Poetry Tuesday: A Time to Laugh

Today's poetry comes from my research to find readings for our wedding (I have some time, I know, but I just love thinking about the ceremony) but I think is very appropriate to my life right now, when I'm trying to not take anything personally and laugh at all my mistakes.  I think the last one is my favorite though - laughing when plans get changed because now I get to be spontaneous - to "take a piece of life and treat it with reckless abandon"!  Enjoy!

e

A Time to Laugh, By Sister Joan Chittister

1. Laugh when people tell a joke. Otherwise you might make them feel bad.

2. Laugh when you look into a mirror. Otherwise you might feel bad.

3. Laugh when you make a mistake. If you don't, you're liable to forget how ultimately unimportant the whole thing really is, whatever it is.

4. Laugh with small children. They laugh at mashed bananas on their faces, mud in their hair, a dog nuzzling their ears, the sight of their bottoms as bare as silk. It renews your perspective. Clearly nothing is as bad as it could be.

5. Laugh at situations that are out of your control. When the best man comes to the altar without the wedding ring, laugh. When the dog jumps through the window screen at the dinner guests on your doorstep, sit down and laugh a while.

6. When you find yourself in public in mismatched shoes, laugh as loudly as you can. Why collapse in mortal agony? There's nothing you can do to change things right now. Besides, it is funny. Ask me; I've done it.

7. Laugh at anything pompous. At anything that needs to puff its way through life in robes and titles. Will Rogers laughed at all the public institutions of life. For instance, "You can't say civilization isn't advancing," he wrote. "In every war they kill you in a new way."

8. Finally, laugh when all your carefully laid plans get changed; when the plane is late and the restaurant is closed and the last day's screening of the movie of the year was yesterday. You're free now to do something else, to be spontaneous ... to take a piece of life and treat it with outrageous abandon.

- Sister Joan Chittister, originally published in her book, There is a Season

(and recopied from the knot readings post)

everything that goes wrong

As an intern, any time there's a debate about whether something actually IS wrong vs. you DID something wrong, you always think it's the latter (at least I do).  The dressing is soaked? maybe I didn't close the wound or dress the wound correctly.  Her pap smear came back abnormal? Maybe I didn't do it correctly. The medication isn't working? Maybe I prescribed it incorrectly.  She's bleeding? Maybe I forgot to give her medications/ didn't do something completely.  This constant underlying mindset of "everything that goes wrong is my fault" is important in understanding this story.

It is one such struggle to find the right plane that this story takes place - I was running around in clinic, per usual, and my senior resident calls me into his patient's room to do an ultrasound so he can evaluate and teach me. Every new obstetrics patient needs an ultrasound to date the pregnancy.  One cool thing (well, obviously I think it's cool) about the developing fetus is that in the first, and really even in the second trimester, most fetuses are about the same size, giving us the ability to measure different body parts (head, abdomen, thigh bone) and accurately determine how long the woman has been pregnant.

For this patient, I introduce myself to the patient, explain what I'm going to do, she gives me an excited nod like "yes! show me my baby!" (women love their first ultrasound and I don't blame them) and I place the ultrasound on her belly.  By her last menstrual period, she should be about 20 weeks pregnant, which means the fetus should be pretty easy to see and measure.  I'm trying to scan quickly because I've already done 10 ultrasounds today and I have three patients waiting in rooms for me to get back to them, but also accurately so I can show my senior resident that I am capable of independence, so when it's difficult to find the right level of the head to measure the BPD, I get a bit impatient with myself for being so incompetent and slow.   Then I decide to try to measure the femur instead, because it's actually the more accurate measurement anyways, and can get a pretty good view of the femur, but it's measuring small - about 14 weeks.  I think to myself, "man, I'm such an idiot that I can't even measure a femur correctly" but decide after trying for a few minutes to move onto the abdominal circumference - but I just cannot get a clear picture of the fetal abdomen - everything seems a bit...squished.  At this point, my senior resident has been trying to correct my verbally for about five minutes (try moving your hand to the left, don't push as hard, make sure your angle is correct, no that's not quite it) and finally gets frustrated enough to just take the ultrasound probe from me and try himself.  I step away from the machine feeling like a complete and utter failure, not only because I somehow couldn't measure any part of the fetus correctly, but because I still have 3 patients who I'm keeping waiting in other rooms.  I mentally beat myself up for a moment and then a thought occurs to me:  "Elias!" I say calmly, "Can you check for FHM?"  this is code for fetal hearth movement, a tell-tale sign that a baby is alive and well.  I say this in code because I just realized I didn't do that at the start of the scan and reflecting on what I did see, there wasn't much movement at all.  Then, as Elias scans through the patient's uterus,  he and I both realize at the same time that this fetus is not alive, has not been alive for probably over a month.  The patient,still craning her neck to better see the ultrasound, asks us if we can tell if it's a boy or a girl.  Elias and I look at each other, and then, as the senior resident and the person ostensibly in charge, he says, "we are having a hard time seeing the baby's heart beat.  we need to check with a better machine."

He and I both know that no machine is going to show us a beating heart in this fetus, but as the doctors in training, we have a responsibility to the patient and to our attending physician, to make absolutely sure that we have not gotten something wrong.

As I stood explaining the next steps to the patient, I wished two things: first, that I did make an error and therefore there was some other explanation other than her baby had died, but second, angry at myself for being so self-doubting, so certain that all inaccuracies were from my lack of skill or knowledge that I didn't even stop to think: what if I am scanning this correctly and this baby is 6 weeks behind its dating with anatomy that doesn't look quite right.

It is an important lesson of intern year that I keep learning over and over again - yet can't seem to get quite right: trust in the knowledge that I do have and at least consider the possibilities if I assume that I do know what I'm doing some of the time.

*an instagram original of me staring into my coffee cup at 5am 

wondering what this day has in store for me*

~~

 "Gilean threw his head back and laughed 'a mistake? one mistake? you should be so lucky.  you'll make dozens!  I made four or five on my first day alone! Of course you'll make mistakes.  Just don't make any of them twice.If you do mess things up, don't try to hide it. Don't try to rationalize it. Recognize it and admit it and learn from it. We never stop learning, none of us."

-John Flanagan, Erak's Ransom

Wednesday 3 things:

1. courage

well, there aren't really 2 more things to follow that!
have a good week!

not to seek

I have been trying to restart my yoga practice and think I've finally found a studio that gives me the spiritual and physical work-out I need, with more emphasis on the former than I realized I needed.  I talk often with friends and family about the search for a spiritual community in our highly-educated, agnostic and scientific lives.  Especially as I get closer to establishing my own new family and going through the rites of marriage (most of which we are adapting and blending from all the spiritual and community traditions we like), I find myself thinking more about how to cultivate this part of my life - both within myself and as a more public acknowledgement of spirituality as an important part of my life.  

so for you, a public acknowlegement of this with a quote from Rumi and my favorite chant we have done in yoga class lately, the Gayatri Mantra.

"your task is not to seek for love, 

but merely to seek and find all the barriers within yourself 

that you have built against it"

-Rumi

the literal translation of this repetitive chant is:

"May we attain that excellent glory of Savitar the god:

so that he may stimulate our prayers"

Flashback Thursday: Augusts of years past

Flashback to Augusts past...

from my 100-mile relay

August 2011: the first test of motherhood
It seems like a pretty good test of what's to come: are you willing to tear yourself from the inside out in order to give life, air, comfort to this brand new baby that you aren't even sure what it will be like, but you already know you love it enough to rip yourself open.

August 2010: Rilke inspiration: live your way to the answer
I would like to beg you dear Sir, as well as I can, to have patience with everything unresolved in your heart and to try to love the questions themselves as if they were locked rooms or books written in a very foreign language.

August 2009:  Atul Gawande's 5 rules of medicine

1) ask an unscripted question
2) don't whine
3) count something
4) write something
5) change.

magical moments

While biking home from clinic a few days ago (yes, the bike commute is the best!) I was thinking about how I wanted to go into this field because I like being able to offer support, guidance, and skills at women's most vulnerable moments - but that these moments don't always take the form of delivering a beautiful baby or removing a breast mass or uterus and curing someone's cancer, they are not always helping someone get pregnant after years of trying.  Often they are much less magical and women feel much more ambivalent about how helpful I'm being, and more frustrated or scared about their situations -

they're a woman who comes in from clinic after being told she has an intrauterine fetal demise (IUFD) for induction, a woman who thought she was coming in for a regular prenatal visit who is told she is in preterm labor and going to deliver her baby months sooner than she had planned, a woman in her 40s with symptomatic fibroids (pain, bleeding) who has never had sex, but doesn't want to have a hysterectomy because she doesn't want to give up on the idea that someday she could be pregnant, another woman in her 50s with vaginal bleeding for years who has never had a pelvic exam or a pap smear who you have to counsel about her high risk of cancer, a woman who fled her abusive family to come to a new country only to live with abusive "friends" here with few other options because she is still undocumented, another woman trying to figure out what she is going to do with her young child in labor because she has no one to watch him, or the woman with a urinary infection during pregnancy who refuses to leave the hospital, even after her antibiotics, because she is so afraid of the pain she isn't sure she can go through with labor, a woman spending her pregnancy in prison who hasn't slept for days because she cannot figure out a comfortable position for her growing abdomen on her one allowed mattress and built-in pillow.

** 

but I guess those ARE the moments why I went into this field: to explain what's happening with her body, to explain that it's not her fault, to explain what we are going to do to try to make it better or easier, to write prescriptions for extra mattresses, to talk to the other people in their lives with the authority of someone with knowledge and skills, to counsel about her options, to hold her hand and tell her that 

I'm just so sorry this is happening to her.

~~~~

"the wound is the place where the light enters you"

-Rumi

soy una doctora

me llamo Erica, soy una doctora aqui

apparently now I speak spanish. or at least am really, really trying to speak spanish.
this month, I'm assigned to our resident clinic, which serves a large spanish-speaking population.  One thing I love about living here is that I feel like I travel to different countries throughout the day.  During my morning commute, I feel like I'm in India - where people can disregard lanes and honk just to say hello (as well as to communicate several other, less kind, things), when I enter the hospital parking lot, I feel like I'm in Ethiopia, since all the men who work in the parking garage are Ethiopian with huge white smiles and absolutely no patience for my inability to fit into the parking spots they have chosen for me.  Later, in clinic, I travel between rooms and it feels like I go from El Salvador to Guatemala to Somalia to Cote D'Ivoire.  After clinic, travelling to happy hour, it's as if I drove down to Mexico, because our waiter tells us (in spanish) that these are the best nachos in town because the chef is truly from Mexico.  I don't know what's better - that nacho chefs exist or that I got to eat the illustrious final product.  When I coast back home on my bike, it's a bit like being in Amsterdam with all the bikes lined up one after the other along the river bike path.  Finally, while falling asleep, I hear Billy Holiday playing loud on our neighbors stereo and realize it doesn't matter where it is, I'm home.

e