Syncope

(2005ish)

I wake from a dead sleep to the words, “hey, could I get some help our here?”  Everything is dark in my dorm room, and it takes me a minute to realize the voice was not part of a dream.

I clamber out of bed and find my glasses, snap on the light, scoot my illegal hotplate out of the way so I can open the door.

Out in the black and white tiled hallway, my friend and hall-mate David is on the floor in his African safari print pajama pants, limbs sprawling.  His hair looks like he may have been electrocuted, but this is normal for David, and he doesn’t seem to be near an outlet.

I squat by his head, “what happened?”

“Not sure,” he says into the floor, “I just kind of…passed out.”

I rock back on my heels.  I’m a premedical student.  I can explain mitosis and I can run a mean chromatography lab.  I can dissect fetal pigs with precision.  I can explain how color vision works and I can diagram the circulatory system.  But I still don’t really know anything about human bodies overall or how they work or what to do when they don’t work. 

With the hall lights on, David looks pretty green.  I call 911 on my cell phone.  The EMTs come and check him out.  Flashlights in the eyes, blood pressure cuff squeezing his arm.  They decide to strap him to a backboard and carry him down the three flights of stairs to the ambulance waiting on the sidewalk.  They have to stay in shape somehow, I guess.

I will meet them at the ER.  As they carry David off, I duck back into my room.  I put on jeans and shoes and grab two books – Rumi and Organic Chemistry.  We could be there a while.

We aren’t there too long, it turns out.  I beat the ambulance to the ER.  All six beds are quiet.  The nurses are kind.  David looks embarrassed when they stick the EKG leads to his chest. 

As we wait for the doctor, I try to maintain an attitude of concerned curiosity.  David looks more himself now, sitting up in the bed and chatting.  I’m less worried about him than I was half an hour ago, squatting in the hallway in my PJs. 

The anxiety rising within me now is about the doctor.  I feel preemptively defensive and protective of my patient.  Will the doctor assume David is on drugs?  Will he scoff at me for being a lowly premedical student?  Will fail to introduce himself or not ask before he touches David’s body or ignore me entirely or not answer questions?  Will he do any of the multitudes of seemingly inconsequential things that doctors don’t realize are hurtful and dehumanizing?

I’ve been seeing enough doctors for my own health issues lately that I have learned to set the bar very low.

My fears in this case are not realized.  When the doctor comes to see us, he is not in a hurry.  He sits down, speaks slowly.  He introduces himself to both of us. He asks permission before examining David.  He explains vasovagal syncope, writes it down for me, winks at my Organic Chemistry book.  He talks about the vagus nerve wandering and makes theatrical motions with his hands.  He treats us like whole people, and for me this is so rare and special in my encounters with physicians that I want to bottle it.

And the thing is, this whole night still sucks.  This thing has not even happened to me, but still the idea that the human body would just short out like this…it feels like a betrayal.  How dare you, vagus nerve?  I have learned about the ion channels and the nodes of Ranvier and I assume that when I recite these things like mantras, they will keep us safe.

They don’t, though.  Knowing is not enough.  Acing a human physiology course is not enough to ensure that your own physiology doesn’t fail you. 

Years later, David will write that his physiology failing him temporarily highlighted the miracle of how well it works the rest of the time.  That it is a miracle that we are here, that we get to walk around in these bodies and live our lives at all.

And it is a miracle.  My understanding of the human body has grown dizzyingly complex over the past several years, and every new molecule or gene or process I understand is a miracle.  (Both that it exists and that I understand it.)

But the lesson I take from this night is slightly different.  We are all subject to our own human fragility; we each have weaknesses in our very DNA.  No knowledge or power or faith is enough to make anyone exempt.  And so, by all means, we should celebrate the miracle of what is working. 

But what isn’t working is sometimes just going to suck.  And sometimes the best I can do as a doctor is to just not make it suck any more than it has to.    So my new mantra is less about ion channels and more about shaking hands, introducing myself, being mindful of my patients as whole people.  Remembering that every patient I see in the ER or in the clinic comes from someplace as real and textured as that dorm room is to me.  Most of my life now is here in this hospital, but most of my patients’ lives are elsewhere, in the real world, where they may wear silly pajama pants.

It seems like these things should be easy to remember.  That most people have this basic sense that other people are real and intrinsically valuable.  But the process of medical education is not the process of fostering this understanding.  Instead, it is the process of deluding ourselves into thinking that we are special enough to warrant exemptions from our own human fragility.  And by extension, our patients who are sick, were obviously not special enough to warrant an exemption from their own biology.  Patients must be unlike and inferior to ourselves if we are to remain psychologically isolated from the horrors of bodies simply failing.

Some doctors have obviously been able to retain this ability to see their patients as whole people, and I have seen from the patient’s perspective how healing it is to be treated in this way.  So I will fight the good fight that is being mindful of each person’s humanity.  It’s all I can manage right now. 

In college, David and I had a problem with clubs.  As soon as we joined a club, we would be nominated to lead that club.  As soon as we saw a problem, we were suddenly in charge of solving that problem.  This is how we ended up co-leading a faltering campus living wage campaign.

So I hesitate to mention this, but while being mindful of each person’s humanity is the good fight, it’s clear to me that the better fight is finding a way to train physicians that doesn’t rob them of this intrinsic sense in the first place.  Surely there is a way to educate physicians without training them to be aloof assholes.  But guys, I don’t have time to reform medical education, so please don’t nominate me.  (At least not till after residency? Please?)

The Current Inventory

Benjamin and I got married in October, and we are still finishing the thank-you cards. 

Marriage is awesome and I totally recommend it. 

I have not had an actual clinical rotation since August.  I go back to the hospital on Tuesday, and I am terrified.  What if I don’t remember anything?  What if I never knew anything to begin with?  What if I get lost in the hospital?  What if I don’t learn or re-learn all this stuff before June?

The flip side of being terrified is being really excited.  I have been bored out of my mind these past few…months.  I need structure and work and getting up and taking a shower every day.  I think this bodes well for our plan for me to work and Benjamin to be a stay at home dad. 

I’m supposed to be writing a thesis for my Master’s in Public Health.  I find I much prefer talking about writing my thesis and whining about having to write the thesis to actually, you know, working on it.

I am done all my interviews for residency.  Now I just need to rank them, submit my list, and twiddle my thumbs until March 16^th, when the computer tells me where I end up.  All the programs are really good options where people are friendly and I would get great training.  It’s just the not knowing that is killing me. 

I am ten weeks pregnant.  (No one reads this, so I might as well tell you.) I feel…sort of weird.  A little nauseated and reflux-y and dizzy, but otherwise normal.  There is certainly no magic inner biological siren screaming, “you are growing another person!”  I’m glad to have justification for my strawberry/burrito/olive/oatmeal cravings, but those have been going on for years.  I can totally see how people don’t notice they are pregnant for a long time.  My pants could not fit because I ate 3 dozen Christmas cookies this week.  (To be fair, not all of them made it to the cookie stage, yumm delicious dough.) 

My parents and sister (and presumably aunts and uncles) are not speaking to me.  I had a surprisingly wonderful Christmas anyway.  I’m grateful for wonderful friends and a little time and space for my new family.

The Shooting (Star)

My clock radio went off at seven even though there was no reason to get up.  It was spring break, and I was home from college, isolated from most of my friends, and had nothing to do.  Facebook had not been invented yet.  I lay there in my twin bed in my childhood bedroom letting the dulcet tones of Morning Edition wash over me.  President Bush was saying something asinine again, the stock market seemed to be going well.  In local news, absolutely nothing was happening.  Except there would be a meteor shower tonight. 

Astronomy is not normally my thing. I built a pretty rocking paper maché model of the solar system back in the day, but that is where my interest ended.  It didn’t matter.  This sounded like a reason to get out of the damn house.

Baltimore City is not exactly an area of low light pollution.  I could not think of anywhere in the city that it would be dark enough to actually see stars.  From my parents’ house the night sky usually looked like a dark orange smear.  But outside the city, out in the suburbs where my grandparents lived, there was a baseball field where I knew the turned off all the lights by about nine.  The meteors would not be at their peak until midnight or so.

I called my friend Shannon, who was still in high school but also on spring break.  She was game, as was her boyfriend, Matt.  I would pick them up around eleven, and we would head out of town. 

I stewed at home all day, complaining loudly about how bored I was.  My dad, who works from home, has an amazing ability to tune out human speech, and I am sure this was the only reason he did not strangle me. 

Finally it was the appointed hour.  I bundled up and headed out to my car, Gay Lightning.  Gay Lightning was a champagne-colored 1991 Nissan Stanza sedan with a cranky transmission.  She had been so christened because of a rainbow lightning bolt decal that I had placed on the rear windshield.  The car had automatic windows that only worked on the left side, and a CD player that stole and repeated CDs for months at a time, refusing to eject.  Gay Lightning had selected Savage Garden as the soundtrack of choice for spring 2003.

I picked up Shannon and Matt at her folks’ house, and they climbed into the car with flashlights and snacks.  We headed on out of town. 

When we got to the field by my grandparents’ house, it seemed pretty dark.  We rolled out our blankets and stared at the sky.  Nothing.  We lay there in the grass and ate the snacks and talked about the meaning of life and what we would do if we were in charge of the world, and wouldn’t it be nice to start a commune someday?  We didn’t see a single shooting star.

By 2:00 am, clouds were rolling in, and it was obvious we weren’t going to see anything.  We packed up our blankets and finished up the crackers and apple slices.  We drove back into the city.

I love driving through the city at night.  It seems empty in a friendly way, and I like all the lights and infrastructure without all the people and traffic.  We were cresting a hill on Cold Spring Lane, which had been part of my regular commute to high school, when I saw it.  A man darted into the street right in front of us and dropped to the pavement.  I had to slam on the brakes on Gay Lightning to avoid hitting him.  The three of us sat there for a split second in shock.

I put the car in park and jumped out.  The man was lying in the road right in front of my car, clutching his shoulder, which was oozing blood.  Not spurting, but oozing at a good clip.  I hadn’t hit him, had I? It took a long time for my brain to realize that he had been shot. 

Hmm, shot seemed bad.  I looked up.  The street had filled with people, most of them on their cell phones.  I assumed the calling 911 was covered.  No one else was approaching the victim; I guess they figured I had that covered.  I squatted next to him.  “Hey, are you ok?” Stupid question, really, since the rapidly expanding pool of blood I was squatting in seemed to indicate that no, he was not ok.

“Think so,” he grunted.

“Good,” I said, “What’s your name?”

“Michael.”

“Hi Michael, I’m Mali.  Are you hurt anywhere other than your shoulder?”

“Don’t think so,” he grimaced.

“What happened?”

He tried to shrug in response.  Shrugging being a shoulder-based action, this did not seem to go so well for him. 

I had taken basic first aid, and I thought that I should apply pressure to his wound.  I also knew that I did not have any latex gloves on my person, and that I didn’t really want to touch this guy’s blood.  I always thought I would be cooler than that, more self-sacrificing – that in an emergency, “universal precautions” be damned!  But I had a strong sense that I should not touch his blood, and so I did not.  There didn’t seem to be a lot I could offer him. 

“You keep taking deep breaths, ok?  I’m going to go check on why the ambulance isn’t here yet.”

I stood up and walked away from him.  In the front row of the crowd of onlookers, one woman seemed to be shrieking and turning an unnatural shade of green.  I walked over to her and she grabbed my arm as if she was drowning.  I guided her to the curb and had her put her head between her knees and take deep breaths. 

I much preferred this non-bleeding patient.  The deep breaths seemed to be calming her.

“Do you know Michael?” I asked.

“No, I don’t know either of them, but that one back there looks bad.  I don’t think he’s gonna make it.  I never seen someone look so bad,” she pointed down the side street.  “This one looks ok,” she said, pointing to Michael.  She had a lilting Caribbean accent that I hadn’t expected.

I nodded.  I decided I didn’t want to see the one that didn’t look so good.

The police arrived before the ambulance.  They put on latex gloves but still didn’t touch Michael.  They didn’t walk into the pool of his blood.  They took statements from us, asked us what we saw, scribbled in their little notebooks, ignored the squawking of their radios.  The ambulance came and the EMTs tromped through the blood puddle to strap Michael onto a stretcher.  I went back to his side while the EMTs fussed with the straps and oxygen tubes. 

“Good luck,” I told him.  What else do you say?

He nodded at me.

A little while later another ambulance came and loaded up the body bag from the side street.  It drove away without sirens.

Shannon and Matt and I looked at each other.  Before I climbed back into Gay Lightning I tried to rub the blood off the soles of my sneakers onto the curb.  We drove home, silent except for the Savage Garden soundtrack.

I don’t really know what lessons to try to glean from this experience, about myself, about my city, about violence or race or the actions of crowds.  Two men were shot.  One died.  I am not sure if they shot each other or were shot by someone else.  I don’t know what happened to Michael.  The shooting was not reported in the paper.

Years later, with four years of medical training behind me, I think I would do the same thing.  I wouldn’t touch his blood.  I always thought self-sacrifice was something to be valued, something noble.  I always thought that a white girl being afraid to touch a black man’s blood would be a mark of irrational racist fear. 

And maybe it is.  Maybe I’m not as anti-racist as I think I am.  But I know enough about blood-borne pathogens to know that while the risk of HIV transmission is incredibly low, the risk of Hepatitis transmission is higher.  Neither of these risks are zero.  It’s not a risk I am willing to take. 

I got tired of thinking about this, pondering its meaning.  I bought a box of latex gloves and put them in my car.

Welcome to My Blog!

Hello, Crickets!

I've decided to jump on this blogging bandwagon.  Let's hope that this attempt to record my thoughts and life happenings goes better than my long-lost livejournal of yesteryear.

At the very least, I can pretty much promise that this blog will contain less whining.

So, what can you expect from Dr. Zetcetera?

Full disclosure, I am not yet a doctor.  I am a 4th year (actually 5th year) medical student, and I will graduate in May 2012.  I plan to go into Family Medicine, and will start residency in June 2012.  I am also a healthcare reform zealot, a feminist, and a Quaker.  I have been a nanny and in the future (spoiler alert!) I will be a parent.

Some topics/themes I plan to cover (in no particular order):

- the doctor-patient relationship

- the dehumanizing elements of medical care and medical education

- the experience of illness

- end of life care

- spirituality in medicine

- work-life balance

- physician privilege

- why healthcare reform is pretty awesome and how it could be awesomer

- healthcare as a basic human right

- the built environment and health

- the misguided "war on obesity"

- the challenges facing women in medicine

- nannying stories from the trenches

- the residency match process

- medical mysteries - how doctors deal with things science doesn't understand

- the feminist/Quaker/doctor/hippie take on news of the day

That should be enough to get started!