schedule

As I'm apt to do when confronted with large blocks of free time, I've developed a semi-schedule for my weekdays. It's very broad in its division of time, and loose in obligations, and makes me pretty content every day.

Morning: Run or climb. Running makes for good alone time that gives energy for the rest of the day. Climbing in the morning means quality time with my classmate/friend Caitlin, who also gives energy for the rest of the day, and it means a mostly empty gym with lots of room.

Afternoon: Write and/or research. On some days I have interviews for research. Most days I spend long afternoons at coffeeshops, sometimes with other friends doing work. I have long stretches to write; I don't spend much of the time actually writing, but it feels like a process.

Evening: Spend time with M. We divide active activities between squash and climbing. He usually makes food, and now that he's taking classes, we spend some time studying. During that time I also do stray work that I don't like to do during the day, and that I find more bearable in his company. If there's not much work to do we watch movies, and regardless of what else there is to do, we talk.

Meals are often spent with friends, and evenings mixed up with friends too, and as I've been thankful for the past several years, I continue to feel lucky for the balance and perspective they give. And I feel lucky for the balance of these times of day, and how much they give me, so that in the future I can share. In the meantime, it's nice to just absorb.

patience

Hemingway, who was my favorite writer in college and will always remain significant to me, said he would stop writing when he knew where to go next. This could be mid-sentence or mid-idea. This way, when he started again, it would be easy to start, and starting is always the hardest part. It’s advice that many aspiring writers quote, because it’s good advice. It works, by leaving something in anticipation and coming back to it in anticipation. It works not just in writing but also in living, I think.

But it’s hard to leave something with the feeling that there’s more. It takes discipline, willpower, and foresight to consider the benefits of delay. I’m not too good at it. Probably because in one sense I have a lot of patience for both good and bad. I don’t get tired of continuous good too easily, and I don’t mind trudging through some or a lot of bad to get back to the good. I’m not too particular about the ease of things, and I don’t give much thought to efficiency when it comes to abstractions in my life (or concrete things either, but that’s a different topic). While I think this is useful in some areas, I wonder if it’s the best way to go about things. Instead of having patience for inconvenience and difficulties, maybe I should have more patience for trying to cut down the inconvenience and difficulties, in my writing, in my life.

recording

This morning, I met with my research advisor to go over a transcript of my first interview, which I conducted back in September. My project is qualitative research, speaking with hospice or near-hospice patients about their main concerns during this transitional period that we term end-of-life. My first interview was with a lovely woman from the South, with a subtly sharp sense of humor and generous spirit, who died a couple months after I met her. She's the one who I wrote about previously, who had written a story she'd wanted to publish in her nursing home newspaper. We'd worked on it together, and she died before it could get published; it will be printed in April.

With those strings in mind, I read the transcript with my advisor, who said, isn't it funny to hear her voice coming back? I agreed, and I thought how nice it was that I had the interview on tape, and also how nice it was to see it transcribed on paper. I've been so trained to close-read that when conversation becomes written, I pay attention differently. Words take on much more contextual meaning. And as fresh eyes to the interview, my advisor noticed motifs and word choices and turns of phrases that I hadn't, while speaking to the patient. She also loves telling any story that comes to her mind when something reminds her of it; they're always funny, or touching, or interesting.

Reading the transcript made me excited anew about the project, realizing that there was more than I realized in those conversations. I'd worried that without structure, and with such different people in different situations, it'd be hard to glean anything from the interviews. But even if each transcript turns out to be very different, there are plenty of individual insights into a person's thought process and expression of them, and that's worthwhile.

Much of the reading I've been doing on qualitative research and narrative analysis emphasizes what's lost when conversations are transcribed into script. You lose tone, pauses, faces, and so on; it's true that much nuance is sacrificed. And so I was surprised to see that simultaneously true is that something's gained in this translation. There's something about the act of recording, which inherently must be in a different medium than actual experience, that gives a perspective outside of the experience itself.

*
This afternoon the wife and I continued to labor over our class slideshow, to be shown at our school's annual second-year-show this weekend. Each year the graduating class puts together a slideshow of pictures. Ever since I saw the fourth year class slideshow during my first year here, I've wanted to work on ours.

We downloaded all the pictures sent from our classmates, and because I wanted to give the show a theme and not just be a conglomeration of pictures, we went through them and organized them. Then we laid them out into slides, keeping in mind order and cohesiveness and variety. Then wife and another friend/classmate of ours chose music to correspond to different parts of the slideshow, and had to learn how to splice music to put together a mix. Then we had to sync, sync, sync, and sync again the music to the pictures; there were a lot of transitions in the pictures that we wanted to line up with transitions in the music. Then we embedded a short video to conclude the show.

We probably spent the equivalent of 24 hours over different days in order to piece together this 6-minute slideshow. We had to choose which parts of songs we wanted, decide which pictures to cluster together, find pictures of everyone in our class, learn how to have certain pictures come into view, figure out how to time slides. All of this required learning details, looking up programs, pulling hair, and intermittent/continuous swearing.

It also meant watching the show over 20 times to see whether our piecemeal efforts congealed into solid form. As frustrating as the process could be, watching the product always made me nostalgic. Four years of people and experiences, compressed in two-second segments placed side by side like pages pressed in a book. Each time we would notice new nuances, the way a lyric coincided with an item on the slide or how, small moments of self-pride and love for the images--that won't be noticed by anyone else, but are known to us and after all that work, gives a lot.

It's a representation, but not only a representation--not in the sense that it's something else other than a representation, but that "representation" encompasses more than we give it credit for. It's not a replica of the experiences that give rise to the memories or even the memories themselves, but it's an experience on its own. The process of making this out of things already made, surprises in the way that in how new it is, how much there is still to learn and feel.

There's the personal satisfaction from creating something with your own hands, and also the sense that something's happening to you. This dynamic way of connecting yourself with things outside of you that are also kind of part of you, and of connecting the outside with parts of yourself that are also kind of already part of your environment, is obviously too poignant for me to describe with any sort of clarity. But for all the curses and furrowed brows, it feels damn good (so long as it goes well for the show, too).

*

I'm really grateful for small experiences like these, things no one would pinpoint as reasons to be a medical student. And of course it's more than medicine that led me to having these moments, and of course if I'd done something else I would've been led to others, but I don't think I've been exposed to quite as much compact variety at any other phase in my life. M and I talk a lot about reasons for and against a career in medicine, with the long stressful process being a drawback. But there are also a lot of opportunities to meet things you may never have felt. I'm lucky that Yale is particularly suited to exploring these things, often without much idea of concrete goal. I also feel lucky for being a part of a small community of students for four/five years; for me it's combined aspects of high school and college I liked most (with some of the bad of each thrown in there, too). I don't think I'll ever experience anything like it again, and in remembering and living it, I miss it too. So for that too I want to record.

free time

We've been so ingrained to work for things, work so hard that we long for free time and freedom, that when there's no immediate goal to work for we feel a little lost. Writing is difficult because the hours don't add up to results; what is put in doesn't correlate to what is put on paper. I don't think I've had anything else in my life that's so painful and so fulfilling at the same time, except for maybe relationships, and it's funny to think of something so solitary to be most like something so connected to people.

I find it difficult to focus, turning to multiple writings to override the block in one (hence the blogging, the emailing). When trying to write things with clearer details and points to the details, it can be relieving to ramble with whatever comes to mind. I go back and forth between the endeavor of writing and the typing of thought, in almost a frenzy.

And I place things in the background; there is always always music and often there's a book. Currently I'm reading about qualitative research--how to analyze narratives, interpret stories. Which is interesting and informative, but also occupies a lot of the same space allotted for writing, and crowds things a bit.

I doubt that there will another time in my life quite like this one, where I can give so much attention to the space and crowding in my mind. It's ungrateful and honest to complain about the difficulty of free time and uncertain pursuits, and it's also necessary to fully portray how lucky I feel to be both so wound-up and unwinding.

anniversary

I like anniversaries for the thought of remembering and reflecting, all that's happened between two points in time. Which is a lot, and considering how many days go by without significance--to feel that one year with someone has given you this much to feel and consider and grow, is nice. We went through a long phase of uncertainty, intermittent phases of awkwardness, a phase of closeness through distance, a phase of travel, and are in something good at the moment. I've always thought it was valuable and important to experience different stages, as we're different in different contexts. Through these with him, we've tried to be honest and open, and more than ease or sap, this is what I've loved best.

hospice (ending)

I just finished my month-long hospice rotation at the Connecticut Hospice in Branford, which both gave more and took more than I anticipated. Perhaps because after a slew of clinical rotations, I've lost a bit of the expectant newness that used to come before each new venture, and so there wasn't much anticipation to begin with. I didn't think much about what hospice would be like before I started. Having had a strong experience that led me to being interested in the rotation in the first place, I think I unconsciously felt that I'd reached a certain level of intensity that would prevent me from being taken by surprise here, even as I approached this rotation as an opportunity for broadening experience, concrete and emotional. I'm glad to have been wrong.

I haven't felt this motivated to write about a medical school experience for a long time, but before doing it in a structured and comprehensive form, it feels nice to sit in bed and ramble about all the things that made it filling, and hard.

On my last day, an APRN asked me what was the most memorable event during the rotation. It would be hard, and probably not accurate, to choose one event or interaction or experience. Instead it was more generalities absorbed that most affected me. I told her that I'd take with me the calmness of the place, the simplicity of the medicine, and the kindness of the people.

Connecticut had the most snow in January on record since years and years ago. We had two two-feet snowstorms, a couple ice storms, and record below freezing temperatures. While I was used to this in Boston where the winter is more harsh than here, I'd never had to deal with the visceral challenges of snow and ice. For the first time in my life, I had to shovel my car out of the snow, had to try to drive it through the narrowly plowed driveway, had to shovel myself out of the driveway that wasn't plowed widely enough, had to shovel piles of snow off the entrance to the street where the tires would just spin in place, had to chip away at inches of ice off every window and off the roof of the car, had to see why getting ice off the roof is important as a I saw sheets of ice slip off cars on the highway, had to steer my car as it slid on unsalted iced roads, had to walk strategically to avoid puddles of slush and piles of iced snow. It was uncomfortable, and tiring to have to work so hard and think so hard about how to simply get somewhere.

There were also incredible vignettes of how pretty harshness can be, in the snowflakes that would freeze on my car windows to create a printed pattern I'd have to scrape away, in the ice that dressed bare tree branches making the forests on my drive looks like crops of glistening gray hair, and in the sheen of clean soft snow hardened on top like creme brulee, by the ice. There were incredible views from the windows, of big flakes falling against warm yellows and cold grays. There were the first falls, untouched, and the old snows, dirtied.

After the trek through all of that, I arrive at a workplace with windows in tandem, bookshelves, and fireplaces. Laid on the beds are crocheted blankets and patchwork quilts. Hand-painted signs of patient's names are hung in their respective spaces. Guitars strum, and every other day there are sweets from families or employees. It seemed to me I was lucky to have done this rotation during the onslaught of winter, to have to confront bitter elements with reason to escape to this cove. It's not often that you think of a workplace as soothing, especially not hospitals.

It's true that this atmosphere is partly due to the way that the rough edges of medicine are worn away a bit by the different goals and mindset of hospice. There is more thought to necessity, and the removal of what's not. In that sense, things feel simpler. There are no fancy tests to order; people often get sicker and instead of embarking on a diagnostic quest for etiology, we acknowledge the worsening condition and continue. There's still a lot of room for creativity in catering to individual needs. My attending pushed us to consider the best options for care, to not get stuck in status quo. But grounding all of that movement is a framework of simple stability. Not to say that dying is simple, but in the face its possible complexities, people's wants and needs become basic and streamlined to the core, without the excess that can often distort. After awhile the pharmacological treatments become routine, leaving more room to focus on non-pharmacological care, and hospice focuses on that much more than other areas of medicine. Its wholistic perception of people is reflected in its interdisciplinary approach to care; doctors aren't at the center, are instead an arm, of the scheme. There is constant, continual communication with the nurses, social workers, pastors, and family. And while there are many factors to consider, the way in which all these people work together to focus on each person's care, gives a simple sense of value.

I imagine that the comforts and simplicity help the staff as much as the patients, because as calming and welcoming a place it is, it is a hard place to be. Because of that, I think it attracts and seeks certain qualities in the people who work there, making for an incredible community. I've never met such a cluster of genuinely warm, kind, and strong people. The nurses, who are the heart of hospice care, made the biggest impression on me, but the kindness is palpable in every person encountered, from the person at the front desk to the person manning the cafeteria.

In the morning, the nurses and physicians round together, going over the care for each patient. The nurses are the ones giving report, which has never been the case for any other rounds I've seen. They make me remember why I want to be good at whatever it is that I do. They take care in the most whole way possible: delicate where people are fragile, tough and honest when needed. They advocate for their patients, they know their stuff, and they all have voice. It's this combination of warmth and strength that I admire most in women who give care, and every day it reinforced goals to work for.

On my last day I told a slightly demented patient of mine that it had been really nice to take care of her. She replied, "It was really nice to take care of you too." Even as her response was a rote one, I appreciate the truth in that. I think that at their worst these patients and their loved ones have given me more than I could give at my best. Each person copes differently, experiences different pains and discomforts. It would be misguided to say that all of them gave the same thing, but as a whole, it was valuable to witness their capacity to give when so much is being taken from them. There is a woman whose body has been distorted and disfigured by tumors, and as she struggles with grace and patience, she makes me think of how deep our reserves run, how much we can face without being torn. There is a man who has accepted that it will be difficult for him to breathe until he no longer has to, and his first thought in conversation is to answer all the questions he knows you'll ask before you ask them, without pause and without rest, with the creases in his face working with effort to give you all he can. There is a man actively dying before the eyes of his wife, who comforts me with stories of him before he was sick--redheaded, singing silly songs in the morning.

In conversation about this, it was pointed out that perhaps it is something about this stage in life, and not something intrinsic to these specific people, that make us that way. It doesn't matter to me too much from where the source stems. To see people in pain, so close to something unknown, be gracious and generous and sensitive gives me faith in the endurance of these qualities and makes me try harder for the patience to endure. And it's not to say that these people weren't struggling, weren't falling back in some ways, but that there seems to be a pull to hang onto the good when things are slipping away.

I can't say that I endured the past month of this rotation with the same kind of grace that I observed in my patients and their families. The rotation was hard for me. I was surprised by how quickly people transitioned from alert to unresponsive, how I could never get used to someone changing so much over hours or days from the way I first met them even for the ones I rationally knew had come to hospice to die. I missed the people they were as they were still breathing, and I wondered how it was for people who had been their lives. While the pace was unhurried and I was never overworked, and I loved most days there, at the end of them I felt tired.

And I was mean when tired, and the emotional stress of seeing and taking in this weighty process manifested in a lot of physical breakdown. Getting sick, breaking out with a cold sore, a couple allergic reactions, and developing various muscle strains, I was told that I was pushing myself too hard, that I needed to listen to my body. I think it is true that we should take care of ourselves, but I also find value in digging for the resilience that lies in vulnerability, and believe that this first means knowing what makes us weak. I didn't plan this of course, and it could be argued that I'm rationalizing the discomforts of the experience. But somehow, an intuitive, inexplicable part of me feels that there is good reason the weather was so harsh, the people so fragile.