Songs for the Lost

We acts as we sing. Song is a sign of our internal loves, because song is a form of intimate communication. (Fascinating implications for our country, the Reformation, the Church, and pretty much anything else.) Song is imbued with emotion, and emotion can be fuel to whip up zeal, contain grace, and remember God.

Some time last week, I was facing a dark development in the life of a friend (which has disappeared and all is as it was). The friend seemed lost, off the path so far I could not reach him. Despair is easy to slip into in such times, although a Catholic has hope. I was so hope-emic, though, that I needed some IV hope. Enter, song.

Song of the Church who has reason for her hope in the Cross. Song, especially, of the Medieval Church.

Adam lay ybounden,
Bounden in a bond;
Four thousand winter,
Thought he not too long.

And all was for an apple,
An apple that he took.
As clerkes finden,
Written in their book.

Ne had the apple taken been,
The apple taken been,
Ne had never our ladie,
Abeen heav'ne queen.

Blessed be the time
That apple taken was,
Therefore we moun singen.
Deo gracias!

Hope trumps sin; Christ saves Adam. This song captures the true happiness amid suffering and courage amid darkness.

First afternoon in first preceptorship

My first afternoon in Dr. F's preceptorship gets mixed reviews. You may recall that it had a rocky start.

So, confession time: I really want to be a doctor. I want to put my stethoscope on people and ask them questions and think up some things that might be causing their problems! I want to get messy and make mistakes! My preceptor, Dr. F, has a different approach. She wants me to see a lot and transition slowly. So, I spent the bulk of my day shadowing, took one history, and performed zero physicals. That made me angry.

I admit, her approach may have been a result of the way I presented that one history. I know presentations are supposed to be brief recaps of longer interviews that a med student makes to a physician. This allows the physician to check the student's mental work: what did she think was important? What step did he take next? What is he thinking of for a differential diagnosis?

I boiled down the history too much, I'm afraid, and I left my preceptor with the idea that I hadn't taken a complete history. To my frustration, she did not ask me for more; instead, she went in and interviewed the patient again, obtaining the same set of details that I did and all the while interjecting meaningful injunctions to me about collecting details.

Ah, misunderstandings! How you art rife when there is a power disparity!

I hope next week is better.

Conflict Resolution: I...can't do it.

You might think that the oldest of seven children, a "talker" in TAC sections, and a leader in lots of student groups would have some conflict resolution skills. But in the past few weeks the need arose for conflict mediation with a superior (Dr. F) and I was completely ineffective.

Although Dr. F asked for my goals during the preceptorship and was no doubt trained by my course coordinators in what I could and should be doing, my afternoons with her did not resemble a preceptorship at all. 

We spent large chunks of time closeted in her office talking about spiritual things and her philosophy of medicine (very alternative). While spiritual things and alternative medicine are terrific, it grated on me to see time slip away when I knew that I should be seeing patients (or studying). Worse, the patient volume while I was there was very small--I only saw two patients this week, and that was representative of the past three sessions. Finally, I was not able to practice forming assessments and plans, since the patients I was seeing were being evaluated for federal disability and no treatment is ever given. Granted, she calls me in to show me pathology, like femoral bruits or xanthelasmas. But the primary purpose of the preceptorship is to hone H&P skills.

I tried several times to ask her whether I could see more patients. "I could go in and see this one while you see that one," I'd say, but she would gently coerce me to do what she wanted in an annoyingly nice way that she probably meant well. All of this made me really angry.

Upshot: I called the course coordinator and I'm being moved; I won't even talk to Dr. F again.

Ironically, we have a Professionalism class about "Communicating in Challenging Situations" on Monday. I was reading through the presentation just now, which articulated all the things that I experienced:

The Typical Physician [and, by extension, the med student] is...

• Compulsive [check]
• Perfectionist [check]
• Guilt prone [CHECK]
• Exaggerated sense of responsibility [check]
• Limited emotional expressiveness [check]
• Significant communication deficits [ouch]

Conflict arises when...

• Perception that another person is blocking our goals [exactly what happened]
• Another person is not acknowledging or understanding our beliefs or values [definitely contributed]
• Different expectations about roles, resources or outcomes [the root of the problem]

I wonder how a two-hour class hopes to teach us how to resolve such complicated problems. These are moments when I'm glad I went to TAC, where criticism of ideas happened daily and formal behavioral  feedback (don rags) happened twice a year.

I guess I'm no perfect communicator, but I trust that the rest of medical school and residency will shape me a lot.

YAY!

So, the meeting today with CMA-SS's advisors about whether we're going to become an actual chapter of the national CMA-SS was...a complete success!

The advisor who expressed doubt about the cost/benefit ratio of chapterhood spent 90% of his time talking about how we could raise funds to pay the dues. The other advisor did the same. It was great to sit down and talk about what the group can realistically be. (And what we can be is exciting!)

Aaand, that's all I have to say. Sorry for the measly blog post.

Fortnight of Frenzy?

If I survive the next two weeks, it will be a feat of incomparable scheduling gymnastics. Watch what's happening:

1. Sept 17: CMA meeting to decide if our local CMA-SS will be a chapter of the big CMA-SS (involves finances and money, etc yuck)
2. Sept 17-20: Lectures covered by Exam 2
3. Sept 20: MedSFL reception in Houston (I'm going for fundraising and networking) [too crazy]
4. Sept 21: Exam 2
5. Sept 24-27: Lectures covered by Exam 3
6. Sept 23: first (mandatory) meeting of bible study I signed up for
7. Sept 23: monthly Mass with CMA-SS members
8. Sept 25: MedSFL meeting at my school (big event I've been working on for about a year, or maybe since June 2011)
9. Sept 26-30: CMA Conference, at which I am presenting a poster. If it seems odd that I be in Minnesota at a conference and at home taking an exam, don't be confused, because...
10. Sept 25: I take Exam 3 early (four days after Exam 2)

In order to do this, I am studying Exam 3 material now. (It's awesome, it's all about cardiac conductivity; I just wish things were a little more spread out.) I'm grateful that I'm not in the anatomy lab, that I've been taught cardiac physiology at every level of my education since age 14, and that Our Lord is present in the Eucharist all the time, waiting for me to lay the head of my soul on his Heart when everything gets too hectic. 

Hopefully, this won't be a frenzied time, just a very, very busy one where I hang on to Christ's peace until the whirlwind is over.

Law, Tests, and Posters

After taking Spirituality in Medicine and Literature in Medicine, I jumped at the newly-opened chance to take something a little more hard-core: Law and Medicine. We're learning all about the role of the expert witness, which is how doctors (who aren't being sued) see the inside of courts most often.

Also, today I took the first Cardio exam! It went well.

Afterwards, I picked up the printed poster I created for the upcoming CMA conference! I am very excited. Here's the abstract that goes with the poster:

Repair of Fallopian tubes (tuboplasty) was the standard of care for tubal disease before the advent of artificial reproductive techniques like in vitro fertilization (IVF). Tuboplasty is a morally acceptable treatment for women with tubal factor infertility. 

The recession and the upcoming compensation changes in the Patient Protection and Affordable Care Act provide stimuli for mainstream medicine to prioritize what Catholic gynecologists know to be the ethically superior treatment. This year, the Practice Committee of the American Society for Reproductive Medicine (ASRM) edited their Opinion on tubal surgery: where they had recommended IVF as the preferred treatment option for any woman with tubal disease, they now recommend tubal recanalization techniques for treatment of several tubal disorders in young women with no other significant infertility factors. 

This presentation aims to review the research prompting the ASRM’s shift and the potential corresponding shift in medical practice. Surgical techniques reviewed include falloposcopy with a linear everting catheter, guidewire cannulation, coaxial cannulation, falloposcopic catheterization, selective salpingography, fluoroscopy, and hydrotubation. The best of these techniques have success rates similar to those of IVF and should be preferred for medical and economical reasons, if not moral ones. 

In conclusion, there are manifold opportunities to increase availability of IVF alternatives in mainstream gynecology, especially to young women who suffer from tubal factor infertility. At the same time, gynecologists have a chance to popularize ethically superior alternative treatments and raise discussions among their colleagues about other morally excellent practices.

(Like NFP.)

Struck by Dignity

Another opportunity to think on my feet: I was told to see a returning patient who was following up on pain problem.

The patient told me about her pain and that she figured out what started it all: holding the phone with her head for hours while working around the house. At that time, a new relationship was beginning for her, and she would spend a lot of time on the phone. After a few more minutes of history, I asked her conversationally about that relationship.

She told me it was great! They were finding so much in common and it was a great source of enrichment and joy for her. I could see that it lit up her face. Then, between sentences about how the relationship was flourishing she said, "now, I won't lie to you, it's not a man--it's another woman, and..."

I stopped hearing her for a few words, feeling as though I had been struck. Everything was so normal until that sentence. Now what do I do? Instantly I began to determine how I should receive this news: it is clear that this relationship is more than friendship and I know that homosexual acts are naturally disordered and spiritually harmful. But I am not this woman's doctor and am, in fact, a stranger and a medical student visiting the office for education. But will I give scandal if I calmly smile and nod? I am wearing a crucifix and am therefore a representative of Christ for this woman, who is surely observant enough to notice my necklace.

The patient was concluding, saying that she felt valued in her relationship. I decide to say true things but withhold the truth that is inappropriate to provide. "I am so glad that someone can make you feel the dignity you have as a person, can appreciate your worth," I said.

Her response was almost as shocking to me as the original admission. She was delighted! She said, "that's exactly it," and that I completely understood. She went on about her partner while I went off into thought. Untangling my thoughts later, I wondered:

1. This woman only found appreciation of her transcendental value in this relationship. This is terribly sad: everyone can appreciate everyone's human dignity...we don't need intimate relationships for this (although I'm sure this love is crowned with greater intimacy).
2. Is hunger for this appreciation fueling homosexual intimate relationships and the gay marriage drive? 
3. If there someone else made this woman appreciate her human dignity, her , would she ever want a homosexual relationship?
4. This woman is missing out on a unique element of marriage: self gift as a woman, to a man. There is so much more to marriage than simple (though profound) appreciation of human dignity.

The patient later told my preceptor that I was "an excellent human being" (I guess, the highest praise of the secular world?). I think I was at least excellent in one thing: I saw what she loved about being loved.

The Preceptorship Diaries

During second year, medical students at my school are placed one afternoon each week in a physician's office to learn to take histories, perform physical exams, create assessments and plans, and document their work at a tempo that resembles real life. (This replaces the lovely take-your-time atmosphere of the simulation center.) I became really excited: finally, a chance to play doctor at a real pace!

I knew that my preceptor, Dr. F, was an internal medicine physician. Further, I'd heard that she gave an informal talk on superfoods and was going to come talk to the Holistic Medical Society (which is actually a cool group, when it avoids the hippie commune end of the spectrum and adheres to good practice using all available wholesome methods). Her name was Indian.

Her office was adjacent to an acupuncturist's (later she told me that she was also certified in acupuncture). I entered and was asked to wait in the waiting room while she got off the phone. This was unusual for a medical student (usually, I'm told to come right back), but I sat among the patients and quietly waited the short time until I was called back. I noticed that this office, like Dr. D's, attracted people like the doctor: Dr. F's staff and clientele were more brown than, say, Dr. C's or Dr. A's.

When I was called back, Dr. F greeted me warmly and sat me down in her little office. She asked me what my goals were for this preceptorship, for which I was grateful. Next, she discovered that I studied philosophy and theology, and asked me for a favorite scripture. I mentioned the Song of Songs, and recited the verse that appears when my alarm goes off in the morning ("Arise, my beloved, my beautiful one, and come!"). She was charmed, and hinted that she might look up the book on Google.

While I was describing TAC, she learned that I was Catholic. She asked me, "what do you think of diversity?"

I answered honestly, if in an abbreviated fashion. "It's beautiful," I said. "I haven't always spent time in the most diverse environments" (TAC had one black student?) "but I realize that people's different experiences and cultures are enriching." This was true, and largely the product of my summer with Dr. D. I left other thoughts about diversity unstated: its ascent to a replacement for true exchange of ideas in this culture is strange at best, and relativist at worst.

Dr. F smiled slightly, but then looked at me squarely. "I meant difference in religion," she said.

For an instant, I was at a loss. I gathered that Dr. F was something of a pancretist: she had a large carving of a Native American medicine man on driftwood in her office, she wore a tiny rhinestone angel pin, she had a calendar displaying a Hindu god, she promised to look up the Song of Songs, and she was asking me this question.

I could not lie. "While I believe that my faith is the truth, I cannot and will not treat others without the dignity they have as human persons."

Boy, that was hard to say! A little wall went up in her eyes after the first clause, and her next sentence started in a tone most professors reserve for the correction of a wrong thought. ("Well, hypertension is associated with atherosclerosis, but this question is actually asking something else....") I'm not sure whether this preceptorship will go as swimmingly as I'd hoped. Time will tell.

A Report on the Vital Signs of the Profession of Medicine: We're sick, but we're Fighting it

I recently sent out a mass email inviting the entire College of Medicine and the entire College of Nursing to an event cohosted by the Bioethics club and Med Students for Life.

(Ooh, I hate sending out mass emails! The trauma of clicking "send" when you know four thousand people will receive the message makes me wince and shiver.)

As you can imagine for an event cohosted by a bioethics club and a pro-life group, the topic is slightly controversial. But this story isn't about the controversy stirred up by the speaker. Ho no! Just the name Med Students for Life generated this response from an unknown physician professor:

To imply, as the name of your organization does, that not all physicians are "for life" is ludicrous. Of course we are. That is why we became physicians--to preserve life. But while I do not personally perform abortions, I do support a woman's right to make decisions regarding her health and what happens to her body. Why not simply call yourselves Medical Students Against Abortions? Or is that not sufficiently charged politically?

Obviously MedSFL has no problem getting enough political charge.

The doctor has a beautiful point, though: doctors preserve life. I was just talking with my probably-pro-choice classmate this morning about how doctors want to make things better. We were speaking about our Humanities selectives and I mentioned that my professor seems like the typical lawyer: he talks fast and a lot, he is opinionated, his vocabulary is sophisticated yet peppered with profanity, and he mentioned in one breath that he had a taste for social work and a taste for blood (meaning the figurative blood of the people he grills in courts). He's a divorce and child welfare lawyer, and acknowledges that half his time is spent tearing families apart. Yikes.

My classmate and I were musing, 'thank goodness we belong to a profession that most people enter to put things back together, to preserve and protect.' So this doctor hits the nail on the head: doctors enter medicine to preserve life.

I'm sorry that this doctor does not feel that the unborn patient falls under our professional jurisdiction, but I don't need to spend space rebutting his position (even though the decision to abort is in over 90% of cases not pertinent to a woman's health and is in 100% not pertinent to her body alone--oh, oops), nor do I need to demonstrate that "against abortion" is not the same as truly "pro-life" (when a consistent ethic of life, i.e. being pro-person and pro-human dignity across all ages, races, abilities, etc is the core any good pro-life group like MedSFL--oops again).

I calmly replied, apologizing for any hurt he felt and gently explaining that our group's name is not designed to degrade doctors, but is meant to encompass a consistent care for unborn patients, pregnant women, and women for whom pregnancy would be dangerous or inconvenient. Calmly as my words seemed, I was a little shaken by the vitriol. Aren't we supposed to be evidence-based people? People eager to hear lectures and read papers, providing that they're scientifically rigorous? Aren't we supposed to let the little things (like student organization names) slide? And would you send something like that in response to an invitation?

Moreover, I was surprised at the age of the argument, that a woman's body is her domain. According to research by Charles Kenny and the Right Brain People (not the political right, the neurological right) showed that women realize that a fetus is alive and has a right to life, but that killing that life is the least of three evils they face when caught in an unplanned pregnancy.

So the email disturbs me on several counts: first, it admits that our profession preserves life while defending the opposite (it's inconsistent); second, it displays a sort of uncharacteristic emotionalism not accepted elsewhere in the profession but routinely accepted on this issue; third, it exhibits outdated perceptions of female patients in a profession allergic to anything outdated and chauvinist. It appears that medicine, not unlike the legal profession, is sick.

Oh, I told myself, at least we're not sick unto death, like the profession of law. Then that the doctor sent a reply to my reply to inform me that "what [I was] saying is that [I] want to impose [my] value system on all patients. But," he asked me, "are you going to force a Jehovah's Witness with a life-threatening GI bleed to accept a blood transfusion? Of course not. You are against abortion. Fine. Then call your organization what it is. Medical Students Against Abortion." I did not reply to this one.

The profession of medicine has a stage IIB (of IV) cancer and we're starting some aggressive chemotherapy. Young doctors and medical students are dragging speakers into their med schools and demanding that others look at the issue and think consistently (drat the decline of liberal education). Check out MedSFLA's fall tour schedule and their 2013 Conference and see what I mean.

This has been your report on the profession of medicine's vital signs. We're sick, but we're fighting it!

Blocks

My medical school curriculum is divided into blocks based on organ systems. We've finished Core Principles of Medicine (I and II), Intro to Disease, Neuroscience and Hematology/Oncology.

Next, we embark upon five weeks of cardiology (cardiovascular-ology? anyway....) in the Cardiovascular block.

After that, we have Respiratory, Gastrointestinal, Reproductive/Endrocine (!!), and Musculoskeletal. (I might be missing one.)

The cardio block is distinguished by its weekly tests, mounds of physiology, and fast pace. Despite these terrors, it was rated "best block" by last year's M2's.

Here we go!