The days have followed a routine these past days, of early morning heat collecting more and more moisture that it returns at night with heavy rain, adding some noise and light in the mix. It's not just that this weather doesn't bother me. I love it, and I can guess how you'll respond--but it has nothing to do with a principle of appreciating imperfection. I tolerate the dry heat of California and dislike it when it hits the high 80s, but I love East Coast summers of the sort we've been having in July (not the steady cold gray rain of June), where the sun fries the days and we walk through dense air that cools with rain. Coming home to a stuffy non-air-conditioned house, I open all the windows and wait, and the water comes down so thick and loud that it's like being outside, hearing the slickness of the roads and the miscellaneous trees and railings interrupting the rain's course.
This is the first time I've been on the East Coast for summer since Cambridge in 2005. I have so, so many moments I hold so close from that summer, of being able to live through the night in summer clothing, of escaping to the river after the stillness of lying in front of the fan in my dorm room, of getting drenched in post-humidity rain. At the same time this summer takes me back to a places nearby, it reminds me of summers faraway. I've been so lucky to have been able to travel the last three summers, the past two in Asia where the humidity allowed me to slip into the foreign surroundings. I'll never forget the calm rain of Japan or those crazy amazing thunderstorms in Vietnam.
People say they love travel, and I would say that too except that I think it's more that I love places. I like transiting too, and the movement, and places may not quite be the same without all that, but mostly I think it's what place has meant to me, whether it's everyday corners or momentary visits. These summers have been Greece in love, Japan in transition, Southeast Asia in adventure, Vietnam in solitude and history, cross country in anticipation, Eastern Europe in relief. I never write cohesively as much as I'd like about these bulks of time, because as always I struggle between wanting to experience so that I may express and finding that experience takes from me the time that a slow one like me needs to write.
I did journal through a lot of it. In college, knowing that I wanted to go there one day, one of my roommates gave me a spiral journal clothed in a red Japanese print. When I went to Vietnam, my best friend from high school gave me a travel journal (it came with a protective plastic bag, perfect to shield from rain). It's funny how there are places you long for, that you still long for after you visit; then there are places you long for, that after you visit you don't imagine in the same way again. Japan preoccupied a part of me for some time, but is a place whose significance for me changed afterwards. My desire to go there developed from images, and now afterwards I can't conjure images the way I can for some places. But I do recall a lot of what I felt there--the struggles of that time period and that trip, understanding and learning (still) to value the tough nitty gritty of connections to my family and friends, the long train rides, how much I appreciated really living with myself.
From that journal more than two years ago, a day in Nara--
So many of the temples, statues and buildings here were destroyed in some way (burned, earthquake, conquered), and then rebuilt. On the train back to Kyoto--walked a great deal today, as the sights in Nara Park are very spread out. A deer bit my shorts and ate my map. The people here are very proud of this ancient capital--Japan's first permanent one, though it was only capital for 74 years, before it was moved to Kyoto for 1000. That endears me to this city, to which the Japanese are so connected to, despite its short life as capital. I like the idea that something like that persists in communal memory. The largest bronze Buddha is in Nara, and I liked the temple it was enclosed in very much--the largest wooden structure (and the original was even bigger). The building had been burnt twice and an earthquake knocked the head off the Buddha and melted it. Yet these were restored and the Japanese are all over the place as a tie to the past. I respect that kind of respect for history and conceptual entities.
It was fairly late after I left the temple and it was a far walk to the last sight I wanted to see, Kasuga Shrine. By the time I got there it was closed but I hadn't planned on seeing the inside anyway. It turned out to be the best part of Nara.
It's tucked away in the woods and contains 3000 stone and bronze lanterns. They went on forever. It was pretty empty since it was early evening/late afternoon but the few wanderers around asked me if I wanted a photograph of myself. Even when people offer it's hard to accept but I appreciate the sentiment. For most of this I was very much alone, and I liked taking my time to walk around. The lanterns were beautiful--I can only imagine how other-worldly they'd be when lit. I'm not sure why they appealed to me so much. Thinking of it now, the simple idea of sources of light is appealing, but also that there's something so heavy and sturdy built to contain a bit of warmth and light--something fragile, really. Also something with a lot of power. Mostly I like the idea of holding and containing and protecting light. The idea that it's a delicate thing which requires defense and protection with bronze and stone. And there were so many.
I like old Japan a lot, even contrasted against all the modernity. It's a refuge, and perhaps will never again feel like the original, not a part of daily culture, but it stands as a backdrop.
Apparently from 768 to 1863, the Kasuga Shrine was torn down and rebuilt every twenty years, based on Shinto beliefs of purity. How funny that rebuilding is both a philosophy, deliberate; and an unplanned necessity.
Wednesday, July 29, 2009
Monday, July 27, 2009
pineapple
I cut my first pineapple the other day, in preparation for one of my favorite mom foods. I used the huge wide knife J. brought back from China, which compensated for my lack of strength but not for my lack of precision. I watched a YouTube video on how to cut one (it also told you how to choose a good one, but I was about a week beyond that step, as noted by hovering fruit flies). You start by lying the pineapple horizontally and slicing the top and bottom, which is about a fifth of the fruit (more like a fourth in my case; will remember in the future that pineapples ripen quickly). Then you lie it upright and slice the sides, turning every so often to get missed curved edges, cutting into the fruit deeply to remove all the peel--and also the spikes embedded horizontally in the pineapple. This surprised me, because the spikes lie deeper than I expected, meaning that I sacrificed a lot of flesh to remove them (they are interspersed every few centimeters). You're then left with a hunk of flesh, which you cut in halves, then quarters. I was further surprised to find that in addition to the outer inedibles, the inner core consisted of a tough spine, a pale white that distinguishes it from the yellow edible. You form slices of pineapple around this, and add the spine to your pile of throw-away.
I think about the knowledge and experience I'm working to absorb, the frustrations in the midst of it, a depth that swallows and scares and humbles, a depth that is uncovered to me, a depth that is brushed aside, a fullness that's both suffocating and liberating, the bareness when I return home to myself after a day of people. I think of the brutality of this art and science, and what's left after we cut, cut, cut. Her red hair, the stud in his ten year old ear, his long eyelashes that are maybe an illusion of a small baby face.
The pineapple was sweet, its flavor fragrant and its skeleton awash in my hands.
I think about the knowledge and experience I'm working to absorb, the frustrations in the midst of it, a depth that swallows and scares and humbles, a depth that is uncovered to me, a depth that is brushed aside, a fullness that's both suffocating and liberating, the bareness when I return home to myself after a day of people. I think of the brutality of this art and science, and what's left after we cut, cut, cut. Her red hair, the stud in his ten year old ear, his long eyelashes that are maybe an illusion of a small baby face.
The pineapple was sweet, its flavor fragrant and its skeleton awash in my hands.
Monday, July 20, 2009
in review
Pediatrics was my introduction to life in the hospital, and while it gave me time to cook and exercise and spend time with my friends over dinner and at the beach, finding balance still meant too tired at night to flesh out the day. So as inadequately as usual, some snippets of a wonderful four weeks working with school age children (spanning ages five to eighteen, though the highest I personally got was thirteen).
*Getting personal with swine flu: It was splashed anywhere our eyes and ears fell upon, and overexposure created distance. It's true that it's not much different from your annual winter flu, but it gave me a chance to see its effects during a summer rotation, out of its usual season. "Asthma exacerbation secondary to swine flu" sometimes made up a quarter of the hospital admissions while I was there, and it was my first patient. Heard real "crackles" in the lung for the first time (sounds like undoing velcro). Flu is inconvenience for most; for asthmatics it means being confined to a hospital room where people come in and out armed with a gown and gloves and strapped with a respirator mask, a mouth mask, and a face mask.
*Listening slowly: A patient with chronic pain, in the hospital for an acute episode, was my foray into this world of subjective disease and healing. I learned that one way to measure a pain is whether a person is "easily distractable," and learned that distraction is a two-way street. My sickle cell patient read aloud deliberately and slowly. So slowly that I lost track of sentences and just heard words. She decided she didn't like two books after a few pages; she did finally like Nancy Drew.
*Witnessing what's worthy: I never found a way to the feverish little one, who was seen by so many different doctors and nurses and random people like me. Politely answered my questions, politely refused offers of games, always said he was feeling good, in between and during fits of cough and sputum. But he lit up for his older sister, my age. His sister who stayed nights with him and left at six in the morning to commute to her job a couple hours away, after having left a detailed note about where she left his Taco Bell leftovers and full of thanks for taking care of him. Who was so happy to see him improve, happy maybe more ingenuously than anyone I've seen. When I told him he was lucky to have such a sister, he looked at her, smiled a slow crinkle of lips, and said I know. How many kids know, how many grown-ups really know.
*Finding the elusiveness of observation: So many of the kids we saw had been through so much, for so little body grown and so little time lived. Being impressed by their toughness became quickly ingrained, such that moments of outright vulnerability surprised me, and reminded me to let things show themselves and to consider them as they did. Hearing a little girl say she was scared, pulling her hand away from the IV, hearing her dad talk about not wanting to put her through another sedation, stood in my mind beside the images of her walking steady and holding her head firm, despite physical oppositions--I was pulled back to what was there, reminded to be open and not escape into all else that had formed.
*Gathering more and more respect: I admired one resident's natural cheerfulness through sleepless nights and ease of humor, another's tough efficiency and caring demeanor with the kids over whom he towered, and the attentiveness of everyone on our team to everyone else, past the patients to everyone in the hospital regardless of role or involvement. I was more than awed by the expertise of the nurses, their quickness and ease of movement. Sometimes I want to be them, with so much concrete need in their hands, more presence to their kids.
*Memorizing contours from senses: We've absorbed so much from sight and experience, almost without effort, that I wonder why I've tried so hard all my life to pound all that's outside inside. I think I felt this most with my last patient, who sometimes slept with his glasses on, and whose facial features would register at odd moments. Long after the day was over I found myself worrying about how he'd grow up and whether he'd gain the comfort of a secure home, the self-confidence of good health taken for granted, and the weight to develop into a person that could physically stand among others. He smiled inadvertently and in surprise when I beat him in Connect Four, with a diagonal line he hadn't noticed. When I remember that, I worry also that his teeth might always be in the wrong place.
*Seeing people return: I've seen more than a handful of patients return: with the same thing, with the same thing but worse, with a different thing, for nothing at all. It is strange to feel some sense of accomplishment with sending a patient home, then to feel a sort of regression when they return, because it's the same person. There's a disconnect between the linear or even cyclical image we have of a person's life, and thereby our relation to it, and the connect-the-dots relationship we actually have with them. I was disconcerted by some of the discontinuity, some of the chronic non-health problems.
*Seeing people disappear: We talked about how we thought she would still be there when we finished our month of inpatient pediatrics. Each day hearing of her tiny progress, only to find out the next that she'd deceived. She wasn't healed when she left. Watching her leave that one day, one day earlier than had been scheduled earlier that week, many days earlier than in my mind--face and nails made-up and leaving me a sense of glittery blue even as I'm unsure that's what she was really wearing--I felt I understood so little.
A., who likes to sit next to waterfalls, talks often of being humbled by feeling his smallness among big things and his incapacity to know anything in this vastness, and recently listed a slew of good places to perceive this: in the hospital, in a warzone, in love. I hope that the next time I forget, I'll try to think on how the immensity of small things and small people made me feel small too.
*Getting personal with swine flu: It was splashed anywhere our eyes and ears fell upon, and overexposure created distance. It's true that it's not much different from your annual winter flu, but it gave me a chance to see its effects during a summer rotation, out of its usual season. "Asthma exacerbation secondary to swine flu" sometimes made up a quarter of the hospital admissions while I was there, and it was my first patient. Heard real "crackles" in the lung for the first time (sounds like undoing velcro). Flu is inconvenience for most; for asthmatics it means being confined to a hospital room where people come in and out armed with a gown and gloves and strapped with a respirator mask, a mouth mask, and a face mask.
*Listening slowly: A patient with chronic pain, in the hospital for an acute episode, was my foray into this world of subjective disease and healing. I learned that one way to measure a pain is whether a person is "easily distractable," and learned that distraction is a two-way street. My sickle cell patient read aloud deliberately and slowly. So slowly that I lost track of sentences and just heard words. She decided she didn't like two books after a few pages; she did finally like Nancy Drew.
*Witnessing what's worthy: I never found a way to the feverish little one, who was seen by so many different doctors and nurses and random people like me. Politely answered my questions, politely refused offers of games, always said he was feeling good, in between and during fits of cough and sputum. But he lit up for his older sister, my age. His sister who stayed nights with him and left at six in the morning to commute to her job a couple hours away, after having left a detailed note about where she left his Taco Bell leftovers and full of thanks for taking care of him. Who was so happy to see him improve, happy maybe more ingenuously than anyone I've seen. When I told him he was lucky to have such a sister, he looked at her, smiled a slow crinkle of lips, and said I know. How many kids know, how many grown-ups really know.
*Finding the elusiveness of observation: So many of the kids we saw had been through so much, for so little body grown and so little time lived. Being impressed by their toughness became quickly ingrained, such that moments of outright vulnerability surprised me, and reminded me to let things show themselves and to consider them as they did. Hearing a little girl say she was scared, pulling her hand away from the IV, hearing her dad talk about not wanting to put her through another sedation, stood in my mind beside the images of her walking steady and holding her head firm, despite physical oppositions--I was pulled back to what was there, reminded to be open and not escape into all else that had formed.
*Gathering more and more respect: I admired one resident's natural cheerfulness through sleepless nights and ease of humor, another's tough efficiency and caring demeanor with the kids over whom he towered, and the attentiveness of everyone on our team to everyone else, past the patients to everyone in the hospital regardless of role or involvement. I was more than awed by the expertise of the nurses, their quickness and ease of movement. Sometimes I want to be them, with so much concrete need in their hands, more presence to their kids.
*Memorizing contours from senses: We've absorbed so much from sight and experience, almost without effort, that I wonder why I've tried so hard all my life to pound all that's outside inside. I think I felt this most with my last patient, who sometimes slept with his glasses on, and whose facial features would register at odd moments. Long after the day was over I found myself worrying about how he'd grow up and whether he'd gain the comfort of a secure home, the self-confidence of good health taken for granted, and the weight to develop into a person that could physically stand among others. He smiled inadvertently and in surprise when I beat him in Connect Four, with a diagonal line he hadn't noticed. When I remember that, I worry also that his teeth might always be in the wrong place.
*Seeing people return: I've seen more than a handful of patients return: with the same thing, with the same thing but worse, with a different thing, for nothing at all. It is strange to feel some sense of accomplishment with sending a patient home, then to feel a sort of regression when they return, because it's the same person. There's a disconnect between the linear or even cyclical image we have of a person's life, and thereby our relation to it, and the connect-the-dots relationship we actually have with them. I was disconcerted by some of the discontinuity, some of the chronic non-health problems.
*Seeing people disappear: We talked about how we thought she would still be there when we finished our month of inpatient pediatrics. Each day hearing of her tiny progress, only to find out the next that she'd deceived. She wasn't healed when she left. Watching her leave that one day, one day earlier than had been scheduled earlier that week, many days earlier than in my mind--face and nails made-up and leaving me a sense of glittery blue even as I'm unsure that's what she was really wearing--I felt I understood so little.
A., who likes to sit next to waterfalls, talks often of being humbled by feeling his smallness among big things and his incapacity to know anything in this vastness, and recently listed a slew of good places to perceive this: in the hospital, in a warzone, in love. I hope that the next time I forget, I'll try to think on how the immensity of small things and small people made me feel small too.
Thursday, July 16, 2009
embarrassment
Being a med student, for me probably more than some, means being embarrassed on a daily basis. No matter how much preparation goes into the presentations we give each morning to a group of people whose knowledge, experience and doctoring you respect and feel capable of emulating in maybe your next life or the one after that, there will be questions you didn't anticipate and don't know how to answer. Sometimes I get nervous so that even when I do know things, I articulate the opposite. My classmate mentioned that her growing dependence over the years on electronic communication and the written word has made it difficult to verbalize aloud, and I found this to be an accurate description for my problem as well. Sometimes I say "stool movements" instead of "bowel movements," and mix up "antigen" and "antibody," often I find myself reaching speechless for the right phrase to introduce what I need on the phone, fully aware that the person on the other end feels the intermittent mumbles and silence.
I'm incredibly lucky because on my first rotation, on school age/adolescent pediatrics, I've had an incredibly supportive team of residents and interns who take the time to ask us questions to teach us, not to embarrass us. So I'm not complaining. Still, as students, we've been conditioned to want to be right, to answer correctly at least 91% of questions, and to know our responsibilities well. There's so much to learn that we can't go hunting for in textbooks: how to interpret strange lab results, when a patient can stop getting IV fluids, how to present a person's medications to the group, whether their drugs are being given in a dose that's therapeutic, how to page someone in the hospital and how to call someone outside the hospital, what to do when a person has two infections at once and the drugs for one is causing the other.
In the end, you're embarrassed for a few minutes, and then you go about your next task because you're a tiny part of taking care of someone and maybe the best way to do this is to be consume and absorb as much humility as possible. It's probably easy for me to be more positive about it because my team is so nice and cognizant of our learning; I imagine this will be harder on some other rotations in the hospital, so I'm trying to grill this into myself now. Some qualities go hand-in-hand for me, and this includes being observant of smaller things (which I like--even as I might be oblivious to what others think of as bigger things) and being very self-conscious (which I hate, with no qualifications). So I get embarrassed pretty easily and I lend myself to embarrassing moments (I'm clumsy, I find it hard to express myself verbally, and I take a long time to process things), but I'm learning slowly to appreciate it. The way an audience presses you to try harder stays with you long after they are gone, and the embarrassment leaves when they leave. Not to say that I enjoy it, but in some ways it is a unique opportunity to be pushed to move around enough in your skin to get over it quickly and feel the freedom to make mistakes because in the end only you live with them, the audience a distant spotlight.
I'm incredibly lucky because on my first rotation, on school age/adolescent pediatrics, I've had an incredibly supportive team of residents and interns who take the time to ask us questions to teach us, not to embarrass us. So I'm not complaining. Still, as students, we've been conditioned to want to be right, to answer correctly at least 91% of questions, and to know our responsibilities well. There's so much to learn that we can't go hunting for in textbooks: how to interpret strange lab results, when a patient can stop getting IV fluids, how to present a person's medications to the group, whether their drugs are being given in a dose that's therapeutic, how to page someone in the hospital and how to call someone outside the hospital, what to do when a person has two infections at once and the drugs for one is causing the other.
In the end, you're embarrassed for a few minutes, and then you go about your next task because you're a tiny part of taking care of someone and maybe the best way to do this is to be consume and absorb as much humility as possible. It's probably easy for me to be more positive about it because my team is so nice and cognizant of our learning; I imagine this will be harder on some other rotations in the hospital, so I'm trying to grill this into myself now. Some qualities go hand-in-hand for me, and this includes being observant of smaller things (which I like--even as I might be oblivious to what others think of as bigger things) and being very self-conscious (which I hate, with no qualifications). So I get embarrassed pretty easily and I lend myself to embarrassing moments (I'm clumsy, I find it hard to express myself verbally, and I take a long time to process things), but I'm learning slowly to appreciate it. The way an audience presses you to try harder stays with you long after they are gone, and the embarrassment leaves when they leave. Not to say that I enjoy it, but in some ways it is a unique opportunity to be pushed to move around enough in your skin to get over it quickly and feel the freedom to make mistakes because in the end only you live with them, the audience a distant spotlight.
Tuesday, July 14, 2009
basics
Words like emesis and metrodinazole roll off tongues and letters like PRN and BID are strung together as though they were ABC, and you might be fooled into thinking this is medicine. At the end of the day, you discover that it's not academic, it's visceral. First and last, your patients must be able to drink water, eat food, pass stool, urinate not too little or too much, and move as they did before sick (this can mean walking as freely as I do, or it can mean being able to get out of bed and back again).
There are patients whose every act of daily living is monitored, recorded, reported, and regulated. An anorexic is weighed twice a day and can only walk to and from her bed (but not repeatedly). A diabetic counts his calories and has his finger pricked four times a day to measure his blood sugar. A girl with cystic fibrosis breathes according to a wall-long schedule of physical therapy and treatments designed to clear her lungs. A shy boy with inflammatory bowel disease reports on his bowel movements: quantity, color, texture. The hospital does much of this for them: we supervise them, we stick their fingers with needles, we call physical therapy, and we position a container in the toilet. But they will have to go home and live, and in our qualifications for their leaving the hospital, we include their ability to: eat, drink, pee, poo, take care of themselves and/or be taken care of.
It's not easy to take care of your senses. Sometimes to do so, we corrupt them. One afternoon we taste-tested about twenty common drugs. The last smelled and tasted like rotten eggs, horrifying our taste buds long after it'd traveled past them. Another afternoon we tried for a minute what some people do for an hour daily: adorned ourselves with vests that made our chests, front and back, vibrate. This is how you get mucus out of your airways so that you can breathe. It's not a drug, it's just a motion against the physical barrier to your breaths. It makes your voice shake, and the sound is like a helicopter except you're stuck on ground.
Today we learned a little about the numbers and routine that go into being diabetic. Your meals have to be regular in calorie count and timing, because you can only regulate your sugar with sporadic shots of insulin, not all day long like people with functioning pancreases. For someone who is too careless with ingredients and grew up on sugary snacks, this thought process astounds me. We did a fingerstick glucose on ourselves, which diabetics have to do before every meal and before sleep. It doesn't hurt much, but the moments before you push the button that plunges the needle into your finger (it retracts immediately), caused me some anxiety. I don't like the idea of holding my breath and biting my lip on a regular basis. Based on the number from the fingerstick glucose and the number of calories you consume, you adjust the three daily shots of insulin you need to give yourself. We gave ourselves shots of salt water to simulate what it might be like. As the needle goes in, it doesn't hurt that much, but when pushing the fluid in (an amount of fluid that could be as little as 10% of what a diabetic might require), I cringed. It stung, and it throbbed for awhile afterwards.
Pediatrics is humbling in many ways, when we meet or hear about kids with chronic illnesses, who maintain their right to live their lives through conscious control of the basics, who earn the character of living with more awareness of the fragility of what we do each day.
There are patients whose every act of daily living is monitored, recorded, reported, and regulated. An anorexic is weighed twice a day and can only walk to and from her bed (but not repeatedly). A diabetic counts his calories and has his finger pricked four times a day to measure his blood sugar. A girl with cystic fibrosis breathes according to a wall-long schedule of physical therapy and treatments designed to clear her lungs. A shy boy with inflammatory bowel disease reports on his bowel movements: quantity, color, texture. The hospital does much of this for them: we supervise them, we stick their fingers with needles, we call physical therapy, and we position a container in the toilet. But they will have to go home and live, and in our qualifications for their leaving the hospital, we include their ability to: eat, drink, pee, poo, take care of themselves and/or be taken care of.
It's not easy to take care of your senses. Sometimes to do so, we corrupt them. One afternoon we taste-tested about twenty common drugs. The last smelled and tasted like rotten eggs, horrifying our taste buds long after it'd traveled past them. Another afternoon we tried for a minute what some people do for an hour daily: adorned ourselves with vests that made our chests, front and back, vibrate. This is how you get mucus out of your airways so that you can breathe. It's not a drug, it's just a motion against the physical barrier to your breaths. It makes your voice shake, and the sound is like a helicopter except you're stuck on ground.
Today we learned a little about the numbers and routine that go into being diabetic. Your meals have to be regular in calorie count and timing, because you can only regulate your sugar with sporadic shots of insulin, not all day long like people with functioning pancreases. For someone who is too careless with ingredients and grew up on sugary snacks, this thought process astounds me. We did a fingerstick glucose on ourselves, which diabetics have to do before every meal and before sleep. It doesn't hurt much, but the moments before you push the button that plunges the needle into your finger (it retracts immediately), caused me some anxiety. I don't like the idea of holding my breath and biting my lip on a regular basis. Based on the number from the fingerstick glucose and the number of calories you consume, you adjust the three daily shots of insulin you need to give yourself. We gave ourselves shots of salt water to simulate what it might be like. As the needle goes in, it doesn't hurt that much, but when pushing the fluid in (an amount of fluid that could be as little as 10% of what a diabetic might require), I cringed. It stung, and it throbbed for awhile afterwards.
Pediatrics is humbling in many ways, when we meet or hear about kids with chronic illnesses, who maintain their right to live their lives through conscious control of the basics, who earn the character of living with more awareness of the fragility of what we do each day.
Saturday, July 11, 2009
bon iver
No better time to reflect on winter than summer.
After a long absence I started running over Thanksgiving break, when I was in Denver at my oldest brother's place with my whole family. Historically, running has always started when my life has entered a certain phase, a difficult one or a transitional one. This time around I'm trying to add more permanence to its association and role in my life. Anyway this isn't about running but just to say that when I began in Denver, I was feeling a lot and running felt simple beside those things. The beginning of second year was...crazy. We were overwhelmed in every way, and Thanksgiving was the first breather. I spent a good deal of it studying drugs, which I hadn't even attempted to learn all semester. While the mechanisms were interesting, the new language blew my mind a little. I'd sit and wonder why we were learning to talk this way, and whether my mind would always sound like a stranger to myself, and not just strange like unfamiliar but strange like not right. Since this was my second school Thanksgiving break, and since I instinctively compare one time marker with its predecessor, last year's week came back to me often. Last Thanksgiving I was in Chicago, visiting a couple friends and exploring on my own. I wasn't studying, I missed the proximity of classmates I'd recently gotten to know but also absolutely relished solitude for the first time since a pretty rough time at the very edge of ends/beginnings that fall, everything was ahead. This Thanksgiving, it was wonderful to be with my whole family and my brother's new baby, the first in our family; people who'd been good friends the past year were now my other family and I didn't have to miss them, and I didn't feel any particular need to be alone either. I wouldn't say one Thanksgiving was better than the other. Putting them aside one another just made the year in between swell a little.
So much has happened. Even from now to this last Thanksgiving, I feel I know new facets of things and older ones more deeply. In any case, even though I wasn't thinking this at the time, I think all the things of the recent past were converging to make a me that wanted to run. I was tired. Spending the summer in Vietnam, road tripping cross country just a few days after, moving into our apartment right after that, starting school before moving even finished, then continuing full speed onto a year of massive mind-stuffing--I was tired. Things had been so fast I was still trying to decide how to approach the rest of the year, what did I want to do and what could I do. A year of tumultuous boy situations also reached its worst that fall, one that I never knew what to do with and another I didn't even realize was there. By Thanksgiving I had made myself proud though not particularly happy by eventually doing the right thing with the latter (yes, that is to say I probably didn't start out right), and transitioning to what would be the best time of our friendship with the former. I didn't know this at the time, though, and deciding how I would proceed was a struggle that break. It really took a lot in me, a lot of fighting my less admirable qualities, to continue the way I ultimately did, and so my energy was low for that reason too. Seeing all of my family was really wonderful; I'd been so looking forward to it but it still surprised me. Happiness is consuming too.
I always look forward to the music I run to. One night I decided that the next day I'd listen to Bon Iver, which really isn't typical running music if you like to listen to things chipper and upbeat. It's true that Bon Iver has a distinct tone, that could be described one-dimensionally as melancholy and quiet, but for me those things have always been so expansive. The sounds are so layered and raw at the same time. The effusiveness is subtle, tugs at things in you kept underneath. The next morning we woke up to a world draped in white. It was my first snowfall of the winter, and first run in a snowfall, and the soundtrack couldn't have been more perfect. Through the slow thirty-seven minutes of the album I went past my brother's neighborhood to discover water rushing fast down its creek, fluff atop and a mix of bare trees and clothed trees, for frame. I've loved Fremont and Cambridge runs, found lesser but palpable enjoyment in San Francisco and New Haven, but this was something I experienced in a place I had no real connection to and would likely never return to in that setting. For that and for everything else, in that sliver of space I felt everything.
The anticipation of good and stress, the tension of what happened, uncertainty of what I'd do and what would be done, the warmth of people I loved, gratitude for people who loved me so well--my family at school and my family-family, frustrations over words and connections, things I don't like admitting I feel (resentment, slighted, inadequate or superior, dislike and regret), open spaces, the heaviness of breathing, someone else's winter in mine, little life, treading and traversing over states, moving downtown, learning for the first time how to learn, a return after absence and the small changes, the walks to school, making home, laundromats and grocery stores, autumn, unfamiliar pressure, working hard to barely keep up, the newness of place and the continual resurgences of past that are so constant for me they may not even qualify as nostalgia--all there in a compact five feet two inches (and a half).
I bought a vinyl record of Bon Iver's album at their concert in Brooklyn, where wife and I were front row. I don't own a record player, and I purposely haven't gotten one yet. I would like to go to a store that probably doesn't exist anymore where they are still lined in rows and I can touch the spindles, on my own because I take a long time to make decisions, and choose one for myself...but not yet. But I like imagining that someday, when the time is right for me, I will have one, and I'll sit on my wood patterned floor and listen to those thirty-seven minutes. I might cry. Not for past melancholy, not even for present happiness, but for fullness in the crevices.
After a long absence I started running over Thanksgiving break, when I was in Denver at my oldest brother's place with my whole family. Historically, running has always started when my life has entered a certain phase, a difficult one or a transitional one. This time around I'm trying to add more permanence to its association and role in my life. Anyway this isn't about running but just to say that when I began in Denver, I was feeling a lot and running felt simple beside those things. The beginning of second year was...crazy. We were overwhelmed in every way, and Thanksgiving was the first breather. I spent a good deal of it studying drugs, which I hadn't even attempted to learn all semester. While the mechanisms were interesting, the new language blew my mind a little. I'd sit and wonder why we were learning to talk this way, and whether my mind would always sound like a stranger to myself, and not just strange like unfamiliar but strange like not right. Since this was my second school Thanksgiving break, and since I instinctively compare one time marker with its predecessor, last year's week came back to me often. Last Thanksgiving I was in Chicago, visiting a couple friends and exploring on my own. I wasn't studying, I missed the proximity of classmates I'd recently gotten to know but also absolutely relished solitude for the first time since a pretty rough time at the very edge of ends/beginnings that fall, everything was ahead. This Thanksgiving, it was wonderful to be with my whole family and my brother's new baby, the first in our family; people who'd been good friends the past year were now my other family and I didn't have to miss them, and I didn't feel any particular need to be alone either. I wouldn't say one Thanksgiving was better than the other. Putting them aside one another just made the year in between swell a little.
So much has happened. Even from now to this last Thanksgiving, I feel I know new facets of things and older ones more deeply. In any case, even though I wasn't thinking this at the time, I think all the things of the recent past were converging to make a me that wanted to run. I was tired. Spending the summer in Vietnam, road tripping cross country just a few days after, moving into our apartment right after that, starting school before moving even finished, then continuing full speed onto a year of massive mind-stuffing--I was tired. Things had been so fast I was still trying to decide how to approach the rest of the year, what did I want to do and what could I do. A year of tumultuous boy situations also reached its worst that fall, one that I never knew what to do with and another I didn't even realize was there. By Thanksgiving I had made myself proud though not particularly happy by eventually doing the right thing with the latter (yes, that is to say I probably didn't start out right), and transitioning to what would be the best time of our friendship with the former. I didn't know this at the time, though, and deciding how I would proceed was a struggle that break. It really took a lot in me, a lot of fighting my less admirable qualities, to continue the way I ultimately did, and so my energy was low for that reason too. Seeing all of my family was really wonderful; I'd been so looking forward to it but it still surprised me. Happiness is consuming too.
I always look forward to the music I run to. One night I decided that the next day I'd listen to Bon Iver, which really isn't typical running music if you like to listen to things chipper and upbeat. It's true that Bon Iver has a distinct tone, that could be described one-dimensionally as melancholy and quiet, but for me those things have always been so expansive. The sounds are so layered and raw at the same time. The effusiveness is subtle, tugs at things in you kept underneath. The next morning we woke up to a world draped in white. It was my first snowfall of the winter, and first run in a snowfall, and the soundtrack couldn't have been more perfect. Through the slow thirty-seven minutes of the album I went past my brother's neighborhood to discover water rushing fast down its creek, fluff atop and a mix of bare trees and clothed trees, for frame. I've loved Fremont and Cambridge runs, found lesser but palpable enjoyment in San Francisco and New Haven, but this was something I experienced in a place I had no real connection to and would likely never return to in that setting. For that and for everything else, in that sliver of space I felt everything.
The anticipation of good and stress, the tension of what happened, uncertainty of what I'd do and what would be done, the warmth of people I loved, gratitude for people who loved me so well--my family at school and my family-family, frustrations over words and connections, things I don't like admitting I feel (resentment, slighted, inadequate or superior, dislike and regret), open spaces, the heaviness of breathing, someone else's winter in mine, little life, treading and traversing over states, moving downtown, learning for the first time how to learn, a return after absence and the small changes, the walks to school, making home, laundromats and grocery stores, autumn, unfamiliar pressure, working hard to barely keep up, the newness of place and the continual resurgences of past that are so constant for me they may not even qualify as nostalgia--all there in a compact five feet two inches (and a half).
I bought a vinyl record of Bon Iver's album at their concert in Brooklyn, where wife and I were front row. I don't own a record player, and I purposely haven't gotten one yet. I would like to go to a store that probably doesn't exist anymore where they are still lined in rows and I can touch the spindles, on my own because I take a long time to make decisions, and choose one for myself...but not yet. But I like imagining that someday, when the time is right for me, I will have one, and I'll sit on my wood patterned floor and listen to those thirty-seven minutes. I might cry. Not for past melancholy, not even for present happiness, but for fullness in the crevices.
Friday, July 10, 2009
strength
She sits on her bed facing her wall, her Spongebob blanket a cape protecting her shoulders. She hasn't talked to me much these past few days; she didn't want a sticker, and she doesn't smile or wave back; I've stopped using my speaking-to-kids voice with her. Her door is plastered with pictures she's drawn of a lady with long black hair in boots, and when I ask who it is, she says she doesn't know but I'm pretty sure it's someone. I can't tell whether she can't or won't express; I have little to offer and she much to risk. At 7:30 in the morning she's usually still lying in bed, sometimes with her sister or mom engulfing her in the bed. But this morning she's alone and awake and she speaks first, for the first time.
"SURRRRGERY!" she hollers. In that way she has of making booming noise with no apparent effort. Her voice is its usual deep, but her eyes shine. She ignores the television behind her, and tells me she's having surgery today. Her hair, thick, flees from her face and sticks midair. She lets me put my arm around her, and she tells me what she knows about her problem, and I learn. Her eyes stay wet, her face dry. She's done it many, many times before, is always fine, and I would be scared too but she's strong and not anyone can do it, only her. She has had more taken from her, more pieces rearranged, more removed from her and filtered and re-administered, than I can glean from reading and re-reading. Only you. She nods, knowing, but open enough to humor me a little longer. I feel horrible that this is the only way I've had to her, and if it has to happen I wish it were something closer than another white coat. At some point I listen to her lungs and feel her belly.
She says she wants to get outta here. She takes us aflight, and I hang onto the side of the bed as we sift through clouds. She speaks loudly with a kind of distinct firmness that I, with fewer doubts, will never have. I've never met a kid with her clear throaty voice and intonation. Later that afternoon she'll play and yell, tossing around handheld toy dogs named Nanny, Jessica and Peachblossom, watching them topple happily in a plastic pink tub under which she traps them. Later that afternoon she will fold her tiny limber limbs into the cabinet, with a flashlight and the toys and she will leave the door open while I crouch to peer inside, and close it when I stand and leave and when she can use the flashlight. This morning, while we are flying with her bed as sail, she says we've made a faulty landing, and now we're in Tokyo, though she'd been aiming for Orlando Florida. What's in Tokyo, I wonder. "Chinese people!!!" Then we're in Kansas, and she says the landing will be hard. If I could land on my feet I wouldn't be this sick.
"SURRRRGERY!" she hollers. In that way she has of making booming noise with no apparent effort. Her voice is its usual deep, but her eyes shine. She ignores the television behind her, and tells me she's having surgery today. Her hair, thick, flees from her face and sticks midair. She lets me put my arm around her, and she tells me what she knows about her problem, and I learn. Her eyes stay wet, her face dry. She's done it many, many times before, is always fine, and I would be scared too but she's strong and not anyone can do it, only her. She has had more taken from her, more pieces rearranged, more removed from her and filtered and re-administered, than I can glean from reading and re-reading. Only you. She nods, knowing, but open enough to humor me a little longer. I feel horrible that this is the only way I've had to her, and if it has to happen I wish it were something closer than another white coat. At some point I listen to her lungs and feel her belly.
She says she wants to get outta here. She takes us aflight, and I hang onto the side of the bed as we sift through clouds. She speaks loudly with a kind of distinct firmness that I, with fewer doubts, will never have. I've never met a kid with her clear throaty voice and intonation. Later that afternoon she'll play and yell, tossing around handheld toy dogs named Nanny, Jessica and Peachblossom, watching them topple happily in a plastic pink tub under which she traps them. Later that afternoon she will fold her tiny limber limbs into the cabinet, with a flashlight and the toys and she will leave the door open while I crouch to peer inside, and close it when I stand and leave and when she can use the flashlight. This morning, while we are flying with her bed as sail, she says we've made a faulty landing, and now we're in Tokyo, though she'd been aiming for Orlando Florida. What's in Tokyo, I wonder. "Chinese people!!!" Then we're in Kansas, and she says the landing will be hard. If I could land on my feet I wouldn't be this sick.
Friday, July 3, 2009
little ones
It's been sprinkling or pouring with a spurt of sun after stretches of gray since I've been back in Connecticut. The weekend before orientation we went to the beach at Lighthouse Point and shielded ourselves from water splinters underneath a large warm blanket Ali carries in his car, along with a portable bench of sorts and lawn chairs. We smiled at A. and B. sitting past the shore in the ocean, their chairs in wet sand, few inches deep in salt water. Then we went on the swings; I’d never swung on a beach before, and just like flying a kite in the sea in Puerto Rico, these whimsies are made magic by the blue or bluish gray of the beach. Swinging back, you’re immersed in a jar of lighweight sand, grains you separate like the beaded curtains you find in hippie homes, and swinging forward, you burst through the sand, crash lightly through glass to see water seamlessly meeting sky. We were also laughing hard.
Moving from this to my pediatrics rotation required less destitching and sewing up than I anticipated. Two weeks into working on the schoolage-adolescent team (5-18 year olds), I feel ablur. I know as little as I suspected, and the pace is fast and learning wide. My stethoscope heard its first wheeze and crackles. A little one shields her hand and says, I’m too afraid. Video games make his face light up one day, less so as the days pass. I press the fingernails of a ten year old who has been through too much, to see if they blanch in the right amount of time, but they’re painted red and I can’t see underneath. A girl, whose words spill forth from her mouth like water, sees Ali bid farewell and drive away on his scooter and proclaims “Niiiiiiiiiiice” with vehement approval and tells me she’s going to get him and me both Hannah Montana shoes. We taste different medicines, some of them tolerable, many gross but started to blend together as I had one after another, and the last left a long long aftertaste of rotten eggs that made us gag. We also had our lungs uncomfortably scrambled by vibrating vests and pseudomassagers, which are used to disrupt the mucus in patients with cystic fibrosis and bronchiectasis. The boy in a red wagon calls for help from his room, and I sit him on his chair and place his new red shoes on his feet. It’s hard to understand what he says, but he doesn’t give up until you give some sign that you get it, taking the shoe and mimicking several times before I know to tie the laces twice. He points outside, wraps his arms around his chest and shivers, and shakes his head until I ask, you want to know if it’s cold outside? He’s overcome with glee when I tell him it’s warm, and when I look at a picture of a truck he’s colored and notes that it looks like his wagon, he pats my back excitedly, and somewhere in the subsequent pride that I feel for figuring it out, I realize again I’m as much kid in all this as the one who colors.
When I come home, some days I cook dinner with J. and most days we talk a little about our days and those are good moments. Last night was the first I didn’t have to sleep early, and A. and B. cooked a delicious, delicious dinner of a tuna noodle salad, cornish hen, red cabbage and rice textured with potato. Most of their meals can’t be duplicated, because they make it up as they go and add innumerable amounts of spices and sauces they can’t recall afterwards. We ate on their balcony in the cool summer night, then closed the sliding door when it got cold and listened to them make music the same way they make food, while the girls listened and laughed. He strummed Michael’s Song from the Godfather, and sang acappella the Italian one from Part III, sung by Michael’s opera-singing son. When J. asked him to sing about fruits, he sang, some girls are like bananas, others like strawberries, I want to make a smoothie. He sang a silly tune about mom, sister and wife that earned him a hug. B. controlled mood and speed with the guitar and chimed in, carrying the last words of A’s phrases, like “louder,” with impressive timing. I love music and these people. The room was dim, it was raining sleet black outside (we caught a flash of lightning), and I fell asleep.
Today we were outdoors again, driving beneath a canopy of green trees to rest beneath the waterfall at West Rock, climbing what was called a cave and what was more like some rocks with crevices that went in one way and went out another, and grabbing a view of the city before rain splattered down. We shared red bean & jelly popsicles, nectarines, and strawberry jam and nutella sandwiches in the car, and smelled over and over some honeysuckle that Ali found.
At night, I did another thing I've never done on the beach: watch fireworks. West Haven is a small town, and the beach is a popular place to celebrate July 4. We parked a good ten-minute walk away from the beach and walked through the residential area to get to the sand, and summer was palpable. The streets were packed with families, and the beach densely peppered with the same. People were selling cotton candy, people were carrying lawn chairs and towels. We arrived just as the fireworks began, and we could see them shoot from their source up to their destination; we were close and they felt huge. At some points there would be a steady stream shooting a short distance up while others sporadically went higher, and at the end they were insanely bright like snaps of lightning. The sounds were louder too, than I've heard in the past, and some had distinct sounds, just as their colors and trajectories and lifetimes are distinct. A small group of small girls frolicked with glow in the dark sticks, singing "land of the free, for you and for me," attempting cartwheels and screaming "fireworks!" while generally paying no attention to the lights underneath which they were dancing. Afterwards we walked to the shore's edge, and Allison mentioned it reminded her of Puerto Rico, the last time she saw the water at night. That time the bay lit up as your brushed your hand through the water or dipped your oar into it, from the light of microorganisms. The first time I moved through water at night.
As we stood people continued to set off fireworks, in all corners, such that standing in one spot you felt the sparks in every direction and couldn't see them all at once. Families set them off in the sand and water, and the ocean picked up the colors and melted them. We walked away as the fireworks kept going, and drove home with the windows down to keep the cool summer air.
One thing I've yet to do at the beach is swim. I do as I do in the hospital--I wade, I move with the waves, I jump the waves, I sink into the waters and gaze up and down, but I don't know how to swim. I'm scared to learn, but I want to and have to, and when I do it, I trust that the ocean will again make the sensations of what's commonplace as strong and sharp as those that little ones feel.
Moving from this to my pediatrics rotation required less destitching and sewing up than I anticipated. Two weeks into working on the schoolage-adolescent team (5-18 year olds), I feel ablur. I know as little as I suspected, and the pace is fast and learning wide. My stethoscope heard its first wheeze and crackles. A little one shields her hand and says, I’m too afraid. Video games make his face light up one day, less so as the days pass. I press the fingernails of a ten year old who has been through too much, to see if they blanch in the right amount of time, but they’re painted red and I can’t see underneath. A girl, whose words spill forth from her mouth like water, sees Ali bid farewell and drive away on his scooter and proclaims “Niiiiiiiiiiice” with vehement approval and tells me she’s going to get him and me both Hannah Montana shoes. We taste different medicines, some of them tolerable, many gross but started to blend together as I had one after another, and the last left a long long aftertaste of rotten eggs that made us gag. We also had our lungs uncomfortably scrambled by vibrating vests and pseudomassagers, which are used to disrupt the mucus in patients with cystic fibrosis and bronchiectasis. The boy in a red wagon calls for help from his room, and I sit him on his chair and place his new red shoes on his feet. It’s hard to understand what he says, but he doesn’t give up until you give some sign that you get it, taking the shoe and mimicking several times before I know to tie the laces twice. He points outside, wraps his arms around his chest and shivers, and shakes his head until I ask, you want to know if it’s cold outside? He’s overcome with glee when I tell him it’s warm, and when I look at a picture of a truck he’s colored and notes that it looks like his wagon, he pats my back excitedly, and somewhere in the subsequent pride that I feel for figuring it out, I realize again I’m as much kid in all this as the one who colors.
When I come home, some days I cook dinner with J. and most days we talk a little about our days and those are good moments. Last night was the first I didn’t have to sleep early, and A. and B. cooked a delicious, delicious dinner of a tuna noodle salad, cornish hen, red cabbage and rice textured with potato. Most of their meals can’t be duplicated, because they make it up as they go and add innumerable amounts of spices and sauces they can’t recall afterwards. We ate on their balcony in the cool summer night, then closed the sliding door when it got cold and listened to them make music the same way they make food, while the girls listened and laughed. He strummed Michael’s Song from the Godfather, and sang acappella the Italian one from Part III, sung by Michael’s opera-singing son. When J. asked him to sing about fruits, he sang, some girls are like bananas, others like strawberries, I want to make a smoothie. He sang a silly tune about mom, sister and wife that earned him a hug. B. controlled mood and speed with the guitar and chimed in, carrying the last words of A’s phrases, like “louder,” with impressive timing. I love music and these people. The room was dim, it was raining sleet black outside (we caught a flash of lightning), and I fell asleep.
Today we were outdoors again, driving beneath a canopy of green trees to rest beneath the waterfall at West Rock, climbing what was called a cave and what was more like some rocks with crevices that went in one way and went out another, and grabbing a view of the city before rain splattered down. We shared red bean & jelly popsicles, nectarines, and strawberry jam and nutella sandwiches in the car, and smelled over and over some honeysuckle that Ali found.
At night, I did another thing I've never done on the beach: watch fireworks. West Haven is a small town, and the beach is a popular place to celebrate July 4. We parked a good ten-minute walk away from the beach and walked through the residential area to get to the sand, and summer was palpable. The streets were packed with families, and the beach densely peppered with the same. People were selling cotton candy, people were carrying lawn chairs and towels. We arrived just as the fireworks began, and we could see them shoot from their source up to their destination; we were close and they felt huge. At some points there would be a steady stream shooting a short distance up while others sporadically went higher, and at the end they were insanely bright like snaps of lightning. The sounds were louder too, than I've heard in the past, and some had distinct sounds, just as their colors and trajectories and lifetimes are distinct. A small group of small girls frolicked with glow in the dark sticks, singing "land of the free, for you and for me," attempting cartwheels and screaming "fireworks!" while generally paying no attention to the lights underneath which they were dancing. Afterwards we walked to the shore's edge, and Allison mentioned it reminded her of Puerto Rico, the last time she saw the water at night. That time the bay lit up as your brushed your hand through the water or dipped your oar into it, from the light of microorganisms. The first time I moved through water at night.
As we stood people continued to set off fireworks, in all corners, such that standing in one spot you felt the sparks in every direction and couldn't see them all at once. Families set them off in the sand and water, and the ocean picked up the colors and melted them. We walked away as the fireworks kept going, and drove home with the windows down to keep the cool summer air.
One thing I've yet to do at the beach is swim. I do as I do in the hospital--I wade, I move with the waves, I jump the waves, I sink into the waters and gaze up and down, but I don't know how to swim. I'm scared to learn, but I want to and have to, and when I do it, I trust that the ocean will again make the sensations of what's commonplace as strong and sharp as those that little ones feel.
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