Ramblings

Free Write Friday: Pier

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Tourists flock to the historic pier, smart phones in hand, they extend their arms to capture snapshots of pink faces with emerald mountains regal in the distance. They stroll down the concrete walkway, flip flops flapping, gazing side to side. 

Slender sailboats dot the bay, punctuating the azure waters. Vacationers cool down with a swim or awkwardly attempt use of a boogie board to ride a wave. Children kneel on the beach, legs caked with sunscreen, industriously patting at the wet sand to form castles with heaped towers and scooped moats. 

On the other side of the pier sunset catamarans embark where the river meets the bay. Crimson kayaks coast toward the ocean at the outlet, stand up paddleboarders glide along the shoreline. In the distance, pods of surfers catch wave breaks in the hazy early dawn light. 

A roof offers shade at the end of the pier. People linger at the edge, waiting to see if the local fisherman will make a catch. Teens taunt each other to jump off the blocky corner. Signs warn: “Shallow. No Diving.” But they’re not seen, or ignored. The clear waters allow visualization to the sandy depths from high above.

Eventually, the revelers will meander back. Maybe grab a carne asada or fish taco from the food truck for lunch. Sitting on the south side of the pier, a half moon of ridged mountains astound. The pier juts silently into the breathtaking panorama.

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Narrative Medicine

Narrative Medicine Monday: The Colostomy Diaries

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With humor and candor, Janet Buttenwieser writes in “The Colostomy Diaries” about awaiting her gastrointestinal surgery and the aftermath that leaves her with a colostomy. 

I like Buttenwieser’s use of visual details, putting the reader in the room with her, receiving this disappointing news: “‘You’ll have to have your entire rectum and anus removed,’ my surgeon told me over the phone as I sat in my living room, an unread newspaper on the table, cherry blossoms blooming on the tree outside my window.” 

Buttenwieser faces difficulty getting the trash can she needs to dispose of her colostomy bags at work. The humiliating barriers she encounters illustrate the ridiculousness of much “beurocratic red tape.” After her surgery, she struggles with how many details to disclose about her sensitive change in physical status, even to friends. 

Buttenwieser’s candid anecdotes of everyday challenges post-surgery, such as shopping for clothes and dealing with an emergency malfunction of the colostomy bag while out with her small children, show why her new book Guts, set to be released in 2018 by Vine Leaves Press, is likely to be an entertaining and enlightening read. 

Writing Prompt: Think of a time you’ve dealt with “beurocratic red tape” in relation to a medical condition or the medical field. List all of the obstacles you encountered. Can you infuse some humor into the piece, despite the frustrating experience? Write for 10 minutes.

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Ramblings, Writing

Till

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I’m at a long weekend writing retreat so, ironically, won’t be posting a free write today. The space is lovely, set on a converted farm. I’m looking forward to writing workshops, long stretches of sitting in silence and conversation with the best kind of people. May your weekend be filled with the same. 

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Narrative Medicine

Narrative Medicine Monday: Locked-in Syndrome

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Pakistani bioethicist Anika Khan reviews Jean-Dominique Bauby’s remarkable story in her essay “Locked-in syndrome: inside the cocoon.” In it, she describes how Bauby, an editor of a prominent magazine who suffered a debilitating stroke, lived out his days entirely paralyzed but with mental clarity completely intact. Bauby’s only method of communication, and how he eventually wrote his 1997 book The Diving Bell and the Butterfly was by blinking with his left eyelid. He used a French alphabet provided by his speech therapist to painstakingly blink his way to communication with the outer world.

Khan relays some of Bauby’s remarkable insights into living in such a state and she also reflects on how medical providers need to take a “more empathetic look at the incapacity and helplessness experienced not only by patients with locked-in syndrome, but by analogy, other patients who have no way of giving voice to their experience of sickness. Often, patients become diseases, numbers and syndromes to healthcare professionals who have repeatedly seen illness and have lost the capacity to relate to the experiences of patients.”

Writing Prompt: Have you as a patient ever felt misunderstood by your medical provider? What were you trying to relay and what was the response that revealed to you the miscommunication? Think about your visceral reaction to this encounter. As providers, what specifically have you done to combat the risk of patients becoming “diseases, numbers and syndromes?” How do you maintain this empathy while still preserving some emotional boundaries? Write for 10 minutes.

 

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Ramblings

Free Write Friday: Pain

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I notice it gradually, while exercising one morning. It’s a familiar routine, but that day bending over to touch the floor, leg lifted behind, I can’t hold the pose and my back gives way. The pain is insidious, then persistent. I go to work, hobbling throughout my day. Coworkers ask: What happened? Do you need something? Then they suggest: Try my chiropractor. Try downward dog. Here’s a hot pack. This is the only thing that helped my sciatica years ago. They’re all trying to be helpful but I can only wince. I can hardly walk. The pain is shocking, debilitating.

As a physician, I see people in pain every day. Pain from overexertion, pain from chronic illness, pain from medication side effects, pain from heartache. But to experience it myself, the slowing of body, the unexpected twitch of muscle with a movement, the limitations imposed by a body that isn’t working as it should, by a body that is a conduit for pain rather than a vessel for function: it’s humbling.

I don’t exercise for a week, then two. It’s hard to explain to others who only see me as able-bodied. They don’t realize. I shuffle as I cross the street; my husband and children walk casually ahead, so far ahead, on the crosswalk. I feel slow, I feel invalid. I get massage therapy, apply heat therapy, ingest ibuprofen religiously. The pain, initially searing in my back, flares unpredictably, shooting through my hip as I rise from sitting, as I twist to respond to a question, as I bend to pick up my baby from her crib.

A week into the flare, I just want to lie in bed, not get up, not go out. Though I am loathe to just lie there. I resent the creeping sluggishness. I want to defeat the lethargy and, simultaneously, be enveloped in it. I can suddenly see how people succumb: to numbing medications, to despair. Pain steals all functionality until the pain is all that’s left. And then it becomes your only companion. It is a cruel tease. One day or moment might feel a bit better, hope rises. Then, cruelly, it dissipates as the pain roars back.

One day I wake and can sit up without wincing, can walk with only a slightly antalgic gait. Everyone asks: How are you feeling? I feel tentative. I feel better. I feel anxious that it might come back, might return to level me again. I’ve learned now, it’s taught me. Pain is a presence, but also a thief.

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Motherhood, Narrative Medicine

Narrative Medicine Monday: The Sink

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Author Kate Ristau writes about her son’s heart surgery in “The Sink.” She starts the essay remembering her mother’s farmhouse sink, then describes the simple motions she went through at her own kitchen sink the morning of her son’s surgery.

I like how Ristau uses a common utilitarian object as a focal point in this piece. She describes in detail washing her hands at the sink in the hospital waiting room. She implies that these actions grounded her – loading her dishwasher, washing her hands – during this tumultuous life event. Ristau relays the telltale sign that her son, when well at home, has actually brushed his teeth: “That’s how I know he brushed them–the splash of color sliding down the porcelain.”

The reader is thrust into the narrator’s experience waiting for her son to wake up from anesthesia. When he does, the details she provides allow the reader to enter into her experience as the mother of the young patient: “…we used words like valves, clots, stitches, glue and morphine. Complications, IVs, shots, and applesauce, along with fluid in his chest cavity and so many possible futures balanced on the edge of his hospital bed.” Ristau reflects on how her son eventually asks for something quite surprising, out of his usual character, when he is finally able to get up and out of bed. The reader gets the sense that, on the other side of this surgery, he is changed, as is Ristau.

Writing Prompt: Think of an object in your home or workplace that is also found in a doctor’s office or hospital. Consider a plate of food, a chair, a computer, a bed. Describe the experience of that object when at home versus when you or a loved one were ill. Write for 10 minutes.

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Ramblings

Free Write Friday: Bridge

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She likes to sit under the bridge after her appointments, down by the canal. The benches at the corner are a little too breezy, she brings a cardigan when she remembers. It’s right by the trail, the one that weaves through half the city, along the waterfront, through the industrial and suburban outskirts. 

She sits facing the water. She likes how the curve of the worn wooden bench feels beneath her. Cyclists whiz behind, along the paved path; she likes the sound of the spokes on the wheels lightly clicking as they pedal by. Sometimes there’s a rollerblader, a scooter. She hears the footfalls of joggers’ shoes, light conversation of two coworkers strolling on a lunch break. 

Across the way are small houseboats, some modern, some quaint, some barges. Kayakers and yachts pass under the steel bridge. When the big boats glide by she can hear their engines whirring, working hard to pull them along. A small fishing dingy passes and she thinks about how it’s dwarfed by the steely grandeur of the bridge, rusted sheets of metal bolted in, criss-crossed throughout. 

The locks are further down, she hasn’t been for years. She took the kids once, should take them again. It’s a marvel, really: all that water rising up, draining down. Carrying the fish, the seaweed, the boaters along with it. Each year the salmon run brings a viewing crowd to the locks; it’s a destination.

She hears the traffic on the bridge overhead and the next bridge down. Today the birdsong is bright and clear, outshines the highway traffic. It’s not rush hour, but still, it’s perplexing, that nature would reign in this way. 

She likes to see the American flags hung on the sail boats; a bolt of red, white and navy set against the creamy hull, the bluebird sky. She likes to see the freeway across the lake, all the cars gleaming in the sunlight and wonder: where are they going, where have they been? She likes to consider the seagulls gliding overhead, hovering on the wind; sometimes they’ll suddenly dive or take off, as if they just remembered someplace they need to be. 

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Narrative Medicine

Narrative Medicine Monday: New York Lungs

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In her poem, “New York Lungs,” medical student Slavena Salve Nissan writes of the intimacy of knowing a patient “underneath her skin fascia fat.”  Nissan notes how her beloved city left a mark on her patient’s lungs. She thinks about the people who loved her patient and how even they didn’t know that the patient looks “like a frida kahlo painting on the inside.”

Place is a central theme in this poem. I like the subtle imagery of the medical student and her patient breathing the same air, from the same city, in and out of their lungs. This commonality, too, connects them.  

As a medical provider, we experience intimacies with patients that are both strange and surreal. It is a great privilege that our patients allow us, for the purpose of diagnosis or treatment, to perform these intrusions: cutting into the skin, sampling cells from the cervix, looking into the ears, listening to personal stories, palpating the lymph nodes. Over time this can become routine to the medical practitioner, but I do still wonder, and hope I never lose keen curiosity, about the lives of my patients beyond the exam room. 

Writing Prompt: Reflect on the vulnerability between a patient and physician. Is it surprising that we can be so open and trusting with a near stranger? Think about such a time, perhaps a surgical procedure or mental illness or embarassing symptom, when you put your complete trust in your medical provider. What was that like? Write for 10 minutes. 

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Ramblings

Free Write Friday: Speed Boat

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My three-year-old calls it a speed boat, and it is. Wind whipping our faces, hair swirling behind, strands winding around each other haphazardly. It’s their first time on an inner tube. A long braided rope tethers the inflated donut to the sleek new vessel. The sunny long weekend, barbecue in our bellies, exuberant friends all contribute to the exhilaration. 

Even so, I’m surprised at my six-year-old’s enthusiasm, eagerly egging on the captain to go faster, faster, weave serpentine over the murky waters of the strait. She learned to swim, and swim well this year. But the bouncing motion, unpredictable and jolting, makes me cringe, watching her from afar. Any moment she could bounce high, bounce right off, face stinging into the green waters, choking on the unexpected douse. Gripping tight to the inner tube though, her smile is so wide, so unabashed, so gleeful. I can’t help but exult with her. 

My skin sun-kissed by salted air and pummeled by the wind, I feel taut, relaxed, satisfied. An early summer glow to the late afternoon, washing away months of rainy Pacific Northwest grey, particularly gnawing and extended this year. I rest into the warming sun, the exuberant children, the rush of air past my ears, pressing into my chest as we speed along, parallel to the rocky shore. 

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