and now for a sappy entry where we all go aww

I have been down lately, Feb is dark, cold and my wrist is becoming steadily less functional. Microbio is endless and boring and suddenly Dr. Esch (my parasitology prof from ugrad) is appealing in a strange nostalgic way. I am lonely and tired of small talk. I am an oddball at med school too socially conscious, independent and not Republican enough for the a close relationship with 98% of the Christian people and not interested in partying, too much in pain for dancing and not interested enough in reality TV for the single people in my class. Every one else is married, studies for fun or busy running marathons every other week. Outside med school, I kind of destroyed my best shot of a social life when I stood up for my roomie who was being torn to shreds by jealous girls who wanted the attention that a certain guy was paying my roomie. I am now known as the frumpy, holier than thou, too smart for her own good med school kid (notice that everyone always labels me med school girl) who doesn’t like gossip and thus doesn’t like fun. Alas, my big mouth gets me every time.
I also have realized my slice of life in college was odd. All of my friends and 85% of my acquaintances wanted to save the world in some way: save the environment, stop discrimination of every minority group from gypsies to homosexuals to heterosexuals, stop AIDS, terrorism, capitalism, communism, sexism, ablism, pretty much every -ism and of course a smattering of people who wanted to be missionaries or preachers or get rid of the education gap in America, or be a supreme court justice and bring justice to various groups. All my pre-med friends wanted to do something really idealistic and noble like go live in the third world or change the American health system, run a free clinic for the homeless even the ones who wanted to go back to their home towns had very distinct ideas of how they were going to treat the homeless or the migrant workers….I wasn’t just an idealist in college, I surrounded my self with other activists and idealists.

Outside of my little ugrad world, I have gone from being a casual activist to that crazy med school girl who wants to save the world. People ask me questions like, why in the world do you care about children dying of AIDS in Romania, its not like you can cure them? Or my personal favorite, people who get AIDS do it because they make bad choices, why should we pay for their drugs? (because all people who get AIDS are obviously adults who sleep around) I have at least 5 conversations a week that surround LIFESTYLE, I don’t like that specality because it doesn’t match up with my lifestyle. Lifestyle could means hours, its could mean they want a family (many girls consider this and some guys of course) but it is also code for salary. I had one kid be like, so you want do sub-specality peds don’t you know they make less than general peds? And I want to be like, do you realize I DON’T CARE about the bottom line? Do realize that I never think about it? Do you realize that the American dream motif means very little to me?
And these are the moments where I am lonely for my little insular of idealists and activists and for people who don’t look at me like I have a third eye. I was ready to graduate but I was not ready for isolation that it would bring.

here is the sappy part…

But as I set there feeling sorry for myself this week, I kept getting phone calls, IMs and spontaneous meetings in McDonalds in Greensboro that reminded me that I may be that crazy med school kid who wants to save the world who is not quite Republican enough for the Christians and not a party girl enough for the rest of them but I am also the kid whose has 3 to 4 non-family members who love me pretty much unconditionally as if I was family. My few new friends here know almost as much about these people as they know about me, because most of my stories have to do with them. And I know its the same on the BE, LK (BK lives here so its different)’s ends because when I went to see BE everyone knew who I was, so this is THE Amy one said… And I realize I am pretty darn blessed, because I may not be winning any popularity contests but the friends I do have are of superior quality. and yes they keep my little idealism flames alive and they keep from losing myself in an attempt to fit some doctor, single, Christian, etc mold. And for that I am eternally grateful.

end sappy moment.

Protected: I am angry, questionably hateful and indignant.

I saw it going differently in my head…

well I have completed my quest for a modified  reflex hammer. This morning, I went early down to Comp Rehab, Wake’s state of the art  outpatient rehab and therapy center.  I came armed with a reflex hammer and  a ID badge that should help me gain access.  I asked the receptionist where occupational therapy was. She looked at me like I had a third eye. I  waved my reflex hammer around for emphasis. And told her of my quest.  She was intrigued. She led me back to PT/OT/ortho  where  I received more stares and  shurgs. We don’t do that sort of thing.  After a series of dead ends. I finally said hey I am going upstairs to peds. So I march up . And am instantly surrounded by  adorable special needs kids. And I relax . I find the peds receptionist and tell her of my plight. She doesn’t skip a beat. She takes the reflex hammer and goes back to find me some foam. She come back 2 mins later with a  ped OT/PT who ushers me in through a colorful, almost  familiar room with balls, mats and toys. We grab a jar of foam and  some scissors and  we are in business. We topped it off with a bandage that sticks  to itself  to help the foam stay. I thank her perfusley for taking me seriously and for seeing my need. I told her about my dead ends downstairs and she says, “Ironic, since you will be one of them soon.” I laugh and I say I live with that irony every day.

I walk down stairs and go see the wrist specialist. I am greeted by a young fellow who comments on the wonders of Clinical Microbiology Made Ridiculously Simple (I was reading it). He probes and prods, I jump at approciate moments. He apologizes for not remembering what Kniest was exactly.  I explain for billionith time I don’t have rheumatoid arthritis. But overall I am impressed, he is efficient and does not belittle my moderate medical knowledge. We rapidly discover that when the 250 lb kid from Colorado fell on my wrist in Katrina ravaged MS last Spring, he didn’t just crack my radius, he tore the heck out of my fibrocartilage complex. My ulna has no support and the damaged tissue is growing and putting pressure on ulnar nerve and tendons. I have already unknowingly been treated with both the first (cast after injury) and second lines (PT) for the injury.  5 minutes later a MD/PhD, head of the hand/wrist surgery program is handing me consent forms and strongly urging me to talk to my parents and asking when my spring break was? I nearly got whiplash. We went from microbiology textbooks to surgery in 5 mins.

I sat there and stared at the surgery consent form and realized I had never held one before much less read one before.  I read down the list and suddenly started having VIVID flashbacks to anatomy. The tendons, nerves, veins and arteries of the forearm and hand mocked me. I could see myself going “OH crap that was the ulnar nerve” and laughing at my clumsy scalpel wielding. I suddenly feel the distinct need to panic. At that moment, in comes the orhto-s with more paperwork and a stethoscope to make sure I am fit for them to wield scalpels in my wrist. All my mouth could say, “Would be ok if I refused to have medical students in the operating room?” I felt guilty as soon as I said it yet the reassured me that I had a legitimate concern, they were my classmates not my doctors. I sign the papers ignoring the laughing tendons and nerves telling myself the risks have always been high, all previous 15 times. I was just ignorant and in hindsight extraordinarily trusting of my parents and my pediatric orthopedist.
On through the review of systems and PE we go. I am declared healthy, of course I am. I am a medical student. I ask some more garbled questions about outcomes and how much does the fact I  had mutant cartilage in the first place count? My concerns are met with the cool confidence that surgeons have, we can’t cure your wrist but we can make it much, much better. I stutter dumbly and realize that being an adult sucks and signed more papers. He gave me his e-mail, my films and a couple more confident nods. I walked out breathless and happy to return to the other side.
Yesterday, we went up to the children’s hospital and for the first I got to take a medical history of child. I was in my element, I was confident, professional and I connected with my patient. It was a 11 yr girl with leukemia. Last summer, she woke up one morning and had extreme hip pain. Two days later she had cancer. Whiplash, she got it too. It was our last day of interview class and we had our final evals. My facilitator told me he gave me honors largely because of that last interview. You got her, you understood her and you didn’t pity her. You really have learned a lot overnight all of the sudden (I was not teacher’s pet…in less they needed someone to play patient, which they asked me to do nearly every time). I thanked him.

and as I was staring down at that consent form I thought about that. And I realized that I had unfair advantage to my classmates. I broke the curve. I didn’t learn anything that helped me in that last interview in medical school.

Like I said I live with the irony every day.

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)