At arm's length

In medical school, I remember quite distinctly the day we talked about personality disorders. We discussed schizoid personality disorder. These are the folks who prefer solitude. They are lighthouse keepers or wander the desert. This is in stark contrast to social anxiety disorder, where a person is unable to interact with people, and this inability causes great distress.

I remember this because it was when I realized that I have made some terrible decisions in my life, choices that I am not proud of, in order to wake up in the morning and not shoot myself.

I was recently forced to do a lot of introspection. This is something that I am relatively comfortable with. I keep this blog, I write in a journal, I feel like I am pretty in touch. But surprisingly, putting a voice to my inner monologue was quite horrifying.

In my life, I've had my fair share of romantic disappointments and failures. Couple this with other issues with intimacy and relationships growing up, and somewhere along the line, I decided that I could not take it anymore. I made the quite conscious decision to hold the world at arm's length, to distance myself emotionally from all this turbulence. And without that horror, I've thrived. I've done well in medical school and residency, and I feel like I've managed to accomplish quite a bit in my life.

But it comes at a steep price. Sure enough, I have not had my heart broken in a long time, and I haven't felt that pain again, but the problem is that the pain and joy come from the same place. I have cut myself off from a world of happiness, because the risk of pain was unacceptable.

And I've watched life pass me by from my little castle, with all interlopers thwarted by the high walls and deep moat. And actually, if I am really honest about it, women have tried, some trying pretty hard, to get inside. And rather than welcome them in, I have put up more walls, and closed myself off.

This distance has its pluses. I can unflinchingly deal with most patient interactions. I've had people cry, people yell at me, the whole gamut of emotions, and I have been able to be empathic, and none of it hurts me, because I don't let them get close. They have to work on my schedule. I can deal with patients in convenient 15-20 minute chunks. They open their doors to me, but it isn't reciprocal.

It's too bad that joy and sorrow come from the same place, and that it is our greatest loves who can hurt us the most. I just don't know if I can risk it. I don't know if my heart can take it. I so desperately want to be loved, but the thought of me loving another person is absolutely petrifying.

I portray to the rest of the world a man of confidence, an outgoing and gregarious guy, but at heart, I am none of those things. They are adaptations so that I can operate in this extroverted world. And I think of how wonderful it would be to meet a girl who could cut through all of this façade and get to know the real me, and not this face that I portray to the world. She would tell me, "Hey, it's okay. This is safe, you and me," and I could finally, finally let my guard down.

No touching

Kilmer Middle School bans handshakes, high fives, hugs.

So, I happened to flip past CNN and Paula Zahn was having a talking head bit about Kilmer Middle School and their policy of no handshakes, no high fives, no hugs, no touching essentially. People are arguing back and forth, and there are all sorts of positions one way or the other.

Rationally, I can understand both arguments. However, in my gut, I found this rule to be outrageous. I went to a private school, and we were reprimanded for NOT shaking hands. Hugs I can understand, but the handshake? The handshake is the most basic unit of human, adult interaction. You might as well ban smiling or saying hello.

These days, the only human interaction I have is shaking hands. If I didn't have that, I might as well be a hermit.

Completely disarmed

A friend of mine made me blush the other day, which isn't much of an accomplishment, but it made me think a little. I started to tell this story, but thought better of it. But now, I find myself wanting to tell this story. I'm not trying to add suspense. It's actually a terrible story. Anecdote is a better word.

I had a patient not too long ago who was completely gorgeous. She was radiant and beautiful, and it was ridiculous that I would be put in charge of her care. I actively avoided entering the room. She had some problems, and eventually it was far over the intern's head, so it was up to me. It took a while to get things straightened out, but after nearly a week, I still had a hard time looking her in the eyes.

The only point to this story is that this woman could've absolutely had her way with me. If she had told me to give her 4 kilos of Oxycontin, I'd have written the script then and there.

And that was part of why I was avoiding her room. I know my weaknesses, and pretty girls are my kryptonite. I get all nervous and apprehensive. I look down a lot. I am for all intents and purposes quite useless. So I've done some hard work to try to desensitize myself. I made a point to talk to all the pretty nurses in the hospital. I try to smile and be friendly. But still, every now and then, I find myself completely disarmed.

31 flavors and then some

Interns come in so many different flavors, and it can be hard to be a senior resident. Being a senior is a unique skill, and so I hope that I can provide a little guidance.

1. the stupid — his fund of knowledge is bankrupt.
   
2. the slacker — rounding on time? Not this guy.
   
3. the cluttered — Most labcoats have 5 pockets. This 'tern needs more.
   
4. the superstar — what I told one of my superstar 'terns: "I love having you on service. I get to eat a nice long breakfast."
   
5. the casual — He is completely frustrating in his unflappability. You'd swear he smokes pot.
   
6. the procedurist — He is single-minded in his focus to do every humanly possible procedure. But H+P? Pass.
   
7. the overwhelmed — One of my interns spent 4 hours doing an H+P. Think about that. FOUR HOURS.
   
8. the workaholic — His solution to all problems is work harder. While admirable, not always the best policy.
   
9. the earnest — "Well, I didn't document a skin exam because I didn't look at all of his skin, just his head, neck, chest, admonen, and legs." An actual quote.
   
10. the overconfident — He does not know what he does not know.
    
11. the disrespectful — I had one intern who was so disrespectful that I actually told him, "What makes you think you know anything?" I am not above putting a disrespectful intern in his place.
    
12. the unprofessional — All the above, while quirky, are just aspects of all of our personalities. At some point in time, we were all one of these flavors of intern. But without fail, the most dangerous intern is the unprofessional one. From a core competencies standpoint, knowledge can be taught, systems can be navigated, practice based learning speaks for itself, communication can be instructed, but you can't teach how to be professional. One of my attendings said something profound on the matter: "Ifinding, tell me, how do you teach someone that lying is wrong? I don't have a fix for that."

It may sound like I'm hating on the interns, but the truth of the matter is this: if you are an intern, there are only two things that any senior resident are looking for. He wants you to (1) work hard and (2) give a damn. Everything else can be taught. And my favorite interns aren't the smartest or most talented, but the ones who I called at 4AM and still got the job done.

I'm sure that I'm forgetting about some flavors of interns. Feel free to leave a comment with your favorite flavor of intern.