The Size of Sickness

To answer a question I've been asked a few times this week: I'm on a basic science block. Every two clerkships (save this one) are followed by a two week basic science lecture/journal club series where we return to the classroom to reflect on the finer intellectual and philosophical points and controversies of the fields we have just rotated through. My current two week block is a little different in that I have only finished one of the two "grouped" clerkships (i.e. surgery, since medicine will come at the end of May), and focuses not on surgical principles, but on ICU care. This is neat because we get very little controlled exposure to the ICU (i.e. classroom time), and I think this is a good way to learn chest tubes and central lines and ethics.

The course director is an interesting man, someone who has grown on me over the past two years. He holds joint appointments in three departments - ICU, surgery, anesthesia - is married to a thoracic/foregut surgeon whom he simply adores (were that Tom and I followed their model!), and perpetually wears cowboy boots. He's a bit of a pontificator, so it is easy to lose the message in the words, and I think that fits perfectly with a family's experience of the ICU.

When I started medical school, I had a very simplistic definition of sickness. You were sick when you had a cold, couldn't breathe, succumbed to a stroke or heart attack, or had an accident. I find it hard to express my new definition of sickness, but I'd like to try. In the community, sickness happens when one of your organs goes bad and you need it fixed. The thing to highlight is that only one thing has gone wrong and there is an answer. But for people who actually get admitted for things other than elective surgery, this is rarely the case. Sickness, in truth, is not about the degree, but about the size. As patients, we think to do battle with single and recognizable entities - stroke, heart attack, bacteria, viruses. As student doctors we learn that the scariest monster we battle is the patient themselves. There is no such thing in the world (or imagination) like the inflammatory cascade. You know those days when you get so upset you start to cry? And can't stop? And can't figure out why on earth you're so upset? The body can kind of be like that sometimes, deciding that it is so overwhelmed and overstimulated by the initial insult that it might as well blow itself up through acute respiratory distress syndrome. And it's heartbreaking to realize that there is nothing we physicians can do to slow the speeding train. We can offer "supportive care," clean up the spilled milk and smashed dishes and offer a tincture of time. Humbling and inchoate, truly.

Now that that's out (I've been sitting on this post for days...) we can resume our regularly scheduled wedding fluff. Although the size of sickness has left me rather uninspired. Hug your neighbor, then hug yourself.