Quiet Nights of Quiet Stars

It’s the morning now after I’ve driven back from my first Pine Springs Retreat––the annual LLU School of Medicine and friends event in the San Bernardino National Forest––and I figure I have approximately way-fewer-than-I-think minutes before I have to start hitting the books again. That should definitely be enough time to write this post, though. Physiology can wait! YOLO!!

(I’ve been known to say that a great many things on this planet are both hilarious and tragic. I think the fact that putting physio off for another half hour has totally sated my rebellious streak for the week is definitely, definitely hilaragic).

To be honest, though, I actually don’t even mind the fact that I have to “catch up” a bit after spending the last couple of days at Pine Springs Ranch. My PSR experience definitely deserves its own post anyway, and mostly because of a little song called “Corcovado.”

“Corcovado”––also known as “Quiet Nights of Quiet Stars”––has always been one of my favorite tunes. The original recording by Joao Gilberto and Stan Getz on their album “Getz/Gilberto” (Verve, 1964) gives me chills nearly every time I put it on––the beautifully haunting intro, Gilberto’s serene vocals over the never-hurried, yet slightly driving groove, and one of Stan Getz’s always captivating tenor saxophone solos has cemented its status as not only one of the most iconic standards in bossa nova and jazz history, but also as the song that plays in my head in those moments where despite the travails of life and love, everything feels just about right.

With that in mind, imagine my excitement when I somehow got Drew Sheldon (alto saxophone), Daniel Chiou (bass) and Giovanna Sobrinho (fluent in Portuguese and a real-deal Brazilian!!!!!!, vocals) to let me play with them for the talent show at Pine Springs!

Of course, to do the song justice, we would have to practice, which takes time, which is unfortunate because, well, we’re all medical students! When we got together for only the second time an hour before we were supposed to leave for Pine Springs, there was some uncertainty. Do I come in here? Is that a G-sharp or a G-natural? Half-step or whole step? When am I supposed to come in again??

After practicing until what we thought was the very last minute, and then taking a few more to sort out a few important details (skinny black tie, or skinnier black tie?) and to WAIT FOR SOMEBODY TO PACK BECAUSE HE HADN’T YET (I still love you Daniel), we somehow loaded all of our bags and gear into my little Hyundai compact and started to meander our way to Pine Springs. The car ride was a blur of not knowing how to get there, sort of knowing how to get there and then doubting that we were getting there (all set to a eclectic soundtrack accompanied by our, uh, “singing”), so we were really happy once we got there, even if we had to run to the cafeteria to get fed before they closed.

What I noticed immediately was this odd sensation that I had been displaced from my natural habitat, which by now has become the annals of Centennial Hall and the library. It wasn’t an unwelcome contrast––there was a beautiful view of the mountain, clean air, and most importantly, when I looked up, there were the stars––Pleiades, Draco, Cassiopeia and the rest, twinkling like the final flickers of life’s ember. Later that night, as I laid down on the side of a hill with a few friends, took out the guitar and sang the first few lines of “Corcovado,” I couldn’t imagine wanting to be anywhere else.

The next day, between worship, some ill-fated hikes, and some combination of volleyball/basketball/ultimate frisbee games, the four of us found a bit time to practice again for the talent show that night. It wasn’t perfect, but who could care at that point? The only things left to do were to look as awesome as possible and to groove as hard as we could. That night, after a few brilliant acts ranging from spoken word, to musical comedy and opera, we got our chance.

 

When we sat down afterward, we were all wondering the same things. How did you think it went? Do you think they noticed _______? I think some people were singing along! Of course, everyone was super polite after the show, but it was hard to not feel a little trepidation about how it was really received. As the boys of our group walked back to the car to put away our gear, there was the feeling that we were trying to reassure ourselves that it had in fact gone well. Yeah, you sounded great man, don’t worry about it.

A while later, we had stuffed our faces full of dessert at the ice-cream social, said our goodbyes, shoved all of our stuff back in the car and were on our way back to Loma Linda. There was only one thing to do: boot up the laptop and watch/listen to the recording. Oddly, something happened that usually doesn’t when I listen to recordings of my own performances––I smiled. I was proud of us––a couple of med students that had absolutely no business trying to pull off a passable performance of a jazz and bossa nova classic did just that, and in front of the whole medical school community no less. As we drove off into the quiet night of quiet stars, this time accompanied by our own original soundtrack, I couldn’t help but think that things just felt right, even if just for one delicate, fleeting moment. Corcovado… oh how lovely.

Humble Pie

Maybe it was the white coat I was wearing, the inexplicably long strides I was taking, or the fact that he had his eyes glued to me as soon as I walked through the door, but everything felt so official. Unnatural. Completely the opposite of what I was expecting.

Up until the moment I walked in the room, I had delusions of walking in, being greeted with a wonderful smile, and having an absolutely engaging, perhaps even cathartic conversation with the patient. We would laugh and joke about our age difference, I thought, and share pithy sentiments about how much we both miss home. Unfortunately, it seems that I didn’t anticipate that people stuck in an hospital, especially those who have been there for a long time 1) are not, by no fault of their own, jolly folk, and 2) see a white coat and anticipate being poked and prodded or exhibited to an audience, not expectant of a whimsical conversation about the universality of life’s travails.

It was in this rather unsettled atmosphere that I attempted to introduce myself.

“What?” Of course he was hard of hearing. I was certainly off to an auspicious start.

“Hello sir, I’m a first year medical student, and I was wondering if I could speak to you as a part of an assignment. We have been asked to…”

“Are you here about taking me somewhere else?”

Hmm? That was unexpected. Apparently the doc had told him that morning that he would be going to stay in some sort of care facility before he could finally get home, and like any other normal person, he was distraught. Eventually, with all the enunciation I could muster and the loudest voice I dared to use, I was able to introduce myself properly and convince him that I wanted nothing more than to talk to him. To my relief, his shoulders relaxed, his facial expression changed to what could be optimistically regarded as “resigned,” and I, on cue, grabbed a chair, sat down, and began trying to fulfill the goals of my first assignment––to “connect” and “listen”––in earnest.

Though the conversation had not started in the most ideal way, I was unfazed. I began to implement everything I knew about trying to be a good listener––I leaned forward slightly, made eye contact, deftly changed the subject when I felt it had run its course and spoke softly and infrequently. I offered my condolences for his unfortunate situation, and tried to commiserate with him about the unique homeness of home. However, despite my efforts, the conversation gradually waned, and fifteen minutes after I had walked in so stridently, I excused myself and walked out, far humbler and a little confused.

It’s been a few weeks since that encounter, and I think I now have a better idea as to what happened. It would be easy to blame the fact that he had received disheartening news a few hours prior, that he had trouble hearing what I was saying, or that the rather stilted start to our conversation was too disadvantageous to overcome. I could say that it was understandable because I was four days away from my first patient interview class, and therefore I wasn’t armed with the full arsenal of interview tactics. However, it’s pretty obvious to me now that it wasn’t at all that I didn’t have enough techniques to unleash on him; instead, it was something beyond them.

To be sure, I’ll have practice and internalize the various aspects of the medical interview endlessly to be an effective clinician; there is no substitute for sheer effort and repetition, especially in trying to cover the vast scope of a proper patient history without seeming robotic and unnatural. However, knowing our physical diagnosis notes cold is not an end in itself. Rather, it is only to ensure that a lack of knowledge does not impede our true goal––to be able to express real empathy.

It’s really hard to be able to express empathy if we’re struggling to remember what we’re supposed to do after the social history; in turn, without real empathy behind our words, our efforts will appear less genuine at best and utterly forced at worst. With enough practice, maybe I would have been able to use my patient interview techniques in an organic and natural way, and as a consequence make him feel genuinely cared about. It would definitely have helped me avoid so many cliches (“there’s no place like home”) or be generally less awkward (“it’s not home, but it’s better than the hospital, right?” I’m still dying a little inside after that one).

What’s crazy is that I totally thought I was being empathetic, but I didn’t realize that I wasn’t really until now. It seems that the shock of finding out how little I know about nearly everything is a pretty ubiquitous experience among us medical school rookies. But that’s another post altogether; for now, I’m just going to have to work up a healthy appetite for humble pie.

I think… I think I know why I want to be a doctor!

Hilariously (or tragically, take your pick), I think I finally know why I want to be a doctor.

Why is it so hilaragic, you ask? What if I told you that I’ve spent hundreds of hours shadowing doctors of all sorts of specialties? What if I told you that had never considered another vocation since the beginning of high school? What if you knew that I’d attended medical school interviews all over the country, and that I passionately insisted that I knew exactly why medicine was for me in every single one? You would definitely ask me why it took me until the fourth day of medical school to actually figure it out!!

Well, it is true that I had some idea why, and those reasons are no less valid now. I still appreciate the fact that proper patient care simultaneously requires my scientific and humanistic faculties; I am still looking forward to being in a position to be a respected voice in regard to the most pressing political issue of my lifetime; and I still cannot wait to create the funkiest all-doctor band in existence. However, nothing spoke to my soul like what I experienced my first few days in medical school. And at the crux of it is that medical school is the absolute hardest thing I could ever fathom doing.

What?? Surely you knew this going in, you say. Everyone knows medical school is hard! But “everyone” thinks it’s hard for the wrong reasons. Everyone knows that you have to take lots of tests, and that you’ll have to study more than you ever have in your whole life… blah blah blah blah blah. What everyone misses is that what we medical students should strive for with every ounce of our will, what we should be shedding blood, sweat and tears for is something far beyond the realm of standardized testing.

Dr. Werner, the Dean of Medical Education, gave us first-years a talk yesterday where he precisely delineated these extra-academic goals. We must seek the utmost standard of professionalism, he implored us, and to be a professional is to be worthy of trust––the trust of the other members of our medical team as well as the most sacred trust, that of our patients and their loved ones. He demanded that we be compassionate, with universal positive regard for our patients, no matter what our biases or their behavior. There are no gomers. We must, without exception, be men and women of integrity, without respect to our pride or inconvenience or disciplinary consequences. We must also prepare to be whole physicians, always knowing that to be truly well is to be physiologically and spiritually healthy, a valuable lesson for the rigorous path that lies ahead of us as well as our future vocation as our society’s healers.

It was pretty apparent that Dr. Werner, if he wouldn’t be sued for it, would have grabbed us all, one by one by our collars and shook us until we frantically, tearfully agreed. There was no compromise in his tone. His messages were clear: this path that we are on will require us to change; the change will be an unspeakably difficult one; and the change will entail a whole lot more than how hard we will are able to hit the books. Far from it.

It occurs to me then that my journey through medical school will necessarily have to be a spiritual one. It is only through a deeply personal and emotional commitment that I believe that I can even begin to embody the qualities of the truly ethical physician. After wandering in an existential netherworld for the past year, I am invigorated by the knowledge that there is a worthy ideal to aspire to, an ideal worthy of my time and attention.

I’m not stupid. I know that what I’ve written above will sound grossly idealistic to most of you, and I suspect that those of you further along in your medical training will be especially skeptical. But somehow, getting good board scores and getting a good residency just wasn’t cutting it as sufficient motivation. I’m actually pretty sure that I will be a pretty sad sack if those were the only things I could shoot for. I’m not saying that I’m going to save the world, or be the smilingest doctor, or that my shots will feel like kisses. I’m just saying that I will try my hardest to make being a good doctor a sacred obligation, because I feel like it deserves it. Sue me if you can’t agree with that.*

*Actually please don’t.