Ekphrasis: Relating and Responding

“And don’t be so earnest,

let others wear the sackcloth and the ashes.

Let go, let fly, forget.

You’ve listened long enough. Now strike your note.”

~Seamus Heaney

Okay, howdy howdy howdy. Sorry it’s taken me a year to get back to this, but it has been a fun, busy start to a new term. I would like to begin by thanking all of the people who commented via e-mail, facebook and carrier pigeon. It was really nice to hear other’s views regarding humanity’s (and Humanities’) place in medicine. I would like to especially thank “Swampstorm” for the detailed reply in the comments section. Being relatively new to the whole blogosphere (ugh…portmanteaux like that make me cringe)… “The Land of Blogs”…I must say that I was rather chuffed to see that people (outside my immediate family –love ya mum!) actually read this stuff. I will endeavor to continue the dialogue that Swampstorm took up. I will also try to throw up (perhaps poor phrasing) some photos to keep this from getting too serious. As always, I encourage comments – here or elsewhere; let me know what you want to hear about, and in a year or two I’ll address them.

So, to start at the end: Swampstorm asked the significance of the introductory image: Holbein’s “Ambassadors.” It is an image I find quite intriguing. There are the obvious ties between the sciences and arts (various cartographic paraphernalia and the lute on the shelves). But it is also fitting in its use of the anamorphic image in the foreground. The light blotch, at first mistakable for a stain, when viewed from the extreme left side (try it on your computer!) becomes a skull. I was really just using it to emphasize the need to look at things from different angles: medicine especially.

After reading your comment, Swampstorm, and re-reading my last post I recall that my intent there was to frame the omnipresent matter that I strive to take up (Humanities in Medicine) in a confrontational manner (Humanities vs. Medicine). My goal was to spark a bit of discussion (and as I said I am thrilled with the conversations that ensued) but by framing my post in this manner, perhaps the segue into my true intention (highlighting the importance of coalescing Humanities and Medicine) ebbed.

I like your introductory point about humanities embracing a marginalized position. Where humanities are on the fringe it is often quite accurate that groups will adopt (“with masochistic relish”) the role of underdog. I enjoy your Althusserian reading of humanities constructing itself upon the Ideological State Apparatus of resistance against science (now even the English major in me is wincing). Sorry to bog this blog down with theoretical jargon, but basically just referring to the idea that established social practices (like the media, education, science etc.) impose a role on people. To take this ratiocination a wee bit further: Althusser speaks of Repressive State Apparatuses which are invoked when groups pose a threat to the dominant order. This idea provides a fun (if slightly paranoid) interpretation of Campbell’s 90% cuts to the arts in British Columbia.

Well anyway, thanks again to Swampstorm and to everyone who gave the issue some thought.

Now for something completely different:

As most of you know, my girlfriend Lise has moved out here for the term for a drop of the Irish sunshine. Despite living in a 10X10 (centimeter) cubical cubicle we’re having a grand aul’ time! I’ve had a new opponent to beat at scrabble (in my dreams anyway) and someone to unload the contents of my brain upon (hence the lack of writing here). She’s also been a wee dote in helping me prepare for the OCASE (Oh-Casey) we had last week.

Me winning in Scrabble

Galway by day...

...and by night.

The OCASE (forget what it stands for) is a clinical skills exam with 12 stations and 6minutes for each station to perform a skill that would normally take three times that amount of time. The stations required us to: walk through the curtain and almost into the director of paramedic training for Ireland who dropped a manikin in front of me and said “this man has just collapsed, you are the only person around – GO!” After six sweaty minutes of CPR I hustled to the next station and behind curtain number two was a rubber pelvis that I was to perform a pap smear and bimanual exam upon. Even after ripping three gloves (in half) I just managed to creep in under the time limit, without traumatizing anyone – whew! The exam was even complete with three “rest stations” to pace and contemplate all the things you’d forgotten up to that point. The rest of the hour and half was filled with similar adrenalin-inducing mayhem, I was just glad we didn’t have one of the stations that was apparently on last year’s OCASE: walk into the station to one of the deans of our school (mid-sixties, prestigious doctor) sitting behind a desk with a big red dildo on it and having to spend the next 6 minutes explaining how to put it on. Sometimes six minutes flies…and sometimes it doesn’t.

...But man, by eleven o’clock the top image sums up how we all felt.

Catharsis: Cleansing the Stain

“I have mummy truths to tell

Whereat the living mock,

Though not for sober ear,

For maybe all that hear

Should laugh and weep an hour upon the clock.”

-W.B. Yeats “All Souls’ Night”

I can actually say that I have been working on this post for a while now, hence the delay, so I hope that it provokes some discussion, or at least some thought. As you may have gleaned from the introductory quotation there's going to be a bit more philosophising today - sorry! I think that I have to take all of my deep thoughts out on you because all of the rest of my time, my head is being filled with information and this blog is the outflow of the concentrated dregs of my brain juices.

I mentioned in the introduction of my previous entry that I had come across a way of thinking that had jarred me, but I ran out of oomph to properly describe it. It's quite huge, and countering it is a large part of the reason that I keep this blog at all. This grating philosophy is Western Medicine's highfalutin' superiority complex. I'm trying to think of a snappier abbreviation, maybe: WMPD (Western Medicine's Philosophy of Dominance). One could really remove the “M” and still be accurate as I’ve noticed after my time in Ghana) but I want to be very careful not to let this turn into a full on rant...

I first met the WMPD in my English Lit. undergrad. I was something of an anomaly running from my 18th Century Women’s Literature course, in the “quaint” Cornett building, across the campus to the shiny new concrete engineering and computer-science building for my Pure Chemistry lecture. Being split across the campus, externally, and split across interests internally, the antagonism of Humanities versus Sciences was a psychomachia within me. My wonderfully, bumbling English professor would grumble - articulately, and accurately - about all of the university’s funding going into the sciences and then put his sandals back on his socked feet. And my biochemistry lab technician would justify (nasally, but also accurately) that research is where the university gets funding from, before going back to cleaning mashed mouse brains off of his pocket protector. It was not just a debate of resources that I was in the middle of, but rather a clash of ideologies. Oftentimes my science-minded colleagues simply could not see the point of Humanities, and the Arts in general. Poems aren’t going to save the world, but I think that they have more of a chance of doing so than technologies.

This would be the place to insert a long and bilious rant regarding the priorities of Western culture, but rather than falling down that bottomless pit, I will nimbly sidestep it. I do, however, wish to note that it is a testament to pre-postsecondary school (awkwardly meaning high school and before) that I first bumped into the WMPD in university. Indeed throughout my former schooling the arts and sciences were balanced (science fairs and musicals, lifecycles and life drawing) both in terms of resources and their perceived importance.

Now we meet the heart of the issue. In my brief time in medical school so far I have found that the Western Medical Philosophy of Dominance is more deeply rooted than I originally knew. Almost anything that is not based on hard science is considered fluffy. It is not the nomenclature that I take exception to, many lovely things are fluffy, but rather the pejorative tone that accompanies it. I am no longer strictly talking about the perceived dominance of Western Medicine over social sciences or liberal arts, but the WMPD in general. Indeed it exists within medicine itself: some of my colleagues would scoff at Alternative or Eastern medicine, though these are the only types of medicine that have been proven for millennia, and also patronized by the British Royal Family (and their longevity is admirable). More distressingly, some of my fellow medical students dismiss psychological illnesses as less important or even something that can simply be overcome if one just “puts their mind to it.” Although psychological illnesses are sometimes less biologically visible, their effects on those who suffer from them can be profound, and are certainly very real. This attitude is not solely forwarded by unknowing students, I have had a lecturer solemnly report to us that there is no benefit (in terms of longevity) to thinking positively. Suffice to say I nearly fell of my chair. I am thrilled to report that the majority of my classmates are extremely worldly, open and equally conscious of the necessity to bring the human element back into medicine. I am commenting, rather, on overarching beliefs that have become implanted in the discipline and are still passed down the line to unwitting students.

The goal of Western Medicine is to prolong life whenever possible. The humanities, through culture and joie de vivre, teach us how to live life to the fullest. It is really a matter of lifespan versus quality of life. It seems obvious to me that if these two doctrines could meet - that would be the ideal. A balance between longevity and exuberance – I suppose “vitality” captures the two. This is the goal of my blog. To rebuild the bridge that has long since been burned down between Western Medicine and “The Fluffies.”

And it was not always this way; before the nineteen hundreds there was a great unity in the two as exhibited by such characters as Sir Arthur Conan Doyle (a physician and author of “Sherlock Holmes”), Leonardo Da Vinci (anatomist and artist) or Dante Alghieri (a physician, political poop-disturber, and poet (of, among other works, “The Divine Comedy,” including “Inferno”). These and countless others have exhibited what is possible when both halves of our brain work in synchronicity. But that is a tale for another day.

I’d like to end in the rather hackneyed manner of inserting a few quotations by influential people that got across the point that I am trying to make many moons ago:

“It has become appallingly obvious that our technology has exceeded our humanity.”

~Albert Einstein

“The Roots of Violence: Wealth without work. Pleasure without conscience. Knowledge without character. Commerce without morality. Science without humanity. Worship without sacrifice. Politics without principles.”

~Mahatma Ghandi

“The humanities and science are not in inherent conflict but have become separated in the twentieth century. Now their essential unity must be re-emphasized so that twentieth-century multiplicity may become twentieth-century unity.”
~Lewis Mumford

Thank you for reading and considering my views. Again, I hope some bits get you thinking, and if they do please feel encouraged to share your thoughts, either via e-mail or the comments section.

Imagery: Speaking of Pictures Envoked...

"I am speechless

because you have fallen beside me

because your eyelashes

are the spines of tiny fragile animals."

Leonard, in his perpetual brilliance, has managed to encapsulate some of my own feelings of awed speechlessness. I am at a loss for words because I feel, at times, that I am learning a new style of language and this language is a new way of thinking and feeling. It is both a new way of living and a reflection of the machinations therein. It is the Poetry of Medicine.

I have several things to blame for my contemplative state of late: a film, a family member and a philosophy.

The first is a perspective-altering meditation on global interconnectedness in cinematic form. It is a film entitled Baraka (an ancient Sufi word meaning "the thread that weaves life together") that my new good friend Erin shared with me. I watched the film in total isolation (even blocking out the surrounding acoustic world with my headphones) but emerged from my reverie with an overwhelming sense of togetherness.

My brother recently read Cormac McCarthy's anti-bildungsroman "The Road," a novel that I read on my flight over here. The discussion that it sparked in us ignited the English major in me that has been lying dormant over the past few months. It was really refreshing for me to engage in that level of analysis because it is something that I cannot yet do in the medical realm. In keeping with my introduction of speechlessness, I am still in the neophyte stages of learning the foundations of the language and mentality of medicine. In the words of Walter Sobchak "[I'm] like a child who wanders into the middle of a movie..." But I am learning fast and to this end my health-science friends and colleagues are being indispensably wonderful. It was just nice to talk lit. and remember that I do, in fact, know some things.

I would like to share a few photos of the amazing friends and colleagues that I've been alluding to over the posts. As I griped last time, my camera is bust so I am borrowing these photos from other places to give you an idea of the setting and characters of the Limerick Stage.

The long and winding Living Bridge tha-a-t leads to my door.

The daily commute

A bunch o' chums:
Naren, Carolyne, John, Jimbo (at the back), James (up front), Mike, Erin, Moi, Kat, Christine

Brain food with JM, Georges, Anna and Naren

One litre cans of Kaiserdom (aka cerebral diesel) with JM

Mike and I "taking a study break"

Erin and I, the founding members of the soon-to-be world famous doctor band: "Reverend Right and the Wronged Ones"

St. Arthur's Day - Celebrating the 250th anniversary of God's gift to beer
(N.B. While Sir Arthur Guinness was never beatified, (or knighted for that matter) I am taking the honour to induct him into the hagiology)

A long and delightfully insane bus trip around the Midwest (of Ireland)

And there you have it, a snappy snapshot into my first month and a half of medical school in Limerick.

I had mentioned in my introduction that one of the things that has had me thinking these days is a philosophy. I have, subtly, touched on it throughout this post, but would like to save it for a future post (in hopes of decreasing my absenteeism from this site). I do just want to mention one other connection to Leonard Cohen's genius. The "spines of tiny fragile animals" is a very apropos image as we struggle through human embryology. The transluscence of the tiny fetal bones really hops to mind with Cohen's words. Well, I must arise and go now to mash 10lbs of potatoes and then titivate myself for our massive 50-person Thanksgiving Dinner tonight! Happy (Canadian) Thanksgiving one and all!

Awake and Dreaming

"...The waves beside them danced; but they
Out-did the sparkling waves in glee:
A poet could not but be gay,
In such a jocund company:
I gazed -- and gazed -- but little thought
What wealth the show to me had brought:..."

A week into medical school and my initial hesitations are gone. Rather than Wordsworth's "Daffodils," it is the reality of being in medical school in Ireland that has elated me so and carried me through my first week of studies. That, and the unbelievable weather.

It is amazing to look back now at myself in South Africa in 2003 when, working on a service project around Doctors Without Borders, medicine first sunk its teeth into me. Or surviving Organic Chemistry lectures solely through counting, with my neighbor, the number of times the professor said "namely" in one lecture (I think the record was 23 - or about once every two minutes). Or sitting in UVic's gym in the bleak midwinter staring at a Biochemistry exam wondering which part of the formation of the archegonium in the life cycle of a fern I would ever need to know again (the answer is zero). I definitely do not consider myself to be a "means to an end" kind of person, my Undergrad. in English Lit. is in the top five greatest things I have done to date. However, there were those times when medicine seemed awfully far away. But now the end is nigh, and (as is often the case) it turns out that it is really a beginning in disguise.

I know that, for the sake of chronology, these nostalgic ramblings should have been the substance of my first entry, but I did not feel them at the time. It has taken me this week for everything to sink in, for me to fully realize that I am here. Now.

My lectures embody the surreality of dreams: a clinician who teaches us medical ethics by telling us interesting stories of lives saved and doctors sued from her own practice and the media, An anatomist who looks like a caricature of someone from Barcelona and speaks like Manuel (of "Faulty Towers" hilarity), an ENT specialist (ear, nose and throat) expressing candidly that by the week's end we will probably know more about the ear than he does, another anatomist who champions the etymology of words as much as I did to my anatomy classes and who told us that the rate of publication of new medical literature is such that if you read two journal articles every week for a year by the end of the year you would be the equivalent of 800 years behind.

While daunting, it solidifies the idea that we are certainly learning a tremendous amount now, but it is all with a view of continued lifetime learning. Our medical training will not end with our four years at the University of Limerick.

As I mentioned, fleetingly, the weather over the past week has been tremendous!! No rain, blue skies, lovely warm days. If only it could last - the clouds are already descending. Anyway, being dense, I didn't take any photos of the beauty of the campus in the sun, so I might have to nick some from a friend. Next time I'll also try to post some pics of the ECC (Elite Cerebrex Crew) ie. my friends and maybe even my domicile (if it's presentable) so that you can get a wee bit of an idea of where I am and with whom. hehe.

in media res

"And nearer fast and nearer

Doth the red whirlwind come..."

~Horatius

Lord Macaulay's words fit strangely well with the coming of a new term, my first at medical school in Ireland.

Okay, let's reel back the pomposity a wee bit. After the roaring success of the blog of my Ghanaian adventures (lettersfromghana.blogspot.com), I decided to give it another whirl here in Limerick. This blog seems like a great idea right now, but I can make no guarantees on its regularity or even its chances of survival. This week has been somewhat breezy with just a few orientations (though they are 8 hours long) and a kajillion forms to fill out and have stamped, however, as Lord Mackers alluded to, I can feel the med school storm abrewin' and come Monday we'll see if there is time enough to breath, never mind blog.

Thus far, Limerick has been awesome. After a disoriented first night, I met a wonderful crowd of fellow "first year" medical students sheltering from the rain the next morning. We have scarcely separated since. We have already had two jam nights (guitar jam not strawberry jam) with electric guitars, mandolins and much drunken singing; a "Flight of the Conchords" viewing sesh, and big communal dinners together. I must admit that I'm a little surprised by how excited I am to be spending the next four intense years with these people. I didn't know that med school harbored such gems.

Our lengthy orientation the other day provided my first opportunity to see the entire University of Limerick's Graduate Entry Medical School class of 2013. With something like 50 Irish and 40 Canadians it seems we are slowly taking over. The four year program is divided into two years of (largely) classroom work: lectures and problem based learning groups (the PBL system, the flagship of Limerick's innovative approach, is described with rabid vigour) and two years of (smally) classroom work: more time spent in "the field." We were also reminded that we would soon be introduced to the the two patients (an expectant mother, and a person with a chronic illness) who we will be following (medically as opposed to stalkerly) for the next few years.

It is all very exciting and with my new med student buddies beside me and my umbrella in hand I am eager to face the flurry of studies ahead.