Tuesday, September 28, 2010

saying no

One of my biggest challenges is saying "no" to things, especially to things that I sincerely want to do. Last week I was accepted into a scholars program focused on a topic that is my favorite to learn about. It is a program that I was rejected from last year, making this year's acceptance that much more exciting. The course includes 20 weeks of weekly online learning, small group sessions, and a final project. I had until today to make a decision about whether to participate in the program.... and after much strife about it, I decided to say no.

I'm super bummed. I really wish I had the time and energy to participate. If I had known I would be accepted this year, I would have not taken on other commitments.... commitments I am very much already committed to. At the end of the day, school needs to be my #1 priority along with staying sane and setting myself up to get into a good residency.

Saying "no" is an art. An art that I very much suck at. However, I also realize that if i want to succeed at what I am already doing, I need to say "no" in order to stay focused. There are hundreds of good options and potential activities to engage in but part of growing up is realizing that I simply don't have time to do everything I want to do; especially if I want to do these things well.

So here is to learning to say "no", to being at peace with these decisions, and to trusting that an occasional "no" (to maintain sanity) will not completely obstruct my personal development or cause my world to implode.

Wednesday, September 22, 2010

Med School Burnout

Tonight marks the start of succos, my absolute favorite Jewish holiday. Who doesn't love a holiday that commands you to build something, gather with friends outside, dwell in a shelter that lets you see the stars, eat yummy fall food, and shake branches while praying for a rain in a totally pagen way?! Last year I spent the first days of the holiday at one of my favorite places in the world: lost in the mountains of New York, in sukkah built for 150 of my closest (and newest) friends, overlooking a beautiful lake while watching the leaves change color. Plus there was really awesome learning, and very cute goats!

What am I doing this year to top last year's experience? I am spending it at home, very much inside, studying for Friday's exam. I had some lovely offers for meals in the community, in lovely sukkahs that my friends, the local synagogues, and chabad have put up; but a) I need to study and b) it isn't the same (mostly because the weather in the South is still 100 degrees out and the farmers here are praying for the rain to stop, not start).

While I know this sacrificing of identities is not good for me, today was the first time I realized that it might be detrimental for my future patients. By sacrificing social time and religious practices I'm setting myself up for burnout. I justify it by saying that something I learn, or don't learn, now might be the difference between life and death for one of my future patients. An article published today by the Mayo clinic in the Journal of the AMA on med school burnout though makes me think twice. A synopses on the article can be found here. These types of articles reinforce my belief that medical school is one of the least healthy endeavors one could engage in. Ironic, right?

The conundrum remains that there simply are not enough hours in the day. How can I learn everything I am supposed to know, while still doing all the things I need to do to stay sane and avoid burnout? It is undoubtedly a juggling act; one without a simple solution. My guess is that I'll learn to master it just in time to graduate medical school and start residency... just in time to face a new conundrum on time management and burnout avoidance.

I promise, er suspect, that once the fall chagim (Jewish holidays) are over, there will be a little less discussion on finding balance between Jewish and medical student identities. This just tends to be the season for such guilt.

Saturday, September 18, 2010

Yom Kippur 5771

The Jewish community in this small southern city is fragmented. I live within walking distance to the chabad, but have to go stay out in the suburbs for the conservative and orthodox communities. I have spent multiple holidays and many a shabbos out in the 'burbs and have been well adopted into the community.

Last year, for Yom Kippur, I decided to stay home and go to chabad. Because I can't fully fast due to my diabetes, I don't like spending it away from home. Also, we had an anatomy exam right after the holiday and I was too stressed to go out to the suburbs. As much as I love the chabad community, it felt totally unfulfilled and decided to spend this year in the suburbs. However, at the last minute I changed my mind and stayed home.

I have mixed feelings about having stayed here. "Yom Kippur 1984" By Adrienne Rich speaks to some of these feelings. The alienation between identities and isolation from the community/ies I want to be in. I spent it at one of the local Reform temples with many if my classmates, professors and the dean of student affairs. While it became clear that I am no longer a reform Jew, it mirrored so many of my holidays growing up; it also magically made my classmates and professors feel like family. There was also an AMAZING drash about gay marriage- and how it is our duty to use Jewish doctrine to embrace it. Overall, a mix of blessings and frustration.

Hope ya'll had a meaningful holiday & gmar chatima tova!
"Yom Kippur 1984" By Adrienne Rich

What is a Jew in solitude?
What would it mean not to feel lonely or afraid
far from your own or those you have called your own?
What is a woman in solitude: a queer woman or man?
In the empty street, on the empty beach, in the desert
what in this world as it is can solitude mean?

The glassy, concrete octagon suspended from the cliffs
with its electric gate, its perfected privacy
is not what I mean
the pick-up with a gun parked at a turn-out in Utah or the Golan Heights
is not what I mean
the poet's tower facing the western ocean, acres of forest planted to the east,
the woman reading in the cabin, her attack dog suddenly risen
is not what I mean

Three thousand miles from what I once called home
I open a book searching for some lines I remember
about flowers, something to bind me to this coast as lilacs in the dooryard once
bound me back there--yes, lupines on a burnt mountainside,
something that bloomed and faded and was written down
in the poet's book, forever:
Opening the poet's book
I find the hatred in the poet's heart: . . . the hateful-eyed
and human-bodied are all about me: you that love multitude may have them

Robinson Jeffers, multitude
is the blur flung by distinct forms against these landward valleys
and the farms that run down to the sea; the lupines
are multitude, and the torched poppies, the grey Pacific unrolling its scrolls of
and the separate persons, stooped
over sewing machines in denim dust, ben under the shattering skies of harvest
who sleep by shifts in never-empty beds have their various dreams
Hands that pick, pack, steam, stitch, strip, stuff, shell, scrape, scour, belong to a
brain like no other
Must I argue the love of multitude in the blur or defend
a solitude of barbed-wire and searchlights, the survivalist's final solution, have I
a choice?

To wander far from your own or those you have called your own
to hear strangers calling you from far away
and walk in that direction, long and far, not calculating risk
to go to meet the Stranger without fear or weapon, protection nowhere on your mind
(the Jew on the icy, rutted road on Christmas Eve prays for another Jew
the woman in the ungainly twisting shadows of the street: Make those be a woman's footsteps; as if she could believe in a woman's god)

Find someone like yourself. Find others.
Agree you will never desert each other.
Understand that any rift among you
means power to those who want to do you in.
Close to the center, safety; toward the edges, danger.
But I have a nightmare to tell: I am trying to say
that to be with my people is my dearest wish
but that I also love strangers
that I crave separateness
I hear myself stuttering these words
to my worst frineds and my best enemies
who watch for my mistakes in grammar
my mistakes in love.
This is the day of atonement; but do my people forgive me?
If a cloud knew loneliness and fear, I would be that cloud.

To love the Stranger, to love solitude--I am writing merely about privilege
about drifting from the center, drawn to edges,
a privilege we can't afford in the world that is,
who are hated as being of our kind: faggot kicked into the icy river, woman dragged
from her stalled car
into the mist-stuck mountains, used and hacked to death
young scholar shot at the university gates on a summer evening walk, his prizes and
studies nothing, nothing availing his Blackness
Jew deluded that she's escaped the tribe, the laws of her exclusion, the men too
holy to touch her hand; Jew who has turned her back
on midrash and mitzvah (yet wears the chai on a thong between her breasts) hiking alone
found with a swastika carved in her back at te foot of the cliffs (did she die as
queer or as Jew?)

Solitude, O taboo, endangered species
on the mist-stuck mountain, I want a gun to defend you
In the desert, on the deserted street, I want what I can't have:
your elder sister, Justice, her great peasant's hand outspread
her eye, half-hooded, sharp and true
And I ask myself, have I thrown courage away?
have I traded off something I don't name?
To what extreme will I go to meet the extremist?
What will I do to defend my want or anyone's want to search for her spirit-vision
far from the protection of those she has called her own?
Will I find O solitude
your plumes, your breasts, your hair
against my face, as in childhood, your voice like the mockingbird's
singing Yes, you are loved, why else this song?
in the old places, anywhere?

What is a Jew in solitude?
What is a woman in solitude, a queer woman or man?
When the winter flood-tides wrench the tower from the rock, crumble the prophet's
headland, and the farms slide into the sea
when leviathan is endangered and Jonah becomes revenger
when center and edges are crushed together, the extremities crushed together on
which the world was founded
when our souls crash together, Arab and Jew, howling our loneliness within the tribes
when the refugee child and the exile's child re-open the blasted and forbidden city
when we who refuse to be women and men as women and men are chartered, tell our
stories of solitude spent in multitude
in that world as it may be, newborn and haunted, what will solitude mean?


Wednesday, September 15, 2010

A picture is worth a thousand words

This is from "Stirrups and Stories", an amazing attempt for patients to reclaim the OB/GYN experience. Looking through the site I am very much reminded of what brought me to medical school in the first place and why I want to be an OB/GYN. I want to empower women to reclaim their own bodies.

It reminds me of my college thesis. I spent a year examining elements of power and agency in pregnancy that lead to a woman being educated about her pregnancy and birth options. Using anthropology and photography, I created a multi-dimensional ethnography with a corresponding photography gallery exhibit. I was blessed to spend my year engaging with women who opened up to me, sharing their stories, families, homes and images of their bodies with me.

On a similar note, here is a pretty awesome article on home birth. The article illuminates the reason that I choose medical school over nurse midwifery: the desire to advocate for reversing the over-medicalization of births from the top. Additionally, I want to empower ALL women to embrace their health and trust their bodies, instead of just working with women who choose midwifery care. I strongly agree with a lot of what the article is saying, especially the following paragraph: "
In anthropology, we say that "normal is simply what you are used to." The power of socialization and the dominance of biomedicine have kept us from systematically examining a variety of birthing environments and providers as viable alternatives to the expensive and interventive hospital delivery that has become the norm in the U.S."

Here is to hoping that we can start listening to women's voices and remembering that birth happened long before western medicine came along; and that I don't forget my background as an anthropologist and
a labor doula as I progress through my medical training.

Monday, September 13, 2010

conflicting identities

Since starting college, every fall brings with it a little bit of dread. The chagim (Jewish holidays) which are supposed to be filled with meaningful contemplation, community, and celebration seem to instead be filled with stress, guilt and juggling. I hate the fact that for a solid month, I feel like neither a good Jew nor a good medical student. By trying to find a compromise between my identities, I simply fail at being either. The saddest part is my disconnection from sukkot as it is totally my favorite holiday but seems to get overlooked by the post Rosh HaShana & Yom Kippur catch up games.

Since it is very apparent that I'm no longer on the professional Jew track (there was a period of time where I seriously considered becoming a Rabbi), it seems to be time to re-conceptualize my religious identity. What does being observant mean to me now? Now that I am without my progressive-trans denominational-intellectual Jewish community, now that chabad is my only walk-able option, now that I am a busy med student who never has enough time, and now that my kavinah (spiritual intention) seems to be elusive at best. Now, what is meaningful for me?

Goals for 5771: (0) Spend some time reconnecting with and reformatting my spiritual identity. (1) Work on broadening my Jewish community in this southern town that I now call home; especially by expanding my circle of liberal-queer-intellectual Jews. While I already know most of the people that fall into the above category, I need to put more energy into really making these people part of my community. (2) Revisit what being shomer shabbos means to me. (3) Make more of an effort to connect with my inner Jewish mother. I miss having people over for shabbos and holidays. I miss taking care of others in my community. (4) Follow through on my plan to volunteer with the local chevra kadisha (people that do burial preparations) as a means of connecting my conflicting identities. (5) More text study! I miss text study.

Tuesday, September 7, 2010


I subscribe "Pulse", a weekly internet-based literary journal. Some of the pieces are so-so but others are absolutely wonderful; this week being one of the later. The story was titled "Broken" and tells of a pivotal moment all medical professional go through, the point where our idealistic nature gives way to jaded frustration. Besides being a good read, it hit close to home as the shifting mindset of budding physicians is something I've been thinking (and talking) about a lot recently.

Last week I had my first official meet up with my "first-year buddy" where I passed along a piece of advice I had been given by a doctor-friend. Before I began this doctor-friend told me that her biggest reget was not keeping a paper journal throughout her med school journey, as she knew she was profoundly changed, but lacked documentation of the evolution. I was already keeping a journal at the time (having started during the interview trail) but have used her words as motivation to keep up the practice. When I passed these words on to my buddy, she immediately asked what, if any, changes I had noticed so far? To which I responded with a simple "yes". It is not easy to express how an experience changes you. It is even harder to do when you don't view all these changes as positive. And harder still is to present this information in a way that it wont bias the experience of my first-year buddy.

While I have not yet "broken", what are some of the things that have changed over the past year? The top 3, or at least the 3 I feel like mentioning right now, are:
1) I have become more impatient with people and with bull shit. Because my time is overly structured and because I can't take a break from studying without feeling guilty, I find myself inpatient to anything or anyone that slows down my productivity.
2) My vocabulary has changed. I now use words like "acute", "lateral", and "pathological" in every day, non-medical, conversation. I also triage my conversations with friends in order to extract the most important information first. I blame this on being impatient .(see #1)
3) Having yet to see a really successful model of personal life for career driven physicians, I have been making peace with the idea of potentially not getting married and having children. (see previous entries with "family" labels)

I am sure that I will continue to change over the course of medical school and my career, and am hopefully that these changes will be chronicled in my paper journal and maybe also on this here blog. I sincerely hope that I never significantly change or break to the point of being driven away from medicine and the idealistic desire to do good in this world. If I do, I hope that I, like the author of the article, can find ways to be reminded of my goals and be made whole again.

Monday, September 6, 2010


This article titled "Are You Sexually Normal -- and Does That Matter?" by Dr. Marty Klein may just equate a literary orgasm. I think I'm in love with it, or at least significantly lusting. I want (all) my potential future partner(s) to read it, assuming that I, G!d willing, have future partners. If society as a whole could just take the message to heart, we might be able to create a utopia, or at least a much less anxious and more sexually satisfied community.

Wednesday, September 1, 2010

silly traditions

Right before the first anatomy exam of our first year of medical school my classmates and I were all freaking out. Between the sheer quantity of information we were excepted to know, the uncertainty of what to expect from the exam, and the fear that doing poorly would alert the admissions office to their mistake of accepting us... we were anxious to say the least.

Two days before the exam we were sitting in the main lecture hall for a review session which we had been informed was "extremely high yield". About 15 minutes into the 2 hour review a noise began to grow louder outside the doors to the auditorium. Out of no where a large amount of the second year class came storming into the lecture hall, hurling candy, mardi gras beads and plush toys at us. Looking around, none of my classmates appeared to know what was happening as we laughed and ducked. Before leaving, the second years sang to us and explained that this "review session storming" was simply an annual tradition with no explanation. They left us with a noticeably more relaxed attitude and a huge mess to clean up in the auditorium.

I look back on the experience as one of my founder memories from last year. It was the moment I realized that everything really was going to be okay. If the upper classmen could take a break from their studying (as they also had an exam to cram for), and if our professor could allow for this to happen during his review time (and then continue to teach while wearing beads and eating candy), and my classmates could see the humor in oddity of the situation: I too could learn to relax and enjoy the experience.

Today it all came full circle. It was our day to storm the first year review session, which I did with 30 or so of my classmates. Seeing the same look of confused enjoyment on the faces of the first year class, I could sense that they too were getting it: the moment of clarity that medical school will be okay and maybe even a little bit enjoyable at times. The surprise though was realizing that not only did I help give this experience to the first years, I was able to take from it as well. As chaotic as this year gets with course work, step I preparation and extra curriculars, there is ALWAYS time for humor, to be silly, to carry on tradition, and to make someone else's day.

Though there really are never enough hours in the day. So, with that, back to studying for Friday's exam I go.