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. 

Saturday, October 3, 2015

All the Small Things

Ever see those internet lists of stress busting tips? You know the ones that you click on every time but never seem to actually incorporate into your life. I just can’t resist internet lists. But I swear I have an automatic reflex to roll my eyes any time someone says the word ‘mindfulness.’ If I can’t have a week at the Four Seasons Waikiki then I’m not about to dick around with breathing exercises, sun salutations or the like.

But weirdly enough, things that have helped me feel rather Zen have found a way of creeping into my life (and no, none of them involve wine thankyouverymuch). Here they are in list format for you to try (or roll your eyes at, as the case may be).

1. Lighting a candle. Understandably, this is a weird one because its still surface of the sun hot right now. But I was studying in Med Ed last night and a dear classmate brought a lovely vanilla scented candle. It made the room smell delightful and when I closed my eyes I could swear it was feeling more like fall outside. Such a simple thing, and yet it lifted my mood and made studying slightly more bearable. FYI…I am fairly certain candles are not actually allowed in Med Ed, so if anyone asks you didn’t hear that from me or get a flameless one for hours of flammable free study time.

2. Make time for gratitude. This is one of those things that I really want to do—and usually I’m not sure how so then I don’t do anything and end up eating Chipotle in my bed. Countless studies have shown that being purposefully grateful for the good things in your life make us happier and allows us to appreciate our lives more. Can’t find anything to be grateful for? That’s okay, just the act of searching is enough to boost your mood. Although I bet if you try hard enough, you can find at least a few things. This is also a great way to get a jump start on Thanksgiving, so when someone asks you what you are grateful for this year, you’ll know what to say. Here’s mine (in no particular order and partially plagiarized from John Carroll’s amazing SF Gate column): sunsets, apples, bedrooms in the morning, Jack Johnson, birthdays, the smile on the face of a passing stranger, rivers, mountaintops, cathedrals, Shakespeare, Tina Fey, the nation of Switzerland, grass, oranges, jumbo shrimp, Occam's razor, clean restrooms, potable water, penguins, French kissing and chocolate.

3. Do a Random Act of Kindness. A friend of mine recently lost her mom to cancer. She told me that the only thing that made her feel better was doing random acts of kindness. She literally became addicted to good deeds. If you're so inclined try slipping a kind note into someone’s locker or buying someone coffee (or diet coke) or I dunno...I hear this one girl really likes wine. Try one random act of kindness this week okay? Its magic I swear.

4. Hug it out. Not that stupid side hug crap. Full on body press, bear type hug it out. I'm betting Ngabo is willing to show you if you need reminding. There are 106 of us to choose from, not counting the first year class. Hug them too, except not if they just got out of anatomy- that’s gross. Hug your dog, hug your mom, hug your roommate—they have to live with you are you’re probably messy (note to self; hug Roshelle and then apologize profusely for leaving a tomato in the fridge for 6 months.) Hugging releases good old Oxytocin and that shit feels amazing.

5. Treat yo self. We work hard, no doubt about that. Show yourself some love (wink face). Other options for loving yourself include: Going for a walk, calling a friend, reading a book (for funsies), giving in to your Netflix playlist, having a dance party, taking a shower or just generally putting down those disgusting derm pictures.

So there you have it. No kombucha required. Can you feel the floor beneath your feet get sturdier? Can you see the holes being patched? Med school is fraught with stress—some real and some of our own creation. Embrace the crazy—I’m betting you’d miss it if it wasn’t there.

When it comes to wellness, the limit does not exist.