Equilibrium

According to a YouTube video I watched one time, if you were to assess what you are made of right this second, down to the subatomic particles, 7 or so years from now, not one of those particles would still be “you.” Parts of you die, regenerate, proliferate; you sweat, eat, poop, high five, and scrape your toe on the sidewalk when you wear flip-flops and aren’t careful to lift your foot high enough over that curb. Being that YouTube is an undisputed fountain of truth, we can reasonably think of one another, not as singular people inhabiting singular bodies, but rather, as relatively stable equilibria of ordered substituent parts that nonetheless change constantly. In this sense, one might say we are each the products of existential hearsay, an ongoing game of telephone between particles that become and unbecome us yet somehow maintain our sense of identity. As one leaves, it hands the baton of you-ness off to the one arriving. I certainly believe the principle of “the whole is more than the sum of its parts” in this scenario, but I can’t help but wonder where the pieces of my past self are now.  Maybe this is why we can look back on photos or videos of ourselves from years ago and think, “Was that really me?” Perhaps in a deeply physical sense the answer would be “No.”

            As with nearly every subject, one can either take a scientific or philosophical perspective (though I would contend that the two are not so far removed as people often imagine). On the one hand, it’s kind of fun to think about the possibility that your elemental infant self might have been reassimilated into a sea cucumber somewhere on the other side of the world, and on the other, it’s interesting to draw correlations between our physical state of change in relation to our development as people. We wake up to what we feel like is the same face looking back at us from the mirror each morning, yet given enough time, there comes a day when we look back and marvel at how much we’ve changed. For me, February 14^th was one of those days. If you would have asked me on that day as I sat in a Vanderbilt Cancer Center chair receiving my final round of chemo what I would be doing a year from then, sitting here in an operating room in Kenya would have been extremely low on the list. Beyond geographical displacement, however, I feel distinctly removed from that Robert by leagues of experience and growth. I’m usually one to bemoan the speed at which time passes, and yet I find myself being cynical that only a year has elapsed since that day. Just the sheer amount of stuff that has happened between then and now inclines me to disbelieve it. Hairlessness notwithstanding, I look back at pictures of myself and almost feel like I’m looking at a close relative or good friend, but not me. Is it possible that only 12 months separate me from that person?

            I’m incredibly grateful for what my past experiences have taught me, how they have shaped me in many ways, and how they have equipped me for the future. I wouldn’t be who I am without them. And that’s the thing about an equilibrium (if I may be so bold as to beat this metaphor into the ground): its stability doesn’t lie in its ability to resist or avoid change but in its ability to find balance in response. Coming to Kenya has necessitated its fair share of adjustments, and it has only been recently that I have felt more or less settled in terms of establishing a routine and functioning like a real life human being instead of flailing around in ineffectual foreignness. I would by no means say I’ve got this Kenya thing down, but I also don’t feel quite so clueless as I did on Day 1. That of course begs a few questions: in what ways have I changed in only 2 months? What parts of me are new? What parts of my old self have I lost? What parts of my former self are now sea cucumbers? I suppose only time will be able to fully articulate the answers to those questions, but for now, simply being grateful for the opportunity to change is enough for me.

Scrubbing In

For me, there is a special kind of satisfaction in the sense of touch. Given that you have to be at least as close as your arm is long to whatever the subject in question is, the ability to press your fingertips against something implies an intimate proximity that, unfortunately enough, we don’t get to enjoy with far too much of the world.  I was granted the privilege of scrubbing in (meaning I had to undergo the same sterilization processes as the surgeons) for a few cases over the past week, and as such, I got to be as close as I have ever been to the inside of the human body. Though I’ll go ahead and put the disclaimer out there that what I got to do during the course of these operations was nothing more exciting than holding retractors and cutting a few stitches, as an uninitiated premed, I was geeking out. The first case I got to scrub in for was the removal of a large Wilms’ tumor in a young boy. The tumor was so large that it had displaced a significant portion of his intestines and distended his diaphragm into the chest cavity. The procedure went slowly, as we had to be exceptionally careful not to rupture the tumor, but without complication.

Post-op picture of Wilms' tumor removal

Following removal, the patient’s abdominal cavity was essentially wide open, and, per the suggestion of the presiding physician, I got to feel live human internal organs for the first time. You and I are probably similar in the fact that we both had frog dissection day in middle school. If you pursued a science-based academic career, then you probably have experiences in dissecting any number of formaldehyde-drenched specimens and are just as familiar with poking floppy, lifeless guts as I am. This was a totally different ballgame. Not only was everything pink and turgid with life instead of slightly grey and sagging, but each member seemed to swell and recede in time with the patient’s breathing. I may only be speaking for myself here, but somehow in studying pictures, textbooks, and dead frogs, I’ve managed to minimize the dynamic nature of my insides and instead think of them as essentially stationary objects. Seeing them with my own eyeballs quickly corrected that faulty conception, however. I would have to say that the bowels take first prize in terms of being the most entrancing to the touch. The best way I can think to describe them is as warm, wet balloons that aren’t completely inflated and, at first glance, appear to be the result of a clown seizing in the middle of making some elaborate animal for the birthday boy. If you pull them out, however, they organize themselves into logical bends and curves, each of which are anchored to the abdominal wall by a fan of mesentery and vessels that branch outward from their attachment like blood-colored heat lightning. Then, towards the end of the large intestine, at least in this case, the solid remains of digestion felt like wet sand vacuum-packed into a soft rubber tube. I know intestines usually get a bad rap for being disgusting or generally unpleasant, but I find them stunning in their own way, odd as that might seem.

            In addition to gaining more appreciation for the inner workings of the body, I’ve also gained more appreciation for the endurance required by surgeons and doctors in general. Yesterday ended up being a 15+ hour day in the hospital, including a cloaca repair on a young girl that took over 9 hours. Whereas a normal girl develops with three separate openings for urogenital and excretion purposes, sometimes a developmental defect results in all three being combined into one opening: a cloaca. We broke for an intermission at about the 7^th hour of this procedure, and I promise that the Dr. Pepper’s and sugar wafers we consumed at that time couldn’t have been more glorious to our tired taste buds. As exhausted as I felt, all I did was stand there and hold a metal stick most of the time; I wasn’t even the one straining to ensure the correct tissues were being separated or planning how to rearrange various organs so they could function properly. I’ve long held a deep respect for surgery as a whole, but this experience drove home the physical, bodily taxation that is sometimes required in this field. However, the goal we were working towards, to restore the normal functions that are so easy to take for granted in this little girl, made each second well worth the effort.

            It would be nearly impossible to articulate just how much I have learned and how widely my perspectives in several areas have expanded during the past month, but one principle that has been particularly poignant in my mind recently is the value of practicing perseverance as a lifestyle and not as an occasional force of will during strenuous situations. Several doctors have advised me through the years to be sure medicine is what I want to do because there is nothing easy about the road ahead for someone pursuing a medical career. Being in the hospital, however, and seeing how the years of training and self-sacrifice allow these doctors to help people on a fundamentally human level makes the journey ahead seem no less difficult but all the more exciting.