Poetry Assignments in Medical School

Poetry is too easy. I know this because five minutes ago I turned on my brain* and I wrote a poem. It was quick. It was too easy. People always seem to think "poetry" is a mysterious art form. It's not. It just allows less analysis than other forms of expression (read: actual writing). Less analysis is bad, because it inhibits us from seeing how poor poetry is.

Why am I all of a sudden angry about poetry? Because apparently there is poetry in medical school. And it is atrocious.

*Let me explain. I spent my entire day (more than that because I walked out thirteen hours later) in the anatomy lab, looking at dead bodies and absorbing formaldehyde. We are a visual species, humans, so now, when I close my eyes, I see dry fascia being peeled away from faint pink, striated skeletal muscle. If I fixate long enough, I hear the sound of my hemostat and probe, hacking away at accessory connective tissue, like vultures ripping into a Saharan carcass. It is haunting, and yet, because of the time spent and formaldehyde, strangely calming. My brain, right now, is all about anatomy. When I am not thinking about anatomy, I am hating myself for not thinking about anatomy. I will periodically glance down at my hands and re-affirm that the giant line that extends from your thumb into your forearm when you arch your hand into a thumbs up, is really just your english premier league--mnemonic--your extensor pollicis longus. Below that, or slightly more medial and anterior to that, is your ... wait, wait... what the hell is that again? Your... your... the other component of your snuff box... is it an extensor pollicis or a abductor pollicis? It is the extensor pollicis brevis--thanks Wikipedia--and the abductor pollicis is on the border of your palmar surface.

But back to poetry. So we the first year medical students are enrolled in communities. I think this is a wonderful opportunity. We are afforded a real, practicing doctor contact. We get to see patients. We get to talk about some big issues. I am actually really glad that the communities exist, despite the fact that they, unfortunately, use up time I do not want to give up. Anyway, it's coordinated by a new dean who either attended Northwestern University or Northwestern Medical School, but either way, manages to exude a liberal arts vibe. So are assignments for this course, is to write.

And sometimes people write poetry.
Sometimes people write crappy poetry.
Other times we have to read poetry.
Not as crappy, but not critically acclaimed stuff.

So let me explain how I think poetry should be written. At its best, poetry is really just like normal writing, except it's shorter and thus easier to sustain.

1. Avoid cliches
This is what you have to do whenever you write. Unfortunately, most people who didn't align themselves with more than a few english courses won't know this. I swear to god (cliche) that if I have to pour through (cliche) one more poem that incorporates a line as melodramatic as "the bright light of day" I will shoot myself in the foot (cliche).

2. Don't be melodramatic
Medical school is heavy stuff. You don't realize the emotional baggage (cliche) you're holding onto while you're going through it, because you have so many more cerebral things to worry about. But if you just stand in the anatomy lab long enough, surrounded by sixty or more unwilling dead people, it will occur to you just how serious medical school can be. You are never allowed to get to that point, however. So I don't recommend you go delving into the deep, emotional end (adapted cliche) and pour out your feelings. You must be desensitizing yourself to absolute dread, otherwise, you'd never get past your first term. Don't pretend you're not.

3. Use pretty words
This step is an important confluence of both a big vocabulary and rhyming schemes. Modern day poetry doesn't require sonnet-esque rhymes. But it is important to make sure you have a rhythm in your prose. Sadly, even writers must do this, so I don't know why poetry gets all the praise for "sounding cool." Using big words is helpful, but only if it helps the flow and only if its a word that your audience will understand. Iliopsoas is a beautiful sounding muscle, but it's not that attractive in the human body. Thus, Iliopsoas is a poetical term, but it is not a pretty picture.

4. Say something new
I had this drilled into my head (cliche) by an English teacher in seventh or eighth grade: New or novel. Otherwise, no, don't say it. I guess that's my biggest problem with poetry. How do you make something new or novel in twenty lines that hasn't been done before? Hell, most poems probably could be found paraphrased in Facebook status updates. I'm not impressed, but my theory still remains: get a crazy angle on your story, and you and your listeners will benefit. Yes, anatomy lab is creepy, yes, you feel guilty for saying that anatomy lab is creepy. Now, take it to the next level. Or else, all other medical students will be bored with your thoughts. And when people are bored with your thoughts... well, not good.

5. Consider your audience
Your potential audience is different once you enter medical school. Your knowledge and your fears, they change tremendously**. If I am writing to an average American, I have to take several steps back in order to be able to communicate effectively. If I am talking to a physician, I need to fact check my affirmatives, make sure I haven't said anything that would be embarrassing if proved false.

6. **Don't use adverbs
Adverbs like, totally, ruin a good story. Absolutely avoid adverbs whenever possible. They are not verbs and they are not nouns. They ruin good story lines by instituting a framework in which subjects and verbs are separated unnecessarily, or without necessity. Which of the previous clauses do your ears enjoy more (tip 3).

So that is it, but I will throw in one last hint. The reason why I hate poetry is because people naturally think that things they don't understand are profound, like the profundus flexor digitorum... apologies. But this isn't always the case. You can say several pleasant sounding words together, and they'd make no sense. This theory can be proven by talking with someone afflicted with Wernicke's aphasia or by listening to Jack Johnson. In order to be a good poet, you have to be aloof and yet somehow understandable. Think about it. Finally (adverb), the best writing always comes from pleasantly (cliche) thorough thinking and re-editing. Or should I say: superb, ecstasy-filled writing arises from cerebral endeavors made spectacular by the mundane process of editing.

End Game

I've recently had to change my entire outlook on life. For the first six weeks of medical school, half of the first quarter, I was enraged that anyone would ever expect a person to learn so much… unimportant information. I hesitate to say unimportant, but that's exactly how I felt. Fortunately, I recently had an epiphany. 

It happened in Biochemistry, which is probably the second or third most pure rote memorization course we have. One of our main biochemistry professors even has a study question website with "ByRote" as part of its URL. I suppose rote memorization isn't bad, per se, but my entire life I have been taught that real intelligence is critical thinking. (Incidentally, this same Biochemistry professor also informed our class in his first lecture hour that Wisdom comes from facts, implying that we would someday be thinking critically, so he seems very well intentioned as opposed to some who seem to be lecturing in a vacuum and not a nearly empty auditorium.)

Anyway, this week in biochemistry we began learning about heme metabolism. Thankfully, the physiology of blood is really straightforward from a chemical point of view, so it's ability to be understood is less "by rote" and more by the greatness of Chemistry. During the first lecture hour, our professor mentioned P450, and it hit me:

The reason I'm learning everything right now, the reason why the amount of information I'm processing feels like it could kill me, the reason why I'm suffocating under lecture notes and text books… it's because this is the last time I will actually be learning this stuff. This is graduate school. This is the end game. 

It's taken me until the third month of medical school to realize that this will be the end of my heavily structured learning.

I've learned about cytochrome P450 once or twice before. In fact, during my last semester at Colgate University, I wrote an entire paper on how one could use the gene that codes for cytochrome P450 to determine how a population of Lake Michigan fish had evolved in response to manmade pollutants. And yet, despite writing an entire paper, do you know how much I knew about cytochrome P450 in undergrad? Nothing--besides the fact that the gene coding for it is under heavy selection in fish that live in the Hudson river. Now I know almost everything about P450 that would ever be relevant to anyone caring to know… Like a really curious patient. 

I don't know when this would ever be necessary, but let's say a teenager comes in who is currently enrolled in AP biology and has recently started drinking. Let's say she asks me about why drinking is bad, and I take a look at her chart, and notice that she's anemic. I could easily tell her:

"Listen Maggie, your body as it is doesn't produce enough hemoglobin to carry oxygen around. If you start drinking, your liver will need to up-regulate its production of cytochrome P450 to process the alcohol. P450 is derived from the heme protein, which constitutes hemoglobin. Your liver will preferentially up-regulate P450 in favor of hemoglobin. You will be weak and drunk if you drink excessively all the time. Do you want that?" (For the record, I'm not entirely sure that this would have any visible affects on Maggie, but it's true in theory, so it's true enough for a moral lesson.)

"Also, you may want to have sex at your age, and you might think alcohol is the best way to go about doing that, but you should probably wait until you're old enough to make smart decisions. Because even though you may be ready for sex, are you ready for teen pregnancy? Also, Maggie, there's only a 12% chance you will marry the first guy you have sex with, FYI, so be wary." (Maybe I'll be a cool doctor who makes up statistics. I don't know.)

I accept that I will have to learn everything now. But it really is terrifying and exciting to finally be learning the minutia of all the things you've learned superficially, several times in the past. It also doesn't help that I am in graduate school for human-centered medicine, a field that is studied much more intensely and is weighed down with a lot more information than the academic field of deep sea mussels, if only because humans are a highly self-involved species that neither wants or needs to care about the deep sea mussel. Every day it seems I read something and my understanding shifts, snapping into place, and I feel several different little things from all the science classes I've ever taken in my entire life--from fourth grade to evolutionary biology--correcting themselves and informing me a little bit more about how humans work. It's amazing. I think with a little more practice, this feeling may turn into wisdom. And for that, I am finally very excited. 

Overdramatic Politics

So no surprise, the Federal government wants to cut $60 billion from Graduate Medical Education. That's pretty upsetting. The only important things in life are education and health--trying to impede health education is against the only principle I have. I took advantage of a link to send generic e-mails to my congressional and senate representatives by making the e-mail a little less generic:
 
As a medical student from Wilmette, Illinois, currently attending Chicago Medical School, I write to urge you to protect Medicare funding for graduate medical education (GME) and indirect medical education (IME). While I recognize the importance of budget cuts, I am truly shocked that my government would actually try to make it even harder for medical students who only want to help people. Good health is happiness; threatening future healthcare providers seems like a good way to make the future a sad and virulent place. Right now I am attending school in the tenth congressional district of Illinois. I've lived in the tenth district my entire life. I've grown up here. I was diagnosed with diabetes here. I am now proud to go to medical school here. But did you know that there are only two primary care physicians accepting new patients in this district? This district is huge. It touches Wisconsin and descends all the way into the hinterlands of Chicago. Two. Two physicians. This will be an epidemic. This is an epidemic. I don't want to see the people I've grown up with and love fall prey to easily preventable diseases because they literally could not get a part of the best health care in the world.

Physicians take an oath to do no harm. Do politicians?

Intrinsic Motivation

I have not tried to write anything for this blog in a very long time. The reasoning behind this decision is heavily influenced by the fact that I am failing the majority of my classes at the moment. It is altogether an incredibly stressful situation. I have stress headaches when I wake up that make me believe my blood sugar is elevated, and for about four or five days I smelled absolutely atrocious and inhumane. I am living through hell. As a type B personality, I have never been strung tighter. It is a very unnatural situation I find myself in at this moment.

But I've come to reconcile this. Very few people would ever be smart enough to be smart enough to get through medical school without studying. I tried to be that type of person. But alas, I am more or less just like everyone else I have ever met in my entire life.

Anyway, it's been hard for me to think about my life objectively while this has been going on. I've questioned myself a lot. I've wondered if I deserved to be a doctor. I guess because both of my parents made it, and because both of my parents seem relatable, I assumed that medicine was an accomplishable field. And I suppose it still is, but I have something to say…

In my thesis, I start off, early on, proclaiming that "some physicians suck." I immediately apologize. If you could get through this material then I trust you to treat me…

But do I really?

So I have spent the last two weeks thinking about why I deserve to be a physician, and I believe that I can explain why I should be a practicing doctor even though I am currently failing many classes at this point…

It's all about humanity.

Or at least, it's all about relating to other people and appearing human.

I have been diabetic for nine years. In that time, I've learned many things about myself. But I have not learned, not once, why diabetes is bad for me. I mean, I know the complications, and I know them in excruciating detail. Blindness, amputations, early death. But why is diabetes actually bad for you, instead of just being an annoyance?

I learned this, even when I was failing biochemistry. Will the majority of my patients want me to explain what regulates the Kreb Cycle? Or will the majority of my patients want me to tell them why having elevated blood sugars will severely affect their health?

Exactly.

Though to be fair, I love biochemistry. And I love all the classes I am taking right now. But to know that I am borderline failing them? I am not excited about that. Because who else could sit down with a patient and really hammer this out? Who could have the highest adherence rate around? Would it be me? A first year medical student who tests poorly? Or someone else? Who does really well on exams but is static in conversation and who never thinks about other people, other people's thoughts, or being an important pillar of society.

Clearly I am "just saying" at this point. I have started to improve my test scores. It is looking less plausible that I will "fail" all my classes. But I may not do super well in all of them. All I know, is that I am a damn good teacher. And I see my role as primary care physician as being very similar to that of an excellent grade school teacher. I need to know the topic well enough to instruct small children on it. I need to tell a diabetic why high blood glucose is bad for them, instead of scaring them with the associated affects.

And if that's what required of me, I will respect my responsibility. I didn't get into medicine to become smarter than everyone else. I got into medicine to help people like me, nine years ago, when I was scared and threatened yet excited by my prognosis, and still willing to waste the next nine years of my life joshing around and eating whatever the hell I wanted because I didn't really truly understand what was happening inside my body. That's not right.

I was a teenager when it happened. I attended one of the best schools in Illinois. I won a state wide competition in Science Olympiad. I was intelligent. I was curious. Hell, it was my body, and I had a right to know. You should have told me. You shouldn't have scared me with how serious it was, with threats of amputations and blindness. You just should have told me in ways I would have understood. I wasn't an idiot. I could have followed you. You should have at least tried.

I won't fail my patients, if only because I know what nine wasted years can mean.

BRCA1 or BRCA2? Either way, whatever this is, it's definitely new.

Sometimes it's hard to study. I desperately need to study today, and tomorrow, and the next day up until Tuesday. We have a test next Tuesday, and half of its question are from Biochemistry, a class I would love to not be failing right now. But I am. I feel well prepared, but I also feel like this is the first time in a long time that I will not be pleased with anything less than one-hundred-percent. It's possible. But a 92% is also possible, and I would find that devastating.

Has medical school turned me into a type A personality?

Perhaps. While I was studying tonight, I noticed something odd. Mind you, I was ready to go to sleep, lying in bed reading a clinical medical cell biology text book. It's a good book--and by good, I mean it has a serif font. I started reading chapter four. And somehow, I ended up sitting in front of my laptop looking up how often nipple discharge is associated with breast cancer.

Yes. That's right. Somehow I went from studying, which is important, to discovering that my right nipple is capable of discharging fluid. I believe in self-examination, sure, but what this should really tell you is that I'm studying way too much. I don't even like my breasts. To find something wrong with them should only indicate how much I hate reading text books.

I hate it a lot, I guess.

Turns out there are about five illnesses that can cause nipple discharge, and very rarely does a malignant breast tumor indicate itself through fluid production. I just wasted twenty minutes googling that information and then posting the good news to my Facebook.

This is what being a first year medical student is all about. You can know something is wrong, but you have little idea how bad it is, and no idea how to fix it.

And it's probably always cancer.