Pulmonology

First of all, let me just tell you that medical school gets so much more interesting once you finally get to start learning about medicine.  SO much more interesting. 

But.  Most days it still feels like school to me.  Which, for whatever reason, at this stage in my life, is having the strange effect of eliciting revolt from just about every part of me: my will, my attention, my mood, my alertness, my social impulses, my sleep needs, my bank account.  Unceasing mutiny on my desire (which, thankfully, does still exist) to be a doctor.

I am still not quite sure why I have not ever, since I moved here and started at Emory, felt like I have found my groove, or totally gotten into the med school mindset.  During my postbac year, I thought nothing of sleeping very little, hanging out with friends even less, going for weeks without talking to loved ones on the phone or shopping or going out to eat dinner at a restaurant, but this year I have been fighting it tooth and nail, living in a strong, strange denial that this is what medical school requires.  The way that I have explained it to a couple of people recently that that I used to have a life, and I miss it.  

Anyway. 

We are in our pulmonary medicine module right now, just finished week four of five.  (Side note: am I the only one who cannot believe how fast the year is flying by??!?)

Last Thursday was one of the best experiences I have had in med school in months.  The module director assigned us in small groups to hang out with a pulmonology fellow for an afternoon in the Emory hospital.  The idea was that they would take us around and let us listen to some abnormal lung sounds, which are really difficult to understand until you actually hear them in real life.    

It has always been the interactions with patients as real people that have most inspired me and reminded me of why I am here to do this in the first place, and Thursday was a much needed refresher for me.  

One of the patients we saw was of interest to our fellow because he had a hemi lung transplant, and he wanted to give us a chance to listen to the transplanted lung and compare it, side by side, to his "original" one.

He was a 66-year-old man; a sweet, soft-spoken old-school Georgia farmer.  He had worked hard by himself on his own farm all his life.  He described himself as basically healthy, but had a splenectomy at as a child, suffered kidney stones, developed idiopathic pulmonary fibrosis, which necessitated a lung transplant, then heart disease, heart attack, pacemaker inserted, kidney failure, cancer twice (the second time was the reason he was currently in the hospital) had his ear removed along with his cancer, and got Bell’s palsy (paralysis of half the face) as a result of that surgery. 

Lung transplants are really interesting- I never really knew that much about them before.  This patient that we met was transplanted 12 years ago- by lung transplant standards this is a remarkable success story, given the fact that he is still alive.  He never smoked in his life, but developed a terrible disease called idiopathic pulmonary fibrosis (IPF), which basically means that the tissues surrounding the tiny air sacs in his lungs became progressively fibrotic and stiff- thus making it progressively more and more difficult for him to breathe.  Idiopathic means that there is no real known cause.  Prognosis for patients with IPF is poor- without a lung transplant, almost all patients die within five years of diagnosis. 

The lungs are the filter of the body- one of your first and most important lines of defense against infectious agents.  In order to get a lung transplant, however, the number one factor for matching potential donors and recipients is height.  The lungs have to be roughly the right size.  So in order for the transplant to work, the patient has to be massively immunosuppressed, so that their bodies don't reject the transplant- at least, not right away.  Eventually, all transplants will be rejected, while, in the meantime, the weakened immune system can't fight off other disease processes, and patients suffer from frequent, serious complications.  Lung transplant is the last resort for someone with lung disease.  At best, it buys you more time.  Usually, though, most of the time it buys for people is spent in hospitals.

As we listened to our patient's breathing, the difference between his two lungs were striking: his original lung was thickly and loudly crackling, almost bubbling, from his IPF, and the transplant sounded much clearer- although it, too, had a distinct wheezing (a sign of rejection, the fellow would later inform us).  The patient dutifully and patiently let all ten of us shuffle through, put our cold stethoscopes on the bare skin of his back, listen for whatever it was we thought we were supposed to be hearing, thank him awkwardly as we moved to the back of the line to let the next student through.  

What was most amazing to me about this encounter was the way he told us his story: he married his very sweet wife, had two boys, worked his farm... his wife teased him that he had been sick their whole married life.  Despite everything that he has been through (all of his very significant medical issues in the past twelve years can be at least indirectly attributed to his transplant), he told us that it had all been more than worth it, because he got to raise his sons, see them graduate from college and become teachers and EMTs, and he was proud of the men they had become.  He was glad than he had been able to share those years with his wife and that he had been able to keep working.  There was no bitterness at all.  At the end of our visit, before we all trooped back out of the room in a long line, he thanked us for studying medicine, adding that even though he wouldn't be one of them for much longer, people needed us.  

It really choked me up.  And made me feel sort of ashamed... it is so easy for me to lose perspective on the motivation that got me here in the first place.  I am not sure why I am always surprised when people express gratitude for those who choose to go into medicine and dedicate their lives to helping others, but I always am.  And I always feel uncomfortable when I am the one on the receiving end of those comments.  Of course, in my better moments, I remember that this is a calling, that it is a deeply felt desire of my heart, that I truly believe in it, and I believe that it really matters, otherwise I would not have been interested in pursuing it.  But most moments of the day, that is just not where my head is.  I think that the same good intentions and genuine motivations are true of most of my classmates, as well, but... we are all very human, and I am definitely no exception.  I am always tired, I like to complain about bad lecturers and boring classes.  I envy my friends who work 9 to 5 jobs and get to do what they want on the weekends.  I study to pass my tests, but I don't put in the extra effort to make sure that I know the material to the fullest extent that I possibly can.  I judge classmates for being young and immature, but I am often just as self-involved.  I am easily distracted and waste hours doing stupid stuff when I should be learning instead.  Because it is important.  Because someday, people will need me.  I am grateful for these interactions that serve as reminders for me; they refresh my love for being here and being lucky enough to study medicine.  And they also make me feel really nervous, which is probably a good thing.