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(no subject) [May. 14th, 2007|01:16 am]
[Current Location |home]
[Current Mood | exhausted]
[Current Music |dntel - roll on (ft. jenny lewis)]

i am sorry if you have been at all troubled by my lapse in writing. why have i taken so long? because that last one was so bleak it got some bad responses, and i didn't really want to just keep writing that. the problem there is that most of the time that's how i felt about medical school. and the rare times i didn't, well, i didn't have the time to write.
so, what's changed? a very good friend reminded me of the importance of writing, and of course to be honest with it. so i'll give you the straight business, and if you stop reading i won't mind a bit.
i'm two weeks out from the finish of my first year of medical school. i've learned a lot of stuff, some of it is even pretty neat. some of it may even be useful. but to be really honest with you, i don't care for medical school that much. i more or less stand by my earlier analysis, but i have realized that my first response to it was not the best choice.
that is, my first response to this feeling was passive aggression. i quit going to class as an immature defense mechanism, and i paid for it. so when i'm done with pharmacology and pathology, i have to study to take a test over the first half of cell biology.
that bump in the road didn't really change my approach, though. the realization of how badly i was handling myself helped me change my attitude a bit, but my plan is still to try and discern the important concepts and learn them and just pass the classes. it's risky and dangerous to approach it this way, because just knowing the concepts doesn't put you far above the mark of failure, but i have a hard time motivating the other way.
in my opinion, arrogant though it may be, i just don't see the purpose in trading hours of my life for honors, although i did honor one course, very early on, and by accident.
i do have to pass these hurdles, though, and so i do still spend up to 8 or 10 hours a day for a week or more when tests approach. but i also still go climbing, and we play kickball and see movies and try to have a good time.
i even started taking yoga. it's a barter class that i have so far paid for with cupcakes, a loaf of banana bread, and a bottle of wine. it's fantastic stuff.
and there are other good things. when i started ditching class i also started volunteering at la clinica. i figured it would be a fair trade, and it has been a wonderful experience. i get to do intake and translation at a clinic right around the corner from my house that primarily serves spanish-speaking populations. it's really interesting and very fulfilling, although it can be quite challenging. there is a wide gap between making conversation with grandma in spanish and explaining medication dosings. not to mention the stakes being a little bit higher.
in terms of classes, i now have a basic working knowledge of the numbers behind the studies from epidemiology and biostatistics, i have shown proficiency in medical ethics (my most highly anticipated class, and disappointingly the shallowest treatment of philosophy i've ever encountered), developed a deeper understanding of the immune system and germphobes everywhere in microbes and host responses, learned why you don't kiss your cousin in genetics, learned the basics of drugs in pharmacology, and have seen more mutilated children before noon than i care to remember in pathology (these last two i'm in now). oh, and i had the elective on medically underserved healthcare (quick tip: don't be poor or non-english speaking) which was pretty much my once-a-week bum-out session.
and of course, summer is fast approaching, with all of its promises. i'm going to germany to keep company with the fabulous family Nissen and have all kinds of adventures (a sense of what sorts of adventures i had last time i saw them can be had by clicking here.), then i'm off to prague with my medical school adventure crew for a selective that will take us on rotations through hospitals for the month of july, then a few days in vienna and a few more in budapest before we come back a little under a week before year 2 starts.
as is generally my style, i don't know a lot going in, but am trying to stay open to the experience and see what happens. although we do need to figure out housing for prague soon...
so, i guess that's it for now. expect updates more often than once every 8 months, as i have realized how many golden stories you have missed due to my failure to write. you will not be so unfortunate in the future.
be well, be happy, and give somebody a hug from me.
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inertia [Nov. 6th, 2006|09:29 pm]

beard-o
Originally uploaded by yourfriendalex.
I know it's been a while, and i'm sure you've all been very concerned/interested/surprised about my continued progress in medical school. i started writing this second epistle about a week ago, but stopped for fear that the vitriolic content would stupefy and amaze and decided to come back to it when maybe i had calmed down. reading over it again, i see that it's all pretty much true, so i'll take up where i left off.
Just by looking at me you can tell i've gotten serious about giving up. i read a toothpastefordinner comic about this once, so i decided to include it for your own pleasure. Toothpaste For Dinner
toothpastefordinner.com
and a picture of me taken just this evening for comparison. delightful, this new technology.
and when i say giving up, i mean on the way i have been doing school. why?
Medical school finally broke me of the supreme illusion I had somehow worked myself into: that this would be the point where things finally got to be realistic and sensible. After years of studies focusing on absurdly miniscule levels of detail, I had convinced myself that medical school would be the beginning of meaningful assignments, pointed work and realistic (albeit difficult) demands. WRONG WRONG WRONG.
i should have looked more deeply into that initial surprise at not being angry about 12 hours of work. the lack of frustration and blind anger was more a product of the softening effect of initial enthusiasm and excitement than a product of a well-crafted system.
Rather than emphasize the basics and take ten weeks to really thoroughly learn the foundations of anatomy, leaving us with a basis for anything we might go on to do, they tried desperately to cram any and every detail regarding human gross anatomy into us, save of course the major joints. Why?
I am certainly not stupid enough to believe that anything I will go into will actually demand that I have photographic recall of every minute detail of every millimeter of the human body that i learned in my first ten weeks of medical school. And yet, they tried to motivate us with just such a sales pitch. Doctors from numerous specialties were routinely brought in to give guest lectures and bring home the importance of whatever nook or cranny we were studying eagerly that week. Incredibly, anyone who was up to speed with the material could easily follow right along as a neurosurgeon took us through his work, or a radiologist showed us what the structures look like on CT or X-ray.
Perhaps I am somehow deficient, but this inspired revulsion in me rather than gratitude. A neurosurgeon requires TWENTY YEARS of training. Since my last letter I turned twenty-three years old. Please take a second and let that settle in. How would you feel if you were required to learn more or less all of the landmarks that surgeon needs to know in a matter of days. Does that make sense at all? Many is the day I worried quietly about the possibility of my morning multivitamins having been replaced with crazy pills.
"So, Alex, how do you manage to stay fly in spite of all of this?"
It's easy, old friend, and I encourage you to do like Alex does: phone it in. Is this a terrifying thought for you? That a future physician deals with his workload by just not doing as much work? As always, it's just my opinion, but I think you've got to blame the system, not necessarily my own ennui, grave as it may be.
The incredible difficulty is not the material itself, at least certainly not for the caliber of student (pfffft) they hand select for medical schools. rather, it is the volume, the detail, the speed, the inherently competitive atmosphere, and the self-guidance of the program. my problems come from constantly trying to select out what actually matters in all of it, trying to keep from getting swept up in the competitiveness of the class (muted as it may be, comparatively), and figuring out how to make this all work on my own. it's really disorienting, all of it, and it takes a lot to forge together some semblence of a routine that you can rely on and use as a safe place by which all of the noise can be evaluated and filtered as need be.
i guess what i really want is some honesty. the level of detail doesn't seem honest. we won't need to know these details to do our work, and if we do our future training will certainly not be silly enough to rely on what we learned way back when. moreover, the attention to detail and numbers suggests that medicine is about precision, about knowing and about being right. guess what? it's not. it's about guessing.
i'm not saying you don't have to know anything, of course you do. but in the final analysis, you will come into the clinic sick, scared. you will ask for my help, for my expertise. i will come to you and say, this is what i think it is, this is what i think we ought to do about it. and explicitly or implicitly, the truth is that i might have a better or worse idea about what it is and what to do, but knowing that this treatment is 86% effective in a Level 1A/Grade A study doesn't mean that you, the person of interest, isn't part of that other 14%. in the end, i am making my best guess, and if that doesn't work i'll guess again and again and as often as you'll let me until we can find something that will help. and you're scared and i'm scared and this is the best we've got. but it's us, not just you or me alone, but us. that's the reality of medicine, that's the experience that i'm willing to take on unfathomable debt for, that i'm giving up my time for, that i'm putting up with this frustration for. and i don't see it in my classes, and i think that's the worst part of all. but i'm still looking, and still believing, silly as that may be.
college taught me that you've got to be your own advocate, because the people that are supposed to be looking out for you have to look out for themselves, too, and sometimes little you gets lost in the shuffle. i'm not trying to change the system, i'm not that crazy. dad says you've gotta find the true and the lasting, and i remember that it's about becoming always better, and helping people realize the good that's within them. sure is easy to lose track of it, though.
and dad says, "well, you can always kill yourself."
but you and i both know he was just ripping off Camus. and the Stoics. but that's for another night.
as always, i hope this finds you well, growing and finding peace and joy in your life. feel free to drop a line whenever, i love hearing about your life and adventures. oh, and keep it real on the 1's and 2's.
searching for a former clarity,
alex "awesomeface" gamble
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a letter for advice at a lower point.... [Oct. 11th, 2006|04:09 pm]
[Current Location |medschool library]
[Current Mood | cynical]

hope things are treating you well. not sure if you ever got a chance to read that last email i sent out, but it seems that the optimism that permeated it has given way under the constant grind of anatomy. burnout has set in lately and it's hard to maintain focus. i'm afraid the situation you described regarding the optimism of medical students in the face of absolutely stupid requirements (memorizing the Krebs cycle again, etc.) wore off of me prematurely. it is endlessly frustrating to realize how completely stupid most of the work they make us do is. unfortunately, these realizations do not necessarily bear on the things that made me decide to do this, so i have to keep going. this is an overly polished way of getting to some questions i have wanted to ask for a little while.
unless i am making it up, you are now in psych. reading your blog entries yields numerous references to your own problems and your desire to be there where other people were there for you. while i'm not certain what sort of medicine i want to get into, i do sometimes consider psych for somewhat similar reasons. at the same time, i've received numerous warnings against the field. i'm still pretty far from getting much of a firsthand experience, so i thought i'd better ask you.
how are you finding the work? what are you looking for in it, and do you think you'll be able to find it? the general opinion seems to be that psychiatry is essentially psychopharmacology, that the days of talking cures are gone and that that path now belongs to therapists, or at least that you don't need to go to medical school to do that sort of thing.
i also wanted to ask what you think about the relational nature of medicine and how it plays out in real practice. it seems to me that medicine, truly practiced, has to take a holistic view to the nature of the participants. it's a relational practice, involving the physicians who are making an effort at using their knowledge of a good life to help their patients live a good life. my undergraduate degree was in philosophy, and i was looking at this question for my senior thesis, and i think about this stuff pretty often. i was discussing it with a doctor here after a small group epidemiology/biostatistics session, and i didn't get a very encouraging response from her. it's not that i didn't know that medical school wasn't going to address these issues, i did, i'm just trying to keep up with them and make sense of them as i go along. i'm a little worried about what will happen to me if i don't, because i know no one else is going to ask them for me.
anyway, sorry for the lapse in writing and the wandering, expansive questions. i would love to hear some of your thoughts about this stuff whenever you get a chance.
thanks again for caring and taking the time to listen and respond. it means a lot.
your friend,
alex
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the autonomic nervous system is a motor system [Sep. 23rd, 2006|03:17 pm]
[Current Location |home]
[Current Mood | busy]
[Current Music |bayside - they looked like strong hands]

medical school! sorry it has taken me so long to put this thing together, but as it turns out, this bit is pretty time consuming.
yesterday marked the completion of my sixth week of my medical education proper at the esteemed Saint Louis University School of Medicine, and thusfar i have survived. there is certainly plenty i could say about my experience so far, many angles or approaches, and while i would like to treat all of them individually, i'm not sure you have time (or patience, desire) for a book written about 6 weeks of schooling, so i'll just stumble around what medical school has been like thusfar and we will call it even steven.
medical school is pretty hard. i can almost hear your surprise. i knew it was going to take a change of method long before i started, and i resigned myself to finally becoming the good student i had been telling myself i would become at the beginning of every semester since i thought that mattered. and to my great pleasure, i found that i actually did pretty well with the transition. on the first day of medical school i was on time for my 8 am class, stayed awake through the various material that was presented to us, did not puke or pass out on initial examination of our cadavers, and proceeded directly to the library to study after lecture. i remained studying until 4, when i headed up to the lab to review the first dissection which involved the superficial and deep muscles of the back. i came home and had dinner with a friend, enjoying a break of a couple hours, then reviewed the day's material for an hour and pre-read for the next day for an hour.
the reason i go through the first day in such detail is that if you know anything about me you will recognize that every single step of that day stands in direct contradiction to what you might consider my "normal style". the hour total between lecture and study? 12. and yet i found that having totalled that time at the end of the day, i was neither sick of it nor pissed off about the volume of study a single day required. on the contrary, i rather enjoyed the material. i took this as a good sign, that perhaps i had made the right choice and something will come of all of this.
in the first couple of weeks i more or less followed this pattern of rigorous study, and a few things marked the beginning of this period. at some point each day i would stumble onto the realization that i am actually in medical school, and it would blow my mind. it's a rare feeling, realizing that you are actually participating in the culmination of pretty much everything you've chosen for yourself up to that point. you're out of all of the grind that builds up to it, the junk you put up with to get there. you are actually there.
now, there's still plenty of nonsense, but at least there are times when you are actively working at the goal. you are really a medical student. this is serious. up until this point they actively weed you out. they try to shake you off and get you to quit. they tell you it's not for you and try to rock your boat. but once you're in, they try their best to keep you in. and i'm in. i'm learning how the body works from the inside. i put my hands in it, cut it up, explore it. i learn levels of detail that i might have once thought impossible at a speed that can leave you breathless. and i discover my inner nerd as i make jokes no one thinks funny: the function of the serratus posterior superior and inferior muscles is participation in inspiration. "not feeling too creative today, alex?" "i'm afraid my serratus posteriors are a bit weak this morning." RIMSHOT.
the thing about this focus, this singular effort is that it teaches you how to budget your time, especially if you're like me and you never learned that before. and if you can learn that, you find that your life starts forming itself into fast-moving partitions where you are spending most of your time working very hard, and trying your damndest to suck the sweetness out of every minute you allot for yourself, whether that be roaming the internet, cooking dinner, or spending time with friends. the intensity takes the highs pretty high when you stop and notice it. when you are breaking from studying you are doing something you really want to do, not just because it's there and you're bored as in the past. and when you are working, you are learning things you are fascinated with, being exposed to information that you have a deep hunger for.
but the road is not totally even. it is not perfect and you are not always pleased. they throw an embryology along with the anatomy, lectures falling at seemingly random intervals. and unlike the anatomy, which shows its purpose often and is taught with at least some thought to utility, embryology comes at you in a gattling-gun approach to education; information riddles you like bullets, each sentence of your syllabus peppered with new terms that make no sense because you aren't taught the background behind the processes. instead, you get the basics required to perform on the major tests that will come "sooner than you think". indeed, you are still not free of the thing you have always hated most: learning for the sake of testing.
and then there is your first bite of the series of classes designed to develop more of your skills than simply your gross knowledge base. the first is a course in human development, basically a psych across the lifespan, and every moment you spend in this class is agony. at the beginning of the first class, when it is opened with a silly song with larry the cucumber, you laugh at the absurdity. when the break in that first class is resumed with yet another silly song, you laugh a little less forcefully and become a bit worried at the pattern developing. by the fourth class you are infuriated that you are made to watch children's videos twice a class period, and it doesn't help that the "material" that is sandwiched between these pleasant little songs is peppered with condescension and nonsense. when someone innocently asks why we are watching these videos, they are verbally stoned in front of the class. you hate it you hate it you hate it why are they doing this to you how is this helping make it stop. you take the one test for the class, having studied for approximately one hour in total, the night before. you do fine, but it doesn't matter, it's time to move on to the first test for anatomy.
that test is five hours long.
the next week you have the first embryology test. you overstudy for that one, and it puts you behind in anatomy.
the one piece of advice you received from anyone you asked advice of during orientation? whatever you do, don't fall behind in anatomy.
now things get interesting.
somewhere in there you manage to make some good friends who are reliable, smart, and hardworking. somewhere in there you fine-tune the way you learn. you lose your weekends and take time where you can get it. you become more and more effective with your limited time, but battle yourself going back and forth between new good habits and old bad ones. you learn to listen to your mind and rest when you need to rest. you find great happiness in simple diversion. you get a little better at recognizing what's going on inside of you and being responsive. somewhere in there you learn to accept where you are and recognize where you have to go. somewhere in there you still manage to be a good friend.
and somewhere in there you make time to manage the house you bought, even as the rain comes in the roof, the fleas that appeared out of thin air chew you in your sleep, the refridgerator dies and the furnace leaks.
and somewhere in there you realize that you are working harder than you ever have before, and you realize that you really love it, even if some days it feels like you're going to break.
i guess that's it for now. i'm sorry it took me so long to put this out, i hope it captures honestly the sorts of things i've been up to. (i wrote it late last night, and rereading it today it's not as funny as i would like. i promise the next one will be more entertaining.) i would love to hear from you, even if it's a little note.
i love you very much and i hope you are doing well.
-alex
ps a snippet from Chuang Tzu, which i find time to read in the bathroom.
"The fish trap exists because of the fish; once you've gotten the fish, you can forget the trap. The rabbit snare exists because of the rabbit; once you've gotten the rabbit, you can forget the snare. Words exist because of meaning; once you've gotten the meaning, you can forget the words. Where can I find a man who has forgotten the words so I can have a word with him?"
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an introduction of sorts [Aug. 16th, 2006|12:31 am]
[Current Mood | content]
[Current Music |chris cornell - preaching the end of the world]

taken from a letter written to someone with more experience and greater perspective who has kindly offered me some advice:
all last week i was just in the holding pattern of orientation week, which was what you would expect. a lot of big talk about how great the program is, about how great we are, and a lot of tense-ass kids trying to feel each other out without committing to anything at all. you don't have to be socially proficient to get into medical school. thankfully, someone who plans the after-hours events has heard of the great social lubricant, and people relaxed a little bit. between a pub crawl and a float trip, a few decent comrades appeared ready to join together for the fields of war in gross anatomy. cute, too.
so at this stage i guess i'm where a lot of people have been. i've been answering the "what are you gonna do when you grow up?" question with "doctor" for more years than i care to count, and now i'm on my way. i'm actually in medical school, i've survived two days and it appears manageable. i worked harder and longer yesterday than i have ever worked on school in a single day my whole life, but at the end of it i wasn't burned out or angry. i actually enjoyed it. and so the thought occurred to me that maybe this is a good choice. that maybe all the doubt and cynicism is just a natural part of it and this could be okay.
you go through the stages closest to it, and you finally see underneath to what it really looks like. in high school medicine is an abstract concept. you don't know anything about the actual work, and can only pretend to know about the issues that face practicioners. in college you get some shadowing maybe. you see the tedium, the frustration, the paperwork. you are asked to summarize yourself in a page (this is not the first time, but it's always a reminder of the bullshit grind) you are asked to explain and demonstrate your desire, and God help you if you say some shit like "help people". be a trash collector, boy. people need their garbage taken out. that'd really help them.
but what the fuck are you supposed to say? because i've always dreamed of spending the best days of my youth locked in a library reading about sickness or in a hospital room with no windows and sick people so that maybe, just maybe, i will someday be qualified to do paperwork all day as dictated by a greedy fucking company and spend 5 minutes with actual patients because i've somehow grown accustomed to a life i can't afford?
so you tell them what you want to hear, because you don't know but you think this is what you want to do and there's really only one way to find out if you're going to be any good at it. if you like it. if it's what you need to be doing.
buy the ticket, take the ride.
and there is the persistent cynicism. the resident who sees your volunteer shirt and asks derisively "you think you want to do this?" and follows up with "get out while you still can" before you can respond.
but there are others, the ones who seem like they are taking part in that thing you have heard about, who seem to be doing what you think that just maybe you should be doing. maybe you'd even be good at it. they are practicing medicine. they are making an effort, stretching their abilities, entering into uncertainty, visiting the suffering and fear of other people and making it their own, at least enough to make an effort and do something. you can't really put your finger on it, because you haven't had a chance to do it. you can't articulate it perfectly, but you've seen a little bit, and you've heard a little bit, and it got you excited.
your email was another such instance of this whiff of hope. that yes, you are slogging through shit, but yes, there is still something good in there. there is something challenging and meaningful in all of it. and maybe i'm not waving a ticket for the titanic.
i'm trying to take your advice to heart. the third point you mentioned helped me realize that i was actually in a pretty good place. every time i've had to start over from scratch i have had the same fear and turned to questions and searched like this. and it helped me keep perspective, helped me to realize that i'm starting on something that will shape me slowly and to participate in that shaping by my awareness, rather than go with it passively and wake up one day trying to realize how the fuck i became a heartless asshole.
i wanted to ask you more directly what you meant by your second point, though. i have decided on working hard (everything to this point admitting of heavy procrastination) and taking this seriously, but the studying can still be balanced with personal time and grounding experiences, friends, hobbies, etc. what parts of your experience are you thinking of when you say it is dehumanizing?
i am at St. Louis University SoM, which in principle is a Jesuit institution and so is shaped by this affiliation. this is the beginning of my 9th year in Jesuit education, so i am familiar both with these ideals and the way they actually play out in academic institutions. and while i have found that they are just as susceptible to all the horrible bullshit that goes on everywhere else, i find that they still attract people with the mission statements that go largely ignored, people who are drawn to the professed ideals and still seek to live with optimism and compassion to build good in their communities and societies. i hope i keep finding that here, but we'll see.
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