poetry alert

Memento Homo Quod Cinis Est
(Remember, O Man, that you are Dust)

Standing in the dissection suite,
scrubbbed and gloved
(as if latex were protection
from the knowledge of one's own mortality)
I map out veins and tributaries,
tease out secret nerves
and contemplate the possibilities
of the awful glory of God
made manifest even here.

Skinned one,
Dismembered kindred, I too
have had someone
saw through my pelvis; I have been
the lovely assistant
split in two,
still smiling as the blood begins to flow.
I too have had someone finger my heart,
probe the chambers and valves,
Squeeze it like a child's toy and not
the seat of the soul that it is, that delicate tether
Binding body to earth.

Today we skinned your left hand,
removing a lifetime of jingled quarters
and turned pages;
today we stripped away
the last time you held your wife's face in your hands,
those familiar caresses as much a part of you
as that thin skin,
those ridged white gloves.

Despite the things
that have been lost,
the loves and longings wrenched
from between my fingers,
I am still able to hold on; am not yet
so far beyond the grip of grace
they might not be restored, or found anew.
I covered you, washed my hands, and as I washed
said a small prayer of thanks
for my small life,
and yours.

Stigma

Today in one of my 'selectives'--sort of "extra" cool little classes that you take on the basis of interest rather than...how do you say?...requirement--we had several presenters speak on mental health services in St. Louis, and on the failings of infrastructure and policy in the American mental health system generally. There was also a discussion beforehand (with the 'coursemaster'--I love that term; it makes me think they should be wearing wizard robes and brandishing a staff, shouting, "Behold, I am the coursemaster!") on the stigma associated with mental illness, and the extent to which that's a barrier to people who would otherwise benefit from mental health services.

Stigma. The word itself means 'mark.' "Stigmata" are the markings of the crucifixion; someone with a contract on his head is a 'marked man'; Cain was stigmatized, marked, after he killed his brother Abel. Believe it or not, there wasn't always such a stigma attached to madness in Western society (I say madness only because that's what it was called back then; there are no medieval texts on 'mental illness.' Trust me, I wrote several loooong papers on this in the process of getting a German lit degree in my former life as a student of the humanities). Sure, some societies still thought that the mentally ill were possessed by demons, but an equally probable explanation was that the individual had been touched by God. Craziness was actually a good deal better tolerated then (by which I mean during the Middle Ages/Renaissance--read Michel Foucault's fabulous book "Madness and Civilization" to see what I mean). Then again, everyone and their dog had neurosyphilis back then, so maybe the bar for psychiatrically normal was a little lower, too.

Now, of course, psychiatry works with the laudable goal of alleviating human suffering; it also (sometimes) works with the much less laudable goal of making everyone maximally productive and optimally functional within the confines of a society that I think most enlightened and sane individuals would agree is inherently crazy-making...and while there have been some shifts in attitude even in the last twenty years (celebrities can speak frankly about substance abuse problems and battles with postpartum depression; mainstream sitcoms feature characters on antidepressants) there's still a lot of work to be done when it comes to acceptance of mental health issues.
The last time I was getting my car fixed (I always take it to the same shop--the owner is the father of a friend I had in elementary school) I mentioned I was going to medical school, and that I hoped to become a psychiatrist. My friend's dad took this as an invitation to expound on the virtues and failings of psychiatry as an institution, and more specifically the ways he saw psychiatric diagnoses as misplaced--as attempts to excuse moral deficiency or dodge responsibility:
"I think bipolar disorder is just another way of saying someone doesn't want to take responsibility for their actions...that they're immature."

I literally didn't know what to say, and not just because I'm (medicatedly) bipolar myself. It's that sort of attitude, that refusal to recognize that a disease is no less real because it manifests in the brain rather than in the pancreas or heart, that makes medical faculty and students deride psychiatrists as "not real doctors." That's the attitude that keeps a man from going to his physician with his suicidal ideations, for fear of being thought weak; that makes someone push and push and push themselves, a la Sisyphus, to run the mental equivalent of a marathon without pausing to consider that their anxiety or depression is the mental equivalent of a broken leg, and needs treatment equally as urgently. All right, I recognize that last sentence was awkward and clunky, and that's my cue to go to bed.

Let the games begin!

In high school, I wasn't sporty. In middle school, yes, and in college, but not in high school.

I had band letters and academic letters (and debate) for my letter jacket, but no sports. So it struck one of my teachers as particularly funny when I described finals as "my Olympics." Seriously, I practically ran around the school in a tracksuit and headband emblazoned with "pi"--shouting, "1,2,3,4, I know what adrenal glands are for! 5, 6, 7, 8, and who won the Lincoln-Douglas debate!" DORK. Then as now, though now I am comfortable with and embrace my dorkdom. The popped collar and Chanel handbag contingent can be who they are, but I am who I am--someone who thinks enzymes and cell structures and clotting factors are pretty damn cool.

So, kids, I'm about to go do the first leg of this week's Olympic marathon--that is, midterms. MFM (which you may remember as "biochem, but interesting," not least because the prof is awesome) is this morning, in approximately half an hour. I've studied, as Holden Caulfield might say, "like a bastard," and I've gotten a good night's sleep (OK, a slight exaggeration, seeing as I never have 'a good night's sleep,' but as good as I ever get) and had a hearty oatmeal breakfast, and I'm wearing my lucky shirt. We do what we can. Let's see who comes out on top--me, or 100-odd questions about enzyme kinetics and metabolism. For once, I'm actually NOT nervous. But that could very well change in, say, 25 minutes or so.

A standardized test?

We had our first standardized patient session today, something for which I felt woefully unprepared. It was supposed to focus primarily on communication skills and history-taking (right up my alley, no? You'd think...) but there was the addendum of the physical exam that made everyone a little...squirrely. Nervous, edgy, though of course everyone does their best to hide those things (I can't be the only one hyperventilating, can I? Of course, maybe I can). Some of the things we were supposed to know how to do hadn't been covered in our small groups at all; the best summary I can give of the 'musculoskeletal exam' I was taught would be, "Have them move things around and see if it hurts. Then you move them around and see if they hurt. Also, there are lots of bony landmarks you should be aware of, and everyone hurts their ankles and knees at some point so you should probably know what to do for those sorts of injuries." Standardized patients, by the way, are actors who are paid to come in, sit in exam rooms, and serve as fake patients. They give the histories from the scripts the medical school provides; they act out all the physical findings you're supposed to see (limps or tenderness or stiffness or whatever). The woman today was quite convincing; I found myself actually worrying that I might be hurting her. Some standardized patients really get into it deep, from what I've read: here at this Slate article I learned there are even those who let medical students try out their newfound pelvic exam skills (there's. not. enough. money. in. the. world. to make me do that).

We weren't even being graded, per se, on this encounter; I really shouldn't have been nervous. But we were kept standing outside the little exam rooms for almost 5 minutes, just giving us time to get more worked up (of course, some people would see this as time to 'collect their thoughts,' I suppose--cognitive restructuring, man, make it something positive!), and suddenly as I went in I could feel my face go numb and everything sounded echo-y and yes, I did a focused history and exam, and I didn't drop the stethoscope or lunge at the patient to feel her posterior lymph nodes (nothing like putting your hands around someone's neck without giving them warning), and I did wash my hands before and after thankyouverymuch, since failing to practice good hand hygiene is one of the few ways you can actually fail an encounter. I can't say too much more, since not everyone in my class has had their standardized patient experience yet (and there's an honor code saying you won't pass on information, that the exam suite is a secure testing environment, lah ti dah), but my patient did tell me that I "didn't do terribly at all," which hardly sounds like a ringing endorsement--but wait.
"You were just so nervous. I could feel your hands shaking as you were taking my pulse." Oy veh. But she went on: "You really have the personality for this. I can tell you'll be great at this, you just need to get over your nerves and then you'll be fine." Which I know is true; when I worked with Dr. B. doing preliminary interviews of his patients, they always told him 'what a nice girl' I was. Never mind that a 20 year old isn't really a girl, or that they were mostly geriatric patients who really needed someone to talk to, even if it was an inexperienced college student taking down their past medical history and medication information (but who was also willing to listen to them talk about their fears, and their grandchildren, and their gardens). Their bar for 'such a nice girl' wasn't very high, is what I guess I'm saying--just someone to smile, and listen, and care a little. Everyone needs to feel heard. Maybe that's what I need to focus on...maybe if I focus on that connection, everything else will fall more easily into place.

First anatomy exam

The first anatomy exam was, in fact, less of a debacle than I expected it to be. Of course there was test-anxiety galore (for everyone--enough to take me out of my shell and spontaneously fear/anticipation-hug two people in the hallway outside the dissection suite), and the test itself, well, it was engineered for maximum fun--if you were a professor watching, I guess. It's what I'd imagine a social psychologist would arrange to look at the effect of stress on anal-retentive, type-A individuals.

Put 30 of them in a room at once, where they can see each other scrambling and scribbling (or, if they get to a question they do know, standing idly and making everyone nervous because obviously that kid knows everything and I don't know anything and he's going to end up head of neurology at Brigham and Women's and I'm going to have to go live in a box).

Have at least 5 parts to every question. Incorporate as many different colored strings as you can into the question--the same goes for colored pins. If you have large and small pins in the same color, use both of them (I spent 30 seconds on one of the questions yelling in my head, "There is no mother #$*^ing large white pin!")

If you pin an organ that's easy to identify, make sure that identification of said organ is not a question for which students may receive points--rather, ask about vascular structures associated with it, or disease states, or its embryonic origin (that'll show the little bastards to skip embryology lectures).

Allow only 2 minutes per question. Use a buzzer to indicate the 2-minute intervals. Make it loud, so as to destroy concentration and work anxiety up to a fever pitch. If you have a student with long Q-T syndrome, see if you can put him into fibrillation with the combination of stress and buzzer. While not quite as dramatic, you may also be able to get someone to hyperventilate or faint.

Actually, while I'm speaking tongue in cheek, the anatomy exam was tough but fair. Nothing especially esoteric or ambiguous was pinned; there weren't any questions that were nebulous. There was even a 'rest stop' during one of the 2-minute periods with a bowl of small candy bars (proof that I'm "in the army now"--I took one of the candy bars and ate it. Outside lab, of course, but still...as one of the other students said, "Dude, that's dissection suite candy." I just think it was very nice of the TAs/profs to bring it in). And I passed, well above the requisite cutoff, thankyouverymuch, and when I picked up my paper (It may have been a little obnoxious, but I don't apologize) I did a little jig in the hall.

And now it's time to start studying for midterms, week after next. Oh joy. But seriously, there's nowhere I would rather be than here.