Any discussion in metaphysics serves only to entertain in my drunkenness among good company. However this is the night before Thanksgiving and I have nothing I'd rather do than get this out of my head.

Problem: Am I truly free to do things as I will them; or have I been predetermined to do those things (whatever mechanism one proposes for predetermination)?

Most of the time, the focus is on the human being and his/her perception of the capacity to make a decision. The arguments for each side (free will versus predetermination) quickly based on the perspective taken. If the choice (or illusion of choice) is seen through human eyes, free will seems like a plausible reality. On the contrary, the viewpoint of God or an absolute order of the universe could support predetermined natured of our lives.

In my extensive research (of 5 minutes on Google), I have yet to come across anyone who questioned the assumption of separate entities. Who is God? What is a human being? What is an absolute order? The first question belongs to the theologian. The second to the sociologist, anthropologists and other -ologists. The third question posed to physicists. There are no clear answers on these questions in year 2007.

Right now I have the choice of going to bed or stay in front of this computer, but I am going to stay in front of the computer. I have exercised a choice in options. However, whether that action (or inaction) was a result of free will or predetermination depends on the definition of Who "I" am. If "I" am an entity of single human unit which decided not to go to bed, then the action was the result of exercise in free will. However if "I" am an entity composed of countless molecules subject to laws of physics, then perhaps the seeming single action of "staying in front of computer" was a predetermined output of a predetermined input. Neither answer alone is satisfactory in explaining the phenomenon of causation of "my" action just now because ownership of this action is not clear. Even if one were to accept the two seemingly contradictory perspectives, the reality is not any more understandable or acceptable.

Eh, of course, I am not going to stay up and try to define who I am. That would take too long.

One thing is certain though. If I define myself too strongly (or with too much certainty), I will create more dilemmas about metaphysical nature of my experiences. The practical application of this intellectual exercise is very clear: be damn unequivocal about the self if any semblance of harmony is desired.

11/21/2007
-Wilbur

Do you remember the first time you did something? First day of school. For example, the first date with someone special, first time at work, or first time traveling abroad. For me these times were both exciting and scary. I usually have these same thoughts, 'I'm really happy to begin something new, but what if I mess up?'

Zay was my first patient as a medical student. I was excited to finally be on the hospital ward. At the same time, I was also scared that I might make a mistake. What if I tell her something not true? What if I tell her something that upsets her? What if I hurt her during physical exam?

On that first day, we talked for an hour. Zay in her blue hospital gown sitting on her bed, and me in my yellow gown in a chair. She told me about her life with CF (cystic fibrosis) and the lung transplantation. How she had to come to the hospital this time because she wasn't feeling well.

She also told me about other things about her life. How she had worked as a town manager. How she had traveled to Paris and would like to go back sometime. How she cared for others. How she cared for herself. Every morning for the next three weeks, I woke up Zay up apologetically to see how her night went. Listen to her lungs. Talk about how the day might go. And both of us leave each other with our fingers crossed as a quick prayer of sorts.

Soon I became comfortable being Zay's reporter for the team. I would tell the team, "Miss Lawson had no acute events overnight. Her temperature was 36.7. Respiratory rate 16" and so on. I even learned how to treat bronchiectasis and pneumonia. Advair, albuterol, atrovent, saline nebs, supplemental oxygen, tobramycin nebs, and antipseudomonal antibiotics. What was initially a mumbo-jumbo really started to make sense to me in two weeks.

For this opportunity to learn, I am grateful to Zay.

Grateful, too, for being patient with me when I took too long to listen to her lungs and heart. For putting up with my own anxiousness towards her well being. For allowing me and my teachers to do the best as a team. To trust us and thereby allowing us the satisfaction of being the caregiver of someone who deserved the best.

I am still very scared for my other patients, 'What if I forget to ask an important question? What if I overlook an important lab value?' I worry quite a bit when someone gets a fever; I think about Zay. Her fever was the sentinel event to her passing.

Zay makes me careful. She helps me to remain human when I find it difficult to face the suffering of another human being and through her example, find redemption and comfort in our inevitable human nature.

I am in debt for the beautiful experience of getting to know Zay personally and of partaking in her life though briefly. I hope to pay off the debt of her spirit as I continue to live this life and dream of traveling like Zay often did.

Here's to you, Ze-Ze; I hear Paris is a beautiful place this time of the year.

To begin this story, I have to confess that my opinions on cultural sensitivity and sensibility are biased because I was once a migrant myself. Having experiences the stereotypes and prejudices - not all of which are negative - I am sometimes overwhelmed at how crude and insensible my fellow students could be toward another human being because they did not understand the psyche and social apprehension people of different cultures hold.

The hospital is not a place where only physicians and patients are the only people who exist and matter. The doctors and medical students provide a large part of the service, but without the nurses, food services personnel, pharmacists and other staff, we cannot function in our role at all. In the basement departments and hallways are people who work to pick up the trash, wash the laundry, clean up empty rooms of blood and feces and generally keep this a hospitable place. These most basic functions of the hospital are most often served by a Hispanic person.

Today during our physical diagnosis round with the chief resident, we came through the set of doors outside the 5th floor Women's hospital elevators only to be greeted by a foul smell in the hallway. A student blurted out rambunctiously, "Oh, man! What is that smell? It smells like trash!" It became immediately apparent to me the smell was coming from one of those large trash carts which was being pulled by a service staff - invariably a Hispanic gentlemen.

Another student next to me pointed in the general direction of the man and trash cart, "It's the trash!" The students, stimulated by the irony of wondering what smells like trash and finding out that there was a large cart full of trash, started laughing. The student who first asked the question laughed also because he found his own remarks to be silly.

I looked at the man again. He was a dark-skinned, short man. He was moving down the hallway but had stopped because of the noise we made. We had caught his attention in our childlike laughter. He saw us point at the trash. His face turned sour, then he looked away. Walked away.

Of course, I cannot say for sure what exactly he was thinking or feeling, but I can tell you that I have been in a similar pair of shoes in my life. I had worked along with Mexican construction workers. I befriended these guys and learned lay Spanish from them. Often when we would work, the American home buyers and American supervisors came to look at the house. When these people showed up, we felt that we were invisible or transparent. Our existence felts as an inconvenient but temporary measure to fulfill the needs and wants of these strange blue eyed creatures who somehow have a lot more money than we do. The people who can afford to live in the houses which we built with our sweat and blood. Whenever those people passed by me, they never said hello or looked at me in the eyes. I felt very, very small.

As I saw the man push the cart away from us, I became sad and enraged. I was sad that we may have made the service person embarrassed. I was enraged that my colleagues would be so insensitive as to point and laugh at a person who is providing a valuable service which none of us would be glad to do. Are we not supposed to be doctors? Are we not supposed to comfort people?

I have a tendency to antagonize people in these situations as I try my best to protect the people who have less capacities to protect themselves. I tried my best to convey the man's perspective to the students involved, but I wasn't well received. One of the students told me that she or he was laughing only because of the situation and not at the man. I decided to drop it at that point. I have still much to learn in the diplomacy of bringing the perspective of the disadvantaged side to the table without causing more friction.

However, the reader must understand. Our failure was not in the intention; we didn't have any intention except we let our mind run free where it shouldn't have. It was insensitivity which led to that one-sided situation. We should have recognized that we were in the presence of another human being who was carrying a cart full of dirty trash. Perhaps we would not have laughed so loudly or pointed at the cart. Maybe just a smile would have been enough for us. Maybe some of us could even have smiled at the person and nod our head in greeting - as we did for a Hispanic mother and child we saw just 40 second later.

This assignment was supposed to be a reflection on how culture affects patient care. However, the discrepancy between what I saw in the hallway today and what other students saw serve to show the real failure in cultural competency. In our training we are asked only to recognize cultural issues as they exist in the context of clinics and in whom we consider to be "patients." Perhaps such training serves the requirements of a prominent social medicine faculty or a Medicare requirement, but it does not address the fact that medical students and doctors treat people of lesser socioeconomic background with ignorance. We must not only remind ourselves to treat all of our patients with respect but also with everyone else we see daily. We cannot simply say, "we'll treat this group of people well because these are our patients but not the nurses or cafeteria workers." We must recognize culture everywhere.

I am sorry to tell you that I have been served much more by my immigrant background, my travels overseas, and by the drunks I've met than by social medicine class or the interviews with that patient from a privileged background. By my humble but frank account as a someone outside of the "main" culture, too many our students are culturally incompetent and insensitive. I won't have them take care of my family.

I am also sorry to say that we cannot teach equanimity; it can only be learned. For those of you other students, good luck. For you residents and attendings, I'm going to keep standing up for the migrants, poor people, the homeless, alcoholics, the service staff, and others for whom medicine serves only to increase the gap between the well and not-well. All I ask is that you don't berated me for being naive or idealistic during morning rounds when I stand up for a chronic pain patient.

Wilbur Larch

10/31/2007

Remember Carmen

Soon to come.

Rain on my Conscience

Buzz, buzz, buzz, buzz, buzz, buzz…

I have been stuck in this windowless excuse for a library entering research data for a whole Friday afternoon and evening. I look to the bottom right corner of the computer screen to see that it is 2:13 AM – a lot later than I imagined. Look at all these piles of patient files I have gone through!

Buzz, buzz, buzz, buzz, buzz, buzz…

I stretch my hands to reach for the pager, but it slides away from me with each vibration. I stand up, stretch my back, and snatch the pager as a cat would a black mouse. It’s probably not Doctor King or Poe at this time. Most likely a trauma code.

“ATL1 TB1 ETA 15m”[i]

I am so damn right. It’s all about pimping the page demographics. Wait… what else could it be besides a trauma code at 2am? I’m not thinking straight. I am hungry. I decide to call the computer quits, pack up, and walk out of my building towards the ER.

Drip, drop, drip….

It’s raining. The air is humid as it always is on a North Carolina summer night, but it’s surprisingly nice outside. The humid warm air feels soft and warm on my skin after being in the air conditioned building for so long.

Splat, splat, splat, splat…

My slick, black Danskos on slick, black rain on slick, black asphalt. This code has to be a MVA (Motor Vehicle Accident). I am 90% sure. I actually don’t know what that means because when that person comes through the door, he is not going to show up with 90% MVA and 10% some-other-trauma-diagnosis-on-rainy-night. He’s going to be either MVA or not. Percentages are impersonal like that. Same thing with cancer patients. They are either going to have complete remission or they are not.

Buzz, buzz, buzz, buzz, buzz, buzz…

“ATL1 TB1 ETA 10m”

The trauma codes are usually paged twice. Most of the time, the message is exactly the same except for the ETA (Estimated Time of Arrival). The trauma personnel told me the second page is to keep the trauma team updated as the patient is en route. However, I have my own explanation. Occam be damned. I secretly believe that the second page is an apologetic whisper for that poor trauma surgery resident who suffers from chronic sleep deprivation – alluring him to leave the stupor of on-call room and greet the next customer at the ER door with a tired smile. I never say stupid stuff like this except in my head because I know my mentors would put me into a Zen coma of tying knots. I forget which resident is on call tonight. Poor guy. Wonder how much sleep he got last night.

Swoooosh….. Phooomp.

The electrical door opens as I approach the ER. I nod my head at the nice security guy whose name I forget. Hence the nod instead of “How are ya, Ted or Bob?” I feel bad. I glance at his name tag. His name is John. John, John, John, John, John.

I pop the little blue handicapped figure on the little round plate next to the door that says, “Press Here.” Another set of doors open for me. I imagine I am a little mouse in a labyrinth of a hospital. All day long, I have been pressing buttons for my morsels of cheese. Right now, my cheese is the trauma code. This code is my reward for working so hard tonight. I feel bad for the person who is coming in. He’s probably in really bad shape. I have to learn from this though. It’s difficult to look at hurt people, but it’s the right thing to do. Face the pain and fear. Learn to do something about it.

The ER is quiet. Few regulars in different rooms, and no one seems particularly rushed. The nurses are chatting up the trauma code. Blah, blah, blah, MVA, blah, blah. MVA it is.

For the next few minutes, the sleepy looking people straggle in. Rhyne is the lucky trauma resident. Five feet six inches of caffeine junky. I smile. She smiles. Her eyes betrays her desire to look sharp and awake; I can clearly see sleep deprivation-induced ptosis. Conjunctival mucosa is definitely dry with mild injection. I wonder how many surgery residents use stimulants at our hospital. Oops, not supposed to think about stuff like that. Think happy thoughts. Think happy thoughts. Think happy thoughts. William Osler. Harvey Cushing. What was Cushing syndrome again? Moon face, buffalo hump. Excess steroids? Let’s see Addison’s is no steroids, so… Oh, Rhyne is getting ready. I should, too.

I dress myself in a yellow gown and put gloves on, too. We lean against the wall in ER hallway next to the trauma bay with our arms folded in. The attending walks in – Dr. Pruell. He looks like crap, too, except he looks good looking crappy. That’s the difference twenty years makes. De facto tiredness that doesn’t faze him. Just too cool. I greet him.

“Good evening, Doctor Pruell. It’s MVA.”

He nods. He puts his gear on and leans against the wall next to us. Dr. Pruell is probably thinking about his children. Rhyne is thinking about… I don’t know. What do mid-thirties surgical residents think at 2:23am in the morning? Oh, she might be wondering how long this case is going to take. She’s probably hearing the tempting call of on-call room bed. Poor Rhyne.

We wait. The trauma bay is clean and ready for our patient. Three generation of medicine people crazy about spending countless nights with hurt strangers. I know what drives me, but what drives Rhyne and Dr. Pruell? Money? Value? Obsession? Faith?

Bang, clang, shwoooo-clang, phoomp…

The ambulance crew flies through the door with the patient on a gurney. Had it not been for the straps, the patient surely would have fallen off the gurney; the crew was in a hurry to get to the bay. The patient’s eyes are open and wanders over to me and other people in the hallway. He has a neck collar on. His arms are moving.

OUCH! I feel a chilling sensation through my spine even before I recognize what I see. Bone. Bonessssss. More than one. I see several phalanges and metacarpals on his right hand. The hair on my neck stands up erect, but I maintain a serious poker face. Someone calls for orthopedics resident on call. I wonder how much sleep that resident got last night.

“Patient is a 38 year-old African-American male who was traveling on a motorcycle… GCS of 15...”

One of the EMT’s blurts out the relevant facts in rapid succession. The busted hand and motorcycle story fits. He wasn’t wearing gloves, eh? Rhyne, Doctor Pruell, and the rest of ER staff rush into the trauma bay after the patient and EMT’s. It’s an orchestrated chaos. Doctor Pruell is conducting, and the team moves in a fluid manner. There is little waste in motion or time. Beautiful as can be.

People are shouting out medical findings at the speed of light. Another trauma resident, Jack jumps into the bay. This patient is a human funbag. They poke him every which way possible. They shine light in his eyes, cut his clothes off, get IV started, and insert a folley catheter. Jack shouts to the patient that he will insert his finger into the patient’s rectum to check for blood. The patient does not hear Jack first because he is in a lot of pain and second because Rhyne just asked him to open his mouth and say “Ahhhh.” In front of my eyes, Jack performs the fastest digital rectal exam I have ever seen. The patient cringes. I cringe.

“Patient’s assigned name is Zebra.”

The record nurse yells out the trauma patient’s pre-assigned name. These names are predetermined names in alphabetical succession so we know what to call the patient even before the trauma patients’ identities are known. Mr. Zebra is the last patient on this set of names. I wonder what the next trauma patient’s name would be. Abracadabra? Angel? Doctor Pruell is staring at me. I think he just asked me why one of the legs was shorter. I respond with a slight delay.

“Doctor Pruell, I think… I think he, uh, I think the leg is broken. I’ll get the femur traction kit right away.”

I sound like an idiot. Why didn’t I say he has a broken femur? Femur, femur, femur, femur. I unravel a cardboard box that contains a simple yellow sheet of plastic that folds into an open box which allows a strap to pull on the broken leg. We apply the traction kit to his leg. Even with the utmost care, it still hurt him like hell. We pull. He cries. God knows I hate people in pain. Wait. That’s not what I meant. I hate to see people in pain.

The X-ray technician comes in. I step behind the closest person wearing a lead vest to save my thyroid and testes. Everybody stops moving around as if their own bones are to be X-rayed. After the films are taken, Mr. Zebra is again molested by prodding fingers and by interrogative questions.

Beep….. Beep….. Beep….

The monitor is online. It shows Mr. Zebra’s blood pressure, oxygen pulse, heart rate, and few other numbers I don’t understand. ABC (airway, breathing, and circulation) looks good. From what I can understand, Mr. Zebra seems very stable.

The X-ray is on the LCD screen. I step closer to hear Dr. Pruell, Rhyne and Jack talk about the fractures. I see little white clouds floating on a black sky. The little white clouds are broken femur pieces belonging to Mr. Zebra. That sucks. Comminuted fracture. He’s going to need screws to set them in place. He is going to need surgery for his leg as well as his hand.

I wonder if he has kids. Just as I look to for a wedding band, the resident grabs the ring-cutter and works the wedding band over the bare bones. Mangled. Like its owner. I wonder if this is going to really change Mr. Zebra’s life. The orthopedic resident comes in. Tall, white guy. I haven’t seen him before. Brian’s name tag tells me his name is Brian. Brian the Bone Doctor.

Brian preps the cast material. I stand watch. The trauma team decides the patient is stable. One by one the room empties. The trauma surgery team back to sleep. The ER staff back to homeless patients and a pair of anxious parents of a febrile, crying baby. I hope the baby has something benign.

The ortho resident picks Mr. Zebra’s hand up to his face and stares as he would a fine piece of tangible art.

“Mr. Zebra, we’re going to need to do surgery on your hand. OK?”

“OK.”

I look closely at Brian. Judging from the little hedgehog on his chin, I know he didn’t have time to groom himself. Less groom, more sleep. Still, his eyes are sharp, and I am sure he’s really good at what he does. He moves over to the leg and glances at the X-ray on the LCD screen. Brian immediately knows that it’s going to be a long night. He’s not happy about it. He’s looking at Mr. Zebra. I sense a bit of edge in his eyes and in his voice.

“What were you doing this late at night in the rain driving on a motorcycle?”

“Driving home.”

“Were you drinking?”

“No.”

“What were you doing?”

“…”

“What happened?”

“I lowsided. Too wet.”

“No shit, man.”

“….”

Mr. Zebra is tired now. He wants to rest. He really wishes he wasn’t here now. He wishes he was home. I wonder if he has insurance. Brian starts wrapping Mr. Zebra’s leg.

“So… what kind of motorcycle do you ride?”

“…”

“What kind of motorcycle do you ride?”

“It don’t matter.”

The nurse in charge of paperwork is called out of the bay. I look up. It’s a battlefield for sure. Cabinets are left open. There’s stuff lying around everywhere on the counters. I look down. Blood and plastic wraps litter the floor. The dirty clothes bin is overflowing with yellow gowns with blood stains.

Brian, Mr. Zebra, and me. Hey, great! White, Black, Yellow. What is that? The German flag. I think.

“Was it a crouch-rocket? It bet it was nice.”

“Why you wanna know?”

Yeah, why do you want to know? Why are you fixating on this, bud? Do you ride a motorcycle yourself? Wait, no sane orthopedic resident rides motorcycles. Why is he grilling this guy about the motorcycle? That’s the least of Mr. Zebra’s concerns right now. His bones are sticking out for crying out loud!

“Is your motorcycle OK?”

“Why you wanna know, man? It don’t concern you, man.”

Wait, Brian doesn’t care about the motorcycle. He’s just pissed at Mr. Zebra.

“Well, I wouldn’t want you to have a broken motorcycle. That would be just awful. I wouldn’t want you to lose money on it and stuff.”

Oh, now that was just too obvious. Come on, Brian! You know damn sure that this accident put him back at least 50 grand IF he has insurance. We may bankrupt him for this admission. That’s bullshit about you caring about his motorcycle and money. I know it. You know it.

You are only pissed because you don’t want to stay up and put Mr. Zebra bones and tissues back together. Brian wants so badly to call Mr. Zebra an idiot for riding in the rain at 1AM. Brian probably believes that Mr. Zebra deserves a Darwin award for the state that he’s in. The worst part is that it’s not that he doesn’t want to say it; he cannot say it. There is no use in scolding the patient at this point. Sort of like how you don’t tell a end-stage lung cancer patient “if only you hadn’t smoked so much.” The milk is spilt. There is no need to yell at the spilter now.

My hands are sweaty. My body feels weird. This is really uncomfortable. I see their mouths moving, but I don’t understand. I try.

“……………………..Just leave me alone, man.”

Brian, leave him alone. Just do your job. I’m sorry you’re tired. He’s tired, too. We don’t need to make him suffer any more than he already does. He’s paid dearly for his decision. I feel compelled to say or do something.

Just shut up and pretend like you are cool with everything.

I hear Pete, my mentor in my head; he’s right. I speak too much of my mind at times. My throat feels tight. I am a mannequin. Brian knows he screwed up. Mr. Zebra is more unhappy about Brian than about the accident and his broken bones and possibly his broken life. I know saying something to Brian wouldn’t help because I’ll force him to defend himself more. I also don’t care for any excuse he maybe have for himself.

Mr. Zebra, did you expect this to happen at the hospital? Do you think that Brian is treating you this way because you are black? Would you have preferred a black resident? Is this disparity? Is this racism? Mr. Zebra, it’s funny. I’ve lived in the U.S. for more than a decade now as a foreigner and as a minority, but I do not remember being treated as you have been here by Brian. I am sorry that you are in so much pain, and I am sorry that things are the way they are.

“Hey, you’re going to need surgery for your leg, too.”

“…”

“Did you hear me? I said you’re going to need surgery for your leg, too.”

“Why do I need surgery on the leg? The cast is good enough.”

Mr. Zebra needs surgery.

“Your bones are broken in such a way that you need screws. Otherwise, your leg will not heal right.”

“My cousin had a cast for his leg. He didn’t need surgery.”

“I don’t know what your cousin had, but your legs are broken in multiple pieces… we need to put screws in…”

“I don’t need it.”

Brian, I think what Mr. Zebra means is he doesn’t want surgery from you. At best, he thinks you are a punk and at worst, a racist. If I were Mr. Zebra, I would probably choose to walk crooked than have you fix me. On the worst hour of my life, you judged me and gave me a hard time for a decision I already regret more than anything else in my life. I probably would’ve punched you in the face if my hands weren’t so mangled. Or I would’ve punched your face with my other hand if it wasn’t for the morphine-induced haze. I wouldn’t care if I have to go to court for it.

But I’m not Mr. Zebra. I’m a medical student. Just here to learn. Shut up and watch. You have to watch. Learn from Brian. Learn from Mr. Zebra. I am sure Brian is a great guy. I would not have thought Brian to be the way he is now if he and I were out drinking at a bar together, but he certainly did his best to make me second guess him. More importantly, he lost his chance to become Mr. Zebra’s confidant, and Mr. Zebra is alone in this hospital.

Brian knows it himself, too. He has become quiet in the last minute. He’s thinking. Maybe he’s thinking about his medical student days when he slept 8 hours a day and thought about ideals as I do now. Are you hating yourself for being mean? Were you just tired and cranky?

“Well, it is my professional opinion that you need surgery on your legs. I am going to go ahead and get ready for the operating room and call my attending. You think about it and let me know when I come back.”

Brian struts out of the bay and leaves the heavy air and his guilt behind. Now it’s just black and yellow. What is that, a bumble bee? He’s looking at me. I look at him. He doesn’t say anything initially, but I know he wants me to stand up for him. He needs someone he can trust. I am not that person. I try anyway.

“Are you cold? Do you need more blanket?”

“I’m fine, man, but let me ask you something.”

“Yeah?”

“Do you think I need surgery for the leg? You see, my cousin had a broken leg once, but he didn’t need no surgery, man. I don’t want to get surgery.”

“Well, I’m only a medical student. I don’t know anything.”

“Yeah, yeah, but what do you think?”

“You see that X-ray on the computer? Your leg bone is shattered. I agree with Brian about the surgery.”

I bite my tongue. Damn it! I sided with Brian. Stupid, stupid, stupid! Why did I do that?

“I don’t know, man. I don’t think I need it.”

I so want to come clean and tell him straight that Brian was an asshole. I don’t.

“Hey, I think you’re always entitled to a second opinion. But it might be hard to get a second opinion right now. You want me to go grab a nurse and see if she can page another bone doc for you?”

“…”

“Just let me know.”

I’m sorry, Mr. Zebra. It’s crap, I know. Wish I could help you more.

“Where are you from, kid?”

He sounds more composed now.

“Korea. The one without nuclear weapons.”

He chuckles.

“Hey, you said, you’re a medical student, right?”

“Yeah.”

“What you wanna do?”

“Probably surgery. I like kids, so maybe pediatrics. I don’t know yet.”

“I probably don’t need to tell you this, but don’t be like that white guy. Fucking asshole.”

I don’t reply except with a hint of a smile.

“I’d like to talk to a nurse. Can you please go ahead tell somebody?”

“Sure thing, Mister….”

“James. Call me James.”

“Alright, James. I’ll go get that nurse and then come back and say goodbye before I head home.”

“Thanks, man.”

James closes his eyes. The monitor is still beeping in rhythm with his heart. Regular rate and rhythm. He’s going to be fine. I leave the bay under the pretense of looking for a nurse, but I know too well that I deceive myself. I am enjoying the escape from the heaviness of the room just like Brian did earlier. I tell a nurse behind one of the counters and tell her that Mr. Zebra wants another orthopedic doctor. She looks at me with a where-am-I-going-to-find-another-orthopedic-surgeon-at- 3am-on-a-Saturday-morning look. Just as she was about to ask why, she halts and realizes why the patient might be asking that. She probably knows what happened in that room.

“Thanks, kid. The attending orthopod is going to see him later anyways.”

“Thank you, Ma’am.”

I walk back to the bay.

“James.”

“…”

“Hey, James.”

“…”

He is out.

The monitor is still beeping. I decide not to wake him up; the ortho attending will wake him up shortly anyway. He can use the sleep. Just like everyone else in the hospital. Just like Brian. Just like Rhyne. Doctor Pruell. As do I. I should go home and sleep.

Splat, splat, splat…

I walk out into the drizzling black rain to my car. The image of James’ bare bones follow me into the rain, and it gives me spine chill again. I think about my old 600cc Honda crouch-rocket. I am glad it was stolen instead of destroyed – along with my hands and legs. Then I judge and hate Brian for having worked 100 hours last week and being tired and cranky tonight in front of James. What a bastard. No matter how tired I am, I am never going to torture my patients like that. Never ever. I bathe in my self-righteousness.

Buzz, buzz, buzz, buzz, buzz, buzz…

Uh, oh.

“ATL1 TB2 ETA 25m”

Another trauma code. I consider for a split second if I want to stay for this code, but I remember how awful it was in the room with James and Brian. If I have to see Brian again tonight, I don’t know if I can look into his eyes. He would probably figure out that I am judging him, too.

For Brian’s sake, I hope the new code is for a white person who doesn’t need an ortho consult. For my sake, I hope that I figure out a way to get enough sleep when I am a resident myself. If I fail to do that, I hope I just shut up and do my job for James’ sake. It’s only right.

Ok, I go home. This headache is killing me.

---

[i] ATL1: Adult Trauma Level One; TB2: Trauma Bay One; ETA 15m: Estimated Time of Arrival in 15 Minutes.

La Vita é Bella (Speech)

Thank you Madam Toastmaster.

Fellow toastmasters. Welcomed Guests. Dear friends.

Have any of you ever watched the Italian movie La Vita é Bella? Or Life is Beautiful?

The movie portrays the life of Guido and Giosuè, an Italian Jew and his son, in a concentration camp during World War II. Now, if you have not seen this movie, you must be thinking how can living in the concentration camp be anything close to beautiful? If you have seen the movie and don’t remember, you probably are wondering “why was that movie called Life is Beautiful again?” Ladies and gentleman, in the next few minutes I wish to answer these questions by first sharing with you a little bit about my life, then propose to you, life can be exceedingly beautiful even in the least hopeful settings.

My father. He was an abusive man. Before I go on any further, please do understand he dearly loved me and the rest of my family, and I love him very much so. I cannot condone what he did to me as a father or as a person, but I also understand the frustration and pain he suffered as he grew up in postwar Korea with an abusive father himself. In that light, I feel that he had done his best and would like you to know that I have relieved him of any guilt as far as our relationship is concerned.

I mention this about my father and the abuse because it was the biggest stumbling block of my life. I felt that the world was a sick, sad place for a father to beat his child. There was a period of my life when I had nightmares of violent fights with my father. I often woke up from these recurring nightmares in the middle of the night and became very scared of falling asleep. At times I found solace in alcohol-induced stupor in mornings after those long, sleepless nights. I am finally coming to understand that my experiences are very similar to what physicians describe as post-traumatic stress disorder in psychiatry.

I tried whatever I can to forget about these things and move on with my life. Finish undergrad, find a job, find love, have kids and live happily ever after. It took me two years of what people call “soul-searching” to find peace. There was a lot of introspection and remembering the stories my father told me about his childhood. I remembered he would often tell me how he could not go to school because his father made him work in the field. How he was always hungry. How he loved to eat grasshoppers because it was the closest thing to any kind of meat he could eat. He found the most satisfaction in buying us food so my brothers and I could stuff our fat faces! In the end, I realized that he did the best that a father could do as an abused child himself. To that extent I give him credit for trying his best. Realizing this, the world was not such a bad place anymore. I felt that I did not have to live my life as my father did. More importantly, I felt that I had the choice not to live as he did.

When I was just beginning to see the world in a different light, the Indian Ocean tsunami had struck various parts of South Asia. This time, instead of despairing about this world, I joined a friend to volunteer in a small fishing town in India where several villages had been devastated by the disaster. We worked on many different projects, but the activity I enjoyed the most was playing with the orphaned children there. I was sad for those children – not all whose parents were lost to the water but to diseases. Every morning, we woke up at the urging of the Indian sun and went to work doing whatever the day asked us to do. It purified my soul to have the simple daily objective of helping others. It was such a wonderful period of my life. Naturally, it was heart wrenching for me to leave India and the people behind.

Since that trip, I had kept my head shaven as you see me now in remembrance of the little boys and girls whose heads were shaven when their parents had passed away. I also threw out my bed because I felt that I should sleep on the floor just like my friends did in India. Also, I traveled to New Orleans, Haiti, and Guatemala to volunteer. These trips reinforced my idea that life is not so sad or meaningless and that I am able to make this world a little better. I found myself worthy of life for the first time.

To this date I still do not have a bed to myself. However, I have recently been diagnosed with a sleep condition. My neurologist pleaded me to sleep on a bed because comfortable sleep is especially important with my condition. I am not totally convinced yet, but I may be getting a bed for myself soon. I pray that the children do not think I am a sellout. I hope I stay the course and become a savior of children - not for my own ego but for the resilient children who still found a way to smile.

In Life is Beautiful, the father tries hard to protect his son’s innocence even through the hardships of living in a concentration camp. Beauty is not defined by the surrounding conditions - be it good or bad. Indeed, the world can be a very depraved place for a lot of people. Just like the father in the story, I feel that I can make this life a little more beautiful if I worked to protect the lives and innocence of people who live in worse conditions than I do.

True beauty is found when we look into each others’ eyes and realize that our basic desires and needs are very much the same. When we share what we have and who we are, we finally find beauty that transcends good and evil. This is my outlook on life now. I cannot deny that my upbringing was not ideal. I also recognize that there are many man, women and children dying of hunger, famine, curable diseases, and war. Despite this, I hold a positive outlook on life because I now know that today I am doing what I can to help these people. Ladies and gentlemen, I humbly submit to you, in spite of what is going on in our world and in our lives, Life is beautiful.

-Wilbur