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Wednesday, November 9, 2016

A post-election letter

Dear songwriters and aspiring songwriters,
If you are interested in connecting with a Trump or Hillary supporter, email me at hih.connect16@gmail.com. No musical experience necessary, just a willingness to listen and connect with an open mind and heart with someone we hope we can understand better. Details below:

Last night and today have been full of confusion and alienation for many of us. Into the early hours of the morning, we watched as it seemed we no longer knew the people of America. Paul Krugman shares the sentiment in his article "Our Unknown Country."

I think many of us are in despair over our country we love so dearly. I see from the flushed faces of friends, the posts of outrage on facebook, support groups at the medical center, and my sleepless tearful night, too. While we grieve and mourn, many of us feel an intense desire to do whatever we can to help.

The night before the election, I had an unexpected call conversation with Alan, a 68-year-old devoted Trump supporter in Alaska. Hillary's get-out-the-vote script told me to politely end the call with this Trump supporter, but I listened because he wanted to speak. I disagreed with him on most every issue, but after 30 min, I also heard about how he liked to go fishing, and how he wanted a better life.

I didn't change his mind about who to vote for in the slightest, but I developed fellow-feeling and connection with a man I would have previously thought unrelatable, and I think he felt at least somewhat similarly about me, too.

The fight towards understanding is not always palatable or easy. As I write and convince myself, it might not make sense. But sometimes the most important thing we can do is connect and heal on personal levels. For me, I know of no better medium to do so than through music.

Friends, if you are willing to try this, I ask you to email me at hih.connect16@gmail.com. You will collaboratively write a song with a Trump or Hillary supporter, and I or other musicians will guide you through the process of doing so. You do not need prior musical experience, only an open mind and heart to connect.

Our country is resilient and we will go forward. It starts with working together. We can connect with other stories and share our own—it's one small step towards healing our nation.

Email me at hih.connect16@gmail.com if you are interested in participating.

Thursday, November 3, 2016

Andrew Bird and Atul Gawande on Music and Medicine

Dr. Gawande, my sister, and me at Dunkin' Donuts--jk, The New Yorker Festival!
My sister Lucy and I half-run half-skip to Gramercy Theatre in East-side downtown NYC. I check my watch as we exit the 23rd St 6 train subway—"Lucy, we're making good time: 6:55 pm!" Just 5 min before the show...

As we enter the there's this suspiciously festive red glow which reminds me of a BBC Proms moment in London's Royal Albert Hall, except it's The New Yorker Festival and I'm equally nerding out to see Dr. Atul Gawande and musician Andrew Bird in conversation. "Whoa, Lucy...I was kind of expecting a lecture hall or something..." Are you serious

Are you serious—no question mark—is the new album of Andrew Bird's. Andrew's music makes me think of the intimacy of Zoe Keating's one-woman looping cello orchestra with the energy of Joy Kills Sorrow's folksie-stringy-plucky drive. A classically-trained "true goth," as Dr. Gawande describes, Andrew casually remarks, "well, there's a reason why conservatories are called conservatories." A rebel, he wields his violin like a ukulele-turned-fiddle-turned-harmonica as he whips out what The New York Times describes his "inner operatic folkie." Lucy turns to me and whispers, "he makes me want to play the violin."

We listen as "Puma" fills the theater:

'Cause it gives rise to the rumor she's a girl and not a puma
And that light that shines is not a pearl, it's just a tumor
...
But the doctors, they told me to stay away
Due to flying neutrinos and the gamma rays, oh


"What is cancer?" Andrew ponders aloud, first as an aside; then, his eyes light up as it hits him—he's talking to a surgeon..."What IS cancer???" And in childlike curiosity, "I mean, does cancer have a reason for being there?" It was one of my favorite moments of the evening, as Dr. Gawande explains in true physician-educator style the mutations that give rise to cancer, and that the cells are trying to survive...

"Ah! So they have a will..." Andrew replies, somewhat-satisfied.

"I write about things I don't understand," says Andrew. Cancer. Fake palindromes. He also writes about "a lot of things we're not talking about as people," and sometimes his approach is from a "scientific angle that shows us what we're made of."

An audience member asks Andrew about the social responsibility of the artist. He says, "when it speaks from the heart, do it." But when the responsibility comes from external pressures, from "duty to speak out," it "usually doesn't go well."

I think music is one of the best mediums in which external motivations can start to dissolve, because art allows us to so naturally connect and start the feel that intrinsic understanding rather than the prescribed duty; the sense of what I get when I read a piece of fiction, like George Eliot's Middlemarch rather than one of those "develop kindness" books like David Brooks' The Road to Character (Rebecca Mead further makes the point).

After the talk, Lucy and I discuss over pizza and chocolate mousse cake (a delicious combination, by the way): how does the social responsibility of the artist compare to that of the physician? It's a question for us all as we ponder the boundaries of our professions, but in medicine in particular, there is the toxic notion that as long as we treat the biological disease, we're doing our job. But Dr. Gawande and many know otherwise. Gawande writes in Being Mortal,
We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive...

The chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.
I think tonight's conversation is about a sense of will. Why are we alive? It's about creating our own meaning, of crafting our own song, of breaking from classical traditions to create something richer—looping and whistling along. And the will of connecting with another, of seeing how our experiences are inherent in another's—whether between physician and musician, or any number of communities and identities. It's a testament to the power of listening and relating through music.

Monday, August 22, 2016

Our power to choose


Premiere of David Lang's "the public domain" for 1000 voices at the Lincoln Center. Lyrics: "Our power to choose"

"Where have you been? I wondered about you..." says the patient lying on the bed in front of me. Light streams in from the Hudson River, and I think how peaceful a time this is, how unchanged and natural it feels, to be seeing the searching calmness on this man's face. He has a gentle smile on.

Except that everything is not the same. It had been a week since I had seen my patient. On my last day on the wards, I told him I needed to help this world make music. And he said, "go do it."

I came back for a practical purpose--to pick up my tablet. I had stalled long enough. Part of this seemed symbolic. I'd given him my tablet so he could talk to his family; I'd entrusted a part of me to him. So maybe I stalled because telling him felt like a statement bigger than any meeting with a dean or signing of a contract.

Donned in my white coat, he asks me the usual questions--

"What do records say?" "What's happening to me?" Eyes alight.

The tablet is on the table. His phone, now fixed, is in his hand. I sit down on a chair beside him. And I have to I tell him I didn't know what was happening--I hadn't been a part of the team for the past week. I see the dejection in his face; I feel my own disappointment. And then he says,

"go do it."

I will go forward caring for others in a different way: it's uncertain, but I believe in it for us all--and if I don't, I will forever ask, what if? I have to give it a shot or live with regret. I have a deep sense of what I'm fighting for and why, and no matter what path or profession I end up in, I'll never lose that: music at the core--about connecting with humanity.

Before going, something compels me to ask him, "what makes a good doctor?" His answer:

1. Be loyal
2. Be prepared
3. Be charismatic
4. Believe in god

A doctor comes into the room. I'm about to say--"I'm just a medical student," but I catch myself.

As I look back, I smile, we smile, I'm going.

Friday, July 15, 2016

Neurology and the beauty in losing oneself

As both a physician and as a writer, Sacks’s two great themes were identity and adaptation.
"Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.” ~Oliver Sacks on Learning He Has Terminal Cancer

Neurology was a land of intrigue and (somewhat romanticized) mystery for me; neuroscience was my territory: fMRI studies, language, social and personality development, brainbow, neurons and synapses, visual cortex, cognition--a flashback to the undergrad days. At the core: how do we think, who are we, what makes us human, as opposed to simply biologic? And especially, neurology and neuroscience are the places where music seeks to be understood and understand--by which I mean, where through functioning and dysfunctionings of the brain, we can understand how music has power, and how music can provide therapeutic intervention.

Neurology got me excited about medicine, I remember. I remember my senior high school self holding Musicophilia in my hand, exclaiming to my mom with excitement that I'd be like Oliver Sacks and be a neurologist and musician and psychologist (she gave me a look like I'd just said that I'd enter the Hogwarts School of Witchcraft and Wizardry). My psychology teacher was the one who had recommended the book to me in the first place. I have no doubt that it helped spark my interest in my to-be major and love. As a psychologist, I loved neuroscience--it was mini-major within the department for me (although every subdiscipline ended up being a mini-major for me it seems). 

I'm nowhere as excited as I'd have expected myself to be about neurology. After a day in the Parkinson's clinic, I was sad and tired. Looking at neuroanatomy, I wonder where my sense of wonder has gone. Why do I not marvel in the way I had when I read those neurological cases in Musicophilia or The Man Who Mistook His Wife for a Hat? In the hospital, it can be hard to maintain that sense of wonder when the conditions seem so sad. Especially in patients with dementia, especially when family members plead with desperation in their eyes: "He doesn't do anything he used to. Is he depressed? Don't you remember how you used to hose the driveway?" "Oh yeah, I used to do that...I forgot..."

But with this sadness is the realization that neurology lies at the core of what it means to be human--what makes us distinctly human is our ability to remember, to be conscious, to have language. To lose those things is devastating; but to work with that which makes us most human is a privilege, and to understand a person beyond a localized deficit, towards the "reservoir of potential that was untapped in the patient" is our striving. From Jerome Groopman in The New Yorker
Neurology is often depicted as a discipline of great detachment. Sacks, who was eighty-two when he died, trained in the field before the advent of the CT scan and the MRI. He learned to observe his patients in extreme detail, calling on his professional training and uncanny perception to make meticulous analyses of motor strength, reflexes, sensation, and mental status; in doing so, he arrived at a diagnosis that might locate a lesion within the anatomy of the brain or spinal cord. And yet, because medical technology had only gone so far in those days, once this intellectual exercise was completed, there was often very little that could be done to ameliorate most neurological maladies.
Sacks showed that it was possible to overcome this limited perspective. He questioned absolutist categories of normal and abnormal, healthy and debilitated. He did not ignore or romanticize the suffering of the individual. He sought to locate not just the affliction but a core of creative possibility and a reservoir of potential that was untapped in the patient. There was the case history, for instance, of a color-blind painter who lost all perception of color but discovered that he could capture the nuances of forms and shapes in hues of black and gray with great mastery.
In a similar vein, I'm working to overcome limited perspectives of my own. These manifest themselves in many ways, whether beyond a localization, beyond a familiar framework, beyond a centric perspective, beyond constraining realities, beyond losing a sense of self or control or wonder or hope or selflessness--I know this all sounds frustratingly abstract, please forgive me!

A few weeks before Dr. Sack's passing, I wrote in my journal a promise to write to him and thank him for inspiring me to pursue medicine and music. I was too late in sending it. But as I go through neurology, I'll pay tribute to Oliver Sacks who embodied "a boundless generosity of spirit...intense curiosity and boundless energy..." and brought out that reservoir of untapped potential in his patients, students, and all the many he reached through his stories. 

Monday, May 2, 2016

In a library

Upon entering
"You must be the first med student to discover that library" says the attending physician, who was driving me back "home" (er, the library) after a day in gynecology and the Planned Parenthood Clinic. She was referring to the Ferguson Public Library, a 20-minute walk away from the hospital in downtown Stamford, Connecticut--children's books on right, book club books straight ahead with presidential candidate biographies next to Brooklyn and Americanah, the book shop and Starbucks to the left--one of those places where light streams in and movement of the street and feet through windows mark the passage of time. "You like the comfy chairs?" she asks. "I like the idea of discovering something new...yesterday I read about how Hillary Clinton met Bill (in a library of all places, aptly enough!)...." and I trail off, unsure how she would take my idiosyncrasies.

Why must I go to this library, every day? It's true I haven't seen any other medical student frequenting this place. Yet every evening after 5:30 pm sign-outs, I shed off my scrubs into running gear underneath and steal to this secret portal beyond hospital walls--like Belle to the dandelion fields to escape her provincial town, or Mary Lennox to her secret garden, or The Little Princess to her dingy room which holds the imaginative richness of a palace--and am transported. Yesterday, I was at the Lake District, where Bill first proposed to Hillary (and she refused him); before that, Walt Whitman advised to focus on personality above all else; before that, a strong-headed Nigerian girl journeyed into womanhood and America. 

I tell her, "I need those breaks, those distractions."
"You have time for that"? she asks.
"Just a few minutes here and there, and during dinner..." 
"You're cute," she replies.

Cute. Not quite what I had in mind, nor the characteristic of a physician. I baffle myself. On my good days I believe have something valuable to add to a medicine with endless innovative potential for society; on my not-so-good days I feel like a misfit in a rigid field contained within itself. 

I found out this morning that this doctor had first studied journalism and wrote for a medical magazine--that is, until she realized she had to "make a living." I mentioned how I might take a year off medical school and also explore the world of writing, or something like that. She said, "just make sure you stay in clinic."

This need for beauty, for windows, for books, for writing, for runs, for morning quiet time, for music, for radio--these are needs that have become promises to myself, though I'm not sure what makes me see them as promises worth making. Maybe because these things are like the people I meet who have changed my ways of thinking, living, being--a way of meeting new characters and meeting myself. 

Monday, April 18, 2016

Labor & delivery nights while reading Americanah

She wondered where time went in the hospital. Not that time passed fast, but that it disappeared. The walls were static, the rooms unchanging, stuck in some place with no end nor beginning. On night shift, the unending pulsations of fetal testing.

At times she felt fond gratitude for medicine, other times she wondered--all the residents all seemed so unsatisfied, overworked, yet she saw such beauty, awe, admiration in what they did. Was it enough to just love, and be in awe, to preserve the faith?

Yet those other times--the busyness, the frantic callings--

"Don't get married," the resident said. She thought she'd misheard. "Why not?"  Doctors can't get married. Said she loved her husband, but couldn't care for him.

3:15 am.

She wondered whether the walls ever got bored, never seeing the light of day. At least without windows, day and night were so easily interchangeable. So that by the time she stepped outside, she'd be in awe, every time. The keys don't stop clacking, it's so strange stuck in this state.

Thursday, March 17, 2016

Hope and aspiration

Evening ensemble
Evening ensemble, from metmuseum.org
From Jeff Nunokawa's note today:
"One thing essays have always been about (not all of them of course, but enough of them to notice and call part of the tradition) is everyday life: things that come with everyday life (the death of a moth; the rise of the sun). Well, there’s something about everyday writing, especially the kind that aims to help keep you company while you start everyday that reminds me of the morning as it’s been handed down to me. It’s a little repetitive (to say the least, as my mother would say), but also a little hopeful. It’s some weird combination of routine and experiment: writing everyday, starting everyday. I guess what I’m trying to say is this: the faith of our mothers and our fathers you can also find in the everyday writing I’m trying to do here. That faith inheres in a hopeful feeling that goes along with and a little beyond the less than hopeful feeling that you have when you first wake up and realize you have to to get up and do the same damn thing you did yesterday and the day before. It’s the faith that believes that there’s something on the other side of our everyday trying and it’s not all dark."

And a poem my classmates and I discussed today in our Narrative Medicine session:

Aspiration
Henrietta Cordelia Ray, 1848 - 1916

We climb the slopes of life with throbbing heart,
And eager pulse, like children toward a star.
Sweet siren music cometh from afar,
To lure us on meanwhile. Responsive start
The nightingales to richer song than Art
Can ever teach. No passing shadows mar
Awhile the dewy skies; no inner jar
Of conflict bids us with our quest to part.
We see adown the distance, rainbow-arched,
What melting aisles of liquid light and bloom!
We hasten, tremulous, with lips all parched,
And eyes wide-stretched, nor dream of coming gloom.
Enough that something held almost divine
Within us ever stirs. Can we repine?

Tomorrow, I'll have my evaluation on history-taking and the physical exam ('H&P' History & Physical, in med-speak). I'll share songs written for patients and evaluate the impact of those songs. I'll write a final patient case write-up on chest pain. Next week, I'll take the Shelf Exam in Ambulatory Medicine and give a presentation on the songwriting project. Lots to study, learn, write, present! But in the spirit of Jeff's note and Henrietta Ray's poem, I shall climb the slopes of life with throbbing heart / and eager pulse, like children toward a star.

It’s the faith that believes that there’s something on the other side of our everyday trying and it’s not all dark. 

Monday, March 14, 2016

In New York you can be a new man

Hamilton proudly stands today in my favorite outdoor reading-writing spot!
(near Butler Library, Columbia University)
This is too good not to share: Hamilton at the White House! You've got to check out these video performances:
Alexander Hamilton
My Shot

When I watch these, or listen to the soundtrack on Spotify, I'm filled again with the belief that music matters because it instills us with collective feeling and belief--to take pride in the democracy we have and its true values, to remember that we are a country rooted in immigrants, spirits in opposition to the wave of exceptionalism or superiority or divisions of otherness,

to stand up for others, especially the weak, especially the vulnerable, knowing that each of us is only here because somebody, somewhere, stood up for us.
~2016 State of the Union Address

Thursday, January 21, 2016

Snapshot of a moment

So many moments to remember. The 90 year old man in the ICU, head down, back hunched—I needed to hold his hand. I know it matters. Wife also hospitalized—lupus and dementia—he kept saying "oxygen." The defeatedness in his face. "Lymphoma" his first whispered words. The bright, white hospital light—too bright. There needed to be tenderness for this frail, strong man. As the resident and intern walk away, the patient turns to me, eyes bright and wide, hand still in mine, squeezing. I lean in close to listen: "I need oxygen or I get violent." The resident waits for me, at the door. O2 sat 94%, fine, but he was short of breath. Resident shrugs, "he's okay."

I wanted to stay. I wish I could do more. We are in the presence of such vulnerability, such humanness, and every little thing—touch, listen, glance, leaning—matters, I think, I hope, as I walk down the hall with the residents, back to our ward.

There have been a couple of encounters like this in the past weeks (another week gone by, already?). It's hard to stop and write and think. It's hard to collect my thoughts and process them. It's easy to let my emotions dictate myself. I wanted to write about Obama's State of the Union Address. About America the Philosophical. About e.e. cummings at Book Culture. But right now I need another kind of mental processing. I'm yearning, toiling, praying, loving.

Tuesday, January 5, 2016

First Day

The Painfully Enthusiastic
AH, I'm part of the medical team! (Island Med Student blog)
I'm writing to capture this sense of gratitude and appreciation for today, my first day on the wards in general medicine, and my first rotation ever. This is a day to remember! I'm working as part of the team at the Bronx Veteran Affairs hospital, and I'm feeling 1) relieved, 2) grateful for the education and support I've received, and 3) optimistic and hopeful about this rotation, and this year.

A couple of thoughts:
1) I cared for Mr. M, a patient with gangrene. True, I've taken the H&P (history and physical in med-speak) multiple times before, but this time I felt like I had a much more substantial role in making a difference for him. When he wanted a salad, I could try to find one for him, and go back and check to see if he'd gotten it. And I think he appreciated having a hand to hold during the blood draw. I hope I'll get to see him tomorrow again, if he's still here (he's scheduled for a surgery). He's not my assigned patient, but I'm feeling this sense of "myness" for him. 

2) I presented Mr. M's case to my intern (1st year resident), who seemed impressed by the completeness of my presentation, and gave a lot of good pointers. I'm excited to start doing things on my own: presenting to the attending, writing progress notes, drawing blood, really helping out the team--as soon as I can! It felt validating to have prepared for the H&P, and to be able to do well on it, and I'm going to work to get it better, fluent, and memorized. 

3) Tonight, I don't have to worry about studying. Yes, it'll be learning, but I'll be reading and learning on my own accord, to learn everything I can about my patient, and it feels real and meaningful.

4) I'm grateful to my intern for spending such a great deal of time with us medical students, spending two hours going through my presentation. I will make it a point to get better and smoother. I'm still quite loss at to what to expect in terms of the daily schedule, how to use the computer system, how to write progress notes; yet the laid-back atmosphere of the team and their expectations has put me much more at ease. Still, I want to take charge of my own learning and challenge myself so I can help the team and patients the best I can.

To communicate, present, learn, connect--art really is at the heart of medicine. 

Friday, January 1, 2016

Hello 2016, hello again!

"The Doctor" by Luke Fildes (Wikipedia)
It's been so long since I've written that I'm quite at a loss at how to start. So much has happened in the interim: I finished my Bachelor's in Psychology, went on to do my Master's in Music Studies, and am now in medical school, year two! With the transitions and medical school, this blog fell way to the side, for which I am making amends starting...now!

Where to start? I still can't quite grasp that I started this blog in June of 2010—I remember it was a summer day in Beijing between my freshman and sophomore year; I was interning in the marketing department of a seed company, and I had an impulse (it may have been too muggy to move much and too polluted to go outdoors), which resulted in The Birth of the Artistic Synapse. There, I decided "synapse" was an apt metaphor for connections, though at the time I hadn't known to what manner and extent those connections would play out.

This blog became about connections between ideas, thoughts across disciplines. Especially in music and psychology, and more generally in beauty and artistic perspectives toward unconventional subjects and objects, and in the world of living. It also became about connections to myself: what I want, what I love, and, why I am going into medicine (The Art of Medicine). It does me good to read that post again today, as embark on my very first clinical rotation next week in internal medicine.

But most importantly, this blog has made connections with others. Strangely enough, one reason it has been so hard for me to write again is the paradoxical knowledge that comes with readership: I am less at ease writing when I know others are reading; yet all the more reason to do so! You, readers, have delighted with me in neuro-analyzing Mona Lisa's smile, relating the works of Escher and Chopin to String Theory, and (mis)applying the Heseinberg Uncertainty Principle to love. You've even stuck around for infatuations with Organic Chemistry (a product of orgo-withdrawal). 

One message from a reader in particular struck me dearly, and left an impression. I think I was in my neurology block, when I received in a message in my inbox asking if I still wrote, especially now about life as a medical student, and referenced this blog in his new blog project: poeticlust.com. I'm touched I played even a slight role in someone else's blogging endeavor, and I'm writing this post, starting anew, with his words and encouragement in mind. He quotes Carl Sagan: “writing is perhaps the greatest of human inventions, binding together people who never knew each other.”

I think of how other blogs speak to me—Loose Signatures, The Feminist Spectator, Live Thoughts—whether a delightful thought, an unexplored topic, or a relatable personal experience, and I see how blogging mattersover time thoughts are better formed, emotions better understood, actions better intended.

Looking through my old posts, I do think my writing has helped me become a better version of myself. As I read, I am reminded of the wonder and delight present even in the face of tedious memorization so often necessary in medical schoolI'd been there before, after all. And as I go forward, I think there is no better time than now, as I care for patients, in bringing out the best of medicine: the beauty of human life and connection. It's time that I write again, because I want to capture and preserve these moments; I want to always remember the artistry in our profession, and writing helps me do that. It helps me be a better self, and maybe, even, help others do the same.

I came across a post from exactly three years ago on this first of the year with the thought, "Our journey is right here, right now, and to discover we'll just have to keep our eyes open, new, and shining." There's nothing like the past to help us go forward, to help us learn what makes us tick and make the most of our learning. It's even better when shared with others. I'm excited to bring in the new year with you! It's going to be a good, growing 2016.