Disease — epidemiology — pathogenesis — presenting symptoms — treatment — prognosis
I am doing flashcards almost rhythmically, rocking my chair and thoughts to the lilting cadence. It’s early, and my fingers are curled around a steaming coffee. I move forward through the deck, slotting each pearl of information into my brain as best I can, until one prompt jolts me from my focused state.
Placental abruption — third trimester bleeding with pain — immediate delivery — life threatening for mother and fetus
A vivid scene swims up. My mom is eight months pregnant. She is bleeding in the bathroom and we are afraid. “You might have to take me to the hospital. Dad isn’t home from work yet,” she says, forcing a smile through lips blanched white. I nod nervously, tracing the route in my head. At 16, I am a barely competent driver even when there is no blood involved.
I flicker my eyes towards the ceiling in an attempt to brake the accelerating memory, willing myself to take deep, abdomen-expanding breaths. Get back to studying, I sternly self-admonish. I flip to the next card.
There are many days in medical school that I agree with Carrie Fisher: my body is a brain bag. Most of my hours are dedicated to building and filling the perennially too-empty filing cabinet in my head — a fairly dry endeavor, as it turns out. I strip down the messy glory of human experience to its most basic parts: how our physiology works and how it breaks. How our matter comes together and how it falls apart. Rinse and repeat, and repeat and repeat. This body-as-brain-bag mindset is protective to some extent. We learn about too much suffering, much too quickly, to fully appreciate the cumulative human havoc that each pathology wreaks. To do so would be impossible, not to mention completely debilitating. I cannot open those floodgates. I cannot mourn every day.
But there are moments that break through the rinse-and-repeat cycle and stun me with their ferocity.
Earlier this year, I was dissecting the roots of the brachial plexus away from our cadaver’s cervical spine. I had fallen into a pleasant workflow, letting my brain idle as my hands manipulated her tissue. To unearth the graceful nerve formation, I carefully pulled back her anterior scalene muscle, and, in the process, brushed my hand against her lung. The visceral organ felt so different than the muscle, bone and fat with which I was used to working. It felt buoyant and reactive and, even though I knew otherwise, alive. Surprising myself, I started to cry. The asymmetric intimacy hit me viscerally. I knew so much about the physical construction of this woman, but so little of what really mattered. What made her manicured fingers drum with excitement? What fears made her take deep, abdomen-expanding breaths? What was behind those smile-lines on her temples? Did she hold grandchildren in her lap, write furiously in her journal about chapters that moved her, sneak extra fudge after dinner? I stood over her body, lying prone in her plastic blue bag, wondering.
Brachial Plexus — formation of nerves originating from the cervical and thoracic ventral roots, providing cutaneous and motor innervation to the shoulder and arm
In March, I finished a daylong cardiology exam to learn that my uncle had died from a massive heart attack. We had studied the disease process in earnest for weeks, sketching out exactly what happens when a thrombus occludes a coronary artery — how it blocks the blood supply, how that necrosis translates into squiggles on an electrocardiogram, how it is treated and how patients fare. I burned it into my brain and regurgitated it all day via the best multiple-choice selection I could muster. Uncle Joe had a mullet for a while: “Business in the front, party in the back.” He rode a motorcycle. He kicked my ass at cards and drank Grand Marnier. He was 54.
Myocardial infarction — blocked coronary artery — crushing, substernal chest pain — 30 percent mortality
A patient and his mother came in to talk with our class a few weeks ago. At 10 years old, he developed a brain tumor and required major surgery to remove it. Nearly a decade later, he and his family are still dealing with the repercussions: a myriad of medical challenges, partial blindness and, perhaps the most troubling, significant personality changes. His mother showed us photos of her son just before he was diagnosed — a little rascal with gangly limbs, holding a water gun with a grin. You can just see the motion in his body, energy waiting to be released the second the shutter snapped.
Craniopharyngioma — benign proliferation of pituitary embryonic tissue — no known risk factors in pediatric patients
On days with these moments, I can’t maintain the illusion that my body is just a brain bag. I can’t dissociate completely, can’t approach it clinically, can’t not jump into the water once the floodgates are open. I can’t help but ponder the questions I write off as distractions and try to avoid. Questions like: How do humans go on? How do we move forward? How do we continue to weave networks of love, support, mutual caring, generosity and interest, knowing all the while that they will break?
I will die. The people I love will all die. This is undeniable to the point of being obvious. Should I be embarrassed that thinking about this — really thinking about this — has me reeling? Has everyone else already figured this out? The people I love will die because of chance misinteractions between molecules leading to uncontrolled growth. They will die out of turn, children before parents. They will die after being hit by cars driving a little too fast on roads a little too winding. They will die because of the hatred, bigotry and intolerance that are baked into the systems that govern our lives and dole out tragedy in unequal, heaping spoonfuls. They will die after tripping down the stairs. They will die at their own hands. They will die by pathologies we know all too well and by those we don’t yet understand. They will die peacefully, in their own beds, at 95. No matter what, or how, or when, they will die. We will die.
And yet, we go on. We orient our whole lives around others, turning to face them like sunflowers in the sun. We love with eyes wide open, knowing that loss is both terrible and certain. We let others in — learn them, and let them learn us. We say “yes.” We say “I do” and “I’m pregnant” and “You’re my best friend and I would be lost without you” and “I got this lovely book for you” and “Can I hold your hand?” and “Do you want to come fishing with me?” and “Good morning kiddo!”
I’m not sure how humans go on. But I know that we do, and for now, that simple fact is enough.