Course description: This is a wholly immersive, sensory integrative solo spirit journey into the kingdom of the sick, a kingdom to which each and every one of us makes application on the day of our naturalization into the kingdom of the living, the kingdom of the well.

This is a lifestyle course. You will forfeit all regularity hitherto known. Strictly speaking, habit will stop dead in its tracks for the sake of the learning opportunity herein.

This is a burst dose course, if you will, with a gentle taper designed to instill habits of daily thanksgiving for your youth, young doctor. NO READING, NOT EVEN SUGGESTED.  This is a course in which the ascetic, the penitent, the self flagellant and the ready at arms will undoubtedly excel. Humility is a must. No application. No prerequisites.

Grading:

-Successful admission to the hospital via the Emergency Dept: 25%

-Attendance, participation in rounds as patient: 20%

-Fluent use of the pain rating scale: 20%

-Tolerance of uncertainty: 19.99%

-Display of patience: 15%

-Reflective essay: 0.01%

Glossary of terms:

Commitment: Emotional and spirituo-psychic dedication to a task that is, ideally, so physically pressing that after subscribing you cannot conceivably quit.

Ex lap: Exploratory laparotomy. Abdominal reconnaissance. Cutting in order to see and to feel, and therein to know.

Hospital bed: An underacknowledged seat of higher learning.*

(*Did the Buddha stream from home the principles of the interconnectedness of all being while breading a beef wellington? No. He sat under a tree for 40 damn days.)

Malrotation: A disease of structure, of suboptimal positioning, which can steal the stage at birth from those millions of other formations chose to go right, or, alternatively, can hold its tongue until the ripe age of twenty-seven. Causes midgut volvulus.

Midgut volvulus:  The microcurators of your very nutrition attempting cultish suicide by mass hanging. An impetulent death reserved historically for traitors of the state. Also, an uncommon indication for ex lap in the otherwise healthy adult.

Frequently Asked Questions (FAQ):

What’s the point of this course? Empathy matters. Learn it once, learn it in the superlative, learn it well.

Imagine that it’s 7 am in the cafeteria. The bacon-egg-‘n’-cheese sandwiches are out for breakfast. Little short stuff from the kids’ hospital treks over with her IV pole in tow, this being one of the less inclement days of her long admission. She reaches blindly on the counter above her head, but the foil sandwich troves occupy the very back of the warming zone. Her hand IV heats and boils the antibiotic in the plastic hub, quinolone smoke curling under the eye of  terawatt lamp and condensing in arabesques on the sneezeguard. She mewls. You approach and hand her a sandwich.

That was easy. Good. Recognizing basic human need should be. But what does your gut tell you about the methadone dependent head pain case in the ER? The new cancer diagnosis who prefers sagebrush burning to cyclophosphamide? How do you know you’re doing the most good in an incomprehensible situation?

So heap the awful on. Now is the time. (M4 is practically a year of vacation!) With the self-knowledge gained in this course, your skill and grace on the wards will be lustrous. Clinically speaking, you will skitter like a hummingbird above the peat bog of the rest of your medical class, and you will go on to earn highest honors always.

Sold. What are the objectives?

Objective #1: Wake up. Your body is rioting.

The intro lecture will startle you in the middle of the night. All good medical emergencies begin this way, so as to maximally sacrifice comfort and sleep. Feel the epigastric thrum and change positions a few times. Reassure your bedmate when they wake up. Things are fine. Just curl up again and wonder as the thrum grows to a gnawing pain.

When every arrangement fails to relieve– knees to chest, piked on the left side, facedown boardlike– bolt up cross-legged like a swami. Hear thunder roll in a teacup. See an ethereal bit of chaos combusting like a sun, contained (recall the term “localized”) by a small space.

Don’t despair until you run to the toilet and vomit bile.

Your bedmate will contemplate the relative merits of an ambulance ride. Lie and say that you’re fine, that you don’t need a hospital. Then use this time to recognize just how sick you are. (This won’t be easy). Try to run a dummie’s differential- stomach exploding, pancreas scraping, basal ganglia rattling.

Then acknowledge the billions of feats of chemical gynmastics that have carried you through so many healthy years. Realize that now, just possibly, might be the time to address something serious. Get in the car.

Objective #2: Travel a common point of entry into our healthcare system.

Survive a car ride that will string and pluck your intestines like harpstrings. Arrive in the ED and survey the waiting room. See the lineup of Friday night invalids trying desperately to look the most pitiful; see your competition.

Tell the clerk that your pain is a slam dunk ten. Ask for a barf bucket then sit down and, amid all the quiet sniffling and limb holding and crying, proceed unabashedly to retch. The cymbal crash of your stomach bile will summon the nurse on triage.

Collapse gratefully into the wheelchair escort she offers to your private room. Deflect the jealous stares of other patients. 

 Objective #3: Abandon ye all decency. With the help of some good medicine.

Accept the Dilaudid when the Zantac, lidocaine and morphine all fail. Just minutes later, try to recall the sequence of events leading your nakedness under the hospital gown, but when your mother suddenly materializes in the corner of the room, stop trying. She probably had a hand in it.

It will be a phantasmagoric staff taking care of you in such a time of need. You will not notice them coming and going, and all the normal clues of a well socialized individual- names, faces, kindness in the eyes- will elude you. They will ask you to point, to indicate, to rate, and to tell a story that you can’t even recall. Humor them until you can no longer articulate a basic vocabulary. They’ll frown and think, frown and think, push your Dilaudid, and soon be just among others a marching cast of characters in a chemical dream.

Objective #4: Treat support staff nicely.

You’ll wake up in a hot, dark room with a tech pressing wet jelly into your right upper quadrant. He’ll frown and think. Follow his gaze to the ultrasound screen, where instead of a liver there is black abyss. Curse. Apologize. Barf into the kidney bean basin now cleaned and deposited next to your head.

Stay calm when the pain rebreaks your stratospheric haze. Attempt to formulate a question. Attempt to rethink your dummies’ differential. Faces of your care team will be more distinct now that there’s worry in the air. Calmly abort the ultrasound and ready the CT machine. Don’t hesitate to ask for the Dilaudid.

Objective #5: Deal gracefully with uncertainty.

Choke down a liter of contrast dye in juice. Don’t worry about the chalky taste, or the significant amount that comes back up.

Wake up again when a tech in the CT suite rubs your sternum. “This is the IV dye, sweetie.  Might leave a metallic taste, and might make you feel like you wet your pants.” Ungh hghhh. Wake up again in the belly of the white plastic whale. “Sweetie, we need you to hold your breath and stay very still.” Click.

Meanwhile, the surgeons will circle at icier altitudes. One by one they’ll alight on the wings of an emergency and descend. They will examine and speculate, stop short of conclusions. The lines on their foreheads and around their eyes, though, will speak in memories of tragedy and victory. Accidents and odd cancers that claimed the young, cases that should have been wheeled back sooner.

The lead surgeon will try to show you your jejunum on the computer. It’s bloated and fat stranded. But through it all your sixth dose of Dilaudid truly put you outside yourself. You see a sick looking, sweaty boy drugged past the point of sleep. You see his worried family, hanging on every word of the lead surgeon’s: cut into the abdomen, something funny happening, no obvious cause, especially since you’ve never had a problem.

Do they have your consent?

There’s a contract dangling in the sick, sweaty boy’s face. ALL OF US WILL DIE SOMEDAY, BUT I, initial here, DO ACKNOWLEDGE MY MORE IMMINENT RISK OF DEATH OR DISABILITY AS A RESULT OF a) hemorrhage, b) infection, c) perforation, d) etc.

sign here

The boy wakes up long enough to write his first name, then the rim of unconsciousness slips back over him. His face, inclined a little above the plane of his legs, looks pale and fitful. His mother is closer now, reading the contract and thumbing the hair off his forehead like she once did during his bird baths in the kitchen sink as a baby.

You will be alright.

Objective #6: Don’t go anywhere.

Wake up to a world that is fundamentally quieter. The noise of the pain blunted things like the cool bedsheets, the air conditioning, the worry on the faces of the people around you. Notice it. Pain begot pain, and late last night you were convinced on an almost subconscious level that your suffering could only, despite the best interventions, persist.

Don’t get up. If you try to you’ll quickly notice that you’re pinned down by the left antecubital fossa, the right naris and the urethra. Tubes force sphincters open at prow and at stern, and all that’s left for you is to suffer The View until a nurse comes and hands you the remote.

Meet the nurses who claim to know you. That was another life, you’ll tell them, back when you peed without an audience. (Realize that a hospital environment will burnish your lonely old man jokes).

Objective #7: Keep house.

Prepare yourself for guests. Tie up your gown in back and cross your legs so they can’t spy your junk. Unhook your NG from the wall and hang up the towels in the bathroom.

Your most intense bouts of loneliness will not come when you’re actually alone. No, not after several days when the still relief of night is broken by the ambient chime of your IV pump and the paternal drone of some boner pill infomercial on television. Loneliness will strike in the middle of a conversation, when your smooth shitting and all-around-healthy guests express their shock at what passed, their concern for the future, and then run out of things to say, standing around picking their nails and staring at you. That, young and unbridled M4, will be you alone in this venture.   

 Objective #8: Apply your experience.

Your hall walks may as well have been to the bottom of the Bering Strait; they won’t let you go until you poop. The Foley and NG coming out will make you feel slightly more human, or at least make dressing for the first time a realistic possibility, but following your first successful bowel movement in nine days, rejoice!

Receive uncertainty. Your diagnosis will be a topic of conversation for the next several followup appointments with surgery. Your prognosis- or the chance that you will relive this whole experience all again- will a topic kicked down the line of sub-specialists.

Go back to work. Keep a SlimFast in your bag for as long as substantial food presents a challenge. So about a month.

Learn to sense stress as easily as you would smell smoke in a burning building. Reassure even the healthiest who find themselves in the belly of a health system. Even those who seem to be wasting your time, not to mention valuable resources.

Recognize that the halls with paintings of all the old dead doctors are also halls of rebellion. Some bad chemical fate incited your patients’ bodies into betrayal and now, whatever part you lay hands on, you touch a knowledge of truth and sense of trust disturbed profoundly.

Histories are lives and lives are made up mostly of history. It is the singular imperative of the imagination that we reach into them. 

So how about this reflective essay?

It will practically write itself.