Friday, December 22, 2017

the weary world rejoices

The year is coming to an end and every time I have sat down with a few spare minutes to write a few words here, those wards have multiplied into an incoherent rant, and an incoherent rant is the last thing anybody needs at this point in 2017. It was an odd year in so many ways. There was this constant thrum of all the terrible things happening in the country and in the world, the constant blinding light shone on the reality of these United States of America. But I also finished my 10-year journey of The Goal by graduating from fellowship, and even better, I got my lifelong wish to become a professor. But like most dreams and wishes, the reality looks different and there have been a lot of challenges and I'm not entirely certain how it's all going to play out. But those are anxieties for another day.

I decided today I just wanted to think about the things that brought me happiness in 2017, things that were not personal (i.e. private) in nature. So here they are, in no particular order, with the usual over-explanation:

  • Hasan Minhaj's Homecoming King: This felt like the realest, most unapologetically South Asian-American stand-up I've ever seen. It's filled with immigrant stereotypes, sure, but Minhaj infuses it with both pride and love. He also does something that resonated with me- he takes the frustration he sometimes encounters with his parents to think through their experience, their perspective, without getting saccharine about it. Also Minhaj's set covers the truth about immigration, the otherness that is felt even in a community that is supposedly moderate to liberal, interracial dating, interfaith marriage. I don't know how he did it all in one set while also earning every single laugh. He still turns up from time to time on The Daily Show, but I hope we'll keep seeing more and more of him. He also doesn't shy away from loving and celebrating brown women, which sadly puts him in a minority of South Asian-American male comedians these days.

  • Tiffany Haddish: I will not even pretend that I noticed Tiffany Haddish much when she co-starred in Keanu. I also only ever watched a few episodes of The Carmichael Show, because that sitcom never really grabbed me (weirdly, even though Jerrod Carmichael played with it, it still felt too formulaic in the episodes I saw). So I was definitely one of the bandwagon-jumpers who saw her on Jimmy Kimmel and marched right out to see Girls Trip. Not to detract from the other women who were also solid in that movie, but that movie was a full-on start-to-finish Tiffany Haddish coming-out party. Lately, I've started to think of her along the lines of Robin Williams- she shows up, she's larger than life, she's quick-witted, she's hard to control, but she is hilarious and full of heart. Watch Kimmel realize he's in the midst of something out to go viral, watch Colbert develop a "Tiffany Haddish problem," watch Ellen squirm uncomfortably in her inability to control the interview, watch George Stephanopoulos get dragged into dancing with her while Robin Roberts and Michael Strayhan lose their minds, and watch Trevor Noah giggle uncontrollably while gushing over her book. You can't watch any of those without smiling. Also, the single greatest moment on Weekend Update on SNL this season (granted, a very low bar) was Tiffany Haddish randomly paying homage to Coming To America in a blink-and-you'll-miss-it reenactment.

  • Sally Q. Yates: One of the first heroes to emerge this year was Sally Q. Yates, Attorney General of the United States, who blocked the immigration-related executive order that was issued, got fired for it, and then patiently dealt with the House (lack of) Intelligence Committee hearings, which might have been the spark that kicked off the "woman are done with your sh**" flame war.

  • Kendrick Lamar, DAMN.: I'm not sure that this album always makes me happy or fills me with joy, except at its existence. Sometimes it makes me very angry, sometimes it makes me self-righteous, sometimes it even makes me melancholy. I know some people were wanting Lamar to release 2017 marching orders or something, but this was just Lamar being excellent as far as I'm concerned. Didn't hurt that he lit people on fire, got Don Cheadle to lip synch, and made a mind-bending video with Rihanna.

  • The Leftovers, Season 3: The Leftovers is definitely not for everyone, and there's certainly an argument to be made that it's problematic in terms of proper representation. But it's unlike anything that has ever been on television, and it's such an existential show that it has felt so fitting for our current times. Even though it is a serious and sometimes seriously depressing show, it is also absurdly funny too, including a surreal moment involving the Perfect Strangers theme song which made me wonder if the show was made specifically for me. I'm disappointed it didn't get the credit it deserved but I wonder if the show cares because ultimately for those who loved it, we loved it so hard that we were ride or die for it. Also, why knew Liv Tyler could play a very believable villain?

  • Maxine Waters: I don't need to say much more than: "reclaiming my time." Again, women have had enough, and Maxine Waters definitely is not interested in your nonsense.

  • Halt and Catch Fire, final season: This show initially pissed me off even when it had gone from pretty lousy to pretty good, in part because it was a show about the early days of technology that erased most of the people of color out of it (one season, they had a South Asian character but named him Ryan Fricking Ray, and I immediately turned off the television. Poor Manish Dayal seems destined for a string of bad casting, since he's next starring as the South Asian underling of a cocky Matt Czuchry in The Resident, which looks to be yet another medical drama with terrible casting but one-ups by also painting the medical profession to be a mostly capitalistic undertaking). But the show morphed and its final season was so amazing that I ended up being in hook, line, and sinker. It's no mistake that this show was also on AMC. The common thread it shares with Mad Men is that it's about work and the relationships that develop in the workplace. But the beauty of Halt and Catch Fire is that its beating heart was really about two women who love their work, regardless of what it costs them and regardless of their other life choices. And that's a new story.

  • The trailer to Black Panther: I have never been more excited about a superhero movie. Ryan Coogler has never done wrong in my book, and this movie looks amazing. Honorable mention: Thor: Ragnarok- if you have seen Boy, Hunt for the Wilderbeasts, or What We Do in the Shadows (my personal fave of the three), then you know Taika Waititi's unique voice. He elevated the Thor franchise to pure, unadulterated fun though it still had a heart. Both Thor and SpiderMan Homecoming this year leaned into diverse casting and lightheartedness, and it was all the better for it.

  • Ed Skrein doing the right thing: Ed Skrein was not a marquis actor, not someone with a huge name. His biggest role was probably being cast in Deadpool. He then got cast in a role in an upcoming Hellboy reboot, and fans, tired of the 'Emma Stone is Asian in Aloha, Scarlett Johansson in Ghost Shell, Matt Damon is the star of The Great Wall' phenomenon, were understandably pissed to hear he had been cast in a role that was a Japanese-American in the original comics. Then Ed Skrein, an actor who actually could have used the work and probably didn't know when his next paycheck was rolling in from film, did something no one else has done before. He apologized and took himself out of the game. It is easy to talk a good game- if 2017 showed us anything, it was that a lot of people can pay lip service to what is right. But to actually do it, when it's not easy, when there are personal costs, that's really praiseworthy.

  • Immigrants, We Get the Job Done, Hamilton Mixtape: Look, I'm not a Hamilton Diehard. I don't live in New York, I don't have tons of disposable cash to seek out tickets, and eventually I'm sure I'll be late to the Hamilton party and slap myself for it. But in the meanwhile, this came out, with a fiery verse from Riz Ahmed to boot, and if ever there was a year for it to be released, this was it.

  • One Mississippi, Season 2: this season features Tig Notaro's usual brand of humor and exploration of her own relationship, with a incisive take on sexual harassment at the workplace, but what really got me this year was the development of a romance between her stepfather, a conservative, uptight man from the South and an African-American woman who turns out to be her soulmate. To realistically portray an older white man genuinely want to better himself both to be a better person as well as to be equal to the relationship he wants, it's a rare and wonderful thing. And it's quite, quite touchingly romantic.

  • Jose Andres: the last time I saw Jose Andres in the media he was on Emeril Lagasse's silly Amazon series Eat the World showing Lagasse around the best eats in Asturia and Barcelona. I'll admit I was not aware of his humanitarian efforts until disaster struck Puerto Rico. And then he was very, very hard to miss. This is a man who is a modernist chef who makes his living feeding the affluent. But this year, he made it altogether clear that what he loves to do the most is cook and feed. And he translated his restaurant business savvy to bring more than 2 million meals to Puerto Ricans in need after Hurricane Maria. I can't think about it without getting a lump in my throat.

  • This story on NPR's Code Switch is one of those that once you hear, you can't believe it hasn't been broadcast all over the place. The fight Miss Hamilton wages to be addressed properly by the court and her unsung role in the Women's movement needs to be a bigger story. Hopefully it will be some day, but thanks to Code Switch for, as usual, shedding light on stories that no one else tell that are distinctly part of the American fabric.

  • Roxane Gay's Hunger: admittedly, I don't get to do much recreational reading these days, but this one is a book everyone should read, including physicians. Even though she makes some clear boundaries that delineate to deliver the message that her experience is not the same as mine, there's still a lot to which I can relate. But it's not really about relating to the book. It's about empathy. Reading her honest account about her struggles with weight and her interactions brought out a lot of the wrong reactions, in particular defensiveness about her feelings about the medical profession. But it's important to bite that down because there is a lot to learn about being a better, more caring human from Gay's honesty about how things make her feel.

  • That's what's made me happy this year. Probably there's been more but these are just what seemed to stick with me. I'm sure you all have your own. We should share them more these days to get us through the dark days ahead.

    Sunday, October 22, 2017

    and I get so tired when I have to explain

    Long before much of anything else, this blog was about music. I have about 743 other things I should be doing besides writing about music, but that's adulthood and this is my continued attempt to avoid it.

    When I was young, I listened to a lot of different music. I think of The Smiths and The Cure and Kate Bush and Squeeze, but really, I listened to anything I could get into my ears. I think I might have been looking for home, looking for a place where I fit, or maybe looking for the words to say what I was feeling. The way we talk nowadays about the representation of women and people of color in the media and film, I was looking for something even more specific in music. It was a lot to ask out of songs, and most of the time, they fell short, but I think I wound up stitching them together into a mosaic, an endless mixtape to help me define myself.

    There are songs that will always remain specific. I'll never hear Camper Van Beethoven and not be 15 again, in my friend JJ's car, breeze blowing into our hair as we blasted this song on our way to her parent's summer home, hollering about taking the skin heads bowling. I'll never listen to Edie Brickell's Circle without being 16 in my room, having one of my episodes (as I would later characterize them), feeling hopeless about everything. Chiquitita will always remind me of my masi and the way she sometimes wrapped her arm around me when I was probably 7 or 8, as if to say she was on my side when no one else was. I don't think I'll ever forget the first time I heard Public Enemy's Fight the Power, or saw Pearl Jam sing Alive, or heard Nirvana on the radio. Those are crystal clear, distilled down memories, little portals back in time.

    But then there are all these songs, because I was listening to everything, songs that were background music, stitched into the fabric of pop culture and pervading into our collective conscience. Some are ever present- Michael Jackson and Prince are never going anywhere as far as I'm concerned. Some are stuck in the past- a beloved past, but the past nonetheless. And some songs are timeless, but time does change them.

    I recently main-lined the final season of AMC's Halt and Catch Fire, which is a mystifyingly beautiful show that smartly gave in to the power of the friendship between two women on the show. They were not romantically connected, and they were not even like-minded. They were both really smart, they both had their own talents. Their clashes were not about men, and what bound them together was not about that either. I think it may have been one of the few dramas ever produced in which these two women's entire dynamic rested on their work.

    Maybe it does not resonate for everyone because a lot of people work to live. Work is the thing that allows some people to do the things they really want to do with their family, their loved ones, themselves. Work, to steal from Halt and Catch Fire itself, is "the thing that gets you to the thing." And if that's how you feel, then you would watch this show and wonder at the tragedy of two women wasting so much time and energy banging their head against various metaphorical brick walls.

    But some of us live to work. For some of us, work is part of who we are. And the beauty of Halt and Catch Fire is that it does not go the Mad Men route of translating that to mean 'alone and unable to make any social connections.' One of the women is brilliant, a loner in some senses, but on the other hand holds those connections she does have so dearly that it hurts her moreso when she loses friends. The other woman is also brilliant, but is more pragmatic, and is the woman trying 'to have it all,' with a husband and children and a career, with predictably varying degrees of success. But what's great is that even though these two women work together and then don't work together, the show is aware that both of these women need their work. You just don't see this on television in a way that feels this unapologetic, this realistic.

    If all of that had not been enough, the soundtrack to that last season was littered with all the songs of my youth, but none hit me as hard as the sneak attack of Dire Straits' So Far Away.  It's played at a somber moment on the show, and it just took the first few bass notes to plunge a dagger deep into my heart. I wasn't a rabid Dire Straits fan, I didn't own all their records, I wasn't reading every bit of information on Mark Knopfler I could dig up. But their music was just ever present in my teenage years. I didn't even notice that it had taken up residence deep in my heart until that record started spinning on the show.

    It's not always something you can put into words and maybe you shouldn't. The show uses Solsbury Hill later in the season to good effect, but it didn't pack the same punch, because, no offense to Peter Gabriel, but that song has been plastered across plenty of montages on television and film- like Leonard Cohen (and most memorably Jeff Buckley)'s Hallelujah, it's been used in ways that have made it harder to think of those songs in a personal way. Strangely enough, though, the use of So Far Away in this particular instance actually elevated the song beyond the show. The show uses it as people are packing. A character has died, but the song plays through the house while each person, alone, is in a separate place dealing with their demons

    As the song played, my heart squeezed, thinking about life, thinking about when I first heard that song and how I hear it now. How alone I felt then, and how alone I feel now, but in such very different ways. The song is about missing someone, but because it was released in the 80s, there's this odd juxtaposition of Mark Knopfler's lamenting vocals and this light-hearted, catchy slide guitar and synth. When it was first released back in the 80s and when I was hearing it later as a teenager, I think it failed to light a spark in me because a teenager cannot understand that feeling, that kind of sadness that comes with a smile.

    The song is about missing someone, being separated from them. Nowhere in the song does Knopfler propose doing anything about it. Which makes sense- he's a musician, writing from the road, undoubtedly. And you can't be Mark Knopfler and not live to work.

    I'm writing all of this as I sit down to study for board exams, while juggling teaching, treating patients and conducting research. The ball that gets dropped, more often than not, in this situation is family, friends, loved ones. And it sucks, sometimes it really and truly does, and I wish I had more time to spend with the people I love and to cultivate new relationships. There are people I have lost in the process of pursuing my dreams and I miss them. More than once, I've wondered if it was worth it. It was not always one-sided; increasingly, in this world with all of its technology, we seem like we are in touch but are actually just friends on Facebook. We get older and get lost in our own little sphere of responsibilities and time constraints. There are so many reasons we're so far away from each other. But it doesn't mean we weren't connected together once. Maybe we will be again.

    Thursday, August 10, 2017

    there's no need to say goodbye

    This is not a post anyone wants to read, but I am writing it nevertheless because I foolishly reread Elizabeth Bishop's One Art with impeccably bad timing.

    I signed two death certificates this week.

    Ms. H was an anxious ball of nerves who initially thought she could live for several years with metastatic renal cell carcinoma. But after a surgery to remove a significant deposit in her spine, when it came time to medically treat her cancer, she had a change of heart. She was a strong-willed woman who had been diagnosed only because she could no longer carry bricks into her backyard as she had been doing for most of her life. She lived alone and though she had children, she felt strongly that she did not wish to be a burden on them. She passed peacefully at home. I knew her for less than a year.

    I inherited Mrs. G from a physician who had left. She was supposed to just be monitored to make sure her cancer stayed away, supposedly in remission. The first time I met her, she had new neck pain, and the next day, she was in the hospital getting an aggressive sarcoma excised from her cervical spine. She should have lived for six months after that, but for a while radiation held the sarcoma at bay. She saw me every month, with her two daughters, one with healthcare experience who kept trying to prepare her mother for the end, the other with no healthcare experience who wanted her mother to fight until the bitter end. The two sisters would squabble, and sometimes the medical assistants would tell me they were about to brawl in the examining room. But when you grow up in a South Asian family, loud sisters don't frighten you. The sisters would always apologize afterwards and Mrs. G would always make some joke.

    One of Mrs. G's daughter's had a son in college, all the way out in EBF, where I grew up. It was one of those details that patients and their families believe bind you to them. Because it does.

    She beat the odds, and when I say she beat the odds, I mean that it took a year before the cancer came back. As if to give us all the middle finger, the cancer came back vengefully, in her nerves, starting by making her face droop on one side. Then her legs started to go numb. The cancer was laughing at the chemotherapy we had attempted. She asked three times if she could still come see me if she went on hospice. When I told her she could, she was satisfied. But she died two weeks later.

    As if the week was determined to mock me, Mrs. P was hospitalized.

    Mrs. P is in the process of dying. She has a rare cancer that spread into the lining of her abdomen, and it wasn't even entirely clear from where it stemmed. She asked me a dozen times when we first met a litany of questions: How did this happen? Where did this start? How much time do I have? Why me? She is one of those patients who can articulate exactly the experience of having cancer and living with cancer. She would tell me about episodes of rage she had about not being able to do things she used to be able to do. She would tell me about fights she had to wage with insurance companies and her intentions to make them rue the day they messed with her. For two years the cancer behaved itself, and then one day, it just stopped behaving, undoubtedly picking up some mutation that made it grow more rapidly. Her belly started filling up with fluid and she had to be hospitalized because her nausea was uncontrolled. The surgeons confirmed there was nothing they could do.

    In the hospital, Mrs. P was being looked after by a fourth-year medical student, and a senior resident. I worked with the senior resident when she was an intern. It was breathtaking to see her now leading a team of patients. Still, neither the student nor the resident wanted to have a conversation with Mrs. P about her cancer. It was fine by me. To be honest, I can be a little greedy, a little bit of a control freak about my patients. The student and resident came into the room with me, and listened as I told Mrs. P about the cancer progressing, about the lack of treatment options, about how it was time to start focusing on getting her feeling as well as we could.

    She looked at me, not a somber molecule on her face. She looked at me matter-of-factly really, and nodded. "You're not telling me anything I didn't already know," she told me. And it was true. Just the week before, when she was starting to feel poorly, we had talked on the phone, and as I talked to her about some medications she could take for nausea, she had confessed to me, "I think I'm in the end run here." I'm still early in my career, but I've never heard a patient say something like that and then end up living another year. Patients always know, and oftentimes before the physician does.

    Mrs. P made sure to thank me, and she said a kind word about the care I'd provided her. When the medical student, the resident, and I walked out of the room, I spontaneously told them that though such conversations were difficult, this was what made my job so worthwhile. They both looked at me like they were contemplating a psychiatric consult.

    I guess I sometimes don't see it from the outside anymore. You know, Valar Morghulis and all that, so to me, what's important is the journey. And there are few more meaningful journeys you can have than the final one. No one gives a care about the physician during this journey, and let me be clear in saying- nor should they. What we do as physicians is not particularly noble. But we are lucky, as anyone is lucky, when they accompany someone down a bad path, a final path. Some patients don't find peace at the end either, they fight and are bitter about their illness until their last breath, and that's something fortunate to witness too.

    Even when I don't like my job, I do love my job. And weirdly I realize it more on a week like this, when I'm assigning causes of death and giving patients the bad news that their time is almost up.

    Thursday, March 23, 2017

    live your life, stake your claim

    Recently I moved. I had to move, because my landlords had decided to sell their house. It wasn't the best time of year to be moving. I had about 17 deadlines looming during the time I was supposed to be house hunting, and I had only signed the dotted line on the contract for my soon-to-be job about a month before I had to move. So that took buying property off the table- of course, that was a welcome relief, because even though I've been living in the same square mile radius for 10 years, I still have a real fear of committing to home ownership.

    I ended up renting a house that is probably a bit more decadent than I deserve. I am not complaining about that- it's a beautiful house, and I sometimes feel like I'm on vacation when I'm at home (not great for productivity except for productivity found in the sun-filled kitchen). But a funny thing happened when I got the place- a number of my colleagues expressed discomfort with me for renting the place. The comments were along the lines of "for just you?" I get it. As I said, I fully acknowledge it's a bit decadent. But I cook a lot. I like to have people over. I like to have a spare bedroom so that people can visit from out of town. It's a little decadent, yes, but it's not exactly insane. Setting aside all of that, though, I also have the means to afford the place.

    Still, I keep joking around that when I enter the house every day, I am pretty sure my neighbors think it's the maid coming in to do the cleaning. It's one of those half-jokes that bends a little too close to the truth. The part I don't include in the joke is that I am, currently, content to have them think that. It's easier. I'd rather have the neutral looks of someone thinking they're watching the help go in to do the cleaning than the definitely not-neutral looks of the neighborhood wondering how I have the audacity to live in such a place. I realized with this move that I have always kept a low profile in terms of my living situation, and part of it was not to do with being a cheapskate (which I admittedly am), but rather this need to remain unnoticed. It had seemed paranoid. But in 2017, it hasn't felt paranoid at all.


    My cousin had a surgery and I could not be there. She chose a hospital which was a solid 3 hour drive away, and I was working on a hospital rotation. Her parents and brothers were there, but still, when there were (relatively minor) complications after the surgery, I was on the phone with them trying to sort through what was actually going on as well as how to comfort them. Two weeks after she was discharged, she called me frantically one morning while I was in the midst of rounds with a team of interns and attendings and very sick patients, begging me to drive an hour to come take care of her. She had developed a headache and was convinced she was bleeding into her head.

    Within a short exchange with her, I knew she was not catastrophically bleeding into her head the way she thought. She was due for a CT scan that day. I did what physicians do. I triaged. I had 32 sick patients to take care of in the hospital as well as two patients I needed to see that afternoon in the clinic. I called a few other family members and no one else could get to her either. My cousin was not alone- her fiance was there. But he does not work in healthcare, and isn't the person to calm her down when she's panicking. I offered to come that night, which was the earliest I could be there. She was convinced she would be hospitalized by then, and she had already summoned her mother, who was flying in that evening. So, she bluntly told me, if I came that night, it would be too late.

    She didn't have a bleed, not at all. She had tapered off her steroids too quickly and she had a headache as a result. I knew she was hurt by my choice to stay at work, wounded that I had not dropped everything to get to her, and a bit offended that I had suggested that she was probably going to be just fine. And I realized, once again, that medicine has this habit of creeping into you at a molecular level. For better and often worse, it becomes how you live and breathe. I was a decent doctor that day. I knew who really needed me and didn't need me.

    My cousin, she didn't see it that way. To her, I was just a shitty cousin who was choosing her patients over her family. And I couldn't really blame her for feeling that way.


    Every time I sit down to write anything, including the little anecdotes above, it just feels so pointless and trite. So much is happening right now that I feel like my head is exploding with both a crescendo of thoughts and a stunned silence. I can't even address the very big things happening. All I can do is keep writing something down, mostly little notes to myself in the hopes of finding some clarity in this muddled world.

    Monday, January 23, 2017

    we got no chance of recovery

    Two weeks ago, the microcosm of safety in which I live was invaded. My cousin, who is supposed to get married in a few months, had a seizure. The day is a blur. It started with receipt of a frantic text message, then a phone call to a dumbstruck fiance, followed by throwing a bunch of things into a backpack and driving to the hospital with my stomach churning. I didn't want to be a physician at that moment. I didn't want to know the things I knew. A woman so young, with the symptoms she had, and the timing of it, there were very few things that could be the cause. So when I heard there was a mass in her head, I was unfortunately not surprised.

    There were conflicting impulses when I got to the hospital. I wanted to hug her and burst into tears. I wanted to take her hand and tell her everything was going to be okay. I wanted to see the MRI with my own two eyes, wanted to speak to another physician, wanted to review her labs. I wanted to be everything all at once, her cousin, her protector, her physician. I'm not sure I succeeded at being any of those things.

    In some ways, she turns out to be lucky. When the neurologist did show me the scan, I exhaled an involuntary expletive. The mass was large enough that it had caused swelling in her brain, and shifted one side into the other, likely in part the cause of those seizures. The part of me who was a physician checked out in that moment, and it was just about this woman who was as close to a sister as I'll ever get having a tumor, how her life was about to unexpectedly change in this instant. The neurologist had to get my attention to point out that the mass looked like a meningioma, one of the few tumors you can have in your brain that is not malignant.

    She needs surgery but it will be complicated because the mass is so close to blood vessels. And she was stable and not having seizures, so by the next day, there was no reason for her to stay in the hospital. She's getting surgery in a week. I am racking up the miles driving back and forth to see her, mostly to keep her distracted from the uncertainty that lies ahead. We haven't been able to talk about her wedding and its feasibility because it brings up possibilities to do with her recovery that she does not want to face right now, and I can't blame her for that.

    I wanted to be at the Women's March. I spent the day instead with the near antithesis of a feminist- much as I love my cousin, much as she is the closest thing I have to a sister, she and I hold wildly different beliefs about most things. But I was thinking of the march and thinking of the power shift in this country, and thinking of the uncertainty to do with my cousin's surgery. There are patients out there, who, when ACA is repealed, will have a diagnosis such as hers, will be diagnosed with a mass in their head, and because their seizures are under control, they won't have the luxury of arranging a complicated surgery. They'll be told they're not covered to get elective surgery, they'll be told this doesn't qualify as an emergent surgery, and they'll be stuck with a tumor lodged in their head for an undefined amount of time. My cousin is very worried about whether this surgery will go well, whether it will leave her with neurologic deficits, how long it will take her to recover from the surgery. But to imagine the added stress and turmoil that would come with not even knowing if she could have the surgery? It's appalling.

    Friday, January 20, 2017

    it is my day to live a simple life

    Not great art, sure. Although, actually, I will say that if someone acts well, they can elevate even the silliest of movies, and I think that is what Donna Murphy does in this scene.

    It's also, insane though it may sound, a scene I think about all the time on days like these. What she says, I believe in deeply. I always go back to the work, and it is always what I need. To justify my existence, to prove to myself who I am, to chase away all the doubts. Always, the work.

    The last couple of months have been concentrated turmoil, and the election only slightly contributes to it. I think there is more turmoil ahead. But it is a Friday, and I am going to do what I always do on most Fridays. I am going to work. My colleagues and I will talk about science for an hour. I will work on a research project. I will write some more of a manuscript. I will see patients.

    One of my patients will be photographed. She told me about her granddaughter, who at 10 years old, decided on her own to grow out her hair, then have it cut to donate to cancer patients who are in need of wigs. When I asked her if I could share her story, her eyes lit up; she beamed. I realized that in the end, this is what we all crave. To have our stories told, to be heard as we tell them ourselves, to be told our stories have value, to be remembered. My story is my work, among other things. Today, I am grateful to have that work. Others are not so fortunate, and I feel how much harder this day is for them.

    Friday, November 18, 2016

    what's the use in worrying about the ways in which the world might come to end

    You can't tell me how to feel.

    Today, I told a man, and his very large family, that the man had esophageal cancer. They knew that, but I told them the even more horrific news that the cancer had spread to his liver. I have been having conversations like these for the past five years, maybe even slightly longer. Somehow, even when I was a medical student, maybe because I was older than my colleagues, I was often the designated hitter for these gloomy talks. Once, when I was an intern, the other intern on my team confessed to me that she didn't have it in her to help a family as they transitioned their mother to comfort measures, meaning our ICU team would take her off the breathing machine that was keeping her going, and give her medications to make her comfortable. Here's the thing- the other intern was a white woman, and that patient was an old Chinese woman. And that other intern said, "I just don't feel comfortable" and I gave in to her, because the patient was the important one in all of this.

    But you can't tell me how to feel. I felt a certain kind of way about that entitled white woman. I did my job and I did what was best, but I did not forget.

    It's been a hard time, recently, with everything that has gone on in this country for the past year, and also in my own personal and professional life. There have been a lot of things that have led me to feel both this deep despair about where it's all headed, and also a profound gratitude for my insignificance, for my quite bearable lightness of being at present, childless, husband-less, and in some ways even orphaned.

    Still, whenever I've felt bad, whenever it's all going wrong, from the time that I was 18 years old, and this is the very honest truth, I've gone back to the work, and it's healed me. At one point, it was in a hood with starting materials and solvents and stir bars. At another, it was just reading science journals in a library. Last weekend, it was writing a manuscript. Today, it was a difficult conversation with a patient and his family.

    A few others have mentioned feeling right back like they did after that day in 2001. I've felt that way. I never felt so divided from those around me. Even in my very own house, which I shared with two white roommates. I was hurting too. All I wanted was to hug my roommates but we weren't feeling the same way about things. They were watching news coverage on an endless loop and like so many people around me, they were hushing any notion of dissent. Even though I grew up in a very homogeneous, white-as-snow part of the country, it wasn't until that day that I really felt with finality- these will never be my people. To this day, that feeling has haunted me. I never wanted to feel that way, never wanted to believe that to be true, and I consider it incredibly sad that I do feel that still at times. Fifteen years later, I thought maybe I had been wrong; maybe the dark chapter was behind us. Especially here, in my comfortable bubble of inclusivity in this very blue state.

    But I haven't felt that way for the past week. And you can't tell me how to feel.

    I have treated patients who have commiserated with me about politics - some of them have told me about their leanings unprompted. I have treated patients who have come into the clinic wearing NRA hats. I have treated patients who have asked me, while chuckling, knowing they are trying to say something discomfiting, if I have seen a video that brings to question whether the First Lady is, in fact, a woman. I have treated patients who have called me "honey," have characterized me as a nurse. I have treated patients who have openly made terrible comments about minorities. I once treated a patient who had swastikas liberally tattooed all over his body. I have treated a lot of other patients too; it's been a lot of years.

    I used to walk into any patient encounter with a blank slate, with the benefit of the doubt. But you can't tell me how to feel, and I can't be quite so magnanimous right now.

    So I sat down with this patient today. He and his very large family, a white family from a rural area, and I wondered, for a moment, what they thought of me, if they would be happier were it a white doctor breaking this news to them. It was only for a fleeting second that I pondered it, and then I shook the thought out of my head, and gave them this very bad news, and it did not matter who they were, nor did it matter who I was, not in a superficial sense. What mattered is they were collectively a patient and his family, and that I was a doctor. I told them the bad news, and they didn't yell out "wrong!" and they didn't dispute my words as being liberal propaganda. I told them facts, and they heard them. Some places are still sacred, it turns out. Some places are still bipartisan.

    We sat there, and I told them the news that I did not want to tell them, the news they did not want to hear, and they told me how beloved the patient, this man, was. As they were slowly starting to absorb the unacceptable truth, the patient's brother, a teacher, looked up at me and said, "this is some rough job you have."

    I replied, "some days, it really is." It was then I really got a look at his eyes, and it turns out they were sincerely kind. You can't tell me how I feel, and it will take me a long, long time, and maybe an eternity will not be long enough to feel a true sense of comraderie, togetherness, patriotism.

    I'm reminded of these words that were sandwiched into a funny (funny because it's disturbingly true) bit that Amber Ruffin did for Late Night with Seth Meyers (she's a writer for the show, which has really found its footing in the last months):
    But then you realize that by doing what you do everyday, you prove to them that you are unstoppable. They can spend their time trying to pass laws that take away your rights and silence your voice. But all you have to do is live your life right in their faces, and it proves that you cannot be stopped.
    So I am relying heavily on work, and I am hoping others are too, in particular those folks that do the very good and true work of journalism and community organizing. And I am hoping those are not the last kind eyes I see from the other side.