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.