Island Med Student

She awoke in the morning to the sounds of birds chirping outside her window. A quick glance at her clock revealed that it was only 6:00 a.m., too early to arise from bed on her day off from work. But the sounds of her rustling the covers awoke her black and white companion. He launched himself from the sofa onto her bed, under the covers and into her arms. She allowed him to nestle into her as she caressed his soft fur. After a few minutes of this loving interaction she realized that she was now fully awake.

Might as well get out of bed now.

She prepared her morning coffee, as she does every day: using the exact same proportions of coffee grounds to water, and sugar to milk. As she sipped her coffee and stared out the window at the sun rising on the horizon she was exhilarated by the realization that it was going to be a wonderful day away from the hospital.

The weather did not disappoint her. The temperature quickly rose to almost 60 degrees Fahrenheit and the glistening sun filled the cloudless sky.

It was going to be a good day.

After saying farewell to her partner, she looked around at her apartment for something to occupy her now empty hands. Two projects proved to be challenging, but oh so rewarding. Sewing a button onto her gray “work pants” and using needle-nosed pliers to fix a bead imbalance on a pair of earrings served to fulfill her perpetual need for accomplishment.

The day was progressing well, but the need for the warmth of sunlight and external stimulation compelled her. She fastened the leashes onto her energized, furry lovers and made her way out into the city. As she scooped up the warm piles of feces, she commented to herself how happy it made her to take care of animals in need, and she realized how caring for them extrapolated out to including anyone in need.

After a shower and preparations, she again exited her apartment, but this time for purely selfish reasons. As she listened to the melodic sounds of Bob Marley on her iPhone, she couldn’t help but allow the contagious facial muscles on her face to elevate her lips. She thought to herself about how the grin on her face seemed to affect the passersby, and that forced the grin to exaggerate to an obscene level.

All too quickly she arrived at her destination: a dilapidated store on Broadway Avenue, run entirely by Vietnamese immigrants. After “picking a color,” she was seated and proceeded to roll her jeans up to her knees. As she soaked her feet in the warm water and bubbles, her reasons for visiting this establishment were mentally affirmed. A young Vietnamese man wearing a surgical face mask and latex gloves greeted her from below.

She exposed her feet.

As he removed the previous nail polish from her toes she mused about how incredibly ugly her feet were. Large, misshapen, always calloused from compulsive running, and too wide to fit into most “cute” shoes. But it barely phased her. The thoughts were quickly replaced by the waves of relaxation and pleasure brought on by someone else’s pampering. She gave in to his magic, allowing his small, strong hands to massage away all the stress and tension that miles of running had built up in her feet.

She exited the salon in pure ecstasy, ready to take on the world.

Once home, she again leashed up her dogs, loaded film into her Holga camera, carefully placed her headphones and extraordinarily large sized sunglasses around her ears, and made her way out into the city of Brooklyn.

One mile turned into two, and two turned into four. She allowed the pure bliss of the sun caressing her shoulders, music reverberating through her tympanic membrane and sensation of her feet against the sidewalk to carry her into another dimension. She barely noticed the remarks of the people she passed on the street. The construction workers’ catcalls drifted by her like invisible smoke.

And then fate intercepted her journey. A well-Yelped restaurant met her visual field. It had outdoor seating as well. Perfect for today.

After tying her dogs to a pole, she went inside and gave into temptation. A glass of Bordeaux and a plateful of New England mussels would fulfill her wildest palatal desires.

She sat outside on the patio in the warmth of the sun, her black and white furry companion on her lap, and her brown one at her feet. She savored every last drop of the wine and even chewed the raw oysters for the first time, so that she could make the moment last even longer. People walking by were barely visible, as she was blinded by her own ecstasy.

The three mile walk home was an artistic orgasm. She snapped photos on her manual film camera with wild abandon. So what if the film was incredibly expensive, there was art to be made! Photographic opportunity after photographic opportunity filled her path. And she was not shy about capturing every last pixel of it.

Once home she contemplated her day’s journeys. Yes, today WAS a good day. But not because of all the externalities and environmental adventures. She had allowed herself to create a good day.

“The most erroneous stories are those we think we know best – and therefore never scrutinize or question.”
- Stephen Jay Gould

Today was a wonderful day of pediatrics clinic. I saw, I learned, I made way too many kids cry with my prodding and poking. During some downtime today started talking with another med student about taking patient histories. He commented how that was his least favorite part of being a doctor. I realized that it was my most favorite part of being a doctor. For me, there is nothing as fascinating as getting to know a person, and hearing their story.

I guess it’s no surprise that I ended up in psychiatry. Psych is all about getting to know the stories that made and make a person an individual. To me, taking a history or listening to someone share their life’s details with me is like opening a gift box. I enjoy peeling back the layers to reveal the gift inside.

Please enjoy the trashy photos along with today’s post. I took them all on my walks to and from the hospital today. It occurred to me as I was snapping the shot of the discarded hotdog that one of the reasons I enjoy (and am possibly obsessed with) taking photos of trash is because I’m interested in the stories they tell. How did that pile of smashed up computer parts end up so non-randomly assembled on the sidewalk? Why did someone discard that hotdog after only one small bite?

Perhaps just as fun as knowing the stories behind the trash, is making up my own stories for them.

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

I only have a second to type, as I have to go in right now for a peds 12-hour night call. I just want to let the world know that I am happier than I’ve ever been. Everything has just been coming together lately. I couldn’t be happier with the road I’ve travelled.

Yesterday (my birthday) was great! I got tons of happy birthday wishes (thank you, everyone!), and I got to do one of my most favorite things, lay in bed all day, pig out, and watch movies. It was very relaxing, and just what I needed.

Today was long, and wonderful. I just got home from 13 hours at the hospital for my pain management rotation. I’m too tired to share all the juicy details, but I got to see a lot of great cases and meet some wonderful patients. One of them was an ex IVDA (IV drug abuser), whose veins were all shot from years of abuse. He told me that he’d be a hard stick, so I spared him my poking, and got the anesthesiologist to place his IV access. I ended up talking to him for a while before his operation, and afterwards. He really opened up to me and shared some of his most intimate details. He told me how guilty he felt for abusing his body for so many years, and I pointed out to him that the most important thing is that he now takes care of himself, and has grown as a person. Eventually, he was in tears and I held his hand and tried to support him. Those are the moments that make long days completely bearable, and even more than that, meaningful.

Tomorrow I have a residency interview in Brooklyn. But now, it’s time to feed my calorie-starved body!

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

“There is no psychiatrist in the world like a puppy licking your face.”
- Ben Williams

My mom recently sent me the above quote, and I thought it was too cute not to share. T’is soo very true! As I was searching for the above photo of my doggy Scope licking my face, I stumbled across the two below, and wanted to share them as well.

Today was a good day of “pain management.” I assisted on a cervical and lumbar epidural procedure, and observed a few others. I also had a nice, long talk with one of my patients about exercise. He had become overweight and it was exacerbating his spinal stenosis. Over the past year he’d lost 65 pounds, and he found that the weight loss had helped immensely with his pain. We started talking about how much we both enjoy exercise, and at one moment I had to grab his hand and just scream, “I KNOW!” because we both had the exact same feelings on exercise. We agreed that that there’s nothing more exhilarating than your own body’s endorphins, and a runner’s high is perhaps the best thing in the universe.

Anyway, it’s time for me to continue catching up on emails. If anyone out there is having a bad day, I recommend going for a run, or walk, or anything that gets your heart rate up. That, or find a cute puppy to lick your face!

I remember the last few months of my grandfather’s life. His Alzheimer’s was progressing and his memories were fading. I remember him calling me “Linda” (my mother’s name) and asking me about how my day at school went. I remember how I felt, and thinking how precious memories truly are. I call myself a “life enthusiast,” and to me that has many meanings. I try to enjoy even the smallest of pleasures and treasure every day that I get on this planet. I’ve been blessed with so many wonderful memories. And it’s easy sometimes to forget how very lucky I am. I think that’s one of the reasons that I enjoy documenting my life so much. It’s why I’m constantly taking pictures, videos, and writing about my experiences. For me, it’s a tangible way of preserving my life.

I took the photo above some months ago, and forgot to post it on my site. As I was going through my photos just now, I stumbled upon it, and it brought back all the wonderful memories associated with the night I took it. Please enjoy the photo, and my updated “Video A Day” (days 1 – 23) project below. I enjoy them both immensely.

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

“When I admire the wonder of a sunset or the beauty of the moon, my soul expands in worship of the Creator.”
-Mahatma Gandhi

Photo taken today on my walk home from the hospital. My iPhone doesn’t do it justice.

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

As long as I can remember I’ve been a “cryer.” I cry at SPCA commercials, ridiculously silly movies, and yes, even that one episode of Jeopardy. I never really thought that much about it until I worked with seriously ill people every day. I see tragically sad patient cases all the time. I’ve watched patients die and have dealt with a variety of very sad incidents. I’ve realized that my threshold for tears is set a bit lower than most of my peers. Try as I might, I’ve had to excuse myself out of patients’ rooms at times. As much as I try to separate myself from situations, I find it incredibly difficult to not cry at sad circumstances (for better or for worse).

From what I know about psychological theories, I can understand why my threshold for crying could be related to my upbringing. But it never seemed so real as is it did a few weeks ago. I was watching an incredibly silly, poorly made, Disney-esque movie involving some dogs. Really, it was not a reason for an adult to cry. It was just an infantile, fun-loving movie. But during one scene I felt the tears well up in my eyes. I tried to hold them back, but they poured down my face in rebellion. Then I looked around the room and saw my mother and sister crying as well. They had the same problem as me.

Call it nature. Call it nurture. Call it a ridiculous love for dogs. Call it what you might, but I realized at that moment that I came from an emotional gene pool.

I’ve thought about it many times since then. I know that the fact that I came from such a loving family has had a lot to do with the person I am. We express our emotions. We don’t hold back. We laugh out loud. We cry out loud. We bitch out loud. We YELL out loud! And that is something that I have always been proud of. Regardless of how many times it has made me look silly.

In addition, I came from a very “animal intense” and dog loving environment. I grew up on a farm, surrounded by many different types of animals. I have never not had a dog in my life. And for that I am grateful.

Tonight my mother sent me this “silly” email about “A Dog’s Purpose.” She warned me that it would make me cry. Well, it made me sob uncontrollably. And my sisters all replied saying the same. We share that same intense bond.

And I realized that I do try to live life like a dog, as the email encouraged. And I wouldn’t have it any other way. Below is the story. Cry, or don’t cry. Laugh or don’t laugh. But either way, I hope you enjoy it:

A Dog’s Purpose (from a 6-year-old):

As a veterinarian, I had been called to examine a ten-year-old Irish Wolfhound named Belker. The dog’s owners, Ron, his wife Lisa, and their little boy Shane, were all very attached to Belker, and they were hoping for a miracle.

I examined Belker and found he was dying of cancer. I told the family we couldn’t do anything for Belker, and offered to perform the euthanasia procedure for the old dog in their home.

As we made arrangements, Ron and Lisa told me they thought it would be good for six-year-old Shane to observe the procedure. They felt as though Shane might learn something from the experience.

The next day, I felt the familiar catch in my throat as Belker’s family surrounded him. Shane seemed so calm, petting the old dog for the last time, that I wondered if he understood what was going on. Within a few minutes, Belker slipped peacefully away.

The little boy seemed to accept Belker’s transition without any difficulty or confusion. We sat together for a while affer Belker’s death, wondering aloud about the sad fact that animal lives are shorter than human lives. Shane, who had been listening quietly, piped up, “I know why.” Startled, we all turned to him. What came out of his mouth next stunned me. I’d never heard a more comforting explanation. He said, “People are born so that they can learn how to live a good life …like loving everybody all the time and being nice, right?” The six-year-old continued, “Well, dogs already know how to do that, so they don’t have to stay as long.”

Live simply.
Love generously.
Care deeply.
Speak kindly.
Remember, if a dog was the teacher you would learn things like:
When loved ones come home, always run to greet them.
Never pass up the opportunity to go for a joyride.
Allow the experience of fresh air and the wind in your face to be pure ecstasy.
Take naps.
Stretch before rising.
Run, romp, and play daily.
Thrive on attention and let people touch you.
Avoid biting when a simple growl will do.
On warm days, stop to lie on your back in the grass.
On hot days, drink lots of water and lie under a shady tree.
When you’re happy, dance around and wag your entire body.
Delight in the simple joy of a long walk.
Be loyal.
Never pretend to be something you’re not.
If what you want lies buried, dig until you find it.
When someone is having a bad day, be silent, sit close by, and nuzzle them gently.
ENJOY EVERY MOMENT OF EVERY DAY!

Check out my post on Medscape to read a story about my patient who loves almonds.

Click Here To View the Entry

Have you ever noticed that sometimes the most emotional or worst days tend to be the ones where you learn the most? Well for me, that was true today. I had a particularly stressful day at the hospital. It was probably the combination of PMS, a huge patient load, and a longer than normal day.

When I was at the point that I was so tired that I had mentally “checked out” I got a text message from my partner Micah. He had accidentally broken the freon line in the refrigerator when attempting to defrost it, and the cookie jar fell into the dog bowl. Now, I know this isn’t the worst sequence of events that could happen to someone, but I was so already stressed out that it sent me over the edge. I started imagining Micah and my three doggies all lying dead on my apartment floor after having been exposed to the toxic fumes. I imagined having to call 911 and some sort of doggy 911 all at the same time. That, and my favorite cookies were now in the doggy bowls. If that weren’t enough, I imagined the already half-dead doggies consuming the chocolate cookies and dying from that as well. All while Micah lay dead on the floor already, without being able to save them.

Yes, I have somewhat of an overactive imagination. But everything together just sort of sent me into a mental downward spiral.

Then I met the last patient of the day. She was being dialyzed when I met her. Her health conditions sounded like a medical textbook: diabetes mellitus, hypertension, CAD, double above the knee amputations, asthma, AIDS, Hep C, s/p MI and CVA, CKD and ESRD on hemodialysis, metastatic colon CA, anasarca, SBP, pneumonia, and sepsis. She should have gone a long time ago, but she was still hanging on. I tried to talk to her but she just mumbled incomprehensibly. Eventually she asked me for some water. I asked my attending if I could give it to her even though she was NPO and on fluid restriction. I mean, yes she wasn’t supposed to have it. But at this point, did it really matter? Or would giving her a few sips of water to help with her cracked, dry lips and mouth be the humane thing to do? My attending agreed, and I raised her bed and put the cup of water to her lips. She thanked me.

Afterwards my mind went back to my dead partner, dead dogs, and broken fridge. As horrible as my day had been, compared to this poor lady, my life wasn’t all that bad.

It’s really all about perspective. One extraordinary thing about working in a hospital with incredibly sick folks is that it gives you perspective. Every day. And for that I am incredibly grateful.

Photo above is my new “fire escape refrigerator.” I guess 20 degree whether isn’t always a bad thing.