Not the One

The world of running seems vulnerable, somehow. Unprotected, carrying only my keys and my wits about me. No money, no cell phone, no iPod. Only awareness, glasses, a pair of shorts, grimy rain-stained gym shoes, and invariably, a t-shirt whose manufacturing predates my birth. In this space, I feel sacred. Primitive, even. Although I am running more for sport than survival. Or maybe I am running for survival—against obesity, heart disease; complications down the line. I feel safe running. Even when the seediest male eyes scan my body, as if I’m some anomaly, or object. But, I don’t know if this is the world that I really live in. I think it’s more the world I want for myself, and for other people. I want to exist in a space where I am utterly unperturbed, where I’m not messing with anyone either. I want to be as safe in the real world as I am in my dream world.

Apparently, that’s too much to ask.

On Friday I boarded the Western bus with promptness thanks to the CTA Bus Tracker. I noticed a sketchy pair of teenage eyes look me up and down with a gnarly grin. Noted, registered, and set aside. But, something about this kid’s look was sinister. I chastise myself about this sixth sense all the time. I don’t want to be that girl that’s afraid of kids younger than her, or who clutches her purse on public transportation. Usually, I’m not that person until someone disrupts my peace.

I decided to turn my concentration elsewhere and pulled out my Case Files: Family Medicine. But as I passed stop after stop, I decided to look at my phone. My old iPhone from 2008 or 2007 that my cousin gave to me. My cousin who died this year. Busted, slow, sacred and still useful. Clenched in my left hand, I surfed the web, reading to myself and passing time on my commute. And then I heard all the noise; the intentional distractions. Still, I decided that teenagers were teenagers. Some made noise and some brooded quietly. I didn’t think much of it, and I carried on.

Suddenly, a thin set of fingers reached over the screen of my iPhone poised to clench and carry. I resisted, left hand stiffened and right hand raised in astonishment. With a quickness I didn’t know I possessed, I put my right hand over the phone already in my left and pulled the phone towards me, only to look up and see that they had bolted. Two teenage boys; both black, and one of them being the kid with the gnarly snaggle-toothed smile.

This is the second time in 5 months that I’ve been harassed by teenage boys. The scenario is similar—public transportation, black teenage boy. In the other situation, the kid was trying to steal my personal space from me—pressing himself against me so I was fleshed towards the window, elbows waving towards my eyes. He expected me not to say anything, and got nasty with me when I did. He mentioned something about me calling the police, mockingly saying, “these niggers are bothering me”.

I’m not sure which situation is worse. I’m not sure what kind of assumptions people are making about me. Maybe that I’m not black. Or maybe that I am black, but not black like them? The constant struggle of my life is being black and being accepted for not taking on a role dictated to me by media, or a solely black American experience. How can I be anything other than what I know? I can’t change who my parents are, the culture I grew up in, or the neighborhood I called home.

Or maybe these instances where people take their liberties with me have nothing to do with race. Maybe it’s gender, height, class, assumptions about my age. Whatever it is, or isn’t, I am watching.

Even when I’m running, I am watching. Even when I feel safe, I’m watching. I’m watching with restraint, with courage, with anger that I have to be watching myself, my things, my body. I’m watching my emotions. If you’re thinking about it, don’t even think about it. Because I’m not going to sit there and let anyone of any race take me for granted.

Month Long Sigh

It has been a while since I’ve written anything. Not for want of thoughts, let me tell you! There’s a lot going on in my mind. Most of it has to do with cell injury and neoplasia right now, but that’s not the only thing racing through my brain.

I guess I’m at this point where I’m wondering (yet again) how to keep moving and pushing and motivating myself more throughout the process of studying for “part 1 boards” (thanks, Goljan)! If you read my last post you might have detected some excitement with regard to studying for the medical licensing exam. It was there, that excitement. But it has since waxed and waned, then returned like the phoenix from the ashes—then died again, etc.

Part of me enjoys having nothing to do all day but study and challenge myself with questions. But when I do abysmally on said questions, I get kind of freaked out! I mean, my natural inclination is to lock myself into a room where I can cry. But so far I haven’t reacted with that much extremeness. I just keep going, even if it means my path review book is now tear and coffee-stained.

The whole process of medical school has had me on my knees wondering, “Can I do this? Should I do this?” Before medical school my level of self-doubt had never skyrocketed to such a degree. I grew up with the mentality that I was ever capable and brilliant; that I should reach for the stars and one day float lightly throughout the galaxy. I like that image, but at this point I feel like I’m pretty far from the Milky Way…

But, the human spirit is an incredible thing. It’s the very thing that keeps me running in the morning and studying right after. 12 hours of using my brain and wondering, hoping if it will pay off—if I’ll be able to impress some residency program with a 3-digit score that somehow brands me “competitive”. This is the dream. But, it’s almost a little bit shallow. Reduced to a number. People like to talk about how degrading beauty contests are because they reduce women to a score based on various criteria. Isn’t this a little bit like that? Aren’t my colleagues and I being further homogenized and reduced to a score by our performance on Step 1?

None of my musings “matter” in the grand scheme, however. By the time board exams are “revolutionized” I’ll probably be retired and living in Tanzania (the dream!) or running a successful eco-boutique (other dream)!

And it’s not so much the homogenization or shallowness of the process that has gotten to me—it’s the indescribable loneliness of being inside your head for 12-hours a day, often with very little human interaction. I’m surprised by my reaction to this reality, being an only child and all. I can only wonder if it’s a little bit like having locked-in syndrome, but being able to move, talk, etc. If I could convey my sorrow in a blink, I would. And then I would hope that it would be blinked away afterwards. Sometimes that is the extent of my bummed out mood, but sometimes it lasts longer, and I wonder and keep hoping that this feeling of isolation and deep focus pays off. It’s not that I don’t study with friends sometimes, or even around other people, it’s the constant preoccupation with remembering, synthesizing, regurgitating, and striving to be impressive; to feel that all of this torture in medical school is a means to an end.

I don’t know whether this means I’ve bought into the shallowness or not, but at least I’m being honest. I’m scared! My heart races when I check my scores on USMLE World. And the only time I’m truly happy is when I’m running. It’s the only time that I don’t think too hard about anything—I just let whatever I’m listening to sink in as my muscles contract to the rhythm.

Be still, my beating heart. I am trying not to worry too much—to use the heavily tested “mature” coping mechanisms, but I’m having a hard time.

But, whatever it takes, I’m still fighting, moving, pushing, and HOPING for some feeling of redemption at the end of this month. In the end, I hope I at least impress myself. Maybe that’s the real challenge. All the expectations high-achieving people place on themselves is really incredible, and maybe even potentially damaging. Cause for pause.

I think I just checked myself…

M2 Mitzvah

I cannot commit myself to studying today. Maybe it’s because I’ve been running ‘round like a chicken with her head cut off trying to get this poster done for a conference in Canada. Or maybe it’s the beautiful weather. Or maybe it’s because of the butterflies in my stomach as I wait for all of my grades to trickle in. Or maybe—JUST MAYBE (this is the big one) it’s because I am so so happy that I’ll be embarking on the Step 1 journey and starting rotations in a couple months.

For those that don’t know, Step 1 is like the equivalent of a Bar or Bat Mitzvah for doctors. No, you won’t be a doctor after taking it (just as you are not really a man or a woman after you get your mitzvah on) but you’re somehow closer. And you’ve got numbers and letters to prove it. Sounds kind of scary—like when you realized you outgrew the shoes in the children’s section and you keep wandering over to look at them longingly. But, really it’s kind of a big deal. Bigger even, than realizing you can’t fit into kids’ Keds. But, I’m kind of excited to put it all together and to move on from “undergraduate medical education” and become a scrubby bottom feeder in the medical hierarchy.

Will I be thinking in the hospitals? Or will Livin’ On a Prayer continue to define my every move? I can’t really answer that now, but I’m excited for the possibilities.

I’ve been thinking about all the things that have happened in such a short space of time since I’ve started medical school. I had a quarter life crisis M1 year; I got married; my cousin died; my family shifted; I became a better friend to some; and a worse friend to a few; and now here I am standing before the proverbial mirror reflecting on it all. All the ways I’ve grown and all the confidence that has been shattered and rebuilt, and then shattered, and then…contemplated in medical school. What the HELL is this experience?!

And what about the people who walk the same halls as you, but don’t say “hello” unless they’ve had a few at a post-exam party? Med school is just a weird place. It’s like being in a high school movie where there are cliques that lack fluidity and the “ugly girl” is really a “pretty girl” with glasses. It seems fake and manufactured at times. I often wonder if that’s because of what it does to those that walk the path of medicine. It homogenizes us and it also breaks us down. It creates a sense of accomplishment through an oddly oppressive psychological process—a little bit like the army, but slightly more subtle. Only slightly.

These past 2 years have felt like a whirlwind of binging and purging information as I coiled my already curly hair around an index finger. More, more, more—nothing is ever enough. But, I guess the trick is to always keep trying to be better. Everyday. And also kind of knowing your limits. Like, I mean, I sleep. I enjoy sleeping and I’m not giving it up for nobody or they mama!

Plus, we’ll never know it all. We are just Pac Mans gobbling up little treats as we whiz on by, but we’ll never know it all. I find that kind of beautiful and also a little bit horrible. Sometimes you bust your ass, but that mess was just not on the test. And sometimes we get a little bit lucky and the universe (or whomever you believe in) shakes things out in our favor. But it’s all about trying, and pushing, and crying, and running, and trying again to be better than the last time. Or maybe even the best we can be for the moment, given the circumstances.

So, maybe I did learn a little about the Pentose Phosphate Pathway, but mostly I learned a lot more about my own humanity. And I also took away some keen observations about the people around me. I won’t ever be sure what isolating classmates, or walking past people as if they were ghosts will do for anyone’s career. It just goes to show that IQ and EQ may never meet somewhere in the middle. But, it’s alright. I learned a lot and I didn’t have to do it alone.

Besides becoming really tight with Goljan over the past year, I’ve accumulated some really beautiful people along the way. This experience is definitely something I would never want to do alone. With that said, let us continue to be responsible for each other as well as ourselves. Part of medicine is learning how to care for and be responsible for others. I think my friends and I have gotten the hang of that.

Happy M2 Mitzvah!

Filtered Out

I keep trying to figure out where I fit in this city. Odd, yes? Because I am from here. But medical school kind of complicates this notion of “belonging”. I feel like I’m always bouncing around, trying to figure out the right place to study. Most of the time, it is school. ::ShuDDeR:: I can get a great deal of work done when I get a study room—sit there by myself or with Sola. Headphones in our ears—and sometimes hours pass by without much being said. We eat together, we study together, we ride or walk home together. This is often the equivalent of study nirvana for me. Being around someone that doesn’t stress me out is kind of a beautiful thing. And we are good friends. So to share in the evil that is medical school is kind of a bonding experience. Suffering makes people really close. I would know—I went to a relatively malignant high school program and also to Yale. The pattern is the same no matter how you cut it. Work-->Downpression-->Camaraderie. This is the simple linear relationship that is my life with school and friends.

But, sometimes I want to be by myself. I’m an only child. I have this deeply insular world that I need to tap into from time to time. I’m a thinker. I like to feel anonymous, and yet accountable. This is why I end up at cafes and coffee shops. This is why I’ve ended up at Filter Café in Wicker Park two Fridays in a row. This is why I go to other places to study that I won’t name (because I don’t want to see you there, sorry)! And plus, if you’re my real friend, you know where I am. And that’s all that matters. It’s always good to let at least one person know where you are, even when you’re avoiding everyone you know.

Anyway, Raj and I ended up at Filter this past Friday. We ate breakfast and then I opened up Goljan’s Path book. And the magic happened. Then a baby was brought into the establishment. Why would you bring your baby to a place like Filter? In the study section?! To a place where they serve Hipster Hash? And why would you sit next to me? I’m studying. I have a book out, and a pen that is FLYING over paper landing, and earphones in. But the baby was cute, and didn’t make a fuss until she made a fuss and the parents were embarrassed and left. So I scratched “baby sighting” off my list of annoying things that happen when you study. Raj had left by this time, so he wasn’t privy to the hipster ass in my face hours after baby had left.

Why do you need to stand up and type on your computer in the AISLE? Why do you need to put your ASS in my face—up in my vicinity? I wanted, so badly, to say something. But I didn’t want to be that colored chick making a fuss. I guess that’s my problem. I’m of the “pick your battles” variety, but I wanted to cut him. I did.

And that’s when I realized it. I am not a hipster. And Wicker Park cannot be my study spot. I thought that maybe, just maybe, my predilection for the “underground”, vintage, Passion Pit, and Dirty Projectors aligned me with hipsters. But, now I realize why I’m not a hipster. Reason # 1: I don’t think I’m the only person on the planet! I’m considerate of other human beings. Reason # 2: My ego isn’t tied up in my desire to out-do someone with how ridiculous my clothing can be or how tight my pants are. Reason # 3: I don’t have a NEED to be seen. Reason # 4: I am not from a privileged ethnic group.

Reason # 4. This might be the most important of all. Reason # 4 is why Reasons 1-3 exist. There is just something about being privileged that gives people license to do and act as if others aren’t impacted. It’s an overall laissez-faire vibe that permeates all that these people do. You can put your ass in my face because I am invisible to you. I don’t factor into your equation. You can bring your baby to a coffee shop because that won’t bring extra attention to you, especially if you look like everyone else.

Now, I’m no stranger to racial ambiguity. And I’m not saying that I don’t have certain privileges that others of my own “race” may not. I am aware of that. And that is kind of what separates me from the privileged—a constant reification that I am “other”. Not hipster. Not completely black, not completely white. Not completely anything solid. Just “inter”.

So maybe I’ll be scouring this city for other spaces to insert myself. Other places where I can achieve my goals of anonymity for the moment. But, it won’t be Filter. Aside from the vast spread of “nothing like me’s” scattered about the place, the joint gets blasted hot if you sit anywhere near a window. Your name is Filter. Can’t you Filter out the sun?

I think this assessment of Filter is a micro-commentary on Wicker Park in general. I like being there because it’s full of action and I like to be in awe of the ridiculous things I see. It’s like anthropological participant observation. They have some cool stores mixed in with the gritty. Most of the food isn’t anything special. And there is a mix of races and ethnicities walking in Wicker Park, or waiting for the next bus. But, I don’t see many “others” inside of the more pricey establishments, or even the moderately pricey ones like Filter (expensive for a coffee shop) and Piece (more expensive than commercial pizza joints). All the things that get me into Wicker Park, make me want to run out of it.

Gentrification is really something. But, that is for another blog post. While I can’t wrap my mind around all the things I truly love about Wicker Park—maybe there aren’t any. It’s complicated. It’s a place where I like to observe and draw conclusions—make assessments about the state of young folks in Chicago—contemplate why a girl might wear sheer green stirrup pants and tattered shoes with deliberateness. But, it’s also a place where the big windows are really slits. The people on the outside will stay on the outside. And somehow I got to slip through and join the majority.

But, I don’t quite fit.

Who's afraid of the big bad body?

I would post a picture of myself being bent into the shape of the Greek letter, gamma but I am too lazy for that, and my back is still stiff.

Is this not sad? 26 and throwing your back out? There is something about this state of inactivity—this surrendering to the desires of the spasming muscle that has made me really productive and go-gettery today. Maybe it’s because I couldn’t GO ANYWHERE. I stayed away from the toxic environment that is school. There was no one to socialize with (except via the InterWebs) and a whole lot of daily goals to cross of me list! And so that is what me did!

Was Oprah the only person I felt I truly connected with today? Yes. I watched her show on women who don’t know their men and momentarily considered that I might not know my own husband. But then I chalked it up to ‘so what’ and started the day off smoothly with a Psychopathology lecture. Then I wrote more of my Pathology study guide. Then I listened and took notes on a Pulmonary Path lecture. Then another Psychopathology lecture. And maybe I’ll do another—but I feel like that’d be pushing it. I’m tired. There are NSAIDs rushing through my system along with the risotto we decided to make for dinner and all the Kettle corn I ate after that.

Although I hate getting sick or being in any kind of physical pain maybe sometimes pain is the body’s way of keeping us in check. Maybe the body’s really saying, “check ME out for a change!” Cause really, the body is in charge. And as my friend, Nic, once mentioned to me, the body will turn against you with the quickness if given the opportunity.

Today I surrendered to the pain of my aching back, bent over like a cane-less crone, and I worked my ass off. But can you imagine all the things rushing through my mind as I contemplated spinal cord lesions? Could this be due to an upper motor neuron lesion? Lower? MS? Lou Gherig’s? Med school is a hypochondriac’s worst nightmare—and we all think we have something!

In a way, today gave me a chance to press the reset button. It was me, my checklist, and the sunlight streaming through the blinds.

I hope tomorrow is just like today—just without the pain. I get it, body. You’re in charge.

Spread the love around

After a 4 mile run in the outside world (not the gym) I came to a realization while in the shower. The reason why I’m in medical school (even though most days I question my decision) is centered strongly on the premise of love. Yeah, it sounds cheesy. But, the reason why I’m sweating out these boring basic sciences is because I have a deep love for people, and an appreciation for how circumstances shape the life course.

On Wednesday, I had my last day of Service Learning Program where we worked at a shelter on Chicago’s west side called Cathedral Shelter. We put on a showcase with all the different groups and their experiences. Some worked in a domestic violence, others did HIV/AIDS, and another group centered around immigrant health. My group was homelessness—hence the shelter. The object of the program is to assign a continuity patient in each of these categories to students participating in SLP. I had two—a woman and her daughter. I won’t go into their story but I will post here the things I read at the showcase. They are a bit reflective of several homeless experiences I was privy to hearing about. These pieces demonstrate and remind me why I’m walking this path. And I think I should post them so that when I get all hatey-hatey I can track my own cyberprints and basically slap myself back to the end goal—to infiltrate medicine with deep insight and care for folks. It’s a lot more rare than you’d think.

The first piece was part of an intro:

We’ve all engaged in some debate about health care access given the current political climate. Not having insurance is a barrier to health and being unemployed is also a barrier to health care access. Imagine being homeless on top of that? Health care might not even be a priority when your basic needs aren’t being met. Surely, eating and safety come before seeking access to health care. Unstable housing situations or a relatively nomadic lifestyle make it difficult for people to commit to healthcare and have consistent access. It might be easy to wait in line at Cook County in order to take care of immediate concerns like a wound, but taking medication for hypertension is opening up a whole ‘nother can of worms. Medication adherence entails being able to afford medication, pick it up, and keep it safe. That isn’t necessarily a top priority for homeless patients. And for some, it isn’t even a possibility. Creating a sustainable health care system that works for people WITH homes has been an uphill battle in this country. Creating a system that works for homeless people is even more trying.

We have found that the individuals we interacted with at Cathedral Shelter usually came from families with substance abuse issues or suffered some degree of trauma—whether it was war, the death of a loved one, or incarceration. This knowledge led to our appreciation of the systemic and cyclical nature of homelessness. An unstable childhood often begets an unstable adulthood. The concept of a “level playing field” was shattered by our interactions with the residents at Cathedral Shelter. And our concept of homelessness was simplified. A homeless person is someone without a home—not a lazy person, or an uneducated person, or someone that lacks insight. There is no “stereotypical” homeless person. We don’t get to choose the families we are born into, or the values they demonstrate for us. Instead, we use those things to navigate the world, however steadily or unsteadily. If anything, our experiences at Cathedral Shelter have unified the common human experience and reminded us that at the core we have far more similarities than differences, despite our fortunes or lack thereof.

And this last bit is a poem. Poetry is a major element of my life. It helps me distill the world around me so I can make sense of the things I might not be able to control.

Taking Flight

Suffering has

No gender

Has no definite

Shape

Lies on thresholds

Sleeps on streets

Couches

Park benches

And temporary beds

Lacks comfort

Trust

Space

Only circles

Of past

Encroaching on present

Childhoods

Where liquor flowed freely

Relationships that started sweetly

With heroin kisses

Ending with heroin and love withdrawal

Suffering has a degree

Has a home

Had a home

In and out of homes

Had a stable relationship

With a substance

With abuse

With loneliness

With loss

Guilt

Famine

Feast

Love lost

Love left

Love never given

Behind jail bars

Lies jailbirds

Singing out

For glory

For a better way

Wanting to be treated

With humanity

Respect

Because no matter

The circumstance

Those that have

The fight or the fuel

To dream their way

Out of limited

Existence

Know that respect

Is a right

Not a privilege

Suffering

Cycles on

Has a beginning

And for some,

Has an end

Sing with us

A song for the

Jailbird

For the sage

For the frightened child

Turned adult

Shaped by life’s circumstances

But not defined by them

It is not our boundaries

That shape us

But when we take flight

And how we escape

COPYRIGHT 2010 JADE PAGKAS-BATHER

I Ain't a Playa I Just Think a Lot!

I totally wasn’t planning on writing a blog entry just this minute. Before me lies my Neuro Clinical Pathophysiology notes, my beloved Sigg bottle, and the subscription slip for Runner’s World which I have used to note down my daily tasks. Most days are like this. Work out, come to school and do work independently (FAR, FAR AWAY FROM A CLASSROOM!), check my Twitter, check gmail, attend meetings (if any), go home, eat, listen to class recordings, take notes, sleep, REPEAT!

This is why medical school just feels boring sometimes. And don’t start with that, “Try going to class mess”! Nuh-uh! Better grades without attending classes proves that not all of us learn by being talked at. That’s just the problem. We are mass-educated because people think this is the most effective manner to distribute knowledge. But, the fact that only about 20 of 186 or so students regularly attend class should tell someone out there that the other 166 of us are finding alternatives to archaic learning modules.

In this space, I have felt completely…marginalized. My writing talents have been swept under the rug except when I choose to write independently or write a scholarship essay. Most days, I fight “dronedom” with fashion. I dress a little out of pocket or I toss on a dress to boost morale. If this is my “job”, I should dress the part, right? Here's a sample from today:

When I’m not hating on med school or studying, I’m usually filling my time with family or friends. Sometimes I’m wandering or riding the train (one of my FAVORITE things to do in Chicago). But this past Saturday, I got my volunteer on! 30+ med students put on a Student National Medical Assocation (SNMA) Health Fair in Chicago’s Englewood community. For those who don’t know, Englewood is one of the neighborhoods in Chicago hit hardest by HIV/AIDS and is also one of the poorest in the city. Ah yes, lest we not forget that health follows wealth (to a point). At any rate, I felt like my comrades and I got together for the greater good of a community that needs physicians. We provided basic screening services such as: BMI, cholesterol, blood glucose, musculoskeletal, sexual health, neurology, etc. We also had two physicians on hand to give consultation to attendees.

The event was a success for sure—well attended despite rain, and well-staffed by med school folk. But, it left me with a few questions: 1) Where is the sustainability in such an effort? 2) When most patients are uninsured are they waiting for the next health fair to address their health needs? 3) What can medical students do to fill health gaps in depressed communities? I love that we do good and feel good helping communities, but I can’t help feeling that health fairs are a sort of sloppy band aid. I’m not saying we shouldn’t volunteer, but maybe we need to start partnering with clinics like Mile Square (a Federally Qualified Health Center) that agrees to take on a certain percentage of uninsured patients. Too bad FQHCs are too few and far between—not to mention far too saturated.

What’s an anthropologist-turned doctor to do? I see all of these inequalities and glitches in a system, not to mention a basic dirth of empathy between physicians and patients. But, I’m just ONE person. We need to be indoctrinated and educated in ways that don’t contribute to our growing apathy. I’ve read too many articles that demonstrate med student loss of empathy over the course of four years of medical school. Bridging gaps is really hard. Bridging gaps with a workforce that is disparaged and burnt out is even harder.