residency

48 - Hexagram Forty-Eight: Ching The Well

Deep Waters Penetrated and drawn to the surface: The Superior Person refreshes the people with constant encouragement to help one another.

Encampments, settlements, walled cities, whole empires may rise and fall, yet the Well at the center endures, never drying to dust, never overflowing. It served those before and will serve those after. Again and again you may draw from the Well, but if the bucket breaks or the rope is too short there will be misfortune.

SITUATION ANALYSIS:

There is a Source common to us all. Jung named it the Collective Unconscious. Others hail it as God within. Inside each of us are dreamlike symbols and archetypes, emotions and instincts that we share with every other human being. When we feel a lonely separateness from others, it is not because this Well within has dried up, but because we have lost the means to reach its waters. You need to reclaim the tools necessary to penetrate to the depths of your fellows. Then the bonds you build will be as timeless and inexhaustible as the Well that nourishes them. above: K'an / The Abysmal, Water yin yang yang below: Sun / The Gentle, Wind, Wood yin The Well Wood is below, water above. The wood goes down into the earth to bring up water. The image derives from the pole-and-bucket well of ancient China. The wood represents not the buckets, which in ancient times were made of clay, but rather the wooden poles by which the water is hauled up from the well. The image also refers to the world of plants, which lift water out of the earth by means of their fibres. The well from which water is drawn conveys the further idea of an inexhaustible dispensing of nourishment.

THE JUDGEMENT

THE WELL. The town may be changed, But the well cannot be changed. It neither decreases nor increases. They come and go and draw from the well. If one gets down almost to the water And the rope does not go all the way, Or the jug breaks, it brings misfortune.

In ancient China the capital cities were sometimes moved, partly for the sake of more favourable location, partly because of a change in dynasties. The style of architecture changed in the course of centuries, but the shape of the well has remained the same from ancient times to this day. Thus the well is the symbol of that social structure which, evolved by mankind in meeting its most primitive needs, is independent of all political forms. Political structures change, as do nations, but the life of man with its needs remains eternally the same-this cannot be changed. Life is also inexhaustible. It grows neither less not more; it exists for one and for all. The generations come and go, and all enjoy life in its inexhaustible abundance. However, there are two prerequisites for a satisfactory political or social organisation of mankind. We must go down to the very foundations of life. For any merely superficial ordering of life that leaves its deepest needs unsatisfied is as ineffectual as if no attempt at order had ever been made. Carelessness-by which the jug is broken-is also disastrous. If for instance the military defence of a state is carried to such excess that it provokes wars by which the power of the state is annihilated, this is a breaking of the jug. This hexagram applies also to the individual. However men may differ in disposition and in education, the foundations of human nature are the same in everyone. And every human being can draw in the course of his education from the inexhaustible wellspring of the divine in man's nature. But here likewise two dangers threaten: a man may fail in his education to penetrate to the real roots of humanity and remain fixed in convention-a partial education of this sort is as bad as none- or he may suddenly collapse and neglect his self-development.

♦ Two handed tying with either hand ♦ Basic suturing skills ♦ Knowledge of basic surgical instruments: names and uses ♦ Repair of simple lacerations and skin closure techniques ♦ Placement of central lines ♦ Basic competency in laparoscopy skills lab ♦ Fluid and electrolyte management in trauma and post-operative patients. ♦ Pain management in post-operative patients. ♦ Parenteral and enteral nutrition in post-operative patients ♦ Participation in initial resuscitation of the trauma patient ♦ Evaluation of patients with right lower quadrant abdominal pain Non Clinical Skill Set: ♦ Be able to perform and document a complete history and physical examination with differential diagnosis and therapeutic plan. ♦ Write post-operative orders. ♦ Write complete operative notes. ♦ Write daily progress notes. ♦ Develop communication skills with patients and families. ♦ Gain appreciation of the impact of psych social stress associated with surgery, malignancy and trauma on patients and families. ♦ Development of communication skills with non-surgical members of the health care team to optimize patient care. This includes nurses, patient care managers, physical therapists etc. PGY-II: Clinical Skill Set: ♦ One handed tying with either hand. ♦ Basic laparoscopic skills. ♦ Mastery of the Basics of Laparoscopy Lab ♦ Begin advanced skills lab. ♦ Repair of complex lacerations. ♦ Placement of central access and invasive monitoring including Swan-Ganz catheters, arterial lines and intubation. ♦ Assessment and management of complicated post-operative patients in the intensive care unit with ventilatory and inotropic support. ♦ Evaluate and manage patients in the emergency room with abdominal pain. ♦ Evaluate and manage patients with soft tissue infection. ♦ Interpret chest x-ray, abdominal x-ray, and basic CT scan and ultrasound. ♦ Initial assessment of multiply injured trauma patient Non Clinical Skill Set: ♦ Improve on communication skills with patients and families. ♦ Improve communications with health care team. ♦ Teach skills and knowledge to intern and medical students.