Up on a hill
- garland of crop and flower as neck,
the Eagle dwells
House of twigs and thorns
her rounded iron beaks
make into feather beds for her young.
I remember!
Young birds thrown gently over rocky cliff
Forced to fly
with wings not dry
Mother soars above—eyes watching
Sharp!
Glides in, gentle breeze
lest we break.
Rock-solid span
soft, comfortable, sure!
Unlike the rockier death to which we plunge
our dance
of life and death
Can I ever marry?
Would my heart anyone else love?
A taste of you
is the first drop of rain
that teases the parched, broken land
that is the landscape of my heart
whispering of the louder downpour
blood through venous cracks
giving life—and mending
I thirst some more!
Nurture the new plant—green
head high, stem straight without a bend
Give the adult strength
to make its food
Independence!!
So what locks my jaws—strangles me
prevents me from telling
I sing your love
speak my love
for you on your hill
The world hears, its heart listens, feels
The ear that’s valued the most
becomes the island
wondering, feeling, wondering
About a son’s love
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
Monday, May 31, 2010
Tuesday, May 11, 2010
Musings from my time away – Akpa evelia (second part)
Hi, my name is Akpa evelia. If you have not read Akpa gbator, it may be difficult for you to know me. But if you are brave anyway, here goes ...
Next up were Neurology, Psychiatry and Radiology. Neurology was a large field with many unknowns but it made a lot of sense to me. In many ways, it was logical. Like 1+1 = 2 and very rarely was it something else. It could be summarized in deficits or excesses. Deficits naturally were the easiest to see as in strokes when someone suddenly cannot use an arm or cannot feel temperature differences or touch on a part of the body. Reasoning through the losses and what normal function is, one can usually pinpoint which region of the nervous system the problem lies, something called “localizing the lesion”.
Excesses are much more difficult to notice. For example, when does an old lady who suddenly becomes hypersexual and happy come to attention or when does someone with repeated vocal ticks and a propensity to burst out in curse words realize it is Tourette’s syndrome? Much has been achieved in the medicine of the nervous system but a lot still needs to be done and I found it difficult to come to terms with the futility of a lot of it. We could determine what the problem was in most cases. We could not always treat them. One of my patients died with us knowing neither what caused his problem nor how to definitively treat him.
The most important thing I found in Psychiatry is we all have mental problems to an extent and if you dig below the surface, you could very easily come up with a diagnosis of yourself. It is also not for me. Radiologists are some of the smartest people in the medical field and not only because they make the best lifestyle decision of us all. The breadth of differential diagnoses they have to know is beyond belief and they know more than just the names, they know the pathophysiology and they know the best management practices. They are everyman’s doctors with no direct patients.
The best, and the reason I have been incognito for the past 3 months, was saved for last. Surgery was the light at the end of my proverbial third year tunnel. Since I was a child, I have wanted to be a surgeon. The simple idea of getting into a person’s body, fixing a problem and closing up like nothing had happened in the first place was just amazing to me. It is as good as instant gratification goes. As I grew, I got more and more excited about the heart. I saw a heart come back to life after being stopped for surgery and oh my! It was poetry in motion. But I jump forward. Let me rewind for a second.
My surgery experience ran the gamut from an attending telling me she would “take away [my] scissors if [I] cut like [I] did again” and duly taking it away on the next cut then not saying a word to me for the rest of the day’s surgeries outside of sending me to get her camera for a picture of an interesting pathology, through opening the six pack muscle to enter the abdominal cavity to resecting a lipoma, replacing a hip and suturing multiple incisions closed. Through all this, I never did tire of cutting into human skin…for good, of course.
I would have to say as a pre-clinical student, I thought watching a surgery was incredibly boring. I did not understand a lot of the pathophysiology, I did not know much about the procedures and in many cases, I could not even see what was going on. However, once I got into my third year and started putting together the link between pathology and physiology, it was easier to think through what procedures were going on, how the problem would be approached, why surgery was indicated in the first place and most importantly, the anatomy of the situation. In addition to this, I started looking at how surgeons exposed problem areas, how they were holding instruments and what instruments they were calling for during various parts of the surgery. And of course I thought through what the anesthesiologist was doing.
Let me tell you a typical day. I woke up at 4am, got to work by about 5am to pre-round on all patients on the team. This involved getting their vital signs, fluids in and out and for my patients, reading through the consult notes from the previous night, checking out on events overnight and writing a preliminary plan of action for the day. I was lucky to have another student, “Goose” to my “Iceman”, on the team and we could very easily divide and conquer. I felt the sting when he moved on to another service. We rendezvoused at 5:50am with the Intern and then rounded with the Senior (Boss – he hates it and this is the last time I will call him that) at 6am. Then we did “gravity rounds”; starting with the patient on the topmost floor and ending down on the surgical floor. Our role as we saw it as students was to get the patient charts, do dressing changes, get pimped (tested on multiple surgical and non-surgical knowledge) and in general make the morning a smooth and enjoyable one for our team.
7am saw us in rounds where we went through the trauma admissions of the previous night and the cases for the day and then we were off to the operating room of which you have heard enough. Suffice it to say, there was a totem pole and we were at the bottom of it. Our work mostly involved transferring the patient onto and off the OR bed, transporting them to the post-anesthesia care unit and in-between, cutting stitches and retracting other organs out of the way so the surgeons could get a better view of what they were doing and if we were so fortunate, getting further pimping. And NEVER contaminating the field.
And here-in lay the bane of the medical student’s OR existence. The circulation nurse. Yes I have been lucky to have the best of them. The ones looking out for you and the ones who were only vested in your success, helping you maneuver the OR adroitly. Yes I have also had the worst including those who invented more and more ingenious ways to charge you with being “contaminated”. You remember that totem pole in the OR? The circulation nurse, see, is on top of it. They are the people tasked with setting up the operation room, getting things and people moving and overall, making the operation a success. And they take their work seriously. If you are ever in an OR, make sure you have had your orientation and know who they are. Ask what you can do to help, get the temperature of the situation and act accordingly. One source that helped me with this is found here. Seriously though, a lot of them are very nice people who are more than happy to teach you and you should learn from them.
Back to the time line. Between cases, we checked on our patients “post-op” to ensure we did not screw up that physiology or the other anatomy. Then it was off to didactic lectures at 1pm during which we ate lunch. The rest of the day was spent either in cases, managing the patients on the floor or answering consult requests. We sign out to the night team at 6pm and go home to begin in another few hours. For the medical student, that meant dinner, and hitting the books for however long you spirit or body could take. Then sleep beckoned and before long, the annoying alarm goes off and you are back again.
As far as my personal experience, it was awesome. I have to say these were the most brutally honest people I have ever worked with and that was refreshing even if it meant there were harsh critiques half the time and I felt worthless the other half. I had, most of the time, teams with doctors who were committed to the philosophy of education and challenged my thinking, knowledge base and surgical skills. They also gave me a lot of responsibilities during cases, handing me large parts of the simpler cases and making me experience first hand, the art and science of what the French call Chirurgie. It is a time I will always cherish and most of the people will be remembered by me through my career. Above all, what made surgery great for me, and what keeps me excited about it, is seeing the problems in peoples’ bodies with my eyes and then seeing them solved. As one Senior said to me after we witnessed a ventricular fibrillation, “internal medicine doctors can only read about this in books”.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
Next up were Neurology, Psychiatry and Radiology. Neurology was a large field with many unknowns but it made a lot of sense to me. In many ways, it was logical. Like 1+1 = 2 and very rarely was it something else. It could be summarized in deficits or excesses. Deficits naturally were the easiest to see as in strokes when someone suddenly cannot use an arm or cannot feel temperature differences or touch on a part of the body. Reasoning through the losses and what normal function is, one can usually pinpoint which region of the nervous system the problem lies, something called “localizing the lesion”.
Excesses are much more difficult to notice. For example, when does an old lady who suddenly becomes hypersexual and happy come to attention or when does someone with repeated vocal ticks and a propensity to burst out in curse words realize it is Tourette’s syndrome? Much has been achieved in the medicine of the nervous system but a lot still needs to be done and I found it difficult to come to terms with the futility of a lot of it. We could determine what the problem was in most cases. We could not always treat them. One of my patients died with us knowing neither what caused his problem nor how to definitively treat him.
The most important thing I found in Psychiatry is we all have mental problems to an extent and if you dig below the surface, you could very easily come up with a diagnosis of yourself. It is also not for me. Radiologists are some of the smartest people in the medical field and not only because they make the best lifestyle decision of us all. The breadth of differential diagnoses they have to know is beyond belief and they know more than just the names, they know the pathophysiology and they know the best management practices. They are everyman’s doctors with no direct patients.
The best, and the reason I have been incognito for the past 3 months, was saved for last. Surgery was the light at the end of my proverbial third year tunnel. Since I was a child, I have wanted to be a surgeon. The simple idea of getting into a person’s body, fixing a problem and closing up like nothing had happened in the first place was just amazing to me. It is as good as instant gratification goes. As I grew, I got more and more excited about the heart. I saw a heart come back to life after being stopped for surgery and oh my! It was poetry in motion. But I jump forward. Let me rewind for a second.
My surgery experience ran the gamut from an attending telling me she would “take away [my] scissors if [I] cut like [I] did again” and duly taking it away on the next cut then not saying a word to me for the rest of the day’s surgeries outside of sending me to get her camera for a picture of an interesting pathology, through opening the six pack muscle to enter the abdominal cavity to resecting a lipoma, replacing a hip and suturing multiple incisions closed. Through all this, I never did tire of cutting into human skin…for good, of course.
I would have to say as a pre-clinical student, I thought watching a surgery was incredibly boring. I did not understand a lot of the pathophysiology, I did not know much about the procedures and in many cases, I could not even see what was going on. However, once I got into my third year and started putting together the link between pathology and physiology, it was easier to think through what procedures were going on, how the problem would be approached, why surgery was indicated in the first place and most importantly, the anatomy of the situation. In addition to this, I started looking at how surgeons exposed problem areas, how they were holding instruments and what instruments they were calling for during various parts of the surgery. And of course I thought through what the anesthesiologist was doing.
Let me tell you a typical day. I woke up at 4am, got to work by about 5am to pre-round on all patients on the team. This involved getting their vital signs, fluids in and out and for my patients, reading through the consult notes from the previous night, checking out on events overnight and writing a preliminary plan of action for the day. I was lucky to have another student, “Goose” to my “Iceman”, on the team and we could very easily divide and conquer. I felt the sting when he moved on to another service. We rendezvoused at 5:50am with the Intern and then rounded with the Senior (Boss – he hates it and this is the last time I will call him that) at 6am. Then we did “gravity rounds”; starting with the patient on the topmost floor and ending down on the surgical floor. Our role as we saw it as students was to get the patient charts, do dressing changes, get pimped (tested on multiple surgical and non-surgical knowledge) and in general make the morning a smooth and enjoyable one for our team.
7am saw us in rounds where we went through the trauma admissions of the previous night and the cases for the day and then we were off to the operating room of which you have heard enough. Suffice it to say, there was a totem pole and we were at the bottom of it. Our work mostly involved transferring the patient onto and off the OR bed, transporting them to the post-anesthesia care unit and in-between, cutting stitches and retracting other organs out of the way so the surgeons could get a better view of what they were doing and if we were so fortunate, getting further pimping. And NEVER contaminating the field.
And here-in lay the bane of the medical student’s OR existence. The circulation nurse. Yes I have been lucky to have the best of them. The ones looking out for you and the ones who were only vested in your success, helping you maneuver the OR adroitly. Yes I have also had the worst including those who invented more and more ingenious ways to charge you with being “contaminated”. You remember that totem pole in the OR? The circulation nurse, see, is on top of it. They are the people tasked with setting up the operation room, getting things and people moving and overall, making the operation a success. And they take their work seriously. If you are ever in an OR, make sure you have had your orientation and know who they are. Ask what you can do to help, get the temperature of the situation and act accordingly. One source that helped me with this is found here. Seriously though, a lot of them are very nice people who are more than happy to teach you and you should learn from them.
Back to the time line. Between cases, we checked on our patients “post-op” to ensure we did not screw up that physiology or the other anatomy. Then it was off to didactic lectures at 1pm during which we ate lunch. The rest of the day was spent either in cases, managing the patients on the floor or answering consult requests. We sign out to the night team at 6pm and go home to begin in another few hours. For the medical student, that meant dinner, and hitting the books for however long you spirit or body could take. Then sleep beckoned and before long, the annoying alarm goes off and you are back again.
As far as my personal experience, it was awesome. I have to say these were the most brutally honest people I have ever worked with and that was refreshing even if it meant there were harsh critiques half the time and I felt worthless the other half. I had, most of the time, teams with doctors who were committed to the philosophy of education and challenged my thinking, knowledge base and surgical skills. They also gave me a lot of responsibilities during cases, handing me large parts of the simpler cases and making me experience first hand, the art and science of what the French call Chirurgie. It is a time I will always cherish and most of the people will be remembered by me through my career. Above all, what made surgery great for me, and what keeps me excited about it, is seeing the problems in peoples’ bodies with my eyes and then seeing them solved. As one Senior said to me after we witnessed a ventricular fibrillation, “internal medicine doctors can only read about this in books”.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
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