This IS my life...Now.

I doubt that most people reading this have quite the precise, vivid memory of exactly one year ago as I do.  Unless you were in labor or on some exotic beach or in jail or something.  It has been one year since I wrote anything on this blog.  That has been intentional.  My personal life has had a complete overhaul, and while writing is incredibly therapeutic for me, pouring out the details of the last year in a public forum seemed sordid and inappropriate.  Like wearing a tube top to Christmas dinner.  I don't want most people to see that much of me.  And it tends to hurt others more than help.

Those of you that know me well already know what I have been through in the last year.  I have allowed details of it to slip out to those in my inner circle, trying my best not to point fingers or name names or hurt anyone in the process.  But we all know that, despite our best intentions, that never happens entirely the way we plan.

On this anniversary of my new start, I feel the compulsion to reflect on where this year has gone, how it has changed me, for I am barely a shred of what I was a year ago.   That is a great thing.  In the days leading up to the last post, I consciously and purposefully decided to examine my life.  Time away, and the grace of angels in my path, shown a bright light on things that I could not ignore any longer.

The beauty is this--  that painful reflection, with all the tears and hurt and fear and doubt, is the sword that cuts a path through that jungle of chaos to a new life.  To that new path you are meant to find, if you will admit to yourself that you are, in fact, lost.

I was completely and totally lost.  There is no better way to say it than that.  I wandered for years, thinking I was pushing steadfastly down the golden road.  I had no idea that I was ridiculously disoriented and off track.  One year ago, I stopped pushing, looked up, and saw myself surrounded by vines and leaves and winding branches in the middle of a dark forest.  I was hurt, resentful, introverted, weighed down with guilt to the breaking point.  I was ashamed to admit I was even lost.

And just when my crushed soul cried out for guidance, and tears of ugly humility poured down my face, a light began to peak through the overgrown wilderness.  It was actually always there.  But it took a conscious, purposeful decision to stop, look, and trust.  And then to follow it.

That has been the hard part...letting go of all I have known and clung to for years, and trusting that this was right, that I knew best for me and my life.  I have heard that phrase so many times in our self-obsessed culture, to "trust ourselves".  It has usually been in the setting of a some girly Lifetime movie or after-school special where some girl ends up in a mess and (in a disgusted, mocking tone) "doesn't know how to trust herself anymore."  Until it happened to me, I hadn't given a lot of thought to what it actually meant, not really.  I could not get my mind around how someone couldn't know themselves, how they let that happen to them.

I have always been strong-willed, strong-minded, opinionated...a decision-maker.  *Been* would be the keyword here... I was not any of those things a year ago.  I could barely order dinner off a menu.  Every decision was a struggle.  There was a right and wrong answer for every choice.  What if I made the wrong one?  What if I chose... poorly... would my head melt away like the guy in the Last Crusade who drank from the wrong goblet?  I never realized how much I needed other people's approval to back-up my decision-making.  It was never really conscious or out-loud, just quietly there.  Without it, I was completely alone with no idea where to turn or what to do.  In hindsight, I wasn't without support, honestly.   This was simply a life-altering decision that had no right answer.  And that scared me to death.

About that time, I started seeing a magnificent counselor who, along with so many others in my path, helped show me my truth.  I will not name names, since I will invariably leave someone out.  There are not enough words to tell how important they were and how much they impacted my life.  Just know that I am forever grateful for all of them.

One decision turned into another, and another, and another.  Trusting myself turned into simply choosing what felt right for me, regardless of popular opinion, and not looking back.  And I did it again and again.  And the snowball began to roll downhill, gaining size, strength and speed.  Some choices were not great.  Some were exactly right.  All of them led me to right here, right now.

Those that have been along this road with me, and those who have known me before, know that I am not the girl I was a year ago.  I have been completely inverted, turned inside-out, still the same shell but with different parts showing.  I am more honest, vulnerable, brave, loving and introspective.  I am becoming the parts of me that I was searching for a year ago, that I always wanted to be.  I am thankfully a work in progress, as are we all.

My heart will never be the same.  Once broken and cracked, time and love has healed it.  First and foremost, love of myself, then the steadfast and unfailing love of others.  The scars remain, but have given it a character and color all its own.  This newly forged strength can now afford the purposeful vulnerability of love again.

One of the fruits of this new fearlessness has been a new job in California.  This summer I will start work at Children's Hospital of Orange County as a Pediatric Oncologist, with a mentor in my research area who is enthusiastic and energetic, and a group in which I seem to be a great fit.  I could not have conceived of this future for myself a year ago.  Without this journey, I would never have had the courage to pursue it, to believe in myself.  Now, others believe in me too.  I have not only found the door into a vast open room of possibilities, but opened it and walked through, without hesitation, as though it was my door all along.

This IS my life now.  It feels as if I have trekked through the dense jungle of an Indiana Jones movie, choosing purposefully to brave the rickety rope bridge over the ravine rather than face certain captivity.  Standing at the other side of that tattered span, I turn to look back at that which I have overcome.  I am giving myself this moment to reflect on what this means, to appreciate it, to congratulate myself for being brave and facing fears and trusting what was right.  This moment is brief.  Now I must steadily turn towards the path in front of me.  It is uncharted, unwritten, and still covered in thick woods.  That is how all great journeys begin.  No one remembers those that followed the path already paved.

This is your Life.

My friend posted this today. It is the embodiment of what I have been thinking about for the last few weeks. I have been searching, restless, uneasy and unhappy. Honestly, I decided to change my life before I saw this, but the timing of it is certainly impeccable. I have spent many years working to get to this point in my life. I'm glad I did, because I love my job more than anything. I'm gaining immeasurable confidence that I've not had in years, professionally and personally.

I used to be fearless. I got on a plane at 18 years old and didn't look back. It never occurred to me for one second that I couldn't, or wouldn't, do anything I wanted to do.... Experience and maturity caught up with me over the years and have been slowly poisoning me with self-doubt. But not anymore.

Looking back now, this transformation started with one decision on one ordinary day in January. And it was a decision that I had made many, many times before. I started Weight Watchers for the 4th time. All those times didn't matter. What mattered was THIS time. THIS life. THIS day. I was done being the THAT girl, not for anyone else, just for me. This decision was all on me, whether I succeeded or failed, would be because of my choices. It has been 4 months, and it hasn't been perfect... but I haven't given up. I'm still making one choice on one day to be better and give this gift to myself.

In this same vein, with the new momentum, I took a big risk and changed my research focus at work. This is risky because I am running out of time to finish my project before fellowship is over. At that point, I had lost a lot of valuable time to a project that I hated, that wasn't mine. I was intimidated by it and overwhelmed, and the inability to cope with it was embarrassing. I had to present my work for the department and got skewered. The project needed to be overhauled and redesigned, which was not working out at all.

I had an epiphany. As long as I needed to start over, why not start over with something I loved and was passionate about? Doubts still crept in-- Would people laugh at me, or would they even care? Is this too big a risk? Despite the nerves, I pressed on, made a completely new project, and it's been the best decision I could have made professionally. Four months ago I was ready to quit all of it, work, school... move back home and find something else to do. Now, I pushed open this door to a whole new realm of possibilities that I never thought were an option. I love my job again. I can't wait for this future and what I have to offer.

I don't remember the day I gave up on myself. I've been broken and wounded and shackled. I've tried to fit myself into the shape that other people had for me. It has required some trimming, but I've managed to do it. When I looked around, I was no where to be found. My fearless, bubbly, outgoing, fun-loving, introspective, passionate friend was gone. That girl that I used to be, the girl that I loved being, has been slowly smothered with the adult-ness of growing up, paying bills, working. Part of that is expected with maturity and experience. But I miss her. I have realized that she is the essence of my true self... the one I want to be... the full and positive version of myself that I love. She has been quiet for long enough.

So today I stand at the gate of a new life, a new day. I am seizing this chance, changing my perspective, doing things I've been afraid to do. I'm taking my life back. I'm done being perpetually unhappy. I'm through riding through life in the backseat.

This is your Life.

Do what you love, and do it often.

If you don't like something, change it.

If you don't like your job, quit.

If you don't have enough time, stop watching tv.

If you are looking for the love of your life, stop; they will be waiting for you when you start doing the things you love.

Stop over-analyzing, life is simple.

All emotions are beautiful.

When you eat, appreciate every last bite.

Open your mind, arms, and heart to new things and people, we are united in our differences.

Ask the next person you see what their passion is, and share your inspiring dream with them.

Travel often, getting lost will help you find yourself.

Some opportunities only come once, seize them.

Life is about the people you meet, and the things you create with them so go out and start creating.

Life is short.

Live your dream and share your passion.

"The Holstee Manifesto", 2009, written by Dave, Mike, and Fabian. www.holstee.com/manifesto

Permanent-ness and the Edge of the Clouds

That's a funny word- permanent. I've been thinking about that a lot tonight. In actuality, nothing is permanent except death. We can change our mind about anything at any time and that is ok. No one actually makes the rules, there are no rules except the ones we have for ourselves. Hmm.

I am not a stickler for rules per say, at least not dumb ones, but I do appreciate order. Chaos makes me shudder. Rules make the game even. I have been trying to play by the rules, yet continuing to lose. That is very frustrating. And it is burning up my emotional and psychological reserve. That is also frustrating, but I don't have the energy to care as much.

I flew home to visit my parents and family last week, amid the bubbling cauldron of chaos that has been my life this fall. I desperately needed the break, to get out of my situation and gain some perspective. The day we left Birmingham, it was raining and overcast, gloomy: an ironic reflection of how Birmingham has been for us since the beginning. But then a glorious thing happened.

The plane entered the clouds, swam around in the soupy haze, and after only minutes, emerged on that sunny side of the sky. It turns out that there is always a bright, booming sun just on the other side, even through thick, dark clouds. Who knew.

Once again, I am approaching a crossroads in my life, one I have been driven to by forces that seem all around me. But are they real? Are they permanent? Or did I make them up myself? Hmm. Unfortunately I don't think it makes my decision any more clear, but knowing that I have the capacity to see a situation for what it really is- I have to say, it is a morale booster. It is empowering. It is a burst of air for a drowning swimmer.

But for now, do I hunker down with my umbrella to wait out the storm, or do I get in the car and get out of town? As un-permanent as those wispy storm clouds are, so too are the clear bursts of sunshine. You can bet there is another squall line following along behind and headed your way. Hmm.

The Middle Chapters

Several months ago, I started listening to The Tobolowsky Files podcast. If you are at all interested in, well, anything related to the human condition, be it funny, poignant, insightful, shocking, whatever - you should check this out. Stephan Tobolowsky is a character actor that has an extensive resume to say the least. You will know him when you see him. Ned Ryerson on Groundhog Day. Sandy Ryerson on Glee. Dude that turned stuff into gold on Heroes. Look up the rest on IMDB.

So last fall he started this weekly podcast about things, really unbelievable things, that had happened to him in his life. It is HI-larious. It is poignant and meaningful. It has made me think about a lot of things in life.

One of the stories he tells is about a young man with AIDS who promised his mother that he would write his autobiography. Except he had a dilemma. He knew how it began, and he knew how it would end, but he didn't know what would come in the middle.

This got me thinking about the middle chapters of my own life. I have felt so trapped in my situation at times in this past year, wondering how in the world I got here. It was so hard, impossible at times, and I felt as if there was no end in sight, no hope. But this thinking about The Middle actually gave me some peace.

I am so torn about what we will do next, where we will live, what job I will have. It is a near-constant irritating thought. But all the while, weeks and months and years are passing. I have to find a balance between the datebook and my life. I don't want to lose all my life in the chaos, simply because I was too busy planning it.

As hard as some times are, as magnificent as other times are, they are still only the Middle Chapters of this life. Their length we have very little control over, but their quality and substance we do.

So from here on out, it's carpe diem for me. At least for today.

The Soul Cloud

I have not contributed to this blog in a long time. Looking back, its been since the move here. That would have been the last time I was frankly comfortable with revealing the state of things to the outside world. It was not a pretty start. But that is passed, and we have moved on. Tonight I sit at work, on call again, at the end of an emotionally gray day. Contrary to many days during fellowship, this was not a particularly bad day for me by most standards. Clinic was lighter than usual. I managed to dodge the escalating local drama, which typically captures me with tentacle-like strength. But my soul has still been heavy today for reasons that are not entirely clear.

I do not typically have the good fortune of time for reflection on my gray feelings. I just have to shove them back into the sock drawer of my soul, along with the other mismatched and misplaced parts of my life, to be sorted out at a later date. There has been a cloud over me today. It has been kept neatly in place above my head, in Pig-Pen and Charlie Brown style, by a series of high-pressure fronts coming in from all sides. They take the shape of a million parts of my life, from new diagnoses to old clinic patients with new problems to life-changing choices about the future. As I'm writing this, it's clear that I do not have words to acurately describe the pressure of my current situation. Any description can only appear trite and cheap, as the handfulls of metaphors that came before them. Here is just one more thing to add to my list of frustrations.

It has been very difficult to open up about how hard this year has been. I'm not sure why. There is very little that keeps me here, mostly that I'm so far in and the thought of starting over is excruciating.

What makes a fulfilling life? I used to know. I used to love my job, but it has been beaten out of me. I do not know if I will ever be the same person that I used to be, even after this year is over. I hope it will sort itself out, since I do not have the capacity to do it myself.

'Bama Update

Hey friends! We're getting settled here in Birmingham finally.

Well, I should say that I am getting settled, as Jason is still in Greenville waiting (for the 3rd week now), to hear about whether he is going to get the job with Verizon here. Ugh! Every few days they find someone else he needs to interview with, then it's a holiday, then someone's out of town, then it's Yom Kippur or some craziness.

Anyway, we (me and Chloe the Super Chihuahua) are here and gettin' our learn on... Who knew there was this much stuff to know?? Yikes! Thankfully, I am in "fellow kindergarten" this month, just doing some clinic, looking at slides (Ummm, is that a white blood cell? It is? Yay me!), getting some lectures, and trying to figure out where things are. First off, UAB is... um, GINORMOUS - compared to Greenville. Thankfully the medicine is pretty similar, just a lot more of it. But I'm diggin' the blood stuff and the faculty here is wonderful.

My mom came and visited for 2 1/2 weeks right after we moved, which was wonderful because she helped unpack, cook, clean, put stuff away... It was AWESOME. We're talking about warm banana bread waiting for me after I came home from work. Clean bathrooms. Folded and ironed clothes. She even scraped, refinished and painted an old bedside table that we've been hauling around for years. I do not remember her doing all this stuff when I was a kid. Why did I ever leave home?? Well, she went back to Idaho yesterday, so I'm on my own again. It's probably best though, because now I can just focus on studying and reading as much as I can before I start on the BMT and inpatient services in August. And after all the craziness with the move, it's wonderful to have some (relative) downtime.

For those who didn't hear, the move to Birmingham was atrocious.

• First off, it was hot. Seriously hot. Like a sauna on the surface of the Sun.


• The air conditioning went out in my car the day before the move. So we were stuck driving Jason's beater around, complete with the ear-piercing-fan-belt-squeal and convenient, overheat-at-every-stoplight features.


• The movers couldn't fit everything in the Uhaul, so ~ 1/4 of our stuff is still in our garage in Greenville.


• By the grace of God, we finally got the truck loaded, and then... Jason's car wouldn't start. But somehow it did, and off we went.


• After getting to Birmingham, the A/C in the house was on the fritz and it was 80 degrees inside, but only in the master bedroom and bath, then only two rooms not filled to the brim with stuff.


• The movers (not sure if it was loaders or unloaders) demolished my bookshelves and wounded every piece of my new grown-up bedroom furniture.


• Two days after arriving, I got to spend my birthday in Orientation, only to arrive back at our house to hear that Jason's grandmother had just died.


• Before we left Greenville, we weren't able to get my car fixed because of time constraints. It was also going to cost $900. We found a mechanic here, who was recommended by one of the doctors at the hospital. The mechanic apparently thought that $1700 was a better asking price for an A/C compressor. But they were conveniently located next to Enterprise, where we rented a car for the next 5 days. But at least we had air conditioning. And a tin of cookies from the mechanic afterwards. Seriously. They had them shipped to the house. I've never seen cookies that cost roughly $200 each. They were good.


• The installer for DirecTV blatantly lied to us when he came to do the install, saying that he didn't have all the parts he needed, and he didn't have the right ladder, and on and on... I guess satellite installation is a hot commodity, because they couldn't reschedule it for 5 days. So no TV for 5 days. Already without it for 3 days because our TV was in the box. I was starting to twitch from withdrawl. Then had to reschedule installation again because of the funeral, which pushed it back to the next week (!), which was completely unacceptable. Pitched a fit and they came the next morning.


• Verizon has continued to string Jason along throughout all of this, so he's spent the last two weeks in Zack and Jessica's guest room in Greenville.

All that aside, things are looking up. We have started visiting a church that we really like so far. All our neighbors are little old ladies, ranging from ages 50-something to 70-something, which I love because everything is quiet and they take care of their stuff. Our townhouse is close to everything, and now thanks to Mom it looks more like a house and less like a storage unit.

The Kill from the Great House Hunt

Hey all! We just got back last night from our most recent trip to Birmingham for the final round of the Great House Hunt. We emerged victorious and are now the proud new renters of a fabulous townhouse in Hoover, AL. With no yard! Yay at no yard work. We did a solid 3 days of searching, and finally decided on one of the first ones that we saw. I really tried to change our crazy ways with the number of places that we actually looked at, because really, how many do you have to see? In the past, we have looked at dozens of apartments in a single weekend, only to end up with one that we had picked out online anyway. I was just not in the mood for that. We ended up looking at 6 or 7 houses/townhouses, and had it narrowed to 2 pretty quickly. One was a 3 bedroom spacious brick townhouse that has been redone inside, and the other was a 2 bedroom on a lake that must have beed designed by the Golden Girls. Complete with pastel flowered wallpaper and gold/brass fixtures. Nothing against the Golden Girls. I just don't want to live in their house. In the end, the 2 bedroom was just not quite big enough, and more space won the day. I guess we can live on a lake later. Boo. :-( I'd rather live there now. But I'd rather have plenty of room.

So today I hit the packing hard and heavy. So far, I have done NOTHING. For those that know me, this is a huge departure. For each of our last moves, I think I started packing at least 2 or 3 months ahead of time, had my moving timeline printed out, complete with extensive Dewey-Decimal-style labeling system for easy reference to box contents. I just haven't really been into it this time... I'm not sure if it's because I'm tired from the end of residency, or not looking forward to this and procrastinating (probably that one), or what, but I haven't done anything at all. I guess on some level I thought I had to know where we were going first, and didn't feel like it was time to do anything else until that was done. I am certain I will pay the price for this. However, today I did get the dining room, closet and part of the office packed in just a couple of hours. So maybe all is not lost...

I cannot believe that in just under 3 weeks I will be finishing residency, leaving South Carolina and starting over again. There is just SO much to finish before we leave, so even though I'm not over the edge yet, I can see it from here. I wonder what it is like for people that never leave their hometown. That must be nice. I think they have the right idea.

BTW, we have a LOVELY home for sale in Greenville. Seriously, someone please come buy my house. And give my husband a job. That would be awesome. (Jason actually does have an interview on Thursday for a store manager job with Verizon, which are incredibly hard to come by, so please keep praying for us and for him this week!)

The Start of a Fabulous Vacation

So I have not fallen off the edge of the earth, didn't end up in a padded cell after my crazy call month. It has been a crazy winter, and I've gotten away from blogging (obviously). But I'm back, and with far less pressure on myself, and much happier now because we are starting our vacation this weekend!

We have not taken a planned, away-from-family, go-do-something-touristy vacation in years. Needless to say, I have pretty high hopes for this week.

The goal was to slowly make our way to Washington DC to see friends after spending a day or so in the Outer Banks of North Carolina and Colonial Williamsburg, Virginia, all the while trying to be free and pretend to not have a plan. But you know what God says about plans. He has laughed in our face this weekend. Our plans were thwarted by a crazy big rain/snow storm that pummelled the south with inches of snow in ludicrous places like Birmingham and Atlanta.

This was what Day 1 looked like.

We started out on Saturday morning headed towards Charlotte and Greensboro, then skipped over to Chapel Hill, Raleigh, and then over to the coast. I was SO excited to get to the ocean that I didn't really care how bad it was raining. I don't know what it is about the water that fills me with absolute unspeakable joy. The smell of saltwater, the sand on the side of the road, palm trees and sand dunes and beach houses up on stilts. I could live on the beach for the rest of my life and be completely content.

We found a place to stay, and a very good place to eat, and then chilled out in the hot tub. Ahhh... I went out on the patio of the hotel, unfortunately under construction, which limited our view, but the sound was what was impressive. I have never appreciated the actual roar to the ocean before, this underlying tenor like a Siren-song, constant and unwavering, hypnotizing. Only today it is accompanied by stormy rain and fierce winds, which added a certain defensivenss and aggression that demanded respect. Although I was standing on the safety of the hotel's patio deck, I was captivated by the power of the water. It felt a little like if you suddenly found yourself in the bear cage at the zoo, logically thinking they probably wouldn't hurt you, but the capacity was certainly there...

After breakfast (and 2 hours worth of weather reports), we checked out and decided to limit the excursions around the Outer Banks to just driving north towards VA. One stop we did make was to the Wright Brothers Memorial at Kitty Hawk, NC. I would recommend it if you are out that way, but do not try it in the wind and rain. Some of the coolest parts are outside and this was not the best day to try to see all of it. I'll post some other pictures from there if I can figure out this Picasa thing. From there, we drove through Norfolk, taking the interstate past the Naval Base in the hopes of seeing some cool ships and stuff, but alas, thwarted by fog and rain again. We finally made it to Williamsburg but the weather was still wet, windy, and increasingly cold, with snow likely coming soon. We decided to call it quits on any more tourist-ing for now, and to head on to DC tonight to at least get ahead of the worst of the weather. I'm really glad that we did.

I'm so thankful that I've grown enough to not have a complete come-apart when things don't go the way I intended. It was frustrating to not spend more time at the beach, to not see the boats at Norfolk, to change plans for Colonial Williamsburg. But I think my greatest expression of malcontent for the trip so far was, "Rats." I don't know what has come over me. Maybe I'm just so grateful to be unshackled from the rigors of a schedule. Or so grateful to get to see these places that I've always wondered about that I just don't care.

So plans are funny. What is funnier is how we react when plans don't go according to plan. Actually, it's not funny at all when it's happening to us. Right then it sucks. A lot. Now, I am speaking for those of us who cannot buy gas or make a sandwich without a plan. Why do we get so wrapped up in making the path lie down in front of us? Can we not go forth and make out our own path, hap-hazard and crooked and fraught with untimeliness? Gasp! How would anything ever get done the right way?

The Beatings Will Continue Until Moral Improves...

I am on call tomorrow. Tonight I sit and wait. For those of you unfamiliar with exactly what that involves, allow me to elaborate.

Imagine this: tomorrow morning you will wake up, get dressed, then be marched off to face a firing squad. The anticipation. The agony. Will you be beaten first? Will the shots kill you? Will you know what's coming, and from what direction? As you stand there, blindfolded, contemplating exactly which wrong turn lead to this moment, the waiting seems endless. Suddenly, shots go whizzing past your head; you sense your fallen comrades around you. Walls are crumbling at your feet and chaos is everywhere. When will your turn come? Then, as quickly as it started, the dust settles, and you are marched back to your quarters, where you are told that there has been a stay of execution for you today. You have survived; you get to rest for now. In 3 days, you will face it again. Next time you might only be pummelled with rocks instead.

For any given rotation, this is sort of how it goes...

The day starts anywhere between 4 AM and 6 AM, depending on the rotation. After trying to milk those last few minutes out of the snooze button, as this may be the last bit of rest you get for the entire day, you pry yourself from the bed covers. You grab your call bag, which conveniently stays packed with the essentials: toothbrush, toothpaste, sweatshirt, On-Call reference book, iPod, crackers/snack, cell phone charger, and extra blanket. You don't dare bring a project to work on, as this will ironically assure that you get at least 15 extra admissions.

When you get to the hospital, you pick up the pager from the post-call resident, who has been there for the last 24 hours and just got a call about an admission coming from the ER, who is your problem now. Yay. There are already 10 patients on your list, all of whom you need to see in the next 2 hours, formulate today's plan, answer random questions from the nurses, and write thorough, articulate notes on each one before rounds. And all the while, stay pleasant and polite to everyone, be respectful and attentive. Clearly, part of this plan is flawed and will have to be sacrificed. Your choice which part.

As the pager goes off for the 5th time during pre-rounds, you sort of hit your stride, you've got a bit of a rhythm going, and you just might get done in time to hit Starbucks. Thank God most of your patients are either intubated or asleep, so there's limited patient interaction, as that will considerably slow your progress. The solitary goal of this morning is to see all your old patients, get the orders written, and get the discharges done before the new admissions start pouring in. Too bad for you, that ship has sailed, and you have 3 admissions waiting by the time rounds start at 9.

Rounds are the time when the team discusses each patient and comes up with the plan for the day. They can last anywhere from 15 minutes to 7 hours. There are obviously innumerable variables in this equation, mostly dependent on the number of patients and the attending physician. The nature of rounds is a topic for another blog entirely.

So after rounds are out of the way, the pager goes off again, this time with an emergent situation or a critically ill patient, or any number of other things that demand your complete and urgent attention. By now it's 2 pm and you haven't sat down for longer than 3 minutes, much less had time to eat lunch, so you grab a pack of graham crackers, peanut butter, and a Diet Coke from the nurses station to chow down while you run to see the next catastrophe. Your next patient is very sick, has a dwindling blood pressure, no IV access, and is struggling to breathe. Holy crap, what first? You intubate her, place a large catheter in her subclavian vein for IV access, and start blood pressure medications to keep her heart and blood pumping. She is someone's mother, wife, sister, daughter, and she might live or die based on what you know, your skills in procedures, what you can remember from the last lecture, what resource you can find to help you find the answer, how fast you can think on your feet. At this moment, you are one of God's instruments, and you wish desperately that He didn't trust you with this, call on someone else. One minute she is clinging to life, yet after a few interventions she seems to be hanging on a bit better. The satisfaction of this moment, and a dozen others like it today, is among the reasons why you got out of bed today. Their family sits in the waiting room in agony, looking for any news. One is weeping, others are pacing, and one sits alone with only a blank stare. You struggle to find the words, just the right words, that are not too bleak but still convey the appropriate intensity of this tumultuous situation. At an inappropriate moment in your discussion with the family, your pager goes off again, this time it is the clinic calling about your patient on chronic narcotics whose monthly prescription is due today. Terrific. You add it to your list.

This onslaught continues in varying levels of intensity for the remainder of the evening and will press on into the early morning hours. You watch the day shift people leave, and the night shift arrive, with fresh faces and peppy steps. Ugh, it's 7 PM already? You shrug it off, sneak off for a bite of dinner, and forage ahead. Finally, around 3 AM, all the labs have been checked, the orders written, every urgent page for Tylenol answered, and you selfishly head to the call room. 

The ideal hope: to actually fall asleep for a couple of hours. The actuality: short bursts of horizontal drowsiness, interrupted by call after call. Forget meaningful sleep, or REM cycles, or even a light rest. Your only prayer is that there is not a CODE between now and when you have to get up to start seeing patients again, because this is not the time of the morning to have someone try to die, as your brain is now slowing to a dull crawl. The focus is only on finding a small piece of quiet time, just sweet peace for 5 or 10 minutes, where you can lay still without all the ringing and alarms and paperwork and lists. Surely that is enough to recharge me for tomorrow, which now starts in 20 minutes.

When the alarm goes off at 5 AM, you either:

a) awake with a start, throwing off the covers and knocking your pager to the floor/under the bed in the dark, paranoid that you missed a page while your eyes were closed
b) barely stir because you are comatose from an interrupted REM cycle
c) were awake already and waiting for it to go off because you never got to sleep at all.

Now you are off to pre-round on your patients-- only now with the added challenge of the dense brain fog of sleep deprivation, sore, swollen legs from standing for 20 of the last 24 hours, and the post-call nausea the comes from being awake through 6 mealtimes. Right about now, the day-shift, the same day-shift that was leaving yesterday, is now coming back to the hospital. Resentment towards them turns to actual anger when you think that they have all been home, showered, eaten, and done regular life stuff, all while you have still been digging away in the trenches. Bastards. 

As the morning progresses, you continue to lose speed and mental acuity. You "hit the wall" around 10 AM. Perfect timing, in the middle of rounds, when the details of all your patients are running together, you can't seem to speak coherently, and it takes all you have to just find the next patient. You finally wrap things up for the day, check out your patients to the next on-call team, and head home around 1 PM. You ride with the windows down and the music up so you don't fall asleep in the 20 minutes it takes to drive home. You debate whether the extra 15 minutes it will take to get lunch on the way is worth it, decide that it's not, and keep driving. Your bed has never felt so good. Don't forget to set the alarm, not for this evening, but for the morning, as you will likely sleep from now until tomorrow, when you will get up to do it all again.

As patients, we only see that apparent part of our caretakers' interactions with us, the part where they come in the room, talk to us and our family, listen to our heart and lungs. It is more brief than we think we deserve. Where does the rest of their time go? What else are they doing back there? I hear them cackling and laughing; don't they know I'm waiting? As patients, we do not see the iceberg of time and commitment that lies behind the door: reading old records, checking labs, researching the current medical literature for the latest recommendations, discussing the case with specialists and other physicians and nurses to try to cover every base, documenting the appropriate paperwork, answering phone calls, and a hundred other things that go on day in and day out. 

Expect your physician to treat you like a person, not an illness or a number. We, as physicians, have been entrusted with your lives, your children's lives, your families, and it is the greatest responsibility you can give to another human being. It is deserving of the utmost respect and compassion, and I will do my best to honor that.

It is all I ask, that I also be treated like a person, that you may remember that I am just like you. I go to the gas station and the grocery store and get called for jury duty. I have a family, and I have sacrificed time with them to be here with you. I have heartache and sorrow and sickness; I love and hurt and dream, and I will push forward with everything I have to try to help you now. And it's not for the glory, or the money, or so I can walk down the hall in my long white coat. If you only knew the heavy weights that sit deep in its pockets.

At the end of the day, I do have one of the best jobs in the world. I work with some of the smartest, most compassionate and caring people, whose mission is to teach me how to be the best I can be. I get to make sick people well again. I get to make esoteric science into something with meaning and purpose. I get to play with kids. I get to help families' grieve. I get to give a wake-up call to a heroin addict after a heart attack. I get to hold tiny babies in my hand and see their tiny arms wrap around my fingers. I get to talk a daughter through her grief as she accepts her father's Alzheimer's disease. I get to prevent thousands of illnesses with vaccines, education, and medicines. If it all ended tomorrow, I have still been blessed by the bucket-loads.

With each day, I gain a little more ammunition for my arsenal. I am a little less scared of what will be thrown at me tomorrow. If I can store up enough, I just might make a battle plan of my own.

And so I will face the firing squad again and again and again.

Where is Matt?

I absolutely love this video. If ever there was an advertisement for the universality of music, dance, and laughter, this is it. If you haven't watched it before, check it out. If you have, watch it again. Every time I watch it, I see something new. And by the end, my heavy heart is lifted and my soul is bubbly again.

It's a little fuzzy here, but if you watch it on YouTube, there is a high-quality version that is more clear.

The song from the video is sung by a Bengali girl named Palbasha Siddique and is based on this poem.

Stream of Life

by Rabindranath Tagore

The same stream of life that runs through my veins night and day runs through the world and dances in rhythmic measures.

It is the same life that shoots in joy through the dust of the earth in numberless blades of grass and breaks into tumultuous waves of leaves and flowers.

It is the same life that is rocked in the ocean-cradle of birth and of death, in ebb and in flow.

I feel my limbs are made glorious by the touch of this world of life. And my pride is from the life-throb of ages dancing in my blood this moment.