The Chinese say

I’ve learned a few new Chinese sayings on this trip.

“Do gooders attract trouble.” Sums up the mentality of not rocking the boat. Keep your eyes down and just go on your way. I’m not sure if it’s an accurate generalization, but there are quite a few people in my own family do tend toward the attitude that “things just won’t change” or worse, that “causing a big ruckus can bring unwanted attention and trouble”.

电灯泡 = Electric light bulb. Last night, my mom and I went to sit on some beach chairs by the pool to look up at the stars. Beside us was a canopy with the curtains drawn down. My mom thought there might be someone inside and asked if we should find some other chairs because she didn’t want to be a “ding dang dam” or an electric light bulb. This is basically Chinese for a cockblock. The idea is that two lovers (or as my mom put it, “two people who are not just dating but courting”)would want to kiss in the dark. To be an electric light bulb would be to spoil their romantic fun (or sexy shenanigans, as people like to say!)

I knew all along

But I didn’t want to believe it.

The signs were there.  I stepped over it every day, pretending it wasn’t there.  I  even caught a glimpse once in a while, thought I saw something fly up at me; but I just ran my hands over my pants and still I chose to ignore it.

Until.  I run my blue highlighter dry.  While writing notes for Pharm, where blue means a drug, this won’t do.  My now useless highlighter barrel does not fit in my life anymore, and in line with my clawing toward a more organized, structured life, I go to throw it out in the kitchen bin under the sink.  I open the cupboard door and there it is.  It flashes by.  I can’t ignore it anymore.  A cockroach running across the top of the bin.

I shriek.  I slam shut the door.  I back away.  I don’t throw out the dried highlighter. It’s on my desk.

Right outside my door, just down the steps.  For days.  Dead, on it’s back.  A cockroach.  Surrounded by what can only be tiny cockroach babies, one of which I believe flew up at me as I skipped over it with my dirty laundry bag.

In other news: I hate you mosquito, get out of my room and out of my life.

Ashley Judd’s response to people’s response to her face’s response to medication.

Media outlets talked a lot about Ashley Judd’s face, saying it was puffier.  They had plastic surgeons talk about what procedures she probably had.  It turns out she had been sick and was taking corticosteroids for a long time (immunosuppressants), developing the typical “moon face”.

Here is her response to all the hullaballoo.  It is great.

Best quote:

That women are joining in the ongoing disassembling of my appearance is salient. Patriarchy is not men. Patriarchy is a system in which both women and men participate. It privileges, inter alia, the interests of boys and men over the bodily integrity, autonomy, and dignity of girls and women. It is subtle, insidious, and never more dangerous than when women passionately deny that they themselves are engaging in it. This abnormal obsession with women’s faces and bodies has become so normal that we (I include myself at times—I absolutely fall for it still) have internalized patriarchy almost seamlessly. We are unable at times to identify ourselves as our own denigrating abusers, or as abusing other girls and women.

Amanda Beard and lessons for young women?

So says this article.

Amanda Beard was my swimming hero growing up.  For as long as I was in swimming, she was the top of my best event.  What she went through with isn’t completely unheard of in swimming, but it’s just so surprising to be reminded that it can happen to anyone, even if you’re at the top.

I don’t normally like to read comments sections, but (trigger warning in the link) Jezebel’s article on Amanda Beard‘s book has some interesting comments, from trigger warnings to the nature of swimming and how the timing of swim careers with body’s natural development make for a complicated relationship with the sport.  I’m reminded of my mom’s genuine concern with my “compulsion” to swim and make it to practice, of my shared laments that “normal people” just don’t seem to understand it’s more than a sport.  Looking back now, after some time away from it, I still remember how emotional it is, but I’m still not sure what to make of it all – whether it was  completely justified or not.  I learned a lot of lessons and my character is largely shaped by the whole experience, but still I’m not sure if I would put my own kids through the same.

Whoamygosh. Or, how I became a Glimpse Correspondent

The first time, I was in Thailand and my PayPal account was going to put me behind the deadline.  Sitting in an uncomfortable internet cafe in Bangkok, feeling the patience of my brother running down, I was clicking away at my computer, editing my writing sample while in other windows I was working on setting up a PayPal account to pay the application fee.  It was an old fiction piece I had written for my high school senior English class about the last days of your mother’s life, and letting go.  All interspersed with lyrics from “Across the Universe”.  I loved it back in high school.  When I reopened it years later, I was shocked at how bad it was.

That was after my MSc, when I was in that strange funk of excitement to explore the world, with simultaneous fear and disappointment of not knowing what I was doing with my life.

Now, three years or so years later, I’m in Grenada, sitting in Taylor, a chilly study hall on my medical school campus.  I’ve heard it described as a “freezer full of angry medical students” but when I opened the email from Glimpse it had at least one speechless one.  I shook Frond, and we headed outside where I could properly freak out, dance and yell unintelligibly in peace.  “The extensor surface of my arms are tingling!  My radial nerves are flipping out!”  I am such a nerd sometimes.

I am so fortunate.  Really.  To have finished my MSc then decided not to continue in the same field, so I had time to explore other options and stumble across the Glimpse Correspondent program.  To move to Grenada after having been rejected by all the North American medical schools I applied to, after two rounds and thousands of dollars in application fees, and just as many tears.  To have had Frond to help look over my application writing sample and tell me not to try so hard, to just tell the story and not tell people what to think or feel.

I have so much more to learn about writing!  I’m so excited.  I really want to become a great communicator; to tell stories that make people think and feel, and to use this when I keep going on, to help people around the world learn about each other, and to connect them.  Maybe along the way I’ll learn how to stop using commas so much too.

My extensor surfaces are still tingling, my schoolwork has gone totally untouched, and a mosquito is having the time of it’s life with my knee.  But that’s all great.  Somehow, sometimes, when you really put yourself out there, the stars align and you get that email.

Here’s what I submitted to Glimpse as my writing sample.  It might seem a bit familiar as it has pieces taken from other blog entries.

New In Town.

Rumbling down a dusty unpaved road in Shervin’s jeep, we whipped around a leafy green blur and came to a clearing.  There were two small buildings, surrounded by knee-high kids in twos and threes, running here to there, stopping, then taking off again in a new direction.  They were each monochromatically dressed in either green, red, or yellow.  It was a multicoloured ant hill.  On the other side were older kids dressed in long navy blue pleated skirts, white collared short-sleeved blouses and red ties or navy pants and white dress shirts.  These kids were leaning over the railing of the second floor, many yelling, some throwing food onto the yard, most just gazing about coolly.

We had come to talk to the principal about a new pilot program we were starting.  In light of the diabetes and obesity epidemic on the island, we were proposing to help teach some life skills and healthy food choices on the backdrop of fun physical activities.  Healthy Grenada, we called it.

As the three of us were standing under the sun discussing how we would run the first session, a pair of girls in their pleated dresses walked up to stand behind me and giggled when I glanced at them.  After a few minutes we were ready to leave, and we started back towards the jeep.  The two girls, still giggling, followed us a few steps behind and in the instant just before we pulled away, I heard one say: “I want to be white too”.

—

Two months earlier, I was on a bench under a tent in the Carenage in a concrete room with two walls and no roof.  It felt like an old construction site, perhaps abandoned after Hurricane Ivan in 2004.  There were about 70 Grenadians patiently standing in line to sit beside me, ranging from middle aged to elderly.  I was helping out at a school health fair, a student-organized event where students and our physician clinical tutors come out to screen the community for high blood pressure and diabetes.  My job was to take blood pressure and ask a few questions before they went on to see the physician.  Beside me was Helen, a well dressed lady in her 50s or 60s in silver rimmed glasses and a white blouse.  I asked her how she was doing, and she said, “Fine, just a little warm but that’s okay”, with a smile.  It was humid and hot, with an occasional spattering of rain, but typical of Grenadians, the participants were patient and without complaints.   I apologized for the lack of set up early on.  There was a miscommunication with the organizers and although the volunteers and participants arrived on time, the equipment, tables, chairs, and tent was about an hour late.  “That’s fine”, Helen said “we make do.”

I wrapped my blood pressure cuff around her arm and began to pump it up.  The crowd around our small table leaned in slightly, watching the process.  160/90; it was high.

“Have you ever been checked for blood pressure?” I asked.

She had.

“What kinds of things are you doing to manage it?”

Helen looked at me and said, “Well I have a prescription.  But the pharmacy is out so I haven’t had it.”

“Do they know when they’d be restocked?”

“They’re not sure.”

“Since when have they been out?”

“Three weeks.”

“How often are you supposed to take the medication?”

“Every day, morning and afternoon.”.

The next woman eased onto the bench beside me and I pulled the table closer for her to rest her arm.  It was hard to tell her age, but she was young, perhaps in her 30s.  She was well obese and had come during her break-time from work, as clear from her green uniform shirt and baseball hat for a local grocery store.  I introduced myself and asked her name.  “Angel”, she said.  As I unwrapped and wrapped the cuff around her arm I noticed the Diet section of her questionnaire hadn’t been filled out.

“Can I ask, how many meals a day do you have, typically?”  I asked.

“One or two.  Usually one.” she answered.

“Do you get to eat regularly?  Or do you find yourself skipping meals here and there?”  I started.

“I skip meals, maybe every other day.  When things get busy.”

“And what’s your typical meal like?” I asked Angel.

“Juice, bread” She trailed off, still looking around.

“Any vegetables or leafy greens?”

She looked directly at me for the first time since sitting down.  She had hazel eyes but was wearing no make-up, unlike many of the young women who had previously come by.  “I eat what I can find.  When you have no money, you eat what you can find.”

I thought back to the brief training we had done for the health fair. “Offer a bit of counselling,” the coordinators advised us. “It’s easy, basic nutrition and healthy eating – balanced meals, being active however you can.  You guys will do great.”

—

We walked up the long road toward the school with a group of volunteers and a folder full of quizzes, worksheets, and activities we had planned for our first session of Healthy Grenada.  Alongside us were a group of young boys, about 9 years old, in burgundy pants and white polo shirts, laughing and running about.  One of the boys had a long thin stick and was playfully swinging it about and making growling noises.  They told us they were playing a game they made up called Daddy.  “It’s a different culture,” Shervin said to me, “let it go.”

Later that night I slipped quickly out the door, trying to leave faster than the mosquitoes could enter.  It must have looked pretty comical, like Kramer from Seinfeld as I opened and closed the door in one movement, manoeuvring my gym bag out of the way.  I glanced around to see if anyone saw my awkward exit.  There was no one, but a silhouette of two little boys, maybe 10 or 12, drinking cartons and rummaging through the trash bins outside the apartment.  Neither had looked up.  Not wanting to embarrass them, or perhaps embarrassed myself, I started walking towards school as if I hadn’t just seen two kids looking for food in my trash bin.  About two minutes later I passed the security gate of the school, and as I approached the student center, I passed a group of students chatting and holding takeout containers full of food.  I walked past students playing basketball on the lit-up court, filled up my bottle at the water fountain, and ran on the treadmill for a half hour.

Everybody Solar

Everybody Solar

Mission Statement:

Everybody Solar works to protect the environment and strengthen U.S. communities through solar energy projects. By providing solar power to local charities we help them reduce electricity costs and direct their limited resources to the communities they serve.

Vision:

Our vision is to create healthy and sustainable communities. We want current and future generations to have equal access to essential social services while living on a thriving and sustainable planet.

We aim to improve our communities by giving the gift of clean energy to organizations that need it most; non-profits on the front lines, serving our most vulnerable populations. By eliminating electricity costs for non-profits we help them maximize their impact on their direct cause. With our help, these organizations are able to invest funds directly into their missions: to feed children, provide counseling, support a shelter, or start a movement. By saving thousands of dollars for those who need it most, and harnessing the power of the sun, we help local communities thrive.

We believe that everyone has the right to affordable energy and clean air.

Our Philosophy: Efficient spending, easy breathing.

 

Giving people the tools.  Nice!

 

Hospital Dress Code

This term we’re heading in to the General Hospital and for the first time, interacting with real patients (who aren’t being paid for us to poke them).  Our school sent us an email outlining our dress code for the hospital trips.  Here are a few of them:

• Skirts must be no shorter than 2″ above the knee.

I was happy about that one.  It’s reasonable!  The usual at or below the knee is only good if you’re wearing a towel.

• Trousers or pants must be loose fitting

At my Catholic high school it was a big deal when girls were allowed to wear grey pants instead of the usual kilt.  But the admin didn’t expect people to start wearing grey yoga pants with their blouses.  I guess the Pope would not have been cool with that.

• No sleeveless clothing allowed

Not even under our white coats.  Someone told me that most of the hospital isn’t air conditioned and that last term someone fainted every week.

• No see-through clothing
• No topless

I wish I knew the story behind the making of that last rule.

 

Noni for Lupus

I just caught up with Ktown over dinner, movie, and after-movie tea.  She’s studying grad school in Environmental Science and gave me some great insights into my possible year off from school; people to contact and ideas bounced (note to self: don’t assume first nations communities just need more research and surveying — perhaps they need something less academic, more tangible.  consider your own assumptions).

One cool thing was talking to her about her mom, who has lupus but has been in remission for years.  I was asking Ktown about what kinds of symptoms her mom has had (Ktown recalls hearing about pericarditis), what medication she would take (prednisone and methotrexate), etc.  I’ve met her mom and it’s amazing that she’s ever had a chronic condition; she seems perfectly healthy, even above-average active for her age.

Ktown and her mom both swear by Noni Juice as the reason she’s been so healthy.  At first I was skeptical, but then again…

Frond:  noni juice?

me:  http://www.nonijuice.us/

her mom called in to order more and the customer service person had the same story, lupus ‘cured’ by noni juice.

“Medical professionals studying Noni juice have discovered that it works on a cellular level to support healthy living” – Ktown says that to me: “it works on a CELLULAR level!”

but everything does, i think.

but food is food, and much isn’t known i suppose

it’d be easy for me to scoff, but i don’t think i should

Frond:  if it’s working it’s working. or at least she’s in remission

me:  it’s not that it cures everything for everyone, but if someone’s finding it’s working..

some people pray, some people drink noni, and some people just have more and more meds

Frond:  seems worth being understood if it’s having such a real effect and it sounds like it’s being studied

me:  the more i read the more i want to try it!

Death panels, rationing, and a call to act

Quotable quotes from the outgoing admin of Centers for Medicare & Medicaid Services’ address to the annual conference of the Cambridge-based Institute for Healthcare Improvement:

On cynicism:

Cynicism grips Washington. It grips Washington far too much, far too much for a place that could instead remind us continually of the grandeur of democracy. . .

Cynicism diverts energy from the great moral test. It toys with deception, and deception destroys. Let me give you an example: the outrageous rhetoric about “death panels” – the claim, nonsense, fabricated out of nothing but fear and lies, that some plot is afoot to, literally, kill patients under the guise of end-of-life care. That is hogwash. It is purveyed by cynics; it employs deception; and it destroys hope. It is beyond cruelty to have subjected our elders, especially, to groundless fear in the pure service of political agendas.

On “death panels”

If you really want to talk about “death panels,” let’s think about what happens if we cut back programs of needed, life-saving care for Medicaid beneficiaries and other poor people in America. What happens in a nation willing to say a senior citizen of marginal income, “I am sorry you cannot afford your medicines, but you are on your own?” What happens if we choose to defund our nation’s investments in preventive medicine and community health, condemning a generation to avoidable risks and unseen toxins? Maybe a real death panel is a group of people who tell health care insurers that is it OK to take insurance away from people because they are sick or are at risk for becoming sick. Enough of “death panels”! How about all of us – all of us in America – becoming a life panel, unwilling to rest easy, in what is still the wealthiest nation on earth, while a single person within our borders lacks access to the health care they need as a basic human right? Now, that is a conversation worth having.

On rationing

The true rationers are those who impede improvement, who stand in the way of change, and who thereby force choices that we can avoid through better care. It boggles my mind that the same people who cry “foul” about rationing an instant later argue to reduce health care benefits for the needy, to defund crucial programs of care and prevention, and to shift thousands of dollars of annual costs to people – elders, the poor, the disabled – who are least able to bear them.

When the 17 million American children who live in poverty cannot get the immunizations and blood tests they need, that is rationing. When disabled Americans lack the help to keep them out of institutions and in their homes and living independently, that is rationing. When tens of thousands of Medicaid beneficiaries are thrown out of coverage, and when millions of Seniors are threatened with the withdrawal of preventive care or cannot afford their medications, and when every single one of us lives under the sword of Damocles that, if we get sick, we lose health insurance, that is rationing. And it is beneath us as a great nation to allow that to happen.

Our moral duty

And that brings me to the opportunity we now have and a duty. A moral duty: to rescue American health care the only way it can be rescued – by improving it. I have never seen, nor had I dared hope to see, an era in American health care when that is more possible than this very moment. . .We can do this, we who give care. And nobody else can. The buck has stopped. The federal framework is set by the Affordable Care Act and important prior laws, such as the HITECH Act, and, quite frankly, we can’t expect any bold statutory movement with a divided Congress within the next year or more. The buck has stopped; it has stopped with you.

Now comes the choice. To change, or not to change.

Bam.  Dr. Don Berwick = new hero.

When you don’t like your patient

I’m still on the way home, on the second leg of my trip.  I am eavesdropping on the conversation going on in the row in front of me.  13C is coming home from Guyana where he’s been working in mining exploration.  He looks like a young guy, maybe around my age, with a kind of Western or Southern drawl.  He’s describing what he does to 13D and I’m trying to listen for any indication of gross injustices against the environment or local communities.  He’s an outgoing guy and seems really friendly.  He leans over the empty seat beside him and is now chatting with 13A, whose contribution to the largely one-sided conversation is the occasional “ah” or “huh”, “yea…”.  He’s talking about his life working overseas.  He proudly mentions having 4 girlfriends, who don’t know about each other “no, they don’t know about each other”.  He sounds jovial, like someone talking about how fresh the fruits are at the local market or maybe how a dad would talk about his son’s little league team.  I wondered how I would approach this if he were my patient.  Would he tell me about his 4 girlfriends?  How would I respond?  Impassionate, matter-of-fact: “Oh, well do you use protection? Have you been tested for any STDs?  Alright, well we have the facilities here to do that”.  I pictured the movie effect where you have a map with a pin-point on it that just spreads like a black wave, sludgy and oozing across the continent.

I remember one time my mom came home from the office upset.  One of her patients was cheating on his wife who was terminally ill.  His mistress wanted him to promise to be with her.  He was stressed and depressed but didn’t know why.  When my mom asked if he thought perhaps it had to do with his relationship situation, he was surprised and hadn’t considered it.  My mom was boiling the whole hour of therapy, as she was reminded of being cheated on herself so publically by my dad.

As much as Western medicine is about micromanagement and control of biology (at least we like to think that), we’ll eventually end up with patients who we will feel crappy listening to.  I’m thinking of the simulated patient we had who was abused by her husband but didn’t want to admit it.  Doctors are legally mandated to report child abuse and elder abuse but not spousal abuse, and I can’t imagine what it will be like to have to see some women walk back out into trouble despite all the counselling you give.

I guess part of becoming a health professional is always keeping a professional front.  Obviously my mom couldn’t bring her own baggage into the care of her patient.  The trick will be finding the balance between being jaded and being human.