themindofmani


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Loneliness

For the past few months I’ve been grappling with grief from my friends death. This grief has been compounded by moving away from a good support system of friends and having a falling out with one of my best friends. This has all resulted in major insecurities with my ability to even hold friendships and has had me self reflect on how I can change for the better. The problem with this philosophy is that it makes you obsess over things that you can not change.

I know what you’re thinking. You are thinking “hey , this sounds a lot like depression”. I mean, you would be right. This post is titled loneliness and I am going into why I feel lonely. But what I didn’t realize until recently is that grief can absolutely mimic depression and cause depressive symptoms. I’ve gone through cycles in the last few months where I will be fine for days and then a rush of memories brings me back to a place of mourning. In my case, I can relate all of my emotions right now to a series of events that happened months ago.

The storm of emotions that comes your way with grief is indescribable. It is different for everyone and yet it brings emotions that we all have to deal with in our lifetimes. It is normal and human to deal with grief, but in a culture of constant motion, we don’t take the time that is required to actually deal with it. We are fed the ideal that we have to be emotionally “OK” at all times.

My loneliness has likely stemmed from that fact that grief and depression make you turn inward and shun people away. This has led to the feeling of not having a support system. These things are all not true but it has been hard to shed my layer of heartache this winter.

Being human is complicated. Emotions are complicated. As much as I want to be fine right now, I know that being fine is a process. Grief is not something that just goes away after some time of working on it. It comes in cycles. Frankly, I think grief is one of those things that never truly goes away. Its just something that gets subdued over time. It can still hit you 50 years from the event like it happened yesterday. Thats the hard part about grief.

For me, not only did I lose a friend to death (the ultimate form of loss), but I also lost one of my best friends last year to a major falling out. Death is one thing but grief from losing someone who is still alive and well in this world is something else. I want to have my best friend back but somethings can’t be fixed and some hurts can’t be undone. It’s harsh, but it is also a reality. It was horrible that this falling out happened after our mutual friend died, but a lot of us connected to that death kind of fell apart and away from one another. The wounds are slowly starting to heal but in their place we will always have scars. These scars will be a forever reminder of what happened but like all scars, they will eventually also show us the strength that only comes with healing.

Maybe this post should have been titled grief, but I will stick with loneliness for now because grief brings with it a whole mess of emotions that include loneliness. These emotions are like a dark cloud that you feel stuck in. You can’t see in front of you or behind but you know you just have to pick a direction and move out of it. I guess this is a reminder to just keep moving.

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Hat

I have this purple knitted hat that my grandmother made for me about a year before she passed away in 2011. Its my favorite hat and I’ve worn it religiously every winter since she made it for me. Its kept me company through some cold nights and through some great memories. Because its a hat, and hats are generally worn when it is cold, I’ve been wearing it a lot these days. Last night I was walking on the beach with my trusty companion keeping me warm while I looked at the stars. As what usually happens during nights like these, I was thinking about my grandmother, the maker of my favorite hat.

My grandmother was a firecracker. She suffered through some serious adversity in her life. She never went to school and taught herself how to read and write a little in our native language of Punjabi. She was a young woman when the partition between India and Pakistan occurred and was one of the roughly 14 million people who had to cross the border during a time of upheaval and grave danger. It is estimated that upwards of 2 million people lost their lives due to the violence imposed by the various religious fundamentalist groups that were active at that time.

She never really went into the details of these stories so I can only assume how she felt as a young girl between the age of 18-20 when all this was happening. She was already married to my grandfather at that point but had been at her parents village when word of the partition reached them. Story goes that her family sent her back to my grandfathers village so that she could travel with his family but she became stuck at the village where her cousin was married in route. Everyone assumed she was safe at the other place when in truth she likely made the journey with a bunch of strangers. Anything could have happened but she made it across safely. I always have wondered if she was ever afraid or what atrocities she may have witnessed. If she had seen anything or experienced anything horrendous, she never let us know.

I was never the greatest of grandchildren. I was never overly loving or precious. If anything, I was the most annoying out of all her grandchildren. I was loud, jumped on every piece of furniture, and rarely showed affection. The only time I would sit quietly with my grandmother was when I sat next to her as she prayed. I remember doing this from a very young age since my grandmother prayed twice a day. It was her daily meditation, and growing up in a condo where there were 5 of us plus all of my brother and I’s friends constantly running in an out, it was a time for silence in an environment that was always loud.

The truth is, my grandmother had many meditations. Like folding the laundry just right. While my mom rushed to fold laundry, my grandmother did it methodically and slowly. I would always feel like a nuisance when I did any chores with my mom, since she would claim that I was too slow. I eventually stopped doing chores with my mom, which then gave her fuel to call me lazy. My grandmother on the other hand didn’t care. We would sit and watch whichever Indian soap opera my grandmother was into at the time and fold laundry slowly. I remember it being on of my favorite tasks to do with her. The smell of fresh laundry detergent and a laundry basket full of clothes that were warm and fresh from the drier. My grandmother would let me take as much time as I needed to fold that t-shirt or a pair of pants just perfectly to fit my OCD tendencies. All those times with my grandmother, I felt calm and loved. Folding laundry just hasn’t been the same without her. After she passed away, it has been my responsibility to find that peace on my own. Often I find that peace at night, taking long walks on the beach by myself.

That purple hat that my grandmother knit me was the last hat she ever knit me. It is my favorite hat, and sometimes I look at the pattern and feel the warmth of all the love that was put into it. I think about my grandmother often, and what she would make of me today. At 30 something, a doctor in the military, I’ve never been married and have had more freedoms and more education than she was ever privy to. My life is already so vastly different from the one she lead. I know I made her proud, because she told me as much before she passed away. This was when I was applying to medical school and was barely on my own feet as a poor and homeless college grad in the recession. She passed away a month before I received my first medical school acceptance letter and well before I commissioned as an officer in the Navy.

I worry about the day that my already worn out hat will deteriorate further. My mom and my aunts have tried to replenish my supply of hand knitted hats over the years but none of them compare to my purple on. In my hat drawer, I always gravitate to my favorite because my grandmother made it. On of my friends always says that she wishes everyone with a grandmother thats prayed for them. I’ve always been glad that I not only had one that prayed for me, but one that loved me so deeply.


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Military Honors

This past year I attended my friends funeral with full military honors. I think all of us have seen that sight in a movie. Men and women of the honor guard in full military dress uniform performing three volleys from their rifles and folding the flag on the coffin and presenting it to the family. Some people say a few words for the deceased and the ceremony ends with “taps” being played on the bugle. The scene is somber and the ceremony all very precise just as you would imagine a military ceremony to be. Salutes are rendered and everyone goes home.

Watching this same procession for someone that you loved and cared for, on the other hand, is a completely different yet strangely the same experience. You know that person, and while all funerals make you feel somber, watching the honor guard fold your friends flag with their precise movements is something I will never forget. The moment seems slow but also fast.

The men and women of the honor guard that day were wearing their summer dress whites. There uniforms were perfect from their covers down to their freshly polished shoes. They rendered their salutes as the coffin was being brought in and all I can remember is how all of them looked immaculate. Pristine in their uniforms and standing up straight perfectly while doing their duties. They performed all of their ceremonial tasks perfectly, most of which escape my memory. Then they folded the flag just right and handed it to my friends wife whose little silent sobs you could hear from the front row. They did the same for his mother and father at which point my colleagues made their was up to the stand to say a few words. The words, I also can not remember but their faces will always be etched in my mind. They all told their stories with tears running down their faces, their eyes periodically settling on the coffin which we knew held a person with a once boisterous personality. Their bodies showing how they all carried a giant weight of sorrow as they spoke on the podium that day. A sorrow that mirrored my own. And as I listened to my friends struggle to convey the message they so desperately wanted to say, I felt my sorrow crack and tears began to form in my eyes.

We all stood at attention in our own uniforms, which were not so pristine, when the honor guard took their rifles outside. The set up and from within the chapel we all heard the orders sound. The gunshots went off like a loud blow. One, my body shook from its core when the shot went off and I was startled by how loud the sound was. Two, those tears in my eyes fell with a fury like they had emotion of their own. Three, their was silence and I could hear the discrete sobs of all of my friends also desperately trying keep their composure and stand at attention around me. One of them passed me a tissue which I took graciously. No one tells you how jarring it is to hear the sound of the rifles go off so close to where the funeral is being held. Every shot is like a blow to the chest knowing that with the third it summons the end of an era and you will have to say goodbye to your friend. A friend that you had just hugged and held a few days before.

A young women from the honor guard walked with her bugle to the other side of the chapel from where the the riflemen shot those volleys. She raised the instrument to her lips and started to play “taps”. That song will always bring me to a place where I feel honored and humbled. It will also always bring me, as I am sure it does for others, a sense of grief and peace. It has been played since the civil war to close the day when both the union and the confederates adopted it into tradition. Even then, with the country so divided, it was unifying. When it is being played at the close of your friends life, it brings on emotions that I am sure only the finest writers could ever manage to remotely put on paper.

The day, I assume, will always be in my memory as somewhat cloudy but also so clear. Like the fact that you can see your fingerprints when your hand is held close to your face but the boat on the horizon as you look over the ocean, even on a clear day, seems murky and you can not see all the details. It is a moment that I will carry with me forever. Now, those scenes of military honors being performed in the movies hold a different meaning. They transport me to my own experience with my own dear friend. And instead of dismissing it, I always shed a tear.


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His name was Stephen. He was a physician but he was also so much more.

8 weeks ago I lost one of my closest friends at my residency program.  His name was Stephen. It was a Thursday  and he was having a rough time through residency and we all saw it. We saw it because we also live it everyday. The day he went home and committed suicide was just like any other day. We were in clinic, he saw all of his patients and finished up all the notes. We are required to go to academics in the afternoon on Thursdays but he didn’t show. I had seen him just 15 minutes before when he was talking to one of our attendings. I didn’t interrupt the conversation because I figured I would talk to him later. I wanted to give him a hug because I had grown accustomed to giving my friends hugs on Thursdays since we all saw each other at academics. “Thursday hug day” is what I’ve been calling it all year. Although I haven’t given very many hugs since.

I miss him every day and unfortunately he is not the first friend I have lost to suicide. That box I carry around just became so much heavier. He had the biggest heart and he wore it on his sleeve. You could see it in the way he took care of his patients and his friends. He was always there for me. I struggled early on in my intern year because I was insecure and felt that I needed to prove myself and my capabilities to my residency program. I ended up in an awful spiral down because the more I felt I was being watched the harder it was to answer the attendings barrage of questions even when I knew the answers. I was anxious and insecure but Stephen saw that I was struggling. He witnessed a day where I was so nervous that I could barely present a patient on rounds. He pulled me aside and told me to let all of my insecurities go. He told me to stop worrying about what the attendings said or how judged I felt and just care for my patients. He helped me change my thinking by changing the focus from myself to making sure that every presentation was about advocating for my patient and making sure that they were getting the care that they needed to improve. When I started fighting for them and making sure I got the patients story correct on rounds, I started improving automatically.

We lose something in medical education. I’m still trying to figure out what all I lost in the process so far. We come into it for good reasons but the system continues to break us. We constantly hear about how bad it was for the previous generation but why does this need to be so soul crushing at all. Some how the humanity of medicine gets lost and with it we lose beautiful people who simply wanted to help. Stephen made me a better human and a better doctor just by being him. We saw how much he was struggling but we also all had to have our blinders on to get through our days. Medicine leaves so little room to look at what is happening with the world beyond your own personal peripheral vision. We try to do right by our patients every day and we are judged for our compassion but time and time again I see how some of us don’t have compassion for those struggling with us or those behind or ahead of us who are on the same path. Some thing has to change and I read so many articles and watch so mane youtube videos about physician/med student suicide. Some programs have multiple suicides in a year. I see my colleagues and I struggling without a suicide in the program let alone having one.

The culture of medicine needs to change…


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Radar

Just a few days ago, I was told by one of my attending physicians that to get through life you should try to never be on any radar. He was referring to the fact that I had a hard time in one of my rotations earlier this year as a first year intern. It was a kind of a smattering of events that lead me to not do well in the rotation. My lack of confidence in myself was one of the biggest reasons (and it will remain a big reason), but it also had a lot to do with a lack of willingness of my senior resident to show up on time and teach us the things that we needed to know. I’ve spoken to this senior and he openly admits to his behavior but I get reprimanded. My program director is a “good ole boy” from somewhere white America and my senior resident in this incident is the same. My program director also has his favorites in the program and all those individuals just happen to be straight white men.

What I am learning here is that I was on the radar before I even got here. My whole name is very long/complicated to say and it stands out in the sea of John’s and Jack’s that I currently am swimming with. I am a short brown woman surrounded by tall and balding white men (a few women and minorities exist at this program as well). I am one of three women of color here. I wish I wasn’t on the radar and that I could slip in and out of situations with ease, but I can’t. Unfortunately, this is my reality. I am by no means saying that these people are racists, but I am saying that we tend to observe those that are different from us with more care. Those people that are different are simply unknown. I work in an environment that is mostly white and male. To them I am unknown.

I want to be able to explain this to my attending, but I know my words won’t come out eloquently. I also know that this may simply be seen as a defense since I am already under scrutiny. So under scrutiny, I will fight. I will continue to do what I can and be the best I can. At the end of the day, the person on the radar cannot afford to be anything but the best. Sometimes being different means that people are waiting to watch you fail. And I have failed numerous times. Some of those times have been real deficiencies in myself that I have needed to improve on. Other times I have watched other people get away with things that I would always be reprimanded for.

All of this will eventually make me better. This I know. Meanwhile, I can work on letting the fear of failing go and just state my truths. The world is unfair. There is no point complaining about something I can’t change overnight. People in the past have made the world better for me and I will continue in that tradition. So I will continue to fail. As long as I fail forward, I am still making progress.


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Keys

This past year has involved a lot of traveling and moving. The one constant has been my little car that has taken me to all of these places. It has been my home and constant companion and the keys to it are accompanied by a different set of keys to a house/room/apartment every month. Each transition brings a time where my car key is the only solitary key on my key chain, which weirdly reflects the uncertainty of the next month. There is always a sense of panic and excitement when I hold my solitary car key at the end of every month. There is also a sense of purpose and acceptance with every new key I obtain at the beginning of every month.

The thing about keys is that we get used to the weight of them in our hands. I personally fidget with mine in my pocket all the time. In normal life, your keys weigh the same month to month. We tend to have the same keys for an extended period of time. For me, the weight of my keys changes every month and it is always a little strange to handle them when this happens. It’s like a little piece of my life disappears when take some keys off. Maybe that’s why I held on to my keys from my aunts house. It was a split second decision but when it was time to give her the house keys back after a month of living with her, I couldn’t. Instead I stated that I was taking them with me and drove off. I eventually gave them back a few months later but it was my way of keeping some semblance of normalcy. They gave me the feeling that even as a vagabond, I still had a place I could go back to and have something that I could claim as my own.

Looking back at my life, I have not stayed in the same environment for more than a year in the last 12 years. This year felt like a culmination of all that moving since I have spent the last 12 months moving every month. My life in general has taught me about minimalism but the last 12 months have taught me that sometimes, the simple things like your keys and their weight and how the feel, can be the most important thing to stay grounded.


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Self Absorbed

I am 29 years old and for the majority of my life I have lived in my own head. I was a quiet kid that spent a lot of time by herself either sitting in a corner and drawing, or playing on the monkey bars and going back and forth. It was monotonous and something I could focus on without letting my mind take control and propel me into a cycle of anxiety and worry. I worried a lot as a child. Maybe it stemmed from being an immigrant or the new kid. Maybe it was from the fact that I was bullied and had no friends. It probably had to do with how I combat my own sorrow and the lack of self worth.

Now as an adult, I do much of the same. When faced with the tough situation, I like to sit in a corner and write or color in my mandala coloring book. When things get extra anxious, I put on my running shoes, pick a direction and just go. All these years have passed since I was a kid and yet I still have the same coping mechanisms. Some would praise me for being able to handle my life, but the thing is that I don’t really praise myself.

As I have become older and more set in my ways of handling my life, I see how this practice has actually made me self absorbed. Suddenly, when things are bad, I am unable to see anyone else’s troubles but my own. It is all about combating my own anxiety. This way of life makes me focus so far inward that I can not see the anxiety of others. I can’t empathize with the plight of my fellows. Often it takes days to come out of my own mind after a stressful event.

I guess, as always, it is something to acknowledge and something to move forward from.