I have to admit, after all of my talk of looking forward to this trip, and ostensibly planning on and off for a few months, I was a bit underwhelmed upon my arrival here. Granted, the sense of rushing to get here (in terms of getting closure on a few things at work, and then having a bit of a whirlwind trip home before my slightly painful flights) could have something to do with that. My exhaustion-induced delerium might also have contributed. But now, a few touristy stops, nd more than a few Euros in, I’m enjoying being in a foreign city. Dublin has been a nice start … Being here reminds me a bit of my trip to Melbourne, in that it has been a pleasant surprise. Part of that is that I’ve changed my usual way of travelling; instead of exclusively keeping to myself (in line with my being a social introvert), I’ve forced myself to be open to interacting with people, even just on a bus or tour. And, even with that minor alteration, I’ve noticed that everything has become a bit more of a learning experience and an adventure. Even now, I’m sitting at a place that may be called “The No-Name Bar” … amongst other names. This is definitely off of the tourist maps, and came as a recommendation of a bartender at another less touristy place. This is a perfect place to wind down the night … Part comfortable living rooms, part small bistro, I’m definitely in love with this place.

As for my other adventures in Dublin, I’ve been diligent in exploring the touristy areas. Checked off the list yesterday were Trinity College Dublin and the Book of Kells, Graftom Streey (with buskers), a bit of O’Connell Street, and St. Stephen’s Green. Today, after a wonderful run across some of the bridges and through Grafton St. And around St. Stephen’s Green, I wandered off to the Guinness Storehouse. A note about that — it is the best tourist trap, in my opinion! But that might be the pint talking. Then, to round off the day, I made it to Knowth and Newgrange, where we encountered the awe-inspiring architecture of Neolithic Man.

I don’t quite yet have a favorite part of Dublin, although I suspect it’ll relate more to the people than the locations here. But, we’ll see if that changes tomorrow, as I get to experience Joyce’s Dublin (one of the main reasons for this trip).

Over the past few weeks, I’ve been bombarded with random thoughts and ideas in the midst of the work day … but instead of pushing them to the side, I’ve been able to write some of them down with the desire to try and write more about them.  Here’s a sample:

– 2 feb 2010

—> balance (of life, of decision making, of information giving …)

I had a family meeting with a patient I met through urgent care. He is in the midst of a work up for vague symptoms, with a likely terminal prognosis. As I sat there, trying to wade through the information we had and that which we needed, I realized that there is a fine balance involved in all aspects of medicine … especially when it comes to end-of-life care. With meetings like this, there is so much information that can be relayed; however, even knowing the importance of full disclosure of all facts and findings, there comes a point where the information is emotionally and cognitively too much. Add to that the necessity of giving the data in a sensitive and understandable fashion; something always becomes lost in translation this way.

Once the information is given, decisions need to be made. How many interventions do we want, just to seek a confirmation of the likely diagnosis? How invasive should the treatment be? How much should we focus on the quality of life left versus the quantity of days left? How much should the family make the decisions in place of the patient? There is an almost palpable tug-of-war whenever these sorts of questions need to be answered, with the patient’s best interests in the middle. The worse part of this for me has been when the family wants me to add my thoughts, especially as the whole reason for a family meeting is so that I won’t be the one making any of the decisions.

—> semblance of confidence; play acting

Obviously, after a certain amount of training, there is an expectation that we as medical professionals have a clue all of the time.  And while this is true a fair amount of the time, there are cases where the information requested or needed is above and beyond our training or current knowledge base. Now, I’m definitely one of the first people to admit when I’m not sure of something, and I’m always more than happy to look it up. But, in times when the uncertainty has more to do with the situation, and not the medical knowledge, there’s nothing to look up. Again, remembering that family meeting, I felt so out of my league, as I had yet to have such an intense discussion, especially with a patient with whom I had a very minor relationship. But, letting that unease show would have been possibly harmful to the meeting. So, I did my best to hide my discomfort, and just help the family wade through what was happening to the patient.

14 feb 2010

–> realizing that i do not have a home … that sense of ownership/lived in location, w/ family/pets/friends/a neighborhood … and it is nearly impossible to get in Zuni!

I had gone to Albuquerque to attend a friend’s baby shower, and was able to stay at their relatively newly bought house.  Seeing their renovations and aspirations for future changes, as well as those of their friends, made me (for the first time) wish I could be going through the motions of homeownership.  Granted, I know absolutely nothing about that, as I’ve lived in rented property my entire life … and I’ve never owned anything more than pets. And, I have a pretty good living situation in Zuni, being able to walk to my friends’ houses (well, most of their houses), and work, and the Wellness Center. But that sense of settling won’t be something I have here. The best I can do is make a home where I fell happy and at peace, both inside (with renovations like painting) and out (with environmental changes and community building).

16 feb 2010

—> the finality of a diagnosis that is terminal … a stark truth that was known but hidden …

Back to that patient with whom I had the family meeting … given the constellation of symptoms and lab tests, the patient had a diagnosis that was most likely terminal. I spoke with my colleagues, sharing the story, and they all agreed. But, we didn’t yet have more confirmatory testing; that was what I needed to start arranging after the family meeting. The patient was sent to another facility for one of the less invasive tests which would help continue to clarify his illness. I had to hunt down the results, and finally got them (before they were sent to the specialist).  My heart sank as I saw the one line impression on that piece of paper, because it made the diagnosis even more real.  I don’t think I was in denial about what was happening to the patient, but a very small part of me had some doubt (“What if I’m having a family meeting about a wrong diagnosis”) and some hope (“Maybe his illness isn’t that bad”). This test result put those feelings to rest. And, while it simplified the situation from my perspective by narrowing the options of diagnoses and treatments, it complicated the lives of the patient and his family.

Wow … those are all somewhat morbid/depressing, aren’t they? I do have some more positive thoughts … but I think the more meaningful ones have been these harder to process thoughts. Maybe I’ll put some happier thoughts up later …

In looking up the definition of “reunion”, I had a difficult time finding one which encompassed my experience with reunions over the past month or so.  If I had to cobble together a description of a reunion, it would be something to the effect of “a coming back together of a group of people who knew each other through some former connection” (if you want a reference, just google “definition of reunion”).  And even that definition sounds so simple — people who once knew each other end up meeting together. It doesn’t encompass the reliving of shared experiences and communities, the joys of working through current life events and struggles, the comfort of familiarity …

Going home for the holidays this year was wonderful, but not just because I was able to visit my home town after more than 4 months away. This time, unlike many other times, I was able to see many friends from various parts of my life, all of whom impacted my experiences in some way.  This group of people included my mother, my godson and his family, close friends from college and the time I spent in Cambridge after college, colleagues from residency, and friends from my last church and my book group in NYC. Each bit of time spent with these people made me appreciate the ways our lives intersected in the past, and continue to do so now.  Even more amazing was the fact that I hadn’t seen some of these people in years … yet the connections were still there.

I’ve been fortunate enough to continue reuniting with friends this month, as I am in California seeing friends from my old church in Cambridge, as well as a good friend from residency.  Even despite the unfamiliar location, going to church and bible study, sharing meals and TV watching felt like a homecoming.

The only drawback to having so many reunions is the stark reminder of a lack of the sense of reunion upon returning to Zuni.  It was wonderful being able to come back “home” to New Mexico, and having the familiarity that comes with a familiar environment and familiar things … but, I am not nearly as settled as I had thought, and I have not built up the shared experiences inherent in being a part of a community. There are the beginnings of connections with the people through professional and social interactions, but nothing so firm as what I’ve had in the past. I know this will take time … probably not as much time  given the forced socialization inherent in living in a rural community. In the meanwhile, I’ll have the memories of reuniting with old friends, as well as the knowledge that there are more reunions to come over the next few months.

No, I haven’t yet found my Aladdin. But I have been living in an entirely different world. It took a trip to NYC and DC to really appreciate this fact.

I know that there’s the very obvious fact that I am living on the reservation to prove my entrance to a different place. But there’s more to the world change than a simple geographical translocation. I’m in a place with a few similarities to places to which I’ve been in the past. I’ve studied medicine, I’ve sung in choirs, I’ve learned to find joy and excitement in my environments, and I’ve built up communities for myself. But in Zuni, none of those experiences are sufficient to make an easy transition into this world. At times, I feel way in over my head, and want to look for a way back home; granted, it is this forced pushing of boundaries in a somewhat protected environment that will help strengthen my professional skills. At times I feel as though I’m barely scratching the surface of experiences, likely because I know that they will never match up to past ones (case in point — my church experience in NYC vs. in Zuni).

Don’t get me wrong; I am even more convinced that this was the right move for me, both professionally and personally. I am growing as a physician, and am developing friendships and relationships that will last past my time in Zuni. And where else have I been able to do corn grinding with 50 other women or watch hot air balloons or have a free personal trainer or sing in a choir without an audition? But, as I prepare to return to Zuni and to the hospital, I need to keep the perspective that it is a different world, and not take that for granted. I need to stay intentional about using my past life to create a new one in Zuni. Over time I will be able to assimilate into the special culture that is a part of being medstaff there.

Oh, before I forget, Happy New Year. May the upcoming year be full of growth and joy and blessings for us all.

As usual, now that the novelty of being in a new place has gone away, so has my diligence in keeping up with writing! Granted, I still haven’t signed up for internet at home, which makes it challenging for me to keep writing. For now, I’m still reliant on free wifi at cafes to keep me in touch with the outside world.

I find it hard to believe that I’ve been here for more than two months … I’m in the strange middleworld of feeling as though I’ve never been anywhere else, while at the same time feeling that I’m still new here. The day to day life feels pretty routine, in terms of working, going to the Wellness Center (a home away from home), getting to know people and continuing to unpack. I’ve had a few blips within the monotony, with TV watching at my next door neighbor’s house, road trips (both near and far), and finally getting to go to church. But, because I’m so tired and still adjusting in some ways to working out here, I feel that I’m just floating around getting stuff done.

Despite all of this, though, there are still somethings that take my breath away; for example, a few nights ago I was walking home from dinner w/ some friends. I looked up, and saw what looked like diamonds and glitter sprinkled on a pitch black backdrop. The night sky here is unlike anywhere else I’ve been; getting to see it again like that reminded me of the beauty and vastness of God’s creation.

I’m sure there’s more to write, but I can’t string any more coherent thoughts together into a story. I’ll write again, hopefully sooner rather than later …

As I continue to acclimate to life in Zuni, and more importantly, to work at the hospital, I’ve come to a realization that I was so not ready to come out here … I am so far out of my comfort zone, with no end in sight. For example, I was writing the draft of this entry while riding back to Zuni in an ambulance; we transferred a patient that ended up getting intubated, and I needed to ride along in case she crumped. Seriously.
I’m not complaining about it … Not too much, at least. The whole reason for my uprooting my life and leaving behind (or abandoning, depending on whose view you take) my friends and family was to become a better GP. By pushing myself (not sacrificing patient care, of course) I’ll be able to further all of my skills and recognize my strengths within the field.
That being said, I’ve been using humor to try to make light of the insanity out here. Our urgent care has been seeing an average of 18-20 people more per day than this time last year. And, despite an attempted transition to an EHR, we are still insanely bogged down by paperwork. All of the oldtimers try to alleviate some of my feelings of anxiety and helplessness by reminding me that this is not normal for this time of year. My new response is: “that’s ok; I’ll add it to the list of things that, if I had known about before, I might have changed my mind about coming out here”. I’m mostly joking

“addendum”

I had initially written this post at around 1am the evening of my first insane night call … I think it was a direct response to stress this week stayed plenty busy, but with sufficient support from my colleagues, it was manageable. Now I’m spending a bit of time at a cafe before heading back to the retreat center; as a medstaff, with so many recent changes in personnel and in the work environment, we decided to take space from work to reflect on our work at Zuni, both from the providers’ perspective and from the patients’ perspective. I’m not sure how much this will carry over to allay the frustrations everyone has had of late, but I’ve truly enjoyed the chance to get away, have deeper conversations with people, and remember why we came to work at Zuni.

As each day passes, my eyes are more and more open to experiencing living out here. I’ve already started coming to terms with the fact that I’ve moved out here for an undertermined amount of time. That feeling of just visiting has abated significantly.

So what misperceptions did I find?

1) that it would be easy to reboot my life … After 6 weeks of laziness, I thought it would be easy to swing the pendulum the other way into overactivity. You know, losing myself and any of the sad feelings of leaving NYC behind in making a new life. I have succeeded in doing things like praying more, and exercising more, but I’m constantly fighting the pull of the laziness.

2) that I’d struggle a lot more with loneliness and missing people. Don’t get me wrong, I do miss my friends in NYC. But, I’m enjoying the space of the emptiness.

3) that Zuni would be the perfect place to work,without issues. It is a wonderful place to live and work, and I can honestly say that I have no regrets about the move. But, with increased patient loads and amounts of time at work, I realize that even great working environments have their flaws. But, what’s important is that we don’t let the flaws hinder patient care or our interpersonal relationships.

4) that it would be hard for me to continue singing. I know, this may not seem terribly important, but for me, music is an integral part of my life that helps to keep me balanced and focused. So, it was a huge blessing from the Lord when I stumbled upon a choir performing parts of the Messiah! Finally, I could sing in a group setting again! And, our choir director is wonderful. We may not achieve the level of skill of the choirs from my college days, but I’ll be able to live with that.

The next weeks will be even more eye-opening, as I start to work weekends and really get grown into work. But, with no regrets, I think I’ll be able to meet the challenge.

It is so hard to believe that another week has come and gone.  As with many of the other times during which I have travelled, I feel as though I just got here, and yet I’ve never been anywhere else.  I don’t really think that I’m fully settled in — a part of me still feels that I’m going to be going back home for good in the not-too-distant future.  But, I’ve been busy enough with work and unpacking, and trying to make a life for myself here, that I haven’t had time to feel homesick (this isn’t to say that I don’t miss people … I do!).

Work has been, well, interesting.  I realized that in even just a week, I started to feel more like an attending on staff at the hospital, instead of a visiting doctor.  Of course I still have questions (the system is not one that can be learned in a few days), and I’m constantly looking things up (a doctor has to be both a life-long teacher and a life-long student).  But I’ve grown comfortable with my role as a primary physician, or an urgent care physician, within the setting of this hospital.  This week, of course, will be the real test, as I have many more clinic/urgent care sessions, and a normal amount of admin time, as opposed to endless time in which I have little to do.

I’ve also been proactive in trying to find my place in a social context.  I’m still looking for a church community to join, but I know that won’t be sufficient. We’ll have a book club soon, and I’ll continue my exercise (ah, the joys of a free wellness center/gym less than a 5 minute walk away). But I think I’ll want to do more exploring and more group activities in which I can meet people.   On the list; exploring a choir that will be performing “the Messiah” this December, and another trip to a local farmer’s market.

I guess I’ll be pretty busy over the next little bit of time … but I do want to be a “resident” of this community, and not just a visitor providing health care to people in need.  I’ll never be able to replace the family and community I’ve left behind back East, but I think I’ll grow more from this experience the more I sink in to it.  Plus, the sooner I settle, the sooner you all will have a home to visit in New Mexico!

13 September 2009

I can’t believe that I’ve been here for one week already … it seems like forever, and only a short time.  I don’t think I’ll be able to summarize what’s happened to give people a good sense of my week, but I’ll try to give a taste.

I love being back in Zuni, as it has been a return to a familiar place.  Everyday, I was graced with a welcoming smile, or a “It is so good to have you back!”  A security officer remembered that I had taken care of his little girl when she was an infant (I got to see pictures of her as a little girl who is now very opinionated, with a very strong personality).  Driving along the highway and the roads, and going for a jog, I remembered my favorite views, and my favorite paths.  Although it isn’t quite home in the true sense of belonging that the word “home” implies, it could be a home of sorts.

Yet, at the same time, I feel like I’m starting all over again, both professionally and personally. I’ve changed around my schedule (no more 4am bedtimes … instead, I’m up by 6am, and try to be in bed by 10:30pm, with a full 7.5 hours of sleep a night)!  Everyday, I have to ask both procedural questions (“How do we do this consult?”) and medical questions (“Can you look at this x-ray with me?”).  And of course, I have to learn how to live here — paying rent and electricity and gas and on and on.  Plus, I have to set up house, literally. My belongings arrived 5 days after I did; so now, instead of an echoing space, I have boxes and furniture and suitcase, and a general mess!

As for the people, the reunions and the introductions have all been such a joy.  And, while it’s too early to have a sense of community  here, I can see it forming.  I’m looking forward to making my space in the group here.

7 September 2009

Hello from New Mexico! I’ve finally made it (after a few days, or a few weeks, or however else you want to look at it).  And already I’ve had a few interesting experiences and changes, despite having been in Zuni for less than 24 hours.

Saying good-bye to NYC was harder than I had anticipated.  After eagerly awaiting the start of the next phase of my life, I thought that even saying good-bye, or see you later, would be smooth.  Of course, I was wrong … over my last two weeks in New York, I became more acutely aware of what, or whom, I was leaving behind.  That sadness overwhelmed any excitement I had coming into town.

I had hoped that my usual love of flying would help correct the sadness; for me, flying, and most long-distance travel bring a lightness and joy that are hard to explain.  However, with the pain of no on-flight entertainment, and the sadness, the flights simply filled gaps of time between point a and point be.

Soon after, I had remembered my last trip to Albuquerque, and the peace that came over me as I flew into one of the most amazing sunsets.  At that time, my concerns and doubts with regard to working at Zuni were in full force, and I had convinced myself that the trip and the interview were mistakes; the sunset erased all those feelings, and made me feel as though the Lord was stamping a seal of approval on the situation.  I really hoped that the same would happen this time; but, as I flew in, all I could see was mist and thick rainclouds, putting a grey cover over the mountains.  I had to remind myself that I didn’t have Storm’s mutant powers of controlling the weather, despite how closely the weather matched my feelings.

Thankfully, things slowly turned around once I left the airport (despite a broken suitcase and a painful car rental).  I stayed with my one good friend and her husband, getting to participate in a delayed wedding celebration.  I was able to go to a church service with her mother and brother the following morning, and make plans on returning to Albuquerque.  And then, the disorienting adventure really started.  My “mutant powers” returned, granting Albuquerque, and Gallup, amazing weather. I felt as though I were driving into a painting.  I met up with a good friend in Gallup (our paths briefly crossed as we were going cross-country), before making it into Zuni late last night.

So, after all that, how do I feel? Still disoriented … I haven’t gotten over the feeling that I’m just visiting, despite having “moved in” to my house (with suitcases and a backpack).  Incredibly thankful; a couple of the maintenance workers at the hospital found a bed for me, and between my next-door neighbors and the hospital staff, I was able to get bedding for it.  In awe of the Lord’s creation; I woke up and realized that I have one of the most amazing views in my backyard (yes, I have a backyard AND a front yard, with a garden plot and a couple of trees).  Excited; I spent time with some of the medical professionals this morning catching up on the past few months, and remembering what a good fit this is for me.

Don’t get me wrong; I’m still feeling sad, missing my friends/family back East.  But I feel more settled with this decision, and am looking forward to working and living in Zuni.