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.