just for a moment, let's be still

Lately I have been thinking that I could just start a blog called "this week in heartbreak" based on my job. For example, this week's contenders would be:

• The elderly man who has leukemia that just won't respond to any therapy, who is universally adored in our unit. I had to perform a bone marrow biopsy on him this past week and he thanked me and told me I did a good job. Also every time I go to see him, he always says he is glad to see me.
• The couple who are in their 70s who sit side by side in the hospital room, like they are trying to reenact those scenes in When Harry Met Sally where elderly couples recount how they met. They met in Staten Island, childhood sweethearts.
• The woman who was just diagnosed with breast cancer, who I met in my clinic for the first time yesterday, who ended our clinic encounter with "I am so glad you are my doctor." This was particularly heartfail material because about forty five minutes prior, I was seriously considering quitting due to not feeling good enough.

But I can't write about such things without it sounding awfully schmaltzy. I love, love, love my work, but at least once a week, more often multiple times a week, I question my competency. Everyone tells me it is the nature of the beast and all that, but it chips away at me, and usually by the end of the every week, I have a pit in my stomach and feel doomed.

Which is why, on my day off, I often find myself trying to do something in the kitchen. Because that's a place where I've spent a lot of time over the years. I don't follow recipes well, and I don't write down a lot of the details of how I make things, but most of the time, I can still produce something salvageable. And when I really want to feel accomplished, I make caramel. I have written about why it is therapeutic to make- it requires undivided attention and a feel for things. You can't daydream about chemotherapy regimens and lab results while you are making caramel, or that bastard will turn on you and take you down.

And now it is fall, and it is the season for caramel and all things apple. Last week I experimented on my day off and made a cake with grated apple and roasted sweet potatoes. It was okay (mostly because I covered it in brown sugar frosting), but it was not a keeper. Last year, I used smittenkitchen's recipe for apple cider caramels. I tinkered with it, but not much, because her recipes are fairly airtight. Those were tasty caramels but they were the kind of caramels you wrap in waxed paper and give your friends, and they love you forever. So, you know, kind of perfect. But I was not trying to make those types of caramels today. I wanted a caramel sauce. And I also did not feel like dealing with a candy thermometer.

Making this sauce was a process. First, I had to boil down 4 cups of fresh apple cider until it's about 1/3 to 1/2 cup. Then I deviated from the recipe, so all hell broke loose. But it's also different when I am in the kitchen, because the only downside of failure is a waste of perfectly good ingredients. So I just plugged away and sure enough, I managed to make a thick, apple-intense caramel.

On my next day off, maybe I will figure out what to do with it.

***

To switch gears a little, in my last post, I was writing about how the choices we make come with a price and we have to pay for our dreams, and the artist formerly known as piedpiper pointed out that this is more of a universal plight than I had perhaps suggested. He is right. And I was reminded of it this week, because someone very near and dear to me came out of the closet. It broke my heart a little that he felt he could not tell anyone sooner, and it was heartrending to hear that his family had put a lot of pressure on him not to tell anyone about it. He sounded so happy when he told me, and I realized how this must have weighed on him for such a long time. Already, he is having to pay a lot and in his case, it is not even a dream he is living, just his life.

good is better than perfect

Sometimes, this work gives one pause. Okay, not sometimes. All the time. But for different reasons, at different times. Sometimes, it's the work itself, sometimes it's the system in which we practice, and sometimes it's the repercussions of the work.

There are some matters which I find difficult to articulate for two distinct reasons- 1) it is so specifically personal that I am not sure I should be sharing it and 2) I have an irrational fear of being misunderstood- irrational because who cares and also hardly a handful of people read these words and most of them are fairly non-judgmental types.

For several years in this blog's history, actually, I wrote in an abstract away about this Goal I had, this big dream I was pursuing, and I knew, even as I was writing about it, that it would be a letdown when it was discovered that all I wanted to was become a physician. In some ways, the most unoriginal idea a brown nerd could dream up, really.

So I have no coolness factor. Oh well. That is no surprise, that has never been my area of expertise. What I did have was a deep certainty that I was doing the right thing for myself. And it is a good thing I did, because it was a long play. I mean, a longgggg play. Studying for the MCAT (while working full-time), going to medical school and 'carelessly' tossing away many of my savings in the process, three years of indentured servitude as a resident, all to get to this point.

All for the privilege of treating cancer patients. And it is a privilege. I can say that without a doubt, without reservation, and there are days when my rib cage feels like it is going to crack wide open from how full I feel from the satisfaction of this work. That is true.

But here is what is also true. This choice has cost me. It has cost me money, that is probably the most trivial of the losses. It has cost me friends. It has cost me family. It has cost me my own health. These are things we joke around about as physicians. But these are very real losses, and they exact a price that cannot be quantified and cannot be recovered.

Many, many years ago, I was still trying to figure all of this out, what I was supposed to be doing with my life. I knew I was not supposed to be working in a chemistry lab synthesizing molecules someone else told me to make. So I thought what I needed to do was get my PhD in chemistry. I started working on a research project in my spare time, after work and on the weekends. And I will never forget that my friend K casually remarked that she had stopped inviting me to things because she figured I would be too busy. It crushed me. I suddenly felt like I was really missing out, like the sacrifice of trying to pursue my PhD was too great to give up happy hours and weekends with my friends.

I trusted that feeling, I trust it still. When I decided to go to medical school, I kept giving things up, one by one, and it was frighteningly easy to do. Some of it is by design. Medical school is a wrecking ball, is a cult, is the Borg, is a hurricane. Medicine is a tidal wave that sweeps you out to sea, you drown and after a while, you learn to breathe under water, that is what I think.

This past weekend, after a particularly taxing week that made me question my stamina to complete fellowship and come out of it a competent oncologist, out of the blue, two friends of mine from the east coast texted me. They were drunk at a pub crawl. An annual pub crawl, a pub crawl I used to attend with them, many a year ago. They were planning an impromptu trip to New Orleans, and did I want to come?

Yes! I wanted to go. I missed them. I missed the outside world. My patients make me miss the outside world when I talk to them, and they tell me about their trips and their family and their dogs and their hobbies. They remind me of all the things I have set aside. So I wanted to go, and I cheerfully suggested February, when I had the sort of schedule that would allow me to take some time off.

My friends thought this was funny, and pointed out they were thinking more like next weekend. I had forgotten the meaning of impromptu, see. There is little in the way of spontaneity when you are a fellow. You have a schedule and you have responsibilities. They suggested December, and I thought about the patients who were scheduled to see me then. I am their doctor. I have obligations.

Everyone has obligations. Children. Pets. Mortgages. Everyone has them in some form. This time, I was not crushed when I told my friends I could not escape to the Big Easy on a moment's notice. I was sad. Because I miss my friends, and in an ideal world, I would love to be able to take off with that kind of spontaneity. But dreams have a price, and I knew, right from the start, that I would have to pay. So I have. And I will not apologize for that. As I have stated, there is nothing I want to do more. If I won the lottery today, I would do exactly this job. It is an obligation, this work, but it is a responsibility I have wanted, a purpose I have craved. I cannot pretend to regret that.

But what I will do is try. Not try 'to have it all' because I think that is a dream that we are fed to feel constantly like we are not succeeding, like we are something less. There is no having it all, there is no balance. Life is too messy for that, and chemistry has taught me that equilibrium is a dynamic state, that we are constantly being pushed in one or other direction away, but there is a pull, and it is not a pull away from the center. So I am just going to try not to let go of everything, not to be quite so weightless. I am going to try to find that steady state.