11/24/06

Thoughts \ Developed Thoughts \ Rants \ Raves \ Writing

09/14/2004 10:10 -0500 GMT

Blue Physician in Training

The truth is that I'm hanging on by the plaque of my teeth in medical school. There are some who will think I am somehow saying that to make my image appear stronger, but in fact, I'm hanging on by the plaque of my teeth.  On the one hand, I studied 20 hours over the three-day Labor Day weekend, and I thought I was hitting it pretty hard, making real inroads into my understanding of adult anatomy, and the embryology that leads to that. On the other hand, I was slow in my efforts, and I feel sure that I can improve my efficiency in studying.

I can vow until my face turns blue that I will not fail out of medical school, but it happens to some, and I need to make sure that I am not one of those who is compelled to repeat a year of this. There's a deeper lesson I'm omitting here, I'm sure of it, but I'm responding emotionally to an emotional week.

I learned on Thursday that Bernard Malanda died, and it struck me with such sudden precision as to make me cry in front of my fellow students in the lobby of the fifth floor of Volker Hall.

I was flippant, checking my email on the wireless network, and then I got Mwelwa's (my brother-in-law's) email. The subject was a simple "Hello." But when I read the three sentences that said that Bernard had died, I couldn't believe it.

"What?!" I asked the universe, out loud.

Someone said, "What?" in response.

"Jesus Christ," I said after finishing the email quickly, and then I simultaneously shut down and opened wide up at the same time. Tears burned my eyes, and I subconsciously ignored any external stimuli. All I wanted to do was get on the phone with Maggie. I stood and was speed-dialing Maggie as I felt some respectfully inquisitive eyes on me. I told  everyone within earshot that a friend of mine had died.

I walked to the corner of fifth floor Volker, and I heard Maggie's voice. She didn't sound upset, as she has during other similar phone calls over the last several years. We've seen so many die.

Too many, for God's sake.

I told her I had just gotten an email from Mwelwa and that he had bad news. She said that she knew; she hadn't called me because she knew I had an exam. I said that Bernard died, but she had already lost control of her emotions. As she wept, I lost control too, and I leaned on the wall of Volker Hall, with my forehead resting on my forearm, the phone to my ear, and I couldn't help but let it go, let it be, let the sorrow flow through me, a force, ominous and foreboding and harrowing and heavy and paralyzing and unrelenting. My shoulders shook and my voice broke and I tried not to get snot on my shirt as Maggie and I wept together, separated by electrons, but bonded by our understanding of the loss of a common friend.

I'd like to say "Thank you" to Michelle and Jamie and Joe and Rachel for saying a few words of condolence to me in that moment and in the days that have followed. While I wanted to hide and let it all hang out, that wasn't possible, and as I realized that, I simply gave in to my sorrow and pain, in front of others that I trust to understand, if not now then later, and I wept.

I did retreat to the bathroom to really let it out for a moment or two, and finally I recollected myself enough to focus back on jaundice and the case study that we had to present an hour hence.

You know, one of the things I think about AIDS in Africa is that people who haven't lived there think that everyone dies of AIDS, and that people must be numb to this tragedy of mother nature. I am here to tell you that these are two misconceptions, and that I am as guilty as you of harboring them.

When I read that Bernard had died, somewhere in the recesses of my subconscious I thought he died of AIDS. He was young, and presumably sexually active in Zambia, so it must have been AIDS. This was not correct. In fact Bernard reported to a private clinic with chest pain, was administered a drip, and suffocated before corrective action could be taken. It's difficult to get a clear picture from 8,500 miles away, but I suspect some sort of anaphylaxis - it may have been that or cerebral malaria that just happened to coincide. One myth, that AIDS is the reason for all young deaths in Africa, is a misconception.

Second, Bernard's death causes pain, but it is not muted by all the deaths that occur in sub-Saharan Africa these days. In other words, one might believe that so much death occurs there that it's not that bad when another one dies. For me it is the contrary. As I considered the death of my friend Bernard, and I as I broke down in tears while I heard my wife doing the same, I was reminded, fresh and pure, of the deaths of other friends we have lost, too young and unnecessarily. Godwill Mughandila, whose absence still rocks me, Bernard Chitundu, Daniel Mponda, and his wife, and his three children, Masoze Gondwe, Willie in DC, Elias Banda, Sheba Chali...Boba...I was also reminded, in way of the future, the imminent risk of death of other friends and family, if intervention is not implemented now-now. The point is that I am not numbed by Bernard's passing. To the contrary, I am reminded fresh and anew of the wounds that other deaths have cleaved, and Bernard adds to that chasm in my soul, and it leaves me with an unspeakable sense of growing loss that may never end.

I do not know where this story goes from here. But if you are inclined as a reader to dedicate a portion of your life to assist in the effort of relieving this kind of sorrow, I cannot think of a better way to spend one's life. If you are in medicine, imagine the number of lives you can affect by dedicating some of your time in Africa, where needs are great and skilled personnel are few.

It is my belief that if one is in medicine to help people improve their lives in terms of health, one can not do better than to focus their efforts in Africa.