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.



 





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.

 

intern year, end. second year, begin.

during our intern orientation last june, one of the chief residents said, "if this year isn't the worst year of your life, you've had a pretty horrible life." this past year was definitely not the worst year of my life (and i have not had a horrible life). this past year was hard, but i've had harder. this past year was hard, but there was grace.

there are things that have been difficult: a three-day hospitalization for pneumonia. turning down a residency position at hopkins because something in my heart told me i need to be here in pittsburgh for now. keeping people alive who should have been allowed to die in peace. letting people die who i wished could have lived.  

but there are also things that have been beautiful: finding out i really like seeing patients. being healthy enough to see patients. only needing to take five sick days all year (compare with at least thirty the year prior). giant chocolate chip cookies from the hospital cafeteria. being able to meet my parents for dinner after living away the past nine years.  making new friends. escaping to mexico and the pacific northwest with old friends. finding i am stronger than i imagined.  

so i take a deep breath in and let a new year begin. 

one of those days

"i think part of the struggle just of everyday life is

remembering that the love is there...to wake up in
the morning and realize that love is there in the world -

if i can do that, that's half the battle." - kathleen norris

i was grumpy. and exhausted. and sick.  and i had an out. 

but i was also stubborn and trying to prove i wasn't that weak, and i said i would go see patients in clinic that afternoon anyway.  then take a sick day tomorrow. 

i regretted that decision as soon as i walked into the building.  it hit me how very tired i was. how i could be home napping instead. but it was too late now.  oh well.

the first chart i grabbed wasn't that heavy. i figured it would be an easy patient. until i realized that this was chart volume 2.  i scanned the face sheet: hiv. bone disease causing 2 hip fractures. cancer. depression. chronic pain. neuropathy. 

as i was heading down the hall, the nurse practitioner gave me a heads up: he just got a new electric wheelchair. and he cut his hair.

i walked in the room, expecting someone grumpy and bitter and sick.  instead, he was smiling. 

how are you, i asked. honestly, i think this is the best i have been in my life, he said. 

how is the pain? it's there. but i have this new wheelchair and it's totally opened up the world for me. i can go places now, i don't have to sit in my apartment. i may try to take a computer class at the senior center soon. they offer them sometimes.    

i hear you cut your hair?  yeah, i donated it to locks of love. i wanted to give back. i smiled inside, wondering what kind of wig would be made from middle-age, graying, ex-hippie hair.

the attending physician came in. we talked some more, sorted out some medicines, set up follow-up visits.  at the end, the attending prayed with him: god, we thank you for the blessings you have brought in this man's life, for his health, for your grace.

i cringed inside.  blessing? very little of his story felt like blessing.  but he took those small moments - leaving his house without the pain of walking and giving away his hair - as gifts.  and i was humbled...because i know there is sickness in my body too. there are limits and exhaustion and fevers and feeling like i am missing out on life and worry that these little symptoms now could be harbingers of a coming disaster. but there are moments of grace too - people that notice when i need a day off, sunflowers blooming on my walk home, sisters who don't care if you use their popcorn maker, dinners with friends, and patients who remind me to name the good in my life.