Saturday, October 22, 2005

Sukkot: Temporary Residence

Approaching the Beller's house for Sukkot dinner: the first thing I can make out in the unlit night is their driveway basketball hoop, blackened by darkness to the color of the asphalt it stands upon. A few steps closer...and then, like the first rays of a musical sunrise, the faint glimmer of voices in song peek around the corner, growing in intensity by the moment, streaking harmony through the darkness...a few steps closer...finally, I approaching the sukkah, I feel my heart blossoming into flower, erupting into smile; steaming dishes of sweet harvest vegetables crowd the table, and gleaming faces of these friends I love fill the space between table and walls...I slip into empty seat and song, exchanging smiles all around, filling the spot that was meant for only me. This is the feeling of coming home.

The next morning, I stand crowded in another 3-walled structure meant to be a makeshift home for a different kind of spiritual traveler. It is exam room 9 of the YNHH emergency department, and we are two doctors, a medical student, a patient, and a son, cramped into this room that has no room. Mrs. K lies in her bed, and we hover around her. The room is somewhat dark, and her face gleams green in the shadows, biliously. Her diagnosis is pancreatic cancer, her prognosis grim. And, lest I forget to mention the obvious, she is 93 years old. Still, after we have finished gathering information about her medical history, we have to ask her the final, important question: would she like to be rescuscitated should the need arise? Her son begins to cry. This I did not expect. Our fearless leader, the resident, pauses from his routine interrogation, leaving a precarious silence in its stead. Mrs. K isn't looking at her son, and she can barely hear a thing we're saying, but she can sense the gist of what's going on here. Now she starts crying, asking me why we're still keeping her around, telling the resident that she just wants her son to be happy. It feels as though we have invaded the intimate moments of this family's relationships for our own legalistic gratification.

That night, studying in Atticus, a father and daughter eat dinner one table over. The girl is slender, articulate, flat-chested--the prototypical 9-year-old pre-intellectual daddy's girl. I am fascinated by her inflection and tone, as well as her remarkable vocabulary and sophistication of speech. "I bring a lot of pizzaz to my class, daddy," she says seriously. At one point, emphasizing her argument, she pats her father's knee affectionately, setting off pangs of pseudonostalgia in the recesses of my fatherless childhood memory bank. At another point, I notice the absence of wedding band on daddy's left hand. Divorced? Must be... my mind plays the "what if" game before I can stop it--is this what it would have been like? Would we have gone out for soup and bread pudding at high-end dessert places in NYC or LA or NJ? Yes, which city--where would I have thought of as home? Thinking about home, about temporary residences .... This time, unlike in the ED earlier today, I *want* permission to dwell--even for just these moments--in the sacred temporary space of this father and daughter enjoying dessert together.

Monday, October 10, 2005

Bringing the Jackson 5 to Kushlan 8

The scene: A rainy night in New Haven, on the eighth floor of Yale-New Haven hospital. It is our valiant med student Rachel's very first day of her two month medicine rotation, and she has already braved an exhaustive orientation, a painstakingly detailed demonstration of the muscle strength exam, two full hours of instruction about the marvelous yet soporific world of microbiology and laboratory medicine, and--hardest of all--the crushing news that she would be on call her very first day.

Rachel has now spent a good amount of time interviewing, examining, and working up her first patient admission. It is well past dinnertime. Rachel would love to get permission to leave for the night, when suddenly, her well-meaning resident appears out of nowhere and says:
"There's something important
that I need you to do.
We need a stat blood gas
on the lady in room 2."

Rachel, trying to appear confident and eager despite her obvious ineptitude and inexperience, quickly blurts out: "Uh...sure!" And then thinks to herself with horror "Oh no, I can't believe I'm going to kill my first patient on my very first day!"

Sensing the fear in her eyes, Rachel's extremely clever and incredibly earnest intern Ernest looks right back at Rachel, takes her hand as he pauses with melodramatic gusto, and begins to sing as he dances her down the hallway: "Come on, come on, come on, let me show you what it's all about!

You went to med school to learn girl
things you never knew before
like heart failure causes edema and why a diabetic gets a foot sore
now, now, now
Im gonna teach you, teach you, teach you
all about blood girl, all about blood
put on those gloves, prep the arm clean
all you gotta do is repeat after me

A B G , It's easy as
1,2, 3, palpate the pulse
radially, needle in deep, so gently
you've got your first ABG girl!"

[They dance around the patient's bed, syringes and vials of deep crimson arterial blood in hand, then skip down the hallway to send the sample to the blood gas lab, and the music dies down as they high-five and saunter back into the charting room]

Scene 2: Same place, several minutes later.
The context: the valient med student Rachel, her extremely clever and earnest intern Ernest, and the well-meaning resident are all chatting about the moving but jarring noon conference they had seen earlier in the day by a Yale doc who had put together a team of area physicians (and one chiropractor!) to bring primary care medicine to hurricane refugees in Mississippi. Thinking about the unusual preponderance of natural disasters in recent weeks, the well-meaning resident remarked, in a way that only a doctor who brings hope and healing to people every single day could: "Maybe the world is ending. Then I won't have to preround on my patients tomorrow morning."

The End.

Saturday, October 08, 2005

Celebrating Ambulating: My Month in Greenwich

Friday concluded my taste of ambulatory care--so-called, I have reasoned, because (in contrast to the bedridden ill overnighters of inpatient medicine) the ambulatory patients walk into the clinic, and then walk right back out. To sum up the entire rotation in one sentence, I think this first introduction to primary care general medicine confirmed my suspicion that family medicine is the best fit future career for me. That definitely calls for a (somewhat preemptive) woohoo!

As evidenced by my journaling absence, these past four weeks were consuming in a way I had not anticipated. For reasons still somewhat unbeknownst to me, that mild sublinical depression I develop on psych (which I mostly attributed to the fact that I was, after all, on psych) blossomed into a full-fledged case of The Blahs (technical term). I couldn't sleep, I couldn't blog--I even (gasp!) lost interest in the novel I was reading. Interestingly, though, almost every friend or family member I talked to during those middle days of September appeared to be swimming in a similar funk. Maybe there was something awry in the cosmos, maybe the change of season has some crazy effect on people's serotonin levels, maybe we were all feeling the rootlessness of the millions of displaced Americans...whatever it was, it was definitely *not* just me.

In any case, I think I'm over the funk, and not a moment too soon, either; tomorrow I start the mother of all rotations: Internal Medicine. For the next eight weeks, I will try my darndest to be the best perfectly punctual, enthusiastically eager to learn and please, painstakingly perfectionist, compassionately caring, and occasionally obsequious third-year medical student I can possible be. I will endure call every fourth night, many hours of rounding, possibly even the death of a patient of mine (hopefully due to something completely unrelated to me!) Yet, in spite of the pain, I can look forward to what might be the most transformative two months of my medical school career. If there was any time that I felt as though I was about to get bound tight inside a cocoon (a cocoon called Yale-New Haven Hospital, that is) and emerge a butterfly (a butterfly who can act like a doctor, that is), this is it!

In conclusion, here's a quick list of highlights from the past month:

HOT: Went to my second Cuddle Party today and might be on TV! It was a media event in response to the recent CSI episode on Wednesday that featured the fictional organizer of the Cuddle Party as a possible murder suspect. Fortunately for my own self-consciousness, the only media that showed were a pair of women writing a documentary about unconventional communities for an Italian TV channel, a wannabe journalist NYU student, and a spandexed older lady named Gisella writing a story for some German magazine. Whew!
HOTTER: Won a pair of toasty-warm footie PJs at the Cuddle Party today! I think the last time I wore footie PJs was one night about 22 years ago when I woke up in the middle of the night with the horrifying feeling of wet warmth running down my legs, and puddles inside both of my watertight footies. The PJs were pink and furry, with white plastic footies; let's just say that I highly discourage the wearing of such PJs if there's any chance of overnight "rain". Ick.
HOTTEST: Started doing Bikram Yoga, aka "you must be fucking kidding me", consisting of 23 asanas (yoga poses) done in a room heated to some ungodly temperature (around 95 I think). Having only done it once, I haven't fully decided yet whether it's a 90 minute medieval torture or an hour-and-a-half of transcendent bliss. More on that soon.

MEMORABLE: Did my first testicular examination on a patient and palpated my first set of artificially augmented breasts (also on a patient. Different patient.)
MORE MEMORABLE: Saw Dar Williams in concert for the second time! Fell in love with her music all over again, especially "The Babysitter's Here" and "The Pointless, Yet Poignant, Crisis of a Co-ed". Also fell in love with the divine tight harmonic blend of her opening act, the unambiguously gay trio Girlyman.
MOST MEMORABLE: My Best Friend's Wedding! Eli and David got married on Sept 25 in Boston, going down in history as one of the first thousand gay couples to legally wed in Mass. They planned every detail of the wedding themselves, and did an interesting, suprisingly good job of making one of the most heterosexual, feminine events in our culture uniquely personal to them and also quite masculine. Even the flowers were sort of phallic. I was the best man. :-)