JUL-B-8
THE NOW VETERAN GROUP, HAVING BEEN
OVERWHELMED
BY THEIR “FIRST DAY IN THE OFFICE” LEARNING
THAT MEDICINE IS HARD AND OFTEN
UNCOMFORTABLE,
RETURNS TO THE SAME CLINIC AFTER THE FIRST 300
PATIENT DAY TO TRY AGAIN TO “DO GOOD, BETTER!”
AND
MORE EFFICIENTLY
The day began with the early morning run through the mostly deserted streets of Leh at dawn, and through a pack of marauding dogs attracted by the smell of blood from the Halal slaughter at the market outside town. There, as we had also seen yesterday, and each time I have made the early morning run, I see the desert hillside, trashed with refuse and a silent contemplative series of men, quietly squatting and staring serenely up at the Karakorum Mountain Range with Stok Kangri catching the light of the early morning sun on its snow-capped peak, as they quietly went about their squatting business in this meditative isolation of the desert hillside. Just beyond them are the groups of sheep, each sporting their red swatch of dye along their back as a proud fashion statement that makes them belong as members of this select group. That this group is standing in a huddle as one after another is dragged over to a trough in the sand to have its throat quietly slit and kick for a few moments before being hung up on a rack and skinned is a group participation event. Those who are left behind as their fellows are hauled over to the pit are a compulsively social animal and struggle to join them. They only get the big picture in that they are not eager to be left alone, and this big happening seems to have involved all of their fellows so they must get into the same act. There must be a human lesson in this somewhere!
I came back for a cold bucket bath, which of course is something that wakes up and makes tingle whatever the run had not already got into that condition. Ironically, the water that was running for the bucket bath seemed to warm up just as I completed my toweling off, leaving the newly warmed up shower for Lee Dutton, my running partner each of the last two days. The students who have been gung-ho participants in a lot of the activities described to them, like the care of patients, have at the last minute realized that getting up early and running at 12,900 feet through diesel smoke, desert trash, packs of mangy curs and the stench of fresh blood and offal on the road way from the Halal butchery may not be what they might prefer given the option to roll over in bed, and so none has joined us, despite many talking a good game on each of the several days after the acclimatization few days when I have discouraged them, and me, from any exertion. So, we have made a 10 K run yesterday and a 12 K run today, not getting any easier, but stretching the distance within the same time—the same process we hope to instill in them for the next clinics.
I believe the students need a Dutch Uncle talk—since they had anticipated the thrill of victory, but do not want any part of the agony of defeat in this practice of medicine business. It is hard enough not to know enough to take care of anyone sick, but it is also hard to be made to look dumb and helpless while that might be avoided simply by dodging the first and foremost act of medical care—the assumption of responsibility, putting someone else’s interests ahead of your own. After all, I am very tired, I have had little sleep, and I do not know enough, and would really rather not either take the responsibility for this patient nor try to learn enough just now to manage this problem, so I believe I will just duck out and throw a Frisbee, or drink beer and play cards to avoid confrontation with my own inadequacy. This is perhaps a critical impasse to get through today, to have them realize that they are embarked on a forever long continuous struggle to improve their management of sustained ambiguity with this health care thing, and how it seems to be so totalitarian as to get in the way of a lot of other things in life that might be more familiar and satisfying, since I already know how to drink beer and throw a Frisbee.
WE are going back to the same clinic with increasing dental care and a rotation of one of the two presenters from each of the six teams and an intensifying number of patients thrown at the reconstituted teams for the same drill in patient presentation after dinner tonight. One of the students has not participated in any of the lectures nor clinics, based in his diarrhea, but now it may become increasingly difficult for him to get back up to speed, since he has missed all the instruction in the pattern of the drill.