Author: karuna

of letting go

~ karuna ~ Leave a comment

It’s amazing to me how far I’ve come. I rode the wave of medical school; I was crushed under its weight and dragged across the bumpy sea floor. I rose from the sand after the water receded and was not only still whole but was stripped of old vestiges and ideas and misconceptions. I was stronger, and I was no longer afraid.

Much of the tumult of this journey was feeling like a laughable outsider. The language and rules and norms of this new culture were foreign to me; I was a stranger in a strange land. I was a foreigner in what could be a quite brutal milieu. I was self-conscious and vulnerable, scared that my ignorance and my sensitivities and disenchantment and disappointment meant that something was indeed wrong with me– as if this ailing system of inequities and capitalistic fantasies confirmed my greatest fear of not belonging, of being some kind of mistake, of needing to leave the healing profession altogether. What a relief it was to realize that my sense of self– both my professional identity and personal identity– could be completely separate from my “belonging” or acceptance inside a disdainful medical culture and a healthcare system (i.e., insurance companies, pharmaceutical companies, and other for-profit institutions) run by dusty dodos and fossilized pterodactyls. It doesn’t matter what anyone thinks of me within a rotten environment. I am free to be myself, and that’s all that matters. I am not perfect, and that is perfect. I am worthy of love simply because I exist– not because any one of my supervisors or employers or whoever else thinks I’m valuable.

I let go of my need to impress anyone or be validated. I am free to make mistakes and to learn and grow without my shortcomings– or my perceived belief that I have shortcomings– threatening me or my identity. My self-worth is not dependent on how much I know or what I am “good” at or what anyone else says I am.

Peace is available to me, but it is not something anyone else can construct for me or give to me. It is from inside of me. I’m grateful that I learned all of this in medical school. It was a profound piece of hidden curriculum.

A Work in Progress

~ karuna ~ Leave a comment

I’m nearing the end of my third year of medical school, and it’s hard to believe I’ve reached this point. I’ve noticed the subtle accommodations that my sense of self has made to squeeze in this new, very tender, very nascent identity of “doctor”: learning to listen and simply stay quiet (rather than spout off random advice or explanations of pathogenesis/pathophysiology, as if my memory on the topic will permanently fail me if I don’t immediately recall all the information on that topic that I can muster at that moment) when someone starts talking about their medical problems, withholding judgement when someone– including patients– talks to me about any type of problem they’re having, placing myself in a space of suspended belief/disbelief when listening to a person tell me about their life or their experiences with others or their feelings (there is no shortage of realities in this world…), noticing a person’s affect when asking them questions, trusting my intuition more often than not, and most importantly… believing in myself and my capabilities but always remaining humble enough to admit ignorance or ask for help.

I’ve grown a lot personally in other ways this year– and certainly to a degree the previous two years, too. I was floating along in my mid-to-late 20s haze of feeling really “mature” before medical school, but I’ve realized lately that I still had a lot more “adulting” to do before being able to call myself fully grown or mature. For example, recently it dawned on me that one of the hallmarks of being an independent adult is being able to do things you don’t want to do but that you have to do. Caring for my ailing mother is one of those thresholds that I crossed that illuminated this idea for me. I’ve also learned from my peers about how to just be nicer to people– and by nicer, I mean non-judgemental or overly analytical. Forgiving people for being imperfect and making mistakes is hard for me, but I feel like it’s a requirement for being a healthy adult who has healthy relationships professionally and personally. I also learned over the past month or so about what it means to just mind my own business and not get involved in others’ life decisions (partnerships, deciding to vaccinate their kids or not, who to vote for, what to care about, etc). These are things I personally involved myself in previously out of some heart-wrenching desire to make the world a better (according to… me?) place, but they’re just not things I’m interested in being involved in anymore. Other people may be as much me as I am me, in a spiritual or basic physical sense (like, made of carbon, I mean), but they also exist way beyond me in regard to consciousness. I am not responsible for others or their consciousness, and I refuse to take on that work anymore– even if I never chose to do it consciously; boundaries matter. Finally, I may still emotionally crumple under the how-can-you-be-so-dumb glare of an attending physician or a miserable resident, but I no longer see it as a crisis that threatens my sense of existential belonging. I have something to contribute to this world, a healing touch to offer others in need of support, and whether other people recognize that or not is not my problem. I know my gifts, and I know– to some degree– my areas for growth. But no one can take away my love for myself or those I serve with their own arrogance or misery or hatred.

Looking toward fourth year, I worry about the compassion fatigue I see in the physicians around me, my teachers. It’s too real, too close to home, and that scares me. Will residency extinguish the love I have for others? The empathy that allows me to deeply feel? I feel its grasping tentacles spreading out around me, maybe inching in and moving closer without me even realizing.

Home Visit

~ karuna ~ Leave a comment

[This writing was from late February/early March 2020. This was my last home visit before the pandemic hit my city.]

I rushed from a busy ward floor of the hospital to my car to drive to go meet Ms. Bee for a home visit. Her rose colored wooden house with peeling paint surrounded by overgrowing vines and grasses appeared to rise up from the earth organically. It felt out of place on the side of a very busy four-lane thoroughfare of our city and surrounded by newly built, imposing condo buildings that lack the character and charm of her small dwelling. Her house was like a lush desert island in a sea of concrete. “My mail box has been knocked over so many times by drunk drivers. I can’t even count them anymore! One time it got dragged all the way to the corner store,” she recalled with genuine amusement.  

We met in her living room of her home. She sat in her burgundy recliner that seemed to envelop her tiny, bony body, just like her large knit sweater seemed poised to swallow her up at any moment. The moss green carpet beneath our feet felt like an earthy mat. Her medications lined up on the table next to her large recliner gave the impression that Ms. Bee doesn’t move much from her perch. She and her house felt like steady old relics in a city of non-stop movement, expansive growth. Time seemed to slow down a bit inside her little house. There was nowhere to be and nothing left to do other than sit and connect.  

Talking with Ms. Bee was like stepping back in time. When asked if she had any life advice or lessons she’d like to share with young people today, she spoke of her work as an orthodontist’s assistant. You can learn a lot from people’s mouths and learning when to keep yours shut. She also spoke of her childhood picking cotton on her family’s farm and on farms out west where her and her siblings worked with her parents to earn money in the late 1920s and early 1930s. Picking 350 pounds of cotton a day is an unbeatable teacher. She recalled her family’s covered wagon, her father finding a shade tree every summer under which he’d sell the family’s watermelon crop, and the corn they grew for her family of 15 to eat.

Was this modern-day home visit with Ms. Bee a little glimpse into the practice of medicine of yesteryear? Connections were made at home, and a physician was able to assess a patient as a located, contextual, relational human—not as a member of a revolving cast of characters participating in the drama of the contemporary clinic. Similar to how doctors used to visit her family farm when one of her 12 siblings became ill, I met her in her environment, and for that reason, I feel like I learned a great deal about who Ms. Bee is. Seeing where she lives and how she lives painted a three-dimensional picture in full relief of what it meant for Ms. Bee to take care of herself. Her home environment provided me with a glimpse into what made Ms. Bee more than any other elderly woman with a handful of common chronic health conditions; I saw her as a full person rooted deep into the land on which she lives, the same sprawling piece of land on which she was born 99 years ago.

to my fellow medical students

~ karuna ~ Leave a comment

I’d like to make a loving call to all of us and especially to those who are new to racial justice work. In light of COVID-19’s disproportionate impact on communities of color and the disproportionate impact of racial violence and police violence on black communities, it is unacceptable to let other people do the work that building a just, healthy, anti-racist society demands. The change begins inside of us. We, as students, are in an excellent position to learn about the multitude of discrete ways that we harbor racist and prejudiced ideology– innocuous as it may seem. The problem isn’t “out there” or “other people” or “those people.” It’s us, if we leave ourselves unexamined. We all carry the chains of dehumanization wrought from a centuries-long history of enslavement, genocide, and imperialism, as we have all been socialized in a nation where white supremacist discourse and political-economy has been normalized since its conception. The foundation of our home is built upon rotting material. To embody anti-racism begins by first examining our own–often quiet, unassuming– beliefs regarding lots of things that don’t explicitly seem to be about race or have anything to do with racism, and then there’s the stuff that is explicitly about race. Let’s take a look at our selves and begin to fashion the tools we need to build a new foundation while we simultaneously root out the old, rotting one. There are various gates through which to enter into this work, and they’re all valuable. The point is to begin– don’t worry about doing it “right”. Just begin.

Resources

https://colorofchange.org/

https://www.showingupforracialjustice.org/

https://undoingwhitesupremacy.org/

some excellent books and suggestions listed here

anti-racism resources

beyond the white echo chamber (web meetup every sunday)

Racial Capitalism: A Fundamental Cause of Novel Coronavirus (COVID-19) Pandemic Inequalities in the United States https://journals.sagepub.com/doi/pdf/10.1177/1090198120922942

article on the intersection of racism, structural inequality, and COVID-19 https://www.theatlantic.com/ideas/archive/2020/04/race-and-blame/609946/

The COVID Racial Data Tracker https://covidtracking.com/race

My pandemic reading list

~ karuna ~ Leave a comment

I’ve spent the past 12 weeks riding the highs and lows of being isolated at home, unable to go into the hospital or clinic. I’ve volunteered my time delivering food to families and elders in the housing projects; I’ve also organized self-care and mental health activities for fellow students. I do my school work– sometimes with great difficulty, depending on the week and the day; the unfolding, no-longer ignore-able injustice in my community and our nation is so traumatic and thus hard to bear some days. Feeling hopelessness or grief easily derails my “productivity.” I have no reading list, no summary in bullet points, no cleanly organized cross-section of information through which this time can be understood.

evaluations

~ karuna ~ Leave a comment

As I read evaluations given to me at the end of a clerkship, I wonder about what the utility of an evaluation is. It’s a chance for physicians and residents to comment on my personality, work ethic, interactions with patients, and clinical knowledge. Yet how much do these observers really see? What kind of snapshot does my limited time with them provide? How much weight should I put into assimilating what they write into an understanding of who I am as a future doctor?

I receive lots of positive comments and then the one or two token constructive comments: have more initiative, read more before coming into clinic each day, know the basics, keep working on your assessment and plan. What does this give me?

I am writing evaluations to three individuals I worked with who I think could do a much better job at being compassionate. Is it my place to critique their interactions with patients? Is it my place to critique their interaction with me as non-constructive, unhelpful? I suppose so. I feel strange evaluating their skills which rest on the foundation of their personalities and qualities/characteristics. Perhaps that is the crux of this situation: being a physician (and developing oneself into a “great” physician) is about how you are as much as what you know.

a struggle in 55 words

~ karuna ~ Leave a comment

Charcot foot and weeping ulcerative wounds dragging on the bare ground.

He wanted more time, more options, more consultations with vascular specialists.

A below-the-knee amputation, deferred.

He needed a wheelchair so he could leave the hospital. No one could find him funding for one… for days. Days! Social workers, nurses, doctors, students scrambling to help.

Memory

~ karuna ~ Leave a comment

COVID-19 is in our city now, and our medical student clinical duties are cancelled. I left the hospital early today and saw it as a great opportunity to take time to teach myself about the novel coronavirus that is infecting people around the world. I also saw this (sorta unfortunately unexpected) long weekend as a chance to refresh myself– get centered again after the slog of my school’s women’s health rotation which felt interminable and soul-crushing and rife with examples of social injustice for poor, immigrant, non-English speaking women of color. But ya know, life is unpredictable. Nothing is in our control. My weekend is no longer fully mine.

My mom needs help, so say my three aunts who talk with her the most out of anyone in my family aside from me. She had surgery and is recovering at home– alone. An aunt is there supporting her today, and they all wanted to talk to me today because they’re concerned about her memory (i.e., they think she’s demented and specifically they believe she has Alzheimer’s dementia). I’d agree with them that there’s reason to be concerned about her memory. Her and I have been talking about her memory troubles for years now. The trouble seems to wax and wane with a slow, steady overall decline over the past 5 years. What they don’t know– possibly because my mom hides it so well– is that my mom’s memory issues probably don’t simply spring from some underlying neurodegenerative process like one of the (very many) different kinds of dementias; her memory is also impacted because she is seriously, chronically depressed. I know that her chronically depressed and anxious mental state and her chronic, under-treated sleep apnea for which she uses a CPAP machine inconsistently and her lack of exercise and her poor diet and her lack of hobbies/interests and her lack of cognitive stimulation other than her TV all contribute to her cognitive and memory abilities. She isn’t simply demented. At least, this is what I believe given what I know about my mom right now.

Truly, my mom needs neuropsychologic evaluation. I think the only way we can have that happen is if she comes to visit me here in the city where I’m in school so I can take her to a clinic with me and we can get her evaluated together. How am I– someone not trained thoroughly in neurological/psychological evaluation– supposed to discriminate between Mild Cognitive Impairment (MCI) vs early Alzheimer’s vs some other kind of dementia with amnesic components? To me as a learner, they all kinda look the same right now.

I’ll be going home to be with her for a few days. To make matters more complicated, I don’t even know if I should be spending time with her right now, given my extended time spent in hospitals and clinics for the past weeks while on rotation. But what can I do? When I called her today to see if she’d be ok with me coming home to visit her this weekend and make sure she’s taking her meds and comfortably recovering, she cried. I heard the loneliness and the anxiety and relief in her voice when she said that she’d love to have me at home. Virus or no virus.

What a sacred and intense time illness is. Our lives are literally in each other’s hands. What are we other than our care, our effort, our vows to one another and to ourselves? If this viral outbreak and my mom’s declining health teach me anything, it is that.