Dear Diary...

Wow. Third year is coming to a close pretty darn quick. Here are some things on my mind right now:

• I began the year feeling clueless and overwhelmed. I will probably finish the year feeling clueless but aware that that's what Medicine will be about - a career of perpetual learning and relearning and paradigm redrawing. Welcome to perennial studenthood.
• I liked Medicine. I liked Family Medicine. I really like Pediatrics. I really like working with the geriatric population. What to do what to do what to do what to do???? Hmmm...you know, there are some Combined Medicine/Pediatrics Residency programs out there. I know what you're thinking - "Mikey - ENOUGH with the combined degrees already!" I think that much of this attraction to combined degree stuff is rooted in the fact that I can be pretty indecisive. I mean, all those evenings it's been asked of me to decide which restaurant we're going to? Yeah, that's right. I can't decide.
• One thing that stands out with the Pediatrics clerkship is that it has presented me with more ethical questions than any of the other clerkships thus far. Perhaps it's just coincidence. Like - what makes a person a person? Does a baby born with hydranencephaly qualify as a person? I struggled with this. Immensely.

Dr. K: Mike - do you think this baby is a person. And do you think it matters whether you think it's a person?
Mike: Yes, it's a person. And no, it doesn't matter what I think - I should still treat it with as much respect as I would any other patient.
Dr. K: You think the baby is a person, yet you keep on referring to this baby as 'It.'
Mike: Uh, yeah. I guess I'm struggling with this.
Dr. K: No kidding. Why do you think it matters that you're clear on the definition of 'person'?
Mike: Well, because if I'm uncertain about the patient, then that will complicate my decision-making in the course of treatment. And sending uncertain signals to the patient's family in this case could be disastrous.
Dr. K: Precisely. Does this patient feel pain or hunger?
Mike: No.
Dr. K: Will this patient ever develop a personality?
Mike: Uh...no.
Dr. K: Well, then. Where do you think the word 'person' comes from?
Mike: UNCLE!

• The miracle of life. The past few days I've spent with newborn babies - both healthy ones and preemies. It's astounding to realize that just a few minutes ago this little bundle was still inside another person breathing and drinking amniotic fluid. And now I'm standing above them checking their wittle ears and wittle hands and feet and tiny wittle tongues and soft wittle bums as they adapt to the outside world. So dependent, so innocent, yet so lucky when compared to some of the preemies in the neonatal intensive care unit (NICU). Technological advances have made it possible to keep babies alive who have been born at only 24 weeks gestation. This would have been impossible even a decade ago. You wonder if it's worth it, though. A 24-weeker could possibly face so many complications later in life - chronic lung disease, vision disorders, cerebral palsy, to name a few - is it worth it to keep them in the NICU for months in order to face life with such difficulties?
• My cooing and gurgling language is getting better. However, I've found my talent in the newborn nursery. During painful procedures such as drawing blood or putting in intravenous catheters, someone has to keep the baby from fidgeting. One trick is a simple solution of sugar water (sugar molecules will bind to the human opioid receptor and reduce the sensation of pain). The other trick is getting them to concentrate on something else - like food, or making them think that they're getting it. Babies are born with amazing 'suck' capability and if you stick your finger in their mouth, they'll suck on that thing like there's no tomorrow. Thus we come to my natural gift: My Finger. Able to quiet babies for tens of minutes while they're being poked and prodded and jostled and manipulated to no end.

Well, Diary, that's it for now. I'll write to you later.

Mikey (aka "NippleFinger")