We just finished a week long obstetric-gynecology module, and I really enjoyed it. Before school ob-gyn never crossed my mind and upon entering, I didn't imagine it being something that would appeal to me. But it was the perfect subject to greet us post-break, a point of all time low as far as motivation goes. Because ob-gyn makes very apparently clear one of the elements of medicine most valuable to me--intimacy. It does this in large part because it deals with sexuality, which people immediately connect to intimacy in mind and practice. I once called our high school lockers "intimate" because we were in block of 8 half-lockers in a small space, and my friends laughed at the connotation. But in learning this past week, I'm reminded that intimacy doesn't stem directly from physicality at all. Intimacy is feeling safe when vulnerable. And that vulnerability comes in many forms. Ob-gyn makes it obvious with physically uncovering what we normally protect, but that's just a conduit for all the other things we keep close, things that are there whenever you become connected to someone else.
In workshop we had a case on a miscarriage, and after going over the symptoms of abnormal bleeding and the treatment required to clear her system, I realized that I'd never fully considered what a miscarriage entails. I thought of it in simple terms of something going wrong that prevents you from continuing your pregnancy, and then it's gone. But I never once thought of the fact that there was something inside of you, that is no longer living, and it has to go somewhere. Meaning that the place that once held it, has to let it go. And not to be graphic but for reality, there's blood, and pain, and someone has to open you and physically remove what they call "products of conception" (your baby), and it's less like plucking an egg out of a basket and more like undoing the interlaced weaving. How visceral, how traumatic. Without ever having had gained or lost anything quite like that, to imagine hurts.
When doing the pelvic exam, I was really nervous to be given responsibility to handle what's intimate. At one point we were told that we'd "feel the uterus between your hands." I was a little taken aback by how amazing I found that thought. My hands? The ones that a few minutes of chipping icy snow off my windshield render red and dry? Yes, mine. The ones that also felt the pulse of the ovarian artery. Besides the fulfillment that comes with learning concrete things after so much academia, these solid things are tied to people...their relationships with their bodies, the notions of family and your ties to others known and not yet known to you, the intricacies of conception and its complications and emotions, or even just those of being made to conceive.
I've felt safe at my most vulnerable rarely enough to remember and feel the feeling distinctly and vividly. To find a presence with whom you are able to bare yourself, in whatever sense that might mean to you, and then to feel safe, without ever losing the sense of fragility and value that made safety necessary in the first place. I've only known that to happen for me after long cultivation with time and trust and test. Now, to think of that as a mutual goal for every stranger you meet as your patient, closes some of the distance and isolation that studying can nourish. In broadening something defined by smallness, I find I have more of it.
Tuesday, January 13, 2009
Friday, January 9, 2009
to love words
Old English, translated; foreign languages, translated; foreign writers writing in English; English. Florid stream of consciousness, bare bones stream of consciousness, lush detail, spare journalistic or iceberg style. Three word sentences, or forty page monologues. Straightforward plot and storytelling, or postmodern abstraction. First person, third person, ambiguous. Spans a day, or a lifetime, or generations, about the past or future. All feeling, all conversations, all thoughts, or page-turning plot. Contemporary cynicism or 19th century sentimentalism, archetypes or individuals, gritty realism or talking cats, magical realism and surrealism and fairy tales, domestic or worldly, social commentary or personal story. Picture books and tomes, flashbacks and predictions, pretending and extrapolating, light or dense, funny or bleak. Children, adolescents, twenty somethings, middle-agers, older, oldest. Moody, surging, monotone. Trips and stalemates, poetic or hardy, vignettes or chapters, loose ties and randomness and patterns. Chronological or insensible, quick or langorous, girly or tough guy, symbolic or concrete. In most any form and context, they give the ineffable.
Thursday, January 8, 2009
the abcs of 2008
I stole this idea from Victo, who did it several years ago.
Ayden met the world August 12, and brought us together for our first full family Thanksgiving celebration in snowy Colorado.
Bon Iver holed himself up in Wisconsin in the depths of winter to recover from a rough year, and ended up recording the ineffable album that’s been my constant companion in 2008’s winter, the sounds to my first snowfall and its cold snowy run past icy creeks and flake drenched roads. Wife & I were front row in concert, bought our first vinyl records (still in need of a player), complete with autographs due to the kindness of a roadie.
Chapel Street, where lies our new residence, is home. Our roomy kitchen’s been host to big planned group dinners, roomie meals, smatterings of guests, which means Nupur’s spice-filled veggie Indian with bread from scratch, my mom’s crack chicken and noodles with fish sauce and crispy 2 AM egg rolls, and Jen’s comfort Chinese and strawberry banana smoothies and friends cooking in our kitchen, pancakes and Korean rice and pastas.
Dani California was the theme song to our summer cross country drive from California to Connecticut: “Black bandanna, sweet Louisiana/robbin’ on a bank in the state of Indiana/Never made it up to Minnesota/North Dakota man was a gunnin' for the quota/Down in the Badlands she was savin the best for last/It only hurts when I laugh/gone too fast.” We didn’t rob in true Thelma & Louise style or see Louisiana, but we did bask in the surreal Badlands that, from seemingly nowhere become surreal canyon, and we DID drive straight through the entire span of Minnesota.
Elected Obama and for once felt good to be a part of the current events of this generation, and to know that long stuggles are worth something and will continue, because “what began in the depths of winter cannot end on this autumn night.”
Friendship pushed me to act on what it really means to be there for those close to you, to put someone else before what can hurt you. Goes without saying that friendship requires give and take, but normally what’s good and happy for one is mutual for the other. It doesn’t usually require you to give up something really, really valuable. But this year, I let go of a friendship that I want in my life and will always tangibly miss, and worked everything in me to its worn edges to keep another. Knowing it’s best for people you care about is worth the effort, even if it doesn’t take away moments of difficult and sad, and there is the reward of a best friendship. Knowing this is easy; actually being tested and doing it wasn’t, for me. But that’s what 2008 gave me for the first time, and twice. I’d be lying if I said I didn’t wish circumstances had been easier, but given this, I’m glad for the challenge and the hope that I’m capable.
Guson’s camera, which I had to borrow for Puerto Rico because my faithful college digital camera died (which became obsolete within months but served me for years), got me to give myself an SLR, to document summer and future travels. With such sensitivity to light, images are no longer lost in the dark.
Harvard reunions with the roomies nearby in New York, Henry coming back from South Africa, Jen coming by New York. Visiting, as I have annually in the fall-winter since I’ve left, for the Game, visited the old dorm, tunnels, library, dining hall and Bernard. The snow-in-a-can still sticks to our fireplace brick, and they’ve put a new DVD return box in the Adams library.
Iron & Wine, our Halloween costume to mirror our namesakes. Made a flowy thing out of burgundy curtain and a tissue paper wine label (Gamay Rouge, made in California for most likeness as possible), and Jen went crazy attaching metal things to herself (utensils, safety pins, jewelry).
Jojo’s, the dark reddish coffee shop with pillows on the next block from home, joins my list of favorite study spots (with Koffee Too and the architecture library). Each has things to endear (window ledges, warmth, good chai, open space, sun-pouring windows, quiet/noise) and things that bother (dimness at night, cold, quiet/noise, crowds), and where I go at a particular moment depends on a number of these things.
Kites stole a corner of my affection,seeing hundreds of them in the sky in the big grassy field at El Morro, where we dispersed to the edges of the grass to the water and stood on walls, watching families fly so many that they felt like stars. Then flying them on the island of Vieques, standing in the ocean somewhere where the Atlantic merges with the Caribbean (we never could decide where we were standing), the first time I flew a kite in the ocean and the first time, at twenty four, G. flew a kite at all. Then in Vietnam where my favorite photograph is of my favorite person there looking up at one, as she told me how kites work, how you run and release and there it goes, up.
Learned the physical exam and will continue to find new ways to mess it up.
Music reached the height of addiction (this I realize when I get a little physically anxious studying without it). There’s little that can be felt that music doesn’t feel too. It’s kind of amazing that sounds can do that. Books, movies, even food makes sense; we make, as a society and individuals, associations with words, images, tastes; but why are songs in minor key darker and more somber than those in major? Why does a certain bow across a certain string make something in you move too? For that phenomenon…concerts include Glen Hansard & Marketa Irglova, Built to Spill, Thao Nguyen, The National, Rachael Yamagata and Bon Iver.
New Mexico tickets bought one week before flying, for my oldest brother’s no-frills-but-beautiful wedding where I made my first speech for the person who raised me with such love and care.
Older, like every year. I can’t remember when I stopped feeling my age but this year was no different in that either.
Published Atrium, the first volume of our literary magazine. Its coming out party consisted of Bar pizza and wine, live music and readings from my classmates and people from the nursing and public health schools, and the majority of our class supporting.
Quit writing only about myself and started writing more about other people, granted because they made me feel or think. This happened because I learned a lot about people outside my friends and family, and in an entirely new setting. The chance to meet, even for a moment, such variety and depth in real people, even though I see the limitations (now and in the future), was the best thing med school’s given me so far.
Richard got married, my first very close friend from high school to do so. Despite this grown up rite, a long California drive and night of champagne and dancing with the girls whose lockers were next to mine for years made me feel how young we are, despite time passed.
Spring break in Puerto Rico was the best week of first year, obviously. Kayaking in a the bioluminescent bay, hiking in the rainforest, ferrying to the beach island of Vieques, lazying on a different beach each day and the hot tub at night. To be outdoors all the time, in weather that rendered lotion unnecessary, was insanely happy.
Turned carrots into carrot cake (“wait, does carrot cake have REAL carrots?” asked an innocent first year), after eating so much of Claire’s carrot cake, and apples into apple pie and flour into pie crust and so on. I love sugar.
Undid the epic knot in my hair, which was particularly unruly due to being wavy and very long this year, and required the long, assiduous work of several friends. 2008 was host to my first distinct hairstyle (that I liked, thus excepting my 6th grade perm). I’ll miss long wavy hair, even if tangled to the point of oblivion.
Vietnam was the place of many firsts: meeting my uncle and relatives, spending a summer abroad, completing the public health project, hot humid days on end without electricity, finding how quickly you adapt to sleeping on back-aching slabs of wood, seeing my dad’s countryside village, riding motobikes with strangers. Best first experience.
Writing has gone slowly: began half a dozen trains of thoughts, finished not close to one. Because I didn’t do it and because it was the one thing I wanted to do most, writing more is my one concrete resolution for this year.
Xiphoid process, an extension of the sternum, was what Allison came up with for an “X” word, when we played the alphabet game night driving through Colorado (after I told her it was not likely we’d spot a “xenophobe”--not being able to see anything, we just guessed at what we might see if it were daytime), showing how much we learned in anatomy.
Yale Med was my life, 2008 being my first full year of being a medical student. It’s hard work, and hard sometimes to learn and cooped up with yourself without being able to do much with it. Though as med students issues of balance, usefulness, and ability arise often, finding a swelling sense purpose in the people, science, and experience reminds me of how lucky I am.
Zero is how many times I talked to strangers, my one resolution for 2008. Oops.
Ayden met the world August 12, and brought us together for our first full family Thanksgiving celebration in snowy Colorado.
Bon Iver holed himself up in Wisconsin in the depths of winter to recover from a rough year, and ended up recording the ineffable album that’s been my constant companion in 2008’s winter, the sounds to my first snowfall and its cold snowy run past icy creeks and flake drenched roads. Wife & I were front row in concert, bought our first vinyl records (still in need of a player), complete with autographs due to the kindness of a roadie.
Chapel Street, where lies our new residence, is home. Our roomy kitchen’s been host to big planned group dinners, roomie meals, smatterings of guests, which means Nupur’s spice-filled veggie Indian with bread from scratch, my mom’s crack chicken and noodles with fish sauce and crispy 2 AM egg rolls, and Jen’s comfort Chinese and strawberry banana smoothies and friends cooking in our kitchen, pancakes and Korean rice and pastas.
Dani California was the theme song to our summer cross country drive from California to Connecticut: “Black bandanna, sweet Louisiana/robbin’ on a bank in the state of Indiana/Never made it up to Minnesota/North Dakota man was a gunnin' for the quota/Down in the Badlands she was savin the best for last/It only hurts when I laugh/gone too fast.” We didn’t rob in true Thelma & Louise style or see Louisiana, but we did bask in the surreal Badlands that, from seemingly nowhere become surreal canyon, and we DID drive straight through the entire span of Minnesota.
Elected Obama and for once felt good to be a part of the current events of this generation, and to know that long stuggles are worth something and will continue, because “what began in the depths of winter cannot end on this autumn night.”
Friendship pushed me to act on what it really means to be there for those close to you, to put someone else before what can hurt you. Goes without saying that friendship requires give and take, but normally what’s good and happy for one is mutual for the other. It doesn’t usually require you to give up something really, really valuable. But this year, I let go of a friendship that I want in my life and will always tangibly miss, and worked everything in me to its worn edges to keep another. Knowing it’s best for people you care about is worth the effort, even if it doesn’t take away moments of difficult and sad, and there is the reward of a best friendship. Knowing this is easy; actually being tested and doing it wasn’t, for me. But that’s what 2008 gave me for the first time, and twice. I’d be lying if I said I didn’t wish circumstances had been easier, but given this, I’m glad for the challenge and the hope that I’m capable.
Guson’s camera, which I had to borrow for Puerto Rico because my faithful college digital camera died (which became obsolete within months but served me for years), got me to give myself an SLR, to document summer and future travels. With such sensitivity to light, images are no longer lost in the dark.
Harvard reunions with the roomies nearby in New York, Henry coming back from South Africa, Jen coming by New York. Visiting, as I have annually in the fall-winter since I’ve left, for the Game, visited the old dorm, tunnels, library, dining hall and Bernard. The snow-in-a-can still sticks to our fireplace brick, and they’ve put a new DVD return box in the Adams library.
Iron & Wine, our Halloween costume to mirror our namesakes. Made a flowy thing out of burgundy curtain and a tissue paper wine label (Gamay Rouge, made in California for most likeness as possible), and Jen went crazy attaching metal things to herself (utensils, safety pins, jewelry).
Jojo’s, the dark reddish coffee shop with pillows on the next block from home, joins my list of favorite study spots (with Koffee Too and the architecture library). Each has things to endear (window ledges, warmth, good chai, open space, sun-pouring windows, quiet/noise) and things that bother (dimness at night, cold, quiet/noise, crowds), and where I go at a particular moment depends on a number of these things.
Kites stole a corner of my affection,seeing hundreds of them in the sky in the big grassy field at El Morro, where we dispersed to the edges of the grass to the water and stood on walls, watching families fly so many that they felt like stars. Then flying them on the island of Vieques, standing in the ocean somewhere where the Atlantic merges with the Caribbean (we never could decide where we were standing), the first time I flew a kite in the ocean and the first time, at twenty four, G. flew a kite at all. Then in Vietnam where my favorite photograph is of my favorite person there looking up at one, as she told me how kites work, how you run and release and there it goes, up.
Learned the physical exam and will continue to find new ways to mess it up.
Music reached the height of addiction (this I realize when I get a little physically anxious studying without it). There’s little that can be felt that music doesn’t feel too. It’s kind of amazing that sounds can do that. Books, movies, even food makes sense; we make, as a society and individuals, associations with words, images, tastes; but why are songs in minor key darker and more somber than those in major? Why does a certain bow across a certain string make something in you move too? For that phenomenon…concerts include Glen Hansard & Marketa Irglova, Built to Spill, Thao Nguyen, The National, Rachael Yamagata and Bon Iver.
New Mexico tickets bought one week before flying, for my oldest brother’s no-frills-but-beautiful wedding where I made my first speech for the person who raised me with such love and care.
Older, like every year. I can’t remember when I stopped feeling my age but this year was no different in that either.
Published Atrium, the first volume of our literary magazine. Its coming out party consisted of Bar pizza and wine, live music and readings from my classmates and people from the nursing and public health schools, and the majority of our class supporting.
Quit writing only about myself and started writing more about other people, granted because they made me feel or think. This happened because I learned a lot about people outside my friends and family, and in an entirely new setting. The chance to meet, even for a moment, such variety and depth in real people, even though I see the limitations (now and in the future), was the best thing med school’s given me so far.
Richard got married, my first very close friend from high school to do so. Despite this grown up rite, a long California drive and night of champagne and dancing with the girls whose lockers were next to mine for years made me feel how young we are, despite time passed.
Spring break in Puerto Rico was the best week of first year, obviously. Kayaking in a the bioluminescent bay, hiking in the rainforest, ferrying to the beach island of Vieques, lazying on a different beach each day and the hot tub at night. To be outdoors all the time, in weather that rendered lotion unnecessary, was insanely happy.
Turned carrots into carrot cake (“wait, does carrot cake have REAL carrots?” asked an innocent first year), after eating so much of Claire’s carrot cake, and apples into apple pie and flour into pie crust and so on. I love sugar.
Undid the epic knot in my hair, which was particularly unruly due to being wavy and very long this year, and required the long, assiduous work of several friends. 2008 was host to my first distinct hairstyle (that I liked, thus excepting my 6th grade perm). I’ll miss long wavy hair, even if tangled to the point of oblivion.
Vietnam was the place of many firsts: meeting my uncle and relatives, spending a summer abroad, completing the public health project, hot humid days on end without electricity, finding how quickly you adapt to sleeping on back-aching slabs of wood, seeing my dad’s countryside village, riding motobikes with strangers. Best first experience.
Writing has gone slowly: began half a dozen trains of thoughts, finished not close to one. Because I didn’t do it and because it was the one thing I wanted to do most, writing more is my one concrete resolution for this year.
Xiphoid process, an extension of the sternum, was what Allison came up with for an “X” word, when we played the alphabet game night driving through Colorado (after I told her it was not likely we’d spot a “xenophobe”--not being able to see anything, we just guessed at what we might see if it were daytime), showing how much we learned in anatomy.
Yale Med was my life, 2008 being my first full year of being a medical student. It’s hard work, and hard sometimes to learn and cooped up with yourself without being able to do much with it. Though as med students issues of balance, usefulness, and ability arise often, finding a swelling sense purpose in the people, science, and experience reminds me of how lucky I am.
Zero is how many times I talked to strangers, my one resolution for 2008. Oops.
Saturday, January 3, 2009
transition
Synaesthesia describes one sense stimulating another, and in my mind, how they get mixed up; how inhaling the lingering warmth of a pillow recalls the sun's texture long after it's sunk for the day.
I thought for a long time about how to make this transition, mostly about what I wanted to do with my old entries. My instinct was to import my Livejournal, begun in April 2004, to a new site. But after settling on this name and URL, I looked at the fresh, empty pages and thought maybe it would be better, and easier, to move on.
But I've never been built to forget, or to compartmentalize. So since there is no easy way to import my old journal to blogspot, I copied and pasted every old entry into this new blog (I did find a program that purported to import, but as computer illiterate as I am, figuring this out would take as long as my way). With each entry, I had to change the date to reflect when I wrote it, and after posting thirty odd entries, blogspot made me word-verify each entry (and some of those are so hard to read, I feel like I'm taking a test). I'm uselessly adaptive when it comes to doing monotonous tasks for extended periods of time, so that I can finish something I've set my mind to, even though it could be done more efficiently. Though the day, month and year of these past entries are accurate, the hour and minute reflect the time I recently posted them. So I traversed 4 and a half years in an hour and a half, as you can see by the 2:53 AM posting of the first entry, and the 4:25 AM posting of the one before this. I'm up this late because I was compelled to be, and because there is finally nowhere to go tomorrow.
I left everything as it was. Kept the silly beginning posts, when I wrote often and about nothing at all; the less frequent, longer posts that were also nothings, just more; the painful ones where I was at my worst and the ones with memories past. Still, I am making the change to another place to store these things. Things changed in the switch. The pictures that disappeared after I graduated college, leaving behind the storage space they gave us, now appear as little boxes. Font and color and width are different. To preserve certain things, I had to change format. For a long time I had an entry title, then a photograph, then a titled link that you clicked to see the actual entry. I can't do the titled link thing here, so sometimes I put whatever words were in the link in parentheses after the entry. If I felt it was important; I didn't do this for all of them. Didn't think that was straying too much from the original, since in any case I had to change what the original looked/felt like. This probably makes no sense unless you've seen my old entries on Livejournal (which are still there, where they started). Couldn't transfer comments from the few & faithful; those stay on LJ as well.
I got pretty proficient at copying and pasting, even after word verification was required for each entry, so the old words flew by me. But having to type out each title, write in the date, and scroll through to highlight made for a re-experience. Even though everything is felt differently, slightly or by a whole lot, it's still very much there.
A very good friend told me on New Year's Eve that she reads life too symbolically, that she takes everything as a sign to apply to her life. She thought it was a bad thing, to let the outside and inanimate influence how she feels, but I think in the end these things come from us. A couple weeks before break I sprained my right ankle running in the rain (not from one motion but from repetitive accommodation of slippery road), so that it hurt to just walk, and it recently recovered around Christmastime. On New Year's Eve, in an excited dance move a very large man brought his foot down on my left, and the pain I thought would wear away slid into the new year, in the form of a bulging purple fourth toe.
And so while I look forward to new things, more changes, bettering and likely lapses and more bettering, with this blog and with 2009...I also know I carry everything. They don't completely shed their old coverings but they find another kind of place, and it's all connected by synaesthesia. Someday I'd like to more subtly, accurately express this in a story.
It's near dawn now and I'm growing tired, the effects of the evening's chai tea wearing away. This time and from now on I don't have to change the date on my automatically dated post, and so here's to continuing.
I thought for a long time about how to make this transition, mostly about what I wanted to do with my old entries. My instinct was to import my Livejournal, begun in April 2004, to a new site. But after settling on this name and URL, I looked at the fresh, empty pages and thought maybe it would be better, and easier, to move on.
But I've never been built to forget, or to compartmentalize. So since there is no easy way to import my old journal to blogspot, I copied and pasted every old entry into this new blog (I did find a program that purported to import, but as computer illiterate as I am, figuring this out would take as long as my way). With each entry, I had to change the date to reflect when I wrote it, and after posting thirty odd entries, blogspot made me word-verify each entry (and some of those are so hard to read, I feel like I'm taking a test). I'm uselessly adaptive when it comes to doing monotonous tasks for extended periods of time, so that I can finish something I've set my mind to, even though it could be done more efficiently. Though the day, month and year of these past entries are accurate, the hour and minute reflect the time I recently posted them. So I traversed 4 and a half years in an hour and a half, as you can see by the 2:53 AM posting of the first entry, and the 4:25 AM posting of the one before this. I'm up this late because I was compelled to be, and because there is finally nowhere to go tomorrow.
I left everything as it was. Kept the silly beginning posts, when I wrote often and about nothing at all; the less frequent, longer posts that were also nothings, just more; the painful ones where I was at my worst and the ones with memories past. Still, I am making the change to another place to store these things. Things changed in the switch. The pictures that disappeared after I graduated college, leaving behind the storage space they gave us, now appear as little boxes. Font and color and width are different. To preserve certain things, I had to change format. For a long time I had an entry title, then a photograph, then a titled link that you clicked to see the actual entry. I can't do the titled link thing here, so sometimes I put whatever words were in the link in parentheses after the entry. If I felt it was important; I didn't do this for all of them. Didn't think that was straying too much from the original, since in any case I had to change what the original looked/felt like. This probably makes no sense unless you've seen my old entries on Livejournal (which are still there, where they started). Couldn't transfer comments from the few & faithful; those stay on LJ as well.
I got pretty proficient at copying and pasting, even after word verification was required for each entry, so the old words flew by me. But having to type out each title, write in the date, and scroll through to highlight made for a re-experience. Even though everything is felt differently, slightly or by a whole lot, it's still very much there.
A very good friend told me on New Year's Eve that she reads life too symbolically, that she takes everything as a sign to apply to her life. She thought it was a bad thing, to let the outside and inanimate influence how she feels, but I think in the end these things come from us. A couple weeks before break I sprained my right ankle running in the rain (not from one motion but from repetitive accommodation of slippery road), so that it hurt to just walk, and it recently recovered around Christmastime. On New Year's Eve, in an excited dance move a very large man brought his foot down on my left, and the pain I thought would wear away slid into the new year, in the form of a bulging purple fourth toe.
And so while I look forward to new things, more changes, bettering and likely lapses and more bettering, with this blog and with 2009...I also know I carry everything. They don't completely shed their old coverings but they find another kind of place, and it's all connected by synaesthesia. Someday I'd like to more subtly, accurately express this in a story.
It's near dawn now and I'm growing tired, the effects of the evening's chai tea wearing away. This time and from now on I don't have to change the date on my automatically dated post, and so here's to continuing.
Tuesday, December 30, 2008
maggie
This semester I pathetically finished one novel (Breathing Lessons by Anne Tyler), only because I read about a third of it while traveling home for break (which, with train ride + subway ride + airtrain + plane flight, all in all takes a crazy 12 hours). Next semester it’ll be short stories, because losing the flow of a book by stealing a few pages here and there when I’m not intellectually or physically or emotionally drained (rarely) pretty much sucks the life out of it. When references were made to little things that came before, I had to neurotically search for the first mention of them because I couldn’t remember. Despite this, the character of Maggie emerged with palpable tenderness, and is now one I hold close. While the story was engaging enough and its feelings nuanced, and there were moments of the kind of writing that surprises with descriptions unusual and perfectly accurate (do you know what I mean? When something you’ve felt is encapsulated exactly right, in a way you’ve never thought before, and you wonder how it can be so far from your vocabulary and thought, and yet so right)…most of that wasn’t too special for me. For me it was Maggie.
Even though she’s a married woman in her late forties, with two grown children and a whole life to look back on and contemplate, in many ways she still lives by a philosophy cultivated before experience set in. To that quality in her I’m attached, if only because I foresee the same for myself, for better or worse. These are the things I love in Maggie, not necessarily because they are good things but because they give shape to strange things I’ve felt, whose tangibility I sometimes question. And more than a relation to myself, the value lies in knowing that they exist, on their own, elsewhere.
disheveled/clumsy: Maggie digs through her purse trying to find the same things that have inhabited it for years, because she’s never formed a system where each thing has its place. I often tell myself that I should just designate a certain coat pocket for my keys, phone, etc., so that I always know where to look, but when it comes down to the moment I reach for whatever feels convenient, which isn’t consistent. Maggie’s husband, Ira, and children sometimes perceive her as bumbling, silly in a way: “She was always making clumsy, impetuous rushes toward nowhere in particular—side trips, random detours.” I’m a little more straightlaced than that, but I can relate to having a messy demeanor, to being not-put-together. And while Ira sees it as not taking life seriously enough, I think it’s that Maggie takes so much to heart, it’s hard to find focus.
not too good at cultivating:Along the same lines, Maggie doesn’t have a knack for taking care of things, like her homegrown tomatoes that are always “bulbous” despite years of trying different kinds. She senses that people attribute the failure to Maggie herself, with her “knobby, fumbling way.” I’m awful at taking care of plants and my possessions in general (much to the chagrin of B. who helps me with each of my computer problems and N. who hates the torn insides of my peacoat), and I worry sometimes about whether this will translate to other things that require care, whether it does have to do with something internal.
she takes care of people: I think Maggie’s scared of the same thing because she tries really hard to take care of people. Instead of going to college, she continues her high school job as an aide in a nursing home, where concrete tasks make her feel capable and she knows when to laugh or nod during conversations. She tries to take care of those around her even when it’s not up to her or outside of her capacity…it’s a significant problem, leading to misunderstandings and misplaced feelings. I think it’s natural to try to impact others’ happiness in part because it affects our own, but Maggie can’t let go of the interconnections.
guilt causes overthinking, and vice versa: She feels bad about things, all the time. When placing a long distance call from another person’s home she considers leaving them some change. After playing a prank on a bad driver, she’s worried he’s been overly affected and makes her husband go back and check on him. Allison once said that she thinks guilt is a good thing, a sign of consideration for others. I think this has truth but I think, for me, guilt can be a kind of copout, a way of trying to keep your good after you’ve done something bad. Maggie, I think, is better than that; her regrets don’t stem from initial selfishness but instead from good intentions gone wrong, or from human responses. Even when she consciously sets out to right her ways, she’s horrible at not repeating her mistakes, because her characteristics are so ingrained, and man do I know something about that.
emotionally neurotic and impulsive: Maggie debates every emotional maneuver, and then in the moment her instincts take over, and they’re not always good ones. An image or thought can take hold of her so completely that she will feel that someone she doesn’t actually know is the most wonderful person she’s ever known, and it will be true because she feels it so.
easily affected: She forms incomprehensibly strong, oft impulsive connections to people removed from her, and she’s easily moved. In a hospital waiting room she encounters an elderly couple and across from them a burly man in coveralls. A nurse is asking the near deaf elderly man for a urine sample, and has to shout, “Pee in this cup!” The elderly woman is visibly embarrassed, explaining how deaf her husband has become, and Maggie doesn’t know what to say. The burly man shifts his weight and comments on how funny it is, he can pick up the nurse’s voice, but really, can’t make out her words at all. At this Maggie tears up. He asks her if she’s okay: “She couldn’t tell him it was his kindness that had undone her—such delicacy, in such an unlikely-looking person.”
acutely aware of presence and loss: On the loss of her cat: “His absence had struck her so intensely that it had amounted to a presence….But here was something even stupider: A month or so later, when cold weather set in, Maggie switched off the basement dehumidifier as she did every year and even that absence had struck her. She had mourned in the most personal way the silencing of the steady, faithful whir that used to thrum the floorboards.”
can’t give up even when it could be the right thing to do: She can’t give up on people she loves, to a fault, because she relies on what she knows they feel, and knows that they feel genuinely and kindly; rather than their actions and words, which are often not so kind. Her husband says that she believes the people she loves are better than they are. I’ve been told I do this too, but I don’t think it’s such an altruistic thing. It stems from the fact that I know my own faults but I like to think I’m still passably okay, and to believe this requires understanding others’ faults. At one point Maggie wonders whether she’s been a bad mother, too forgiving of her children because she remembers so strongly what it’s like to be a child. I really believe in understanding other people’s context, to know why flaws exist and persist, probably because I can get so complicated that I need that sort of understanding from other people. Sometimes, though, in allowing so much room for complexity, you miss the basics that are as much a part of people as the layers.
she believes in romance: Not just the pretty things in the right place romance, but the idea that through all the crap and non-ideals, people will love each other enough to make it work and be consciously happy. Even when she doubts this for herself she thinks she’s just missed out and it’s still to be had in this world. Sometimes you might get the sense that Maggie’s trying to find refuge, making it easier on herself by always trying and not accepting the hurtful truth. But who’s to say what’s reality, or that her refuge is any easier than the accepted reality (sometimes it’s damn harder)? In my own experience there’s been no shortage of crap and non-ideals but I’m grateful for the incredible amount of good that comes along in spite of and because of. My past connections, few and not straightforward but valuable and full, have played part in shaping what I can and should give, and what I seek, want, need. And it’s funny, this makes me think both how hard it will be find, and how amazing it will be to someday have.
**
I don’t know if things really work out for Maggie, and whether this is because of all the above. I get the sense that as you’re reading, you might get annoyed with Maggie’s meddling and desire to right things that aren’t meant to be controlled. You might want to tell her that sometimes beauty is past. You might want to stop her from perpetuating her poorly implemented good intentions, to dread the impending disasters that end in large disappointment for her and those she loves. But that doesn’t work, because it’s not about how fixing flaws would make life easier to accept, or to live. It’s about facing the difficult because you’re trying to preserve value, even if it’s stupid and mistaken and fails. I don’t know if it’s right, but for Maggie it’s true.
Even though she’s a married woman in her late forties, with two grown children and a whole life to look back on and contemplate, in many ways she still lives by a philosophy cultivated before experience set in. To that quality in her I’m attached, if only because I foresee the same for myself, for better or worse. These are the things I love in Maggie, not necessarily because they are good things but because they give shape to strange things I’ve felt, whose tangibility I sometimes question. And more than a relation to myself, the value lies in knowing that they exist, on their own, elsewhere.
disheveled/clumsy: Maggie digs through her purse trying to find the same things that have inhabited it for years, because she’s never formed a system where each thing has its place. I often tell myself that I should just designate a certain coat pocket for my keys, phone, etc., so that I always know where to look, but when it comes down to the moment I reach for whatever feels convenient, which isn’t consistent. Maggie’s husband, Ira, and children sometimes perceive her as bumbling, silly in a way: “She was always making clumsy, impetuous rushes toward nowhere in particular—side trips, random detours.” I’m a little more straightlaced than that, but I can relate to having a messy demeanor, to being not-put-together. And while Ira sees it as not taking life seriously enough, I think it’s that Maggie takes so much to heart, it’s hard to find focus.
not too good at cultivating:Along the same lines, Maggie doesn’t have a knack for taking care of things, like her homegrown tomatoes that are always “bulbous” despite years of trying different kinds. She senses that people attribute the failure to Maggie herself, with her “knobby, fumbling way.” I’m awful at taking care of plants and my possessions in general (much to the chagrin of B. who helps me with each of my computer problems and N. who hates the torn insides of my peacoat), and I worry sometimes about whether this will translate to other things that require care, whether it does have to do with something internal.
she takes care of people: I think Maggie’s scared of the same thing because she tries really hard to take care of people. Instead of going to college, she continues her high school job as an aide in a nursing home, where concrete tasks make her feel capable and she knows when to laugh or nod during conversations. She tries to take care of those around her even when it’s not up to her or outside of her capacity…it’s a significant problem, leading to misunderstandings and misplaced feelings. I think it’s natural to try to impact others’ happiness in part because it affects our own, but Maggie can’t let go of the interconnections.
guilt causes overthinking, and vice versa: She feels bad about things, all the time. When placing a long distance call from another person’s home she considers leaving them some change. After playing a prank on a bad driver, she’s worried he’s been overly affected and makes her husband go back and check on him. Allison once said that she thinks guilt is a good thing, a sign of consideration for others. I think this has truth but I think, for me, guilt can be a kind of copout, a way of trying to keep your good after you’ve done something bad. Maggie, I think, is better than that; her regrets don’t stem from initial selfishness but instead from good intentions gone wrong, or from human responses. Even when she consciously sets out to right her ways, she’s horrible at not repeating her mistakes, because her characteristics are so ingrained, and man do I know something about that.
emotionally neurotic and impulsive: Maggie debates every emotional maneuver, and then in the moment her instincts take over, and they’re not always good ones. An image or thought can take hold of her so completely that she will feel that someone she doesn’t actually know is the most wonderful person she’s ever known, and it will be true because she feels it so.
easily affected: She forms incomprehensibly strong, oft impulsive connections to people removed from her, and she’s easily moved. In a hospital waiting room she encounters an elderly couple and across from them a burly man in coveralls. A nurse is asking the near deaf elderly man for a urine sample, and has to shout, “Pee in this cup!” The elderly woman is visibly embarrassed, explaining how deaf her husband has become, and Maggie doesn’t know what to say. The burly man shifts his weight and comments on how funny it is, he can pick up the nurse’s voice, but really, can’t make out her words at all. At this Maggie tears up. He asks her if she’s okay: “She couldn’t tell him it was his kindness that had undone her—such delicacy, in such an unlikely-looking person.”
acutely aware of presence and loss: On the loss of her cat: “His absence had struck her so intensely that it had amounted to a presence….But here was something even stupider: A month or so later, when cold weather set in, Maggie switched off the basement dehumidifier as she did every year and even that absence had struck her. She had mourned in the most personal way the silencing of the steady, faithful whir that used to thrum the floorboards.”
can’t give up even when it could be the right thing to do: She can’t give up on people she loves, to a fault, because she relies on what she knows they feel, and knows that they feel genuinely and kindly; rather than their actions and words, which are often not so kind. Her husband says that she believes the people she loves are better than they are. I’ve been told I do this too, but I don’t think it’s such an altruistic thing. It stems from the fact that I know my own faults but I like to think I’m still passably okay, and to believe this requires understanding others’ faults. At one point Maggie wonders whether she’s been a bad mother, too forgiving of her children because she remembers so strongly what it’s like to be a child. I really believe in understanding other people’s context, to know why flaws exist and persist, probably because I can get so complicated that I need that sort of understanding from other people. Sometimes, though, in allowing so much room for complexity, you miss the basics that are as much a part of people as the layers.
she believes in romance: Not just the pretty things in the right place romance, but the idea that through all the crap and non-ideals, people will love each other enough to make it work and be consciously happy. Even when she doubts this for herself she thinks she’s just missed out and it’s still to be had in this world. Sometimes you might get the sense that Maggie’s trying to find refuge, making it easier on herself by always trying and not accepting the hurtful truth. But who’s to say what’s reality, or that her refuge is any easier than the accepted reality (sometimes it’s damn harder)? In my own experience there’s been no shortage of crap and non-ideals but I’m grateful for the incredible amount of good that comes along in spite of and because of. My past connections, few and not straightforward but valuable and full, have played part in shaping what I can and should give, and what I seek, want, need. And it’s funny, this makes me think both how hard it will be find, and how amazing it will be to someday have.
**
I don’t know if things really work out for Maggie, and whether this is because of all the above. I get the sense that as you’re reading, you might get annoyed with Maggie’s meddling and desire to right things that aren’t meant to be controlled. You might want to tell her that sometimes beauty is past. You might want to stop her from perpetuating her poorly implemented good intentions, to dread the impending disasters that end in large disappointment for her and those she loves. But that doesn’t work, because it’s not about how fixing flaws would make life easier to accept, or to live. It’s about facing the difficult because you’re trying to preserve value, even if it’s stupid and mistaken and fails. I don’t know if it’s right, but for Maggie it’s true.
Wednesday, November 26, 2008
cancer, etc.
Hamlet is one of my favorite Shakespeare plays. Besides the richness of language, intense drama, and so many characters with sharp life, I can relate to Hamlet’s obsessive contemplation of his own consciousness. The accepted interpretation that Hamlet destroys himself with this introspection—he thinks so much that he can never act—is my own biggest fear. A major reason I want to be a doctor is to stop only thinking about stories and instead start shaping them. But I also feel that this assessment of Hamlet attributes his failure to one misleading cause—that is, he can’t apply his thoughts to real life. As hard and real of a problem that is for many, I don’t think Shakespeare had everyone die at the end merely to say, “just don’t think; just do it already.” It’s true that the tragedy lies in the disconnect between Hamlet’s interior and the outside world. But the source of that disconnect isn’t only his inability to externalize his desires, to physically do what he mentally feels. It’s also his inability to internalize his surroundings, to absorb what he sees and hears and relate it to himself. Because he never understands what the outside world has to do with him and his identity, he can never become a part of it and so can never make any sort of impact on it.
And so after our oncology module, a compressed period where I wished I could just-do-it and thereby not feel helpless, I’m still not doing, still trying to find time and space to internalize all we’ve been exposed to and were supposed to learn. Learning about cancer comprises a slim two weeks in our curriculum, devoted to teaching us the overarching mechanism of how cancerous cells arise, spread and hurt us, and how we fight back. We received a detailed lecture on breast cancer, as a model for other cancers, and a third of each of our three workshops is a case study of a specific cancer. But mostly we just learn about cancer as a whole. After doing leukemia research and interviewing cancer patients weekly during first year of medical school, cancer remains mysterious to me and I learned anew with this module. In class we learn about it scientifically, what distinguishes it from your normal cells, how it survives, and why it’s so bad. Once as we worked through cases someone asked a question I’d wondered often before: “What actually kills you?” A lot of things, any number of things.
In class we also learn about it emotionally, hearing patients speak about their experiences and physicians lecture on palliative care. We learn big topics in forty minute increments (resting dazed for ten minutes between lectures), eat lunch, and spend the afternoon being exposed to (depending on the day) age, illness, dying and death in hospitals and hospices and nursing homes. We dedicate any and all gaps in the day to studying. It’s made slightly easier and more pathetic by the fact that we’re in a group all doing the same things.
For people in their twenties, we hear a lot about death and all that goes along with that: the preceding disease, the lives that were had and how they changed. It makes me feel I’m on the edge of a world that’s eluded my grasp for so long, that I’m growing up and into real life. Then I learn in class that one way to reduce your risk of getting breast cancer is having a child before you’re twenty-four. I’m twenty-four, and I still am a child, and I wonder what exactly I’m supposed to do with the things I know.
The language of cancer is very distinct, not just a matter of science and technical terms but also a firm foundation of key concepts, containing a lot of m’s (metastasis, malignant, mortality) and rife with percentages and units of time. Like in other areas of science, we personify it. A professor called CML a naïve cancer because it involves just one gene, making it easier to target and eradicate. In pharmacology we learn that even though some drugs eliminate mechanisms that both cancer and normal cells use, they preferentially kill cancer cells because cancer cells get addicted to one mechanism. While a normal cell can rely on other means once one is taken away, a cancer cell has lost perspective and doesn’t know what to do with itself.
I think we personify disease to understand and fight it, but we also get addicted to our language. We talk about the effects of cancer and the success of treatment in terms of five-year survival. Which isn’t a very long time to survive. But no one addresses the instinctive thought that this living five years is almost the opposite of continuing to live, since we’re beyond instinct now. We know that if your cancer hasn’t overcome everything in five years, it either wasn’t that bad to begin with or treatment is good. We know our language so well that meaning surpasses words. I think I pay close attention to words and in a little over a week I forgot how to hear them and I learned this from being told so. During a lecture on palliative care, a kind oncologist whose gray hair and matching eyes projected a natural softness told us about his wife who’d had breast cancer and subsequently acute leukemia. After being diagnosed with leukemia, someone offered her comfort in the fact that 75% of people with acute leukemia have a five-year survival. When her husband came home to find her sobbing over this, he asked her what it was that bothered her, assuming that she’d interpreted the statement as a quarter of people not achieving five year survival. Instead, she told him, “I’m 41 years old. And I only have until 46.” She thought “five year survival” meant that she’d live five more years and then it would be over. Despite that being the words’ most intrinsic meaning, I hadn’t even thought of that possibility.
These thoughts slip me because the days are crammed. One went like this. We begin the morning with a workshop on lung cancer (the cancer that takes most lives, with an overall survival rate of 15%) and brain metastases. If cancer has traveled from your lungs to your brain, they will irradiate your entire brain (our notes remind us that these patients will experience cognitive defects). It’s deemed prophylactic, and after treatment you can expect to live for one year. Following workshop, we listen to the lecture on breast cancer, which feels both scarier and less so by nature of being so prevalent in the population and mainstream culture. I know several people with breast cancer (seems like many in comparison to the number of people I know who have other illnesses, which are few) and somehow that commonness made me complacent. I am surprised to find that despite improved screening and detection, the percentage of survival isn’t as high as I expected. A quarter of women diagnosed with breast cancer die from it. We then hear from a breast cancer survivor, someone in our Yale community, who speaks to us for a near hour about her experience. From this I realize the more significant thing I’d forgotten was the visceral challenge of being ill with something that has any chance of killing you, no matter how positive the eventual outcome. In another workshop our teacher mentioned a procedure having a 5% risk of mortality, which is low, but well, “high if it’s your risk.” It’s true that on a daily basis we all face some slight percentage of dying, but cancer means having this overshadowed by something concrete and pseudo-quantifiable and personal and internal.
One thing I appreciate in medicine is individual context amidst the absolute values of care and quality of life, and there are few places wherein relativity is as palpable as cancer survival. While cure is always the ultimate goal, cancer can be so ominous that small advances are noteworthy. For colon cancer that's spread so that it's incurable by surgery, chemotherapy can prolong life significantly, “in some cases, up to two years.” A new treatment for kidney cancer is seen as an enormous breakthrough because it prolongs survival by 50%—increasing it from two months to four. Of course four versus two is a lot when it’s all you have, and who’s to say how much worth lies in any amount of time. Still, here relativity can feel like a copout.
Later that afternoon, as part of our pre-clinical curriculum we speak to a patient whose care is palliative, meaning being treated not for cure but for comfort. Ours is an 83 year old man with the mischievous sparkle of a teenager, coated with a brand of boyish charm that only comes with experience. He’d been diagnosed with lung cancer that he didn’t want to treat. He’d lived long enough, he felt, and if it’s time, it’s time. Then he came down with some sort of abdominal infection that doctors told him would kill him within a day, and still he didn’t want treatment. He hadn’t been seeking to die, but nor did he seek to live. He said goodbye to his family, and then the infection miraculously cleared on its own, leaving him alive, albeit with cancer still. When we see him, one of the first things he says is that the idea of dying in one or two days didn’t bother him. “Does that bother you?” he asks, pointing at me as I’m still maneuvering to find the right position in a narrow chair. I’m confused as to what he’s asking and I interpret it to mean, does his acceptance of his death bother me? Which is not a normal question to ask at all, but I don’t have the two seconds it takes to overthink the question even more than I already have and realize this isn’t what he means. So I respond with a quick no and during the ensuing chorus line of no’s from my classmates that might’ve just been nervous echoes of my response, I realize what he’d actually meant. And no, I do not want to die in the next couple of days. I’m completely happy with the life I’ve led so far but that doesn’t mean it’s done. If it were to happen, I’d be grateful for all that I’ve had in 24 years. But yes, I would be bothered.
In the evening, I have a meeting for the geriatrics interest group, and after talking to Don about the day he asks why I like old people. They’re different from me and I have no idea what it’s like to be them. I think maybe they’re honest not because they have nothing to lose but because they know what honesty gives. They carry everything with them that I am still looking ahead to, and they carry so much. They’re living with what I work for each day: experience, and they take that with them to each next day, because despite all they’ve lived they haven’t stopped living anew. At the meeting we talk about our screening of Rolling, a documentary where three people in wheelchairs tape their daily lives. None of them are “old.” Dr. Berland, the filmmaker, tells us the film is being promoted by the geriatrics group because it’s about facing change with dignity, and independence. I’m struck by how very different each person is, done not purposefully but truthfully. One tells us in an off-center closeup that he has so many blessings, and that nothing can take those from him. But “being blessed doesn’t mean it doesn’t hurt.” Like that Whitman line about how he’s a contradiction, and that makes sense because he’s large and he contains multitudes. That’s what each day feels like, a multitude.
And all I can do is sit with my books, which can feel empty and wrong even if necessary and engaging. After that day I go to the architecture library to study about breast and lung cancer in detail, making semi-meticulous notes from the textbook and lecture notes and workshop we’d had in the morning, putting together the details of screening, diagnosis, subtypes, staging and treatment. That we have this knowledge is beautiful, but cancer is so mysterious and we know really so little. When we first start learning about diseases we learn what begins them and here often we only know the end. All this crammed in one day, and no time at the end to think about what it means and how to use it. For lack of time and energy, I furiously scribble down events and details, with hopes of returning to fill gaps, but so much will be lost. Another day brings more, the feelings will gain different nuances, the way I started writing about my dad’s truck and he sold it before I finished the story. I’ll forget how it all started, what it was like to not know and to be introduced into these big things, encased in a hospital room and a one hour interview, to learn from these people as med students and as people. If I leave it for too long, I may look back and think I’m past the age to absorb it. As if reflection on the beginning only saves you from a blurry end where you can’t look back and remember, if you do it before you’re twenty-four.
And so after our oncology module, a compressed period where I wished I could just-do-it and thereby not feel helpless, I’m still not doing, still trying to find time and space to internalize all we’ve been exposed to and were supposed to learn. Learning about cancer comprises a slim two weeks in our curriculum, devoted to teaching us the overarching mechanism of how cancerous cells arise, spread and hurt us, and how we fight back. We received a detailed lecture on breast cancer, as a model for other cancers, and a third of each of our three workshops is a case study of a specific cancer. But mostly we just learn about cancer as a whole. After doing leukemia research and interviewing cancer patients weekly during first year of medical school, cancer remains mysterious to me and I learned anew with this module. In class we learn about it scientifically, what distinguishes it from your normal cells, how it survives, and why it’s so bad. Once as we worked through cases someone asked a question I’d wondered often before: “What actually kills you?” A lot of things, any number of things.
In class we also learn about it emotionally, hearing patients speak about their experiences and physicians lecture on palliative care. We learn big topics in forty minute increments (resting dazed for ten minutes between lectures), eat lunch, and spend the afternoon being exposed to (depending on the day) age, illness, dying and death in hospitals and hospices and nursing homes. We dedicate any and all gaps in the day to studying. It’s made slightly easier and more pathetic by the fact that we’re in a group all doing the same things.
For people in their twenties, we hear a lot about death and all that goes along with that: the preceding disease, the lives that were had and how they changed. It makes me feel I’m on the edge of a world that’s eluded my grasp for so long, that I’m growing up and into real life. Then I learn in class that one way to reduce your risk of getting breast cancer is having a child before you’re twenty-four. I’m twenty-four, and I still am a child, and I wonder what exactly I’m supposed to do with the things I know.
The language of cancer is very distinct, not just a matter of science and technical terms but also a firm foundation of key concepts, containing a lot of m’s (metastasis, malignant, mortality) and rife with percentages and units of time. Like in other areas of science, we personify it. A professor called CML a naïve cancer because it involves just one gene, making it easier to target and eradicate. In pharmacology we learn that even though some drugs eliminate mechanisms that both cancer and normal cells use, they preferentially kill cancer cells because cancer cells get addicted to one mechanism. While a normal cell can rely on other means once one is taken away, a cancer cell has lost perspective and doesn’t know what to do with itself.
I think we personify disease to understand and fight it, but we also get addicted to our language. We talk about the effects of cancer and the success of treatment in terms of five-year survival. Which isn’t a very long time to survive. But no one addresses the instinctive thought that this living five years is almost the opposite of continuing to live, since we’re beyond instinct now. We know that if your cancer hasn’t overcome everything in five years, it either wasn’t that bad to begin with or treatment is good. We know our language so well that meaning surpasses words. I think I pay close attention to words and in a little over a week I forgot how to hear them and I learned this from being told so. During a lecture on palliative care, a kind oncologist whose gray hair and matching eyes projected a natural softness told us about his wife who’d had breast cancer and subsequently acute leukemia. After being diagnosed with leukemia, someone offered her comfort in the fact that 75% of people with acute leukemia have a five-year survival. When her husband came home to find her sobbing over this, he asked her what it was that bothered her, assuming that she’d interpreted the statement as a quarter of people not achieving five year survival. Instead, she told him, “I’m 41 years old. And I only have until 46.” She thought “five year survival” meant that she’d live five more years and then it would be over. Despite that being the words’ most intrinsic meaning, I hadn’t even thought of that possibility.
These thoughts slip me because the days are crammed. One went like this. We begin the morning with a workshop on lung cancer (the cancer that takes most lives, with an overall survival rate of 15%) and brain metastases. If cancer has traveled from your lungs to your brain, they will irradiate your entire brain (our notes remind us that these patients will experience cognitive defects). It’s deemed prophylactic, and after treatment you can expect to live for one year. Following workshop, we listen to the lecture on breast cancer, which feels both scarier and less so by nature of being so prevalent in the population and mainstream culture. I know several people with breast cancer (seems like many in comparison to the number of people I know who have other illnesses, which are few) and somehow that commonness made me complacent. I am surprised to find that despite improved screening and detection, the percentage of survival isn’t as high as I expected. A quarter of women diagnosed with breast cancer die from it. We then hear from a breast cancer survivor, someone in our Yale community, who speaks to us for a near hour about her experience. From this I realize the more significant thing I’d forgotten was the visceral challenge of being ill with something that has any chance of killing you, no matter how positive the eventual outcome. In another workshop our teacher mentioned a procedure having a 5% risk of mortality, which is low, but well, “high if it’s your risk.” It’s true that on a daily basis we all face some slight percentage of dying, but cancer means having this overshadowed by something concrete and pseudo-quantifiable and personal and internal.
One thing I appreciate in medicine is individual context amidst the absolute values of care and quality of life, and there are few places wherein relativity is as palpable as cancer survival. While cure is always the ultimate goal, cancer can be so ominous that small advances are noteworthy. For colon cancer that's spread so that it's incurable by surgery, chemotherapy can prolong life significantly, “in some cases, up to two years.” A new treatment for kidney cancer is seen as an enormous breakthrough because it prolongs survival by 50%—increasing it from two months to four. Of course four versus two is a lot when it’s all you have, and who’s to say how much worth lies in any amount of time. Still, here relativity can feel like a copout.
Later that afternoon, as part of our pre-clinical curriculum we speak to a patient whose care is palliative, meaning being treated not for cure but for comfort. Ours is an 83 year old man with the mischievous sparkle of a teenager, coated with a brand of boyish charm that only comes with experience. He’d been diagnosed with lung cancer that he didn’t want to treat. He’d lived long enough, he felt, and if it’s time, it’s time. Then he came down with some sort of abdominal infection that doctors told him would kill him within a day, and still he didn’t want treatment. He hadn’t been seeking to die, but nor did he seek to live. He said goodbye to his family, and then the infection miraculously cleared on its own, leaving him alive, albeit with cancer still. When we see him, one of the first things he says is that the idea of dying in one or two days didn’t bother him. “Does that bother you?” he asks, pointing at me as I’m still maneuvering to find the right position in a narrow chair. I’m confused as to what he’s asking and I interpret it to mean, does his acceptance of his death bother me? Which is not a normal question to ask at all, but I don’t have the two seconds it takes to overthink the question even more than I already have and realize this isn’t what he means. So I respond with a quick no and during the ensuing chorus line of no’s from my classmates that might’ve just been nervous echoes of my response, I realize what he’d actually meant. And no, I do not want to die in the next couple of days. I’m completely happy with the life I’ve led so far but that doesn’t mean it’s done. If it were to happen, I’d be grateful for all that I’ve had in 24 years. But yes, I would be bothered.
In the evening, I have a meeting for the geriatrics interest group, and after talking to Don about the day he asks why I like old people. They’re different from me and I have no idea what it’s like to be them. I think maybe they’re honest not because they have nothing to lose but because they know what honesty gives. They carry everything with them that I am still looking ahead to, and they carry so much. They’re living with what I work for each day: experience, and they take that with them to each next day, because despite all they’ve lived they haven’t stopped living anew. At the meeting we talk about our screening of Rolling, a documentary where three people in wheelchairs tape their daily lives. None of them are “old.” Dr. Berland, the filmmaker, tells us the film is being promoted by the geriatrics group because it’s about facing change with dignity, and independence. I’m struck by how very different each person is, done not purposefully but truthfully. One tells us in an off-center closeup that he has so many blessings, and that nothing can take those from him. But “being blessed doesn’t mean it doesn’t hurt.” Like that Whitman line about how he’s a contradiction, and that makes sense because he’s large and he contains multitudes. That’s what each day feels like, a multitude.
And all I can do is sit with my books, which can feel empty and wrong even if necessary and engaging. After that day I go to the architecture library to study about breast and lung cancer in detail, making semi-meticulous notes from the textbook and lecture notes and workshop we’d had in the morning, putting together the details of screening, diagnosis, subtypes, staging and treatment. That we have this knowledge is beautiful, but cancer is so mysterious and we know really so little. When we first start learning about diseases we learn what begins them and here often we only know the end. All this crammed in one day, and no time at the end to think about what it means and how to use it. For lack of time and energy, I furiously scribble down events and details, with hopes of returning to fill gaps, but so much will be lost. Another day brings more, the feelings will gain different nuances, the way I started writing about my dad’s truck and he sold it before I finished the story. I’ll forget how it all started, what it was like to not know and to be introduced into these big things, encased in a hospital room and a one hour interview, to learn from these people as med students and as people. If I leave it for too long, I may look back and think I’m past the age to absorb it. As if reflection on the beginning only saves you from a blurry end where you can’t look back and remember, if you do it before you’re twenty-four.
Wednesday, September 24, 2008
changes and happenings
A lot of things have happened. While not everything has been smooth or even pleasantly rocky, I feel the heaviest kind of lucky. It's quite sappy how consciously lucky I feel every day to have everything I do, how much it holds up even the worst days. To inadequately recap. I spent the summer in Vietnam to work on a public health project. I traveled to the center and south, and lived in the north. I stayed in a rural town for a couple weeks, visited my dad's old village, and lived with my uncle, his son and his son's family in the city the rest of the time. My cousin's wife, quite possibly the sweetest person I've ever met, cried at the airport when I was leaving.
I spent three full days at home in which my dad told me how he planted a near dying cherry tree in the middle of our yard and my mom armed me with hoisin sauce to bring to New Haven. You know how parents are cute to everyone but their own kids? My parents are so cute even I think so. I'm looking forward to Thanksgiving, and having a full week with them (and all the brothers, so I think it might be our first full family Thanksgiving ever). My mom keeps reminding me we'll make the turkey together (she made her first one only a couple years ago) and that she'll make my favorite meal too. She and my dad keep asking me if I need funds, something they haven't done in years. I'm guessing they're asking now because they think I've run out, which I was worried about too, but it looks like I'll be able to ride out at least this next year on residual income and aid, which is another part of the luck. But it's funny to me that my mom tells me not to worry about buying a dress for the semi-formal because she doesn't want me to "suffer" (literal translation).
I drove cross country with Allison. We stopped in Tahoe, Lovelock Nevada, Salt Lake City Utah, Denver Colorado, Wall South Dakota, Madison Wisconsin, Rockville Maryland, Lancaster Pennsylvania and arrived here after ten days, 72 hours which were spent driving. We saw lots of rocks and castles, real and figurative. We saw salt and sunsets and my new nephew. We talked a lot, and laughed an unfathomable amount. We played lame games and took pictures of nothing (on the hour). Silly things happened, like our Wisconsin adventure which included bruises and a flooded bathroom. Beautiful things were seen, like Utah and the beautiful beautiful Badlands, which are not castles but make you feel royal, but also small. I'm so so glad that we took the trip and that Allison was the Thelma to my Louise, because how often do you get to do that and more rarely, have it be quite perfect? When in your life you feel both brave and unsure and open to emptiness, drive across your country with your Thelma.
Upon returning to New Haven, I embarked on a scrambled unique honeymoon with the wife, traveling in a 14-foot U-Haul to retrieve and move furniture. First time I've bought real furniture, first time I drove a U-Haul. It took me a full week to get everything and unpack, a week in which I ignored all things school while realizing in class that we were already supposed to have learned in that week what would've amounted last year to a month of material. But it doesn't matter, because I love our new home almost as much as I love the wife. We live on a street lined with restaurants and little shops like the camera store and the random stuff store and the art store and the Art School, and two coffeeshops, including one that's half a block away and owned by Asians who already know how much I love chai. We're on the first floor of an old brick house with hardwood floors and white walls encased in darker wood, with a big kitchen and the homey feel I knew I wanted when we were looking for an apartment. It's just that much farther from school, and that much closer to downtown. Jen and I cook, and Nupur has a bread machine.
School is intense. I can't learn this much this fast. We're learning in modules this year, and we've started with the heart. One of the most interesting, and complicated. Apparently in a month we're supposed to understand the diseases, know the treatments (what do you give first? what's a last resort? what do you give to diabetics?), comprehend how an EKG works and what it's supposed to look like in every kind of dysfunction of your heartbeat (do you know how many different ways your heart can beat?). All this makes me again grateful for being here, without real exams or grades, so I'm still able to appreciate how intellectually satisfying the science is and remember how lucky and awesome it is to pursue something that works your mind and heart. The year's going to be a bit insular, all of us cooped up studying, which sounds kind of sucky but there will probably never be an excuse again to just be cramming in knowledge (hopefully) without other obligations.
At the very least I like the people I'm cooped up with, and through everything else I feel most lucky for the sheer quantity and quality of the people in my life. My college blockmates are all really happy and kicking ass in their respective areas of work/study, and that makes me really happy, to think of everyone growing through the ups and downs of the post-grad years with such grace. It's even crazier to think on the growth with my high school friends who are still some of the best people I know. And in New Haven I have the family I adopted (or who adopted me), people who really love me and at the lowest points (which have indeed already been experienced in the past few weeks) remind me I have absolutely everything I need. Anything that's been hard reminds me also of how there are things I still don't know about myself, and how the more painful experiences force you to know yourself. How you're built, what you value. I know better that honesty matters to me more than acts, that there are things I know I deserve even as much as we hate to use that word on our own behalf, that for as much as I communicate there's a whole lot I miss about even people I know really well and so I need to work on that, that even if you're supposed to pick your battles I will never be able to give up on a person that gave me reason to start trying in the first place. In the end, even if what you find makes things harder--not so much the realization but you yourself--there's good reason for being how you are, and good reason for how each person is.
Reading this over confirms the sap that gratitude makes you produce. But another point is just--so things are quite different. I don't think I'll be blogging much from now on, because I started writing a tiny bit over the summer and I think I want to try as much as I can to continue that, and this year forces me to choose. I'm not sure what happened, but I think it's been this accumulation of gratitude that's pushed me to finally put some things into stories, or rather, clumps. I'll return somewhere in between clumps.
I spent three full days at home in which my dad told me how he planted a near dying cherry tree in the middle of our yard and my mom armed me with hoisin sauce to bring to New Haven. You know how parents are cute to everyone but their own kids? My parents are so cute even I think so. I'm looking forward to Thanksgiving, and having a full week with them (and all the brothers, so I think it might be our first full family Thanksgiving ever). My mom keeps reminding me we'll make the turkey together (she made her first one only a couple years ago) and that she'll make my favorite meal too. She and my dad keep asking me if I need funds, something they haven't done in years. I'm guessing they're asking now because they think I've run out, which I was worried about too, but it looks like I'll be able to ride out at least this next year on residual income and aid, which is another part of the luck. But it's funny to me that my mom tells me not to worry about buying a dress for the semi-formal because she doesn't want me to "suffer" (literal translation).
I drove cross country with Allison. We stopped in Tahoe, Lovelock Nevada, Salt Lake City Utah, Denver Colorado, Wall South Dakota, Madison Wisconsin, Rockville Maryland, Lancaster Pennsylvania and arrived here after ten days, 72 hours which were spent driving. We saw lots of rocks and castles, real and figurative. We saw salt and sunsets and my new nephew. We talked a lot, and laughed an unfathomable amount. We played lame games and took pictures of nothing (on the hour). Silly things happened, like our Wisconsin adventure which included bruises and a flooded bathroom. Beautiful things were seen, like Utah and the beautiful beautiful Badlands, which are not castles but make you feel royal, but also small. I'm so so glad that we took the trip and that Allison was the Thelma to my Louise, because how often do you get to do that and more rarely, have it be quite perfect? When in your life you feel both brave and unsure and open to emptiness, drive across your country with your Thelma.
Upon returning to New Haven, I embarked on a scrambled unique honeymoon with the wife, traveling in a 14-foot U-Haul to retrieve and move furniture. First time I've bought real furniture, first time I drove a U-Haul. It took me a full week to get everything and unpack, a week in which I ignored all things school while realizing in class that we were already supposed to have learned in that week what would've amounted last year to a month of material. But it doesn't matter, because I love our new home almost as much as I love the wife. We live on a street lined with restaurants and little shops like the camera store and the random stuff store and the art store and the Art School, and two coffeeshops, including one that's half a block away and owned by Asians who already know how much I love chai. We're on the first floor of an old brick house with hardwood floors and white walls encased in darker wood, with a big kitchen and the homey feel I knew I wanted when we were looking for an apartment. It's just that much farther from school, and that much closer to downtown. Jen and I cook, and Nupur has a bread machine.
School is intense. I can't learn this much this fast. We're learning in modules this year, and we've started with the heart. One of the most interesting, and complicated. Apparently in a month we're supposed to understand the diseases, know the treatments (what do you give first? what's a last resort? what do you give to diabetics?), comprehend how an EKG works and what it's supposed to look like in every kind of dysfunction of your heartbeat (do you know how many different ways your heart can beat?). All this makes me again grateful for being here, without real exams or grades, so I'm still able to appreciate how intellectually satisfying the science is and remember how lucky and awesome it is to pursue something that works your mind and heart. The year's going to be a bit insular, all of us cooped up studying, which sounds kind of sucky but there will probably never be an excuse again to just be cramming in knowledge (hopefully) without other obligations.
At the very least I like the people I'm cooped up with, and through everything else I feel most lucky for the sheer quantity and quality of the people in my life. My college blockmates are all really happy and kicking ass in their respective areas of work/study, and that makes me really happy, to think of everyone growing through the ups and downs of the post-grad years with such grace. It's even crazier to think on the growth with my high school friends who are still some of the best people I know. And in New Haven I have the family I adopted (or who adopted me), people who really love me and at the lowest points (which have indeed already been experienced in the past few weeks) remind me I have absolutely everything I need. Anything that's been hard reminds me also of how there are things I still don't know about myself, and how the more painful experiences force you to know yourself. How you're built, what you value. I know better that honesty matters to me more than acts, that there are things I know I deserve even as much as we hate to use that word on our own behalf, that for as much as I communicate there's a whole lot I miss about even people I know really well and so I need to work on that, that even if you're supposed to pick your battles I will never be able to give up on a person that gave me reason to start trying in the first place. In the end, even if what you find makes things harder--not so much the realization but you yourself--there's good reason for being how you are, and good reason for how each person is.
Reading this over confirms the sap that gratitude makes you produce. But another point is just--so things are quite different. I don't think I'll be blogging much from now on, because I started writing a tiny bit over the summer and I think I want to try as much as I can to continue that, and this year forces me to choose. I'm not sure what happened, but I think it's been this accumulation of gratitude that's pushed me to finally put some things into stories, or rather, clumps. I'll return somewhere in between clumps.
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