30 September 2010

Mon amie

From the hospital, United States, today.

She reached her hand for mine, gentle clasp, and shook it. Simplest human contact.
I almost cried.

Over a month ago – 6 weeks – she couldn’t have done that. She could barely hold anything. Barely speak intelligibly. And we didn’t know if it was ever going to get better. Today, she was dressed in her own clothes, not a hospital gown anymore (strange what a hospital gown does to a person. More on that later). Six weeks ago she didn’t want to live.
Yesterday I was laughing with her and her friend about how she owes him money, has to get back to work and overtime, fast, to make it up.
And today she shook my hand.

And I almost cried.

Beaming, dazed, I – again, it’s not marked! – opened the stairwell that sets off an alarm. Ohwell. Wandered around to find the staff exit (you’d think I would know, by now, what was where). It didn’t matter. I have been so sad about this patient, so desolate, and over the past few weeks, I have spent so much time beaming. And laughing. Laughing with her.

Today I almost cried.

From Mvangan, Cameroun, today.

And today I almost cried.
I don’t cry enough, I think, maybe I’m numb to this sort of thing.
Email from good friend in Cameroun: Alice la commercante est morte suite d’un incendie dans sa boutique au marché. Megan était malade mais ça va un peu. Régine ne cesse de penser à toi.

« Alice, the one with the boutique, died from a fire to her boutique at the marché. »
“Megan (friend’s niece) was sick, but she’s a little better.”
“Régine (another friend) thinks of you all the time.”

And this is how the news goes.
I have been so, so incredibly lucky. I am so incredibly lucky – born here, basically things are going to be okay. (with my circumstances of birth/family/etc). But there…not even that matters. None of my close friends have died since I left (that I know of). Friends of friends. Young friends of friends. Babies. And no, no – that’s not true – I think I had heard that the boutique owners near my house, the ones where I went in the mornings sometimes for breakfast or just to pick up something quick from the ‘corner store’ – died. One or both. When I was back a year ago in Mvangan.

Alice, the one with the boutique, died.

“MON AMIE!” She exclaimed every time I walked by. My friend. Every time. I walked past her old boutique at least once a day. At least. Alice was anglophone, but mostly she spoke pidgin and not anglophone English, so we communicated best in French. Some Bulu (hers was much better than mine, of course). I bought things from her –  kerosene (I stayed faithful with that) and various others. I realized after a few tries that her bags of pasta were so old they had weevils in them, which I wouldn’t see in the dim light of the kerosene lamp or flashlight when I was cooking. They floated to the top, and after the first, disgusted viewing (very, very early in my service), I would skim them out, no bother. Kerosene, candles, other. She ended up buying the boutique that had better hardware (nails, basically, rope, locks). I would get those from her when she moved to the marché. I didn’t see her as much then. There wasn’t much I went to those boutiques to buy, except on days I did manage to get up early enough to go (ie before 6 am. Funny, now it sounds pretty relaxing… ). Occasionally tomatoes from the girls there during the week, and I’d look at kabbas or babouches (the only ‘window shopping’ available in Mvangan, on those wooden stalls).

I do miss living there.

Alice died. Alice had a goiter – no iodized salt, probably. Maybe hypothyroid, maybe not. Alice with the three little kids running around – third born when I was there, but I hadn’t even known she was pregnant – kabbas, larger woman. Alice taught me to make beignets. There. I must have bought those from her, in the mornings I would brave crossing the mud. I sat in her kitchen. After awhile, I would just stop, having nothing to buy, feeling slightly guilty that I did so much of my shopping at other boutiques, now. But I would sit with her. Mon amie.

Mon amie taught me to wrap pagne. I walked by one day, early on, with pagne around my waist tucked in the way any Westerner might imagine. Somewhat like a towel.

It’s wrong.

It doesn’t stay.

(I also realized soon after that…who the hell wears pagne into town? no. At home, sure. Au quartier, sure. Then again, I could get away with just about anything. But in general, you don’t wear that into town. I learned. Ca ne se fait pas).

So she taught me. She called me (yelled me) over – I may have been a bit annoyed, I was probably on a mission to get somewhere with as much of a goal as I could have managed  – "MON AMIE!" – Alice pulled me into her shop and started taking my clothes off.

The pagne, I mean.

(oh….Cameroun). I hadn’t been in Mvangan very long, maybe a month. So it was strange, a bit, and I had no idea what the *&$# she was doing… but, okay. (and no, it’s not so strange).
“Non, comme ca!” I don’t remember what she said. She redid it for me, showing me.
And that is how they do it – so miraculously, it doesn’t come off. I can walk, dance, carry water on my head without it slipping. Without safety pins, without anything else holding it up (the elegant, subtle, confident brilliance of African women).

So chastised, I walked the rest of the way into town (she was half-way). I know how to wear it now.
She probably fixed clothes for me a few other times. Mon amie.
Never Ntangen. Never la blanche. Or la whaat. Whiteman! No. But not my name, either – and she did know that. She had her own name for me (and no, it's not what she called everyone).
Always. Mon amie. Always.

Alice, mon amie, slept in her shop. Most people do that. I’m not sure if she had a new room behind the marché one – her old one was much bigger, lots of space to walk around. The marché one was more of a counter crowded with many, many items. I bought locks there. The mugs I coveted for months – then bought, matched set. Probably cost me about 1000 F CFA ($2). Maybe more. The comparisons to life here. Online shopping. Amazon storing my credit card number.
Mon amie slept in her shop. Her mother was there, not when I first met her but later. Her older mother – we didn’t have a language in common. I would alternately ask things in English, French, Bulu, my broken pidgin – probably asking where Alice was, or that’s what she was telling me. Her mother did more of the cooking. I learned with them.
I should have sat more.
I should have been more.

I wonder if I have any photos of her. Probably not – the dailies, the true fixtures of my life, I didn’t. Alice. Ma’a Monique. Pa’a – still forget my Fulani boutiquier’s name. I learned it eventually. We spoke a lot, though. Pa’a Jerome. Ma’a…Dorothee, I think.
Names are slipping. And yet – and yet – when I was there, last summer, things came to me that I didn’t think I remembered. Bulu. People’s names. So many people I remembered, that I can’t recall now. As if the memories are stored in a particular place. I got in a taxi in Limbé, and until I got in I had no idea where I was going. I knew exactly where, but couldn’t think of the name of the town. I started to describe it, and a few words in I remembered the name. It was there. It was I needed it. That is enough.

Mon amie died. Megan was sick and got better – she’s three now, maybe. Sick doesn’t always get better, there. I know she’s in good hands. Régine thinks of me.
Régine’s sister died, TB. Other....? AIDS? Probably. Maybe. Most likely. She was coming back from Gabon – seemed that was always the story, or so often. Gabon as a source. Not that Cameroun didn’t have its own sources. But travel, travel of any kind…

 I took photos of Régine’s dead sister in the morning – that’s tradition, before the burial. Morning after she died. I got up, went to take pictures, and bought avocadoes in the marché. Must have been a Wednesday, then. The photos are on Régine’s wall.
One of the strongest women I have ever known or will ever know.
Régine thinks of me often.
Mon amie died.
Megan was sick and now is a little better.
Mon amie died.
Régine is there – and in health – that’s what he means, he would say so otherwise. Régine has been sick and almost not gotten better, before. Malaria. Yellow fever. Etc.
No news of her soeur (another sister) in the Camerounian sense, or of her soeur’s daughter, who was named for me. Her môn-a-minga . Little girl. My mbombo. Namesake. 

And the friend who emailed me has email now, has a job, and has a facebook page. He has skype too. All of this at the government office where he works, and internet cafés.
He has all of this (and may be reading. Mbamba mos, N! Akiba.)
Some people are doing well.
Alice, the one with the boutique, died.
And some people are doing well.

As in the hospital. Some people are dying, have died. And some are doing well. Some will go home, some even better than when they came in.

There are things doctors try to do, maybe, that work, maybe.

In Cameroun – things happen as they happen. People are fatalistic – don’t often think or plan past tomorrow, which or what will happen dieu voulant (god willing). A Zambe.
A Zambe wôm.

Because you don’t know. Shops burn down – might have been burned.
Children die. Crops die. Not enough food or water.
Some people – so few people – get lucky, get jobs or opportunities to go to school, the 10% (maybe) of the examinees who get by on merit (the rest on corruption).
Probably less than 10%, most of the time.
(Things that stop being shocking, surprising after awhile. They shouldn’t).

Alice, the boutique owner. Mon amie, always smiling and with the voice carrying out to me, she heard/saw me somehow from the inside of the shop and would come out to greet me. I don’t yell or project as well – but I would do the same thing to her. MON AMIE!

Mon amie.

And some people are doing well.


25 September 2010


I was having a discussion with some physicians the other day about Dante. (rather, they were discussing, and I was somewhat on the fringes of the fire, I, the student trying to dry the clothes she was wearing as she’d forgotten to bring extra pants on the trip to swim in a mountain river…) But as often-enough happens, there was a trigger point for me in the conversation and I jumped in.

I do believe that essentially everyone is more learned than I am (the people with whom I generally surround myself, at any rate. I like to be around people I can learn from. Then again, everyone can school someone else on something).

I’m a dilettante, professionally (perhaps euphemistically aspiring to be a renaissance woman…). Even title-above-and-description-wise. Could be a better physician(in training), could be a better writer, but – can’t pick one – and therefore can aspire to be kinda good or okay, maybe, at both. And I’m in general wholly impressed and overwhelmed by the general culture and knowledge of the physicians I know and have the privilege of spending time with (though these are, also, those who have chosen to remain in academic medicine and spend a good deal of their time teaching).

 However. This particular group started discussing Paradise Lost and then The Inferno. One started going on and on about how Dante was so ahead of his time in writing about/describing heaven and hell in that way, etc, that that was the big thing about the work, and I’m thinking (and soon saying) ahh…no. Two things. Writing in Italian. And politics. Big, big politics. Just as political as Machiavelli, in some ways, but a prettier and much more interesting and complex story. (no need to expound. again, amongst people (I’m sure) who know this better than I do.

so...sometimes I know things.

Everyone’s a poet. Poetry is natural, poetry is breathing, it’s a way of being quiet and looking at the world. People translate that – or feel impelled to translate, transcend that into another form. Or they don’t, and it’s still poetry – the moment is, still, poetry. Anything exquisite. Anything that makes you catch your breath, or stop, or see or listen or feel in a slightly different, slightly new or nuanced way.

But people are afraid of poetry, think it’s esoteric, complex, overly intellectual, overly analyzed, and – frankly – pointless, perhaps a historical footnote. “I don’t understand poetry,” they say. I hate that. I hate that it seems – or makes itself seem – so inaccessible. There are so many different ways to read. If you read something and you like it, that’s good enough. If you see a painting, hear music, and you like it, that’s good enough. That’s appreciating. There are other ways and more and more things to delve into and appreciate and fall in love in other ways… but it shouldn’t be inaccessible. Art should be – is – for everyone. Enjoyment, expression. It’s all about communicating and translating, bringing across experience, which is not unique to the artist, at all. At all. (There are what, two stories in human experience? In literature? If that?)
To me, anyway, art is something about a collective unconscious, to get slightly Jungian.

I took a class called “Art for the People.” And bridging science and art, as I did and still try to do, flailing-ly, I see people have the same-same fears and feelings of inadequacy vis-à-vis science and art. Science makes itself out to be intimidating. Medicine speaks an entirely different language – not just in medical terminology. Medicine turns English, commonplace words upside down.
“How is the patient mentating?” (thinking. are we judging? yes. cognition. alertness and orientation. but also judging… the patient’s relationship to the world, as if we know how to govern that).
“Please ambulate the patient.” (‘order’ to nurses. help/make sure the patient gets up and walks).
“Is the patient’s sensorium intact?” (ie. hearing voices/seeing things? feeling things that “aren’t there?”)
Medicine  auscultates heart, lungs, carotids, abdomen, rather than listen.
Rather than sortof sad, someone is probably dysthymic, and if they’re just feeling normal, they’re euthymic.
Patients “complain of.” (did you know that’s what you were doing when you went to see a doctor for a particular reason?)
Patients “deny” symptoms (did you know that’s what you were doing when you said you didn’t have whatever the doctor asked you about?)
There is too much to digress upon here.

Poetry used to be communication transmitted across towns, countries (by modern definitions), across time. The poets were idolized. (in some countries, they still are. In France, streets are named for poets, philosophers, composers. In the US…presidents…some generals, maybe…)
Plato banned poets from the Republic because they were too influential, and because they made mirages, in some sense. Turned things upside down. Forms are supposed to be pure, organic.
Words are powerful.
Words can destroy.
It’s a dangerous thing, to wield a pen. It could get you exiled, incarcerated, killed.
Still does.

That is poetry. That is writing. That is being a writer.
A good friend once told me that all you need to do to be a writer is to write. It’s a heady thing, to call yourself a writer.
To be a writer, you just have to write.

I’m intimidated in the same way by writing poetry that rhymes and by drawing or painting in color. I feel like, with both, you have to do it really, really well – really skillfully, artfully, delicately, and deliberately – or it comes off as heavy-handed and trite. And overbearing.
So I almost never write things that rhyme.
And I prefer to draw in charcoal.
By the same token, I love writing, and I love drawing in black and shades of grey (I supposed I don’t actually draw “in” white, except for the pieces that are pages shaded full of charcoal then erased to create shapes and shadows.

For poetry. Rafael Campo, a personal hero who I am honored to call mentor (and, as he said once, future colleague), often writes formal sonnets. Many of his poems – entire books – are composed of formal sonnets (the Shakespearean, not (or sometimes?) Petrarchan kind – ie, 3 stanzas of four lines each plus an ending couplet, ABAB CDCD EFEF GG. Iambic pentameter. End-rhymed. You’d think something like that would be pretty damn obvious.
And yet I didn’t notice for awhile. I’m slow, perhaps. I don’t notice things. All true. But it wasn’t until a second, third, reading, and perhaps reading the poem aloud, that I realized the lines rhymed.

I was floored.

Knocked over, stunned, gasped. Floored.
(this is what poetry does to me).

It takes a subtle, delicate, absolutely %$*&#*& brilliant writer to pen lines that ‘happen’ to rhyme, where the words are completely organic and belong there, each in their own right. You would never question any of them, or see them there only to serve a purpose. It’s completely fluid.

And, in my mind, next to impossible to do. (for mere mortals like myself).
Formal poetry has a place both in history and in vivid, living memory and practice. There are those who say, probably, that contemporary poetry is too…anything…not rigorous in the same way it used to be. Or something. Forms are a fantastic exercise to use (and for those who are absolute masters, a natural vehicle in which to write). As an exercise, I wrote a sestina (if you want to talk about ridiculously complicated forms… suffice it to say, 6 stanzas of 6 lines each plus an ending tercet. There are six words, through the poem, that end lines. That’s it. And the alternate in a particular pattern through the stanzas. And they rhyme. My six words were: alive, body, line, words, hypochondria, worry. These are sometimes slightly altered – “live” for “alive”, “align/realign” for line, “wary” for worry, once. But still. Imagine a poem in which “hypochondria” appears 7 times….)

But you can’t do this if you can’t do it well. I say. And writing something that “happens” to rhyme is unbelievably difficult. You can’t choose a word because it’s close enough/approximate enough to what you mean, and rhymes with the word you want it to. They both have to be exactly, absolutely right. Standing alone. And then they have to rhyme.

Art is similar for me. I can stand/sit/stare at paintings for time that doesn’t seem to pass. There isn’t thought. There’s something…visceral, zen, implicit. Indescribable. Each large city with which I am familiar has a few paintings like this for me. And when I’m there, I have to visit. It’s like going to see friends. You don’t * not* see some people when you’re in a certain place.

Dear gods, I digress. In writing and in live conversation.

Drawing. Art. Mine. Anything I do in color feels garish. I have to really mean it. It can’t be incidental, it has to be exactly right, or it feels out of place and like artifice. Pencil. Charcoal. Black ink wash. I hesitate to use color. I hesitate to use rhyme.

When flute players first learn to do vibrato (really a ‘coming of age’ moment for that instrument)…we want to use it all the time (or, I did). Showing off? Yes. Does it sound good? No. Vibrato is, in my mind, one of the most unique and beautiful things about the flute. It is an instrument that feels organic – not quite the hollow bamboo of yore (though some still are) – but – in essence – the music is from a column of air pulled up from my body, directed across and into this hollow cylinder by the force and delicate shaping of my lips, and I, in the same way, control the octave and the tone itself. Nothing fancy. No reeds. Nothing. You can play a range of beautiful notes on a headjoint, without any keys or fancy trappings.
And the separations in the air, the notes, are merely small, deliberate interruptions of the air by my tongue. Breathing marks phrases. This, too, is visceral.

But back to vibrato. It’s a decorative element, it’s a way to add emphasis, to add color or mood or shading. And at first – WE FIGURED IT OUT!!! – it’s all the time, and the flute section melodies (cause we always have the melodies) sound wobbly, slightly off key, and annoying as hell as the wobbles are all happening at different frequencies from the vibrating throats of the young arrogant flautists*….
Until we learn.
Delicate. Deliberate. Only when it means something. And then, dear gods, it can be stunning.

* okay there * may * have been a similar phenomenon when I learned to do the back-of-throat clicks in Cameroon. There are just some things you do have to respond to that way, though. And that here I keep trying to (still!) because, really, why say “uh-huh” or “I hear you” or nod or make non-specific murmurs of assent when you can do this. Which took a lot of assiduous practice to figure out the mechanics thereof.

I did learn to use vibrato sparingly. Somehow, that hasn’t been true yet of rhyme or of color. If it is the same thing.

Patient today.
“Are you going to be my regular doctor?”
“Yes, for now.”
“What does that mean?”
“Well…I’m not here forever (why do I hesitate to say – only for a few more months?). There are other people who will be here longer than me, that you’ll see later.”
“Will they be like you?”
Step back. “…what do you mean?”
“Will they have your personality?”
“Ahh…well they’re all very good doctors…”
The patient’s friend looks at me. “She likes you. She hates most doctors.”

Masquerading in a short white coat. Trying to get people to call me by first name. Never introducing myself as doctor. And yet – and yet. Everything I say, can say, can think or figure out to do in medicine feels pretty black-and-white, simple. I don’t have the nuanced colors yet. And if I try to use them, I’m generally – wrong. Anything fancy, any shortcuts. There’s a hell of a lot of color in the body. New language to learn. It’s easier for me, sometimes, with patients because I don’t have enough of the language or the knowledge, I am a lot closer to their level of understanding. My physical exam – black, white, subtle shadings of grey that are emerging. “Within normal limits” or not. (and even that…) “murmur” or not (aka ‘I didn’t auscultate one). Or “I think there’s something there…but I’m not sure what it is.”
Easy to start to feel fancy and knowledgeable and…real… when you’re (sortof) dressing the part, all the right toys are arranged in your pockets, the sign on the exam room door has your name written, the MAs call you doctor, the patients call you doctor (though they see your attending coming in to ‘visit’ and talk, probably exam them as well, every time..). Somehow, somewhere, there will be the time and the will to learn, to remember that none of this is “real” and it has to be made real, really earned – if I can find both.


19 September 2010

... and sometimes there are miracles.

I think I wrote about both of these before.
The patient, not-so-slowly degenerating over a year to the point of losing function, losing vision, and starting to lose speech, who wanted to kill herself because she could no longer do anything he cared about. Who couldn’t do it because she can’t take the pills, by herself.
She’s getting better.
This almost never happens (at this level).
She’s getting better.
I go in, not often enough, but a few times a week. And, gods, she’s glad to see me. That in itself is miraculous. The doctor-patient relationship. Being someone to someone, but in a very different way than every other relationship in my life.

(addendum to the other, the patient with the wires in her heart. She survived. She went home. And if she has brain damage, after all that, it seems minimal. These are. Miracles. And by miracles I mean unlikely events that turn out well)

The only doctor I’ve ever really liked or felt like I had a relationship with, at all, was my orthopedic surgeon. Ironic, as they’re renowned for not having charisma, warmth, all the things we call ‘bedside manner’ (there has GOT to be another name for it. I’ll ponder that). But I saw him every week for months, then every two weeks, then every month, then every time (once? occasionally twice) per year that I was back from college. Then once, twice after Peace Corps. I think. I haven’t seen him in two years; perhaps I should stop by and say hello.

Orthopedic surgeon. By stereotype, jock-ish types who like to break things. And run a lot. And be really mean to residents. And be crazy in med school and only study in order to have stratospheric USMLE scores that have no correlation with either future promise in medicine/actually application of knowledge/ ability to be a good physician.

Orthopedic surgeon. He saw….forty patients per day? Perhaps. But the five minutes he was in the room meant something, and he was connecting for that time. You didn’t count it. It wasn’t short. It was real, he was there, and he was there. That’s what matters.

Dr L didn’t fix me. He tried. Twice. Things are put back together, then other tendons were moved around and remade, and then… well he told me before the second surgery that for some people it didn’t work even after three. That they were still in pain. (why he told me this directly prior to surgery, I’m not sure). And two didn’t fix it, but as there’s no guarantee that three would – there’s no point in reopening the thin white line that I think gives my wrist character.

He didn’t fix me.
But I read the records. I was seventeen, and in my medical records it mentions that I was filling out college applications and that’s when I had noticed how difficult it was to write anymore. It mentions that, a little later, I delayed surgery because of Academic Decathlon, and I didn’t want to schedule it until I knew if we were going to Nationals, or not. (not. but only by a few points). It doesn’t mock that. It states it. This is what was real in my life. The things that matter to me are written down.
They were not only listening but remembering.

In medicine, left is right and right is left. Things are organized according to the patient. That is our perspective in space. Looking at a person, their left faces my right. Same with x-rays. Looking at a CT or MRI, we look from the feet up. Seeing into a person from the ground to the sky. So, sometimes, now (and I was never very good at this) – I get it wrong with myself. I become my mirror-image patient and I’m confused. Directions are not according to me, anymore, or to my body in space. In the neuro exam, we test for the integrity of nerve fibers that judge position in space. Proprioception. Where is your body? Where are you….
and yet we, ourselves, no longer see ourselves – at least in the encounters – as our own point in space.

(as a sidenote, I once examined a patient who had lost his joint position sense. It’s fascinating and strange, almost unbelievable. We test by having the patient close his eyes and moves a finger or toe, at the joint, up and down. “Is it up or down?” we say. Sometimes we’re tricky and keep it neutral. This patient didn’t know. He didn’t know where his body was, when he couldn’t see it anymore.

I try to remember this. I don’t always write it, but I remember. It’s a great PR trick (I’d imagine) to remember clients’ families, their names, favorite hobbies, important things in their lives, etc. Schmoozing points. So maybe it isn’t all that different. Do I want them to like me? Of course. I want them to trust me, and I want to earn that – whatever that means. Be respectful of it. The shrewder docs who were in private practice (and love to tell me how much money I’m hypothetically losing, sometimes, by taking too long and not billing enough) say it’s because patients are much less likely to sue a doctor they like who made a mistake than one they were indifferent towards. Fine.

So why does it matter, then, that I remember the salient details and ask about them? Yes, I care. It also helps me remember the patient, file them in my head as a person and not just a disease attached to a face/name.
But why, other than the insecure need/want to be loved, like, appreciated, or the normal-human aspect of that, does it matter if they like me?*

* there's also the patient who told me her son calls me "the pretty doctor" (as opposed to her other, ugly doctors? ha....the real doctors....i never say i'm a doctor, but it's confusing, apparently, because to them i function as one. or, they think i'm a nurse)

Then there was the ophthalmologist. Dr R. I saw him a few times a week at first, then every week, every two, and a few months apart. It was an infection that (somewhat dramatic, but serious, as well) could have left me blind in one eye. Granted, this is without treatment/ or with much-delayed treatment, and being a person who is informed about health, has access to medical care, and has a job and life situation flexible enough so that I could see a doctor… I could do it immediately. And “immediate” meant the day after I woke up and couldn’t really see out of one eye. Not itchy, not painful, but everything blurred and just difficult to…see…at all. It took a month for normal vision to come back. At any rate, in those frequent visits, I lost my sense of squeamishness about eyes, and I started to connect with the doctor I saw as saving my vision. I remember him, still. He wore glasses. He thought contacts were part of the problem (for everyone), in general, and recommended (as did the US govt) that contacts shouldn’t be worn in Peace Corps. Little details. But he appeared in a poem, later that year*. He never saw the inside of my hand, manipulating and moving the delicate wires, like Dr L. He put green fluoroscein drops in my eyes, looking at arrays splayed through an opthalmoscope (spider webs, I picture, little fingerings). Bright green tears from the extra liquid. You can see into the brain through the eyes. (We learned that, last year. I’m amazed by medicine where you can see internal organs. )
At any rate.

* come to think of it, so did Dr L. Not by name, but a very vivid image of him in the OR as I drifted into a dreamless, timeless sleep.

Hands. Eyes. There isn’t much that’s more personal about how we see the world. Perhaps an otolaryngologist, if I lost my voice. A neurologist, if I couldn’t think anymore because of a mass lesion, an infection, something else blurring my vision, changing my sense of touch, of senses, of…everything. Perhaps a psychiatrist for the same reason.

Hands and eyes are easy symbols.

But it is everything. And there I return to what I do love about medicine, what makes me stay in the every 2-3 week episode of wanting to drop out and do something more, more, that isn’t micromanaging and expands my mind and my world rather than contracting it.

It isn’t the disease, it’s the person and how the disease process affects the person. How they feel it. (everything’s subjective). What else it means to them. How it affects daily life. How it affects their vision of themselves. (…and here, the grammatical structure breaks down).

To wit. “Written on the Body”, Jeanette Winterson. “Illness as Metaphor,” Susan Sontag. The canon.

There are things that vibrate in this world. To finding that….