happy christmas, you guys! it's been awhile.
i learn something new about myself & how to do better everyday. do you? this fact has always astounded me -- the fact that you spend every waking (and sleeping) moment with yourself, year in and year out, and yet still have personal epiphanies daily. if you're in the habit of being introspective, even little things can prompt such discoveries; for example, i give you: fortune cookies!
okay, okay. i know what you're thinking. fortune cookies are pretty cliche and usually not worth the paper they're haphazardly typed on (is that too harsh?). even so, this one from our favorite local sichuan place (see: legend. OMG, go there.) the week before thanksgiving gave me a pause. was it because it was the week before thanksgiving? or because i was then wandering the hospital wards on a semi-elective neurology rotation with lots of time on my hands to observe other doctors in action and be pimped-on-the-daily about obscure neurologic diseases? the answer to both of these could be yes. regardless, it elucidated why despite inadequacies in my memory, intelligence, and other measurements of medical prowess, my patients still seem to think i'm an okay doctor; because i truly take so much joy in taking care of people.
i read a lot. it's one of the things i've loved about living in NYC (did i mention we're moving to philadelphia in july for my infectious diseases fellowship at UPenn?!? ecstatic!) -- being able to read on my commute. this year i read a plethora of medical and non-medical and marginally-related-to-medical books. one of my favorites: abraham verghese's autobiography my own country. it's a raw, honest, introspective piece of hard-to-put-down writing. it chronicles his early career living in rural tennessee, as an indian physician, taking care of HIV patients at the beginning of the AIDS epidemic. heavy and light all at the same time. one of my favorite things about the book is the clarity with which you're introduced to his genuine care for his patients. he doesn't say it. but you see and feel it (and so much echoes the experiences i've had going through residency): "i have lived for five years in a culture of disease, a small island in a
sea of fear. i have seen many things there. i have seen how life speeds
up and heightens in climates of extreme pain and emotion. it is hard to
live in these circumstances, despite the acts of tenderness that can
lighten everything. but it is hard to pull away from the extreme life
lived far from mundane conversation. never before have i felt so close
to love and pain, so connected to people."
aren't people and the care of them what this life is about? despite my intermittent and moody introversion, that's my realization looking at this silly fortune: cure is sometimes out of your control, but caring never is. care for people.
henry and i have been trying out different online music services recently. and when i say "henry and i," i mean that henry has been trying them out, and i just started an account with spotify yesterday. :)
in my (straw man) defense, i have had a pandora account for a few years which has mesmerized me in its ability to read my mind and play things i like. i've found some of my recent favorite bands in this way. what's more -- some of these newer programs are now even allowing you to listen to whole albums. (!) revolutionary, people.
unfortunately for henry, this means that i have all the more access to my oft-criticized obsessive genre of music: strong-rhythm'ed, complex-lyric'ed, male british crooners (did i get that right, babe?). and yesterday, i discovered ben howard. needless to say, i've listened to 'every kingdom' about 3 times through already and love every piece of it.
do yourself a favor: pour yourself a glass of wine, snuggle into the couch, and turn on this album. you might fall asleep (i concede this, henry), but you also might soothe your soul.
how would you know?
when everything around you's changing like the weather,
a big black storm.
and who would you turn to?
or hide a ghost, a shadow at the most, would you let me know?
cause i don't want to,
to trouble your mind with the childish design of how it all should go.
but i love you so,
but it all comes clear, when the wind is settled, i'll be here, you know.
.gracious. ben howard
so i've been sort of down lately.
i think a lot of my sadness is a result of recent events. busy schedule leading to loneliness. scheduling situations at work leaving me feeling left out. inability to follow through with research tasks. failing to get to the gym and plan healthy meals ahead of time. spending precious little time on the phone connecting with long-distance family and friends.
in case you don't know me well, it's abundantly true to most that i have really high expectations. these pertain to both myself (leading to guilt when i don't meet them) and others (leading to frustration when they're not met). sometimes these have been helpful in my life (like, y'know, when they help me get through med school), but most of the time just cause a lot of emotional strife. i think that being intermittently sad and disappointed recently probably stems from this; every once in a while my expectations are actually met which creates all the more angst when the norm is that they are far far far from met.
i had a realization at church tonight: i am ALWAYS going to be sad and disappointed if i continue to allow myself to respond with guilt and frustration to the shortcomings of myself and others. we are all imperfect, and i'm setting myself up for defeat. it seems like a pretty simple statement, but i just sort of got it in a more real way while singing at church tonight:
"and Lord, i know that you are for me
i know that you are for me
i know that you will never forsake me in my weakness
and i know that you have come down
even if to write upon my heart
to remind me who you are"
.kari jobe.
such joy and sense of rest i have in this: you are for me! you are for me! i will never be forsaken, especially not in my weakness. and yes, having this reminder being written on my heart should be a daily thing for me.
i can't count the number of patients i've taken care of during my last two years of residency who i've had to declare. i could probably contact the department of health and ask how many of my signatures litter the bottoms of death certificates, but this wouldn't get at what i'm trying to express. the fact is, although i secretly cry every time i place my stethoscope on a chest and hear no heartbeat, i don't always have the time to really process what has happened. there's an aching, empty feeling in my soul that insists that i mourn, but often a louder, tangible, set of duties i have to fulfill that keep me from responding. the tears often come later, at home, under my covers as i drift off to sleep after a grueling 16- or 27-hour shift. this was especially true recently when my overnight admission (on a night i was covering) died unexpectedly prior to morning rounds. she made a profond impression on me and i offer this that follows as a celebration of her life and for my own mourning.
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of all your glorious 95 years on this planet, we only knew each other for the last 9 hours. it seemed like longer than 9 hours, didn't it?
we first met in the bustling, chaotic cave known as the emergency department. it was 11:30pm. you had been there all day; several doctors had seen you and given you various treatments and diagnoses. i spotted you from afar: you were sitting on the edge of your stretcher, beaming from ear-to-ear, jabbering on with your son at your side. you took my introduction as your cue for a big, welcoming hug punctuated with a sloppy kiss on my forehead. i was instantly infected with your enthusiasm.
how did you feel, i asked. "like a bullet!" you told me in spanish, "better than ever" and "wanting to go home."
you had so many medical problems; only a few months prior you had been ill and admitted in this hospital. although you're weren't in eminent danger of dying then, the overall prognosis was abysmal. you had been discharged to an inpatient hospice with round-the-clock care. as a testament to what i was already experiencing as your insatiable appetite for life, you did so well in the hospice you were discharged home into the care of your 3 generations of offspring.
but here you were, with the vague and initimidating Shortness of Breath and exponentially complicating Chest Pain. you had abnormal labs and evidence of an ongoing mild heart attack. your kidneys weren't working very well. the plan for these problems several months prior had been "keep her comfortable." and i could see why: often doing invasive tests and procedures in a 90+ year-old can lead to worse complications and suffering. in fact, you had already decided to be "DNR/DNI" which meant that if your heart stopped or you stopped breathing we wouldn't do chest compressions or put in a breathing tube, a really thoughtful and appropriate decision.
i admitted you to the ward. i spent time at your bedside, re-examining you, trying to help treat your pain. i repeated your bloodwork: it hadn't much changed. i talked to the covering cardiologist. i dosed medications. what did you want during this time? "cafe con leche, doctora." your nurse, a wizard in her own right, found the last cup of de-caffeinated coffee in the hospital and we plyed you with it -- only after, did you finally opt to sleep.
i checked in on you several times thereafter and you were sleeping peacefully. at 8:30am, i stopped by to let you know i would be handing off care to the day doctors. you gave me a giant hug and thanked me profusely; i sat down at the foot of your bed and listened to a story about your oldest son who would be coming in later to visit. would i call him for you, you asked? would i tell the day team you could go home today? i assured you i would heartily suggest it.
waiting to present to the team, i lounged on the couch in our resident lair. my waist buzzed at an incoming text page: "patient expired. please come." i rubbed my eyes. wait, what? i thought. did i read it correctly? did patient's ORDERS expire? my movements came quicker than my thoughts -- i ran down the hall to your room. i found a frantic site: a rolling blood pressure machine hooked up, an NP, a resident, several nurses and my patient's nurse all standing around her bed. "what's going on?" someone belted across the room. "who's this person's doctor?" another near her chimed in: "i think she's DNR?"
i sprung into emotionless action as i've been trained to do and took over the situation. i shooed people away; yes, she was DNR/DNI i answered. yes, i could handle it from here. i moved towards your lifeless body, eyes closed, skin cold. i placed my stethoscope on your chest: no heart beat. no breathing. the silence contrasted sharply against the barage of thoughts parading through my mind at that moment. my overwhelming sense of inadequacy was embarrassingly at the forefront: what could i have done to prevent this? nothing, i realized. it was your time. your body finally gave out and i'm glad it wasn't before one last cafe con leche.
rest in peace, mi amor. you are greatly loved by generations, including this young doctor-in-training who could not resist your enthusiasm for life. you truly got your wish after all: you went home that day.
in light of the recent national discussions on same sex marriage, i've been thinking a lot about love.
to preface, i had my eye on this pillow for a few months in the fall because it sums up exactly what i feel about love and know to be true about life. i was lucky enough to receive it as a gift from henry for christmas, and it has become a daily reminder to me about how superfluous and thing-filled my life is.
another daily reminder: 1 corinthians 13:4-8 hanging in our living room. ok, so it's beautifully written in chinese caligraphy, but i know it by heart (in the new living translation):
love is patient and kind.
love is not jealous or boastful or proud or rude.
it does not demand its own way.
it is not irritable and it keeps no record of being wronged.
it does not rejoice about injustice but rejoices whenever the truth wins out.
love never gives up, never loses faith, is always hopeful, and endures through every circumstance.
prophecy and speaking in unknown languages and special knowledge will become useless.
but love will last forever.
to start a complicated and potentially controversial (to some) post, i need to mention that i have been incredibly lucky in my life to be the recipient of unconditional love from family, friends, and my now husband. i've experienced love poured out to friends, neighbors, and especially those less fortunate than me. i've watched in awe as henry offers patience and kindness not only to me, but to most everyone he meets. i've watched my sisters rejoice when truth wins out and endure with me through every circumstance. the point of this exercise is not to paint my friends and family as saints -- of course they mess up! we are not perfect and the love we're able to provide to others as human beings is not perfect.
...but love prevails, don't you see? love is how we survive. love is always hopeful.
in light of this, i've had a hard time listening to the discussions on same sex marriage, as an enthusiastic supporter of love, and listen to anyone put a limit or boundary on true love as it's described above. i don't believe that love exists in a vacuum. i don't believe that love should only exist between two people with anatomically different parts and genetically different 46th chromosomes. LOVE IS HUGE AND IMMEASURABLE; it is found during periods of deep sorrow and jubilant celebration. who are we to lasso love? who are we, as imperfect lovers, to set the limits on the glorious, omnipresent, enduring force which will last forever? i beseech you, behold love where it is, between whomever it is, whenever you can and cling to it with your entire soul that you can become a better lover than you are now.
"no law's gonna change us
we have to change us
whatever god you believe in
we come from the same one
strip away the fear
underneath it's all the same love"
.macklemore & ryan lewis.
to quote the beatles, and my pillow, and Jesus (difficult to argue with these three):
LOVE IS ALL YOU NEED.
i am absolutely due for a post about the epic vacation henry and i took last month to barcelona, madeira, the canary islands, and malaga. it was legendary and relaxing. i felt like a normal (okay, extra-rich special normal) person for a little while and had some time to relax and pursue goals which was a rich blessing i can't figure out how to articulate quite yet. more soon.
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i'm writing today because i had an epiphany, and i often don't know how to express myself fully other than in writing. i am fortunate that despite the 110% of my job that involves face-to-face patient care, i also do a lot of writing (and secretly really enjoy it). it's also dawned on me over the years that i have a hard time opening up to other people in person about things that are really important to me (i seem to have no trouble jabbering endlessly about superficial matters) secondary to my extreme insecurity that i will either be 1. judged, or worse, 2. ignored. writing takes some of this anxiety out of my disclosures and thus here we are.
"are we killing time while these days unwind?
we can't see past our own sad stories
and wonder what we're missing."
.patrick park. from here we are
my epiphany came to me, as many do, through the lyrics of a song blaring through my ear buds through my iphone on the C train to work. i recently heard this song on a pandora station, bookmarked it, later downloaded it, and it came on unexpectedly when i was in a contemplative mood. mr park starts the song in saying: "here we are with burning skin, where we've always been" and goes on to the chorus that i've typed above. although i've thought some permutation of this chorus quite often, i finally GOT IT on the train.
being busy, being in residency, doing what your version of 'residency' is for you -- it's miserable because you're dog tired and overworked but also because you're missing out on LIVING. it's miserable because it forces you to become painfully selfish and the self who you are focusing so intently on is exhausted and uninteresting. it's circular, nauseating, and painful. you isolate yourself from interesting. you isolate yourself from confidence. you become a slave to your own insecurities and are further driven by them to work harder, all the while isolated from the (relatively) sane world around you. you become isolated from the love you desperately need to both give and receive. at one point in the song:
"we've given new names
to our hopes and our pain
but love just gets harder to find"
i get glimpses of love and caring at work in the context of my ability to be people's doctor. i find this the redeeming quality of my job and of residency. it's one of the reasons i came to the intense program that i'm in now: i am able to take care of underserved, unloved people who need unconditional care. i recently realized these small glimpses of love make me that much more homesick to return to living in the non-residency, non-busy world and be able to shed the selfishness that i've clung to with this schedule and pour out love on everyone around me and really listen.
i'm ready to stop singing the chorus of my own sad stories. i do wonder what i'm missing -- and sometimes get a glimpse of it -- and long for it to return. here's to one more year of residency. cheers!
although we're a month into 2013, i've decided it's still a great time to publicly proclaim my unattainable and ambitious goals for the year!
a prompt: over the past year and a half during residency and the 4 years preceding that in medical school, i've slacked off in many areas of my life. there's always a push and pull -- in all the years pouring over studies, endless hours at the hospital, agonizing over clinical decisions, i have lost the drive to really take care of myself properly. this is not to say i haven't showered or changed my underwear regularly, but i truly have gone too long without true self-evaluation. for this reason i sat down with henry and made some goals. we were quite comprehensive in this endeavor, and some goals pertain to our collective finances and the state of our apartment. the rest of the goals we personalized and are mainly within two categories: 1. nutrition/exercise and 2. personal growth. i wanted to share some of these with you both for external accountability and personal reference going forward. ahoy!
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1. nutrition/exercise.
okay, let's face it: this is the most cliche of all 'new year's resolutions.' even so, i think it's a lot more important than some of us give it credit for, and it's something we should all consider on a much-more-frequently-than-yearly basis.
as a card-carrying member of the female sex, i have struggled with issues related to diet, exercise and weight for most of my teenage and adult life (damn you, skinny little kid i used to be!). although i would like to say most of these issues were cast on me from society around me, i have clearly internalized them over the years and too often find my waning self-worth (at least from an appearance-perspective) in my inability to reach my own 'ideal' weight.
now as a budding adult with a working frontal lobe, the importance of this issue has shifted towards healthfulness. over the years, i've established unhealthy eating habits and have not made time to exercise, and as a result, packed on some pounds (especially since i've been married -- what's up with that?). i have made a few feeble attempts to address this issue during the past few busy year, but have generally failed miserably.
last summer, henry and i decided to really take charge of the exercise aspect. we joined a local gym and paid for several weeks of personal-training sessions. i learned so much and am excited to continue to get my muscles in shape. i'm not a marathon-runner or olympic athlete, but getting the body moving in different ways and toning muscle is a great start. nutrition is the major area in which my goals are focused this year: would love to finally put into practice healthy eating habits that i can maintain and that will help me head gracefully towards a more healthy weight. this has proven tricky with my ridiculous work schedule in the past and will continue to be hard this year, but in being purposeful in making changes, i'm hoping i can be successful.
2. personal growth
how often have you taken a step back, looked into the mirror, and said (with your best ben stiller in zoolander impression): "who AM i?" i can tell you my answer is not often enough.
as a child, i was an intensely creative, loud, always-on-the-move creature, causing both my siblings and parents a lot of strife (but i like to think with some joy interspersed!). i created craft projects, read every book in the library, made mix-tapes, played musical instruments (violin, flute), built forts in the woods, wrote extensive short stories and made elaborate scrapbooks, had epic barbie play sessions with my sister, rode bikes, roller-skated, and had an intense love for (depending on the week): ancient egypt, humpback whales, infectious diseases, archeology, american history, early scientists, etc. if you had asked me who i was, i could have proudly declared to you multiple adjectives and activities which identified me.
now? i'm a medical resident. my routine varies little and changes really depend on the rotation i'm on. there's a tremendous lack of personal growth from activities in which i can explore my own interests and opinions. this is not to say i haven't learned SO MUCH about myself while practicing medicine -- i truly have. however, i have no idea what 'medical resident sharon' likes to do in her free-time, what she thinks about major issues going on in the world (are there major issues going on in the world?) and what activities i might finally pursue when i have the time to do so.
so, accordingly, my goal this year is to explore my own interests in various ways. i have a list of books, movies, and magazines i'd love to dig into. at the prompting of my grandmom, i bought some yarn and a crochet hook and plan to make a gigantic zigzag multi-colored blanket! henry and i received a membership to the metropolitan museum of art for christmas from my dad, and we found a groupon deal for a membership to the natural history museum -- we plan to become quite savvy in the knowledge of art and anthropology. we are actively searching out opportunities to see our favorite bands in concert when they come to NY. ultimately, the plan is to take the short amount of 'free-time' we have each day and use it deliberately towards things that will allow us to grow personally.
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so here's hoping 2013 will be a year of pursuing goals purposefully -- and becoming a better person both inside and out. looking forward to the journey!
