Negative Controls

October 30, 2011 § Leave a comment

We heard from a patient during our Dermatology week, who worked as a medical laboratory technician, running hundreds of blood samples every day, and frequently using her own blood as the negative control. Then she began to notice that the numbers stopped making sense. Her ANA had shot through the roof and her white blood cells started dropping.

“I couldn’t use my blood as the negative control anymore,” she said, shrugging slightly.

Her stoic face didn’t reveal much, but I imagine that being dethroned from the pristine world of negative controls into the confusing milieu of mucked up numbers and unsteady ground couldn’t have been an easy thing to accept.

She had lupus.

A few more things followed. A friend confessed to me that she didn’t particularly appreciate the accepted, if not expected, gallows humor that our classmates used in talking about diseases and disease states. Sure we all knew that we were teetering on the edge of propriety when we tried to remember the functions of the different cranial nerves by acting out their deficits, but there were good reasons! There were always good reasons. We were coping with the vulnerability of the body, the darkness of the world we encountered daily; we were only using humorous study techniques to process the huge quantities of information thrown at us; we were just being kids. We were joking. No harm, no foul.

But the friend protested the unspoken assumption that as medical students, as those on the other side of the patient-doctor relationship, we were well. Not many of us have cruised through life without ever having visited the realm of the ill, or perhaps seen a close family member or friend acquire such a passport.

One of my classmates in fact recently published a piece in JAMA’s A Piece of My Mind illustrating her experiences of going through medical school against the backdrop of cancer. Shekinah wrote about how medical students, like physicians, are imagined to be among the well. Professors reinforce this, calling us healthy for being young and presenting without ‘clinical findings’. “The mechanisms for heartbreak and loss are not on the docket of our formal education,” she wrote.

It’s not an easy balance to manage. Physicians don’t like to count themselves among their patients, despite the fact that they very well may be some other doctor’s patients. We value this dichotomy, this breathing space, this space to joke and fool around and talk about diseases and being ill without feeling vulnerable or sad. With the model of thinking that we’re all in this together, that any of us can be implicated, we lose that. There’s the idea that treating illness as something too sacred to tease would force us all to be politically correct at all times. That too much respect would lead to fear, and so on.

But I think that no one really requires either extreme. Acknowledgement can coexist with detachment, empathy with intellectual curiosity. To illustrate –

Another classmate recently told me that in her psychiatry small group, the physician prefaced a discussion of schizophrenia with a nod to the idea that no one in the group suffered from such a burden to the mind.

That. There’s the danger. That’s the logical leap in question. None of us are spared, now or later. To forget that is just not fair.




Professionalism is Skin Deep

October 16, 2011 § Leave a comment

This Friday marked the end of our Neuroanatomy block, and I celebrated by taking a day trip to New Haven to visit a few friends at Yale. Over some crazy expensive froyo, my friend Apoorva and I got into a conversation about her hair. In high school, Apoorva was my way-too-fabulous friend who I vividly remembered for her untamable mane – it was long and fantastically wavy, and as she puts it, sometimes caused a bit of confusion about her ethnicity.

“I got it all the time. The ‘Wait you’re Indian?’ with a look of incredulity,” she laughed.

Now her hair was shorter and straightened. It was seriously transformative. I told her about a conversation I once had with a classmate at Harvard about girls who wear makeup. My classmate, a total bro, told me quite seriously that he thought makeup was overrated and that he disliked it when girls ‘tried too hard.’

I pulled out my lipgloss and absentmindedly put some on. He continued opining – why do girls feel like they need all that makeup anyway? Chicks with the confidence to rock the barefaced look are so much sexier. And on and on and on.

I told him that men were the judgmental gender after all and he really needed to stop being hypocritical and blaming girls for trying to improve their appearance because this was all a very obvious double standard please and thank you.

Apoorva recommended that I check out an article in Wednesday’s NYT Fashion & Style section. A study released by psych researchers from Procter & Gamble (of CoverGirl and Dolce&Gabbana fame), BU, and the Dana Farber (umm ???) suggested that when confronted with four images of a woman with different levels of makeup (barefaced, natural, professional and glamorous), respondents almost universally judged that the woman with the most cosmetic application was also the most professional, capable and trustworthy.

That’s right. Levels of makeup that researchers themselves deemed glamorous enough for the dance floor won all assessments of competence and likability, whether by snap judgment or prolonged examination.

… Twilight dresses and twilight makeup?

I remembered a blog that I once stumbled upon, written by a fellow medical student, that distributed advice on all things relevant to medical school applicants – from anticipating interview questions to taking notes on the campus tour. The blogger firmly advised against dolling up for the interview day. “Don’t wear open-toed shoes, don’t wear jewelry, and don’t smell like anything,” she wrote. “Don’t do make-up and don’t paint your fingernails. I actually thought that men looked very professional everywhere I interviewed. Sadly, I cannot say the same about women.”

I ended up following only part of her advice, since I still wore earrings, put on makeup and got French manicures for most of my interviews. Did it ultimately help or hurt me? I can’t say. But if the results of this study are right, for better or for worse, us women are still continually being judged by our appearances (and more so than previously imagined), be it at a cocktail party or in the office. Less is not more.

Le sigh.

But again, why were researchers affiliated with the Dana Farber CANCER institute helping out industry beauty giants at all? makes no sense.

So… second year.

October 1, 2011 § 2 Comments

In a small bay of our skills lab, seven of my classmates gathered around as my friend A gripped a small mace and shut one eye as he bore down slowly into a slice of brain. I don’t know about the others but I for one wasn’t breathing.

“How did it feel?” we asked him when he exhaled (so I wasn’t alone) and looked to us for affirmation.

“It’s strange,” he said. “It felt softer than jelly.”

Then he picked the knife up and sliced the brain again, and again, and again.

So much surrealism is contained in our neuroanatomy block. Such long hours, so many diagrams of remote nuclei and signaling and circuits that I may or may not remember one week from now. So many zombie jokes.

This month has been something of a metaphor for second year. Things are getting heated and we’re all losing our minds.

Last year, I could count on one hand how many hours I studied per day. This year, I count on one hand how many times I remember to shower in a week.

Last year, I called and skyped friends from college and home ALL THE TIME. This year, I found myself blanking on a friend’s name, rushing to Facebook to try and find him, and then diagnosing myself with aphasia.

Last year, my friend J and I bitched about skinny girls by calling them ‘ano’. This year, we do the same thing (because we haven’t grown up) but call it marasmus.

Give me a few more months and I’m going to need a halfway home if I ever want to go out in society again.

The other day, for the first time ever, I experienced retail therapy… online. (Time’s in a pinch, ya know) Did I experience the same kind of euphoria that I usually do when I swipe down my credit card and gather up my new apparel close to my heart? Not really, but I still got to hang up a few new sweaters in my closet. It’s not classy, it’s not sexy, but it’s getting the job done.

“You just cut through countless memories,” I said to A, when he was finished with the brain.

“Or a bunch of prions, you know,” he returned. “It all depends on how you slice it.”

Where Am I?

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