Tuesday, October 26, 2010

Examining Robby

I interviewed a 27-year-old patient the other day who was in pretty bad shape.  I’ll call him Robby.  Robby was a morbidly obese Hispanic male who due to some health complications was suffering from congestive heart failure in his mid-twenties.  Congestive heart failure is a condition where your heart doesn’t pump blood as effectively as it should, and as a result, your body retains fluid causing generalized swelling.  You don’t often see it in twenty-something-year-olds.  But here was Robby with his normally heavy frame made even plumper by CHF.  To put it bluntly, he was a sad sight.
The first thing I noticed when I walked into Robby’s room was the smell of stale urine.  The next thing I noticed was that the room was occupied by one of the largest human beings I have ever seen.  Now, everything in medicine has taught me to find compassion, set aside preconceptions, and ignore unpleasant odors.  Yet if I were truly honest with myself, I would acknowledge that a small perhaps veiled part of my consciousness could not completely block out the unkind prejudices that one might associate with a foul-smelling, 300-plus-pound man.
Without a doubt, the nobler part of my medical student being felt sorry for Robby.  This part of my soul wanted to cry out against the indignity of letting anyone to sit in his own filth.  I thought if I were a nurse, perhaps I would be the one kind enough to bathe Rob—not so much to restore his hygiene, but to restore his dignity.  After all, I entered medicine because I believed in the goodness of restoration and healing.  But as always, our virtue is rarely left unperturbed by our demons.
The darker part of my psyche balked at the physical examination.  Because taking a blood pressure might mean getting my instruments dirty.  And touching this patient might even mean soiling my shirt sleeves.  And while I am the first to pay lip service to compassion for the broken and ailing, heaven forbid that I transfer anyone’s stale odor onto my own hands.  I hate this part of myself.  Often, I am tempted to pretend such feelings don’t lurk in the shadows of my consciousness.  But then I’ve always believed that darkness is galvanized when we ignore the bit that resides in our own hearts.
I think there are people in this world who would look at Robby and see nothing but a beautiful soul in poor health—saints among us who know only compassion in its purest form.  I have always admired these people, especially when they happen to be physicians.  And I never fail to wonder whether their undiluted humanity was acquired somewhere in their education and experience.  Or are some people just born with a deeper well of compassion?
I sat across from Robby, holding his thick arm in my substantially smaller one, and I took his blood pressure.  I ran my fingers along his swollen ankles in search of a pulse buried in his puffy feet.  And I examined him as thoroughly as I possibly could, realizing that I was not only learning to care for a patient, but I was hoping to wash away a tiny bit of the sickness that swims in my own pulse.  Because in my more hopeful (or na├»ve?) moments, I think that I may one day be able to finally exorcise that stubborn stench.  Yes, maybe one day.

Wednesday, October 6, 2010

A Brief Guide to Test Week

One of the crowning achievements of all medical school admissions offices is their ability to assemble such a brilliant collage of neurotic behaviors.  Our test on the kidney is this Friday, which means it’s exam week.  Which also means my classmates and I are finding creative ways to bolster our individual expressions of neurosis.
Many med students—perhaps myself included—will generally stop sleeping during this electric week.  Within this group exists a rarer breed that begins purchasing double-caffeinated espresso by the handle starting Monday morning (I think the Starbucks on our campus is having a special this week).  Still others give up shaving, or bathing, or changing their clothes for a string of five or six days, spurning hygiene in favor of multiple-choice glory.  A rather common variation of the anti-hygiene syndrome is the collapsible food pyramid.  This is when a med student foregoes the standard five food groups, essentially packing away the beloved pyramid, with the aim of living out of boxes labeled “Nabisco” for a few days.  This is like camping.  I think.
However, while the surface expression of exam-induced neurosis can be quite variable, the pathognomonic lesion is the Facebook update which cleverly indicates yes, I do indeed have an upcoming test (especially a new status containing notions of how much/little I am studying).  For the sake of fulfilling this duty, I have written a haiku:
The Kidney
Concentrates my pee
As my concentration vies
To produce the most
Sometimes I joke that I applied to medical school not because I wanted to become a doctor, but because I love tests and I heard medical school had some good ones.  Of course, this is just me being facetious.  But it is also probably 9.22% true.  There, I confessed my neurosis.  Now I need to get back to studying.

Saturday, October 2, 2010

To Do

Over the summer, I picked up an age-old practice that is popular among my peers.  I started a “to-do” list.  It was one of those moments in early adulthood where I worry that I am becoming an adult too early.  But since medical school is brimming with forms to fill out and meetings to attend, I grudgingly yielded some ground to age in order to prevent schedules and errands from derailing my mind.  Plus, it gives me an excuse to own an iPod.  It’s curious how tapping a back-lit rectangular touch-screen is somehow infinitely more satisfying than keeping a pen and pad.  But I’ve realized something else in 2 months of electronic list-keeping.  Having a to-do list doesn’t guarantee anything will actually get done.  In fact, my list seems decidedly more effective at highlighting (or back-lighting) all the things I don’t have time for.  Kind of like a chubby middle finger—with all the things I can never get around to tattooed from nail to knuckle.
Some of the regulars on my list include a pair of jeans that need tailoring, a tooth cleaning that requires finding a new dentist, and an oil change for my car that is roughly 2000 miles overdue.  I think of these tasks as the loners who checked into my sad motel of errands and never checked out.  And the problem with housing such tenants is that you never know which ones are going to turn out to be closet psychopaths—introverts who never call any attention to themselves until one day they set the entire establishment ablaze.  Maybe I’ll get tartar buildup, all my teeth will rot, and I won’t get into a good residency because straight teeth and a good smile are the first things a residency director notices during an interview.  Maybe my car’s engine will explode while I’m cruising down the freeway and they’ll have to shut down the 405 so rescuers can pry me out of my self-inflicted burning wreck.  Or maybe, I’ll get too fat for the jeans I bought 3 months ago.
Aside from the undone errands, I have also managed to partially embark on a handful of recreational endeavors.  Like the acrylic painting I started last Christmas.  I felt inspired to create after my girlfriend, Tiffany, and I went on a holiday hike and took some beautiful pictures.  Nine months later, I am the proud owner of a half-inspired canvas which adorns the floor of my storage closet.  There’s also the novel I started reading this past summer, One Flew Over the Cuckoo’s Nest.  I got 90 pages into it before school started 8 weeks ago, and it’s been collecting dust on my nightstand ever since.  I am quickly entering that nebulous territory where if I don’t pick the book up soon, I might as well start again from the beginning.
But among all the great un-achievements I’ve amassed, the most disheartening are a handful of aspirations I have long held but never appropriately addressed.  Sure, it’s nice to have healthy teeth, clean engine oil, and fitted jeans, but when I’m old and broken, I can’t imagine thinking to myself “if only I completed more errands.”  No, the items most worthy of regret are always the ones that don’t fit nicely on a to-do list.  Things like travelling and improving my Spanish, learning to rock out on the drums, and spending more time exhaling as I swan dive into forward bend.  Aspirations that have nothing to do with due dates and everything to do with the character I hope to embody.  Sometimes, I wish they had taught me in first grade to accomplish all my life goals before I turned thirteen.   Because now I’m stuck behind the eight ball wondering, will I be any closer when I am a working physician?  When I have kids of my own?  When I’m senile, have erectile dysfunction, and have forgotten to save up for retirement?  Exactly how swollen is this middle finger going to get, doc?
But even as I stumble, I try not to lose heart.  Because if medical school has taught me anything, it’s that hope plays a key role in the therapy of all chronic conditions.  It’s what ailing patients say when you visit them—just one day at a time.  It’s a faith that in the midst of disease and deadlines, we’ll find space for the things that are important, for the things we love.  For me, this includes writing.  Writing to tell a story, writing to find myself, and writing for no other reason than to finally check off an item that has been on my to-do list for over 4 months.  So at least for this moment, the swelling has gone down just a bit, and this is a hopeful sign.

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