week 5/6

i think this is a rather common experience for those of us in outpatient primary care - the feeling of, what more can i be doing. i do feel really sheltered because of who i work for (large group), how i work (schedule largely laid out for me), and who i serve (higher socioeconomic class).  i think many of us may be experiencing professional existentialism - if i did not go into the job to serve and protect, just what am i doing? a struggle between required heroism and self-preservation.

week 4

this week i spoke with a very angry young man.
he was black (his photo was in his medical record). identified as being from west oakland. and very upset why he could not get the care he perceived he needed.
this is a common occurrence already. it mostly came from the privileged, entitled demographic. and to be fair, i did not know much about his socioeconomic situation. however, as we spoke, it seemed he had a profound illiteracy for his own health. i reviewed his last actual in-person visit with an urgent care physician a couple months ago. he was given recommendations and treatment. and two months later he is calling in for more treatment, somewhat inappropriately, because by his own admission he had failed to adhere to the first.
it would have been very easy, i think, to get in a battle of frustration with this young man. frustration on our part because he was not following up as recommended, and then barging in to the clinics, against all public advice to call in advance, ostensibly not wearing any type of protection because "coronavirus is a hoax."
i think after "discussing" his medical issues (quotes because, it was largely him being angry and not understanding/accepting my explanations), this was the thing that stunned me the most. i couldn't even be angry, i was so shocked that he would say that. "if it's real then tell me why they're all these construction workers around then"
it burst the bubble i've been sitting (very comfortably) in for the last few weeks. presuming that people would understand the "right" and "wrong" thing to do. as if everyone had a basic working knowledge of germ theory. and had the inclination to listening to the large institutions from which they are disenfranchised from in the first place. and even if they did, the resources to comply.
yeah, he was angry. he had every right to be angry.
what was i to do? tell him never to come and only accept treatment over the phone? "i'm paying so much money to you guys and i'm not getting xyz."
what is the individual primary care doc to do?

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.