March 30, 2011

A personal Hippocratic Oath

Today was the last day of the Healer's Art course at school--as a closing exercise, they asked us to think of four clauses of an oath that we envisioned as an embodiment of ourselves as physicians.  Here's mine:

This I ask of all that is holy, now as I look to my future in medicine:
May I see my patients as beings endowed with a spark of the divine, each with their own story to tell.
Help me to honor the autonomy of my patients, so that their treatment is their will and not mine.
Grant me the ability to care for myself as much as my patients, so that my spirit is renewed daily.
May I do all I can to lessen suffering in this world, no matter how small the affliction or how deep the pain.
This do I ask and this do I pledge to do, with solemnity of purpose and strength of will, so that I extend by one more link the chain of physicians from before history into the future.


I'm not sure where the second clause came from.  I wrote it and it felt right, but I don't remember a time when it felt like the doctor was infringing on a patient's autonomy.  Maybe I'm afraid I will take too from my own world view and impose it on my patients?  I'm just not sure.  I like that it's in there, though.

I think the best part was at the end, everyone read their oaths or a portion of them aloud.  Each person's little bits and pieces made me think, "Oh! I should have put that in mine!"

March 29, 2011

Hypothetical

I'm up to my elbows in a difficult cesarean section, the woman's abdomen retracted on both sides and about to slice into her womb to retrieve her baby.  The lights overhead sizzle and with a pop we are plunged into darkness.

I freeze.

"No one move.  Does anyone have a cell phone on them?"  A few murmurs go around the room as the anesthesiologist and the one nurse that isn't scrubbed in pull out phones, mashing buttons until their iridescent glow illuminates their owners' chins.

"You, go and find out what's going on.  I need power back in this room and I need a flashlight, now!"  The nurse hurries out of the OR.  The anesthesiologist looks at me, and I look back and wonder what we're going to do for this woman.

"We need to monitor her vital signs, and I don't have any monitors."  His face is tense, his mouth narrowed into a thin line.  His fingers come to rest on the woman's pulse.  The woman is fine, for now, but the surgery needs to continue; she can't remain open on the table for long.

"What's going on?  Why is it all dark?  I'm blind, I'm blind!  I can't see!  What's happening?"  One of the pediatric nurses steps next to the patient and begins to speak in a low, soothing voice.  The patient's shrill cries die out as she grabs tightly onto the nurse's hand.

The nurse I sent out of the room returns with a flashlight.  She brings it to the table and puts it in a sterile bag, like they use for other reusable equipment.  "I need your hands," I tell her.  "Is there any way you can hang that above us from the lamp?"  She looks at the lamp and decides it's doable.  We use suture thread to snag the top of the bag and then loop it over the handle of the OR lamp.  The light is dangling a couple feet from the sterile field, and I pray that it won't fall and that I'll be able to see enough to finish what I'm here to do.

I take a few deep breaths before I pick up the scalpel again.  I make the incision into the uterus and even though the rest of the OR is in pitch blackness, the table feels almost like any other c-section.  At the same time, I feel linked to the surgeon who first performed this act, hundreds of years ago, with no more light than an oil lamp or a candle.  The baby emerges from the womb and gets handed over to the pediatric nurses immediately, who cradle him in towels and wipe his face, and suddenly he cries out.  It is a miracle, and he is alive, and now the only task I have is to save his mother here, in the dark.

I peer closely at her abdomen.  I take up the suture needle and thread and begin to stitch her organs back together, repairing her uterus and weaving her flesh back into a whole piece as I work my way toward the surface.  I am securing the subcutaneous fat when I hear an electric hum in my ears.  It is followed quickly by the blinking on of bright fluorescent lights, and now the OR is bathed in light.  I finish stapling the woman closed and once her bandage is on, we lower the sterile curtain.  The nurses bring the baby over to the new mother and she has tears in her eyes as she looks at him, her baby from the darkness brought here into the light.

March 25, 2011

Song and Dance

I am a toe-tapper.
I wait for the music to swing
and I sing the words under my breath
as the melody is sweeping up
into chords
vibrant and triumphant and
shining into the dark like a
night light.  I hum harmonies
and pick out thirds above
or below and add
my own notes despite groans
when I miss the mark
just a bit.

I am a clapper-along.
I wait for the rhythm to tell me
that I belong in the middle,
bouncing a strong down-beat
with my feet on the ground
or my palms on my thighs
and the sound of my stride
makes music as I walk.
Even if I'm wrong and the
tempo trips me up--long
instead of short or I have to
clap on quarter notes instead,
my body picks the time
and I climb stairs with a lilt
so that the music in my head has percussion.

March 10, 2011

Dirty Heathen

An old friend and I were chatting on Facebook the other day. After the usual life updates, the fact that it was Mardi Gras surfaced.

"So, what are you giving up for Lent?" he asked.

"...Pffft. Nothing. I'm a dirty heathen. And dirty heathens get to be hedonists."

That got me thinking about the whole practice of giving something up for Lent in the spirit of the Lenten fast that Christians used to observe during the holy period. It's not that I think a little self-restraint is bad (far from it). And from a spiritual perspective, I think depriving the self of certain excesses for a period of time is a healthy way of clearing the mind and the body and preparing it for other tasks.

But I think another important aspect of this is that after the "fasting" period is over, you celebrate some sort of rebirth by allowing yourself to partake in whatever it is you've given up again. And since for Lent, that involves celebrating the resurrection of Christ and thus the salvation of mankind, as someone who doesn't really believe in that I don't feel the need to pick this season specifically as a time of fasting and spiritual preuve.


On the other hand, I have no problem with people who give things up for Lent.  If anything, I admire their resolve.  I just hope they're getting something spiritual out of it as the practice was intended.  Otherwise, it's just like a bet you make with yourself: "Can I make it 40 days without x or y?" And even if you lose the bet, the only one who knows is you (and the big Guy "upstairs").

Oh well.  This dirty heathen will continue to enjoy her chocolate up to and including Easter.

March 5, 2011

Endurance

I woke up on time to my alarm this morning and as I swung my feet out of bed, it occurred to me that it was only Saturday. As in, there are still five more days of intense, all-day studying before being able to enjoy the empty freedom of spring break. I almost pulled the covers over my head.

Not getting home until 7pm today means that I took a two hour dinner-TV break. Now I think I have to go study some more.

ARRRGH!