Professionalism

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20 below and walking into my clinic at sunrise

I leaned over a bed in the ER and stared into the opioid epidemic. The patient was a late sixties Vietnam veteran who looked up at me from sunken eyes, his body shaking on the small bed. He was going through withdrawals after trying to quit prescription Dilaudid that he was supplementing with Heroin. Fighting back tears, he told me he was prescribed narcotics for neuropathy in his right leg. My mind, already struggling against ever strengthening biases and heuristics, didn’t have to work hard to see that this man was in pain. Distinguishing real versus feigned suffering is an instinctual judgement call whether we like it or not. Pain is complex and it forces us to ask philosophical questions for which we don’t have answers. Whether we have fibromyalgia or necrotizing fasciitis, pain is all in our heads. It doesn’t exist without our brains and it only matters to us because of the neural connections running between the primary somatosensory cortex and the amygdala. Even though this brain tissue is as biological as our fingers, we cannot help but ascribe agency to it. To do differently would be to alter the very idea of what it means to be human and how we see ourselves in the universe.

 

The man in the bed in front of me was suffering. It’s so fucking hard, so fucking hard he stuttered again and again. He was brought to the ER by the sheriff who had heard from a friend that he might harm himself. When and where to ascribe blame is always complicated, but this patient was unfortunately a perfect example of someone whose brain had hijacked their life. Narcotic abuse, like any other drug abuse, is an complex problem that challenges our ideas of free will. If we control our own actions, why would we do something that makes us suffer? What do you do when patients demand narcotics, when patients appear to be in real pain, and when you have that power at your fingertips? I deleted and stopped listening to the podcast “Reply All” after their episode on Opiod Abuse. It frightened me to hear people so convincingly simplify a staggeringly complex issue in order to make it more palatable and give it more zing.

 

Pounding up the final ascent of my last hill repeat I wondered why the hell I was doing hill repeats. I was up on the Birkie trail with my family after Christmas. After finishing eight meaningless repeats I skated off deeper into the woods. Tall pines graced the sides of the trail as I skated alone through the trees. The trails around Telemark snake through a rugged undulating forrest and every so often you can turn a corner and find yourself in a magical grove of old-growth trees. It’s enchanting to look up at the towering pines sheltering carpets of soft white snow. Floating through the trees stirs the same feeling as when you look at someone you love and she smiles back at you. That jump in your chest that tells you the world is an endless maze of possibilities ready to be conquered. I stayed on the trails till the sun went down.

 

On Monday afternoon I met “John,” an obese white male in his late 60s. He had shaggy gray hair, a shaggy gray beard, and red suspenders just barely holding onto a massive belly contained within a stained white t-shirt. He was in the clinic to have a cyst removed. The cyst removal was important, but so was his “oh by the way.” My hand was on the doorknob ready to escort him to our procedure room when he started to talk about his depression. In a flat voice he began to me tell his story. I was transfixed, placed momentarily in a world I’ve never known and would never want to.

 

You’re from another state but have been living in Ely for ten years now. Never making friends besides those of us you see in clinic, you believe that someone once diagnosed you as a hermit. You don’t get out much, maybe to the grocery store twice a week. You live off disability and spend your days in your small apartment watching tv, sitting, staring, watching the world go by without you. You had a dog that a friend gave you. He wasn’t house trained but he loved you. You both loved it when he sat on your lap and you scratched behind his ears. He made you happier than you’d been in years, but your apartment complex took him away because made messes inside. You don’t want another dog because you’re afraid he’d get taken away too. Sometimes you get confused about things.

 

I eventually had to take him into the procedure room to incise and drain his cyst with the help of another doctor. The cyst was scarred over the top and diffuse under the tissue after it had been squeezed multiple times. We had to use two different scalpels to cut through it. I’m not sure that I’ll ever get used to that smell. Every day since, he’s come in for wound care at 11 am. Usually the nurses take care of wound management, but in the interest of learning functional skills and not being an asshole who makes people do things I can do just as easily, I asked if I could take over. Every day, one of the nurses lets me know when he’s roomed and I then proceed to unpack, irrigate, pack and dress his wound. We talk as I carefully shove centimeter after centimeter of packing tape into the hole in his back. He gets by with his life and I selfishly get to peel back deeper layers of a wounded humanity. Whereas he makes me confront my own biases about dog owners and white male suffering, I also can’t help but marvel at the adaptability of the human spirit.

 

On New Years Eve I watched Jesse Diggins race on TV in a bar in Northern Wisconsin. She was amazing, racing fearlessly against the top skiers in the world. It shouldn’t have, but it made me proud to be in a bar where a group of people watched women perform feats of unthinkable athletic achievement. I bombed back to Ely the next morning to coach middle school skiers. I co-coach with one of the doctors in the clinic. When Dr. Bianco and I told the skiers they could head back in, I noticed that there were 3 girls who seemed like they wanted to stay out longer. So I volunteered to take them on one more loop and teach them V2 alternate, a simple technique we hadn’t worked on yet. As we took off our skis in front of the chalet, the girls turned to me for what I took to be a final word on the day. After telling each one of them what I thought they rocked at and what I wanted them to work on next time, I mentioned that I thought that each of them could grow up to be as strong as Jesse Diggins. Seeing the smiles on their faces reinforced just how powerful it is for young women to have role models like her.

 

I’ve had my own trouble with smiling recently. Yesterday I lost my composure with a patient for the first time in medical school. Twice actually in one day. The first time was early Friday morning when I was seeing a patient for stomach pain. As he told me about his one-day bout of ten to fifteen loose non-bloody stools, it seemed to be a pretty clear case of a limited diarrheal illness. I was comfortable with my diagnoses and therefore caught of guard when he finished in a thick Minnesota accent, “I decided to come in yet because last night I was talking to my friend on the phone and I farted and shit myself.” I lost it. Not being able to get ahold of my laughing, the next thing I knew I was telling him that I was only laughing because I had recently done the same (which isn’t inconceivable but not true either). I felt terrible but it was all I could do to keep a straight face through the rest of the visit.

 

The second visit was different. I spent a half hour or so talking with a seventy year old man about his insomnia. The trouble sleeping turned out to be secondary to a depression and anxiety brought on by a multitude of stressors. He told me that he’d called his son the other day, and that his son must have thought he was crazy. Why? I asked. Because I told him I was just callin to visit. But you know it felt good to talk to him eh. His eyes watered and mine welled up. I put my hand on his shoulder and told him that I was sure that his son would like to hear that. I told him how much it means to me to be able to talk to my dad.

 

I’m coming up on four months now in Ely and I’m still snorting at farts, gagging at cysts, and tearing up in exam rooms. Yesterday wasn’t a win for professionalism but who am I kidding? I’m loving it up here but can’t help counting down the days until I get to fly to NYC to stand next to one of my best friends as he gets married. Almost as importantly however, I’m counting down the days until I get to reunite with the other two members of the greatest dancing trio of all time.

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Rainy Christmas

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All I hear are the soft sounds my skis and poles make in the fresh snow. Driving one leg forward and then the other, I slowly find my rhythm. I’ve never been a graceful classic skier. I glided through Sunday lost in my stride and my thoughts while my face stayed hot against the twenty below. The trees lining the trail were thick and weighed down by fairytale goops of snow. Arctic air only made it more striking.

My high beams cut into the black highway at 3:30 am. It only took a few hours of public radio and guzzling coffee before I had to pull off the road to relieve myself in the woods. I wanted to get to Standing Rock by noon. The dark woods soon gave way to the open plains of North Dakota as the sun crept over the horizon behind me. I stopped for fuel in Mandan and then sped across more plains towards the camp. I didn’t expect it to be so beautiful. The clear blue  sky was framed by snow-capped hills which opened up into the Cannonball river valley as I reached my destination. Flags whipped in the wind as I rolled up the road toward the entrance. The camp spread out on both sides of the river, Oceti to the East and Rosebud/Sacred Stone to the West. Tepees, yurts, tents, woodsmoke, colors, people, mud, snow, and dogs all blended into one feeling as I pulled my car in and found a place to park and set up my tent.

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Snow hangs heavy again on the pine trees today. The forest is becoming my midday meditation. I keep driving my feet forward trying to get kick as I stride up the back trails. It feels unfair that I’m allowed to ski like this. I wasn’t sure if my car would make it up the steep quarter mile hill to the ski trails over lunch. The snow was 3 inches deep and falling fast. I hit the bottom of the hill at 40 mph and crawled across the top bottoming out at 7 mph. Once in the woods, I pushed forward hard, gamely slipping and sliding as my ski tips cut through the thick layer on the tracks.

Woodsmoke formed a thick and continuous haze in camp. After completing my instinctive and almost animal hike through the entire settlement to get my bearings, I walked over to the main medic tent. There I met another third year medical student who told me she’d been at Standing Rock for over a month. For some reason she decided I was legit, and gave me an informal orientation to camp. Spending the afternoon with her and the other long term activists gave me a flashbang insight into the place. Emotions seemed to be a mix of love, pride, passion, resolve, and frustration with each other and newcomers. I worked in both Oceti and Sacred Stone on the day I arrived. It didn’t take me long to find a stethoscope, figure out where supplies were stored, and get to work. I stopped at a massive woodpile in Rosebud as I hiked between from Sacred Stone back to Oceti. Using my body for an hour helped steady my nerves and gave me time to think about the place and my role in it. I was taken aback by the legitimacy that I was immediately imbued with in a place that was so questioning of motives. It’s hard to tell why you’re accepted or not, but it was sobering to reflect that my profession, gender, and race all seemed to advantage me even in a community of activists. As the first day faded into night, I took a break from the medic tent to make dinner in the back of my car and walk around the tent city at sunset. Long underwear was key as the temperature fell into the teens.

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My friend shared her birthday with the coldest day of winter thus far. At 6:00 pm it was dark, fifteen below and getting colder. She asked me if I wanted to go night skiing before we met up with people at the bar. How could I say no? Besides her inexcusable lack of quality ear protection (so my ears suffered), it was pure magic. We didn’t turn on our headlamps, so the trails were like ghostly streams weaving front of us.

Over the next two days I split my time between the two different medic tents, stopping to split wood for a couple hours each day at lunch. The medicine itself was everything from asthma and URIs to extreme agitation and head lacerations. The positive energy was palpable as we all seemed to get a thrill from being a part of something bigger than ourselves. It was hard to keep a clear head and avoid being seduced by the sense of purpose and feeling of being needed. Everyone came for their own reasons, and questions of privilege, appropriation, respect, and space were present all the time. There seemed to be an ongoing argument/discussion regarding who was up at the protest, how long they were there for, and their motivations for being there. I had thought a lot about why and whether to go before I left, and decided that I would rather go and risk being problematic than not go at all. I did my research and I believe that the Standing Rock tribe’s claim to the land is just. Either way however, I felt uncomfortable  that the government and local police have been using force against peaceful protesters. It was powerful to be a part of something so strong yet rooted in non-violence. Things seemed to be coming to a head when the Veterans for Standing Rock decided to come on the weekend that the government had given the protesters an ultimatum to leave. I figured if there was any weekend I could be of some use, that was it.

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Rain hit my face like cold little pebbles as I sat in the hot tub looking up at the trees on Christmas night. Strange winds howled and whipped the naked tree branches back and forth. The sky was beautiful. Icy rain made our house feel even more cozy and welcoming as family, friends, and neighbors poured in. Sitting in the living room with Niko, Brad, and Nate it felt like we were in a time capsule circa 2005 in Brad’s basement.

The only thing that I see as a guarantee is that things will change, and I’d rather ride that wave than fight it. I left Standing Rock after the easement was denied and the tribal elders asked people to decamp for the winter, but I didn’t feel any sense of accomplishment as I drove home. What I felt was an energy pushing me to keep fighting for a better world. Trump’s election was so devastating because I think for the privileged among us, it had felt like we were on a moving sidewalk on the way towards that better world. I think this gives us the opportunity to see that this world won’t come easy and that there are millions of people who didn’t feel like they were riding that wave of progress. It takes small steps, like my cousin Megan explaining to her husband how he doesn’t see his white male privilege. Or my brother, throwing his life and energy into social justice and teaching. I have no answers, so I guess that just means I’ll have to go on that 10th Mountain Division Hut ski trip in March. Even if we don’t come up with answers, it seems better to ask the questions in a log cabin surrounded by snow capped peaks in the Rockies.

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Civic Engagement

A few miles outside of Virginia I pulled my Prius into a snowy gas station to refuel on coffee and gasoline.There was a paper sign taped to the coffee maker that read Please pay for the coffee whether you like it or not. Too many people are dumping it out without paying. I felt uneasy but the coffee was cheap. After forking over ninety cents, I eased the Prius back onto the highway. Seven hours earlier I had opened my eyes to the inside of a cold and frosty tent. I tried to pack up as much as I could while staying in my sleeping bag, but eventually had to unwrap myself and tumble into the black morning air. It was 6:30 am Monday morning, the day after the Army Corps of Engineers  denied the easement on the Dakota Access Pipeline. I took down my tent, packed up my bags, and bombed out of camp without stopping until I was past Fargo. The bad coffee was the second stop on my nine hour drive back home from working as a medic at the Standing Rock Native American Reservation. I’m still figuring out how and whether to write about that experience.

Now I’m back home in Ely  and continuing to humble myself. Three days ago I was sitting in an exam room with a congenial patient afflicted by the ever more common metabolic syndrome. While scanning through his charts and discussing diabetes, weight, hypertension, and hyperlipidemia, I asked him if there was anything else that he’d like to follow up on. He nodded and said that his knee had been bothering him lately, especially early in the morning. Thinking nothing of it, I absentmindedly reached down to palpate the knee while simultaneously checking his labs for his latest hemoglobin A1C. My fingers ran over a kneecap that was hard, boxy, and unlike any I had ever felt. Can you tell me a little more about your knee? Anything precipitate the pain? I hadn’t gotten to his past surgical history in my chart review. He pulled up his pant leg with a smirk. I just had a little surgery, no big deal or nothin. I found myself staring down at a 2,000$ prosthetic holding up a right BKA.

I’m dead serious about what I do, but I’ve given up on taking myself serious. The nurses and patients seem to have given up on that too. Sometimes I think the patients can smell it on me.Last week I walked into an exam room and was met by a bleach blonde 65 year old woman who was a retired long-haul trucker. I usually don’t have much trouble guiding patient interviews, but her stories blitzed me and I found myself trapped in her musings about her “36 inch all American stems.” When I finally corralled the conversation back to the HPI, she told me she woke up with chest pain. My stomach dropped as my mind flitted through a vast differential and images of her dropping dead on the floor in front of me. Yeah, the chest pain was bad but then I looked down and realized I was standin on my nipples! I groaned as she grinned up at me.

Whether it’s the nurses changing my contact picture to an anal speculum or the doctors feeling comfortable enough to have me close up hernia repairs, I feel like I’m integrating and getting in the swing of things here. I might have put that all in jeopardy on Tuesday night after I got a phone call from my mom. I was making a snowy trek to the grocery store and the laundromat when she called to ask about my weekend in North Dakota. After I talked for a bit about the camp, she told me about a comment that was posted on Facebook by a newly elected member of the Ely City Council. She’d read about it in the Star Tribune and saw that the next Ely City Council meeting was scheduled for that night to discuss it. Councilman Forsman’s post read as follows: Do you suffer from Trump Acceptance Rejection Disorder (TARD)? Ask your doctor if suicide is right for you. I was furious. Not only is this a disgusting statement that uses a slur for people with different abilities and makes light of suicide, but the writer is an elected official who insinuated that if you’re upset with the election, you should go kill yourself.

I googled the when and where and found out that the council meeting was 3 blocks away and started 5 minutes before I got my mom’s call. I paid my grocery bill and jogged over. Once inside City Hall, I pushed my way through a packed room and found a spot along the side wall of the chamber just in time to hear Mayor Chuck Novak address the assembly. The mayor was seated at the center of the council in order to facilitate the meeting. Before the conversation started however, the mayor made a few things clear. First, he argued that people need to understand that there’s a difference between private and public life.  And I’ve known Danny since he was a boy, and he’s not a hateful guy. He finished by turning up the folksy accent and saying Some people are even calling for me to resign. Well I ain’t going nowhere! Dan Forsman then made a brief apology and that was that.

I walked out of the chamber as my blood boiled. The mayor had just delegitimized the concerns of roughly half the people in attendance through faulty logic and a blatant appeal to nativism. Not only that, but the hall itself felt threatening as a group of six or seven young white men stood cheering in the back clad in red “Make Ely Great” hats, Trump paraphernalia, and American flag cutoff t-shirts. I stood off to the side and watched the crowd, waiting like everyone else for the open forum at the end of the meeting. The group of guys in the back kept looking over at me, eyeing me and trying to decide whether or not I was part of their in-group. I leaned back against the wall hoping they could sense that I wasn’t. Finally, the people who had signed up beforehand were called up to speak. In the interest of time, I’ll just leave it at this: the (mostly women) who spoke out against the hate speech all thanked Forsman for his apology and argued that this was a moment to learn from, while the (all men) who spoke up in his support told him to stay strong against the bullies in the room and questioned as to how we got so politically sensitive and serious about a joke. I’m sure that Forsman received some horrible hate mail, but I didn’t see any bullies in the room that night and I didn’t hear anyone tearing him down. I did however see people asking the mayor and the council to hold a man responsible for his actions.

When it was my turn to speak, I tried to keep it simple. I introduced myself as a new Ely resident and thanked the town for welcoming me in. I then talked about how I’d taught 5th-11th grade in the peace corps before starting medical school. I said that both in our country and abroad, we teach children that they will be held accountable for hurtful things they say in class or post online. When a child punches another child on the playground, we don’t pass it off as I’ve known this kid since he was in 1st grade, or she’s not a hateful 5th grader. We hold them accountable for their actions so they can learn from their mistakes and so that we set a precedent in the school community. If we hold our children to this standard, we should hold ourselves to it as well, let alone our public officials.

Insinuating that people should commit suicide and making fun of people with differing abilities isn’t about being overly serious and politically correct, it’s about having the bare minimum of decency and social graces. The people who I most often hear malign our culture of political correctness are usually those with no idea what it means to have a politically correct conversation that stifles intellectual thought. They’re immature individuals who want to continue to get away with saying shitty things that hurt and frighten our marginalized communities. I looked at Mayor Novak when said I that I specifically disagreed with his distinction for elected officials differentiating public and private life in regards to social media. I thanked Forsman for his apology, thanked Ely for welcoming me to town, and stepped back from the mike.

I looked towards the group of men in the back as I made my way back to where I’d left my coat and groceries. They didn’t look friendly. I’m not sure why it struck me as funny, but I couldn’t stop smiling when I thought about them as I walked back to the laundromat. I think the idea of white men feeling disenfranchised is just too ridiculous for me to handle anymore. I want people to be straight up and say what they really mean. White men (myself included) have always had all the seats at the table, and now many of us are pissed as hell that we have to give some of them up to brown people and women. We’re pissed that we can’t just say whatever we want to anybody we want without incurring consequences. These angry white men don’t get it, they don’t feel disenfranchised, they’re pissed that brown people, immigrants, and women are being enfranchised. Yes, poverty in rural America is real, but that doesn’t mean that we need to keep using false pretenses to cover up fear, misogyny and racism.

 

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Rebellion

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View from the top of the fire tower

Her wheels spun next to me as my feet pounded cold pavement, arms pumping at my sides. I could no longer talk. Our conversation had gradually faded into this moment as my lungs sucked air. Rounding the final bend we burst out of the woods and strangers stared as she screamed at me to run faster. I was murdering myself to cauterize an old injury with fresh tissue. I’m lucky to have my mom as a one woman cheering section to spur me on.

 

Our country needs a rebellion, an open resistance against the established authority. We must rebel against white supremacy, male supremacy, hetero/cis supremacy, and nationalistic bullshit. We must rebel for love, acceptance, tolerance, progress, and the future of our species. Pigment, gender, and sexuality place me in the dead center in the establishment, but I’m okay being problematic and learning to be okay with being checked when not properly woke.

 

On Thanksgiving morning my brother, parents and I found ourselves scattered around our kitchen drinking coffee and grazing on breakfast food. Discussing. Whether or not. To discuss. Politics. But life is politics. This idea that there’s normal life and then there’s political life is a fantasy concocted by white people, those settled comfortably into the dominant culture. Like myself. Besides, it’s way more fun to experience life in all it’s grime and awkwardness instead of settling for bland, meaningless, and good enough relationships with the people who will be with us from birth to death.

 

Thanksgiving was good. Grease dripped from a piece of Turkey meat my cousin dangled in front of me as has become our holiday tradition. He cooks and I steal food. Eyes glazed over and stomach distended with pie and stuffing, I leaned back on my parents couch with my newest infant cousin falling asleep on my chest. River honored me with some namesake drool and we might both still be napping on that couch if I didn’t have to drive back north to learn more about doctoring.

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Helping me eat birthday cake

Because we’re the Cousins, Thanksgiving got political, it wasn’t all babies. Sometimes it’s good to talk to a likeminded friend under the northern stars. And sometimes it’s even better to have a bellyful of whiskey and a cigarette between your lips as you talk with your conservative cousin in his 4-door pickup. Listening was my first step. I was told by one relative that my intensity was overwhelming, so I listened as much as my mouth would allow. What I heard was fascinating.

 

Perpetuating the fear and racism driving our descent towards authoritarianism is an assault on information. We don’t get the same information. We don’t talk the same discourse. Our facts are not the other’s facts. Too many of us believe that institutions of learning and science are inherently biased and therefor untrustworthy. We have no common source of facts and information to depend on. The first step towards destroying a democracy is to undermine the institutions that pursue knowledge and speak truth to power. The white nationalists/Trump campaign did an excellent job of this during the election.

 

Creating accepted and trustworthy sources of information is a tremendous task in our age of exploding information. More importantly however, we need to be honest with ourselves about the role that fear, racism, and complacency have all contributed to our current political climate. Trump won all white demographics: young, old, female, male, rich, and poor. Forget the fact that we need to push back on the racist implication that only white people are working class, we’re kidding ourselves if we think that this election was about economics as much as about white nationalist fear.

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Sunset at the firetower

Today I’m back up in the northcountry, leaning against exam tables with my head in my hands as I try to figure out how to best serve the men and women who come into our clinic. The sky is grey and the ground is wet, which is unusual for this time of year. Today in the Babbitt clinic I sat back while an elderly white couple in their late eighties railed against the racism, sexism, and economic insanity of Trump and what he stands for. It seems like it’s my fate now to let the wisdom of the elderly wash my soul clean when I find myself losing hope.

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Hope

I couldn’t smell the piss that I was told might be soaking the soft clinic chairs. The sun blazed in through the glass windows and I could see rows of single story houses marching down the street. I was working at the Babbitt community center and clinic, a retirement community for the rugged. A bead of sweat was beginning to form on the top of my nose when the old man roused himself.

 
Those things he said about women. Awful. Not sure what’s going on anymore here. D’ya watch it last night?

 
It was Wednesday morning and I was hunched over a clinic computer scanning through labs and hoping that the numbers would help me forget. The room was hot and my stomach hadn’t yet uncoiled from the night before.

 
For the first time since Ohio fell, a little pressure lifted from my shoulders.I looked up at the old man and nodded. Then I stood up, walked across the carpet and pulled on the metal latches to feel the cool air move into the room.

 
The next day I was back in Ely and I screamed at a patient that I was better looking than Dr. Montana. He was mostly deaf and mostly blind. During the physical I asked him to exhale as I pressed my fingers into the soft tissue of his abdomen to feel for his liver. He looked at me with sightless eyes.

 
My stomach don’t hurt nothing. Least I don’t think so. Might’ve shot myself in it votin for Trump. I dunno. Beard makes you look old ya know. Thought you were older than Montana. Beard makes em handsome.

 
He grinned as I sat him up. The history was taken, exam completed, and note written. We were shooting the shit waiting for labs to come back. I forgot that I was screaming into his left ear. Greg the triage nurse looked at me funny when I left the room. My beard was shaggy, I hadn’t slept well since Monday night, and I was pretty sure I was wearing the exact same clothes as the day before. I didn’t have it in me to deny my claim and explain myself.

 
I needed time to think in the woods. I don’t have the money for a good camp stove right now so I stopped by Shopko after work to pick up a hatchet and tarp. On my way home I dropped by the bar to grab a quick beer with some of my coworkers. It was cheap, but not knowing their politics allowed me a moment of respite.

 
The next day I sewed up a boy’s hand in between impromptu cardiology lectures by the visiting heart doctor. The hand owner wasn’t much younger than me and regaled me with wild stories after I put the local in and the pain went away. I felt competent cleaning, numbing, and sewing the hand, and frustrated when I realized how much I forgot about cardiology. I headed up to the woods on Sat night.

 

It was the day before the super moon, but it was still impressive as it floated higher and higher in the sky illuminating my camp with ghostly light. The night was cold and good for sleeping. The next morning I held black and boiling coffee in my hands as I sat on the rocks and watched the sun crawl over the treeline. This morning was good for thinking.
The election had no winners. Trump and those who stood by him lost because they fell prey to our basest, saddest, and most pathetic selves. History never smiles on those who act out of fear and hate. However, human civilization is but the blink of an eye in the cosmos, so this is about something bigger than history. America lost this election because love lost, decency lost, equality lost, and justice lost.

 
We aren’t lost because we lost the election. The struggle for love, decency, equality, and justice plays out from the micro to the macro level every single day in every single human interaction. I have hope that this election will teach us by opening up our eyes to our flaws and bringing people together to fight for love.

 
But words are nothing, especially these words which are only echos in the deafening chorus of pain and sadness. There are real people who are in fear and pain because of the results on Tuesday night. There is a generation of women, girls, immigrants, people of color, LGBTQ citizens, and muslims who all may feel unwelcome and less than. There are women, children, and men who will suffer because of the actions Trump has threatened and behaviors that he has legitimized. There are people suffering already today because of fear and hate that existed long before Trump entered the stage.

 
Therefore it is up to every one of us to make use of our own blink in time to fight for love and make the world a better place. I don’t need to lay out an argument for this philosophy because I know that it is embedded in our DNA. From the pro Trump diabetic overjoyed by the success of his CABG, to the six foot tall and devilishly flirtatious 87 year old Lady in Blue, each patient I meet has a goodness in them.

 

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So sitting in the sun and drinking coffee on a cold morning in the BWCA, I thought about how I needed to buy better cookware as well as how I personally will move forward without losing faith in the humanity of those around me. I guess it’s my own weaknesses that comfort me, because I know if I can be better then we all can be better. Although I voted for Hillary Clinton and not Donald Trump, I know that there are days in which I lose my own battles to fear and anger, as do we all.

 
I can count on one hand the moments and people which/who make me want to be a better man. It’s why I keep feeling drawn to them no matter how destructive they might be. I vow to keep coming back to this election to remind myself to use my time on this earth to stand up and fight for the wellbeing of all people no matter what their gender, color, culture, sexuality, or religious creed. I will work towards being brave enough to make the inevitable sacrifices that come with fighting injustice. And I won’t lose hope.

 

 

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Our better angels

 

Yesterday afternoon I dove off the end of a dock into a glass lake. November water closed over my toes and squeezed the air out of my lungs. I came up sputtering and breathless. The smell of fear didn’t wash off me until I made three trips between the hot cedar sauna and the freezing lake.

 

Every room I walk into in the clinic has a smell. Soap, sweat, flowers, teen, woods, stress, urine, feces are bold strokes overlying individual smells that aren’t good or bad. I walked into the room last week and the smell was stress, sweat and tobacco. I haven’t been working in Ely long, but we had already met. Underneath the tattoos and anger, there was a sweet woman managing mental and physical health with polypharmacy. She was terrified and stuck between a mountain of medications and a fetus in her womb. HowdidIgethere whataremyoptions Iwishitweredifferent Whyme I’msoscared.

 

I could still feel the tension that the room left in my body hours later as I listened to ‘Start Anew’ by Chook Race and made my way to the sauna by the lake. That feeling of wanting to start over again and remake the past is universal at one point or another. I wanted so badly to tell her that it was all going to be ok. That kind of fear is terrible, but at least there some answers and steps we can help people take to address it. However, there is another subtle kind of fear up here. It’s creeping across America but finding its way most profoundly into poor white rural towns like Ely.

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The people of Colombia just voted against peace. Great Britain voted against unity because of fear towards a mirage. The United States is on the precipice of electing a demagogue who rose by stoking fear and hatred against that same mirage. These are not aberrations and our flawed systems can only shoulder so much blame. What happens when the ‘will of the people’ is morally bankrupt? The Crusades, the Renaissance, the Inquisition, the Truth and Reconciliation Commision, the World Wars, and the Christmas Truce, human history is littered with greatness and horror. I believe that we need to begin to lay bear most shameful weaknesses along with our greatest achievements if we hope to discover a better way.

 

I ran in the woods today, weakly shielded from bullets in my blaze orange t-shirt. I felt no fear as my footsteps padded down pine needle carpets. I felt no fear when I scrambled up rocks wet with rotting leaves. I felt no fear when I was lost at dusk, scrambling through foot trails as darkness made the woods around me black and unknowable.

 

I still feel have fear, but that fear has changed. When I was little I was deeply afraid of death and what lies beyond my consciousness. When I was little I was afraid of what and whom I didn’t know. The depths of infinity can still rip the ground from underneath me and I’m sure there are things that jump in the night that could still make me pucker. However, the twin gifts of education and exposure have taught me that I have much more to fear from my own follies than the deep woods and dark unknown.

 

What frightens me today is the possibility of time misspent, people maltreated, and opportunities wasted. I fear that my own weaknesses could prevent me from becoming the man I want to be. I’m afraid that I’m not smart enough, not good enough, and not hardworking enough. I’m afraid that the signposts of time will tick by faster than I can see them and I won’t be able find my way.

 

The average ‘white working class’ American man is not fighting to put food on the table or a roof over his head. We live in a country where jobs are on the rise and the economy is rebounding, but we are terrified and massively discontented. By no means am I saying there isn’t crushing poverty and that we don’t have an obligation to do better by one another. However, this white male rural fear is deeper than economic and social mobility. One might argue that old and potent racism underlies the current rage. I believe however, that ‘fear of the other’ forms the foundation of racism, and therefore it’s essential for us to try to understand it. Without education and exposure, grappling with existential questions about your place in society has historically led to bigotry and violence.

 

Now watch these ‘fears of the other’ become kindling. The first seasoned log is our segregated society. The second log is an explosion in technology which numbs our thoughts and perpetuates our biases. In a landscape dry of quality education and cultural awareness, all we needed was the demagogue spark to ignite a raging wildfire of ignorance and hate.

 

My dad always told me that the post WWI Germans who allowed Hitler’s rise weren’t bad people, they were just afraid. I hear the same language now from people whose friends and family support Donald Trump. However, no one ever argues that what followed WWI wasn’t horrific and that everything that could have been done shouldn’t have been done to stop his rise and prevent that from ever happening again.

 

We must be better. We must engage our better angels and make a better world. Stopping Trump will only put out the current fire, (Of which I am not minimizing the importance of, fuck Trump), but I believe it is contingent on those who are fortunate to try to understand the real fear in America and meet it head on. We have an obligation and opportunity to build a better world.

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My mom is my own yardstick in this regard. I’ve never watched her spend one day without thinking about how to better our world. She is the bravest person I know. She stood up to a faux-liberal South Minneapolis to fight for what she believes in. She put her career and reputation on the line in order to take a stand for just and equitable education. Her peers and colleagues used to disgust me for their cowardice, but now I’m trying to understand their fear. They were some of the people who raised my own friends and peers, so again, good people. Beyond her career, she walked the walk in the way that she educated her own boys. She taught us to be good instead of great and never pressured us to be anything more than kind. I watched her stand tall.

 

As I pulled myself onto the dock yesterday, I rolled onto my back and felt the unseasonably hot sun steam lakewater off my skin. My heartbeat radiated up into my skull and the whistling pines were the wind instruments in my symphony. Life can be grand sometimes.

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Burntside lake

I’m going to finish this off with a post from my cousin Megan, I couldn’t have said it better myself:

 

Regardless of what happens on Tuesday, Trump does not nor ever will represent me. I decry his hateful, violent, bigoted, and racist rhetoric. My Muslim neighbors, I stand with you. My Somali neighbors, I stand with you. My Latino neighbors, I stand with you. My immigrant neighbors, I stand with you. My Native neighbors, I stand with you. Women, feminists, LGBTQ individuals, I stand with you. We must do better. Vote for Hillary on November 8th.

 

 

 

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Goodbye to the 612

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I’m not sure how I’ll handle the separation, so I figured I’d reflect on the last month of living with dreamboatdrayton. The past few weeks  have thrown both the beauty and brevity of life into sharp contrast. I watched my impossibly stunning friend Grace get married as the pacific surf crashed behind her. On a cold gray day 72 hours later, I opened my phone and found out that another friend had passed away. This past month was split into a two week child psychiatry rotation and two weeks of construction work. After concrete ended, I packed up my Prius and drove far into the north country.

 

I spent the mornings of child psychiatry talking one on one with patients. Conversation bounced back and forth with footballs and soccer balls. Afternoons filled up with admitting patients and discussing cases with the two doctors I worked with. This was easily the most intuitive and heartbreaking work I’ve done in medical school. Every day I met with traumatized children who didn’t have the opportunity to see the world as the safe, loving place that I did growing up. I wanted to take each and every one of them home with me. On the other hand, it was astounding to see their capacity for introspection and tenderness. A young boy who was nonverbal and violent during admission would end up talking softly to me about his favorite foods the next morning. A high schooler who screamed at his mom and the staff on Monday, hung out with me on Wednesday, smiling shyly and laughing as we talked about school. I struggled through oragami and coloring but excelled in football and legos.

 

This rotation led to a conversation with a friend of mine about the ethics of medicating mental health conditions. He questioned the long term health effects of medications, symptomatic vs etiological treatment, and the pressure that we put on parents and their children to exist on the range of what “experts” have decided is normal. I agree that medicating children in hopes to achieve “normal” functioning can be dangerous, but I also believe that we need to do the best we can with what we have. I saw talented clinicians work with deeply troubled children who had become a danger to themselves and others. It was powerful to see the child after layers of illness were peeled back. That act of discovery made me want to come back for more.

 

All children should have a fair opportunity for success. All children should have loving and supportive families. All children should meet our world through thoughtful, educated teachers and police who take the time to see their goodness. That world doesn’t exist right now. I see my role as a doctor as pushing to better the world we live in while simultaneously treating patients in the context of our current and flawed planet. The literature is clear that besides inherently increased morbidity, mental illness is associated with decreased life expectancy. So why are there so few resources dedicated to mental health? How do we decide when to rehabilitate and treat people versus jailing them? How much autonomy should destructive parents (most likely suffering themselves) have over their children’s lives? Etc, etc, etc. Plenty of thoughts for the following weeks.

Five months ago, I staked out the two weeks after child psychiatry for blissful nothingness. It was my first time to relax in many months. But when my dad told me he could use a hand, and I fought against my inherent laziness and came out of retirement to work for Cousins Brick and Stone.

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On Wednesday morning construction week two, we poured concrete at 7:00 am. The sky was dark and the air was cold. After ten minutes of wheeling cement, I stripped off my sweatshirt. The cold air hit my hot skin and I felt alive and deeply well.  Concrete work is fast and hard and it’s quickly obvious if you don’t know what you’re doing. Most of all though, it was a pleasure and unique opportunity to be able to spend time as a man working alongside my father. I still have much to learn from this man whom I’ve used as a model to mold my own life. I watched him design complicated structures while thinking about how they might need to evolve in the future. Driving from lunch buffets to steel yards I watched him embody his stated philosophy that “We’re only here for a short time so we might as well have fun.” He has friends scattered all over the city. Someone once told me that I was too hard on my dad. She was right. We can blow up at each other after less than a look. However, the flip side of being so similar is that we both work hard to cherish the time we spend together, comically quick to reconcile and tell each other that we love one another. These past two weeks were a priceless embodiment of that relationship.

 

Unfortunately, construction was short lived and I left the cold concrete to fly down to Malibu for a friend’s wedding. I watched my beautiful friend get married on a white sand beach. I panted through mountain runs with another friend who’s more like a brother. I found myself a part of a debaucherous dancing trio of men tearing up a gravel dance floor populated by women in their 60s. I passed out on a beach after being body slammed by the cold surf. Sunday morning I was already fantasizing about my future practice in Southern California. Everything about the weekend screamed life, but it’s hard to differentiate the fantasy from reality. I knew someone who hated when I constantly questioned and deconstructed pleasurable luxuries that fall my way, so she would have appreciated the unabashed exuberance of Malibu. However she would have quickly seen my misanthropy regain control when I found out my return flight was first class. I tried unsuccessfully to pawn my seat off on a few passengers and then the flight staff.

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It wasn’t until I was sitting in my marginally wider seat back to Minneapolis that I fell to questioning the reality behind the white sand beaches and million dollar homes. On whose back is that kind of luxury built on? How can that kind of wealth justify itself?

 

Time unravels in front of me as I turn over these questions in Ely. The space heater rumbles next to my chair, warming my legs, sore after a long run alone in the woods. I’m happy up here in the cold, and the occasional pang of yearning I feel isn’t for beaches and bikinis. I feel content in these quiet moments with a glass of whiskey while reading or listening to NPR. Without the constant distraction of the internet or the pleasures of the city, I’m left with peace and a pleasantly melancholic pang for family, friends, and good moments of time since passed. This life here is another kind of luxury, one however that I hope is training and rejuvenation for a life of continued service.

 

For Ari, we will always love and remember you.

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