Cool as a Cucumber

Week 14

Oct. 6-13th

At this point in block 2, the work seems unending—but the end is in sight. Watching myself and those around me as the end of the block nears is interesting. Stress is the norm. People carry themselves with this spirit of stress, and it is contagious. And, at times when I do not feel DISTRESS, I wonder, “am I normal? Should I be feeling peace? Am I disconnected from reality?” Everyone else seems to be overcome with it and yet, I am not. Perhaps, I need another week to get there. But, honestly, I do not have the patience for it anymore. That was undergrad.

I want to try a new thing.

Monday: So We are Supposed to Do All of This? 

This is the question I honestly have on my mind everyday. This week in PD, we learned that will have to carry out a complete physical exam on a standardized patient.

MY THOUGHTS:

Oh, a complete physical exam already? No biggie. Yup. It will get done. I’ll learn it sometime. 

My hope is that the ridiculous (and growing) amount of information we are expected to absorb will just teach me how to handle stress in a mature manner. Not complaining. Not asking people what they are studying. Not saying, “I am so behind.” I am so guilty of this—as if, there is a tangible train running away from us that we have to catch.

What I think we are missing (myself included) is that this is supposed to be hard, and this is training for the future. And, it is going to work out. Being overcome with fear never helped anyone out really.

I can’t revert back to my biochem junior year days. I just cannot, and will not.

In Jesus’ Name, AMEN.

So to my stressed out peers, we WILL make it.

image

Tuesday: Exploring Palliative Care

From RAMP (ie shadowing) we are expected to travel out to hospital or health care facility to see doctors doing their jobs. In the administrative chaos (which is scheduling at CWRU SOM), I signed up for palliative care.

Honestly, I did not want it.

My thoughts before my experience were something along these lines: “I want to be a doctor so I can help people—not watch them die. Great, I’m going to be depressed.”

So, when I found out that I had palliative care (since none of the other days of family practice or pediatrics or OB/GYN worked with my schedule), I was a little bummed out. I thought, that I had been dealt a bad card.

When I look back, I am amazed at how my RAMP experience has transformed that perspective. What I got truly was not a bad card. What I was given was a gift.

Death is one of the most human things we will ever experience, and yet we are so disturbed by it. The saying, “death is a part of life” is a truth we begrudgingly accept yet ignore constantly. But, shadowing Dr. Harrington at Metro showed me that in the face of death or in fact any situation people do not have to despair. People can actually laugh.

When Shyam and I showed up at Metro to look for Dr. H, fe wasn’t in his office (of course), and when the administrative assistant told us that we would be with one of his fellows, I was disappointed and annoyed. I thought for a few minutes that he didn’t want to “deal” with us because obviously I am a very important person (*sarcasm*).

She took us across the hospital to where he was, assuring us by saying how many “good things” she had heard about Dr. H. Luckily for us, his fellow (a DO by the way!) was in a meeting so we got to shadow him, the director of the palliative care health consult service at MetroHealth hospitals.

We waited awkwardly for him as he finished he typing up some notes. Dr. H introduced himself with his first name, a bizarre thing some attendings do because two first year medical students would never call him by his first name. Immediately, I picked up on his witty and dry sense of humor.

“So are you both first year medical students.”

“Yes,” we nod.

“I thought so. Your white coats are so clean, and you’ve buttoned them up.”

We follow him into a waiting room as he continues, “You are also walking three feet behind me at a respectful difference.”

I did not even notice that we are doing that until he said so. #scaredofthedoctor

While we waited for two 3rd year students to join us, Dr. H drew and showed Shyam and me a graph that looked something like this:

image

Our health (or here “wellness”) gets worse as we age.  Doctors generally have a curative approach to how they take care of people. It is about the disease. The second curve shows how treatment can get a sick person back until the normal curve for life. This is can be successful, and the reason why most future doctors want to be doctors.

But what if you can’t get someone back on that normal curve? What if treatment does not fight the disease or sustain life? (third curve) This is what palliative care is all about.  It can be hard to judge were someone is on this “absolute” curve, but in instances when the prognosis is bleak, it is important to not treat the disease—but treat the person. This is what Dr. H does.

My experience was so cool because I had firmer understanding of what it is that palliative care doctors do, and how it does not all have to be gloom and doom. Several of the patients were surprisingly up beat. He had an amazing way of making so many of them smile. He almost never stood over the patients. He would squat down to speak with them or take a seat in a nearby chair. He jokingly called Shyam, myself and the M3s his “bodyguards.” At times patients were more distressed and yet he was as cool as a cucumber. How does he do it?

Meeting the M3s was also great because seeing them present to him showed me what my life is going to look like in two years. He also asked them the hard questions and Shyam and I were able to just observe and not be quizzed (YASS). We did get some questions from time-to-time.

[Random side-note: Do not tell an attending, “I have no idea” when you don’t know something. If you do not know, it may be better to say. “I do not know, but I will research that and get back to you.” It is a much less lazy answer, and one of those folks got slight shade for saying that they had “no idea.”

“Maybe you should.” – Dr. H. ]

At the end of the day, we got to see him give patients prescriptions for pain medication another palliative care treatments, explain procedures, listen to patients’ stories, put on their socks, ask about their “wigs” and so forth.

He also was an exceptional teacher and explained why he did everything he was doing to the patient to us.

I left Metro feeling so differently than how arrived.

How could I think that Dr. H’s job was meaningless? How could I think that it was not helping the patient?

He does the hard work. He does what people shy away from. He faces death everyday, and reminds patients that despite the diagnosis they are still living.

How amazing is that!

Wednesday: Neuroexam and Hornblower’s Lessons on Duty

For SIM today we had the neuroexam, and I did it!! I was so nervous about this one. I realize that although PD makes me anxious during the day, my relief after a good session makes it almost worth while. Getting to practice “doctoring” is awesome.

That evening after orchestra, I planned to go to bible study, almost made it to the Waldorf and remembered that location had changed. I gave up and drove back home.

Jen and I like to procrastinate a lot and it is ALWAYS great. We watched clips from Sense & Sensibility and she showed me a new abc show called, Forever. I am not sure how I feel about the show (haven’t seen entire episode yet), but I have been a fan of Ioan Gruffudd for years!

Have you seen Horatio Hornblower? No? You should! Especially if you like historical dramas, war stories, Napoleonic war period of history in particular, costumes, and British accents. The program is based on the novels by C.S. Forester.  I would watch it with my family growing up. The story is about a young man named Horatio Hornblower who rises up the ranks from the lowest of the low to a naval captain in the British navy.  After all the procrastination, I just took the night off and watched a Hornblower episode (really a TV movie).

This is probably the best thing Gruffudd has done with is life thus far because we all know that Fantastic Four wasn’t it. If he returns as Hornblower, that will certainly be his crowing achievement. The programs ran from 1998-2003 and can ALL be found on YouTube.

image

RECOGNIZE THE GUY ON THE RIGHT??

Thursday: More Scandal? Honestly what happened today?

That is all.

Friday: Student Ambassadorship 

I am officially a student ambassador for the Cleveland Orchestra! This means I can see ALL the performances I want FOR FREE!! All I need to do is tell you all to go see the orchestra too! If you are interested in learning more about this position, let me know!

Saturday: Anatomy Lab-ing

Finally went to doc opera band rehearsal! I loved playing the Game of Thrones theme (with Jerome, Felicia, Isaac, Shyam, and more)! Case musicians, unite!

In a moment of genius (even more genius than normal for her) Aaida suggested to Sharif and me that we should put Vic’s Vapor Rub under our noses before going into anatomy lab. Definitely transformed the experience! It felt so much better! Menthol > > > Formalin.

OH THE POWER OF GOOD IDEAS!

Sunday: The Key to Seeing is to See One Thing

I went to church this week and heard so much wisdom. The pastor was stillpreaching on the Sermon on the Mount. This week’s verse was Matthew 5:8: “Blessed are the pure in heart for they shall see God.”

I always thought of this verse as very exclusive. Like, you had to be “pure” somehow to get access to a special experience with God. But, the thing about Christianity is that you cannot be pure of your own volition. Humans fail at that. Purity is not a personality type. So how is it defined and how is this useful?

To be pure of heart is to be singleminded about God in the Christian faith—(not simpleminded, I may add.) There is this great C.S. Lewis quote that I love. It is, “I believe in Christianity as I believe that the sun has risen: not only because I see it, but because by it I see everything else.”

I share Lewis’ perspective, and Jesus was pretty smart because the “beatitude” has some applications for the now and how we should consider our lives.

What is the lens through which you see the world? What are we really working toward? This principle of singlemindedness (extreme focus), I think can be really critical for us all. What holds you together? Where is the eye in your storm, and how can you get there?

Maybe with these ponderings we can transform from pretty manic medical students to something more.

Like cool cucumbers.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s