The Culprit Life

I am definitely not ready for this test.

I went into the anatomy lab for the third day in a row to study for the practical. I did the practice practical and feel pretty confident in my ability to do well on that part of the exam. Now if only I felt confident about the rest of the exam. I studied the rest of the day in the library and lounge.
Not nearly as exciting as day 100 but still a milestone I suppose.

Fireflies

The extended cut of Fireflies was released online today and luckily, it is the only version which CMF put up! We had to turn in a shorter, not nearly as good version, for the festival because of their time constraints. That means that this is the definitive version of the film, the version that will be remembered. For that, I am extremely grateful.

In med school, we learned how to give cardiac exams today. It was pretty cool because I feel like I actually learned something from the 4th year preceptor who was teaching me. Unfortunately, that isn’t always the case. It is quite difficult to differentiate the different sounds and possible murmurs of the heart with the stethoscope. It’s definitely gonna take a lot of practice but I think it’s awesome that we’re finally getting a chance to master the use of this legendary tool.

Tonight was the Campus Movie Fest USF Finale, the contest in which we entered our newest movie, Fireflies. My group of friends won quite a few things, almost everything actually, except Best Picture for a variety of reasons I wont go into here. There is a lot of controversy over it behind the scenes of the festival. I will say one thing though: my friends and I make films and art in general with two things at the forefront always, integrity and creativity. There are no substitutes for those two things. In fact, if someone was not in possession of them, I would not dare to call them an artist at all. A business man maybe, a manager perhaps, but not an artist.

At the end of the day, it is comes down to this: my friends and I make art, not for the sake of awards, not for the sake of competition, but simply to create something beautiful. That is our primary objective. And with that statement in mind, I believe we have succeeded in what we set out to do.

Here’s the list of awards we racked up:

Fireflies: Best Drama, Best Actress (Emily Wilson), Best Special Effects

Dennis: Best Comedy, Best Actor (Dan Bakst) [I am credited as Executive Producer of Fireflies and humorously, On Set Doctor in Dennis which was filmed in my house as I was studying.]

After LCE, I had a physiology small group and then an LCE small group that I thought would be terrible because of the preceptors for each but it turns out they weren’t bad at all. It was a pleasant surprise because they are the two faculty members that I clash with the most (probably the only two I clash with at all come to think of it). My only guess is they must have taken their medication this morning.

Library

I’m sick of seeing all text on this blog. So I brought my camera to the library with me. I finished 5 lectures and took/edited the following in record time. I love the library. It is making me much more productive. In other news, I was tricked into actually attending a lecture today because it was labeled as “mandatory”. They didn’t take attendance though so I relabeled it “waste of time”.

I studied the development of the circulatory system (including the heart) today. They were old lectures that I needed to brush up on and I actually found them to be pretty interesting. The human fetus is amazing. We have a hearbeat before 4 weeks. Crazy.

I met with Joyce and Sarah today to discuss some changes to implement in the long cut of our new film. While driving, I came up with an idea for a new screenplay. It’s exciting because I have most of the plot points set already and I think it’s kind of a unique blend of a few concepts. Plus, it has to do with someone who has a medical condition which means I can probably use it as a project for my arts and humanities scholarly concentration. Bonus!

This morning, a trauma surgeon came and gave us a lecture before lab. While I agree with the rest of my class that it was pretty much pointless because it wont help us on the test and so it shouldn’t have been mandatory, I actually found it kind of interesting. Mostly, he was talking about how air and blood find their way into spaces where they shouldn’t be in the thorax/abdomen and how to get them out.

Lab was actually good this morning. Our table got another long winded personal lecture from one of the instructors but by then end of it I felt like I knew 10 times more about arteries and veins than I did going in. It was definitely worth it.

I’ve noticed this weird thing about the test cycle for me. The first 2/3rds of it or so, I feel like studying is a chore and I really don’t like it. Then a funny thing happens, I start to fall in love with the material. Suddenly, while I’d still rather do other things… I don’t really. My interests even out and I would just as eagerly pick up my anatomy atlas as my guitar. Honestly.
For as much complaining as I do, I love studying anatomy. I love studying medicine. I will take a quiet night at home learning the intricacies of the human body over a crowded night at some bar almost any day. Does that make me strange? Yes, probably even in comparison to my fellow students. And you would think with that outlook, I would be at the top of my class. But I’m not. I’m at the bottom. What does that mean? I’m not sure, but if there is a choice between being bored with what you are studying but still making great grades, and barely passing but being completely in love with what you are learning, I will choose to barely pass. I will choose to be in love.

There was a semi-interesting class on spirituality in On Doctoring this morning. I say “semi” because I can pretty much sum it up right here: few doctors discuss spiritual things with their patients, most doctors would discuss spiritual things with their patients and pray with them if the patient requested it, the closer to death a patient is the more likely a doctor will bring up spiritual concerns, supposedly about 80% of patients would like their doctors to talk to them about spiritual things.
What a lot of it boils down to is communication issues. The doctor-patient relationship is similar to a romantic relationship in some ways. The patient may want to discuss an issue and the doctor may be willing to speak about it but if neither one of them brings it up, they will never address it. One may leave feeling good about the encounter and the other may be entirely dissatisfied. But again, if no one says anything, how are these things going to come to the surface???
As a doctor, I will most definitely inquire about my patient’s spiritual beliefs in relation to their medical care.
It just makes sense.

The rest of the day was filled with studying and getting the ball rolling on printing posters for the new film series. I did get a chance to hang out with the communications staff some more though.
They are a funny bunch I think. A quirky anomaly that has sprung up in the center of the med school. Their attitudes are unlike anyone else’s I’ve come across here. Maybe because they are generally concerned with things that are completely different than what the people in the offices around them are concerned about. I can’t describe it exactly but there is a pleasant atmosphere about that department. I feel like there should be a fireplace or something in there. It’s almost magical. I wonder if any of them feel out of place like I do. Maybe they have similar thoughts about how the heck they wound up at a medical school in the first place. At any rate, it looks like I’ve made some new friends that I can poke my head in every once in a while to see.

Sometimes I feel like the illegitimate child of the College of Medicine and the College of the Arts. Like some accident they tried to cover up back in 1987. I feel like I don’t belong in either one of them. I don’t fit in.
I don’t think anyone really knows how awkward I feel walking through the corridors here. I am mentally skiddish.
Still, there are some people in our class that are oddly comforting when I talk to them. They don’t even know it, but they make me smile inside. It’s like when you go to a foreign country where you don’t know the language and you find that one person who is bilingual. That is who they are for me.
In lab, we didn’t find any of the veins in the neck. Figures.
For the next few days, you can find me walking around campus with my big headphones on, listening to angsty rock music and seeking sanctuary in the library.

I was in the hospital from 5:50am to 1:30pm today.
Killer.
It was better than going to class though because I actually learned something.
I can’t remember if I’ve mentioned this equation before but here is how I calculate my medical education quantitatively: Anything in the hospital »»»»»»> Anything in the classroom
Here are my reasons: 1. more practical 2. more memorable 3. more interesting
Really now, I don’t think I’ll ever write a six page blog entry on an experience I had in the classroom. Just sayin…

On a sad note, I met this elderly lady today who suddenly became severely depressed for reasons no one can explain. She just sits down, doesn’t keep up her hygiene and will hardly talk to anyone. One of the RNs told me she used to be a spunky patient. Now she doesn’t even smile. She has no other symptoms of disease and is basically still being kept in the hospital because no one can figure out what to do. After meeting her, I wished more than anything that I could be the one to figure it out, to get the reason out of her, but I know that is just the young idealistic first year medical student speaking. If this were a prime-time television drama I would definitely succeed. But it isn’t. This is life and (though I hate generalities) we can’t always figure everything out. Still, I think I’m going to go back and visit her sometime, I don’t know why, it just seems like something I need to do.

Random but, I also felt a really strong pulse today, in someones abdomen! It was the descending aorta and I could only feel it because the lady was so skinny. Crazy.

Last week I had a conversation with my friend Xander, who’s in my class, in which he pretty much said he thinks actually going to class may be a waste of time. I think, for the most part, he is right. Today I stayed home, missing six hours of in class lectures. I watched half of them online and studied some other things while I was waiting for them to be uploaded. Here’s the way Xander put it: you spend all day in lecture from 8 am to 3 or 5pm and then come home only to realize that you have to 8 more hours of work to do because you have to watch all those lectures over again and take good notes this time. This is crazy. And I’m starting to realize that. Instead of sitting through 8 hours of lecture and watch as most of it goes over your head, why not take good notes the first time? This makes sense. It feels weird though because from a young age we are trained to think if you are not present in class, if you skip class, you are a slacker. But with the technology available and the proper time management this may be the most efficient way to learn. I was already doing this for anatomy and it seemed to work (I’m passing it) so maybe I should just take it a step further.

Metropolis

Polley and I went to a performance by the USF Symphony Orchestra today in St. Pete. It was set up in three parts. The first was a series of pieces with a smaller number of musicians that seemed really fragmented to me but showed the skill of each musician in their ability to come in and out at the right time and play their notes correctly amid the audible confusion. The second was a series of Russian pieces with only a cello and a vocalist. It was good but by far the best performance was the third part when the full orchestra came out to play a series of compositions titled “Metropolis Symphony” which was based on the story of Superman. The first composition of the set in particular was a highlight as it featured a female solo violinist who stood in front and used a metallic sounding electric violin through an amp. That’s pretty rock and roll as far as orchestras are concerned. Other compositions in the series were inventive as well with the use of two by fours, athletic whistles and tango rhythms. Very cool. Plus, my friends Emily Lenck and Grace Juliano (who incidentally both played on Outwatch the Bear) were in the orchestra playing violin and cello respectively. They played superbly of course :)

Today, with the blessing of my professor, I took Dan Nguyen into the anatomy lab to help me figure out how to light the new dissection videos I want to make for our class. I don’t think it will be too hard, I just need to use the right lens.

After studying the rest of the day, I picked up my guitar and wrote the little tune you see below. I recorded it in one take on my tiny lo-fi voice recorder just like I did for “Half the Man”. Obviously, it’s not the same song I had been recording with the help of Omar. Hopefully I’ll be able to finish recording that one within the next month or so.

This is actually a love song of sorts. But I will tell you right off the bat, it’s not what you think.
I was reflecting on a paragraph I wrote for Day 184. Is it possible to be inspired by something you wrote yourself? I think so. Is it possible to say that without sounding totally narcissistic? Probably not. Actually, I wouldn’t say I was inspired by myself as much as I just had some lingering feelings on a certain subject that I had already expressed in prose. Sometimes words aren’t enough. I need a melody or a moving image to say what I want to say. What I need to say. I’m sorry.


“The Things I’ll Never Own”

Here’s the part where I tell you that I’m falling for her again.
It’s the heart, it’s the selfless nature I know that you wont understand.
With a knife, there’s a romance on a tightrope between life and death.
It’s a fight, it’s a slow dance and my hands are about to commit.

I’m gonna burn my letters and fold my bridges back down.
I’m gonna make this island my home or watch myself slowly drown.
I’m gonna burn my letters and fold my bridges back down.

Here’s the part where you panic and start stripping off all of your clothes.
Now the floor is a canvas for the things that I never will own.
In the heat of the moment, you whisper inside of my ear.
You’re a whore and I know it but you tell me what I want to hear.

I’m gonna burn my letters and fold my bridges back down.
I’m gonna make this island my home or watch myself slowly drown.
I’m gonna find the one that I love and tell her the truth:
I’ts all my fault and I’m sorry for the hell I’ve put us through.

I’m gonna burn my letters and fold my bridges back down.
I’m gonna make this island my home or watch myself slowly drown.
I’m gonna find the one that I love and tell her the truth:
I’ts all my fault, it’s always been my fault, it’s all my fault and I’m sorry for the hell I’ve put us through.

The arteries were so difficult to find in lab this morning, I pretty much gave up toward the end. Even after the professor came over and dissected about three pages worth of structures for us, we still had three more pages left to finish. Sometimes, it’s just not worth it.

I studied at home the rest of the day. Meanwhile, the rest of the crew from my new short film finished shooting the last scene. I would have given anything to be there to hear our director yell “that’s a wrap!”. Anything except my education. Apparently.

This morning, we had a wonderful On Doctoring capstone course on the heart. In the first two hours, one of our deans delivered a well done presentation/discussion that incorporated a lot of film clips, some paintings and even dance and music. In the last hour he turned it over to another professor who explained the connection between the heart and mind from a behavioral medicine standpoint. She mentioned that a person who is consistently sad has the same risk factors for heart trouble as a person who has hypertension. After this, the dean wrapped things up by showing us a clip of the movie All That Jazz. This was a great day to be the On Doctoring liaison because the class was taught the way it should always be: with the incorporation of many art forms, a chance for us to participate in discussion and our teachers passionately trying to implant empathy within us.

Later, several of my filmmaking friends came over to work on their editing and animation while I studied. I got kind of sad when one of them was talking about how much people were learning on set. I wish I could be on set to refine my cinematography skills too. I feel rusty.

Today, on my drive to school, I realized something that I’ve learned over the past several days: The human heart is only beautiful when it is working. I believe this observation to be more than a physical one. It is perhaps another reason to keep pushing myself. Another reason to proclaim, today is a beautiful day to study medicine.

If you go to a six year olds birthday party, watch as someone transforms a jumbled mass of brightly colored canvas into a moonwalk before your eyes. Observe it inflate from one side to the other, quickly at first and then slowly as it fills every last crevice and contains just enough pressure so that seven or eight children (including one who’s getting a little too old) can jump in it and be catapulted through the air from one side to the other.

That’s what it’s like to watch a lung inflate for the first time in a person’s open chest after they’ve had a transplant. There is slightly more or less blood depending on the children, but you get the idea.


This is how I like to start my mornings:

Walking into the cario-pulmonary ICU at about five minutes to six, my friend Wilfredo’s LCE doctor tells me that there is a lung transplant going on right now in the OR. I am convinced that this exchange only exists because:

1. I get to the hospital roughly 10 minutes before Wilfredo almost every Tuesday.

2. I get to the hospital roughly 15 minutes before my LCE doctor almost every Tuesday.

3. Wilfredo’s LCE doctor gets to the hospital before ANY of us EVERY Tuesday.

4. Both doctors know we’ve been dying for a transplant since we started this rotation three months ago (no pun intended) (okay, maybe it was).

Upon being the first to receive this information (even, as I find out later, before my LCE doctor) I of course play it cool. I have been in the OR many times. For transplants even. But not for a lung transplant. But still. It’s an OR right? An OR is an OR. But I haven’t been in one for about a year! Okay, now I’m excited. I take out my moleskin notebook and pretend to read through my notes as the doctor does paperwork. I think about the fact that Wilfredo is coming soon and will probably pull out his notecards that he writes notes on and then look at my notebook and then talk about how he has to get himself a notebook soon too. He does this every week.

Enter Wilfredo with his green sweater vest and wool pants. My sweater vest is brown and my pants are grey with light brown squares. Fast forward 45 years. I call Wilfredo for a consult on a patient. We are still wearing the same clothes. Rewind 45 years. I tell Wilfredo about the transplant. He is noticeably elated. Also, from the left outside pocket of his white coat, he pulls out a new notebook.

Ten minutes later, my LCE doctor appears. Wil and I are standing outside of a patient’s room like giggling school girls. The patient is jokingly insulting Wil’s LCE doctor. We don’t even bother to go into the room. We’re too excited about seeing the transplant.

In ten more minutes we are walking out of the ICU, headed for the OR. My doctor asks how long the surgery has been in progress. Wil’s doctor relplies that its been about an hour. As we exit the double doors and turn the corner, I become disappointed that we weren’t there to catch the first hour. (on a side note, I just realized that hospitals are the only places that contain wooden automatic doors)

After hanging up our coats, my LCE doctor has us put on these white fabric jumpsuits, hair nets, booties, and masks. Wil has trouble with the booties. He thinks they are defective. Then I remember that this will be his first time ever seeing surgery. For a second, I feel old for my age. Then I look down at myself in the big white jumpsuit and realize I look like the Easter bunny.

Inside the OR, I’m delighted to find a familiar orange square surrounded by a field of blue fabric, untouched. Pristine even. No cuts have been made yet. We are just in time to see the start of the surgery. I scold myself for forgetting how long ORs take to set up.

The surgeon walks in with his arms elevated, elbows bent and wrists flexed toward his face. His team wraps a surgical gown around him and helps him into some sterile gloves. Wil is standing back conversing with my LCE doctor as I walk over to the center of the room beside the patient’s feet. The surgeon quickly draws a curved line with a marker on the orange square. Then he cuts.

It’s quick, like an exacto knife through a thin piece of cardboard and it catches me off guard.

Then, everything appears to slow down.

I watch.

There is no blood.

Time catches up again. The surgeon and his assistant are pushing back the layers of fat and skin. Now there is blood but not a significant amount. Wil walks over. I feel like he’s missed out on the beauty of the first incision. We turn to each other in amazement, he from the sheer rush of his first surgical experience, myself from how stunningly clean everything is.

Soon, we see the surgeon take what looks like a large pair of wire cutters to the patient’s ribs. I am anticipating a huge crack at any moment… and there it is. My LCE doctor explains that the surgeon just removed a tiny square of rib that will not be going back in the patient. This will allow him to push aside the other ribs and get into the pleural cavity where the lungs are housed without having to make any other breaks.

For the next half hour or so, Wil and I maneuver around the operating table attempting to get a better view of the gaping hole in the patient’s right side. Somewhat suddenly, the surgeon removes the patient’s right lung and then places it in a plastic bowl. This action is almost haphazard. The lung is red, vibrant red with some occasional black spots. It’s form seems to be a mix of liquid and solid as it takes the shape of its container but the texture and movement of it reminds me of the small bits of peaches that come in those plastic fruit cups I’ve been eating during my lunches on and off since the 3rd grade.

One thing I will say about my LCE doctor is that he really goes out of his way to make sure I get all of the experience and education possible while I’m with him. For instance, he’s now motioning me over to the head of the patient, where the anesthesiologist sits, to get a better view. Then, upon finding out that a side view is actually better during a single lung transplant, he ushers me over to a short platform that has been placed behind the surgeon. Stepping onto the platform and looking past the surgeon’s left shoulder, an image comes into view that is easily one of the most significant that my brain has processed in the last 22 years. Tucked deep inside the large surgical cavity, under the rib cage, there is a human heart beating and on the far side of it, a lung that is pulsating in time.

Unbelievable.

You spend your whole life hearing this word “heart” in all of its various emotional connotations. You feel it when you’re running or lifting heavy objects. You place your head against other peoples’ chests and listen to their heartbeat. But never have you actually seen a human heart beating with your own eyes. Never before has that drum that you feel inside your chest or that warm, familiar rhythm emanating from a loved ones, been connected to a visual image of the organ itself working in real time.

It is the equivalent of being able to see hope or happiness or some other intangible thing that is spoken of frequently in our society. The human heart, possibly the most prolific organ in all of creation, when viewed live, still beating in another human’s body, does not fail to meet expectations. It surpasses them tremendously.

Eventually, the surgeon has pity on Wil and I and asks his staff to place several small platforms directly behind him so we can get an over the shoulder view of the action. Before ascending to the enlightened view however, the staff wraps surgical gowns around us but they do it backwards so our hands are trapped underneath. I’m not sure if this was done intentionally to inhibit our ability to touch things or not but either way, the effect is one which feels similar to being a snowman without any stick arms placed on a cliff in the hot sun but with a fantastic view of the town below. Consequently, our focus on the operation is only inhibited by our occasional effort to remain balanced on the tiny platforms without the use of our hands and the realization that sweater vests were a bad idea.

My LCE doctor leaves us to attend to the rest of his patients. Meanwhile, the surgeon has finished cleaning up the new donor lung that had previously been kept in several layers of plastic bags and stored inside the kind of cooler you would take to go fishing for blue gill or on a family beach outing.

The donor lung looks somewhat thin and shriveled. It is pink mostly but also white in some areas. The different lobes are splayed out as if they were about to undergo a trial where each one would be called as a witness and then cross examined separately.

The surgeon has begun to attach the airway from the donor lung to the one inside the patient. He does so with sutures one by one. The sutures themselves are dark blue and each contains a small metal hook at the end, not entirely dissimilar to a fishing hook, which the surgeon uses to drive the thread through the walls of the airway. There is nothing remarkable about the logic of this procedure; the technique however is undeniably beautiful. With unwavering confidence, the surgeon performs a delicate ballet in which the dancers are his fingers and the multidimensional stage is the string. I am mesmerized as he darts and dives, parrys and pulls in and out of the web he is constructing. He is the maestro and the concertmaster. He both conducts and plays in this orchestra of mortality. This is the intersection of art and science. This is the moment when the same dexterity used to change chords accurately on a guitar, will save a human life. This is the reason why medicine is labeled an art based on science.

Suddenly, I am in love again. With every knot made and wire cut, I am remembering why I began this affair with medicine. Surgery for me is that moment on the second date or in the second year when you realize that you will never be completely happy sitting across the table from anyone else at dinner. It is a marriage steeped in self-doubt, frustration, and adultery. I have been unfaithful. I am unworthy. She has been waiting here this whole time for me. Pure. Undefiled. Silently pleading with me to drop my camera and guitar and pick up the scalpel, to abandon the frivolous fine arts of the bourgeoisie and embrace my calling as a restorer of beauty in its highest earthly form. The human body. I can no longer turn a deaf ear to her cries, a blind eye to her tears. Today, I am renewing my vows.

The surgeon has finished connecting the airways. He clamps the pulmonary artery and vein and begins to shorten the ends of both inside the patient. Wil and I ask if this will make it more difficult to connect them to the vessels of the donor lung. The surgeon responds by telling us he is doing this the “old school” way. Newer surgeons will leave these vessels longer because it will make them easier to join with sutures, but this sometimes produces kinks that are less than desirable post-transplant. I digest this bit of information quickly, recognizing the futility of denying a generation gap. This man is clearly from the “old school” of surgery who’s methods he is ascribing to. He belongs to the so called golden age of medicine in this country when patient’s didn’t ask questions and submitted their complete will over to the man in the white coat whose peppered hair and balding scalp functioned as a simple veil to mask all of the privileged answers of life.

I turn to Wil, his eyes are on the surgeon’s hands. I don’t think the two of us will ever possess the unflinching confidence this man seems to have in himself. We have grown up in the information age, the post-information age even, where physicians choose ever narrowing specialties because there is no way to master everything anymore. No way to feel completely in control. The ocean of knowledge is too large. It has flooded the collective landscape of our young sensitive minds. It has wrecked our mighty wooden vessels we had dedicated to crossing and conquering it. There are no more Columbuses or Magellans. We will be proud if one day we can say that we have traversed the pond behind our backyards.

The surgeon finishes attaching the vessels. He releases the clamps. There are some leaks but they are small and he quickly patches them up with more of the blue wired sutures that he wields like tiny daggers.

In another moment, he is pushing a tube filled with blood into a spot on the vessels that is too deep for Wil and I to identify. He tells someone on his staff to start the perfusion. Blood runs through the tube and into the new, donor lung. It is turning the same red color as the lung he pulled out of the patient.

Five minutes later, the surgeon is telling the staff to stop the perfusion. It has been going on for five minutes and fifty seconds; much longer than necessary. He now turns to the anesthesiologist behind the head of the patient and tells her to remove the device that is blocking the airway to the newly attached lung. What proceeds next is a stunning picture of the relentless endurance of human life. The lung inflates and acquires a healthy shade of pink like a hot air balloon rising in the early morning sky. The lobes that once seemed flayed and disorderly now organize themselves into an anatomically immaculate fortress of air. They are a confused Christ, resurrecting upon being placed inside the tomb. Three days too soon.

But still, it seems they need a bit of prodding. The ends are a purple color and flat compared to the rest of the organ. The surgeon notices this too and begins to massage these areas, squeezing air down into them from the expanded part of the lung. As he does this, they turn from purple to white and then to pink. He explains that these sections had collapsed during the transition but are typically easy to revive given some encouragement.

Finally, the surgeon is satisfied. As he begins the process of closing up the ribs, his own LCE medical student, our classmate David, enters the OR with scrubs, his hands ready to dive into a fresh pair of gloves and assist his instructor. It is 8:30am.

With quiet pride, Wil and I explain to David that the surgery is pretty much over and that we had been there from the beginning with his LCE doctor. David tries to act composed but I can see he is significantly shaken by this. Wil and I are smiling from under our masks. We have just stolen our first surgery.

The surgeon is now burning off some tissue from the end of a rib with an electro-cauterizer. Although it sounds disgusting, I typically like this smell because it reminds me of surgery and how much I love it. However this time, it gets to be too much. Instead of the light scent of heat and bone, there is a pungent vapor rising up from the charred looking rib. It smells like someone is burning down a rotting wooden house directly under my nose. I don’t bother to ask what the purpose of this action is; I’m too concentrated on trying to breathe in a little as possible.

After a few short minutes of this, the surgeon begins using thick metal wires to tie together the patient’s ribs. In order to get them as tight as possible, he employs the use of a sizable mechanical tool that looks like it would benefit a worker who’s building a suspension bridge more than a surgeon who’s reconstructing a rib cage. On the opposite side of the patient, David is holding the suction. There is clearly no need to suction anything at this point but I don’t think he knows what else to do. He is still somewhat in shock. And I don’t blame him, I probably would be too. He asks us what time we typically arrive at the hospital for our LCE every week. We answer, “about six”. I have never been more thankful than at this moment for being obligated to get up before the sun.

A staff member has now replaced David on the other side of the patient. He and the surgeon suture at a furious pace to reattach the muscles that hug the patient’s ribs. Eventually they reach the final, superficial surface: the skin. Their stitches are precise (the surgeon’s much more so than the staff member I notice though) and they quickly complete their task. Wil and I descend from the platforms. The surgeon steps back from the patient for the first time since he made the first incision two and a half hours ago. He is tired. Plain and simple. He removes the light contraption from the top of his head, a high tech miner’s helmet that has allowed him to extract worthless components from the dark, bloody shaft, and replenish the cavern with a rich treasure from the outside world. It is a reversal of sorts. A way to give back to the earth.

Wil and I dispose of our surgical attire, relieved to have survived the heat. We wave goodbye to the surgeon and thank him for his kindness. In the tiny locker room, we remove our sterile bunny suits and return to the lobby where we first came in.

Our short white coats are hidden underneath the long white coats of the surgeons and other doctors. It is a metaphor for the protective educational environment we are being fostered into by the attending physicians, or simply the result of coming into the OR at 6:30am.

We now head to the bronchoscopy lab. Wil and I part ways. He leaves to do more rounds with his LCE doctor. I stay with mine in the lab to extract lung biopsies. They are interesting but have the same effect as a sedative when you’ve just finished watching a lung transplant. Everything grows slow and hazy. The doctors and staff walk through the corridors with thin motion blurs. I sit on a chair beside the door watching my LCE doctor finish his write up and wondering when the world will fall back to sleep.

The human heart is disgusting.

And also, beautifully intricate.

I know this because I held one in my hands today for the first time.

But I will decline on making abstract connections between the physical and emotional realities of this central muscle. It’s too easy and will probably come off as trite.

To be fair, it probably seemed more disgusting because it was surrounded by fat.

Opening all four of it’s chambers up, you can see the tiny valves and tendons dispersed appropriately. The professors call it simple in class but I think it’s a rather clever design. Especially when you realize that this thing you have in your hands has been contracting and shooting blood and oxygen through someone’s body roughly 70 times each minute for the past 78 years.

Before you are born, there is an opening connecting your two atriums so that blood doesn’t flow through your lungs. Instead, you get oxygen from your mother’s lungs through the placenta. As soon as you’re born, and they cut that umbilical cord, that gap seals shut and your little lungs fill up with air for the very first time.

Brilliant.

That’s why it’s a good sign when a baby is crying as it’s coming out. That means everything’s working properly.

Ironically, I did not cry when I was born. I think it gave the doctors and my parents a bit of a scare.

I’d like to think it’s because, upon seeing it for the first time, I immediately fell in love with the world and what it meant to be human.

Besides the whole holding a heart moment, today was one of those days when I felt like I should have never got out of bed. Six hours of lecture before being in lab for two hours is not how I like to spend my Mondays (or any day for that matter), especially when, between my own degrading attention span and the lack of good lectures, I hardly learned anything.

Highs and lows people. Highs and lows. This is medical school.

Splendid

Photo by Morgan Penton
This day was beautiful on a variety of levels. Polley and I went back down to the art museum since we didn’t really get to check it out the day before (she had to go to work) and my family joined us this time. Now, I will admit I am not the biggest fan of the new museum’s boring architecture. It’s just a giant metal box. But it actually kind of works. Inside, the high roofed atrium makes you feel like this is a real art museum in a real city (an attribute which was missing from the old building). All of the spaces for the art are upstairs and all together seem quite small compared to modern art museums in other cities like New York and San Francisco but thankfully they are all well done. Really well done. Finally, Tampa gets a museum of some real quality. And, at least currently, it contains a really good mix of art. There was a large exhibit on Matisse that took up about half the museum, then a room that holds a portion of the museum’s permanent collection of ancient greek and roman antiquities, a black and white photography exhibit on women from the 60s and 70s in everyday life, a hard to describe exhibit on cities that was a combination of mixed media sculpture and photo art, a modern minimalist rotating exhibit of paintings on canvas, and even a weird video installation in one of the connecting halls. I think I liked the photography best but the broad mix of art displayed was a really good sign to me that the new management of the museum has a good handle on things and will probably be able to bring some more notable exhibits to our city in the future.

Hello Museum

Polley and I went to the opening ceremony for the new Tampa Museum of Art in the morning. The mayor and other people who influenced the building of the new museum spoke. It sounds like there is a lot of community support for this thing which is excellent because it means more opportunities will open up for artists and patrons of the arts in this area.

Filmmaking Shenanigans

I had three classes this morning in which I totally understood everything that was presented immediately. Crazy. The rest of the day was spent watching and taking notes on two, yes TWO, anatomy lectures. One of them took me about 5 hours to finish. Insane. There’s just too much information in each one of those lectures. That’s why I don’t attend those anatomy lectures live anymore. It’s overwhelming. It’s like someone standing in front of you and speaking a language you don’t understand for an hour.

Anyway, later, Dan, Joyce and Dan came back to the house to finish up filming. Then they skyped me in to a meeting for the movie I’m working on with Sarah Wilson. Technology is pretty cool, especially when you’re in med school and don’t have time to actually drive to and from a meeting.

House Guests

Did you know that our medical school has an art director??! I didn’t. But now, through the web of art minded people involved in my scholarly concentration, I’m friends with him.
He’s really down to earth and has some interesting ideas and the other people in his office are just as delightful. I’m looking forward to getting to know all of them. Their offices are located in the heart of our medical school. It is a sort of secret stronghold of aesthetic thinking. Consequently, I felt really at hope spending time there. Some of the projects they’re working on right now are journalistic in nature and so they’re thinking of including me as something similar to an “underground” reporter in the med school. They also like the blog and may post a link on one of the USF sites. I hope it doesn’t scare off anyone from going to medical school here!

The morning consisted of an On Doctoring session in which some really good discussion was generated in our class about motives for being here, the current state of our medical system and idealistic views of what the life of a doctor is like amongst other things.
At lunch, there was a liaison meeting with the faculty. I had a little verbal shoot out with another student over the need for better quality anatomy dissection video and the possibility of producing them. Everyone seemed receptive to the idea except this student who apparently felt so strongly about it he had to voice his opposition verbally and reveal his total lack of any kind of knowledge about film/visual media. At one point he actually stated that “a camera is a camera”! Are you freaking kidding me? Common sense will tell you some cameras are better than others. He also incorrectly stated that there’s no way to display more high definition video online. Apparently he hasn’t heard of vimeo or watched youtube for the last 2 years because it gives its viewers options to watch in a variety of high definition levels. What bothered me more than anything about it is that he even spoke up against it at all. Despite all the niceties and goodwill, liaison meetings are essentially two sided: the students and the faculty. The students have to support each other. If another student is talking about something you’re not passionate about, you either don’t say anything or change the subject, but don’t speak against it. We have to back each other up. Otherwise, we wont get the faculty to help us out at all.

Anyway, the best part of the day came after meeting with the art director when I went to CACL to perform my neuro exam. Talking about art with those people must have calmed me down because I wasn’t nervous at all when I went in to see the patient. I ran through the whole exam and barely even looked at my notes. At the end, the 4th year who was my preceptor told me I did a fantastic job. The patient said he felt comfortable because I was so calm. Oh and he had a positive babinski sign too! Crazy. Anyway, I got marked off for just a couple, very minor things but when the feedback session was over the preceptor told me that I was performing at a much higher level than a first year! As you can tell, this made me pretty darn excited.

Finally, I’m better than average at something.

The rest of my day was spent studying at home while my friends, Joyce, Dan Nguyen, and Dan Bakst shot part of a new film in my house.

I am exhausted. Frequently. And sleep deprived. And its only two days into the new test cycle. We had two hours of physiology today and it was heavily physics focused. Turns out, the circulatory system acts just like circuits with resistors arranged in parallel and series. So I guess that’s why they put physics on the MCAT.

I found out my preliminary test scores today and they weren’t very good but I did pass. Hopefully with the added corrections later, they will look a little better.
After attending a really good review for our neuro assesment, I started giving free neuro exams to my friends who were a little confused at first about what they entailed but dived in non the less. I think when you are friends with a medical student, you probably get a number of experiences that the general public doesn’t. It’s probably like having a little inside look at med school whether you asked for it or not. Luckily I have some pretty awesome friends who are willing to let me practice on them.
One really interesting thing happened when I was doing a neuro exam on a friend of a friend. She tested positive for Babinski’s sign. It usually indicates a defect in the cortical spinal tract of the spinal cord but she seemed fine otherwise. She told me that she had some brain surgeries before and so maybe those contributed to it. Still, it’s a really rare thing to see that in a patient so I was happy for the experience.

LCE was pretty interesting in the morning. I rounded on a patient who had sub-cutaneous emphysema. When you touched his skin it felt exactly like rice crispy treats. This is a condition in which air has escaped from holes in the lung and flowed into a space between the skin and other tissue. The patient ends up looking puffed up like a baloon because of all the air under the skin. It’s a pretty rare condition.

At night, I visited my family, who I haven’t spent time with in ages, and conducted some crude neurological exams on all of them to practice for my upcoming assessment.

Okay, I didn’t forget the toothbrush but I definitely should’ve brought an extra jacket.
The practical was not too bad, except for the fact that I stupidly changed a correct answer at the end to a wrong one because it was bothering me. I hate when that happens. I have a faulty intuition.
The regular test however, I thought was sufficiently terrible. I felt like it was one of the most poorly written tests we’ve had, and that’s saying a lot. Several questions were testing things that wern’t even from this test cycle and then they just phrased things really badly.
You know, when a test is that poorly worded it is a bad thing for the people who administer it as well as the people taking it because then you are no longer assessing someones proficiency on a certain topic, you are just assessing if they can understand the way the question writers articulate themselves.
All that said, it wasn’t my worst test but it definitely wasn’t my best. I guess I’ll find out how bad it really went in a few days.

So that lasted from 8am to about 1:15. After that I had intended to finish recording that song from last test day and do a photoshoot with Kimberly but for various reasons, neither of those two things happened. Instead, I spent most of the rest of the day hanging out with some people that I care about. Which is probably better anyways since I hardly get to do that.

Some productive things I did do though was nail down a location for our film that shoots next week and pick up a vintage looking record player for it with Dan. Plus, our director informed me that we got permission to use this really awesome song for the end sequence! Win!

And then, one odd thing happened. While I was in the lower level of a parking garage, I heard someone playing violin/viola so nicely I thought it was a recording from someone’s car. Then I noticed it was a student. A really good student. Anyway, I was impressed, so I introduced myself and gave him my card. He said he played down there because of the acoustics which are tremendous. Who would have guessed, parking garages = concert halls???
The thing is, I think I would really get along with this guy. He is the type of musician I like to work with, someone who would just as easily play in an alley as on stage in front of thousands. Someone who doesn’t care that no one plays classical instruments on the street, let alone a parking garage. Someone who cares more about what the music sounds like than who is listening to it.
I don’t know if he’ll contact me. Actually I kind of doubt it because I was so random and obscure about the whole thing. But I really hope he does. The Year One record for The Culprit Life could use some strings on it when it gets recorded late this summer and I think this guy may be the one to make it happen.