style

the cheerleader tells me i have style

it's because i finally embraced womanness
the breasts, the hips, the jello arms andres black named in eighth grade
that jello i once wished would go away
but oprah said that underarm fat stays for life
and indeed it does

irreversible womanness
it's the only way to dance

i am who i am
this body is what it is
here to stay
for a while anyway
until it withers

i am who i am
a woman
and a healer

a stifled healer

patient after patient and the spark in my hands never ignites
words upon words travel through me like my ears don't work
is this what healing is?

i am who i am

a stifled healer
with style

intubation number six

As soon as I saw her I knew she had hours to days, not days to weeks,
not weeks to months,
but hours to days.

When her lungs were too tired to keep staving off death,
her withered, white-haired balding husband burst into the room
and burst into choked tears:
"Oh, God bless you, I love you"

he planted a kiss on her forehead

his trembling lips tortured, his cry agonal

around the room all the women's eyes were wet

some of us no doubt wondering if our love
in our dying breaths
is destined to be like that.

blue hyacinth

this unruly beauty a three dollar whim
its stalks unkempt green dreadlocks that dare to dream
a new dream against the crackling blizzard at the window pane

EM wins, #3

On Being Called a Doctor

"Did you see the guy in 82?"

"I literally just walked out of the room."

The nurse rolls her eyes. "He said no one has seen him yet."

"Well, I guess I'm no one."

As a female doctor, you get used to being no one.

I used to introduce myself to patients by my first name and tell them I would be their doctor that day. And repeatedly, I'd have extended interactions with those patients over several hours--eliciting their illness narrative, examining them, reporting back to them about their test results and making shared decisions about their care plans--only to have them call me "nurse," refer to me as "that lady," or ask, "When will the doctor see me?" "Why hasn't a doctor seen me yet? I've been waiting all this time here."

One might ask if this is really such a big deal. Sure, it makes my inner feminist wither, and it made it harder to cast off the initial tenuousness of my own understanding of myself as a doctor, but if patients are getting good care regardless of their perception of who I am, does it really matter?

Here's the thing. It matters when patients expect me to have nursing skills I don't have, like pulling and administering medications, priming their lines, or getting them the right type of bedpan. It matters when patients complain to hospital administrators that they never saw a doctor over a twelve-hour visit to the emergency department, when in reality they saw two--myself and a female attending. It matters when you're overworked, underslept, and it's just one more thing that takes away from your personal satisfaction and sense of self-efficacy at work, which ultimately compromises your relationships with patients.

Over time, I started introducing myself as Dr. Chary. No more first names.

I'm not really sure it helped.

And then one day, there was a small moment worth celebrating.

I had just finished giving a patient a spiel about migraine management, to which she responded, "Yeah, I think I understand this all a lot better after talking to you and the doctor."

My inner running commentary sighed. "The doctor" was a white male--the kind and brilliant attending physician who was supervising the residents in our pod that day. Here was yet another patient who thought I wasn't a doctor. But, as I so often did, I showed no reaction on my face. I simply nodded, as images and recollections of so many patients who couldn't believe a brown woman was their doctor flashed before my eyes.

"Wait," the woman said. "I didn't mean that you're not a doctor--I meant, after talking to you and the other doctor."

I now like to think of my inner feminist as a succulent plant. And that drop of water will last me a long time.

Happy moments in EM, #2

The Walnut Cookies

"Our patient wanted you to have this," a nurse thrust me two clear plastic packages. Walnut cookie, the wrappers read in fancy gold italicized print.

It felt like I'd spent too long seeing the patient. She was a Cantonese-speaker, and the twenty minutes it had taken to get an interpreter on the phone and figure out that the woman had pneumonia had felt like an eternity. During that time, four new patients had manifested in our pod. During that time, the patient had apologized to me three times for peeing in her pants. "I've been coughing so much, doctor, that sometimes I pee a little," the interpreter stated on speakerphone. I wondered momentarily if the interpreters ever slipped into the third person.

"Please, there's no need to apologize," I spoke into the air, and a string of words I couldn't understand emerged from the phone, followed by a string of words I did understand: "Could I please have a maxipad, or better yet, a diaper?" I helped the patient wriggle out of her pants, which were indeed damp, and covered her up in two layers of warm blankets. Throughout the physical exam, she apologized again, twice, and then asked for a diaper and maxipad again, twice.

I exited the room and, somewhat reluctantly, went hunting around the various stock rooms and carts for an adult diaper, all the while aware that there were other patients waiting to be seen. I cursed myself for not knowing where simple supplies were and felt frustrated that everyone else was too busy for me to ask for help. It was a pleasant surprise to find diapers in the third tower I inspected, and the patient thanked me profusely when I delivered one to her. "Thank you, thank you, thank you," she spoke in English in a heavy accent.

When the nurse tossed me the cookies later on in the night, my heart melted a little bit.

"She said it's for Chinese New Year," the nurse told me.

It's really because I brought her that diaper, I thought to myself.

Happy moments in EM, #1

This year, Ash Wednesday and Valentine's Day coincided.

One of the last patients I saw was a woman with a cross of ashes etched onto her forehead. She wore a blue mask over her mouth and nose; her primary care provider had alarmed her into thinking that her headache might be due to bacterial meningitis – which means that patients get a lumbar puncture and are admitted to the hospital for IV antibiotics.

This patient was very somber and afraid, in contrast to her husband, whose forehead was crossless. He was quite upbeat and quite drawn to the glass doorway of her room, where he could appreciate with morbid fascination all of the psychotic patients acting out, screaming, having fake seizures, and yanking and beating on their restraints on their stretchers.

I have become thoroughly desensitized to these noises, which comprise the background rhythm of the Emergency Department.

This husband, on the other hand, was like a baby discovering a mirror, reveling in this completely novel and human experience. He couldn't control his laughter. His wife immediately scolded him and told him not to watch and to sit back down. It brought a smile to my face, which was hidden behind my own blue mask.

The woman's headache turned out to be a tension headache, and she was relieved that she got to go home.

At the end of the night, I joked with them that they had spent their Valentine's Day in the most romantic of places. And that brought a smile to both of their faces.

Pain

Just having a little anthropological thought experiment about pain.

Sometimes we have to hurt patients to "help" them. About half of the people I did ultrasounds on today were in pain when I scanned them, and my scan caused them distress. A tattooed black man who had just been shot in the chest and I had to press the probe into his tensing muscles to get a subxiphoid view. A young white woman who had just had knee surgery and gripped the bedrails, shaking, while I glided the probe up and down her leg and all around her knee to look for clots. A gray-haired old lady who had been backed over and then run over by a car who cried out when I swept the probe over her bladder.

There was also an old man slowly oozing blood from his rectum, heart rate increasing, pressure dropping, and yelling and flailing in pain from a finicky peripheral IV insertion, working himself up into a panic attack, hyperventilating. He begged us not to do it. He said he'd rather die than get stuck again. I knew he meant it but didn't mean it. I knew he was not himself. Pain makes us not ourselves. It makes us not our best selves. And my voice slid into the loud, firm tone that makes me sound more American than I really am, that's not me in real life, but is me in doctor life, and talked him down. That voice cares, but it also doesn't.

"I know this is hard, but you're losing a lot of blood and we really need you to have this IV, all right? We have your best interests in mind here, okay?"

He nods, incoherently. His eyes seem teary and I'm embarrassed for him and he's embarrassed for himself.

Their pain makes you detach.

At first, you're a novice, and you try not to press hard. And then you realize that it's better to press hard and get your image and get it over with than to torture them with a light touch. It's better to just rip off the bandaid in one fell swoop.

You don't want to cause them pain. You don't want to cause anyone pain. That's not why you entered this profession. But you are causing them pain. Even if it's with the intention of helping heal them, whatever that means in modern biomedicine, you are causing them pain.

So the easiest thing to do is detach. I pay attention to your pain but I also don't. I pay attention to my job and getting my job done. If there is someone else in the room--a nurse, a tech, a student, another doctor--who can console you, I'm not going to use my energy to do it, I'll just let them handle it. I'm just going to focus on my job.

And now I feel your humanity, but only in an abstract sense. I'm still present to you. But I'm present to you the patient, not you the person.

The old man got transferred to the trauma bay soon after his pressures tanked. I walked by and I thought his eyes were closed. He looked asleep. But he waved to me.

"Hi there," I said.

"Hi there," he responded.