A couple of songs immersing my trudges to and from, and much in between--
Two by the Antlers, from Hospice
http://www.youtube.com/watch?v=ZsXKa97J6pM
The sound at first feels so different from the words. The sound begins simple, a kind of pure that I'd like first thing in the morning. More and more builds, and you can't really hear the words too well, but phrases slip into sharpness and over time you string together pieces and realize the story is sad. Listen more and more, and the conflict comes into focus, but then blurs back into background, because it's not so much that the sound and word oppose; they layer.
Cosmic Love by Florence & the Machine, from Lungs
http://popup.lala.com/popup/432627079823895964
Soft female voices that can really howl give so much. I heard this song and thought for awhile of a word to describe what her voice does, and soon after I settled upon "howl," I noticed that song #4 on her album carries that title. Fitting for an album celebrating the capacity of her lungs. And that volume doesn't have to be about overcoming or battling in order to for her sound to be soaring; it can just be the volume of what she feels and the expression of that. I love when femininity proves its strength by pouring forth the full-blown force of vulnerability.
Sunday, February 28, 2010
Wednesday, February 24, 2010
alone
Leaning against my car, I didn’t see any water. Void of any geographical sense, I wasn’t sure where the Long Island Sound was situated but I wasn’t really looking for it either. Though the space between, between where I was and where the bank of trees ahead lay, steeped down and gave a feeling of being higher up, the parking lot was likely not elevated enough to afford a view. It was cold, not bitingly so, just so to match the gray that comes too early in the day during months like December. The sky held a dull solid gray, the trees blended a hazy one.
It’d been a short and unfamiliar drive from New Haven to the Connecticut Hospice, and now that I’d entered and left the entrance of the building, it was easier to stay. The stray leaves clinging to deceptively precarious branches didn’t keep the trees from being bare, but made them feel heavy, and I tried to focus on the lean trunks. I tried not to choke on my heaving breaths. And to stop the flow of salt and water from my eyes to the air around, air that you could tell was dry by the way it soaked up the moisture layering my skin.
He’d been transferred from the hospital to hospice the day before. He hadn’t been happy about it, had responded with “horrible” when asked how he was doing, the last two syllables swallowed by the effort of the first. Often his breathing was too labored for fluency, and sometimes words took a long time, occupying a space that I didn’t realize was open until his voice closed them. Even though his voice sounded the same whether he was comfortable or uncomfortable, it moved more than anything else about him. It was never accented by the rest of his face; his lips didn’t migrate from the straight road they naturally formed, the taut white of his forehead never disrupted even while his lungs crumpled into rough coughs.
He lived in a bed next to the door in a room of three, and when we waved from the hallway he called out hello if he saw us. The wet brown of his eyes drew a full film from one corner to the other and felt protective of something, but they kept him from seeing his food well enough to eat. He didn’t want to eat anyway, and he directed his gaze towards the sound of the television, even when the hospital headphones slipped off his ears and forward onto his chest like a necklace. It made me think that hospital gowns don’t lend themselves to accessories.
He had been a patient on our list of patients to see every morning for almost a week before I really met him, when the physician taking care of him allowed another medical student and me to sit in on a conversation she had with him about his health. Earlier that day she had talked of him as a patient she knew would stick with her; “he’s sweet; you can tell life’s been unfair to him.” I’d felt somewhat guilty for not noticing, as once I sat down on his bed it was palpable through the blankets.
The doctor touched his shoulder, which was usually enough to rouse him if his eyes were closed (at this time they weren’t), and told him she wanted to talk to him about things.
She gently explained the state of his major organs and how in trying to support one, we hurt another. When things reach a balancing act where balance would be unstable, when piling or removing things from either end keeps hurting, we turn our attention to the fulcrum. Again nothing in his face moved, but he said he wasn’t ready. He’d have to talk to his wife. She didn’t visit because they didn’t have a car, and a taxi would be too costly for their resources. She didn’t like seeing him so sick, anyway. But Thanksgiving was coming up, and his nephews and nieces had cars that could carry his family, and turkey with cranberry sauce in plastic containers, to the hospital then.
I was also in the hospital on Thanksgiving, when his room went from three patients whose beds were separated by cloth curtains maneuvered by nurses and doctors, to a flock of relatives standing in their puffy winter coats that they didn’t remove once inside. His wife’s shape matched her voice on the phone but she looked much older than him, with the gray in her hair prominent since she’d let it go long while his hair was still brown, and the wrinkles I sometimes imagined to be hiding in his forehead openly lined her eyes. A teenager with glasses and thick strands of hair across his forehead, a nephew I presumed, brought him a walkman. The headphones that came with it weren’t any more stable around his head than the others, but he took them with him to hospice; we had to disentangle them from the other pair to make sure he had the right ones.
I said hello to the group forming a sort of semi-circle at the foot of his bed as though participating in an icebreaker, and saw the cranberry sauce. It is strange to meet people whose lives give a disproportionate amount of substance to yours when compared to vice versa. I wasn’t in the room when the doctors talked to them about the future. But I saw them leave the room and walk down the hallway in a choppy stream, some visibly upset and others subtly so.
His wife nodded as I passed and said that she would like him to be comfortable. I nodded back, and went into his room out of an invisible inertia, without thought to if I had anything to offer and if so what form that would take. And so I started as we did every morning.
“How are you doing?”
“Oh, half and half.”
“I saw your family in the hallway. It must’ve been nice to have them here.” I looked at his bedside table to see if he’d eaten, but I couldn’t really tell. It was only then that I heard what he’d said, which was something he would say often in the following days. When evaluating his physical state, the doctors taking care of him spoke of him as having good days and bad days. It is true that on some days his face looked cleaner and his lungs sounded clearer, and other days the crackles that our stethoscopes could hear would rattle his chest so that he looked limp and for some reason during those times, the crust that develops from standstill remained in his eyes instead of being washed with blinks. “Half and half?”
He nodded, which for him meant bringing his chin down to his chest. By the time he’d bring it back up, you may have forgotten the first motion.
“Did you talk to your family about things?”
“We’re looking for a place. There’s one near my house so my wife can walk there and see me.”
Surprised that the logistics of things had already been discussed, I nodded.
Back in the room with the computers where we typed records of how our patients were doing today versus yesterday, they tried guessing what would take him, eventually: his kidneys, said one; his lungs, said another. How does that work, when his cancer had started in his throat? He never asked, but I wondered and despite the daily updates on his physical state I never knew.
Later through a process of which I wasn’t aware but trusted, it was decided that he go to Connecticut Hospice in Branford, not to the place he mentioned in his town. We told him it would probably be better when he was settled into a place, in a room with more privacy. He asked whether he would be in his own room, and was told that it was likely to be shared but that the rooms were vast. Although he seemed to want his own room, he wasn’t eager to leave the company of the people passing his open door in the hallway, though he never stated either sentiment directly. “It’s nice to just see faces,” he said in what felt more like a confirmation than a confession.
On one Friday, after having seen him on our morning rounds every day he’d been in the hospital, I said I’d miss him over the weekend.
“Well, then you should work on the weekend.”
I paused. “I’ll come by to see you.”
There was no pause, and no movement of his eyes from their station. “That’s very nice, but you won’t.”
Our interactions were not scarce, but brief. We ran out of things to say. I didn’t find out much about his life before here, or his life at that time outside of that bed. The natural course of asking how he was would be to discuss the present and near future, and I didn’t know how to bring the past in relief. On days when he wanted to be in limbo or something more than that, he’d talk about the new cancer center and what his doctors had told them. On the days it was explicit, mostly he said he didn’t want to die. Asking why would have felt too easily misunderstood, but now feels too easily absent.
So the day he left for hospice was one of the half and half days; to his doctors it was a bad one. In the hours before the transport from hospice arrived, he was having trouble breathing, and when they arrived he was receiving a breathing treatment to help open the vessels in his lungs. The man and woman in uniform who had come for him stood by the window and told us to take our time; they were “in no rush.” When he finished breathing into the mask, they brought a thin stretcher alongside the hospital bed.
“We’re going to move you from there into this so we can drive you there, okay?”
“How far is it?”
“The ride will be over before you know it. Barely twelve minutes.” The woman’s conversation was proficient, and I became acutely aware that this was my first time seeing all this happen. Her hair was tight where her braid started to form and then throughout. Nothing about her gave way, but still she was kind in a way difficult to pinpoint with tone or act. Maybe it was this softness without known source that made me turn away when they put the rails down on his hospital bed.
But I watched as they gathered the sheet below him and swiftly transferred him to the stretcher. Narrow as he was, the stretcher still just accommodated him. The man and woman layered him with blankets that had the texture of towels.
“There will be a brief period, less than a minute, where you’ll be outside as we move you into the van. It’ll be cold, but we’re putting these blankets on you, and it’ll be very quick.”
His belly was large, but he was seamlessly consumed by a swarm of blankets. Once covered, his arms and legs disappeared. His small face lacked sharp edges and fell into underlying pillow without difficulty. There were hints of him against the sheet: the deep brown of his hair splayed in tufts, the red in his cheeks dissolving thinly out and down to his jaw and seeping into the pillowcase, the wet in his eyes making all else feel dull. This was all I could see of him; everything else was white on the black stretcher.
“We’re going to strap you in now, okay?”
He brought his chin down to his chest, and coughed, “Okay.”
The woman pulled on a black belt with a heavy buckle, stretched it to as far as her arm extended, and handed the other end across his body to the man, who pulled down and tightened it. This spanned his torso. They started another across his lower body but as the transfer of buckle was taking place, one caught the other’s eye and they paused. “It’s probably not necessary.”
I’d never seen him walk while in the hospital, though I knew he went to and from the bathroom on his own, but it wasn’t until now that it seemed that he couldn’t move, with or without the one buckle. He was breathing less heavily now and unlike when he was sitting up in bed with his gown in full view, as he lay there I couldn’t see his chest struggling.
“I hope you’ll come see me.” We’ve been advised never to promise anything, and despite instincts, we force ourselves to rephrase things into “I’ll try.” It was a Tuesday, and I told him I’d try my best to come see him, though it might not be until Thursday or so. I watched them wheel him through the door and down the hallway, no further though I could have rounded the corner to the elevators with them.
I’d never been to Connecticut Hospice but had heard it was beautiful, overlooking the water. I looked up its information on the internet on Wednesday morning. I called their number for his room number, and was given it, though they said I wouldn’t need it. The person at the front desk would help me once I got there.
It was late afternoon when I got there. Though the streets were a little confusing, I’d found the way fairly easily with my friend’s GPS. The parking lot was large and three fourths full. As I walked to the main entrance, I felt glad the transition had been made, and looked forward to seeing him in a brighter place, one designed for comfort. The front desk was where they said it would be, and I found myself thankful for the ease of things. The woman manning it wore a thick sweater upon which her light curls rested. When I gave her his name, she carefully scanned a list in front of her. As the seconds crawled, I regretted forgetting the room number I’d called for in the morning.
She picked up the phone to call for his room, and as I waited I watched others pass through the front desk and down a corridor past large glass windows, without stopping. She spoke softly, but I heard her say his name. Then, “oh,” to the phone and to me, “Are you a family member?”
“No. I’m a med student. We took care of him at the hospital.”
“Oh,” to me, and to the phone, “She took care of him at the hospital.”
I watched her nod several times at the phone, continuing to speak softly, and hang up. “Someone’s coming.”
“Thank you.” I waited and watched more people pass, without waiting.
Someone whose face and shape I don’t remember came. “Hello, are you a family member?”
“No. I’m a med student. We took care of him at the hospital.”
“Oh.” She nodded. I gave a small smile. She told me she was very sorry; he’d passed away that afternoon.
“Oh. That was fast.” So fast. Twelve minutes to get from the hospital to there. What happened in between? I’d called that morning. He’d had a room number. One with a letter, so he was sharing space. But it was more space. Blinking to buy time, I paused before it came to me to ask, “Was his family there?”
“No. We called his wife. She didn’t want to come.”
I nodded. “Thank you.” I wanted to give her more than that thank you, or to fully give the thank you, and paused. But it was too brief, and the sentiment too blurry. I turned slowly, maybe to match the stride of what had come before. But once out the door, the passing air that grazed my skin on its way to elsewhere held in it the shortness of my time inside, taking it for itself and carrying it away. Maybe because of that I stayed outside.
He hadn’t asked to be moved to a building with a view, or for much of anything other than our presence. It wasn’t much to give, and it wasn’t hard to want to give it, but in the end it was the most elusive. When asked about how he wanted to proceed, he’d defer to what we thought, saying we knew best. There were a lot of us: the respiratory team watching over his lungs, the oncology team monitoring his cancer, the renal team reminding us that his kidneys were failing, and the geriatric team checking every morning for a bad or good day. Each of them explained things, and asked questions to cater to his needs, trying to provide care in the niches they’d formed in training and in experience. Because the weight of confrontation and decision was too much for him, and because this weight had become a part of their anatomy, they let him give it to them, in the hopes that they could give something to him.
I thought this too, thought that though it felt viscerally out of place to attach him to that stretcher and move him, it would take him to a place that would be better, eventually. What happened in that transition to this place, that took from him the time required to make it better? We’d left him alone before.
Never having seen him in a new place, standing with the hospice in close distance I only saw him as he looked when I first knew him. After not too long I left for home, with the water still out of view behind the low level of trees.
It’d been a short and unfamiliar drive from New Haven to the Connecticut Hospice, and now that I’d entered and left the entrance of the building, it was easier to stay. The stray leaves clinging to deceptively precarious branches didn’t keep the trees from being bare, but made them feel heavy, and I tried to focus on the lean trunks. I tried not to choke on my heaving breaths. And to stop the flow of salt and water from my eyes to the air around, air that you could tell was dry by the way it soaked up the moisture layering my skin.
He’d been transferred from the hospital to hospice the day before. He hadn’t been happy about it, had responded with “horrible” when asked how he was doing, the last two syllables swallowed by the effort of the first. Often his breathing was too labored for fluency, and sometimes words took a long time, occupying a space that I didn’t realize was open until his voice closed them. Even though his voice sounded the same whether he was comfortable or uncomfortable, it moved more than anything else about him. It was never accented by the rest of his face; his lips didn’t migrate from the straight road they naturally formed, the taut white of his forehead never disrupted even while his lungs crumpled into rough coughs.
He lived in a bed next to the door in a room of three, and when we waved from the hallway he called out hello if he saw us. The wet brown of his eyes drew a full film from one corner to the other and felt protective of something, but they kept him from seeing his food well enough to eat. He didn’t want to eat anyway, and he directed his gaze towards the sound of the television, even when the hospital headphones slipped off his ears and forward onto his chest like a necklace. It made me think that hospital gowns don’t lend themselves to accessories.
He had been a patient on our list of patients to see every morning for almost a week before I really met him, when the physician taking care of him allowed another medical student and me to sit in on a conversation she had with him about his health. Earlier that day she had talked of him as a patient she knew would stick with her; “he’s sweet; you can tell life’s been unfair to him.” I’d felt somewhat guilty for not noticing, as once I sat down on his bed it was palpable through the blankets.
The doctor touched his shoulder, which was usually enough to rouse him if his eyes were closed (at this time they weren’t), and told him she wanted to talk to him about things.
She gently explained the state of his major organs and how in trying to support one, we hurt another. When things reach a balancing act where balance would be unstable, when piling or removing things from either end keeps hurting, we turn our attention to the fulcrum. Again nothing in his face moved, but he said he wasn’t ready. He’d have to talk to his wife. She didn’t visit because they didn’t have a car, and a taxi would be too costly for their resources. She didn’t like seeing him so sick, anyway. But Thanksgiving was coming up, and his nephews and nieces had cars that could carry his family, and turkey with cranberry sauce in plastic containers, to the hospital then.
I was also in the hospital on Thanksgiving, when his room went from three patients whose beds were separated by cloth curtains maneuvered by nurses and doctors, to a flock of relatives standing in their puffy winter coats that they didn’t remove once inside. His wife’s shape matched her voice on the phone but she looked much older than him, with the gray in her hair prominent since she’d let it go long while his hair was still brown, and the wrinkles I sometimes imagined to be hiding in his forehead openly lined her eyes. A teenager with glasses and thick strands of hair across his forehead, a nephew I presumed, brought him a walkman. The headphones that came with it weren’t any more stable around his head than the others, but he took them with him to hospice; we had to disentangle them from the other pair to make sure he had the right ones.
I said hello to the group forming a sort of semi-circle at the foot of his bed as though participating in an icebreaker, and saw the cranberry sauce. It is strange to meet people whose lives give a disproportionate amount of substance to yours when compared to vice versa. I wasn’t in the room when the doctors talked to them about the future. But I saw them leave the room and walk down the hallway in a choppy stream, some visibly upset and others subtly so.
His wife nodded as I passed and said that she would like him to be comfortable. I nodded back, and went into his room out of an invisible inertia, without thought to if I had anything to offer and if so what form that would take. And so I started as we did every morning.
“How are you doing?”
“Oh, half and half.”
“I saw your family in the hallway. It must’ve been nice to have them here.” I looked at his bedside table to see if he’d eaten, but I couldn’t really tell. It was only then that I heard what he’d said, which was something he would say often in the following days. When evaluating his physical state, the doctors taking care of him spoke of him as having good days and bad days. It is true that on some days his face looked cleaner and his lungs sounded clearer, and other days the crackles that our stethoscopes could hear would rattle his chest so that he looked limp and for some reason during those times, the crust that develops from standstill remained in his eyes instead of being washed with blinks. “Half and half?”
He nodded, which for him meant bringing his chin down to his chest. By the time he’d bring it back up, you may have forgotten the first motion.
“Did you talk to your family about things?”
“We’re looking for a place. There’s one near my house so my wife can walk there and see me.”
Surprised that the logistics of things had already been discussed, I nodded.
Back in the room with the computers where we typed records of how our patients were doing today versus yesterday, they tried guessing what would take him, eventually: his kidneys, said one; his lungs, said another. How does that work, when his cancer had started in his throat? He never asked, but I wondered and despite the daily updates on his physical state I never knew.
Later through a process of which I wasn’t aware but trusted, it was decided that he go to Connecticut Hospice in Branford, not to the place he mentioned in his town. We told him it would probably be better when he was settled into a place, in a room with more privacy. He asked whether he would be in his own room, and was told that it was likely to be shared but that the rooms were vast. Although he seemed to want his own room, he wasn’t eager to leave the company of the people passing his open door in the hallway, though he never stated either sentiment directly. “It’s nice to just see faces,” he said in what felt more like a confirmation than a confession.
On one Friday, after having seen him on our morning rounds every day he’d been in the hospital, I said I’d miss him over the weekend.
“Well, then you should work on the weekend.”
I paused. “I’ll come by to see you.”
There was no pause, and no movement of his eyes from their station. “That’s very nice, but you won’t.”
Our interactions were not scarce, but brief. We ran out of things to say. I didn’t find out much about his life before here, or his life at that time outside of that bed. The natural course of asking how he was would be to discuss the present and near future, and I didn’t know how to bring the past in relief. On days when he wanted to be in limbo or something more than that, he’d talk about the new cancer center and what his doctors had told them. On the days it was explicit, mostly he said he didn’t want to die. Asking why would have felt too easily misunderstood, but now feels too easily absent.
So the day he left for hospice was one of the half and half days; to his doctors it was a bad one. In the hours before the transport from hospice arrived, he was having trouble breathing, and when they arrived he was receiving a breathing treatment to help open the vessels in his lungs. The man and woman in uniform who had come for him stood by the window and told us to take our time; they were “in no rush.” When he finished breathing into the mask, they brought a thin stretcher alongside the hospital bed.
“We’re going to move you from there into this so we can drive you there, okay?”
“How far is it?”
“The ride will be over before you know it. Barely twelve minutes.” The woman’s conversation was proficient, and I became acutely aware that this was my first time seeing all this happen. Her hair was tight where her braid started to form and then throughout. Nothing about her gave way, but still she was kind in a way difficult to pinpoint with tone or act. Maybe it was this softness without known source that made me turn away when they put the rails down on his hospital bed.
But I watched as they gathered the sheet below him and swiftly transferred him to the stretcher. Narrow as he was, the stretcher still just accommodated him. The man and woman layered him with blankets that had the texture of towels.
“There will be a brief period, less than a minute, where you’ll be outside as we move you into the van. It’ll be cold, but we’re putting these blankets on you, and it’ll be very quick.”
His belly was large, but he was seamlessly consumed by a swarm of blankets. Once covered, his arms and legs disappeared. His small face lacked sharp edges and fell into underlying pillow without difficulty. There were hints of him against the sheet: the deep brown of his hair splayed in tufts, the red in his cheeks dissolving thinly out and down to his jaw and seeping into the pillowcase, the wet in his eyes making all else feel dull. This was all I could see of him; everything else was white on the black stretcher.
“We’re going to strap you in now, okay?”
He brought his chin down to his chest, and coughed, “Okay.”
The woman pulled on a black belt with a heavy buckle, stretched it to as far as her arm extended, and handed the other end across his body to the man, who pulled down and tightened it. This spanned his torso. They started another across his lower body but as the transfer of buckle was taking place, one caught the other’s eye and they paused. “It’s probably not necessary.”
I’d never seen him walk while in the hospital, though I knew he went to and from the bathroom on his own, but it wasn’t until now that it seemed that he couldn’t move, with or without the one buckle. He was breathing less heavily now and unlike when he was sitting up in bed with his gown in full view, as he lay there I couldn’t see his chest struggling.
“I hope you’ll come see me.” We’ve been advised never to promise anything, and despite instincts, we force ourselves to rephrase things into “I’ll try.” It was a Tuesday, and I told him I’d try my best to come see him, though it might not be until Thursday or so. I watched them wheel him through the door and down the hallway, no further though I could have rounded the corner to the elevators with them.
I’d never been to Connecticut Hospice but had heard it was beautiful, overlooking the water. I looked up its information on the internet on Wednesday morning. I called their number for his room number, and was given it, though they said I wouldn’t need it. The person at the front desk would help me once I got there.
It was late afternoon when I got there. Though the streets were a little confusing, I’d found the way fairly easily with my friend’s GPS. The parking lot was large and three fourths full. As I walked to the main entrance, I felt glad the transition had been made, and looked forward to seeing him in a brighter place, one designed for comfort. The front desk was where they said it would be, and I found myself thankful for the ease of things. The woman manning it wore a thick sweater upon which her light curls rested. When I gave her his name, she carefully scanned a list in front of her. As the seconds crawled, I regretted forgetting the room number I’d called for in the morning.
She picked up the phone to call for his room, and as I waited I watched others pass through the front desk and down a corridor past large glass windows, without stopping. She spoke softly, but I heard her say his name. Then, “oh,” to the phone and to me, “Are you a family member?”
“No. I’m a med student. We took care of him at the hospital.”
“Oh,” to me, and to the phone, “She took care of him at the hospital.”
I watched her nod several times at the phone, continuing to speak softly, and hang up. “Someone’s coming.”
“Thank you.” I waited and watched more people pass, without waiting.
Someone whose face and shape I don’t remember came. “Hello, are you a family member?”
“No. I’m a med student. We took care of him at the hospital.”
“Oh.” She nodded. I gave a small smile. She told me she was very sorry; he’d passed away that afternoon.
“Oh. That was fast.” So fast. Twelve minutes to get from the hospital to there. What happened in between? I’d called that morning. He’d had a room number. One with a letter, so he was sharing space. But it was more space. Blinking to buy time, I paused before it came to me to ask, “Was his family there?”
“No. We called his wife. She didn’t want to come.”
I nodded. “Thank you.” I wanted to give her more than that thank you, or to fully give the thank you, and paused. But it was too brief, and the sentiment too blurry. I turned slowly, maybe to match the stride of what had come before. But once out the door, the passing air that grazed my skin on its way to elsewhere held in it the shortness of my time inside, taking it for itself and carrying it away. Maybe because of that I stayed outside.
He hadn’t asked to be moved to a building with a view, or for much of anything other than our presence. It wasn’t much to give, and it wasn’t hard to want to give it, but in the end it was the most elusive. When asked about how he wanted to proceed, he’d defer to what we thought, saying we knew best. There were a lot of us: the respiratory team watching over his lungs, the oncology team monitoring his cancer, the renal team reminding us that his kidneys were failing, and the geriatric team checking every morning for a bad or good day. Each of them explained things, and asked questions to cater to his needs, trying to provide care in the niches they’d formed in training and in experience. Because the weight of confrontation and decision was too much for him, and because this weight had become a part of their anatomy, they let him give it to them, in the hopes that they could give something to him.
I thought this too, thought that though it felt viscerally out of place to attach him to that stretcher and move him, it would take him to a place that would be better, eventually. What happened in that transition to this place, that took from him the time required to make it better? We’d left him alone before.
Never having seen him in a new place, standing with the hospice in close distance I only saw him as he looked when I first knew him. After not too long I left for home, with the water still out of view behind the low level of trees.
Sunday, February 14, 2010
finding time
I’ve been struggling of late about my plans for the next year, or two years. Here we have the choice to graduate in four or five years. If we choose to take it, the “fifth” year happens between our third and fourth years, our clinical years. Because we are required to write a thesis on any sort of research related to medicine, many students take this year to complete the research. Others take a “flexible fifth year” wherein they do short-term research for a few months, something else for a few months, back to research for awhile, and so on. That “something else” is quite diverse; we can take electives here or abroad, or something completely unrelated to medicine altogether. You can also take the year and not do research at all. Some people get their MBA or MPH, or they take undergraduate courses on literature.
As I’ve already completed the research required for my thesis, I could graduate in the standard four years, which is what I’d always planned on doing. But somewhere during third year, I found the idea of a “free year” pretty enticing. It’s not that I want a break. I’m certainly feeling burnt out; it’s hard for me to tackle learning with the same vigor as before, but I know that it will slow down a bit after this semester and that I could take it in stride if I wanted to. I don’t want to take a year for the sake of taking time. I would like to have a purpose for that time. But as I think about what that purpose would be, a lot of it is about time: making time for things important to me that have slipped in the busy of third year. And I’ve enjoyed being a student; it has afforded me valuable time with people, time that I know I won’t have in residency when I graduate. And while I’m really eager to learn the practical and intellectual skills in residency that I’ll need to take care of patients in the future, I also want to know people more deeply before I presume to be a care provider of them. Maybe it’s because I’m slow at learning things, but I accept that and I would like to be a student of people for a little longer.
There are a few things I would like to do with a year, the biggest being to be able to write about some of the experiences we’ve had in the hospital, and how they’re related for me to my life in general. Associated with that, I’d like to have more experiences with people, and I’ve found a mentor enthusiastic about forming a project around me simply spending time talking with patients, a population of patients to whom I’m particularly drawn. I also want more clinical experience in different places; I’d like to do both a primary care and hospice elective in Uganda, an ob-gyn subinternship in New Mexico, and a hospice elective here at Connecticut Hospice (the first one established in the States). There are others, but I’m trying to limit myself in order to focus on a few things, because even as I try to hold back while writing now, I know it’s hard not to overload a blank slate of a year.
There are many things I worry about in making this decision. We say it’s just one year, and it’s very true in the long run. Yet somehow it still carries more weight. I didn’t give a second thought to taking a year before medical school; I needed it both practically and internally. But though I’m not sure what I would’ve been like without that year, I don’t particularly look back on that year as one of much growth or significance. I don’t want this to be like that, especially because as I said, for various reasons, it carries more weight now at almost twenty-six years old than it did back then at twenty-two.
Taking another year isn’t exactly taking an “extra” year; the time has to come from somewhere. I’d be lying if I didn’t admit that I don’t think about the same things as other girls my age in terms of relationships and the future, which though distant now won’t feel so much so when I graduate, especially if that’s in two years instead of one. The relationships (in the way I define relating to a person) I’ve had here have been worthwhile and valuable emotionally, but also tumultuous and inconducive to what I eventually want concretely. Finding quality and compatibility is hard enough, but doing that in the realm of logistics and future is even worse, and as such I’ve largely avoided the endeavor of considering anything beyond the present. During the time I stay here, I’d probably continue doing that, and can I really keep avoiding it for so long? On the other end, who’s to say that graduating, moving, and working intensely will bring me out of the place I’m in, any better than staying here? On the same lines, I miss my family a lot, and another year here is another year away from them, but graduation doesn’t bring any guarantees that I’ll be closer to them.
I worry I’ll be restless, as I often am while in the educational system, with the idea of not doing anything concrete to be useful. With the sense of constantly being trained for something that seems so distant. I also worry that the insane momentum of third year distorts and exaggerates my need for time, that perhaps I only wish to take it because it’s there for taking. At the same time I wonder if this is an unexpected gift, as this school has been as a whole, and whether I shouldn’t shy away from something simply because it wasn’t in my original plans. Honestly, the idea of this—the time, the commitment to writing, the uncertainty of what I can do and how it will all fit together—scares me like hell. While as a general philosophy I believe in things falling into place, and they’ve been chaotic before and always have fallen right, I’ve had the benefit of the outline of things still following an overall path. I don’t know if this year really falls into any concrete way for me to go, and I know it’s largely up to me to make it worth something.
A friend recently made fun of me for still wearing a watch, now that cell phones have replaced every daily function including checking the time. I love my watch, which was a Christmas gift from my oldest brother in 2001 who said I never knew what time it was, so I’ve had it for nearly a decade and have had to change the battery a couple times in that time period. It uses hands and it has only four dots on its face to signify every three hours, without any numbers. Since I’ve been on surgery I can’t wear it, and yesterday I realized it was the weekend and I could wear it. This morning I went to the gym and took it off as I normally do when running. Since I’d gotten used to not having to do this during the week, when it was time to go, I forgot to put it back on. After I came home and noticed it was missing, it took me some time to realize this is what was happened. It probably took me more time than usual to connect the sequence of events because we'd taken a detour on our way home, and sat on a hammock we saw outside one of the colleges. It was a usual cold winter day with sun and old snow, and we sank into the hammock with ease. I told my roommate I would go get my watch after showering and getting dressed, but she said I should go now, as the more time passed the more likely it was that something would happen to it. So as I hurried back to get it (bemoaning the minutes I was losing doing this, as I’d planned on being on my way out to the architecture library by two o’clock and it would already be two by the time I reached the gym again), I thought how funny and fitting it was to literally find time. Even if it’s gaining back something you lost, and not giving you any more than baseline; even if it’s actually taking some away from you as you do it, time feels different when it’s passing than when it’s found and taken.
As I’ve already completed the research required for my thesis, I could graduate in the standard four years, which is what I’d always planned on doing. But somewhere during third year, I found the idea of a “free year” pretty enticing. It’s not that I want a break. I’m certainly feeling burnt out; it’s hard for me to tackle learning with the same vigor as before, but I know that it will slow down a bit after this semester and that I could take it in stride if I wanted to. I don’t want to take a year for the sake of taking time. I would like to have a purpose for that time. But as I think about what that purpose would be, a lot of it is about time: making time for things important to me that have slipped in the busy of third year. And I’ve enjoyed being a student; it has afforded me valuable time with people, time that I know I won’t have in residency when I graduate. And while I’m really eager to learn the practical and intellectual skills in residency that I’ll need to take care of patients in the future, I also want to know people more deeply before I presume to be a care provider of them. Maybe it’s because I’m slow at learning things, but I accept that and I would like to be a student of people for a little longer.
There are a few things I would like to do with a year, the biggest being to be able to write about some of the experiences we’ve had in the hospital, and how they’re related for me to my life in general. Associated with that, I’d like to have more experiences with people, and I’ve found a mentor enthusiastic about forming a project around me simply spending time talking with patients, a population of patients to whom I’m particularly drawn. I also want more clinical experience in different places; I’d like to do both a primary care and hospice elective in Uganda, an ob-gyn subinternship in New Mexico, and a hospice elective here at Connecticut Hospice (the first one established in the States). There are others, but I’m trying to limit myself in order to focus on a few things, because even as I try to hold back while writing now, I know it’s hard not to overload a blank slate of a year.
There are many things I worry about in making this decision. We say it’s just one year, and it’s very true in the long run. Yet somehow it still carries more weight. I didn’t give a second thought to taking a year before medical school; I needed it both practically and internally. But though I’m not sure what I would’ve been like without that year, I don’t particularly look back on that year as one of much growth or significance. I don’t want this to be like that, especially because as I said, for various reasons, it carries more weight now at almost twenty-six years old than it did back then at twenty-two.
Taking another year isn’t exactly taking an “extra” year; the time has to come from somewhere. I’d be lying if I didn’t admit that I don’t think about the same things as other girls my age in terms of relationships and the future, which though distant now won’t feel so much so when I graduate, especially if that’s in two years instead of one. The relationships (in the way I define relating to a person) I’ve had here have been worthwhile and valuable emotionally, but also tumultuous and inconducive to what I eventually want concretely. Finding quality and compatibility is hard enough, but doing that in the realm of logistics and future is even worse, and as such I’ve largely avoided the endeavor of considering anything beyond the present. During the time I stay here, I’d probably continue doing that, and can I really keep avoiding it for so long? On the other end, who’s to say that graduating, moving, and working intensely will bring me out of the place I’m in, any better than staying here? On the same lines, I miss my family a lot, and another year here is another year away from them, but graduation doesn’t bring any guarantees that I’ll be closer to them.
I worry I’ll be restless, as I often am while in the educational system, with the idea of not doing anything concrete to be useful. With the sense of constantly being trained for something that seems so distant. I also worry that the insane momentum of third year distorts and exaggerates my need for time, that perhaps I only wish to take it because it’s there for taking. At the same time I wonder if this is an unexpected gift, as this school has been as a whole, and whether I shouldn’t shy away from something simply because it wasn’t in my original plans. Honestly, the idea of this—the time, the commitment to writing, the uncertainty of what I can do and how it will all fit together—scares me like hell. While as a general philosophy I believe in things falling into place, and they’ve been chaotic before and always have fallen right, I’ve had the benefit of the outline of things still following an overall path. I don’t know if this year really falls into any concrete way for me to go, and I know it’s largely up to me to make it worth something.
A friend recently made fun of me for still wearing a watch, now that cell phones have replaced every daily function including checking the time. I love my watch, which was a Christmas gift from my oldest brother in 2001 who said I never knew what time it was, so I’ve had it for nearly a decade and have had to change the battery a couple times in that time period. It uses hands and it has only four dots on its face to signify every three hours, without any numbers. Since I’ve been on surgery I can’t wear it, and yesterday I realized it was the weekend and I could wear it. This morning I went to the gym and took it off as I normally do when running. Since I’d gotten used to not having to do this during the week, when it was time to go, I forgot to put it back on. After I came home and noticed it was missing, it took me some time to realize this is what was happened. It probably took me more time than usual to connect the sequence of events because we'd taken a detour on our way home, and sat on a hammock we saw outside one of the colleges. It was a usual cold winter day with sun and old snow, and we sank into the hammock with ease. I told my roommate I would go get my watch after showering and getting dressed, but she said I should go now, as the more time passed the more likely it was that something would happen to it. So as I hurried back to get it (bemoaning the minutes I was losing doing this, as I’d planned on being on my way out to the architecture library by two o’clock and it would already be two by the time I reached the gym again), I thought how funny and fitting it was to literally find time. Even if it’s gaining back something you lost, and not giving you any more than baseline; even if it’s actually taking some away from you as you do it, time feels different when it’s passing than when it’s found and taken.
Saturday, February 13, 2010
bypass
They tell us to look for patterns in medicine, in the way diseases work and in the way we treat them. One of our favorite things to do is to bypass. When a vessel supplying blood to the heart becomes blocked, we use other vessels to go around the blockage. Same idea with a block in the vessels supplying the small intestine. And when you don't want food going to the stomach, you bypass it by cutting off a point where two points of the stomach connect and reconnect the stomach to the small intestine instead. It all works pretty well, perhaps not quite as well as the anatomy with which we're born, but after the wear and tear of time and experience we cope the best we can.
Currently on my one month gastrointestinal surgery rotation, and have seen several gastric bypasses for morbidly obese patients. They were good surgeries to see; the abdominal anatomy is compact and clear. When the stomach is cut, you find the pancreas behind it. As you move horizontally to maneuver things, you find the liver and spleen flanking the stomach. And you follow the small intestine down to find the best place to cut, and to reconnect, saying hello to the large intestine amidst the surroundings along the way. Seeing things in real color (the spleen really is purple, and the pancreas off-white), and three dimensions makes for a pretty view.
Sitting in the back during a informational meeting for gastric bpyass patients also afforded an interesting view. Insurance typically covers this procedure once a person's BMI is greater than 40 (ideal being 20) and most of the patients I've seen run beyond 50. They suffer from an interaction between their physiology and their environment that makes it nearly impossible for non-surgical interventions to help. Interestingly, their internal anatomy is not so different from others. At one point, the surgeon giving the talk said all of our stomachs are the same size, "including that of my med student sitting in the back there." To my relief no one turned around to look at me, but I was grateful to be present. A secretary who'd had a bypass herself talked about the experience, the looking forward before she'd had it and the looking backward now that she had, while emphasizing that the process was never over. The surgeon went into detail about what the procedure entailed and what it demanded of its patients. People listened and asked questions.
Medicine so randomly throws you into the stories of people you might otherwise never consider, and being literally dwarfed in a corner of this room made me feel it pretty strongly. Seeing one bypass after another in the operating room fools us into thinking the stitches signify an end and numbs us to the change that's happening or will happen. But hearing an acknowledgment of the anticipation leading to this surgery and hearing the patients be told the long course of care that must happen after the surgery reminds us of context. There's a lot--a lot of work, thought, feelings--encased in a two hour procedure that for those in the operating room starts with an incision and ends with a suture. Up until then surgeries for us as students have been so open-shut, and part of why I feel out of place during the week is because I have nowhere to put what we see on a daily basis. Settling their organs and skin back into place still leaves a sense of intrusion that isn't fully reversed. From the room full of people hoping to become more by becoming less, I'm more able to place what I see back into the people themselves, and this isn't something we can afford to bypass.
Currently on my one month gastrointestinal surgery rotation, and have seen several gastric bypasses for morbidly obese patients. They were good surgeries to see; the abdominal anatomy is compact and clear. When the stomach is cut, you find the pancreas behind it. As you move horizontally to maneuver things, you find the liver and spleen flanking the stomach. And you follow the small intestine down to find the best place to cut, and to reconnect, saying hello to the large intestine amidst the surroundings along the way. Seeing things in real color (the spleen really is purple, and the pancreas off-white), and three dimensions makes for a pretty view.
Sitting in the back during a informational meeting for gastric bpyass patients also afforded an interesting view. Insurance typically covers this procedure once a person's BMI is greater than 40 (ideal being 20) and most of the patients I've seen run beyond 50. They suffer from an interaction between their physiology and their environment that makes it nearly impossible for non-surgical interventions to help. Interestingly, their internal anatomy is not so different from others. At one point, the surgeon giving the talk said all of our stomachs are the same size, "including that of my med student sitting in the back there." To my relief no one turned around to look at me, but I was grateful to be present. A secretary who'd had a bypass herself talked about the experience, the looking forward before she'd had it and the looking backward now that she had, while emphasizing that the process was never over. The surgeon went into detail about what the procedure entailed and what it demanded of its patients. People listened and asked questions.
Medicine so randomly throws you into the stories of people you might otherwise never consider, and being literally dwarfed in a corner of this room made me feel it pretty strongly. Seeing one bypass after another in the operating room fools us into thinking the stitches signify an end and numbs us to the change that's happening or will happen. But hearing an acknowledgment of the anticipation leading to this surgery and hearing the patients be told the long course of care that must happen after the surgery reminds us of context. There's a lot--a lot of work, thought, feelings--encased in a two hour procedure that for those in the operating room starts with an incision and ends with a suture. Up until then surgeries for us as students have been so open-shut, and part of why I feel out of place during the week is because I have nowhere to put what we see on a daily basis. Settling their organs and skin back into place still leaves a sense of intrusion that isn't fully reversed. From the room full of people hoping to become more by becoming less, I'm more able to place what I see back into the people themselves, and this isn't something we can afford to bypass.
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