February 13, 2010

I'm having some incredible trouble focusing-- I was supposed to study, but instead I find my mind wandering, replaying memories and thoughts from the past year. I tell myself it's because of Lunar New Year Eve, and in many ways I feel grateful to be born into a tradition that celebrates two new fresh starts a year, forcing you to reflect on how time has progressed.

On the other hand, it might also be my lack of clinical duties at the moment. As a medical student, so many things happen to us so quickly, and we're so busy that we don't have much time to really process or digest our experiences. Everything is a blur, up until the moment you finally stop to breathe.

***

"We're taking a field trip," my upper level resident said, rather abruptly. I looked at the other students a tad nervously, and we've definitely never taken a field trip in the hospital before. "In fact, it's a taste test."

We followed her into the elevators, and up to the pharmacist's office. On his desk were a pile of small syringes, each filled with brightly colored fluids of different shades. There were a few cups of water, and, improbably, a bright red M&M dispenser. He didn't have much in terms of introduction. "Ampicillin," he said, handing each student a syringe.

I squeezed a small amount of fluid onto my tongue, and watched the other students gag and reach for water. Apparently, I didn't have the taste receptors for it, but I remember a sickly sweet, almost alcoholic sensation on my tongue.

We repeated this process for several antibiotics, a corticosteroid, and who knows what else. It was a bizarre scene-- all of us in our white coats, taking shots of medications interspersed with palate-cooling drinks of water. "The cefalexin is delicious," someone said. I remember a sweet brightness, with notes of citrus and berry. And then there was the Cipro, which has a taste difficult to describe without profanity. Everyone was gagging, one classmate reached for the trash bin, and the water didn't seem to help. I found myself wishing, oddly, that we had shut the door. Instead, I reached quickly, desperately, for an M&M.

Two weeks later, the same resident brought us down to the microbiology lab. There, we received a tour and waved hello to the staff. We learned about what happens after a lab is drawn, and the people who dedicated their careers to hunting and growing microbes. One tech passed around a series of a petri dishes, where we wafted odors of bacteria up to our noses. Each microorganism had a different smell-- odors of rot and decay, dust and mice, and the surprising sweet grapes of pseudomonas.

Later, I peered down at a series of cells through a microscopic in a darkened room, a series of cells glowing bright red and yellow and green against the darkness. The thought that I was seeing light reflected off antibodies attached to viruses was thrilling. Before, a virus seemed almost like a fantasy, a child's story of invisible animals comprised of nothing but a membrane around some nucleic acids (they sometimes wear coats). By seeing the light, even the most fantastical organisms became real.

These field trips, held in the final weeks of my third year, had the weird effect of making everything I was doing with my patients seem as real as the glowing viruses.

I found this unexpected. For all its powers in the applications of science, medicine has this odd way of making you forget the reality of the situation. I found it a weird paradox that even in clinical medicine, when the patient is literally right in front of you, it's still so easy to distance yourself. In many ways, having just a little bit of decreased empathy is adaptive. It makes it that much easier to draw their blood, cut open their skin with a scalpel, and it's an easy way to let you sleep soundly at night, knowing that the patient you just admitted is likely to be gone in the morning. You distance yourself because it's the easy thing to do, and when you see a series of drama after drama, sometimes the troubles of others becomes mundane.

In the preclinical years of medical school, the opposite occurs. Although we do a good job of making sure we had the occasional patient contact, at the end of the day the majority of your time is dedicated to books. The diseases seemed almost theoretical, esoteric even, as the effects of the diseases in the real world are often muted out by the science. I remember there was a dramatic shift in the class when one of the patients who came to speak with us about cystic fibrosis suddenly died a few weeks later. She was young, energetic, a hero. I found myself oddly upset, perplexed as I didn't really know her at all. Instead, after coming home to my apartment, I stared at my pile of books, wanting to cry for a girl I barely knew.

Now, I'm forced again to study nothing but my books, reading about diseases I've seen. I flip through the books to realize that for many pages, I see faces of the patients I've met, the stories I've collected, the connections I've made to the lives behind mere names of diseases. I wonder where they are now, and whether are not if we really made a difference in the end.

Yet for many sections, there are words on the page but my memory is blank. These are diseases I have yet to see, and they remain so on the page, only barely real. I spend my days treating artificial patients projected onto a computer screen, patients whose problems are solved by multiple choice. It becomes easy, again, to forget that what I'm learning affects actual lives. In many ways, I already crave being back on the wards. I wish I had the sweet taste of cefalexin in my mouth, reminding me that it's the mastery of both theory and practice that ultimately makes the magic of medicine.