acoustic by night

Commercial Break

2012-01-29T21:40:00.002-07:00

2 weeks in, 8 interviews down, 6 cities, one brother married off.

All of that later.

The unimportant things first:

-I win at packing for bus/car/plane/train travel x 4 weeks with carry-on only. Suit, sleeping bag, pillow and towel all included + room to spare.

-I have the best travel/preinterview playlist.

-I love driving. It's environmentally unsustainable and individualistic and all that is wrong with Edmonton city planning, but it's the only motion-sickness proof form of transportation. And fun.

Oh. And this is pretty much med school in a nutshell.

CaRMS tour (part one): A start

2012-01-18T20:02:00.000-07:00

One interview down. Ate breakfast in an empty apartment, Ottawa shining through the window. Spent the day in the National Art Gallery, and wandering downtown. Walked to Hull to touch Quebec soil. Staying with a wonderful R2 in family medicine, and grateful for the company of someone who genuinely loves people.

Out of paranoia, I will not be talking about the actual interview content and my opinions on various programs here, only the state of my psyche (much less interesting, sorry).

17 interviews in 26 days in 9 provinces for 2 specialties. They call it the CaRMS tour, and I can see how the superficiality and brevity of 'tour' is appropriate. Flocks of students moving through cities with trained smiles and suits, eating appetizers and making small talk. Yet Shinobi used the word 'pilgrimage' the other day, and it stuck with me. With only 12h in some cities, a chain of deep experiences seem impossible to hope for, but I wonder if it's possible for this trip to be temporal but meaningful. Perhaps I am not leaving this carbon footprint and crashing the couches of nice people just to assuage my insecurity and indecision.

Perhaps there can be learning and growth while my clinical skills wither from disuse.

alert and oriented

2011-12-18T08:41:00.001-07:00

Twenty-three.

Sometime around now. My mom has no recollection of when I was born (to be fair, it was a precipitous delivery) and in the proud tradition of a second child of a dual income household, my birth stats are also a mystery. This is okay to me. Birth happens. The rest you get to choose.

I have never been one for tradition. I love key, specific rituals, the ones I have made for myself, or discovered and appreciate. Fire is always a good start.

I am an adult. Have been for a few years now, but it is slowly becoming more of an identity, rather than a facade. I am finally used to being a medical student. I am finally confident in the decisions I want to make, in the small things I know here and again. I can usually get myself between two places, no matter how I'm feeling or how little sleep I've had. I can go on dates with boys and I can determine that I'm not up to a relationship right now, expectations be damned. I can work through the knot of insecurities and nihlism I default to under stress and make enough of my commitments to not be disowned by anyone. I can manage status quo. Not well or all the time, but I can get through it.

"Life gets harder. You get stronger," said Mr. Severin, trying to fill in our grade 9 math class on how the world worked. After a year of writing childrens' books about polynomials (still one of my favourite pieces of writing) and jumping across the classroom for the trig-olympics, he had sat us down for some high school advice. It was the last thing any of us wanted to hear, but it is the only thing that has stuck with me from the many voices that poured into us in those final weeks of junior high.

I am, in some haphazard way, stronger. So I guess it's time for life to get harder.

And so, in that way I anticipate residency. It's time to move out, pay rent, earn enough money to pay taxes. Time to make decisions without the safety net of a cosign. Time to be pressed further out of myself. Time to try and fail at new things, and find God in the debris.

The sun is rising on new snow.

Reprieve: Real Life in a Walnut

2011-11-25T22:03:00.001-07:00

November happened in a rush of anxiety and confusion and joy.

A week ago the lovely D and Tony got married, and I was honoured to be at their side. Weddings are strange to me, most of the time, but this one wasn't strange, and after I got over the stiff tension of reenacting rituals and being in front of people and not wanting to screw things up, it was beautiful, it was comfortable, and it was fun. It was right, and it was perfect, and they deserve every happiness.

Yesterday, a month and a half of paperwork and logistical failures culminated anticlimatically as 1500 MST hit and CaRMS closed the applications. Thirty-two program applications really was overkill, in retrospect (average application number last year was 11.5, and most people have more location or program preferences than I do), but they are in. And I am incredibly grateful.

"Anna, I want to steal your friends," said Abba to me, a couple of weeks ago. I looked at her, a bit confused. "They are so nice!"

Amid the panic, I have been thinking about the people I know and love. Shinobi helped both Abba and I with our personal statements. Jeana spent hours taking photos for our applications. Chantelle stayed up past midnight Sunday night, despite starting at 6 the next day, to help me format a document when I arrived back in Edmonton and realized I had to mail five not-yet-existing documents the next morning. Tuesday night, Jeana, Shinobi, Chantelle and Jill all were simultaneously editing my personal statements. My parents made me lunch and breakfast most of the past week, my mom priority mailed in my incredibly late documents, and tolerated my frantic running around the house muttering to myself, ignoring everything else.

Danielle put up with the most distracted maid-of-honor in history. Sonia prayed and listened to me rant. D and Tony's friends somehow put up with my social eccentricities. Carmen and Abba took me shopping for shoes. Arian let me crash at her place and added a needed dose of organizational skills and practicality to the foreign-ness of wedding chaos.

Residents and third years said hi in the hallways and told me everything would be okay. Dr. Lewis stopped for me in the hallway, 5 minutes late for her meeting already, gave me reference letter advice and told me that she was confident I would match well.

I am not very good at life in many respects. And I often feel that I have neglected my friends ever since clerkship began. I have a stack of emails pending reply in my inbox, and I have begun to approach social events with a bit of apathy. My current MO involves showing up late in a hoodie and jeans, and not trying particularly hard to impress anyone. I don't think this is a good thing in any respect, but it is a thing.

A year ago, I preemptively told these people that I would be distracted and distant. That I would be stressed and cynical, and emerge from the woodwork rarely and full of things to rant about, things they wouldn't understand. They have stuck by me, all the same, full of more grace than I could have ever had for myself.

Six more months, then I am a doctor (?!) in the legal sense. Two to five years until I am truly in charge of my own work life and schedule. The pressure will get worse before it gets better. And I wonder if my current way of living is truly sustainable. As an individual, I can hack my way through these years and come through okay, lack of sleep and food. I am alright with how things have been. But I question the sacrifice of my relationships, and the strain on the people who inexplicably care about me.

I don't have people relying on me in the same way I once did. I no longer am drawn to exist in any particular locations or feel that I might be swapping sleep for another's survival. These things have moved from my personal life to my work life, and with it, perhaps, some of the urgency.

Things are more intangible now, no longer a matter of life or death. Yet no less significant.

Contagious

2011-10-17T19:46:00.002-06:00

My two weeks in Infectious Disease in Saint John were remarkable. Saint John Regional is a tertiary hospital, with cardiac and neurosurgery, but with enough community hospital warmth to make it okay to call up the radiologist as a student and ask for clarification on a report.

The team was supportive, the medicine was amazing. Epiglottitis, (serology confirmed) Lyme Disease, incredibly strange multiorganism cases of sepsis, every possible permutation of cellulitis. Terrifyingly resistant organisms, like a panresistant Pseudomonas where we pulled out old-school antibiotics as a last ditch attempt. (Tragically, the patient passed away after a few days). Pediatric subspecialties are poorly represented at SJRH, so we also rounded on febrile neutropenias and cystic fibrosis exacerbations.

Most of New Brunswick lacks the charm of PEI or Halifax's hipster vibes, but small towns in the Maritimes are a hundred times cooler than small towns in Alberta. It might be novelty, or it might be the ocean, or it might be the weight of history. Vancouver island seemed like the sort of place where you could turn a corner and end up in the Cretaceous. Instead of dinosaurs, Atlantic Canada hides founding fathers and war heroes in its harbours.

I literally lived in a call room for the fortnight, thankful for my ability to sleep through codes. It was a taste of the dorm life I never had, cumulating in sushi and a movie with the other students living in the hospital. A strange group of us, with far too much shop talk, but a good group, and the sort of interactions that make me optimistic about the future of medicine in Canada.

I flew back to subspecialty surgery. Thoracics was fun enough, with some cool cases in clinic, and vascular is off to an okay start. I miss something though. I don't know if it's the independence or the medicine or the people or the ocean.

The Great Maritime Road Trip: endings

2011-09-30T08:21:00.000-06:00

Rest for me, is often in the movement. I understand pilgrimages, and the reason why journeying is more than the physical. Melting back into something resembling humanity again, I began to find this thing we call a soul again. I began to remember when God seemed instinctive again. Hymns on my lips and the hamster in my head napping away, I did rest, and I did pause, more often than not. Sitting on the highway atop a hill overlooking three counties of NB, or sleeping in the backseat of my car, waiting for the ferry, these patterns of work and rest seemed a microcosm for my life as it is now.

The final leg from Charlottetown back to Saint John, my heart ached for the first time in months. I paid my toll on the Confederation Bridge, then drove the ten minutes of white arches and turns, a mirror to the maritime roads I'd grown to love. I blasted the satellite radio as I coasted into Saint John, a couple hours later. I checked into the hospital.

I texted my parents from the airport: "Car returned. Waiting for taxi." I doubt they read the triumph between the lines. This was okay. My over-protected, scattered self had survived a week of my own devising, by external grace and internal determination.

1724km, one week, three provinces, innumerable firsts, and back to where I'd started with a handful of rocks, a bag of red sand and a dozen maps. Deeper though, I felt the weight of confidence, of faith, a sense of sureness in God and of my own soul.

Maps

The Great Maritime Road Trip: lessons

2011-09-29T08:14:00.000-06:00

I am not very good at being a tourist. I discovered this quickly. I have a tendency to turn off roads too soon, or wander past signs suggesting that national parks are closed. And so many of my adventures involved being alone by the ocean. I watched the sun set on a dock in Lunenburg, cold and happy under the stars. I spent hours climbing up and down rocks in the fog at Peggy's Cove, soaked by salt spray, only to turn a corner and suddenly see the postcard-perfect lighthouse and with it the other tourists, high above me, obeying the warning signs about rogue waves. I watched the tide come in on a deserted beach at Hall's Harbour, cliff behind me, hoping I wouldn't have to think about scaling the red rock.

I also got incredibly wet and, later, incredibly seasick on the ferry to PEI, clutching my camera in the strong winds. The camera was an excuse, of course. There are two types of people who stay outside in this type of weather- the smokers and the photographers. I was not the first, so I pretended to be the second, taking pictures as a way to keep my hands busy, secretly on deck out of the sheer thrill of the insane weather, leaning into the voice-robbing wind.

It takes cold water stinging my face or the bite of warm gingerbread to help me ground myself in the present. I've grown even more cerebral this year, and sometimes it takes an entire ocean to draw me back out. By the Bay of Fundy, waves flowing like breathing, inhale and exhale, my weight found the grounding of a boulder or the skeleton of a tree. Knowing the body of the world around me was knowing my own skin again. I recovered perspective, found the edges of my being, remembering the reasons that I am where I am.

I learned again to forgo sleep to see the stars in Halifax. Relearned how to drive an hour out of my way to meet my former camper in Wolfville, and marvel at the fact that she's starting university. I learned my colours again in the red rock and green grass and blue water of south-shore PEI. I ignored signs, I visited everything in bad weather and the off-season. I watched the sandpipers, alone on a white beach, gorging themselves on shrimp for the 4 day nonstop flight to Brazil. They flew from the waves then swarmed down again, over and over. I ran with them. I learned how people live, asking to hear their dreams again, remembering to know people beyond their physiology and chemistry. Focusing again on the sum, not the parts.

Life is what happens outside the hospital. And life is why I am in the hospital. These charts and this bloodwork, my stethoscope on your heart, they are real because of you on your wedding day, all shy and shivering and smiling in white; because of the road trip you took with your buddies, drunk, young, broke and happy; because of the wrinkled hand playing with your white hair, 60 years later; because of the baby asleep on your shoulder.

I watched you from the other side of the beach, I ate across the restaurant from you. I was alone and smelled like ocean, and you probably though me strange, but I was content. There are good things about travelling with people- having someone to navigate, or watch my stuff in airports, or even take the wheel when I'm nauseated and drowsy. Someone to split dessert. Someone to help me remember these things I am learning.

But I savoured the days alone and the pace of living by my own choices, however unwise. Without a voice of reason, I woke up every morning and ate what I felt like eating and drove where I felt like going. For better or worse, I was stuck with myself. And strangely, it was hard to hate myself with no one else around. My overactive vestibular system and my directionally-challenged parietal lobe, my absentminded hippocampus and my hypersensitive amygdala, the Greek chorus of my flawed self was all I had to remind, to suggest, to console. I had a car, I had a mission, and no one else on this side of the country was going to care if I fell in the ocean or drove into a train. When things went wrong I could despair or I could get things done. So I got things done.

The Great Maritime Road Trip: lives

2011-09-27T08:12:00.000-06:00

Couch-surfing might be the single best decision I made this trip. The idea of staying with strangers, hospitable strangers no less, would be terrifying to my parents, and so I was brief on the details. Yet, for all my social ineptness and general nerdiness, I was overwhelmed by the goodness of people who open their homes and lives to travelers. There are places only locals know about, also. A twilight drive to the ocean found me clambering over rocks under a full moon, watching the waves in awe. L and A and I sprawled on smooth boulders as a cruise ship left the harbour, talking about life, the universe and everything.

People are incredible. I remembered this over late night pizza and Monty Python in a student flat. Or mass producing salads in a tiny kitchen, talking with C about computer science and linguistics. Or in Charlottetown, sharing curry nachoes in a pub with J's friends, 50-year-old women, loving their exuberance, soaking in their life-long friendships and strength. They were survivors of chronic illnesses and divorces, smoking despite themselves, living by sheer force of will.

I complain often that medicine robbed me of many of my social graces, though, realistically, I never really had too many. But for a week, I didn't have to be a med student, didn't have to impress. My introversion was okay, my absentmindedness was okay, and I am struck by the openness of the people I've met.

The Great Maritime Road Trip: departures

2011-09-24T08:08:00.000-06:00

Even writing down everything does not cement it in my mind. But I write, anyway.

.

OSCEd out and self-loathing, I packed desperately two Saturdays ago. Terrified, somehow, and sleepless, I found the initial bravado of the trip ahead becoming somehow brittle in the impending hours. I've always been adventurous, but exhaustion from months without rest destroyed any sense of confidence, replacing it with a desire for a place to hide, a blanket and a good book.

But I hid my anxiety from my parents and said my goodbyes, then climbed onto the plane and popped my Gravol, only to fail to sleep despite the heady hit of antihistamines. Five hours later I curled up miserably on the floor at Pearson airport, sprawled over my backpack, for a beautiful and uncomfortable 3 hour nap -and almost missed my connection.

I blame the sleep deprivation for the edge of anxiety that crept into my voice when my Visa was declined at the car rental place in Saint John. Nevertheless, a few phone calls to customer service and 30 min later, I was driving a silver Ford Fusion (two free upgrades from my booked economy car) out of the lot.

I didn't realize it then, but that car would become a home of sorts over the next 7 days.

Transience changes one's sense of home. Whatever else I've decided about home, sometimes it's just a place to put one's possessions and self knowing you likely won't be maimed or robbed. Food helps, and internet, and something or someone to confirm your existence, but the physical safety is enough.

All the same, safety was far from my mind during the 4.5h sprint to Halifax. Post-call days have bred bad habits into my functioning, like the irrational belief that a human can move at 130km/h on 3h of sleep within centimeters of other beings moving at similar speeds in the opposite direction. But within minutes I fell in love a little with the twisty roads of Atlantic Canada. Between the scenic turns and slopes and the beauty of satellite radio, I was a little less than stuporous when I finally found a parking spot in Halifax.

Halifax is not a city for cars. It's a city for college students and their yoga mats, drunks and their shopping carts, academics and hippies and suits. But parking is luxurious and my budget was not, so I polished off my parallel parking skills and tried to find side streets to ditch the car.

a little resurrection every time i fall

2011-09-03T08:34:00.000-06:00

A week on nephro later, I am feeling pretty good about life. It's ward nephro, aka the non-fun nephro, and it feels a bit like CTU all over again, especially since about 70% of the ward isn't here for primarily nephrology issues. But I like my team, I like getting to try to optimize every aspect of management, and there's something satisfying about going home at the end of the day knowing I've addressed every possible aspect of care about which I could think. My team is a bit more involved than my CTU team was in Internal, which is probably a good thing, and it's good to feel that there is both safety for the patients, care-wise, and safety for me as a learner. All the same, I do my best to try cover everything, consider everything, and ask as many questions as I can.

Definitely better than surgery. Kind of a three way tie between Internal and Emerg and Rural Family.

It's almost fall. I love fall. I love the chill and I love the strange promise in the air. Sort of the no-holds-barred final chance to glory in sunlight and colour and harvest and life. Years of returning to school with new hopes and ambitions set strong patterns into play, even when really, for me, it's more of the same things.

Last night, I went to Symphony Under the Sky with my high school friends. I've gone all but one year (was on call last year) since I started university, but we usually end up at the Monday afternoon show. The 1812 Overture and live cannons tend to tip the odds.

Yesterday though, between Handel and Mozart and Brahms, was all late afternoon light and rustling leaves, and the strange familiarity of most classical music to me. Knowing songs without realizing that I know them, but transported anyway by a familiar passage to a long family road trip, or the kitchen chaos preChristmas dinner, or the classical mix tape that my parents conditioned me to associate with sleeping (An inadvertently awesome parenting technique, incidently. Made sleeping in hotel beds on vacation remarkably easy). And then after the intermission, as Brahm's second symphony began, so did the rain. We huddled under tarps and umbrellas, even as half the audience fled, wet and happy.

I finally booked flights to Saint John. I'll be flying into New Brunswick, renting a car, driving out to Halifax. A few days there, a ferry trip to PEI, a night or two there, then back via the Confed Bridge to Saint John, home for the next two weeks. The car is pricey since I'm 22, but I'm couchsurfing accomodationwise, so I still come out ahead, budgetwise.

And it will be an adventure.

Stitches

2011-08-24T20:08:00.000-06:00

Grande Prairie. It feels like a large suburb. Like Edmonton with more pickup trucks, but there's a small comic book store, one bubble tea shop, and a few reliable cafes. There is sushi, although I haven't tried it, an art gallery (under renovation), and cheap movies.

Here is a rather large, angry appendix + some extra, inflammed bowel. Aka here's what happens when you have appendicitis for 3 weeks.

I am not going to be a surgeon, but I don't mind being here. There's a surprising lack of shame-based learning, even though it's surgery. Even though it's been a year since I've done subcuticular sutures and one of my patients sits up gasping on the OR table a mere 5 seconds after I finish my last stitch...

Whoops.

I adventured with Cindy in Kleskun Hills, last week. She was crazy enough to wander with me, and my insistence on climbing higher, farther, skirting as close to the electric fences as she'd let me.

Ravens dipped and circled as the prairie dropped out from under us, surrounding a rookery, perhaps. One flew over me, close enough to see the contours of each feather, hear the beating air.

(Tansen Mission Hospital from Colin Cabalka on Vimeo.)

One of the surgeons here has worked half-time in Grande Prairie, half-time in Kathmandu and Tansen for the last 11 years. We had a long talk about Nepal. I miss it deeply.

It's strange which places stick with me and which slide off. I can live comfortably anywhere, but some places become home, if only for a season. I am such a wanderer though. I wonder sometimes if I will ever be able to commit to a place long enough to make an impact. Maybe my determination can override my fickleness.

Living alone is great. I know this, and I re-remember it every time I leave my family, but there is something about coming home to solitude that is good for my introvert soul. I don't mind people, but sometimes it takes a lot of effort to be around them. Up 'til grade 9 I used to find corners of the house to curl up in and hide, behind beds and between bookcases. Places I could disappear for hours and read, undisturbed. Alone, my whole house is my corner. It's beautiful.

Sometimes I think I spend all my social skills at the hospital. I stare indecisively at menus and ask waiters stupid questions. I walk away mid-conversation with strangers, and forget to say "Good morning" to a passing neighbour, until she repeats her greeting, insistently.

I am a bit softer, away from Edmonton, oddly. Still the usual mix of introversion and cynical humor, but less angry. I'm less guarded against the world, I think, and less set into patterns. More likely to buy ice cream, or walk across the city just to say I did. More likely to wander barefoot under a lightning storm.

More likely to find some semblance of emotion, here and again.

It's safer here, maybe. Safe to say "I don't know" to a question (I think... we'll see when I get my eval). Safe to listen to songs that used to make me cry, even if nothing really does anymore. Safe to exist.

Determinants

2011-08-06T20:53:00.000-06:00

July happened and I forgot to update. I did night shifts, emerg shifts, ran around clinic, found the part of me that knows how to work with kids (or at least pretends to), and celebrated the end of pediatrics and third year by driving out to camp.

I'm back in town, a weekend later, and starting 4th year with adult Emerg. I'm working literally across the city from my parents' suburbian neighbourhood, and curse my lack of fluency in asian languages daily.

Couple shifts ago, a patient comes in, pregnant and bleeding, triage level 4. I draw the chart because I haven't examined anyone pregnant for a long time. Key word missing at triage- fever. No clear infection source from history and physical. Start an IV and go looking.

In the midst of the workup, she ends up bursting into tears and telling me that she's booked a termination anyway, so we should just do whatever we need to do and not worry about the pregnancy. I don't have much to say, only to acknowledge the socioeconomic factors that have led her this decision. To realize that she feels that she is choosing between her ability to care for the rest of her family, and this previously wanted child.

I'm haunted by my inability to provide concrete support. She thanked me for not judging her, and indeed I do not think it ever could be my place. But I'm frustrated that what prochoice advocates see as an empowering option is far from one, in practice. And I'm frustrated that what prolife advocates see as a clear moral decision does not play out beyond the theoretical.

And maybe I'm just frustrated that I don't have solutions to the systemic problems behind the cases I see in emerg.

I spoke to a family doctor at a SHINE shift a couple weeks ago. He's living much of my dream, a rural family physician with some extra skills in emerg and anesthesia. He works 2-3 weekends each month doing locums in rural Alberta, and earns ridiculous amounts of money that he spends on trips to work with hospitals in the Philippines.

He reminds me where health care falls in the WHO's Determinants of Health. That pushing for socioeconomic equity, access to education, safe water, good working conditions, and social supports have a far greater impact than what my mind and hands can do. And so he is going back to school to get an MPH, and shoot some crocodiles of his own.

Shift in an hour. Time to drive across the city in the brewing storm.

Knowing the Ending

2011-06-24T16:43:00.002-06:00

I think one of the hardest bits of medicine is knowing the end of the story ahead of time.

A neonate comes in last night in cardiac arrest, down for an unknown amount of time. Interosseous access by EMS failed. No response to epi en route.

I stand in a corner, out of the way, as the emerg resident runs the code. Intubation and bagging, I/O somewhat established, fluids moving in, more epi, CPR throughout. Blood gas sent. Working through the algorithm in my mind.

Time morphs. Each second takes forever. The ten minute mark comes too soon. Pulse check. Some activity on the cardiac monitor. No pulse. Not a shockable rhythm. U/S shows agonal heart movements. Low odds drop lower. CPR continues anyway.

Dr. C, supervising his resident, mentions that the parents are on the way. He asks for the baby's name, and we work out the pronunciation. Someone passes around the blood gas results. "Incompatible with life," murmurs the resident next to me, in case I missed the damning numbers.

And then the parents arrive. Dr. C has met them in the hall, done what he can to ready them. The crowd parts and chairs are placed next to the small body. They are distraught, of course. Dad is praying in another language. Mom is silent.

They don't know, I realize. Or they can't allow themselves to know, as though losing hope were betrayal. We know the ending, but we can't tell them. They need to see the story. And maybe we need to act it out anyway. It's not really about hope when you're moving. This much I know. Feeling is for later.

The next fourteen minutes are the longest. Dr. C gives atropine and bicarb anyway. Pulse checks are more and more dismal. The echo is still. Dr. C prepares the family. Two more minutes. Nothing. Dad isn't ready for the last page though. "One more?" he asks. Dr. C nods. "Two more minutes, okay?" he says. He waits five, then calls it. He says all the right words, with all the right emotion behind them. The hospital chaplain has arrived.

Lines are disconnected, a quilt laid on the bed and the body wrapped in colourful fabric. Mom cradles her child, instinctively. Dad breaks, and I disperse with the crowd out of respect.

My classmate and I stand awkwardly in the hallway. There is nothing to say. I'm okay with not saying anything though. I pause, regroup, and shift my mind to the patient I am admitting and the next thing I need to do.

My resident is fawning over me. I tell her I'm okay too many times, that I don't need to talk- I don't have words to say- until I realize that she isn't okay. That she is thinking of her kids at home and she needs to talk. I am pretty useless here, too, uncertain of how to comfort a superior, and I am glad when another resident shows up and gives her a hug.

A patient sticker arrives on the desk from Dr. C- scrawled on it, "new diagnosis, leukemia." He goes to tell the family, and I imagine he is saying the right words again, with the right emotion.

The odds are reasonable. Around 80% survival. But I don't expect that the family can see the ending right now.

sol invictus

2011-06-17T22:23:00.000-06:00

My two weeks in Ladysmith slipped away and deposited me back on my doorstep, tanned and faintly smelling of cinnamon and salt, missing good friends and the ocean.

I am not very good at coming back home from places. This is how it's always been, and the patterns are hard to break. It is no excuse for being curmudgeonly, of course, but I am pretty ready for change.

I'm done the CTU (clinical teaching unit) part of my pediatric rotation. Six more weeks, five until the exam. It has been objectively good, even if I am a bit burned out and cynical and will never be a pediatrician. But my patients are still my patients, even if they have a habit of screaming and hiding behind doors when I show up. So I adapt to the new list of syndromes, new ways of doing things, and sit on the floor and push a baby swing and answer a family's questions.

I sent all my patients home today, dictating in the margins of the afternoon. I am learning how to be efficient. How to always have something I can work on when rounds gets sidetracked, and all the strategic times to page people.

I have a fair amount of travelling ahead of me, the rest of the year. Grande Prairie. New Brunswick. Tennessee. Maybe Hamilton. I'm reaching the point where I am prying my miserly fingers off my VISA and reminding myself that fourth year is expensive, there is little way around this, I am fortunate to not pay rent, and that I will be okay.

I need a higher credit limit on my VISA soon.

'spective

2011-05-29T22:08:00.001-06:00

Psych was the first rotation where someone has told me that I was instinctively good at the field. My tendency to speculate and ask questions rather than suggest a clear plan of action certainly was more welcome than in most other fields. Both preceptors are on my CaRMS letter list. I caught a true zebra. I actually had fun on call.

But it's not my place, and I know this. Maybe it was the excitement when a patient was homicidal AND had lupus. Or the tension in working through an incredibly interesting consult, trying to not eavesdrop on what sounded like a case of Guillain-Barre on the internal service. Maybe I'm good at seeing the big picture of a person's circumstances, and certainly I can get along with most people, and I will miss the hours of psych, but.

But I, despite myself, still love generalist medicine.

I say this after a week of 1000-2100h days of nonstop clinic interspersed with emerg, lunch had in small bites between cases. My preceptor is amazing, but admits her lack of work/life balance readily, even as she stays late to make sure we get some teaching time in around each day's patients. There's incredible variety in the cases, and some decent medicine besides, and I do appreciate having a more internal medicine sort of caseload vs the obs-focused practice (as much as deliveries are cool) I saw in Edmonton. Certainly there's the satisfaction of suspecting a diagnosis, and sending the patient away for the specialist to confirm, knowing that your history, your stethoscope, and your own radiological prowess suspected the malignancy long before the CT.

Until today, Vancouver Island had decided to be wet and rainy rather than the sunny paradise the calendar promised. I'd wandered most of Ladysmith, and that was about it. The hours precluded much interaction with the rest of the town- and with Sonia and Noah (Darren is in Alberta)- and I was becoming the adopted teenage daughter in the basement, coming home at strange times and evidenced only by the disappearance of food and the appearance of dishes in the dishwasher. And a pie. (Always pie.)

So, this weekend, we roamed. Sonia showed me all her climbing haunts, and I wandered through forest and into ocean, scrambled up trails and made my own (sorry trail society!) inevitably. So much moss and ferns and green, some faint reminder of simpler times in botanical history. Shadowed, of course, by gymnosperms, distant descendants of dinosaur fodder. I clambered, Calvin-and-Hobbes-like, across streams and along waterfalls. We made it to the ocean, and I marvelled at the distant mountains across the way, freezing my toes and climbing on skeletal driftwood.

There is something deeply good in being outside, something I too readily forget. After all, there is water and trees and rocks in my own neighbourhood, albeit nothing like this untamed splendor. But I need to remember to wander and climb, to move and to sit by water and think.

Perhaps it is worth picking a path in medicine that might afford me as much.

there's still fire in you yet

2011-05-21T19:35:00.000-06:00

Sitting in the YVR airport. It's been almost a month. I'm not doing so well with the updating anymore.

There have been a few freak snowstorms, but the pile on our lawn has finally melted. It's safely spring now, baby leaves on branches, inhaling mosquitoes, winds and wildfires consuming northern Alberta.

Finished my psych rotation. Somewhere along the way things clicked a bit for me. I still don't feel like a psychiatrist, but I enjoyed the last month or so. Psych is a system. I like systems.

My parents went on a whirlwind tour of Europe, arriving back home this past weekend. By all accounts, they had a great time, with the photos and souvenirs to prove it. It makes me happy to see them doing things purely for themselves.

And now I'm en route to Ladysmith. Rural family elective. Looking forward to it immensely, even though it's supposed to rain the whole time I'm there. I will be staying with good people, and I am excited to use my stethoscope again.

Andrew and Sarah got married this morning. A wonderfully simple ceremony. A lighthearted ceremony. Mulan made an appearance, of course, and Star Wars. But a very traditional ceremony, also, with the 'who gives this woman' and 'respect vs love' vows and all. I'm glad these paradigms are meaningful and helpful to them, even as I am glad that they do not work for me.

One hour. Maybe I'll explore this place.

one more time with feeling

2011-04-24T17:35:00.002-06:00

I passed Internal, with no remedial OSCEs. I am so grateful.

I'm on Psych now. It's been hard for me to comment on it so far, for a few reasons. It's a bit of culture shock after Internal, simply in the different expectations. Preceptors have established relationships with their patients, and one doesn't always have a chance to get involved in interviewing, especially when the interview itself is part of the therapy.

And then there's the subjectivity, also. No comprehensive physiological models exist for the mind (I'm aware that all of medicine is under constant revision also). We don't quite understand what exactly is wrong in a manic patient's brain- though we certainly have some crude neuroimaging and neurochemistry markers. We are pressed to rely on 'ability to function' as a key to diagnosis, and all diagnoses are still syndromic.

Psych also reminds me of my own brokenness, and the edges I still walk around. I would never attempt to diagnose myself, though I can say my GAF (global assessment of functioning) scores are far less volatile than they might have been previously. I avoid talking about my psyche these days less out of fear of vulnerability, more out of utter frustration at that same subjectivity.

Verbosity following. You have been warned.

Here is one version of the past. No version I could give would be entirely accurate, which bothers me, but here is one version anyway. I avoid the most important bits because they are the threads I am least certain of. I know God is in it; I do not dare guess what is His intent and what was me, or how or to what end He works. I believe in redemption; I don't know what redeemed looks like.

I was not a particularly happy child, according to my parents. I was anxious about many small things, disdainful of anything involving large groups of people, generally confused by and uncertain of what to do with strong emotions, especially my own. I was a social catastrophe and when a diagram I'd made of the social structure of our grade 6 class turned up on the bus (I was also an organizational catastrophe), I lied (I was a pathological- and successful- liar) about it. Even though I didn't quite understand why anyone was offended, I knew they were, and I knew I didn't want to face angry classmates.

I was a bully in elementary school, also. I helped chase a new kid out of the school- permanently- with well-aimed kicks to the shins and ostracizing. No matter how unpopular you are, there is always room to put someone lower. The guilt from that (there was a lot of guilt, at least I know I wasn't a psychopath in the making) set the tone for much of junior high. Every semester was a new start. I would finally be a kind person. I never was, not by whatever definition of nice I had predetermined. Junior high was also my first crisis of faith, when I realized reading explanations of how the dinosaurs fit on the ark was not going to be enough to support my crumbling understanding of God.

High school was when I actually made friends and stopped expecting people to turn against me, although 'trust' would be far too strong a word. Bible studies and cell groups taught me I could share deep dark secrets without actually being vulnerable. But I had friends. I had emotions. I also set a lot of things on fire.

Then four years of a lot of labs and textbooks, and now this year.

There's more to it than this. There's the year I spent as an agnostic. There's the suicidal ideation/planning, and self-destruction. There's the deep sense of inadequacy and failure that no perfect test score could ever shake. There's the attempt at romantic relationships which only highlighted my inability to trust other humans, and there's my failure to relate healthily to my family. There's a lot of stuff. I never actually know what stuff matters.

Two years ago I turned myself in. That's what it felt like anyway. I was passing all my med courses, even though I'd spent 10% of the last month crying, and 20% researching ways to die. It wasn't every day though, and I could still manage enough productivity every 5th day or so to still get by. And then there was a 180 at the end of the month where I woke up and felt okay. Nothing even close to mania, just simple, glorious, okay. And so I went to the office. Tough to explain to the advisor that I wasn't acutely suicidal, and in fact would not have come in if I were. She handed me a referral and a goofy pen, still puzzled.

I walked out after two sessions with the psychiatrist and never went back. Not that it was his fault. I just didn't know how to answer his questions. And he could not give me the answers I wanted, or a concrete paradigm by which to understand my mind. No one could tell me what were reasonable expectations for myself, or how I should go about meeting those.

And so I stumble on. I sleep early when I can't deal with life, and hope I can be productive when I invariably wake up at 3am. I avoid alcohol and try to get enough sleep. I skip most large social events, and the accompanying stress. I try to make decisions based on what I think is good, rather than based on what might make me happy; nothing reliably makes me happy. I don't expect to have experiential knowledge of God. And to be honest, I am too busy most days now to even be certain of how I am feeling or if I am feeling at all.

And sometimes, I am not completely convinced it matters. Function is not substance, but it is the only reference point I have in this mess of self-reported data. And sometimes I think I am the only obstacle keeping me from better mental health. That some combination of hard work and gratitude and perspective can indeed keep me from these places, and that perhaps it is ultimately my own choices that keep me from being whole.

Upside Down

2011-04-24T15:40:00.000-06:00

What looks like failure is success

And what looks like poverty is riches

When what is true looks more like a knife

It looks like you're killing me

But you're saving my life

What looks like weakness can do anything

What looks like foolishness is understanding

When what is powerful has not come to fight

It looks like you're going to war

But you lay down your life

And I give myself to what looks like love

And I sell myself for what feels like love

And I pay to get what is not love

And all just because I see things upside down

What looks like torture is a time to rejoice

What sounds like thunder is a comforting voice

When what is beautiful looks broken and crushed

I say, "I don't know you"

But you say, "It's finished".

-Derek Webb

Full

2011-04-09T09:51:00.000-06:00

I am done Internal.

I am not sure if I passed the OSCE, but the likelihood of me repeating the entire block is slim. A few days of remedial, even the OSCE all over again, nothing like these eight weeks.

I am shifting in that usual mix of nostalgia and sense of achievement that follows an ending. The worst of the year is over. Surgery, Obs, Internal, the most taxing rotations, are done.

For the first time, I feel like I know something. Not nearly enough, but something.

And I want to know more.

I think I love internal. I think somewhere along the way the utter terror of (too much) independence shifted to responsibility. The sense of inadequacy percolated to curiosity. I want to understand. I want to know how to make my patients better. And they are my patients. Whether or not they like me, whether or not I like them. They are my patients.

Thursday was a rare blessing of a day. Mr. M had turned the corner while I was postcall Wednesday, and I was ecstatic to see him up and about, doing laps of the unit in his walker, getting ready to go home. I walked by Mr. O alert and oriented, no longer suicidal, crying with his family. Dr. A updated me on a few patients I had discharged with trepidation early this rotation, who are doing surprisingly well in the community.

Mrs. S lay still in her bed. Massive brain damage had left her with no ability to communicate, merely enough cognition and strength to actively refuse all treatment. Her pain was finally under control, and I suspect that she has passed away by the time I am writing this. I had a chance to say goodbye to Ms. L's family. And then I finally eased myself into the chair next to Mrs. H. Two failed cycles of chemo, and here we were. The palliative team had been by earlier, and she was agreeable to their suggestions and wanted to go for hospice. She is soft spoken, gentle and determined. Frighteningly frail. Her cancer has filled her body with fluid, and taken away her ability to stomach full meals. Her exposed bones hurt under their thin cover of skin.

"How are you?"

"Good. The palliative doctor spoke to me and my husband. We liked what she had to say. It would be good to go somewhere quiet. It's too busy here."

"Have you had a good life?" The words burst out of my mouth. Not really what I had intended to ask, but what I needed to know.

"I have," she said. "Oh, I really have."

"Has anyone told you how strong you are?"

She smiles. She grew up in a TB hospital. She lived through the era of residential schools. She has many adopted children. Her daughter is dead. "Girl, you have to be to survive in this world."

I'm in the same hospital for my next rotation, so I promise to visit. And I know I will.

To heal, sometimes. To alleviate, often. To comfort, always.

Those words started me off on my medical education. I am still learning, but my patients are teaching me.

waiting

2011-04-08T08:08:00.000-06:00

Such a disconnect between what I know is true and what I experience.

8 more hours.

Purpose in everything, no matter my perspective.

no alarms and no surprises

2011-04-02T18:45:00.000-06:00

I love the city at night. I love the edges of tall buildings and the cool air. Quick, quiet steps back to my car, loving the darkness and the chill, and the way things seem softer without sun.

Internal is almost over. I don't know if I've done well, ultimately. I generally don't hate it, and since I've been told I'm at the worst hospital in Edmonton for internal, I am encouraged. Right now, if I had to pick a specialty, it would be internal, and I would probably do some ICU somewhere along the way.

My hands itch for procedures. Putting in lines and tubes. Less thinking, more doing. I love the uncertain diagnoses, the atypical presentations, and the thrill of occasionally finding a zebra in the herd. I am less fond of the management issues, booking patients for procedures, negotiating with subspecialists and allied health professionals. I am told these issues are less marked at other hospitals though, which is a relief. Even so, I still can't quite answer if I'd rather wake up at 3 to a) catch a baby, b) cut out an appendix, or c) make sure someone isn't having a heart attack; thinking is easier, but doing is often more satisfying. More definitive.

I still want an MDiv. Maybe an MPH. And I wonder if internal is flexible enough; mobility seems more limited than with surgery or certainly rural family. Although internal has more scope for continuity. And hopefully sustainability. The biggest changes are not always the most sudden, after all.

I also want to write something worth reading. And translate part of the Bible.

And go to Antarctica.

Also learn how to swim and actually play the guitar.

Etc.

Sometimes I don't want any more life. And sometimes there is so much left to do.

Lesson One

2011-03-20T21:08:00.000-06:00

Lesson one: do not hide

Lesson two: there are right ways to fight

And if you have questions we can talk through the night

Lesson three: you're not alone

Not since I saw you start breathing on your own

You can leave, you can RUN, this will still be your home

You know who you are

You know what you WANT

I've been where you're going and it's not too far

It's too far to walk but you don't have to run

You'll get there in time.

In time to wonder where the days have gone

In time to be old enough to wish you were young

When good things are unraveling, bad things come undone

You weather love and lose your innocence.

There will be liars and thieves who take from you

Not to undermine the consequences

But you are not what you do

And when you need them most

I have a hundred reasons why I love you.

If you weather love and lose your innocence

Just remember- lesson one.

-Jars of Clay

Rites

2011-03-12T19:39:00.001-07:00

It's been seven months since I started clerkship. It's been a blur of faces and facts, exhausting, overwhelming and enveloping.

My soul and body are tired. It is a marathon (says the girl who doesn't run) and I am constantly challenged and humbled. I am not brilliant, I am not even coherent all of the time. I am not unfailingly compassionate, and I fight my gut reactions to abrasive personalities, and my introversion after a long day.

I have been startled by the shape of myself, depressed by my continual discovery of new character flaws and old gaps in my understanding of physiology. I have been resigned to change, determined to change, desperate to change. And now I am here. Changing. Not as fast as I'd like, not as slow as I fear, but changing.

There are rites of passage for every med student, the 'gradual instant' that captures what has been happening below for some time. These are pivotal moments where one grasps a bit of the meaning of medicine, and what it might mean to be a doctor.

It began with a very sick patient during a particularly chaotic set of weekend rounds postcall, 1 week in, vibrating with the eagerness to do and see and be. She was supposed to be better. She was not, that morning. I emerged and found myself alone, uncertain of what to do, uncertain of what to order. I tracked down my team. I shook off their insistence that I go home. I interrupted the staff. Twice.

Today, I could have explained my concern and clinical findings in a relatively logical manner and listed the initial investigations I'd have ordered. Then, I knew nothing, except that she was not okay. But the panic in my voice caught, and the team doubled back to see her. "This," said NL, the senior resident, "this is what sick looks like. Don't forget it." And then I was sent home, drained and grateful, and for the first time truly aware that I bore responsibility in these halls.

Responsibility. In the misquoted words of a passive-aggressive computer, 'we do what we must, because we can'. Around 3 am on a busy call, or 12 hours without food (or both), the synapses that lead to the warm and fuzzy feelings of medicine stop firing. Rigorous chart reviews, thorough histories and physicals, thoughtful labwork, stopping in to check on a patient in person rather than ordering over the phone-- sometimes love is in the obligations we choose.

Sometimes, obligation is a joy. Late nights are better with the snarky nurse who makes me toast, or the surgeon on call who takes me on a pizza run for the whole OR staff, Ke$ha blaring as I balance greasy cardboard in her SUV. There's enough emotion in a delivery room to trickle down to the med student catching her first baby, fingers locked tight around ankles, feeling utter relief at not dropping the healthy, perfect child. "Makes you feel like a real doctor, hey?" says the resident as I slip out into the hallway, and I can only grin.

Firsts are significant. I remember the elation of putting in a chest tube (under the careful tutelage of a resident) and celebrating with hot chocolate afterward. The first intubation, first IV start, first set of reasonable stitches, first diagnosis and management plan that your preceptor agrees with fully are all little reassurances that the path, though hard, is walkable. Reminders that one can find a way.

"You are not here to make me happy. You are not here for a good evaluation or a reference letter. All of you, ultimately, whether or not I like you, are going to sail through clerkship and you will probably end up in the specialty you want. You are here for your patients," says our preceptor, "to learn how to be the doctor you want to be."

It has been a challenging week, but in spite of it, or perhaps because of it, I try. I spend the time I don't have to actually listen to a patient talk about her deceased husband. I read through the binder a mother of a child with a rare condition has put together. The mother hugs me when I drop by before taking off for the weekend. "God bless you," she said, and though my insecurities have been welling up all day, I do indeed feel blessed.

A year from today I will have matched to a residency spot, and the next segment of the journey God has planned will be revealed. Between then and now lie more uncertainty, more work, more caffeine, and more stories.

Sometimes I step outside the hospital at night and watch the city breathe. Sometimes I hang out with my non-medical friends and listen to them talk about math or programming, because in a parallel universe I'm griping about bad code instead of bad charting. Sometimes I need to remind myself that the hospital is a small, albeit oft significant transition point in most lives, a blip amongst the romances and dreams and losses and poetry. Medicine concerns itself with restoring and preserving health, but only the patient can say to what meaning, to what aim. So I listen to good music and watch meteor showers and try to remember the beauty that is life, and why I want to give my patients as much life as I can.

the simple and the complex good

2011-03-12T10:25:00.000-07:00

'Seest thou not how here in this little realm in the Deeps of Time Melkor hath made war upon thy province? He hath bethought him of bitter cold immoderate, and yet hath not destroyed the beauty of thy fountains, nor of my clear pools. Behold the snow, and the cunning work of frost! Melkor hath devised heats and fire without restraint, and hath not dried up thy desire nor utterly quelled the music of the sea. Behold rather the height and glory of the clouds, and the everchanging mists; and listen to the fall of rain upon the Earth! And in these clouds thou art drawn nearer to Manwë, thy friend, whom thou lovest.'
-The Simarillion, Tolkien.

for now

2011-03-06T10:20:00.000-07:00

"And what now can I say of God? Only this: I am brought to this moment and this place (in time and in life) by forces greater and beyond myself.

There is some meaning and purpose in and mostly behind it all which, for now, I have no direct access to.

Leave it at that.

For now."

-[hopeandimpatience.wordpress.com]

if it's in my head it's in Your hands

2011-02-27T11:21:00.000-07:00

I'm postcall- probably the worst time possible to be blogging- again. Sometimes I have a postcall high. Sometimes, like today, it feels like nothing is ever going to be right again. I'm still working on the ideal sugar/sleep/caffeine ratios to a) function and b) feel okay, though I'm getting better at it.

Worst call shift ever, in some respects. I admitted one patient, of three total, in the full 24 hours. Nothing happened. On the other hand, I feel much better about my EKG reading skills; I have the basics, I just need to keep practicing.

I am desperate for redemption these days. Wanting to see the strings of things, the meaning and substance behind my mess. Wanting to believe that I am not here for nothing. Wanting to believe that I can become who I need to be. That grace can make my less-than-adequate good enough.

My worth isn't dependent on performance. But what does that matter to my patients, or my preceptors, or my colleagues? I've never prayed to be good at something simply to be good at it, but I am so scared of the consequences of my fallibility. I don't understand how God can fill the gaps.

breathing's just a rhythm

2011-02-25T20:21:00.001-07:00

Week two of internal done. I'm on call tomorrow, but I'll call it a week anyhow.

I spent an hour or so sobbing yesterday. I don't cry often, but when I do, it tends to happen when I feel that I've failed somehow.

He was my patient for exactly 23 hours and 7 minutes, 20 hours of which I was home postcall, but he was mine. If I had done everything perfectly, he would have died anyway. Nevertheless, I know I didn't do everything perfectly, and this bothers me. I think it will always bother me. But I gather the comfort of my classmates who help me think through the situation, see what I might have done differently, what is reasonable to expect from myself and what anyone else would have done. Might I have made a difference of hours? Unknown. Could I have saved his life? No.

Shinobi helps me work through the deeper questions that I cannot help but ask. I am here because I think God wants me to be here. It's the last thing I was certain of, and sometimes not even that. But my faith and this training are intricately connected, however little I understand where God is taking me.

I don't understand why God wants me here. Why me, I mean. I am so deeply aware of my inadequacies. I don't know what He is going to make of me. I don't know if I can become a competent, compassionate physician one day.

I know, but I don't know. I suppose this is faith.

off in the night while you live it up i'm off to sleep

2011-02-23T18:29:00.002-07:00

First patient with impending death early this morning, and I was postcall, instructed twice to leave, and thus and not there for it. He was actively dying when I admitted him, sick beyond the simple measures he and his family are willing to undergo. Dr. G's second sentence to me, was "He's a DNR"- and realistically, he would have been an ICU admit if there were any chance of saving him. I know this, but feel uncomfortable with my management, the things I should have ordered sooner, my inability to communicate the severity well to the family. I didn't know him, I don't really feel sad, but I wish I could have done everything perfectly, even though it wouldn't have made a difference. That said, he's been admitted often in the past month, and it seems that his family and him were at peace with everything. All my investigations were cancelled when my staff showed up- instead, IV morphine, fluids, medication just in case; I expect that he will not be there when I round tomorrow.

I'm often confronted by my inadequacy again this rotation. I keep reminding myself I will learn, if only because I must. I want to be good at this. I think that's a good sign, career-wise, if only I can stop from feeling hopelessly stupid in this highly intellectual field.

I still want to fix the world. I remembered this Monday night, reading the world news for the first time in months. I know I cannot, but sometimes I forget that it's okay to want things for which I can only pray.

we do what we must because we can

2011-02-18T12:53:00.000-07:00

Post call, should sleep.

Internal reminds me of how much I don't know. I like it though, I think. A lot of problem solving. We also get our own patients for real, and I enjoy having a more focused experience. I got to do a thoracocentesis (with a lot of coaching), which was a good reminder that procedures do exist if you want them.

I guess I'll see if I'm still enjoying it in 7 weeks...

Sleep. Now.

the smallest bones

2011-02-05T07:38:00.003-07:00

The seasons have lost their rule over me.

I still notice them, scraping ice off my car off in the morning, balancing between the impending delivery and a safe drive to the hospital. I still feel the fatigue of these clouded days, sometimes, with the eerie never-dark of grey skies, punctuated by the occasional blue or black.

But I don't find myself cursing winter. I don't feel despair simply because it is February, and spring is two months away in Alberta.

Sometimes I am sad, or stressed, angry, or overwhelmed. Some days I come home and I sleep at 1900, because it is more productive than trying to force my defiant mind to study. Some nights I am reading webcomics at 0200, because my preceptor bought me a latte and I was too shy to decline.

But it ends. I know it ends, I know the cold will lose its edge and blood will return to my fingers, I know there will be stars again, light again, life again.

Maybe this is hope.

It's hard to realize this in the midst of clerkship, and the gnawing senses of insecurity and isolation, and all the lies that my heart still finds comforting in familiarity. I don't hope for change in the way that I used to, I don't pray prayers for dramatic shifts in my outlook. If my mind is being transformed, it is gradual and stilted, freezing and thawing and freezing again, and it's only every now and again that I realize that the days are indeed longer and my ears no longer hurt.

158

2011-01-28T23:26:00.001-07:00

I'm two weeks into my urban rotation. It's not bad, overall. My preceptor and I are a great lesson in contrasts. She's 6'3" with blond curly hair, fashion conscious, a self-proclaimed girly-girl, athletic, extroverted and an organized super-mom. I am shorter than her 10-year-old daughter, and I think the rest speaks for itself. I think we've figured each other out now, though. It's a good coexistence.

Some aspects of urban practice don't really appeal to me. I admit I get bored easily with streams of muscle strains and sore throats, especially when none of the presentations demand further investigation. It's not the roulette of rural practice, it's a bit more mind-numbing, a bit less of an adrenaline kick. I found myself wishing to see more acuity at the end of my first week, to see someone who, well, actually needed a doctor.

Not that only the dying need doctors. There's a goofy flower shaped thing that the faculty likes to throw up on slides, of the CanMed Competencies- aka, how the CMA sees the major roles of doctors. Every doctor has to dabble in all of them, but it's inevitable that some specialties will see more of one role than another.

Exists for the sole purpose of residency interview questions.

And I suppose there are individual parts of medicine that appeal to me more than others. I already know that I love the patient education part of things. I personify the immune system. I like talking about risks and benefits. I like being a resource, and answering questions. I try to switch between the medically descriptive notes I am scrawling and colloquial explanations.

I like psychiatry, I discovered today. I like talking to people who are a little off, whose symptoms are manifest in their bodies, but whose illness is in their minds. I'm not surprised to like psych, even though I've already decided against practicing it.

I like complexity. I don't know how much complexity, yet, I need to see the trainwreck of internal before I can comment on that.

I like resource-limited populations. I like working with addicts and refugees. I like rooting for the hep C positive single mom with a likely history of FASD who finally has gotten her life together to be able to keep this child, this last child before she does the responsible thing and gets her tubes tied.

I do like some aspects of primary care. I like being that point of contact with the Health Care System, where I can walk into a room, figure out the 10 things that are wrong with this patient, and tackle as many as I can in one visit, even if 3 are referrals to specialists. I like the breadth. Sometimes.

I want to know more than the basics though. I want to read about migraine infarctions. I want to know the weird and wonderful of medicine. I want the strange exotic diseases and yes, I do want the adrenaline.

I like procedures. I like cutting and stitching. I like the tactile satisfaction of putting things together with my own hands. I like the sense of craftmanship, of actual skillfulness that comes with practice. I want to go overseas knowing how to deliver a baby, do a C-section, and, if absolutely necessary, take out an appendix. I want to know the life-saving things.

I don't know where that leaves me. Too physical for psych or neuro, too general for most specialties. General surgeons realistically do not deal with the laundry list of patient issues. Internists don't catch babies or do sections. Rural family med comes closest. Maybe. I wonder if I'd miss feeling like an expert in something.

Inventory:

Active uninterest: radiology, path, lab med, derm, plastics, ophtho
Little interest: physiatry, cardiac surgery, ortho, oncology, urology, peds, ENT, neurosurg, peds neuro, thoracic surg, nuc med, urban family,
Some interest: anesthesia, obs/gyn, psych, neuro, rad onc, community medicine, med genetics,
Strong interest: emerg, gen surg, rural family, internal

just enough nightfall to cover up the strays

2011-01-14T00:29:00.001-07:00

I am listening to Great Lake Swimmers and I should be sleeping, but I am not, quite yet.

Fairview has treated me well. I am well fed and relatively well rested, warm even as the winds rebury my car with snow. It is so deeply winter, and I am only now letting myself realize this, let myself feel that impulse to hibernate or cocoon.

One more day, then the drive back to Edmonton. It's been a success, ultimately, this living-alone thing. I can go places, make real food, find friends, and still be at the hospital on time (almost) every morning. I can find myself a mechanic and a church, and I can go on day trips and lose myself in the deep familiarity that is Alberta, no matter how far north I go. I can budget and bake and I can have clean laundry. I can eat at the houses of strangers or alone in a fancy restaurant and be comfortable. I can walk home under the stars, and be grateful for the Chinook. I can risk frostbite under the eclipsing moon with a tiny dog and a beautiful friend.

I knew this, but now I know this.

I'm comfortable starting IVs, at last. I don't always know the answer, but I make a reasonable attempt at assessing most conditions. I can recognize pityriasis rosacea across the room. I can freeze and cut and stitch. I can hear heart murmurs, sometimes. I can see optic discs. I can get the gastroscope down into the duodenum, navigational skills be damned.

Last week, I cracked open my fortune cookie and pulled out four identical strips of paper.

You do not have to worry about your future.

I know this, but sometimes, I know this.

Unrelated: Everytime I see pictures of mountains, I miss Nepal.

melting

2011-01-02T19:39:00.000-07:00

Back in Fairview, at last.

It's always tough, coming home. This Christmas was no different, and maybe it's enough that it's ending and I will be back on the bus tomorrow. But I am glad for the past week, even with all my rough edges and mistakes and the darkness I failed to shake.

Yesterday, I had hot chocolate with Giselle, and we tried futilely to update each other on the past 12 months. So much life has happened. Whether or not I am able to see it, I know that I have changed drastically this year, and certainly not always in the ways I'd hoped. I'm not as sympathetic as I thought I would be, with patients. Already I am calloused. I am no longer afraid to hurt people. To stick them with needles or scalpels, to believe, in the inherent arrogance of medicine, that I know best, that I can hurt to heal. I wonder if that affects how I deal with other people outside the hospital.

Giselle's catching a plane to Zambia in 11 days. When I come back from Fairview, she will already be there, on a one way ticket. When she's done her teacher training course in 5 years, I may be done residency.

Kyla's leaving for Mozambique this April, to work as a public health nurse for at least a year. When she comes back, I will be a month into residency.

Soon enough, it will be my turn to board a plane. I don't know who I will be then. I hope she will be someone worth becoming.

when you were young

2010-12-18T20:42:00.000-07:00

I like living on my own in this little house. It helps that I have a lot of free time and so I can muddle my way through cooking and studying and cleaning and grocery shopping without suffering too much when I overlook something. It's isolated up here, but the hospital gives me some human interaction every day, and it's vastly positive. I press out of my shell and am chatty with grocery clerks and shop owners as well, and I find I'm largely content with my existence.

Everything is within walking distance. Everyone knows someone who can help with any given problem. It's a small town in the best and worst of ways, I am told, and I suppose I won't be here long enough to deal with the worst of ways. As it is, I listen to the gossip bemusedly, and keep neutrality.

I haven't been outside as much as I thought I would be. It's been cold and mostly cloudy, and the clear skies I was hoping for haven't materialized yet. There's a lunar eclipse on the 21st and I might have to hit the roads then, if the skies cooperate. It's a truck and hockey town, blue collar jobs and a church on every corner. Small town Alberta.

I wish I could do this in the summer, with reason to be outside and go for long walks without risk of frostbite.

But this is good, also. This little house has easily become a home for me; I fit into it well. I am not as tidy as my parents would like me to be, but I am more responsible than I am in Edmonton. I don't mind cooking when it's just for myself and I don't have to think about presentation. I get to come home after hours at the hospital and unwind with House episodes and good music and a 1000 piece puzzle. I can talk to people, or I can not, and no one minds. I can see myself eventually getting stircrazy, needing adventures and excitement, and I don't know if I can find outlets for those in a small town like this, but then, my escapes have never been about large crowds and big events, but places to climb and discover and enjoy. And surely even this 10x10 block town can fit that sort of spirit.

I can see myself eventually getting lonely here, too, at least where I am right now without having plugged myself into a community in a meaningful way yet. But then, if I were here longer I feel that people would surely make an effort to get to know me; as it is, they are helpful and friendly, but we both know that there is little sense in more than the formalities. As it is, I have savoured this first week, and I expect to love the second, down to my trip back to Edmonton on Thursday for Christmas.

It's beautiful out right now, sparkling snow and a fading wind.

Fairview 101

2010-12-14T18:48:00.000-07:00

1. Everyone owns a truck.

2. Stop at every intersection, even if you have the right of way, and regardless of what others are signaling. If you forget, no one will honk at you.

3. Every trip to the grocery store, someone will wave you and your meager armload in front of their cart.

4. Strangers will greet you on the street.

5. No one knows how to bus out of the town (see rule number 1), but they will call random numbers and speculate options for you. Eventually, you will hit gold.

6. Drive everywhere. Even though everywhere is only a block or two away. Once you get there, let your ~~car~~ truck idle, and don't worry about anyone stealing it.

7. Nurses genuinely like med students. So do lab techs.

8. Embrace early bedtimes, tea, and 1000 piece puzzles. Being an old lady makes the experience awesome.

9. Even if you excitedly buy perfectly respectable groceries, don't be surprised if you end up having grilled cheese and tomato soup from the last student's leftovers for supper.

10. Everyone's occupation is "truck driver".

the weary world rejoices

2010-12-11T13:05:00.000-07:00

Obs/gyn is done. It's been the usual roller-coaster of victories and defeats, confidently delivering a baby on my own while the resident and staff were in the next room, being retaught yet another approach to Leopard's on the last day of my rotation, a family's gratitude, a nurse taking over my assessment...

My preceptor's evaluation encouraged me to seriously consider going into obstetrics/gynecology. Even assuming I passed the written exam/OSCE yesterday, I'm not sure it's high on my list. Reaching into an abdomen and pulling out a baby is more rewarding than a laparoscopic cholecystectomy, but I miss the rest of the body after all of this abdominal/pelvic anatomy.

I don't know if I have the confidence to be a surgeon. I still love the OR, but I'm getting tired, and I don't know if I love it enough. It's hard to know, 4 months into clerkship, what I will value for the rest of my life.

It's a lot of pressure, and some days I want to just say "Look, I'm 21. I'm still working on being a fully functioning adult, the sort that can make food that doesn't come out of cans and get herself out of bed and remember to buy gas and deposit cheques and pay my visa bill." Every morning, I manage other people's health when I can scarcely manage my own.

Sometimes, I don't understand why people trust me to do these things. Why they will trust me to do these things. And yet, I need their trust to learn and practice and propel myself closer to competence and independence. Such a terrifying privilege to learn.

My fingers want to type and my mind wants to read about things that do not relate to medicine. I am leaving for Fairview for the next 2 weeks, and I think I will take books and paper with me, a camera and maybe even some paint, seek ways to be creative in this town of 3000 where no one locks their doors.

I desperately want to love this next month of medicine. I want to fall in love with rural family med, to embrace the culture and pace, the medicine and the patients. I want to find something I love more than the thrill of trauma surgery, more than handing a teary mom a squirming child. Because I'm not sure I can do 5+ more years of either, not sure I am made to wield a scapel or forceps.

I know I can be useful internationally no matter what I do, but somehow it seems to matter anyhow.

So much uncertainty. So much faith to believe that I can end up on the right path.

Packing to do, choices to make, but tonight dinner and bubble tea and gratitude for friends.

family

2010-11-28T20:20:00.001-07:00

My grandmother fractured something (details were lost in translation), and is recovering in hospital in the Philippines. My dad flew back after avoiding the country for 29 years. He calls and my mom passes me the phone. "Does she remember you?" I ask. "She just asked your mother where I was, and I'm right here," he says, and his laughter sounds forced.

He sends updates via text, and they are warmer than any conversation we have in person. It was like that in Nepal, also; we are maybe both better at saying the right things than being the right things, well-meaning words come easier with distance when we never have to act on them.

My brother and Kim are engaged now, and I only found out by my mom's prompting. I didn't ask for details and he didn't volunteer any- it would have been too personal and insincere all at once to suddenly express interest or the desire to divulge. Instead, we debated abortion ethics over dinner, and we both managed to be civil. I don't expect to play a part in the wedding, although I will try be in town that day.

I feel sorry for my mom sometimes, and for her attempts to hold us all together. The remaining three of us are misanthropic, each in our own way, and we don't exactly like each other's company. There is too much pride between us, too much controlling from my father and my brother, too much defiance from my brother and I. I don't feel the ache that I used to, the way I once craved some sort of overt sense of family or belonging or love or whatever it is that people are supposed to be to each other when they live together. Parental approval doesn't seem so important as it once did, nor do I fret over whether Ivan and I will do more than send each other Christmas cards (if that) in the future. There is some regret and a tinge of guilt instead of the need, a sense of ownership for my part in these relational tensions, but no real sense of conviction, no desire to make something more of them anymore. They are, and they aren't nearly as bad as they once seemed.

We've done... not our best, except maybe my mother, but we've done some things, and we do care, and we want each other to be happy, even if we don't want to live with each other.

It's messy and fractured, like everything else I have. Less than ideal, but existent, and sometimes that's all that matters.

babies and bathwater

2010-11-20T10:26:00.000-07:00

I'm halfway through obstetrics and feel obligated to write about the experience thus far.

It's a very different dynamic as Kyle and I are the only students at the MIS, and I haven't been assigned to a preceptor for the past 3 weeks. I'll be working with Dr. Gleason for the next couple of weeks, and then there's another week of this self-directed mix of call, OR and subspecialty clinics.

I knew I didn't want to be an obstetrician/gynecologist even before I caught my first baby, and that hasn't changed since. Some babies are pretty cute, and it's a great feeling to actually deliver one, but they aren't really all that miraculous except in the most abstract, theoretical sense. I miss the rest of medicine and the rest of the human population, although it's nice to see happy, healthy people most of the time.

What Obs has done however is give me more perspective on Gen Surg, and mellow out some of my excitement around it. Cutting out tumors is rewarding, but so are babies, and while I like the OR, its a far different place when the attending is actually not trying to make the residents and students feel stupid. Shame based learning is far more engaging, but it's kind of nice to not feel that pressure all the time. If I do end up doing family medicine, I definitely want to deliver my patients' babies, but it's a part of practice I could also do without if I had enough procedural time elsewhere.

I still feel stupid most of the time, but I am okay with the routine things like rounds and histories now. My differentials sometimes still are pretty disorganized and my grasp of pelvic anatomy is abysmal, but I can and I will learn.

The rest of life is unremarkable, mostly because it's absent. I know this is far from ideal, but I have been trying to get in one social thing every week. It's not always very much or very exciting, and I certainly can't hold up my end in most conversations anymore, but I still like my people, and I'm glad when they can tolerate my disjointed ramblings about hospital life.

Chantelle's coming over and we are going to master gynecology today. Onward!

Barbed Wire

2010-10-30T23:03:00.003-06:00

Some people cut their hair, or buy things they don't need or go and drown themselves in crowds who don't know their names.

I climb fences and scramble up rocks and ignore bright yellow signs that warn of impending doom.

I used to break things. Now I just break bylaws.

It used to be the rush of doing something forbidden, like the sharpie all over the drama room wall, or the chill of the bottle in my hand and the melting shingles seeping through my jeans. Something cold and acute and very much alive. I was never alone then. Always someone else's courage to feed mine. If things went wrong, I wouldn't be alone.

All my infractions are solitary now, and they aren't about being rebellious anymore. Sometimes I just want to sit on a bridge and watch the sun set undisturbed.

Intermission

2010-10-20T16:46:00.000-06:00

I am not making good decisions right now. But I think it might be better to make a decision, any decision, than to stay here. It's too easy to believe that little events can alter the course of one's life. Too easy to be passive. So many fears. It's my week off, I can do what I want to do. This isn't it though.

I need to get out of here.

Surgery- Un-Final Thoughts

2010-10-10T14:54:00.000-06:00

At the end of last year, I had mostly ruled out the diagnostic specialties (rads, path, med micro), psychiatry and surgery. I picked a track that would give me a few months before internal medicine to hopefully polish up some of my weaker areas before, hopefully, being semicompetent in the spring. The end of this rotation leaves me conflicted, simply because I am realizing that I might want to be a surgeon when I grow up, after all.

Speculating about specialties long before med school, I remember musing to Andrew that I'd love to be a surgeon, with the same uninformed confidence I've used to declare my intent to take a road trip to Antarctica (still on the slate). The same things that appealed then still appeal now. Surgery is beautifully definitive, and simply a lot of fun. It makes far more sense than, say, psychiatry, when it comes to international practice. It requires an incredibly wide amount of expertise that I would love to take with me halfway around the world; having the skills to read one's own CTs at 3am, assess complex internal medicine patients to some degree, and conduct psych consults in the lockdown ward on top of the ability to operate sounds terribly... useful.

That said, it's hard work and I've met both people with whom I click, and people who seem to hate me on spec. I'm finding that thick skin, thankfully, and realizing I can learn from people who I dislike or who dislike me. Overall, I think my biggest regret comes in the form of not being able to get outside myself enough and be more assertive with learning opportunities and connecting with residents/staff. I did a lot in context of how introverted I am, but it would have been so much better to do more. Put in more foleys and NGs, get more suturing time, see more consults, make more friends and allies. I hope that it gets easier to make positive first impressions with each rotation. I hope, if I do end up finding that nothing quite compares to the allure of the OR, that I can get some solid elective time in Gen Surg.

Not that it's been a failure, but I am sitting here trying to puzzle through my motivations, trying to decide if I am interested for the right reasons, and then trying to decide if I am truly capable of walking this path should I choose it. I question everything, my technical skills, ability to deal with stress, and that most infuriating comment on what to work on- 'read a little more'. I frankly don't feel smart enough to be competent in this field (any field?), and I wish there were some way to know if I can be capable in the future.

Is a good mark on a horribly constructed exam experience enough reason to stop questioning my potential? Is the praise of patients? I don't honestly know. If one doctor or resident had directly encouraged me to pick surgery, that might have tipped the balance. As it is, the overall positive but undirected comments make me wonder if anyone has any more clue than I do about where I may someday fit.

A good friend of mine in second year linked me to a documentary that followed 7 Harvard medical students for 21 years, from their first day of classes to their eventual careers. It was hard to watch- these kids come in so young and idealistic, then we see them through the slow burnout of residency, the divorces and career changes. The loneliness. The happiest ones seem to be those who didn't fight the system too much, those who married others with far less demanding careers, or didn't marry at all. Some ended up where they thought they would. Most did not. And maybe, I am asking all the wrong questions about my future. I'm really not sure.

What I've been most struck by though is that the people around me have been stellar. I warned my friends that I would be insecure and unavailable, isolated and antisocial. And I have been. They have stuck around though, listened me rant online about things they don't understand, and spent far too much time reminding me that I'm on this path for a reason. The guys from high school kidnapped me for a night of hockey and Settlers of Catan. Brett and Jess risked being late for an academic session to double back and pick me up when my spaceshipcarfromthe80s broke down, and then Kyle called after to make sure I had a way home. Brett caught onto my inclination toward gen surg (it might just be relative interest, he wants to be a psychiatrist) and has encouraged me at every possible point to give it, give myself, a fair chance. My mom has started packing me lunch occasionally (it's been years) and my dad often offers to drive me home postcall. There is comfort in knowing that not only am I not expected to go through clerkship and residency alone, but that people actually want to help. And I hope I can communicate these things beyond words, baking gluten free cookies or pumpkin pies or brownies to express my gratitude.

"The best StarCraft player in world is called Flash. Now, what makes him so good isn't that he is the fastest or the smartest, but he spends an immense amount of time understanding what he does and then practicing the shit out of it. In the beginning, I mean, he kinda sucked. Like he was okay...but nowadays, he's pretty much an unstoppable force and everyone who's ever talked to him will tell you that he never gloats when he wins or gets sad when he loses, he just goes back and practices some more. And I can see you doing that. So what I'm saying is that one day I think you'll be the Flash of medicine."- Eds

Icarus Winds

2010-10-01T20:10:00.000-06:00

Only one more week of Surgery. Our exams are Monday, which I am actually thankful for as that will leave the rest of the week to actually enjoy medicine.

My classmates have been remarkably helpful these past few weeks. I've been feeling rather stupid and rather insecure, and it's been good to be able to voice those thoughts. Whether they rant in empathy, or encourage me, or simply make me laugh, I am quite thankful for them. Allies make anything tolerable.

I'm still not very good at thinking through potential diagnoses and coming to conclusions. It makes sense that I am not; I spend most of my life information gathering rather than making decisions. But I can learn. I've learned to dictate. I've learned how to prioritize information when presenting histories. I can learn this too.

There are so many emotions. The thrill of placing that first chest tube. The sorrow as I explain to a patient that we cut him open only to discover his cancer is inoperable. I don't really feel everything that happens, every victory or every defeat, and I think this is okay. Compassion, I think, is not just in the moments I feel empathy, but in the way I am trying to do what is best, what is kind, what is good with each interaction.

When it comes down to it, I love medicine. I don't always love the hours, the people I work with, or the constant revelation of how far I have to go. But it's rewarding, it's fascinating, and it's somehow right.

It is such a relief to be able to say that. I will feel inadequate for years. Criticism will continue to haunt me. I could be happy doing many other careers. I am missing out on what some people consider important parts of life. But, I know that this is where God wants me, and it's even sweeter when I can actually feel it.

Now, to study.

Margins

2010-09-26T11:57:00.004-06:00

I think it is autumn now. At some point, leaves changed and the air cooled. My steps are crunchy when I run out the door in the moonlight every morning, car windows frosted over.

The Grey Nuns' is very different in atmosphere from the University Hospital. Smaller, kinder, more personable. It's too bad that I'm getting quite introverted, and even a half-day in clinic seems like a lot of people time. I can do it, and I don't think I'm horrible at it, but it's more of a necessity than a joy. Sometimes I think I like the OR just because conversation is minimal.

Medicine takes most of my life, but it's a bit more tolerable than when it was all book learning. I come home too drained to sustain meaningful human interaction, however, and I wonder how people maintain reasonable family lives.

They don't, though, in surgery. One of my favourite residents at the U talked about how he had just enough time every day to come home, kiss his wife, hold his baby daughter for 5 minutes, force some food down, and sleep. But he loves surgery, and as much as it kills him to miss so much at home, he couldn't see himself doing anything else.

I have no such ties though, and sometimes I think it's a blessing.

Surgery Midpoint

2010-09-17T21:00:00.000-06:00

I'm 1 call shift away from being done the tertiary care half of my surgery rotation.

It's been hard. It's been fun. I do something new almost every day. I do something I regret almost every day. I feel like such an introvert sometimes, left with nothing to talk about with the residents after a full day in clinic. I feel like an extrovert sometimes, happy to be able to joke around with the residents.

I have half my evals in now. I don't know what the last one says yet (long story, will get the book back from Devin on Monday), but the general conclusions seem to be 1) my people skills are good and 2) I need to study more. I'm pretty aware of the latter- I admit that much of my knowledge thus far has been acquired based more on what caught my attention, vs what is useful clinically. I have holes in my understanding of most disease processes without the crutch that is multiple choice, and for the first time, I'm really motivated to start filling in those gaps.

I caught a potential bowel perforation this morning in a previously recovering patient. No one else had evaluated her. No one had intended to review or sign off on my orders (it's required, but nurses have taken my orders in the past sans cosign). No one asked about her. She had been doing well, after all. If I hadn't done enough of a history/physical, if I hadn't made a point of mentioning the acute pain to my resident, even though I was post call and it was time to go home...

So many cracks in the system, and I am thankful she didn't slip through one of them. It's sobering to realize that my small contributions to the team really do matter.

Ultimately, it's been a good final week. My opinion may change Sunday, but I got to do a fair amount in the OR (cautery, cutting some fascia, tying, suturing), I got my bearings on writing up consults and dictating clinic visits. I am feeling the lack of dedicated teaching time though, and really just want to sit down and read for more than 1h at a time.

I really have appreciated the OR. I'm realizing that no case is the same, no matter how many gallbladders one has removed. People really are quite unique inside (although often more in a frustrating way than in any sort of perfect snowflake mush). I enjoy the variety, between operating, consulting and clinics. I think I'd want to do some sort of practice that would let me do some procedures; certainly more than what I'd see in, say, psychiatry. Surgery is more about the 'hows' than the 'whys', although pathophysiology obviously matters. That makes it less instinctive for me, but also somewhat appealing in that overwhelming complexity can be reduced to some important binary distinctions.

It really isn't the kindest specialty, and I do sometimes cringe at the comments that fly at scrub nurses. I have a relatively thick skin, but feedback from my seniors in medicine must matter to me, and so any criticism is taken to heart. I don't want to disappoint people; more than that, I want to practice good medicine, even in the smallest ways.

But I'm beginning to taste medicine, and when I'm done being overwhelmed, I think I do like it.

Guts

2010-09-11T13:53:00.000-06:00

Morning tires
On morning street
Sleep-drunk I meet
The day, still fired
Up on the hope
that I can become
something worth being,
that the product and the sum
Of my reading
May help heal
someone someday.

And I've got nothing
To offer but time
And space to place
a story or two like staples
Between the race
Between the rhyme
Of things to do.

Do you have grandchildren?
How did you meet?
Where is home?

Home is a dirty drug
Home is two cats
Home is this steeping mug
of earl grey tea that
you will cradle against
these questions I ask
at ungodly hours

Home was a long time ago
When I still remembered
How to pause to hear you.
But already the steel
Is in my soul
And on the table.

Here, a bowl:
This colon, yours.
This drain, mine.

My learning Your body
My training Your recovery
I can't approximate
Can't abbreviate
Can't dictate gratitude
And awe at how colourful you are
Inside.

Splices

2010-09-11T07:48:00.000-06:00

This week was the Worst Week™. The surgery has been frustratingly uninvolved on my part, and there simply are too many students at the UAH. I'm beginning to feel a bit isolated with my necessarily strict 4:45-20:00 schedule. Thursday, I got unsolicited life advice from the Most Cynical Man on the planet, and I came close to crying yesterday morning, after the anesthesiologist reamed me out for the pathophysiology I've forgotten (the vectors of each EKG lead, anyone?), poorly chosen prereading topics, lack of precision when answering her questions, and my general incompetence.

But I survived. And after she sent me to read, I went back. And even if she didn't particularly like me, she did let me intubate a few patients, and she did make a point of teaching me. She's probably afraid for the future of the medical system, either way, but I was able to sincerely thank her for poking holes in my flimsy understanding of some topics by the end of the day.

Last night, the CMDS dinner ended up being exactly what I needed, a safe place to work through all the excitement and stress of clerkship. And the presentation I'd thrown together in 3 hours actually went well, and, moreover, tied in nicely with the next speaker's thoughts. I needed the reminders of purpose coming from my own lips, the simple things I learned at Green Pastures, and the presence of people who were not evaluating my every word.

Sometimes I say that I need an area of my life where it's alright to be less than competent. I think art is quickly becoming one of those areas. No one dies if I can't get the perspective right on a painting, or if I miss a comma splice (unless it's in a prescription).

But third year is far less terrifying when its actually happening, as I explained to the second years last night. The activity doesn't give you room to be scared, and each new experience quickly becomes knowledge and skill. I'm a bit bruised, but at least I know those damn vectors now. And that feels good.

And today is the pie social, and Berni is coming over with apples. There is time to pause in the shower, time to write, and time of course to try blaze through some material.

Lists

2010-09-05T07:27:00.000-06:00

It's been one week on the wards.

So far, I've:

- closed 2 wounds with subcuticular sutures (still not too confident with those)

- closed 2 wounds with staples (pretty straightforward, but umbilici are a bit tricky)

- sutured/tied in a drain (feeling good about my 1-handed ties)

- misplaced my stethoscope (feeling sick about this)

- placed two foley (urinary) catheters on anesthetized males (comfortable with this now, want to try on a female)

- intubated pre-op (mallanpati 1, but super rewarding. would not attempt on my own)

- determined my glove size (6 and 6.5)

- figured out what's expected of me on consults and rounds

- put in some interrupted stitches (relatively comfortable with those now).

- retracted various layers of fascia, muscle and skin.

- 'driven' a laparoscope camera.

- figured out how to interpret intraop CO2 tracings.

- memorized the branches of the celiac trunk.

- diagnosed a textbook case of appendicitis.

The main areas I think I need to work on are:

- presenting patients I've seen in a succinct but thorough way, with all the important info at the beginning. (i can practice this often, especially when i get into the clinic next week).

- being even more self-directed with consults- taking the time to research guidelines so I can present a confident (however wrong) plan to my seniors. (won't be able to do this until I'm on call again)

- keep showing an active interest in anesthesia so I can get more experience intubating.

- feeling more comfortable attempting orders, even if they are wrong, so I can work out the errors in my thinking. (can practice this every day).

-finding said stethoscope (assuming it's not stolen...)

Goals for today:

- go for a long walk.

- practice writing admission orders on a few patients i saw this past week.

- do a systematic search of my house for my stethoscope.

- bake something or read something nonmedical.

- have one good conversation with a human.

Preliminary Thoughts on General Surgery:

I was beginning to place myself as an internist by the end of last year. I'm an introvert, comfortable with academia, and like knowing why things happen. That said, I've been having a ridiculous amount of fun this past week. The infamous 'surgeon's personality' has surfaced, but at least at the U, it's less cutthroat than described. People are blunt, outspoken, and will tell you when you need to work on something- but they are also a lot of fun. The nurses and unit clerks are lovely and helpful, and the anesthesiologists are eager to teach when the surgeons are occupied.

It's hard to compare myself to my peers since most of them at the U are most likely headed for rewarding psychiatry careers. I know that I am less driven to sit and talk for hours with patients than some of my colleagues, but I do enjoy getting a sense of who people are, and answering questions about their management (eg: clarifying that the tumour removed wasn't malignant and the patient can move on with the rest of her busy life). I can see the parallels between the layers of hierarchy in surgery and my time at camp; as you ascend through the ranks, there is less and less time to spend directly with campers, but this shift in priorities allows you to get other, important things done. And when one is fully staff, one can spend as much time talking to a particular patient as desired. There's a team for a reason, and even if the attending surgeon isn't the one who will get a deep understanding of the patients' backgrounds, the nurses do an amazing job in filling in that part of care.

And the OR. It's actually quite an introvert's paradise, where most of the conversation focuses on the task at hand, and pleases and thankyous aren't necessary (unless you are a student, of course). Someone will hand you an instrument or transfer your hand for you to a clump of bowel to retract, and you obey. Questions will be fired at you on occasion, about anatomy or the disease process affecting this patient, and if you answer correctly, you are rewarded with the opportunity to answer more questions. Things aren't tense, but they are focused and orderly, and there is an obvious sense of purposefulness. I love it. The intensity, the surprising beauty of guts and blood, the ritual of aseptic technique, and each of us with a role to play, even if mine is sometimes only to retract, dab blood, and dash off the paperwork at the end of the case.

I have always been a bit intimidated by surgery- there are so many deep nuances to the decision making, and yet as I approach this rotation, I've been determined to act and respond as though I am going to be a surgeon when I grow up. I don't know how I will feel when I have other clinical experiences to compare to, but right now I am prepared to think that I could be a surgeon one day, and that if I chose it, people would teach me what I need to know and I could learn what I need to learn. Already, they are teaching, and, though I am slower than I want to be, already I am learning.

Only 2 more weeks at the U, then off to a community hospital for more cutting, and hopefully some scoping. I am actually sad that I won't be on call for more than another week- I find that I really enjoy call, even with all the sleep and food deprivation. It's when we actually get to try things for ourselves, and it's when the deepest learning seems to happen.

Spark

2010-08-28T21:18:00.000-06:00

I read about a surgeon
Who said 'Ah, Fuck it' when the thoughts came
Resigned himself to be recharged like a battery
With electric sanity when he ran low

These days I am running low
Or high alternating currents waiting for the
Circuit to break-

The Steps You Take All By Yourself

2010-08-28T09:46:00.000-06:00

Surgery's academic portion is over. I am sitting at a table with a pocket-sized binder, full of 6 holed pages. I have rubber shoes for the operating theatre. My Netcare homepage shows my team's patients, ready to print. I just need to transcribe the week's notes into this binder. I just need to read up as much as I can before call on Monday. I just.

I am doing all these adult-ish things like driving to school? work? what do you call internship?; wearing professional clothes; figuring out my way through the hospitals and the people within. I appreciate the people in my track, and I anticipate working well with most of them, but it's a far more independent existence, especially for people like me who seem to follow no particular pattern of hospital placement. I will do what I can to make my trackmate's lives better, and hopefully they will do the same for me, but we're ultimately all responsible for our own work, our own learning, our own patients.

I wonder when we start feeling less uncertain, when we stop feeling like little kids pretending to be doctors.

I am grateful for Nepal. I need to believe that this path is right.

lights

2010-08-16T10:44:00.002-06:00

My heart started filling the moment I descended my favourite hill just before the turn onto the gravel road leading to camp. The sun was bringing the storm clouds into sharp relief, and a rainbow stretched across the sky. A weekend later of movies and meteors, the climbing wall and some of my favourite people, I am walking around the dining hall, saying goodbyes. And then the tears explode and I duck around a corner to recover.

"You'll always be a part of camp," Andrew says, after my nod gives him permission to approach.

"It's still home."

Even now, even halfway around the world, this place can call to me. However much heartache it has caused me, I will always choose to rest here, choose to laugh until I can't breathe, choose to love, if only for a summer, here.

"It's so hard to leave," I say the obvious, "but at least I know why I'm in school now. I know the faces. I know the needs, I know why."

I am choosing to walk this path and there is strength in leaving. I walk over to the last table, hug Sharaya and Scotty, and then it is back on the road, the timeless prairies and the balm of movement.

Tooth and Nail

2010-08-12T19:38:00.001-06:00

I fight my way through life. Jeff's been telling me as much for years, but I think travelling highlighted this, the restlessness that descended without fail, even half-way around the world. I thirst for adventure, and sometimes end up creating it unnecessarily. As I puked my guts out after paragliding (having spent the last 10 minutes of flight trying to convince my guide to fly higher, though both of us knew it was a bad idea), I went from cursing my vestibular system to doubting my sanity, interrogating myself as Chantelle and I slowly made our way back to our guesthouse.

After drugging myself through the 5 flights that had brought me to Nepal, had I expected anything other than this nauseated ending? (Nope.) So why no drugs this time? (I wanted to be awake and coherent.) Was I happy I went paragliding? (Ask again in a few hours.) Was I happy right now? (No.)

I motioned to Chantelle to stop, slumping against a wall as I waited for my viscera to settle. Wouldn't life be far simpler if I accepted the way I've been designed, down to my hypersensitive inner ear? (Yes.) Would I be happy living within my limits? (No. Absolutely not.)

Weeks later, back solidly at 668 m, I am happy for those 40 minutes of bliss, even with the unfortunate 20 following.

Roots and wings should not be mutually exclusive, but life seems to arrange itself as such. The older I get- and yet I know I am anything but old- the more foolish it seems to be to be still talking of adventures and places I haven't been. I am surrounded by people getting real jobs and buying apartments, marrying and having children and choosing to invest in simple, deep lives, so innately full of purpose and meaning.

Instead I am reading, my blood pressure rising with global injustices, still keeping my fingers to the pulse of this world, the thrill of all the ways one could leave things a little better. So many places a person might spend her life. But what good is this wanderlust, when I spend so much of my time as a hermit? Hermits are generally not in the habit of changing the world.

Introversion and absentmindedness, impatience and a lack of talent for languages. It's too easy to list my failings, and I'm reminded of missed opportunities as I ruminate over my stint in Nepal. So many people I might have met, so many words I might have spoken, if only...

I try to cull the learning from my failures. I try to trust that somehow my personality and my dreams aren't entirely in opposition. Something can be made of these things. Something can be made of me. So I push past my instinctive reserve to speak to a patient, even just a few words before a procedure. I push past the language barriers as I try to introduce myself to a small child, her laughter at my broken pronunciation a sweet sound. I choose a career to which I'm not entirely well suited, I dream things I am not able to accomplish in my own lifetime, and I never say no to flying.

Rads

2010-08-06T21:28:00.003-06:00

Acro-osteolysis and periostitis from leprosy.

It seems like a good plan to blog about each specialty as I experience it, and give myself something to look back at when trying to make decisions a year from now. It won't make good reading, but maybe it will be good for me.

Here goes:

Radiology was a good experience. Really. The daily countdown, the utter dread that filled me every morning and the hours of avolition upon arriving back at home each night notwithstanding, it wasn't actually that bad. The stress and the uncertainty can probably be credited to My First Rotation TM Syndrome and my vendetta against Alberta Health Services (still no password). While the actual evaluation hasn't been uploaded yet, Dr. H assured me that my presentation was excellent and the feedback for my evaluation was positive.

That said, it took exactly one day for me to decide I am not a budding radiologist, and nothing in the past two weeks swayed me from that decision. I love screens and pictures and technology, and the procedural side of rads is pretty neat. I find something inherently attractive about how imaging renders the human body, and I have a deep love for diagnosis. All considered, I came into the elective prepared to like it- but I didn't.

I want to see patients, know more of their stories than the moment I am injecting a joint on their way to the MRI- although I certainly have seen the difference a radiologist can make in how she approaches that 10 minute encounter. I want to know the diagnoses, not just provide a differential. Radiologists are in some senses the consummate consultants, dictating suggestions and interpretations from their immaculate desks. There's elegance in it, but it's not the sort of practice that appeals to me. Green Pastures taught me that I like blood and gore and kind of appreciate the viscerality that medicine can offer.

It's too bad really- rads is an ideal lifestyle specialty, 8-4 days with an hour's lunch, extra time off if it's a slow day, and negligible call. Catching bits of personal phone calls in the margins of my time with various preceptors, I've heard about home renovations, trips to exotic locales, and a thousand and one ways to spend a lot of money.

But that would be too easy, wouldn't it?

Up next- Link block, where we learn to start IVs, intubate, and chart. Among other things.

Landings

2010-07-30T21:53:00.000-06:00

Alberta unfolds like a quilt, all green and yellow and brown. I love the smell of night, the crisp edges to the air. I keep forgetting it is still summer. Rain here is slow and steady, not the violence of the monsoon. It is quiet, also, like everything else here. Even the thunder seems quieter. Darker nights. Mellow sun.

It is hard to talk about Nepal. I'm not a storyteller in that sense- there are things that matter to me, but they are more impressions than events, series of moments rather than a whole. I lived there, just as I do now. It's hard to make much more of it than that, yet I am as tied to those places as I am to camp, to these prairies, to any place where I have fully allowed myself to dwell.

I keep absentmindedly scratching the mosquito bites on my limbs to blood, and it leaks onto my clothes and the floor. But I find it hard to actually think about them, or about the heat, or about all those questions about what to eat or what to do everyday. I am glad for the elective in Rads if only that it means I get up and go somewhere every morning, even despite myself, and the rest just happens from there. I've gotten to see people the past couple of days, which is good. I don't instinctively want to see people, but I know it is good for me to keep trying to press out of myself. I didn't make it out to camp this weekend, but perhaps that is for the better.

I am not sure how to live here entirely. I exist though and I am making jokes and driving my spaceship car from the 80s. I still like sushi and ice cream (now that my duodenum's brush border has replenished its lactase) and I am listening to Stars and Regina Spektor and Paramore. I think maybe I should read; I rediscovered how good it is for me to read over the past few months, coming home from the hospital and burying my mind in something meaningful.

I need to find a church. I need more practice highway driving. I need an AHS account.

Maybe I'll bake something. Put this restless body to work.

Finalities

2010-07-17T08:50:00.000-06:00

We've spent the past few days in Kathmandu. I love it here. I don't understand fully why, but something between the familiar bits and the unfamiliar bits make it exactly where I want to be right now.

I stood in a village high above Bhaktapur and something caught. On one side, the three kingdoms of the Kathmandu valley stretching out below, buildings sprouting from the rice paddies. On another, the forest, now army territory, yet still green and inviting. Between, an alluring path I have no time to walk. (No time only this time my mind reminds.) It takes everything to rip a rock from the ground and turn and run down the road back toward the church instead of moving along the path.

Hours later, we are finding an unguarded entrance into the old city, avoiding entrance fees, walking ahead in my kurta, secure in the fact that I am actually able to pass for Nepali now, albeit a Nepali with very poor language skills. It is a city of passageways and carvings, a beautiful place to lose oneself for hours, and it is only willpower that keeps me from doing so. Next time.

I got to sit in the front of the bus back to the hostel, looking out over this city that has become home within days. Even the smog is transfigured in late afternoon sunlight, scattered radiance and the weaving bus, the odd sense of timelessness in haze, and a strange impression that I could ride here infinitely and be infinitely content.

I am no more extroverted in Nepal than Canada, and engaging with the outside world is a struggle regardless of language. Yet this is a home, and I am at rest here.

I am exactly where I am supposed to be right now. Tomorrow I will leave where I am supposed to be to go where I am supposed to be. I think this is what kept me from shedding tears atop that hill, what keeps me lighthearted even as Chantelle and I prepare to bid farewell to the little hostel family that's sprung up over the past few days. So many stories I have yet to live, so many people I will not get to know. But the leaving is as right as the coming, and if nothing else, the elective portion of the trip has reminded me of why I am in medicine. Perhaps it is enough to know the faces and the diseases, the whys.

I sit here in an internet cafe, drinking Tibetan soup, sipping a lassi, wearing a kurta and carrying my messenger bag. Tomorrow, Singapore.

Onward.

Pause

2010-07-09T09:28:00.001-06:00

In the Gunj, rather anticlimatically. No rocks falling, no insane heat, no death. A drizzle followed us south from Pokhara and so we've landed here on a rare overcast day.

The drive down was a patchwork of terrain, hairpin turns for 4 hours, winding along hills and avoiding oncoming traffic, then suddenly the Terai, my prairie-grown heart inevitably smiling at the stretches of endless flat. 6 hours later, A & R's place, a strange oasis where Dal Bhat is eaten with cutlery, and chocolate banana loaf is sliced for after dinner. And there is a generator, running merrily so that there are fans (!) even with loadshedding. Chantelle and I each have our own rooms. It is veritable luxury, and it is suddenly confusing, though certainly appreciated.

Yesterday, we said goodbye to Pokhara. Thank-you cards and guestbook signings, words crafted in hopes of expressing gratitude and appreciation that I am not sure I fully can express yet. And that inevitable question, of whether we will return.

I am noncommittal on that point. There is no certainty in my mind. But Thursday afternoon, standing on the landing at the hospital, I feel the burn of leaving and I know that this place has embedded itself into my heart.

Is it the place? Is it the people? It's hard to say. A bit of both likely. I feel I've done so little in these brief weeks, and yet it is never my doing.

I am honoured by the moments though. AA dragging us out to dance in the rain. That morning on Sarangkot, speaking to the skies in the haze of a cool morning. Patients greeting me on a Saturday morning. The smile of a mom as I play with her child. SB laughing to the point of tears, reading my ode. Dr. J talking about his 'happily ever after' when he and his wife will finally be in the same country for more than a month at a time. And Dr. P finally talking, sharing a story we could not have imagined. Each point of connection is a strange gift.

If I pause in these memories long enough something catches. Not tears or anything. Just a heck of a lot of significance that I still don't grasp.

A cold shower, then rest under a permethrine treated curtain. Certainty can't be rushed.

Ode to Magnificat

2010-07-06T21:54:00.001-06:00

We have seen thee feline king
Thy empty eye like fertile Nile
Fragrant flood with verdant spring
No medication to defile
And only is this pustular pocket
Outshone by remaining orb
Ectropioned in dripping socket
Flea-bit fur thy tears absorb

Three-legg'd wonder bless thy beauty
No quadruped could match thy grace
Even as the red car slew thee
Rolling twice o'er thy sweet face
Limping came thee, shrieking left thee
Noble beast to thee we owe
Half-truths and shame to ward off blame
For neglecting to reverse in slow.

RIP Magnificat. ?- July 2010

-Anna

Sweat

2010-07-03T04:47:00.001-06:00

I don't notice temperatures anymore, only how much I perspire. I don't think about motorbikes anymore, I just jump out of the way. I am still awed by the mountains when they choose to appear in the mornings, and I still appreciate the difference a fan makes in temperature.

I am finally at that point where I think I would either need to stay for a year or leave next week. Comfortable enough with how life works here to actually feel stircrazy at times (!) though mostly just on slow clinic days, and also comfortable enough to want to get to know people on a deeper level. It makes me a little sad that I'm only just beginning to learn the important things about the people I work with, only beginning to really have fun with them.

Not that I have a choice in the staying or going. I am leaving next week after all. A week today, I will be in Nepalgunj (barring landslides and other delays), sweating away. A week after I will be flying en route to Singapore. And a week after that I will be sleeping in Edmonton. Time moves too quickly.

I have fewer answers than perhaps I wanted, but maybe that is okay. I have a list of things I don't have time to do, and I find it is not hard to believe that I will come back and I will do them, even if that is years in the future. It will have to be years in the future.

I am happy though that I like medicine. I am happy that I can diagnose some dermatological conditions accurately most of the time. I am happy to eat with my hands and be called 'didi' on the street and for the medical officers to teach us how to eat mangoes in a spare moment. I am happy to bring cookies to work and have Dr. Jas exclaim that he wished every day were Canada Day. I am happy to have met Jenny and Phil and Mark and Jo and Sandra and I understand that I will not fully feel the weight of their absences until long after I am back in school.

But I will send emails and care packages, and maybe I can repay in encouragement what I've soaked up in their experience.

I wonder if I would be lonely, living here... anywhere... on my own for awhile. I wonder sometimes if I am lonely here and simply don't let myself feel it. But it is a good place to be, even if I don't always have much to add to conversations, and I take comfort in knowing that I am fully here, frustrations and issues and all. These weeks I have not been running away from myself, and perhaps that will make the transition home easier.

I am sentimental and stircrazy. But then, I always am.

I am leaving so soon.

It is not forever.

I don't know what that means, but I will come back.

Beautiful

2010-06-20T21:42:00.000-06:00

There was a beggar by the gate called Beautiful
But this is not that beggar nor that gate
And I am not an apostle
Only a traveller or a student a lapsed saint a
Girl who could not speak the words even if
She had them on her lips.

I am walking with my kurta full of rupees
And I am rich for the walking and the kurta and the rupees
I will eat today and I will eat tomorrow
And I will sleep indoors, a queen.
I am healthy my legs able to feel the strain of work
My eyes able to burn from reading too much too late
-- Able to read--
Able to cough and cry and complain.

Wait I want to say I am learning
To heal to comfort to speak
To spend my money well
My life well I see you I will
Return Already my feet have passed.

And I know that tomorrow
I will be there but he will
Not.

Home

2010-06-18T05:36:00.001-06:00

Today I sat cross-legged in a room of Nepali health care professionals and sung along in English. It felt so deeply right.

Home is where a soul can rest, I think. I worry sometimes about finding a home, about whether any place will ever be a place I belong. But I realize that I already speak of the guesthouse as home, and of Edmonton as home, and both are true enough. Perhaps it is enough to have small scattered places to be at peace.

Even in a song.

I am starting to let myself exist here, without asking the questions that press beneath the surface. I don't know why I am here but I know why I am here. And the rest will work itself out.

Dreams

2010-06-12T07:56:00.001-06:00

I've been having some. They are not pleasant. But I wake up and life is good, so I go about my days and enjoy them. And then I sleep and the darkness returns. The dreams are violent, or I am violent in them at worst, and isolating and discouraging at best. I am not sure what to do about them.

There is no rain. Still.

I am learning a lot at the hospital. Inevitable when leprosy was afforded one footnote in our learning and dermatology (our preceptor's specialty) was all of a week. Different conditions are endemic in different areas also, so perhaps we could be forgiven for staring blankly at a classic case of DLE. We've done a few hours of research to catch up. We've also been assigned some patient cases to follow though, and our preceptor has said we can assist in surgery (within the bounds of our abilities) so things should pick up next week.

I don't have a concrete role here, and this is both restful and difficult for me. The hospital is willing to teach us so I am eager to learn, but I still feel like a liability at times. I also feel a bit conflicted between trying to integrate as best as a language-challenged bideshi can (kurta sarwar and all), and fielding the 'touristy' options constantly offered to us. Go swimming at a hotel, urges our host. Skip the evening dahl baat to try the "Canadian" special at a local restaurant. And so I am split between the fact that I am always going to be an outsider, especially in these brief 5 weeks, and the fact that I long to exist here in more than a superficial way.

I was asked to write down why I am in Nepal the other night, and while the most simple, most pure answer is easy, I am conflicted about the details. I know I think too much about these things, though, or at least I do in my sleep. Life is pleasant, existence is comfortable enough, I have time to read and learn, study new things and have significant conversations with other humans. I feel more isolated from purpose than I thought I would though, and I suspect this is what is plaguing me.

The questions in my heart have no answer, yet.

Next week, the rains should come.

Walk

2010-06-09T07:21:00.003-06:00

It's a one hour walk at a comfortable pace to and from the hospital. I know this because it's my chosen method of transportation, much to the amusement of Ram and Sabine, the guesthouse owners. It also hasn't rained for the past couple of days, making my adventure even more perilous with the heat and the humidity. My body is slowly figuring it out though. Figuring everything out, really. Bouncing back from a flu-like illness over the weekend, my mind and body are ready to go, and the hour-long walk is not arduous, even in the heat. It helps that the clear skies bring the Annapurna range into view for our first glimpses this trip, snowy peaks tantalizingly far from our 30*C reality.

But I am learning to love the weather and the food (Dhal Bhaat, the national dish, at least once a day), the traffic and the people and the simple ways of being here. It's simple, really. Umbrellas shield sun as well as rain. Handkerchiefs are a good idea. Cars use their horns to let you know they are coming. There are as many lanes on a road as the number of vehicles one can fit.

Tea. Tea is essential. It is milky here and sweet, and served at 11am sharp at the hospital, right after rounds, by an Amah who runs a tea shop on the property.

So every morning, rounds, tea, clinic of some sort, lunch. Then surgery, or physio, or whoever will teach us something, then walking again, this time in a deeper heat and a slower pace. More vehicles later in the day, more people, and no more mountains in the distance. The stretch from the airport to Lakeside to the guesthouse always seems the longest.

I like it all though. There's a sense of accomplishment and there's a sense of rhythm in it all. A routine in a new place that doesn't feel all that new after all, merely another way of being, another place to channel the same self.

Rain

2010-06-02T08:18:00.000-06:00

Kathmandu now, with RK and JK. It's a huge change from Singapore, and yet I have to say I prefer it here. It's chaos, absolute chaos compared to the well-groomed modernity of Singapore, but I am already beginning to understand how people fall in love with this country. I am not sure what it is, yet. Cows wandering free as they are sacred, vehicles carving out lanes wherever there is room, I am satisfied to navigate in the margins of the roads, jumping alongside the rubble of various half-completed construction projects. Hours after arrival we are invited to a baby dedication, and with it food and a dozen new words, and then onward to wander the city with JK and be invited in for tea by an old friend of hers. I am using the few phrases I know often, and trying to overcome my general ineptitude with languages. The grammar is simple and people are forgiving, which helps.

We ran into a few expats today and heard their stories, their commentary on Nepali culture juxtaposed with my wide-eyed observations. I value their knowledge and experience, yet I wonder if things are as bleak as they see them to be. I can grasp the frustration at the root of the criticism however, that tension between how things are and how they might be. But it's far too early for conclusions. (I don't come to those easily at even the best of times.)

It's pouring outside, a harbinger of the monsoon. With it, cool air and a show to rival the best of Albertan lightning. Tomorrow we go to Pokhara, which is home for the next 6 weeks.

2010-05-31T20:32:00.001-06:00

Therefore, prepare your mind for action...

Singapore. Chantelle and I are grateful for this 29 hour stop over after a day and a half of flying. We're staying at the Yee's place on the National University of Singapore campus, and adjusting to the humid weather. It's a taste of what Nepal will be like, I'm told.

Off to explore.

Waves and Wires

2010-05-27T07:54:00.001-06:00

March 1 2006- I picked up a scrap of charred paper and researched the entrance requirements for medicine.
March 2007- I started thinking about going to Nepal.
August 2007- I went to Zambia, learned and grew and rested and realized it was the wrong place.
May 15 2008- I got into med school.
Dec 2008- I started wondering why I was in med school.
April 2009- Anna: "Wanna go to Nepal?" Chantelle: "Sure!" Anna: "Really?" Chantelle: "Yeah! I know people there."
May 1 2009- I went to camp and met Heather, and found Dr. Helen Huston's biography on the dining room table.
Early August 2009- I met Helen at an Interserve meeting with Chantelle.
Late August 2009- Dr. Carolyn Wats stayed late after an Interserve presentation to answer the questions of a group of 5 female med students. In summer 2010, all 5 will be doing electives in Asia or Africa.
Fall 2009- We email various organizations, including Interserve. We are turned down for clinical electives.
December 2009- We apply to Green Pastures Hospital in Pokhara at the suggestion of Alan and Rosanna Clark, Chantelle's family friends. We are accepted by INF.
January 2010- We learn we should have applied to INF through Interserve. The powers that be are gracious. The endless paperwork begins.
February 2010- Passport renewals, interviews, wills, medicals, travel agents.
March 2010- The endless paperwork ends.
April 2010- Bakesales + Grants. Finances covered.
May 2010- Impromptu language lessons, shopping trips, studying, packing, tea with Helen, goodbyes.

You know that things are going well when the one thing that doesn't work out is the colour of the shirt you ordered online.

Over the past few months we've been fed and prayed over, encouraged and supported beyond our expectations. For the next couple of months, Chantelle and I will be staying in the houses of strangers, friends of her parents, and an incredible network of people who know each other and trust us implicitly.

Not everything will go as planned, but things will go as they should. There's a difference, and I'm glad to recognize this before we take off. This trip has been awhile in the making. I could've started the timeline earlier, when Chantelle's parents got connected to Interserve, or Chantelle wrote the first penpal letter to Alan and Rosanna's children, or Heather picked that book up from a rummage sale, or when Helen went to India and ended up in Nepal.

It's not about the learning, although I know I will learn. It's not about the adventure, although it certainly is one. There are deeper things at play here, and I hope I will be able to move with them.

Today, studying. Tomorrow, exam. Saturday, packing. Sunday, flight.

Victory Lap

2010-05-21T21:46:00.000-06:00

This week held the last lecture of preclinical, last clinical skills group and last block exam. There's literally 4 more hours to preclin, 2 for the OSCE and 2 for the Comp, at 7:45am Tuesday and 9:45am Friday respectively. The rest of those hours are studying. Eeek.

I'm exhausted, but the end is in sight. We used to call the last week of camp [your muscles aching and your immune system shot and your mind the cognitive equivalent of lake mud] the Victory Lap. It feels like that right now. I want to be done but I also love it, and so I am impatient but savour these lasts.

I got a letter from my past self yesterday. Funny how future and past selves have perspective. Old-me reminded Now-me that I'm exactly where I'm supposed to be, and that was enough.

I don't have a flag or a medal but I'll wrap myself in a white coat and hang a stethoscope around my neck, run around a bit and write some words. And true to Canadian fashion, we'll all have to party.

Don't worry, we'll keep it off the ice and out of the wards.

14

2010-05-14T18:58:00.000-06:00

I don't want to study, so I'm letting myself have a bit of time before I start trying to catch up on this past week's worth of material.

Nepal is looming closer, and I've been quite silent about it because I am not sure what to say. Physically, Chantelle and I are a shopping trip away from prepared. Financially, the generosity of friends, CMDS and our faculty has been overwhelming. My thoughts are consumed with school, with the Comprehensive two weeks from today.

I won't have time to say goodbye to everyone properly before I go, and this is a bit sad, although I have certainly dropped off the face of the earth for longer before without warning. I just want to be competent. I want to learn and practice and... not be a complete idiot this August on the wards.

I also have an exam this Friday. I should start studying for that soon.

roots

2010-05-12T11:55:00.001-06:00

“To practice stability is to learn to love both a place and its people. The twelfth-century Benedictine Anselm of Canterbury compared a restless monk to a tree that, after being ‘frequently transplanted or often disturbed,’ will not take root anywhere, but only withers and dies. ‘If he often moves from place to place at his own whim, or remaining in one place is frequently agitated by hatred of it,’ Anselm observes, then the unhappy monk ‘never achieves stability with roots of love’.

“The desert mother Amma Syncletica said, ‘If a bird abandons the eggs she has been sitting on, she prevents them from hatching, and in the same way monks or nuns will grow cold and their faith will perish if they go around from one place to another’.”

-Jonathan Wilson-Hartgrove: “The Wisdom of Stability: Rooting Faith in a Mobile Culture”

adrift

2010-05-04T22:51:00.000-06:00

I don't feel lonely often. With the constant influx of people at school, it's a relief when I can sit at home and watch movies or read books on my laptop alone in my room. I absolutely adore solitary movie watching. And it's been too long since I've been able to do that.

Lately though, I find myself craving an actual social group to which to belong. I'm not sure I've ever known that completely. Things at home have always been messy, and that's as much my fault as anyone's. Church has never been a haven, and now the people I knew and loved there are elsewhere. Camp is the closest thing I have to a home, and that won't be an option for a few years. There's a deep level of responsibility on my part for each estrangement, of course, and I know I am not good at tying myself down to anywhere or anyone for very long. I don't even know that I would want to belong anywhere in particular, or that I wouldn't feel restless the moment I did, only that it seems that there could be comfort in that.

I feel very inadequate when it comes to medicine; I always do. Sometimes hopefully inadequate, that I am becoming competent, sometimes hopelessly so. It's a relief that I am in a better place right now than I was a year ago, and two years ago, but I still can feel the pressure of thoughts and emotions that are either not true or that I am not equipped to deal with right now.

I am not sure when I will deal with them, which is I guess the problematic part. I'm not sure if they demand any sort of change on my part, because I think I've acknowledged them over and over already to no avail. Perhaps it's just a matter of being aware and trying to not make decisions solely on their behalf.

Sleep. Maybe I can get some tonight.

Last Stretch

2010-05-02T18:20:00.000-06:00

I'm not sleeping enough. It's a conscious decision, and a poor one.

I am finding myself with a shorter fuse emotionally than usual, the past week. It's nearing the end of the year, and so it makes sense that, after this marathon part two, I'm a bit frayed and burned out. I don't want to go to any of the social engagements scheduled next week though, and I kind of don't want to do anything. I have trouble communicating when I'm tired. I don't know when I'm complaining or when I'm working through things and could benefit from vocalizing them.

I want to keep a tight rein on myself this year. I just need to get back on a sleeping schedule and make myself study while I have time. I don't have to be funny or likeable, I just need to show up to things and time will move itself. I have to get back on track before I derail completely. Soon enough I'll be done.

Saving Lives

2010-05-01T10:14:00.003-06:00

My clinical skills group is sitting in a room, presenting the patients we've individually examined. My case is unremarkable, aside from a query of ovarian cancer that has already been investigated by imaging. She is a strong woman, and seems equipped to deal with the stresses she's facing.

R's case is far less benign. The physical disease, a rare endocrine condition, is under control; not much else is. History of neglect and abuse, starved and locked in a small room by poor immigrant parents. An early forced marriage that endures 38 years later, "abusive at best". Mom is still alive and lives with the couple, being cared for by the daughter she could not love well.

Even second-hand, I am taken off guard by the words, perhaps more so that they are removed from any emotional context. It's anger, and helplessness, the realization that sometimes healing the body is not nearly enough.

There are deeper things wrong with humanity.

I try to talk about these things with friends in vague terms, later, but it is the wrong place and the wrong time. I don't know how to do more than communicate the shock value. It should shock, but it is no worse than the litany of evils I review in the headlines each morning.

It's the immediacy perhaps that frustrates, the people that allow us to behold them, that we can touch their skin and hear their hearts and yet be powerless to change the patterns that govern their lives.

Medicine is interesting in that we learn and practice it divorced from its ethical background. We choose virtues to encourage in our procedures, non-maleficence, beneficence, justice and autonomy, but there is more than simple guidelines that shape a person's actions. The tension emerges as they teach us about how to care, how to break bad news, how to express concern, as though the timbre and content of a voice is the angle of a needle or the counting of rib spaces.

Don't lie, don't cheat, don't steal. Don't maim, don't be self-serving. Care about people and seek the best for them. Speak what is true about their situation and their diagnosis, with compassion. Do your best. Admit when you are wrong. Seek forgiveness. Keep secrets unless someone's life is in danger.

Simple things. Things every major worldview subscribes too. Things every kindergarten child has been taught to value. Things that land doctors in the news every month, despite millions of dollars poured into a screening process.

We are selected because they believe we are good. We are expected to do good, but not taught or reminded of what it is to be good. What's demanded is professionalism, regardless of our personal state, donned and removed as simply as our white coats. Do what you will outside of the hospital. Just don't let us hear about it. We become fragmented healers, and don't know the wholeness we offer our patients.

Patients need good people, not professionals. I am more and more convinced of this. I'm not interested in maintaining any myths of superhuman physicians. I don't believe being a good doctor, morally, is any different than being a good engineer or a good waiter, a good father or a good daughter. And the most obvious of similarities is that we fail regularly at all of them.

But why lower the standards and lead a Jekyl-and-Hyde existence? If we are interested in restoring health, restoring wholeness, then surely we need to be striving for similar integrity. When our only goodness is in the clinical realm, then we are impotent in the personal aspects of our patients' lives, in seeking their complete health. And whether or not that should be our domain, we are regularly invited there.

Goodness matters. It makes us compassionate. Interested. Humble. It makes us no more powerful to change the course of another's life, but it gives us the ability to offer people hope, and the space and reason to heal.

Wind

2010-04-06T23:29:00.002-06:00

After much thought, I've decided that if I were born into the Avatar universe, I'd be an air bender.

It's the most esoteric of the elements, and in some ways, also the most cerebral. It is deflection and diplomacy, but direct when it needs to be. It prefers to guide than to force, to suggest than to order. All the same, it is itself undirectable, uncontrollable. One can adjust the sails, but one can scarcely hope to contain the wind.

Air can be pragmatic, and air can be whimsical. Air can whirl into tornadoes or toy with leaves. It feeds fire and carves earth, moves water and guides migrating birds. It is the least substantial element, yet no less powerful for its invisibility.

Of course, Avatar is all about balance, and I think I've had to attempt to learn other elements of life. High school was water, changing forms and states, something fluid but incompressibly constant. Learning to allow life to hit me, to absorb and redirect emotion. Learning the spirit of healing, if not the outworking, and the desire to be salve to others. Med school, I think, has been earth, assertiveness, perseverance, inertia, and hardest of all, consistency. I am managing, despite myself, even though I miss other ways of doing life.

Maybe, I muses to Jeana, maybe I'll figure out fire someday. Earth and air may be opposed, but fire seems the most foreign. Though I understand something of purpose and drive, I don't have that sort of steadfast ambition, or the confidence in a vision beyond myself. But maybe I can believe in something enough to be that passionate about it, to actually strive to see the world conform to my will.

limbs and branches

2010-03-24T22:05:00.000-06:00

Had a remarkably good conversation with a first year today, about science and religion, philosophy and history. He's a baptist-turned-atheist, and we talked civilly of the things we have believed and the things we believe now. His journey in those regards mirrors mine closely, and it as as though we had been taught the same things, thought the same thoughts, had the same objections, and then chose differently. He's a well-spoken guy who clearly enjoys these conversations for their own sake.

It is so nice to speak to someone who is not trying to convert me. I hope he felt similarly.

These are the conversations that keep me here.

amaurosis fulgax

2010-03-22T21:08:00.000-06:00

Studying makes me want to contemplate life and human nature and the big questions. Procrastination is like that.

Spring triggers such a drastic change in my perspective. It is good to shake off the mental haze of winter, but sunlight brings other challenges. I am trying to convince myself it is fall because I am sanest in the fall. Productive. Balanced. I do stupid things in the spring, driven by a restless running ache to recklessness. So I am glad for the cool days and the snow, puddling around my hurried footsteps, a bit of help in my self-deception.

Exam this Friday. Hopefully I can manage to study effectively for it, instead of being mired in the paranoid thoughts that try to catch my attention. 9 more weeks after, with 3 more exams, an OSCE or two. I just need to hang on 'til then.

Then I can fly.

plunk

2010-03-16T20:18:00.000-06:00

Ivan's talking about getting married in 2011. It's strange to me. I have barely spoken to his girlfriend, though she seems like a decent human being.

Life is moving too fast. Exam next Friday. 10 more weeks of school. Plane tickets to purchase. Money to obtain.

It is nice out and I don't want to work.

Status Quo

2010-03-12T22:53:00.000-07:00

Hit-and-run updating. Easier than trying to actually blog.

Listening: Vitamin String Quartet Covers

Reading: Webcomics, Lecture Notes

Scheming: Nepal. Culturally sensitive and weather appropriate skirt acquired. One interview left.

Worrying: How to survive next year.

Irritating: Creation Science day camps, the ignorance of church kids about STI prevention and contraception, 10 years of sex ed later. Makes one want to be a high school science teacher.

Watching: Almost done season 2 of Avatar:The Last Airbender.

Tutoring: Can barely remember how to work with logs, sadly. Chemistry is going far better.

Painting: Need to complete zoo by lunch tomorrow. Luck required.

Studying: Worst block of the year, in terms of organization and teaching style. 3 absent lecturers this week + 1 fire alarm. Still like the content. Yay Neuro.

Church-Hopping: Like some parts, hate others. Enjoyed mass more than I expected last week. Could I be a Catholic? (Probably not).

Wondering: What might set me apart from every other student in my class. If there is anything remotely unique about me, this far into the gaunlet with only one way out. Why I care so much less about many things than I used to. Who I will be when I grow up.

words like silent raindrops fell

2010-03-11T23:13:00.000-07:00

10 half-written blog drafts saved.

Hard to find words I can grasp long enough to type out.

Such Unlikely Ways

2010-02-20T21:05:00.002-07:00

Inventing Aladdin

In bed with him that night, like every night,
her sister at their feet, she ends her tale,
then waits. Her sister quickly takes her cue,
and says, “I cannot sleep. Another, please?”
Scheherazade takes one small nervous
breath
And begins, “In faraway Peking
there lived a lazy youth with his mama.
His name? Aladdin. His papa was dead….”
She tells them how a dark magician came,
claiming to be his uncle, with a plan:
He took the boy out to a lonely place,
gave him a ring he said would keep him safe,
dropped in a cavern filled with precious stones,
“Bring me the lamp!” and when Aladdin won’t
in darkness he’s abandoned and entomed….

There now.

Aladdin locked beneath the earth,
she stops, her husband hooked for one
more night.

Next day
she cooks
she feeds her kids
she dreams….
Knowing Aladdin’s trapped
And that her tale
has brought her just one day.
What happens now?
She wishes she knew.

It’s only when that evening comes around
And husband says, just as he always says,
“Tomorrow morning, I shall have your head,”
when Dunyazade, her sister asks, “But please
what of Aladdin?” only then she knows….

And in a cavern hung about with jewels
Aladdin rubs his lamp. The Genie comes.
The story tumbles on. Aladdin gets
the princess and a palace made of pearls.
Watch now, the dark magician’s coming back:
“New lamp for old,” he’s singing on the street.
Just when Aladdin has lost everything,
she stops.

He’ll let her live another night.

Her sister and her husband fall asleep.
She lies awake and stares up in the dark
Playing the variations in her mind:
the way to give Aladdin back his world,
his palace, his princess, his everything.

And then she sleeps. The tale will need an end,
but now it melts to dreams inside her head.

She wakes,
She feeds the kids
She combs her hair
She goes down to the market
Buys some oil
The oil-seller pours it out for her,
decanting it
from an enormous jar,
She thinks,
What if you hid a man in there?
She buys some sesame as well, that day.

Her sister says, “He hasn’t killed you yet.”
“Not yet.” Unspoken waits the phrase, “He will.”

In bed she tells them of the magic ring
Aladdin rubs. Slave of Rings appears….
Magician dead, Aladdin saved, she stops.
But once the story’s done, the teller’s dead,
her only hope’s to start another tale.
Scheherazade inspects her store of words,
half-built, half baked ideas and dreams combine
with jars just big enough to hide a man.
and she thinks, Open sesame, and similes.
“Now, Ali Baba was a righteous man,
but he was poor…” she starts, and she’s away,
and so her life is safe for one more night,
until she bore him, or invention fails.

She does not know where any tale waits
before it’s told. (Not more do I.)
But forty thieves sounds good, so forty
thieves it is. She prays she’s bought
another clutch of days.

We save our lives in such unlikely ways.

-Neil Gaiman, Fragile Things

Ash Wednesday

2010-02-17T17:03:00.002-07:00

Four years ago, I ran out of matches and picked this scrap up from the snowy ground.

Today I shadowed in neurosurgery. For the first time when shadowing, when the attending asked me questions, I knew the answers.

a little more than i can give

2010-02-04T21:52:00.000-07:00

Winter is wearing on me. I am feeling pervasively lonely again. It's been awhile since there has been the piercing chill of sky, only shades of grey and the muted temperatures that come with cloud. I want to set something on fire.

Understanding saves me. It always does. Even in elementary school, I could always think myself into .. and out of... despair. It is not pleasant for these syrupy regrets to pool around my feet, but as long as my mind is alive, I can keep moving.

For the first time in a month and a half, my inbox has under 30 messages to deal with. <20 is when I can breathe. <10 is when I know I'm not in school. I feel like I've just discovered air again. At the very least, it means I'm functioning at a minimal level again.

I am losing my literacy in North American Church. Every congregation is beginning to sound the same, half-a-year into church-hopping. Some are better than others. Some are more familiar than others. The orders of magnitude are tiny though, and first impressions blur together. I hunger for depth of some sort, to find people who behold mystery and know how to be silent in the presence of things we do not understand.

I want to be that sort of person. I still have too many words.

I don't find the sort of warmth I used to strive to feel. I once expected God to curl up around me like a blanket, finding me in the dark places where I hide when I am weak. And sometimes, He seemed to be there, whether in my own creation or in truth. I think He is still here, but more distantly, more quietly, breaking my falls, gesturing back to the road. And sometimes I don't perceive Him at all. But I'm done trying to blame myself for the things I don't experience. So I try to get up and walk a bit farther. I don't know what God wants the way I sometimes did, but I try to do things that I think might be right, try to make something of my small days, and sometimes the fog seems less threatening.

all the comebacks in the world are in your head

2010-02-02T20:28:00.001-07:00

This comic stupidly made me cry, the other day. I think I have too much empathy for robots, but then, it wasn't so long ago that I had similar conversations in my mind. It's too easy to believe that Doing The Right Thing can buy freedom and rest.

I'm feeling a bit off. I'm getting dizzy when I move too quickly, and I feel warm all the time even though I've been getting too much sleep. I just got over the cold that's migrating around the class though, and I don't have a real temperature. So maybe I'm just tired.

I do tend to burn out quickly in winter semester. Reading Week is coming quickly, but I'm not quite sure how I can best recharge. I am beginning to feel woefully inadequate again, and I am struggling to keep motivated, keep moving. It's hard to not believe that others are walking better paths, hard to find my own steps rather than try to keep chasing after everyone else.

My perspective is skewed. It's hard to type words that I believe.

Neuro

2010-01-30T10:01:00.000-07:00

MSK is done (17 more weeks)! Our cadaver's dissected to shreds, aside from the head and neck (slated for the next 2 months). I've learned the basics of suturing and I just need practice. Yesterday I traded a unit of blood for a bowl of soup. I love giving blood after exams- it reminds me that I can be concretely useful to the world, no matter how the whole school thing goes. I called from the blood clinic to confirm with Jeff that I won't be at camp this weekend. It was reassuring to hear him say he was proud I'd decided to do something for myself, even though I'd already made up my mind.

Weeks ago, Dr. Patrick spoke of medical education as an 'intellectual wasteland'. He was being facetious, but something in me knotted over itself. I ranted to Chantelle later, she patiently trekking with me over the banks of Lake Chestermere, the Chinook stealing our words. I know a jaded fourth year who's written this: "The culture of the MD is such that you must want it so much that the sacrifices you made to 'get in' are no longer a problem. That means you no longer miss what you've lost, because you neglect it as part of who you are. But that portion of your soul that no longer has time for your hobbies? Easy - fill it with medicine." I am not so cynical, but my skin itches sometimes for more. It's not so much that I miss extracurricular activities, either, it's that I miss extracurricular learning. I miss thinking.

I feel too young some days to be tied so certainly to an academic (and ostensibly, a career) path. I don't really care if my high school friends are buying wedding dresses and applying to grad school. I'm just not there yet. I still want to be an astronaut and a writer and if National Geographic called me up, half-way into residency, I don't think it'd be a hard decision. I want to learn some philosophy, and some history; I want to understand the context of the ideas I have. I want to appease the tech geek in me and spend some time learning C++. I want to pick up a martial art. I loved what I'd taken of genetics and would like to learn more. I want to take up climbing. I want to study etymology and Koine Greek.

It's not all mutually exclusive, of course, but school drains me like it never has before. Even when I have time to read books I want to and take courses that interest me, all I want to do is sleep. I admit I'm not used to discipline in an academic context; it still feels like I have to demoralize my excited toddler-on-crack of a brain into submission in order to actually succeed in school. After fall semester, it wasn't until the end of Christmas break that I found my mind free and rested enough to actually start thinking about the things I've been learning. As unproductive as my random ponderings usually are, they make me happy. I miss having the mind-space to engage thoughtfully with life.

But for now, I am here at Jeana's table, voraciously reading about physics and wanting to write a story and make pie. My brain is happy, and so am I.

It started when I thought that to be strong you must be flame retardant

2010-01-22T22:31:00.000-07:00

I've been listening to Amanda Palmer this week. I've kept tabs on Dresden Dolls since Eds sent me a few songs half a decade ago, but her solo stuff is fascinating. Still theatrical, but not always. Her range is limited vocally, but stunning emotionally.

And I'm not gonna live my life on one side of an ampersand
And even if I went with you I'm not the girl you think I am
And I'm not gonna match you
'cause I'll lose my voice completely

I didn't get into ICC. Many good people did, and many good people didn't, so it's hard to take personally. After a few hours worrying about the inevitables of clinical rotations in the city, and the accompanying stress, seemingly unconnected things ground me again, like reminders that life is incredible, the world can be a playground, and there is so much I have yet to see.

Life is really really cool.

Change

2010-01-17T22:18:00.000-07:00

The problem is you can change the world
without changing yourself,
and people who try to change the world
without changing themselves
tend to become leaders of suicide cults
who make killing yourself righteous,
or worse,
politicians,
who make killing others righteous.

- a wise friend.

Fearfully and Wonderfully

2010-01-03T13:20:00.000-07:00

In this latest installment of college-age church dissatisfaction, I'm trying the online sermon route today. There's one obvious pitfall here though- unrestricted reign of my distractibility.

I'm still listening to the sermon. It's just paused for now, while I'm reading the Creation vs Evolution essay posted on the site of the Emerg Doc referenced as a sermon example. Well-written, balanced stuff, and encouraging to realize how long ago it was written, even if I disagree slightly with the conclusions.

I'll try to type out coherent thoughts about church later, suffice to say that it's never been deeply important to me as an institution, and I've been mostly surprised by what I don't miss, more so than what I do.

What I'm mostly thinking about these days is complexity and creation. The mechanics of how God may have made the world don't excite me as much as they used to, but I still nestle comfortably into my evolutionary theism. The aforementioned essay notes that most of how Christians choose to interact with science seems to bear more with their concept of God than on any sort of consistent set of objections. It's true. I like the story of evolution. I like God as an artist more than a magician, shaping eons of development like movements of a symphony.

I can run through evidence for certain readings of Genesis later, if anyone actually cares (... *crickets*... Okay, thought so.) And honestly, I don't really care which viewpoint people eventually subscribe to- so long as they understand the uncertainties and implications of their positions. I just want to address the statement that ends most discussions about science/religion I have with church people. They will wade through the distinction between types of knowledge, even humour a discussion of literary genres in the Old Testament, and acknowledge that using God merely as the caulking for any gaps in our scientific understanding is a foolish approach to apologetics. (My God is more than the Strong Force, thanks.) Some are even okay with the suggestion that sections of Genesis are Mythological in their approach to truth.

The objection is far more primal: "It's just too complicated."

There's something horribly messy and wasteful about natural selection, even with the provision of divine guidance. It's brutal and unelegant, and worst of all, it's indirect. There is something inherently confusing about an omnipotent being choosing to accomplish plans through such convoluted means, especially if we are to believe that humanity is somehow special amongst the species, more than a bald ape with a highly developed prefrontal cortex.

And then there's death. Buying into anything but a literalist interpretation of Genesis involves the demise of individual organisms, if not the extinction of entire species (depending on which of the non-literal readings), before humanity even emerges with the moral capability to sin. Even if we make a distinction between 'physical' and 'spiritual' death, the idea that decomposition and degradation were part of Plan A contradicts some basic assumption of my flannelgraph days.

Don't ask me how to reconcile Augustine with Darwin. I don't think it's possible. But, entering med school with this tension has led to some interesting observations in everyone's favourite class to hate- embryology.

The reason we hate it? It's complicated.

I've spent time designing dragons in the corners of my notes, and I have to say, I would never make them the way that humans are made:

It's wasteful. We go through two sets of kidneys, one pair of which we even test run for a few weeks before giving up and moving onto the third set (the ones you know and love). We spend energy creating both reproductive tracts only to destroy one. Even our precious primate digits are whittled away by cell death rather than built up. A natural selection process of sorts happens with neurons, where we go from a quadrillion neurons at age three to 100-500 trillion at adulthood. And let's not talk about the attrition of gametes leading to your existence in the first place. (See The Great Sperm Race.)
It's indirect. Why place the heart in front of the brain before folding the whole thing over to place it (hopefully) in the center of the thorax? Why push the entire contents of our abdomens out into the umbilical cord for a month while we try to grow the peritoneal cavity fast enough to fit them all back in? The kidneys we do end up using begin in our pelvis, and make a slow trek up our backs, switching blood supplies every few spinal levels.
It's messy. Aside from all the gore of childbirth, or the lasting health consequences you imparted to your mother at conception, keep in mind that you practiced breathing in utero by inhaling your own urine.

It's not just that the process is hard to learn, either. It's the fact that every step is another opportunity for something to go wrong- and there are many seemingly 'useless' steps. Each of us should be dead many times over, and it's fascinating to me that any of us make it alive, much less (mostly) intact.

Yet the complexity is also why we are alive. Most of the redundancy in our formation is why we run better than any nonorganic machine. Like our planet, our bodies are adaptable systems, and remarkably resilient. Our immune system, 99% of the time, manages to reject and accept the proper molecules. Our kidneys (I hate kidneys) are counterintuitive filters. Rather than simply throwing out all the toxins and keeping all the useful nutrients, they throw out everything smaller than albumin, and then choose to reabsorb the useful stuff. A waste of energy, until you consider that, this way, the body doesn't need to anticipate every sort of possible toxin ever to be invented and encountered. Starting with more than enough neurons allows us to choose the connections that our early childhood stimulates most, ideally the pathways that we will use most in our adulthood. Our frustratingly random networks of nerves and blood vessels ensure that blocking off a single pathway will usually still allow some oxygenation/innervation of the affected area through a collateral.

That said, I still don't understand v1.0 and v2.0 kidneys, except perhaps as part of the history of our origins, little signposts buried like trilobite fossils in the mire of our primordia.

Reset

2009-12-31T19:54:00.000-07:00

We've just spent hours talking about religion and politics, design and medicine, art history and martial arts. I love her insight into areas of life I know little about, how well our fields flesh out each other's. She explains what modernism means in terms of architecture and manufacturing, I talk about it in terms of philosophy. We mourn the backlash against post-modernism, this new scientific materialism, this new religious conservatism. We geek out over the potential of using limestone-producing bacteria to restore Venice. I muse about colour theory in terms of wavelengths and photoreceptors, she explains the philosophy behind fashion and paint choices.

Biting into a chicken wing, she says she wishes sometimes that she had gone into medicine.

I pause.

Why?

Because I wish I could actually know that I'm helping people with my life.

Art matters, I say, reflexively. I know it's true, though I haven't quite figured out why yet. I'm not going to change the world, fixing one person at a time. The things you do impact whole groups of people. It's more rewarding to see individuals and make their lives better, but that's not where lasting, societal change comes from. It's the difference between vaccinating a village and performing one brain surgery. Saving more lives is a far less concrete success.

I know what I am saying is true, but I know I'm answering the wrong question.

She continues by explaining that designers used to think they could change the world. As a uniquely practical approach to art, industrial design hopes to shape people's living environments and change how they see life. A well-designed item should endure as both function and form, and in that age-old debate, it should both reflect current times and point toward future philosophies.

When you're told that you're supposed to cause revolutions, you have to be optimistic. We got cynical though, we realized that we work for the same consumer-driven market that we claim to stand against. How can we change the way that people think when our salaries are paid by the people whose minds we want to change?

I don't know, and I tell her that. We silently stab at our food, 4 years removed from our high school idealism.

It matters. I say again. Art matters.

And then I figure out why. I'm a glorified mechanic. The body's a beautiful machine, and I'm honoured to work with it. I can make lungs breathe better, hearts beat stronger. I can replace joints so people can move again. I can kill bacteria. It's important, but it's not essential. When I'm depressed, the respiratory centers in my brainstem aren't what keep me breathing. In third world settings, the greatest predictor of a patient's prognosis is his/her sense of purpose and determination. It's true here, too, with a lot of chronic pain. And yet we are offended to think that illness is at least partially 'in our heads'. Maybe mental health is medicine. Maybe it's art. Maybe it's both.

But the thing is, all my manipulation of physiology does is provide a vessel, a means to life. That's useless though, on its own. Good art reminds us to seek and sacrifice, to find meaning to existence. It inspires and reminds. Art can communicate hope.

She smiles.

By the River

2009-12-26T09:57:00.007-07:00

Today I cross thin ice for you

Scaling fences with you in mind

I ascend, hands frost-burnt

To this temple, rising out of the mist

Like it were morning and we were pilgrims

Seeking enlightenment or salvation

Bargaining the prices of our souls

Your heart is heavier than a feather

But it is warm with fire.

I would give anything.

the hopes and fears of all the years

2009-12-25T08:43:00.002-07:00

My body is too cold to sleep, an uncharacteristic 5 layers later. Even the down comforter isn't helping, so I give in and scavenge breakfast, contemplating giving my mom a head start on the cake she had planned. Instead, I add my laptop to the layers of warmth and listen to old, predictable songs.

Outside, all is snowy and dark. The sun won't rise for at least another hour, daylight still stymied by angles and distance. I haven't noticed the darkness as acutely this year, aside from gawking at the sky in hopes of meteors, walking to the bus stop. I am on edge against it- I am always on edge against it- but I wonder if I will be able to make it through most of this year without shutting myself down.

I've heard back from 2 of the 3 places I applied to for electives now. Options so far are research with other international medical students in Brazil or community medicine projects with Chantelle with a university hospital in Dharan, Nepal. The final elective, and my personal first choice, a leprosy rehabilitation hospital in Pokhara, remains silent.

It doesn't feel like Christmas. This is a good thing.

I think I'll go for a walk.

Twenty-one

2009-12-20T23:22:00.003-07:00

Jeana and AJ orchestrated a weekend I could never have imagined for myself. From the first hug in Katz, my mind still preoccupied with the preceding quiz, to the parting in the airport, every moment has been two moments. It's been months since I've really allowed myself to sink into nostalgia, but there is so much value in seeing the places that have held me through the eyes of another. There is so much context to the random escapades that have been outlined in text, triggers to remember the people I have been.

The bridge by Ainlay, where Berni, Vera and I went after Nico died, where Andrew helped me burn a note I had written in my mind for years. The windowsill I'd sit in and study in, in ETLC. The tables there where Shinobi, Eds, Uri and I would construct Froot Loop graphs or sandwiches. Philosophy books Dennis, Zak, Vera and I would peruse. The river, that I've rowed and walked alongside and walked even, the paths that my muscles know when my mind forgets. The greenhouse and the friendly birds that ate my lunch every now and then. Even my bookshelf is piled with memories, trinkets from places I've been, rocks from friends old and new, the weight each has pressed into who I am.

And as we sat around a table last night, Cindy and Shinobi, AJ and Jeana, Berni and I, I couldn't help but marvel at the miracle of each of these people. They are my people. Locked in a room together, they could likely retell every significant moment of my life. Even if I don't see all of them as often as I used to, they have witnessed the past 8 years of my life (what I consider my real existence, when I started expressing myself beyond the confines of my head).

I mourned a little, this morning. It sometimes takes the borrowed eyes of a visitor to recognize what has been true for awhile. I don't always like the edges of me, but I have them now, more certainly than I ever did. It'd been ages since Ainlay was where I fit, and even main campus felt slightly foreign, a couple of years later. It isn't the places that change, it is me, and this is both sorrow and joy.

But there were new escapades with my new self. New adventures to remind me of life, and the sweetness of being. Cracking ice and cold snow melting through my hoodie, chain-linked ladders and concrete playgrounds. A bridge under construction, claiming forbidden ground. New places to belong.

And I got to show AJ and Jeana a part of campus that is representative to much of what occupies me these days. I can't adventure as much as I used to, as spontaneously as I used to, and yet this new phase doesn't lack goodness. It is hard for me to devote myself, mind, heart and body, to the study of any one thing, rather than to a thousand little pursuits. But there are rewards, like today, information tumbling from my mouth as I realize how much medicine is becoming a place for me. It's small in geography, but a deep well. And so I have been poured into it, molten steel, exchanging old corners for new, filling a different form, different purpose, same substance.

My body needs sleep but my heart is strong.

bursting at the seams

2009-12-18T22:00:00.001-07:00

I am so happy right now.

Two days

2009-12-15T19:10:00.000-07:00

...'til my ICC interview.

Three days 'til Christmas break.

One-and-a-half more weeks 'til Christmas.

One more month 'til MSK is over.

Two-and-a-half more blocks 'til the end of the year.

One more semester 'til I'm done with lecture-based learning, forever.

Two more years 'til I apply for residency.

Two-and-a-half more years 'til I graduate.

It's hard to see life as more than the countdown. To do more than clamp down and focus on the numbers, hear more than the sound of engines powering up and feel more than the seemingly accelerating passage of time.

I am sitting on the kitchen floor with Theo-the-faithful, my laptop, trying to work a knot out of my left trapezius against the corner of the island. I don't know what has happened to the past few months. Occasionally, we get lectures on elusive concepts like 'balance' or 'resilience', and I try to grasp exactly what other people mean with those words.

I'm not quite sure what they are to me either.

I do know that I like having quizzes on Fridays, so that I don't have to study through most weekends. I know that the occasional real breakfast at home, with tea and webcomics, is exponentially better than a ziploc bag of cereal in class. I know I like getting eight hours of sleep and I like the Discovery Channel theme song (... boom de yada). Smaller, less poignant blessings, not the stuff of dreams or ideals, but real things that matter and keep me going.

Life is less heavy this school year, perhaps because I'm learning to deal with stress better, or perhaps I'm simply too tired to feel it anymore. It's honestly hard to tell. I know that I'm depressed or anxious far less often this fall than I've ever been since elementary school, and yet I must still be feeling because I've been able to recognize anger and vocalize it, rather than become self destructive. I also know that it's harder than ever to move beyond the items and objects of life to the concepts and principles that used to occupy my mind. I miss the internal monologue, solving the problems of the universe-- or creating new ones-- in the margins of my days. I miss quickly finding things to say to people, meaningful things, personal things. Sometimes the distance is a good thing. Instead of being paralyzed by the prospect of future failures, I set study goals for the night. Or I rehearse clinical exams on the bus, timing myself as I imagine the motions. I still feel scared or angry or sad sometimes, but the emotions seem transient and then my mind is quiet again.

I'm not fully satisfied with how I'm living, but it is functional and I can't fault that. It's a stage, not a destination. But then, I am rarely completely at rest in places. And ahead of me, soon enough, is time, hopefully for rest. Time to remember how to explore the insides of my mind, rather than use it like a machine. Time for good people and short, bright days, and dark, clear nights.

I want to get through a few more anatomy lectures tonight.

Running for Buses

2009-11-23T18:51:00.001-07:00

Lately, it's difficult to write or talk about life. Things are not terribly remarkable, although they are also not remarkably terrible. Things are. I am.

Every morning, running out to the bus stop, I catch my thoughts introducing myself to the world. "My name is Anna. I'm __________." It changes every day. "I'm strange, but strangely okay with that." Or "I'm learning." Or "I'm here. And it's now." Or something equally simple, maybe trite. But my self seems insistent on introducing and reintroducing, reminding, remembering, becoming. So I let the thoughts flow, propelling myself into another chilly morning.

Weekend mornings, I savour empty houses and cooking adventures. Goat cheese and dried figs on flatbread, egg on the side, with earl grey tea for breakfast. Salmon with snap peas and sweet tomatoes for lunch. Dinner involves Chinese food from T&T, duck and tofu, greens I know by sight, not name. If all works out and I am living in a small town this time next year, I will miss having my family's amazing food selection at my disposal.

I drove on the Henday yesterday. First time I've broken 100km/h. My dad no longer cringes when I am too sudden with the brakes, or perhaps I am giving him less reason to cringe. He gives me his vote of confidence on my odds of getting my license before I leave the country. I feel 16, practicing turning and merging, but these are things I couldn't do at 16. It's odd how confidence feeds into itself, how I can shake off a less-than-stellar mark, how I can guide tonnes of steel along icy roads, how I can choose to make dinosaur noises in the middle of a room full of classmates. These are things I couldn't do at 16.

I should be studying gynecology, but my screen is divided between passport renewal forms, the Integrated Community Clerkship application, and a dozen tabs of information on travel immunizations and Nepalese visas. None of it is remotely certain, and yet the possible futures are snowballing now, this Friday's final, 3 more blocks, then the comp exam. Off for 6 weeks at a hospital in Nepal, a bit of sight-seeing, and then to a small town for clerkship. A place of my own, a schedule of my own, a life and learning to carve out for myself.

Life is happening. Change is happening. My parents are learning to live with each other again. Ivan has a girlfriend. Friends are finding the places where they fit, and they root themselves ever more certainly in the world. I am still restless, I am always restless, and my peace with my degree comes only in understanding that medicine is just one thing. There will be other places to go and things to try. My soul's settling down into these academic patterns, even as I plan for new adventures.

Catching buses. Going places. It seems just moments from the first lecture in the Katz theatre, but already I am weathered and more confident, beginning to believe that while I don't know much medicine, I don't know much life, I know some things, and I will learn what I need to know.

I rest my face against grimy glass, and watch lights streaming past in the snow.

Remember

2009-11-11T12:52:00.002-07:00

In Flanders fields, the poppies blow
Between the crosses, row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below...

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved, and were loved, and now we lie
In Flanders fields...

Take up our quarrel with the foe:
To you from failing hands, we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields...

-John McCrae

.

Thank you.

Inventory

2009-11-05T22:56:00.001-07:00

I've been playing with this to procrastinate. It's interesting to characterize writing as 'masculine' or 'feminine' (although this gadget and the study it stems from seems to be more concerned with the author's gender than that of the text). Almost all of my writing seems to score as 'male', probably due to the lack of personal pronouns as "she" and "we" are both worth many 'male' points. Using more 'and's seems to be the one thing that will catapult a given section of writing into the 'female' side, conversely.

It's Repro (reproduction) block, so gender theory is an inevitable part of the curriculum, overtly or implicitly. While I'm not qualified to talk about sexual identity, I'm fascinated by the philosophy behind transgenderism--- its existence assumes gender as a concrete facet of identity, contrary perhaps to political correctness.

The theory is that even as the presence/absence of testosterone causes masculinization/femininization of one's internal and external physical features, sex hormone effects also extend to the brain. Disruptions in hormone exposure in utero can cause genetic and external physical sex to differ (see recent sports news and at least two Miss America winners). Hormonal errors can also cause internal and external physical sex to differ- eg: a person with male internal gonads but a female body form. Given these cases, it isn't unreasonable to think that 'brain sex' can also be different than physical sex. What separates a male brain vs female brain, I can't speculate, but there are a growing number of studies in this field.

For my part, I'm trying to put my bevy of questions on hold until after this block is over. But I have to wonder (however ignorantly) if the radical sex-reassignment-surgeries some transgendered people choose to undergo would be as popular if gender did not remain so important to society.

Everyone's sick of hearing about H1N1, especially those of us living next to the hospital. Peds ICU is putting the healthy kids in the isolation rooms since every other kid is infected. Public Health hasn't slept in weeks. Let's not talk about how Emerg is doing.

Incidentally, H1N1 has saved at least one life-- a good friend with asthma was too sick to smoke for a week, and is now well on the path to quitting.

People far more qualified than I have had much to say on the topic of vaccines, all I'll say is that I think that those who have access and are not allergic should get the shot. Even if you are healthy and at low risk, herd immunity is your social responsibility.

(H1N1 viron by Luke Jerram, via BBC).

[reviewing Cardio and playing with words.]

2009-10-11T15:15:00.005-06:00

Post-Call

Night shift
A series of friends present in obvious distress:
- Syncope of misplaced affection
- Regretful atrial flutter
- Post-relational angina
- Chronic melancholic bradycardia

I drop a beat.
No, two.

Physician heal thine own
Coding conduction block.
Coolly clinical skin.
Stagnant ventricle blood.
My forgetful drummer.

Give me a chemical pulse, Cocktail beats
regularly irregular, Press
these leads to pale flesh. A jolt

Let's start over
This muscular music,
This call-response of valvular voice,

Me-Me. You-You. Life-Life. Love—
Life-Life. Death-Death. Truth-Truth. Love—
Love—
Love—
Love—

help i'm alive

2009-10-10T20:13:00.010-06:00

I tremble

They're gonna eat me alive

If I stumble

They're gonna eat me alive

I'm getting more used to not knowing answers. It's not so bad, guessing my way through exam questions, wondering why I can't summon those neatly packaged facts back to my working memory, calculating percentages as I tally up my uncertainties.

Frankly, I'm not sure what is 'acceptable'. I'm not sure what is expected. And no one can tell me. I just want to be adequate. Competent. Knowledgeable. Keep my head down and work hard and hope.

I get wherever I'm going
I get whatever I need
While my blood's still flowing
And my heart still beats

Went for a walk on the High Level this morning. Hadn't quite realized how close it is to campus. Could stop by, eat lunch over the water.

I like bridges. Maybe it started in high school, lingering in that concrete overpass winter mornings, watching traffic stream past. I seek them out now. They're good places to be still and let the world rush on.

Hard to be soft

Tough to be tender

Come take my pulse

The pace is on a runaway train

There's a Thanksgiving party tonight but I didn't make it that far. It's nothing against people. I just am odd around them, laughter too brittle, questions too distant. It's the cause and effect of paranoia. There is a delicate balance: I want time away from opinions and emotions and judgments; the more I detach myself from others the more tempted I am to let go.

Soup and Canada's inbred indie scene. A quiet house and central heating.

I am so tired.

Help I'm alive

My heart keeps
Beating like a hammer

Deleting Death

2009-10-01T21:37:00.006-06:00

I'm usually not overly keen on identifying as a med student, but the MedGear designs were pretty this year and I have a weakness for graphic tees and hoodies...

At left is one of my favourite designs. I'm a sucker for typography.

It is snazzy. And possibly meaningful.

I just got an email-- they've made a change to the design. Apparently some people thought the word 'death 'was far too prominent. And perhaps it is.

But death is important. Medicine is about healing and compassion and prevention and sacrifice and commitment and change.... but medicine is also about death. Death is the battle we are losing, or the outcome we are averting, or the process we are seeking to humanize. Death is the natural close to a well-lived life. Death is the unfair ending. Death is.

Here's the new design. Nothing innately wrong with it, of course, but it seems a bit emptier to me.

I'd like to delete death. Believe me, I would. I would like to delete the awkward words of an ER resident, trying to explain to a patient's family that their father is in the last stages of heart failure as nurses rush by in the busy hallway. I would like to retrieve my grandmother and Ivan's piano teacher and a ten year old who hung himself while his parents fought in the kitchen.

To a medic, death is our Achilles heel, our failing. We will touch death, we will fight it, we will see it come gently and we will see it come horrifically. And perhaps all we can hope for that we will not cause death.

But death is what keeps us humble--- because no matter our heart or compassion or responsibility or knowledge, our patients will die. And so will we.

Still Here

2009-09-21T19:26:00.004-06:00

Sunday morning, a couple tears escaped during singing in church. It had nothing to do with the service; it had everything to do with the news story my mom had paraphrased to me while I brushed my teeth. The segment had interviewed parents in Afghanistan who choose to dope their children with opium to dull the sensation of hunger. A thirteen year old had noted that it made him 'feel less sad.' "I don't want to hear it," I told my mother, shutting the bathroom door against the words.

And maybe it shouldn't have been so surprising to remember that I am capable of caring as more than an act of mind and will. For all the horrific things to which I've allowed myself to be acclimatized, there are still levels of tragedy that can catch me off-guard. It was good to realize this. Good, when I am settled in learning and practicing and planning, to find the kernel of outrage that makes me long to seek and find and heal and love.

Life shifts every couple of years. One year of transition, one year of understanding. Last year was the transition, this year is the understanding. Growing roots and letting more of myself sink into the places I go. Illogical maybe, when next year I'll take flight again, before another year of rest, then another year of movement...

It is distinctly fall now. Leaves linger greenly, but the air has an edge to it against my throat, running for buses in the morning. Sunrise slips later, glinting off migrating geese as my shoes clap against pavement. Fall is my favourite season, a shifting of activity and contemplation, vibrant and brilliant and short. Darkness will find me soon enough; I have no more of a contingency plan than I ever do, only the faint hope that I may keep learning and growing and changing for the better.

Seasons and patterns and cycles. I wonder when and where I will land.

Refocus

2009-08-30T00:35:00.005-06:00

The evening is waning, but the five med students present have found our way into the living room, thirsty for advice. This Interserve meeting's presenter is a obstetrician/gynecologist, who spent 4.5 years, before the closing of the borders, before the onset of a chronic illness, in Afghanistan.

Young medics, we are all cut from the same cloth of faith-driven idealism, and our questions are many. "What are the most useful specialties in international medicine?" "When is the most practical time to do overseas electives during training?" "What's one thing you wish you had done differently before going to Afghanistan?"

Her response to the latter: "Realize I can't do it all."

We pause.

There will always be need, the doctor tells us. There will always be too much need. We will never fill it to our own satisfaction, nor the satisfaction of others. She explains the seemingly simple choice between a night's sleep and the sick patient at the gates of the hospital. Of that same choice multiplied night after night. Of the utter helplessness of contemplating a career ended after 5 short years, due to illness and politics.

We cling to her words like sacred relics. So many of our choices are driven by our awareness of the needs of others. As she quotes Romans 12 in perspective of her own experience, we nod along, understanding that sacrifice of our lives is necessary. We have all felt the twinge inside that whispers that it would give anything, do anything, see and climb and touch anything if only to reshape the world. I have often longed to offer something, anything, to create a purpose to justify breathing, a reason to allow myself life.

She moves in the scriptural passage though, backward, not forward. "Who has ever given to God, that God should repay him?" Who has ever given to God? She lingers on each word.

We do not seek to heal because we need to fix things, we do not heal because the world is broken, we do not heal to redeem ourselves. We heal because of our relationship with the Healer, because we have been redeemed, we heal because it is who we are created and called to be.

"Be driven by God's calling, not by the world's need," she tells us, gently.

There is something freeing in her perspective.

the colour of our planet from far, far away

2009-07-25T10:48:00.005-06:00

Old friends talk and I remember why I love the shapes of their speech. There's a distinct syntax that makes a voice a voice even when there is no sound, just the curve of san serif fonts and the spacing of words and rhythm of line breaks. A broken poetry of sorts.

Nights ago, I wandered out of the basement of the house, sweat-sticky in the humid heat, sprawling in a shadowy patch of grass. The stars speckled above between streaming ions, magnetism and magic. I sung, of my own accord for the first time this summer, something melting finally.

I flow through seasons with my heart. Sometimes it takes weeks to soften myself again, to find the way of living that is truly open to absorbing the lives of others, the ease of being that soaks up the sorrow and joys alike. It's only now that I'm beginning to find that freedom.

Why I harden again when I do, I don't know. But I know the little things like Pam's incredible joy after a night of laughter and tears with her cabin, her face shedding light as she talks about the friendships that have built up between her girls. I tell her I admire how she takes all of these things to heart so consistently. She tells me that she can't imagine any other way of living being worth living, and I love her all the more.

Try to Move Your Feet

2009-07-18T16:10:00.003-06:00

It's like forgetting the words to your favorite song.
You can't believe it; you were always singing along.
It was so easy and the words so sweet.
You can't remember; you try to move your feet.

- Regina Spektor

Today, I returned home and realize the sprig of ivy on my bookshelf is officially dead. I picked it up from the pruning clippings 3 Christmases ago, one lonely, hopeful day. It never grew, but it never died, a stunted reminder of where my affections lay when I was 17. This summer, it started to wilt despite my watering, 'til only 3 leaves were vaguely green when Staff Training Week started.

It is now very dead. Tangle of dry roots and faded leaves. I scorch it with a lighter, reducing life to carbon.

Hope is such a funny thing, how something so significant can wither away until there are no tears as I set it ablaze.

Camp has consumed the last 3 weeks. It is a hard, trying, rewarding experience as always, sunbleached and tearstained. My CLTs have come and gone, almost before I could comprehend it. Many are returning as support staff, but the program is over and summer presses on.

They were very different from last year's group. Younger, more outspoken, less harmonious, more raw. I loved them just as much, even as I fought feeling like a cabin leader to all 18 of these crazy kids. I question if I had enough to give them, emotionally, even as I know that questions like that are futile when I know I gave all that I had.

It is a hard thing to hear the stories of my kids from last year, their tangled lives in the months since last summer. The things they didn't tell me, the guns they pressed to their heads, the meals they didn't eat, the chemicals they ingested; all these things they didn't tell me. I long to show them how much they are loved, wishing they could understand how much they are worth.

First aid attending is a challenge for me. I fight the sense of inadequacy that coils around my ankles, the voice that reminds me that I lack so much in practical knowledge. Even as I draft a policy for suspected cases of H1N1, I question decisions of the past week, drugs I dispensed or didn't dispense, the questions I didn't ask, the wounds I could have monitored more closely. It is difficult to separate my role at camp from my deep insecurities with school, and I still find myself far less decisive than would be ideal.

Is this what I am called to do?

I mull over this question as I hand out vitamins and pull out slivers. I consider stomach aches and puncture wounds with gravity, a thousand differential diagnoses swimming through my mind. A fellow staff remarks that "First aid is all common sense; anyone can do it," and I wonder why I feel that I cannot.

Living in a community like camp is becoming a bit of a jarring transition for me. I am introverted in every sense, and I feel that I've forgotten how to learn to get to know new people, as much as I desire to. I love the other girls on leadership, but find that I lack the energy or desire or whatever it is that makes girls able to collapse together into laughter together, or disappear for their breaks with a bag of chocolate to debrief about boys. I almost wish I understood these things at times like these. Instead, I stare blankly at the cards in my hand when the cabin leaders try to include me in one of their ridiculous games, unable to comment on the romantic potential of any of the guy staff.

People seem so inconsistent and distant. It is my fault, disappearing from Edmonton as I always do with little time or ability to keep in touch with the people I love. I long for deep conversations, but have nothing to say when I start them. I want connection, but seem to have forgotten how to have fun in the conventional sense. And so I sit alone in my room in the house, praying for my CLTs or reading or memorizing, wondering why the things I want most to say make so little sense in the ears of others.

I want my life to be significant. I forget sometimes that I want to change the world. And then I remember, and I ache with the understanding of my flaws and failures.

It is the small moments that sustain me. The things I am learning. I talk to the campers in the few moments I have with them atop the zipline. I learn what they have learned each week, to offer their cabin leaders some encouragement. I take a page from Dr. D__ and pray, at first hesitantly, over visitors to the first aid cabin, or staff sick in their beds. I ponder the interconnectedness of the physical and the spiritual when healing does occur in several senses. I get to answer the questions of a cabin of asian geeks (who ask me for three digit numbers so they can square root them for me in their heads) about science and religion. I pray protection over a CLT who dreams of demons and suicide and learn that the nightmares cease. I am a bit stunned still, clumsy at fighting these things, grateful for each victory, knowing that the only battles that can be won are those that I am intended to win.

Thunder on the horizon. The air is electric.