28

I’ve been neglectful lately. Somewhat willfully, since I have been gifted late mornings and a job that I leave behind when I go home. But somehow I have not had the drive to write. And I have suffered for it, I think. Like exercise or yoga, reflection is one of those activities that makes us feel so good that they are the first thing to go when we get anxious or restless.

So I am nearing the end of my 2nd rotation. Family Medicine. Experiences continue to occur, although I feel less engaged by them this 6 weeks around. I’m not sure if it’s the place I’m learning or the field itself, but I certainly don’t feel the light me up sort of passion I felt during my OB/GYN rotation. That may not be a bad thing. In fact, if my goal is to wind up living a balanced life where medicine is a job rather than a lifestyle, family medicine is the simplest answer. For sure it is lackluster, but I like to think that it would inspire me to seek passion elsewhere. That said I have some concern that dullness is catching – leaving me with an overall subdued existence. The dying adolescent in me shudders at the thought of such complacency (the horror, oh the horror). Of course I also am worried that an uninspired medical career would swing the pendulum in some warped direction where I forget to fill my time with things like outdoors, music, food, art, politics, thought, people, etc, etc. Instead, in search of more intensity, I would resort to old habits of poking at my relationships till I create some purposeless drama and find myself in a familiar mess I had sworn off years ago. Luckily no decisions have to be made yet. This year is just for observation and information gathering.

In truth, the last 4 weeks have brought out strong examples of both responses. Instead of writing and reading and playing and exercising, I have slept and complained, and (oh the shame of admitting this) watched T.V. And when I wasn’t doing that, I was regressing to my late teens and foolishly getting caught up in ridiculous drama. I behaved poorly towards others and towards myself and almost cost myself a friendship or two (the outcome may still be uncertain). Suddenly old tapes were playing and I lost the clarifying breath of perspective; I became a person I like to think I no longer am, but obviously still have the capability of becoming. I suppose we are never rid of our lessons learned.

But on the eve of the start of my 28th year, I figure I get to clear a slate. Birthdays, like New Years, are good times to kick start the drive to grow and improve. Resolutions (that will always be broken, and set again) abound. As Emily would say, it’s probably a good time to build that bridge (yet again) and get over it (thanks lady).

Well, sentimentality is getting the best of me, but it’s almost my birthday, so I can give in to it tonight. I just want to say thank you to all the folks in my life (those who read this and those who don’t). I am damn lucky to know such incredible people. When I look around, I see crazy beauty and passionate commitment and so much laughter. It’s a good reminder to breathe and live it up, all purty like.

I love y’all.

Well Said

Exactly that. . . well said
You can sign it too (scroll down to the very bottom).

Part 4: Economic Down-Turn

This is Part 4 of a 4 Part Entry. . you might want to scroll down to Part 1 - Sometimes Dreams Do Come True.
**
Other highlights included an incredibly athletic, very tall black stripper who was so flexible (like pretzel flexible) that I’m pretty sure she had some cartilage disorder. At one point she was doing the splits and then put her arms under her legs and lifted her entire body off of the floor and proceeded to do multiple push-ups. It was like Olympic gymnast quality. I was floored. I went up to the dance floor and gave her money, but I made someone go with me.

A highly informative chance encounter with a different stripper in the bathroom revealed that stripping has lost some of its stigma and has seen an increase in the number of women coming to strip bars. According to her women in strip clubs are a mixed bag because, while they do buy dances, they usually only buy one and they often make the 40 y/o virgin males (“who still live with their moms. . .can you believe that?”) uncomfortable and shy. Just like Sexy Lexi, she loves her job, although she is disappointed by the recent decrease in her earnings which she suspects is due to the economic down-turn and high price of gas.

Very rarely, illusions do (more or less) turn out to be the reality. I am still completely overwhelmed by the amazingness of last night. Really, all that was missing was a pole.

Part 3: The Wisdom of our Elders

This is Part 3 of a 4 Part Entry. . you might want to scroll down to Part 1 - Sometimes Dreams Do Come True.
**
When the waitress came over to take our drinks, Sexy Lexi told her my plan. The overweight, older waitress became very concerned that I was serious and said, “Honey, do not drop out of medical school to become a stripper. I mean, you could do it, and maybe do it to pay for school, but don’t drop out of school. It may look glamorous, but it gets old fast. You only have a few years in you, and then, well. . I used to be a stripper, and now look at me – waiting tables here.” I felt like I was in a movie.

I reassured her I wouldn’t do it, and counted myself lucky. It’s not often one receives words of wisdom from a former stripper.

Part 2: A Stripper Called Me Crazy, And Other Tales of The Night

This is Part 2 of a 4 Part Entry. . you might want to scroll down to Part 1 - Sometimes Dreams Do Come True.
**
Sexy Lexi was the 26 year-old woman who my kind and generous colleague hired to give me a lap dance. She started by telling me I was hanging out with a very hot group of guys, “Um, thanks?,” I said. I wasn’t really sure what to make of that.

(On a side note, what does one do during a lap dance if one is getting a lap dance? Obviously no touching, but where are you supposed to look? What facial expression are you supposed to have? I felt horribly awkward and when I feel awkward, I just start grinning from ear to ear. I’m not sure goofy grin is the facial expression of choice for lap dance reception.)

My friend chose wisely in Sexy Lexi. When she was done, she said “So you guys are really all medical students? I have so many questions for you.”

Could this have been any more perfect? I was so excited “And I have so many questions for you!”

Turns out, she has her BA in international politics and used to work as a para-legal until she found that she makes bank (and I mean bank) stripping. She and a friend are essentially traveling strippers. They come to a USA town that has good gigs, strip for a while, and then take all of their earned cash and go travel to other countries (Guatemala, Costa Rica, Japan next). Eventually she wants to go back to school to get her masters and become a Mandarin Chinese interpreter. Really, not a bad set-up.

I asked her if she likes stripping. “I love this work, it is so much fun.” And she told me that the lap dances are for the customer, but on stage, she dances for herself. Wow. I was totally sold.

She hung out with our group for a while. She told us that she wanted to make out with all of us and we should return on the 27th, her last night of work, when she didn’t care if she got fired (later at the all-night diner, my friend said earnestly: “No, I don’t think I’m going to go back on the 27th – hah!). The anthropologist in me continued to pick her brain. I told her about my fascination with strippers and that I was thinking about dropping out of medical school to become a stripper. (a joke folks, a joke). “You are really crazy,” she said and then looked at my friends, “She is really crazy.”

Part 1: Sometimes Dreams Do Come True

I went to a strip club last night. The Great Alaskan Bush Company is apparently notorious for being the “classiest strip club outside of Vegas” (according to my friend, it is the tourist strip club in Anchorage - who knew there were strip clubs for tourists and strip clubs for locals). A regular hang out spot, I was told, even the women come there to hang out. And, once I became desensitized to all of the tits, ass, and pussy, it was sort of like a normal night’s activity. It was more like watching a show, or going to the circus than it was like hanging out at a bar since everyone’s attention was focused in one general direction (the naked women) rather than scattered over the variety of intentions found in a bar. It was, as my friend put it, a sort of amusement park. I didn’t find it particularly arousing or erotic (I actually felt the opposite of those), but I was never bored, so I guess I can understand the entertainment value of the whole thing.

The truth is, I’ve wanted to go to a strip club for a long time. There is an allure there similar to my fascination with debutantes, sororities, Texas high school football, and the mafia. It’s rooted in curiosity about a culture that exists side by side with, but is very different from my own. And, if I’m being honest, I have several glorified fantasies of those lives not lived. I mean, really, what girl hasn’t wondered at some point about what it’d be like to be a stripper. So yeah, I’ve wanted to go for a long time, but I was always reticent for fear of shattering the illusions I have about the glamorous lives of happy strippers. I didn’t want to see the depressing reality of sleazy bars, disgusting old men, and miserable, bitter women. I figured that I would just chose wisely so that the strip club I would eventually go to would be clean and classy and not too much of a let down. Who knew I would find all that and more on my first real night out in Alaska? (I love that this is one of the first things I’ve done other than medicine in AK)

Mistakes Were Made (Mistakes Will Be Made)

Yesterday was one of those days that reminds you that humility is not always a graceful, humbling, educational experience. Sometimes it comes in the form of plain old red face embarrassment.

So I finally got to do my first pelvic exam. It was going ok (not great, not horrifically) until (you knew there was an until) the bimanual exam. Now, mind you I got an “Exceeds Expectations” on this part of my OSCE during medical school, so I was thinking, “yah, I got this one down.” Apparently doing a bimanual exam on a plastic model with no legs and no pubic hair is a bit different than doing a bimanual exam on a real live human being.

Without being too graphic, what happened involved some uncertain fingers, a misguided approach (but, thankfully no entry), and a rapid readjustment prompted by the patient’s, “Um. . .are you supposed to use the back door?” My attending looked at me horrified and asked “Did you just do a recto-vaginal exam???” I shook my head (somewhat frantically) and said “No,” in an incredulous voice (as if to say, “what do you think I am, an idiot?” Of course I am an idiot. That’s my job, and that’s all I am going to be for the next few years). This was the beautiful conclusion to a very long day of me being unable to answer basic questions like “what is pregnancy induced hypertension.” I perceived the aftermath to be a totally disappointed attending who thinks I am hopeless.

I left the clinic humiliated, beating up on myself. I had excuses: I’ve been sick, on cold meds, end of the day, first pelvic exam in almost a year, nervous, etc., etc., etc. But, that didn’t make me feel better. I was not a happy girl. And then I realized that I had damn well better laugh at myself for a botched pelvic exam, because if I don’t start lightening up on myself, I’m going to have a complete breakdown when I accidentally cut an artery in surgery or hit a nerve during a procedure. I say when because mistakes will be made (for good reasons and for no reasons) – it’s a matter of time, not a matter of if .

Lesson One: Check

First lesson. I know that I have ranted and raved about how taking a political stand is one of our most important doctorly duties, but sometimes my words taste mighty sweet, so I am eating them. Nurse D is sort of in charge of our experience in L&D (that’s labor and delivery in fancy schmancy medicine talk). She’s an important person to be on the in’s and in’s with. She’s someone you want to be on your side. You don’t want to piss her off. And, as I learned yesterday, you don’t want to let her see the Obama pin on your bag, because that quickly pisses her off and puts you on the out’s and out’s, on her enemy’s team. Here was the sequence of events: Scene 1: Laughing about small talk, everyone smiling. Scene 2: awkward elevator induced silence during which Nurse D eyed the offending pin on my bag and then scowled at me (there were eyewitnesses to this event, so it wasn’t my paranoia). Scene 3: Nurse D is mean and unfriendly towards me, but nice and friendly with everyone else. Scene 4: I covertly (and sheepishly), take the pin off of my bag and stuff it into my bag, along with my high horse (see earlier posts). Apparently AK is a red state. Who knew? Chalk that error up to education: Lesson one learned.

So this bring up 2 things. First, if I accept that my job right now is to learn everything I can from everyone willing (and unwilling) to teach, projecting my strong opinions about things is probably not the best way to be successful at my job. I remember in grade school they used to tell us to put our hands down and write down our idea so we could pay attention to our classmate speaking instead of spending all our energy concentrating on the brilliant statements we wanted to make. I’m not saying I need to give up my core beliefs and not so core political alliances, but I do believe that, at least in these early days, the more neutral of an image I present to my teachers, the more they will be willing to fill in my (seemingly) blank pages with their thoughts and knowledge. Then I get to go home and use those stored morals and values to sort through their beliefs and ideas. And I guess that brings me to number 2. Being neutral (within reason – you have to have a spine and think for yourself) for our elders is beneficial (again, in the early days); being neutral for our patients is almost essential. This is why we dress nicely, but not too nicely (business casual, or maybe a bit more). This is why, at least early on, we do not wear flashy jewelry, or dye our hair green, or show too much cleavage. It’s almost as if we want to be inconspicuous, because the less our patients notice us as individuals, the more reflective we become, and the more they divulge to us (and usually themselves) and the more we are able to help them (and they themselves). Later on, as we learn other tricks and become more steady on our doctor feet, this undercover, almost sneaky method of information gathering will become less important, but right now, it’s one of the only tools we have.

Hardness

This is hard. So much harder than I thought it would be. I truly believed that I was going to enjoy studying for the boards. I had visions of studying for 8 hours a day, and then going home to cook dinner, run, play frisbee, watch movies, read a book, play guitar, languish in long philosophical conversations with friends over wine or beer. This was going to be the beginning of reclaiming just a little tiny bit of my life back. I was going to be able to start being that person I used to be, or that person I really, really want to be. So innocent, so naive.

Turns out this is hard. It’s not that the 8 hours has turned into 10 and 12 hours. It’s not that I’m (not surprisingly) so much less productive and efficient than I imagined myself being. It’s not even that I am finding relearning this stuff less interesting than I had hoped. It’s the hopelessness. It’s the reality that I will spend my next 3 weeks studying all of the time only to start working 100 hours a week. Sure, it is doing something I want to do (or that I willingly signed up to do), but it’s actually that much further from being able to shape my life into something that feels more manageable, more bearable, more me.

Roughly two weeks ago I had a conversation with a colleague. Not a friend, but a classmate I know from before I even started at UW. Back then, he was making the same decision between schools as I was and we conversed a bit through email about the decision. Without knowing each other’s names, we exchanged pertinent personal background data and gave each other tips/insight into our “difficult” decision. I had a symbolic crush on him – he seemed so thoughtful, so smart, so interesting, so passionate. . .to me he was exemplary of the world I was about to enter – endless possibility, life changing, completely engaging, and the future source of my most meaningful friendships and, hopefully, lifelong partner. He remains symbolic to me because he, like so much of this experience, has been vastly different than what I expected. Almost the personification of this school, I find him subtly deceptive and frequently the bearer of cold truth. I don’t dislike him, but I am wary around him. We were at baseball game and as we walked out, we started some uncomfortable small talk about the end of the year and how great it felt and how we can’t wait until we get to start “what we really came here for.” I mentioned how nice it was to have some free time. He laughed almost ominously, “It’s nice,” he said “that we get a transition. That we get to slowly move from our old lives to this new one. That we have 2 years to adjust to being busy all the time, to never having enough time to ourselves, two years to become doctors. I don’t think I could do it overnight.”

There is a good deal of talk in medical school about becoming a doctor. We talk about the privileges and the responsibilities. We talk about the changes and the sacrifices. We talk about what it means to our family, what it means to our communities, and what it means to the greater world around us. And we talk about what it means to us. My colleague, the bearer of realities I’d rather ignore, seems to have equated becoming a doctor with sacrifice of self. I’m not sure he would describe it that way, but I think he will thrive on denying himself to serve his profession. I think he is excited about that (and in some ways, what an easy way to live .. if you know that your work is the most important thing, decisions are essentially made for you).

At this point I am far from sure about what becoming a doctor means to me. Truth is, I think I’ve been (and continue to be) in a bit of a denial about how much this process will change me. A good piece of me still believes that when I am done with these eight years, I will just return to the life that I lived before. I will have this skill when I am done, and with it I will simply slip back into the life I’ve put on hold. Intellectually I know that this is unlikely and emotionally I am beginning to realize that no matter how I resist, I will finish this 8-year process a completely different person. Obviously 8 years doing anything changes someone. I think what I have been fighting (tooth and nail) is the rather obvious idea that this process is going to change me in ways different than if I’d done something else for the next 8 years. What I think I am uncomfortable with is that there is a prescribed change that I have to go through so that I can become this doctor person. It seems like I will no longer be able to hand pick the changes I want to move through and ignore those that I dislike.

It’s a funny feeling to no longer be in control of the direction of my growth. It takes a huge amount of trust in my elders (something I am terrible at) and an even larger amount of faith that this will all turn out alright in the end. For me that faith has always been patchy at best: I did not enter this process knowing, without a doubt that I want to be (was meant to be) a doctor. I hemmed and hawed over 6 years; I weighed options, made lists of pros and cons, and, in the end, going to med school had a slight edge over the other options. I understood it as a process, one more adventure. And I suppose I still see it as that, on some level. I think the gravity of what I don’t know coupled with the unabashed expectation that this become a lifestyle has given this journey some weight. I must travel more slowly, more deliberately, more thoughtfully. Lately I do so looking backwards at what I have left behind or left and right at what I am missing. At some point I should probably do a turn around in my head and refocus my attention. I’m sure it would change the sensation I have of being swept up by things I have no control over. I’m just not quite sure how to get there, especially when I feel so empty of the doctor faith that is supposed to drag me through this.

Retreat

It's been a while, I know. . .and lots has happened and not very much has happened. I'm spending the week out on Orcas Island studying - a retreat away from the distraction that was the city. I have no internet or phone service at the house, and that is conducive to wholesome things like studying, playing guitar, and writing. The writing seems to be a bit more. . .well, reflective, contemplative, heavy, and maybe a little long, but I guess that's where I'm at these days. And I think the way that this whole blog thing works is that I post what I want to post and you read what you want to read. Or something like that.

3 types of smiles

My friend Nate finds the most ridiculous stuff on the internet during class. You can always tell how bored he is by how much stuff he texts out to everyone. Anyways. . today he sent out 3 things that made me smile, each in a different way.

The wry smile

The awww smile

And the hah smile

Oh. . and this was just a full laugh out loud for me. . I guess I'm a little mean.
(let it load first, and then watch it for full effect)

Fun with. .

Stephen makes all of the ridiculous shit that has been going on in the democratic circus feel a little less horrific.

Go here and watch Hillary's video first, then Barack's.

And then watch this to make you wish that there still were 3 people in the democratic race, even if it might have meant another white male in office. . . .

That Thing

Talk about Synchronicity. . .I wrote the following yesterday with the plan to post it today. . and now with osf and Toby's comments (especially Toby's) - well, yeah.

**
I’ve been thinking about compassion. Perhaps inspired by the Dali Lama’s visit, perhaps from hearing about empathy in my ICM class, perhaps from the gentleness my mom is exhibiting in the face of her father’s decline, her sister’s insecurities, and her mother’s panic. Perhaps it’s because I’ve been struggling lately – my blues are encroaching in tighter and tighter circles. I’m fighting it, but I am so busy these days that I don’t even notice what’s going on until I’m cloaked in monotony. These oh so gray days are flat, disheartening, and discouraging. It’s not depression - that is too personal – it’s more of an anhedonia borne from the underbelly of the medical profession. It’s the despair that comes from crying uncle on trying to hold onto the life that once ways; it’s the defeat you feel when you accept that your life can no longer be relationship-centered, at least for a while.

Lately compassion has been in short supply in my life. I’m worn down by my friends, I’m annoyed by a patient’s complicated presentation, I mutter about my housemates for the chaos that is our fridge. I can’t remember the last time I felt positive about a class and just about every sentence I form starts with the words, “You know what would be great,” or “Why can’t they just. . .” My parents never say the right things on the phone and even Annie, the dog, rubs me the wrong way. Basically, I’m sitting deep and dark in the thick of it.

I’m convinced that compassion is the cure. But compassion is a funny thing and while I know that I need to breathe more, compassion more towards those around me, I think that the real deficit is inward compassion. Just like that age-old adage, you can’t truly love others until you love yourself (or something like that), I’m not sure it is possible to express compassion towards others until you feel compassion for yourself. Can you even know what forgiveness feels like if you don’t forgive yourself all the shit you do wrong? And if you have never felt forgiveness, can you genuinely give it to others?

This may be coming across as all wooo-wooo-y , so let me try and clear it up a little. See, I am beginning to see that compassion is an art that walks the fine line between being patronizing and being invested. I don’t really know what it truly looks like, or feels like, because I am either too engaged or too removed. When I am too involved, my feelings become my focus and I can’t get any perspective. When I am too distant, I view those suffering with curiosity or, even worse, pity. Thus far, when I say “I have compassion,” it is linked with a sense of having figured out the other person’s problem, being beyond his or her problem, being unaffected by his or her problem – and there is some superiority in there that doesn’t belong. And there is the strange paradox that I experience which is that the more compassion I feel towards someone, the less connected I feel to them. Even my closest loved ones – when the compassion washes over, the detachment creeps in, and shortly thereafter the dissatisfaction and the loneliness. Obviously, I have some serious work to do.

This brings us back to wise words about compassion. “Be compassion,” is likely less about giving compassion to others and more about breeding compassion from within. And to do that, I think forgiveness of self is required. This means I have to forgive myself when I have to cancel an obligation. I have to have more compassion when I fail at doing daily living things (like getting my oil changed, making my bed, cooking). I have to let myself fuck up on tests, cry because I fucked up, and rationalize both of those events. When I get annoyed at my peers – forgive. When I am not exercising as much as I would like – compassion. When I skip class – permission. Even though everyone else around me seems to be handling it all so much better – compassion, compassion, compassion. That’s not to say that I should throw my hands up in a relativist fit and say, well, none of it matters anymore. Of course not – I still strive to improve all of those things, I still evaluate my (endless) shortcomings, I still fight and cry and struggle. But I work on decreasing the guilt, quieting the critic, and just slowing down the panic. Perhaps once I have that down, then I can spend some time figuring out the whole golden rule thing.

In Sync

The Dali Lama just left town. He spoke at several large events and, no, I did not get to see him, sadly. But I still received a bit of his wisdom indirectly – I actually think this city is moving a little more lightly since he was here. I have never met the Dali Lama, I have never seen him speak, and I have no personal experience with his wisdom or the clarity that people find in Tibetan Buddhism. But I have witnessed the effect he has on others, and it is powerful. I remember when I was in high school going to a symposium held by some top-level physicists who had met with the Dali Lama in an exchange of ideas, unsolvable problems, and solutions. They were glowing with their transformation and, through them, I was too – US history and geometry have slipped away, but I still hold on tight to what I learned there. And yesterday I was on the bus when two older women got on. They were carrying programs from one of the Dali Lama events that had just happened and the young man sitting next to me asked them how it was. Another lady joined in and a conversation between strangers ensued. Not many were talking, but everyone in ear-shot was listening. Compassion, they said, that was his message.

I don’t much believe in fate these days, but I do believe in warped moments of synchronicity. And I think that being on the bus at the same time as those shinning women was one of those moments. When they came on, I was having a rather negative conversation with one of my classmates. I don’t have a lot in common with her, so complaining about school is the only way we have found to fill the awkward bus time we share. There was a sharp, almost visible contrast between our dark, angry tone and their brighter airs and it was humbling. Suddenly I heard the words coming out of my classmates mouth and I was reminded of how awful complaining really sounds. This was a reminder to shut up and appreciate.

Returns

Long, long time ago, I started this blog. And I think I said something like, "1 post every 2 weeks, or so." Well, it's been longer than that. I've been a bit busy these days, and my mind has been more than a little dry. Or at least dry of things that belong here. I'm going to try and pick it up again, but I'm not even sure what is happening in the rest of world. If I'm supposed to write about what I know, it might be time for me to focus on medical school, medicine, and such.

In the mean time. .

Here's what I did for Spring Break:


And here's something that happened today - it's important.
We should be protesting the Olympics in China, and I'll try and get into that later.