Sharps Container

Opening Heaven's Gate - Part 4

noreply@blogger.com (AB) — Mon, 10 Aug 2009 18:47:00 +0000

Opening Heaven's Gate - Part 3

noreply@blogger.com (AB) — Sun, 09 Aug 2009 23:49:00 +0000

The following short story, titled "Opening Heaven's Gate," was written for an assignment in a narrative theory course I took during my final year in college. This was my first attempt at any type of creative writing.

It will be presented in a series of four posts. These divisions were not part of the original assignment, and carry no thematic or structural intent. Enjoy.

--

Sarah didn’t say anything, but agreed that she was. All wrapped in pure innocent white, with a pink shell to protect her, the child had no conception of the life that lay ahead of her, but was somehow contented, like a turtle pulled into a pastel fortress against the world. Sarah knew her child would need to be comfortable around her father, needed to become a strong figure capable of coping with the leering eyes of the community’s grown men who in fourteen short years, no doubt, would be looking for another plural wife. Maybe there was a man out there, already with a few wives of his own, who the Lord had destined to join her daughter in holy union. Hell, rumor had it Abe had gone visiting the Gantry homestead up in Hildale a few weeks ago. Terah Gantry, still virile at eighty years of age, had a few daughters who were coming of age. Sarah wanted her daughter to be strong, familiar with the men so she would not be taken advantage of. Confidence around the men would give her the power to influence decisions, make a difference in the community through influence with her eventual husband. Sarah lifted the child out to Abe.

“I don’t want to hold her, not yet. Only a woman knows how to hold a child proper, and that little foal needs to get further acquainted with her mamma,” Abe said.

Sarah fumed, barely able to conceal the undercurrent of rage that burned deep within her bosom. Her face flushed and she used her free arm to pull the blanket further up over her chest. His lack of attention during pregnancy was forgivable. She had plenty of help from the other wives. But to not hold his child, his brand new, living, eating, breathing, possibly thinking child? His temerarity drove a stake deep into her very core.

“Well I came in because I’ve decided on the name,” he opined, fully ignoring her crimson cheeks. As was tradition, the man in the house always had the responsibility for naming the child. The women conceived, carried, suffered, cared for, and raised the children, but it was the husbands who always decided the name. “We’re going to call her Hannah. It means God’s grace. I was hoping to one day have a Hannah. I’ve almost gone through every other name in the book, but this one’s something special. Look at her blond hair and blue eyes, just like her daddy.”

Sarah’s anger slowly abated. Hannah, the Lord’s good grace, a fitting name. Birthed like an angel, rising up to relieve Sarah from all her pain. The physical incarnation of the Lord’s grace manifested on earth, in a tiny bundle of white cotton and pastel pink. Her personal friend and saviour, a guaranteed package of unconditional love, delivered for her to enjoy for the rest of her life. And best of all, the last syllable of the name rhymed with her own. Hannah, Sarah, just like mother and cub. The cub never straying too far from her benevolent, omnipresent protector. Life would be good, with Sarah to guide her. Hannah would be her daughter forever, tied to Sarah through blood and name, a bond no earthly force could rend apart. There would be a certain musical cadence to the name when, in a few months, the cantor would sing out in his deep bass voice, “Hannah daughter of Sarah and Abraham, be forgiven for your sins,” eliciting a stately echo from the marble walls of the temple’s main chamber. Sarah approached the baptismal font with Hannah grasped close to her chest, clothed in a miniature plain white gown she had sewn just for the occasion. When she reached the font, the elder acting as priest said the necessary prayers and instructed Sarah to baptize her child in the Lord’s life-giving waters. Sarah moved her child away from her bosom, held her above the font, and completely immersed her for a short half-second in the water. The baptismal gown, once a brilliant pure white, now soaked, clung to the tiny body as Sarah pulled her from the water. The cotton turned a shade of grey and felt heavy with the weight of the water, desirously grappling to drag the young girl back into the depths of God’s healing waters. “The Lord welcomes you, Hannah Clarkson, into his full communion,” the apostle said as Hannah shivered, now safe against Sarah’s chest. Shivered, without so much as a sound.

Opening Heaven's Gate - Part 2

noreply@blogger.com (AB) — Sun, 09 Aug 2009 00:24:00 +0000

The following short story, titled "Opening Heaven's Gate," was written for an assignment in a narrative theory course I took during my final year in college. This was my first attempt at any type of creative writing.

It will be presented in a series of four posts. These divisions were not part of the original assignment, and carry no thematic or structural intent. Enjoy.

--

Watching the child as she nursed, Sarah slowly unwrapped the pastel pink blanket, wanting to see if the angel that had arisen from between her legs amidst Rebecca’s yelling and her own flights in and out of consciousness was indeed a corporeal being. Careful to keep the child close to her body for warmth, she removed the pink blanket, revealing another of pure white cotton underneath. Removal of this layer exposed spindly arms and legs, perfectly formed hands, feet, and toes, and a pink torso, almost imperceptibly rising and falling with the intake of each short breath. A marvelously formed body, straight from the vaults of heaven: supple, untarnished skin, light wispy hair like the finest of spider silk, all finished off with those cerulean jewel-eyes. The baby’s body looked so innocent, lying in the crook of Sarah’s arm, suckling down milk with healthy vigor, relishing the sublime pleasure of her mother’s provisions. Held tight by the fleeting peace of her daughter’s contented suckling, Sarah wondered if her mother had ever looked at her with similar eyes when she was newborn, a short fifteen years ago. Wondered if her mother had looked at her body before it was assaulted by pastel dresses, bonnets, stockings, proper shoes with a proper heel, the cloistered stares of the adolescent boys and the open gawking of mature men. Or had she thought her ugly, with her brown eyes and nearly black shock of hair, a curse for sins unknown to her? Had she once been innocent too?

A faint tapping on the door startled her from this train of thought. She heard Abe’s voice behind the door, and out of modesty, removed the child from her breast and slid back beneath the blankets. The infant began to kick and the face again turned red and contorted, but no sound came out. Sarah turned her head to make sure her hearing was working, but heard nothing other than the faint huskiness of Abe talking quietly with Rebecca out in the hallway. Everything was there: the flushed, angry, contorted face, the kicking, and the shaking of a scream. Everything but the sound. The child, still frustrated and obviously hungry, was not making any noise. Knowing Abe would soon enter, she rewrapped the child, first in pure white, followed by pastel pink, albeit without the skill Rebecca had developed through six children. Abe entered the room, and walked around the foot of the bed.

“I want to see my daughter,” he said.

Abe was a good catch by any girl’s standards. One of the founding members of Heaven’s Gate Ranch, he was the head foreman and engineer for the construction crew that ran all building operations. Thirty years ago, as a young man of twenty-two years old, Abe left the settlement of Bountiful with four other men and their ten wives, two each, respectively. The story had now become legend at Heaven’s Gate, one journey in a long line of wanderings, dating all the way back to the prophet’s first move from New York to Pennsylvania in 1827. Abe employed his carpentry skills in the construction of the first house in their remote corner of New Mexico, a sturdy, five bedroom dwelling—one for each man and his two wives—which had been expanded over the past thirty years to hold his five wives and close to thirty children. He had since built houses for the other men and their expanding families as well. The once small community had, with its own thriving growth and the arrival of other like-minded settlers, grown to nearly five hundred members. If these people needed anything built—be it house, temple, or something in between—Abe was the man they turned to, from the first conceptual architectural drawings to completion of the final structure. Abe was always building, bettering Heaven’s Gate for the glory of the Lord.

Sarah stood outside the oaken door of the temple’s main chamber, examining the expert scrollwork lovingly carved into the face of the door. The space was divided into six squares, each of equal size. In the center of each square was a series of five concentric circles. She traced her finger along one of the larger circles, going round and round, always tracing the same path in a never ending contemplation of infinity. The temple was cold inside, the lights were out, and the yellow flickering of candles contrasted with the pure white moonbeams that shone through small clerestory windows. A chill ran through her body and the starch of the simple, neatly pressed white wedding dress she wore felt rough against her skin. Yesterday had been her fifteenth birthday, and she had received the dress as a gift, the first recognition of her birthday in fifteen years. Abe Clarkson, the man who she had never met, but only seen from afar, waited inside with the rest of the elders, and she could hear their voices, muted to the volume of a whisper through the thickness of the door. Suddenly, as she traced, the door opened quickly, leaving her finger pointing in midair, her body in a prophetic pose, as if pointing the way to the Promised Land. Sarah’s father gave her a strange, unfamiliar look, and beckoned her inside with an unemotional distance she had never experienced from him. Abe, with his reptilian, sun damaged skin and a slight paunch overhanging his large gold belt buckle, looked all of his fifty-five years, even in a fresh-pressed shirt, black jeans, and black jacket. Sarah could have sworn she saw him flinch nearly undetectably as she entered the chamber.

“She’s beautiful,” Abe said.

Opening Heaven's Gate - Part 1

noreply@blogger.com (AB) — Sat, 08 Aug 2009 03:09:00 +0000

The following short story, titled "Opening Heaven's Gate," was written for an assignment in a narrative theory course I took during my final year in college. This was my first attempt at any type of creative writing

It will be presented in a series of four posts. These divisions were not part of the original assignment, and carry no thematic or structural intent. Enjoy.

--

Opening Heaven's Gate

“Almost there, just a little further, another good push or two and this will all be done. Stay with me here, stick with me. Stick with me, you’re ready. Deep breaths. On my count, we’re going to push. One, two.”

Just as she heard three, Sarah prepared to push, summoned all of her will to break through a pain-induced fog. It was not enough. The world quickly reduced to slits, smaller than the eye of a needle, and then, with another contortion, zoomed back in its bright, variegated glory. Starched white curtains and neutral yellow walls were cutting, razor-edged. The lavender pleats of Rebecca’s dress contrasted sharply with her flushed, sanguinely pleading face. The past thirty hours had been rough on her too. Sarah just had to stick with her. Gather the strength one more time. The world began to fade again.

Then a jerk and the plea underwent a spontaneous malevolent transformation.

“FOR GOD SAKES, IF THERE WAS EVER A TIME TO PUSH, NOW IS IT!!!! PUSH YOU GODDAMN HEIFER!!!!!”

Sarah supposed the Lord would forgive Rebecca’s single curse in a moment such as this. Spurred to action, she collected her reserves for one final salvo. She bore down with all her might and, miraculously, the acute, searing pressure released. A naked, wingless angel arose from between her frog-splayed legs, held aloft by Rebecca, dripping yellow molasses, tethered to the table, kicking, face contorted in the grimace of a nascent scream. Sarah’s body, its resources spent, gave out, and she spun into the midnight black of a moonless night.

She awoke supine, unable to move her legs, a consequence of the heavy woolen blankets under which she lay, Rebecca’s knowing action taken to guard against the encroaching winter cold. Looking out the second story window, she noticed a teenage boy traipse by on the dirt road outside, preoccupied with a stone he kicked along as he walked. Not in the mood to see any of the outside world, she tried to move her arm to pull the blanket up over head, but instead felt as if she was lifting a weight, something about as heavy as a half empty bag of potatoes. Turning her head and staring, she was startled to find a small pastel pink bundle, the now serene angel face gracing the end closest to her head. Sarah took a closer look, and a set of new bright blue, unfocused eyes connected with hers. Thank God. The cerulean glow of her eyes was just like Abe’s, blue as the sky, not her own muddy light brown. This little one would not have to cope with the incessant teasing of her fellow schoolchildren, as Sarah had.

“Where’d you get your eyes? Devil visit your mamma in the night? My mamma says all God’s children got blue eyes. Just like all the angels. Blond hair too. Brown eyes is real bad.” That childhood scourge would end with Sarah. Her little girl’s eyes and hair were blue and blond, beautiful, normal, communal. Blue and blond, just like Abe. No one could question her paternity; The Lord had colored her eyes just the same as all the children of the other wives.

The miniature face contorted again into the recognizable grimace, though this time out of hunger rather than anger at the eviction from the familiar comforts of its mother’s womb. The child’s mouth opened to release the scream and the face turned three shades of famished scarlet. Sarah felt the frustrated exhalation lightly brush her cheek, but no sound came out. Maybe she was tired, unable to hear anything. But she had heard the boy’s boot lightly scrape the gravel outside as he kicked the stone. Sarah labored out from under the weight of the blankets, propping herself up against the headboard of her large, oaken bed, one of six in the house. Suddenly, she was overcome with a wave of fatigue. Unable to give the silent scream more than a few seconds of cognitive attention, her thoughts and movements relied on newfound maternal instinct. Lifting the bundle with her right arm, taking care to support the head, she bared her breast and the child took as naturally to suckling as the brown calf Abe had delivered last spring. The warm flow of milk made her instantly relax. It was a relief. The child Rebecca birthed a few months ago had trouble suckling just like her other five, but that one lost a pound or two, looked like a starved lizard there for awhile until he figured it out one day. Scared his mamma half to death. Sarah would not need to deal with those problems. This was her first child, and with her children things would be different.

Feliz navidad a todos...

noreply@blogger.com (AB) — Wed, 24 Dec 2008 16:17:00 +0000

Wider post area...

noreply@blogger.com (AB) — Tue, 02 Dec 2008 21:36:00 +0000

I recently widened the blog's main post area using this modification from The Blogger Guide. I've heard that there may be some issues with this update when viewed on a lower resolution screen. Please let me know if you're having any problems in the comment section of this post, and I will change it back. Thanks!

Scream...

noreply@blogger.com (AB) — Mon, 01 Dec 2008 18:24:00 +0000

Nearly a year and a half have passed since we met, but I can still remember the terrified tenor of his screams. I looked him the eyes and caught a glimpse of a once vibrant spirit, now teetering on the edge of extinguishment. He returned my gaze with the precursor of a nascent smile for a short moment before recognizing the familiar sights and smells of his surroundings. A look of horror obliterated the smile, and in a brief nanosecond his expression changed from one of mischievousness to sheer terror at what he was about to experience. His slight three-year-old body writhed violently against the iron grip of the nurse as she attempted to calm him. "Tranquilo, Yason, tranquilo. Shhhhh. Tranquilo."

At this point in my trip to Guatemala, I had been working mornings in the operating room for about two weeks. A small stroke of luck brought me to this moment. I had traveled to Guatemala intending to learn Spanish at a Guatemalan school, with the hope that I would have the opportunity to spend some time observing and possibly helping local doctors at one of the many clinics sponsored by international aid organizations. My first few days of volunteering were spent in one of these clinics, where I encountered a total of three patients in twelve hours. After making a connection with one of the local doctors, I asked for a transfer to a hospital, and found myself on the bus to a small city in the highlands the next morning at 6:00 AM. Upon arrival, the physician in charge asked where I would prefer to work. He was pleased when I chose surgery and sent me down the hallway to the surgical wing of the hospital, which consisted of two small operating suites that had clearly--even to my untrained eye--been built sometime in the late 70s. Seafoam green tile covered the walls, and the operating lights lacked the occasional bulb or two. I changed into a pair of borrowed scrubs, conversed with an anesthesiologist for a few minutes in broken Spanish, and was then asked if I knew how to scrub. My first operation was a cholecystectomy on a thirty-five year old woman--a standard operation in the land of little access to birth control and 5+ parturitions--and I never looked back. I learned how to snip suture, hold retractors, and operate the bovie as I went along, finding the work simultaneously fascinating and immensely enjoyable.

Yason was different. He was three, and, as far as I could tell, had once been the archetypal healthy young Guatemalan. I had scrubbed on a few pediatric cases in the preceding two weeks--hernias and such--but this one was bore no resemblance to the others. Severe burns covered roughly fifty percent of his body. According to the doctors, he had pulled a pot of boiling water onto himself, and had been in the hospital for the past two weeks. New skin was slowly displacing the dead tissue, but pus and scabs were forming over the burns, necessitating disinfection and debridement. This was his fourth trip for debridement since the injury, hence the writhing and screaming. I stood at the scrub sink and attempted to fortify my emotions for what I knew would be a tough case.

Fast forward a year and half. I am sitting in a lecture on child and elder abuse for a class on human behavior. A slide flashes across the screen depicting patterns of injury that indicate abuse, and the moment comes rushing back. Suddenly, I am standing in the OR, gloved and gowned, with the surgeon and a medical student. Weilding sterile brushes with plastic bristles, we scrub--back, buttocks, back of the thighs, parts of the foot, the palms of the hand. Yason whimpers despite the anesthetic, his face flinching now and then, screams and contortions numbed by unconsciousness. Rich carmine blood oozes from the burns, as if protesting our assault on the skin's healing processes. We finish after forty-five minutes of scrubbing, our white gloves stained bright red, bristles glistening. Yason whimpers more as the anesthesia begins to wear off and we apply bandages to the burns. A nurse wraps him in a blanket and spirits him off to recovery.

After Yason was gone, I stepped back from the OR table and removed my gloves and gown, finally permitted the chance to contemplate the event in which I had just participated. My eyes welled up with tears for the young boy, a few dripping onto my mask and darkening its baby blue fibers. I marveled at the seeming lack of fairness. It made me want to scream.

But now--with nearly a semester of medical school behind me--I think my reaction to the case would be changed. If I encounter something similar on the wards as a medical student, the case will hopefully have been referred long ago to child protective services. American burn care is also much more advanced than that available in Guatemala. But I would still want to scream. I hope I never lose that impulse.

(image via Wikipedia)

Please keep this person in your thoughts...

noreply@blogger.com (AB) — Sun, 30 Nov 2008 03:56:00 +0000

Those of you who are familiar with the medical or military blogospheres may have heard of CPT Rob Yllescas, a soldier who was severely injured in Afghanistan about a month ago. He arrived back in the United States a few days after his injury and has been receiving treatment at Walter Reed ever since. His wife keeps a blog with updates on his condition that can be found here. Earlier tonight he suffered a clot in his brain, and he is currently undergoing surgery in an attempt to save his life. Please keep him and his family in your thoughts during this unimaginably difficult time.

dr im sick. :-( rofv.

noreply@blogger.com (AB) — Sat, 22 Nov 2008 18:53:00 +0000

I've been spending the weekend thus far studying for an upcoming biochemistry exam, so I thought I would drag myself up from the mess of initiation factors, ribosomes, and lipoproteins in which I am immersed to update my blog. The consistently heavy workload that defines medical school tends to curtail the amount of time I have to spend writing updates. But study breaks spent pondering subjects only tangentially related to the material tend to reinvigorate the mind. Or at least that's the goal.

Anyway, this past week, a disheartening post on the NYTimes Bits blog came across my Google Reader. The gist of it is thus: a new physician-led, internet-based company--American Well--is in the process of rolling out a service that offers patients online consultation with a physician over video and chat weblink. The company's founder claims to be motivated by a desire to make the most basic element of healthcare--talking to a doctor--easily available to the numerous healthcare consumers who obtain the majority of their health-related information through online means.

At first blush, this may sound like a desirable proposition. Both the typical, and I use that word broadly, healthcare consumer and the physician who treats him or her are time-starved. The opportunity to consult over chat with a physician for ten minutes rather than set aside a minimum of an hourlong (counting trip, time spent in waiting room, etc.) block of time for a trip to the physician's office might provide a significant benefit to the patient. Instead he or she can, from the comfort of a favorite chair, sit and dicuss the most intimate of subjects with a caring and compassionate physician.

This is the point at which the premise begins to crumble for me. Aspiring doctors are introduced to the proper methods of interviewing sometime within their first year, hopefully prior to the first contact with living, breathing patients. We learn the importance of sitting on the same level as the patient, asking open ended questions, maintaining eye-contact, and proferring encouraging statements when subjects cover topics that might be hard for a patient to relate to a stranger. These techniques are taught with a single goal in mind: to communicate our willingness to listen confidentially and non-judgmentally to our patients, while remaining attuned to the salient issues of their lives.

By virtue of its basis in realtime video chat, the interaction between physician and patient offered by American Well suffers from an interruption of this attentiveness. As a student who lives far away from friends and loved ones, I use Skype nearly every day to keep in touch. Yet despite a high-speed connection, there are often technical issues that interrupt the flow of conversation. And anyone who chats via webcam knows that it is no substitute for the type of interaction available through a face to face conversation.

I can see you saying to yourself now, "you're overreacting, American Well doesn't aim to replace face to face conversation between doctor and patient. It's just a useful tool for checking in with your physician and getting some advice." To which I respond: just wait. Supplementing the doctor-patient interaction is not the American Well's aim. The founder of the company puts it best: "without reworking the budget, without going through Congress, we can bring affordable health care to people who cannot access it." This ephemeral, vapid talking point would almost make me laugh, if access to healthcare weren't such a pressing issue. American Well markets their product to physicians on the notion that it will permit them to "Increase revenue and care for patients on [their] own terms. [And] Introduce a new balance to the way [they] practice by offering [their] services online for a fee." Clearly, the number of those with access to healthcare isn't expanding.

And how, may I ask, will this bring affordable healthcare to anyone who currently lacks access? It won't. Let's offer a scenario in order to illustrate. Let's say American Well allows physicians to charge 50 dollars for a ten minute online consultation:

Ms. B, a post-menopausal 56 year old woman, works as an insurance agent. She has been having headaches off and on for the past few weeks. She doesn't think her symptoms are anything to worry about, though she would like to get them checked out just to be sure. But Ms. B doesn't have health insurance. Her headaches have been worsening over the past two days, so she decides to pay 50 dollars and see a doctor on American Well. Dr. X, prudent physician that he or she is, sees that Ms. B is overweight, is concerned that these headaches could be related to possible undiagnosed hypertension, and tells Ms. B that she needs to see a physician in person. The doctor's concern worries her, and she agrees to pay $110 dollars to see a physician in person.

Outcome A
The doctor rules out hypertension, talks to her about some lifestyle improvements, prescribes 800 mg ibuprofen, and tells her to schedule another visit if the headaches continue to worsen. Total cost of treatment rises from $110 to $160, not including the cost of medication .

Outcome B
Despite the physician's advice, Ms. B decides her headaches aren't that bad and that she can tough it out for a few more days to see if they get any worse. Little does she know, her blood pressure is sky high. She wakes up in the middle of the night three days later in a cold sweat, unable to move her right side. Her husband calls paramedics and she is rushed to the hospital, where she is diagnosed with a severe stroke. She spends a week in the hospital, her blood pressure is brought under control, and she slowly regains function in her right side. Six months of physical therapy follow. Cost of treatment: $50 + ambulance ride + stroke treatment + rehabilitation.

Outcome C
Thankfully, Ms. B isn't aware of American Well in the first place. When her headaches worsen she goes to see a primary care physician for $110. She is diagnosed with severe hypertension, the physician prescribes her a relatively inexpensive generic medication, tells her to come back in a few weeks, and has a conversation with her about lifestyle changes. On her second visit, her blood pressure is back in the normal range, she has lost a few pounds, and plans to lose a few more. Cost of treatment: $220 plus cost of medication. Stroke averted.

Outcome D
Again, Ms. B isn't aware of American Well. She pays $110 to see a doctor, who finds her to be mostly healthy, except for a few extra pounds. They have a conversation about healthy lifestyle changes, and she gets a prescription for 800 mg ibuprofen to take as needed for her headaches. Total cost of treatment: $110 not including the cost of medication.

I ask you, American Well, which outcome is better for the patient? For the American healthcare system? Is this really even a question?

(image via Wikipedia)

If you do nothing else tomorrow...

noreply@blogger.com (AB) — Tue, 04 Nov 2008 02:08:00 +0000

PLEASE GO VOTE!!!!!!!

Thanks for the memory...

noreply@blogger.com (AB) — Thu, 16 Oct 2008 23:49:00 +0000

Thursday afternoons are always the highlight of my week. My weekly schedule normally goes something like this: For about three hours every morning, my entire class (or those of us who choose to attend) sits in a large lecture hall, listening to various professors expound upon the intricacies of their chosen fields. Biochemistry is the designated (and much disliked, in my mind) topic on Tuesdays, Thursdays, and Fridays, while Mondays and Wednesdays are filled with gross anatomy. Monday and Wednesday afternoons are spent in the anatomy lab dissecting out the various structures that were covered in the morning lecture session. As an aspiring surgeon who enjoys nothing more than wielding a blunt probe and pair of small, slightly curved scissors in the battle for anatomical knowledge, I enjoy anatomy a great deal. There is nothing more remarkable than the intricate layering of the various muscles and tendons in the hand and forearm, or profound zigzagging of the brachial plexus nerves, which appear muddled when seen for the first time but gradually yield their own logic when revisited dozens more.

Occasionally, the dissections prove more frustrating than didactic, and yesterday was no exception. My lab team and I were scheduled to observe the abdominal viscera in situ, expose the vasculature of the gut, and delineate the main vessels that branch off the abdominal aorta. We are assigned to cadavers in groups of eight, with four people dissecting at any one time. For this section--thorax, abdomen, and pelvis--we work in groups of four for two hour shifts, with the second group continuing the work started by the first. I was in the second group yesterday and expected to find a colon and a small intestine with vasculature exposed upon my arrival in the lab. Instead I spent two hours sorting through the remnants of Beatrice's (her nom de guerre) bowels, which had undergone quite extensive surgical alteration. The entire colon was missing, with the end of the ileum anastomosed to the cecum, which had been sewn to the rectum (sub-total colectomy?). The previous groups had spent an entire two hours clawing their way through the mess of adhesions that was the small intestine. What was left of the superior mesenteric artery and its branches in the small intestine had been exposed, but there was still a great deal of work to do. So we jumped right in and attempted to find the inferior mesenteric artery braching from the aorta. I say attempted, because we discovered that it had been cauterized and removed in its entirety, save the superior rectal branch. Following that morass was a two hour struggle to expose the portal triad (portal vein, common bile duct, common hepatic artery). We scratched our heads for a hour or so while we revealed branches incorrectly branching off of other braches, which looked nothing like any of the variations that Netter so masterfully depicted. After some oooohhhhs and aaaaahhhs along with the anatomy professor at what we'd found, we concluded that we had another unique variation on our hands, and left the lab exhausted.

I am constantly amazed by the extent to which the body serves as a record of all life's occurrences, from the catastrophic to the imperceptibly minute. I'm not talking about the obvious here--years of smoking, major surgery, traumatic injuries, etc--but about the tiniest of tiny things. My foray into the anatomical variation of the celiac trunk and superior mesenteric artery was the product of an event that began approximately seventy-four years ago, when a few cells migrated a few micrometers in a strange direction during the embryonic stage of development. I doubt Beatrice felt any adverse effects from this event during her lifetime, and yet I, humble student, was privileged enough to discover its record almost three-quarters of a century later. Sometimes being an anatomist, even an inexperienced and occasionally bumbling one, provides the opportunity to play archaeologist for the afternoon.

But I digress. Back to my weekly schedule. Most of my Thursday afternoons are spent in the hospital playing archaeologist of a different sort, sorting through the physical and emotional events of patients' lives as my fellow students and I nurture our nascent interview skills. My group of five fellow students and I have conducted only about ten interviews so far, but we've encountered some fascinating stories. Today was no exception. We interviewed an elderly woman struggling with Parkinson's, once a healthcare provider herself. Despite what appeared to be a slight pharmacologically-induced delay in her cognitive processes, she was sharp as a tack, remembering well and maintaining her dignity and bearings while six rather green medical students peppered her with questions. I was reminded of my grandfather--a truly great man--who suffered from debilitating Parkinson's for many years before passing away about six years ago. So thank you Mrs. X, for our encounter today. Though you didn't know it, talking with you elicited the most pleasant of memories and certainly brightened my day.

Damn, I'm lucky to be doing what I'm doing.

Evolution...

noreply@blogger.com (AB) — Wed, 15 Oct 2008 02:06:00 +0000

Around this time every year, thousands of students, young and middle-aged, throughout the country are considering applying to medical school for admission to the fall class that will matriculate in two years. If they are fortunate enough to attend a college or post-baccalaureate program with a dedicated professional school admissions advisor, such as I did, then they are likely attending meetings on a regular basis to ensure that the important milestones in the process of selecting schools and filling out the AMCAS application are on track. Preparedness at this early stage means two things: planning to take the MCAT in the spring, and writing the first drafts of the admissions essay that will serve as cornerstone of the medical school application.

Preparing for the MCAT is mostly self-explanatory. A certain amount of science must be reviewed and, if necessary, relearned. Achieving the MCAT score that will yield the best chances of admission requires dogged persistence and rote study of the material, no more, no less. Writing a good AMCAS essay, however, is a different story, or more aptly, a consistently evolving narrative. Two years ago, when I was at this particular juncture in my medical career, I found the writing of the essay to be the most difficult task of the whole application process. Medical school applicants are a diverse bunch who find common ground in medicine. Many of us major in biology, but others take less traditional routes--English literature, history, philosophy, dance. The overwhelming majority have experience in some aspect of the medical field, ranging from biomedical research, to relief work in third world countries, to volunteer work caring for the elderly and infirm in nursing homes. And these qualifications are by no means mutually exclusive; the most visible applicants are those who defy easy categorization. A tuba-playing, HIV-researching, comparative literature and biology-majoring student who finds the apotheosis of human existence in the octogenarian whose endless font of stories she taps every Thursday afternoon when she volunteers at her local nursing home represents a typical combination of extracurricular and personal qualities seen in a medical school applicant.

Which is what makes the writing of the application essay such a taxing proposition. The golden nuggets of truth derived from years of academic and personal growth and achievement must be summarized in the cramped space of a meager 5000 or so characters. But, more essentially, these nuggets must convince their intended audience that the applicant's motivation to become a doctor grew out of a fundamental curiosity regarding the functioning of the human species within its set environment, which is really what health boils down to at its core. Which begs a single question: what leads a person down the path to becoming a doctor?

In conversations with my fellow first year classmates, I've found, unsurprisingly, that our motivations are as diverse as our backgrounds. Some are engineers who see the human body as the most intricate of machines, others find themselves enamored of the complex science that underlies the most elemental physical functions. Still more choose to enter medicine not for its scientific offerings, but for the opportunity to be part of the solution to one of the greatest humanitarian issues of our time--the unconscionable disparity that exists in our contemporary healthcare system. Personally, I have chosen to become a doctor for one primary reason--the opportunity to witness the life and health narratives of my patients.

But that certainly was not the only reason I applied to medical school, which further complicated the essay writing process. If some of my readers here are currently working on their essays and looking for some useful tips, I have one that proved very useful as I fought through numerous drafts on my way to a successful final copy. However you have arrived at your current desire to become a doctor, demonstrate how that process is one component of a consistent evolution. It might be an obvious point, but I'll say it anyway. Expect medical school to change the way you look at the world and interpret the interactions with those who surround you. Roughly six years from now, when you walk across the stage at graduation, you will be seeing the world through an entirely new set of eyes, hopefully one that allows you to better understand your fellow humans--anatomically and physiologically, yes, but also economically, socially, humanly. Let your essay show that you adequately prepared for this evolution, and understand what it entails. The medical profession requires constant adaptation and reinvention. Be prepared.