On Hearts

heartWhen I was a little girl and people asked me what I wanted to be when I grew up I told them a heart surgeon. They would laugh that sweet laugh adults laugh when cute, naive children speak of that which they know not of. As I grew older I started vocalizing that dream less, partly because I was tired of being reminded that I am a woman, partly because I became self-conscious that perhaps I wasn’t capable. Though I shoved it deeper and deeper into my subconscious, that idea never entirely dissipated.

I was in the OR the other day preparing for a coronary artery bypass when I struck a conversation with a man who asked me if I wanted to be a surgeon. I let him know that I haven’t entirely ruled it out yet. I’ve found that I enjoy working with my hands, that there’s something miraculous about using these fingertips to perform procedures that were once taboo, once unknown, but now saves lives. He reminded me, quite kindly, that I had to evaluate my goals in life. To be a surgeon takes many years of training, many hours, more than not of them spent in the hospital, is high stress, and not very family friendly. This I was very familiar with. This I noticed, when on the first day of the service I found myself to be the only woman, when I walked past the wall of memorialized medical giants and found all of them to be older white men. I could have been defiant, sassy, fiery with a response but I recognized the truth in his words and the kindness in which he spoke. And I want everything-the independence, the career, the family, the happiness, at levels perhaps others would call me insane. And I can. I told him it’s like a puzzle. Your pieces need to fit. I have to find all the pieces that fit.

At the stroke of midnight I witnessed a heart transplant. Someone died. Someone was dying. A group of world-trained surgeons gave a person a second chance at life. A medical student who was once a naive, little girl dreaming of fixing broken hearts had the privilege of witnessing a medical miracle.

This could not be a coincidence.

She is still deciding who she wants to be. She is still trying to figure out how the pieces of her puzzles will fit. Everyday continues to be a lesson in balance, progress, grabbing opportunities. Sometimes she wishes she could just know the future so that decisions wouldn’t be as hard, but it’s okay. She knows she’s getting closer, twenty-four hours at a time.

To the little girl I once was, look at where we are now. You are a woman. You are capable. This isn’t a dream anymore.

2017 is for Growing

In my planner, under goal for the month, I simply wrote Growth. I wanted to take January slow, to properly ponder what I truly wanted for 2017-⠀

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My aunt stopped me in the kitchen one day. She sat me down and told me, I know you’re going to be a doctor, but remember before anything you are a Woman first. Take care of your body. I was starving myself, feeding only the mental, emotional, spiritual parts of me. I wasn’t balanced. Find balance.

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Once, in a class analyzing a literary work, the professor asked if the author was too self-aware. Do you think it turns the reader off? No-embrace your awareness. There’s honesty, and difficulty, in seeing yourself for who you are, in striving to fix the parts you don’t like. As long as it doesn’t cripple you, as long as there’s gratitude in the journey. We are works constantly in process. Remember there’s beauty in appreciating every step of the way. ⠀

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I’ve realized that the hardest part of letting go is having to construct a future different from what you envisioned. It’s trying to have full faith and trust in the fact that there is no one single path. We move, we stop, we adjust, we move, we stop, we adjust, and somehow in the end we’ve zigzagged around but in that zigging and zagging we’ve picked up people and stories and lessons and memories and the full confidence that everything happens for a reason. I’ve accepted what happened. I’m embracing the unknown.⠀

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Be light, my dear. Be light, with your thoughts, with your actions, with your self-criticisms, with your anger, with the heaviest of burdens that sits in your throat, on your chest. Be light. Be light. Be light. Breathe deeply, think clearly. Be light.

Intersections II

These are just points. Points that become lines, and lines that become crosses, and crosses that keep intersecting, like those Etch A Sketches we used to play with as kids.

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2iPM009 by Magdalena Fernandez

What this photo deprives you of is the sound in the background-rain. Starting off with a couple of drops, pianissimo, then crescendo to thunder with bright, blinding flashes of lightening, but only for a brief second before going into a steep decrescendo, morendo. The points and lines and crosses become less and less until you’re engulfed in darkness. As soon as the silence settles in, your eyes adjusted to black, your ears pick up the sound of distinct rain drops beginning once again. Dal niente.

And you can sit, in the exhibit, on a bench, just listening and synchronizing. After a couple of cycles, if you’re paying attention, you’ll realize that the sound you’re hearing isn’t rain. It’s a chorus, clapping and snapping and whistling, in imitation of one of the most calming, one of the most frightening moments of nature.

I’ve been reflecting a lot, about the crazy world we’ve learned in history books but never imagined experiencing. About how, this moment, right now, will be in the same history books. Future generations, of a future, hopefully more united world, will analyze this. They’ll ask what happened. Sit in an exhibit, on a bench, question.

Alone, we are just points in space. When we mobilize we start forming these lines. When we organize, when we connect, when we make an effort to intersect, we cross into each other’s paths. When we take all of our collective actions, all our efforts to attempt change, we’ll form a thunderous applause.

That’s history. Injustice crescendos until we can’t take it anymore and we fight back. And right now it’s overwhelming, and there’s tension and discord, and your heart drops at every breaking news report, but we’re experiencing a moment that will define the future. We’re reaching the thunder, with the bright, blinding flashes of lightening, and we’re the chorus in one of the most frightening moments of our history.

Keep clapping, snapping, whistling, doing what you can. Take those points, turn them into lines, and become crosses that keep intersecting.

Let There Be Light

I took a mental day off. Or at least tried to. I laid in my bed watching lights dance across my wall for the better half of my early morning-

Last night, once again, I found myself amongst classmates discussing death. How do we define it, how do we define personhood, what is a soul, does a soul even exist, what is man, is man man if there is no neocortical function, is neocortical function the essence of man, who are we to come up with guidelines based on samples and statistics, are we using science to ignore philosophy?

And that’s how I fell asleep, with heavy thoughts that neither I, nor anyone else, could satisfactory answer. In all our scientific brilliance we accepted humility in the face of the unfathomable.

That’s the problem with rationale. There comes a point where you no longer have the answers and you have to accept. If not, you go in circles and you lose something so critically important-empathy. In all of our equations, we will never have a definite variable for H. Human. And for me, G. God.

You change, when you’re twenty-three and you’re discussing death, when you’re having conversations questioning if the methods you’re learning will be debunked years from now, when you’re constantly refining your morals and values, when you have to make your heart big enough to hold everything your mind can’t answer, when you think of the day you have to stand before a family and say that their loved one is brain dead. Even if through a machine their heart is beating, even if they are still breathing, even if there might be a twitch here or there that gives some hope of life but science tells you it’s improbable, it’s meaningless. And you have to suggest to them that it’s time to let go. And you have to be confident in that suggestion. You have to be confident in how you defined death and meaning.

You change, when you’re twenty-three and you get up in the morning knowing you need a mental day off because that’s the first thing in your mind. But simple things, like watching light dance across the wall makes you feel warm and acutely self-aware of mortality and how alive and blessed you are.

When I Was a Pre-Med

My professor told us his daughter was dying.

Though he said it matter-of-factly, his tone and body language told us everything. His voice was softer and lower than usual, his eyes were downcast, his fingers frozen on his phone, his shoulders hunched. He remained in that position, still, as the silence following his words washed over the classroom.

My professor told us his daughter will die and no one knows why.

Immediately I felt an overwhelming sense of emotions, the first being guilt. I felt guilt because in a room of about twenty students, I was the one pursuing medicine. I was the one who had to understand that death is inevitable, that medicine has its limitations, that doctors are not the cure all and they sure do not know all. I felt guilt because despite that understanding I was hearing this news from the parent of a patient who wanted and needed answers. I cannot tell him death is inevitable, that medicine has its limitations, and that doctors are not the know all, cure all answers. When so much faith is placed on medicine to deliver answers and delay death, how could I?

No one knows why.

How could I explain why we do not know why? How could I explain that throughout the whole span of human history the most significant medical advance happened 88 years ago? How could I explain that the first organ transplant was 62 years ago? How could I explain that the war on cancer was announced 45 years ago? How could I explain that we think we are in a golden age of medicine with our wars against diseases, yet we have not even taken one step towards what lies at the horizon, nonetheless beyond it. The life-changing medical advances we know have yet to celebrate their centennial. We are constantly doing research, and we are making progress, but there is still more to gain, and for those who fall between the crack we are trying to learn why.

How can medicine explain to a parent of a child with an unknown disease that we simply do not know and we cannot help? We are not, and never will be, masters. We are simply apprentices. But how can we explain to the suffering that we are simply humans when they come to us seeking divinity?

I felt guilt because medical professionals are expected to carry humanity in their hands and perform miracles with the snap of a finger but cannot always come through. I felt guilt because my professor wanted answers but no one could give it to him. I felt guilt because ten years from now, when I am working in a hospital, I am going to have to tell a patient that it is their time, or a loved one’s time, to confront death and I do not know why. I will tell them I tried the best I could, that I did everything I was taught, and I will apologize that it wasn’t enough. I will hold their hand, I will give them a hug, I will perhaps shed a tear, but I won’t be able to feel their immense loss, their hope, their reliance, their disappointment.

Death will always be our limitation and no matter how hard we try it is something we cannot grasp. It will always beyond our reach, in territories that will forever be uncharted. Yet medicine is evolving in a manner that views death as a failure and actively seeks to avoid it.

That is what I felt. I felt failure.

I felt guilt because I felt failure and I felt failure because I felt responsible. I know it sounds ridiculous but I felt it. Now that I am in medical school, now that I have taken ethics, now that I have thought and discussed death, now that I am wiser for it, I still can’t shake that feeling off.

So where have I failed?

Intersections

It was the afternoon of a so far productive day. We woke up early, found our way into a new favorite coffee shop, and engaged our brains in a four hour, memorize everything you can about Cardiology and Heme/Onc, study session. As a scientific break we stopped by the Contemporary Art Museum and found an interactive exhibit by Mark Flood. Canvases of harsh realities, critical views, and political incorrectness spanned the walls. The interactive part was simply a like sign, to place in front of the work that touched you the most.

This was mine.  Continue reading

On Perspective

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FLOW 流 by Jae Ko

You’re checking the blood pressure of a Syrian Refugee. It’s a community health fair, she’s only been here a couple of weeks. You find it high and ask her if she has hypertension and she says yes, but she hasn’t had access to medication in months. You tell her to hold back on the salt until she can get some meds. It’ll help a little. She responds it’s not the salt that is causing her the hypertension. It’s the nightmares. They won’t end. Even when she closes her eyes. They won’t end.

You’re taking history from a Latina woman admitted to the ER. She has a long history of hospital visits in the past week that you’re trying to get straight so you can find out what led to today. You’re having a congenial conversation when she takes her hand, puts it on your arm, looks you in the eyes and tells you she’s going to tell you something she hasn’t told anyone, not even the attending. The reason why she came to this hospital, a hospital that’s nearly an hour away from her home, why she left the one she was in last, was because someone over there accused her of being an illegal alien. She has been a US citizen for decades. She thanks you for treating her like she’s human.

You’re at a community clinic and a daughter is concerned about her diabetic mother. Blood pressure readings tell you that right now she should be in the hospital, it’s a hypertensive urgency, but she’s sitting fine, looking fine, talking in a tongue you can’t understand fine. It’s the end of your shift but you stay back to help. Do a manual check, using your own cuff, your own stethoscope. The daughter asks you to teach her so you sit her down and hand her your tools. Hear the beat there, see the reading here? She tells you that back home she used to be a nurse, but since she moved she hasn’t practiced in years. She checks her mother’s pressure, thanks you, and gives you a hug. I have only known you today, she says, but you are like a daughter to me.

You’re sitting home on a Sunday night, have a candle lit to ease the anxiety, staring at notes taking up all the space on your L-shaped desk. Right now you’re thinking really small. You’re considering physiology and pathology, sometimes your mind wanders to philosophy and policy. You have forgotten that all this, all this would be nothing if it weren’t the stories you have experienced with real people. Real humans. How they felt comfortable enough to open up and share with you, to let you in, to let them in. So your perspective shifts-

You’re sitting home on a Sunday night, have a candle lit illuminating memory by memory the experiences that motivate you, staring at notes that will one day aid you in helping, maybe saving, a life.

And that’s perspective.

The Mind is a Curious Place

Today I was told the reason for a hospital visit was hearing voices that said horrible things. I was told it wasn’t a regular occurrence, only once a year. I was told when they were young they witnessed their father kill their mother. Every year, around the time, the voices come. 

The chart said Chief Complaint: auditory hallucination with homicidal and suicidal ideation. Diagnosis: PTSD.

The attending apologized for assigning this patient. He didn’t expect the history I gave. In a sense, though I am in training, he wanted to protect me. I’m learning right now, I shouldn’t have to face burdens like that right now. I’m supposed to be taking thorough histories of simple complaints and performing physical exams with majority normal findings. But these aren’t textbook cases. These are complex, real human beings with histories that can shock us, with unexpected life experiences that can bring us to tears, can inspire us, can cause us to shake our heads. They are stories always requiring us to lend an open ear and a comforting touch, to say it’s okay, you can trust me.

Form relationships, provide intimacy, gain trust.

In order to do that, the physician is burdened with carrying the stories of others. We can’t ignore. We can’t remain ignorant. We can’t be oblivious. We can’t turn our cheek and say this is too much I want nothing to do with it. We can’t remove our extended hands. We have to ask questions we shouldn’t know the answers to, sometimes we don’t want to know the answers to. We have to place ourselves in the midsts of crisis in order to perhaps provide some sort of relief. We carry people with us, we have to witness their suffering, we insert ourselves in a moment of their life and incorporate them into the rest of ours. We build relationships, intimacy, trust. And it isn’t easy, to open yourself in a way that allows you to receive.

In the moment I didn’t know what to say. I was a student, granted important information, shocked, trying to search for the right words. I fell upon a generic empathy statement we were taught in class-that is very tough and you are very strong to have faced that and to overcome it as you have. It felt wrong to me, as if I should have said or done more.

But as simple and generic as those words felt, I was told thank you for saying them. Then I saw a smile and I knew I had said the right thing. I hadn’t done nothing.

Though the physician is burdened with carrying the stories of others, it is a privilege. We confront the mind, its memories, experiences, and thoughts, in its rawest form and we try to make sense of it. I had a moment with relationship, intimacy, trust. I was allowed in, though I didn’t have to be, to try to understand a curious place. 

What I should have said is thank you. Thank you for believing in me, so young in my training. Thank you for opening up, for entrusting me with carrying the weight of your words, to allow me to make you smile briefly. Thank you for teaching me.