themindofmani


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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.


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Stranger in a strange land… amongst other strangers

I can’t get over the fact that their are so many foreigners here. I am in Cambodia, but every corner I turn I find someone else from somewhere else who is usually doing the same thing I am in this country. Because of this, their are distinct places for ex-pats (or as I like to say, white immigrants) to hang out and other places for locals to be. Personally, I am having a bit of an identity crisis. I know what it feels like when one is an immigrant but here I am referred to as an ex-pat because I am here for a certain amount of time and I live in a certain class where the locals do not. I am a citizen of a country that many of my co-workers want to be in, and I am also referred to as “white” by my fellow colleagues from the States. It is the “white” people here that are the aid workers, that can go to the expensive coffee shops, that go to the “local” hang outs made especially for the foreigner and I am a “brown” girl who fits in more with that lifestyle than the Cambodian one. This city is literally divided into where the locals go and where the ex-pats go. It is rare to have a cross over but it happens when a local has manged to learn English amazingly well or when an ex-pat has stayed here long enough to learn Khmer decently (its a tough language).

I was 7 when my family immigrated to the US. I am American in every way and proud of it but I am still an immigrant. I fit in everywhere there and yet I don’t. Their is still an undertone of being different. Now I come to Cambodia expecting not to fit in anywhere but I do, and it is with the other Americans, Canadians, Aussies, Kiwis, and Brits. Maybe it is because we are here for all the same reasons. Maybe it is because we all feel a little different in our own countries. I think it is because far away from our countries, we finally see our similarities in stead of our differences.


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Priviledge

I’ve been thinking a lot about privilege today. Privileged is something I have always been in my life. I am painfully aware of it because no matter how hard my life is, someone always has it much worse. In the US, overall I am pretty average. I am an average 20 something (that is sooner rather than later going to be a 30 something) who has a pile of student loan debt that is just trying to make it. For some, making it means that they are rich and famous. For me, it is the want to live a peaceful life. I just want a little place somewhere in the corner of the world that I can call a sanctuary. For the last few year, I thought that goal was so far away and so unattainable. I have been bouncing around and at times basically living out of my car. My father continues to remind me that I am, in fact, homeless, and I myself have never managed to stay rooted to a spot for more that a year and a half since I was seventeen.

But lets go back to making it for a second. Here I am in Cambodia and I have ditched my car now so I am living out of my backpack. Literally, I don’t even have a closet. I live in a hostel and my space is a single bed in a dorm room where some nights I have a roommate and others I don’t. But this little bed and my backpack are my sanctuary. I am at peace here and I can afford to pay for my little bed every night and have a roof over my head. I especially think about the roof on the days that the monsoons are so loud that I have to scream across to whoever I am talking to that night.  I come home to this hostel every night and it is home. It is a home where I feel pretty safe and it is somewhere that I sigh a breath relief every time I see it as I turn the corner on my bike ride home from work.

I am lucky. I didn’t have to do much to live here. I just came with the money I had and rented a bed. I also know if my money ran out, I would be able to make more by getting a job because I have an education which allows me to make more than minimum wage. I also don’t have to be like the girls I study. The girls that are my age that were dealt a different card. Whether they were sold into sex work or chose it, they never had the opportunity to have anything different. They have to sell their bodies to make the same money I make because apparently I read enough books along and threw enough money at some institution that gave me a piece of paper verifying that I am a professional. Frankly, they are just trying to make it too.

My heart goes out to these girls. Even though I am here trying to make a difference in their lives, I’m not doing much. I wish I could help everyone but I’m here and still privileged. I go “home” to my hostel, in their country, which is cleaner and nicer than anything they have probably lived in. I am Privileged beyond anything these girls could ever imagine about me. They see my type of privilege in the bedrooms of the men that they go with at the end of night. They live my privilege for a few hours a day being a slave to some rich white 70 year old asshole. I live my privilege for free…

So at the end of the day I have a sanctuary, I have food in my belly, I have bike for transportation… I have made it already. How do I help these girls do the same?

“I’m not interested in competing with anyone. I hope we all make it.” – Erica Cook


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Cambodia

I have been in Cambodia a week now and it already feels like I have been here for a month. I am weirdly comfortable here (despite having to create my own form of sign language with most people) and yet certain things I may never get used to. Things like lemon grass in all the food, or every tuk tuk driver asking “lady! tuk tuk?” when I am clearly trying to walk somewhere, or how everything smells strangely like India but with more of a fish and oyster sauce undertone rather than a curry and urine undertone (I honestly don’t know which one is better). Regardless, they are all things that are familiar to me from all of my other travels.

Each day I meet someone else from some developed country just hanging out here. They are all here for the same purpose, to find something or to find themselves. Their are people who recently graduated with a degree, traveling before they start their “real” lives. Their are people who quit their desk jobs that they have had for years and are now starting their “real” lives. And then their are people like me, transplants, here for a few months or a few years, working for NGO’s and trying to give something back but mostly failing, and just contemplating what “real”means.

Maybe “real” is just that late night game of scrabble and a lot of beer with strangers. Or maybe it is the morning greeting and the smile from the girl my age (probably younger) who cleans the hostel. Or maybe it is kitten who plays with the security guard with the incredible smile as I walk into the office every morning. Or maybe it is simply riding a bike along a bank of a river that is not familiar to you and watching all the boats go by.