I think you gotta just be happy with what you have today (soooo lame! Cheese attack!) but it’s true. One good thing and one good day at a time, makes a life of it. Do good things that make you happy, be happy day by day, and then before you know it you’ve got a happy life.
– The one and only Wholly Marvelous
When I was little, my family used to drive up to Toronto on weekends to have dim sum with the grandparents and cousins, and to pick up some Chinese groceries for the week. I didn’t want to go but once I was there I didn’t want to come back either. My mom would bribe me with Chinese candies and I’d drag my feet in our Toronto apartment, enjoying the plush carpeted floors while I could. These memories feel so far away, but also so familiar as if it could happen again this next weekend.
On the drive back I’d pop in cassette tapes of Fairy Tales – readings of silly and sometimes serious or creepy stories for kids – or Classical Music for Children – famous pieces done in synthesized beeps and boops. Being the youngest, I always wanted my brothers to be my friends, and I’d hope that they’d stay up on the car ride home and be in good enough moods to sing or joke with me. When everyone was too tired, I’d just look out the window at the stars and my mind would wander.
I’d think how amazing it was that the stars were so old and everyone sees the same ones. I’d think it’s strange how each of the other sets of headlights on the road had at least one person in them. I’d think how unbelievable it was that one day I’d be older and an adult and living a life somewhere. I wanted to live in an apartment with carpet and lots of Chinese sugared jellies and chocolate original Pocky. I wondered if my mom would still be nearby. I wondered if I’d still be alive when my mom died. I’d assume I would be, and I’d feel so sad that she would die one day that I’d start silently crying to myself while my mom, alive and well and unaware of her suddenly tearful distraught little daughter beside her, drove down the 401.
Obviously I’ve always been a sensitive kid. I grew up with anxiety, a healthy level usually but sometimes a little too much. It makes me indecisive but also careful and thoughtful. The trouble is I have a hard time telling when my worries are justified or when my mind is just getting away with itself.
I was driving through the ice sheets and snow today and my wipers were iced, useless. I was thinking about loss and feeling loss of things that haven’t happened. I’ve been mourning death of memories that haven’t been made, as if these moments once had life and now are sick, shriveling. There has been so much good and happiness in my life and in friendships but I find I’m wishing to have things returned to me that haven’t even happened. “Keep your promise!” I feel, out to life, the universe, or nothing. “I have lost!” I want help finding it, keeping it, preserving it before it’s all gone.
I’m not sad about anything that’s happened, which makes all this so strange. I’m so happy for everything. Yet I feel so much loss right now and I hope it’s just my mind getting away with itself but I think that I need to just let myself be quiet and let myself see that life continues to move and all it is in the end are memories made – lived, lost, and yearned for.
Here are a few things I’ve done so far:
– felt cynical
– been humbled
– felt guilt
– went by someone else’s opinion instead of my own, and was burned
– cried at family meetings
– cried on the drive home
– hid in a bathroom and cried some more
– yelled at a patient
– felt disrespected/intimidated/supported/appreciated by other healthcare staff
– felt bad about myself for not knowing a fact
– treated someone rudely because i had just been rudely treated by someone else
– pronounced people dead
– broke it to an old lady that she had syphilis
– watched families watch their loved ones be coded
– felt like I should have been able to do more for someone
– felt like there was nothing else I could do for someone
– fetched drinks for patients
– gagged while examining someone
– woke up with anxiety cramps
– seriously questioned being a doctor
After 6 months of excitement, self-doubt, and growing pains, my morale had hit an all time low. I felt alone, isolated, and stuck. I thought it was maybe the weather, or maybe just me. I’ve wondered why I’m doing what I’m doing and why did I want this so badly – was I totally wrong? Is this what my life is going to be like forever?
It was a rough few weeks.
I’m not sure when things started to shift. Maybe it was from hearing so many co-interns mention something about feeling tired, feeling burnt out, feeling like they didn’t know why they were doing this. There was that time a 3rd year overheard us talking and sat with us for an extra hour after night clinic had finished, to tell us that he understood how we felt, that he was sorry, but that it’d be ok. He drew that graph someone had drawn for him, telling us that it’s half way through the year, the days are dark, and everyone at every level is feeling low. It’s expected and it’s ok. The more I confided in others, the more they confided in me that they too had been feeling dark and down, questioning themselves and where they are, lonely yet reclusive. In groups we wanted to appear confident and capable, but one-on-one we were openly vulnerable, anxious and insecure. One day while driving, it occurred to me how ridiculous it was to feel I was a bad person for not knowing something. Then you named this perspective and put this conflict into words.
A friend, a co-intern, told me of waking up devastated and guilty for not remembering what he had read the night before. Another told me of feeling it was time to quit. Another told me of anger over not being trusted, or fear of being thought of as not performing. And another told me how alone he felt. We all wanted so badly to show what we are capable of, to be told we are capable, to feel capable. We were falling apart.
It’s halfway through the year, and it’s some long dark days. But I’m feeling new. Newer than before when I felt like I was all untapped potential; vast and mysterious, awaiting the dramatic reveal. Now I feel like a sprout; little and very green. But earnest. Nothing more, nothing less.
Yesterday I teared up on rounds as we were discussing end-of-life care.
We were talking about the end of life and how the caring for the person at that point changes when you are balancing quality and quantity of life. More specifically, we were discussing people who are imminently dying and whether or not they feel thirsty or hungry, and whether feeding them and providing fluids for them was doing more harm than good. My attending was telling us that feeling thirst at the end of life isn’t correlated with the amount of fluid the person needs, and that the thirst can often be alleviated by swabbing the person’s lips and mouth with a moist sponge. Over time, people tend to stop feeling thirsty or hungry at all. She described a common scenario where the family of the dying patient are alarmed that their loved one isn’t being fed or given fluids anymore, even if the family understands that the patient is imminently terminal. There’s an instinctive cross-cultural urge to continue feeding the loved one, thinking that it’s needed to be kept comfortable and alive. I was trying to focus on her point which was that when it comes to people who are that far gone, feeding them can lead to more discomfort with increased salivation and GI secretions that can predispose them to choking, infections, increased interventions and potentially a more drawn-out and painful death.
But I was just picturing my grandma in the hospital bed asking over and over for hot water. But she was NPO because they were worried she’d aspirate. I finally wet a gauze and put it in her mouth. She sucked on it and didn’t ask for water any more. A few days later she died, they said it was because of aspiration pneumonia. I cried because I thought I had contributed to that since I had given her a bit of water when she was thirsty. Even though people told me the small bit of moisture in her mouth couldn’t have caused her aspiration, that she already had food remnants in her esophagus before coming to the hospital, and even after hearing from my attending on rounds that providing a swab of water helps relieve the thirsty suffering without risking them aspirating, I still felt sad and teared up.
Funny experience, standing on the ward floor in our white coats and steths around our necks, discussing studies and evidence for this or that medicine or treatment or intervention, while feeling such dramatic emotions inside. We talk about these things without talking about how it makes us feel. It’s ok to bring up previous experiences with patients, but we don’t bring up personal experiences with our own family or friends. Even though I think one of the most important things is to be able to feel what you’re talking about, to be emotional, to empathize, I still struggled hard to dissociate any feelings from what we were talking about, and to look at it as just facts.
Kinda Cliché 
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