For the past three years we've spent most of our education considering things that harm, threaten or take life. Now on my ob-gyn rotation, for the first time in med school and really in my life, I've given serious thought to the birth of life. This brings to mind something I heard somewhere (okay, from Dawson's Creek) about how people think of life as the opposite of death, but really birth is the opposite of death and life has no opposite. I still think the latter part of this is true, but I feel now that the former is not quite so straightforward. Setting birth and death apart from life assumes that they're isolated events. But as medicine has showed me that dying is a process, ob-gyn has taught me the same for birth.
The process happens in so many different ways in so many different venues, and even the same kind of labor and delivery holds unique crevices. That the joys of fostering life can be so nuanced makes me think that Tolstoy's all-happy-families-are-the-same philosophy isn't true. I haven't minded observing deliveries several times over. Each baby is different by nature of being new. Besides that inherent change, every woman experiences this process in her own way, absorbs and gives in her own form. Even the same silence, or the same cries, can't be described quite similarly. It's the eyes and the lips and the hands clenched or open that I find drawn to, that I want to use to etch the outlines of those sounds that might sound the same but travel to the ear and register in mind in singular paths.
Then there are all the other places where life is considered and formed. At the fertility clinic, I watched a sixteen year old deal with premature ovarian failure and I watched a forty year old couple contemplate their options for having a child. Having failed in vitro fertilization three times, they would like to try again, and after that? Adoption, egg donation? I clearly remember the first time egg donation ever crossed my mind as any sort of thought, sitting at the freshman dining hall and glancing at a school newspaper advertisement for egg donations from tall women with high SAT scores. I don't think I've given it any sort of thought since then, until fertility clinic, where I realized that childbirth includes all that precedes it, the carrying and laboring. And this is why women choose to place within themselves someone unconnected to them, to take this process into their own hands and foster the connection with strength and desire and commitment. Later in the antenatal testing unit, where women receive ultrasounds during pregnancy, I watched twins float within a 45 year old woman, a phenomenon made possible by egg donation. In class we watch a video about home birth, and debate its use. Regardless of anything else, home birth pays attention to the labor of childbirth, and I find this respect for the process so important. Like most things, it's not something that happens to you; it's something you go through. I can't honestly say it seems easy or pleasant to bear all that pain, but I do believe feeling fully allows for a heightened awareness of experience and why settle for less of something so substantial?
Ob-gyn brings to the forefront much of what I've enjoyed in medicine, the broad range of experience and emotion, and the role of healthcare providers to connect to patients dealing with personal, sensitive, important issues. With each component of this field as a whole and of individual patients, it challenges us to confront things as continual processes with steps, thoughts, and consequences, immediate and far in time. I've really enjoyed seeing babies born, which is a given, but I'm thankful for the surprise of how the value of this moment comes so much from the before and after.
Saturday, April 24, 2010
Sunday, April 18, 2010
surgery / strength
A few weeks ago I finished my two month surgery rotation. As with much of this year, and more so with this rotation that consumed more time and energy than any other, I felt the need for catch-up, a need never fulfilled because of the constant forward momentum that is med school. I don't think I'll ever do reflection full justice; it's gotten to be too hard to even just describe. I think a lot will be lost in time and memory, but so it goes. I keep saving it up for later, later; at the very least, next year I will put aside blocks of time for this later. It's my main consolation during this time, a time when as much as I want to put everything I'm experiencing down, I also just want to experience. Which is one of several things surgery taught me to do better.
Surgery seemed to me a lesson in survival--not just in the sense of getting through, but of gaining strength. On a concrete level, I learned to pay better attention to my body's basic needs. Eat at any chance, eat two breakfasts (when you first wake up at four in the morning, and then at the normal breakfast hour). Before a long surgery, hydrate and use the restroom. Running on graham crackers, peanut butter, and apple juice (consumed at each and every break) made me strangely aware of pockets of emptiness inside me and how they fill up.
Standing for most of the day also motivates movement. It was on surgery that I went from running a few times a week to every day. You'd think that you'd be too tired after a fourteen hour day in the hospital, but it was actually the one thing that gave me energy at the end of the day. I tried variations of running longer and faster, and everything felt good. It wasn't just counteracting physical stillness; it was battling the sense of having spent most of the day doing very little. No matter how it ends, time spent running is time well spent, and there is an individual sense of having done something. There's no particular goal other than to do it, which I could also say about days of work, but in this case it's solely my decision telling my legs what to do. Besides broadening things that were comfortable for me, I found it useful to try new things (squash, rock climbing), none of which I'm good at, but the topic of how I'm not good at most of the things I enjoy is for another time. The rigidity of schedule forced me to flex other parts of life, and being mindful relieves some of the sting of the numbness I slipped into during long hours of watching, not really seeing.
Despite this complaint, it jars me to think of how much there is to feel and say as a result of my surgery rotation. Because there were substantial things to see, and besides building up some inner muscle in fighting for life outside the operating room, I found myself with much admiration and respect for the strength of people. As usual it's beyond me to articulate in this venue, and is something I'm saving. Briefly, I think that transplant surgery (the most exhausting, and best, part of my rotation) sets much of the tone for what seeing organs can do for a person. Transplant surgery, which deserves many writings, was an amazing thing to see--to see people give to and receive from one another, with natural humility and generosity. To see the liver charred black as it's cut and burned, so that it can be given away, renders more sharply the outlines of what it means to donate. To feel the liver in a new body grow from cold to hot in your hands, as foreign blood warms it, made the idea of a gift something to carry and hold. A mother to her daughter, a young aunt to her nephew suddenly inexplicably ill, a fiance to his fiance. They seem like easy enough decisions, but they're not simply decisions in concept. They are procedures felt with scared tears preceding, and recoveries borne with tangible changes after.
Surgery seemed to me a lesson in survival--not just in the sense of getting through, but of gaining strength. On a concrete level, I learned to pay better attention to my body's basic needs. Eat at any chance, eat two breakfasts (when you first wake up at four in the morning, and then at the normal breakfast hour). Before a long surgery, hydrate and use the restroom. Running on graham crackers, peanut butter, and apple juice (consumed at each and every break) made me strangely aware of pockets of emptiness inside me and how they fill up.
Standing for most of the day also motivates movement. It was on surgery that I went from running a few times a week to every day. You'd think that you'd be too tired after a fourteen hour day in the hospital, but it was actually the one thing that gave me energy at the end of the day. I tried variations of running longer and faster, and everything felt good. It wasn't just counteracting physical stillness; it was battling the sense of having spent most of the day doing very little. No matter how it ends, time spent running is time well spent, and there is an individual sense of having done something. There's no particular goal other than to do it, which I could also say about days of work, but in this case it's solely my decision telling my legs what to do. Besides broadening things that were comfortable for me, I found it useful to try new things (squash, rock climbing), none of which I'm good at, but the topic of how I'm not good at most of the things I enjoy is for another time. The rigidity of schedule forced me to flex other parts of life, and being mindful relieves some of the sting of the numbness I slipped into during long hours of watching, not really seeing.
Despite this complaint, it jars me to think of how much there is to feel and say as a result of my surgery rotation. Because there were substantial things to see, and besides building up some inner muscle in fighting for life outside the operating room, I found myself with much admiration and respect for the strength of people. As usual it's beyond me to articulate in this venue, and is something I'm saving. Briefly, I think that transplant surgery (the most exhausting, and best, part of my rotation) sets much of the tone for what seeing organs can do for a person. Transplant surgery, which deserves many writings, was an amazing thing to see--to see people give to and receive from one another, with natural humility and generosity. To see the liver charred black as it's cut and burned, so that it can be given away, renders more sharply the outlines of what it means to donate. To feel the liver in a new body grow from cold to hot in your hands, as foreign blood warms it, made the idea of a gift something to carry and hold. A mother to her daughter, a young aunt to her nephew suddenly inexplicably ill, a fiance to his fiance. They seem like easy enough decisions, but they're not simply decisions in concept. They are procedures felt with scared tears preceding, and recoveries borne with tangible changes after.
Monday, April 12, 2010
experience
I wanted to do medicine for a strong desire for something vague--experience. I spent a good chunk of my life reading stories, thinking about stories, cooped up inside of myself. I wanted to see things, do things, understand things, as a means to reach outwards. I wasn't sure of the actual texture and contours of these endeavors, but I knew that I wanted texture and contours. And the main reason I love med school is that it has been just that. It's let me in on so much experience.
There's so much variety. We rotate through so many different areas of medicine that we constantly see people dealing with different aspects of life. A sudden heart attack, the realities of the deficits of a stroke, a long struggle with cancer, a steady adjustment to a chronic disease, recovering from the pains of a surgery, having parts of your body rearranged, having parts of your body removed, giving birth, terminating a pregnancy, battling mind with mind, losing movement, losing thought, recovering movement, recovering thought--so much can happen to a person, and each experience tells you so much about people and what's around people and what's in between people and what's independent of people.
A friend of mine recently mentioned an aversion for how a crowd of people tend to respond to things in the same way, stripping people of their individual qualities and interactions with things around them. Once you've chosen your path in medicine, it's easy to do this to people, by nature of seeing similar things over and over. But even within the same experience, there's depth and nuance. I saw four women give birth today and each one was different. Each person feels things differently; expresses in their own way; lives what happens to them as only they are fit to do.
In one day there were these experiences, for me to absorb and give back in some form. Today was a long day and I have to write quickly so nothing will be entirely accurate or remotely elegant, but at the least it's fresh. One of my top ten things is seeing people do things for the first time. Two women gave birth for the first time. Many sets of eyes saw the outside for the first time. I delivered my first baby, a six pound girl with curly black hair. I tried my hardest to hold it like a football but I probably forgot how because my memory sometimes fades in the presence of wonder. When pushed to do more, one woman immersed in pain continued to give more and more. Her friend of twenty plus years hung onto her leg and told her the baby was getting closer and closer ("you're lying!"). The father of one baby held tentatively to the mother's foot, unattached or unsure. A head popped from the abdomen (perhaps blossoming is more ethereal but popping is what it was); in another, the foot came first. These ones were purply gray, wrinkly, gross and so damn gorgeous it hurt you through your double gloved hands. He said his little girl was suffering from ET skin, so apt. There is a female camaraderie where certain things can be said in the open and cause laughter and comfort, as women just met share something momentary and lasting. There is a lot of endurance but only because there is a lot of pain, and it reminds you that you're here not for a blip but for the spectrum.
There's so much variety. We rotate through so many different areas of medicine that we constantly see people dealing with different aspects of life. A sudden heart attack, the realities of the deficits of a stroke, a long struggle with cancer, a steady adjustment to a chronic disease, recovering from the pains of a surgery, having parts of your body rearranged, having parts of your body removed, giving birth, terminating a pregnancy, battling mind with mind, losing movement, losing thought, recovering movement, recovering thought--so much can happen to a person, and each experience tells you so much about people and what's around people and what's in between people and what's independent of people.
A friend of mine recently mentioned an aversion for how a crowd of people tend to respond to things in the same way, stripping people of their individual qualities and interactions with things around them. Once you've chosen your path in medicine, it's easy to do this to people, by nature of seeing similar things over and over. But even within the same experience, there's depth and nuance. I saw four women give birth today and each one was different. Each person feels things differently; expresses in their own way; lives what happens to them as only they are fit to do.
In one day there were these experiences, for me to absorb and give back in some form. Today was a long day and I have to write quickly so nothing will be entirely accurate or remotely elegant, but at the least it's fresh. One of my top ten things is seeing people do things for the first time. Two women gave birth for the first time. Many sets of eyes saw the outside for the first time. I delivered my first baby, a six pound girl with curly black hair. I tried my hardest to hold it like a football but I probably forgot how because my memory sometimes fades in the presence of wonder. When pushed to do more, one woman immersed in pain continued to give more and more. Her friend of twenty plus years hung onto her leg and told her the baby was getting closer and closer ("you're lying!"). The father of one baby held tentatively to the mother's foot, unattached or unsure. A head popped from the abdomen (perhaps blossoming is more ethereal but popping is what it was); in another, the foot came first. These ones were purply gray, wrinkly, gross and so damn gorgeous it hurt you through your double gloved hands. He said his little girl was suffering from ET skin, so apt. There is a female camaraderie where certain things can be said in the open and cause laughter and comfort, as women just met share something momentary and lasting. There is a lot of endurance but only because there is a lot of pain, and it reminds you that you're here not for a blip but for the spectrum.
Sunday, April 11, 2010
playlist
I periodically lose my song playlists, which upsets me at the time because I spend some time putting them together based on various associations, and then they develop more associations as I listen to them. A few times now, they've disappeared from my iTunes and I'm left to start over (I've tried saving them but I don't do this often enough to encompass changes over time, so that the last ones I've saved are not the ones that were currently on my iPod when I lost them). A friend once told me that this might be good, to consciously change and renew, and I thought this was a good point. Sometimes, though, I remember the old and ache for it, like now--when I'm fully enmeshed in the third year of medical school which is also soon nearing an end, when I suddenly remember a song that was so definitively part of a playlist entitled "second year" and a handful of the songs on that list come back to me and though I can't remember all of them, I go back to the ones I do and remember so clearly the walks and study sessions and nothingness spent listening to those sounds, and more than that, how the feelings of the songs themselves get mixed up in how I felt back then, how those songs chose me and I chose them for that time and experience in my life, how suddenly the gap between then and now can simultaneously open up and close. It's a crazy, crazy thing.
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