Thursday, August 28, 2008

God Second-Thinks?

So, I've been reading 1Samuel some. It's about how David got put into the position of "being a man after God's own heart." Good story. I've not finished it yet, but still, I know it's a good story. But the other night, I was reading and I was surprised by something I read.

Now, this doesn't happen much-- not surprise/shock. The most probable and correct assumption would be that I don't read the Bible enough then. But ususally, I do have something that speaks to me or is unexplicably wise, but usually not surprised. Here it is---

1Samuel 15:35: "And the Lord was grieved that he had made Saul king over Israel."

My first response was "Wow, really? The Creator of the Universe was sad that he did something?" I mean, he's omnipotent, omniscient, omnipresent... He knew what the outcome would be before the world was even made, yet even then, He was sorry that He did it. He doesn't answer to anybody, has no obligations to fulfill, and can do whatever He pleases.

The Israelites had asked that God give them a king. He tried to indicate that even though they thought they did, they didn't want to be like all the other kingdoms, but they insisted--and got Saul, who was awful. All this time, God was planning on putting David in after Saul. So, if Saul was the means to the end to get David in, then why would He be sorry?

This is one of the times where I wish I knew Hebrew. I'd like to understand the nuance of grieved. Was God grieved because of all the trouble His choice was causing Him? (like, needing to do more work to fix it?) Was God grieved that He was seeing His children make a bad choice, which He granted? Was He just grieved that He'd made a bad decision? But how could it be a bad decision/mistake if He knew the outcome and could have prevented it in the first place?

Ok, my head is spinning now, but you get the point.

If God was grieved over a decision He made, I wonder what other times that He grieved/grieves in the same way? I'm sure there was grieving over Jesus' death on the cross, but at the same time joy.

Lessoned Learned: Maybe sometimes God isn't so happy with all of the things He decides to do.

What it's Worth: It's worth knowing that I have a God who understands what grieving over a decision is like, and He's here to comfort me through it, and He's got a plan further down the line that's better.

Wednesday, August 27, 2008

Blow Up

Today, I went over the edge. Blew my top, had the straw break my back, flipped out, flew off the handle--all of that. We're talking about yelling, face turning unnatural colors, sweating, and a few small choice words, then more yelling. It may be that I've been stressed lately (probably that's umm 99% of it) but it was also the FACT THAT NOBODY EVER SEEMS TO KNOW WHAT'S GOING ON WITH AHEC ROTATIONS!!!! For those of you who don't know, those are rural rotations out in other parts of the state--Area Health Education Centers(?)

I've been signed up to do a Rural AI with our Dept. of Family and Community Medicine SINCE MARCH...and the rotation is supposed to start Sept. 1..... today, after speaking with multiple people multiple times (oh...about a total of 8 emails/face to face convos/etc.) I FINALLY get the name of just one person down there, so I wouldn't just show up and have nowhere to go.

The thing is, the AHEC coordinator had never heard of this so called "Rural AI" --didn't even know what an "AI"'s the thing: IT'S A COURSE IN OUR CATALOG!!! IT'S BEEN A COURSE IN OUR CATALOG!!! Somewhere, obviously, somebody isn't so organized or good at sharing information. I don't blame the AHEC person, either.

Lesson Learned: Just because something is listed as available, it doesn't mean that it will go off without a hitch, even though any NORMAL person would expect that.
OH-- update--this just in, I will NOT in fact be living in what is quoted as "Housing is in an efficiency basement apartment with its own entrance. The apartment consists of living room, bedroom, bathroom, dining area, and a small kitchenette in the utility room. There is a microwave oven and refrigerator. You will be sharing the washer and dryer with the family on weekends. The apartment is completely furnished (please bring bath towels, wash cloths). " I just spoke to the lady who has said area and she says "Oh, did Kathy not tell you? There's already a student living there, she couldn't find anywhere else for you to live, so you'll be living upstairs in a room in my house, you'll have a private bath, but you'll have to share the kitchen with me.
Now, I'm very fortunate to have a place to live, I'm happy about that. BUT IT WOULD HAVE BEEN NICE TO HAVE FOUND THIS NEW INFO OUT A LITTLE SOONER, dontcha think?

Thursday, August 21, 2008

Dream Deferred

I'd never really understood Langston Hughe's poem "Harlem" or "A Dream Deferred." Then, I heard it read by Morgan Freeman for one of the Olympics commercials...and it made sense. Call me a literary idiot, but I just didn't GET IT until then- I think I thought that he was talking about a dream that you have while asleep.

What happens to a dream deferred?
Does it dry up
like a raisin in the sun?
Or fester like a sore--
And then run?
Does it stink like rotten meat?
Or crust and sugar over--
like a syrupy sweet?

Maybe it just sags
like a heavy load.

Or does it explode?

We read it in high school, and I would challenge that high schoolers really have no business reading it, or at least reading it for being understood. Read it for historical perspective, possibly. But, I think it takes an adult to understand "dream deferred." I think you have to have had a "dream deferred" to understand it.

I also looked up the Merriam-Webster definition of "deferred"-- "to put off, delay OR withheld for or until a stated time."

That's the power of this poem, and of dreams--Langston Hughes didn't say a dream demolished, or's been deferred (but still has the possibility of exploding).

I think mine right now is somewhere between festering like a sore or rotting like meat... or sagging like a heavy load-- it basically depends on the hour of the day and who I see in passing or who I'm with.

Wednesday, August 20, 2008

A Thread That Joins Us

Today, I cried at school. It's happened before, and I'm sure it will happen again. But this wasn't related to my grades, my classmates, a patient, or even a human. I read this story about a gorilla whose 3 month old baby died. She's been carrying him around with him ever since. I hate to
include such a gruesome picture from the story, but I'm going to.

Her baby is on her back (where it seems she often carries him) and another gorilla's baby is in her hands.

I'm almost at a loss of words describe how much this affected me, and how deeply it resonated. I know some would say that animals don't have feelings, or a soul, or the capabilities of emotion that would come near what we have as humans, but I think that the power of motherhood and the sense of loss here clearly challenges those boundaries.

I feel as though she is looking at the camera, saying "Here is what I had, here is what I lost...and here is what I wish I still could still have."

I don't know about the long-term memory of gorillas, but I'm sure that she'll continue to carry that baby on her back long after his little body has been removed.

Wednesday, August 13, 2008

Square Pegs in Round Holes

I promised to do a blog on a summary of third year... now it's fourth year and I've not gotten to it, and this blog isn't the review of third year either, sorry.

Right now I'm doing research, which I started during our (3 week) summer break. It involves surveying patients, assessing their health literacy, asking them some true/false questions and then randomizing them to a verbal or video & verbal module designed to teach them about severe dementia and the end-of-life choices somebody could make before coming to that state of being. The choices are Life Prolonging Care, Basic Medical Care, and Comfort Care. The website for the video can be viewed here:

During this research, I've often been frustrated at patients not answering my questions to fit in my neat check-boxes. I've often screamed inside, "IT'S TRUE OR FALSE, STOP HEDGING/QUABBLING OVER ONE WORD!" But then I have to remind myself, they want to do well, and have varying experiences with dementia and end-of-life decision making. Still, fitting square pegs into round holes has been hard.

I've also been confronted with my too-much type A syndrome. There are times that patients tell me things and I'm just wanting to focus on the matter at hand--doing the survey, watching the video, getting through the protocol. I feel like time is being wasted by small talk, or interjections of "one time so and so down the road had this happen..."

But, they keep my type A in check because there are times when I've been blown away by some of the stories that complete strangers have told me. One doctor from olden days disclosed some of his former ethical battles involving too few iron lungs and too many critical polio patients (I would love to go into more detail, but think it's best that I not do that in this forum). Another lady related how she was responsible for one of the first Alzheimer's nursing units in the state. Another talked about her nursing career working with mentally handicapped children.

A man told me how much pain he was in after the loss of his wife only a few weeks earlier. He said, "and I'm about to explode right now" regarding thinking about the loss of his companion after 60 years, and how, although he knew it was coming, he didn't expect it when it did occur and how much her absence had overtaken his life.

Another man, who was still relatively young (and appeared younger than stated age), told me that he had metastatic cancer, but felt fine, and so didn't know how to answer the question "In general you would say your health is ... " They always tell us that the definition of health isn't just "being free of disease" but I didn't believe them until then.

A woman related some of her distrust in the medical field due to her mother (who was DNR) being brought to the hospital after a carotid blow-out. She felt that the surgeons tried to save her just to get practice in doing the procedure, and when she relayed her frustration to the doctor, he said "Well, why come to the hospital then? You only come here if you want saved."

One lady told me that she'd never told anyone this certain fact--that she had doubts about her one of her family member's choice of a husband.

I'm almost in disbelief of how much information people are willing to share with somebody who is in the medical field, or who the person sees as fulfilling a "doctor" role. I'm just a medical student doing research--I have nothing to do with their medical care or visit during that hour, but many want to share with me. I find it hard to imagine how much I'll learn while being a "real doctor." I hope my "type A" doesn't taint my encounters and that my patients see in me a willingness to listen and hear, and thus want to share those things on their minds that day. I'm sure my healing will be much more potent and successful if I can do that.

Lesson Learned--The power given to us as doctors is immense, and part of the power lies in being a ear for our patients to be heard.

What it's Worth--It's worth being satisfied with my job, loving my patients, and having my patients be satisfied with me.

Tuesday, August 5, 2008

Politically Correct ... Genital Warts?

Ok, a medical rant!!! I'm tired of the Gardasil (copyrighted) commercials which continue to shroud the prevalence and problems associated with all things sexual.


Here's the website in case you're wondering:

I guess the new euphemism for "genital warts" is "other HPV diseases." As if saying "genital warts" causes them to come into existence. Do people ACTUALLY think that the average patient, let alone the AVERAGE girl/young woman between the ages of 9-26 knows what they mean by "other HPV diseases"?

Honestly, I've seen genital warts. They're not pretty. At all...not to mention uncomfortable. (No, I don't know this because of my own personal experience.) You have to freeze them off, or burn them off with a laser, or use cream...and even then, they can come back.

It all comes back to the worry that vaccinating girls against this highly prevalent virus (between 1/2 to 3/4 of people have it) will remove all of the consequences from having sex ...either at a young age, unprotected, unmarried, with multiple partners (take your pick) and will all of a sudden cause them all to run out and have sex, since they no longer have to worry about *gasp* other HPV diseases. Come on. Honestly, I'm sure that it's the rare girl who said "No" to sex only because she was afraid of getting cervical cancer or genital warts.

That said, I'm completely for the vaccine, don't get me wrong. And I'm also all for waiting until you are in a stable, committed, adult (preferably married) relationship before having sex. But all of the rhetoric surrounding it, as stated above, is just silly. Young people need to know all of the consequences and responsibilities of sex--physical, emotional, social, financial. In the US, 1/2 of all pregnancies are unintended. Obviously, hiding behind euphemisms and sweeping things under the rug isn't quite cutting it.

Lesson Learned: Euphemisms, especially medical ones probably don't help anyone. Be clear and honest, especially about some of the most intimate things humans deal with.

What it's worth: It's worth saving some confusion and lots of uncomfortable explanation later.

Oh, and I apologize for not giving you references for the above stats...but I'm being lazy this evening, and they're true, I promise.