Working at Hospice

So this semester I've been doing one of my internship rotations at the San Diego Hospice. I knew it would be difficult, but it's been much, much more difficult than I anticipated. My supervisors are great, and I'm so happy for the opportunity and the growth. It's been one of the clearest examples of patients-as-teachers that I've ever experienced. I knew I wanted to do this shift as soon as I got to San Diego and found out about it, and I do not regret my choice. But yowza, is it ever hard work keeping my head above water some days. I mostly think of myself as pretty tough and resilient, but sometimes I guess I come awfully close to biting off more than I can chew.

Still, it's been a fantastic learning experience--both about the medicine I've chosen to practice, and about myself. I'm not always as tough as I want to believe that I am--I'm also not always as empathic as I like to think I am. As often as I am taken aback by the stomach-socking sorrow, love, fear, and sympathy that comes hollering up between me and a patient, I am surprised by the boundaries I erect and the attachments I don't form.

I miss my mother. I'm finding that part of the reason I think I signed up for this shift was that I hoped somehow I would find her at Hospice. I thought maybe some sort of connection, some message from her, would turn up there. It's such a ridiculous oversimplification, I see now, reducing her whole self and her whole life to the weeks in which she was dying.

But then again, I look for her everywhere. Maybe at Hospice it made sense that she might be closer, in a place where the twilight connection between life and death is less fuzzed than we manage to make it nearly everwhere else. And she is there and she isn't, just as she is and isn't everywhere else. It breaks my heart that my relationship with her won't evolve any further than where it was when I was a difficult and confused teenager, and I watch us grow together into an adult relationship that I don't know how to relate to the other parent-and-child relationships I see growing around me.

There are multiple lessons here, I know. At least one big one. I'm not sure what it is yet. Today I found out that a patient that I had been treating at Hospice died over the weekend. It was expected, of course. She was the same age my mother was when she died; like my mother, she wore red lipstick in her bed and lay among the humming machines and hospital linens like a tiny, jaundiced queen, gracious and imperious all at once. I wanted something from this patient that it was not her place to give me. I wanted forgiveness, I wanted to be allowed to effect the miracle of healing her. When I learned she had died I wanted to grieve her death in a way that felt natural and visceral and feel a sense of relief when I was done. What I did instead was swallow and do my paperwork and visit with other patients, and feel alternately ashamed of how selfish my own sense of loss is and disturbed by how disconnected I felt from the patient's death.

The engagement ring I'm wearing has a red stone; it's the favorite color my mother and I shared. She would have loved that my lovely fiance gave me a custom-designed ring. He proposed to me the weekend of Mother's Day so that I would feel like it was something I could share with her. She would have loved him; I dreamed of her smiling and radiant in his chair. I can't believe that she isn't with me all the time, and I can't stop trying to get closer to her either.

this is happening

I have these really vivid dreams at least a few times a week, the kind of dream that feels so real you check in with yourself during the dream to figure out whether you're awake or not, and you can't tell. Often they're stressful and anxious; sometimes they're scary .

Sometimes they're just wonderful--I'm so happy in the dream I can't quite believe it. In those dreams, I go around asking people if I'm dreaming, and almost invariably they assure me I'm awake. I pinch myself and I think I feel it, I touch the objects around me to reassure myself. Eventually, in these happy dreams, I give over to the joy and celebrate without fear of waking. Then I wake up--happy still, but feeling a little tricked that it was just a dream in spite of all my sleepbound efforts to prove otherwise. I call somebody, usually Jam Guy, before having breakfast, because my mother used to say that that's what you do if you want a dream to come true.

On Saturday, Jam Guy and I woke up to his dog, Toby, being super-hyper--not unusual for Toby. Jam Guy suggested we take Toby to either our friends' orchard or to the beach to get him some exercise. I chose the orchard, partially because I wanted to see Ray and Barbara, the lovely couple that owns and lives on the orchard, and partially because the fragrant, sunny mountaintop setting of the orchard appealed to me more on that morning than the equally-beautiful-but-different beach with its stark setting in various shades of black and grey.

On the drive up, I started talking to Jam Guy about all the conflicts I'd been feeling about transitioning out of transition, moving into what I hope can be a happy and stable life, and moving to a city like Santa Rosa. I told him how much I appreciated him being open to my discussing these conflicts with him over the past months. I said I thought I felt ready to be happy.

Up at the orchard, we visited with Ray and Barbara, ran Toby around a bit, and picked a bunch of lemons and limes and avocados. Then we walked down to this sunset deck that Ray and Barbara built, which overlooks this amazing view of the valley--on a clear day you can see all the way to the ocean--and talked story for a while. We saw a hawk wheeling over the valley--Jam Guy said the hawk was reveling in what he could do, how effortlessly he could cover those gusted miles in the air; I guessed the hawk was also reveling in his beautiful home turf. A few moments later, I saw what I hoped was a large brown dog about 20 yards away--there are a few friendly neighbor dogs that show up at the orchard. I thought about pointing it out to Jam Guy, but since most of the time when I'm not wearing my glasses I think I see a dog and it turns out to be a rock, I decided not to say anything. Then the rock moved--and it was not a neighbor dog: it was a deer, a stag, with a full rack of antlers. I gasped and pointed, and Jam Guy and I watched it bound away; Toby loped after it a little, curious. I decided that it was a sign I needed to trust my instincts more and not doubt myself into silence.

Jam Guy was sitting a couple of steps below me and took my hands in both of his, and started saying all these beautiful things about how much he loves me, how glad he is I'm in his life, and how he didn't know where he would be if we hadn't found each other. I was so caught by surprise by all the beautiful things he was saying that I found myself starting to tear up; then I got concerned about his sudden outpouring of emotion, and asked him if he was all right.

Then he asked me to marry him. And right then everything shifted into that happy-dream mode, and dreamlike, I shifted into disbelief: I said "Really? For real?" and he pulled out the ring we'd collaborated on, with that lovely ruby we chose that day after I had the dream about my mother--one of those happy dreams. And it looked, if possible, even more exactly like what I'd wanted than I had imagined. I still couldn't quite believe it was real. I cried and cried; I kept asking if it was really happening.

I knew this was going to happen--I mean, we were designing the ring. What caught me by surprise is just how happy I am and how pure the happiness feels. I knew I would feel happiness when Jam Guy proposed, but I thought it would be happiness mixed with circumspection, cynicism, pragmatism, flashes from a difficult past full of hard lessons. What I felt in that moment, and what I feel now, is just happy: just pure, open-hearted love; freely rampaging hope for the future; all kinds of joy and glow and gratitude. I feel a kind of happy that I really thought I was too old and too jaded to feel anymore; what a wonderful discovery it is that I am able to feel like this.

Since Saturday I don't think I've quite stopped smiling. I really do feel different because I am engaged. I feel a little bit transformed, and I feel more solidified. Telling my family and friends--part of why Jam Guy proposed at this point in time was to allow me the gift of sharing this with classmates while I'm still here in San Diego and in school--has been, like, the most fun thing ever. There has been a lot of squealing. I feel like a girl in a way I don't usually really allow myself to be.

I am so very very happy, and so, since Saturday, I keep trying to reassure myself that this is not one of those improbably-happy dreams that I am going to wake up and away from. I keep looking for the fissure in normalcy that sometimes gives away that a dream is a dream, and not finding it. The only big abnormality is that I feel as happy as I do--not that I'm not usually a pretty happy person lately, but this degree of happiness is extreme for me--and that I go around grinning like a dork more or less 24/7. I had Jam Guy pinch me and it stung. I have fallen asleep six times since becoming a fiancée and woken every morning still engaged to this perfectly remarkable person.

If I never get used to being this happy, that will be okay. Every day I am grateful, and maybe from now on my gratitude will just continue to widen and deepen. I might be ready to be happy, like I said; I know at least I am ready to try. No matter how I turn it, finding happiness means making a leap of faith: so here I am, in midair, and wide awake.

I have to get better at asking for help.

So--my car is in the shop again (maybe it wasn't my bad housekeeping!) and I have bronchitis; both of these things are slowing me down. Today I got up super early to take the bus to my 8:30 class. This meant I had to hop on a 7:15 bus, because public transit in San Diego can be a bit meander-y. When I moaned a little about my early morning to one of my classmates, three people piped up that if I had called them, they would've been happy to give me a ride.

Truth is that it crossed my mind, but I have a hard time asking for help. I feel embarrassed somehow--that I need, that I am not utterly sufficient. That being said, I'm usually happy when someone else asks me for help, and I counsel my patients to remember that everyone needs the support and love of other people, and that soliciting it is not inherently negative (or better put by my therapist in New York: "Needing is not the same thing as being needy."). I need to remember that in my own life. It's a process.

I remember when I was leaving the bad ex-boyfriend, I felt so in over my head that I didn't know what to do but reach out to everyone and ask, ask, ask. And everyone came through--I had a place to sleep, receptive ears to vent to, textbooks to borrow when mine had to be left in the very fast departure, jam mailed to me, help with shopping for clothes for my new "unfettered" look, money lent to me; kind words and gestures everywhere, far more than I could have expected. It was heart-healing abundance. It was just what I needed.

At that point I promised I'd be better at asking for help in the future, and I think I have gotten better, but there appears to be room for improvement. It will be something for me to practice.

Every time I start feeling kind of car-savvy,

something like this happens: after four days of freaking out about my car not starting; three calls to AAA; three strangers solicited to help push my car up a hill so that I could jump it by rolling it down; various discussions with Jam Guy, my sister-in-law, and the AAA technicians about whether it's the starter or ignition switch or battery; one call to Jam Guy dissolved in tears because after getting the car jumped to drive it to the mechanic's I found that the mechanic's lot was blocked off by the Adams Avenue Roots and Folk Street Festival; and several rides bummed from considerate friends--I brought the car to my super-honest, super-amazing mechanic shop, and was called today with a diagnosis.

Basically, the clutch pedal has to be floored in order for the car to start. This I knew. What I didn't know is that my driver's side carpet was bunched up underneath the clutch pedal, preventing it from being fully depressed. All my worries about the engine bits, and as it turns out it was all about some rumply linens. My bad housekeeping will keep biting me in the ass, even in my car.

sick day

Today I woke up with a scratchy throat, a persistent cough, and that flu-ey run-over feeling, which came up out of nowhere. I was feeling fine yesterday--actually feeling pretty fantastic all week.

I have about three months to go before I take the exam to get licensed as a primary care provider in California. So based on the knowledge I've studied my booty off to acquire over the last four years, here is what I should have done:

1) Canceled on the late-night bridal shower for my good friend that I've been really excited to attend so that I can get to bed early.

2) Self-assessed: viewed my own tongue, attempted to feel my own pulse, considered my symptomology. Diagnosed a wind-dryness invasion with underlying lung qi vacuity.

3) Made a decoction of various herbs. Drank said decoction. Cooked a large pot of congee with ginger, ate that throughout the day; in general stuck to typical Sidewalk Monkey no-processed-foods diet. Wrapped up in large scarf and warm hoodie and long pants and wool socks to encourage sweating and protect myself from drafts.

4) Practiced a little qi gong to keep my qi flowing and encourage healing.

5) Gone to bed early.

Here is what I am actually doing:

1) Canceled on the late-night bridal shower for my good friend that I've been really excited to attend because I feel like crap.

2) Rolled around in my bed most of the day. Accomplished very little besides rolling around in bed. Watched old episodes of The Office on my laptop. Wished I had ice cream. Called boyfriend at frequent intervals to egregiously solicit sympathy. Called sister and solicited extra sympathy. Called friends and solicted still more symptathy. Wore tank top and boyshorts all day.

3) Drank some wine. Walked to corner store; would have driven but car is broken. Bought Cheddar and Sour Cream Ruffles, Ben and Jerry's Make Poverty History Cheesecake Brownie Ice Cream, and Benadryl.

4) Drank more wine, ate chips and ice cream while watching more old episodes of The Office. Cried whenever Pam cries on screen. Got kind of drunk, because I'm a lightweight, and I drank two whole glasses of wine.

5) Decided I will probably go to bed early, after dosing self with Benadryl both to aid sleep and decrease furious histamine reaction resulting from snuggles with lovely kitty cat. Before going to bed, will probably dance around in bathroom mirror while lip-syncing to Alicia Keys.

So: I am practicing self-forgiveness. I acknowledge that I have my crappy, rather less responsible days, and I guess this was one of them. I worked a bit harder than I think I really have the capacity for this week; I had a lot of fun too, but definitely not enough sleep. I tell my patients how important rest and self-care are to their health, and I think that at some point I really need to heed my own advice.