The Tenth Circle

I am currently house-hunting, in another state, which is a special kind of hell. The area where I’m looking is rapidly gentrifying (and I guess I’m about to contribute to that?) which means that it’s awash in fixer-uppers that have been fixer-upped with the trendiest possible design.



I have a job.


I mean, it’s great to be done with training (or almost done — six months to go!) I started on this journey a dozen years ago, in January 2006, when I began studying for the MCAT. It’s been a doozy of ups and downs along the way.

There has been nothing more doozy-ing than the academic medicine job market, let me tell you.

I had very specific goals in mind for a job. I had to have movement disorders. And I had to have narrative medicine. So what I did, in early 2017, was make a list of all the academic centers that had both.

It was a small list.

Then I reached out to them individually last spring, a sort of pre-application inquiry. Like, hey, are you hiring?

One place had just hired a movement specialist the year before, so no go. Lots of places were looking for more traditional research-oriented physicians, not educators, so no go. It was stressful and dispiriting. I ate a lot of cookies.

Slowly, though, better news started filtering through. I got interviews. (Fun fact: on faculty interviews, they pay for everything! It’s an actual recruitment!) Magically, somehow, I had two offers roll in at close to the same time.

I read Getting to Yes, which multiple people had recommended to me as a “how to negotiate” book. The biggest take-away I got from it was that negotiation is about finding out where your priorities align. As someone with an inherently relational worldview, this made a lot of sense.


In my heart, there was one place where I really, really wanted to be; they were the clear front-runners since the beginning of this process. They had an opening. They had a humanities center. They had a tenure pathway for clinician-educators. I knocked the job talk out of the park. (Detailed how-to-job-talk post later.) We found multiple (multiple!) areas of alignment. The details of the offer were basically crafted around using my strengths to fill their needs. Things were looking good. I was prepared to sign. I started looking at houses on Trulia.


Something deeply deeply shitty happened. I don’t want to get into specifics, but it was confirmation of a suspected terrible pattern of behavior. I tried to set it aside for a week, pretend it didn’t happen, but I couldn’t. It was a really big deal. It was a deal-breaker.

So, I cried a lot, and then took the other offer. Then I called people at the first place, and told them, and cried even more as soon as I hung up the phone. For days after, I kept having to run out of the shared fellows’ office at clinic and go hide in the stairwell so I could cry.

That was two weeks ago. I’m no longer crying every five minutes, but I still feel really, really sad about it, especially when I tell people where I’ll be headed. Because I want to be able to say, “I’m going to FirstPlace.” I’m trying to think about all the positive things about the place I’m actually going. There are plenty of positives!

But still.

I guess what I’m trying to say, for anyone looking for advice, is not to get emotionally attached to anything in this freakish environment known as academic medicine.


On failure

I failed NaNoWriMo this year.

I wrote valiantly for about a week, then Stuff Happened, just like it did around this time last year, and I fell off the writing wagon, and I just kinda … stopped.

But I’m leaving that word counter up there, at least for now.

Because failure matters. Acknowledging failure matters. Acknowledging failure, and pain, and things going not-quite-as-you-expect, is part of resilience.

Or something.

As they say, you fall off the bike, you cry for a bit over your skinned knee or your volar plate avulsion fracture, then you get back on and you keep riding.

(I got my butt back in the chair today and wrote a pomodoro. Tomorrow, I’ll write two.)


Who do you want to be when you grow up?

Earlier this week, I met the guy whose job I want to have in 20 years. Physician and scholar and novelist! The guy talks about getting medical humanities grants like ordering a salad at Chop’t: “So one of my colleagues had this idea and we got a grant and studied it.”

For the last several months, as I’ve been on the academic medicine job market (post on that struggle later, once I actually Have A Job), my attendings have asked me, “do you want to be like … Ned? Or Emerson? Or Lonely Tourist Charlotte Charles?” And I’ve always answered, “None of the above?” Not really, I pick a name usually at random. (But I’ll take Chuck’s dress sense any day.) But frankly, none of the career paths that my current attendings have, really fits with my goals and interests. They are great people, who clearly love what they do and are fun to work with, and I have learned a LOT from them, but what I want to do is pretty niche, and while I’ve had some excellent role models as a medical student and resident, there isn’t anyone here at my fellowship institution who does what I want to do.

There are times, intermittently, when I still feel I missed the mark and should have stuck with literature. Don’t get me wrong, I love taking care of patients. But I love it because I love their stories. I am doing NaNoWriMo this year, and I cannot wait for November 1.


A Play in Two Acts


Interior: Clinic Room. Morning. 

And how far did you get in school, sir?

Sixth grade. I had to quit because of the Depression.



Interior Clinic Room. Afternoon

Any family history of tremor?

No, but it’s just my parents, they were orphans. The rest of their families were killed in the Armenian genocide.


You forget, sometimes, how close some of the tragedies of the 20th century are.


Winning and losing

Today a 87 yo demented man who has called me “young lady” for the last year, ever since I told him he shouldn’t be driving, told me that he liked me and that now I was a “real doctor.” (I think he has just forgotten about the driving issue.)

And someone else hugged me because I reprogrammed their DBS to give them better tremor control with less speech impairment.

And then, just before I left work, I got to tell someone over the phone that their spouse had an incurable, progressive, inherited condition. They started crying. They were at work. Note to self: never ever ever do this over the phone ever again.

books · politics

Tuesday Thoughts

In an effort to try to move past all the anger in my heart into something productive, I went and found a copy of Martin Luther King Jr’s Letter from Birmingham Jail.

You may well ask, “Why direct action, why sit-ins, marches, and so forth? Isn’t negotiation a better path?” You are exactly right in your call for negotiation. Indeed, this is the purpose of direct action. Nonviolent direct action seeks to create such a crisis and establish such creative tension that a community that has consistently refused to negotiate is forced to confront the issue. It seeks so to dramatize the issue that it can no longer be ignored. I just referred to the creation of tension as a part of the work of the nonviolent resister. This may sound rather shocking. But I must confess that I am not afraid of the word “tension.” I have earnestly worked and preached against violent tension, but there is a type of constructive nonviolent tension that is necessary for growth. Just as Socrates felt that it was necessary to create a tension in the mind so that individuals could rise from the bondage of myths and half-truths to the unfettered realm of creative analysis and objective appraisal, we must see the need of having nonviolent gadflies to create the kind of tension in society that will help men to rise from the dark depths of prejudice and racism to the majestic heights of understanding and brotherhood.

I would like to point out, for the record, that my high school American literature class, in 2001-2002, did not include any readings from Dr. King. We spent a month on the Scarlet Letter, including two class periods watching a terrible movie starring Demi Moore and the dad from Home Alone, and an insane amount of time doing “art and architecture” powerpoints about daub-and-wattle, but not even one hour could be spared for one of the greatest thinkers of the 20th century. We half-assed the 20th century in general, both in American lit and its sister course AP US History. In fact, in 17 years of public education, including majoring in Comparative Literature, I came across only five works by writers of African descent: I Know Why the Caged Bird Sings by Maya Angelou (which was opt-in), Invisible Man by Ralph Ellison, Une Si Longue Lettre by Mariama Ba, a poem by Derek Walcott, and Passing by Nella Larsen. In college I specifically sought out a seminar on the literature of the South Asian diaspora, but in my high school and college survey classes, there were no Native American or Asian American or Latinx writers anywhere. So when people say structural racism, that’s what it means, that even in an affluent, fairly progressive district where half of the student population were first-generation Americans, the only voices in the curriculum were those of Dead White Men.

To be fair, the DWM were generally good writers. (After all, they had a running start.) Mark Twain has been one of my BFF since I read A Connecticut Yankee when I was, like, 12, and he’s good enough that I can even almost forgive him for dissing Jane Austen that one time. Shakespeare’s not so bad himself. You know who else is a good writer? Martin Luther King, Jr. Frantz Fanon. Sherman Alexie. Chimamanda Ngozi Adichie. Zadie Smith. Abraham Verghese. Yaa Gyasi. Frederick Douglass. Edward Said. Jhumpa Lahiri. WEB DuBois. Just about all of these would have been appropriate for high school (ok, maybe not Fanon, I struggled with Black Skin White Masks at age 25, I think I would have been frustrated at 15).

The reasons I’m so worked up about this right now is because a) I’m a reader and a writer, so this is the shit I think about when my bus is stuck in traffic, and b) the scumbags who descended on Charlottesville this weekend are my age. Richard Spencer graduated a few years before me; Jason Kessler was two years after me. That means they grew up exposed to the same general atmosphere that I did, and like me, they probably grew up reading mostly white texts, and seeing people like themselves on TV, and playing characters like themselves in video games. I’m not totally sure that reading other perspectives would help them empathize with other human beings — after all, The Diary of Anne Frank was definitely required reading, and the take-away message from that book is not supposed to be “Hey that Hitler dude had a good idea.” But I think it’s a little like triaging in medicine. There are some people you just aren’t going to save, because the disease has them rotten to the core. But there’s a whole bunch of kids who have literally never heard the voice of an Other, and if you dose your antibiotics (i.e. reading) appropriately, you might, you just might, be able to pull them out of the ICU, and you won’t even have to worry about renal failure.