Tuesday, May 24, 2016

Live Where You Live

I walked to work one day last week, something I fantasize about doing regularly in the future. I walked behind a little boy and his grandmother. He was probably 5, maybe a tall 4. She was probably 40, maybe a young looking 45. He had a superman cape on and those shoes that light up when you stomp. He clutched some nondescript glazed pastry in one hand, the kind you can get for 1.99 at the check out counter of 7-11. His other hand was holding onto grandma. Grandma was holding him tight in one hand, and swinging his batman backpack in her other hand. They weren't rushing, but walked steadily, with purpose. I walked behind them for about 5 blocks until they reached his school and we parted ways. She let go at one point and told him to run ahead and get his energy out before school started. Off he darted, happy to have some freedom. Her newly unoccupied hand reached for a cigarette which she enjoyed over the next few blocks, still swinging batman with her other hand. She caught up to him, put out her cigarette and dropped him off at school. His batman backpack looked huge on his wirey frame, but he darted happily inside the brick building. You could tell life wasn't perfect, but grandma loved him and he loved batman.

It was only about 7 minutes in total, but it reminded me of how valuable it is for me to be present and to live life in the same geographical and social space as my patients (another life long fantasy). There's more information to be gotten from that morning observation than from 10 minutes of diligent question asking in an exam room.

I thought about that kiddo the rest of the day. I wondered if he was hungry after the sugar rush wore off? I wondered if he had asthma, and grandma's smoking made it worse? I wondered what his home life was like? I wondered what he learned in school, and what was inside that big batman backpack? I wondered if he would get mislabeled as ADHD, or if stomping his feet to make his shoes light up filled him with feelings of security and magic powers, like batman, to face an imperfect world every morning. Kids are resilient, people say. But are they? Really? Look how many people grow up to have physical, mental, relational difficulties because of their childhood. That's not resilience, it's incubation.

A few miles away from that morning walk, and two years ago, I remember sitting in my hospital's lobby. This time, I was a patient, waiting for lab work. I had decided I'd go to doctors and deliver my baby at the hospital in which I worked. On the one hand, it was convenient. I was an intern with no time, and proximity and inside connections were gold. On the other hand, I knew all too well the flaws and messiness of my hospital. Sitting there in the lobby, it was pretty clear I wasn't the typical patient.

Similar to being a neighbor in the neighborhood where I work, being a patient in my own healthcare system was probably the best medical education I ever got. I learned about long wait times, frustrating insurance, chaotic offices, an overwhelmed hospital, and being surrounded by people who didn't look much like me. I pushed a baby out in a hospital room that was less than luxurious, yet had everything I needed. I faced my own sense of entitlement that things should work better for me!

But it isn't the humble environment or semi-chaotic atmosphere that I remember. It's is the deeper joy and importance of having my vocational, social, health, and geographical worlds collide. It is the deeper meaning behind having my baby delivered by a Nigerian, washed by an Ethiopian, and handed to me by a Korean. There's a peace that comes with being fully present- it overcomes awkwardness and social or cultural barriers. I've since delivered a few other babies in that same room, and each time had heightened meaning because of my own relationship with that space.

Live where you live, I've learned. Work where you live. Be where you live. Don't just see patients, be one. Don't just treat patients, live with them. It makes me a better doctor, to be sure, but also a better neighbor. We're all just neighbors in the end, aren't we?

Tuesday, May 10, 2016

Street Cleaning, Solo-Parenting, and Margins

Tuesdays were my least favorite day of the week this year. 

Tuesday is street cleaning day on our street. (don't even get me started on how ridiculous street cleaning is) I'd guess that most of DC has felt the burn of waking up on "street cleaning morning" with a sharp pang of "argh. *&*$^&$^** I forgot to move the car." It might only be 7:01AM, but you probably already have one of those infuriating pink tickets. 

If you park before 6:30pm on Monday night you have to go out and move your car to the other side of the street before 7am on Tuesday. And then if you get home before 7pm on Tuesday night you have to move your car back to the normal side by 7am on Wednesday. I repeat, *@^&@&$*@!!. 

With Jonathan away in NYC during weekdays this year, street cleaning day has become particularly painful. Do I drag a newly bathed, ready-for-bed kiddo out to the car, strap him in, and drive around until I find a new parking spot? Do I wait until he's in bed, sneak out and hope he's ok and drive around alone to find a new spot? Sometimes I found a spot immediately, other times it was a 15 minute ordeal complicated by weather or traffic or other people's poor parking. 

It's such a simple thing, but each week it brought to surface the difficulties of solo-parenting.** 

If this year had a theme, it would be margins. I did a lot of living life in narrow margins. 

Margins provide extra space. Room to correct mistakes. Wiggle room. Cushion. Protection. 

Life without much margin feels tenuous, and perpetually vulnerable. Small deals become big deals. A kid with a cough becomes a potential day-care phone call that he needs to be picked up, which turns into leaving patients waiting or unseen. A patient close to her due date becomes a potential 2am phone call saying I need to go to the hospital and figure out what to do with my sound asleep kiddo. A night on call means planning weeks in advance about who can pick up munchkin from daycare, feed him, and be with him all night. Staying later at work means late dinner for munchkin means cranky-pants kid. Not being able to carry everything from the car to the apartment turns into worrying what item is least likely to be stolen while it sits in the backseat, and wondering if it’s ok to leave munchkin alone in his crib while bringing in groceries up 3 flights of stairs. Spending 2 glorious hours from 6-8pm feeding, bathing, and playing with legos means maybe my medical board scores won’t be as high.

I’ve never in my life spent so much time double and triple checking when I leave the house that I have everything- phone, keys, wallet, food, kid…etc. Forgetting those things becomes lots more complicated when you’re alone. I worried more about getting a flat tire or having the ER suck all the battery out of my phone and being unreachable more than ever before.

Small deals become big deals when life doesn’t have much margin. Distant worries become real fears. Potential snags in the day seem to become imminently possible and probable.

Were there friends to call? Sure. But this is DC. Everyone is busy. It’s hard to call for help at 2am when you have to go to the hospital no matter how good of a friend.

By the grace of God, I haven’t had any big emergencies. No 2am hospital calls that didn’t work out in the end. No late dinners or early mornings or street cleaning days or chief resident emergencies or lack of groceries that had any lasting impact. Practically and tangibly, things worked out. But life still felt vulnerable, hanging in a delicate balance between “things working” and “system failure.” There didn’t seem to be any middle ground.

I’ve learned how much I love margins. I’ve thought deeply about individuals and groups who permanently live life without much margin. Single parents, unemployed, homeless, disempowered minorities, the chronically ill. Small things become big deals. Life is more delicate.

Everyone needs margins and help on their “street cleaning” days.

**I use term solo-parent rather than single parent because, well, I'm not single. Jonathan may have been away a lot, but we're still together, and we're only apart for a year. He was always there for a supportive text or call or email. Once he even rushed back from NYC on a train (I wouldn't let me him tell me how much last minute tickets cost) when I had to bring Theo to the hospital. We saw him for long weekends almost each week. We mutually agreed that this was the best plan for us this year. I'm not single, but I learned a lot about what single parenting might be like.