When you don’t like your patient

I’m still on the way home, on the second leg of my trip.  I am eavesdropping on the conversation going on in the row in front of me.  13C is coming home from Guyana where he’s been working in mining exploration.  He looks like a young guy, maybe around my age, with a kind of Western or Southern drawl.  He’s describing what he does to 13D and I’m trying to listen for any indication of gross injustices against the environment or local communities.  He’s an outgoing guy and seems really friendly.  He leans over the empty seat beside him and is now chatting with 13A, whose contribution to the largely one-sided conversation is the occasional “ah” or “huh”, “yea…”.  He’s talking about his life working overseas.  He proudly mentions having 4 girlfriends, who don’t know about each other “no, they don’t know about each other”.  He sounds jovial, like someone talking about how fresh the fruits are at the local market or maybe how a dad would talk about his son’s little league team.  I wondered how I would approach this if he were my patient.  Would he tell me about his 4 girlfriends?  How would I respond?  Impassionate, matter-of-fact: “Oh, well do you use protection? Have you been tested for any STDs?  Alright, well we have the facilities here to do that”.  I pictured the movie effect where you have a map with a pin-point on it that just spreads like a black wave, sludgy and oozing across the continent.

I remember one time my mom came home from the office upset.  One of her patients was cheating on his wife who was terminally ill.  His mistress wanted him to promise to be with her.  He was stressed and depressed but didn’t know why.  When my mom asked if he thought perhaps it had to do with his relationship situation, he was surprised and hadn’t considered it.  My mom was boiling the whole hour of therapy, as she was reminded of being cheated on herself so publically by my dad.

As much as Western medicine is about micromanagement and control of biology (at least we like to think that), we’ll eventually end up with patients who we will feel crappy listening to.  I’m thinking of the simulated patient we had who was abused by her husband but didn’t want to admit it.  Doctors are legally mandated to report child abuse and elder abuse but not spousal abuse, and I can’t imagine what it will be like to have to see some women walk back out into trouble despite all the counselling you give.

I guess part of becoming a health professional is always keeping a professional front.  Obviously my mom couldn’t bring her own baggage into the care of her patient.  The trick will be finding the balance between being jaded and being human.

Go home

One of the most frustrating things about my school are the other students and the things some of them say.

On my way home to Toronto via Trinidad, the first leg of the flight was in a Turboprop with about half the plane full of students.  In this small plane, some are talking about how desperate they are to get off the island and never return.  You couldn’t pay me to come back, one said.  When the cabin was sprayed for mosquitos, one joked about the next thing waking up in a strange place, Hostel-style.  Reply was that even being drugged and abducted and tortured would be better than staying in Grenada.  And so on.

It’s embarrassing to be in the same group as these people, so harshly ripping into an amazing, beautiful country in front of people who have grown up there and live there now.  Totally without a clue, these guys are.  I feel pretty certain that they’ve hardly ventured out from campus except the usual trips to the IGA or beach, and doubtful that they’ve had a conversation with a Grenadian outside placing an order for food.  Because that’s the only way I can explain how anyone can live here for 1-2 years and still talk like that.

As seen on Facebook

Things I won’t have to deal with anymore… at least for awhile… hopefully:

Accidentally wearing short-shorts on a Clinical Skills day and then being nominated to be examined in all manner of undignified ways.

Giving a daily presentation on a disease (as though I’m an authority on the matter) having only just discovered what it was 4 hours ago.

Studying the night before a Clinical Skills / Standardized Patient quiz not because I give a damn about my grade, but purely to avoid emotional damage secondary to being shamed… which usually happened anyways.

I won’t miss you, Term 4.

There’s a lot to thank Term 4 for: learning professionalism, patience, flexibility and a bit more maturity.  Snarky, ya — but the truth in this post was just too funny to not share.

Get It Done: Revived

If you haven’t yet seen this video of Anjali Appadurai addressing the U.N. Climate Change Conference, you should.

Last night I was talking to Frond about a friend of his from the India Fellowship, who had taken ideas from her year in India and was applying it to a new clothing line she was starting, with a business model based on developing the local economy of Detroit.  I thought about my roommate’s sister who went from International Development into Jewelry Making (“metal-smithing” she calls it), and makes amazing pieces that are out of this world.  I thought that it would be nice to have a passion that was more whimsical, that was more creative, and less emotionally draining than some “cause” like Climate Change.  In response, Frond told me about the advice he was given back when he wanted to go into music and philosophy.  Basically, not to do it.  That unless he found an academic position, he’d be another artist working hard in music, pouring their passions in, and having to scrape by.  Or having to accept struggling to find students to teach music to, in order to make a living out of their passions.

I can see how any passion can be draining, just as much as it drives you.  So although Anjali Appadurai is preaching to the choir when it comes to people like me, it is so invigorating to see someone so angrily, eloquently, and – there’s no other word for it – passionately express why you were drawn to this passion in the first place.

The transcript:

CHAIRPERSON: I’d now like to give the floor to Miss Anjali Appadurai with College of the Atlantic, who will speak on behalf of youth non-governmental organizations. Miss Appadurai, you have the floor.

ANJALI APPADURAI: I speak for more than half the world’s population. We are the silent majority. You’ve given us a seat in this hall, but our interests are not on the table. What does it take to get a stake in this game? Lobbyists? Corporate influence? Money? You’ve been negotiating all my life. In that time, you’ve failed to meet pledges, you’ve missed targets, and you’ve broken promises. But you’ve heard this all before.

We’re in Africa, home to communities on the front line of climate change. The world’s poorest countries need funding for adaptation now. The Horn of Africa and those nearby in KwaMashu needed it yesterday. But as 2012 dawns, our Green Climate Fund remains empty. The International Energy Agency tells us we have five years until the window to avoid irreversible climate change closes. The science tells us that we have five years maximum. You’re saying, “Give us 10.”

The most stark betrayal of your generation’s responsibility to ours is that you call this “ambition.” Where is the courage in these rooms? Now is not the time for incremental action. In the long run, these will be seen as the defining moments of an era in which narrow self-interest prevailed over science, reason and common compassion.

There is real ambition in this room, but it’s been dismissed as radical, deemed not politically possible. Stand with Africa. Long-term thinking is not radical. What’s radical is to completely alter the planet’s climate, to betray the future of my generation, and to condemn millions to death by climate change. What’s radical is to write off the fact that change is within our reach. 2011 was the year in which the silent majority found their voice, the year when the bottom shook the top. 2011 was the year when the radical became reality.

Common, but differentiated, and historical responsibility are not up for debate. Respect the foundational principles of this convention. Respect the integral values of humanity. Respect the future of your descendants. Mandela said, “It always seems impossible, until it’s done.” So, distinguished delegates and governments around the world, governments of the developed world, deep cuts now. Get it done.

Mic check!

PEOPLE’S MIC: Mic check!

ANJALI APPADURAI: Mic check!

PEOPLE’S MIC: Mic check!

ANJALI APPADURAI: Equity now!

PEOPLE’S MIC: Equity now!

ANJALI APPADURAI: Equity now!

PEOPLE’S MIC: Equity now!

ANJALI APPADURAI: You’ve run out of excuses!

PEOPLE’S MIC: You’ve run out of excuses!

ANJALI APPADURAI: We’re running out of time!

PEOPLE’S MIC: We’re running out of time!

ANJALI APPADURAI: Get it done!

PEOPLE’S MIC: Get it done!

ANJALI APPADURAI: Get it done!

PEOPLE’S MIC: Get it done!

ANJALI APPADURAI: Get it done!

PEOPLE’S MIC: Get it done!

CHAIRPERSON: Thank you, Miss Appadurai, who was speaking on behalf of half of the world’s population, I think she said at the beginning. And on a purely personal note, I wonder why we let not speak half of the world’s population first in this conference, but only last.

An ode to the last exam

[8:50:01 AM] Shane:

“Twas the night before finals, and all through the college, The students were praying for last minute knowledge. Most were quite sleepy, but none touched their beds, While visions of essays danced in their heads. Out in the taverns, a few were still drinking, And hoping that liquor would loosen up their thinking. In my own apartment, I had been pacing, And dreading exams I soon would be facing. My roommate was speechless, his nose in his books, And my comments to him drew unfriendly looks. I drained all the coffee, and brewed a new pot, No longer caring that my nerves were shot. I stared at my notes, but my thoughts were muddy, My eyes went a blur, I just couldn’t study. “Some pizza might help,” I said with a shiver, But each place I called refused to deliver. I’d nearly concluded that life was too cruel, With futures depending on grades had in school. When all of a sudden, our door opened wide, And Patron Saint Put-It-Off ambled inside. His spirit was careless, his manner was mellow, When all of a sudden, he started to bellow: “On Cliff Notes! On Crib Notes! On last year’s exams! On Wingit and Slingit, and last minute crams!” His message delivered, he vanished from sight, But we heard him laughing outside in the night. “Your teachers have pegged you, so just do your best. Happy Finals to all, and to all, a Good Test!”

How doctors die

An article shared to me by another friend in med school.

How Doctors Die

I’m not sure about CPR doing more harm than good (no references), but it’s something to think about when it comes to doing “everything” possible to extend someone’s life; in terms of quality of life, financial strain on the system (and families), and even the actual extension of life.