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Psychiatry
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Vintery, mintery, cutery,
corn,
Apple seed and apple thorn;
Wire, briar, limber lock,
Three geese in a flock.
One flew east,
And one flew west,
And one flew over the cuckoo's nest.
and pso the psych rotation pstarts. pso far,
pso good. (psorry, i'll stop that now). anyways, i've had about 4 days now
of my psych rotation and it's a totally different world. besides the patients,
psychiatry itself is way off from the other medical specialties. the history
and physical are totally different (with peds vs. family vs. obgyn vs. surgery,
it was all the same, although different ones focused on different parts).
but with psych, it's all talking and then not only getting the answers, but
watching how they are given. the history involves asking questions; the physical
involves analyzing the content and delivery of the answers. i barely ever
use my stethoscope. not to mention the vocabulary is completely foreign to
anything else. there are common words that they use differently and then all
new made up words (two of my favorite are witzelsucht and trichotillomania
(and for the smart and mean people, no, trichotillomania is not what happened
to my head :)).
k, so i start these first three weeks at the VA hospital in waco (pronounced
"wacko" for the purposes of this conversation). i think i previously
discussed the general population that you see in the VA from my surgery rotation,
so i won't rehash that, but as you can imagine there's a lot of post traumatic
stress disorder mixed in to that due to the death that these guys have seen.
now before i go into the stories, let me throw in a little disclaimer: there's
nothing funny about mental disorders (well, that's not entirely true, some
are funny. like amathophobics who are afraid of dust) and i think not being
mentally healthy is way worse than most physical ailments. and it's really
sad for the ones with the problems, especially those who are messed up and
know it, but can't do anything about it. so i'll try to be delicate and focus
on the hilarity of the situation and not on degrading the patient. and i'll
try to avoid insensitive monikers such as 'lunatic', 'psycho', and my personal
favorite 'whack-job'. that being said, here we go.
i get to waco on tuesday morning (which kind of stinks, having to drive 40
miles every day. i lose sleep and gas money) and get thrown right into seeing
patients. the department i'm working in is basically just triage: we see all
the patients who may need to be admitted to the psych ward, check them out,
and either admit them or send them home. my first job is to do a full history
and physical (henceforth abbreviated "h&p') on a new patient. all
i know about him is that he came in the previous night and had a psychotic
episode (definition: psychotic is basically having delusions, hallucinations,
and other boundary problems with reality). when i get to him, luckily he is
no longer psychotic. but now he is demented (def: impaired memory, thinking,
language, behavior and personality) and delirious (def: fluctuating loss of
awareness and consciousness). now normally i can do a medical h&p in about
20 minutes, which isn't bad. but the inexperience, plus the dementia and delirium
added a nasty little twist to this one and i was trying to be very thorough
and complete to impress the doc i'm working with. it took about 2 hours! it
was the most excruciating conversation i've ever had with anyone. every other
question he would tell me that the words were floating around in his head,
but he couldn't understand what i was saying. then his memory was shot, so
getting any kind of history was hit or miss. the worst part was that he had
blocking (def: patient's train of speech is interrupted before a thought or
idea has been completed), so i'd ask a question and he'd start to answer,
then just stop. sometimes it was because he was slow, others because he forgot
what was going on. so i'd sit there and wait a few seconds to a minute for
him to answer. there was a plethora of awkward pauses (only felt by me) and
i hate that. sadly, though, it was a better conversation than i've had on
any dates over the past 6 months (k, that was obviously not true. no dates.
just thrown in for comedy's sake) anyways, we couldn't figure out what was
wrong with him, but we finally got some history from his son and found out
that he had used about 6 bottles of nyquil over the past week. there's an
ingredient in there that has anticholinergic effects (you can look that one
up yourself), which basically led to intoxication and his symptoms. the mnemonic
for the symptoms of anticholinergic poisoning are "blind as a bat, dry
as a bone, red as a beet, mad as a hatter, and hot as a hare." and what
i had to deal with was the 'mad as a hatter'. now, i don't know many hatters
(or ''milliners', as they prefer to be called), but they have to be really
jacked up if they're anything like this guy. thankfully, it's one of those
things that goes away as his body clears it, and he's been much more lucid
these past couple of days. then there were a bunch of other patients, mostly
depressed and/or drug and alochol abusers and/or post traumatic stressers.
so i dealt with lots of people with suicidal ideations or attempts and all
that. very sad how they keep screwing up there lives for various reasons.
but i basically talk with them and try to figure out what's up. i've gotten
way more comfortable than i used to be at being around crying men. the hardest
part is that i'm not the best people-reader. i tend to believe people when
they say stuff to me, but i always wind up talking with the psychiatrist after
each of us have interviewed the patient, and the conversation involves "what
did you think about . . .", and i say, "well, he said . . .",
and i hear, "oh, no, he . . . " i've already ruled out psychiatry
for my future, but it is good to have some skills in this, since lots of family
practice patients have psychological issues. the most exciting patient was
a paranoid schizophrenic with auditory hallucinations. for the most part,
he was 'normal', as far as thinking and speaking and all that. the only exception
was the voices in his head that he talked to as i was talking to him. every
few seconds or so, he would turn his head and say "hmm, yeah, uh hmm"
and answer them. very difficult conversation. i kind of liken it to talking
to someone on the phone while there kids keep popping in and saying thing
to them. i felt bad for constantly interrupting. he had 4 members of the aryan
brotherhood in there calling him names and telling him stuff. when i asked
if they were telling him to hurt himself, he said no, and i felt better. when
i asked (twice) if they were telling him to hurt other people, he said he
didn't want to talk about it, and i made sure i had easy access to the door.
the worst part was when he'd get mad at them for what they were saying and
curse them out and i'd hear "shut the *bleep* up, you *bleepity* *bleeps*",
and so forth. and with no one else in the room, it kind of felt like he was
talking to me. very strange. he definitely falls under the category of psychotic.
speaking of psychotic, there is a psychotic disorder i ran across in my book
called 'koro' that pretty much only occurs in asia, and they have the funniest/strangest
delusion i've ever heard of. cracks me up. i won't go into it because of the
mixed audience, but if you want to email me i'll tell you about it. lots of
weird conversations this week. and, like any of you who have ever taken a
psych class, i've already diagnosed myself with about 8 disorders (for doctor-patient
confidentiality i can't discuss any of the details) and i should be on a dozen
or so meds.
the other neat thing this week was a meeting we all (med students) had about
our 4th year. it's time to start picking our advisors and scheduling everything
for next year. very cool because 4th year is very nice, we get 12 weeks off
and get to do whatever we want rotation-wise (if anyone is getting married
or having babies or anything next year, let me know so i can schedule around
it.) the hard part is that we have two tests in there. one is the 2nd written
part of the test (USMLE) i took last summer. the other is a practical test
(with the fake patients) that they just added last year. it's kind of a rip
off that everyone is upset about. because it's new, it's only offered in 5
cities around the country (luckily for me one is houston, but other people
have to travel really far). even worse is that it costs $985. i don't care
who you are, that's a lot of money to pay to spend the day with people pretending
to have jaundice (or even people who really have jaundice).
oh, and speaking of bad timing, i found out that some of the astros relief
pitchers were up here at our pediatric ward this week hanging out with the
kids. when i was on, we just had some minor league hockey people i had never
heard of. it's probably for the best though. had i been there, i might've
had some nasty comments about the nlcs (except to brandon backe, he was there
and i love that guy)
biblically, i learned a lot from locusts this week. i started studying joel
last week and there are locusts all throughout that thing (and not just plain
locusts, but gnawing locusts and swarming locusts and creeping locusts and
stripping locusts). they are described as a great army and are basically used
by God to attack israel (His people) to discipline them and bring them back
to Him. i've also just been kind of reading through the old testament for
fun, and i'm in exodus right now. and i noticed here how God uses pharaoh
(who hates Him and His people) to carry out His purpose in making Himself
known and freeing His people - 9:16-17 "but, indeed, for this cause I
have allowed you to remain, in order to show you My power, and in order to
proclaim My name through all the earth. still you exalt yourself against My
people by not letting them go." both are just great examples of the sovereignty
of God. the message to me: He will bring about His purposes whether He has
to use bugs or rebellious enemies. but the precious gift offered to me is
to be a part of His purposes in making Him known and raising up obedient children
who love and delight in Him. another c.s. lewis quote (i really like him):
we all serve God inevitably, but it makes a great difference whether you serve
like Judas of serve like John. the other comfort is that His purposes won't
be thwarted by our disobedience, so we can trust in His word and be confident
in prayer that what He says will be done. the illustration that comes to mind
(because i love illustrations) is michael jordan. back before the second retirement,
any time he was on the court, especially in the playoffs, you knew he was
going to win. and we, as john paxson or bill cartwright, can either pass him
the ball and contribute, or try to do things ourselves (and fail). but no
matter what, the game is his. so that's the truth of the week, and the prayer,
that i would be obedient (and joyfully so) and carry out the purpose i was
chosen for. either way, i will serve Him.
isaiah 43:7,10-12- everyone who is called by My name, and whom I have created
for My glory, whom I have formed, even whom I have made. . . you are My witnesses,"
declares the Lord, and My servant whom I have chosen, so that you may know
and believe Me. and understand that I am He before Me there was no God formed,
and there will be none after Me. I, even I, am the Lord, and there is no savior
besides Me. it is I who have declared and saved and proclaimed.
the waco va safari has ended.
all in all not too bad. very restful. and i know i definitely don't want to
be a psychiatrist, if for no other reason than not wanting to be called a
"shrink".
the rest of the patients were mostly similar. there was one lady i had who
thought that some trial had been carried on without her and she had been convicted
and sentenced to death. it turns out that it was a manifestation of the guilt
she felt for not turning in an ex-boyfriend who abused her daughter (i.e.
because she wasn't punished for that she felt like she needed to be punished
for something). it's amazing what the mind will do to deal with stuff (atleast
what the jacked-up mind will do). we also had a sad case of a man with alzheimer's
dementia. the average course of the disease is a 60 year old who gets diagnosed
and then lives/deterioriates another 10 or so years. this guy was 53 (5 years
post-diagnosis) and had already lost most cognitive functions. he could barely
remember his first name and not much else. he could only eat and shave after
he was shown how. pretty bad off. the worst part is that he knew that he couldn't
remember- so it wasn't a blissful ignorance- and he'd get sad if you asked
about his wife. he was recently married and had a young kid.
there was another "difficult" patient this week. he was a 40ish
year old guy with borderline personality disorder and cocaine abuse. quick
description of borderlines- unstable self-image. unstable, intense relationships
with splitting (splitting=seeing people as all good or all bad, and quickly
changing between loving and hating them). big fear of abandonment. very moody.
self-mutilating. maybe sounds like some people you know? anyways, when they
are "on", very hard to talk to, especially when he's splitting and
says med students as bad and incompetent (which i really can't fault him for
:) anyways, i go in, he's laying down and won't face me and mumbles a bit
of information. shortly afterwards profanities spew at me because i'm "playing
with him" and i "think it's funny". so i excuse myself and
let him chill. i come back in about 10 minutes, same rigamarole (like pulling
teeth, and not those loose wobbly ones, the molars). he's still cussing at
me and spend forever in there because i ask and sit for minutes waiting for
an answer. but i'm slowly getting all the info i need. so i leave again, and
then the doctor comes and asks how it's going and i tell him. then he tells
me how with borderlines you have to interview them totally differently or
they'll always be difficult (obviously that would've been nice to know an
hour earlier). the 2 general rules in talking with them: 1) don't show emotion
(i.e. don't seem upset or shocked at the things he says for attention. just
be businesslike) - no biggie; 2) set firm boundaries - a little more difficult
for me. i don't tend to be very firm or boundary-ful, as many of you know
(especially if i've ever baby-sat for you!) but i go back in for the trifecta
and but atleast now i'm armed with knowledge. i was determined to win this
battle. i went in with the attitude of ivan drago "i
must break you". so i set my boundaries- i am your doctor. i'm doing
my job. you will answer my questions or you can leave. you won't get any medicine
or privileges until i'm done. and after a few minutes of intransigence he
submitted to my will and i felt powerful and i liked it. well, not completely.
but it was cool. he even thanked me afterwards.
one thing i noticed about myself with all this talking to people is that i'm
very physically empathetic. when i talk to people, my facial expressions and
body language match their level of happiness/sadness. i do it with real people
too, and i think most of the time people think i'm mocking them, but i'm really
not. my body subconsciously tries to match the level of excitement of the
other person, no matter what i'm feeling. i also noticed a similar thing on
family medicine, but with the physical exam. when i tell people to stick out
their tongue or take in a deep breath or any other commandment like that,
i copy what they're doing. it's especially noticeable when i'm in watching
a doctor exam the patient and i'm just standing on the side with my tongue
out. i can stop it if i think about it, but it usually just comes out. freaky.
my choice to do family med over anesthesiology was affirmed this week - i
watched "anesthesia nightmares" on the learning channel (it was
in between "when surgical tools get left behind" and "you swallowed
what" -fyi, 4 americans die per day from choking). it had all of the
stories of people not being "out" while they were operated on, so
they couldn't move but they could feel everything and the resulting mental
anguish and all that junk. i had a somewhat similar scare back in the day.
i saw a news thing about that problem and the next week i had to get my wisdom
teeth out. so at the dentist's, they gave me the nitrous and some iv succinyl
choline or something and paralyzed me, but i could still feel everything and
hear the nurses and all that. and that "dateline" special or whatever
comes rushing into my head. but then i wake up and it's over. so it wasn't
really similar at all, but true.
one thing i learned from being around the mentally ill is that the people
who tend to do better invariably have a good support system. most of the chronic
visitors and really screwed up people don't have much of a family or friends
to speak of, and they usually have been betrayed by them in the past (especially
abuse, abandonment). it's also usually listed as a positive prognostic factor
in my books. on further reflection, it's easy to see that we were definitely
created to be relational beings and we need and thrive on our interactions
with the people we love. which makes sense, being that we come from a relational
God. Not only were the Father, Son, and Holy Spirit in perfect fellowship
from all eternity, but the Son gave up His life so that we also could have
fellowship with them. and He made His church (us) in a way that we only function
right when we love eachother (john 13:35-by THIS all men will know that you
are my disciples, if you have love for one another). it was just a good illustration
and reminder to me of the necessity for us as the church to love one another
and encourage eachother, etc. unfortunately for us (and for His name and reputation),
we usually opt for strife and dissension and back-biting.
1 corinthians 12:12-26- For even as the body is one and yet has many members, and all the members of the body, though they are many, are one body, so also is Christ. For by one Spirit we were all baptized into one body, whether Jews or Greeks, whether slaves or free, and we were all made to drink of one Spirit. For the body is not one member, but many. If the foot says, "Because I am not a hand, I am not a part of the body," it is not for this reason any the less a part of the body. And if the ear says, "Because I am not an eye, I am not a part of the body," it is not for this reason any the less a part of the body. If the whole body were an eye, where would the hearing be? If the whole were hearing, where would the sense of smell be? But now God has placed the members, each one of them, in the body, just as He desired. If they were all one member, where would the body be? But now there are many members, but one body. And the eye cannot say to the hand, "I have no need of you"; or again the head to the feet, "I have no need of you." On the contrary, it is much truer that the members of the body which seem to be weaker are necessary; and those members of the body which we deem less honorable, on these we bestow more abundant honor, and our less presentable members become much more presentable, whereas our more presentable members have no need of it. But God has so composed the body, giving more abundant honor to that member which lacked, so that there may be no division in the body, but that the members may have the same care for one another. And if one member suffers, all the members suffer with it; if one member is honored, all the members rejoice with it.
well, i'm finishing up psych
right now. 4 more days and i'll only have 1 more block to go in my third year
(although it's 3 months). i'd like to say the first ¾ of the year have
gone by quickly, but i have no sense of time. but it is nice to be nearly
done.
these past few weeks after the va have been spent at the inpatient ward in
scott & white (known as STC-1 - "special treatment center, first
floor"). the first day was kind of exciting. we (me, another student,
2 residents and attending doc) went see a psychotic lady in the closed ward
(i.e. locked down so they can't get out). as the resident was interviewing
her, i just stood there quietly and listened. but this lady keeps glancing
at me then looking away, very weird. finally, she looks at me and yells out
"he's calling me stupid!" i just stand there with a look of shock
and chagrin on my face as the resident tries to ground her in reality by saying
that i didn't say anything. she doesn't agree and closes the matter with "well
i think he's stupid too!" needless to say we didn't become very close
after that. there were a bunch of other patients, but nothing too exciting
or that i haven't gone over before. i did decide that manic people are the
funnest to talk to (if you have the time), and borderlines are the hardest.
manics have pressured speech (i.e. they talk loud and nonstop without breaks)
and flight of ideas (as they talk on a topic, a word leads them to a different
thing and so on. each thing becomes a jumping off point to another). to give
you an example of a typical conversation, i copied this from the internet
(i didn't feel like making one up):
"Why good morning, Doctor, and good morning to all the lovely little squiggles you have on your tie, and to squiggles everywhere, who, by the way, are outward representations of chaos, a soon-to-be-quantified branch of physics and mathematics, which, if you haven't boned up on your integrals, will leave you without much hope of doing more than passing over the topic, as the cow passes over the moon in the ditty which you may have heard when you were a child. You were once a child, Doctor? It is safe to assume that we all were children once, that is a safe assumption . . ."
it's really fun to try to follow along. borderlines
(like the guy from the last email) are hard because they are very manipulative.
and because of the splitting- when they see all doctors as bad, they say/do
things to get you riled up so you'll punish them and then can they say "see,
i told you he's mean and hates me." so you have to be really careful
what you say and how you respond to what they say and even if you are careful,
you can never really win.
last week i spent the afternoon on consults, and we had one guy from surgery
to check out. he had had should surgery and had gotten a staph infection in
it. then, probably from a mix of the infection and the meds he was on, he
got delirious. he wound up (late one night) wandering down to the ER. there
was a security guard driving around outside that area who had stopped and
came inside to get more tickets. well, our delirius dude went out to his car
(where the keys had been left), took it, and drove around while being chased
by a few cops until finally he crashed into a ditch. luckily the cops saw
his wristband and returned him, and now he's ok. another funny story from
this monday. we were in the closed ward trying to talk to a new patient, and
as we were looking around for her, another girl on the ward started to follow
us around. she's a tiny little lady with paranoid schizoprenia and very difficult
for the nurses. well, she followed us around with this creepy little look
on her face, then when we went into the room, we asked her to leave and she
did so. a little bit later, i hear a click noise at the door and she's standing
there and then walks away and i don't think anything about it. after a couple
minutes, we're ready to leave and as the doctor goes to open the door, it's
locked. and this schizo lady is smiling and laughing at us through the window
from her room across the hall. and she's yelling out "physician, heal
thyself!" we had to press the little nurse call button and have one of
them come unlock the door. we were cracking up. funniest psych moment so far.
even funnier if you know her and could've seen the look on her face. and lastly,
i got to experience the famous electroconvulsive therapy last week (aka shock
treatment). it's not as bad as i think it's stereotyped to be, and it can
do a lot of good. one of my patients had major depression not responding to
meds, and after a couple shocks he made a tremendous turn around. basically
the patient has a couple electrodes on the front and back of the head, and
a small current passes through it causing them to have a seizure. i like to
think of it as a "reset" button. like when your computer is jacked
up and you just restart it and it gets back to normal. the seizures aren't
too bad, because the patient is under general anesthesia with a paralytic
agent. so no thrashing, just lots of neurons firing off in the brain. it's
mainly used for depression, but also for mania and schizophrenia. good times.
since we're finishing psych, here's a few more weird psychotic disorders for
you (apparently everything has a name):
capgras: belief that a friend/relative has been replaced by an impostor (invasion
of the body snatchers type thing)
mal de ojo: belief that you have been cursed by the "evil eye"
lyncanthropy: belief that you are a werewolf
windigo: belief that you are possessed by a demon/monster that murders and
eats human flesh
cotard syndrome: belief that you have lost everything, including internal
organs and are a corpse walking around.
thankfully i haven't seen any of these.
for the "let's laugh at bobby" part of the update, i got locked
out of my apartment this past week - with one door unlocked and while having
my keys to the other door (which is no small feat!) i got home from working
out at about 11:45pm, came in and locked the door. then i remembered i was
going golfing the next day and wanted to put my clubs in my car so i wouldn't
forget. the clubs are in the storage closet outside on my little patio area,
outside my sliding glass door. and for protection (if you've never had them),
they have a little bar that rotates down and keeps the door from sliding.
so i lift up the bar and open the door and then go out to get the clubs. well,
i slide the door closed to keep the warm air from coming out, and the bar
falls down and blocks the door. i go to open it, and it's jammed closed. i
don't panic, but i hop over my patio and put the clubs in my car. then i go
around thinking i can unlock the front door and get in. sadly, i've locked
the deadbolt inside and don't have a way to undo it. so now it's midnight,
forty or so degrees, and i'm in shorts. i go to see if any windows have been
accidentally left unlocked, but no luck there. now i'm starting to think about
which window would be cheapest to break, and if it would be cooler to use
my fist or a rock or something. but i'm industrious, so i go check out the
sliding door. i've opened people's cars on multiple occasions using a coat
hanger (not to commit a felony, but because they had locked their keys in
:), so i figure the same prinicple could apply here. only i don't have a coat
hanger and all my friends nearby are sleeping. so i go to my car and see what
items i have. first i use a screwdriver to loosen some little latches holding
the non-sliding glass, but there are parts of it that are bolted, and it won't
come off completely. but this did give me a little room to play with, where
i could fit something as wide as the screwdriver shaft through. this is where
a hanger would've greatly helped to reach in and lift the bar up. but alas,
i had none. so i get whatever junk i had in my car to help, which included
a hair ribbon (don't ask), a piece of plastic, some suture (0-vicryl), and
a pair of hemostats (kind of like locking pliers used for surgery). after
about 30 minutes i'm able to get the ribbon around the bar and lift it somewhat,
but it slips off as the bar is raised and i've only moved the door about 2
inches. fortunately that's enough to squeeze my fingers in and lift the bar
as i push the door and an hour and a half later, i'm back in. it made me feel
very macgyver-ish (like a slower and dumber macgyver, but macgyver none the
less). and now i know that any idiot with a screwdriver can break into my
apartment.
oh, and on a super cool note, my grocery store here (HEB) finally got some
of those self-checkout machines. i love those because, besides being able
to make that beep noise yourself, you can checkout without anybody else knowing
what you bought. call it paranoia, but i hate when people assume things about
me, and i always feel that as they look through my things, the checkers will
form opinions that may or may not be true. i just don't like that. sadly,
it effects many areas of my life. i don't like talking on the phone in front
of other people for the same reason, because they can only hear one part of
the conversation and make assumptions based on that. and when i write and
make an error, i have to completely scratch it out because i don't want them
seeing what the error was or guessing i what my thought process was. i really
tend to overthink things. maybe i'm a little neurotic. it's sad when we're
discussing qualities of a patient and the doctor is calling it strange while
i think, "yeah, i do that too". we had a guy this past week with
mild obsessive-compulsive disorder (OCD), and he was saying how when he sees
numbers, he has to manipulate them to make them equal 13 somehow and he does
some other weird stuff with letters. and i do the same thing- when i see numbers,
my mind starts to make them either into a balanced equation or somehow get
ordered. and with words, i always try to rearrange them into other word(s)
(but because of that i'm really good at the jumble in the newspaper). it's
not an obsession with me to the point that it causes distress and i have to
do it, but it's there. these 6 weeks of psych have taught me that i fit many
of the criteria for most of the disorders (especially the personality ones),
as do most people i think (unless that's a delusion to make me feel normaller),
it's just to varying degrees.
now for the life lesson from the past few weeks. it seems like the issue that
popped up the most (at work, at church, reading the bible, tv, magazine article)
was pain and suffering. this whole year, i've seen a lot of "sick"
people who had some little muscle pain or a couple days of sore throat or
little things like that where most people would just take a couple advil and
deal with it (and that's usually all we'd tell them to do). and i got to the
point where i would just kind of discount their complaints. or some depressed
people in psych who either did something stupid (drugs, cheated on spouse
who then left, etc) or had a common life event that causes sadness, and i'd
think "suck it up". sure it hurts but everyone goes through times
like these and most of them don't have to go to a hospital or suck down a
whole bottle of pills. but after seeing pain and suffering from many different
people in many different ways (physical, emotional, social, psychological
and spiritual - pretty much every aspect of life), i've developed a different
understanding of it. (and i could be way off, but this is what it seems like
to me, so pardon as i wax philosophic for a bit) first, pain is all relative
and what might be insignificant to me may be horrible to someone else. and
it's easy to judge them by my standards. we had an older man in family practice
who had some weakness in his thumb which wouldn't be a big deal to most people
his age, but to him, it meant he had difficulty playing the violin (which
he did with some buddies weekly and had been his passion all of his life).
some people lose limbs, some have constant headaches, some have horrible bone
pain from cancer metastases, some have lost loved ones, some are going through
a divorce , and on and on. and you can't say to the headache patient, "well
atleast your wife is living" and you can't say to the grieving guy "well
atleast you aren't hearing voices and losing your mind", etc. you can't
make comparisons because there are so many other factors and people value
different things, so they feel loss with different things (and that goes for
physical stuff, things, relationships, etc). and on the road to being an empathetic
physician, it was good to get an understanding of that. the other thing i
noticed about pain is the necessity and use of it. if for nothing else, it
helps you know what's wrong. as doctors taking a history, we're taught to
ask more questions about that than anything else. we ask about what type of
pain, how bad it is, where, if it radiates, how long it's been there, what
makes it better or worse, and with that, you can often make a diagnosis. without
pain we wouldn't know when we're hurting ourselves (like a leper burning themselves
in hot water). and i've seen people who are saturated with opiates and not
feeling any pain, but unfortunately they're not feeling at all. they lie in
bed drifting in and out of consciousness. we can take away all pain, but life
(atleast meaningful life) goes away with it. and there's a way that pain makes
us appreciate things. there are so many things going on that we often take
for granted until there is some loss or hurt. i don't realize how nice swallowing
is until i get a sore throat and hurt every time i eat, or how great just
being able to walk around is until i pull a muscle and it becomes difficult.
and i think we do the same with people, and don't appreciate our friends or
family until there is a loss, or near loss, or even just a perceived loss.
sometimes we don't see the worth in things without pain. and to tie it all
together biblically and give this meaning (otherwise your just reading my
not-so-eloquent flight of ideas), pain and suffering are a huge part of God's
redemptive work in our world.
first of all, we serve a God who experiences the same pains. He was sorry
that He had made man and grieved in His heart after seeing the rampant disobedience
and lack of love they showed Him. in Isaiah 63, the Holy Spirit is grieved
when the people whom He redeemed rebelled. and suffering is obviously and
intimately related to Jesus' work on the cross. hundreds of years before He
was born, it was said of Him that He bore our griefs and carried our sorrows.
then we can obviously see the physical pain of the cross and the spiritual
pain of being forsaken by the Father as He bears our iniquities on Himself.
it was necessary, because without shedding of blood, there is no forgiveness.
so now we, as the servants, are called to suffer just as the master. it's
not the exception, but the rule. 2 tim 3:12- all who desire to live godly
in Christ Jesus will be persecuted. and if you read 1 peter, you can see the
necessity and fruit of suffering, and how it's not just something He "allows",
but it is the will of a faithful Creator who does what is right. we can endure
it and rejoice in it if we realize the result is being refined and having
our impurities melted away, and proving our faith. there is a way that pain
and suffering show us what we truly value. and there is a way that it makes
us needy and dependent. and that's a good thing if it draws us closer to home
and draws glory to Him out of our frail, sick bodies. c.s. lewis quote: "God
whispers to us in our pleasures, speaks to us in our conscience, but shouts
in our pains: it is His megaphone to rouse a deaf world"
we can curse God for pain and complain about having to hurt, but there is
a way that pain can speak to us in a way that nothing else can. we just have
to listen and embrace it, rather than trying to avoid it at all costs.