Showing posts with label writing. Show all posts
Showing posts with label writing. Show all posts

Wednesday, April 6, 2011

bird by bird

Back from a near three weeks in Vietnam, where the first half sped by and made me feel I'd been there forever and where the second half slowed to normality and felt too short, and where both halves exhausted me with experience. I went to Vietnam to translate for a medical mission, a group of plastic surgeons repairing the lips, eyes, and ears of children and a few adults. Afterwards I was able to spend some time with family and family friends.

Coming back I've returned to a disorientation that almost feels familiar at this point, coupled to the overwhelming sense of too many things-to-write that also feels familiar and would be friendly if it weren't for the fact that many times I'd rather it be a stranger. I have a couple months before I go to California for a primary care rotation, and in those couple of months, I'd like to:

-complete patient interviews for my research project
-start sorting through the lit review & begin introduction for my project
-write on translation & pros/cons of medical missions
-work with my co-translator to write about particular aspects of our mission, namely--how much do we know about our patient population when entering this foreign place?
-work on several projects for atrium magazine
-finish loose ends on the public health research project from years ago
-compile information re: family & relation to Vietnam
-plan trip to Bar Harbor with Allison, possible end-of-May trip with M somewhere?
-plan things-to-do in my month in California

Most everything is writing-oriented, and most everything is vague and nebulous; I'm working in the realm of broad goals, not yet to the point of concrete tasks. I've been re-learning chemistry as M bravely marches through his post-bac classes, and it's strangely been a deceiving escape to a contained world of facts and answers. But I think back to when I was contained in that, and how I saw it as a gateway to where I am now.

My advisor recommended a book on writing to me this morning, called Bird by Bird. The title comes from a story about the author's brother, who had a year-long term paper to write on birds. Near the very end, he'd attained encyclopedic information on a large number of birds, and sat unable to write anything about him. His dad told him to take it bird by bird, and somehow the image of birds on a wire turned a rational -ism into something real and felt to me. It's always been hard for me to multi-task, as the significance of each thing is so present to me, but as I chug piece by piece I feel it's not about finishing but about continuing; I remember that I'll never want to run out.

Wednesday, February 16, 2011

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.

Tuesday, February 15, 2011

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.

Tuesday, September 28, 2010

editing

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.

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.