I have things in my life that I call my “sentinel activities”: cubing, music, running, studying. They’re activities that push the boundaries of my body and mind, and I can measure all of them with extreme precision.
With cubing (i.e. one-handed speedcubing) I can measure my dexterity and reaction speed with millisecond resolution. That is, I know I should average sub-17.50 seconds and if I can’t, I start thinking that my fingers are sluggish or shaky because they’re cold or I’m hungry. Maybe i’ll intervene by eating something or jump around to get blood flowing. In the future, cubing will be the first to alert me when arthritis or carpal tunnel syndrome begin to set in.
Piano and viola are part focus, part memory, and part dexterity. They’re somewhat redundant with cubing, but they’re extremely sensitive; I can sense if I’m even a little distracted or if my wrists are a wee bit fatigued when I kinda forget or botch certain passages. Which… I’ve forgotten about a third of my repertoire already, uh oh.
Running is my newest sentinel activity. It measures cardiopulmonary fitness and abdomen-to-toe musculoskeletal intactness, and it’s naturally quantifiable on repeat trials. For instance, if I could run 6 miles at 6:40 pace two months ago before and struggle to run a single mile at pace now, I would know something is wrong.
And that precipitous drop in performance are totally happening right now. So yeah, I know something is wrong, and that something is the medicine clerkship (MEDICINE) plus research plus everything happening outside of med school.
I’m tired! I’m not getting enough sleep, I’m not eating enough regularly enough, and running was — as predicted — the first activity dropped from my schedule. As a consequence, I’ve rapidly deconditioned as my legs have lost muscle mass and relinquished their preferential blood flow.
All that energy is being redirected to the final and most important sentinel activity: studying. Med school. It’s vaguely evaluated (ahem, grade transparency) and it takes a tremendous amount of attention to maintain (like 90-100 hrs/week now), but thus far it’s developing adequately (I hope).
Funnily enough, my sentinel activities — or their utility in monitoring my body’s and mind’s function — is partially a consequence of that medical education. They’re far from the standard metrics like ADLs, or MMSE, or METs on stress tests; my sentinel metrics have high degrees of inference and are easily confounded, and they’re also really greedy. My time on medicine has made that painfully obvious.
Because my goodness, people get REALLY sick. When a body is failing, it crashes hard. Not a single bodily function can be taken for granted. In the hospital, we have a whole different world of metrics for measuring the body’s capacities, and they scare me.
Forget running 6:40 miles. Forget jogging, or even walking. In the hallways above the lights hang “walk your way to RECOVERY” signs every 25 feet. They loop around the ward and has a celebratory banner at 250 feet exclaiming “well done!” For many patients, getting OOB (out of bed) is a monumental accomplishment. Nurses or PT are often present to assist.
Dexterity’s too ambitious. For coordination, we return to the basics. Can you touch your nose and then my finger a few times? Can you walk? Do you have trouble chewing and swallowing? Need help going to the bathroom? In other words, the ADLs, or “activities of daily living” — dressing, eating, ambulating, toilet care, hygiene. These are actually the scientifically proven metrics we use for assessing one’s functional capacity.
To test brain function, we ask them their name, where they are (hospital), what day it is. It’s part of the MMSE, or the “mini mental status exam,” and obviously it’s bad when someone isn’t oriented to self, space, and time. Those deficits happen sometimes. Actually, it happens kind of all the time.
How is this real? Why is a hospital a place where the most fundamental bodily functions are routinely compromised?
Moving around is often hindered by medical equipment and, while bedrest is therapeutic, on some floors it’s so odd to see patients OOB that housestaff comments on it. Sometimes they’re instructed to go back to bed. Quick fixes to complaints are favored, and they come in the form of pharmaceuticals with side effects that range from constipation to jitteriness to sedation. Even for the mentally intact, there’s little to do other than watch TV, read books, or be entertained by visitors only during visitor hours.
Hospitals can help out with incontinence with indwelling urinary catheters, can override eating with PEGs (feeding tubes), can co-opt breathing entirely with Trachs and vents. All of that is cool but also extreme and unnatural. It’s like your body doesn’t belong to your body anymore.
Being a patient in the hospital sucks! Like okay, it’s necessary given the preceding illness, but being admitted exacerbates your suffering in so many ways. I kind of expect every single admitted patient to be constantly flipping their shit. So thanks, patient patients. Maybe that’s why they’re called patients.
While patients are enduring their hospitalizations and having so many of their bodily functions affected, I feel a bit guilty for going home and whining about my faltering sentinel activities. Even as med school is screwing with my body, med school is teaching me what a privilege it is to have a healthy body.
So, internally, that’s what I celebrated this Thanksgiving. I’m grateful for nimble fingers and nimble mind. I’m grateful for lungs that breathe okay even if they’re funny shaped, for knees that bend straight and for feet that don’t blister and for bones that don’t break. My intestines absorb nutrients, my macrophages eat dutifully foreign stuff, and my kidneys filter and resorb the right chemicals. I’ve got a brain that hasn’t been hypoxic or too atrophied yet, so I’ll count that as a huge success.
Combine that with everything else my body does for me and I get to spend my life solving cubes, playing piano, running amok, and working towards becoming a doctor, and that’s pretty great. Thanks, body.
The first third of this post was conceptualized in February, and the rest was nearly complete the week of Thanksgiving. It was posted retroactively on 12/5. No joke, the medicine clerkship really is screwing with my schedule this badly.