C, the answer is C, That is incorrect, you do realize it wasn’t a mulitple choice question?

I recently had a conversation with my one of my classmates that made me realize that there are a lot of things they don’t teach in medical school. The conversation started off ordinarily enough. It was one of those so what the heck is wrong with you conversations. Except this time we were at a large table at Panara with a sea of molecular biology, nucleotide synthesis and clinical genetics notes between us. Thus instead of the normal I have the kind arthritis old people get line…I went into a short summary of the finer points of collagen synthesis. After I finished, a big grin spread across my classmate’s face, she exclaimed, ”all we need to is to give you collagen. It is so simple!” Why haven’t you taken it yet? For a moment I was overwhelmed by her optimism, then I was overwhelmed by how much she didn’t get it. (I was sorely tempted to throw the gene therapy lecture notes in her face)

I was sitting on the sofa with another classmate watching Grey’s (yes get over it) two weeks ago. As we watched George and his family take his Dad off life support, she comments, “I can’t understand why anyone would ever just give up on a patient. And likewise I can’t understand how a patient would ever want to give up on medicine. There is always hope, hope of a cure, something we can do.” I know that for at least 30 seconds, I must have looked dazed and confused. Does she really not see why someone would choose not to live on life support? Does she not even understand why someone would refuse treatment or chose alternative treatments to conventional medicine? Does she really find hope only in a medical cure? Again I am touched by her optimism yet overwhelmed by how little idea she has of what its like to make those kinds of decisions (for the record I don’t claim to know how I would react if I had to turn off my parents’ life support BUT it is something my family has talked about, I know what my parents’ and grandparents wishes are and I would like to think I would honor them…I DO HOWEVER know why one would turn down surgery, drugs, etc in favor life, having children, occasionally living outside of the hospital, etc). I seriously think if I started talking to her about why I am not taking Fosmax, she wouldn’t get it and that makes me sad.

Every week in case, we solve problems, we treat diseases, we strap insulin pumps on 14 yr girls, we do a mastectomy on a 57 yr. old woman, and feel satisfied at the end because we beat the bad guys, we fixed the problem. We won. I love PBL, I will admit it. Because as we all know problem solving is the disability superpower. It is my one class in med school, where I can play the game and do well, be near the top and all that jazz. However, I am now recoiling from it slightly. Because in a way we have taken the humanity out of the medicine. There are no actual people involved to learn how to live with diabetes or deal with the emotional aspects of losing a breast to cancer. Sometimes psycho-social issues come up and we talk about them but at the end of the day we still go home with the attitude we beat the cancer, diabetes, etc. It’s over. But in real life these things don’t just end that 14 yr has to live with that insulin pump for the rest of her life, that woman has to worry about remission, reconstruction and continue to digest what has just happened to her.

This is the medicine that doesn’t have an easy solution. We can’t fix these problems. These are where the tough decisions come. Here we enter the gray area that is beyond the sterile, methodical world of academia and medicine into the trenches of real life with real people who actually have to live with the “cures” we doctors offer them or who have to find ways to live with and without spoons.

More and more I am getting stares and questions about why I have a third head. Its not the wheelchair, its not the cane, its not the limp, the funny PE methods or the hearing aides. It’s the fact that I am chronically ill and I am not waiting anxiously awaiting a cure, nor did I enter medicine to fix people….Which means when I open my mouth, I speak a language that no one else seems to speak. How do you teach healthy people these things? I don’t know how to bridge the divide. I don’t what to say when these issues come up. I don’t know how to explain to these highly motivated, optimistic, hopeful classmates of mine that you can’t just fix people. People aren’t machines, people aren’t statistics, people aren’t outcomes. I don’t want to kill their optimism I don’t want to destroy their dreams. I don’t want to be the one to tell them medicine has its limitations, that they will have to look people in the eye one day and say I can’t do anything else for your father, your cancer has spread beyond our control. I can’t even explain that I have an incurable and unfixable (and will be for at least a couple more decades) genetic disease even when I am surrounded by notes talking about the failure of multiple gene therapy trials. I think in the back of their minds they know these things are going to happen in their careers but they have no sense of what that really means.

Ironically, I am criticizing or at the very least marveling at their lack of readiness to give and deal with bad news. Yet I am not willing to be the one who gives them the news that medicine is not the end all hope for freedom from death, disease and general evilness everywhere.

Well at least we have something in common.

(on a side note this entry is shockingly similar to some of my journal entries in Romania where I was frustrated with Christian volunteers whose solution to the social and medical problems disabled/ill children faced was to pray they would covert so they could to heaven and be normal…that was how they were going to fix them…the problem there was when I tried to preach social justice and healing I was called an heathen….so if you were going to leave me a nice comment about hope and faith, be delicate in your wording…I am much less interested in finding hope in fixing people as I am in helping people live happy, peaceful, lives that glorify God and teach others for as long as they have in this life)