Blogger of Jared

A little more than a year ago, I moved far away from my beloved family and mountains to attend medical school in Pennsylvania. The first months, in particular, were harrowing, and all my time here has had been challenging. The other night, though, I found myself feeling particular trepidation because, in January, I will begin work in the hospital. I will replace the endless parade of powerpoint slides with patients–living, breathing, ailing, suffering humans who need our help to get well. The burden, as you might imagine, can seem daunting and the expectation is almost worse. I include here an e-mail written to my parents that night, slightly edited for presentation here, but hopefully remaining true to the urgeny of my feelings that night; I would appreciate the thoughts of anyone who has ever scaled a peak that, beforehand, seemed nearly insurmountable:

My sadness last night, I think, is part of a larger nerrvousness that is slowly growing within the class: the clinics are looming large and have begun to convince us that we know nothing (what, I’m supposed to remember EVERYTHING I’ve learned in the past year? Right….); we don’t know nothing, of course, but we know relatively little, it seems. I think beginning work in the clinics is kind of like beginning a mission: you look ahead of you to this vast expanse of undiscovered territory and realize you have no concept what the journey will really be like. Sure, you can ask people who’ve been there for advice or at least description, but even their answers further persuade you you have never been on a trek even remotely like the one on which you are beginning to embark. So you pause at the edge of the desert, draw in a deep breath, check your pack one last time, and wonder whether you really have the wherewithal.

The big difference, or so it seems, is a mission provides a whole cadre of companions (including literal companions as well as local ward members and mission leaders) who want nothing more than your success. Rumor has it, though, that the clinics are filled with interns who are too tired to care too much about your success, residents who are too far removed, attendings who are much too smart, and collegaues who are much too competetive, so that, at the end of the day, I wonder if anyone in the hospital will really be looking out for my welfare or if I will be engaged in some weird version of that TV show “survivor” (which I’ve never seen, but which apparently involves a group of people “voting” off the island one less-astute member of the team daily).

All of this, of course, comes on top of a schedule that would make a sailor cringe: surgery, for example, has you at the hopsital a 4:30 AM for prerounds and not leaving until 8 or 9, five days a week, plus some weekends. Then, on top of that, you are supposed to study for difficult upcoming exams (the dreaded “shelf exams”) not to mention studying for being “pimped,” a new term to which I’ve only been recently introduced: it refers to a higher-up, usually an attending, asking you questions, point blank, to see if you know your stuff. I’ve described the sometimes miraculous way in which answers have been brought to my memory during difficult medical school classes up till now; in the hopsital, though, any given day can bring up any given organ system which means anything we’ve studied in the past year–it’s all fair game for being pimped. In fairness, fourth year students say not to worry because no one expects you to know anything when you begin, anyway; still, while you’re obviously not expected to know everything, they must expect you know something, probably a good number of somethings, I mean you’ve been going to Ivy League medical school for a year and a half, and you passed the classes, right? Even worse (horror of horros) what if I have one of my fellow students on my team and, when I don’t know the effect of parathyroid hormone on calcitonin secretion is primary hypoparathyroidism, my collegue graciously (not) steps in and provides the explanation as if he were repeating his phone number.

The irony about the last paragraph is that we had a meeting with many of my fellow-students on thursday night and just about everything I’ve expressed here floated palpably in the air, like smog. Everyone’s eyes were darting about like squirrells’. Everybody is pawing nervously at the starting line, simultanesouly dreading and longing for the beginning of the race–we sense how hard its going to be but also know intuitively it must be better to get in there and dig our fingers into the dirt than to stand at the desert’s edge and fantasize about phantom know-it-all students.

And, yes, at least I hope, there is still the reason we came here. On Tuesday night I traveled with Dr. K (a retro-hippy with a gnarled sprig of gray hair who wanted to know “how did Salt Lake end up with a democratic mayor?”) to visit a 96-year-old man who is nearing death. This African American fellow had fluid accumulating inside his belly (ascites) and his heart is failing and his vision’s going. His hearing is out unless he puts in and cranks up the hearing aids. He just left the hospital after a month there and now no one is sure how far the insurance will extend–at some point, his family may have to let him go. He lied on his bed, haloed by the tacky crawling flowers typical of seventies wallpaper, and moaned occasionally because of his bedsores. He spoke with the doctor and told us how he’d been doing great till about a month and a half ago: two months ago he was still riding his motor scooter to go fishing over across the Delaware.

“Fishing?” I asked–”you like fishing?”

“Yes, son, ya ever do any fishing?”

“Oh yes, in Utah: browns, and rainbows, and cutthroats. What about you? What do you catch?”

“Anything that bites.”

“That’s a better answer than the one I gave.”

“I once caught a twenty-five pounder; I’ve even caught sharks off the coast of Florida, you have to use a net, they’ll break any line you put out there.”

And now we had connected–Alaska, Florida, trout, sharks, fishing, nets, hooks, worms, lines, mountains. Stories and memories came gushing forth:

“And those little girls,” I asked, “what were their names?”

Mr. C. looked a bit puzzled–he knew he should know the answer but he couldn’t remember his granddaughters’ names (each was about five years old).

Finally his daugher volunteered: “Mr. Johnson, ask him what he calls them.”

“Mr. C, what do you call those pretty little girls?”

“Sugar-momma,” came the reply, without hesitation, in a voice as sweet and gritty as brown sugar.

Later, when we had to turn Mr. C. over for examination, we brushed his bed sores and he howled in pain: “oh, it buhns, it buhns lak fahr, lak fahr.” So I put my hand on his shoulder and stroked him, cooing: “it’ll be alright, shhhhhh, it’ll be ok, you’re alright:” and, again, we connected, this time the energy flowed from my hand to his shoulder, imparting, silently, the kind of comfort that only comes from human touch.

The moment was beautiful and mixes a sweetness with the trepidation I feel as I approach clinics–this is why I came, right? I just wish I wasn’t quite so nervous.