Stages of Grief (1 of 2)

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The 5 Stages of Grief were defined by Dr. Elsabeth Kubler-Ross as follows (parentheses mine):

1. Denial (“This can’t be happening to me!”)
2. Anger (“Why is this happening to me? This isn’t fair!”)
3. Bargaining (“I promise I’ll be a better person if…”)
4. Depression (“I don’t care anymore.”)
5. Acceptance (At peace with new reality)

In a way, my experiences in med school lately have been a grieving process. This obviously isn’t a case of losing a loved one, but any loss or significant change can invoke a grief response, regardless of how trivial that might seem to others not having personally experienced it. Few would question the grief over a deceased relative or the loss of a job, but a voluntary career change? Moving to another city? C’mon, those are changes in life you just deal with; there’s nothing to grieve.

Wrong. In roughly 2-3 months, the following changes have happened to me (and I’m sure many of my classmates):

• I have lost a well-paying, nearly permanent job
• I have lost a standard of living that said job afforded us, such as not thinking twice about ordering out for dinner, buying some cool toy, or not sacrificing for important things like medical care and car maintenance
• I have lost living in my home country, going from the most developed nation in the world (don’t argue with me on this one, please–other countries do certain things better, but not as a whole) to a third-world country with a patriarchal, corrupt government whose corruption extends from the highest offices to the lowest traffic cop, where I have little, if any, rights (especially as a foreigner)
• I have lost the ability to come home after work (see unemployed above) and do whatever I wanted, whether it be personal hobbies, more work, or just lounging
• I have lost valuable time alone with my wife, relegating much of our small excursions/outings when I can fit them in with my school schedule.
• I have lost an identity (information security and internet services specialist) in which I had multiple supervisory roles, in exchange for a new one, “1st year medical student,” where I’m the gum on the shoe of the established medical hierarchy.

I think these first brush strokes on this canvas is enough to show where this is going. I don’t put 100% stock into the neat, compartmentalized stages above, but I know I have done at least some of them since having moved here and started school.

It would be enough to say it has been just all the change and school itself that has caused such upheaval, but the indifference to communication that our school seems to have on certain academic matters has left me more disillusioned about being here than I would have thought. We had a guest speaker in a anatomy lecture for two days. He’s a pharmacology professor, relatively young, and an alumnus of the school. He was lecturing on two “big” cranial nerves, the trigeminal and facial CNs, and it was a breath of fresh air because for the first time since the first week of school, any real clinical information in terms of evaluating patients was shared. While we are not going to be conducting gross neuro exams anytime soon in clinics, we can at least understand some of the obvious tell-tale signs of lesions involving these nerves and their branches in a meaningful way, rather than the dry, morphologic approach in a vacuum. I’d love for him to teach more topics, but he’s going to the states soon having participated in the match.

He’s been a general doctor here (and teaching to supplement income) for several years, but when asked why he wants to go to the US when he’s already “set” here, he used as an example that attendings here are always right, period. When you ask, the answer you get is law. Even if you go to Medline or the like and print citation after citation proving your approach at least has merit, if the attending doesn’t think so, you don’t even get a “well that’s not how we do it here,” you get more of a “So?” at best, and at worst, marked for being “difficult.” Remember that Mexico is very patriarchal, so authority and respect aren’t necessarily earned, they are expected and conferred with a title. As such, how can a trainee know whether or not a given set of protocols, procedures or the reason why it’s done is really “right” at all when the litmus test is (may be) solely how your boss does it? Period. This mentality sets the stage for you, my dear reader, to understand this very difficult week for me.

To be continued Friday…(registration/login required to read conclusion so I can speak a little more freely)

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  By Frank, April 26, 2006 @ 1:44 pm

  If you had to do it over again would you? I’m finishing my prereqs and apply to schools next year. I’m debating about the carib schools and UAG. I’m Cuban so I understand the latin culture but the whole “attending” is always right is not something I look forward to. I know it’s present but throw the attending attitude add a dose of machismo and the compound that with the respect they expect….makes for bad juju.

  Anyway, like what I’ve read so far. Lot’s to catch up on.

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