Saturday, April 29, 2006

Dissecting a Human

This is something I wrote in my first year of Med School while dissecting bodies on a regular basis:

It is so strange to learn the body as a material thing, a rather loose and squishy conglomeration of material objects. So many things that I “knew” before—bone, heart, brain, womb, stomach, cancer, skin—I have held in my hands: cold, fleshy, firm. They cease to be feelings or experiences. They enter the solid world, into the category with rock, mud, wood, steel, wires. The body can be cut open and physically manipulated with the hands, and physical manipulation changes function.

And the body acts just as the machine that it is. Neuron depolarizes ==> Myofilaments slide across each other ==> Bone pivots ==> I move my arm. Birth and death are similarly mechanical: both reducible to flow charts, both preventable by surgical intervention or ingestible tablets which interrupt the mechanism. Even the brain (that mysterious, soft, gray organ) is shown to be a composition of billions of cells. And these cells do just what neurons do: depolarizing and repolarizing. Nerve cells do not know and they don’t care. They just depolarize and repolarize in response to stimuli. Not very magical.

No, there is no inherent compassion or fear in the study of the human as a thing. There is only the thing itself: a highly ordered group of atoms that maintains its order by breaking down organic molecules and moves itself grossly with a system of levers and pulleys.

The problem with this learning of the body as a thing is that it bears no resemblance to anyone’s experiences of their own body. The mechanical body of the medical lecture hall is true, but it isn’t real. It has little relation to anything of value or even anything in the real world. The real body is an experience not a thing. The real body is sacred. No person I will ever know has that mechanical abstraction that I am spending four years to learn. The material body is nothing but a lie, a construction that has fortuitously proven to be a useful model for preventing death and illness.

I remember the day that we dissected the pelvis in anatomy. I went home disgusted because I had seen with my own eyes that the vagina is only a muscular tube lined with stratified squamous epithelium set between the urinary bladder and the rectum. How could I have set so much expectation and mystery into something so banal? And then it was the heart. No, I knew better than to think of the heart as the seat of emotion (we all know now that the limbic lobe is the seat of emotion)—but what does this muscular lump have to do with the experience of that thing that surges and thumps in my own chest? Then came the brain. I have taught the brain to students of my own. I have told all the useful lies. I have watched their mouths drop open as I move through the tangles of gyri and sulci with my pointer. “Here is the frontal lobe. The center of personality and decision making. If a stroke destroys this you end up a very dull person. Here is the Amygdala. It is the center of fear and rage. Bad place to have a lesion. And here is the Hippocampus. This is where memories are formed. And here is language, and here is spatial mapping of the world, and here is vision, and here is movement, and here is…” Of course it sounds impressive, and it is useful for predicting the effects of a stroke, but we all know it isn’t so. No one, not even the neuroscientist, has ever experienced the cortex. The cortex is a thing. It is a series of circuits that mediate electrical impulses through a series of chemical probabilities. The cortex is not experience, it is not aware, it knows nothing. (If it exists in us at all, it exists as an idea by which we think of ourselves.) Awareness is more real than gray matter, and experience is more real that physical things.

The objective body is an invention of doctors, anatomists, and biochemists. It is as abstract as mathematics. It never lived. Only scientist and doctors believe in it. I have had a body for 23 years but this bioelectrical, mechanical object has only grown into my body over the last few years. Before I only knew my body as a real, raw experience. It is good we study the mechanical abstraction. But approach with caution! It has very little to do with humans or their bodies. The flesh and blood is more than what doctors and scientists can ever know.


Thursday, April 27, 2006

We Need a Third Party

Some recent thoughts about why it is best to be neither Liberal nor Conservative:

The Republican and Democratic parties have a permanent stranglehold on our government. They decide who runs in elections. They draw all congressional districts. They (with minimal input from the citizens of New Hampshire and Iowa) decide the two people from whom we get to choose a president.

The two-party division of political thought is both annoying and destructive to public discourse. America and the world seem to have permanently divided into Left and Right, and no longer even acknowledge the possibility of other approaches to the organization of society. Generally those who don't ally themselves with one side or another are either uninterested in, or disillusioned with politics.

Although "third parties" have existed, they tend to either be either more Left than the Democrats, more Right than the Republicans, or ideologically nebulous groups based around some leader's personality. Since the two ruling parties already have enough Liberalism, Conservativism, and personality cults to keep us bothered, it is no surprise these 3rd parties never take off.

This Right vs. Left division of civil discourse first struck me as absurd when I was voting in my first presidential election after college. I was tired of studying for my Anatomy finals and decided I would sit down and write out my political opinions and beliefs. I was surprised to find that I could neither be a Conservative or a Liberal. Neither party would want me. I'm no opinionless or compromising "centrist." I have strong beliefs, but they just don't fit into Left or Right molds. On my views on environment or poverty are so "left" people think I'm a socialist, but my views on abortion or constitutional interpretation are so "right" as to make me sound like Regan.

It was so liberating to find myself unaffiliated and step off of the Right/Left spectrum. It has opened my eyes to the absurdity of status quo American politics. Without an "us" to identify with, the us vs. them debates in congress and news shows begins to look more and more like the squabbling of self-important gangs of children. It often seems the Democrats and Republicans have little ideology at all but to thwart the agenda of the other party.

It is a bit lonely being partyless but still caring passionately that our society is run well. Everyone seems more interested in figuring out what side you are on than in listening to ideas. Generally Conservatives and Liberals need to recognize an idea as coming from the Left or Right before they are able to agree with or argue against it. Everyone wants to label you even if your political ideas don't fit the label. I find interesting that most of my conservative friends think me very liberal, and my liberal friends think me very conservative.

Conservativism and Liberalism are at least somewhat useful as they have developed two opposite theories on how society should be run, but it strikes me that neither approach is correct, and that there are plenty of better approaches to democracy we could create if we weren’t so obsesses with upholding these two outdated Enlightenment models.

So in a political world without options, I end up stuck choosing between the lesser of two evils. Voting on individual issues for Republicans or Democrats that I don't like or respect. Hopefully, someday we will have a better system free from the hegemony imposed on us by the two-party system. Until then I get to rant on my blog and hope that enough people will read this that someday we might have more choices.


This site is an excellent example of a movement that couldn't be classified as Liberal or Conservative: Seamless Garment I would gladly vote for a political party like this over any Democrat or Republican. It is a novel and consistent approach based on an ethic that most people could accept. I fear such movements could never get off the ground because we refuse to leave our worn-out political parties.

Thursday, April 20, 2006

The Allure of Wealth in Medicine

I wrote this when I was in Medical School. It is amazing how easily idealism can become greed in the world of medicine. I need to think on it more often as I approach the point when I will finish residency and apply for jobs:

In medical school you work for free. In fact, you pay to work 16 hours a day and go into debt doing so. It conditions us for greed. When I arrived in medical school I thought it a bit vulgar that doctors are so highly paid for the work in human suffering. Now I am ready for the big paychecks. I am tired and the dream of wealthy leisure appeals to me. During the late nights on call I find myself dreaming of a large house deep in the woods far from the rest of the world. I long for the room full of books with the seat by the great fireplace where I can read my books and drink my coffee, safe and secure in the comforts of riches. It is comfortable, safe, unconcerned, and it is a far cry from the ideal I learned in Haiti from the Brothers and Sisters of Charity. Greed creeps in under cover of comfort that I begin to feel that I deserve. Medicine makes one tired. It teaches you that no matter how hard you work suffering always continues.

Temptation whispers in your ear, "Why not look out for your own comfort? You have done enough for your poor suffering brothers and sisters. You have done more than your share. You deserve this. How can you be what they need without taking care of yourself? You are called to share the sufferings of Christ and consider yourself the least among our brethren, but your responsibility of suffering has been paid of in these years of grueling training and long hours. When off-duty you must be pampered, safe, and free from concern for your fellow men. You need to be rich."

And so the physician who should be servant of all suddenly becomes a person of wealth and privilege. I should fear this temptation much more than I do. This new and wealthy "Dr Whittemore" is here to rob you of who you were meant to be. Do not trust his kind and happy face. He means to suck you dry and leave you greedy yet unsatisfied.


Tuesday, April 18, 2006

Watching Someone Die

I watched a woman die a few weeks ago. I wrote about it in my journal. (All personal identifying info about her has been taken out.) Here it is:

I have never seen anyone die so fast. One minute she was awake and crying in pain and fear; then a moment later she was dead. It is so strange that after years of being in medicine seeing a death would shake me so much. Usually I see people die slowly and see it coming far in advance, either that or I am called to a "Code Blue" when the body is already in collapse and thus a person's death is just a mechanism that I am combating. This woman is the first person I ever watched die suddenly and unexpectedly.

When the nurse called me saying she was having chest pain, I knew I needed to get there quickly since she was old and had a known heart problem. But she was in the hospital for an unrelated problem. I didn't imagine I would be the last person she would ever see. She was afraid. I think she realized she was dying before I did. In retrospect, I'm glad that I took a moment to take her hand and tell her we were going to take good care of her. I did take good care of her. I did everything right, but nothing worked. I had been with her only a couple minutes when I saw the EKG waves change on the monitor above her bed. Only then did I realize how bad the heart attack was. Most of her heart muscle had just quit. I ordered the nurses to give medicines and get equipment but none of it was any use. I remember asking, "Maam, please take a deep breath" and realizing she wasn't breathing at all. The nurses and I felt for a pulse, but it was gone.

She had a DNR (Do Not Resuscitate) order. Part of me wished I could run a Code Blue, not that I could have made any difference in someone her age with a heart so severely damaged. I was glad that I wouldn't have to hear her ribs crack with chest compressions, but in some secret way a Code would have helped me. It would have given me a chance to keep working, to keep analyzing the mechanisms of her cardiovascular collapse.

Without work to do all I could do was watch her; watch as the pink warm flush went out of her cheeks. I could only look a her as a person: a woman who thirty seconds earlier I had told not to be afraid. A woman who had lived and loved and feared for many years that had suddenly ended. Looking at her as a person is frightening when she is a stranger who has just died under my care. I never even knew her, but I loved her then, because I thought no one should have to die without someone who loved them there. I almost cried in front of the nurses.

I closed her eyes, and pronounced her dead. Before that night I had always thought the idea that life is "fragile" was a bit of an overstatement. I had been amazed at how stubbornly the dying body could cling to life. As I watched her die I realized how fragile it could be. It was just one breath between her pleading look to me and the blank eyes that I saw when I asked her to take another breath that she could never take. She was gone in a second.

I helped the nurses clean up. We removed all the medicines and oxygen tubing and pulled the sheets back over her. I straightened her hair out of her eyes. I wanted her to look beautiful for her family when they arrived. As my hand was on her forehead I silently repeated the blessing:

"The Lord bless you and keep you,
The Lord lift up His countenance upon you,
And be gracious to you.
The Lord cause His face to shine on you,
And give you peace."

It is a blessing Christians have spoken to each other for centuries. I only realized now that it is about heaven.

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the gridbook blog

When I was in college and medical school I used the grid-lined notebooks I had for my laboratory classes as places to collect my thoughts. Over the years I packed about 30 gridbooks with essays, journals, plans, thoughts, confessions, ideas, or drawings. They went with me everywhere. I was always writing. Occasionally I would show a particular page or two to a friend to share my thoughts or ideas.

Over the last several years the gridbooks have been collecting dust on a shelf as I have transitioned to electronic documents. The idea of blogging appeals to me, so I am trying my hand at sending thoughts out into the world to see if anyone else is interested in reading them.

Feel free to read and respond as you wish. I'll be posting new ramblings as well as some older things I think you might find interesting (I'll be sure to mark the older stuff so you know the difference). I write a lot of thoughts on various topics (medicine, politics, culture, Christianity, personal, etc) so I'm not sure what sort of blog this will turn into. Stay tuned.


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