Friday, November 20, 2015

"LOL"

I’ve always joked that Irish Catholics respond to tragedy with laughter.

Maybe it’s some quirk in my upbringing.  But I often follow up anything serious I say, be it a rough day at work, or a reference to something difficult that I experienced in the past, with a “hahaha.”  Friends who text me frequently can attest to this.

In mundane matters, the response can be perfectly appropriate.  Yet, for serious matters, like those considering pain, loss, mortality, it can seem inappropriate.  Maybe it is inappropriate.  I’ve always been unclear on this.

The other day, while speaking to my psychiatry attending about the patients we had met with that morning, we came onto the topic of laughter.  About one of our patients who kept laughing intermittently between heavy, silent tears.  He would always go on a monologue when he did this, saying he laughed because it was the only way he could accept that he was going to die, that he was going to die soon.  He had end-stage lung cancer.

Afterward, my psychiatry attending and I discussed whether this coping mechanism was appropriate or not.  This eventually devolved into a discussion about our favorite comedy shows.  We had a five-minute aside about the humor of South Park.  About whether certain topics should not be joked about - like current events, issues about race, death.  For some reason, I found myself asking him if he’d ever read Reinhold Niebuhr, seeing that my attending is an Ole grad like myself.  He had not.

I mentioned an essay that had struck a chord with me in college, titled “Humor and Faith.” In it, Niebuhr talks at one point about how both “humor and faith are expressions of the human spirit, of its capacity to stand outside of life, and itself, and view the whole scene (p. 49).”  Yet, he continues, the problem with viewing the whole scene are all the inconsistencies contained there.  The incongruities of reality that conflict with our narrative.  For instance, to reference a Louis C.K. stand-up bit, we complain about waiting 30-minutes for an airplane, yet afterward we FLY THROUGH THE AIR, LIKE A BIRD.  The disconnect between our complaints and the fact that we are flying, which from this new perspective is miraculous, causes us to laugh.  Yet inconsistencies exist in other ways: I am alive now yet one day I will die.  How can this be?

We as humans do not usually laugh about this.  Though maybe I would.  As I’ve said, it’s a habit of mine.

Niebuhr continues with the conclusion that faith is an appropriate response, as faith can reconcile the “incongruities of existence which threaten the very meaning of life (p. 50).”  Yet faith has other effects.  For instance, the fact it nearly drove me to suicide in college over the issue of my sexuality.  It is funny - people often ask me why I continue to defend religion, even though it nearly destroyed much of my adolescence.  My response: “Because it was a beautiful enough vision that I was willing to sacrifice everything, even my entire identity, to make it true.”  Even in the absence of faith, I still strive to find that beauty.  Maybe that is why I write.

Maybe it’s why I laugh.

I’m reminded of a passage in Elie Weisel’s work, ‘Night,’ documenting his experiences in the Holocaust.  In a class in college, we discussed the issue of theodicy in his work - theodicy being a theological query into why evil exists in the world.  Most of us came to the conclusion that he no longer believed in God.  Yet there is a scene where a man plays fiddle deep into the night, and the tears it provoked in the Jews as they were corralled in a tiny barracks.  When they awoke, he was frozen.  Dead.  It has a strange tragic beauty, and this beauty always felt to me as if Weisel were asking a question.  Is this God, he seems to ask?  These moments of humanity, of complete vulnerable, mortal beauty, in the face of so much suffering?

A few days ago, I attended a speech appointment for a patient of mine with ALS, or amyotrophic lateral sclerosis, more commonly known as Lou Gehrig’s disease.  The disease represents one of the more aggressive motor neuron diseases, usually beginning as weakness in a hand or foot, and spreading to the muscles that allow us to swallow and breath.  Most patients die in 3-5 years after the presentation of their first symptom.

At the current appointment, they’re recording his voice.  For when he can no longer speak and be understood.  Phrases such as “I’m hungry” and “I love you.”  Later, he will be able to speak these phrases so people can hear him in his own voice.  At the end of the appointment, the speech pathologist checks the audio file and notes, “You’ve got about 316 phrases right now.  Is that enough for you?  Or is there more you would like to be able to say?”

A life.  An entire life.  In 316 pre-recorded phrases.  I feel something but I bury it, opening up my cell phone e-mail inbox.

Afterward, the speech pathologist goes over a few learning points.  “We try to keep things that he would actually say.”  He points to a few off-color ones, such as “Fuck you” and “Nice ass.”  Then he plays one of laughter.  He nods vigorously.  “These are the most important recordings,” he states emphatically.  “If you cannot speak, you at least should be able to laugh if something is funny.  Studies have shown it builds a greater relationship between the patient and future providers.”

He plays the track.  We hear laughter.  2.12 seconds of it.  We shake hands and I leave the room.

Later, I’m driving home, one of those chilly nights where the heater from your car blazes your fingers while you feet grow cold.  An episode of ‘This American Life’ emanates from my phone in the coffee cup slot.  They’re talking about time machines and the many reasons people would use them.  About half of people will change history (usually, killing Adolf Hitler) and the other half will change some part of their past (not get in the subway because that guy will vomit on you).

One woman comes on toward the end and says, “I would change the last conversation I had with my husband before he died.”  She describes that it was over tupperware, on the phone.  That she hadn’t ordered it and her husband asked her why.  Because, she noted, the ordering catalogue was on his truck dashboard.  And he was driving on the other end of the phone, and looked, and saw the catalogue right in front of him.

“And then we laughed about it,” she chuckles dryly.  A few moments of silence.  You can hear the static of the microphone.

Then she continues, more somber, “At least we laughed.”

Wednesday, November 4, 2015

5 Things Every Pre-Med (And You) Should Know About Networking

1.  You’re completely irrelevant.

“Whaaaaaa?!” you’re saying.  Back off.  I’m a pre-med student!  I work hard!

Yeah, I work 80+ hours a week minimum, have an inbox with more messages than Amy Schumer has jokes about STI’s, and somehow manage to date (poorly), have a social life (alcohol alone), and occasionally call my mother (she’ll refute this).
So when you want to network with me and feel like I don’t have time for you, you’re probably right.
So why do we mentor?  Why do I have a number of students I’ve met for coffee or a phone call over the years?  It’s because it makes me feel good.  Because it turns out it feels nice to give advice and share your knowledge.  To feel like my knowledge might matter to someone.
When I’m at a networking event for pre-meds, you should realize that I’ve volunteered my time to waste my time.  I’m not getting paid to be there.  So don’t be intimidated to approach me.  THAT’S LITERALLY THE ONLY REASON I’M THERE.  With the exception of the occasional free beer or cheesecake slice.
Two pieces of advice come out of this: 1) know why I’m helping you.  It’s not for a one-time hour-long coffee.  It’s for that one-in-every-ten mentees who will contact me consistently, once every three months, to give a succinct, three-sentence update on their life.  Someone who thought my advice mattered and that I might want to stay in touch with them.  There is almost no way that me helping you will benefit my career, except in the most tangential of ways.  But I do want to help you.  See me as a person who wants to be a part of your career, not a stepping-stone on the journey.
2) If you can offer anything, like time to work on a project with me, or collaboration on an essay, let me know right away.  I love nothing more than working with other professionals or students, and if you can actually do something to make yourself relevant in a real way, do not keep it in your back pocket.  I want to see your talents if you want to contribute.  But BE SPECIFIC.  Don’t say I’d like to work on “anything you could let me do.”  Tell me EXACTLY what you want to do, why you want to do it, and why I’m the best person to help you out.



2.  Do your research.
That girl who sent me an email that one time?  I don’t remember her name.  In fact, I never even bothered replying to it.  It’s not like I didn’t care about whether she got into medical school or not.  It was just kind of was like laundry – something I sort of thought about doing until I wasn’t thinking about it anymore.  And her message got buried somewhere between inbox message 26,001 and 26,003.
What I do remember is that message that started with a name.  “I talked to so-and-so who mentioned your name as an (expert, thought leader, mentor).  I noticed you did (x, y, or z).  That’s incredible and I’m highly interested in talking about your work in that area!”
If you use that literal format in a message, you’ll sound stupid, but the general gist remains.  I was FLATTERED.  Someone had taken the time to learn about me and had found this information because my NAME IS FLOATING AROUND IN THE ELITE ETHER.  Obviously this is a complete and total non-fact, but that’s the way this email will make me feel.  It shows someone took the time.
And if someone takes the time, it behooves me to do the same for him or her.
DO YOUR RESEARCH.
When you see a networking event and a list of highbrow, hoity-toity names, look them up.  Prioritize 1-3 people.  KNOW THEIR FACE.  Know what they study, what they do, where they went to school, what they’re passionate about in healthcare.  Don’t come across like a stalker.  Don’t reference their childhood address.  But show that you know who they are, that you know why they matter, and make them realize why they matter to you.
Because they DO matter to you if you’re talking to them.  Tell them why.  Make them know they’re a priority to you.
Be a good person, and again – DO YOUR RESEARCH.



3. Don’t apologize and don’t ask permission, unless you want to look like a child.
My least favorite phrase in an email?  “Thank you for your time and get back to me as soon as you can.”  Or “I’m sorry for taking up your time but…”  Or “I’d love to meet with you when your schedule frees up.”
Yes, it sounds polite.
This email is considered RUDE in the professional world, because it’s an email that doesn’t tell me what I need to do.
Every time I receive an email I use the following heuristic:
1)   Is the email long?  If yes, I probably won’t read it unless it seems critically important.
2)   Is this something I can postpone?
It’s the latter question that raises the issue.  When you say “get back to me as soon as you can” or “I appreciate your time” it implies to me that this doesn’t need to be dealt with right away.  And if I don’t respond that day…  I’m unlikely to respond a week later when I’m equally as busy.
Ending an email as I often do with “please shoot me two or three times you would be free to meet and I’ll adjust my schedule accordingly” I usually will get a response that day.  It’s an easy end to the email.  It gets to the point, which in healthcare is POLITE.  I don’t want you to tell me I’m nice or that you appreciate my time.  Just tell me what you want from me and I’ll do it so I can delete another email from my inbox.



4.  Medical applications are an art, not a Mad Lib.
You know that guy in your class?  The one who goes to all the school parties, has a million hobbies, and got that completely average MCAT score?
Well, he’s surrounded by all those popular faces in school for a reason – he’s fun.  He’s energetic.  He’s interesting to talk to.  He’s not brilliant, but he’s not stupid.  I would want to work with him.  I’d like to break up the monotony of dealing with thirty patients in twenty minutes by talking with him on my lunch break.
This is no excuse for doing poor school work for that sake of a social life.  If you’re credentials don’t meet some rudimentary cut-off, you won’t make the initial cut that will grant you an interview.  But after that?  I don’t really care that you got a 4.0 and the guy behind you only had a 3.59.  Because he competed at DIII nationals and enjoys backpacking Glacier every summer – and that’s what I’m going to talk to him about for at least ten minutes of his interview.
Yeah, it’s cool that you volunteered at ________ making ________ number of people feel ______, but so did everyone.  It’s like a Mad Lib every medical student on earth could fill out ad nauseum.  Yes, you should be able to fill in the blanks.  But unless it’s saving a third world country, to be honest, I probably don’t care.  And if you say it made you “feel good” or that you were “humbled” and “transformed” I’ll probably reject you out of spite.
You don’t prove you’re a good person by having a series of good things you do on a resume.  It’s by being unique.  It’s by making people happy to be around you.
If the volunteerism section of your CV has twelve bullet points, but there are only three people you consistently eat with over your lunch break, I suggest you reprioritize over the next two months.



5. My training is to spot bullshit.  Don’t do it.
This could be reworded as “be authentic.”  Don’t tell me you care about people.  Tell me about that time you sent your best friend a care package in Oregon because her mom had passed away.  Don’t tell me you enjoy basic science research.  Tell me that you hate it but love writing essays about the patients you’ve met.  Don’t tell me you want to do medicine because it’s a chance to work hard at something worthwhile for other people.  Tell me you do it because it’s the only job on earth that could get you out of bed in the morning – even though you’ll mumble profanities the entire time you cook your eggs.
BE AUTHENTIC.
My job is to know that the drug-seeker in the ER poured water into his urine sample rather than peeing.  My job is to know that the sexual history I just received doesn’t sound quite accurate.  My job is to know that even though all the labs look right… something is seriously wrong with this patient and I need to figure it out now.  I’ll go back to the room and do the physical from head-to-toe again.
My job is to spot bullshit from a mile away.
DON’T DO IT.
If you’re a total mess, and confused about why you want to be a doctor, and unsure if you can afford it, and worried about having friends, or having a husband or wife down the line, it’s ok to say that.  No one expects you to have the answers.  Having a poster-cut-out answer implies you’re obsessed with your image.  And an image has no correlation with reality.
I want to know who you are.
I want you to be vulnerable.
That for me is the purpose of healthcare – or maybe just the purpose of any human art.  Maybe just human life in general.  Seeing the world as fallible.  Seeing the world as messy.  Seeing all the different tones of moral grey and still choosing one, and choosing it because it’s beautiful and maybe you just want to, maybe you just happen to think a life in healthcare would be good for you, and that’s all that matters.  Choosing an illusion and believing it so wholeheartedly that it becomes real and the world is swept away in your vision.
Live authentically.  Live uniquely.  Live messily, sin boldly, and make the world more beautiful in it’s wake.
After all, you’re completely irrelevant anyway.