stamina

Stamina is one of my skills. Speed and technique are gaps in my skill set, but I can do things for a long period of time, and sometimes this is adaptive and sometimes it's counterproductive. With one and a half more nights on my month of nights, I've pretty much run out of steam. But as I've been chugging along, I've spent some time every day looking back on what I've seen and done--reading about patients who I admitted to the hospital and seeing what happened to them after the one night that I spent with them. The list of patients is long, and I remember most of them well because I spent so much time gathering their histories and presenting their stories, and it's interesting to see how things continued after I initially saw them. As I go through the list, it reminds me of when I hiked Kilimanjaro after a month of an intense rotation admitting many patients. The last night of the hike was a 16 hour hike, with the first half being a night hike ascending to the peak. It was an eight-hour, slow and winding climb up the mountain, with everyone quiet and concentrating on their breathing as we battled the altitude, and to keep myself occupied I went through a mental list of every patient I could remember taking care of in the previous month. I thought about why they came to the hospital, their eventual diagnosis, how we treated them, how they left the hospital. This took several hours, matching the rhythm of our hike with the ticking off of patients in my head.

Thinking about it now, I think that everything we do is just about finding a rhythm to match the inherent rhythm of our lives moving forward. And like we often talk about, this can be arbitrary and probably no one pacing method is more valuable than another. To me it seems kind of just like a way to keep up with what's going to happen regardless of what we do. I don't know if it affects anything other than turning a monotonous, meaningless pace into something that can be measured, even if this measurement can be arbitrary. I think that even if it were true that there's no inherent value in any way we choose to live our lives, the reason we continue as individuals and as a species is that we find something to parallel each footstep we take.

inhumane nights

Most of my time in residency has been spent at our county hospital, with a few months at our university hospital. I love the county and it's where I feel most at home. This month, working mostly night shifts, I've spent most of my nights at the university hospital, which I also enjoy, for different reasons. It is pretty amazing how different the two hospitals are, and I feel lucky to be able to experience both. Because of how different they are, everyone has strong feelings about which hospital they prefer. Thinking about the comparison makes me reconsider our definitions of misfortune and suffering, and our subsequent responses of empathy and connection.

There are definitely things about university patients that make them more readily relatable. For the most part, they are what people call "normal." They are generally employed, have supportive family, and can tell you a coherent story about their symptoms and their medical history. This is what people imagine when they imagine patients. And here, many of them have life threatening illnesses--advanced cancer, organ transplants, rare immune disorders. Many of them have had vibrant, successful, active lives, with strong professional and familial ties; people who write, research, travel; who have been doing pilates and karate and go camping. They are most often kind to us, and grateful for our care. So it is always very sad to see them face an acute change. All of the sudden, a man stops being able to swallow solid foods and is diagnosed with cancer of his throat. All of the sudden, a woman loses her memory over the course of a few months due to a rapidly progressive dementia. For these people, we relate to the people they were before their sickness, and can imagine the difficulty they face, and for me they are the ones that instill a familiar ache in the center of the chest, wherein resides what's closest to us.

This makes me re-frame the patients at the county hospital. They are often difficult to attain information from; they are usually less functional, less engaged in society, or engaged in a part of society that their providers have never lived in. We often think of their ailments as self-inflicted, such as drug and alcohol use that then predispose them to infections and withdrawals. It's difficult for us to see the people they were before these gradual, chronic conditions. Seeing the same patient over and over in the hospital for the same thing makes us more familiar with the illness but more distant from the person, as we consider futility in a way that is different than caring for a person with life-threatening cancer. And it would be dishonest not to acknowledge that some of these patients are less pleasant to us and often present behavioral difficulties, and are less able to see how hard you are trying to help, and less able to understand our own challenges as they are facing theirs. It takes real, hard work to take care of patients, and we are overworked, and when you are both overworked and feel like there might not be much purpose to your work, this fosters anger and resentment and ultimately distance.

I don't deny the differences, or deny that I respond differently to these situations. I do want to challenge myself to consider the similarities, to consider that so many of the things that make our lives physically and mentally challenging are beyond our control, and that somewhere in life we are very similar. Some people diverge from general commonality before others, and sometimes the source and timing of divergence interferes with our ability to relate to them. This is sad to me, the loss of a person's potential to become tied to the rest to the world. There are a lot of barriers to feeling this loss in the center of the chest the way we do with others; very real, understandable barriers like harsh words and violent motions and inconveniences to our own lives.

So I recognize the tangible differences and feel viscerally the differences in how I emotionally respond, intuitively. I do think that our intuition can be malleable, and that with thought, exposure, and practice we will come to intuitively relate to others' suffering as what could be our own, despite how much separates us. This isn't to say that I'm immune to the barriers; anyone close to me can tell you how unstable, distant, irritable and devoid of empathy working these hours has made me. And so in some ways as I advocate understanding for others I'm also asking for some myself, and maybe that's the way to stay connected to a circle of commonality.

young

As I sit up at night, trying to adjust again to a night schedule after a couple days off, I feel the hours differently than the day. Overall this month has stretched out very slowly, and it's made me think about time more. Even though the time feels longer, it feels less full since I'm mostly just working and sleeping. So I thought it would be a good time to write about thoughts I had when my life was more full. I remember feeling great after coming home from a short trip to Denver this past winter, when I went snowboarding in beautiful mountains with my brother, and telling M that it gave me a real sense of three things that keep me feeling young as the years past--

Movement. I think feeling the power of your body to move, especially as your body experiences changes as you get older and you start trusting it less, really does keep you feeling young. As I get older I find myself trusting my body more. I know it better but I've learned to adapt to its changes as I go along, and this combination makes for an exploration that keeps me learning more about what I can do. And it makes you feel both undifferentiated and developed--undifferentiated in that you can do anything you choose, and developed in pursuing different paths.

Nature. Being in diverse natural environments brings a freshness that can be stolen from our reserves as we sit working inside. It's one thing I am consistently grateful for, the opportunity to really be surrounded, immersed, and loved. The strength and kindness of landscapes mirrors everything I want. And I love them all. Deserts. Mountains. Oceans. Streams. Forests. Caves, valleys, canyons, volcanoes. Snow, blossoms, foliage, dry branches. There's just so much, and I think that what really keeps you young is the depth of wonder.

Doing new things. I think this is something I really appreciated when I learned to bike and swim, not just because these things are associated with youth and that's when normal people learn them, but because as an adult I could really appreciate how new the experience was. And it made me feel young, completely apart from the association. The sensation of experiencing something really different from what you've done before again brings you back to that sweet spot between being undifferentiated and developed, that sense of potential and achievement and boundaries still untouched.

february

Last month's update on my resolutions, while trying to stay up and on my night schedule this month:

1. Blogging: This was the one resolution I was able to fully keep, and glad as it was a really important month for processing. There was so much more to write and process, but I'm glad that I didn't let the intense ICU experiences pass me without some recording. That was a singular month in my life, and even if experiences can never fully be encapsulated I'm grateful for the means to track some part of its trajectory.

2. Recipes: I wasn't a big fan of the two new recipes I tried this month, though M was. The first was a dessert that sounded like a dream to me: baked croissant french toast with lemon cream cheese(found here: http://www.everyday-reading.com/2015/02/baked-croissant-french-toast-with-lemon.html). It looked so good, and I made it for our anniversary. I found my result to be a little too soggy; luckily M thought it was delicious and finished most of it. I would try it again, making sure the croissants are more on the stale side and also actually following the directions about either refrigerating it or letting it sit for 30 minutes, because I think that would congeal things and make the bread less soggy. The second recipe I tried to make was an adaptation of a restaurant dish we absolutely love--the Cajun shrimp from Cha Cha Cha, a Cuban tapas place in the Haight. I found someone's attempt to recreate the dish: http://www.epicurious.com/recipes/member/views/cha-cha-cha-cajun-shrimp-50041610. I didn't think it tasted anything like the original, and this may be because I adapted the recipe a bit, but again Mark liked it a lot and said it did taste similar. I would try it again, making sure that I use sweet paprika (ours was smoked), and also a dark beer for the base (we only had a pale ale). I've still not quite learned that the details in cooking do matter, and that using substitutes requires a good understanding of what taste each ingredient is being used for, and the nuanced difference between ingredients used for particular bases and flavors. I think that's where the difference lies between a good and excellent cook, and while I'm content with being good enough to follow directions, I'd like to develop more of these skills. In any case I feel lucky to have tried two recipes at all, because I basically didn't cook at any other point in the month.

3. Albums: I didn't have much spare sitting time to listen to music, so a couple of these albums were half-hearted listens. But I did get to fully absorb Bjork's Vulnicura (was so happy to hear about this early release from wife). I think Bjork is the most creative artist ever. I still remember the moment I fell in love with her: seeing from a far distance her tiny energy bring to life a Coachella stage, amazed by how much power such a small woman could carry, and then going home to listen to all her albums, each one uniquely creative and inspiring. I can't even describe how much I admire her, how she instills this incredible sense of how amazing people and the world can be, by showing us what we are capable of. Anyway, so anything else really has no chance of standing out even if I had been in a more clear state of energy to listen. But I did try to give Lost in the Dream, from the War on Drugs, another chance because I've heard so many good things about it, and I can't say I'm that crazy about it. I think it's okay, but it hasn't blown me away yet. I also gave Viet Cong's self-titled album a quick listen, though I really hesitated about the name for obvious reasons. I cringe to think of what my dad would think, even understanding rationally that the name obviously isn't an endorsement of cruel communist politics. Anyway, they sound a lot like Interpol so I enjoyed it and thought it was a well-done album, though again didn't fall in love. There's always Bjork.

4. News: Just have to admit that it was no surprise to me that this fell completely by the wayside. I don't anticipate March, a month I'm working mostly nights, to be much better, but I will try.

5. Exercise: Sadly, I struggled with this one and it made me really grumpy not to have time to do the things I enjoy. I usually had to sleep soon after coming home from work most nights, and after 30-hour call days I never had any reserve to exercise. I managed to climb twice, go to yoga a few times, and run a few times. I only managed one week where I accomplished my resolution of biking, swimming, yoga, and climbing all at lest once in the week. And I'm pretty proud of achieving that once. Again, March doesn't seem optimal for this, given that being up at night and sleeping during the day gives you a unique kind of fatigue. But I did run home from work the other morning, and it felt good both during the run to actually be outside and seeing daylight (I miss light much when on nights), and the next day when at work I could feel the lightness of my legs that comes after a run, reminding me that I'm human and can move and be out and about, even when I'm stuck at the hospital.

It was a hard, rewarding month and even though it was impossible to keep up with all these resolutions, having them in the back of mind pushed me to do more of what I wanted than I would have otherwise, so grateful for the intentions.