Tuesday, January 30, 2007

Listen

Mr. A sat in the exam room holding a grimy fistful of papers about ticks, tick bites, and the multitude of horrific things that can result from them. I caught the letterhead of S.T.O.P. (Stop Ticks On People, I kid you not) and tried hard not to laugh as I pictured S.T.O.P. rallies and protests in Washington (Hey-Ho! Ticks gotta go!)

Dr. Good* – “So, what brings you in today, Mr. A?”

Mr. A – “Well I just haven’t been feeling right since these bitesYou** see there are five different types of ticks. Many people only know about the deer tick and the dog tick, but…”

Like a seasoned politician, Mr. A moved flawlessly from his answer to his speech, in this case a dissertation about all things tick-bite. I settled in, expecting that once he got this speech off his chest, Dr. Good would resume the detective work. But Dr. Good had other plans.

Before Mr. A could get to the comma after “dog tick” Dr. Good was peppering him with questions. Where are the bites? Do you have a rash? When did they happen? I don’t see the rash. Tell me about this fever. Where are the bites? Did you see the ticks? Do you have a rash? Tell me about this fever. Where are the bites?

Dr. Good had decided that he was in charge of this interview, and he was beginning to flex his will power. This specifically entailed interrupting Mr. A’s every answer with a new question. Just as Mr. A would start to say “Well, there were some bites here, and maybe on my legs…” Dr. Good was studying his arm, already asking about a rash. Mr. A was still on bites when Dr. Good was asking about fever. Mr. A was doing a poor job of following the questions Dr. Good was firing off let alone answering them. It seemed Dr. Good wasn’t even following his own questions; he asked about the same things so often I had to bite my tongue to keep from blurting out Mr. A’s answers for him.

I was watching a skit on precisely how NOT to interview a patient. By Act 3, Mr. A had been “broken”. He submissively answered all of Dr. Good’s questions in as few words as possible, and Dr. Good whisked out of the room to record his victory under Progress Notes. As he shook my hand and thanked us both for all our help, Mr. A was visibly stunned by the whole event and looked unsure of what he had done wrong.

We’re continuously taught to let patients tell us their own stories about their illness, to listen carefully to them, and to pull the “facts” out as they arrive rather than forcing them out. Everything I know about Doctorin’ tells me that Dr. Good was a bad doc there. Dr. Good isn’t a bad doc though…well, at least he wasn’t at any other time. In fact, he was the perfect doc to everyone else we saw that day. The more interviews I witness, the more I see doctors shape-shift to match their patients, pulling out different personalities every 15 minutes. The stars apparently aligned against Mr. A that day, and he saw a very mean shaped doctor.

*Not his/her name. I decided to start creating characters for my stories. Mr. A will likely be followed by Mrs. B, etc. Dr. Good, Dr. Bad, and Dr. Ugly – maybe not Dr. Ugly, cuz that’s mean – will also come out to play.

**I’ve adopted the no-space sentence as a way of conveying a pause-less segue. Its much easier to communicate by voice than on paper. In this case, slam sentence 2 (You) into sentence 1(bites) by refusing to take a breath and pronouncing the two words as one…bitesYou

My Stories

I like to tell stories, but more importantly I like to tell stories while simultaneously not getting sued. That compulsion leads me to remind everyone that what I post is fiction. Not actual events.

Lies.

I make up names, I make up actual events, and on occasion I've made up diseases.

The stories I tell might bring up strong feelings of what was done wrong, or what should be done. I don't bring those issues up head-on, partially because I don't always think of them, and partially because I don't enjoy debating ethical issues on my blog. But sometimes, rarely, the story was written to make you feel that way - I manipulated your feelings with my dirty, lying stories - mostly because life never plays out as vividly black and white as you'd hope. So sometimes I "turn up the contrast" a little.

Sunday, January 28, 2007

2nd grade Essay, and Then SuperRant!

We have these writing prompts for one of my classes. Some are good, some are "meh", and this one...well I felt like I was doing a book report for Mrs. Snyder's class all over again. So, what did I do? I got super-wordy and soapbox-y. In my mind, if I'm using two dollar words it feels less like elementary school. Oh my tangled logic...
__________

5. Describe someone who personifies the humanistic practice of medicine. Why?

Albert Schweitzer is a role model who personifies the humanistic practice of medicine. Dr. Schweitzer championed the phrase “Reverence for Life”, where he encouraged us to give as much reverence for every creature’s will to live as we give our own. Similar in practice to the “Golden Rule” of treating others as you wish to be treated, “Reverence for Life” pushes beyond mere practice and encourages us to love and revere every creature in the same way that instinct compels us to love and revere ourselves.

Through “Reverence for Life” we learn altruism, and are compelled to serve others selflessly. Dr. Schweitzer lived his philosophy out by leaving his comfortable life in Europe, establishing a hospital in rural Africa, and spending a majority of his remaining life serving as a healer and caregiver to the least fortunate in the world. As shown in his following quote, Dr. Schweitzer viewed service as central to happiness and well-being.

“I don't know what your destiny will be, but one thing I know: the only ones among you who will be really happy are those who have sought and found a way to serve.” – A. Schweitzer

_____________

Albert Schweitzer really is a role model of mine, and for that very philosophy of Reverence for Life. My heart really wasn't in conveying that to whoever grades these "Reflections" though. Partly because there's much more to that whole philosophy.

The pursuit of selflessness is, well, a really romantic and idealistic idea. When the chips fall, we are all just looking out for ourselves and our progeny, right? In that case, Reverence for Life is a farce, a pipe dream, a bedtime story...right?

Wrong. Okay Right for most, but Wrong for me. Yes it is romantic, yes it is idealistic, but the idea is a valid one. Dr. Schweitzer did it, and thousands followed. Heck, med schools - fortresses of cold hard science - are making service part of their curriculum. The demand for service based learning is growing rapidly, and its because of romantic, idealist...students. I'm young, I have no family to care for, and I still kind of believe I'm invincible: I have no need for self interest, because I have no one to protect yet.

The hard part will be in 10 years when I have a job, a family, a mortgage, and I'm still paying of that !@#$% med school debt! Where is Reverence for Life then? Perhaps I'll just have to pack up my family of five and move to Haiti for a few years ;)



PS I do not advocate moving one's family to the third world. It doesn't make sense for most, but I guess that's part of the appeal, isn't it?

Like a Post, but Not

http://scienceblogs.com/drcharles/2007/01/the_power_of_story.php

Storytelling in practice. Not the best example of Narrative Medicine, but I'm starting slow (read: I'm too lazy to post or find a more accurate example).

Wednesday, January 17, 2007

One Month Plus Passes...

I see that button on the toolbar - "blogger.com" - tens of times per day, whenever I open a webpage. I think to myself "I really need to get a post in soonHey look at that over there!", then I'm off on a new tangent.

I don't talk enough to my blog recently, because I tend only to turn to it when I'm socially needy (Why go outside and meet people when you can just write on the online?). The convergence of 1. winter break and 2. realizing that I really need to be more outgoing already has left behind a poor, lonely little blog. So do I choose healthy social behavior or digital journaling.....I choose both.

I mean...I kind of...well...I will choose both. You see, a big reason I'm even writing a post right now is that I'm lonely and I miss my Katie. I saw her this past weekend when I drove her to the airport so she could spend the week in Honduras. She is going on a short-term mission trip with her church, and is completely cut off from civilization...well, from me at least. We usually talk on the phone each night, recounting in minute detail the day we had (this is what I ate, this is where I went, and he said, and I said I just don't see why...etc). Sounds dull, but its not. Its all we have.

So, I'm here now because my girlfriend is in a third world country. But I want to change how I approach the blog. Maybe resolve to write once every weekend ... less about my week and all that, and more posts about medicine and school in general.

Here's the thought process: I like writing...kind of. I'm very fond of medicine. Last semester I did a project about "Narrative Medicine" a fanci-fied word for focusing on the Narratives we find in Medicine. Narratives include the stories of patients, the stories of doctors, and the stories of students (i.e. me). I have a writing platform...a "blog" as it were...why not venture into some narration.

Here's the admission of guilt: I have some writing assignments I have to do this semester for a medical humanities class. I'm kind of twobirdswithonestone-ing here in that I can fulfill the writing assignments and be a better blogger at the same time.

What, you've never heard the term twobirdswithonestone-ing???