From White Coats to West Coast: We're Off!

On Friday, I biked home from the pediatric clinic, officially marking the end of my third year of medical school ; on Monday, I drove out of my mom's driveway, officially marking the beginning of my long-awaited three week cross-country roadtrip! You can track our progress at http://raroadtrip.blogspot.com

Full Circle

Well, this is it. Tomorrow is my last day of my third year of medical school. In some ways, it's been a one way trajectory out of the bright and shiny world of the layperson into the deep, dark underbelly of a physician's work (oh the sights! oh the smells! oh the blood and guts! ... ok, I exaggerate. a little.) But in other ways, I've come full circle: last June, as the undergrads fled New Haven, to be replaced by the frappuchino slurping, gum snapping gaggles of high school campers; and my reliable puke orange bike replaced my car as primary mode of transportation (yes, puke can be orange--I distinctly remember getting sick on one of my preteen birthdays and puking up a fountain of foamy orange from the push-pop I had just eaten)...uh, where was I? oh right, full circle--so just as last year at this time I started off my third year on the 10th and 11th floors of the hospital bringing new babies into this world and then not seeing them again because as an ob/gyn I was only in charge of the mothers: I spent every morning of this last week of my third year back up on those very same floors, this time finishing the story of birth, giving newly born babies their first physicals, giving newly minted moms the first of many of what pediatricians call 'anticipatory guidance'--encouraging them to use the carseat correctly, to put baby to sleep on his/her back, etc.--and then sending them on their way off to the bright blue yonder world of life. Ahhh. Life truly is beautiful, especially when people are healthy and happy. Before I wax so nostalgic I need to use Q-tips to undo myself, here are a few highlights/memorable moments/memorable patients of this past year on the wards:

Ob/Gyn: Bringing five new humans into the world with my own two hands, and not dropping any of them!

Psych: Witnessing a true psychotic episode up close and personal, Jesus impersonating and all. And getting to know two very special siblings, whose unfortunate external circumstances may already have wrought irreversible damage on their tenderly developing minds and hearts. And the guy with the letters F-U-C-K Y-O-U-! tattooed across his knuckles.

Ambulatory: The 55-year-old woman whose inexplicable muscle pains could best be explained by her only relevant past medical history--bilateral silicone breast implants.

Medicine: Holding my patient's living heart in my hands for 20 minutes while the CT surgeons fit it with new coronary artery piping--and then visiting the rest of him as he recovered and eventually went home. And my most memorable patient, a very complex man with only half a nose who was hated by many a nurse, but who gave me the sweetest gift and card when I said goodbye. He was the first patient to write "To Rachel, My Doctor". I was touched more than he'll ever know.

Neurology: Doing my first spinal tap, clearly not very adeptly, on possibly the most dangerous type of patient in this situation; one with suspected mad cow disease!

Surgery: The rich emerald hue of a healthy gallbladder, the mesmerizing undulations of live bowel--the beauty of the inside of a human. And suturing my first skin incision. And feeling proud of myself for participating so actively in a complicated and interested case...only to find out that while the surgery was successful, the patient died the next day.

Pediatrics: Catching C-section babies in my arms. Caring for the littlest live humans on the planet. Helping a 400-pound teenager realize that if he just stopped drinking those 64 oz. of Hawaiian Punch every day, and did nothing else different, he could automatically consume almost 1000 fewer calories every day, and lose 2 pounds a week!

What a long, strange trip it's been. I've stuck my hands and fingers places no normal person would ever do to a stranger, asked questions no normal person would rightfully answer to a stranger, and felt more connected and compassionate to patients than I ever thought I'd feel toward a stranger. And, of course, my own personal life has continued to be strange, unpredictable, and wonderful. On to the next adventure!

Moving: A Failure of Natural Selection

This is my thought of the day, after walking through the streets of New Haven and witnessing dozens of little dramas unfold on and around the ramp of many a U-Haul: Humans are not adapted to move. That's right, I want to argue that moving is just not a naturally selected skill that we possess. Let's think about it: first, we were hunter-gatherers, who had no possessions. Then came the agricultural revolution, so we adapted not by developing stronger backs, or universal desires to give up our earthly possessions for monastic living--but by plopping ourselves into small villages, where we would more likely than not live out the entire length of our days without moving our bodies beyond a 25 mile radius, let alone picking up and moving all of our crap to another city. Thankfully, technology is now helping our poor bodies adapt by making some of this crap smaller and easier to carry (I can't believe I ever actually owned a desktop computer with tower and monitor!), but we're still far behind any true evolutionary success on the issue.

Five Things I Hate About Moving:

1. The Rectangle Tango: having big queen size bed to maneuver down winding flights of stairs, through too-small doorways, requiring the inevitable rectangle tango, in which the holders of said bed do an awkward two-step as they attempt to position and contort the bed through various variations on the conventional lengthwise pickup-and-charge pose.

2. Tchotchkes: not significant enough to take, not meaningless enough to throw away. What to do?

3. Books: I love reading them. I love buying them. I love living with them. I HATE moving them. One sheet of paper is so light--how can a few hundred sheets suddenly become heavy enough to injure if thrown? I will never give up the supreme pleasure of curling up in a comfy chair on a rainy day and reading a chick lit novel in one sitting; or leafing through an old favorite book to reread a memorable passage or chapter; or just the smell and excitement of cracking the cover of a new acquisition...but packing all those pleasures into cardboard boxes and lugging them one by one (so many!) to their new home does make me think for a moment about the possibility of replacing my entire library with a single, thumb-sized, 100 gigabyte flashdrive.

4. Helping: The only thing worse than moving your own stuff....is moving someone else's. You get none of the nostalgia of finding that old shirt you used to love and thought you lost, none of the satisfaction of deciding once and for all to throw away your college notebooks that you know you'll never read or use, and none of the fun of looking forward to your new place. You do, however, get all of the hard work, all of the exasperation, and all of the idiosyncratic instructions and annoying packing rules from whoever you're helping. And don't forget the years of guilt (on your part) and resentment (on theirs) if you happen to drop and break the heirloom vase or tear the vintage band poster.

5. Anticlimax: Feeling that sweaty exhausted pride of having finally moved every last box out of the old house...only to realize that you now have to completely reverse the process into the new one. Auuuuuuuugggghhh! Really makes you start to reconsider minimalism as a serious way of life.

On Time

Note: This isn't, in fact, a posting about "being on time". This is, instead, a posting On Time, about Being.

The Future: Driving on a highway recently, I came upon a car crash that had apparently just occurred on the other side of the divider. Paramedics hadn't yet arrived, one car was still sitting in its tracks spitting smoke, and there was only a short lull in the flow of cars on my side. But as I slowed down dutifully alongside the crash to pay my rubbernecking respects, then sped off into the distance, I had a strange sensation. I had just seen into the future. For a good mile behind the accident, the southbound highway was a parking lot, cars strung end to end like an automotive necklace, packed tightly onto a long chain of asphalt. I wondered if these drivers wondered what had happened. I was tempted to open the window and shout "car crash!" to them as I passed, so they would know what to expect. Then, several minutes further down the road, the bumper to bumper gradually thinned out, and soon traffic was zooming along just as efficiently on their side as mine. That's when I really got a pang of schadenfreude, chase quickly by a pang of guilt. Boy, if they only knew what they were in for, I thought to myself. I imagined the driver of that white mazdat talking on his cell as he whooshed past me: sure honey, I'll be home in 20 minutes, the parkway's clear as a bell, no traffic in sight... little did he know that in just about 83 seconds he was going to go from 60 to 0. I felt a bit like Merlin. Except without the cool wizard's hat. and wand. and beard.

The Present: I think about death more than someone in their hopeful, virile twenties should. What if today was the last day? But this still has people all caught up in thinking about what they would have done in the future, or what they should forgive or forget from the past. Our lives are still in the way. But now on the newborn ICU. Biking up the hill at sunset, seeing night descend on the modern village of New Haven. Thinking that somewhere around, a person probably took their last breath today. But someone also took their first breath. What if it was both? There are babies who don't make it to day 2 of life. They only live one day. What if today was your only day to live? No past, no future. Just today. No expectations for what things should be like, what they used to be like, what they could be like if they were different. Just this moment, and whatever this moment would bring.

The Past: Last weekend, at a hippie coffee shop in PA with my mom and her friends, I had a craving for apple strudel. Given that there was a woven basket full of saran wrapped pieces of homemade apple strudel at the counter of this hippie coffee shop, it is most likely that my craving was contextually, and not neurologically, induced. Nevertheless, I chose to say yes to the craving (because it's not everyday that one gets the pleasure of an apple strudel craving, let alone the even greater pleasure of the apple strudel itself--can you tell I love saying 'apple strudel'?). I found the others sitting around one of the coffee tables (why aren't there more conventional coffee tables in coffee shops? or more coffee table books? hmm), so I joined them and proceeded to carefully unwrap my strudel. Of course, as I did this I was struck with the memory of the first (and only) time I made apple strudel by hand, a great many years ago, at home on my kitchen table. So of course, I began to tell the group about it. All I remembered was rolling out the dough so thin it filled the entire table and nearly hung over the sides. So as I was retelling this anecdote to my little audience, I said just that, and then I said, and the funniest part was that the cats came over and started batting at the dough hanging off the sides of the table, as if it was a little animal. I knew this would get a laugh from the crowd, and it did...but I also knew, as soon as I thought of this detail, that it hadn't actually happened. At least, I don't actually remember it happening, though I suppose it might have if I have some memory for it. Point being, I just altered my memory of the past, but seemed to improve it instead of degrading it. I guess you could say I upgraded my memory to a more storytellable format.