Rotating in a Small Town

I was walking around downtown Casper yesterday and some guy high on god knows what came screeching around the corner a block away and then erratically stopped in the middle of the road. He was waving his hand out the window at nothing. He drove and acted like someone who might become interested in taking a potshot at random human flesh so I took cover flatting myself against the wall of the entrance to a closed store still unable to stop myself from peeking out to see what would happen next. Curiosity killed the cat, they say. 

He went speeding by, stopped after the traffic light, placed a random traffic cone in the middle of the lane, hopped into his little old truck and sped off. A big truck came lumbering through when the light changed and had to stop. The driver was a middle aged lanky rancher, with some chaw in his lip and a none too hurried gate. He looked like this random traffic cone in the middle of the lane business was an everyday occurrence.Chewing contentedly, he moved it unperturbed and climbed back into his lifted truck and drove away.

Yesterday evening I was in a nice family oriented park between my hotel and the hospital and there was a group of two men and a woman drinking a huge bottle of whiskey. As if Sunday night in a park was the time and place to be getting completely hammered. At least when they passed out it was easy to get them to the emergency room. 

Perhaps it was payday this week and everyone is out abusing the drug of their choice. 

All I've heard here, is how Denver is such a terrible drug infested city. While in Denver, I have never seen anything like I've seen here. It exists in certain byways and streets but its avoidable. Here it's just everywhere & you can't get away from it. 

After that, the night on the ambulance and the high speed chase I witnessed through downtown last week it's easy to think Casper is full of people who are off their rockers. Many I've witnessed, I'm sure, are whacked on drugs and a few are part of one of the most violent South American gangs that has moved into town. 

As far as the rest of the driving Casper-ites I'm in contact with like squeezing their big trucks next to my Prius in the compact car parking spaces in the hospital parking garage. It's comical, there's my Prius, a compact car fitting nicely into one of the labelled compact car parking space and then a row of HUGE trucks and SUVs, hanging their full length beds and bloated backsides so far out into the ramp of the parking garage it's hard to pull past when using the ramp (this isn't an exaggeration, I wouldn't have believed it before living here). Plus they are all door to door so they can barely squeeze out from between the trucks once they open their doors. 

Nothing wrong with these vehicles, something is lost on the drivers when they think their extra cab full length bed Ford F-150 is a compact car. Several days I have laughed out loud at the silliness of it, other days its irritating to get into my car without door dinging their vehicles and exit the garage without removing a tailgate. 

Colorful place, this Casper, WY. It makes me laugh, often. 

Men Will Believe What They See

While doing my rotation, I followed my attending to the door of a patient’s room in his small town clinic. Under his long white coat he wore dark jeans, polo shirt and wingtip boots; he looked like a local, like he belonged here. As he pushed the door open, his velvety voice quietly permeated the space, "And that's the sound of sunshine coming down..." The patient’s expression opened into a broad smile. The doctor’s convivial hello illuminated the room like a burst of light. I was surprised by his cheerful energy as we had been up the night before, delivering a baby.

When his patient spoke he sat quietly and listened, giving her a chance to tell her story, gently focusing her efforts. He treated the patient, finished his chart and walked out the door within the scheduled time. 

This is how nearly every visit of every day went; it wasn’t a façade simply for the benefit of the patient. Once out the door, no matter what had happened in the room we just left, a quiet song created a balloon of tranquility that enveloped us in an atmosphere of care. As its notes drifted away and he opened a door to the next unknown, it was as if he transcended whatever malady he had just treated only to begin the same cycle again. Before the end of the day he would pause during a chance encounter with his nurse and thank her for her meticulous work. 

On the weekend I invited his children to rock climb with me. He calmly and firmly supported his young children as they faced their fear of trusting their belayer and the rope. When they cried he climbed up to support their back and hold their feet so they could learn how to rappel securely. He whistled as he walked along the climbing area, stopping to chat with the other climbers in the area, exchanging fishing-hole secrets and coming back from his conversations to cheer on his wife who was taking her turn on the climb. 

The experience fundamentally changed my idea of professionalism. I no longer associate stark dress code and rigid rules with professionalism, but think of it as fluid and ever changing to meet the demands of each circumstance and individual. It’s like monitoring a heartbeat and responding as needed, moment by moment. Professionals dress according to the culture so as to reach those around more effectively; they conduct themselves in a way that is respected both in and out of the office; and they likewise give respect to all those who touch their lives. What gives professionalism its fire and buoyancy are the qualities of humility, compassion and joy. These are the essence of professionalism that gives depth and meaning to every task and interaction.

Professionalism well lived spreads like a contagion from its practitioner. As Thoreau said, "If you would convince a man that he does wrong, do right. But do not care to convince him. Men will believe what they see. Let them see." The doctor never told me what I should do. He never sat me down to lecture on professionalism. The subtle beauty of his influence changed my heart, and in this way I will continue through my days, quietly striving to live the life I have come to admire.

My final, final has been passed and my second year of medical school is over. It's a big event in my journey toward doctor-hood.

Never again will I be seated in a classroom for days on end watching endless powerpoint lectures while texting smart remarks to my friends beside me or projecting tiny spit wads at the more studious, unfortunates that sit within firing range of my seat.

Never again will I sit in "my seat" for fear ridden exams, in the dark, back, left corner furthest from the front of a 200 person auditorium as I can physically get. My tick marks tallying the number of questions I think I got wrong on the desk beside, remain there from this morning's final until some innocent erases them, erasing the anxiety that is stored with every hashmark that mocked my hard work.

Never again.

It's time to move further forward into a future I once scarcely dared to dream might be mine.

Thank you for your encouragement, your comments, your prayers, your cheers and your smiles. Thank you for your reminders that life still exists outside this alien world I have chosen to inhabit and that there are bigger things than what is looking me in the face that day and seemed insurmountable.  As I've said in the past, "it took a village to raise this Doctor," and I simply hope the patients I touch will feel a bit of the warmth and love you shared with me.

In the Mirror

Until this week if you would have asked me what the hardest part of medical school was I would have said changing the parts of me that needed honing to succeed in medical school. It has ground me ruthlessly down via a relentless daily scouring until I shed the bad habits and unnecessary clutter that I've carried like suitcases for years.

I've learned I can't always be there for everyone, goodness knows I can't even be there for people I love many times. I've learned the world goes on anyway and the people I love and who love me do their best to understand.

I've learned to draw lines around myself emotionally and protect what little vital energy is flowing in my soul and not waste it on things that aren't important.

I've learned how much time I've wasted in my life and what's possible to accomplish in 30 minutes.

I've learned that I need help, desperately.

And in spite of what the American/Protestant way has woven into every fiber of my soul. I've learned that motivation and self-control should be regulated.

I've learned when motivation and self-control are given free reign they cause my heart to die and my body to become ill. That there is a point where you can have too much self-control and too much motivation. Imagine that.

I've learned, "They're the expert... Why not try it?" Isn't always the best sentence to live by. That experts don't know all of what is best for the individual.

I've learned that it is only healthy to change so much at one time.

I've learned that there are things that are my essence and I shouldn't change them or they break my soul.

I thought the list above was the sum of what I needed to learn...

Then I went for a climb, my first trad multi-pitch 480 ft climb, and my perspective changed; my heart beat again. I was ready to learn the real lesson.

Today I should be studying, and I will. But instead I've sat for awhile, looked out the window and cried. I had a long text with my mom. I ran across a Ted Talks that spoke to my heart...

http://www.ted.com/talks/brene_brown_listening_to_shame.html

And I realized the personal change hasn't been the hard part.

The hard part is trusting myself, accepting I am smart enough, wise enough and have what it takes to survive. Not just for medical school but the future that sits before me.

The hard part is being ok, that I failed a class and being ok with the shame of not being perfect. Facing the critic inside that will never be satisfied and with a smile saying, "I am satisfied".

The hard part is learning to look in the mirror and loving what looks back, even if I'm messed up.

The fight isn't medical school, the fight isn't changing habits, the fight is with myself.

Medical school isn't special. We all face the potential shame of failure or the shame of past failure. Almost all of us have to make the decision to start the fight again or give into the inner critic every single day.

It takes courage to get back on your horse and go into hand to hand combat.

And so I am trying again to be kinder to those around me, be gentle and encouraging. Less judgmental...

I'm trying to say more often, "Take heart, you're not alone. And no matter how many times you've fallen, I'm proud you have the courage to stand up, face the possible shame of failure and try again. I know what that feels like."

"It is not the critic who counts: not the man who points out how the strong man stumbles or where the doer of deeds could have done better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who errs and comes up short again and again, because there is no effort without error or shortcoming, but who knows the great enthusiasms, the great devotions, who spends himself for a worthy cause; who, at the best, knows, in the end, the triumph of high achievement, and who, at the worst, if he fails, at least he fails while daring greatly, so that his place shall never be with those cold and timid souls who knew neither victory nor defeat."

Achieving at What Price

I wrote this while watching a movie called, "The Doctor" filmed in 1991 for ethics class. I finally had time to stop and think... and here is what I thought...

With all this achieving in medical school, which is amazing... I have one sadness... I forget to see the stars; the moon. I spend all my time inside studying things that are completely enrapturing. Yet I don't see the flowers blooming by the road, the rabbits on the lawn and the trees turning their flaming yellow. I don't see the mountain range I love looming in the morning sky when I drive to school because my mind is focused on von Willebrand and the coagulation cascade.

And that's what's hard to lose. Somehow I'll have to find it and not let 4 wonderful years of my life go by. They say it's a snap and it's gone, they mean that in a positive way. Funny, that's what I fear. Life is too  short anyway.

An interesting dichotomy, I'm in medical school because life is short, too short to not do, be and experience everything I want to and I'm sad because this experience could make it feel shorter.

So on top of all the things I'm learning and the many things I'm adjusting just to survive, I'll have to figure out how to step out of the doorways of my artificial world, breathe in a quiet breath and see again.

Life is not simple.

But that's what makes it worth living.

Fun Fact: Hedgehogs cause Cyclops

We have a subfamily of pathways that is active during the fetal period called Sonic Hedgehog. If there are mutations in it, it can cause babies to be born as cyclopses. This is common in mt goats & sheep in the west because there is a plant Veratrum californicum/Corn Lily/Cow Cabbage that if eaten around the 14th day gestation and it causes the mutation in the Sonic Hedgehog pathway & the babies can be born as cyclops. And yes, it's named after the game, Sonic the Hedgehog.

Fun Fact: Sun Made Dimers

I'm learning all sorts of fun things so I thought I would start putting up fun facts. Here's the fun fact for today:

For every second of sun exposure 50-100 dimers are created in your exposed skin cells. These are caused by two base pairs or nucleotides (nobs that code for your proteins) on your DNA covalently bonding (sharing electrons) and causes a problem in DNA a big chunk has to be cut out by enzymes, unzipped from the double helix, removed, and then put back together and the DNA backbone taped up with the tape enzyme ligase.

So when those errors become more than can be fixed you can have skin cancer.