that true is also what makes repair possible.
Saturday, March 27, 2010
Tuesday, March 16, 2010
ellipse
We removed a mole from the scalp of a sweet little boy today (it has a low potential to become cancerous). They incised an ellipse around the area to be removed. A circular wound doesn't work, because when you bring the edges together to sew into what will be his scar, there will be areas that don't meet and cause a bump. To render it smooth, you make an ellipse instead (three times as long as it is wide). And with your hand, you have to stretch all the surrounding skin under the scalp, to release the tension. Tension doesn't bode well for stitching the wound.
For all the pains of surgery, it's pushed me to stretch farther than I imagined. And at the least and most, I've had many experiences, which is what I came here for. I'm looking forward to processing and stitching them up, into a scar whose pain is past but whose presence is palpable.
For all the pains of surgery, it's pushed me to stretch farther than I imagined. And at the least and most, I've had many experiences, which is what I came here for. I'm looking forward to processing and stitching them up, into a scar whose pain is past but whose presence is palpable.
Sunday, February 28, 2010
two
A couple of songs immersing my trudges to and from, and much in between--
Two by the Antlers, from Hospice
http://www.youtube.com/watch?v=ZsXKa97J6pM
The sound at first feels so different from the words. The sound begins simple, a kind of pure that I'd like first thing in the morning. More and more builds, and you can't really hear the words too well, but phrases slip into sharpness and over time you string together pieces and realize the story is sad. Listen more and more, and the conflict comes into focus, but then blurs back into background, because it's not so much that the sound and word oppose; they layer.
Cosmic Love by Florence & the Machine, from Lungs
http://popup.lala.com/popup/432627079823895964
Soft female voices that can really howl give so much. I heard this song and thought for awhile of a word to describe what her voice does, and soon after I settled upon "howl," I noticed that song #4 on her album carries that title. Fitting for an album celebrating the capacity of her lungs. And that volume doesn't have to be about overcoming or battling in order to for her sound to be soaring; it can just be the volume of what she feels and the expression of that. I love when femininity proves its strength by pouring forth the full-blown force of vulnerability.
Two by the Antlers, from Hospice
http://www.youtube.com/watch?v=ZsXKa97J6pM
The sound at first feels so different from the words. The sound begins simple, a kind of pure that I'd like first thing in the morning. More and more builds, and you can't really hear the words too well, but phrases slip into sharpness and over time you string together pieces and realize the story is sad. Listen more and more, and the conflict comes into focus, but then blurs back into background, because it's not so much that the sound and word oppose; they layer.
Cosmic Love by Florence & the Machine, from Lungs
http://popup.lala.com/popup/432627079823895964
Soft female voices that can really howl give so much. I heard this song and thought for awhile of a word to describe what her voice does, and soon after I settled upon "howl," I noticed that song #4 on her album carries that title. Fitting for an album celebrating the capacity of her lungs. And that volume doesn't have to be about overcoming or battling in order to for her sound to be soaring; it can just be the volume of what she feels and the expression of that. I love when femininity proves its strength by pouring forth the full-blown force of vulnerability.
Wednesday, February 24, 2010
alone
Leaning against my car, I didn’t see any water. Void of any geographical sense, I wasn’t sure where the Long Island Sound was situated but I wasn’t really looking for it either. Though the space between, between where I was and where the bank of trees ahead lay, steeped down and gave a feeling of being higher up, the parking lot was likely not elevated enough to afford a view. It was cold, not bitingly so, just so to match the gray that comes too early in the day during months like December. The sky held a dull solid gray, the trees blended a hazy one.
It’d been a short and unfamiliar drive from New Haven to the Connecticut Hospice, and now that I’d entered and left the entrance of the building, it was easier to stay. The stray leaves clinging to deceptively precarious branches didn’t keep the trees from being bare, but made them feel heavy, and I tried to focus on the lean trunks. I tried not to choke on my heaving breaths. And to stop the flow of salt and water from my eyes to the air around, air that you could tell was dry by the way it soaked up the moisture layering my skin.
He’d been transferred from the hospital to hospice the day before. He hadn’t been happy about it, had responded with “horrible” when asked how he was doing, the last two syllables swallowed by the effort of the first. Often his breathing was too labored for fluency, and sometimes words took a long time, occupying a space that I didn’t realize was open until his voice closed them. Even though his voice sounded the same whether he was comfortable or uncomfortable, it moved more than anything else about him. It was never accented by the rest of his face; his lips didn’t migrate from the straight road they naturally formed, the taut white of his forehead never disrupted even while his lungs crumpled into rough coughs.
He lived in a bed next to the door in a room of three, and when we waved from the hallway he called out hello if he saw us. The wet brown of his eyes drew a full film from one corner to the other and felt protective of something, but they kept him from seeing his food well enough to eat. He didn’t want to eat anyway, and he directed his gaze towards the sound of the television, even when the hospital headphones slipped off his ears and forward onto his chest like a necklace. It made me think that hospital gowns don’t lend themselves to accessories.
He had been a patient on our list of patients to see every morning for almost a week before I really met him, when the physician taking care of him allowed another medical student and me to sit in on a conversation she had with him about his health. Earlier that day she had talked of him as a patient she knew would stick with her; “he’s sweet; you can tell life’s been unfair to him.” I’d felt somewhat guilty for not noticing, as once I sat down on his bed it was palpable through the blankets.
The doctor touched his shoulder, which was usually enough to rouse him if his eyes were closed (at this time they weren’t), and told him she wanted to talk to him about things.
She gently explained the state of his major organs and how in trying to support one, we hurt another. When things reach a balancing act where balance would be unstable, when piling or removing things from either end keeps hurting, we turn our attention to the fulcrum. Again nothing in his face moved, but he said he wasn’t ready. He’d have to talk to his wife. She didn’t visit because they didn’t have a car, and a taxi would be too costly for their resources. She didn’t like seeing him so sick, anyway. But Thanksgiving was coming up, and his nephews and nieces had cars that could carry his family, and turkey with cranberry sauce in plastic containers, to the hospital then.
I was also in the hospital on Thanksgiving, when his room went from three patients whose beds were separated by cloth curtains maneuvered by nurses and doctors, to a flock of relatives standing in their puffy winter coats that they didn’t remove once inside. His wife’s shape matched her voice on the phone but she looked much older than him, with the gray in her hair prominent since she’d let it go long while his hair was still brown, and the wrinkles I sometimes imagined to be hiding in his forehead openly lined her eyes. A teenager with glasses and thick strands of hair across his forehead, a nephew I presumed, brought him a walkman. The headphones that came with it weren’t any more stable around his head than the others, but he took them with him to hospice; we had to disentangle them from the other pair to make sure he had the right ones.
I said hello to the group forming a sort of semi-circle at the foot of his bed as though participating in an icebreaker, and saw the cranberry sauce. It is strange to meet people whose lives give a disproportionate amount of substance to yours when compared to vice versa. I wasn’t in the room when the doctors talked to them about the future. But I saw them leave the room and walk down the hallway in a choppy stream, some visibly upset and others subtly so.
His wife nodded as I passed and said that she would like him to be comfortable. I nodded back, and went into his room out of an invisible inertia, without thought to if I had anything to offer and if so what form that would take. And so I started as we did every morning.
“How are you doing?”
“Oh, half and half.”
“I saw your family in the hallway. It must’ve been nice to have them here.” I looked at his bedside table to see if he’d eaten, but I couldn’t really tell. It was only then that I heard what he’d said, which was something he would say often in the following days. When evaluating his physical state, the doctors taking care of him spoke of him as having good days and bad days. It is true that on some days his face looked cleaner and his lungs sounded clearer, and other days the crackles that our stethoscopes could hear would rattle his chest so that he looked limp and for some reason during those times, the crust that develops from standstill remained in his eyes instead of being washed with blinks. “Half and half?”
He nodded, which for him meant bringing his chin down to his chest. By the time he’d bring it back up, you may have forgotten the first motion.
“Did you talk to your family about things?”
“We’re looking for a place. There’s one near my house so my wife can walk there and see me.”
Surprised that the logistics of things had already been discussed, I nodded.
Back in the room with the computers where we typed records of how our patients were doing today versus yesterday, they tried guessing what would take him, eventually: his kidneys, said one; his lungs, said another. How does that work, when his cancer had started in his throat? He never asked, but I wondered and despite the daily updates on his physical state I never knew.
Later through a process of which I wasn’t aware but trusted, it was decided that he go to Connecticut Hospice in Branford, not to the place he mentioned in his town. We told him it would probably be better when he was settled into a place, in a room with more privacy. He asked whether he would be in his own room, and was told that it was likely to be shared but that the rooms were vast. Although he seemed to want his own room, he wasn’t eager to leave the company of the people passing his open door in the hallway, though he never stated either sentiment directly. “It’s nice to just see faces,” he said in what felt more like a confirmation than a confession.
On one Friday, after having seen him on our morning rounds every day he’d been in the hospital, I said I’d miss him over the weekend.
“Well, then you should work on the weekend.”
I paused. “I’ll come by to see you.”
There was no pause, and no movement of his eyes from their station. “That’s very nice, but you won’t.”
Our interactions were not scarce, but brief. We ran out of things to say. I didn’t find out much about his life before here, or his life at that time outside of that bed. The natural course of asking how he was would be to discuss the present and near future, and I didn’t know how to bring the past in relief. On days when he wanted to be in limbo or something more than that, he’d talk about the new cancer center and what his doctors had told them. On the days it was explicit, mostly he said he didn’t want to die. Asking why would have felt too easily misunderstood, but now feels too easily absent.
So the day he left for hospice was one of the half and half days; to his doctors it was a bad one. In the hours before the transport from hospice arrived, he was having trouble breathing, and when they arrived he was receiving a breathing treatment to help open the vessels in his lungs. The man and woman in uniform who had come for him stood by the window and told us to take our time; they were “in no rush.” When he finished breathing into the mask, they brought a thin stretcher alongside the hospital bed.
“We’re going to move you from there into this so we can drive you there, okay?”
“How far is it?”
“The ride will be over before you know it. Barely twelve minutes.” The woman’s conversation was proficient, and I became acutely aware that this was my first time seeing all this happen. Her hair was tight where her braid started to form and then throughout. Nothing about her gave way, but still she was kind in a way difficult to pinpoint with tone or act. Maybe it was this softness without known source that made me turn away when they put the rails down on his hospital bed.
But I watched as they gathered the sheet below him and swiftly transferred him to the stretcher. Narrow as he was, the stretcher still just accommodated him. The man and woman layered him with blankets that had the texture of towels.
“There will be a brief period, less than a minute, where you’ll be outside as we move you into the van. It’ll be cold, but we’re putting these blankets on you, and it’ll be very quick.”
His belly was large, but he was seamlessly consumed by a swarm of blankets. Once covered, his arms and legs disappeared. His small face lacked sharp edges and fell into underlying pillow without difficulty. There were hints of him against the sheet: the deep brown of his hair splayed in tufts, the red in his cheeks dissolving thinly out and down to his jaw and seeping into the pillowcase, the wet in his eyes making all else feel dull. This was all I could see of him; everything else was white on the black stretcher.
“We’re going to strap you in now, okay?”
He brought his chin down to his chest, and coughed, “Okay.”
The woman pulled on a black belt with a heavy buckle, stretched it to as far as her arm extended, and handed the other end across his body to the man, who pulled down and tightened it. This spanned his torso. They started another across his lower body but as the transfer of buckle was taking place, one caught the other’s eye and they paused. “It’s probably not necessary.”
I’d never seen him walk while in the hospital, though I knew he went to and from the bathroom on his own, but it wasn’t until now that it seemed that he couldn’t move, with or without the one buckle. He was breathing less heavily now and unlike when he was sitting up in bed with his gown in full view, as he lay there I couldn’t see his chest struggling.
“I hope you’ll come see me.” We’ve been advised never to promise anything, and despite instincts, we force ourselves to rephrase things into “I’ll try.” It was a Tuesday, and I told him I’d try my best to come see him, though it might not be until Thursday or so. I watched them wheel him through the door and down the hallway, no further though I could have rounded the corner to the elevators with them.
I’d never been to Connecticut Hospice but had heard it was beautiful, overlooking the water. I looked up its information on the internet on Wednesday morning. I called their number for his room number, and was given it, though they said I wouldn’t need it. The person at the front desk would help me once I got there.
It was late afternoon when I got there. Though the streets were a little confusing, I’d found the way fairly easily with my friend’s GPS. The parking lot was large and three fourths full. As I walked to the main entrance, I felt glad the transition had been made, and looked forward to seeing him in a brighter place, one designed for comfort. The front desk was where they said it would be, and I found myself thankful for the ease of things. The woman manning it wore a thick sweater upon which her light curls rested. When I gave her his name, she carefully scanned a list in front of her. As the seconds crawled, I regretted forgetting the room number I’d called for in the morning.
She picked up the phone to call for his room, and as I waited I watched others pass through the front desk and down a corridor past large glass windows, without stopping. She spoke softly, but I heard her say his name. Then, “oh,” to the phone and to me, “Are you a family member?”
“No. I’m a med student. We took care of him at the hospital.”
“Oh,” to me, and to the phone, “She took care of him at the hospital.”
I watched her nod several times at the phone, continuing to speak softly, and hang up. “Someone’s coming.”
“Thank you.” I waited and watched more people pass, without waiting.
Someone whose face and shape I don’t remember came. “Hello, are you a family member?”
“No. I’m a med student. We took care of him at the hospital.”
“Oh.” She nodded. I gave a small smile. She told me she was very sorry; he’d passed away that afternoon.
“Oh. That was fast.” So fast. Twelve minutes to get from the hospital to there. What happened in between? I’d called that morning. He’d had a room number. One with a letter, so he was sharing space. But it was more space. Blinking to buy time, I paused before it came to me to ask, “Was his family there?”
“No. We called his wife. She didn’t want to come.”
I nodded. “Thank you.” I wanted to give her more than that thank you, or to fully give the thank you, and paused. But it was too brief, and the sentiment too blurry. I turned slowly, maybe to match the stride of what had come before. But once out the door, the passing air that grazed my skin on its way to elsewhere held in it the shortness of my time inside, taking it for itself and carrying it away. Maybe because of that I stayed outside.
He hadn’t asked to be moved to a building with a view, or for much of anything other than our presence. It wasn’t much to give, and it wasn’t hard to want to give it, but in the end it was the most elusive. When asked about how he wanted to proceed, he’d defer to what we thought, saying we knew best. There were a lot of us: the respiratory team watching over his lungs, the oncology team monitoring his cancer, the renal team reminding us that his kidneys were failing, and the geriatric team checking every morning for a bad or good day. Each of them explained things, and asked questions to cater to his needs, trying to provide care in the niches they’d formed in training and in experience. Because the weight of confrontation and decision was too much for him, and because this weight had become a part of their anatomy, they let him give it to them, in the hopes that they could give something to him.
I thought this too, thought that though it felt viscerally out of place to attach him to that stretcher and move him, it would take him to a place that would be better, eventually. What happened in that transition to this place, that took from him the time required to make it better? We’d left him alone before.
Never having seen him in a new place, standing with the hospice in close distance I only saw him as he looked when I first knew him. After not too long I left for home, with the water still out of view behind the low level of trees.
It’d been a short and unfamiliar drive from New Haven to the Connecticut Hospice, and now that I’d entered and left the entrance of the building, it was easier to stay. The stray leaves clinging to deceptively precarious branches didn’t keep the trees from being bare, but made them feel heavy, and I tried to focus on the lean trunks. I tried not to choke on my heaving breaths. And to stop the flow of salt and water from my eyes to the air around, air that you could tell was dry by the way it soaked up the moisture layering my skin.
He’d been transferred from the hospital to hospice the day before. He hadn’t been happy about it, had responded with “horrible” when asked how he was doing, the last two syllables swallowed by the effort of the first. Often his breathing was too labored for fluency, and sometimes words took a long time, occupying a space that I didn’t realize was open until his voice closed them. Even though his voice sounded the same whether he was comfortable or uncomfortable, it moved more than anything else about him. It was never accented by the rest of his face; his lips didn’t migrate from the straight road they naturally formed, the taut white of his forehead never disrupted even while his lungs crumpled into rough coughs.
He lived in a bed next to the door in a room of three, and when we waved from the hallway he called out hello if he saw us. The wet brown of his eyes drew a full film from one corner to the other and felt protective of something, but they kept him from seeing his food well enough to eat. He didn’t want to eat anyway, and he directed his gaze towards the sound of the television, even when the hospital headphones slipped off his ears and forward onto his chest like a necklace. It made me think that hospital gowns don’t lend themselves to accessories.
He had been a patient on our list of patients to see every morning for almost a week before I really met him, when the physician taking care of him allowed another medical student and me to sit in on a conversation she had with him about his health. Earlier that day she had talked of him as a patient she knew would stick with her; “he’s sweet; you can tell life’s been unfair to him.” I’d felt somewhat guilty for not noticing, as once I sat down on his bed it was palpable through the blankets.
The doctor touched his shoulder, which was usually enough to rouse him if his eyes were closed (at this time they weren’t), and told him she wanted to talk to him about things.
She gently explained the state of his major organs and how in trying to support one, we hurt another. When things reach a balancing act where balance would be unstable, when piling or removing things from either end keeps hurting, we turn our attention to the fulcrum. Again nothing in his face moved, but he said he wasn’t ready. He’d have to talk to his wife. She didn’t visit because they didn’t have a car, and a taxi would be too costly for their resources. She didn’t like seeing him so sick, anyway. But Thanksgiving was coming up, and his nephews and nieces had cars that could carry his family, and turkey with cranberry sauce in plastic containers, to the hospital then.
I was also in the hospital on Thanksgiving, when his room went from three patients whose beds were separated by cloth curtains maneuvered by nurses and doctors, to a flock of relatives standing in their puffy winter coats that they didn’t remove once inside. His wife’s shape matched her voice on the phone but she looked much older than him, with the gray in her hair prominent since she’d let it go long while his hair was still brown, and the wrinkles I sometimes imagined to be hiding in his forehead openly lined her eyes. A teenager with glasses and thick strands of hair across his forehead, a nephew I presumed, brought him a walkman. The headphones that came with it weren’t any more stable around his head than the others, but he took them with him to hospice; we had to disentangle them from the other pair to make sure he had the right ones.
I said hello to the group forming a sort of semi-circle at the foot of his bed as though participating in an icebreaker, and saw the cranberry sauce. It is strange to meet people whose lives give a disproportionate amount of substance to yours when compared to vice versa. I wasn’t in the room when the doctors talked to them about the future. But I saw them leave the room and walk down the hallway in a choppy stream, some visibly upset and others subtly so.
His wife nodded as I passed and said that she would like him to be comfortable. I nodded back, and went into his room out of an invisible inertia, without thought to if I had anything to offer and if so what form that would take. And so I started as we did every morning.
“How are you doing?”
“Oh, half and half.”
“I saw your family in the hallway. It must’ve been nice to have them here.” I looked at his bedside table to see if he’d eaten, but I couldn’t really tell. It was only then that I heard what he’d said, which was something he would say often in the following days. When evaluating his physical state, the doctors taking care of him spoke of him as having good days and bad days. It is true that on some days his face looked cleaner and his lungs sounded clearer, and other days the crackles that our stethoscopes could hear would rattle his chest so that he looked limp and for some reason during those times, the crust that develops from standstill remained in his eyes instead of being washed with blinks. “Half and half?”
He nodded, which for him meant bringing his chin down to his chest. By the time he’d bring it back up, you may have forgotten the first motion.
“Did you talk to your family about things?”
“We’re looking for a place. There’s one near my house so my wife can walk there and see me.”
Surprised that the logistics of things had already been discussed, I nodded.
Back in the room with the computers where we typed records of how our patients were doing today versus yesterday, they tried guessing what would take him, eventually: his kidneys, said one; his lungs, said another. How does that work, when his cancer had started in his throat? He never asked, but I wondered and despite the daily updates on his physical state I never knew.
Later through a process of which I wasn’t aware but trusted, it was decided that he go to Connecticut Hospice in Branford, not to the place he mentioned in his town. We told him it would probably be better when he was settled into a place, in a room with more privacy. He asked whether he would be in his own room, and was told that it was likely to be shared but that the rooms were vast. Although he seemed to want his own room, he wasn’t eager to leave the company of the people passing his open door in the hallway, though he never stated either sentiment directly. “It’s nice to just see faces,” he said in what felt more like a confirmation than a confession.
On one Friday, after having seen him on our morning rounds every day he’d been in the hospital, I said I’d miss him over the weekend.
“Well, then you should work on the weekend.”
I paused. “I’ll come by to see you.”
There was no pause, and no movement of his eyes from their station. “That’s very nice, but you won’t.”
Our interactions were not scarce, but brief. We ran out of things to say. I didn’t find out much about his life before here, or his life at that time outside of that bed. The natural course of asking how he was would be to discuss the present and near future, and I didn’t know how to bring the past in relief. On days when he wanted to be in limbo or something more than that, he’d talk about the new cancer center and what his doctors had told them. On the days it was explicit, mostly he said he didn’t want to die. Asking why would have felt too easily misunderstood, but now feels too easily absent.
So the day he left for hospice was one of the half and half days; to his doctors it was a bad one. In the hours before the transport from hospice arrived, he was having trouble breathing, and when they arrived he was receiving a breathing treatment to help open the vessels in his lungs. The man and woman in uniform who had come for him stood by the window and told us to take our time; they were “in no rush.” When he finished breathing into the mask, they brought a thin stretcher alongside the hospital bed.
“We’re going to move you from there into this so we can drive you there, okay?”
“How far is it?”
“The ride will be over before you know it. Barely twelve minutes.” The woman’s conversation was proficient, and I became acutely aware that this was my first time seeing all this happen. Her hair was tight where her braid started to form and then throughout. Nothing about her gave way, but still she was kind in a way difficult to pinpoint with tone or act. Maybe it was this softness without known source that made me turn away when they put the rails down on his hospital bed.
But I watched as they gathered the sheet below him and swiftly transferred him to the stretcher. Narrow as he was, the stretcher still just accommodated him. The man and woman layered him with blankets that had the texture of towels.
“There will be a brief period, less than a minute, where you’ll be outside as we move you into the van. It’ll be cold, but we’re putting these blankets on you, and it’ll be very quick.”
His belly was large, but he was seamlessly consumed by a swarm of blankets. Once covered, his arms and legs disappeared. His small face lacked sharp edges and fell into underlying pillow without difficulty. There were hints of him against the sheet: the deep brown of his hair splayed in tufts, the red in his cheeks dissolving thinly out and down to his jaw and seeping into the pillowcase, the wet in his eyes making all else feel dull. This was all I could see of him; everything else was white on the black stretcher.
“We’re going to strap you in now, okay?”
He brought his chin down to his chest, and coughed, “Okay.”
The woman pulled on a black belt with a heavy buckle, stretched it to as far as her arm extended, and handed the other end across his body to the man, who pulled down and tightened it. This spanned his torso. They started another across his lower body but as the transfer of buckle was taking place, one caught the other’s eye and they paused. “It’s probably not necessary.”
I’d never seen him walk while in the hospital, though I knew he went to and from the bathroom on his own, but it wasn’t until now that it seemed that he couldn’t move, with or without the one buckle. He was breathing less heavily now and unlike when he was sitting up in bed with his gown in full view, as he lay there I couldn’t see his chest struggling.
“I hope you’ll come see me.” We’ve been advised never to promise anything, and despite instincts, we force ourselves to rephrase things into “I’ll try.” It was a Tuesday, and I told him I’d try my best to come see him, though it might not be until Thursday or so. I watched them wheel him through the door and down the hallway, no further though I could have rounded the corner to the elevators with them.
I’d never been to Connecticut Hospice but had heard it was beautiful, overlooking the water. I looked up its information on the internet on Wednesday morning. I called their number for his room number, and was given it, though they said I wouldn’t need it. The person at the front desk would help me once I got there.
It was late afternoon when I got there. Though the streets were a little confusing, I’d found the way fairly easily with my friend’s GPS. The parking lot was large and three fourths full. As I walked to the main entrance, I felt glad the transition had been made, and looked forward to seeing him in a brighter place, one designed for comfort. The front desk was where they said it would be, and I found myself thankful for the ease of things. The woman manning it wore a thick sweater upon which her light curls rested. When I gave her his name, she carefully scanned a list in front of her. As the seconds crawled, I regretted forgetting the room number I’d called for in the morning.
She picked up the phone to call for his room, and as I waited I watched others pass through the front desk and down a corridor past large glass windows, without stopping. She spoke softly, but I heard her say his name. Then, “oh,” to the phone and to me, “Are you a family member?”
“No. I’m a med student. We took care of him at the hospital.”
“Oh,” to me, and to the phone, “She took care of him at the hospital.”
I watched her nod several times at the phone, continuing to speak softly, and hang up. “Someone’s coming.”
“Thank you.” I waited and watched more people pass, without waiting.
Someone whose face and shape I don’t remember came. “Hello, are you a family member?”
“No. I’m a med student. We took care of him at the hospital.”
“Oh.” She nodded. I gave a small smile. She told me she was very sorry; he’d passed away that afternoon.
“Oh. That was fast.” So fast. Twelve minutes to get from the hospital to there. What happened in between? I’d called that morning. He’d had a room number. One with a letter, so he was sharing space. But it was more space. Blinking to buy time, I paused before it came to me to ask, “Was his family there?”
“No. We called his wife. She didn’t want to come.”
I nodded. “Thank you.” I wanted to give her more than that thank you, or to fully give the thank you, and paused. But it was too brief, and the sentiment too blurry. I turned slowly, maybe to match the stride of what had come before. But once out the door, the passing air that grazed my skin on its way to elsewhere held in it the shortness of my time inside, taking it for itself and carrying it away. Maybe because of that I stayed outside.
He hadn’t asked to be moved to a building with a view, or for much of anything other than our presence. It wasn’t much to give, and it wasn’t hard to want to give it, but in the end it was the most elusive. When asked about how he wanted to proceed, he’d defer to what we thought, saying we knew best. There were a lot of us: the respiratory team watching over his lungs, the oncology team monitoring his cancer, the renal team reminding us that his kidneys were failing, and the geriatric team checking every morning for a bad or good day. Each of them explained things, and asked questions to cater to his needs, trying to provide care in the niches they’d formed in training and in experience. Because the weight of confrontation and decision was too much for him, and because this weight had become a part of their anatomy, they let him give it to them, in the hopes that they could give something to him.
I thought this too, thought that though it felt viscerally out of place to attach him to that stretcher and move him, it would take him to a place that would be better, eventually. What happened in that transition to this place, that took from him the time required to make it better? We’d left him alone before.
Never having seen him in a new place, standing with the hospice in close distance I only saw him as he looked when I first knew him. After not too long I left for home, with the water still out of view behind the low level of trees.
Sunday, February 14, 2010
finding time
I’ve been struggling of late about my plans for the next year, or two years. Here we have the choice to graduate in four or five years. If we choose to take it, the “fifth” year happens between our third and fourth years, our clinical years. Because we are required to write a thesis on any sort of research related to medicine, many students take this year to complete the research. Others take a “flexible fifth year” wherein they do short-term research for a few months, something else for a few months, back to research for awhile, and so on. That “something else” is quite diverse; we can take electives here or abroad, or something completely unrelated to medicine altogether. You can also take the year and not do research at all. Some people get their MBA or MPH, or they take undergraduate courses on literature.
As I’ve already completed the research required for my thesis, I could graduate in the standard four years, which is what I’d always planned on doing. But somewhere during third year, I found the idea of a “free year” pretty enticing. It’s not that I want a break. I’m certainly feeling burnt out; it’s hard for me to tackle learning with the same vigor as before, but I know that it will slow down a bit after this semester and that I could take it in stride if I wanted to. I don’t want to take a year for the sake of taking time. I would like to have a purpose for that time. But as I think about what that purpose would be, a lot of it is about time: making time for things important to me that have slipped in the busy of third year. And I’ve enjoyed being a student; it has afforded me valuable time with people, time that I know I won’t have in residency when I graduate. And while I’m really eager to learn the practical and intellectual skills in residency that I’ll need to take care of patients in the future, I also want to know people more deeply before I presume to be a care provider of them. Maybe it’s because I’m slow at learning things, but I accept that and I would like to be a student of people for a little longer.
There are a few things I would like to do with a year, the biggest being to be able to write about some of the experiences we’ve had in the hospital, and how they’re related for me to my life in general. Associated with that, I’d like to have more experiences with people, and I’ve found a mentor enthusiastic about forming a project around me simply spending time talking with patients, a population of patients to whom I’m particularly drawn. I also want more clinical experience in different places; I’d like to do both a primary care and hospice elective in Uganda, an ob-gyn subinternship in New Mexico, and a hospice elective here at Connecticut Hospice (the first one established in the States). There are others, but I’m trying to limit myself in order to focus on a few things, because even as I try to hold back while writing now, I know it’s hard not to overload a blank slate of a year.
There are many things I worry about in making this decision. We say it’s just one year, and it’s very true in the long run. Yet somehow it still carries more weight. I didn’t give a second thought to taking a year before medical school; I needed it both practically and internally. But though I’m not sure what I would’ve been like without that year, I don’t particularly look back on that year as one of much growth or significance. I don’t want this to be like that, especially because as I said, for various reasons, it carries more weight now at almost twenty-six years old than it did back then at twenty-two.
Taking another year isn’t exactly taking an “extra” year; the time has to come from somewhere. I’d be lying if I didn’t admit that I don’t think about the same things as other girls my age in terms of relationships and the future, which though distant now won’t feel so much so when I graduate, especially if that’s in two years instead of one. The relationships (in the way I define relating to a person) I’ve had here have been worthwhile and valuable emotionally, but also tumultuous and inconducive to what I eventually want concretely. Finding quality and compatibility is hard enough, but doing that in the realm of logistics and future is even worse, and as such I’ve largely avoided the endeavor of considering anything beyond the present. During the time I stay here, I’d probably continue doing that, and can I really keep avoiding it for so long? On the other end, who’s to say that graduating, moving, and working intensely will bring me out of the place I’m in, any better than staying here? On the same lines, I miss my family a lot, and another year here is another year away from them, but graduation doesn’t bring any guarantees that I’ll be closer to them.
I worry I’ll be restless, as I often am while in the educational system, with the idea of not doing anything concrete to be useful. With the sense of constantly being trained for something that seems so distant. I also worry that the insane momentum of third year distorts and exaggerates my need for time, that perhaps I only wish to take it because it’s there for taking. At the same time I wonder if this is an unexpected gift, as this school has been as a whole, and whether I shouldn’t shy away from something simply because it wasn’t in my original plans. Honestly, the idea of this—the time, the commitment to writing, the uncertainty of what I can do and how it will all fit together—scares me like hell. While as a general philosophy I believe in things falling into place, and they’ve been chaotic before and always have fallen right, I’ve had the benefit of the outline of things still following an overall path. I don’t know if this year really falls into any concrete way for me to go, and I know it’s largely up to me to make it worth something.
A friend recently made fun of me for still wearing a watch, now that cell phones have replaced every daily function including checking the time. I love my watch, which was a Christmas gift from my oldest brother in 2001 who said I never knew what time it was, so I’ve had it for nearly a decade and have had to change the battery a couple times in that time period. It uses hands and it has only four dots on its face to signify every three hours, without any numbers. Since I’ve been on surgery I can’t wear it, and yesterday I realized it was the weekend and I could wear it. This morning I went to the gym and took it off as I normally do when running. Since I’d gotten used to not having to do this during the week, when it was time to go, I forgot to put it back on. After I came home and noticed it was missing, it took me some time to realize this is what was happened. It probably took me more time than usual to connect the sequence of events because we'd taken a detour on our way home, and sat on a hammock we saw outside one of the colleges. It was a usual cold winter day with sun and old snow, and we sank into the hammock with ease. I told my roommate I would go get my watch after showering and getting dressed, but she said I should go now, as the more time passed the more likely it was that something would happen to it. So as I hurried back to get it (bemoaning the minutes I was losing doing this, as I’d planned on being on my way out to the architecture library by two o’clock and it would already be two by the time I reached the gym again), I thought how funny and fitting it was to literally find time. Even if it’s gaining back something you lost, and not giving you any more than baseline; even if it’s actually taking some away from you as you do it, time feels different when it’s passing than when it’s found and taken.
As I’ve already completed the research required for my thesis, I could graduate in the standard four years, which is what I’d always planned on doing. But somewhere during third year, I found the idea of a “free year” pretty enticing. It’s not that I want a break. I’m certainly feeling burnt out; it’s hard for me to tackle learning with the same vigor as before, but I know that it will slow down a bit after this semester and that I could take it in stride if I wanted to. I don’t want to take a year for the sake of taking time. I would like to have a purpose for that time. But as I think about what that purpose would be, a lot of it is about time: making time for things important to me that have slipped in the busy of third year. And I’ve enjoyed being a student; it has afforded me valuable time with people, time that I know I won’t have in residency when I graduate. And while I’m really eager to learn the practical and intellectual skills in residency that I’ll need to take care of patients in the future, I also want to know people more deeply before I presume to be a care provider of them. Maybe it’s because I’m slow at learning things, but I accept that and I would like to be a student of people for a little longer.
There are a few things I would like to do with a year, the biggest being to be able to write about some of the experiences we’ve had in the hospital, and how they’re related for me to my life in general. Associated with that, I’d like to have more experiences with people, and I’ve found a mentor enthusiastic about forming a project around me simply spending time talking with patients, a population of patients to whom I’m particularly drawn. I also want more clinical experience in different places; I’d like to do both a primary care and hospice elective in Uganda, an ob-gyn subinternship in New Mexico, and a hospice elective here at Connecticut Hospice (the first one established in the States). There are others, but I’m trying to limit myself in order to focus on a few things, because even as I try to hold back while writing now, I know it’s hard not to overload a blank slate of a year.
There are many things I worry about in making this decision. We say it’s just one year, and it’s very true in the long run. Yet somehow it still carries more weight. I didn’t give a second thought to taking a year before medical school; I needed it both practically and internally. But though I’m not sure what I would’ve been like without that year, I don’t particularly look back on that year as one of much growth or significance. I don’t want this to be like that, especially because as I said, for various reasons, it carries more weight now at almost twenty-six years old than it did back then at twenty-two.
Taking another year isn’t exactly taking an “extra” year; the time has to come from somewhere. I’d be lying if I didn’t admit that I don’t think about the same things as other girls my age in terms of relationships and the future, which though distant now won’t feel so much so when I graduate, especially if that’s in two years instead of one. The relationships (in the way I define relating to a person) I’ve had here have been worthwhile and valuable emotionally, but also tumultuous and inconducive to what I eventually want concretely. Finding quality and compatibility is hard enough, but doing that in the realm of logistics and future is even worse, and as such I’ve largely avoided the endeavor of considering anything beyond the present. During the time I stay here, I’d probably continue doing that, and can I really keep avoiding it for so long? On the other end, who’s to say that graduating, moving, and working intensely will bring me out of the place I’m in, any better than staying here? On the same lines, I miss my family a lot, and another year here is another year away from them, but graduation doesn’t bring any guarantees that I’ll be closer to them.
I worry I’ll be restless, as I often am while in the educational system, with the idea of not doing anything concrete to be useful. With the sense of constantly being trained for something that seems so distant. I also worry that the insane momentum of third year distorts and exaggerates my need for time, that perhaps I only wish to take it because it’s there for taking. At the same time I wonder if this is an unexpected gift, as this school has been as a whole, and whether I shouldn’t shy away from something simply because it wasn’t in my original plans. Honestly, the idea of this—the time, the commitment to writing, the uncertainty of what I can do and how it will all fit together—scares me like hell. While as a general philosophy I believe in things falling into place, and they’ve been chaotic before and always have fallen right, I’ve had the benefit of the outline of things still following an overall path. I don’t know if this year really falls into any concrete way for me to go, and I know it’s largely up to me to make it worth something.
A friend recently made fun of me for still wearing a watch, now that cell phones have replaced every daily function including checking the time. I love my watch, which was a Christmas gift from my oldest brother in 2001 who said I never knew what time it was, so I’ve had it for nearly a decade and have had to change the battery a couple times in that time period. It uses hands and it has only four dots on its face to signify every three hours, without any numbers. Since I’ve been on surgery I can’t wear it, and yesterday I realized it was the weekend and I could wear it. This morning I went to the gym and took it off as I normally do when running. Since I’d gotten used to not having to do this during the week, when it was time to go, I forgot to put it back on. After I came home and noticed it was missing, it took me some time to realize this is what was happened. It probably took me more time than usual to connect the sequence of events because we'd taken a detour on our way home, and sat on a hammock we saw outside one of the colleges. It was a usual cold winter day with sun and old snow, and we sank into the hammock with ease. I told my roommate I would go get my watch after showering and getting dressed, but she said I should go now, as the more time passed the more likely it was that something would happen to it. So as I hurried back to get it (bemoaning the minutes I was losing doing this, as I’d planned on being on my way out to the architecture library by two o’clock and it would already be two by the time I reached the gym again), I thought how funny and fitting it was to literally find time. Even if it’s gaining back something you lost, and not giving you any more than baseline; even if it’s actually taking some away from you as you do it, time feels different when it’s passing than when it’s found and taken.
Saturday, February 13, 2010
bypass
They tell us to look for patterns in medicine, in the way diseases work and in the way we treat them. One of our favorite things to do is to bypass. When a vessel supplying blood to the heart becomes blocked, we use other vessels to go around the blockage. Same idea with a block in the vessels supplying the small intestine. And when you don't want food going to the stomach, you bypass it by cutting off a point where two points of the stomach connect and reconnect the stomach to the small intestine instead. It all works pretty well, perhaps not quite as well as the anatomy with which we're born, but after the wear and tear of time and experience we cope the best we can.
Currently on my one month gastrointestinal surgery rotation, and have seen several gastric bypasses for morbidly obese patients. They were good surgeries to see; the abdominal anatomy is compact and clear. When the stomach is cut, you find the pancreas behind it. As you move horizontally to maneuver things, you find the liver and spleen flanking the stomach. And you follow the small intestine down to find the best place to cut, and to reconnect, saying hello to the large intestine amidst the surroundings along the way. Seeing things in real color (the spleen really is purple, and the pancreas off-white), and three dimensions makes for a pretty view.
Sitting in the back during a informational meeting for gastric bpyass patients also afforded an interesting view. Insurance typically covers this procedure once a person's BMI is greater than 40 (ideal being 20) and most of the patients I've seen run beyond 50. They suffer from an interaction between their physiology and their environment that makes it nearly impossible for non-surgical interventions to help. Interestingly, their internal anatomy is not so different from others. At one point, the surgeon giving the talk said all of our stomachs are the same size, "including that of my med student sitting in the back there." To my relief no one turned around to look at me, but I was grateful to be present. A secretary who'd had a bypass herself talked about the experience, the looking forward before she'd had it and the looking backward now that she had, while emphasizing that the process was never over. The surgeon went into detail about what the procedure entailed and what it demanded of its patients. People listened and asked questions.
Medicine so randomly throws you into the stories of people you might otherwise never consider, and being literally dwarfed in a corner of this room made me feel it pretty strongly. Seeing one bypass after another in the operating room fools us into thinking the stitches signify an end and numbs us to the change that's happening or will happen. But hearing an acknowledgment of the anticipation leading to this surgery and hearing the patients be told the long course of care that must happen after the surgery reminds us of context. There's a lot--a lot of work, thought, feelings--encased in a two hour procedure that for those in the operating room starts with an incision and ends with a suture. Up until then surgeries for us as students have been so open-shut, and part of why I feel out of place during the week is because I have nowhere to put what we see on a daily basis. Settling their organs and skin back into place still leaves a sense of intrusion that isn't fully reversed. From the room full of people hoping to become more by becoming less, I'm more able to place what I see back into the people themselves, and this isn't something we can afford to bypass.
Currently on my one month gastrointestinal surgery rotation, and have seen several gastric bypasses for morbidly obese patients. They were good surgeries to see; the abdominal anatomy is compact and clear. When the stomach is cut, you find the pancreas behind it. As you move horizontally to maneuver things, you find the liver and spleen flanking the stomach. And you follow the small intestine down to find the best place to cut, and to reconnect, saying hello to the large intestine amidst the surroundings along the way. Seeing things in real color (the spleen really is purple, and the pancreas off-white), and three dimensions makes for a pretty view.
Sitting in the back during a informational meeting for gastric bpyass patients also afforded an interesting view. Insurance typically covers this procedure once a person's BMI is greater than 40 (ideal being 20) and most of the patients I've seen run beyond 50. They suffer from an interaction between their physiology and their environment that makes it nearly impossible for non-surgical interventions to help. Interestingly, their internal anatomy is not so different from others. At one point, the surgeon giving the talk said all of our stomachs are the same size, "including that of my med student sitting in the back there." To my relief no one turned around to look at me, but I was grateful to be present. A secretary who'd had a bypass herself talked about the experience, the looking forward before she'd had it and the looking backward now that she had, while emphasizing that the process was never over. The surgeon went into detail about what the procedure entailed and what it demanded of its patients. People listened and asked questions.
Medicine so randomly throws you into the stories of people you might otherwise never consider, and being literally dwarfed in a corner of this room made me feel it pretty strongly. Seeing one bypass after another in the operating room fools us into thinking the stitches signify an end and numbs us to the change that's happening or will happen. But hearing an acknowledgment of the anticipation leading to this surgery and hearing the patients be told the long course of care that must happen after the surgery reminds us of context. There's a lot--a lot of work, thought, feelings--encased in a two hour procedure that for those in the operating room starts with an incision and ends with a suture. Up until then surgeries for us as students have been so open-shut, and part of why I feel out of place during the week is because I have nowhere to put what we see on a daily basis. Settling their organs and skin back into place still leaves a sense of intrusion that isn't fully reversed. From the room full of people hoping to become more by becoming less, I'm more able to place what I see back into the people themselves, and this isn't something we can afford to bypass.
Wednesday, January 27, 2010
another m&m
While my last M&M post was about losing life, this one is about saving it. Not so much in the bringing back a pulse kind of way, or even the complete eradication of pain, but in the way that good turns all else into sources of gratitude. This M&M is called medicine & music.
"Medical school" has too many syllables, but really, it's more accurate than "medicine," because that's where I am, and what saves me. School allows for things that medicine may not: a certain free flowing mode of learning, and complete freedom to observe. And the beginnings of anything carry a peculiar poignancy that makes you very aware of them in the moment. Working in the emergency department is humbling, as the best parts of medical school have been. Crammed in a small space are little clips of people and problems, and as a student you can appreciate that you are in the middle of it. At this point in our lives, the weight of things still correlates with how they heavy they feel. A man with vertigo finds it's due to a stroke--the dizzy you feel that should just go away cause it's just in your head, but it won't go away because it is in your head. A man whose nephew passed away at 21 from a heart attack waits as we track his chest pain with labs and tests, his eyes wet as he talks about living in the southeastern tip of a small island. A woman finds the hard back of a trauma board more painful than the floor she's been lying on for twelve hours after a fall that fractured her arm in two places. A man writhes with tremors from an overdose, who is so thin you can't help but feel he might be right that things are too much.
Medical school is also more apt than medicine, because with school comes the family of friends I've had here. Early into my first year, a time that coincided with personal difficulties, I realized how much better I function in a small community. And more importantly, how much this small group of people offered. In this past week, small acts of kindness respond to my need for them, without knowing the nature of why I needed them but not questioning why. Dinners out with honest conversation about silly things and things most important to me. Someone who makes me believe in trying for genuine good, regardless of stumbles. The Wonderful Story of Henry Sugar in hand, and a mini avocado cheesecake in my fridge. Complete, sincere, effortless, unconditional acceptance of my faults from someone too hard on himself; he takes my mess and throws back simplicity. Company at the gym and the library. Encouragement disguised as a rap, both funny and sweet, and a typed smile from someone who has never before given one. Each person offers things in their own way, and the parallel care in individual qualities is such love.
While these things often take me beyond myself, music lets me be. I've returned to sounds that I loved years ago (Flaming Lips: Yoshimi Battles the Pink Robots), or to sounds from years back that I didn't listen to properly back then (Linkin Park & Jay-Z: Collision Course, and lots of Linkin Park in general). I'm as addicted as everyone to The XX, whose atmospheric beats have both flash and depth, and I don't think I've loved this hard since Bon Iver. Besides catching up to the distant past, I'm catching up on 2009 with the timeliness of The Antlers' Hospice, and the new Muse, which has different parts all that I love through & through. A splash of Beirut's strange ache (Realpeople), all of Sigur Ros & Phoenix piling up on me, and so on and so on and it's all so filling. It's why I love commutes, the walks and train rides and road trips, the time I can take for music and myself and it's hard to describe in any other way except to say that it saves me.
I was walking around New Haven a little past four in the afternoon today, while it was still light. New Haven isn't thought to be pretty, but sometimes it is. The sky was filled in with gray but the top halves of all the brown-gray buildings were made golden by a sun you would have to turn around to see, but you wouldn't because you wouldn't move your eyes from the unearthly glow. Looking up at one point one such building merged its frame with quietly sprawling branches also alight with a mysterious sun, and my breath was sharp as I drew it in.
"Medical school" has too many syllables, but really, it's more accurate than "medicine," because that's where I am, and what saves me. School allows for things that medicine may not: a certain free flowing mode of learning, and complete freedom to observe. And the beginnings of anything carry a peculiar poignancy that makes you very aware of them in the moment. Working in the emergency department is humbling, as the best parts of medical school have been. Crammed in a small space are little clips of people and problems, and as a student you can appreciate that you are in the middle of it. At this point in our lives, the weight of things still correlates with how they heavy they feel. A man with vertigo finds it's due to a stroke--the dizzy you feel that should just go away cause it's just in your head, but it won't go away because it is in your head. A man whose nephew passed away at 21 from a heart attack waits as we track his chest pain with labs and tests, his eyes wet as he talks about living in the southeastern tip of a small island. A woman finds the hard back of a trauma board more painful than the floor she's been lying on for twelve hours after a fall that fractured her arm in two places. A man writhes with tremors from an overdose, who is so thin you can't help but feel he might be right that things are too much.
Medical school is also more apt than medicine, because with school comes the family of friends I've had here. Early into my first year, a time that coincided with personal difficulties, I realized how much better I function in a small community. And more importantly, how much this small group of people offered. In this past week, small acts of kindness respond to my need for them, without knowing the nature of why I needed them but not questioning why. Dinners out with honest conversation about silly things and things most important to me. Someone who makes me believe in trying for genuine good, regardless of stumbles. The Wonderful Story of Henry Sugar in hand, and a mini avocado cheesecake in my fridge. Complete, sincere, effortless, unconditional acceptance of my faults from someone too hard on himself; he takes my mess and throws back simplicity. Company at the gym and the library. Encouragement disguised as a rap, both funny and sweet, and a typed smile from someone who has never before given one. Each person offers things in their own way, and the parallel care in individual qualities is such love.
While these things often take me beyond myself, music lets me be. I've returned to sounds that I loved years ago (Flaming Lips: Yoshimi Battles the Pink Robots), or to sounds from years back that I didn't listen to properly back then (Linkin Park & Jay-Z: Collision Course, and lots of Linkin Park in general). I'm as addicted as everyone to The XX, whose atmospheric beats have both flash and depth, and I don't think I've loved this hard since Bon Iver. Besides catching up to the distant past, I'm catching up on 2009 with the timeliness of The Antlers' Hospice, and the new Muse, which has different parts all that I love through & through. A splash of Beirut's strange ache (Realpeople), all of Sigur Ros & Phoenix piling up on me, and so on and so on and it's all so filling. It's why I love commutes, the walks and train rides and road trips, the time I can take for music and myself and it's hard to describe in any other way except to say that it saves me.
I was walking around New Haven a little past four in the afternoon today, while it was still light. New Haven isn't thought to be pretty, but sometimes it is. The sky was filled in with gray but the top halves of all the brown-gray buildings were made golden by a sun you would have to turn around to see, but you wouldn't because you wouldn't move your eyes from the unearthly glow. Looking up at one point one such building merged its frame with quietly sprawling branches also alight with a mysterious sun, and my breath was sharp as I drew it in.
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