No one tells you this, but it turns out being supernaturally healed is pretty overwhelming. I suppose I might have expected that, but given that I wasn't expecting healing, I hadn't exactly done my research.
Showing posts with label this perfect Christian life. Show all posts
Showing posts with label this perfect Christian life. Show all posts
Sunday, April 18
Sunday, February 14
Thursday, December 31
So Here's To Hope
I'm pretty sure I cried straight through the first half of 2020.
In my defense, I was having an objectively tragic year. I left not just my job but my career under the unrelenting pressure of my worsening disability. My husband and I moved, again, this time for a job I knew I needed but wasn't sure I wanted. Two close family members developed devastating chronic illnesses. And I realized that I'm gradually losing my ability to walk and use my hands. All this against the backdrop of, y'know, the raging collective trash fire that has been 2020.
All I was was sad, all the time. I couldn't even talk to anyone about it, really. I just cried every day.
Midway through the year, a close friend sent me a link to a book and informed me we were going to read it together.
I clicked on the link and was greeted by a bright yellow cover with - of all things - an enormous smiley face on it. The Happiness Advantage, the cover screamed. How a Positive Brain Fuels Success in Work and Life. I snorted and texted her back some version of absolutely not. I wasn't about to buy a yellow smiley book on being happy. I don't like yellow. Or being told how to feel. I'm not even sure I like happiness. I find it suspicious a lot of the time, schmaltzy and commoditized, and often exhausting. A forced smile in a toothpaste ad. No.
When it arrived a mere two days after I ordered it, the book and I stared at each other for a bit. I can't believe I'm reading this stupid book, I texted my friend. Don't ever doubt my love for you. She responded in the cheerfully assumptive manner of someone who never has: we should discuss once a week. Do you want to do one chapter at a time or two?
I truly didn't expect this book to change me so much.
The breakthrough came when we got to the chapter about gratitude. Gratitude: another word I have learned to eye suspiciously, given its cachet with trendy influencers and people who like motivational posters. It conjures up carefully posed social media posts full of product placements - cynicism lacquered in toxic positivity. This was different, though. The author gave a simple hypothesis: maybe the brain can be trained to be more optimistic by marking the good things that are already present in one's life. Invoking the power of accountability, he suggested telling a close friend or loved one three things you are grateful for each day, things that didn't have to be profound but did need to be specific. This appealed to me. It seemed practical and attainable. Maybe we could try it?
So we began. Every day, we would tell each other about a great cup of coffee or a glimpse of beauty, a moment of laughter, a kindness we received. For the most part we kept it small. Almost immediately, we realised that just hearing about the other's happy moments brightened our own day. We didn't anticipate this recursive loop of happiness, but we embraced it, and it became its own self-reinforcing system. We would reach out to each other greedily in the evenings, sometimes simultaneously: tell me about your day! What are you grateful for?
Some days it was a real stretch. It's 2020; a lot of crummy things happened. And nothing about this exercise changed the essential facts of my life. But with practice, we learned that even on the worst days, there was something to feel legitimately grateful for.
This may sound basic, but consider its effects. In the manner of a river slowly changing its bed, my focus has gradually eroded away from the major obstacles I face, instead eddying around bits of happiness. I'm learning to better appreciate small pleasures. And I'm finding that I'm emotionally stronger for it. Far from this change being a distraction or a waste of time, when I turn back to the big challenges they are somehow less overwhelming, because I recognize now that my life will always have a wealth of good things in it. I just have to take the time to notice them.
It's my prayer that in 2021, we would all be able to apply this lesson. There is joy trickling through all the little cracks in our lives, and this next year I hope to settle into that understanding further. It's a small goal, but I'm satisfied with that. A change, no matter how incremental, can gather a curious momentum of its own with time, gradually pressing through the mud to find hope.
So here's to hope.
Happy New Year.
Monday, May 4
Song of Ascents
"Are you ready to leave clinical medicine?"
His indifferent tone belied the importance of the question, not just to me but to the eight other people currently sitting around the table, waiting for my response with varying degrees of patience and interest. Outside, an unseasonably warm January day coaxed buds from the trees dotting the hospital campus.
I looked over at the chief medical officer of the hospital and blew out a wry breath. A half truth slipped out before I could stop it. "Is anyone really ready to leave clinical medicine?"
His indifferent tone belied the importance of the question, not just to me but to the eight other people currently sitting around the table, waiting for my response with varying degrees of patience and interest. Outside, an unseasonably warm January day coaxed buds from the trees dotting the hospital campus.
I looked over at the chief medical officer of the hospital and blew out a wry breath. A half truth slipped out before I could stop it. "Is anyone really ready to leave clinical medicine?"
Friday, December 13
Like air
I fought for her as she held
her diamond breath in her
hands, close
close to her chest
finite and precious
saving it carefully, losing it
every other word
When I returned
heavy-laden from long hours
she smiled
took my hand and prayed
and I felt
the breath I had given her
being returned
her diamond breath in her
hands, close
close to her chest
finite and precious
saving it carefully, losing it
every other word
When I returned
heavy-laden from long hours
she smiled
took my hand and prayed
and I felt
the breath I had given her
being returned
Saturday, September 21
Healing
"Your kidneys have shut down.
There's nothing I can do.
I'm so sorry."
Her husband held her as she cried.
Later, I came back.
We talked of the power
of The Great Physician.
I prayed for her.
She clutched my hands in thanks
And I realized
That in my helplessness
I had offered true medicine.
There's nothing I can do.
I'm so sorry."
Her husband held her as she cried.
Later, I came back.
We talked of the power
of The Great Physician.
I prayed for her.
She clutched my hands in thanks
And I realized
That in my helplessness
I had offered true medicine.
Monday, January 7
Uncertainty, or, 2019: Midnight Tracks
I love planners; I'm a bit obsessed with them, really. I've always had one. I think by nature I'm a plan-maker, someone who takes the long view. Years of practice and training have taken my penchant for journalling and turned me into a list-maker as well. At this point, if I don't have a formal planner, I eventually clutter up my life with piles of to-do lists and thought fragments. This year, when it became fatiguing to write, I tried to abandon my paper planner for digital alternatives that I can talk into, but it's not the same. So a 2019 paper one it is. Usually I get something with monthly and weekly pages, and room for notes - pretty standard. My planner choice* is different this time, though. For the first time, I want a goal-setting planner, I think for several reasons.
Wednesday, September 5
Suffering
It's 6am and I've been up for three hours, the consequence of coming off a long weekend of night shifts. I read for a while, but as often happens to me, eventually I was driven to write. And so here I am.
My hands are healing, I think, and my feet. In retrospect I've been through this cycle a dozen times before and just didn't recognise it. It matches what my neurologist told me about my disease. It's a cyclic dance, led by demyelination, followed by damage to the axon, the long delicate wire of the nerve cell, as it loses its insulating myelin sheath. I lose some function. Then comes whatever healing the body can muster and some degree of functional improvement - all set against the relentless drumbeat of the disease state itself. So I get worse, and then I get better, sort of. What matters to me now is that I've crossed back over the invisible line that lets me use my right hand. I can write again, so I can do my own paperwork at work. I can hold a glass in my dominant hand without thinking about it. I can put my car in gear without reaching across my body. I can type a bit. I'm definitely not back to normal. I still wear a wrist brace (like this one) on the right about half the time since it's very fatiguing for me to control my wrist and fingers simultaneously. I prefer to use a big silly-looking pen that's easier for me to grip. I've switched my mouse to my left hand and don't plan to switch back. And at this point I still can't really do repetitive tasks that require fine motor skills - scissors, suturing, chopping vegetables. But it's so much better than it was.
Obviously it's going to get worse again eventually.
I've been thinking lately about suffering, and about God's purposes in allowing His children to suffer. I have found myself crying out to Him this summer in confusion and pain. Why, God? Why this? Why now? Why my right hand, the hand I rely on? Why should I suffer like this? It's a hard question, and a nuanced one. It's different from painfully pouring oneself out to serve others, different from the direct and expected consequences of sin, different again from persecution for my faith. This just... sucks. It sucks every day. And nothing I or anyone else did caused this. I think the temptation is to see suffering as meaningless, just a random consequence of living in a broken, messed-up world, but Christians don't have that philosophical out. We trust and believe that we have a personal God, one who cares for us and is invested in us. So why the suffering?
Yesterday I sobbed through a talk given by Joni Eareckson Tada, a lady who is a staunch believer in Jesus, an author, speaker, and artist, and a quadriplegic since the age of 17. I highly recommend that you listen to the talk, although if you're not dealing with personal hardship/ disability it may not resonate with you. She confronts the endless gauntlet of her daily life (you'd better believe that being a sharp mind trapped in a useless body involves suffering) with a matter-of-fact courage that frightens me. She does not spare anyone the harshness of truth. I'll give you an example. For anyone, but especially a quadriplegic, to say, There are better things than walking. There are better things than the use of your hands, is deeply shocking, right? But with reflection I've realised that of course that is true, especially for a Christian. Jesus is better than anything.
The goodness of God is the truth that sustains a person through even the deepest darkness. I thank her for reminding me of that. Joni Eareckson Tada exemplifies for me the concept of suffering well, something she touches on in that talk. It's hard for me to get my arms all the way around the idea, but I think it's a mixture of day-to-day grit and unswerving, joyful faith in a good God. I don't know how to do it yet like she does (I'll grant that she's had fifty years to learn how to suffer well and I've had, like, two months). But I think most people never learn how. It's just not guaranteed. And I think it's a lofty goal but a worthy one, this idea of suffering well as a Christian. I have this disease. There is no getting rid of it. But to suffer well... if that is my race to run in this life, God grant that I might achieve that.
My hands are healing, I think, and my feet. In retrospect I've been through this cycle a dozen times before and just didn't recognise it. It matches what my neurologist told me about my disease. It's a cyclic dance, led by demyelination, followed by damage to the axon, the long delicate wire of the nerve cell, as it loses its insulating myelin sheath. I lose some function. Then comes whatever healing the body can muster and some degree of functional improvement - all set against the relentless drumbeat of the disease state itself. So I get worse, and then I get better, sort of. What matters to me now is that I've crossed back over the invisible line that lets me use my right hand. I can write again, so I can do my own paperwork at work. I can hold a glass in my dominant hand without thinking about it. I can put my car in gear without reaching across my body. I can type a bit. I'm definitely not back to normal. I still wear a wrist brace (like this one) on the right about half the time since it's very fatiguing for me to control my wrist and fingers simultaneously. I prefer to use a big silly-looking pen that's easier for me to grip. I've switched my mouse to my left hand and don't plan to switch back. And at this point I still can't really do repetitive tasks that require fine motor skills - scissors, suturing, chopping vegetables. But it's so much better than it was.
Obviously it's going to get worse again eventually.
I've been thinking lately about suffering, and about God's purposes in allowing His children to suffer. I have found myself crying out to Him this summer in confusion and pain. Why, God? Why this? Why now? Why my right hand, the hand I rely on? Why should I suffer like this? It's a hard question, and a nuanced one. It's different from painfully pouring oneself out to serve others, different from the direct and expected consequences of sin, different again from persecution for my faith. This just... sucks. It sucks every day. And nothing I or anyone else did caused this. I think the temptation is to see suffering as meaningless, just a random consequence of living in a broken, messed-up world, but Christians don't have that philosophical out. We trust and believe that we have a personal God, one who cares for us and is invested in us. So why the suffering?
Yesterday I sobbed through a talk given by Joni Eareckson Tada, a lady who is a staunch believer in Jesus, an author, speaker, and artist, and a quadriplegic since the age of 17. I highly recommend that you listen to the talk, although if you're not dealing with personal hardship/ disability it may not resonate with you. She confronts the endless gauntlet of her daily life (you'd better believe that being a sharp mind trapped in a useless body involves suffering) with a matter-of-fact courage that frightens me. She does not spare anyone the harshness of truth. I'll give you an example. For anyone, but especially a quadriplegic, to say, There are better things than walking. There are better things than the use of your hands, is deeply shocking, right? But with reflection I've realised that of course that is true, especially for a Christian. Jesus is better than anything.
The goodness of God is the truth that sustains a person through even the deepest darkness. I thank her for reminding me of that. Joni Eareckson Tada exemplifies for me the concept of suffering well, something she touches on in that talk. It's hard for me to get my arms all the way around the idea, but I think it's a mixture of day-to-day grit and unswerving, joyful faith in a good God. I don't know how to do it yet like she does (I'll grant that she's had fifty years to learn how to suffer well and I've had, like, two months). But I think most people never learn how. It's just not guaranteed. And I think it's a lofty goal but a worthy one, this idea of suffering well as a Christian. I have this disease. There is no getting rid of it. But to suffer well... if that is my race to run in this life, God grant that I might achieve that.
Tuesday, August 7
News
I thought about being artistically coy in how I would introduce this post, but I can't bring myself to do it. I got some bad news about a month ago and it has changed my life.
I was recently diagnosed with Charcot-Marie-Tooth disease. In medical terms, it is a genetic neuromuscular disorder, caused (in my case) by a duplication of one tiny area of chromosome 17. It leads to abnormal nerve structure and thus abnormal nerve signal transmission. Over time, the nerves degrade and die off (this is called neuropathy), taking the muscles with them. It starts in the feet and works its way up the legs, and at some point begins in the hands and works its way up the arms. The rate and degree of progression is different for every affected person.
I know, I know. I'm crazy. No one in their mid twenties should be falling and having trouble walking. I know. But I... just didn't think about it. I was trying to hold it together and finish training, and there was work to be done. So I went to work.
I will be honest here and admit that I feel inexpressibly sad about it all. I don't know what this will mean for my personal life or my career. It's scary and taxing to try to navigate the sudden drop in my physical ability (a topic to discuss more in a later post). I feel newly, terrifyingly dependent on Jesus, while at the same time I feel so confused that He would allow a time bomb like this to be seeded in my DNA. I trust Him. But I don't understand.
I expect the tone of this blog will change significantly from here on out but I don't yet know how. I guess I'll just take it post by post and day by day. But I knew that I couldn't blithely write about the happenings of my life and career while withholding this diagnosis.
I was recently diagnosed with Charcot-Marie-Tooth disease. In medical terms, it is a genetic neuromuscular disorder, caused (in my case) by a duplication of one tiny area of chromosome 17. It leads to abnormal nerve structure and thus abnormal nerve signal transmission. Over time, the nerves degrade and die off (this is called neuropathy), taking the muscles with them. It starts in the feet and works its way up the legs, and at some point begins in the hands and works its way up the arms. The rate and degree of progression is different for every affected person.
CMT is a progressive disease, and the form I have generally comes on slowly. So it was with me, although I didn't know it. I've been "clumsy" all my life, with weak ankles that are prone to rolling, and weak reflexes. I've always gotten muscle cramps a lot. My feet are always cold. None of that held me back, per se, but there were a series of nuisances to be managed. No stiletto heels. Watch how you walk so you don't sprain an ankle again. Do any workout besides running. But otherwise, it was fine. Then during residency, I started getting intermittent weakness in my feet and toes. The cramps got worse. I started having falls and trouble keeping my balance, especially when I'd been awake for long shifts or wasn't sleeping well. People commented a few times on how my gait looked different, "like it's hard for you to walk." They were right. It felt very hard to walk. I assumed I needed to sleep more and be more diligent about working out, chalked the falls up to residency fatigue, and kept pushing.
I know, I know. I'm crazy. No one in their mid twenties should be falling and having trouble walking. I know. But I... just didn't think about it. I was trying to hold it together and finish training, and there was work to be done. So I went to work.
Fast forward a few more years. This spring I started tripping over my toes, and I realized I couldn't move them. My right hand began cramping around my pen every time I picked it up. I realized I couldn't feel the bottoms of my feet. Then my knees started to constantly feel like they were giving out, and I finally got scared enough to pursue a possible diagnosis. If you think a doctor can't have denial, think again; despite all of that I honestly thought they were going to tell me it was stress. Instead, two neurologists and $3000 worth of tests later, I was given a diagnosis that explained every troublesome thing I've ever had with this body - and made it clear it is going to get worse. And it has gotten worse; it's gotten a lot worse just in the past couple of months. Apparently that happens sometimes.
I will be honest here and admit that I feel inexpressibly sad about it all. I don't know what this will mean for my personal life or my career. It's scary and taxing to try to navigate the sudden drop in my physical ability (a topic to discuss more in a later post). I feel newly, terrifyingly dependent on Jesus, while at the same time I feel so confused that He would allow a time bomb like this to be seeded in my DNA. I trust Him. But I don't understand.
I expect the tone of this blog will change significantly from here on out but I don't yet know how. I guess I'll just take it post by post and day by day. But I knew that I couldn't blithely write about the happenings of my life and career while withholding this diagnosis.
Tuesday, March 20
Tired.
It was so hard to get my sorry self to work yesterday. I had the flu a couple of weeks ago - I don't recommend it - and the cough and fatigue have lingered. I entered this stretch of shifts feeling sluggish and still a little short of breath. My coworkers cracked good-natured jokes the whole weekend about how I needed to check in as a patient. Considering I've spent most of the last two weeks first feverish and vomiting, then alternately passed out and hacking up a lung, it felt more accurate than amusing. I'm pretty tired.
Thursday, August 31
A Break In The Darkness
I have a little eclipse story to tell.
My husband and I were lucky enough to live within driving distance of the path of totality, where the moon would completely blot out the sun. As soon as I found that out, I decided we were going to have to make a day of it and drive north to see THE REAL THING. I perused blogs and astronomy websites; I purchased multiple sets of eclipse glasses (after the first set turned out to be fake - thanks Amazon); I had happy daydreams about laying out in the sun in a green field, slowly watching the moon eat the sun, and then perfectly witnessing all of the crazy things happen during a total eclipse. I was especially excited to see the eclipse itself. I badgered my husband into taking the day off. We may never get to see this again! It will be amazing and it's only a few hours away! Pleeeeeeeeease. Pleaseplease.
The night before, I checked the forecast one last time and found to my dismay that essentially everyone in the path of totality was going to have a spotty view of the eclipse except people living just east of the Rockies, which we do not. Weather in our town was meant to be perfect, but of course without the chance to view all of the amazing phenomena that come with a complete eclipse. My husband and I talked it over and decided to take the chance. Better to potentially see THE REAL THING than to definitely not see it.
Cut to the morning of. We left late, first of all, which - although I'm not a very nervous person - sent my nerves through the roof. It's not like the moon is going to hold off on beginning the meeting because there are still some stragglers coming in. Then the clouds started gathering as we drove. At first it was just some cheerful light clumps, but after a couple of hours it was clear we were heading into a storm system. My husband got one glimpse of the very beginning of the eclipse while we were on the road. Then, nothing. Clouds.
My pastor recently had been teaching us about improbable prayers. He pointed out that in Acts when Peter was headed for execution, the church prayed for his release and he was indeed broken out of prison by an angel. When he showed up at the house where they'd been praying, they were amazed! His point was this: pray for things so incredible that if they happen, you will be shocked. Pray for improbable things. Give God that chance.
Well, why not, I thought. Driving that morning, every time I looked up at the dense cloud cover, I prayed. I know this isn't particularly important, Lord, but please. Please clear the weather so we can view this spectacle. In fact, clear it so everyone can view it. Please make a way in this.
And you know what happened? It started raining. Yeah. Raining. On and off for the last hour or so of the drive, it sprinkled and poured by turns. We didn't see another glimpse of the sun that entire time. I kept praying but my mood gradually soured. Come on, God, please? Let everyone see the eclipse during totality, including us! Matt kept an eye on the radar, but there was no chance that we could outrun the huge bank of clouds in the region, no chance that we could cut east or west and find a clear spot within our little slice of totality. We were stuck. So we kept to the original plan, although there was no happiness in it for me anymore.
When we got to the park I'd chosen, it was dark, cold, and wet. The rain had settled into a steady light shower. There was no way to tell if the appearance of things was from the storm or the developing eclipse, but you can guess what my suspicions were. We found a low hill with good visibility only because Matt insisted. I was ready to sit in a low parking lot and read a bloody book just to spite the stupid eclipse and the rain and the day and everything. I pulled out my knitting, for goodness' sake, because why not? There was nothing to see. I can see clouds and rain whenever I want. There was certainly no way to appreciate anything else.
I let myself talk to God about the whole endeavor one last time. I asked you for such a little thing, God. I've been looking forward to this for weeks and You know that. You couldn't have given me this? Thanks a lot.
My husband and I were lucky enough to live within driving distance of the path of totality, where the moon would completely blot out the sun. As soon as I found that out, I decided we were going to have to make a day of it and drive north to see THE REAL THING. I perused blogs and astronomy websites; I purchased multiple sets of eclipse glasses (after the first set turned out to be fake - thanks Amazon); I had happy daydreams about laying out in the sun in a green field, slowly watching the moon eat the sun, and then perfectly witnessing all of the crazy things happen during a total eclipse. I was especially excited to see the eclipse itself. I badgered my husband into taking the day off. We may never get to see this again! It will be amazing and it's only a few hours away! Pleeeeeeeeease. Pleaseplease.
The night before, I checked the forecast one last time and found to my dismay that essentially everyone in the path of totality was going to have a spotty view of the eclipse except people living just east of the Rockies, which we do not. Weather in our town was meant to be perfect, but of course without the chance to view all of the amazing phenomena that come with a complete eclipse. My husband and I talked it over and decided to take the chance. Better to potentially see THE REAL THING than to definitely not see it.
Cut to the morning of. We left late, first of all, which - although I'm not a very nervous person - sent my nerves through the roof. It's not like the moon is going to hold off on beginning the meeting because there are still some stragglers coming in. Then the clouds started gathering as we drove. At first it was just some cheerful light clumps, but after a couple of hours it was clear we were heading into a storm system. My husband got one glimpse of the very beginning of the eclipse while we were on the road. Then, nothing. Clouds.
My pastor recently had been teaching us about improbable prayers. He pointed out that in Acts when Peter was headed for execution, the church prayed for his release and he was indeed broken out of prison by an angel. When he showed up at the house where they'd been praying, they were amazed! His point was this: pray for things so incredible that if they happen, you will be shocked. Pray for improbable things. Give God that chance.
Well, why not, I thought. Driving that morning, every time I looked up at the dense cloud cover, I prayed. I know this isn't particularly important, Lord, but please. Please clear the weather so we can view this spectacle. In fact, clear it so everyone can view it. Please make a way in this.
And you know what happened? It started raining. Yeah. Raining. On and off for the last hour or so of the drive, it sprinkled and poured by turns. We didn't see another glimpse of the sun that entire time. I kept praying but my mood gradually soured. Come on, God, please? Let everyone see the eclipse during totality, including us! Matt kept an eye on the radar, but there was no chance that we could outrun the huge bank of clouds in the region, no chance that we could cut east or west and find a clear spot within our little slice of totality. We were stuck. So we kept to the original plan, although there was no happiness in it for me anymore.
When we got to the park I'd chosen, it was dark, cold, and wet. The rain had settled into a steady light shower. There was no way to tell if the appearance of things was from the storm or the developing eclipse, but you can guess what my suspicions were. We found a low hill with good visibility only because Matt insisted. I was ready to sit in a low parking lot and read a bloody book just to spite the stupid eclipse and the rain and the day and everything. I pulled out my knitting, for goodness' sake, because why not? There was nothing to see. I can see clouds and rain whenever I want. There was certainly no way to appreciate anything else.
I let myself talk to God about the whole endeavor one last time. I asked you for such a little thing, God. I've been looking forward to this for weeks and You know that. You couldn't have given me this? Thanks a lot.
Matt opened the car door. "Get out. You can see the sky, Zoe, get out of the car." Well, duh, I thought. Of course you can see the sky; you can always see the sky. I want to see the sun. But I abruptly got sick of my own bad mood and decided to play at being a good sport. I got out of the car and peered up into the rain. Sure enough, there was an odd-looking dark grey patch briefly visible through the clouds. Matt nudged me. "I think that is blue sky." The more I looked, the more I thought he must be right.
It got darker all of a sudden. Darker. Then, still darker. A cold wind blew across the hill. People started to murmur, wow, so cool, how about this. Suddenly the horizon looked like it was on fire - all the most amazing sunset colors at once, spread out in all directions. Diffused as it was through cloud cover and distant rainfall, the effect was especially mysterious. Crickets started chirping and all the birds landed. I grudgingly thought, okay God, this is pretty cool. Thanks for this at least.
Then people started screaming.
I mean really screaming, in a way that was frightening and seemed out of their control. We heard more screaming from across the park and even, faintly, the nearby town. I realised everyone was pointing up. And there, right overhead, the dense clouds had cleared perfectly in the right spot for us to have a great view of the total solar eclipse. We got to see about thirty seconds of perfect corona leading into the diamond ring signaling the end of totality. It was uniquely beautiful and unsettling in a way that eludes description. We all felt a brief, hot wash of sunlight as totality truly ended. Then the clouds closed up again.
I mean really screaming, in a way that was frightening and seemed out of their control. We heard more screaming from across the park and even, faintly, the nearby town. I realised everyone was pointing up. And there, right overhead, the dense clouds had cleared perfectly in the right spot for us to have a great view of the total solar eclipse. We got to see about thirty seconds of perfect corona leading into the diamond ring signaling the end of totality. It was uniquely beautiful and unsettling in a way that eludes description. We all felt a brief, hot wash of sunlight as totality truly ended. Then the clouds closed up again.
I cried, of course. Not at the eclipse itself, although it is something I will remember for the rest of my life. I cried because God reminded me that a faith that endures is one that endures to the end of hope, through the disappointment and rain, trusting that there will be a break in the darkness. He could have whisked all of the clouds away and left us with a "perfect" cloudless sky and the chance to see the entire eclipse process without interruption. He chose not to. But did He not answer my prayer (and surely the hopeful prayers of many others) in spectacular fashion and in a way that imprinted the event into our minds forever? Cold, darkness, and rain! A sense that time was running out! Then - the clouds opening! A perfect glimpse of THE REAL THING! The return of the warmth of the sun! End scene.
Amazing. Never doubt God created the concept of dramatic tension.
I am really sorry that I gave up on God answering my prayer too early. And how kind of Him to package my subtle rebuke as a rare, beautiful gift and reminder of His faithfulness and majesty.
The lesson is this: if He cares enough and is powerful enough to even just move the clouds so we can see something cool, how much more able and willing is He to help with the things that truly matter? At the same time, when I pray that He would get rid of all the clouds and give me a nice sunny sky, I have to remember that often that is not His way, because when He does that I learn nothing and do not grow. I thought that day that THE REAL THING was having good weather and seeing the full eclipse. But in this, as in all things, that was just a cipher for what the Lord was truly doing for me that day - teaching me to trust Him more and being willing to risk disappointment and loss based on that trust.
The lesson is this: if He cares enough and is powerful enough to even just move the clouds so we can see something cool, how much more able and willing is He to help with the things that truly matter? At the same time, when I pray that He would get rid of all the clouds and give me a nice sunny sky, I have to remember that often that is not His way, because when He does that I learn nothing and do not grow. I thought that day that THE REAL THING was having good weather and seeing the full eclipse. But in this, as in all things, that was just a cipher for what the Lord was truly doing for me that day - teaching me to trust Him more and being willing to risk disappointment and loss based on that trust.
Wednesday, November 9
Another step back, or, This is what it looks like to recover from severe burnout
I am in that featureless, dimly lit middle stage on the journey out of burnout. They say with attention to the issue, it gets better and that with time I can be fully invested in my work. Right now it varies day to day. Some days I drag myself out of bed late, reluctant to meet people and be happy. Some days I rise from bed fresh and invigorated; I cherish these days as harbingers of change.
I laugh with coworkers. I bring coffee, help decorate our new clinic. I like the patients I see. I am lavish with my emotional coin since urgent care requires so little of it overall. No one asks me to be their everything here, so there is no emotional abyss of investment to guard against, so I can be generous with myself. I encourage, educate, rebuke, reassure. I remind myself not to get too possessive or protective of these people; these are not my patients. They are just patients. I get to do immensely satisfying things like sew lacerations and fish things out of ears and burr metal flakes out of a man's eye. I puzzle over rashes. I argue about antibiotics. I work twelve to fourteen hours a day, then drive home and smile easily at my husband.
At work, I get a card someone left at the front desk. A card? For me? Yes, says my receptionist. I don't tell her the truth: I don't want a card.
It has my name on the front. I open it and read it aloud to my nurse. It is from a patient I saw a week ago who was in emotional crisis. I remember that we talked for a while and after I determined that she was not in imminent danger, I started her on some medications. I told her she needed a therapist. I remember that I tried to show her kindness but not too much.
The language of the card is effusive. My compassion and flexibility floored her, she writes. My prayers gave her strength. She tells me I saved her. She asks if she can see me again at the urgent care clinic.
I read the letter feeling as though someone has started to press down on my neck. My nurse cries and says she has goosebumps, which is a helpful signal to me to pause for a moment. I just want to run, but a reaction is required here. I mumble something about how touched I am, but really I'm uncomfortably reminded of how much of my shows of compassion are a farce, external signposts that freely promise warm, green destinations but lead instead to cool grey expanses of indifference. I push away the dread and remind myself that navigating a continued doctor-patient relationship with this woman is not my job anymore.
How nice of her, I say. But no, she can't come and see me again. I put down the card and pick up the next chart in the rack.
I laugh with coworkers. I bring coffee, help decorate our new clinic. I like the patients I see. I am lavish with my emotional coin since urgent care requires so little of it overall. No one asks me to be their everything here, so there is no emotional abyss of investment to guard against, so I can be generous with myself. I encourage, educate, rebuke, reassure. I remind myself not to get too possessive or protective of these people; these are not my patients. They are just patients. I get to do immensely satisfying things like sew lacerations and fish things out of ears and burr metal flakes out of a man's eye. I puzzle over rashes. I argue about antibiotics. I work twelve to fourteen hours a day, then drive home and smile easily at my husband.
At work, I get a card someone left at the front desk. A card? For me? Yes, says my receptionist. I don't tell her the truth: I don't want a card.
It has my name on the front. I open it and read it aloud to my nurse. It is from a patient I saw a week ago who was in emotional crisis. I remember that we talked for a while and after I determined that she was not in imminent danger, I started her on some medications. I told her she needed a therapist. I remember that I tried to show her kindness but not too much.
The language of the card is effusive. My compassion and flexibility floored her, she writes. My prayers gave her strength. She tells me I saved her. She asks if she can see me again at the urgent care clinic.
I read the letter feeling as though someone has started to press down on my neck. My nurse cries and says she has goosebumps, which is a helpful signal to me to pause for a moment. I just want to run, but a reaction is required here. I mumble something about how touched I am, but really I'm uncomfortably reminded of how much of my shows of compassion are a farce, external signposts that freely promise warm, green destinations but lead instead to cool grey expanses of indifference. I push away the dread and remind myself that navigating a continued doctor-patient relationship with this woman is not my job anymore.
How nice of her, I say. But no, she can't come and see me again. I put down the card and pick up the next chart in the rack.
Sunday, September 13
Well, That Took a Long Time, or, The Price
Things are getting better. They are certainly better than they were a year ago.
I contemplated apologizing for not writing for so long, but whatever. I'm allowed. I had very little to say this past year anyway. I finished intern year without any major (external) problems and moved on to being a senior resident. In my program, rank has some privileges; your workload drops from 80+ hours a week to more like 60, and (most importantly for me!) you don't have to get up nearly as early most of the time because you do more outpatient, or clinic, rotations. I do not miss 4am!
All of that luxurious ease (ha), however, made it possible to sink into a state of quiet apathy. It was easy to do, and apathy has a lot to recommend it for someone who's coming back from hysterical sobbing in the middle of the resident lounge. You don't enjoy much, but you also don't have to walk around bleeding emotions on everyone, which is not my favourite. I learned a lot of medicine. I did not learn much about myself or grow much in my understanding of Christ. The ice started cracking this summer, though, and I have been a bit sad to see it go. I'm not saying that's a good way to feel; I'm just being honest. It was very effective self-protection. I think the last couple of years (and in a wider way, the last six years or so, with my husband's deployment and all) taught me a lot about how to be afraid and how easy it is to get compacted into a smaller person by the worries and risks of this world. I think I needed to learn this first so that I could be prepared for the next lesson - how to love people anyway.
Jesus tells us to count the cost of following Him - "Whoever does not bear his own cross and come after Me cannot be My disciple. For which of you, wanting to build a tower, doesn’t first sit down and calculate the cost to see if he has enough to complete it? Otherwise, after he has laid the foundation and cannot finish it, all the onlookers will begin to make fun of him, saying, ‘This man started to build and wasn’t able to finish’... In the same way, therefore, every one of you who does not say good-bye to all his possessions cannot be My disciple." We can understand from the larger context of Luke 14 that Jesus is not only speaking of the willingness to give up material possessions. He is also referring to the willingness to abandon ourselves to serving the goodness of His will. There is a vulnerability required in showing people love. And there is inherent danger in showing love to people who you don't know; in fact, there is a guaranteed emotional price that you will have to pay, because not all of those people will choose to love you or the One who sent you. You will at times be betrayed and abandoned by the strangers you have chosen to love.
I paid that price a couple of times as I was learning to serve people at the beginning of residency and I didn't like it one bit. God knew I would react that way and He very kindly gave me time and the comfort of His Spirit to pull back somewhat and heal up. For a while it seemed as though I'd gone through something horrible that it would've been better to avoid. I'm remembering, though, that my call as a Christian - and by that I mean the regular everyday Christian job description - makes no mention of safety of any kind. It says God will go with us, that He loves us, that His ways are good and His plans for us individually and collectively are also good, but safety and comfort are not guaranteed. Despite that I say God is worth it. His kindness, the peace of His Holy Spirit, the care He takes with my life - these things remind me that the price is not too high. I am still, after almost ten years, only beginning to learn how to walk with God, but I have learned that His presence is immensely valuable to me. More valuable than safety. More valuable than any price I could pay. And I believe that even more good will come from this painful lesson.
He has stuff for me to do.
I contemplated apologizing for not writing for so long, but whatever. I'm allowed. I had very little to say this past year anyway. I finished intern year without any major (external) problems and moved on to being a senior resident. In my program, rank has some privileges; your workload drops from 80+ hours a week to more like 60, and (most importantly for me!) you don't have to get up nearly as early most of the time because you do more outpatient, or clinic, rotations. I do not miss 4am!
All of that luxurious ease (ha), however, made it possible to sink into a state of quiet apathy. It was easy to do, and apathy has a lot to recommend it for someone who's coming back from hysterical sobbing in the middle of the resident lounge. You don't enjoy much, but you also don't have to walk around bleeding emotions on everyone, which is not my favourite. I learned a lot of medicine. I did not learn much about myself or grow much in my understanding of Christ. The ice started cracking this summer, though, and I have been a bit sad to see it go. I'm not saying that's a good way to feel; I'm just being honest. It was very effective self-protection. I think the last couple of years (and in a wider way, the last six years or so, with my husband's deployment and all) taught me a lot about how to be afraid and how easy it is to get compacted into a smaller person by the worries and risks of this world. I think I needed to learn this first so that I could be prepared for the next lesson - how to love people anyway.
Jesus tells us to count the cost of following Him - "Whoever does not bear his own cross and come after Me cannot be My disciple. For which of you, wanting to build a tower, doesn’t first sit down and calculate the cost to see if he has enough to complete it? Otherwise, after he has laid the foundation and cannot finish it, all the onlookers will begin to make fun of him, saying, ‘This man started to build and wasn’t able to finish’... In the same way, therefore, every one of you who does not say good-bye to all his possessions cannot be My disciple." We can understand from the larger context of Luke 14 that Jesus is not only speaking of the willingness to give up material possessions. He is also referring to the willingness to abandon ourselves to serving the goodness of His will. There is a vulnerability required in showing people love. And there is inherent danger in showing love to people who you don't know; in fact, there is a guaranteed emotional price that you will have to pay, because not all of those people will choose to love you or the One who sent you. You will at times be betrayed and abandoned by the strangers you have chosen to love.
I paid that price a couple of times as I was learning to serve people at the beginning of residency and I didn't like it one bit. God knew I would react that way and He very kindly gave me time and the comfort of His Spirit to pull back somewhat and heal up. For a while it seemed as though I'd gone through something horrible that it would've been better to avoid. I'm remembering, though, that my call as a Christian - and by that I mean the regular everyday Christian job description - makes no mention of safety of any kind. It says God will go with us, that He loves us, that His ways are good and His plans for us individually and collectively are also good, but safety and comfort are not guaranteed. Despite that I say God is worth it. His kindness, the peace of His Holy Spirit, the care He takes with my life - these things remind me that the price is not too high. I am still, after almost ten years, only beginning to learn how to walk with God, but I have learned that His presence is immensely valuable to me. More valuable than safety. More valuable than any price I could pay. And I believe that even more good will come from this painful lesson.
He has stuff for me to do.
Sunday, March 23
R1 Winter, or, The Wall
When people are miserable, they get cagey about their emotions. It's a protection thing. I understand that. But it means I can't verify with certainty what I suspect: that I am not the only one who is struggling right now. I know all the cheery, hopeful, "Hey, we're doctors!" posts have disappeared entirely from my Facebook feed (at least from my class; the crop below me just matched so of course they're thrilled), so I am fairly certain I'm not the only one having a hard time.
On that note, let's talk about hitting the intern wall.
I'm an intern, which is generally equivalent nowadays to being a first-year resident. (Intern status used to be a year below being a resident, but for a bunch of boring reasons they've mostly merged the two at this point. In short, it makes residency shorter and more secure.) First year is the foundation for your clinical training, so it's the time when you have the least control over your life and when you work the hardest. The learning curve is necessarily steep, although since you were already ascending a steep learning curve in medical school, you think you're probably prepared for what residency holds. You're wrong about that. Residency is a new beast entirely. The mix of being at the bottom of the totem pole again, having new and weighty responsibilities, working significantly longer hours, and suddenly being bad at everything you do is exhausting. It's all-the-way exhausting, actually, as in it wears you out until you're wrung dry. That point is what doctors call hitting the wall; when you have nothing left and yet you have to keep pulling the same hours and seeing the same awfulness and making the same hard calls. It's burnout, plain and simple; for an excellent article on this, read this JAMA publication; the Wikipedia article is also pretty good.
I hit the wall right at the end of December, during my first pediatrics rotation. One day I was chugging along, doing more or less okay; the next day I started to feel kinda hopeless for no reason. My patient load started to seem overwhelming and defeating. January I was on labor and delivery, something I neither love nor hate, but for various reasons our team was effectively a rudderless ship which was horrible for all concerned. Feeling abandoned by the residents who you depend on to help double-check your work is pretty scary, and all those negative emotions take an enormous amount of energy to maintain. By the time I started internal medicine in February my tank was close to empty, and that was before I had a truly, truly stressful month, including a high patient load and a sick family member requiring me to take a week off work. You can't be a person, do life stuff, and do residency stuff at the same time. You just can't. You will suffer and one of those other things will suffer, because the truth is that residency takes up everything you have to give. The evening before I left on my emergency trip, I was so tired and so worried and so overwhelmed that I couldn't even pack a suitcase; my husband had to do it for me as I sat on the bed and sobbed helplessly because it was too hard to figure out what I needed. Things have not gotten much better from there.
It's been a bad season, you guys.
Both my Maslach Burnout Inventory and my PHQ-9 scores are pretty terrible. The PHQ-9 is a quick screen for depression; the MBI is specifically for burnout. Basically I hit the intern wall so hard, and my ears are still ringing from it. I've got precious little fight left in me. I'm not really capable of providing the level of personal care I was giving six months ago because I'm not capable of caring that deeply right now. I want to, I just... can't. It's hard enough to convince myself to go back into work every day. It's hard enough to not snap at people all the time. It's hard enough to make sure I only cry about it in the dark, quietly, where I won't upset anyone else. And on a side note, I'm kind of angry that this is essentially expected. Why is something this terrible expected? And why don't we know how to fix it? And why haven't we overhauled the system so there's less attrition and fewer patient care issues from burnout? Why do we as a profession just let this happen to everyone?!
Anyway.
I'm very grateful to have a good, steady job that lets me reliably have a roof over my head and food to eat. I'm grateful that I have reliable employment. But that's all. It's not a calling right now. It's just work, and it's a lot of work.
Today at church, though, we sang this, and despite my hopelessness and exhaustion, this resonated deeply:
I will remain confident of this:
I will see the goodness of the Lord.
It's paraphrased from Psalm 27. And it reminds me that when you belong to the Lord, there is always cause for hope. I really needed to hear that.
On that note, let's talk about hitting the intern wall.
I'm an intern, which is generally equivalent nowadays to being a first-year resident. (Intern status used to be a year below being a resident, but for a bunch of boring reasons they've mostly merged the two at this point. In short, it makes residency shorter and more secure.) First year is the foundation for your clinical training, so it's the time when you have the least control over your life and when you work the hardest. The learning curve is necessarily steep, although since you were already ascending a steep learning curve in medical school, you think you're probably prepared for what residency holds. You're wrong about that. Residency is a new beast entirely. The mix of being at the bottom of the totem pole again, having new and weighty responsibilities, working significantly longer hours, and suddenly being bad at everything you do is exhausting. It's all-the-way exhausting, actually, as in it wears you out until you're wrung dry. That point is what doctors call hitting the wall; when you have nothing left and yet you have to keep pulling the same hours and seeing the same awfulness and making the same hard calls. It's burnout, plain and simple; for an excellent article on this, read this JAMA publication; the Wikipedia article is also pretty good.
I hit the wall right at the end of December, during my first pediatrics rotation. One day I was chugging along, doing more or less okay; the next day I started to feel kinda hopeless for no reason. My patient load started to seem overwhelming and defeating. January I was on labor and delivery, something I neither love nor hate, but for various reasons our team was effectively a rudderless ship which was horrible for all concerned. Feeling abandoned by the residents who you depend on to help double-check your work is pretty scary, and all those negative emotions take an enormous amount of energy to maintain. By the time I started internal medicine in February my tank was close to empty, and that was before I had a truly, truly stressful month, including a high patient load and a sick family member requiring me to take a week off work. You can't be a person, do life stuff, and do residency stuff at the same time. You just can't. You will suffer and one of those other things will suffer, because the truth is that residency takes up everything you have to give. The evening before I left on my emergency trip, I was so tired and so worried and so overwhelmed that I couldn't even pack a suitcase; my husband had to do it for me as I sat on the bed and sobbed helplessly because it was too hard to figure out what I needed. Things have not gotten much better from there.
It's been a bad season, you guys.
Both my Maslach Burnout Inventory and my PHQ-9 scores are pretty terrible. The PHQ-9 is a quick screen for depression; the MBI is specifically for burnout. Basically I hit the intern wall so hard, and my ears are still ringing from it. I've got precious little fight left in me. I'm not really capable of providing the level of personal care I was giving six months ago because I'm not capable of caring that deeply right now. I want to, I just... can't. It's hard enough to convince myself to go back into work every day. It's hard enough to not snap at people all the time. It's hard enough to make sure I only cry about it in the dark, quietly, where I won't upset anyone else. And on a side note, I'm kind of angry that this is essentially expected. Why is something this terrible expected? And why don't we know how to fix it? And why haven't we overhauled the system so there's less attrition and fewer patient care issues from burnout? Why do we as a profession just let this happen to everyone?!
Anyway.
I'm very grateful to have a good, steady job that lets me reliably have a roof over my head and food to eat. I'm grateful that I have reliable employment. But that's all. It's not a calling right now. It's just work, and it's a lot of work.
Today at church, though, we sang this, and despite my hopelessness and exhaustion, this resonated deeply:
I will remain confident of this:
I will see the goodness of the Lord.
It's paraphrased from Psalm 27. And it reminds me that when you belong to the Lord, there is always cause for hope. I really needed to hear that.
Thursday, December 12
R1 December, Or: Embracing The Suck
Hey all.
I am sorry I have not written in a long time.
I have, actually; you just haven't seen most of it. I have several posts sitting in my virtual drafts pile in various stages of completion; I just have barely had the willpower to finish all of my real work, let alone come and write something I am happy with.
I wanted to take a smidge of time and say this, though: it's getting better. This is for two reasons. One is that I am getting better at my job. A great deal of my daily angst comes from the fact that I have to learn on people who really deserve a fully trained doctor treating them, because everyone deserves that. I feel like I'm cheating people somehow and I hate that I'm not good at my job yet. But after almost six months of working at this every day (literally every single day, in one form or another), I can tell I'm improving. There's no substitute for immersion when it comes to rapid and sustained learning, and residency is nothing if not immersion in medicine. There are days I come home feeling like my brain is an overstuffed pillow because I go through so much new stuff - everything from how to fill out an obscure bit of paperwork correctly to reading up on a complex disease interaction I wasn't aware of.
Reason two is that I have adjusted. By "adjusted" I pretty much just mean toughened up. At first there was a lot of shock and resentment at how much work this is, not just in terms of hours but also in terms of how mentally and emotionally exhausting it is. Responsibility = stress! It was also really physically hard to make my body get up at 4am and work for hours and hours. And I'll just come out and say it: I missed emergency medicine with a quiet but deep bitterness that made everything just that much harder to get through. Today, though, I realised I was starting to legitimately embrace the suck. I work all the time, I have crappy (read: no) work-life boundaries, I don't get to see family for the holidays this year, and I feel constantly like I'm coming down with some bug. And all of that is okay. It's residency. It sucks. Somehow that's not an inherently bad thing anymore. And I'm not angry about having to let go of emergency medicine anymore, which is a huge weight off my back.
I don't know where things will go from here. But I will say that change has been happening while I wasn't even paying attention, and it's good. This is me trusting the process God put me into.
I am sorry I have not written in a long time.
I have, actually; you just haven't seen most of it. I have several posts sitting in my virtual drafts pile in various stages of completion; I just have barely had the willpower to finish all of my real work, let alone come and write something I am happy with.
I wanted to take a smidge of time and say this, though: it's getting better. This is for two reasons. One is that I am getting better at my job. A great deal of my daily angst comes from the fact that I have to learn on people who really deserve a fully trained doctor treating them, because everyone deserves that. I feel like I'm cheating people somehow and I hate that I'm not good at my job yet. But after almost six months of working at this every day (literally every single day, in one form or another), I can tell I'm improving. There's no substitute for immersion when it comes to rapid and sustained learning, and residency is nothing if not immersion in medicine. There are days I come home feeling like my brain is an overstuffed pillow because I go through so much new stuff - everything from how to fill out an obscure bit of paperwork correctly to reading up on a complex disease interaction I wasn't aware of.
Reason two is that I have adjusted. By "adjusted" I pretty much just mean toughened up. At first there was a lot of shock and resentment at how much work this is, not just in terms of hours but also in terms of how mentally and emotionally exhausting it is. Responsibility = stress! It was also really physically hard to make my body get up at 4am and work for hours and hours. And I'll just come out and say it: I missed emergency medicine with a quiet but deep bitterness that made everything just that much harder to get through. Today, though, I realised I was starting to legitimately embrace the suck. I work all the time, I have crappy (read: no) work-life boundaries, I don't get to see family for the holidays this year, and I feel constantly like I'm coming down with some bug. And all of that is okay. It's residency. It sucks. Somehow that's not an inherently bad thing anymore. And I'm not angry about having to let go of emergency medicine anymore, which is a huge weight off my back.
I don't know where things will go from here. But I will say that change has been happening while I wasn't even paying attention, and it's good. This is me trusting the process God put me into.
Wednesday, August 21
WHAT THE *&$^@ *@&#!% IS GOING ON (*$*#@*$&#&$, or, R1 July: Internal Medicine
Fairly recently someone asked about where exactly I am in my training. "So what is a resident? Are you a doctor now?" he asked, "or not a doctor?" The answer is yes. I am technically a physician now, and yet in so many ways I am still more student than professional. This is true in both the philosophical sense - I still have a lot to learn, I need a lot of supervision so I don't make mistakes, etc. - and in the concrete sense - I can't sign prescriptions for narcotics yet, I need to have formal supervision, etc. So I am a doctor because I graduated medical school, and just like a doctor I see patients by myself in the clinic and the hospital. But I am in the postgraduate training phase, and that means during this time there are limits on what I am allowed to do, especially what I am allowed to do unsupervised. I've reached journeyman status, I suppose. For people training to be family physicians (meaning me), this period lasts three years. If I choose to pursue more specialised training after that in OMT, psych, ER, OB, whatever, it would add another 1-2 years of postgrad training.
So I'm a resident now. July was my first month. And it was... I can't even tell you how it was. I wrote some (terrible) haikus my first week that, looking back, I still think are fairly representative:
patient is acidotic
with high bicarb and high CO2?!
acid-base, you bring despair
a drug seeker yells
you doctors never help me
rage his only wealth
small cell carcinoma
how do I tell them he's dying?
I am just an intern
I can tell you this much
one day I will love being in charge
not today. but one day.
the alarm says five
OH MY GOSH THAT'S WHEN WORK STARTS
THERE IS NO POETRY FOR LATENESS
CRAP
The last month was really an extended exercise in fear, uncertainty, and depression. And somehow it was also an exploration of sacrifice and worship. I can't say last month was fun, or that I liked it to any degree. And it's hard even for me to say it was good because there was so much bad stuff in it. But somehow... it was right. It was right that I be there, working all the time, feeling insecure, starting to learn what medicine even means. It was right that I have to struggle with how to show compassion to drug addicts and angry families and the slowly dying (and the acutely dying), again and again and again. I sound crazy, don't I.
I have to be honest, though. After all the years of college and medical school where I refused to give up on my dream, three weeks into this thing I woke up and was like, "This is medicine?! I want out. So long, and thanks for all the fish.*" It was a sobering moment. In school I would get fed up with people who said that, but now I'm wondering if everyone has that moment (or several of those moments) on this journey.
I ended the month by taking care of a manipulative alcoholic and persuading a patient, in progressive stages, that 1. his organ failure was terminal, and 2. getting on more transplant lists in other states probably wouldn't help, because 3. he was no longer a surgical candidate. I also had my first experience with trying for several days to get some kind of help for a patient, only to have every possible avenue of help closed to me. We prayed together over the unavoidably terminal diagnosis, and then that person essentially went home to die. Alone.
Walking all day through other peoples' misery is really exhausting. And it's worse when you are crippled by near complete ignorance of everything from the computer entry system to the specifics of the treatment plan you want to implement (I told you I'm still part student). Calls from nurses, for example, are generally terrifying. How much insulin should you give? Can you give that person pain medicine? How should I know?! Oh, because I'm the doctor. Well. When you put it like that. A nurse called me one day to tell me one of my patients had a critically low platelet count of 16,000 (you want it over 150,000). I thanked her and put the phone down. Then I put my head in my hands and said aloud, "I literally have no idea what I'm meant to do about that." A very kind attending who was sitting nearby put her hand on my shoulder and said, "I remember being there. You'll figure it out."
I didn't, though, because after much research it turned out that issue was unfixable. I sent that patient home to die, too.
:/
I don't think I have formed a very good perspective on all of this yet. But I haven't quit. And God has given me a breather in the form of working in the ER this month. He knew what I'd need after my first month on the floors. Next time, Lord willing, will be better.
*If you don't already know that this line is from The Hitchhiker's Guide to the Galaxy, you need cooler friends and you should probably read more.
So I'm a resident now. July was my first month. And it was... I can't even tell you how it was. I wrote some (terrible) haikus my first week that, looking back, I still think are fairly representative:
patient is acidotic
with high bicarb and high CO2?!
acid-base, you bring despair
a drug seeker yells
you doctors never help me
rage his only wealth
small cell carcinoma
how do I tell them he's dying?
I am just an intern
I can tell you this much
one day I will love being in charge
not today. but one day.
the alarm says five
OH MY GOSH THAT'S WHEN WORK STARTS
THERE IS NO POETRY FOR LATENESS
CRAP
The last month was really an extended exercise in fear, uncertainty, and depression. And somehow it was also an exploration of sacrifice and worship. I can't say last month was fun, or that I liked it to any degree. And it's hard even for me to say it was good because there was so much bad stuff in it. But somehow... it was right. It was right that I be there, working all the time, feeling insecure, starting to learn what medicine even means. It was right that I have to struggle with how to show compassion to drug addicts and angry families and the slowly dying (and the acutely dying), again and again and again. I sound crazy, don't I.
I have to be honest, though. After all the years of college and medical school where I refused to give up on my dream, three weeks into this thing I woke up and was like, "This is medicine?! I want out. So long, and thanks for all the fish.*" It was a sobering moment. In school I would get fed up with people who said that, but now I'm wondering if everyone has that moment (or several of those moments) on this journey.
I ended the month by taking care of a manipulative alcoholic and persuading a patient, in progressive stages, that 1. his organ failure was terminal, and 2. getting on more transplant lists in other states probably wouldn't help, because 3. he was no longer a surgical candidate. I also had my first experience with trying for several days to get some kind of help for a patient, only to have every possible avenue of help closed to me. We prayed together over the unavoidably terminal diagnosis, and then that person essentially went home to die. Alone.
Walking all day through other peoples' misery is really exhausting. And it's worse when you are crippled by near complete ignorance of everything from the computer entry system to the specifics of the treatment plan you want to implement (I told you I'm still part student). Calls from nurses, for example, are generally terrifying. How much insulin should you give? Can you give that person pain medicine? How should I know?! Oh, because I'm the doctor. Well. When you put it like that. A nurse called me one day to tell me one of my patients had a critically low platelet count of 16,000 (you want it over 150,000). I thanked her and put the phone down. Then I put my head in my hands and said aloud, "I literally have no idea what I'm meant to do about that." A very kind attending who was sitting nearby put her hand on my shoulder and said, "I remember being there. You'll figure it out."
I didn't, though, because after much research it turned out that issue was unfixable. I sent that patient home to die, too.
:/
I don't think I have formed a very good perspective on all of this yet. But I haven't quit. And God has given me a breather in the form of working in the ER this month. He knew what I'd need after my first month on the floors. Next time, Lord willing, will be better.
*If you don't already know that this line is from The Hitchhiker's Guide to the Galaxy, you need cooler friends and you should probably read more.
Thursday, June 13
Residency training, day #1
Things I learned from my first day of residency training:
1. Lower your expectations.
2. Be on time.
3. Pay attention.
[3a. If you're falling asleep, hold your breath until your brain thinks you're dying, freaks out, and floods your system with adrenaline. Problem solved! You are now awake, if twitchy and a little pale.]
4. Don't make excuses for your stupidity.
5. Don't harbor regrets for your stupidity.
6. I am probably as ill-prepared as I think I am, if not more.
7. Things will probably be okay anyway.
I'm doing a bit better spiritually/ emotionally, by the way. It's incredible how the Lord comforts us in our struggles. My attitude toward residency isn't settled yet, but it'll get there.
1. Lower your expectations.
2. Be on time.
3. Pay attention.
[3a. If you're falling asleep, hold your breath until your brain thinks you're dying, freaks out, and floods your system with adrenaline. Problem solved! You are now awake, if twitchy and a little pale.]
4. Don't make excuses for your stupidity.
5. Don't harbor regrets for your stupidity.
6. I am probably as ill-prepared as I think I am, if not more.
7. Things will probably be okay anyway.
I'm doing a bit better spiritually/ emotionally, by the way. It's incredible how the Lord comforts us in our struggles. My attitude toward residency isn't settled yet, but it'll get there.
Sunday, May 26
Wherever there is jealousy and selfish ambition, there you will find disorder and evil of every kind.
I wrote this a week or two ago, but followed the advice of a wise friend who suggested I wait and make sure I could handle this much transparency. I'd be lying if I said this issue is closed, but I've already sat on this post in one form or another for months and I'm starting to feel like I'm hiding it. That's not okay. I don't want to give the false impression that this walk with Christ has no stumbles or sharp turns in it, and I don't like keeping secrets. So here it is.
I often get the sense that real struggles with sin are not okay to talk about in a lot of church circles, but I don't currently have any thoughts on eschatology or the latest Joyce Meyer book, so this will have to do for discussion. Let me start by saying that I'm still really ashamed of the content of this post, which is proof that this internal journey is nowhere near finished yet. But it would be dishonest of me to pretend this isn't going on, and it's something that many, many doctors (Christian and not) have a hard time with, so it should be brought out into the light and examined with the eyes of truth.
The real story of my winter and spring is not auditions, or rotations, or matching, or medicine. Those things just form the backdrop for the action. The real story of my past six months is how, for the first time since coming to know Christ several years ago, I fell unresisting into sin - the sin which some have said lies at the root of most other sins, pride. I have almost no idea how to even talk about it. It's so hard. It came about so gradually at first, over years, that I didn't even notice it, and it started with something very simple and not wrong at all: I liked emergency medicine more than family medicine as a potential career.
You all know that for me, the FM/EM fight has been raging for years, and I always put it like this: I feel like FM has big strengths and undeniably lends itself to missions, but I just honestly like the ER so much. And that sounds good. But I didn't realise that other things were building up around that, things like: ER doctors get to tell cooler stories. All family physicians get to do is drudgery, and they don't get any respect. I would really like the flexibility that comes with shift work. I don't have fun managing diabetes and such. My feet hurt when I walk the floors on internal medicine. I would hate to have to run a business so I'll never be a clinic doctor.
I have listened to so many incredible doctors warn about how obstacles to serving Christ creep in and take the form of our desires for comfort, stability, respect, and choice. And you know what? I still have let all of those things creep into my heart. And I was so sure that everything was fine that I let it get worse. By fourth year, my thoughts went more like this: yeah, I'm going to be an emergency doctor. I'll do all the interesting stuff. I will be the Christian who survives in a demanding secular environment. I will be the spiritually sound one who still has the trendy job.
Pastor Mark Driscoll did an interesting sermon series this year about identity, and he mentioned something that resonated like a bell for me: when you commit identity idolatry, that is, when you define yourself by something other than your relationship with Christ and put great worth in that identity, you eventually get extremely nervous. This is because you can sense that whatever or whoever you have pinned your identity on is not reliable enough to keep you stable. I recognise this in myself during audition season. I had let my career become everything to me, the deepest part of my desires for my future and the center of my self-image; and the strain was starting to show. My anxiety about matching into family medicine vs. emergency medicine was profound. I probably cried about it 2-3 times a week for months. It became very important to me that I match into an EM residency, although I still didn't realise why. I just knew that I had to match into emergency medicine. I had to. That was all there was.
Except I didn't, did I? I matched as a family medicine resident with a Christian residency program. (How I was brought there when I was essentially running full tilt in the other direction is a whole other post.)
I wish I could tell you that I'm thrilled to start at this program. I should be. It is an incredible place, filled with deeply admirable people, and they deserve better than I am giving them. And it is really sick that I can look at their graduating class and think, I really want to be like each of those people both as doctors and as Christians, and yet I feel shame when I tell people that I am going into family medicine. During my spring rotations I had to constantly interact with ER attendings and residents and a hot little knife of embarrassment jabbed me every time.
I haven't been able to pray with a whole heart since October or November. I feel like I'm fleeing from the Word even as I seek it. I have no peace about my immediate future even though it's settled now. I am terrified that I am denying myself joy in the beginning of my residency. I've admitted to myself that I crave recognition and am full of self-righteousness, that it's possible I never wanted EM for the right reasons, and that part of me wants to simply switch those terrible reasons over to my new field without working on my heart so that I can keep my pride. There have been many layers to this repentance and each is more painful than the last, and I'm still not finished; at this point part of me doesn't even want to continue, which is why I persist in this spiritual listlessness. I feel like a fraud and I feel an inch tall. I wonder how the Lord could possibly use me for His purposes when I am such a sinner. I wonder why on earth He would inflict me on such a good Christian ministry when I am anything but an asset to them right now. And part of me can't help but repeat that maybe if I'd loved Him more, if I'd been a better Christian, I would be headed to work in an ER right now - which is totally theologically unsound. The Lord doesn't work that way. I know there is victory and freedom in Christ, and I have reveled in that in the past, but I am so far from that now. And I worry that I don't know how to truly seek the ways of the Lord instead of the world.
So there you go. I am lost and I feel like time is running out. I trust God's promise that He is with me always, even to the end of the age, but I also remember Jesus' clear warning that following him requires taking up your own cross - a metaphor for death to self and a call to sacrificial living. My faith is small right now. I'm glad all He asks is a mustard seed's worth.
I often get the sense that real struggles with sin are not okay to talk about in a lot of church circles, but I don't currently have any thoughts on eschatology or the latest Joyce Meyer book, so this will have to do for discussion. Let me start by saying that I'm still really ashamed of the content of this post, which is proof that this internal journey is nowhere near finished yet. But it would be dishonest of me to pretend this isn't going on, and it's something that many, many doctors (Christian and not) have a hard time with, so it should be brought out into the light and examined with the eyes of truth.
The real story of my winter and spring is not auditions, or rotations, or matching, or medicine. Those things just form the backdrop for the action. The real story of my past six months is how, for the first time since coming to know Christ several years ago, I fell unresisting into sin - the sin which some have said lies at the root of most other sins, pride. I have almost no idea how to even talk about it. It's so hard. It came about so gradually at first, over years, that I didn't even notice it, and it started with something very simple and not wrong at all: I liked emergency medicine more than family medicine as a potential career.
You all know that for me, the FM/EM fight has been raging for years, and I always put it like this: I feel like FM has big strengths and undeniably lends itself to missions, but I just honestly like the ER so much. And that sounds good. But I didn't realise that other things were building up around that, things like: ER doctors get to tell cooler stories. All family physicians get to do is drudgery, and they don't get any respect. I would really like the flexibility that comes with shift work. I don't have fun managing diabetes and such. My feet hurt when I walk the floors on internal medicine. I would hate to have to run a business so I'll never be a clinic doctor.
I have listened to so many incredible doctors warn about how obstacles to serving Christ creep in and take the form of our desires for comfort, stability, respect, and choice. And you know what? I still have let all of those things creep into my heart. And I was so sure that everything was fine that I let it get worse. By fourth year, my thoughts went more like this: yeah, I'm going to be an emergency doctor. I'll do all the interesting stuff. I will be the Christian who survives in a demanding secular environment. I will be the spiritually sound one who still has the trendy job.
Pastor Mark Driscoll did an interesting sermon series this year about identity, and he mentioned something that resonated like a bell for me: when you commit identity idolatry, that is, when you define yourself by something other than your relationship with Christ and put great worth in that identity, you eventually get extremely nervous. This is because you can sense that whatever or whoever you have pinned your identity on is not reliable enough to keep you stable. I recognise this in myself during audition season. I had let my career become everything to me, the deepest part of my desires for my future and the center of my self-image; and the strain was starting to show. My anxiety about matching into family medicine vs. emergency medicine was profound. I probably cried about it 2-3 times a week for months. It became very important to me that I match into an EM residency, although I still didn't realise why. I just knew that I had to match into emergency medicine. I had to. That was all there was.
Except I didn't, did I? I matched as a family medicine resident with a Christian residency program. (How I was brought there when I was essentially running full tilt in the other direction is a whole other post.)
I wish I could tell you that I'm thrilled to start at this program. I should be. It is an incredible place, filled with deeply admirable people, and they deserve better than I am giving them. And it is really sick that I can look at their graduating class and think, I really want to be like each of those people both as doctors and as Christians, and yet I feel shame when I tell people that I am going into family medicine. During my spring rotations I had to constantly interact with ER attendings and residents and a hot little knife of embarrassment jabbed me every time.
I haven't been able to pray with a whole heart since October or November. I feel like I'm fleeing from the Word even as I seek it. I have no peace about my immediate future even though it's settled now. I am terrified that I am denying myself joy in the beginning of my residency. I've admitted to myself that I crave recognition and am full of self-righteousness, that it's possible I never wanted EM for the right reasons, and that part of me wants to simply switch those terrible reasons over to my new field without working on my heart so that I can keep my pride. There have been many layers to this repentance and each is more painful than the last, and I'm still not finished; at this point part of me doesn't even want to continue, which is why I persist in this spiritual listlessness. I feel like a fraud and I feel an inch tall. I wonder how the Lord could possibly use me for His purposes when I am such a sinner. I wonder why on earth He would inflict me on such a good Christian ministry when I am anything but an asset to them right now. And part of me can't help but repeat that maybe if I'd loved Him more, if I'd been a better Christian, I would be headed to work in an ER right now - which is totally theologically unsound. The Lord doesn't work that way. I know there is victory and freedom in Christ, and I have reveled in that in the past, but I am so far from that now. And I worry that I don't know how to truly seek the ways of the Lord instead of the world.
So there you go. I am lost and I feel like time is running out. I trust God's promise that He is with me always, even to the end of the age, but I also remember Jesus' clear warning that following him requires taking up your own cross - a metaphor for death to self and a call to sacrificial living. My faith is small right now. I'm glad all He asks is a mustard seed's worth.
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