...this year, my third, has brought a loss of some innocence. As I trained on the hospital wards, I was surrounded by unhappy, jaded residents -- med school graduates doing their first stints as working doctors. These residents were my teachers, and they griped about the "bitchbox" or pager that they had to wear and about bothersome patients, such as "High-Maintenance Mom." Cynicism certainly catches on. I was stunned how quickly I had started to change. Just a few months in, I rejoiced with one young doctor when our frail, demented patient was finally transferred to a nursing home. We celebrated not because we had helped him--though we did, a little--but because we were relieved that he was finally off our hands. Another classmate ruled out a specialty she had long considered, because the patients were too needy. "Too needy?" she said. "I can't believe I am thinking this way, but they were just too draining."

But as much as cynicism is contagious, so are compassion, optimism, and hope. One professor required us to include in our case presentations what our patients like to do for fun. He understood that while wading through a sea of data about a patient, it was easy to dehumanize care. The woman with Marfan syndrome and a serious heart problem, it turns out, had been an avid hoops player. The man with cocaine-induced chest pain--he's a serious stamp collector.

One resident showed me that even while being bogged down with paperwork and beeping pagers, taking a few minutes to do what's not "required" is still possible--and can make a real difference. In the clip of a busy day, he found time to counsel a homeless patient, a former lawyer who was diagnosed with alcohol-induced heart disease, about the very serious cardiac consequences of his addiction. "I always thought alcohol was bad for my liver," the patient said, somewhat surprised. "I didn't know it could damage my heart." The patient was discharged, newly informed and newly hopeful, holding a list of local sobriety programs.

Fellow students have reminded me, as well, that we possess strong medicine--not the drugs we can give to patients but our words, the timbre of our voice, and the touch of our hands. A few months ago my classmate Julie, who was transferring her patient's care to me, brought me to his bedside to introduce us. A pungent sour odor wafted through the air. There was a pink tray by his side to catch his frequent vomiting. The thin, white-bearded patient greeted her like a close relative: "Julie, my darling, I've been waiting for you."

The man, recently diagnosed with end-stage lung cancer, was troubled. His wife had suddenly stopped coming to visit him in the hospital. He worried that she was too scared to see him go, that she could smell the aroma of death in the air. "Do I smell like death, Julie?" he asked, patting his lips after hocking up a small concoction of phlegm and blood. Julie placed her hand on his bony shoulder, bent over toward his straggly beard and took several deep whiffs. "Absolutely not. Don't you worry one more minute about that." He smiled, looking relieved, and then he thanked her. And I smiled too, to thank Julie for helping to restore my faith in this extraordinary relationship.

I just returned from my 2nd trip in a month, to Los Angeles, a city that previously was known to me by Disneyland, 5 and 6 lane highways with tons of traffic, and gaudy touristy sites (nostalgic memories from vacations with my parents years ago). I now find myself fascinated with the culture, politics, and people of Los Angeles, where 145 languages are spoken. [The picture to the left was taken from the airplane, and is a view of somewhere in California just east of Los Angeles]

So, I was in LA doing what is called a "2nd look" at a family medicine residency program that I really liked during an interview last month (my first trip there in the month). Many medical students applying for residency programs do these "2nd looks" as they deliberate on what order to rank the programs that they applied to. The whole process of interviewing is so bizarre -- in a day's time, both you and a program are trying to impress each other (hence the 2nd look -- more impressing and more perspectives on a program and a city). Back in December, Dr. Quinn of Push Fluids compared interviewing with a series of one-night stands:

first, there are the decisions based on the surface: ugly or attractive, too small, too big, bad food choice, the presence of a snaggle tooth.

as the experience continues things get more interesting. both parties try to make themselves seem much more attractive than they really are. in addition, both parties stretch the truth just a little bit to make their weaknesses seem less horrific.

the finale of both experiences includes the awkward "i'll call you"/"we should get together again sometime"/"you're the best ever" interaction. in both situations it is possible that both parties are being truthful, but it is ultimately more likely that someone is fibbing.

then there is the follow up dilemma - i.e. how many days do you wait? is emailing ok or is that cheap? how do you find something nice and personal to say to someone after your tenth experience when everyone seems the same?

while a series of interviews can make a girl feel almost as dirty as one night stands (especially when the interviews are back to back and do not allow enough time for a trip to the dry cleaner), they are actually supposed to be informative. from these short experiences, i am supposed to glean enough truths to decide where i want to spend the next 3 years. i mean, if i was that hasty about things in the rest of my life, i would be married and divorced many times over by this point. but since i have no choice, i will continue to travel the country, clean my suit as often as possible, try to find the most truth with each interaction, and try not to feel like a slut as i tell one program after another how much i love them and they really are the best ever.

This seemed all too familiar back in December as I was first interviewing. But I feel more comfortable now in my relationship-building with a few programs that I'm very impressed with.

My trip to LA was more fun than I had expected and included being blown away by a revolutionary family medicine residency program, seeing good friends, protesting at the Federal building in LA during Bush's coronation in DC (more posts on that), and exploring parts of LA I hadn't previously visited. But I didn't know how historic it was until I checked out the daily NY Times headlines email and happened to glance at the bottom of the email where the "On this Day" section is highlighted. 68 years ago, on the day I traveled cross-country to Los Angeles (January 19th), Howard Hughes set a transcontinental air record by flying his monoplane in the opposite direction from my flight (from Los Angeles to Newark, NJ) in 7 hours, 28 minutes and 25 seconds! That's a fascinating time for a monoplane (years later, our commercial airliners average around 6 hours for a nonstop flight of the same distance). And without pressurized cabins and automatically adjusted oxygen air levels, he had quite an adventure:

He was wearing a new type oxygen mask for high altitude flying. With nothing to see except the top of the cloud stratum he began experimenting with it. He finally adjusted it so that it fed too much air and not enough oxygen and he began to feel faint. Over the Sierras he had fears for a moment that his attempt might not be a success, but at last re-adjusted the mask so that the gas revived him.

As I figure out which residency programs I'd like to have more than a one-night stand with, and as I continue obsessing over whether or not they feel likewise about me, I'm starting to feel faint...need...more...oxygen...

A few weeks ago, I took in the beauty and views of Albuquerque, New Mexico and Tucson, Arizona. I had interviews scheduled at the Univ of New Mexico family medicine residency program and the University of Arizona family medicine residency program. I decided to extend my interviews into a small vacation and spent a few days with friends in each town. In Albuquerque I stayed with my friend and co-host of this blog, Andru Ziwasimon. I'm always reinvigorated and re-inspired after hanging out with Andru and other wonderful people there -- Mara, a 2nd year family medicine resident; a few other family medicine residents; and John Fogarty and Lucy Boulanger, wonderful physicians who work in the Indian Health Service and do some state-wide organizing around environmental issues; and some non-medical activists and artists.

During my stay in Abq, I had the privilege of seeing the wonderful medical clinic that Andru's setting up, aptly named "Just Healthcare". The clinic is meant to serve people regardless of insurance status or documented vs undocumented status. In fact, Andru won't even accept health insurance, not out of hostility to those who have it, but because accepting health insurance would mean he would need to employ several people full-time just to deal with the billing aspects (the inefficiencies of our health care system require such staffing).

This clinic is a peoples' clinic, a grassroots effort. What does that mean? Community members have helped in every way possible to build it (also see earlier post by Andru on this topic). Some donated concrete for the wheelchair access ramp, others painted the rooms vibrant colors, others donated their creative talents to paint a beautiful wall painting in the waiting room area, and yet others tiled the floors of one of the rooms. Medical equipment was also donated from various places in New Mexico. In the picture above, I'm showing off how level the x-ray reader is, after Andru and I installed it in an examining room).

This is just one piece of a much larger community health campaign, developed over time by a few visionary community members to achieve health justice over a number of years. The plans include greater accountability of the University of New Mexico hospital to the public (as it gets whopping amounts of tax dollars to serve the underserved) and new ways of achieving greater empowerment of folks in albuquerque. Andru's posted on the hospital issues here and here

And with this, I wish you all an inspiring 2005 -- the year of thinking outside the box.