A blog about nothing.

Friday, July 14, 2017

GOOD THINGS COME, or ALL'S WELL THAT ENDS

Sketch of Medical Arzt mit Stethoskop an einem Schreibtisch sitzt in h Lizenzfreie Bilder - 11990092
At dinner recently my brother asked me, "If you knew then what you know now, would you have still gone to medical school?" 

I believe GT asked me this question for the benefit of one of our interlocutors, Danny, who is due to start medical school himself in San Diego come August. I replied that getting a medical degree was the right thing for me to do at the time - which was in my early thirties - but if I had to undertake those grueling 5 years all over again at my current age of 44, I just don't have it in me. The art and science that is the practice of medicine took everything I had; I gave my studies my all; and I was left with a body that was broken, wits that were frazzled, and eyes that were perpetually red. 

And yet my brother's query took me somewhat by surprise. Not only because I had just seated myself down to dinner and hadn't yet even ordered a drink. I guess I just assumed that he knew, as do I, that the past is perfect and cannot be improved upon. As for proof, the MD degree was a fulfillment of a prediction my family didn't take lightly. Even though I do not practice medicine any longer - I left the family medicine program at the University of Colorado after the first of three years of residency - even though I don't work as a doctor anymore, I reminded my brother of the words of the holy man Sathya Sai Baba, who said when regarding my brothers and me - this was back in 1981; I was then just a boy of 8 - that there would be a doctor in the family. In addition to a businessman and a scientific engineer. 

Leaving aside the fact that these three professions are perhaps the most highly regarded of all jobs in India, any parent's dream for his adult children, and also that our other brother, Justin, passed away before he was old enough to embark on a career, GT has indeed become quite the entrepreneur. And my parents, especially my father, regarded Sai Baba as the Lord on Earth, Divinity Incarnate, an Avatar of Vishnu. So this prediction was, to my dad at least, quite literally "the word of God." 

I thought my answer, though rather pat, was pretty right on. Of course this was the abbreviated response to a question I have discoursed upon at length in my own head in nearly a decade since leaving medicine. I could have waxed loquacious, as I like to say, but I am not the type to monopolize dinner table conversation, especially when there are 4 other guests at the table, and I'm not the one picking up the check. That's our titan's territory.

Had the exchange been just between my brother and me, I would have added that everything happens for a reason. I am with Leibniz in the belief that we live in the best of all possible worlds and every element down to the most minute speck and the most seemingly incidental occurrence are all necessary components of this perfection. Therefore, to look back over your personal history and declare that you'd have done something differently or not at all, or that you'd have acted on an occasion where you had refrained from acting, is to say that the grand design can be improved upon, that the universe is not perfect, and that by extension neither is the designer, i.e. God. And it was God after all who told my parents that one of their children would grow up to become a doctor. Funnily enough, I had the day before happened upon my mother's diary written around the time of the India trip, and I read with a mix of humor and heartbreaking tenderness that she was certain it was not me but her son GT who would be the MD. Specifically a plastic surgeon. The only thing I dislike more than unnecessary procedures is blood. And he winds up becoming the successful businessman she always thought I'd be. How's that for a twist! 

GT was already CEO of his own company when at 30 I decided to make a life change. It was either medicine and engineering, and I wasn't even sure what the latter entailed. I decided to study medicine because it seemed a noble profession. Unlike with philosophy, which had been an interest of mine, by treating disease I could actually "serve others," which is one of Sai Baba's commandments. What's more, on the road of life I had run headlong into a dead end. I was in a dead end job as a teacher in the inner city, in a dead end relationship with a girl I loved but knew I'd never marry, in an apartment I was subleasing and could get evicted from any day, and driving a car whose payments I had taken over from my brother. Sure I had dreams, but the screenplays I was writing weren't selling, and I had penned a half a dozen of them. Insanity is doing something over expecting a different result, so I was out of my mind. Also, I was drinking too much and doing too many drugs. Things had to change, and since I had always been a good student - more As than Bs - why not go back to school? The fact that science was never my thing - more Bs than Cs, but some of the latter - I viewed as added incentive to achieve. If, as student, the study of science had been my worst fear, and since what doesn't kill you makes you stronger, then by confronting my insecurities I could also become a better individual. Needless to say Sai Baba's twenty-year old prediction was ringing in my head, and I used his words to incentivize my father to subsidize my schooling, since Dad has ever endeavored to "do Swami's will." And I really needed his munificence, as having already declared bankruptcy in my twenties I was debarred from taking out student loans. 

So medical school, there I went. And during my five year marriage to medicine - first in the Caribbean, then in Louisiana and finally in Denver - I watched myself grow and develop in great strides. My drinking and smoking diminished, at least initially. As I studied the human body in perfect working order (in Physiology) and in diseased states (in Pathology) I cleaned up my diet and exercised more. More. I signed up for road races, one of which I won, and even completed triathlons. But I knew even then that I would not practice medicine, at least not for very long. In the wards, nurses would ask me what specialty I planned to enter and without batting a lash I'd reply, "I just want my medical degree." 

Writing had been my first love, and growing up I had most admired those authors who, curiously enough, were also doctors who had, either briefly or never, practiced medicine. Men such as Michael Crichton, Sir Arthur Conan Doyle and Anton Chekhov. My time as a student doctor at the hospital taught me that as a doctor I'd be without a niche in medicine. No specialty appealed to me. It seemed fun to explore the mind as a psychiatrist, but I saw in my rotations that "psych" was mired by an overreliance on pharmacotherapy, while I, then as now, advocate meditation over medication. I didn't want to specialize so as not to lose my basic science knowledge. Therefore fields like nephrology and neurology and pulmonology and the like were not options. I chose family medicine knowing that the conditions which the average GP sees most regularly - heart disease, diabetes and COPD - are really tiresome to treat (hello algorithms). And in the vast majority of instances are totally preventable by lifestyle modifications alone! As I learned on my first day of residency, if you don't drink or smoke, if you exercise moderately and eat predominately unprocessed plant foods, you are all but guaranteed a lifetime of good health. Sadly, prevention is neither lucrative nor sexy.

Nevertheless I undertook residency to wear the long white coat, which has a mystique all its own - they don't call the nervousness that patients experience when entering the doctor's office "white coat syndrome" for naught - and I wanted at least for a time to wear the badge that says doctor, and to sign my name on prescription pads. Just for the experience. My real dream was if not to use my medical degree as a credential to launch my writing career, then at least to use the experiences I had while completing the degree as fodder for fiction. Did I achieve these dreams? Not so much, though I did write a book on vegan nutrition which hardly anybody has given the time of day. More importantly the knowledge I had obtained in the wards enabled me to assist with the diagnosis of my mother's metastatic cancer and also my father's rare blood condition. I then became the personal physician for the final 6 years of her life to the woman who had given me life - which is really the highest form of service I can imagine. Love all serve all, as Swami says.

So you see, everything is meant to be. Try hard, shoot for the stars, achieve your dreams, but know that God's will must be done.

Medical school also gave me the opportunity to travel and meet new people and do what I do best: be a student. I explored new facets of my personality and watched as my relationship with my loved ones changed: my mother and I saw each other only a few times a year but it was on these occasions that we explored our mutual love for movies and good restaurants. And being a doctor added to my confidence. No one can take the medical degree, which as I see it is the most laudable of all graduate accolades, away from me. Sure, I had redlined my body and mind for those five years. Often up at 3 a.m. to start running at 4 before hitting the books from 5:30 to 7:30 and from there to class until 5, before I'd return home for a bike ride and lights out by 8. This routine I'd repeat every day, weekends included. If you take a random day, any day between 2004 to 2009, and ask me to describe my day I could tell you where I was and even what I was studying with total certainty. It took years before I was fully able to weed out this devotion to routine, this ever present feeling that I needed to rush from task to task. Years before I was finally able to slow down. I have a little of the machine in me to this day, eight years after that wild ride ended. But I only awaken each morning at 5:30 because I have no choice: my dog sees to it, by licking my face!

Sure, I'll never know what I would have done with those ambitious years. The early 30s are in certain respects a man's peak, just look at the movies Brad Pitt starred in during that phase of his life. That was before he met his wife and the fun ended. Had I not embarked on a career path that led to another dead end, there's no telling what I'd have gotten into. Maybe I'd have written the next great American novel. But that's neither here nor there. It is like crying over spilt milk, which vegans like me would never drink anyway. So good riddance!

Anyway, the machine that is modern medicine has become sick care over health care. Patients are viewed as collections of symptoms rather than as individuals. It is a money-making apparatus that has motivated doctors to profit off the very diseases which could be prevented by eating less, moving more and meditating, which takes care of the rest. The irony is that medical doctors are the ones the public listens to the most when it comes to dietary advice, and yet most MDs, with their 3 hours of classroom instruction on nutrition, are really the least qualified to dispense it. 

And while I'm on the pulpit, I'll tell you that most conditions can be diagnosed with a good history and physical, but today's clinicians place too much importance on expensive lab tests and imaging studies to diagnose what in Doyle's day would have been obvious to an inquisitive clinician with maybe a stethoscope. That's how I diagnosed the pleural effusion my mom suffered secondary to metastatic cancer, after her doctor had sent her home with a clean bill of health. Sadly there is not a spot for a diagnostician like me who can spot conditions early on but who likes to stay at home. For that there is Web MD. In my ideal future there would be a role for holders of medical degrees to interact with the general public and answer health questions, suggest diagnoses, or at the very least assist with navigating the labyrinth that the medical system of today has become and possibly serve as liaisons between the layperson and the unapproachable white coats. But that day hasn't come. And when it does, I may not be around or in the mood, since I do cherish my free time. Without idle hours I'd never have the opportunity to ask myself questions such as this, let alone answer them.

For me the hospital was no place to be. I learned that during a visit to Cedar Sinai as a boy of thirteen, when my father took my brothers and me to see our grandfather as he languished on the cardiac floor for one month recovering from open heart surgery. The moment I entered the stuffy, serious environment filled by so many pasty do-gooders wearing pajamas and pious expressions, I wanted out. And years later, after a paltry 3 years in the wards as a student and then as a doctor, my body was breaking down - neck pain and hip pain and back spasms were my daily plagues - and the vices I thought I had left behind had returned with a vengeance. I was once again back up to 4 to 6 drinks a day after work, plus a couple cigars. I called myself a healer and yet I was more in need of a good doctor than many of my patients. Sinus infections are often self-limited and the body can rid itself of almost every condition, while I was suffering some of what the philosopher William James referred to as a soul sickness. James was also a doctor who never practiced.

All that studying put me way too much in my head. I found myself analyzing everything, overthinking things, being lost in thought. Not a good thing for a meditator seeking to go beyond thought altogether. And yet despite the struggles and setbacks, if I had to repeat my fourth decade on earth, I'd still earn my medical degree. In a perfect world I would have drank and smoked less than I did, but I probably needed these vices to get me through the day much the same way that a runner needs his caffeine. They say the top medical students often drink the most. You play just as hard as you work, and earning straight As in Basic Sciences and class valedictorian honors in addition to a score of 99/99 on my board exams, then training at one of America's top teaching hospitals, I've done lots of both. And I left it all behind.

But I am fine with the way things are, even though in the practical (read: money-making) sense medical school has had no value for me. Practicing medicine is the only job I'm qualified to do and without board certification I cannot write prescriptions nor would I want to. America is overdosed as it is, read the book. Going further back, a college degree often has no practical value. Of my six closest friends, 5 are millionaires who have barely a high school diploma, if that. The sixth, my boy Deej, has a college degree and works as a waiter. Those 4 years that bridge the teens and the twenties are crucial, and what you learn from the school of life when you're not in class often proves more lucrative than the names of Russian tsars and the dates of the French Revolution. Which I've long since forgotten, and I was a history major.

But I don't regret going to college even, which I did merely to please my mother. Life is perfect, everything works out. The trick is to be able to understand it. First by understanding the past, then bringing this awareness into the present so you see the relevance of every moment and how it fits into the grand scheme of the great story that is your life - while living it. Why ask why? Because it's the only question that matters, really.

Not to beat a dead horse, but I've been doing it up till now so why leave off when I'm on a roll! The timing of my decision was also perfect. My father, having just turned 65, had become the newest social security recipient; the added income enabled him to afford putting me through school. It was as if a window in time opened for me to fly through. Even had I been eligible for student loans, the crippling debt would have compelled me to practice medicine for years more than I wanted to, just to pay back the creditors. See, it's all meant to be. Is my father resentful that he paid $200,000 for me to complete a degree I'd hardly use? Nah. He told me himself to consider the sum a sort of inheritance, since when he dies he plans on leaving nothing behind. Besides, my father is the same guy whose idea of life advice when I was 20 and asked him to help me select a suitable profession was to leave me with the biography of an Indian holy man Ramana Maharshi who had abandoned society at the age of 15 and spent the remaining 55 years of his life in almost constant meditation at the foot of a sacred mountain. Unlike other gurus, this individual never wrote a book or opened an ashram or went on a world tour. He remained fixed in his reclusive ways, his sole possessions being a loin cloth and staff and begging bowl; he never strayed more than a mile or two from his mountain home and died a saint. His funeral was attended by 40,000 well-wishers. By comparison, at the funeral for the rocker Chris Cornell, who committed suicide earlier this year after an illustrious musical career that spanned decades and sold millions of albums, there were only a few hundred people in attendance. Who has made a greater impact? Maybe my father was onto something by giving me such unstated and unconventional career advice. In other words, the best job may be no job at all. Or as my Dad is wont to say, "Don't become, just be." Some of my father's other pet sayings include "Be conclusionless," as well as my personal favorite, which I believe is also the Samurai code: "Expect nothing, but be prepared for everything." In case you're looking for words to live by.

And so I persist in my aim to be a modern day saint. We all should. That's ushering in the Golden Age, which is what Swami, who left his body in 2011, said he came to Earth to do. We need our torch bearers. How well I succeed we'll only know once it's over and we view the guest list for my funeral. But by then I won't care, since I don't plan on attending. But good things come to those who wait, as they say. And all's well that ends.


No comments:

Post a Comment