Saturday, July 27, 2013

There's Everything Else

   
My first day of doctorhood
As a medical student, surgical intern, and anesthesiology resident, I ate, slept, and breathed medicine, and every one of those rites of passage came topped with the cherry of long-awaited and hard-fought-for success, the kind where you're supposed to say to yourself afterwards, "Looks like I've made it." When I graduated from medical school, I must've written "Kristyna Mazur Landt, MD" a zillion times, practicing my signature which now resembles the Loch Ness Monster. I was the first person from Mercer University School of Medicine to be accepted into Emory's general surgery program, and it was kind of a big deal. You don't get to pick where you go for residency; you're matched through a national lottery. 


Emory had been my first choice for surgery residency. Vanderbilt was second. No one, not even your academic advisors or the programs themselves, has any idea where you'll end up. That's what makes Match Day so exciting or disappointing, depending upon how you were ranked by each program. On the morning of Match Day, you sit with your classmates in an auditorium, waiting for your name to be announced. When your name is called,  you walk up to the podium where you receive a sealed envelope. At least, that's how it happened at Mercer. Anyway, I could hardly believe it when I opened mine and saw "Emory." To congratulate me on that accomplishment, the chairman of Mercer's Department of Surgery gave me his first edition copy of "The Papers of Alfred Blalock." I was on Cloud Nine. Well, that is until July 1st actually rolled around.
     
My surgery internship class
Internship was a rude awakening into the organized slave labor trade known as residency. My intern year occurred a year or two before the legislation mandating an 80-hour limit on resident work hours was passed; there were plenty of weeks where I worked 100-120 hours. Think about that for a moment. There are 168 hours in a week, and if you're working 100 of them, you're left with approximately 9.7 hours per day for your remaining activities of daily living, at least six to eight of which ideally should include sleep. Based on those working conditions, my house physician salary of $32,000 averaged out to about a dollar above minimum wage. Economically speaking, my college degree and four years of medical school didn't amount to jack squat. 

     I switched from surgery to anesthesiology after my intern year, and it was a very wise decision. There's a mindset among surgeons that there's operating, and then there's everything else. At the young old age of 39-about-to-turn-40, I knew I couldn't commit to that lifestyle. I missed my kids terribly. I missed being at home. I didn't want to miss out on any more of our lives together. Faye, a friend of mine who'd gone through three years of surgery residency before switching to anesthesia, convinced me to consider changing paths. At that point, I was less than six months into my year of internship. 


My very special set of skills? Test-taking!
Test-wise, I could have easily had surgery in the bag. Even as an intern, I passed the mock board exam that we all had to take each year, and was one of ten from a residency of about 75 to earn $200 in book money. That meant there were chief residents who didn't pass. I was so disillusioned, though, and I don't think my misgivings were strictly a by-product of sleep deprivation. I was actually thinking about dropping out of medicine altogether, maybe getting a research position of some sort, but seeing as how I'd never done any research, that was a long shot. I felt stuck. It was while I was on my super-sucky Grady Hospital emergency room rotation in January of 2002 that I ran into Faye. Seeing her so relaxed and happy was kismet. Thank goodness my program director, Dr. Dodson, was so supportive of me. Not only did he go out of his way to secure me a spot in Emory's anesthesiology program for the following year, he never criticized me for my decision to leave surgery. When our mock board score letters were released, he'd inscribed an addendum: "You will do well in anesthesiology, and they will be lucky to have you." 

     For me, the study of anesthesiology was much more difficult than that of surgery. Being an anesthesiologist means you have to have a solid grasp on internal medicine, cardiology, pediatrics, obstetrics, pharmacology, as well as the intricacies of airway anatomy and the complexities of cardiac, respiratory, neurologic, endocrine, renal, and maternal physiology. As if that's not challenging enough, you have to be able to integrate all of that knowledge to formulate a safe anesthetic plan for your patient in ten minutes or less. 
   
Emory Anesthesiology Class of 2005
My three years of anesthesia residency weren't exactly a piece a cake. Eight months into my first clinical year, my father died suddenly. That catapulted me into a serious depression, and I ended up having to take an antidepressant just to be able to function. I went back to work only a week after he died, and spent every private moment I had, crying in the call room and trying to remember the sound of his voice. To make matters worse, not all of my attendings were aware of the situation, and some of them gave me a really hard time about being spaced out. I did everything I could to keep it together, but by that point, my marriage was falling apart. Being at home wasn't a refuge; it was a battleground.

   
Ahmet in 2003
In 2004, during my final year of training, one of my residency buddies fell to his death in a freak hiking accident. Ahmet's death was a stark reminder of how tenuous life really is, a realization that was difficult to reconcile against the demands of being a fledgling physician. One month before I graduated residency, my husband informed me he'd filed for divorce and custody of our twins. Whereas my peers were celebrating the end of residency and the beginning of their new professional lives, I was grieving the end of my marriage and fearing the loss of my children. Not a great way to start off the rest of your life. Fortunately, my ex and I were able to settle things amicably, sharing custody of the boys and handling our divorce cooperatively, out of court. To this day, we remain on friendly terms.

   
Dr. Me
The last eight years of my life as an anesthesiologist have been a push-pull affair. As hard as I've tried to push away from my identity as a physician, I keep getting pulled back into it, whether I like it or not. There is just no escaping that part of who I am. For some time now, I've rejected Dr. Me, as if it were some sort of embarrassment, an albatross that I've tried my best to ignore. But, I'm realizing that it's really our collective workaholic "I'm a physician, therefore I exist" identity I abhor, not mine individually. I am a physician, but it's not who I am. It doesn't define me.



I've never been one to float the mainstream. Why would my brand of doctoring be any different? Four years of medical school, four years of residency, and eight years of being an attending anesthesiologist have reinforced my suspicions that there's wisdom in being lazy, that committing to my own personal happiness and freedom, as opposed to revolving my entire life around medicine, is what's prevented me from becoming a burned out and cynical physician. Working part-time is pretty amazing. It's like having the best of both worlds. I enjoy practicing anesthesia again, instead of dreading what each day has in store. Long gone are the days of eating, sleeping, and breathing medicine; now, I'm channeling Hippocrates.  It comes naturally. Intuitively. And, I do love it. Doctor, there's everything else, and then there's medicine.

 


Related posts:
About my friend, Ahmet: Ahmet, Interrupted
Self-explanatory: The Day I (Almost) Got Fired From Residency
A funny story from anesthesia residency: Boo
Why I hated my emergency room rotation: Asthma and Detention
A taste of what it's like to be a surgical intern: A Special Kind of Bedlam
The social aspects of cadaver lab: Elegance and Horror
     

Sunday, July 14, 2013

Halfway

   
Juicer or torture device?
When I was in high school, my dad discovered the wonders of freshly squeezed grapefruit juice. Dad jumped into anything that interested him feet first and, as crazy as some of these things were, he really was about 20 years ahead of his time. My parents' bookshelves were bursting at the seams with books and manuals that catalogued his progression of interests, from making yogurt and cooking with tofu to building an earth-sheltered home, eating for your blood type, and naturopathic healing. We'd barely recovered from having to recycle every scrap of aluminum and styrofoam when juicing struck his fancy. Adjacent to the giant ball of compacted aluminum foil which occupied a tremendous amount of kitchen counter space, there sat one of those old timey citrus presses, the kind where you inverted halved fruit over a ridged cone and used all your might to crank down on the handle that clamped the lid, all for a few lousy tablespoons of precious life-giving juice.

   
 
Me in 11th grade. SO not interested in juice!
The thing about Dad's new fad was, he wanted either me or my sister to prepare his juice for him. Whichever one of us set foot in the kitchen first for breakfast was greeted by Dad's melodious Polish accent: "Good morrrning, daughterrrr of Barrrtek. I am rrrrrrready forrrrr you to prrreparrre my grrrrrrapefrrrrruit juice." O mój Boże! (That's "OMG!" in Polish). I've never been much of a morning person, and the only thing my sixteen year old self was interested in at the crack of dawn was gobbling down a bowl of Captain Crunch so I could call first dibs on the bathroom I shared with my sister and two brothers. I'm really not sure why Dad got hooked on grapefruit juice. True, it was the mid '70s, and the Hollywood Grapefruit Diet had taken the nation by storm. But, Dad was never one to follow trends; he was more of a trend-setter himself. He wasn't drinking grapefruit juice to lose weight. I suspect that he believed fresh juice had real health benefits, and over the years, his suspicions have proven true. Raw whole foods contain all sorts of micronutrients and digestive enzymes that pasteurization and processing kill, and nowadays, it's widely accepted that freshness is where it's at.
     
These grapefruits didn't fall far from my tree...
My son, Nick, requested a slow juicer for his 23rd birthday, which is coming up on the 21st of this month. Over the last couple of years, he's become extremely conscientious about his health and has developed quite an interest in plant-based nutrition. There's no doubt in my mind that the dietary modifications he's made, along with yoga and meditation, have had a significant positive impact on the progression of his cystic fibrosis, that the gradual improvement in lung function and decrease in serious pulmonary infections he's experienced cannot be attributed to medication alone. Coming from a 22 year old guy, this might sound like a strange gift request, but it's really just part of his DNA. Nick's fascination with nutrition isn't surprising, given his legacy. It's the same with his brother, Rory, and his enthusiasm for making music. Grapefruits never fall far from the tree.

...or from their Grandpa's.
I gave Nick his juicer  a few weeks early. Since he works at a natural foods store, he now has an innovative way to use up all that expiring produce that would otherwise be tossed into the compost bin. After hearing him rave about the joys of juicing, I decided to give it a try myself. I eat lots of fresh fruit and veggies, and carry my lunch to work in order to avoid eating crap. Unless I have cherries or apples on hand, Spartacus forgets about all the yummy things I have stashed in our crispers, so I have to find creative things to do with wilting greens, limp broccoli and cucumbers, and bruised fruit. There's only so much cobbler and soup stock I can make!


Hmmm...isn't this how this thing's supposed to work?
Several weeks ago, I injured my back from one too many HIIT workouts, and have been very aware of the fact that my jeans are fitting a little tighter than I'd like them to. I'll rest my back by walking for a few days, then I'll get disgusted and go balls out with a Spartacus workout, and boom! I'm back to being practically crippled. It's complete madness. Sure, exercise is a great way to burn calories, especially if you're resistance training and building lean muscle mass, but exercise alone won't compensate for caloric overconsumption. My eating habits haven't really changed since I switched jobs, but my alcohol intake has. When I was taking hospital call, I'd have at least two alcohol free days per week. In-house hospital duty is physically taxing as well, so in general, I was moving around a lot more at my old job. Now, I'm at home every night for cocktail hour. No matter how much you work out or how little you eat, the calories from alcohol are burned preferentially before those from fat, so you're basically negating any metabolic afterburn potential by ingesting booze on a regular basis. This has been on my mind for a while now, and I'm sure that's why I've gained a little weight. So, I figured I'd eliminate alcohol, substitute an array of fresh juices, and see if it makes a difference. It'll be interesting to see what happens.
   
My new wine
My first batch of juice came out kinda "meh." It was blueberry, black plum, and mâche with fresh ginger and a bit of turmeric root. I forgot to strain it, so it was really viscous. According to Spartacus, it would have been better served over ice. The second attempt yielded a groovy concoction called Pumpkin Pie juice. This one contained winter squash, apple, fresh ginger, and carrots. It was smooth and rich and absolutely scrumptious, like the lightest, most sunny pumpkin pie filling you could imagine. Yum! Next, I made a green juice with  green apple, celery, cucumber, lime, kale, and turmeric and ginger root. In case you're wondering about the turmeric, it has anti-inflammatory properties, and I'm thinking it might help with my sore lower back. Anyway, the green juice was delicious and refreshing, especially when chilled. Lastly, I made ruby red HeartBeet juice from beets, beet greens, rainbow chard, cucumbers, kale, celery, apple, lemon, basil, and broccoli. That was my "wine" for the evening, and it too was very satisfying.

   
Waste not, want not...it's all edible!
After juicing, you're left with quite a lot of dry pulp. I figured I'd just put it outside in the community garden, but then I wondered if it would be too acidic and whether or not it needed to be composted first. As far as I know, there's not a compost heap around here. I didn't want to throw the pulp away, so I googled "what to do with leftover juicing pulp." Who knew there were so many things you could do with pulp? It's all edible, so it makes sense to use it in some way. I learned that, besides composting it, you can make bread and crackers with it, add it to soups and pasta sauces, stir it into cream cheese for a sandwich spread, and even make dog treats with it. Since my dogs are allergic to whatever the heck's in storebought dog treats, I decided to whip up a batch especially for them.
   
I think this dehydrator's finally gonna get some use.
I mixed the pulp with sunflower and flax seeds and some nama shoyu, spread it out on two dehydrator trays, scored it into bite-sized pieces, and let it dehydrate for about 16 hours. It smelled (and tasted) really good! This morning, Simon and Lilly were introduced to these homemade canine cookies, although I'm not sure they deserved it after tearing all the stuffing out of their dog bed on Friday afternoon. Welp, I suppose it could be worse; they could be chewing on shoes or furniture. Eight cups of leftover vegetable matter made my dogs and me very happy. They got crunchy wholesome treats and I got the satisfaction of knowing that no part of the produce I juiced went to waste. I even shared some with our neighbors' dog, Mason.

I thought Kevlar was indestructible!
"Chew on these, not your dog bed!"
                 
Yesterday afternoon was a little voyage in discovery, transforming each colanderful of Nature's gorgeous abundance into supercharged nutrients in liquid form, glowing like jewels on the top shelf of my refrigerator. I can't help but think I've made a healthy move here. I was so excited about baking those dog biscuits that I ended up making another trip to the store for flax and sunflower seeds. As I was leaving, Spartacus looked at me and said, "You don't do anything halfway, do you?" He wasn't being critical; it was just an observation. "No," I responded on my way out the door, suddenly reminded of the unbridled enthusiasm for the little things in life that I share with my sons and their grandfather. "I suppose I don't."
Gorgeous jewel-toned juice


Tuesday, July 2, 2013

There Are Millions of Suns Left

   
Two of my lonely books
I'm gonna go ahead and put this out there: I don't enjoy reading. Although I spent the majority of my youth reading anything and everything I could get my hands on (including "The Joy of Sex," which my parents thought they'd hidden in the linen closet), sitting down with anything other than a cook book lost its appeal for me somewhere between pregnancy and medical school. So far, only Hemingway, Lao-tzu, Alan Watts, and Jack Kerouac have re-ignited my interest, and that's been spotty at best. I've tried so damn hard to get through Robert Pirsig's "Zen and the Art of Motorcycle Maintenance," a book which really blew my mind when I started reading it two years ago, but have never been able to finish the last fifth of it. It's sitting patiently on top of my nightstand, bookmarked and collecting dust, along with a copy of "The Complete Poems" of Walt Whitman.

My colleagues are incredulous when they find out that I'm a writer who doesn't read. I suppose that blogs, cook books, fitness magazines, and an occasional anesthesia-related periodical don't really count as self-edification, do they? Yesterday, a friend of mine posed this question on Facebook: "What's the best book you've ever read? Your favorite author?" The answers were pretty diverse, ranging from classics we had to read in high school, such as "Moby Dick" and "The Old Man and the Sea" to  mysteries like "The da Vinci Code" to popular fiction du jour, e.g. "Fifty Shades of Grey." My answer? "Pretty much anything by Dr. Seuss." Not especially dignified-sounding, but it is poetry. Maybe it's true that all I really need to know I learned in kindergarten.

   
This qualifies as literature, right?
Funny thing is, I consider myself a pretty well-read person. I can't quote literature or regurgitate famous sayings off the top of my head or engage in witty, incisive historical and political dialogues, mostly because none of that interests me. Being booksmart doesn't make one intelligent. Nor does having an opinion. The most heartless, ignorant people I know are also the most highly educated. They take themselves very, very seriously. They're sure they're right about everything, their main source of ammunition being something someone else once said somewhere. In a book. In other words, they're incapable of formulating their own original ideas. Ideas like that don't come from books; they come from experience. I have my own experiential understanding of things, yet I don't feel constrained by opinions, mine or anyone else's. I agree with Lao-tzu: "The more you know, the less you understand."

   


Lilly & Simon, taking a breather
On most days, I take my dogs on hour long walks. I live inside the city of Atlanta where there are lots of quaint old neighborhoods with narrow, buckling sidewalks. Sharing them with other dog-walkers, runners, bikers, and baby carriage-pushers has proven insightful in understanding the rigid social conditioning that's so ingrained in us humans. For instance, since Simon and Lilly are quite large and I walk with them at my left side, it makes sense for me to keep to my left, too. That way, the dogs are walking on the grassy strip between the sidewalk and curb, freeing up the other half to two-thirds of the sidewalk to my right. What I've observed is that this throws people off. It's sort of like the scene in "Midnight Express" where mental patients are circling a column clockwise, and Billy Hayes, in an attempt to preserve his sanity, starts walking in the opposite direction. His non-conformity greatly disturbs the other patients, and also makes him a Communist. I get an equally reflexive response on the sidewalk. The further left I veer in my attempt to make more room for oncoming pedestrians, the further to my left they go, until we're practically dancing to get around each other.


My son, Rory, was being cross-examined by a leftward-leaning musician acquaintance on Facebook the other night. Apparently, this guy had taken issue with Rory's status update that "all presidents suck." This prompted a lively and somewhat heated discussion between me and said musician about reconciling one's individuality against the confines of the social contract during which I was reminded, "It's not all about you." Yawn. To think there has to be a compromise indicates a lack of regard for anyone but oneself. How so? Well, it's pretty strong evidence of the moral superiority and lack of humility that accompany the hypocrisy of self-sacrifice, the goal of which is to be rewarded. It's the failure to understand that nature isn't cruel, it's selfless, and that the social order is what's cruel and unnatural. Why else would mankind need  its sacrificial lambs? Real selflessness isn't a product of self-denial, it comes from self-acceptance, recognition of one's limitations, and detachment from outcomes.

   
Causality...meh.
As someone who's never been particularly interested in patriotism, politics, money, or imposed morality, I've managed to function in society without buying into it hook, line, and sinker. Sure, I pay my taxes and contribute to charity and whatnot. I've never viewed social responsibility as a big threat to my independence. Selflessness is a no-brainer when you're not at odds with Nature or seeking recognition for doing what comes naturally. I don't view the universe as me against "it." I am with it, of it. It's not a causal relationship. I'm not orphaned by it; I am its expression. Society and its demands don't interfere with my individuality because I'm not subjugated by them. I mean, without individuals, society wouldn't exist, right? If your plane is going down and the oxygen masks pop out, you affix your own first before trying to assist others. That's not being selfish. It's the applied practical understanding of the way the universe works, otherwise known as common sense. 

      

Boris, the epitome of Tao
For me, flying under the radar is about following my own heart and doing what comes naturally, instead of feeling constrained by social mores and norms or being imprisoned by opinion. It's entirely possible to be a free spirit, even in society that isn't really free. And, being free from one's own ideas is where real freedom lies. That's probably why I'm not a big fan of rules, micro-managing, or know-it-alls. I've yet to meet a person who actually likes being told what to do or think. If moderation, compassion, and patience were the rule instead of the exception among people, maybe self-responsibility would obviate the need for self-serving self-sacrifice. Laws, social contracts, and altruism would be obsolete. Subversive-sounding, huh? Looking after others and looking after oneself aren't mutually exclusive in nature, except among humans. The fact that society operates on ghost power doesn't deter me from tapping into nature's spontaneous immaterial wisdom. 




Me (on right), flying under the radar as Mrs. Cowbell (1973)
The conversation ended with his assertion that "none of us can blissfully fly along 'under the radar' unattached for long. It's not in our natures, nor is it in our reality." I suppose there are grains of truth in that. But, that "either/or" reasoning that says we can't be a part of things without losing ourselves is counter-intuitive, unless one views life as a continuum, not a cycle. Detachment isn't isolation or laziness; it's indifference to  the extremes that disrupt simplicity and moderation. The Puritan work ethic is a perfect example of one extreme creating another. All work and no play makes Jack a dull boy. The harder he works, the harder he has to play, burning the candle at both ends. Eventually, something's gonna give. Being consumed by one's work isn't an asset; it's a liability, just another vice. 



Me, my favorite rockers, & my gravity-defying silver disco boots
Our difference in opinion boiled down to his belief that "if you give up your small amount of control over your environment, someone else will take it and do their will" and mine that control, other than that which we have over ourselves, is more or less an illusion. "Nice lecture, bad reality," he responded.  I wasn't aware that reality had a value or that Nature obeyed contrived moral laws. Here I was, thinking that Nature controlled itself like I control me. As far as reality goes, I'll grant that people (including myself) do seem to have their own subjective interpretations of reality, which is what makes discussions about it so interesting, but  to contradict yourself by sanctimoniously invoking the theory of gravity as an illustration of practical reality while in the same breath yammering on about the control you have over your surroundings is  pompous and hypocritical. Gimme a break, man! That's basically what happened next, and as far as I'm concerned, his argument lost any validity it might have had at that point. 

Wooden gymnasts, embracing the mystery (of the chopstick)
I don't think reality and fate are mutually exclusive. They might even be the same thing. That poor Cirque du Soleil performer who fell 50 feet to her death a couple of days ago exemplifies just how little control one really has over one's external environment. Despite a highly developed set of skills and rigorous quality and safety assurances, her safety wire snapped, its tensile strength overcome by the weight of  her and other aerialists whose job it is to entertain us by simultaneously tempting Fate and defying gravity. I have to think that gymnasts possess an exceptional grasp on their physical limitations and the uncertainty of chance,  that embracing the mystery of the unknown, instead of fighting it, keeps them balanced. Otherwise, they'd all be choking on fear. That wouldn't be very good for ticket sales, now would it? 

A few weeks ago, I gave a legal deposition in a malpractice case. (No worries, I'm not being sued). One of the questions put forth to me had to do with whether or not it's possible to erase the "retrospectoscope" of hindsight. To clarify, the retrospectoscope is medicine's equivalent of Monday-morning quarterbacking in which causal relationships are implied through a provocative association of events. "Shoulda, coulda, woulda" is always crystal-clear after the fact. Outcomes that have already happened are easy to predict. The scope of hindsight transforms the ho-hum into heroic, slip-ups into sin, and duty into disillusionment and doubt. It occurred to me that relying on history to interpret and manage the conditions of today could be equally misleading. 

Does history really repeat itself? Or was Mark Twain right when he said, "History does not repeat itself, but it does rhyme....To wit-no occurrence is sole and solitary, but is merely a repetition of a thing which has happened before, and perhaps often."? Certainly, past experience provides opportunities for change and growth, but recycled knowledge seems an awful lot like the retrospectoscope. Maybe that's why scholars, philosophers, and historians are so smug. The brain power required to draw conclusions from historical events is approximately zero, yet they've managed to convince everyone that they're brilliant. 

Society's got it all wrong. Relying on intellect, instead of the innate intelligence we're all born with--compassion, self-mastery, and contentment--is precisely why people are so divided. Real intelligence can't be learned or measured. Real intelligence doesn't come from a book: it comes from the heart. Real intelligence is a lot like common sense. It's practical wisdom. This is why I find conversations about social contracts and governance so superfluous and unenlightening; they keep missing the mark, the root of the problem. As silly as it sounds, the world would be a lot better off if we were the persons our dogs think we are. Believe me, I spend a lot of time with my dogs and cat. With the exception of their knack for vomiting on a certain area rug, there are plenty of days where I find their behavior preferable to that of most people. Maybe if we all spent more time reading and writing poetry, the language of the heart, we'd experience a collective return to intelligence.




After ending my rather exhausting Facebook conversation with Rory's friend, I did just that. Weirdly enough, Uncle Walt was calling to me. So, I opened up his dusty book of poetry and randomly selected a page.



Not surprisingly, this resonated with me, especially the part about not feeding on "the spectres in books." The "dumbing down" of America that everyone loves to complain about comes from too much knowledge and too little intelligence. There's little that's new in the way of knowledge. It's like being served up a continuous loop of leftovers. Dogma in, dogma out. Knowledge isn't power, it's pretense. Knowledge only empowers those who don't think for themselves. Freedom from ideology, that's where it's at. The poets all know it. Lao-tzu thought having an empty head and an open heart was the way to roll. In a way, so did Dr. Seuss. I think that's exactly what he meant when he said, "It is better to know how to learn than to know." And, good old Walt was definitely onto something, too. Indeed, there are millions of suns left.