"Come, I want to show you something."
These are the words that I dread, especially since coming from my attending, they usually mean some kind of test. So far, doing rounds in the hospital has been fun because the challenges have been reasonable. Take a history. Conduct a physical. Present findings to the attending. Check, check, and check. I'm beginning to sound like I know what I'm talking about. "CBC creat and BUN are high, but not stable so I'd hesitate to calc a GFR. Crit's high, and she's hypenatremic; I think she' dehydrated. We should watch her drip, and monitor that IV antibiotic dose... "
This case, however, was something else.
"Come on, I want to show you something."
"Okay. Should I grab the chart?"
"No, just come. She' my patient. I want you to do an H&P on her. Right now."
"Right now...in front of you? And everybody else?"
"Yes. You up for it?"
"[me thinking: OMF...shit.] sure!"
Half an hour later, I had no idea what was wrong with her. Imagine my relief when the attending himself admitted he didn't know what was wrong with his patient. Still, it was a peculiar case: young mother comes in with diffuse, non-radiating abdominal pain for past 72 hours. Has not had a bowel movement due to her pain. Urination and urinalysis was normal. Abdominal CT scans were unremarkable. Blood count was normal. Electrolytes were normal. No burst appendix. No signs of appendicitis. Everything was so normal, in fact, that there was nothing we could do but give her a morphine drip for her ever present, ruminating, tear inducing pain.
She was a young, pleasant woman, just delivered twins via C-section four weeks ago. She said everything was fine until 2 nights ago when she woke up with 'extreme abdominal pain'. Apart from the stress of dealing with twins and a five year old daughter, she seemed a happy new mama. My attending was flummoxed. The radiologists who looked at her CT scans were flummoxed. Surgeons were coming in droves to examine her, checking out the C section although her scar was healing nicely. By the time my shift ended, we still didn't know what was wrong with her. The attending promised me he would let me know what happened. And I went home.
It wasn't until I was well on my way that a question I'd brushed aside earlier bubbled up to consciousness: "What was that bruise on her belly?". It was the size of a fist, no evidence of skin break indicating that it mostly likely was a blunt trauma of some kind. But I didn't ask her about it. I don't think my attending asked either. We had noted it on the physical, but both of us ignored the finding and continued to look elsewhere for clues: in her lab results, in her CT, in her history...everywhere but the place that now seemed ripe with clues. Come to think of it, the bruise looked to be about several days old--its edges have begun to heal, but the center was still a deep purple. How could it be that numerous other doctors before me had examined her and not a single one remarked on her charts the patient's explanation for her abdominal bruise? Did all of us forget to ask?
A recent article in the Boston globe criticized doctors for a phenomenon call 'attribution'. It was basically an attack on the way doctors think, the way we are taught to think along the lines of stereotypes, salient classic associations that help us make standard diagnoses but too easily make us miss other important clues. Sure, the bruise could have been nothing. But I doubt anyone of the doctors know for sure. I don't know what happened in this case, but I suspect that had she been black, young and poor as opposed to white, suburban, and well to do, many more doctors would have paid more attention to the orange-size bruise on her belly and asked more questions about the stresses that can wreak havoc on a young family regardless of race or socioeconomic. They would ask if only to rule out a diagnosis of domestic abuse. In retrospect, it could have been the most important question of all.
Sunday, January 28, 2007
Monday, January 22, 2007
A question of Faith.
I wrote this letter to Andrew Sullivan recently, regarding a post that was a reader's response to an ongoing dialogue between Andrew Sullivan and Sam Harris, book author, intellectual, atheist. I doubt Andrew sullivan would answer my email, but in any case, my questions were genuine, and so I post them here. You can go here to read the AS post that inspired my response.
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Dear Andrew,
I am an avid reader of your blog. I am also a person of no particular faith tradition, having been raised Buddhist but without parental compulsion to practice it. I, however, have a Catholic boyfriend, and while I do not understand his devotion, I deeply respect it. It is with this general outsider perspective that I feel compelled to respond to several points in the reader's email regarding Sam Harris that you have posted.
Your reader is right. Religious books are not just books. Rather, they seek to offer guidance on how to conduct a virtuous life. They are moral texts. However, this says essentially nothing about their origins. Humans have been writing moral texts about the nature, the mystery, if you will, of life since the beginning of recorded history. Many gods and goddesses have come and go, and we today largely relegate these figures to the realm of myths. What primarily differentiate religious texts from nonreligious ones is a reflexive reliance on the supernatural to lend credence and power to particular moral systems. The question thus remains: why rely on the divine? Is it because the Judeo-Christian's 'God is Truth' as you say, or is it because invoking the divine can do so much: help enforce moral points, assuage human fears of the unknown, provide a sense of collective identity...etc?
One should not doubt the power of these books to change lives, to structure moral behaviors, to beget civilizations. But these are all end products of religion that, again, do not answer Harris' central assertion: Why couldn't it all be bogus? Clever human solutions for human concerns? As your reader claimed, most of us need religion to show us 'proper conduct' based on 'very old traditions'. But if anything, this need lends Harris' suggestion of an earthly origin for all religions even more weight. Just because something is old doesn't make it right or supernatural. If most other 'ways of knowing', to use a Harvard coinage for general education, are undoubtedly products of human curiosity and our desire to understand, why not also religion?
Moreover, to dismiss the charge that writers of religious texts are 'regular guys', as the reader tried to do, is avoiding the issue. While I agree that they are not merely regular guys in the sense that anybody can fill their shoes, the possibility exists for their inspirations to be earthly, not godly. First, the human population bell curve certainly allows for outliers with extraordinary intellects like Newton and Einstein, and religious writers of old are probably of a similar lot. By most accounts, Einstein was not divinely inspired; why couldn't this also be true for religious writers? Second, assuming that religious writers felt ecstatic exhilarations they interpreted as divine inspirations, there is little external proof to let us know that such ecstasy is, indeed, 'of the Spirit'. Essentially, those of us who are not religious must take these writers, and by extension all religious persons, at their word. The question remains to be why, and in today's global climate of competing religious systems all claiming to know Truth while threatening to tear the world apart with ideological differences, can we afford to?
Going back to the practical benefits of religion, I fully empathize with the reader for commenting that nonreligious moral philosophies do not seem to help us navigate everyday life. Ignoring the problem of jargon and non-intuitive, highly abstract arguments commonplace within contemporary philosophical discourse for just a moment, these philosophical models are fundamentally scary for most of us in their general supposition and acceptance that we are free moral agents (to a great extent) without anybody above. By suggesting that human existence stands always at the brink of oblivion--with no afterlife, no external judgments or punishments for virtue or vice at the end of time--the question of why we should lead an ethical life, whatever that means, becomes very troubling. However, it can be simultaneously exhilarating, liberating even. An answer that includes a self-imposed responsibility for decency, kindness, and virtue, irrespective of cosmic rewards, is, at the end of the day, the formation of a personal moral compass and the beginning of an ethical life. While religion may claim this compass to be a gift of 'God', a hypothesis of human origins for such a phenomenon represents, for some, the true ecstasy of existence.
With great respect,
PLN
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Dear Andrew,
I am an avid reader of your blog. I am also a person of no particular faith tradition, having been raised Buddhist but without parental compulsion to practice it. I, however, have a Catholic boyfriend, and while I do not understand his devotion, I deeply respect it. It is with this general outsider perspective that I feel compelled to respond to several points in the reader's email regarding Sam Harris that you have posted.
Your reader is right. Religious books are not just books. Rather, they seek to offer guidance on how to conduct a virtuous life. They are moral texts. However, this says essentially nothing about their origins. Humans have been writing moral texts about the nature, the mystery, if you will, of life since the beginning of recorded history. Many gods and goddesses have come and go, and we today largely relegate these figures to the realm of myths. What primarily differentiate religious texts from nonreligious ones is a reflexive reliance on the supernatural to lend credence and power to particular moral systems. The question thus remains: why rely on the divine? Is it because the Judeo-Christian's 'God is Truth' as you say, or is it because invoking the divine can do so much: help enforce moral points, assuage human fears of the unknown, provide a sense of collective identity...etc?
One should not doubt the power of these books to change lives, to structure moral behaviors, to beget civilizations. But these are all end products of religion that, again, do not answer Harris' central assertion: Why couldn't it all be bogus? Clever human solutions for human concerns? As your reader claimed, most of us need religion to show us 'proper conduct' based on 'very old traditions'. But if anything, this need lends Harris' suggestion of an earthly origin for all religions even more weight. Just because something is old doesn't make it right or supernatural. If most other 'ways of knowing', to use a Harvard coinage for general education, are undoubtedly products of human curiosity and our desire to understand, why not also religion?
Moreover, to dismiss the charge that writers of religious texts are 'regular guys', as the reader tried to do, is avoiding the issue. While I agree that they are not merely regular guys in the sense that anybody can fill their shoes, the possibility exists for their inspirations to be earthly, not godly. First, the human population bell curve certainly allows for outliers with extraordinary intellects like Newton and Einstein, and religious writers of old are probably of a similar lot. By most accounts, Einstein was not divinely inspired; why couldn't this also be true for religious writers? Second, assuming that religious writers felt ecstatic exhilarations they interpreted as divine inspirations, there is little external proof to let us know that such ecstasy is, indeed, 'of the Spirit'. Essentially, those of us who are not religious must take these writers, and by extension all religious persons, at their word. The question remains to be why, and in today's global climate of competing religious systems all claiming to know Truth while threatening to tear the world apart with ideological differences, can we afford to?
Going back to the practical benefits of religion, I fully empathize with the reader for commenting that nonreligious moral philosophies do not seem to help us navigate everyday life. Ignoring the problem of jargon and non-intuitive, highly abstract arguments commonplace within contemporary philosophical discourse for just a moment, these philosophical models are fundamentally scary for most of us in their general supposition and acceptance that we are free moral agents (to a great extent) without anybody above. By suggesting that human existence stands always at the brink of oblivion--with no afterlife, no external judgments or punishments for virtue or vice at the end of time--the question of why we should lead an ethical life, whatever that means, becomes very troubling. However, it can be simultaneously exhilarating, liberating even. An answer that includes a self-imposed responsibility for decency, kindness, and virtue, irrespective of cosmic rewards, is, at the end of the day, the formation of a personal moral compass and the beginning of an ethical life. While religion may claim this compass to be a gift of 'God', a hypothesis of human origins for such a phenomenon represents, for some, the true ecstasy of existence.
With great respect,
PLN
Sunday, January 21, 2007
Friday, January 19, 2007
bloody
I just devoured a blood orange, and my fingers now smell of citrus. My room wafes scents of citrus too. The rinds are drying in the wastebasket, curling slowly.
So this is boredom.
So this is boredom.
it's been 2 years
I don't know what to do for our anniversary. We have so little time, he and I, busy with school, not to mention the odd timing. But oh, what I wouldn't give for just 3 days to fly to Bermuda. Sand bars of pink coral, crushed over millions of years into a fine powdery blush. Salty breezes. Emerald waters. We'd rent scooters and zoom up and down Hamilton, maybe head out to St. George's Sound, or just lounge around Coral Beach. Brunch at the Royal Yatch Club. Dinner at the Waterloo.
I know he'd like it. If only we had the time.
I know he'd like it. If only we had the time.
Friday, January 12, 2007
Massachusett's heartland
Decisions, decisions. It's about that time of year, the rite of passage: picking medical clerkship schedule. The clerkship is our first real exposure on the wards as clinicians in training, learning trial-by-fire. The school keeps telling us this is the light at the end of the tunnel--only we don't know which end we're about to get. In the midst of cramming for pathophysiology, studying for the USMLE, deciding on clerkship, I am now presented with an additional choice of spending my *entire* third year in Western Massachusetts. The only obvious drawback: it's in Western Massachusetts. Rolling hills of snow. Amber waves of nothingness. Medicine 24/7.
I'm a cityboy, always have been. I like my cafes around the corner, my local grocery pretentious and pricey, and my company queer. This is a big decision. Of course the school knows; that's why it is trying so hard to make the site attractive, promising a dedicated staff to care for the 30 odd medical students all from my school (without the added competition with students from other medical schools that would happen if I were to complete my clerkship in Boston), and brand spanking new facilities with state-of-the-art technology and dedicated teachers. I could pursue 1 uninterrupted year of research on top of my medical clerkship, have a mentor of my choosing, and potentially, get some really nice recommendations out of the experience. To a 'gunner', as we'd like to call those in the medschool class who are always willing to go one step beyond to best the competition, this sounds like a heavenly opportunity. It probably is.
I cannot deny the fact that I can personally benefit from this arrangement. Third year of medical school really boils down to 2 things: getting honors on all clinical rotations and really good recommendations. Since many medical schools stopped recording grades for the first two year of training, residencies can only use three markers to gage candidates: board scores, third year clerkship grades, and letters of recommendations. If I go, I will have a good chance of maximizing my return on 2 of the above criteria, and the one year of research can do nothing but add to my chances of landing a better residency. Somehow, a place at MGH seems more possible, and an eventual life in Boston more certain.
Many of my friends are not considering this option. They say that the 30 that end up at this hospital will be the gunners of the class, thus distilling the competition and raising stress for everyone involved. We are largely stuck with each other the entire year, although everyone will have his own rotation schedule. Relationships will be strained because of the distance. Medicine 24/7 is never healthy. Life sucks out there.
For now, I have not made up my mind. I do like the reduced stress of having everything at one site within 5-10 minutes of where I will live, and having clinicians who will know my name, know my needs, and see me not as another lowly medical student groveling for grades, but one who might actually want to learn something. The site visit next week should give me a better gut feeling for the place. So many of life's major decisions are really based on instinct anyway, why should this be any different? Additionally, I'll see who is actually interested, and if indeed this distillation effect everyone fears is actually happening. Whatever. Bring it on.
I'm a cityboy, always have been. I like my cafes around the corner, my local grocery pretentious and pricey, and my company queer. This is a big decision. Of course the school knows; that's why it is trying so hard to make the site attractive, promising a dedicated staff to care for the 30 odd medical students all from my school (without the added competition with students from other medical schools that would happen if I were to complete my clerkship in Boston), and brand spanking new facilities with state-of-the-art technology and dedicated teachers. I could pursue 1 uninterrupted year of research on top of my medical clerkship, have a mentor of my choosing, and potentially, get some really nice recommendations out of the experience. To a 'gunner', as we'd like to call those in the medschool class who are always willing to go one step beyond to best the competition, this sounds like a heavenly opportunity. It probably is.
I cannot deny the fact that I can personally benefit from this arrangement. Third year of medical school really boils down to 2 things: getting honors on all clinical rotations and really good recommendations. Since many medical schools stopped recording grades for the first two year of training, residencies can only use three markers to gage candidates: board scores, third year clerkship grades, and letters of recommendations. If I go, I will have a good chance of maximizing my return on 2 of the above criteria, and the one year of research can do nothing but add to my chances of landing a better residency. Somehow, a place at MGH seems more possible, and an eventual life in Boston more certain.
Many of my friends are not considering this option. They say that the 30 that end up at this hospital will be the gunners of the class, thus distilling the competition and raising stress for everyone involved. We are largely stuck with each other the entire year, although everyone will have his own rotation schedule. Relationships will be strained because of the distance. Medicine 24/7 is never healthy. Life sucks out there.
For now, I have not made up my mind. I do like the reduced stress of having everything at one site within 5-10 minutes of where I will live, and having clinicians who will know my name, know my needs, and see me not as another lowly medical student groveling for grades, but one who might actually want to learn something. The site visit next week should give me a better gut feeling for the place. So many of life's major decisions are really based on instinct anyway, why should this be any different? Additionally, I'll see who is actually interested, and if indeed this distillation effect everyone fears is actually happening. Whatever. Bring it on.
Sunday, January 07, 2007
Early gaypril
I've had a traumatic holiday season. In lieu of this, and the fact that I will not have a social life for the next six months due to studying for the boards, the music player will now feature really really gay club music, for a very long time. Rock out with your (for some, metaphorical) c%*k out sort of thing. The older playlists are still around, but they will be featured less frequently. You can select for other playlists under the 'user profile' section of the finetune media player.
The new playlist has Cher. What could be better? Oh and, Oxford street refers to Oxford Street, Sydney, where the party never ends. If you're ever in town, do check it out. The drag shows are a hoot!
The new playlist has Cher. What could be better? Oh and, Oxford street refers to Oxford Street, Sydney, where the party never ends. If you're ever in town, do check it out. The drag shows are a hoot!
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