Monday, March 31, 2008


There and back again. Back and gone again. I came home, or here, or there, again briefly, shortly, just for a few days. Not enough time, but some time, some time which is more than no time. On Sunday, yesterday, we walked in the low tide onto the green rocks. Wet feet, wet sand, gritty in our toes, all tangled in sea kelp. And it was the sheer bright of noon and everything was thinly glowing and the air was thick and wet with water. The entire world was silver--shining back sharply against all that ocean and air. We sat on the hot rocks in the cool morning and I was at once hungry for everything--needing to take it all in big fists and gulps, choking on the thickness of an old life--and willfully inanimate, trying to freeze out little chunks of time, trying to settle the minutes.

Today we drove up the coast to the airport, and today the world is clear bright blue blown empty by the wind off the water. Driving through Half Moon Bay, I get it. I understand suddenly that I have lived almost all of my life in ambient beauty, lazy and passive in a world of small wonders.

Thursday, March 27, 2008


On the way to work, pushing through teaming, standing masses on the platform, my train approaches while I am just clocking through the turnstile. I know it's my train because it is the littlest train in the stable, the runt of a fleet    of iron steel siblings. Built for a population believed to be less significant it is small, run down, unappreciated. I know it is my train because it sounds different than the others, falling apart as it often it is, on the rails. And I must run now. Because I will never make it half way down the platform unless I do, often even if I do, because there aren't enough cars to fill the whole length of the station, because this is the population that is less significant. And no one moves. No one steps away. Men in suits and women in pointy footwear, they remain, standing, eyes cast downward, paper in hand, diligently not looking up, not looking out, not engaging. 

It's late already, I stretch out my mornings too thin, reluctant and weary to spend another day as I do. As I tack my path towards the open door, my bag--unusually empty, unassuming thin canvass--brushes against the back of a woman as I dodge through the significant population to make my way towards mine. And as I pass her, brief contact through canvas, she screams "fuck you you stupid fucking cunt! Fucking bitch!"

And in that instant so many things occur to me, crashing gracelessly through that last, closing door, slipping and lurching from the momentum.

I realize that I do not turn around, gesticulating dramatically, mouthing the words sorry sorry sorry sorry. I don't turn around at all. I don't pause, I don't, even for a moment, consider it. I realize that the words fucking bitch and cunt are so common in the ambient ether of the world I share in, the impact is all but gone. I realize too, that I've assigned in my mind, a set of expected accents and inflections that are associated with words like bitch ass cunt, especially when delivered in rapid fire. It occurs to me only later that the reason the incident stood out, was at all or in anyway unusual, was the accent. The kind of inflection that her words were contained in. The absence of a certain expectation supplanted with another, unexpected. It got stuck for a moment in my auditory nerve, rattled my cortex. 


I dutifully follow the resident. Walking unquietly behind him, clutching a clipboard to my chest like armor, my hard soles hitting the plastic tiled floor; the sound travels before me, a kind of echo and announcement, filling up the green and yellow halls. I walk with my head up and down, at once intent on living presently in this space, this place, this hospital, and desperately trying to claw my way out. We walk in, disorganized, a small collection of white fabric and ties, low heels and books in our pockets. I watch as the resident turns to his left--to check his pager, grab a pen, tuck a lab result into the fold of his jacket--and asks our patient how she is feeling. He does this in the same action: turning away from her, attention divided, asking her how she is, only to answer for her. In one swift moment all is lost. How are you feeling today Mrs So and So, better, no? She looks at him, he is not looking at her, focusing in instead on his stethoscope, rustling some pages. I am on the side, watching them both. Her eyes brighten, then dull, she turns away. I'm okay. 

He says nothing more, pulls back her gown, listens to her lungs, her heart, her belly, places her gown, her only object, her thin something, back in disarray. Today you have the CT, ok? Today we will look at your belly. Ok? She has recently moved here from Trinidad. He is telling her, listen, we're really worried that you might have cancer. In your large intestine. Just below your stomach, in your guts. We are very worried that it has spread, maybe, to your liver. Or your kidneys. Or your lymph nodes. We hope that we will see nothing, but we are expecting the worst. Because you are in your sixties. And you have never been to a hospital. And by the time you came here, you could barely pass stool. And when you did it was black and tarry. This is a bad sign, we are very concerned about you. 

That is what he is telling her. What he is saying, in an accent very difficult for her to sift through, sleepy, disoriented, afraid, is Today you have the CT, ok? And later, when we have rounds, he tells our Attending, patient understands what we are doing and she has given her consent. 

I suck in on thick, pungent air, sometimes uncertain if I can keep up with this. 

Monday, March 24, 2008

monday rounds

Attending: any new patients?

Resident #1: no sir, we are having no new patients today morning.
Attending: what about Mrs. Blah blah blah?
Resident #1: this patient is well, she is ready to go home to the hospice.
Attending: she's going home then?
Resident #3: no sir, she is going to the hospice.
Attending: home?
Resident #1 and 2: to the hospice, sir. The hospice.
Attending: home hospice?
Resident #2, 4 and 5: no sir, she is having the care of the inpatient hospice.
Attending: ah, so she's going home then. Very good.
Resident #3 and 1: to the hospice, sir.
Attending: what about this patient?
Resident #1: which patient?
Attending: this patient.
Resident #5: ah, that patient is doing very well. She will probably go home tomorrow.
Attending: to hospice then?
Resident #1, 2 ,3, 4 and 5: no sir, she will be having the discharge to go home not to the hospice.
Attending: home hospice?
Resident #4 and 3: no sir, she will be having her discharge to go home.
Attending: very good. Has the social worker talked to her about home hospice?
Resident #2 and 5: no sir, this patient will be taking the chemotherapy
Attending: which patient?
Resident #4 and 3: this patient.
Attending: this patient?
Resident #3: no, that patient.
Attending: you there, student, did you do your presentation?
Me: ahh.....yes....I did
Attending: did you do it then?
Me: yes, I did it.
Attending: very well. 
Me: .......????
Attending: did you do it?
Me: yes I did it.
Attending: okay then, hurry up. Quick.
Me: okay I'm going to be talking (briefly) about pancreatic neoplasia, focusing primarily on adeno-
Attending: have we seen this patient today?
Resident #2: which patient?
Attending: this patient.
Resident #5 and 2 and 3: no, not yet.
Attending: lets go see her then, right now. Let me write this note first.
Me: um, sir?
Attending: what?
Me: don't you mean this patient? 
Attending: what do you mean?
Me: you're writing in that patient's chart. Here, this is this patient's chart.
Attending: ah, very good. Have you done your presentation?

Sunday, March 23, 2008

puzzle pieces

March, 2006

The letter comes. Late. Weeks late. Almost months. An invitation. And interview. A school who's name I barely recognize, the collateral result of an otherwise indiscriminate application process. My criteria of choice involving only proximity to something I was willing to call Life, a lesser aperture set on learning. The process of it alone was heartbreaking, waterlogged and full up with the hollow ache of outgrowing an old love, an older friend. Waking up to realize that I am ready for more and he is still looking backward, leaving me anyway behind. Watching the remains of a short life lived too fully come to its necessary end. 

June, 2005
I apply in piecemeal and unintentionally. Self sabotage at the core of it all. The best of schools were written to last, deadlines lapsed, easier to attribute the end result to a clerical error than genuine consideration and, later, genuine rejection. Unwilling, I suppose, at the time, to let go of my life unraveling. Waiting for him to change his mind, come back into the house, tell me "girl, stay. Don't go off without me." And I would have. I did. I would have stayed behind indefinitely for him. I would have exchanged my life wholly for the intermittent glow of his love. I would have stayed and been nothing if it meant, then, being with him.

August, 2005
I do not stay. Not because I am smart or strong or level headed. Because, in the end, it was him. He was some kind of combination of above, embedded in the angry ego of our gender inequity. He made me go. Pushed me, gasping like a chest wound, away. Such a long goodbye, seen myopically and unevenly by everyone. It took a year to do and happened in a single day.

March, 2006
It was half-hearted, at best. All that was left had to be shored up to just keep breathing, remembering to eat. There was enormous much inside of me, and I grew more invisible every day.

I had thrown them each out, every stone I had left. I was feeble and shaky, uncertain and unwilling. And this is where I landed. This letter. On the counter belonging to my sister-in-law's sister. She had taken me in, gave me a room and a bed and a place to be undone in; she was sympathetic and wet with her own sadness. We annealed together like dew. And I called them, responded. Sent them my money. Replied. Yes. I will be coming, thank you, see you then.

February, 2006
He comes without warning. Careless and intentional. Perfectly brown skinned with small somthings that look to me like freckles. He surprises me completely and I am winded when I look at him. He is better looking than I am, I think. I am red and blotchy, sweaty, hiding under my baseball cap, gwaky in my running shoes, just barely back to living; only just remembering little joy, smiling easily, creasing my face. We lean around each other awkwardly, talk about our dogs. I suggest walking, because I cannot sit inside my own skin without moving, because looking at him makes my heart fibrillate and I am not at all ready for this. I am only now just slightly dry.

December, 2005
I am tired of hearing that I am too skinny. I feel that I own this, have earned it. Like a scar, this is what is left. I replace one empty ache for another. Hunger is distracting, it fills me with its demanding emptiness, until I no longer know what it's like to desire. To crave.  Hunger is the way I calm the maelstrom within. I run eight miles a day. Because I cannot quell my own hard-beating heart. Because I cannot sit still any longer in anguish and wait. Because I am ready to move on and I need some place to go to. Because I have almost successfully outrun my own messy insides, turning them into sinew and muscle. Something structured, something solid, something other than this. 

January, 2006
I feel urgently destructive, intent on transforming the resident ache of old loss into the sweet distraction of new skin. Superficial gain. All I want is someone good looking and unavailable. Additionally, a major drinking problem, a legal past, unemployment or an unremitting use of the word "dude",  an inability to spell the word "cucumber" would be ideal. And they are everywhere. These men. Beautiful and golden and utterly absent. They are anywhere that I look. They live here to surf, all else is secondary. They are nothing to get stuck in and they are everything I am looking for. 

I am skinny enough. Pretty enough, maybe. So it begins the same, with all of them. A drink at the bar. Someone bums a cigarette. Stilted conversations ensue. But in the end, despite my best efforts, they see through me. I don't use the right language, or tilt my head just so, or giggle in the way they have come to recognize. I am interesting enough to consider, but in the end my vocabulary betrays me, my stature, my deadpan deliveries give me away. They retreat, some more reluctantly than others, knowing ultimately that I am Complicated. Pretty, but Smart. All in all, a complete Liability.

I go home and take Tylenol PM, wondering why of all the times I have ended up with shitty guys, the one time I am actually looking for one, they are abysmally out of reach.

February, 2006
He comes out of nowhere. He is golden and calm and distractingly good looking. He is everything I am afraid of: intelligent, employed, kind. He has a dog, an Ivy League education, he keeps his plants alive, surfs, takes trips to Mexico, practices yoga. I want him to be stupid. I want him to be disposable. I want to be dizzy, but not like this. I wanted someone to trip on, not fall over. Not now. Not again.

But he is kind. And normal. And easy. I cannot protest. This is too simple. He is too easily my love. I tremor only at thinking that I wasted so much time not knowing him, not living such a breathful, uncomplicated life.

Friday, March 21, 2008

falling is like this

Sometimes I leave that hospital feeling like a 5 foot metal pylon was shoved into my chest. Sometimes when I leave that hospital I can barely breathe from the weight and heft of it, from sorrow and sadness and disappointment and disbelief. Sometimes, when I leave that hospital, I want to sit in a corner and press my head against the wall. Because that is palliative. Because the enormity of it is overwhelming. Because the depth of it is winding. 

Sometimes I want to fucking rage and scream and bite and kick. That this is considered enough. That this is the expectation. That I have to wash my hands in a patient's bathroom, next to a toilet that is covered in piss and shit and blood. That there are never any paper towels in the dispenser. That there is rarely enough soap. That this is okay. That this is expected. Sometimes I want to rip my fucking hair out that the nurses yell at me for having the charts. Because nothing is computerized. Because everything is handwritten and just barely. Because they need to do their job. And the orders are in the chart. Along with the medical record. And the pathology report. That was spit out by a printer that hasn't had it's toner changed during this millennium. Such that the report reads like this: "Impression: Moderate___________________________changes most likely indicative of______________________________________ as well as significant_____________________________. Recommend clinical correlation."

And this is okay.

That my Attending can't keep a coherent thought process for more than 37 seconds. And this is accepted. And he is the Chair of his department. That the residents all argue and speak over each other. That they are all dismissive and rude and it's hard enough that I can't understand their accents, and certainly they can't understand mine, but that asking a question, because I am a student, because I am here to learn, nay am paying out my fucking ass to be taught, is too often met with an impatient hand. That when I want to say "but wait a minute, if you have Interventional Radiology come to flush out the PICC line that isn't working right now, and that you suspect is fraught with millions of fungal colonies because the blood cultures came back positive for mixed yeast species, aren't you not only propelling those colonies from the PICC line into the blood and but also thereby cleansing the line of said, alleged colonies? Such that, if you get a negative culture, you couldn't be certain that it was true? Because Interventional Radiology did such a bang up job of cleaning out the non-functional PICC line that they also removed the yeast from the lumen? Which is where you drew your sample from?"

In other words, why not just pull the damn thing out if you really think he has disseminated fungicemia and put in a new one? Instead of getting an answer like, no we can't or won't or aren't going to do that because of (some reason I can't come up with which is why I asked the farking question to begin with) or actually we might consider that or anything remotely intelligent at all, they turn to me and say "IR stands for Interventional Radiology. A PICC is a peripherally inserted central catheter. We cannot flush it out ourselves".

At which point I want to climb out the window and jump, because clearly I am doing something irrevocably wrong.

And when I tell my Attending that I would really benefit from some extra time spent identifying and describing heart murmurs and wouldn't this be a great learning opportunity 99.97% of our patients have one murmur or another, what does he tell me? Oh. I cannot teach you that. You have to read the books.

Thanks, @#$%@. Because, you see, I've read the books. I can use all the words like crescendo decrescendo, blowing, soft and halosystolic. And I can do it over and over and over again, until my cats grow thumbs and come and surgically remove your appendix, but I still can't identify them on real people and you're my goddamn teacher. So teach me. 

It makes me want to throw a bedpan at his head.

And when the girl who I dislike the most, out of all the people in my class, the one who drives me batshit crazy, the one who saunters into rounds 10 minutes late, with no fucking stethoscope, no notes and not a goddamn clue about much else besides her eyeliner, the one who's answer to the question of "what are the causes of hyperkalemia" and she says "umm.....drugs?" and they say, "very good, what kind of drugs?" she actually says, "oh I don't know that, I only know that the answer is drugs", when this girl tells the residents that she is going to one of the better medical schools in the state of New York next year I want to rip out my own esophagus out because I will never be able to stop the vomiting. 

And when I walk the halls, when I walk into the rooms, when I come to see our patients, when I come to see the incremental end of their lives, I cannot put the two disparate pieces together. I cannot walk from the kind of discussion where frequently the gender of the patient is forgotten or unknown ("Doe, Jane is doing better. Today he ate some applesauce and said his pain was better"), where we regularly and repeatedly swat around terminal diagnosis amongst each other in an almost jocular setting, jousting for who got one terminal diagnosis over the other (I KNEW it was metastatic histosarcoma! No you didn't! Yes I did! I called it. No you thought it was osteosarcoma), as if it weren't an actual person we were talking about. As if it were some abstract exercise and we are still working out case files on paper, not people made of carbon. I cannot walk from that to the room with the woman laying beneath the thin blankets, naked beneath her worn, patterned gown, staring at me with big wet eyes, tube in her nose, mask over her mouth, IV in her hand, silent, watching, following me with her face. Waiting for what I don't know. But it is hard not to imagine that she is only waiting for someone to come talk to her, to touch her hand, to say something, anything, besides, "are you feeling better today Ms ____________?" Waiting for someone who isn't going to come and pull back her gown, comment on her third spacing, listen only to her lungs. It is everything I can do not to crawl in next to her, read her a story or tell her that the sun is out today, that maybe it will be warm tomorrow. It is everything I can do not to start sobbing right there, in the middle of rounds, because I can't breathe. Because the only thing I will ever know about her is that she has aortic stenosis and sacral decubiti. And all I can do for her  is to remember her gender, remember her name.

Monday, March 17, 2008

what you call 'delusional', I call 'totally possible'

When I was about 23 I was working at Starbucks #954,276,391--- paying my way through school, toiling in the death grip of frappuccinos but revealing in the glory that is brought only by having a Banana Slug as your University mascot. Really, you'll never know. If you have to ask, you wouldn't understand.

And there was this girl, Emily, who worked there. Emily was Really Cool. Emily was Really Cool in the way that only people who Came From Seattle are cool when it's still 1998. She just was, you know? She was all effortlessly hip and totally listening to Modest Mouse when I was still stuck on Toad the Wet Sprocket. For fuckssake. 

It goes without saying that Cool Emily from Seattle had an ever cooler (I KNOW) boyfriend, who everyone wanted to go steady with, but couldn't, you know, because she already was. And we all kind of wanted to go steady with her, too but couldn't (see above). So I settled for being her Starbucks BFF. Which is something.

And one day we were in the back, restocking plastic lids or incurring herniated lumbar vertebrae in the milk fridge, and she was sitting on a plastic crate wearing this head thing that was one part head band one part banana (head-dana?) and I was TOTALLY wishing I had the kind of short spikey quirky cute hair that one could just "put back" with a head-dana or leotard or some panty hose or what the F ever but instead know from painful experience that any attempts at hair shorter than my shoulders results in irrevocable mullet status and no, I'm not talking about the fashion mullet. I'm talking Leonard Skinnard and Kenny G. I want to die just thinking of it.

And I was trying, emphatically, seriously (had I known, I would have used the Power of Powerful Power Point Presentations: Powerful Stuff!!) to tell her how I really felt that I was kind of a little bit black. On the inside. Since clearly I'm not, you know, black on the outside. Because I was REALLY FEELING IT. I was really feeling Cisco back then, you know, so I figured it must have meant something. Like maybe I want to change my name to Shaniqua. Because it's THAT REAL inside.

And she just sat there, calmly stirring her pot of Mocha Mix, staring into the deep morass that is desiccated chocolate, contemplating if, after what I just said, she could still speak to me and avoid years of therapy afterward. 

"That is a common affliction that many people, I'm afraid, suffer from. Not only you".

And I'm thinking  about this statement now, ten years later, as I sit at my table watching the sun set behind the wall of red brick in front of me, stuck in this interior life, paging through the glossy lives of the Patagonia catalogue, dying on the inside.

Much like Cisco and Lil Troy, this is something I've really been feeling a lot lately. That there is a wide open and Extreme (extreme!! exclamation points!!) life out there and I'm definitely not living it. I am, for the record and in case there was any confusion about this matter, not scaling a vertical sandstone wall in Patagonia Stretch Cotton, pulling my canoe up after me, as I ascend to a crevice about the size of my cat, where I will sleep for the night. At least, as we speak. Nor am I running through a field of wildflowers, along the cliffs or in the Mojave Dessert. I am also not paddling out at to Teahupoo, which should surprise no one since this past Christmas I paddled out to Halewia Beach Park in barreling 3-5' sets and realized that, quite possibly, maybe I die now. However, every time Andy and I talk about our fantasy surf trip to Indonesia, in my mind, I'm totally shredding Rifles and NOT AT ALL DYING.

Because, in my mind, I'm all tough and athletic and I totally rock everything. Because, in my mind, I'm pretty unwilling to accept that I'm stuck in a city with no place to run to except a bridge and the most extreme part of my day is walking through the ghetto. Because in my mind  I'm TOTALLY that chic climbing up a rock wall, dragging my canoe behind me. (I'm looking at you, Stella).

Sunday, March 16, 2008

play the piano drunk like a percussion instrument until the fingers begin to bleed a bit

Alright already. Alright. I'll stop being such a lame, obnoxious whiner. Also, I'll stop pretending I'm 12 instead of 32.968 (actually 32.969 (leap year)) years old. I'm not entirely certain I can shoulder all of the blame though for that last post. I mean, come on. A Power Point Presentation on giving Power Point Presentations? That's just asking for it.

Also, in case any future employers are reading this (which would be really impressive since it'd mean you'd be digging a good 12 months back and that means you either really want to hire me, considered hiring me but now have Growing Concern that maybe I have mental Turret's or are never going to hire me but find yourself completely unable to resist my wit and charms) it seems prudent to say here and now that I don't actually have a drinking problem. The only kind of drinking problem I have is that I completely abhor the taste of alcohol and therefore can't actually drink at all. This has presented itself as a problem at several different times in my life. Also, I do not have an elicit, clandestine pill popping problem. I don't actually do methamphetamines. I'm actually extremely boring and sedate and have to make up BLATANT LIES about myself in order to feel funny. Telling everyone how I organize my closet by both size and color, always clean the litter box and make up interactive pie charts for my Daily Activities? Totally not funny.  
Occasionally pretending to be Chuck Bukowski? F-ing hilarious.

Tuesday, March 11, 2008

it's because I'm crazy, actually

You know those days when you just want to say screw it and run off to the Mentawais? Yeah, that'd be me today. I don't know what my problem is; I mean, I do, but I don't. I really need to shut up and get over myself and stop being so bratty, because the truth is, I've never had it so good. It used to be working this hard, but for $7.05/hour at Starbucks. So seriously, come on already.

Today was a complete waste of a day and I resent it wholeheartedly. Yesterday I got some great accolades and professional pats on the back from my preceptor at our End of Rotation little sit down and that was nice. He said some really nifty things to me. Really. It kind of made these last five weeks feel less like scraping my brains out with a fork with no anesthesia and more like maybe they gave me some morphine. So that was groovy and all and it felt super (and by super I mean super make me want to barf because nothing puts the pressure on you like having people think great things about you. I'd kind of rather have people expect nothing of me and have me occasionally dazzle them than the converse and repeatedly disappoint). But then I left wondering what I've been wondering all month: should I have gone to medical school? Was this the Right Thing To Do, after all? 

But before I could feed the ulcer with it even more I got home and promptly fell flat on my face at 8:15 pm, woke up this morning at 4:00 am to prepare for my super duper special betrothed spot as a guaranteed scrub in student for a radical nephrectomy (latin for: burley take out your entire kidney surgery) because I figured since said preceptor (mentioned above) called the attending surgeon, gave him my name and told him to absolutely let me in, I'd better fucking know at least something about something and maybe a vein or an artery. Or something. Since I was coming in all, yeah hi, I'm Amy, "the PA student", the one Dr. So-and-So called you about. Yeah, I'm special. Let me in. I don't know jack shit.

And then I left the house and forgot my scrubs. I forgot my scrubs. What kind of retarded surgical student forgets their *&@#! scrubs? I got all the way to hospital and only then realized I forgot them. And no, for those of you who might be thinking what I think you might be thinking, no. There are no scrubs I can "borrow". Or use. Or anything. I had to go back and get them. On the train. At 6:30 in the morning. So by the time I got back to the hospital, only 10 minutes after the scheduled start time of the alleged super duper special cool surgery that I and I alone was getting to scrub in on as a treat, the farking thing had been cancelled. Cancelled. Who does that? Who cancels their nephrectomy the day of? Like, yeah, I know. I have massively invasive renal carcinoma and that it's almost all the way through my renal artery, has grown into my adrenal gland and is adhesed to my liver but actually, I'll pass. Thanks.

So then. SO THEN. We had all these lectures scheduled for today that we sat around waiting for, moving from one lecture room in the hospital to another, only to have them all cancelled with one fell swoop, three hours later. So that was awesome.

But anyway, the point is. The point is, the point is. While waiting for mystery lectures to commence, I sat in our little locker room lounge reading Surfer Magazine (I know and all I can say is, I have no idea) and kind of dying inside. I don't know. Really, if you had a magical time travel space machiney thing and you appeared in front of me at that moment and were like, jump in my magical implausible time travel space machine thingie and run off to Indonesia forever and never look back and never return and never set foot in another hospital maybe ever again? I really might have been like, Peace Out and Word to Your Mother. For serious.

But, obviously, I didn't. Because I'm here. (And because they don't actually make magical space time travel machine thingies but whatever, like that matters). And then, the very next minute I was off to a coffee shop to shove enormous quantities of information into my brain and totally kind of sort of loving it. 

Because I'm clearly mental and need to be institutionalized. 

Sunday, March 9, 2008

delayed closure

I am hanging on a thin rope, clinging to a leaky lifeline, grabbing at faulty plastic to stay afloat. Something has changed in me, I cannot say what or when or why, but I am tired of this city. Tired of the trash and the noise and always always always-ness of everything around me. And I am so blessed, so lucky, so fortunate and cheeky, because where I live is quiet, and the streets are safe, and I know my neighbors and the trees are big. And in the summertime, there are fireflies. And I can walk the short blocks to the streets that are even nicer than my own, and I can bask in it by proxy, and I should be grateful. Because my apartment is lovely. The streets have gardens. In the spring everything is pink blossoms and muted brownstone. And there are quaint cafes and cozy restaurants and haughty boutiques that sell clothing that bewilders me at prices that astonish. All of this means something, quiet a lot actually. It means I don't live near the projects. It means I don't live in a musty multi-floor, mega-building in an apartment the size of a Brazilian bikini bottomIt means I don't live across the street from a hospital, or a major intersection, or above and below and on all sides of crammed in with people, living on top of one another, colonized. It means a lot of things and each of them is ostensibly good and I should be grateful and be quiet and suck it up and appreciate.

But somehow, lately, I can't. It's too much. Too much much. Too much trash, too much honking, too much too little too often. It's too hard and too fast and there is no softness anywhere. Not under my feet, no where I can sit or stand that is not made of concrete. No where I can sit or stand that wasn't made by someone for something. Fabricated. 

Andy is getting ready to leave Santa Cruz in the next two months. We are both a little soggy, a bit watery at this unavoidable truth. He tells me that it's beautiful right now: perfect, brilliant. Gorgeous. It is the Santa Cruz I remember: the surf double over head and glassy, the sun reluctant to set, the redwoods and cypress thick and green and golden. 

Sometimes, when a wound is too messy, too old, too infected or too fragile, the only choice you have is letting it heal by delayed closure. You just leave it be, not touch it. You bandage the area, keep it clean, dry, irrigate as necessary, remove the infection. Sometimes you can go back to it, close it up with stitches, neatly. And sometimes you just let it heal from the inside out, scarring its way closed, leaving behind the mark, a testament to the process. Sometimes I wonder if this is for me my own delayed closure, leaving behind one of my greatest loves of all time, a place kind of magic and immortal and perfect to me, packing the wound only now, long after the fact.

And there is much there that was hard and heart breaking and complicated for me. The bones of my own, old sorrows, the remains of all those necessary losses. And every place I can go there is no place I have not travelled. I have been everywhere at some point, at all points, of my life there. And all of it is filled up of me and my life, the happy ache and the anguish; every bit the architecture and landscape of nine years of life and everything that filled it. And sometimes I just want to return, to remember, to recall, to revisit. Sometimes I just want to go down to New Brighton at sunset and sit in the setting glare of light on water and remember. Remember coming to tend to every broken heart, remember the clear bright day when I met my soulmate, my husband, my mate. Sometimes I just want something more of a place that is my own, that isn't made up of grey concrete or red bricks or stone. 

Sometimes I just want what I don't have, because I am made up of faulty wiring and dysfunction and because it's always easier to see what's behind than what lays ahead. And because I am tired of looking at what lies all around me after a while.

Saturday, March 8, 2008


It's late in the morning here, I slept too long. Yesterday marked the end of a 72 hour week in the hospital, the last 36 spent consecutively. Last night was the first time I'd slept since Wednesday. There is such a different slant to life, the world around you, your own internal mechanisms, when you force function on thin reserves.

And today I have a homesickness of sorts, caught up in an an old familiar ache, for things beyond my reach, for small, quiet things that have passed or are gone, tucked into the corners of an old past, barely visible ahead. I miss the ocean and a wild, uninterrupted sky. I miss the thick, golden air, the lower hum of a different kind of living. I miss the quiet, laziness and slow minutes that stretched out effortlessly, so that I could be greedy and spoiled and use them all up, hungry, leaving nothing, full up and still grabbing.

I sit in my little apartment, surrounded by noise and grey, trying to recreate . My life has come undone around me, everything needs attention. There is much in front of me to do. But instead I am unraveling, so that hopefully I can pick it all back up again. Put things back into place, reorganize the unquiet within.

Part of me wants to give up altogether. After a week like this--after feeling as if I will never learn it all, or enough, after feeling as if I need more time, that I am not ready, that I want the benefit of more years, more books, more teaching but knowing that, in the end and no matter what, the onus is on me, to read, to learn, to adjust, to absorb everything--after a week like this, I kind of want to throw in the towel. After a week like this I can't stop thinking about waking up at dawn in Costa Rica to go surfing, walking with dirty feet through small streets, sandy and warm, full up with endless sun. After a week like this I can't help but wish for and want an entirely different kind of life, in a way that is infinitely unrealistic. After a week like this all I can think of in front of me is an older life gone by or an newer life not waiting.

And I stand in the murky middle, in the clutch between giving everything and being so excellent, and giving up everything and living life uncomplicated. I want each, and both, together, simultaneously. I want to flee to the Seychelles, exist unapologetically for enormous swaths of time. I want to move back to the ocean, live life again golden, red against the setting sun. I also want to be so amazing as the man I worked with, eagerly chasing, leaning in to hear every word, as we went from room to room, from sick to dying patient, in the blue-walled and buzzing Surgical Intensive Care Unit, filled from end to end with people. People in the full spectrum of death and recovery, in ways I hadn't seen before.

And when a chief resident comes up to me to ask my name, the same chief resident who yells out at morning report, the chief resident who is at once dismissive and kind, saying things like "extremely impressed", "better than some of the residents", "one of best students we have" I want to die and fall into the floor and can't help but turning around to make sure he isn't talking to someone else, isn't mistaken. Because I feel as if I am drowning, as if I know nothing, as if I know I've read about everything once, but remember nothing, that it isn't available in the back log of my brain, that it's come, and gone. And I want to die because when someone like him says something like that, all I can think of is, "oh shit, I've got a long fall in front of me from grace".

And it happened time and time again. Somehow there was a mistake. And each of them came up to introduce themselves, tell me they hear "how strong" I am on the unit, am I considering surgery. And each one of them didn't even try to mask their shock at learning that I am "only" a PA student. Which made feel fucked up and frustrated, because I don't know anymore what I am, whether I made the right choice, if I should have gone on to be an MD, or not.

All I know is everything I don't. All I know is that the man I worked with, the fourth year resident, the best I've seen, was amazing in a way that made me crazy. Because all I want is to be that good, and all I can see is how I am not. And I don't know if I ever will be. And when he took me under his wing, made notice, gave me praise, it only made it worse each time I didn't know an answer, didn't full understand a concept, had to reveal my weaknesses within. Because I felt that I had disappointed him, made him question his faith in me afterall.

So instead I recede, retreat, reconsider. And all I want is to replenish, one day of sun. There are too many parts of me to take care of. Too many things inside to keep in order. I fear I am not single minded enough ever be happy, that there will always be a part of me that is sullen and sulky, sitting in the corner, feeling ignored.

Sunday, March 2, 2008

friend of the devil

Okay, so to start, I've slept. A lot. It was delicious. And when I say that sleeping in until 8:00 am on a Sunday is not, in fact, beyond the pale, it's because it's exactly 4 hours and 15 minutes later than I've been waking up every other day and that's just fucking wonderful.

Also. The sun is out. And I fell asleep before closing my blinds. So I woke up to actual full spectrum sunlight, unfiltered by white paper, which was surprising and jarring and lovely. 

And then I had coffee, with just the right amount of milk and sugar. And everyone knows that coffee is magic. And now I am sitting in the thin rays of Sunday morning sun and I am thanking everyone profusely for not only saying really nice things to me as I blubbered and wiped my virtual snot all over you but also for not turning, running away and screaming GROSS at the sight of all that emotional vomit. Seriously. I was just a few days ago considering discontinuing this site and not using a blog as a form of catharsis, because it's becoming something other than what I think I first anticipated, which was a place to put my sticky insides so that I don't have to walk around with them all day, everyday. 

But I've found recently that I have this lurking feeling of inadequacy that there are only about four people who actually read this thing, and then I have to Address Why I Am Writing A Blog. Which I didn't. Because I am lazy and secretly suspect that as much as I need to write, I also need to feel popular and cool and well liked and totally fucking awesome.  Because I am still fourteen, apparently.

Anyway, for now I'm staying because you all are the raddest, most wonderful, most kick-ass readership of four a girl could ever hope for and well, you're funny and beautiful and your hair looks great today, too. And I have I told you how much I love your shoes? Stunning, really.

So that's all. This is only to say, thanks, you're awesome and here, have a wash cloth, I think there's still a little bit of my barf on your sleeve.

Saturday, March 1, 2008

my heart's the bitter buffalo

At some point yesterday I lost my mind. Actually, it was right around 5:30 in the afternoon, that much I know for certain. I was on the phone with Andy, washing up the remains of my 3:45 in the morning coffee, when I asked him how things were going with the house--and before anything else, I haven't been talking about freaking out about the house lately because Things Are In Contract and Negotiations are being Countered and lots of Faxes are Being Signed and none of it has, or rather can have, anything much to do with me, so I've just been waiting to see what happens, asking Andy every now and then how things are going with it and usually am met with a "about as fun as cutting my own testicles off, actually", so I generally keep my mouth shut. 

But the thing is this. Whenever he does talk about it, whenever it comes up in conversation to friends or family or the bogglelingly well-connected network we have access to here in New York, he uses words like "I" and "me", which breaks my heart and makes me crazy every time. This is, admittedly, an old wound for me. Long ago and in another time I had a boyfriend who was always talking in "me's" and "I's", even and especially about things we had clearly done or invested in or built or made together. So my vapor point is a little low. 

And I'm exhausted. And I'm tired sometimes of being 49 states apart. And there are strange things, poorly defined, malignant things about me that reside in the soft recesses of my mind that exist for the sole purpose of Making Things Complicated. And sometimes they get the better of me, and sometimes they win, and usually it is about one or two predictable, reliable Issues that live like squatters in my heart.

So when I asked him yesterday, how things were going, and he read to me an email that he had sent to the sellers, informing them that if they didn't get their (literal) Shit Together in the form of Septic Tank Issues, he was "prepared to walk". And then I got really upset. And I told him what a terrible bastard he was, or something close to it, and that he was insensitive and what did it matter anyway what I had to say about one bit of it, since he was clearly making unilateral decisions and speaking as if he were the only person involved in this. And he told me that he was the only person really involved in this, well, because it's true, but that drove me even further into insanity, because school has completely eclipsed everything in my life for two straight and uninterrupted years and there is not a goddamn thing I can do about it. And it makes me crazy and I feel powerless and every damn time I have tried to sneak out a little bit early, or stow away for one day, to do something like look at a house we are buying one more time to really make sure it's the right decision, each and every time I almost jeopardize everything I've put into the past 19 months in the form of getting found out and reprimanded. And then I have to sweat and try to cover my tracks and come up with Great Excuses so that I don't look like a Complete Fucking Asshole to my program because at some point I fooled them into thinking I was A Really Excellent Student and there is nothing worse than falling far distances from grace. 

And then my brain melted. So when he tried to tell me that, although he's the only one involved in the process of buying "our" house right now, at "some point" it will be both of ours and "you'll be paying the mortgage too" and who cares if my name is no where on any of the Contracts or Bank Notes or Emails and who cares if I am more of a financial liability at this point than anything else and all I've done for the past two years is suck enormous amounts of money into the vast black hole that is Living In New York, not to mention the small galaxy of debt called Student Loans. And so when he said that, especially the part about "you'll be paying the mortgage too" I really fucking lost it. Because not only am I supposed to graduate in 6 short months and suddenly if not miraculously, be able to autonomously manage patients on my own, setting out on shaking feet towards my Career In Medicine, but I'm also supposed to create, carry and care for our future and abstract ideas of Children. In the next five years. Before my ovaries blow out.

All of that. Simultaneously. 

So that's when I said that I'm not going to have children, actually, because clearly I need to be focused on my career and making money and trying to rectify the financial inequity that has existed between us for so, so long. And while I'm at it, I'm not going to have horses or travel, ever, or do one more goddamn thing that generates any kind of expense and never fucking mind if I just wrote twenty goddamn paragraphs about how much I hate surgery and no amount of money could ever entice me to go into it because of a detailed litany of reasons, I'm actually going to work seven days a week now, 12 hours a day. In fact I'm going to get two jobs. Because I'll be fucking damned if I can continue to go on living like I'm just a side note "wife" to the greater (financial) force of anyone.

That's what I said. Because I was feeling hurt and hurtful. And I wanted to balance out my own frustrations and anger and pain by inflicting some of it onto someone else. Because sometimes I am irrational and angry and probably need more therapy.

But in the end it was hard and horrible and hurtful. And in in the end it remains an enormous, impossible problem for me. Because so much of myself and my ego and my identity is wrapped up like a messy bandage into my career and medicine. I have alloted and sacrificed and invested so fucking much into it, from wanting to go to vet school at 19 to deciding on human medicine at 24 and finally choosing not to go to medical school but rather PA school at 30. And ultimately I choose PA school so that I could have a life and a family and some kind of balance. And rarely do I regret the decision. But sometimes, when I am feeling marginalized and unimportant, when I am feeling as if I've given up far too much for strange little, I fall into the familiar territory of, well, at least if I had gone to medical school I would be a doctor. Because apparently I am still juvenile and against all the evidence indicating otherwise, I harbor the unrealistic belief that being a doctor will somehow vindicate me against every imaginary injustice I've come across.

And now I am 32 turning 33, and I am about to finally be done with school after being in it since I was five and I already have all these Issues about not being the Best Student, because I could have been, but choose--or sometimes had to--instead to also be a wife and a friend and a daughter. And I already have all these issues, that I am just about to begin, finally, and at last, after years of life and pounds of flesh and blood and sweat and tears, doing what I've been trying to do for a decade. And, instead of being able to really do it, and be excellent, I have to think about how to balance not only being a partner and a friend and a daughter and a sister in law and an aunt but also a mother and a caregiver and a medical praciticioner and I have to be excellent at all of it. Instead of what I have been, which is mediocre in all. And I don't have the time anymore that I used to, to take a moment to Figure It All Out. The moment is now, my fertility is now, my career is now, my relationship is now. And I have this incredible husband, right now. I have this human being who, against what should certainly be his better judgement and despite everything, loves me astronomically, whom I love enormously, even though I am sullen and hurtful and stupid at times. And he gives me everything he has, which is born out of love but creates lots of Complications, because I haven't lived of life of being given much of anything. And I am stubborn and prideful and full up of my own, idiotic Id. And in the middle of all of this, at the center of it all, is the small, nagging, fearful realization that, after all this time of trying to Be, I really don't think I ever expected to actually Be anything at all.