Tuesday, October 19, 2010

Home is where the heart is?

I used to argue furiously with anyone who expressed the least bit of doubt about living a successful life in Ghana. From where I stood, I grew up in Ghana, reasonably comfortably, didn't die of cholera or dysentery or some other infectious disease, went to good schools and really, had no notion of extreme poverty or hardship. True, things might have been a lot worse if my parents didn't make the sacrifices they did, but I figured, if they did, then everyone else should be able to.

These days, I don't really care what who says. Part of it is my apathy showing, but part of it is also maturity in realizing that life happens. People start out with great idealistic plans and then realize that things aren't as easy as they seemed to be from afar. Some people left Ghana under terrible conditions and so really have no desire to return; others haven't been to Ghana in about 20 years and have a very warped view of what Gh is like.

Either way, whether or not someone returns to Ghana/the land of their birth/ancestry to live is a very personal decision- not one to be made by consensus or by some 18 y/o idealist who thinks she has all the answers.

Why do I bring this up, because it was an old post I started and didn't get round to finishing till now. But also because I found that priorities and ideas change with time. My desire to go back and work and like in Gh is no longer driven by some idealistic ideal of saving Gh from itself. Nah, its based in a very selfish desire actually. I want my kids, if they ever get born, to know their family and to be close to their grandparents, uncles, aunts, cousins and all the craziness that is my extended family.  I want my kids to grow up in the secure way I did, and to know what it is to be surrounded by family and by love. I want to live a comfortable life, knowing that with all its good and bad and ugly, I'm in the place where I feel most comfortable and most confident. In effect, I want to maintain what I had growing up, and the best place I know to do that is home.

This is me at twenty something. At 18, I sounded very different and had very different ideals. Somehow, I suspect that at 30, my priorities and outlook will have shifted again, perhaps become more clarified. I don't know. All I do know is that I have a dream and a goal, and I'ma keep working towards that. Let me do me and work towards what works for me. As to what decisions other people make about where to settle or with whom or how or if........that's their business, not mine.

Cynicism and what it does to you

I've been called cynical by some of my friends. I counter that by saying I'm not cynical, just realistic. I'll admit though that yeah, in some things, I can be a bit of cynic. But my cynicism or lack thereof is  not the point of this entry. This is about cynicism in the medical field.

It appears that something happens when people graduate from med sch and become residents. They get tired, they see the same stuff day in and day out. Unfortunately they are confronted by less than stellar behaviors from pts. They work long hours, get paid next to nothing and are the workhorses of hospitals. They're very tired (did I say that already?) and their buttons are much more easily pushed. As a result of all this, residents, I find, have little patience for some patients. Especially the ones who represent the "typical problem patient" for which ever specialty is involved. It may be the alcoholic who gets discharged from alcohol induced pancreatitis, and then returns to the hospital a few days later with the same problem. Or one who is convinced that he has some dire surgical emergency that never is. Or the one who comes and tells a sob story about having a pain or panic attack and only wants to abuse prescription medications. And on and on and on....

After seeing enough of these patients, the residents quickly lose their sympathy, and quite frankly have better things to do than to aid such behavior. So they send these pts out as quickly and efficiently as possible, and move on with their days. What happens then, when a patient actually has legit pain from cancer mets? or when a patient's pancreatitis is not from alcohol because they've been sober? Or the patient has undiagnosed or untreated psychiatric issues? or the patient goes home and tries to harm themselves? Unfortunately, these patients, with real and legit needs get shafted because of the actions of others- and in fact, sometimes due to their own prior actions.

The med students are the suckers who believe any and every story. In a sense, they're still fresh and new and unjaded. The attendings are removed enough and balanced enough that they can be a little more objective in recognizing real from unreal, and are more likely to give the benefit of the doubt. And even when the attending knows that this patient is faking or making things unnecessarily difficult, they have the foresight to see why this is and sometimes they address it.

In the end, a lot of different factors go into shaping a patient's care. Sometimes the cynicism is undeserved and represents a barrier to rapport building and sometimes to effective care. Other times, the cynicism is well deserved and every one breathes a sigh of relief when the pt is gone.  Eitherway, the task for the medical team is to remember that every pt needs the best care and needs an equal chance. But seriously, the medical team is made up of human beings, not cleverly trained androids who just churn out cures. I wish there was a more just way of rationing care and keeping people who abuse the system confined or contained. Then people who dont abuse the system wont have to pay for the misdeeds of others who do.

Thursday, October 7, 2010

Failure, and the fear thereof

Why do the most random things bother me? Why do I feel like I've failed at something which is really beyond my control? Why do I insist on basing my self worth on extraneous things and not on what truly matters- that I'm a child of God, who was wonderfully and fearfully made? Why do I keep looking to worldly markers of success, when I know that they're false? Why do I keep wondering what I look like in the eyes of the world? Why do I keep feeling so emotionally far from people sometimes? Like I always make the effort to reach out? Like I'm not really needed by many of my friends? Why do I need to be needed, and yet feel constrained by the demands of people? How and when did I get so selfish? Why am I so afraid that some dreams will never come true?

A friend of mine said in an email "I miss your no-nonsense ways" and I've often been called "the practical one". I don't feel nor sound very no-nonsense or practical right now.

"In repentance and rest is your salvation, in quietness and trust is your strength" Isiah 30:15. I need to keep remembering and claiming this verse. I need to learn to rest and be quiet and be still in my God.

I am not a surgeon

I am not a surgeon. This is obvious. I'm a med student. But in the deeper aspect- I'm not cut out to be a surgeon. I dont have the talent, temperament or patience for that field, and this in pt surgery rotation is turning out to be some styles. See, it's not about what they do- I think the art of surgery is very cool. It's about the characters, and I'm really not liking the character's that I'm working with this month. This is a problem, because I need to become an active part of the team, and I need to suppress my dislike and disdain for the members of the team.

If I learn nothing at all during this rotation, I will learn that being a team player often means putting your thoughts and feelings aside and working with all sorts of people.

In the mean time, I need to keep doing the best I can and try to love all people. 1/2 way there.....