Thursday, May 29, 2014

On Eating Elephants

I had an anxiety dream the other night. Unpleasant while I was in it, but I had to laugh when I woke up for the complete lack of subtlety. I dreamt that I was at Scott's upcoming memorial service, reading my reflection. Except I couldn't read it because the font was tiny and the text was full of utterly unpronouceable drug names.

I feel like I'm trying to eat two elephants these days. Elephant #1 is studying for my upcoming Boards exam. There is so much to commit to memory. Pharmacology, biochemistry, physiology, anatomy, pathology. Everything we covered in the first two years of med school, all fair game over the course of a seven-hour 322-question multiple choice exam. It's a beast, and it's happening exactly two weeks from today. I'm fairly confident I'll pass, but it would be nice to get a high score, as this is an important number for residency applications. I wish I had an extra month to study but I'm looking forward it being over and done with. I'm trying to remind myself that I will do exactly as well as I need to do for whatever needs to happen next.

The second elephant I'm working on is, of course, grief. I've been sad since coming back to San Francisco, missing Scott more regularly. I was making coffee for myself on Sunday morning and suddenly remembered how, for years, I would make coffee for him and me every morning. I'd froth milk in our "Mom" and "Dad" mugs, divide coffee between them, and wait to take my first sip until we'd toasted each other, "To you." I stopped making coffee for Scott a while ago - he stopped waking up early with Clark and me because he needed more sleep, and even once he was awake the bitter flavors were often too much for his chemo-ravaged taste buds. I've been making coffee for myself for a long time. But that ritual suddenly felt like an acute absence. We did it at Delafield, in Davis, here. And somehow the thought that I won't get to make coffee for him again is giving me a lump in my throat right now. Our mugs are still hanging in the kitchen, within easy reach.

This elephant, unlike the Boards, has no clear endpoint. To be honest, I'm a little annoyed to have to be digesting this chunk just now. Can't I just focus on one elephant for a while? But having it so prominently in my life provides balance, perspective. It's good to remember that there is so much more than a Boards score, now and always. And anyways, pretty soon after Boards I'll launch into surgery, which will be a whole other animal. I think I'm set up to have a life full of elephants for the time being.

Scott's East Coast memorial service is in two weeks and two days. It will be good to see people there, to connect.

Saturday, May 17, 2014

A confession of willful ignorance

I came across this article, "The Day I Started Lying to Ruth," written by an oncologist about his wife death from cancer. Many parts of it resonated - the idea of unfulfilled aspirations and promises, explicit and implicit; the medical decisions that never felt like true choices, because of course he was going to try everything possible, what else was there?; and the strange loneliness now of having "plenty of people to do things with, but nobody to do nothing with."

But the article also made me grateful for my relative medical ignorance throughout the majority of Scott's illness. Unlike the author, I didn't know what the end would look like, or even basic facts about his cancer type. That first month after Scott was diagnosed, I looked up one paper on neuroendocrine carcinoma, and the survival statistics were terrifying. I consoled myself that the paper was old (outdated, I decided), and didn't read anything further. I think Scott was surprised, maybe a little hurt, that I didn't take more interest in the medical details of his cancer. For me, it wasn't a completely conscious decision to avoid learning about it, but I was aware of a gaping hole in my knowledge and did not take steps to fill it. It was easier to just think, "Scott's cancer is really rare. There's not enough research to be able to draw any conclusions." Ignorance wasn't exactly bliss, but it was at least protective.

By the time we covered cancer in school, Scott was very weak. Learning the details of neuroendocrine carcinoma hit painfully close to home, but I didn't need protection from the information any more. I already understood that he wasn't going to be among the very small minority who surived five years.

Scott was diagnosed two weeks before I started med school, and he died during our cancer unit; my medical education (and practice) will always be inseparable from his experience as a patient. There are times when I see him very clearly in patients. I've been thinking a lot lately about whether and how I'll hold on to that compassion when I move into third year (and beyond) and start seeing a lot of patients and being a lot busier. I know that Scott will always be part of me, and that the things I've learned over the past 18 months will never be unlearned, but I wonder how accessible it will be. I worry about those lessons not being so close to the surface, about lapses in memory, about other things coming along and tamping down, crowding out what's inside right now.

And then I remind myself not to worry, because I'm thinking about him now. And the future has't arrived yet, only the present. A grey fox just jumped the fence into my parents' backyard and rooted around the grass below the birdfeeders. And a red, red cardinal was out there earlier, singing. The trees are just starting to bud. There's still ice on the lake, but it comes and goes depending on the wind. The full moon the past few nights has been casting bright rays through my bedroom window. I'm glad to be where I am. There's still grief in looking back and in thinking about unfullfilled aspirations and promises. But I will not lose what is in the past. I will not lose Scott and the life I had with him. As for what might have been, a friend suggested this: "Pray that the dream comes back to you another way."

Sunday, May 04, 2014

Happy birthday Scott

Clark's birthday was bittersweet, and the feeling continued throughout the next week - Scott's birthday was the following Tuesday, April 22nd. That day was a busy day at school, and although Scott was on my mind throughout the day, I didn't have much of a chance to really absorb it until I got home at four o'clock. I decided to watch the DVD that Scott recorded last summer. It was my first time watching it, and it was wonderful and painful all at once. I heard his voice again - the voice I fell in love with. Scott was so sad to have to say goodbye, and his absence felt more acute than ever. But parts of it were comforting - he was doing his best to take care of us, to comfort us even after he left. He truly believed that even after his death, he would still be loving us, present tense loving us. I absolutely believe that as well.

Clark and I are at my parents' house in Duluth this month, so they can take care of us while I study for the boards. My mind is very firmly in the books these days. It feels good to be able to focus on studying, but I'm trying to make space for my emotional life (for lack of a better word) as well - still using my mindfulness bell app and trying to make time for meditation.

"With life as short as a half-taken breath, don't plant anything but love." - Rumi