April 26, 2009

Phoenix

What does it mean to have self-esteem? Parents think their children having enough of it will prevent them from doing stupid things to mess up their lives. Books are written on how to acquire or nuture it. But what is it, really? Who has it? What happens when you wake up and realize you don't have much of it?

Medical school is designed, much like fire academy, to show you your lowly place. That you know nothing, or that the work you do is so worthless it is always repeated by someone else. There is a never-ending parade of exams, all orchestrated to assess how much you don't know. Rounds are structured so that people ask you questions you can't answer, or they ask you harder or more questions until you can't answer, then they provide the answer to show you that you don't know enough. Occasionally you get lucky and get it right, but usually the question is set up so the asker can deliver the answer, like a joke. And virtually without exception, your intellectual emasculation is in the presence of witnesses. There's a name for this: pimping. Rotations are scheduled so that every month or two weeks you are sent to a different hospital or neighborhood clinic - sometimes every day for two weeks - with different people, hospital hallways, security codes, computer systems, equipment, storage, forms, at times you even have to switch your brain over to the predominant language of the new locale. Even the antibiotics used for an infection with the same bacteria might have different resistances depending on the institution or geographical area you are in, so you could find that what you knew last Friday at Hospital A is the wrong answer on Monday at Hospital B. Or that what works for adults, due to whatever random biochemical reason, doesn't work for kids.  I want to shout, same species! same species! all the time.

If you can imagine changing jobs every month or two weeks and having to learn a whole new set of skills under pimping supervisors who you can't tell where to go, you are on your way to imagining a med student's life.  To add insult to injury, you are paying for the uplifting experience of being everyone's bitch.  Or maybe someone else is paying for it, be it your spouse or your family or the bank, then you are not only everyone's bitch who pays to be mistreated, you are also everyone's bitch who goes into debt to be mistreated.  That certainly doesn't bolster confidence in your own intelligence.  Even the fire academy was only for three months, and I was paid $10/hr for my daily beatings.  It is a wonder to me that medical students ever smile.  

Some of us have incredibly supportive, nurturing, caring significant others who don't take advantage of our state of constant humiliation to make us feel worse.  Others maybe have friends or family outside of medicine who can provide perspective that outside life isn't quite as punishing - it may be to some degree, but not at the steady pace of Chinese water torture as in medicine.  And then there are those whose inner Phoenix gives them strength from within, that reminds them that they are intelligent, accomplished, rational, sensitive, caring, and good.  That the mental torture may be pretty bad at times, but can be survived as long as one doesn't lose the broader sense of one's self.

Maybe self-esteem is really a little firey bird in your soul that rises out of the ashes of your emotional beatings to remind you who you really are, when you are led to doubt your own perceptions of yourself.

April 13, 2009

Teenage Lessons

What can you teach a teenager in five minutes?

I've been doing pretty well with my three year-olds, six year-olds, and I've been all right with the 17-18 year-olds, too. I've made a pleasant discovery that doctors totally take off diapers to check whatever, but then they get to say, "Okay, I'm gonna let you put him back together now," and go on their merry way. I can even calmly complete an ear exam with a screaming one year-old now, which I consider the crowning glory of my first pediatric outpatient week.

But those adolescents and early teens, they're awkward and weird and not at all like the other age groups. To be sure, I am the consummate professional, and always do my best to speak factually, without showing signs of discomfort.  Sometimes I just make a quick little speech about teenagers being at higher risk of STDs, drugs, etc. because 1) we don't have the time in one office visit to explore the depths of their bourgeoning sexuality and angst, 2) the pediatrician himself doesn't go near the topic but I feel like they should - even if briefly - hear the message we are taught to deliver, and 3) I've been told teenagers just want the spotlight to be off them and not have to talk much about themselves. I do all the things they tell us in class, to make sure the parent is out of the room when asking about sex and drugs, always reiterate safety, and let them know they can talk to their doctor if they want information.  I do the speech in front of the parents, skipping the personal questions part, when I don't actually think the kid is into anything yet.  But it bothers me when the parents look uncomfortable. I think, this is their kid and they're the ones uncomfortable here? Then I second guess myself: am I overstepping boundaries? I sure would want an authority figure drilling into my kid that they should avoid sex and drugs but be careful if they do decide to do them.  But of course I realize I'm not everybody, in fact, I'm not even a parent. So what do I know.

So what can I do... I guess just stick to the biological and statistical facts and be nice and polite and personable.  And bide my time until pediatrics is over in three weeks and I can go back to talking to adults about their sex and drug habits... you know, back to the easy stuff! 

April 6, 2009

I Don't Remember Saying This

To whom might I have said this? Back in December 2004? I've never even seen this article before. Another good reason to avoid the media, perhaps.

April 5, 2009

Highlights for Children - ER Editon

No one wears button-down shirts and ties in the ER, and the monitor behind us is blank. What other wrong things can you find in this picture?


And to be clear, I didn't exactly say all those things that were in quotation marks. This is why everyone knows - avoid the media at all costs!

April 1, 2009

Coupon Fairy

Here's something Darron and I like to do:

Next time you go to a restaurant with coupons, take along the inevitable second coupon that you won't use in the next three days before its expiration date. Scan the room, and find a nice couple, the lone diner, a cute family. Then give them the coupon. It's always smiles all around.

The other night we picked a little family of a dad and his three kids. As they left, the teenage boy jubilantly said, "thank you for the dessert!" while the little kindergartener just smirked sheepishly and looked around nervously as his dad told him to "say thank you!" It was cute.