Suffering

Sometimes I wish that I could just miraculously transmit my thoughts to this blog, without the effort of having to actually sit down and write. But that would be too easy, and as I am learning through this process, "easy" will not teach me how to be a great physician. Medical school is still just as hard as ever, and there are the constant murmurings from upper classmates that it just gets harder as it goes on. The experiences of the past several months have really changed my perspective on "hard" and more importantly, my resistance to this process.

Last week I finished a nine week elective class, "Medical Literature", and by far, it has been the best time spent out of the scientific classroom; a time spent reading, creating, and thinking about this whole process of becoming a physician. The class was led by an Emergency Medicine Fellow, and we had visiting physicians from the ER department who came to listen to our thoughts about the writings we read, as well as to add their wise words from years of experience dealing with the emotional side of medicine. How a physician handles trauma, life threatening illness, death, dying - both the handling of how to communicate to the families and patients about these things, as well as how to handle the internal pain these things stir up inside of the physician. The class was a breath of fresh air, a place to talk about the emotional struggles of being in medicine, and how to cope.

Coupled with this class was our last term of Principles of Clinical Management, the afternoon class that teaches us the clinical side of medicine, how to interview patients, how to listen to the heart and lungs, how to do an abdominal exam, as well the myriad other skills that we need to learn and practice. This term was less hands on, and more focused on the end of life issues that come up with patients. How to tell a patient "bad news", how to treat the terminally ill, how to treat the bereaved family members, and how to take care of the geriatric population. We each got to visit different assisted living homes, and come back with reports to our classmates about the living conditions, and the medical care of the residents. Last week a group of elders from one home came to our school, and we got to practice interviewing someone of the older population. We were fortunate to have a sweet 93 year old man who came to our small group. We did a mini physical mobility exam, took a medical history, and then did a mental status exam, to determine the state of his memory and cognition. The purpose of these exam are to look for signs of declining ability to do activities of daily living or for dementia, or any other indications that it might be time for more support. Most of the time we just listened to him talk about his life, (and he told us that was the most important thing we needed to be able to do as a physician). And I have to admit, that was my favorite part - listening to his stories about his family, his triumphs as an engineer, his losses such as when his daughter was killed by a drunk driver. When I escorted him back to the lecture hall, I thanked him for coming (this was his third year visiting the students), and told him I hoped to see him next year as well. Then he reached out and pulled me into a hug, tightly into his stooped over shoulders, with one hand on his walker, and he held that hug for some time. I had a huge smile on my face when he released me.

This week was also the last week at our preceptorship, the one afternoon every week that I have been spending with a family practice doctor since last September, watching, listening, learning, and practicing my interviewing and physical exam skills, as well as studying diseases that I saw in clinic, and writing up weekly chart notes. In short, doing all that I will do one day as a physician. This experience was incredible. Challenging, exciting, tiring, and emotionally draining (and it was only one afternoon a week!!). There is no way that I can succinctly say how much I learned while there, but the one thing I do know is that a lot of doctoring seems to be about just being present to the sufferings of others. And I saw so much suffering. Physical suffering of course (which the doctor had the most power to heal), but also, a lot of emotional suffering - an adult patient who was dealing with his dying mother, a female patient who had a baby that was not developing normally, a twelve year old patient who was skipping meals in order to stop boys from teasing her about her weight, an adult woman who admitted to being a victim of rape and domestic violence, a 54 year old woman with early onset Alzheimer's, a severely autistic child and his exhausted mother....the list could go on and on.

These experiences, with the medical literature class, with the Clinical class and the interactions with patients in the clinic, have changed me in a way that I'm not sure I can qualify, but I will say that I finally understand why medical school has to be so "hard". The amount of suffering I will be witness to, and the tremendous responsibility I will have, to be in charge of someone's life or death, demands a sacrifice on my part. I must earn the right to be such an intimate partner in a patient's life, and there is no easy way to earn this right, nor do I think there should be. I definitely do not want a physician taking care of me that was able to just get by in school, or one that passed with minimal effort. I want to know that my physician struggled and pushed themselves to be the very best, because that is what I feel we will have to do for our patients.

I finally have stopped complaining about how "hard" medical school is, and have instead realized what a privilege it is to become a physician. I know that the struggles now will allow me to better understand my patients and to take the very best care of them.

Coffee and Wine

Well we've just begun the last class of the year - BBOD - Biological Basis of Disease, where we start on the molecular and cellular level to look at pathology. This will be the bridge to next year, where we will return to each system in the body, but from a pathological perspective; ie. what can go wrong, and what we as allopathic physicians have to offer in an effort to help the body heal.

The first two weeks of the class were focused on the process of cellular and tissue inflammation, and what it looks like under the microscope (yup, we went back to the lab in the deep basement of the school), and then, oh so joyfully, we focused on cancer physiology. To spend every day learning about the mechanisms of cancer, and then to spend two hours looking at cancer cells under the microscope has taught me two things. One, I do not want to be a pathologist, and two, every choice I make in my life has the potential to steer my cells into the direction of malignancy.

So the coffee I drink in an attempt to keep me awake erodes the lining of my stomach, increases the amount of acid in my stomach, which can cause the cells of my esophagus to change in an effort to be protected from the powerful acids that sometimes gush up into my esophagus. Yikes.... then there's the other side - the glass of red wine I enjoy at night (it's good for my heart right?), not only adds to the acid in my stomach, but may (if I stray too far from one drink, which has happened maybe once or twice), add insult to my liver cells, which also have the potential to proliferate, mutate, and transform into renegade cells. So I should cut out the coffee and alcohol right? Duh, you might think.

Then there's all the other carcinogens in my environment - the BPA in the plastic of my water bottle, the benzene from the tail pipe of my car, the pesticides on my vegetables (the ones I can't afford to buy organic anyway), not to mention all the other pollutants I am subjected to on a daily basis. No, I am not one of those medical-school-student-turned-hypochondriacs; I am not worried that I have every disease that we are beginning to study. I am not worried that I have cancer. I am just so aware now, in every moment, that my body is fighting a huge onslaught of harmful chemicals, and that I do have some control, at least over some things.

Well, that's the theory anyway. I have my not-so good days and my bad days. I wake up thinking, I am NOT going to have any coffee today....and then I start to fall asleep in the afternoon while trying to catch up on the studies from the day before. I then have a wonderful cup of coffee, one that keeps my eyes open on the page in front of me, the stark text that explains how my immune system responds to toxins in my body. Thankfully, my body is still on my side, and continues to thrive day after day, so that I can continue to soak up all this knowledge. Go body go! I'm about to finish round one, and there's 7 more rounds to go. (7 more years until I can hang up my doctor sign on the door). When that day comes, I won't need coffee, and by then, I will have earned a good long nap. In the meantime I will enjoy my cup of coffee and glass of wine, when I just can't get by without them, and I'll trust my body to do the rest.