Med Lit 5038

I signed up for this elective in hopes of keeping my literary side alive. And maybe in hopes of starting a project or collaboration somewhere. Anyway, first assignment of the year, done:

Post an essay on Blackboard about a medical encounter, in which you tell about the same events from two different points of view. For example, Patient/doctor, patient/family member, medical student/family member, etc. You may structure the essay into two parts if you like.


Me:

St. Patrick’s Day, 11 PM. Anthony, my roommate, was next door pre-gaming with our buddies for an all-out St. Patty’s bash downtown. I was waking up and getting dressed for my rotation at St. David’s ER—the first rotation of my EMT clinical training. A required part of my uniform was a black fanny pack, which I wasn’t allowed to take off at any point during the rotation. I felt a bit self-conscious strapping it on before leaving the apartment.

The charge nurse on duty that night introduced himself as I came in and reported to the nurses’ station. Mike was a large man in his mid-30s, who had a vise-like handshake and sported various Celtic tattoos winding up and down his forearms. I saw his eyes shift to my fanny pack as he greeted me, and a faint smirk formed in the corner of his mouth. “You’re with Colleen tonight,” he said. “You can find her with her patient in room 30B.”

The woman in 30B was a narcotics addict. It was apparently not the first time she had been brought in for an overdose. Colleen waved me over as I came in. “You can help us hold her down while we get an IV in place,” she said. It was easier said than done—the woman was easily over 200 pounds and would not stay still long enough for anyone to place the needle in, not to mention the fact that her arms were already covered with needle tracks. Mike came barreling in after five minutes and began giving orders. Among them was an order for me to strap down the woman’s arm and hold it still with everything I had. I knew from the moment he came in that everything he said would be non-negotiable. With that in mind, I choked out any and all thinking and put my weight on the patient’s arm. After what seemed like an eternity of cursing and needle caps being thrown about the room, the IV was placed. The ER attending finally came in to give orders for oxygen and fluids, while everyone else funneled out.

Our next patient was an old man brought in for a heart attack, already intubated and stabilized by the paramedics. Colleen joined in with the other nurses as they wired him up with the usual mess of tubes—IV, Foley catheter, heart monitor, oxygen mask. Colleen handed me the ventilator bag and told me to hold on to it for a minute while she filled out some paperwork for the attending.

The night went on like that, patients coming in, getting tubes attached and then handed off to someone else. There wasn’t much time to ask questions or feel guilty about my detachment. I was a 6-foot, 180-pound pair of hands with a fanny pack and the word “dumbass” stamped across my forehead. Finally, at 6:30 AM, half an hour before my rotation ended, a technician found us and asked me to help with a patient. I followed her into the room, where a teary-eyed young woman was lying naked from the waist down on a bed, looking like she had been through a hellish night. A resident physician came in and explained the situation to us—the woman had a painful abscess in her lower groin region which needed to be drained and bandaged. Our job was to keep her calm during the procedure, and to make sure she didn’t move too much. She cried through the whole procedure as we clasped her hands in ours and told her it would be over soon.

Mike and Colleen smiled and waved to me from inside the double doors I walked out of the ER. I felt I could take some pride in Mike’s last words to me—“You’re going to do fine here.”—although I wasn’t sure how I had earned that. I left St. David’s just as the sun was coming up. Cars were beginning to line up for the freeway entrance, and coffee shops lining the streets were opening for business. It suddenly seemed strange that so many things could exist and function outside of the hospital.

Anthony was already up and making coffee by the time I walked in. I walked straight through the living room and threw off the fanny pack before stepping out onto the balcony and lighting a cigarette. Anthony came out with two cups of coffee, and we smoked and drank. “So how was it?” he asked. “Did you get to do anything cool?”

I thought back to my night, all the incoherent patients I met that I barely spoke a word to, people I strapped tubes and wires to, people I held down so nurses could start IV lines on, and finally the young woman whose hands I held as a doctor tore open a hole above her vagina. “No,” I said. “I didn’t do a damn thing.”



Mike:

Nobody ever wants the graveyard shift for St. Patty’s day—it’s usually just a shit-show. Most of our patients are always drunk, crazy, or incoherent in some other manner. I guess it was just my turn to bite the bullet this year.

The night starts out like any other. I get my coffee, look at the rotation list to see who’s on for the shift, and then look through the patient charts. An hour into my shift, Colleen tells me that there’s an EMT trainee coming in later for a rotation. “Alright,” I tell her. “You mind looking after him?” She gives me the ok, and not long after, I see him walk in through the double doors, wearing a buttoned uniform, complete with what looks like a fanny pack hanging off his waist. I can't help laughing to myself a bit. The kid looks eager but clueless. With his gangly frame and remnant traces of acne, he can hardly be over 19. He comes around to the nurses’ station and I let him know where to go. Colleen’s already with one of our regulars—a heroin addict that likes to steal meds from vet clinics and overdose from time to time. The kid shuffles on over while looking back at me, like he’s half uncertain whether Colleen’s actually in the room or if he’s about to walk in on some elaborate prank.

After about 10 minutes, I get buzzed to help out with our dope addict—no one can get a line started on her. I crack my knuckles and walk into the room to get things organized. First off, I need to get her to lay still and stop moving her arm. I give everyone a job and tell the kid to hold her arm down for me. I can tell he wants to say something, but he forgoes it, instead snapping on some gloves and jumping in. I get the line started and Dr. Ramirez arrives to take over. We can tell right away he’s in a bad mood, so nobody stays to chitchat that isn’t needed.

The rest of the night goes about how I expected. Drunk old men, some homeless schizophrenics, one or two heart attacks. Colleen and the kid seem to be seeing a lot of action—they barely get a moment to sit still for the next 8 hours. The kid’s expressions seem to sway between confused and frustrated, but he keeps doing what he’s told. No job seems too dirty or trivial for him to complain about, and I like that about him. The ER isn’t really the type of place where you can take a lot of time to process things in your head; people come through, we plug up their holes and make sure they’re breathing ok, then send them off to whoever is next in line to treat them. It’s a completely new experience for the kid, but he’s trying hard to get acclimated.

I give him a pat on the arm as Colleen finishes signing his paperwork at the end of the night. “Good job tonight,” I tell him. “You’re going to do fine here.”

We wave at him as he walks out, and then get back to our charts as the double doors close. An announcement blares again on the intercom: another ambulance arriving soon with a Tylenol overdose patient.

OBD, Ethics, and Ray Carver

The Author of Her Misfortune

-Ray Carver

I'm not the man she claims. But

this much is true: the past is

distant, a receding coastline,

and we're all in the same boat,

a scrim of rain over the sea-lanes.

Still, I wish she wouldn't keep on

saying those things about me!

Over the long course

everything but hope lets you go, then

even that loosens its grip.

There isn't enough of anything 

as long as we live. But at intervals

a sweetness appears and, given a chance,

prevails. It's true I'm happy now.

And it'd be nice if she 

could hold her tongue. Stop

hating me for being happy.

Blaming me for her life. I'm afraid

I'm mixed up in her mind

with someone else. A young man

of no character, living on dreams, 

who swore he'd love her forever.

One who gave her a ring, and a bracelet.

Who said, Come with me. You can trust me.

Things to that effect. I'm not that man.

She has me confused, as I said,

with someone else.

Week 2. OBD, or "On Becoming a Doctor," lectures are spaced in-between our hard sciences. They're a varied mixture of ethics discussions, clinical skills and applications, and introductory psych material. Today, for our ethics discussion groups, we read a short story published by a former faculty alum: Abraham Verghese, an infectious disease specialist who found his niche during the peak years of the HIV/AIDS epidemic in the early 90s. His patient in the story was Ed Maupin, an American working class homosexual brought in for a severe respiratory infection after developing AIDS. I read the story at 3 AM last night and tried to picture myself in Abraham Verghese's shoes for a moment, speaking to Ed's family of construction workers and his lover outside the hospital. Ambulances pulling up to make drop-offs, paramedics, agitated working class stiffs smoking in huddles on the curb, and one lone gay pariah sobbing amongst a gang of red-blooded Americans. 

We're not treating immortals, after all, he writes. And that, I think to myself...that's why I signed up for this whole thing in the first place. I'm here, finally, after 3 years of waiting and fixating, and this concept of mortality in the dregs of the world still seems tragic to me. 

So I started reading Raymond Carver again. Poet voice of the working class American drunk, died of lung cancer the year I was born. What strikes me over and over again about his work is how his staple theme of losing hope shows you this immensely vulnerable yet somehow redemptive existence that he's navigated for a lifetime. You read it a couple times over and after you get past the initial feeling of wanting to drink yourself into a stupor and then maybe contemplate slitting your wrists, you can't help but feel like he's got a real heartfelt longing to be a better man. And so, ladies and gentlemen--I give you blue-collar America at its finest: the tragic yet self-redeeming men and women I've dreamed of serving since my college days. Or really, blue-collar anywhere. Mortals and filter-feeding scum of the earth, I'll be honored to treat you one day.

"For the world is the world

And it writes no histories that end in love."

-Stephen Spender

(Tagline to Carver's poem)

The derivative of thursday with respect to drank is J Dilla and a G. Rap album

People aren't supposed to live like this. I watch Netflix until the crack of dawn, nap, wake up, nap again, write, nap, and teach some calculus to a kid 7 years younger and with twice as much potential as I ever had.

Thursday, I'm awake for once before noon, feeling my way down the freeway to Sugar Land. Enter my dented Honda Accord blaring Bone Thugs and Notorious BIG into the 'burbs, complete with automated gate and manicured lawns. It's like driving back into my adolescence.

So 20 minutes into explaining derivatives to Zach, I realize I'm basically winging the lesson of the day and grasping at straws when I try to prove the product rule of derivatives on a blank sheet of wide rule. Thankfully, FBISD still uses the same textbooks as they did 7 years ago--Appendix A saves the day. Bingo, twelve o'clock comes and I'm up another 50 bucks as I head to Yangtze with Matt for the $3.50 lunch special.

Matt and I hound the soup bucket for three rounds, then relocate to the organic tea house to work on summer projects and get a pint (of tea, mind you). A couple hours in, Matt's got sound effects lined up for his game production and I'm half-assing a track for some cut scenes, Peter calls up and mentions that it's "Ho Thursday" (our little joke about Cafe 101 happy hour). ("Yeah, it IS Ho Thursday.") One Ho Thursday later, we're in the car rolling around Hong Kong City Mall, honking (literally) through all the parking lots and looking for sushi.

When we finally make it home, I pass out for a bit and when I wake up, it's 1:44 AM. It occurs to me then that this, this was my day. Somewhere in the back of my mind, there's a voice saying stuff like "Don't y'all got anything better to do? Don't you have jobs?" But it's all drowned out by another voice doing a 2Pac impression, throwing up fake gang signs and yelling "THUG LYYYFE!!!"

So it's 3:45 AM, the world's asleep, I'm running J Dilla and G. Rap on my playlist, wondering about my next calculus lesson plan for Zach, and watching some video clips from my 25th birthday. I have to laugh as I watch Peter hobbling around the video in his crutches, Andy rocking out on my guitar singing Third-Eye Blind, my pneumonia meds sprawling across the coffee table. My thoughts stray back to New Orleans, and the future career doctor in me is incredulous at these memories. There's an overwhelming sense of guilty pleasure involved in all of this.

Life should not be this obnoxious.

Remember where you were when....?

It's 11 PM, I'm at a bar on Richmond with a pitcher of beer between my buddies, and Barack Obama is on the radio addressing the nation about Osama Bin Laden's death. Drunk customers are around us cheering and shouting slogans, and in the spirit of the moment, we drink to America at each refill.

I try to keep my mind away from the place it's headed, the place I know it'll end up when I finally make it home and there's no one but me and a bottle of scotch in my room. The night grinds on, Anthony and I talk about liver cancer, share a pack of smokes and shoot pool. In-between drinks, I sign on to facebook and check all the status messages blowing up across my friend list, "Osama is dead," "GW is karate kicking the air and shotgunning beers," "Thank you to our soldiers." Then I see your picture pop up in my news feed, E, and I have to wonder about the utter strangeness of the world.

Back home finally at 3 AM, I'm reading the New York Times, and the front page pictures slide across my screen in a bitter commemorative roll. Firefighters sitting in a row in Times Square, a midnight parade in DC, and then pictures of Bin Laden smiling and looking perfectly at peace with his lot. I'm wondering now about who he was as a boy, what his mother and father were like, whether there was an alternate and more simple life for him that didn't involve these last 10 years, and somehow I've wandered into what feels like sympathy. Hate leads us in circles, somehow vengeance doesn't feel just but neither does the alternative of inaction. How should we instead celebrate the moment?

Maybe I just need to go to bed. 

Microsoft Word, welcome to story time.

She was 19 when we met. I had just turned 28. Back in those days, I played a lot of Scrabble and listened to NPR every morning on the way to the work. Obama had won the election, and I was listening closely because I had a personal stake in healthcare reform—namely my insurance options.

This was it, I thought, one Monday morning. I had arrived to some vague plateau of achievement, and I had this to look forward to for the next couple of years. The feel of sliding into pressed khakis after my morning shower, the reliable sound of the NPR jingle at 7:45 on the dot in traffic, the smell of coffee as I walked into the office and greeted Pam and Brian. This was my time, I thought. Maybe not so much my time to bask or gloat over anything—I had never been a very smug person anyway—but it was an opportunity to enjoy comfort in my life. Yes. Comfort, I thought. That was when I almost ran her over.

The initial shock came and went as normally as it should have in an almost-accident type of situation. What lingered was my sense of infuriation—three cars stopped dead in the middle of the street to avoid hitting her, and she stood there looking more confused than apologetic. You ran out into the road during rush hour without looking for cars, idiot girl. What did you think would happen?

Her books had dropped out of her arm, and after finally realizing her situation, she quickly scooped them up and rushed off of the street. One book remained on the asphalt, however—Dancing in Odessa, by Ilya Kaminsky. It was slightly worn, but I recognized it right away. My friend Patrick had given it to me on my 22^nd birthday, right before he left for army boot camp. Ignoring the honks and revving engine sounds, I stepped out of my car to retrieve it. Her name was on the cover: Rose Madox.

I read it somewhere once

An article I read once that talked about writing, especially via internet mediums like blogs, said that the trick to selling yourself is to write about your obsessions, and to write about them in a compelling manner. So I wondered if I applied that to myself as of late, what my obsessions would be, in terms of the things that I'm constantly thinking about (though not necessarily always engaged in). Here's what I came up with, in no particular order: time, identity, responsibility, faith, women, alcohol, self-improvement, music, school. Going back and reading some of my old blog entries, I think I've spent a lot of my obsession quota on time and identity. So maybe I'll write about school tonight. The rest will come later. I think alcohol, women, faith and responsibility might come as a package deal in a big ranting post one night when I can't hold back the dam anymore.

My culminating exam is tomorrow. I swapped my thesis option with this so I wouldn't have to write up and present a research project in one semester. The capstone exam covers the five basic disciplines of public health and is basically the last hurdle before graduation. After 2 years of research and 1.5 years of coursework in public health, this is what it boils down to. I spent 2008-2011 completely immersed in public health (obsession: time, check.), for better or for worse. Now I'm a month from the finish line, and I barely care about school. If I pass my exam and graduate, that'll be good enough for me. Seems like the degrees you earn feel much less important by the time you earn them. What do you say after the fact? I am biology. I am public health. (obsession: identity, check.) But so what?

I should add that I'm not disillusioned/jaded/cynical/other synonym, i.e. I still believe in the benefits of public health, I still believe in the benefits of research, I still believe in academia. The difference is that I just care less and like sleep more than I used to. Given the option to turn in a stellar paper versus getting 3 extra hours of sleep and turning in something unimpressive...I'll take the sleep. Hell, I'll even take 1 hour. Why? Well because I'm tired, dammit. It's the reason I'm doing this right now instead of studying. Lately, I've kind of just been wishing my monday-thursday nights could be in front of the TV with an unhealthy snack, guilt free.

I've got about a month and a half of free time this summer before my life basically ends. I'm kind of thinking about just using my time to get fat. I've got the rest of my life to get in shape, right?

There was this one time in college....

.....I wrote a 12-page anthropology paper about black people and ebonics. Actually, to be more specific, it was about mixed white-black people and whether they used ebonics or not. For my "ethnographic research," I talked to mixed white-black college kids about football, Tupac, and how to make bongs. For my efforts, I got a 100 on the paper.

Last semester, I turned in my final Manual of Operating Procedures for my field epidemiology class with a joke in the budget section about my salary justification for being an MD/MPH/Ninja/Treasure Hunter/Exotic Chef/World Class Cowbell Musician/Flamenco Dancer. For my efforts, I got a reprimand and a dirty look from the professor for being unprofessional. I guess nobody thinks it's cute to be a clown in grad school. But if only...

When I first fell in love with the idea of being a doctor, I had my own idea of what it could potentially look like. It was somewhere between Patch Adams and MacGyver. There's still a part of me that wants to realize that crazy-ass and inappropriate, albeit completely genuine, vision I had. When it's 4 AM on a Wednesday night, that's when some part of my brain looks for a creative outlet and plugs in unabashedly, starts dreaming up wild nonsense that I want to latch onto and become completely serious about. 

You know what I could actually see happening? Someday using my kids as creative canvas. Trying to turn my son(s) into a Ninja/Treasure Hunter. Sure, creativity and outlandishness don't pay the bills, but they're fun as hell at a young age. I'll take him camping and make forts with him. Then when he's old enough, I'll drink with him and talk with him about women. Funny thing is, I didn't have any serious conversations about women with my own father until I had already graduated college. And the first talk, loosely translated, went something like this:

"Son, I know you're just screwing around right now. Just don't make it a habit. ....and don't tell your mom I said that."

That's my dad for you, I guess. Not exactly the deepest conversationalist, but always simple and straightforward. Complete opposite of who I am.

If I have a daughter, I'm screwed. If I have multiple daughters, I'm buying lots of guns when they turn 14. Maybe a battle axe or something too, hang it on the wall facing the doorway for any boys willing to lose their balls to take my girls on a date. But all that aside, they'll learn a thing or two about artsy crap. Music. Books.

And somewhere else along the way, all my kids will learn about strength and its variations. As much strength as I can give them. Strength so they can grow, outrageous passion so they can dream.