Hearts in the Age of Med School

“Science! true daughter of Old Time thou art!

Who alterest all things with thy peering eyes.

Why preyest thou thus upon the poet’s heart,

Vulture, whose wings are dull realities?”

Sonnet To Science — E.A. Poe

“Out of the 10 couples in our section in med school,” related a lecturer in legal medicine, “only 2 eventually ended in marriage, and both are now in the process of annulment.” M___, a med student, listened with a bit of skepticism on the grim figures of the fate of intimate relationships made while attending med school. But when his own 6 year relationship ended just before completing his internship training program, the reality of the statistics came crashing down on him. “I don’t know what happened, not much quality time I guess,” would be a typical rationalization. The basic question is therefore this: Can love survive medicine?

According to one study done by Tarayn Grizzard, an MS-III resident in Harvard Medical School, medical students who marry during their residency training program often show poor prognosis, stating divorce rates climbing up to 50 percent.Further comparative data show medicine and its subspecialties have higher divorce rates as compared with an equally stressful profession like the armed forces, with divorce rate for psychiatrists (50 percent), for surgeons (33 percent), and a 22 to 24 percent rate for internists, pediatricians, and pathologists compared to only 7.1 percent for U.S. Air Force couples. Stressors such as sleep deprivation marathons and the amount of emotional strain physicians and physician-in-training are subjected to were pointed out as the main culprits. With the absence of a pioneering study in the local incidence of failed relationships among medical students and practitioners, one can only assume that the above data is quite in proximity, with the hope that the truth is so much better.

However, a true student in the medical art is not without hope. Knowledge on the physiology or pathogenesis of love is essential to understanding the dynamism of relationships, and how one can respond when unwanted situations arise. When the Nobel Prize winning scientist Francis Crick indicated that hormones not only control the body but our dreams and identity as well, the world was stunned. Today, even first year medical students are aware that love is a product of a complex interaction of hormones and neurotransmitters that alter brain activity and perception. The main chemicals released that give one that elation characterisitic of love are: PEA(phenyl ethylamine) which is found in chocolates; Adrenaline which modulates the sympathetic nervous system, and finally, Endorphins which is an analgesic and is produced after strenuous activity, responsible for giving athletes that “light” feeling.Some experiments indicate that oxytocin, a hormone that governs childbirth, is also responsible for couples staying together.

Men and women respond differently to a same set of stressors, and physicians are no exception. Modern times have placed unreasonable amounts of demands on male and female gender roles that nature through evolution has initially intended, with expectedly devastating results. In their bestselling book, Why Men Don’t Listen and Women Can’t Read Maps, Allan and Barbara Pease scientifically explored the essential differences between a male and female brain and behavior and how relationship problems can be resolved with the acceptance of these fundamental variations.Whereas a man’s brain is naturally equipped with the logical, spatial, targeting precision of a hunter, a woman’s mind is able to multitask, globally intelligent and emotionally alert characteristic of a nest-defender. A man when confronted with a problem analyzes and looks for a solution in relative solitude. A woman in contrast voices out her concerns as a means to resolve a situation. It is therefore normal to see a male medical student poring over a case, alone, self-absorbed, oblivious of his surroundings; while his female counterparts are often seen in groups with open books, engaged in spirited discussions.

The potential for the development of relationship problems due to this natural differences between conditioned behaviours rise exponentially with the increasing demands of medical school. Man is a social being. Two individuals who are attracted with each other, experiencing that surge of hormones and neuropeptides that know no exact titers, bond naturally as they did thousand of years earlier to prolong their species. But soon, they find out that love is not the same with attraction and comes heavy with responsibilities each with their own conflicts. A male doctor, after prolonged hours of forced wakefulness in the ward, goes home and wants peace and quiet. While a female physician, goes home and talks for hours about her day as a form of relief from stress. Every man when confronted with a problem alienate everybody else to think. Women, with her multi-track mind, talk about it while preparing dinner.The current blurring of roles in home and family care have already compounded this problem, with medical school and med practice added into the equation, it is not surprising the rates of failed relationships rise for years to come.

Can hearts in the age of medicine survive? Armed with the knowledge of basic human physiology and behavior, a doctor should have had a headstart when it comes to relationships. But with all the data being in the contrary, one can only say no one gets too much love anymore, even to those who possess empirical and peer-reviewed wisdom about its phenomenon. Einstein once said, “Marriage is the unsuccessful attempt to make something lasting out of an accident.” Who knows, Love is patient and kind.

Perception of Undergraduates to Medical Students

Curiosity. One of the basic qualities a physician must possess, and arbitrarily the most important in his diagnostic arsenal, is his or her infinite capacity to wonder; that inquisitive nature that cannot help but explain the rationality or irrationality of a given phenomenon. The endless whys and hows and the patience to go through the logical steps of the Scientific Method— that agonizing process of elimination just so the crystal cut  difference between differentials and final diagnosis be clear. Of course there is objectivity, and there is time management, but I digress.

The phenomenon of perception has always fascinated me. In this decade when medical students are dwindling by the minute, and nursing is being hailed as the new exodus, I often wonder if public perception about us students of the art of healing have been reduced to a diminutive, somewhat microscopic, or worse, totally irrelevant state.

Magnursing ka na lang seems to be the new motto of our generation, certainly with a little help from well-wishing but otherwise pernicious relatives. Previously, in an age when polio vaccine was the craze and Diabetology was unheard of, the family physician was perceived as the go-to-guy in unimaginable areas of expectations regarding expertise as varied as what we have now as structured, compartmentalized subspecialization. So you can expect an average licensed doctor to treat diseases like tonsillopharyngitis, do circumsicion, and be baffled at illnesses as puzzling as lupus. Those were the days of the rural physician.

Interestingly, those achievements we have a lot to be grateful for. It has placed doctors at the very top of the elite vocations, which arguably includes priesthood and law. People perceive us doctors as their only hope even in the most dire of predicaments imposed by a disease afflicting a family member. We are the miracle workers: the gentle hand of God that soothes the suffering of mankind. That is, or quite possibly was, their perception. Thousands of Filipino students who were able flocked to medical schools, all eager, all hopeful, and most probably suffering from some degrees of either parental pressure or messianic complex. Medical students were then equated to words like hope, pride and cure. As we all know, cure can sometimes come from many, unexpected, unexplained places.

Placebo effect. The placebo effect stems from a patient’s perception, or lack of it, that is to say, a belief, however erroneous or improbable, that a therapeutic regimen can cure his or her illness. Never learn to underestimate this unusual aspect in the practice of medicine. In many pharmacologic studies conducted here and abroad, in medical journals, and in all scientific studies dealing with introduction of new therapeutic techniques, a placebo group is always initiated apart from the experimental group to gauge the actual effectivity of  a given procedure or treatment. Somehow so that even during ward rounds and mock physical examinations, facilitators always advocate ad nauseum that when you come in close contact with the patient, when you begin that  initial attempt at tactile examination, you must make the patient feel as if the healing process has already started.  It all starts with perception.

Fortunately, almost 90% of the undergraduates I’ve interviewed for this endeavor responded quite favorably, relatively speaking of course, although admittedly the method I’ve used does not rule out false-positives or false-negatives or anything approaching falsehood for this matter. They said they see us medical students as snobbish, booklovers who lock-up themselves in libraries during weekends rather than spend time smelling the fresh morning air, which ultimately, in a ridiculous kind of way, makes us sexy. They see us as rich kids, or at least well-to-do, which could translate that we are spoiled brats but know better. Some see us as workaholics, or studyholics, and caffeine addicts.

It is actually a consolation, considering that we live in what I would like to call a post-Gray Anatomy/House/Scrubs age that younger people exposed to toxic levels of cable are becoming more and more aware of the kind of internal torment we go through. These results just shows the inherent dynamism or, to put it more bluntly, fickleness of perceived notions. Fortunately, as was expected, the stereotype is still there; this an advantage or a disadvantage depends entirely to us practitioners of modern healing. An expectation come from perception; and when expectations are met, then comes respect; and respect, as we all know, is earned with a lot of courage.

***

In retrospect, as an undergraduate once, I saw medical students and doctors as distant, unreachable stars of characteristic brilliance: that unique light that draws out inspiration and challenge you to do better in things just for the sake of doing better. There is an air of purity and simplicity of thought in such academic pursuits. So I took up medicine.

Empirically speaking, that is to say: now that I am here, exposed to the rigors of self-discipline, thick books thick eyebags, caffeine intoxication, and basically living the life of a 16^th century monk, an average undergraduate would never in a million years be able to know how much an average medical student has to go through to become a physician. There are just not enough words for it. We bury ourselves in books and cram our heads with facts in the shortest possible time; facts that may someday save somebody’s life. We burn money like paper, constantly poor and would probably be poor for the next decade of our lives unless we hit an oil-well or something. We torture ourselves if we make mistakes, because mistakes mean somebody suffered more than he/she has to, or worse died, and it’s our fault, and see ourselves inept and incomplete. I’m a 2^nd year student by the way, a long way to go, I know.

The scientific method is an efficient process of opening up our eyes, but sometimes step no. 4 can be so overwhelming you can only counter it with chewing more than you can bite, instead of the other way around.

Fortunately, there is always beauty, however misconstrued or malpresented, pathologic even: The beauty of hard work and esoteric knowledge and pursuit of something nearing the excellence of something indefinably Supernatural. Seeing someone eat an ordinary meal on an ordinary day, and draw from that totally ordinary act the physiology of mastication, the enzymes of digestion, and biochemichal processes as arcane as the Kreb’s cycle, and the almost imperceptible, totally benign movements of apparently disjointed anatomic machines converting the foodstuffs into nutrients down towards a perfection the size of a mitochondria. The human body is a beautiful thing. And at least, we medical students have a glimpse of what our forefathers has died trying just to perceive that beauty.

Denying

DENYING

I do not love you

I am not
in love with you.

Denouncing vehemently
But it is salient
Denying the emotions…

to hold, and not to be true

In stillness, intoning, loving, all hold nothing for you,
how providential that I do not adore you.

DULL

A sole era

In the desk of my emotion

The sharpness of the sun

Is on my head

So many memories distressing

Though some quite alluring

But life ever been so exquisite

Vivid in its reason

Sometimes painstakingly hunting

Still caresses my person

But all concludes to tears

The heart shattered apart

How long will it take to bear

My mind obliged of understanding

But seems to many to grasp

And I have few to gamble

So tedious as I think

But it is what my emotions ponder

Denseless as it may weigh

But never so meaningless

Never so dull

Addiction

the drug addict, addicted to his weed

the dealer, the same with his money

the american, addicted to tv

and depression, addicted to me

’Tunity

If you know what you want

why do you say you don’t

And if you can take it

then why is it you won’t

…should I draw you the picture of my heart it would be what I hope you would still love though it contained nothing new. The early possession you obtained there, and the absolute power you have obtained over it, leaves not the smallest space unoccupied.

I look back to the early days of our acquaintance and friendship as to the days of love and innocence, and, with an indescribable pleasure, I have seen near a score of years roll over our heads with an affection heightened and improved by time, nor have the dreary years of absence in the smallest degree effaced from my mind the image of the dear untitled man to whom I gave my heart.

To A Friend

I ask but one thing of you, only one,

That always you will be my dream of you;

That never shall I wake to find untrue

All this I have believed and rested on,

Forever vanished, like a vision gone

Out into the night. Alas, how few

There are who strike in us a chord we knew

Existed, but so seldom heard its tone

We tremble at the half-forgotten sound.

The world is full of rude awakenings

And heaven-born castles shattered to the ground,

Yet still our human longing vainly clings

To a belief in beauty through all wrongs.

O stay your hand, and leave my heart its songs!

I put together the words that were dried up…

And all i wanted to do was…

Convey my simple feelings.

That somber the wind…

Was blowing on that day.

I threw it into the ruins of yesterday.

And now, smiling, I can live with you.

But this affair… Will crucify you.

So that’s why we have to say goodbye.

As it is now, we try to know each other

Until nothing remains.

And someday we will…

Realize that that’s all there is to it.

The sadness… Will flow down our cheeks

And become a river of tears.

That quivering feeling

Will become a strong whirl

And fuse together.

Moral Compass

Adrift,

Lost, wandering

The boundless ocean

Of life…

In search for meaning with

Your Promise as my Compass.

Beyond the horizons,

The True North lies.