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October 18, 2016

People : Actually Good



"Feel free to be whoever you want to be with me.  For the next 45 minutes, you have freedom."

So said the singer behind the stage name Christine & the Queens to an audience of Bay Area music fans at last weekend's Treasure Island Music Festival.  Among whom included: a man in a space suit complete with an astronaut's helmet, a guy dancing in the mud in flip flops, another doing the same barefoot, a woman in a yellow raincoat onesie, a pack of people floating glowing jellyfish on sticks, people in skeleton tights and neon tights, a spry aspiring gymnast doing somersaults and sliding across slick wet mud--and sprinkled throughout, garlanded girls and guys.

It may have sounded a little corny and too classically Bay Area at first, but as she sang, I felt the truth of the free space she and we created.  As easy as these words sound, committing to them is difficult, and making them reality is the hardest.  She did it all: spoke, committed, made real.  As she introduced her song Tilted she talked about the sense of feeling out of place, and how she never quite felt like the straight person that she felt society expected her to be, and how at our core we all feel this way.

"But I'm actually good / Can't help it if we're tilted."

That word actually--as if to be good is a surprise, an unexpected thing--both hurts and comforts.  It assumes that there's an assumption of bad, that needs to be overturned.  That there needs to be active effort to make a place like this island where strangers arrive, open to what comes, accepting it all.  Which, on this particular weekend, included: a storm that turned ground into swamp; a vibrant rainbow that gradually, but not completely, lost its color along its span from Treasure Island to the Bay Bridge; a human arcade machine in which people shot balls at a man's head bobbing in and out of view; a three-walled corner covered in vinyl albums where people danced to a mini-music fest within the larger festival; a man alighting crowds with huge swaths of bubble foam.

I people-watched and music-listened with one of my primary care colleagues, and in between observations of the scene, we swapped patient stories.  Our patients have faced and continue to face so much more difficulty in their lives than I can really wrap my mind around.  As a result they're often in a constant state of defense, trying to fend off dangers and protect themselves, even in the absence of concrete threat.  This manifests in symptoms that we're ill-equipped as medical providers to treat, and sometimes personality traits that can try our patience as providers--neuroticism, aggression, compulsion.  My co-worker and I empathized with the struggle to calm our patients' anxieties, and cater to idiosyncrasies whose roots can be difficult to unearth.

A woman came to me after being hospitalized for stomach pains, confirmed by bloodwork and imaging to be due to pancreatitis.  She told me that her symptoms are a result of knee surgery that she had several years ago.  When I asked her to tell me more about why she thought these were related, she started at me intently and said: "When I woke up from that knee surgery, my ears were ringing."

She didn't feel the need to expand, letting the minutes while I waited expectantly fall silently in the continued stare between us.  It seemed like I should know why this knee surgery led to ears ringing which led to stomach pain years later.  I tried hard, but couldn't follow her thought process.

When I failed to meet her expectations of me, I finally spoke.  I affirmed that there are many unknown side effects to our medical interventions, and it's hard to really know the cause and effect of everything that goes on in our bodies.  Could she tell me how her experience with knee surgery affected how she was feeling now?

She responded as earnestly as before: "What are the side effects of waking up from general anesthesia?  Right hand pain?"

And I gave up.

There are so many times during my work day that I think, "I wish someone who I know in my personal life was here to witness this and understand what I mean when I say that work is crazy." It's hard enough when you can't do the things you know you need for patient care--it's unbelievably frustrating to not even know what it is that you need in the first place.

It's one of the big reasons that I've heard every provider at work pose the question: "How do we keep from getting burnt out?"

It's a complex problem, with multiple layered answers. But when things get crazy, I find a lot of help in simple sentiments like the freedom promised to me by Christine & the Queens.

At the core, these 15 minutes patients have with us are 15 minutes to be free to be whoever they want to be, a time they might get nowhere else, a time when they are trying to assert that they are actually good.  And no matter what we feel capable or incapable of doing for them, it's an opportunity for us to say, commit and make real: not actually, but of course you are.

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