Steinbeck

Sitting in College Coffee in Fairbanks, AK. In a bit of a funk these days - a Fairbanks funk. Apparently it's de rigor for the rotation up here. And not surprising, really. The town is a bit strip mally for most folks (think Twin Falls meets Pocatello or Idaho Falls) and it's lonely. And for many of us, spending significant amounts of time with doctorly folks intently focused on the money in medicine can be disheartening.

But all that is beside the point. . .a funk is a funk is a funk. And it's dissatisfaction defined. It's unsettled and aching. It's a pity party, but a confused one.

And so I'm sitting in the coffee shop and I walk up to the board and see this written:

"Where does discontent start? You are warm enough, but you shiver. You are fed, yet hunger gnaws you. You have been loved, but your yearning wanders in new fields. And to prod all these there's time, the Bastard Time."

-John Steinbeck, Sweet Thursday

Ahh Steinbeck, your words are wise. Message received, funk in check, thank you.

Touch-up

In the last 3 years, I've noticed myself momentarily hesitating before I touch someone. Rest assured, this isn't the result of me becoming a born-again germaphobe, although medical school has afforded me a new found respect for protective barriers. Certainly I now ask myself, "are your hands washed," before I touch I touch anything (a patient, a door handle, my book, my food, a friend), but there is something else contained in my hesitation. It's more a pause to clarify the reason behind my touch, what I want to gain or communicate. Of course touch is significant - this is why we find comfort in it, why it makes us cry, why we are so stingy with it, and why we recall moments of touch (especially the first ones) with visceral clarity. It used to be that my reasons for touching were buried somewhere beneath my awareness - not repressed, but not considered either - like food, touch was simply a thing to receive or give, want (even need) or reject.

In the last few years, the significance of touch has risen into my consciousness. Now I am almost hyperaware of it's existence and completely dependent on it's power. Practically speaking, in the doctorly profession, it is through touch that we learn about the decay of the skin or the disease of the heart. A patient's response to our hands on their abdomen allows tells us to move appendicitis higher or lower on our differential (the running list in our head of reasons for symptoms). Pressing behind the ankle and on top of the foot, we learn about circulation problems. A toe dulled to sensation makes us concerned for diabetic neuropathy. We ask, "Does it hurt here? Can you feel this?" We say, "Your knee feels swollen. Your abdomen tight. The two sides of your lungs sound different to percussion (essentially tapping on the body)." Before we order the (very important and useful) blood draws and the CT scans and and the stress tests, we gather information by touching.

And then there is the other side of touch. Its less practical, but more human (and almost more useful) significance. It is through touch that we are concerned and passionate. Standing side by side, a hand on the back emphasizes that we, the patient and the doctor, are allies in the process of health. Running a hand up and down an arm a few times conveys sympathy. Two hands on the shoulder, looking a patient in the eye tells them we are heartfelt, serious, and speaking the truth. A long hug tells a patient it's O.K. to cry.

For the record, I am not celebrating the days when touch was our primary diagnostic tool. I do not believe that we can heal through touch alone, but I do think that without touch we cannot heal.

Touch is different for me now. I am aware of its significance, and so I try and choose with consciousness. And this new-found awareness does not stop with patients. Now before I shake hands with a patient or hug my dad, before I lay my head on my mom or test a patient's reflexes, before I feel a patient's heart or hold hands with a friend, I delay momentarily. And in that delay my mind runs through these questions: Who is this person? What is my relationship to them? What does this touch mean? And, of course: Do I need to wash my hands before this or after this?

Adventuring in Fairbanks

I just finished my first week of surgery rotation in Fairbanks, AK. I'm starting this rotation after 12 weeks of doing nothing related to medicine. Well, not exactly nothing - I had 6 weeks of psychiatry (the neglected underbelly of the medical world, not because it isn't important, but because it operates blind, with unpredictable pathology refractory to what few "treatments" are available) and then 6 weeks of nothing related to medical school (blissful, beautiful stress-free nothing). And despite my best efforts, time passes, so now I'm back in the med school game again.

A decision: I decided to expand my last year - meaning I will take 2 years to do my fourth year. This is great because it enables me to do some last minute adventuring before I graduate, postpone decisions I'm not quite "ready" to make, and basically revel in studentdom for that much longer. This is terrible because it means I am a student for that much longer.

A few first week tidbits to share.

1) I have heard arguments on both sides and I've officially decided that Fairbanks is not the best of what Alaska has to offer. That's really all I have to say about that.

2) Dr. Montano is an old cowboy who has been operating in Fairbanks probably before the hospital was even built. He's done surgeries that people spend 8 years in residency learning how to do. He's cowboy defined, and it's unsafe for patients, but he's grandfathered in because he has been doing it for so long. The other surgeons had to band together to convince him to stop doing craniotomies (hole in the head). He's thin and spindly, crotchety and irreverent. Reminds me of Harry Dean Stanton. He's the definition of a libertarian. And he's got a great sense of humor.

I told him Ross had told me to tell the docs that they shouldn't be mean to me. He said, "I couldn't be hard on you - it'd be like being mean to a puppy."

He found out I was from Idaho (I emphasized Idaho over California - it seemed like a wise decision) and his second question was, "Are you Morman?" He's not subtle.

His daughter is a pediatrician in Anchorage and he told me I shouldn't be a pediatrician cause I won't make any money.

He also has 5 houses, I think.

That's it for now. More stories to come.