Thursday, June 23, 2011

Making it Worse

"So how great are you at handling weird shit?"

The instant message box popped up from an acquaintance.  We barely knew each other beyond our sparse interactions online.  Apparently there was no else online to talk to.

With weak reassurance from me, he dropped the bombshell.

There was no right way to react, he admitted.  There was also nothing in particular he was looking to hear.  Still, I felt more impotent with each response I gave.

Empathy led to sarcasm.  Additional questions led to evasion.  Expressing uncertainty about how I was reacting led to silence.  I was sure I was making things worse.

He had some whiskey and left the keyboard for awhile.  When he came back, the subject was over.  He thanked me for listening.  "I don't know how I'm supposed to feel," he finally said.

Me neither.

I chalked up my incompetence to my barely knowing him.  Surely if I knew him better, I'd know exactly which conversation buttons to hit to help him cope.  But I didn't know him at all.  This was the first time someone who I barely knew confided in me something life-changing.

We learn a lot of things about how to react to raw vulnerability in people we don't know.  We have our stock phrases and tricks about how to validate feelings.  "This must be hard for you." "I'm sorry."  "Take all the time you need.  "This is not your fault."  "A lot of people go through this."  "Your reaction is normal."

What I didn't learn until now is sometimes nothing--absolutely nothing--works.  Sometimes it's the moment, sometimes it's the person, sometimes it's both.  And so you have silences, and missteps, and too many apologies.  Out of desperation, you say inappropriate things like, "I'm pretty sure I didn't do anything to make it better, but I hope I didn't make it worse either."

You may make it worse.

But maybe the game is rigged.  Maybe every door to making things better is locked.  Maybe I'm not the person with the key.  Maybe there's nowhere to stand but in the hallway, offering nothing for now but a bit of body warmth.

Note: I asked for (and received) consent to write this.

Monday, June 20, 2011

Finished Year, Unfinished Business

The jury's still out on reflective first year sentiments, but it's been gratifying to share my thoughts back from the very beginning of medical school.

I had the honor of reading my "Letter to a Young Doctor" on the medical documentary series White Coat, Black Art. The radio show ran on the Canadian Broadcasting Corporation (Canada’s national public radio and television broadcaster--similar to America's NPR or PBS).

Link to audio--my piece is at 22:00.
Link to June 10 show description.


I'm officially a "rising MS-2," or second-year medical student.  During the last few days of school, we were asked to write a two-page reflection statement about first year.  I meant to write something original, but it proved difficult.  Nothing I was thinking seemed remotely appropriate to hand in to a person who could be writing my recommendation letter.  I didn't (and still don't) really feel anything at all right now.  I don't feel particularly learned, or empathetic, or acculturated right now.

The dorm is quiet.  Our lecture hall/study center is quiet.  In April, the former second years became third years.  They started on the wards in their respective hospitals.  They no longer spend long hours in the computer labs studying for boards or mingling with our class in common areas during lunch breaks.  They no longer live with us either; many have moved out out of the dorm to be closer to their hospitals or because they finally desired their own bathrooms.

Right now, we exist in a strange sort of orphan limbo.  The former second years are no longer in our proximate space to give advice, guidance, reassurance.  The incoming class will not be arriving until August.  Without other classes for comparison, perspective is difficult.  The changes do not become evident simply because it's the current assignment.

I am a guest editor of the AMA's ethics journal Virtual Mentor.  One of my main responsibilities is to describe a clinical situation in which the physician faces an ethical dilemma.  I write a short narrative depicting the situation--the doctor, the patient, the setting.  Then, there's what the editor in chief calls the "trigger."  There needs to be a very specific event that occurs that ignites the dilemma.  It could be a patient's question, a lab result, a colleague's comment.  A solicited author then writes commentary on my proposed situation and "trigger," using a larger ethical framework to buttress arguments.

The "trigger" in various clinical situations constitutes the backbone of the journal's cases is appealing to me on a number of levels.  It is a concrete and focused way to think about nuanced and abstract philosophical issues.  The "trigger" is unique, and yet it isn't.  Although physicians may not have experienced identical situations to the ones proposed, likenesses make the situations realistic and relevant.

What I'm missing right now is the trigger.  Perhaps it will be a former second year laughingly recalling how terrified I was before our first exam.  Perhaps it will be when an incoming first year asks me how it's possible to memorize the names and functions of nearly every muscle in the human body.  Perhaps it will even be when a patient tells me that I what I said was particularly sensitive, or knowledgeable, or clear.  What I do know is that staring at my computer screen has not been the trigger.

Out of desperation, diplomacy, and a desire to be honest, I ended up smushing together two previous blog posts as a reflection.  Both had triggers: a USPS mishap, and a late-night perusal of PubMed.  Both accurately represented thoughts from various points during the academic year.  Both (I believe) were reflective.

I'm still waiting for a trigger before I can wax poetic about the entirety of first year.  Luckily, there are no deadlines this time.

Wednesday, June 1, 2011

Final Countdown

I would love to think about things other than viruses, worms, and fungi, but alas--it's going to be two more days until I get that luxury.

Last exam of the year this Friday.

Integration week (no details on what exactly this entails. some things? all things?) from Monday-Thursday next week.

Then medical school will be one quarter over.  Wow.

Can't wait to look up from the grindstone and think a little more about life since last August.  Soon.  So soon.