For richer and poorer, in sickness and in health.
The Christian life that we have is one that is normal, without one bit of peculiarity, yet it is also miraculous; it is a story of the Triune God living within us. The rarest and the most honorable Christians are those who can handle poverty as well as abundance. When Christians are suffering, having a difficult time, it is easier for them to depend on the Lord; however, when they are successful and are taking it easy, it becomes difficult for them. You need to know that during difficult times, there are not that many defeated Christians; during easy times, there are not that many Christians who can stand, either. For a Christian to maintain himself as neither poor nor rich is an exceptional matter.
Messages given to the working saints, chapter 4.
I had a practice question today about a dude who got stabbed in the back. I was given a long list of his sensory and motor deficits, and then was asked to locate his lesion. Of course, I could do it with my **~enhanced neurological ability~**, but I feel in a real life (i.e. not multiple choice) scenario, the easiest way to localize his lesion would be to check the guy’s back. (yeah yeah everyone’s spinal cord is different but for the quick results here we are)
Interventional radiology is a little different from diagnostic radiology. For starters, no one ever seems to sit in one, and no one ever seems to stand in the other. I spent two days as a wallflower in the operating suite, about as useful as a debutante at a rodeo. The most interesting thing about surgery, however invasive, is the delicate ballet to preserve sterility: the knights hoods and bouffant caps, the ritualized gowning and gloving and chlorhexidine swabbing. New items, when needed, are quietly and calmly summoned, and someone ancillary swings in and banana-style peels the wrapping from the item to let it fall to the instrument table. Like airmail. Amazon’s same-day delivery has nothing on these. Before each procedure, the attending rapid-fire spools through the information of the case: the patient, name, procedure, special considerations, and finally, the names and roles of each person on the case. I remembered reading of this in Atul Gawande’s The Checklist Manifesto. Three years later, I’m in an operating room myself. The lights are dimmed. The spotlight is trained on one circle of flesh, an island in a sea of blue sterile draping. Every so often the patient’s breathing or sounds remind me that he is still conscious during the procedure, a radiation therapy for advanced liver cancer delivered through his arterial supply. At some point I thought to myself, What animals are we? How have we had the gall to try to detain our mortality? And with such wild inventions. Wires that inflate inside the body; tubes that can stiffen and stretch and bend at one’s bidding; machines to light up the inside of the body. Drug cocktails to forget, to soothe, to kill.
On Wednesday afternoon, I started reading Just Alice, which was mandatory reading for the Neurology clerkship. I wasn’t ready to be hooked. The story towed me along for the next 500 pages and flipped me up onto the shore, flopping and gasping for breath. It was a personal account of a distinguished psychology professor’s grappling with early-onset Alzheimer’s. At 50, Alice had reached the highest echelons of her field; she had a happy, if preoccupied, marriage; her children were outwardly successful but one, seeking her happiness in acting. But just like every ordinary person, her ordinary life had its flaws, as well. Her relationship with her actress daughter was strained from expectations for traditional success. Her husband’s passion for his career propelled her to pursue her own more diligently, but their work kept them from seeing each other for more than glimpses. Though they clearly loved each other, they didn’t communicate as much as they used to. Then dementia inserted itself into these carefully balanced equations. What struck me the most was Alice’s regrets over how she spent her past time, in which she could guarantee being thoroughly herself. Her remaining time held no such promises. It also pained me to watch through her eyes her husband’s denial, withdrawal, and even fear.
In this kind of story, no one is at fault. There’s no villain and no hero. There are only flawed people who love each other, for better and worse, richer and poorer, in sickness and in health. But sickness is the hardest. At what point was Alice’s husband right in saying he married a different woman than the one he now clothed and fed? At what point could Alice decide for her future, demented self that she had passed the threshold of being her anymore, that the woman who forgot her children’s names and needed assistance for tasks of daily living would be happier dead? I still think that Alice’s life after losing “herself” was happy. It was simple and confused, but happy. Is that kind of life not worth living? Who can make that choice better than Alice?
One of the procedures I watched this week was on an octogenarian with a fractured vertebra. On the coronal MRI, I noticed that his brain, all lit up from the contrast they gave him, seemed a little small for his cranial cavity. The ventricles, fluid-filled recesses deep in the brain, were large. This was a patient with at least mild dementia. Probably more.
We met Mr.— before the procedure. He must have been in such pain—I hear bone pain is excruciating—and when we adjusted his pillows to administer anesthesia, the nurse anesthetist asked, “Are you okay? Does that hurt?” He had groaned a little, but then said, “No, it’s just me mumbling and grumbling. Don’t worry.” We asked him about his family. He had no children, but many nieces and nephews who lived nearby. One had brought him here. He asked my partner’s name three times in ten minutes. We explained his procedure to him. A few minutes later, an interventional radiology tech busted in and asked him quick questions: “Do you know your name? Do you know your date of birth? Do you know what procedure we’re doing today?” He had forgotten. He sheepishly replied, “I don’t know what procedure we’re doing today. What are we doing?” The tech huffed and left. Mr.— looked at us. “What are we doing today, do you know?” We explained the procedure again. I wish the tech had stayed to answer. Just outside the ajar door, I heard the anesthesiologist and tech talking. “He’s got dementia, hasn’t he?” It was clearly audible to me, but Mr.— showed no sign of hearing it.
The nurse offered for us to try putting in his IV for the procedure, as long as we asked him. We had never put IVs into real people before. These, which were hand IVs, would hurt. I asked him, “Mr.—, would it be alright for me to put in an IV for your procedure? You’ll be asleep already, so it wouldn’t hurt.” He must have heard when I told the nurse right next to him that we had never done it before. “Sure, go right ahead.” I then was conflicted. I would get to put in an IV, which was good practice. But did I insufficiently explain to him my ineptitude? Was he authorized for consent for his IV if the doctors were right outside getting consent for the vertebra procedure from his niece? I didn’t resolve the matter. After Mr.— was put to sleep, I tried to put in an IV. I blew the vein. The anesthesiologist successfully put in the next one. Sorry, Mr.—. You’ll have a bruise on your hand. It’ll hurt. You won’t even know why it’s there. You might not remember that I asked to give you that bruise. But I’ll remember.
