Monday

Okay, so this blog is generally a negativity-free zone, but I have a little venting to do. Medicine isn't a job, it's a way of life. Even though I am only a third year (I just wrote "third ear" by mistake, kind of fitting for what I do), and perhaps I'm a bit drunk on my new-found responsibility, but it never feels like the medicine part of me goes home for the day. I'm always practicing, even at the coffee bar where I went to do a little "light" reading on brain tumors after being dismissed early today. You can't help but watch everybody. As Tom will likely agree, recent subway rides with me have been insufferable because I am diagnosing everybody.

There are very few escapes in life, especially after a day like today where I've been drafted to help with two patients with newly diagnosed incurable brain tumors. I'm a coward - I ran the consult for one of these patients on Friday and knew they were going for a craniotomy (read: brain surgery) this morning, and even though I really wanted to, I couldn't bring myself to visit them and wish them good luck. I rationalized that I am such a peripheral member to them - how many people have they met over the weekend? - and even though I was there when we hinted at the diagnosis as housekeeping inconsiderately continued to clean the next bed (were I the Attending, I would have asked them to come back later), and carefully described their symptoms and work-up in minute detail, and empathized as best I could - I rationalized that they wouldn't remember me. But I feel a loss now that I didn't take the time - for me, really - to wish them luck. And all day I have fixated on their pronouncements of how "healthy" they are and how much responsibility they have and kids to care for.

Something has changed between this week and last...In surgery you are never alone, always functioning within a unit, but in the medical specialties, you are one arm of an octopus. As such, I have found my purpose changed. Rather than catching things early - skin infections, stitch loosening - I'm responsible for treatment decisions (or at least I should try to be). And so my studying has changed. No longer is it that I am reading because I'm expected to know this. I am reading because I want to know this. It's amazing how much better things stick when applied through the filter of "how does this apply to my patient?"

So here's my complaint. In the background of terminal cancers and debilitating strokes, and an NPR station that hammers on the economy's volatility, it's a little disheartening to read wedding blog posts (you knew there was a wedding tie-in somehow, didn't you?) involving Jimmy Choo shows, lavish dessert buffets, and copious amounts of Veuve Cliquot. I know the intended response (as with fashion magazines) is aspirational: these posts are meant as flights of fancy and escapism. But it's hard to take them that way when their reality is so disconnected from your truth. Weddings are celebrations, sure, and if you have the means to pamper your guests, you should. But I hope this feeling of financial inadequacy (even though my wedding budget seems astronomical and generous) is fully supplanted by an expression of utmost appreciation for my family and friends, however I am able to express it. I have begun to think of theming our wedding as "All you need is love," and something so plebian as the symbol of the heart has taken on new meaning for me. In medicine you try to avoid giving the obvious answer in order to seem smart. But things like the heart are universal because there is just no better way to say what you mean. I hope my wedding is not about the show but about expressing my gratitude for those who have gotten Tom and I so far in our lives, and for forging a new community together.