Love and sorrow

Today marks one month from a day that was far too unexpectedly eventful, when a number of things changed in very big ways and pretty much none of them for the better. And the worst of them was, Naani died.

I don’t have a childhood, teenagehood, adulthood full of memories with her, because she lived in India, and I live here. But I still have a wealth of memories from the short spurts of time I did get to spend with her, and her larger-than-life personality helped fill the gaps left by time and distance.

She had a unique way of talking, a blend of proper language and slang that was inimitable, though Mama does a decent impression every now and then. Whenever I would hear Naani say something unintentionally hilarious, or drop a pearl of colorful wisdom, or when Mama would quote her dropping said pearl, I would think to myself, ‘I really should write these down, or record them or something, before they are lost forever.’ I never did get around to it, but in retrospect, it makes those memories and moments so much more precious.

My earliest memories of her are colored by the vagueries of childhood. We would collude in my mischief, in sneaking me treats and TV time. We would tease Mama together. Naani would help me win Hide and Seek, or protect me from Kanu’s wrath after my merciless pestering (while gently scolding me along the way). Whenever I was in India, she became my Mama Bear, and heavens help you if you messed with her grandkids.

I learned to love our conversations – by phone when I was home, or over chai and kachodi when I was in Kirti Nagar. Naani was a spiritual person, unphased by almost any trouble life threw her way. She came into her self-assuredness through preachings, and passed those along to us as we grew old enough to digest them. She emanated the same serenity otherwise only found at the temple.  

Naani was always thinking of us, her grandkids across the ocean. She had the most exquisite taste in fabrics, and would get beautiful suits made for us whenever we visited. She would make sure I got to eat all my favorite foods whenever I was home with her. She was selfless with her time and her spirit. She had such a big heart…but she really hated hugs. I made sure to give her extra ones whenever I was there.

I’m going to miss her voice, with its rough gravity. I’m going to miss bantering with her, and teasing Mama with her. I’m going to miss her palpable presence in their flat, filling every single room. I’m going to miss her playfully swatting me away when I would try to hug her. I’m going to miss curling up on her bed next to her, with my head in her lap and her hand on my head, grounding me in a way no one else could.

I’m going to miss Naani. Period.  

Real Talk: The long white coat

As a medical student, I often yearned for the day when my short coat would be replaced with a long one, my name embroidered with an “M.D.” after it. I would gaze longingly at my residents and attendings adorned in their Capes of Knowledge, flitting about the hospital in their flowing white garment dispensing Ativan and reassurance like candy and wine. (Just kidding, candy is bad for you).
Well, I am half-an-intern-year wiser and I’m here to tell you: The Establishment has you duped. They have carefully cultivated this illustrious image of the Long White Coat (LWC), but what they aren't telling you is that it is not worth its weight in anything except maybe Robbins Pathology textbooks.

I know, I know, there are things people actually like about their LWCs. It’s a shining beacon of authority! (Especially the day after Laundry Day). It serves as an extra layer of protection from hospital subarctic temperatures and bloody vomit, sometimes simultaneously! It comes with pockets for carrying Very Important Stuff like energy bars, the purple book of wisdom, and an IV kit for mainlining caffeine!

The most tragic dupes of The Establishment are women, who have been brainwashed for years upon years by the fashion industry into being thankful for the pockets, since every other garment leaves them (us) deprived. It’s a massive conspiracy that’s been playing out for centuries! But that belongs in a separate article that I will never write because fashion is so far from being my thing.

Okay, so the benefits pretty much end there. Now for the drawbacks, with some suggestions sprinkled in:

The Coat Mass Index

• It is a couple feet longer than our student coats, which just means extra inches to iron (ha.) and keep clean. Ain’t nobody got time for that! Those are precious minutes that could be spent sleeping, or stealthily scarfing down lunch in the bathroom where no one can find you.
• Those extra inches also mean you keep rolling your chair over it, which means it gets dirty, which means you have to wash it again (maybe), which means you have to iron it again…you see where I’m going with this.
• More square inches = greater surface area to cover in miscellaneous fluids, including but not limited to: blood, emesis, printer ink, stray pen marks, etc. Cue vicious cycle yet again.
• New and improved length blocks universal scrub back pocket access! Making for awkward moments when you hike your coat up to fish out your phone.
• Extra length means the stethoscope in your pocket is now at perfect door-snagging length. Excess fabric is more than happy to co-snag with the stethoscope, making it difficult to maintain a semblance of dignity and authority while cursing at a door knob.
• Yes, they come with nice, roomy pockets. But as with any benefit offered to a capitalist society, you’re tempted to ‘make the most of them’ and stuff them chock full of Very Important Stuff, which makes for sad shoulders and a sad back.
• I hear the Pocket Capitalism Effect tapers off as you go up the ranks, since eventually you will be a bad-ass attending who only needs to carry around your brain and a pen to scrawl chicken-scratch on the souls of your minions.

Just for kicks, how cool would it be if white coats grew on their own? Lengthening by a percentage of your height per year of experience – eventually, they will all be like awkward, collared and buttoned, infected wedding dresses.

Fashion Commentary

• The fabric is hot. And I don’t mean the kind of hot that gets you all excited. I mean the kind of hot that gets you all disgustingly overheated and uncomfortable. You’d think they would have discovered a more breathable material by now. Can we get Under Armour on this?
• Also: Why aren't LWCs fluid resistant yet??
• Maybe instead of white, they should come in shades of body fluid, the ultimate camouflaging technique. I’m not entirely sure how this could best be engineered. A swatch for each type of fluid? A fancy cloth mosaic?
• The LWCs are inherently sexist! I’m sure this shocks exactly no one (see fashion industry mini-rant above).
• Guys don’t get a slimming band across the back. Why not? They have as much right to a tapered fit as the rest of us.
• Gals don’t get pocket-accessing side slits! I mean, it’s bad enough we usually get gypped on the pocket square footage front, but now we can’t even get to them!

 The [unwelcome] Genius Effect

• People think you actually know stuff. I mean, the coat even says “M.D.” on it. This is dangerous.
• It comes free with a 15th century pager. Run away! This is not a good deal! Silence your inner capitalist!

Cargo scrub pants are the great equalizer. Everyone should have to wear them all the time whenever they’re in the hospital. The end.  

Lows and lows

"Nothing is permanent in this wicked world - not even our troubles."

- Charles Chaplin

It was my last Friday on the wards for this go-round, the last day our current two teams would spend together before all the non-interns switched over. And from noon onward, it turned into an emotional roller coaster I struggled to navigate.

Code Blue, ICU. Code Blue, ICU.

My attending and I were on our way down to the ER to see a new admission when a code was called in the ICU. The ICU staff is the rapid response team, so typically the floor doctors don't descend en masse; a few people headed over there while we two continued our trek downstairs.

Our admission was a very elderly lady with late-stage Alzheimer's who had fallen victim to a vicious infection and recently stopped eating. Her family had made her 'comfort measures only,' and she was being admitted for gentle care until hospice services could be put in place for her to receive care at home.

Spindly fingers. Raspy breaths. Vacant eyes.

Her room was crowded with family and her caretakers. Her presentation, from so many angles (minus the infection), bore strong echoes to my grandfather's last days. My attending spoke to the children as I held her hand, thinking back to when I last saw him, similarly cachectic and lost to the world in all ways except for the air his lungs still pulled in, the blood his heart still labored to pump.

After talking to the family and the ER doctor, we made our way back upstairs. Just as I was settling into my seat to work on her admission orders, a second code was called in the ICU for the same patient. They needed more hands on deck for CPR, and several of us rushed over.

1--2--3--4--5--6--7--8--9--10-- x 2 minutes

The patient's room was the one right next to the room where my patient's harrowing code had occurred one month ago, when I was working in the ICU. Half of the staff was the same that had been present that day. When I was struggling in the aftermath of the code last month, one of my medical school mentors told me, "Events like that tend to stay entrenched in your memory for the rest of your life. You'll always remember the details." It's only been a month, too soon to extrapolate to a lifetime, but I had flashbacks that Friday in a way I never had before. But there was no time to indulge (there rarely is); time to be present.

After some time, the family asked us to stop, and the code was called. Those of us who had come to help trudged back to the wards with a heavy heart, back to the grind of work. My resident had finished the admission orders for me, and I began the admission note. Soon after, my pager went off -- please call radiology.

Peritoneal carcinomatosis. Subcapsular splenic lesions. Periaortic lymph nodes.

They had CT scan results back for another one of my patients, a sweet, feisty elderly lady who had come in with intractable vomiting and unintentional weight loss. The results were grim. She had widespread metastases, likely related to a past cancer for which she had undergone treatment years ago.

I called her primary care doctor to give him the update. He came by the wards within the next hour, and we went to deliver the somber news to our patient. She took it in with her usual stoicism, giving little hint as to how she was feeling, and little room for us to explore that with her.

Olé!

What was left of the day went toward tying up loose ends and finishing paperwork. And was then followed by the final jarring event of the day -- a celebratory two-team dinner to feast to our time together, which had been scheduled since several days prior.

I wouldn't say I ran the full spectrum of emotions that day, because mostly I wallowed at one end of it, and had to play-act at the polar opposite end for the final few hours of an otherwise exhaustingly mournful day. There were too many echoes in speedy succession -- of my grandfather, of my ICU code, of my first medicine patient I had as a third-year medical student, who happened to be the first patient I had to break the news about cancer to, and the first patient I had transferred to the ICU, only to see him die a slow, sad death there.

Somehow that Chaplin quote seemed to belong with my memories of this particular Friday. When I was an MS-III with my first patient with newly diagnosed cancer, while simultaneously struggling to process my aunt's sudden and tragic death, my intern at the time would say, "This too shall pass." And more recently, as I struggled through that Friday, and some of the days leading up to it, another mentor/friend told me of her dance party with her adorable son to Taylor Swift's "Shake It Off."

How can we build in time to do that? I hadn't fully internalized what a wild, visceral ride I went on that day until over a week later. It was after I transitioned back to an 8a-5p schedule, had caught up on some sleep, and found myself with a two-day weekend to finally try and decompress.

There has to be a better structure for processing, even within the constraints placed upon us by training. How else will we stem that empathy degradation we keep hearing about?

Things to ponder. In the meantime, if you see me jamming to TSwift, all I will say is, don't knock it 'til you try it.