Bad photography and public eavesdropping, part 2

While much of the past year has felt like everything has changed while nothing is changing (i’m pretty sure i matched while eating red pepper hummus for dinner over a west wing rerun), more recently it’s felt just the opposite (i spent a whole day trying to remember how i got twelve pairs of jcrew pants and rationalizing shipping my weight in murikami novels to denver). Moving is ridiculous and gas-like and somehow expands or shrink to take up whatever time you have available for it. But between dumpster diving for cardboard boxes and unearthing random screws that hopefully don’t belong to anything weight bearing, I set aside an afternoon to wear about ten pounds of unbreathable velvet and get baked in a chapel-sized brick oven!IMG_0894 2So glad that there were professional photographers to document the day. Very unglad that I went to my hooding stoned out of my mind (jk …but i should probably rethink that oven metaphor).

Here’s one from my Uncle Nixon who is @nixpixl because some goobers already took @nixelpixel and @nixpix:IMG_0874 2Okay so maybe that’s just the way my face is and this is an instance of bad photographs versus bad photography. I have taken my fair share of both, and since I’m feeling particularly reminiscent and longing and hesitant to say goodbye (this is going to be like one of those episodes of boy meets world that’s not actually a new episode and just made of clips of other episodes) here is a sample of my worst photograph(s/y) from the past four years.IMG_4348This is an incomplete and overexposed photograph of scottie socks hanging in front of my unwashed apartment window that I took during my first year of medical school. I have no idea what I was thinking. Fortunately, I had my friend, Soo, model them for me and make them glamorous. This was back when I didn’t know she was dating my roommate and just thought she really liked hanging out in our unfurnished living room watching him play Xbox and sitting in REI camping chairs.IMG_5018This is my manbun hat, which (surprisingly) has a whopping eighty seven unique downloads on ravelry! I made this for my friend, Sam, when he transitioned from rugged curls to full blown bun during my second year of medical school (this was also about the same time he transitioned his hand lettering from 𝑎 to a. it was a big year for sam.). This is when I learned how important a neck is in photography.DSC_0950There is no one in this photograph because third year of medical school is isolating and lonely in so many ways. This is my marled baby blanket dropped onto a near empty newsstand in front of a random bodega in San Francisco. I was home for Christmas and thought the juxtaposition of soft, domestic knits and hard, gritty, urban photography would be both provocative and profound. It was neither.IMG_0302And this is my nephew (in frank violation of back to sleep)! Born shortly before my graduation and shortly after Cardi B’s album dropped and destroyed the world, he was the recipient of my most recent babymoon blanket and absolutely hated it. Or maybe he was pooping. Or maybe he was realizing that the world is bigger than my sister’s uterus. I don’t know, It’s hard to tell because he freaks out over just about everything (drama queen).

So, tomorrow I leave for a new home in a new city (danver), and looking back, it’s weird to think about how much I’ve changed since moving to Chicago (he-cago #pridemonth). But as I prepare to move from one UC to another (having originally come six years ago from yet another, go bears), I am pleasantly surprised by what has stayed constant in my life and what has grown into something beautiful. And I’m excited for the next poor souls who will pose backlit and blurry in a slanted, poorly composed photograph in one of my cowls, and those who will cry inconsolably, like the world is ending, just wanting to be picked up and held.

For those of you looking for something more than throwback knits and close-ups of my nephew bawling (and geography based puns), read on.


Public Eavesdropping: A Glossary of Medical Terminology, Part 2

swalla

Good is hard to find when a baby girl succumbs to injuries sustained from child abuse, which is why we reached out to Gift of Hope. We were in search of a silver lining.

Gift of Hope operates independently of any hospital, so it sent its own staff to evaluate her brain-death and identify any harvestable organs for their long list of potential recipients. They visibly looked like strangers. Their ID badges were small and rectangular, vertically oriented instead of horizontally like ours, and they wore scrubs just a slightly different shade of robin’s egg blue. They got lost in our halls but walked briskly and purposefully wherever they went.

One night, I followed a parade of them as they wheeled her downstairs to the operating room, an entourage of IV poles and monitors in tow. It was well past midnight, which is when these sorts of things tend to happen. Two unfamiliar transplant surgeons stood on either side of an empty operating room table when the crowd of us arrived. They moved and prepped her body with expertise, framing her dark belly with sterile drapes and painting it a chemical orange with a sponge on a stick. Two people on stepstools counted instruments off to the side and several others walked around the room holding clipboards, making notes to themselves and checking off boxes on official-looking documents. There was a person for each organ about to be harvested, and a corresponding van, plane, or helicopter idling outside, ready for immediate sirened transport.

I joined other observers against the cool tiles of the back wall with my arms behind me, tired but vigilant about my proximity to the sterile field. In a sleep-deprived stupor I swayed to the music overhead. It was barely audible beneath the bustle of pre-op, murmuring small talk behind cornmeal masks. Someone on hands and knees tried to find a reachable outlet for a thick coiling plug. The rrrrrips of nurses breaking sterile seals on equipment kits and autoclaved tools sounded almost human.

It began, as all operations do, with a time out. A public reconciliation of the patient we planned for and the one who showed up. And then a woman who wore thick, black-framed glasses and had a tall afro barely contained by her airy bouffant cap—she seemed to be the coordinator of the whole affair—proclaimed a moment of silence. So there we stood, in a lopsided circle, and acknowledged the fact that this was no ordinary operation, there was no recovery room expecting us after we were through, no fresh linens, or dinner menu, or call button. Just the morgue.

And in that silence:

When she back it up, put it on the Snap

When she droppin’ low, put it on the Gram

DJ poppin’, she gon’ swallow that

Champagne poppin’, she gon’ swallow that

“Non sequitur” does not begin to describe the jarring seconds spent listening to Jason Derulo’s 2017 hit single, Swalla, in that crowded, somber, and otherwise silent operating room. None of us moved a muscle, our bodies lining the walls, as Ty Dolla $ign exposed the song’s double entendre, its more lewd interpretation from which I assume Derulo derived the song’s hook as well as—in a more colloquial form—its title. I scanned the room but no one met my gaze.

No one said anything. No one was breathing.

And then the operation began and lively chatter consumed the room. No one heard Nicki Minaj begin the third verse.

Only now, reflecting on this memory again and again, do I finally realize the most jarring part about that evening, the strangest thing about lyrics of twerking and blowjobs before a midnight organ harvest. It wasn’t the communion of strangers, stoic figures who refused to betray whose job it was to manage the operating room iPod or release a gasp or, even worse, a snicker. No, it was what wasn’t there that stood out most, which is perhaps the very purpose of a moment of silence. A way to give voice to absence. In this case, the absence of a ticking clock, missing the steady metronome of a heartbeat, waiting for, but never getting, the quiet walking rhythm of a vibrant pulse.

 

died

We are taught how to inform someone of a patient death because, I imagine, it takes sixteen years of schooling before we are prepared to set aside obfuscating euphemisms and hold pure, unrefined tragedy in our hands, a couple decades before we’re ready to concede to the silence of what we have done or what we have missed, what is not our fault and what we had no power to stop in the first place.

I have only ever seen two people die, and in both instances “brief” would not be how I’d describe the process. So it’s ironic that the word itself is so unsubstantial, a quick retreat of my tongue and almost no air from my lungs. It’s shorter than death or deathly or dying or dead. Shorter than terminal or hospice care. Shorter than end of life. Shorter than DNR/DNI.

So it’s ironic, again, that something so small can be so difficult to say, and so difficult to leave alone, marooned in that quiet space separating you and me.

Two in the morning on a winter night, your grandmother, your mother, your wife and your daughter, came to us by ambulance. Her sheets were stained with dirt and sweat and her belly was swollen, quickly filling with blood. We were in the corner endovascular suite on the sixth floor, and the large white doors creaked as it opened and closed all night. We gave sweaty compressions under polka dot printed leaden skirts. It was snowing outside, and you could see the moon reflected in Lake Michigan.

I’m sorry to say, she died.

 

therapeutic consult

Medical school is not free, and tuition is just the first thing it costs us. Stepping onto the hospital floors, we give up so many things we thought we’d earned to keep long ago: our hands, dedicated to sending errant faxes and pages that wander orphaned in the ether, our futures, as chance encounters and traumatic events alter our career paths like switchbacks on a mountain face, and even our confidence, steadily eaten away by an ever-present cloud of inadequacy. From out of touch department heads who think our collective name is “medical student” to the woman at Starbucks who gives a soul-releasing sigh when we pull out a long list of orders on behalf of the entire adult endocrine consult team, it seems like no matter what we do, no one is ever pleased with us, our thick, unbreathing white coats just getting more bothersome and in the way by the day.

And then there’s the concession of time.

Time is not our own as medical students; it belongs to everyone else in the room. So we cling to our seniors, preternaturally bound to them until every last checkbox on the back of a folded-over sign-out is summarily crossed off and we are released, like tethered haunts biding until the twilight of a blood moon. We try to lose ourselves in the moment, but each one is arbitrary. They can be fast and slow and eventful and boring. They can be sweet and scarring. They can be cruel at the most inopportune moments.

I hate losing time.

But medicine is nothing if not transformative. Often at a glacial pace, but, sometimes, impressively swift. It tends to happen on ordinary days, when what looks like a long night ahead dissolves into air, when I receive a four o’ clock consult on a slow Friday afternoon and with heavy, reluctant steps I arrive to see my work already done—labs self-normalized, discomfort a mere memory, a man out of bed wearing sneakers with his hands behind him, holding together the back of his bare-bottomed gown, as eager to go home as I am.

These situations have been explained to me as “therapeutic consults,” as if the very act of contacting a consult service is curative, usually with a soft elbow jab and an under-the-breath comment about better things we could have been doing. And though I smile, too, acknowledging my good fortune as I head for the door while the sun still hangs in the sky, I feel badly for adopting such a term. It’s tongue in cheek, yes, but also fraudulent and hypocritical, taking credit for something we assume yet discount yet hoard so selfishly. A missed opportunity to resist wit. A joke, but still.

Time is not our own as medical students—though, it is not so much out of our possession as it is out of our control, this panacea that frustrates to no end, its only formulation a slow and steady drip of seconds. But it is no less momentous than when we knew it last. Perhaps even more so, because what a miraculous and thankless thing it creates: restoration, at no cost to us other than a touch of patience, a few moments of our day to just wait and watch it happen.

 

code titan

It felt like a hot, inescapable spotlight when a nurse pressed a suture kit into my hands and a man with just shy of ten fingers sat before me in the emergency room. I flexed my own fingers, aching in empathy, and sifted through the plastic tray in search of proficiency or, at the very least, some confidence.

No luck. So I picked up a vial of lidocaine instead.

I pulled on a pair of 7½ off-white gloves that snapped at the wrist. First, a finger block at the metacarpophalangeal joint of the digit in question, and then some local anesthetic along the smooth edges of the laceration. His finger ballooned and oozed blood at first, and then, out flowed clear, cold analgesic.

A deep breath.

Five simple interrupted stitches of 6-0 nylon suture, each one steadier than the last, and then a brush of bacitracin and clean, white bandages covered by an everyday band-aid with instructions to return in a week. And, of course, not to multitask the next time using a mandolin.

I didn’t feel the prick on my own finger until minutes later. A nagging itch and a single, glossy bead of blood. Just one drop, but it drained me, leaving me cold, sweating, and shaken. I sidled up to a nurse as calmly as I could and showed her my finger and explained what I thought had happened, but before I could finish—

“Code titan,” she said.

The entirety of the emergency department descended upon me.

The charge nurse gathered my information and entered me into the EMR. With a mouse click my name appeared on every monitor in sight, in that same Courier New font describing the waiting room of coughs, elderly falls, and fussy, febrile babies. She asked for an emergency contact and I wanted to ask back under what circumstance would this be considered an emergency but instead I gave a name and number.

“Relation?” she asked, and I said mom instead of mother because that’s how old I felt.

She slapped two plasticky ID bands onto my wrist and handed me a small stack of black and white forms, which I signed blindly.

One nurse measured my vitals and took my history while a second drew two vials of blood from my right arm. I saw the man whose finger I had just sewn up escorted back to his room. We needed blood from his as well. We shared a brief and awkward interaction.

“I don’t have AIDS,” he said. “I promise.”

“Me neither,” I said.

My attending pulled me aside into an empty triage room and looked closely at my hand the way a father inspects an invisible play yard scratch. He asked me what happened and I told him, speaking slowly and clearly but wanting nothing more than to shrink exponentially into nothingness. I felt every inch of my height, towering over everything like a pin on a map. When he was finished, we returned to our stations and he gave me a soft pat on the arm. My next patient was waiting.

No more than fifteen minutes had passed, but time runs like honey when dying from embarrassment. I was bombarded with reassurances throughout. Of the slim chances of transmission, the precision perfect testing, the ubiquity of needle sticks—most, as it was colorfully explained to me, much more horrific and contaminated than my own. But the biggest reassurance, the most quieting and soothing, had long since passed. It was that brief moment following absolute terror, before that white spotlight found me for the second time that day, the two word starter pistol that mobilized an entire workforce to respond to a single, nervous slip of the hand. Amid a cloud of dread, it was the tiny bit of grace, a reminder that none of us, stemming from the beginning of time, are infallible, that even the ancient and powerful among us are prey to moments of carelessness, everyday primordial gods who cannot deny snagging a finger or two on a hellfire blade from time to time.

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