Thursday, August 20, 2009

Trilogy: On being a Physician. Part II Resident.

 Sometimes those nights where monsters leap out from nowhere and fill in the screen of imagination make for a restless sleep. The waking moments are spent resolving the subconscious errors of the mind and its firing neurons. What does that dream mean? What bearing will it have on life? Is it a future told in a dreamscape? Is it a harbinger of things to come? Or is it just the manifestations of fears and desires coming together in an idle mind at rest trying to create a reality? No one knows except may be the dream readers or merchants of psychic persuasion.

Yet there are those who have this blend of fancy occurring during the day. It manifests itself as reality. It is termed a hallucination. Rightfully or not it is that same desire of the brain to fill in extraneous, out-of-left-field experiences with some modicum of reality. Many drugs illustrate that power. These compounds or hallucinogens hold the power to disassemble the framework of normalcy, distort, bend and violate the fabric of reality into phantasmagorical images of the bizarre.

When this occurs suddenly and without known reason, the puzzle assemblage begins. Piece by piece the detective work of the physician is categorized in his mind as tests are made and deciphered. Somewhere in the deep recesses a thought emerges and manifests itself as a possibility. A spent afternoon in the library or “something from the blue,” lays the seed of what it could be – a diagnosis.

On a bright afternoon in the middle of summer while tanning at the beach this young woman was brought in to the Emergency Room after she started scratching herself bloody. Her eyes crazed to the world, wide with terror and her head bent sideways looking over her shoulder as if trying to stave off an attack from a predator. Her husband recalled no such previous occurrences. “No,” he said categorically, “that drugs were not an issue and she had not taken any medications either.” Her core temperature was slightly high but signs of fear and flight manifested in her being. Her husband was holding a fictional novel about Vampires; he claimed that she had been reading.

Minutes later when she had been sedated and all the tests were run, the answer remained elusive. Puzzling over this set of disparate facts Joe called his friend Jack a continent away on the West Coast.

“So what’s going on?”

“I’ve got an interesting one.” Joe said.

“Yeah well I have my handful of them.”

“No seriously.” And before Jack could answer, Joe started his monologue of the recent events.

“ What does the MRI show?” Jack asked.


“Get a T2 weighted TSE MRI.”


“Stands for T2 weighted Turbo-spine echo MRI which is computer algorithm generated view and picks up extremely small lesions. In a denovo occurrence like this without previous history in a youngish person suspect a brain pathology.”

“Thanks. But where did you get that?”

“Wasting my time in the library since no girl wants to go out with me.”

“Fly down here and I can fix that.”

“Oh yeah, like Shirley. My supposed date that became magnetized by you.”


Three months later a knock on the open door and in walks Jack.

“Hey, man good to see you?” Joe looks up from his sofa where he is sprawled.

“You look like hell!” Jack surveys the room. “I was in the neighborhood. Thought I’d drop in. Not getting any sleep?”

“Questions! Questions! The simple answer is that those advertised eight-hour shifts end up as 12-14 hours by the time the paperwork and handover of cases and all that. You know? This residency thing isn’t as glamorous as television makes it.”

"You certainly don't look like Dr. McDreamy." Jack turns towards the desk strewn with piles of journals.

“Hey, Joe I have been meaning to call you about that case you called a few weeks ago?”

“Huh!” Sudden change in thought and question is Jack’s forte; always inquiring.

“Oh yeah, that one, she had an Astro grade III. This brilliant neuro-surgical fellow figured it out. He enhanced the MRI imaged films and found the tiny little sucker was perched in the temporal lobe. Just like you said. It took them three hours to remove it and voila she is fine. No residuals. No more hallucinations.” With those few words and hand-arm gestures the ordeal of one life has been catalogued. A hidden scar beneath the hair serve as the remains of a troubled, deranged moments in that patient's life.

“Good to hear.” Jack says opening up the refrigerator. “What no beer?”

“Fresh out. You still haven’t told me what are you doing here?”

“Interview.” Jack looks back with his muted smirk.

“Any place I know?”

“Yeah the place next to your hospital.”

“Serious! That is great! Man that is a world-renowned institution. You’ll make a good professor”

“We’ll see I haven’t made up my mind yet.”

“Lets go out and celebrate anyway.”

Medicine is a lived life. Never separate from one’s being. It conquers the mind and becomes one with your being. You live it. You walk down the street and your mind floats in a sea of diagnoses as you pass by people. You stop and help those in need and feel the joy in little victories and when you are unable to help, suffer through the defeats against nature only to emerge stronger for battles that lie ahead. Like jabs in the sides, these pricks of conscience deflate while the puffs of small miracles inflate the soul. Medicine is like a friendship; both thrive in the giving.  

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