Tag Archives: People

The Moments We Have Together

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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.   

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Remembering Her This Mother’s Day

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This week I lost a kindred spirit. I met her in college, over 10 years ago now, when I visited a college friend’s home over winter break. She was his mom. And in the decade since I graduated, I lost touch with the friend but never his mother. It was her efforts that kept us connected. In my life she was a cheerleader, frequently offering support and sending messages of encouragement.

In the last decade, she was brave – divorcing, taking on new jobs, moving across the country, and entering seminary – all while being a mom and a middle-aged woman with all the challenges that come with those realities. She was a loud advocate for many people including women and people with disabilities. She was a staunch supporter of her sports teams.

Her death was unexpected. This week my thoughts have been with her children who are without her this Mother’s Day. I have also spent the week reflecting on the positive force she was in my life. I admired her for her fiery spirit and her devotion to the people she loved. As she was a dedicated reader of my blog, I wanted to write a post in her honor.

She believed strongly in God. If the world is what we believe it to be, then she is with her God watching over her children and the others she took under her wing from a new vantage point. May she rest in peace.

The Night Chef

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Overnight, the hospital halls are quiet; all the administrative areas are closed. There seems to be endless dark ends of corridors where no one is. There is the constant beeping of heart monitors and other hospital machines. The night shift’s laugher periodically fills the space – the nurses and others making sure patients get what they need overnight. Of course, if you’re a patient and trying to sleep it seems loud and it’s annoying because you’re woken frequently for vital signs checks and other things.

Some folks chose night shift. Some folks like the autonomy that a less full hospital affords. Some do nights so they can be with their kids during the day. Some do it for the higher pay. Others are just night owls. I do night shift out of necessity – either when the budget requires it or there’s no way out of it. And that is how I found myself in the hospital when I met the night chef. I was on a rotation that had a week of night shifts.

The night chef is the man who runs the grill of the only cafeteria open overnight at the hospital where I train. When your shift is overnight there’s not much to be done but have lunch at midnight. If you’re like me and prefer to be asleep well before midnight, midnight lunch is daunting. On my first night of nights, one of the residents I was working with reassured me that the night chef was one of the best things about night shift. I was curious what she meant.

The night chef can make anything. He’s gregarious and happy despite working at odd hours of the morning. When I met him, I could not understand why he was working in the cafeteria. He is one of those people who could sell anything. You know, one of those lively talkers who connects with anyone. Why had he chosen to be a hospital chef at night?

He welcomed me and the resident I was with when we entered the cafeteria. He listed the delicacies he had imagined that evening. And despite the terrible hour of day, I found myself smiling and feeling only a little guilty for turning down the pizza with gobs of meat he gloated about for a different option.

During my first week of nights, it became routine to visit the night chef at some point. I never bought his most creative dishes, but I did enjoy his cheer.

Eventually my stretch of nights ended. On my last night, I stopped by the cafeteria on my way home. “Will I see you again tomorrow?” the night chef asked.

“No, I’m going back to days.”

“Ugh, too bad,” he said. “But… I understand.”

I went on my merry way wondering if I’d see him again. And, of course, I did soon thereafter because I started my day shift before his night shift ended. He was jolly as ever, even at 6 in the morning after having cooked all night. “Where have you been?” he said the first time I saw him again. “Nice to see you.”

“Nice to see you again too!” I said. I meant it. It doesn’t take much to make someone’s day and his happy greeting made mine that day. The night chef is a master at brightening his customers’ shifts. Perhaps that is why he had chosen to be the hospital night chef. Night shift at the hospital needs him most.

My Experience Getting the COVID Vaccine

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Disclaimer: If you’re looking for scientific information about COVID or the COVID vaccines, check out the CDC as a starting place for information. This post doesn’t address science or research surrounding COVID; it is simply a recount of my personal experience getting COVID and the COVID vaccines.

I got COVID almost a year before any vaccine was approved. To be honest, I was one of the luckiest people to catch the virus. I hardly had a fever. I did, however, spend hours lying on the floor too tired and nauseous to get up. I had to force myself to eat because every time I ate, I got sick to my stomach. My brain was foggy. My body drained. I didn’t feel short of breath but, breathing took more energy than usual. I thought about breathing more often than I did normally. I didn’t get diarrhea or lose my taste or gasp for breath like others did when they had COVID. Not once did I think I needed to go to the hospital because of the virus. And, as you can tell because I’m writing this, my case of COVID wasn’t fatal. And, since it was the height of COVID closures when I was sick, I hardly had to change my lifestyle to quarantine because I already wasn’t leaving the house. I was lucky because the subject I was studying in medical school at the time was easy, so I was able to study and pass my exams despite spending hours lying on the floor with my mind floating is some other universe. I was lucky because all the pieces that came together for me resulting in me not getting that sick did not come together for everyone who got COVID.

The first Moderna COVID shot was exciting. Finally, we had something to prevent COVID, that terrible infectious disease that had changed my world and threatened to make it impossible for me to study medicine. Finally, we might be able to prevent people from dying. I think I got a sore arm after that shot, nothing serious.

The second Moderna COVID shot was also exciting because it marked a completion of my duty to prevent COVID from spreading as best I could in addition to wearing a mask and social distancing. I felt like I was contributing to humanity while also protecting myself – how uncommon it is to be able to put yourself first while also helping others.

But, also, the second Moderna COVID shot wiped me out. I passed out the night after getting it. To be honest, I knew I was going to pass out, so I lay on the floor before I fell. I lay on the floor for what seemed like an eternity before the chills and nausea passed enough for me to crawl back to bed from the bathroom. That was a rough night, but I knew it’d be over in 24 hours because I wasn’t sick; my body was just doing exactly what it was supposed to do. My body was making antibodies (those protective proteins that help fight off infections). My body was responding to the vaccine. I felt awful, but still thought science was cool. I mean, we can make our bodies build defenses before we get sick—that’s kind of magic.

Recently, I got my booster Moderna COVID shot. It also hit me hard. I couldn’t sit up without feeling nauseous for at least the first 12 hours the day after I got it. All my joints and muscles ached. The feeling of the blankets against my skin was painful. It was 16 or 20 hours after the shot and two very long, hot showers; a day of maximum recommended Tylenol; and some Ibuprofen later when I finally started to feel like a tired version of my normal self. But, despite how awful I felt, the morning after the shot I was relieved because I knew I wasn’t sick. I was relieved because my reaction showed that I still had COVID antibodies. I was relieved because as bad as I felt, I knew it would pass in 24 hours. When we get sick, we don’t know how long it’s going to last. The uncertainty of illness is part of its trying nature. I’ve always like deadlines and end dates.

Everyone has different reactions to the COVID vaccines. I have a strong reaction, but by no means the strongest reaction. When I work in clinic some patients explain how fearful they are of their COVID vaccine reaction. Fear of feeling sick is valid. It sucks to be confined to bed for any amount of time. But when it comes to the COVID vaccine, it’s nice to know it’ll be short-lived. Just 24 hours, maybe 48 hours. When I had COVID my symptoms were mild, however the fatigue lasted for at least a month after the other symptoms subsided. For me, at least, feeling sick for 24 hours is acceptable knowing that I will decrease my chance of ever getting the real COVID again. I also can’t accept not being part of the group of people willing to try to stop COVID. It’s a legitimate feeling to dislike having a reaction to the COVID vaccine but, it’s a sacrifice I’m willing to make to keep COVID at bay. If it takes getting a COVID booster every year that’s a small price to pay to prevent millions more people from dying from a disease we have a vaccine to help prevent.

Together

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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

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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.

A Cup of Coffee

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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.  

One Example of Sexism in the Operating Room

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Often enough to be considered a pattern, the men in the operating room chose to discuss the annoyance of the hospital’s anti-harassment yearly training videos and anti-harassment policies when I was the only female in the operating room with them or when it was just an older female nurse, them, and me. And while I also find the hospital’s anti-harassment training videos frustrating (for entirely different reasons than my male counterparts), I did not appreciate when a surgeon said he could get tips from the scenarios in the video. I did not appreciate his comment (despite his humorous tone) because the truth is that harassment doesn’t just occur in training videos. It occurs all the time and in all settings of women’s lives.

And I found it interesting that these men were complaining when most of them are fathers of daughters, and many are fathers of young daughters. And if the risks weren’t so high for me, I would have asked them the questions I pose now, “How old do you think your daughter will be when she first gets cat-called so badly she feels unsafe? How long riding public transportation will it take before she has a set of rules she follows because of the physical and verbal harassment she experienced from male passengers?” The use of “when” and not “if” is intentional.

You see, women close to me have been strangled and shoved into walls. I’ve sat by as a younger woman asked for advice from an older woman about what to do because her husband raped her every night. I’ve been called by friends in tears because they were cat-called so badly they were shaken. I’ve sat with women as they hid behind dark glasses waiting to get photos of their bruises to use in court. On my first day of one of my first jobs, my preceptor told me how to use the printer and warned me to be careful of our male boss. He left the company before I had to worry about exactly how careful I had to be. By the time I’d worked in healthcare two years, two of my female friends had been groped by male patients. I’ve only been training in the hospital as a medical student for six months and already two female physicians have taken time out of their busy schedules to have lengthy conversations about how to keep my head up and build my career despite disrespect from male colleagues and male patients.

And the reason I would ask the fathers of young daughters the questions above is because I know they love their daughters. And I know they can’t fathom that they are being exactly the type of men who will get in their daughters’ way as they reach for their dreams. And I would ask the fathers of young daughters these questions to remind them that they cannot protect their daughters from the future. And, truth be told, they will likely never know the harassment episodes of their daughters’ life. And I would ask these questions to recommend that they learn how to respect women so that they can set an example for their daughters of what it’s like to be respected. That way, when their daughters do experience disrespect, they know it is not their shortcomings but the shortcomings of the disrespectful one. In other words, it’s worse to be a daughter of a father who doesn’t know how to respect women because he sets a poor example of the male gender. And the behavior of these men in the operating room made it clear that they still had much to learn about respect despite surgeons being among the most highly educated people around. What an unsettling reality to have so many years of education and still lack competency in a basic principle like respecting all humans.

You can look up the statistics in the US for harassment and rape of women (and other demographics) if you’re curious. It’s an easy Google and the numbers are almost as bad as the news that makes the front page of the newspaper. If you want to get really dark, look up statistics related to intimate partner violence. The numbers are horrific. And the numbers always surprise me because all women are daughters and perhaps sisters, mothers, and partners. Fathers and mothers see the statistics and are inclined to tell their daughters to be careful. To not drink too much. To not wear too revealing clothing. To never set down their drink. To not walk alone at night. To not live on the first floor. To lock their windows and doors. To always go out with friends….the list goes on. But the question I always wonder when I hear these statements of warning is why don’t parents just tell and teach their sons that “no” means “no,” “stop” means “stop,” respect applies to all people regardless of genitalia, and that drunk or not you are responsible for your actions? Because all men are sons, and many are brothers, fathers, and partners. It would seem more helpful to prevent the problem of people harassing others, than react to the problem by telling the victims to avoid harassment.

I also find parents’ lectures of caution stifling because they do not address so many of the manifestations of sexism their daughters will experiences. Yes, there is the risk of rape and physical abuse. But for those women going into competitive or historically male professions many of the troubles we face as women are more subtle and persistent than acts of violence. The times we’re told we’re mean or bossy when a male counterpart with the same behavior is considered strong. The times we’re ignored, spoken over, interrupted, and discredited despite consistently being correct. The times (like in the operating room when men decided to complain about harassment protection for women) when we’re othered and made to feel like demanding respect isn’t a right, but a burden we place on our male counterparts. The times we’re underpromoted, underpaid, and passed over simply because we are women. The times we must dig deeper than our male counterparts not because of shortcomings but because our parents taught their daughter to be cautious and taught their sons to be bold.

And as these fathers of daughters discussed sexual harassment policies as an annoying restraint placed on them, I thought about their daughters. I knew when they’d be cat-called. I knew how long it would take on public transportation before they developed their safety rules. And I hoped for those daughters’ sake that they would have men that set an example of what it’s like to be mutually respected. It had made such a difference for me to coexist with many men who looked at me as a person and not some different creature. You see, it’s helpful to know respect is possible because at times it seems like a fictional concept. I thought about those young daughters one day standing where I was. I sent them strength. As much as I hoped the world would change in the years between us, I wasn’t sure it would because these men I stood with in the operating room would still be here. And their sons who had them as role models would be here too.

And I was once again weary, not so much because of the long hours I was spending studying or the fact that I was scoring equal or better to many of my male counterparts in medical school while also getting cat-called and navigating colleague and patient sexism, but I was weary because these men in the operating room, like so many others, stood in the way of my father’s daughter. They stood in my way because they made things more difficult for me than my brothers simply because of my genitalia. None of this was new or surprising, but it did make the hours in the operating room seem especially long. And if the operating room had been a safer place for me, I would have told these fathers the reason I didn’t like the hospital’s anti-harassment videos was because they were triggering for those of us who have been sexually harassed and spoke of a justice system that I have not found anywhere I’ve worked. And I’ve worked in many places.

In Her Memory

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I’ve been thinking about an old Paraguayan woman, La Abuela, who died this year before I was able to return and see her one last time. Her eyes were cloudy and her knees swollen when I last saw her. She hobbled short distances holding onto chairs and walls. She was from an era I have only glimpsed through stories shared while gazing out at the world passing by and over snacks. She wrapped her hair in a scarf each day and worn simple skirts and shirts. And always worn sandals. She was the mother of one of the señoras who took me as a daughter during my years in her community and with whom I still often speak.

La Abuela was alive during the Chaco War (1930s). It was a particularly deadly war for Paraguayans. My and her community in Paraguay has a jail. When she was younger, she used to cook for the jailguards. That was in the era of the Chaco War when the jail was full of Bolivian war prisoners. I guess during that era the prisoners could leave the jail and she used to cook for them too. When I lived there, the jail was still active, but she had long stopped serving the folks who lived and worked there.

She told me how it used to be. It used to be that the only way to get to Asunción, the capital of Paraguay, was by canoe down the river that ran around our community. It was hard to come and go during those times. When I lived there, it was a simple 2-hour bus ride into the capital—a journey I made frequently.

She told me that later, once the road was constructed, she used to run a bunkhouse for the bus drivers. She would cook for them. She had one rule, no women in the bunkhouse. And if she found out the bus drivers were sneaking in partners, she’d no longer offer them a bed. She was a woman with strict ideas about how things should be.

And there was a period when she worked in Asunción, cleaning homes. That’s how she and the señora who was a mother to me, learned Spanish. Paraguay is bilingual. But the people of rural areas speak more Guarani than Spanish. And the people of the city speak more Spanish than Guarani. And that’s despite the dictator they had for about 35 years during the middle to end of the 1900s who tried to erase Guarani.

La Abuela endured the dictator, her Guarani remained more robust than her Spanish. It was thanks to her time in Asunción that we could communicate reasonably well in Spanish. She’d reminisce of the order that used to exist under the dictator and the chaos of current times. We did not discuss the disappearances and deaths of the dictator’s time. She was a strong woman and she had seen more sadness than I could fathom. But she was more likely to discuss the wind and recent gossip than sadness long past. 

La Abuela and I shared many afternoons sitting on the porch watching the school children walk by and various neighbors run errands. And she had so many stories of getting up early and working hard. Of her garden. Of cooking. Of milking the cows. Of raising children. Of her neighbor’s parrot who spoke so well and was once stolen and then returned. And the hazy day and mango shade would fade to dusk. We’d sit in the evening, still hot but without the beating sun, and we’d have dinner. And the stories would continue interspersed with many long periods of quiet contemplation.

No one knew exactly how old La Abuela was. She was from an era when records were stored in the family’s memory. She had had too many of her own children to remember her exact birth year after her mother died. But the wrinkles of her face and the grayness of her hair and the curvature of her spine spoke of many years of hard work.

I knew La Abuela was fading before she died because her daughter told me. Her daughter told me when her mother became bedbound. In Paraguay families care for the sick. I knew her daughter was caring for La Abuela. La Abuela had 6 children, but only one daughter. It’s almost always daughters who bear the brunt of caring.

I got the tearful message that La Abuela had died from her daughter not long before I had a huge exam. At the time, I didn’t have much left in me to think about death. But these days I see lots of people La Abuela’s age in the hospital. Recently my team helped several families put loved ones on hospice (care for those likely to die in 6 months, usually less). And while medicine can cure many things, it cannot stop death. And I think about La Abuela’s daughter caring for her in her last days. And I know that the care La Abuela received at the end of her life was equal or better than any hospice care the US has to offer.

I think about the thatched roof and the dirt floor of her home, the wood fire on which she and her daughter cooked with smoke billowing around them, and the stories of the ants and mice that sometimes passed through the house. I find myself smiling. Because as complex and sophisticated as medicine becomes, hope isn’t found in the hospital. It’s found at home and in our hearts.

La Abuela built a home large enough for all her children, grandchildren, greatgrandchildren, and me to visit peacefully; a home where the mango pits she planted so many years ago were now towering trees offering shade to whoever might need protection from the sun. And as summer slips away I think about that shade waiting for me whenever I can once again visit our community. She won’t be there when I return, but I know her daughter and I will share stories of her life.

Rainy Days

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The rain fell. It fell hard. It was a mate drinking kind of day. It was a flood-warning day. And the rain reflected my mood. I’d seen a rainbow just before the rain started. With the rain comes rainbows, but on this rainy day I was feeling the grayness more than the light reflected off the raindrops.

And I thought about a text I’d gotten from a friend not many days before the storm hit my town. She’s a good friend and checks in when the world is in shambles and I’m ignoring the news – which is to say, she checks in whenever something happens in the world I should know about because I almost always ignore the news these days. Despite my efforts at ignorant bliss, I’d heard about some of what she said already. And I felt the same as she: what we were doing seemed pointless when so many people were suffering. And yet, it seemed school would give us skills to better help the world. However, the future is hard to predict.

On this rainy day, I thought about allies and who we can trust. I’d recently seen a patient riddled with cancer. It doesn’t require one moment of school to recognize a dying person. This patient was the picture of death. Their eyes were dull, their movements slow, and their skin ashen. The patient couldn’t eat, yet begged for food, and now their cancer had spread so much that it was making connections between their organs. Their pain was barely controlled. They didn’t desire surgery or treatment; they wanted the pain to stop. They wanted to eat. On one hand, the patient and their healthcare team knew exactly when the pain would stop – the word wasn’t mentioned. The family of the patient, on the other hand, pushed for treatment. Treatment in this case meant prolonging life but not ending the pain and not preventing the eventual end we already knew.

Medicine can’t change fate, nothing can. The family had convinced the patient to continue with treatment, and yet the patient wavered. The patient didn’t want to disappoint their family, but they were so tired. I reflected on their family’s choice to push the patient to continue fighting. I realized that I hope that the folks I call allies are there when I need them, when the going gets tough. And I hope that in the tough moments of my battles they think about what’s best for me, even if it’s not their preference.

I wondered if the betrayal of a family wasn’t so different from the betrayal of a country. In this case, though, the patient wasn’t allowed to pursue their end in peace. The news of Afghanistan was quite the opposite. We’d left so many allies to die perhaps avoidable deaths. And I thought back to the day the Twin Towers fell. I was in 6th grade and now I was in medical school. Seeing images of babies handed to strangers on planes in a hope they’d have a better life didn’t seem like much progress from the smoke and rubble that filled New York City when the towers fell. Politics are complicated, but I wondered about the definition of “progress”; was it simply a fiction invented to instill hope? I wondered about trust; which allies are ones we can trust? I wondered what could have been done differently.

On this rainy day, I thought about the good of the individual and the good of the whole. I’d seen a young patient recently walk away from treatment. It would have been a simple procedure with an 80% chance of completely curing their disease without them even needing to stay in the hospital. Declining treatment is a right. But by saying “no” this patient had most likely condemned themselves to metastatic cancer in under a decade. They’d decided to die of cancer well before they turned 50 because their cancer wasn’t curable once it spread. When they declined treatment, the cancer hadn’t spread yet and we most likely could have cured it.

I weighed my feelings about this patient’s decision against my feelings about people declining COVID vaccines. They were both examples of people making health decisions. It is our right to decide what happens to our bodies. But, choosing to die of cancer compared to choosing to put others at risk of infection feels starkly different. You see, the thing about cancer is you can’t pass it to others. The thing about viruses is that they spread. While you might be just fine after catching COVID; others may die when they’re infected. And it could be you who infects them.

The rain fell and I thought about the nature of the world. I had an exam looming and I wanted to ignore everything else. Like rain drops on a rainy day you don’t have to look that far for sad things in life. It’s also true that with rain comes rainbows. And while I’m certain I like rainbows, I’m not certain they make up for whole rainy days.  And it seems that some of us get more moments with rainbows than others. There’s something about the angle between the sun and the water drops. Not everyone has the same angle.