Category Archives: Life

Swim

I survived boards!

To sum it up as concisely as possible, preparing for my Step 1 exam was like diving into the ocean, and I ended up going for a longer swim than I anticipated.  Long story short, I took boards in September instead of during the summer, which is partly why I’ve been away from blogging for so long.

IMG_6579

I also wasn’t sure where to start writing again.  Which is why this post if being written in December, long past the reasonable timeframe for using my I’M-STUDYING-FOR-BOARDS-AND-CAN’T-WRITE excusplanation (my latest neologism: a cross between an excuse and an explanation.  I coined it specifically for this post). 🙂

IMG_6583

Since I’ve taken time off for research before starting my clinical rotations, I had the flexibility to extend my study period, and that’s what I ultimately did.  For some reason, saying I took additional time almost feels like a confession.  I suppose part of me feels a little guilty for having the opportunity to study longer (other med students may not have schedules that are so accommodating), and part of me wonders if I should’ve felt ready sooner.  However, a friend passed on some advice from his sister (a medical resident) that helped to ease my decision: take the time you need, and take the exam when you feel ready.  It’s okay not to rush it.

I think it’s unlikely that any student ever feels completely ready for boards, but at least it’s possible to feel that we’ve done everything we can with the time and resources each of us have.  For me, this was the right choice even if it did mean doing a lot of swimming and diving (figuratively speaking, of course, since my real-life water skills fall into the category of barely-good-enough-to-not-drown).

I finally came up for air after my full day at the Prometric testing center, only to realize that life was waiting for me above water like a clamoring flock of seagulls.  To be honest, part of me wanted to just go back into the water and turn into a mermaid.  Over the last several years, the life of studying (for college, the MCAT, med school, and finally Step 1) has become a familiar ebb and flow around me, and it’s comfortable in its own odd way.

Well, I guess it’s time to get pushed out of that comfort zone.  I’m done with my preclinical years, and there will be no more quarters to define the pace of my life, or daily lectures and midterms, or labs where curiously-shaped cells make faces at me through the microscope lens.

Now I’m gearing up for my clinical years.  I still have a few months to prepare myself, but it’s daunting for me to think about functioning as part of the medical team.  I’ve had opportunities to participate with patients throughout the first two years of medical school, but it was always briefly, as if our interaction were a haiku of three lines instead of an essay of three hundred.  I’ll still have supervision and guidance, but my responsibilities and expectations will be greater, including the expectations I place upon myself.

One thing I’ve been thinking about is how to connect with people on a personal level, because that is important to me.  Sometimes medicine can feel very mechanized, and with the pressures of being a clinical student, I can see myself losing sight of the more ephemeral aspects–the very things that make this pursuit worthwhile.  I’m worried that in trying to navigate wards and find my way around, I’ll lose some of myself.

And maybe I will for a little while, as I try to orient to the life of a clinical student with its early hours (on some rotations) or intense schedules (on others).  But I also have faith that I’ll be able to find myself again if I do.  Beneath my white coat (which still feels like a costume when I wear it), I’m an artist and a writer.  That, I think, will help me find my way home to what I care about: the story, the healing art of listening, the release of telling, the feeling of having been seen and understood.  That’s my hope, at least.

IMG_9959

I was surprised by a rain shower today as I left a meeting at the hospital.  I found some leaves with pearlescent water droplets reflecting the diffuse light, and the constellation of spheres made me think of a universe in miniature.  Maybe this is what souls look like, with droplets of memory and experience coalescing to reflect the light and shadow of who we are inside?

My imagination is getting the best of me.

But I like to think that if each droplet were a little world of its own, and if I were as small as an ant, I’d be able to see and appreciate each one.  And when we meet people, that’s really what we do, isn’t it?

Each of us has our oceans, and each of us is a universe of our own.

Halewright

One Test to rule them all, One Test to define them; One Test to bring them all and into knowledge bind them

Like Bilbo and Frodo did in their times, I am about to embark on an adventure beyond the borders of all I have known.  (Did I actually just compare medical school to the Shire?)  This morning (since this post has taken me past midnight to write), I’ll begin my two-month journey of studying for the USMLE Step 1–an eight-hour long exam which will test all the medical knowledge I’ve learned in the past two years of medical school.  To speak with a bit of poetic license, it is the exam which will determine my destiny.  It is the One Test to rule all tests, the score to end all scores, for the grade I receive on it will influence how desirable of an applicant I am when applying for residency in a few years.

IMG_4423

Thankfully, my future is (in reality) influenced by more than just the score I receive on this test.  Nevertheless, the Step 1 is a very important exam, and I’ll be devoting about 10 solid hours a day to studying for it.  Factor in time for meals, exercise, and the ebb and flow of natural life, and I’ll be starting my days around 6 AM and ending around 9 PM.  As intense as this will be, I’m excited about this block of time to study and really see how everything fits together.  I hope that I will be like a hawk soaring high above the landscape, taking in a panoramic view of everything that is going on so I can hone in on details and dive for deeper understanding.

I like to think of funny things like that.  It makes life more interesting to me. 🙂

Levity aside, it’s going to be an intense two months.  For me, a bright spot is that I’ll be studying with a very close friend, and we’ll be sharing the journey together.  As the old proverb says, “a sorrow shared is a sorrow halved; a joy shared is a joy doubled.”  I’m looking forward to teaming up with my friend to make deeper connections with the material as we grow into the doctors we dream of becoming.

That dream, however, is something I’ve been thinking about recently.

Very recently, for a few bleak weeks, I lost sight of who I wanted to be in medicine.  After nearly two years of studying and training, I felt that my path had led me into a seeping bank of fog.  I couldn’t see my way forward into the life-giving occupation I had imagined when I applied to medical school, and I began to feel increasingly lost.

For several agonizing days, I felt that I had lost my purpose.  After pushing myself in my studies for months while simultaneously struggling with the fact that life goes on even when you don’t feel like you have the reserves to deal with it, I was beginning to burn out.  It’s something that happens, and it’s a real thing.  I don’t think I burned out all the way, but reflecting on the past months, I see that I was beginning to.  I’m okay with admitting that because I know it happens to others too, and I hope that we can begin to dialogue about it more since doing so will help us, our colleagues and our future patients.  It will validate our own human experience.

It’s okay to be worn out sometimes.

IMG_4436

What helped me re-engage with my purpose was a recent encounter where I didn’t feel listened to.  It was a situation when I wanted the comfort of being heard, and I instead felt more like an avatar for my electronic medical record.  The interaction was relatively brief, but served as the wind to blow away the fog I had been muddling through.  I realized at a visceral level that, as a medical professional, I want to help my patients feel heard.  Even if they don’t always want to open up to me, I want each person to know they have had the opportunity to talk and be heard.

Yesterday, I watched a fantastic TED Talk by Dave Isay called “Everyone around you has a story the world needs to hear.”  Dave Isay is the founder of StoryCorps, which started as a recording booth at the Grand Central Terminal in New York to allow anyone to record an interview with another person.  In his talk, he discussed how empowering and validating it can be for people to tell their stories.

Of recording interviews as a radio broadcaster, he said “Over the next 15 years, I made many more radio documentaries, working to shine a light on people who are rarely heard from in the media. Over and over again, I’d see how this simple act of being interviewed could mean so much to people, particularly those who had been told that their stories didn’t matter. I could literally see people’s back straighten as they started to speak into the microphone.” (TED)

This was the other light that helped me begin reconnecting with my meaning in medicine.  I want something more than the technical skills and knowledge can give me; I want to be a healer through stories.  I want to be an artist who creates a space for people to speak themselves into existence.  Going back to the creation account in Genesis, words are what brought substance out of the void.  I think this is what can happen in our lives today when we pay attention to what people have to say–when we pay attention to their experience and their feelings and thoughts and what it means for them to be a human and a patient.

IMG_4652

IMG_4855

IMG_4885

I’m finding my way again, one step at a time.  So as I study the names of medications like ticlopidine and ticagrelor or diseases like loa loa and acute sclerosing glomerulonephritis, I’m also paving the way for stories to be told.

Since I love words and neologisms, here’s a word I’ve crafted to describe what I want to be:

Halewright (noun)

From Old English hǣlu-whyrta, corresponding to hale (health) + wright (builder, creator)

Someone who aids in bringing healing and wholeness to other humans through the act of listening to their stories.

And so the journey continues…

IMG_4868

Holes in the Universe

This morning, I was thinking about what my purpose in life is.  Even as a medical student, it’s possible to have some days where you wake up and wonder what the point of your existence is.  Those kinds of days do happen, although they don’t always make sense.  We don’t often talk about them.  Perhaps part of it is that we shy away from the seemingly illogical nature of such feelings; after all, we are med students in training to save lives.  Our destiny is to help heal, comfort, and make a difference in the world–if that isn’t enough to give one a sense of purpose, what is?

I was brushing my teeth as I thought this over.

Rather than try to logic my way through to a resolution, I began to think about how I’d feel without the people who are most important to me–how empty my soul would be without them in my life.  Each person who means something to me would leave a void in their absence, which means that they are actively filling that void by their mere existence.

That’s when I realized, at some deep level, our purpose is to stop up the holes in the universe.  We aren’t always conscious of these holes in the fabric of human existence, but we know they’re there when we’re missing someone.  We feel them in the middle of the night when we remember a lost love or in the airport when we say goodbye.  We glimpse them as we drive past crosses standing sentinel beside a freeway, or in hospital waiting rooms, or in poetry drawn from the depths of the soul.

So I just wanted to share this.  If you ever wonder what your purpose is, remember that you help to hold the universe together.  You are the only one who can close the gap.  Each of us has a hole to fill, and each of our lives have been uniquely cut and shaped by our experiences to fill the void in another’s soul.

Just think of something that is meaningful to you and imagine how you’d feel without it.  Maybe it’s hard to imagine a person–perhaps it is a pet or a beautiful wild place where the pines grow tall or something that makes you smile even on days when your smile feels worn out.  Perhaps it’s a favorite song.  Whatever it is, try imagining the void without it.  Then feel for a moment how its presence fills that void.

Whether you realize it or not, your presence also fills an empty place.  This doesn’t have to do with your job or what you do for others or how beautiful or strong you are.  It doesn’t have anything to do with your intelligence, grades, title, or degree.  It has to do with who you are–your favorite color and the way your hand feels when someone holds it and the way your eyes shine when you watch the sunset.

Your life fills a hole in the universe, and it keeps the void from spilling through.

photo

Ocean Soul

Where am I in this slipping tide
when will I believe the words
they come and go and ebb and flow
upon the far shore of my soul

The quiet place of wet and salt
I walk alone by the setting sun
with sand like stars upon my toes
and my beating heart undone

So many nights I pace this shore
as moonlight spreads across the sea
listening for something far
beyond the things that shadow me

My heart is clasped within this cage
of woven flesh and ribs and vein
still it feels the ocean storm
that rides the billowed silver waves

I’m waiting here beyond the cliffs
in the places lost to man
tracing words upon the shore
dreams spelled out upon the sand

With me is this lamp of old
lit before my wet lungs flung
their voice into the sea-born wind
when I first sang the ocean song

I hold my lamp against the storm
against the clouds and driving rain
waiting for the ship to come
I will wait and wait again

Here upon the furthest lees
here beside the wind-swept tide
ocean soul and ocean eyes
I wait and hold the sea inside

– The Stethoscopist

How The Light Gets In

Sometimes in life, all you can do is brace yourself after the impact.  I believe in being prepared, but I’m beginning to realize that the hurricanes of life don’t always come with warnings.  At times, they just come.  I feel like I’ve gotten soaked through by a recent storm that I’m weathering, but I am also convinced that I am growing from it.  It still hurts.  But I don’t regret the growing.

I’ve been watching the ongoing demolition of Meyer Library here at Stanford, and it’s resonated with a place deep inside of me. I have only been inside this library twice (and I’ll admit the first time I was looking for a shortcut across campus; the second time I was looking for a bathroom) so I never really had sentimental feelings towards it.  However, in its destruction, the library has spoken to me in ways that all the books inside couldn’t have.

IMG_3380

This hole opened up in Meyer just days after one opened up in me.

I’m realizing there are different types of people in life, and it’s hard to explain but all I can think of is the ocean shore.

Some people have brushed against my heart like sand, leaving shards that I feel I can do little with but slowly wrap with the nacre of my soul until they become pearls. These people are leaving me incrementally wiser and also more sensitive to others.  I am beginning to understand it now.  We’ve all gone through something that has changed us.

It is as the quote says: “Be kind, for everyone you meet is fighting a hard battle.”

There are other people, too, though.  There are those beautiful hearts who have stood beside me on the shore when the storm surge drove me upon the rocks, shattering my shell into a dozen pieces and baring my soul to the burnished sky. There are those who have held the pieces with gentle hands.  Those who have listened.

Those who are healers.

IMG_3513

Not long after the first gaping rend appeared in the library wall, I was walking past another corner of the building when a bit of light deep within caught my attention.

IMG_3849

Sunlight was filtering into places it had never touched before.  Through the broken glass and twisted metal, the sun was streaming in.

To me, it was a perfect picture of the lyrics penned by Leonard Cohen in his song, “Anthem:”

Ring the bells that still can ring
Forget your perfect offering
There is a crack in everything
That’s how the light gets in.

Everything that has been happening has been teaching me more deeply about humanity–about what it means to live and breathe and trust, what it means to feel like a kite cut loose from its string.  What it means to know that we all have felt things deeply, things that have made us who we are.  To know that there are reasons and stories behind every person.

Every one.

IMG_4199

The afternoon sunlight caught the dust and turned it into an auburn mist as I walked by the library today.  The demolition is progressing at a remarkable pace, and a whole swath of sky is now open, no longer blocked by the roof and walls.  The library was opened in 1966, which means that I am one of the first people to see the sky from this perspective in 49 years.

It’s been nearly half a century since the sky has been open here.

That tells me a story, too.  Sometimes when things are broken, that’s when you really see.

Deliberate Practice

I’ve never really spent much time looking at the bricks inlaid on the path that runs past the Li Ka Shing Center, but yesterday morning I snapped pictures of the following words while on break between lectures.  I was trying to catch an impression that I wanted to write about without exactly knowing what it was, but today I think I know.

IMG_1966

IMG_1972

IMG_1974

It came together after reading from the Harvard Business Review.

I hadn’t realized how breathtakingly relevant pieces from this journal could be to my training in medicine. As part of my Managing Difficult Conversations class, however, I was reading through an article in the HBR this morning when the following sentences jumped off the page and into my lap like an oversized tabby cat:

“Not all practice makes perfect. You need a particular kind of practice—deliberate practice—to develop expertise. When most people practice, they focus on the things they already know how to do. Deliberate practice is different. It entails considerable, specific, and sustained efforts to do something you can’t do well—or even at all.”

This was particularly relevant because, just yesterday, I was mulling over how I am hesitant to do some parts of the physical exam when working with actual patients. The parts where I’m not yet confident of my skills.

Certain things I’ve practiced enough to feel mostly comfortable with—for example, placing the stethoscope in the four positions on the chest wall to listen to the heart. And some things are straightforward enough that they are no longer intimidating.  I am confident while feeling for the rush of blood through the carotid arteries, listening for bowel sounds, or examining the extremities for edema.

Other things leave me feeling like I’m approaching a forest with mist swirling about my feet. How exactly do I test strength and reflexes in a patient who is unable to leave the hospital bed?  Is that really the thyroid gland I’m feeling…or should I ask them to swallow one more time as I feel for the subtle slide of lobes beneath the skin? What if I forget to test one of the cranial nerves while doing the neurological exam?  What if I don’t feel something that is there, or if I think I feel something there that isn’t?

What if I mess up?

For me, our Practicum sessions this quarter have brought some of these anxieties to the forefront of my consciousness. In Practicum, we spend an afternoon in the hospital every other week, and during this time we each meet with an assigned patient to gather their history and perform parts of the physical exam. After the history and physical, we join our preceptor and present our patient’s case in (what is hopefully) a concise, organized manner. All this comes together to prepare us for when we start our clinical rotations, and it is an invaluable opportunity to gain actual experience in the hospital setting.

As I reflect on my own performance, however, I realize that my times of practice aren’t fully yielding the dividends I seek. This isn’t a fault of the sessions–Practicum gives me all the opportunities I need.  Since a good portion of my time is spent alone with my patient, I am the one who decides which questions to ask and which physical exam maneuvers to perform.  And as a student, I have the rare gift of time to do so.

But I have been drawn towards the things I already know how to do fairly well. I have the human love of discovery, but I also very much have the human love of competence. It’s uncomfortable pushing myself out onto the tight wire that spans the cliffs between what I am and what I can become.

As I read on, one other sentence in the HBR article caught my attention.  It especially stood out since we’ve been receiving coaching on how to improve the cohesiveness, clarity and delivery of our oral presentations in Practicum:

“Bear in mind that even Winston Churchill, one of the most charismatic figures of the twentieth century, practiced his oratory style in front of a mirror.”

It’s awkward to do so, perhaps, but this echoes what I’ve told about improving my presentation delivery by practicing out loud on my own.  More than any other time since starting medical school, I’m sensing that the way forward is through focused, intentional practice above and beyond what I would normally do in my sessions.  I need this deliberate practice–the sort of practice that drives me into the realms where I am not skilled, past all the whispering shadows of fears that would try to keep me out.

By embracing the discomfort of what I can’t do well, I will be in position to move forward in the way I need and want to.  I know who I am and who I have been; I am not one to back down in the face of challenges.  But somehow, my journey as a medical student is revealing vulnerabilities that have laid latent within my soul.

That’s okay, though.  As I talk with some of my classmates about these areas, I find that I’m not alone in how I feel.  We all have our own uncertainties, hopes, visions and vulnerabilities, and although on individual journeys, we’re still in this together.

I’m excited to see how far we’ll all have come a few years from now!  And since I’ve realized how to engage in deliberate practice, I’m not as afraid of falling short of my vision of who I want to be as a third- and fourth-year medical student.  I have a plan moving forward, and I believe I can actually get there.

I really do.

Halloween 2014

I biked to class today in a green and gold gown, trying to keep its flowing sleeves tucked into my backpack straps so they wouldn’t fly out like streamers on either side. I hadn’t dressed up for Halloween since I was a young child, and although I felt a thrill of excitement at doing so once again, I didn’t want to draw much more attention to myself than I already did pedaling down the rain-washed paths in medieval costume.

IMG_1770 IMG_1779 IMG_1778

I had spent the evening before scrambling to hem my dress that it wouldn’t bunch up around my feet like an accordion; as I’m on the shorter side, I wasn’t surprised when my costume arrived with the skirt nine inches too long. After a last-minute trip to the fabric store to buy needles, and thread, I set to work, thankful that my mom had taught me how to hem by hand when I was younger (as my jeans and slacks never seemed to be the right length either, I had a decent amount of hemming practice growing up).

Our lecture on thyroid cancer was made memorable by a bunch of bananas sitting in front of me…

IMG_1747

…and I had fun seeing the various costumed characters scattered throughout the medical school. None of us dressed up as doctors, though; it’s as if there’s an unspoken agreement among medical students that wearing a white coat no longer counts as a Halloween costume.

Truth be told, the white coat still feels like a costume at times.

Some costumes you grow out of…others you grow into.

After snatching an hour of studying post-class, several of us went to the Lucile Packard Children’s Hospital (LPCH) to help give candy to the parade of children trick-or-treating in its halls. Every Halloween, the children’s hospital transforms into a kaleidoscope of candy-filled tables, brightly costumed children, and creatively dressed staff.

When I reached the children’s hospital, it was like stepping into the pages of a book. I glimpsed Glinda the Good Witch’s billowing pink skirts as we headed towards the stairs and caught sight of bone-printed socks peeking out from someone’s blue scrubs. Children swarmed the halls, dressed as ninjas and fairies, pirates and skeletons, superheroes, princesses, and animals. Not surprisingly, there were many girls in blue gowns with white braids, snowflakes and sparkles.

Some of my favorite moments were seeing the little babies—the ones only a few months old—cradled in their parents’ arms. These moments were both bitter and sweet, but the sweetness of seeing the little ones in their tiny costumes and sensing their parents’ love for them outweighed the pang. For this moment, at least, these kids could be kids.

As things began to wind down, my friends decided to make a last-minute stop at the Haunted House on the first floor. I tagged along and brought up the rear as we slipped through a door into a black-lined room swirling with eerie lights and little ghosts swooping around the ceiling. I have no idea what purpose this room actually serves in everyday life, but at this moment it was a dark cavern echoing with ghostly sounds. A ghoul slipped from the wrinkled walls behind me, and I squeezed closer to my classmates. LPCH had done well.

Looking back, I think what struck me most about today was seeing how much life filled the children’s hospital this afternoon. To me, it really was like stepping through a doorway into a magical realm. All the effort the staff and volunteers put into making this day as exciting and normal as possible for the children touched me.

It also reminded me how many people are living extraordinary lives. To the parents of the children here, to the children whose lives are anything but ordinary, I am in awe of you.

IMG_1760
Happy Halloween!

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

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.

photo 1

And I determinedly pressed my hand to the ground.

photo 2

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

IMG_0721  IMG_0722

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.  

IMG_0723

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.

IMG_0724

IMG_0725

IMG_0726

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.

IMG_0730

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

IMG_0735

IMG_0734

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.

IMG_0747

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.

IMG_0745

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.

IMG_0727
Campus bell tower – September 2014