nocturne

Set off on a night-sea journey
Without memory or desire
Drifting through lost latitudes
With no compass and no chart

Flying through hallucination
Distant voices, signal fires
Lighting up my unconscious
And the secret places of the hear

Dream - temporary madness
Dream - a voice in the wilderness
Dream - unconscious revelations
The morning says, the answer is yes
- nocturne by n. peart

      Dreams, at least for me, are the poetic and prose, the prayers and curses, the fears and desires of my deepest self all written in a tongue that refuses to follow the language of the waking world. Imagery and imagination trump fact and historical accuracy. With that said, I view them as signposts and guides on this journey of my life where all too often of late it leads through paths untrodden and seas untraversed.  As such, I tend to dream more vividly when an unformed cogitation is ruminating.  The biggest obstacle to solidifying this wild imagery into a coherent message is that I often do not remember the dreams.  I wake up in a fitful state, my subconscious agitated that its message was not received and my emotional state confused at the cause of the disrupted sleep.
     When disrupted at 3 am by a visit from the dreamworld, I've found that jotting a few notes will help me remember it in the morning.  Those few notes typically relate to the emotion that the dream generated and I can work back from there.  One such night I was awoken by a powerful dream.  I needed my sleep so I quickly spit out the feeling on my iphone.  The next morning I barely remember any of the events.  Did I have a dream?  I did.  I check my phone and it reads, "NOT the way it used to be."  The imagery refuses to form and I'm left with the haunted feeling that my psyche intuits that more is yet to still change in my surreal life.
    

fruits of labor

     In a hurry, I sat down at a nursing station to grab a computer.  I needed to see if the final read of Mr. Smith's chest CT was up and if the immunology blood work up on Mrs. Jones was completed.  Instead I was interrupted by a nurse.  She stated, "Mrs. Evans in Room 2112 says that you're the best doctor she's ever had.  She says that you were the first one that ever sat down and actually listened to her."

a walking meditation

     My last month was spent in the hospital enrolled in the clerkship dubbed "acting intern".  It is essentially supposed to have me perform as an intern, or first year resident, would.  Now I see why so many residents start to become less empathetic towards the patients.  Overworked, too much red tape, sleep deprived, hassles with the EMR, clashes between the rest of the people taking care of the patient, and did I mention overworked?  I began to imagine ways of fighting against this natural pull of the stream.  One method I developed was to check on my patients in the afternoon for just a few minutes (assuming we were not slammed with new admissions).  When prerounding at 0 dark thirty, your time is spent hurriedly trying to figure out how the patient did overnight and whether they responded to the adjustments in treatments implemented the day before.  Then you have to take all that information and type it into a coherent note for the attending before actual rounds.  Then the patient is often overwhelmed by the presence of the entire team when rounding.  Who would want to talk candidly when 5-6 people step into the room looming over you in the hospital bed?  I know I wouldn't.
     But when I stop by in the afternoon, there is no agenda.  I just sit down and briefly talk to them.  That's it.  Mostly I just ask how they're doing?  It doesn't take long but it does take effort, especially if that time could be spent taking a power nap.  But I've been amazed at how that 3-5 minute visit deepens the connection with the patient far beyond what I would have expected.  They trust me more and are far more willing to engage more in their own treatment.  And in return, I am one step further removed from becoming burned out and jaded. 

insight

     If you've read my blog at all, you know that I have a keen interest in psychology and psychiatry, despite going into family medicine. As one psychiatrist attending told me, "family med is just psychiatry with procedures."  So I've been meaning to post this for awhile but have been too busy in the hospital. This month is a bit slower, so better late than never. It's comic Mark Maron's comments on the suicide of Robin Williams. You only need to listen to the first 7 minutes to get one of the best descriptions of the suffering of depression I've heard in awhile. If you listen to the rest, well, it is Robin Williams so expect both the profane and profound.

Press here to listen.

hard work realized

     Normally I do not check my school email often.  It's mostly announcements from the school about various going ons.  But the past two days, I've started checking it more frequently.  The process for applying to residency has started.  It's a centralized process that is nationwide across multiple specialties.  You apply and then sit and wait to hear back from the programs.  Interviewing usually starts in earnest in November.  And I only had one letter of recommendation uploaded out of the three required.  One got lost somehow.  The other is from a busy faculty member so I figured I'd have to wait a bit longer since I was missing those two letters still.  Only I haven't had to wait that long.  I have three interviews offered for October and one more coming.  After all that has happened in my life, it's hard to imagine moving on to the next step.  It is not that I do not wish to move forward.  Far from it.  Still, it is surreal to be honest.  I wasn't sure this day would come despite all reassurances to the contrary.  There have certainly been far too many opportunities for me to collapse or fall apart.  I have walked along that cliff for what seems a lifetime.  Experientially, I have lived several lives in the past several years.  And yet I am still here.  I cannot say how but yet still the next phase of my journey is beginning nonetheless.