something lost, something gained?

This morning I took the 5th of my 6 shelf exams. It was for Ob/Gyn, and I was so burned out as I walked into the room that I joked that I would be proud of myself if I simply showed up for my last exam in 8 weeks. That was in stark contrast to the first shelf exams we took this year, a day which was saturated with anxiety and celebration. I finished my exam without concern or satisfaction, turned it in, and left the room with 20 minutes to spare.

Within an hour I was at the memorial service for Allie, the 4th year medical student who lost her life in a plane crash this week. It was surreal, depressing, remarkably sad. But it was also mechanical -- the second memorial service our school has had this month, the second funeral I've gone to in a year. Jittery, unsettling and banal all at once.

I went to lunch with friends. We laughed together in the sunshine and ate cheap and delicious Mexican food.

Within a few hours I was rock climbing with other friends. Nearly doing splits on a 5.11a, my foot cramping in plantarflexion, praying that I don't lose my concentration and let my twisted body fall until the rope pulls taunt. My muscles breathed and stretched in relief, but my mind just wasn't focused on the holds and nothing felt completely right.

So I went home, took a bath,and met up with friends again. Bars, greasy food, people being happy with each other, dancing. It felt good. I got drunk, got home and took another bath (yes, I know, drinking and drowning: bad combination.)

Then I started to think that this is how I have really changed: that I can go to something as devastating as memorial service for an extraordinary classmate and then hours later, go climbing and dancing with my friends. This is how medicine has numbed us. We sit with a patient who has just found out they are going to die, and then we get up, refuel on some diet coke and go do rounds, congratulate a patient on getting dischared, write up paperwork, go home and study for the next test that is hanging over us. We deal with the gamut of emotions every day as if they were just different flavors of skittles candies. Handfuls at a time, for some, or, if you are a little OCD like me, organized in order, but eventually all eaten up anyway.

Is it sad? I'm not sure. Having known well a few people who have survived wars, I realize that this is nothing. My friend who passed away a this year, had an entire life of friends and family extinguished when she was only 20 years old. She lived to her mid-80s, with a new and remarkably rich life, and throughtout that time, she continued to deal with loss after loss, as we all do, as the years passed on. She was for me the ultimate example of that oft overused philosophhy to Carpe Diem. She really meant it. She seized the day, year after year, for more than half a century after one would have expected her soul to have been shattered.

In medicine, we see death and suffering all too frequently. We are expected to be the strong foundation around which our patients and their families can rest their burdens and hopes. We train to be these superstars in clumsy ways. I have never before been able to laugh and cry within minutes, as I can now. I have never before felt the responsibility to box my feelings and release them during appropriate times, but I do now. Sometimes I feel as though I've signed up to be a professional rollercoaster rider, and then sometimes, like today, I wonder how that aspect of this profession has seeped into every part of my life.