Thursday, November 8, 2012

Notes to Self

This morning, I woke up and this man will still be president for a good while yet:

image from the NY Times

But more importantly, I woke up this morning and, other than being way too tired because I stayed up way too late for surgery time with friends to watch the election returns, I did the exact same thing I always do, every day.  Which is to say that I stumbled through my morning routine, downed some oatmeal with peanut butter, went to the hospital, and worked, along with all the other people.  And my joy at the president's reelection notwithstanding, the immediate thing about the day after the election that makes me the happiest is a tie between not having every single Facebook status update on my feed be something stupid and political, and not having to hear "... and I approve this message" for another couple of years, at least.  

I say more importantly because today really was just like any other day in our country.  The day after a huge election to decide our leader, the day after a bitter and ugly campaign race between two very different candidates, the day after our huge and diverse and struggling country all went to the polls - life went on as usual.  There were no riots, no violence, no coups.  I went and voted, as a woman, driving my own car, and then went to my job, where I am pursuing my dream, getting a top education, and training to enter the career field of my own choosing.  There were no hostile, tense or unkind words today among colleagues in the operating rooms, even though as a collective we made an impressively mixed gathering - we were men and women, young and old, black and white and everything in between, from all different backgrounds, histories and countries from around the world.  Those of us who were American citizens had undoubtedly cast our votes for both parties, and those who were not able to vote undoubtedly held similarly strong and varied opinions regarding the candidates.  And everything was normal.  

How amazing is that?  

Even more than the outcome of the election, the thing that I was most glad about this morning is our incredible good fortune to live in a country and in a period of history where all of that is possible.

~ ~ ~ 

So, I went to work today, I scrubbed in to a few surgeries, I ate my lunch during our late afternoon lectures, and then, when they were over, I had enough time to make it to an evening yoga class for the first time in weeks.  Now, this is going to sound all crazy-hippie-yoga-crackpot (and especially now that you know how I lean politically) but tonight's yoga class was exactly what I needed, and not just to stretch out my sore back muscles.

I don't really know much about this sort of thing, and I think that going to church just because you really like the pastor's sermons is not the best or most valid reason to go to church, necessarily, but I do believe that going to church even for any random reason can put you in a space right when you need to be there to hear right what you need to hear right when you need to hear it.  And when it happens, you know, because that word speaks to your soul.  And I know it might sound strange, but I have also had that experience in yoga classes before.  In fact, when I was a senior in college, I used to go to this Wednesday night yoga class.  I went almost every week, almost the entire year.  I adored the teacher, and the class actually met in a multi-faith chapel on campus - we would stack up all the chairs and push them to the sides and corners of the room, and then fill every available space on the carpeted floor beneath the stained glass windows and the quilted tapestries with imagery of doves and we would do an hour-long yoga class as the sun set.  The lights in the chapel would be dimmed, and often we would end class in near darkness.  

That yoga class was one of the most powerful spiritual experiences I have ever had, even to this day.  I was just able to meet and connect with God there, for whatever reason.  It can be hard for me to do that in a church, at least consistently.  But that yoga class that year was like a sacred time for me.  I have continued to practice yoga as regularly as I can since then.  I have been to probably over a dozen different studios and practiced with more teacherrs than I can recall, but I haven't had another yoga class come close to the spiritually transformative experience that my practice was that last year in college, until tonight - the class I just took tonight was by far and away to nearest approximation to it.

Anyway, that was a lot of rambling just to say that I don't think that you need to be in a church to conect with God, and I don't think that you can only hear a message you need in a more "traditional" spiritual setting, whatever that means to you.  Nor do I think that if something speaks to you in a yoga class, that it means you are buying into Buddhism or Sanscrit or Hindu spirituality or whatever.  But I do know that tonight, something about the class just touched me in a way that I really desperately needed, spoke words to me that I was only dimly aware I needed to hear.  I actually cried a tiny bit at one point, it moved me so powerfully.

Weird, right?

I raced home to try to get it all down on paper before I forgot what it was that the teacher said during class that grabbed my heart and gave it such a good shake, but what I remembered is definitely not going to do justice to the way I heard it in class.  At any rate, some of the basic gists were something along the lines of this:  "Be here.  The future is only a concept- you have never been there.  You are here, now.  You are alive right now where you are.  Be here.  Only when you reach the limits of your own strength do you discover the strength that comes from outside yourself.  Only then do you discover who carries you.  You will get tired if you are doing this on your own.  Your worth is total and complete, and it depends on nothing - not what you do or what you accomplish."

Yoga is pretty cool like that - the asanas, or the physical practice, are so symbolic of the way we tend to approach our lives.  The teacher can be talking seemingly about one thing, but then when you pay attention, deeper layers of meaning reveal themselves.

Life has been tough lately.  School is tough.  Surgery is really tough.  Lots of other things are really tough.  And I am starting to feel the kind of worn-down that makes me feel numb and disconnected, and not at all like myself.  I just feel completely subsumed by the demands of what I am doing every day, and by the end of each day, I'm not really happy or sad or angry or proud or excited or loving or... anything.  I don't really feel.  I am just tired.  Drained.  And I find myself thinking a lot these days that the people I am working with have no idea who I am, because I am not myself.  Not a good version, anyway.  But I have also been realizing that they have no idea who I am because, paradoxically, being so exhausted makes me focus only on myself.  I feel like I am constantly in Survival Mode.  I am self-conscious and insecure and unsure of myself.  I become more difficult to engage, I am distracted and distant, I don't go out of my way to care for anyone else or show that I am interested.  Honestly?  I probably seem like a total bitch.  And later, I end up berating myself for how I must be coming across, and that only makes me feel worse.

Literally everything the teacher said in class tonight felt like it was personal, meant specifically for me.  A lot of it felt like a reminder of really obvious stuff that I shouldn't need reminding of, and other things were more challenging.

"Be here without effort.  It doesn't mean that the intensity will be any less, but let it be effortless.  Even when things are intense, that doesn't mean that you have to feel suffering.  Settle in here, embrace this, now.  Stop struggling against it every second of the way."  Back when I wrote about being out in the Hallway?  I still feel that way.  I still hate it.  It still feels really, really shitty.  And the more I try not to dwell on how much I hate it, the more impossible it is not to think about it all the time.  And it is totally exhausting.

I don't know how to ingrain the words I need so that they inform how I live day to day, when I am so tired and worn-down and it feels like it takes everything I have just to get by.  But I figured that writing them out was a good start to remembering them.  Especially, especially remembering the ones that made me cry tonight, the ones that speak directly to the absolute hardest part of life right now:  "You are not alone.  It is a lie, the isolation that you feel.  You are not alone, you are connected."

Wednesday, October 31, 2012

The Score So Far

One and a Half Weeks In: 

I have to preface this by saying that I was really, really nervous about the surgery rotation, for a few reasons.  The main reason is that I am not a morning person, I hate getting up at unreasonable hours (and for me, anything before 8 am is unreasonable), I am always late to everything, I am naturally a diehard night-owl, and I do not function well on little-to-no sleep.  Granted, I do it all the time, but I rarely feel like I am functioning well.  Anyway, needless to say, all those factors taken together made me very afraid that I was a) probably going to be the worst surgery student of all time and b) certainly going to be totally and completely miserable on the rotation.

The uniform.

I was also nervous because I hate feeling inept, and even though I feel that way every single day in medical school, I figured that feeling would be intensified on surgery (and this has actually turned out to be more or less true.)

New fall shoes! :)

Other reasons I was nervous include some of the questions mentioned in my previous post (and, full disclosure: the last question/concern was actually mine).  I was feeling really bummed that my heretofore somewhat-respectably-consistent exercise routine would be over forever, and that my much-healthier eating as of late would be out the window also.  

However, I am very happy to say that so far, none of my fears have been realized.  (Major caveat: I am starting out on my specialty surgery half of the rotation, and I am on the plastics service... they are notorious for having amazing hours - read: only somewhat longer than regular working hours, as opposed to inhuman hours - and they are also just a very laid-back and fun service to be on in general.  In other words, THIS COULD/WILL ALL CHANGE when I go to general surgery next.)  

In terms of getting exercise, I have actually made it FitWit most nights so far, and squeezed in a run one night when I couldn't go!
[winner: me]

Haters gonna hate.

How about eating healthy?  For the most part, I think I have done fairly well.  Eggs for breakfast!  Salads for lunch!  Apples for snacks!  Boo-ya!  Today was actually the first time in over two months that I have not packed my own lunch for work.  Pretty good streak, right??  But it might be over, sadly... I have no more groceries at home.  And today I had not one, but two Cliff Bars.  And a burrito.  And a beer.  And lots of Halloween candy.  Soooo... let's call it a wash.

Social life?  Haha... ok, this one has been sort of legitimately sucky.  Thank God I live with people I like talking to, because I have pretty much only seen them.  And I have only seen them a handful of brief times.
[winner: surgery]

But!  On plastics, you basically have weekends off (shhh, don't tell the other surgery students!), so this past weekend, I was able to drive up to Chattanooga to visit my great uncle John along with my mom, aunt Jane, and brother Martin.  Beautiful chilly fall weather, gorgeous leaves, lots of good food, plus seeing my great-grandparents' old home for the first time in probably 17 years...
[winner: me]

Great Uncle John, Aunt Jane, Mom, Martin, yours truly

And of course, there have been some holiday celebrations... that have consisted mainly of making Izzy wear this awesomely adorable costume (hey, it's my first Halloween with a dog!  I couldn't help myself.)  The roommates and I also carved jack-o-lanterns last night, which I haven't done in years.  It was a lot more work than I remembered!  But so fun.  And we also roasted the seeds... yummmm.  It also took a really long time, and so I didn't study at all and I went to bed really late, which made today sorta rough.
[winner: me, I think]

Izzy the WonderDog!

(She doesn't love wearing costumes.)

Also, on a somewhat surprising note, I have found that I am kind of loving surgery.  Like, a lot.  So all in all?  I'd say, so far... I'm still coming out ahead.  :)

Monday, October 22, 2012

Surgery Has Started....

Today, in orientation...

Clerkship director, MD: "So let me just take a few moments to address some of your fears about this rotation."

[Student concern.]

"You are worried about getting enough sleep.... You'll be fine.  You'll be really tired, that's just the way it is.  But you will be fine."

[Student concern.]

"You don't think you will be able to study enough and learn all there is to know?  Ha.  Yeah, you won't.  Don't even try."

[Student concern.]

"Your knowledge of anatomy is rusty?  Um, yeah, none of you know anatomy.  Don't worry, we expect that."

[Student concern.]

"Getting enough exercise and eating healthy??  Oh, forget it!"  [Laughs hysterically.]  [Recovers a little.]  "Seriously, though, take the stairs."  [More laughter.]


Monday, October 15, 2012

Everything Possible?



During my nursery week on my pediatrics rotation, I saw a patient in the NICU who, even in the land of unbelievably tiny, critically ill infants, was doing exceptionally poorly.  She weighed around three pounds, required assistance to breathe, had severe hydrocephalus and a ventricular assist device to help shunt the excess fluid out of her skull.  She had already spent more than two months in the unit, and she was still two months away from her estimated due date had she made it to term.  She had been born via emergency C-section when her mother went into pre-term labor as a result of an infection at 22 weeks of pregnancy.  She had a twin sister that did not survive.

For reasons that aren’t entirely clear – perhaps unreliable dating of the pregnancy and therefore the infant’s gestational age, perhaps poor communication between the patient, the obstetricians, and the neonatologist – the neonatologist who was present at her birth believed that she was around 27 or 28 weeks’ gestational age.  She had to make a quick decision at the time of birth about whether or not to intubate the infant, and she says that even though her visual assessment of the girl was that she seemed terribly small, even for a 27-week preemie, she went ahead and intubated anyway.  She says now that she doesn't know if it was the right thing to do, that she had simply acted on the information she had at the time, and that she often regrets it when she passes by the isolette of this horribly fragile, tiny baby.

Babies born prematurely suffer more adverse health outcomes than term babies, and the more premature they are, the greater the number and severity of the complications they have, both in the short-term and the long-term.  Normally, the cutoff age for viability is 24 weeks’ gestation, and babies delivered at this age have a grim outlook – less than 50% even survive – but in this case, an infant even younger than that was kept alive when prevailing best medical practices would have dictated not to resuscitate such a premature baby.  The reasons behind these guidelines are numerous and range from the sheer probability that the child will live to the overwhelming health challenges they are guaranteed to have if they do.  Another, not at all insignificant factor, is the incredible amount of resources it takes to care for them after birth.  The daily average NICU stay exceeds $3,500 per infant, the average NICU stay costs $45,000, and it is not unusual for the total cost of an extended stay to exceed $1 million.  That is the kind of extended stay that Baby 22 Weeks is currently having here in an Atlanta hospital.  It is unclear at this point whether or not she will ever be well or strong enough to leave the NICU, and if she does, what quality of life she will be able to have.  Her mother won’t entertain any sort of conversation at all with her baby’s doctors about how to manage her case other than to “do everything possible”.  

~ ~ ~

No real deep thoughts here tonight.  It's test week, so I have neither the time nor the energy to do a whole lot of reflecting or writing.  I was just doing a quick little write-up for an upcoming ethics session we have during this last week of the peds rotation.  It is supposed to be about an ethical issue that we have witnessed during the rotation, and this is what I kept coming back to.  I am curious about people's thoughts.  I am not at all saying that this baby does not deserve to live, and I really hate the economic/financial expense argument when talking about the worth of a life.  I am in awe of what doctors are able to do, both before and after birth, to save the lives of infants with conditions that, until only very recently in history, would have had a 100% mortality rate.  I'm not even totally sure there is a real ethics issue here: the obstetricians tried to keep the mother's preterm labor at bay, the neonatologist acted to save the life of an infant she believed to be unquestionably viable, the mother wanted (and continues to want) everything possible to be done for a child that she loves.  Surely mistakes were made and surely this outcome was by no means unavoidable.  Maybe it's just the tragedy of the whole situation that gets to me.  Maybe it's just that, in a medical world with so much potential to do so much good, sometimes a lot of very smart people trying their best still get it wrong.  And maybe it's not the ethics of this case that gets to me.  Maybe it's that sometimes there are just no easy answers to be had.

Saturday, October 6, 2012

Tiny Babies

Oh, hey there, October!  Where on earth did YOU come from??!?

This is where I've been all week:


Nursery week!  

Mornings with the healthy babies on the Mother-Baby floor, and then afternoons with the teensy-tiny ones in the NICU.  It is all very adorable and prettttty great.  Especially because the healthy newborn exam is a snap and they are so freakin' cute, and they don't really let students touch the teeny sick ones and they are really freakin' cute too.  So in other words, I have not really done a whole lot this week other than make my ovaries want to explode.  

Why am I still awake right now??  Happy weekend, people.


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