Sunday, September 10, 2006
Long time, no write
So, when last we left our hero, he was locked in a battle with the forces of evil bent on world domination. Thenceforth, having lost the battle and the war, our hero finds himself doing mere damage control. More on this later. For now, let it suffice that there is some poetry to offer the interested reader...
1. Dark Star
The unimaginable mass in his abdomen
Pushes mercilessly through his back
Passes instantly through the hospital bed
And sinks into the center of the earth
Pinning him in position
– a specimen in a collection
a great recumbent termite queen
a distended and humbled, Jabba the Hut
Ballooning
Pregnant like a blister
Without shame or irony
He tells me, “I try to drink a 12-pack a day.”
Do I hide my shock?
An awkward attempt at connection,
Or is it that I’m trying to surprise him
right back in the kisser
By predicting that he no longer gets a buzz
that some people drink like that
just to keep from getting the shakes,
“Yep, and so I won’t hallucinate like I did last Wednesday.”
In Labor –
ed breathing
We deliver him by
Caesarian invasion
crossing the Rubicon into his homeland
by “tapping his belly”
He is polite and grateful
Chatting easily about his
Interesting and lost career
Cause and Effect
Ascites fluid – Clear and golden
Streaming into sterile vacuum bottles
Produces a startlingly nice head,
Usually
We fastidiously capture his
Disturbingly milky elixir
Easy blame slips away
7 liters later
He breathes easier
While at the same moment
The other person in the room,
His dark star child
Begins to grow again
Inside his belly
2. On receiving the news that you have lost your nerve
In that moment, when the horror
Of an accidental workplace mutilation gets to you
You wish it just not-to-be, and to disappear from the situation
You do not want to watch this one; you are not fascinated
Between duty and revulsion, you are transfixed
Into the smallest of vector quantities
You stay and watch,
In secret shame and doubt
You gave up everything to become a doctor
After monstrous suturing
The replants remain cold and dusky
You have no hope they will survive
What are you going to do now?
3. Peds Onc Consult
It’s late, on-call-tired
we dash into a third floor room
for a cross-cover page
as always both ceiling-mounted TVs are on
tuned to separate channels
we whisk past a preoccupied mother
the boy standing there with those foreboding
sparse wisps of hair
infused with too many lines
running from as many IV bags
hanging starkly on a wheeled pole
we round a curtain to find
a squad of posed action-figures
resolutely standing guard
strategically placed by their leader
to ward off evil spirits
slumped rag-doll side-ways
a pale, pale, thin boy
with dark-crusted, cracked lips
blood slowly seeping from purple little bumps here and there
The shiner he sports
you wish
was from getting punched
but it’s not, it’s
from the rock-bottom platelet count
from the cancer
from the treatment
from the chromosome
from the mutation
from the virus
that wriggled and jiggled and wiggled inside him
the mom calmly consents to the platelet transfusion
which along with everything else tried through the night
will not save him from bleeding out
even till morning
4. Beasts of Burden
Sitting waiting for my pizza order
to be ready for pick-up
a woman my mother's age
comes in to place her order
her accent beckons
with the promise of a story
I chatted her up
She was from the mining districts in the south of Wales
we remarked on the recent mining disasters in West Virginia
I shared that my great-grandfather was killed in a mining accident in Indiana
At the turn of the last century
She then told me about the husband of a friend
who had grown weary of the hardness of the pits
and had gained a transfer to the relative safety of the top
within months he was pining for the grime and darkness
He found his way back down again
by becoming a pony driver
and spent 20 years
hauling carts of coal
According to tradition
once down in the pits
blinded by the stygian darkness and the coal dust
the ponies never left the pits alive
I told her how it reminded me of the K-9s
I handled in the Marine Corps
once the dogs are trained to attack
by the United States Government
they are doomed to live out their days
langushing in kennels
never again to know civilian comfort
coming out only for training or work
When one of our dogs
became too old, too arthritic, too hip-dysplastic
to actually fulfill their purpose
we would fudge, and white-lie and cover-up
to steal them another few, hard months
in our limited, awkward care
before their bureaucratic
euthanasia was eventually carried out
according to regulations
My pizzas ready,
I said good-bye to her
and as I got into my car I wondered
whether we are not too terribly different
from the Pit Ponies and Military Working Dogs
That once we enter into our labor
leaving our houses at zero-dark:thirty
leaving the hospital well past sundown, even in summer
6 -7 days-a-week, week after week
are we also doomed
never again to see the light of day?
or to know the comforts of home?
1. Dark Star
The unimaginable mass in his abdomen
Pushes mercilessly through his back
Passes instantly through the hospital bed
And sinks into the center of the earth
Pinning him in position
– a specimen in a collection
a great recumbent termite queen
a distended and humbled, Jabba the Hut
Ballooning
Pregnant like a blister
Without shame or irony
He tells me, “I try to drink a 12-pack a day.”
Do I hide my shock?
An awkward attempt at connection,
Or is it that I’m trying to surprise him
right back in the kisser
By predicting that he no longer gets a buzz
that some people drink like that
just to keep from getting the shakes,
“Yep, and so I won’t hallucinate like I did last Wednesday.”
In Labor –
ed breathing
We deliver him by
Caesarian invasion
crossing the Rubicon into his homeland
by “tapping his belly”
He is polite and grateful
Chatting easily about his
Interesting and lost career
Cause and Effect
Ascites fluid – Clear and golden
Streaming into sterile vacuum bottles
Produces a startlingly nice head,
Usually
We fastidiously capture his
Disturbingly milky elixir
Easy blame slips away
7 liters later
He breathes easier
While at the same moment
The other person in the room,
His dark star child
Begins to grow again
Inside his belly
2. On receiving the news that you have lost your nerve
In that moment, when the horror
Of an accidental workplace mutilation gets to you
You wish it just not-to-be, and to disappear from the situation
You do not want to watch this one; you are not fascinated
Between duty and revulsion, you are transfixed
Into the smallest of vector quantities
You stay and watch,
In secret shame and doubt
You gave up everything to become a doctor
After monstrous suturing
The replants remain cold and dusky
You have no hope they will survive
What are you going to do now?
3. Peds Onc Consult
It’s late, on-call-tired
we dash into a third floor room
for a cross-cover page
as always both ceiling-mounted TVs are on
tuned to separate channels
we whisk past a preoccupied mother
the boy standing there with those foreboding
sparse wisps of hair
infused with too many lines
running from as many IV bags
hanging starkly on a wheeled pole
we round a curtain to find
a squad of posed action-figures
resolutely standing guard
strategically placed by their leader
to ward off evil spirits
slumped rag-doll side-ways
a pale, pale, thin boy
with dark-crusted, cracked lips
blood slowly seeping from purple little bumps here and there
The shiner he sports
you wish
was from getting punched
but it’s not, it’s
from the rock-bottom platelet count
from the cancer
from the treatment
from the chromosome
from the mutation
from the virus
that wriggled and jiggled and wiggled inside him
the mom calmly consents to the platelet transfusion
which along with everything else tried through the night
will not save him from bleeding out
even till morning
4. Beasts of Burden
Sitting waiting for my pizza order
to be ready for pick-up
a woman my mother's age
comes in to place her order
her accent beckons
with the promise of a story
I chatted her up
She was from the mining districts in the south of Wales
we remarked on the recent mining disasters in West Virginia
I shared that my great-grandfather was killed in a mining accident in Indiana
At the turn of the last century
She then told me about the husband of a friend
who had grown weary of the hardness of the pits
and had gained a transfer to the relative safety of the top
within months he was pining for the grime and darkness
He found his way back down again
by becoming a pony driver
and spent 20 years
hauling carts of coal
According to tradition
once down in the pits
blinded by the stygian darkness and the coal dust
the ponies never left the pits alive
I told her how it reminded me of the K-9s
I handled in the Marine Corps
once the dogs are trained to attack
by the United States Government
they are doomed to live out their days
langushing in kennels
never again to know civilian comfort
coming out only for training or work
When one of our dogs
became too old, too arthritic, too hip-dysplastic
to actually fulfill their purpose
we would fudge, and white-lie and cover-up
to steal them another few, hard months
in our limited, awkward care
before their bureaucratic
euthanasia was eventually carried out
according to regulations
My pizzas ready,
I said good-bye to her
and as I got into my car I wondered
whether we are not too terribly different
from the Pit Ponies and Military Working Dogs
That once we enter into our labor
leaving our houses at zero-dark:thirty
leaving the hospital well past sundown, even in summer
6 -7 days-a-week, week after week
are we also doomed
never again to see the light of day?
or to know the comforts of home?
Thursday, July 01, 2004
Denial is an amazing thing
I talked my way into tagging along on weekend morning rounds on the family medicine service. I sit in on sign-out from the night float; the residents are very nice, but astonished that I'm doing this voluntarily. The clerkship director is attending (faculty rotates this gig). I'm trying to follow along, but still don't have normal labs memorized, etc. There are a couple cases that sound interesting, Asperger's adult with pneumonia; pulmonary fibrosis; liver failure; and a man with a sarcoma in his arm that needs amputating, but he doesn't believe he has cancer. The pathology report from a doctor visit back home read in Spanish, "sarcoma..." but hand-written on the same page was, "No Cancer." He believes the latter.
Sign-out's over; the residents go their ways (home and I don't know where). I ask the attending if I can follow her on rounds; she agrees. I see some patients, listen to some chests, and ask a tentative question or two.
I ask about the patient with the cancer and is there any way to save his arm. She says, "Wait till you see this guy's elbow!" She knocks on a patient room door and walks in; I look at his arms, and I don't see anything. I try to see something, so as not to look stupid. She speaks to the patient in Spanish and I'm not listening - I'm looking; still nothing to my eyes. She's leaving; I spin around to follow, disoriented. "Wrong room; they moved the patient. We'll have to track him down."
She finds his room from his chart at the nurse's station. She knocks; we enter. There's a middle-aged man seated right there by the door, calmly watching T.V. His left arm is wrapped in a chuck. This is the right guy. The attending starts speaking in Spanish. This time I'm listening. I'm internally embarrassed because I'm surprised by the fact that her accent is very good and she's very fluent; who the Hell am I to not expect such competence!
She is nonchalantly asking him how he's feeling. He's fine. How about the arm? It's fine. Anyway, it's time to take a look. Once unwrapped, there's what looks like a large lump of coal as big as my fist sticking out of a ragged, swollen, draining socket in the flesh of this guy's lateral left brachium just a little proximal to his elbow. He does not seem phased by the meteorite sticking out of his arm. I like to think that I contained my shock, while I concentrated on following their ping-pong match conversation. She is nonchalantly telling him that the thing on his arm is cancer. He just as nonchalantly says that it's not. She tells him that they will need to amputate his arm above the wound. He acts like he has never heard of such a notion and that it isn't that serious. This guy is cool as a cucumber.
We don gloves and palpate the skin adjacent the sarcoma. The skin is hard and hot. He doesn't seem to feel any discomfort. She tells him she believes that this is very serious. He is unswayed, but respectful; he even seems a little concerned for our unnecessary worry. We say our good-byes.
We leave. She tells me that he is told that it is cancer multiple times a day and that he calmly, but consistently denies it. A routine biopsy is down at pathology. Hopefully, he can see the "new" results from this report. But, who knows? Of course, you think of a psychiatry liaison consult. That's been tried. In his case, it's pure psychological denial, just like Uncle Sigmund said, about 100 years ago; meds don't work very well on stuff like that. I am astonished at a workingman's need not to be deathly ill and to keep his arms (his life), at all costs.
Sign-out's over; the residents go their ways (home and I don't know where). I ask the attending if I can follow her on rounds; she agrees. I see some patients, listen to some chests, and ask a tentative question or two.
I ask about the patient with the cancer and is there any way to save his arm. She says, "Wait till you see this guy's elbow!" She knocks on a patient room door and walks in; I look at his arms, and I don't see anything. I try to see something, so as not to look stupid. She speaks to the patient in Spanish and I'm not listening - I'm looking; still nothing to my eyes. She's leaving; I spin around to follow, disoriented. "Wrong room; they moved the patient. We'll have to track him down."
She finds his room from his chart at the nurse's station. She knocks; we enter. There's a middle-aged man seated right there by the door, calmly watching T.V. His left arm is wrapped in a chuck. This is the right guy. The attending starts speaking in Spanish. This time I'm listening. I'm internally embarrassed because I'm surprised by the fact that her accent is very good and she's very fluent; who the Hell am I to not expect such competence!
She is nonchalantly asking him how he's feeling. He's fine. How about the arm? It's fine. Anyway, it's time to take a look. Once unwrapped, there's what looks like a large lump of coal as big as my fist sticking out of a ragged, swollen, draining socket in the flesh of this guy's lateral left brachium just a little proximal to his elbow. He does not seem phased by the meteorite sticking out of his arm. I like to think that I contained my shock, while I concentrated on following their ping-pong match conversation. She is nonchalantly telling him that the thing on his arm is cancer. He just as nonchalantly says that it's not. She tells him that they will need to amputate his arm above the wound. He acts like he has never heard of such a notion and that it isn't that serious. This guy is cool as a cucumber.
We don gloves and palpate the skin adjacent the sarcoma. The skin is hard and hot. He doesn't seem to feel any discomfort. She tells him she believes that this is very serious. He is unswayed, but respectful; he even seems a little concerned for our unnecessary worry. We say our good-byes.
We leave. She tells me that he is told that it is cancer multiple times a day and that he calmly, but consistently denies it. A routine biopsy is down at pathology. Hopefully, he can see the "new" results from this report. But, who knows? Of course, you think of a psychiatry liaison consult. That's been tried. In his case, it's pure psychological denial, just like Uncle Sigmund said, about 100 years ago; meds don't work very well on stuff like that. I am astonished at a workingman's need not to be deathly ill and to keep his arms (his life), at all costs.
Wednesday, June 30, 2004
McMed School Full of Sociopaths?
Towards the end of my first year, I experienced one too many shopping-cart-left-in-the-middle-of-a-parking-stall-type incidents (done because you're bags are in the car, you're leaving and are not currently looking for a parking space, somebody else [one of the servants] will move it, and nobody's going to confront/punish you. A primitive ethic derived from a superficial/punishment-avoidance/pleasure-seeking/play-everything-on-the-margins paradigm, as opposed to a more developed/civilized/meta-cognitive/greater-good paradigm) with my class mates, which led to the following rant:
Uncle Reemus tells a story where acting out on one's outrage can get one completely stuck in a tarry trap. My writing this is an attempt to get a little clearer about all of this, and not just haul off and punch the "Tar Baby."
That being said, I, naively enough perhaps, bought a bill of goods labelled "ethics" all over. Well, I'm here and I feel instead like I'm working in the Enron Accounting Department in the late 90's. At-large, everything seems like a cynical game; there doesn't appear to be a commonly held notion of voluntary, intelligent activity for the greater good; and it appears that service that doesn't get you something - C.V./Dean's letter entry, a letter of recommendation, etc. is for "suckers;" if no one's looking some will just take the copy of the past test from the copy room rather than make a copy for the next person; classmates take semi-guarded stuff even if someone is looking with incredible gall (mostly food intended for event attendees, or worse food for interviewees away from home); Medical Ethics as a course is openly held in contempt; etc.
My attribution is that the average medical student is a selfish, entitled, disingenuous, corner-cutter. My main concern is that if they indulge themselves to limited resources set aside for the vulnerable, e.g., take food for traveling interviewees, what stops these same people from talking patients into unneeded proceedures, abandoning them, or copping a little feel. If poeple don't have the equipment to refrain from minor unethical behavior with small rewards, what makes anyone think the same people have the equipment to refrain from unethical behavior with larger rewards?!
I am aware of the peer review apparatus; I have just submitted my first concern and I'll see how the process works in pratice. I have watched these phenomena wanting them to be isolated, aberrant anomolies. I didn't submit any of the unethical incidents I witnessed, while I took in the lay of the land. The creepy part is since nothing has changed for the better, I suspect virtually no one else has either. I have a growing sense that the collective process has been to allow, by degrees, the lowest common denominator to plumb the depths of the outrageous, while the group normalizes the sub-standard, and then no one seems sure if any particular outrage before their eyes is really outrageous enough to report - a very slippery slope. And if you do report will you be dismissed as a whiney prude at best, or a "rat" at worst for reporting a "normal" behavior?
A complication in my discernment and subsequent activity is that I come from a military background. And while there are problems brewing at all times, everywhere in the military, they tend occur in pockets, often hidden from view. However, military types won't put up with their boss lacking integrity - makes for the led becoming cannon fodder for a crooked, careerist boss, and everyone knows it. When subordinates figure out their leader is not to be trusted, the train comes to a surprizing, abrupt halt, and the offical processes of bypassing the chain-of-command are activated. When in doubt, people get administratively relieved of duty; military justice issues are a little trickier. When a boss finds out a subordinate is crooked, action is usually swift; if not, the boss who doesn't act is at grave risk of "going down" too. For instance, while I could be wrong on this one, I am fairly certain that many more heads, than the press will ever know about, have and will roll over the Abu Ghraib scandal. I struggle with having lived with what seem like noble standards that are just too high for the civilian context. And so, I often second-guess my attributions as contextually inappropriate.
For over 10 years, I have been acculturating to the seedier, "real" world. However, to my mind, the physician vocation has similarities to the military vocation at the wider, cultural level. The vocation is imbued with status, perrogatives and power along with reciprocal trust, expectations and responsibilities. Yet, I am aghast at the collective ethic of my peers. It seems like the game is get the goodies, and if one absolutely has to, then make minimum token gestures at the reciprocities, but get the goodies at all costs, before someone else beats you to it - very late Roman Empire.
Police departments psychologically screen applicants for sociopathy, etc. If the profession is at-risk, as it seems to be, is there a prohibitive risk-benefit ratio of instituting a similar apparatus for medical school applicants?
Did I join the wrong club? I am at a loss as to how to negotiate what appears, at least to my eyes, at present, to be a disappointing sham.
Uncle Reemus tells a story where acting out on one's outrage can get one completely stuck in a tarry trap. My writing this is an attempt to get a little clearer about all of this, and not just haul off and punch the "Tar Baby."
That being said, I, naively enough perhaps, bought a bill of goods labelled "ethics" all over. Well, I'm here and I feel instead like I'm working in the Enron Accounting Department in the late 90's. At-large, everything seems like a cynical game; there doesn't appear to be a commonly held notion of voluntary, intelligent activity for the greater good; and it appears that service that doesn't get you something - C.V./Dean's letter entry, a letter of recommendation, etc. is for "suckers;" if no one's looking some will just take the copy of the past test from the copy room rather than make a copy for the next person; classmates take semi-guarded stuff even if someone is looking with incredible gall (mostly food intended for event attendees, or worse food for interviewees away from home); Medical Ethics as a course is openly held in contempt; etc.
My attribution is that the average medical student is a selfish, entitled, disingenuous, corner-cutter. My main concern is that if they indulge themselves to limited resources set aside for the vulnerable, e.g., take food for traveling interviewees, what stops these same people from talking patients into unneeded proceedures, abandoning them, or copping a little feel. If poeple don't have the equipment to refrain from minor unethical behavior with small rewards, what makes anyone think the same people have the equipment to refrain from unethical behavior with larger rewards?!
I am aware of the peer review apparatus; I have just submitted my first concern and I'll see how the process works in pratice. I have watched these phenomena wanting them to be isolated, aberrant anomolies. I didn't submit any of the unethical incidents I witnessed, while I took in the lay of the land. The creepy part is since nothing has changed for the better, I suspect virtually no one else has either. I have a growing sense that the collective process has been to allow, by degrees, the lowest common denominator to plumb the depths of the outrageous, while the group normalizes the sub-standard, and then no one seems sure if any particular outrage before their eyes is really outrageous enough to report - a very slippery slope. And if you do report will you be dismissed as a whiney prude at best, or a "rat" at worst for reporting a "normal" behavior?
A complication in my discernment and subsequent activity is that I come from a military background. And while there are problems brewing at all times, everywhere in the military, they tend occur in pockets, often hidden from view. However, military types won't put up with their boss lacking integrity - makes for the led becoming cannon fodder for a crooked, careerist boss, and everyone knows it. When subordinates figure out their leader is not to be trusted, the train comes to a surprizing, abrupt halt, and the offical processes of bypassing the chain-of-command are activated. When in doubt, people get administratively relieved of duty; military justice issues are a little trickier. When a boss finds out a subordinate is crooked, action is usually swift; if not, the boss who doesn't act is at grave risk of "going down" too. For instance, while I could be wrong on this one, I am fairly certain that many more heads, than the press will ever know about, have and will roll over the Abu Ghraib scandal. I struggle with having lived with what seem like noble standards that are just too high for the civilian context. And so, I often second-guess my attributions as contextually inappropriate.
For over 10 years, I have been acculturating to the seedier, "real" world. However, to my mind, the physician vocation has similarities to the military vocation at the wider, cultural level. The vocation is imbued with status, perrogatives and power along with reciprocal trust, expectations and responsibilities. Yet, I am aghast at the collective ethic of my peers. It seems like the game is get the goodies, and if one absolutely has to, then make minimum token gestures at the reciprocities, but get the goodies at all costs, before someone else beats you to it - very late Roman Empire.
Police departments psychologically screen applicants for sociopathy, etc. If the profession is at-risk, as it seems to be, is there a prohibitive risk-benefit ratio of instituting a similar apparatus for medical school applicants?
Did I join the wrong club? I am at a loss as to how to negotiate what appears, at least to my eyes, at present, to be a disappointing sham.
I wanna play, too!
So, my narcissism has gotten the best of me. I fancy myself having the insight, discpline and time to blog about my experiences as a med student. We shall see. I am older than most med students and have seen and done many things before embarking on this quest. I volunteered for this, but I am fairly disappointed in what I see around me. So, the themes I anticipate emerging are disappointment and disillusionment. Hopefully, in this process, I'll be able to withdraw my projections, own my Shadow, and make peace with a process of, by, and for people.
