tag:blogger.com,1999:blog-182037642024-03-13T00:40:13.501-04:00 approach a scalpel with wordsWriter, Doctor, and RPCV, who is not, currently, in Cameroon.Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.comBlogger91125tag:blogger.com,1999:blog-18203764.post-91350796583037717862015-01-11T11:04:00.000-05:002015-06-07T00:00:04.653-04:00All the dangerous things we do with our hands<div align="right" class="MsoNormal" style="text-align: right;">
<span lang="EN-US">le 10 janvier 2015<o:p></o:p></span></div>
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<span lang="EN-US">Wielding pens. Waving swords. Stopping traffic.<o:p></o:p></span></div>
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<span lang="EN-US">I’ve believed that for a long time, not just in the old adage that “the pen is mightier than the sword.” As a writer and a doctor, one of my greatest hopes and exultations in earning my MD was the power and respect the degree bestows, for better or for worse, deserved or not, to be a spoken/outspoken advocate, and to be published for it.<o:p></o:p></span></div>
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<span lang="EN-US">I use writer in the sense of “someone for whom the act of writing is not an option; someone for whom writing is as necessary to existence as is oxygen.” I use doctor in the sense of not just the traditional physician and caretaker for a body and a person, but in the Latin derivation of “<i style="mso-bidi-font-style: normal;">doceo, docere</i> – to teach.”<o:p></o:p></span></div>
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<span lang="EN-US">Almost every sentence and every paragraph here starts with I. There is, too, now, “Je suis Charlie/ I am Charlie,” for what it’s worth, for belief in and disbelief against the recent attacks in Paris of freedom of speech.<o:p></o:p></span></div>
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<span lang="EN-US">I have recently felt ill, paralyzed, galvanized by moment and by turn by the deaths of Ebola, inequalities in Africa and health systems in Africa, prejudice, hatred, and fear of those of African descent living in the United States, focus on a few individuals sick in a country where they can be taken care of versus thousands upon thousands in countries whose fragile infrastructures are being destroyed; by injustices perpetrated by institutional racism across the country and most poignantly, most close to home in New York, a system in which I, physicians in general, anyone in a hierarchical position of power is complicit, where I weakly, as a primary care physician, offer flu shots and preventative measures to my patients who, in the South Bronx, are more likely to go to prison than to college, who could be stopped and frisked on the basis of nothing, who fear and are injustly feared on a daily basis.<o:p></o:p></span></div>
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<a href="http://www.ouest-france.fr/charlie-5000-personnes-au-rassemblement-lannion-3105561" target="_blank">Lannion, my hometown - where 5000 people is a large percentage of the population</a></div>
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<span lang="EN-US">There is the public health.<o:p></o:p></span></div>
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<span lang="EN-US">There is fear, worry, and helplessness because my friends in Africa have a higher chance of dying because, well, they have a higher chance of dying, and in two and a half years I went to exponentially more funerals, including those of children, than I have ever attended in the United States.<o:p></o:p></span></div>
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<span lang="EN-US">There is anger, outrage, need for telling when one of my patients almost died because of his insurance company and the lack of single payer health care, the lack of a generalized belief in health care as a human right in this country (article in progress, submission of said article to be done).<span style="mso-spacerun: yes;"> </span>He’s the first patient I asked if I could write a story about, a patient I know well, and he wanted me to publicize his story, to let others know, to try to help this not happen to anyone else. It was one of the best medical visits we’ve ever had.<o:p></o:p></span></div>
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<span lang="EN-US">I often end up watching the news, being part of the world, in patients’ rooms. We talk about it. It’s where I’m near TVs. In the intensive care units, these patients might be comatose, sedated, intubated, and as I try to remember and still speak to them as people, I become more part of the world.<o:p></o:p></span></div>
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<span lang="EN-US">I watched the events in Paris, some of, unfold in such a room. The patient was maybe-dying; a patient we’d had arrive last week in a similar condition did die. Because the hospital does not have the capacity it should for patients of this acuity of illness, because systems and overcrowding and a Bronx that has one of the highest burdens of illness of anywhere I’ve worked, he had not received an adequate level of care for the two days since his heart stopped and was restarted. I know little more about him that what the scant notes told me. I know he immigrated at some point, I know he mostly speaks Spanish, and I can imagine that due to a paucity of translators (though the phones are available everywhere), minimal time, and sometimes a lack of value placed on communication with patients and families in languages that they fully understand, he had likely not received the highest level of care or explanation of his condition. He apparently has a primary care doctor, that’s somewhat lucky. He was able to have a procedure to open the clogged vessels in his heart, that’s lucky too --- though it shouldn’t be.<o:p></o:p></span></div>
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<span lang="EN-US">So I was standing behind the head of his bed, increasing his level of sedation as he started to resist us placing a line in the largest vein in his neck, to give him the medications he needed to increase his blood pressure to the point of getting sufficient oxygen to his brain and to the rest of his body. It’s not just because Paris is partly home (true), or because I was there two months ago (also true), or because so many people I care about so much are there (true), but I felt more sick and focused on this, the fear minimally of death compared to the fear and horror of violence against writing and writers, than by the pain I was inflicting on a human being for “his own good,” necessity, for his illness that was contributed to by societal inequalities.<o:p></o:p></span></div>
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<span lang="EN-US">All of the above would be silent, unknown, if they could not be written of. There is TV now, internet, social media and the Arab spring, There is the movie held from theaters for political threats. But first, foremost, and still (yes, a picture may be worth a thousand words), there are writers, there are pens, there is finding the exact expression of something that is not for and by one but that is for and by a collective.<o:p></o:p></span></div>
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<span lang="EN-US">Plato banned poets from the Republic. They were too dangerous.<o:p></o:p></span></div>
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<span lang="EN-US">It’s not just that they were writers and artists. It’s that an editorial board meeting was targeted (and what, more than that, proves the power of words?) In France, political satire is an integral part of the culture. The political cartoonists were, are famous, before their violent deaths for writing. Not every country would hold a national day of mourning for writers. In few countries are major streets and squares, and so, so many other public and critical things, named for writers and philosophers. Writers are venerated. Artists are venerated. There are TV shows, many, solely of political cartoons and sketches. There are more newspapers than this one. Growing up in the United States, spending much but far too little time in my native country, in my first language, even I knew their names.<o:p></o:p></span></div>
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<span lang="EN-US">With everything wrong and injust and indignifying and terrifying and almost to be believed in the world (what else makes the news?), the largest piece of meaning, what I personally (and everyone is making this personal. Freedom of speech, freedom of expression is not just a societal but a personal human right granted to every individual – or should be—Je suis Charlie, I am Charlie) want to make a major part of my life is to write about it. There is arrogance in that too, in the need and want for publication. But it is tapping into a collective conscience, conscious and unconscious, Poetry is, anyway. Many of the writers in Paris wrote under assumed names, partly because that, too, in political satire there, is part of the culture. They were still known as people. Any attack on writers is not just an attack on writers but on everyone with a mouth, a tongue, a hand, an ear.<o:p></o:p></span></div>
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<span lang="EN-US">In Cameroon, I know people afraid to speak of politics in taxi cabs. On presidential election day in 2007, my friends didn’t want me to leave my house for fear of what I would see and what could, potentially, happen to me. The same year, I spent six months trying to master the bureaucracy of the French embassy in order to register to vote as a citizen abroad, I traveled (four times) one hundred miles in fourteen hours in order to vote. In the United States, I have campaigned in every presidential election since 2000. And I have been grateful for the accident of birth that gave me two passports in two countries that honor, that promote the right to speak and write freely. This shouldn’t happen in my first, my native country and language or in the country I am also from and where I’ve spent most of my life.<o:p></o:p></span></div>
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<span lang="EN-US">There is nothing left to say, there is nothing left to write but to speak. And to write.</span></div>
Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com1tag:blogger.com,1999:blog-18203764.post-12256561639561577642015-01-11T11:03:00.003-05:002015-06-07T00:00:04.649-04:00Toutes les choses dangereuses qu'on fait avec nos mains<div align="right" class="MsoNormal" style="text-align: right;">
<span lang="FR" style="font-family: Times; mso-ansi-language: FR;">le 10 janvier 2015<o:p></o:p></span></div>
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<span lang="FR" style="font-family: Times; mso-ansi-language: FR;">Manier le stylo. Brandir l’épée. Arrêter les voitures.<o:p></o:p></span></div>
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<span lang="FR" style="font-family: Times; mso-ansi-language: FR;">J’y ai cru pour longtemps, pas seulement dans le vieil adage que « le stylo est plus puissant que l’épée. » Ecrivain et médecin,<span style="mso-spacerun: yes;"> </span>un de mes plus grands espoirs et joies dans l’acquisition de mon doctorat était la foie dans le pouvoir et le respect qui vient avec, pour le meilleur ou pour le pire, méritée ou pas, d’être défenseur a haute voix, et d’avoir mes écrits publi</span><span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">é</span><span lang="FR" style="font-family: Times; mso-ansi-language: FR;">s.<o:p></o:p></span></div>
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<span lang="FR" style="font-family: Times; mso-ansi-language: FR;">J’utilise « écrivain » dans le sens de « quelqu’un pour qui l’acte d’écrire n’est pan une option ; quelqu’un pour qui l’écriture est aussi nécessaire a la vie que l’oxygène. » J’utilise « médecin » non seulement dans le sens du médecin traditionnel, celui qui s’occupe du corps et de l’humain, mais dans le signifiant originel en Latin, « doceo, docere » - enseigner. »<o:p></o:p></span></div>
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<span lang="FR" style="font-family: Times; mso-ansi-language: FR;">Pratiquement chaque phrase et chaque paragraphe ici commence avec « je. » Il y’a aussi, maintenant, « Je suis Charlie, » dans tout ce que cela représente, pour la croyance et l’incrédulité envers les attentats récents a Paris contre la liberté de l’expression.<o:p></o:p></span></div>
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<span lang="FR" style="font-family: Times; mso-ansi-language: FR;">Récemment, je me suis sentie malade, paralysée, pousse a agir par moment et par tour autour des morts d’Ebola, les inégalités en Afrique et dans les systèmes de sante en Afrique, la préjudice, la haine, et la peur de ceux d’origine Africaine vivant aux Etats-Unis, la focalisation sur quelques malades dans un pays où on peut s’occuper d’eux, contre mille et des milliers dans des pays où les infrastructures neuves et fragiles sont en train d’</span><span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">ê</span><span lang="FR" style="font-family: Times; mso-ansi-language: FR;">tre d</span><span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">é</span><span lang="FR" style="font-family: Times; mso-ansi-language: FR;">truites ; par les injustices perpétr</span><span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">é</span><span lang="FR" style="font-family: Times; mso-ansi-language: FR;">es par le racisme institutionnel </span><span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">à</span><span lang="FR" style="font-family: Times; mso-ansi-language: FR;"> travers le pays et, plus poignant pour moi, </span><span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">à</span><span lang="FR" style="font-family: Times; mso-ansi-language: FR;"> New York, dans un syst</span><span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">ème dans lequel je, et les médecins en général, tout le monde qui fait partie de l’hiérarchie est impliqué, où je impuissante, comme médecin généraliste/des soins primaires, offre des vaccins contre la grippe et d’autres mesures préventifs à mes patients qui, dans le sud du Bronx, ont plus de chance d’aller en prison que d’aller à l’université, qui pourraient être arrêtés dans la rue sur la base de rien, qui ont peur et qui font peur, injustement, chaque jour.</span><br />
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<a href="http://www.ouest-france.fr/charlie-5000-personnes-au-rassemblement-lannion-3105561" target="_blank">Lannion, lieu de ma naissance--5000 personnes, c'est une grande partie de la ville</a></div>
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<span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">Voilà la santé publique.<o:p></o:p></span></div>
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<span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">Il y a la peur, le souci, la faiblesse sans défense parce que mes amis en Afrique ont une plus haute chance de mourir car, que cela, ils ont une plus haute chance de mourir, et dans deux ans et demi j’ai participé à un nombre impossible de deuils, y parmi ceux des enfants, auxquels j’ai jamais participé aux Etats-Unis.<o:p></o:p></span></div>
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<span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">Il y a la colère, l’indignation, le besoin de raconter quand un des patients a presque perdu la vie à cause de sa compagnie d’assurance santé et à cause du non-existence d’un système de santé organisé et national aux Etats-Unis, le manque de croyance générale dans la santé et les soins de santé comme un droit humain (mon article est en progrès, et après le dépôt de mon article en progrès). Il est le premier patient auquel j’ai demandé la permission d’écrire un article sur son histoire, un patient que je connais bien, et il veut que je publie son histoire, pour que les autres puissent savoir, pour essayer que cela n’arrive pas à personne d’autre. C’était une des meilleurs rendez-vous que nous n’avions jamais eu.<o:p></o:p></span></div>
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<span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">Souvent, je regarde les infos dans les chambres des patients hospitalisés. Nous en parlions. C’est quand je suis auprès des télés. Dans les unités de soins intensifs, ces patients peuvent être dans le coma, sous sédatifs, intubés.<o:p></o:p></span></div>
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<span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">J’ai regardé les événements à Paris, quelques uns, se dérouler dans une de ces chambres. Le patient était peut-être mourant ; un patient qu’on a reçu la semaine avant dans de conditions similaires est décédé. Parce que l’hôpital n’a pas la capacité qu’il devrait pour autant de patients avec cette acuité de maladie, à cause des systèmes, parce que le Bronx a un des taux plus élevé de maladie que j’ai jamais vu aux Etats-Unis, il n’avait pas reçu un niveau adéquat de soins pour les deux jours depuis que son cœur s’est arrêté et qu’il s’est remis à battre. Je connais très peu sur lui, pas plus que ce qui contient les notes courtes. Je sais qu’il a immigré à un moment de quelque part, je sais qu’il parle principalement espagnole, et je peux imaginer qu’à cause de l’insuffisance des traducteurs (pourtant, il y a des téléphones avec services de traduction partout), peu de temps, et parfois un manque de valeur placée sur la communication avec les patients et leurs familles dans des langages qu’ils comprennent, il n’a probablement pas reçu les meilleurs soins ou une explication de sa condition. Il a, apparemment, un médecin primaire ; c’est un peu chanceux (et ça ne devrait pas l’être). Il a pu avoir une procédure pour ouvrir les artères bloquées dans son cœur, c’est aussi chanceux.<o:p></o:p></span></div>
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<span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">Alors j’étais debout derrière la tête de son lit, j’augmentais son niveau de sédatifs parce qu’il commençait à nous résister dans le placement d’une ligne dans la veine la plus grande don son cou, pour lui donner les médicaments ce dont il avait besoin pour soutenir sa tension artérielle<span style="mso-spacerun: yes;"> </span>au point de circuler le sang et l’oxygène à son cerveau et au reste de son corps. Ce n’est pas seulement parce que Paris, c’est en partie le chez moi (vrai), ou parce que j’y étais il y a deux mois (aussi vrai), ou parce que tant de gens que j’aiment tellement y sont, mais je me sentais plus malade et focalisée sur cela, la peur de la mort minime comparée à la peur et à l’horreur de la violence contre l’écriture et contre les écrivains, que par la douleur que j’infligeais à un être humain pour « son propre bien, » la nécessité, pour la maladie avec grande contribution des inégalités sociales.<o:p></o:p></span></div>
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<span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">Tout cela serait silencieux, pas connu, si on ne pouvait pas en écrire. Il y a la télé maintenant, l’internet, les médias sociales et le printemps Arabe. Il y a le filme caché des théâtres à cause des menaces politiques. Mais en première place, au début (et oui, une photo peut valoir mille mots), il y a les écrivains, il y a les stylos, il y a la trouvaille de l’expression exacte de quelque chose qui n’est pas pour et par une personne mais qui est pour et par la collective.<o:p></o:p></span></div>
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<span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">Platon a exclu les poètes de la République. Ils étaient trop dangereux.<o:p></o:p></span></div>
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<span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">Ce n’est pas seulement qu’ils étaient écrivains et artistes. C’est qu’un rendez-vous éditoriale à été ciblé (et quoi plus prouve le pouvoir des mots ?) En France, où la satire politique fait tellement partie de la culture. Ce n’est pas tous les pays qui déclareraient une journée nationale de deuil pour des journalistes.<o:p></o:p></span></div>
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<span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">Avec tout ce qui est mal, injuste, terrifiant et presque ne pas à croire dans le monde (qu’est-ce qu’il y a d’autre dans les infos ?), la partie la plus signifiante, ce que je personnellement (et tout le monde fait de cela le personnel. La liberté de la parole, la liberté de l’expression n’est pas seulement un droit des populations mais un droit humain et personnel accordé—ou que ça devrait l’être—à chaque individu—Je suis Charlie) veux faire une grande partie de ma vie, c’est d’en écrire. Il y a l’arrogance dans cela aussi, dans le besoin et le souhait d’être publié. Et connu. Mais en vérité, c’est accéder à la connaissance collective. Au moins, c’est ça, la poésie. Un attaque sur les écrivains, c’est non seulement une attaque sur les écrivains mais sur chacun avec une bouche, une langue, une oreille.<o:p></o:p></span></div>
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<span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">Au Cameroun, j’en connais qui ont peur de parler de la politique dans les taxis. Le jour des présidentielles camerounaises en 2007, mes amis m’ont défendu de quitter ma maison pour la peur de ce que je verrais et de ce qui, potentiellement, pourrait m’arriver. La même année, j’ai passé six mois à naviguer la bureaucratie de l’Ambassade de France pour m’inscrire aux listes électorales. J’ai voyagé (quatre fois) deux cent bornes en quatorze heures pour voter. Aux Etats-Unis, j’ai fait de la campagne politique pour chaque élection depuis l’an 2000. Et je suis énormément reconnaissante de l’accident chanceux de ma naissance qui m’a donné deux passeports dans deux pays qui soutiennent, qui protègent (à priori) le droit de parler et d’écrire librement. Ces événements, ces attaques, ces actes ne devraient pas se passer dans mon premier, mon pays natale et ma première langue, ou dans le pays duquel je viens aussi et où j’ai passé la majorité de ma vie.<o:p></o:p></span></div>
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<span lang="FR" style="font-family: "Times New Roman"; mso-ansi-language: FR;">Il n’y a rien d’autre à dire, il n’y a rien d’autre à écrire que de parler. Et d’écrire.<o:p></o:p></span></div>
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Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-79422037862994735522014-12-14T23:18:00.002-05:002015-02-25T01:41:02.360-05:00The Whiter Coat<div align="right" class="MsoNormal" style="line-height: 24px; text-align: right;">
<span lang="EN-US">14 December 2014<o:p></o:p></span></div>
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<span lang="EN-US"><span style="mso-tab-count: 1;"> </span>I hadn’t worn it in a year.<span style="mso-spacerun: yes;"> </span>Halfway through internal medicine residency, I’ve lost two of my allotted four. But yesterday, for the <a href="http://www.theguardian.com/us-news/2014/dec/13/marchers-protest-police-brutality-new-york-washington-boston" target="_blank">Millions March</a> in NYC, I donned my white coat under the banner of “<a href="http://www.pnhp.org/news/2014/december/medical-students-to-hold-nationwide-%E2%80%98die-ins%E2%80%99-and-protests-wednesday-because-blac" target="_blank">White Coats for Black Lives,</a>” over jeans, under scarf and knit hat. Doctors worldwide wear stethoscopes—a necessary tool, used for heart-lungs-belly-neck. A patient feels taken care of if you’ve listened to her heart and lungs. We have the laying on of hands and the laying on of stethoscope diaphragm and bell. Doctors worldwide wear white coats, a tool of nothing but repository for tools, a signifier of identification, power, an instrument of implementing hierarchy, and whatever else (including the positive) that is associated with the profession. With power comes implied responsibility, a mandate to earn the given trust.<o:p></o:p></span></div>
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<span lang="EN-US"><span style="mso-tab-count: 1;"> </span>Before even my first day of medical school, we received our white coats in a ceremony, parents came and took pictures, and we solemnly recited the Hippocratic oath, months before touching our first patients. A symbol of induction into the lifelong guild. For students, the white coat is short, still symbolizing power to patients perhaps oblivious to the length, but clearly showing the lowest rank to other doctors. It takes so many years to arrive at medical school. We had made it. Quickly, I learned to hate the coat, resent it, except for its many practical pockets, and I relished the rotations—pediatrics and psychiatry—that didn’t require and even discouraged its use. In my social medicine program, there is something vaguely uncool about the white coat, the long white coat we worked so hard to achieve. I wore it for the protest, yesterday, faint ink marks still visible after hospital dry cleaning, in a contingent of many others---to show we know We are an institution, We are implicit and complicit, and We, in positions of power, are here in solidarity because, among other things, racism is bad for health.<o:p></o:p></span></div>
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<span lang="EN-US"><span style="mso-tab-count: 1;"> </span>But to reject the whiteness of the coat requires whiteness, no need for cloth that soon shows sweat stains to confer that final privilege.<b style="mso-bidi-font-weight: normal;"></b></span><br />
<a name='more'></a><span lang="EN-US">How are non-white-coated doctors of color seen in comparison to those in white coats? I’ve never thought or asked. It is the white doctors who can reclaim the coat in this particular era of protest (…partly because doctors are, still, majority white), to say fuck the institution, to say lie down, pretend to die, and fuck them, one minute of silence (eleven) for every “I can’t breathe.” Too, at a medical school, administration having heard vague rumblings of a coming protest, emailed a few vocal students of color to ask what was happening, assuming this issue and its demonstrations were divided by color lines. Elsewhere, faculty and administration were in visible support.<o:p></o:p></span></div>
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<span lang="EN-US"><span style="mso-tab-count: 1;"> </span>Shortness of breath is a common chief complaint in offices and then ERs. The white-coated have algorithms memorized to diagnose and treat that. “I can’t breathe” generally means heart or lung. And for how long. Are the lungs closing up at any level (either no sound or whistles), or is the heart unable to move blood and thus oxygen through the body effectively, fluid backing up to legs (pitted like play dough), lungs (sound like crumpling tissue paper or the sound it makes if you pour milk over puffed rice), or the neck announcing every heart beat (anxious or arrogant in columns directed to the brain). History and physical lead to different paths, different etiologies, and different treatments. There is also the anatomic. If your chest wall is constrained and cannot move for force applied. If your neck is in a noose. This is easy to diagnose. You are unable to breathe.<o:p></o:p></span></div>
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<span lang="EN-US"><span style="mso-tab-count: 1;"> </span>It takes privilege to reject privilege. And maybe in reality a black doctor should keep a white coat in his car in case he gets stopped at a non-roadblock, coupled with “MD” ID and stethoscope to toe past doubt. And maybe in reality a black med student should wear the coat at all times, because even in a tie he might be confused for any other worker.<b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div>
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<span lang="EN-US"><span style="mso-tab-count: 1;"> </span>There is nothing inanimate about an institution. Medicine is not the prison-industrial complex. But in some places, a nurse is a warden is a prison medical director. In some places, doctors (<i style="mso-bidi-font-style: normal;">docere</i>, Latin, to teach) supervised executions. In every place in this country, pronouncing death requires doctors, as if anyone could not know by focused observation. If someone dies and no white-coated human passes by, did they really die?<o:p></o:p></span></div>
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<span lang="EN-US"><span style="mso-tab-count: 1;"> </span>Each white coat is full of pockets, full of tools to fix things in theory. The four pillars of medicine are: Non-maleficence (do no harm), Beneficence (do good), Autonomy, and Justice. Too often, the fourth is missing. The injunction to save every life, regardless, is legacy from ancient Greece. It is so much harder to <i style="mso-bidi-font-style: normal;">do good</i> than to <i style="mso-bidi-font-style: normal;">do no harm</i> (in which we are often also paralyzed). Many times, it is not possible.<o:p></o:p></span></div>
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<span lang="EN-US"><span style="mso-tab-count: 1;"> </span>After the protest, I removed my coat. I replaced it in my closet, haphazard and somewhat folded. At this rate, I’ll end residency with zero coats, but my next job will likely give me one the next step up, embroidered with my name. Sewn on and into privilege. White Coats for Black Lives is from <a href="http://www.pnhp.org/" target="_blank">Physicians for a National Health Program (PNHP)</a>: health care, equal access for all, health care as a human right. White Coats for Black Lives, because every doctor gets at least minutes to be white. I can reject the coat. I should not reject the privilege and power implied (earned and un-) to speak. We are given the coats from before the beginning. From this position, not just to the individual patients, we owe: Doing Good, Not Doing Harm, Respecting Autonomy, and Advocating and Fighting for Justice.<o:p></o:p></span></div>
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<span lang="EN-US">Jennifer Stella, MD</span></div>
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Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-57656729155181730072013-09-09T23:28:00.001-04:002013-09-09T23:28:19.604-04:00Communion<div class="MsoNormal">
<span style="background-color: #cccccc;"><i><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">Yaoundé, Cameroun</span></i><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><i><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">Centre Hospitalière Universitaire (CHU)</span></i><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><i><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">April 2013</span></i><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><i><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">Last day at CHU</span></i><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">I flipped open my patient’s blue cardboard folder. <i>Groupe
sanguin. </i>Blood type. ---</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial;">The day before, I'd gone to the blood bank at
CHU.</span></span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">It was the first time I'd ever donated – my more
than 6 months straight in Western Europe since 1980 disqualify me by Red Cross
standards (mad cow disease/CJD). And even if that ever changes, after living in
Africa, there's no way I'll ever be able to donate blood in the States.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">The irony. I can donate in Cameroun. I explained to
the phlebotomist that I can't donate blood in the US, trying hard to make my
explanation make sense, without the questionable undertones of the Red Cross
rules rejecting African or "African-ized" blood. It was my last day
at CHU. In a month, I had watched people die, and I had maybe, minutely,
helped. I had spent a night on call learning about how overstaffed the hospital
really is, when compared to the resources they have for patients. Compared on
that alone. The nursing censuses are lower. The doctor censuses, even, are
lower. There were so many eager med students (their education, not mine),
working zealously on med student-thorough, handwritten H&Ps in French or in
English, that they sent me to the resident call room for an hour or two of
sleep. The GI fellow was in there, and she woke up enough to kick off her
shoes, move over, and give me part of the twin bed. I felt hesitant and
unnerved; they were treating me like a doctor (and four months later, firmly
enmeshed in my intern year, I finally don’t jump to attention at the
appellation “med student”).</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">The transition from dark to dawn is the same in
every hospital. There are the early evenings hours. There are the middle ones
that stretch forever—nothing good happens, then. Either people are asleep. Or
they are very sick. It's the slight undertone to complacency on a quiet night.
In the US, we have pagers; if you lie down, you will be awoken. In Cameroon,
there are cell phones, of course, but there is almost no reception in the
hospital. And no one knows who is there.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">I learned—and taught—chest compressions. I helped
“consult” 140 patients in two hours by kerosene lamp in a cement block school
room after a 21 hour trip and sleeping in a field. I gave hundreds of shots.
Hundreds of deworming pills (mebendazole). (That, the last, is the only thing
that rivals blood in real utility, real helpfulness).</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">The public health self gave mebendazole.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">The doctor self gave blood.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">And it was only one unit of blood. One g/dl
hemoglobin. And it’s not type O. I’m no universal donor. I’m A negative. The
phlebotomist exclaimed over and over how rare it is. A raw moment of guilt. My
blood type.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">“Will it help, anyway?” I asked. Hesitant. A real
question. How long does it keep. To whom do you give the units. How well do the
generators work that maintain the freezers. Let this not be mainly to make
myself feel better. I don’t know the epidemiology of A or AB in Cameroon. In
brief genetic terms, I can donate to A pos or A neg and AB pos or AB neg. And I
can only receive A neg or O neg. But it also means that in emergency
situations—when you don’t know the person’s blood type and don’t have time or
lab availability (and the lab closed or out of reagents or on strike about one
third to one half of that month)—you can only use type O. Not mine.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">Let there be a point to this. Rather than just
calling it an early day and going to lie down on a table, arm out-stretched,
awaiting a quick sugar reward. Tired, on my second-to-last shift of a long
month; days in the hospital and weekends on health campaigns in villages. A
congratulatory and regretful marker—why did I not think of this years ago.
There are useful ways to leave pieces of yourself where you do, regardless.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">***</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">Mr. C needed whole blood. He needed fresh blood. I
don’t remember the medicine of why or if I understood it in the first place.
Fifty-two, seemingly healthy for the ICU, had some sort of job, I think, and he
was weak but awake enough to talk, and he had a wife, and there was a cousin
with a moto or a friend’s moto taxi who was going to the other hospital’s blood
bank or to find someone else to donate or to find money to pay for the
materials to transfuse.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">Those were the ICU days. Sylvie (ER resident from Belgium)
and I had decided to go downstairs from the ER (every other emergency
department I've known is on the ground floor or near enough). Maybe it would
feel less futile. Patients there had gloves and beds. Some had blood draws.
They had family. They had windows, near the open air conference balconies.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial;">Mr. C needed blood within 24 hours of its
donation.</span></span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">What did I bring on that trip but a suitcase of
scrubs. Another medical implement to leave. Concrete. Gauze pads, tape, saline,
alcohol, needles, suture, scissors, gloves, and a small cache of medication I
imported directly from Mexico. Everything suddenly feels small, that one can
bring in regulation-sized checked bags. Sub-Saharan Africa, unlike most of the
world, still allows two.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><br /></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><br /></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><span lang="EN-US" style="color: black; font-family: ""Times New Roman"","serif"; mso-bidi-font-family: "Times New Roman";">***</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><br /></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><i><span lang="EN-US" style="color: black; font-family: ""Times New Roman"","serif"; mso-bidi-font-family: "Times New Roman";">Last day at CHU</span></i><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><br /></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><br /></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><span lang="EN-US" style="color: black; font-family: ""Times New Roman"","serif"; mso-bidi-font-family: "Times New Roman";">I opened Mr. C’s blue
folder. Groupe sanguin. Blood type.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><br /></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><span lang="EN-US" style="color: black; font-family: ""Times New Roman"","serif"; mso-bidi-font-family: "Times New Roman";">A positive.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";"><br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--></span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="background-color: #cccccc;"><br /></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">I had waited until the late afternoon. No one
thought I should return to work minus a pint of blood. So, it was the last act
of my second-to-last day.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><span style="background-position: initial initial; background-repeat: initial initial; color: #222222; font-family: ""Times New Roman"","serif";">My A negative and I, my exclaimedly difficult venous
access and I, requiring the head blood bank nurse and her no-nonsense
deliberation and needle (I'm accustomed to apologizing for my veins. I'm
accustomed to directing the one holding the phlebotomy tray) were hours too
late.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><br /></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><span lang="EN-US" style="color: black; font-family: ""Times New Roman"","serif"; mso-bidi-font-family: "Times New Roman";">I set this up as a too
obvious story. But it was a too obvious omission, that day, that I hadn’t
looked first. Had I read his chart the day before. Had anyone asked. It was a
pat irony, or an obvious one. This is the way the story goes. Some people give
patients bus fare or metrocards. Some people give blood, marrow, and organs to
friends, family, or strangers. I could have given my blood to my patient.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><span lang="EN-US" style="color: black; font-family: ""Times New Roman"","serif"; mso-bidi-font-family: "Times New Roman";">Just hours before. Would it
have been too personal? Too martyr or savior-role, anyway?</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><br /></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><span lang="EN-US" style="color: black; font-family: ""Times New Roman"","serif"; mso-bidi-font-family: "Times New Roman";">***</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><i><span lang="EN-US" style="color: black; font-family: ""Times New Roman"","serif"; mso-bidi-font-family: "Times New Roman";">NYC</span></i><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
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<div class="MsoNormal">
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<div class="MsoNormal">
<span style="background-color: #cccccc;"><span lang="EN-US" style="color: black; font-family: ""Times New Roman"","serif"; mso-bidi-font-family: "Times New Roman";">Mr. D came back from
surgery. Mr. D was bleeding. Mr. D was losing so much blood that he was getting
dizzy. Mr. D needed blood. I put in the order, printed a label and stuck it to
my hand, and walked quickly, the way doctors do, to the blood bank. “I need blood
for Mr. D. We already called.” Here, only physicians can sign for blood. Sign
out blood. Blood, plucked from freezer to fridge to a brown paper bag clutched
in my hand, with implements for transfusion. The most useful thing I did that
day was to walk to the blood bank and walk back. But here there’s no shortage,
and here no one in Mr. D’s family had to donate in kind.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><br /></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><span lang="EN-US" style="color: black; font-family: ""Times New Roman"","serif"; mso-bidi-font-family: "Times New Roman";">We asked. We were given. We
gave it.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><br /></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><span lang="EN-US" style="color: black; font-family: ""Times New Roman"","serif"; mso-bidi-font-family: "Times New Roman";">***</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><i><span lang="EN-US" style="color: black; font-family: ""Times New Roman"","serif"; mso-bidi-font-family: "Times New Roman";">Yaoundé, Cameroun</span></i><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><br /></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><br /></span></div>
<div class="MsoNormal">
<span style="background-color: #cccccc;"><span lang="EN-US" style="color: black; font-family: ""Times New Roman"","serif"; mso-bidi-font-family: "Times New Roman";">There is not enough blood
here, or water.</span><span style="color: black; font-family: Times; mso-ansi-language: ES-TRAD; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal">
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<span style="background-color: #cccccc;"><br /></span></div>
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<span style="background-color: #cccccc;"><br /></span></div>
<div class="MsoNormal">
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Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-6465086979072458552013-08-25T23:48:00.001-04:002015-02-25T01:41:02.355-05:00Peripheral<div class="MsoNormal">
<span lang="EN-US">I look idly at the hand grasping the
laundry basket. “That’s a beautiful vein,” I think. “Someone would be lucky to
get to slip an IV into that.” And like everything that gets accidentally
carried back from the hospital—venipuncture kits, 4cm x 4cm gauze (think:
measures I am learning), alcohol swabs, tape, fecal occult blood cards and
guiac solution, gloves—I have the materials to do it. But I’m not the one I
would need practice on. It’s the patients with scarred veins<span style="mso-spacerun: yes;"> </span>(drugs, fistulas, too many hospital visits)
or overloaded with fluid—the “vasculopaths”— that take skill. A patient with
good veins is a good patient. Ones that don’t roll or slip away from you. Ones
that leap to attention under tourniquets and alcohol. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">We are vampires not only at night.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">It’s using your hands (not trusting your
head), taking ownership of each step of the process, delegating tasks (most)
that don’t take a medical degree to yourself.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">I’ve caught myself thinking “I wish I had a
med student for this.” To get patients’ weights while standing (find the heavy
scale, wheel and weave it through the hallway, support the hesitant frame). To
get orthostatic vital signs (vital. Life. Here, to check the difference in how
fast and how hard the heart beats, how much the veins and arteries contract and
relax, when equilibrating between lying down and standing up). It takes
minutes. Five. Or more. I picture third year of med school, two hours per
patients, an afternoon to sit and talk…<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">Or carry blood.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">It’s the beginning and the end of the day’s
menial tasks. I learned to relish the quiet moments, years ago—coffee and
morning labs. Keeping track of numbers. Comforting shapes (mean: which value is
this. Which electrolyte, element, atom. Which part of your blood) scattered
across the paper—it used to be the pride, the insider-ness of using them and
starting to understand what they meant. Now, it’s the morning labs. And in the
evening, it’s entering orders for the next day’s labs. (What do I need to know
about the inside of you. What am I following). It’s still trying to be careful
and responsible with language, when entering notes into the permanent medical
record. For example: patient refused the dose.<span style="mso-spacerun: yes;">
</span>Or, patient declined the dose. Patient refused the exam. Or, patient
declined to participate in the exam. Participate in the exam. Or follow
commands. Or not.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">For so much of the day, it’s numbers.
Numbers correlated with symptoms. Refusing the medication lactulose, for
example, means Ms. A’s liver disease will cloud her mind. I picture a shroud of
permanent damage (cirrhosis. Hepatic encephalopathy). Septic flood waters
rising into the brain. We have a medication for that. And we’ll titrate it,
we’ll base our decisions upon how many bowel movements recorded in a day. The
septic systems pulled down from the brain, down, down, and out. It’s one of the
most important medications. It’s critical.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">“Patient refused the dose.” And sometimes,
this is followed by documentation of “Dr—notified.” And sometimes not.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">The patient’s mental status is a
temporarily soluble problem. There are so few problems we can fix. This one. We
can help. But she refuses.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Because a 57 year old woman who brought up
her (I found out today) 28-year-old severely autistic niece, who used to draw
caricatures of tourists on the street, whose house slippers are red, does not
actually want to soil herself and the bed (how many do I want) four times per
day. When I read the “1”, “2” in the morning I’m disappointed. So I increase
the dosage. It’s not working. It’s not working. And she can barely move to get
up, and when she does, it’s certainly not swift enough for something this
powerful. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">In the middle of the day, I know this. At
the end of the day, I finish my progress notes. “Ms A was cloudy today because
she declined two doses.” But, I think, upbeat, she has a PICC line
(peripherally inserted central catheter). It’s an IV inserted through the arm
into the heart. It’s a longer-term and deeper-inserted IV, which is so easy to
use and consistently get abundant blood flow for labs that it’s equivalent to a
sigh of relief anytime I realize I need more information about my patients’
insides. Patients with PICCs are the sicker ones, whomever will need that many
blood draws and that many days, weeks of IV medications.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">I want blood from a sick patient. These
labs will be quick. I’ll draw them myself. This is the one easy moment of the
day. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">I sit down, on the bed or in a chair pulled
close, with the labeled, carefully colored-tubes beside me, and biohazard bag, two
syringes full of sterile saline, gauze, alcohol swabs, and vacutainer adaptor.
And gloves. For the one minute I’m here, knowing that I’m not causing any pain
or discomfort, and doing something almost effortless and overflowing with
potential, I am completely relaxed. I am accomplishing something – to check off
– necessary. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">And my patient and I can talk.<o:p></o:p></span></div>
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Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-88410120897462136592013-07-01T02:09:00.001-04:002013-07-01T02:09:13.613-04:00New siteNow also posting at: www.scalpelwithwords.blogspot.comJennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-49505105874881408732013-04-08T02:31:00.000-04:002015-02-25T01:40:40.164-05:00Where there is air<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">A warning: the cliched "not for the </span><span class="il" style="background-color: #ffffcc; color: #222222; font-family: arial, sans-serif; font-size: 13px;">faint</span><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;"> of </span><span class="il" style="background-color: #ffffcc; color: #222222; font-family: arial, sans-serif; font-size: 13px;">heart</span><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">." It's not that. This is brutal and real and written in the way it was lived and that now, three weeks later, I remember. I don't dissimulate because, well, why should I. If you don't want to read it, and there's nothing wrong with that, then don't.</span><br />
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
<br />
<div>
There is much more to write that I am writing or have almost finished, and I'll send those, too. There is more that is, actually, happy. The month was that, too, but this is the medical part. </div>
<div>
These are no longer chronological -- and -- I'm currently back in the States.<br />
<div>
<br /></div>
<div>
I started this piece during a workshop I was leading on public medical writing, and for some reason I decided to leave myself (explicitly) out, though in truth I was very much a part of all of it. A lot of what was happening was both the resident <i>and</i> me, or I was giving and carrying out orders that she gave. And yell is a more appropriate speaks strongly, or gives orders in an emergent situation because it's necessary.</div>
</div>
</div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
<br /></div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
I hesitated about writing and then about sending this one. I am anyway. Because it's the truth, and because it could have been written more graphically and more difficultly than it is.</div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
<br /></div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
***</div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
<br /></div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
<span lang="EN-US">The trauma room is caked in mud: people’s shoes, falling off of clothes, some mixed with blood but all mixed with small rainy season.</span><br />
The aide from that week’s emergency room team was sweeping.<br />
The patient had been wandering around for days, slightly bored and healthier than most. She couldn’t speak. She looked almost comical, if you’re allowed to think that sort of thing. Tongue protruding (<i>macroglossia.</i> Medical term, like hypothyroid? I still hadn’t read the chart; there kept being something else to do) from her mouth. Larger than tongues are. When she made sounds, they might have been words and just unintelligible. I’d never tried a conversation. The thick bandage is wound like spools around her neck. Her bed was in the front room, where it never made sense who stayed and who went to the other, quieter observation rooms with four beds and curtains or eight beds and curtains. In the big room, the front one, everything was open. So many nurses sit at the triage table, close enough to see most of the patients, bored. There are the two men in, basically, comas, another one with machete injuries who is too large to move, and her, sitting on her bed or wandering. I don’t know if she had HIV, after which I’d have to say “too,” adding to the list of so many others in the department.<br />
<span lang="EN-US"> </span>It happens fast. No one screams or someone does, and enough were in the room as she grabbed at her throat. It must have been uncomfortable and hot, anyway, in equatorial Africa, the highest level hospital has no air conditioning (and no mosquito nets in the big room). One nurse starts to unwind the bandage. Slow. An ER resident here from Belgium for a rotation yells for scissors. There aren’t, or no one knows where, or no one tried to get them. They keep unwinding. She keep grabbing at her throat. The bandage was off. And she was on the floor. Bed. Fell.<br />
The aide kept sweeping.<br />
The resident looks at the nurses. Move the other patients over. Make room. We need her in the middle. Is she breathing.<br />
<span lang="EN-US">She is not.</span><br />
The aide kept sweeping.<br />
It's the second time for chest compressions in two days, the nurses had started to learn the first new rule – thin, gym-like mattress to the floor. No point in compressing a bed that’s only springs. There aren’t any boards here. Mattress to the floor.<br />
The aide kept sweeping. The resident yells. Points. The aide left the room.<br />
Oxygen, get oxygen, she says. There isn’t. But we did this yesterday, she says. Someone move her to it. Someone get the tubing and the mask. Minutes, minutes. This time, someone goes to get the adrenaline when asked. Someone else doesn’t have a syringe. Wait. Where to get a syringe. Steal it. Steal it from the other patient.<br />
The intubation kit. After asked. After pounding on the chest for however many minutes (still a pulse), with the ill-fitting mask, some oxygen, bagging it into her lungs three times after every thirty compressions (still a pulse).<br />
<span lang="EN-US"> </span>Are there any other doctors? Get anesthesia! The resident yells at a nurse. The nurse walks. The nurse starts to run. Minutes. Thirty compressions. Three breaths, or pulses from the bag into the mask into her mouth. No pulse in-between. A nurse kneels hesitant, holding the wrist, slight pressure on the radial artery. The resident yells. Femoral. You won’t feel it there. Femoral. The nurse kneels hesitant. Hand moved to the other pulse. Is there a pulse (no) are you sure (no) are you sure (yes). Still waiting.<br />
The resident tries to intubate. A tube. A larger one. A smaller one. The laryngoscope has a light. The woman is choking to death. Her neck is swollen beyond recognition of what a neck might be. There is no way to pass a tube. She needs a tracheostomy, she needs a hole in her neck to help her breathe. The resident doesn’t know how. There is no one else.<br />
A nurse is back. Slow. Anesthesiologist is in the OR. Get him! The resident yells. Slow walk away. Is he findable. A doctor appears, the ER one, but either he’s new to codes or he doesn’t believe this patient will live anyway or he doesn’t believe any patients in this hospital might survive. He leaves. After the gesture of wrist pulse to groin pulse to a few compressions. Minutes.<br />
He returns with the ENT attending and a resident. A kit. They start to prepare the tracheostomy. Is there a pulse? (not sure) Compressions stop. Does that rock the hands of the attending trying to cut into the neck? (Yes) Should they keep going? (yes) Thirty. Three breaths. Starting a hole to the outside air. Minutes. Is there a pulse? (no) Tracheostomy finished. Is there a pulse? (no) Is there air? (no) How long? (Ten. Fifteen. Maybe). Compressions stop. There is no pronouncing in this hospital. There is sitting back and leaving the tools and closing her eyes and trying to close her jaw.<br />
Then close her eyes. A nurse tries to close her mouth. Then pull her dress back down, the sheet up. Not fast enough. Not good enough at finding the pulse (why is that hard). It is.<br />
There is finding the charge nurse and asking him what we say. There is calling for her <i>garde malades</i>, again, thinking or knowing that they weren’t there because the last three times we called no one came and the others standing outside—every family knows the others, at this point, and so many of them sleep outside—said they were gone. (How do we tell them).<br />
This time, they came. Must have been away for a few minutes. They didn’t know. Two men. About her age. The doctor said, the one who’d called the ENT. I can’t remember the words in French, now. They nodded and pulled out their phones and started making calls. In this culture, in this hospital, the women who start to grieve wail, scream, exude, ululate grief. You know, everyone knows when someone has died. The men, first, pull out their phones.<br />
The day before was the first time I had ever performed chest compressions. For anyone who’s taken the Red Cross classes, one of my first thoughts was that those dummies are actually pretty realistic. That is what it feels like to pound, press all of your weight into, compress a human chest. They tell you not to be gentle, at all, not to be afraid of breaking ribs because that means you’re pushing hard enough. That doesn’t matter. I almost hoped that I would break a rib. That day, the resident and the doctor and I were sitting in the consult room. Slightly stunned. He pulled a <i>jus</i> (bottle of soda) out of the fridge. Something I do after a death, he said. People might think it’s insensitive or irreverent. I don’t. We took a minute, there, to drink, to be quiet and think.<br />
So on this day, the second day, I change my clothes just enough to be decent to leave the hospital. walked across the treacherous like all in Cameroon) road, andI buy the same jus we’d had the day before. I bring it back. Let’s do the same thing, I say, again. It’s right. And we do.<br />
Later, I go to get her chart. I hadn’t known her name, or her age, or remembered them. Now I do. M---*. Twenty-six.<br />
There are so many people we can’t save. There aren’t resources or they’re too far away. The blood bank is closed. It’s not fast enough. There’s not money.<br />
<span lang="EN-US">We could have saved her.</span><br />
<span lang="EN-US">We didn’t.</span><br />
<span lang="EN-US">We could have saved her.</span> </div>
Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-67059529412403130112013-03-29T08:15:00.001-04:002013-03-29T08:15:40.445-04:00Let there be equatorial light<br />
<div class="MsoNormal">
<span lang="EN-US">le 27 mars 2013</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">I used to think of writing (or doing
anything inside) by headlamp as spelunking. It was certainly more practical
than my first year PCV strategy of candles and kerosene lamp propped on various
books and papers—before I had a table—and sitting hunched over to the in the
right part of the penumbra.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">It’s a funny thing about light.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i><span lang="EN-US">The
Constant Gardener</span></i><span lang="EN-US"> came out weeks before I left for
Peace Corps in Cameroon. Without mention anything else I love about the movie
(which was great for terrifying many parents of about-to-be PCVs about to move
to Africa), the light struck me. The quality of it. I’d noticed years before
that Paris has its own quality of light. Some photos, movies capture it (<i>Amélie</i> does). I don’t think you can
successfully pretend that something is filmed in Paris. </span></div>
<div class="MsoNormal">
<span lang="EN-US">This light, though, the Kenya-in-the-movie
light, was unlike anything I’d ever seen.</span></div>
<div class="MsoNormal">
<span lang="EN-US">And then I moved to Cameroon.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">It’s the same light. Gazing across the city
at very familiar views this morning (Yaoundé, like Rome or San Francisco, is a
city of hills), I remembered it. I have photos of the same view, and in the US
they look—faded. Light-stained. But that’s how things actually look.</span></div>
<div class="MsoNormal">
<span lang="EN-US">The forest almost never comes out, either.
I think it’s more greens than the human eye can discern (we can see sixteen
shades of gray, I recently learned, on CT scans).</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">**</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">I was reminded of <i>why</i> the old Snickers ad (<a href="http://jenny-and-cameroon.blogspot.com/2006/08/not-going-anywhere-for-awhile.html">Not
going anywhere for awhile?</a>) and Green Day (“I’ve been…waiting a long
time….) used to enter my head so often. It took almost three hours to print and
copy one document, for various reasons. On the way to the second printing
place, though, I heard someone call my name. I turned. And it was a friend I
hadn’t seen in 4 years. Now, he’s at the hospital where I will be this time,
Centre Hospitalier et Universitaire de Yaoundé, a different one from where we
were previously (he’s a resident). Currently, he’s working in the ICU, which is
<i>reanimation</i> here. It’s about coding. (“Code
blue”). Come back from the dead, make something alive or lively. Resuscitation,
they call it, instead of our Intensive Care. Shortened, it’s “<i>Réa</i>” – it sounds flip in a hopeful way. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">This—the chance meeting—is something that
happens. In Ebolowa, my provincial capital, I couldn’t go anywhere without
seeing people I knew; it was amazing and heartening a year and a half after I’d
initially left. And it used to happen in Yaoundé, occasionally. When I had my
first chance run-in in NYC, I knew I really lived there. And here? Apparently,
I still do. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">**</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">I’m waiting for the chief medical officer
of the hospital to meet me and certify that I can be here. All I know thus far
about the hospital is from the two French nurses who just left. They saw an
upper GI bleeder come in. Died. They didn’t know exactly what was done or what
happened.</span></div>
<div class="MsoNormal">
<span lang="EN-US">This time, I’ll learn about the medical
management here—what’s the same, what’s different, and what doesn’t exist. I learned
some of that, before. And that you have to buy everything down to the IV
tubing.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">ER. Six weeks ago, I was in an ER in
Guatemala (working, not sick). Small rural hospital compared to one of the top
four in Cameroon, a major teaching hospital. There, they were oddly
over-staffed. Here, I am the functional sub-I, or intern to the residents, or
whatever approximated role.</span></div>
<div class="MsoNormal">
<span lang="EN-US">Here, I walked in to see the repair of a
scalp laceration, and by scalp lac I mean the cut penetrated to the dura mater,
through the skull. Assault by machete. I’ve seen that, but the one I remember
was due to a machete accidentally dropped from a tree. That kid looked like he
was partly scalped. (And that was one of Doc’s gleeful moments, showing anatomy
on monkey bones). Now, I wonder if, in the US, we’d put a JP brain in before
closing the laceration. The kid is going to CT. Don’t know.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">Next case. Moto accident led to a
comminuted tibial fracture and a shattered fibula. We waited while the
patient’s brother bought all the supplies requested. (Were I not there, would
they still have had him buy two pairs of sterile gloves….? How to reconcile
“teaching hospital” with patients paying for everything you use on them? </span></div>
<div class="MsoNormal">
<span lang="EN-US">It was the first time I’d sutured in over
two years. The light is weak and far away, we can’t raise the bed, the
patient’s ankle is a mess with visible bones, he hasn’t had any pain killers
and crying/screaming…(we did use local anesthetic)… But medicine is already
(re)baptism by fire. Everywhere. This is nothing new. It’s vaguely remembering
hand tying and instrument ties (it slowly returns), correctly angling the
crescent-shaped needle, with the surgery resident showing me where to close
because in that erratic wound with jagged layers, I have no idea.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">Later in the day, I go to Hôpital Centrale
to meet Dr. Bwelle for his medical student teaching rounds. He shows me the
tall, modern glass-and-brick structure that looks like an added-on center to
the other, spoked buildings. It was a Swiss project, he says, supposed to be dedicated
to neurosurgery. But the people building it forgot that they were building a
hospital. The floors are all completely flat—in ORs, this means nowhere to
direct water. It’s all stairwells, for four stories. No elevators. The building
has been empty for the past four years.</span></div>
<div class="MsoNormal">
<span lang="EN-US">This is all too common a story. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">**</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">As always, every day is every emotion.
Aggravating (the personal level—dérangements, harassment, etc), but then also
the men speaking in Bulu about me this morning led to “<i>mintangen a wôk”</i> – you know, the white woman understands you. And
then I sat down with my spaghetti omelet and bread and “coffee,” (I’d forgotten
about the sweetened condensed milk) and we chatted over their morning beer.
(or, it’s evening for at least the one who drives trucks overnight). </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">But running from hospital to hospital (and
angry when the taximan who <i>had</i>
accepted my negotiated price then refused it and wanted more money), an
exquisitely-peeled (not a good enough word. It’s beautiful, geometric)
green-fleshed orange is just perfect to raise blood sugar back to awake-enough
levels. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">**</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">63 year-old woman. Altered mental status,
sudden onset. Fever. Tachycardic. (and immunocompromised…) My mind starts
racing through differentials, I try to rule out meningitis, I start to think
about how to work up…and, wait, what we can work up, and I go talk to the
attending. “It’s probably neuro-malaria.”</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">Oh. Right.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">~j</span></div>
Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-71555054829712038602013-03-26T05:10:00.003-04:002015-06-07T00:13:24.335-04:00The almost-doctor returns to Cameroun <span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">Dear all,</span><br />
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
<br /></div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
I'm writing from Yaoundé, Cameroun. I will be updating my blog again during the next month, as I am working with Ascovime (<a href="http://www.ascovime.fr/" style="color: #1155cc;" target="_blank">www.ascovime.fr</a>), an NGO here that does health campaigns in rural villages, among other things, incorporating clinical work and public health. </div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
<br /></div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
<br /></div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
I will do some writing in French, but Spanish...lo siento. </div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
<br /></div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
I'm less than two months from my medical school graduation. </div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">
Everything comes full circle. I took the MCAT weeks prior to leaving for Cameroon, the first time. I got my MCAT scores while in Bandjoun for training--my parents called. My fellow (then) Peace Corps Trainees knew I had been waiting to hear, and they were ecstatic for me--if I had to take the MCAT again, it would have been 3 years later, delaying medical school more (at the age of 22, I thought that time like that mattered). I saw my first surgery in Cameroon, a week and a half after arriving at post--December 30th, I think, 2005. I set foot in the OR in Mvangan in chacos and capri pants, probably with sunglasses pushing back my hair. My job was to hold down the patient's legs, so he'd stop kicking Doc who was trying to repair the perforated bowel piled in loops on top of his abdomen. I counseled my first patients, there--HIV, malnutrition. Learned and taught health professionals about preventative and public health. I ran a health district.</div>
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<br /></div>
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And then I applied to med school. Middle of my second year of Peace Corps service, June 2007, AMCAS--I turned it in the first day it opened; I'd had time at post to prepare the essays with help from my Peace Corps Volunteer friends. Everything was ready ahead of time because it had to be. I couldn't guarantee when I'd be in the city, and even if I was, when power would be working, when internet would be working...etc. Before that, I remember taking the (few years old) book of medical schools from the Case, our Volunteer house in Yaounde, and poring over it on the woven plastic mat in my house in Mvangan, by candlelight. I crosslisted schools by research rank, primary care rank, and school of public health (and then it turned out that the best one for me doesn't actually have a school of public health (well, at Berkeley, across the Bay), and I went for MFA and not MPH). I knew no one else applying, that year, I knew little more about the schools and process than what was in the years-old book, and everyone around me was supportive and helpful. A friend brought me my old laptop from the US, and when Doc's generator was on in Mvangan (and he always generously connected it to my house), I'd type furiously for my secondary essays, writing and editing otherwise by hand, and emailing/updating every 2-3 weeks in Ebolowa (almost missed an interview invite. Didn't). I scheduled all the interviews while I was in Cameroon, and I started interviewing a week after I returned to the US.</div>
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Medical school is why I left Cameroon. I very seriously considered extending my service for a third year and delaying med school, or staying for 6 months, or somehow going back to the States to interview on home leave and tell them I was planning to start in 2008--and then defer until 2009 after I got in. But my MCAT scores were expiring, for some schools (including UCSF), and so I left. In the end, I decided because I wanted Mvangan to have (two!! health and agro) volunteers for two more years, it was better to leave; I wouldn't have added enough time.<br />
<br />
And for the first two years of med school, at least, I considered dropping out - frequently. Several per month. In order to go back to Peace Corps, do Peace Corps Response (then Crisis Corps), be a UN Volunteer...I was on email lists for all kinds of positions, and any time not being there felt like too long away. After being in the US for about 6 months (when I finished my service, interviewing for medical school, etc), I had the opportunity to go back to Africa, Kenya this time, for public health research (funded) - and I ran. I was away from Africa for 6 months. Then, 10 months. And now...three and a half, almost four, years. A friend said to me once, "it's hard to imagine there was a time when you'd never been to Africa." True.</div>
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I was called "dokita" for the first time in Cameroon; <a href="http://jenny-and-cameroon.blogspot.com/2006/05/paging-dr-jenny.html" style="color: #1155cc;" target="_blank">http://jenny-and-cameroon.<wbr></wbr>blogspot.com/2006/05/paging-<wbr></wbr>dr-jenny.html</a>. I was introduced as "Docteur Stella, une etudiante..." by Dr. Ndom when I went back the summer between my first and second years of medical school. And now? It won't feel disingenuous. I'm returning to the States from Cameroon in order to graduate. I've finished all my credits. Really, I'm done.</div>
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In Cameroon, in Mvangan, I found the kind of medicine and public health that I want to practice. I had to leave in order to learn. My "back up plan," I told people, if I didn't get into medical school, was to stay, learn with Doc, and buy a medical degree (quite possible in Cameroon). Now? I'll be signing my residency contract in Cameroon and sending it from the Peace Corps office in Yaounde. </div>
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When I was there, Bush and Cheney were on the walls in the office (in federal offices, required). We shuddered every time we walked in. Now? Much has changed.</div>
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My name is still on the wall, I'm told --- literally. My group decided that we would sign the wall in the Case when we COSed. Since then, some others have, but not all. My name, my writing, is still on the wall, just like it is in homeless clinic here.</div>
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---</div>
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As I was flying in last night.</div>
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The capital city is barely lit. At 2 miles up, it's 51°F. 66°F, a mile and a half.</div>
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You wouldn't know this was the second biggest city (I don't remember if Douala was more lit, arriving at night). Quiet. The only thing about this country that is. The rainforest, every night, was loud and exultant. Insects make noise, animals, people. Silence usually implied ear plugs. </div>
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The way to the airport is dark. Pitch, in this almost-on-the-equator country with 12 hours of each day and night. 73°F at 3000 feet. The plane feels it, already. It was dark as we edged over the Sahara. Sahel. I know where we are and what it looks like. This, too, is rainforest. </div>
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We land. The entire plane erupts in applause.</div>
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Outside, I will kiss my fingertips and press them to the ground. It's a mark of reverence, of respect. In African dance, we do this in front of each drummer, at the end. Here, I do it when I leave.</div>
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And every time I return.</div>
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<br /></div>
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On est ensemble - we are together - estamos juntos - bi ne vale!</div>
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<br /></div>
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~j</div>
Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-42106407565311524232012-08-13T02:41:00.002-04:002012-08-13T02:41:43.852-04:00A Hell of a Town<br />
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<i>I wrote most of this ~ 3 weeks prior to leaving New York. "Here," then, refers to NYC.</i></div>
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There are two ways to parse that. </div>
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Before moving here, I thought HELLUVA town. Hells yeah.</div>
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Moving here? a HELL of a town.</div>
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Now – it’s both. Everything is both. Everything is
ambivalence.</div>
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I bike to work – felt like a legit NYC commuter today,
messenger bag and all. Door-to-door, to bustling Long Island City and the DOHMH* with the secure bike room. Used my ID three times to get into the most secure building I've ever entered, belonging there. I rode under the
BQE, across the Pulaski Bridge, right into Queensborough plaza. </div>
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<span class="Apple-style-span" style="font-size: x-small;">*Department of Health and Mental Hygiene</span></div>
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That felt like the boldest part, first time. I used to
commute to school, from my old apartment/old schedule. But that’s all in
Brooklyn. Now, crossing the bridge. Crossing boroughs. And as I cross the bridge,
to my left, across the East River, is midtown Manhattan. One of these days I’ll
pull over to take a picture. It’s a narrow, two-way path, up up and over, with
pedestrians and bikers--all commuters, at that hour. So I watch, crane a
little. It’s beautiful. I don’t go to work before sunrise, anymore, and I go home before sunset. At this
time of year.</div>
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<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/--18uJaNH8CQ/UCie1K9TKcI/AAAAAAAADoY/fXpgyyktmGU/s1600/me+dawn+dohmh.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="http://1.bp.blogspot.com/--18uJaNH8CQ/UCie1K9TKcI/AAAAAAAADoY/fXpgyyktmGU/s320/me+dawn+dohmh.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dawn at the DOHMH, before going to Riker's Island jail to do Hep C education</td></tr>
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For my first rotation of my third year of medical school, I was
in ob/gyn at Highland, Oakland’s county hospital. Living in San Francisco, I
had a reverse commute--thank everything--against the traffic that barely crawls into the city in the
morning and out again at night. Leaving my house at 5:45, I could make it to the
hospital around 6:10 – it's 17 miles. Only at that time of day and with that kind of
(no) traffic. Traversing the Bay Bridge is more magical than the Golden Gate, in
some ways--because you can see Golden Gate Bridge. And it was sunrise, every
morning, and sunset, every night. Sun setting over the ocean. Sun rising.
Marin, the green green hills that would pass for mountains on the east coast.
The port, in front. And the cars at a standstill on the other side.</div>
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You pay going to San Francisco, not coming from. And I’ve
always thought that the compensation is, coming back to the city, you’re on the
top of the bridge. You see better. The view is worth it. Beautiful, beloved
city, the mystifying blanket of fog, some days, up to the radio tower. As I got
off 580, onto 101, curving toward Duboce, I’d see it. Home is somewhere under
there. </div>
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After that rotation, I spent a week at Naropa, for a writing
conference/retreat. And I wrote a poem about that, about my commute. About my
breathtaking commute, returning home, over that same bridge, 14 hours – or more
like 30 – hours after I’d crossed it in the first place.</div>
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Breathtaking, meaning breath-stopping. </div>
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(Poem about my commute – this is excerpted from the series
“Your lapidarium feels wrought.”)</div>
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<span style="color: black;"><br />
When the bay collapsed<o:p></o:p></span></div>
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<span style="color: black;"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>on
Tuesday, it wasn’t<o:p></o:p></span></div>
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<span style="color: black;"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>shrapnel
some<o:p></o:p></span></div>
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<span style="color: black;"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>jumpers
survive. Like<o:p></o:p></span></div>
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<span style="color: black;"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>cobblestones,
side-by-side and<o:p></o:p></span></div>
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<span style="color: black;"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>radiant.
Sightless<o:p></o:p></span></div>
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<span style="color: black;">waking ships are from Japan<o:p></o:p></span></div>
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<span style="color: black;"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>or
everywhere, almost<o:p></o:p></span></div>
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<span style="color: black;"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>alone.
While listing away<o:p></o:p></span></div>
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<span style="color: black;"><span style="mso-tab-count: 1;"> </span>from
the sun, no one<o:p></o:p></span></div>
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<span style="color: black;"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>moves.
Or<o:p></o:p></span></div>
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Not a lot of poems to write about commutes. That one. But I
could write it about driving in San Francisco, about being on a bus, about
walking, about that sudden moment where you see the Pacific, the Bay, Golden
Gate park, or just that beautiful, beautiful city, over the hill. And when I
say breathtaking I mean that even after 3 years, there, it got to me. Every
time. Even when I knew it was coming. It’s enough to supersede that. Surprise
all over again--I get to live here. I get to live here. </div>
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San Francisco is getting a series of poems, all on its own
(currently, there are 3? 4? It’s probably the first thing I’ll work on, when I
get back. A propos. City on a hill, City of no left turns, city of most
sickness, city of<span style="mso-spacerun: yes;"> .... </span>).</div>
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I’ve missed you.</div>
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(And yes, the poem above is referring to the Bay Bridge
collapse in October 2009. It was on a Tuesday. Promise).</div>
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A good friend who lives in Cambridge bikes to her job in
Boston. Not quite opposite ends of those cities, but close enough. It sounded
like a long commute to me, long-long, knowing the geography of those cities,
when that used to be my scale.</div>
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Used to be.</div>
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Then she told me it was 4 miles.</div>
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My commute to work in NY is 4.5 miles. I live very close to work.</div>
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My commute to school was 4 miles. And those are the shortest
distances I go anywhere (well, groceries is more like 2 miles). Subway takes a
similar amount of time, when you count walking to and from the station and
waiting for the train. </div>
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<a href="http://4.bp.blogspot.com/-mm94ncveXM4/UCifAAgzw-I/AAAAAAAADog/Ijcb--F7lMo/s1600/BAM.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="http://4.bp.blogspot.com/-mm94ncveXM4/UCifAAgzw-I/AAAAAAAADog/Ijcb--F7lMo/s320/BAM.jpg" width="320" /></a></div>
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Scale, everything has changed. Work is 6 stops on the subway
– that’s <i>nothing. </i>That’s crossing all of Cambridge on the red line. But still
you get to know people in the bodegas on your corner – the old man where you go
buy the little finger bananas, the store where the cat lives. The cat who
almost wouldn’t let you leave. He closes his store – maybe 11pm, maybe
midnight. It’s surprising. So many things never close. Anything that does –
say, your favorite cafe at midnight (and the more challenging nights it closes at 11!) In
neighborhoods with such blurred boundaries, public housing across from organic
grocery stores, the subway stop that was on the news because an 82-year old man
was beaten up for his iPhone. Graham Ave changes eponyms every few blocks – la
Avenida de Puerto Rico, then via Vespucci, then it’s Greenpoint and Polish, and
then suddenly you’re in Queens, and…</div>
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A few blocks away, the Lubavitchers or other Hasidim live in
a completely different century, and further south, the Chabads of Crown Heights
bleed into West Indian stores, then back up to the mosques on Fulton St, next
to the revival churches, west to the few Yemenite blocks. I forget now where
the Hungarians are in Brooklyn, though, of course, everyone knows the Hungarian
Pastry Shop in Morningside Heights. Where else would you write a novel, except
everywhere. Across the street from St. John’s the Divine, largest cathedral in
North America. The Georgian, as in the country, store. And you're also in Harlem.</div>
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<a href="http://4.bp.blogspot.com/-WpKwpumwFZI/UCigzRIcmhI/AAAAAAAADoo/1b7_cjNTwdQ/s1600/my+subways.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="http://4.bp.blogspot.com/-WpKwpumwFZI/UCigzRIcmhI/AAAAAAAADoo/1b7_cjNTwdQ/s320/my+subways.jpg" width="320" /></a></div>
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I can measure this year in the towers being built where the
World Trade Center was. One and Two. I’ve watched the panes spiral up the
angled scaffolding. The radio antenna that makes one, yes, the tallest building
in Manhattan. I didn’t believe that until I was flying over the city. I saw.
Trademarked, stereotyped, TV’ed and movied and storybooked city, recognizing so
many buildings from that height. A clear evening. But it’s different now. The
Citibank building near the 59<sup>th</sup> St bridge is near work, and on that
corner is the coffee cart I go to (not every day, once I discovered the fount
of free coffee in the office), where the man working there calls me – and
everyone else – sweetie. Tracing smaller routes. The Empire State Building is
next to school, actually (CUNY Grad Center), and on the west side of the lobby
is where I get coffee before class (yes, there’s a theme). I didn’t notice for
two weeks it was the Empire State Building. I didn’t know it was right in
Herald Square. Why the tourists, why the tour guides in front, why, why – and
then the lesson. To look up. And the financial district, those two new towers, will
always, always mean Poets House. It’s a short walk. And my favorite bodega on
the way, to get coffee, closed. Rent, in Manhattan. Walking down 14<sup>th</sup> st, avoiding any more subway
stops than necessary, I once ran into a friend. Happenstance in Brooklyn, too.
Several places. That’s how you know you live somewhere. Eight million people.
Coincidences. That’s when you feel like you live somewhere.</div>
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<a href="http://1.bp.blogspot.com/-YS0TiHTAjGA/UCihgO8gH9I/AAAAAAAADow/VqvH_Ce4jrI/s1600/passionate+city.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="http://1.bp.blogspot.com/-YS0TiHTAjGA/UCihgO8gH9I/AAAAAAAADow/VqvH_Ce4jrI/s320/passionate+city.jpg" width="320" /></a></div>
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But I haven’t lived anywhere that wasn’t lucky in some way.<span style="mso-spacerun: yes;"> </span></div>
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The way to work, here. In San Francisco, going to work, school, everywhere, includes the Pacific, the Bay, the Bridges, mountains and forests and etc. So it’s midtown Manhattan. A different kind of beauty. I
haven’t gotten immune to that either, I try. </div>
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On the way to Poets House.</div>
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<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-8ZJBukQUhJ4/UCiefuq-xCI/AAAAAAAADoI/mELnSrohK18/s1600/ChambersSt+Eye.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="http://4.bp.blogspot.com/-8ZJBukQUhJ4/UCiefuq-xCI/AAAAAAAADoI/mELnSrohK18/s320/ChambersSt+Eye.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Chambers St subway station</td></tr>
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This isn’t a salutatory address, New York.</div>
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There’s no place like this one. It’s an organism. Living,
breathing, shitting, f*cking. Hell. It’s alive and teeming with
not-just-people. With itself. City more diverse? Not many. Any?</div>
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Then there are things like <i>money</i><span style="font-style: normal;"> that you can’t ever not think about. Subways.
MetroCards. How late you’re getting home every night, how loud it is, always,
how dirty, how much cement, how many people, many people, many people, pushing
through them, elbows and fists past umbrellas, elbow in your back and jostling
for finger space on the pole, book in one hand or e-book and headphones and
everyone staring into space in the particular way that means you’re looking at
nothing and no one. </span></div>
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On my bucket list for New York, this time, is biking into
Manhattan. (To Poets House, most likely. Rather, the Greenway along the
Hudson). Biking across the Brooklyn Bridge. At one time I was afraid of cars
(biking with). Now I bike in Brooklyn and Queens. It’s all NYC. Then Manhattan
(Bronx and Staten Island…not this go around). The only problem with biking is
it’s harder to stop and stare. </div>
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<br /></div>
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I didn’t have time to do everything. New York, we have
unfinished business. Besides the unfinished MFA. </div>
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<br /></div>
<div class="MsoNormal">
I look forward to getting to know SF in this way. I already
know it walking – most of it, walking. In truth. And I know it well enough from
walking and driving to approximate the Wiggle and imagine how I’ll get places
while avoiding things like, say, 17<sup>th</sup> St.</div>
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<br /></div>
<div class="MsoNormal">
(Hills? There’s a bit up the Pulaski. There was going north
on Franklin, people said that was a hill. That’ll be the new challenge).</div>
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<br /></div>
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Dear New York, I will compare you now to Mark Doty. I had to
read his book for class. I hated it. Poetry? Hardly. Sequins. Silks. Kimonos,
and, for some reason, mostly in cascading tercets. Sparkles. But I was
presenting, so I read it again. And again. And at some point I fell in,
completely, immersed, completely, and I’ve now read most of his other books.
Incredible writer. Heart-stopping. When I met him, at AWP this year, I told him
that. How much I hadn’t liked his work. And then. The book I asked him to sign
is dog-eared, underlined, full of post-it notes. The best kind of book. He
noted that. Maybe that’s more real kind of love – you fall already knowing the
faults. Loving with and anyway.</div>
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If you can make it here, you can make it anywhere.</div>
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<br /></div>
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Damn straight.</div>
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Bring it on, New York – and you did. Bring it all on.</div>
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<br /></div>
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But I’m going home.</div>
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<br /></div>
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~j</div>
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Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-61476862439426484592012-07-22T15:27:00.000-04:002012-07-23T01:04:39.670-04:00...before beauty<style>
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<span style="font-family: Times;">So many more patients on our
service are my age <span class="il">than</span> I'd like to count. They're all <span class="il">older</span> – by 6 months, 3 months. There's an age I don't have to
think about, looking at the year*. I know.</span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Times;">It's an adult service, and
I'm going into adult medicine. But none of them, right now, are younger <span class="il">than</span> <span class="il">me</span>. No one should be and be this
sick. </span></div>
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<br /></div>
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<span style="font-family: Times; font-size: 10pt;">*yes, other
times I get the subtraction wrong…</span><span style="font-family: Times;"></span></div>
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<br /></div>
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<span style="font-family: Times;">It’s HIV, AIDS, whatever CDC
or WHO classification you’re using these days. Every patient I have, right now.
Without exception. </span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Times;">When I was at the VA, first
for emergency psych, and then later for surgery, it used to surprise me how all
of my patients had been “in the service.” (strange thing to forget, when
working in a hospital for veterans). Mostly in Vietnam, as the stereotype goes.
History of mental illness, mostly, substance use, and then everything else that
happens to so many sixty-odd-years old men. If you have private insurance, you
don’t go the VA. There’s your demographic. </span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Times;">I’m not used to working with
homogenous populations - by which I mean - when any of the rote descriptors were the same. The problem was partly surgery, where I barely knew the
patients, anyway, didn’t meet them for much time prior to them being wheeled
into the OR, and the surgeries would often repeat, within a day (if the patient
comes in for surgery; ie, it’s not emergent, you might just meet them in
anesthesia pre-op). And it’s the same procedure. Had I actually known them, had the time, the wherewithal to come in before 5 to have enough to do so and get the requisite work done - it would have been different.</span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Times;">Funny thing about the HIV**
service, actually. I’m in the county hospital – where I want to be. Where I’ve
wanted to be for so many years. We have translators on staff and on phones for
a reason. But in 3 weeks, I haven’t used any of those resources. It’s not the
demographic of the epidemic here – and that isn’t even true. Is it the
demographic of those who are less likely to have been tested? Or, for some
reason, not as many are as almost-dying? (Because more newly infected, maybe,
relatively newer in the epidemiology?) I don’t know. </span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Times; font-size: 10pt;">**I change
how I answer the phone and introduce myself to patients, at times. “HIV consult
room/ AIDS.” “with the HIV doctors.” And what do you say when the patient has a
roommate? But doesn’t that apply to all conditions, really? No HIPAA in a
hospital. Not within the rooms, among patients, their family and friends. </span></div>
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<span style="font-family: Times;"> I’ve only done two weeks of
inpatient medicine at the university hospital, for pediatrics. Kids, kids that
sick, are eligible for Medicare. So they weren’t anyone in particular. There
was the patient who lived on a reservation. The few in foster care/ adoptive
situations suspicious of abuse or neglect. It’s the “better off” ones I don’t
understand. Rather, I don’t understand why I’m there. Why there. I’m not
needed. (and “I”, in this case, am anyone. Nothing in particular about me).
It’s not what I want to be doing.</span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Times;">One thing about HIV is that
Occam’s razor**** doesn’t apply. Ever. There is no need to connect a
constellation of disparate symptoms – rather, you try, but it could very well,
very likely, be multiple processes. Our service has been about three times
busier than usual, apparently. I’ve seen almost every major opportunistic
infection, at this point. With HIV, that’s the dangerous part, that’s what
kills you – it’s not the virus itself. It’s the lack of immune system induced
by the virus. Things that don’t make most people sick, do. Things that are
rare, aren’t. You cease to be able to fight back – and everything, greedy
everything – bacteria, viruses, fungus, parasites, and your own cells working
against you (cancer) – takes advantage. Opportunistic. Opportunists. Who else
preys on the down-and-out.</span></div>
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<br /></div>
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<span style="font-family: Times; font-size: 10pt;">****<i>House
</i></span><span style="font-family: Times; font-size: 10pt;">talks about this a
lot. It’s more likely to be one process than many. Not here.</span></div>
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<span style="font-family: Times;">Why so sick. Why here. And
why, with this disease, are they eligible for more services than people without
this disease. In some ways. You can get aid to buy medication. You can get into
clinics with multi-disciplinary services – the one here and another one I
worked in have a psychiatrist on staff, social workers, case managers, people
to help with housing, etc. There are pharmacies that are specialized in HIV
medications (in this city, at any rate. But this was one of the initial
epicenters), and you can ask them to make “blister packs” for patients. It’s a
disease with many medications, but not always, not anymore. It was, what, 30
pills at one time. Now, you can get away with one per day. And depending on how
good/bad your immune system is, a few more. Some patients are on seven, ten or
so. And as the people, as the epidemic ages, they’ve got high cholesterol,
maybe diabetes***, a lot have mental health issues as well, high blood
pressure, etc etc etc…</span></div>
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<br /></div>
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<span style="font-family: Times; font-size: 10pt;">***Though,
in general, it’s one of the adult populations in the US with the lowest rate of
obesity. The sickest ones, anyway.</span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Times;">But do pharmacies make
blister packs for those patients? A Monday, Tuesday, etc; at least what I’m
picturing. Is it available for anyone else? I’ve never heard of that. Not until
now. I could be wrong.</span></div>
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<br /></div>
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<span style="font-family: Times;">Why this disease. Why now.
I’ve seen babies die – almost never happens here, anymore. The rate I
calculated for our health district in Cameroon was about 10%. One village was
25, 30%. But that’s one village, one place where truckers went through to Gabon.
The country itself, though, is between 5 and 6% - lower than East, Southern
Africa. When I was in Kenya, the rate in that health district was about 30%,
over tens of thousands of people. Or more. For one island, it’s 90%, actually.
One good thing – there’s no stigma at that point. Little. We had an obvious
tent (and a few interior rooms) at a large hospital in town, everyone knew it
was AIDS, but so many, so many people were there….</span></div>
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<span style="font-family: Times;">I don’t know what to say
here. Or what not to say. What is the stigma, here. I’m sheltered, I’m in the
health care system at a technically liberal, open-minded school in a
technically liberal, open-minded city. A city with one of the highest
prevalences of HIV in the US. I don’t know.</span></div>
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<span style="font-family: Times;">One patient, who’s been in
the hospital a few weeks now, not getting better (I hope. I hope he is this
weekend, did this weekend. Otherwise, he says he’s leaving on Monday), has
started refusing daily labs because he’s so tired of getting stuck with
needles. Bleeding, being bled. He’s a difficult stick, it seems, and in him,
not because of IV drug use. (That’s the case for many patients I’ve seen. They
“have no veins,” even for small blood draws, you have to put a central line in
one of the largest neck veins. A jugular line, maybe. To have any access at
all. The arm veins are all too scarred. When that isn’t the case, though, they’re
less likely to create an easier port of access). But I’m a “difficult stick,”
too. I could commiserate on the multiple times his skin was pierced to get one
vial in the morning. (Up to seven, once, for me). I’ve since learned exactly
which vein is easiest, and I show the phlebotomist every time. He does that
too, but they’ve already used those many times. One morning, he told me how
they missed, or didn’t get the tube connected (or disconnected) in time, and
his blood spurted. I had a moment of terror. The interior recoil of “…it wasn’t
me.” His blood, in my face, and as I pictured it, in my eye. It happened with a
patient of mine, once, but she wasn’t HIV positive. (Actually, we didn’t test
her. The potential exposure was essentially nil. It wasn’t worth it to go on
post-exposure prophylaxis, not for that). What he described was maybe more,
though. Knowing what’s in his blood. A lot of virus, maybe, probably, still.
Rafael Campo has a story about that – it happened in the same hospital where I
am now. Exactly one floor above, I imagine. Where the initial AIDS ward was.
Exactly one floor above where this patient is now. It was the early nineties
then, though. So much less known, so much less treatment at all. A poet
exposed, my mentor exposed. I wasn’t, not this time.
We-are-our-patients-are-us. What’s more human than that? A disease, an
infection anyway, can jump. Person-to-person. It happens with non-human
primates, too (current theories on how HIV mutated to be able to infect human
hosts, from simian immunodeficiency virus (SIV). Another story). Monkey
diseases can make us sick. Goat diseases. Pig diseases. Bird diseases. (Easy
argument for evolution). </span></div>
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<span style="font-family: Times;">One of the intimacies of
medicine. It’s amazing to listen to hearts, lungs again. To see, hear, feel,
think, and learn. From all of that. But with this—the thing making my patient
sick, the thing that’s been inside of so many of his cells, that’s been there
(in his case) since at least the early eighties, when he was first diagnosed,
that’s been making uncountable copies of itself, using him. Intercalating into
his DNA, into the substrate that made him, him. And that thing, exactly, going
into other people. Host to host. That little not-even-alive strand of molecules
that starts to define him, in hospital (and elsewhere) parlance. “HIV patient,”
“patient with HIV,” in the HIV/AIDS clinic, 58 year old man with HIV (and then we
cite the current numbers of his infection. Disease). How many other, unchosen,
permanent connections. </span></div>
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<span style="font-family: Times;">~j</span></div>
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<br /></div>Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-54001455790175850552012-07-04T19:41:00.002-04:002012-07-04T19:43:18.182-04:00"Weird it up."<style>
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<br />
My first semester workshop. And coming back to poetry after 6 years out of
school for it, 8 years out of long-term, rigorous workshops (+ 1 week at Naropa
a year before). I listen. To our brilliant, young, poetry prof (National Book
Award finalist at 26, professor in creative writing 4? 5? years later, just
published his first novel to critical acclaim...)<br />
"Weird it up."<br />
<br />
(Along those lines, another piece of poetry advice from that prof that I
don't plan to do in medicine - "keep going with this until you fail.
There's a project for winter break - write a book. And fail.")<br />
<br />
Also: "I try 100, 500 lines until I get the right one."<br />
<br />
So, I'm not right yet. But some poems do have 40 drafts. Average is 10, 12,
for me.<br />
<br />
I can't find the John Ashbery line I've heard quoted often enough, about how
he knows something is done if he just keeps moving a comma.<br />
Me: with current manuscript, still changing punctuation. And spacing. Right
margin? Left margin? Middle? ...and does the fact that I put <i>two</i><span style="font-style: normal;"> periods at the end of one poem, rather than my
ever-present and over-used ellipsis, look like a mistake, or something a poet </span><i>might</i><span style="font-style: normal;"> have done on purpose? Perhaps it should be one,
then. Perhaps three. But two is so much more of what I wanted to convey, that
incompleteness and hesitation and where on earth am I going with this
line.(..). </span><br />
<br />
I'm on the AIDS consult service/clinics this month. <br />
<br />
Things I can't do:<br />
- draft patient notes 40 times. Let alone 10-12. Let alone 2.<br />
- "weird up" my patient notes. Or make them rhyme.<br />
- "weird up" the physical exam. Disease does that all on its own. <br />
<br />
<a name='more'></a><br />
Things I can do:<br />
- I have no idea what's going to happen when I go into work, every day. I'm
always behind in reading, at least one day. And you can tell by looking -<br />
- Except you can't tell anything by looking. Some of my current patients, if
they walked in, you'd never think to test them for HIV. Ever. (Often enough,
that's a cause for delay of diagnosis). <br />
<br />
<br />
‘Weird it up." There's <i>House</i><span style="font-style: normal;">.
There are glass boards for dry erase markers (I want one). There's Occam's
razor - the simplest explanation, tying together all the symptoms, is the most
likely. In medicine, it’s the mantra of “if you hear hoofbeats, think horses,
not zebras.” But there are some zebras. And there are a lot of patients who do
have two rare diseases. Or three. (and a lot who don't). You still have to know
all of them. The body weirds it up. Or disease does. Or we do.</span><br />
<br />
Often enough, "atypical" might just mean "unlike the
population originally studied." An easy one is heart attacks - myocardial
infarctions (MI). (Is it like a newspaper headline..."Heart ATTACKS!"
or more like "attacks to the heart" ?)<br />
"Typical" symptoms. Tested in middle-aged white men. It turns out
that populations other than middle-aged-white-men actually present with
different symptoms. So that becomes "atypical." Even if
"typical"/"average"/"within normal limits" in
whatever peer group you're talking about.<br />
<br />
One pathology. One pathway to disease, one thing happening in cells that are
essentially identical in different people. But the visceral-to-somatic, the
unconscious-to-conscious translation is different.<br />
The body, the mind, the whatever it is (something about XX vs XY? Does this
make any sense?) weirds up the process on its way to being verbalized (in the
body sense).<br />
<br />
It's an elephant (sitting on my chest). There aren't wild elephants in the
US. In Cameroon, they're much smaller than the East African ones, and they eat
plantains and mess up fields. Damn elephants. So is it then a giraffe? A
gorilla? Are we going for large and docile, or lots of weight and inertia?
Affable, aggravating, innocuous, plodding? Bus, crane, helicopter,
hippopotamus? (Referred pain perhaps, or a panic attack, or an aortic
dissection, or an esophageal rupture, or esophageal spasm should be referred to
as 'a snuffleupagus sitting on my chest.' The sensation is the same. But it's a
completely different animal. And why not one that is, technically perhaps,
"imaginary"? So is the proverbial elephant). <br />
<br />
"Weirding it up," the very analytical, poetic term, deserves a lot
more exploration. It's not <i>abou</i><span style="font-style: normal;">t making
the reader work for an image. It's not </span><i>about</i><span style="font-style: normal;"> obfuscating for the sake of obfuscating, making
poetry illegible to all but other poets (and even then), it's not </span><i>just</i><span style="font-style: normal;"> about pushing your mind beyond where it naturally
might go. An expected image, after all, isn't really an image; depending on how
much it hews to convention, it might be more like clip art. </span><br />
<br />
A patient presentation - the art of the 3-minute presentation, the ultimate
art of the one-liner - is about conciseness and absolute precision. The team
should have an idea of the patient before walking into the room (and a somewhat
extended view of the patient-as-person in the longer presentation and note).
It's about your interaction; you were there, you know and can distinguish this
patient from anyone else in the hospital or in your clinic at that moment. But
the language we can use is...both limited an incredibly specific, ridiculously
separate from life, and unbelieveably close and beautiful. On surgery service
at the VA, sometimes I'd get confused about which patient was which (awful).
The why, though - most were 60-something-yr-old male Vietnam era vets, with
approximately similar medical problems, and I might have seen/talked to them
for ten minutes before they were completely draped in the OR. The image evoked,
then, was completely generic - I didn't know them. Or remember enough names.<br />
<br />
A patient was talking to me about his primary care provider of the past 9
years, whom he thinks is wonderful. "I've been working with __...."
He laughed. "I mean, I've been her patient since 2003." I uncorrected
him. "You were right the first time. That's the way it should be -
patient-provider relationship, working together."<br />
<br />
It's the interaction that keeps it interesting. Who wants to work with clip
art all day? Who wants to have generic patients? <br />
<br />
A real image - the "weirded-up" one, but the one that's a vortex,
too, that's closer to something exact - is an interaction, too. It's not
flat. It's a conversation without beginning or end.<br />
<br />
The next time I get a comment/<i>look</i><span style="font-style: normal;">
about the (both in-progress) MD/MFA thing (daily to weekly), new response. Had to weird it up.</span><br />
<br />
~j<br />
<br />
<br />
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<br /></div>Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-74514169016608094772012-07-03T03:25:00.000-04:002012-07-03T03:25:35.545-04:00Day One<style>
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Day One</div>
<div class="MsoNormal">
Year Four, Part Two.</div>
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It’s relearning this particular kind of efficiency,
impatience with the IT guy on the phone when he doesn’t actually know what I’m
talking about, taking the stairs not really for exercise but for time, and
rushing, rushing everywhere. What a pager feels like. How many notes, papers,
pens I might end up carrying and how to organize them. That I still remember
where the stairs are, just carried there naturally,without thinking. After all,
I used to write while walking, here, email while walking, where everything
becomes rote, in a finite space. Only seven floors. </div>
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<br /></div>
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Remembering only with the third patient visit that, yes,
appended to my name is supposed to be “medical student.” or “student doctor..." partly forgotten because any introduction with "poet" or "writer," while in writing school, felt self-important and uncertain. We used to discuss that - what it felt like to attach those names to ourselves. At what point. For what.</div>
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Impatience with the white coat. Impatience with the white coat. </div>
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<br /></div>
<div class="MsoNormal">
So many things the same – nurses the same, wards the same
(and why wouldn’t they be?) but a face recalls the patient we both had, a room,
another one I wonder about. It’s a year ago. It isn’t. And every mistake (all.
day) I make when trying to read paper or computer records recalls one I’ve made
before. Once I figure out the answer. Second time around.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Some kinds of authority are still there. Walking in. Sitting
down. Asking the questions that aren’t easy, asking and not being asked back.
Though, today, “have you ever experienced anything like this?” (tuberculosis,
isolation). Through my N95 particulate mask. Leaning forward. “No.” Another
comparison she makes: “it’s like when you’re just waking up, between asleep and
awake…that’s what the headaches feel like. That’s when the nightmares are.” I
take human experience, my human experience, as evidence and descriptor. We are
our patients are us are our patients. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I managed to hit most of the necessary points in the story.
It’s a story, after all; any reader knows what she wants and needs to know. For
the most part. “Felt like the house was moving.” Another line in my note. This
part, I’ve done. This part, the listening, is poetry too.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The part slower to come back. Causing pain (“discomfort”),
the importance of my exam, findings that I can actually report if they haven’t
been reported before. Maybe. First day back. Full neuro exam. And
putting the reflex hammer in the coat had felt superfluous, over-eager med
student-like. But later I almost wished I had the needle points. The tuning
fork. Pain, cold, pain. Vibration. I didn’t test proprioception – where are you
in space, what is this room where people wander in so covered that no air
escaping you, nothing of you into that air, could enter them.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Causing discomfort. My half-thought out, presented rationale
“well, the patient was already doubled over in pain…so I didn’t do that part of
the exam…”. Now I realize that <i>that</i><span style="font-style: normal;"> is
the question – that pain (I didn’t cause it, I can call it “pain”) – the why.
Why. And so tomorrow morning I have to go in and cause discomfort on top of the
pain. My prerogative, our prerogative, the “greater good.” Of her, us, whomever
else. </span></div>
<div class="MsoNormal">
Poets? Pain, anything acute or acute-on-chronic or
chronic-on-acute is a medium. The medium of poetry is image, the medium of
fiction/literature/prose is the word (Ezra Pound, highly
paraphrased/oversimplified). </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There’s one thing the same. Poetry and medicine, with bodies
as interlocutors. The use of poetry – fiction can’t describe simultaneity in
the same way, conflation, distortion and ambivalence and reality within
irreality within reality of an internal and external universe. Medicine is…the
art of figuring out what the body is actually saying, and all we have are
words, numbers, and some pictures (intrusions. inner) to describe. For poetry…it’s
images, and we have words and space and placing (proprioception – where is this
word, this phrase, this articulation, this sound. How is it related to anything
else. How does it find itself).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Returning from a field that treats nebulousness with particularity
and infinite variation with rigorous category and study. To another field that
calls nebulousness particularity in word and in acronym, and organizes infinite
variation into bell curves.</div>
<div class="MsoNormal">
To the Venn diagram, scatter plot, Punnett square*, and any
other shape used to cull entropic humans into a visible form.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
~j</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 10pt;">*poetry prof actually used
that to describe one of my poems, the other day…</span></div>Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-58524709689543876592012-01-26T02:49:00.000-05:002012-01-26T02:53:20.070-05:00“…and they tell you that your blood is purple till it hits the open air, well…”<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
For New York, it’s an intimate-but-not-in-an-unpleasant-way
venue. Bar, a few tables, a stage, good but not
overly-imposing-or-meaning-to-impress atmosphere. The amps weren’t too loud. I
was as close as possible – close – and the sound was right, and I could hear
all the words.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
After a day shuttling between medicine, public health, and
poetry contexts, with many, many subways and miles of walking
in-between, I re-learned what it means to be an artist.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Rachael Sage.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If I have a favorite musician – a singular one, one who is
alive and performing and now, and who is not so very well-known or
widely-played to be obvious – it’s her. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And it’s been her for the past decade – little more than. A
friend gave me <i>Smashing the Serene</i> in
the fall of 2001. It’s technically Rachael’s second CD, but it was my first. As I told her tonight (crazy, idolizing fan like I’m the
crazy, idolizing fan with some of my poets): “I realized that I’ve had a
relationship with your music for over a decade, now. That’s longer than with
most of the people I know.”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It’s true. That’s formative
years (aren’t they all?) Music, good music, can be both background and foreground. One of the four options (she gave) for her last/encore song
was the first Rachael Sage song I ever heard. (“Sistersong,” <i>Smashing the Serene</i>). I know the words
to that one and to many others. And the ones she sang that I’ve heard – but not
memorized – brought the same knowing smile of familiarity, triggering memory
and attachment.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
That’s what it means to be an artist.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
That’s what you want it to mean, to be an artist… to mean
something. To get to be part of someone else’s story, in a way, to have given
and shared that gift.</div>
<div class="MsoNormal">
<br /></div>
<a name='more'></a><br />
<div class="MsoNormal">
It’s the same with poets. Cyrus Console read a section from
a book I love. I hadn’t memorized, not by a long-shot, but I was familiar
enough with the words that they were little triggers. Anytime I go to a reading
and someone reads a piece I love. Poets publish CDs, sometimes, of themselves
reading. (see: Li-Young Lee, <i>Behind My
Eyes</i>). There’s an art to that, to reading – and learning how to <i>read</i> (out-loud) poetry was an important
part of my poetic education.</div>
<div class="MsoNormal">
Digressing.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
For any show, musicians have to include songs that are “known”
with the new ones. Would we be…disgruntled otherwise? Maybe. But you can best,
I suppose, develop a relationship with the new pieces through segue with the
old ones. The nostalgia (and the triumph!) for older ones,
knowing-the-words-ones, isn’t just for the piece itself but for whatever
particularity it evokes.</div>
<div class="MsoNormal">
Whatever life it has taken on, now, for the listener.
Everyone owns a little piece, and each piece is now different. Poets often read
from both published books and new, unpublished poems. (fiction writers – same.
etc, etc). For the artist, it’s part of trying out the piece – does it work
with an audience, what does it sound like in that context, etc, etc.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
One of the best things about poets is that when you tell
them you’re skipping out on a social event to go write – they not only understand
but are excited for you. If it’s urgent, too, that means the
Martians/muses/whatever are visiting, <i>now</i>,
and something might be happening or about to happen. This happens to all of us,
planned or unplanned. Poet-in-tandem, poet-interlocutor days. And
poets-need-to-be-alone days. After a friend’s reading, one night, I told her
she’d inspired me to write, and that I had to go home and do so. It was true –
and I knew, too, that it was a gift to tell her that. The best response to a
reading you can have, she said. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
More recently, I sent a poem(s) to my workshop, for them to
read before we met. One poet/friend replied to my email, saying the poems made her
want to write again.</div>
<div class="MsoNormal">
That’s an incredible thing to say to a writer, and from a
writer who knows what it means.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I had written most of a piece about art school versus grad
school, and what it’s like to be in art school, and … I’ll finish that
soon. Later. Also. I’d been thinking about the process – and all of it <i>is</i> a process. More like a continuum.
Like a day of medicine-public health-poetry. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
***</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
At a health policy colloquium at a medical school, today, a
Distinguished Professor introduced the speaker with the biography she’d given
him and a little ad-libbing. “...where she majored in English. . .which is extremely
related to medicine…” I would have been annoyed, had the colloquium coordinator
not already told me that the D.P. supported and was very interested in people
doing medicine and humanities. (He was less eloquent, later, “My son-in-law is
a poet!”)</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
*</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
At Poets House, later today. As the library was closing, and
I was leaving, one of the staff (whom I’ve met before) came over to chat. He’s
also a poet. I had the <i>Collected</i> of
Wallace Stevens on the table, as well as <i>Nerve
Squall</i>, by Sylvia Legris. He asked about the latter. “Oh…she writes using a
lot of science, often botany, here fish and birds…a friend recommended her
because I write a lot using medicine.” He nodded. Picking up the Stevens, he
commented on how part of what he really likes about Stevens is that. . . poetry
is one of the things he does, he’s not an academic poet, not trying to
participate in the academic discourse of what poetry is, who, etc…(It’s funny
to note that people often refer to Stevens as “an insurance salesman.” He was a
lawyer who worked for an insurance company. Odd). I don’t know a lot about
Stevens, but he did write about poetics, as well, some critical essays – but not
much compared to his contemporaries. </div>
<div class="MsoNormal">
He went on to talk about poets who aren’t also English PhDs
and who just. . .write…and do something else, too. How he likes/appreciates
them. We talked about a few other writers. Then – “what’s your background?
undergrad? did you major in…medicine?” </div>
<div class="MsoNormal">
And thus I reveal myself as aspiring to be, perhaps, a poet
like one he admires – not-academic-but-that’s-okay.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
***</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Another poet/friend, today. We were discussing (“interlocuting”)
what it’s like to write, for each of us, where poems come from, how they do,
what we’re doing with them, what we’re reading and how that influences things…etc.</div>
<div class="MsoNormal">
He said, “Being a poet sometimes feels like being a homeless
person, when you never know where you’re going to sleep next/next meal is going
to come from…”</div>
<div class="MsoNormal">
It’s a curious analogy, but I think it’s okay because it’s
not actually referencing or alluding to starving artists. Also not comparing the difficulty of either situation; more, I think, speaking to the unpredictability/ seeming lack of agency. I think. You don’t know where
the next poem (or other artistic inspiration) is coming from, or when, or if.
(With time, the anxiety of the “if” has lessened. A lot).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The “if,” though, has little remedies. Read poetry. Go to
readings. It will come. For the ones giving the readings, then, it’s a gift
they’re offering. Hoping, in fact, that will take, that anyone will take. If it’s
a good reading, an amazing reading, I’m either writing lines down, madly scribbling
ideas for my own new pieces, completely stunned and entranced by the reading,
or I can’t find my pen and notebook. Any of the four are possible. (also – it’s
not just the good readings that give ideas. In truth).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
With another poet-friend of mine, after a reading we
attended last week: he said he’d liked the second-to-last poet best. “The ones
about high school.” (that writer is a high school teacher). “Oh...I don’t
remember those very well…then again, that’s when I was writing the most, so I
guess that means they were good?”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
To a writer.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If someone is writing, they are thanking you.</div>
<div class="MsoNormal">
If someone will remember your words next week and not be
quite sure where they came from, they are thanking you.</div>
<div class="MsoNormal">
If someone will put your line in a poem in a year and have
no idea they didn’t write the line, they are thanking you.</div>
<div class="MsoNormal">
If someone will need to read your book, they are thanking
you.</div>
<div class="MsoNormal">
If someone will pass that book on to another person, they
are thanking you.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If someone will write now, tonight, tomorrow, next week,
next month, in a year or in ten, they are thanking you.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Being an artist isn’t all about the art. The art comes from
somewhere. It goes to somewhere. And you get to be the tenuous hands that have
a part in that connection. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Why do you care about publishing, I’ve been asked. (“Why
have a blog” is a similar/same question – or, actually, these days, I suppose
we could debate the relative differences with other forms of publishing…) It’s
sure as hell not altruistic to be an artist and to want to exhibit/publish your
work. But even paintings should live off museum walls, and there’s a difference
between printed impressions and the physical object. It’s what you see, how it
makes you feel then and later. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If one person reads and wants to write, if one person uses a
line of mine, if one person uses a line of mine, many years from now, because
it’s been stuck inside them that long and they have no idea where it came from.</div>
<div class="MsoNormal">
If one person thinks I must have written about exactly what
happened to them, because it <i>is</i> what
it means. If one person connects to a poem, thinks about it later, keeps it,
somehow, is reminded about it by an experience that happens later.</div>
<div class="MsoNormal">
If one person remembers reading my book and what happened at
that time. If they reread the book (!!) and different things are more and less
poignant, more and less meaningful. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
(it’s poetry, it was never going to be about the money.
Though the publications and the prizes and the fame and the money and the
bookstores and the…would be nice…)</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Enough.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
~j</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
…red’s the only honest color, after all, we’re flesh and
blood…”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
-<span style="font: normal normal normal 7pt/normal 'Times New Roman';">
</span>Rachael Sage, “Crack of Dawn” <i>Smashing the Serene</i></div>
<br />Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-42407611789464836842011-12-12T01:17:00.001-05:002012-08-14T09:26:05.996-04:00Kevin in the elevator<br />
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: 'Times New Roman', serif;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<b><i><span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Dear
Kevin-in-the-elevator,<o:p></o:p></span></i></b></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<b><i><span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></i></b></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Yes, I am using
your real name. As told to me. Assuming you are real. Assuming I did not walk
around 14 floors – as directed by the guards, this is a very secure building,
with my large box of office supplies and binders with information on
buprenorphine – and down, around, past more guards (how secure if I don’t have
a badge yet?) – to end up on a not-real elevator in a not-real building.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">But really,
Kevin, imagine my surprise when the elevator door opened – me and my not heavy
but awkward box, my colleague M with the dolly that refused to take corners
well; we took turns with that and the box – and there you were. I’ve called it
a folding chair when I tell this in person, but I don’t know what to say the
chair <i>was</i> – nicer than a lawn chair,
not folding, but the kind with spindly legs and textured plastic seat. I think.
Did you even have a cushion? It was the Metro paper folded underneath – the
free one. There’s very little light in the elevator.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">We mentioned our
surprise upon seeing you, me and M. And you responded, “Oh, I’m new, I’ve only
been here since Tuesday.” It was Friday. Kevin, M and I had never taken the
freight elevator, alone or together; you seemed to assume we’d known your
predecessor. Or it was just another bad or awkward joke. She asked your hours.
We were shocked at the – constancy of them. Eight to six, you said. Hour lunch
break I assume. And every day. Who gets weekends? Or is there no health
department freight on weekends?</span><span class="Apple-style-span" style="font-family: 'Times New Roman', serif; font-size: 16px;">(the buttons,
after all, are the pretty normal push-‘em kind, you know).</span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span class="Apple-style-span" style="font-family: 'Times New Roman', serif; font-size: 16px;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">When we got back
on the elevator, I remembered your name – M was impressed. How many men living
in boxes does she know?<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Name, man,
elevator.</span><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="http://1.bp.blogspot.com/-49NFihsHB9Y/RybllnRj9SI/AAAAAAAAAMo/HP9bCfQITjU/s1600/P1010541.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="http://1.bp.blogspot.com/-49NFihsHB9Y/RybllnRj9SI/AAAAAAAAAMo/HP9bCfQITjU/s320/P1010541.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 13px;">Market, N'djamena, Tchad<a name='more'></a></td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="text-align: -webkit-auto;">
</div>
<span class="Apple-style-span" style="font-family: 'Times New Roman', serif;"><br /></span><br />
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">***<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">I could turn Kevin into a metaphor for
Americans, or really for many populations or groups of people or myself in
(formerly) <a href="http://jenny-and-cameroon.blogspot.com/2010/08/medicinethe-microcosm.html">microcosmic med school </a><b>.</b> I will endeavor to not be that
ridiculous. Or not.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">So, to Geoffrey G. O’Brien’s <i>Metropole</i>. Geoffrey G. O’Brien was, at the recent
Berkeley police-against-peaceful-community riots, beat up. Unceremoniously, per
the article, was recovering from broken ribs the same weekend we were assigned
to read his book. And discuss it. That was the same Monday I went to my first
protest since the anti-war ones. (There’s
a poem in there, somewhere, about all the places I’ve marched and demonstrated
and protested. Somewhere). This isn’t a place for explication – suffice it to
say – the title poem, “Metropole”, moves through politics and protests in
America. Writing about politics without polemic. (There would be more to say
about the poetry, but, not now, and I’m not the one to say).<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">The
following seemed almost eerily prescient – I don’t know if this had happened to
him before. But as I was reading it, it was happening:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 1in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">“Outside the
bedroom buses stuffed with passengers pose family unawares.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 1in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Pedestrians,
commuters, worries pleased they’re happening, equivalent<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 1in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">designs. The
square completely filled then drained, a battle neither can<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 1in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">afford to win.
And banners, nightsticks, chanting, things with arms – from<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 1in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">over either
shoulder daylight knows the march as angry signs but crowds at<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 1in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">night are
demonstrations minus signs (portfolios). A struggle: fighting with an<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 1in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">absent force.
The rally’s unknown number when divided by itself”<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">This contrasts with Mark McMorris’s <i>Entrepôt</i>, apparently. Which I read in a
Politically Irresponsible Manner. I did not read the lines, abruptly shifting
between end-stopped and enjambed, as explicating the ambivalence of
relationship to archive and colonial trauma. I’m not saying the former isn’t in
the intent of the poet and isn’t in the explication and close reading. But. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">I didn’t know I was a Politically
Irresponsible Reader until that workshop, after which, incidentally, I wrote
the <a href="http://jenny-and-cameroon.blogspot.com/2011/12/approx-one-week-ago-some-days-i-hate.html">previous post </a><b>. </b>Do I
hate being a poet when I feel like I’m not good at it or not getting it? More
when – yes, I don’t understand and maybe it’s over my head and maybe it’s too
much and maybe it’s over everyone’s heads – I’m not sure I see the point.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">I like the political poems. It’s damn
hard to do well. Like painting in color or writing in rhyme. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"> *** <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><o:p><br /></o:p></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<b><i><span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Dear
Kevin-in-the-elevator,<o:p></o:p></span></i></b></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<b><i><span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></i></b></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">The second time,
on the return trip, M was impressed I remembered your name. She was impressed
when I mentioned your name to A, our supervisor, too. Who else do I know who
lives in an elevator? </span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">When we got on that time, a group of people with food got
on. Some meeting somewhere. And they got off – two different floors maybe, with
ours being the third ones. The elevator doors opened, the silver (jaws, to you,
or quicksand) doors slid open – reminiscent of my cousin’s Delorean, perhaps –
and there was a flash of another floor, beyond another set of doors. Whatever
might have been there? Elysian fields, Madison Square Garden, Point Reyes, a
sandcastle competition, the set of <i>CSI</i>
(one of), hot air balloons in New Mexico, another group of cubicles and some
with flowers, a very large kitchen making nothing but pâté…<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Whatever makes
your day more interesting. There is a finite number of floors – have you
assigned attributes to each? Are they mutable? And what about the people who
pass through – what are they doing with whatever large box or tray of
sandwiches? Where have they come from?<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Etc.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="http://3.bp.blogspot.com/-0khUOfi42T4/RyWy0nRj9DI/AAAAAAAAAKU/BgFiJrhqKY8/s1600/P1010526.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="http://3.bp.blogspot.com/-0khUOfi42T4/RyWy0nRj9DI/AAAAAAAAAKU/BgFiJrhqKY8/s320/P1010526.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 13px;">Waza, Cameroun</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<div style="text-align: center;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">***<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">There’s a story about Robert Duncan, in
the H.D. book. He’s sitting on the grass at Berkeley, reading poems with some
women. The bell rings for him to go to ROTC (mandatory in those days, whatever
those days were, exactly). The women impugn (per his account) “You don’t have
to go, “Stay with Joyce, “Rejoice with Joyce.” <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">And he stays.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Separating that moment from what ROTC was
for, in those days, what going/being a conscientious objector might have meant…the
point, more, as written, is about turning to the authority of a poem. Away from
not just military but university and everything else. About poem as higher
order. And how poets (in some views) cannot engage in politics and be both.
That when trying to make poems do something in the world (can they?) they are
defamed, somehow. That that’s not poetry. About this I don’t know enough. Yet –
what I love about literature is its power to transform, transcend. But maybe
that’s just it – if you focus on transcendence, then everything else is mundane.
In a word.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">And Kevin? The surreality, perhaps. That
him being there seemed like it must be symbolic of something. The imagination
in an elevator. More – you can imagine what’s outside the doors, without every
actually seeing it. If you can sustain that. Less – well, no stimulation.
Little. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">I worry about poetry being inside the
elevator. There are the conversations that take place there – whomever is passing
by, whomever notices. And takes the moment to see it from <i>that</i> perspective – the elevator stops on someone else’s floor, and
for a second, you imagine what might be there. Anything. A world that doesn’t
have to conform to yours, and it could be an image, something whirling-dervish
like (that’s a paraphrase of Ezra Pound – for another day) (and I have just
thrown entirely too many poets into few pages). An engagement – or, an almost
engagement – or, the infinite potential of engagement every time the door
opens. Or not. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="text-align: center;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">***</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<b><i><span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Dear NYC
Department of Health and Mental Hygiene,</span></i></b></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<b><i><span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><o:p></o:p></span></i></b><span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Kevin is in the
elevator. I work on the Mental Hygiene floor. I don’t believe the elevator is
very hygienic for his mental health, or for anyone’s. If you need a person to
sit in the freight elevator – and again, I’m really not sure where you’re going
with that – have them switch off. Like, every hour or two. And then do a job
that involves running around the building. Or at least guarding something that
is not the interior of a box. Let’s not be hypocritical, shall we? (Much like
our syringe-return drop boxes (here – kiosks). You know we’re having trouble
placing them in various places in the city, due to property lines, landlords, etc…is
there a reason we can’t have them outside, here? It’s the right neighborhood.
And there are certainly a lot of diabetics in the building – 24 floors? Yes. (…et
al).<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Maybe you’re
worried because there is that big movie studio place (I’m assuming there are
sets there) nearby? I mean, it’s easy to see, and I could definitely walk there
during a quick break. I wonder what their security’s like. Or if they have
anyone sitting in the elevator. If they do – okay, I’m picturing a fancy hotel –
it should be made of glass and riding up and down in the middle of a lovely
courtyard. There is a situation in which one can Sit in an Elevator. Much like
subways, right? I imagine there’s a different in mental health and job
retention between those on more above-ground lines and those on purely
below-ground lines, right? I know several do go above ground, at one point.
Take the Q. Those drivers are probably doing a little better than, say, the
2/3/4/5. You see the Brooklyn Bridge, downtown, etc. That’s pretty. And the Q –
again – and the 7, etc, the ones that go over the Queensboro bridge. Okay. And
I guess the A train drivers sortof see the ocean (do they?) on the way to the
Rockaways.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">You are
concerned with my mental hygiene, perhaps. From my floor – the Mental Hygiene
floor (only one of, I hope! but am not certain) – we have a panoramic view of
four boroughs; with binoculars and imagination, we can likely see Staten
Island, too. Across from my desk, I see midtown, the Citicorp building, and,
craning a little to the left, the UN. If I go to the printer, I can see La
Guardia, with fewer planes ascending/descending (visibly) than I would expect.
I can see a lot of the Bronx, which is good, as we have many projects there.
And, these days, I’m there when the sun sets. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">BUT KEVIN IS IN
THE ELEVATOR.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">***<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<b><i><span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Dear
Kevin-in-the-elevator,<o:p></o:p></span></i></b></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Perhaps, next
time, I will bring you poems. If you’re still there…<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: 0.5in;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">~j<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-73869990085504180862011-12-07T01:03:00.001-05:002011-12-12T01:22:02.135-05:00Recursive in printAddendum: By comparison with my other friends in other grad schools, I've often felt like a very lazy student. Like I'm not working much at all. And then I realize - if I add the hours of writing, the hours-upon-hours per poem, the reading of poetry - it could even be more. But I don't count that as work. It's what I want to be doing, anyway.<br />
<br />
<span class="Apple-style-span" style="font-size: x-small;">(approx one week ago - true, then. don't hate it today. more to write, soon)</span><br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Some days, I hate that I’m a poet.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As I’ve said before, it’s not a choice. Do I wish I were…a
novelist? a journalist? a documentary filmmaker? an influential blogger? </div>
<div class="MsoNormal">
Maybe, maybe, I could do the things I want to do, then.</div>
<div class="MsoNormal">
Thing is, I’m a poet.</div>
<div class="MsoNormal">
And today, I hate that.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I was speaking with one of the program admins/alums today,
turning in poems for a scholarship application. She asked me if I like the
program (MFA) better than med school. I replied with a decisive “No.” What I
didn’t say, the background voice, is that I think I like med school better.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Problematic.</div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-size: 15px;"></span></div>
<a name='more'></a><br />
<div class="MsoNormal">
I saw a friend from med school last night. And standing
there, on a street corner, discussing the aesthetics of science and the
unbelievable, incredible elegance of development, experiments that can show
that… I wasn’t an imposter. Not then. Med school friends are coming through for
residency interviews. It’s a view of an alternate life, the path I could have
been/could be on…but even discussing that, the medicine, how absolutely
incredible it is, the privilege, to be a doctor… feels right. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Right.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I’m supposed to be getting an education in poetry. I think.
My tutorial (one-on-one) prof said to me last week that I should take her class
next semester, on 20<sup>th</sup> century American poetry. Because my
ignorance, my naiveté shows in my work. (True? sure). One thing – that would
mean 3 classes with her this year, which is too much. Second thing – it’s the
same poets we’ve been discussing in this semester’s workshop. Third thing – I
just can’t make myself care, enough. Right now.</div>
<div class="MsoNormal">
There’s another course I could take, on more contemporary
poetry – and this does actually include a number of poets I know and like. But
then there are the comparative literature-type classes…*</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 10pt;">*which explains that though I
have a BS in Creative Writing, I have little to no education in poetry. I took
the workshops, I did the one-on-one writing work, I wrote the thesis. I read a
lot, I did. But I don’t have the background, and except for one course in
France, I’ve never had that sort of formal study. Ever. And the one required
course on the Western Canon, which is the only reason I’ve read (and loved)
Milton. I wrote things with a lot of
religious imagery, that semester – the influences, yes, are important. But I
took comparative literature courses for everything else. It’s more what I care
about. Literature in context. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So do I eat my poetic vegetables, so to speak?</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I don’t want to.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I’m working 20 hours/week at the Department of Public
Health, now (that’s DOHMH in NY – Department of Health and Mental Hygiene. I’m
actually in the MH part. Haven’t quite figured out what the “hygiene” bit is). </div>
<div class="MsoNormal">
And it’s comfortable, easy to walk in, easy. I get how
people are. I speak the language and I want to – I want to learn more, I want
to learn so much more, I want to be part of that conversation, so to speak.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A few weeks ago, we did a training on buprenorphine, for
doctors, so that they can prescribe it to patients. (It’s similar to methadone
in that it can be used to help with heroin addiction, treatment, etc). I
decided to go and help with it, though I didn’t have to – partly, yes, because
it’s good form for work (to do semi-extra things), and partly because I was
really, really interested, after I’d helped to put together the materials.
(That’s another thing I really like about NGO/health dept-type offices –
there’s no shitwork, no lowly intern things to do. If I don’t make the phone
calls to remind people about the peer educator meetings? My supervisor does. We
all – all levels – worked together to collate the materials (that took awhile…)
Etc). </div>
<div class="MsoNormal">
And it just felt right.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Before this happened, I was describing it to my poet
friends. It was a Friday evening, we’d gone to a poetics lecture, and then we
were workshopping in a pizza place. (these are the truly wonderful moments –
that – and that we care enough to do it, to hold extra workshops). </div>
<div class="MsoNormal">
One of my friends said – “What on earth can you talk about
with methadone for a whole day?!?”</div>
<div class="MsoNormal">
I didn’t respond much more than the “Everything….”</div>
<div class="MsoNormal">
And I was thinking “How can you talk about line breaks for
two hours?!?”</div>
<div class="MsoNormal">
That.</div>
<div class="MsoNormal">
“How can you spend a career studying Emily Dickinson?”</div>
<div class="MsoNormal">
That.</div>
<div class="MsoNormal">
It’s not that I don’t respect the above. I do. I do.</div>
<div class="MsoNormal">
But I couldn’t do it and I don’t *get * it, quite. A little
bit. With a lot of explanation. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I used to think that doctor was what I did and poet was what
I was. Writer, rather. Everything has become inseparable.</div>
<div class="MsoNormal">
Much of what I write, these days, is somehow related to
medicine or medical language. More explicitly than before – perhaps on purpose,
perhaps reactively, and perhaps as another way to re-engage.</div>
<div class="MsoNormal">
I haven’t, as previously planned, applied medical ways of
thinking/examining patients to examining a poem. That should be next. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Looking at the graduate English course catalogues of three
schools, I’ve found three or four classes I would take. Not more than that.
Were it a public health catalogue, it would probably be the majority of the
courses. Were it a medical school “elective” list – I would want to take almost
everything listed under medicine and under psychiatry. </div>
<div class="MsoNormal">
As it were.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Problem is, I am a poet.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
*******************************</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And yet.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And yet.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Some days, I love being a poet – or, at least, I love
poetry. And poets.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A few months ago, I first* read Cyrus Console’s <i>The Odicy.</i> This was before going to a
reading he did with Omnidawn Press. And the first time I read it, I couldn’t
stand it was over – I had to start again. I did this at the end of each of the
five sections, too…no, no, no I wanted it to keep going. Breathless. Submerged.
It had been a long time since I’d had that sort of experience with a book of
poetry. I was expounding on how much I loved it to my classmate/friends, before
the reading began, and before I knew that Cyrus Console was sitting behind me.
At one of the breaks, I did have the nerve to talk to him.** I only get this
way around writers. So I said – the above. I didn’t want the book to end, I
didn’t want the sections to end, it was one of the best books I’d read in a
long time. He said thank you, quietly, I think. It was a very quiet and
seemingly awkward exchange. But, I’d said what I had to – and I had to say it.
Too much to not. ***</div>
<div class="MsoNormal">
I certainly didn’t have the nerve to ask him to sign my
book, then. It’s fine. It was fine. What counts is the interaction with the
writer, the reading, etc…</div>
<div class="MsoNormal">
Later, at the reception, Cyrus Console came up to me. And he
asked if he could sign my copy of his book.</div>
<div class="MsoNormal">
He said – thank you. For what I had said. Because that would
make him keep writing, another book – hearing that kind of thing. That it meant
something to write something out in the world.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
He asked me if he could sign it.</div>
<div class="MsoNormal">
On the title page, he crossed out his name. And then wrote: “To
Jenny, with thanks – Cyrus.”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Best inscription I have, besides the ones from mentors
(different).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Even published writers – ones I admire so, so much – don’t
believe in themselves and what the words can do for other people.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 10pt;">*I’ve read it 4 times since.
Several more to go until I understand/see more and more and more…<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 10pt;">** Cyrus is, perhaps, 5-7
years older than I am. At the most. Not intimidating at all – quite the
opposite, quiet, unassuming, somewhat diffident. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 10pt;">*** Similarly, I once told
Li-Young Lee “you’re the kind of poet who changes my breathing.” I think he
understood. He seemed to, anyway. But he is quite wise.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Poets certainly aren’t known for their self-confidence. I
recently read Console’s first book, <i>Brief
Under Water</i>. Same reaction. It was over too soon; I had to start again. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It’s the love-hate of poetry. In other (non-art)
disciplines, you can finish things. There are infinite things, but you can
finish one. Thing. Gain an understanding of something. Learn about a disease.
Policy. Community programs and theory and epidemiology and pharmacology and
pathophysiology and pathways. </div>
<div class="MsoNormal">
You can finish a book, you can finish a paper. But a poem?</div>
<div class="MsoNormal">
<o:p> (as described above)</o:p></div>
<div class="MsoNormal">
<o:p><br /></o:p></div>
<div class="MsoNormal">
A “finished” product
is one (often) I can’t bear to look at again. If I do, I’m likely to drown or
light it on fire. In my undergraduate poetry thesis, there is a poem about just that - how much the poet wants to destroy the manuscript. A year later...it was better. Okay.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Anything, looked at too much – and carefully, down to each
punctuation mark, spacing, letter – loses meaning. Like a word you say too
much. A poem becomes – terrible. Nothing. Can’t see the forest for the trees,
to use a terrible clichéd metaphor. And the work itself – hurts. It’s
recursive. It’s never done – until the above happens. I spent six hours working
on one poem last weekend (and many others on others; this, however, was six
straight hours). One poem of 19 lines. And it’s passable, maybe, with several
red marks and slashes (not mine) as of this afternoon. The poem was initially
written in September, was then completely dismantled and rewritten, and, soon,
it will be again. Unless I get rid of it entirely. All the work? Well,
learning, becoming a better poet, better eye, more critical, etc…</div>
<div class="MsoNormal">
but to show for it? Lots of unused and failed files.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Our “assignment” over winter break is to write a book. And
to fail. “May as well get it over with,” said our workshop teacher. Setting out
– to fail. “How many failed books do you have?” “…All but three.”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And it can fail, and you might get one page, or one line,
and that’s good! He says. I don’t know. Including us in that dialogue, though,
included us in the discourse of published and future-published writers.
Failure. Blood, blood everywhere (“writing poetry is easy; all you have to do
is find a vein, and open it). Discarded paper everywhere (to be recycled). </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Thus, simultaneously, public health program design, research, paper writing, article searching, curriculum creating - things that do feel satisfying. Partly in their ability to be complete, enough.</div>
<div class="MsoNormal">
For writing.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Start again.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
~j</div>
<div class="MsoNormal">
<br /></div>Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com2tag:blogger.com,1999:blog-18203764.post-76826046242588996532011-11-04T02:58:00.001-04:002011-12-12T01:29:06.413-05:00Freedom fries<br />
(This is a sketch of a post. The rest...later). <br /> <br />I used to actually hear that, fairly frequently, in 2001 and 2002. Somehow, that was a response to my being French. <br /> <br />It's an interesting word, "freedom." <br /><br />It has a number of negative connotations for me now. "Operation Iraqi Freedom." et al. (not going into that now). It's a way to wrap things in the flag. That flag. <br /> <br />"Land of the free, home of the brave." <br /> <br />from Emma Lazarus, as engraved in the pedestal of the Statue of Liberty: <br /><br />"Give me your tired, your poor,<br /> Your huddled masses yearning to breathe free,<br /> The wretched refuse of your teeming shore.<br /> Send these, the homeless, tempest-tost to me,<br /> I lift my lamp beside the golden door!" <br /><br /> from Tom Petty, "Free Fallin'" (incidentally, excellent Americana song, too..) <br /> <br />"And I'm free, free fallin' " <br /><br /> As one who's been in freefall, before, I preferred parachuting down (skydiving). Freefall is too fast. In sixty seconds (less? I don't remember) we descended 5000 feet or so. However the physics works out from starting at 13,500 feet and parachuting from somewhere around 6000. <br /><br />It was too fast to experience, really - that would take another jump, but as - even if I jumped tomorrow, it would be 6.5 years later - might be like starting over again. Freefall. Fun? How would you remember? Too much to process, see (and I had to adjust my goggles; seemed like they were going to fall off. I do remember that). <br /><br /> Freedom. <br /> <br />I was at Riker's Island today. Famous NYC jails (and poss prison too? unclear). Tens of thousands of detainees/inmates/incarcerated...today was my second time doing any sort of prison work; I'm just starting to learn the language. I'm working with the NYC Dept of Health, and, in particular, with Harm Reduction services. Every month, we go to Riker's to teach about harm reduction, clean needles/syringe exchange on the outside, hepatitis C, and, today, overdose prevention and treatment with naloxone. It was wonderful to get back to that work. <br /><br />Being in a prison is incredibly strange - the checks, the IDs, the leave-everything-including-everything, all the bars opening and closing behind us. <br /><br />I had done that before. And the similarities with psychiatric wards, also (they're co-morbidities, anyway) are fascinating... <br /> <br />That's not the point. <br /> <br />On the bus to Riker's (MTA bus goes directly there, from Queens), you pass La Guardia Airport. And then thirty seconds later you're on Riker's Island. <br /><br />People worry about planes landing in the water? They could just as easily, truly, land on Riker's, on any of the jail complexes. It's an unbelievably short distances. The planes were, essentially, there. Everyone's looking for the NYC skyline as they land - who sees Riker's? Notices? I never did. <br /><br />What could symbolize more freedom? International airport, busy, restricted to people with some amount of money/privilege, vacation vs business vs... <br /><br />airplanes. coming. going. landing. taking off. <br /><br />Right over Riker's. <br /><br /> As to Emma Lazarus and "The New Colossus" - the Statue of Liberty and Ellis Island are well-within view of downtown Manhattan. I remember the towering displays of suitcases at Ellis Island. But then - and now. Now. "Give me your..." to whom, for whom, and for what reason? It's not Arizona in most of the country, certainly. But the sentiment...is so ...condescending. "Wretched refuse"? Wretched how and in whose eyes? "We" certainly take people with very diverse backgrounds - including very high levels of formal education, wherever they come from - and say those things don't count. At all. Redo, redo, redo. Or pretend "whatever" wasn't done at all. In medicine, the ones who get counted as doctors (after however many years of practice, retaking boards exams, and entering the Match) go where students from American med schools don't want to. For the most part. <br /> <br />"Give me your tired, your poor..." <br />Wretched. Demeaned. Demoralized. Dehumanized. <br /> <br />"Send these, the homeless... to me" <br />Because other homes aren't a home. <br /> <br />"I lift my lamp beside the golden door!" <br />And try to see inside. Gold, shut tight; if it's pure, maybe the lamp will melt some of it and allow an opening, an acquiescing, a bending. <br /> <br />"refuse..." <br />For Riker's Island, over 20,000 people, there was no evacuation plan during the hurricane. As stated, it's essentially sea level. At La Guardia. <br /> <br />In French, "La liberté éclairant le monde" - liberty lighting the world. <br />Floodlights that can be seen...well, across a large river and probably farther. <br />After all, electricity is an unlimited resource, not a commodity. <br /> <br /><div>
Let freedom ring. <br /><br /> <br />~j</div>Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-5958594621741244402011-10-15T18:38:00.000-04:002011-10-15T18:41:16.599-04:00Colonized, not conquered, tonguesIn my Creole Poetics class this week, we discussed Caribbean poet and scholar <a href="http://www.poets.org/poet.php/prmPID/668">Edward Kamau Braithwaite</a>’s “Nation Language.” In essence – colonized people, who’ve had to assimilate to
and be taught in the language of the colonizer – need a more natural form of
expression. Part of independence, part of forging a national identity and
establishing roots, was valorizing that language. Making poetry in the diction
and rhythm of <i>that</i> language – iambic
pentameter, for example, is not native to Barbados. (Is it actually natural to
English? debatable).<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I’ve seen this in Cameroon – French is, technically, my
first language, but for the first few weeks in country, my “French” was
translated into “French.” As I now call it, that’s French-French to
Cameroonian-French. I was incomprehensible. I understood what was being said to
me, or I thought I did. In time, I changed – I had to. It’s the inflection, the
diction, the choice of words, the syntax, the prosody, the sentence length,
word order, ways to get attention, non-verbal sounds to punctuate phrases…</div>
<div class="MsoNormal">
Everything.</div>
<div class="MsoNormal">
It’s not the same language. </div>
<div class="MsoNormal">
I see it now as general, amorphous “French” for the basic
structure – and there’s the French-French, the Cameroonian-French, the
Senegalese-French, the Malagasy-French . . . they’re all different.</div>
<div class="MsoNormal">
(And why shouldn’t they be? It’s obvious enough for Belgium
and Québec).</div>
<div class="MsoNormal">
But Africa was colonized.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The marks are there. Senegal was more closely held for
longer – the French is closer to French-French in accent. Cameroon got passed
over from Germany. French is different – the culture, too, is different.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And then there’s Anglophone – as PCVs, we defined at least
three (basic) languages in the Anglophone (previously British-held) provinces
of Northwest and Southwest. “Grammar” is the “Queen’s English,” or so they say.
(Grammar – reductive; it’s language without culture or any social attachments. Pejorative?
True? The way English was taught in former colonies (and is still), it’s the
generic, over-arching Language. This Is. How could something so authoritative have
meaning to real people, <i>terre-à-terre</i>?)</div>
<div class="MsoNormal">
Anglophone. Not quite grammar, or – it <i>is</i> “grammar”, but we call it something else. English? No. That’s
British-English. “Anglophone” is, like Cameroonian-French, related to accent,
inflection, diction, syntax, vocabulary… it’s neither British nor American
English nor any other Western form. We Americans were not always
well-understood speaking American English.</div>
<div class="MsoNormal">
So what did we do?</div>
<div class="MsoNormal">
We spoke Anglophone.</div>
<div class="MsoNormal">
(And many volunteers who lived in the NW and SW learned and
spoke pidgin, as well as other local languages – as a visitor to the Anglophone
regions from my own francophone province, I didn’t go further than Anglophone
and a few phrases in pidgin). </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It’s reflexive, now. </div>
<div class="MsoNormal">
This is what we do. </div>
<div class="MsoNormal">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-OZXAhIW3RAA/RyWs93Rj8tI/AAAAAAAAAHg/y1GvWRnWMpU/s1600/P1010504.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="http://3.bp.blogspot.com/-OZXAhIW3RAA/RyWs93Rj8tI/AAAAAAAAAHg/y1GvWRnWMpU/s320/P1010504.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The Vegetarian Carnivore - Rhumsiki, Cameroun</td></tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br />
<o:p></o:p></div>
<a name='more'></a><br />
<div class="MsoNormal">
I do the same in other languages, though – it’s either a
function of being bilingual (since I’ve had language, lucky lucky) or just of
being…strange. Speaking English with French people who have some accent in
English, some significant accent, my speech softens slightly. Slightly. I’m not
going to speak with an accent I don’t have, but...it changes. Situational. If I
know a person’s first or native language, it’s hard for me to speak to her in
anything else.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Thus, in Cameroon – Cameroonian-French and Anglophone.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
When I went to Kenya, I started to speak what I think of as
Anglophone – it was English-speaking Africa, after all…</div>
<div class="MsoNormal">
I got a few Looks.</div>
<div class="MsoNormal">
(What does the <i>mzungu</i>
think she’s doing…)</div>
<div class="MsoNormal">
(Just like, when, in response to “I want to marry you” or “I
love you” in Bulu, the <i>mintangen</i> shot
back “Teke djom!” or “Ma vini wo!” (Never/I hate you). </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In Kenya, they don’t speak Anglophone. The English in Kenya,
yes, does have a distinctive Kenyan accent, diction, syntax, etc etc etc. But
it is closer to British English, in some ways, than Anglophone sounds. Longer
occupation and more <i>in situ</i> because
there are good safari parks.</div>
<div class="MsoNormal">
It was hard to remember to speak English at first, actually.
For me – Africa meant “speak French,” for the most part. </div>
<div class="MsoNormal">
In Equatorial Guinea (briefly), I had to remember to speak
Spanish – Spanish mixed with Bulu, that is, as differentiated from the French
mixed with Bulu that I was used to – same ethnic group, arbitrary border.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Arbitrary.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It makes the most sense for me to speak all my languages at
once. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In Cameroon – as in many places, but this is what I know –
there are 240 local languages. Country the size of California. Several of the
languages are related in various groups, granted. But there’s the reason there
is no African official language (as Wolof in Senegal or Malagasy in Madagascar)
– there isn’t one. Not enough of one. (If Biya could decide that, on top of
everything else, it would be a Beti-family language. Of which Bulu is one,
actually). </div>
<div class="MsoNormal">
One village to another could be a different language. French
and English are necessary to communicate in a country with 8 Francophone
provinces, 2 Anglophone provinces, a German past, and 240 other languages…</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Bilingual has a strict definition in people’s minds: French
and English.</div>
<div class="MsoNormal">
I, then, am bilingual. Every Peace Corps Volunteer in
country is bilingual.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And my friends who spoke 3 (least amount), 4, 5, 6
languages? </div>
<div class="MsoNormal">
Didn’t count themselves as bilingual unless English was
truly amongst those. </div>
<div class="MsoNormal">
Every single person I know in Cameroon speaks more languages
more fluently than I do. Most of them don’t count them as languages. They call
them “patois” – dialect. Pejorative. Some are written, now, some have been,
some are being codified by missionaries and/or linguists. In Bulu, there is <i>Kalate Zambe</i> – Bible, or “god book.” </div>
<div class="MsoNormal">
Books are Serious. </div>
<div class="MsoNormal">
Because I was often seen reading, people thought I was
constantly working. Constantly. Always studying. It didn’t matter that some of
the “serious” books I was always reading included books I consider equivalent
to TV – passive entertainment – in a village where I couldn’t watch TV or
movies. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But it’s not just that there’s not a conception of reading
for pleasure (there’s not), for so many cultural reasons….*</div>
<div class="MsoNormal">
Books are expensive. Books are expensive and sold on
sidewalks. There are bookstores in Yaoundé, the capital – two, I think. Small.
Most things are copies, copies of copies for university, and it’s hard to get
them (corruption/competition and otherwise) and it’s expensive. </div>
<div class="MsoNormal">
It’s not books. Even benches are shared – and paid for.
Books are very expensive. Magazines, too. Anything that’s reading material,
anything printed, thus gains value.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 10pt;">*I’m reminded of nights in my
homestay in Bandjoun (perhaps written, 2005, the earliest posts here…). There
was power. Technically. Low voltage. The bulb over the dining table was so dim
that I rarely really knew what we were eating. For studying at night (in truth)
or reading (in general) or writing letters, I needed an extra candle/kerosene
lamp. This was probably (was) considered wasteful. My host sisters somehow sat,
hunched, and did homework, after doing all the cooking/cleaning/taking care of
the three screaming children under four. My host parents graded papers that
way. But the TV and DVD player worked. In my room, with the light on, I read by
flashlight. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 10pt;">In Mvangan, until I got a
table made (long saga and looooong time in production…), there were evenings
lying on the floor with the book or letter, trying to get in the right angle
with the light to see enough. (A headlamp, later, helped). <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 10pt;">That’s both the importance of
reading/writing to me – and the barriers that are set up just by the physical
parameters. And no one but wasteful me (or other PCVs) would light more than
one candle or use more than one lamp just to be able to see well.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But I was going to talk about language.</div>
<div class="MsoNormal">
It’s not the same language. And yet, the books are
French-French. In college, I got to take a Francophone (Diaspora) literature
class – actually, it was an intro to French literature, and the professor
(Returned Peace Corps Volunteer from Chad), focuses on Francophone versus
French. I’ve probably read more than most people in Africa have, of that canon.
I can buy the books here. More easily. Writers are getting prizes in France, in
the US…</div>
<div class="MsoNormal">
Africa?</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I reviewed a book of Cameroonian poetry. The poet teaches
and lives in the States.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Literature – the language of a people – should make sense.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
*</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And then there’s medicine.</div>
<div class="MsoNormal">
Words are always approximate. Always. Every art is
approximate. The closest thing to anything, I think, would directly involve the
body – and thus there’s singing (or any music not involving instruments) and
dance. </div>
<div class="MsoNormal">
And medicine.</div>
<div class="MsoNormal">
We interact with this art form, shaping it and trying to
understand it – I’m talking about surgery, I’m not talking about changing things
through medicine, I might be talking about psychiatry, in some respects, but
it’s not exactly that.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We ask people to describe and quantify things in common
words.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Sharp/stabbing/dull</div>
<div class="MsoNormal">
Aching</div>
<div class="MsoNormal">
Where is it? Where?</div>
<div class="MsoNormal">
And what about referred pain – how do you actually know the
locus of anything, as everything is “all in your head” – interpretation of
pain.</div>
<div class="MsoNormal">
For many
things, the body isn’t actually very good at that.</div>
<div class="MsoNormal">
I worry about this with the optometrist. What if I get it
wrong? What if I can’t exactly record the nuances of the images, which is
really better, or just a little bit better, or not at all better?</div>
<div class="MsoNormal">
(At my last visit, he assured me that I couldn’t mess it up
– he used each image enough times, each diopter, and in contrast to other
things that I should recognize more easily. This was slightly helpful – but
still, I’m not completely convinced).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
What about the power of suggestion? The review of systems.
If I hadn’t asked about something, would the patient have thought about it or
noticed it?</div>
<div class="MsoNormal">
(For some patients, this actually does become an issue –
asking the ROS becomes a litany of issues they’d never considered or might be
slightly off kilter).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We define these things and assume people understand.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Pointing is helpful – that’s the body speaking more directly
– and yet, with anything visceral (in basic terms, organ-related) – the body
isn’t good at localizing. Take the classic case of appendicitis:</div>
<div class="MsoNormal">
(this is textbook)</div>
<div class="MsoNormal">
Initially, pain is dull, maybe, and periumbilical (around
the belly button). Vague, diffuse.</div>
<div class="MsoNormal">
(Is the appendix there? No. Not usually).</div>
<div class="MsoNormal">
And then it moves to a more specific location – McBurney’s
point, 2/3 on the direct line between the umbilicus and the ASIS (anterior
superior iliac spine). That’s classic. And the only reason it localizes, then,
is that the appendix is so inflamed that it’s actually directly touching and
irritating the peritoneum (wall of the body cavity). It’s not just the
intestine anymore. And all of a sudden the body has a better idea of where it
is.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The body, too, isn’t the best historian.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A friend (who just started med school) told me last night
that his pain had begun at 6:30 pm the previous evening. “That’s precise…”
“Well, give or take half an hour. Med students are good historians, aren’t
they?”</div>
<div class="MsoNormal">
Yes, and sometimes hypochondriacs (I do think that improves
with time, though).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
What happens when you start to acquire the language of the
body? The basics, as always, come back to pleasure and pain. And in order to
communicate that to doctors (specified: doctors. Or any health professionals.
Or people in a medicalized context). </div>
<div class="MsoNormal">
Do doctors care about pleasure in the body?</div>
<div class="MsoNormal">
Begs the question.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
You could call importance of the patient <i>feeling better</i> as pleasure. Joy in
resuming activities – or adding them, when things are truly “better.” When the
patient-provider relationship has resulted in something positive and
productive. There is joy in the
improvement (or ceasing! gone!) of disease. (One patient called me “an angel”
for helping with his cholesterol and getting him an expedient appointment with
a surgeon for his hernia. Me – hardly. That’s the point of all of this, isn’t
it? That’s what we learn, for? Behavior change communication, harm reduction,
and <i>then</i> the medicines and <i>then</i> the surgery (order depending on the
issue and its acuity).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
How does the body – and how does the person – represent
pain? The patient with metastatic cancer who says she’s in pain is more –
terrifying, to me – than the five-year-old who is crying over a scraped knee.
But?</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A friend explained it this way. She was in the beginning
stages of labor, with her first child. The nurse asked what her pain level
was*. “Nine.” The nurse paused. Surprised. “You know…the actual birth is going
to be a lot more than this.” “I know. But right now, this is just about the
worst I can imagine. And now I’ve experienced this…so later, it’ll still be a
nine.”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 10pt;">*This is a person who would
probably be among the <i>most</i> stoic.
This may have contributed to the nurse’s surprise. Also, this friend is in
medicine.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Everything’s relative. The utility in measuring,
quantifying, qualifying in common language is that we feel we can treat
something, that we can communicate effectively with the patient.</div>
<div class="MsoNormal">
That’s why physicians like the physical exam and lab tests,
too.</div>
<div class="MsoNormal">
But how much of the physical exam is truly objective?</div>
<div class="MsoNormal">
And for lab tests – much closer – as is imaging, certainly –
but unless there are specific points of comparison, you don’t know what the
patient’s baseline might be.</div>
<div class="MsoNormal">
(Patient. Person. Patient. Person). </div>
<div class="MsoNormal">
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-cK5JXO-8b7E/R3FPZMdRHWI/AAAAAAAADPM/kUpcrRjd0ps/s1600/P1010415.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="http://1.bp.blogspot.com/-cK5JXO-8b7E/R3FPZMdRHWI/AAAAAAAADPM/kUpcrRjd0ps/s320/P1010415.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Small small catch monkey<br />(offered to me as a present, Mvangan, Cameroun)</td></tr>
</tbody></table>
Poetry is about specificity of language – actually, it’s
about Vortex and Image (Ezra Pound), but that’s for another day. In medicine, specificity of
language is crucial; it’s how patients tell stories to physicians (and we
complain! it’s not specific enough, AND it’s not in the right words!) and it’s
how physicians communicate with each other.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Epocrates isn’t quite a thesaurus, but . . . working on it.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
(this is already far too long).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
~j</div>Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com3tag:blogger.com,1999:blog-18203764.post-38080891067338481382011-10-06T14:12:00.001-04:002011-10-06T16:39:33.550-04:00Who wants to be a poet, anyway?<br />
<div class="MsoNormal">
<i>The delay is that –
well – since writing is so much of what I do, now, it’s neither escapist nor
explanatory nor therapeutic/exploratory to write </i>about<i>, all the time. But it returns, now.</i></div>
<div class="MsoNormal">
<i>*other poets may
disagree. That’s fine. This is my experience. I'm envious, perhaps, and/or admiring of - in awe of - those who are so dedicated to this as I am to no one thing</i>.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The first poem I remember is from second grade.</div>
<div class="MsoNormal">
Poem that I wrote.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I was a better poet then than for the approximately ten
years after that –</div>
<div class="MsoNormal">
because I didn’t know, yet, what poetry was. What poetry was
“supposed” to be. What “sounded like” poetry.</div>
<div class="MsoNormal">
From seven to seventeen, there was subversion, inversion,
and perhaps glimpses of things that had merit! maybe! that said something!
maybe! But it “sounded like ‘poetry’” – which is, really, not good at all. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Even poetry that conforms to rules – i.e., Shakespearean
sonnets in strict iambic pentameter, for one – is <i>good</i> if it’s so natural that you don’t know for awhile that that’s what
you’re reading (unless it is, obviously, Shakespeare). The rhymes, the rhythm
are not forced. They’re what exists – and what happens to be in that form. And
then you look and realize it’s three quatrains, ABAB, CDCD, EFEF, and a couplet
– GG. Ten syllables to the line in iambs. Trying that – doing that – is hard,
and often sounds heavy-handed and sing-songy with inverted structure to get the
right rhyme at the end. I think everyone goes through that phase. (and maybe it
becomes something amazing and <i>there</i>
is the real poetry. Not for me, not now). </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But at seven I was a poet.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
To be a poet is not a choice.</div>
<div class="MsoNormal">
Who would choose this? It’s a lonely vocation. You sit,
alone (or alone in a crowded room, as we crave the (prototypical?) background
noise of cafés. Street and people-watchers, listeners, we are). You spend an
inordinate amount of time in a difficult headspace that most people don’t have
to inhabit so often. You – if you’re really going to write – are connected as
much as possible to everything, and you’re always listening, and open.</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="MsoNormal">
It’s dangerous.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-_DJ4TIjd1F0/TW9BuupL9FI/AAAAAAAADCM/rmqxIgQQd-s/s1600/P1020963.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="http://1.bp.blogspot.com/-_DJ4TIjd1F0/TW9BuupL9FI/AAAAAAAADCM/rmqxIgQQd-s/s400/P1020963.JPG" width="300" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Nselang, Cameroun - you can't capture the greens of the forest in a photograph - can't - This isn't a great photo, but that's irrelevant for this point -<br />
and you can't capture everything with words, but we try</td></tr>
</tbody></table>
<a name='more'></a><br /></div>
<div class="MsoNormal">
Why be a poet, and why not be another sort of writer? (many,
many of us are, as well. These days, I’ll claim poetry-fiction-non-fiction,
whether I have a “right” to or not).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“No one reads poetry.”</div>
<div class="MsoNormal">
“People are afraid of poetry.”</div>
<div class="MsoNormal">
“To say ‘poetry’ – to say ‘I’m a poet’ – has serious
connotations. To say ‘writing’ or ‘piece’, rather than ‘poem’; to say ‘I’m a
writer’ or ‘I write’ – that sounds different.” Less presumptuous? Less
evocative of I’m-disconnected-from-the-world and I’m-part-of-the-tuberculosis-aesthetic,
living-in-a-garret-aesthetic, surely-starving-artist who, well, teaches,
because who can make a living at this, and who would do it anyway?</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Among my coterie, among my new colleagues and friends and
cohort, these are common discussions. Why do we do this. Who do we read. Who
and what stops your breathing and heart and makes you gasp and reread from the
beginning again, and again, and again.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
To be a poet is not a choice. We didn’t choose this. People
might choose to write fiction, in some sense (paperback? Things that sell? Even
over and above that – it’s a different kind of discipline).</div>
<div class="MsoNormal">
There is discipline to being a poet, certainly. I was
reminded of this in the poem that I have, perhaps, spent approximately 18 hours
on – thus far. It’s not done. It’s far from done. It’s what absorbed much of
last weekend, has kept me up until 3 am a few times (that and other new
pieces), brought me to a café (“my office”) with my unabridged thesaurus,
reminded me that being a poet is <i>damn</i>
hard, and is unbelievably exciting.</div>
<div class="MsoNormal">
Why?</div>
<div class="MsoNormal">
I could articulate it, I know it – but to whom, and who outside of
poets – and those who know me and try to understand – would get it?</div>
<div class="MsoNormal">
And why is that important.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I didn’t choose this.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
One project, lately, has been rereading every poem I wrote since
freshman year of college, when I first started getting serious about this
poetry thing. When it went from being something I vaguely did and vaguely
wanted to do to something I was really going to put energy into because it
mattered. It matters.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Why on earth do that? There are the bad ones. So, so, so
many bad ones. (The impulses and ideas for “bad poetry” are still there – I’m
just better at self-censoring (we all learn to do this) and don’t write them
down). But things are resurrectable – lines, ideas. Two of my recent poems,
turned in for workshop, were resurrected – and severely edited – from pieces
that are, respectively, 9 and a half and 7 years old. They’ve changed – they are
<i>something</i>, now, maybe – but the raw
material is that old. It needed time and maturity.</div>
<div class="MsoNormal">
So that’s why. There are things there that I just didn’t
understand, before.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Reading this – yes, cringe-worthy at times, but actually
less than you might believe – I have so much separation from most of the pieces
(not all) that they almost feel as if someone else wrote them, as if I’m
reading them for the first time, with only a vague memory – is useful. One of
the poems – the nine-and-a-half-year-old – has been stuck in my head for many
months. Just a few lines. And that meant something. That’s why I had to find
it. </div>
<div class="MsoNormal">
Senior year of college, there was a line that was
persistent, pestering all year. I tried to write poems with it. So many poems.
And nothing worked. All were “bad.” </div>
<div class="MsoNormal">
In the end, that line happened to be the title of my thesis.</div>
<div class="MsoNormal">
That happened another time (another memorable time – but many,
many more times – this was before I understood and had experienced the
phenomenon frequently). A line came to me – I had no idea what it was, where it
came from, or what it meant. But I knew it was “something” and that I had to
write it down. I did. Turns out that it was the title of a piece I wrote three
months later. Not on purpose. It was after I wrote the piece that I realized
what the title was.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And thus Jack Spicer’s Martians (for the morbidly curious,
it’s from the Vancouver lectures (starts in #1, but here's #3 - <a href="http://jacketmagazine.com/07/spicer-lect3main.html">http://jacketmagazine.com/07/spicer-lect3main.html</a> – or, in brief, <a href="http://www.poetryfoundation.org/harriet/2008/07/taking-dictation-from-a-martian-muse/">http://www.poetryfoundation.org/harriet/2008/07/taking-dictation-from-a-martian-muse/</a> ). Others call them muses.
Martians feels more appropriate, to me.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It’s reading these that I realize I am a poet, that there’s
never been a choice, there isn’t one, and that taking time from med school for
an MFA was, well, not really a choice, either. The MPH? Yes, later. But I can –
and do – work on public health in the meantime (7 years, now. Much like that
second poem, above). I’ll now be ‘working’ in some capacity with the Department
of Public Health now. Fine.</div>
<div class="MsoNormal">
I know many, many people who understand my love, my passions
for medicine, and how integral that has become. Ditto public health.</div>
<div class="MsoNormal">
Poetry? Harder to find them. And I have.<br />
(Another commonality? We all hate Shel Silverstein and Jack Prelutsky. The "classic" children's "poets." Hate. Always did. This was a discussion the other night - Dr Seuss is a better poet. Certainly).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The poem from second grade:</div>
<div class="MsoNormal">
“The moon holds a beauty within itself. That beauty is
called silence.”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A more recent line*?</div>
<div class="MsoNormal">
“The silence is palpable; I’m not.”<br />
<br />
<span class="Apple-style-span" style="font-size: x-small;">*completely unrelated to the project of resurrection. Interesting only in having some relationship, maybe. And in calling both "poetry" though they don't "sound like poetry." Education, too, is dangerous. Some types and some things in it. Powerful stuff. And the first doesn't have an "I", and the second has "I" as speaker - the delicate separations we make, earned or not. "I" could be the moon (really, too obvious an image for 'poetry', unless done well), or...whatever else. I just thought this was interesting. Curious. And anyone can certainly think that both/either are terrible lines</span>.<br />
<br /></div>
<div class="MsoNormal">
It’s never been a choice. I don’t think anyone is a poet –
not a “real” one – because they <i>want</i>
to be. Want to hone, yes. Want to really work on and devote time to, yes. Perhaps this is reductionist, but you don't "become" a poet - you are or you aren't (apologies to some), and you can become a better poet, much. I wonder this while looking at the $#*%^ turned in as my portfolio for my first workshop - I got in on <i>that</i>?? There must have been something. A few lines.<br />
And there are ways to write - read poetry. Go to readings. Be in workshops and around other poets. But the 'discipline' of poetry is different that that of fiction, I think. And others - you can choose to be a journalist. You can choose to be many things - and you can be a good writer, certainly, and you can work on that.<br />
Realize the necessity, yes.</div>
<div class="MsoNormal">
But no one <i>chooses</i>
to be a poet.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I wouldn’t have.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And last week I went to the ER (the next story) to shadow
for a shift (no longer covered by malpractice, I can’t do anything hands on –
it’s frustrating, in a sense, because it feels like many steps back). And yet –
I read EKGs, I read head CTs, I helped do differentials and diagnose, I looked
up criteria for admission, I saw physical exam findings and talked to patients
and thought about things – I saw a stroke code (and could anticipate the exam
and what would be done), I saw an intraventricular shunt placed to relieve
pressure from hydrocephalus from a hemorrhagic stroke (i.e. – yes – the neurosurgeon
bored a hole into a woman’s head and put a drain in it, and things came out. A
little brain matter? How not?)</div>
<div class="MsoNormal">
All of this was rejuvenating and invigorating and exuberant
and the time passed more quickly than time has in a long time. Similarly to the
alone-work of a poem for late, late hours.</div>
<div class="MsoNormal">
Reading an EKG as reading a line. Thinking through how to
put things together. How to get to somewhere. And the unbelievable, incredible
nature of medicine.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
That too is no longer an option.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Many people want to be doctors, initially – and maybe they
don’t, for various reasons, because they didn’t understand what that actually
means, the pre-work, the study, and then the work. And some do and become
disillusioned. Others don’t and wish they had. Others do and it’s the
absolutely perfect, right choice. Is it a choice? In some senses. I chose it –
at least, I thought I did. Perhaps that’s not quite how it happened.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I didn’t choose to be a poet.<br />
<br />
But no one asked me.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
~j<br />
<br />
<span class="Apple-style-span" style="font-size: x-small;">***Addendum: in relation to this: my poet-cohort has sent emails to our workshop teacher entitled "Poets hate Labor Day" and "Poets hate Columbus Day." Both holidays have meant missing (Monday evening) workshops - which isn't okay.</span></div>
Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-34256930221931096122011-09-13T14:52:00.003-04:002011-09-13T14:53:51.687-04:00The Imposter17 August 2011<br />
<br />
<span class="Apple-style-span" style="font-size: x-small;"><i>For several reasons, I wrote this approximately 3 weeks ago, but I haven't been able to post it until now. To be read in the context of mid-to-late August. I'll write soon about the up-to-present. And how I saw the writer from "Stahnding Room Only" (February) again last week.</i></span><br />
<span class="Apple-style-span" style="font-size: x-small;"><i><br /></i></span><br />
After a job interview, my new boss suggested I check out St.
John the Divine. “Have you been there?” “No .” “It’s the largest cathedral in
North America.”<br />
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
I walked up Amsterdam to 110th . I like cathedrals – it’s a
place to commune, to be quiet. I like the stone and cold, windows and dark
light. In Paris, it’s Notre Dame (however clichéd) and everywhere else. Here,
it’s…<o:p></o:p></div>
<div class="MsoNormal">
I went in,
similar feeling, similar, except not nearly as cold. Quiet. Leaving, I walked
up the street to discover more of my new New York. Next to the cathedral, there
is a hospital. Pause. Ridiculous – no – nothing to do there – to see whom?<o:p></o:p></div>
<div class="MsoNormal">
Pause, but there's a small pull and I walk towards the main
entrance. It’s unfamiliar (but I’ve worked in 7). It’s private (never done
that) and there’s a guard at the desk.</div>
<a name='more'></a><o:p></o:p><br />
<div class="MsoNormal">
I was
planning to try the Hungarian Pastry shop – almost everyone I’ve met has
mentioned it, in a week and a half. So many writers have written books there,
they said. Covers on the wall. Except – there is a hospital. And if the
cafeteria’s anything like that at my home hospitals (ie, tables, chairs, space,
half-decent coffee at times) – that’s where I could write a book, too.<o:p></o:p></div>
<div class="MsoNormal">
I’m not
dressed for it. Yes, I was at a job interview, but it’s <i>hot</i>, I’m wearing flip-flops – though, the rest, I have worn to work
in pieces. The Cameroonian skirt. Etc.<o:p></o:p></div>
<div class="MsoNormal">
There is a
guard. He asks me “what floor?” and I answer lamely, pointing in the wrong
direction, “the gift shop.” (having forgotten my initial coffee idea. It looks
alien in here).<o:p></o:p></div>
<div class="MsoNormal">
I pass people in scrubs – some in the green ones that are my
favorites. The yellow cord on that woman means size small. Someone passes me in
a white coat. I gravitate. They don’t know I belong.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
When I
returned from 2 Peace Corps years in Cameroon, I would see groups of West Africans
on the street (yes, I can usually tell), in subways, hear African French
spoken, see West African clothes, and feel I belonged over there. Once, I
chased a woman through a train station to tell her I had a dress of the same
women’s day cloth (the bright pink one).<o:p></o:p></div>
<div class="MsoNormal">
If I dress
like that, it’s a little clearer. Or on bush taxis with strangers speaking
Bulu, I could surprise and make everyone laugh when I suddenly joined the
conversation. Yep, <i>ma wok</i>. I
understand. To me: “<i>Ma nye wo!” </i>My
reply: “<i>Ma vini wo.</i>” (I love you!/ I
hate you. Always good for a laugh). Or…the “marry-mes” (forgetting the Bulu
words right now). Me: “<i>Teke djom</i>!”
(Never!) Really, anything I said in Bulu was great for laughs. The <i>mintangen</i> (white woman) speaks Bulu!
(some, and diminishing).<o:p></o:p></div>
<div class="MsoNormal" style="text-indent: .5in;">
Back in the States, it was easy
enough to blend with Americans (any color) except it felt <u>false</u>. I could
look like a visitor at this hospital where I have no patients. They don’t know
me. I’m posing.<o:p></o:p></div>
<div class="MsoNormal">
In my
hospitals, no white coat on, hasty ID still in the bag where the iPod earbuds
have just disappeared, everyone knows I work there. We’re all obvious to each
other and to everyone else. Ownership? Boredom? Concentration? Walking down the
hall, checking email, entering stairwells (especially that) without once
looking down? We walk faster. We are not, in general, crying (later). We carry
no presents, no balloons. And especially in this county hospital (true), we
dress differently (it is a level one trauma center, so those patients are
undifferentiated – the patient with <i>purposefully</i>
(expensive) distressed jeans stood out).<o:p></o:p></div>
<div class="MsoNormal">
I walked
out. I wished I was wearing scrubs, maybe. It’s close to 3 weeks since I’ve
been a med student (I’m ____, one of the (a?) student doctors here) (have I
forgotten my opening line?) and my stethoscope is on the wall in my apartment.
Not stuffed in a bag. Swinging, swinging, swung around my neck. Nameplate
facing out. It looks lonely, awkward. It’s only supposed to hang like that on a
neck, <i>my</i> neck, and it twists. A
stethoscope is never static.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
From
October 2008 to August 2011, the longest I ever went without seeing patients
was 2 weeks.Usually one, usually 3 days. And for a year and a half, five to
twelve patients a day, every day. Sometimes for 12 days stretches (or 30
hours). And after this, for the rest of my working life. Same-same.<o:p></o:p></div>
<div class="MsoNormal">
In the
tradition of William Carlos Williams (the one everyone cites to me), I am a
poet. “Somewhat writer,” I say. And I only claimed <i>that</i> after the first check came. (<span style="font-size: 10pt;">First
one? $6. But I kept it because in the memo section of this university-generated
check is typed “Writer”).</span> <o:p></o:p></div>
<div class="MsoNormal">
Almost doctor (<span style="font-size: 10pt;">and I only
claim that because, logistically, I have 6 months of classes – by which I mean
mostly hospital work – left to graduate</span>). And here I am, many, many
miles from the city that’s become home and the hospitals that are home (people,
places, patients. In a recent dream, the trope of someone intruding on me at
home? Me, scrubs, hospital, waiting for an interminable elevator).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I’m an imposter
non-med student, MFA student, and I could walk into a hospital in my scrubs and
white coast (both made the packing list) – but I wouldn’t know where to go. No
team and no patients. To people who run writing series, lit mags, are
published-published-published, I, 7 years out from a literature class (or
analysis), very under-read/educated by comparison, published only in lit
mags-for-medicine, not knowing poets or literary movements or presses, am going
to say I can keep up and have something to contribute? Doctor with a writing
hobby? Writer with a doctor hobby? My college degree is in both, I defended a
thesis in both, but MD will always precede MFA on the name badge, and I have
fewer class hours in a week that I worked in a day. In a city I don’t live in,
without any of my hospitals, I’m supposed to sit in cafés and – except for when
I’m tutoring med and pre-med students (the aforementioned “job”), writing is <i>not</i> what I do between notecards and
medical references. The journal, the poetry book are not what I <i>add</i> to what I carry. They are what’s
supposed to be there, this is what I’m paying tuition to do and to learn, and
no one expects me to pre-round at 5 and be prepared for rapid fire
presentations and invective.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I don’t
know what they want or what I can give. This school isn’t a job (paying for the
privilege to work, guild system, hierarchy, etc). I call most of my hospital
attending by first name anyway, but these poets aren’t <i>doctors</i> (<span style="font-size: 10pt;">and what, then, is
acceptable formal address? Mr/Ms? <i>Seriously</i>??</span>
<span style="font-size: 10pt;">They’re not all professors</span>). People used
to doubt I’d go back to finish med school after this. “I’m more than halfway,”
I’d say. “I have to have something to write <i>about</i>.”
“Besides, I can’t be a poet with med student-sized debt.” (the joke). It used
to annoy me, the: oh, so you write about medicine? Well, when some weeks,
months, all of my waking hours except 4 are spent at the hospital, what else
might I much write about?<o:p></o:p></div>
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And now?<o:p></o:p></div>
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17 days out and I consider communing in hospitals.<o:p></o:p></div>
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This
imposter – Franco-American and bilingual, bi-passported, with Cameroon
considered a home, grad school nested in grad school, keys for houses in two
very different cities on my key chain –<o:p></o:p></div>
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will try to learn to pass.<o:p></o:p></div>
Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-25582261506293981312011-08-29T01:41:00.005-04:002011-08-29T10:11:33.768-04:00The title is a lie.<div class="MsoNormal"><span class="Apple-style-span" style="font-size: x-small;">(to follow)</span><br />
<br />
There is literally nothing that did not happen today.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I spoke with a friend in Cameroun.</div><div class="MsoNormal">I found out that the research article section I wrote is, in fact, good, even with the inclusion of some writerliness.</div><div class="MsoNormal">I went to a county hospital, participated in infectious disease rounds; spoke with HIV doctors and people working in public health in Africa and people teaching about narrative medicine.</div><div class="MsoNormal">And then I went to a poetry reading with a new poet friend and we went out with one of the readers and all her writer friends after.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Dizzy.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I was in three of my major communities – Peace Corps/Cameroon/public health, medicine, and poetry.</div><div class="MsoNormal">And only in the third did I feel intimidated and like an outsider with little to say or knowledge of how to interact.</div><br />
<div class="MsoNormal">I carried a white coat to the poetry reading in my doctor bag. I wore Cameroonian clothes. I had my med student ID. Just in case. It’s next to the MFA student one. I wrote new poems on the subway. I’m better at that than reading in transit.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">At the hospital, not-quite-just-a-visitor and not-quite-a-student, I asked, “should I masquerade?”<br />
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Meaning, wear white coat + ID, even bring stethoscope, to show I belonged. Walking along with the team, though, and dressed as I was, I didn’t look out of place. Comfortable, except I don’t know these hallways. Even the cafeteria was comfortable with that coffee-bad-in-a-particular-way. Going on my good things about this city list? Hospital food was cheaper; apple cost 35 cents rather than 75.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">There, I know what I’m talking about. “Do you know <i>Pharos</i>?” in rounds, we were speaking of medical publications that incorporate literature. “I’m published in <i>Pharos</i>, actually.”</div><div class="MsoNormal">“Why do you still want to be a doctor, after this?” “Because it’s the best job in the world.” Nods. They know. They get it, too. There is no other reason to work so hard and not sleep.</div><div class="MsoNormal">I was remembering the antibiotics – I knew, I knew, I took notes, I thought of the antibiotics cards I needed…and I still haven’t done the poetry homework for first workshop, the explication of the long poem.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">This hospital is four stops from MFA school on the same line. Convenient. In any kind of metaphor, MFA school is the last stop on this line.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Three worlds and drinks at night with the one I’m least comfortable, have the least to say and interact the least – but 3 writers* – THREE! – were mentioned whom I know, personally, including my mentor and two I met last summer. I have signed copies of the books we discussed; I’ve read all of one of them.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-size: x-small;">*Promoting poets, the three are: Olga Broumas, college mentor and leading/initial writer in <i>Calyx</i>, Ross Gay, over whose poetry book I actually met a friend, last year, and Bhanu Kapil, whose work is indescribable.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I should see it like medicine. I was asked to teach a class on Whitman’s Brooklyn poems – I’ve barely read Whitman, and I certainly didn’t know he was from Brooklyn. The professor asked me to teach that day as the poetry “expert.” So, just like in medicine, I pretend to know. I’ll learn. See one-do one-teach one. See one-do one-teach one.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Medicine feels appropriately fast. In my head space, I am thinking through the body. <i>Where</i> are the offenders, the intruders, and who could they be? <i>How</i> do we find the intruders, <i>how</i> do we get to them, and <i>how</i> to eradicate them, and <i>how</i> do we make the patient better? Better.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">In rounds at the hospital, this hospital, where I’m not a student, I take notes, whether I will need them or not. I’m remembering, I’m thinking, I’m trying to keep up and realizing how much in just these few weeks has moved to the back of my brain. Maybe that’s why we work so many hours in a row.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">So there is poetry homework. I did buy the book, early, and I identified the poem and counted the pages. A poem to dissect, to explicate* (one of my favorite words). Can I approach with a differential? It’s a scalpel, I say. I call this. “Approach words with a scalpel.” (line poached from my poem).</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-size: x-small;">*Explaining a poem. It is like dissection – the nerves/arteries/veins/lymph channels (NAVL we say for the femoral triangle), where they are in relation to each other and how they work together and what that means. What is the brachial plexus of the poem and what-leads-to-what and how; this is also the derivation and the allusions. What nerves mix to create what other nerves, and where do they go. We don’t make up dances or mnemonics for that in poetry, though. Unless it’s formal poetry and you’re talking about meter or shapes or rhyme schemes – each dance is different. A little different. And each author’s dances are related to each other, somehow, and the thread might be the voice.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">It’s false. Everything I’ve said, this title, is false. I’ve been approaching scalpels with words. My MFA applications? About how I see medicine. How medicine is like poetry.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I wrote, I explained, I sold why-should-a-doctor-be-a-poet. Why, then, should a poet be a doctor? It’s why, perhaps, they want me here. Whatever that is.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I’ve approached scalpels with words.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I brought the poet’s eye, hand to medicine. And somewhere along the line, my old explanation ceased to be true. No.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">“I’m a writer. Medicine is what I do.”</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">“Doctor” is who I am, too. Will be. Were I staying, I’d be applying for residency right now. And it’s not a brainwashing or mind-melding or beating-into-shape transformation.</div><div class="MsoNormal">Writing, neither, is not my “hobby.” I hear that a lot.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">But up until now, for the past several years, I’ve been learning about scalpels and approaching them with words.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Writer and a doctor.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Now is the time to approach words with a scalpel. To learn why that’s a good thing (assuming it is). The doctor will graduate more balanced – words with a scalpel with words.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">And there’s a white coat in my doctor bag and two poetry books and notebooks, one of which has medical lecture notes – all that’s missing to make this “normal” is a stethoscope, many more than the one highlighter, and some papers. These have gone together for awhile. There is poetry inside the white coat at times. Maybe I should wear it to write. Maybe I should wear it to teach poetry, wear it to readings, and be subversive – there, it won’t represent the hierarchy it does in the hospital. In the hospital where I don’t like to wear it for reasons other than practical pockets. It represents who I am. Maybe the stethoscope would be easier to carry.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">On the subway on the way to my first day on poet-campus, I considered bringing <i>JAMA</i> to read. For med school, I often had poetry with me. Close to always. Novels. I brought a poetry book(s) for boards – totems of good luck, things of balance. To my first workshop in college, I brought what was, at the time, my favorite book of poetry. You didn’t know until you arrived at the door if you had made it in. We had turned in the pieces – applications – the week before. I didn’t expect to get in. If I didn’t, the reasoning went, I would still and always have poetry.</div><div class="MsoNormal">And then I got in.</div><div class="MsoNormal">The first poem read in that first workshop – it’s Li-Young Lee’s “Words for Worry” – became my touchstone, after that. I started a reading I did with that one. I’ve started workshops I’ve run with that one. Any poetry class I teach should begin with that poem. (<a href="http://www.youtube.com/watch?v=ILPbJHqEXu8">http://www.youtube.com/watch?v=ILPbJHqEXu8</a>)</div><div class="MsoNormal">So <i>JAMA</i> on the way to poetry school for balance? Maybe it should have been. Instead, the compromise, I read a book of ‘psychological poems’ – by providers and patients.</div><div class="MsoNormal">That’s where I belong. And today I wrote in the hospital.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I’m not the writer who graduated with dual degrees and dual theses in college. I’m not the writer who returned from Peace Corps. I’m the writer whose signature has not degenerated, per se, but is often accompanied with an identifying code and a pager number. I’m the writer who uses abbreviations and bullet points in the hopes that maybe notes will be easier for others to read. And shorter for her to write. There are so many…</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I’m the writer who could have been, would be, a doctor in less than a year. Who’s still trying to work on having thorough differentials with a consistent approach. A flow to the physical exam. To work with patients. To presentations. Conciseness. Meaning. What is said and what isn’t said.</div><div class="MsoNormal">That’s what poetry brought to medicine.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Now medicine brings to poetry not-just-subject-matter. I don’t know what else that will mean, yet.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Use it.</div><div class="MsoNormal">Use everything.</div><div class="MsoNormal"><br />
~j</div>Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-40539815017831099502011-08-21T16:59:00.000-04:002013-09-03T00:23:39.680-04:00The Mental Status Exam and obsolete ethernet cables<br />
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I’ve written the neuro exam, the respiratory exam, the cardiac exam? (not yet) – what else. Pelvic exam will certainly deserve something. Anything that intimate. Eye exam (except I’m not good at it/we don’t really learn a good one, in med school). Musculoskeletal could be interesting.</div>
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Dermatologic, again, we don’t really learn, but that sort of scrutiny to the outside might be the most similar to psychiatry’s scrutiny of outside-to-inside-to-outside.</div>
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It’s applicable to anything. In psychiatry, actually, I did a presentation on the mental status exam and interpreting poetry – poetry I blurred on the projector screen so that you couldn’t read the words.</div>
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Mental status includes action, includes movement and speech and anything that indicates internal state in externalization.</div>
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I spend a lot of time, lately, searching for wi-fi<span class="Apple-style-span" style="font-family: 'Times New Roman', serif; font-size: 16px;">.</span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-AUQndqD2YS8/RybpKHRj9ZI/AAAAAAAAAN8/Bios5WAPZrQ/s1600/P1010548.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="http://1.bp.blogspot.com/-AUQndqD2YS8/RybpKHRj9ZI/AAAAAAAAAN8/Bios5WAPZrQ/s320/P1010548.JPG" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Crossing into Chad</td></tr>
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<o:p></o:p></div>
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We haven’t installed it at home yet (new apartment, new city, new life as a writer-med student rather than med student-writer), and so we’re stealing – pirating – where we can. There’s one network that’s usually close enough for us to get onto (have they realized? How much slower has it become for the mysterious Them?)</div>
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It’s available at different points in different parts of the house. If that makes any sense – but there is a distance from the invisible (waves I don’t understand) that makes it easier and harder – and the distance is about 20 feet. There is, most of the time, a cloak or shield around my room. I don’t have it. And rather than take that as a sign that I should be doing other things, I should be reading, or I should be writing other-than-emails.</div>
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Instead, I search. I go look for it. I move around.</div>
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I’ve been back too long.</div>
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My frame of reference for frustration in Cameroon:</div>
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The summer prior to leaving, I was frustrated when our wireless internet wasn’t working and I had to go downstairs to plug in my computer.</div>
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A few months later I didn’t care if there was power, I’d rather it stayed off than dimming the bulbs (yes, there, it can be cut by what seems like half) and flashing in and out.</div>
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I’ve been back too long.</div>
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(I’ve said this, I know). But there is cell service in the village, now. In Mvangan. I’ve gotten calls in the middle of the hospital from friends in village – things I can’t explain about how I can’t talk at work, I’m with a patient, I’m in the hallway, and I can run into the stairwell but I can’t stay for too long and I can’t really shout and if I’m heading into the elevator I’ll lose connection. Or have to cut it off.</div>
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I wonder how frustrated they get with me. And because I have to Skype I have to count the hours, be at home, and remember. And my excuse now for not answering the phone calls upon phone calls (it’s biping, for the most part – call and hang up so the other person sees the number and calls you back). </div>
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Because there isn’t always internet.</div>
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In Cameroon, they can call me. For me to call – money less of an issue on this side – there are many, many other factors.</div>
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It’s the logistics here that are more complicated, and that’s what I have the most difficulty with. Logistics. Dealing with such. And having intermittent internet. Being in a large city in the United States, naturally, it’s easy enough to wander to a nearby café with free internet. Sit for hours with a table and a mug in the style (is it really first from <i>Friends</i>?) And even from there, it wouldn’t be couth to have a loud (necessarily, it’s both Skype and a phone call across sometimes-hesitant network to Africa).</div>
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I’m pirating and it’s more difficult to communicate. Or that’s an excuse.</div>
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In psychiatry, everything is relevant.</div>
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(Even this)</div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
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<tr><td class="tr-caption" style="text-align: center;">Cacao drying, Mvangan</td></tr>
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One of the interesting – and difficult – things to learn, in the beginning, was that in an hour you can speak with two patients who are very anxious. One is afraid of a recurrent heart attack, a recurrent theft, an attack, a nightmare.</div>
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The other can’t access wireless internet and feels disconnected from the entire world* (yes, without ‘smart’ phone or 2/3/4 G).</div>
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<span style="font-size: 10.0pt;">*Not actually the case</span>. <span style="font-size: 10.0pt;">Though, anyone who knows me does know that I don’t have an internet-capable phone.*<o:p></o:p></span></div>
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Another (perhaps relevant) point is that, when too tied to internet/devices and <i>searching</i> for internet/devices, you forget to pay attention. Attention to detail. To listen to everything around you – we block things out with headphones and ear buds (how much more intimately invasive can you get than actually blocking the ear canal directly?) Loud noises that drown out less loud ones. Right now, as I write, I’m periodically checking to see if I can access Wi-fi. If I could, would I be periodically checking email? Likely. </div>
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I had learned at one point to turn off the internet capability of the computer in order to <i>really</i> write. Editing poetry is generally long-hand, on paper, with red pens and a paper thesaurus. That helps with the concentration. And typing <i>that</i> is stream of thought, something moving forward, at any rate, so I’m less likely to multi-task in the middle. (And this, compared to any sort of essay or assignment, is stream-of-consciousness and directed thought. And yet. I’m still searching for internet. I’ve moved to the part of the apartment where I’m more likely to find it…are they onto us? Are we cut off???)</div>
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The mental status exam, like writing poetry, is about using every sense.</div>
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<b>Appearance.<o:p></o:p></b></div>
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The patient might say he doesn’t drink, ever. Or hasn’t had a drink in two weeks. Your sense of smell gives you a different answer. Write it down .</div>
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We classify each other into subtypes – the ones most discussed in my life, currently, being hipster and hippie. High school was goth. Emo. Etc. These change, generationally. And they don’t at all. Incredible how people, even, are tropes. Would that be a shortcut to describing appearance? And how do you describe so that someone can listen to your presentation, someone can pick up your note and see the patient, exactly? A psychiatrist, any doctor, should be a writer. Is.</div>
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<b>Behavior.</b></div>
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Who’s actually calm, these days? Behavior is being constantly connected. Behavior is what’s on your facebook status, gchat status (previously AIM – someone recently said I was betraying my age when I admitted to having an ICQ account, long ago). Behavior is having to tell people where you are, when you are, how to find you, your GPS coordinates, what you’re reading, where you’ve been, and who you know. I remember the Kevin Bacon game (preceding or co-existing with the advent of IMDB?) We do it to each other now, and not celebrities.</div>
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Behavior is voyeuristic. (Photos of people you haven’t spoken to in a decade? What, really, is the curiosity, and why is that what becomes part of the procrastination routine? (admitted)). Finding out how friends are connected to friends of yours, from other parts of your life – connections necessary to know for curiosity? This is how the world is real. There are few people who do not, to some degree, know each other. Whatever knowledge is, now. Behavior is having to be online to work and thus being online for everything else. What’s “productive” and what’s not. </div>
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And because I am in a coffee shop – and I spent at least 15 minutes trying to troubleshoot why the internet was, initially, not working, though I mostly don’t need it – and because this is procrastination from working on a research article – and because this sort of rambling, this sort of unedited diatribe, is common in the self-promoting, self-actualizing world of blogging and online conversations without punctuation other than key returns becomes unbearably long – I will continue the mental status exam later.</div>
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Attention to detail. Attention to length. Attention to the icon on the bottom of the screen that, moused over, declares both local and internet connection. The shiny blue circle over the superimposed monitors, on my computer, looks like a little world of oceans.</div>
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~j</div>
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<br />Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-19995194710836181512011-08-16T10:47:00.003-04:002015-12-05T09:16:23.129-05:00The Procedure<div class="MsoNormal">
<span class="Apple-style-span" style="font-size: x-small;">(This was written several weeks ago – refers to all month of July)</span></div>
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Today I used sound waves and a plastic transducer to take moving photos of a fetus-squiggle<span style="color: black;">. I was outside, it was inside, and now it doesn’t take long for me to find the uterus, to see the black-filled-collapsible bladder on top of the double-stripe collapsible uterus that now, in pregnancy, isn’t so collapsible (<i>potential space</i>). The black-fill is water, and there’s a tiny yolk sac (depending) and there’s a little squiggle (this early). And it turns and turns and turns on a stalk, and I have to move, patient, to capture it. Length-wise. Freeze.</span> I measure. My machine converts that to weeks.</div>
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And I print the photo, attach it to the woman’s chart on which I’ve written LMP/Gs and Ps/prior c-section or surgery. Bleeding or pain? Prior ultrasound?</div>
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I’ve filled in provider (the attending), the clinic, the date, and the patient’s name, DOB, medical record number are stamped at the top of the carbon-copy page. White copy on top.</div>
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I write in the length I found (if it’s first trimester-early, it’s crown-rump length - descriptive, no?) and I write it in mm and I write the gestational age.</div>
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I mark: + IUP. + FCM</div>
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Single, intra-uterine pregnancy</div>
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Fetal cardiac motion</div>
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Under “reason for exam” I write “dating – undesired pregnancy.”<br />
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Every day for the past month I have been working in an abortion clinic.</div>
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And three days a week for the past 4 weeks I have done abortions – yes, I, at least once on each of those days. And at times more (depending on patients – can the student doctor do it? Yes/no. Would I let me, if I were the patient? Yes/no). </div>
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On the other two days, I’ve been helping to prepare for other abortions.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
These are TABs or VIPs – Termination-abortion (as opposed to SAB, Spontaneous-abortion, commonly known as miscarriage).</div>
<div class="MsoNormal">
VIP. Voluntary Interruption of Pregnancy.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This is not a treatise on abortion. This is not political. This, simply, is.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-align: center;">
<o:p>***</o:p></div>
<div class="MsoNormal">
<o:p><br />
</o:p></div>
<div class="MsoNormal">
I’ve been working in an abortion clinic – it’s part of my education. It’s my fourth year, now, so I chose this. I chose to work here. A clinic in a large-liberal city in the United States. Where we are, at this clinic, we don’t have to deal with protesters or laws forcing doctors to do things doctors shouldn’t have to do or say. Legalities interfering in even the conversation of the doctor-patient relationship.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There are legalities in every part of medicine. We learn medico-legal speak. We learn what to write, what not to write. How to cover yourself and everyone else.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And for billing purposes, I write “undesired pregnancy.” That is the reason for the ultrasound.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And I do ultrasounds.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-align: center;">
***</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It doesn’t matter what the stories are; I don’t need to tell them.</div>
<div class="MsoNormal">
My patients have been mothers of 3, high school students, animal trainers, women with master’s degrees (spoke 5 languages) now "without a home; if I have one more child my family is going to ...." Another, talking on the phone to get furniture delivered and 4 kids picked up from school… taking a day off from school + 2 jobs. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Twenty, three kids, here on a bus alone (can’t tell anyone at home), wandering around all night..and that’s why she showed up so early, and why I didn’t want to let her into the clinic, yet, when I was the only one there (protocols? Liability? Who knows. Or my laziness and wanting to finish breakfast, studying, and work for the day before anyone came in whom I had to talk to). </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 0in; mso-add-space: auto;">
then the other one whose entire family lives on the same street</div>
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or the one with a two year old and a six month old – she’s 18.</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
or the one whose mother is there to hold her hand</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
or the one whose partner is pacing, anxious, in the outside waiting room</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
or the one whose social work/case manager is the one in the clinic, in the ultrasound, in the procedure, holding her hand</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
it was a different one who came from the psychiatry floor</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
it was a different one and a different one and another one who didn’t know she was pregnant</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
it was another one who had had to cancel three appointments – mother-in-law sick, died, funeral, then she was sick, then something else happened… but today, she had a day off, and she could do it.</div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 0in; mso-add-space: auto;">
(same for another, who luckily didn’t have to miss one of her summer school class days).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This is what keeps my day and my job alive, vibrant, constant, and me invested in what I’m doing with fresh (tired, tired, tired, red) eyes and hands, again.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Otherwise, it doesn’t matter.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Some are there for fetal anomalies (abnormalities? wide, wide range), chromosomal abnormalities (from amniocentesis; some, we know exactly what they mean – Down’s syndrome, etc. Others, it’s not clear, exactly, just clear it would be bad. Bad). Fetal demise (died inside. Didn’t come out. Could be an incomplete miscarriage, could be…whatever. Something happened. And something inside is dead and has to come out). And then there is every other imaginable reason. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But it doesn’t matter, does it.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-align: center;">
***</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As a future physician who will specialize in HIV/infectious disease, I shouldn't feel differently about my patients with AIDS-by-blood-transfusion or AIDS-by-heroin-shooting-up. (But are the babies different? Yes...) Health care worker? (yes, I identify more here). Unprotected sex, bad luck, the traditional birth attendant in Cameroon, the wife of the husband who was with the teenager and all those other ones...man in the same situation. Teenager (young). Before HIV was known about and how to protect from it. After. </div>
<div class="MsoNormal">
The medical treatment is the same. The clinical treatment, patient in the clinic, <i>my</i> patient in front of me, should be the same in that moment. I'd like to hope that one-to-one, <i>ceteris paribus</i>, it will all be the same.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But it doesn't matter, does it. The how or the who.</div>
<div class="MsoListParagraphCxSpMiddle">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
If I feel differently about the ones with anomalies or chromosomal abnormalities</div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 0in; mso-add-space: auto;">
If I feel differently about the fetuses that were absolutely desired pregnancies but, for some reason, the pregnancy can’t be continued – health, health, dying, fetus dead, health .</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 0in; mso-add-space: auto;">
But no one’s happy to be here. </div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
No.</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
The staff are happy to be in this amazing clinic, to be working together, doing this work, helping – counseling for psychosocial, support where there might not be any other in this woman’s life. Doing something small. Having a positive impact. And in this clinic, at least, family planning and contraceptive options are a big, big part of the counseling. Looking toward the future. No one actually wants to do this again - the providers don't want to see the same patients again. The patients don't want to be here again.</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
No one is happy to be having or doing an abortion. That's not the word.</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
Nothing is easy about this. In the beginning, it felt different – believing in, supporting abortion rights – and being the one who performs it. Is it? If I weren't in medicine and had the same socioeconomicpoliticalhealthcare views, I wouldn't be on the side with the hands-in-gloves, the mask on, concentrating on the procedure. </div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
But I am in medicine, I want to be in medicine, and that's part of the views, anyway. Getting to enact - getting to be part of extending health care, of making that a more positive experience for people who might not have those in a power structure. Respect. Just...being there. Like Peace Corps. Being there with whatever skills you have, working to learn as much as possible, always learning, and working because you care so much about it and about what you're doing. Lucky to get to do that. Lucky to be there, on this side. And that's all.</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; text-align: center;">
***</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
Before I started medical school, there was one procedure I was looking forward to learning:</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
This one.</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
I didn’t want to be a surgeon; I wasn’t looking forward to learning about appendectomies or heart transplants or venous grafts. I had no conception, yet, of so many of the things I would come to love in medicine. I didn’t know.</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
This, though – I knew. It had nothing to do with the procedure itself. This is, again, the privilege of medicine to me – and the responsibility, or what I feel it as. I’ve worked in places where abortion is illegal (though I haven’t worked in any of those places in the US, where everything is an unbelievable barrier). I’ve seen the sequelae, actually, a few times. And I’ve read about it (who hasn’t?), even back to my John Irving days and <i>The Cider House Rules</i> (book. better than movie). I wanted to be able to provide safe abortions. Safe. I wanted to learn how to do that, not just a safe procedure but a safe space to come for it. I want to fill in the gaps, in medicine. The things where there aren’t enough people (just need to be filled) or any at all.</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
Here’s a gap, to me. It’s a place I can fit.</div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 0in; mso-add-space: auto;">
Nothing is easy about this, and I don’t think it ever will be.</div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 0in; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 0in; mso-add-space: auto;">
Nothing is easy about this. I'm learning. I'm going to keep learning. The skills will build. It won't be easy.</div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 0in; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 0in; mso-add-space: auto;">
~j</div>
Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-18244681294755115422011-08-04T01:29:00.001-04:002011-08-04T01:41:45.022-04:00The Luckiest<div class="MsoNormal">It’s said in many ways.</div><div class="MsoNormal">Absence makes the heart grow fonder.</div><div class="MsoNormal">Nostalgia in looking back.</div><div class="MsoNormal">Selective memory.</div><div class="MsoNormal">And, per Ben Folds, “The Luckiest.”</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">This usually refers to, I think, people/place/thing. Certainly people. Certainly place. Time period. Self at a different stage of life.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">It’s not usually used in reference to career.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">It’s now been three days since I was an active medical student.</div><div class="MsoNormal">And I miss it. A significant lot.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I can’t wait to be a doctor.<br />
<br />
<div class="separator" style="clear: both; text-align: center;"></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-cUSyt1YRWZI/R3FQpcdRHoI/AAAAAAAADPM/ux8bBLob79o/s1600/P1010458.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="http://4.bp.blogspot.com/-cUSyt1YRWZI/R3FQpcdRHoI/AAAAAAAADPM/ux8bBLob79o/s320/P1010458.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Kribi, Cameroun</td></tr>
</tbody></table><br />
<br />
<a name='more'></a></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Before I started med school, I couldn’t believe how lucky I was to <i style="mso-bidi-font-style: normal;">get</i> to go to medical school. I’ve had a lot of privilege in my life. This is one of the greatest, most amazing, most incredulous ones.</div><div class="MsoNormal">What I’ve done, what I’m doing, what I will be doing.</div><div class="MsoNormal">I was let into this hallowed profession – in some places, hallowed, darkened halls – in which I <i style="mso-bidi-font-style: normal;">get</i> to learn all about the body. Get to. And I <i style="mso-bidi-font-style: normal;">get</i> to interact with people in the most intimate way, at their most vulnerable – they trust me, let me in. I have to earn that trust.</div><div class="MsoNormal">Starting, and before starting, I didn’t understand that sacred trust. It’s something I continue to learn, every day. And I am amazed. </div><div class="MsoNormal"><o:p></o:p></div><br />
<div class="MsoNormal">After a day with patients, last week – any day – I left the hospital exhilarated. Exhausted. Beaten down, burnt out at times. But exhilarated.</div><div class="MsoNormal">I will have no days this amazing as a writer. Or as anything else.</div><div class="MsoNormal">I am unbelievably, incredibly lucky. I <i style="mso-bidi-font-style: normal;">get</i> to do this. They let me in.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">When I graduate from medical school, I will have been thinking about becoming a doctor for about 17 years. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I am the luckiest.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">When I hear about people studying for the MCAT, my first question – reaction – is <i style="mso-bidi-font-style: normal;">why.</i> It’s partly that I’m still not sure if I would do this again; there are other things I could have been very happy doing, and I wouldn’t have known, exactly, what becoming a physician means. <i style="mso-bidi-font-style: normal;">Why. </i>This is too damn hard if you don’t love it. Too hard. Not worth it. Become a lawyer, go into business, science, anything, anything, anything that is intellectually challenging/prestigious/hard/will make you money. Whatever the motivation is. This is too much work if you don’t love what you’re doing.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Perhaps I’m already nostalgic, but that’s why it’s important to write this now – so I remember, have it to read again, on the inevitable terrible days and nights.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I <i style="mso-bidi-font-style: normal;">get</i> to be a physician. I get to have patients.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">When doing procedures that are <i style="mso-bidi-font-style: normal;">uncomfortable</i>/ painful. . . I give patients license to do whatever they want. Whatever helps, I say. Swearing. Call me names, I say – it’s nothing I haven’t heard before. And it won’t hurt my feelings - promise. It’s definitely not personal. You can talk on the phone. Whatever. . . If I’m holding a patient’s hand during a procedure that someone else is performing, I joke about breaking my hand. Go ahead, I say.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The unbelievable, unbelievable, incredible privilege.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">It began with cadavers.</div><div class="MsoNormal">No, before that. It began with getting in. Before that. The opportunity to do pre-med at a ‘very good’ university, with a lot of support, and enough liberty to really have time to focus on classes. Which goes back to high school, etc.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I was in the school bookstore today and I almost started tearing up, looking at the stethoscopes. Mine is coming with me to writing school. It’s part of me, at this point – it’s an extension of my ears, another way to augment my senses. And it hangs so naturally around my neck that I once picked up someone else’s stethoscope – same color – thinking it was mine, and didn’t notice I was wearing two until someone pointed it out.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I get to have a stethoscope. Mine. I get to listen to the inside of the body. And with this training, I learn to interpret what I hear. Sounds and silences. The natural unwinding of this caduceus. At one point, I thought I’d lost it – left it in a clinic, somewhere. (I know people who have lost them/had them stolen). And it wasn’t just the frustration/annoyance of having to spend money on another one.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">It was the thought of losing <i style="mso-bidi-font-style: normal;">mine</i>. I can keep this one for the rest of my career. I’ve gotten to know it. In mine, there are still a few grains of sand around the bell from the time I put it in a bag I’d just taken to the beach…</div><div class="MsoNormal">If I don’t use it, as a writer, it’ll hang on the wall. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The early med students walk around in clean white coats (I remember being told that was how we were recognizable), and the stethoscopes look a little awkward. The scrubs are almost a status thing, at that point – a little bit in awe of getting to wear them. (<i style="mso-bidi-font-style: normal;">Getting</i> to). And now… well, nothing used in that context stays white, and bleach barely works. The stethoscope that I used to wind carefully into a little bag, the one my sphygmomanometer (blood pressure cuff) came in – now goes around my neck, winds into a pocket, gets dropped into my bag. It isn’t fragile. And it’s mine.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I get to be a doctor.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I can’t imagine any job as incredible as this one. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">This morning, talking about this with a med school friend –I, starry-eyed, was waxing poetic. I know it. And I’m trying to not forget the hours of exhaustion, “scut” (busy + mundane + worse at times) work, being grilled on the spot and judged on absolutely everything you do in a day, subjectively. And being graded just on that. And test scores. I got into this business for my patients. I want to be a <i style="mso-bidi-font-style: normal;">good</i> doctor for my patients. That’s the point and it comes back to that, it should always come down to that.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">No matter what else is going on in the day – getting yelled at by an attending for something out of your control that you had no idea about – you <i style="mso-bidi-font-style: normal;">get</i> to be alone in a room with a patient. I do. And there are the patients who scream and throw things (more often, on psychiatry). There are the patients whose affects are so disturbing that you really hope the drug test comes back positive, to give you an explanation…There are the patients perseverating on things you really don’t need to know about and you have limited time and the story isn’t making sense and they’re ranting about things in the clinic or the health care system or life in general that are out of your control but they’re somehow being put on you. . .</div><div class="MsoNormal">There’s that.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">There isn’t anything that doesn’t happen.</div><div class="MsoNormal">There isn’t a person, or a “type” of person, who doesn’t get sick and need to go to the doctor at some point. (Or they show up in the county hospital ER, or they need primary care but are marginally housed. . .) Or needs primary care/preventative medicine, which is generally not covered at all. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">In the room with a patient, I am focused on that patient, and – the point is what the point is. I want to be a good doctor for my patients. And that’s most of what I have to think about, in those moments. That’s what I’m doing. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">And I do it every day. Now, it could be a dozen times in a day. Different people, different stories, different ways lives are affected by the exact same pathophysiologic disease. But I have to do something different. The treatment might be the same, the procedure might be the same, but the way in which I approach it, talk about it, take time explaining (or not, as patient preference dictates) changes. The way I sit. The way I talk. What I talk about. Tone, volume, rhythm, posture, eye contact/facial expression – it’s not an act, it’s a mirror, and it’s finding how to be what your patient needs in that moment. Learning how to do that. You’re not changing yourself – you’re accessing all of yourself in different ways. You use the patient’s language and metaphors.</div><div class="MsoNormal">And then there is the science, some of which is supposed to become second nature. Pattern recognition and understanding the underlying conditions, the physiology, what is going on in this body at this time.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I get to do all of this.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I am trusted by the physicians around me – my colleagues – and by my patients. I get to go in, alone, and do all of this. And it’s the trust on both sides that helps me need to do it <i style="mso-bidi-font-style: normal;">right</i>, or as “right” as I can with the training I have. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">There are the times I’m frustrated with the <i style="mso-bidi-font-style: normal;">thing</i> (or the patient). The vein is rolling or they have no veins left… the cervix is wayyy anterior and it’s hard to find/access. The tonsils are large and obstructing the intubation. The heart sounds are muffled. The patient <i style="mso-bidi-font-style: normal;">will not</i> get the concept of taking a deep breath (“in through your mouth, out through your mouth). And I still have difficulty (a lot) finding the optic disk…</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">For now, I get to take time as a writer – a writer who misses medicine and patients and remains involved, in ways – </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">But I still can’t imagine a job as good as this one (perspective).</div><div class="MsoNormal">There are days I left my internal medicine clinic almost skipping across the parking lot. My patient’s blood pressure was better. Another one’s insomnia was improving. Another was seriously keeping track of his blood sugars. Another brought his three-year-old in to meet me (not all the same day).</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">My job. My future job, my future, and the present/future job of so many wonderful people I know. We – no, they – no, we – are going to be incredible doctors <i style="mso-bidi-font-style: normal;">for</i> these patients, because that’s the “why” in this privileged position.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Lucky, lucky patients?</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"></div><div class="MsoNormal">Luckiest – us.</div><div class="MsoNormal"><br />
~j</div><div class="MsoNormal"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-D0xRbnSN3BE/SEHL5JQ113I/AAAAAAAABkk/J6H8hft9i10/s1600/P1010310.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="http://3.bp.blogspot.com/-D0xRbnSN3BE/SEHL5JQ113I/AAAAAAAABkk/J6H8hft9i10/s320/P1010310.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Kribi, Cameroun</td></tr>
</tbody></table><br />
</div>Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0tag:blogger.com,1999:blog-18203764.post-91691911849501611172011-07-31T19:16:00.001-04:002013-09-03T00:24:11.946-04:00Licensed to<div class="MsoNormal">
In James Bond terms, it’s a license to kill. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In philosophical terms, it’s a license to heal or to help live.</div>
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In pragmatic terms, it’s a DEA number and a way to bill and get reimbursed by insurance.</div>
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In French, <i>license</i> means bachelor's degree, and <i>permis</i> means license. Unspoken, assumed permission. Allowed.</div>
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A medical license – just a general one – requires five full days of testing, over 3-4 years. </div>
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A lot of time is spent studying – during school, after hours from the hospital. A lot of money goes into each part of the exam, from the question banks to the tests themselves, with the requisite nothing-but-the-ID-check-in and checks inside of your sleeves .</div>
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Eventually, 5 years after starting medical school, many more years after starting the process of getting into and moving toward medical school, you have a license.</div>
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On the most basic level, this allows you to prescribe – that’s helpful for your patients, your attending (who no longer have to cosign your scripts), and potentially for your friends and other loved ones. All it takes is your name and license number – the person you’re prescribing for’s name, birthday, and allergy-to-medications status, and any pharmacy will transcribe it over the phone . </div>
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But a medical license – and the steps to obtaining one – implies more than this sort of power (and responsibility).</div>
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Doctors can pronounce death – we learn to know when someone is dead, or alive, and to say it officially. Saying it makes it true.</div>
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Doctors can teach other doctors. There’s no teaching certificate required, here, but the way medical students, in the clinical years, and residents and fellows learn is by teaching each other. On down the food chain. The main source of information, actually, is the teaching on the wards. There’s no training in that.</div>
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Doctors can run businesses – what else do you call a medical practice? No business acumen or training required (technically, not optimally).</div>
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Doctors can work in public health without an MPH.</div>
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Doctors can get a loan for a house – even med students can, sometimes – while 100s of thousands in debt. “Future earnings potential” they call it, not taking into account whether your career choice within doctor-dom actually has much of that.</div>
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Doctors can run labs without having PhDs.</div>
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Doctors are more likely to get published as op-eds or letters to the editor – “MD” looks pretty official and officious, tagged onto whatever-name.</div>
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And doctors can tell patients to focus on self-care, sleep, the importance of healthy eating and exercise. Well, we do get exercise on a service that runs up and down the floors of the hospital. Even on one floor, you’re constantly dashing between rooms. </div>
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I don’t have a medical license. I have ½ or 2/3, depending on how you count it.</div>
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And I hurt people on a daily basis.</div>
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With license.</div>
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I hurt people, by which I mean I cause pain.”Discomfort.” </div>
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I don’t lie to patients. “Will it hurt?” </div>
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“Well, it’s not fun. It shouldn’t <i style="mso-bidi-font-style: normal;">hurt</i>, but it’s not comfortable. It’s different for everyone – you know, I had a patient the other week who was talking on the phone the whole time.” (Now I can count that as two . And I’m not even counting the texter).</div>
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I don’t lie to patients. The one who, somewhat suspiciously, asked “how old are you?” I told her. She’s three years older. And she decided to trust me – I can say I’ve done this (dozens) of times before, that I’ve only been in this clinic a few weeks, but before that, I was working other places (…in other areas, not doing this particular job, but I can hand-wave a little about that).</div>
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“How much longer do you have in school?” </div>
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In truth? Six months of coursework.</div>
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I like procedures. I like working with my hands, having those physical skills. And on this rotation, I did just a few procedures but many, many times. You can get good that way – or, closer to good. Pretty good. To the point that, at least, I can carry on a conversation the entire time, smoothly, while doing what I need to do.</div>
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One Filipina patient – her entire family lives on the same street (in the US). Everytime someone leaves, they buy up another house.</div>
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Another patient is a horse trainer and travels around to county fairs.</div>
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Another works as a security guard.</div>
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Another is majoring in environmental studies.</div>
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Another’s kids are at Disneyland.</div>
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The list continues. And this is what we talk about.</div>
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For some, it doesn’t help so much – but others are so distracted that they have no idea what I’m doing, and they’re surprised when I tell them I’m done.</div>
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We’re done. “Great job!” I say.</div>
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I say. </div>
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I tell them about books I’ve read, if they bring that up. If it’s a commonality, what I majored in, in college. If I lived where they do now, know the area. If my friend is moving there. That one of my patients lives on the same street as her entire family. For a Procedure, there’s a whole other set of shtick. “I swear, I think I spend half my day fighting with this lamp…” (it was actually somewhat true, but it made patients laugh). “Hopefully, this will be the longest part!” I say similar things about computers. Math, etc. The light self-deprecating humor works pretty well.</div>
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(My doctor self is really, really good at small talk).</div>
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“Do you like your job? Do you like doing this?”</div>
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“Yes, I do. But the part I don’t like is when it causes people pain.”</div>
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~j</div>
Jennifer Stellahttp://www.blogger.com/profile/01985168402480341835noreply@blogger.com0