Hello loyal readers,
Thanks for following along this far. I have started a new blog, partially because I like Wordpress better than Livejournal, and partially because I thought it was time for something more professional, more general, and no longer partially anonymous. If you're interested in coming along, please comment and I'll help you make the move. This blog will still stay up for a while - I may migrate some posts over too - but I don't think I'll be writing new posts here.
~Miya_MD
1 Comment | Post A Comment | Add to Memories | Tell a Friend | Link
 |
| 2008-02-07 20:30 |
| Coals |
| Public |
|
No posting in a terribly long time. Why?
Why... I've been busy, for one, but that hasn't always stopped me before. I think that my previous post gives something of a clue: I knew I had entered and would continue to be in a time of greater uncertainty in some respects. More than anything, I'm in a tunnel. The light at the end is April 12, when I will not only be done with my second year of medical school and my entire preclinical training (that's on April 5) but will have also jumped through one more of the infinite hoops, Step I of the Boards, our licensing exam. Right now I'm just walking along through the tunnel, struggling with renal pathophysiology and for the Boards trying to resurrect things I never really learned in the first place. I know what is waiting for me at the end, but I have a ways to go before I get there: for now, I'm just plugging along. Left foot, right foot, left foot, stumble and fall (freak out then go into denial about all I have to learn/week of migraines/other such obstacles), then pick up again and keep on walking. Not a bad time, really, but not one that has led me to many inspired or insightful moments worth writing about.
As for the other strand of this journal, spiritual exploration has fallen by the way side for the moment. It's not that I'm beginning to question, because I don't think I really had any answers before. I guess that being forced to trim down on activities other than school and exam prep made me realize that, while I enjoyed going to church every week, it wasn't important or satisfying enough to me to trump other things. I have been feeling somewhat less connected to my previous congregation ever since our former senior minister left. He was followed within a year by our education minister (both separations on good terms and the timing was unrelated), so now the congregation is led by two interim ministers. The congregation is undergoing a long and complicated process of soul-searching and identity-discovery that at some other time I would enjoy being a part of, but honestly right now I need stability and structure. That combined with the commute meant that I stopped attending when I went home for the holidays, and I just haven't gone back since. I went a few Sundays to another much closer church. I love that it is a beautiful building (my soul is Unitarian Universalist, but my eyes are Catholic) and that their choir is able and that they use their organ more. I appreciated the services and the minister. I didn't feel an instant connection, not that I was expecting one... my real connection to First Parish came from the people I interacted with mainly through the campus group and then through the choir, but again, I'm not in a place right now where I can give much more than my presence. So yes, I'm for the moment being spiritually selfish: I want to show up at 11, be uplifted and inspired, and then go home at 12 to get back to work. Does this mean that, for now, church isn't for me? Maybe. There are other churches to explore where, who knows, I might find more within the bounds of the Sunday service. I also realized while talking to another UU at a friend's friend's potluck how different young adult worship is from the Sunday worship, and remembered how much I had enjoyed it when I had experienced it, so I would consider finding a young adult group. I'm pulled in both directions, the choir-and-stained-glass and the small-group-circle-meditation, which is probably a post for another day. Maybe someday I'll wind up back at First Parish, which I do miss.
The point of all of this, I guess, is that it's the part of the winter night where the fire has died down, but the coals are still quietly glowing. I have enough faith and optimism and mental health right now to know that they can and will flame up again. For now, it's left foot, right foot, stumble, and try again, and keep trying, and keep moving forward toward the future.
1 Comment | Post A Comment | Add to Memories | Tell a Friend | Link
|
|
Growing up, of course, I thought of Advent in terms of counting down until Christmas. We would get out the advent calendar with its twenty-four little wooden figures, and mark the days as we got closer and closer to the main event. The box marked 24 was always the largest, and the most important, and from the minute we opened it on Christmas Eve morning the anticipation just accelerated until Christmas Eve dinner with the family and then, finally, waking up on Christmas morning to begin the ritual of stockings, then kringle, then... presents! I once wrote myself a note saying "It's Christmas!" and put it in the bars of my canopy bed over my head, so that it would be the first thing I saw when I woke up and I wouldn't lose a second of knowing it was that special day.
Now, of course I still love the counting-down aspect of Advent, the focusing on what is to come; the number of days has just become somewhat more flexible. I am counting down with a cheap advent calendar with unpalatable chocolate, but the little images in each window of airplanes and ornaments remind me that I am marking the days until I fly home to my family and to the world of Christmas as we practice it on the 21st. I may even have to open doors 22, 23, and 24 in advance, before I leave Boston. And I sent my long-distance boyfriend a calendar as well, to count down the days not only until Christmas but, by implication, until we get to see each other again on the 27th.
But I no longer just love Advent for what happens when it is over. I have come to love it as a celebration of waiting itself, an honoring of the time-before-the-happening. This time of year is by its nature a time of waiting and uncertainty and always has been: once the last harvest is in, wondering whether stores will last until the spring, and as the sun sets earlier and earlier in the day, waiting for the night to slowly begin to shorten again. Personally, the last few wintry weeks have been difficult for me as my emotional energy flags and as I struggle to stay engaged in my schoolwork at a time when professional competence and rewards feel very far in the future. I am also struggling with uncertainty, with the inescapable fact that I cannot have complete mastery of the infinite amount I could want to know about medicine. Moreover, I am facing an overall paradigm shift as I come to recognize that much of my success before medical school was rooted in the availability of answers, but that my future success as a doctor and as an adult will be rooted in my ability to make the right decision based upon incomplete information.
So I resonate with Advent all the more. The metaphor of being in darkness and waiting for the light, being uncertain and waiting for an answer or a solution, is incredibly powerful. Whether the awaited light is the solstice or the Messiah or the lifting of sadness or worry, the waiting itself is worthy of recognition. It is even worthy of celebration, especially as it already is by faith communities, because it is part of the essence of faith. Believing in troubled times that a child will be born to change the world and that a star will bring light where there was darkness. Believing that the laws of the universe mean the Earth will continue to turn on its axis and bring back the daylight, without ever being able to see it move. And acting on that belief by continuing to put one foot in front of the other and continuing to go forward, and preparing the manger. The Maccabees did so, as I understand the Hanukkah story: expecting the oil in the temple to last only one night, they lit the lamp anyway, out of a need to express their joy at their victory and to show that their lives and their culture would continue on despite persecution. And sometimes the answer to faith is unexpected happenings: a great miracle happened there, the oil burned for eight days. Centuries later, as I gathered together with friends around a menorah in my classmate's apartment and mumbled through the candle blessings then talked earnestly with them about our dreams and our fears, I felt surrounded by love and light, and the holiday season became a time of brightness for me even in the face of my uncertainty and the darkness of the winter.
O come, O come, Emmanuel
And ransom captive Israel
That mourns in lonely exile here
Until the Son of God appear
Rejoice! Rejoice! Emmanuel
Shall come to thee, O Israel.
...
O come, Thou Day-Spring, come and cheer
Our spirits by Thine advent here
Disperse the gloomy clouds of night
And death's dark shadows put to flight.
Rejoice! Rejoice! Emmanuel
Shall come to thee, O Israel.
1 Comment | Post A Comment | Add to Memories | Tell a Friend | Link
|
|
Something I wrote back in August, originally as an email to a friend that I never sent. It's more personal than other entries here and many of my readers already know about the context - I hope it's not too hard for you to read it. I put it here on this medicine and spirituality blog because the second part says something important about end-of-life experiences in medicine, and the two parts together are about me consciously and subconsciously trying to make some sense of the changing of the generations: the feeling of no longer being the third living generation of my family, but now the second, and of how time can change the roles of caregiver and cared-for...
I had a dream last night that I have to believe was inspired by your talk at the panel about caring for people at the end of their lives... I dreamt I was with my paternal grandmother, who died several years ago after a long period of being ill and not really herself. We were talking as if it was before her illness, but I think I somehow knew - as one does in dreams - that she was dying, or that she had already died. I can't remember exactly what was said, but they were loving things, and it felt good to be close to her. She was upset for a while about a trip she regretted we had not taken together, but otherwise was at peace. And she wasn't just lying in a bed with me at her side: I was holding her. I felt very clearly the warm, loose skin on her arms, and the softness of her curled white hair. It was unlike any moments we had shared in life except for the reversed situation when she would hold me on her lap to comfort me when I was little. She would rock us back and forth shushing gently, and saying, "there there, bubbe."
My grandfather, her devoted husband, passed away a few weeks ago. He was in fact alone at the moment of his death, but only after all of his close family had been able to gather around him and say goodbye. Of all the ways that it could have happened, I think his death was a blessing. My plane reached Seattle in time for me to join the others at the hospital. We all sat with him as he breathed quietly, sedated and comfortable, until the end of his beloved Mariners baseball game on TV. Then we each had our moment to say the things that we hoped he knew already. We came back in smaller groups to sit with him in the day or two after that that he held on, but each day his body somehow seemed to contain less and less of him. I had the profound sense that he stopped looking like himself - once his eyes had closed and his smile had been smoothed away. And then he was gone. His death was expected, peaceful, quick, and surrounded by love.
Post A Comment | Add to Memories | Tell a Friend | Link
|
|
For a change of pace, a poem I workshopped tonight (still very much a work in progress) at the HMS Writers' Group:
Maple Leaves: A Responsive Prayer
October 3, 2007
The week we got the diagnosis,
we heard from all over – Texas and Canada.
Cancer… it was a big word.
My husband’s whole family said prayers
and lit candles.
Like a big shrine,
as wide as the spread of my arms.
They are very Catholic.
(I can see the candles shining.)
That was three years ago, and now it is October.
In Boston, it is still summer-warm,
but we know the frost is coming,
and the paper snowflakes in the windows.
(Your husband stays, sitting quietly behind me.)
More than anything, I am tired.
The medicine makes my skin itch and peel.
My stomach is sick,
my head aches,
my mouth is full of sores.
But I am so proud that I made it through twelve times,
and now thirteen,
and tonight will be fourteen.
(I hope you get to go home soon.)
No, not too soon,
because I want to get more treatments.
And I hope that I will be back in a few months
to go through it all again,
because that will mean it is working.
Cross your fingers for me.
(I will.)
It affects my brain too.
Neurotox-… I can never think of the word.
(Dreams, your husband says, then falls silent again.)
Yes, vivid dreams.
And once
I saw maple leaves falling.
They were everywhere.
Maple leaves falling, and behind them everything was gray.
(What has been helping you get through this?)
Oh, I’m not religious, but I’m spiritual.
And I’ve got God right here with me,
everywhere I go.
(Amen.)
I started out intending to write a little background and it turned into a lengthy reflective essay. So be it, I'm writing-starved. This poem is based on my interview with a mid-50s patient at BIDMC with metastatic renal cell carcinoma. The neurotoxicity from her interleukin-2 therapy had in fact once caused her to have the hallucination of falling maple leaves, and I was struck by the beauty of the image and by her bravery and confident spirituality in the face of her devastating illness. I wrote the poem more or less as a creative reworking of our verbatim interview, and it was only afterwards that I recognized its resemblance to the form of Christian responsive prayer, and changed the title accordingly. We sometimes use responsive prayers or litanies at First Parish, and admittedly I don't like them much - they tend to be too scripted and impersonal to meet my spiritual needs and they feel too "high church" (yet simultaneously lacking in the mystery and comfort of high church ritual). But when the form of this poem emerged, it showed me the similarities between the medical interview and the responsive prayer in a way that has made me appreciate both forms more. First, the parts in the medical interview are largely scripted: there is always room for adapting the questions to the patient, but in general there are certain ways that certain questions are always asked, wordings that we are taught from the very beginning of our clinical skills curriculum. The introductory question "what brought you into the hospital today?" is simple on the surface, but is actually carefully scripted to elicit the so-called chief complaint while avoiding launching prematurely into the history of present illness and the past medical history (which one might get if one asked a very slightly different question like "what is your medical problem?"). Yes, there are some patients who respond "an ambulance brought me, obviously!" but other than that it is a very effective question. This scripted quality of the medical interview, in which theoretically the doctor knows exactly what information they need and what to ask to get it and the patient knows the role he or she plays in response to the doctor, can be off-putting for some people and yet simultaneously comforting... like, for me, responsive prayer. I bristle at it because I have trouble setting aside my own ego, identity, and agenda, spiritual or otherwise - I think "My concerns aren't being addressed" or "I would have phrased this differently." I'm sure patients often feel the same way, and it's a huge issue for otherwise caring physicians who sometimes need to get just the facts, ma'am, in a very constrained period of time. But if I were able to let go of clinging to my ego (this is where Buddhism interjects briefly into the conversation) and accept that responsive prayer is not about me as an individual but about voicing the nature and needs of the religious community and my participation in it, I might find responsive prayer - as many people do - to be comforting precisely because it is so scripted and ritualistic, while simultaneously potentially very powerful. Similarly, if patients otherwise are happy with their care and feel that their concerns are being addressed (which is definitely possible within the interview script, something I proudly feel I achieved in today's Patient-Doctor II interview), then the script can become a reassuring part of the "therapeutic environment" I wrote about in a previous post. I have to acknowledge two failings in the analogy between medical interviewing and responsive prayer. First, it goes without saying that the purposes are very different. I have tried to focus my comments here in true writers' workshop fashion on form rather than content, although when it comes to poetry (like architecture), form and function are closely intertwined. The analogy also breaks down in that the response portions of responsive prayers are typically voiced by the community as the community (using "we" rather than "I", or even speaking for all of humanity) whereas medical interviewing is much more one-on-one. That being said, especially with the presence of the husband in the room in this patient's case and in the future the knowledge that I will be asking the interview questions on behalf of my entire team and everyone else who will be involved in this patient's care and have access to her medical record with my writeup, the sense of community should never go away. It is a strange sort of intimacy, to speak so deeply with another person sometimes, but to be doing so on behalf of so many. That's enough overanalyzing of this poor poem (you know you're in post-college literary criticism withdrawal when you overanalyze your own works). I very much welcome comments and feedback on the poem itself and on what I've written afterwards.
The HMS Writers' Group is a small group of students, faculty, and other HMS affiliates who meet every few weeks to share and workshop our work, read the work of other writers both medical and non-medical alike, do writing exercises, and generally "live the writer's life on the side," as our poet-teacher-guru Sophie Wadsworth put it tonight. It has been a real blessing to have this group exist, even though I can't always attend or contribute, because it reminds me of my longstanding love for writing and provides a community of kindred spirits who also confront the harsh and sublime realities of medicine through words. I love readership, but this poem is copyrighted and may not be copied or reused in any form without my permission. Please leave your contact information in a comment if you would like me to get in touch with you about its use.
1 Comment | Post A Comment | Add to Memories | Tell a Friend | Link
I've gone back and tagged all of my posts so that, if you wish, you can view them by topic. For example, clicking "medical education" next to this post would let you see all the entries on the same general subject. The tags may evolve a little more, but it's a start. Let me know if you find them helpful, or confusing.
And some content to almost justify a new post: We received our Patient-Doctor II assignments today. I'm assigned to Beth Israel Deaconess Medical Center. I'm looking forward to spend the year there because it's nearby (admittedly a very important factor) and it has a reputation for putting a lot of energy into teaching students. Time to dust off the white coat.
Post A Comment | Add to Memories | Tell a Friend | Link
|
|
Our diagnostic equipment came in today! I have a brand new - and yes, shiny - Welch-Allyn Harvey Tycos Elite stethoscope (burgundy, with a little interchangeable pediatric head :-D) and Welch-Allyn PanOptic Ophthalmoscope and Otoscope, as well as the various tuning forks, reflex hammers, penlights, and so on that make a white coat look well-stocked. In other words... I'm equipping myself with the tools of the trade. Not that I know how to use any of it yet, but that will come with time and practice this year. I am excited about learning to do a good physical exam because, even in this era of modern diagnostic technology, you can learn so much about the body just by looking and listening with a little assistance. And I very much appreciate the idea of therapeutic touch - the doctor's reassuring hand resting on the patient's shoulder when listening to the lungs is not just a part of the traditional Norman Rockwell image of the doctor-patient relationship, but a very real way to forge connections in moments in the midst of a busy hospital or clinic. Ironically enough, the stethoscope was invented to make possible a more distant doctor-patient relationship: the first one was a paper cone improvised to distance the ear of the male doctor from the heart (and, therefore, bosom) of his demure lady patient. Nevertheless, its use is a huge part of the therapeutic environment we create to improve the health of our patients, both because of its direct observational and diagnostic benefits and for the patients' general sense of being taken care of by a medical professional (call it the placebo effect). Therefore, the arrival of the stethoscope in particular marks another important if surrogate milestone on my path into medicine: have stethoscope, will doctor.
Speaking of tools of the trade, I am greatly enjoying our first course as second year students, Principles of Pharmacology. While the course has been dramatically shortened from eight weeks to two by the curriculum reform (don't get me started), we are still expected to cover all of the fundamental principles of drug action, dosing, metabolism, and so on. I like the problem-solving aspects, and I love the immediacy of the potential application of this knowledge: we will be using these lessons to someday improve the health of patients. The connection is much less abstract than the implications for clinical practice of much of the first year material, signaling a transition that I think will make second year very rewarding if challenging. Moreover, I am having my first glimpses of what it will be like to "think like a doctor." A classmate asked me a question about a hypothetical case involving both warfarin (an anti-clotting agent) and tuberculosis treatment; the principle at issue has to do with the metabolism of both drugs by the same particular set of enzymes, such that they interact with each other's metabolism and change the effective dosages. I found myself quickly putting together an answer that incorporated both the pharmacological principles and the implications for the patient. It wasn't a particularly complex situation to analyze, but I realized right then that it was exactly the sort of question I would need to answer every day in my own future clinical practice. Even just the first forays into that kind of clinical decision-making make the clinical years feel much closer and clinical success more achievable.
2 Comments | Post A Comment | Add to Memories | Tell a Friend | Link
|
|
I began writing this entry at the end of last year and never quite got around to finishing it, so I didn't make it "public" until now, but I think it's a worthwhile - if rough - snapshot of where my mind was at the end of my first year in medical school. Much more to come as I continue the reentry process. My mood at this moment approaching second year is somewhat apprehensive as I realize how much I will need to learn in the next seven months, but it helped me a bit to reread this entry and remember why I'm doing this in the first place.
"Journalists and doctors tend to think modestly in terms of their own personal contribution to society, and consider the world at large to be a fascinating sea of untapped knowledge and possibility. Businessmen, entertainers, politicians and lawyers think modestly about the world at large and feel their own personal contributions to society are fascinating seas of untapped knowledge and possibility."
--comment on "When Doctors Write"
You, reader, may or may not agree. The commenter did add: "(And if you can’t make a sweeping generalization in public every now and again, what’s the point of blogging?)" I do think though that the comment - in response to Stephen Dubner's question "So why do these doctors write so well, and so much better...than other non-writers?" - taps into something very interesting. Do we bring to our profession a sense of wonder and curiosity that perhaps other people do not? And is the difference in us, the people who choose to become doctors, or is it in our subject matter itself?
Dubner continues eloquently, "Perhaps there are elements of doctoring that lie in harmony with writing: peeling back the layers to get to the core of an issue; confronting the obvious but being willing to look beyond it; learning where to “cut in,” of course; and, more than anything, recognizing that this object before you – in one case a human body, in the other a manuscript – is on a certain level a miraculous object with the power to astound, and on another level is a complex, dynamic system which can (and must be) reduced to a schematic, laid out on paper or x-ray film."
I am going to claim the difficulty of the reduction of complex systems to schematics as an excuse for my lack of posting lately... Actually, life has just gotten busy as we approach the end of the year. Final projects and papers are done or soon due, and we have two more exams before we end on June 8. Along with and among the flurries of work have come a network of interrelated things-that-are-fascinating, any of which could be a post in itself, but I'll try to address in a nutshell here for now.
Cluster one: AIDS, its sociocultural context, and narrative medicine, which by the end of the month will lead to a massive product encompassing the Casebook itself and four appendices, as this project will now have formed the basis for final products for five classes (Mentored Clinical Casebook Project, Mind-Body Medicine, Role of Discovery in Medicine, Introduction to Social Medicine, Patient-Doctor I). While I originally intended to be more broad in the subject matter for these various projects, and I regret missing the opportunities to do some other interesting work while recognizing that it was not feasible in terms of time and effort, working on my Casebook patient's story from all these various aspects has been an incredibly rich experience (even beyond that of just learning his story in the first place). I am turning in and presenting tomorrow the narrative medicine piece for PD1; I advocate for the power and importance of narrative medicine, the application of narrative analysis techniques to patient stories, and do a first-pass analysis of my patient's story. The social medicine piece has a long way to go yet, but I just finished reading the book And the Band Played On, a journalist's contemporary account of the early years of the AIDS epidemic, and it opened my eyes to so much that seems like it should be long ago and far away (stigma, ignorance, hatred, prejudice...) but isn't.
Cluster two: abortion, HPV, sex education, women's health, ob-gyn, contraception, sexuality, sexual orientation. education and ignorance and prejudice. Outrage and sadness, and fear for the future of reproductive health. Also not entirely unrelated to cluster one. more on this soon, but one of these days I'm hoping to do something about it, in my own small way.
...
Post A Comment | Add to Memories | Tell a Friend | Link
|
|
Someone from Chalice Circle, appropriately enough, alerted me to the fact that today is Vesak, the "most holy time in the Buddhist calendar" because it commemorates Buddha's birthday, as well as his enlightenment and death. Just as my Casebook patient says, "I am not a Buddhist; I strive as best I can to be Buddhist in each moment." But it made me happy to find out in my Wikipedia surfing on the topic that I did in fact achieve two of the main observances of Vesak without even knowing them:
1) meditation - I attended the Harvard School of Public Health's lunchtime mindfulness meditation
2) giving to charity - I signed up for the AIDS Walk (donate here) in honor of my Casebook patient, and made a donation myself
Note: I did not achieve 3) vegetarian diet - I am definitely not a vegetarian and don't intend to become one, but I am trying to eat less meat, especially beef. Today was not a vegetarian day, although two of three meals were.
I also did not go to temple, although the HSPH group is one of several groups that I collectively consider my sangha.
But my point is, that any day in which I have lived "Buddhistly" (or UUistly, for that matter) is one that I consider to be a day lived well. Conversely, by living today well - by making time for mindfulness and giving of myself to worthy causes - I adhered to the basic principles of at least these two religions. To me that is the essence of religion: beyond any specific set of rules or principles, they are frameworks to inspire and facilitate leading good and fulfilling lives that benefit both self and others.
1 Comment | Post A Comment | Add to Memories | Tell a Friend | Link
|
|
Another back-dated [diamond-in-the?-]rough entry.
Not sure yet how to connect together the elements of the day, but we'll see what comes in writing them down.
First: today was our skills exam for Patient-Doctor 1. It consisted of a videotaped interview with a patient-actor, feedback from the patient-actor, feedback from a PD1 faculty member (not our own), a videotaped mock oral case presentation to a resident, and feedback from the resident. How wonderful to have so much feedback! Anyway, I wasn't feeling too nervous going into it per se, but I did want to do well especially since I've been ambivalent recently about my interviewing abilities. So I wore my best doctor outfit under my white coat, including the uncomfortable doctor shoes (my med school interview high-heeled pumps) as opposed to the comfortable doctor shoes (Dansko clogs, which an internist corrected me are not doctor shoes but surgeon shoes). I also wore a pendant of Guanyin that I've had for a while but haven't put onto a necklace before; I wasn't at the time thinking about it as being part of the doctor outfit, but it turned out to fit in. While I was prepping for the interview, I found myself silently singing the version of the Buddhist Loving-Kindness Meditation that was set to hypnotically beautiful music in our new UU hymnal:
May I be filled with loving-kindness,
May I be well,
May I be filled with loving-kindness,
May I be well,
May I be peaceful and at ease,
May I be whole.
May you be filled with loving-kindness...
May we be filled with loving-kindness...
Follow-up (8/12/07): The interview went well. And I felt, at least a little bit, like a doctor. I think it was relatively easy for me to assimilate the interviewing skills we learned in first year because talking to patients is such a big part of my idealization of what it will mean to be a doctor. It remains to be seen what patient interactions will truly be like in the future; I have a feeling it will be a lot of uninspiring fact-finding, but with the occasional glimpse of a compassionate meeting of souls to keep me going.
Post A Comment | Add to Memories | Tell a Friend | Link
|
|
What would I do if I was a doctor, and someone like Cho Seung-Hui walked into my office needing medical care? The code of the medical profession, like the path of the bodhisattva, calls us to extend help and care and compassion to all beings. Unitarian Universalism calls us to radical inclusivity; how much more radically inclusive can you get than being compassionate towards a senseless murderer? And yet that is what I have found myself trying to do since I first heard the news on Monday. Of course I was moved to first say a prayer to the victims, their families, and the university community, though recognizing that there is nothing that can change their incredible losses. Then, I found myself wondering about the killer - asking why and how he could have come to that level of violence and desperation. As a future medical professional, I found myself wondering about his psychiatric and psychosocial problems, and whether any additional services and support could have been provided to him - for his own good, as well as for the prevention of this horror. I am not trying to absolve him of guilt for this crime; far from it, the majority of my being wants to wall him off from the species I call mine. But difficult as it is, I am trying to cultivate a level of compassion for him as well. Because as soon as we choose who is deserving of compassion and why, rather than extending it to all people (Buddhism says: sentient beings), the limitless compassion of the bodhisattva and the ideal medical provider becomes limited compassion, and loses its radical power, and is mired in judgment, and gives up its capacity to heal those who are in need.
I got choked up several times in the last few days as the news continued to come in, the number of dead and injured increased, and more and more bizarre and awful things about the behavior of Cho Seung-Hui were reported. But when I really cried, I wasn't thinking about him, but about Liviu Librescu. He was the professor who physically barred the classroom door to give his students time to escape; he was shot, but saved their lives. I cried when I read that he, a Holocaust survivor, died on Yom HaShoah - the Jewish Day of Remembrance for the Holocaust. The fact that he survived one senseless killing only to lose his life in another hit me hard. However, with help from Apollo, MD, I've been able to turn it around and see that his action is a reminder that even within incredible darkness, some light can be found. People who represent such points of light enable me to believe that there is a higher power of good and love and creation - one that moves within us - that can overcome the evil that is its absence.
[And I'm not far from the only one who has been so moved: in our own strange children-of-the-new-millenium way, young people by the thousands have been showing their respect and appreciation for Professor Librescu on Facebook.com, as well as sending their hearts out to the victims and the survivors at Virginia Tech.]
In closing, an incredible testament to the possibility of human goodness and compassion: a prayer from beliefnet.com that was posted for Yom HaShoah but on April 14 - who could have foreseen it would have an additional meaning after this April 16?
Lord, remember not only the men of good will, but also those of ill will. But do not remember all the suffering they have inflicted upon us. Remember rather the fruits we have brought, thanks to this suffering: our comradeship, our loyalty, our humility, the courage, the generosity, the greatness of heart that has grown out of this. And when they come to judgment, let all the fruits we have bourne be their forgiveness.
source: Found on a scrap of paper at the liberation of Ravensbruck Concentration Camp in Germany
---
I may come back to this post and revise or add later; but at the moment, these are the thoughts in my heart.
Post A Comment | Add to Memories | Tell a Friend | Link
|
|
Three things that happened today, all of them unexpected and all of them wonderful reminders of "the interdependent web of all existence of which we are a part":
1) For the last presentation of our Spirituality and Healing in Medicine elective (which I know I haven't posted about, for various reasons... I may address it in the future), a pediatrician who is also an observant (Protestant) Christian addressed the class. He had beautiful thoughts and ideas that he expressed very compellingly, many of them through personal stories that I won't repeat here at least for the moment. I have sadly not gained a very good impression of Christianity in general, particularly as practiced in much of the United States, but he exemplified what I see as the most redeeming and downright admirable qualities associated with Christianity in particular. Mainly he talked about love - about the radical notion of defining one's actions through love, and how the essential "job" of a Christian was to "love others" even more than it was to submit to the will of God or any of the other tenets. He was certainly inspiring, and got me to thinking about what that would be like - to have love as the central characteristic of all your interactions with other people. Certainly something worth aspiring to, whether one is a secular humanist or a Christian believer or an admirer (maybe someday I'll be worthy to call myself a follower) of Avalokiteshvara.
2) The wind was ridiculously strong in the streets of Boston today, and I saw it blow over several of the free periodical stands near Boylston. I was inside waiting for a friend, so it was like watching a silent movie... People were scurrying by, huddled against the wind and rain, and cars were avoiding the stand that had been knocked into the street. A dapper-looking young man with a battered briefcase came along, set down the briefcase, picked up the stand that was blocking the road, righted the other two stands, gathered the scattered papers that had fallen out and returned them, picked up his briefcase, and strode off. I tried to knock on the window to flash a thumbs-up or mouth a thanks or something, but he didn't hear me, so now here is my chance to say thank you for taking the time to make the world a slightly better place.
3) A friend I met and have intersected with mainly through classes at the college and here sent me an email out of the blue expressing his gratitude to me and to all the people who have been kind to him in his four years in this country, and his sadness at leaving us behind when he returns soon to his home country. He wrote to me, "I appreciate your presence." What a simply powerful statement! I am having trouble finding words to express my sense of grace, of suddenly being shown the deep-running current of human connection that we are lucky enough to tap into. I am also so grateful that he took the time to express his gratitude and appreciation to me. There was no need for him to, no reason for this flash of connection to occur in this one moment, and yet he chose to give me this rich gift. Seen in the context of my own spiritual journey, it reminded me of an article called A Theology of Gratitude that gives a very intriguing argument that the defining religious principle of Unitarian Universalism should be gratitude--as submission is for Islam, obedience is for Judaism, and love is for Christianity (and now I'm back where I started). While I know that one word could never sum up Unitarian Universalist values any more than one principle could completely define any faith, I do think that the practice of gratitude is the root from which many fruitful branches have been growing for me as a "newly spiritual" person, and that the practice entails both cultivation (really, awareness or mindfulness) and expression. Better even than the tree analogy is that of the wheel, a common image in Buddhism (for example, the Wheel of the Dharma/Wheel of the Law): gratitude is the axle from which the spokes radiate, and from the unmoving center the wheel turns... It is the expression of gratitude that was put into motion by the email I received, and it has in turn started its own cycle of cultivation and, now, expression. I hope you reading this are able to keep the wheel rolling forward.
1 Comment | Post A Comment | Add to Memories | Tell a Friend | Link
|
|
Newsflash: "miracle cure" causes depression, bipolar disorder, and suicidality to vanish nearly overnight; formerly institutionalized child is now a happy, healthy 11-year old baseball-playing boy; teenager with three suicide attempts recovers completely and is now a successful art school student
Sounds pretty appealing, right? Something that you would expect the medical community to be behind 100% and doctors would be lining up to try? An intervention insurance companies would trip over themselves to pay for? Unfortunately, no. Only a handful of doctors administer this treatment in the United States, and some patients have to go to Thailand to find it. A negligible fraction of insurance companies provide any coverage for any part of it. It's controversial among medical professionals, and many of them tend to avoid at all costs patients who seek it.
This seemingly miraculous, life-restoring treatment is... gender reassignment.
We had an amazing set of speakers today in our Human Sexuality in Medicine elective: a pediatric endocrinologist who specializes in gender identity and intersex, and two of his patients, one a young adult and the other an elementary schooler. The endocrinologist didn't use exactly these words, but he basically made it clear that he felt he had been called to this career path (after many years in other areas of pediatrics) out of a desire to help patients that had few people to turn to. He was an inspiring person not only because of what he does but also because of how he obviously had worked so hard to understand where his patients were coming from and what they most needed in terms of medical care and emotional support.
The patients themselves were even more amazing. I have heard from one other person who I knew to be transsexual, but he emphasized his experiences with the medical system as an adult more than the process of transitioning, so this was the first time I really got to hear about what it's like to grow up in the wrong body. The endocrinologist mentioned that transsexual children and adolescents are frequently diagnosed with bipolar disorder, when really "it's more like post-traumatic stress disorder" from the unbelievable trauma of feeling that your brain doesn't match your body, and of course all the stigma and other emotional issues other people cause these children.
The 19-year-old woman, an art student, was born as a boy. She had suffered extreme anger and depression, and had attempted suicide multiple times; 50% of transgender adolescents do. She talked about going through puberty and feeling intensely hostile to the changes in her body. All the messages about transgender she initially got were on Jerry Springer or porn sites she found when she tried to search the internet. Fortunately, she eventually came into the possession of some legitimate information, and she lit up when she talked about the immediate identification with all the feelings the materials talked about - "this is me." From that moment on, her emotional life completely turned around. She came out as transgender to her parents at age 14; not an easy process, but one that ultimately resulted in them being extremely supportive. While they went to bat for her, she has also been an incredible advocate for herself, including educating people like therapists who were supposed to be helping her, and doing extensive research on "every surgeon in the world" who does gender reassignment surgery, ultimately traveling to Thailand for it. Now that she is transitioned and in college, she says, being transgender isn't even a big part of her life. She broached the topic with her boyfriend, but most other people don't know, and she no longer goes to support groups or conferences. Her identity can now be defined by other things: a woman, a college student, an artist, and all the other things she does and is.
The younger patient was a sweet, goofy, buzz-cutted boy in a Red Sox shirt who was volleying teasing back and forth with his dad and confidently interjecting his views into the conversation. Hard to believe that earlier in his young life he was aggressive, depressed, possibly suicidal, diagnosed bipolar, given lithium, and institutionalized... but that's when he was living as a she. According to the dad, practically from the moment their daughter started to walk and talk, it was obvious that she did not identify as a girl. When asked after watching the Disney movie Pocahantas if she wanted to dress up as Pocahantas, she replied adamantly "No! John Smith!" and marched around the house with swords tucked into a belt. She refused to wear girls' clothes, and made it clear in many other ways that she didn't want to be a girl. So, these incredible parents agreed to let their child transition... and it was clear from the way the father glowed when he talked about "my son" that he felt he had gotten his lost child back. The mother attends a yearly transgender conference, where the son can hang out with two friends who are the same age and also female-to-male transgendered. The boy seemed to take it all in stride, reflecting a patience and maturity well beyond his years. He left school for spring break as a girl and returned two weeks later as a boy. The school had been incredibly supportive, fielding calls from parents and making accommodations. I could only think how lucky this boy was to have been taken care of so well and so early; compared to people who have to spend most or all of their lives hiding their true selves, he can spend nearly his entire life as the person he truly is and wants to be. And he truly embodied the idea of looking "happy in his own skin".
I won't go into details here, but suffice to say that the endocrinologist talked about a new treatment pioneered in the Netherlands that, for kids identified before puberty, can not only delay puberty's irreversible changes into the genetic gender that the child wants to reject, but can also basically buy some time for the child to mature emotionally/psychologically before making the decision to mature physically. It was one of those simple interventions, perfectly in harmony with the workings of the endocrine system, that can only be called "elegant."
One other thing of note was the language used throughout the talk, particularly calling the gender to which patients transitioned the "gender of affirmation." I hadn't heard this usage before, and the more I think about it the more I love it... It is so positive, but without any notion of normativity (not "the right gender"). More importantly though, it implies a very different concept than the phrase "gender of choice", to which one might be more inclined to gravitate. Because as these patients' miraculous turn-arounds after transitioning indicate, their birth genders were not even an option; just as gay people do not choose to be gay, transgender people do not choose another gender, but rather find ways to affirm the gender that they feel they have been all along. They did not somewhere along the way choose to change. Their birth gender is, basically, a pathology... one that can lead to intense crises that, while yes they have psychiatric as in "in their head" implications, also pose very real physical risks and certainly prevent the total health and wellbeing of transgender patients. Studies have shown significant gender-related brain differences in transgender people, for those who look for physical findings to establish something as a medical problem. And yet gender reassignment surgeries are considered elective and cosmetic... As I tried to communicate with my admittedly leading beginning to this article, there is so much potential here for making positive changes in the health of these patients and yet gender identity disorders and "disorders of sexual differentiation" are regarded by the American medical institution as psychiatric maladjustment-like issues and therefore not eligible for insurance coverage.
I look forward to the day when any person could have access to the quite literally transformative services of gender reassignment should it be appropriate for them, as well as to a time when anybody who doesn't fit stereotypical social molds has greater rights to self-determination. I just kept feeling tonight that this is a new frontier of acceptance and ability to change a life for the better, for both the medical community and American society as a whole.
Finally, I also have to mention that the first patient's mother is a Unitarian Universalist, and she was raised as a UU; she described standing up in her home church to announce that she was transgender and was transitioning, and getting an ovation. I was so proud to be a part of a religious community that is, in the words of the Young Adult groups, "radically inclusive"--especially given that so many religious communities are quite the opposite, especially when it comes to embracing diverse gender identities and sexual orientations. While it sounds like she was going through too much emotionally at the time to participate in the UUA's extremely comprehensive (as opposed to non-comprehensive, i.e. abstinence-only) sexuality education curriculum Our Whole Lives (OWL), I still have to believe that it helped to know that her religious community would accept her, and she has since spoken to several OWL groups. The more I think about it the more excited I get about someday teaching OWL (in my spare time...); issues of sex and sexuality are not only inherently fascinating, but also so important to the overall health of children and adolescents. It would be an amazing opportunity to foster young people learning about these topics in a setting that emphasizes not only medically correct information but also respect and inclusivity.
Disclaimers: A lot of this entry is very opinionated, and I haven't yet done much research on the topic. The Intersex Society of North America seems like a good place to start, and the book True Selves is now on my reading list. I just wanted to get some initial thoughts and feelings out there.
1 Comment | Post A Comment | Add to Memories | Tell a Friend | Link
|
|
In a fitting follow-up to my post about the NICU, I just read an amazing article in the New York Times about perinatal hospice care. The article itself is beautiful and poignant, but the accompanying video was unbelievably inspiring and devastating. The tears have only just stopped. I am in awe of these families and how full of love they have managed to be for babies, even unborn, that they know will die. And they are so affirming of life; not in their decisions to carry the pregnancies to term, but in how they have worked to make their babies' lives rich and meaningful. I can't say I know what to believe about what happens after death, but I think that if there is such a thing as life after death, it is the living on of the little bits of ourselves that we have given to others as we have lived, and the mingling and passing on of those pieces to others through time and generations. If that's anything like the truth, then these brave families have already given their babies eternal life, by allowing themselves and others to be touched. One of the fathers talks at the end of the article about experiencing grace; that sense of being touched, being blessed, and gaining a glimpse of insight into something beyond human words and comprehension is what I am feeling right now.
Post A Comment | Add to Memories | Tell a Friend | Link
|
|
It was MEN1. I presented the syndrome to the tutorial group today and went through step by step how it tied all the pieces together: the pedigree that suggested a genetic disorder, the multiple glands affected that suggested hereditary cancer, the way the different hormonal axes interacted, and even threw in my suspicion that a prolactinoma and infertility might be in her future... And it was spot on. On the next page of the case, Mia was having trouble conceiving and had stopped having regular periods. An MRI found a pituitary tumor (the prolactinoma). We talked for a bit before getting the final page about what to do and I suggested the dopamine agonist bromocriptine, and we talked as a group about how that would work and why she would have to discontinue it as soon as she got pregnant because of its effects on another hormonal axis necessary for fetal brain development. We got the last page, and that was spot on too. "Our patient" took bromocriptine and became fertile, conceived, stopped the bromocriptine, delivered a healthy baby girl, and they all lived happily ever after. It was a great feeling: to be right, to have a happy ending for this paper patient that as I mentioned before I had come to feel emotionally connected with, to recognize how powerful our knowledge of what was going on with her medically made us... And it's all summed up as "This is it. This is why I am in medicine."
Post A Comment | Add to Memories | Tell a Friend | Link
"If you cannot see God in all, you cannot see God at all." ~ Yogi Bhajan, on my teabag label
Post A Comment | Add to Memories | Tell a Friend | Link
|
|
We have talked a lot in classes like Patient-Doctor and The Healer's Art about hearing and eliciting patients' stories, with the idea that understanding these stories enables us to understand the patients better. Stories keep the patient from being just a diagnosis, or help medical providers to understand how illness affects that particular patient within their particular context of family, community, and culture. Arthur Kleinman pioneered this idea in his Illness Narratives, in which he situates each patient's illness as continuous with the narrative of their life, another chapter in which the same plotlines and dramatis personae play out (though perhaps in new ways).
The kind of doctor I want to be is the kind who listens to patients' stories, but this will by no means be an easily kept goal. While the patients and the stories are seemingly inextricably bound together, a patient can get in the way of or even seem to contradict his or her story as it is told to and considered by the medical professional. A difficult patient, in any of the meanings of that word--angry or hopeless, manipulative or withdrawn, too chatty or too withholding, and any of the million other ways to create a disconnect between the patient and the medical system--can obscure the communication of his or her story.
Two things this week provided me an unusual illustration of the power and the slipperiness of patients' stories. First, we had videotaped interviews with "standardized patients" (trained patient-actors) for Patient-Doctor. The people were real, but they were not real patients (at least in relation to us, the first year medical students), nor were their stories "real" in the sense of being stories about any particular person. Mine was a fretful 53 year old single mother on welfare whose multiple injuries turned out to be due to her borderline alcoholism. Though I was play-acting being a doctor and she was play-acting being a patient, I found myself readily drawn into her story of worrying about her welfare checks being taken away, of trying to find the energy to keep up with her two teenage girls, of tripping on the stairs after going to get another six-pack, and of how to put together the pieces of a life that had never perfectly fit together. My PD group read an interesting opinion piece about the utility in the patient-doctor relationship of seeming compassionate even if you are having trouble feeling it, and saying the right key phrases to communicate empathy; what's surprising is how quickly the line blurs between saying things like "That must have been so hard for you" or "It sounds like you have a lot you are worrying about" and truly developing empathic feelings as you say them. I said all my lines, in our play-acting, but I felt them too... I re-watched the video today, and it was strange to see the few seconds of video of just her sitting alone after I had left the simulated exam room. Some part of me expected her to "change back" into whoever she really is, but she didn't seem any different before and after I left; even though I knew that this "patient" and this story didn't match up, I couldn't extricate her from it.
An even greater distancing between patient and story happened while I was preparing for tutorial. Every week we get a case related to what we are learning in class. Some are real, or based on real cases, and some are not. Each tutorial meeting we discuss what we have learned and then get the next pages that tell us what happened next (whether it is lab values, the surgical outcome, or what happened at the patient's next visit). We are covering endocrinology in Physiology right now, and I love it--I love the tremendous explanatory power of hormones and their effects on every system of the body, and I love the problem-solving nature of understanding normal endocrine physiology and its perturbations. Anyway, the patient in this case is a young woman with hyperparathyroidism, an enlargement or over-activity of the parathyroid glands in the neck (i.e. around the thyroid) that regulate calcium levels in the body. We talked about the effects of high parathyroid hormone and high calcium on various body systems, and how these problems could explain her diverse symptoms ranging from kidney stones, fatigue, and poor concentration to weight loss. Like any medical student worth her salt, I jumped on the least common but most interesting explanation for the hyperparathyroidism (the "zebra", from the famous saying "when you hear hoofbeats outside your window, think horses, not zebras"... unless you're at MassGeneral) and predicted that she had type 1 multiple endocrine neoplasia (MEN1), a hereditary syndrome caused by a mutation in a tumor-suppressor gene that predisposes affected people to parathyroid hyperplasia (basically cell proliferation, like benign cancer) as well as to multiple other tumors of the pituitary, gut, and pancreas. The more I put the pieces together, the more excited (and vindicated) I felt: when I drew out her family tree, her father's "stomach ulcers" and her sister's pituitary tumor plus the family history of kidney stones produced a perfect pedigree for an autosomal dominant condition like MEN1. A tumor in her gut could be a gastrinoma, a tumor that inappropriately secretes the hormone gastrin and increases stomach acid production, leading to her and her father's peptic ulcer disease (Zollinger-Ellison syndrome). I was high on problem-solving, picturing myself as the next Gregory House... and then I read more about the pituitary tumors. Our (wonderful) tutorial leader had been dropping hints to us all week about considering how other aspects of the patient's endocrine function might be affected, especially in a 25-year-old woman "who might, say, be considering having children." I realized that just like the gastrinomas that inappropriately secrete gastrin, pituitary tumors in MEN1 can often be prolactinomas: tumors that inappropriately secrete large amounts of prolactin. Prolactin is the same hormone that is released during breastfeeding to stimulate milk production and also acts as natural birth control; it feeds back onto other hormonal axes to suppress ovulation. If the patient in the case had a prolactinoma, she might very well be infertile, at least without treatment.
As I read that, my heart sank in my chest. I felt genuine sadness; again, even though I knew that this was not a real patient (and there wasn't even a patient stand-in, the case was just words on paper), I felt the power of the story and how it could be profoundly impacted by this diagnosis. I also realized how caught up I had been in the diagnosis, in the puzzle, in the chase after information and interconnections, and I knew that my crestfallen feelings when I read about the prolactinomas were still mixed with the joy of feeling I had successfully "figured out the problem." And that was for a patient whose story I knew, who I could empathize with, whose potential problem of infertility moved me, and in fact who was (in the case) just about my age...and named Mia. Imagine if this patient were a difficult one, or one with major psychosocial problems, or one whose language I didn't speak, or one who was the last one before I finally got to go home after a thirty-hour shift. Or imagine if the diagnosis were not a zebra but a regular old horse (as this case may well turn out to be in the end, though my bets are still on MEN1), something I had seen a hundred times and would see a thousand times more. Would I be one of those doctors who treats patients like puzzles to be solved, diagnoses to be made, and codes to be billed rather than like human beings? Of course I hope the answer is no. But this week's two unusual experiences--unusual in that the patient and the story were not, in fact, one and the same--helped remind me of the complexity of issues bundled up and presented to doctors as the patient for us to disentangle, elucidate, treat, and respect.
Post A Comment | Add to Memories | Tell a Friend | Link
|
|
I shadowed a neonatologist, one of my Clinical Epidemiology tutorial leaders, in the Children's Hospital Neonatal Intensive Care Unit for a few hours tonight. There were no new admissions but she showed me a few of the babies and I had a good chance to just observe and get a feel for the place.
The NICU was a strange blend of abstract dehumanization and a very essential humanity. The tiny babies, many of them born as much as fourteen weeks premature (as young as 24 weeks!), were dwarved and even sometimes hidden by the plastic incubators, the raised beds, the heavily laden IV stands, the computers, the ventilators, and all the other equipment of any extremely well resourced ICU. All this mechanical equipment did what their mother would have been doing if they were still in the womb: kept them warm, breathed for them, fed them, protected them from injury, and of course a host of other things. Some of them needing phototherapy for jaundice were under bright lights like tiny tanning bed patrons, complete with tiny foam eyemasks. And yet the plastic bubbles were interspersed with enormous comfortable chairs, in which parents were ever-so-gently bouncing their infants on their knee, or just holding their babies skin-to-skin, sharing warmth. And we spoke to the mother of a baby unexpectedly born with trisomy 21 - Down syndrome - who was just so unbelievably stoic and loving. With perfect composure, she pointed out all the classic features of the disease on her baby's body: the low, curly ears; the flattened nose bridge; the single palmar crease; the slanted eyes; the lack of muscle tone in the core muscles that made him flop back when lifted and made every breath an obvious effort; the almost normal heart sounds that belied the heart's severe anatomical defects. The next minute, she was making faces in response to his making faces, and talking softly to her "sweet, floppy boy." She had taped to the crib photos of her other son, this baby's two-and-a-half year old big brother, who was healthy and normal. The baby was dressed in several layers of coordinated patterned cotton in baby blue. I listened with reverence as she talked about making her plans for the next hours, then the next days, then the next month, "and after a year we just go from there", and as she and the neonatologist looked fondly at the baby and talked about maximizing "so much potential" of "this little being." And that was the amazing thing about the NICU, was that at the heart of all this machinery and testing and highly skilled staff, it was a roomful of little beings, just struggling or waiting peacefully for their chance to live and grow up. And of course their loving, heartbroken, nervous, resilient parents, holding on until they could take their babies home.
I am so glad to have made this visit at this particular time, because after just three weeks of Physiology, I am suddenly feeling so much more knowledgeable and empowered clinically. Though there have been so many times I've been overwhelmed by the amount of material and frustrated feeling that I don't know anything, tonight I felt the difference. I understood why the jaundiced babies were receiving phototherapy; we covered the liver in GI physiology only yesterday. I was able to follow more of the respiratory physiology, and was inspired to come back and do more reading, and now I understand the amazing transformation that takes place when a baby takes its first breath. It's more than just the symbolic passage from another world (the womb) to this one. Because the lung doesn't have air to breath in utero and too much pressure through there would damage the developing lungs, the entire fetal blood circulation is actually rewired compared to the adult circulation to bypass the lungs almost completely. There is actually a hole in all fetuses' hearts, and another connection that reroutes blood from the right side (the lung side) of the heart to the aorta, and these let the blood flow directly into the body rather than through the lungs first. The lungs (in both fetus and child/adult) have the unique feature of closing off blood vessels to areas that aren't getting oxygen, called hypoxic vasoconstriction, so basically everything is closed off in the fetus and blood doesn't flow through the lungs. But the baby has to be able to instantly switch over to adult-type circulation the moment it takes its first breath of air. When that first breath of oxygen hits the lungs, the blood vessels open up, resistance to blood flow drops, blood flows through the lungs, and the blood pressure coming back into the heart causes that hole to slam shut. (It later fuses closed, and the other connection shrivels up, though the remnants are still there in adults... more than just our navels, we are all carrying the reminders of our fetal origins inside.) In terms of cardiovascular anatomy, the baby has instantly grown up. Anyway, I think it's important to me to have these reminders now and again of my ultimate goals and the reasons (including the small, resolutely living reasons) that I am on this path, so even though I am not sure that I would ultimately go into neonatology, I am so grateful for the opportunity tonight to see physiology come to life.
2 Comments | Post A Comment | Add to Memories | Tell a Friend | Link
|
|
I realized I never did finish talking about my belated-Ramadan no-sweets diet/fast, but I am doing the same thing and giving up desserts for Lent (with exceptions for birthdays!). There was a question on the livejournal UU community Chalice Circle about people's practices for Lent and other times of fasting/introspection with some great responses about many different religious and personal traditions, and I've copied my original comment below. Not a fully formed set of thoughts yet, but just some things that I have been thinking about as my interest in Buddhism has been growing, and certainly things that will be brought to mind more often for the next forty days. I'll hopefully get a chance to elaborate on the health/medicine-related points.
---
Joining into this thread's delightful mixing of religious traditions, and echoing what amispyder said about Lent as a time of mindfulness, I'm giving up dessert for Lent (a very difficult task for me!) partially out of Buddhist ideals. A friend and I also gave up sweets right after Ramadan, and while I'll admit that it was partially motivated by a desire to lose some weight (or with the more general goal of healthy living), I found that it was a powerful lesson in desire and attachment, held by Buddhists to be the roots of human suffering. My relationship with unhealthy foods was one of habit and illusion (I was never as satisfied by desserts as I had built myself up to be with anticipation), and those habits and illusions were getting in the way of me having a more honest and mindful, and therefore more physically and spiritually healthy, relationship with food and eating. When I'm not eating dessert, and especially since I'm in a context (med school, ironically) in which eating is a part of many social situations as well as a typically rushed and distracted part of life, every time I say no to dessert it snaps me into a more mindful state about the choices I am making in the rest of my day, what I am doing to/with my body, and what kinds of issues other people including my future patients face when making decisions about health behaviors. I definitely wouldn't want Lent or Ramadan or anything like it to be imposed by UU congregations, but I do think it is worth encouraging goal-setting and personal change, as part of the process of reflection and self-discovery that I think comes naturally along with much of UUism. I got a kick out of a ten year old boy in my congregation telling me about how his RE class had learned about Ramadan and he had made his own decision to fast, "for personal reasons." And as others have said, having there be a set time of the year for this and a time that many others are undertaking similar efforts just makes it that much easier to make some kind of meaningful progress or achieve some kind of enlightenment that will-hopefully-carry forward through the rest of the year.
Post A Comment | Add to Memories | Tell a Friend | Link
|
|
I was reading Thich Nhat Hanh's The Miracle of Mindfulness on the subway this morning. I have only just started it, but based on what I've read of Being Peace, it is what I expected: a deceptively simple, lucid demonstration of fundamental elements of Buddhist thought and practice; in this case, mindfulness, "keeping one's consciousness alive to the present reality." Mindfulness is the part of my life and my self that I am most working on at the moment, and I think it is the key to me being not only the human being I want to be, but also the doctor I want to be: centered on the patient and the moment of our encounter, alert to details and to the unsaid, observant, respectful, present, clear-headed, deeply compassionate, and insightful.
My reading the book on the subway combined with a spiritual state that had already been heightened earlier this morning by singing with the First Parish choir: a Latin mass set to jazz that heightened my awareness of harmonies; a joyful calypso round that we taught the congregation, which lapped like waves around the meeting house; and especially a simple Cameroonian song of praise that involved the altos singing the same repetitive part six times - far from boring, it enabled me to focus on the gradual layering of the three other parts, each making a new completeness out of what had been already whole. Anyway, with these sounds echoing in my head and combining with Thich Nhat Hanh's beautiful passages, I felt myself suddenly and beautifully aware of the noise of the subway train itself as it rumbled through the tunnels. I've always enjoyed that sound, partially because of the romance of trains, but I don't think it has ever been brought that suddenly into my consciousness. Then, lifting itself out of a wealth of sound, I became aware of the sound of the man across from me tapping his foot. He was wearing headphones, and tapping in time, and I began to feel connected to him by the way his foot communicated the rhythm in his head into a rhythm in mine. Over the rumble of the subway, I could hear it; I could feel it. That feeling quickly transformed into something even deeper, as I realized that he and I were breathing the same air: the air leaving his lungs was entering mine, and back, and forth, as we sat there on the subway car. Two perfect strangers, perhaps never to be in the same place at the same moment again, bound up in interconnection and interdependence by the simplest of realities like rhythms and oxygen molecules.
Emerson takes it further: "within man is the soul of the whole; the wise silence; the universal beauty, to which every part and particle is equally related; the eternal ONE." In his poem "The Tuft of Flowers", Frost's narrator "...And dreaming, as it were, held brotherly speech/With one whose thought I had not hoped to reach./"Men work together," I told him from the heart,/"Whether they work together or apart."" The last two examples are from recent services at First Parish, the Frost poem being from what I found the best service Reverend Anita has led so far. Everything - readings, prayers, hymns, sermon - was focused on the theme "Alone Together." I loved it for its beautiful linkage of the first and seventh UU Principles: "the inherent worth and dignity of every person" and "respect for the interdependent web of all existence of which we are a part", the individual and the interconnected community.
This linkage between individual and community has been detailed to me - only scratching the surface of what, as a healthcare provider, will surely become a major part of my chosen profession - by the finer moments of our Clinical Epidemiology course that just ended on Friday. Certainly the discussions of cost-benefit analyses and evidence-based medicine linked individual with communal perspectives, but what really brought it home was the pandemic flu simulation. The entire class was divided into groups that were faced with the challenge of pandemic flu arising in the town of "Springfield." I was part of the Springfield Fire Department and EMS; there was a mayor's office, local and state public health departments, three hospitals (each with clinician, administrator, and emergency management teams), and of course the Springfield media. It was a real feat on the part of the course administrators, because all the teams were headed by emergency preparedness experts from the Boston area, and we were receiving minute-by-minute emails detailing the progress of the situation; everyone I know was extremely grateful for all the work they obviously put into it. And it wound off being extremely realistic, if you're cynical about emergency preparedness: in less than 90 minutes, the mayor's office was late and ineffective about issuing any public notices, the hospital administrators were worrying about budgets, the state and local public health departments were sending mixed messages and clashing over jurisdiction, no one was communicating with the front-line responders (my team!), and the only group effectively talking to all the others was the media, who then spread panic and misinformation. Seriously though, it was an extremely effective illustration of just how interdependent all the different facets of leadership and health care provision are, especially in a major emergency. Not exactly something that struck me as a spiritual experience at the time, though Thich Nhat Hanh would be quick to point out that any moment can be a moment of enlightenment (just read the book, because I won't do him justice), but something that combined with the service the following Sunday to pull a lot of thoughts together in my mind, in general and specifically with respect to medicine as a spiritual practice.
P.S. Another moment, on the same subway ride and in the same transcendent frame of mind, that made me think of the Robert Frost poem specifically: the driver was announcing the stops and said something like "Next stop Park Street. Change here for the Green Line. When you exit the train please remember to take your bags, purses, backpacks, coffee cups, water bottles, sodas, children..." and went through a whole list. It came across as very sweet, a combination of him being bored and wanting to spice up the ride at least a little and just going a little bit "above and beyond the call of duty." Who knows if anyone else was listening, but I was listening, and appreciating, and like the man gathering the grass in Frost's poem and the children in Reverend Anita's sermon, I felt connected to someone I couldn't see and didn't know but who was nevertheless sharing a message or a thought with me.
Post A Comment | Add to Memories | Tell a Friend | Link
|
|
|
|
|
![[info]](http://l-stat.livejournal.com/img/userinfo.gif){kind=small}