Lego Rediscovery

March 11, 2019

For some time now I have had a goal of transporting my Lego collection from its storage location at my mom’s house to my current place of residence. This past weekend, I made the beginnings of progress during a brief stop through Maryland.

When I arrived at her house, my mom had kindly gathered all of the bins from their various hiding places. I knew I had a lot of Lego, but somehow there was even more than I remembered. Part of this is because I used to put the sets away still partially constructed, which meant there was a lot of room for consolidation into smaller bins by fully taking everything apart.

It’s hard to overstate how much my brother’s and my childhoods revolved around Lego. From playing Duplo together when Mark could barely walk to our sprawling Lego City in the basement, we were always doing something with the modern implementation of Ole Kirk Christiansen’s “automatic binding bricks.” One of our favorite activities was telling stories with the various themed sets, naming characters and playing out innumerable adventures in space, underwater, or on the high seas. As we grew older (and our purchasing power increased), so did the complexity of the stories (and the extent of the collection). One of the Final Iterations (and the last one to take place in my bedroom) involved the 1998 Ninja theme. Ultimately the Ninja sets are the ones I decided to transport back with me to California, which led to Mark and I opening up the old bins with the intent of disassembling everything.

Our memories of the buildings, the characters and the stories we had spent so much time constructing came flooding back and we found ourselves caught in a surreal connection between the present and the past. We were overcome by wave after wave of powerful nostalgia, the powerful kind that grabs the stomach and twists. Everything had been put away exactly the way it always had been, with the clear expectation that we would soon be getting it back out. We had never said goodbye to that time, never decided that “this was it” and packed things into a closet. No, instead there was a day where we put the Lego in the box with no thought whatsoever that it would be the very last time. That the box of bricks, swords, and minifigures would remain sealed for fifteen years, the dust within still bearing clumps of fur from pets who have long since died.

As we started taking things apart, it somehow felt like taking apart the past. I can still see myself surrounded by those sets kneeling on the light blue carpet across from Mark, planning a raid or a betrayal. Knowing that they will likely never be built that way again left me with a cavernous empty feeling. That period, that time of my life, is over forever. Even now, as I start to reclaim my Lego collection, I won’t be playing out stories with my little brother like that–I’ll be interacting with them as an adult. I want to sort them into individual pieces and build something new, my own creations that will be both more complicated and more static.

Fifteen years is a long time. Our lives now are so very different from what we thought about and imagined at the time; I’m not sure we ever considered how much time existing would consume. I dreamed of getting my own place and setting up a Lego room. One of my good friends has already done that, years ago. Mark and I? Not so much. Instead we have moved and traveled, studied and hustled, all while the crates of Lego, laden with memories, sat waiting to be rediscovered.

I don’t want to go back and be twelve, and yet, there is still such a powerful sense of loss. One that deserves to be sat with and felt, even though that means some tears.

Signed, Sealed, and Delivered

May 24, 2018

A while back my school gave us a pre-graduation checklist of sorts that required students to travel around campus on a “signature scavenger hunt” so that representatives of various departments could sign a single, increasingly valuable piece of paper. Some of them were easy (turn in your scrub machine card, return locker keys), while others had multiple dependencies (take ACLS class, present proof of completion to rotation coordinator so coordinator will sign for completed ACLS in a paper “Red Book”, turn in Red Book for checklist signature). Ensuring this Master Form got signed and delivered to the appropriate person was the final hurdle to ensuring that the folder handed out during this weekend’s ceremony did, in fact, contain a diploma.

Thanks to fitness tracking I learned that I walked about five kilometers over several days sojourning between various buildings, realizing I needed to go elsewhere first, discovering that office had already closed, and so forth. Finally, I had everything completed. I handed in the form, Rosalyn briefly checked things on her computer before looking at me. “You’re good.”

I stared back, dumbly. For eight years there had always been more to do, new obstacles to surmount, one more step to complete in an endless journey. With that last form, it was all over. It was an incredibly weird feeling, like looking over the edge of a cliff before jumping into the ocean water below.

“Congratulations.” I realized I was still standing in front of Roslyn’s desk. “Oh, thank you!” I walked out of the office much more slowly than I had walked in. I’d been seeing all of these people for one reason or another since the day I started here, and there would never be another reason to do so again. At last I felt confident enough to post my graduation portraits on Facebook, pictures I’ve quietly been holding on to since March.

I’m nervous going into this weekend.  I don’t feel prepared at all, despite the steady stream of emails arriving with instructions for where and when I need to show up. I think part of me is still afraid that there is another barrier yet to appear, and won’t believe that I’m actually finished until the degrees are in my warm, sweaty hands.

Wraiths

April 11, 2018

We are the wraiths floating in the shadows, keeping the monsters off the path.

Our souls are bare and tattered, the memory of a form.

You marvel at what was lost to carry out this task,

But perhaps we took the work because our souls were already worn.

Please Wait, Death Is Loading

April 8, 2018

Ms. A was brought in from a nursing facility by the transport team my first week of ICU rotation. I had no idea what I was doing and my first thought was, “she looks old, I hope she doesn’t code before someone else gets here.” She was around 95 years old and had the kind of problem list that gets summarized as “complex medical history:” COPD, chronic kidney disease, diabetes, some kind of lymphoma status post treatment that had returned. Now she was here for one of the usual chief complaints that bring people her age into the ICU: COPD exacerbation, MI of some kind, strokes–in this case it was septic shock secondary to a urinary tract infection.

This isn’t one of those educational cases where the diagnosis and treatment required the clever differential puzzle-solving that draws a lot of people into internal medicine. Everything was more or less straightforward for the team: treat with antibiotics, manage fluid balance, oxygen, blood glucose. My main challenge was reciting all of the items of my presentation in the correct order as I fumbled through my first week of ICU, and the first time I had routinely dealt with treating adults in about a year. This also isn’t one of those situations where I formed a strong emotional bond with the patient and learned a valuable lesson about how we’re all afraid of something. Mrs. A came in with a mental status that was better assessed with the Glasgow Coma Scale instead of the Mini-Mental State Exam. My most meaningful interactions involved getting her to open her eyes or squeeze my hand. Even her family was scarce, a single daughter who arrived from who knows where and sat quietly in the room, nodding wordlessly as we updated her with the daily plan. She didn’t have many questions; she’d been through all of this before.

A few days into her care, Mrs. A’s condition began to deteriorate. She started requiring pressors, increasing oxygen requirements, decreasing renal function. It was time to have “the talk” with the daughter, which in the ICU means discussing the patient’s code status. With the cancer coming back on top of everything else, the daughter decided it was time to change Mrs. A’s code status to DNR/DNI, comfort care only. We put in the consult to hospice and stopped the antibiotics, but she couldn’t fully transfer to their service until we weaned the pressors, so she stayed put. Daughter was still there at bedside, quiet, not asking for anything. There were no other family members, no decorations or flowers or balloons.

I came in the next morning to pre-round on my patients, nothing had changed except that Daughter had left to go take a shower for the first time in days. I went about my business and was asking one of the interns a question when the person monitoring tele called out, “hey, room x just died.” This wasn’t new; I’d had patients die before, I’d been with sick loved ones and attended funerals, but this was the first time I was actually present when it happened. The intern got up to go call the time of death: Mrs. A wasn’t even his patient, but he was the closest. “Have you seen a death called before?” I shook my head no.

He started showing me the death exam: verifying lack of cranial nerve responses, listening for a heartbeat. I listened, heard nothing, and thought about how many other times over the course of medical school I had listened to obviously living people and also heard nothing. Maybe I expected this silence to be different, somehow? Suddenly, she breathed, and the monitor beeped once as a blip ran through the horizontal green line. I must have looked surprised because the intern started explaining “agonal respiration.” I knew that was a thing, I saw air was only going out and not in, but it still startled me. I thought that the actual moment of dying would be more, well, final. Everything stopping all at once, like a light switch. This was more like watching a wind-up toy run out, where every so often it ekes out a couple more turns on its way to the end. It was mechanical, much like the dissections in anatomy lab I did what seems like forever ago.

Since then a lot of my patients have died after a changed code status. For these people, I suppose ICU is limbo, a kind of loading screen for death. Though death inevitably comes for all of us, here it is acutely on its way–maybe in days, maybe in hours. We’re all just waiting to find out when.

Scheduled (Dis)Appointment

March 9, 2018

There’s no easy way to say this: No matter the Match outcome, a lot of people I love and care about are going to be disappointed. Chances are that if you’re reading this, you have a place in mind you’re hoping I’ll end up. Because my economic class dictates that I can only live in one location at a time, the harsh reality is that in a few weeks I’m going to be the Papa Nowroz of handing out bad news. Once the waveform collapses, I’ll be able to face the inevitable fallout; however, during this purgatorial period, I experience every possible disappointment simultaneously.

It is this feeling that rises to the surface when I am asked if I’m “excited” for the Match. Despite any appearances to the contrary, making people sad isn’t actually one of my life goals. In addition to not being particularly excitable in the first place, that really puts a damper on things. Suffice it to say that I won’t be one of the folks immediately posting on Facebook.

Overcoming Inertia

August 10, 2011

I stand on the edge of the lake, the weathered rocks pressing uncomfortably into my feet. Chilly water laps at the shore, inviting, daring me to join it; voices behind me yell encouragements. I wave my arms as though loosening up in an attempt to buy time: I am ready to jump, but I stand in place, paralyzed.

I often find myself in situations like this, bifurcated into opposing selves who battle each other to a standstill. I have thought through the situation already, perhaps multiple times, and now I am willing to act. Yet some force continues to hold me back with unnatural strength.

It adapts itself to all sorts of situations, from somewhat risky but enjoyable activities, to projects I want to work on, to difficult tasks in lab. I know that I want and possibly must do it, and that I will feel incredible having completed it–and still the immobility remains. I frequently will engage in a holding pattern around this state until la hora cero has passed. A missed opportunity, yes, but at last freedom from the clutches of indecision.

It begins with the scenarios: What if I trip at the last moment and fall onto the rocks instead of the water? What if the water is too shallow? What if I became a quadriplegic because of what I am about to do right now? If I’m near a computer, it manifests as a compulsion to check Google Reader, Twitter, or even Facebook despite having satisfied my interest only minutes prior. When those have been vanquished (at the expense of considerable mental effort), what remains is not victory but a raw, filleted inertial force insisting “no” in a tortured rasp, as unrelenting as it is irrational.

I don’t know if it’s possible to win these conflicts. The best I have been able to achieve so far has been to work around them, attempting to circumnavigate the fight through trickery. These strategies have taken the form of switching between projects when I feel the inertia beginning to build, committing myself to something (such as a camping trip), or merely thinking about something else for a few minutes rather than allow myself to get lost in an hours-long distraction spree. Perhaps it will become easier with practice.

I walked away from the water, back to where it was partially obscured by the trees. I thought of all the ways following through with my action would score personal victory points. Abruptly, I interrupted my contemplation and began running. My heart pounding, I saw the blue water rapidly approaching, but it was too late to abort. I plunged into the icy depths, surfacing a few moments later with a jubilant shout that, for me, was laden with significance.