Gone Fishin' (with photos!)

I went fishing on Saturday and although i discovered that my sea legs are not quite as strong as i'd like, I had a great time. The sea was calm, but consistently rolling and in the fog that made everything surreal and eerie, the horizon was nowhere to be seen. Apparently this was not a good combination for me, as I got queasy. But I held my stomach and learned that my personal solution to sea sickness is to sit down outside while holding a metal thermos - go figure. The fish were biting and we immediately caught a triple (every line had a fish), although I lost mine and we sent one lucky guy back to the sea. I caught some fish, I lost some fish, and I learned that when a pole wobbles with a fish, everyone gets very excited. I'm not sure I'd really call fishing the most relaxing thing I've done: each fish would go something like this:

Fish! There's a fish! Set it! Set it! Shit. . .Set it! Reel, reel, reel, reel. . harder, reel harder, STOP!!!!! Don't reel anymore, move back step back, steady, steady. . damnit. . bring it closer to the net, closer. . There! Got it in the net. . . . . . . .Thwock, Thwock Thwock (sound of fish getting hit on head with club). . silence, flop, flop, flop. . WOAH!. . Thwock, thwock, thwock.

Yes, I the animal lover did hit a fish or two on the head, but mostly it was because I would look in the cooler and see the fish still flopping and that would make me sad because I thought that they might be suffering, so I would hit them again. Sometimes it worked. I will admit that it was satisfying to get a good clobber in, but ONLY because I knew I was putting the fish out of its misery, I swear.

As the fish stopped biting and our cooler filled - silvers and pinks and bass, oh my - our captain turned the boat towards the sunshine and we headed to Long Island, which is just off of Kodiak. Kodiak Island was a major staging area for North Pacific operations during WWII. During WWII, Long Island housed Fort Tidball, bunkers, and gun emplacements. Per one of my guides, due to leaked PBCs, Long Island has the distinction of being the first superfund site in America. Apparently it's not safe to drink the water or eat the deer or feral cows that roam the island. Yes, feral cows. We boated past a puffin rookery and hiked up to a bunker site and lollygagged (love that word) in the sun for a bit.

Here's a map.

Here are some links with info about Long Island:
Military History (scroll down to the Long Island section)
Deer Point info


The boating adventure finished with a trip down cannery row (in the water) to a cannery that cleans and packs the fishies for winter eatin'. . and then over to the sea lions where we cleaned the fish. But don't tell anyone we did that, it's illegal. But goodness illegal things are sometimes awfully cool - it was pretty dang neat to be so close to such silly, big, slow moving creatures.

The day ended with a delicious feast on two of our fishies (a bass, a pink salmon, and a king salmon that Mark had caught a few days ago). I went to the house of the two docs who own the clinic and it was, without a doubt, my dream house - absolutely gorgeous with a great big open kitchen and living room. Right on the water with a gorgeous deck. They built it themselves (at least half of it). . and lived in a tent while doing so. "We never fed our children store bought meat and we never eat frozen fish." Sigh. . .I'm a bit in love with their life.

Click the photo below to see even more photos (look at me, I'm doing pictures - wow).

Gone Fishin'

Kodiak Island

Kodiak Island is BEAUTIFUL. I have been to many a pretty place in my life, and this may be the prettiest place I've ever been. It's a mixture of the dramatic mountains of the Pyrenees, the lush green of Guatemala, the coastline of the San Juan Islands, plus the wildflowers of Idaho. It's pretty in comparison to Alaska, which is saying a lot, since Alaska is, well, gorgeous.

I've just begun to explore Kodiak, but already I can tell that it runs on "island time." In other words, it's mellow. But more than that, it's got the energy of a community whose rhythms, at least to some extent, are determined by mother nature's. Things like the tides, the weather, migration patterns of fish all impact the days, weeks, months, and years of the people who live here. I like living somewhere where the local radio station includes the tide with the weather and both are significant beyond mere interest. The population of Kodiak wanes and waxes as the fishing boats and the Coast Guard patrols depart and return. Turnover is high - the hardship of fishing and the maximum of a 4 year station make for impermanence.

One week done and I really do love it here. Family Practice is back on the very short list. Folks here are so incredibly nice. The docs here love to teach and care for their patients in this calm, relaxed way that puts the patients at ease. 15 minute appointments are rare, so nothing is ever rushed. Being an FP doctor here would mean practicing primary care the way it should be practiced - more than a mere gateway, you are the center of your patient's care. You handle the things you are qualified to handle (and maybe a few that you aren't, out of necessity) and refer the very complicated things. In the lower 48, it seems like most FPs refer everyone and everything they are expected to and they can. Malpractice is on everyone's mind and no one general is given agency to make decisions they at one point were qualified to make. The primary care profession is leeched of confidence (and thus competence)

Up here on Kodiak, you build relationships with specialists in the big city (Anchorage) and call on them when you need help or advice - and they eagerly (and non-possessively) give it because they understand that in Alaska, referring to a specialist is not always possible. You deliver babies (maybe do c-sections if you are trained), work in the ER, and see patients in clinic. You tailor your practice both in the patients you see and the hours you work. And at KIMA, your fellow health care providers are amazing, inspirational people. This is one of those seductive practices (like Alaska Women's Health Services) that lures you into the field (family medicine in this case) by fooling you into believing that all practices are like this.

The separation of practice versus profession. How much of what I like about being an FP is dependent on location? What about with pediatrics?

I'm quite thankful I don't have to make my decision tomorrow (yes more loans, I knew there was a reason I signed on to you).

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.

Nighty?

So I'm driving into work today (yes driving, working on that) and in front of me is a much-too-large SUV with a license plate that says "Nighty." And I say to myself, "Nighty," what does that mean, or, more importantly, what does the owner intend that to mean? I'm thinking . . maybe they like night gowns, maybe they are trying to say good night, maybe they associate with the night and intend "Nighty" to mean "night-like." In that vein, it's possible that they are middle-age enthusiasts and couldn't fit the K on the plate. It also crossed my mind that maybe they wanted to say "Naughty," but that was already taken. In any case, the message was lost in translation. This is the problem with free vanity plates.

Butterflies

Well, so much for promises n' resolutions n' stuff. One week, one month. . . what can I say.
In my defense, I did write something between my last entry and this one. Unfortunately, it was in desperate need of a fine tooth comb-through. . . and, well, that never happened.

So yes, I am on psych. And yes, this is one of those rotations that affords me with quite a bit of free time. It's also one of those rotations that is rich with stories. These are ridiculous, unbelievable stories. They are incredible, fascinating stories. They are heartbreaking stories and they are not my stories. These stories belong to other people. Without a doubt, the stories that I have told during other rotations are other people's stories too, but there is something more intimate about the stories of the mind.

For one thing, the majority of the patients that I am working with do not have the capacity to understand their own stories, at least not in the way that the rest of us understand them.

For another thing, these are difficult stories. The insane trace paths that are frighteningly close to the sane. In the beginning, the stories sound and feel the same; their potential is limitless. But somewhere they split. More than just diverging away from each other, they come to exist in a completely different reality. Indeed, I'm beginning to find that the sane and the insane seem to live parallel lives in entirely different universes. And sometimes it is so easy to see how they jumped into their reality. This scares me because it makes sanity seem so fragile. It makes me wonder what will set me off. Other times it is impossible to dissect a patient's movement into psychosis. Their stories are indecipherable, completely obscured. These patients underscore the tragedy of a psychotic break because it is impossible to tease out the person inside their illness.

For a third thing, these stories are funny. Devastatingly funny. It's hard not to laugh, but I feel guilty for laughing. I don't know how else to cope, because I am depressed by what we, "the healers," are forced to force the patients to do. So I laugh. I'm not sure if that's fair to the patients. I am laughing at them, for they do not have the ability to laugh with me. And so I tell the stories to those who are capable of laughing with me - and we laugh together. I am fairly certain, however, that we do not laugh out of humor. The laughter seems to come from a place of uncertainty, discomfort. I think we laugh out of disbelief.

And so I tell these stories out loud and the little conscience butterflies I keep in my stomach flutter self-consciously. Which is why I have yet to be able to write them down. But I'm working on it.

That Entry

Hello world.
I'm back.

This is the requisite, "I'm back" entry. The entry where I apologize for being so MIA and thank my readers profusely for sticking with me. The time in a blog where I explain that I was busy and then busier, and then just exhausted and taking a break from everything that involved anything, and then I got caught up in some stupid, stupid, stupid, poorly written books about stupid teenage vampires. And then when I finally had time to write/realized how stupid the vampire books were (and continue to be), I was a little unsure about how exactly to get back on the proverbial horse. But then it dawned on me: Just write an entry about how you are going to start writing, about how you are sorry that you have been gone, but that you are back again.

And so that's what I'm doing.

Also required in this sort of come back is a brief update of what I have been doing for the last several months. . . it should be a sentence, no more.

Since November, I finished medicine, went to California, came back to Alaska, started and completed my pediatric rotation (right now, I am about 95% pediatrician, 5% family medicine doc - more on that dilemma later), went backcountry skiing, got new skis and bindings, went backcountry skiing again on my AMAZING new skis and bindings (thanks Luc and Tarby), broke some pipes in my apartment, saw Josh Ritter (love the boy), went out dancing a few times, have generally been enjoying myself despite the fact that I continue to have agonizing dilemmas about what I am doing with my next year/life, and am welcoming back the sun. Speaking of the sun - damn, it's nice to have it back. Speaking of the weather - it's been all over the place. No global warming up here, Sarah Palin says so.

And last requirement of this entry (self-imposed) is a tantalizing teaser of things to come:
I'm on psych now, working at the state lock-down psych facility, need I say more? My goal (if you put goals up in public, you are more likely to hold yourself to them) is to write at least weekly.

So to recap:
I'm sorry I've been gone for so long, I did some shit, fat skis rock, there are some crazy folks in the world, most importantly, thank you for your patience, encouragement, and continued attention, and I'm back.

Certainty

Another one of those cases where being wrong rocks.
Yesterday afternoon, I overheard the doctor who had showed me the man with the Nec Fasc talking.

Apparently he was still alive (as of yesterday)and had actually regained his sight (he was blind prior to yesterday).

This may be the uplift before he dies, but it was not predicted, so maybe it means he will live. Maybe he didn't have true Nec Fasc and so the antibiotics we gave him actually worked.

All in all, a much more uplifting Thanksgiving story than yesterday's.

I guess nothing is ever certain, even when we are sure it is.

Necrotizing Fasciitis

I saw a man with necrotizing fasciitis today.* This is a medical student's dream; the grand hoo haw of infectious diseases. Nec Fasc is not something that you come across every day. It's the joy of being a med student that every practicing doctor wants to show you this crazy thing they just found. They haven't seen anything like it in all their years of practicing, and there you are, lucky enough to be a student and the receptical of all things educational. Our job is to be enthralled, inquisitive, and to validate their excitement. We reassure them that this is fascinating, we confirm that this is important, and perhaps our learning injects some hope into what might otherwise be merely a tragic incident; a sad waste. But that might be vanity speaking.

So back to this man I saw today. I got chills tonight, a momentary tear in my eye when I thought about what I had actually seen. It was not just necrotizing fasciitis. It was not just an infection superimposed on an already feeble, ill man. It was this man's death that I saw. The way that his life will end laid out on his body like tarot cards predicting the future. By the time he was diagnosed, 8 hours after admission, the flesh-eating bacteria had attacked too much of his already crippled body. Down one leg, up his back, weaving it's way down his other leg. Like a wave in slow motion, yet so fast, too fast for his body, for our medicine. There was nothing to be done except treat him for pain, treat him with antibiotics for palliative care, and help him die. And that's what grabbed me tonight. I saw this man for, at the most, 5 minutes, but he made an impact on me and not just because I had never seen necrotizing fasciitis before. He's the first person I have had contact with in the hospital who I know is going to die in the next several hours. And what's more, I know what he will die from. In my brief time in the guts of the clinical world, I have met many patients who I know are not long for this world. I know that we are merely postponing their death, but I do not know which one of their 10 problems will finally claim them. So even though we know they will die soon, we are ignorant about what they will die from, and the patient and the doctor(s) are gifted the freedom of continuing on in the charade, blissfully naive to the ending. Seeing this patient was like watching Hamlet after having already seen it. There is nothing to do but simply wait for the ending that you know by heart. You want to run up and console Ophelia before she drowns herself. You want to pull the poisoned glass from Gertrude's lips before she drinks. You want to reconcile Hamlet and Laertes before they stab each other. But you can't, because the show must go on (or so they say), and the ending always comes, and it always comes in the same way.

And so I know that tonight, at 10:45, the infection has now completely consumed both of his legs. It has moved onto his upper body. I am almost certain that he has finally developed sepsis and possibly fallen into unconsciousness. It is quite likely that, at this hour, roughly 24 hours after coming to the emergency room, he has succumbed to the ultimate, irreversible outcome of such tissue destruction.



*Necortizing fasciitis is one of those things that really scares me - both from a doctoring stand point and from a patient stand point. In other words, it's something I'm worried I'm going to miss in a patient and something I'm petrified that I am going to acquire. It's also something that fascinates me. I get the same chills up my spine, the same obsession/revulsion feeling about it as I do about deadly snakes and sororities.

Alaska

This week, I saw a man in his 70's. He was wearing a thick flannel shirt, suspenders, and a trucker's hat. First question out of his mouth was "Who did you vote for? I voted for McCain." He's a retired bear hunting guide and taxidermist, but he still likes to guide for 30 day scientific expeditions through the Yukon, in the winter (yes folks, I did say he is 70). He also swears that fried chicken gizzards are just about the most delicious thing he's ever had.

Amazing.

I Love Tuesdays

One week later and I am still in shock. Like everyone else who blogs, I feel the need to put something down to mark such an historic, nation changing, nation shaping event and I figure that within 1 week, it still counts as current. I sent a text message to pretty much everyone in my phone (except for my die hard conservative friends). Below are all of the texts I received about the election over a 30 hr period, including the responses to my text. I heard back from people I hadn’t talked to in years, highlighting for me how enormous the collective sense of relief, freedom, and change was. My text was sent at 19:15, it is italicized

(And a side note: Tuesday is apparently going to be the most superior day of the week this year. .last week was the end of stupid-people-in-charge era, and today it’s dumping in Alaska. . .did I mention I’m back in AK these days.? . happy like a clam).

5:48: I’m at the polls right now-very exciting.

18:04 Looking good

19:15 Congrats! Woo! This is the best day in eight years.

19:17: Yay!

20:21: Owwwwwwww!

20:26: !!!!!!!!!!!!!!!!!!:)!!!!!!!!!!!!!!!

20:29: Amazing night! We can be prove americans again!

20:34: Maybe 30 years. Halle-flippin-lujah!

20:34: Absolutely!

20:38: Indeed it is.

20:39: I finally love america :) When can we get together?

20:40: Drinking and cheering

20:40: Historical moment my friends! Obama!

20:41: Fuck yay

20:42: Yes yes. ** says he has been depressed for 8 years. Just ichatted with – Log what a speech

20:45: Fuck yeah!! 221 years in the making.

20:45: Cap hill we’re all cbheering and crying and just f*ing ecstatic

20:45: Yes congrats to us all. It’s a great new day in this country.

20:47: No kidding!!!! It’s fucking AWESOME! Awesome speech too

20:48: Fucking amazing

20:49: Yay! Coming to the comet tomorrow?

20:49: Wooohoo! I have chills! That speech was incredible!

20:50: Indeed

20:50: Totally! So excited!

20:52: Hell yeah

20:53: People at literally dancing in the streets here in NYC.

20:56: oh hells yes. We’re in DC right now… total mayhem… like effin carnival… it’s beautiful… love.

20:57: Indeed! Bravo! Hurray! Watershed moment ;-D

20:57: woo hoo is right. What a great feeling! I still have goosebumps from his speech too!

21:01: Epic! So proud. Miss you!

21:03: Fosho… How u been?

21:09: Yeah!!! Um, who is this?

21:11: Not sure who this is but I agree!

21:14: Oh nice to hear from you. And thank goodness we won! I cried.

21:14: Yeah! I feel so good the election is over and obama won

21:15: Yay!!!!!!!!!!!!!!

21:17: Ppl lighting fireworks in Berkeley streets

21:20: so youre alive

21:22: Let’s see what happens on prop 8 before we get too excited, but yes, I am happy so far!

21:24: Gregoire!!!!!!! Obama!!!! Happiest moment of my life :-D
F Yeah America!

21:39: We did it! Democracy worked. We are a better nation today. I’m so damn excited

22:28: Why? What happened?

Wednesday, November 8, 2008

3:40: Yipeeeee!

6:01: Amen to that!

11:33: Who the hell is this

11:34: Hey my phone got messed up, who’s number is this?

11:37: Aw Jessie I miss you and I still cannot contain my happiness today. I wish we could celebrate together!

Teaser

I am nearing the end of this whirlwind tour through academic medicine. I have had the impulse to blog, flashes of thoughts I wanted to put into written form, but my desire to reflect is weak compared to my imperative need for sleep. And so this page has remained silent for almost 6 weeks. Which is funny, because I feel brim full of epiphanies had and stories witnessed. So as I wind down my time here and transition back into the slower world of winter in Alaska, I am hoping that my memory will hold and I will have time to sort through the jumble of emotions and thoughts brought on by my last 6 weeks.

For now, this:

Frequently I look at those of us who are training to be doctors, and those of us who are residents, and those of us who are attendings and I think, dear god, we are just children play acting. There are young children, like myself, who mimic and there are older children, like the attendings, who decide which games we will play, but we are all nothing more than children in a big, scary, chaotic world. We have information gleaned from good and bad studies that we use to make decisions, we have the experience of the way similar situations have gone in the past, we have a stethoscope, we have MRIs, and we have blood tests, but these are weak defenses against the uncertainty that fills the spaces created by the heterogeneity of patients. There is, over our shoulders, a constant question of uncertainty. Sometimes it looms large, sometimes it squeaks small. The latter are days of success, I think. This uncertainty is not what I find disconcerting. It is expected, it is why medicine is referred to as an art rather than a science. It is why so many of us are drawn to the field.

What I find disconcerting are the ways that we try and manage the uncertainty. There is the ridiculous paperwork that tries to minimize unnecessary uncertainty. Perhaps our best response to it is the collaboration that is the foundation of doctoring. And our worst, the one that would keep me up at night if anything could keep me up at night these days, is our collective approach to each patient as a game, a puzzle to be solved, a mystery to explore, a lesson to be learned.

I think of the pre-code we were called to several days ago on a post-call morning. In front of us was an unconscious, large middle aged man. His pillow was red from the blood drooling from his mouth. He grunted to pain, when we pulled his eyelids open, we could watch his eyes rove back and forth in a rhythmic pattern. One side to the other, one side to the other. His vitals were stable, his blood gases normal, nothing to indicate what was going on. And the three, maybe four of us in white coats stood at the foot of the bed nonchalantly discussing his case.

R3: What do you think is going on?
Other R3: I have no idea. . . maybe a seizure?
R3: Yeah, that's a good guess. Probably is what it is. I mean, it doesn't look exactly like a seizure, but, what else could it be?
Other R3: Yeah, I mean, his vitals are stable, ABG was good n' normal, normal sugars. . a seizure could look like this, I think.
R3: So should we give him some ativan?
Other R3: Maybe. Did you call Neuro (to the intern)
Intern: Yes. Couldn't get ahold of them.
R3: Hmm. . I guess we could just give him the ativan, it's not going to hurt him, right?
Other R3: I don't think so. Seems like it's something to do.
Silence
Nurse: So do you want me to go get the ativan?
R3: Yes, I guess. . I mean. . I think so. Yeah, sure.

And so on. . eventually no ativan was given, and we all backed away from the patient as his primary care team arrived. He was still seizing, or doing whatever he was doing. I was struck by how we stood at his bedside, fascinated by what he was doing, without any urgency to fix it. I felt like we were children – our white coats fit too large, our stethoscopes looked awkward. Our feet shuffled. .how can we make this more fun again?

Sound advice. . .

. . that I overheard the other day went something like this:

"Just remember, you never know when you are going to have your last first kiss."

Priests and Layfolk

I can’t believe I am actually saying this, but it may be that the thing that I find unsettling about family medicine is the emphasis placed on patient centered care and preventative medicine. It’s not that I don’t believe in those things, I absolutely do. The only way we as a population can become healthier is by preventing ourselves from doing those things that make us unhealthy. And of course, the patient should always be at the center of health care.

The problem with preventative medicine in its current incarnation is that we have made basic common sense seem like something you need an MD to understand. Preventative medicine is not rocket science: don’t smoke, don’t drink too much, eat fresh stuff, exercise, don’t get too fat, don’t get too stressed. It is possible that by naming these topics medical we have actually done a disservice to our patients. Once something is medical, it is seen as inaccessible to anyone other than a health professional. Practitioners have become the priests required to access common sense; we are the intermediaries between laypeople and their own health.

Along those lines, with patient centered care, the patient is always right and every concern they have is equally valid and important. Of course a patient’s worries should be addressed, but I’m not sure it’s to their benefit to come in for every 2-second pain or unusual sensation they experience. This is linked to the sequestration of common sense to the medical elite. People don’t trust themselves anymore. They have no connection to their bodies and so they doubt every feeling they have. Normal body processes are now seen as death knells. The medical field reinforces this ignorance of self by giving a visit to every preoccupation. And we validate every anxiety by solving it with medical advice. Instead of saying. “well, sometimes that just happens,” we prescribe opiates or anti-anxiety medicine. And our latest trend response to non-issues issues? Yup, you guessed it. . preventative medicine, which means that people only do preventative medicine when they are told to as a curative measure (and is that really preventative anymore??). (And on a side note, of course there are forms of preventative care that should never be abandoned - cervical cancer screening, for example).

I'm not 100% sure if I agree what I wrote above. Since I believe in holistic medicine and I believe in treating the entire person rather than the illness, there is something to be said for being able to prescribe things like "eat better," and "exercise," and "meditation." And I never want the medical pendulum to swing back in the direction where doctors are patriarchal figures - telling their patients what is best without any input from the patients. That said, I do think that we these 2 concepts aren't sitting quite right. There is work to be done there, because I'm not sure that, at this point, we are doing the best by our patients.