My few weeks of nothing is coming to a close, as I ready for a cross country drive to Arizona, where I'll be doing a primary care rotation for a month. Probably because my mind is preparing and no longer in cruise control, I've come to the realization that these past weeks were more editing and maintenance than writing and moving forward.
In one respect, I enjoyed that a lot. Often I relish editing someone else's words more than forming my own. It's less taxing in a lot of ways that writing can be frustrating, and it can also be its own sort of challenge, as I found anew while working with the patient for my project on her personal story. On first read, you might think that it required a lot of reworking, both structurally and textually. In terms of structure, it wasn't something I could shape just by removing repetitions and grouping similar details. That's the first step, but just a concrete one, and if anything solid is to come from that, I had to understand what the author wanted to say. The same goes for nuances of text, choosing words etc. But in terms of that, I found it a really interesting and satisfying endeavor to keep her words while trying to manipulate the presentation of the words to better convey what she wanted. Again, on first read the story would be taken as undeveloped in terms of style, but I found myself falling in love with her simple narration, very much a mental print of memories as they came to her. I liked the sense that this was her, and didn't feel compelled use or add different words, which would change this sense.
Figuring out what she wanted of course was the most important, and this isn't straightforward. I can most definitely relate to writing without consciously knowing my purpose. So this grew out of a lot of conversation, questions, and reading versions of the story as things were concretely refined. And in those, I found that her words supplied both structure and text, and overall purpose. Everything added was added in the raw form that she gave it, and then it was a matter of placement and detail.
She had begun the story all because of the fact that she had known this person, and she ended it feeling that she hadn't really known the person at all. To go through that process with her and be able to document and express that process, it made me feel again how natural it is to want to shape narratives, how complex and fulfilling the effort can be.
It was also a pleasure to speak to someone who has experienced worlds and lands so vastly different from the ones she occupies now; to see in one person how much can be had in a life. It makes me feel less caught up in doing the things I wanted to do during these weeks, makes me feel all right with letting experiences happen and unfold as they come, to feel less lame for expending energy on simply maintaining the things in my life that take me places without actually going any place (car, camera, body). Just continuing can bring newness and fullness, and even though I've done almost no writing at all in this period, maybe sometime in the near future my words will come as simply and clearly as hers.
Tuesday, September 28, 2010
Thursday, September 23, 2010
perspective
This morning I walked home with my pockets empty, no keys to let me in my house. Luckily my roommate was home, and at the time I figured I had left my keys and the attached red pouch, with my license, credit cards and ID, inside. But once inside, they were nowhere to be found: purse, backpack, desk and countertops scoured without find. I remembered that I had used the keys to lock the door, then had returned to grab something from my room, so I knew that if I'd left the keys in the house after the return, they would be either in 1) the door, or 2) somewhere visible I would've tossed them, like a table or dresser or the bed. They were in none of these places.
Which left my trajectory from after leaving my place to returning to it. After the keys' last use, I got on the handlebars of his bike; he thought it was safer than walking in the dark with the bike. I had a bookish childhood in which I never learned to ride a bicycle, much less ride on the handlebars, and I was hesitant. The streets were newly damp from fresh rain, still warm in the late summer/early fall. It smelled clear, but the air had the presence of humidity dissolving after the rain, one of my favorite weathers. I leaned back for more balance, and braced my face against his. It was late with pockets of quiet, and pockets of silent sirens where streetlights had gone out, so that his breaths felt close. I'm so used to the New Haven street wanderers and police cars that the visuals of danger don't incite much, and I felt safe flowing by in a breeze.
Not being able to find my keys and wallet the next day, the only other possibility was that they had fallen on this ride. Despite not being fazed by red and blue lights, I knew that if they had fallen in this part of New Haven they were pretty much lost to me. But I tracked my way back, this time on foot, and when strangers tried to make conversation with me (I learned that the large man who sits on the porch of the big green house is Aaron), I even asked them if they'd seen my keys. I went back to his house and rummaged those rooms too, and then scanned the streets again on my way back. Nothing. On the way back, I stopped at the Yale Security Office, who gave me the number to the central security office, who gave me the number to the Yale police, who gave me the number to the New Haven police--all of whom were very nice, none of whom had seen my stuff.
So I came back home with my roommate's keys. I called my friend who has a copy of my car key. I brought these to the locksmith kitty corner from our place, who said they wouldn't be back until 12:45. So I went back home, and canceled my credit card and my ATM debit card. I looked up how to get another driver's license, and realized that it's a bitch to do from across country, and called home to ask my parents to go to the DMV in California, and see if they could fill out the forms there for me. I went back to the locksmith, still closed at 12:45, and decided to go to our landlord down the street to see if I could get a copy of our house keys. I could, for $25. I headed back to the locksmith for my car key, still closed at 1:00. So I walked to campus to get a new Yale ID, for $20, paid for by cash borrowed from my friend. Walking back I passed the locksmith, who was finally open, but who could not copy my car key because it has a chip in it. Instead, I had to go to a locksmith in West Haven, 15 minutes away. After calling them first to make sure they could make a copy of my key, I drove over there, where they made me a copy for $35. I handed them the one credit card I had that hadn't been in my nowhere-to-be-found wallet, and they handed it back to me: "Um, this is expired." Only $7 in cash left, no other cards, no friends nearby--shit shit shit. I got back in my car, maneuvered it in the small awkward parking lot, called Bank of America who told me to get a temporary ATM at the bank, then backed my car back up into a spot, and went back to the locksmith to ask if there was a nearby Bank of America. I drove several minutes down to it, where they told me I couldn't get a temporary card since my account had been open in CA, and here we are in CT. But I could still get cash with a photo ID and my SSN; I had an old license that has expired, but luckily now I also had a new Yale ID. So I withdrew some cash, went back to the locksmith, and got my new car key.
On the drive home my parents called and told me they couldn't get a license for me; I had to be present at the DMV in California, so that they could take a new photograph and attain my fingerprints. I won't be back in CA until December, and I'm driving cross country and back before that happens; a license would be useful.
I came home, and sighed.
The one thing I couldn't recover was the least important, the coffeeshop card with which I'd ranked up almost enough coffees to get a free one. After the day's escapades I escaped to the coffeeshop, told them I'd lost the card and could I get a new one? It turns out they had my name in the computer, with my records and that this coffee would be my free one. So I upgraded from small to large, and told them that this was the first thing I'd lost that I'd gotten back without effort or expense.
As I settled down with my large drink to write about this, I received a call from my other roommate. I had called her in the morning to see if she'd seen my keys in the door. But I didn't see them anywhere in the house where she might have placed them, and she hadn't called me to tell me she'd found them, so I figured this hadn't happened. It turns out that it had; she had found them in the door, taken them with her, and wasn't able to call me until later this evening. After I spent the day replacing things I don't even really want back but "need" in some form.
If someone were to ask me hypothetically, whether I'd go through all that, to have wasted over four hours and eighty dollars, all because I sat atop handlebars of a bike ridden by a silly sweet boy whose face I could feel the whole time, I (like anyone else) would say no. And it's not something that logically follows; I didn't need to lose all my things, scrounge to replace them, eventually find that I'd never lost them--none of that needed to happen in order for me to have that ride. It could've happened, and I could've kept my stuff at the same time. But the comparison changes perspective. Having a nice moment is one thing, and having its niceness sustain itself through moments of not-so-niceness is another. Knowing how little the inconvenience of those four hours of wasted time and money will matter to me tomorrow, and feeling how those four minutes with him will last, I would have to say yes, it was worth it, to really feel what's close to me and what's not.
Which left my trajectory from after leaving my place to returning to it. After the keys' last use, I got on the handlebars of his bike; he thought it was safer than walking in the dark with the bike. I had a bookish childhood in which I never learned to ride a bicycle, much less ride on the handlebars, and I was hesitant. The streets were newly damp from fresh rain, still warm in the late summer/early fall. It smelled clear, but the air had the presence of humidity dissolving after the rain, one of my favorite weathers. I leaned back for more balance, and braced my face against his. It was late with pockets of quiet, and pockets of silent sirens where streetlights had gone out, so that his breaths felt close. I'm so used to the New Haven street wanderers and police cars that the visuals of danger don't incite much, and I felt safe flowing by in a breeze.
Not being able to find my keys and wallet the next day, the only other possibility was that they had fallen on this ride. Despite not being fazed by red and blue lights, I knew that if they had fallen in this part of New Haven they were pretty much lost to me. But I tracked my way back, this time on foot, and when strangers tried to make conversation with me (I learned that the large man who sits on the porch of the big green house is Aaron), I even asked them if they'd seen my keys. I went back to his house and rummaged those rooms too, and then scanned the streets again on my way back. Nothing. On the way back, I stopped at the Yale Security Office, who gave me the number to the central security office, who gave me the number to the Yale police, who gave me the number to the New Haven police--all of whom were very nice, none of whom had seen my stuff.
So I came back home with my roommate's keys. I called my friend who has a copy of my car key. I brought these to the locksmith kitty corner from our place, who said they wouldn't be back until 12:45. So I went back home, and canceled my credit card and my ATM debit card. I looked up how to get another driver's license, and realized that it's a bitch to do from across country, and called home to ask my parents to go to the DMV in California, and see if they could fill out the forms there for me. I went back to the locksmith, still closed at 12:45, and decided to go to our landlord down the street to see if I could get a copy of our house keys. I could, for $25. I headed back to the locksmith for my car key, still closed at 1:00. So I walked to campus to get a new Yale ID, for $20, paid for by cash borrowed from my friend. Walking back I passed the locksmith, who was finally open, but who could not copy my car key because it has a chip in it. Instead, I had to go to a locksmith in West Haven, 15 minutes away. After calling them first to make sure they could make a copy of my key, I drove over there, where they made me a copy for $35. I handed them the one credit card I had that hadn't been in my nowhere-to-be-found wallet, and they handed it back to me: "Um, this is expired." Only $7 in cash left, no other cards, no friends nearby--shit shit shit. I got back in my car, maneuvered it in the small awkward parking lot, called Bank of America who told me to get a temporary ATM at the bank, then backed my car back up into a spot, and went back to the locksmith to ask if there was a nearby Bank of America. I drove several minutes down to it, where they told me I couldn't get a temporary card since my account had been open in CA, and here we are in CT. But I could still get cash with a photo ID and my SSN; I had an old license that has expired, but luckily now I also had a new Yale ID. So I withdrew some cash, went back to the locksmith, and got my new car key.
On the drive home my parents called and told me they couldn't get a license for me; I had to be present at the DMV in California, so that they could take a new photograph and attain my fingerprints. I won't be back in CA until December, and I'm driving cross country and back before that happens; a license would be useful.
I came home, and sighed.
The one thing I couldn't recover was the least important, the coffeeshop card with which I'd ranked up almost enough coffees to get a free one. After the day's escapades I escaped to the coffeeshop, told them I'd lost the card and could I get a new one? It turns out they had my name in the computer, with my records and that this coffee would be my free one. So I upgraded from small to large, and told them that this was the first thing I'd lost that I'd gotten back without effort or expense.
As I settled down with my large drink to write about this, I received a call from my other roommate. I had called her in the morning to see if she'd seen my keys in the door. But I didn't see them anywhere in the house where she might have placed them, and she hadn't called me to tell me she'd found them, so I figured this hadn't happened. It turns out that it had; she had found them in the door, taken them with her, and wasn't able to call me until later this evening. After I spent the day replacing things I don't even really want back but "need" in some form.
If someone were to ask me hypothetically, whether I'd go through all that, to have wasted over four hours and eighty dollars, all because I sat atop handlebars of a bike ridden by a silly sweet boy whose face I could feel the whole time, I (like anyone else) would say no. And it's not something that logically follows; I didn't need to lose all my things, scrounge to replace them, eventually find that I'd never lost them--none of that needed to happen in order for me to have that ride. It could've happened, and I could've kept my stuff at the same time. But the comparison changes perspective. Having a nice moment is one thing, and having its niceness sustain itself through moments of not-so-niceness is another. Knowing how little the inconvenience of those four hours of wasted time and money will matter to me tomorrow, and feeling how those four minutes with him will last, I would have to say yes, it was worth it, to really feel what's close to me and what's not.
Thursday, September 16, 2010
what i'm doing
I've finished my month of subinternship and am in the midst of a month in between rotations. I'll be starting a primary care rotation in October, but in the meantime, when people ask what I'm doing, I usually say, nothing. Which is both true and not true. It's true that I'm not assigned a particular rotation, don't have a routine schedule, and don't have any concrete tasks to accomplish each day or even by the end of the month that anyone is going to check on. And it's true that I've prioritized getting enough sleep, food, exercise, and time with people above all else, which can generally qualify as what's commonly regarded as nothing, as it's not work. But it's not true that I don't have goals to work towards during this time. This block of time was blocked off for research and writing, both endeavors with less concrete goals than this past month.
The last month of being in the hospital was absolutely worth the time and work (of which there was an incredible amount), and I loved it more than I thought I would (in the beginning I was mostly terrified). The structure, mindset, and general atmosphere are very different than my current state, though. Being in the hospital is about treating acute problems, accomplishing tasks: figuring out a diagnosis, ordering the right medicine, filing out the right paperwork, presenting numbers. You work patients up for their problems, you try your best to make them better, and then you discharge them from the hospital. In the gaps and in the broader scheme there are all the other things that make a good doctor, that are more abstract and less straightforward, but the day to day is about getting stuff done.
Which isn't the case with research and writing, both of which I've been working on this past week, without much visible to show for it.
In terms of research, I developed a project that is more about knowing patients than attaining data, which is a difficult thing to 1) do and 2) measure. The general gist is that I want to speak to terminally ill patients who have transitioned from care with goals of cure, to care with goals of quality of life. In the hospital we're good at acute care and quantifiable results, but not as good with transitions that happen over time and aren't easily communicated. I think it's important to know what factors play into patients being ready for this transition, so that we know when and how to talk to them about it, so that care is focused on minimizing suffering, not so much maximizing breathing time.
The first patient I interviewed is dying from lung cancer and had been admitted to the hospice unit of the VA. He was very open to speaking with me but was breathing so heavily, with few gaps between large gasps, that he couldn't talk for longer than a few minutes. When I came back the next day, it was only worse. So nothing came about from those efforts, in terms of my project. But it reminded me of what it's like to see someone actively dying, and of what I want to learn in this process.
My second interview was an actual interview, with a lovely 88 year old woman with lymphoma. She had very developed thoughts about her life and death, and was very comfortable talking about them, so the outcome was completely different from my previous attempt. Another thing I wanted to explore was personal writing, and to have patients journal about their experiences at the end of life, because that can be so different than what someone is able to share in a conversation with a doctor. So at the end of the interview I asked the woman if she'd be interested in participating in something like that. She said that she can't really write due to arthritis, but she had been working awhile ago on a story about her childhood. She brought out several pages of yellow lined paper, and asked if I wanted to read it. We talked about typing it up and having me help her finish it.
So I took the pages home to read and transcribe. Several of them are numbered the same number, such that the order was hard to determine, and as I read through them I realized that's because she had written several different beginnings. Throughout there are some anecdotes told in slightly different ways, so that in typing up the story, I had to maneuver some passages, putting the similar ones side by side, so that she could decide which parts of the same story she wanted to keep, discard, combine. During some particularly difficult parts to decipher, where reading continuously didn't seem to give a sensible narrative, I saw that she'd written in every other line, and in the lines in between added other parts of the story. All of this required some rearranging as I read and typed, and I liked indulging in both the neurotic need to organize and the creative desire to piece things together. The story has nothing to do with my research, but it does have to do with what a lot of people seem to want, a desire to record certain memories, something that resonates a lot with me personally.
I really appreciate the flexibility of this time, that allows things to happen that don't fit a mold of efficiency or list of things to do, where I'm led not by steadfast goals but by natural happenings and my natural responses to them.
And this woman's story comes to me during a time when I've been working on a story about my childhood too. The writing part of this time off is even more vague than the research. I have a list of things I want to write about, which is a little overwhelming, and even when I focus on one, I'm not quite sure what I want to say or how to say it. All I'm sure of is that I feel compelled to write about them, but having the time to do it means being faced with why, and that has resulted in major writer's block. I could spend an entire day on something without much to show for it, and the lack of proportion can be disorienting. But I'm endeared to writing in the way that it's not science and things don't logically lead to other things, and it is amazing to wake up each day with the freedom and privilege to just try, with no expectations, to feel that that's enough, for now.
And so instead of explaining to every person who asks, I say I'm doing nothing. It gets somewhat tiresome, because we're not used to nothing being okay. I'm not traveling anywhere, so it's not like a vacation. The few times I've tried to go more deeply into it, I usually just confuse the person and I'd rather have them think I'm doing nothing of significance instead of misunderstanding something of personal significance. Besides, everyone takes nothing in their own way, and I think we could all use more of it.
The last month of being in the hospital was absolutely worth the time and work (of which there was an incredible amount), and I loved it more than I thought I would (in the beginning I was mostly terrified). The structure, mindset, and general atmosphere are very different than my current state, though. Being in the hospital is about treating acute problems, accomplishing tasks: figuring out a diagnosis, ordering the right medicine, filing out the right paperwork, presenting numbers. You work patients up for their problems, you try your best to make them better, and then you discharge them from the hospital. In the gaps and in the broader scheme there are all the other things that make a good doctor, that are more abstract and less straightforward, but the day to day is about getting stuff done.
Which isn't the case with research and writing, both of which I've been working on this past week, without much visible to show for it.
In terms of research, I developed a project that is more about knowing patients than attaining data, which is a difficult thing to 1) do and 2) measure. The general gist is that I want to speak to terminally ill patients who have transitioned from care with goals of cure, to care with goals of quality of life. In the hospital we're good at acute care and quantifiable results, but not as good with transitions that happen over time and aren't easily communicated. I think it's important to know what factors play into patients being ready for this transition, so that we know when and how to talk to them about it, so that care is focused on minimizing suffering, not so much maximizing breathing time.
The first patient I interviewed is dying from lung cancer and had been admitted to the hospice unit of the VA. He was very open to speaking with me but was breathing so heavily, with few gaps between large gasps, that he couldn't talk for longer than a few minutes. When I came back the next day, it was only worse. So nothing came about from those efforts, in terms of my project. But it reminded me of what it's like to see someone actively dying, and of what I want to learn in this process.
My second interview was an actual interview, with a lovely 88 year old woman with lymphoma. She had very developed thoughts about her life and death, and was very comfortable talking about them, so the outcome was completely different from my previous attempt. Another thing I wanted to explore was personal writing, and to have patients journal about their experiences at the end of life, because that can be so different than what someone is able to share in a conversation with a doctor. So at the end of the interview I asked the woman if she'd be interested in participating in something like that. She said that she can't really write due to arthritis, but she had been working awhile ago on a story about her childhood. She brought out several pages of yellow lined paper, and asked if I wanted to read it. We talked about typing it up and having me help her finish it.
So I took the pages home to read and transcribe. Several of them are numbered the same number, such that the order was hard to determine, and as I read through them I realized that's because she had written several different beginnings. Throughout there are some anecdotes told in slightly different ways, so that in typing up the story, I had to maneuver some passages, putting the similar ones side by side, so that she could decide which parts of the same story she wanted to keep, discard, combine. During some particularly difficult parts to decipher, where reading continuously didn't seem to give a sensible narrative, I saw that she'd written in every other line, and in the lines in between added other parts of the story. All of this required some rearranging as I read and typed, and I liked indulging in both the neurotic need to organize and the creative desire to piece things together. The story has nothing to do with my research, but it does have to do with what a lot of people seem to want, a desire to record certain memories, something that resonates a lot with me personally.
I really appreciate the flexibility of this time, that allows things to happen that don't fit a mold of efficiency or list of things to do, where I'm led not by steadfast goals but by natural happenings and my natural responses to them.
And this woman's story comes to me during a time when I've been working on a story about my childhood too. The writing part of this time off is even more vague than the research. I have a list of things I want to write about, which is a little overwhelming, and even when I focus on one, I'm not quite sure what I want to say or how to say it. All I'm sure of is that I feel compelled to write about them, but having the time to do it means being faced with why, and that has resulted in major writer's block. I could spend an entire day on something without much to show for it, and the lack of proportion can be disorienting. But I'm endeared to writing in the way that it's not science and things don't logically lead to other things, and it is amazing to wake up each day with the freedom and privilege to just try, with no expectations, to feel that that's enough, for now.
And so instead of explaining to every person who asks, I say I'm doing nothing. It gets somewhat tiresome, because we're not used to nothing being okay. I'm not traveling anywhere, so it's not like a vacation. The few times I've tried to go more deeply into it, I usually just confuse the person and I'd rather have them think I'm doing nothing of significance instead of misunderstanding something of personal significance. Besides, everyone takes nothing in their own way, and I think we could all use more of it.
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