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Playing Dress-up October 31, 2006

Posted by Benji in Journal.
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            My first day to play dress-up doctor actually coincided with Halloween.  It wasn’t the first time I had donned the garb of a physician, however.  I had made my premiere in the fabled white coat (size 44) last year, just prior to taking the Hippocratic Oath with my classmates.  Soon after, I purchased a blue Littmann Cardiology III stethoscope, and – presto! – I was a doctor.  Or, at least, I looked the part.  Besides the cliché of wanting to help people feel better, there was little substantive knowledge behind the costume.  Regardless, there must have been some change, for when I stripped off the white coat to work at my pediatric clinic assignment, I was still – incorrectly – called “doctor.”  Children and their parents let down their guard and exposed themselves to me, both with their honesty and with their flesh.  What was it that, with only a piece of rubber tubing around my neck, elevated me to an expert, even when it had clearly been stated I was only a student?  Though this was part of my training, and I had been privilege to some difficult situations, our encounters were still make-believe.  I thought it was an eerie parallel that my first day seeing patients in a hospital was on a day defined by false costumes and playing pretend.

            My access card to patients at Connecticut Children’s Medical Center was not a white coat (a cloth specter that would have scared the kids – something I had learned in my out-patient pediatrics clinic), but a thin adhesive badge listing only my name and “hospitalist.”  Again I had been given a small white article that would serve as a magic key to open doors and – usually – other people.  As my classmates and I followed the multi-colored hallway, we noticed the “H” in the word “hospitalist” had been misprinted.  Laughing, we penned in the first stroke of the letter on each other’s nametags.  I quietly mused on the significance of only having part of the word show up properly: Were we going somewhere without knowing where we had started?  Were we running around with our heads cut off?  (Something that probably wouldn’t have garnered much of a response on Halloween.)  More optimistically, I thought maybe it was like feeling I had earned the first half of the “M” in “M.D.,” having completed my first year of medical school.  Three more to go.

            Sitting down in a conference room near the cafeteria, I could barely contain my excitement.  I was already thinking how maybe I should do a residency in pediatrics.  I felt comfortable interacting with kids, and the green dinosaurs and other figures that had been painted on the hospital walls made the whole situation feel a little less serious.  It was a hospital, yes, but its lack of sterility made me temporarily forget where I was.  Dr. Jung, a pretty young physician dressed as Little Red Riding Hood, walked in, handing us guides for our upcoming oral presentations on the patients upstairs.  Indeed, the photocopied papers were maps to get us through the woods – the jungle of kids in costume, locked away from Halloween on the street, but still eating candy in their hospital beds.  We were both caged: the children were too sick to leave, and I, if not escorted, could get locked in the stairwells.  There was no escape for either of us.  An unexpected wave of nervousness flushed over me as we readied to meet our assigned patients.  Jealous that Diego had been given a Spanish-speaking patient, I volunteered to go with him.  I must admit (with some embarrassment) that though I have a fondness for Latino culture, I also enjoy surprising people with my ability to speak another language.  I don’t think it’s incorrect, either, to try to contradict expectations made my first impressions.  My Germanic features were another part of my costume: what you see doesn’t always give away what’s behind it.

            Upstairs, more costumes: nurses dressed as lady bugs, doctors in Egyptian robes, and children in hospital gowns.  One lucky girl was healthy enough to put on overalls and stuff her pockets with golden straw.  Her thin frame made her a perfect scarecrow, but as she stepped out from the shadow of her room into the fluorescent-lit hallway, her frailness became apparent.  Angling myself to peer into another room, I saw a teenager curled up in his bed, coughing from a genetic disorder that filled his lungs with mucus.  My eyes were wide with sad curiosity.  I had read about cystic fibrosis, but to see its effects 10 feet away certainly was very different.  I realized this was the first time I had been witness to truly sick kids.

            The other students peeled away one-by-one to interview their patients, and Diego and I were the last students left.  We arrived at a closed door.  Soledad, a four-year-old girl, waited inside with her mother and father.  Hypervigilant to the prospect of communicable disease, the hospital staff had put her on “droplet precautions.”  A red cart outside her room contained disposable blue plastic smocks and yellow facemasks.  Ah!  My costume!  Unwrapping and untangling the hospital couture, Diego and I introduced ourselves from the doorway.  I slipped the textured plastic over my head, covering my orange tie and black pants, and immediately crouched down to be at Soledad’s level.  With my mouth covered, it was nearly impossible to show her I was smiling, let alone get her to give one in return.  I hoped my eyes, at least, were expressing a friendly warmth.  I tried to give her a high-five, but despite her mother’s encouragement, she stared at me blankly.  My small bag of “tricks” already used up, I shifted my attention back to Diego, who had been interviewing the father.  Diego’s crisp words contrasted mine: He was serious and efficient; I stumbled over my Spanish and got lost in the chronology of Soledad’s illness.  Despite my desire to interact with the patient and make her feel more at ease, I recognized the utility of Diego’s approach.  Grudgingly, I gave up on getting Soledad to smile and focused my attention on her father.

            This was the fourth time Soledad had been in the hospital: first for being born prematurely, then for a rare form of liver cancer, and now twice in the last month for pneumonia.  Though she had vomited last night in the emergency room, Soledad wasn’t in pain – she was just bored.  Silently she squirmed on the bed, positioning herself to get a better view of the telenovella on Univision.  In examining her, I was surprised to find her lungs sounded clear.  Soledad was totally apathetic to us revealing the scar on her abdomen, even though Diego tried to garner some rapport by noting he had a similar scar.  Apart from the hospital location, the history and physical exam were like any other I had done before.  The difference was just that we were invading the patient’s space, rather than her entering our office.  I felt a sense of accomplishment as Diego and I escaped the hot plastic outfits, washed our hands, and thanked the family for their time.  Outside the room we looked briefly at Soledad’s chart, confirming the vitals we had taken were accurate and recording the ones we hadn’t taken.  I wondered how I would have responded had she been “sicker,” like the young man with CF.

            After reorganizing our notes, we prepared to give an oral presentation to Dr. Jung.  Despite having had some practice with this in my pediatrics out-patient clinic, I felt some stage fright – that my words would again escape me when it came time to speak.  No option, I thought, but to just jump into it.  Indeed, I had to trust in my skills and not psych myself out.  As I spoke, I took solace in the fact that both Dr. Jung and Alexa, our Fourth Year medical student mentor, were nodding in agreement.  Once everyone had presented their patient, our game of playing doctor came to a close.

            On our way out of the hospital, we removed our sticky badges, part of our costume for the day.  One of my classmates folded hers over so that her name and “hospitalist” were on opposite sides, leaving one identity to be shown and the other to be hidden.  It finally occurred to me that I didn’t know what “hospitalist” meant.  Later, reflecting on the symbology of the day – in other words, the symbolism and the rituals associated with it – I looked up the suffix “-ist.”  Though “biologist” was an easily-accessible example of the suffix, I could not quite define “hospitalist.”  Wishing the word were actually “hospitalitis” – inflammation of the hospital – and shaking my head amusedly as I thought this, I found the answer: “-ist,” one who is engaged in, or one who believes in.  Ah, so a “hospitalist” is someone who believes in the institution of a hospital…  It’s someone who works in a hospital.

Diction, like a mask that covers only part of my face, like my white coat, is another small part of my costume.  Fancy words or foreign tongues, they are something I can, personally, hide behind, though my role in medicine shines through.  White coat or not, my future career is not something I can take off.  I am primed like Clark Kent – when I need to, I can revert to my alter ego.  So that begs the question: which is my costume and which is me?  Who is the real man?  Superman or Clark Kent?

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500 views October 28, 2006

Posted by Benji in General.
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Thanks for reading!

Personal Demons October 24, 2006

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            Twenty-five minutes after: My mind is adrift, lost in a proverbial haze of emotion.  Yet, in considering what I feel, in trying to quantify and qualify it, I seem to be in more of an emotional desert.  My mind is dry, sterile.  There is something concrete – I can feel it – but when I stoop to pick it up, the sand pours through my fingers, and I am unable to construct a response or emotion from the tiny glass pieces.

            Without meaning to, I confronted my own mortality.  I also came up against a stereotype I don’t want to acknowledge.  Is it my own prejudice in assuming one word begets another – at least in the eyes of others?  Am I wrong for trying to be “better” than the majority to avoid falling into this stereotype?

            I am a gay man.  Honestly, it is not something I am always proud of.  Why would I want to celebrate something that has made me feel a slight distance from even my closest friends?  Why would I want to celebrate a non-choice choice – something I have to embrace to be true to myself, but something that makes me inferior in conservative American politics?  For all the struggling I’ve done over my sexuality, I’m surprised how quickly it can cut me down.

            Sexuality, I thought, was who you have sex with.  Apart from requisite boasting in the locker room as an adolescent, or the birth of an infant, why would this information be shared?  But I realized: I’m gay whether or not I’m pursuing what my body’s chemistry tells me is attractive.  I’m gay 24/7 – it’s an integral part of who I am.  So to this end, I feel most at ease with my so-called “own kind.”  They, too, share the same (potential) secret.  What other single issue would worry me more to reveal?  So pair me with another guy my age – that’s a start.  We share the same religion?  I’m feeling more at home.  If he’s gay, too, well, then, I feel an unspoken understanding.  As a future physician, though on the one hand I worry about giving unfair attention to people “like me,” I also feel a responsibility to protect them.

            And as a physician, there will be times when I fail to protect my patients.  As a human being, I will fail to protect my friends and peers.  Sometimes this will not result from anything I did (or did not do), but I will still feel awful.  Drawing the line between “fault” and “guilt” should be clear enough, so why have I taken on responsibility that is not mine to take?

            Sixty minutes prior: It all started because I was hungry.  Well, my insertion into this piece of history came as I was driving down I-84.  I didn’t know yet the lengthy prologue that hadn’t included me.  I was driving back to
Hartford to both appease my empty stomach and to see an old friend who had been incommunicado for a year and had just yesterday reestablished contact.  Two birds, one stone, I thought.

            Emerging through the drafty diner door, my friend looked like the day we first met – back in 1998 by the pond in the arboretum, two future homosexual teens deciphering their sexual orientation.  Either my memory of his past hugs failed me, or he squeezed me tighter than usual this time.  We proceeded to “sit down and catch up.”  Somewhat naïve to his evasiveness in answering questions the day before and mostly unable to add a word of conversation to his excited, stream-of-conscious monologue, I sat back and watched.

            Have you ever sensed when something is not right?  You wonder if maybe you’re being a little paranoid but you’ve got an uneasy feeling that can’t be attributed to the greasy diner bacon burger you just wolfed down?

            He kept setting me up for me to guess what had gone on in the past year.  I just interlaced my fingers and asked, “Is it something I’m going to get mad at you for?”

            And so he confessed: He had been using crystal meth, a drug that has gained somewhat recent notoriety for its use in the gay population.  A numbness crept over me, and I couldn’t shake the memory of my previous drug-addicted patient.  “Okay,” I was thinking, “I’m not sure how to feel.  This is so out of character… isn’t it?”  I wondered if I really knew my friend anymore.

            “That’s not all.”  The monologue looped back to something that had been mentioned earlier: He had been sick with meningitis.

            “The doctor said, ‘It’s not bacterial, or you would have been dead by now.’  And I appreciated his bluntness…”

            And I knew.  I knew.

            What other type of meningitis is there?  Viral.  Pair that with crystal meth, and I saw what he was circling around but not saying.

            He continued: “Remember back in May when I had a scare…?”

            Now in the gay community, this immediately means, “there was a chance I had been infected with HIV.”  I had had them, too.  I remembered vividly the question posed by a counselor when I went in for a routine check: “What would you do if the test came back positive?”

            “But it wasn’t just a scare…  The doctor called me up – she left me a message, actually – that we should discuss some blood work in the office.  Yeah, right.  Blood work.”

            Without ever saying that he had become HIV positive, my friend had communicated it three times, at least.  I was speechless.  Again I felt like a child, unable to offer a solution or even meaningful comfort.  I had known him “before and after” infection.  Two things could not be further apart in my mind – my friend and HIV.  I struggled to face the (un)reality.

            I felt badly for him and then got mad at myself for feeling that way.  I tried to decide if I should feel or act differently or if our relationship was the same.  It was and it wasn’t.

            He pulled out a card from his rubber band-looped make-shift wallet and showed me the black numbers that recorded his CD4 count and viral load.  I wished to have some emotion – any emotion.  I worried that a gay man with HIV was fulfilling a stereotype.  I was angry for his choices and angry how that reflected on a minority community that had to bond together, but then recognized the futility, thinking “water under the bridge” – what I had thought when I accepted his apology for ignoring me for a year.  As soon as I realized I felt something, I deemed it “inappropriate” and tried to cast it away.  I didn’t know what to do.

            “I love you,” I said before driving home.

Twelve and a half hours later: After leaving the dichotomous road-side diner and confessional, I had called one of our mutual friends, spoken with one of my roommates, and written to another friend whose brother had died of AIDS.  Whereas my friend had had months by now to get used to his new “status,” it was a heavy surprise for me, and I didn’t want to bear the load alone.

            “That’s how I felt at first,” the third friend wrote me back.  “I was numb, too.”

            I imagine my thoughts will change eventually.  There is something unique to a personal friend who acquires an illness.  It nails you to a railroad track of empathy where you are bound to get crushed periodically.

            All I could do was take note that the weather had gotten warmer and the violet crocuses had come out.

Safety First October 22, 2006

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No Exit October 20, 2006

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Hell is other people.

I saw a phenomenal production of Sartre’s “No Exit” at Hartford Stage this week.  (Quite apropos for my life at the moment.)  It was performed on a stage that could tilt to about 30 degrees in all 4 directions.  This was particularly effective as the venue is theater-in-the-round.  And, frankly, I thought it was brilliantly integrated into the staging of the script.  Sartre was brilliant, and to see how this production adapted it… well, I was very impressed.  I tried to research and see if this tilting-stage idea has ever been used for this particularly show, and I came up with nothing.  Any dramaturgs out there that know better?

Books October 16, 2006

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There’s something exciting about buying new textbooks.  I love their crisp edges and clean matte pages, flashing with information to be communicated.  It’s like the promise of a new schoolyear as a child.

Books

Nonetheless, I have a lot of anxiety about the next block of classes.  They make up the real “meat” of the second year curriculum…  And the next 8 months lead up to the US Medical Licensing Exam (step 1), which is absolutely horrifying for a neurotic guy like myself.  Well, I’ve made it “this far” (which isn’t really that impressive in the grand scheme of things), so I’m gunna try my best not to let this bucking bronco kick me off.  It really is a rodeo and I’ve gotta hold on for another “big 8.”

Red Ribbon October 15, 2006

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I didn’t have such a great birthday (I had an exam which wasn’t too bad… but still, it was an exam) and no one seemed to be around to go out, so I thought I was just going to skip the AIDS Project Hartford walk on Saturday.  But an old friend of me called me at 2am after he got out of work, and I decided to meet up with him for an early breakfast at a diner just down the road.  It was an almost eerie parallel to a meeting we had there last spring.  (I have a journal entry on that coming soon.)  But he did put me in a much better mood, so I woke up the next morning after only 4 hours sleep to talk 3 miles around the reservoir.  I guess I was kind of motivated by this friend as well as another blogger down in Texas (see below).  I only found out about the walk this week, so I didn’t have time to fundraise, and I felt a little guilty about that, but I’m glad I participated.  Doctors aren’t just health-advocates when they’re wearing white coats.

AIDS Walk 2

As we were walking, I was talking to one of my new-found teammates about the kind of life I want to have as a physician.  In checking to see how much weight I put on family, the other walker (who was there with his wife) asked me, without missing a beat, if I was married or if I had a partner.  And I thought, “Gosh, that’s great.  He’s all-inclusive by nature.”  Granted AIDS charities tend to be gay-friendly, but it was a nice respite from religio-cized politics (politicized reglion?).

Team Abriola

Now for the aforementioned blogger…  If you’ve never read ThisBoyElroy, you should take a look.  The guy behind it is really special; he’s inspired me on several occassions.

TBE: Memories Keep the Spirit Alive
TBE: Mission Accomplished

Things Change, Things Stay the Same October 13, 2006

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Today’s my 26th birthday.

Self-exam October 11, 2006

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 This is particularly appropriate given that (1) I have a human behavior exam on Friday and (2) this video was actually part of the “Health Promotion” lecture.

Seasons of Change October 9, 2006

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 Winding Trails 2006

Fall in New England: The leaves are changing into their wonderful reds and golds, and the moon has been full and soaking the crisp nights and frozen ground.  I went out to a Wilderness Medicine conference yesterday morning, and steam was rising off the lake.  It was so fantastic.  My 26th birthday is approaching (on the day of my next exam) and then we really get into the “hard” science of the second year of medical school.  I’m totally worried about that.  I think of myself as a “marginal” basic science student, but at least it’s been a lot of fun to mentor the first year students in the free clinics.  That’s where I actually feel like I know a little bit of something…

I’m really pleased I’ve had over 100 views to my blog in the last week — thanks everyone!  I hope you’ll leave me some comments…