Dissecting Grief

My rotation through Internal Medicine started off with a month-long stint in the Intensive Care Unit (ICU). Names were often misleading in the hospital regarding what types of patients you were going to encounter; I would see patients strolling into the Emergency Room for the common cold and another patient with trauma and major parts of his hand missing to the “low-key” walk-in outpatient clinic. However, the ICU was perhaps the most aptly titled unit I had rotated through, and the experience was intense in more ways than one. Where I was often used to seeing ten different patients with one acute problem elsewhere, I now saw one patient with ten chronic problems here. Looking back now, the entire month was one big blur where days bled into one another, quick rounds turned into endurance-testing marathons, and one dysfunctional organ system precipitated the downfall of another, like dominoes.

The ICU renders itself as a gateway for the acutely and chronically weak, patient’s whose lives are literally placed in the mercy of a higher power: what that power is depends on who you ask. I would be lying however, if I didn’t admit that the ICU has a distinct aura of holiness. Family members often tiptoe and whisper in profound deference to the medical team and to the patients as if the patency of the patients’ airways depends directly on their ability to minimize all sound. All who enter seek antidotes for their crisis, a distress composed of both physical and emotional elements and sometimes, the emotional masquerading as physical. Replace the pews with endless stretchers, the stronghold confessional with a curtain-veiled bed, and a priest cloaked in black bearing a cross with a physician shrouded in white bearing a stethoscope. Trade religious fervor for actual fevers, church bells for code calls. Some find God in a stained glass, we see god in a CBC. What we lack in offering salvation and moral and spiritual guidance, we make reparations for by providing physical and mental relief often in the form of pharmacological deliverance.

However, just as prayers are often not enough, so are the limitations of science. What do you do when your knowledge is failing, your faith wavering? When you’re forced to make a home out of a barricade?

Keep Calm and Think Zebras

The Tempest was one of the first plays I read while taking a crash course on all things Shakespearean in college. Prospero is a commander of nymphs, an engineer of enchantments and a conjurer of magic that is exiled onto a tropical island, using his talents for his own needs whether they be for vengeance or protection. Taking the opportunity to seek retribution upon a ship carrying those that banished him, Prospero, through the aid of his nymph, turns a placid sea into a roaring storm, capsizing and shipwrecking all on board. The pace of the emergency room often seems determined in the same capricious manner.  One minute, the day’s moving at a snail’s pace with non-urgent patients meandering in with a sore throat or two and minor discomfort, taking time for granted, when without warning, we’re slammed with a wave of burst appendices, pulsatile aneurysms, and aches from every inch. The divide between calm and chaos can be a fickle one, gossamer at best, and while we’re all attempting to maneuver our own way through Prospero’s devices, it’s easy to underestimate the full force of tumultuous tides when you’re in the midst of tranquil waters.

Six weeks of psychiatry followed by six weeks of emergency medicine resulted in twelve weeks of two very different types of chaos. One was more of an inner turmoil while the other presented as an outward maelstrom, while both settings challenged me to maintain my own course. The ER served as our habitat for most of both rotations (three weeks of psychiatry consults), where we identified the patient, evaluated their relative level of distress, and tried to extract a thorough history of present illness. However, that’s where the paths diverged. In psychiatry, we were taught to chase the stories—any significant life changes occur recently?, what caused your relapse?, can you tell me about your childhood?— while emergency medicine coached us to chase the symptoms—where is the pain?, when did it start?, how would you characterize it? 

Nevertheless, both fields advised us on becoming oriented to being disoriented. Some 20 years of lecture experience were swept by the wayside as I entered my first rotation, before I could even register how to transmute everything I learned in the classroom to the clinical setting. You stand helplessly as each and every day your comfort dissipates like ether from your clasp, doing the best with what you know and what you do not. The true wonders of medicine can’t be appreciated when it’s your first day as an MS3 against the gaggle of interns, fellows, and attendings who swiftly seem to know it all and do it better.

An Ode to Grenada

In what could be one of the greatest satirical pieces of work, Catch-22, Joseph Heller once wrote:

What is a country? A country is a piece of land surrounded on all sides by boundaries, usually unnatural. Englishmen are dying for England, Americans are dying for America, Germans are dying for Germany, Russians are dying for Russia. There are now fifty or sixty countries fighting in this war. Surely so many countries can’t all be worth dying for.”

Heller was right. Surely, all countries cannot be worth dying for. Only those countries you choose to regard as your own. I wasn’t born in Grenada, but a part of me is certainly alive because of this island. Some might even argue it’s the most important part: the piece that nourishes your what-ifs and gives substance to your wishful thinking. On the night of my own departure, as I try to test out my own wings from the land that’s served as my nesting grounds on-and-off for the past several years, will I ever deem Grenada as my own? 

Some of my favorite shots of campus:

Study hard, play harder.

Even alley ways have their charm.

View of campus from my bedroom window.

View from the Library.

Campus on a rainy day.

Only time can tell what Grenada will become to me as I continue my life elsewhere: a pit stop, a detour, or a makeshift home? Even more, what will I become to Grenada? An honorary citizen, or merely a temporary dweller, holding as much fondness for each other as a midnight traveler to a dingy motel room. Was Grenada merely a means to an end, or did it define a bigger purpose? All I know is that when I moved to a different country four years ago, nothing was harder than saying hello for the first time. As those years started turning into hours, it got even harder to say goodbye for the final time. 

The Beat of A Different Drum

As a student known to sleep through a larger portion of my immunology lectures, the material, for me personally, lacked a little oomph. IgM. APC. CD28. C4b2a3b. A litany of cells, cytokines, and receptor molecules with unimaginative names and, often, even less enticing tasks that sounded more like a roll call for Star Wars characters. Little did I know, however, that the lessons imprinted on me in immunology translated to a much broader message.

Our biological well-being relies on the body’s meticulous ability to distinguish between the innate and the foreign. Thus, recognizing our own self is a lesson imbued to us by our own immune system. If the crux of good health relies on our body’s ability to recognize the “self” from “non-self” then being a good doctor, in my opinion, is about recognizing one’s own motives, perceptions, and attitudes against the backdrop of competing interests.

While conducting a research study on undertreated pain in sickle cell patients in a small middle-income nation, I interviewed around 40 sickle cell patients. After several long weeks of talking to patients, they all seemed to blend together as one in my head. However, one particular patient would always stick out in my mind. William, as I’ll call him, was rather gaunt and scraggly when he walked into the clinic where I was conducting interviews. His uncharacteristically hollow and worn face spoke volumes about his disposition and how mismanaged his pain was as a result of his disease.

Nevertheless, it wasn’t his face or his stature that made him more noticeable in my mind, but rather something about his eyes. There was a glaring yellowish tone within them, signs of full-blown jaundice, a common symptom of the disease, but even that was far from what made them distinctive. It was, instead, the dejected look he carried about him, a man who lost that sustaining spark to carry on. More so than his body, it was his spirit that was crippled.

Cultural Vagabond

I don’t think I’ve ever fallen in love with a city faster in my life than I did with Bangkok. The organized chaos mixed with the utterly tranquil, Southeast Asia, if my words can do any justice, is one gigantic kaleidoscope, satiating every single sense in your body. I traveled in fear of blinking my eyes for the off-chance that I may miss seeing or doing something that I may never get an opportunity to see or do ever again.  Sometimes I wonder how I’ll ever fall asleep again without the babel of Bangkok, the chatter of street vendors, the hustle of tuk-tuks, or the sweet lullaby of water taxis.

Grand Palace, Bangkok, Thailand

Back in March I made the decision with a bunch of my friends to take a 2-week Thailand medical selective. SGU offers students the opportunity to glimpse into the healthcare systems of various locales around the globe from Sweden to Kenya to Thailand. At the end of my first year and quite possibly my final summer break, I wasn’t all too ecstatic about having to fill my mere 6 weeks of freedom with having to think about more medicine, but the chance to breathe new air and roam was gnawing at me. While my brain made light-year leaps over the course of the past year, my feet were thirsting to do the same. However, it took me a trip halfway around the world to even realize what lusting for the horizon really signified.