January 12, 2020

What are some things you like to do to relax & rejuvenate yourself?

I really look forward to coming home in the evening and working on my writing. When I’ve got time, some decompressed space, I can just throw on my PJs and pour a glass of wine and work on my book. The book is about two years I spent living in Nepal, and how that was a super formative experience of growth, specifically of growth through suffering. I think in the bookstore, it will show up somewhere in “travel” or “spiritual memoir,” and can hopefully offer a little insight into medical missions and what is it to practice medicine in a resource-limited setting -- the impact that can have on providers, the decisions you’re making, some of the frustrations that can arise. And also, speaking as a Christian, it’s about how God taught me a great deal through that experience that I don’t think I could have learned apart from the very pressure of the environment that I was in. They say “Nepal brings you to the end of yourself,” and that was definitely true for me.
 

Can you share some of what you learned during that time?

I really don’t think you can actually have growth without suffering. That crucible is truly the place where transformation happens -- literally, metaphorically, spiritually. A lot of my growth was through the suffering I witnessed, being present to people’s illnesses, their pain, their death, and much of that mediated and exacerbated by poverty. Poverty brings whole other layers of pain, because you become so acutely aware of the awful injustice that exists in our world. 

And then there’s the pain of one’s own inadequacy. In America, I felt like I was able to be really on my game, juggling all these balls and spinning all these plates, and it was generally working pretty well. Sometimes you’re at the limits of what you can do, but you can still do it. In Nepal, though, I couldn’t do it. I couldn’t manage the level of acuity I was seeing all the time. There were times you’d be literally running from case to case, and people would be dying before you could get there. 

What’s more, I also came thinking I could just import my credentials over, and make this lateral move professionally. Here I was, holding a junior faculty appointment at this Ivy League institution in DC, recognized as this great teacher, and I’m just going to come here and everyone is going to be like “Thank you, you’re here!” But instead it was more like, “Who are you?” Essentially, you’re this young white girl from America, and why should we listen to you? You don’t have a relationship with us, you don’t know us. The house-staff who were junior trainees were Nepali nationals, generally older than me, often male. There were barriers to be negotiated that I just didn’t appreciate, and at times I really got in my own way of building those relationships. 

About 18 months into my time there, I was incredibly burned out, constantly frustrated, angry all the time. I was completely at the end of myself. And then April 25 was when the first earthquake happened, followed by another one less than three weeks later. I stayed another 8 months beyond that, and was engulfed in some of the relief work at the epicenter of the earthquake. There were times I didn’t know if I would survive that, and worried that my parents might have to read about my death in the paper or something like that.

I sort of left that whole two-plus year experience feeling really confused and flat and just plain bewildered. There was an image I would have frequently, the image of being seaweed strewn on the beach. That’s who l was. Flat out. Then I remember this really powerful moment about a year after that point, during a yoga class here in Tarrytown. It was New Year’s Day, and we had our arms up and the teacher said, “Now drift your arms to one side, and now to the other, just like seaweed in the ocean.” It was coming full circle for me, seeing how much healing I had experienced during that year back home. You’re reintegrated back in your reference group, with people around you who can affirm you who you are, reflect back to you your identity. But I do notice my family sometimes says yeah you’re different now. It’s almost like you learn to tolerate more, you can absorb more discomfort. You weather it with a different sort of equanimity. 
 

What were some of the major shaping influences and events for you as a doctor?

When I was in college, my mother was diagnosed with stage 4 lung cancer. She was a vehement non-smoker, so she was one of those fifteen percent of women who get adenocarcinoma without the smoking history. She survived to the two year mark. I was finishing the end of my first block of med school, and during those last 6 weeks she was in the ICU the whole time, on a ventilator and undergoing very aggressive interventions like a VATS/ decortication procedure for recurrent (malignant) pleural effusions. Very, very aggressive care for what was very clearly a terminal illness. In retrospect I do wish we had gone the palliative route, that we’d had more guidance from her medical team to do so. When death from terminal cancer takes a family by surprise, something is clearly wrong. We should not have been surprised. I wish we had been better prepared. But that was a very shaping experience, medically speaking, for my career, and my interest in pursuing palliative care training eventually.

It was a unique experience, being face to face with death for that period of time, and the telescoping effect that has on a sense of time unfolding. Usually, time feels like it just stretches on eternally forever in front of you. In some ways it can’t go fast enough; there’s a sense of so much spaciousness in life, so much time in the years ahead. But there’s something about the experience of the death of somebody close to you, or fear for your own death maybe, that at some level seems to compress time. It’s almost like this veil is lifted. There’s nothing between here and eternity, just a flashing moment between now and then. I don’t necessarily feel that all the time these days, but it was an important insight into what those earth-shattering moments of life can do to your perspective.

How about in residency training? What was an important area of growth for you in that time?

During most of my residency training, I felt very disconnected from my patients. I had this image of leaving 95% of me outside the room when I would go in; I would just be this shell of a person that couldn’t connect, couldn’t be a human in the room. Part of it was insecurity, part of it was not having enough medical knowledge as a trainee. I was trying to cross major gaps in terms of experience and background, and didn’t feel like I shared a lot with my patients’ stories. I almost didn’t know how to make that connection. Then as I got more comfortable with my own sense of self, and also through exploring actual patients’ stories, hearing about their lived experiences, you begin to see, “Wow there’s a connection happening here. We are all just human in the room and we all have these relationships and desires and fears and things that make us angry or sad or joyful,” and there’s a way to find connection through that. Narrative medicine and the arts were really powerful to help me see what I couldn’t see otherwise. 

It's true in training, just as it is in practice, that the suffering you’re experiencing as students -- and that you will experience as residents -- is not for nothing, it bears fruit. It is sometimes the only way to get that fruit, actually, as awful as it feels in the moment. I have this image of one’s heart being stretched out and expanded more fully by the experience of suffering. There’s an alternative approach one can take too, that you can cut off the emotion, harden to that pain, because it hurts so much. When you do that, though, you can miss the stretching, the growth. By virtue of leaning into the experience of suffering, your heart does expand, and enable you to hold more of that emotion. Then you’re in a place to be able to give out that tenderness and care to a world that is, in turn, suffering around you.

What are your 5 Most Recently Played Artists on Spotify? 
Audrey Assad, Over The Rhine, Thomas Tallis, Josh Garrels, The Milk Carton Kids

If you could have any superpower, which one would you choose? 
It may be cliche, but I’d REALLY love to be able to fly. Or at least bound really high. And of course, it would be practically SO useful to be able to instantaneously teleport anywhere I wanted to be.

Pick something or someone from NYMC to give out a shout to!  
How about our amazing Branch House!! And all the literary-genius members of our Book Club (including you two gals!!)

If someone wanted to talk to you, they should lead with:
“What’s something beautiful that you witnessed today?” (But dry humor also works very well!)