A fresh voice from med school: LUKE MYHRE

Clearly the last few weeks of intensive Swahili and repeated transition and goodbye have taken a toll, and blog writing has lagged for me.  If you're on our prayer e-mail list you should have heard from us a couple of times in August (email me if you wanted to but did not).  

Last week Luke was on break from his 3rd year of UVA Medical School and took time to write his family and some friends a thoughtful, reflective email about his experience thus far.  With his permission, here are his thoughts.  He can use your prayers as well, so read and remember him.

The date is August 18th, I'm at a suburban poolside outside of Boston visiting my roommate's family, a 90's summer playlist is booming and we have officially completed the first half of our third year at UVA medical school. This is our week to sleep in, spend time outside, and let the minutes trickle by without panicking about tomorrow's responsibilities. 

We are only a fraction, a sliver, of our way through medical training. Already thoughts of specialty choices, residency programs, MPHs, and research opportunities, loom. For all practical purposes we are the bottom of the food chain. We hold the retractors, we fax requests for medical records, we call family practices to set up appointments, we wait our turn to listen to the pneumatic lung or a mitral murmur. 

In the last year, however, a crucial line was crossed. With the advent of our first board exam, pure theory was exchanged for the gritty mess of the wards. Flashcards were replaced with scrawled patient notes. We began scrolling through the EPIC medical record system instead of question banks. Late nights at the library fell way to shifts scuttling around the Emergency Department. The shift from wide eyed trepidation to undeserved confident swagger is already underway. 

It is hard to avoid the cliches, to bring a fresh perspective to a profession packed with sharp and insightful minds... but wisdom from the mouth of babes, right? 

Two experiences stand out, as book ends. 

The first, in my first month, the beginning of a life. My first day on the labor and delivery service on the eighth floor I scrubbed in to my first cesarean section. One of the most common surgical operations worldwide, it is a dramatic decision, a rescue mission. Armed with forceps, clamps, scalpels, and scissors, we slice and tear through each layer of the abdomen (carefully delineated in every medical student's mind: skin, superficial fascia, deep fascia, anterior rectus sheath, rectus abdominus muscle, transversalis fascia, extraperitoneal connective tissue, peritoneum, uterine wall ). There is no subtlety, little delicate detail. Surgeons make a small incision in the muscular vascularized wall of the uterus, insert two fingers, and literally tear it open. I was engrossed in the anatomy, the blood, the different tools and techniques. The amniotic sac burst in a literal flood of fluid, latex hands plunged in to the muck struggling to get a hold. Out of this chaotic mess emerged perfection. It's ironic, in retrospect, to be so unprepared for a moment that I knew was coming for hours. I shouldn't have been so taken aback. So overwhelmed. But I was. 

My left hand supported the baby's neck while I dried him off, wiping some of the vernix caseosa from his eyes. I was thankful for the surgical mask, because the thing is, I couldn't stop smiling. I think I would have laughed out loud, from relief and joy and sheer wonder, if it wasn't for the stern surroundings.

From many waters came a mind and body that fit in the palm of my gloved purple hand. 

The second, in my six month, a life already ended. I was on call for internal medicine with our team: student, intern, and resident. We were given the responsibility of admitting new patients, and manning the code pager (auspiciously lined with red warning tape). When the pagers went off, I wasn't even sure I was supposed to follow- they were normally just drills and medical student's usually aren't in the inner circle know-how. The room was a logistical and moral mess. Nurses and techs fumbled at both arms to put better lines in the patients vessels, one doctor had started CPR, my resident stood at the foot of the bed shouting instructions. You could taste blood and feces in the air. I primed bags of blood by pumping the cuff (inflating a bladder that would force the blood through the tubing into her system at a much higher rate than gravity would normally allow) while they gave multiple pushes of epinephrine and slapped AED stickers onto her chest. She was too big for most nurses to get any leverage with the chest compressions, so I stepped up to help, rehearsing the rate, depth, and placement, desperately acting like I had done this before. Each compression made a ripple spread out from her sternum, the sheer volume of fat between my palms and her heart absorbing the majority of the force I pressed down with. After my two cycles, an eternal four minutes, and 400 compressions, I called out a thready pulse in her left radial artery. Her eyes rolled back in her head in pure terror. Her heart started to beat again, but after we handed her off to the intensive care unit team, she died. My own heart hurt.

Both, moments of emotion and blood, flirting with the fine line between life and death. The first, an example to emulate. A decision to act, to intervene, to yank an infant out of it's suffocating prison of muscle and fluid, as it's heart dropped to dangerously slow rates. A nonpareil glimpse into the potential of every soul. The second, a lesson that still weighs on me. A futile shot at an impossible chance, a failure to foresee a very real possibility (I later learnt her heart stopped because of massive blood loss into her bowels- she was known to be in awful health and unstable, and was only 'full code' because her family had not accepted the harsh realities of her current state). We filled her last moments with pain, we smashed ribs and bathed her brain in adrenaline to keep her tissues oxygenated for a few extra minutes. I don’t think we are very good at knowing when less is more. 

This time, for me, is not necessarily about making a difference. I am often a wallflower. It is about learning. We learn medical technicalities- drilling drugs and differentials in every free moment… But I’m also feeling out the edges of my own personality, charting the spheres that augur 80 hour work weeks. 

I've learned that I don't shy away from a challenge. Even wallflowers need to speak up if they want to get their hands dirty in the muddle that is health care. Sometimes you wish your means justified the ends. I've learned that I truly enjoy the mystery medicine, the complex web of physiology and morals. I've learned that one of the few things I fear most is mediocrity, that I'll strive for my utmost wherever I end up.

I'm frequently asked what specialty I plan to pursue: what kind of doctor do I want to be? The only answer I have now, is a doctor who is committed and faithful, one who seeks to liberate the oppressed, one who works so others may live, who sacrifices for those he loves. 

I'm impossibly far off, but I'm raring to go.

Pray that God would give me love for all. May he be with you.  

in Love,

Luke.