week 3

every day, i walk by a tibetian prayer center. in the front yard, obscuring the front entrance, is a cherry tree that in the last few weeks has been bursting into white clouds. i would sing a song in my head i learned in grade school about popcorn popping on an apricot tree. wrong fruit. the streets would be relatively still. it was often gray and rainy. no noise save for distance traffic and the click of my boots on the concrete. i would stand at a crosswalk waiting for the light to turn, only as a gesture, as a matter of course, because there was no one around to wait for them to pass.
i went to Oakland on wednseday morning to get onboarded. i rounded on a single person as practice. it came back quite naturally. the whole ceremony. gestures to walk through. standing at the door, quick chat with a nurse, coating my hands with hand sanitizer. walking up to the bed, introducing myself. the cursory exam. sitting back in the doctor's room, stumbling over the overwhelming maze of digital information to peel back the relevant bits.
one more patient testing positive. he went to the ER, and was obs'd.
one more week of waiting.
i am rather nervous for the future of my career. what is it going to mean to practice medicine from now on?
yesterday i noticed the intermittent rain pelted all the fluffy white cherry blooms of that tree into the ground.

everything depends on the red wheelbarrow.

week 2

this last week has been a lot of waiting. a lot of the initial fear and nerves are, well, not gone, but in the background. taking it day by day. ear to the news - getting called in, might be 24 hrs notice.
turning inward. small stuff. petty stuff. on one hand it's been a relief getting this gift of time to finish things in the office - reviewing charts, ie. but on the other hand, just a growing sense of dread for what will happen once people start coming to the office again.

week 1

things were relatively quiet in terms of the outpt world. a lot of time spent getting oriented to working in the urgent care/green zone setting, inpatient setting. nothing remarkable happened, except for a day where there was drama with one of the MAs and she threatened to quit.

the isolation is not helping much. i appreciate my girlfriends so much, letting me express my views and fears and doubts about what is going on. with my dance acquaintances it's pretty apparent that i don't fit in when physical presence is not required. i am making a choice to try to continue to insert myself in this group of people but ultimately they have no idea what i do, nor do they really care.

even though we are given this precious gift of time to prepare, instead of being very motivated and productive i find myself drawing more and more inward. i think i've already established my fear is not so much for myself. i think i am more afraid of causing more harm than good. i also fear for what the rest of my life is going to look like. if it is short, how will i spend this time? instead of plunging into work and work and work - should i be taking a different approach? instead of trying desperately to leave a footprint in others lives, should i just focus on "being" and becoming individually satiated?

I was trying to handwrite a will the other day. it is difficult.

the crown

in the last few weeks, i have thought nightly, in between burying my conscious brain in the sewage of youtube and social media, about my own mortality.
who could have predicted this reckoning? a plague, people are calling it.

i recently started talking to a complete stranger via video and phone. i disclosed to him, how unafraid i feel towards death. that i would rather die doing something meaningful than nothing at all. he was taken aback. he is only a couple years younger than me. "i don't want to die." neither do i (today) (dumbass), but if i were faced with it - well, i should like to think that i have been exposed to it enough to tamp down the insane fear of it. that is: if i were dying for a cause...i would go quite gently into that good night. i have an idea of what that journey entails.
until then, yes, i am terrified. terrified i will do a bad job. that i will harm, instead of help.

a new resolution. to blog something daily. to leave some trace of myself during this time. even if my physical body remains, i suspect this type of fire will leave me and everyone around me changed forever.

i think i would like to continue documenting the bad cases. as well as the good. the outpatient world has been rather mundane, with several notable exceptions. reading my old posts from the inpatient days (what a gift to myself, to have documented some - like a goldfish, i would never have been able to recall any of it), it really does seem like i made the right choice. wasn't cut out for it. and yet, here i am. on the precipice of being called back in to war. and suddenly i wish quite deeply for the mundane again.

some beautiful moments: on march 30, national doctor's day, someone bought ten pizzas for the entire clinic.
every other patient i talk or email to expresses their thanks, gratitude, and empathy for those of us in healthcare. i remind myself, i get the privilege of taking care of some of the most wonderful people in the world. (i also get the dubious honor of taking care of some of the worst people in the world, but never mind this for now)

tomorrow, training begins.

post-dc

i am appreciating clinic for its low key nature. it has bothered me at times, the feeling that i need to prove myself to a specialist, just to seem competent.  that never feels fun.  i know that overall i am vaguely competent.  but not excellent. that does bother me.
the rest of my life is such as mess that it feels overwhelming to strive for that excellence.  and what does that mean, anyway?  that i have to be on call essentially, available 24/7 for my patients, most of whom are about as privileged and well as i am?
i wish it was more clear from day to day if i am doing the right thing by these people.  of course real life is never as clear cut as a board exam.
day to day i also ruminate on my secondary boarding -- where do i want to go from here?  there isn't anything that i am doing that necessarily is above and beyond something a fourth year osteopathic student would do.  long gone are the days of shared meditations with my patients, working in the fluid, the ether, the embryonic zones.  a part of me scoffs, easily, at those times -- the idealism of an ignoramus.  the feeling is like a past lover.  you wonder how you could have been so silly.
but also, here i am willing to shell out hundreds of dollars for that treatment for myself.  i'm not sure what this represents for me and my journey in health and as a healer but i hope that someday it will lead to something good for the world.

A jumble

sometimes it feels like everything is scrambling, scrambling, scrambling, on low heat.  if you're gordon ramsay, then also with tons of butter.
today was just a jumble of cases.  i don't think i felt good about any of my discharges.
every day makes me glad that i wont be doing this anymore.
jaime tries really hard to make me feel better about the work here.  he inspires me sometimes to be more likeable.  always, until i realize i will never be likeable.
another holiday season working. alone.
here we go again!

i am definitely listening to the DMX/reading rainbow remix on repeat.

another one i guess

so yesterday, it was deja vu all over again.

i can't help but think it was the exact same thing.  patient with cancer, liver. unclear etiology. presenting with abd pain, nuasea, vomiting, distension.  she'd already been treated with NGT.  surgery'd already signed off.  and yet things turned from bad to worse.  she coded.  i was present, standing in the corner, impotent as the code leader, looking towards the intensivist who was already in the process of intubating her as i arrived.  and today, she died in the ICU.  i heard the wails of her daughter at the other end of the unit.

i wonder if i shouldn't have dropped an NGT tube.  I wonder if i should have been more persistent in getting surgery to come back.  i wonder i wonder i wonder.

part of the reason i feel i am not fit for inpatient is just this.  the tendency to ruminate.  i could have done all those things and the outcome would not have changed; this woman was fragile, a cirrhotic from drinking so many years.  and yet, i can't let go of the what-ifs.  and certainly, i am not the first person that this (sudden and rapid outcome) has happened to (arguably this has not "happened" to me, but i am choosing to put myself in the center of this scenario). but i can't help but feel ashamed, a little disgusted at myself, scared, angry.  like, an unwitting murderer.

one thing that bothers me about this case is how unaffected i feel, in comparison to patrick.  his death devastated me.  and i had only known him for less than a day.  i had been rounding on this lady for a couple days at this point.  i am not sure what the difference is.  maybe after the first couple deaths, one starts to get "used to it?"

if that is the case, then i surely am in the wrong field.  i don't want to get "used to it."  i don't want to be so jaded (as a defense mechanism) that i stop caring about the human side, the family side, the meaningful side. 

her death, i will carry.  as i have patrick's.  even though my shoulders are around my ears as i'm hunched over the computer, stressed, walking down the hallways as if trying to make myself like a mouse, like a ghost...their deaths weigh on my neck like elephants.  reminding me with every breath, that for some reason i am here and they are not.