Thursday, June 05, 2014

and it's getting nearer, soon it will all be true

As the Monty Python quote goes, 'I'm not dead yet.'

Real life pummeled me but good the last few months, the final push before residency ends intermingled with personal drama. Distracting me from the 'what's it all about' that usually occupies my mind at times like these. Because in my life, because of these odd back roads I've taken to get to where I am, there have been a lot of beginnings and endings, or chapters, if you will.

I've had this theory, and maybe it's a theory that only applies to my life, but I think there are but a few people you can hope to carry along with you as precious from every chapter of your life. I've always held this belief, but I think it's become more nuanced for me now. Because there are people in my heart from different chapters in my life nowadays who I haven't spoken to in years- and that is okay, because such are the realities of life, time zones, delineating circumstances.

Even though I've always had this theory, I think I expected to come away from medical school with a solid handful of people that were mine. Instead, it turned out to be one person, and it wasn't the person I expected. But it was the person who probably understood me (and still understands me) the best from those days. There were other people to whom I thought I was closer. But they faded away, or turned out to be false, or whatever it was that actually happened- they were gone in the end.

When I started residency, I was more wary. I expected to just keep my head down and work. I didn't take stock of the other residents the way I did in medical school. The work was plenty enough to keep me busy, too busy to worry about likemindedness and comraderie. And then- it just happened. And still, it took a while, it took some evolution, some shuffling of chairs, but in the end, there are more than I expected who really get me.

Sometimes I wonder how much of that is the world, and how much of it is the barriers I put up against the world. I've always been someone who gets blue and brooding when people don't understand me, even while knowing that part of the reason is that I don't explain myself, I don't show myself. I think the maintenance of this blog over the years is probably a perfect example of that- I very much doubt most people who know me IRL would guess that I spend (well, used to spend) time writing, contemplating, musing. And that has always been okay, because I haven't necessarily needed someone to understand everything about me.

Yet, I have to say, it's something. It's one thing when you're in a romantic relationship, and someone puts up with all your nonsense. But it's quite another to have friends who have seen you at your worst, when you're really on the verge of falling over the edge, and for them to have this breathtaking grace of being there for you. Not just that- but letting you be there for them too. The latter is something I've realized more and more as I've gone through my medical training. It may be the only thing I've really, truly come away with, this bit of wisdom- that you are doing your loved ones a favor when you let them help you in any small way.

I suppose that's what I have learned from taking care of patients these past three years of residency too. A lot of residents get burned out, talk about how thankless the work is, how the benefits have now been outweighed by all the burdens of medicine. I get that. But I have spent time talking to my patients, talking to their families, discussing impossible decisions about the last days of their lives, and I never feel like it's a weight on my heart. It's a strange profession these days. Patients have increasingly unrealistic expectations of their doctors, and doctors in turn have unrealistic expectations of their patients. I've realized that so often, patients actually are really in charge of their own health. And I've also realized that they deserve the credit more than I do, more often than not. But none of that really matters to me in the end. I just like my job. I like the being there. They need me, I need them, whether either of us likes that.

Anyway. I'm getting my head screwed back in straight, and I'll try to blog more. But it occurs to me that the blog has been this strange chapter that is separate from the rest of my life, that intersects other chapters, neither a prequel or a sequel, almost just the same tale told in a different voice. And this chapter too- I'm lucky to know some of you from this chapter, I am sorry if I have taken some of you for granted, but you mean a lot to me too.

Monday, March 03, 2014

don't you waste me in the ground

Strange things I've realized of late. For one thing, revelations always seem to occur when I work in the ICU. Let me be clear- I don't enjoy being in the ICU. It's not my thing, patients that are that sick and that tenuously sick- in the sense that they may, at any moment, turn the corner from sick to threatening to die. And yet, aside from working with cancer patients, the ICU is the only other experience I have with talking so openly and frequently about death.

A woman today said, "I don't know how you all do it," and it was meant to be a compliment, but I could not stop thinking about it as also a little bit of a criticism. The woman was the wife of a patient we were taking care of, who was not doing better, who had been quite clear about his intentions and wishes, and who we had just decided to extubate to let nature take its course. People have this impression that when you are "on life support," it is simply a matter of turning off the machine or taking the tube out, and then death follows. But like everything, it's not often that simple. I had just finished explaining what the process of taking the tube out would look like, what might happen afterwards, although we often can't even predict that. There is so much research out there in medicine, and yet that moment of death and dying remains mostly a mystery- people hang on unpredictably or pass just as unexpectedly.

But here's the other odd thing I've learned during the course of my residency. It's not really about what's happening, the details of it. As physicians, especially when we're in training, we have this tendency to fixate on that, the specifics of the problems a patient has and how we are failing at fixing them. This morning, the intern on the team presented the patient's problems and our plans while the patient's wife stood nearby. His wife then turned to me and said, "I didn't understand a word of that." After explaining to her what was going on, I went back to see her with the attending, and that's when we talked about his overall goals, and decided it was time to focus on his comfort. When she said, "I don't know how you all do it," she was grief-stricken and wondering how we saw such things regularly and treated it like a matter of course. I wanted to tell her that inside, it doesn't get any easier. That it haunts us too, that we couldn't make him better. That every patient we admit afterwards, we treat with all the more reverence, knowing how challenging healing can be in the very, very ill patient. I wanted to tell her too that sometimes I don't know how I do it either-- not in a conceited way but in the sense that I don't know why I'm not in therapy or in a deep depression over the things I have seen. Let me tell you- the ICU is 50% hopelessness, 25% idiocy, and 25% success. That's probably a generous estimate of the latter, by the way.  I can't explain why, in the process of training, you learn to just deal with these realities of treating patients.

In the end I didn't tell her any of those things, because yet another thing you realize about death is that, as a physician, it's definitely not about you. Your job is to walk the balance between being there and staying out of everyone's way in those final moments.

Of course, then I go home and bake three dozen cookies, and realize that, oh, all of this does most definitely affect me. Which brings me to the much smaller realization which dawned upon me today. Lately, some of my friends/co-workers have been suggesting coming over to bake with me, or for me to come bake with them, and the thing is- I don't want to. I'm not trying to hide trade secrets or anything. It just occurred to me today that I don't really like sharing the process of baking with anyone because I find it relaxing, and it's one of those selfish things, almost like my form of meditation. I can't really imagine finding it so peaceful if someone else was there. Which probably says a lot about me and my attitudes about people, come to think of it.

Anyway, more navel-gazing at some future date. I have some more hopelessness, idiocy, and (hopefully) success to face in the morning.

Monday, February 17, 2014

no single bite could satisfy

Lately I haven't been traveling to faraway places. I have not really had much vacation time, but also the motivation has been sorely lacking. There are lots of reasons. Probably, primarily, just sheer exhaustion from residency. It's tiring and I don't like to drag when I'm at work-- so I will work my 30-hour shifts, while grumbling all the while, mind you, but at some point, it all catches up to me, and when I want to decompress from it, the idea of going on an involved vacation seems more wasteful than anything else.

But not to whinge. Because honestly, I am well aware of my good fortune. It just so happens that I live in a place that allows me to get to plenty of what I want and need. A stay-cation is all the way justified around here, because a short drive gets me to the ocean, the mountains, the vineyards, and my niece.

Even then, I did some real staying. Some time at home in my kitchen, and now I am well aware of my age, because I was much more pleased to spend a day tinkering around with making pie crust than I would have been flying somewhere.

I bake a lot because it's something that's actually become rather expected. And that's fine, because it still doesn't feel like an obligation, but rather a routine, that has a soothing quality to it from the very rote of it. But every so often, the scientist part of me itches to experiment, and I want to learn some new technique or try some new recipe. It matters to absolutely no one; I have no delusions otherwise. It's not like I'm becoming an expert at anything, and it's not like anyone else cares about any of this.

But that's part and parcel of the decadence of it all. It feels like the height of luxury, the day I spent rolling out pie dough, and learning to make pastry cream. I might have cursed at how small my wooden rolling board is, and how one of my whisks malfunctioned. Maybe I groaned at the batches of macarons that failed before I got to one that was passable. You would think that would make for more frustration than relaxation, but for some reason I have made my peace with failure. At least in the kitchen, I look at every failure as just a finding from an experiment- troubleshoot, tweak, try again. It's actually a comfort now when something fails the first time I try to make it-- then when I've figured out why and gotten it to work, I know it wasn't just a fluke. I know I can write it down and it will keep.

But still. A person likes to feel some sense of hope. So I ended that day by cooking up an industrial batch of salted bourbon caramel, which I knew would turn out - because I had failed at it in the past, of course.

Monday, December 16, 2013

it's my dream but it's yours if you want it too

The arrival of my niece has not changed my life. I didn't meet her and suddenly have a baby-fever type of revelation. She didn't make me question all of my choices and doubt all the decisions I have made in my life. She turned up, all six pounds of her, to happy parents, and I laughed at almost every thing that came out of the bro-seph's mouth. When she was a day old, he remarked "she's got a really chill personality," and I didn't have the heart to tell him that actually she was just a newborn baby. My mother turned up 4 weeks later and complained that the baby didn't play much, that she slept all the time. The woman has started her unrealistic expectations now, so I fear for that baby's adolescent years.

She looked like a wrinkly alien when she arrived, my niece. She wasn't some angelic perfection (shh, don't tell my brother and sister-in-law). And also, she's not the first baby born to people I love. I have two godsons, and many of my dear friends have had children, and I am happy for every single one of them.

But when my niece showed up and settled into my arms, I did have a strong reaction all the same. Funnily enough, before she was born, I had this irrational thought that maybe my brother and sister-in-law would hoard her, and would find me an annoyance. It was completely and totally and absurdly irrational, as it turns out. Because, for one thing, there was something my brother and I learned growing up-- there is simply no such thing as too much family.

We grew up surrounded. Two uncles, two aunts, their spouses and children, all living in a one mile radius of us. My brother and I were the oldest but it didn't detract from the importance of their presence. There was quarreling alternating with teasing. There were equal measures of tears, bruises, and laughter. And I remember, when I was younger, finding it all very suffocating-- like nothing I ever did was mine, because so many other people were involved, talking about it, their expectations adding more pressure, their bragging about anything I'd done somehow diminishing anything I did as wholly my accomplishment.

My niece arrived, and I knew I wanted to be geographically close to her if at all possible, because my brother and I grew up with the idea that you needed as much back-up as you could gather around you. And the problem then was that I wasn't sure I'd actually be able
to stay around, because that was somewhat out of my hands. Some friends, trying to make me feel better, kept telling me that being away from my niece for a couple of years would do no harm. "They don't remember anything at that age" and all that. But thing is- I knew that to be false. I can't tell you why, I don't even understand it myself, but I can tell you I'm very close to those twerp cousins who I cradled and played with and babysat in my teenage years-- they're adults now and we all live far apart, but when we get together, there's an unmistakable closeness that I treasure.
Circumstances are what they are. I would have had to deal with it, had I not lucked out, had I not been able to stay. I learned that from my extended family too- time came and they had to do what they had to do. I struck gold though with this little niece of mine. I've got a brother and sister-in-law who want her to know her foi as much as possible, and I get to stay near enough that I can see her frequently enough to be a part of her life. Looking at that kid, I did feel a sense of responsibility- to not drop her, to hold her when she fusses even if it's spoiling her a bit, and all that other unconditional stuff that comes with family. But also there's a different kind of responsibility- to find as much joy in my life, to share that with her and as many others as I can.

So the little pipsqueak did teach me something already. She reminded me what I already had known- that there is no such as too much family. Her arrival coincided with some big news in my life that was good (actually, great), and when there was this amazing outpouring of sincere happiness on my behalf, I realized what an idiot I was when I was younger and found sharing my accomplishments to lessen them. It's exactly the opposite as it turns out: knowing that so many people have supported me, have cheered me on, have held their breath on my behalf, have known what this means to me-- it's actually amplified my own happiness, and made me feel wrapped in a collective embrace that I had not known was there.

Some of that family who've been part of that embrace, they're family not by blood but by love. Some of them are you.

Friday, December 06, 2013

sometimes is seen a strange spot in the sky

Well who knows where to begin and how to end, and whether this is any kind of beginning or if it's time to end. Just three days ago, an Indian-auntie type was trying to console me "you know how people of our culture say that things work out in the end."

And I responded, like I wasn't blatantly quoting The Best Exotic Marigold Hotel, "and if it's not working out, then it's not quite the end, right?" Which earned me a nice hearty Indian-auntie cackle. She thought it was an original quip and I felt like a fraud, but it got me out of the conversation- I was tired of getting these kinds of pep talks by then.

There's some truth to it. But what of its converse? Life is not a movie or a novel, and sometimes it's such a letdown that it's not. Because I've had some drama in my life, I've had my lows, and then I have these moments-- these amazing, cinematic happy endings. Everything has come together, it's all worked out, the heroine has emerged victorious, and you could end scene and roll credits and it would be so beautiful, it could play Sundance (I keed, I keed).

Except life is not like that. Which is why this stupid blog continues on. There is this thought that in our youth, we are confused and angst-filled and struggling. Then we clear some hurdle and everything settles down, we settle down, and there is no further questioning ourselves. That's the thought, but I mean to tell you it's 100% false. Either people stop examining their lives, or they just stop publicizing all their quandaries, but there all of those doubts remain, stewing within.

Or maybe that's just me, I don't know. I thought about saying goodbye this week, to the blog, to social media, claim my happy ending, and end this story. Yet, there are still things to want in life, things to strive for, things to dream about. And so much more to experience. So instead of bidding it all adieu, I think it's better to take a moment and really savor how precious the present tense is, when you reach one of these chapter ends. When the cliffhanger will-they, won't-they ends with a kiss. Knowing that life is not like this, it is best to be grateful for the beautiful moment when you do get to proclaim "I am no man!" and stab the Witch King dead. And just like The Return of the King, there are many fake-out endings ahead, I suspect.

Sunday, October 20, 2013

to find our way home, to break in these bones*

Having grown weary of a seemingly endless string of flights for the past two weeks, I opted to drive from Northern California to Southern California (and back) this week. It was illogical, really, and many of my friends told me so. But I reasoned that I'd neglected to buy a plane ticket, and now it was too expensive to fly.

I was writing down directions for the way home (I get annoyed trying to use my phone to navigate, and I do not have GPS, so yes, the world and all of its advances have passed me by), and scrawled down "then drive up I-5 until your eyeballs fall out." It is a straight shot like that. And even though it is a long, almost interminable drive, it is also mindless, and thus allows your mind to wander.

It was much needed. I had to exorcise a bunch of negativity and demons, reset my brain, examine what lies ahead. I didn't arrive at any epiphanies, not even close.

California is beautiful. There is no state like it. But then, there is no place like any other. California, I realized, has become home for me, and that long drive up and down I-5 reminded me that this might be a swan song. A goodbye, or a farewell for now. The only thing that changed along that drive is that I became more comfortable with all of the uncertainty. Take a deep breath, breathe in the sunset that tinges the sky purple against stretches of farmland and mountains, stretch that imagination and consider a different life, a new dream. But I'm just not sure of anything.

I came home, and slept, and when I woke up, I was a year older. So busy with the plates sliding beneath my feet that I didn't have time to acknowledge the passing of another year. I could have made cookies or a cake, some sure fire, trusty standby. But that's not the kind of space I'm occupying these days. So I revisited macarons, which are the most temperamental m*@!$* that a person can bake. I've already previously accepted that macarons are one of the few items that I think are worth shelling out the cash for, rather than trying to recreate at home, because they are so involved.

But I was feeling up for failure. I was feeling that sense of daring-- that willingness to roll the dice for high stakes. I was feeling extreme- I could have gone for a good, hard cry or a joyous victory dance. I was ready to accept my fate. I was ready for it to all be for nothing. And only, only when I feel like that, I think, is this possible:

There were some happy feet in my house that day.

It's not a long drive, or the baking of macarons, or any one thing that will help make this all clear. I see that much now. It's just the necessary turning myself inwards, filtering out the background noise, the external voices of right and wrong. And if I stand very still, while the macarons are baking, while the sun is setting, while the music is playing games with my heartbeat, then I'll feel the right path.

* Maybe because I am old and so an 80s vibe does nothing but make me giddy, the new Killers' single Shot At the Night is owning me right now.

Saturday, September 21, 2013

I will dare

I'm a different kind of tired. Usually, these days, I am tired because I am tired- because I have worked a long shift, been awake for too long, have been running around the hospital, have been writing notes and answering pages. That kind of tired, it's an easy kind of tired in a way. All it takes is a little rest, a little sleep, and for the most part, it goes away.

This is not that. I am the kind of tired that involves waking up at 3 am in a panic, that involves never feeling quite well-rested, that involves a churning sensation in the stomach, a steady state of anxiety. There's a fatigue that comes with that. The constant nerves eventually translate to pure exhaustion, but not the kind that can be relieved by sleep alone.

I'm so close, I'm so close I'm afraid to even name it, I'm afraid to want it. I want it that badly that I'm afraid to say it out loud. Does that make any sense?

That's the kind of pit in my gut that I've been grappling with this week. Yesterday, I had my first interview, and it should have been the easiest, but it was actually the one which worried me most, because, again, it has to do with wanting, and being afraid to want, and of course, at the end of it all (and haven't we all felt this at one time or another?) the fear of not being good enough. It had gotten to a fever pitch the night before, and I was nearing hysteria. I was bouncing around the house unsure what to do with myself.

I could have prepared in the traditional way. I could have read through my CV, reviewed possible questions I could be asked, all the things they say you should do. But I'm not so sure that would have done anything to help, not for me, and my miswired brain, my weird way of coping. So instead, last night, when I really felt my fears bubbling past the surface, threatening to boil, I decided to just face a completely different fear instead-- the terror of homemade pasta.

It is ridiculous, I am aware. But when you distill it down, the fear of making pasta from scratch is really just as ludicrous and just as justified as most of my other fears. My fears regarding pasta are many. Do I have the necessary ingredients- do I have what it takes? Do I have the necessary tools? How will I know if it is right? Will it form, will it all come together? And the biggest fear of all-- will it be any good?

This recipe had coincidentally been posted that allayed a lot of my fears, as orecchiette does not require a pasta maker. Don't get me wrong. I have wanted a pasta maker, have I ever, but I haven't been able to justify getting one when I don't even know how to make pasta. I divided the recipe by 8, because this was just a test batch. This was for therapeutic purpose, strictly. And while I kneaded the dough and then tried to make the coins curl into pasta, everything within me focused on that. I calmed down.

So maybe I won't get what I want. Maybe nothing will work out. Maybe I'll continue to bash my head against the proverbial brick wall. But not all endeavors end in failure. As evidenced by the orecchiette. Was it perfect? No, not even vaguely. However, it tasted good, and I knew what I needed to do to make it better next time. And in short, I was no longer afraid.