salmon

I've had a weird fascination with salmon swimming upstream since elementary school science. I don't know why. But seeing a salmon swim upstream was on my to-do list in Alaska.

It didn't take long. There are lots of spawning salmon in September. They swim from the ocean and into the rivers where they lay their eggs and then die. When they are dying en-mass, it smells kinda bad. 

One of my patients told me she was praying for rain so the salmon would have enough water to keep swimming. I looked out the window at the downpour. It rains A LOT here.  God must love the salmon, she smiled. 

In Native Alaskan culture, the salmon is a symbol for determination. Something about that resonates with me. This year has been an uphill swim, a fight against sickness. Yet grace continues to rain and makes the swim upstream just a big easier. Sometimes that rain is just enough energy to get through another day, other times it is a glorious downpour like a month in Alaska. 

God must love the salmon.

i'm going to alaska!

i'll be posting from here for the next month!

 

in memory of her

i knew when i met her she didn't have long to live. it was a sad story, a few months of nausea that was mostly ignored, actually a rare cancer that had spread throughout her belly. 

 

they decided to start chemo. she was optimistic; she told me she was gonna fight this thing. we talked about how her hair would fall out, and what head scarves she was gonna buy. how she wanted to go to the beach this summer but was scared to be away from her doctors. about how cute her granddaughter was.  

 

her family was always in the room. her mom drove her crazy, with the fluffing of pillows and the force-feedings of sherbet and ensure. her sisters told stories of what an amazing person she was. her pregnant daughter brought in ultrasound pictures of her soon-to-be baby girl. her three-year old granddaughter ran through the room, making everyone nervous. they made me feel like family.

 

the chemo was hard on her, but she managed to get discharged, only to come back a couple days later, dehydrated and weak. this time, when her family had left the room, she told me, i know this is gonna kill me. i'm not ready to go.

 

she kept getting sicker, and her story changed: i know this is gonna kill me, but i'm ready. her mom pulled me in the hall and started crying: i know she doesn't have long. what do you think? i couldn't argue.

 

there was something about her, her mix of sadness and hope, resilience and resignation, her honesty, and her willingness to just let me sit with her that kept drawing me back to her room long after i had rotated off her team. maybe because i could carry the grief of my own sickness there and sit with it as she sat with hers. she heard my voice weakening as bronchitis set it, saw my mask when i was at risk for infection, but never asked more than how i was feeling that day. so we would both sit there and separately hold our losses, hers greater than mine, and talk about small things. sometimes she would cry. i would bring rita's and cupcakes that she would inevitably throw up.

 

i knew she was dying fast, but i didn't think it would be only two days after she left the hospital that second time, only six weeks after the cancer was detected, still four months before her second granddaughter takes a breath. 

 

i went to the viewing, not to say goodbye to her, but so i could hug her daughter and her mom and her sisters, because she made me want to hug my mom and my sisters, because life is just too short sometimes.

 

second year end, third year begin.

i started this year with deep breaths of thankfulness. i had survived what was supposedly the worst of the medical training process: intern year. the year ended with a week exploring the pacific northwest with a friend - eating our way through pike place market, kayaking around san juan island, biking and hiking in vancouver. i felt full of life.

 

second year started with continued triumphs: the color run. kayaking all summer long. a friend's wedding in india. loving work.

then things spiraled down: the death of a friend. recurrent hospitalizations. work and life becoming far too exhausting.

now this year comes to a close with another week of sickness, a chest rattling with cough, and a body heavy with fatigue.

like last year, i know life comes with both things difficult and things beautiful. and like last year, i am finding i am stronger than i imagined.
 
so i take a deep breath in and let this last year of residency begin.

telling secrets

i've only told three patients that i have lupus. 
normally, i don't tell.
because my experience of illness is not their experience of illness.
because the things that have given me hope aren't necessarily what will give them hope.
because my trajectory is not their trajectory.
because my journey cannot be extrapolated to their journey.

but sometimes, you need to know you are not alone.
sometimes you need someone else to say "me too."
so on three occasions, i have shared that understanding.

~~~

she thought it was just an ulcer, the nausea she'd been experiencing. it was metastatic cancer. she started her chemo in the hospital. what she wanted to know: when will my hair fall out?

she brought it up a few days later, looking sad. i'm waiting for my hair to start falling out. i could tell she wanted to not be upset. when you are diagnosed with metastatic cancer, it seems petty to care about cosmetics. except that it matters. it is a loss to grieve. it changes the way the world sees you, because now they can your sickness. the disease that was visible only to microscopes and CT scanners is now on display for everyone. i lost half my hair seven years ago when i got sick, i told her. don't downplay your grief. it is real. 

~~~

apparently he usually refused to see med students, but i guess that day he lost his fight, so i picked up his chart and went in.

his recent medical course had been tenuous. recurrent infections and hospitalizations, despite how adherent he had been to his HIV medicines. he now was contemplating taking a leave of absence from work. his worries about this were endless: that his co-workers would find out his diagnosis; that he would lose his job; that he would never be well enough to go back. he started to cry.

i took a deep breath. i had to take a year off of school because of sickness. i wasn't sure i would get better either or that i would be able to go back. it was a long hard year. i don't know what it will be like for you if you take time off or if you will get better or what will happen with your job. but i know life won't be over for you and that you'll come through.

~~~

his thin frame was covered up to his chin with stiff hospital blankets.

they tell me i have lupus, he said. i looked it up online. there are two kinds. i have the systemic kind. that's the bad kind. what happens to me from here? then his eyes filled with tears.

only my eyes were visible above the mask covering my face; they too filled with tears. i have lupus too, i confessed.

he seemed stunned. he commented on how i seemed so functional.

i've been really sick before, i get really sick sometimes. then sometimes i'm better and i cram life into those days and weeks and months. i don't know what this illness will be like for you, but i do know that it isn't a death sentence and that your life isn't over. the waiting and hoping to feel well and the uncertainty of it all is hard, but you are strong. you will come through this.

he is.

 

enough

she asked me to tell her about myself. i grew up in south florida. moved to swaziland for a year after college to do HIV public health work. came back to go to med school. now i'm doing residency here.

do you think you'll go back to africa when you're done here? well, maybe. i want to. i have some health issues.

then the tears start. i tell her how sickness once again caught up with me. about my recent hospitalization and missed trip to europe. how i was well enough to fly to LA for the last couple days of my vacation. how i don't want to start the new IV medication they are putting me on.

she tells me how amazed she is at how much i've accomplished despite this sickness. how i managed to finish med school. how i'm finishing residency. i breathe out deep breaths of thankfulness as she says this. the stepping back to tell the whole story reminds me of how far i have come. the little losses of this past month seem small in comparison to all the huge graces that have carried me this far.

i once read about a jewish song, dayenu, that is apparently a part of Passover celebrations. the word roughly translates to me "it would have been enough for us." the song talks about how god led israel out of slavery, about the miracles god did for israel. at each point, it pauses to say "it would have been enough." if god had only given one of those gifts, it still would have been enough.  

as i told my story, the concept of dayenu kept running through my head.

if i only got the chance to live on red swazi earth for a year, it would have been enough.
if i only finished med school, it would have been enough.
if i only finished the first year of residency, it would have been enough.
if i only danced in a sari at my best friend's wedding in india, it would have been enough.
if i only had enough energy and love to get through today, it would have been enough.

the list goes on, a trail of goodness that fills the life that often feels like wilderness. i'll take the mix of good and bad: the trips to india where i pack both saris and pillboxes. the southern california sun that came after a canceled trip to europe. days in a hospital bed surrounded by amazing friends and cafeteria milkshakes. 

it is enough.

 

 

life, interrupted

september 2012:
it was a triumph. an act of defiance against a disease that limits me. i knew there were risks, but i had to take a chance and live life.

it was the middle of the night when the plane landed in delhi, and there was only darkness out the windows. my flight to bhopal took off a few hours later. the sun was rising by then. as the plane lifted, i saw the indian landscape for the first time. without even thinking, i exhaled the prayer: blessed are you, o lord, who has kept us alive and sustained us, who has brought us whole to this moment.

i had first come across that prayer in the worst of my illness a couple years earlier. it bothered me because though i knew i was alive and sustained, i felt anything but whole. i repeated it over and over in my head, wishing it to be true. 

in the air over delhi, i finally felt that wholeness and breathed out my thankfulness.

march 2013:
we'd been planning it for months, my friends and i. we were going to see london, then take a train to belgium, then i would fly over to prague. i had a stack of tour books from the library and a list of everything 1000 places to see before you die told me i needed to see. i imagined myself walking along brick streets and through the alleyways and across bridges, taking it all in.

the pain started 5 days before my departure, and i thought i could shake it. i tried so hard to get better in time; in the end, i was admitted to the hospital hours before my flight to london was scheduled to depart.

that triumph i had felt on a plane only months earlier, that i was expecting to feel again as i drank tea in london and ate chocolate in brussels and explored the streets of prague was replaced with with sadness.

again that prayer came to mind: blessed are you, o lord, who has kept us alive and sustained us, who has brought us whole to this moment. except i didn't know where that prayer fits when my assigned seat was empty and a hospital bed was occupied, when the fatigue wasn't from jetlag but from not getting enough oxygen, when it isn't belgium chocolate but hospital cafeteria food that i was eating.   
 
this disease that feels like death by a thousand cuts - a cumulation of a million little losses - is somehow countered by the one thousand gifts that fill my life.

there is sadness over this lost opportunity, over the time with old friends that wasn't lived, over the world i couldn't see, over the air i struggle to breathe, over once again having my plans altered by a disease i didn't want. but my heart is also filled by the friends who visit the hospital even though it is their day off and who make sure i get a milkshake on each meal tray, by the sister who stays all day and paints nails and plays drawsome even though she hates hospitals, by the parents who bring lunches and daffodils, by the sun the rises over the city reminding me that someday things are gonna get brighter.