Sunday, December 27, 2015

The F Word

There is a woman from New York in my head.

Well that’s not very interesting,” she kvetches every time I try to write something.

I hold down the delete key.

Better starting writing, or we’ll be here all day,” she chides and stamps her imaginary foot in time with the blinking cursor.

GET OUT OF MY HEAD,” I yell to no one.

Even the most accomplished authors, E.B.White- who wrote Charlotte’s Web, Steven King-- the notable horror story writer and inspiration for the movie Carrie, have written extensively about the voice of their inner critic and how they deal with those pesky and rather annoying voices. My favorite method for banishing one’s inner critic comes from Bay Area author Anne Lamott who recommends shrinking down your critic until they are small enough to fit in a mason jar. Then put them in the jar and close the lid tight so you can’t hear what they are saying. Then throw the jar off the roof.

Okay, okay—maybe I added that last part. Not that you would ever think of something like that.

As we head into a New Year with all of the promise of fresh starts, second chances and a clean slate, we are encouraged to leave our failures behind us. Throw everything that hasn’t gone your way out with the Christmas trash, leave it curbside for someone else. 2016 is nothing but blue skies and clear sailing. Believe me I want that. I really do. But my nasal East Coast inner critic reminds me how important it is to bring the struggles and failures you have had with you.  

I have had lots of failures—most the commonest of shortcomings and some fairly spectacular ones too. I failed O-Chem during my sophomore year of college. And I’m not talking D here people, nope, the big F stamped right there on my transcript for the rest of my life. Ironically the same grade a drunk frat guy unaware that he was even enrolled in the class would get. I did everything I could not to fail. I went to every lecture, met with tutors and the unsympathetic and wholly unhelpful professor. I took the final, knowing I would fail the class.

In retrospect, I learned way more from failing than I would have from squeaking through with a C-. Did you know that its possible to get a 14/100 on a final? Yup, It is. I learned that. I also discovered that even though I got an F in a class, I still had a nice warm dorm room to come home to. I still had food to eat and a loving family. My other classes had gone well, so that my overall GPA that quarter wasn’t actually all that terrible. The world kept turning, the sun came up, I was still a student (albeit not one that passed O-Chem, but nevermind). And that was it. My first real meeting with failure as a newly minted 19 year old. Now I’m told anyone over 18 is technically an adult—although being 29 I have to say I’m still waiting to become one.

I have had other failures since O-chem. Failed relationships—some I caused the end, others I chose to. I quit a summer job my senior year of college as a lifeguard—in a spectacular blow out one only dreams of doing. I let my boss have it real good. I knew I was burning a bridge—or rather soaking it in lighter fluid and throwing the match behind me. It felt good at the time, but ultimately the shortcomings in that position were partially mine.

The first time I applied to med school I sent applications to 28 schools. I got no interviews and received rejection letters from every single one. Apart from being an expensive adventure- it was an exercise in emotional stamina. One can really only read so many rejection letters before it starts to get to you. At least send my $70 back to cushion the blow.

During medical school there have been more times than I care to recount that I have walked home from school convinced I failed something, bombed a quiz or totally blew it by giving a wrong answer or having an awkward interaction. Maybe you’ve walked there too? While most of the time my worries are completely made up in my head as opposed to real problems, I greet failure each time. I know its presence and as much as it sucks, I welcome it, for it has been the failures in my life that have fueled my grit, my success and my ability to function with every test, every situation where failure might be possible.

As we hurtle towards 2016, I know the desire to have the fresh, clean sheets of the New Year. A clean slate. We’ll do things right this time. No more waking up with a bottle of red and a half eaten chocolate cake on your night stand…repeat after me…celery, lots of celery.

Let’s remember how important it is to take your failures and your inner critic with you into the New Year and all of the years to come. May they inform your life and help you deal with unforeseen circumstances.

I wish you nothing but success in 2016, but when you feel failure looming over your shoulder or become deafened by your inner critics, don't run from them or put them in a jar-- rather turn towards them and say, “hello old friend, its good to see you.”

Thursday, December 17, 2015

Jew Me

This year Cards Against Humanity sent those who were dumb enough to give them $16 (aka me) Eight Sensible Gifts for Hanukkah. Basically this December, 8 envelopes full of fun/stupid/awesome things have been showing up in my mailbox. My most favorite yet (mail is slow so we are still on day 6) has been vacation photos from the people who work in the factory in China where Cards Against Humanity is made. Part of the $16 went towards giving everyone who works there a week's paid vacation. 

I am also now the proud owner of the Jewish expansion pack to CAH (if you want to play with me, meet me at the Boathouse with wine and you're on). In addition to little presents, a letter of parental advice (because Jews duh), from a different dad of the Cards Against Humanity creators (all 22 of them are Jews you know) is included. Today's by Josh's Dad was just too good not to share. I love when you're just going along in life and all of a sudden you read something, or see something or someone does or says something that really hits you right in the feels and knocks you out of being your tired, overly self-involved, under caffeinated, miserly self. 

l'hadlik ner shel hanukkah

On Gratitude
By Josh's Dad

What's your superpower? Can you run faster than a speeding bullet? Can you leap over tall buildings or fly through the air like a plane? Probably not. But everyone of us does have a superpower that we carry with us at all times. It's not vulnerable to kryptonite or any comic book villain. It's the superpower of gratitude and it can empower its source as well as its recipient.

We have the ability to demonstrate our appreciation for what other persons do to make the world or our lives a better or nicer place. These things don't need to be profound events. Everyday people are interacting with you. It does not matter if you interact with them in person, over the phone or online. A "thank you" or an acknowledgment of their effort can mean the world to them. Think of the person in a tollbooth. They are confined to a five foot square box all day inhaling exhaust fumes, likely too hot or too cold. You may not be able to help them get a better job but you can make their job better. A smile and a hearty "thank you" for being here for me can make their day just a bit more tolerable. If enough folks did the same then maybe that box doesn't seem so small.

I own a small business and I try everyday to express kindness, empathy and yes gratitude towards those who work for me. It's harder to be grateful for, or even aware of, the hard work a stranger does for you on the other side of the ocean. I'm proud of the Cards guys for helping us show our gratitude to them too this year.

Just as Superman performs his feats with ease so can we. The opportunity to express your gratitude to you siblings, parents, coworkers, and strangers is available almost continuously. When you express any kind of gratitude there is almost always a reward. You often get a thank you but a smile or just a nod feels as good. We all have that power, the superpower of gratitude.
Don't let it go to waste.

---Josh's Dad

Wednesday, December 9, 2015

The Monster Inside Us

I am a monster.

I fear I have relegated myself to the darkest, most dank place on the internet.

The comments section.

Here in the semi-anonymous maze of haters, trolls, religious zealots and the self righteous, I find myself, fingers hovering over the keyboard. 

You see, this morning NPR posted a most interesting article about how medical students depict their attendings and other supervisors in a 'Comics in Medicine' class taught at Penn State College of Medicine. The comics and artistic renderings of the med students are hilariously funny but the point of the article is that the majority of students drew their attendings as monsters.

Its not hard to understand why. Med students often feel bad, stressed, worried, tired and berated by the doctors training them. The comic class offers an outlet for students and insight into how doctors are trained. Many physicians remember feeling horrible during their training and perpetuate the cycle of abuse. There is work to be done in medical education. And its ironic that medicine—a profession which extols health and wellness, should inflict such misery on those within it.

A physician from Pennsylvania commented on the article that, “maybe they are taking the wrong medical students.” And that those in training just need to suck it up. I bet no medical student has ever drawn that guy as a monster ;).  I looked him up. I was possessed by rage. Turns out he has multiple actions taken against his medical license and was fined for lying about the completion of his CME credits. Geez, maybe the “wrong medical students” they take turn into doctors who lie to the medical board. 

I want to call him out. I type a scathing comment. Impressed by my razor sharp wit and vicious rhetoric I re-read it over and over. Then delete it, and go downstairs to make coffee.

It scared me what a rush I got at the notion of belittling someone on the internet. I can see the thrill. And its powerful.

I suppose I am especially aware of the impact of internet comments at the moment, because last week my post on KevinMD got a nasty comment from a doctor in Utah. The discussion was on Doximitry—a kind of doctor’s only LinkedIn. As I am not a doctor, I wasn’t allowed to see the comments section. Rather, I found out about his comment, which criticized my work ethic (I have 3 master’s degrees, screw you) by an overwhelming flood of supportive, loving emails from doctors all over the country.

Don’t worry about that doctor from Utah,” one reply read, “We’re handling him.”

Another from an endocrinologist in New York read, “Your insights are superb, and I'll be forwarding your url to my current (and future) students.” And then he invited me to lunch the next time I’m on the east coast.

Some doctors sent me helpful links and access codes to e-books they had written. Most offered loving words of support, food, encouragement and coffee- should I ever be in their neck of the woods.

I have seen the best of the best during my medical training…and some monsters too. I don’t want to be one. If it means forgoing feeling powerful and smart all of the time, then I’ll take it--its better to actually be smart and influential as opposed to just feeling that way. It's hard to show love and patience, especially to people that probably really deserve getting called out. But I'll try to make a different choice and try to find other, more positives ways of discussion. We all have a little monster inside us. It speaks by interrupting, by tearing other people down and through self-righteous quips that feel good for a second, and turn to ash in your mouth. 

Let's be doctors who are kind and loving even when it is difficult to do so.  Let's be the way forward. Let's stand up for a better way to train doctors. To the good ones who we have the privilege of learning from-- you inspire us to show empathy and understanding and love. You give us the strength to ignore those who are not as courageous—those monsters who would rather belittle than help.

May they be relegated to the comments section.

Sunday, November 29, 2015

Fly Baby

Ugh. I hate flying. Everything about it is extraordinarily horrible. Security lines, screaming babies, germy recycled air. I think we can all agree its just terrible. But what makes flying particularly heinous for me, is my intense fear of dying in a fiery fiery crash.

Everyone is entitled to an irrational fear or two. Ron Weasley is afraid of spiders, Billy Bob Thorton claims to be scared of antique furniture and I am paralyzed by the thought of getting on a plane. Its not a rational fear I know. I have read the statistics over and over again. It doesn’t make a difference.

My fear has gotten so intense that when Rural Prime attended a conference in Irvine last year I chose to take a 16 hour bus ride instead of a 45 minute Southwest flight. At 2am the bus stopped at a Burger King in Salinas because a woman on board was having a psychotic episode. The bus ride was so terrible and so freezing cold, that I did end up flying back with the rest of my Prime buddies. Although the flight back to Sac was smooth and completely uneventful, I buried my head in my hands the whole way—only looking up to see Steven thoroughly enjoying the whole experience.

I do not want my life to be limited by fear, so this Thanksgiving I managed to ply myself with enough wine to fly down to LA. But when it was time to fly home, I found myself stone cold sober, stuck in a backed up line waiting to find our seats right by the cockpit door—which was open. I glanced at the array of buttons and knobs and levers. The man sitting in the pilot's seat couldn’t have been a day over 25. Sitting next to him was a salt of the earth man in his late 60s—clearly a seasoned pilot.

They were discussing the vector on which to land at SFO to clear the seawall and hit the runway. I saw the young captain gesturing a turning plane with his hand. My mind flashed back to the Asiana Airlines flight which crash landed at SFO due to pilot error. Vomit started to build at the back of my throat.

What if this was his first flight as a captain?

I found my seat. Glanced at the people sitting next to me, who’s faces would no doubt be the last ones I ever saw. The cockpit door was still open and I craned my neck into the aisle to peer in. They appeared to be going through a checklist, while the older pilot sipped his coffee--like just another day at the office.

On the instruction of the older pilot, Baby Face pilot picked up the plane’s intercom and promptly dropped it. It didn’t do anything to change my mind about our imminent doom, but it was kind of cute. His Captain's uniform was just a little long in the arms and the four gold stripes around the cuff of his jacket must have been from a Halloween costume. Fumbling to pick up the dropped intercom phone, he said, “Thank you for flying Virgin America, my name is Eric and I will be your Captain.” I wonder if he had ever spoken those words before. He proceeded to recount to the passengers the wind conditions and current temperature awaiting us in San Francisco, as well as the local time—which was an interesting choice seeing as Los Angeles is and always will be on the same time as the city 300 miles to the north. He sat back down in the Captain's seat and then sprang up suddenly to adjust it.

Oh Jesus Lord, homeboy doesn’t even know how to work the God damn chair.

I watched him test the engines, first the left and then the right. Both times the engines sprang to life with his touch of the throttle. As he grabbed both to throw them back for take off, the flight attendant slammed the cockpit door closed.

We’re all going to die.

I would feel much better about things if the seasoned pilot were at the helm, instead of some little pipsqueak who probably only learned how to drive a car 6 years ago. But then I think about how we ask patients to trust us—in the infancy of our training. We ask strangers to trust us with their lives and bodies.

The fear I feel as we leave the ground is akin to what a patient about to undergo surgery might feel. Scared at having little control over the circumstances. We ask patients to put their trust in us. And in turn we go over and over our notes, procedures, resources and simulations to learn. We care about doing a good job. Being young—both in years and in training, isn’t necessarily a bad thing whether you’re a doctor or an airline pilot. We have passion and an eagerness to learn that seems to fade with the years. Everything is new and exciting and scary. And that means we’re paying attention. Plus if we never had people in training to take over in professions like these, we’d be totally screwed.

What makes me so fearful of hurtling through the sky at 39,000 feet is the same thing that I hope will make me a good doctor—the need for control. When I have to give that up and put my life in someone else’s hands—its really scary.

We need to keep in mind that patients make a choice to put their confidence in us. And we need to be worthy of it.  We must take the time to talk with patients, explain what's happening and ask for help and support from older doctors. And we must stay committed to learning and staying current in our jobs for the rest of our lives. That’s what it takes for 200 people to let you take them for a spin around the stratosphere, or lay down naked on a table under your knife.

Needless to say, the flight went well. We did not hit the seawall and touched down with the same turn I saw the Captain gesture with. As the plane emptied out and I made my way off—I couldn’t help but  pop my head in the cockpit.

Baby face was looking over his flight log.

Great flight.” I said.

Thanks,” he replied.

You’re a really good pilot,” I said.

“I’m trying to be,” he replied, “I’m still learning.”

Saturday, November 21, 2015

A Walk in the Woods

Photo Credit: Eric Mann, PhD

I hate living in Sacramento. Every time a big truck drives on the freeway overpass, conveniently located right outside my bedroom window, I wake up from my deepest slumber, scream EARTHQUAKE and dive under my desk for cover, only to discover it is yet again a false alarm. This shit is getting old. I’m tired of almost being run over in the T and Stockton crosswalk every day on my way to school. I’m fed up with the poor air quality and the lack of parking. I can’t remember the last time I put my toes in the sand or climbed a mountain or saw how bright the stars can be. Do you?

Medical school doesn’t leave us much room to breathe. Try as we might, those deep breathing exercises they have us do in the lecture hall (which frankly make me look pregnant) just don’t compare to how deeply you would breathe in the air if you were by the ocean or on a hike somewhere beautiful.

That’s why, this break I am determined to get away from it all, rest and see some of this amazing planet we call home. I am told there is life outside the 4 blocks between Med Ed and 34th street and gosh darn it, I am going to find it.

I have never been good at quieting what Buddhists call the ‘monkey mind.’ Its been rather loud as of late and the frenzy of school and the urban landscape isn’t helping. So today, I packed up my Subaru, left my coffee cup in the sink and drove to Muir Woods.

Its the most beautiful lush old growth forest. I walk along a forgotten dirt path into a grove of trees, wet from the fog. The air is crisp and cold. The trees hold me in their shelter. The sky is cloudy and I can hear a noisy brook in the distance. I stand amongst the trees, breathing in the crisp air and crunching leaves beneath my feet.

I’m drawn to trees in a way I can’t quite explain. When I was little, my Dad brought me to work with him and I went around to every cubical and asked people to sign a piece of paper if they liked trees (ironic I admit). I guess Greenpeace is just in my bones. Plus I was freakin adorable.

Standing in a forest is almost like being in a crowd of people. There are babies—little saplings that can barely hold their leaves off the ground. Ostentatious ones with bright red leaves like a woman wearing a red dress. Birch, Oaks, Maples—all kinds, just like people. I find myself especially drawn to the old trees. The survivors. Battered and scared, bark peeling away. A little worse for wear, but still standing their ground—these trees have really known life.  

There is something magical about nature in general and the forest in particular. Perhaps it is my sheer joy to not be within the same quarter mile for once. Everything is so green, so full of life and possibility. Out here I am not alone, I am not lost—which is frankly more than can be said for when I’m at school.

Our lives as med students are like when you’re trying to cram too many sweatshirts into your dresser drawer. It just won’t close without lots of cursing and shoving and a jammed finger or two. There is so much stuff in such a tiny space; we get squeezed smaller and smaller until we gasp for air.

I hope you can use our time off to get out a little bit. You don’t have to go far. If you want to study a little bit, that’s okay. You do you. But make sure you temper your worry and your stress by spreading it out over a beautiful sunset. Un-furrow your brow on a beach at dusk. Get drunk on the rain drops that are supposed to fall this week. Only you can quite your monkey mind. Let it out of its cage, you’ll both feel better.

Wednesday, November 11, 2015

Who Turned Out The Lights?

by Sameera Mokkarala

Ive been a bit of an early bird ever since high school. My dad, whose business associates lived on the East Coast, would rouse at 5:30AM to begin the daily onslaught of conference calls, and since my bedroom shared a wall with his office, I usually wound up joining him in being awake at ungodly hours. It became a habit that stuck with me through college, grad school, and now into medical school. And so, when Daylight Savings Time rolls around every November, I am typically the only person in my social circle whos been counting down the days, since I also tend to be the only weirdo whos consistently up before the sun.

Its disorienting to spend the first several hours of your morning in the dark, which is why I prefer the earlier sunrises that come along with rolling the clocks back. Even so, walking out of MedEd after class to find that its pitch black outside is its own type of unsettling. It becomes easy to ignore, for example, the many productive hours you ought to have left in your day when a 4:45PM sunset leaves you second-guessing the time display on your phone. Are you sure its 8PM? Because it definitely looks like midnight...

Its gotten darker out there.


During my first year of medical school, I heard an older student comment that if you arent having breakdowns a couple times per block, you probably arent doing med school right, and at the time this unsolicited advice made me laugh. I know this because I recently had occasion to flip through my intermittently-kept journal and found a set of entries from around this time last year which, while tinged with the usual exam stress, were fairly chipper. Maybe other people had to go through breakdowns and crying jags to get through, but not me. After all, as much as med school may be challenging at times, didnt I ask and even fight to be here? Isnt this me finally (after years of study and CV-plumping) living the dream?

A year and a few meltdowns later, Im not as sold on this logic as I was. Much of the time, it doesnt feel like the dream so much as it feels like a slog. Uphill, both ways, through the snow. Or through the allergen-laden breeze, as the case may be in Sacramento. Comparing my journal entries over the last couple months with those I made towards the end of 2014, its clear that something has changed, and that its changed in a way that I cant see when examining myself directly. When I think about myself and who I am, I dont feel that Ive changed overly much in the last year and a half; I still have love for what Im doing, and the goal that brought me to UC Davis--to promote care for underserved communities--burns as brightly as it ever has. I like to think Ive maintained my sense of humor, and that Im still managing to fulfill my roles in other peopleslives. I am who I was. But the consistent shift in the tone of my writings, from upbeat and somewhat glib daily updates to more measured weekly or monthly entries, betrays something else. Something is different.

It has, as I said, gotten darker out there.


This week, the medical education admin folk lured our class with free burritos to an introductory talk about third year Clerkships. Two weeks ago, they brought us together to talk about Boards. Cue 106 MS2s breaking out in nervous sweat at precisely the same moment.

While they might not always know exactly what these keywords mean, the non-medical people in my life have quickly come to understand them and their related terms as imbued with both great importance and an impending sense of Armageddon. This is USMLE. This is a Shelf Exam. This is Sameeras spiking blood pressure and sense of constant existential dread. Tread lightly.

These specters have been floating over our heads since the day we got to MedEd, but their insistence on now materializing and becoming real is, quite honestly, scary. I have found that its really easy to get overwhelmed and decide to solve the problem by ignoring it and re-watching Amelie instead. (I have also found that, in spite of my fondest hopes, this is not a viable problem-solving method.) While I wish I were the kind of person who felt invigorated by this sort of challenge, I am embarrassed to admit that I am more frightened than anything else--frightened of failure, of not being smart or personable or xyz enough, of somehow compromising my chances of being the doctor Ive always dreamed of being. Even more than that, Im afraid of not being able to be the person that the people I love need me to be, of disappointing them with my inability to be present and attentive. At the Clerkship meeting, they told us that one of the most difficult adjustments for third-year students is the fact that their time is no longer their own. But if Im already having problems with time, and if Im already having to miss things I care about--birthdays, holidays, Skype dates--, what does that say about the next two years? What does that say about me?

The people I love all assure me that it will be fine. That well figure out, well handle these things as they come, that were a team. I, for my part, remind myself and others that bigger fools have made it through with their MD and most of their sanity, so why not me? Why not us? I am trying, per my mothers very good advice, to cut this thing into sensibly-sized pieces, to take reasonable bites, and to chew the appropriate number of times before swallowing so as not to choke.

Ive thought about changing the way I write--about being more determinedly upbeat, deliberately infusing my entries with the positive, recording less of my doubt and anxiety--but I want whatever records I keep of this time to be true to the experience. Its why I do the time-consuming thing of actually writing by hand rather than typing my thoughts down, and why I use pen instead of pencil: if left to more impermanent formats, I would likely wind up with airbrushed gloss rather than faithful portrayals. I want to be able to look back in five or fifteen years and remember things as they were, whatever that winds up looking like.

What I can do is try to reach for my pen in times of happiness as often as I do in times of stress, to remind myself that there is a moment of magic--cheek kisses from a grateful patient, an impromptu visit from my younger brother, successfully out-punning my boyfriend--for every moment of frustration, sadness, or difficulty.

As I write this, light is beginning to creep its way across my kitchen floor. The sun is rising from over the hospital complex, casting the world in pink and orange. Its quiet, and its beautiful.

This is definitely worth the dusk.

Thursday, November 5, 2015

The Emperor of all Maladies

After those delightful oncology lectures, I haven’t had a glass of wine in 2 weeks. I’ve thrown out all of my potentially cancer causing deodorants, shampoos, body washes—basically all products that help me look human. And this weekend I attempted to make milk from legumes—it was gross and made a sticky mess all over the kitchen. I’m pretty sure none of these things are really helping to lower my cancer risk, but they sure help me feel like I’m taking action against a disease so diverse in symptom and yet so uniform in suffering.

Some of you may have been privy to my minor freak out during lecture, when I learned I have basically all of the risk factors for cancer that were discussed.

1.     Being from Marin: Yea- I’m from there…but if you ask me, I’ll probably say I grew up north of San Francisco. Apparently we also drink a lot there…come visit Paige and I sometime.
2.     Being of Ashkenazi Jewish heritage: Haven’t the Jews been through enough? I mean really. I swear this comes up as a risk factor in just about every lecture. Ugh, why did they all marry each other? Why?
3.     Alcohol: Daniel suggested that this is really the only modifiable risk factor in my life (and then he suggested I have a kid and I punched him in the face). Sometimes life requires you to drink, just saying. #boathousethrowdown
4.     Having kids…actually make that not having kids: I’m busy. I also cannot keep a house plant alive and today for dinner I had sour skittles from my loser MCE bag. Also, did I mention, I’m busy. So very busy. Where’s the wine?

So yea, I left that lecture not feeling great about things and convinced that everything everywhere causes cancer at all times. I’ve been hunkered down in my room since then. Its safe in here. Although the flame retardants in my mattress might be slowly seeping into my pores.

In preparation for our final, I’ve been reading some delightfully uplifting lines from our syllabus.

“…prognosis is grim.”

“Five year survival is zero.”

“Certain cancer by the age of 30.”

“Once disease progresses it is incurable and will relapse.”

I scan the black and white pages for some reassurance. Occasionally there are faint glimmers of hope scattered in the mire, but ‘30% cure rate,” just doesn’t seem like enough, especially if you’re the other 70%.

If I were a patient reading our Oncology syllabus I would be scared out of my mind. Even though we’re studying the material to learn it for our patients, it scares me that 1 out of 2 men and 1 out of 3 women will be diagnosed with cancer. When I look around the lecture hall, I wonder who it will be.

In addition to being all around horrible, cancer is also a racist asshole. As you know, minorities are far more likely to be diagnosed with and die from cancer1.

If there was a vote-- a la Survivor style, we’d all vote cancer off the island (although I’m pretty sure Nolan is the only one who watches that show anymore).

YOU CAN’T SIT WITH US cancer—because you’re dumb and that vest is disgusting.

I have no idea how patients do it.

The narrative of a patient with cancer is not something I can speak to. But I have read several moving, honest and brave accounts. You can read them here, here and here.

I overheard a doctor in the hospital saying that it is the job of the physician to help patients deal with the uncertainty of life. I think that’s true. I also think that’s way easier when we’re talking about other people’s uncertainty and not our own.

It is also our job as friends to help each other deal with what life throws our way. When my anxiety about all of the worlds ills (including cancer) gets too intense, I avail myself of the hospitality of my friends Julie and Lyndon. They are real adults in the sense that they have clean laundry, food in the fridge and none of their furniture is foldable nor inflatable. Julie cooks me dinner and we lose track of the number of glasses of wine. They are game to watch any documentary I choose (and we have watched some really weird things). And on nights when the world seems an especially scary place, Julie makes us chocolate chip cookies in miniature cast iron skillets. My time with them is some seriously restorative shit. 

I’m pretty sure it causes cancer to worry about your cancer risk too much. Just do the best you can. Don’t smoke, limit your bacon intake, etc. But remember that life is for living and loving and serving—not worrying.

Life is uncertain and scary and weird and no one makes it out alive. My favorite micro professor from undergrad- Dr. Mann (God I hope he reads this) says that we live under a preciously thin veneer of normal. That’s true. I remember it, and then I forget it. I think that’s okay. Let yourself be reminded not to take life for granted, and then forget and take it for granted and let yourself be reminded again.

I think when that happens; it means you are busy living. And that’s a good thing to be busy with.  


Thursday, October 29, 2015

The Tribe

As we start to sense the cold snap of fall in the air, we are surrounded by messages that the dead are scary and should be feared. As big a fan of horror movies as I am, I don’t buy into the concept that those who have gone before us wish us harm. Rather I think of my deceased relatives like my cosmic cheering section. Sometimes I wonder if they have a hand in helping me find my lost keys or a parking space. When I see a penny lying on the street I wonder if my Great Uncle sent it to me to remind of me of the times he let me win at dreidel.

If you have known loss, then you know your heart is never really whole again. It seems impossible to live without that person. And so so unfair. Your heart will always be broken. That’s where they live--in the cracks that never completely heal.

Dumbledore said it best, “the ones who love us never really leave us.”

Regardless of the festivities you partake in this Halloween season, let us look for pennies on the street, be kinder to one another and make those we have lost proud.

Hope you enjoy this week's guest post by my dear friend. Happy Halloween

The Tribe
By Brendan Ian

Granpa John sits up in his coffin, his eyes angled slightly away from my face, speaking slowly to me, the room, and the universe.

I wish I could say, I love you.

I wake up in Oakland, knowing my grandfather has spoken from beyond his cylinder of ash. We had followed his requests, delivered his shrouded, sunken body in a cardboard box to the incinerator after I recited “The Cremation of Sam McGee” to his gaping stare, since my father could not:

And there sat Sam, looking cool and calm, in the heart of the furnace roar;
And he wore a smile you could see a mile, and he said: "Please close that door.”

We sat around his body as the oxygen was removed, as his chest lifted and lowered with the crescendos and diminuendos of his respiration, as the hospice nurse delivered a few extra boluses of morphine and diazepam. I spoke to him one last time, recited a poem I had written for him from a stack of dog-eared white pages, his body near dead.  He calmed down.  He recognized me; he winked.

At the deathbed my face was marked by diffuse stubble and impetigo I neglected to treat till my parents coaxed me into a doctor’s appointment.  The impetigo disappeared, but the stubble grew into a beard as unruly as the anti-career passions a close friend and I took to Portland in my black 2002 Accord, its bilateral bumper dents unchanged since Granpa John gave me the keys. There was grey-blue morning chill, Mount Saint Helens twelve hours after we left Berkeley, the ripe stench of new life from deathly rubble, then our friends in the hipster capital living poor, but free to be themselves, and my companion’s little blue guitar with nylon strings which inspired me to write a song we could carry back to our band from the romance of Portland night.  Back in Berkeley I was unproductive, so unable to focus on emails and spreadsheets that I drove uphill to Grizzly Peak to take in the Bay Area panorama.  I called my father and told him that enough was enough, that medicine and science would restrict me from my passions for life, for love, and for art, so his only child was no longer going to apply to medical school.

It is lucky that I did not give my father a heart attack. My mother was comparatively patient with my rebellion, but she did not agree with my train of thought. They adhered to their parental guidelines (thankfully).

In spite of crises of passion, my friends, peers, and mentors have seen my progress along a path to practice clinical neurology and neuroscience research.  A few of them know why I am on this career path, that I got into this because my grandparents developed neurodegenerative diseases in my lifetime. My late Jewish grandparents had Parkinson’s disease— Grandpa Jack fought it, Grandma Ruth could not—and my late Irish-American grandfather, Granpa John, had Lewy body dementia. My parents know the particulars of Granpa John: his unchained spirit; his exploration and then rejection of monastic Catholicism as a young man; his pursuit of a rich intellectual and creative life as an organic chemist and an artist; his passions for truth and for human rights; and his deep love for my Sicilian-American grandmother, whom he nicknamed Granmarie, for me, and for everyone, which he expressed through his gifts of storytelling, homemade art and granola, and humorous wit. My parents know the time he spent teaching his only grandchild to cook, to create, and to think, and his desire for my mental liberation in tandem with his. His art, his books, and his clothes are scattered across my old and new bedrooms.

As much as anyone thinks they know about me, only I will know my dreams of the dead as lucidly as a human mind will allow, or their power to move me in their absence.  I cannot objectively prove that an afterlife is possible or that spirits can communicate through dreams. Then again, as much as I think I know about medicine or the science of life, it is impossible for me to consciously grasp beyond four perceived dimensions of space and time.  In this vein the foundational dream psychologist Carl Jung mused in his memoirs, Memories, Dreams, Reflections, that the deceased may transcend our four conscious dimensions and that the unconscious realm of dreams may uniquely allow their interface with space and time.

How clever!

Granpa John has appeared multiple times. He has moved through my old house, in my dreams and perhaps in unexplained shadows passing before my father’s open eyes, as if my grandfather wants my father and I to share these visions. It is comforting that he may be watching over me as I struggle through the ceaseless demands of a professional life, perhaps providing unseen approval of the breaks I take for fresh air, for piano, for sautéed vegetables, and to give others my love and appreciation. Same-sex marriage was federally ratified this year on what would have been Granpa John’s 92nd birthday, and I pictured him disembodied, whispering in the Supreme Court justices’ ears, mentioning something particularly silly to piss off Antonin Scalia.

Granpa John’s is not the only spirit.  My late Uncle Gary appeared in a recent dream, almost two years after his death from metastatic colon cancer.  He had once lived the romantic California dream as a photography student in San Francisco long before I knew the Bay, though eventually he settled down in southeastern Florida with my aunt and cousin.  He worked full weeks of car and furniture sales to support their life in the subtropics, somehow making time to help my cousin with her homework, to install and remove storm shutters during hurricane season, and to see Grandpa Jack almost nightly and drive him to and from doctors’ appointments or Passover dinner. There was little time for himself to sit in front of the television, his cockatiel perched on his shoulder and nuzzling his ear with a beak.  We last spoke when I was just starting the med school interview trail and hoping to visit him along the way.

It was the first day of orientation at a medical school, and a kiosk was serving fresh grilled crustaceans to medical students. The man inside the kiosk upset me by asking, Are you really a medical student? I sought out his employer to complain. The employer was a man with curly brown hair and hazel eyes, my late uncle, who then apologized for his employee and assured me he would make things right. My younger cousin was a new student at this medical school; my uncle was there to protect her. I was worried she would not be ready to encounter him in his present form.  He agreed.  Uncle Gary and I went on to converse through a cryptic symbolic script appearing on a piece of paper, and I awoke with an ethereal jolt.

The man with hazel eyes was Uncle Gary, and he is keeping an eye on me and my cousin. Fantasy or not, he still exists in some form I do not understand.  Perhaps my cousin would be comforted to know his presence, though I do not believe she needs help.  She is a strong, self-sufficient woman who is currently powering through a college honors program. She is the proud descendent of my uncle and aunt, for though Uncle Gary left her a year into college, she found her strength and marched forth to a promising future.

While some dreams have reminded me and my family of our antecedents’ love and care for our futures, there is a different dream which proclaimed my duty and responsibility to follow my path in medicine.  My Guatemalan babysitter Lily—my comadre—died from metastatic cancer the summer before I began medical school. The night before medical school, her emissary held my hands and sang that bone-chilling hymn from her funeral, Entre tus manos, to tell me that the lives of my family, friends, and future patients, the human race she left behind, are in my hands.

The next morning, Monday, began our medical school orientation, and I cried, the dream of Lily behind my tears, and in front, my new tribe of students, staff, and faculty assembled to save the lives and livelihoods of our fellow humans.  That Thursday we donned white coats and stethoscopes as we were ceremonially inducted into medical school.  A group of kilted bagpipers blared “The Blue Bells of Scotland” as we filed toward the stage, chills and more tears pouring over me because I knew my antecedents marched with me, like the Irish ancestors of Granpa John marching with war pipes to possible death.  I speak for myself, but I imagine my peers too are surrounded by the love of their kindred spirits as we all march forth in scrubs and white coats, ready to do battle with the world’s ills.

One-and-a-half years into medical school, I continue to follow my bliss.  My path in two words from Granpa John:

The possibilities!

He would have me say, with twinkling eyes, My grandfather told me that.

Friday, October 23, 2015

She's the Man

I wonder how things would be different if I were a guy. Not only because I am curious about what its like to pee standing up, but because I wonder how differently the world would treat me.

I was walking through the Farmer’s Market today, in scrubs, coming back from shadowing.

“Nurse,” I hear someone yell from across the row of stalls laden with tomatoes and persimmons. Seeing as I currently have far less training and experience than a nurse, I didn’t turn around. But then he called again.

“Nurse!!!!!!” he yells.

Thinking someone might need an actual nurse I wheel around. It’s the cheese guy.

“Hey Nurse, want to try some cheese?” He says

Now, I’m not a girl to pass up free samples. But I refuse to be subjected to society’s standards of women in medicine inflicted upon me by a man selling cheese. Its bad enough in the hospital, let alone outside of it.

But what really gets me (and my roommates, who are reading this over my shoulder) going is when men—particularly men in power, think I’m interested in them telling me how to live my life—or inquire about when I intend to get pregnant (see. Never. Adverb, at no time, not ever).

This blatant mansplaining makes me want to lose it. I have thoughts and feelings and ideas. I know myself better than they know me. Having met me for five minutes does not give them any insight into my life. And yet, today I was supposed to shadow in a clinic. But instead of seeing patients, the attending talked to me for 4 hours about what he thinks I should be doing during med school and oh…he would like me to help him with his research.

Having three master’s degrees does make one rather popular in the research department. But I have never been paid for any of the data analysis I have done. How many more letters must I have behind my name to be taken seriously? The one and only time I ever asked to be paid for crunching numbers, the surgeon responded that there was no money for me, but not to worry because he doesn’t get paid for research either. He left out the fact that he makes over $500,000 a year and oh hey…is that your Maserati out front Dude?

“What’s a girl to do?”

No seriously. Tell me what I should do.

For more advice on being a woman in medicine, I reached out to the first woman to graduate from our medical school, back in 1972. Her name is Joanne Berkowitz and up until last year, she was still practicing medicine here in Sacramento. You can check out her picture right outside our lecture hall.

We talked for an hour about what UC Davis was like in 1968. Sexism was blatant and there was precious little she could do about it. Getting called nurse was the least of her worries. Surgeons would show up drunk to rounds, grope her and then operate. Harassment, crude jokes and being sent to make coffee just came with the territory. When I asked her how she managed to make it through what sounded like a horrific 4 years, her answer surprised me. She told me that she would have never made it through med school without the kindness and friendship of the men in her class.

“Most of them, were really, really good people,” she explained.

She told me about how one of her attendings got into the habit of ‘accidentally’ dropping things and then asking her to bend over and pick them up for him. But one of her male classmates always reached down to fetch the item before she could. Eventually the doctor gave up and stopped dropping stuff.

I know this post has a little man hating vibe to it, but that’s really not my intent (unless you happen to be that drunk surgeon from 1968 or drive a Maserati— then we have serious beef Sir).

I’m angry and frustrated when I feel as though I can’t stand up for myself without consequence. I hate that even in 2015 there is a double standard for men and women, that I barely know how to put into words, let alone try to change. But I know that regardless of our gender differences, we’re on the same team. 

Women and men are both critically important to helping women physicians succeed. 

I have been humbled by how women in our class empower and show love for each other—something that is so rare, and yet so amazing. Its all too easy to tear down a woman for even a modicum of success—but we reject the notion that if one woman succeeds that means another cannot. We purposefully reach out our hands and pull each other up and everyone ends up stronger for it.

I have also witnessed countless examples of men in our class supporting their female classmates. Whether by respecting them in leaderships roles, asking them for help, intentionally making room in a discussion for our thoughts or encouraging women who mumble an answer in class to yell it real loud. Most of the fathers in our class have daughters (Robert, you could be next my friend). I'd like to think that those with a Y chromosome have just as much girl power as we do. 

You my beautiful people are the way forward. 
You give me hope that we will continue to make medicine a more equitable place.  
You remind me that we'll be part of the solution instead of the problem.  

And on days like today when that barely seems enough, you give me wine and then call me so I can bitch about it.