Only the Weak

I had to remove this blog. I had originally set out to make an achingly personal point by creating an anonymous person who was the compilation of multiple people I knew and experiences I had. However, I suppose it got out of hand and put in too many specific details which eventually lead to me pushing some buttons I didn’t originally intend to push.

I found myself at an impasse; I felt really strongly about something, an issue that has haunted me all throughout college, however I relieved it unintentionally at the expense of someone else. So what is fair? I keep it bottled up and have it eat at me, or piss someone off? I originally intended to write the blog knowing that none of my immediate friends knew I had one. I wrote it so that I could clear my conscience; put my thoughts into a neutral zone. Psychologists of the Lacanian school call it telling the “Big Other”. For example, when a child, while no one is around, says “I’m taking a cookie from the jar” as he reaches in to grab one is essentially telling The Big Other. He is relieving himself of guilt by stating what he is doing, so that he can complete the action with no harm done. He’s played by the rules. He has has done it with a clear conscience since he has promulgated the action. This concept is what “fine print” is all about.

This was my intention, to put into words something I cared about, and to put those words out there so that I could relieve some of the tension. I was confessing to the Big Other, letting the anonymous ear listen. Its interesting, though, that I did strike a chord with people who did read it. It wasn’t a personal attack, and should not have been taken as one. I was merely holding up a mirror; trying to make a point larger than a personal relationship.

SPSA: 34th Annual CME Conference in Traverse City, Michigan

At the moment I’m in Traverse City, Michigan with the Society of Philippine Surgeons in America attending their 34th annual Continuing Medical Education seminar in surgery, more specifically entitled “Surgical Highlights 2008: Controversies, Problems and Techniques”. I’ve been coming to this annual meeting for two years now, where last I year I was in Norfolk Virginia attending “Surgical Highlights 2007: From Complications to new Technology”.

Rather than droll on about the different surgical lectures (all of which at the moment I have trouble following due to my inferior medical knowledge), I have found a common thread that seems to catch the perview of all the experienced surgeons that attend. It is a simple one; new surgeons that are practicing now have been subject to advanced technology and are therefore losing “old school”, yet critical surgical technique. Case in point, the ability to convert a percutaneous laparoscopic procedure to an open procedure when complications begin to arise.

Take for example a laparoscopic cholecystectomy. The stigma is that opening a laparoscopic procedure is a sign of an unskilled surgeon. However, the opinion and statistical data show that laparoscopic complications (i.e. bile leak) occur after the learning curve; it is the experienced surgeon that becomes a bit too comfortable, thus leading to a problem. Compound that fact with no training in open surgery, and we are left with the statistic that only 0.1% of open choly procedures have a post-op complication, versus the 0.6% complication rate of a lapcholy. How does such a stigma still survive when the “advanced technique” produces 6 times the complication rate of an open procedure?

I guess the point is that yes modern technology helps in tremendous ways. Yet, we lose the art of surgery; the feel for the anatomy is lost to the secondary interaction via cold steel, the surgeon is now working in two dimensions on a tv screen, rather than three. I think the take home message is frugality with technology, and therefore one should not abandon the classic procedures, but cultivate such skills.

Marx talks about this phenomena. He describes man as “an appendage to the machine”. I’d like to think that what I will be doing in the future evades such a benign fate. I think that I am fortunate to have such a glimpse into the minds of the experienced, and I plan on taking their concerns to heart when doing my surgical training. To some, technology is God, but to others, I hope some of us find it scary when surgical procedures are no longer the outcome of a surgeon’s dexterity, but an outcome of the maturity of the technology being utilized. The newest and best thing in the technical world always has a built in expiration date, but refined skill and practice remains constant.

Thoughts?

Summer Anxiety

I guess this summer should be, or at least one would think it to be, the quintessential summer of freedom. This is how I at least hoped it would be. However, after 3 or 4 graduation parties, I soon realized that the rest of my friends were racing towards the “real world”, leaving myself behind in a lagging haze, awaiting a fresh start in academia.

Its strange. Perhaps I should have had this experience in college, however I did not; I’m living with another MS1 in my class, a person whom I have never met. However, in college this experience comes with a sense of security, rooms regimented and set up so that this type of relationship reiterates itself per dorm floor, leaving for a sense of community amongst those sharing the same anxiety. In my case, I found a place in North Philly, went onto our blog, and wrote “help, I need a roomate”. I got a response, which is money because it cuts my rent in half, yet, for the first time I really feel stranded, left to be defined solely by the consequences of my actions. No academic advisors, no mass-exodus to and from lunch, no crowd to follow up and down the main artery of campus, no patio to sit on to enjoy the blur of life as it passes by, no 2 minute walk to class in whatever I decided to sleep in that night… no scranton community. I went to a small liberal arts college where everyone I knew was within a mile radius of me, everyone purely available when needed. Imagine diluting such a community over the greater philadelphia area… thats my class and their physical proximity to one another outside of Temple… I was always on the more stoic side of the scranton culture, but I always had someone I knew and could trust right around the corner. In a month, I will be living in a corner of the city, living a preset schedule, running a pre-planned life for success. What if I miss something, or forget a form? Will there be that frequency of social interaction that allots for the probability of discovering my own mistakes and shortcomings? or, Will I go on ignorant to something I may have done (or not done) until its too late? I guess what I am asking is the whole sense of community gone for good once the Wachovia Center empties that afternoon in May, leaving only promises constrained by the new limits imparted upon us by the “real world”? Maybe I’m being too harsh, or perhaps blowing this feeling out of proportion. But at least I’m glad Ifeel some sort of anxiety. I trust that its better than feeling nothing at all.

I hope this sort of anxiety will soon be replaced by excitement. Nix that. I hope the fact that all this is really happening soon hits me as a reality in itself. I’m still unable to believe it. I do not want Med School to pass me by in the same way that college did; a reality too fast to get a handle on. Memories blurred into random conglomerations due to the inability to be conscious of each and every moment.

There’s an interesting problem; time flies when you are having fun, completely immersed in your life at the moment, and thus, unable to consciously recognize each and every one of those moments until they are only elidgible for recollection. So whats better, participating only part-way in life, living the other part in your head as a narrative, forfeiting some participation, so that the most precious moments don’t slip away without notice? Or, completely immersing yourself everyday in your experiences, not missing any crevice of the reality around you, living in one sense, a vibrant experience in real time, but a diluted life when becoming conscious of it? Stopping to smell the roses is nice, but what do you miss in the time it takes to do so?

Right now, I’m in Hafey, typing my reflection paper for Dr. Steele.

Thoughts?