Before and after

One thing I've been noticing lately is that I have to stop and concentrate hard to remember what it was like being a layperson. Did I know what a clavicle or myocardial infarction was? How lungs work? What viruses and bacteria are? A lady recently asked the doctor how you get oxygen into your blood, and a guy asked whether you can trace the source of bacteria from a swab. Certainly the fact that antibiotics are for bacteria only clicked in med school for me.

It goes further than just knowledge, though. It's being grossed out - or not - by certain things. I don't blink an eye at blood or guts or vaginas, but purulent wounds still make me go ick. Can't remember if I used to be affected by such things. It's how I feel about hospitals nowadays. For normals, they can be a place of fear and grief. The feelings of claustrophobia, displacement and unease from when my grandma was sick occasionally come back to me: all those depressing neon lights, haggard faces and barely masked smells. After Armidale though, I feel at home in hospitals - even theatre is now familiar and cool. They've become a place of learning, where we seek out interesting and fun experiences - and some of those interesting and fun things are other people's illnesses. Kinda twisted really. I've never been an inpatient before (except as a hairy-backed preemie), and I imagine it's got to be disorienting. I remember, in law we read some Foucault, about the parallels between hospital and prison. You're stripped of power, put in a uniform, your movement is restricted, you live by others' schedules, people do things to you which you mightn't fully understand or consent to, and you're surveyed day and night.

In politics one of my lecturers talked about how it's difficult for democracies to fight in asymmetrical wars because citizens generally aren't happy to send their sons off to commit the brutalities that are often unavoidable when you're fighting unconventional forces (NB: much is debatable there bien sur). Obviously, this theory was derived from Vietnam-type conflicts. The way around this is professional standing armies, as opposed to concripts. You separate citizens from civil society to a boot camp in the bush, teach them loyalty to each other and the institution, show them how to function in extreme circumstances.

I find this an apt analogy for med school, in particular clinical rotations. Besides the teaching of facts and skills, they help to transform us from wet-eared civvies into hard-assed troops. You learn the ethos, conventions, secret language, and see and perform things that would be considered horrors in other settings. Sticking a needle in someone's back or a finger in their bum. Cutting them open, exposing organs, then shoving everything back in again. Kinda absurd if you think about it. What's amazing is that this sort of initiation isn't uncommon. Nurses, undertakers, cops, firemen, carers, social workers, vets, soldiers, hell even dunny cleaners! Entire classes of otherwise normal people to whom weird-to-Joe-Average things are routine.

Some of the hardening is necessary of course. You can't have a doctor getting disgusted or freaked out every time they come across an anal abscess or something. But it's also a bit dehumanising, because dodging the discomfort of the situation also disconnects you from the patient's experience. I reckon it's a good thing to stand back once in a while and think, yeah, to normal people, this here is weird, embarassing, absurd, scary or gross. Like taking your own pulse, it tethers you back to your own humanity, the kid who lurks behind the professional.