sense and sensibility

From: Sachin D. Shah [mailto:sdshah@alumni.princeton.edu]
Sent: Sunday, October 03, 2004 9:32 PM
To: 'matheyites@yahoogroups.com'
Subject: sense and sensibility

a sad story from this week that I felt compelled to pass along. sorry this is the first thing you're hearing from me in a while, I've been meaning to write, but I just haven't gotten a chance to.

I'm in my third year of med school now, and I started my clerkships this past july, so I'm in the hospitals full time. for me this has been 100% better than the first 2 years in which we were just lectured to and required to memorize exorbitant amounts of information for exams every 2 weeks or so. while most of the information was admittedly important and at least somewhat relevant to our profession, it just wasn't my bag. I like the process of applying and solving, not the mindless hoarding of information that is unfortunately highly rewarded in medical school.

still, finally doing what I signed up for remains a double-edged sword, since it exposes me to realities that by association with the journeymen and women health professionals I'm training under I feel myself becoming desensitized to. what once were (and still, I can't help thinking, should be) overwhelmingly genuine, striking examples of death, suffering, and tragedy (to name a few abstract characterizations) are becoming alarmingly routine. so many in this profession I'm training to join, I'm finding, are callous human beings. and I feel myself becoming subject to this inertia, which is undoubtedly a personal (collective) defense mechanism.

I've been on surgery the past month and change, and I still have 3 weeks left. it's been simultaneously fascinating and depressing, since I've been working on the trauma service in the only hospital in one of the worst parts of detroit. I see about 4-5 gunshot wounds daily, another 5-7 each night that I'm on call, and at least that many victims of motor vehicle accidents, in addition to frequent stab wounds and victims of assault, gang violence, and any number of other run of the mill traumatic injuries we associate with 'rough neighborhoods' and avoid like the plague whenever possible.

the last 5 days, for example, I've scrubbed in on 5 exploratory laparotomies secondary to gunshot wounds. a laparotomy entails taking a scalpel and making a giant midline incision from the xiphoid process (the bottom of your sternum) down to the waist, and just opening up the abdomen to assess and hopefully fix the damage that bullets and shotgun pellets do. we've done countless bowel resections and reanastomoses, spleen repairs, liver repairs, and all the other abdominal and other critical repairs you can think of. we leave the brain stuff to neurosurgeons, but most of the time, as you can imagine, there's not much to fix once a bullet has gone through your brain.

the low point last week was tuesday when we got 4 people in at the same time with GSWs from a guy that opened fire (w/ an automatic weapon) in the morning at a daycare center. I was taking care of a 3-year-old girl (3 years old?!) who was shot in the head. this beautiful child took a bullet that went in the back of her skull and came out from the top of her head. she didn't make it. I don't know what anyone could have done to deserve such a fate let alone a 3-year-old girl. don't even get me started on the absolutely asinine obstinance that continues to pervade this country in regards to gun control (how recently did the ban on assault weapons expire? how many people did I hear saying that those weapons don't have much of an impact in the grand scheme of things?). all the legislators and NRA members that oppose such fundamental common sense should have to spend a week on the trauma service at this hospital and tell me that they still feel the same way afterwards.

the hours are long. I wake up at 4 every morning, and with my 2 call nights last week I worked 99 hours on the nose. but in truth I don't mind it too much. most weeks I have one call night and I end up between 85-90 hours. I'm not doing much else right now b/c I simply don't have the time or the energy, but I figured this much coming in and know it's for a finite period of time, which makes it not too bad. too much associated bullshit for me to want to do surgery, like hierarchy and egos and blind ambition and competitiveness, to say nothing of the hours, which render you rather one-dimensional, by my estimation--or would me, in any case. but it's undeniably cool stuff at the medico-scientific and technical level, and I'm learning a whole lot.

but I'm also recognizing a subtle transformation in my attitudes toward human tragedy since I've been seeing so much. it worries me, but I guess I understand it, because we become desensitized to that which becomes routine to us, which I guess makes this transformation simultaneously natural and unnatural.

but I do think that I would be allowing these events to become far less routine to me if I were on my own experiencing this, and were able to trust my intuitive reactions more. it's amazing how influential the people around you are in these situations. you suppress what is natural in order to assimilate, so that you more rapidly blend in and appear to know what you're doing, which is a coveted way to be perceived in general, and this profession is no exception.

on the bright side, I'm doing ob-gyn next, starting on october 25th, for 2 months. I'm also doing this rotation in a pretty rough neighborhood, but at a women's hospital that is renowned for its maternal and fetal medicine program. we'll get a lot of complicated pregnancies with very little to no prenatal care, but I should get to deliver between 30-40 babies over those 2 months, which should be an energizing reprise to what I'm doing now.

I guess that's all I got for now. I hope everyone's doing well.

I miss you all.
much love,
sach