Sunday, September 11, 2011

The First Weeks . . .

First day of class, patient presentations, Family Centered Experience, first day of anatomy, soccer, barbeques, Michigan's first game, tests (affectionately called "quizzes"), canoeing down the river with the family, tests on 16 lectures of material every week and the list could go on . . . I have already learned that is easy to get caught in up in the details in med school. So instead, I will simply focus on the "moments" of the last few weeks:

The Patient Presentations
Patient presentations are sessions with real patients who have a condition related to what we are studying. For purposes of confidentiality, I can't go into specifics or use real names, but the specifics aren't what mattered. In the two cases we saw, both of which featured life-altering conditions (Down's Syndrome and Huntington's disease), I was struck by this commonality: In the midst of major illness or condition, both patients and their families dropped the social masks we use everyday. As an actor and well, human being, I am fascinated by the concept of masks, how we present ourselves and what we obscure. It is unfortunate, I think, that it often takes something life-altering (or threatening) to feel comfortable being ourselves. In the case of one of patients, when her very life hung in the balance, somehow presenting the best face was hardly a priority. The quandry of human expression: how to live like you have nothing left to lose, before you have nothing left to lose. Both patients and their families were incredibly inspiring and definitely challenged me to grow into a doctor that will respond with real and creative empathy.

The Family Centered Experience
Like the patient presentations, the Family Centered Experience or FCE as it is called Let me take a quick break to mention that three acronyms are VERY popular in medicine. So far we have had FCEs, Multi-disciplinary conferences (MDC's), LC's, CFM’s and it just goes on and on . . . I think if medicine had its way, we would not have breakfast, lunch and dinner but FMD(First Meal of the Day), MDP (Midday Portion), and OLB (One Last Bite)!) But back to FCE. In FCE, we are assigned in pairs to a member of the community with a chronic illness. The idea is to expose us to the context of an illness not just the manifestation of the disease. I love this idea; it is humane and eye opening. Patients, in fact, have dogs. Good to know . . . 

Wow, this was intense. I made the “first cut” into my body a few days ago. I felt a mixture of awe, anxiety and excitement all at once. Good news: I did not accidentally stab my classmates with the scalpel! We had a wonderful introductory lecture in which this quote on Anatomy stood out: “We would suggest that whenever human material is used, a connection is established between the biographies of two people, the researcher and the researched.”
-Winkelmann A, Schagen

Every time I would come across a nerve, I could not help but think that there was a time when that nerve carried sensation (warmth, cold, pleasure . . . pain). Anatomy is both daunting (ridiculous amount of memorization) and rewarding (you engage the human body in the most tactile, hands-on way imaginable). And as for the big question: what does it feel like to cross the physical threshold of another person's body, I found this quote from our lecture to capture it well:

"Yet I also believe that the lesson of anatomy is that we do not  need to overcome all our emotion or conquer all difficulty in order to  be good clinicians. In fact, in light of the important balance that clinical detachment  requires, I should perhaps feel encouraged by my inability to always emotionally disengage."

I was engaged and I was disengaged simultaneously. Now where I have come across that paradoxical state before? Perhaps as the actor who is emotionally engaged in his or her character, yet maintains a certain objective distance. In this sublime tension, exists both the actor and the doctor . . .

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