Coming Up For Air
Somewhere over the rainbow
Way up high
And the dreams that you dreamed of
Once in a lullaby
Isreal Kamakawivo’ole's sweet tenor flooded my headphones as the plane reached cruising altitude. I looked out my window. Blocks of farmland and neighborhoods passed by slowly under us. Rivers and creeks cut through plots of land. Clumps of trees, ponds, lakes, major roadways – they all remind me of something I saw under the microscope in histology.
Science is beautiful, and it’s everywhere.
Somewhere over the rainbow
Bluebirds fly
And the dreams that you dreamed of
Dreams really do come true
In that moment, I loved flying. Seeing the world from that height. Structures that are so big seemed small, like models in a hobby store. I needed that perspective. To feel wonder. Because I’m a stressed fourth-year medical student traveling to another audition rotation.
The road to residency is long and not for the faint of heart. My heart feels like it’s a hundred years old. I hope I can make it.
Someday I'll wish upon a star
Wake up where the clouds are far
Behind me
I think back to a 67-year-old patient the other day coming in for concerns about her increasing dysphagia. Amidst a pandemic she had put it off, but her growing concern finally pushed her to find courage, come in, and seek answers. I gathered the history, did a physical exam, told her the plan and naturally -- being a health clinic -- we talked about that dreaded virus.
Where trouble melts like lemon drops
High above the chimney top
That's where you'll find me
I asked how she was doing.
“Are you feeling isolated?”
“What does your support system look like?”
She tearfully shared that as she went for her daily walk yesterday in the cold Alaskan winter – “Pandemic or not, I’m getting my exercise” - somebody tried to rob her.
She held onto her purse and looked for someone to call out to for help, but cars kept passing by. Finally, one pulled over, chasing her assailant away.
She was so scared, and so grateful for the kindness of a stranger. “I live alone,” she told me, “and I have no family in the area.” After that frightening encounter, she can’t stop thinking about her frailty, and the loneliness that grips her.
Somewhere over the rainbow
Bluebirds fly
And the dream that you dare to,
Oh why, oh why can't I?
I was in one corner of the room, and she in the opposite, as we talked about her attempted robbery. I started to think, “What can I do? How can I help?” All I wanted to do was offer a hug.
We’ll I see trees of green and red roses too,
I'll watch them bloom for me and you
And I think to myself
What a wonderful world
More tears threatened to fall from her eyes as she examined her helplessness. I got her a tissue, then retreated back to my socially distant position. All I wanted to do was break that distance and offer physical reassurance to someone who could so easily be my grandma.
Well I see skies of blue
And I see clouds of white
And the brightness of day
I like the dark
And I think to myself
What a wonderful world
As I talked to her about the proper use and concealment of pepper spray, I stopped.
“You’ve been through a lot that last 24-hours,” I said. “If you’re comfortable with it - given the pandemic - I’d like to offer you a hug.” She stared at me. Then she nodded.
The colors of the rainbow so pretty in the sky
Are also on the faces of people passing by
I see friends shaking hands
Singing, "How do you do?"
They really sing, "I...I love you"
I approached her as she stood to receive my embrace. I hugged her like I would my mom or grandma; firm, but not crushing. I felt her take a couple shaky breaths, and she cried. Then she stepped back, wiped her eyes, smiled and said, “Thank you.”
I hear babies cry and I watch them grow
They'll learn much more than we'll know
And I think to myself
What a wonderful world
I smiled back. I told her she was more than welcome, and that the MA would be in shortly to do a blood draw. As I wrote up my note at the desk, I didn’t know if the referral to GI or the hug was more important.
Perspective.
Someday I'll wish upon a star
Wake up where the clouds are far
Behind me
We have a strange profession. We’re gatekeepers of the crossroad, standing between life and death. Sometimes we deny death access as other circumstances require us to warn the family. Then we grant entry for the inevitable.
And still, other times death sneaks in at night without warning.
Sometimes what we do to save a life causes harm or drastically changes an individual’s quality of life - but at least they’re alive… right? We constantly stand at a juxtaposition. The strain from holding that tension can cause symptoms of fatigue, dizziness, burn-out, callousness, angry outbursts, broken relationships, or somnolence.
I claim no wisdom in knowing how to survive these struggles, but I don’t want to stop standing in the crossroads; striving to feel the wonder, sadness, joy, anguish, amazement, and sometimes pure grit.
Where trouble melts like lemon drops
High above the chimney top
That's where you'll find me
Medicine in textbooks and on exams is black and white. Medicine in real life is grey. The depth grey adds to the picture is beautiful and terrifying. We must feel that depth but not be drawn down too deep. We have to remember to come up for air – to feel the sunlight.
In taking a deep breath and seeing the light, we may process the deep dark from which we came.
Oh, somewhere over the rainbow
Way up high
And the dream that you dare to
Why, oh why can't I? I?
Anne Keeling
Fourth-Year Osteopathic Medical Student (OMS IV)
Pacific Northwest University of Health Sciences