Hope

This week, I met a patient who made me feel really good about medicine, and about being able to really make a difference. NS is almost 80, and has had problems with his heart for all his life (many of his family members died before turning 50 from heart disease). NS had had a quintuple-bypass surgery, and had lived happily after that for many years. He was a ski instructor, a tennis instructor, an English teacher, a Sunday School teacher...he even retired and went to teach in parts of the world where almost everyone is illiterate (and no, he had surprisingly not heard of Three Cups of Tea!). He is also obviously in love with his "new" wife of 20 years, and simply has a lot going on for him. But a few weeks back, he came in the hospital with shortness of breath, and as he was being tested had a stroke. His doctors gave him TWO DAYS to live.

Tough, right?

He was released from the hospital on a weekend, and somehow he was able to get a hold of his cardiologist. After talking on the phone, the cardiologist drove an hour to NS' house on his day off so they could chat. The next day, NS had surgery. And now it's four weeks later, and he is getting ready to go home.
His cardiologist just knew that he would be able to survive yet another operation on his fragile heart, as he had treated him for years. And thus risks were taken, and NS has now the face of that who has faced death, who has been given a terrible lottery ticket with those bad genes, but who has, at least for once, teased death away. This is my first patient that has come so so so close to it. And I don't think I'll forget the depth of his eyes, so heavy with wisdom.

And that right there is the power of medicine and the difference that one doctor can make. I honestly don't know what did the cardiologist know that the ER docs didn't. I don't care. I just know that thanks to a turn of luck, of right people at the right time, and of using and abusing our healthcare system, NS will live to teach his granddaughter how to ski, to read more books, and to inspire a few more people like me and like his Sunday School students.

So today, despite knowing a lot less about pyruvate carboxylase than I should, and despite missing teaching, I am very happy with my choice. Maybe one of these days I can actually help out. Make a difference on someone, on someones. That, right there, would be cool.

In the meantime, I just completed one of these cycles that go on in 1st year med school (and I just have a feeling this happens everywhere in the country). Test monday. Beers monday. Relaxed week. Today, movie and beer (and OMG have you watched The Single Man? I haven't watched such a good movie in a looooong time!!). Tomorrow, I learn to cross-country ski. And then there will be Monday, 2 weeks from our next test, and I will realize just how little do I know about the 100+ pages that our teachers have covered in lecture. Oh. Well.

~E

PS: Oh. And it's EIGHT Farenheit outside. How is a Spaniard supposed to cope???

More on Dr. Berk

Dr. Berk is coming back as full time CEO of the Medical center. What do you guess that a job like that takes? 50? 60 hours a week? This man is amazing!

http://www.urmc.rochester.edu/news/taubman/?id=2742

AND to continue with depressing stories, my patient yesterday had MS, diagnosed in his early 40's. Severely disabled practically since diagnosis, and acc to Dr. N, without much hope for him to get better (he practically can't walk and even if he could he has absolutely no energy). From lack of activity he is gaining weight. And weight gain and chronic lack of activity make an excellent recipe for shit to happen. So that was another very upsetting day at the Rehab unit. I wonder if I will get callous at some point. I don't know if I want to, though. Will I loose my humanity?

~e

Stroke and accidents

This week we've been focusing on life after a traumatic accident or after a stroke. One of the patients I saw (who I interviewed for almost 2 hours) had just had a stroke. She's thin, looks healthy, and walks (make that walked) around. But she is 85 and just lost her husband of 60 years (!!). Did that give her a stroke? Why did her body decide this particular moment to fail a little bit in its blood supplying job to the brain, rendering her leg and arm a dead weight?

"My" patient was upbeat and hopeful, given that she has a little mobility of some fingers. But after talking to the doctor I realized that this upbeatness is out of blissful ignorance, as she probably won't be able to walk again without a walker or go up her stairs--among other things.

I realize that 85 is a great age to make it in good health. She's lived a long life and she told me that she was "ready." It's the natural course of life, and it is a matter of time, and not of whether, that "mishaps" are going to cause our bodies to fail us like that. But I still have trouble accepting it. I guess it goes back to death and our coming and going in the world...maybe I haven't thought of that as much as I should. I am sure I will have plenty of opportunities to face death and the natural path of life in the next few years...

On the other side of things, the unnatural courses, we had a presentation by the Medical Center CEO, Dr. Berk. He had a biking accident in June that fucked up his C3 vertebra. And there went his ability to walk, grab things, control his bodily fluids, sign his name, wiggle his toes. Dr. Berk was not a CEO for no reason, and his talk was eloquent, matter-of-fact, and devoid of any self-pity. He simply took the turn too fast and skidded and went over his handlebars to break his neck upon landing. And as he was laying there, beginning to pant, he realized exactly what had happened, how high his break had to be for his diaphragm to be out. And he felt the sensation in his limbs leaving him, some of it without return, as he was laying there. Scary, huh?

He is back to work now and has a superduper chair that enables him to be a little taller than me if he presses a button, which I guess is good if you go to a lot of fundraisers where people tend to spill their drinks.

And sure, he still has an amazing job and a wonderful family and many things to go for him.

But he broke his neck. Not at age 85, but while still youngish. And even though he is gaining some sensation and some movement, he is now faced with a life very different from the one he had envisioned.

With this also I have issues (who doesn't!). And with the cases we were presented with right after the conference, like a teacher who had a skiing accident while in his 20's. Yep. Wheelchair for the rest of his life. Now happily married, happily employed as a 5th grade teacher. Looks happy and hipermegaenergetic. So why does it depress me?

I went on a ride today because it was over 30 degrees (most of the snow on the roads is gone) and because I am physically addicted to my bike. But as I was coming down new, unknown turns, I was sure slowing down more than usual.

The soberness of our week doesn't end up here. We've also been learning about all these genetic disorders that can be really messed up (and are more frequent than I ever thought). Just like last week we had patients with disabilities that were obviously living a full, satisfying life, we had a parent presentation this week of parents of children with disabilities that seem more overwhelmed than happy with their kids. And that might just be my impression.

Ahh. The weight of knowledge. Time for some Twilight (what!).

~e

Ice and First Patient

So the ice skating was fun. My first lap consisted of very tiny steps, and many of my classmates stopped to make sure I was allright, held my hand, and gave advice. There was no rail or wall, and most of these people have grown up skating. I was of course the Southern Spaniard from Oregon who hadn't been on a rink before. But at the end of the night, I was "skilled" enough to compete in dives, which is when you go as fast as you can and then dive on the ice, and whoever goes further with their body wins. I had a blast, obviously.

But to more serious things. Today I saw my first real patient, at a hospital. We were briefly briefed in what to do and there we went. My partner and I were given 90 minutes to obtain a history and perform an exam. I thought at first that 90 minutes was gonna be a looooooong time, given that the doctor I shadowed spent an average of...I don't know, 30 minutes, with each hospital patient.
But time went by superfast. She had many things to tell, she was very interesting, and she had many many medical problems. I only felt frustrated when she sought reassurance from us and we couldn't provide it. First, we don't know anything. And second, even if we did, the news might or might not be good. That's gonna be hard, ain't it?
But anyways. It was an awesome experience. In the midst of all the textbook stuff, it is so wonderful to be able to actually get a feel for medicine.

I'm gonna stay out of her story for many reasons, but I can tell you this: when I introduced myself, she said, "Oh, Esther, biblical!!," not knowing that everyone in Spain had to name their kids with names out of the Bible or fear being boiled in oil by their in-laws/parents/neighbors... So she later asked me what church do I go to. I was able to hide my chuckle. I wanna say it's been a couple of years since the last wedding (and thus the last time I went to church). Then she lectured me a little, that we have to care for our spiritual self. I got out by saying that I didn't need to care for my spiritual self at church, that I could do it elsewhere (I did not tell her that I did it in my once-a-week 15 minute yoga routine...).
But yeah. Good thing that I am going to go by Dr. CM. Otherwise this might get tricky...

Time for some Genetics...
~e

Oh. And IM training started this week. Which meant running in 16 degree weather that felt like 6.
Only my toes felt cold. And it was a bit tricky to run in slippery snow.
But now i think i might have a frigging cold. Maybe I caught it on the airplane, no? Can't possibly be from running!!!!

Week 1.

I know it's still thursday. But darn, Med School moves so fast!
So from break we dived right into 8 hours of lecture on Monday. And on it goes. The good thing is that most lectures are done by an amazing teacher/pediatrician. The bad thing...EIGHT hours of lecture (which translates in 8^200 hours of studying).
We're learning Genetics (labs are done, YAY!!), genetic disorders, chromosomal abnormalities. And the very cool thing is that every 3 lectures or so, we get a patient presentation. Say, for instance, that we learn about cerebral palsy. That day a woman with the disease comes in and tells us what it is like live with a disability that makes her speech and gait appear like she is drunk, and that makes her motor coordination so poor that writing anything is a real hardship for her. This woman was as alert as you and I (well, at least the day that she presented, more alert than I am), and at least as intellectually capable as anybody in my classroom. Yet, she was sent to a "special school" when little, was told that couldn't get a degree, and had a hard time finding love and praise in her life. Just because she sounds drunk. But stubbornness and a bit of luck allowed her to find a fulfilling career path (as a social worker) and she has been blessed with what it seems like a wonderful family (who seems a lot less bothered by her disability than she is). And she is able to come to med school to teach us all about focusing on what she, and all people with disabilities CAN DO, rather than on what they can't. Focus on my abilities, she said, not on my DISabilities.

We're also preparing for next week (when we start working with real patients) by having pediatrics clinical examination presentations. That is, they bring a few kids and their parents, and they show us some tricks to examine a terrorist (that is, a 15-18-month old) without causing an uproar. Or they tell us that part of caring for a kid is to schedule an anti-terrorism policy appointment with the parents (ie, have a talk about the terrorist's behavior, what's normal, what to expect, etc). This is far from a classical classroom setting, as our teacher is doing this in front of 100 of us, while the kids are being supercute and crazy, and the parents are telling us how they cope (and what do they think of their pediatrician...). Even though I am not really into pediatrics, I have to say that it was an awesome conference. All of us had a smile on our face for at least 80% of the presentation. Kids sure can be cute!

And here is the other thing. We were studying chromosomal abnormalities that might lead to, say, a person with male genitalia but that has boobs. Conveniently, i have just finished Middlesex (the story of an intersex person). And I have a good friend that has posed many many questions about sex versus gender. So I go and ask the teacher what does he think that determines sex identity. He says sex chromosomes. Your other genes. Your anatomy. But then he says that really what matter is our attitude. That we need to keep an open mind. That it doesn't matter whether Calliope is raised as a girl or as a boy, as long as her parents love her, as long as if there is a point in which she decides to switch genders, it comes in a loving environment where she feels supported. Open mindness, he keeps saying.

So for this week I have been taught to keep an open mind about "dis"abilities. And about gender.

Man. I love med school!

Oh. And I am going skating tomorrow. Will let u know if I loose my teeth :)

Gotta get to bed. Week 1 still has 4 more lecture hours!!!
~e