Goals 2016: Work

I’m lucky enough to love my job. Sure, there are politics—red tape, entitlement, insurance muck to slosh through. But most days, I leave the office genuinely thankful that I’m able to do this.

I have big dreams for my patients. B.I.G. (hopefully ending better than the one & only Notorious). But I also have a family that I adore. The truth is that the smiles may come from my patients, but the substance comes from my family.

My age is a touchy subject in my line of work. I feel it my responsibility to seem mature, knowledgeable. But then again, certifications, letters-after-my-name, & ALL THE SCHOOL LOANS kind of prove those things. I get asked a lot. Apparently some think that I graduated from high school at age 11.

When the question is asked, though, I reassure them that I am old enough to have completed my training. The truth is that I want to throw my hands up & prompt a pop quiz about the first line antibiotic for pneumonia or the molecular pathology of diabetes. I am more comfortable there, in the land of blissful academia. I am more comfortable where someone asks the question and, if I did the work, I know the answer. I’ll write you an essay, draw you a picture, or make you the best goddamned color-coded notecard you’ve ever seen. I’ll even use sparkly gel pens if you ask.

But ask me to hold your hand & sit in awkward silence because you just found out your marriage is broken or your father has cancer or your grandmother is suffering? That is the hard part for me.

I realized, not too long after starting work in the “real world”, the post-residency world where neurosurgeon’s call you by your first name & medical students cower in fear of your evaluation, that I was bad at the in-between. I love this job because I get to solve problems; I struggle when I have to sit through them with you.

The hard truth for me is that both aspects are part of my job—the solving & the sitting. The former is the science. The latter is the art.

I’m slowly learning the brush strokes, the color-mixing, the medium to work on. I’m slowly learning the hand-hold to console, to lean into the emotion instead of pushing it away.

And perhaps the most important part of what I am learning is to leave work at work. To close the office door & shut the laptop to just be done. The science is easy to leave, the sentiment drags behind like muddied footprints on a clean floor.

They say our visual memory is like a rolodex of cards—ready to be accessed, spun, at any time. Every so-often a smell, a look, a sense will trigger a memory of a patient or experience. Most are pleasant & evoke feelings of bravery & peace. Some are not, though; some are bitter & course, grating away at the joy that hangs just overhead.

We’ve discovered the difficulty in the constant grating recently. My husband switched jobs, which is what prompted our move. New field, new perspective, new hope.

We are taught that our jobs matter almost as much as our lives in this country. And as an unfortunate consequence, the lowly janitor (who is really not so lowly at all) feels like his life is worth nothing because of his title.

In Mrs. Hays fourth grade class, as part of our Medieval Social Studies unit, we held a royal knighting ceremony. Our parents made food & set out crockpots & snack trays on top of the paper tablecloths we handcrafted. We made a crown, a scepter, & a long purple cape. And, when the time came, the knight of our school walked in, ready to be given what was royally due. Our Janitor got royal treatment that day. He already knew each of us by name--& from thenceforth we got to call him “Sir”. He was a knight in shining (paper) armor, after all.

The symbolism was lost on me in fourth grade. It now brings me to tears.

So the last will be first, and the first will be last. (Matthew 20:16)

The irony does not escape me that my mind is most comfortable in the pretentious world of academia & my heart is brought to tears at the very thought of it.

As much as hand-holding & sitting through it is part of my job, as much as the diagnostics & the competency is part of my job, learning who I am holds an equal place of priority. Who I am to my patients. Who I am for the unacknowledged important. Who I am with my family.

Sparkly gel pens, pharmacology, & ambitious dreams aside, work for me needs to be something in which I can recognize the value of people & help make them better. It is also a tool with which I can teach my kids about the world. So that they can make it better, too.

•  Work for the JOY learning brings & the people it touches.
• Be present at work. Be present at home.
• Dream, plan, create—but savor these years of youth & the beauty of your children at this age.
• Stop working—in every sense of the word—when it is time. Stop working to seek approval. Stop working toward worldly updates on Facebook or the Nightly News. Stop looking for eye-candy; stop searching the outside world for self-worth.  
• Work because I can and because I love it, but remember why God gave me that work to begin with. Don’t let the red tape become the Red Sea, partible only by miraculous intervention.

(See parts ONE, TWO, & THREE)

playdates & dinosaurs.

we played dinosaurs for 20 minutes.
my leg fell asleep squatting on the hard tile floor.
his little red wagon had been wheeled out to the nurses station.
his room empty, dark, lonely.
his mom disappeared days ago.
she left him with a little dinosaur.

i made the dinosaur eat his toes.
and then he shared his socks with the plastic creature.

he asked for water.
i filled up a girly cup covered with silver sparkles.
this four-year-old boy didn't care.

he bounced balloons on my face.
we had a dinosaur fight.

the nurses wheeled his little red wagon back to room #253.
where he curled up, plastic dinosaur in hand.
and went to sleep, alone.

it was the best playdate i've had in months.

psalm 139.

i volunteered to pick up a new patient. and, thinking it would be an easy add-on to my already bulging list, i picked her. or rather, she picked me.

i opened her chart to find a "doctor's orders" section already 1-inch thick. daunting. and while most patients are admitted for a miniature list of problems, hers spanned five pages & well-exceeded the longest five-paragraph essays i have in my repertoire.

crap.

while i likely should have welcomed such a learning opportunity, i did not. it wasn't for lack of interest, or rarity, or even compassion. mostly, it was because before i'd even met the patient, i already hated her problems. i might even surmise to say that i hated her.

i hated her rare genetic disorder--the one that could never be fixed & would make our efforts embarrasingly futile.
i decided i didn't like her parents, such selfishness they had keeping her alive all these years, trapped in a dying body.
i couldn't find the empathy for her delays, caused by genetic chromosomal abnormalities so severe that she would never walk, never talk, never communicate in an audible or interpretable way.
i was annoyed by all the "failures" listed next to her vital organs & processes: developmental failure, renal failure, liver failure. the first from her genes, the last from the 'food' we'd pumped into her veins, her PICC line, her stomach tube.
i was mad at God--wondering why he didn't just take her, quickly, painlessly; mad because we all had to watch her suffer.
and i was sickened by all this 'modern' medicine that we so proudly claimed was helping her.

...or was it?

and two hours later i walked into her room. mom attentive at her bedside, lovingly stroking her course black hair while the nurses cleaned the diarrhea that covered her lower half & was smeared about the sheets beneath her. the infection that raged in her colon was the culprit--another diagnosis to add to the list. she moaned. she moved. she breathed, occassionally. and all the while that loving, petite pretty mommy rested cheek to cheek with this emaciated, groaning patient--loving her the only way she knew how.

i'd only walked in to tell her we were shoving a catheter up her daughter's urethra to get the pee out of her atonic bladder--news delivered in the kindest way i could muster.

as luck would have it, i walked out 10 minutes later in tears, ashamed.

crap.

i'd missed the boat. overshot the target. fallen off the bandwagon. and i'd totally, misjudged.

praise songs to Jesus played in the background.
a Bible rested on the bedstand.
a prayer journal overturned on the meal tray.

they are a Psalm 139 believing family. a family who believes this little black haired, nonverbal, diarrhea covered little girl is a gift from Christ himself. who believes that He renews their strength every morning, every evening, and at every moment in between. they are a family who is learning the joy of suffering, finding His Will in sorrow, & navigating this difficult choice to let their daughter continue to live day-by-day. they are a family who believes that they weren't chosen because of what God knew they could give, but because of what they could receive through the fragile spirit of this little miracle.

and suddenly, somewhere between the bed and the hallway, i realized i've been right & wrong all along. i was right: modern medicine isn't helping her. in fact, in many ways, we're making her sick: aspiration pneumonia from the surgery, antibiotics from the pneumonia, colon infections from the antibiotics, diarrhea from the antibiotics,  urine infection from the dirrhea...

but oh! how i was wrong in thinking that this is all about healing. i was wrong in thinking that i, we, medicine is the only one with something to offer.

afterall, the truth is that she's the one helping us. helping us learn. helping us grow. and somehow in the middle of the moans and the process of her problems, teaching us how to believe.

believe in miracles.
believe in hope.
believe in survival.
believe in Psalm 139.  

For you created my inmost being;

you knit me together in my mother’s womb.

I praise you because I am fearfully and wonderfully made;

your works are wonderful,

I know that full well.

My frame was not hidden from you

when I was made in the secret place,

when I was woven together in the depths of the earth.

Your eyes saw my unformed body;

all the days ordained for me were written in your book

before one of them came to be.

How precious to me are your thoughts,[a] God!

How vast is the sum of them!

-Psalm 139: 13-17

fanny pack.

the waistbands of my pants are all stretched out. and i didn't figure out why until tonight.

originally, i'd thought that poptarts & yogurt for dinner might be the culprit. but surely my body knows that when the hospital cafeteria is closed, calories don't count....

and when i tried to pee tonight & my pants nearly flopped in the toilet, i finally realized that perhaps it is the TEN POUNDS of technology attached to my waistband.

seriously?

left to right: name badge. pager. on-call cell phone. personal cell phone.
not pictured: 2 pens. clipboard. stack of reading material. water bottle.

****
as a HILARIOUS side note about my pager...i asked tayte (sister, 17 years old) what it was.

an insulin pump? i didn't know you were diabetic!

a gum case? seriously!?!?!?!? they make those?

a cell phone? wait...where are the buttons?

and no folks, she'd never seen one before. neither had the paint boy at Home Depot who asked me what the heck that black thing was i happened to be wearing on my belt.

which is either a sure-fire sign that i'm getting old. or that i need a fanny pack.

if this isn't just ridiculous...

...then i'm not sure what is.

SERIOUSLY!?! JULY!?!?!?! where the heck has time gone? and who stole all the calendar months?

needless to say, i guess time has, indeed, passed. and in the meantime, a lot has changed for us. a lot for the good. a lot for the stressful and busy and work-filled and God-waiting and ....well, a lot has changed. and we are here, finally back at "home" in the Pacific Northwest. adjusting. settling. and enjoying.

it feels so so good to be back. to have full seasons. crispy fall leaves currently covering the ground. forecasted snow in the next couple of weeks. and the potential to skip through the mountains (real! mountains!) this winter just makes me giddy.

life has been too full to summarize. but like all our stories, they'll come out one way or another. and part of the beauty of life is that some stories are locked in little boxes that play music with dancing ballerina's when we open them. in the meantime, they'll rest safe inside our memories. and for us, that is okay right now. it has to be.

we've been busy. like really busy. but not any more busy than the rest of America, i'm sure. and right now, for us, busy is good. like, really good. we're soaking it in. and although i wish i had a few more hours in the day to read and blog and exercise and make wholesome, healthy meals, i'm taking it all with a grain of salt--knowing full well that life will change and a new season will be upon us shortly, waiting with its own musical ballerina box for us to open & enjoy.

shortly after our last blog post, we left north carolina. not without living in an apartment with only an air mattress, 2 spoons, 3 bowls & 4 plates for 16 days though. oh yes, and did i mention a broken air condition in 900-something percent humidity? (at least it felt that way...). the movers came, boxed up all our stuff and hauled it away. we were left with just us. a bottle of wine. a few bags of popcorn. a pantry to empty out. an airmattress. the aforementioned dishes. and a whole-lotta potential & excitement about what was coming 'round the bend next.

and you know, we had a reason to be excited. life, for the first time, was aligning for us. this was, of course, by choice. and brave, generous, ever-supportive jon make that sacrifice for me. which still boggles my mind each morning when i get up to trudge to the hospital once again. so he made that choice for us...which, for the first time in 3.5 years of marriage, is letting us be together.

jon stood in his last formation. and humbly accepted an award for working so so hard over the previous 12 months of deployment. he saluted for the last time as an active duty captain...and we walked away & into starbucks. where else would we have celebrated this crazy heart-breaking-breath-taking milestone?

we packed up the car. ehem...JAM packed the car and bid adieu to friends i hope cross our paths again (many, many times again!)...and we were off. i have a folder packed with photos. of landscapes. and red vines bags. and (disgusting, ate-for-the-first-time-in-a-decade) mcdonalds fries. and state signs.

for now, though, i'll just leave you with my feet. they've taken me a lot of places since i snapped this photo on our way in to new life.

we arrived in Washington and ransacked jon's parents house for about a month. before our own house was ready. i started work just 3 days after we pulled into the town we'd call home...and have been busy every since.

i guess they don't call it intern year for nothing.

but moral of the story is that i am LOVING my job. i'm loving my days. even the one like today, where the clock at this moment marks hour #18 that i've been in the hospital...with 12 more hours to go until i can finally roll down the windows of my car & hope i make it home in one piece.

so in summary, we are ALIVE. and we are loving life right now. loving being settled, close to incredible people, plugged in & involved at church, blindly making our way through the 24-hour-sequences God gives us to be salt & light...and fill up dancing ballerina boxes of memories.

more to come. more to read. more stories to share. more pictures to download. there is more certainly more.

and it will come. in time.

so don't give up on me. i'm still alive. out there.

and now if you'll excuse me, i have adorable sick babies to check on....

irreplaceable.

I had trouble at my graduation. Showing excitement is not my area of expertise in the first place, and stacked on top of my God-given personality traits (Lord help me, sometimes) were the sometimes complicated-overly-excited-family that had come to shower me with well-wishes and well, love. But the truth of it is that yeah, big deal, medical school is over. Residency is starting. But all the “aren’t you so excited to move on”’s, truth-be-told, got a little annoying after awhile. Because yes I’m excited to move on; on into the HOLY CRAP I forgot everything, into the “don’t kill anyone at work today,” onward to the 80-hour-work-weeks & the life-is-not-my-own. And in a way, I felt, I’d be moving backwards. All assumptions I was making, you see, but still backwards. Back to the ‘do I study or shave my legs for the first time in two-weeks’ attitude that ohmygosh my to-do list will never end.

And so, I had trouble at my graduation. And the ohmygosh’s have just gotten worse. But despite the occasional (or not-so-occasional) freak-out’s, I’ve had time to do something I haven’t had the privledge of in, well….ever. I’ve had time to think.

The pace is slow here, for the time-being at least. When I roll over in bed at 7:30 & realize that it’s been two hours since Jon got up & left for work, I usually don’t see any reason in greeting the day with gusto. And so I lay there. Letting my back sink into the memory foam & letting the fan blow around my bed-head a bit longer. And its there that I think. And sometimes, on days I’m feeling particularly adventurous, I think about those eighty-hour-work-weeks and choosing to shave my legs and kissing homemade pedicures goodbye for the next three years. Most of the time I get carried away with the ohmygosh thoughts; women have babies & raise children & start cooking blogs during residency for gosh sakes. But then I remind myself that I’m not them, that I had trouble at my graduation, & that I always have to prepare myself for the worst as some weird coping mechanism I probably picked up at 32 months-old when I started Montessori.

I lay there for longer than I’d care to admit usually. Dreading my workout (thankyouverymuch p90x), wanting to workout, wanting a PopTart, hating PopTart’s, eventually turning eight again like it is 1992 & daydreaming about growing up. Wrapping my thoughts around things like eating chocolate for every meal (that ohmygosh has to do with my pant size) and little people that will hopefully someday inhabit our house (Mom, I said someday, not tomorrow) and work.

Yes, I said work. But they aren’t the “Jlyn saves the day!” daydreams. More like “JLYN YOUR PATIENT IS CODING, DO SOMETHING TO SAVE HIM!” daydreams. Or should I call them “daymares”—nightmares except in daylight? And in the midst of these thoughts, somewhere between the trouble-at-graduation and the daymares, I decide unofficially who I want be. Like, the toenails-always-painted girl who doesn’t use the name “doctor” because it feels too official & who keeps a clean desk, despite the crazy wordload, & eats oatmeal everyday for breakfast because, you know colon health. Or like the go-with-the-flow’er who downs coffee like its water & who has bundles of energy & rides her bike everyday to work & grows a garden just for fun girl. Or like something else entirely.

But this thinking time, it’s good for me. Some things are matter-of-facts, no compromises, nothing-gets-in-my-way for-sure’s; things like oh being nice, showing Jesus, giving grace. You know, the normal stuff. But then there’s those other things—the things that come out when you leave the patients room or they call their best friend Sally & tell her about their ‘rather young to be a doctor’ Doctor. And it’s those other things that I’ve decided my back-in-memory-foam-fan-blowing-hair thinking time is about the other things.

And since I’ve mostly devoured the literary candy of Kelly Corrigan since I picked up her book last weekend, this morning during my thinking time I thought of her.

"...Coming down the hall in a silk Banana Republic scarf that I thought made me look professional, I could hear the booming voices of my aunts & uncles & cousins & I was glowing with tribal pride. I was a Corrigan. When I turned the corner, Greenie said my name so loudly that the whole room started laughing & clapping & tearing up while Greenie & I hugged & rocked back & forth & laughed into each other & my dad called out my name again & again:

"'Love-E! Love-E!'

"Until I became a mother, it was the most irreplaceable I'd ever felt. I had "made the night". But then I watched him greet Rocky Shepard & Chris Burch & Betty Moran &

I realized that making people feel irreplaceable was his gift."

--Kelly Corrigan, The Middle Place, p. 145 (emphasis mine)

Now, I don’t own a silk Banana Republic scarf. And I am certainly not a Corrigan. But my morning times, those daymares and those ohmygosh’s have all come together in the perfect pinnacle of thoughts. I’ve decided, once and for all, who I want to be when I grow up.

And I feel like the trouble at graduation is now justified. Because it wasn’t about graduation at all, really. It was about celebration. Celebration of a milestone, an accomplishment. And mine happened to include a velvet unitard & mushroom hat. But not everyone’s does.

For some, like my pretend future patient in room #502 with a bowel obstruction, it will still be about celebration, accomplishment, passing a milestone. And the future momma in Room 8 on the obstetrics floor will need celebrating for her work in bringing new life into the world. And the kid with the respiratory infection and the grandma with the broken hip and the brief-case-carrying business guy with newly diagnosed prostate cancer; they’ll all have their own accomplishments, pass their own milestones, run their own races & win their own medals (metaphorically speaking for some broken hips, of course).

And I’ve decided. And I want to be there, present & in the mood for dancin’. I want to be that crazy Patch Adams-like-doctor who throws the chart into the air & dances with Mr.-Room #502 about his successful bowel movement, who hugs that momma with all I have in me because a new life breathing this Earth’s air & the physiological miracle of it all is too overwhelming. I want to be the ‘professional one’ who rips off those stupid yellow contact precaution gowns when the respiratory infected kid no longer needs isolation & who dances when the grandma with the broken hip takes her first step with her new Cadillac walker .

Because gosh dang it, somewhere along the line I got two new letters after my name. And with those letters come a lot of ohmygosh responsibility. But at some point this whole gig needs to stop being about medicine & start being about people. And celebrations. And yelling “Love-E! Love-E!” at the top of my lungs, just like George Corrigan.

And on top of all that, I’ve decided something else: I want that gift, too. I want to make people feel irreplaceable.

Simple as that.

graduation: day 3

The weekend, the one I didn’t want to attend & made up every excuse to avoid, came to a close much too quickly. Breakfast was had (my pants were getting tight by then), hugs were given, and goodbye’s said. It came & went faster than my memories could catch up, soak in, linger.

But that is why we have pictures, right?

Looking back on the whole weekend, it confirmed that people are willing to sacrifice for us. and how honored we are to have a family, to have parents & siblings & aunts & uncles, who model that sacrificial behavior. Who stand up & say yes we want to be there, despite my fit-throwing & avoidance-seeking; who love on us when we don’t want (or don’t think we need) to be loved on.

The pride that was expressed at this accomplishment pales in comparison to the lessons learned from the journey. Jon & I have been through a lot over the past four years (but who hasn't?). And this accomplishment--& the photos posted here—shouldn’t at all detract from his accomplishments, too. But those will come out—you’ll all be awed & amazed at his humility through it all.

One thing I must say, though, is that we got through this past year without complaining, for the most part. We made it a goal: him in Iraq, me who-knows-where on rotations that we would take each day as it came, embrace what we were given, & try to be the best person we could be despite the trials & frustrations & strains that life seemed to slip in to golden moments. And we did it. Together.

With time, the memories of this weekend will fade. The specifics will blur together...and I won’t remember that I drank a 16-oz chai everyday while I was there. I won’t remember that our room at The Greenbrier smelled like an old woman’s perfume (probably for good reason as lots of old people stay there). I won’t remember Jon standing on his chair in the middle of the circus tent doing fist-pumps & shouting my name. I won’t remember the humidity or the polyester unitard or the wine we sipped at dinner.

But this. This is what I will remember: that we were loved. That we were together. And that life, at the present moment, was good, wonderful, full, & sweet.

And those are the memories I choose to carry with me. Like sunshine in my pocket, an umbrella for when the rains come. No doubt, the storms will come someday…but for now, I’ll bask in warmth & leave the post-storm rainbow for someone else.

graduation: day 2

The “BIG” day. Which in all reality, wasn’t really the end—more like the beginning. The odd feeling I had, the one that found its resting place at the bottom of my stomach, seemed to echo the sentiment that yes this is an accomplishment…but yes you’ve got a LOT of work to do. I guess if I was confident in what I didn’t know my future patients might run the other way. For good reason, too.

The humidity was bearable (certainly better than North Carolina), but still thick. And the polyester unitard (as I fondly took to calling it) was NO help at all. I had to pee. I kept drinking water because I was nervous. I was afraid my family would do something embarrassing.

But in the end, it didn’t really matter. I stepped up on stage, shook hands, got my GIANT diploma (I thought they’d at least try to save paper), & then walked down (I won’t tell you that it was followed by sprint [in my polyester unitard with my mushroom hat nonetheless] to the bathroom. I thought after those shenanigans I might be dubbed the “runaway graduate” since it was a professional ceremony and all. But my bladder told me otherwise.

Anyways…the ceremony was over…we snapped some photos…ate some snacks (good thing my hefty tuition paid for something!)…and then Jon & I left for more chai, a lunch alone, and a long walk (with my then-blistered feet from uncomfortable shoes).

The evening was the highlight of the day. We had dinner inside the mini-house my family rented at The Greenbrier. It was DELICIOUS. There was conversation, wine, laughter, memories, and encouragement.

It is an odd thing, these big “events” that come after the wedding. Perhaps it’s been my own selfishness, but the more we are surrounding my loving, encouraging people; the more we put ourselves in the middle of the legacy our immediate family provides, the closer our marriage becomes. It is in the recognition that we are something together instead of just two people wearing rings, in the recognition that we are supported by those more wise with more miles on their proverbial tires, and in the recognition that although I might not have chosen the people in my family that they were chosen for me by Someone who knows so much more.

I chomped on my oh-so-amazing chicken & sipped down the red wine in my glass until just smears of sauce & a red-wine drops were left & couldn’t help but think about how blessed we are.

We topped the night off with bowling. In the basement of the Greenbrier. Yup…the place IS that amazing. It was hilarious. And muscle-pulling. And squeal-provoking.

And it was perfect.