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.