doc w/ pen

a journalist becomes a doctor before your eyes

Category: The American

Among the child believers

Puddles and gray skies seen from the front porch of my lodgings in Naggalama, Uganda, some 40 kilometers northeast of Kampala. My thoughts about the cooling rain — and about issues like childbearing and marriage — are very different from those of many people I met in Uganda, as I discovered during my month-long stay there.

This morning it’s raining in Naggalama, Uganda. It’s been raining a lot the last two weeks, both brief, light showers and heavy deluges. Naggalama is my home base during a month-long Ugandan stay in which I’m visiting a number of rural hospitals as part of research into palliative care.

Around Naggalama, gray skies shroud the blistering, equatorial sun and the rain cools the usually hot air.

For me, it’s a welcome respite from sticky heat. But for the Ugandans I’ve talked to, this is their equivalent of frigid winter. While I walk comfortably in a short-sleeve shirt, I see others shivering in their sweaters and coats. They look at me wide-eyed, and I return the gaze. It’s not a critical look, more one of surprise; shock at my (or their) response to this weather.

Other differences have arisen, some of these more philosophical, cultural, and belief-driven.

A common topic of conversation here is family. Family is of utmost importance in Uganda. The measure of manhood for many here is how many children you’ve fathered. Not so in the United States. It is not surprising, then, that the average number of births per woman in Uganda (5.6) is more than 3 times that of the average woman in the United States (1.8, according to 2016 statistics from the World Bank). Some professionals I’ve spoken to want smaller families. But I’ve seen people in the rural villages with eight, nine, 10, even 11 children, and not always enough food for them all.

It’s hard for me to wrap my head around this practice. I understand the desire to have children but my heart breaks when I see families that have more than they can afford.

Similarly, it’s hard for people here to comprehend the fact that at age 36, I don’t have any children. And I may not have any, ever.

“Don’t you want a child?” many have asked me.

“No,” I’ve replied, simply.

The measure of manhood for many in Uganda is how many children you’ve fathered. Not so in the United States.
“But you will not be complete until you have a baby!” they’ve insisted.

“I don’t feel that way,” I’ve responded. “I find fulfillment in other things in my life.”

My principle always surprises, but the level of others’ incredulity varies.

“Lorien, are you normal?” one person asked me.

It took me a moment to fully understand this question. What did “normal” mean in this context? I realized later that normal might have been a euphemism for being heterosexual. The opposite, “abnormal,” then referring to being homosexual —still a crime in Uganda, although no longer one that gets you the death penalty.

This conversation about having children is inherently circular. I orbit my credo, and they theirs. But our diametric circuits never intersect.

Likewise, being divorced is a strange concept here. Being separated from your spouse, finding a new one, or simply having children with someone to whom you are not married — these things are commonplace. The act of a formal, legal divorce though, is not.

“Don’t you want to find a new husband?” people have asked me.

“I would like to,” I’ve said. “But I need to find the right man. It’s better not to be married than to be married to the wrong person.”

Frequently, after exhausting the topic of divorce, the conversation returns to children.

“But you didn’t even have one child when you were married?”

“No,” I’ve said. “And I’m glad I didn’t. It would be very difficult for me to raise a child on my own.”

Saying those words has always made me imagine what it would be like to raise a child as a single mother while also attending medical school. I shudder. I have the greatest respect for anyone raising children during this journey toward becoming a doctor, single parent or dual household. I find it hard enough to take care of myself, let alone take care of someone who is entirely dependent on me for their every need. I don’t explain all of this, although maybe I should.

“But we women in Uganda often raise our children alone,” one woman told me. “The husband often leaves. If you look at 100 schoolchildren, you would find that for 90 percent of them, the school fees are paid by the mother,” she said.

Puddles and gray skies seen from the front porch of the author’s lodgings in Naggalama, Uganda, some 40 kilometers northeast of Kampala.

Those statistics aren’t backed by research, of course. But I know that while there are many good fathers and husbands here, the suggestion that women are the ones who generally tend to the children has some truth in it. Many women do raise their children alone here. If a woman can’t bear children, or can’t bear any more children, her husband may leave her, I’ve been told time and time again.

And if a woman becomes seriously ill, her husband may also leave her. I’ve seen that firsthand with the palliative care patients we’ve visited in rural villages. From a trip I made to Uganda two years ago, I remember one woman who had terminal cancer. She had 11 children, some of them adults with their own families, but several of them young and still living with her. Her husband had left and found a new wife. He continued to “give care” — provide financial support — for the children while the patient was alive. But she worried about what would happen to her children when she died.

Uganda has no formal state safety net. No foster care, no welfare services, no alimony or child support.

To me, having a child in this environment sounds terrifying. But for many Ugandan women, this situation is all they’ve ever known. What frightens them more is the thought of not bearing any children at all.

At some point, I always steer the conversation toward another topic, knowing that we’ll get nowhere no matter how long we discuss the merits of having (or not having) children.

In the end, all I can hope for is that I’ve done my best to listen and remain open to hearing about and discussing beliefs other than my own. To consider why someone might hold those different beliefs, even as I do the opposite.

I remind myself that cultural exchange isn’t about convincing someone else that your ideas are better. It’s about sharing what you do, finding out what they do, and talking about why. And at the end of the day, doing your best to respect each other.

 

Note: This essay was first published in the online magazine The American, for which I write a monthly column called Bio-Lingual. You can read the original version here.

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The white coat

Me in my white coat: a piece of clothing that started as a costume, but over time has become a uniform — just like we were told it would at our white coat ceremony almost three years ago.

At my white coat ceremony almost three years ago, a physician gave a brief speech about this new attire we were about to don. I don’t remember his name, but I do remember, with stunning clarity, his simple premise:

When you start medical school and put on your white coat, he told us, it will seem like a costume. But eventually, as you embrace your new profession, you will come to see it as a uniform.

I’ve thought about this concept throughout medical school, tested its truth as year 1 became year 2, and then year 3. As I approach the start of year 4, I conclude the speaker was right. The first time I put on my white coat, it felt completely foreign. The first time I wore it in the hospital, to spend an afternoon observing in the burn unit, I was shocked at how my white coat and hospital ID acted as an all-access pass. With them, no one questioned my presence, even in “restricted” areas. No one, that is, except for me.

I don’t recall the precise turning point when the white coat finally felt comfortable. What I do recall is that at the start of my psychiatry clerkship, a rotation in which you don’t generally wear your white coat, I initially felt confused, almost naked, as I went about my medical student duties in the hospital. Then I knew with certainty that I had accepted the white coat as a uniform, and not a costume. It had become a part of my identity.

It was with all this in mind that I selected a date for my Step 2 Clinical Skills (CS) board exam recently.

I took my first board exam, Step 1, the February of my second year of medical school. We have to take two more board exams during our fourth year, prior to graduating. Step 2 Clinical Knowledge (CK) is a daylong multiple-choice test. Step 2 CS is a daylong series of 12 encounters with standardized patients (actors). Each encounter lasts 25 minutes. You have 15 minutes to conduct a focused history and physical exam based on the patient’s chief complaint (known as the presenting problem). You then have 10 minutes to write up your findings, top potential diagnoses, and the diagnostic tests you would order next. You are graded on a number of things, including your interviewing skills, physical exam skills, and diagnostic reasoning. The exam is pass-fail. I have to pass to get into residency — but no pressure, right?

Step 2 CS is only offered at a handful of sites throughout the country, the closest to New York City, where I live, being in Philadelphia. So it’s a bit of an ordeal. You have to take the train or bus the night before and stay in a hotel. And you need to plan for a week or two of studying first — this is not a test to go into blind or unprepared. It’s an expensive ordeal, too — $1,285 to be precise. Aside from the terrible effects a “fail” would have on your residency application, you don’t want to shell out that application fee a second time. So, you choose your date carefully.

Based on my fourth-year schedule, I had planned to take the exam in late October or early November. Sitting at my laptop, looking at the dates available, I had to make a choice. But how do you decide between a day earlier and a day later? Was there a strategy to this? There must be. I groaned (audibly, I imagine), with the weight of this decision, and the frustration of indecision.

I looked at the available dates again, more closely this time. As I did so, that speech from my white coat ceremony came back to me.

Halloween.

It was perfect. Poetic.

I would slip into my white coat to take Step 2 CS, an exam that heralds a further transition from costume to uniform, the transition from medical school to medical residency, and from medical student to medical doctor, on the holiday when millions of other people wear costumes too.

I smiled as I clicked on “October 31” as the date to take my exam, and completed my registration. I had no doubt that this was the right day. Suddenly, I had transformed a day that had so far filled me with dread into one filled with meaning.

Changing my attitude in this way won’t erase the anxiety surrounding this exam. But it will ease that anxiety. And I believe approaching the exam with this positive perspective will lift not only my spirits, but my confidence too, because what started as a costume has in fact become a uniform. And I have both been given the privilege, and earned the right, to wear it.

 

Note: This essay was first published in the online magazine The American. You can read the original version here.

Picking among disciplines

“What do you want to be when you grow up?” It’s a common question throughout childhood. It comes from teachers and parents. It’s also a question we ask of ourselves. We dream into adulthood, trying on different career costumes, imagining what could be.

My own sense is that the question is in constant evolution. It can’t be definitively answered after high school, college, or even graduate school. Few people in this era complete a career with the same company. Each new promotion, each new employer, provide further clues into our professional identity.

When I decided to go to medical school after a career in journalism and publishing, I turned over a radically new leaf. I handed in my pen for a penlight, political sleuthing for a stethoscope.

Could I have imagined such a change in course when I first thought about my future? No.

As I approach the start of my fourth and final year of medical school, the original childhood question takes a far more specific turn: What kind of doctor do I want to be?

It’s pondered endlessly, ad nauseam, at times to the point of true nausea. As in childhood, my reply to the medical school version of the question has changed over time.

For as long as I can remember, I’ve made things with my hands, from beaded necklaces to stained glass windows to origami flower bouquets. So I initially pictured myself in a procedural specialty, something surgical, making the most of my manual dexterity. But I quickly realized that I much preferred waking patients to those under anesthesia. I also realized that the reporter in me craved stories, conversation.

In the context of my career history, filled with interviews and human contact, my chosen field — psychiatry — makes obvious sense. Admittedly it wasn’t the choice I’d imagined when I began medical school. In fact, it was among the fields I thought I wouldn’t choose.

But in a way, psychiatry chose me.

Before starting my psychiatry rotation, I’d rotated through obstetrics-gynecology and primary care (outpatient adult medicine). I’d loved aspects of each. In the ob-gyn segment, it was my two weeks on the labor and delivery service. Holding the hand of a mother-to-be, counting with her as she pushed out a new life. Talking, in between pushes, with her and whomever was there to support her (husband, partner, mother, sister, friend) about their hopes, dreams, and fears. During primary care, it was sensing the trust that patients put in their internist, who’d known many of them for years, knew their life stories and struggles as well as their medical diagnoses.

Not long into my psychiatry clerkship, I realized that in this one field, I could experience my favorite parts of my time in ob-gyn and primary care. I could talk about a patient’s hopes, dreams, and fears as well as develop ongoing relationships with them.

I could also use many of the skills I’d honed in my decade-long career before medical school. Psychiatry, like journalism, is about stories. It’s about developing quick rapport, asking the right questions, and being an active, empathetic listener. These skills are certainly not unique to psychiatry, but they are especially important in psychiatry, where a detail from the patient’s medical history, past hospitalizations, relationships, or living situation might be crucial to how you manage the person’s care. This background suddenly takes on immense importance because of the way past experiences shape mental health.

There is also an investigative aspect to psychiatry. One of the tasks frequently given to medical students on the psychiatry clerkship is to track down so-called “collateral” on a patient – to talk to a person’s medical doctor, therapist, psychiatrist, case worker, significant other, sibling, parent, or friend – to get a more complete picture of the person’s immediate situation. In psychiatry, as in journalism, you don’t rely on the story you get from one person. You approach information with healthy skepticism. And so you gather evidence from a number of sources and put the pieces together yourself.

Each field of medicine also has a vibe, a unique personality. Part of finding your place, I realized early on during my clerkship year, is finding your tribe. In psychiatry, I did. I found people whose personalities, interests, goals, sense of humor, wardrobe choices, and even favorite eyeliner color meshed with my own.

After completing my psychiatry clerkship, I was almost sure that I wanted to be a psychiatrist. After finishing other rotations, I’m entirely sure. Because the things I liked best about each of them also have a place in psychiatry. In neurology, my favorite patients were those whose illnesses blurred the lines between neurology and psychiatry. In surgery, I thrived under the tutelage of a particular trauma surgeon, one of the best educators I’ve ever met. He inspired me, on a daily basis, to learn and explore, to be curious. I’ve found mentors in psychiatry who do the same, and I find psychiatry’s subject matter inherently interesting in a way surgery concepts were not. In internal medicine, I liked the challenge of using artful communication skills to broach difficult subjects with patients and family members. I also felt at home in the role of being a comforter to those in distress.

While I’ve answered the next iteration in this serial question – “What do you want to be when you grow up?” – my future is by no means fully defined. First of all, where do I want to do my four-year psychiatry residency? And after that, do I want to do a fellowship for more advanced and focused training? Do I want to work with inpatients, outpatients, or a mix? What city do I want to practice in? I’ll find the answers to these questions and others, in time.

For now, I focus on what’s in front of me: finishing medical school, and finding the right place for me to become the best psychiatrist I can be.

 

Note: The original version of this essay appeared on the online magazine “The American.” You can read it here.

 

Running the mental gantlet

This essay was first published in the online magazine The American. You can see the original version here.

 

Learning about a patient is like digging into a demanding novel: plot and characters need fleshing out.

Running the mental gantlet

Some people compare starting a new clinical rotation in medical school – something you do every six or eight weeks for an entire year – to starting a new job. A job you’ve never done, and one you feel wholly unprepared for. I liken the experience to being dropped into the middle of a novel. Dialogue explodes around you. But the speech lacks context and you struggle to make any sense of the words. Characters fall in love, have sex, shoot each other, but you can’t always tell the good guys and bad guys apart. For heaven’s sake, you don’t even know where you are. Russia? Iowa? The moon?

That’s how I felt when I started my inpatient psychiatry rotation on a summer Monday last year. I arrived promptly on the unit at 8:20 a.m. as I’d been instructed. I knew the names of the attending, resident, and medical student I would be working with, but not their appearance or where I was expected to meet them. I sheepishly hung out with a kind, chatty nurse until the 8:30 a.m. team meeting – a meeting I had no idea I was supposed to attend until the friendly nurse told me. A dozen or so of us entered a room and sat or stood around a big table to discuss general issues – safety concerns, upcoming discharges, new admissions, staff absences, special activities.

After this combined meeting, we had another meeting just with my team to discuss more specific updates on our own patients. Since I was new, those present introduced themselves. Overwhelmed by it all, I promptly forgot most of their names and their roles.

I got slight comfort in telling myself I’d pick up the details after everything settled down.

I noticed that the woman running the meeting had two binders. One bore the name of my attending psychiatrist, the other the name of a different attending. Not all the patients were covered by my team, which made me wonder where exactly they wanted my focus.

As the meeting progressed, with notes and updates on specific patients, I noticed that my medical school colleague, who was sitting next to me, occasionally scribbled a few notes. “Should I be taking notes?” I wondered.

I didn’t want to be perceived as not paying attention, but I had no idea who these patients were, which ones (if any) were my responsibility, and which updates mattered.

One of these updates might consist of something like this: “On Saturday, Jane Doe took her medications. She spent most of the day with her family. She expressed her needs appropriately. She slept well.”

That sounds bland, but perhaps this was the first day Ms. Doe had agreed to take her medications. Perhaps sleeping well was a major improvement for her. I just didn’t know.

With patient names and behaviors swirling in my head, I did my best to keep the confusion at bay, reminding myself that this was my first day, my first hour. I couldn’t be expected to keep things straight. Not yet.

Then the team resident, my classmate, and I talked individually with patients in one of the unit’s small, private meeting rooms. The resident immediately launched into questions. Sleep? Appetite? Mood? Hallucinations or delusions? Medication side effects? Thoughts of hurting yourself or others?

Between patients, my classmate tried to give me a brief synopsis of the next patient: diagnosis, treatment plan.

With only that to go on, I struggled to make sense of the encounters. The journalist in me cried out for each patient’s fuller story. Understanding the past would help me understand their present, and their prognosis.

As the patients answered the resident’s questions, in my own mind the replies only provoked more questions. One patient made a vague reference to a brutal childhood trauma. Another hinted at magical powers. How could I not want to know more?

Making matters even more complicated I had little understanding of what my supervisors (the psychiatry resident and attending) expected of me for the next four weeks. The medical student told me what he’d been doing – interviewing two of our five patients one-on-one daily, and writing a progress note on each. But more concrete information was hard to find.

I finally went to the source, asking the resident what her expectations were. She told me to do essentially what my classmate was doing — pick a patient or two, spend some extra time with them, and write my own notes. I had figured as much, but now it was official.

I selected my patients and dug into their medical records, combing through the notes in each person’s electronic chart. I was back to reading the novel, starting at the beginning and working my way forward. I began with each patient’s presentation to the psychiatric emergency department. That gave me a sense of how they were when they first came to the hospital compared to how they were now. I then moved to the initial evaluation note from the psychiatric unit (where I was now working). These two comprehensive notes helped me understand each patient’s present psychiatric illness, as well as past psychiatric history, medical history, family situation, and other life factors. I also read what are called “collateral” notes. These are conversations between a medical practitioner (often a medical student) and someone else in the patient’s life — a spouse, friend, psychiatrist, therapist, or caseworker, for example. They provide an outsider perspective on how the patient’s current condition compares to their norm. Last, I read daily progress notes, finishing with the one written that morning. These brief and focused progress notes told the story of the patient’s day-by-day existence on the inpatient psychiatric unit. How they were eating, sleeping, behaving, and overall living while in the hospital. These daily updates clued me into whether someone’s delusions or insomnia had improved, for example, or whether they were tolerating an increased dose of a medication.

At the end of that first day, I was still in the middle of the novel, on page 200 or so. But I’d gone back and at least skimmed the first 199 pages. And with that background, I was now ready to move on to the next chapter: the next day.

“Dr. Dating”

In a recent post, I shared one of my early online magazine columns from several years ago. Today, I’m sharing my most recent column, published this week. Most of my pieces (both for the magazine and here on this blog) explore science, medicine, and life in medical school. This piece, however, explores new territory. It’s called “Dr. Dating,” and as the title suggests, it delves into what it’s like trying to find a partner while surviving as a 35-year-old medical student.

This piece was first published in the online magazine The American. You can see the original version here.

Dr. Dating

Dating in medical school is hard. When your 3:30 a.m. alarm heralds a 15-hour workday, you have little time left for yourself, much less a partner.

Dating as an older medical student is even harder. When most of your classmates are a decade younger than you, your dating pool automatically shrinks. Dating apps make the whole thing almost impossible. When Cupid’s main criteria is pixelated faces there’s little room for meaningful romance.

I tend to post on sites that allow a more freeform profile, minus images. I want responses to my words alone. So far, I’ve had mixed results. I’ve dated two men seriously; one for a few months, the other for a few weeks. I was comforted to know there were people out there who shared my mindset. I’ve also gone on a number of dates with like-minded people who weren’t the keeping kind. There was either no physical chemistry or political differences of opinion too deep to overcome. I can’t date someone who doesn’t believe in the importance of social welfare programs, for example.

My online profile says I’m an intelligent, attractive, ambitious woman. I mention I’m a writer who wants to be wooed by words. I say I want more than a laundry list of hobbies. I ask for a photo or two, clothed please, promising to return the favor.

I put replies in folders so I can keep track of my suitors. My folders are labeled: “reply!,” “maybe,” “nope,” “compliments,” and “LOL.” The most interesting responses usually don’t lead to dates. Many say a lot about the people — I can’t say men, since until you meet the person it’s impossible to know — who wrote them and society at large. I’m part-lover and part social anthropologist. Human behavior intrigues me.

The messages in the “nope,” “LOL,” and “compliments” folders have taught me a lot.

But let me break it down. The “nope” e-mails are usually one- or two-liners like this:

Hi, I’m interested in you, hope to read back from you.

Or vague:

Good evening, how are you? I hope all is well. I am reaching out regarding your post. I am in my early-30’s, 5’10”, and looking to meet someone new outside of my social circle. Hobbies and interests?

I hope we have a chance to chat soon. Take care and enjoy your weekend!

If you’re looking for a wordsmith, you skip past these.

The “LOL” responses exist to remind me there are still plenty of misogynistic men who feel threatened by confident and capable women. Some believe a bad marriage is better than divorce. Many can’t imagine they might be the source of a divorce. I try not to respond to such messages. Here are a few examples, as well as my potential responses. I’ve made some minor grammatical changes for the sake of clarity, and have removed identifying details.

On divorce:

I’m white, live in [NYC borough], and [am] looking for a relationship hopefully leading to marriage and raising a family. I’ve never been married, no kids, don’t smoke or do drugs, rarely drink, no pets, not a vegetarian, and am Catholic. And you? You seem like a nice person. Why did you divorce?

Another:

The most interesting thing about [your profile] is the part where it notes you’re divorced and that you chose not to offer an explanation re: same. Thoughts?

I might reply this way:

Just because I posted an online profile with some vague details about my personal life does not mean that I owe you — someone I have never met, and know nothing about — an explanation. To be honest, I mentioned that I’m divorced for one purpose and one purpose only — to screen out people who have a problem with dating divorced women. Looks like my strategy is working.

One man responded every time I changed my profile. Here are excerpts from what I received — so delightfully — over a two-week span.

1. You’re pedestrian and obvious, you’re a plebe and a wannabe. You’re a middle-aged … student. Not sure where you get the right to be that pretentious. I wouldn’t even consider bedazzling your face with my semen.

2. I see you started four out of five paragraphs with “I.” Do you lack such an imagination as a writer that every sentence needs to start with “I” or “I’m”? Also — SELFISH. Your ad reads as “me me me me.”

3. You’re fucking stupid.

To this eloquent man (assuming he is one), I would reply:

Given that you have replied not once, not twice, but three times to my profile, not with the goal of meeting me, but of insulting me — and are therefore wasting your own time — I have no choice but to conclude that it is you who are stupid. Best wishes in your own search.

Some just don’t understand intellectual attraction:

What planet are you from where men will be drawn to your words before they are drawn to your body?

To which I would say:

Dear Sir, I am from Earth, a planet where a minority of men still desire not only physical but intellectual intimacy with their partners. This may not be your goal, but it is the goal of dozens of people who have replied to my profile. I do thank you for your kind concern, though.

My “compliments” folder exists to remind me good men are out there. Three snippets in that vein:

1. If you don’t mind me saying, this was probably the most well written and grown-up post on [this website]. I’m impressed, most everything else is devoid of any type of substance. Although I would love to go back and forth with you about any and all topics, I’m probably not what you’re looking for. But I felt compelled to write you. Anyways, I wish you the best in your journey!

2. Hi, seriously I wished I was 35. I loved everything about your ad. Unfortunately I’m [in my mid-20s]. Been looking for a woman like you for awhile but it’s so hard to find. My last relationship didn’t last long because she was more of a Nympho and I wasn’t unfortunately. But I need someone like you in my life. I hope to find my own … soul mate. I wish you all the best.

3. I just wanted to say I really enjoyed your ad. It was a pleasure to read such a well-written, clever ad. It brought a smile to my face as I perused the rest of the junk [on here] today. … Unfortunately, I’m not your type. (I fail in one important category. I’m married. Otherwise, it would be a great match.) But I wanted you to know that your ad brought a smile to my face and gave me hope of finding someone decent on [this website]. Good luck.

So there are kindred spirits out there. Somewhere. And one day I’ll find a smart, funny guy who isn’t married, isn’t crazy, and I click with. For now I’ve got medical school, and she’s a demanding mistress.

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.