Learned today that before insulin was discovered, the treatment for diabetes was starvation. If you ate normally, you'd die from ketoacidosis (without insulin, your body makes too much acid, a process which pretty much messes up everything that's regulated by acid-base balance in your body and kills you). So people could choose, our teacher told us, a slow death of starvation over the quick one of diabetes. Then they found a way to isolate insulin and use it as treatment. Now, though there are still awful consequences of diabetes, it's possible to have it relatively under control. This all reminded me of how I recently learned the meaning of the word iatrogenic. This describes harmful, unintentional consequences of medical treatment. This doesn't quite exactly apply to the starving diabetics thing, but the extreme of a "treatment" directly causing death made the idea resurface.
It's something I've been thinking about for awhile. I've probably heard it before but the first time I remember it, and remember understanding it, was when I met a patient whose esophagus was perforated while receiving anesthesia for surgery for bladder cancer. This caused life-threatening inflammation of everything in his middle chest area. That was a mistake, which is what iatrogenic refers to. But somehow I take it to encompass all the fundamental harm medicine knowingly and necessarily inflicts, in order to treat illness. Last semester I met a patient with malignant bone cancer, a frank man in his thirties who managed to be friendly without smiling. He'd done a lot of research on his chemotherapy treatment, and told me that after he'd agreed to it, he read that there was a slight chance of developing leukemia from the chemo. He said he'd wished he'd been told that before. When I asked him whether it would've changed his decision, he said quite possibly, because why fight one bad thing to just acquire another.
I'd taken it for granted that one would choose to go through the treatment, especially for one so young. This is how I'm personally built, and in some ways how medicine is built. To try your damned hardest to do everything you can to fix people and situations and lives. But sometimes there's no insulin to be discovered, and trying too hard can mean starvation.
I wrote a long time ago about Jonathan Franzen's "The Corrections" and recently about "Breathing Lessons," both of which deal with the futility of our efforts to change things, and the irony of our solutions creating or worsening the problems they seek to resolve. I don't know myself how to get out of that cycle, sometimes. Despite complete understanding and direct acknowledgment of the reality of things, of the net gain or loss of happiness from my choices, of the same recurring hurt that results--I refuse to stop trying. I have found so many ways to see the value in things that are unpleasant, painful, non-ideal, but I have never reconciled myself to loss. And I mean, really. I think about it almost every day, and it is not just a matter of time or out of sight for me. People say that loss isn't your fault; it's natural, so you shouldn't try to resist so much. But I think it would be easier if it were our faults, because as reasonable and obvious as it is, the reality of loss as natural and incorrigible is incomprehensible to me sometimes. In the few connections I've had, I've fought so hard to preserve certain aspects, even when the process chipped away at me, that I ultimately have to let it all go if I want to keep myself together. I end up with a loss greater than the one I was trying to prevent.
I read Norwegian Wood during a time of all consuming ache, and one of the passages that meant most to me then comes to me again often and particularly now when I ache again: "Things will go where they're supposed to go if you just let them take their natural course. Despite your best efforts, people are going to be hurt when it's time for them to be hurt. Life is like that....You try too hard to make your life fit your way of doing things....But who can say what's best? That's why you need to grab whatever chance you have for happiness where you find it, and not worry too much about other people. My experience tells me that we get no more than two or three such chances in a lifetime, and if we let them go, we regret it for the rest of our lives."
I felt this to be so true and something that fit right into me at the time, but of course I didn't listen, not then or now. So here I am, a girl who for some inexplicable reason hates losing people more than anyone I know, turning away from a friendship that means so much to me. Giving up a connection in its entirety because not wanting to give up anything before, wanting to fix to make you and thereby myself happy, put me in a place to hurt you and be hurt. In the end it's true that this is right because we all deserve the same happiness, and it's true that we have a choice in our own happiness and I have to be the one to think of my own. Still, I'm sad.
Monday, February 23, 2009
Saturday, February 14, 2009
amy / new york / french
This dinner (one year ago to this day) was my best Valentine’s Day. I traveled to and from NYC in the same day, since that year Valentine’s fell on a weekday, for a night with one of my best friends from college (from neighbor to blockmate to roommate). I remember seeing Amy sitting at the bar from the window and thinking she looked very cosmpolitan with her cocktail dress, hair swept in a ponytail and wineglass in hand. (I on the other hand was carrying a big book bag and had to change out of my jeans in the bathroom. Am also sure that that infamous knot in my hair was present). The restaurant, Nice Matin, was intended to be modeled after a place you might find in the French Riveria (haha, Nice perhaps), perfectly fitting. The food was heaven. I had sole, which is rarely anything special, but here it was so flavorful. We shared a dessert whose name and ingredients we didn’t recognize but we went for it and it was so worth the risk. Creamy and subtle and sweet and textured. This was all in the company of a girl I could talk to for hours whether it’s been forever or just a day since we’ve talked. Our conversations are always honest, which cultivates humor and emotion. Having experienced together the onset of anxiety attacks concerning Purpose, Love, Family, etc., these are topics we continue to share in comfort. We went for coffee afterwards and talked more until the last minutes I could get my train, and I traveled back feeling much love for and loved by.
Thursday, February 12, 2009
untitled
In Connecticut, a morning in January and a morning in March don’t look too different when you look outside for help with what you should wear that day. Usually it’s bright and there’s often unplowed white on the sidewalks and people shuffling in layers. Even if there aren’t, you know enough about this coast to know that your scarf is not accessory but requisite. I came here from California, where warmth is numbing. Here winter occupies half the year, and the seasons are stitched together. Sometime in April someone starts pulling the thread. White turns to gray to yellow, a familiar and welcome flow. As capricious as the outside can be, even if it’s cold when sunny or if twenty degrees separate two consecutive days, we sense its character. And so, the oft elusive weather becomes part of our concrete knowledge.
This is why, when testing a patient’s cognitive function, we ask them what season it is. It’s supposed to come naturally. Our patient is seventy-eight, and the deeply pressed lines of her face change what I consider natural. As she furrows her forehead in an effort to find the “right” answers that she so badly wants to give us, the rain falls steadily harder outside. Watching her sit and speak in front of the weather, the bus ride we took to the nursing home feels farther away in time. I’m suddenly aware of my socks wetly clinging to the inside of my shoes.
When asked, our patient tells us the correct month—April. It’s only when she says this that I realize how far into the year we are. Only a couple weeks ago stacks of muddy ice tinged with white still created tunnels on the street. Not so long did thirty degrees feel warm. At some point in that winter the snow glazed over and made a varnish still visible at night and worthy of ice skating. During the day a friend commented that he liked how bright it was, when the snow was fresh and the sun piercing. This year it all ebbed into spring slowly so there was no time for embrace or longing. But we still remember.
When then asked what season it is, the woman sharing with us her presence hesitates. She doesn’t consult the window behind her, even though I look past her to the outside. Instead she looks ahead and I wonder at what or for. I think the sound of her delicately mouthed April has faded. Then she says, “fall,” and I think our insides break a little.
Would she have known, if we had been sitting outside to let the falling water slip off our cheeks, rest in her creases? What if the season had been the stronger one of few weeks past, and she could hear the salted snow stuck in the grooves of our shoe soles as we walked across the room to her? Or if she’d walked long enough for the water to seep into her socks? It’s out of grasp to feel what touches her, much less link sense with thought.
And fall here is not far from spring, anyway; what does it mean to mix and match transitions? It’s solemn on the ride back to school. My classmate sitting next to me confesses some depression over what he’s seen. In not these exact words he says that life is for interaction with experience, and to not know your experience takes away purpose. It’s funny to me that this sounds and is often true, when I came to medical school with the purpose of meeting experience.
But our windows tell us little, and what we feel of the outside is inexplicable. For the woman giving us her words, the layers of expression have been shed, and the experience left so bare that it’s gone from our view. Without even the frayed threads of winter past to twist around her fingers, it’s still spring.
This is why, when testing a patient’s cognitive function, we ask them what season it is. It’s supposed to come naturally. Our patient is seventy-eight, and the deeply pressed lines of her face change what I consider natural. As she furrows her forehead in an effort to find the “right” answers that she so badly wants to give us, the rain falls steadily harder outside. Watching her sit and speak in front of the weather, the bus ride we took to the nursing home feels farther away in time. I’m suddenly aware of my socks wetly clinging to the inside of my shoes.
When asked, our patient tells us the correct month—April. It’s only when she says this that I realize how far into the year we are. Only a couple weeks ago stacks of muddy ice tinged with white still created tunnels on the street. Not so long did thirty degrees feel warm. At some point in that winter the snow glazed over and made a varnish still visible at night and worthy of ice skating. During the day a friend commented that he liked how bright it was, when the snow was fresh and the sun piercing. This year it all ebbed into spring slowly so there was no time for embrace or longing. But we still remember.
When then asked what season it is, the woman sharing with us her presence hesitates. She doesn’t consult the window behind her, even though I look past her to the outside. Instead she looks ahead and I wonder at what or for. I think the sound of her delicately mouthed April has faded. Then she says, “fall,” and I think our insides break a little.
Would she have known, if we had been sitting outside to let the falling water slip off our cheeks, rest in her creases? What if the season had been the stronger one of few weeks past, and she could hear the salted snow stuck in the grooves of our shoe soles as we walked across the room to her? Or if she’d walked long enough for the water to seep into her socks? It’s out of grasp to feel what touches her, much less link sense with thought.
And fall here is not far from spring, anyway; what does it mean to mix and match transitions? It’s solemn on the ride back to school. My classmate sitting next to me confesses some depression over what he’s seen. In not these exact words he says that life is for interaction with experience, and to not know your experience takes away purpose. It’s funny to me that this sounds and is often true, when I came to medical school with the purpose of meeting experience.
But our windows tell us little, and what we feel of the outside is inexplicable. For the woman giving us her words, the layers of expression have been shed, and the experience left so bare that it’s gone from our view. Without even the frayed threads of winter past to twist around her fingers, it’s still spring.
Sunday, February 8, 2009
february & 2009
I dated something the other day 2008, and afterwards told myself that we're well into February now. I think taking most of January to consider 2008 is about as far as I can stretch it, and besides, February is a good time to consider 2009. Because it's a packed month. This month is finishing my research project, the second year show, and planning the rest of the year because they kind of make you do that.
A year ago I was still writing the proposal for this project in Vietnam, and now I'm frantically writing everything up. The three main categories of findings are household consumptions (when confronted with health costs, what items on which households then spend less--including food, education, farming expenses), coping strategies (how do households without financial resources pay for healthcare--which we found to be mostly borrowing and a cycle of debt), and insurance (is the relatively new insurance system decreasing the economic burden of healthcare). It's been satisfying to put it all together, but it's also taking much more of my time than I'd like. Mostly, while public health as a concept is essential, I'm still averse to the need for research and theory to prove it.
Just as I can't believe it was one year ago that we started this project, I can't believe it's been one year since last year's second year show. The second year show is a string of skits, dances and videos that make fun of our faculty, traditions, phrases, and other Yale Med specific quirks. It's a nice thing to do as an entire class, reminiscent of our high school spirit weeks. It means setting up and practices and such, over the next couple of weeks. So it's an event to anticipate and to overwhelm (us).
So that's February in its active form. The part that lurks is the planning part. 2009 is split into halves: the Boards and the Wards, both of which are punctuated by travel. These things bring to mind some of the new vocabulary I've learned in med school that I hate. They will come up as I go.
The Boards consists of three steps, all required to attain a medical license. I'll be taking Step 1, the most important of the three, at the end of May. Step 1 is a 7-hour exam with 350 multiple choice questions that tests everything we've learned (and haven't learned) for the past two years. Off the top of my head, that includes biochemistry, anatomy, stats, immunology, microbiology, pharmacology and most importantly, physiology and pathology of all organ systems. Med word I hate #1: high yield. This refers to bytes of knowledge that will likely appear on an exam, things that will give you the most bang for your study time. I know it's realistic to think in terms of yield, but I also think that sometimes medicine is too entrenched in the approach of thinking about what gives you the absolute most. I know waste is not good, and I don't have a rational logic for why this would bother me except that perhaps the measurement of what has value is so regimented.
The reason this is the most important Step is because it's the main factor in applying for residencies after med school. If you want to go into something competitive, it matters a lot, and it matters a lot to most of my class. Med word I hate #2: gunner. Gunners themselves don't bug me that much as long as they don't shortchange other people to get ahead, but it is a little bothersome that the general impression of our culture is that we're all gunning for...something? At this point nothing I'm interested in is competitive (apparently 2% of graduating med students go into primary care these days), but who knows what I might end up enjoying, and I would like to pass. More than that, I would like to feel that I'm doing relatively well in what I'm consuming my life with, and I would like to know things.
The latter part is why I'm looking forward to going home to study. We get six weeks off school to study, and by studying, they mean something like ten hours a day, six days of the week. Though I doubt both my ability to study for that long and that the amount of time's sufficient to learn everything, I look forward to a routine of learning. I look forward to morning runs in Fremont, a consistent study schedule, meals at home, quiet nights and the one day a week of nothingness. It might sound sad to compartmentalize a month and a half of your life to not really living, but I'm in school to learn these things and I haven't done a great job of it thus far, so I'll be glad for an excuse to try.
Besides, afterwards comes the punctuated travel, to Prague!
Then comes the rest of June and the second half of 2009, the Wards. The wards are when we enter as the lowest rung in the hospital. We "rotate" to different areas of medicine, like ob-gyn, surgery, pediatrics, and so on. So we leave behind the realm of no responsibility and re-discover on a whole new level how little we know. Med word I hate #3: pimping. This means being drilled by your superiors in the hospital, and in my case 99% of the time, not knowing the answer. I'm very much looking forward to patients and active learning and doing the history and physical exam for the patient's sake instead of ours, but I'm not looking forward to being pimped, thanks.
But after the beginnings of that comes a month off (December), half of which will be spent lovingly at home and half of which will be spent in travel to somewhere to be decided!
In any case 2009 is a hefty year. I'm not ready but I think I will remember to write 2009 from now on.
A year ago I was still writing the proposal for this project in Vietnam, and now I'm frantically writing everything up. The three main categories of findings are household consumptions (when confronted with health costs, what items on which households then spend less--including food, education, farming expenses), coping strategies (how do households without financial resources pay for healthcare--which we found to be mostly borrowing and a cycle of debt), and insurance (is the relatively new insurance system decreasing the economic burden of healthcare). It's been satisfying to put it all together, but it's also taking much more of my time than I'd like. Mostly, while public health as a concept is essential, I'm still averse to the need for research and theory to prove it.
Just as I can't believe it was one year ago that we started this project, I can't believe it's been one year since last year's second year show. The second year show is a string of skits, dances and videos that make fun of our faculty, traditions, phrases, and other Yale Med specific quirks. It's a nice thing to do as an entire class, reminiscent of our high school spirit weeks. It means setting up and practices and such, over the next couple of weeks. So it's an event to anticipate and to overwhelm (us).
So that's February in its active form. The part that lurks is the planning part. 2009 is split into halves: the Boards and the Wards, both of which are punctuated by travel. These things bring to mind some of the new vocabulary I've learned in med school that I hate. They will come up as I go.
The Boards consists of three steps, all required to attain a medical license. I'll be taking Step 1, the most important of the three, at the end of May. Step 1 is a 7-hour exam with 350 multiple choice questions that tests everything we've learned (and haven't learned) for the past two years. Off the top of my head, that includes biochemistry, anatomy, stats, immunology, microbiology, pharmacology and most importantly, physiology and pathology of all organ systems. Med word I hate #1: high yield. This refers to bytes of knowledge that will likely appear on an exam, things that will give you the most bang for your study time. I know it's realistic to think in terms of yield, but I also think that sometimes medicine is too entrenched in the approach of thinking about what gives you the absolute most. I know waste is not good, and I don't have a rational logic for why this would bother me except that perhaps the measurement of what has value is so regimented.
The reason this is the most important Step is because it's the main factor in applying for residencies after med school. If you want to go into something competitive, it matters a lot, and it matters a lot to most of my class. Med word I hate #2: gunner. Gunners themselves don't bug me that much as long as they don't shortchange other people to get ahead, but it is a little bothersome that the general impression of our culture is that we're all gunning for...something? At this point nothing I'm interested in is competitive (apparently 2% of graduating med students go into primary care these days), but who knows what I might end up enjoying, and I would like to pass. More than that, I would like to feel that I'm doing relatively well in what I'm consuming my life with, and I would like to know things.
The latter part is why I'm looking forward to going home to study. We get six weeks off school to study, and by studying, they mean something like ten hours a day, six days of the week. Though I doubt both my ability to study for that long and that the amount of time's sufficient to learn everything, I look forward to a routine of learning. I look forward to morning runs in Fremont, a consistent study schedule, meals at home, quiet nights and the one day a week of nothingness. It might sound sad to compartmentalize a month and a half of your life to not really living, but I'm in school to learn these things and I haven't done a great job of it thus far, so I'll be glad for an excuse to try.
Besides, afterwards comes the punctuated travel, to Prague!
Then comes the rest of June and the second half of 2009, the Wards. The wards are when we enter as the lowest rung in the hospital. We "rotate" to different areas of medicine, like ob-gyn, surgery, pediatrics, and so on. So we leave behind the realm of no responsibility and re-discover on a whole new level how little we know. Med word I hate #3: pimping. This means being drilled by your superiors in the hospital, and in my case 99% of the time, not knowing the answer. I'm very much looking forward to patients and active learning and doing the history and physical exam for the patient's sake instead of ours, but I'm not looking forward to being pimped, thanks.
But after the beginnings of that comes a month off (December), half of which will be spent lovingly at home and half of which will be spent in travel to somewhere to be decided!
In any case 2009 is a hefty year. I'm not ready but I think I will remember to write 2009 from now on.
Sunday, February 1, 2009
tanvi / chicago / indian
I once started writing about my top ten meals of all time, a good meal being one of my top ten favorite (semi)concrete things in life. I couldn't write about them all at once, so will post them as they were experienced, every so often.
**
T and I met as the only freshmen in high school biology and have never stopped giggling and neuroticizing together since. Well, there was a gap towards the end of college where we didn’t keep in touch as well, but nothing was lost. Yale gave us a week off for Thanksgiving (what novelty!) so I visited her in Chicago. She took me on honestly one of the best dates ever, with the best Indian food ever. Devon is the Indian & Pakistani neighborhood of Chicago, and streets were lined with Indian restaurants one after another. It was the first time I had Indian style okra (perhaps any kind of okra). I don’t remember the name of the place or what we talked about but I do remember being in awe of how she’d grown, so beautifully, inside and out. I remember that it was very cold outside, that inside was a warm brown haze, and that our table was small; she sat facing a window to outside and I sat facing the restaurant; we were in a corner. Afterwards she took me to a jazz club called the Green Mill. The sounds coating the walls and drenching the silhouettes between chairs, tables, stage, drinks on the table, made me sharply, dizzily aware of fullness.
**
T and I met as the only freshmen in high school biology and have never stopped giggling and neuroticizing together since. Well, there was a gap towards the end of college where we didn’t keep in touch as well, but nothing was lost. Yale gave us a week off for Thanksgiving (what novelty!) so I visited her in Chicago. She took me on honestly one of the best dates ever, with the best Indian food ever. Devon is the Indian & Pakistani neighborhood of Chicago, and streets were lined with Indian restaurants one after another. It was the first time I had Indian style okra (perhaps any kind of okra). I don’t remember the name of the place or what we talked about but I do remember being in awe of how she’d grown, so beautifully, inside and out. I remember that it was very cold outside, that inside was a warm brown haze, and that our table was small; she sat facing a window to outside and I sat facing the restaurant; we were in a corner. Afterwards she took me to a jazz club called the Green Mill. The sounds coating the walls and drenching the silhouettes between chairs, tables, stage, drinks on the table, made me sharply, dizzily aware of fullness.
Tuesday, January 27, 2009
path of least resistance
Told wife today that one reason I didn't pursue journalism was a fear of reality. I don't write anything about the world, mostly because I don't have much new or original to say. The only thing I know any more about than anyone else is my own life, sadly. But in addition to all the immediate coverage, reading the flurry of links sent about Israel & Palestine from friends the past day or so, well, I still don't have anything new to say...but it does make me think about choices and how things we do on a daily basis seep into the world as a whole.
It is unbelievable to me how natural it is for people to cling to status quo even, and even especially, in the face of overwhelming reason to change. And how hard it is to commit to a principle rather than a side. To realize that though context does affect what's right and what's wrong, there are absolute rights and wrongs we have agreed upon. Among some friends the phrase "path of least resistance" has come up some times this year, not in relation to current events, but I find it apt for the awful craziness of what's going on in the Middle East. And back here, we continue the way we've been because it's easy.
The phrase came up in relation to me as a person. In recently asking a wonderful friend for some reassurance, of a kind thankfully rarely needed, he told me I'm a crazy person, a mix of immediate relentlessness and everlasting patience. It's true that this doesn't make for an easy personality, that patience simply being a euphemism for the neurotic relentlessness. Aside from pure stubbornness, I hope that the difficulty stems from certain value, and I am thankful every day for the people and things in my life that make me feel that. I've never been and probably will never be the path of least resistance. And I don't want to be, even if were to make me the path that's taken.
But for the world, let's not make this an exception, let's please take the harder route this time and the next.
It is unbelievable to me how natural it is for people to cling to status quo even, and even especially, in the face of overwhelming reason to change. And how hard it is to commit to a principle rather than a side. To realize that though context does affect what's right and what's wrong, there are absolute rights and wrongs we have agreed upon. Among some friends the phrase "path of least resistance" has come up some times this year, not in relation to current events, but I find it apt for the awful craziness of what's going on in the Middle East. And back here, we continue the way we've been because it's easy.
The phrase came up in relation to me as a person. In recently asking a wonderful friend for some reassurance, of a kind thankfully rarely needed, he told me I'm a crazy person, a mix of immediate relentlessness and everlasting patience. It's true that this doesn't make for an easy personality, that patience simply being a euphemism for the neurotic relentlessness. Aside from pure stubbornness, I hope that the difficulty stems from certain value, and I am thankful every day for the people and things in my life that make me feel that. I've never been and probably will never be the path of least resistance. And I don't want to be, even if were to make me the path that's taken.
But for the world, let's not make this an exception, let's please take the harder route this time and the next.
Thursday, January 15, 2009
my mom
My mom turns 67 today. It was only recently that I realized that she was three years older than her officially documented age (this changed her age to me by two, since I'd previously thought she was only one year older than her official age). Growing up in Northern Vietnam while the Communists were fighting to oust the French, she stopped going to school for a few years during the fighting. When it was time to return, they tried to put people back in the grades corresponding to their age, but they were all behind. My grandparents lowered my mom's age, so she could be in the grade in which she belonged. Growing up, she was a daddy's girl, and later, she tells me, she had many suitors (I believe her). She worked as an accountant for the government for awhile and married my dad, and then taught high school history, and somewhere in there gave birth to four boys in seven years. She took them, carrying the baby whom she fed powdered milk, through fields and marshes and sea to Thailand and to Germany and eventually to here. Her dad passed away in Vietnam before she left, and her mom passed away there too, but when my mom was in America, when I was five and remember her crying in the hallway. In California she made clothes, helped my dad run the bakery and then the convenience store and then the wine store, was and is still a receptionist at my aunt's pediatric office, and gave birth to me. When I was a kid she worried I'd never grow much hair. Once when I was in elementary school and she found out about something really bad I'd done, she didn't yell with anger; she cried with disappointment. In high school before I could drive and I wanted to volunteer at a hospital 40 minutes from home, she'd take me there after school and wait there for three hours until I was done, to take me home. When she saw me off for college, she wouldn't leave to go to the bathroom until after I passed the security gate. In med school when we had to interview a relative with an illness I talked to her about the heart surgery she had when I was thirteen, when she stayed home for a few months and we gave her a bell to call us if she needed anything. She doesn't like chocolate, butter, sweet things or any non-Vietnamese food. She likes jewelry, watching National Geographic and Animal Planet, posing for pictures, and talking to anyone. I don't know that many concrete details about her life before the time that I noticed details, and it took a long time after noticing before I started asking. I hope to know.
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