Waiting by the Library One Freezing Morning

The pressed kiss of my buttocks
against the cold concrete is mediated by
the thin cloth of my jeans
This bench is a parasite
Across its placenta of 96% cotton and 4% spandex
it steals every molecule of heat
from my begrudging ass

In games of waiting I am a sore loser
with muscles aching and contorted from
spasms of shivering
teased out by every cold breeze
each of them lovers – must be
to garner such
instantaneous, overwhelming reactions

The wind caresses my face with ice
kisses the tip of my nose with frostbite
attempts other intimate contact
I would like to defer

There is nowhere to run,
only the cold confines
of this damn stone bench
pressed up against my backside
like some
unsolicited dance partner

I cannot wait
for this waiting
to be done.

Sometimes, there is flying

I don’t work in the kind of profession that offers travel benefits. I’m not whisked around the country or region or world for business (or even pleasure) but sometimes – one time, really – there is flying.

I don’t work in the kind of profession that waits for you to feel better to do your job, that gives you sick days without a grudge or lets you sleep when you’re tired. My job makes you stay up straight for 36-48 hours. It forces you to save dying patients somewhere into your thirteenth straight hour of being on your feet. To think coherently and organize an inter-hospital patient transfer by army helicopter (because we don’t have actual medical helicopters).

Then my job expects you to fly a patient to the other end of the island, long past the time when you should have gone home to your boyfriend and your cat (your cat will never love you if you keep this up) while making sure this patient keeps breathing until you can get her the help she needs.

My job is endlessly demanding. Forcing tired, gritty eyes to watch the rolling greenery  of the Cockpit Country, while deep inside your sleeping brain you wonder why the government wants to destroy this last bastion of nature, uninterrupted. Peer down at hidden away houses so high up in the hills you wonder how they got the cement and blocks that far. Watch buildings, light posts melt away to ponds and trees, the odd farm here and there.

To fly, lost in your thoughts and the steady roar of the engine that is fighting gravity for you. To fly until you leave behind the hills and valleys and peaceful farms and blend again into well-paved roads, multi-level architecture and

Look, there’s the hospital now. My job forces you to stay awake for hours and hours with no thanks. No pat on the back.

But sometimes, there is flying.

Evolutions II

I’ve always been big on letting go and moving forward. Which is the life coach way of saying that I like cutting my losses and starting over. It started with MS Paint and Word; if I didn’t like the way a drawing looked or a story sounded and I was in too deep for a couple of undo’s to do the trick then I would click the close button – don’t save, thank you – and open a new file. I approach my career and relationships with the same objectivity (or is it callousness?).

Whatever you want to call it, I have the remarkable ability to walk away with very little tears shed, once I’ve made up my mind to do it. Of course the build-up to the actual decision is fraught with feelings of guilt, several tears and usually at least two sleepless nights. But once its decided I usually feel relieved, refreshed and ready to move forward. Which all sounds very normal and emotionally healthy and therefore very unlike me. Call it my saving grace.

As I get older (sometimes I panic about how close I am to thirty, and I’m not as close as you might think), I spend more time thinking about the way my life has unfolded. I like to think that all this reflection helps me plan the next stage of my life, but really it’s mostly a lot of self-congratulation. Oh, I’m so proud of the way I handled that break-up. Oh, I’m so glad I made this career decision despite everyone telling me otherwise. But I also came to recognize this useful habit of letting go of the things that are harmful to me and moving on to different mistakes or healthier choices. Cue self-congratulation.

Recognizing that habit helps me to realize that as I grow and change some things about me will remain constant, like my ability to accept growth and change without too much struggle. And my ability to close the door on things that no longer have a place in my life, but also my ability to recognize things that will always be a part of my life no matter how long I neglect them. The nature of my involvement with hobbies like writing and dance will change – my time constraints will change – but even if I don’t publish stories, even if I don’t perform on stage there will always be a part of me that is a writer and a dancer no matter what.

Being able to believe in these less public aspects of myself despite our culture of “pics-or-it-didn’t-happen” translates into believing in myself on a whole. It gives me the confidence I’ll need to handle the rest of my twenties (and eventually my thirties) with not necessarily grace, but at least something close to resembling aplomb.

Evolutions

The evolution of an illness is similar to the evolution a story.

My colds always start with sniffles and a tickle at the back of my throat. Except instead of a tickle it’s more like a yard fowl decided to gently graze for scraps on my soft palate. Naturally I get a sore throat.

The next day I have serious sinus issues. My nose is Niagara Falls – the rushing water and the dam all at once. I take cold medicine, which wins the battle but not the war. My upper respiratory tract infection starts to trickle downstream.

Because I don’t cut my nose off, all that Niagara falls goodness gets washed down into my bronchi and smaller airways. Two days later I’m coughing up a lung – that yellow stuff, so you know it’s infected.

Shortness of breath and chest pain go hand in hand with the hacking, reminding me this isn’t some simple flu and that I probably have a pneumonia (for the umpteenth time). This goes on for a week or so before I try to get help. When I give in to the less-than-kind remarks about my unhealthy appearance (thank you, work colleagues) it’s antibiotics and sick leave that doesn’t involve actually resting.

Despite myself I get better, though it takes the better part of two weeks. My body rediscovers its equilibrium, but the cycle is always poised to start again.

Like my cough started with some virion, stories start with an idea. A suggestion that replicates and multiplies into something significant. That grows from its point of origin towards some inexorable, organic destiny. Stories run their course despite us, whether they are stopped prematurely or reach a natural conclusion. And the writer rests, but the cycle is always ready to start again.

What is a CRH Internship like?

So here we are, one year out of medical school. Internship is behind us and we’re venturing out into the world of fully registered medical practice. And the question one everyone’s (no-one’s) mind is, what is internship at CRH like?

Internship anywhere in Jamaica and the Caribbean is rough. The high patient load and typically low resources keep our clinical practice particularly inventive, and adhering to evidence based medicine is a lot like playing whack-a-mole (just when you think you’ve hit the nail on the head, it’s disappeared and you have to try again).

I chose CRH for my internship for a number of reasons. Montego Bay is my hometown. Because it’s a Type A hospital we see more complicated cases and therefore get more clinical experience. Compared to the other two Type A hospitals, the patient load is a balance between overwhelming and nonexistent and the staff are (for the most part) approachable.

Surgery, Internal Medicine, Pediatric Medicine and Obstetrics & Gynaecology share the same basic traits no matter where in the world you practice. What I have found different is the slant of intern duties. In my opinion, a CRH internship gives you primarily clerical experience. Any additional medical experience is dependent on the interest and enthusiasm of the individual intern.

Broadly speaking, the intern’s job is to see or SOAP inpatients every morning, round with the consultant, carry out requested procedures and tests, and follow up the results of these tests and act on them. Variations of this theme can have the intern seeing or clerking new patients in the Emergency Department, making interdepartmental referrals, organizing procedures off the compound, administering medication etc etc.

At the end of the day the intern’s is tasked with making sure the patient gets whatever they need to get better and get out of the hospital.

A lot of your time is going to be spent writing request forms, writing referral forms, writing notes in the docket and writing orders for medication. Your practical procedures will primarily involve phlebotomy and placing intravenous accesses. There will be times when you don’t feel like a contributing member of the team and there will be times when you’re the one leading ward rounds. There will be plenty of opportunities for learning, and in the same breath you will feel stifled by your supervisor when they only want you to be a scribe and a gopher. Brush these moments off and look for teaching moments. They’re not always obvious, but you can learn something from everyone.

Surgery

On the Surgery rotation, interns spend six weeks in General Surgery and six weeks in a surgical specialty such as Urology, Orthopaedics or Paediatric Surgery (Neurosurgery didn’t take any interns at the time). There’s a lot of hands on experience to be had here, participating in major and minor operations like laparotomies, appendectomies and the ever-frequent digital amputation. It’s impossible to leave this rotation without knowing how to suture and the basics of pre-op and post-op care, especially since the intern is the one leading the ward rounds, the one with primary management of inpatients.

Paediatrics

Paediatric Medicine divides your time in two six week blocks of the paediatric ward and the special care nursery. Here you learn attention to detail, the importance of acting on the results of investigations and how to handle stress. While on paediatrics you pick up skills in lumbar puncture and intravenous access placement, medication administration and infection control. Interns on Paediatrics are responsible for  administering all IV medication, which is something unique to CRH. If this doesn’t sound daunting, it should. The ward capacity is 20 patients (each. For the ward and the SCN), who require medication up to four times per day.

Medicine

Internal Medicine is a straight three month block with no sub-specialization (small chance of getting some Nephrology exposure). Patient load is high, resources are low and most of your patients are frequent visitors to the ED. It can get frustrating, especially if you like ‘saving people’ because the majority of patients are repeatedly sick because they are non-compliant. There are a lot of social and economic reasons behind this non-compliance but tertiary facilities are the ones feeling the brunt of that primary care failure. This is where you hone the twin skills of BLS/ACLS and breaking bad news. The practice of Internal Medicine is roughly the same across the board, with variations in level of academic exposure and access to resources (CRH falls low on both spectra).

Obs/Gynae

Finally, Obstetrics and Gynaecology is the Other surgical rotation, where instead of gunshot wounds and pus filled abdomens you get happy bouncing babies and failed abortions. The scope of your exposure ranges from suturing multigravid vaginal lacerations to contacting the Centre for Investigation of Sexual Offences and Child Abuse (CISOCA) for your 13 year old patient with pelvic inflammatory disease. OB/GYNs balance surgery and medicine remarkably well, with a smattering of paediatrics (neonatal jaundice has to be diagnosed by the OB/GYN intern before referring to Paeds) and the general atmosphere of the department is one of bonhomie. Interns on O&G  don’t have very active roles in patient management (most of the decisions are made by the consultant, with the intern carrying out the orders) and the consultants round daily so you’re never really on your own (pros and cons, here).

Conclusion

CRH definitely has its ups  – interns have the option for on-compound housing, for instance – and its downs – necessary machines get broken, a lot. And at the end of the day the decision about where to do internship is multi-factorial. I wish I could offer a comparison among internship sites in Jamaica or even the wider Caribbean but alas. I’m not so lucky enough to have enough friends in high and low places.

I will say this: no matter where in the island or Caribbean you do internship, almost everyone will be prepping for USMLEs or some other foreign licensing exam. Internship may feel like the worst year of your life (and in some ways, it is) but it’s just a stepping stone to postgraduate qualifications and the start of your actual medical career.

The Unfortunate Business of Death

Breaking bad news at one in the morning
Is not part of the prescribed medical school curricula
Real life has no point score for empathy
Patience
Directness
But conversations twist as they need
And break when they must into tears
Screams
Silence
Five minutes.
(Is an exam, not the ending of a life)

Chasing Creativity

The muse of inspiration is a very elusive fellow. The mole in Whack-A-Mole comes to mind, or that crafty Bugs escaping poor Elmer Fudd. Maybe it senses my subconscious’s mixed feelings towards creativity (like, why did I choose such violent analogies?) but whatever the reason inspiration is certainly not sleeping in my bed at nights.

Of course, if being inspired isn’t part your day job, it’s much harder to clear the cobwebs from your boxed up dusty mind at whatever odd times you can snatch to first be inspired then find the time and will and consistency to write or paint or choreograph. If you’re not in a state of continuous and conscious open-mindedness (as, for example, in my day job where being closed off happens whether you want it to or not) your task is that much harder.

My problem isn’t getting inspired though. I frequently think of topics I’d like to talk about at length, or story ideas to get on paper (someday) but at the exact moment of inspirational breakthrough I am nowhere near pen or paper or laptop. I’m in a taxi, or about to head out to work, or in the middle of seeing a patient and my brain goes ‘We’ll just file it away for later’ and it goes the way of the Dodo.

(I cannot be the only person whose brain does this).

The obvious solutions are to jot down a quick line on my phone so I can remember at least what I was so inspired about. Or to walk around with a voice recorder (or, again, use the one on my phone. Ha.). But, that quick line on my phone often fails to capture the essence, the vivre, of my brief excitement. The line goes dead and hangs limply in black pixels, mocking me with its wasted potential. Repeat ad nauseam.

Perhaps the real solution is to quit my day job and roam the streets, laptop or notepad in hand, digging for inspiration like a coal miner: grubby, starving and desperately grateful for the light of the sun.

Dawnchaser

I love travelling.

I love the quiet stillness that enters my mind when I’m riding along though noisy traffic or empty back roads with serene pastures. There’s a weight that feels lifted off my shoulders, a loosening of the usual necktie of anxiety and suddenly I can breathe. I can think without over thinking. I can decide without second guessing. Best of all, I can sleep.

Travelling in the wee hours of the morning is even better because now it’s combined with the mysterious delight of being awake when no one else is. That feeling also leaves me at peace and content.

Maybe this is a metaphor of some sorts. A reminder to cherish the journey more than the destination.

And isn’t that the whole point of life anyway?

Conquering Duty Anxiety

I really don’t like being on call at the hospital.

Yes, someone has to do it. Yes, we get paid overtime to do it. Yes, this is how we gain experience as doctors. But all of those logical structured reasons fade away when I’m startled awake at 1am by a nurse calling about the patient in cubicle 5 who won’t stop bleeding.

When I was on pediatric medicine I would have a lot of anxiety to deal with on duty. It’s terrifying to be the first responder to a critical situation when you’re not 100% sure you can handle the case. To make matters worse, I was dealing with babies. Delicate (yet somehow also borderline indestructible) little human beings. In the beginning I would have regular panic attacks and palpitations, but as time went on I got more comfortable handling the common emergencies. I became more confident in my abilities, and could usually rest assured that if there was anything I really couldn’t handle, I could call my senior.

The most pervasive part of duty anxiety for me, though, the one that crops up on every rotation regardless of my self-confidence is the uncertainty about being called. You can never tell whether a night will be calm or hectic, whether you will be called ten times in one hour or once for the whole night. And that kind of unpredictability is anathema to me.

As humans we like to think that we have control over our universe. As interns we have all kinds of superstitions for keeping emergency duties light. Knock on wood to keep the bad karma away; when you notice that a night is being particularly uneventful, you can’t say so out loud or you’ll jinx it.  We do these things to try and hold on to the idea that we can dictate how a night will progress just by monitoring our actions.

But letting go of duty anxiety means letting go of the crazy notion that what we do or think will somehow impact the chances of a patient taking a turn for the worse. Or will somehow keep a hundred people from turning up in the emergency department in the middle of night.

It won’t.

The night will unfold as it was always going to unfold, whether or not you stay up having the world’s most intense staring match with your phone, whether or not you knock on all the wood. Whether or not you try to grab a few hours of sleep or comment on how quiet the wards are being. All the superstitions are doing is tricking you into thinking you have some measure of control, so that you think it’s your fault when the emergency duty turns into a madhouse. “I have 3 emergency surgeries because I didn’t knock on wood this morning”.  It sounds completely illogical, because it is. But that’s usually the nature of anxiety.

I have found that the best way to conquer my duty anxiety is to relinquish this idea of control. To let the night progress as it will, without trying to force it into whatever hopes or expectations I might be harboring. When I do that, when I go about my tasks and breaktimes free from the thought that what I’m doing will make or break the night, I find that I’m a lot less anxious and a lot less tired too.

Getting Okay with Being Happy

There are two tragedies in life. One is not getting what one wants and the other is getting it.
-Oscar Wilde

Does anyone else find that they are most miserable when they finally get what they want? I’m not talking about the feeling of almost-but-not-quite-satisfaction when you have nothing else to wish for (and come on, we’re human beings. There will always be something else to wish for). I mean the other feeling. The feeling that there’s something wrong with you being happy.

Am I crazy? Yes. Am I alone in my craziness? I really hope not.

My life has been coming together in a way that is entirely surprising and entirely unfamiliar to me. So far everything is on track (I am knocking on ALL the wood, universe): my career, my personal life, my finances. And I’m a little bit (okay, a lot) baffled by how coordinated it all seems. Granted, on the inside I’m still a wibbling mess trying to pass off as an adult. But on the outside and in the big picture things look kinda sorta maybe okay.

And that freaks me the hell out. Instead of enjoying the good times while they’re here I am anxiously waiting for the other shoe to drop. For the storm after the calm. When will this all be dragged away from me, I wonder frantically. How long can happiness be mine??

As if there’s something inherently wrong with me being happy. As if the universe in some way needs to balance out this time of contentment with an equally horrible tragedy. When in reality no one is taking stock of the good times to balance them out with bad, and for God’s sake what is so wrong with being happy?

Freud blames my parents. I blame the messed up way my mind works sometimes, tricking me into thinking that I’m only doing well if I’m suffering. Why do our brains lie to us? Is there some magic way to stop the lies, or at least ignore them?

Maybe the only answer is the daily reminder to be gentle with myself, and appreciate each moment as it happens. Which is a good enough answer for me.