Jan 29, 2024, 06:28AM

Second Year Syndrome

Learning a fundamental concept of artistic creation from Merck Manual.

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First-year medical students, accustoming themselves to performing human autopsies, often play tricks on each other. A doctor, a family friend, who later became a respected generalist, once told me that he, as joke for a party that evening, borrowed a human hand from the cadaver he worked on that day. All the party guests, other medical students, were in on the joke except for the girlfriend of one of the other students, who was training to be a nurse. That night, after everyone was a bit tipsy, he asked her to go to the kitchen to fetch the “snack” he’d prepared. When she opened the refrigerator door there was the severed hand, sitting on a bed of lettuce. He told me that since she was a nurse he knew it’d be okay, so even though she screamed, she quickly recovered and understood what had happened.

I wondered afterwards if he’d spared me other gruesome variations on that story. Would they sew together strange versions of human bodies for laughs in the autopsy rooms? Something like drunk musicians jamming for fun? I can image at three a.m. a bunch of guys stitching together a three-headed corpse, maybe a head on the back, one attached to the stump of a leg. Consider that he told me that once at a fellow student’s house he’d seen the top of a human skull used to hold jelly beans. It makes one wonder where Marcus Welby ends and Ed Gein begins.

My father had a large collection of medical textbooks. One was dedicated to pediatric diseases and was filled with black and white photos of children and teenagers, all with black rectangles over their faces, each illustrating some horrendous physical condition. There were deformities, skin conditions and rashes of every conceivable type. It’s where I learned about elephantiasis and progeria. They were all extreme cases, so, for example, if chicken pox was illustrated, it was the equivalent of terminal chicken pox. A catalog of the horrors which, for members of the medical profession, are simply the daily grind. I hoped that somehow that all the kids in the book miraculously got better. Maybe they did.

“Intern’s syndrome” or “second-year syndrome” sometimes occurs among medical students. This is where they start imagining that they have the diseases they’re studying. For example, a student has an allergic reaction to a tuna fish sandwich and he or she becomes convinced that they have beriberi. Some say that this is a myth but it’s reasonable to me, for it’s the environment which surrounds them, it isn’t abstract, they know it’s a possibility.

Among the books sitting on the shelf was the Merck Manual, which is a list of every known disease accompanied by the usual treatments given by doctors. Thumbing through, I could see where one could easily do a self-diagnosis of any number of rare and fatal illnesses. A gift for any hypochondriac friend.

It was thanks to the Merck Manual that I learned what has become a fundamental concept of artistic creation. It grew out of reading about the procedures taken before performing surgery. The list is endless and involves the patient, the surgeon and his team. These include items like sterilizing all the instruments, washing hands with bacteriological soap, disinfecting everything, checking X-rays, performing blood tests, etc. Then there are dietary considerations before anesthesia. At the end of this list there was a single sentence. It said something to the effect that in case of an emergency all the aforementioned rules are to be disregarded. Meaning, if the patient is dying, open his chest with scissors if necessary.

That last sentence described the artistic experience as I know it. One may plan, create rules, lay down a schematized form, etc. but when working, all that disappears. It’s in the act of creation and solving the problems at hand where order’s established.


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