The Game of Life, and How Best to Play It

Most of these little capsules and pills don't taste substantially better coming up than they did going down.

Board games have fallen somewhat out of vogue these days. Does anyone here remember "The Game of Life"? It was, if I recall correctly, much like "Monopoly" except with a distinct pro-college-or-university agenda. In playing, one was forced to  decide very early in the game, once completing high school (I'm not even sure there was even an option for not completing high school), whether to go immediately to work and to begin earning money, or to delay work and earning power by first obtaining a college or university education. The outcome was  rigged in favor of those who completed college.  i don't remember if there were options for graduate or professional school and, beyond that, options for sub-specialization in a field such a medicine. I ought to find it the next  time I go home to my parents' house, or if it's in the game room on the pediatric oncology floor, where I will spend next week.

When the topic of the game came up in casual conversation recently,  Cool Guy suggested that, if such has not already happened, the game is ripe for an update based upon people choosing obscure majors for which they cannot find jobs in their fields of education, or for those who completed their educations while incurring tens of thousands of dollars of debt in student loans. Some of those with heavy debt, (I'm talking about real-life college students now; not people playing "The [board] Game of Life") who chose majors wisely,  stand a reasonable chance of paying off their loans early in their careers, or at least prior to projected retirement age, while others may as well add the  student loan payment to their projected monthly budgets for as long as they live and breathe. Another consideration is that "college" and "work" are not mutually exclusive.  An ambitious young person (an obvious person comes to mind here: I'm sending  shout-out to Judge Alex Ferrer of "Judge Alex" [now available in rerun format on a local channel near you] TV show fame) who obtains a full-time job, particularly a young person who worked before graduating from high school and gained adequate experience to be considered for an above-minimum-wage-paying position, and who took advantage of options such as community colleges, which typically offer the lowest possible cost for the first two years of a student's education, may have the best of both worlds. Furthermore, academic merit scholarships and advanced placement courses figure into the equation in the real world.  In short, "The Game of Life," as it was played when i was a child, is now both obsolete and misleading. I may find out the nitty-gritty details next week if "The Game of Life" is one of the board games I end up playing while interacting with oncology patients and helping to distract them from anxiety and physical discomfort as they pass the time waiting for more tests, procedures, and test results.

It's been a rather event-filled week for me, with much of it on the rough side of exciting.  I wish I could say more about the main event, but that is someone else's story to tell, and the person will tell it if and when he or she is ready. All that is left for me to do is to ponder the miracle of life that we see every day yet all too often take for granted, and to take anti-exposure prophylaxis (PEP) because of an unlikely but still possible exposure to the human immunodeficiency virus, more commonly known as HIV.

My possible exposure is through cutaneous non-intact skin. Even if the source of my exposure were HIV presently positive, with timely treatment my risk would be something like 0.09% because of the rapidity of my treatment. The imperative is for the exposed person to receive anti-exposure prophylaxis within 72 hours, and the goal is for it to be given within 1 hour. I received it within 20 minutes of exposure. The quick-result test indicated that the source of my potential exposure is not HIV positive. The more accurate lab tests probably come back tomorrow. The sucky part of it is that I need to continue with the post-exposure prophylaxis for the unlikely possibility that the source that exposed me is, himself or herself,  in such an early stage of HIV that the person is not yet showing up as positive but eventually will. It's incredibly dubious, but were it to turn out that the source was positive, I'd have no one but myself to blame for not having followed through with the post-exposure prophylaxis.

At this point, I cannot tolerate the oral forms of the antiretroviral drugs. If I throw them up, even (I know this is gross, and I apologize) if I pluck them out of wherever I threw them up, the experts cannot with absolute certainty determine how much of the drug I absorbed, so they can't necessarily assume it is safe to give me again the drugs that turned up in the vomitus. At this point, the best alternative  is intravenous administration. There's a possibility at some point that simple injections might be another alternative. (Who would ever have thought that I, Alexis, who lined the floor of my bedroom with aluminium foil, in addition to attaching jingle bells to the handle of bedroom door, in order to prevent my father from sneaking into my room while I slept and giving me a flu shot just because I hated injections in any form that much, would concede willingly to undergoing injections in favor of swallowing pills? For the record, my subterfuge wasn't successful. My dad was able to slide the business end of a pie server through the crack of the door to silence the jingle bells, and he silently cleared a path through the aluminum floor covering to make it to my bedside and to inject my arm with the dreaded inoculation before I woke up and, at 5:00 a.m., alerted the entire neighborhood to the injustice of what had just occurred.)  The IV administration is inconvenient, and it deprives me of much-needed learning time on the job. Still, it's the only alternative at this time, and it's also a way for me to obtain much needed hydration, because the IV-administered drugs still cause me to hurl; it's just that I'm not hurling pills that I just took and very much need to stay in my system.

Next week I report to the pediatric oncology unit. Professor Larry Bakman has offered to go with me the first time I enter the unit. It's a scary thing, and I had considered asking my dad to accompany me, but at some point my reputation will be harmed by the perception of others (deserved or undeserved) that I cannot accomplish anything without Daddy helping me. If Professor Larry just happens to turn up when it's time for me to enter the unit, no one will know why he's there and won't necessarily connect him with me. He said it's not something he would do for just anyone, but that a twenty-one-year-old prospective physician deserves more consideration in that regard than does an older med student.

Before we're allowed even onto the pediatric oncology floor, we're subjected to a mini-physical exam. Professor Larry can pretend he was asked to show up to help with that. We'll still be subject to some scrutiny each morning, but will be expected to self-monitor to some degree once we've been told for what to look. I will probably pass the physical despite my less that optimal condition at the moment. I've been told to interact (though not physically) with the patients and to observe procedures, but not to perform or even to assist in procedures myself. I won't be inserting any IVs for the next four weeks or so, except in myself.

I assume the next week will be filled with a great deal of violin and piano playing for patients, puzzles, and a lot  of Uno,  Candyland, and other board games perhaps including the aforementioned 'The Game of Life" (video games are provided, but we endeavor to get the children to do something besides X-box, Wii, and other electronic activities; we should serve as good examples to the parents - to remind them that something doesn't have to be plugged into an electrical outlet or to contain batteries in order to be worth doing) depending upon the patients' ages, and a lot of talking to children, in addition to  a great deal of observation. Furthermore, I now have more than I previously had in common with the children receiving powerful drugs that cause their stomachs to evacuate their contents  on a regular basis. The children and I can commiserate with one another and compare notes.  In the past, I've been allowed to participate more actively in rotations than has the average third-year student. Now I will experience what it is like for most of the rest of them. 

My original schedule was for me to move onto obstetrics and gynecology following the pediatric rotation. I don't want to go into that rotation without the health clearance for more hands-on involvement in the procedures, so my schedule is being flip-flopped. I'm doing my psych rotation starting Monday. My OBGYN rotation will follow the psych rotation. While I'm disappointed not to be going directly to the OBGYN rotation, I greatly appreciate the flexibility of the person,  whoever he or she may be,  who made the change on my behalf. 

I am not nearly so jazzed about the psych rotation as I was by the prospect of participating in OBGYN, but I recognize how very fortunate I am  that those in power caused this change to happen. The psych rotation was not something I was anticipating with any particular degree of eagerness. Now, however, if I'm cornered by a dangerous patient, I have a secret weapon in my arsenal. "You don't want to mess with me!" I can tell a crazed patient. "I may very well be HIV-positive!"  Since I'm stuck with this limbo status, I may as well use it to my advantage in the psych ward. Additionally, I should remind myself and everyone else that not all psych patients are crazed maniacs. I was a psych patient, and not all that long ago.

In 28 days, both the potential source and I will again be tested. At that point, if nothing appears amiss, I will get on with my life. The source will be left alone entirely as far as HIV status is concerned from that point forward. I'll have 3-month and six-month lab checks -- possibly unnecessary, but because of the field I'm entering, i owe it to patients with whom I'll come into contact to do what is practical to ensure that I'm not infected.  At that point it will be time to leave well enough alone. I could also be carrying Lyme Disease, a latent form of the Bubonic Plague, Rocky Mountain Spotted Fever, or an undiscovered form of TB that isn't caught by routine skin testing. At some point, one must assume that all is well or one would have some indication to the contrary.

Meanwhile, the nausea just won't quite go away. I'm going to look like a bona fide anorexic or an albino Ethiopian refugee before this is over.  I'll try different anti-nausea drugs until I find one that actually works. My peers have been wonderfully supportive. They've made jello for me and offered to insert my IVs. They've offered to cover shifts if I can't drag myself to my assigned location. So far, I've managed to be there physically, though I've spent a fair amount of work time worshiping the porcelain goddess. I'd feel guilty for the amount of on-the-job time I've spent barfing, but we're not getting paid a cent. We're free labor -- practically slaves. 

The administration mysteriously turns up wherever i am entirely too often for it to be a coincidence. I've given up on thinking there's something subversive about their surveillance and am growing less paranoid. The deans and other important people not spying on me to ensure that I'm treating confidential matters as such, or, for that matter, ensuring that I am not attempting to exceed the scope of the training I've received thus far. They're checking up on me because they're concerned for me. Even as recently as a year ago, I may have had difficulty in accepting this, but a basis in reality has supplanted conspiracy theory in the default mode of how my mind operates. 

Meanwhile, if anyone knows of any great homeopathic remedies for constant nausea with frequent vomiting, I'll listen. I've gone through 1/4 of a box of ginger snaps as well as fresh ginger, and neither does a thing for me. If the remedy you suggest involves anything resembling tossing frogs' legs (fresh or freeze-dried)  into a blender, liquefying the frogs' legs with the blender's most powerful setting, and mixing the ensuing concoction with wine vinegar and vanilla extract, please do not take it personally if I neglect to try your magic potion.

Ciao. I shall try to get some sleep tonight, but I'm not overly optimistic.

This is one of the blast-from-the-past games in which I'll probably find myself engaging in next week.