Where the Soul Swims

Since the last entry, much has transpired. If anatomy is the metric by which I can track my progress and medical education, then I have ascended to the next level of understanding: we saw our cadaver's face. Some said that the visage of their cadaver will remain impressed on their memory cells (which ironically we removed later in lab). While I'd like to believe that there can possibly be eddy's in this new flow of information in and out of my mind, collecting pools of memories and emotions, I know too well the results of fast paced learning: everything is forgettable and it is often not under the control of the individual which experiences crystallize permanently in our memory and which become fleeting moments.

The exposure and removal of the brain was truly existential. Exposing the centerpiece of human existence to the open air, removing and feeling it, and realizing that I had cut through not only the skull but also the dura mater surrounding the cerebrum and the brain tissue itself was a new kind of exercise. I found myself thinking about where in the brain itself my experience of seeing the brain was stored. Dr. Stefan told us that some people say that the soul 'lives' in the ventricles (the open spaces) within the brain and then contended that, if the soul did in fact live there, it would in truth be swimming since the ventricles are the factories that produce the
cerebrospinalfluid which coats the brain and spinal column. Is this woman's entire existance contained in the 4 pound mass that we held in our hands?

As I was driving home from Lynn today, I was listening to a program on the radio of an interview with a Eboo Patel (his blog, his organization), I was struck by his statements about American’s pluralism. He summarized his organization’s goal as one which builds an environment (or in his words, a “movement”) of “religious pluralism” by fostering respectful relationships whereby people from varying backgrounds can celebrate their commonalities and at the same time understand their differences. I think this is important and all, but this idea is nothing new to me.

What struck me was when he continued to flush out the aspects of such respectful relationships, noting that we discover and define ourselves when we meet others that are different. I was reminded of my own periods of the continual self-discovery while abroad, when my homestay father and his son would ask me questions like: “Why is it that in America, people move out the house when they turn 18?” and “What is important in America?” and “How on Earth do you Americans pay for college (opening up an interesting series of discussions on the notion of credit)?” My mind turned to one of the women that we met at the New Americans Center in Lynn. She was an immigrant (or perhaps a refugee) from Russia and as I looked around her office, I noticed artwork and trinkets which encapsulated the different aspects of her culture: a matryoshka doll and a menorah both on her bookshelf, an abstract drawing of a concentration camp, and another Jewish-themed drawing on the opposite wall. Marks of a Russian Jew. My mind jumped again to a dinner conversation with my girlfriend’s father about how his grandparents were “Old Country” Russians and how the only shoes they wore were black boots that laced all the way up above the ankle. I found myself there, in that woman’s office, in the same mental pickle that I found myself in while I was in Nicaragua talking to my host-family about my (American, Jewish, suburban, twenty-something, etc.) customs. Again, I was trying to answer the question: “Who am I?” in the context of “Where do I come from?”

What's in a Name?

As we went around the room today, learning names, I realized after labored attempts that I the only names I had remembered of the seven who were introducing themselves were the two, European-derived monikers which fit my European-derived mental framework. The other five African identifiers simply slipped in one ear and out the other without any chance of being learned. During my travels abroad, I had been able to fit new terms into an old system, appending my own European/American culture with items that were foreign, but still connected at least linguistically. Even the myriad of new medical terms finds its place in my mind in the Latin skeleton that I created from seventh to eleventh grade (five full years!) which itself rested upon that majority of English words which is connected phonetically to its Latin roots. I suppose that what they say about teaching an old dog new tricks applies to me.

Nonetheless, these newcomers, nearly all of whom must be awestruck by the mere industrialization of an American city, who must be struggling with the humbling nature of realizing that their old skills and wisdom are not easily transferable to our culture, and some of whom are (according to some readings we received and common sense to boot) battling post-traumatic stress disorders, are expected to do just that: learn new tricks. I mean, simply, that English has no common derivation with the languages that these refugees use to express themselves and insofar as the transformation of language parallels the transformation of cultures, neither does their culture relate to American culture (although this is somewhat of a less scientific comment). However, sympathy is about as far as anyone can go on the emotional scale for these new Americans; their timeline for assimilating is ambitious—4 months—and learning the language and the culture is only a means to the goal of becoming self-sufficient. In fact, I felt a sense of emergency, rather than pity, when considering the fact some of those with whom I spent time teaching how an “uncle” is related to his “niece” or how a “grandmother” is related to her “granddaughter” had already been in the country for a month, one fourth of the allotted time for finding a job and avoiding welfare.

There was one man who especially struck me and who was also especially having trouble learning his new tricks. I happened to glance at his résumé, which the IRC helps its clients to create, and saw that, prior to the eleven nine years that he spent in a refugee camp in Tanzania, he had been a farmer for 19 years. For nearly as long as I’ve been alive, this man had tilled fields, cultivated land, and harvested crops. He had lived the simple (romantic) life that many of this nation’s forefathers dreamed of fulfilling themselves. Then, in 1998, something had drawn him away from what he had likely been doing for a hefty majority of his life (I’m not sure how old he was) and brought him first to a refugee camp and then to 101 Tremont Street where he was trying to learn English. It was heart wrenching for me, especially because his identity as a farmer could serve no purpose in the urban or suburban landscape, short of learning how to mow a lawn or if he were lucky, start his own garden (which plants that would undoubtedly be foreign to him). He essentially had to start with a clean slate at some mid-life age. When trying to transpose this circumstance onto my own life, I am at a loss for how I would manage to retain, frankly, my own sanity.

Perhaps even easier to relate, but along the same vein, was a news report that I heard on the radio while running errands last week: Iraqi medical students relying their frustrations with having to interrupt their medical training because of the seemingly ceaseless war. One interviewed student said something to the effect of: “I entered medical school because I want to help people and now my country needs help, but I cannot be there because our schooling has stopped. I don’t even know how I can conclude my training so that I can fulfill my dream to help.” Stripping someone of their dreams is perhaps the most debilitating of malices, especially when that person is already on the path to achieving them. Again, I don’t know how I would manage similar circumstances in my life.

My goal for this clerkship is to understand how better to help immigrant and refugee populations that I may encounter in my professional career. While one component of that will certainly be having knowledge of support services and opportunities, I believe empathy and understanding is another.

My Mind Wandering About Genetics Before the Exam

Check these out:
http://www.or-live.com/

Also, typing "surgery" into the search function of Google Video dumps you into a myriad of keyholes into the world of a surgeon. It's pretty amazing that 1) we can perform procedures like laproscopy, brain surgery, and lazik 2) any Joe Shmoe, from the comfort of their home can watch these surgeries. Surgeons are becoming more and more like Roboticists in that it seems they work with their hands less and with their machines more.

I wonder about the future of medicine often with the speed of innovation pointing our society more and more to computers. I especially wonder what will happen in the coming decade as we further explore the human genome - its inner mechanics, its nuances, and its faults - and eventually learn to control it. I mean, what happens when Science discovers how to do away with useless body parts like the appendix, wisdom teeth, and other unneeded organs before the womb? Or when we decide that humans are better off with four arms and extra muscle? What about when we discover that DNA and protein complexes are not the more efficient way to store and transmit genetic information. I am very eager to see these discoveries take place but it begs the question: in what field should I investment myself now which will enable me to be involved in change - whether scientific, social, or governmental?

Change and Goals

My life is slowly being self-refined to improve efficiency and output. I suppose anyone who realizes that time is limited while ambitions are boundless needs to make the choice to section life down to the essentials, whatever those may be. I'm still trying to figure out what my essentials, my essence, is. Strangely enough, time doesn't really factor into some kinds of mastery. I find it ironic that, since medicine is both and art and a science, there are aspects of this field that counter every pre-medical, hardworking, stay-up-until-four-in-the-morning-to-cram-for-the-test instinct that I've cultivated over the years. Building relationships comes not from hard work, although can be a prerequisite; relating to people does not follow a straight, predictable path. Finding a connection with someone is not like learning information, where clearly the more time that you spend studying, the better you will know the material. No, connecting to people is like Zen Buddhism (from my limited understanding of it) whereby you Do By Not Doing and Progress Forward By Moving Sideways. In fact, sometimes ambitious effort is retroactive. This is obvious to most, but what it means is that my learning here is split between working to synthesize information, connect concepts, and comprehend the scientific face of medicine, while at the same time, understanding how to be a professional in the face of sickness, sorrow, or sometimes simply check-ups. It is developing dueling and quite different skills and layering on top of these my own person, my own preferences, style, and...essence.

Skills for Life

I continue to intimidate myself with the understanding that what I am learning here and now will become the foundation of my life's work. While my experiences, lessons, thoughts, memories, moments, successes, and failures which have formed me into what I am and how I think were by no means for naught, there is a sense of eternity that this new information has. I feel as though I am shaping future career as a physician and so each time I sit down to study there is an added sense of urgency to remember every morsel of biochemistry, genetics, and anatomy which presents itself; it is the (perhaps false) feeling that everything now matters.

Then, this sense of eternity transforms into a reminder of my own mortality, to an understanding that if I put off fun and games now, that I will likely continue doing so until sometime in my 50s when I wake up only to realize that I've spent the past 30 years worrying about progressing professionally and I've neglected the simple important things in life and in doing so, lived a dry, monochromatic existence. Of course, these are two extremes, but it is difficult to how the road ahead will and more importantly, should traverse them.

We had our first biochemistry and our first anatomy exams, both of which were wake up calls and proved to be adequately challenging (that is a euphemism). They were good wake-up-calls to not only my own need to study, despite any level of innate intelligence I may or may not possess, but as well to the caliber of my peers and my predecessors: there are a lot of smart people in this profession. It was a reminder that excelling in this world ain't easy and that simply hard work and diligence are not even enough to succeed. It requires that certain je ne sais quoi which I have not found yet.

The Beginning

Medical school has begun and I've already received my second taste of death (my first, being in the anatomy lab, which I will touch upon later). My grandfather, aptly named "Pop Pop", passed away on Saturday; he was the last of my living grandparents. Even a mere twelve days into medical school, I can already see how medical school will inevitably change me. I saw myself mentally traversing between sadness and analysis as I watched, in the hospital room, my dying grandfather. I was of course deeply saddened by my Pop Pop's death and perhaps it was even more difficult to watch him struggle to stay alive, than it was to see his skin change from peach to pearl and to witness the nurse and then the doctor come in, check for vital signs, and then shake their heads. It was scary, though, to catch myself chugging through conjectures and hypotheses of what the cause of death was, for moments, as if I had turned off the sadness and turned on the science. I use the phrase "taste of death" purposely above, because it stimulates the same response in a careful reader as my own oblivious thought processes stimulated in me: "Is that normal to think of death in that way? Is it inhuman, cold, unfeeling?"

My first "taste of death" was met with similar confusion. The notion of anatomy lab, of dissecting a once-living-moving-thinking-feeling person, was, as described by a classmate of mine, "Exciting and nerve racking." It is, in my humble opinion, the medical school rite of passage. We had a lecture on the history of dissection, tracing it back thousands of years, followed by a talk about the UMass body donation program. Smell of fear stunk up the room as we first year students all realized that we would be carving and cutting in less than 24 hours. I imagine that this will not be the last time when fear will have to be buried in the name of performance. However, after the first incision, the four of us in my anatomy group realized that it was in fact easier (physically and psychologically) than we had thought to cut through human flesh, muscle, and fascia. Barely a week later, anatomy lab is equally awe inspiring but far more mechanical. My fear, then, has transformed from what it was before out lab--"Will I be able to do it?"--to something new. I now fear that routine will take over and my mind will convince itself that cutting into someone is not a note-worthy event. One of the many lines that I will have to straddle will be between mechanical, unfeeling, stone-cold precision on the one hand and emotion on the other. Both are necessary for my sanity and my future profession, but they can be mutually exclusive.

So, medical school and my training has begun.