anna in med school

Taking a break from the sciences to write my bioethics paper.  I have to say, it’s kind of fun.  It’s on physician-assisted suicide and, as we found out in Italy, John and I fall on opposite sides of the argument.  Sure wish we had realized that before consuming a bottle of chianti…I might have then been a bit more articulate, rational, and less teary, though jet-lag might have contributed a little (alcohol and different time zones–looks like I’m taking zero responsibility for my emotions :/).

I’ve been in communication with an executive assistant for the Master of Bioethics Program, peppering her with too many questions.  In her last response, she began, “Your messages reflect an extraordinarily kind woman.”  Clearly evidence that she does not know me well…but her comment made me so happy, a little like the Grinch at the end of the movie, with his heart “swell[ing] three sizes that day.”  Maybe making this comment public, doing away with humility, negates any meaning in it.  Forgive me.

One of John’s favorite quotes:

“I expect to pass through this world but once. Any good thing therefore that I can do, or any kindness that I can show to any fellow creature, let me do it now. Let me not defer or neglect it, for I shall not pass this way again.” ~ Anonymous (possibly William Penn)

Apparently it snowed in Philly on Thanksgiving, but I was traipsing around Tuscany.  In honor of my first winter 2010-11 flurries:

The Lighting of the Lawn: the recently decorated Rittenhouse Square doesn’t hold a candle to you (pun intended).

“Well, the cello is the sexiest instrument.”  Wow–John, if you only knew that that was the moment you won me over almost eight years ago, you could have saved yourself a lot of trouble.

I was first a cellist.  I chose the cello when I was eight because there was this French girl (Marie), with whom I used to spend summers, who played the cello–and I wanted to be just like her; that simple.  And then when I was 13, Luciano–my beautiful Chinese-Italian cello (made out of Chinese wood in Italy) who sings like Pavarotti–entered my life.  He’s currently living with my other love in Boston.  I think we should celebrate our reunion in June with a new bridge and set of strings, and maybe I can reteach my hands how to play you sans horrible screeching.

I hadn’t thought about the reasons I started playing the cello in a long time.  It kind of makes me think of the reasons I chose to go medical school.  When I interviewed at Goucher for post-bac, Liza asked me how much John contributed to my desire to pursue a medical profession.  I don’t really remember what I told her, but I very well might have said that he had nothing to do with it, which is not exactly true.  We never talked through the decision; I think I just blurted out one day that I thought I had made a mistake and that I wanted to go to med school.  But I don’t think I would have ultimately known it was what I wanted without seeing John and his friends living it every day.  I was a little bit of a brat about it–the lifestyle, that is–being extremely vocal in my discontentment with the inflexible schedule, the steady stream of med school speak at any and all social events, leaving me in a daze of acronyms.  (I look at some of my peers’ significant others–they all tolerate us so much more than I did!)  Anyway, back to the point: thanks to Marie and John (and all of UVA Med 2008) for being excellent “role models” (for lack of a better term), and helping me discover two fairly fundamental parts of my life.

To wrap things up, two overly simplified take-aways from microbio:

1) Never ever use antibiotics.  (Okay, sometimes use antibiotics.)  Staph aureus is one scary bitch.

2) Looking back at the number of times I had strep and impetigo concurrently in grammar school, I’m starting to agree with John more and more: children, though adorable, are little germ bags.

About a week before Thanksgiving break, I decided to walk instead of bike home from school (which, to where I live in Market East, is kind of a trek but I was in the mood).  I slid in my head phones and just listened to the “playlist” of “recently” (often not recently at all) purchased songs, not really having any idea what that included.

A few songs in, the familiar swell of the first chord of “Lo, How a Rose E’er Blooming,” the Robert Shaw Chamber Singers rendition, sounded.  In the split-second breath between the first two notes, tears came to  my eyes.  This very simple carol is stunning.  Like Rachmaninoff’s Vespers, which literally has countless incidence records of divine occurrences during performance, this is one of many a cappella choir pieces that has a way of overpowering me.  I am not a religious person (as the only one of four siblings not baptized–a pretty hilarious story for another day–I’m the little heathen of the family), but I can’t help but believe that something otherworldly must exist, for she is felt within the string of notes assembled by the impassioned, delivered by uninhibited singers.

Music has been a wonderful part of my life. Well, you know I tend to be a little melodramatic (and this post has been kinda mushy), so I’m just going to come out with it: I think I’m grieving the loss of music.  Sounds totally ridiculous, no?  But the little scene I made on 24th and Pine while listening to the Robert Shaw Chamber Singers was not an isolated incident.  This past weekend, I attended Erica’s choir concert at St. Bart’s in NYC, and then Monday morning in Anatomy, Doria asked, “So, how was the concert?  How many times did you cry?”  Lower lip jutted outward: “Just once” (during Whitacre’s Lux Aurumque).  Finally, in Italy, on the train to Florence, I didn’t exactly cry, but I did listen to Holst’s Ave Maria for 8-part women’s chorus quite obsessively on repeat.

I’m in a choir now (sort of…more on that later), but I don’t think that will be possible a year from now, and that understanding is starting to sink in.  One of the questions I ask students interviewing at Penn is what they think the hardest part about medical school will be for them, what they’ll miss from their previous lives.  Absolutely no regrets, but I miss music, and the part of my identity tied up in it.  It’s been on my mind a lot recently–hence the unusually somber tone of this post–so I’ve decided to devote the next four days to remembering some particularly poignant musical experiences/moments/endeavors…don’t worry, lots of anatomy and microbio will be spliced in, and it won’t all be so serious.

From the weekend:

Kyle, former roommate from post-bac, currently taking Cornell Med by storm:

Halle and Ted, they are good-humored friends who are willing to eat gelato with me in 15-degree weather and insist on dragging around my suitcase for me:

Jaw-dropping incredible. This kid is so modest, that I fear I will embarrass him by gushing over how inspiring he is.  So I’ll keep it simple: I’m thankful that people like Matt M exist.

This morning in Tribeca, NYC:

Stephan (the brother): Do you know where Aunt Anna is going today?

Henderson (the nephew, age 3): Phil-la-DEL-pheee-ya!

S: That’s right!  That’s where she lives.  And do you know what Aunt Anna is going to do in Philadelphia?

Silence.

S: Is she…going to work at a gas station?

H: Naaaahhhhhhhh!

S: Is she…going to work at a bank?

H: Nehhh!

S: Is she going to learn how to become a doctor?!

H: Yeah!

S: That’s right!  She’s going to Philadelphia to go to medical school.

H: Yeah, Aunt Anna is going to Philadelphia to go to medical school AND be a GIRL PIRATE!

Sure thing.  I’ll just swing by Penn’s Landing on my way home and raid a couple ships.  No big deal.

Yesterday’s Doctor-Patient talk and small group session were on aging and elder care.  We had two incredibly energetic/adorable representatives of the older Philadelphia population come and speak with us, and I think they just might have converted a few peers toward considering the field of geriatrics.  Here’s the thing: I think that geriatrics has the potential to create surprise more so than almost any other field…predominantly because we think of the patients as so, well, unassuming.  God, it sounds like I’m making them out to be criminals or something.

Far from it, of course.  In my very minimal experience with elder care, the patients have been consistently warm and appreciative and, for the most part, open and honest, with a slightly playfully sneaky, rarely devious side at times.  One patient I followed in her final stages could hardly eat at the end, yet she still mustered enough energy to hide the overcooked chicken the facility served, fib about it, and then proceed to eat cookies or just the icing off a cupcake for dinner–“I’m 93 years old; I’m not going to live to be 94.  I eat what I want.”  Things become a little more complicated if the patient is non-compliant with her cocktail of medications for rheumatoid arthritis.

The mystery of geriatrics runs deep.  First of all, it’s a pretty new field–only in recent history have we had such a huge subset of the population live to be 70+, 80+, 90+, and so on.  Assisted care facilities, first discussed as part of the New Deal, are in reality a product of the last 50 years.  Secondly, whereas with most patients we’re looking for one, maybe two chief complaints or causes for disease, the elderly tend to have multiple, often compounding.  And then there’s the fact that, even if we’re only dealing with one primary, well-known and understood disease (pneumonia, for example), an 80-year-old will present with completely different symptoms (inability to get out of bed, general confusion and instability) than a 50-year-old (fever, difficultly breathing, cough).  You can imagine how a physician or other health care professional might treat the former inappropriately, leading to potentially disastrous health outcomes.

So, geriatrics is new, complicated, and with potential high acuity.  Not to mention that it’s a field in tremendous need of physicians.  Can anything be more exciting?

For our small group, we read this article by Atul Gawande.  If you haven’t read any of his pieces, you’re in for a treat.  Then, if you have about 90 seconds, here’s a light read about a woman I had the privilege to know and serve.

Not to stereotype horribly, but if there’s any doubt about how great elder folk are, I turn to this fictional representation of passion, determination in the face of adversity, and compassion–all while living with a number of health-related challenges:

Today the lovely large black woman who hands out scrubs at HUP gave me, not one, but two pairs of scrubs for anatomy lab.  And she didn’t look at me like I was so totally high maintenance when I specified “small top, medium bottom” (to accommodate my Tuscany-mandated expanded derriere)…not that I don’t feel high maintenance anyway, like one of those customers at coffee shops who rolls her eyes and sighs, “Okay, I just want one tall, soy latte with a splash of water, two and a half pumps of sugarfree vanilla syrup, and a small dolup of whipped cream.”  Nope, she just said, “Sure thing, baby-girl.”  She calls me baby-girl.  This rainy Wednesday is looking up already.

Truly, you’ve outdone yourself.