Orientation

Its happened. I am really going through with this. I am writing this at the end of the second day of orientation, because frankly, yesterday happened without me. It just was. And I was there, but the entire thing seemed like a dream state; faculty and students engaging one another through intense gaze, sprinkled with colloquial niceties. The first dissection you do in medical school is of the students in your class. I never thought I would admit to this, but if you’re a medical student, you are narcissistic to some degree.

Its interesting to watch, and even more interesting to feel yourself secretly scowl at the people around you. That is, until you realize what you may resent in some of your fellow classmates (even before meeting them, I am sad to say) are the faculties within yourself that you once held dear. They are the very things that once made each and every one of us unique at our respective alma maters, from Princeton and Penn to Moarvian and Scranton. I’ve never seen such a quick dissolution of individuality in my life. Yes, each of us as students are individuals in our own respect, but as to the magnitude of what got us in the door of Temple, they completely cancel each other out.

I suppose I should find some solace in that fact. I now have the ability to remold myself, and for one thing, after talking to my fellow classmates, I’ve found that each have the drive to do so as well. But it is no longer to some further end (other than residency, but the numbers seem to govern that, not so much the complexities of human experience), but for the sake of a self-refinement. I’ve found that the second dissection one does in medical school is of the self; an almost panic-induced self-inventory. At least I hope everyone does this… it should be a momentary humbling experience, one that opens you up to the ability to respect the achievements and stories of those who will be sharing the next four years with you. For those who do not experience this, I suggest sitting down to allow yourself to be grounded.

Dr. Lyons, a prolific and extremely well spoken professor at Temple (who also interviewed me for medical school), shared a couple of thoughts with our class that first morning. I remember two of them very well. The first being the difference between “not knowing” and “ignorance”. Not knowing is not a conscious shutting out of information and experience, but more of an innocent lack, whereas ignorance remains double blinded. In one respect it does not know, but as a compounding factor, it does not care that it does not know when made aware due to some determination of necessity. I guess thats what I mean by the dissection of the self; to be successful in this field, one needs not only to become aware the s/he does not know, but must be comfortable with that fact. However, that comfort should be paired with an almost animalistic vigor to find out. This allows for one to open to the entirety of life experience. This is excellence.

The second thought. “Perfection is the enemy of excellence”. Dr. Lyons started with “life is demanding enough”, not as a prescription for getting what you need and want out of it, but that life demands enough from you without having to compound it with the stress of “knowing absolutely everything.” In this day of medical science it is impossible, and furthermore, a completely transparent and empty goal to be attained. Let the mindlessness of computer storage “know it all”. Which lead to his conclusion; don’t have a life in medicine, “have a life with medicine”.

Relief. Maybe this field is the right thing for me. Or, maybe against all probability, I managed to get the quack doctor buried in a University mislabeled for excellence in healthcare for the the underserved, and this is all a load of bullshit. Not likely. For anyone who has read the entry before this one (before I even stepped foot into the school), I wrote under Only the Weak, “I have no intention of being a doctor, its what I hope to do. I am still working on being human.” I am lucky to have found a school that understands the distinction between a life in and a life with medicine, between who I am, and what I hope to do. These two ideals are not at odds, nor are they mutually exclusive, but complimentary. I hope that one day they will still be identifiable as separate entities, yet intertwined to a complexity that rivals that of the human mind. It seems oxymoronic, but if you get the first distinction, maybe someday we’ll both discover what it means to live the second.

Only the Weak

I had to remove this blog. I had originally set out to make an achingly personal point by creating an anonymous person who was the compilation of multiple people I knew and experiences I had. However, I suppose it got out of hand and put in too many specific details which eventually lead to me pushing some buttons I didn’t originally intend to push.

I found myself at an impasse; I felt really strongly about something, an issue that has haunted me all throughout college, however I relieved it unintentionally at the expense of someone else. So what is fair? I keep it bottled up and have it eat at me, or piss someone off? I originally intended to write the blog knowing that none of my immediate friends knew I had one. I wrote it so that I could clear my conscience; put my thoughts into a neutral zone. Psychologists of the Lacanian school call it telling the “Big Other”. For example, when a child, while no one is around, says “I’m taking a cookie from the jar” as he reaches in to grab one is essentially telling The Big Other. He is relieving himself of guilt by stating what he is doing, so that he can complete the action with no harm done. He’s played by the rules. He has has done it with a clear conscience since he has promulgated the action. This concept is what “fine print” is all about.

This was my intention, to put into words something I cared about, and to put those words out there so that I could relieve some of the tension. I was confessing to the Big Other, letting the anonymous ear listen. Its interesting, though, that I did strike a chord with people who did read it. It wasn’t a personal attack, and should not have been taken as one. I was merely holding up a mirror; trying to make a point larger than a personal relationship.

SPSA: 34th Annual CME Conference in Traverse City, Michigan

At the moment I’m in Traverse City, Michigan with the Society of Philippine Surgeons in America attending their 34th annual Continuing Medical Education seminar in surgery, more specifically entitled “Surgical Highlights 2008: Controversies, Problems and Techniques”. I’ve been coming to this annual meeting for two years now, where last I year I was in Norfolk Virginia attending “Surgical Highlights 2007: From Complications to new Technology”.

Rather than droll on about the different surgical lectures (all of which at the moment I have trouble following due to my inferior medical knowledge), I have found a common thread that seems to catch the perview of all the experienced surgeons that attend. It is a simple one; new surgeons that are practicing now have been subject to advanced technology and are therefore losing “old school”, yet critical surgical technique. Case in point, the ability to convert a percutaneous laparoscopic procedure to an open procedure when complications begin to arise.

Take for example a laparoscopic cholecystectomy. The stigma is that opening a laparoscopic procedure is a sign of an unskilled surgeon. However, the opinion and statistical data show that laparoscopic complications (i.e. bile leak) occur after the learning curve; it is the experienced surgeon that becomes a bit too comfortable, thus leading to a problem. Compound that fact with no training in open surgery, and we are left with the statistic that only 0.1% of open choly procedures have a post-op complication, versus the 0.6% complication rate of a lapcholy. How does such a stigma still survive when the “advanced technique” produces 6 times the complication rate of an open procedure?

I guess the point is that yes modern technology helps in tremendous ways. Yet, we lose the art of surgery; the feel for the anatomy is lost to the secondary interaction via cold steel, the surgeon is now working in two dimensions on a tv screen, rather than three. I think the take home message is frugality with technology, and therefore one should not abandon the classic procedures, but cultivate such skills.

Marx talks about this phenomena. He describes man as “an appendage to the machine”. I’d like to think that what I will be doing in the future evades such a benign fate. I think that I am fortunate to have such a glimpse into the minds of the experienced, and I plan on taking their concerns to heart when doing my surgical training. To some, technology is God, but to others, I hope some of us find it scary when surgical procedures are no longer the outcome of a surgeon’s dexterity, but an outcome of the maturity of the technology being utilized. The newest and best thing in the technical world always has a built in expiration date, but refined skill and practice remains constant.

Thoughts?

Summer Anxiety

I guess this summer should be, or at least one would think it to be, the quintessential summer of freedom. This is how I at least hoped it would be. However, after 3 or 4 graduation parties, I soon realized that the rest of my friends were racing towards the “real world”, leaving myself behind in a lagging haze, awaiting a fresh start in academia.

Its strange. Perhaps I should have had this experience in college, however I did not; I’m living with another MS1 in my class, a person whom I have never met. However, in college this experience comes with a sense of security, rooms regimented and set up so that this type of relationship reiterates itself per dorm floor, leaving for a sense of community amongst those sharing the same anxiety. In my case, I found a place in North Philly, went onto our blog, and wrote “help, I need a roomate”. I got a response, which is money because it cuts my rent in half, yet, for the first time I really feel stranded, left to be defined solely by the consequences of my actions. No academic advisors, no mass-exodus to and from lunch, no crowd to follow up and down the main artery of campus, no patio to sit on to enjoy the blur of life as it passes by, no 2 minute walk to class in whatever I decided to sleep in that night… no scranton community. I went to a small liberal arts college where everyone I knew was within a mile radius of me, everyone purely available when needed. Imagine diluting such a community over the greater philadelphia area… thats my class and their physical proximity to one another outside of Temple… I was always on the more stoic side of the scranton culture, but I always had someone I knew and could trust right around the corner. In a month, I will be living in a corner of the city, living a preset schedule, running a pre-planned life for success. What if I miss something, or forget a form? Will there be that frequency of social interaction that allots for the probability of discovering my own mistakes and shortcomings? or, Will I go on ignorant to something I may have done (or not done) until its too late? I guess what I am asking is the whole sense of community gone for good once the Wachovia Center empties that afternoon in May, leaving only promises constrained by the new limits imparted upon us by the “real world”? Maybe I’m being too harsh, or perhaps blowing this feeling out of proportion. But at least I’m glad Ifeel some sort of anxiety. I trust that its better than feeling nothing at all.

I hope this sort of anxiety will soon be replaced by excitement. Nix that. I hope the fact that all this is really happening soon hits me as a reality in itself. I’m still unable to believe it. I do not want Med School to pass me by in the same way that college did; a reality too fast to get a handle on. Memories blurred into random conglomerations due to the inability to be conscious of each and every moment.

There’s an interesting problem; time flies when you are having fun, completely immersed in your life at the moment, and thus, unable to consciously recognize each and every one of those moments until they are only elidgible for recollection. So whats better, participating only part-way in life, living the other part in your head as a narrative, forfeiting some participation, so that the most precious moments don’t slip away without notice? Or, completely immersing yourself everyday in your experiences, not missing any crevice of the reality around you, living in one sense, a vibrant experience in real time, but a diluted life when becoming conscious of it? Stopping to smell the roses is nice, but what do you miss in the time it takes to do so?

Right now, I’m in Hafey, typing my reflection paper for Dr. Steele.

Thoughts?

What to Expect

This blog will perhaps someday be a log of my experiences, thoughts, concerns, and triumphs over the next couple of years of my life. I won’t only address my medical experiences in a scientific way, but sometimes under a moral construct, or perhaps from a philosophical disposition, as I’m sure the challenges that lay ahead of my generation cannot be championed on just a technical level alone.

I was accepted into the Temple University School of Medicine’s Class of 2012, and, in a couple of weeks, I will no longer be in that temporal space that every accepted pre-med undergrad has been so accustomed to… the space that treats time as a safety cushion, where we can say “yeah, I’m going to medical school”, without actually having to feel the gravity of those words. It’s scary.