MS-4 · New York

Refuge

Whenever New York City starts to get to me — as it does about every two weeks these days* — I hightail it up to the very tip of the island, to Inwood Hill Park, and walk into the woods.

Inwood Hill Park is one of the last remaining (the last remaining?) old growth forest in the city, and as you climb up and around the side of the hill, the city drops away to just a dull roar. My usual MO is to enter near Payson Avenue, and just keep walking and walking until the cars on the Henry Hudson Parkway are replaced by crickets and the crunch of my own footsteps.

I’ve hiked this in all weather, in snowboots and in sneakers. On a sunny weekend, like yesterday, there were plenty of people out and about. I passed about 6 groups, more than I’ve ever seen. Most of the paths are paved, which makes it pretty family-friendly (so easy even a grandma can do it!) but occasionally I come across real trails, leading off to Narnia.

The whole point of hiking is to be away from noise and chatter. I suppose I am something of an introvert, stranded in the world’s most extroverted city. So having this refuge, for days when even the Cloisters is abuzz, is key for me. The goal, if there is a goal, is to get lost. (But not too lost. Safety matters. Phone++.) Of course, sometimes you do some across signs of life.

After two hours of hiking on Sunday, I reemerged just off Broadway, feeling full of goodwill, the way people are supposed to feel in Christmas movies. And as I made my way back home, passing young families (Inwood: the new Park Slope?) and people walking their dogs, I suddenly realized, “What the hell am I thinking? I don’t want to leave New York.”

This feeling lasted just about till the George Washington Bridge, before I started feeling stressed again just trying to cross the street without getting run over by a gypsy cab or a MetroBus or a little old lady with a walker (true story!). Ah, well, it was nice while it lasted.

* There are only so many times you can squeeze yourself onto a crowded subway carrying groceries in both hands and just hoping that your eggs make it home unsmashed, before you start pining for a car with air conditioning and some space of your own. The current rotation, where I “take care” of 90 year olds by causing them a great deal of pain for little clinical benefit, doesn’t help. (But that’s a story for a whole nother post.)

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medicine · MS-4 · narrative medicine · New York

Not done yet

I had brunch with a good friend today, down in the West Village.  She is a literature PhD candidate, about to switch careers and head down the med school route.  And I was telling her about my own near-career switch, back when I was a fourth-year undergraduate so in love with my comp lit thesis that I was about to withdraw all my applications to medical school and apply to lit Ph.D. programs instead.

“But I’m glad I didn’t,” said I between forkfuls of an exceedingly delicious Greek salad with herbed goat cheese. (You can order things like this in the West Village — such a change from the chicken-and-rice cart outside the hospital.) “Because then narrative medicine turned up, and I got to do that instead. I needed that year, but I missed clinical medicine so much.”

“And it sounds like, from what you said about your thesis, that you weren’t done with literature yet, you still wanted to explore.”

“Yeah. And there’s a lot more still to explore — I feel like I just learned a lot of new vocabulary and am barely getting past the surface. Maybe I’ll go back, do a PhD later. But for now… I really need to take care of people.”

I think I’d never articulated that to myself before. Back in November, I started really missing medicine in a very visceral way. I missed the process of history-taking, the back-and-forth, the reconstructed (co-constructed?) timeline of events. I missed the thrill of physical exam findings. (The differentiation between aortic stenosis and hypertrophic obstructive cardiomyopathy is hot.) I missed curbsiding my friends on other services to ask their opinion about xyz, or frantically UpToDating at the nurses’ station. I missed the putting-it-all-together, the generation of a coherent story to pass along to my resident and attending.  As soon as I could rearrange my schedule appropriately, I began volunteering at the free clinic, in order to get at least a little of that back.

There was a re-learning curve at the beginning of this month — I had to look up how to write notes, I had to look up the most basic principles of pathophys, I even once had to look up the normal values for coagulation factors. *shame* But now that I’m back in the swing of things, I feel too excited by it ever to want to leave again. I mean, I helped convince a man to make a lifestyle change that has already dropped his weight by 110 pounds. One hundred and freaking ten pounds — that’s a me. Formerly inside him; like Athena and Zeus. The man now feels better, breathes easier, walks longer. How can you not be excited by that?

So, no, I’m not “done yet” with literature.  But more importantly, I’m not done yet with medicine. As frustrating as the hospital can be at times — one of my patients has been hanging out for a week because of discharge planning problems — it’s also hugely fulfilling. Not necessarily just in the “good outcomes” way, but also in the sheer pleasure of doing something that is of use to other people.

Our conversation moved on to other things, like the evils of the application process (med school vs. residency), the commercialism of Times Square, the sheer awesomeness of Zadie Smith. But that “not done yet” line of K’s lingered in my brain.

Who knew that such profound moments could arise in a slightly hipster joint off Christopher Street?

culture · health policy · infectious disease · narrative medicine · New York

The Normal Heart

Friday night, I went to see The Normal Heart, a revival of a 1985 play about the early days of AIDS. (Starring Lee Pace! And Jim Parsons! More on them later.) It was quite shocking to us, for whom HIV/AIDS has become … well, not a commonplace, but a fairly straightforward chronic disease. I was on the infectious diseases service last January, and it was one of the most difficult months of my life, but we knew was wrong with these patients. We knew it down to the molecular level. We had drugs to extend their lives. We couldn’t cure them, not quite yet, but we could do something. 

And so forgive my naivete, but it was a shock to step back nearly 30 years (the play is set 1981-1984) and see a time when that wasn’t possible. The Normal Heart is basically a rant against the people that twiddled their collective thumbs while young men died. It’s happened before, and it will happen again. It’s probably happening now, and I just don’t see it because of the New York bubble. The title comes from a poem by WH Auden, which you should all go read because it’s Auden, nuff said.

The didacticism and emotional manipulation did get a little heavy-handed at times, but there was enough nuance to just save it. The relationship between Ned and his conservative brother Ben, for instance — love, uncertainty, and depth. The City government and the NIH bear the brunt of Ned/Larry Kramer’s diatribe, probably fairly, but they do come across as straw men. I guess it’s easy to attack institutions, but I would have preferred to see the people within those institutions.

And fantastic acting all around. Lee Pace as a jerk (though hints of backstory suggest non-jerkish behavior)! And Jim Parsons — holy crap. He had very few lines, but he just commands the stage in this understated and powerful way. Everyone was amazing, but he was just on point.

I was thoroughly impressed and should probably read And the Band Played On at some point. Why don’t we talk about this stuff in medical school?