Wednesday, June 5, 2013

Remembering Socks

If you talk to any recent med school graduate they will often have all kinds of advice regarding how to approach the dreaded residency interview circuit.  When it comes time to sell yourself to future employers in order to shore up a job upon graduation, the advice varies and is often contradictory, just as personalities vary and often contradict.  Interviews can be fun and terrible at the same time.  You meet dozens of applicants from around the country, listen to program directors sell their individual programs, and smile.  Always smile.  And for those who knew me, they seemed to always add that I should try staying awake while smiling.  I guess because smiling with your eyes closed is sort of creepy.  But these ended up being my first two pillars of good interviewing which I feel necessary to pass on to future generations.  It seems simple enough, but there exists a fundamental principle of attending multiple interviews.  The first interview is exciting.  Then the next four—or twenty-four—interviews after that are all exponentially more exhausting.  You begin digging deep within the sacred reserves of your soul to keep both mouth corners and eyelids peeled in upward fashion.  Interviewing for residency is like the smiling Olympics.  You feel confident going in, but then quickly realize you are up against a lot of world-class gunners…uh,  I mean grinners.  But smiling and staying awake aren’t enough.  It was actually on my fourteenth interview, when I was fast losing hope that I would even be counted among the finishers, that I discovered a third pillar of success.  Do not forget your socks.
Yes, everyone should learn early on to make a list of things to pack on every interview.  This keeps you from forgetting things like cellphone chargers and toiletries.  But in my case, it didn’t save me from showing up in Portland without socks.  So my name is Jay, I am now a physician and surgeon in training, and earlier this year, I showed up to an interview having forgotten to pack my socks.  This is my story.
Just to be clear, I did not actually show up in a new city without any socks.  I had white tube socks, because I was forward-thinking enough to pack athletic gear since I was training for a triathlon at the time.  I ran five miles on a treadmill the night before my interview, and the socks I wore for that run were both fantastic and fully present in my suitcase.  The footwear problem did not surface until the morning of my interview when I woke up, quickly showered, and donned my gray suit and tie.  After checking my smile in the mirror, I discovered that my dress socks were incredibly absent from my suit case.  It was an hour before I was scheduled to be at my interview site, but being the cool character that I was, I did not panic.  I knew I had the tube socks, so I tried those on first.  A quick glance in the mirror immediately revealed that wearing white tube socks with a gray suit makes your ankles look like they are glowing in the dark whenever you sit down.  I recall this realization coincided with the onset of my panic.  I tore off my socks and evaluated myself without any socks at all.  Though naked ankles were marginally better than glow-in-the-dark ankles, I determined that showing off your ankles is not a pillar of good interviewing.  I began to panic some more.  So I hurried downstairs to my hotel front desk.
The next few discoveries I made were perhaps just as novel.  When you ask the front desk worker if they carry extra socks, this is equivalent to asking for a ride to your interview in a kangaroo.  Their eyebrows are at first too askew to give you a straight answer.  Only after explaining that I had a job interview in an hour and had forgotten my dress socks did I get a straight answer.  The answer was no.  It was a very polite no, and the lady was even kind enough to call a few drug stores just to confirm that nobody was awake at five in the morning to sell me socks.  This is when I began running scenarios in my head.  If I went to my interview sockless, should I take a proactive approach and mention to my interviewers that I was not bearing my ankles on purpose?  Or do I just play it cool and hope that nobody notices the flesh between the end of my pant leg and the lip of my shoe?  Is being a guy who forgets socks better than being a guy who goes au naturel in his nice shoes?  These were terribly complex questions that my brain was not prepared to answer at five in the morning.  Maybe I could try pulling my suit pants down so low as to minimize my ankle exposure?  But then is sagging your suit pants better than flashing your naked ankles?  I felt like I was trapped in this awful game of non-hypothetical would-you-rather.
I’ve often heard artists talk about inspiration striking when they least expect it.  And while I have never considered myself any sort of an artist, my muse must have been close by that morning.  Amidst the tightening grip of my panic, I suddenly had a desperate thought.  I turned back to the lady at the front desk and this time asked for (or perhaps demanded) a pair of scissors.  She gave me a curious look, but handed me a pair without question.  I grabbed my suitcase and darted to a corner of the lobby.  I pulled out a gray long sleeve t-shirt—the exact one I had worn during my previous night’s run.  I glance quickly at the shirt sleeves and knew they were my only hope.  With a few imprecise snips, I was able to detach the sleeves from my t-shirt, quickly fashioning a pair of poor man’s leg warmers.  I slipped my heel into these and pulled the end halfway up my calf.  They were ill-fit and baggy, but when I stepped into my shoes, they gave the impression of socks.  I tied a knot in the upper end of these cloth tubes to better fit my calves and returned the scissors with a triumphant thank you.  The lady was nice enough to not ask questions, although I was quite sure she had unknowingly witnessed what was perhaps the most inspired moment of my medical school career.
I made it through the entire interview day without incident, though I did have to adjust my makeshift ankle coverings a few times because they kept coming lose and drooping.  Honestly, after interviewing at over a dozen locations, all the flights, the faces, and the formalities tend to become somewhat of a giant blur.  But of all the cool experiences I do remember, slicing the sleeves off a t-shirt to make leg warmers is definitely one of my favorites.  Thus my three pillars of having a successful interview season are this: smile, stay awake, and socks.  Super easy to remember and guaranteed to improve your performance.  You know how they say when life gives you lemons, you should try making lemonade?  I think the truth is that in life, we are often the ones gifting ourselves with lemons.  The whole adage is just an elegant way of saying that we all have a stupid version of ourselves whose sole purpose is to collect lemons and dump them on us at the most inopportune times.  Our only hope is that when our brains are working at some measurable capacity, we can come up with a passable recipe for lemonade.  But of course, it makes much more sense bring socks to an interview than to make t-shirt-sleeve-dress-sock lemonade.

Friday, May 24, 2013

A Letter in Darkness

I haven’t posted in many, many months.  For those I have spoken to in person, you may know that this past year has been simultaneously one of the best and worst of my life.  All rolled into one joyfully aching mess.  I matched into University of Washington’s surgery program, I graduated from med school, and I even completed an ironman distance triathlon up in Napa Valley.  Truly, it has been an amazing journey, but one where celebration seems constantly juxtaposed against personal loss and mind-numbing grief.  I am learning to ride the highs and the lows and if nothing else, learning to put one foot in front of the other.  There is so much to say but there is also nowhere to begin.
I think when things are going well, it is hard to grasp how imperfect life can be.  That is the beauty of healing—that a collection of good and pure moments can wipe away past darkness, no matter how immersive that darkness may have once been.  In happiness, we all tend to forget what pain is.  In celebration, in tender moments, in joy, we are allowed to forget.  So the past four years of med school have in many ways been the happiest of my life.  And in many ways, without getting into details, I was totally unprepared for my personal life to fall apart.
I think sometimes I am under the false impression that with talent, hard work, and with commitment to character, we can eliminate misfortune.  True joy seems invincible, and that is why it is called joy.  But no journey is without stormy stretches.  Life is humbling, and at times it will bring you to your knees.  It is unfair and incomprehensible, and during such times, if nothing else, you learn to crawl.  Because that is all you can do.  And as your knees scrape the ground, for periods you might even wonder if you will walk again.  Because pain can also seem invincible.  The kind of pain that seems to drown out hope and beckons forth shadows from every corner.  Real pain.
I am learning that when life brings you to your knees, you just have to learn to crawl.  I guess the paradox has always been that without pain, there can be no empathy.  Hope, and comfort, and healing only matter to those who have been taken to their knees.  For those who know what it is to crawl.  Life is humbling, and it is unfair, and there are people who crawl for an entire lifetime.  So I’m learning. Because it is not only in war that we must find it in us to crawl.  But also in love.

Thank you to all my friends, to all my family, and to all who have walked (and perhaps crawled) beside me, no matter how briefly. To you I owe the world.

Monday, July 16, 2012

The Old Man

The old man stood about a foot shorter than the others gathered in his clinic. This made the tarnished streaks in his silvery hair easy to spot, but he still combed it so that the thin ivory strands stretched across the barren areas of his scalp.  It was like this every morning.  Perhaps what time and experience had not provided him in stature, it had offered back in depth.  Years of refinement and wear—buried in his eyes.  It was such that his age reflected most profoundly not from the specks and the creases of his skin, nor from the tarnish in his hair, but from a shadowy well within those eyes.  A flickering, rippling depth that you could catch brief glimpses of, magnified through the thick lenses framed upon his nose.  And it was with those eyes, and in spite of his height, that he peered keenly down at those around him.  He spoke bluntly, moved deliberately, and gave orders without wasting words on common courtesies.  His thick Vietnamese accent delivered his speech in rolling jabs that never quite crossed the line into rude.  But his presence—his quiet, cavernous presence—brushed uncompromisingly against my senses.  It was the entirety of this old man’s presence that irritated me from day one.
Together, we were perhaps nothing if not an ill-formed match.  An intense, eager, yet green medical student teamed with an intense, stubborn, and seasoned family physician.  It was determined from the start that I would prove myself to this old man.  And from the start, I quickly realized this man had no desire to prove anything to anyone.  The pace and fashion in which he worked was fixed, mechanical—like a piston, or maybe a turbine set long ago—still steadily driving and being driven by the charts, the exams, the prescriptions.  With a quick flurry of questions, a few inquisitive glances, and a practiced touch, he moved from patient to patient until the lights in the waiting room dimmed and it was time to clock out.  It was an inertia built up over a lifetime.  And the unwavering force with which it moved caused everything around it to bend.  I imagined how in his twenty-seven years of working at the same clinic, he had witnessed everything around him evolve.  Computers being installed, electronic records being implemented, new systems, new nurses, new policies, and new technology—all buzzing in a colorful blur around him.  And I imagined him standing calmly in middle of it.  An aging yet unmoving constant.  Like an ocean carving fissures into the side of a mountain, the old man’s steady presence swelled up against those around him, causing all of us—patients, nurses, and me—to bend and abide.
“Good morning, Doctor Pham.”  I offered the same greeting each morning as he walked into the clinic.  A brief nod and a thin smile indicated his readiness.  For six weeks, we operated just as we were—two entities set into motion sixty years apart.  We clocked in at the same time each day and clocked out one right after the other each night. Yet in all the time and space bracketed between these choreographed bookends, we managed to operate side by side, but never quite together.  It was as if the inner workings of his faded exterior hummed in constant disharmony to some of my most basic values.  And as a result, my frustration simmered beneath a thinning patience.  Only behind closed doors and beyond the old man’s ear would I allow it to escape in harsh whistles from every pore of my skin.  But for the most part, I kept my grievances a secret smolder, hidden from the old man yet fanned daily by watching him practice his stiff, spindling brand of medicine.  There was something in the jaded physician’s disposition that must have been forged fiercely long ago, and as a result presented itself more rigid and ill-fitting than might otherwise be expected.  For patient after patient left the clinic having battled in those hurried moments to steal from the man some small resolution to their private concerns, only to be blown backwards by the invisible force of his forward-churning style.  It was a style driven by the weight of his unbending disposition which he yielded with a mechanical ease.  And it stood upon that oceanic depth which pooled within those black eyes, guarded behind the thick frames which he cleaned intermittently on his coat sleeve.  The grand effect was an undertow that remained placid at the surface, but swept rippling hues of frustration through the old clinic and clean out the door.  In a way, I drew a strange comfort from noticing this.  Every clenched jaw and furrowed brow meant that the agitated secrets which bristled beneath my fa├žade were being shared among others who happened into the old man’s dusty wake.
I turned the ignition and with one last pained sigh, my truck pulled out of the parking lot, away from the faded white building and the sunburnt sign that simply read “clinic.”  I didn’t look back as I drove away that final time, and seldom have I since.  The irritation that circulated within me for six weeks gradually dwindled and eventually vacated altogether.  Perhaps to haunt some other host.  But every now and again, I can’t help but think about the old man.  In my less restful nights, I wonder if maybe it wasn’t really his disposition or demeanor that clashed so harshly against my own, but rather the injustice of time itself—strewn across his every wrinkle and draped in his every movement.  It was an injustice largely shifted in my favor during the snapshot of our interaction, and magnified by the coincidence of our proximity.  By the nature of my youth, time still presented itself as a dimension soft and moldable, like clay.  Yet being next to the old man provided proof that this would not forever be the case.  For the old man, his allotment had already been shaped.  Only the last intricate details remained to be sculpted, and as we stood beside each other in that clinic, we stared from opposite ends of time’s unforgiving canyon, eyes fixated on different sights within its depths.  And perhaps it was exactly this difference in perspective—this ever-shifting injustice—that irritated me most deeply.  When I think back to the old man, I wonder if all the discomfort I harbored poured forth from a more basic anxiety.  A fear that the time grasped before me might solidify before I can mold within it a fraction of my dreams.  It seems to me that youth has an easy way of staring into the canyon of time, giving little notice to the ledge on the other side, and the old man who will one day stand upon it.

Thursday, June 21, 2012

Paging Dr. Einstein

About a year ago, I was having lunch with a friend when the subject of finding a good doctor came up.  What makes a good doctor?  What qualities are most valued?  My friend leaned forward and asserted, “I really don’t care if my doctor is nice and all that stuff, I just want the freakin’ smartest doctor I can find.”  I pressed my lips into a half-smile.  I didn’t agree with her at the time, but I found my ability to counter lodged somewhere between my heart and my throat.  The truth is, when I started medical school, I felt much the same way.  Who cares if a doc pats you on the shoulder and comforts you?  Who cares if she smiles and asks you about your wife, kids, and pet zebrafish?  To me, all this was much like the toy that comes with your kid’s meal—a delightful bonus, but not the real substance of medicine.  I just wanted someone to do the right tests, give me the right meds, and send me on my way—fixed up and ready to go.  But even in the first few months of my training, I could see that my initial impression of good medicine was rather short-sighted.  It seemed odd that on one hand, I was a proud member of a fraternity that prides itself on stratospheric test scores and intellectual acrobatics.  Yet on the other hand, I was beginning to see that brute intellect plays only a small supporting role in medicine’s celebrated script.  For many of us, this comes as a hard pill to swallow.  But the truth is it doesn’t take a genius to be a great doctor.
Part of the problem for both patients and providers alike is that we often view illness as a technical difficulty. If our computer crashes, we expect the whiz at Apple to uncover the problem and provide the restorative reboot.  If our car crashes, find us a skilled mechanic who can dive under the hood and give it new life.  Hell, if the economy crashes, we believe the officials we elect to office should have the power to tweak a few policies, rejigger the interest rate, and get our GDP rocketing skyward again.  And why not?  We are of a bold generation that has always viewed even the most complex problems as a giant brain away from happy resolution.  But what if a loved one gets sick?  And what if it’s my child—not my computer—who’s crashing?  Often, our initial intuition is the same.   Employ the smartest doctor in the hospital to swap a few meds, execute some elaborate surgery, and restore everything back to normal.  A doctor’s job is to fix our cracks and mend our leaks so we can get on with our lives.  And presumably, the smartest ones are also the best fixers.  But of course, matters of life—and death—are never quite so simple.
Despite whatever value we assign to our beloved gadgets, laptops don’t think, and cars don’t feel.  They also don’t dream, aspire, believe, defy, invent, or imagine.  It’s the fingers that touch a keyboard that possess the ability to translate the ideas and emotions of a brazen mind.  Cars carry passengers, but it’s the passengers who carry a lifetime of joys and sorrows.  And when an economy crashes, it’s the people who suffer, not the GDP.  So while flawed devices and failed policies can be restored and renewed, they can also be discarded.  Human beings—well, not so much.  This is the real grit of medicine.  We can preserve health, but not indefinitely.  We can treat pain, but we don’t cure misery.  Despite all our medical advances, more often than not, our job is not to fix, but to advise, to advocate, and to comfort when suffering has already established a foothold.  The brilliant engineer must decipher when old parts should be abandoned and outdated systems replaced.  The great physician—she must walk with the worn, and sit with the broken.  And it’s not that we should disregard the breadth of her knowledge.  It’s just that there is truly no replacement for the depth of her compassion.
For those of us who still view illness as technical blip, it’s likely because we have never been truly sick or cared for the gravely ill.  Yes, we’ve probably taken antibiotics for a throat infection or received x-rays for a broken bone.  Maybe even gone through surgery and rehab for certain injuries.  But the most common and costly diseases afflicting Americans are the unsexy, life-sapping diagnoses that prompt years, even decades, of suffering.  Diabetes, depression, heart disease, cancer—all chronic diseases without cure.  If you spend enough time around doctors, you will hear them refer to treatment as “medical management.”  Because in cases of long-standing illness, it isn’t about coming up with dazzling answers or pondering over a mysterious case until reaching that single “aha!” moment.  You work with patients to juggle a dozen prescription pill bottles.  You remind patients why they can’t eat their favorite foods—the ones they’ve grown up enjoying.  You even prepare patients for how chemotherapy will cause them to lose their hair, their hearing, their sex drive, and much of their independence.  And you help them understand why once your health leaves you, it doesn’t often come back.   Because for patients whose lives are marred by poor health, medicine becomes more about dedicated support, compassionate care, and constant education.  It turns out the ability to perform high-flying mental acrobatics is really just a bonus.  Like that toy that comes with your kiddy meal.  When you are truly famished, your focus shouldn’t be on the toy.
The truth is that for many patients, they come to a doctor sick, and leave sick.  And for 365 days a year, they are the ones taking care of themselves.  Physicians don’t get to play miracle healer as often as they’d like.  Instead, the challenge is how to better empower patients to choose for themselves the lives they want to live, even when illness has become a part of everyday reality.  I know if someone I really cared about got sick, there are some people in my class I would trust without hesitation.  Not because they are brilliant, though most of them are.  But because they are the type of people that you can trust to carefully guide you while understanding that your diagnosis is not your defining characteristic.  For those who are truly ill, there are often many tough decisions with few good outcomes.  And the “right” decision is different for each individual.  Because after all, we aren’t just a collection of moving parts, all mass-produced from the same mold.  We harbor unique thoughts, values, and aspirations.  And all of these things play into excellent care.  Clearly, amputating a pinky finger might mean one thing to me, and something very different to a concert pianist.  Simply put, there are “good” answers, and then there is true guidance.  The latter is what distinguishes the outstanding physician.  It may not require the gift of pure genius, but it demands a level of human compassion that is perhaps every bit as rare.

Thursday, June 7, 2012


“It doesn’t have to look pretty,” my resident grinned as he slipped out of the room, pass the sliding glass doors.  I looked up from the half-tied knot that was securing the gown to my waist.  “Alright,” I nodded.  Around me, the whirlwind of alarms that compliments most ICU beds had ceased.  I lifted a needle holder off my patient’s lap, grabbed the needle that had been laid out for me, and loaded it.  The room was now dim, aside from the lamp that hovered at arm’s length above me.  It draped white over my shoulder and onto the wound I was prepared to close.  My gaze slid along the serrated fibers of muscle which framed a crude window cut between two ribs.  There, through the gaping slit in this man’s side, a piece of the lung stared out at me.  And at the top corner of this window, just beneath the breastplate, a fleshy corner of his heart peered out as well.  I lowered metal to flesh and watched the needle take its first bite.  His body was still warm.
Wednesday 9:12 p.m.  My trauma pager had gone off.  Instinctively, I squelched its beeping, shuffled to the nearest elevator, and descended down to the emergency room.  There, I met up with the rest of my team and listened as a nurse on the phone provided updates.  A patient had been found down by the side of the freeway.  He was en route by helicopter.  We stationed ourselves around the designated room, waited, and made small talk.  Fifteen minutes went by.  Then a pale, unresponsive man was wheeled into the trauma bay with a medic crouched above him performing CPR.  “This is a thirty-year-old John Doe… jumped out of a vehicle moving at highway speeds… unresponsive with agonal breathing when first responders arrived… heart stopped beating in transport.”  As the medic gave his report, a curtain of providers descended in a synchronized flurry upon the patient.  From my position at the edge of the room, I watched as the trauma resident grabbed a scalpel, sliced open the chest, swept the lung aside, and began compressing the heart.  The patient’s intrinsic heartbeat returned and within seconds, we were in an elevator on our way to the operating room.
I could hear the steady rhythm of my breaths cycling beneath my facemask.  It was punctuated momentarily by the click of my needle holder as it seized the metal tip at the surface of the skin.  I pulled another stitch through, gave it a tug, and felt the thread bite into my palm.  Slowly, the edges of the wound began to ease together.  Across the man’s chest, the suture spiraled silver—diving in and out, back and forth, from the breastplate to just beneath the nipple before jumping off the skin and onto the needle at the end of my instrument.  The rest of the wound stood open from this point.  It widened underneath the armpit before tapering back down to a corner where the patient’s frame rested against the bed.  I looked at the half that remained open, re-angled the light above me, and continued working.
A bead of sweat dripped down the side of my cheek and dissolved into my facemask.  I fastened one last knot, cut the remaining suture, and set my instruments down.  With a damp cloth, I wiped the dried blood off the newly closed wound.  I stepped out from underneath the lamp light and glanced at the closure.  The suture that held the incision together resembled the seam of a baseball, only knotted within the flesh of this man’s chest.  In some ways, it looked every bit as unnatural as when it lied open with organs visible between flaps of skin and tissue.  I turned toward the door, shed the protective layering I had on, and stepped back into the heart of the ICU.  My resident looked up from his seat.  “I’m done,” I informed him.
Thursday 12:53 a.m.   I propped myself on a step by the patient’s chest.  He had made it through surgery only to have his heart stop twenty minutes after arriving in the ICU.  My resident was calling out orders from his position at the bedside as nurses zipped in and out of the room.  I could hear the practiced calm in his voice.  “Alright, take over,” he instructed, stepping away from the bed while continuing to run the code.  I began chest compressions.  Our attending surgeon slipped into the room, exchanged a few words with the resident, and moved to re-open the patient’s chest.  I took my hands off the breastplate.  Reaching for the lamp above me, I focused it on the thoracotomy.  The attending cut the sutures, spread the ribs apart and reached in.  A nurse handed him a small paddle connected to a defibrillator.  He positioned it on the heart’s surface and everyone stepped away from the bed.  A shock was delivered.  Nothing.  The attending stuck his hand back in the chest and resumed cardiac compressions.  After two minutes, we tried the defibrillator again, followed again by internal CPR.  Still nothing.  “Fuck,” I heard someone whisper.  After nearly thirty minutes the doctor stood up.  “Let’s call it.”  The bustling stopped.  A nurse’s voice floated above the whirring and beeping of machines, “You want me to hold the epi, then?  Okay, we’re calling it.  Everyone, time of death: one twenty-three.”  We all stripped off our gowns and filed out of the room, quietly.
Out of the corner of my eye, I could see where my patient’s body lay beyond the glass pane—motionless under the glow of the examination light I had forgotten to turn off.  My resident stepped into the room, took a cursory look, then popped back out.  “It looks good, man.”  I smiled and thanked him.  It seemed strange accepting a compliment for placing stitches in a dead man.  But before I could mull it over, two women led by a nurse entered the ICU.
One was older, and the other much younger—maybe a mother and a sister.  I couldn’t be sure.  The nurse led them to the room’s entrance, slid the glass door open just wide enough, and whispered something inaudible.  The guests nodded and the nurse stepped away, leaving them alone.  I eyed the older woman as she paused at the doorway.  The younger one—she must have been the daughter—took her mother’s hand and together they stepped into the room.  Both paused a few feet from the bed.  Then deliberately, the sister glided right up to the bedside and slipped her hand over his.  I watched her tremble and for a moment I tried to focus my gaze elsewhere.  Then the sister lowered her face into the man’s shoulder and began to sob.  This time, I looked down at my keyboard and didn’t look back for some time.  But I could hear her faint whimper through the opening in the glass door.
Thursday 2:10 a.m.  I was slouched in front of a computer in the ICU.  My fingers scampered in syncopated bursts across a keyboard and underneath the weight of my eyelids, the ICU faded out… then in… then back out again.  Through this sweet haze of thinly formed sleep, I heard the approaching footsteps of my resident.  “You want to close the thoracotomy?”  The fluorescent lights of the unit rushed back into focus.  “Yeah, I’ll do it,” I heard myself respond.  It was almost a reflex.  I had never closed a thoracotomy before, but as a student, I wasn’t in the habit of passing up such opportunities.  “Okay, everything you need is already in the room when you’re ready.  Let me know if you need help or anything, but it’s pretty simple.  I mean, it’s just got to stay closed.  Don’t worry about making it pretty, you know.”  He picked up a chart and continued walking.
The exam light remained illuminated in the dim room, its single beam never wavering from the wound that I had closed.  Even as family members mourned in the darkness, I could see every insignificant detail of my suture gleaming from behind the glass.  Under the spotlight, the wound seemed to glow as some strange memento of our hollow impact.  All our efforts had amounted to essentially nothing.  And as officials from the coroner’s office sealed the body bag, I held in my head images of his dropping blood pressure, his frenzied surgery, the rosy color of his lung, and the numbers on the clock when we pronounced him dead.  These things I knew, but really I knew nothing.   I knew nothing of how a story of thirty years had unfolded.  Or what thread held together the chapters of a life I had watched unravel in a few dark hours.  I was only there to place the last few stitches, and stand in the shadows as fresh wounds opened in the lives of those who knew enough to mourn.
Eventually, the night faded into nothing, and with it our empty efforts.  Yet all the details remained imprinted in my mind as a reminder of medicine’s harsh reality.  I’ve been lucky enough to stand alongside heroes who pour their hearts and minds into providing some small amount of healing where it is needed most.  I’ve seen them labor and sometimes limp in their efforts to create some meaningful impact in the lives that intersect with their own.  All the while knowing that the stakes are high and their best may in large part be forgettable.  But they push forward in spite of this.  If for no other reason than because it is their singular privilege to do so.

Saturday, February 11, 2012

What You Could Learn From Eating a Cheeseburger

Somewhere between the physical inactivity that comprised my internal medicine rotation and the animalistic gluttony that comprised my holiday vacation, I acquired a sneaky 7 or 8 pounds.  I hadn’t even realized what new travelers were stowed away beneath my belt until out of curiosity I stepped on a scale five weeks ago.  All of a sudden, I found myself standing in a spot that was not so familiar or comfortable—but one shared perhaps by a good many of us.  From my view up above, the blinking digital numbers beneath my feet were flashing a disappointing message over… and over… and again.
So I started something that I’ve never tried before.  Something that I’ve asked many patients to take a stab at, but had no previous experience with.  I decided to change my diet.  I didn’t tackle a heart healthy diet, or a weight loss diet, or even a low fat diet.  I knew I wasn’t going to be one to count calories or weigh my celery sticks.  Instead, I tried something that a friend of mine in college had suggested to me years ago.  I elected to cut out meat and non-whole grains from breakfast and lunch.  I liked this idea, first of all, because it sounded doable.  Secondly, by cutting back on my carnivorous blood thirst, I felt like I could do my small part to help out the environment.  And finally, I figured that since I had been skipping breakfast for most of my adult life, anyway, all I had to do was make it to dinner, and then all bets would be off.
I do not greatly exaggerate when I say I almost starved to death on the first day of my new diet.  Per usual, I skipped The Most Important Meal of the Day, and found myself stuck with a salad and some yogurt for lunch.  Driven by the memory of how my stomach raged on that fateful initiation, I swore to myself that I would start eating breakfast and I did.  And that, kids, is the story of how I rekindled my old love for Quaker Oatmeal Squares.
Aside from a newfound appreciation for a meal once relegated to middle-child status, my experience has also given me a bit more insight into how difficult it is to make bona fide lifestyle changes.  I’ve never been one to write off patients who continue to smoke despite croaky, gurgling lung disease; or those who have difficulty taking two, three, or three dozen pills on schedule.  I’ve always believed that people possess a unique set of strengths and weaknesses, and live under unique pressures and circumstances.  What I may view as a simple task could be undeniably difficult for someone else.  But that was exactly it.  I considered non-compliance—medical speak for patients not listening to divine orders handed down by MDs—a problem of those other people.  I felt I had appropriate pity for all the portly parents and their now puffing-up-so-fast pediatric population.  But honestly, I’ve always figured that if I ever had diabetes, I would check my blood sugars, eat healthy, lose weight, and give myself insulin injections without fail.  And it wouldn’t be that hard.  You know, for me.  
But surely enough, even on my self-proclaimed “easy” diet, I realized that my touted compliance sometimes didn’t have the balls to stand and defend the paint when a McDonald’s craving was driving down the lane to slam home a juicy cheeseburger (March Madness is around the corner, sorry).  There was a day last week when my tomato basil soup and hard-boiled eggs just weren’t making the cut.  I remember listening to the radio during my lunch break and dreading the next 4 hours because it was an especially slow day at the clinic.  So I justified my rendezvous with the drive-thru by telling myself it would be cruel and unusual to have to spend the second half of my day succumbing to boredom AND hunger.  Thus, I welcomed the delicious melt-in-your-mouth taste of non-compliance.  And I asked for extra ketchup.
I guess in truth, we are all non-compliant.  Ask my college roommate.  I am non-compliant with putting my socks in the laundry bin.  Ask my classmates.  I am non-compliant with staying awake in class.  And God forbid you ask my girlfriend, who will tell you I am non-compliant with taking out the trash, doing the dishes, and remembering who has the parking spot tonight.  But fortunately for me, I don’t have to check in monthly with an expert to provide updates on all my worst habits.  If I did, though, I would hope my expert wasn’t so out-of-touch and condescending as to think she was beyond an occasional misplaced sock or dirty dish.  Yes, we are all non-compliant and it is part of this broken humanity that we get to share with one another.  For me, I just find it funny that reminders can sometimes come in the form of a cheeseburger.

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