In his left hand was a journal with glossy pages and shiny black text. Underneath a grey-scale bar graph on the right page was a caption that included the words “joints”, “forces”, and “intervention”. The top header of the page demurely proclaimed its identity as a journal for rehabilitation medicine.
On his left ring finger was a polished pewter ring.
He saw her board the bus. My eyes followed his eyes which followed her body. She was cute: Her brown hair was tied back in a simple ponytail, revealing her silver dangly earrings and the thin silver hoop that pierced through the cartilage near the top of her right ear. A turquoise fleece scarf poked out from her muted orange jacket. Merlot-colored clogs peeked out from her boot-cut jeans. In her left hand was a spiral-bound notebook, its pages a mosaic of Powerpoint slides.
On her right middle finger was a wide silver ring. The fingers of her left hand were unadorned.
A surprised expression crossed his face when she took the empty seat next to him. Her eyes never left the pages of her syllabus; they studied the text and images intently to ignite the electrical impulses traveling between the neurons of her studious brain.
He extended his left arm a bit and continued to look at the pages before him. Without moving his head, his eyes darted to her face before returning to his study of joints and forces.
As the bus bumbled over the potholes and scraped against the curb, he continued to sneak glances at her, the whites of his eyes betraying the movements of his eyeballs. Once, they directed his gaze onto her syllabus and the expression on his face broadcasted his thoughts: What is she reading?
She continued to read, unaware that her neighbor’s retinas were snapping neuronal photographs of her for his private enjoyment.
The bus lurched to a stop. She clutched her notebook to her chest and hoisted her bag onto her shoulder. He tucked his journal underneath his arm and swung his bag over his back. He looked out the opposite window when she looked over her right shoulder to ensure that her bag hadn’t hit anyone. I followed them down the aisle.
Once off of the bus, she went right and he went left. Her gait, though unhurried, was purposeful. Her bag bounced against her back, providing the cadence for her walk.
He looked back at her once—twice—three times—and one last time!—as he continued towards the hospital. He craned his neck farther and farther to the right as his feet insisted on carrying him to the left. He finally resigned himself to entering the building.
And she had no idea.
30 Mar 2007 | 5 comments.
Riddle.
They weren’t close. Family obligation was the sole reason why Sandra was present.
During the eulogy, Sandra couldn’t look at the casket—not because she did not want to see the stately container that held the remains of her older brother, but because the sunny glare from the surface of the black, polished casket irritated her retinas. Looking down at least gave others the impression that she was somber and grieving.
Seated five seats away was a man wearing sunglasses. Everything about him seemed fixed: His gaze on the speaker. His arms across his lap. His right leg hooked over his left. The locks of his sculpted dark hair rolling away from his part, as if it was a scene from the biblical Red Sea. Only his black necktie moved; it wobbled slightly from the anchor of the double Windsor knot due to the afternoon breeze.
Sandra leaned over and whispered, “Who is that guy?”
“Which guy?” Elizabeth whispered back. She was the elder of the two sisters, though both were younger than the deceased man.
“The guy with the long scar on his face.”
Elizabeth did not even turn her head to scan the audience for the matching face. “Oh, that guy? He’s Adam. He’s a close friend of mine from college; that’s how he met Thomas.”
The scar on Adam’s face seemed fixed, too: the irregular pale line, like a discarded piece of string, traveled from his left cheekbone down to the area near where his lips joined together. It was almost as if he had bitten a baited fish hook, only to have it rip across his cheek as he struggled for freedom.
“Oh,” Sandra replied, still tracing Adam’s scar with her eyes.
“I’ll introduce you to him at the reception,” Elizabeth murmured. “You’re going, right?”
“I think I’m going to go home first,” Sandra answered. “I’ll show up at your house probably half an hour after it starts.”
Sandra gently placed the casserole dish onto the table and hugged her sister.
“Thanks for coming,” Elizabeth said. “Mom and Dad are looking for you.”
“I saw them when I walked in,” Sandra replied. “But I haven’t seen Adam yet.”
“Yeah—he apparently had to catch a plane back home right after the funeral.”
“Oh.”
Three days later, Sandra murdered her sister.
Why?
UPDATE: The answer is below the jump.
28 Mar 2007 | 5 comments.
Alive.
I originally posted this in February of 2003. This patient crosses my mind periodically—maybe every six months or so. I saw her with my mind’s eye a few days ago. I’m not sure what triggers my memory of her. I imagine that she is now a beautiful woman who is breaking hearts left and right. I hope she’s healthy enough to do that.
I also note how my style of writing and idealism have shifted over the course of four years.
I peeked into her room and saw her sitting at her makeshift desk, grasping a bright red marker with her thin fingers. A wide smile sparkled on her face, like a new quarter in a pile of pennies.
Even though she was still clad in a drab white hospital gown, she looked so beautiful, so alive.
I recalled her face when I first met her nearly two weeks ago. Pale, tired, sickly. I remember waking her every morning around 6:30am to check up on her and ask about complaints. Even in the thin greyness of dawn, when she was in great discomfort and pain, her intrinsic beauty was apparent.
She was always so quiet, so demure. She never complained about the time, about my questions, about my cold hands. She never whined when I mashed on her belly. She patiently permitted me to listen to her strong heart. She breathed deeply so I could hear her lungs. She quietly adjusted her gown and her blankets so I could inspect her limbs, her skin, her mouth. She never became angry with me when I pushed on the right side of her belly—even when we both knew it caused her great discomfort. She simply regarded me with those large brown eyes—maybe with disdain, maybe with understanding. But always with patience.
The sunlight streamed in through her window and onto her light mocha skin when I sat across from her this afternoon.
Her big brown eyes smiled back at me. Her smile outshone the bland hospital lights.
I thanked her for being my patient, for being so kind to me, for allowing me to learn from her. She shyly turned her head away, and a half-smile played on her lips.
I got up to leave and took one last look at her before I left the room. She had gotten up from her desk, her brown hair cascading across her shoulders.
I could hardly believe that this teenager has leukemia. She looked so alive, so healthy. I know that she will soon fall ill, when we poison her body with chemotherapy drugs again.
I walk down the hallway, adorned with oddly colored forest animals painted on the walls. I think about her disease… I think about the tragedy of leukemia in children. I think about the hope that most kids with her specific malignancy will be cured, and that she will likely lead a healthy life once she finishes her chemotherapy. I think about her life, her experiences, her lessons in character building. I wonder if she takes life for granted, like so many of us.
I think about the joy of seeing a healthy child. I see the potential. I see the hope of healing.
The attending physician told me today that even he, who has been a pediatric oncologist for nearly forty years, still feels emotionally drained every day. Working with children so ill with cancer does take its toll on the spirit. But he found the successes so satisfying, so joyful. The challenges and their rewards sustain him.
I am exhausted. I am emotionally sapped, physically sluggish, mentally taxed, and intellectually resigned. But I am humbled.
I would have never thought that I would actually see her go home. I never thought that she would leave the service before me. But I saw her packing up her things today.
There is always hope.
27 Mar 2007 | Comments?
Tact.
He was about ten feet ahead of and nearly fifteen years younger than me. The semi-inflated tires of our clunky bicycles rolled slowly over the gravel; the rusting bike chains creaked and groaned from our weights as we lethargically pedaled up the hill.
He effortlessly swung his right leg over the seat and dismounted the bike. Leaning his weight through his arms onto the handlebars, he dropped his head, sending his dark hair flopping over his face.
My legs were tired, too.
Maybe my left foot missed the pedal; maybe I had prematurely shifted my weight to the sinister side.
I fell off the bike.
He heard the rattle of the chain and the clatter-shatter of the bike frame crashing into the loose gravel. Both he and his bike halted. An expression of concern graced the features of his pubescent (though still hairless) face.
“Are you okay?” he asked.
“Yeah,” I replied, brushing the pebbles that had planted themselves into my left palm. They left shallow, irregular craters in my skin. Hoisting myself back onto my feet and the downed bike onto its wheels, I felt the twinges of pain associated with the birth of bruises: violet blossoms would soon appear on my left knee, right wrist, and left ankle.
“I’m fine,” I lightly continued, already pushing my bike forward to hasten the passage of the event. He waited for me to catch up before resuming his walk.
“That must have been embarrassing,” he commented in total seriousness.
I was unsuccessful in stifling an amused smile.
“Yes, it was,” I replied.
26 Mar 2007 | 3 comments.
Impressions…
… from the Annual Meeting of the Washington State Psychiatric Association:
Drug reps. I was disappointed, though not exactly surprised, to see the cadre of pharmaceutical reps with their colorful posters for their respective drugs. I avoided eye contact (to the point that I can’t even tell you what they looked like, other than they were dressed in dark suits and wore shiny shoes). My peripheral vision nonetheless caught sight of the Rozarem table. I hate that.
The fat cats and the drug reps. Some of the uppity members of the association specifically instructed us to go speak with the drug reps because “without them, we’d have the meeting in the basement of some hospital”. They also suggested that we collect the available “free goodies”; from his brightly colored Namenda bag, he pulled out a flashlight emblazoned with some drug logo, several retractable pens of questionable quality that were plastered with names of other drugs, and other colorful and extraneous office supplies.
“As you can see, I’ve made my way around the tables,” one man proudly said, pulling open his coat to display six drug pens poking out of the pocket of his dress shirt.
I wanted to throttle them all.
Tea. Bigelow’s Constant Comment Tea, in my opinion, tastes better than the Orange and Spice Tea. I, however, prefer black teas to fruity teas.
Money and politics. Some of the association members (the same ones who were touting their “free” drug rep items above) essentially implied that in order to influence mental health legislature, psychiatrists need to proactively give large sums of money to people in politics (i.e. “I’ll scratch your back if you scratch mine”). One man dryly characterized this system as “legitimate bribery”—which it is. What a sad way to effect change—what ever happened to the individual merits of social problems? or integrity?
Suicidologists. They consistently deliver talks that contain solid scientific evidence and urgently remind us all that complacency about suicide has absolutely no place in our line of work. Their presentations are consistently engaging, stimulating, and motivating; they renew my own fervor in working with people with complex problems. I wish I could say that all of my supervisors demonstrate this level of enthusiasm.
Physicians for Social Responsibility. While in medical school, one of my classmates founded a chapter of Student Physicians for Social Responsibility (SPSR). I was the webmaster for the chapter’s SPSR website and maintained it for a year. Upon graduating from medical school, I forgot about PSR—until today.
I appreciate the “systems” view that organizations like PSR endorse: Medicine, like everything else, does not exist in a vacuum. Consider the issues of obesity in America. Education about proper nutrition (on a gross level, not a micronutrient, “you need these exact amounts of carotene, biotin, and omega-3 fatty acids in your diet” sort of way) is lacking. Highly processed and unhealthy meals at McDonald’s are significantly cheaper than healthier options (fruits, veggies, etc.) at the grocery store. Many major metropolitan areas do not offer incentives for people to become pedestrians (more exercise) and use public transportation. It doesn’t matter that doctors are constantly counseling patients to eat healthier foods and exercise more; society does not facilitate achievement of these objectives and, really, the path of least resistance is the most appealing.
Now that I actually have my medical degree, it is time to join Physicians for Social Responsibility.
Sexual conversion therapies. … in the context that they are ultimately harmful. There are obviously strong social, religious, and political forces at work in generating support for these controversial therapies (that lack any data) that tout the necessity of changing (”curing”) one’s sexual orientation from homosexual to heterosexual. The speaker (a psychiatrist who is a vocal opponent of these “reparative” therapies) provided an apt analogy: There was a time when left-handed people were forced to become right-handed, though they were never fully “converted”. I’d like to think that this is a fair comparison, though that may be an overly simplistic approach. (There are certainly enough societal pressures to be heterosexual; maintaining one’s identity as a homosexual is not the path of least resistance.)
Role models. The primary reason why I attended this conference was to receive an introduction to a specific form of psychotherapy (based off of concepts of mindfulness and acceptance) from one of the best psychotherapy supervisors I have ever worked with. I learned many skills from him and only wish that I had more opportunities to be his pupil. His ardor for and dedication to education also resonates with me.
I hope that we all have teachers that we deeply admire and idealize; not only do they inform our thinking and practices, but they also teach us to perceive the world differently. Often, this can help us to make positive changes in our environments—where “environments” may mean our friends, family, peer group, neighborhoods, schools, cities, the planet… I (idealistically) believe the butterfly effect is possible.
The last time I sat in a classroom setting for eight consecutive hours was during my second year of medical school—I had forgotten how stimulating and exhausting it could be. I love to learn—people joke that I am a sponge—and the possibility of making the world a better place (even if only one person at a time) through newfound knowledge may only be a dream, but one that I believe is worth pursuing.
24 Mar 2007 | 10 comments.