The Importance of Caring

Several days ago I came across this article, The foundation of medicine is care. Like many words in healthcare, "care" has become overused (right up there with "professionalism"). What does it even mean anymore?

We adhere to standards of care - the set of questions, actions, labs, imaging, etc that we do to diagnose a patient's problems and provide adequate treatment. We provide care to patients, to help them when they request it of us. None of this necessitates that we care about our patients. As the article argues (and I agree), this last kind of care is the most important.

Today, a distraught parent explained her daughter's "history of present illness" to the physician I am working with this week. In trying to get an accurate picture of her daughter's current illness, he asked the mom question after question to make sure he had the story right. The mom got frustrated because she's had to explain the whole thing for who knows how many times and she felt like he wasn't listening - such is the perils of an academic teaching hospital, you must tell the same story at least 3 times (and often more). The mom became so frustrated that she broke down. She was the first person I met who said how horrible this hospital was, how no one seemed to care enough to get the story right or talk to each other so that everyone's on the same page. She's not entirely wrong. Our hospital system is set up in a rather fragmented way. We provide the same standard of care (if not better) than most other hospitals, we provide good care for our patients. But we, as a system, didn't care about the patient.

Inpatient medicine is very different from outpatient medicine. In the outpatient setting, I felt that every physician actually cared for his/her patients on a personal level. I had a . . . heated discussion with my roommate about a month back. He asked me why I cared so much, why I get so worked up over a patient encounter. Really, I couldn't help it. By actually caring about my patients, not just for them, I feel like I am able to do more and am willing to try harder for them.

He didn't share my same views. For him, once he met the standard of care, he need not go further. If he couldn't get a patient to comply, then he is perfectly satisfied to give up and walk away from the situation. While in some scenarios this is indeed the correct course of action, I felt that it would be a disservice to our patients if we gave up every time they gave us even the slightest hint of grief.

Anyway, just some thoughts.

Privilege & Entitlement

"The moral test of government is how it treats those who are in the dawn of life, the children; those who are at the twilight of life, the aged; and those in the shadow of life, the sick, the needy, and the handicapped."

I came across that quote in this article, Addressing the needs of the disadvantaged in our health system. The words themselves struck me and the article is well worth a read (it's by a med student).

I linked that article to a friend and she shot it down as overly idealistic because people will find a way to take advantage of and manipulate the system. Then people will begin to feel entitled to the help from the government and stop trying as hard to pull themselves out of whatever situation they find themselves in. The public health aspect of me balked. She turned it back on me and remarked that I probably felt more entitled than her, and that her boyfriend almost certainly feels more entitled than either of us. I was confused. She stated that I must feel entitled to be paired with good physicians as my clinical teachers and that I expect certain things to happen or else. I was taken aback. This then became a philosophical discourse of sorts.

I have never really felt entitled to much past high school. I learned very quickly that things in life must, more often than not, be earned. I have never felt a sense of entitlement in med school. Whether or not I am paired with a good physician or not is purely luck (that said, I've been pretty lucky lately).

Every moment I have time to give pause I am filled by a sense of privilege. Truly, being a doctor is a privilege and one of the highest out there. In how many other professions can you ask someone to take off their clothes and allow you to touch them in ways that would otherwise get you arrested? In how many other professions will someone come to you and ask you to cut them open and do what you will inside them without getting sent to jail? In how many other professions can you ask someone about the whole "sex, drugs, and rock-and-roll" without getting them arrested?

I am aware that every time I walk into a patient room, I have mere seconds to earn their trust. It's an interaction that takes place within a few seconds' time, but it is so critical. With adults, this is an introduction and a shaking of hands. With kids, this is more subtle but can be sensed by the look in their eyes (and whether they give you a high-five or fist-pound). With newborns, it's a settling back into a calm. I am motivated by a sense of awe for the practice of medicine. For patients to allow me to listen to their stories, to examine them physically, to place trust in my words (as a M3 med student), to consent to have me assist in their surgeries and be elbow deep into their abdomens - I'm not sure words can express the sense of gratitude and privilege one can feel.

Unfortunately for many of my peers, the rigors of the training and the complexities of the patients out of our control have jaded them. To quote Dr. Walcott in the movie, Patch Adams:

"Our job is to rigorously and ruthlessly train the humanity out of you and make you into something better. We're gonna make doctors out of you."

In a profession that deals with humanity, how have we allowed it to smother out our own humanity? It's a curious thing. I would be lying if I said I haven't had my moments when I wondered why I even bother to help some patients, knowing that they will not or cannot help themselves. I would be lying if I said I haven't ever been pissed at a patient when things took a turn for the worst.

But thinking back to WHY I'm here in the first place brings me around full circle and sustains me. Everyone has a reason for going to med school, some of them better and nobler than others. I believe those who hold onto their reasons and do not lose sight of it are best able to make it through without become (as) jaded.

Well, this post has been rather long and I'm not sure it makes a whole lot of sense. I'll have more to say after my exam on Monday. Eep!

Happy New Year 2012!

Hey everyone, Happy New Year 2012! I know I'm a day late, blah blah blah, but Happy New Year nonetheless. May 2012 be fulfilling and rewarding; and for those of you who had a crappy 2011, may 2012 be much much better.

Already at least one blogger started 2012 off on a bad foot. Please go over to Landyn's blog, Stuck In The Middle, and offer him your best wishes and any help you may be able to provide. He's in a really bad spot right now and could use our support.
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On a completely 180-degree note, I've got more answers to questions from Well I gotta say, Being gay is . . . (now re-named to "Normally Gay").

1. What is your favorite trait about yourself? It can be physical or character-wise.
Hmm, a tough one. My best character trait is that I'm extremely hardworking and dedicated when I need to be, sometimes almost to a fault. My best physical trait . . . my eyebrows I guess?

2. Describe your perfect man.
This is a tad tough, haha. Originally I had separated this into 2 categories: "requirements" and "pluses." Then I came to the realization that I could give a little more on the requirements and some of the pluses are really more important. So here's just a laundry list below (in no particular order, and the question did specify "perfect" man, after all):

- Beautiful eyes. I find eyes really attractive. The color isn't important, though I find green and hazel eyes particularly mesmerizing.
- Cute face with a cute smile. This is very subjective and no one face fits this description. It may be a clean-shaven face on one guy or with stubbles on another, it just depends.
- Reasonably in shape. Not too thin, not fat (a little overweight is fine), is pretty toned, not too muscle-y.
- Height -2 inches to +6 inches from my height. That'd give a range of about 5'5" to 6'1".
- Age -6 to +6 from my age. That'd give a range of 19 to 31.
- Non-smoker, non-alcoholic, non-drug user. This really is a deal-breaker. Though, I could make an exception for very occasional marijuana use . . .
- Intelligent and can hold a decent conversation. Now, I don't need a doctor or someone with a PhD (pluses though that may be, haha), but an undergrad education is pretty much a must.
- Someone who can consistently get me to smile and do things I otherwise might be hesitant to do. Really, I need someone who can put me at ease when I get too tense.
- Someone who is honest, loyal, keeps promises, and likes to cuddle.
- Is a good cook. Food is definitely one route to my heart, lol.
- Plays a musical instrument and/or speaks a foreign language.
- Likes to travel.
- Is fairly neat & organized. I flit back and forth between being a neat freak and OCD organized and somewhat lax about it all. But I don't want to clean up after a slob.
- Has an "average" to "slightly above average" dick size. That'd give a range of about 5" to 7" or so. Also, not so thick that I'd choke.
- Is uncircumcised. Honestly this is pretty low down, but it is a plus.

3. Last song you listened to?
It'd probably be this: "How to Save a Life" (with Alex Goot)


Before that, it'd be this song: Gravity - by Jason Chan.

4. Favorite thing which is green?
Until recently I would've said my 2 philodendron plants. But I recently-ish bought an "olive green" messenger bag that I really like. :-)

5. Would you ever participate in an orgy?
Umm, no. Three-way, probably.

Answers!

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Mask of Loneliness

Loneliness by *MikaTrta on deviantART

Of all the ways to express loneliness, why have I chosen a picture of the empty park bench above? The world around it is bright and sunny, the trees and grass a luscious green, people and life moving about in the background. Precisely because it's the kind of loneliness I'm experiencing . . . and have been all along.

That bench is like my Mask of Loneliness. It sits there, alone, in a vibrant world waiting for someone to occupy it and linger for a while. To a passerby it doesn't appear "sad" or "happy," it simply is. Only when one takes pause to notice and contemplate the situation can one appreciate the loneliness. And so too it is with me. My Mask of Loneliness often appears invisible, even when worn directly in front of you. I'm surrounded by friends and peers. I have few enemies and I get along with most anyone. I wear my Mask of Smiles even when I don't feel like it. I can now interact and blend in so flawlessly that you'll probably never notice that I'm alone.

But I notice. I feel the Mask of Loneliness on my face. I'm painfully aware that several of my friends are now married, at least one of whom now have kids. Though I don't show it, I'm actually rather awkward when I'm one of maybe 3 people in a group who're single. And though you don't notice it, I don't really care to hear about your relationship problems with your girl/boyfriend/spouse.

And no matter how much I tell myself that we all go at our own pace, how I still have time, how my busy-ness is only "for now," I can feel this Mask begin to harden on my face. It is, after all, partly my fault. I don't make a particularly concerted effort to "get out there." And the longer I wait, the more excuses I make and the easier it becomes to make them.

Lately I've begun to feel that I'm "undatable." I hung out with Drew on Sunday (he's seeing someone else now, figures) and it was . . . rather awkward. Neither of us had any particularly good conversation topics. We were just on two completely different pages the whole time. I felt like I had become so one-dimensional as the conversation topics I brought back either drew from a subset of things I knew well or otherwise drifted towards the medical. Even I wouldn't date me.

Lol, I suppose I've become more like that park bench than I thought. At first glance, I'm just made of wood - one-dimensional. But if you happen to come closer, you'll see the words etched into that wood and read the stories of my past, present, and future. And it's not like I'm intentionally hiding, I'm right here in front of you! I hope you linger a bit and keep me company, and take from me my Mask of Loneliness.

Until then, may this quote ring true:

"Pray that your loneliness may spur you into finding something to live for, great enough to die for." ~ Dag Hammarskjold

Yes, I've used that quote before in this post (if you recall).

Mediocrity

mediocrity by ~seven20 on deviantART

In grade school (K-12), I was always at the top of my class. I was pretty good at everything (except gym) and the world was full of endless possibilities. In undergrad, I understood that few people are truly Renaissance men. I learned where my strengths were and I knew where my limits were, in some cases hitting that unmovable wall. In grad school, the world - while more limited - was still full of potential. I learned what I loved and I learned what I could excel at.

In med school, I am mediocre. During M1 and M2 years I did pretty average on exams. Actually, no, I often did below the class average (though, my end grade was "average"). Even the classes that I had a solid background in and did above average I usually was still not among the top. But this didn't deter me as I had come to learn that grades don't necessarily equate with how well you know, understand, and appreciate the material. Then on the USMLE Step 1 exam I did below national average. While this was a hit, I eventually shrugged it off because I still passed, which was what truly mattered. Plus, since I would likely be going into pediatrics (or possibly internal medicine or both), it didn't matter SO much as long as I passed.

Surely come M3 year, with largely subjective evaluations, I should do better! Alas, it appears that I'm still relegated to being mediocre. It seems no matter how hard I try, how hard I study, how excited and motivated I appear, how much I care for my patients, I am only "mediocre." I am only "average." And this befuddles me. Here I am compared against my peers, many of whom I KNOW do not care for their patients in the same way that I care for mine, and yet we end up with the same grade (and sometimes they do better than me). What gives?!

I'm kind of afraid. I really really wanted to excel on my pediatrics rotation. I've mustered every ounce of excitement, enthusiasm, motivation, genuine care for my patients, willingness to do scut work (aka, the residents' bitch work), willingness to receive feedback to improve . . . and yet I'm not sure I can make it out with more than "average." I'm afraid that no matter how hard I try I will remain in the same place.

I am tired from my months on medicine and surgery. I've worked my ass off in hopes that I'm able to mask my exhaustion and put on a face of enthusiasm. And I honestly did care for my patients. I don't know what else I could do, I don't know what other well of strength I can draw from.

As I talked to my friend, he said the following to me:

"Don't feel defeated, you passed and you are a bad ass med school person. You're like, proving yourself beyond 99.9999% of all people in the world. Can't get too upset about that last 0.00001%."

I always loved him for his perspective on things.

Welcome To Life

Newborn Egg by !Kikariz on deviantART

Welcome to this thing called life. Open your eyes and see the love that brought you into this world. Sleep in the arms that embrace you, linger in childhood while you can, but grow up strong and healthy. You are full of the world's hopes and potential - you can become anything! What will you choose to be? You won't remember me, what with me prodding and poking you. But I hope my thoughts are etched into your heart: I wish you the best on this journey called life and I hope you are equipped with the love and the help to get through anything.
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I just spent the last 2 days in the newborn nursery. I had the opportunity to examine a baby less than 48 hours old. The mom handed him over to me, trusting me unequivocally that I wouldn't hurt him. He peeked at me through suspicious eyelids and went back to his tenuous sleep. Of all the people to have examined him in his brief existence, he tolerated me the best. I believe there aren't many people who have "the touch," or the ability to connect with babies in a way that they tolerate you poking and prodding them (they're still not happy, but they'll tolerate you); I'm hoping that I've got it. Really, there was only one baby who didn't tolerate me, but that was because he was fairly sick.

There is something about holding a newborn. It's the feeling of holding unadulterated potential in your arms - something so fragile and yet resilient. I mean, come on, the childbirth process is rather traumatic (for both mother and child).

And so it is that I thought the above in my head as I laid him in his bassinet next to his mom and left the room. The odds of me seeing him are next to nil, but all the same - welcome to life.