Insecurity and Intimacy

We had the coolest Ethics lecture ever on Tuesday. It was cool for several reasons:

1. it was the last one
2. it was...
1. genuine
2. helpful/relevant
3. humorous
4. worthy

The speaker was an older family doc in the navy—he was actually an admiral—. The topic was professional insecurity. Having induced a universal from our previous lectures, I thought this would be a powerpoint full of half-baked slides about our litigious society and our collective psychological failings.

But I was wrong. There was no powerpoint. There were no stupid, unnecessary definitions and bullets to introduce us to the topic. Instead the admiral dove into the idea, assuming we all knew what it was.

"We are bilaminar creatures," he said, explaining that we have a confident outer face, and an inner quivering/normal face. The outer face matches what we and others think of our profession; the inner face is ourselves, terrified at the position in which we've been placed. He said that this insecurity is with us throughout our lives.

Further, he said, there are several "nodal points" where insecurity becomes most obvious. Until this time, he didn't have my full attention. But as soon as he began to write nodal points on the board I was all ears, because without knowing a thing about me or my curriculum he recited what I went through this semester.

Nodal Points

1. First day of medical school
2. First exam(s)
3. Clerkships
4. Graduation
5. Internship

I'm sure he could've noted more. But this is exactly how I felt!! At the White Coat ceremony I remember thinking to myself, "I am the admissions' committee's mistake. They keep joking about it and reassuring us...but this is real. They didn't know how behind I am, how dumb I am. How can any TACer do this? I am going to fail painfully. How embarrassing. And after I fail, then what?"

This admiral told stories from his first day, his first test, his clerkships, and his graduation. He was hilarious! He also had some hard stories: after doing what he was told by his attending, he was rebuked by a staff internist for sending a woman home when she should've been sent to the ICU or CCU, and for a while he thought he had cost the patient her life. How horrible, how crushing! (He later discovered the woman was okay.)

He soon moved on to solutions to this insecurity problem, which makes anyone unhappy and dysfunctional. He listed several possible ideas: alcohol, drugs, other addictions, other distractions, superspecialization, more degrees.... He rejected all of those (some more quickly than others). Then, he wrote what he thought was the true solution on the board, in six-inch letters.

[Intimacy]

He said we must find a person to trust and show them our interior—our inner layer, the insecure one—confessing our imperfection, ignorance, and ordinariness. And not to only one person (like a spouse); to a network, a team.

It's a risk. Sometimes, he said, when you show someone your imperfection they laugh and alert everyone, giving you pain. "But most times," he continued, when you show someone your imperfection their response is a relieved and desperate reciprocation, and you create an immediate community.

I've been reading about some fascinating social experiements that go right along with this! Also, I'm reading The Seven Levels of Intimacy.... One of our greatest desires is to be known. And of course, it all goes back to desiring God in the beatific vision. I cannot wait for heaven!

What an excellent lecture. The more we are humble and frank with everyone and the more we can be truly intimate with those God gives us...the better for our profession, our patients, and our country.

Breast Cancer/Abortion

I'm still really interested in this.... Here are two links I found today:

• Abortion Nearly Triples Breast Cancer Risk, New Study Finds
• Epidemiologic Studies: Induced Abortion and BC Risk 1957-2011

Interesting. Listening, AMA?

Two other cool tidbits about motherhood:

• Breastfeeding lowers infants' risk of ear infections! (We did oral cavity and Eustachian tubes today, and I'm sad the lecturer missed this point. There are so many plusses to lactation I can't control my enthusiasm.) 
• This picture of Our Lady (right) is the third result when I google "mother." (I'm searching for reusable images with safesearch.)

Stand by the roads, and look and ask for the ancient paths, where the good way is and walk in it, and find rest for your souls.

This is an article by a non-Catholic businessman. He speaks so kindly of the Church, and his view is so refreshingly accurate! This article was written in '03. A must-read, especially at the beginning of Advent when we rekindle enthusiasm.
http://www.ewtnnews.com/catholic-news/US.php?id=380

Butternut squash soup (and apple tarts)

 Butternut squash (cubed, from my freezer but less immediately from Sam's)
+ chopped baby carrots
+ half a large onion
+ a tablespoon of ginger root (from ♥Mom♥)
+ crockpot
+ blender

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A yummy, tasty soup for chilled lunches; accompanied well by nuts and bacon. Next time, I might actually be patient enough to roast the squash first. But probably not.

Pretty, and pretty tasty.












Baby food....I mean healthy cuisine. Umm...












And because I still had half an onion (and a ton of apple slices left over from Thanksgiving dessert), I decided to make apple/onion/pecan tarts. An ambitious and random project that tasted good but looked...ambitious and random.

And my pie-crust skills need improvement. The dough wasn't uniform enough. However, it was still fun and tasty, as anything with butter will inevitably be.

Clearly, I cannot divide a chunk of dough into four equal pieces! At left is the only pretty shell (the empty one). I finally realized that I should probably form the sides of the tart before I stuck the stuff in.

Today, I also made soda bread, which came out like sandwich thins (exactly as I'd planned). Since they looked sort of underwhelming, I'll post about them later. I believe my long semester of questing for the perfect homebaked bread for the medical student is almost over....

Medical Ethics is ending...

...which means I can look forward to the post-test, the repeat exam that is supposed to show that this class made me "more moral" (a quote from the course director at the beginning of the course).

I am continually mystified by the purpose of this course. In a post-Christian yet pre-Aristotelian society (i.e. we're post Christianity but can't reach the height of the pagans before Christ) we feel the need to do something about ethics, but can't articulate anything with certainty. Some verbatim quotes from the course director exemplify this:

"[Ethics is] the study of the principles of human behavior with respect to moral actions."

"[Beneficence is to] do what is good; help others further their own legitimate interests."

"[Justice is] the duty or obligation to allocate social burdens and benefits."

"I have no answers."

Each of these statements has philosophical (and even logical) problems.

Found a hospital

The other night, my sister and I spent two hours on the phone talking about dreams. Big dreams. She described a wonderful school she wants to start; I admitted that I want to start a hospital.

Her school is very well conceived. She wants to make good use of students' time instead of stressing them out by keeping them in fruitless programs during the day and activities until late at night. She wants to pay teachers based on merit, teach practical skills (e.g. home ec), and incorporate service. I'm so impressed by her desires to mold better people without all the fat in our current schooldays!

My hospital was less complete in my mind. First, I am very unsatisfied with the nursing shortage, the over-technicalization of patient care, and the treatment of crises instead of persons. I'm especially fed up with these problems because of my visits to nursing homes. I want dedicated persons who will stay with patients and get to know them, instead of coming in when the light is on or when there is a form to fill out.

In addition, I want a hospital that is wholly Catholic—half retreat-house, half hospital! I want the chaplaincy to be about truth (not comfort), and I want it to be very available. I want to hang Crucifixes in the rooms instead of TVs, and place placards with good quotes from the saints and scriptures. Being ill is like beauty—a natural thing that jerks our attention to the supernatural. In a culture so bent away from God, sickness is an ever-remaining crack that Christ can use to pry His way in. A holy hospital can do great good in saving souls!

Then, my sister and I started talking about the breakdown of the family; then, we voiced hopes that our family of origin will remain close together (our extended family is stretched all over, and I think we don't want that for the next generation); finally, we ended up dreaming of creating a Catholic planned community outside some city. Think: if there were two thousand Catholic cities all over the nation, what sort of effect could there be! A concentrated effort can be better than a dispersed one; my hospital would be safe from legislation there (since it would serve primarily Catholics); studies could show how good social teaching improves economies, moods, etc.... So, pretty much I want to go start a city now. (This is what happens when two girls stay up late on the phone!)

God keep this desire to spread holiness in me; God show me how I ought to direct it.

Beauty

Even though I stopped doing ballet after ten years, I'm still a dancer inside. I was struck by this picture, so I thought I'd add some thoughts and post it.

Beauty is a miraculous part of our world! It is such a mercy of God to allow this journey to be sprinkled with lovely moments, like wholesome physical beauty, or hidden psychological consolations, or the elegance of nature's laws, or a holy soul or a holy deed.

And as an aside, one of the things I think of the most when I think of beauty is the feminine body and soul. So, this picture says a lot: in every ordinary woman there is a natural beauty inside.

ballet | Tumblr (clipped to polyvore.com)

Recipes for fall...

Hosting a dinner party left me with tons of leftovers in very maldistributed sections of the food pyramid! I am forced to be creative.

1. Butternut squash soup
2. Meatball soup
3. Roasted onions
4. Shrimp
5. Pigs in a blanket
6. Hamburgers, meatloaf...

Yum!

Painting!!

In the middle of studying the cranial nerves, I took an hour to paint!

Way back in August or September, my roommate suggested that we decorate by painting some blank canvases. I was fine with blank walls--they looked really Carmelite, but I wanted to be a good roommate and hanging stuff on the walls certainly couldn't hurt. We bought two three-by-four foot canvases, a bunch of paint, and some snazzy brushes at Hobby Lobby. Then...the canvases sat blank for months. We had to think of things to paint, prime the canvases, and draw some pencil lines. These steps aren't very impressive, and when they're spread out over months of busy life, they're even less so. So today (when I finally applied color to canvas) was wonderful!

The painting is going to be of a darkened theater, with five period silhouettes in the foreground. Right now, I've painted the side of the theater (dark and grey as the light from onstage filters across it) and put some leftover black paint in the middle of the silhouettes (it looks really weird--sorry about that). The third picture is the rough draft I created on my computer, which I scaled to the canvas before I began to paint.

I remember liking to paint as a kid, just like everyone did. I was sad to lose art in seventh grade, and sort of sad to not paint in high school. All through those years, I'd have these great ideas for paintings, but I wouldn't have time or tools (or talent!) to execute them. However, I'm committed to stay with painting now--it's so wonderful and addictive! The upper left corner of my painting is an inky black (not quite black--there is some red and blue in it, but it's still very dark), and it was tremendous to watch my brush change the canvas so dramatically.

If you watched the video I linked above (or just the last few moments of it), then you saw a nun writing an icon. For some time, that has captured me completely! New aspiration: become an iconographer.

Anatomy is almost over!!

As I approach the end of the semester, I find myself counting down anatomy labs. (As of 3:30 today, five left, and I am only dissecting for two of them, orbit and nasal cavity!) Today, we sawed a crown-like cut through the skull and removed the brain. I tolerated seeing the cadaver's face (last Monday) pretty well. He had been a handsome, older man. I noticed that his brows were slightly knit in an expression of effort or light pain; otherwise, his countenance was peaceful.

Also of note: this morning I spoke to the professor I saw at Planned Parenthood. (It turns out, he hadn't recognized me.) He was as polite as ever, explaining that he'd read pathology reports from before Roe vs. Wade, and never wanted someone to die such a horrible death. He and I acknowledged that we both care about women, but that the battle across the fence was nevertheless real. He even called it "ferocious." I told him in parting to keep caring about women, and that I would do the same.

The brevity of this post is hardly excusable, but I hope you'll believe me when I judge it inappropriate to spend much longer online--I have a comprehensive histo quiz, an ethics test (gah) to take, and an exam (the penultimate of the semester!) next week.

OB/GYN shadowing

I started taking advantage of the OB/GYN mentorship program last week, shadowing a local OB/GYN for a morning in clinic. In three hours, Dr. A saw five or six patients at her group practice, and six or seven patients at a prenatal clinic linked to the FQHC I wrote about last week. Miraculously, she didn't seem rushed!

She was full of energy, she cared about the patients and spoke at their level, although she was by habit brief. The best part was, she allowed me to palpate some women's abdomens to feel babies' heads and buttocks! (She now believes I can find fundal heights, which is laughable.) Then, she started to let me use the fetal heart doppler. By noon, I was finally getting used to placing the transducer on the patient and hearing the (other patient's) rapid heartbeat!

One of the first things Dr. A asked me was where I was from and where I went to school. Hearing that I went to a Catholic college, she surprised me by praising the Church for working for the poor in healthcare throughout history. This was followed by a brief comment about how she was not "down with" some of the other things the Catholic Church does. I could tell by her wall decor that she was liberal (the Obama '08 sticker removed most of my doubt), later that morning she lauded Clinton, and told a NP and I that she is on the board of Planned Parenthood in the largest city nearby. (PP is eating all my mentors.)

I have no concluding thesis or thought from this experience, except that the degree to which pro-choice stuff soaks our culture is confusing. (She measures heartbeats but approves abortions?) It was, however, nice to shadow an OB/GYN. I like what I saw (and did!) a lot. I hope I can find a place where I can be tolerated, and I wonder whether I need to find a mentor who isn't pro-choice.

Dinner party

From the past few posts, it looks like it's all been fun lately. (I've been working, too; I promise.) I wanted to share a fun thing: I cooked for more than three!

I racked up a huge grocery bill to create shish kabobs. The menu included chicken, bacon-wrapped shrimp, and beef sausages. I marinaded the chicken in something I mixed up myself! 3:1 white vinegar to olive oil, plus some premade chipotle seasoning my Mom gave me. I combined the meat with onions, bell peppers (green, orange, red, yellow), pineapple, butternut squash, and button mushrooms. I drizzled the veggies with basalmic vinegar, lined up a row of kabobs on a baking pan, and baked them for ten minutes. I served rice on the side.

As always, there are surprises in the kitchen. For instance, I didn't realize the shrimp needed peeling (they still had shells and legs) until the last minute! Happily, most of the surprises were good ones: my guests brought more food than I thought. Someone brought half a birthday cake, another brought a pie and cupcakes, a third brought a fruit plate and a huge loaf of garlic bread! Someone even brought wine. We forgot to open it, he wouldn't take it home, and since I'm a teetotaler I think it's going to age until I think up something to cook it in.

A few happy moments: someone who I occasionally experience tension with complimented me on the chicken. She said it was moist and flavorful, and this especially encouraged me because of that homemade marinade! Everyone insisted that the food was good and that I should do this more often; one of my friends even sent an email afterwards. The world is so bright today!

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Edit: I added pictures today (12/13/11) since a tankmate posted them on facebook!

Lack of discernment = unhappiness

Whoops! I failed to think through and pray about several medium-sized things during this section of the curriculum. I signed on to shadow an OB/GYN the day before the exam, I missed the test reviews (vital vital stuff happens at those!) by double-booking myself and simple forgetfulness, I'm giving a dinner on the same day as the CMA-SS meeting, I went home last weekend instead of studying.... oh dear!

Discernment should've been in the front of my mind. Unfortunately, I don't have a habit of discerning. I have the opposite habit: making decisions (quickly or slowly) based on what sounds good to me. I need to use my time and energy more carefully in the future.

FQHC's

A federally-qualified health center (FQHC) is a practice that receives grants from the Health Resources and Services Administration (HRSA, the same people that offer rural loan forgiveness to medical students and residents). I read more about them here.

When I first heard of FQHC's, I thought they were a good idea and even thought I'd like to practice in one. It's a good idea to provide care to people who need it, yes? And these are the poorest of the poor, yes?

But on Friday I shadowed a pediatrician in an FQHC. I'm not a fan any more.

I was surprised by the sick-child visits. Children came in with no true complaint. I thought this must be due to low health literacy. (A 99° fever is not a reason to worry, especially if the fever doesn't register on a thermometer and the only reason for the visit is "he feels hot to the touch.") I asked the the doctor I was shadowing about this. She agreed with my assessment, but added another reason for these empty visits.

"It's so cheap" to come in, she said, that patients come in at the drop of a hat. She added that sometimes they are using their visit to skip school. If I were a provider to this population, I would much prefer these patients get good phone advice and go to school! But the doctor again surprised me.

She laughs at these empty visits and says it's "good for the numbers." An FQHC must maintain a certain volume of visits, otherwise it loses its funding. Upshot: he better the education she provides, the worse the numbers. Moreover, the more FQHC's that are established in an area (the fewer visits at each one), the worse the numbers. "Bad for business," this doctor sighed when she told me three satellite clinics were being established this year.

Now I have problems with FQHC's.

1. The Republican in me: our taxes are paying for what? (Not all these patients are here legally!)
2. The ethicist in me: where money is on the line, who can provide patient, solid counseling to patients?
3. The patient advocate in me: this arrangement is worse for patients; they become dependent on the doctor because they are not taught how to take care of themselves, the underlying cause of their visit (problems in school?) aren't addressed, and they receive poor-quality care (this was my experience yesterday and might not be universal).
4. The idealist in me: why is the patient's good bad for doctors?

There must be some better way to take care of the poorest of the poor; some way that does not involve government programs and conflict of interest, some way to provide true education and quality care. FQHC's make me sad because they're so close to a solution, but at the same time so problematic! Our system seems so misguided.

The Fence

I have a lot of favorite professors, but this post is about one of them in particular. He more than other professors reminds me of a TAC tutor—he loves his science, loves teaching, and doesn't mind what the world thinks of him. He is very polished and thoughtful. His lectures are a little scatterbrained, but that's also endearing and reminiscent of a few TAC faculty I admire. I sit in the front row and I feel like I got to know him. (I silently notify him when his microphone turns off; I answer questions, I make eye contact.) I wish I could tell you more, but I shouldn't give identifying information.

This past week, he presented the female reproductive system as his last lecture to us. We clapped when he finished; mine was an applause of gratitude and recognition of excellence.

Conscience Rights

A few newsbites:

• USCCB writes open letter to protect conscience rights. CMA, NCBC, Knights of Columbus, Catholic colleges sign on.
• An NJ hospital pressures 12 nurses who refused to assist in abortions.
• Christian Medical Association criticizes Obamacare's useless conscience clause (scroll down for Jonathan Imbody and David Stevens' editorials)

I got this summary from an AAPLOG email:

In a nutshell, Health & Human Services (HHS) has adopted the most limited right of conscience language ever to be used in federal law in its new contraceptive mandate to health insurance. Using language developed by the ACLU, the mandate now requires all policies issued to cover all forms of FDA-approved contraceptives, sterilization and counseling with no co-pay. The only entities exempt are those that:

1. Have the inculcation of religious values as their purpose;
2. primarily employ persons who share its religious tenets;
3. primarily serves persons who share their religious tenets; and
4. are non-profit organizations under section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii) of the Code.

Practically, this means that ROC protections are limited to churches. The one-in-six hospitals in the country that are Catholic must provide coverage for birth control and sterilization. Christian practices and non-profits that serve the poor must provide coverage for morning after pills.

Missionary for a moment

"You're Catholic, right?"

I was eating/studying over lunch with a classmate, and he asked this toward the end of the break. I wondered why he had to ask: I wear a San Damiano crucifix, I've blasted the entire medical school with two emails about the Catholic Medical Association, and I had blessed my food in front of him. I supposed that he was just speaking for the sake of something to say. But after he got my happy "yes," he kept going.

"What do you think of the pope?"

What do I think of the pope?? He's my vicar, my father, my teacher, my superior.... "What do you mean?" I asked him.

We talked about the pope for a little while, touching on authority, succession, and publicity. I tried my best to listen although I was bursting at the seams to say lots of theological stuff! It was fortunate that I held my tongue, because we stopped talking about the pope when my classmate got to the heart of the issue: faith and knowledge. How can you assert something without being able to prove it?

I was able to answer that question, goofing at first but then growing more simple and less scholastic. I told him that not everything that is not rational is irrational; not everything that is not natural is unnatural. And he actually seemed to be thinking about what I said.

Histology was our next class and we are in different labs, so we parted after my few sentences. But I was a missionary for a moment. (As an aside: thank goodness I am not a full-time missionary. I sort of shrivel up at the thought!) How wonderful; I hope I was a good tool.