Every blog seems to have an obligatory list of things to be thankful for, not necessarily always at Thanksgiving. I've never made a public one, mostly because I often write when I'm happy for something and I assume that comes across. Lately though I've been feeling a bit of an ache. While there has been as much to be happy for as always, instead of appreciating those things, I've entertained that ache more than I'd like. So here's to being grateful (though nowhere near adequately) instead of self-pitying (whose threshold of validity has been surpassed long ago).
I am glad for:
public transportation
It's not so alarming to get lost on a subway, because there are really only so many places to go and there is one map with solid lines and colors and only so many directions. You have little responsibility once you get on except to remember when to get off. I spent a fourth of my time in Chicago on trains and buses, and walking short distances, and count all of it as seeing the city. Thank you for keeping me still and taking me places.
things that keep you warm
Tea. How the flavors can be a intricate mix of spices and things but still taste smooth and simple, and thereby, comforting. How it holds lovely things like milk and honey and sugar. Fireplaces, books by the fireplace, and winter music like RHCP's By The Way and Radiohead's In Rainbows and The Cure's Disintegration. Large groups of people you love in one place. Coffeeshops. Winter accessories that you lose, mourn, and never quite replace. Blankets borrowed from friends. Hot pies.
the uniqueness of people
As I re-meet old friends and make new ones, I find each one to be irreplaceable. It's overwhelming to think of what each one offers, how each person gives me something different and compels to give them something different. I miss my friends from home. I miss how Victoria is part of home, how Aud understands my introversion, how Tanvi laughs at everything and makes me laugh at everything, how Kristina speaks with a fiery passion that somehow brings out her core gentle kindness, how Sarah lets me be whatever I feel like. I miss my college friends. I miss Andrea's questions and listening, Jackie's genuine caring of everyone, Jen's sensibility to things around her, Amy's honesty, Melkis's quick propensity to laugh and cry, Steph's warmth, Chris's elusiveness, Henry's love which he extends so naturally, Frank's contagious positivity, Courtney's love of quality things like NYC and coffee. Hi Albert, I miss you too and your empathy. On Thanksgiving break I missed my classmates--Allison squatting in my room and how easy it is to talk to her about whatever, Bibhav's silliness cheering me without fail, Don's nightly milk stops and how he seems to appreciate those few minutes, how Guson both echoes my thoughts and makes me consider new things, Macdale's tangible humor, my awesome PCC group. And everyone I see in class and don't even talk to regularly, I missed them too. Thank you for Andy and Connie and Gina who I saw in Chicago and make me think once people enter your life they stay in some form. And I miss you; I think I will always miss you. You are in everything beautiful, and there is much beautiful.
having things to miss
Thank you for things and people so worthwhile that I consciously miss them.
yale
Thank you for keeping me busy and fulfilled but not too stressed, for being an unexpected fit. You're not without your flaws but neither am I and I think we understand each other okay. Thank you for making me feel this is a privilege and that I need to keep deserving it each day, and understanding when I can't quite do it because I'm a bum. Thank you for the amazing financial aid that makes me fear less postgraduate debt and gives me some leeway to pursue what I want.
loves
Thank you for the joys and pains of the first, and for the formless idea of an unknown second. Thank you for the constant ones: Mom, Dad, Hoang, Bao, Duy and Binh (all the names for those of you who try to remember those brothers of mine)--for how I don't have to miss you because you always feel close.
my memory
I know it makes me think too much and things linger longer than they should and it makes things hard for me. But thank you for letting me keep everything in one place.
I feel the need to say thank you rather than to just give thanks, just because it's nice to think of directing all this toward someone/something. To think that there's something out there enveloping the thanks we give, like the catcher in the rye that Holden Caufield imagines catching those bodies as they're thrown. Some things for you to catch.
Saturday, November 24, 2007
Monday, November 5, 2007
afternoon
It was a mildly cold, sunny day and after just two hours of class, lunch and errands, a long Monday afternoon stretched its limbs for me to follow. I packed my bookbag and walked down York Street with Radiohead's newest because I'm addicted; it's so delicious. The up and down I routinely take on York reminds me of how we felt like we'd been in Luang Prabang (Laos) forever because there's one main street and we walked it multiple times a day. The intersection with Elm Street reminds me a little of Cambridge, with Au Bon Pain on the corner and the expanse of brick becoming evident as you stand in the middle, a triangular intersection on your left and half of a cross on your right. I saw several girls wearing brown knee high boots. I have fond memories of Amy and I finding ours for $30 at a Nine West outlet in Atlantic City.
I went to Koffee Too to study. I don't like its structure--two adjacent rectangles separated by a wall--as much as Koffee which has two adjacent squares flowing into one another (more angles but open ones so that it feels like one big place with lots of corners). I usually choose it over Koffee for proximity's sake, but today it was also for the busy street view.
I ordered almond steamed milk but the order was wrong and they gave me peppermint instead. I told the guy it was okay and that I'd try something new. I've only had vanilla and almond before, and peppermint wasn't better than those, but it made me want to try all the flavors (there's maybe thirty). Which I can probably do because I always get steamed milk. I thought about how Toscanini's has closed in Harvard Square and how I can never get Vietnamese coffee (coffee with condensed milk, lovingly sweet so you don't need extra sugar) from there again. Steamed milk, which is also warm and sweet, isn't better or worse, just different.
I opened my biochemistry text and began reading about glycolysis, which we started learning a couple weeks ago (um, I'm just a little behind). I've tried looking at it before but it all seemed like mindless mechanism and I didn't think there was any point in memorizing details I'll just forget. But our biochem conferences have been pretty interesting and I find myself with a funny desire to want to understand conceptually the breakdown of glucose and all the related processes. Today it fell into place more and I decided that glycolysis (and all the pathways we've learned since) is an acquired taste, and I believe in letting things grow on you (probably because I'm the type of person who needs to grow on people). There's certain satisfaction in being able to follow a system. I read in more detail about how glucose synthesis isn't the exact opposite of glucose breakdown because breakdown requires some irreversible reactions. You can't just go back; to make glucose you have get around those irreversibilities, make up some new reactions. And there are all sorts of ways your body tells you to make or break down sugar. It's pretty cool.
I took breaks to read Kafka on the Shore, which came in my mail today. Haruki Murakami is like an old friend, immediately comforting. His language pulls you in so swiftly, you don't even notice except that so suddenly you realize you're content. The main character in the book runs away to Takamatsu, on the island of Shikoku: "Shikoku, I decide. That's where I'll go. There's no particular reason it has to be Shikoku, only that studying the map I got the feeling that's where I should head. The more I look at the map--actually every time I study it--I got the feeling that's where I should head. It's far south of Tokyo, separated from the mainland by water, with a warm climate. I've never been there, have no friends or relatives there, so if somebody started looking for me--which I kind of doubt--Shikoku would be the last place they'd think of."
During my solitary trek south to get to Aud's island this past summer, I went to Takamatsu and it was one of my favorite parts of the trip, partly because I felt the most alone there than anywhere else. From my journal that day: "The train getting here was shaky and lacked signs. Getting off at a station, there was one person manning a run-down booth...The train only comes every half hour. It might be the typhoon but everything is empty and desolate, and the air is a bit ominous. I found groves and a small nursery on my hunt for bonsai. There's almost no one around, and the landscape here is so different. Very few buildings. Just sharply shingled rooftops, train tracks, narrow streets, and green and brown, plant and dirt."
While studying, an English teacher began holding office hours with her students at the table next to me. It was so representative of the kind of meetings I'd have back in college. I miss the kind of thoughts that writing essays forces you to consider and develop, but am also glad that I'm free to think without need to commit to a structure and thesis. I eavesdropped on two different students' ideas for their papers (the role of women in proposal scenes in The Importance of Earnest and how language interacts with social context of separate plays) before I decided I needed to move if I wanted to study anything.
I moved to a window-side cushy chair and while I got some work done, I found that my studying requires a hard surface and space to spread my things. It wasn't too long after that that I headed back to campus, darker out now, especially with daylight savings disappearing. Another day over that in retrospect, will be the filler between significant events, but that in the moment is all you have.
I went to Koffee Too to study. I don't like its structure--two adjacent rectangles separated by a wall--as much as Koffee which has two adjacent squares flowing into one another (more angles but open ones so that it feels like one big place with lots of corners). I usually choose it over Koffee for proximity's sake, but today it was also for the busy street view.
I ordered almond steamed milk but the order was wrong and they gave me peppermint instead. I told the guy it was okay and that I'd try something new. I've only had vanilla and almond before, and peppermint wasn't better than those, but it made me want to try all the flavors (there's maybe thirty). Which I can probably do because I always get steamed milk. I thought about how Toscanini's has closed in Harvard Square and how I can never get Vietnamese coffee (coffee with condensed milk, lovingly sweet so you don't need extra sugar) from there again. Steamed milk, which is also warm and sweet, isn't better or worse, just different.
I opened my biochemistry text and began reading about glycolysis, which we started learning a couple weeks ago (um, I'm just a little behind). I've tried looking at it before but it all seemed like mindless mechanism and I didn't think there was any point in memorizing details I'll just forget. But our biochem conferences have been pretty interesting and I find myself with a funny desire to want to understand conceptually the breakdown of glucose and all the related processes. Today it fell into place more and I decided that glycolysis (and all the pathways we've learned since) is an acquired taste, and I believe in letting things grow on you (probably because I'm the type of person who needs to grow on people). There's certain satisfaction in being able to follow a system. I read in more detail about how glucose synthesis isn't the exact opposite of glucose breakdown because breakdown requires some irreversible reactions. You can't just go back; to make glucose you have get around those irreversibilities, make up some new reactions. And there are all sorts of ways your body tells you to make or break down sugar. It's pretty cool.
I took breaks to read Kafka on the Shore, which came in my mail today. Haruki Murakami is like an old friend, immediately comforting. His language pulls you in so swiftly, you don't even notice except that so suddenly you realize you're content. The main character in the book runs away to Takamatsu, on the island of Shikoku: "Shikoku, I decide. That's where I'll go. There's no particular reason it has to be Shikoku, only that studying the map I got the feeling that's where I should head. The more I look at the map--actually every time I study it--I got the feeling that's where I should head. It's far south of Tokyo, separated from the mainland by water, with a warm climate. I've never been there, have no friends or relatives there, so if somebody started looking for me--which I kind of doubt--Shikoku would be the last place they'd think of."
During my solitary trek south to get to Aud's island this past summer, I went to Takamatsu and it was one of my favorite parts of the trip, partly because I felt the most alone there than anywhere else. From my journal that day: "The train getting here was shaky and lacked signs. Getting off at a station, there was one person manning a run-down booth...The train only comes every half hour. It might be the typhoon but everything is empty and desolate, and the air is a bit ominous. I found groves and a small nursery on my hunt for bonsai. There's almost no one around, and the landscape here is so different. Very few buildings. Just sharply shingled rooftops, train tracks, narrow streets, and green and brown, plant and dirt."
While studying, an English teacher began holding office hours with her students at the table next to me. It was so representative of the kind of meetings I'd have back in college. I miss the kind of thoughts that writing essays forces you to consider and develop, but am also glad that I'm free to think without need to commit to a structure and thesis. I eavesdropped on two different students' ideas for their papers (the role of women in proposal scenes in The Importance of Earnest and how language interacts with social context of separate plays) before I decided I needed to move if I wanted to study anything.
I moved to a window-side cushy chair and while I got some work done, I found that my studying requires a hard surface and space to spread my things. It wasn't too long after that that I headed back to campus, darker out now, especially with daylight savings disappearing. Another day over that in retrospect, will be the filler between significant events, but that in the moment is all you have.
Sunday, November 4, 2007
hunger
I'm always hungry. It's not always I'm-starving and it's not like I can't go without food during my cravings. Sometimes it's just a slight hollow that shifts to different areas of my stomach and mind, making me think I'd like something sweet one moment, salty the next, ooh maybe sweet and salty.
Today I told Albert that I think I'm leptin-deficient with a super metabolism (kidding, but this is a scientific possibility no?). Leptin is related to satiety; without it you feel hungry even after eating and this can lead to obesity. He said that in this case I should be grateful for my deficiency because without it my super metabolism would kill me. I hadn't considered that. My abnormalities, a lack of one thing and an excess of another, balance each other. The fetal heart comes to mind again, how sometimes when you have multiple defects, one abnormality keeps you alive in the presence of another. Science is an endless source of unoriginal analogies and I've been studying all day, somewhat to catch up and mostly to be alone.
Also today I told D that he's peculiar, not so much because his individual qualities are peculiar but because the combination of them is. All this got me thinking about qualities in general, how they communicate and interact within a person.
People always say that when you arrive to a new place, you can reinvent yourself, offer whatever representation of yourself that you'd like. But we also know that even if you attempt that, you inevitably fall back into yourself. I've been lucky to grow up appreciating what I can offer and also knowing full well the wide expanse for improvement, and being comfortable with both.
But with each new place, there is still that inner desire to transition from quiet to loud. I use these terms not to necessarily describe literal volume, but more as a way to classify people whose selves come across with ease (loud), versus people whose selves are below the surface (quiet). And this doesn't correlate to superficial versus deep. There are people who are deep that immediately come across that way, and I'd classify them as loud.
The process of knowing yourself and other people here has been interesting, because it's a dynamic I haven't encountered before. A hundred of us, with the same schedule and routine of work and play, half of us living and eating in the same space, the other half barely dispersed in a two-mile radius from the rest. There's only so much room for difference in what we do, and maybe because of that, there's also a lot of space to draw upon individual characters and qualities. You see yourself being unravelled and digested by other people in the same way that people have unravelled and digested you before. There are the few more invested encounters that have their unique nuances but where you place among the larger population often follows a similar pattern.
Here I'm one of many because I'm from California and went to Harvard. Here I'm distinct for being an English major and the only Vietnamese girl. Most everyone knows these superficial details, and while they're superficial, it's nice that we know them about each other. It's nice to have a baseline, so that certain things come across despite quietness. And though I feel the time may have passed to get past baseline with some because friends have formed and niches carved, there are many opportunities for those things beyond baseline to come across.
Even with the potential, there sometimes feels like something is missing, something I can't quite share because of my quietness. Because of the stillness that arises from fierce deficiencies and stormy excesses. Maybe it's not solely me. Maybe the quiet of connection is the result of not just my own quietness but of a serendipitous balance between the quirks of interaction. One means of communication working in high gear masks the inability of another to function, leaving a neutral line of understanding. Maybe the intricate compromise struck between abnormalities and oddities within a single person is also characteristic of interaction among people, lying in the space in between. The only way you can tell if this is true is if you feel that slight hollow that's fed and then needs to be fed again.
Today I told Albert that I think I'm leptin-deficient with a super metabolism (kidding, but this is a scientific possibility no?). Leptin is related to satiety; without it you feel hungry even after eating and this can lead to obesity. He said that in this case I should be grateful for my deficiency because without it my super metabolism would kill me. I hadn't considered that. My abnormalities, a lack of one thing and an excess of another, balance each other. The fetal heart comes to mind again, how sometimes when you have multiple defects, one abnormality keeps you alive in the presence of another. Science is an endless source of unoriginal analogies and I've been studying all day, somewhat to catch up and mostly to be alone.
Also today I told D that he's peculiar, not so much because his individual qualities are peculiar but because the combination of them is. All this got me thinking about qualities in general, how they communicate and interact within a person.
People always say that when you arrive to a new place, you can reinvent yourself, offer whatever representation of yourself that you'd like. But we also know that even if you attempt that, you inevitably fall back into yourself. I've been lucky to grow up appreciating what I can offer and also knowing full well the wide expanse for improvement, and being comfortable with both.
But with each new place, there is still that inner desire to transition from quiet to loud. I use these terms not to necessarily describe literal volume, but more as a way to classify people whose selves come across with ease (loud), versus people whose selves are below the surface (quiet). And this doesn't correlate to superficial versus deep. There are people who are deep that immediately come across that way, and I'd classify them as loud.
The process of knowing yourself and other people here has been interesting, because it's a dynamic I haven't encountered before. A hundred of us, with the same schedule and routine of work and play, half of us living and eating in the same space, the other half barely dispersed in a two-mile radius from the rest. There's only so much room for difference in what we do, and maybe because of that, there's also a lot of space to draw upon individual characters and qualities. You see yourself being unravelled and digested by other people in the same way that people have unravelled and digested you before. There are the few more invested encounters that have their unique nuances but where you place among the larger population often follows a similar pattern.
Here I'm one of many because I'm from California and went to Harvard. Here I'm distinct for being an English major and the only Vietnamese girl. Most everyone knows these superficial details, and while they're superficial, it's nice that we know them about each other. It's nice to have a baseline, so that certain things come across despite quietness. And though I feel the time may have passed to get past baseline with some because friends have formed and niches carved, there are many opportunities for those things beyond baseline to come across.
Even with the potential, there sometimes feels like something is missing, something I can't quite share because of my quietness. Because of the stillness that arises from fierce deficiencies and stormy excesses. Maybe it's not solely me. Maybe the quiet of connection is the result of not just my own quietness but of a serendipitous balance between the quirks of interaction. One means of communication working in high gear masks the inability of another to function, leaving a neutral line of understanding. Maybe the intricate compromise struck between abnormalities and oddities within a single person is also characteristic of interaction among people, lying in the space in between. The only way you can tell if this is true is if you feel that slight hollow that's fed and then needs to be fed again.
Wednesday, October 24, 2007
broken
My laptop fell against the wooden table in the dining hall and the wireless card cracked, so that the covering doesn't seal the metal beneath. I Scotch-taped it, and lodged a book underneath it to keep it semi-stable. My internet flickers in and out. I have to reconnect, both to wireless and to Yale's private network each time. Don lent me a wireless card until I get a new one, but I've yet to use it or to order a new one. I'm waiting for this one to completely die out. My cell phone got caught in the rain, and wouldn't turn on. When it finally did turn on, I couldn't dial or receive calls. When I can hear someone, there's a lot of static. It sometimes turns back off, and is stubborn about returning to me. I check on it every few hours, nurse it and hold out hope that I will not need to replace it.
I have a neurotic thing about using up all my toiletries, a habit that didn't develop or become evident until I came to college and had to move each year. I like to finish my soap, toothpaste, shampoo, laundry detergent down to their last sliver, pea-sized blob, drop and so on, before I go on to another place, and in the rare case that I time it incorrectly, I bring these things with me. I can't throw them away. I have old folders whose sides I've taped up repeatedly to use again. I'm also obsessive about recycling paper, and it has little to do with the environment, more about making use of things. I keep most things, and often not out of sentimental value but out of pure value. I still have my first pair of flip-flops, from high school. And it's not about being frugal. They probably cost four dollars and I definitely got my money's worth after the first year of constant wear. I still have them because I can still wear them and because I still like them. Their jean-blue is interrupted by lines of white as their fabric's worn, and I've scruffed the layers down near the sole. I keep most anything that still fits no matter how old, I re-use and re-use.
Yesterday I wanted to write about how amazing anatomy has been. Working on her foregut pre-lab in my room, Allison mentioned how "hardy" the body is. How so many things go wrong but we find ways to survive, imperfectly. You don't REALLY need a gallbladder because bile can go from your liver to the duodenum fine. Every place in your body has at least two sources of blood, just in case one goes astray. It might make the vessels in your abdomen protrude like the head of Medusa, but you'll be alive. And of course we learn about syndrome after syndrome. Marfan, Wilson's, Horner's. Have seen patients with kidney transplants, spleens five times the normal size, cancers of the kidney and blood and so much. And each person functions in their own way, a little broken in places in the body and sometimes, most painfully, in heart.
The frail woman with Wilson's sat so still, clenched her hands so tight, stared out at us without blinking and little fear. When the light of the projector flooded her face, she squinted slowly and covered her eyes matter-of-factly. For all that calm, it felt at times like she was hiding, and how much of it was her illness and how much of it was her, I couldn't tell. I came out of that lecture thinking that my body's built better but she's stronger. With her, the way the pieces fit differently was visible, and you feel that with every patient who tells you that this or that is wrong, and it made something else wrong, and they're trying to put themselves back together but things might be missing or awry but they just want to be kept together somehow. It's okay, things have to be moved around. Scotch-taped.
And so it's hard for me to let go. I understand the difference between a quality existence and a mere existence for existence sake, but I believe so strongly in giving something its fullest life, to finding what lies in between the broken pieces. And the thing is, I do believe in an inherent, inexplicable value in just existing, continuing.
Today we had class about patient autonomy, the right of a patient to refuse treatment, to be treated as he wishes. We watched part of a documentary about Dax Cowart, a man who was severely burned in a freak explosion. Words could never conjure the image of his pain in that aftermath; it looked and felt excruciating. He wanted badly to die. He felt his life would so decrease in quality, that it wouldn't be worth going through the pain of rehabilitation to get there. He was a versatile athlete, and those days would be long over. His shrunken figure, with skin so foreign you could barely register it except for when a limb moved beneath it, begged to relieve its burden. I don't think anyone watching his whole self asking to be gone wanted to say no.
We talked for awhile about Dax. Then we saw a clip of him years later. After rehabilitation and two suicide attempts, Dax became a married lawyer. He'd lost his sight, but could live independently and actively. He fights for patients' rights to autonomy. He says that he doesn't blame his mother for keeping him alive, but that he should've been the one to make the decision. He emphasizes quality. For example, he says, if he lost his hearing, he would see that as a lesser life and he wouldn't want that. I didn't buy that, though. If he'd lost his hearing first and still had his sight, he'd probably value his sight in the same way. But because he'd already lost it, he learned to live without it. And yes, who am I to judge whether he is living as fully as if he weren't like that? I do respect people's choices, and I know that how I see life is different from how each person sees life. And of course there are boundaries and limits to how much pain a person can bear, and it depends on what lies ahead, and quality does matter because life is the non-necessities, the more-than-breathing. How I feel about this isn't a straightforward statement about how I'd want to treat a patient or even Dax himself; I still have much to learn.
But what I think about most is this. He's still living; each day he chooses to live. Do the pieces fit differently? Yes. Do they hurt, jamming into each other and sliding past and reorganizing? Yes. But do they continue? Yes.
I have a neurotic thing about using up all my toiletries, a habit that didn't develop or become evident until I came to college and had to move each year. I like to finish my soap, toothpaste, shampoo, laundry detergent down to their last sliver, pea-sized blob, drop and so on, before I go on to another place, and in the rare case that I time it incorrectly, I bring these things with me. I can't throw them away. I have old folders whose sides I've taped up repeatedly to use again. I'm also obsessive about recycling paper, and it has little to do with the environment, more about making use of things. I keep most things, and often not out of sentimental value but out of pure value. I still have my first pair of flip-flops, from high school. And it's not about being frugal. They probably cost four dollars and I definitely got my money's worth after the first year of constant wear. I still have them because I can still wear them and because I still like them. Their jean-blue is interrupted by lines of white as their fabric's worn, and I've scruffed the layers down near the sole. I keep most anything that still fits no matter how old, I re-use and re-use.
Yesterday I wanted to write about how amazing anatomy has been. Working on her foregut pre-lab in my room, Allison mentioned how "hardy" the body is. How so many things go wrong but we find ways to survive, imperfectly. You don't REALLY need a gallbladder because bile can go from your liver to the duodenum fine. Every place in your body has at least two sources of blood, just in case one goes astray. It might make the vessels in your abdomen protrude like the head of Medusa, but you'll be alive. And of course we learn about syndrome after syndrome. Marfan, Wilson's, Horner's. Have seen patients with kidney transplants, spleens five times the normal size, cancers of the kidney and blood and so much. And each person functions in their own way, a little broken in places in the body and sometimes, most painfully, in heart.
The frail woman with Wilson's sat so still, clenched her hands so tight, stared out at us without blinking and little fear. When the light of the projector flooded her face, she squinted slowly and covered her eyes matter-of-factly. For all that calm, it felt at times like she was hiding, and how much of it was her illness and how much of it was her, I couldn't tell. I came out of that lecture thinking that my body's built better but she's stronger. With her, the way the pieces fit differently was visible, and you feel that with every patient who tells you that this or that is wrong, and it made something else wrong, and they're trying to put themselves back together but things might be missing or awry but they just want to be kept together somehow. It's okay, things have to be moved around. Scotch-taped.
And so it's hard for me to let go. I understand the difference between a quality existence and a mere existence for existence sake, but I believe so strongly in giving something its fullest life, to finding what lies in between the broken pieces. And the thing is, I do believe in an inherent, inexplicable value in just existing, continuing.
Today we had class about patient autonomy, the right of a patient to refuse treatment, to be treated as he wishes. We watched part of a documentary about Dax Cowart, a man who was severely burned in a freak explosion. Words could never conjure the image of his pain in that aftermath; it looked and felt excruciating. He wanted badly to die. He felt his life would so decrease in quality, that it wouldn't be worth going through the pain of rehabilitation to get there. He was a versatile athlete, and those days would be long over. His shrunken figure, with skin so foreign you could barely register it except for when a limb moved beneath it, begged to relieve its burden. I don't think anyone watching his whole self asking to be gone wanted to say no.
We talked for awhile about Dax. Then we saw a clip of him years later. After rehabilitation and two suicide attempts, Dax became a married lawyer. He'd lost his sight, but could live independently and actively. He fights for patients' rights to autonomy. He says that he doesn't blame his mother for keeping him alive, but that he should've been the one to make the decision. He emphasizes quality. For example, he says, if he lost his hearing, he would see that as a lesser life and he wouldn't want that. I didn't buy that, though. If he'd lost his hearing first and still had his sight, he'd probably value his sight in the same way. But because he'd already lost it, he learned to live without it. And yes, who am I to judge whether he is living as fully as if he weren't like that? I do respect people's choices, and I know that how I see life is different from how each person sees life. And of course there are boundaries and limits to how much pain a person can bear, and it depends on what lies ahead, and quality does matter because life is the non-necessities, the more-than-breathing. How I feel about this isn't a straightforward statement about how I'd want to treat a patient or even Dax himself; I still have much to learn.
But what I think about most is this. He's still living; each day he chooses to live. Do the pieces fit differently? Yes. Do they hurt, jamming into each other and sliding past and reorganizing? Yes. But do they continue? Yes.
Sunday, October 21, 2007
save october
For all the useful (2%) and useless (98%) thinking that I do, feeling inevitably comes first.
October doesn't feel like October. It's too warm, and the trees haven't changed color. Maybe in the next few years, what used to be October will weave its way through to November or December, the way that wine country is predicted to move north from California through Oregon to Washington. So maybe it's not lost; it will just be in a different place, and that's the kind of thinking that normally comforts me. Except this time I can't bring myself to idealize the change. Because just when October has become my favorite month, it's slipping away from me. And October in November is not the same as October in October. Even if another month stole its temperature, its sunny cold days and light brush of a breeze, the effective crunch of dry leaves and the soggy stickiness of the wet ones slicked to shoe bottoms, the warm fiery colors, the medium-long days, even the sweet nostalgia for passing heat and anticipation of cold, and if you're in Boston, the first snow of the year...even if some imposter could do all that, it can't take its place in time. October is situated in transition. It lives after the waning summer, in the throes of schooltime beginnings, nestles itself before the big holidays and end of year. So please don't pass into something else, because you are the comings and goings. You can't come and go.
Awash in moods like this, I fixate on a question someone recently asked me about whether I'm easily attached. I do form strong affection for little, stupid things quickly, like the bump on my ring and the dots on my face (not moles, not freckles?) and people's laughs and the way they sleep. And okay, while I could accept letting go of those things if I had to, I do like sustaining the bigger things, in mind if nothing else. I can still feel the linoleum of Donnolly Hall against my bare legs on skirt days, can place myself into the intimate coziness of Adams B-37, will still smile at how he'd take care to return the strap of my tank top back to my shoulder after moving it to kiss me there, can every so often let the chill of the Sunset fog pass over and through me.
I value intimacy, the things that make me want to wrap my arms around them. Like everyone else, I want connection. Why, then, am I so drawn to distance in my relationships? With A and me, distance was defining. Physically apart, lives on entirely polar paths, opposite sensibilities. My parents always wondered why I didn't date anyone from school, my friends never imagined me with someone so different from me. Proximity wasn't appealing. In recent encounters there's been emotional distance, which somehow lends itself to an emotional interaction. Distance takes effort, it's rewarding, it challenges you and can sometimes make you more true. But sometimes, more than anything it's too hard and it's so elusive that I wonder how it can have such a grasp on me.
I don't make any sense but this is how it is. I don't want October to move to November, and I want to keep distance close.
October doesn't feel like October. It's too warm, and the trees haven't changed color. Maybe in the next few years, what used to be October will weave its way through to November or December, the way that wine country is predicted to move north from California through Oregon to Washington. So maybe it's not lost; it will just be in a different place, and that's the kind of thinking that normally comforts me. Except this time I can't bring myself to idealize the change. Because just when October has become my favorite month, it's slipping away from me. And October in November is not the same as October in October. Even if another month stole its temperature, its sunny cold days and light brush of a breeze, the effective crunch of dry leaves and the soggy stickiness of the wet ones slicked to shoe bottoms, the warm fiery colors, the medium-long days, even the sweet nostalgia for passing heat and anticipation of cold, and if you're in Boston, the first snow of the year...even if some imposter could do all that, it can't take its place in time. October is situated in transition. It lives after the waning summer, in the throes of schooltime beginnings, nestles itself before the big holidays and end of year. So please don't pass into something else, because you are the comings and goings. You can't come and go.
Awash in moods like this, I fixate on a question someone recently asked me about whether I'm easily attached. I do form strong affection for little, stupid things quickly, like the bump on my ring and the dots on my face (not moles, not freckles?) and people's laughs and the way they sleep. And okay, while I could accept letting go of those things if I had to, I do like sustaining the bigger things, in mind if nothing else. I can still feel the linoleum of Donnolly Hall against my bare legs on skirt days, can place myself into the intimate coziness of Adams B-37, will still smile at how he'd take care to return the strap of my tank top back to my shoulder after moving it to kiss me there, can every so often let the chill of the Sunset fog pass over and through me.
I value intimacy, the things that make me want to wrap my arms around them. Like everyone else, I want connection. Why, then, am I so drawn to distance in my relationships? With A and me, distance was defining. Physically apart, lives on entirely polar paths, opposite sensibilities. My parents always wondered why I didn't date anyone from school, my friends never imagined me with someone so different from me. Proximity wasn't appealing. In recent encounters there's been emotional distance, which somehow lends itself to an emotional interaction. Distance takes effort, it's rewarding, it challenges you and can sometimes make you more true. But sometimes, more than anything it's too hard and it's so elusive that I wonder how it can have such a grasp on me.
I don't make any sense but this is how it is. I don't want October to move to November, and I want to keep distance close.
Wednesday, September 26, 2007
the heart
Me: I think I have a heart defect.
Friend: Why?
Me: I have to think about it. I just know it's an odd heart.
*
We've been learning about the heart. We've read about it from the point that two cells make one embryo, to how it functions in a baby, to how it morphs into an adult. We've seen our professor twist foam tubes to help us visualize (couldn't tell one end from another). We've watched animations on our computer on how the heart folds, closes, develops. We've detached the lungs from the heart in our donors, and held the heart in our hands--not fully, still clinging onto the body. We haven't seen the individual chambers yet, but we can peer at the vessels cut open on either side.
The heart, like everything when you really think about it, is complicated and simple. It is important and complex. It's a system, and of course another system could have worked, but it's this one that we have. It's an amazing one, but a million things can go wrong. In the end it's a fragile thing; it gets confused and malformed and tired out. It is so beautiful.
The fetal heart can't depend on lungs for oxygen. So it comes up with all these mechanisms to deal with it. It might make you wonder why the fetus doesn't just have functional lungs. But you don't instinctually think that. Instinctually you think that of course, it has to grow. Its starts one way and it learns and ends up in another way. It doesn't happen right away. I think it's funny, though, that the mechanisms the heart has to cope with not being fully developed yet, are just as complex as the development the heart is waiting for.
Sometimes the adult heart suffers because one of these fetal heart qualities persists, never goes away. In the fetal heart blood can travel between the right and left atria. In the adult heart, this portal closes. It should close.
In one of our case studies, a patient had a thrombus (clot) in his vein that traveled to his brain and caused a stroke. In a normal person, this clot would have traveled through his heart to his lungs and might not have caused much of a problem. But this patient still had the portal between his atria. So the clot has two paths: a normal one through one atrium to the lung and an abnormal one, through one atrium to the next atrium and to the body, to the brain. The clot in this patient took the latter path. An online animation showed the clot on its course, and I found myself mourning it aloud. Oh no. Oh, that's sad.
This is called a "paradoxical" clot, because it starts out in one system (pulmonary, that of the lungs), but it ends in another (systemic, that of the body). That's the price of staying undeveloped, of staying open, of leaving another path, one that's not right and not healthy. Your system hurts itself, makes a mistake, misjudges.
But you can't say it's unnatural, this so-called defect--it's natural, it's how you were made. And so what if you didn't make the decision to have it that way, to keep a remnant of your innocent, brand-new self? And so what if you still have the choice of two paths, when inevitably you are going to have to go down both and one will hurt?
I love the heart. It's so strong and vulnerable. It can adjust to some alterations, but it's particular. It needs certain things, and it needs them to give them away, all the while sustaining itself. I love the heart. But I don't think I will study it in isolation. Someone else should prevent strokes and the like, but me, I don't think I can look after odd hearts. I wouldn't want to fix them.
Friend: Why?
Me: I have to think about it. I just know it's an odd heart.
*
We've been learning about the heart. We've read about it from the point that two cells make one embryo, to how it functions in a baby, to how it morphs into an adult. We've seen our professor twist foam tubes to help us visualize (couldn't tell one end from another). We've watched animations on our computer on how the heart folds, closes, develops. We've detached the lungs from the heart in our donors, and held the heart in our hands--not fully, still clinging onto the body. We haven't seen the individual chambers yet, but we can peer at the vessels cut open on either side.
The heart, like everything when you really think about it, is complicated and simple. It is important and complex. It's a system, and of course another system could have worked, but it's this one that we have. It's an amazing one, but a million things can go wrong. In the end it's a fragile thing; it gets confused and malformed and tired out. It is so beautiful.
The fetal heart can't depend on lungs for oxygen. So it comes up with all these mechanisms to deal with it. It might make you wonder why the fetus doesn't just have functional lungs. But you don't instinctually think that. Instinctually you think that of course, it has to grow. Its starts one way and it learns and ends up in another way. It doesn't happen right away. I think it's funny, though, that the mechanisms the heart has to cope with not being fully developed yet, are just as complex as the development the heart is waiting for.
Sometimes the adult heart suffers because one of these fetal heart qualities persists, never goes away. In the fetal heart blood can travel between the right and left atria. In the adult heart, this portal closes. It should close.
In one of our case studies, a patient had a thrombus (clot) in his vein that traveled to his brain and caused a stroke. In a normal person, this clot would have traveled through his heart to his lungs and might not have caused much of a problem. But this patient still had the portal between his atria. So the clot has two paths: a normal one through one atrium to the lung and an abnormal one, through one atrium to the next atrium and to the body, to the brain. The clot in this patient took the latter path. An online animation showed the clot on its course, and I found myself mourning it aloud. Oh no. Oh, that's sad.
This is called a "paradoxical" clot, because it starts out in one system (pulmonary, that of the lungs), but it ends in another (systemic, that of the body). That's the price of staying undeveloped, of staying open, of leaving another path, one that's not right and not healthy. Your system hurts itself, makes a mistake, misjudges.
But you can't say it's unnatural, this so-called defect--it's natural, it's how you were made. And so what if you didn't make the decision to have it that way, to keep a remnant of your innocent, brand-new self? And so what if you still have the choice of two paths, when inevitably you are going to have to go down both and one will hurt?
I love the heart. It's so strong and vulnerable. It can adjust to some alterations, but it's particular. It needs certain things, and it needs them to give them away, all the while sustaining itself. I love the heart. But I don't think I will study it in isolation. Someone else should prevent strokes and the like, but me, I don't think I can look after odd hearts. I wouldn't want to fix them.
Monday, September 24, 2007
one part
I've been itching to write about old and new for the past month I've been here, but I honestly haven't had a period of time and space to do so. When I'm not in class or attending a meeting with a free meal or doing an anatomy pre-lab or in anatomy lab or eating pizza (New Haven = pizza town) or waiting for the ridiculous elevator in Harkness (my dorm), I'm having pure, concentrated fun with my classmates. I consistently push aside thought for experience. The entry I've been longing to write and thought I would write this weekend will remain a longing because I went to the beach and spent an evening playing board/word/kid games.
Last week I attended a reading by Christine Montross, a doctor-writer, who wrote a book based on her experiences in anatomy. A couple of weeks ago, our entire class heard Anne Fadiman speak, the author of a book about the role of cultural differences in caring for a Hmong baby with epilepsy. She said that she didn't choose to write the book; it chose her. The second she said that, I thought, nothing in my life has chosen me. I've chosen everything. And maybe that's why I haven't felt compelled to really write anything. Both Anne Fadiman and Christine Montross mentioned the importance of writing in the moment, as you feel, to gather your experiences, to journal. When I asked her how one goes about being chosen, Anne Fadiman interpreted my question as how do I go about being chosen and suggested that I draw upon everything that I'm seeing and doing now in medical school.
And there is an amazing amount to draw upon. But the thing is--there is an amazing amount. Even in one day there is so much. Most days I spend two full minutes in awe of it. That doesn't sound like much, but how often do you spend two full minutes not really thinking anything but just in stupefied wonder? Instead of incompletely fleshing it all out, I let these things stack and build and sometimes topple. They don't dissipate in my mind, but I'm becoming so awash, so inundated that I'm resorting to bits and pieces. Which is maybe more realistic, more representative.
This is ending up to be ironic because I wanted to write about how I think I might have overcommitted myself here. But there are several things I'm truly excited about, and the idea of potential is always so nice to share. I've also been out of touch with the few of you who read this, so here's an update of one part of my life: the extracurriculars.
Atrium Magazine...So a few of my lovely classmates and I are starting a literary magazine for the students in all the health schools at Yale. We've named it ATRIUM, which calls forth a structural, living, artistic throb with and without analysis. I'm incredibly excited to create something from scratch, to see the talents of all the people here, and there has been so much enthusiasm and support already. The community is so small that most anyone in my class can come up to me and ask me about it. There is warmth in a communal recognition of one of your passions.
Haven Free Clinic...I'll be working in the Social Services department, something on which Harvard and Project Health have gotten me forever hooked. It's here where things are most basic and most complicated--people's baseline needs and the labyrinth you go through to get them. So many students are involved in the clinic that we work only a few weekends a semester, which is something I've been disappointed in here (the lack of more regular, long-term activities), but it does give exposure and allows room for other pursuits. A great deal of it focuses on insurance, which will be incredibly useful, and the experience will cover a lot of ground that school won't look down to see.
Immigrant & Refugee Services...Because of that, I looked for some things outside of Yale I could do more regularly, and found a really great program focused on helping refugees adjust to life in New Haven, in all respects--English tutoring, cultural adjustment, community outings, social services. They come from all over; each family is given individual attention. Today I was told that a mom, dad and one year old girl would be moving to New Haven from Somalia on September 24. Anyway, I just have a small commitment. I'll be taking people to doctor's appointments, helping them navigate the bus system to get back and forth and help make sure communication with the doctors are okay. Working with refugees is something I'd really like to do in the future, and this seems like a great way to get to know this town, its people and its transportation and neighborhoods and feel.
Educational Care Clinic...So this program is so much like ASK that I couldn't really pass up on it. The differences are that it's much less regulated (no doctor working with us, no actual clinic, less protocol and expertise overall), but a bit more narrow and personal (we have one student that we tutor regularly). We advocate for educational resources similar to the way we did in ASK, but more on our own (depending on how this goes, it would be nice to offer some of the things we did in ASK to this program). The appealing part is that we get to tutor at the same time, giving it a more wholistic character and real attachment. It's also a very new and rough program. Project HEALTH spoiled me with its ability to look at broad social structures and work personally with people too. I miss it.
Columbus House...This is another few-times-a-semester commitment that a whole bunch of the med students do because of the patient time. It basically involves taking histories from people getting free healthcare at a local homeless shelter. At school they devote a whole year to teaching us how to take a good history, how to elicit a patient's story. It's one of those things that make me feel that this fits.
But I also think I might not pursue this until next semester. I wanted to write about these things because each one makes me look forward and excited. It wasn't to show how much we do here, because most of the things don't require huge investments. I'm also not particularly ambitious, because a huge number of our class is involved in these things (class dynamic is a topic that will not go unwritten). Still, I'm overwhelmed, because somehow I've forgotten that I'm also in school and I need to learn things. And not just school, but school that is life not just in physical place and mental hours but in the way it grips you inside-out because it's what you feel and think and work for, hope for. More on that, little by little.
Last week I attended a reading by Christine Montross, a doctor-writer, who wrote a book based on her experiences in anatomy. A couple of weeks ago, our entire class heard Anne Fadiman speak, the author of a book about the role of cultural differences in caring for a Hmong baby with epilepsy. She said that she didn't choose to write the book; it chose her. The second she said that, I thought, nothing in my life has chosen me. I've chosen everything. And maybe that's why I haven't felt compelled to really write anything. Both Anne Fadiman and Christine Montross mentioned the importance of writing in the moment, as you feel, to gather your experiences, to journal. When I asked her how one goes about being chosen, Anne Fadiman interpreted my question as how do I go about being chosen and suggested that I draw upon everything that I'm seeing and doing now in medical school.
And there is an amazing amount to draw upon. But the thing is--there is an amazing amount. Even in one day there is so much. Most days I spend two full minutes in awe of it. That doesn't sound like much, but how often do you spend two full minutes not really thinking anything but just in stupefied wonder? Instead of incompletely fleshing it all out, I let these things stack and build and sometimes topple. They don't dissipate in my mind, but I'm becoming so awash, so inundated that I'm resorting to bits and pieces. Which is maybe more realistic, more representative.
This is ending up to be ironic because I wanted to write about how I think I might have overcommitted myself here. But there are several things I'm truly excited about, and the idea of potential is always so nice to share. I've also been out of touch with the few of you who read this, so here's an update of one part of my life: the extracurriculars.
Atrium Magazine...So a few of my lovely classmates and I are starting a literary magazine for the students in all the health schools at Yale. We've named it ATRIUM, which calls forth a structural, living, artistic throb with and without analysis. I'm incredibly excited to create something from scratch, to see the talents of all the people here, and there has been so much enthusiasm and support already. The community is so small that most anyone in my class can come up to me and ask me about it. There is warmth in a communal recognition of one of your passions.
Haven Free Clinic...I'll be working in the Social Services department, something on which Harvard and Project Health have gotten me forever hooked. It's here where things are most basic and most complicated--people's baseline needs and the labyrinth you go through to get them. So many students are involved in the clinic that we work only a few weekends a semester, which is something I've been disappointed in here (the lack of more regular, long-term activities), but it does give exposure and allows room for other pursuits. A great deal of it focuses on insurance, which will be incredibly useful, and the experience will cover a lot of ground that school won't look down to see.
Immigrant & Refugee Services...Because of that, I looked for some things outside of Yale I could do more regularly, and found a really great program focused on helping refugees adjust to life in New Haven, in all respects--English tutoring, cultural adjustment, community outings, social services. They come from all over; each family is given individual attention. Today I was told that a mom, dad and one year old girl would be moving to New Haven from Somalia on September 24. Anyway, I just have a small commitment. I'll be taking people to doctor's appointments, helping them navigate the bus system to get back and forth and help make sure communication with the doctors are okay. Working with refugees is something I'd really like to do in the future, and this seems like a great way to get to know this town, its people and its transportation and neighborhoods and feel.
Educational Care Clinic...So this program is so much like ASK that I couldn't really pass up on it. The differences are that it's much less regulated (no doctor working with us, no actual clinic, less protocol and expertise overall), but a bit more narrow and personal (we have one student that we tutor regularly). We advocate for educational resources similar to the way we did in ASK, but more on our own (depending on how this goes, it would be nice to offer some of the things we did in ASK to this program). The appealing part is that we get to tutor at the same time, giving it a more wholistic character and real attachment. It's also a very new and rough program. Project HEALTH spoiled me with its ability to look at broad social structures and work personally with people too. I miss it.
Columbus House...This is another few-times-a-semester commitment that a whole bunch of the med students do because of the patient time. It basically involves taking histories from people getting free healthcare at a local homeless shelter. At school they devote a whole year to teaching us how to take a good history, how to elicit a patient's story. It's one of those things that make me feel that this fits.
But I also think I might not pursue this until next semester. I wanted to write about these things because each one makes me look forward and excited. It wasn't to show how much we do here, because most of the things don't require huge investments. I'm also not particularly ambitious, because a huge number of our class is involved in these things (class dynamic is a topic that will not go unwritten). Still, I'm overwhelmed, because somehow I've forgotten that I'm also in school and I need to learn things. And not just school, but school that is life not just in physical place and mental hours but in the way it grips you inside-out because it's what you feel and think and work for, hope for. More on that, little by little.
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