Monthly Archives: December 2022

Welcoming 2023

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Fog

by Carl Sandburg

The fog comes

on little cat feet.

It sits looking

over harbor and city

on silent haunches

and then moves on.

2022 was a year of achievement. I finished my last exam and clinical rotation of medical school. I applied for residency and got cool interviews. I went to my first medical conference. I got married. I re-combined houses with my husband after he graduated from nursing school and started his first nursing job. I did some of my longest hikes. I feasted frequently.

2023 will be marked by change including finishing medical school and starting residency in a place yet-to-be-determined. I started with Carl Sandburg’s “Fog” because quietness, absorption, and forward movement are the 3 themes I think will get me through the whirlwind of transitions that will unfold in the coming months.

Quietness

Life is loud whether visiting with friends and family, undertaking adventures, or working. In all pursuits, inner quietness can act as a grounding point. This year my primary goal is to cultivate my inner quietness.

Absorption

Residency is a huge leap of responsibility from medical school. It’s the first time I’ll get paid to be a physician, but with more responsibility comes a ton more to learn. In this context, I’m planning to tap my inner sponge and absorb as much knowledge as I can.

Forward Movement

Whether the days are long or short each one is a step forward. This can be difficult to remember in the moment. As I work through the joyful and unpleasant times of 2023, I hope to remember that my efforts are moving me along life’s adventure even if it’s not readily apparent how each piece fits together.

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Battle at the Kitchen Sink

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Disclaimer

This is a throwback story from my Peace Corps days. I’ve been thinking a lot about Paraguay lately and decided it was time to share some of the stories I didn’t share when I lived there. I always find myself thinking about Paraguay when the weather gets cold in New England (my current home), because I miss the sun and the mango trees Paraguay reliably had year-round.

Setting

The last quarter of my 27 months in Paraguay as a Peace Corps volunteer. Which is to say, I was very comfortable. At that point, Paraguay was my home.

Battle at the Kitchen Sink

It was grapefruit season. I remember this because we had gone foraging for grapefruits. In Paraguay there’s a citrus season (there’s also a season for every fruit you love… passion fruit, avocadoes, mangos, pineapples…). The Peace Corps volunteers who came before me had shown me how to hunt for grapefruits, so it was one of the first things I showed the new Peace Corps volunteer visiting me that weekend. It was her first time traveling beyond the training community in Paraguay where all Paraguay Peace Corps volunteers in my era spent their first three months learning language, culture, and other skills they might need once they arrived in their sites (where’d they work for 2 years). She was visiting me to learn about what it was like to transition from training to working in Paraguay.

After our lesson on foraging grapefruit, I showed the visiting volunteer (just as the Paraguayans had shown me) how to peel the grapefruit properly. This involved using a knife to carefully cut the peel off in a spiral, leaving a thick layer of that bitter white stuff that hides under the colorful part of the peel. I showed her how to cut a little cone-shaped hole in the top of the grapefruit. Then, how to squeeze the whole thing and suck the juice out until the grapefruit was dry. This is how Paraguayans most frequently eat grapefruit and oranges. It is my preferred method above all methods I’ve tried.

We then had lunch. I took the dishes out to my kitchen sink, which was located outside my apartment in the back under a mango tree. I had running water (which was nice) but my kitchen sink was outside – an unfortunate location on rainy days, but perfectly fine on this day. I set the dishes in the sink and then looked around for my soap and sponge. As with all full sinks, the sponge was hard to find. I went to dig under the dishes to see if it was there. Sitting among the dishes exactly where my hand had just been when I put the dishes in the sink, was a tarantula about the size of my palm.

I don’t know your position on spiders. But, living in Paraguay I developed a set of rules for all home invaders. Spiders were included in that list and my rules for them were as follows: they received the death penalty if they were too big and in my home territory (which included my sink), if they were too close to my bed, and if they were too close to the toilet. If they did not violate any of these rules, I was willing to live peacefully together. The tarantula in my sink resoundingly violated the size rule permissible within my territory.

My heart thumbed. I didn’t know much about tarantulas, but it was the largest spider I’d seen outside of a zoo exhibit. I yelped (sound effects are always part of my life) and then promptly went to find my bottle for fighting invaders (obviously I developed rules for invaders because there were many including ants and roaches). My invader-fighting bottle was a rather short (maybe 10 inches in length) plastic bottle that was square and originally contained my favorite yogurt in Paraguay.

I banged at the tarantula as hard as I could. Of course, having never fought one before, I was jittery.

I missed.

The tarantula climbed out of the sink, plopped on the ground, and started marching toward me.

I didn’t miss the second, third, and fourth time I tried to hit it.

Luckily, the new volunteer was at the front of the house and did not witness this battle, though I told her about it promptly thereafter. All in good time. She would likely battle her own home invaders during her years in Paraguay.

Reflection

These years since I’ve returned to the US have been challenging as I plodded through pre-med classes and several jobs and now, medical school. I’ve encountered many challenging situations with people who act tough and aren’t particularly nice. Most, if not all, of these tough-acting people have never battled a tarantula. Knowing that they lack tarantula experience has put my interactions with them into perspective. Afterall, toughness is relative, like all attributes.

There are many times in medical school where I’ve thought of my Peace Corps days as reminder that the current challenge is not harder than ones I’ve encountered before. Resilience comes from knowing where you’ve been even if others don’t. It comes from applying skills you learned in the past to new scenarios in the present. Most challenges can’t be overcome with a plastic bottle weapon. But, having a plan and being ready to implement it even when surprised can be applied to almost anything.

Did the Jones Cheat?

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I strode along one of my most frequented paths which combines my town’s main street and a side street that parallels it. I like the route because it represents two separate worlds despite their proximity. The main street is scattered with restaurants reflecting the many Central and South American cultures that comprise a large portion of my town’s heritage, hair salons, family-owned gift shops and clothing boutiques with their signs as much in Portuguese and Spanish as English, churches, places to learn English and send money orders, and empty store fronts. The side street is lined with one-family homes so large that if I lived in them, I’d need a map to navigate them and an intercom to find my family members in the far reaches of rooms and floors away from me.

As I crossed a four-way intersection, navigating the streetlights (including their left turn arrows) as I always do because I don’t think the walk signal ever turns on, I came upon the first house in the row of mansions. I slowed my pace. There was a landscaping crew. This was a common sight on this street and in many places in Connecticut – people spend lots of money on their lawns here. You always know a landscaping crew because they have big beaten-up trucks with letters painted on the side and a big trailer behind. What made this crew different was that they didn’t have mowing equipment, pruners, or leaf blowers from what I could tell. They weren’t even looking at the plants in the yard. THE LANDSCAPE CREW WAS HANGING CHRISTMAS LIGHTS AND CHRISTMAS WREATHS FOR A PRIVATE HOME.

I thought of that scene in The Grinch where one neighbor is using the Christmas light gun to decorate her house and the other neighbor is blowing electrical fuses to try to get her Christmas light display to just turn on. It never occurred to me that people might pay someone to hang their Christmas decorations at their home. Businesses obviously do that, but a private home having someone else decorate for Christmas?

On a later night, I passed the house of the family who had paid a crew to decorate for Christmas. Their house looked fantastic but in my heart of hearts the decorations were empty. I found myself wondering:

  • Is decorating for Christmas more about the quality of the decorations or is it more about the combination of annoyance and joy of putting them up and then criticizing and loving your own work until you must go through the added chore of taking the decorations down again?
  • Is decorating for Christmas about the quality of your house decorations or the conversations that go into convincing various family members or friends to help you hang decorations or the determination required to hang them all by yourself?

I found myself leaning toward the belief that decorating for Christmas was a lot about the journey and less about the end. Having decorated many a Christmas tree I cut down in the middle of my dad’s woods as a child, which is to say that we had untrimmed trees in all their asymmetrical glory, I find myself solidly believing that what makes home Christmas decorations special is that they were done by amateurs in the spirit of holiday cheer, family fun, and acceptance of an imperfect final product. It’s not that I faulted this family who paid to have their house decorated for Christmas, it’s just that their approached seemed business-like. Much like the Christmas displays on 5th Avenue in NYC, the house with decorations hung by a hired crew was beautiful.

I found myself chuckling about the concept of “keeping up with the Jones.” I found myself glad I grew up in a space and time where lawns were sometimes mowed by teenagers, often not mowed recently, and sometimes mowed by livestock. I’m not sure why the imperfection of unprofessionally maintained homes warms my soul, but it does. And as the holiday season unfolds, I find myself thinking about what exactly is most important in creating holiday spirit.

Heartbroken

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Tears fell down their cheeks. There was a long pause. “My heart broke and I’m just having trouble processing that,” the patient said. They’d been hospitalized for a heart attack several months earlier. I was seeing them at a primary care visit long after discharge. On paper they were recovering well, but they didn’t feel that way. They felt broken.

This interaction resurfaces in my mind periodically because it shows a side of illness that isn’t often seen in the hospital (where I’ve spent most of my time training). This patient had experienced an acute illness (heart injury). They had recovered their functionality. By medical definitions, they were a success story. Yet, they were miserable. How could that be?

In medicine we organize diseases into buckets with specific treatments and endpoints related to the organs affected by each disease. For example, this patient had a disease of the heart which might include endpoints like their ability to tolerate exercise or their heart rhythm. These endpoints are a simplicity required to synthesize something as complex as the human organism. However, as this story shows, looking at only specific endpoints can lead to missing things related to the illness that aren’t listed as clear endpoints to track. In the case of this patient, the heart is connected to the brain which is an organ of personality, mood, and feelings (among other things). While the functionality of this patient’s heart met all medical endpoints, their mood/feelings were severely affected by the experience of surviving a heart injury.

This patient’s experience reminds me that the diagnoses we make and interventions we do have lasting impacts on patients. Remembering this motivates me to provide information and support that I think will empower patients in their processing of what happened to them while they were hospitalized. I often wonder what conversations this heartbroken patient had with their care team while they were in the hospital recovering from their heart attack. Was there anything that their care team could have done differently to lessen the patient’s distress after discharge or was the patient’s feeling of heartbrokenness inevitable? I’ll never know the answer.

With this patient’s experience in mind, I try to ask myself if there is anything missing or left unclear before I discharge a patient. Healthcare is far from perfect (it’s quite broken actually) yet, even in a broken system, we can choose to communicate and help as best we can.