Ice Cream Sandwich Socks.

She was the most terrifying surgeon in the hospital.

In an age where white coats were to be worn only by men, she walked fiercely into medicine anyway. She took the sneers and barking from senior physicians but she held her chin held steady. Back then, medicine was not a woman’s game. With each step she climbed, she tacked on another piece of armor and she grew stronger. It toughened and polished her, and she was built into the indestructible surgeon she is famous for today.

I have watched chief resident’s fingers tremble beside her. I have watched fellow surgeons, renowned and respected in their own right, fall silent as she stepped into the room. Scrub nurses, usually bustling and preparing while chatting with the circulator,  stand alert with fingers poised and eyes glued her hands, anticipating her next move. Medical teams in the hospital, young doctors visiting from out of state, senior doctors trailing the end of their careers – they all know her name.

For weeks, we had stood shoulder-to-shoulder in silence as she performed many of the biggest surgeries known to medicine. The infamous Whipple procedure – a grueling 8 hour minimum- was her favorite. Her fingers seamlessly twirled around the surgical instruments, and I longingly watched as she carefully cut open the belly, clamped arteries, and unsheathed the pancreas. I stood perfectly still, often for over 10 hours, with my hands carefully planted on a corner of sterile draping. Others had warned me: “She prefers medical students to simply observe. Whatever you do – don’t grab anything.”

Yet something in me resonated with her. There was the smallest hint of a smile in the corners of her mouth under her mask when her eyes met mine. I recited my patient presentations I had spent hours memorizing for her clinic and could see a flash of approval in her stone cold expression before she spun on her heel to enter the patient’s room. Then one day, she handed me her suture. That day in the OR, I was taught the sacred ritual. She began to signal for me to cut her sutures with the slightest flicker of her fingers. One day, I nearly tripped over my own feet in shock as she stepped back from the operating table and silently waved for me to assist the chief resident in stapling the bowel in half.

She was like no one I have ever met. During my last day on her service, she unwrapped the ice cream sandwich socks I had bought for her and she squeezed the breath out of my ribcage. And I will never forget the words she told me:

“Hailey, you are a surgeon. I can see it in you. Do what you are.”

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I remember you.

I remember you were embarrassed but you let me help you anyway. You joked that you could be my mother and I joked that I could just pick you up and take you to the bathroom myself but you wouldn’t let me you wanted to do it on your own you said you could do it you said. Every day you were weaker and you were disappearing into the bed around you but your spirit never did and you smiled so much I remember that. I helped you make the text bigger and you always remembered that somehow and you wrote it in that note you gave me that I still have hanging in my bedroom and I think about you all the time. You said you could do it and I was right behind you, watching your legs flail under you and your white knuckles on those bars and you scared me half to death but I was always right there and we always made it so when your legs crumpled you fell in my arms we both laid on the cold tile and you said it’s okay I’m okay and you laughed and cried and I heard his cold voice in class say the disease that riddled your bones and I thought of you and you’re always right there.

And then you, I can’t forget you even though I knew nothing about you except you were from Montana. I remember that because they said that’s where your children where and that’s why they weren’t there with you. I knew things about what had happened to you about how someone came into your house with a baseball bat and that’s why they found you in your kitchen with your head caved in like that and they brought you here and found a fungus growing in your brain and I didn’t even know that was possible but I didn’t know anything about you. They unplugged you and left you and no one ever came for you, your children never came but your breath held on and all the nurses kept waiting for you for the room for the next patient to swing through but they never came and you kept waiting, waiting, waiting and I was nervous to be alone with you because I didn’t know what to say god please help me so I washed your skin and moisturized the cracks in your lips and tried not to look at your skull caved in like that. You had a tattoo when I felt your pulse I remember that and I don’t know what it was or what it meant but you had a childhood and stories so many stories and I know you heard me because your eyelashes moved, can you hear me, everyone is here your children are here and telling you they love you they love you so much we are all here we’re here. I left you and you stopped waiting because when the nurse went in you were gone and they rolled you to the basement but no one ever came for you.

But for the life of me, I can’t remember what brought you. I remember your mother telling me you were an angel and how you would spend your weekends pulling weeds, helping people move, being a friend for the kids who didn’t have any but I can’t remember what shattered your skull like that. They said the clear fluid dripping from your nose was fluid from your brain and they didn’t know what to do with you because your skull was like pieces of an eggshell and they couldn’t piece it back together, can’t you see. And even though I looked away the way her voice sounded I knew her heart was breaking and the hallways echoed she can’t lose you, she won’t lose you, DO SOMETHING doctor, but we can’t fix you we can’t fix you. So they left and she stood there and she looked at me but this time I couldn’t look away, yes I’ll stay with you yes I’ll pray with you and she whispered to me in the dark as we cried and in the morning I left and so did you but when I got home I still smelled like you and the water was so hot but I couldn’t get rid of you they never came for you I knew nothing about you we’re all here for you I can’t lose you we can’t fix you so the water dripped, dripped, dripped.

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Read This When,


You think life is hard.

Penny danced along the edge of life for the first few months of her life, her diagnosis remained a mystery until he pieced all of her puzzling pieces together. “She can’t get sugar into her blood,” her mother was told finally. “You’re going to have to do it for her.” This angel wore deep, dark circles in her sallow skin, but her daughter Penny was radiant and beautiful – impeccably dressed and smiling at all the stiff white coats before her. “People tell me, ‘She looks so healthy!’. But they don’t understand.”

She told us how Penny doesn’t know how to chew because she gets fed through a tube, and how she vomits – a lot. She told us how every single night for the past 4 years, she had to set 5-7 alarms so she could wake up and stumble into her daughter’s room and pump corn starch into the tube in her belly while Penny slept. She told us how she had to keep hiding her alarm clock throughout the night, because her exhaustion wouldn’t let her wake up. She could not afford to hit snooze, like so many of us do. Her daughter’s life depended on her. They finally scrounged up enough money to buy an IV pump for Penny while she slept – until the night God awoke her to find Penny’s pump had become clogged. Her daughter’s life was too precious. The alarms continued.

They were told the odds of their second child having the same disease was very small, but when their son was born, he beat the odds. Her strength crumbled and her shoulders shook as she cried. “I never knew I could love something as much as I love them. I would do absolutely anything for them. I have given up everything for them – my dream job I had worked for so many years to get, my life, my sleep, my sanity,” She choked a laugh and looked at her two little ones, smiling cheeks glistening. There was a long silence before she looked back at us and said, “But you know what’s funny? That physician who saved Penny’s life and finally solved the puzzle for us that night in the Emergency Department, I didn’t even learn his name. He was only in our lives for the blink of an eye before he sent us off to her specialist. I think of him sometimes, like when I’m in the middle of the grocery store covered in Penny’s spontaneous vomit, and I think to myself, ‘He has no idea what happened after he handed us that diagnosis’. He has no idea how my life got flipped upside down after he said those 3 short words – Von Gierke’s Disease.'”

You think you know something. 

Lupus is an enigma that insidiously sneaks past it’s diagnosis until a keen physician comes along. For Rose, that took 15 long years. “I feel like those years it took to get diagnosed with lupus – feeling constant pain and crippling fatigue and getting treated like I was crazy – those years were robbed from me.” Her symptoms appeared slowly, as most with her disease do, and were shrugged off or ignored by herself and physicians. When she became so fatigued she couldn’t get out of bed and her joints were too swollen to move, she finally started aggressively searching for answers. “I felt like no one was really listening to me. I even remember being diagnosed with a mood disorder at one point, can you believe that?” Her eyes moved from our faces to the floor, and the reel I’ve seen played one thousand times since starting medical school followed: her gaze returned to us as she said, “If you remember nothing at all about me or lupus or how to test for it, just remember this: Challenge your assumptions.”

You’re facing the impossible. 

I noticed his hands trembling while he shuffled his papers that were packed with tiny scribbles. He had beads of sweat collecting at his perfectly groomed hairline. He had worn his finest tweed suit and he used a cane – just like the SketchyMicro videos used to symbolize his disease. “This is my first time speaking in public, and the first time I have told anyone about my condition. I’m very nervous, please forgive me,” he said to us, avoiding eye contact. He took a deep breath and began.

“This sentence is the hardest I have ever written. But just like that, I have done it, and although it wasn’t the best it could have been – as is life.” The most beautiful words began flowing from his mouth as he read his notes, each sentence becoming less shaky than the last. He congratulated us on our progress thus far in medical school, he asked us to keep an open mind as he shared his story, and to forgive his lack of medical literacy. “I get my hands on any medical things I can,” he told us, eyes sparkling as he scanned the room for the first time. “I envy you.”

It had taken him eight years to share his story with anyone – with us. He lived in seclusion, without a single friendship or relationship, too ashamed of his diagnosis and  disowned from his family after they found out. “Don’t think I haven’t tried, though,” he offered. “I would have it all planned – clothes ironed and laid out, shoes polished, teeth brushed. I would get all ready and dressed, walk to the door, stand there for fifteen minutes trying to get myself to grab the handle, and then turn around, get undressed, and go to bed. This went on for years.” He began needing an oxygen tank at work, and when people would ask him about it he would simply reply, “lung problems”. “I never knew what it truly felt like to be alone before this,” he told us. He spoke about how everyone makes mistakes when they’re younger – hundreds of them. Petty theft from a gas station, experimentation with drugs or alcohol, reckless decisions that make you wonder how you ever made it out of those years alive. “But you can never press the reset button. Not even once.”

He told us that he was reminded of his mistake every day – from the moment he opened his eyes until his head hit the pillow again. His life had morphed into a living countdown timer, ruled by a virus that was ripping out his immune system one day at a time. “You don’t know what you’re made of until you’re up against it.”

After finishing his last page of notes, he stood back and looked up at the hundred fledgling doctors sitting before him. Then he said, “Oh! I almost forgot!” and he reached in his pocket and pulled out a small sheet of paper. He carefully unfolded it, cleared his throat and said, “First they ignore you, then they laugh at you, then they fight you, then you win. Ghandi.”

 

 

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You Will Stumble, You Will Fall.

It took medical school 259 days to knock me down.

At some point in the 4 years of medical school education, you will step into The Pit. I’m not talking about feeling down after a poor test score or being discouraged by a heavy course load. I’m talking about the suffocating blunt force that slams you flat on your back with the wind knocked out of you. It may be your first week of Year 1, or halfway through your Year 3 clinical rotations. But it will happen.

I honestly never really expected to arrive in this dark place myself. I thought my deeply-rooted passion and joy for medicine would steer me safely from it’s boundaries. But I have come to realize – no one is immune to this process. I have lost my joy for studying. I find myself wanting to sleep all day and night. I have found myself interacting with others less and less. I can’t even open my emails because of the heavy boulder it places in my gut: just one more deadline, assignment, expectation.

It is incredible we successfully float through this at all. How is anyone supposed to study such an immense amount of lecture material, while integrating additional material from STEP1 resources, working on research publications and submissions, spending countless hours finding research conferences to present your work at, volunteering and organizing clubs – all the while trying to balance family and spouses and real-life responsibilities like filing your taxes or FAFSA or paying bills or getting your oil changed? I have lost all sight of any hobbies I once embraced, and instead I have evolved into a human machine engraving and regurgitating facts and numbers. I am watching days roll by with something very crucial missing in those hours I am watching: me.

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Thorny Weed.

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More than anything else, medical school is a mind game.

The design is not incidental, but instead it is erected to test you. You are placed statistically with the top 6% of students, all equally as competitive and scrambling for the top just as you are. The tests they hand you are not to see what you can memorize. They are a stress test, repeatedly eliminating the weak. Because this is not a sport for fragile hearts or still minds. For months you will feel inferior, defeated, humiliated and humbled. But it’s only a hoop.

Some are angered by the process – ultimately leading up to the holy STEP1 at the end of your second year. A single test, only a single shot, determining your worth and the future of your career in medicine. But as I was reminded yesterday by my beautiful mother, this is not about tests. Even STEP1 isn’t about the test.

It’s about how you handle the pressure.

Because when the time comes, and you are the person standing over the table with someone’s life resting in your hands, they want to know – Will you be able to handle the pressure? Will you place steady hands on their skin, or unwavering fingers on a scalpel? Or will you crumble?

Medicine is everything I’ve ever imagined it to be. Every day it’s like putting on a soft, familiar sweater – a confirmation of my belonging and purpose. It is mind-blowing. It is perception-shifting. It is jaw-droppingly beautiful and astounding. But medicine has two faces. It’s a lot like loving someone who is everything you’ve ever wanted, but on the turn of a dime, they can become a cold-hearted monster.

The key is to dig your roots, and refuse to let it tear you apart when it turns. Because in the end it is the resilient weeds that remain. They rise stronger and taller before, standing proudly – ready to love medicine at the next turn.

Be a thorny weed.

 

 

Lighter in the Wind.

I.           Am.           Doing.           IT!

 

Medical school has been like being tossed into a drying machine. I’ve been thrown around, trying to figure out which way is up or down, continuously adapting and revising my schedule and study technique. When I finally did get my legs under me, they wobbled and threatened to collapse at any given moment.

 

It has been the most challenging thing I have ever tackled. Not only because of the intensity of the course load and the heavy responsibility that is always hanging on the back of my mind, but also the emotional and psychological battle. Every day, I have to garden my thoughts – pull out the negative weeds that sprout, and nurture those seeds of passion and inspiration and confidence.

 

It took me 13 months,

 

but I am finally steady on my feet

 

and running.

  

“It’s not the load that breaks you down,

it’s the way you carry it.”

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To Dennis.

 

“God, give me the serenity to accept the things I cannot change,

the courage to change the things I can,

and the wisdom to know the difference.”

 

You know that moment when an earth-shattering realization crashes into your body, and for a split second everything becomes still and quiet as it washes over you? Well, that was how I felt for three straight days.

I had the opportunity this week to be gathered with some of the leading minds in medicine and science, and with Li-Fraumeni patients from around the world. Here are a few moments that have changed my life forever:

  • I was laughing and wearing a silly hat in a photo booth, staring into a flash with my arm around the first Li-Fraumeni Syndrome (LFS) patient I met at the conference. She was only the second LFS patient I’ve ever known, and she stole my heart. She was 13 years old. Her bright, eager spirit poured out of her as she told me about her dream of being a professional horseback rider. I was baffled at the wise soul packed into such a tiny body. I knew from the medical literature that the odds were against her: at age 30, she had a 50% chance of already having developed one type of cancer. Many patients go on to develop 5+ different types of cancers in organs all over their bodies, and rarely survive past the age of 70 due to a mutated gene in their DNA. I sat closer to her, hoping for some sort of osmotic exchange: to soak in some of her resilience and fearlessness, while giving her all of my strength and admiration.
  • He was a large, burly man who poured over the tiny chair he sat in at the dinner table, and I will call him Dennis. When his daughter was 10, his wife died from cancer Only 3 months later, her brother also died from cancer. For 6 years, Dennis clung to the last living part of his family he had left as tumors continued to pop up in her tissues. He watched her transform over the years: her leg was cut off, a chunk of her pelvis removed, and cement was poured into the empty cavities left in her bones. He smiled as he recounted her fighting spirit, telling us how they flew to Seattle to fight her leukemia with a bone marrow transplant. Just a few days before surgery, they ordered a CT scan. I realized that his heart was as big as he was as he described crawling into her hospital bed with her when he saw the doctors’ faces arriving with the results. His giant fingers wiped his eyes and his voice broke as he said, “Her scans lit up like a damn Christmas tree.” She died 3 days later and donated her body to science. If I was Dennis, I would have run far away from from anything remotely related to the pain of LFS and never looked back. Yet here he was, sitting among a room full of people with the condition that stolen his family. He told us that he wanted to make a difference for someone else somehow. If only he knew what a difference he really made in me.
  • One night I was chatting with two incredible minds, a cricket from Wisconsin and a crinkled man from Boston, when I scanned the others seated in the dimly lit lounge. I recognized most of their faces as LFS patients and families from the conference earlier, and it plucked a nerve that stilled me like a long wavering note. Had it been any other circumstance, I wouldn’t have thought twice about the scarfs wrapping their bald scalps or the veins clearly outlined in their thin arms. In a handful of decades, chances would have left only us three sitting by the bar. That night, I remembered that we, as physicians, are simply human beings trying to help other human beings.
  • Oliver Weiss, a famous soccer coach who had also been diagnosed with LFS, paced the stage and voiced the conversation he was having with himself: “We’ve known about this condition for 40 years and what have we done? Sure, we screen the few people that we find with the gene mutation in, but we are still missing people out there. We have no cure. We have no targeted therapy. We have no way to prevent it. And I know you’re all working very hard and I’m grateful for that, truly, thank you. But I just lost my last child to this and..”. He grabbed onto the podium with both hands and stared at the floor for a long time. When he finally looked back up at us, the lights shimmered on his eyes. “It needs to go faster. We’re still dying.”
  • My mentor was telling a woman with LFS about my research developing a new liquid biopsy screening method for LFS patients. She turned to look at me and grabbed my arm, her eyes piercing mine with surprising steadfast intensity despite the empty wine glass in her hand. “Listen to me,” she said. “When you work overtime or you get frustrated or you want to quit, you remember me. I won’t quit if you don’t, do you hear me? You remember who you are helping and you remember that what you’re doing matters. It ”
  • I was staring blankly at the stage, lost in a train of thought about all the wasted time and money in research. I had been remembering a time with a friend of mine who worked in a medical research lab. I laughed and actually fought a tinge of jealousy when he had told me how he spent all day getting paid to watch Netflix. Then I reminisced on the group dinner the night before, which was unquestionably paid with department funding. Clapping snapped me out of my trance, and I began listening to someone explain how they were finally able to mimic osteosarcoma in mice. I found myself angrily wondering – how long did that take you? Because I’m sure there were 50 LFS patients who had died with remarkably authentic osteosarcoma tumors in that time. How did your work help them? Are you focused on the root of the problem, or are you filling in blank spaces far in the periphery? Is it really necessary to spend years to know the exact amino acid in a rare sequence of non-coding DNA, or the exact calculations to determine that there is a 10% false positive rate in cancer screening? Great – so those patients have a cancer scare, undergo further testing, but later find out it was a test error and they are actually cancer-free. Boy, it’s a good thing we have those numbers. I can’t help but feel guilty for undermining curiosity and the value of basic science research. But when I’m sitting around people who are stuck helplessly watching their families get obliterated, I can’t help but argue that what we must ask ourselves is: What is the true impact of our research?
  • Initially, speaking with LFS patients made me uneasy. I stared at them and wondered, how much longer will this person be here? A month? A year? Are cancerous cells bubbling out as we speak, unknowingly infesting other organs until the next yearly screening? I found myself struggling to allow myself to get close to these incredible souls – afraid of the pain that might occur when tragedy strikes. Until I realized there is nothing wrong with allowing myself to connect with their fragile state. Aren’t we all just a heartbeat away from death ourselves? Yes, they are predisposed to a higher risk of cancer – but we are not so invincible ourselves. I’ve heard that coming to terms with our own mortality is one of the biggest struggles to conquer. Maybe that is why becoming close with these patients was so difficult: It held up the mirror into my own mortality. There is uncertainty in their fragility, yes, but there is also something so incredibly beautiful.

 

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