I obviously haven’t written in awhile- although I’m not sure if that matters much, since I may be the only functioning reader of this journal at the moment. However, that’s neither here nor there. I originally had larger plans for this site, but like all new adventures, the novelty tends to wear off as my goals beforehand seemed rather grandiose for this project. I suppose it’d be more advantageous to keep myself restricted to simplicity; that is, focus on one topic instead of spattering all my current, instantaneous thoughts on the page in no particular order.

I, therefore, will waste no time in going against my own prescriptions and offer two things to consider, and hopefully, at some point in the future I’ll have a chance to explicate each in less abstract terms, and more detail.

The First: I’ve been keeping up with the New York Times as they have been following the current evolutionary strides being made in the field of genetics. The newest prediction to hit the pages is the thought that starting in 2019, a mere decade away, all children born will be genetically mapped so that a regiment of preventative medicine can be put into the works for the course of their lifetime. Obviously, there are a slew of ethical considerations to take on, but I’d like to address one; how will this shape one’s view of the human? What will it mean to be human?

Oddly enough, in most of their articles, you only find a mention of “ethical considerations”, without any expansion on them whatsoever. I find that to be a bit scary, as it seems indicative that the general public are either fine with, or, more importantly, don’t necessarily realize that going forth with these possible practices (genetic mapping and such) seem to intrinsically reduce the human to a sack of self propagating cells that, at some point in the future, will undergo some sort of defect in their machinery, and it is the future of medicine to intervene any such defect before it becomes a true problem.

Don’t get me wrong, I am for genetic research, as part of me is a scientist, however my philosophical conscience has been feverishly trying to locate the real problem with this. Thus far, I’ve only really described the problem that is the basis of the movie Gattica – but what of this implicit, unstated reduction of the human? I wish to avoid the commonplace conversation, so I’ll move to the possible practice to be instituted in 2019.

Conservatives and those of religious beliefs hold that life begins at conception (give or take), and that every life is worth saving, as each is human. However, immediate genetic mapping poses two more criteria that I can see, that may negate the conception-human life relationship.

The first is the classical criteria where one can look at a newborn’s genetic map and place him/her amongst a hierarchy of the rest of the newborns based on physiological data, and more importantly, genetic predisposition to disease where one can not only associate a certain probability in the eventual development of certain diseases, but the certainty that such a disease will develop. I find two inherent complications with this- (1) what is to stop someone from placing a cutoff point as to what level of health is considered “socially acceptable” or, in some sort of construed utilitarian argument, “whether the life of the baby will contribute to the common good of the family”, and, if the argument is made rather elegantly, “whether the child, when grown, would find his/her own life worth living” (which would correlate somewhat with the conscious decision to commit suicide, or fill out a DNR card). Another way to say this is what would be the new definition of disease? Currently, we have children, who, over the course of their lifetimes, like all of us develop disease. However, akin to the concept of Original Sin, over time, do genetically mapped children now bear the burden, the label, of being born “diseased” children without ever having developed a single symptom? I fear that our view of the human may be severely impacted by an inherent change in the way we may view disease. (2) The privacy of this information would be compromised. In all practicality, money can buy you almost anything in this life, as sad as that is, everything material in this world has a price, including the dignity of most people. This genetic information would be an investment for pharmaceutical companies – children may become the new retirement plan for drug executives. Search out the few newborns with daunting probabilities for the development of some debilitating genetic disease, and you have the freedom to map out the “preventative” treatment plan for the rest of their lives.

The second, is perhaps, a bit more of a fallout affect of the first. If we are to start raising our children according to a lifelong treatment plan designed from genetic probabilities, what happens to natural evolution? The human body has an amazing ability to adapt and evolve. The drawback, it takes time. With genetically based preventative medicine, we do not speed up the process, but bypass it. Thus, have we lost a pivotal physiological component to the human? Minute to minute adaptation to one’s environment is a function of the frontal lobe of the brain, a sophisticated area of integration driven by real-time practice. The long term effects of such integration allows each successive generation to evolve in complexity, thus discovering new parts of their reality, interacting with their environment on a level higher than the generation previous. This latter part is not so much physiological, but more abstract, a higher level of human consciousness – though I fear we may soon compromise this ability and its growth, for, is it not that higher level of consciousness that serves as the basis for our most fundamental social, educational, religions, political (the list goes on) institutions?

This second consideration (as I mentioned in the beginning I have two) is one I just began thinking about, but I am always open to input, as I have yet to set myself on any specified track on the matter. There is a class that runs the hour before my grad philosophy class (oh, by the way, a little update on my life – I’m taking Aesthetics with Dr. Joseph Margolis where we’re trying to articulate the relationship, if one exists, between the aesthetic and the ethical) called Philosophy of Mind. The goal of this class is to try and justify the “a priori”-esque faculties of the human mind with the hard wiring of neuroanatomy. I always like to think that we’re more than our wiring, but based on the above discussion, the way we’re headed may soon prove me wrong.

If you’ve read this far, congratulations. Your patience is much appreciated. Now its time to see if any of this makes sense to anyone, haha.

sorry its been so long since I’ve last written anything. Last semester ended with my head buried in biochemistry, christmas apparently came, and now I’m back to the grind in physiology. Life has been challenging (insanely hard), intellectually stimulating (absolutely confusing), and nothing less than beautiful in its complexity, all while being constantly being outrun by time.
I have some updates on my life, but, more importantly, some things to think about.
More to come…

I found myself looking in the mirror last tuesday.  I thought I looked different, but didn’t feel so.  To tell you the truth, I didn’t feel anything, I just chuckled at myself.  I’m not sure why that was the reaction.  Maybe it felt natural, but why should it have?  Maybe I’m just not one for entitlement.  Whatever the case, I was staring at myself, in my white coat, stethescope around my neck, collared shirt and sweater underneath.  On a most elemental level, thats not me. But it was. It is.

I know it is because the Friday before, Nov. 16, I found myself sitting on the board of the Temple University Hospital Ethics Committee with our guest, Dr. Rita Charon of the Columbia University School of Physicians and Surgeons, an M.D., Ph.D who was also scheduled to give the Keynote speech later that evening at our White Coat Ceremony.  Who do they see that allows me to even be sitting amongst such accomplished academics?  I felt like a forgery or authority.

Nonetheless, I got to listen to the creator of Narrative Medicine, an entire field devoted to the narration of the physician’s experience;  whether on a basic relfective level, the level of a factual account, one of inquisition, or even to the point of phenomenological examination.  I can imagine it sounds cheesy compared to the precision and complexity requisite to the tradition of the medical sciences.  How cheesy, adding the humanities and art into medicine.  All those useless humanities courses taken in college just “to get them out of the way.”  How absurd, humanism in medicine…

The College of Physicians and Surgeons sends their students to the Metropolitan Museum of Art on assignment.  I know my father would be furious if I was a student Columbia Med spending my time meandering the exhibit halls of the Met.  What for?  Purpose.  Why.  Purpose, setting the structure for all that we do, leaving no space to just do (though this is an entire other digression that I will not delve into at this moment).  Our job as physicians is to be observant; we are trained to see and absorb as much information at a visual level (in addition to others) as possible.  Go look at a Picasso.  What do you see?  What can you abstract from abstract art?  What is there?  Art in Medicine, training the eye to pierce the surface, to navigate what is present, and, more importantly, what is not.

In my previous entry I spoke about exceeding in life on a structure not traditional to “success”.  Exceeding through creation.  Dr. Charon carved out an entire new field of Medicine herself.  Awards and Ribbons eventually go to waste in storage boxes.  She created something.  She made medicine a part of her life, the other part a Ph.D in English, and found a space where the two fused and precipitated a field that more and more students and physicians alike are yearning for.  I have a passion (if you cannot tell by now) not for balance, but for harmony, between philosophical inquiry and medical science, which for so long have been mutually exclusive entities.  A heart and lung tansplant surgeon was at the meeting, and he expressed the same yearning.  Here is a man trained to the highest degree, a master of his craft, who finds himself no longer interested in the dynamics of procedure, but in the non-physical interior of the patient.  What has he truly done to help his patients?  He may have fixed some machinery, but telling by his tired, deep-set eyes, he may have come to a reality that most of his efforts are in vain if he cannot read what is hidden in the deepest corners of patient’s persona.  A void science cannot fill. How scary.

I found Dr. Charon after the ceremony and thanked her, still feeling funny in my starched coat.  She put her hands on the lapels of my jacket, here eyes piercing mine, looking into me as if she knew me all my life.  She fixed the collar and said, “Look at you, you’re there.”  I’ll never forget that moment. It was a verification, a confirmation of my place in the field.  The ceremony itself had no real effect on me, but at that moment, her words elicited a reaction so visceral I can still relive it today with the utmost clairvoyance.  A pure mental marker in my life.  Absent from then until forever, but ever so present in my everyday.

I wrote in an earlier post about the preservation of consciousness while living the everyday, which, I believe, requires a limitation of participation so that we may “smell the roses”, so to speak.  So that we may have that moment of clarity, full awareness of time and place in that very moment; a mental landmark in the day.  Inevitably, taking such a momentary hiatus requires we “step back” from reality, disengage, and perhaps, become invisible for a moment.  I believe that I’ve rediscovered this conundrum in a different form; one that questions freedom in the face of invisibility.

I’ve been in medical school for almost 4 months now, or perhaps more descriptively, for a lifetime’s worth of experience and headache.  The density of the overall events in my everyday are staggering, and by the mere nature of this whole process, are beginning to swallow my presence in the normal everyday social structure I used to take part of.  I feel like I’m disappearing.  I feel free.

So how free are we to do what we want?  I’m taking this from a moral standpoint, the very fabric that tethers our human relationships.  When submersed in the everyday social structure, that of friends and family, our options and actions are restricted by our obligations to those around us.  Sure, we say we are free to do anything, but is freedom in the off-handed option to say so, or is it in exercising that option?  I find that my life is taking a turn that will sever many of the already anemic interpersonal relationships I have now, perhaps labeling me as selfish, but its a path I want to take.  I find that there are those people who die before they’re forty, capping their human potential in exchange for mere financial survival, those who have perfected mere survival in a life of luxury, though still mostly dead in the water when it comes to any sort of substantial existence, and then there are those who live on the periphery of the normal social constucts.  There are those who live their lives by exploiting every opportunty given to them, regardless of how society regards the activity, and excel on an entire different construct.

Maybe that is what we all strive to be, yet, held back by the “reality” of our lives.  Maybe I am selfish in wanting to take this path.  But, when educated everyday on what compromises the integrity of biological life, it seems completely absurd not to go forth and do so.  Heidegger once said death is “one’s most own”, which lead to a philosophy professor of mine to tell me “once we are born, we are old enough to die.”  How absurd. How true.  Like I said earlier, I feel free.  Though, I feel more lost than ever.  There is such a salient mental weight I find myself carrying around everyday; something to the effect of “this is not enough”. 

I know this entry seems rather disjointed, and perhaps vague, but thats the idea.  I still can’t put my finger on it either.  Like a thread with too many ends, I can’t find the one that tethers the entire thing together.

I sawed a human head in half today.  First, my lab group and I disarticulated the head (i.e. popped the skull off the vertebral column), then proceeded to take a saw to the midsaggital plane of the face.  I don’t know if there will ever be a time ever again where I will question, due to such a frontal assault on my reality, the constitution of a “human” who is no longer living.  There is nothing like watching bone dust settle into the cranial cavity or feeling it wander into your nostrils that makes you think of a cadaver as anything but human.

This discussion has been floating about in our class; though it is not so much centered on whether or not the cadaver is human is in fact human, but is our natural objectification of the cadaver indicative of our future encounters with patients?  That is, is the numbing process really taking place, and if so, how quickly.

I’m not interested in that.  Its a bit self-centered, something to be conscious of, but nevertheless somewhat inevitably going to happen to some degree.  Perhaps its the distance, the lack of personality, that is the key to keep going.  Overt emotional investments seem to be anchors that prevent a doctor from being a doctor.

I’m really after the first part, the label that is automatically applied to the cadaver; that s/he is in fact human.  Is the cadaver human?  Isn’t the word cadaver an immediate, perhaps subconscious, predisposition towards objectification?  Its one we seem to overlook.

We can take the classic philosopical definitions of a “human” and apply it here.  For the Aristotelians, the human is a “rational animal” always in pursuit of actualizing his/her potential.  Rationality seems to be the key here, where the cadaver is incapable of anything of the like.  In addition, Aristotle talks of “human becomings”, as we are never fully actualized as humans, always attempting to harmonize the intellectual, moral, and passionate faculties natural to the human life, trying to find the medium that allows a certain ascent towards Eudemonia.  This is in contrast to say a rock, a thing, which is always and completely itself, that is, fully actualized.  A cadaver is, and for now, can and only will be a cadaver, no longer given the space for conscious fluctuation.  Not human.

One could also argue for the utilitarians on the point, as such a sacrafice benefits a greater good in knowledge, and by extension, the impact of the student in their subsequent careers.  We may put the deontologists at ease, since Kant is one to stand that consciousness, and the a priori reasoning we are capable of, is the criteria by which we are human.  The cadaver, therefore, is not.

How harsh does this sound?  The other option is to act as many med students do; the cadaver is human, respect him/her, then paradoxically slip into objectification without even knowing it.  We speak to each other during anatomy using possessive pronouns when referring to the cadaver: “Come look at my brachial plexus if you want to see the musculocutaneous nerve.” 

From such a standpoint, we as students are less human than the cadaver, as we are doing the most inhumane things to it/him/her.  We removed a leg, bilaterally split the penis (thus causing referred pain, I might add), and today, split the head like a melon. 

Maybe, I think that if we are to understand the cadaver from the onset as non-human, then the moral dilemma (or at least the immediate internal hesitation), followed by the subsequent guilt, or lack thereof (since such a lack is such a frequent occurrence) may not be such a problem (though I think it should be, but that I will reserve for a whole other diatribe).  Its a blunt, intellectual bridge over the problem, as the previously stated “lack” only exists as one in the constructs of an initial human understanding of the cadaver. 

Is there anything to this?

I haven’t had internet in my apartment since I moved in a month ago, mostly because this illustrious internet company has managed to drop the ball in ways I can’t even begin to explain.  (The company’s name rhymes with “verizon”)… So, I’ve reverted to stealing ambient wireless signals in my apartment.

Anyhow, quick update; Started medical school proper on August 11th, walked into anatomy lab with sharp objects, and they essentially told us to just “have at it”.  In the course of 13 days of lab we’ve completed, in ridiculous detail, the vertebral column, spine, posterior triangle of the neck, back, upper limb, arm, forearm, hand, hip, thigh, leg, foot, thorax, and heart with all the accompanying neurovascular relations and common clinical occurrences respective to each of the said areas. Oh… and they threw embryology on top for good measure.  First test is Friday, August 29th.  Thats the day after tomorrow.  So what did I do after school today? I napped.

Here’s for something a bit more interesting.  Last Tuesday I met with my first patient at Temple University Hospital.  The day before, we had a lecture on Narrative Medicine in our “Doctoring” course, which took me by surprise seeing as they took a liberal arts approach to a clinical course.  After our first patient experience we had to reflect and write…

Waiting on the elevator to the 7^th floor, I started to think about this actual assignment. For my “Doctoring” course I’m supposed to go into a patient’s room and get to know him or her in a way that, I’m guessing, medical professionals don’t usually get to know him/her. We are doctors-in-training who are supposed to go in and not act like the stereotypical doctor. We are to ask for the details of no clinical relevance, to have a conversation outside of the abrasive medical truths that appropriate one as a “patient”, and perhaps, to get a bit personal. Maybe the initial, somewhat intrusive nature of a stranger at the foot of your bed is of the common clinical practice, but I appreciate the fact that this may be one of the final remnants of a relationship with a pure stranger that is not mediated by a patient chart.

And so I start sweating. I’m at the bottom of the medical totem pole, if it even goes down that far, in limbo between non-doctor and doctor. Not identified with the former, and lacking the professional air of the latter. I have no white coat, like I’m going to war without Kevlar, identifiable only by my TUID which I wear like a hospital ID forgery. Any anchor I have to credibility walked right out the door the moment she dropped us off in Mr. H.’s room. No, this isn’t awkward.

Mr. H. must have seen this. Even with acute pneumonia, he lay there, his right hand cupped behind his head, legs crossed, talking with his left hand. Smiling. Of course one of us rattled off, “How are you feeling today?” like an age old bad habit. Like when your nerves do all the talking on your very first date. He smiled again.

Retired now, Mr. H. lived right off Erie for most of his life. He lives alone, and worked at a furniture store moving and shipping pieces he’ll probably never be able to afford himself. I apologize. I’m not doing him justice. “An expensive furniture store, a big company.” At first shot it sounds trivial, however, his eyes lit up a bit, chest expanded, and chin raised when he said it. Even at one of his most vulnerable moments, when three medical students are doing some directed probing, lost in their own thoughts, Mr. H. was proud to share what he had done with his life. To explain what he did. To just talk.

For the next 10 minutes none of us could get a word in edge-wise. I quickly realized I needed to get out of my own head and just listen. Shut up, and listen. His left hand, scorched by life of manual labor, each crack and tributary a different story, waved in concert with his words.

…

As he rounded out his story I asked him, “What would you advise us to do?”. Words always sound clumsy when speaking and swallowing at the same time. He told me that every time he’d been to the hospital he’s had good doctors that put him “back together”. He said, “You need to keep doin’ what you’re doin’, and keep goin, ‘cuz you need to put people like me back together so we can go on and live our lives.” A simple maxim it was, almost understated, and easily lost in the blue-streaked confusion of anatomy lab. It’s something that no one will tell you explicitly, nevermind as personally, in a pure academic setting. Nor should it be. Simplicity as such should only be colloquial, never to be stripped of its tone, its meaning, and set into a powerpoint.

Again, another smile.

Its happened. I am really going through with this. I am writing this at the end of the second day of orientation, because frankly, yesterday happened without me. It just was. And I was there, but the entire thing seemed like a dream state; faculty and students engaging one another through intense gaze, sprinkled with colloquial niceties. The first dissection you do in medical school is of the students in your class. I never thought I would admit to this, but if you’re a medical student, you are narcissistic to some degree.

Its interesting to watch, and even more interesting to feel yourself secretly scowl at the people around you. That is, until you realize what you may resent in some of your fellow classmates (even before meeting them, I am sad to say) are the faculties within yourself that you once held dear. They are the very things that once made each and every one of us unique at our respective alma maters, from Princeton and Penn to Moarvian and Scranton. I’ve never seen such a quick dissolution of individuality in my life. Yes, each of us as students are individuals in our own respect, but as to the magnitude of what got us in the door of Temple, they completely cancel each other out.

I suppose I should find some solace in that fact. I now have the ability to remold myself, and for one thing, after talking to my fellow classmates, I’ve found that each have the drive to do so as well. But it is no longer to some further end (other than residency, but the numbers seem to govern that, not so much the complexities of human experience), but for the sake of a self-refinement. I’ve found that the second dissection one does in medical school is of the self; an almost panic-induced self-inventory. At least I hope everyone does this… it should be a momentary humbling experience, one that opens you up to the ability to respect the achievements and stories of those who will be sharing the next four years with you. For those who do not experience this, I suggest sitting down to allow yourself to be grounded.

Dr. Lyons, a prolific and extremely well spoken professor at Temple (who also interviewed me for medical school), shared a couple of thoughts with our class that first morning. I remember two of them very well. The first being the difference between “not knowing” and “ignorance”. Not knowing is not a conscious shutting out of information and experience, but more of an innocent lack, whereas ignorance remains double blinded. In one respect it does not know, but as a compounding factor, it does not care that it does not know when made aware due to some determination of necessity. I guess thats what I mean by the dissection of the self; to be successful in this field, one needs not only to become aware the s/he does not know, but must be comfortable with that fact. However, that comfort should be paired with an almost animalistic vigor to find out. This allows for one to open to the entirety of life experience. This is excellence.

The second thought. “Perfection is the enemy of excellence”. Dr. Lyons started with “life is demanding enough”, not as a prescription for getting what you need and want out of it, but that life demands enough from you without having to compound it with the stress of “knowing absolutely everything.” In this day of medical science it is impossible, and furthermore, a completely transparent and empty goal to be attained. Let the mindlessness of computer storage “know it all”. Which lead to his conclusion; don’t have a life in medicine, “have a life with medicine”.

Relief. Maybe this field is the right thing for me. Or, maybe against all probability, I managed to get the quack doctor buried in a University mislabeled for excellence in healthcare for the the underserved, and this is all a load of bullshit. Not likely. For anyone who has read the entry before this one (before I even stepped foot into the school), I wrote under Only the Weak, “I have no intention of being a doctor, its what I hope to do. I am still working on being human.” I am lucky to have found a school that understands the distinction between a life in and a life with medicine, between who I am, and what I hope to do. These two ideals are not at odds, nor are they mutually exclusive, but complimentary. I hope that one day they will still be identifiable as separate entities, yet intertwined to a complexity that rivals that of the human mind. It seems oxymoronic, but if you get the first distinction, maybe someday we’ll both discover what it means to live the second.

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.

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?

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?