I grew up having what I believe to be a pretty realistic view of life and death. It is something my parents were very open and honest with us about. My mom was a hospice nurse, taking care of people in their last 6 months of life. My dad's mother, my grandmother (and my namesake), lived with us when her health started it's final decline. And I always remember (although I dont know that I could have put words to it at the time, although I sort of did with my poetry), that there was the sense that death was imminent, but that it was not something to be fought with.

That is an ethical issue I deal with a lot in work these days. While some of my patients are very realistic with the fact that death is a part of life, some want to fight it tooth and nail to the end...Even after they have done everything, fought with every weapon we have, and their cancer is still spreading, they want to be in the hospital, getting another surgery, or more radiation, or whatever...Fighting tooth and nail to the imminent conclusion. And sometimes they stroke out their brains, and their families want to keep them on life support indefinitely, even transporting their lifeless bodies to ventilator facilities, where the shell of what they once were lives for years by the machine. And I have a hard time with this. It is hard to not impose my own values on things. But I think in the US, we have this false sense of control over things that makes us think that we even have control over our own deaths. I still think death is just a part of life, and sometimes you just have to accept it. I think sometimes you have to allow it to be a beautiful, if not heartwrenching thing. If i were dying, of course I would accept treatment, but if it became apparent that it wasn't working, I would want to spend my last days with the people I loved, at home, or the beach, or whatever, rather than in the hospital trying to cheat off death. That is why I love hospice care.

I even hate that we use the word "fight" when we talk about cancer. I understand that the treatments are draconian and terrible, and you need to have some sort of mentality like that to get through it. At the same time, if you "lose" that battle, what are we saying? That the patient just didn't fight hard enough? That they were defeated? Are we calling into question the person's strength and character when they really entered a battle they couldn't possibly win?

THis weekend I am in Bakersfield to say goodbye to my aunt who is dying. I am glad that I have the opportunity to see her, and the warning that the inevitable is imminent, often when we lose people we are not so lucky. I am sort of nervous to see her, I know she will not be the aunt I remember, and her body will be wasted. I am wondering if we will talk and acknowledge how sick she is, or if we will avoid it, carry on as if it is business as usual, and ignore the elephant in the room.

My life is so compartmentalized and crazy, I don't know that I have dealt with the fact that she is dying, other than when I am post call and exhausted, and every other defense has been worn down and I have been reduced to the emotional capacity of a small child...I know when I see her tomorrow, it will be real and in my face. And I hope that I can recognize the beauty in this process, even as my heart breaks. I hope that I don't do what the world does - ignoring the uncomfortable, ignoring the depths. I hope our hearts can be out there in the rawness of the coming passage. But at the same time, I wonder what she needs, if she needs some "normalcy."

A Historic Day

I look forward to telling my kids about this day. Today is an exciting day. We say that Obama is for "change," but the fact that he was even in the running, and now that he is our president is CHANGE. Just over 40 years ago, African Americans were not even allowed to vote. And today, an African American is president. I heard on NPR tonight that at the time Barack was born, his parent's marriage was illegal in like 16 states.

I am cautiously optimistic about what this means for America. I hope that it is a time for honesty, for new ideas, for (as my mom likes to call it, in reference to the fact that she married a white boy) "some chlorine in the gene pool." I hope it is a time for politics to be less driven by everyone scratching each other's backs, and about what America needs. Let's hope it is a time to be working together and not be polarizing by race and gender and political party and all that (although my cynical heart says that in that world there is rainbows every day and lollipop trees).

To add to the awesomeness of all this - my brother passed his electrician licensing exam today! IT is the culmination of what has been an awesome work of God. I am so so proud of him, and so so thankful to have my brother back...It was years, when I believed that it wasn't possible.

And one of the funniest things my brother has said lately...When I asked him what he wanted for Xmas, he told me he wanted some work pants or something, and that his cat, Chloe, wanted a sweatsuit that says "sweet" on the butt. I almost died laughing when he told me that.

Idea of Community

So when I was applying to residency, on my many interviews, I was often asked "what do you want your career to look like after residency?"

And my answer had to do with community. I described a situation in where I was working in an inner city community, where my medical practice was just one part of creating healthy community. That it would interact and work with other community organizations that promoted education, infrastructure reform, putting opportunities for healthy foods in the city, mentoring, etc. That I think promoting health is not just the job of the doctor, but that it is the job of the community, and only after you have multiple different aspects of community working together will you have a truly healthy population. You can have the best medical care in the world, but if you are a kid who can only get junk food, no produce (because you only have corner stores nearby), and you can't play outside because of the frequency of driveby shootings (all things that were prevalent in my experience in Detroit), you can't have a healthy kid. I described being well integrated into the community, being involved above the medicine level, and knowing my patients and their issues really well, that we would have long term relationships.

And I didn't say all these things because I thought it was a "good answer," but because I really believe them. It was so cool to work in Detroit for healthcare, and then to be involved in making community gardens out of vacant lots, so kids could grow vegetables and learn about health eating...To work with liberal new art galleries on youth art education and expression, giving kids and outlet and an activity other than hanging out on the streets...To buy my coffee and bread from a local bakery that is all about "green" business, as well as hiring local homeless people to work for them... To live in the city and interact with neighbors who taught me "how it was." ANd there were so many other possibilties for working in the community.

I find a lot that I dream, envision things, and then god puts opportunities in my path to realize this. Since being in SD, the first year I was mostly just consumed with medicine and residency and trying to survive. Now, God has given me some new opportunities to connect medicine with the world and community around me. I get to work with a girl's youth group and participate in mentorship for inner city youth, which is something I am really passionate about. One of the girls really wants to be a doctor, and has a very interesting perspective on health in the inner city after seeing her mom struggle with Diabetes, one of the biggest health problems that plagues the inner city. So she has been helping me with some health educaiton materials I have been putting together for my patients in my inner city clinic, which has been helping me to give better care to uninsured patients, which is another passion of mine. It is cool to see how God is connecting the dots, allowing me to realize the dreams I have. And without too much effort from myself, the pieces have just been falling together. I am reminded that the best things come from God, and not by me "forcing" things to work.

I am trying to not feel overwhelmed by all these things, by looking at what I want to do, the bigness of it, in the midst of lots and lots of work and subsequent fatigue.