Humility

People often seek out stimuli for specific emotions. They watch horror movies to feel fear, volunteer at a soup kitchen to feel altruism, dress up to feel sexy, or attend church to feel pious. However, most don't go about looking to feel humility. It is a rarely sought experience. I, for one, did not go to the ER today to tag along with the doctors there, intending to be humbled.

I was hanging out in the doctors' room, listening to the banter and waiting for something interesting to happen. The kind of talk that ER doctors partake in is very similar to firehouse banter. It must be a function of being privvy to the nastiest, most private, raw aspects of a patient's life. I think the irreverence with which doctors and firefighters/medics alike talk about patients is refreshing. It is a welcome departure from political correctness. The particular story that one doctor was telling was about a fellow who came in after a car crash, fully strapped to a board with his neck in a collar and utterly unable to move. The doctor went into the room a while later to examine the patient, and found someone standing at the foot of the bed, but with her head bobbing up and down under the sheets. The patient, seeing the doctor in the doorway, cleared his throat, and the bobbing stopped. Everything was still for a moment, then as the doctor decided the patient could wait and turned to leave, the bobbing started again.

As the laughter died down, one of the doctors asked if I wanted to see a "really nasty abcess." I perked up, "Sure!" and we headed off. A Latino woman was the lucky bearer of this malady. She could have been the sister of my aunt's housekeeper, who I used to help fold laundry because I was uncomfortable with the idea of someone cleaning my stuff in servitude. I nearly asked the patient if she was related to her, the resemblance was so similar. She was in the ER because she had an abcess under her armpit, on the side of her chest. The abcess was about the size of my fist in diameter, angry red, stretching the skin taut, and oozing pus. I had seen abcesses before, and they always looked like they were very painful. They are usually from shooting up dirty drugs under the skin instead of into a vein, where they are supposed to go, but the doctor said that women that speak only Spanish don't do drugs. The men, maybe, or maybe the second generation, but usually not the first generation women: a useful un-PC-ism, an anecdotal, practical truism, that I mentally filed away. He didn't know how she got hers. He then passed me off to the resident who was doing the actual procedure, and stepped out. The resident explained that he had numbed up the skin slightly beforehand, but he couldn't numb everything so it was going to hurt the patient considerably. Sure enough, as he made the two-inch incision, the woman started wriggling her legs around and making muffled pained noises. Pus flowed out of the incision, and I peered in and matter-of-factly muttered, yes, I see, you're right, it is a lot of pus. He asked me to hand him the suction, and sucked up the thick fluid that resembled melted vanilla-butterscotch ice cream with raspberry sauce, and the lady continued to kick her legs about. Then, the resident explained that with abcesses this big, there are pockets of pus branching out from the main pocket, so he would have to dig around for them in order to get it to all drain out. So he jammed in his scissors and poked into the gaping hole under the skin. The pus that I thought was all gone gushed out anew, and the woman screamed louder than I can remember anyone screaming in a long time. This was unexpected. I figured he would make a cut and squeeze the pus out, but the digging around seemed rather torturous. I felt a little bothered. I wondered if it was because causing more pain, aside from starting an IV with a needle to the arm or splinting a broken limb, is not really in my paramedic experience. I wondered if it was because he was poking around so much and that I didn't expect him to be so visceral about it. Maybe it was because I didn't feel that great when I woke up this morning. And this wasn't making me feel better. The gaping hole, the river of pus, the screams, the suction, my head felt a little funny, the resident asked for the suction again, the lady screamed more, the gaping hole, the stabbing scissors, I felt kind of stuffy, more suction, I swallowed, I was going to be fine, I took a breath, the scissors inside the open wound, she screamed louder, my vision got dark on the periphery, I couldn't make it stop, the scissors went deeper, more screaming, writhing legs, my vision finally tunnelled. I tried to put the suction down neatly as I told the resident that I was going to step out. "Sure, sure, no problem," he said, as I left the room and leaned on the handrail in the hallway. I found that standing upright wasn't so easy, so I sat down on the floor, taking deep breaths. I was sweating, parts of me cold, others hot. My vision wasn't so good. The attending came back around the corner and said something to me. I couldn't understand him. I peeled my head off the wall and a gravelly whisper came out, "I'm sorry?" He took one look at me, either said or waved "never mind," and left. A nurse came out of a room, and saw me there. "You okay?" she asked. "You want to come in here?" I didn't know where "here" was, so I laughed weakly and said I was okay. She held out her hand and I promptly changed my mind. She helped me onto my feet, and let me into the nurses' room. I found a chair, put my feet up in another, and she remarked that I looked awfully pale as she switched on the fan for me. I felt really silly but I was sweaty and cold all over, and the darn darkness of my visual field wasn't going away as quickly as I hoped. People moved in and out, variously comforting me and informing me that my face was shades of green or grey. Another nurse brought me apple juice and a packet of crackers. My vision was getting back to normal. I was very confused why my brain was doing this to me after ten years in EMS, the last six of which were as a medic in what most would call a hard-core environment. When I felt better, I went back into the room to watch the resident pack the wound with gauze. It went fine.

So now I sit here, pondering why I reacted that way. I slept in until almost noon today, and was parched when I woke up. I had two bowls of salty egg soup and a half a bagel for lunch, then a granola bar just before I went into the ER. Not the pinnacle of nutrition. I think it was also the causing pain part, and maybe the unexpected scissor-stabbing part of the procedure. Maybe I've seen so much so far that I was caught by surprise by something I didn't see coming. By comparison, cadavers are no sweat (although who knows how I’ll be when we start dissecting the face). At first, I wasn't that worried, but I did hope that I would make it through okay. Now that we have been in lab several times, I think they are distasteful, but they don't scream and cry and flail about. You can't hurt them. Living people are different though, and I think my tolerance of cadavers and prior patient experience has made me too comfortable. In any case, I certainly didn't see humble pie on the menu for the afternoon, but I got a slice of it. It doesn't taste all that great, but I suppose it's a necessary thing to have from time to time.

Discovery

I discovered today that red wine in moderation is not only good for your heart, but also makes studying funner.

Random Thoughts Post-Exam

I've discovered the key to excellent pesto sauce. I've made and eaten a lot of pesto in the firehouse. My favorite can be found at the Nob Hill Cafe in San Francisco, in -oddly enough- Nob Hill. Yesterday I experiemented. The secret ingredient is a little bit of cream. Yes, in addition to the olive oil and sausage. And Italians are slimmer than Americans? Hard to believe. It must be the wine. Also, the key to making good cranberry sauce from scratch is not necessarily adding more sugar, but a little orange juice. Of course, that has sugar in it too, but the OJ adds a little sumpm-sumpm.

My genetics professor really pissed me off. Today was the final exam. Her spelling and grammar were insultingly bad throughout the course - in the handouts and in the presentations. She didn't know how to punctuate either, and sometimes it would convolute the meaning of the sentence. If we are being held to such high academic standards, then the professors should be held to even higher standards. Medical school is supposed to be the pinnacle of higher education, so it's depressing that the faculty can't even spell. AND, she's from Britain! It's her first language! They're supposed to be the originators of the freakin' language! Rrrrgh. Poor spelling really makes a person look either stupid or lazy.

There are no good music stores in Orange County to go buy sheet music for my violin. The music library at UC Irvine is a joke - they have no music librarian, and all the music that they have is tucked away in some corner at the top of the library. Cal has a whole building dedicated to music, with its own librarians. I miss Cal. I didn't appreciate it as much as I could have when I was actually a student there.

I wanted to drive to Napa this afternoon, but it's too far. There's no place like that here that's within an hour's drive, like Napa is to Oakland. So I drove around the endless concrete jungle for a while instead, looking for a musical instrument store. It was rather unsatisfying. I miss Northern CA.

On a happy note... for our fake patient exams last week, we conducted a physical on a normal person who didn't have medical problems. I didn't do the reading beforehand, so I was winging it. The doctor who oversees me and my partner asked some questions to which I had no answer. I let my partner answer those questions and chimed in for the ones I did know from background knowledge. My partner had done the whole reading about how to do a physical exam. He is a very precise, intelligent guy with somewhat businesslike, but good bedside manners - he said "please" and "thank you" every time he asked the patient to do something. During the session, I could tell that the man was bored and not so impressed with what was going on. At one point as the doctor was rambling on about some technique, I quietly asked the man, "How are you doing?" with a slight smirk on my face, because I thought that the whole situation was rather silly, too. When we were finished, the doctor didn't single me out by name, but he mentioned, "...and you should always say please and thank you when you do something to the patient. They really like that." I didn't say please and thank you every time I had the "patient" do something; in fact, I didn't give him much direction because we were repeating what my partner had just done, and he seemed intelligent enough to get it. Plus we both thought the whole situation was rather silly. At the conclusion of the exam, as my partner and I were about the leave the room, the man asked, "What did you do before you came to school?" Taken aback, I told him I was a firefighter. "Paramedic?" he added. "Yes... You're good! How...?" He looked at me over his glasses and said, "It's the way you interact with people, the way you carry yourself. Keep up the good work." I know that there is more to being a good doctor than being a whiz in biochemistry, but sometimes you lose the forest for the trees. It was a nice reminder.

My Feelings Exactly

At the UC Irvine School of Medicine, we often send each other study guides in the spirit of cooperation. I received one such study guide today, courtesy of one of my classmates, Shaun Chung. (Note: it's not plagiarism if it's cited.)

Hey Mitochondronauts!!!
I know there are a lot of people right now throwing there hands up in the air in frustration concerning Wallace's material. Seeing that there is just way too much convuluted mitochondrial minutiae, Greg and I sat down today and made a pretty comprehensive yet concise Wallace review sheet. Hope it helps. If there is any confusion or if you disagree on anything please let us know. Thanks.

Enjoy your weekend,
Shaun and Greg