Day In the Life: Terminal and Ultimate
A few days into med school. Geeky medical details are found in footnotes so as not to detract from the story.
The morning is uneventful - lectures on basic pathology(1) and on the role of genetics in medicine(2). I could tell you about the cool things I've learned from those, but there are many better resources out there for that sort of thing - those portions of my audience that really want to know will probably go look them up, and those that don't wouldn't enjoy being spoonfed medgeekpap anyway.
Suffice it to say that diseases aren't just caused by external or internal factors, they're caused by the interaction of the two. Also, epigenetics is damn cool and we have very little idea how it works. With the possible exception of Barr Bodies. And I'm not talking Roseanne here.
After lunch we had a patient presentation, our first chance to meet a real, live sick person... Well, meet might be an overstatement - we're a well-dressed, white-coated, overeager mob of nearly 200 people.
A hale and hearty man in early middle age comes to the stage, along with his doctor. He proceeds to tell us all about how he came to the hospital with a minor complaint, and about his wife and his three children, and about his fun job in intellectual pursuits. Then he proceeds on through the diagnostic process, talking about which doctors saw him and the tests they did... and then he tells us he was diagnosed with cancer. Did I say his doctor? I should have been more specific. He's on stage with his oncologist.
Ok, I think, I knew that was coming since Dr. X the oncologist is on stage with him. Now he'll tell us about how wonderful his treatment was, how hard it was but how great it was that his family stood by him, and how good he feels now that it's over and the tumor has been removed and he's recovered.
No such luck. It's esophageal cancer, which I was surprised to learn is nearly always fatal. He looks so good because he underwent experimental treatment in a research trial, which halted the cancer's progress long enough for him to take an extended break from chemotherapy. He's still got a death sentence hanging over his head... and the tumors have started to grow again. This is a gut punch for those of us in the audience - he looks fine, he should BE fine, right? Not with cancer growing in his liver, his lungs, his lymph nodes.
He's a dead man walking.
We all are, of course. It's just that his time left is so much less than anyone expected. Even so, he's chosen to spend a precious day telling us about his experience. Having never seen him before today, I'm wiping away tears along with his wife when they talk about how they shared the news of the cancer with their children.
And then, after we listen to him and he answers our questions, life goes on. For us.
In the afternoon, I am reminded forcibly about my own mortality in a much more enjoyable way - I re-encounter the limiting natures of asthma and chronic knee pain when I join a pick-up game of Ultimate Frisbee. I can still forearm huck a disc, but there's no way I can keep up with someone a decade my junior(5) and make sure he doesn't score multiple times upon our team. I feel a bit like I've let down my vibrant young teammates. I leave the game early due to the combined pressures of lack of oxygen and lack of time before running to pick up the boy from day care.
In the evening, I spend time with my wife and our son, and I'm reminded that there are rewards to no longer being 21.
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1 - When injured, cells lose potassium, influx calcium and sodium, swell, get fatty, lose energy (ATP), undergo nuclear condensation and enucleation, lose membrane integrity, and lose cytoskeletal-membrane connectivity. If your cell is lucky, the process can be reversed if it's only a matter of swelling, fattiness, and ion concentration/ATP issues. Once you get to the nuclear changes and membrane integrity levels, well, you're lucky if you can apoptose rather than simply necrosing and digesting your neighbors.
2 - Personalized medicine is a shibboleth(3) euphemism for genetics-based medicine.
3 - Cool word from ancient Hebrew. Look it up. It involves genocide and grains(4).
4 - Yes, I'm so geeky my footnotes have footnotes. See also footnote(4) for recursion.
5 - Pending current changes. I'm biking to school and exercising a lot with classmates. Perhaps I'll regain fighting trim. Also, I need to do more fighting to stay trim.
The morning is uneventful - lectures on basic pathology(1) and on the role of genetics in medicine(2). I could tell you about the cool things I've learned from those, but there are many better resources out there for that sort of thing - those portions of my audience that really want to know will probably go look them up, and those that don't wouldn't enjoy being spoonfed medgeekpap anyway.
Suffice it to say that diseases aren't just caused by external or internal factors, they're caused by the interaction of the two. Also, epigenetics is damn cool and we have very little idea how it works. With the possible exception of Barr Bodies. And I'm not talking Roseanne here.
After lunch we had a patient presentation, our first chance to meet a real, live sick person... Well, meet might be an overstatement - we're a well-dressed, white-coated, overeager mob of nearly 200 people.
A hale and hearty man in early middle age comes to the stage, along with his doctor. He proceeds to tell us all about how he came to the hospital with a minor complaint, and about his wife and his three children, and about his fun job in intellectual pursuits. Then he proceeds on through the diagnostic process, talking about which doctors saw him and the tests they did... and then he tells us he was diagnosed with cancer. Did I say his doctor? I should have been more specific. He's on stage with his oncologist.
Ok, I think, I knew that was coming since Dr. X the oncologist is on stage with him. Now he'll tell us about how wonderful his treatment was, how hard it was but how great it was that his family stood by him, and how good he feels now that it's over and the tumor has been removed and he's recovered.
No such luck. It's esophageal cancer, which I was surprised to learn is nearly always fatal. He looks so good because he underwent experimental treatment in a research trial, which halted the cancer's progress long enough for him to take an extended break from chemotherapy. He's still got a death sentence hanging over his head... and the tumors have started to grow again. This is a gut punch for those of us in the audience - he looks fine, he should BE fine, right? Not with cancer growing in his liver, his lungs, his lymph nodes.
He's a dead man walking.
We all are, of course. It's just that his time left is so much less than anyone expected. Even so, he's chosen to spend a precious day telling us about his experience. Having never seen him before today, I'm wiping away tears along with his wife when they talk about how they shared the news of the cancer with their children.
And then, after we listen to him and he answers our questions, life goes on. For us.
In the afternoon, I am reminded forcibly about my own mortality in a much more enjoyable way - I re-encounter the limiting natures of asthma and chronic knee pain when I join a pick-up game of Ultimate Frisbee. I can still forearm huck a disc, but there's no way I can keep up with someone a decade my junior(5) and make sure he doesn't score multiple times upon our team. I feel a bit like I've let down my vibrant young teammates. I leave the game early due to the combined pressures of lack of oxygen and lack of time before running to pick up the boy from day care.
In the evening, I spend time with my wife and our son, and I'm reminded that there are rewards to no longer being 21.
--------------------
1 - When injured, cells lose potassium, influx calcium and sodium, swell, get fatty, lose energy (ATP), undergo nuclear condensation and enucleation, lose membrane integrity, and lose cytoskeletal-membrane connectivity. If your cell is lucky, the process can be reversed if it's only a matter of swelling, fattiness, and ion concentration/ATP issues. Once you get to the nuclear changes and membrane integrity levels, well, you're lucky if you can apoptose rather than simply necrosing and digesting your neighbors.
2 - Personalized medicine is a shibboleth(3) euphemism for genetics-based medicine.
3 - Cool word from ancient Hebrew. Look it up. It involves genocide and grains(4).
4 - Yes, I'm so geeky my footnotes have footnotes. See also footnote(4) for recursion.
5 - Pending current changes. I'm biking to school and exercising a lot with classmates. Perhaps I'll regain fighting trim. Also, I need to do more fighting to stay trim.