Categories
General Reflection

Scholarly Pursuits

Growing up, my father didn’t get home from work until nearly 10:30 pm.  He worked full-time at Allstate Insurance while also working part time as a realtor. There were days I didn’t see my father because he had been working all day. He told me to be grateful for what I had and where I was in life. I didn’t fully understand him, until now.

My father was unable to complete his education. He had planned to become an engineer, but his dad fell ill and the responsibility for the family fell entirely upon him. My father had to pay for his sister’s wedding and his younger brother’s education. In order to do this, he quit college and started working full-time.

I look at myself now and see how dramatically different my life is compared to his. I have everything I could dream of and more. My father is willing to work hard so that I can, today, pursue my education at the best of institutions. In fact, since preschool, I have studied in private institutions and grown up in a world that is in diametric opposition, in terms of the opportunities and expectations placed upon me, to the world that my father grew up in. He has tried to prevent me from even getting a glimpse of the hardships he endured when he gave up his dreams to serve his family. I am humbled by and grateful for the opportunities my dad’s efforts have allowed me to pursue. I know that my father did not have many of the same opportunities. As the timeless and enduring quote goes, “with great power, comes great responsibility”- I know that having the access and opportunity to seek and find knowledge comes with expectations- to serve the community which has so selflessly flung all its needs and desires to serve the needs and desires of my generation. I have had the opportunity to attend both engineering and medical school. The knowledge I have gained by attending both these schools has not only empowered me, but has also reminded me of what I owe to my community and my family- the responsibility to give back.

Whenever my father sees me with a calculus or physics book, a smile comes across his face. He begins chanting the trigonometric functions and formulas he remembers. But that smile often fades as he remembers the past. My father has never talked openly about the hardships he endured while he was young, but his eyes convey it all. There was this silence that followed that chanting and smile. I knew that my father was thinking back to his past and the educational endeavors he never had the opportunity to pursue. Despite this, my father is able to provide more than enough for our family on many levels, financial and emotional.

However, despite my dad’s success, there is still a part of him that wishes he could finish his education. I have grown so much from my father’s experiences. Although he did not have the opportunity to finish his education and pursue the engineering career he had dreamt of, his sacrifices came to yield. Family has always been incredibly important to him, and the efforts and sacrifices he has made on his family’s behalf have added immeasurable value to his life.

As I tread through my final months of medical school I’ve come to realize more and more just how fortunate I am. Every day is a reminder of the advantage and opportunities I was granted due to my father’s sacrifices. I am now the same age that my father was when he left school, and I am fully aware of the advantages I have over him. But with these advantages come additional responsibilities. I will forever remember his efforts and sacrifices and do my best to honor them.   It is this passion that is the driving force of my life and my scholastic pursuits.

Featured image:
Opportunity by Susan Frasier

Categories
Narrative Reflection

Little Flickers: How Medicine Truly Connects Us

“See the little flicker?” the doctor asked, as she tilted the ultrasound screen and pointed to the tiny movement. The patient leaned forward, squinting, trying to decipher the gray and black pixels that showed she was now a mother. “That’s the heartbeat,” her doctor explained. “Right there,” she pointed again, this time zooming in even further. The patient nodded as she tried to contain her excitement. She smiled with one of those tight-lipped grins as her eyes widened, as if joy was actually bursting out of her. Her husband chuckled at her wild expression and squeezed her hand. “It’s okay,” her doctor said. “Be excited! This is exciting!” And with that word of permission, the expecting mother squealed, just a little, and calmed herself again. “It’s our first, you know, and my sister just had a girl and I wanted our kids to be able to grow up together and we just didn’t know if it would happen this fast, and,” she paused to catch her breath. “Sorry, I just can’t believe we get to start buying baby stuff!”

I looked at the screen again, at the little flicker of light, at the little piece of white against black that would someday have a lot of “baby stuff” foisted upon it. It was one of the earliest pregnancies I had seen on ultrasound – in fact, I had only seen one other scan done at the same gestational age. It was striking how identical this scan was to the first one I had seen, months earlier. The screen had looked exactly the same, with the crown-rump length of the tiny embryo measuring the same, with the same shape of black fluid around white tissue. I thought back to that day, to the tiny portable ultrasound screen so far from home. Instead of an antiseptic outpatient OB/GYN clinic in temperate California, the first scan had been done on the dirt floor of a little hut in Central America.

It was a typical clinic day in rural Panama – humid, muddy, with lines of patients waiting to be seen. Working over the summer with the non-profit organization Floating Doctors, I saw many pregnant women come to clinic for prenatal care. Traveling to indigenous island communities, where most patients have no other access to health care, we would set up makeshift clinics and see as many patients as possible. It is common for women in the Ngobe communities to have as many as ten kids; oftentimes they start having children when they are teenagers themselves. Unsurprisingly, there was a lot of prenatal ultrasound scanning to be done.

When I saw this particular patient, whose ultrasound was done so early in the pregnancy, the crown-rump length was the same as the patient’s I would see months later at home. This woman was 32 and had five children. Her youngest, a two-year-old girl, leaned on her mother’s chest as I scanned, taking a pause in her whining to stare at the screen. She didn’t understand what it was, but her mother squeezed her excitedly anyway as I pointed at the little flicker, the unmistakable heartbeat. Even though they already had a big family, even though it was miserably sweaty sitting on the floor in our little ultrasound hut, and even though the toddler was getting fussy, this woman had the unmistakable grin of sheer excitement.

Talking to the pregnant women in Panama, either during the scan or translating during the physician checkup, I imagined the lives these babies would have. It was an easy thing to think about, seeing so many children running around and playing as their parents waited in line. The kids were a handful to organize; it was no easy feat keeping them far enough away from the clinic to avoid distractions, but close enough to organize whole family visits when it was their turn. They played muddy games of soccer or baseball, chasing each other around and asking us for highly coveted stickers. They were so full of energy, so happy and so free. The mothers usually didn’t find these games as amusing as I did; they were exhausted, overwhelmed, and just trying to get the visits done so they could go home. I can’t begin to imagine the strength and resilience it takes for those mothers to care for so many children, and oftentimes other family members, with such limited resources and support.

There was a mural painted on the side of a school in one of the communities we visited. The mural was a giant world map, not particularly accurate in terms of scale or geography, but vibrantly colored and decorated. When I saw it, I thought it was quite fitting, as I was working in a team with students and doctors from all over the world, living in a country I had never been to before, speaking a foreign language every day. When I thought about its place in the community, however, I began to wonder what it meant to them. These villages are isolated, by geography and lack of transportation and resources. The children who seemed so free to me would most likely find it difficult to leave their small village, if they ever wanted to. I wondered what they thought of that colorful map on the wall, whether it was an abstract concept of the world beyond their borders, or whether they dreamed of a truly unrestricted future. The child back home in Orange County, of course, might dream of just the opposite – wishing the world were not so vast and intimidating, wishing the world stretched just to the end of the block, where everything in between was familiar and safe.

These are the things I wonder about, the things that keep me thinking about certain patients long after they’ve left. These are the things that connect patients, at least in my mind, despite the vast differences in their lives. Ultimately, the job in medicine is to focus on the patient, or the ultrasound image, but it’s not always easy, or in the patient’s best interest, to tune out the context.

We are trained to look at that little flicker of a heartbeat, measure its rhythm and pace, and watch as the baby grows and the flicker gets stronger. We are trained to look at every patient, every heartbeat, the same – without bias, without judgment, without assumptions. At the same time, we can’t ignore the world around us, the world that we are working in and the world that our patients live in. We can’t ignore the fact that differences between two patients’ cultures, communities and access to resources may make them seem worlds apart. But mostly, we can’t ignore how strikingly similar we all are at the start – just little flickers of black and white, so simply alive. Maybe if we try to remember that, all the differences we see every day will become just parts of the mural – not terribly accurate, certainly open to interpretation, but mostly just a beautiful mess of color.

 

Featured image:
Panama Clinic, courtesy of Leigh Goodrich

Categories
General Lifestyle

Semper Fi

In early medical practices, the translating of ailments into Latin and Greek amalgams created a language that set doctors apart from the general society. This boundary signified the value that doctors provided and created a group that could identify with each other because they held similar values and had comparable educations.

The use of the phrase “Semper Fidelis” in the Marine Corps serves a similar purpose.  More than just a slogan, it is a way of life for a select population. United States Marines are admired for their dedication to each other, their service, and their country. Marines are a group that is separate and unique from any other. “Semper Fi” translates to “Always Faithful.” This statement symbolizes the ability of common people to become part of a brotherhood that demands more of its members than any other comparable group.

We don’t have to be Marines to achieve the same discipline. As medical students, we can make this a practice as we transition into our careers. Marines are trusted to make significant, split-second decisions in an environment more dangerous and confusing than those in which most doctors operate. The battlefield is chaotic and information often unreliable. In a medical environment it is important to develop effective means of communication balanced with ongoing decision-making. In practice, however, this standard of communication is rare. Empowering front-line practitioners is vital to the success of the medical system. This is parallel to what Marines do. The Marines have standards; a reputation of excellence. There is a sense of being part of something much bigger than simply an organization. What the Marines understand is the same thing that the best doctors understand- success happens through failure. There is a sacrifice that comes with joining the Corps or becoming a physician. Not only must we surrender our weekend plans and sleep to meet the physical and mental demands of our chosen paths, but we are weighted with the notion that our everyday activities affect the lives of others. No matter how good our intentions, as doctors or Marines, we will not be able to overcome the problems caused by poverty, war, the spread of infectious disease, famine, or climate change. That doesn’t mean we can’t try to help people afflicted by these events. 

Why do we do all of this? Because we take pride in what we do.  Moreover, Marines and doctors alike truly care for the welfare of the human race. Veterans Day was November 11, a celebration to honor America’s veterans for their patriotism, love of country, and willingness to serve and sacrifice for the common good (Dept. of Veterans Affairs). 

 

Featured image: Marine Week Boston, 2010: A Bell UH-1N SuperCobra attack helicopter flies by in front of pinkish cloudy blue skies by Chris Devers

Categories
Disability Issues Lifestyle Reflection

Personality Disorders

In individuals, insanity is rare; but in groups, parties, nations and epochs, it is the rule.
– Friedrich Nietzsche

Personality Disorders (PDs) are defined by the DSM-V as significant impairments in the self and interpersonal functioning across time, which cannot be explained by socio-cultural environment or substance abuse (American Psychiatric Association 2012). These disorders are unique within psychiatry because, unlike many of the Axis I disorders, they did not begin to take form until the 19th century. They also tend to create controversy around their definitions, as they are molded by the behavioural standards within a society, and are therefore quite subjective. This subjectivity may be the reason why personality disorders have the lowest levels of reliability and validity among all psychiatric disorders (Alarcon et al. 1995).

There is an important difference between personality styles and disorders, and clinicians must be able to make this distinction. As society changes, roles and values are transformed, leading to the creation of new disorders. One example of this is  internet gaming disorder.

Perhaps we should start by clarifying our terms: what is personality? Is it something that is inherent and unchangeable? Or is it a malleable entity, a wisp of smoke that can never be grasped; a question to hang above the philosophers’ heads? In 1995, Alarcon et al. suggest that personality implies a way of reacting to stimuli, coping with stress and acting on one’s beliefs about oneself and the world. It has been suggested that a personality disorder is almost a caricature of the normal personality, and that it can reflect the distorted aspects of a person’s time and culture.

Society plays a very powerful role when it comes to psychological disorders. It has been suggested that prejudice can distort societies’ perceptions towards those from disadvantaged backgrounds and inflate the rates of personality disorders in these groups. For example, it has been suggested that almost half of inner city youth who have been diagnosed with antisocial personality disorder have been misdiagnosed, because their behaviors are occurring in a unique cultural context; a context which includes the prevalence of behavioral systems which value violent behavior as an acceptable survival strategy (Alarcon et al. 1995). Furthermore, antisocial behaviour could be seen as an adaptation to the excessive demands of our modern world. With the increasing expectations placed upon our youth, not only for wealth and success, but also for a ‘happy’ life with a spouse and child, a fast car and a big house, is it any wonder that many kids rebel against such idealistic expectations? Perhaps it is society that is towing the soil, encouraging the growth of such ‘pathological behaviour’ in our culture. Are we simply pushing humanity too far?

Borderline Personality Disorder (BPD) is another example of a personality disorder that has become increasingly common in the modern world (Grant et al. 2008). Those who have ever set foot on a psychiatric ward will be familiar with the label, as it is the most prevalent category of personality disorder within the mental health services (National Collaborating Centre for Mental Health, 2009).

BPD is a relatively new diagnostic entity, first described in the 20th century. Although people committed suicide in the past, self-harm in the form of wrist cutting is relatively new, only appearing on psychiatry’s radar since the 1960s (Favazza, A.R. 2011). As societies evolve, symptom banks change, and in today’s world there appears to be an increasing acceptance of self-harm as a signal of distress– a phenomenon termed ‘social contagion’ (Jarvi, et al. 2013). Traits underlying BPD are impulsivity and affective instability. In today’s world, these impulsive symptoms are one of the most common forms of expressing distress among the young. Indeed, it has been suggested that BPD risk factors are associated with modern life (Paris and Lis 2013).

Do we as a society place such high expectations on those around us that we must fall back upon psychological labels to explain away those who do not fit into our idea of perfection? I suggest that perhaps this sudden surge in personality disorders does not merely reflect our increasing awareness of such pathologies, but also a deeper issue within modern society. Perhaps we have become so obsessed with success, with money, with beauty, that we have forgotten what it means to be human. To love, to feel, to belong.

And if this is true, then the answer lies not within the leaves of a doctor’s prescription pad, nor within the four walls of a hospital ward, but in the society that we have created for ourselves. Perhaps this rise in personality disorders, this explosion of emotional distress, is a signal that the world we have created for ourselves may be doing more harm than good. The increasing emphasis on achievements, success, wealth, and fame may indeed be turning into a poison. And if this is the case, then the antidote lies beyond the physicians’ hands; it is a task that is placed on all of us, to encourage our children to create a world for themselves that is filled with love and belonging, rather than goals and desires. It is only through an increasing emphasis upon our own humanity that we can begin to combat this psychological plague.

References

  1. Alarcon, R., Foulks, E.F. 1995. Personality Disorders and Culture: Contemporary Clinical Views (Part A). Cultural Diversity and Mental Health. 1:3-17
  2. American Psychiatric Association. 2012. DSM-IV and DSM-5 Criteria for the Personality Disorders.
  3. Chavira, D.A. et al. 2003. Ethnicity and four personality disorders. Comprehensive Psychiatry. 44:483-491
  4. Favazza, A.R. 2011. Bodies under Siege: Self-mutilation, Nonsuicidal Self-injury, and Body Modification in Culture and Psychiatry. 3rd Ed. JHU Press.
  5. Grant, B. Stinson, F.S., Saha, T.D., Smith, S.M., Dawson, D.A., Pulay, A.J., Pickering, R.P., Ruan, W.J. 2008. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiological Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry. 69:522-545
  6. Jarvi, S., Jackson, B., Swenson, L., Crawford, H. 2013. The impact of social contagion on non-suicidal self-injury: a review of the literature. Archives of Suicidal Research. 17:1-19
  7. National Collaborating Centre for Mental Health. 2009. Borderline Personality Disorder, The NICE Guideline on Treatment and Management. The British Psychological Society, The Royal College of Psychiatrists.
  8. Paris, J., Lis, E. Can sociocultural and historical mechanisms influence the development of borderline personality disorder? 2013. Transcultural Psychiatry. 50:140-151

Featured image:
Female Warrior # 14 “Extinction” by CHRISTIAAN TONNIS