A Special Gift - First Day of Medical School

credit: Instagram @skiddiejoan

What are your plans for tomorrow? The next year? Decades from now?

How about plans for after your death? No, I'm not talking about what you will leave your family, or even your legacy. But your physical plans. What will you be doing? Where will you be? It's not something most people think about. In fact, it's probably one of the things we choose to think about least. Place me in a box and in a special place with some sentimental value (under the tree where we got married, for example) and be done with it--let's not talk about it anymore.

Today was my first official day of medical school. And as I end it quite appropriately--sitting in the library with eBooks on my iPad, notes on my laptop, and anatomy flashcards spread about--I can't help but think back on what our professors call our 'first patient': my group's anatomy lab cadaver. He was an old man in his 80s who died of complications stemming from the West Nile Virus. I have no clue what he did for a living, or even the most basic of identifiers, like his name or where he lived. I have not even seen his face; we met him facedown, a black bag covering his head. From the color of his skin I would think he's Caucasian, but that's quite an assumption, isn't it? I can also assume that he was an academic, hence his reason for having an inclination to donate his body in the first place. Again, an assumption. If I do some research on West Nile, I can probably come up with a narrative about how he contracted the disease, and what his final days might have been like. And just after one day...such begins a string of tales I can't help but weave together about this man...a man who will never know a thing about me. And I'll never know much about him, but at the same time I will know more about him than anyone else has. 

And that's the fascinating part about it--for me, at least. This man gave his body to become a part of something he ultimately has no control over, no say in, and no representation of himself except for the body he has left. I wonder how much he understood what he was doing. Whether he knew that we'd peel back the layers of his being slowly and methodologically, marveling at parts of him that no one has ever seen before. When his family remembers him, he will be a father, or a husband, or an asshole uncle who no one went to visit in the hospital (because, let's face it, it would be unrealistic for every obituary to be filled with praise). When we remember him, it will be for the almost perfect way the striations of his muscles were revealed. Or the difficulty we had with getting through such a deep layer of fat. We will remember the shape of his vocal cords, though we will never hear his voice. The curve of his hip bone, though we'll never know the specificity of his gait. The grooves of his brain without gleaning a single thought, memory, or emotion.

It's scary. It's impersonal. It's intimate. It's confusing.

It's funny...because going in to anatomy, you dread getting the overweight cadavers. You hear they are hard to work with, take longer to dissect, and sometimes the structures can't be cleaned fully. Once in the lab, we comment about his girth and the difficulty that comes with it. We look at other cadavers for a moment more than a cursory glance and silently exhibit a bit of jealousy. Then we realize that this 'curse' is a blessing in disguise: our cadaver's muscles are big and well-defined. We quickly have one of the best cadavers in the room. Teaching assistants marvel over the detail. Very quickly, excitement replaces what had looked to be a particularly hard semester.

It's unsettling, when I think about it. When this man decided to donate his body to science, was he imagining that people would sing him praise or express frustration based on how easy or difficult it would be to dissect him? Would he have been as willing if he knew the criteria that we would evaluate him on?

Then again, maybe he had the right expectations. Maybe he didn't care at all about his body after his spirit/mind/consciousness had left it. Maybe he realized both the gift he was giving and also that it wouldn't always be considered a perfect gift. Maybe he realized that the students his body would be donated to would be uncomfortable, and that the only way to cope with three hours cutting through a being that was once capable of writing poetry, raising children, murdering, flying airplanes, or what have you...would be to focus on some physical characteristic that detaches the body from its resemblance to us.

It's hard to imagine my body lying in a room, under a sheet, all the lights off with my back torn open. Then again, it's hard to imagine lying in a coffin six feet underground (talk about scary....who started that tradition, anyway???). Maybe it's just hard to imagine being dead. And maybe going six feet under is more for the living than the dead, so that we can protect ourselves from the constant reminder that one day that will be us. In this way, cadavers remind us mortality. That something happens to us after, whether we're aware of it or not. If we're not on a lab table, we're somewhere else, most likely a lot less useful. And a little less remembered. And that's uncomfortable. 

This is borderline procrastination. I should be working on my novel, or studying (or trying to find some revolutionary way to do both at one time), and this somehow feels more legit than browsing Facebook. I guess it's important to get my thoughts down, because who knows how much of me will change. Maybe a little, maybe a lot, and I can't say yet which would be bad or good. I only hope that I retain my reflection, my humanity, and at least a memory of the mindset I once had. And keep writing. Otherwise, how will I be able to speak up for myself when it's my turn to be a gift?

Sidenote: I haven't updated this blog in quite a while but I'm still writing and chugging along. There have also been big changes in my life (med school, marriage, alien abductions). I'm not sure yet in which direction this blog will go, but let's hope it stays live. I don't think my well-being depends on it, persay, but it can't hurt!

"The Deadliest Sin" To-Do List 9/30/11

I'm keeping a list of questions that are coming up as I write, so that I can go and research them later. Obviously, some of the more telling details I might leave off.

To Research

• How states/counties deal with heat waves
• Who would ensure a city lake is safe to skate on in the winter?
• Best way to skip rocks.
• Raccoons --> do they live in Virginia? How do rabid raccoons act?
• Oval communities -- characteristics
• Dental assistant role
• Dentist office staff
• Dentist registry
• Dental operating room..?
• Massage techniques
• Process of pressing charges for third-degree murder

I need to sit down and create a timeline. I have the first few/several chapters outlined, but since I'm following multiple families in Pens with different conflicts, I need to know exactly when everything happens relative to everything else. It should be helpful to get on a whiteboard and just list out the days following the 'big event' at the beginning of the story, and then match them with subsequent events.

I need a new name. 'The Deadliest Sin' isn't going to turn any heads.

I need to finish outlining the first half of the book. The first half of the book is going to have a slightly (read: significantly) different structure than the first, so it's important to get that first half down.

Gordon Ferrell - Lunatic of Pens

Gordon was born on June 6, 1955 in Pens, Virginia.  His father, Edward Ferrell, had fought in World War II. Ed never talked about his experience, but Gordon's mother said he was a changed man when he got back. There was a fire burning in him that spared the need to sew his seed, and Gordon was the third of eight children over 10 years. For most of his life Gordon remembered his father as a drunk, and sometimes a mean-tempered drunk. Gordon managed to slip under his father's radar, unnoticed and untouched by his rage. Gordon learned how to be conniving when he needed to, and soon became used to throwing one of his siblings under the bus to save himself.

Gordon grew up in the church under the spiritual guidance of his mother. The memories he did have of his father were short, as he spent most of the time at the church. He joined the choir when he was eleven, although he couldn't sing. When that didn't work out, he floated around different positions in the church, until he became the treasurer when he turned eighteen.

It wasn't until Gordon was thirty that he began to embezzle money from the church. His mother had just died of cancer (his father had died by the bottle years before, but that hardly had an affect on Gordon) and Gordon began to see religion in a different light. It hadn't done much to help him, so he'd have to fix that.

But Gordon wasn't the only liar at Holy Pens. As a long-time church member, he noticed things others didn't. And he became quite sure that Pastor Leroy Cummings was taking more from the congregation than offerings. He 'accidentally' walked in on the pastor taking one of these offerings from Patricia Hawthorne in his office one Thursday evening after Bible Study developed a drug addiction from his newfound money. Pastor Cummings knew about Gordon's habits and threatened that he would have him arrested for embezzlement if he spoke any word of what he saw. The church was all he knew, and Gordon wasn't ready to give that up, so he obliged. Still, the Pastor was paranoid and eventually forced Gordon to leave. Gordon later heard whispers of his crimes amongst the congregation and he became ashamed, and furious. There was nothing he could do. Pastor Cummings had gotten in the first word, and anything he told now would merely look like the ramblings of a desperate sinner.

Gordon turned to drugs, though he continued to read the Bible everyday. Sometimes he would get them confused, the feeling of the Spirit when he prayed and the high when he injected.

When the infamous heatwave hit Pens, Gordon had been addicted for five years. His mind had become fried, and he obsessed over getting back at Pastor Cummings. He ended up hiring a HIV-positive prostitute to seduce the pastor. The pastor died during sex and became one of the many victims the day of the heatwave. Gordon didn't care either way. People now new the truth of Leroy Cummings. His sins had been paid for.

Gordon went through a change that day of the heatwave. He saw 'the light,' as they say, and it was good. He stopped drug abuse and studied the Bible even harder. Because now the Lord was speaking to him in a whole new way. The Lord had a purpose for Gordon. He had never felt that before. The Lord needed someone to bring the sinners of Pens to justice. Gordon's seen these sinners in his dreams, and has been making a list. And he would do anything for the Lord...

Gordon Ferrell may just turn out to be the most interesting character in this book. Is he doing good, or conducting evil? Is he a soldier for the Lord, or is he merely the Devil's pawn? As Pens goes to hell, how will his role be refined, intensified?

And, most importantly, who's on his list of sinners, and how will be prepare them for judgment?

'The Deadliest Sin' - My Novel in Progress

I'm writing a book tentatively entitled The Deadliest Sin. I don't want to give too much away, but it's about a small Virginia town which is slowly going to hell...literally. There will be (and are already many) characters in this tale, but the main one is Michael Barboza, a thirteen year old latino boy. He ultimate task is to discover what's happening to the town of Pens and save the people in it before.....that's right, before it's too late! Got to love the cliche.

There are a lot of journeys I'm currently conquering right now in my life. I'll be a married man in less than three months, I'll be in medical school (hopefully) in less than two years, and I'm still trying to find my own personal relationship with God.  This book represents that last journey a lot, but also allows me to continue with my passion for writing horror. I don't envision for this to be a book that any pastor would put on the Christian reading list, but at the end I want it to reflect some of my own thoughts about existence and God.

What I really like about this project is the prospect of building a whole town. It's a little intimidating and, honestly, might be outside of my current skill level. Hopefully that proves not to be the case, and even if it is, the only thing I've lost is time and bad writing habits. It's loosely based off of my family's hometown, Martinsville, Virginia. A little southern blip on the map which has been going through a lot of changes over the decades economically and culturally. What's the history of the town? Is it divided by socioeconomic status? Race? If so, in what ways? Is the biggest employer Walmart? Is most of the population Republican? Democrat? Christian? How would the city handle a natural disaster? Does everyone know everyone else or do you meet someone new everyday.

These are the questions I have to answer. The first part of the book is spent getting to know all of the different players, both big and small, as the town goes through its 'changes.' I like to think of these almost as a series of short stories that interconnect. Later in the book the focus will be on Michael and his specific journey. 

The plan is to keep blog posts as I go through the writing process, talk about the progress I've made, the obstacles I come across. I have to research a little bit the best way to do this. I.E., what's TOO much information to post on the Internet? I'm thinking of doing character profiles and tell about some of the residents of Pens, one by one, but should I keep that to myself?

I'll look around and see. But, for now, back to writing....

No time to write....or do much of anything

I have two tests coming up this week, one in Cell Bio and the other in Organic Chemistry. Surprisingly, I'm more worried about the Cell Bio test, but I'm studying more for OChem because...well, because' it's freaking OChem.

The sucky thing is (well, besides having a test one day and then a test the next...) is that I haven't had much time to write this past week. I've gotten literally sick sleep-depriving myself and still couldn't find the time to do the thing I love the most. And, of course, the last few days any free time I might have maybe could have possibly obtained was spent getting rest because....well, because I'm freaking sick!!

Excuses, I know, but hopefully things will get better this upcoming week. Although I do have a problem set due Wednesday in Physics (the day after my second exam). It shouldn't be a problem, as Physics is one of those subjects that comes easily, but it simply means I will either be up late Tuesday night or rushing to get it done.

When I decided to start taking classes again I was afraid I would hit this road: choosing between studying and writing. My classmates study a lot more than I do...I can hear them talking about it all the time. Even though I've been sleep-deprived this past week, I've spent some of my time doing things like reading novels (because a writer has to read!), going to my writing group, and trying to get my Twitter game going. Oh, and I've found this awesome podcast, Writing Excuses, and you should definitely check it out.

Don't get me wrong, I've been fairly on top of my assignments. Homework turned in on time, online quizzes mastered, pre-labs done, and I've been to every single class. Even an office hour or two! But I can't help but feel I am less prepared for Monday and Tuesday than everyone else, and I hope I can make this happen. To be honest, the biggest thing that bothers me is that writing has no logical weight in my priorities now. As in, if I chose to spend 2 hours right now writing instead of studying, that doesn't make any sense (assuming I need those 2 hours).

Still, that's what I'm about to do. And hopefully my plan to pull a pseudo allnighter doesn't backfire. I seem to be getting over my sickness. I once heard that once you get over a cold, you won't get one for at least another 6 weeks because of the body's immune system. It's probably a crock of shit, but sometimes shit is all us writers can depend on.

'Creative Writing Can't Be Taught'....

Interesting commentary by Stephen King. Can Creative Writing be taught? He's mostly focusing here on that the reason writers pursue a career in teaching is to make ends meet while they are trying to become successful as writers, but there is something else implied: taking creative writing classes is a waste of time. The only way to become good/better at writing is to read a lot and write a lot.

Hmm....let me cogitate on it for a while.

When the Air Hits Your Brain - My Thoughts

When I was walking back to my car after one of my shifts this past summer at UC Davis Medical Center, I had brief small-talk with a surgery resident. He asked me what services I had been on and what I was interested in the most. When I mentioned neurosurgery, he suggested I look When the Air Hits Your Brain by Frank Vertosick, Jr., M.D. He was a surgeon, and I a lowly pre-med student, so of course I wrote down his advice as if he were God and I was Noah and the ran showers were starting. I started reading it a couple weeks ago, and finished within a few days. Here are my impressions.

Dr. Vertosick begins at the beginning of his medical career: medical school and how he became interested in neurosurgery. His reasoning was more than a little odd to me. Neursurgery was his first rotation in his third year of medical school. At the time he saw the specialty and the work involved in it as boring and tedious, and there was no strong consideration during to pursue it as a post-graduate option. Still, there are stories he remembers from the rotation, one of which had significant importance. One day he was doing a physical on a patient who had been admitted for the removal `of a herniated cervical disk in his neck. Frank noticed that the man's pupils were aymmetrical. That, coupled with some other key symptoms, led Frank to believe the patient didn't have a herniated disk at all, but a tumor. He reported his finding to the resident physician and was able to save the man from an unnecessary and potentially harmful procedure. Some months later, the director of neurosurgery called Frank the Med Student in for a meeting and offered him one of the two neurosurgery intern positions after graduation for his 'good eye.' Frank said he had to think about it. Later, while working in the immunology lab for a side research project, Frank was moving materials under a microscope, where the slight tremors in his hands were exacerbated. The lab technician teased him about it and flippantly commented 'I hope you aren't going in to neurosurgery.' Frank was so offended by the jab that he called the neurosurgery department that night and told him he accepted.

When I read this I literally took a second to scratch my head. Huh? He became a neurosurgeon to prove something to himself? It's certainly not a reason you would bring up in an interview (which it sounds like he didn't have to have). As a pre-med student, I'm starting to get various strings of advice, and some of them have to do with interviewing. We are constantly presented with the question: why do you want to be a doctor? There are the good reasons and then there are the not-so-good reasons. 'Because someone told me I can't' doesn't sound like it would impress anyone.

At the same time, the real world is different from what people say in interview settings. So while it bothered me a little why Frank originally went into neurosurgery, in the grand scheme of things, I don't think it mattered much. He was honest with us, and from the rest of the book it is clear that he cared for his patients and his profession at the level we would all hope from someone with such responsibility.

Dr. Vertosick goes into great detail on some of the surgical procedures he was apart of. Having recently observed a few neurosurgeries myself, I especially enjoyed these pieces. One of them I'd even seen in person. With just about all of the procedures he described, he also told the backstory of the patient. He used these as examples of the many lessons he learned throughout his residency, such as being a surgical psychopath, not being too confident, and that no matter how bad a patient is, you can always make him or her worse.

I really clicked with the commentary on surgical psychopathy. It's an aspect of being a physician I am both apprehensive and understanding of. On the one hand, I never want to become the type of person who is unaffected by death, or who looks at the patients as just numbers on a chart or another procedure. If I make a decision that ends a person's life, I don't want to be able to shrug it off, go have a beer, and forget about it the next day. On the other hand, I don't take death well (at all) and I realize it will be extremely taxing on me as an individual if I let each mortality hit home. Will I be able to strike a balance? Can I gain some of the psychopathy without crossing totally over to the other side?

From reading When the Air Hits Your Brain, it seems that Dr. Vertosick has walked the line and has ended up somewhere on the caring side. There was a particularly heart-wrenching case of a newborn with a brain tumor. They worked on the infant but the tumor was so deep that the damage done to remove it was seemingly irreversible. That, and the cancer would almost certainly remit. The advice to the parents was to say their goodbye's and not come back, move on with their lives as soon as they could, as there was nothing that could be done for the child and the longer they lingered, the longer it would take to try again in starting a family. But the baby ended up living longer than expected, and had more cognitive development than expected. She was soon able to laugh and play, and Frank visited her often. As predicted, however, the cancer came back to take her. Before it did, though, Frank spent nearly a whole day with her. He says he will always remember how, in those moments, he was the most important person in the world to her.

What more fulfillment could you get in a profession?

There were other stories just as thought-provoking, but I don't want to spoil it all here. I have a few areas of critique, as is inevitable with any public piece of work.

For one, the narrative seemed a little rushed at points. For example, I think he went from his first days as an intern to his third year of residency at the turn of the chapter. Or, at least, I was temporarily confused about the progression. All of a sudden he seemed very comfortable in his environment, and the story quickly migrated from telling of his personal transition to focusing on the patients. I was wondering where his confidence had come from, and at what point he went from feeling like a clueless med student/new physician to a surgeon who could challenge the knowledge of other people.

I must admit that I felt a little disappointed by the amount of detail left out concerning the lifestyle of a surgeon. When I picked this book up, I was hoping to come away with a better understanding of how residency is for someone who chooses this profession. I'm getting married in December, and one of my main apprehensions about surgery (and especially neuro) is the demanding lifestyle, and if I can be successful in both my career and my family at the same time. Dr. Vertosick mentioned his girlfriend/eventual wife only a few times, and those were in passing. I was wondering how he maintained the relationship during, or what arguments and hardships might have come out of the lifestyle he chose? When did he get married and how did that affect his career? How did he deal with the long hours of being a surgeon, and was he able to balance work with other aspects of his life? None of that was in there. I can see why the decision was made to keep the focus on the patients and the procedures, as that is more exciting for the average reader, but I came away feeling like I only got one side of the life of a resident: in the hospital.

Still, Dr. Vertosick writes with care, detail, and a poignant grasp of humanity. He is a person who rips people apart and puts them back together, sometimes with dire results, and he knows it. It really is amazing the types of things he has done, and for that I recommend this book to anyone who can read. Sure, it's about being a doctor, but it's about being human more than anything else. And who can't relate to that?