April 19, 2015 § Leave a comment
I had a patient the other day with a resting tremor. It was something that ran in his family, and as we sat there, chatting about his arthritis and recent divorce, my eyes kept darting to his hands, quivering just so in his lap.
“Things haven’t been right since Marge left,” he said. “My daughter comes to visit and helps out, you know, making meals and things, but I’m alone a lot. Things haven’t been right for a long time now.”
His hands quivered furiously. His eyes darted down, past his hands and to his shoelaces – a lifetime with the tremors had normalized them, and he seemed to barely realize how his hands shook harder as his voice broke.
He’d been a mover at the MFA, shifting art pieces and installing them onto the high ceilinged walls for exhibits during his career. I reached out and felt his palms, rough at the edges, worn palms, hard fingertips, given, across a lifetime, to the service of beauty. Those little joints in the middle of his fingers were thickened and knobbed, bearing evidence to the painful arthritis stiffening his movements. His arthritis had showed up over twenty years ago, but he’d only retired five years back.
“How did you manage to keep moving those art pieces when the arthritis started?” I asked. “They must have been so heavy, and the work so painful.”
He’d move them, he said. He’d shift pressure from hand to hand, moving up to use the crooks of his elbows, and leaning them back onto his shoulders. He rolled stacks of art up with his back. He clenched his abdomen and derived his strength from the core. He uttered oaths. He moved pieces with colleagues, each bearing the burden equally, quickening the task and lightening the load. A drink at the end of the day, with feet up on the coffee table helped, he said. As his disease progressed, he took on lighter tasks, lighter and lighter, and finally one day, at a ripe old age, he retired.
“Sounds like grief,” I said. He stared at me.
“I’ll get past this,” he said nodding.
Later, when we moved to the physical exam, I asked him to touch his nose, and then reach out to touch my finger, hovering three feet away. His hands quivered like crazy as he touched his face, but magically, miraculously, stopped doing so as he reached out for me. I asked him to repeat the maneuver, repositioning my finger even farther away. And again, the tremor disappeared as his arm arched out.
“Keep things moving,” I said, as I finished jotting down a couple things and turned to go get my preceptor. “Keep things moving, and you’ll be alright.”
November 4, 2012 § 3 Comments
I think sometimes, when things are rough and it’s hard to appreciate the sunny days that are upon us, it’s easier to begin living in the past. I’ve felt like I’ve been in a rut lately, and every day that I’m in the hospital, writing a progress note and dating it, I’m surprised to see that it’s October already, that it’s November already. Time is flying by and always taking me by surprise.
So I’ve decided to chronicle the different moments in my life that time seemed to have come to a standstill. And in a little bit of circular thinking (or cleverness, whichever you will), I’ll note that a moment can be such a passing glance that to be able to dwell on it is a lasting reprieve.
– when I was less than four years old, and my parents placed my newborn baby sister in my lap, so tiny and pale, porcelain almost, sleeping, so tiny! I gingerly held her little self in my hands and lap, and I yelled for them to take her away because the fear of dropping her or hurting her came in and consumed me whole. They didn’t respond right away, and those forty seconds that I continued to hold her were the scariest and most vivid of my entire life.
– when in the fourth grade, I saw my math teacher rap the knuckles of a boy with her wooden ruler for not finishing his homework. I began to convulsively cry at the sight, and she stopped, completely taken aback by my (over)reaction. “I don’t respect you,” I later wrote at the top of my homework before handing it in.
– when my family took a trip to a water park in 1999 in India, and I watched from the top as my mother’s floating tube spun her around down a slide and she slid into the pool backwards, a look of terror etched on her face. For the fifteen seconds that it took her to get her bearings and beat herself to the top of the pool, I was deaf and numb, and I thought that the world had ended. I kissed her every single night for the next year.
– when my family visited Tirupati, a Hindu pilgrimage site in south India in the early 2000s, and we spent a whole day waiting in long lines among the twenty or thirty thousand something people, for the five second glimpse of the deity at the top of the seventh hill. The deity was all black stone and gold ornament, and I was amazed at how long those five seconds seemed to stay with me afterwards.
– when I’d come home from a life-changing summer program in high school, and was preoccupied for a week after, at all the new ideas that had come my way, all the doors that had opened, the fantastic people I’d met, and began to seriously carve out a vision for the future.
– when I visited Alaska with my family this summer, head and heart tumultuous with a dozen thoughts and utter restlessness, how the ship turned to starboard, and I caught the most magnificent whale kiss the surface and dive back down in a flurry of water and air, grand glaciers in the background. Nothing else mattered. That was perfect, and enough.
My friend N and I were on her bed last night with her computer, trying to stream the movie 500 Days of Summer, but unable to find a working link. There was only one point, a finger-size in width on her touchpad that worked to let you click the screen. Searching was made difficult. Then I noticed that the little date in far right corner read “Nov 21, 2001″.
“What the hell?” I wondered aloud.
“This is a piece of crap,” she grumbled, and moved to fix it.
“Talk about living in the past,”I joked.
That’s what it is. Reflection is a good thing, I think, for it gives our actions meaning and perspective. The things that stay with you, the forces that’ve shaped you, the people that’ve impressed you – it’s important to keep these close to the heart. But at some point, we’ve got to grumble and exhort, take what we can, move to fix things, and carry on.
November 27, 2011 § 1 Comment
The second year class at Harvard Med is staging a completely student-written, directed and produced show this weekend at the Roxbury Community Theater! Our inspiration this year is The Hangover, and it is truly hilarious. I say this not only as one of the writers of the show but as an admirer of the wonderful and multitudinous talents in my class that will be on display.
I’m beyond excited. Never have I been in a room where 75+ of my peers read lines that I’d penned aloud to each other, eliciting laughter every single time. Wow.
Check it out at: http://secondyearshow.com/
If you are reading this, and in Boston, come! It will certainly be worth your while.
November 25, 2011 § Leave a comment
5 things that I’m thankful for this holiday season:
1. Freedom: This one’s first, and is probably synonymous with privilege. The privilege of being young, in relatively good health, the financial freedom that my parents have afforded me, the intellectual privilege of being in medical school.
2. Wisdom: 2011 has been a turbulent year, and it still has four weeks to go. This year, I found myself making lists of some of my biggest fears – finding myself in a career that I am not passionate about, compromising on the once-dream of being a Renaissance woman, deviating from the life-trajectory timeline I had once envisioned, etc etc. After many an introspective night, I decided that I was okay with resting on an ever-shifting center of gravity, and that true happiness comes from being comfortable with the less-than-perfect.
3. Health: Few of us are fortunate enough to be in perfect health. I am not one of those, but definitely still mobile, intelligent, and strong. I aspire now to be the kind of person who, when confronted with illness, can still be counted on to stay the same person I ever was.
4. Youth: As a patient told me in the wards this year: I am at the stage of my life when all that is expected of me is to study, learn and imbibe. Life is simple. Cherishing it.
5. Family: My family is and has always been my rock. My nightly calls to mom, my dad’s terrible singing, creeping into my sister’s bed at nights and laughing at her mock-irritation. What would I do without those three?!
October 30, 2011 § Leave a comment
We heard from a patient during our Dermatology week, who worked as a medical laboratory technician, running hundreds of blood samples every day, and frequently using her own blood as the negative control. Then she began to notice that the numbers stopped making sense. Her ANA had shot through the roof and her white blood cells started dropping.
“I couldn’t use my blood as the negative control anymore,” she said, shrugging slightly.
Her stoic face didn’t reveal much, but I imagine that being dethroned from the pristine world of negative controls into the confusing milieu of mucked up numbers and unsteady ground couldn’t have been an easy thing to accept.
She had lupus.
A few more things followed. A friend confessed to me that she didn’t particularly appreciate the accepted, if not expected, gallows humor that our classmates used in talking about diseases and disease states. Sure we all knew that we were teetering on the edge of propriety when we tried to remember the functions of the different cranial nerves by acting out their deficits, but there were good reasons! There were always good reasons. We were coping with the vulnerability of the body, the darkness of the world we encountered daily; we were only using humorous study techniques to process the huge quantities of information thrown at us; we were just being kids. We were joking. No harm, no foul.
But the friend protested the unspoken assumption that as medical students, as those on the other side of the patient-doctor relationship, we were well. Not many of us have cruised through life without ever having visited the realm of the ill, or perhaps seen a close family member or friend acquire such a passport.
One of my classmates in fact recently published a piece in JAMA’s A Piece of My Mind illustrating her experiences of going through medical school against the backdrop of cancer. Shekinah wrote about how medical students, like physicians, are imagined to be among the well. Professors reinforce this, calling us healthy for being young and presenting without ‘clinical findings’. “The mechanisms for heartbreak and loss are not on the docket of our formal education,” she wrote.
It’s not an easy balance to manage. Physicians don’t like to count themselves among their patients, despite the fact that they very well may be some other doctor’s patients. We value this dichotomy, this breathing space, this space to joke and fool around and talk about diseases and being ill without feeling vulnerable or sad. With the model of thinking that we’re all in this together, that any of us can be implicated, we lose that. There’s the idea that treating illness as something too sacred to tease would force us all to be politically correct at all times. That too much respect would lead to fear, and so on.
But I think that no one really requires either extreme. Acknowledgement can coexist with detachment, empathy with intellectual curiosity. To illustrate –
Another classmate recently told me that in her psychiatry small group, the physician prefaced a discussion of schizophrenia with a nod to the idea that no one in the group suffered from such a burden to the mind.
That. There’s the danger. That’s the logical leap in question. None of us are spared, now or later. To forget that is just not fair.
October 16, 2011 § Leave a comment
This Friday marked the end of our Neuroanatomy block, and I celebrated by taking a day trip to New Haven to visit a few friends at Yale. Over some crazy expensive froyo, my friend Apoorva and I got into a conversation about her hair. In high school, Apoorva was my way-too-fabulous friend who I vividly remembered for her untamable mane – it was long and fantastically wavy, and as she puts it, sometimes caused a bit of confusion about her ethnicity.
“I got it all the time. The ‘Wait you’re Indian?’ with a look of incredulity,” she laughed.
Now her hair was shorter and straightened. It was seriously transformative. I told her about a conversation I once had with a classmate at Harvard about girls who wear makeup. My classmate, a total bro, told me quite seriously that he thought makeup was overrated and that he disliked it when girls ‘tried too hard.’
I pulled out my lipgloss and absentmindedly put some on. He continued opining – why do girls feel like they need all that makeup anyway? Chicks with the confidence to rock the barefaced look are so much sexier. And on and on and on.
I told him that men were the judgmental gender after all and he really needed to stop being hypocritical and blaming girls for trying to improve their appearance because this was all a very obvious double standard please and thank you.
Apoorva recommended that I check out an article in Wednesday’s NYT Fashion & Style section. A study released by psych researchers from Procter & Gamble (of CoverGirl and Dolce&Gabbana fame), BU, and the Dana Farber (umm ???) suggested that when confronted with four images of a woman with different levels of makeup (barefaced, natural, professional and glamorous), respondents almost universally judged that the woman with the most cosmetic application was also the most professional, capable and trustworthy.
That’s right. Levels of makeup that researchers themselves deemed glamorous enough for the dance floor won all assessments of competence and likability, whether by snap judgment or prolonged examination.
… Twilight dresses and twilight makeup?
I remembered a blog that I once stumbled upon, written by a fellow medical student, that distributed advice on all things relevant to medical school applicants – from anticipating interview questions to taking notes on the campus tour. The blogger firmly advised against dolling up for the interview day. “Don’t wear open-toed shoes, don’t wear jewelry, and don’t smell like anything,” she wrote. “Don’t do make-up and don’t paint your fingernails. I actually thought that men looked very professional everywhere I interviewed. Sadly, I cannot say the same about women.”
I ended up following only part of her advice, since I still wore earrings, put on makeup and got French manicures for most of my interviews. Did it ultimately help or hurt me? I can’t say. But if the results of this study are right, for better or for worse, us women are still continually being judged by our appearances (and more so than previously imagined), be it at a cocktail party or in the office. Less is not more.
But again, why were researchers affiliated with the Dana Farber CANCER institute helping out industry beauty giants at all? makes no sense.
October 1, 2011 § 2 Comments
In a small bay of our skills lab, seven of my classmates gathered around as my friend A gripped a small mace and shut one eye as he bore down slowly into a slice of brain. I don’t know about the others but I for one wasn’t breathing.
“How did it feel?” we asked him when he exhaled (so I wasn’t alone) and looked to us for affirmation.
“It’s strange,” he said. “It felt softer than jelly.”
Then he picked the knife up and sliced the brain again, and again, and again.
So much surrealism is contained in our neuroanatomy block. Such long hours, so many diagrams of remote nuclei and signaling and circuits that I may or may not remember one week from now. So many zombie jokes.
This month has been something of a metaphor for second year. Things are getting heated and we’re all losing our minds.
Last year, I could count on one hand how many hours I studied per day. This year, I count on one hand how many times I remember to shower in a week.
Last year, I called and skyped friends from college and home ALL THE TIME. This year, I found myself blanking on a friend’s name, rushing to Facebook to try and find him, and then diagnosing myself with aphasia.
Last year, my friend J and I bitched about skinny girls by calling them ‘ano’. This year, we do the same thing (because we haven’t grown up) but call it marasmus.
Give me a few more months and I’m going to need a halfway home if I ever want to go out in society again.
The other day, for the first time ever, I experienced retail therapy… online. (Time’s in a pinch, ya know) Did I experience the same kind of euphoria that I usually do when I swipe down my credit card and gather up my new apparel close to my heart? Not really, but I still got to hang up a few new sweaters in my closet. It’s not classy, it’s not sexy, but it’s getting the job done.
“You just cut through countless memories,” I said to A, when he was finished with the brain.
“Or a bunch of prions, you know,” he returned. “It all depends on how you slice it.”