A Turning

It has been a season for me. I remember when we got married our pastor talked to us about seasons of not just marriage, but also of life. The last two years have been one of these unexpected seasons. Facing the end of this year, I feel a turning, a shift, the wide open expanse of a new season. Struggling through the valley I have during the last two years, gratitude has taken on new meaning.

My youngest is well into toddlerhood, I’ve reached mid-career, mentoring and teaching and taking on new leadership positions at work. Part of it, I’m sure, is turning 40, the new comfort I have in my own skin, my decisions, my priorities. I have friendships that are true, my relationships are richer for the authenticity they now enjoy. I am planning more trips and solidifying dreams, in medicine, in writing, and at home.

Each year for many years, I’ve worked through Tsh Oxenreider’s alternative to resolutions. She has questions to both look back on the previous year and project forward into the next (now called 12 Months From Now, but I’ve used the older version for years.) As I look back this week on everything I wrote down in January 2018, I am aware that the gift at this time, in December, is much more than I dared hope for. May you know that whatever darkness you find yourself in, whatever hope has been lost, whatever stage consumes you, that there always is hope, there always comes a turning. For me, that time is now. Happy New Year.

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Narrative Medicine Monday: Intern

I’ve written about physician and author Dr. Sayantani DasGupta’s concept of narrative humility before. The first piece I read of DasGupta’s was in Lee Gutkind’s 2010 collection, Becoming a Doctor. Her essay, “Intern,” is a compelling snapshot of a brand new physician.

DasGupta writes the piece in third person and reveals the things that she “hoarded.” The essay is reminiscent of Tim O’Brien’s classic “The Things They Carried.” I relate to DasGupta immediately, the hoarding of “Xeroxed protocols and carefully transcribed antibiotic regimen[s].” DasGupta brilliantly captures the unsure medical intern, who “hoards” in order to feel prepared for anything in a very unpredictable new profession where lives are at stake.

In describing the things hoarded, DasGupta outlines the life of the intern. She notes the importance of keeping “bottles of chemical developer” to look for occult blood in stool. They were always “impossible to find when you needed them” and “there was nothing worse than standing in a patient’s room with a gloved finger full of excrement and nowhere to put it.”

As the essay progresses, DasGupta’s hoarding becomes more figurative. She “hoarded her patients—especially the usually healthy infants,” who, she admits, during a hard night’s call provide an escape “just to hold and rock a baby.”

DasGupta describes hoarding her senses, “taste, primarily, because she found herself so empty” and the hand cream she rubbed on as a ritual, because “[s]he missed the feeling of her own skin.” She hints at how a career in medicine becomes all consuming, that “no matter how much she bathed, or how expensive her soap, her nose seemed filled with the smells of the hospital, the sick, and her own stale and sticky body.”

She is sincere about the toll arduous medical training takes on her sense of self, her physicality, her sexuality: “despite all the pain, she often found herself yearning—aching—to be touched.” DasGupta reveals the challenges to her own marriage during this intense time of training and that, as an intern, there is little space to think of anything else but the work: “In that stillness, she allowed herself to consider—would he wait until the end of internship to leave her? For the rest of the day and night, there would be no more time for such thoughts….”

Of course, DasGupta speaks of sleep and time, the difficulties of each as an intern working all hours of day and night, the pressures unceasing: “She hoarded sleep when she could get it, in the darkened backs of lecture halls, on the cheap, scratchy couches in the residents’ lounge….”

Ultimately, DasGupta’s essay reveals the inner dialogue of a new physician’s arduous first year, gives a glimpse of the challenges to those outside of medicine, and evokes memories for those of us who lived through it.

Writing Prompt: If you’re a physician, think back to your intern year or your first year of medical school. What did you hoard? Make a list. If you’re not in the medical profession, think of when you first started a new job — what did you gather around you to make you more confident, better prepared? Write for 10 minutes.

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Free Write Friday: Santa

All she can think about is David Sedaris’ Santaland Diaries. She heard it on NPR a few years ago and now she wonders if she’s scarring her children by taking them to this place. As a child, though, she longed to see Santa, the fancy department store one: billowing beard, velvet suit, matte boots.

So she takes her children now, clothes them in glittery dresses, in dapper sweaters. The youngest likes fancy “party shoes” so she buys gold flats on clearance at the Nordstrom Rack, presents them to her with a flourish. Unfortunately, the toddler refuses to wear socks, shuns tights. Instead her tiny heels blister, redden with the rubbing of a stiff shoe. By the time she gets to Santa’s lap she has kicked them off, bare feet dangling. Her face clouded by the confusion of curiosity about, and fear of, this large stranger.

The five-year-old has written a letter this year, presents it to the man in the red suit. He wants mom to sidle up, support his entreaty. Head down, he makes his requests in a small voice, so different from his usual chatty nature. He is lately into jewels, into diamonds, into geodes, the shiny treasures of this world. He is lately into big cats, wants to travel to the Serengeti, tells any who will listen his animal factoids. He makes his request, then shuffles away to the safety of mom’s sturdy legs, strong arms and the reward of a sticky candy cane.

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Narrative Medicine Monday: The X-ray Waiting Room in the Hospital

“The X-Ray Waiting Room in the Hospital” by author Randall Jarrell thrusts us into his “big shoes and wrinkled socks,” and one of those “much-laundered smocks” that all the patients wear. Jarrell laments “[t]hese new, plain, mean / Days of pain and care…” and that “routine / Misery has made us into cases.” He describes the “machine” that each smocked patient suffers in, and the reader gets the sense that Jarrell is referring to more than just the mechanics of the x-ray, but also the greater “machine” that is medicine.

Jarrell was an American poet and critic who lived in the mid 20th century but his commentary on the patient’s experience of modern medicine still rings true. Jarrell wants each “nurse and doctor who goes by” to acknowledge him and each patient as an individual, but instead finds that “we are indistinguishable.”

Jarrell concludes that instead of trying to “make friends” with the medical professionals and get them to recognize his individuality, “It is better to lie upon a table, / A dye in my spine.”

Writing Prompt: As a patient, have you ever felt “indistinguishable” from other patients to your medical provider? If you’re a medical professional, do you agree with Jarrell’s assertion that “this routine / Misery has made [patients] into cases?” Can you think of a time when a patient has become merely a case, to you or a colleague? What are the consequences of this, to both the patient and they physician? How can we help doctors and nurses to see patients as individuals again? Write for 10 minutes.

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Narrative Medicine Monday: Brilliance

Poet Mark Doty’s “Brilliance” shows a dying man changing his perspective near the end of life. In Doty’s poem, the man has “attended to everything, / said goodbye to his parents, / paid off his credit card.” He gives away his pets, finds the risk of owning too great, realizes that he “can’t have anything.” When someone suggests he get a bowl of goldfish, he replies “he doesn’t want to start / with anything….” For just a moment, the man allows himself to imagine the goldfish he might like: “hot jewel tones, / gold lacquer.” The fantasy, though, is fleeting because “I can’t love / anything I can’t finish.” Eventually he recants that decision, saying “Yes to the bowl of goldfish. / Meaning: let me go, if I have to, / in brilliance.”

Writing Prompt: Have you ever been at a place in your life when you didn’t want to start with anything new? What prompted that feeling? If you’re a medical provider, think of a time you’ve seen a shifting perspective in patients near the end of life. Write for 10 minutes.

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Narrative Medicine Monday: Reasons for Admission

I opened up a nondescript brown package last week to discover Bellevue Literary Review‘s latest issue, showcasing a beautiful new redesign.

In this 35th issue, Gaetan Sgro’s poem “Reasons for Admission” reveals the complexities surrounding modern day hospitalizations. Sgro notes that often the reasons are contradictory: “Having just gotten insurance. Never having had insurance…. Because you are terrified of dying alone. Because you are terrified of living alone.” Sgro is clearly attune to the many and varied kinds of hospital admissions, including the seemingly non-medical. I like Sgro’s play on words that shows two hospitalization realities: “Because of a broken system. A positive review of systems.”

Writing Prompt: This poem is part of Bellevue Literary Review‘s “Dis/Placement” issue. Why do you think this poem fits this theme? If you work in a hospital, list the reasons, obvious or more subtle, each of your current patients was admitted. Alternatively, think of a patient who has been admitted for one of the reasons Sgro lists in his poem. What was their story? Write for 10 minutes.

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