doc w/ pen

a journalist becomes a doctor before your eyes

Month: August, 2017

A story from the past that explores life and death, and what makes us human

As some of you know, I write a (mostly) monthly column for an online magazine called The American. I have occasionally posted the link to that column here on my blog. But it dawned on me that those of you who read my blog might like to read these columns as well, and are unlikely to come across them unless I share them directly.

So here is the first column I wrote, published online on April 3, 2014. At this time, I was working in a neonatology research lab at Northwestern University in Chicago. In this piece, I tangle with the themes of life and death, and what makes us human.

Note: This column was first published in The American. You can access the original version here.

The taut line

As the freezer door swung shut, the gravity of what I had just done sunk in. Just 15 minutes ago, the body now stiffening inside had been running, climbing, eating, drinking. I injected it with ketamine/xylazine to anesthetize it. I cut its chest open. I put it on a ventilator. I snipped out its heart and lungs with tiny scissors.

When it was all over, I wrapped it in scratchy, brown paper towels, sealed it in a gallon plastic bag, and tossed it in the freezer. Crush a cricket and I cringe; bleed out a mouse and I didn’t blink. What did this say about me? I left the research lab that day with a furrowed brow, but without an answer.

As if I weren’t troubled enough, I realized that in medical school, which I start this fall, some professor will no doubt utter the phrase “life is sacred.” I agree. How, though, to reconcile that idea with the fact that to save human lives, to improve them, we kill other animals?

These questions have nagged me since that first mouse almost two years ago. They haven’t prevented me from working in biomedical research. But asking them forced me to probe what I am doing and why. Along the way, I have asked other questions and made other observations, which I will explore in this column. As a former reporter and editor, I come by such questions and observations naturally. For years, publishers paid me to query and conclude on matters of public interest, such as zoning laws or school board elections. I stick to science and medicine these days, since “physician-scientist” is what I want to be when I grow up (or finish medical school, at least).

That career path means working with animals — probably mice, and probably killing them in the end. Some people might say, “Oh, it’s just a mouse.” When I stare down into a yawning chest cavity, though, at a pulsing heart, that gap between man and mouse narrows for me. Life is life. Death is death. I dole out the latter. (Count for last week: 22 rats, 18 mice.)

Watching a life come and go, instigating that coming and going, unsettles me all the more because its inception is such a miracle. Even now, every time I find a new litter of pups, called “pinkies” on the first day of life for their rosy skin color, I am awed. That first day, we don’t disturb the mother or the pups. To make sure they are alive and wriggling, we peek underneath the clear, plastic cage. From that vantage point, I can still often make out the little white “milk spot” on a translucent abdomen or two. “Good, they’re nursing,” I tell myself. The pups, born naked, blind, and deaf, grow and change daily. Within one week, their ears are fully developed and fur starts to appear. By 14 days, their eyes open. That’s when we kill them.

“Kill,” though, is weighty word, rife with connotation. Instead, we usually say, “sac,” short for “sacrifice.” Though using another word changes nothing, it can allow for a change in attitude — if you let it.

It can lend some respect and dignity to the animals’ lives, some purpose in ending them, and remind us to use only as many as are necessary.

As the word “sacrifice” suggests, there are elements of ritual in what we do, at least unconsciously. The animals are housed in a separate facility; we “sac” them in our lab. After we bring the plastic cage in, one of us drops a few Cheerios — a rare, exciting treat — onto the shredded, woody bedding. I work in a neonatology lab where we study (and hope to one day prevent and treat) a chronic and sometimes fatal lung disease. This disease affects premature babies exposed to high oxygen, so the mice we sac are juveniles, usually 14 days old. The way we induce this disease in the pups is to put them into an oxygen chamber, along with their mothers. So we have to sac the moms as well. This is the hardest part for me.

“I’m sorry we have to do this, mom,” my lab manager often says as she grasps the female mouse by her tail. “Thank you for taking such good care of your babies.”

Then she gently lays the mouse, its nipples still swollen from suckling, into an anesthetic-filled glass jar. The mouse quickly asphyxiates.

Watching this for the first time shook me inside. It still does, a little bit. There is a tension there, a taut line between compassion, curiosity, concern, and conscience. Through it all, I believe in an honest search for personal reconciliation. That makes us different from mice. That makes us human.

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Weird surgery perks

Beneath my white coat, you can see the maroon OR scrubs that I wore every day while on my trauma surgery rotation. Wearing these scrubs every day provided an unforeseen benefit: less laundry to do.

My enjoyment of this surgery rotation thus far has been a pleasant surprise. Besides learning about, well, surgery, I have encountered important life lessons. But I have also accrued some unforeseen benefits. I think that understanding these perks will provide additional insight into what life is like on the surgery rotation.

Chore relief. On trauma surgery, you wear scrubs all day every day, with the exception of Monday morning’s Morbidity & Mortality conference. That meant I had less laundry to do. Given that I have to lug my dirty clothes up and down several flights of stairs and down the block (I’m in a walk-up apartment, and the laundry room is in the basement of a different building), that’s no small thing.

Budget boost. When I was working with the trauma surgery team, I would leave my apartment at 5 a.m. and get home somewhere between 6 and 8 p.m. That’s a long day, by any standards. I noticed that over four weeks of that schedule, I bought significantly less toilet paper. Actually, my grocery bill was lower overall. I was so busy that I simply ate less. In part because the workday on surgery was so hectic, and in part because when I got home at night I was too exhausted to do more than shove some food in my mouth and collapse into bed.

Free medical supplies. Yesterday, while I was cooking a batch of chili, I managed to slice open my thumb on a can of diced tomatoes. I ran to the bathroom, thrust my thumb under a stream of running water, and scrubbed the cut with soap. Before reaching for the box of Band-Aids in my medicine cabinet, I turned to grab a Kleenex to dry my finger. Then I remembered that I had something much better — sterile gauze! A packet from the hospital had made its way home in my white coat pocket. Hm. Maybe I should grab some more?

I wouldn’t consider these reasons to do a surgery rotation, exactly. But since surgery is a medical school requirement, I certainly won’t turn down the random fringe benefits.

A newly prudent pedestrian

Medical school is one of the most intense experiences I can imagine. As such, I expected it to change me. It has. And in some unexpected ways.

On a recent summer evening, I walked some 15 blocks to a Thai restaurant to meet a friend for dinner. It was a lovely evening. I enjoyed the fresh air after spending so many hours cooped up in the hospital over the last several weeks. On my walk, I noticed something. Since completing my four-week trauma surgery rotation, I’d become a much more cautious pedestrian.

When waiting to cross a street with lots of traffic, I didn’t tip-toe into the street, or even stand at the edge of the curb. Instead, I hung back a few feet. I still jaywalked, but only if there were absolutely zero cars in sight. None of this dashing across the street to beat an oncoming vehicle. And when I saw someone else do that, I shook my head (literally). Even when simply walking on the sidewalk, nowhere near an intersection, I found myself paying close attention to the traffic running parallel to me — something I’d never really done before.

I had abandoned my aggressive pedestrian stance because darting into traffic saves you no more than a few seconds, and can cost you so much. I paid more attention to my surroundings because even when you’re on the sidewalk, minding your own business, a car could jump the curb and smash into you.

Technically, legally, pedestrians may have the right of way. But legality melts away in the face of a 2-ton steel monster barreling toward you.

That reality is now all too clear to me. While on trauma surgery, I’d seen too many pedestrians hit by cars. In medical lingo, this type of trauma is referred to as a “pedestrian struck.” Often the collisions resulted in simple lacerations or minor broken bones. But sometimes they resulted in coma, intubation, and craniectomy (removing part of the skull to relieve elevated pressure in the brain).

Maybe increased caution and attention won’t make being a pedestrian in New York City much safer. But they make me feel better. And that’s something, I suppose.

Good hospital food?

On Tuesday, I was scrolling through Yelp listings, looking for a place to dine that was located near my apartment on New York’s Upper East Side (UES). I saw the standard fare, as expected — Italian, Indian, Japanese, Thai, and so on. And then I saw this:

I did a double take. I expect Yelp to be comprehensive, but Memorial Sloan Cancer Center’s hospital cafeteria? I wasn’t expecting that.

I’d actually just been to this cafeteria the day before, the morning I started a four-week rotation on colorectal surgery. (This is the second four-week block of my eight-week surgery rotation.) I didn’t buy anything at the cafeteria, just peeked in. But after reading some of the reviews, I have high hopes. As usual, there were complaints. But there was a positive theme to the reviews, as evidence by this pointed comment:

It really is the best when it comes to hospital cafeteria food. Crab cakes, paninis, chicken pot pies, macadamian crusted fish. Enough said.

I’m not sure if the same could be said about the Garden Cafe at Cornell.

The Garden Cafe, for those not familiar with the UES hospital scene, is the cafeteria at New York Presbyterian Hospital. This is the main hospital affiliated with Weill Cornell Medical College, and where I do most of my clinical rotations. I agree wholeheartedly with this reviewer that the food there is nothing to write home about.

Even though it takes extra time and effort in the morning, I usually bring my own lunch — both to save money and because it’s healthier. But one of these days, I’ll have to try the cafeteria food at Memorial Sloan Kettering. See what all the fuss is about.