Shakespearean Comedy

“Life is a tragedy when seen in close-up, but a comedy in long-shot.”
~Charlie Chaplin

From The Old Blog, November 19, 2014

Can we define “Comedy” and “Tragedy” here?  Because based on what I remember from my Shakespeare class, a tragedy means everyone dies and a comedy means that everyone falls in love and gets married…  I don’t know how they convert.  Oh wait, except usually in those comedies there is some huge mix-up or screw up, or miscommunication that eventually gets sorted out.  Maybe that’s it…

Regardless of the definitions and whether or not you read “A Midsummer Night’s Dream” at some point in your life, I think this quotation offers some hope that in the end, it will all work out one way or another.  I’d like to think that in 10 or 20 years (I will most definitely need that much time) I’ll look back on this time and laugh at how “silly” I was for making such a big deal out of everything that’s happening.  Maybe not.  Or maybe I’ll just need to add more wine to life and then it will become a comedy… or maybe a tragic comedy…?  Either way, I’m pretty sure I’m in Act III, and maybe even Act III.II of some unknown number of sub-acts.

I’m happy to say that I have emerged from the worst part of this Shakespearean Comedy that I call my life.  As I’ve seen in this little month-long exercise of going back and re-reading, re-posting, and responding to my posts from last November, I am much better off now than I was a year ago.  I feel like I can start to see the end of this chapter of my life (likely known as the medical education chapter) coming to a happy, or at least amicable, ending.  I still have a long way to go, so I’ll assume I still at the end of act III, or maybe just beginning act IV, but at least things are going in the right direction.

Looking at the Stars

“We are all in the gutter, but some of us are looking at the stars.”
~Oscar Wilde

From The Old Blog, November 18, 2015:

This quotation makes me think of the scene in “Forrest Gump” where Forrest asks Bubba to lean up against him so they could support each other while they slept: “you lean against me and I’ll lean right back up against you and that way we don’t have to sleep with our heads in the mud.” After a few of these nights of sleeping upright against each other, the rain suddenly stopped, the sky cleared, and the stars came out… And Forrest thought of Jenny.
I couldn’t find a great image of that scene, but I found this small collage of pictures from the torrential rain during movie’s rendition of the Vietnam War. One day it just started raining and it never ever stopped. There was sideways rain, and downwards rain, and rain that even seemed to come from below. But no matter how much it rained, it did finally stop and since his head wasn’t stuck in the mud, Forrest was able to see the stars.

Last year I wrote about how I was stuck in the gutter – not necessarily looking into it, but stuck in it.  As a result, I was not seeing, or even looking for, the stars.  This year I am happy to say that I am not in the gutter.  I don’t even feel like my feet are dragging in the gutter.  I may not always be looking at the stars, but at least I am closer to them this year than I was last year.

On additional difference from last year, as well, is that I focussed much of this post on telling my friend that I admired her for always being the one looking at the stars.  Knowing what I know now, I don’t know if I would say that is always true.  I’m not sure exactly what I mean by saying that; perhaps I just don’t necessarily think that this old friend was always doing the right things or making the right choices.  That could just be my hurt conscious talking after she decided to delete me from her life, but I think it’s more than that.  I think I used to admire her and set her on a pedestal that was unrealistic.  After having time to reflect on everything that has happened and what her role was in my life, I realize that I had many ideas about her that were unrealistic.  Anyhow, this is again, a digression from the point.

The most important fact here is that I have spent much more time in the past year out of the gutter and looking at the stars.

Crazy, Crazy, Life!

“What sane person could live in this world and not be crazy?”
~Ursula K. LeGuin

In honour of this past week being crazy, I decided to (yet again) re-post last year’s entry.  This past week I worked 4 call shifts in 9 days, which included working through an entire weekend.  In essence, I basically worked 12 days straight!  How exhausting! (At least I’ve managed to keep up with the blogging challenge!)

From The Old Blog, November 17, 2014

Oh My!  Where do I start?  This World is just too much sometimes!  What world?  How about all the worlds???

The “Real” World: Technology, Facebook, Movie stars, Competition, Mommy Wars, Politics, Weather… you name it.  The real world that we all live in and that we all share – it is one crazy, difficult to manage place most of the time.

The “Parent” World: If you have kids, you know what I mean.  I ended a friendship over a blog post I shared on Facebook once.  It was titled (something like) “Ten things I hate about being a parent and one thing I love.” It was basically talking about all the crappy, stressful things that go along with having kids: Food everywhere, no sleep, 24hr/7day job with no break, puke in the middle of the night (complete with doing laundry)… the list goes on.  The one thing the author loved was her actual children and the happiness they brought to her life.  Well, my Facebook friend thought this article was far from comical and basically said that she loves every minute of being a parent (to her 6-wk old only baby at the time) and that any person who jokes about how “terrible” parenting is shouldn’t have kids.  Well, Facebook friend, the truth is that being a parent is crazy challenging… (I wonder if she would have a different opinion 3 years later…)

The “Resident” World: If you’re a resident (or medical student, or doctor), you get it.  Regularly working 11 hr days, then working approximately 2 call shifts a week.  All while having academic commitments, and commitments to your staff, and your patients, and yourself, (and your family)… And all that “learning” you’re trying to do while making sure you don’t screw up someone’s medical care… while all you try not to think about is how much you’d like to sleep…
I went to a productivity seminar for my resident retreat a few days ago.  The presenter was telling us how important it is to get a good amount and quality of sleep.  She encouraged us to think about how we could all improve this in our lives and gave an example of why it’s important.  She said that “if a person gets 4 hours of sleep for 4 nights in a row, they function at the same level as someone who has been awake for 24hours straight!  And, that’s the same level of functioning as someone who is above the legal limit of impairment!” (If you are a resident/medical student/doctor, you know where this is going…)  This poor lady then asked us what we thought of that.  We didn’t know what to say.  Every one of us in the room was thinking the exact same thing, but none of us were going to say it: “Do you know how often I am awake for 24hours straight?  Do you know what kinds of decisions/procedures I am responsible for when I am ‘above the legal limit of impairment?'”  Anyway, all that to say, resident life is beyond crazy sometimes.

I have to say, though, it’s nice to know that I’m not the only one who’s crazy!

Together in Pieces

“It takes ten times as long to put yourself back together as it does to fall apart.”
~Suzanne Collins

Image Source: ldsperfectday.blogspot.com

Over the past year, I have slowly been working on putting myself back together.  In last year’s post on this day, I spoke about making an attempt to be more positive and figure out a way to start moving forward.  Here is an excerpt from The Old Blog’s post from last year:

As I child, I remember my mom always getting so angry when something fragile would break because she could never glue it back together without it looking perfect.  This gave me the idea, from a young age, that you are never as good as you were before you were broken.  Anytime I got in trouble or got hurt in some way, I just imagined that it made me less “valuable.”  When I came across this Japanese idea of accentuating flaws – because it makes something more beautiful – I suddenly felt so much less “broken.”

I took the small pieces of myself that I had left and assembled them into a new life.  This really started to materialize in the new year, when I made multiple goals that I wanted to meet – most of which I did accomplish by the mid point of this year.  I am proud of my accomplishments – I ran a half marathon, I made great progress on my goal to read 12 books this year (I read 9 whole books, and I have 3 books on the go… the year still isn’t  over yet…).  I made some new friends, joined a taekwondo club, where I have attained a green belt (that is on hold now while I grow a tiny human), and I’ve got another year of residency completed and under my belt.

The most important part of all of this, though, is that I haven’t been pretending that everything is always okay.  I’ve admitted to difficulties and mistakes – and those are the gold seals that show up in this new and re-formulated life of mine.

Cynicism is The Opposite of Vulnerability

“I always think that cynics are really romantics who have been crushed sometime in their lives and have put up this cynical mask to protect themselves.”
~Jeff Bridges

Again I’ve decided to post last year’s post in it’s unedited form.  There is nothing more accurate and true that this post about vulnerability, in my opinion.

From The Old Blog, November 15, 2014:

This quotation makes me think of one thing: Vulnerability.
Actually, more appropriately, it makes me think of a lack of vulnerability.

Unfortunately, I believe that this quotation is more accurate than most of us want to believe.  Why, after all, are we cynical in the first place?  For me, cynicism is my coping mechanism: Why be serious and face reality when I can be cynical and detach?  Cynicism is also useful for connecting with other like-minded people.  In fact, I am pretty sure Husband and I bond quite a bit over our cynical nature (who doesn’t love a little late night snuggling while watching The Colbert Report???).

If we are all hiding behind cynicism, what are we not revealing to everyone else?  Are we afraid of reality? Are we afraid of being hurt?  Or have we all been hurt  just enough times to make us not want it to happen again.  I don’t really know the answers to these questions.  Regardless, it all comes back to a fear of being vulnerable.

As much as I love being cynical most of the time, I strongly believe that if everyone (not just me) was 1/2 as cynical and 2x as vulnerable, we would connect with each other in a much more authentic and meaningful way.  Cynicism is easy, it is funny, it is relatable, and it is common.  Vulnerability is the exact opposite:  it is hard, scary, uncomfortable, and very individual.  We are all vulnerable for different reasons, yet we all have one thing in common: Vulnerability itself.

As Brené Brown would say, “lean into the discomfort.”  We shouldn’t be so reliant on cynicism.  On the surface it might feel like we are connecting in a comical way, but every time we are cynical, we run the risk of isolating the people we are with.  There is no easy solution to this.  I wish I could say that I would stop being so cynical all the time.  However, I don’t think I am quite ready for it all at once.
Maybe it needs to start with one person – then hopefully it will spread.

Sense Out of Sense

“Hope is definitely not the same thing as optimism.  It’s not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out.”
~Václav Havel

 

It seems as though this quotation didn’t fit with my mindset last year, and it certainly doesn’t fit with how I am feeling now, either.  Or maybe, if I look at it from a different angle, it does make sense.

A few days ago I wrote a post about hope being a song that we sing in the depth of our being – something that never stops no matter what.  Right now I am tired and overworked and I feel like hope is the only thing I have – I hope that I get through all of this and that it will be worth it in the end.

Does that make sense?  I don’t know.  Maybe according to this quotation, it is supposed to makes sense.  Whether or not all of this hard work pays of in the end… hmm… I’m not sure if it makes sense for it to not turn out.  That would be a whole lot of “nonsense.”

The other day I met with one of the staff to go over my evaluations from a few months ago: For July and August.  Apparently everyone only had good things to say about me: I am hard working, I have good surgical skills, I work well under pressure, I don’t get stressed out, I make good assessments and plans, I know my limits, I don’t get bogged down in the minute details… but there was one thing that seemed to concern people – they were worried that I seemed unhappy.  I didn’t know what to make of that comment, or what to do with it.

I’m happy, but I’m not happy.  It’s hard to always be smiling and cheerful when you are tired and wondering if you’ve made all the right decisions in life.  Or more vaguely stated, when you’re not sure if everything in your life makes sense.  So what do I take away from that feedback session?  I should be happier when I’m at work, maybe?  Obviously I know that these last few months haven’t been easy for me, and there is a reason I see a psychologist on a regular basis.  Overall, I didn’t know what to say.  I enlightened her on the whole “people at work found my blog and I was criticized and harassed online because of it and everyone at work was talking about it behind my back” situation that happened in the middle of July.  I told her how I completely shut down at that point because I didn’t know who I could trust to talk to about anything, even something as simple as a night with my kids.  Maybe that contributed to it… I don’t know.  Or maybe it’s just my personality… maybe that’s it!

Regardless, nothing ever makes sense.  I feel like I am blindly floating around with the hope that in the end everything will fall into place… some kind of place.

The Story of Ms. Jones

“Life isn’t fair.
It’s just fairer than death,
That’s all.”
~William Goldman

We were about to round on Ms. Jones (not her real name).  I admitted her the other night after she fell and was found in her bathroom by the aides at her assisted living complex.  She was lucky: she didn’t break any bones despite the grapefruit sized hematoma that was forming over her left hip.  I learned from the emergency room chart that she was a relatively healthy 95 year old lady with a history only significant for hypertension and atrial fibrillation.  I tried to go talk to her and do a physical exam, but she was grumpy and drowsy and wouldn’t cooperate (in her defence, it was maybe 3am and the emergency physician had just given her some dilaudid).  I filled out all her admission paperwork and scanned her home medication list.  I opted to continue her medications for hypertension and her aspirin, but since her hemoglobin had dropped during her stay in the emergency room from 108 to 86, I thought it prudent to hold her anticoagulant (blood thinner).

When we walked into the room that morning, I was pleasantly surprised to see a well groomed, alert, and very proper English woman sitting up in bed and eating her breakfast.
“Good Morning Ms. Jones,” my staff said.  “We are your team of doctors and we are here to see how you are doing.”
“Well, if you want to know about my pain, it is okay.  But if you want to know how I’m doing, well I’m rather upset that the nurses won’t give me any hot water for my tea.”

It turns out there was a communication error and the nursing team believed that Ms. Jones was on a thickened fluid diet to minimize the risk of lung aspiration.  As this diet is quite common in our patients, we continued to explain to Ms. Jones the rational behind why she wasn’t allowed to drink her tea.
“Well, that just ridiculous!  I was just drinking tea the other day and I certainly didn’t choke on it.  I don’t see why it is any different today.”
We offered to place Ms. Jones on an “at risk diet” if she insisted on drinking her tea.
“Well doctors, I am 93 years old.  What do I have left in my life if I don’t take risks?”

She had a point, I guess.  We proceeded with our rounds, ordered the necessary tests and continued on with the day.  We thought about re-starting Ms. Jones’ anticoagulation, but her hemoglobin was down to 80, so we held off and sent her for a CT scan instead.  The results came in later that day and there were no identified areas of internal bleeding.  We decided we were going to restart the medication the next day.

When we rounded the next day, we visited Ms. Jones again.  She was happily eating her breakfast and drinking her tea.  She complained that she had been feeling increasingly weak over the past month and attributed her fall to that weakness.  She commented that it was just part of getting old.  Regardless, we asked for a physiotherapist to help Ms. Jones with her mobility and assess if she needed any aids.  As planned, I wrote an order in the chart to re-start the anticoagulation.  It was all ready to go, but we all suddenly felt uncertain: She had only been off of it for 3 days.  Why not wait one more day and make sure her hemoglobin remains stable?  It is a delicate balance trying to decide how to manage these medications for a person with atrial fibrillation who is also at a high risk of bleeding.  Without the medications, there is a chance that the heart can throw off blood clots that can cause a stroke.  With the medications, however, it becomes difficult to control andy sources of bleeding.
Later that afternoon, I passed by Ms. Jones walking with the physiotherapist and a walker down the halls of the unit.  She smiled at me, and I smiled back.

The next day was Friday and we started rounds in the same way we always do.  Our team was a little smaller, so we divided up the work and moved a little faster so that everything would get done.  We got to Ms. Jones’ chart.  The physiotherapist was convinced that she would safely mobilize with a walker.  Her hemoglobin had been stable over the past 36 hours, and from all other aspects, it seemed like she was ready to go home.  We walked into her room to tell her the good news.  However, Ms. Jones was not sitting up in her bed eating her breakfast.  Instead, she was laying with her head cocked to her left side, her right leg flexed and rotated to the left, and her right arm motionless by her side.  We said hi to her but all she did was moan.
“Ms. Jones, are you alright this morning?”
She just moaned again, this time louder and more persistently.  I went to her left side and looked at her.  She wanted to say something, but all she could do was moan.  She reached for the ID badge dangling from my neck and looked at it.  Then she looked at me.  And she moaned again.  My staff had already left the room and was on the phone with a radiologist requesting a STAT CT scan.  But we didn’t really need it to know that Ms. Jones had a stroke, likely sometime overnight.

By the time Ms. Jones’ sons had arrived at the hospital, the results of her CT scan were back: Large right MCA territory infarct.
We explained to her sons what this meant and that given her age and the size of the stoke, she likely had a poor prognosis.  We explained the options for her further care and it didn’t take long for them to both agree that their mother would not be happy living the way she was now.  The felt that if their mother could talk to them, she would say that it was her time to go.

And just like that, we consulted palliative care for Ms. Jones.  We discontinued all her therapeutic medications, and ordered all our comfort care measures.  She was moved to a private room.  And ever since that day, there has been a constant bedside companion from her family present.  I know this because I visit Ms. Jones multiple times a day.  She knows who I am and she smiles at me when I tell her that I’ve been thinking about her.  Every day she looks more and more like it might be her last day.  But every morning her name is still on my list.  So I go back to visit her again.

It was the day we were going to send her home, and instead it became the day that determined her death.  It isn’t fair.
Ms. Jones was such a fun. happy, feisty little English lady who probably had a few more good years ahed of her.  But our medical care failed her and now she is dying.  Life isn’t fair.
Every day she slips further and further away.  She spends less time awake and I spend more time talking with her family members.  They tell me stories about their mom and it makes them happy.  Then they turn at look at their dying mother asleep in her death bed, and their voices stop.  I let them cry and I place my hand on their shoulder for just the right amount of time.  Death is not fair.

I decided to share last year’s blog post in it’s entirety.  The remains poignant and I still think of Ms. Jones, to this day.

Oh, Eleanor

“Do what you feel in your heart to be right –
for you will be criticized anyway.
You’ll be damned if you do, and damned if you don’t.”

~Eleanor Roosevelt

From The Old Blog, November 12, 2014:

Eleanor Roosevelt has got to be my most favorite woman in history.  I don’t know much about her, but anything that I ever find written by her or about her always makes a solid and lasting impression on me.  This quotation, while I have come across it before, has probably never meant as much to me as it does now.  If I look back at all the events and interactions that took place in my life leading up to this present moment, it occurs to me that I often did what I felt to be the the right thing.  I truly believe that.  Unfortunately, I have been criticized in some of the harshest ways (in my opinion).  And, what if along the way I did the opposite?  Well, I would have likely been criticized too.

More than ever I feel this quotation to be true and accurate.  I have had my fair share (and I’m sure there is more to come) on being damned for doing something I should have or haven’t done – The old “Damned if you Do and Damned if you Don’t” paradigm.  I’ve realized what it all comes down to in the end, is doing exactly what you feel to be the right thing to do in that situation.  What is going to make you feel the best about yourself?  What is going to make you happiest in the end? What values and believes do you want to stand for and represent?

Too often our fears of criticism and prosecution get in our way of making the right choice.  I have to admit: after everything that I’ve been through in the past year and a half, including the discovery, criticism, and backlash of my old blog (and now my decision to start over), I have sometimes made a decision to do something that didn’t feel right just to avoid causing problems for myself.  Maybe in the end it is the right decision for me because I am saving myself from trouble… Who knows?

I have sometimes overcome the fear of criticism  by simply convincing myself that the excuse for not doing what I feel to be right is just not justified.  It is hard to not pull back out of fear, but sometimes it is harder to push forward through the fear, especially when you’ve experienced the ultimate criticism.  As always, Eleanor Roosevelt has the best and most simple solution: just do it anyway, because it will be wrong (and possibly right) no matter what it is you choose to do.

And just for fun, here are a few of Eleanor Roosevelt’s other quotations that I love:

“The future belongs to those who believe in the beauty of their dreams”
We are afraid to care too much, for fear that the other person does not care at all.”
We gain strength and courage and confidence by each experience in which we really stop to look fear in the face… we must do that which we think we cannot.”

Family is The Only Rock

“It’s a good thing to have the props pulled out from under us occasionally.  It gives us some sense of what is rock under our feet, and what is sand.”

~Madeleine L’Engle

 

From The Old Blog, November 11, 2014:

 The only rocks I have live 500 Km away from me.  And while I only have a small umber of supportive rocks, at least if I had stayed where I was, I would still have the sand too.  Either way, The people whom I predicted would be my rocks – well, they have been my rocks.

Bedside Flowers

Bedside Flowers – A photo from last year’s post of some flowers a good friend left on a bedside table for me when I went to visit her.  I am still good friends with this wonderful woman.  While she is not technically my family, I would still consider her one of my “rocks.”

The theme of the past few days really seems to contradict what I wrote in this small segment from last year’s post.  The irony of this whole situation (and possibly the utility of this November exercise) is that the things people I thought were my rocks, really are not my rocks.  Those are the people who live 500Km away from me.  While there are some of those people who are still in my life, albeit in a smaller sense, I have come to realize that there are more important people, people who live so much closer to me, who are my real rocks.  The only real rocks, which will always be there for me, and which have supported me this past year, are my family: my husband and my two kids.  I love them.

 

I Am The Leftovers

“Oh, my friend, it’s not what they take away from you that counts, it’s what you do with what you have left.”

~Hubert H. Humphrey

 

It has almost been a year since I hit “rock bottom,” or “the bottom of the barrel,” or whatever expression you use to describe the worst and most dark moments of life.  When I wrote last year’s post based on this quotation, I actually thought I was there, and I didn’t possibly think it could get any worse.  A few weeks later and I lost one of the most important friends and supports I had in my life.  I realize that it could have gotten even worse from there… but it didn’t.  Thank Goodness.

I spent much of my time and energy last year focussing on everything that was taken away.  I realize now, that this was likely one of the reasons this friendship was stolen away from me.  While I could post quotations about how real friend see you though everything, or that they are the ones who are still standing by you when you come out of those dark moments, and passively lay blame on a person who was actually nothing more than a shitty friend, I won’t.  I also won’t put myself down and take the blame that was handed to me and convince myself that “if only” I hadn’t been such a bad person (or something along those lines), I would still have her friendship.  There are two sides to every situation, and I’m merely realizing that I was negative, and broken, and maybe not working as hard as I could have at picking up the pieces.  Anyhow, I digress.

Last year I was at least thankful that something I “had left” was this friendship that was going to support me and see me through.  But then I lost that, too.  So, really, what did I have left in the end?

Here’s what I had (and still have, mind you):
My husband and my kids, who have loved me unconditionally and are here for me always.
My willpower, which saw me run a half-marathon this year… something I never though I would do.
My dedication to my self and my values, which has (somehow) led me to the decision for a third baby (despite my already crazy life)
My work ethic and my dedication to my job, which has not wavered and sees me succeed on a daily basis, even when it doesn’t seem as much.

Do you notice what all of this things I had have in common?  They are all about ME.  They are all parts of me; my traits; the best parts of the person I am.  Those are things that are left even when it feels like I have lost everything else.  After everything is gone, regardless of whether is was just or fair, in the end there is only me.  The question becomes, then: What can you do for yourself when everything else is gone?