Tuesday, November 21, 2006

To Whomever It May Concern

Today we finished our ethics class in which we covered controversial topics like stem cell research, abortion, and physician-assisted suicide. I found the whole experience fairly intolerable, which surprised me until I found time to reflect on the reasons for my allergic reaction to learning ethics in med school.

First, I have found this year that I am really indignant when my school makes attendance of any class mandatory. So, of course, I was quite miserable every week during our mandatory discussion groups for the ethics course. I found this time, as well as the lectures, to be time that I wished was spent with my Robbins Pathology text or my microbiology notes. The "soft" courses in our curriculum (ethics, psych, clinical exam) have been deemed to be unworthy of my time by the academic defense mechanisms I have erected to cope with the insane amount of material which we are expected to master this year. Couple this ongoing anxiety with the impending doom of our Step 1 licensing exam this summer, and I find myself intolerant of any time wasted. Except time spent writing in this blog, of course!

The tendency of these courses to portray the "ideal" physician and putting forth the idea that said "ideal" physician can only act in certain ways is also a huge turn-off for me. I am sure there are plenty of great physicians that "feel their patient's pain" and "explore feelings and ever-changing goals of treatment" with their patients, but I am just as sure that there are physicians that simply don't have time to spend on these diversions that provide excellent care for their patients by focusing on other strengths. Medicine is far too complicated an endeavor to master simply by following a few "touchy-feely" rules, and I feel insulted when it is portrayed to us as such.

That being said, I think that a poem I wrote a few years ago touches on my conflicted feelings about ethics in medicine--in particular, that hazy line between aggressive treatment with the idea of curing an illness and palliative care in which the goal is to comfort the patient while they die naturally. I would love to hear what kind of reaction any of you have to this poem, or even your ideas about the role of the physician in the dying process and Western civilization's eternal fight against mortality. And, you know, if the poem is just way too obtuse for anyone but me to understand, feel free to let me know that too. No comment is unwelcome.

To Whomever It May Concern
Deaf men bang drums, bleeding hands
protest the primal rhythm.
The blind turn leaden eyes to the sky,
stone synapses flare to life.
An alcoholic, fire in his veins, defiant
stands before his essence, a genetic jury.
You wouldn’t understand.

You couldn’t understand
a fish joyfully embracing the sandy shore,
his best breath, his last.
Or the bulimic refusing herself from within.
A hunger artist painting a visceral desert.
The beauty of a falling eagle,
blanketed by warm vertigo.
That empyrean pull, fatal.

Not you,
you wrote the rules in blood.
You’ve got your millennial plan,
an ivory covenant delivered on death.
No, you couldn’t understand.

87 Comments:

At 11/26/2006 10:10 AM, Anonymous good dad said...

Your steely gaze into the reality of life is, and always will be fertile ground for the pride that wells up within me.

 
At 11/26/2006 11:57 PM, Anonymous Anonymous said...

Heya Jesse, it's Noelle ...

I liked your post on ethics but I feel the urge to comment, as it is an integral part of my major to suffer through sometimes-badly facilitated discussions of controversial topics (in the environmental world). I think the most valuable thing to take from ethics classes are the things we can learn about ourselves through being introduced to different viewpoints. Yes, it really can be difficult discussing theory when we'd rather be out there doing some damn good already, but in the end maybe we'll know a little bit more about ourselves and what convictions influence our decisions and behavior. ;)

 
At 12/02/2006 2:11 AM, Anonymous beefballs said...

Yeah I deal with the same bs at my schoool. I am under the impression that med schools put this crap in place in response to surveys showing people unhappy with their medical care. Never mind the fact that the real reason people are upset (mainly cost) with medical care is not governed by the physician.
I am beginning to think that the healthcare system in general is a broken apparatus, that is only held together in any semblance of working order by the healthcare workers themsleves. NOw for the caveat-no I have no idea how to fix it. But one thing I am certain of is trying to make me some kind of big love bag aint gonna work-I am too bald, too hairy, and too grumpy. I work hard in school to maximize my ability, that is how I show I care-if you want somebody to hold your hand and sing Kumbaya-its never gonna be me.

 
At 12/04/2006 5:41 AM, Blogger Milk & Two Sugars said...

G'day BD!

Your poem says, eloquently, that the people making life-and-death type laws lack the experience necessary to represent the agenda of those who seek that such laws be passed. In particular, they don't understand that death can be sought and satisfying. (They've probably also got a political ideology to live up to - it is America, right?)

Am I right? Did I pass? Actually, whether right or wrong, I liked the poem, because I felt I could relate to it.

Hope your Christmas goes as well as Thanksgiving did.

 
At 12/18/2006 9:56 AM, Anonymous Anonymous said...

A good physician is different than a good clinician and can make the difference between a bad ending and a worse-mediated in a court room ending. If you don't like people and cannot bring yourself to act as full physician rather than a mere clinician, please enter a field such as pathology or radiology where you don't actually have to deal with people that are scared and nervous.
Obviously, you are a worried student that is stressed over finals and the lack of time to study. I can understand resenting time away from your precious "hardcore" classes...I have been there. Hopefully, once you get into practice, you will realize that medicine is an art as much as it is a science. The "soft" classes can help tie the science with the art. For instance, right now I have to call an irrate client back...she is mad because I did not prescribe antibiotics for an allergy attack...and oh, by the way, why did I not give anything for the vomiting that she failed to mention was part of the problem at the first presentation. What do I want to say to her? You redneck ignorant fool, antibiotics only work with bacterial infections. What am I going to say? Now ma'am, as I am sure that know already, antibiotics are for bacterial infections. Since the clear nasal discharge and sneezing are more likely due to either a viral infection or allergy, antibiotics would be a waste of money (see, people like it when you save money). Will it work? I don't know...but if she starts demanding antibiotics and acting bitchy, I might tell her that her needs would be better served by one of those doc in the box places where they give out antibiotics like they are candy.

 
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