Anatomy: a Complete 180

Gross anatomy has completely changed. Last year it was distressing; this year it is invigorating.

Last week I was in the lab again as a peer teacher, and the hours floated by like minutes--an experience I've only had a few times in my life. Three hours into the lab, one of the anatomy teachers said, "say, you can go," and I spontaneously replied, "no, I like it too much."

I'd been walking around the room, helping different groups with whatever they needed, and quizzing them. (What is the blood supply to that muscle? What spinal segments supply the greater occipital nerve? Is it motor or sensory? What is lordosis? What ligament is displaced in a herniated nucleus polposus?) Later, I went into the dry lab and quizzed a group or two on bones. I'd hold up a scapula and ask them where it was a left or a right scapula, and how many muscles attached to it; I'd select vertebrae and ask whether they were cervical, thoracic, or lumbar; I'd grab another and ask which ligaments ran on various surfaces. And later, when the lab began to empty out, I helped the groups that were a little behind (or a little too obsessive) find all the structures they needed. I answered a few questions about what to expect on the test. And I gloriously found a dorsal root ganglion (well, I cleaned off one that they weren't sure about).

Ah, so much fun!!

What's changed?

I've known for some time that I love teaching. I admit that I love the security of being knowledgeable, but I also know I love freely giving that knowledge to others. There's a high that comes with answering questions well, reducing test anxiety, or focusing their studies, or cleaning off a DRG.

I guess it all boils down to: I like comforting people and feeding people (here, metaphorically speaking). In fact, I suppose these are two of the reasons I'm becoming a doctor in the first place.

So, anatomy is different because I'm doing what I was made to do, instead of doing what feels unnatural? I'm still not sure, but I'll let you know in October. I don't serve in the lab until then, because September is the home of...

CARDIOVASCULAR BLOCK.

More soon.

Keeping my head above water

Med students; I'm front and center. (These are actually marines.)

Strangely, last year was substantially different from this year. Last year, we layered on knowledge about anatomy, pharmacology, and the body's general function. This year, our professors assume we have an empty mental index of bodily ills and have commenced stuffing said index with entries. We go at a pace of eight to ten new conditions per day.

Last week, we did lymphomas (forty varieties, eight of which we are responsible for), leukemias (five), stem cell disorders (six, some of which were redundant from last exam's plethora of anemias), bacterial and parastitic blood pathogens (eleven), blood clotting problems (eleven), and miscellaneous (four).

Whoa! A) Who knew there was that much that could go wrong with blood and B) Who knew that someone could learn all that in a week without feeling overwhelmed? (Wait.)

Another way to clock the med school pace is to count practice questions done. At the end of this year (spring 2013) I will take my first licensing exam (the USMLE Step 1). Apparently, all agree that this is the hardest test a future doctor takes, because it is the first time he has learned the material and lessons from books doesn't have as much sticking power as lessons from patients. The universally-proven best way to prepare for this exam is practice multiple-choice questions.

In the past three weeks, I've used 166 practice questions and made another 57. Today, I want to take a practice test and make another thirty- or forty-odd questions based on the material we've worked through so far.

As overwhelming as this is, it's also riotous fun. Without the reassurance of Christ's presence, I don't think this could be really good; with it, I can appreciate how fascinating the material is and how exciting this career will be.

Stepping over the Catholic Line

At one point, I assigned customs and people to points on a "Catholic line" between conservative and (eek) liberal. Guitars in the sanctuary used to make my skin crawl; I used to wince at Novus Ordo Masses in English; religious sisters in suits made me angry. My distraction would be so consuming that I would be unable to focus on the good.

Source: New Liturgical Movement

But the more I listened to homilies at these Masses, spoke with these sisters, prayed for humility, read the lives of the saints, and calmed down as the guitars played, the more I realized I was wrong. I was being prideful.

(To the very conservative Catholics reading this: do not be afraid. The need for reverence will never disappear, the radical nature of priestly and religious life is not altered, and the objectively greater beauty of the old Mass is uncontested.)

I find this concept of a line in most Catholics' minds, but let me make it clear for anyone still confused:

On one side of the Catholic line, there are Masses said in the Extraordinary Form. There are religious in full habit (including priests in cassocks, nuns with wimples, and barefoot Franciscans), contemplatives behind grilles, and Latin chant without accompaniment. There's Lectio Divina and much liturgical reverence. There are old words (like "Matins") and a growing number of young people. There is intense devotion to God's will.

Source: Apostles of the Interior Life

On the other side of the Catholic line, there are Masses in megachurches and spontaneous colloquy with God. There are youth ministers, Eucharistic ministers, and parish bible studies. There are lay apostolates, new orders in street clothes, and old orders in suits. There are guitars, lots of Adoration, lots of Theology of the Body, and lots of culture-engaging. There are old words (like "love") and a growing number of young people. There is intense devotion to God's will.

And the truth is: the line is a distraction. There are different customs, but one Church who strives to love her Spouse by every possible means. Striving authentically for this love and supported by our Lord's fidelity, how can She err? What about guitars can harm a Lord unconquered by death?

It's undeniable that there excesses called "liberal" and "conservative," and certainly so many examples come to your mind that I don't need to cite examples. (Canonically illicit lay clothing for religious, liturgical abuse, sedevacantism.... Oops, I just cited examples.) These are all true failures in devotion to Christ. But why should these make us allergic to legitimate devotion?

I am stepping over this line. I am not conservative or liberal. I am Catholic, charged with traditional and commanded to be open. I will boldly pursue this divine Bridegroom wherever He goes, unafraid of a few guitars.

Trading Stress for Calm

During the first few weeks of this year I felt completely crushed by the onslaught of school and the pressure to lead two student groups (MedSFL and CMA-SS) into a successful year. 

I'm slowly being helped to have more resignation by a collection of Pope Benedict's reflections on Mary. It's been a great help to think about Our Lady's perfect cooperation and calm with God's will.

So what if no one joins the CMA? So what if MedSFL offends some a lot of people? Who cares? God loves, and I belong to Him.

I have changed

Last semester, my class learned the physical exam, head to toe. We practiced everything on each other, except what we euphemistically call "the male and female exams." Practicing these were left until the beginning of this semester, when paid laypeople ("standardized patients") help us to learn proper technique.

Surprisingly, this was easy for me. I was surprised because I am a private person, and I take a long time to adjust to changes in my role. The female exam was not a problem because the summer prepared me very gradually; I expected the male exam to give me trouble, but I simply introduced myself to the patient, examined him, thanked him, and it was over.

My desensitization meter has, apparently, skyrocketed since gross anatomy last year. (In fact, since high school, when I did not used to look at the reproductive diagrams in my biology textbook.) Today, I feel like I can do or ask almost anything I need to to help a patient. 

I wonder how much more healthy desensitization I will undergo.

Recently, we had a professionalism class and shared professional and unprofessional behavior we've experienced while shadowing, working with, or being a patient to physicians. There were a lot of stories about ER physicians that became so desensitized that they turned into rude, mean, and irresponsible doctors.

The friend sitting next to me, whose father is an ER PA, began to whisper to me over the voices of the storytellers. "These people [our classmates] don't understand. ER physicians are exhausted by the worst of humanity over and over again. It's like med school," she went on, and asked me whether I thought I could explain to pre-meds what it's like to go through med school. "No," she said, answering herself. "It's like the army; they put you through something kinda awful, to prepare you for something awful. And you change. ER physicians change, it's the only way they can cope." She was growing defensive, but not losing her calm. "Do you think you could maintain any purity if you were constantly stressed out to the maximum of your capacity like that?"

I listened and made no answer. I know that too much stress and too much desensitization makes for ugly behavior. Medicine, as it is taught and practiced by some, changes the loving into the callous and the sensitive into the abusive. 

But it need not be so, or at least I hope not. I hope that medicine can be practiced by a physician who lives in the peace of Christ's heart; I hope that it can be practiced by people comfortable with intimate subjects, but who still perceive the dignity of others; I hope that it can be practiced as an act of self-donation.

If not, I hope I can find another career.

Don't Scare the M1s = Lie to the M1s?

I signed up for the M1-M2 buddy system at my school, although I later pulled out because I exceeded my personal limit of (5) extracurricular activities. (I'm still trying to push that number down, btw.)

This program is new, but surprisingly developed. Two M2s become 'parents' (a very loosely applied term, since it doesn't matter what gender they are) to a 'family' of two to five M1s. Requests are allowed, there are mandatory hang-out days, and M2s get trainings and a booklet to face common situations/crises. This didn't exist for my class, but I'm glad it does now.

The other day I was talking with the M2 friend with who would have been my fellow 'parent' had I not bowed out. (I know because they didn't take me off the email list until...last week.) We were talking frankly about the health problems that arise because of the stress of med school. Insomnia, GERD, IBS, Crohn's exacerbations, idiopathic rashes and infections, migraines, panic attacks, and injuries due to excessive-coping exercise are things that a sample of four students experience(d). Yikes.

And my friend said that she wished the M1s knew. "They told us, 'don't scare the M1's,' a.k.a. 'Lie to the M1's,'" she sighed. I was sad to hear that.

I find myself guilty of something like it: I always encourage. Whenever I meet an M1, I tell them that the first year is awesome and not bad, to counter everything that everyone said to me and still says. "Oh," people say sarcastically when they hear you're starting med school, "have fun with that." The assumption beneath everyone's words is always that it's awful! Reactively, I take up the contrary assumption.

But maybe I shouldn't. Maybe I should stop automatically proffering an opinion about how med school is, and start asking "how are you?" and "how is it going?" If asked, I can tell people the honest truth:

Med school isn't as bad as everyone said it would be, after I adjusted from moving. I had enough time to do the things I wanted and study hard. Even so, I think the stress is undeniable and I started to feel it in ways I hadn't before.... So enjoy doing what you've wanted to do for many years, work hard, take care of your health, and don't lose your soul's peace.

Pray for us! Med students, for good or ill, expect a lot of themselves and can drive themselves to destruction. Only with Christ is the proper balance of work and rest, so pray we look to His example!

The Year of Faith: I'm So Unprepared....

After reading Pope Benedict's encyclicals, I'm very excited for the Year of Faith that begins on October 11. This theological virtue is one of the things our culture (the Catholic culture, especially) most needs.

So, I made resolutions to grow in faith this academic year, by keeping Christ more in mind and by focusing in prayer on His presence. However, I find I'm running a bit behind the Church: I don't even have the prerequisites for Faith!

I lack meekness, which allows faith in unheckled! I lack calm, so the ship of my spiritual life is constantly buffeted with all kinds of turbulence. And finally, I lack discipline, so that I can't acquire the other two things!

(By the way: all the exclamation points aren't to signify fear, as if my own efforts can get me into shape before October 11. They're an attempt at holy shock at the state of my soul.) It's time to shape up.

Summer schedule and Second Year

Uninteresting post ahead. (Update for the sake of record-keeping.)

During the IBPCA preceptorship I went to morning Mass at a parish other than the one I attended all last year, because thought this would be better for my studies (if not for my gasoline bill).

Summer: (except for Wednesdays, which were surgery days)
6:00am: wake up, drive to new parish and make morning meditation before
7:00am: Mass!
7:40am: Morning Prayer with the parish (I was a little not-enthused about this...they pray so s.l.o.w.l.y and I sometimes skipped it to pray by myself later; in retrospect, I don't like that fact.)
8:15am: arrive at clinic, review charts
9:00am: Dr. D arrives. See lots of patients and learn lots of stuff.
1:30pm: grab a quick lunch. (I missed Midday Prayer almost all summer. And I really missed it.)
6:00pm: finish seeing patients
6:15pm: arrive home for Evening Prayer; research the things Dr. D told me to look up; attempt to win culture wars (online, by planning extracurricular events of this academic year, etc)
10:00pm: Compline and bed!

Second year: (except for Wednesdays, which are preceptorship days)
6:00am: ditto, with Morning Prayer
7:00am: miraculous ditto
7:40am: go back home (if class begins at 9:00) for carpool, or go directly to class (if it begins at 8:00)
12:00am: Midday prayer, lunch
3:00pm: home, and study for four or five hours. (This is the block I purchased by changing Masses, and I really love it.)
9:30pm: stop studying and do something spiritual: work on the icon, meditate on Scripture, etc.
10:00pm: Compline and bed.

Stories of Cooperation in Evil

During an IUD insertion the other day, I may have assisted without my will. I placed gel on the physician's fingers as she performed a pelvic exam before the insertion. It was almost robotic; I'd worked with her for weeks and placed gel on her fingers during almost every exam she'd done in that time. When she held out her gloved first two fingers, I reached for the gel and squirted some on obediently. Then I came to my senses: what had I done?!

Almost immediately, I felt relief, because a pelvic exam is not part of the insertion; it was just this physician preparing herself for the particular patient.

But today I read in the informational leaflet about Paragard that this, in fact, the first step of proper insertion technique.

Thinking back on this now, I can't remember whether the medical assistant, to whom I'd explained my beliefs, was in the room with her back turned to the doctor (doing something else, like looking in the cupboards for a speculum), or whether she was out of the room briefly.

I abstained from Communion for the intervening days before I asked a priest to hear my confession after morning Mass. (He was a young priest, just ordained not less than a month ago, so all his moral theology was still fresh!) I explained that I thought I had materially but immediately assisted and described everything. He said that he thought this might be remote and that he "wouldn't hold that against me," and I felt much better, because he speaks for Jesus!