In the last few days, a lot of people have been addressing the subject of ‘healthcare’ rationing” in terms of what may come. I assure you this is a fear-based reaction and simply the unreasonable nervous jitters of those afraid of what may come. On the one hand, it is natural, on the other hand do NOT believe it.
There is NO WAY an American society will tolerate a government run rationing.
Just don’t let people like that make you nervous
How do the students in class see me? What am I a symbol of? For many, many years I have thought of myself as a person who slipped into the Awards Show or the Ball by accident, or unlawfully through the backdoor or the servants entrance.
I have seen myself as Cinderella
At the ball through magic, enchantment, luck or blessing.
The photographer is on her way. Time to get a new action shot of me in the class for the brochures for my textbooks. I ask the class for help. “I need you to help me sculpt my image into what is most useful for the people who read these books. I need a task force of people in these rooms to help me represent myself as what is needed in the mind of the student. Hence, how I see myself is not as important as how YOU all need to see me. How can I represent myself in this picture that will help you?”
Seeing myself as Cinderella, perhaps, does not help anyone.
Representing myself as a many in class, up at 7am on another Sunday Morning to reach and teach people who are anxious about their future is what is needed.
Another day to polish my art. My 18th year in classes for board review and I feel like I am just getting started. The book tour coming up for ‘Routine Miracles” makes me feel like everything has been preparation.
I feel more passionate to get at the meaning of things now, than I did before. Before, I needed to look good. To not look stupid in class.
Now I need to get at the meaning of things. to see the connections more deeply. Like I am an inch away from a sip of an answer. Almost can wet my lips on THE TRuth.
Deeper, so that when the 50 people in the room leave, a few will think about the fact that maybe I am right.
Maybe they ARE better than Doctors in the past
Maybe they CAN be the one to find the cure, the breakthrough, the ability to eradicate the disease. Maybe we really are incredibly fortunate to have this chance.
Nearly there. A passionate energy illuminates my soul today. Teaching in a class that does not look different from the tens of thousands of students I have been with before.
There is something about asking for help on the presentation of “Routine Miracles” that has really helped me see myself more objectively, how the students see me and that there just isn’t anyone to talk about these issues.
About their excellent and noble qualities and about the responsibility they have to care for a a suffering humanity.
And the students, interestingly, have told me exactly the same thing.
Like today “You are like a Vulgar Mother Theresa”
What do you think?
1. Does it matter HOW the students got jaded/greedy and fearful about money like this?
2. Is it from ‘Bad protoplasm’ , ie those who came into medical school from the beginning seeking personal financial dynasty or did they become poisoned later?
A person commented that I ‘Must have felt like that when I was at their level’ and that is, interestingly, 100% completely untrue and completely the opposite of what I felt. When I was a student, I did not even know the difference between specialties. I thought a ‘radiologist’ administered radiation therapy for cancer. My thought, at the time, was that I had no idea about the difference in incomes.
So, the students expressing this bilge-like attitude of Money grubbing fear….. Did they START like that? Or were they MADE that way by negative exposure to burnt out faculty?
Overall, I will tell you that the efffect of the event was to TOTALLY re-enforce for me the reason I wrote ‘Routine Miracles’ . Whatever the etiology of the problem, the task is clear. As long as personal income in their highest aspiration, the art of medicine suffers.
As long as the mind of the student is warped by “I am UNSAFE, I must HIDE in a safe corner’ then the art is harmed.
The goal is to have them work on ‘How do I solve this medical problem, this riddle, cure this disease”
the Fisch
I make enormous numbers of hospital presetnations each year. I am practicing my art. Almost all of them are for free. to reach people.
At a hospital yesterday, I have been many times before. The crowd is dead. New 3rd and 4th year students on their first month in the hospital for some of them. For others, the first taste of a little competence.
Dead Group.
I have a miniatrure existential crisis. “HEY!!!!! WAKE THE HELL UP!!!.”
“Alright group, forget the boards!! Don’t read any books!! don’t sign uip for classes!!! None of you are going to leave this room until I feel satisfied” I start to make sure they know how to handle the management of an acute myocardial infarction and a pulmonary embolus. We go through the details. It is not that they are more wrong than other groups. Wrong answers are universal. I use to say that the only thing that was different between groups was the amount of the sense of humor. Now I will add something.
The difference in in how much they care. I was VERY angry and upset. I called my scheduler. I was scheduled to go the the Med school in the Carribean where half the group was from. I Shout into the phone “I will call you back in 45 minutes. I will see whether I feel that I should go.{”
I tell the group
“I am here to engage with students and residents who want to try to know everything and to BECOME something. I am not here to help you ‘Phoney it up’ to delude some poor program director into thinking he has somebody better than he has. If you want to travel with me, you better be ready to start moving your ass now.”
I have an existential crisi. ‘What am I contributing to around here?”
Then… it FINALLY seems to be going well. I say “Be enthusiastic!!! This is the BEST time ever to be in medicine, there is finally going to be universal coverages and the research budget is at an all time high. Get Happy!”
And a student says…”Don’t you think universal coverage will lower our incomes?”
Next one”Don’t football players make more than us?”
Next one “Can you get me into an orthopedic residency? I hear it isn’t what you know, it’s WHO you know.”
Not ONE student, not ONE said anything about the fantastic concept we may be a hair’s breadth from more universal coverage, or that the research budget was TEN billion dollars higher than it was.
I leave decimated
A friendly man comes to class this week. I have met the man before. Jovial, warm and gentlemanly, he sports a shiny newly bald head and we joke about our similar hairstyles. On the second day the man comes to me. ‘YOu know, I was a BIG professor in my country Fischer. I left when I was 54 so my family would have a better life than in Cuba.”
The man does not complain about the effort of re-learning all of medical school in his 50’s. He does not feel embarrassed to be with student 30 years younger than him. He makes no excuses for having a hard time absorbing all the new information. He does not get defensive or argue points of management in class with me to show everyone in class that he knows something, and ‘is somebody’ as often happens.
He just seems happy.
“I have tongue cancer Fischer. I have metastases to my lung. I got chemotherapy three days ago. But, you know, I want to pass my boards so that my three children who are all doctors will see that their father went all the way. Youknow that movie ‘The Bucket list”? the list of things to do before you die?
‘You are on my bucket list Fischer”
“I am 64 years old now, but the greatest pleasure I have in medicine is the week I sit in class with you. I just have fun. I was a teacher, but just to keep people awake for 8 hours straight is a big accomplishment. I am happy when I am here with you. I just wanted you to know”
This is the most jarring thing I have heard for a while. THe man says ‘I feel good, I might die this year, I might die next year, but I wanted to spend this week here in class with you”
I think about how people see me. I think about the constant quest for ‘Meaning’ in ordinary things. ANd I think, I will put spending a week with the warm, gentlemanly, Cubano on my bucket list.
WHen in class the teacher has to see the future. To feel the future. THe future has to call to the teacher. The effect of what is taught must be felt as if it were the present. Not theoreticlly, but in actuality. Time itself must be conquered THe future must be felt as if it were the present fact. The need of the future, the good of the effect of the information must be felt in the present. The future must call backwards to you who teach. The greatest need must be perceived. It must be as if the future was screaming at you. THen you have the energy you need to make aliveness flow through the material you are presenting.
Facts, data and information, no matter how seemingly powerful and important is not enough. THere isn’t enough energy in a ‘fact’ to make it, by itself, important. Even in the apparent importance of medicine, facts do not have enough power. data is not powerful. The good of the data, the pain relieved, the goodness achieved, the purity of clear translucent knowledge must flow through the teacher into the present.
THe mind of humans is very vast. More than all the computers in New York City, the mind can contain it all. IF what you are teaching does not feel powerful enough to want to shout, to scream, to pour every neurotransmitter, every emotion into your teaching then you are in the wrong job.
Repetion is powerful. Constant study and a passionate desire to purify the message even though filled with the raunchiest metaphors, similes and analogies is necessary. It will deepen. As surely as a pianist plays with passion. deeper and more beautiful.
as time goes on, swimming amidst the ordinary facts of the days classes, the details of the books and the desparation of the beginning of the application season, I think about the place I have in people’s minds. It is hard to be cognizant of how others see me, in terms of the place I have for them. the ordinary ones just looking for a good grade, the terrified ones, afraid of the ghosts of the past or the unfertilized gametes looking for something much higher.
Hello, everyone. Welcome to the SeeFisch Blog. I hope you enjoy my posts. As time goes on, I will be answering questions from medical students, sharing information about my work, and updating you on news with my new book, Routine Miracles.
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