You, Me, And Everything In Between

(photo: the late Francesca Woodman)

While getting my regular Radiolab fix this morning with Jad and Robert, I began a decent into my introspective meaty bits (I could lose days to this obsession of mine). The selected episode of the day was one analyzing the roots of fate and fortune. In one section, they suggested that good fortune in life may began early on in youth when a child learns about delayed gratification and how that leads to aiming higher and achieving greatness. Now I'm am not a greedy person but I have been known to indulge in the occasional immediate desire. Though I appreciate the benefit of self control and investing in the future, I don't believe in constant denial. All things in moderation, right? At the heart of Buddhist principle is spontaneity and how can one live in the moment if one is constantly focused on an undetermined, unpromised next event? On the other hand Buddhism is all about not giving into desire for desire is suffering ... so in the end I'm just as conflicted as the next kid. I believe in a bright, shiny future, but I have no illusions about entitlement. What I know for sure, as much as you can know anything for sure, is what I have right now and I'm not about to deny that in lieu of a dream, though I dream heavily and dream big. Does that make me less likely to succeed, because I flirt with the present? That seems pretty shitty. In fact, I'd be ok achieving less if it means I get to live a little.

Granted they presented all sorts of convincing data in favor of this idea, success still seems to stem more from a growing sense of self worth and confidence. In effect, good fortune comes from within, from this thing we call self esteem. Growing up and going through all that yucky life stuff like death, rejection, failure, betrayal, &c, I developed this sense that if I wanted anything I'd have to fight for it. Nothing is going to just majestically flutter onto my plate, I'd have to earn it.... and even then it's no guarantee. Hand in hand with that I never gave much thought to how I came off or what people thought of me, I was just too focused on my constant tête-à-tête with reality. Any wax or wane of my self esteem had little to do with my environment and everything to do with my mind, which leads me to my closing argument: perspective is everything.

When realizing that all my previous downward spirals came from an inner battle with myself and not a me-against-the-world phenomena, I had a profound moment of insight. I was choosing to have a shit time with life. Having a bad day was, for the most part, my doing, in the sense that I was choosing to respond with perpetual self deprecation and negativity. What does this have to do with good fortune and success? To bring the pieces together, if I am successful at all, it has little to do with whether or not I deny myself indulgences and everything to do with choice and assuming full responsibility for the ensuing pattern of consequences.

Life is too short and you only get one. So if it hurts, you're doing it wrong.

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Somewhat related side note: The one thing I can't wrap my mind around in medical school is this notion of prestige. Yes it's a bitch to get in, and yes most people dont, but to me this is just another thing I do. I am uncomfortable with this imagined hierarchy and societal ranking. Maybe I'm missing something but I think we're all tangled up together and that the success of the doctor has just as much to do with the confidence, trust, and respect of the patient and fellow medical staff. They are not mutually exclusive but depend on each other. In relation to self esteem, I suppose this means that if you're feeling low about yourself then I have some shared responsibility to help pick you up again.

We're a team. You, me, and everything in between.

Be Cool, Honey Bunny. Be Cool.

What is it about a person that reaches up and grips you, right in the ribs, and holds you? What is it in the look, the touch, the smell of them that peculiarly gathers up the senses into profound liberation? What is it, if a thing, that marks them outwardly to inwardly, for painful lack of expression, as "cool?"

What is this transcending coolness we envy, evoke, and envision? A week or so ago my sister asked me what precisely this cool thing was that we've come to torture over the centuries and what I had to say, I sensed, unsettled her quandary more than quenched. You can look it up, there will be words to dissect words. They have been deemed by Merriam and Webster to be an adequate answer to this inquiry, but if that were all that is "cool," it would soon, in its own due time, fade into a sorted blandness, deprived of all its sensationally capable meaning, as of't becomes of abused vocabulary. It's not merely an aesthetic appreciation, a determined nonchalance, or confronting harmony. It's a breathtakingly pure honesty, rough and raw.

What it is, is something personal, something splendidly oblivious in possession, something that grows in your bones with blood cells, cartilage, and fat. It seeps from your pores and drips from your eyes. It swims under your skin and bounces in your gate. It's unavoidable when it takes you and we all know it, all but you. The most beautiful thing about it is how unaware you are that you have it, and the most excruciating thing about it is how completely aware I am. If it were possible I would pluck out your eyes and exchange them with mine and pull your brain into my bleeding split skull and share my reflections with your blinded hemispheres. Friend, lover, foe, or family, what confirms the suspicion of coolness, just so, is exactly this humbling humbleness, however unintended, however ignorant of that fact. It's a sobering honesty, and enviable oblivion. You just are, and have always been, with suffering justice in terminology, a straight up, brilliant, fucking Cool. Broken, obliterated, fixed, or true, that thing about you that silences the encompassing world is innately indestructible. Fight it and flail all you want, but you'll always be cool.

Permanence

I have been known to temper my more sinewy thoughts with the occasional free writing exercise on scraps of paper, countertops, book covers, emails, lose them, and then find them years later. And when it happens that I rediscover these portals to a past I claim to forget, I am always caught off guard by how foreign the words sound. It is as if some other force had taken a hold of me and for that moment I am a stranger to myself. The lastest find from mid July 2006 is as follows, from unknown context, unedited, and raw. Enjoy:

If I were to take back my venomous, spiteful, hateful, hurtful, malicious words and pack them in a suitcase, lug that case into the back yard and set it on fire, there would still be ashes left. If I took those ashes and shot them into the ocean from a canon for the whales to suck into their infinite bristles with micro-plankton some Japanese fisherman will harpoon that motherfucker and fry that ashy flesh up and some poor soul will devour that beast only to crap it out into some backed up sewage pipe that'd burst in some field in middle America. Even if the earth were to unite that ashy whale shit with the dirt some plant will sprout out and some cow will eat that plant and that same cow will turn into the bloody lump I eat for dinner with pickles and lettuce. It'll never go away at least not while I keep reminding myself with every night alone, and not while I'm running with no place to go, or searching obsessively for answers in endless pages of fiction. I want to do something stupid. I want to carve my heart out and hang it from my tree. I'll smash it until candy comes out. I'll make soup out of it. Soup's good for you, it's half digested already. Steps one and two are all done, cut and chew, done and done.

Two Percent

According to some supposed tried and true personality profile, what I am comprises approximately 2-8% of the world's population (thank you Wikipedia). The first time I took said profile I was probably about 14 or so and took that as a confirmation in my weirdness and, let's use unique, my unique perspective and approach to thinking, experiencing, and understanding life. In a word, I was convinced beyond a doubt that I was destined to be none but a loner, lonely in company. It stopped bothering me that I made no sense to most people and that their expression of such confusion was to categorize me as that itchy word, "quirky" because apparently I only made sense to 2-8% of the population anyway so it was only natural that I'd stand out, be separate, and alone.

Then I came to medical school.

And it was impressed upon me further how dissimilarly minded I am exactly. I'm not just a kinetic learner, but auditory, and visual and and and. I actively involve every possible realm of sensation I can and not quite out of want or desire but a sort of necessity, like an unquenchable thirst for a full, surround sound visceral experience of everything. Beyond that my brain is a potential I have only barely tapped. There's something stirring in there and it's big and exciting but it's horribly trapped behind all my other superpowers like my anti-routine power, my functional insomnia power, my constant rapid cycling thoughts power, my alarmingly accurate intuition but still suck at tests power, or my unnerving ability to compartmentalize and digest life's little horrors in split seconds power...

I'm still working on my living up to my potential power.

But somehow, despite all my splendidly frustrating uniqueness, I managed to find not one but a small crowd people who are as deliciously different as I am. Point in fact, one of them is the exact same kind of 2-8% as I am! And another is simply pure magic, the kind that feels like finally all the madness that got me to this exact point was worth it, like this is what I was fighting for. Suddenly through this most terrific of discoveries I'm not an island, I am not lost in the 92-98% of normalcy. The world is once more a blissful scale of greys, no longer the white of them and black of me.

I'm still weird and different and not like most people but in this great big small world of six degrees and Kevin Bacon, I found a home where I am no longer threatened by my separation but finally at a point of embrace. Still a round peg in a square world but I am completely falling in love, beyond a reasonable doubt, with my curious 2%.

Forgetting to Remember not to Forget

"Make eye contact, but not too much, aim for 80%"

Introduce yourself, shake hands, sit down, give non verbal feedback, summarize, listen.

My professors have relationship building down to a scientific formula.

Sitting there in class I looked around to see if anyone else thought this lesson on patient-physician relationship building was as absurd as I thought it was. I mean, these aren't machines you have to figure out, no IKEA assembly required. They're human beings like you and me, right? When I performed our mock interviews later with the camera recording and thirteen of my classmates plus a moderator watching me fumble my way through a chief complaint assessment with a mock patient I could feel the formula creeping into my natural progression as I tripped over my own thought process. Definitely cramped my style. But this is a different world I'm in now, this isn't Venice Family Clinic, I'm not home, these aren't my neighbors and friends. This is the land of the professionals and figureheads. When I put that white coat on in four years I'll be bearing the weight of great responsibility and it's slowly dawning on me how big a change that is going to be. As I prepare for a hellish next few weeks I am beginning to feel a shift inside me. It's not painful like it was in grade school... and high school... and college. This change is more a natural evolution of perspective, of spirit, of mind and body. But I worry that I may inadvertently lose touch with my own person in the process.

It's so easy to forget myself, forget time and place, forget family and friends, forget the past and dismiss the present while I forge ahead for a pressing future here in med school. Finding time for laundry washing, bill paying, car refueling even, has become an annoying chore. It's easy to let that formula take over, to become a robot, a drone: study, eat, sleep, study, eat, sleep. This is a brave new world I have immersed myself in, and I have to remind myself consciously not to forget that I am a human, too.

But I must remark how frighteningly easy it is to forget your own humanity as you work to save the humanity of others. It seems a vicious cycle... unless I remember not to forget.

Don't forget.... don't forget... don't forget....

Life is Not for Robots.

While discussing stem cells in today's MCB lecture I wandered back in time...

An example of intestinal stem cells came up, and the first thing I thought about was PH. His funeral was one of the few if only where I cried, correction, bawled*, something I loathe doing publically. For some reason I have a complex about showing weakness, but Crohn's disesase is one of those plagues that penetrates, deep into the heart of you and everyone around you and will of steel or not it gets emotional. Remembering PH made me remember SR, that one was a very terminal, fast acting pediatric leukemia. SR made me remember SH, probably one of the most aggressive cases of breast cancer I've come across. And so on...

Given that I didn't know medicine would be my battle field until, truthfully, a year ago, remembering these people, these diseases, and how they did and still do affect me, how I've lost friends and family to other personal battles, how I nearly lost myself to my own -- have all given me a guiding light through these long steady hours of endless studying. Though I wasn't looking for it, life just sort of has a way of teaching you a thing or two about yourself. And what I'm learning, slowly and surely, is that I'm both bigger and smaller than I thought I was. I'm bigger in that I never thought I could achieve anything like this, no, not ever. And smaller because there is so much I have yet to learn, from class, from my classmates, and from life.

The last one is probably the most important. And something you so easily forget here in the receptionless walls of medical school.

This is the eve of our first MDQ. It's technically only worth 3% of our grade but it'll reveal if we've managed to master a semester's worth of material in a week and a half for a quiz that roughly covers the scope of an undergraduate final... I've taken maybe 5 hours of "me time" in the past 10 days... but today I'm taking it easy. It's not even 6 and I'm already in my jammies. I'm slowly learning how to center myself in all the crazed intensity around me. With my notes in hand it's a work in progress, clearly, but I'll keep at it.

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All that we are not stares back at what we are. - WH Auden

3 - 2 - 1 GO!

It's 9:30 on a Saturday morning and I actually felt great starting my kitchen chores before rushing to school to meet up with my study buddy, because it was at least some semblance of a normal life. Med School is a whole different kind of beast. One of my M2 friends said there's something wrong with the M1's, we're studying too much too early, we're supposed to be out getting sloshed, she said. But as my study buddy says, working hard and wanting to do well is not gunning it's being responsible. My impression of what it means to be a gunner is someone who's just throwing fire wildly and intensely in the hope that they'll hit a target without burning themselves up in the process. My study buddy and I are more just terrified of failing, far too pressured and focused and determined to start mowing people over... ourselves aside.

What strikes me most about medical school is how easy it is to lose touch with reality. I went to a show the other night, tickets for which I bought way before I knew what new world of crazy I was entering into, and it was the most incredible release from long nights of academia. I went with two people who are going to become great friends of mine... both of whom condemned me for even thinking about classes while we were out. (I'm going to need to keep them close by for my own sake.) Something so mundane and common back in L.A. as a music venue became this medical-free safe haven of pure stress-free bliss! On my way to the gym this week, something I've taken to not for exercise but for sanity, I had to remind myself that just the day prior I was wrist deep in superficial back muscle of someone's grandpa. I had to take a moment to remember that this hunk of dissected flesh was once a person, with stories, with scars, with memories. It's so easy to forget, and difficult to digest why. Why do I not cringe when I see images of anencephaly or skin harvesting? Burn victims? At the same time I am not altogether unfeeling, no, I appreciate the horror and the sadness, but where do those feelings go? How do they dissipate so quickly? What is this person I am becoming? And what is she capable of with so few limits and a stomach of steel?

In the midst of everything I remain resolved to win, to conquer, to succeed. I say hi to anyone and everyone, keep positive, lighten the mood with my casual self deprecating humor... then I get 5 hours of sleep and push push push! There's a monkey on my back and it's telling me to stop writing and start studying.

Every day I am reminded that this is the happiest time of my life. I am in love with the people, in love with the school, in love with the classes, and even in love with Cowtown. And that is what will keep me going.

I made it. I am here. And I am going to rock. this. hard.