Gremlin In Scrubs

This week was a week of many “firsts.” It has left me quite exhausted and unable to memorize the vasculature of the abdomen on a Friday night.

1) I gave my first real shot (yes, to a living person) and she survived and went on to lead a relatively normal life, though I believe her reaction may have included the phrase, “maybe just a little less forceful next time…” It seems to be a trend now that instructors underestimate my strength when they tell me to “use force”…perhaps the “gremlin in scrubs” metaphor is even more appropriate than I imagined.

2) I failed my first medical school exam. The practical portion of the thorax exam was a surreal and Kafka-esque experience, with scrub-clad clones walking in twisting lines between 30 cadavers, stepping in unison to the deep, thundering “TIME” that was called from some mysterious room somewhere over the loud speaker. It was all I could do to participate in such a bizarre activity, let alone identify the tiny little blip of a piece of tissue within 60 seconds amidst the mess of various biological materials from which we humans somehow spring. My professor assured me, however, that it “takes English majors at least a few anatomy exams to get the hang of it,” and my TA reminded me that “THIS, is not medicine…you are learning to talk about medicine.” Perhaps that will reassure any of you who may be my future patients.

3)I used an AED (Automated External Defibrillator) for the first time. I was certified in Basic Life Skills (yes, it is truly called this), which is CPR, rescue breathing, and dislodging airway obstructions in adults, children and infants. In my practical exam, I used an AED on my dummy, but I did not shout “CLEAR” before I shocked, since I am not dramatically inclined.

4) I saw true pathology for the first time, and it hit me with blunt force. Like a furious natural disaster, our own insides can attack us with undiscriminating violence. Even though my patient was already dead, the evidence of a painful and unexpected death that stared us in the face when we finally opened the abdominal cavity was something that I will likely never forget. I will explain more fully in my next post.

For now I am eager to get out of my scrubs and just be a gremlin.

We had been told many things before we opened our cadavers on Friday afternoon, including that what we saw and did in the course of dissecting a dead human could not be described to those outside the profession. This is not because the layperson is not smart enough or experienced enough, it is simply because it loses its intended meaning amidst the societal background. We had to be told not to talk about our cadaver at the bar over drinks, because over the years people have called to complain to our professor about their 10-year-old daughter being traumatized by some medical student lab chatting at a local restaurant. We had to be told not to take home human bones in see-through plastic bags–this has been a problem in the past on public transportation. We also had to be told not to leave “cadaver matter” on the floor because the cleaning people come in to mop and are likewise traumatized by remnants on the ground. This needs to be told to us because over time, the cadaver becomes less and less human to the anatomy student–day after day we see it and cut it apart in a routine and precise manner –but to anyone else, humanity does not diminish.

I was introduced to a few of the social conflicts and emotional trials of my future profession in lab this past week. I will recount them here in a way that (I hope) is sensitive to the fact that many of you will not be dissecting humans any time soon.

1) For the first time, I truly experienced the internal conflict that will become a perpetual facet in my life as a doctor–the conflict between detachment and investment, seeing the patient as a scientific specimen and seeing the patient as a fellow human who is suffering. More than a place to learn bones and muscles, the anatomy lab is where this realization first hits home. At times I am enthusiastic, (I have already developed a reputation as the wild one with the scalpel), but at other instances I realize exactly what I am doing and lurch backward in disgust at myself and my own fascination with doing something so utterly abhorrent.

2) Among normal citizens, what we do in the anatomy lab would be criminal. We chop people up, take out their organs, and saw them in pieces. What a fitting introduction to an entire profession where such trust and exception is granted and accepted by the very same citizens who criminalize these actions in anyone else. We see people naked, physically abuse them, chop off their limbs, knock them unconscious and take out their organs, give them lethal substances, ask them personal and humiliating questions, touch them and poke them and prod them in places that many would consider obscene. And this is accepted by society at large. What a profound and overwhelming honor. What a horrifying responsibility.

3) I have never so bluntly faced my own mortality, or the mortality of everyone I know and care about. The dead body in front of me–terrifying in its lack of shame and self-consciousness, grotesque and misshapen, molded and swollen–was not a person at all, but a body that a person had left behind. Never has it been more clear to me how much of the beauty we see in the human body can be attributed to vitality. It radiates outward indeed.

We were given a challenge as physicians to always be working to see the humanity in our patients. I found this to be a sad challenge to assign–my biggest fear has always been being too empathetic, too involved. I was reassured that this was “never the problem,” and I would be acting in ways as a third-year that I would never believe if I saw them now. I would be disgusted with myself. Not surprisingly, this was not the “reassurance” I was looking for. Of course a certain amount of distance is required in order to do the job well, but there will always be a “gremlin” in the “gremlin in scrubs.” There will always be a common base that remains unaltered beneath the white coat, but acknowledging that commonality is an ever-increasing challenge for physicians, and thus will be a growing challenge for me. I look at the band-aid on my cadaver’s finger that he must have put on the day of his death and I am painfully reminded of this challenge. Thank goodness for Gremlin in Scrubs, for my family and friends, and for literature and art and writing and all other non-corporeal expressions of humanity. The impressions made upon one another will never be altered by sickness or lost in death.