Forgiveness

The loose thread hangs bare, vulnerable
I see it there
I try to forget it; let it be
I can't
I pick
It unravels

I find another loose thread, at the edge
I know I shouldn't pull it
I want to let it be
I can't
I pick
It unravels

I find each thread
Each imperfection
I need to let them be
I can't
I pick
My self-assurance unravels

Now it's just a pile of threads
Loose yarn on the floor
I want to knit it back together
I can't
I sit
I slowly unravel

Sometimes I have a knack for pulling on every loose thread in my being until I unravel like a sweater and am about as useful as a pile of yarn, lacking form or function.  I wish this weren't the case.  I wish the confidence I seem to exude wasn't a farce, an act.  I want to understand how to forgive myself, and let the imperfections be.  I want to be able to grow and learn without constantly second guessing myself at every turn, every decision.

19 of 19

Body aches,
Brain fatigue.
Constant pain of thinking
That you've missed something,
Done something wrong.

Can you provide hope
When you feel lost yourself?
Can you provide peace
When you are in turmoil?
Who has the answers?

Even without the answers,
I can hold a dying woman's hand.
I can hug her children.
I can stand by their side,
And sense the pain they are feeling.

I can let them know I am here;
I am here for them.
At this point,
I feel like I have nothing
Else to offer.

It’s the Final Countdown…

Today was the first day of orientation for my intern year of residency.  It was fantastic!  We went on a team-building/ropes course excursion.  Needless to say, I was kind of glad that most of the events were on the ground except for two.  But I did those two (mostly).  I think it’s an accomplishment that I was even hanging out 20 feet above the ground with nothing between me and it but the air (other than the tethers holding me up for when I fell).

Our mentor/leader was great.  She really made sure that we were safe and comfortable with what we were getting ready to do.  She also made sure that we each had a voice and that we participated, were thoughtful and worked together through each activity.  Besides hanging out above ground, we did a couple trust building exercises, activities that forced us to work as a team and made us think, communicate and collaborate.  It was a very active day that my legs are quite upset about.

I loved my team.  I think that the small group will be my “venting” group for the next year.  Basically, the group that I will meet with periodically, along with a facilitator, to make sure everyone is happy, healthy, and not burnt out.  I’m excited.  I think we worked well together and really relaxed into supporting and cheering each other on.  I’m excited to know that these people will be my personal cheerleaders over the next year, and I will be able to be theirs.  It’s an awesome way to begin a relatively daunting year.  It will be a lot of work, stressful at times, a huge learning curve, but man do I have an awesome group of people to now call colleagues and friends.  I couldn’t ask for a better group of interns to start my medical career with.  Onward and upward!!

On Medicine

In death, we must learn to celebrate life.  That, I think is the biggest thing I have learned in the past two years: in death, we must learn to celebrate life.  I have now been to the funerals of two children that I have cared for, both under the age of 15.  It doesn’t get easier.  Although I won’t be going into pediatrics, I will still remember these children.  They will be part of who I am for a very, very long time.  The pain I felt for them, I will remember each time a patient dies.  They are all like family.  It doesn’t matter how old or young.  All have family and friends that love them, have memories with them, had imagined their future.  I have fallen into that as well at times, and that’s okay; that’s good.  I may not always be able to become as strongly a member of a patient’s life and family, but I can always be empathetic for the families that are going through very difficult times.  I will try to always be understanding and compassionate and empathetic.  There’s not much else I can truly promise as a doctor except to give fully and do the best I can with what I know and have to offer.

The End

It’s finally here.  A day I’ve been waiting for since before I started medical school.  I always dreamed of my hooding.  The bright emerald green pendants on my black regalia.  A soft cap instead of the undergrad mortarboard.  The soft velvet green of the hood with the gold and black lining signifying that Wake Forest is presenting me with my doctorate of medicine.  The weight of that hood carries more than just the material it’s made of.  The hood signifies the honor, responsibility, pride and humility I will carry with my career.  I cannot begin to describe how much this moment means to me.

But there’s a sadness as well.  Some of the people who have become more like family over the past four years will be moving to bigger cities further away to continue their training.  I remember vividly that first day we all arrived for orientation.  The fear and anxiety.  I didn’t really know where I was or where I was going.  And then I sat down at a table with a girl wearing the exact same color shirt as me (a feat seeing as it was teal) and a girl who had been through this once before, who had lived in Winston for the past five years.  In that moment I knew that as long as we were in it together, we could manage anything sent our way.  Second year brought in new friends to our circle.  One in particular a somewhat shy but giggly girl from California.  She and I have gotten each other through everything since then.  We rotated together through all the third year clinicals.  I say with my heart of hearts that she is as much my family as my own sister.  I love her dearly, and it breaks my heart to think how far away she will be come Tuesday.  The entire United States to be exact.  I can only wait for the day that we have vacations that coincide so I can see her again, and see where she grew up.

It will be a shock the first day of residency when I walk through the doors of my beloved hospital and see so many new faces, but so few of my comrades.  I can’t believe that this is the last weekend that we all will be together as a whole.

Facelift

I have been meaning to update the look of the blog for quite some time.  I wanted the appearance to be airy and fun yet fit with the theme of the blog.  So, here it is!  Colorful circles in a soft green background.  Hopefully it won’t detract from the gravity of some of the posts that either have been added in the past or will be added in the future.  I’ve had relatively the same blog set-up and background since most likely before the beginning of medical school.  With all of the deaths and loss and brokenness of the past week, I needed something to brighten up the atmosphere.  It’s been an unbelievable week.  I’m praying that this is rock bottom and we can only go up now.

Loss

It's amazing how reality can take and overpower you, even if that reality involves people you never knew and  a world of people you've only touched briefly.  So much pain and suffering has touched the very protected world of my medical school.  We started the week reeling from the loss of a beloved member of our school family.  A girl I had never known, yet from all I could see was a beautiful, intelligent, artistic and athletic individual.  She was overcome by a pain so great, she could no longer live with it.  I hurt so deeply knowing that one of my family was carrying this pain, this hurt, and did not know where to turn.  I can only hope that she now knows how loved she is, how she can do no wrong, and how is she never alone.  If only those messages had reached her earlier or that she had had the ability to hear these messages and known them to be true.  I cannot fathom what deep, deep sadness and loneliness she had felt last Friday.  I can only see how deeply she had touched all the people she had met in her lifetime, how deeply loved she truly was, and how confused and lost we all are trying to comprehend and cope with such a loss in our tight knit family at our medical school.  Even those of us who did not know her are moved by this shocking event and are left wondering how we can reach out and help.

Our pain, loss, and sadness were deepened further by disturbing images from the Boston Marathon on Monday which have only worsened as the week has continued.  The Boston Marathon is a crowning event of athleticism and sportsmanship.  The individual runners are amazing people with such talents I can only imagine.  The on-lookers, the greatest show of support I know.  The crowds cheer on and motivate each runner that passes them.  All sports events are unrivaled showings of connection.  Here we have the epitome of human beauty, human nature, and it is muddied, destroyed, torn apart by two men who had long ago been part of such camaraderie   Each man had once been an athlete, had been a vital part of the community, cheered on, just like the runners on Monday.  Then, without warning, the finish line was left in shambles, destroyed by homemade bombs created by two men who made a choice to cause widespread pain and misery.  Had they too suffered an unfathomable pain, one they could no longer hold in their chests, carrying alone, feeling like they had no one to turn to?  Were these men so indoctrinated at some point in the very near past to feel that the only release of this pain was through mass casualties of strangers?  It is incomprehensible.

To make matters worse, this initial shock of the bombings was compounded by the full-on manhunt through Boston that began early Wednesday evening.  The suspects flaunting the choices they had made.  The shutdown of a great city, overtaken by marshal law while the remaining suspect is on the loose.  It is horrifying to watch the images of house by house searches.  I can't feel the same fear and pain those in Boston are going through, the psychological damage that has been caused.  I can empathize.  I can suffer with humanity because I am part of it.  We are all connected.  I am paralyzed by what is replayed on the television.  I want to react, to help, to reach out, to protect.  But I am powerless.

I don't know where to start.  I feel so raw and exposed, but at the same time know that my feelings are only a fraction of what those in the crossfire are feeling.  I can only sit and watch.  I want to take action.  Maybe this is how I'm meant to do that.  We are all connected, and the pain we cause others causes our soul pain, too.  We are given the freedom to make choices for ourselves.  Whatever choices those may be, we will be held accountable be it in life or after death.  Regardless of any individual's beliefs, we all are connected through the understanding of a divine being that loves us unconditionally, who created us but left us free to make decisions for ourselves, and who will allow us redemption through self-reflection.  We must band together, care for each other, and love each other deeply and unconditionally in the image of our Creators in order to maintain the greatest calling of humanity.  We are one and always will be.

Change

The past few days have been spent with my physical life in complete disarray.  The house was pulled apart, shuffled around, repainted, new fixtures, electrical work.  You name it, it was probably done in the last 72 hours.  And the final product is pretty stunning, I must say.  The guest bathroom is all but done.  I just need to earn some extra money to buy the faucet that matches the rest of the hardware we installed.  The dining room has chair molding with a gorgeous golden color underneath that all but makes the dining room furnishings glow with new life.  I'm itching to complete the rest of the upgrades which will probably take a year or so, slowly working through one project at the time.  But I digress from the real purpose of this post (sadly, no pictures included).

During the repaint job on my bedroom, I had to spend a night sleeping on my bed pulled out in the center of the room.  It's amazing how different it feels knowing that no side is safe.  When the bed is against the wall, we have this sense of security knowing that our head is protected, that behind is nothing to worry about.  A nice tall wall guarding us, leaving us only with sides and the foot to worry about.  In the center of the room, it is jarring.  Here you are with every side exposed.  It's unnerving.  I laid there,  looking at the fan, feeling somewhat uneasy.  How strange, right?  There I was, in my own bed, in my own room, in my own house.  The only difference was the positioning of my bed, and yet it completely threw me off.

The strangest part, is that even after my bed has been put back against the wall, my room back to its original  set-up, I still wake up with the sensation that my bed is in the center of the room.  I have to completely wake up to reassure myself that the room is back in its original set-up.  Maybe this sensation is my brain trying to come to terms with the other changes that are coming.  The uneasy sensation is the only way my mind can understand how to show that things will be changed around soon.

The interesting part is that even with the uneasiness, the off-kilter sensation, it's not painful or completely unwanted.  It is there, and I acknowledge it, and I it, but it's not so overwhelming that I overreact.  It's a strange sensation, but it certainly isn't killing me.  And I continue on to the next day, moving closer to the next stage of what will become the rest of my life.  And I think I can be okay with it...at least for right now.  Next week might be different as the reality becomes more tangible.

Alice and Dorothy

I have a very strange obsession with two classic fantasy novels.  As you can tell from the title, they are "Alice in Wonderland" and "The Wizard of Oz".  I have to admit, I have not yet read the original "Alice in Wonderland".  I own, two copies actually.  One in print with pictures, the other on my kindle.  I will read it.  I have to.  It's not really something I can avoid.  These two series intrigue me.  I am officially obsessed.  I have watched as many possible iterations of each that I can.  From the classic Disney version of Alice and the first color movie of Oz to the knock-offs.  The recreations.  I love them.  Over and over again, I will watch them.  I can't figure out what it is that so attracts me to these stories.

Perhaps I have a deep-set need for disappearing into a fantastical world.  A world that is like and unlike ours.  Where you can pick out similarities between the characters and people you know.  Or maybe it's the fact that the worlds can be written and rewritten however you want them to be.  They can be this day and age or 50 or 100 years ago.  They can have actual animals, or people dressed like those animals might seem as people (the lion as a general, albeit, one that's never been to war or even considered it; the white rabbit a nervous little man persistently certain he's late for something, anything).

I'm fascinated by each newly envisioned world for Alice and Dorothy.  Each different persons view on how it should be.  I want to fall into each world like Alice fell into the rabbit hole or Dorothy's house fell on the Wicked Witch of the East.  I want friends like the Mad Hatter or Scarecrow.  I want to have that chance to, just for a moment, disappear from the real world.  I want to enter a world that's topsy-turvy.  Something entirely different from the reality I'm used to.  I want that escape from reality.  But only for a short time.  Long enough to realize, just like Alice and Dorothy, that there's no place like home.

Blue Ridge Mountain Man

You twist the sheets in your hands,

Smiling at me;

Your voice is garbled.

Your daughter says

Dementia,

Congestive heart failure,

The diseases slowly taking you.

Then she tells me your life.

A strong man;

You helped create the Blue Ridge Parkway,

The serpentine road carved

Into the Appalachian Mountains.

The mountains,

Larger versions of the creases in your sheets

Where you are trying to rebuild that road.

And I wonder if the view you saw,

Many years ago,

On a crude road of gravel,

Is the same as I see today

When I drive the smooth paved road.

Was the sun more brilliant

Bouncing off the mountain faces?

Were the mountains more blue

In the fading light

At the end of a long day?

Can you show me

What you see now

From those many years ago

As you rebuild the path

Through the wilderness

In the sheets surrounding you?

Bold

The Experiment was a bold one.  She had been planning it for ages.  Endlessly dreaming about each minute piece of the whole project.  Intricately working everything together in her mind.  The process was arduous.  The wait intolerable.  Each day, a new piece of equipment would arrive at her door, and each day she imagined it's place in the set-up.  Bunsen burners, Erlenmeyer flasks, beakers.  Today it was the retort.  Yesterday was a small case of test tubes.  The chemicals each arrived item by item as well.  Her checklist was almost complete.  She would be able to begin on Friday, work through the weekend, hopefully something brilliant by Monday.

Finally the week was dwindling; her time to create approaching.  Thursday night she spent setting up each of the delicate glass vessels.  Round bottom flask held upright by a ceramic donut on the bunsen burner.  Erlenmeyer flasks and beakers lined up with various burettes  and separatory funnels hovering in the air above, poised to release minuscule drops of liquid into the containers below for precise mixing.  At the end, the retort with the resulting distillate designed to drip into a rack of test tubes.  The end result.  All was ready.  All would start tomorrow.

She couldn't sleep for the anticipation.

Friday morning.  She painstakingly rechecked the glassware set-up.  No cracks, no imperfections, all was set-up as it should be.  She began.  One chemical and then another was placed into the round bottom flask, dissolved in water and heated.  The colors swirled and mixed.  Once dissolved, she began to pour the liquid into various containers.  New chemicals added at each stage.  New colors emerged. Reds and oranges like flames licking the inside of the flasks containing it.  The last stage before entering the retort, a violaceous liquid, like melted bubblegum, filled the beaker.  She held her breath, knowing that one wrong move would upend her entire life's work onto the table where it had been created.  The mixture, safely transferred to the new container, swirled and rolled, exploring its new entrapment.  She relaxed only slightly.  The last step of its journey and hers.  The effervescent concoction warmed by the bunsen burner turned a deep, afternoon sky, blue in the dim light of the laboratory.  A green mist of vapor quietly ascended into the top of the retort containing it and condensed as a radiant teal liquid into the softly curving neck above.  Slowly the distilled liquid dripped into a tiny test tube, turning the new, final mixture an iridescent purple.  Glowing with life unknown.  The scientist smiled with content.  Her experiment worked.

Narrative Medicine

I am rounding out the end of fourth year of medical school in a class called "narrative medicine".  For most medical students, we are never truly taught how to process the emotional situations that we encounter daily in a way that allows us to continue growing.  Narrative medicine provides the base on which to be able to process the emotions we feel on a daily basis, giving us the chance to provide better care to our patients.

It boils down to returning to our humanity.  To begin to again deeply experience and enjoy the world around us through readings, movies, art and music.  As we are exposed to the arts, we are provided the chance to reflect and determine how each piece can fit into our idea of self and our interactions with others.

It is the most enjoyable class I've had since my creative writing classes in undergrad.  It is the release and decompression I needed before starting intern year.  My hope is to continue this writing through residency as best I can.  I will need to continue reflecting in order to maintain my compassion and ability to empathize.  I have a fear of becoming hardened and apathetic during residency thanks to sleep deprivation and the grueling schedule.

I do have fears about residency, perhaps not ready to be posted here.  I can do it.  I have a great support group with me.  I am competent and empathic.  I have the tools to reflect on all that I learn and see in the next year.  Now just to hope that time allows it!

I will try to continue posting similar posts to the one below from reflections I do during narrative medicine.

The Movement

Tin Win became Mi Mi’s legs because she couldn’t walk, and Mi Mi became Tin Win’s eyes because he couldn’t see. Together, Tin Win and Mi Mi were one. Tin Win had discovered that “parellel to the world of shapes and colors, [was] an entire world of voices and sounds, of noise and tones”. What he could hear, the sound of an unborn chick’s heartbeat, the rustling of butterfly wings, the voices of leaves, Mi Mi would seek out and describe. Together, each allowed a new world to appear for the other. Mi Mi discovered the world of sound, the voices of the Earth. Tin Win was able to discover what he was hearing through Mi Mi’s descriptions. He was able to see the world his eyes failed to show him as Mi Mi guided him through it. 

The beauty of the story of Tin Win and Mi Mi is not just in their discoveries of life together. Not just the wonder in the time they spent together. Their first meeting, Tin Win’s discovery of Mi Mi’s presence is the most beautifully heart-stopping moments I have ever read in a book. They unite at the beginning and reunite at the end of their lives in a way that highlights the true wonder of discovering another person who truly knows you. Tin Win found Mi Mi through the chaos at the beginning and end of their life together, and their spirits were inseparable, even when they were not in each other’s presence.

“And through all that crackling, through the creaking, whispering, and cooing, the dripping, trickling and cheeping came that unmistakable soft knocking. Slow, calm and even… There it was. Her heartbeat.”

Across the monastery, through a world full of many distracting noises, Tin Win heard Mi Mi’s heartbeat and following it to her. And when they were separated by continents as adults, each with their own lives, families, jobs, it was as if Tin Win could still hear her heart beating. It grounded him. And it eventually brought him back to her when the time had arrived for them to die.

“He laid his head on her breast. He had not been mistaken. Her heart sounded weak and weary. It was ready to stop.

He had come in time. Just.” 

I have never been so moved by a love story. The pureness of Tin Win and Mi Mi’s delight in their deep connection even when apart. The way Mi Mi wanted so badly to hear the world Tin Win heard; how delighted each was in discovering the source of Tin Win’s noises. It truly felt like one of those moments where I was honored to be allowed in presence of someone else’s most intimate moment.

This story taught me two things that I will carry with me. The first is the pure joy of connection. The delight of someone else wanting to enjoy your world with you and share theirs in return. It’s about taking the time to understand that our perceptions of our surroundings differ, allowing us to be in the same place, look at the same thing and interpret the environment in vastly different ways. IN stopping the hear what another is sensing, allows that connection to form and a new approach to life to be learned. In a clinical sense, I need to remember the raw emotion that can affect a patient and their families understanding and comprehension of a situation. I will need to be able to interpret the situation as they would, and provide the guidance that they need during such a difficult and vulnerable time for them.

The second lesson is how vision clouds our senses, providing cacophony that shrouds other truths from us. By not seeing, Tin Win learned to hear his world. At first, all the sounds, noises, symphonies were overwhelming, making it difficult for him to determine his surroundings. Then, Mi Mi’s heartbeat broke through. It provided a steadiness that allowed him the opportunity to explore his world and make sense of it. When we keep our eyes open, it mutes our other senses and denies us the steadfastness needed to explore our world through other routes. In closing them, we remove that additional chaos and allow ourselves to experience the true beauty of the world around us. Until I read “The Art of Hearing Heartbeats”, I had wondered why closing your eyes made listening with a stethoscope easier. By removing the distraction of sight, we allow our ears to hear the subtleties hidden previously. We distrust our ears otherwise.

This was one of those books that when I finished, I felt I’d lost a beloved friend. I felt so connected and part of Tin Win and Mi Mi’s beautiful world, that when it was gone, I felt lost and immobile. Even now, I find I have trouble completely explaining how unbelievably alive I felt in this book. I wanted to reread it just to hear those beautiful sounds again, to experience a world I felt I had no other way of being part of. I remember sitting on the back porch of my parent’s beach house and closing my eyes in dispair of finishing exploring such a wonderful world. Sitting with my eyes closed, the sensation slowly overtook me. The soft swish of the gliders on the sofa swing with a gentle squeak at the end of each arc. The purr of my sweet Maine Coon asleep next to me. The beating of the tiny birds’ wings and the crack of the millet as they gobbled down the soft center. The creak of a branch as a squirrel jumped from tree to tree. The rustling of the voices of the leaves talking to the wind. The cracking of a twig under a deer’s hoof as it approached the bird bath for a drink of sweet water. I couldn’t help but smile as the realization that the world of “The Art of Hearing Heartbeats” would always be with me if I just closed my eyes and let my ears take over.

Patience

If there is something I have learned in the past 24 hours, it is the power of patience and faith.

One week ago, I decided that Chewy needed a new buddy. Namely, a 19 lb., 5 year old Maine Coon named Boris. Yesterday, we picked Boris up and brought him home. Bringing him home turned out to be more stressful for me than I thought it would be. First, the humane society basically said that Boris would die if he so much as touched dry food because of his weight. (As a reminder, most Maine Coons weigh somewhere between 15-25 lbs. depending on the purity of their blood line). And sure, Boris is a little more round, but it's more of an "I used to live in a happy, healthy, safe home" rather than "I'm royalty from the 15th century where weight denotes status in society". So, of course, I'm freaking out because Chewy is 1. underweight and 2. used to free feeding on dry food that I can't remove from where he can reach it. My image of Boris prior to actually getting home was that he would clean out every bowl in the house like a dog that's sure it will never see food again. I started doubting my decision when my sole purpose in adopting Boris was to have two very happy kitties that would keep each other company when my intern year leaves me with more hours in the hospital.

So yes, I was afraid, doubting myself, losing faith that I wasn't purely acting out of selfishness in bringing Boris into Chewy's and my house and lives. When Boris was released from his crate, the first place he went was the food bowl. My heart rate went up, until I realized that he only ate a couple bites before exploring the rest of the guest room that is doubling as his safe place for the moment. I calmed considerably, being reminded, once again, that cats are smart and don't generally overeat the way dogs will. As the next 24 hours continued, I realized that for his size, he eats like a bird.

The next challenge was getting him and Chewy to interact. I spent most of the first night stressed that he and Chewy wouldn't get along. They would just be angry at each other the entire time, and it would cause undue stress for both of them. Day one, Boris did spend most of his time growling at Chewy whenever he was in sight. Chewy, on the other hand, surprised me; he stayed very, very calm the entire time. I was in awe of Chewy's grace and how well he took Boris's arrival in stride. Now that we've made it through the first night, both cats seem so much calmer. Boris has only made one small meow at Chewy. Chewy has continued his usual routine. I am very proud and happy for my boys. I think the longer the three of us are together, the more love we will have for each other. I now can say, I can't wait to see what each day will bring in my relationship with each cat as well as the relationship they have with each other.

Patience: The act of bearing or enduring pain, difficulty, provocation or annoyance with calmness. Both Chewy and I have learned the importance of patience with bringing Boris into our life. I just need to stay strong in my faith for the decisions I make.