23 September 2007 23:49 -06:00 GMT

This post is a meandering, narcissistic, introspective hike into a strength as a physician-to-be, and my reluctance to accept it. (Of course there are references to HIV and U2.)

Dedicated to the nursing staff on the Hematology/Oncology service at the University of Alabama at Birmingham. They are truly superb.

Today I finished my Hematology rotation, and it has been the most rewarding service of my short medical career. If you know me, you know that I want to study infectious diseases so that I can help those who are HIV positive. (Tuberculosis and issues related to equitable health care are part of the package.) Well, a nice surprise on the Hematology service was that nearly everyone is undergoing chemotherapy that destroys their bone marrow in order to destroy cancerous blood stem cells. Thus folks on the hematology service have no immunity to fight infections.

OK, re-reading those last two sentences reminds me that having no bone marrow is not a nice surprise, as I characterized it.

The nice surprise was that the Hematology service really was an infectious diseases service. When folks' absolute neutrophil count dropped low, they became at grave risk of infection. As a result, I became part of the team that was in charge of thwarting deadly infections. (Of note, these infections are opportunistic in that they only take advantage of immunocompromised hosts. You and I have fungi and bacteria all over us, and we get through our day-to-day lives without fevers or infections. To put it in a pun, with our intact immunity, we avoid the rigors of rigors.)

Immunity is destroyed with the chemotherapeutic destruction of white blood cells. Thus taking call on the Hematology service is a nocturnal fever garden, and my task was to sprinkle the service with acetaminophen, broad spectrum antibiotics, and antifungals. Assess the patient, get cultures of the blood, urine and sputum, and get a chest X-ray. In other words, treat the fever, find the source, and hammer the microbe into merciless oblivion.

Taking it to a deeper level, nearly all my patients are facing death.

That is a pertinent fact for me because I realize that perhaps my greatest strength is meeting my patients on an emotional level during the most trying times of travail. When the rubber meets the road - when it really counts - I am present for my patients in a unique way. I write this not as braggadocio, but as a realization that has never been a formed thought until now.

I've known there was something in me that was going to make me a good doctor. The science and medical understanding is a prerequisite. But what is it about me that's going to make me great? These are the thoughts I had, and now I'm able to articulate the answer. In an emotionally charged medical scenario, I'm able to cut through the fog brought on by pain, uncertainty, confusion, and facing end-of-life oblivion. Somehow I reach through, and together, my patients and I, will make it to the other side, whether that is the other side, or just the other side of this episode of disease.

I was amazed when one of my patients gave me a book as a gift. Then another patient gave me another book. Then another did the same - gifted me with a book. Another gave me a photograph of Albert Schweitzer, a renowned physician whose work was mainly in Africa. We had had conversations about my aims for this career I've chosen. Another patient stopped our attending to give me praises for handling her pain crisis that was a side effect of consolidation therapy. I am not comfortable with these things, but in the last month I have started to accept them.

I knew there was something that people saw in me that must be special because of the way people treated me, and because of the things that people say to me. I didn't have a handle on why folks treated me so well. I still don't. I have an inferiority complex that I must be trying to make up for in innumerable ways. Thank you, Mr. President.

In the last couple of weeks, people have said that I am a star...that I am a heavyweight applicant for Internal Medicine residency programs...that I have performed excellently...that I'm the best medical student they have ever had...that I am not just good clinically, that I am exceptional...that whatever that difficult-to-define characteristic is that is needed to be a good doctor, I've got it. I hear these things, and it feels good to hear them, but I don't believe them. I need to hear these statements, and I crave them, but they can't possibly be true. Deeper still in my psyche is another voice that says this: especially next to my peers, who are so good, so smart, so much better than I am at this thing called doctoring.

I am a naysayer of myself. I am much more likely to find a reason why praise is false rather than accepting it with thanks. They're telling me I'm the "best medical student" because that's what they say to students when they complete their rotations. Patients are thanking me because they were brought up to do so, not because of anything I did. They are giving me this book because they're done reading it, so there's one less thing for them to pack when they go home.

I never want to believe these praises. I think that the moment that I accept these praises, whatever I have will disappear like a vapor in the wind. Samson's hair would be cut, and my single strength would be gone. I could go on, and in fact, I will.

When I was in primary school, my sister was institutionalized for a long history of behavioral problems. This had a significant impact on me. I distinctly recall being at recess and seeing my peers being concerned about who likes who or what people were wearing or other superficial nonsense that goes on...and I remember being very serious - too serious for my age. My thoughts could be distilled into this: How can you be worried about such trivial things when there are so much more serious matters to be worried about? Now, looking back, there's judgment and lack of understanding on my part in that sort of thinking. I know now that their concerns were normal in that context, and that mine were not.

Bringing it back to present, I know that when dire circumstances occur, it is familiar territory for me. It is, in fact, comfortable. It is where I am most calm, most clear, and most able to help my fellow man. Therein lies my strength, and from therein springs my calling - to help those who need it most in times that are most dire.

I can handle that.

I have one final thought, and it relates to the above as well as to my favorite band - U2. U2 were humming along, pun intended, making great music as they have for the last twenty years, and sort of under the radar as far as popular music goes. Then September 11th, 2001 came, and the twin towers fell, and suddenly emotions were raw. Nerve endings that had been nicely covered by stratum corneum were laid bare. Suddenly, in the time it takes to kill 3,500 innocents, people were reminded of the things that matter most. Who are you going to listen to when you see the images of Manhattan on that day? Foo Fighters? Ludacris? I don't think so. When U2s sounds were heard, the resonance was profound.  All the bullshit was washed away, and people could be moved to understanding, to mourn, to feel the freedom of Faith, to rejoice in our blessings.

I do liken myself to U2's music in some ways. I am under the radar, doing my thing, not gaining too much notice. But if you mix in some urgency, and you throw in a fight, and if you ponder your existence, in the dead of the night...that's where I will be, holding your hand, meeting your eyes, and sharing your peace.