Anticipation

I live across from a café that is also as an event venue. The other weekend, I glanced out my window when music uncommon to my neighborhood wiggled through my window screens. My gaze fell upon empty tables perfectly spaced with little plant centerpieces, lawn games in the parking lot, a grill, and green cones outlining the event space. The event organizers meandered around arranged things, chatting, and smiling. Soon the guests would arrive; the evening would unfold. There was no predicting exactly how it would go, but everything was carefully planned with the hope that good things would come.  

I found myself amused by the scene across the street from my home. I’d seen it so many times before, not only in my personal life, but also in a past job when I was an event planner. I’d seen many physical set ups like this one and, perhaps more often, I’d experienced setups and waiting for nontangible events to unfold. The metaphor for my current state of being was obvious. My wedding will be in less than a month (the planning is done). I apply to residency programs the rest of the year (it’s a long process, please don’t ask). My soon-to-be husband is about to move to Connecticut and start his first job as a nurse. Those are the major events soon to unfold; of course, there are zillions of little events where the music is just about to start too.

Life is full of wind ups, waits, activity, clean up, and recovery on repeat. Some versions of these relentless series take more effort and planning than others. Some have more ways they could go wrong. Some events are set up and then no one shows up. Some events last longer than expected. Some events turn out better than you imagined. That’s life. Having gone through these actions over and over again, I believe waiting is the worst. Clean up is also hard, but waiting is the hardest. While my neighbors wait for the food they prepared to disappear into hungry mouths and the games they set up to spark laughter; I find myself waiting for other things that took many more moments (years actually) than cones, tables, and food to set up.

Neurocysticercosis

Repost of a post I wrote for the Global Health Diaries, the blog of the Global Health Program at the University of Vermont Robert Larner M.D. College of Medicine and the Western Connecticut Health Network. Find the original here.

Recently, I treated a patient with neurocysticercosis. While infection with Taenia solium is not common in the US, neurocysticercosis is not a zebra in Danbury, Connecticut because many patients are originally from countries where Taenia infection is a threat. The patient I saw was young and presented after having a seizure. Though they had received their diagnosis several years earlier at another US hospital, the disease course had started long before. Initially after their diagnosis, antiseizure medications were effective. The latest seizure occurred after a series of unfortunate events caused the patient to stop the medications.

The CT scan showed speckled calcifications throughout the brain. MRI revealed several enhancing lesions convincing us there was a need for antiparasitic and steroid treatment. The patient did well after treatment initiation and was discharged home to complete their albendazole and steroid course with a plan to follow-up with neurology. Their case lingered in my mind. It lingered not because of sadness or complexity, but because it reminded me of how connected our global population is and because the patient had impressed me with their calmness.

COVID-19 has highlighted how easily communicable diseases can travel and how important the health of the global community is for the health of our local communities. And while Taenia solium is an infectious disease, it does not spread like COVID-19. My chances of infection with Taenia solium are meager while living in Danbury, CT. Yet, we have patients with neurocysticercosis because people are mobile. I find it fascinating that the mix of diseases that are the most common in a particular hospital is not only dependent on the vectors and circumstance of life in the hospital region, but also the experiences and diseases prevalent in the places from which the people who make up the community around the hospital came.

As I contemplated our connectedness, the patient impressed me with their politeness and trust. Here was a person who was sick and did not speak English, yet they had complete faith that we could help them. I found myself humbled remembering that patients rely on us, the medical community, to guide them to better health when disease strikes. The patient’s calmness spread to anyone who spoke with them. There is something impressive about patients who can impart positive feelings on those around them despite being sick. I thought about the patient’s history and all the roads they had traveled so that our paths crossed during my medical training. Mobility is an amazing feature of the human experience. It both connects and separates us.

The Moments We Have Together

I would think of her often after we met as I hurried down the hospital walls. I always hurry down the hospital halls…rarely because I needed to hurry, usually just because it’s nice to stretch my legs. Sometimes the memory of her bright eyes would shoot across my mind as I opened the electronic health record system to work on different patients.

She had come to the hospital with a stroke. I followed her during the few weeks after she was diagnosed, during her acute recovery in the hospital. I met her on the medicine floor and then wandered the hospital until I found the rehabilitation center wing where she was moved one night.

After the first day when I conducted a thorough history and assessment of the patient, my visits were just “social visits” – the term for checking in with a patient or their family for the singular purpose of offering support rather than providing a medical update. She hated the hospital and visiting hours started late in the morning. I’d visit her before her family could be with her to help pass some time until they came.

Strokes cause a range of outcomes. Her outcome was good; long-term she was a little weak and a little off balance but still sharp as a tack. Strokes are injuries to the brain. In the first week I followed her, she was very depressed. Strokes can do that. I sat with her in the morning as she described her terrible dreams. Flashbacks to her childhood. She had been a Jewish child in Nazi territory. She described hard times. Her husband had also been in that situation – he had lost his whole family in the concentration camps.

As our days together continued, the patient talked less about WWII and more about her family in the US. She talked about how wonderful her children were. How hard it was now that she was old and her friends were dying. When you get old and people start dying, she told me through her stories, there are fewer people who remember your life experiences. Fewer people who truly know the world you knew.

We chatted about the hospital food. The boredom of sitting in a hospital bed. How playing cards with her children was nice, but barely passed the time. As I got up to go, she’d say, “Come back tomorrow.”

I went back until my school schedule sent me to clinics rather than the hospital. Medicine and the hospital are busy. Healthcare is frustrating and terrible sometimes, even often. When I find myself falling into the pit of work that is any job but especially a job that involves dealing with people and clunky systems all day, I push myself to pause and remember why I went into medicine. The weeks this patient was in the hospital she was my light. I like to think I also helped take the edge off her hospital stay. Seeing patients through sickness is the highlight of medicine in my opinion. Not all stories end as well as hers, but all hospital stays can be made better by our shared moments.   

Echoes from the Third of Medical School

The click-click and rickety wheeze of plastic jarred me back to the present from my thoughts about what I wanted to say about finishing my third year of medical school. Even though it’d been 3 years since I operated an ambulance stretcher, I knew that sound like I knew my own voice. The stretcher sound was among the many I’d learned in the past years.

The third year of medical school was a robot period. A term coined by my sister back in our college years. A robot period is a time when you just do as if you were a robot because sometimes you just must get to where you’re going.

I’d ended my third year of medical school learning that the squeak of premature infants is distinct from the wails of infants born on time. I also learned that the cry if a one-year-old is different from the tears that well silently and then exposed loudly before a 5-year-old boy gets a shot.

Before the crying nuggets served by pediatrics were the perfect one-two, one-two sounds of the hearts I heard in family medicine. Or the easy wooshes of lungs moving air happily. In outpatient internal medicine, I discovered the crackling stiffness of arthritic knees.

Before that there was the more forceful woosh of the ventilator in the intensive care unit. Pushing air into the lungs of someone who was silent. That same person had once been a DJ. How odd it was to see them existing quietly when they’d been mixing beats and filling dancefloors for most of their life. Neurology is a dark specialty.

And there was the sizzle sound and burning flesh smell of the electric scalpel in the operating room. The sound of metal tools on metal trays. The snap of putting on rubber gloves and the crinkling of paper gowns as everyone took their assigned places for the operation.

On internal medicine, there were the patients yelling for help. Some of them knew they were yelling. Some were just trying to reconnect with their minds which were lost in the fog of being sick. The beep of heart monitors. The dull sound of lungs full of junk. Oxygen monitors and bed alarms dinging, dinging, dinging.

Before all that, were the screams of women in labor. Of babies announcing their successful arrival with a gurgle-cry. The patter of footsteps as nurses and doctors ran because a baby was coming faster than everyone thought it would.

And that brings us all the way back to the beginning of the year. To psychiatry, where adult tears fell to the sound of congested voices. Or flat voices trudging along telling the stories of visions that no one else could see.

All those sounds are behind me. Today, I find myself listening to bachata and reggaeton. The traffic hums outside of my window. I’m studying for another huge exam. Exams are old news, but this is my penultimate of medical school. It’s the final countdown at long last. It’s been such a noisy year.

Just before I finished the year, I pulled out my violin. I hadn’t played it for almost as long as I hadn’t operated an ambulance stretcher. The songs that were like oxygen in my teens came back slowly. My fingers were awkward on the strings and bow but the jig I’d always loved most bounced around the room just the same. If you do something enough, you don’t forget. If you practice, you get better. Third year of medical school is about practicing. And the best part of practice is not practice, but what you’ve learned after doing it. That’s where I am now. Really glad to have done the year while also certain I’d prefer to never do it again. I’m grateful for the things I learned and the people I met. But, mostly, I’m excited to move on to the next phase of the doctorhood quest.

Home

And the last of three orchids I’d nurtured was sending up new flower shoots. It was the second of two my fiancé had given me when I finished my first medical board exam (about a year ago now). Ironically, I was sliding into studying for my second board exam as these orchids sent vigorous spikes forth with flowers that erupted like fireworks. It seemed my exam schedule was on orchid time.

The orchids weren’t the only plants I’d lugged from one state and town to the next. But, in that moment, their colors overshadowed the perfect leaves of the plants around them. Their colors were competing with the new rug I’d bought when I moved into my fourth (and hopefully last) home of medical school only a week or so ago.

I called it the sunny-side-up rug as it was bright yellow and white like a perfectly cooked egg. Somehow the plants looked greener next to the yellow. The yellow beside the purple African violets and remaining orange blossoms of the Christmas cactus and the orange-salmon ever-blooming crown of thorns was representative of the contrasts in my life. And the complementary colors of the yellow rug and purple flowers reminded me of my roots and my newest stethoscope which I’d decorated with colored zip ties representing the rainbow but paired by complementary color. The stethoscope decoration was an attempt to ward off stethoscope theft and, more importantly, a personal reminder of the same roots for which the contrasting colors in my apartment were a metaphor.

My roots are in the arts and carpentry and the outdoors which is a mix of dirt, water features, plants, trees, and rocks. And my new home reflected my foundation in these things. My time in the clinic and hospital often reminded me from where I’d come. Not so much because anyone I worked with or spoke to in these settings knew my history but because their ignorance of my history was so glaring and central to my relationship with them. It is easy to get lost in the world that is healthcare especially when that world is not even in the universe where you grew up. 

They say home is where the heart is. And when you’re a doctor in training you know that the heart is in the chest. Which complicates things when trying to find your home because your chest is wherever you happen to be. While I don’t think wherever I am is home, my idea of home is not so far off from knowing the heart is in the chest. I’ve had many homes. My tendency toward multiple homes may be a complication of split custody and two homes as a child – though, more likely, the shiftiness of where I call home stems from my personality-defining feature of being a wandering soul. Not wandering in the sense of a gypsy who is constantly moving, but in the sense that one place has never been the only place I called home. My life leading to medical school and through medical school has reflected that. Depending on what you count as moving, I’ve moved over 10 times in the past 10 years spanning two countries, three US states, and several towns in most of those regions and called each location to which I moved home.

When you’ve moved as much as I have, you develop a keen sense for what kinds of places can be called home. And you also learn that some places are easier to call home than others. My new apartment that contains the re-blossoming orchids and the sunny-side-up rug is one of those places that was instantly home. As soon as I opened the front door for the first time, I knew I was home. Home for now and home until I leave. The homy feeling might have something to do with the expansive windows. As a green thumb, the bigger question is not how or why I grow plants but rather if I seek places where my plants will thrive or if seek places where I will thrive. It’s easy growing plants when you need the same thing as they do. Sun. We need lots of sun and sunny days or else we get irritable and fade.

The new apartment was also home because I’d picked it from multiple options. I’d lived in the area for a while and surveyed the land. I’d used the knowledge gathered from my surveying to decide that this new town was the town in which I wanted to live. At least for now. The new apartment was also home because it was the first lease my soon-to-be-husband and I had signed together. It was a new place for us to both start new phases. He, his nursing career. I, my last year of medical school.

Seeing the flowers, the yellow rug, and the ñanduti (colorful Paraguayan lace) I’d placed on every empty surface in the apartment and thinking about the art that could fit on the broad walls made me feel happy in my new place. As I sat drinking my mate in the morning sun, I felt peaceful. As I looked out the windows; thought about how close I was to finishing the third year of medical school, a hard year to say it shortly; and considered all the wonderful things that would unfold in the coming months I felt at home. My literal heart was in my chest and my memories of past homes were in my metaphorical heart and both hearts were here in this apartment. Here, life followed the rhythm of the orchid flower cycle. Here was home because of the colors and sun and feelings that filled the place.

PS: it turns out I’ve written a post titled “Home” before…back in October 2014 when I lived in Paraguay. If you’re curious how my thoughts then compare to now check it out.

Burnt

Her hands had become so numb she could no longer administer the eyedrops that kept the pressure in her eyes from getting too high. If her eye pressure got too high, she’d go blind. So, her eye doctor said she needed surgery if she couldn’t use the eye drops. There were two surgical options. One surgery would take an hour and she’d leave the operating room able to see. One would take 3 hours and she’d leave the operating room blind, requiring 4-6 weeks of recovery before her vision would return. She was lucky because she had family who already helped her a ton because her other health conditions had made independent living hard for her. For some reason, the insurance would only cover the 3-hour surgery that would leave her blind for over a month. The holidays were coming up. The family members that took care of her had kids. She refused to make them care for her while she was blind over the holidays. She postponed the surgery. Would she go blind before she could get her surgery? Is this the healthcare system we want?

~

The patient wasn’t COVID vaccinated. “What will you do to treat me if I get COVID?” she asked. I thought about the patient a resident had told me about. That patient had been dependent on family for care. His family didn’t vaccinate him. He got COVID. He came to the emergency room with trouble breathing and then went to the intensive care unit. He lived on the intensive care unit for a year. Eventually, his healthcare team cut a hole in his neck to put a breathing tube in because he needed it. They did everything they could to keep him alive. The resident said when the patient first came to the emergency room, he was a happy, funny soul. The patient lost his happiness slowly during the year he fought to breath. After a year of an entire hospital trying keep him alive, he died. When exactly did avoiding sickness fall out of favor? Do you ask what firefighters will do if you set fire to your house or do you make a concerted effort to not catch your house on fire knowing that firefighters will do their best to stop a fire if it occurs but are limited because fires are destructive and destroy houses and the people who try to stop them?

~

The patient asked, “Why are so many doctors retiring?” I wondered how he didn’t know the answer to that question already. It seems so obvious. Then, I realized he was not a medical student. Being a medical student is to have a front row seat for observing the current state of healthcare. What had I seen? Why did it seem perfectly logical to me that so many people were retiring from healthcare even as I was striving to make it my career?

Not just doctors and nurses, but everyone in healthcare seems to be retiring…

We report our COVID cases. Our COVID test rates. Our COVID survival rates after hospital admission. Our COVID deaths. Who was there to perform those tests, to care for those people when they came to the hospital, and to close the curtain when the ventilator wasn’t needed anymore? Healthcare workers. But, they were also there for all the other things too. The heart attacks. The stomach pain. The broken bones. The cancer. The normal healthcare screenings. They were there when people looked for help with their depression and their anxiety. Healthcare workers’ hours increased. They worked the job of two, three, four, and five people because the hospital was short-staffed before the pandemic hit. Again, healthcare workers were already working long hours and doing the work of several workers before COVID came. Then healthcare workers got sick. And the ones left standing worked for their sick colleagues, worked for themselves, and worked for the staff who were missing before the pandemic came. Wages stayed the same.

Housing and food got expensive for everyone, including healthcare workers. Healthcare workers missed the same performances, social events, and restaurants that everyone else was missing. Life got more expensive because everything including industry was disrupted by COVID. Healthcare wages stayed the same. Healthcare workers got sick. Sick leave was used up. Shifts were harder because healthcare was short staffed and there were more patients than before. And the patients were dying. And insurance didn’t want to pay for the treatments that patients needed, not that that was new, but it remained disheartening. And there was the need to wear masks at work. And to put on goggles and gowns and for healthcare workers to take extra time to protect themselves from infection. There was the risk of bringing COVID home after working in healthcare. Wages stayed the same.

People got sick. And healthcare workers got tired. Wages stayed the same. Hours were long. Vacations couldn’t be taken like they used to be taken. And just like their patients, healthcare workers got sick, tired, depressed, and anxious. Staff shortages increased in the hospitals and clinics.

People denied that COVID was real. People invented vaccines that helped prevent COVID infection. People refused to get vaccinated. People complained about wearing masks. People got tired of social distancing. People got sick. The intensive care unit was full. The psychiatric ward was full. The cardiac ward was full. Alcohol use disorder, diabetes, high blood pressure, and all the other medical conditions that always exist marched on because they don’t stop during a pandemic. Healthcare workers shouldered the workload of several workers each because some of their colleagues had left, some had died, and some were sick. Wages stayed the same.

In such an avalanche, how long would you have waited to change careers? For many, the answer was between 1 and 2 years.

~

There is always hope and healthcare has been grounded in hope since the beginning. But as a student so excited to become a physician I know that change must happen if hope is to materialize into lives saved. And for my sake and all the people who might need the hospital or a clinic in the coming years, let’s not make it take a healthcare collapse before we seriously consider how we might improve and restructure our healthcare system. I’d very much like some seasoned healthcare workers who are not completed burnt at my side when I start practicing as an independent physician because experience is gold in medicine. I’d also really like to have enough staff to care for patients without having to burn myself and burn my colleagues with the weight of too many lives in each of our two hands.

Together

Repost of a post I wrote for the Global Health Diaries, the blog of the Global Health Program at the University of Vermont Robert Larner M.D. College of Medicine and the Western Connecticut Health Network. Find the original here.

“Here, you can just about always find an internal medicine resident who speaks the patient’s language,” the resident I was working with said, smiling, “It’s amazing.” Another resident had just stopped by to say that one of their colleagues did, in fact, speak that obscure Southern Asian language the translation service did not cover that they needed for an acute patient. I smiled because it was amazing. This was exactly the type of place I’d wanted to train to become a physician.

It was standard that everyone on my teams during my internal medicine rotation had a different accent. And when two of us did have the same accent, our divergent places of origin and cultural backgrounds made up for the lack of difference in how our English sounded. What I liked most, was that in this hospital everyone came from different places – the patients, the nurses, the residents, the physicians, and the other hospital staff. Even in modern America, it’s somewhat uncommon to work in a hospital where the physician diversity almost reflects the diversity of the patients. The hospital where I did my internal medicine rotation in Connecticut was very close to having its physicians reflect the different groups of people who made up the greater community of the hospital.

One thing I found interesting upon returning to Vermont after almost a decade away was how much I missed the accents and the challenge of finding connection across cultural differences I’d experienced during my years in the Washington, DC and Paraguay. There was a subtle feeling of stagnation, almost boredom that crept into my professional life as I began my medical career in my home state. Of course, Vermont has pockets of diversity of all kinds but it’s not like living in an urban area or a foreign country.

After my second year of medical school, I moved to LCOM’s Connecticut campus. As I settled into my new community, I learned that where I lived in Connecticut was a melting pot that buzzed and hummed in ways that more homogenous communities do not.

What better time to dive into a diverse medical community than right after the release of the COVID vaccines? As I listened to the accents of the residents and attending physicians with whom I worked during my Connecticut internal medicine rotation, I was struck by how the medical community is just as connected as the general human community is connected. Afterall, COVID has definitively illustrated how communicable diseases can spread easily around the world. But, also, the speedy development and dissemination of the COVID vaccine showed how we humans can solve dire problems when the minds of people all around the world come together.

There was something unique about how my internal medicine teams came together to solve patient problems. Of course, good medicine transcends culture – some medications and interventions just work. But, in terms of decisions about how to interact with patients and their families, each of us brought our own cultural beliefs and backgrounds to our practice of medicine.

One of the neatest things about working with team members who aren’t like you, is that you’re forced to reflect on your own ways. You’re forced to examine other ways of being. And, in medical school where it’s easy to get caught up in the nitty-gritty of disease states and medication dosages – I was grateful to be reminded of the humanness of the residents and attending physicians around me. And, also, to be reminded that my patients brought their humanity with them when they came to the hospital.

Most of the hours spent on internal medicine were dedicated to identifying the best course of treatment for our patients. But as rounds ended for the day, there was often the lucky opportunity to hear what medical school was like in other countries and how physicians from all round the world had come to find themselves in Connecticut. The walls of the hospital seemed less limiting when I realized that it had taken a global community to staff the hospital itself.

Pride and the Human Experience

The patient was muscular and wore coordinated clothing, both uncommon for someone admitted to the hospital. One of my tasks was to deduce his age from observation; the moment I saw him I knew it’d be hard. He was one of those mystical people who appear much younger than their age.

There are a series of questions we always try to ask our patients in the hospital. They seem silly, but you’d be surprised how often patients can’t answer all of them. “What’s your full name? Where are we? Why are you here? What’s the date?”

This patient made great eye contact. He sat on the edge of his bed with his spine perfectly straight. He used his hands when he spoke. He said his name purposefully. He stated our location without pause.

“Why are you here?” I asked.

“I’m here to evaluate the hospital systems. I have a solution for your computers,” the patient said.

I looked at his wife who was sitting in a chair a surprisingly far distance from the hospital bed. She grimaced. “He’s been fixated on the idea of attending a business conference recently. I can’t seem to get him out of it.”

The neurology exam unfolded (an exam looking at nerve, brain, and muscular function). On the nerve and muscle function part the patient did well. He was nibble and coordinated. He was very strong. Especially for his age. However, his cognitive score was significantly below the normal level – low enough that despite our newness to testing cognitive function the other students and I were confident that he had scored low enough to count for a diagnosis of a memory disorder. How long had his memory been declining?

As I and the other medical students interviewed the patient, his wife interjected ever-so-politely when he denied he had any health concerns. She’d taken over multiple tasks to manage their household, slowly. Now she managed all the finances and everything else too. She mentioned that the patient would fly into a rage for almost no reason which was unlike the man she’d been married to for many years. He’d always been a calm man. He’d always been a connector and a successful man. He’d always been so well organized.

His memory and brain function were poor enough that the man could not complete all his activities of daily living (things like paying bills, buying groceries, among other things). This memory loss and brain function decline had been going on for over 6 months. In other words, the patient met the textbook definition of dementia.

~

The other medical students and I told the physician we were working with what we’d learned about the patient. The physician requested only the information that would change his management of the patient. So, in the end, we shared very little about what we’d learned about the patient. What makes medicine interesting (to me) is the story; however, diagnoses and treatment mostly depend on the distilled details of signs, symptoms, tests, and timeline.

~

The physician examined the patient. “What would you do if your house was on fire?” the physician asked.

“I’d go outside,” the patient said.

“Then what?” the physician asked.

“I’d communicate with people I know,” the patient said.

“Like who?” the physician asked.

“Well, I know some firefighters. They’re friends of mine. I’d probably talk to them,” the patient said. The room was silent for a few seconds. The physician watched the patient, but I watched the wife. Most of us would call 9-1-1 if our house was on fire. I hope.

~

When we left the room the physician said, “You didn’t tell me how bad he was!”

“You only asked for the information that would change your management of his condition,” I said.

As we discussed the patient in greater detail, the patient’s wife came out into the hall to show us a picture of her husband when he was still working. In the picture, he was dressed sharply and similarly to the physician I was working with. We all nodded and smiled. She looked at the picture with love, but her body was tense.

~

The vision of the wife holding up the picture of her husband stuck with me. I hoped she knew it was going to get harder. It was possible that her husband would have angry outbursts more frequently. It was certain that his memory and ability to function would decline. And it was unlikely that even that picture of him as a younger, healthy man would propel her through the remaining years of her husband’s decline if she didn’t have help. Dementia takes a toll on the loved ones of the person who is slowly losing their brain. There is no magic pill or procedure to fix the brain when it breaks in the way that causes dementia. Dementia is a progressive disease with a fatal end where, along the way, the person who began the illness is not the person who dies from it. Dementia reduces our ability to function and, also, transforms our personality.

Despite the frustration of memory loss, one thing that this patient illustrated and continues to strike me about people with dementia, is that they keep their pride much longer than many other aspects of their original personality. The vision of this patient sitting tall and answering our questions confidently floated in my mind next to the picture of him when he was younger. Why is pride something the brain clings to even as other functions are lost?

The patient’s wife noted that his outbursts most often occurred in moments when he realized he was forgetting things. In the beginning stages of dementia, many people are aware that their memory is going. I thought about how this patient’s wife must struggle to strike a balance between supporting the autonomy of her husband while also knowing he could not grasp the intricacies of complex concepts and decisions like he once could. When she looked at him, she seemed reflective. Perhaps she was recalling the grand times they’d had together. She also looked tired likely because their life together was more difficult at the time she brought him to the hospital than it had been previously.

The longer I stay in healthcare the more I come to realize that illness, while very personal to the person experiencing it, is not only an individual journey. For patients lucky enough to have friends and family at their side, their disease impacts their family and friends in profound ways. For patients alone in the world, their illness impacts those who care for them whether it be their primary care provider or their care team when they land in the hospital. And much like pride which clings on even as the brain becomes weak, the odd realization that illness is often a social experience lingers in my mind as a dark side of the human experience.

Grateful

I found myself lying on the floor. The sun had set but it was still early – a tragedy of New England once the summer fades. I was not tired or sad. My to-do list was as robust as ever and my goals circled high above my head, seemingly in the clouds. Yet, I was lying on the floor not even stretching. No music, podcast, book, or movie playing. To be fair, I spent a fair amount of time sitting on the floor (my preferred studying location is at my floor desk) so lying on the floor wasn’t that much of a change. It was the stillness and purposelessness of the activity that was unusual for me.

There was a period of my existence when I could not be still and had to always be actively engaged in something. However, the need for constant stimulation dissipated when I was in Paraguay and, I’ve often thought, “good riddance.” I recall my early 20s. I worked fulltime, studied in college fulltime, trained for marathons, went to parties, and built my first career. It was exhausting. It was the way of life I knew. The way of becoming successful. Of fulfilling the American dream. Then I moved to Paraguay where everything seemed so slow. Hours sitting and drinking terere in the shade. Hours spent sitting and sometimes chatting, often staring into space silently, sometimes cooking or napping. I came to enjoy rainy days where it is common for rural Paraguay to shut down. Rainy days were filled with lounging and drinking mate. I precisely remember the moment I realized that when the Paraguayans told me they were doing “nothing,” they meant it. What an odd thing nothing is.

I’ve reached that point in medical school where I’d rather it was over. That point when the hours of studying, sitting in the hospital, trying to learn everything I can, and testing to see if I know enough to care for my patients are quite tedious. I do NOT say this out of despair; I still know medicine is exactly what I want to do professionally. I still love patients and the puzzles they present, but I’m ready to be good at something again. I recall a similar feeling junior year of high school, junior year of college, 6 months into my first professional job after college, and 6 months into my life in Paraguay. There’s a time in all learning curves where it’s truly a terrible slog. That time when you’ve learned an unfathomable amount, still feel mediocre at managing what you know, realize you still have a ton left to understand, and know that it will still be a while before you’re “good at it.” Whatever the mysterious “it” is.

And that’s where the gratefulness comes in. I’m grateful these days because I’ve played this game before. I’m grateful because I know myself better than I did last time I played the game of learning something completely new. I’m grateful because I know already that I’m attracted to activities that seem impossible yet, at some point (after many days of struggle), I do wind up being excellent at them.

So, I found myself lying on the floor. It was junior year of medical school. It was the breaking point. It was about to be a landslide into graduation. In a couple of blinks, I’d start residency. I was closer to becoming a physician than I’d ever been. I lay on the floor contemplating the joy and misery of learning. I thought about some patients who had changed my worldview ever-so-slightly. I thought about the amazing teachings and mentors who I’d encountered while wandering about the hospital wards. I thought about the first day I showed up to work on an ambulance (my first clinical experience), years ago now. “I won’t let you kill anyone,” my chief had said then. I contemplated this. Soon, it would be I who had to prevent patients from dying if it could be done. That was kind of a big deal. I felt humbled. I had much to learn despite having learned so much. I was grateful for this moment of pause while lying on the floor. Life is quite a whirlwind when you seek out challenge. The secret, therefore, is to be grateful for the moments of calm when they come. Even the worst storms have eyes; I remind myself of to look for them.

A Cup of Coffee

I saw the physician I was working with return from the cafeteria with her normal cup of coffee and a second small coffee. She walked by our computer station and into the patient’s room.

The patient had been plagued by a headache that morning when I saw them, not long before the physician arrived with a cup of coffee. The patient had requested coffee because it usually helped with their headaches. Of course, they would get coffee with their breakfast tray later, but that could take hours.

The patient had had a rough year. They’d been in the intensive care unit several times after trying to kill themselves, the first time almost not surviving. They’d lost a child to overdose. Their life had other stress-causing features. The patient was calm when they were under our care, but they’d attacked their nursing staff earlier on during their hospital stay.  

When the physician returned to our computer station, I thanked her for getting the patient a cup of coffee. Little acts of kindness like that are not as common as you’d like them to be. The hospital is full of burnt-out thoughtful people (also known as staff). It’s also full of people with all kinds of diseases. The diseases of the brain can be quite tough. When a psychiatric illness sends people to the hospital, there’s the suffering of the patient and there’s the challenges that they sometimes pose for medical staff. The brain is a powerful organ and when it gets sick it can do all kinds of things. As such, when healthcare staff are overworked (which is always these days) and when the hospital is full (which is most of the time), patients with brain diseases do not always receive the kindness that they deserve from their care teams. But, on that morning, this patient did.

I thought about that cup of coffee. It brightened the patient’s morning. It can be hard to remember the little things we can do to help others. But, on this occasion, the physician I was working with reminded me by setting an example.