Tag Archives: Hope

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.

Healer’s Art

photo

I wanted to share a picture I drew this week.  It’s based off of a drawing I did as part of my first class in Healer’s Art, an elective founded by Dr. Rachel Naomi Remen at UCSF and now taught at medical schools across the country.

As some background, the purpose of this course is to help medical students clarify and cultivate their calling as physicians and recapture the heart of medicine.  It’s described in our course catalog as follows:

“For pre-clinical and clinical medical students.  Explores core dimensions of meaning, service and healing exemplified by the outstanding physician. Goals are to develop and preserve personal values such as service, harmlessness, compassion, altruism, self care, integrity, equality, justice, respect, and nurturing wholeness; to develop the compassionate listening skill that is foundational for clinical practice and for finding personal meaning and satisfaction; and to clarify a commitment to medicine as one’s life’s work.”

Healer’s Art is taught each fall at Stanford and this quarter came at a perfect time for me, as I am facing some questions of purpose and direction as I move forward into second year.  I know who I want to be, and I at least have an idea of where I want to go within medicine, but the questions are still there.  I suspect nearly everyone faces them and that they never truly disappear.  I’m okay with that, though, because the questions keep me on my toes and push me to explore more deeply why I do what I do.

In our first class, we were each given a little bag of crayons–tangy, waxy, new.  The assignment was simple yet complex: think of something which you value about yourself and don’t want to lose during your journey in medicine, and draw a picture or symbol to represent it.

And so, with my classmates, I drew.  Some of us knelt on the floor while others sat by tables, each of us working to pictorially capture flames too important to extinguish.  I felt like a kid again as I bent over my big sheet of paper with my handful of fresh crayons.  It had been years since I really used crayons.

After several quiet minutes of sketching, we broke into our small groups and scattered throughout the building to settle down and discuss the heart of our work.  Words like “trust” and “resilience” and “love” emerged, along with stories of past journeys, current experiences, and future hopes.

My own picture sprang from a part of me that has faded somewhat over the course of my collage and now medical school years.  As a child, I loved to create stories and imagine fantastic odysseys, and one of my favorite pastimes was writing fiction. I loved to imagine things that could only live in the mind, like horses made of wind that, if touched, felt like streams of cool air blown from a fan.  In the past years, however, my mind hasn’t had as much time to wander such unknown paths.  Rather, it’s travelled the paths of biochemical mechanisms and lines of reasoning, and my writing has been reincarnated as reflective blogging and poetry.  And, while I love these paths, part of me misses the imaginative adventures of childhood.

As I reflected in the quiet moment prior to starting this drawing, a picture came to mind of me as a physician sitting beside a patient’s bed–a child’s bed–telling stories to help chase away the foreign loneliness of the hospital room.  To provide a portal to another world, a wall-less world of color and fantastic creatures.  To heal with imagination.

I shared some of this with my small group, and they shared in turn that the theme running through this picture seemed to be one of hope.  As I thought about it some more, I realized that in a way, it was.

Imagine hope.

For me, imagining hope means being able to see without my eyes–to look beyond time and space and see who the person before me really is.  The child that they were, the journeys that brought them here, the heartbeat beneath the gown.

Maybe I don’t have much time for imagining winged horses anymore, but just perhaps I can imagine the wings of the human soul.

The Color of Hope

IMG_1267

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

IMG_1268

IMG_1269

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.

IMG_1263

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.

IMG_1275

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.

IMG_1273

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.

IMG_1277

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.

IMG_1272

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.

IMG_1281

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.

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. 🙂

Hope

Embrace the moment

Catch the light

Count the stars among the night

Search for spring within all dormant

Seedlings whisper

Hope, ignite

 

See infinity

Another’s eyes

Seek the truth beyond the guise

Listen for the fledgling melody

Awaken heartbeat

Soul, arise