Something = Useful

One might think about the road to medical school as carrying the status of "in training... for training." That's really what it was -- which means that medical school (i.e., "training") actually feels like a legit destination, even though it's clearly a transition towards an even greater one. The difference -- that is, the most surreal quality of this sensation -- is feeling adequate. As a medical student, with all the privileges and responsibilities that confers, I'm treated as "something" and often legitimately feel like I am "something" -- as opposed to "one day, going to be something."

It's almost a spiritual appreciation: one's self-concept and schema for how one fits into the world -- what role one plays, what impact one makes, the experience once crafts for themselves. It's different when you're "something," as opposed to "one day, going to be something" -- even while acknowledging that this "something" changes every single day. The key point is feeling like, no matter what changes happen, whatever that "something" turns out to be at any given point in time is, by and large, enough. There's somehow less anxiety, less awaiting. Enjoying being in the moment, this "training" -- because it's more than just a means to an end; it's awesome in its own right.

Yesterday, I was especially mindful of this. I had my second day at the clinic. I was there for 9 hours again; and, again, I had the time of my life. It was like an epic field trip -- except it's my life. I am on a field trip to LIFE. It's mine. It's here. And it's awesome.

I was a lot more comfortable yesterday -- with myself, that is. I asked bolder questions of my preceptor (whom I officially adore; he really is the coolest human being in the entire universe, and I am pretty darned close to declaring hero status). When I felt like an idiot, I told him I felt like an idiot. He's very empowering: he admits to his own faults and weaknesses, praises me for small doses of sub-idiocy, and never ever ever makes me feel inadequate.

He taught me, directly, to take blood pressure -- the kind of "menial" task often delegated to perceived subordinates (yet is actually a REALLY hard thing to do correctly). He takes all of his patients' pressure himself. Nobody'd ever sat me down with such a "basic" thing before; that's not how it's taught in medical school. We had our standardized patients, given a tool, and were told to "do it." Uh, yeah, sure, I heard something.

I felt moderately useful, too. I feel like, slowly but surely, I am integrating the basic "life concepts" that I know about and how they might fit into a given patient's situation. I find myself having thoughts that my preceptor later posed as his clinical reasoning. I get excited when that happens; it pseudo-reflects that I think usefully. I ask about diet and exercise all the time, when given opportunity to ask questions. My preceptor started asking patients about some of the GI concepts I tell him I care a lot about. Again, I feel useful.

There's something so gratifying about soaking up the subtleties of one's experiences, synthesizing them in a meaningful way, and finding a way to usefully apply them... already. Even while just being "in training." It's something.

And, boy, were there subtleties to soak up yesterday. Note to self: Never allow this much time (24 hours!) to pass between clinic and blogging. I've lost so much already...

* 18 year old kid, wealthy parents sent him here from out-of-state for private drug rehab. Well-mannered and polite, well-groomed. His caseworker was in the exam room with us. He was there for a new patient visit, though requested an STD test. My preceptor asked him if he had any concerns about an experience with a partner; he did, and cited that there had been unprotected contact. My preceptor did not inquire further -- not about the type of contact, whether it had been with a male, female or both, not about any of that. He did ask if the kid wanted everyone else in the room to step out; he declined. I later asked my preceptor if he intended to get into "touchier" subjects at his next visit (in a few weeks) without the case manager being around. Yes. But I didn't ask about what level of detail he was going to pursue. I'd want to have a complete understanding of this person's lifestyle practices, the risks and conditions to which he will be exposed. It's all relevant. It's so tricky to balance when/how one asks about those things -- when is rapport strong enough to be set up for success?

* I did ask a somewhat ballsy question of my preceptor at the end of the night. I noted that several patients we saw throughout the day were overweight, self-acknowledged it, and responded to my questions about diet and exercise with pretty discouraging responses -- and that I wondered under what circumstances did he take the time to intervene? I recognized that I was potentially inspiring awkwardness. Having a student around watching you, analyzing your moves and strategies, must be awkward. He was good about it. He told me that he intends to intervene every single time -- that, over the years, he has these conversations with these specific characters that go nowhere and that he gets discouraged and "gives up." I told him that I doubted that he was really giving up -- it's just that, under time pressures, he was prioritizing what would be most effective in the moment. I think he appreciated my attempt to make him feel better; and I think, also, he was actively reckoning with the dilemma as we sat there. He was trying to set a good example but explicitly acknowledged where he thought he had not delivered. I respected him so much for this. I can't wait to see how he really DOES carry out an intervention. I like this guy so much.

* One thing I particularly dig about this guy is the specific style with which he conveys information. When he mentions a particular detail about a symptom or a drug or anything else, he says: "You remember that..." or "You know that...." -- when, really, I do not know or remember any such thing. It's new. 99% of everything is brand new. I scribble it down, clinging to every detail, lest I never see it again until someone's life depends on it. I later transcribe it into my Excel spreadsheet, and look up whatever I can to fill in the details. Wikipedia is often more helpful about pathophysiological mechanisms than legit books or databases, which surprises me. It's hard to organize everything in a meaningful way, as I encode these random details. But I'm motivated to try, as opposed to feeling discouraged or daunted -- and so much of that has to do with the way this guy teaches.

* While my preceptor left the room to get something for his patient who was partially blind in one eye, I stayed in the exam room and asked him to describe to me what it was like to see both with and without his corrective lens. I wanted to practice inhabiting his existence. It was a really nice conversation, and I could tell that he enjoyed the opportunity to just tell his story. I heard all the nitty gritty crazy details of the past 5 years of his medical woes and, in response to my prompting, how they impacted the other realms of his life. It was rewarding to practice, specifically, the kind of narrative history-taking I've been thinking and writing about so much in recent months.

Fast-forward to today. Had a lunchtime speaker on eating disorders --a Q&A session for my classmates, who by and large are super-sheltered from the whole issue. This shocks and appalls me, mostly. We had an eating disorder theme during MSLG last week, and I was literally APPALLED at how poorly most of my classmates misunderstood any of the salient concepts. I've been brooding about it quite a bit all week. One day I'll write more about the specifics. Earlier this week, I had a Spinning student come talk with me about a friend of hers. I felt like I delivered in the support department; I felt good about it. Today's speaker was coincidentally from the outpatient program to which I referred my student. I conceptualize my role in most tricky areas in which I happen to have a lot of thoughts and insights to be to at least bring to the forefront of my colleagues' minds the kinds of thoughts that they should at least ENTERTAIN down the road. So I asked a lot of questions during this panel, designed to do just that. I was happy with how it went. But I'm still disappointed in how poorly the people around me a) think about relating to people struggling with psychosocial challenges; they get so awkward and b) embrace notions of self-awareness and perspective-informing. I was also underwhelmed by how there are no transitional support services to bridge inpatient and outpatient eating disorder treatment in the Burlington area. This surprised me. A classmate and I were talking, later, about starting up a program.

I think that this is a project I'd find really rewarding to create. More, eventually. Again relating to the point I raised earlier: my self-concept of where I fit into the world, what I'm suited to meaningfully contribute. I forgot how meaningful this issue was to me until the MSLG class pissed the hell out of me. Now that I remembered, I need to do SOMETHING with this appreciation.

Something useful.