Then and Now part 2…

In the summer of 2006 my wife and I found out we were to have our first child.  Shortly after we also learned we would be attending medical school together.  Our main priority in choosing a medical school was that it be somewhere we could attend together.  We had difficulty finding a US based medical school that would take both of us and thus opted to go to the Caribbean for school at Ross University.  In April of 2007 we began our journey in medical school.  Before then, on Christmas evening of 2006, our first son, Christian, was born.  It turns out that Ross was an ideal place to raise a baby.  He was in a daycare during the day when we were in class, but the daycare was right in the middle of campus and the classes were scheduled so that we could see him frequently.  It actually worked out so that we didn’t have to provide the daycare with any food for him[1], as we saw him frequently enough that he didn’t need or want food at the daycare.

My wife, I, and Christian in his daycare at Ross
My wife, I, and Christian in his daycare at Ross

  At Ross, the students take all the basic science courses in their first two years in Dominica (i.e biochemistry, histology, physiology, etc.) and the 3rd and 4th year clinical rotations—where students get more hands on experience– are completed in the states (i.e surgery, psychiatry, family medicine, etc.).[2]  My 2 favorite rotations during this time were both Family and Emergency Medicine.  When it came time to decide which to apply for, several factors came in to play: I mentioned earlier that both my sister and mother are Emergency Department (ED) physicians, their involvement in the field almost made it a family business.  I believed that the lifestyle of an ED physician would be more conducive to family life, as spending time with my wife and son were of critical importance to me. Also, the salary is typically higher for an Emergency Medicine physician as compared to a Family Medicine physician.  Thus, I opted to apply for Emergency Medicine.  My wife had her sights set on Family Medicine.  When applying to residency, most programs offer something called the ‘Couple’s Match.’ This is a program for people in our similar situation: couples entering training who desire to be in the same place or program.[3]

Me during medical school, simulating a delivery, in Saginaw
Me during medical school, simulating a delivery, in Saginaw
Me and my medical school classmates in Saginaw.
Me and my medical school classmates in Saginaw.

Once I began my training in the ED I realized it wasn’t for me.  The hustle and bustle in the ED was too stressful.  Eight-hour shifts easily become 10-hour shifts and there is no ‘down’ time as an ED physician. The name of the game is productivity: in medicine this translates to how many patients you can see. You are caring for as many as six or seven patients at once (this number increases for more seasoned physicians) and you are constantly bombarded with questions from all angles and parties. Finally, there are always cases that you need help with[4], and for these cases you need to call for help.  NO one likes to be called at 3am no matter what the situation, and it seems these specialists (even though for the most part they are getting paid to be ‘on-call’) especially hate hearing from the ED[5], thus it’s not unusual to have a contentious conversation with someone you’ve called for help.  Please don’t get me wrong, if anything I now have more respect for people that can do this job[6], but I just realized that this work was not for me.  Thus, near the end of my intern year I made a switch from Emergency Medicine to Family Medicine.  I was moving along well in the residency, when one morning I awoke with double vision.  Then…well, you know what happened next.

————- After —————

Every day I am grateful to be alive and thankful that this mass turned out to be benign. Unfortunately, however, the removal of it has left me severely impaired.  The first deficit you’d notice when I walked in to the room is my slow and odd gait.  Where it might take five or six minutes for a normal, able-bodied person to walk from point A to B, it takes me double that time.  My gait is wide due to the damage the mass did to my cerebellum.[7] I now walk with my feet abnormally wide, in almost a shuffling pattern.  The next deficit you’d probably notice, if you looked me in the eyes, are that my eyes are slightly misaligned; in the area where the mass was are several nerves that control various functions of the eyes (i.e. dilation, constriction, and movements of the eyes themselves) damage by the mass to the nerves that control the muscles of eye movement impacted the way my eyes are aligned giving me some double vision.  Next, if I spoke, you’d note the delay in my speech.  It’s hard to describe my speech pattern except that it’s slow and doesn’t sound right.[8]  I’ve had speech pathologists tell me that they can detect issues with control of my phonation.[9]  Then, if we spoke long enough, or if you at all brought up a subject of discomfort to me, my head will begin shaking. This can last anywhere from five to seven minutes.[10]  Then as I walk away, you’d notice the giant scar on the back of my head (although I’ve been told that my longer hair now hides most of it).  Thankfully, all of these deficits are improving—I still walk slowly with a widened gait but now in therapy I’m able to jog (while holding the side rails) on a treadmill.  My vision is getting better day by day, and now as long as I have a second to focus on an object it stays single (I am still unable to track a tennis ball being hit back and forth without getting nauseous).  Various people tell me that my speech is becoming more and more coherent.  The scar will remain there for the rest of my life and will not change.  This is what a scar is by definition.[11]  I hope in the future it serves as the only reminder of this ordeal.

Me with my family at a wedding recently
Me with my family at a wedding recently


[1] Those who put their child in daycare might know that they typically need a day’s supply of either breastmilk or formula for the baby.

[2] The idea behind the 3rd and 4th years of medical school is two-fold: 1. It exposes you to the more practical clinical world and 2. It allows you to choose which specialty you will enter.  This is a critical time in any medical student’s life.  This is the time when you decide what you will be doing for the rest of your life.  I included a funny algorithm that sums up this decision.

This is the algorithm I am talking about
This is the algorithm I am talking about

[3] There are some stories from medical school where a significant other uses the Couple’s Match to break up with their boyfriend/girlfriend.  Luckily, in only a few instances, the significant other will choose not to enter the Couple’s Match and not let their boyfriend or girlfriend know.  Then on Match Day when the ‘Couple’ finds their destination are in separate places the fate of their relationship is discovered.

[4] This ‘help’ can range from a cardiologist for a heart attack to an admitting physician so the patient can be managed elsewhere in the hospital.

[5] As with everything, there are always exceptions to the rule; some physicians, as much as they hate hearing from the ED, realize that this is for the patient’s good, and that acting hostile towards the calling ED physician is an exercise in futility.

[6] In fact, as I mentioned in an earlier post, I now hate it when anyone puts down the ED.  Whether it be to admit a patient or because someone thinks they can do the job better, I hate it when clinicians even roll their eyes at an ED page.

[7] There are whole books just devoted to the study and the analysis of gait; different gaits can stem from injuries to various parts of the brain.

[8] I once overheard someone saying that I sounded like a ‘retard’.  Even though this was incredibly hurtful and not at all politically correct, it is the most accurate way I’ve heard my speech described—I do sound like a mentally challenged person.

[9] The cerebellum, besides controlling gait, also controls various fine motor movements.  The apparent simple act of speaking is a conglomeration of proper air intake, tongue movements, and very small vocal cord vibrations.  In fact studies of various musicians’ vocal cords shows that they are able to move their vocal cords differently than us non-musicians. It’s a long clip but worth it: https://www.youtube.com/watch?v=9MDn5GgyxyU

[10] See my previous posts titled Titubation

[11] Merriam-Webster’s definition of scar: http://www.merriam-webster.com/dictionary/scar

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