I’m losing body parts faster than I can find new ones. Faster than Marty McFly . Fast. And furious. It’s not that they’re going anywhere on the physical plane, but their common names are starting to sound less familiar by the day. I’m beginning to think my brain’s gotten the go-ahead signal to start deleting information, no matter if I like it or not. Personally, I think getting rid of the lyrics to Groove Is In The Heart or the theme to Captain Planet might be wiser places to start the neural trimming, but I guess you don’t really get a say.

My shoulder’s way gone. Has been for awhile. Hands and fingers are falling apart quickly, too. Maybe this is just because I’m a med student, but now that I’m learning every part of the human body, I’m kinda pissed I was never taught it before. It makes you appreciate your body a lot more. Or it does for me, at least. I used to always think of my shoulder as, well, a shoulder. Y’know–the rounded-off area between your neck and your arm? It always had a definite shape (“shoulder-shaped”), it was fairly solid, and, although it never had any specific boundaries, I kind of had an idea of where my shoulder started and ended. Turns out, I was completely wrong.

It’s not really a body part to me anymore. It probably will never be one to me again. It’s a collection of bones and muscles and tendons and ligaments that are shaped in a certain way. That notch on the top? Used to be the defining palpable area that I’d call my shoulder. Turns out, it’s the acromion of your scapula . I know! Who knew? Follow it down, that bony part–it’s more scapula. And around the front? Scapula. Clavicle. It’s hard to convey the feeling or the contrast. Of course I knew we had bones, but now, I know exactly where they are. My shoulder’s not a shoulder. It’s a scapula. With muscle all over it.

It’s the same with muscles. I knew we had muscles, but now, I know exactly what they do . It’s a bizarre feeling trying to examine yourself, figure out where your muscles are, and what’s making what move. It’s so natural, so thoughtless, that even trying to think what muscles are moving seems forced and out of place. It’s as if I’m somehow surprised that we don’t have to will our muscles to move. Triceps, medial, lateral, and long heads, contract! Extensors digitorum, go! Opponens policis, flex!

In other news, it looks like we have have discovered some new male birth control and new fertility drugs . Marijuana makes sperm lazy and burn out too quickly, and caffeine makes them more active. Imagine that.

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In stark contrast to my previous love rant , I present a totally different facet and hypothesis: One cannot be a good physician unless one understands love.

I think it’s easy to take a patient–a complete and total stranger–as “just another face” in medicine. The lone patient, completely detached from his or her social attachments, is merely another person who requires care or treatment. Write a prescription, advise smoking cessation and more exercise, and move on. But it’s one’s own experience with love that makes the 2-dimensional patient a living, breathing person. Ten dimensions–twenty–and truly deserving of care and respect.

Even when I was set on becoming a doctor, and I knew I wanted to help and heal, I wrestled with a question to which I could find no answer that satisfied me: “Why go through these extraordinarily expensive and high-risk procedures to keep a person alive? Aren’t they just representative of Americans’ inability to accept death as the inevitable consequence of life?” The latter question was always my default answer. Americans, obsessed with youth and beauty and botox and materialism and secularism, denied that death existed until the very last moment. But then, in one of those eureka moments, those light bulb flickers, I had my answer. I had fallen in love.

It’s the love that makes us try anything and everything to keep someone from leaving us. Why the mother do anything to save her children; why one spouse will spend millions to try to keep the other alive for a few more precious weeks; why a complete stranger will undergo elective bone marrow removal to save someone else’s mother, father, brother, or sister. I’m of the general philosophy that it’s the painful, the difficult, and the bad that facilitate more learning and wisdom than floating along with a semi-charmed life, but it’s also human nature to avoid the painful, the difficult, and the bad, too. And while the death of a loved one probably makes us appreciate living that much more, we’d rather be that much less wise, and be able to keep the person alive.

Now, when I think about that question whose answer I could never quite uncover, it seems almost frightening that I ever had such inhuman thoughts. The answer’s so clear that it’s hard to imagine that I could never quite figure it out for so long. And I guess that’s the way I try to see patients. As a mother, a father, a brother, or a sister. And the pain and grief it would cause if the patient were to die.

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Evolutionary theory, along with today’s testicular dissection has made me a total love fatalist.

I visited the long-distance better-half last weekend in Chicago, and remember specifically thinking, “Love can’t be just a chemical . My feelings are too strong, too real, too powerful.” Love is almost always portrayed in our culture as not just a feeling of one person, but a connection between two people and their relationship. If you’re “in love,” it’s with someone else. It’s always “I love you,” or “we love each other.” People rarely talk about “feeling love,” the way they might describe themselves as feeling “sad” or “angry.”

But then today we were dissecting the abdomen and scrotum, and I had one of those depressing, “there goes the mystery of life” events again . More and more I just feel like we’re all just organic robots. Living cyborgs. We’ve got circuits that pull levers, flip switches, and sound alarms. But now I’m starting to wonder if we’re all just destined for some endless, meaningless reproductive cycle. I cut through a stranger’s scrotum today, ripped out a testicle from his body, and let it just hang outside his body for all to see. I started to get this strange feeling–it’s fleeting now–that we’re just organic robots with one sole purpose: to screw . I use said term as opposed to one of its more pleasant euphemisms because I’m curious how much of our emotions are really just tricks our lower brains play on us to keep us reproducing.

Is there love? Or is it just a chemical process euphoric enough to (hopefully) keep us with a mate long enough to mate and raise a child of our own lineage? Maybe we’re just evolutionarily advanced breeding dogs. We’re clearly built with certain parts in mind. (The penis in lab today seemed completely stripped of its cultural and societal contexts and symbols; I couldn’t help but view it with only evolutionary function: what men use to get their sperm into women.) Maybe culture, thought, philosophy, language, society, and art only get in the way of our one true duty: to reproduce. Maybe love (and hormones) are just a bunch of dirty little tricks so that we don’t spend all of our time thinking and pondering the human condition or watching televsion. It’s kind of counterintuitive from what society teaches, but maybe they’re just there to make sure our bodies keep on the evolutionary track.

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For as benevolent and giving as the medical path can seem, it can seem pretty damn selfish, too. (I partially base this notion on a speech from a 5th year, just to give credit where it’s due.) We’re hit with the firehose of medical knowledge when we can only sip, and we pass on our frustration and grief to our friends and loved ones. When we need them most–for support, love, and sometimes, just an ear. And at the same time, we can’t always give that level of support back.

We give up our future 8 years (“the best years of your life!”), lose touch with close friends, maim relationships and love, go into great debt, put our lives and health at risk, lose sleep, and stress and question ourselves. And all of this under the assumption that we’ll enjoy this “practicing medicine” thing for the rest of our lives. I don’t care how much you’ve shadowed doctors, how many offices or clinics you’ve worked in–there’s no proof that we’ll enjoy this line of work. Matriculation rates are pretty high across the country, so I guess the system’s picking a decent crop of people, but it’s really quite a lot to give up.

“Short term” pain; “long term” gain. I just hope I don’t come out of this regretting that I let someone important in my life slip away, or that I didn’t enjoy the ride, or that I missed out on some sort of generational experience because I was busy in the lab.

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Randy Travis Drinks Cold Beers

(Roots, Trunks, Divisions, Cords, Branches, from medial to lateral)

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David Finkel wrote a great article called A Slave to Health Insurance about a 58-year-old woman who’s taken up a 50-hour-a-week job to pay for her current meds regimen. She’s up by 3am to open the store by 4 and have it ready to go by 5:30. The most ironic part of the article:

bq(quote). By 5, she has taken her Lipitor (for high cholesterol), Singulair (allergies), Ultracet (back pain), Combivent (breathing), Zoloft (depression) and Temazepam (insomnia).

As far as I can tell, she has to take the Lipitor because of unhealthy food, Ultracet because of the 50-hour work weeks she puts in at Hardee’s, and Zoloft and Temazepam to deal with the fact that she’s almost 60 and having to work at a fast food joint to pay her bills. Reminds me a lot of « le buveur » ( English ), like some sort of vicious cycle: he drinks to forget that he is ashamed that he drinks. Or the “I can’t hear you, I’ve got a *banana* in my ear!” schtick. Repeat ad infinitum.

This isn’t the way I want *my* parents to be taken care of. I love the way this health care system is passed onto our generation as some sort of great fixer-upper. (“Add some new wallpaper here, spackle and re-tile that bathroom, provide health insurance for 44 million Americans… no problem!”) Maybe I’m just extremely negative and/or cranky today, but it seems like we’re always told how much room there is for improvement in the health care system, as if we’re so incredibly fortunate to be becoming doctors at a time of such health care disaster. Cut the euphemisms, leaders-of-today. I won’t take responsibility for this system. I’ll work my ass off to try to fix it, revamp it, or start over all-together, but don’t for a second act like we’re equal partners in this one. I’d much rather have one less “exciting challenge” in my career and have everyone in the country have adequate health insurance, or hell, have childhood immunization rates that compete with Mexico’s .

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Y’know, they really ought to put a stop to this ( Quicktime , 360k).

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