Thoughts along the Way: Amber's Medical Journey

lessons learned

2010-08-08T08:30:00.000-07:00

internship is sure to be full of learning. we'll learn how to appropriately manage a person coming in with diabetic ketoacidosis and how to change the ventilator settings in a patient in the ICU. in addition, interns learn how to maneuver a new medical system, full of its individual nuances. these are largely the lessons we are expected to master by the time we finish the first year. however, i'm unsure whether there is any expectation and certainly no standardized curriculum for the lessons that come from caring for flawed people in a crazy world. but these are the lessons that shape physicians for better or worse; these are the lessons that give character and preserve our fragile humanity in a more and more technical world.

i learned a few weeks ago that a patient i cared for in an urgent care clinic died suddenly a couple of days after i prescribed her narcotic pain medications. she was a young, depressed women who had recently been thrown to the ground by her abusive boyfriend, causing her to have significant back pain. she was found unresponsive in her home, taken to the ER by ambulance, and pronounced dead on arrival. in cases like these, overdose is highly suspected as otherwise healthy young people have little other reason for sudden death. her body was sent to the medical examiners for autopsy, and the cause of death at this time remains unknown.

whether she died of a sudden arrhythmia or indeed overdosed, this is a tragedy that i feel somewhat culpable about. no, i did not directly administer 40 tablets of narcotic pain medication to her, but i prescribed them to her as is commonly done and as my direct superiors signed off on. as young physicians, it is common to fear that you are going to kill one of your patients by either direct negligence or incorrect direct action, but i'm not sure we think much about the indirect ways we participate in the demise of those we care for by the small actions we take. it would be paralyzing to heavily measure each medication given but it only takes one experience such as mine to drive one to calling the seemingly innocuous acts of our profession to account. i have surely recovered from any since of overwhelming guilt, but i know hesitate momentarily and consider the consequences of supposedly safe and common decisions.

An everyday hero

2009-02-14T06:12:00.000-08:00

For the last 3 months, I have worked 3 half days per week in the tuberculosis clinic at the Tarrant County Public Health Department. This endeavor is in hopes of fulfilling a required Public Health Practical Experience for my Master's in Public Health. My major duty is to see patients with the clinic physician, Dr. Weis. Additionally, I attend location-based screening efforts at local homeless shelters, occasionally administer "directly observed therapy" to patient's homes/work places/wherever with one of the outreach workers, work on preliminary research for an observational study investigating current trends in HIV mortality, and spend some time in the refugee clinic. Overall, this has been a wonderful and rewarding experience. The people that serve the public's health are dedicated, hard working, underpaid, and for the most part unrecognized. It has been a lesson in what it means to be a servant to the least among us and thus, all of us.

Because I am ultimately working to become the best doctor for the underserved that I can be, the most important part of my experience has been soaking in the small things that make Dr. Weis the best physician I have ever come in contact with. He is kind and jovial with everyone. He takes all the time that is necessary to make sure the patient understands the plan. He explains and shows every patient's chest x-ray, pointing out the anatomy and any lesions that may exist. These may not seem like extraordinary things, but be sure to remember that most of his patients are homeless or immigrants, ripe with unpleasant smells, addiction, illiteracy, and/or cultural differences that many doctors choose to bull-doze through rather than work within.

Dr. Weis is different from every doctor that I've encountered: He loves his job and can't imagine doing anything else. He cares deeply about a population that in my experience are quickly brushed over or excluded from care (not taking uninsured or medicaid patients) by many in the profession. He has never talked condemningly about a patient's vice, rather he tries to understand their hinderances for good health.

Last week, Dr. Weis performed his most impressive feat. A nurse who does the intitial processing of the patients comes into Dr. Weis's office and informs him that a well-known patient has just arrived. This patient is a Mexican immigrant who had been treated for TB many years ago, and recently became unemployed and is now living on the streets. He has lost a lot of weight and isn't looking very good. The nurse informs Dr. Weis that he doesn't have any money and hasn't eaten in two days.
Without any hesitation, Dr. Weis reaches to his wallet and pulls out $40, hands it to the nurse, and says, "tell him it's from you."
She is surprised and hesitant.
Dr. Weis elaborates, "Tell him it's from you or the health department or someone other than me. He's a friend and I don't want him to feel like he's indebted to me."

I hope I can achieve the patience and generosity of this amazing physician.

mute

2008-12-19T08:01:00.000-08:00

I sat in front of this computer for 45 minutes and typed nothing until now. I have not been thinking clearly lately and feel very vapid. I wish I had the words to talk about the myriad of things that have consumed my days in the last few weeks, but I have no words. The mind is cluttered and the soul is restless.
I don't know how to talk about the difficulty of balancing two graduate programs, working 40 hours a week, and being mentally, physically and emotionally available to the amazing individuals in my life. I don't know how to talk about the tragic loss of a friend who personified all that is good in this world. I don't know how to talk about all the controversy surrounding the possible changes at TCOM. I can't express how intimidated I am of the challenges of next semester. I don't know how to explain that lately I feel as if I am surviving more than living.
I need a sabbatical, a time of rest and reliance on God's provision. Not only the provision of the basic survival needs, but provision of mercy and healing love. This time of year, more than any other, is one of great hope, and I hope for restoration.

signs and wonders

2008-10-25T15:17:00.000-07:00

while studing intently for our end-of-rotation exam this week, barrett returns from a short break and we have the following short conversation, whose subject i found amusing enough to share:

b: have you been to the bathroom lately?

a: what?

b: the bathroom. on the first floor.

a: ya, sure.

b: is there a sharps container on the wall?

a: what?

b: a sharps container, like for needles.

a: what's a sharps container doing in the library bathroom?

b: i don't know. maybe the powers at be are making it a safer place to shoot up?

a: maybe the new students are so advanced that they're operating in the cubicles?

b: hmmmm.

silence and some studying:

a: have you been to the gym bathroom lately?

b: not really.

a: well the women's locker room has signs up that say "please don't leave your 'personal items' on the bench." i'm confused by what quote-personal-items-end-quote means. is it anything that belongs to me personally or just dirty socks and undies?

b: i have no idea. maybe they mean your used needles. you wait, a sharps box will appear soon.

a: maybe.

the end.

2008-09-10T16:14:00.000-07:00

Justice is what love looks like in public. - Cornel West

a snail's life

2008-08-20T06:23:00.001-07:00

I get a 'word-a-day' email. Today's word was "argillaceous" meaning "made of, resembling, or relating to clay: clayey." Sometimes the word is interesting or useful, but the thing I love the most about this email is that there is also a "thought for the day." These thoughts are rarely related to the word of the day, but are generally more meaningful to me. A few days ago, the following was the "thought for the day:"

How can a society that exists on instant mashed potatoes, packaged cake mixes, frozen dinners, and instant cameras teach patience to its young? -Paul Sweeney

It's an interesting question. I am one of the young people about whom Mr. Sweeney ponders.

Though my family rarely ate frozen dinners or mashed potatoes, instant or otherwise, we ate at restaurants on a regular basis in order to avoid the trouble of cooking after a long day at work or because we had to rush off to some other obligation so quickly that the prep time required for a full meal would not accommodate our plans. We are not an impatient people (both my parents work with special needs populations), but we are instead a busy people.

Products or services that expedite a process, such as the packaged cake mixes, dining out, computers, commercial airlines, dishwashers, etc., rarely are utilized because the outcomes of the process are improved, rather because the quickening of the process allows for more and more processes to be added to one's day. It's not that we're necessarily impatient, rather that we have created an endlessly demanding lifestyle for ourselves. I firmly believe that lifestyle is chosen, not demanded. There are countless people who make it joyfully through each day without the hustle and bustle (many of the ones I know are economically poor. interesting.); however, most of us are addicted to the initial rush and ultimate numbness that results from frenzy. When I have a particularly full day, I don't have the time to consider the implications of any single component. I just keep going and going and going. It is the unfull and unscheduled day that I feel the emptiness of my life of busy pursuits. It is these days that I feel the regret of rushing through a patient's appointment, not listening to their sorrows, because three other patients were waiting. It is the slow day, that I feel restless and paranoid, like I've missed something, instead of blessed to have a few moments of peace. Perhaps a better question for Mr. Sweeney is "How can a society that exists on instant mashed potatoes, packaged cake mixes, frozen dinners, and instant cameras teach contentment to its young?"

I've found that it is very important for me to intentionally slow myself down, not to learn patience but to learn worth and tranquility. Without deceleration, I have no time to reflect upon what it is I do each day, and then I am but a robot performing my intended function. Time and disciplined relection are necessary for me to be human, to contemplate and feel intensely, and to judge how I should live.

"Old Age-itis"

2008-08-13T06:51:00.000-07:00

I have a 96 year old patient who comes to see me every 2-4 weeks for manual therapy. She may be the feistiest patient I've ever cared for. Every time I inquire about why she came in this week, she says, "I have old-age-itis." She never give much information as to how this specifically manifests, so I have to investigate by palpation and further questioning. I'm not sure how much good I do for her, but she keeps coming back, and every time, I learn more and more about her life.

She's ruthlessly independent and very proud of it, as she and her husband (also 96) still live alone. Neither of them drive, so every Tuesday their baby girl (age 70) takes them to doctor's appointments, the barber, and out for a nice lunch. She refuses to let me help her move from the chair to the treatment table. She once told me that old people are like five year old's, they want to try it for themselves because no one believes they're capable.

She is as sharp as a tack, recalling the difficulties of the Depression and quickly criticizing the current state of the educational system. She proudly states that as this country goes down the tubes, she'll know how to live without electricity or running water because much of her life was spent under these circumstances. She's appalled that young cashiers at the supermarket can't do simple math and require the assistance of the register to determine the change she is due. And, having the wisdom that comes with age, she disciplines herself to not go down certain roads of conversation (politics in particular) as it will be fruitless and only work -up herself and everyone else in the room.

Obviously, this lady has made an impression on me. Most impressive is that I want her to teach my other patients what it is to take care of yourself despite the obstacles.

So many of the people I treat are chronic pain patients who have allowed their illness to define them. Instead of acting like a five year old, they submit to the low expectations of most medical professionals they interact with and refuse to take me up on ideas concerning critical components of self care, such as good nutrition, sleep, and especially, staying physically active. Like 96 year old patient using a walker, we all need some help in becoming healthier, be it a therapist or a workout buddy. Asking for help or taking the advise of a professional does not have to be a marker of personal deficiency. Rather, aquiring assistance helps us to recognize that refusal to pursue what is needed is the major barrier for improvement.

Additionally, many of chronic pain patients have related psychiatric issues, including depression or histories of abuse. Many are fully aware of activity, both physical and mental that compromise their state of mind, yet they have been unable to become the master of themselves. They are held captive to unhealthy patterns that are paralysing. I am fully aware that there are immovable external stressors such as poverty, lack of an educational foundation, physical disability, etc. However, we each are endowed with the free will to choose how we percieve and manuver within the external pressures of life. At 96, my patient doesn't see her near blindness and chronic illnesses as unconquerable obstacles of fully living each day, rather they are just part of the context that helps her to see the world for what it it: difficult, but not unbearable. cruel, but not without goodness. finite, but not without hope.

adventures in bicycling

2008-08-07T11:09:00.000-07:00

A friend of mine is currently in Israel filming a documentary concerning the everyday lives of Israeli's and Palastinians amidst the ongoing conflict. As the three man crew are all avid cyclists, their only transportation across checkpoints and between town to town is bicycles. (http://www.epicpedal.org,%20www.epicpedal.blogspot.com/) The email update of their conversations with folks from both sides of the divide shows that though the physical journey is harrowing, it is nothing compared to the emotional whorlwind of hearing the life-journeys of enemy neighbors. Though he was not explicit on this point, I imagine the elements of cycling and listening reciprocally amplify the intensity of the experience. Lately, I've started to notice that there is something about riding a bicycle as a form of transportation that changes the way you live a day.

Since late April, I have traversed the 4 miles to and from work on my bike more days of the week than not. I only use my car on the weekend unless weather or scheduling does not permit. (This typically means rain, but lately, I've been thinking of adding expected highs of more than 105 degrees to the list.)

The impetus for this change of transport were many: save money by burning less fuel, get some exercise, and do a small thing to decrease the amount of waste and noxious stuff out their. In order to make this happen on a day to day basis, it requires some planning. I buy groceries for the entire week's breakfast and lunch on Saturday and store it in the office refrigerator. Also, I keep shower stuff in a locker at the campus gym so that I can shower before heading to the clinic to care for patients. More challenging is getting up a full hour before I normally would in order to get to the gym for a short workout and shower, and then pedaling home after an exceptionally exhausting day. Likewise, it's difficult to recover from mistakes such as forgetting socks (I've gone a few days without them) or to get home fast enough to clean up for a night out.

Some of the more interesting challenges come when rolling down the street. I've nearly been hit by people opening parked car doors. I've had a near collision with a walker who quickly manuvered in an attempt to avoid me in the same direction I steered to avoid her. The wind has been so strong at times that I've almost fallen over when riding up hill in 30+ mph gusts.

With all of these obstacles, I'm amazed that I saddle up every morning. However, I've noticed a change in me that makes these physical difficulties seem miniscule. For starters, biking creates a space to understand the relationship between physical effort and outcomes. Biking is a small way of seeing that muscles, lungs, and not simply my brain are important to participate in the provision of needs. Though technology and modern life has made many necessities readily avaliable at a moments notice, I'm not sure it's good for us. Humans for most of time have known what it is to wait on and tend to nature to create space for our presence, but in the US, with automobiles and corporate agriculture, we are able to separate labor from sustanance. Yes, we work to put food on a table, but in a knowledge society, I think we are missing out on a sort of intimacy with our daily bread that makes it easy to economically oppress others. Perhaps if we all had to bike to work we would sympathize a bit more with coffee growers in El Salvador, diamond extractors in Liberia, and the struggling farmers among us.

One's world becomes smaller on a bike, but also fuller. Essentially, biking slows and simplifies my life. The world of medical education mores extraordinarily fast. One of my best friends, weary in her studies, confessed that this life was too much for her, as her preferred pace of life was more consistent with watching the sprinkler shift in the backyard than running ragged to round on patients, then attend class, then meetings, then, then...etc. Perhaps there is a way that sprinkler watching or analagously mundane activities inform our experience of life. For me, 20 minutes of biking at dawn sets my expectations of the day. As long as I keep the wheels turning, then I'm moving. Sometimes there are downhills, when I coast, and sometimes there are hills I must push through. But, regardless, the speed I'm capable of on a bike allows me to see and experience the ride. Potholes rarely catch me off guard on a bike, nor do hills, and I'm able to drift in thought from casserole recipes to important conversations because the pace allows for it. In many ways, I've made my life to mimic this ride. I work only as hard as necessary in order to enjoy the experience rather than plow through every obstacle with the same rigor. Additionally, time has become both more and less important to me. Because biking takes longer, I have to plan to do certain things efficiently or not at all so that I can embrace the aspects of my life that have meaning to me. Prioritizing and expecting more from my experiences have changed the way I approach each day. There's little to be done about the demands from others, but we each can consciously choose to slow and simplify life.

Finally, biking makes me happy. The wind in my face is so much more refreshing than recycled air from a car AC. I love feeling strong and healthy. Local residence has begun to wave each morning as we pass each other along our way. And, lets face it, biking is "so in right now." It's novel and admired, and I think, along with my buddy in Isreal, that it can do a part in changing the way things are done for the better.

A scholarship essay...

2008-07-23T11:17:00.000-07:00

I'm in the middle of finals for the summer semester currently. Having little time but a strong desire to post something, here's an essay that I wrote this spring for a scholarship opportunity. Enjoy.

Each time I sit down to write these short words on cultural competency, I am struck by how difficult it is to put my thoughts to the page in such a way that they do not appear contrived and insincere. As a blond haired, blue eyed, pale skinned, middle class, female medical student, I fear I do not have the features that the public associates with a champion for issues surrounding race, class, or ethnicity. However, many life circumstances have compelled me to take a special interest in interracial and interclass dynamics.

As a white student in the Texas public school system, I was by-the-numbers a minority student in both my middle and high schools. Because of this, I quickly learned the existence of cultural and class differences, the labor required to bridge them, and the blessing of doing so. Following high school, I moved to New England to attend a liberal arts college, which desperately attempted to convey the reality of systematic injustices that contribute to the make-up of its mostly white, upper class student body. It was Wheaton’s curriculum, as well as a semester abroad, that helped to contextualize my past experiences and led me to move into inner city Springfield, MA, after college to work with a non-profit organization that has racial reconciliation as one of its main objectives. Ultimately, the social experience of my educational upbringing persuaded me to choose an osteopathic medical school due to the profession’s emphasis on accounting for the physical, mental, and social conditions when planning patient care. Since the practices of both cultural competency and humanistic medicine rely on the fundamental tenet of interconnectedness, it is my opinion that osteopathic physicians should be leading way in the pursuit of excellence in both areas.

Cultural competency can be simply understood as knowing oneself, knowing another, and acting accordingly. For a physician, this entails knowing her own cultural norms surrounding health as well as those of the patient and thereby appropriately providing care. Cultural competence in the medical setting is usually concerned with race or ethnicity; however, I believe there is also a need for competence when working with patients from different economic classes and diverse educational levels. In today’s fast-paced healthcare system, cultural conflict arises when physicians overlook the impact of fundamental beliefs, behaviors, biases, and stereotypes in the patient-doctor interaction and when we as physicians see our professional expectations reduced to proper diagnosis and treatment. In order to be a culturally able physician in a diverse world, one must nurture the capacity for empathy as well as expand her knowledge of the implications of race, class, and other social determinants of health.

In the last year, I have taken two tangible steps toward strengthening my skills as a culturally competent osteopathic physician. First of all, I became a pre-doctoral fellow in the OMM department, which facilitates the honing of my manual medicine skills and has allowed me the opportunity to earn a dual degree (DO/MPH) in public health. Studying medical sociology and medical anthropology has taught me that an individual’s health is largely an expression of the health of the population to which she belongs. The vital signs of population health include socioeconomic standing, public works infrastructure, environmental conditions, political stability, and access to healthcare; it is within the framework of these and many other social and historical circumstances that a health culture is born. Being a physician that formally understands issues surrounding these determinants of health will enable me to more readily and sympathetically understand the context of a patient’s health as well as recognize the health implications of political and social change. Thus, through my public health training, I am learning that it is incumbent on me as a physician to work with and advocate for better public health services in order to both diminish the underlying social and cultural causes of poor health outcomes and maximize the delivery of quality, culturally appropriate clinical care.
In addition to initiating my masters in public health education, I have launched a growing book club composed of 1st, 2nd, and 3rd year medical students. Through the generous funding and unending emotional support of TCOM’s medical ethics department, we read and discuss medical narratives that creatively exhibit the human experience of being a physician. With consideration for the nuance of each clinical case as well as the physician-writer’s existential experience, these texts demonstrate the struggle for physicians to exhibit competence in complex situations. Many of our books, including “The Spirit Catches You and You Fall Down” by Anne Fadiman and “Suffering and Healing in America: an American doctor’s view from outside,” by Raymond Downing, brilliantly present case studies in the importance of practicing culturally competent medicine in today’s diverse social context. It is my goal that by reading these stories of those who have gone before of us into the exciting field of medicine, we will meld our individual experiences as budding physicians with the seasoned experience of others and thus discover a deep capacity to respond with caring knowledge to the medical needs of our diverse patients.

In conclusion, I firmly believe that one of the most overpowering forces that physicians must contend with is the culture we inherit through our training. In order to survive years of bearing the decisions in life and death experiences, doctors in training learn to think of patients in terms of pathology while anaesthetizing themselves from the emotional component of disease. However, regardless of the simplicity of the disease, to the suffering patient of any culture a simple bout of the rhinovirus is more than annoying symptoms. It is an infringement on her capacity to fully participate in life; it is an encounter with mortality, from which she seeks relief when she visits our offices. We must remember this. We must remember that our humanity and ultimately our mortality connect us despite the starkest of differences.

Fear and Principle

2008-07-07T11:08:00.000-07:00

Over the July fourth weekend, I spent my first weekend with Barrett's family. He is the youngest of 4 brothers and 1 sister. We stayed in the lake cabin that he and his family literally built with their own hands. While I was spending my every middle school and high school weekend playing soccer all over Texas, he and his family spent every weekend commuting from the mega-metropolis of Houston to built this home and subsequently utilize it as their base when hunting, fishing, horsing around on their adjacent ranch. Having never done any of these activities nor met this family I've heard countless stories about, it turned out to be quite a weekend.

Much of the weekend was spent enjoying the cool breezes on an adirondack while reading "Into the Wild" by Jon Krakauer, a story about a idealistic young adventurer who dies in a bus in the Alaskan frontier. This book along with the setting spurred my curiousity for primitive survival techniques. I would lump the Cromeen family skills into this category, so I joined whenever they headed out to the ranch. The most interesting (probably because I think I could easily replicate it if need be) endeavor of the weekend was putting out 'trot lines' to catch catfish in the river that runs through their land. I view fishing as an altogether lazy activity so when Barrett confessed that trot lines are the lazy-man's way of fishing, I chuckled. The basic idea of this form of fishing is to string bait over the width of the river by tying rope to trees on opposite sides of the river and hanging small fishing lines along it. Over the course of a day, you'll come to check on the lines multiple time to see if you've caught anything and to restock the bait. The best times to check are at dawn and early night. I joined the boys for a few of their runs to the trot linea. Of note, I joined them during their night run.

Before leaving the cabin to check the lines the first evening, Barrett asked me to not stand right at the shore line when we got there. I said ok in that way you do when you want an explanation as to why, and he replied sheepishly, "Now I don't want you to be scared, but this river is known to have aligators, and at night, they can see you but you can't really see them, so, I just want you to be safe." At this warning, I grew a tiny bit wary of going at all but refused to let on, so I said fair enough and headed out. We made our way to the river via pick-up truck then traversed the small wooded area leading to the water by the guidance of our lone flash light. Once we reached the small boat used to check the lines, I was instructed to hand over the flashlight so they could see while on the water. I was reluctant but did so. Ben, Barrett's brother, then said in a very matter of fact way, "just yell like crazy if anything happens." Then they left.

It was pitchblack, stars littering the sky magestically. Natures orchestra hummed with birds, frogs, and rustling of trees. And, I was all alone, with no tools, and 5 yards from an allegedly aligator infested river. Every new sound or change of barely distinguishable shadow made me back up a few inches toward the steep ridge. As Ben and Barrett moved further from me, my fear grew more and more. I have never been as scared as I was that night.

My imagination went wild and I considered the worst possible scenarios...death by aligator, being forced into the river by a rabid wild pig, snake attacks, etc. I cursed myself for choosing reading material that had enhanced my knowledge of the ruthlessness of the wild.

I prayed and tried logic to relieve my anxiety: I've lived in a neighborhood known for crime and prostitution, and travelled through foriegn countries alone, and I've never had a problem. God has protected me everywhere I've wandered. But I began to realize, my logic cannot calm an aligator nor can it always calm fears. In those moments of intense internal panic, without skills or sight, I wanted a gun.

On principle, I generally despise weapons. I become really nervous just being near them. These days, weapons are too often used to violently injure another human being and have all but lost their utility for protection against or hunting of animals for food. Watching Barrett and his brothers kill wild hogs and poisonous snakes gave me a new respect for the guns, though I still hesitate to endorce them because it is all to easy to use them against humans when they are readily avaliable. More even than my fear on the shore, the direct attack by someone or something has the ability to negate principle and lead to violent self preservation in even the most passionately non-violent individuals. This is a troublesome truth to discover present in oneself. I am humbled by this discovery and continue to work it out.

Within a few minutes of my deepest fear and deepest prayers for protection, Ben and Barrett returned with a couple of catfish and grins on their faces. I had never been so happy to see two people in my life.

The light (literal) and companionship they embodied relieved my fears the way that vision and knowing you're not alone always do. These two things along with divine provision are more life sustaining than elimating threats.

I survived the river. I survived the weekend. Now, I must survive myself as I ponder just how capable I am of violence.

The Prodigal Blogger

2008-06-25T06:40:00.000-07:00

It seemed like a good idea at the time.

Oh, that infamous little sentence that we've all at least thought. Most of us react to middle school glasses or a haircut from a decade ago in this way, but in the world of novelty technology, I wonder why I ever left the simplistic life of blogs for myspace.

As I read through a few of my entries, I realize that I probably left because I was angry and depressed, and writing about it wasn't helping. Try as I might, I just wasn't shaking off the mental and emotional beating of medical school. So, I turned to silliness, superfiscial networking, and humor, which along with altruism, sublimation, suppression, and anticipation, are actually considered 'mature' defense mechanisms by my psychiatric collegues. My original tendency for intellectualization of my struggle, along with denial, passive agression, projection, and acting out, are 'immature or neurotic' defense mechanisms. And, believe me and the few people I let in on the suffering, I was NEUROTIC.

I've come a long way. I feel that I have matured immensely over the past year. I've had professional successes and failures. I've mournfully lost some friends and am elated to have made new ones. And, I'm back to tell about it.

the first thing i've written in 6 months

2007-02-03T06:43:00.000-08:00

Before starting medical school, I regularly wrote. For the most part, friends and family comprise my readership, but every now and then, a piece was deemed legitimate enough to be published for the pleasure of a broader audience. I lack the imagination for fiction, and I don't pretend to possess the intelligence or knowledge to write critically about anything of real importance, like say, renewable energy or ending global poverty. So with limited options, 'creative non-fiction' has been the genre under which most of my attempts to write have fallen. I like to refer to my pieces as 'aggrandized journaling.' When you get good at this, folks bind these small stories and call it a memoir.

To heal and to write: both of these dreams have traveled with me since childhood. For me, the beautiful combination of relieving suffering by curing or simply instilling hope, working with people that are partners in this task, and creatively sharing these experiences is work that takes us to places where we can learn the essence of what it means to be human. A few years ago, while I was really struggling with whether pursuing a career in medicine or continuing to write while working multiple dead-end, minimum wage jobs was the best thing for me, my mom –in her infinite wisdom and steady, middle-class conventionality-- reminded me that you can be a doctor AND write. She seemed to have a point, so, with my mother's prompting, a grueling admission process, and some radical lifestyle changes, I'm going after the dream. However, the unfailing thing about dreams is that they neither come with the tangible details that actually get you to your target, nor do they give you eyes to anticipate all the pitfalls that will impede your progress along the way. I envisioned that the process of becoming a doctor would provide ample experience on which to reflect and write. I failed to consider what the demands of the process would do to the part of me that wishes to write.

Throughout the journey of my first two years of medical school, I am constantly reminded that writing is a task that requires a disproportionate amount of mental work to give birth to even the smallest of products. In my mind, any event that is worthy of retelling must be first fully experienced, then carefully considered, and finally put to the page. Each element in this process is intoxicating; I get lost in this process every time I undertake it, meaning that even in an optimal environment, weeks may pass before a word is typed. The demands of medical school have greatly hindered my capacity to do any of this. First of all, fully experiencing requires exposure to things other than lectures or reading as well as a concentrated attendance during these rare occasions. Often, chatting with the lovely Kiwi librarian, who never forgets to sweetly wish me a pleasant night’s sleep, is the day’s only interaction that isn’t somehow involved in information acquisition. And sadly, in my utter exhaustion, I usually forget all but the spirit of the chat before I reach my car. These prize conversations get lost amongst the pathology, or the demands of tomorrow, or the drunken combo of sleep deprivation drowned in caffeine. In the event that they are retained, capturing these stories seems like simply another task to be completed, another thing I should do, another demand of my precious time and energy.

The deeper I plunge into this strange world of medical education, the more I realize that it may not be drawing me nearer to the essence of the human experience, but rather pulling me further away. The struggle to write is but a first stop on a long, painful track of becoming the physician I hope to be. Soon, I will learn that not only do the knowledge of disease and the daily exposure to pain and suffering inherently alienate one from those who live on the other side of the divide, but it is all but impossible for these things --coupled with the medical institutions expectation of detachment-- to leave ones emotional capacity unblemished. I fear that as I continue to move down this path, my ability and opportunity to interact with people without thoughts of their pathophysiological state will be incredibly limited. Overtime, this will lead to the transformation of my acts of compassion into how well I can diagnose and dispense a treatment to a patient, foregoing the attempt to understand what it means for them to be ill and what it would mean for them to be healed. This is a scary vision, but one that I believe is becoming more and more the norm for those who practice medicine. We enter the profession with hopes of caring for those who suffer and end up only managing their health services.

I hope we discover our imaginations and create a new paradigm for becoming and being physicians. If we do not, my mom might have to rethink what’s possible.

Books...

2006-08-26T08:35:00.000-07:00

I was tagged by a fellow blogger to post response to these prompts. I'd love to hear yours:

1. One book that changed your life: Mountains Beyond Mountains by Tracy Kidder

2. One book that you've read more than once: Heart of Darkness by Joseph Conrad

3. One book you'd want on a desert island: SAS Survival Handbook: How to Survive in the Wild, in Any Climate, on Land or at Sea

4. One book that made you laugh: Extremely Loud and Incredibly Close by Jonathan Safran Foer

5. One book that made you cry: The Kite Runner by Khaled Hosseini

6. One book you wish had been written: another really great novel that contained all the elements of the human experience and allows the reader experience them anew.

7. One book you wish had never been written: Explaining Hitler: The Search for the Origins of His Evil by Ron Rosenbaum (This was a very interesting read, but I wish it had never been written because I wish even more that the horrible acts that precipitated out of his leadership had never occured)

8. One book you're currently reading: Saturday by Ian McEwan

9. One book you've been meaning to read: Pathologies of Power by Paul Farmer

I'm a lucky girl

2006-08-02T17:24:00.000-07:00

I am blessed with amazing friends. It is never a mystery to me as to why I love them, but, with healthy insecurity, it always seems so mysterious as to why they love me, but, alas, they do. While I was away on vacation, I thought about how lucky I am to have a plethora of different friends. As I returned home, it was one of the first times that leaving New England for Texas didn't seem like punishment or an obligation, but as appropriate and joyful. This was amplified by what met me when I returned.

While in her home state of Washington, my friend Molly bought me this ridiculously funny plastic play set called "The Avenging Unicorn." When she saw it, she said to herself, "It's so not Amber, that it IS Amber!" I love it and giggle everytime I look at it.

My friend Sara was in Flordia for a weekend and saw "The Bodies" exhibit, which is a collection of amazingly dissected human cadavers, posed in unique stances, such as kicking a soccer ball or holding their own dermis. In the museum, she visited the gift shop and found a Salmonella plush toy. In the card she attached with the gift, she wrote, "I saw this cute little microbe and it reminded me of you...not because you cause diarrhea but...uhh...anways." I definitly broke into laughter in the middle of the post office, and I was so overjoyed that the strange looks I received didn't phase me a bit.

Deanna visited her brother-in-law in the Rockies and brought me back a really cool slab of pine tree with the following poem engraved into it:
Don't walk in front of me
I may not follow
Don't walk behind me
I may not lead
Just walk beside me
And be my friend
It sits on my night stand and reminds me nightly of the special task of being a friend.

But, perhaps the greatest gift I received came to me today in an email. I am feeling a bit insecure and overwhelmed at the moment. Progress and change occur so slowly, in all areas of life, and this is becoming very evident to me. However, Kate gave me great hope by these kind words:

Dear Amber,
I love and enjoy and am thankful for your company and friendship for many reasons, but right now the thing that stands out most is how you wear the mantles of power you've been given. You are not hungry for it, you do not boast of it, and you would shrug all appearance and fact of it off for maximum equality with those you lead if you could, so that leading for you would be nothing more or less than serving (as it should be, yet seldom is in this world). You epitomize how someone should act in a spirit of service...
I love these things about you, and I love you for them.
Thank you for being my friend and for being a good example for me to try to emulate. (And no worries, you're not on a pedestal...I'm just really happy to know you!)

I don't know what I would do without these amazing women in my life. They make starting back on this long journey after a small, small break seem not so scarry. I love you, gals!

One year down...

2006-07-01T07:04:00.000-07:00

It occured to me yesterday evening while out on a 3 hour walk that I rarely attempt tasks that do not have concrete endings. I went to high school, finished that and 4 years later, I went to college, where another 4 years passed and that task was completed. I've had dozens of jobs that I knew would either end when I returned to school or when the current school year let out for break. I've played season after season of soccer, always aware that about 25 games (if we're lucky) would be played and that too would end. I've grown quite accustomed to envisioning the end even as I embark on a journey. I'm not cognizant of the events that will unfold in the middle, but I am promised by a clear-cut curriculum/schedule/pay-period that there will be an end.

Despite the fact that medical school is broken down by a rigid curriculum, and after 4 years I will again graduate, I know that each year is simply a mile marker on a journey that has no predetermined ending. You do not graduate from medical school and then take a few years to figure out what you want to do. You simply jump right into the rest of your life as a professional.

This is a very foriegn concept to me; thus, at a time when I should be wholey relieved that my first year is over, I am actually experiencing a bit of anxiety. I am glad (and in desperate need) to have a break from the work, but it feels a little off. Instead of feeling closer to an end, I feel as if I'm only stepping deeper into a mystery: the mystery of being a skilled individual with responsibility (aka, an adult?). Soon, I will no longer fumble around wondering what skills I should acquire to impact the world around me. In a few short years, I will be equipted with tangible skills that directly impact the course peoples lives. Unexpectedly, this is frightening.

Confidence is something very few people who really know me would say that I lack, but this new 'project' (becoming a physician) has humbled me more than I anticipated. Throughout the past year, when no one was watching, I have put on my white coat and admired my reflection in the mirror. In the beginning, I felt important, smart, and cool, but lately, I just chuckle because I know that I can no longer fool myself. I may look like a doctor, but I haven't got a clue! Though humility is often unpleasant, I truly hope that it remains a part of me. I hope that in 10 years, I will still laugh at my reflection, knowing that I've still got a lot to learn.

Lubbock or Leave it...

2006-06-01T16:38:00.000-07:00

Its always eerie to hear a critique of the place where you were brought up, and maybe it is especially eerie when it is a critique you share. On the Dixie Chick's latest album, which is largely a response to the betrayal and abandoment of their fans that occured when they spoke critically of President Bush at a concert in London in 2003, Natalie Maines writes of our hometown, Lubbock, TX.

The pit of my stomach sinks and hair raises on the back of my neck everytime I hear the song; commons signs I have come to experience whenever there is guilt, conviction, despair, and a host of other grave conditions present. She has exposed the cheap grace and self-righteousness that so many American religious groups are peddling.

I suspect that many Lubbock-ites will be very hostile to this message (someone wise once said that a prophet is never received in her hometown), but I believe that Ms. Maines and the Chicks have hit on some points that many "small-town", religious centers should take into consideration as they evaluate the effectiveness of their generally good-hearted intentions.

Lubbock or Leave it

Dust bowl, Bible belt
Got more churches than trees
Raise me, praise me, couldn't save me
Couldn't keep me on my knees
Oh, boy, rave on down loop 289
That'll be the day you see me back
In this fool's paradise

Temptation's strong
(Salvation's gone)
I'm on my way
To hell's half acre
How will I ever
How will I ever
Get to heaven now

Throwing stones from the top of your rock
Thinking no one can see
The secrets you hide behind
Your southern hospitality
On the strip, the kids get lit
So they can have a real good time
Come Sunday they can just take their pick
From the crucifix skyline

Temptation's strong
(Salvation's gone)
I'm on my way
To hell's half acre
How will I ever
How will I ever
Get to heaven now
Get to heaven now

International airport
A quarter after nine
Paris Texas, Athens Georgia's
Not what I had in mind
As I'm getting out I laugh to myself
Cause this is the only place
Where as you're getting on the plane
You see Buddy Holly's face

I hear they hate me now
Just like they hated you
Maybe when I'm dead and gone
I'm gonna get a statue too

Temptation's strong
(Salvation's gone)
I'm on my way
To hell's half acre
How will I ever
How will I ever
Get to heaven now
Get to heaven now
How will I ever

Get to heaven now

Community Building at TCOM

2006-05-18T11:47:00.000-07:00

I've been fighting all year against the reality that I am in an "institution of higher learning." Like a typical human, I resist change, especially change from something familiar (thus completely comfortable even in its hang-ups and challenges) to something radically new. With eagerness, I've tried to see and work within this new life as if it were not all that different from the old life, and quite frankly, I've fallen flat on my face in that attempt.

Unlike urban centers, medical school is not a place of losers in eyes of the world. It is a place filled to the brim with acheivement, privelege, discipline, expectation, and financial promise. The ethical and moral issues on the table here are sexy and cutting edge (stem cell research, new technologies, medical law, etc). Typical struggles of the 'typical' student (ie: no kids, not concurrently working on a second degree, live near campus) consist of how am I going to fit yoga, a thirty minute run, and a quick meeting at the coffee shop with other officers of a campus club in with 2 hours of lecture and 6 hours of assigned reading material.

Thus, to participate in the challenges of life in this community will look altogether different from participating in the transformation of a community in the 'real world.' I've finally given myself the grace to admit this. TCOM students don't need a homeless clinic or a group to meet on how to end the violence on our streets. Though these are important issues for neighboring communities, they are merely on the periphery of our current daily struggles. We cannot ignore that these exist, but we must act locally, and our locale is predominantly the classroom.

Here are a few ideas about what our community needs to experience success, enrichment, and growth:
-tutors and teaching assistants for incoming first year students
-folks who will compassionately listen to the personal struggle of others even when they've still got 100 pages to tackle
-appreciation, advocacy, and engagement with the members of staff who largely go unnoticed (custodians, administrative assistants, proctors)
-passion for issues that will be glaring us in the face when we graduate (global health initiatives, healthcare access disparities, transformation of the medical insurance system, patient advocacy, ethical practices, etc).

So, there is where my efforts will be directed in the coming year as far as community (*read: kingdom) building is concerned. It has been exhausting trying to contrive opportunities to serve those that 'really need it,' (*read: oppressed, poor, sick people) but just aren't on the radar of my current life situation. I feel as though the past year I've neglected a lot of folks (and opportunities to grow and love well) by constantly looking beyond them, to something more worthy of my time and love, as if they are less worthy of compassion and time because their (**our) struggles seem so trite compared to poverty, racism, and rampant disease. I am still conflicted over some of these admissions, but I'm certain that the peace I feel by surrendering to the perhaps 'petty' needs of the community I'm a part of for the next year is a blessing.

Longing

2006-04-21T06:01:00.000-07:00

The month of March was incredibly busy. I was out of town for approximately 14 days, and the time that I was actually in Fort Worth was spent making up for the time I was away from school. Thus, the neglect of the blog. Until I have more time, here is a piece I wrote for The Link, our campus newsletter. Enjoy.

A strong wind
carried me
here

now the journey
threatens demise

the labor
the loneliness
the longing

too much is at stake
too many tears of blood
shed
by loved ones who suffer
beyond my fingertips

memories of
impoverished Salvadorian and Mexican friends,
whose smiles veiled their affliction,
open my tired eyes
as sleep attempts to steal our futures

reflecting upon
the unstoppable courage of all
who continue to toil in the urban wasteland I call home
gives endurance to push through
just when I thought I’d done enough

and news of reunions after years apart
breezes in
fuels me with hope
when the loneliness risks compassion

these are the winds that surged to bring me here
though now faint
they will sustain

and armed with the power of healing
I will return to the struggle once again

Leaving for Mexico

2006-03-10T07:04:00.000-08:00

60 or so medical students along with a spattering of non-medical professionals leave this evening for Mexico City. We will spend the week of our Spring Break staffing a few clinics in Puebla, Mexico. Please pray that we might be blessed with hearts that believe that healing is possible in all spheres of life, not only the body but the spirit, the home, the city, and the world. Please pray that we will see resurrection, and maybe even be an instruments in this life giving process. I've got to run and take 2 finals, so this is all that I will be able to post for now. I look forward to writing a post-mexico post, as I hope you look forward to reading one! Peace be with you this week.

Choices and Health

2006-02-17T15:06:00.000-08:00

Choice about medical care is a privilege for those with agency conferred to them by economic standing.

A few weeks ago, 2 very different meetings confirmed this for me. During a lunch meeting, AMSA (American Medical Student Association) gave a presentation on international rotations. Our Assistant Dean of Medical Education, who has practiced medicine in many different places around the globe, gave the talk and showed us many graphic pictures of typical images that we would encounter on a rotation in Kenya. In these photos, folks lined the streets in front of the clinic from dawn til dusk and came in with open wounds, huge goiters, malaria, AIDS, and many other 'preventable/treatable' diseases. These folks had walked for many miles to come to the clinic. They would then wait for hours, be evaluated, and before returning to the long road home, were either given a prescription for which they probably did not have enough money to fill or given free medication that would not be enough to affectively treat their illness to full recovery. Image after imaged passed across the screen. Photos of starving babies and huge skin ulcers were the most recurrent. I turned my gaze away many times. I left the meeting with mixed feeling. On one hand, I was sad and outraged. On the other, I now know how I wish to spend at least one month of my intern years!

The following days, we had our bi-monthly ethics seminar and subsequent group assignment, where we work together to consider the ethical components of a particular case. This semester our ethics course is entitled "Medicine in Spiritual Perspective." Our lovely ethics professor gave a brilliant talk over how spirituality and religious practices inform our rituals surrounding birth and death, and in between, our understanding and interactions with healthcare. We were then given a case in which the patient, a Jehovah's Witness, was in need of a blood transfusion yet her religious beliefs did not permit the 'consumption of blood.' Together, we attempted to understand how her faith functions in response to health. We did this by considered the following questions:

“Do you have spiritual or religious beliefs or faith and practice that may be of help in your health recovery?” “How are these important to you?”
"Do you hold these beliefs or practice in this way alone; or are you part of a group or religious community who share your faith and practice?”
“How can we address your faith and practice to help you make best use of them in your recovery of health?”

We decided that to best manage this patient’s care, were would need to seek alternative treatments to a blood transfusion. There are few alternatives that are truly viable options, but to be considerate of her beliefs and practices, it is imperative, as her physicians, to pursue these options.

The entire group exercise was incredibly painful for me. I am usually vocal in these sessions, but that afternoon I sat quietly with my arms crossed, sinking further and further into my chair, drowning in thoughts that made me cringe. With the images of Africa in the back of my mind, I simply wanted to say to this patient, like a parent to a non-compliant child at the dinner table, “Dying kids in Africa, Iraq, South America, or South Dallas would walk 40 miles one way, in the heat, without food or water to have that blood.” Of course, I would never say this, and under normal circumstances, even when I disagree with folks, I deeply respect anyone who makes difficult decisions based on religious conviction. But, that afternoon, the whole situation seemed ludicrous to me.

The band U2 has a great song called Crumbs from Your Table. It addresses the incongruence between our spiritual language and our everyday ‘praxis’ of these words, especially in relationship to global poverty. Here are a few of the most commanding words:

Where you live should not decide
Whether you live or whether you die
Three to a bed,
Sister Ann, she said
Dignity passes by

And you speak of signs and wonders
But I need something other
I would believe if I was able
I’m waiting on the crumbs from your table.

Poverty robs individuals from injecting their faith practices and ethics into the world of medicine. They are silenced by their desperate need from speaking at the ethics table. It seems that only those who have the luxury of understanding the mechanics of stem cell research or paying for physician-assisted suicide have reserved seats.

These are important issues indeed; however, in some respects, I think that are simply the ones we engage because they are sexy and ‘cutting-edge’ ethically. But when are we going to wake up to the ethical issue with the greatest determinacy on health outcomes? (Economic standing) When will we address the brokenness and questionable ethics of our national healthcare industry, and then the huge disparities in global health? Should these be in the forefront of our conversations as future healthcare providers or should they be left to the economist? What are the real ethical issues for physicians? What do you as a once and future patient think?

Fundraising Effort

2006-02-05T21:38:00.000-08:00

During our Spring Break in March, the Christian Medical Association is planning a trip to Mexico. 40 medical students, including myself, will travel to Puebla, Mexico to administer a medical clinic to impoverished natives of this city located 60 miles from Mexico City. Licensed medical staff from our school will accompany us and will assist us in making decisions about care for each of our patients. However, for the large part, we, first and second year students, will be the acting physicians. This is both a scary and exciting opportunity that I am greatly looking forward to.

All the supplies, including basic pharmaceuticals, urine and blood analysis materials, gauze, stitches, etc. have been purchased from funds we’ve scrapped together from fundraising. All other expenses, such as transportation, food, and lodging are the responsibility of the individual student. This is a somewhat ludicrous expectation, as we are all living day to day on borrowed money. However, many of us consider this trip to be our launching pad into a career as a physician to God’s Beloved: the poor. So, we recall (and must continually remind ourselves) that ‘’if you spend yourselves on behalf of the hungry and satisfy the needs of the oppressed, then your light will rise in the darkness, and your night will become like the noonday.” (Isaiah 58:10)

Lately, many public figures including Bono of the band U2 and Bill Gates, the multi-billionaire, have lead efforts to address the health needs of poor nations all over the world. Compared to their efforts, ours is a proverbial drop in the bucket. However, every time I reflect on the small amount of good we will be able to do for these folks at a great financial cost to ourselves, I am reminded of a certain widow. Rich people went ahead of her and dropped large sums of money into the ‘Jewish Relief Fund.’ These wealthy folks were probably very vocal in local social affairs and obviously did ‘good things’ with their money. I bet they were 'model citizens.' But, it was the widow with two small copper coins to whom Jesus draws his disciples’ attention. He tells them this: “This widow has put in more than all the others. All these people gave their gifts out of their wealth; but she out of her poverty put in all she had to live on.” (Luke 21:4) Bono and Gates do great things with their time, money, and talent, but what does it really cost them? What do you and I do that really costs us something? Costs us our livelihood?

You and I are bombarded everyday with another tragic cause calling for our support. This exhausts me and in the end I usually feel ‘guilted’ instead of compelled into some sort of action. I pray that my blog adds nothing to your personal exhaustion, but rather that it compels you to give yourself recklessly to those that need what you’ve got to offer. This may or may not be “our cause.’ But if you would like to contribute to our effort in Puebla, please do.

Checks should be made out to “UNTHSC-Christian Medical Association.” All Donations are tax deductible and the Tax ID # is 30118211389. If you need my mailing address, send me an email at spamber19@yahoo.com

2006-01-15T11:06:00.000-08:00

"We do not, ultimately, love our neighbor because Jesus told us to. We love our neighbor because God is like that. It is not because Jesus told us to that we love even beyond the limits of reason and justice, even to the point of refusing to kill and being willing to suffer -- but because God is like that too. " -John Howard Yoder

Stranger thinks have happened...

2005-12-27T19:12:00.000-08:00

On Christmas Eve, my Granddad, with beaming pride, showed me the only pictures he's taken with his new digiital camera...a fox on his neighbor's roof. Their quality was a bit lacking; to tell the truth, I probably would have made a complete fool of myself, saying something like "Aww, what a cute cat," if he hadn't prepped me. But he was just so proud and proceded to explain how he came to capture such profound images.

You might be wondering as I was how a fox a) gets into a pretty dense neighborhood and b) climbs onto roofs. When I asked about the 'foxes on roofs' bit, my Granddad explained that he hears footsteps on his roof during the night on a regular basis. Due to his exposure to so many different roof-prancing animals, he's become aware of the distinctive qualities each animal exhibits. A few weeks ago, he noted that the shuffling on the roof resembled the steps of neither a cat nor a squirrel. He made a mental note of this and continued about his busy business of cotton farming. One morning while watering plants in his bathroom window, he glanced up and there he was, the clever fox, on his neighbor's roof. He put two and two together and hypothesised that the clever fox used the power lines to traverse the great divide of his roof and theirs, but he's a bit confused how the fox was allowed in the neighborhood.

Aside from the unusual nature of the story, I assume that this scenario is a familiar one between grandchildren and their grandparents: Grandparents, with pleasure and pride, showing their ability to integrate new technology with amusing stories, and grandchildren, with patience and perhaps pity, endulging them. I was more than happy to endulge my Granddad, and this anecdote will become a memory that will help me to know just a bit more about my Granddad.

I don't really know my Granddad, and he doesn't really know me. In fact, I'd wager that we interacted more during the 3 days at my aunt's house over Christmas than we have in the last decade. Our time together and particularly the interaction I've described above solidifies a bit of regret on both parties that we are strangers. However, the gestures of sharing his story and pictures were his effort to bridge the divide, to alleviate the isolation, and create a space for relationship to grow. Although it wasn't clear to me then, I've come to understand that we do this everytime we attempt to tell an interesting and clever story to anyone we don't really know. They're the premeditated, pre-intimacy stories, the risky stories that hope for peace and friendship, and consequently leave us vulnerable to someone thinking that we are neither interesting nor clever. These stories are subtle invitations into the cuckiness of our lives.

In someways it can be frustrating that this is one of our vehicles to being known (especially if we consider ourselves to be poor storytellers, not clever, funny or interesting), but yet it is hopeful because it really isn't all that much. If strangers that have known each other for nearly 24 years can experience the hope of a new beginning from a fox on a roof, then I believe there's hope for all of us. Peace and love are perhaps just a risk away.

*****

Last night around dusk, almost immediately after writing this post, I went for a walk and saw a fox wondering the streets of my neighborhood! I live in an even more densely populated area than my Granddad. (I literally live within 3 miles of downtown Fort Worth!) At first I thought it surely must be a large mutant cat, but two other walkers squashed my skepticism when they shouted from the other sidewalk, "Did you see the fox?" I responded, "So it WAS a fox?" and with beaming pride that resembled that of my Granddad, they walked on saying, "Ya, how bizarre!"

feeling a little crazy...

2005-12-11T16:23:00.000-08:00

I've been itching to write for weeks, but I've allowed lack of direction and at times lack of complete or coherent thoughts to keep me from hitting these shiney little buttons. Perhaps my lack of direction has to do with the waves of nihilism countered by moments of great hope that have become my reality during this season of advent. My poor bipolar heart isn't quite sure of what to make of times, which often lends towards a sort of intellectual paralysis.

Let me explain some of this with a quick summary of some of the events from last week:

Last Monday, I became profoundly frustrated by the fact that so many Christians support legislation that will give tax reductions to the rich, reduce the amount of domestic funding for poor folks that need assistance, and increase spending for war. I became a bit nervous and maybe even scared when I learned that evening that a good friend will be heading to Washington DC to participate in civil disobedience in response to this legislation, a move that could have him arrested and possibly compromise his professional standing.

On Tuesday evening, I spent 3 hours repairing bikes with a new friend (whose enthusiasm for bicycles convinced me to come despite the fact that I know absolutely nothing about repairing bikes) along with 4 or 5 gentlemen over 55. Mission Arlington, the parachurch organization who graciously or foolishly let this girl (who didn't even know how to remove and inner-tube from a tire at the beginning of the night) volunteer, will give hundreds of used and new bicycles away as Christmas gifts. I left overwhelmed by both the generosity of the ministry and the enoromous patience and assistance everyone had given me.

Wednesday, I read half of a book that exposes some of the major features of the critical condition of the health care industry in the US. I wanted to finish it the following day, but it was just too depressing. It really made me wonder about what I'm getting myself into by becoming a physician. I'm finding it harder and harder to reconcile a profession where I will serve the 'least of these' but am required to become part of a very, very croocked establishment? From where I sit, it seems like crunch time, when being a "critic-from-within-the-establishment' may actually only be interpretted as "complicity with the establishment."

Thursday was a 'snow day,' which means a day of solitude for those who live alone. It was quite nice to have time to meditate and sip tea. It gave me time to sober up from the emotional beating I'd given myself the day before.

Finally on Friday, after a long telephone conversation with a trusted friend followed by coffee with a new one, I was convinced that even my madness can momentarily be subdued. It's crazy, confusing, and complicated out there, yet brief moments of clarity and compassion are just around the corner when you understand that you're not alone.

Thanks to all the folks in my life who listen so well, who are often equally clueless, who humble me, who help me to be more comfortable with uncertainty, who care, and who in general, make me feel less crazy!!

My Dad, the Beatles, and Thankfulness

2005-11-25T11:01:00.000-08:00

I'm sitting on my parent's sofa, sipping tea, staring at the squirrels running along the fence, and listening to the Beatles while the rest of the family is out participating in the extravagant commercial over-consumption that has become just as traditional for this holiday as pumpkin pie. There are layers of contraversy in this scene, but I'd like to reflect on perhaps the less pronounced radical behavior: listening to the Beatles on my own perogative.

To my father this would be considered a glorious and miraculous phenomenon since as a child and teenager he loved, I mean LOVED, to torture my siblings and I by playing nothing but Beatles albums on road trips. And to give some perspective, these road trips were often of the 14 hour variety as we are among the great Texan travelling families who consider 3 hour drives to be comparable to trips to the grocery store. My siblings and I tried every tactic imaginable to entice Dad into listening to some of 'our music' or anything else. We'd have taken Dylan or the Stones or even some CCR, but rational arguments, bargaining, masterly planned sales pitches, and begging could not break this man. Beatles it was, and Beatles it would be.

Today, I recognise that a good bit of my ever-evolving personality and principles continually resonate with the lyrics of which I desperately tried to limit my intake during my youth. The irony.

For instance, Hey Jude says a lot about internal peace-making despite external conflict. You've gotta let the crazy world deeply impact you, but you can't let it dissolve your hope and peace.

Another good one is Rocky Racoon. You never know how or when God's going to foil your grandious plans just as Rocky had no idea he'd leave his attempt to murder in the name of love grasping the Book that tells us to surrender unto death in the name of Love. Rocky and Paul (not the Beatle) bear some resemblance.

And my all-time favorite Beatles song: I am the Walrus. My love for this song has to do with my love for symbols, silliness, and scintillating wordplay. It's just such a clever song, a real piece of art.

So during this Thanksgiving holiday, I'd like to thank my Dad for his obnoxious yet contagious love of the Beatles. And I'd like to thank the Beatles for being revolutionaries. In tribute to both parties and for the sake of educating all 3 of my readers, here's I am the Walrus!

I am he as you are he as you are me and we are all together.
See how they run like pigs from a gun, see how they fly.
I’m crying.

Sitting on a cornflake, waiting for the van to come.
Corporation tee-shirt, stupid bloody tuesday.
Man, you been a naughty boy, you let your face grow long.
I am the eggman, they are the eggmen.
I am the walrus, goo goo g’joob.

Mister city policeman sitting
Pretty little policemen in a row.
See how they fly like lucy in the sky, see how they run.
I’m crying, I’m crying.
I’m crying, I’m crying.

Yellow matter custard, dripping from a dead dog’s eye.
Crabalocker fishwife, pornographic priestess,
Boy, you been a naughty girl you let your knickers down.
I am the eggman, they are the eggmen.
I am the walrus, goo goo g’joob.

Sitting in an english garden waiting for the sun.
If the sun don’t come, you get a tan
From standing in the english rain.
I am the eggman, they are the eggmen.
I am the walrus, goo goo g’joob g’goo goo g’joob.

Expert textpert choking smokers,
Don’t you thing the joker laughs at you?
See how they smile like pigs in a sty,
See how they snied.
I’m crying.

Semolina pilchard, climbing up the eiffel tower.
Elementary penguin singing hari krishna.
Man, you should have seen them kicking edgar allan poe.
I am the eggman, they are the eggmen.
I am the walrus, goo goo g’joob g’goo goo g’joob.
Goo goo g’joob g’goo goo g’joob g’goo.

Just Be

2005-11-18T20:10:00.000-08:00

I just did the most amazing thing I've done in weeks: for about 20 minutes, I watched the steam rise from my cup of tea in complete stillness and silence. I found myself sitting on the couch without a desire to read, no energy to move, no one to call, and the cup of tea sitting in a spot of sunlight on the edge of the coffee table.

I propped my feet up and just lost myself in the beauty of the steam floating off of the surface of the liquid, illuminated by the midafternoon light. Sometimes, the mist floated up in peace and just vanished. Concurrently, a wild storm would be brewing and suddenly hurl itself in a perfect helix toward the sky. Then a tightly wound spiral would flip downwardly off the edge of the cup as if it were diving into the pool of light below. Next, ribbons of steam gently drifted upward, celebrating their newfound freedom. Sometimes the mist resembled definable shapes, but mostly they defied definition and even description. Those 20 minutes were ones of entertainment, meditation, therapy, and magic.

I'd nearly forgotten how to stop. I'd forgotten that it's healthy to do things that aren't 'productive.' I'd forgotten that I wasn't created to study or to become a professional or even to write a witty blog; and certainly not to utter the words 'should be' or 'should have.' The truth is that I've become terrified of stepping out of a routine that has become very comforting, not because of its ease, but it's consistancy. Medical school is no walk in the park, but I've deluded myself into believing that it is managable; therefore, it is secure. However, the lifestyle of medical students is unsustainable and in the end, ultimately unhealthy. In some ways, I am that cup of boiling tea. The energy required to remain at boiling point is beyond my capacity and my purpose; thus, by nature I am moving toward a state of lower energy, toward stillness and peace. I swirl around the surface of the foaming world that demands my energy, but eventually, I'll reach the critical point where I must choose between the rat race of the moment or rest and renewal. Noble dreams of service and responsibility pull me towards the former, but I know my heart constantly yearns for the latter.

Beauty Out of Our Messes

2005-11-06T20:20:00.000-08:00

Running in the morning has many advantages over running at any other point in the day. It's cooler. There is less traffic. Studies have shown that folks who exercise in the morning are more likely to actually do it over those who schedule their exercise during or after work hours. And, finally, if you start your run just before dawn in Fort Worth, you get to see the most brilliant sunrise sky: bright pink and orange, balanced by the blue sky and silver lining of the clouds. It's often breath-taking, (or is that just the running?)

My route takes me briefly through a golf course, and as par for any good golf course, there are a few water hazards. One of these hazards has a little wooden bridge traversing it, and just when you reach the peak of the bridge and peek down at the water, only the generator in the corner of your eye reveals that you are in the center of civlization. Otherwise, all you see is the beautiful reflection of the glorious sky, pierced by the reflection of the surrounding trees and shrubs.

Last week, while I was just reaching the top of the bridge, I recalled that part of the reason that the the colors of the sky are so beguilling is air pollution. The tiny particles floating around up there bend the light of the sun and affect the colors our eyes perceive. Air pollution is not the inherent reason for the brilliance of the sky, but in that moment it amazed me that God's grace and power allows for beauty to remain or even increase out of our mess instead of simply quenching the sky of its natural splendor. As a person living in a polluted reality, both in myself and the world that surrounds us, this is truly Good News. It's Good News in the sense that renewal, beauty, and hope are not beyond our grasps even when the evidence seems to the contrary. Our violence, be it structural, psychological, or physical, self-directed or targeted toward others, will kill and destroy, but the continual victory of Life will eventually arise out of the ashes we create. We can then reflect thankfully on the voice that intercedes, saying,

I will ransom them from the power of the grave;
I will redeem them from death.
Where, O death, is your sting?
Where, O grave, is your destruction? (Hosea 13:14)

Seeing the beauty of the sky each morning helps me to appreciate mercy and compels me to ceaselessly pursue justice and peace in hopes of stepping one step closer to knowing the love that produces such mercy.

The best thing I've found in Fort Worth so far...

2005-10-09T18:37:00.000-07:00

...is the little known but vibrant art culture. There are 3 art museums within stone-throw from my school, and every month, a new collection of local artist's works fills the atrium immediately outside the main lecture hall. It is such a blessing and privelage to exit lecture and see paintings as opposed to yet another research presentation poster. I wholly believe that on a some level, these paintings both keep me from going crazy and remind me why I'm pursuing a medical profession: to constructively participate in both the tragedies and celebrations of life.
I've visited 2 of the 3 museums across the street. Both of their touring installations are amazing. One of them, at The Modern, is of Anselm Kiefers works. Anselm Kiefer was one of the many artist I studied during my undergraduate education, and specifically while I lived in Germany. His work is both mentally and visually provacative, as he lived through the reconstruction of Germany after the second world war. Germany had a great deal of physical devastation to repair, but more importantly the psychology of the nation was in even more distressing shambles, with the shame and guilt that comes with being the perpetrators of genocide. His art exemplifies the struggle of the nation to come to terms with this history. I believe his art is a work of courage because it refuses to let tragedy to remain unadressed, whereby it would be more likely to be perpetuted. With somewhat cryptic symbols and expressions, his work celebrates the possibility of healing without diminishing the grotesqueness of reality.
The Amon Carter Museum has a photography exhibit by Richard Avedon, entitled "In the American West." The installation shows larger-than-life black and white photographs taken mostly in the 1980's of those on the margins of society in the American West. Oilers, waitresses, carnies, ranchers, inmates, and drifters are some of the folks who were photographed, with the oil still soiling their faces and aprons still tied. Avedon is brilliant in his ability to see people; his photos capture both the intrinsic beauty of humans without covering up the blemishes earned in the struggle to make it from day to day at the margins of society. Few of the portraits show a smile. None of the expressions captured appear disingenuine or feigned, and all of the images are graceful. I have not had my 'rotation' yet, but part of our curriculumn at TCOM is to visit this exhibit in what is called the "Eye for Detail" exercise. Our course director will guide us through the exhibit, helping us to see pathology in these photographs. (Scars, facial paralysis, etc.) However, I hope and am confident that we will be encouraged to see these images in a very osteopathic way, as whole people who had dreams, possess beauty and possibility, and are fearfully and wonderfully made.

The End of the Beginning

2005-09-20T16:14:00.000-07:00

Yippee! I am done with Cell Science, my first course in medical school! I finished well, with an an above average final grade, and learned that I can cram a lot of information into a rather small space in a very short period of time. We had our final exam yesterday, and it was a doozie. But, it is over until reviewing for the board exam next year!

Don't let me fool you into thinking that a huge weight has been lifted, because I believe that the blitz-krieg of Cell Science was merely a taste of whats to come. The administrators proved this by the fact that we had our first exam in Osteopathic Manipulative Medicine (OMM) today, one day after our final exam, and we have 3 practical exams next week...one in OMM, one in Clinical Medicine (I have to perform a head-to-toe, complete physical exam on a classmate), and one in anatomy/ histology. I've never been tested in this format (practical exam), so it will definitely be a learning experience, both in how to study and how to perform.

All in all, I'm glad Cell Science is over despite the fact that it only gets tougher from here. The information I will learn becomes exponentially more clinically significant, and, thus, I will certainly find more satisfaction from a good exam performances. Let's hope that happens!

the newest existential crisis...

2005-09-09T14:10:00.000-07:00

I'm not too good at this blog thing yet, mostly because I have a ridiculously discriminating filter on what I deem appropriate for my viewing public of two to read. I don't want to bore you with things like I scored a goal at my soccer game last night (penalty kick goal, my expertise!) and immediately following the game a gnat flew in my eye, which felt like some one poured jalepeno seeds in my eye (luckily my team is composed of future or current physicians, so, no worries, I was taken care of and can almost see clearly again). Concurrently, I don't feel like scaring you away with the burdens of my soul. But, like I said, there are only 2 of you, so here goes with the heavy stuff...

My experiences so far in medical school have added up to a different breed of lifestyle than anything I've ever experienced. There is very little time spent between the extremes of the everyday task (laundy, cooking, etc) and soaking up the knowledge of the microscopic biological facits of the human condition. I dislike this quality of my new reality.

I've always been the heady and serious type, thus, medical school is a perfect fit in many ways. However, I've never had the consciousness of the two types of intellect with which I'm currently wrestling: the intellect with its origin in books and the other with its origin in life. Before now, I feel like I've experienced both, but it was generally either one or the other, never both. During undergrad, my reality, schedule, and thoughts on life revolved around books, while learning from life was something I had simply read about. Life at Nehemiah House opened my eyes to a whole new intellectual currency called community. While the paid-work during my time at Nehemiah House didn't challenge my brain, dealing with my housemates and the stuggles of our neighborhood excavated more truth than 10 or so years of book knowledge. That said, I feel like medical school is a fence, and currently I feel like I'm straddling the fence of individualistic institutional learning and community life, and my soul is being chafed.

Maybe someday, medical school will provide a bridge: a bridge between individualistic institutional learning and community life. I think that bridge will be called my medical career. The present chafing, I feel, is a result of having seen a glimpse of what is possible when people live together in search of wholeness and health, both in their spiritual lives and in their fleshly, biological lives. I'm finding it diffucult to depart from this way of life, even though I'm going out in hopes of gaining skills that will amplify the possibilities of a community's health.

I pray for patience and courage during this isolated portion of the journey.
I pray for partners in the pursuit of balance and wholeness.
I pray for peace in the knowledge that our God is the giver of freedom, love, truth, and hope, and that in Jesus, all things hold together.

"Side Effects"

2005-08-30T12:13:00.000-07:00

I attended a free screening of the independent film, "Side Effects," last night (www.sideeffectsthemovie.com). It was written and directed by a women who worked as a pharmeceutical representitive for about ten years. The film is based on her experiences during that decade, with 'documentary' style interviews of physicians spliced in throughout the work. After the viewing, the director answered questions fielded by the audience. The movie was amazingly well made, considering the budget of under $200,000, and the issues it addressed as well as the issues that surfaced during the subsequent questioning were both enlightening and frightening. Here are a few things I picked up:

*Information released from drug research is largely influenced by what will best market the drug, and often studies that may discredit or expose dangers of the drug are thrown out based on trivial 'flaws' in the study's procedures, patient group, etc. The illustration from the film was with a fictional drug, Vivexx, which had shown to cause significant liver damage in confidential studies. These studies were thrown out of the acceptable literature of the company based on a minute inconsistency in procedure by the researching physician.

*Branding. As I took notes during the film, I realized that the pad of paper I was using was advertising one drug, and the pen I wrot with was advertisement for another. Like the fast food industry and young children, I suppose it is a clever tactic of the drug companies are attempting to win my loyalties early while I'm still in medical student. The film illustrated that pens, paper, and sponsored office lunches are just touching the surface of the drug paraphernalia made avaliable to both the physicians and aspiring pharmeceutical reps. There has since been laws regulating the extent of gifts, but in the past, drug companies have flown physicians on exotic vacations and provided luxury automobiles in exchange for pushing their drugs.

*Pharmeceutical companies research the prescribing trends of doctors and cater their sales pitch toward these habits. This may seem at first like a reasonable tactic, but I wonder if it breaches doctor-patient confidentiality. If they know what is prescribed, do they also know to whom? If so, i would consider this both legally and ethically questionable.

*The writer/director also shared that she does not envy physicians at this time. Not only do they have to put up with the antics and rhetoric of pharmeceutical reps, but they also have to consider the demands/desires of their patients, which are heavily influenced by the marketing of the drug industry. Add that onto the headache of insurance issues, HMO demands, and larger and larger patient loads, it greatly jeopardizes a physicians ability to care and cure.

Like violence, I believe that caving into corporate manipulation/advertising is due to a lack of imagination, (often resulting from a lack of options.) I hope that in time I bump into like-minded individuals who are willing to sacrifice and spend the energy and resources required to first imagine then create a better way of both being consumers and physicians.

Two borrowed thoughts: for those under the fist of oppression, be it a great storm or violent injustice

2005-08-30T07:15:00.000-07:00

Christ would not be Redeemer
if he had not concerned himself with giving food to the crowds that were hungry,
if he had not given light to the eyes of the blind,
if he had not felt sorrow for the forsaken crowds that had no one to love them, no one to help them.
Christianity cares about human development, about the political and social aspects of life.
Redemption would not be complete if it did not consider these aspects,
of the Christ who chose in fact to be an example
of one oppressed under a powerful empire
and under a ruling class of his own people
that savaged his reputation and honor
and left him on a cross.

People of our time,
anguished about so many problems,
deprived of hope,
seeking paradise on this earth:
Seek it not here,
seek it in Christ arisen.
Let us find in him relief for our affliction,
for our worries,
for our anguish,
and in him let us place our hope

both written March 26, 1978 by Oscar Romero.

Music Tag, Anyone?

2005-08-25T05:48:00.000-07:00

I was 'tagged' by a fellow blogger (Amanda Peterson of PUMP Church in Portland, OR... good stuff) to post my current top ten songs, thus, in no particular order...

This World - Derek Webb
It's Alright, Ma (I'm Only Bleeding) - Bob Dylan
Swallowed in the Sea - Coldplay
We Are All Lepers Here - Psalters
Love and Peace or Else - U2
Beautiful Disaster - 311
Every Grain of Sand - Derek Webb
Nightingale - Saves the Day
Fix You - Coldplay
Lover - Derek Webb

Feel free to share your own tunes...

OMM

2005-08-24T15:21:00.000-07:00

Every Tuesday afternoon for about 3 hours, my classmates and I attend our Osteopathic Manipulative Medicine course, or OMM. This course, along with a more wholistic philosophy, gives us a set of skills that set osteopathic physicians apart from our allopathic counterparts. The goal of this set of skills is to help the body reach its homeostatic position, and thereby, alleviate symptoms that occur from a 'Somatic Dysfunction,' or an impaired or altered function of a certain part of the body.

This brief description may persuade you to believe that this is a sophisticated skill performed by trained, intellectual professionals, and I'm sure, in about 2 years, this will be true; however, I assure you, at this point, it is anything but that. For the most part, we stand, sit, or lie around half naked (guys in short, gals in sports bra and shorts) feeling quite sheepish and hopelessly unskilled as we try to mimic the instructor as she/he demonstrates each new technique. It's quite a scene: about 20 exam tables lined up, one of us playing doctor, one patient, limbs going this way and that, the instructor and TA's going from table to table.

So far, we have learned to assess various soft tissue and locate important skeletal components, called landmarks. Yesterday's session was a session in which we really got to 'know' our classmates as we found landmarks, namely the landmarks of the pelvis. As much as we all tried to remain as professional and mature as possible, its just a bit embarrassing and ultimately funny to palpate (examine by touch) the symphysis pubis and inferior lateral angles (I'll let the inquiring-mind look those up) of someone with whom you were casually talking about the new Coldplay album 10 minutes before. We all kind of grin and bear the days when our personal space is 'breached' in the name of our medical careers, and I'm very thankful for our teaching assistants (second year students, who are ultimately our 'real' teachers) when they are able to share an experience that they've had in a clinic, where knowing how to do these things that feel so foolish actually relieved a patient. (Just so you know, if you're experiencing lower back pain, it could originate from the posterior pelvis.)

All in all, OMM has been very challenging because it is a skill where the fingers do just as much 'thinking' as the brain. My fingers are currently amatuers, but I truly hope that I become proficient in this skill.

a Luddite concedes...

2005-08-22T09:53:00.000-07:00

If you've kept up with the events my life over the last 5 years, then you are either someone who changed my diapers as a child, or you are the friend that took the initiative to keep communication lines open. I confess, with a bit of shame, that I stink at long distance communication. And, I believe, this has more do with my loathing of the telephone than anything else. It requires that the participants simultaneously be avaliable, usually accomplished by labor-intensive planning or dumb luck, and it is void of the communication nuances of body language and facial expression. That said, in order to overcome the former complaint since overcoming the latter is a bit expensive and time consuming (ie, travelling to the locale of the other participant), I am starting a blog!! My next lecture on the "Urea Cycle and Ammonia Catabolism" (which is basically the process of our bodies getting rid of anything we don't need that we get from our diet, for example ammonia resulting from the break down of proteins) starts in 5 minutes, so this will conclude my first entry; however, I do plan to post regularly (at least twice a week) and look forward to your comments.