Labels and Identities, Part Three (and then some)

I loved medical school so much that I was never even aware of the fact of “being a medical student.” I was too busy being it it, doing it, loving it, being in love with it.

Nevertheless, I had a sense of solidity that I had never experienced before. With my dual degree program came huge financial commitments, and great opportunities. I applied for and got many kinds of grants and fellowships, some as large as $10,000 and some as small as $300. They all added up, and each one was a feather in my cap.

There were jobs, too. The first years were a patchwork of lab jobs, hospital grunt work, general go-fer gigs for the administration. Then I settled into my niche of tutoring and educational program development. I helped design and implement a model of teaching medical communication skills to new doctors, and a testing tool to evaluate its effectiveness. Faced with an embarrassingly inadequate human sexuality module in our med school, I complained, and was given the green light to develop the ideal one. Med school was “heaven on a stick,” to borrow a phrase.

My marriage surpassed any expectations I could have had, if I was the type to have expectations, and I’m not. I could never have imagined the satisfaction that bloomed from the cultivation of cooperation and intimacy between two people in love with each other and with their respective and mutual work, for we shared certain teaching and administrative duties in the school. We were a team. We were even asked to write an article for the medical school journal on the art of cooperation and compromise.

I got pregnant during the fourth year of my six year program. It was not overtly planned. But since we were using the Cooperative Method of Fertility Awareness Family Planning (another of my hats, since I was a certified teacher and taught in the Student Gynecology Clinic) which required both partners to be clearly aware of where the woman is in her fertility cycle, we KNEW I was fertile and the predictable outcome did in fact result. It took us both a few minutes to get used to the idea, and then we were elated.

I was in the midst of a long subinternship in surgery at that time. A subinternship is just like an internship, except you don’t get paid. You work the same long hours, take the same night call, have the same responsibilities as an intern. Our med school supplied students to a chronically understaffed VA hospital, and there were many excellent subinternship opportunities there. It really was a great thing to do as a student in surgery. At the private hospitals, the best a medical student could hope to do in surgery was stand on a stool at the back of a crowd hoping to get a look at the surgeon working. If you were really lucky, you might get a turn holding retractors, which meant you could actually see the operation in progress.

As a subintern at the VA, I worked one on one with each of two foreign doctors. Dr. Duy was a marvelously skilled Vietnamese surgeon, French trained, with nimble fingers and a gift for teaching. The first day, he taught me how to tie surgical knots one-handed with both my right and my left hand. I still use some of the skills he gave me, even though I haven’t done surgery in more than ten years.

The other surgeon was a North Korean. He was a coarse brute who caused unutterable pain and suffering. I don’t remember his name, thank G@d

My jobs included assisting the surgeon in the evaluation of the patient, preparing the operative site, and if it was an abdominal surgery, opening the abdomen and preparing the operative field. After the surgeon had finished in the abdomen, my job was to close the layers of the abdominal cavity and finally the skin. We had a grumpy old anesthetist: if he thought I was taking too long sewing the patient up, he would “lighten up” the anesthesia so that the patient would start to cough. The old bastard.

One morning I went into the operating room and found the doors propped open. “What’s this?” I asked the nurse. “Why are the doors propped open?”

“We’ve got a leak in the anesthesia machine,” she told me. “Until they get it fixed we’re gonna have to operate with the doors open.” Oh, I though, this way we’ll only be half as anesthetized as the patients.

I inhaled Halothane along with everyone else for the next four weeks. And then, one week after I finished that rotation and went on to the next one, I miscarried. I was ten weeks along.

I had no idea how attached I had grown to that little nubbin of life that was growing inside me. I absolutely fell apart. I couldn’t function. The clinical rotation I had just started was, of all things, Obstetrics and Gynecology. I couldn’t set foot on the ward for a week after the miscarriage. I just lay in the bed and cried.

The dean ran interference for me and spoke to the OB/GYN director, who was a woman. She was the daughter of the senior OB/GYN in that town, and had joined her father’s practice. She had a strong academic background, loved power, and used it freely.

When I finally got my feet back under me I made an appointment to speak with her, for I had already missed the whole first week of my eight week rotation. I knocked on her door.

“Come in,” she called. I entered the sleek wood office. She sat writing at an expansive desk. “I heard what happened,” she said, not bothering to raise her head and look at me. “It won’t affect your grade.”

I waited for whatever came next, but it never came, so I waited some more, not knowing what she expected of me.

“You can go now,” she said to her desk, still scribbling, “The nurse will give you your assignment.”

I wandered back out into the hall, feeling very unsure of myself, and was greeted by a large and cheerful nurse who ushered me down a hall and into a clean green room whose only features were a GYN exam table, an exam light, a wheeled stool, a kick bucket (the kind on wheels that you position with your feet, that’s why it’s called a “kick bucket”), and a room divider screen, with whatever was behind it.

Not too long afterwards, the door opened again and the same nurse brought in a gowned woman, and asked her to make herself comfortable on the table. The nurse positioned the woman and left her alone with me. There was an awkward silence, since we had not been introduced.

Five minutes later the door opened again, and this time it was Dr. S. and an entourage: an intern, a resident, and another medical student. Dr. S. began to talk to the woman on the table, and intermittently explaining a thing or two to the entourage. I felt like a ghost, since no one had acknowledged my existence since the nurse had put me in there to begin with.

Next thing I knew, objects were being retrieved from behind the room divider. A tray with sterilized instruments on it. And a machine that looked like….a vacuum. It was a vacuum. For performing abortions. My stomach contorted. I begged pardon, and stumbled from the room, under the searing glare of Dr. S……

Labels and Identity: Part Two

Medical school was a blast.  I kid you not, I have never had such fun since I was seven years old.

That was the time that my pet baby turtle died.  I have never once heard of a pet baby turtle that did not die young, but instead grew up to be an adult turtle giving rides to children in the zoo.  But I digress.

My baby turtle died, the kind that children are not allowed to have anymore because of Salmonella.  And I buried it in my mom’s flower bed behind the L-shaped brick house we rented, way far away from the road, down a dirt driveway half a mile long.

It wasn’t two or three days until I realized what a blunder I had made.  I had passed up a stellar opportunity to further my scientific education.  So I dug up Mr. Turtle and laid him out upon my little bed, took up my X-Act-O knife and began the postmortem by separating the plastron from the carapace.

Just as soon as I lifted the lid of the turtle’s front shell, some horrible stinking greenish black slime poured out directly on my bedspread.  I jumped back, gagging, fighting off waves of panic.  That has always been my motto, “Do Not Panic.”  It has served me well in many situations.

The hideous stench of the decomposed turtle innards drove me to quick action.  I snatched up the bedspread, turtle swathed within, and ran out the back door.  My chief concern of course was what my mother was going to do when she noticed that my bedspread was gone and that the house smelled like rotten turtle guts.

I dumped the turtle remains back in the flower bed and dragged the bedspread into the garage where the old wringer washing machine stood.  There was a handy half gallon of chlorine bleach within reach, so I spread out the bedspread and emptied the contents of the bleach bottle onto the black slime place in the middle.  Then I wadded the whole thing up and stuffed it into the washing machine and went away from there.

From this it should be clear to anyone that I was destined to be a surgeon.

Anyway.  I loved medical school.  I did not encounter one single dead turtle there, but that was because I went to human medical school instead of veterinary medical school.  I often wonder why I didn’t think of that when filling out my application forms.  But that is water over the dam.

I was far, far too busy being a medical student to think about identity issues.  At first, there was a lot of course work, and a whole new system to learn.  The school I chose turned out to be what I later came to think of as “The Hippy Medical School,” because it was a center for innovation in medical education.  The Dean at that time was a Social Scientist and not even a physician.  The faculty were all top level experts in their fields, but they were also critical thinkers and often quite eccentric.  The most common word I heard during my six years there was:  Inquiry.

The immediate impact as far as I was concerned was that they honed in on my past as a traditional healer (no, I have not written anything about that yet, aside from the turtle), and proposed that I join the new phalanx of the Medical Scholars Program in Social Sciences.  The Medical Scholars Program means you do your four years of medical school, and then somehow or other you manage to do a full graduate program in some other discipline, with the aim of coming out of it with the letters MD, Ph.D after your name.  The accepted second discipline had traditionally been in “hard science,” like microbiology or biophysics, but since our Dean was a Social Scientist she was stumping to get the Social Sciences represented in there too, and I came along at just the right time.  So I became the first MSP student in Anthropology.

Somehow I convinced them to let me “just” go for a Master’s Degree in Anthropology instead of a Ph.D., for the same reason I didn’t become a surgeon:  I wanted to have a family.  Anthro Ph.D’s are known to drag on for seven, eight years on the average, and always involve one full year of fieldwork in some primitive place where one is quite likely to contract some dramatic tropical disease, excellent for bragging about at annual meetings but not so great if you have plans to reproduce someday, and I did.

One of the things that one does as a first year medical student is to dissect a human cadaver.  That is taken for granted;  it is a rite of passage.  Every medical school does it a little differently, but we all need to know what goes on underneath the outer carapace and plastron of the human body.

In our school, one cadaver was assigned to a pair of students, who then alternated dissecting and observing.  Through a series of happenstances, there ended up being an odd number of students and an extra cadaver, and she was assigned to me alone.  Yup, just she and I.  We were the outliers.

My poor cadaver!  I will never forget her.  She was an old, old lady.  She was curled up in the fetal position, and from the condition of her muscles and tendons, it looked like she had been that way for years.  I couldn’t help thinking of an old lady just like her that I had met years before, when I worked as an itinerant phlebotomist and was sent to a “convalescent hospital” to draw all of the patients’ blood there.  The poor little old lady looked up at me in terror from within her blue, blue eyes, her silky white hair combed neatly in a French twist on the back of her head.  She made little whimpering noises as I tried to straighten her arm out to draw her blood the normal way….but she had been curled up like a snail for so long, her muscles were all contracted and it could not be done.  So I drew the blood from her hand.

And there she was, or someone very like her, lying on my dissecting table, all crumpled up.  And I was supposed to be dissecting her armpit.  The armpit is a fascinating place.  It contains an electrical switchbox that operates the whole arm, including the hand.  So it’s essential to open it up and examine its contents.

But my lady was not able to cooperate in even the clumsy way the other cadavers did, and I was wondering how I would ever get the job done.  It didn’t help that I had come into the anatomy lab alone, late on a Saturday night, having no date.  Needing inspiration, I headed over to the lab’s radio to try to find a classical music station.  I have always found that classical music helps, as long as it is not Benjamin Britton.

Just as I arrived at the radio, I nearly collided with another ghoul in a white coat and plastic gloves.  ”Oh, excuse me!  I was just looking for a classical station!”  we said, in unison.  And grinned sheepishly, realizing we were without question the two geekiest geeks on the planet, spending their solitary Saturday nights in the cadaver lab, looking for a classical music station.  Neither of us had noticed the other was there, even though we were just a few cadavers down from each other.  We found a good classical station.

“Oh, uh, well, since you’re here, could you help me with Madame Pretzel (I had named her) over here?  I can’t seem to access her axilla.”

“Mmmmm, why, I’d be delighted to!”  hummed the geek-boy, and he came over and helped me.

I though he must certainly be gay, because he was adorable, had good manners, and liked classical music.  But I took a risk and asked him out for coffee, and he eagerly accepted.  I found out he wasn’t the least bit gay, just highly cultured.  We got married.

By then I had accumulated so many Labels and Identities that I actually hyperventilated if I thought about them.  So I avoided thinking about them, and instead continued running three miles a day as I always had, and added two dance aerobics classes a day plus a weight training session three times a week, just to keep all the identities from running into each other and getting knocked down.

Labels and Identity: Part One

In recent months the question, “What do you do?” has become a recurring theme.   In our society, “what you do” is equivalent to “who you are.”  On a deeper level, it means, “What is your worth to society?”

Now don’t start:  I know that  even now you are opening your mouth to say:  Oh, no, your worth to society is not dependent upon what you do;  and what you do does not define who you are.  ”Who you are” is who you are on the inside, a soul, a PERSON, a LIFE.

Bullshit.  In our society, “what you do” IS “who you are.”  You are a teacher.  A student.  A mother.  A lawyer.  A prisoner.  A doctor.  A patient.  You. Are. A.

10 years ago it was easy for me to answer that question. I was a physician. I was a pediatrician. I had my own pediatric practice. A solo practice, in a small rural mountain community. I was the only pediatrician in three counties. It was a big identity. It was an identity that I was proud to announce, in answer to the question “what do you do?”

I was proud of what I had built. Life had never been easy for me. I dropped out of high school as a teenager, ran away from home, did a lot of drugs, lived on the streets for a while. I never went back to high school.   Instead, I took a battery of tests that qualified me to apply to college. I wrote my way into the University of Chicago, and worked my way through. From 9 PM to 4 AM I cocktail waitressed at a snazzy disco on the Northeast side, and then went to my real job in a microbiology laboratory at the University, where I worked on projects until it was time to go to class at 10 AM.  Between classes I crashed on the couches in the quiet grad school libraries.  There was even a special room called the “Womb Room” that was filled with foam cushions of various sizes and shapes that could be arranged in the perfect configuration for one’s customized nap.  I lived on yogurt and donuts from the myriad campus coffee shops, and the occasional meal bought by a wealthier-than-me friend.  At the end of the day I’d run up to my apartment, shower, change into my work clothes, and take the El north to work.

One day I saw an ad in the school newspaper newspaper soliciting subjects for a study on a new psychoactive drug.  If selected, subjects would receive either the study drug or a placebo, and be paid for their time.   Get paid to take free drugs!  Amazing!  I went right in and applied.

The study was under the auspices of the Department of Psychiatry.  The application process consisted of sitting for a day’s worth of psychological tests, exhaustive and exhausting.  But I marched off afterward, feeling quite confident I’d landed the job, as I’d answered all the questions completely and honestly.

A week later I got a letter from the Department of Psychiatry that said I should call them immediately.  Oh boy, I thought, I’ve got the job!

Not so.  The earnest young man on the other end of the telephone told me that the testing indicated that I was in the clutches of a major depressive episode, and I needed to report to Student Mental Health at once.  He gave me an appointment then and there.

Nuts, I thought.  There go my free drugs and money.  And what is this garbage about major depression?  I didn’t feel any worse than I ever did.  In fact, there had been times in the past when I’d felt far, far worse, and had managed to get through them one way or another.  But now?  I was just going along, doing what I needed to do to get by and do well in college, so that I could go to medical school and be a doctor.

I dutifully showed up at my appointment at Student Mental Health.  A bland, nondescript woman sat behind the desk, radiating benevolence.

“What brings you here today, Laura?”  she beamed.

I told her my story about applying for the job taking drugs and being sent to her instead.  I told her that the young man on the phone said I was having a Major Depressive Episode, but that I didn’t know what he was talking about, because I felt the same as I always felt.

The benevolent lady’s face fell,  suddenly all sympathetic.

“Why, Laura!  You’re attractive!  You’re a straight “A” student!  Why are you depressed?”

I stood up.  ”Thank you for your time,” I said, as I made my way out of her office.

That was Psychiatric Label Identity Number One.  But I ignored it.  It was ridiculous.  It didn’t fit.

On the other hand, it might have explained a few things.  Quite a few things.  But the lady behind the desk had been so insipid and without skill, that the opportunity for connecting at least a few of my dots slipped by for that while, and was lost.

I threw that label in the trash, put my shoulder to the wheel, and met my goal.  I finished college, was accepted to medical school, and began my new identity:  Medical Student.

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