anger

I push the "Up" button on the speed control of the treadmill.  My breathing becomes more rapid but it's not enough.  I now increase the incline.  My legs start to feel like lead weights but it's still not enough.  I increase both the speed and the incline.  My chest heaves up and down with each breath burning inside.  Sweat now begins to stream down my body.  But it's still not enough.  I get off the treadmill and begin to punish my body hoping to trade emotional pain for physical pain.  Pull ups then squat jumps and then I drop to the ground for push ups.  I continue to push msyelf harder and harder, hoping to trade the saltiness of sweat for the saltiness of tears.  I now have a better understanding of people who cut themselves.  It's somehow easier to feel the physical pain than it is the emotional soul wrenching angst.  I strip from my phenol imbued shirt and stare into the mirror.  Sweat is now streaming down in rivulets from my body.  Hoping to get a glimpse into the window of my soul, I stare into my own eyes .  All that I see is a fire burning with anger.

Anger at having to see my brother white as the blanket covering him while he recovered from his biopsy.  Anger at the injustice of it all.  Anger at everything.  He just finished six rounds of chemo.  The tumors actually responded.  Doesn't he deserve some reprieve?  No.  He's getting a biopsy of his tonsils and now the pain in his joints have returned.  What did he do to deserve this?  He did not smoke.  He was active and in shape.  He was healthy.  He was so young.  But then fairness is immaterial in this battle.  I limp out to my car now exhausted physically as much as emotionally.  There is no purgative effect.  There is no feeling better afterwards.  There is only anger, anger as impotent as screaming into a hurricane.

brachial plexus

Brachial plexus?  Never heard of it you say?  Well, pull up a chair and a beer and let me tell ya about that evil monster.  Let me first give you just a clue about my thoughts on the hideous beast.  The next time someone says how wonderfully designed our bodies are, I'm going to tilt my head back and let out a deep belly laugh because I have seen the brachial plexus with my own two eyes.  I have held its chords with mine own fingers.  It is a labyrinth where upon if one stares upon it too long, one goes in mad with confusion and frustration.  An endless knot, it is.  Still want to see it?  Ye be warned.

I spent nearly four and half hours dissecting this monstrosity of nerves on our cadaver.  That's what it is.  It's a collection of nerve fibers that go through your armpit and at that spot they for some reason decided to have an orgy of confusion to wreak havoc on future med students.  They cross and criss-cross and then merge back again just to piss you off.  You couldn't come up with a more confusing bundle of pathways if you wanted to.  It's worse than the drunken Aggie designed Houston freeway system.  But I can proudly say that out of all these bundles going off in inumerable directions, I only cut one single nerve in the wrong place.  Now I just have to figure out a way to remember these buggers long enough for the exam, never mind what they actually do.... 

lessons I've learned from gross anatomy

I was quite proud of myself.  I had successfully finished my dissection and felt like I had a decent grasp of the material.  The warm water ran over my body rinsing away that horrible phenol smell.  I thought to myself how glad I was to bring a change of clothes.  The last thing I wanted to do was sit in rush hour traffic for an hour or more smelling like phenol.  If you've ever smelled phenol, you know what I'm talking about.  It's not an overly horrible smell like week old rotting garbage or anything (not that it smells pleasant either).  But it's an exceptionally powerful smell that permeates EVERYTHING - your clothes, your hair, your pores - everything.  So I was glad to be ridding myself of it.

Then it hit me as I stood smugly washing myself.  I brought clothes.  I brought soap.  I did NOT bring a towel.  Standing there in the shower with the water running off me, I have no intention of drip drying or riding home soaking wet.  So I gingerly walk over to the blow dryer trying not to slip and bust my butt.  It's right next to the door of the bathroom, too, so I'm crossing my fingers that no one walks in while I'm standing buck naked air drying myself.  There is simply no way to do that without looking like a complete freak or pervert.  Med students is ssooo smart.

Lesson #1 - always remember to bring a towel when showering.

chisel & hammer

Our turn finally came to start cutting into the cadaver today.  There were two main tasks.  One was to isolate a small area below one's skull dubbed the "suboccipital triangle" which you can see in the photo below on the right. 

The second requirement was to pound through the vertebrae and isolate the base of the spine.  I am paired with two very nice but very diminutive in frame girls.  So when the option was between delicate cutting or cracking bone, guess which job I got? 

You guessed it.  My first experience with the cadaver was putting a chisel up against the bone, grabbing a rubber hammer, and whacking away relentlessly.  And strike away I did.  I really didn't know what I was doing.  Instead of preparing for the dissection yesterday, I spent a good 10 hours down at mdacc instead.  After a clusterf*#@ of a visit that I'm not going to get into right now because my blood pressure will hit around 200 mmHg, let's just say studying was the last thing on my mind.  But I figured I've cut into an animal or a thousand in my time so I'd just sort of wing it.  How different can human be from rodents really (sarcasm alert)?  Well, I screwed it up at first.  Being used to rodents, I went far too shallow.  Apparently, though, it looked like my winging meant I knew what I was doing.  One of the proffs said that he didn't offer me any advice since it looked like I knew what I was doing.  Sweat dripping down my brow, I was NOT about to let my first dissection end badly.  Pride wasn't going to let me go with my tail tucked between my legs on the first day of cuttin'.  So I hammered until my hand began to tingle and even my scrubs were starting to darken with sweat.  Finally with a crack that was both palpable as well as audible, I knew I had it.  I stuck my finger down into the depths of the back and felt what I just knew had to be the spinal cord below.  Jackpot. 

I removed about 6 more vertebrae, cleaned everything up and brought the pedagogue over to confirm my dissection.  All the necessary structures were there clear as a bright sunny day.  It was beautiful.  That may sound twisted to the average person but I truly do mean beauty in every sense of the term.  Seeing the beauty of the nerves branching off in hundreds of directions to bring pleasure and pain into our lives...how can that not translate into beauty for me?  And yet that means employing barbaric methods that would land me in jail if done outside of this place of learning.  After all, this once was a living and breathing human being replete with hopes, fears, dreams and disappointments.  Doctors, at least the good ones it would seem to me, would almost require a curiosity and fascination about life and death.  I wouldn't be able to do what I did without that appreciation and morbid curiosity. 

And yet life has a way of encouraging your demons and your fears to meet you half way.  Our cadaver?  He died of cancer, colon cancer to be exact.  And one of the key landmark vertebrae that I chiseled through?  Lumbar #5 which is the exact same vertebra that first revealed to us that my brother had cancer.

review - siddhartha

Synopsis - a classic by Herman Hesse, it tells the story of a young Brahmin's journey towards finding nirvana.  He starts off as a young precocious and gifted youth who figures out that none of his elders have reached enlightenment.  So he strikes his own path.  An ascetic beggar who forgoes all pleasure, a rich businessman who enjoys all pleasures, Siddhartha tries it all until he finally finds enlightenment near the end of his life.  While ostensibly a fictional novel, it's really more of a philosophical treatise in story form.

Medical relation - my wife and I (re)read this for a book club.  While discussing the book, many of the participants felt that the character was arrogant, especially when he disobeys his elders and challenges them directly.  I leaned over to my wife and whispered, "but he was right."  And I've seen that with doctors many times from both sides of the coin.  There are simply times when facts need to superscede emotion.  And the ego of both the patient and the doctor need to play second fiddle to getting the correct diagnosis.  The trick is knowing when you're right and when you're not, hence the appearance of arrogance.

Conclusion - I love this book.  I've read it multiple times at different stages of my life and it's never disappointed me.  There are so many life lessons to learn from it that I won't bother to go into them all.  There is one worth mentioning, though.  There's an old chinese saying that goes something like, "if you meet the Buddha along the road, kill him."  A bit harsh to western sensibilities as not many would advocate that about religious figures of the west, but in a nutshell it means that everyone must find their own path, even if at the expense of societal guidelines about what should or should not be done.  What's good for the goose, is NOT necessarily good for the gander, so to speak.  As someone who's never gotten along with convention too well, I relate wholeheartedly to it.  I'm glad, too, my wife finally read it because once she did, she realized that to understand this book was to understand me.  At only 120ish pages, it's a short read but it induces a lot of rumination about life which makes it all the better to discuss with someone else.  I can't recommend this book enough.

weird

We're down in the basement which seems appropriate.  The floor and walls are concrete while the fluorescent lights cast a harsh glow.  Again, apropo.  We raise the body up out of the tank and peel back the towel as the fluid drips back down into the pool of fluid.  A nameless body stares empty up at the ceiling with one eye open and the mouth slightly agape.  The six of us stand there for a minute taking it all in.

"This is weird," one student states.

Seeing the hand saws residing on a cart behind us, the type one can buy at Home Depot, I reply, "it's about to get a whole lot weirder," knowing full well what those saws are for.

1st day

Ever see the movie Groundhog Day?  It's kinda stupid but the main character is forced to live the same day over and over again.  I feel a bit like that today.  See, I've already gone through this first day of medical school.  I've heard these first day lectures, I've felt that 'oh shit' nervousness, been there, done that.  It's a big case of deja vu.  Last year, after that first day I then had a existential crisis of sorts, nearly dropped out, and decided to break the first year up into two years.  It adds a year to my training and more debt but I don't regret it for a second.  As I look back, I become more and more grateful for that option.  It allowed me to work some stuff out, it gave me the luxury of experimenting with different learning methods (a LOT of med school is almost self taught), and it gave me the freedom to spend a lot of time with my family, especially my brother during his diagnosis. 

     I look back at the blog posts during that time and all that I can say is that I'm in a very, very different place.  In short, I was a basket case last year.  I could hardly eat for a week.  Now?  I'm hardly nervous at all and to be honest, I'm almost, just barely, kinda sorta in a strange way starting to look forward to it all.  That's a big change from this time last year when I was ready to chuck it all and run.  While supposedly, the first year was divided in half, it seems like this semester will be a bit fuller.  I have Developmental Anatomy (boring but I've come to terms with having to plug and chug information), Gross Anatomy (the bulk of the semester's work from everyone I've talked to), Intro to Clinical Medicine (this one sounds cool as we begin to learn how to give a physical on paid actors) and Clinical Applications (integrates all the information in the classes in a sort of case study approach so I'll be forced to relearn the stuff from biochem and histology last year).  With the exception of developmental, I'm looking forward to everything else.  In honor of last year's experience, I'm fasting until this evening (a bit like Ramadan type of fasts) so as to give my body a gentle reminder of where I was, where I've gone, and where I'm at now.  It feels good.

an open letter to my canadian relations

My parents and my son are up in Canada celebrating the 60th anniversary of when my dad's family immigrated from the Netherlands to Canada after WWII.  My school starts up on Monday so I wasn't able to go.  As such, I was left in charge of my dad's lawn care business while he was gone.  Translation?  I had the pleasure of mowing 57 yards in 4 days in heat indices hovering around 110 degrees.  Sounds fun, right?  Maybe it was heat induced dementia brought on by severe dehydration, but I had a bit of a vision of what it means to be my father.  So I'm writing an open letter to those participants in the Great White North entitled:

"Papa: The Man, The Myth, The Legend"

To the Canadian Clan,

     Greetings from down yonder in Texas.  There walks among you one who is a bit of a traitor.  He's renounced his Canadian ways and become an American.  Worse, he's a Texan much like that former president who so endeared himself to the rest of the world.  I could say a lot of wonderful platitudes about his Texan ways like how he loves brisket, how he built his house with his own two hands, how he's beyond a devoted husband/father/grandfather, how he chokes up at the song "I'm proud to be an American".  But that wouldn't mean anything to y'all.  You see, I'm down here substituting as El Patron (that's Spanish for 'the boss') keeping his lawn care business running in his absence.  And I am both dumbfounded and humbled by his customers.  Why, you may ask?  Well, let's be honest.  His job is essentially that of a glorified janitor for people's lawns.  I'm not trying to be demeaning but my point is this.  How many in society know the janitor?  How many of you know, I mean really know the janitor at your place of employment?  I'll go one step further.  How many of you know about the janitor's family? 

      Perhaps his customers can say it better than I can.  The 72-year old Hindu who in his soft British accent stated, "Your father is sooooo nice" and then went on to enquire about how my brother's battle with cancer is going.  The 40-something Hispanic woman with whom I traded stories about watching a loved one go through chemotherapy.  The 80-something little old lady who remarked, "I can't tell you how nice it is to have a good honest Christian man."  Or, the retired Aggie (don't ask, you wouldn't understand what an Aggie is) who said "How's your dad doing?  We've talked a lot about your brother and he's on our prayer list when I go to bible study every Saturday."  Or, the bank teller who responded when I cracked a small joke at my father's expense, "I'm not going to let you get away with that.  Ain't right since he's not here to defend himself.  I'm going to defend him.  He's a good guy."

      After walking many miles in my father's shoes, both figuratively and literally, I had an epiphany.  Here is a man that touches and deeply impacts every single person with which he comes into contact.  Despite retiring from the ministry, he's still inspiring compassion in the random people he meets.  How many of us can say that?  So I encourage y'all to get to know that strange American in your midst.  Don't be shy.  As he's both a redneck as well as an educated man, he can converse on nearly any level from mechanics to philosophy.  Ask him a question about air conditioners, or what's Texas like, or plants, or Calvin's theory of double predestination.  Based on the numerous customers of his that I just dealt with, I guarantee you won't be disappointed at getting to know him.

Sincerely,

Isaac

thoughts from behind the mower

My shoes began to break down while mowing yards.  On one, I even attempted to use that magical glue of the universe - duct tape.  But even that eventually gave way and the entire bottom of my right shoe fell off.

"You lost your sole (soul)," my dad quipped, quite amused with his pun.  So the rest of the day I walked uneven.  Every step was off center as I went up, down, up, down, up down.  And what surprised me most was my reaction.  I didn't get angry or frustrated.  First, I laughed.  Then it prompted me to begin to think about the mechanics of walking and why do we even wear shoes in the first place.  A year or two ago, I probably would not have reacted in such an even keeled manner.  It makes me wonder where I'm at in life.  The concept of "being happy" is not one in which I put much stock.  Happy is too fleeting; just one emotion among a broad spectrum of all that is life and nowhere near enough to encompass all that we experience as human beings.  Besides, enough has happened in my life the past year that would induce anything but happiness.  And at the end of the day, I'm just not a happy person.  But I do not necessarily feel the opposite of happy either.  No sense of despair (except before exams).  So how do I describe it?  It's clearly there.  I could see it in the way I reacted to losing my sole.  It's not merely a desire to make the best out of a bad situation.  Again, I'm anything but an optimist.  It's a deepness, a depth, an anchoring of emotions with the Self.  A discovery of soul, to pardon the pun.  For better or worse, that sense of center seems also to be just as fleeting sometimes as happiness.  And I guess that's the trick of life, to figure out how to deepen that sense of center and let go of the rest.  Happiness and sadness, joy and pain, they all come and go.  Holding to that depth, to that Self, to that soul.  Aye, there's the rub.

a break?

"How do you feel about it being the last time at MD Anderson for awhile?  Getting a break?" I enquired of my brother.

"Ask me again in three days when it's done," his reply short and yet loaded with emotion.

Three days of scans, needle sticks, and endless waiting for the doctor passes.

"So how do you feel now?"

"Conflicted."

"How so?"

"I was hoping for more than just modest responses to the tumor.  And the other nodule....."
"You said 'conflicted'.  What would be the flip side of the coin?  The good news."

His pause, pregnant with expectation, was long, "I guess I didn't hear any good news from the doctor."

My mom concurred.  Irony seems to reign supreme as I'm the eternal pessimist and of the three at the table, I'm the only one who felt any measure of good news.

"You realize that only 15 to 20% of people with your disease respond to frontline therapy.  And of those 15-20% a certain amount just have their tumors stay the same size.  EIGHTY-some percent have their tumors continue to grow in the face of the chemotherapy."

"And what happens when I stop the chemotherapy?"

My heart broke at that moment.  I confessed we didn't know.  The concept of a 'break' is illusory at best.  Yes, there is a break from chemotherapy.  But the disease is still there.