Tuesday, December 4, 2012
Cancer is a disease of a healthy population. That seems counterintuitive, but its true. Without considering childhood cancers caused by inherited genetic instability, cancer can only invade a population that is healthy enough to live long enough to acquire it. Millions of base pairs get replicated each day, some incorrectly, and these genetic mutations sometimes go unfixed. Unfixed and persistent genetic mutations eventually lead to other genetic mutations, which eventually mutate something required to keep cell growth in check, and boom, unregulated cell growth. Cancer.
I work in a stem cell transplant unit. Some of the very sickest people come to my ward. Those who are about to receive a transplant, those who have just received one, and those dealing with the complications from one. Despite our best efforts, survival rates for cancer as a disease class have not significantly improved since the "War on Cancer" was declared in the 1960's. Sure, there are some cancers that have excellent survival rates and that, for all intents and purposes, we really can just "fix," but these are the exception rather than the norm.
I hate to be all depressing, and I'm sorry I'm not citing my work, but the main point of this post is not to discuss cancer, but to discuss clinical detachment. That magical protective barrier that clinicians build around themselves in order to be able to do a good job for their patients without becoming emotionally involved.
I arrived on the ward after one of the ward favorites had just passed away. I don't think I ever even met her, except perhaps in passing. The next person who died was someone who arrived back on the ward after a brief stay in a nursing home. I was witness to her "code" and saw the flurry of activity that accompanies calling a code. I think I passed out barrier gowns and tried to stay out of the way. Se didn't pass that day, but sometime later, surrounded by her family. I did not cry or get upset.
There have been several people who have passed while I've been here, no one who was directly under my care at the time, but people that I helped care for, people whose names I knew. I felt detached from them and their situations. I certainly felt that their situation was unfortunate, but it wasn't my situation, and cancer, after all, is kind of a bitch.
But that emotional fortress I thought I was so cleverly hidden behind has cracks. I am not a stone, and I do sometimes become emotionally involved. The patient whose situation had me crying on the drive home last night is thankfully still with us today, although the case is complicated. There's a really wonderful spouse, there's an army of grandchildren, there's a whole life that occurred before this moment, before the word cancer changed a lot of things.
It wasn't the tears of the patient. It wasn't the pressure ulcers. It wasn't the sight of the grandkids even, really. I think it was the tears of the spouse. The patient is in pain. The patient is not perfectly lucid. The patient is asking the spouse to let them go, let them die. The spouse starts to cry. The aide at the bedside, usually so reserved, usually so much better at doing what must be necessary without emotion, is crying as well.
But vitals must be taken. Blood sugars recorded. Daily intakes and outputs collected. The ward must be rounded on. I cannot dally too long, but regardless of where else I went that night, I was still in that room, holding the patient's hand, getting the spouse blankets and pillows as the spouse prepared to stay the night.
I think it's harder when you see that someone loves them. We all assume that they have loved ones, but when you see it - day in and day out - the strain of caring for, and I mean really caring for, a sick loved one...the heavy bags under their eyes, the hand holding even while the other one is asleep...that's my weakness. I can too easily imagine myself in their place, can too readily imagine what they must feel.
Death is the final part of life, the inevitable end to this biological moment. For my patients, it is the end of suffering, the end of pain, the end of chemo. But for their loved ones it continues on. Life, suffering, memories. My empathy gets the best of me when it is their pain that I witness, and not the patient's. There is no cure for that, and I cannot help abate it.
Saturday, September 8, 2012
But that's neither here nor there. Here we're standing at the beginning of my actual senior year. At the end of this school year, I will finally graduate with my undergraduate degree(s). I decided that enough was enough and that I was ready to move on. It's kind of terrifyingly awesome because the next steps are actually rather cool.
I'm taking the MCAT in May. I signed up for a Kaplan course (and managed to negotiate a discount with them for my entire college...woot). I'm taking Physics 1 and Organic 2 with lab this semester. I'm also working in the lab 10 hours a week, participating in student government, shadowing doctors, and trying to find time to do the things I enjoy. I rediscovered some of my hobbies over the summer and decided that they need to be part of my life, regardless of what else is going on.
I also interviewed for and became the "final candidate" for a higher position at the hospital. It has far more patient contact (and actually counts towards patient contact, go figure!) and will give me the opportunity to confront death, dying, and survival in a much more immediate sense.
I am happy. I always wondered what you could do with your life if you didn't spend all your waking hours reading crap on the internet at a job you didn't like. Turns out you can do whatever you want with your life if you get all that time back.
Wednesday, May 23, 2012
I've been thinking about that whole message lately, and how it translates into my life and choices. There aren't any big plane rides that I have to take, any tables of roulette that I need to bet on... in essence, there aren't any lines of demarcation between making the "Big! Giant! Choice!" and the aftermath. For me, it's all a bunch of little chances that might translate into big changes.
The decision to go to med school was not met with a sudden change in my life, although it was toasted with much fanfare and congratulations. It was a big decision, admittedly, but the changes it mitigated were small ones. My class schedule filled up with science and math, my timeline to graduation lengthened, and I added a major to my ever-growing list of credentials.
However, looking at my life this morning, while walking to the lab, I was struck by how different it was from my life two years ago. Two years ago, I drove to a job I couldn't stand, to do work that was uninspiring, for people who didn't appreciate it. My days were an endless recreation of the one before, and while graduation was on the horizon, the changes it would bring would be minuscule to my day-to-day.
I had no idea what was going to happen, or if it did, it would be satisfying and worth all the work I had to go through to bring it into reality. Majoring in public service was something I did because it was easy - the classes were offered at night and on weekends, the subjects were not too challenging, and the work I would eventually be "qualified" to do wasn't that much different from the work I was already doing.
I had a happy life - don't get me wrong - but I didn't realize it at the time. I often felt that something was missing, that I had taken a wrong turn somewhere, and I felt a profound sense of loss for a life unlike the one I was living.
Fast forward to today. I'm about half-way through the pre-requisites for applying to medical school, I'm working on a summer research project funded by the National Institutes of Health, I'm a certified Emergency Medical Technician, and I'm working towards a more patient-centered position at the hospital in which I work.
These changes did not come about overnight or even relatively quickly. They were the conscious effort of many small decisions over a long period of time. I read somewhere that our "...futures are dependent upon today's behaviors and actions." I'm finding that statement to be far more relevant than "take a chance and never look back."
In addition to lengthening the timeline of change, it also lowers the stakes of each choice quite a bit. There are many choices that once made cannot be unmade and that forever change your destiny - but these choices are often the exception, not the rule. It is far more commonplace for there to be a series of choices that actually bring about the change we wish. This gives us a great deal more leeway with individual choices, and allows us to experiment and see how the individual choices impact our environments.
I think my basic point is that it's certainly fun to watch Rachel Berry get on a train and arrive in New York City, her life forever and instantly changed, but it's not very realistic. Alas, it's hard to celebrate the little changes at the moment when a choice is made, but maybe it's better to realize that a long time ago, in a land far away, I once made a choice... and that no matter how small or insignificant it seemed at the time, it set the stage for a whole host of other choices that would eventually bring me to today - and that today is a beautiful thing.
Friday, May 11, 2012
I've started looking at schools, it's actually rather enjoyable. Mr. Crazy has endorsed the plan to sail off into the sunset WITH me, which is actually a change from what I expected. So, between the two of us, we've been doing a lot of broad-strokes of rejection to potential schools - too far! too south! too west virginia!
In all seriousness, there's a lot to consider as I narrow down the list. I started by gathering all the schools in the surrounding states, and then knocked out any school more than 300 miles away from the 'burgh. Last October, I made a declaration that Family Crazy does not drive more than 300 miles, because longer than 6 hours in the car is insufferable.
The next thing I did was pull the rankings from the US News page, and start to rank schools into "safety/good shot/long shot" categories. The Student Doctor Network forums gave me another good list of things to consider - required lectures? Hospitals where clinicals are done? Hours spent in lecture? And other such assorted questions to consider.
I'm down to a list of about 22 different schools, spread all across the eastern seaboard, with a giant excel spreadsheet recording notable details. I figure this summer is a good time to narrow down the list, especially considering that I don't have to obsess over anything academic besides research.
Once I made the decision to go, the future has never been uncertain. For me, this is a certainty. But actually starting to think about where this is going to take place has given the dream a certain quality of realness that eclipses all other things I've done so far.
Well, I think my plasmid is done CIP'ing, so, off to purify some DNA...
Sunday, April 1, 2012
Monday, March 5, 2012
Monday, January 30, 2012
Thursday, January 26, 2012
Monday, January 23, 2012
So, this may come as a bit of a surprise to some people, but I can be a bit shy from time to time. Not, say, in everyday life or in normal circumstances that plague regular people, no. But in unfamiliar situations, well then yes.
Case in point: shadowing. I need/want to shadow some doctors. I'm not even picky, and I kind of want to shadow all different kinds. I work in a hospital that is chock full of doctors. This seems like it would be easy. Walk up to doctor, say 'hey, can I shadow you?', he says yes, boom, done.
But it isn't that easy for me. I mean, is that what you actually do? Is there a form that needs filled out? How do I get him to see me as a real person and not a stretcher-monkey? What if he says no? That's generally my biggest concern. If he says no then I will be embarassed every time I see him and will feel silly having asked.
Do doctors like having med school hopefulls following them around? Or is it annoying? I just don't know. So here we are. I'm swimming around in a sea full of the resource I need, but scared to take a sip.
Today I'm meeting with my med student mentor, so hopefully she has some insight into the process and maybe, just maybe, a little bit of what I like to call "the hookup". I mean, it couldn't hurt, right?