We’re all familiar with the thousand-yard stare.  It’s that blank, dead-eyed expression assumed by those confronted with an excessively horrible reality.  Stunned into submission, the brain retreats into green pastures filled with ponies and rainbows, while the eyes are left transmitting their neuronal impulses into the cerebral equivalent of the waste basket.  I’ve seen this stare more than usual this week, and in two entirely disparate groups of people:  med students and patients.

As my colleagues and I proceed into the final two weeks of our anatomy course (and by “proceed” I do of course mean that we’re desperately blowing air into our water-wings while staring in wide-eyed terror at the tidal wave of information crashing down all around us), the strain is starting to show on some folks.  Our first exam wasn’t terrible.  Certainly it was challenging, but the giddy feeling of taking our first medical school exam mitigated somewhat the abject terror of failure.  After our second exam, however, the giddy feeling wasn’t around to provide soft, cushiony succour in our time of need.  The written exam, as with the previous exam, was tough but reasonable.  The lab portion of the exam, however, was bloody ridiculous.  Imagine a small piece of string tied to a pin, which is in turn sticking into a tiny, brown squiggly thing in the middle of a mass of other tiny, brown squiggly things.  Name that squiggly thing.

The expressions on our faces as we left the lab-exam were doubtless those that would be seen on the faces of our nation’s top generals if they’d just been told that the country had been invaded while everyone was on a coffee break–a strange mix of disbelief, anguish, and the faint hope that the alarm clock is going to ring any moment now.  After years of effortlessly sailing through the rarified air of academic achievement, we had well and truly felt the wax melt from our wings.  But you know, just as I was beginning to feel sorry for myself, I met some other folks who gave me a little bit of perspective.

I’m doing a Geriatrics elective this term.  I’m not going to lie and say that I’m doing it because I believe that old people are the future of medicine (they are), that I’m inspired by the elderly (I’m not), or that I’m filled with compassion (stop laughing).  Truthfully, I did it because military medicine is for better or worse my milieu right now, and the elective has me working with veterans in the VA system.  I’m sure I’ll post some HIPAA-approved impressions of this elective and my patients as time goes on, but I wanted to talk about the thousand-yard stare I saw on a few of the old guys as we rounded.

I’m going to let you guys in on a little secret.  Gather around, and let’s bond:  I’m terrified of getting so old and decrepit that I’m at the mercy of others.  It’s not just because I’m a bastard by nature and I’m scared that everyone I’ve annoyed throughout my lifetime would surround me and beat me to death with their walkers.  No, it’s a terror of becoming what I saw in the hospital the other day: an old guy lying in bed, pierced with tubes, staring dully at the ceiling as the beeping of machinery and the whir of fans provide a souless accompaniment to the EKG lines dancing on the monitor; the warm-up act before the Reaper arrives.

It kills me that medicine has come to this, and you’d better believe that I’ll be posting more about it.  As I look at these people, dying slowly with no friends or family present, I just want to put my hand on their shoulder and give them some human contact.  You’re not passing unnoticed, dammit, because I’m going to notice.  And sure, doubtless it’s stupid, futile, or naive, and maybe the experienced docs are rolling their eyes, but I just don’t think it’s right that our old veterans are passing this way.  Perhaps even the patient is beyond caring, but I’d just like them to know that their service hasn’t been forgotten, that their passing isn’t unmourned, and that as they lie there on the hospital bed, a military officer is passing by and gives a damn.

So yeah, a poor exam score doesn’t seem so bad right now.

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