Thursday, March 10, 2011

The Pigeon Tango, by February blogger of the month Irene Koplinka-Loehr

Pre-mushy tomato, Bedouin flatbread, zatar with olive oil, and a fried egg: my meal, collected. I heard the key in the door as I poured hot water into the largest of the broken handled mugs and sidled over to the kitchen table. Enter Martin (housemate), prototypical perky greeting, slow toe-outturned saunter, cumbersome bike barely fitting through the frame. Cuss words, beating wings; enter pigeon, blinded, frantic, poop splats onto the rarely, but recently, cleaned tile. All of my recently acquired knowledge of viral infections transmitted from pigeon feces flashes through my brain. Disoriented, she searches for perches. Recounting the last time he dealt with a bird in an apartment Martin reaches for the garbage can. I grab a dishtowel—to usher her, door-ward. Minutes of pigeon tango ensue. Suddenly, to my dismay, she is knocked by the garbage can, then trapped, wings beating on plastic, and carried out in our now multi-use, garbage disposal. A cracked egg, yellow yolk spilling from perfect white shell, gleams in the light shed on the landing. A mother pigeon.

Natural disaster, or pigeon, it is how we act in emergencies that is perhaps most telling. After three modules that left me feeling like I wanted something I could sink my teeth into, Disaster Management, the finale, is surpassing expectations. This world, ruled by split-second decisions and rapidly degrading patients, begs the question, do ethics change on the edge of time?

The last two days of our weekly schedule
in all its color-coded glory!
In triage, who ultimately takes responsibility for the lives of patients? Do you choose to pass the responsibility along, to operate on someone without thinking about the conditions into which they will enter the moment you release them from the non-sterile tent? And if the family they will return to, in the event that their family is alive or locatable, has neither food nor water? In releasing a surgery patient to their family you compromise the family: now they decide between staying with the patient or searching for food; between sacrificing their own tenuous health or watching the patient suffer. Dr. Laor, salt and peppered clown ‘fro and bulging stomach, stared us down before embarking into an animated explanation: ‘As a physician here, you compartmentalize. You become two people in one, you learn to stuff one back into the bottle like the devil. You need to be the butcher, to treat only those who have real survival potential, to manage disaster and take responsibility for the lives you witness. You all never learn this stuff anymore. We revert to an earlier form of medicine, one without the advances of technology. One with palpation, analysis of pallor; one that includes the ability to differentiate between a temperature of 38 and 40 with the laying on of a hand.’ He quieted, and in his eyes I could see that he found us wanting, shadows of the former greatness this profession had once held. I looked back into his eyes, the last phrase echoing in my mind. He had roused the dream that brought me here, brought me searching for a different kind of medicine; a medicine that would teach me both to navigate a burgeoning technological landscape and to rely on my own two hands.

"Healer's Art" course members...therapy for physicians.
Having smashed our notion of good patient care, Dr. Laor pushed deeper. Posing a scenario in which a country, recently cyclone devastated, accepts only the aid that passes through their oppressive military dictatorship—taking a cut of both money and supplies—he blithely asks: which do you choose, human rights or people’s lives? Does there come a point at which you must set aside or ignore human rights injustices to help those who are acutely in need? If saving thousands of citizens is contingent upon supporting an oppressive regime, do you do it? I found myself comparing to a more micro scale: do you save someone who you know has committed a crime? Yes, with the hope that they will then be healthy enough to stand trial.

Mounds of brilliant veggies at the entrance to the Beer
Sheva shuk.
Some individuals are naturals in emergency situations—calm, collected, focused, they are at their best. Some are better when at their ease, to ponder, create, invent; brains buzzing with activity. On Tuesday AMSA hosts the inaugural TEDxMSIH, licensed by TED, our independent event is themed ‘Inspiration to Action.’ The evening features those individuals who develop ideas creatively when at ease, chosen to share their passion with MSIH and the wider community. Passion inspires passion, as such, I aim to gain insight into the graceful escort of flighty fowl from indoor enclosures.  - Irene Koplinka Loehr