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.

weekend edition

I went out "the country" weekend with my mother in law. Just her. This is not an unusual occurrence and proceeds a little something like this.

propriety

I do this every time. Every single time I go out to "the country" thinking that it will be, actually, in fact, just hanging out and lazing around the house no need to bring anything special we're just going to cook and enjoy ourselves and not, we're going to drive into East Hampton and I'm going to follow her around to stores that sell $25 hand soap and $350 cardigans wondering why on godsfucking earth I fell for it again and left without at least washing my hair. Such that the shitty little finicky gay boy behind the counter folding the $450 jeans with platinum inlay tissue paper will openly smirk at me with exasperation and pity and I will want to sidle up to him and say "fuck off Frenchie, I know you bought your jeans at American Eagle".

But instead I have to suffer standing in front of those full length mirrors in jeans that are too big for me a white long sleeve tee with a coffee stain on the elbow (I have no idea) and flip flops waiting for her to decide on Mustard or Mud. Or maybe both? BECAUSE WE WERE SUPPOSED TO BE HANGING OUT AT THE HOUSE. While shit head with a pompador behind me shakes his head and my mother in law, who has given me the kind of stuff that could have funded a small nation, sifts through the hangers wondering why her daughter in law can never figure out how to put together decent outfit already.

glass house

My mom calls. Often she feels left out and far away, living an entire continent and half an ocean away. She is in an unsettled place, getting ready for retirement, watching my niece and nephew grow by inches and feet, helping my father, her ex-husband, say goodbye to his parents, her ex-in-laws, over the last few months. She is resltess about life and not wanting to let anymore time without each other accumulate. So she calls. Because she knows I am out there, because she knows what I'm up against. We talk. About the kids and our plans for this summer, when will the house will done, when will the construction will even begin, when will you be in New Hampshire? All questions I don't know the answers to, and she knows it, but we talk about it anyway, because it makes her feel included in my everyday life. I hang up the phone and smile, thinking about my mom, so far away, plotting our final escape as far west as it will take us. My mother in law says:

"God, I can't believe you have to put up with someone who talks so much. I mean, she talks all the time, does she ever stop talking? I could never put up with someone who talks so much. I mean it just seems like all she does is talk and talk and talk and talk and it must have been so hard for you, you must be very scarred".

"Um, no, not reall-"

"I mean, she's so self centered, all she thinks about is herself. I would never do that to my children. I would never call them up and ask them so many questions. I mean I just think if they want to tell me they will. I'm sure it's because I had boys and your mom was never close with your brother, so she never learned these lessons, but I would never go about interacting with my children, how do you get a word in edgewise?"

"Well, actually-"

"I mean, I could just never be with anyone like that. Just the other day I had to tell _________ that I can't spend time with her anymore because all she does is talk about herself. She calls me up and just starts talking about herself and it's like and I just can't have that. I have too much going on in my own life to have to listen to everyone else's problems, you know? I mean, what with everything going on with ________ and then there was the _________ I just don't want to do it anymore. I can't see how you do it. I wouldn't do it. If it were me I woundn't do it. I mean I know you feel like you have to do it but I woundn't do it I don't know how you do it. You must be very scarred."

"Yeah, it's really not like-"

"I mean she's a lovely woman and all, but if she were my mom? Well."

"....."

stones

My husband's best friend died eight years ago. From a drug overdose. His family is a Very Big Deal. Like in a Global way. Every year people fly from all over the planet to gather at his grave and remember him. It is many things. It's a still sorrow existing in dozens of people who come, year after year, to remember their friend, their cousin, their nephew, their brother. It's a hard beauty, surrounded by so much spring. It's a lot of laughter as people gather together whose lives have otherwise splintered apart, it is a reunion, a recollection, an embodiment of joy and remorse. I have been twice now, and each time I walk away thinking it is a thing of beauty, it is an amazing feat and a testament to the strong bonds of love and sorrow.

She asked me if she could come with me this year, she hadn't been in years. I was going alone, Andy back in California tying up our loose ends. I said yes, of course, how lovely. I had no idea.

Saturday night, before leaving the next morning to the cemetary.

"God I do not want to go to this thing tomorrow"

"...?..."

"I mean, this is so fucked up. This whole thing is so fucked up. His parents killed him, they're the ones to blame, they probably want to die from the guilt. It's all their fault, if they had ever said no to him once in his entire life he'd still be alive today".

"...."

"I mean, it's so absolutely fucked up. Everyone around him is to blame. Every single one of his friends is completely to blame here. If they had just picked up the phone once, just once, and told his parents, he'd still be alive today. I will never forgive any of them for not speaking up."

"Um, actually-"

"I mean, whatever. He killed himslef. There's nothing any of us could have done. He was totally self absorbed. He thought he ruled the world. He was a little Prince and untouchable. There's nothing any of us could have done to save him. It's all his parents fault".

"...."

sunday
Driving home, at last, after its all over, all done, listening to New York NPR. There is a discussion on Fur: Couture At The Cost Of Morality? There is a man on the panel, giving out all the names of "fabulous" designers who design without fur, would never use fur, whom all the stars love and adore.

A woman interrupts him. "Yes, but David, I had this problem just the other night. I was going to the Opera and thought to wear my grandmother's fox stole. I mean, it's already dead, why waste it you know, AND BESIDES, David, if you can't wear fur WHAT WILL YOU WEAR TO THE OPERA?"

At which point I rolled down the window, unbuckled my seat belt, and jumped into traffic.

serenity now

Wading today through the new puddles of April, dutifully on my way to the train, I pass by a man in a black SUV at the exact moment that he lays on his horn. For seven full seconds. Seven. One Mississippi two Mississippi....all the way to seven. It's 6:35 in the morning.

A few feet front of me a woman is pushing a stroller, all wrapped up in plastic, through the cracks and pools of rain. She stops abruptly such that we almost collide and as I pass her she reaches out to the front of the stroller, screaming Goddamnit Johnny stop fucking with the plastic!

I am this close, I think, to buying a box set of Nature Sounds: Call of The Wild to Ocean Blue. Because the few intact shreds of my corpus callosum are about to explode.

********

I am shy. I hate attention. I fight the urge and act of fainting whenever I have to talk in front of more than one person whom I haven't known for a year, minimum. I sit in the front of class because, when I have to ask a question (because I always have to ask a question) no one can turn their heads and look back at me, face me full and frontally, make my heart pound and sweat. I am not an eye contact maker. When people compliment me ever, on anything, I am always so shocked and mortified that I invariably say something really inappropriate and aprospo of nothing. "Oh wow, thanks. I actually stole this from an old lady. HAHAHAHAHAHAH". Hands flapping uncontrollably at my sides like an encephalopathic ostrich. 

And yet, I walk now--in the hospital, on the streets, along the crowded sidewalks--belligerently making eye contact, unyielding in my hellos. Especially in the hospital, always in the hospital. It is, I can see now, the only way to survive. To force contact, to create connection, to make me human, to make us collective, to make me to others tangible and real. And when I say I would never have done this a year ago, it is both that never before would I have willingly, intentionally, systematically called the attention of a stranger onto myself and also that I never lived a life like this, feeling so separate from those around me. In this way, in this wonderfully curious way, I am so very changed by this city.

*******

My patient is dying, very painfully, of metastatic prostate cancer. It was diagnosed late, as it is with so many of our patients, after it had spread to his lungs, invaded his bones. He came to us like something out a textbook: elderly man presents to ER complaining of back pain. An xray is taken and on it you see lytic lesions in the lumbar and sacral vertebrae. What's the most likely diagnosis? But he, despite this sadly generic pathology, is nothing to me most likely. He is a 79 year old man, lucky enough to have a bed by a window, spending his days slowly in pain.

We met at the beginning of the week. In a rush of informality I was assigned to him, patient is in room *** go get his history and present his case. Almost as an afterthought, distracted by his discharge papers, the resident brushes me away to him. 

I read his chart, review the CT, the MRI, the series of xrays. The lab work is dismal but nothing is worse than his films. He has a 4 x 3 cm metastatic lesion in the middle lobe of his right lung. There are lytic lesions in 4 of his 5 lumbar vertebra, and they have all collapsed onto each other. His has a lesion on the 4th and 5th cervical vertebra and they are threatening to collapse. If his spinal cord becomes compressed he will be a quadriplegic. If the lesions go any farther up, it may paralyze the nerve that allows the lungs to inflate.  There is much to worry about with him. The least of which seems to be his pain. The constant, unremitting, intractable pain.

We sit in the thin grey light of early morning in a room with a window. Every movement for him is agony and I have forgone the physical exam beyond any region not immediately accessible. The bones of his sternum protrude out by inches, the inappropriate invasion of a distant enemy. This, he tells me, is where it hurts more than anything. All fundamental actions: breathing, talking, shifting his weight render him breathless and panting. I have felt this so many times before, this powerlessness, this inability to ever make it better, and I am no better at it today. It is everything I can do, it is a minor miracle and a major accomplishment, to get the resident to prescribe a pain patch, to consider a pump that he can press himself for some relief. 

We stand in the dark part of the hall, near the wall at the back, outside the door, looking in. He needs to get well enough so I can send him to subacute rehab, the resident frets, I don't want him dying on my floor. And in that moment I am struck by such anger and awe, and it is all I can do to keep from wondering, as I peer into the face of one of my teaching doctors, if this is the inevitable outcome for me: worrying about my monthly statistics, angry that "yet another" patient has died on my shift?

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.

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).

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. 

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.

bleary

Sometimes New York is magic. All I can say is: post-call, 32 hours straight in the hospital, so f-ing exhausted I almost left my eyeballs in the SICU, can't move, too tired, too cold, stupid wind-chill, negative twelve, no cat food, no milk for coffee ohmygodpetstoreandgrocerystoredeliverysleepalldayinpajamas

opendoorshovemoneyatpersonTHNXbye.

One. Hundred. Percent. Genius.

days lost

I hate the grey brown film of too-early winter mornings when the sun is far away and faint and pointless and I'm so tired I'd crawl home on all fours except that there's unidentified liquid objects covering the sidewalks and this is the West Village, New York. I hate sleeping during the day. It's not luxurious or relaxing or restorative. I hate drawn blinds and the oppressive thin white light that leaks beneath my eyelids. I hate days lost and dark hours and fluorescent lighting and the full-room sadness of watching strangers ail publicly on narrow plastic hospital beds in the crowded halls of an impersonal ER.

.

It has taken about 98 hours of no sleep and dark-night and bad coffee and  shift work to loose my soft green sympathy and it winds me how easy it is to turn bitter, grey and grumpy. It is so fucking hard not to loose your whole heart in the hard light of the hospital, with a full board list long full of names but no faces and the off-on-off red lights in the ambulance bays that won't quiet and I am trying to remember to resist it with every cell in my body. I'm trying to remember, but forget more easily day by not-day by day passing. And the nurses are tired. And they are old already, and angry. And everyone around you-me-you is doing it; it's easier to be angry and tired just like cigarettes and coffee is cheap and available and it's really a lot of effort to remain cheerful after being bitten by the woman screaming in her bed, against her handcuffs, against her demons.

.

Most of them are intoxicated. Many are cold and homeless. A good number of them are both. They are drunk and broken and smell of their own urine and vomit and blood and folly. If they can speak they do so loudly and are want to repeat the same things. Over. And over. And over. Again. They are the distracting injuries. They are poor historians. They are listed Unreliable. They are the stereotypes and the statistics and, reliability or not, they are predictable, expected, thick in numbers and coherence. Uninteresting and limitless.

.

But others are not. Not drunk. Not wasted. Not high. They are not here because of blue-sirens or substances. It is hard to remember about them, the sick and the painful and the sad and the fearful. It is hard to remember about the quietly ailing in the midst of the robustly injured and overtly inebriated. And sometimes, just for a moment, I will stop, when I forget to care that others are looking, and focus in on one. On the old man, fragile, delicate, dying, in the corner by himself, grasping his tubes of oxygen, taking it all in, looking out from the middle of the end of his life and I realize: this is what he sees:

strangers, exhausted, angry, caught up in the mechanisms of our own lives, our small annoyances, our short tempers, our own imperfections. 
.

It is usually and often more than I can hold on to, it usually and often takes my breath away, it usually and often renders me tiny, empty, pale and powerless. 

I hate days lost and drawn blinds and the thick film of sleep on my skin. I hate waking up in the evening, feeling bit by bit by bit, my soft green sadness flaking off, leaving behind a hard center: dull and grey and unrecognizably familiar.

driven by quiet fire

Sometimes, I feel such ownership of New York. Sometimes, when the city is bright and thin and golden, I stretch out into the thick center of it, the heavy of abundance of this city, and invite it in. Sometimes it is more than I can take, there is no space for everything here. More times this city is hard and heartless and heartbreaking. More times it is chaos and urgency and inequity and the weight of those who have unto those who do not is hefty and real. More times, even in the comfort of my wide, Brooklyn streets and aging, dark trees I cannot see enough emptiness in front of me to quiet the quick pulses within.