I finished working at the VA hospital a few weeks ago, and started at the Yale hospital for my second month of medicine. I told my 90 yo patient in the hospice unit at the VA that I'd come by and see him every so often after I left the VA. The last few weeks have been so incredibly busy that I kept saying, tomorrow will be a better time. I finally went back today. He'd passed away.
This possibility had crossed my mind since I last saw him, but wasn't palpable; he hadn't been actively sick when I last saw him and people in hospice at the VA can have up to a six month prognosis. I'd envisioned visiting him for months. When someone else was in his room, I walked further down the hallway; maybe I'd remembered incorrectly. I walked slowly back and slowly found my way to the board with patient names and rooms, and slowly scanned it up and down for his name. I wasn't frantic like I might imagine I would be. Everything sunk slowly but not steadily, like steps down a ladder where you don't feel the space in between until you feel the suddenness of the next piece of metal. I walked around more trying to decide what to do, as if there were any options. I thought about looking him up in the computer to know for sure, but I couldn't remember the zillion passwords. Finally I asked the front desk, and they said, yes he passed awhile ago.
I wonder how it was, and most of all I wonder if he was sad near the end, whether he'd ever come to accept leaving life, a reality he was still mourning when I saw him last. I remember so much of what he said, not just because sometimes it was funny or sweet or touching but because always it was true. One night when I was on call and saw him, he was so surprised to have a visitor in the evening. He told me that it was late, someone would snatch me, and to be safe. Lying frail in bed the way he cared about my vulnerability took me home safe. Watching Jeopardy on television, he'd say he knows all the answers but "sometimes the game isn't there." Held up his fingers like he was sifting sand that wasn't there, and looked at me: see, nothing.
Needless to say I feel awful for not being able to say goodbye, for failing my promise. As students the one thing we have more than others is the time and the awareness for good intentions, and the one thing I feel I can offer is the drive to follow through with the intention to care. Yesterday someone reminded me that we can always find time for what's most important; it really is a matter of will. I'm sorry that I didn't have it in me, that I disappointed once more. Even as all these things give more reason to try harder, I sense that circumstances and fallibility align such that I'll disappoint again. One, try harder not to; two, figure out how to proceed once I have.
*
I spent Thanksgiving in the hospital this year, and while I complained about it and missed my family all the while, it was ultimately a source of gratitude. I admitted a patient with lung cancer that's spread all over; when I asked how he was feeling he started sobbing. Upon questions, he said he was worried about his family. Upon more questions, he kept repeating that he just had so much love for them. So much love, it can be hard.
Across the room from him is a patient our head physician is taking care of, I've gotten to know him since he's been here for awhile, and my doctor allowed me to be part of an end-of-life discussion with him. She says he's sweet, you can tell that life's been unfair to him. It sounds strange to call that sweet, but I know how she felt; I think she meant the hardship people carry that endears you to them. He has no car so his wife can't come visit him, and few resources, so that they couldn't find other transport. But on Thanksgiving his grandkids visited and they had a car, so his entire family came to see him. That was nice to see. It was also difficult. As this was the only time his family came, the doctors took the opportunity to speak with them about the same end-of-life issues that they'd discussed with the patient the day before. Like my hospice patient, this one hasn't let go yet, isn't ready to accept that his lungs, heart, kidneys are failing, when his thoughts and feelings are so clear and functional.
The Friday after Thanksgiving, I was on my way out of the hospital and I told him I'd miss him over the weekend. He said well then you should work over the weekend. I said I'll come by to see you. He said that's very nice but you won't. I laughed and said I would. I did, after I drove back from the VA after finding out about the hospice patient; a schedule and route I'd planned in my head this morning before I knew anything, and after I knew, I fought hard against using my guilt and obligation as motivation. And when I saw this patient who is not so well but still alive, and he said, maybe I'll see you tomorrow? -- there's no need for any other reason.
Saturday, November 28, 2009
Tuesday, November 24, 2009
meat
Realized that in my last two entries I used the phrase, the "meat" of something. On both these nights I'd eaten ground beef for dinner; in spaghetti for one and in ma po tofu for the other (http://ineluctable.org/ieatfood/ma_po_tofu/ma%20po%20tofu-9.jpg). I hope this means substance is brewing.
Monday, November 23, 2009
essays
In the hospital I become acutely aware of what I'm good at and not good at. The latter list is extensive: picking up things on physical exam (I'm tone deaf! I can't tell whether that's dull or resonant. And why can't I elicit reflexes, ever?), immediate differential diagnoses, remembering yesterday's lab values, the finer points of the plan for a patient, interpreting radiological studies. Sometimes in these moments of incompetence (and also through the first two years of med school when I realized I knew about 1% of the basic science my classmates knew and was also 1% as quick to learn new information, resulting in an exponential lag between me and them), I think back to when my primary occupation was one in which I was relatively competent. That is, being an English major and writing about stories other people had written. There are a lot of ways I'm a shoddy English major (probably most of the ways one typically thinks of). I can't remember a lot of what I read other than how I felt about it, I can't quote anything, and I even get my eras of literature mixed up because my wayward sense of direction also applies to chronology before my time.
But I did like writing essays and like others taught in the form of close reading, could write a decent one. It takes me a long, long time to write one. I remember my college roommate pulling all nighters to write amazing papers, but it would be literally impossible for me to complete a good essay like that. This roommate visited recently, and we talked about missing essay writing. But even before that, when I screw up the many forms to be learned in medicine, I drift back to those days in our cozy house library, to when I had a system. I'd go through the text first: picking out lines, turns of phrases, images, structure of chapters--pay attention to why this word was chosen, what it conjures, where it's placed in relation to another. I'd type out all the quotes in a document; I enjoyed the false productivity of filling my pages with someone else's words and it helped me immerse in the text. As I did this I'd stream-of-consciously type my commentary on the quotes, and let my ideas and thesis emerge organically from what I found and thought. There's a certain rush after you've been chugging along, either with a boring stream of nothing much or with spurts of disconnected epiphanies, and you suddenly string things together. This begins a flurry of grouping related thoughts and possibly in a general order. And then the introduction can be written. Some say to save this for the end, but for me it was always the most time consuming and important, to know what I wanted the essay as a whole to say, and that's what the introduction does. Even as it sets up the structure for the rest, it's the most free flowing part of the essay too, because it doesn't require immediate, constant concrete evidence. It's just a promise.
In the midst of the forest of scraggly trees that is becoming a good doctor, it is sometimes nice to remember what it's like to take a complexity and reform a small part of it into an essay. An order with enough loose strands to keep it interesting and realistic but overall compact and from the bareness of your hands.
Here is one introduction from my favorite English class in college, a seminar on criminals and misfits in literature.
*
The Real Prison of a False Identity
“He who is subjected to a field of visibility...inscribes in himself the power relation in which he simultaneously plays both roles; he becomes the principle of his own subjection.” -Michel Foucault, Discipline and Punish (323).
The cover of the 1995 Random House edition of Franz Kafka’s The Trial depicts a man’s face, colored in red, behind black bars. The image of a prison is evident, but whether it is the actual solid bars or the rectangular segments of the man’s face that comprise the prison is less clear. Initially, the black bars appear to restrict the man’s freedom, demonstrating a traditional view of imprisonment. However, the red face can also be perceived as the imposing force that breaks the unity of the black background. This dichotomy is similarly reflected in the portrayal of the “gaze.” In “Panopticism,” Michel Foucault asserts that power resides in a supervisor’s ability to view a prisoner while remaining hidden from him (321). Because his face is visible, the man on the cover seems to be the prisoner. Yet, closer examination reveals that he is likewise the supervisor: the prominent eye amidst a hazy face suggests that he sees more than is seen. Both the criminal in the Panopticon and Joseph K., the protagonist of The Trial, unknowingly exemplify this duality.
A man confined to a cell in the Panopticon is highly conscious of his lack of space and movement. K. resides figuratively in a similar prison but with one crucial difference: he does not see his boundaries. Whereas the prisoner in the Panopticon knows that he dwells in the periphery of the structure, K. envisions himself at the center. Neither person realizes that he also assumes the opposite role. Because individuality connotes one identity, these opposing forces negate the existence of a self. Unaware of this duality, however, the Panopticon prisoner and Joseph K. harbor illusions of self-identity which ultimately facilitate their self-destruction. The imprisoning structure maximizes its power by instilling in the criminal what is otherwise typically liberating--a sense of individuality.
*
Looking back, I enjoy it as I did then. I also think, in the end, it is as limited as medicine can often be. The senselessness of semantics and vocabulary, creating complications, wondering what the use is. But each form of practice and expression pushes us to work beyond its parameters. I find that the real meat in writing an essay about a piece of literature or a history & physical for a patient isn't so much to come to a conclusion (even though we sound like we do and this is the stated, accepted and expected reason for doing it), as it is to grapple and stumble. I like how literature and medicine as fields complement, parallel, and contrast one another at different points in my life, my day. They can play tug of war with me the knot in the middle, or gang up on one side with me on the other, or it can be we three against who-knows-what. I'm willing to stumble a lot for that range of visibility.
But I did like writing essays and like others taught in the form of close reading, could write a decent one. It takes me a long, long time to write one. I remember my college roommate pulling all nighters to write amazing papers, but it would be literally impossible for me to complete a good essay like that. This roommate visited recently, and we talked about missing essay writing. But even before that, when I screw up the many forms to be learned in medicine, I drift back to those days in our cozy house library, to when I had a system. I'd go through the text first: picking out lines, turns of phrases, images, structure of chapters--pay attention to why this word was chosen, what it conjures, where it's placed in relation to another. I'd type out all the quotes in a document; I enjoyed the false productivity of filling my pages with someone else's words and it helped me immerse in the text. As I did this I'd stream-of-consciously type my commentary on the quotes, and let my ideas and thesis emerge organically from what I found and thought. There's a certain rush after you've been chugging along, either with a boring stream of nothing much or with spurts of disconnected epiphanies, and you suddenly string things together. This begins a flurry of grouping related thoughts and possibly in a general order. And then the introduction can be written. Some say to save this for the end, but for me it was always the most time consuming and important, to know what I wanted the essay as a whole to say, and that's what the introduction does. Even as it sets up the structure for the rest, it's the most free flowing part of the essay too, because it doesn't require immediate, constant concrete evidence. It's just a promise.
In the midst of the forest of scraggly trees that is becoming a good doctor, it is sometimes nice to remember what it's like to take a complexity and reform a small part of it into an essay. An order with enough loose strands to keep it interesting and realistic but overall compact and from the bareness of your hands.
Here is one introduction from my favorite English class in college, a seminar on criminals and misfits in literature.
*
The Real Prison of a False Identity
“He who is subjected to a field of visibility...inscribes in himself the power relation in which he simultaneously plays both roles; he becomes the principle of his own subjection.” -Michel Foucault, Discipline and Punish (323).
The cover of the 1995 Random House edition of Franz Kafka’s The Trial depicts a man’s face, colored in red, behind black bars. The image of a prison is evident, but whether it is the actual solid bars or the rectangular segments of the man’s face that comprise the prison is less clear. Initially, the black bars appear to restrict the man’s freedom, demonstrating a traditional view of imprisonment. However, the red face can also be perceived as the imposing force that breaks the unity of the black background. This dichotomy is similarly reflected in the portrayal of the “gaze.” In “Panopticism,” Michel Foucault asserts that power resides in a supervisor’s ability to view a prisoner while remaining hidden from him (321). Because his face is visible, the man on the cover seems to be the prisoner. Yet, closer examination reveals that he is likewise the supervisor: the prominent eye amidst a hazy face suggests that he sees more than is seen. Both the criminal in the Panopticon and Joseph K., the protagonist of The Trial, unknowingly exemplify this duality.
A man confined to a cell in the Panopticon is highly conscious of his lack of space and movement. K. resides figuratively in a similar prison but with one crucial difference: he does not see his boundaries. Whereas the prisoner in the Panopticon knows that he dwells in the periphery of the structure, K. envisions himself at the center. Neither person realizes that he also assumes the opposite role. Because individuality connotes one identity, these opposing forces negate the existence of a self. Unaware of this duality, however, the Panopticon prisoner and Joseph K. harbor illusions of self-identity which ultimately facilitate their self-destruction. The imprisoning structure maximizes its power by instilling in the criminal what is otherwise typically liberating--a sense of individuality.
*
Looking back, I enjoy it as I did then. I also think, in the end, it is as limited as medicine can often be. The senselessness of semantics and vocabulary, creating complications, wondering what the use is. But each form of practice and expression pushes us to work beyond its parameters. I find that the real meat in writing an essay about a piece of literature or a history & physical for a patient isn't so much to come to a conclusion (even though we sound like we do and this is the stated, accepted and expected reason for doing it), as it is to grapple and stumble. I like how literature and medicine as fields complement, parallel, and contrast one another at different points in my life, my day. They can play tug of war with me the knot in the middle, or gang up on one side with me on the other, or it can be we three against who-knows-what. I'm willing to stumble a lot for that range of visibility.
Sunday, November 22, 2009
thirteen virtues
In high school English class, our teacher had us list Benjamin Franklin's 13 virtues in the order we personally found most important. We then split the room into 13 areas and as our teacher counted down 13 to 1, we walked to the virtues corresponding to that number on our list. I think Jen mentioned these on her blog awhile back, and for whatever reason I thought of them again today. I don't remember distinctly what my order was back in high school, but can't imagine it's much different.
1. Justice
wrong none by doing injuries, or omitting the benefits that are your duty.
2. Humility
imitate Jesus and Socrates.
3. Sincerity
use no hurtful deceit; think innocently and justly; if you speak, speak accordingly.
4. Resolution
resolve to perform what you ought; perform without fail what you resolve.
5. Frugality
make no expense but to do good to others or yourself; waste nothing.
6. Tranquility
be not disturbed at trifles, or at incidents common or unavoidable.
7. Order
let all your things have their places; let each part of your business have its time.
8. Moderation
avoid extremes; forbear resenting injuries so much as you think they deserve.
9. Industry
lose no time; be always employed in something useful; cut off all unnecessary actions.
10. Silence
speak not but what may benefit others or yourself; avoid trifling conversation.
11. Chastity
rarely use venery but for health or offspring, never to dullness, weakness, or the injury of your own or another's peace or reputation.
12. Temperance
eat not to dullness; drink not to elevation.
13. Cleanliness
tolerate no cleanliness in body, clothes, or habitation.
Groups of values are easier than the ones among them; I can easily choose the top five, the bottom few, all that should go in the middle but between those it's difficult to sort out, though the top two are clearly the top two for me. Number 3, 4 and 5 seem equally important to me and that order changes in my head from moment to moment such that it drove me crazy just to get that order and I give up. Those top five are hardest for me to accomplish, along with a couple of the mid-bottom, like silence. There are several qualifications of these values that caused shifts in their order ("cut off all unnecessary actions"--does the necessary unnecessary count? "trifling conversation"--does necessary trifling count?...these things are part of happiness, silliness, wholeness). Also, cleanliness as #13 doesn't mean I endorse mess, but rather than cleanliness I think "order" is more...necessary. I agree with the latter part of chastity (and personally or for modernity, could replace "health or offspring" with "love or connection") but the meat of it is about injury, and isn't that justice. Temperance seems to be solely related to food and drink, and moderation everything else, so that is low. If I had to make it up on my own, it'd be a little different. But these are important.
Come to think of it, not too good at most of these. Reminder.
1. Justice
wrong none by doing injuries, or omitting the benefits that are your duty.
2. Humility
imitate Jesus and Socrates.
3. Sincerity
use no hurtful deceit; think innocently and justly; if you speak, speak accordingly.
4. Resolution
resolve to perform what you ought; perform without fail what you resolve.
5. Frugality
make no expense but to do good to others or yourself; waste nothing.
6. Tranquility
be not disturbed at trifles, or at incidents common or unavoidable.
7. Order
let all your things have their places; let each part of your business have its time.
8. Moderation
avoid extremes; forbear resenting injuries so much as you think they deserve.
9. Industry
lose no time; be always employed in something useful; cut off all unnecessary actions.
10. Silence
speak not but what may benefit others or yourself; avoid trifling conversation.
11. Chastity
rarely use venery but for health or offspring, never to dullness, weakness, or the injury of your own or another's peace or reputation.
12. Temperance
eat not to dullness; drink not to elevation.
13. Cleanliness
tolerate no cleanliness in body, clothes, or habitation.
Groups of values are easier than the ones among them; I can easily choose the top five, the bottom few, all that should go in the middle but between those it's difficult to sort out, though the top two are clearly the top two for me. Number 3, 4 and 5 seem equally important to me and that order changes in my head from moment to moment such that it drove me crazy just to get that order and I give up. Those top five are hardest for me to accomplish, along with a couple of the mid-bottom, like silence. There are several qualifications of these values that caused shifts in their order ("cut off all unnecessary actions"--does the necessary unnecessary count? "trifling conversation"--does necessary trifling count?...these things are part of happiness, silliness, wholeness). Also, cleanliness as #13 doesn't mean I endorse mess, but rather than cleanliness I think "order" is more...necessary. I agree with the latter part of chastity (and personally or for modernity, could replace "health or offspring" with "love or connection") but the meat of it is about injury, and isn't that justice. Temperance seems to be solely related to food and drink, and moderation everything else, so that is low. If I had to make it up on my own, it'd be a little different. But these are important.
Come to think of it, not too good at most of these. Reminder.
Sunday, November 8, 2009
delirium
I met a wonderful 90 year old who came to the hospital for a serious infection in his lungs and blood, who would go in and out of clarity. There were moments where we could converse happily and he'd tell sweet, funny jokes; other times he'd blink slowly and stare blankly, and throughout his stay pain management was an issue. His intermittent moans of pain, physical and inner, gave slight insight into his distress and distressed his neighbors so that he was moved to his own room. Sometimes there was a physical source; other times it seemed expression for something deeper. A gland in his mouth was infected, making it painful for him to eat, dehydrating him. A nurse described his tongue as lizard skin, crusted over with yellow and white; his teeth and the back of his throat covered in the same film. I watched swabs be used to clean him, and I'd never seen so much foreign come from a person's mouth. Each day we'd check, and it looked better after that but I found myself compulsively swabbing him anyway. Brought heat packs and massaged the area, as recommended by the ear nose throat doctors, needing to do something concrete even though quite unsure of the use. In the hospital he began having pain in his rectum. He had diarrhea so much that the nurses put a tube in him ("fecal management system"), and we tried our best--creams, morphine, opiates delivered directly to the source of pain. Sometimes he cried. Not out of pain; out of sadness. He recovered from his infection, but with his continued delirium and inability to do physical therapy, the decision was made to move him to the hospice unit.
When we came to see him at hospice, he was clean. Every day now he says he has no pain. He draws our attention to his smooth skin, freshly shaven. One day he was in the hallway, and said he was waiting for a hair cut (a trim of handsome white peach fuzz). There are still moments of sadness, of his forming phrases--I don't want to leave you, I know all the answers but the game isn't there, I want to live, yes I know but more. And sometimes there are still hallucinations. But he is clean and without pain, and while we try to not let that be everything, we're grateful for that something.
Later we had a class on delirium. After going through a long list of causes of delirium (infection, decreased oxygen, too little salt, too much salt, kidney failure, dehydration, so on and on), our professor asked us how to prevent delirium. Antibiotics for infection? No. We drew a blank on how to prevent all the other causes, and he told us to give up because that wasn't how to think about it. Instead, he told us that studies had been done to show that when people are confronted with these illnesses, six things were shown to reduce the incidence of delirum: sleep, hydration, cognition, vision, hearing, and mobility. Ensuring lights out and reduced noise during hours of sleep, keeping people hydrated, playing daily memory games to maintain cognition, supplying visual and hearing aids, and having some sort of physical therapy--these things kept patients' senses functioning as their bodies fought sickness. Except for hydration, these things didn't target the direct causes of delirium; the people were still sick, but among those who were sick, their alertness and awareness, and thereby communication, interaction and general comfort, were healthier. So it makes much sense that a place like hospice, a place focused on comfort, kept his delirium a bit more at bay, and the idea of holistic care carries hope.
I've been reminded to take care of myself during the intense medicine rotation, and I think I have. It is true that there is less time and energy to go around during this rotation, but aside from a handful of tiring nights it hasn't been overwhelming. The time to spare does have to be allocated and delegated carefully, and after taking care of myself there's not much left over, but this also means that I've paid good attention to the things that provide care, and subsequently relished them. Everyone has their own six things to keep them sane, with some basics and some variation, and third year had me finding them quickly: sleep, cooking, running, friends, dancing, and places. Sleep goes without saying. Cooking at least once or twice a week reminds me that the days don't have to be rushed or prepackaged. The other week I sat down and ate without doing anything else, for the first time in I don't know how long. No company, no phone conversation, no tv, no internet, no reading book or textbook. Eating, and eating alone, allows for rest and like with any other isolation, for heightened senses; in this case, taste. I also associate a certain strange satisfaction with finishing leftovers, so even those days held a certain sense of still functioning. Aside from a two week hiatus during the height of a cough I still have, I've been running a slow six miles at least twice a week. So far this pace and time is suiting my schedule better than faster or longer, and the thing I now remember with running is that what happens on one run doesn't predict the next. Some days you just feel better and faster, and other days you feel like crap, and I've learned to not feel bad about the crappy days. On those days I remember that it's good just to be moving, and that it's enough to do it, regardless of how, and that the highs and lows balance. And this makes me feel better about whatever else I might be doing not so well at the moment, or at other moments.
As for friends, I continue to be glad every day for the people in my life, here and around, presently and from my past, and find that every interaction affirms the gratitude. I feel lucky to be in an environment where I feel comfortable with a good number of people; namely, a small place, as I think the number of people had a lot to do with some of my isolation in college. I feel lucky to find time for snippets and sprawls of conversation, for the emails and gchats and calls and meals and outings, to know people I really love, and love knowing, and love knowing of their presence. These tend to be with people with whom I'm particularly close, while dancing can extend to my class as a whole. It makes me happy to be dancing with my college roommates on another Halloween, with whom I've danced so many good nights, remembering we don't need much else than ourselves to be crazy and escape-happy. It also makes me happy to be dancing with a crowd of classmates, many I haven't seen in months, in a flashback of our first year when we danced almost every week. Several have distinct styles that are equally awesome and smile-so-hard-it-hurts inducing. And there's just something inherently fun and wonderful about a group of people going crazy for no real reason other than that it's inherently fun and wonderful. This weekend we celebrated two class birthdays, both with a lot of dancing, one more club-style the other a la karaoke, and I wasn't anticipating such fun before either, so all the more reason to relish. It was nice and hilarious to see A., usually not so mobile, moving with such adrenaline; M. singing everything from Beyonce to Barbie Girl; and clusters of us interacting with each other through something simple and thoughtless.
Places may be the most vague, and maybe that's why I need it. The day when it was decided to move him to hospice, we happened upon an ethereal cemetery on the way home from the hospital, and we went. It was palpably cathartic, and beautiful. N. had never been to a cemetery before, and I'd never been to one in quite that way. The air was autumn crisp, with much sun, and we came back another day for pictures, lying on patches of leaves, and re-exploration of its huge open fields, the rows upon rows of stone, slopey hills, and wheat like weeds brushing the pond. We've driven hours north for fall leaves to come across shallow streams we don't dare drive across, and few miles away for a coffeeshop with rain stained glass where we hide until it comes down too hard to wait any longer. Each time I feel the distance from here, from knowing there is more and that though he will be in one room from now on the space is wide.
When we came to see him at hospice, he was clean. Every day now he says he has no pain. He draws our attention to his smooth skin, freshly shaven. One day he was in the hallway, and said he was waiting for a hair cut (a trim of handsome white peach fuzz). There are still moments of sadness, of his forming phrases--I don't want to leave you, I know all the answers but the game isn't there, I want to live, yes I know but more. And sometimes there are still hallucinations. But he is clean and without pain, and while we try to not let that be everything, we're grateful for that something.
Later we had a class on delirium. After going through a long list of causes of delirium (infection, decreased oxygen, too little salt, too much salt, kidney failure, dehydration, so on and on), our professor asked us how to prevent delirium. Antibiotics for infection? No. We drew a blank on how to prevent all the other causes, and he told us to give up because that wasn't how to think about it. Instead, he told us that studies had been done to show that when people are confronted with these illnesses, six things were shown to reduce the incidence of delirum: sleep, hydration, cognition, vision, hearing, and mobility. Ensuring lights out and reduced noise during hours of sleep, keeping people hydrated, playing daily memory games to maintain cognition, supplying visual and hearing aids, and having some sort of physical therapy--these things kept patients' senses functioning as their bodies fought sickness. Except for hydration, these things didn't target the direct causes of delirium; the people were still sick, but among those who were sick, their alertness and awareness, and thereby communication, interaction and general comfort, were healthier. So it makes much sense that a place like hospice, a place focused on comfort, kept his delirium a bit more at bay, and the idea of holistic care carries hope.
I've been reminded to take care of myself during the intense medicine rotation, and I think I have. It is true that there is less time and energy to go around during this rotation, but aside from a handful of tiring nights it hasn't been overwhelming. The time to spare does have to be allocated and delegated carefully, and after taking care of myself there's not much left over, but this also means that I've paid good attention to the things that provide care, and subsequently relished them. Everyone has their own six things to keep them sane, with some basics and some variation, and third year had me finding them quickly: sleep, cooking, running, friends, dancing, and places. Sleep goes without saying. Cooking at least once or twice a week reminds me that the days don't have to be rushed or prepackaged. The other week I sat down and ate without doing anything else, for the first time in I don't know how long. No company, no phone conversation, no tv, no internet, no reading book or textbook. Eating, and eating alone, allows for rest and like with any other isolation, for heightened senses; in this case, taste. I also associate a certain strange satisfaction with finishing leftovers, so even those days held a certain sense of still functioning. Aside from a two week hiatus during the height of a cough I still have, I've been running a slow six miles at least twice a week. So far this pace and time is suiting my schedule better than faster or longer, and the thing I now remember with running is that what happens on one run doesn't predict the next. Some days you just feel better and faster, and other days you feel like crap, and I've learned to not feel bad about the crappy days. On those days I remember that it's good just to be moving, and that it's enough to do it, regardless of how, and that the highs and lows balance. And this makes me feel better about whatever else I might be doing not so well at the moment, or at other moments.
As for friends, I continue to be glad every day for the people in my life, here and around, presently and from my past, and find that every interaction affirms the gratitude. I feel lucky to be in an environment where I feel comfortable with a good number of people; namely, a small place, as I think the number of people had a lot to do with some of my isolation in college. I feel lucky to find time for snippets and sprawls of conversation, for the emails and gchats and calls and meals and outings, to know people I really love, and love knowing, and love knowing of their presence. These tend to be with people with whom I'm particularly close, while dancing can extend to my class as a whole. It makes me happy to be dancing with my college roommates on another Halloween, with whom I've danced so many good nights, remembering we don't need much else than ourselves to be crazy and escape-happy. It also makes me happy to be dancing with a crowd of classmates, many I haven't seen in months, in a flashback of our first year when we danced almost every week. Several have distinct styles that are equally awesome and smile-so-hard-it-hurts inducing. And there's just something inherently fun and wonderful about a group of people going crazy for no real reason other than that it's inherently fun and wonderful. This weekend we celebrated two class birthdays, both with a lot of dancing, one more club-style the other a la karaoke, and I wasn't anticipating such fun before either, so all the more reason to relish. It was nice and hilarious to see A., usually not so mobile, moving with such adrenaline; M. singing everything from Beyonce to Barbie Girl; and clusters of us interacting with each other through something simple and thoughtless.
Places may be the most vague, and maybe that's why I need it. The day when it was decided to move him to hospice, we happened upon an ethereal cemetery on the way home from the hospital, and we went. It was palpably cathartic, and beautiful. N. had never been to a cemetery before, and I'd never been to one in quite that way. The air was autumn crisp, with much sun, and we came back another day for pictures, lying on patches of leaves, and re-exploration of its huge open fields, the rows upon rows of stone, slopey hills, and wheat like weeds brushing the pond. We've driven hours north for fall leaves to come across shallow streams we don't dare drive across, and few miles away for a coffeeshop with rain stained glass where we hide until it comes down too hard to wait any longer. Each time I feel the distance from here, from knowing there is more and that though he will be in one room from now on the space is wide.
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