Day One

Day One

Year Four, Part Two.

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.

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.

Impatience with the white coat. Impatience with the white coat.

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.

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.

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.

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.

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 that 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.

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).

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).

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.

To the Venn diagram, scatter plot, Punnett square*, and any other shape used to cull entropic humans into a visible form.

~j

*poetry prof actually used that to describe one of my poems, the other day…

Kevin in the elevator

Dear Kevin-in-the-elevator,

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.

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 was – 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.

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?(the buttons, after all, are the pretty normal push-‘em kind, you know).

When we got back on the elevator, I remembered your name – M was impressed. How many men living in boxes does she know?

Name, man, elevator.

Market, N'djamena, Tchad

Recursive in print

Addendum: 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.

(approx one week ago - true, then. don't hate it today. more to write, soon)

Some days, I hate that I’m a poet.

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?

Maybe, maybe, I could do the things I want to do, then.

Thing is, I’m a poet.

And today, I hate that.

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.

Problematic.

Freedom fries

(This is a sketch of a post. The rest...later).

I used to actually hear that, fairly frequently, in 2001 and 2002. Somehow, that was a response to my being French.

It's an interesting word, "freedom."

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.

"Land of the free, home of the brave."

from Emma Lazarus, as engraved in the pedestal of the Statue of Liberty:

"Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!"

from Tom Petty, "Free Fallin'" (incidentally, excellent Americana song, too..)

"And I'm free, free fallin' "

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.

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).

Freedom.

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.

Being in a prison is incredibly strange - the checks, the IDs, the leave-everything-including-everything, all the bars opening and closing behind us.

I had done that before. And the similarities with psychiatric wards, also (they're co-morbidities, anyway) are fascinating...

That's not the point.

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.

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.

What could symbolize more freedom? International airport, busy, restricted to people with some amount of money/privilege, vacation vs business vs...

airplanes. coming. going. landing. taking off.

Right over Riker's.

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.

"Give me your tired, your poor..."
Wretched. Demeaned. Demoralized. Dehumanized.

"Send these, the homeless... to me"
Because other homes aren't a home.

"I lift my lamp beside the golden door!"
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.

"refuse..."
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.

In French, "La liberté éclairant le monde" - liberty lighting the world.
Floodlights that can be seen...well, across a large river and probably farther.
After all, electricity is an unlimited resource, not a commodity.

Let freedom ring.


~j

Colonized, not conquered, tongues

In my Creole Poetics class this week, we discussed Caribbean poet and scholar Edward Kamau Braithwaite’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 that language – iambic pentameter, for example, is not native to Barbados. (Is it actually natural to English? debatable).

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…

Everything.

It’s not the same language.

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.

(And why shouldn’t they be? It’s obvious enough for Belgium and Québec).

But Africa was colonized.

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.

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, terre-à-terre?)

Anglophone. Not quite grammar, or – it is “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.

So what did we do?

We spoke Anglophone.

(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).

It’s reflexive, now.

This is what we do.

The Vegetarian Carnivore - Rhumsiki, Cameroun

Who wants to be a poet, anyway?

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 about, all the time. But it returns, now.

*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.

The first poem I remember is from second grade.

Poem that I wrote.

I was a better poet then than for the approximately ten years after that –

because I didn’t know, yet, what poetry was. What poetry was “supposed” to be. What “sounded like” poetry.

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.

Even poetry that conforms to rules – i.e., Shakespearean sonnets in strict iambic pentameter, for one – is good 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 there is the real poetry. Not for me, not now).

But at seven I was a poet.

To be a poet is not a choice.

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.

It’s dangerous.

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 -
and you can't capture everything with words, but we try

The Imposter

17 August 2011

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.


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.”

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…

            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?

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.

The title is a lie.

(to follow)

There is literally nothing that did not happen today.

I spoke with a friend in Cameroun.

I found out that the research article section I wrote is, in fact, good, even with the inclusion of some writerliness.

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.

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.

Dizzy.

I was in three of my major communities – Peace Corps/Cameroon/public health, medicine, and poetry.

And only in the third did I feel intimidated and like an outsider with little to say or knowledge of how to interact.

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.

At the hospital, not-quite-just-a-visitor and not-quite-a-student, I asked, “should I masquerade?”

The Mental Status Exam and obsolete ethernet cables

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.

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.

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.

Mental status includes action, includes movement and speech and anything that indicates internal state in externalization.

I spend a lot of time, lately, searching for wi-fi.

Crossing into Chad

The Procedure

(This was written several weeks ago – refers to all month of July)

Today I used sound waves and a plastic transducer to take moving photos of a fetus-squiggle. 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 (potential space). 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. I measure. My machine converts that to weeks.

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?

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.

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.

I mark: + IUP.  + FCM

Single, intra-uterine pregnancy

Fetal cardiac motion

Under “reason for exam” I write “dating – undesired pregnancy.”

The Luckiest

It’s said in many ways.

Absence makes the heart grow fonder.

Nostalgia in looking back.

Selective memory.

And, per Ben Folds, “The Luckiest.”

This usually refers to, I think, people/place/thing. Certainly people. Certainly place. Time period. Self at a different stage of life.

It’s not usually used in reference to career.

It’s now been three days since I was an active medical student.

And I miss it. A significant lot.

I can’t wait to be a doctor.

Kribi, Cameroun

Licensed to

In James Bond terms, it’s a license to kill.

In philosophical terms, it’s a license to heal or to help live.

In pragmatic terms, it’s a DEA number and a way to bill and get reimbursed by insurance.

In French, license means bachelor's degree, and permis means license. Unspoken, assumed permission. Allowed.

Person to person

I got a patient’s blood on me the other day.

(not unusual)

A patient’s blood splashed in my face the other day.

(unusual)

A patient’s blood spattered over my face, little drops over my neck, cheeks, forehead, and one on the inside of my lip. That I felt – one. None in my eyes.

A patient’s blood spattered on me and her eyes were closed and she was concentrating so hard on her breathing that she didn’t notice I stopped, stopped the procedure. I stopped for a minute, maybe two, at most. More like 90 seconds.

Paused.

We are holding you here

Danger to self, Danger to others, Grave disability

For the past month, my patients have either been dying or seriously troubled. Or both.

These might be different sorts of dying.

This may be an introduction for stories to follow. There were more patient moments of transcendence, on palliative care. That’s next – what it means to be able to imagine a life for someone when you’ve never really met them before almost-death. There are the hours and hours and hours of stories, now. The Mental Status Exam – there’s another piece. Will be. But for now, by way of segue, and because the writing for the evening is meant to be five closely hand-written pages on my patient’s background, the factors that have contributed to her current situation, and an assessment and plan of what, in the hospital, we can do.

Cameroun, primate reserve/rehab near Yaounde

Learning language

The following is slightly modified from a recent graduate admissions essay. (The first paragraph, alone, was posted in December). It may be a cop-out to post something I've already written - and, quite differently from everything else I write here - this one is highly edited and revised. With help.

This, however, is the manifest - and I wanted to explain what the connections are, for me, between the disparate interests. It's like writing poetry - once I've written a poem about something, describing that (event, feeling, person) in other words and sentences falls short. It isn't exactly, not quite, what I mean. Hence the quoting-of-self that happens. Inevitably. This, I imagine, must happen to all writers. So, rather than expound upon what's already been written:

***

It starts when I enter the room. How many words can my patient speak without needing

air? Is she leaning forward to breathe? Are her fingers clubbed? My stethoscope hangs without weight. My hand is on her shoulder now. My eyes close. “Breathe,” I say. “Relax.” And I am listening to the inside of her body. It’s telling me things my patient knows but lacks vocabulary to describe. It is my privilege to explicate this poem.
            I was born speaking two languages, and, as a bilingual child, French and English were imprinted in entwined synapses. I do not always know which language I am speaking. If I read a book in English that takes place in France, I “remember” the dialogue in French. I transpose. In this way, I have learned that translations are only approximations. I connect most with those who speak both my languages because that allows me to use the most precise word possible.

            I speak two languages. From my early years in school, I was drawn to science because of its inherent beauty and creativity. I decided to pursue biology the first time I looked into a dish of pond water under a microscope and discovered an entire invisible world. I spent late hours in the lab, peering at 400x magnifications of cells I had stained green for mitochondria and red for nuclei in a 12-hour painstaking process. I would forget to count and simply stare.

Cacao field, Mvangan

Getting it right

*(I’m studying for boards (at writing) /just took boards (at posting) = Step2 CK)*

I hate the questions I get right – cancer, terrible diseases, medications, hard side effects to deal with, long-term complications – that I know, for sure, because of anecdotes

Anecdotes.

I know how you died.

I know how you might die, I know why your life is and will be difficult.

There are the simple ones – the amoxicillin prescriptions we wrote for kids with ear infections, the reassurance, reassurance, reassurance of parents.

The patients who came in with the side effects to medications that I’d read about – EUREKA! moments – your cough, the nagging cough, and you started lisinopril at the same time.

I know the answer to the puzzle.

I win.

Un des lions indomptables, Ebolowa

Living changes everything

My patient invited me to his funeral.

 Indirectly.

 He asked for my phone number so that his daughter can call me when he dies (he’s dying). He asked for my phone number so that his daughter can call me when her daughter, his granddaughter is born – she’s due in August. He might be around. He might not be around. My patient said that maybe I can see photos of his granddaughter, maybe I can see her grow.

He won’t see that.

My patient invited me to his funeral. It felt sacred but not strange. This many months, years into med school, I’ve learned what boundaries are right for me. I’ve learned that my patients – most of my patients, the ones I truly have relationships with – will not cross those boundaries. So I wrote down my phone number and my email. And maybe his daughter will contact me.

Not everything in pathology is dead

That is, perhaps, what I’ve learned in two weeks. I haven’t been in what’s popularly thought of as pathology – no dead bodies, no tissue specimens. Vials and vials and vials of things, petri dishes grown from people, blood and bone marrow biopsies.

Parts of people, taken out, to see if they are still alive.

(or, parts of people, taken out, to analyze and see exactly what’s in them and what they’re doing) .

It still feels like an inexact science, in some ways. Microbiology is detective work – but this isn’t what they show on House or CSI; it takes days and days to grow. (Then, clinically, what’s the point? In the immediate. . . there isn’t one. Patient is sick, patient looks “toxic”, you treat as if she’s bacteremic.* (Has bacteremia) . Septic. (Has sepsis) .

Rat glioma, nuclei

Sustainable - Ecstatic.

Everyone talks about 'sustainability.' 'Sustainable development.' (which, by definiton, should be sustainable - otherwise - it's patchwork construction and shantytowns, metaphorical or literal). The environment.

Etc, etc, etc. It's as much of a generalized buzzword as "global health" is becoming in medicine.

If there's one thing I learned in Cameroon, it's that I can't take on things much larger than a village. A small part of a health district, perhaps. A health district (rural). A larger health district (someday). Part of a small NGO (someday). One project, perhaps two. Other things are less sustainable.

In medical school, the largest thing possible was a small, student-run clinic in a homeless shelter, operating for a few hours two nights a week and a morning every other weekend. That, in itself, was enormous. And there were several of us. (Alone? Possible? One person is not sustainable).

The Mall, Washington, DC, February 2003

In college, I was actively anti-war (can't even be apolitical in writing). (and I've learned that the strict position of 'anti' isn't useful anyway.) Peace marches, protests, demonstrations, a dizzying 'march on Washington' (to be done once in a life, at least, if politically inclined) gave a sense of community and something greater when the state of the world was terrifying. In this state, there are rallies at the state house for single payer healthcare. I haven't gone. It’s the global and local thing. Someday, maybe, WHO-type work. Someday, definitively, public health education/behavior change communication and program design. Local to larger to local.

Relevance, irreverence

Were I not taking a year off from med school, I could be a doctor soon.

This sounds obvious. Yes, in the practical sense, in 12 months I would be an MD.

Instead, I’m doing three months of fourth year before taking off for an MFA. The fourth year schedule (for later) is so flexible that I could actually spend an entire quarter not here, doing a third semester of my MFA in an entirely different city. And graduate with an MD.

Soon, I could be an MD.

I won’t be.

To take a leave of absence, you have to formally withdraw from school. The form asked what I’m doing - simple. Then it asked what the relevance is. Relevance. (the career advisor/head of ob/gyn department asked me the same question. Relevant. How is poetry relevant. I’m not going into ob/gyn, anymore*) .

*for many reasons, but the above was probably influential on some level