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.

cluttered heart                                           

I used to think that melancholy was a byproduct of being younger, leaner, less steady with our compasses, all the terrain in front of us uncharted; a direct metabolite of intentional disillusionment and green ache. I used to think I would out grow it, some day, like shoes. And I would keep it around as artifact, like a tumor taken out and put into jars, to show to myself: look, look at that, you used to carry that around with you. As if I were cured. 

Driving the green miles of my new roads in New Hampshire, surrounded once more by big, empty beauty, quiet finally inside, something comes on the radio and I am suddenly, unexpectedly nostalgic. And it is a hard grasp to see that I have come so far from there, that I have already gone so long, when sometimes nothing on the inside seems changed. And just like that, in the middle of my life right now, I'm back again and younger, drunk on liquor and life and cigarettes, looking up at the sky, mending a fragile heart, counting stars.

low definition 

My mother in law sends me this as a link from The New York Times and immediately I am angry. I am angry and annoyed and small childish. Because this is my life, in a nutshell, although in some ways even less glamorous and more chaotic, as this is not my hospital. My hospital does not have translators, or computers or sinks. My hospital is even more poor, even more dense, even less dazzling. To write up an article on the hospital I work in would be to outline an exercise in failure, a fall out of our humanity. 

And I am angry. I am angry because never has she asked about what I do, what my day is like, since it is unattached to Important Names and Things To Brag About. Because all New York is about, at this level, is attachment to Enormously Important People and if you are not attached, well...  I am angry because I have, for the past two years, bounced between both upper sides of Manhattan and the underserved in Brooklyn and the stark contrasts have made me schizophrenic. I am angry because as I share meals with them, they laugh and roll their eyes, as if we were talking about a stain on a shirt somewhere that won't come out; as if it were nothing less than a nuisance and when will I learn to choose a better cleaner? As if to say it is somehow my fault, or my patients. I can almost somehow hear the word that's what you get for working in the ghetto. And I am consumed by undifferentiated rage.

And since I am passive aggressive and an impostor of a New Yorker, I send her an email back. I want to say "goddamn you for only paying brief attention because someone finally got it together to write an article about it in The Times. Goddamn you for being so specifically clueless. And goddamn you for rubbing it in my face". But I do not. Instead I write something terse and childish like, Now you know what my life is like every single day. Minus the computers, the translators and the sinks. And yes, my patients are also very, very sick. 

Because I am ill-equipped to live like this.

adios

Sometimes life is so f-ing beautiful and lovely that it seems like the only thing you can do is stick your head in the toilet. Just to get some perspective.

On Friday Andy was being a little irrational totally insane kind of complete f'er particularly special kind of human such that while standing in the driveway, talking on the phone with the insurance companies, I had no other choice but to flip him off. Because I'm classy like that and really believe in communicating my feelings. Later in the afternoon I looked him in the eyes and apologized for giving him the finger. It's just that, it was because I wanted to punch him in the face.

And so is the end of our little lives in Santa Cruz. We've said our goodbyes, I've doubled my body weight in huevos rancheros and halved my Time To Full Body Face Lift. Andy got poison oak in an assortment of places that usually go along with the words: and that's when I realized it was poison oak and not, say, that barmaid in Bulgaria. And can I just say how it never ceases to amaze me how many people get poison oak in places only Bavarian barmaids and a few well trained physicians are normally privy to and that all it takes is one person to open up the conversation for everyone and before you know it you're openly discussing (in depth!) someone else's genitalia and I've just never gotten comfortable hearing the words my vagina in casual cocktail conversation? 

wilder

Willow comes in from San Francisco to see me. We walk around downtown in the sunny chill of April, contemplate Buying Things. We clutch cups of tea and coffee and talk about the heterogeneous ache of life, the disappointments of being human, our own small denials, our little lives in medicine. We use hard laughter, soft voices. I adore her deeply, wholly. I understand why we are friends. 

Vicki, my Hawaii sister in law's sister, leaves work early and we walk the trails of Wilder. I am saying goodbye to friends and family, tracing the blueprints of my life. Every place that I go is a place I have been to so many times before, during very specific times, certain sections of my chronology. This is where I came to outrun an old heartache, that is where I used to drink too much and smoke stale cigarettes, this is where a long ago friend once lived, that is where I would go to watch the water, regain my footing. Wilder is where we are are today. It is an old farm at the base of big, open meadows and I bury my head in the tangled manes of the draft horses, slip them slices of apples, breathe in their dirt. Wilder abuts the Pacific directly; it is sharp cliffs and strong waters and from the top of it you can turn around and see the whole world in front of you, bright blue and unending. 

Vicki and I sit at the top and watch the whales cross the ocean. We try to spot the babies but are only able to make out the spray. She is not my family by blood but we are bound by strong love and shared history. We are so different and so much the same and we will always be a little more than family, we will always be friends.

the long road                                                                

Flying tends to give me migraines. I sit there like a furtive junkie, watching seven straight hours of Bravo and Animal Precinct, unmoving, tucked up like a small fish in my standard issue leather seat. I never drink enough water. I've always eaten a really bad slice(s) of pizza at the airport and I rarely, if ever, open the Cardiology or Nephrology texts I've lugged on to allay my guilt and neglect. 

Such that I return, bleary and famished and squinting, home.

Driving back late at night from San Francisco I stick my head out the window, drink it up. Suddenly and abruptly, there is sky. Stretched out and pin-pricked, thick and uninterrupted. Acutely, ceremoniously, where there was once dirtyfastloudloudscreamhonkpushtrashtrasheverywhere there is now the dark light of midnight and the unalloyed wash of moon. And instantly, unequivocally, I am better.

wind and sea

The bleached out bones of my life are here. I have not tired of Santa Cruz.  I still love the wide, patch work streets, the low trees, the quiet houses, the dank redwoods, my separated life. I love it fiercely now, today, two years out and away. It is notrashnosirensnohonkingscreamingscratchingbigrigsontheexpressway. 

It is quiet, it is only birds and seals--barking, scrapping, fussing over sun spots--and an occasional lawn mower. It is only open windowed sunshine and the clicking of dog feet on hard wood. 

We walk out in the strong on-shore winds to the ocean, lean on the iron railing, look down at The Lane. In the mornings we go to into the redwoods, padding quietly along the paths and needles, shady cool with little sun. The afternoons are all chilled, damp air hung out to dry in the sun; the mornings are full up with kettles of tea and coffee mugs.

The minutes go so slowly, are spent so quickly and I am better already.

reprieve

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.

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.

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.

complications

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.

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. 

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.

cabin fever

I don't know, maybe it's all the grey. Sky, clouds, street, roads, buildings, people, noise. The continual, connected, immutable always-ness of the city. Always on, always lit up or tore down or on show, for something, the ever unquiet world of New York. Maybe it's that my apartment is like a lovely prison--perfect, warm, oppressive-- or that on the rare and lazy thin winter Sunday when the sun does come out, there's no place to go that doesn't exchange currency for space, no unlit, open, uncomplicated place. Maybe it's that every time you walk out the door, there is noise. Somewhere, right there, every time, always. The expressway, the tunnel, the tracks, the passes. A horn on Clinton Street, a truck breaking, a car, a bus, a train, a siren. There is, nowhere around me, the open-endedness of space, an uninterrupted sky or ocean or water. There is, all and only around me, a claustrophobia of stuff.

fever dream

You know those last few pages of Into The Wild where Chris McCandless is deliriously scribbling his final, dying thoughts into his journal before taking his last, raspy breath? Yeah well that's what it's been like around here the last couple of days. I can't say for certain, but I highly suspect that yesterday's fever was the equivalent of seventeen full length Grateful Dead shows in terms of brain damage sustained and not only is it now confirmed that I will be waddling around in enormous Adult Diapers by the time I'm 80 but I'm also going to be on dialysis because I straight up blew out my kidneys with Nyquil. 

So, for the record, Dengue/Scarlet/Small Pox/Yellow Fever sucks and I highly recommend not getting it. Really. Much like Meth, it's retarded to even try. It's probably better to put your head in a blender, I can promise you it would feel better.

And! AND. While I was probably going to stay home today anyway, milking the phenomenal level of sympathy and kindness of my preceptors for all it was worth, as it turns out today is an official snow day and we were given the day off. Officially, and shit. Because New Yorkers are unbelievably woosey and can't negotiate life in the city with 4 inches of snow. And hur-friggen-ray.

So now I'm going to bake a cake. Because tacking at a body temperature of 103.2 F for 96 hours burns you some calories, yo. 

nuchal rigity

You know those days when you get on a plane to go to California from New York, watch 6 1/2 hours of Animal Planet straight, openly sob into your Taro Blue Potato Chips when the Pedigree commercials come on that get you right in the fucking solar plexus (and don't even SAY THE WORDS "that ASPCA commercial" because I friggen lose it just thinking about it so just stop it right now) and every rerun of Animal Precinct makes you realize that ALL YOU WANT TO DO is pack heat and save dogs and then you spend just enough hours in California to get fat on huevos rancheros and margaritas, come to terms with the fact that you miss the ocean like it was a kidney, get back on a plane from California to New York, watch five more hours of Animals (in peril) Planet, get out of the plane, it's -17 degrees, the cab line is fifty million people deep and you didn't bring a hat and by the time you make it home all the take out restaurants are closed and you don't even have cheesy mac in a box and you have to get up the next morning at 6am to get on another plane to New Hampshire to look at the house you bought and hopefully still really really really like many hundreds of thousands of dollars really love, almost get kicked out of school for shirking off on your clinical training and escaping only by the grace of god or someone who just works for him, getting back on another plane back to New York, spike a 102 temperature, start hallucinating, begin your first day of surgery a day late at 5:00am with a core body temperature of 101.7 F (despite 5,000,000 mg of Dayquil) and active rigors, make nice with the residents, literally FLEE during afternoon rounds by running down the back stairs because the whole light/end of tunnel/angel of death thing is going on in front of you and for once its not your patients and so you crawl home on all fours through the snow to get into the bath and there's no hot water and by the time your husband comes home you are speaking in tongues and have swallowed half the bottle of Nyquil and thank god he's there because lord knows the cats can't pick you up out of the bath tub because they have no thumbs and then you proceed to sleep sweat profusely for 11 hours straight only to wake up 99% convinced that, dude, you have meningitis?

Man I hate when that happens.

letter d

So it occurred to me today that we throw a lot of d words around in medicine. For instance, during the course of reviewing hyponatremia (a DEFICIENCY of sodium) alone I came up with ten --deca-- different ways to say "shit's fucked up" using, exclusively, words that start with d:

defect

deficit

deficiency

depletion

disorder

disregulation

damaged

decompensated

deformity

degenerative

Then there's the standard, garden variety disorganized, disproportionate, debilitated, debris (debride), decapitation, decay, decerebrate, delirium, as well the more exotic and alluring:

1. Decipara ~ a woman who has given birth for the tenth time to infants, alive or dead. Notice that they have to CLARIFY that she's given birth to infants, and not, say, kittens. 

2. Dactolysis ~ the spontaneous amputation of fingers or toes. As seen in leprosy, ainhum and produced in utero. Holyfriggencrap. 

3. Deutromycotina ~ the phylum of imperfect fungi. 

And then, my personal, all-time favorite:

Defecography ~ Radiography of the ano-rectal region after instilling barium paste into the rectum. The defecation process is [then] imaged by direct filming (fluroscopy) or video recording. No way.

homesickness

Thomas Wolfe said it:  "you can never go home again".  A boyfriend quoted that to me years ago in college.  It must have driven me mad at the time. I hated how he was always quoting Kant or Proust or Heidegger. It made me want to aim a Chemistry textbook squarely at his head. Regardless, I remember this quote. I remember where we were at the time--Walnut Street, night time, summer. I think about it every time I return home, though I've never gotten around to reading the book and despite the fact that I do not know if home is home any longer. 

I return bi-annually now, twice as much as I ever have before, to a small island in the Pacific; I return to a patch of land, the mercy of weather, assailing memories, the clutch of everything I left behind. I can never make sense of it. I can never wholly dissect everything out, lay the pieces out before me, give them something like names. I feel it all at once: sadness, joy, pride, shame. The muscle memory of the land returns but slowly now, my family grows older, the children taller, my parents frailer. Somedays everything, everything seems small, and spent. Somedays everything, everything feels exactly right, achingly familiar. 

There are sacrifices to living where you are, if not always choices. The singular sacrifices to live in New York City are stark and stern and burdensome. There are times when the numbers add up, when the math makes sense and I can live in the columns--when the light is long and the days are thin, when it is June and the fire flies hang lazy in the air or when the clear distance between me and Manhattan, the span of the East River, is bright enough to read by. But I can see that I am going bankrupt slowly, gradually running aground. 

When I go home I begin to try to count the obvious sacrifices to return. I have no scale to weigh and measure the options, the good, the bad, what will be left, what will be gained; I am too taken by my own evolution, how much I have changed, how little the spaces are now to fit into, how unquickly I have grown, the time that has passed. 

My niece and my nephew look exactly like my brother and I, running sandy and dirty and wet through the small world of Mokuleia. I watch them from the shore of the house we grew up in, my brother and I, waterlogged in my too-big emotion, watching their lives get bigger before me, clumsy in how far I have gone.

surf city

Santa Cruz. Perfect, lovely, impossible Santa Cruz. Santa Cruz of small streets and golden water and thick air. Santa Cruz of cold fog and green cypress and big ocean. Santa Cruz that renders me wordless every time I try to specify with any measure of precision why or what it is that I love about this place so fiercely, so much.

Even moving to Brooklyn was faking it. I could still come back, to get my fix, to defrost, dehydrate, decompress. To be quiet, still. To stretch out, run. But now there is talk of moving, and seriously. We speak of life in New England, together and finally, with real intention. We talk about the quaint niceties of wood burning stoves and big red barns, pick ups and sheep, and I am excited and we will go and make a run of it. And we will chop wood (maybe) and haul hay bales (hopefully) and grow vegetables (certainly) and make stews. And will we be fine, better than before, but I fear that I will live like this with a half broken heart, always trying to find my way home.