I’ve said a lot of goodbyes over the past few weeks–classmates, old friends, family, exes, and now you, my dear readers. (Yes, yes, say it ain’t so!)
I started this blog almost 5 years ago (wow) to document the process of becoming a doctor, write about health policy, explain medicine, and provide an outlet to process and reflect on the things that I experienced. By all possible measures, I’d say it was a success.
The further I got into medical school, the harder it was to remember or understand what it’s like to be a patient–in terms of the knowledge and the experience. It’s hard to remember what it’s like not to know what a drug does, or the pathophysiology of CHF, or when a patient is ready for discharge. I think this is one of the biggest challenges we have to overcome–becoming doctors by definition requires us to enter a different space than our patients, yet we still must communicate and explain without trying to over- or under-simplify.
And along the way, I guess another goal was to show people that doctors are simply fallible humans that are, in the vast majority, trying their best, but are prone to the same flaws and errors and mistakes that all of us are. It just sucks that our mistakes have much bigger consequences. I will always strive for perfection in my practice of medicine, but know I will never achieve it. I wish more patients would realize this.
Thanks for all the comments, support, criticism, and linkage over the past 5 years. This book of my life is over, but who knows, you may see me again. My goals right now are to hit residency with a running start, learn New York, meet friends, find some love along the way, and if I find that I still have time to blog, perhaps I’ll be back. It’s been a great 5 years!
(I’ll be moving the archives over to http://www.grahamazon.com/over/ in the next week or so.)
Continue Reading June 22nd, 2008
And the text:
Good Afternoon Dean Pizzo, family and friends, colleagues, The Guy Whos Totally Uploading This To YouTube Right Now, The Undergrads Who Heard Theres Free Alcohol Afterwards, and of course, my fellow classmates, the Graduating Class of 2008,
Britney Spears once famously said, Hit me baby. That was my ORIGINAL version of the speech. You werent supposed to hear that. Awk! Ward! Blarg. Wow. Uhm, okay. Lets just pretend that didnt happen.
Hannah Montana once famously said, We. Need. Single-payer national health insuran. Okay fine, she didnt. But, Im kind of known for ranting about health care reform, so everyone probably thinks thats what Ill talk about today. But dont worry. I wont. Today, I would like to talk about something thats been bothering me: name-calling.
During medical school (and my entire life) Ive answered to just about any variation on the theme: Graham, Graham Cracker, Grahamazon, Grahambo, Grahamakin Skywalker, Hey you, Kilo, Graham Stain, Graham Positive, Graham Negative, and even, as one attending who didnt care to learn the names of her students called me, a medical student, with the same tone one might use to ask, Could you hand me a pen? Man, Im really going to miss medical school!
But lately, most people have been calling me doctor, and Im not sure if I like it. Sure, people have said it all throughout medical school, but I always had sufficient grounds to correct them: No no, not yet, Ive still got 6 more months to go, or Gosh, I wish, but I still have to pass my boards! But lately, I havent had a leg to stand on.
Its almost as if I dont want Graduation Day to be here. But too late now. Change happens. Today, were becoming doctors.
I remember at orientation an upper-classman saying that we probably thought becoming a doctor was a noble, selfless actbut any of you in the audience can easily vouch for how selfish it can be. We have demanded your patience, love, understanding, compromises, and support for all these years. So up front, I want to say to each of you, from all of us up here, I am sorry. But I promise to do better next time. Not to forget slash have to reschedule: your birthday, our anniversary, the dinner reservations we had, or that trip to Mexico.
But truly, we could not have made it this far without you. Not to get all Mr. Rogers on you, but to us, you are special. You are why we are dedicated to this: because our patients have their own families and friends like you. You are the selfless ones
not us. So from the deepest reaches of our hearts and souls, thank you so very, very much. Today, we celebrate becoming doctors as much as we celebrate you.
I guess I really worry about how the title of Doctor defines you. How it changes you. That Im becoming a little bit more Doctor Walker, and a little bit less Graham. Sure, the title affords me some prestige and privilegefor example, complete strangers will now feel totally comfortable whipping out their strange moles at dinner partiesbut at the same time, it makes people see me as primarilyor onlya doctor, not as a son, brother, partner, computer nerd, or Trader Joes enthusiast.
Maybe this is how its supposed to be. Maybe thats the purpose of the title. To remind us and others of the Oath we take, or that patients needs are to come before our own.
But if becoming a doctor will change how people view me, there are several values Ive learned here at Stanford that should get to represent me, too. And I have numbered these values, as I am going into Emergency Medicine, and have a short attention span. Oh, and just a sidebar: The next time you want to complain about your hospitals Emergency Department, please remember that were probably getting distracted by
oh, I dont know, coding patients, big traumas, (mumbling) bodily fluids being flung
at
us, or
shiny
things.
Sorry. Back to my values:
Number one: I will continue to use objectivity, without forgetting the subjective.
Medicine is an art grounded in science. Ill do my best to know the studies, the data, and the pathophysiology, and try to apply them objectively.
But I wont forget the patient. Ill listen. Ill be compassionate. Ill try to keep social context, chief concern, and patient perspective in mind.
And number two: I promise to ask questions, and on occasion dare to admit: I dont know. And thank you to Stanford for encouraging thisin Gil Chus class, where we werent allowed to leave until we had collectively asked him 10 questions; with Dr. Wolfe, who teaches students to admit their own Areas of Ignorance. We are a generation of physicians who are unfortunately (or fortunately) still human. We are not gods. We still make mistakes, and we still dont have all the answers. But, hopefully, well know where to find them.
Number three: Dont mess with the pancreas. Or, in the famous words of master pancreatic surgeon Dr. Norton, Im tellin you, dont mess with the pancreas! You gotta believe me!
And number four: I promise to be involved. Whether its researching, teaching, advocating, or volunteering, I will remember that health and medicine are often advanced and affected more by time spent outside a hospital than within one.
While passing clerkships and boards and memorizing facts may make us doctors today, its our values that will drive us to become great doctors, like the many we have met here at Stanford. Because the great physician is dedicated to the truth, but also to patient. She is a scientist, but also a healer. He tempers prognosis with hope. I think Kurt Vonnegut sums up medicines curiosity and compassion better than I ever could: We are here to help each other get through this thing, whatever it is.
So, today, fellow classmates, this is it, for better or worse. When our patients call us doctor, theyll finally be right. (How scary is that?) While our profession may change how we see the world, or even how the world sees us, we must keep a part of ourselves the same. That partour goals and our valuesis what has gotten us to this point, up on this stage. You can call me Dr. Walker now, but I promise to remain just Graham. Im too proud of each title to be dropping either anytime soon. Thank you.
Continue Reading June 18th, 2008
My classmate and fellow nerd from Kansas Chris Adams has created a short little blog to detail a walk-thru of the loan deferment process. He sent it out originally as an email, and I just completed it and got confirmation I’m in deferment!
(And if you’re reading this… a plea to contact your Congresspeople, as they’re trying to make it harder for residents to qualify for economic hardship. Please pass on to your own medical schools, as this will affect younger med students even more than it does us!)
The current rule by the Dept of Ed that allows residents to defer their loan payments until after residency is in danger of being removed because it’s too “cost-prohibitive.” For those graduating this year, this means you’d only get to do 2 years of deferment (with later years being a much less favorable type of deferment); if you’re graduating next year, only 1 year of normal deferment, and if you’re graduating after that, you’ll be SOL.
PLEASE contact your Congress people, tell them you’re a doctor or future doctor and it will greatly affect your ability to afford residency!
More info on it here (the AAMC and AMA are both lobbying hard to get this rule change reversed):
http://www.ama-assn.org/ama/pub/category/18024.html
This is a script you can use when you call them:
http://www.ama-assn.org/ama1/pub/upload/mm/16/script.pdf (pdf)
And please also make your voice heard electronically thru this script:
http://capwiz.com/ama/issues/alert/?alertid=10478586&type=co
Continue Reading May 27th, 2008
So I had a wonderful trip to Guatemala overall. I learned a ton of Spanish, saw some great sights, and all.
But then the very last 5 days of my trip, spent in Antigua, Guatemala, were terrible.
(Warning, graphic description ahead.)
After eating a salad (I know, I know, I should have known better) in Antigua (very touristy, and I assumed that meant safe), I was puking. The next day I spent in bed rehydrating. The next day I felt a bit better. The next day I had overwhelming nausea, only controlled by around-the-clock dramamine (an antihistamine). Then finally the next day I went home.
I continued to feel sick for the next 5 or so days after I was home. About two days ago I got an appetite back and finally feel better.
I finished a 3-day course of Cipro, took an albendazole to de-worm, and a 4-dose course of tinidazole (anti-microbe, anti-amoeba). Apparently tinidazole isn’t approved in the US, as a compound similar to it causes cancer in rats. Whoops.
But I feel better. Finally. After 10 days of hell. And I’m 13 pounds lighter, down to 139, the lightest I’ve weighed since I was 19. (Eternal optimist that I am, I now get to eat whatever the hell I want to try to gain weight. Yum.)
Also: take any American who thinks this country is a terrible place (I was not one of them, I’m just sayin’), send them to a developing country for a month, and they will come back the biggest Patriot.
Continue Reading May 14th, 2008