Christmas candles

The recent losses and outcries for justice in Ferguson and New York hit close to home because twice a week I work in the Los Angeles County jail, caring for men who were fortunate enough to survive their arrests. Most are young black men, who are arrested disproportionately compared with their counterparts of other races. 

I never ask my patients why they were arrested. 
Instead,I ask: what are your goals? 

The answers are humbling:
I'm taking classes so I can keep custody of my son. He's nine months now.
I want to have my own Christmas tree someday.
I'm gonna open my own accounting firm; I only need six more credits to finish my degree. 
I want to be a hairdresser. I have a lot of sisters; I'm really good at doing hair. 
I've never walked on the beach with my friend; I want to do that someday. 

So as Christmas comes, I light candles:
A candle in memory of the lives who have been lost. 
A candle for peace, that there would be racial healing and justice in this country. 
A candle of hope, that these men will get the chance to live out these dreams. 

Wishing you a new year filled with hope and peace. 

you can't give hugs in jail

First, some background: 
The LA County Jail is the largest jail system in the country (and possibly the world). It is made of up 9 different facilities that house 15,000-20,000 inmates at any given point in time. 

Men's Central Jail is one of these 9 facilities. It can house up to 5,000 inmates. It is located on the northeast edge of downtown Los Angeles. Five percent of the inmates in Men's Central Jail have known HIV. I work there 2 days each week providing HIV care.

To enter the jail wards, you have to go through a sallyport (aka cage) - where you enter through one gate, which closes behind you, then wait until the second gate opens into the ward. It's a little intimidating. 

I was given a couple pieces of advice for working in jail:
1. Wear pants. (Pants as opposed to my usual dresses. Not pants as opposed to nothing.)
2. If you get lost inside, don't wander. Just fall to the ground and start shaking. A security camera will eventually see you and send help. (I have yet to need this.)

One of my first patients was a young man who recently moved to LA (as always, details changed to protect privacy). He found out he had HIV a while ago but hadn't seen a doctor yet. Despite violence in his family growing up, he'd come far in life. He was credits away from bachelor's degree and had plans to open his own company. He was well-educated about HIV and what it meant when someone had progressed to AIDS. But that knowledge didn't prepare him for the fact that his infection had gone that far. So this beautiful boy, who I'd already invaded with personal questions and now broke crushing news to, started to cry. Because he hasn't lived a quarter of a century and already has AIDS. Because whatever hope led him to LA has been derailed by incarceration. Because his momma sits across the country and has no idea her son is in jail or that he has been living with HIV. 

In any other setting, I'd reach out and touch him - place a hand on his arm or pat his shoulder or offer a hug. But you can't give hugs in jail. So I willed my eyes to speak what I couldn't communicate with touch so he would know he is not alone. Over and over, I reassured him: this is not the end. things can get better. you can get better. 

He was released the next day. He knows where to find the clinic where I work. I hope he comes. I owe him a hug.  

taking in stories

It's crazy to think it's been more than a month already. There is a lot of HIV in LA. I have spent a lot of time listening. I have taken in a lot of stories.

(billboard on my drive home each day)

The stories start to run together. It's not that they are the same - it's just that there are so many:

A woman who was diagnosed while she was pregnant. She told her oldest child but still doesn't know how to tell the young ones. 

A father who didn't want to spread his cough to his baby girl, so he came to the ER to get checked. Now he asks if it's safe to hug her ever again. (yes, it is.)

A woman who was raped while she was crossing the border. Her child and family are still in Central America; she hasn't told them what happened. 

A grandmother who needed a blood transfusion years ago. 
A traveler from Europe who felt sick during his vacation.
A rapper with big dreams who ended up homeless and addicted to drugs.

People who have fought HIV for years, and people who found out only minutes ago. 

People in good relationships and bad ones. 

People who sleep on the streets and people who live in mansions.
People who laugh and cry and fight for life with a resilience I'll never know. 

A lot of the time, the sorrow of these stories is overwhelming. And despite huge advances in medicine, having HIV is difficult - whether it is the hurt or shame of how it was acquired, or the discrimination that those with HIV still face, or isolation from family, or struggling to break free from the addiction that led to becoming infected, or being unable to work due to illness, or simply having to remember to take medicine every day from now on. I'm still figuring out how to take it all in, how to keep listening, how to keep offering hope. 

"Compassion asks us to go where it hurts, 

to enter into the places of pain, 

to share in brokenness, fear, confusion, and anguish." 

-Henri Nouwen

new job, new pager

I started being on-call for the emergency department this weekend. LA County Hospital(LAC+USC) has a HUGE emergency department. I am told they see 180,000 patients each year (compare to Allegheny General Hospital ED which sees 38,000 patients per year, and Temple that sees 130,000 per year). The wait to be seen ranges from 12-36 hours.

Every patient who comes into the ED receives HIV testing (unless they opt out). When someone is newly found to have HIV, I get called to go talk with the person. Sometimes this involves telling them their diagnosis if no one has told them already; mostly it involves talking about what that diagnosis means and connecting them with our clinic. I think I am a bad luck charm becaues I was called about 4 new patients in the first 24 hours.

Not everyone comes in suspecting that they have HIV; in fact, most don't. They come in with coughs and headaches that have gone on too long, only to find the underlying thing causing their symptoms is not only HIV but AIDS.

My first patient (details changed to protect privacy) was younger than me, but life had been unfair. He'd been living on the streets, earning money however he could - even if that meant doing things he didn't want to do. Drugs made doing these things easier. He suspected for a while that he might have HIV, but couldn't find the courage to be tested until now. After 20 hours of waiting, he had his answer. So at 5am, we sat and talked in a quiet corner of the chronically-overcrowded ED. He spilled out stories of his life; of trauma; of how he wants to live now. We scheduled an appointment at our clinic. He'll start treatment. He'll probably be fine. Or at least his HIV will. Most of what he carries, I can't fix. But I can keep hoping for him.  

(view of downtown LA from LAC+USC)

 

the i-don't-knows

i have answered "i don't know" no less than 286 times this month when asked details about moving.

some have been logistical questions that finally have answers:

where will you be living?

monterey hills (east of downtown LA)

have you packed?

finally, yes.

what will you be doing?

it's an HIV corrections fellowship.

i'll be at LA County Hospital's HIV clinic, the LA county jail, and a clinic on Skid Row.

yes, Skid Row is a real place.

yes, I said the jail.

yes, my mom is nervous.

will you miss pittsburgh?

YES!

a lot of questions are more complex, and i don't have answers. i have no idea what to expect. i don't know what it will be like working in a jail. i don't know what my patients will be like or how i will fill my days. i know data and statistics about hiv and jail and homelessness, but i don't know anyone's stories yet so i feel at a loss.

the good news is, i've done a lot of things before where i haven't known anything other than facts:

i moved to swaziland knowing only the perinatal hiv rate (42.6%) and the number of orphans (100,000 of a national population of one million). what i found were amazing friends like zandi and jabu who taught me what it is to hope.

i worked in alaska for a month at a native alaskan hospital. i knew rates of alcoholism and domestic violence were horribly high, but it wasn't until bruised women shared with me their stories did i start to understand.

so now i start this next adventure with all of my not-knowing, and am waiting for the stories to begin.

"instructions for living a life:
pay attention.
be astonished.
tell about it."
-mary oliver

the end of residency

over and over, i'm breathing out thankfulness.

i made it.

3 years ago, i was assigned five patients.
i didn't know how to enter orders in the computer.
my white coat was still white.
i thought i would only do this for a year.
instead, i fell in love with taking care of patients and decided to stay.

i couldn't leave the place of listening to human stories in exchange for shaping global health policy. i know policy touches communities, but i needed to touch the person in front of me. at the time, it seemed like a huge decision to give up hopkins for a general hospital in a post-industrial city. but i knew i had to stay.

being healthly intern  year was grace; without that year of health, i would have left clinical medicine and entered the world of public health.

it has been anything but easy. four hospital admissions. countless infections. monthly infusions. my sister over and over reminded me "just keep swimming."

so i kept swimming, upstream like the salmon, and i've ended up at beautiful over and over: working in alaska for a month. watching a friend get married in india. listening and being humbled by the patients who trust me with their stories.

and the same prayer i have breathed out countless times over the past three years, whispered under my breath in airplanes taking off over delhi and sitka, to cries from hospital beds when planes left without me:

blessed are you, o lord, who has kept us alive and sustained us,

who has brought us whole to this moment.

residency in iPhone photos

This is where I have spent the last 3 years:

The views from the hospital aren't that bad:

I spent most my time trying to figure out which pager was beeping and waiting on people to return my pages:

I survived off of cafeteria food and graham crackers stolen from nurse's stations:

I looked at way too many of these:

I rarely saw the call room (note the unused bed):

 

I made sure the important orders got in first:

Only once did I ever see the emergency room empty:

There were early morning signouts, greasy post-call breakfasts, and rare chances to sit in the resident lounge:

I had lots of opportunites to wear Indian clothes:

 

I tried my hardest to avoid being a patient: 

And got to I spend a month working in Alaska:

It's been an amazing, exhausting, humbling, tiring, but beautiful 3 years.

Now I'm turning in my pager and my badge because I'm done!

 

a million thanks and then some to my family and friends

for all the love that has carried me through these past 3 years.



 





hello, 2014

2013 is over.

i finished second year of residency.

i missed a trip to europe.

i learned to paddleboard.

i was a doctor in alaska for a month.

i ran a glorious downhill 10k through pittsburgh, with "spirit indestructible" blasting in my ipod as i crossed the finish line. two weeks later i struggled to breathe in the step-down icu.

i got an hiv fellowship at USC. i'm moving to LA this year.

life keeps spiraling forward, and i struggle to slow down to listen to the hearts of those around me. but i keep trying.

so hello, 2014.