Monthly Archives: September 2014

The Color of Hope

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This evening, with the dusky sunlight suffusing the air with gold and pearl, I stopped to snap photos of some autumn leaves.

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I love autumn.  It’s my favorite set of months, and each time I remember that it’s fall now I’m filled with anticipation of Thanksgiving, family time and the coming holidays.  I adore pumpkin spices, warm cinnamon, fresh apples, steaming lattes and crisp evenings.  And I love the colors of the season.

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It’s splendid to watch the trees change color.  Green turns to red turns to brown and gray, like a sunset in slow motion fading to night.

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This summer, though, I watched with dismay as some of the pine trees on campus faded to brown.  I don’t know why this happened.  Perhaps it has something to do with the drought we’ve been experiencing, but that doesn’t explain why so many other trees survived.  I’m guessing it might have been an insect infestation or disease of some sort, but I really don’t know.

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I don’t like this kind of color change, this dulling to rust and brown.  Evergreens weren’t meant to be brown like this.

It’s not at all like fall.  The brilliant red leaves of the liquid amber can fade to auburn, and the flaming bracts of the trees outside my window can dull to a muddied gray, but that won’t stir the same vague sense of loss that these dying pines awaken in me.  There is something lonely about a lifeless pine.  Perhaps it is because I grew up where pines stretch to brush the azure sky, singing in the wind.  Or perhaps it is because I know it will be at least half a century before a tree this thick-trunked and tall stands in this place again.

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Fallen pine needles, like the strains of a song fading into silence.

It makes me wonder…why is it that the same series of color changes can stir anticipation and joy in one situation, and sadness in another?

As I thought about this, I realized it’s because with the autumn trees, I know the time of leafless branches will be followed again by spring.  It’s not permanent, while these dead pines are.  They won’t bud again next year.

But the other trees will.

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And so fall colors are colors of hope.

I paused to catch the simple yin and yang of a feather against a fallen leaf, the soft, gray down of a mourning dove’s plume against the crackling backdrop of earthbound foliage.  The similarity of their form is striking, perhaps further highlighting the sharp contrast of their textures.

It’s like life.  The dichotomy of what we experience–the good against the bad–ultimately helps us to more fully recognize and appreciate the good.

I suppose this is why we do what we do in medicine.  Our work is built upon hope–the hope of something good on the other side of suffering, whether that takes the form of a cure or the giving of comfort.  As I delve further into my life as a second-year, I’m beginning to realize everything is deeper, bigger, and more complicated than I had imagined.  I spent some days these past few weeks shadowing in the ICU, and sometimes I’m left wondering how I fit into this intricate network of human suffering and joy.  What can I give?

I can be a hope-bearer.  I can help people find hope.  Maybe it’s not the hope of everything turning out how we wanted or planned, but rather the hope that springs from knowing there are people who truly care and love.  I still have a lot to learn about this, but this is a beginning.

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Red.

This is the loss of green.  The loss of the fresh, living spring and the vibrant, bursting summer.  But it is still beautiful, so beautiful.  I can love the fall because I know the trees will bud again, and this hope frees me to fully embrace the spicy, glorious, flame-filled wonder of this season.

This is the color of hope.

Why

Remind me why I chose this way
Where I am going,
The meaning of knowing

Remind me who I really am
All that defines me,
The pen that outlines me

Remind me what colors fill this life
The red of blood,
The white of light

Remind me why I walk this path
A serpent bound
Upon the staff

– The Stethoscopist

Pancreatic Passion

On Monday, we had our renal system exam.  After two-and-a-half weeks, we’ve finished our journey through the kidneys and their combined 2.5 million nephrons, as well as the ureters, bladder, urethra and prostate (where applicable).  It was a fast-paced and fascinating journey, although I’ve barely caught my breath and we’re already on to studying the GI system.

Today we learned about the pancreas, which I’ve found to be more interesting than any other organ I’ve studied so far.  Including the brain.  IMG_0361 - Version 2Some people may argue that the brain is much more fascinating than the pancreas, but I really like the pancreas.  (Please excuse my bias if you happen to be a passionate lover of the brain.  It really is amazing also.)  I guess I just never pondered how I have the ability to digest myself, and I think it’s amazing that I don’t.  I mean, it sounds rather like science fiction, doesn’t it?  The power of self-digestion.  It’s the closest thing I have at this point to a super-power, except it’s one that wouldn’t save the world. :/

Let’s talk a little about the pancreas and why I’m digesting my dinner and not myself right now (unless I were to get acute pancreatitis at some point.  Which I rather hope I don’t.).  The pancreas produces several different digestive enzymes to break down protein, fat, and nucleic acids.  This arsenal is essential for digesting the nutrients in the steak salad I ate this evening, but it’s also perfectly capable of breaking down my own cells.  However, these enzymes are actually stored as inactive precursors, so they aren’t able to do any damage in the pancreas.  It’s only once they’re released into the intestine that they can be activated, and by that point it’s safe to do so.

The activation cascade itself is quite beautiful.  In the intestine, there is an enzyme that activates trypsinogen (an inactive precursor) into trypsin (a protein-digesting enzyme).  Trypsin then cleaves all the other inactive enzyme precursors into their active forms, and suddenly your intestine has all the digestive enzymes it needs.

On top of all this, there are mechanisms inside the pancreas to stop this cascade from taking place just in case it’s accidentally triggered too early.  There’s another protein hanging around that inhibits any trypsin that might have been aberrantly activated.  And there are to more enzyme precursors that, if activated in the pancreas by trypsin, will actually turn around and break it down!

I’ve tried to make this easier to read by omitting most of the specific enzyme names, as words like “mesotrypsinogen” and “phospholipase A2” are a bit of a mouthful (but still much easier to say than “focal segmental glomerulosclerosis,” one of the diseases we learned about in renal block!).  If you’re interested in learning about it in much more detail, though, there’s information here!

How is it possibly 1:30 AM?  I guess I’d better go study about the pancreas a little more before going to bed…goodnight!

P.S. What do you think of the title of this post?  It sounds like a fruit juice blend… 🙂

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A sleepy pancreas

Grounding Moments

Late in the morning, I sat on a stone step near the Clark Center and planted my palm into the freshly-cut grass beside me.  The sunlight danced through the leaves of the slender tree to my right, scattering confetti of light across the vivid green patch of lawn.  I could almost feel the coming autumn in the air.  Since September has begun, some mornings carry a slight crispness that make me think of misty dawns, fire-colored leaves, pumpkins and home-baked joy.

I probably didn’t draw much attention sitting there with my hand in the grass, surrounded by the glass curvature of the Clark’s windowed walls.  On the outside, I was a student breathing in the sunlit air.  On the inside, though, I was struggling against a vague loneliness that had unexpectedly caught me in the middle of my day.  I think it had something to do with not sleeping quite enough this week, if my drowsiness earlier that morning was any indication.  After class, I wandered down the walkway and settled down on the step, feeling the beauty of the golden leaves against the clear blue sky even as I grappled to understand my own emotions.

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And I determinedly pressed my hand to the ground.

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Last week, a wonderful friend from my class shared with me what another classmate and friend had told her about experiencing the moment–about feeling the earth beneath your hand and the sunlight on your face, and realizing in that moment you are there, alive.  So here I was, my eyes closed and my face to the wind as I tried to regroup myself for the afternoon.

That’s why I was sitting there with my hand in the grass.  And I was reminded of the simple yet intricate beauty of a few willowy branches waving in the wind, painting the sky.

I was reminded just how good it is to be alive. 🙂

A Photo Essay in Textures

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I was heading back from med school today when I paused to snap some photos at Memorial Church.  It was a bright afternoon, and the alcoves were boldly patterned with shadow and dashes of afternoon sunlight.  

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On an impulse, I switched the filter on my iPhone to the tonal setting and peered around, catching the interplay of light and dark.

 I have long loved the concept of chiaroscuro, the dance of light and shadow in photography and other forms of art.  More often, though, I focus on the palette of colors around me–the different shades of green in the sunlit leaves, the heaven-sent blue of the sky, or even the dull black of the asphalt beneath my shoes.

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In the absence of color, however, my eyes were instinctively drawn to the patterns and textures around me.  Rough stone, shadow-ink, arches of light.

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Even an anonymous bicyclist passing by me became a whirling dance of shapes and shadows.

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Later this evening, after watching an instructional video on placing IVs, I paused to examine the snaking paths of my own veins.  We’ll be practicing on each other, and I’ve never had an IV before.  It looks like it’ll be more complicated than drawing blood, and I’m mainly nervous about having one of my valves get in the way of the thin plastic catheter we’ll be threading into my vein.

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Yes, I’m a little nervous.  But this is an essential part of my training and a skill that will enable me to help others.

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Maybe my stethoscope will be a bit like my camera filter…it provides a new lens, teaching me to see with my ears, to notice things I might miss otherwise.  Reminding me to pause and listen, which is a good thing to do any day, regardless of whether or not I’m in the hospital or classroom or clinic.  

It’s easy to let life and others slip by.  It’s like how my heart is always beating; blood is always pulsing through my veins, but I rarely stop to think about it and appreciate this rushing gift of life.  It’s only when I see my blood flashing into the hub of a needle that I really remember it’s there, or when I have to palpate for a vein, or bandage my finger after a mishap in the kitchen.  But it’s always there, just like everything around us.

I can hear the pulse of this life in the footsteps around me as I cross the med school sidewalks, or in the rhythm of voices lost in dialogue.  And with a clock to my ear, I can almost hear the heartbeat of time.

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Campus bell tower – September 2014

Growing Places

We just finished our first afternoon of emergency medicine training, which for my group meant a practical review of phlebotomy (on ourselves) and lessons in how to place Foley catheters and nasogastric tubes (in mannequins).  While preparing for class, I learned that nasogastric tubes can be used to administer medications such as activated charcoal (which can be used to prevent the absorption of ingested chemicals).  Although I didn’t personally have the opportunity to try a nasogastric tube, I did have a chance to taste a sample of activated charcoal.

I eyed the charcoal solution for at least a minute, swirling it around the little cup like some odd potion in a paper flask.  It had come from a tube that reminded me of toothpaste, and I wondered whether drinking it would turn my teeth an unsightly gray before a meeting later that evening.  Would it be as bad as eating blueberries before going out in public?  Blueberries always have a way of messing with my teeth.  However, driven by a sense of curiosity and duty (and besides, my classmates were watching), I tipped back the paper cup and took it in one dramatic gulp.  As there was only about a tablespoon of liquid in the cup, my gulp wasn’t particularly dramatic, but oh well.

How does activated charcoal taste?  Well, imagine drinking something the color of octopus ink, with the taste of hummingbird nectar and the texture of a thinned-out protein powder shake, and you’ll have an idea of what it was like.  A good dose of sorbitol accounted for the sickly sweet flavor, but other than that it really wasn’t bad at all.  If I’d had it delivered through my nose, I probably would’ve felt differently.  

Running my tongue over my teeth (which thankfully remained white), I threw away the paper cup and prepared myself to practice with the Foley catheters.  Like with the other procedures we learned that day, preparation, organization and methodical work would be essential.  We learned to always test the balloon at the tip of the catheter to ensure that it properly inflates and deflates before insertion to avoid mid-procedure problems with inflating the balloon.  This, along with other things such as making sure everything is in place before starting, helps make the procedure easier for both the physician and the patient.

Learning how to do procedures is exciting but also leaves me feeling like I’m a kid wearing shoes a few sizes too large, waiting for my feet to grow into them.  It’s the same feeling I get when I walk the hospital halls in my white coat.  While my coat fits quite well physically, I’m still growing into it in other ways.

Growing is something that’s been on my mind lately, so when I literally crossed paths with these words the other week near the Engineering Quad, they made me smile.

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Later in the week, I received a copy of the book Mindset.  It’s authored by Carol Dweck, a Stanford psychologist of world renown, and I was excited to begin reading it since I’m on a journey to adjust the palette of my perspective and develop greater resiliency.   Within a few pages, I came across the same phrase, its black font on the white page an echo of the white-on-gray letters chalked on the sidewalk stones.

Growth mindset.  It seemed to be more than just a coincidence, especially when my mom told me the next day that she had just requested the same book from the library, and then the topic spontaneously came up a few days later in a conversation with a friend.

So, I think that “growth mindset” is my learning assignment for this quarter.  Perhaps for my whole life–after all, I’ll never be fully “grown up” in the sense that I need to stop growing.  One of the things I’m growing in at this time is confidence, as I am beginning to realize that this is one of the ways I can be beautiful without changing my outward appearance.  To be able to walk tall, knowing that I am on a journey and that I am strong enough to address my shortcomings rather than defining myself by them.  To become comfortable with who I am, rather than continually wondering if I measure up to what I think others think of me.

The knowledge that I am continually growing is a gift that gives me the opportunity to focus, and it lets me to build on my past and present experiences.  It allows me to move forward when I hit bumps along the way, and to laugh at myself more.  To take some things more seriously and other things less so.

This is one of my growing places.

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Life is full of growing places…they’re especially prevalent beneath bumps in the road and around unexpected turns.  They are the damp mist in the shadows that makes the moss and ferns grow green.

Where are your growing places?