fight or flight                                                                      

Often I feel as if I live this life like an animal of prey: unsettled, tachycardic, diaphoretic, always waiting for the trap to spring. In the early light of June in the small, thread bare library on the third floor of fourth wing of my little, broke-down hospital I am sitting in sweaty disbelief. Leafing through the pages of my evaluations, a kind of praise and accolades I will never be accustom to, having just been offered a job and an award for which I was never a legitimate candidate, what occurs to me most is that I am loathe to be separated from the pack and that a fall from grace can seem very long and hard when you are afraid of heights. 

When it comes to praise I am awkward and inept. I fumble at the strings of my scrubs, flush and tremulous and mutely inarticulate. I press hard against the inevitable, internal reaction of just wait, soon you will realize how little I know, how uncertain I am. I dig in against the urge to run, pressing my nails into the flesh of my palms, wondering always and again, why it was that I was given such an unusual, hard-beating heart. 

stockholm syndrome

I came to New York to get my hands dirty, to be in up to my elbows in a mythical urban grittiness. It was to be all gun shot wounds and sweet old men from Russian with poorly defined illnesses from which I would surely nuance a diagnosis. It was going to be big name hospitals in the big, big apple. I would be exhausted and, occasionally, discouraged, but althogether rewarded and balanced, my sanity still neatly intact. I came instead to floors with no sinks and nurses with no mercy and patients with no money, no insurance, no education, no choice. I came to a place where everything was a struggle, a place where I learned to beg, barter and steal. A hospital that demanded I confront my own ill-defined ideas of racism and prejudice and cultural idioms. A population that demanded of me great change and, in exchange, made me infinitely better than I ever predicted. 

On my way out, for the last time, through the sticky revolving entrance I turn to the security guard to say goodbye, heavy with everything I have accumulated in a year, and he smiles crookedly at me, nods. Peace out white girl, he says, stay safe. We knock our closed fists together, opening them to grasp each other's fingertips into a soft, sloppy snap (because I'm ghetto now, you see). At the bottom of the circular drive upto the enterance one of the janitor's comes up to me and says you out, mami? Si, I say, I'm done. You be blessed now, you hear? she tells me in the thick Jamaican accent I am certain to miss. You too, I say, and we part ways. She into the cool dim of those fluorescent floors, me into the bright squint of day.

And I am dirty to my elbows. And I am okay, at last, with the stains.

land locked

It's not that I'm unhappy per se, it's just that I miss the ocean. It's just that I miss diving down deep under and coming up to breathe. It's just that I've been homesick for surfing and sandy sunshine and water and ocean. It's just that lately my dreams are like this

thicker than water

I have been carrying around a homesickness that is heavy and hard and hallow. It lives like a small bird in a cage, like a structure in my heart, and there are times when it is all I can do to hold on to it, contain it, keep it in situ. 

I've taken the long and far road from my small home in the middle of the ocean. Sometimes I don't know if I will ever go back again, if I can, or if I will. But I've been dreaming of water, and iron woods, and muddy sandy children. I miss an entire section of the world so much sometimes I wonder if I will always live like this, walking around with a half-broken heart.

as it were

It's not so much (or only) that I hate the city, it's just that, I have no idea what the point of summer is without an ocean. Or a lake. Or even a slip and slide. Driving around Brooklyn yesterday, watching kids try to come up with ways to play outside, locked in and trapped up, staring side-long at the hot, dirty faces slumped over on the stoops, I had this flash of how different my life could have been, how different I could have been, under any number of different circumstances. How easy and fragile and specific and intricate our little lives end up to become. If I had grown up here, how different would I be?

You should be a doctor. I hear that to varying degree and from time to time. I hear it more now and recently, here in my shocking and unsurprising niche of Obstetrics. You should be a doctor, they say to me and it is a dense and messy thing in me and I rarely handle it gracefully. You should be a doctor. From my mother in law it drives me bat shit crazy, from the residents and occasional Attendings, I wince and shake my head and clutch at the remnant part of me that agrees. What I should be is in ownership of my profession. What I should be is confident and secure that I would ultimately be no different, no better, as MD. What I should be is grateful that I am now finished and not looking down the barrel of six more years. What I should be is unenvious and relieved and contended. What I often am is left wondering if I should have been, could have been, would have been more.

bazaar                                  

On Friday morning, when I walk into the clinic, Leroy is standing behind his desk, wearing all white scrubs, snakeskin boots and rocking out to . Our eyes meet, he puts on arm up, one hip out, swivles in a circle and says Oooh girl, you're looking fierce today child. 

In the waiting room they sit for hours. In the sweltering heat, without air conditioning, in the dark. They are waiting for us, for me, to call their names, lead them through the narrow yellow halls into small rooms, ask them about their last normal menstrual periods, measure their fundal heights, find the small, fast heart rates on the doppler monitors. They sit for hours waiting for a routine sonogram, a yearly exam, laboratory results. Without insurance there is no one to complain to. Without insurance they voiceless, powerless, stifled and sweaty. They wait to be seen by a handful of expert clinicians with swift hands and thick Russian accents but settle instead for us, a bevy of blundering students, to provide some of their most intimate care. It is to these women--dark, bright, braided and beautiful--that I am wordlessly grateful to, for allowing me access to learn on them in a most visceral, surprising way.

exposure

In the operating room there is little mercy, save the relief of anesthesia. In the operating room after the quiet rush of anesthetics, the business of surgery is swift and sterile and succinct. Patients are positioned in ways that best serve our access--exposure as it were--humility excluded. In the operating room, beneath the blue drapes and the sterile towels and the rows of glinting instruments, lay sleeping people who have come to us with hope and fear and eager trepidation that we will improve their current station, that they will, to some affect, leave us better than they were. In the operating room, beneath the hot lights and the glare of the scrub nurse, it it easy to forget who is beneath there, a full life on the wrong side of the scalpel. In the operating room, standing in sterility and in front of my patient in a most comprising position, I am reminded in a rush that this is a privilege, that I am the most fortunate one, that I have been given people, in their most intimate moments, from which to learn. In the operating room, in the clinics, in the exam rooms and on the blue floors left sinkless I am reminded that I have had the very particular privilege to to see so many so sick and it when it comes it feels something like salvation.

desamparado                                        

Because my mom is Italian women, usually older, often come up to me and address me in Spanish. ¿Hermana, hermana usted habla español?

No, I say, no. No habla espanol. 

Pero necesito descubrir cómo conseguir el 38.o autobús de la calle a través de la ciudad. ¿Puede usted ayudarme? ¿Puede usted ayudarme? ¿Yo necesita conseguir al autobús, usted sabe donde está? ¿Usted sabe donde está cercano el 38.o autobús de la calle a aquí? ¿Puede usted ayudarme mi hija?

She stands in front of me in the sweltering heat, sharing the small slice of shade on the scant green hill in front of the hospital. She is hunched over, wet with perspiration, face peering down at me, hands out in the air, talking. Talking. Speaking to me in a language I do not understand, asking for something, a bus, directions, how to get home. Eventually she stops and looks long at me, believing at last no habla espanol and I am left, again and always, feeling full up of all the ways I am unable to help.

parity

My 19 year old patient does not speak English, save the words shit, ouch and no. She has been brought here by her boyfriend from the Dominican Republic, the DR, so that she could give birth to their baby in America, so that they could have some kind of chance of a life told better. She has vomited three times. She is alone behind the curtain in our triage, those are the rules and she obeys them. I come in to meet her and she grasps my hand with such strength I can only think to myself, shit, that's my right hand and she's going to break it. I admit her to the labor and delivery room--small and uncertain in such growing autonomy--holding her hand, wiping her forehead. And when she says, an hour later, after I have inserted two gloved and sterile fingers inside of her to asses her dilation, her effacement, the baby's station ella es mucho más suave que el otro doctor I know only that I have not hurt her in the process, a sure sign that I am doing it wrong.

When she finally delivers I have already gone home, exhausted and spent after the labor of a 36 hour shift. I did not get to see her daughter, or say good bye, good luck, good pushing; and yet, as my first patient in what I now know is going to be the rest of my professional life, she is indelible.

gratitude

There are so many things for which I am grateful. Bird songs, coffee with milk and with sugar, soft cat-chins, Andy. I didn't want to just write a comment response thanking each of you for your comments, for still even being here, because it means more to me than just a comment thanks. Really. Really. Thank you. Thank you for checking in and I am still amazed at those of you who haven't checked out completely. I heart you utterly, messily, fantastically.

hiatus

I've never been comfortable conversing or writing or talking here as if I had some kind of audience (because really, lets be honest, I love all six of you but this isn't a sock puppet show. Additionally, I figure you all have fairly involved, riveting lives that haven't been too disrupted by my recent absence) here. I had intended and hoped only to carve out some kind of space to exfoliate the dead patches without making myself raw. Maybe--vaguely, unintentionally--I hoped to find a handful of other people, flung far across these small distances who were something kind of the same. And I have. And I'm grateful. And I love it.

I'm not sure why I haven't been writing lately. I can't quite verbalize what's changed or shifted. My brain still works the same, functioning to formulate thoughts as if they were words on a page; my daily chronology categorized in squares of words and paragraphs. I still have the compulsion to write and always. But I haven't. I have not read, I have not written. Perhaps because everything might come out a little bit like this: I hate New York City I hate New York City I hate New York City I miss Santa Cruz when do we get to move already holy fucking christ I'm about to graduate I'm not ready I don't know anything I'm going to be a terrible PA all I want to do is plant roses.

Which is only mildly interesting. And that's assuming you're on your third gallon of whiskey.