Monday, January 25, 2010

I wouldn't trade one stupid decision

The woods were lovely, dark and deep, and we had miles to go, but I was already asleep. It’s not like I’m a newcomer to this country, and yet, every time, I am struck by the scale of things here. Trees so large, mountains so tall, and I am so small. Sometimes that is comforting and sometimes that is not. Elsewhere and anonymity and all of that, but also insignficance and the fear of dissolution, disintegration. Am I even here? Am I in one piece, or just a set of molecules barely held together by weak forces, and it won’t be long before I fall to pieces.

You could meditate on such things when enveloped in a cloud of snow, in the blanket of white that makes everything look clean, pristine, untouched once again. It’s a blank slate, a slate wiped clean. You can take it as a sign and forge a path.

Or you can just take a deep breath of the fresh mountain air and behold the beauty of the temporary. Because you have been here before. You know it won’t last. Remember that this slate is really just covered, not clean. You know what lies beneath. But that doesn’t make you jaded. It makes you more aware of how precious, how amazing. So look at the impossibly blue sky and feel the biting wind from the lake, and let your eyes burn from the blinding reflection of the white.

It’s hard work, walking through a snow drift. And once you’re in deep, once you are in the heart of the forest, it’s like so many other difficult journeys- you must finish, simply because you have no other recourse, no other options that require less of you. It’s exhausting and after a while, you feel as though you simply can’t continue. But you stop, and take it all in, embrace the moment, and then you start again. And you keep going until you reach the end. And when you reach the end, it feels such a relief, it feels as though you will never feel so happy to be on pavement.

But the next day, you do it all again.


The drive home took hours longer than it should have. The roads were in some places treacherous. S was worried. When he gets worried, he gets quiet and restless. He kept peeking out windows and between front seats, trying to get a better view. He watched the bad drivers making bad decisions, and I could nearly see the muscles in his shoulder tensing up. K, driving, kept her chin up. She had wanted to leave early, get home in time to face the week with some degree of contemplation. Occasionally, she cursed loudly, but it was kind of a release and then she was satisfied for another hour, back to her chipper, perky baseline. MK was the calmest, reclining, remarking on the traffic and bad weather conditions as if he was announcing a game. And this gave me, trying my level best to distract myself from an onslaught of carsickness because wouldn’t that just add to the fun, a rather obvious idea.

Maybe the game is on the radio?” I asked hopefully, though I was actually asking for permission, not out of curiosity. Of course it was on the radio. The West and the East may be different in some ways, but if there is one thing you can count on, it’s AM radio announcing football games when you are driving home from the mountains.

MK fiddled with the channels and found a station announcing. S asked, “Who do we want to win?S is sort of proud of his lack of inclination towards television and sports (which sometimes makes me wonder how the two of us manage to be cordial towards each other in any way).

I shrugged. I didn’t really care who won (yikes, Maitri, please spare my life!), but, as I pointed out to S, “I’d really like Brett Favre to go away.

He replied, “So we want the Vikings to win?MK and I laughed and shook our heads. Sometimes I think S plays up his ignorance as a badge of honor, kind of the way I am blissfully unable to tell you the title of a single Jonas Brothers song.

We listened to the entirety of the game and still were not halfway home. I suppose I could complain about that, but instead, I have to admit that I was swimming in an ice pond of nostalgia. Frozen, frozen memories, snapshots. Technology, isn’t it great and all that, but sometimes, it’s nice to go backwards. Listening to the game on the radio was wonderful. Unlike S, I wasn’t watching our snail-like progress, or the pickup truck fishtailing in front of us. Instead, the announcers were painting beautiful pictures in my imagination. And radio announcers- I don’t know if they have different training, but they are exponentially superior to television announcers in calling games. I felt as though I watched every play.

Of course, it probably helped that MK told me of his favorite running gag this year, which has been to insert Brett Favre into everything. At first, it was confined to football, and he retold plays like “Here’s the snap, Brett Favre, play action fake to hand off the ball to Brett Favre, and now, oh, it’s a long pass to connect to… Brett Favre- touchdown, Brett Favre!” And then this progressed further into absurdity, such that Brett Favre basically became his personal Chuck Norris. For example- “I was worried about the economy, but I’m sure Brett Favre will take care of it.”


And finally, another song. An entire argument about me unfolded over the past week, and I didn’t even have to get involved in it, which was simultaneously ridiculous and hilarious. It was all about my social inclinations. One faction claimed I was a misanthropic hermit and that an intervention was necessary. The other faction argued that I just had a low tolerance for certain personalities and thus was just selective, and that I would emerge when circumstances allowed. A small renegade faction also voiced the minority opinion that I just enjoy being by myself and that I should just be left alone. I was supposed to rule on this and provide my verdict, but, as usual, I preferred to let resonance theory triumph.

Anyway, it and this past weekend made me remember this song.

Monday, January 18, 2010

eight million stories

In the past, on MLK day, I had nothing very uplifting to say. And I probably don't have anything supremely uplifting to say today either, because med school does chip away at your idealism (especially because, ironically enough, you have to hear SO much of it spewed out all around you, and it more often than not turns out to be nonsense). And also because med school sometimes exhausts you such that you can't muster the energy to be upbeat.

I keep writing about the experiences that I don't actually want to repeat. I gush about surgeons, but I don't want to be one. I can't see myself taking care of children as part of my living, but that's what I did all day today. Perhaps it's when I'm less inclined towards a part of medicine that I spend more time contemplating the colorful personalities and interesting stories that emerge, whereas, when I work in the areas that I feel may be part of my future, I fixate more on self-reflection and doubts. Hopefully, as i become more competent, the balance will shift.

So, today was MLK day. Everyone else working in an outpatient clinic had the day off today, but I began working at a private practice this week, and an overly cautious phone call I made last Friday afternoon bit me in the proverbial rear, as I discovered that the private practice was open.

The phrase private practice brings to mind horrible television shows and posh offices and drug company lunches. I have to admit that I thought that I was probably embarking on a rotation filled with well-insured, well-employed, economically viable patients. And that I was probably going to spend the time with a bunch of doctors who were living a relaxed lifestyle and cashing in the payola. I figured they were working on MLK day because it was about the bottom line.

You know what happens when you assume.

The doctor I was working with today was a wealthy man in Tehran, and, as so many Iranians that I have met, had to start from scratch when he fled to America during the revolution. He had to repeat his residency, and so eager to get started was he that he volunteered to intern for free rather than wait the extra 9 months it would have taken to file an application- he had missed the deadline when he moved here. He had built this practice from the ground up, after having been chief resident at the university hospital. And last year, he had passed it on to a younger pediatrician. He is in the process of weaning his hours down.

We saw all manner of patients today. A few moderately well-off families, but by and large, Medi-Cal patients galore. I forget how spoiled I am to live in this part of the country. In the course of just a morning, I had seen a ridiculously diverse cross-section of the population. And I was very impressed to see that the pediatrician treated them all the same. Whether they had proper insurance or not, whether they came from broken homes or supportive ones, he focused on one thing and one thing alone- their well-being.

I got a text message from a classmate, who was shocked that I had to work today. It said the following (keep in mind it was meant to be taken lightly though):

Wtf? What outpatient clinic racist keeps their office open on MLK day?

Here's the thing. The younger pediatrician who has taken over the clinic? She is- yes, you guessed it- an African-American woman. Her father is a pediatrician as well, and dropped by the clinic in the evening to see the few stragglers left in clinic. Her mother busied herself with finishing up some of the last paperwork. And she, herself, was there, making sure a 14-year old girl with glucosuria was getting a proper diabetes workup, scrubbing down countertops as if it was all part of her job description. She took pride in this work, all of it, from seeing patients to every wire and light in the office.

It struck me as very noble, and I wonder if what I was seeing was not some part of medicine that is slowly dying. Private practices are actually rather rare to come by, especially ones like these, which take Medi-Cal and stay open on holidays. I found out today this clinic stays open on Christmas Eve and New Year's Eve. Also, I found out that the clinic basically breaks even every year.

And here's what else I found out. I'm not sure what I would have done with my day off. I think I probably would have treated it like a vacation day. Maybe I would have studied. Probably I would have baked something. And granted, I am but a medical student, so most of my day entailed looking in baby ear canals, and listening to lungs. But it was probably better than I would have done left to my own devices. And the thing about kids is that idealism is not wasted on them. So little is set in stone for them. So much promise. I suppose it's why I probably ultimately couldn't do pediatrics- I don't think I could bear that sort of responsibility and I definitely don't think I could bear the disappointment when life sent those kids the bad curve balls that life sometimes does. But then, some of them will make it, and defy expectations, and live the dream. I think that's why MLK's dream talked about children. You can see in them so much more clearly the potential for growth, for change. I didn't really do anything noble today, or do anything fitting of the call to service. But I did get to witness both.

Sunday, January 03, 2010

no one needs to know we're feeling

Holy Toledo (I do not know why I always pick Ohio when I am going the Holy route, just another one of those odd quirks that never really occur to me except when I write it down for a blog entry), it's 2010 and it's more than 10 days into 2010, and still, I haven't managed to string a sentence together. For shame, for shame.

I sort of stalled out for a few reasons. One, the mean reds, a little case of funk- does not exactly inspire one to write. You know, you got what you want, but it's not what you thought when you planned it (h/t Amy Mann). And that sounds sad, and occasionally it even feels sad, but then it turns out, it's not really. Because here's the thing. Life is full of all kinds of unexpected twists and turns. And even sometimes with things that are your dreams. And even sometimes with things that are, actually, your happily ever after.

Or, maybe, more accurately, there is no happily ever after. I mean, at one point I knew that. Because otherwise, why is my favorite quote on the sidebar, and why does it state that we shall not cease from exploration? I know that, and actually, I've rather come to savor that aspect of life in the span of that decade that just passed us by. And what a decade it was. Some of it horrible, some of it awesome, and some of it just floating along at contentment.

Some people achieve contentment, and happily ever after, and enlightenment and all that. I'm just not one of those people. Holy Toledo (there, I did it again), I am the biggest malcontent since the history of malcontents. And don't worry, it's not just that I am not content with the world around me, I am supremely a malcontent when it comes to self-reflection. On Twitter, where I really must stop spending so much time, Andrea wrote (paraphrased) that she would unfollow someone if they said about her the kind of things she says about herself. To which I say, indeed and amen.

I have to remind myself every so often of the things that make me this person- you know, the one I really am, who maybe no one else really knows but who cares because I do. I spend my days (and too often my nights) immersed in a world that values conformity. Learn the same things, do it the same way, categorize, recognize patterns, standardize, standardize, standardize. It's okay, as it turns out. I think, because of the rather meandering way my brain works, it does not hurt me to have the drill sergeant that is med school hammering the basics into my head. It's not wrong- there are some things you just better know if you're going to do this for a living. But there is no reason on earth one can give me for turning out physicians with identical personalities.

The conformity in surgical specialties has only to do with one thing- knowledge base and surgical skills. You can be a raving lunatic or a nurturing sweetheart, and they really don't care. I know there are those who will say no, this is not true, and you have to be a cold-hearted, evil no-holds barred maniac to be a surgeon, but respectfully, you are wrong, fool. Surgeons, ultimately, care about whether you know everything a good surgeon should know, whether you can perform in the OR, and whether you can think on your feet. The problem is, I haven't the requisite passion for standing in the operating room for hours on end to be a surgeon.

I've been quieter on other specialties, because in a lot of those cases, they seemed more prone to wanting everyone to fit a mold. Oh, we are all meticulous obsessive compulsives, or oh we all like to hug our patients, or oh we all don't like to have interests outside of medicine. When it's not just about what you know, but who you are, it gets tricky, because it matters in the hoop-jumping process, the process by which people are welcomed into the fold, or whatnot. It feels like it matters a lot.

But it doesn't matter. I guess I finally really and truly realized that. It matters, of course, in the way that looks matter if you want to be a supermodel. You are not likely to be a pediatrician, for example, if cooing over children is not your thing. But it's a big tent, this medicine thing. There is room for everyone, and ultimately you really can do whatever you want. And more importantly, you can find the things that you are good at, or that you want to be good at, in the myriad of possibilities.

In other words, it will all be okay.

But there are other words too. Other words still, words that silenced me for a while because I have a habit of hoarding such fleeting feelings. Yes, yes, it will be okay. But sometimes it will be way, much more than okay. How to explain without not sounding like a total self-indulgent jerk? Oh wait, this is a blog, never mind. There's not a whole lot of third year left for me. That means lots of things, but one of the things it means is that I've started to know enough to do a fairly good impersonation of a physician. People tend to think I am not confident, but I'm only not confident if I'm not sure. And actually, that's something I rather like about myself (take that, doubters of my self-confidence!). But now that I actually know a little of this and that, I am much more natural when treating patients. And I am starting to see the person I may one day become doing this as a living. And I think I like her.

That, my friends, is way, much more than okay.

(Also, haloscan needs to be retired apparently, and even though I've apparently been blogging for five years, I don't know enough about technology to figure out how to change commenting systems. In fact, I don't even know if commenting is currently working on haloscan, it might be. So... bear with me, please, if anyone is still reading.)