It’s the holiday season once again. I am in a Starbucks enduring the overdriven cheer of the Starbucks Christmas album. As sometimes happens, I am struck by a moment of gratitude for my job. There’s lots to complain about, but I don’t spend six straight weeks listening to synthesized sleigh bells and Frank Sinatra wannabees crooning about the most wonderful time of the year. When it’s my turn to order, I try to share a moment of fellow feeling with the employee behind the counter who is wearing a baseball cap from which two plush reindeer antlers emit. “If I had to listen to this album over and over again, I would go insane,” I say. “Oh, it’s not so bad,” she says, cheerily, “I love Christmas!” It occurs to me that she may be wearing the hat by choice. As often happens, I am struck by a moment of personal disorientation: Am I a huge Scrooge who needs to lighten up and feel the spirit or a lone prophet screaming truth into the wind as human civilization crumbles? I am neither. I am a very tired person, about to enjoy a mocha latte in the middle of the afternoon as a group of undergraduates beside me discuss the precise definition of usury for their take-home final. In other words, it’s the most wonderful time of the year: vacation.
Some people spend their vacations in places like this:
(Note: this is exactly how I look in a bikini, only not as good.)
Whereas, I am spending my vacation here:
in physical therapy.
It’s a long story, but I’ll make it short: Sometime during pregnancy or after, my left sacroilliac joint became too loose. You don’t really notice your sacroilliac joint in the course of life until it’s too loose and then every third or fourth step becomes excruciating. The pain started at the end of May during our move and has slowly chipped away at my ability to function at life’s core tasks — picking the baby up, carrying the baby, and working, to name a few. Up until several weeks ago, I had the full expectation that this pain would resolve on its own if I just didn’t think about it (note: denial is up there with gravity in terms of forces that are strong). Then I started needing a cane to walk at the end of the day, at which point C gently informed me that it was time to seek medical attention. (As I have mentioned before, marriage saves me from myself again and again.)
The calculus of life being what it is, the total breakdown of my physical vitality happened to coincide with the most challenging rotation of intern year: the neonatal intensive care unit or NICU. I had been dreading the NICU ever since I chose pediatrics. The schedule is grueling, the knowledge base is totally foreign to the rest of pediatrics, and the ethics are complicated. Babies are being resuscitated as young as 23 or even 22 weeks gestation now and many of these babies go on to have a number of chronic medical conditions, including cerebral palsy, blindness, chronic lung disease, developmental delay, and hearing impairment. Then again, some percentage of them go on to be normal, happy children and there is no way to tell in advance which babies will have good outcomes. Even for those who don’t, it is impossible to objectively determine what level of quality of life merits investment. Where is the line between the mercy of sustaining life and the mercy of letting go? Millions of dollars are spent sustaining these fragile lives in their first weeks and months. From afar, it seemed like an ethical quagmire best avoided. But the calculus of life once again being what it is, it turns out that I love the NICU. As in: I think I may become a neonatologist, the one thing I absolutely knew I would never become.
What I didn’t realize about the NICU is that when you work there, you attend deliveries. When there is any concern about a baby that is about to arrive — a maternal fever, a concerning fetal heart tracing, a mother who did not have prenatal care — pediatricians are called to be at the delivery, receive the baby, assess and rescuscitate them as needed, and decide whether they need to be admitted to the NICU or not. In our hospital, pediatricians are present at about 40% of deliveries, which works out to 2,000 deliveries per year, or an average of 5.5 deliveries per day. That’s 5.5 babies per day who are delivered into the arms of a pediatrician. What greater honor, what greater work could there be than to be that pediatrician? The delivery room was the site of my first contact with the world of medicine as a doula and it was that experience that made me decide to become a doctor. So things have come full circle. For me, it’s been one of those rare moments when the narrative of life seems to make sense after all.
There are other things I love about the NICU. One the one hand, there’s the acuity and the pace of an intensive care unit. The actions you take as a doctor there have the potential to be lifesaving in real time and that feels satisfying. On the other hand, a percentage of the babies at any given time are just feeding and growing, and might spend anywhere from days to weeks to months in a stable state as NICU patients, so there is the opportunity for a longitudinal relationship. It’s like doing intensive care with a little side dish of primary care. There’s also the opportunity to interact with parents in the most fragile, nascent stage of their parenthood. As a recent new parent myself, there is a river — a huge, gushing river — of empathy and tenderness for these parents, whose entrance into their new role is not made easy by the NICU environment. I can’t pretend to know what they are feeling, but I imagine it is a mixture of gratitude that the child is alive and mourning for the normal course of things that was expected. I want to be one of the people who help to ease this time for them. Mostly, though, I just love the babies, with their impossibly tiny yet perfectly formed fingers, their totally distinct and individual faces, their resolute presence in this life against all odds. I am reminded of a speech by one of my favorite authors, Haruki Murakami, as he accepted the Jerusalem Prize. He was speaking, bravely, about the Palestinian cause. “If there is a hard, high wall and an egg that breaks against it, no matter how right the wall or how wrong the egg, I will stand on the side of the egg.” I’m not sure the analogy is perfect, but it’s the closest to describing how I feel as I peer into the isolettes each morning at these little humans whose life is a complicated gift: I will stand on the side of the egg.
But back to the pain in my ass (which is, by the way, the technical term for the sacroilliac joint). So by day I’ve been, you know, helping to save the lives of babies. By, night, I’ve been hobbling on a cane, barely able to climb stairs, writhing every time I have to lie down or get out of bed. I went to a specialist who got X-rays that showed osteitis condensans ilii, a non-specific benign sclerosis of the sacroiliac joint which happens in women who have borne children as a consequence of the stresses of pregnancy. Aka: things I already knew. She sent me to another specialist who ordered more X-rays, an MRI, some labwork, and physical therapy. In regards to the MRI: let’s just say it was not something I was looking forward to.
I scheduled the MRI for a Sunday, my only day off. The hospital was quiet, stripped down to only essential staff and essential activities. Weekends and nights are my favorite times in the hospital for this reason: less hierarchy, more just taking care of people. The radiology reception area was dark with just one light behind the employee assigned to register patients that day. She took my information and handed me a gown. I stripped down to my bare skin then signed a form swearing a blood oath that I wasn’t harboring metal anywhere in my body.
I was almost to the MRI waiting area when I realized I was still wearing my wedding ring. It’s not a thing I like to be without, especially when faced with 30 minutes in a tube, but off it went, leaving behind a dent in it’s sacred spot on my finger. When the tech came to get me from the waiting room, I was in fending-off-anxiety-with-cheer mode. As I chatted (how can something bad happen to you when you’re being charming?), the tech scanned my consent form and paused over the only “yes” answer. Are you claustrophic? Yes. Yes I am. Not so much claustrophic as claustropanicdisordered. Claustro-catastrophically-freaked-out. “You’re claustrophic?” she asked, weary. “Yeah,” I said, “but I’m thinking I’ll be fine.” She got me situated on the narrow metal table and gave me a plastic bulb to “squeeze if you need me.” She started to roll the bed into the tube and my entire field of vision was engulfed by beige metal, only three inches from my face in every direction. “Get me out,” I squawked in the most controlled voice I could find, “Get me out!” She rolled me back. “How about we turn you around and put your feet in first,” she suggested. “Jesus Christ,” I wanted to shout, “Yes, fucking yes. Who wouldn’t choose that option?!” But instead I said, “Hmmmm, yes, let’s try that.” My body went into the tube and as my neck approached its mouth, I shut my eyes and resolved not to open them for the duration of the test, which turned out to be harder than I thought. The human organism is not a fan of constraint.
Lying in the tube with my eyes closed, I could not escape the thought: “We are born alone and we die alone.” In the interest of full disclosure I will say that I have this thought with relative frequency (normal? abnormal? unsure) and it is a source of both anxiety and comfort. But lying there, holding my emergency bulb and willing my eyes to remain closed, it felt closer than ever, the irreducible reality of every being’s solitude. There are things, moments, feelings that are unshared and unshareable. Naked under my gown I thought of all the babies I have seen emerging from their mothers this month, equally unprotected.
The machine began to make loud rhythmic sounds — buzzes, vibrations, fizzes, and clangs. It was beautiful. I wanted to record it, to play it for C at home, but then realized no recorder would make into this metal-free room. (See above: re: the unshareable.)
“You OK?” the tech asked. “Fine,” I said, watching the fractals behind my eyelids.
I was afraid to fall asleep, for fear of waking up and opening my eyes by accident. So I just experienced the time passing. I thought of C who has spent time in a sensory deprivation chamber and loved it. Um, no, I thought. No thank you. Sensation is much to be preferred as far as I’m concerned. But I was doing ok. We are born alone and we die alone. And nobody knows (tiddly pom) how cold my toes (tiddly pom) how cold my toes (tiddly pom) are growing. Between scans, I turned the emergency bulb over in my hand to make sure my hand was still there.
Then it was over. I’ll say this: I wouldn’t do it for funsies, but it’s not as bad as I feared. Just make sure they slide you in feet first.
The MRI was normal — no spinal tumor, which is what I thought I might have all along and which is what I think was secretly preventing me from going to the doctor all that time. I’m embarassed to admit it but it’s true. So on to physical therapy or rather on to three weeks of waiting for my vacation so that I could have physical therapy, which only occurs during business hours. Meanwhile, I attended deliveries, did my first, second, and third lumbar punctures, intubated a patient, placed two central lines, rounded and rounded and rounded and rounded and rounded, fell more in love with neonatology, barely saw my own baby, didn’t have a day off for 17 days in a row, and finally came out on the other side: vacation! So now I’m here in the Starbucks after my daily physical therapy session with my mocha latte. I can’t really remember life before now, but I think it’s the best vacation I’ve ever had. (Actually, I do remember some of life before now and I have had better vacations (ahem, Paris) but this sounds good and brave so I’ll leave it in.)
It turns out, my core is very weak. The muscles of my core are not stabilizing my pelvis and so one tiny muscle, the piriformis muscle, is doing all the work and has become too tight and is pulling the sacroilliac joint even farther out of alignment. It’s a vicious cycle of core weakness and pain. As a poet for whom language is allowed to expand and expand, I am of course concerned that this reflects a weakness in the core of my being, rather than just the core of my pelvic floor, but I don’t have time for psychotherapy in addition to physical therapy, so we’re sticking with the pelvic floor for now. Maybe the one will take care of the other. My therapy consists of a series of exercises involving subtle contractions of my abdominal muscles, a few stretces, and one exercise in which I sit on a huge exercise ball and pretend to unsheath a sword and fling it high in the air sixty times on each side. Also, before my exercises, I spend ten minutes on a treadmill walking backwards (if that’s not a metaphor, what is?) and then the physical therapist gives me a butt massage. It’s not the Bahamas, but it is covered by insurance.
It’s 1:16pm now and my parking meter expired 16 minutes ago, so I guess I’ll go home now and tidy up the house (aka put everything in the closets) because the cleaners are coming, then I’ll go pick up my daughter from day care (pure bliss! pure bliss!) and we’ll play and eat and bathe and go to sleep. I’ll say this for intern year: it robs me of my life but then, for three weeks of the year and assorted weekends, it gives it back to me as the sweetest gift imaginable. And so this is my holiday wish this year for you: that you too will know your very own life, in all its banal details, to be the sweetest gift. (No ninety-hour work week required.)
Happy merry hannukahkwanzaamas!