Ready to burn

Just got back from a wonderful long weekend at my parents’ home in Maine. And while there was more than the usual amount of clouds and rain, there was enough sunshine to fully appreciate the awesomeness of the ocean: its expansive power, it’s mystical beauty, its endless bounty. There was a moment, in the boat, cruising home one evening on the sparkling water with the golden trees lining the banks that I thought to myself…this is good. I could do this.

Air travel is a funny thing. The flight from Maine to Philly is just over an hour. My suitcase was waiting for me on the baggage carrousel, and within minutes of touching down I was waiting for my ride. On one side of me a train buzzed by, while on the other buses and taxis lined up. I crossed the busy street, peering down the lane of speeding cars to spy my ride…in such a short time, it seemed, I had come so far.

Just over a year ago I graduated medical school and began internship. Just over a year ago I was new at this game – expectations were fairly low, to be honest, and a watchful eye was never far away. And now I sit on the brink of year two. Expectations are now fairly high, and to be honest I am a bit nervous. I begin at the burn center. In bed one is a nine-year-old boy who has already undergone multiple surgeries. In just one short year, I feel, I have come so far.

And what is there to do but push onward. With the taste of lobsters still fresh in my mind, I’m ready for anything.

Solstice

Today is the summer solstice, the day when sunlight stubbornly sticks around, refusing to leave. Its counterpart, the winter solstice in late December, is historically linked quite strongly to Christianity, as the celebration of the birth of the Son of God – the Light of the world – ushers in a season of increasing sunlight. Christmas literally comes in the darkest days of the year, and its promises of salvation are accompanied by longer days. In some way, I figure, the summer solstice is the culmination of that promise, the day when we are supposed to have realized the full potential of Christmas’s gift

Today is also Fathers’ Day, a day when we remember the love of our fathers, the gifts they have given us, and the sacrifices they have made. I spent today volunteering at my church’s summer camp, helping to prepare meals and do odd jobs. I spoke to my father from the camp – he was proud of me.

I was feeling good and happy when I drove home. But as I was nearing my apartment, a homeless man at an intersection caught my attention. I guess I’ve grown used to the homeless of this city – some of whom I know by name – but I still find that I am often unprepared to look at them. This gentleman was younger – in his late 30s, maybe – and he looked disturbingly numb, like he was ashamed though not yet scared of his situation. He held a sign with messy writing that read “homeless please help a vet.” I didn’t have a dollar on me. I looked at him through the glass, mouthed “I’m sorry,” to which he subtly nodded in acknowledgement, the corners of his mouth trying to make a smile. My eyes caught a small bag of chips I had in my car – I was too embarrassed to give it to him.

And so on this day, the Solstice, the reality is plan. There is good work being done, lots of it, and the rays of the sun make that visible for all to see. But those same rays point to the work, the seemingly endless work, that still needs to be done. And so I give thanks for the opportunities to do that work, and ask for strength and courage to accomplish it.

Happy Fathers’ Day!

Rituals

Every morning, upon awaking, I begin a series of rehearsed activities. I brush my teeth in the same order, wash and dry in what, to me, seems the only logical way to do so, and comb my hair just as I have for, well, for years now (though some wish that weren’t the case!). This, to me, is nothing but my morning routine – familiar, effective, practical.

In the hospital, we have recently spent a good deal of time teaching the new medical students how to present a patient in a formal manner. The concise and orderly manner of stating an update, vital signs, physical exam findings, laboratory date, and finally the assessment and plan. It is effective communication, to be sure, but its strict order assures that nothing is forgotten. Because when things are forgotten, patients suffer. And so somewhere, now, we begin to assign a certain meaning to routine behavior. It helps us better understand what is going on.

The operating room takes this meaningful routine to its medically-logical extreme. Checklists are run, instruments are counted, the steps are articulated…and all the while a patient lays strapped to a table, his viscera exposed, his whole self reduced to flesh and bones. This routine, here, in this place, has bordered on the ritualistic.

Every Sunday in church we witness and partake in many rituals. Words are spoken in precise order, movements are calculated, and there is even some counting….and all the while a sacrifice on a table is taking place. But throughout it all I find myself asking, for whom are we performing these rituals?

If the answer is for God, then that answer is both terrifying and silly. Do we really think God would refuse to hear the prayers of the faithful because they were not accompanied by the perfect sequence of genuflecting? And if God is that particular, than I, for one, am in deep trouble.

Perhaps we do it for ourselves. Perhaps in performing rituals during worship we somehow ascribe a certain level of meaning that we, has humans, need to have. It doesn’t add meaning, in this case, but it helps us better understand all that is going on.

That’s all for now – I’m off to bed, with a new set of routines and rituals to undertake in the morning.

Back for more

I haven’t written for a long time. It’s not because I haven’t had things to say. I think it’s because I’ve had too much to say. But too many thoughts, especially when kept inside one’s head, are not good for anybody. So here’s to more writing. Not necessarily good writing – I’m going for quantity here.

I am nearing the end of my first year of general surgical residency. It’s been a hard year. It’s been a long year. But it’s been a good year. I am so much smarter than when I started. I realize that’s the hope, the goal, the necessity, but let’s be honest, goals aren’t always achieved, and it’s nice to be on the positive end of an investment. So here I sit, ready to end this year and get on with the real stuff of surgery. Let it begin.

But there is one nagging thing that keeps me mind away from the grind. I recently went on a trip to Haiti, to Quanaminthe, where I worked at a medical clinic. As little as I know in the grand scheme of things, I was told I was fully prepared for what I would see. In some ways I was, but in many I was not. Sure, I can read about malaria in a text book and figure out a way to treat it. But I wasn’t prepared for the extensive need I saw. Sure. I had seen poverty, but I had never seen in while attempting to fix one aspect of it that is so tied to finances, to structure, and that relieves on a society to deliver.

So now, at the start of year 2, I am working on two things: how to become the best surgeon I can be, and how to attack health-care delivery in Ouanaminthe. Here we go.