Archive for September, 2010

God, medicine and suffering

Myself and a friend are hosting a Forum in our church in a few weeks looking at the topic “playing God in the end of life”. We’ll be talking largely about ethical issues regarding end of life in regards to modern medicine.

Thinking about this scares me. When I think of its importance to those dying and bereaved, I see it contrasted with so much of what we do as doctors. I am increasingly coming to the opinion that we are losing our way in our aims and goals in medicine. The responsibility for this lies with both society and the medical establishment.

As usual it appears that someone else has thought these thoughts much better before I did.

In God, medicine and suffering, Hauerwas talks a lot about how we talk and act around suffering and what we have come to believe – both as a society and a church.

It’s a dangerous book to read as a medic, it just might change how you look at what you do. Books are like that. Christianity is like that.

I’ll leave you a few quotes to mull over as I continue to do so. No doubt you’ll hear more on this.

Sickness is a problem because it challenges our most precious and profound belief that humanity as in fact become a god.

and

I think childhood suffering bothers us so deeply because we assume that children lack a life story which potentially gives their illness some meaning.

and

Our medical technologies have outrun the spiritual resources of our society, which lacks all sense of how life might properly end.

Thinking about this is no abstract theological exercise. Hauerwas contends that that is the whole problem with how people talk about the problem of evil – they fabricate an abstract god and abstract suffering to puzzle the brain.

The God we worship and the Bible we read talks about it and struggles with it. We have actual people, actual suffering, actual incarnation. It forms a very different question.

Kevin spoke really lucidly on this a few weeks ago while I was in the midst of reading the book.

Anyhow. My contention is that we are more interested in curing rather than caring. Even if curing will often one of the best ways to care we far too often start at the wrong place.

Muscle Museum

I’m trying to figure out what it is that I like so much about dissection.

For two weeks now that’s what I’ve done. I get up, go to work and sit on a stool hunched over a donor’s remains with my headphones playing medical podcasts. Sometimes I’m the only one in the department.

My head feels at rest doing this. I hesitate to devalue the word peace by using it here when I’m describing a situation where I’m merely focused doing something with my hands and not being interrupted every 2 minutes.

I enjoy the privilege of what I get to do. I enjoy that I am effectively paid to learn at the minute. I enjoy teasing out nerves from behind muscles. I love leaving a dissection when it looks like something from netter’s.

I suppose I feel I’m being somehow creative with the remains of the dead. The human body is superbly well put together and extravagant in it’s function. It’s nice to help make that clearer and easier to see.

Commuter love – #7

Winter has arrived. Even if it’s only early autumn I feel the change so abruptly that I over dramatise it. I have draft proofed the house and added a curtain over the front door. I’m thinking of retrieving the slippers out of the cupboard

Sitting on the train platform I feel the gust blow down by neck and I feel cold. Cold in a way I haven’t felt for 6 months or so. I zip up the top of my fleece and pull the collar of the jacket around me.

Maybe I should take up smoking. It makes sense shivering on a platform and inhaling warm air/smoke. It seems like a good idea despite the obvious limitations if I think about thermodynamics. Best not to think.

I like the cold. When it’s a passing experience, when I know there’s a train coming or a warm house at the end.

My bag will get even heavier. Not just the book, the laptop, the coffee and my lunch. Now I’ll he carrying around hat and scarf. Like a snail carrying his house on his back. Though it’s more akin to a snail carrying his home entertainment system on his back. And a snail would never do anything that silly.

The Black Swan

I read the Black Swan largely at the result of Jerry Hoffman, an emergency doc who helps run my favourite medical podcast.

He’s a smart guy so i trust his book recommendations.

As a brief outline it’s about unpredictability and not how to predict it but how to at least think seriously about it and take it into your decision making.

It’s the kind of thing that should be bread and butter to all emergency docs. For example:

If you work in a randomness-laden profession as we see, you are likely to suffer burn out effects from the constant second guessing of your past actions in terms of what played out subsequently

That fairly accurately describes the weight on my shoulders that I feel as I walk out of work.

The idea of “the Black Swan” refers to the fact that the western world wasn’t aware of the existence of black swans till the discovery of the Antipodes. Centuries of empirical evidence proclaiming that all swans are white was destroyed by the discovery of black swans.

Incidentally I was once attacked by a black swan while on a kayak in NZ. It’s probably funnier than this blog so go read it if you want.

The same thing happens with the turkey who is well fed and looked after every day. Each new day brings positive reinforcement to the idea that its life is sound. Until one day near thanksgiving.

Taleb is understandably a skeptic.

I am most often irritated by those who exercise their skepticism against religion but not against economists, social scientists and phony statisticians. We no longer believe in papal infallibility but we seem to believe in the infallibility of the Nobel

and this one

Physics has been successful but it is a narrow field of hard science in which we have been successful. And people tend to generalise that success to all science. It would be preferable if we were better at understanding cancer or the (highly non-linear) weather than the origin of the universe.

It’s always nice to find a book to confirm your biases – that life is full of unpredictable events and that we’d be wise not to be sure of what we think we know.

All that you can’t leave behind

What was lacking in my medical education that I’ve never even heard of half the muscles represented in this plate.

I have a lot of work to do.

Which explains the blogging in work naturally…

I don’t need no doctor

Doctors like illness. They like diagnosing and managing it even if they don’t fix it. It’s a puzzle to be be played with and solved.

I suspect the fact that the illness is attached to a patient is being increasingly forgotten or pushed aside in the pursuit of the illness.

We would learn more how best to serve our patients by reading more novels than textbooks.

We have lost our way in caring and our “success” in medicine has led us to pursue curing instead.

There are terribly dull courses in medical schools taught by sociologists who try to address the ideas of humanity with terms such as “the biopsychosocial model of health”. This seems to be the art of making the incredibly obvious increasingly complicated and interminably dull.

Having said this I believe we are raising a generation of doctors with great knowledge and decision making but with barely a trace of humanity, and I believe this is happening because we train children to be doctors.

Or maybe they are more fairly called adolescents more interested in drinking, parties and fucking than they are in understanding what they are entering into.

The patients that they deal with come from a world that they have no comprehension of – one filled with fear, pain suffering and loss. This is a world that they will come to understand in their own lives but by careers and personalities they will defend themselves from it till it can no longer be avoided. Many patients will pass through their hands before then.

I know this because I was that child training to be a doctor. I still am in many ways.

Two of my best friends trained as doctors in their mid/late twenties with a degree and some life and some pain and comprehension of beauty behind them. I am immensely proud of them for the way they have approached it and the humanity and understanding that they so clearly bring.

I’m not sure what the answer is to this (though a fundamental re-understanding both by society and the medical profession about what medicine is and should be would help…)  but I wonder if graduate entry would make an impact.

Commuter love – #6

Are the folk on the train listening to music with their DJ cans on carrying Bose CD players tucked inside their denims? If they’re listening to 128 Kbps mp3s on their iPod then it’s a bit like drinking 2.99 Tesco Chardonnay from a crystal goblet.

Or maybe they just think they look cool. Blimey I should probably let them know they don’t.

Commuter love – #5

No one wants to sit beside me today. Not that any one ever wants to sit beside anybody on the train, it’s more the sacrifice that has to be made just to get the weight off their feet.

But I feel it more today. Because I’m one of those guilt ridden souls that feels the need to keep the seat next to me as open as possible, moving bags and coats out of the way so that people can feel free to sit down with minimal embarrassment.

So people see me as the easy option to sit beside.

But not today. I imagine it’s the repeated mucousy noises emitted from my upper airways. No one wants to get a puffy eyed, flowing mucous disease for a few days. I imagine back when we had real coughing diseases like TB that they were ostracized in a similar way.

Wow I just compared having the cold to TB. That’s a new narcissistic high/low for me.

Living is a problem because everything dies

Only medical journals like the BMJ (British Medical Journal) would have an obituary section where certified cause of death is included along with when they were born and when they qualified.

Only people like me skim the obituaries looking only at what other doctors die from.

I was pleasantly surprised to find “Dr So and So died peacefully in his sleep…”

Commuter love – #4

The metro herald is about my only exposure to popular culture these days (he says with gross exaggeration). Newstalk keeps me about as informed as Newstalk can. The lack of a tv or a spouse interested in such things means I’m somewhat out of the loop as to which of the beautiful people are sleeping with who.

I always get an immensely friendly greeting from the girl handing them out in her shiny yellow jacket at the top of the road.

And if my greatest fear ever comes about – finding myself on a train for 45 minutes with nothing to occupy my mind apart from my own thoughts or even worse engaging in contact with my fellow human beings – then at least I’ll be guaranteed to find one stuffed in the folding tray table on the 0936 after rush hour.

Commuter love – #3

I always feel like I’m approaching some kind of epiphany when I’m on the train.

As if the sleepy, hungover crowds of humanity surrounding me are leading me into some kind of deeper understanding of the unbearable lightness of being a pretentious twat… Or something like that.

I heard Keller preach about how people talk about the sacrifice it takes to pursue a ministry in the city where you’re surrounded by concrete and lots of horrible ignorant people and ways of life. He declares that all that is nonsense because in the cities we find ourselves surrounded by the most beautiful part of all god’s creation – human beings.

Since hearing that I find myself watching people on the train with slightly less of the pictured attitude and more thinking about the jokes they tell and the parent that loved them and the child that adores them and all the happiness and joy that surrounds their lives. No doubt there’s plenty of pain and misery and regrets in there but even that makes them more human than anonymous commuting will.

[Picture Via XKCD (of course)]

Commuter love – #2

If you stand in the same place at the same time often enough on regular occaisons you start noticing other people doing the same thing.

Other people for whom the regular occupancy of this piece of platform at this time is a long repeated pattern.

You get to know their faces and dress codes. You get to thinking about what they do that has them there everyday.

I notice their books. I notice the progress they make and I try to judge whether they only read the book while commuting or if it makes it to bed with them each night before they fall asleep.

If this was a party of a friend you’d go up to them and say frendly ice breaking things like “how do you know so” and “what do you do with yourself most of the time.”

But you don’t do that in railway stations. The only reason people do that is to distract them while someone steals something out of their bag. Either that or you must be attracted to them and you’re making some kind of move.

We’re deeply uncomfortable with ‘idle’ chat. I know I am. As much as I’d like not to be.

I think it must be some hangover from stranger danger mantra that was drummed into me at a young age.

If I get over myself I’ll just go up to them and say “well what did you think of the book?”

Commuter Love – # 1

People who do this do it not quite for a living but it is part of what they do. They know the train timetables inside out.

They know that to get a seat on 1638 you need to be standing along the yellow line when the 1635 arrives.

That way when the 1638 arrives you’re in a prime spot. You can look at people’s faces and watch as they calculate the rate of deceleration as the train pulls into the station. Each person making tiny adjustments to their position to give them the best chance of being in front of the sliding doors when the train stops.

There’s a surge forward as the doors open, terrifying the daunted commuters trying to dismount the carriage. A few kind souls make way for the dismounting passengers but positionally this is a fatal move. The scrum invades the carriage and these poor kindly folk will be standing the whole journey.

Inside the carriage swords are drawn, ears are cut off and tiny gasps of victory and dissappointment are heard as the cushioned bounty is snapped up.

Papers are opened iPods are turned up in volume and some seem to be asleep even before the doors have closed

The rest of us poor sods content ourselves with findingthe best pole to lean against while some venture to stand along side the priviledge seaters in case one gets off at an early stop and they can claim their seat.

Just before the doors close there’s the frantic arrival of those guys who always leave it to the last minute. Like indiana jones they turn back at the last minute to tuck the end of their scarf between the closing doors.

They look around for admiration and only find subdued boredom and they realise that arriving sweaty to a tin can of soon to be sweaty humans is bad form.

I shift from foot to foot and open my book.

God damn it, you’ve got to be kind

… sprinkle some water on the babies, say, hello babies. Welcome to earth. It’s hot in the summer and cold in the winter. It’s round and wet and crowded. At the outside, babies you’ve got a bout a hundred years here. There’s only one rule that I know of babies:
God damn it, you’ve got to be kind.

Good morning little schoolgirl

So like all these young folk I trotted off to start a new year in a big school.

No one stole my lunch money. The older boys didn’t flush my head down the loo.

I did manage to completely lose my staff ID seconds after being handed it only to find it in the office where I was first given it.

I get to hang out in a really cool old building in the centre of Dublin and learn lots and hopefully impart some knowledge and skills to some younger folk.

They liked me so much they even gave me one of these.

Do you think it’ll let me into the Old Library to borrow the Book of Kells for a few nights?


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September 2010
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