The Ocean

I’ve never lived by a sea or ocean before. But for a few weeks this winter I am. And not just any salty expanse but the Caribbean Sea and Atlantic Ocean around Puerto Rico. It’s not hurricane season so, in the few days I’ve been here so far, the waves have crashed with careful, well-mannered regularity. Right now, I’m on the Atlantic Ocean coast. The water is warm and blue. Walking along the beach I find myself covered with a salt film both from the lapping waves and the salt in the air. The temperature has been perfect and the sun a beautiful gold. Proximal to the sand and rocks that meet the water are coconut trees, marking where the beach ends and the rest of the island begins.

As I walk along the rocky bits of the shore crabs scuttle so quickly that they’re hard to see – their shell patterns match the sea plants and the design the sunlight creates as it dances with the waves. Pelicans hover above the water, make a diving plummet with a smack as they break the water’s surface, rest on the ocean’s surface to swallow the fish they caught, and then take flight to follow the wind off the water to only scoop around like a boomerang and head back out to fish again.

People sit on the beach and hangout in the water. They listen to their loud music, dig holes in the sand, throw rocks, and drink alcohol (mostly beer). I walk along the junction between the water and the sand – sometimes more on the side of the sand and other times more on the side of the saltwater. The waves fill the gap between me and the seemingly infinite ocean. Sometimes I’m taken by surprise when a large wave barrels to shore and splashes up against my legs and catches my shirt in its spray.

Where there are tidal pools, I look down at the ruby red sea urchins with deep crimson spikes – their colors remind me of the colors of fresh and dried blood or, perhaps more appealing, the colors of red I’d expect royalty to wear. There are little fish that dart around in the tidal pools; they’re the color and pattern of sand. There are sea plants that look like little green balloons. There are shells hiding live creatures whose names I don’t know. Some of the bigger pools have sea anemones. I peer into each tidal pool, eager to see what it keeps in its mini-sea haven.

I love the sound of the waves and the smell of the salt water against the sand. It’s new to see coconuts. But, in this serene backdrop I can’t help but notice the broken glass and plastic bits, bottles of all varieties, cans, and all the other trash humans on the beach have failed to pick up…or humans elsewhere tossed in such a way that their trash found its way to the beaches where I wander now. I walk barefoot in the sand, but it’s almost a bad idea because so many people have broken their beer bottles.

The creatures and features of the ocean are no less beautiful with the trash present, but I imagine how it would be paradise without the plastic bottles there as a reminder that so many places I love are being filled with trash. Will this beach be swimmable when my grandchildren are alive? There must be a better way. There must be a way to keep this beach with its crabs and sea urchins for the generations to come.

As I turn up the road between where I’m staying and the ocean I see heaps of bottles, cans, Styrofoam, plastic bags, and other discarded single use items on the side of the road. They create a scattering of litter among the snake plants, palm trees, mango trees, papaya trees, pothos vines, and other plants of the tropics. Is there another way or is it already too late to return our natural spaces to paradise?

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Pike Place Market

I sat and ate a biscuit with a high cheese-to-dough ratio and a heavy pad of butter soaking into flaky perfection. It was my first true meal of the day. I was hungry and still having trouble believing I was on the US West Coast, having started my day on the US East Coast. The time change was confusing – the journey across the country was space and time travel. This biscuit shop was on the ocean edge of Pike Place Market in Seattle. Before arriving, I hadn’t known biscuits were popular in Seattle, but I was glad to find several biscuit shops as I wandered about the city.

The last time I’d been to Pike Place Market was in high school on a family trip. But, as all the places of family lore are, the market was familiar because my mother had told me about it many times. My parents met in Seattle. I’d lived there for several years before our family moved East, back to the coast of my grandparents. Pike Place Market is a place of fish stands and cute cafes. It’s full of people.

As I experienced the market for the first time on my own and as an adult, I was most struck by the maze that was the market and the perfect, stunning flower bouquets wrapped in parchment paper. I also liked the mosaic mural of North American birds. The mosaic bird mural reminded me of the bird murals in Harlem (where my sister lives). Per my sister, the bird murals in Harlem depict all the birds that will go extinct sometime sooner than I’d like. I wondered about the mosaic mural birds, would a day come when those birds (too) would only be found in murals?

I liked that Pike Place Market unfolded as a maze. It reminded me of Mercado Cuatro in Asunción, Paraguay. The markets share a maze layout, haphazard vendor stands, a huge range of goods, and people-filled walkways. Pike Place Market lacked the feral kittens that Mercado Cuatro had, but it had its own large bronze pigs with bronze pig hoofprints throughout the market. I followed the hoofprints for a bit. I decided the pigs were a good addition to the market.

I would later learn that the Starbucks in Pike Place Market was so busy because it was the founding Starbucks and people visited it for that reason. I was familiar with Starbucks because I’d worked there when I lived in Washington, DC. The Starbucks in Pike Place Market was much fancier than the one where I’d worked. However, I wasn’t inspired to stop at the first, ever, Starbucks. There were too many other places to choose from for me to pick a place I already knew.  I found a tea shop that sold crumpets (which I didn’t know existed outside of fairytales) and got an earl gray tea.

I was mildly disconcerted by the neon lights in Pike Place Market; they seemed a little aggressive for an enclosed space with so little wiggle room. I did like the nooks with tables and chairs and the scattered sculptures I stumbled upon when I rounded sharp hallway corners. I followed the hallways, stairwells, and odd steps until I thought I’d explored the whole market. I found the public bathrooms on both sides of the street. They were not striking, except that their stall doors were very short. A tall person could easily see over them.

I spent time looking out over the construction next to the market at the ocean. It was drizzling and cold, so I was glad I had worn my puffy coat. The waterfront was in flux. I’d later learn from a family friend that there used to be a highway between the market and the ocean. But, for many years now, they’d been slowly working toward reclaiming the waterfront. It’s funny how we call progress building roads and buildings, only to realize years later that beautiful park spaces are more important. I was glad that someday I’d be able to walk from the market to the ocean, but not today. This visit, there was no direct way because of the construction.

Once I felt that I had a good mental map of the market and had seen enough, I turned back to the city to explore its streets. Seattle was a home to me, but not a familiar one. It was a home of my distant past and the setting of early family stories. I wouldn’t have time to return to the market in the morning to watch them throw fish during this Seattle visit, but I knew I’d be back again. And I was grateful to have my own memory of the market. Lore-made memory to re-lived experience.

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.

Goodbye For Now Vermont

It had been over 2 years since I’d set foot in the US and almost a decade since I’d lived in Vermont when I returned 5 years ago. In my time away, I’d forgotten that men might choose to grow beards, plaid shirts are stylish in some people’s eyes, and baggy pants on men (and women) are normal in some regions of the globe. I’d just come from a place where those things – beards, plaid, and baggy pants – were only seen on people experiencing homeness and overheating Peace Corps volunteers clearly out of place in the Paraguayan sun.

Yet, despite the plaid, the cold, and the lack of sun Vermont was better than I remembered it. It was nice being in a place where I was confident everyone I talked to knew how many legs a chicken has (I’ve met people in the urban US who don’t). When I arrived, I wasn’t too worried about liking Vermont. I thought that I’d just come back to start my journey to medical school and that was all. Vermont had more in mind.

I started my pre-med classes which can easily be summarized like this: I’d write a lab report then revise it until it was so boring it made me yawn. Only if I was absolutely bored reading a lab report could I be sure I’d get an A on it.

As part of the journey to medical school, I became an EMT. I remember being petrified showing up for me first EMT shift. My nerves eased when my crew chief (who’d started working on ambulances over a decade before I was born) told me in a matter-of-fact voice that the crew would not let me kill anyone. Our crew would have dinner together every shift (unless we got a call and had to jump in the ambulance). We’d talk about patient cases, science, sci-fi, trucks, and cake. We’d get 2 am calls. I learned to write patient reports in the middle of the night. I practiced finding things to talk about with anyone – an important skill when you have a stable patient and a 30 plus-minute ambulance ride to the hospital. I saw hoarder houses. I learned what it looks like when people fall and can’t get up. I saw what happens when a blood sugar gets too low. I reinforced the knowledge that drunk humans are poor historians.

After running all night (that’s what we called being on the ambulance responding to calls), I’d change into my business-very-casual work clothes and go to work. Then class. Then lab. The hours studying merged as they always do. But, as I prepared for the MCAT (an entrance exam for med school) I knew exactly who to ask to explain some of the physics concepts that weren’t sticking – the brilliant kid with the Vermont accent on my ambulance crew. He’d driven trucks almost as long as he’d been walking and hadn’t done much school. He was smart and if he’d wished to follow different stars he could have. 

“I don’t know the physics equations or anything,” he said when I asked if he could explain how hydraulic lifts work and the physics of pistons.

“That’s not an issue, you understand the concepts,” I said.

I could do pages of equations and get the answer, but it was the meaning behind the symbols and numbers I wanted. And as he drew out a dump truck to explain hydraulics, drawing to explain just as my father and step-father always do, I realized that I liked the people in Vermont more than I’d expected I would.

School, my first job after returning to Vermont, and my time on the ambulance ended around the same time. I transitioned to a new job as an EMT in the emergency department (ED). I learned how to place IVs and draw blood. I saw how the brain, heart, and bones can break. I sat with families as their loved ones died. I saw babies be born and people smile despite the unluckiest circumstances. I learned from fellow EMTs, nurses, and other key players in the ED. The ED attracts fiery spirits and I enjoyed being among them. The patients came and went – suicidal thoughts, dog bite, chest pain, weird rash, car crash, fall, stroke, homeless, ski accident, rape, stomach pain – and I learned about humanity. Healthcare gave me a new angle from which to view Vermont. I saw the stoic Vermonters I’d known growing up. I saw people who had just immigrated to this frigid, snowy state. I met people who have the lives that make up the opioid epidemic. I met folks like me and very different from me.

The people of Vermont gave me a window into medicine. I got into medical school and I decided to study at our state school.

While much of my time in Vermont has been centered on learning medicine, that is not all Vermont has been. I rediscovered the mountains and the forests. I spent countless hours walking along Lake Champlain. I heard the hermit thrush sing as I wandered in the forest. I was reminded how both loud and quiet the trees are. Between the mountaintops and the lake, I also found my life partner. We were hiking and feasting buddies at first, but life has a way of pushing the limits of friendship. I also found friends with whom I cackle and giggle, enjoy the sunset and a stroll, and who I know are standing by ready for anything when the going gets tough. And the going is tough sometimes because becoming a doctor is a long road.

Since returning to Vermont, I rediscovered why Vermonters are stubborn, fierce, loving, and independent – just spend a winter here and you’ll understand. And, while Vermont has been so much more than I imagined, I must say goodbye for now. Every time I leave a place, I can not promise I’ll return for good or stay away forever. I can only promise that the people and hidden hallows that shaped me while I was here will always be with me no matter where I am. As I look ahead to the last years of medical school, I plan to complete them in Connecticut (my Vermont medical school has a clinical partnership there).

With excitement that I’m moving once again to a neighborhood where we speak Spanish and with a heavy heart for the dearest friends I’ve left in my home state let me say, “Until we meet again dear Vermont, may the snow be deep in winter and the summer be sparkly and green.”

The Sunny Side

Last week I flew to Chicago for my last (most likely) medical school interview. I had the window seat on the plane and, surprisingly, wasn’t sleeping as we approached Chicago. I was excited to spend 24 hours in the city and get a feel for a place I hardly knew. I gazed out the window as we started our decent.

Before we decreased our altitude, we zipped along above the clouds, through a bright blue sky with sparkling sun. A thick layer of clouds was below us. The view of bright blue above white divided by shining sun rays conjured images of every version of “seeing the light” imaginable—end of the tunnel, heaven’s gates, nirvana…to name a few. The clearness and stark lines between the blue and white were beautiful.

Slowly, the plane’s path dipped so that we began to approach the clouds. We must have been far above them because it took us a while before we got close to the wall of white. I knew the clouds were a penetrable, gaseous/small particle entities, but they looked solid and impassable. We approached them quickly, and soon the sunny view of blue was obscured and the windows were masked in white. We were in the middle of the clouds and there was nothing to see.

Our journey continued rapidly and, in no time, we were below the clouds, a snowy and gray scene was visible below us. The sun seemed to have vanished, leaving a stark winter city scene. There were no leaves on the trees and the buildings added to the gray of the air between the land and the clouds. It looked cold and brooding. If I hadn’t just observed the sunny blue above I wouldn’t have known it could exist in the same place as we now were.

I smiled as I stared at the houses and streets, a bird’s eye view of the cityscape. I guess it’s just a matter of knowing where to look to find the sun. I held the vision of sunlight within me as I caught the train from the airport to where I’d spend the night before my interview and school tour. I’d been nervous before starting my trip, but I wasn’t anymore. I felt lucky.