The Dark Side

One of my responsibilities as a research fellow working in Dr. ______'s lab is to facilitate the transport of resected liver specimens from the OR to the surgical pathology lab in the adjacent building. There, I ask the pathologists to cut for me a few samples of tumor and normal liver tissue, which I proceed to take back to our basic science lab in another building up the street. Upon arrival at this final destination, these tissue samples (in addition to blood samples) are eventually processed for RNA, DNA, cccDNA, etc. analysis. Much of the funding for our research comes from this tumor banking protocol, and there are several avenues of research being explored with the data that is being amassed through this project. Tissue is harvested exclusively from patients with both HBV (hepatitis B virus) and HCC (hepatocellular carcinoma) and the overarching goal (at least on paper) is to explore the mechanism by which hepatitis B can cause cancer while bypassing the phases of liver fibrosis and cirrhosis. Hepatitis B is unique in this capacity because all other forms of hepatocellular carcinoma arise in the setting of progressive liver damage, manifested first in fibrosis and eventually cirrhosis (hepatitis C, alcoholic liver disease, etc.).

My day to day activities often center around this study of HBV/HCC. However, I have also been assigned to rewrite a paper looking at risk factors for peritoneal carcinomatosis (a type of metastasis) in gastric cancer patients. This was a project started by a medical student a few years ahead of me, and while he produced a final paper, it was never published. My job is to update this paper with the latest numbers (done) and to rewrite it in a manner that will be palatable to at least a few decent journals (in progress). I had been working on this study almost full time for the last couple of weeks, although this more-independent project of mine was interrupted last week when I was requested to help run some assays in the basic science lab. Although I had no experience whatsoever (being that I majored in anthropology), the Ph.D. in our lab took me under her wing and we ran an ELISA last week. It's a fairly straightforward process and not difficult to teach, and she benefited by having me do all the menial tasks (i.e. endless pipetting) for her. Tomorrow, we will be running a Western blot. While absolutely basic for most researchers in biology, this benchwork is completely new to me and I have been having fun learning these techniques.

It's been almost two months since I started this scholarly year and it certainly has picked up more than I ever thought it would back in August. But this entry wasn't meant to be about my research. The problem with all of this activity is that very little of it involves any real interaction with patients. And the problem with not interacting with patients is that it makes one prone to forget the reason any research is being conducted in the first place. I find myself going to the OR once or twice a week to collect my chunk of chopped liver, and the only thing on my mind is how quickly I can get all my samples back to the lab so I can leave and enjoy a nice, long lunch break. Only once in the last two months have I actually paused and even considered visiting one of the patients receiving surgery the next day, and this only because he seemed so terrified prior to starting the case. And in the end, I didn't check up on him anyway.

Up in the surgical pathology lab, you see all kinds of interesting specimens that have made their way up from the OR. Almost all are recognizable - they are usually simply diseased organs of some sort. Today, I noticed a smattering of tissue at one station that looked unlike anything I had ever seen before. The color was all wrong - it was gray-white, almost pale and translucent looking. Furthermore, it wasn't one confluent mass; it seemed somewhat feathery and looked like a scattered jumble of chicken or fish bones. I don't usually like to intrude on random attendings while they are teaching their residents, but this attending noticed me hovering near the table and so I had to ask what it was. She explained that it was a fetus that had been aborted at about 13 weeks because of some perceived anomaly. It was their job to try and determine what that anomaly might be by sifting through what are called the "products of conception." The problem, however, was that there was little left of the fetus to examine. The attending went through the scraps and highlighted the spine and tiny little ribcage that remained together as one piece, another little piece that turned out to be the right arm (complete with little fingers), and another piece that was the left leg. She picked up a tiny little scrap that had a vague circular indentation in it and said with half a smile, "this is the tongue."

The resident and I looked on with appropriate scientific curiosity and marveled at how small all the little pieces were. But inside, I felt a little sick. Just a little. The attending shook her head and said that there would be no way they'd be able to find any "anomaly" with what they had. She poked at a tiny piece that she was calling the heart and said they might try and examine the septum, but likely they would have to report no findings. I went back to my liver soon after that, collected my samples, dropped them off at the lab, and had lunch. I almost completely forgot about that fetus until now, and for fear that I might forget and never remember again, I decided to blog.

Three years ago, had I witnessed a similar discussion/dissection of an aborted fetus, I'm fairly certain I would have been profoundly disturbed. Maybe just reading my description of this morning might produce a similar effect in some readers. But I'm no longer that person. My empathy has largely been replaced by apathy. Over the weekend, I received news of the deaths of two people - immediate family members of two friends/acquaintances. Though I tried to express outward sympathy, I was not moved. Our church sent out a request for prayer for an elderly man who had been going back and forth to the hospital in the last few days. I dismissed this notion, thinking (and saying), "the ER is sending him home for a reason, it's probably no big deal." A similar cry went out for healing for a lady who had suffered a stroke a few weeks ago. In my head, a voice uttered: "not likely."

What's the problem here? Is it really the lack of interaction with patients that's caused me to stop caring about people? Is it simply the inevitable jadedness/cynicism that will befall every medical student who's finished third year? It's not the research. Research is an important and interesting process, and I'm glad I'm taking this year off to familiarize myself with its workings. It's me. I was never the most selfless person to begin with; however, I feel like what little has been left of my "good intentions" in coming to medical school has been spiraling downward for the last few years. While experiencing first-hand what hospital life is like for patients and their families when my dad was sick helped me to empathize with patients this past year, I am discovering that this empathy is remarkably short-lived. More often than not, I find myself presuming to know more than others because I have already been through such an experience, and I downplay their sufferings because I refuse to accept that anyone can suffer or has suffered more than I have.

Which is absolutely absurd. There is a reason for suffering in this world and it is sin. That is a central tenet of the faith I subscribe to... and yet sometimes I wonder if I really believe it. Why is it so hard for me to practice what I preach? Why is it so much easier to slip into the corners of anger, bitterness, self-pity, and self-righteousness? In community group about a month ago, we talked about how prayer can be a scary thing - particularly when you ask God for something you don't really understand. In my case, I remember at the end of college, I thought I had it all. I felt like my spiritual life was on track, my professional life was on track, and even my romantic life was on track, albeit with a few hurdles to cover. I had prayed the year before for the ability to fully trust God, and after feeling like that prayer had been answered, I started to pray for brokenness. I wasn't even sure what that meant, but I prayed that he would break me, teach me what it is to be fully dependent on him and nothing else.

I forgot about this prayer until we happened to discuss it at that particular community group. Three years later, I'm looking back at how I've been living since college, and examining how I feel at the moment. I feel broken. Broken and dependent not on God, but on worldly things that I know won't satisfy - career aspirations, material pleasures, emotional needs, and desires of the flesh.

And I don't know whether to praise God for his faithfulness or beg God for some way out of this pit. The answer, I suppose, is what it always is: both.

Hallelujah... and hosanna.