Author: ejp107

The Alternative

Research fellowship began. Two months ago. Its going.

A stormy weekend between ending residency and starting fellowship. I was angry, burnt out, terrified. Resentful of Beginnings. Told that I was a faculty member in the role of a research fellow. Not a research fellow who practices medicine as a faculty member. It was a distinction that changed everything.

How did I really want to spend these two years? The years Before. The years Before a CHILD Changes Everything.

Alternate Ellie #1: The Journalist
Human Rights Journalist. Writing about vulnerability and poverty and the human capacity for violence and forgiveness, apathy and activism and the inherent loneliness in life. Traveling around the world illuminating the cruel injustice of inequality.

Alternate Ellie #2: The Writer
A novelist, carefully crafting a collection of stories rooted in a child’s journey through adolescence and into adulthood. A narrative of mental illness and love, a reflection on the complicated evolution of empathy. A narrative that celebrates and reflects on both the impossible beauty of Uganda and the melancholy of a country road in Central Pennsylvania. A narrative filled with the silences of death, isolation, and a broken heart. A narrative filled with Life. My story.

Alternate Ellie #3: The Doctor
Competent, confident, directed. Continuing Education. Sexually transmitted infections. But not HIV. Sexual trauma. Pregnancy terminations. Family Planning. Ensuring reproductive rights and human rights through clinical skill. Practicing Public Health.

Alternate Ellie #4: The Researcher
In the field. Ethnographer. Medical anthropologist. Documenting the experience of refugees negotiating the development of identity across cultures. Examining the effects of public art on the empowerment of communities. Evaluating innovative approaches to health, helping to create population-based definitions of wellness that reflect culture and the incredibly complicated evolution of inter-generational relationships in migrating families.

Alternate Ellie #5: The Student
Public Health School. Finally. I can inhale knowledge. Rediscover the world with different eyes. Total immersion. Responsible for only myself.

The truth is that I am just barely hanging on. I am not Alternate Ellie #1-5.

I am Me. I am struggling to keep up with my clinic notes, literally haunted by patient-related anxiety. Trying to deal with the theoretical disappointment that I will never be the Journalist, the Doctor, or the Researcher.  My courage stubbornly fighting against the increasing desire to use these two years to become The Writer.  Impatiently waiting to become The Student.

And so it has begun. the Fellowship. And it is going.

A Return to Uganda

Trying to get back into writing, more publicly, more thoughtfully. Not sure where to begin, never sure where to begin….
April  12, 2013
Kampala, Uganda
Back again in Kampala, the familiar smells and sounds blanket me in memories that now seem so distant—even as compared to three years ago.  To be honest, I am not sure what I am doing here. I don’t exactly want to be here but felt compelled to return. I argued that traveling back here was about wanting to “explore” global health elective opportunities for medical students and residents. I guess that is part of it….but there was a much deeper drive to return here, to the beginning. Again, I write….
Feeling the need to go back to the beginning of this journey but not quite sure where to start. A college student, an intellectual awakening, an explosion of curiosity. A man in Uganda, in a house made of mud, dying of AIDS, crumbling back into the earth, exhaling exhaustion, defeat, pain. A pivotal moment that changed my life, a tangible whisper that forcefully pushed me onto the path of medicine. In my mind, I return to that mud house often, re-experience its darkness, attempting to find myself in that experience, to reconnect with that moment of awakening. I never can.
Instead, I go back farther. A teenager–insecure, introspective, pathologically sensitive.  Suicidally depressed adolescent. Arrested for shoplifting. Hiding under the desk at a police station followed by a night forced to sleep downstairs in the living room in front of the fire, in public. For watching. A week later, “Africa”!, Uganda and the incredible Awakening. London, Smoking on Airplanes and it is Night and then smoky, cool Ugandan earth. Faith, poverty, power, disease, inequality, compassion, ignorance, death. The realization of these concepts and realities was overwhelming.  Meeting people in different stages of death. Impersonal, agonizing, lonely death. And Cancer. Impersonal, aggressive, needy, tangible cancer.
Returned to my high school student life and it was snowing and I was a depressed (but not as depressed) adolescent.
Medical school. #1Rwanda. Is different. Maybe more beautiful. Violence, justice, a different kind of death.  I miss Jake.
Medical school is almost over. Back to Uganda. A very dark night, a very intense airport drive. Kampala again. I think Jake is not trusting me. I worry, but then We experience Every game park, Gorillas!, delicious delicious dahl. Return to the mud house, now concrete, and I start to write and think again. Faith, poverty, power, disease, inequality, compassion, ignorance, death. These things mean different things now.
Residency is ending in less than 3 months. This particular journey is ending and I am emerging from this experience intact, but just barely. I am, as usual, in a goal directed place, but not as much as I should be. I feel intensely introspective and am realizing that this is, in fact, a deeply personal trip for me. Seventeen years ago, this place, the way I experienced this place set me on my path to medicine. Using a third of my life and all of the energy of my childhood wonder, I have completed the process of becoming a “healer” and now I again find myself at a point of profound personal and professional transition, questioning my relevance–who I am, what I am doing, where I am going. I am returning to Uganda, feeling the need to heal myself more than to heal others-to write, to process and assign meaning to this period of transition, to reconcile my adolescent life aspirations with the reality of the obligations of adulthood.
I am graduating residency with a feeling of significant resignation, like I gave this whole medical thing a try and have decided that I am just not very good at it. Ten years of rewiring my brain to think and react quickly and concisely, building memory maps to places I don’t want to go, pouring creativity into the spaces between the stress, surrendering different parts of myself for different patients.
(There are, of course, moments of intense satisfaction—when you are, as a healer, able to be completely present when confronted by the vulnerability of a person as their body begins to betray their life. I appreciate the existential moments in my days and the diversity of humanity I am in the position to witness.)
I feel calmer than I was when I was here three years ago–when three years of residency was beginning to stretch out before me. I was anxious then in a way that is difficult to describe—loosely cognizant of the brutality that stretched before me, knowing that both Jake and I were going to be forced to change, to conform, in order to survive. What am I bringing back with me to Uganda at this point?  What did I think I would be bringing back to Uganda? What did I want to bring back to Uganda? Did I even really want to come back here?
I suspect that part of this internal peace has to do with the slow realization that I am once again in a position to direct my life, to start the long but eventual walk away from the medical field. It is like my entire being is exhaling an extended sigh of relief. I feel like have free will again, that I am no longer bound to an anchor of insecurity, like I can open up my mind again and start to re-explore the world.
However, I cannot escape bringing the darkness of the last couple of years with me as I move forward…the tense agony of the isolating nights on call, alone in the dark, waiting hesitantly for the next page, which could either be the imminent disaster of a life crashing or a request for an order to help with constipation.
The short narratives that I have written during residency are cynical, negative, laden with insecurity and almost contempt for the profession I have chosen. I feel almost (almost) as useless as I did in Uganda during college. A decade later, I hoped that things would be different. But I am right back where I started—not knowing how to use my skills in a way that is meaningful, meaningful to me and not just others. Needing a new Awakening. Needing to find a way to use the intensely rich experiences (positive and negative) of my medical training towards a new and different end. Needing to figure out what that end is or what that end will be for the next phase.
I used to love traveling to Uganda because it made me feel alive—it used to challenge me to think, to feel, to breathe in the inequalities inherent in life and force me to recognize my privilege and reject it or accept it on a minute to minute basis. It was tormenting, but in a way that motivated me, inspired me to want to be an agent of change. As we drove through the small towns today on the way to the source of the Nile, I realized that I did not feel this way. Instead, I just kept experiencing the variations of myself that have traveled these roads before….variations of the same slightly disconnected person I have been since I was little, my mind lost in the existential, wanting to go back to those different versions of myself and collect the pieces I have lost during the last two decades.
I know that I need to let go of what I cannot change. I know that I need to go back to those versions of myself and determine what has been added, how I have grown. I met this country for the first time when I was painfully drowning in the overwhelming process of identity formation, as an exquisitely insecure, introspective, pathologically sensitive child uncomfortably adjusting to the discomfort and power of breasts and the cruel and fickle game of popularity. I met this country again during the next phase of identity formation—as a college student–intensely reclusive, disconnected completely from what should have been the most profound social experiment a late adolescent can experience. I lived inside my head, afraid of my shadow but empowered by my expanding intelligence and independence.  I returned again as a final year medical student, on the precipice of change, confident and inquisitive, energized and nervous; in love, wanting to share this world of my past with my future, Jake. And now I am meeting this country again, in awe of how much has changed and how much has stayed the same and wondering where the current me fits in, if at all.
April 17, 2013
Entebbe, Uganda
In Entebbe. First part of trip is complete. Bombing of Boston Marathon. I feel despondent. Not in the “mood” to continue on to Rwanda. I am sort of dreading the trip to Rwanda and I am not exactly sure why. I feel uneasy in Rwanda, even after spending a significant amount of emotional and intellectual energy sorting through the human capacity for violence (and I want to write evil, but I don’t even know what “evil” is to me).  I want to think of Rwanda as this incredibly resilient and forgiving place, a testament to the human capacity for violence and forgiveness. But I can’t. I feel distrustful, hesitant….it is not a place I want to open myself up to.
In fact, last night when I was lying in bed, unable to sleep due to latent anxiety, I had this moment of realization that this is not what I want to be doing, traveling here, doing this whatever “this” is.  The goal of this trip was to “explore” clinical elective opportunities for medical students and residents and thinking about appropriate curriculum to anchor these electives, create opportunities that better reflect the many dimensions of global health. But what the hell am I doing. I don’t know. I don’t have the experience to do this—it is like I am creating something that I think reflects global health, but just based on my experiences (which are limited).
Every time I think I am going to sit down to think about what I am supposed to be thinking about on this elective/trip, I feel the need to write about my future. I am, at this moment, very much regretting my decision to stay at Jeff for a research fellowship. I already feel claustrophobic and uncertain, wanting to be as far away as possible—from medicine, from Jefferson, from Philadelphia. I want to start to learn again, I want to just write. I keep saying that but I don’t know what it is that I want to write. I want to travel and interview and report and write. I don’t want to build up a brick wall around myself—which is what I feel like the next two years will be. It is time for me to disconnect, to move on, out of the shadows of my father, into a world that is unfamiliar. I promised myself I would do this.
Anyway, back to Rwanda. Probably one of the most beautiful places I have ever been—painfully beautiful, a surreal primordial humbling pulse of nature.  So many of my feelings about Rwanda are tied up in those uncomfortable 6 weeks I spent in Rwanda during my first visit, those feelings of independence and betrayal, my deep poisonous insecurity.
April 19, 2013
Remero-Rukoma
Sitting here idly in a chair, the medical students playing with a soccer ball made of old clothes and banana leaves, so full of life—voracious to learn and explore, confident in the way that final year medical students are in the months before graduation, before the humbling experience of being “responsible” for the lives of others. They are so fucking naïve and I am so fucking toxic. I don’t get off on the medicine behind someone dying, the excitement of looking at a rolled up ct scan and viewing an inoperable cerebellar tumor with fascination while a patient in the background dies without pain medication.
As we met with the young medical director to discuss a potential partnership, my mind was alive with the possibilities—of establishing a formal teaching and clinical exchange relationship, of opening up a new world for physicians in training….and then my thoughts crash into a hesitation that I cannot describe. That same voice inside of me whispering….this is not what you want to do, this is not what you want to do, do not build this wall around yourself, do not get involved. I will do the intellectual exercise of writing a proposal for a partnership–outline a very persuasive argument grounded in reciprocal clinical education because it is interesting to think about and write about, but that is all. I think I am doing this because I feel like I should, because it is what my dad is doing (even if only because I have been very firm about the necessity of him coming on these last two trips). I think that I am doing this because it is a part of my life that needs some closure. I need endings and not beginnings. And right now I guess I am somewhere in the middle.
I think that by marrying Jake, I am committing myself to a different life than this. He marginally accepts this traveling, marginally accepts this open wound of mine, but he doesn’t like it, he doesn’t respect it. And I think he is probably right. He always is.
I do stop to wonder if my perspective of this trip is clouded by depression—and the negative thoughts, the self-consciousness, the paranoia, the difficulty sleeping—these are all my old friends, omnipresent and consuming. I am sure that it is affecting me more than I would like to admit. That said, I really do think I am trying to scream something at myself, warning me to run away….but run away from what. I don’t trust this place. I don’t trust this experience.
I spent several hours at the Kigali Memorial yesterday afternoon, just watching as people negotiated the experience. Some people cried quietly, some people laughed, some people just sat. Like me.
I think this might be easier if my dad was not so god damned positive all the time. He looks at the world with wonder every day, appreciating it in ways that I cannot with a patience that I will never have.
April 22, 2013
Butare (Huye), Rwanda
Sitting at Hotel Beaux Arts looking at the banana trees against a rust colored tin roof, a cloudy sky and shockingly verdant world beyond narrated by multiple sources of music, invading the silence of the late afternoon. It is the genocide commemoration for this part of the country today, the marching of university members through the center of town, a surprisingly small show of solidarity and remembrance that failed to disrupt the vibrating chore of daily living.
The village was a different matter, the commemoration space overflowing with grief, the gentle rural landscape violently shaken by the wailing of those remembering. I cannot describe the sound—the eviscerating, violent expressions of grief, the sound of post-traumatic stress manifest in a loud, desperate wail. The cries are changing something inside of me, changing my perception of this place. This exposure to emotion, this recognition of humanity, the fragility of the human condition, the inherent human capacity for violence….what happened here was unimaginable. Being here during the genocide commemoration has been profound.
We visited Ntarama again. My third visit. Different than before, always the feeling of being an intruder. The first trip, 2006, a peaceful place, untouched since the massacre, the ruins of humanity decomposed and disintegrating beneath a cross, beneath my feet, a soft breeze and beautiful butterflies, a room of bones and blood stains and the inconsequential tools of everyday life. A second trip, 2012, a peaceful place, now organized, compartmentalized, processed, narrated. A place where the lives of infants were extinguished with an explosion of brain matter against stone, a room where women were raped with machetes and then burned alive, a church where there was no god. A third trip, 2013, a peaceful place populated by the sounds of grief and songbirds. Sharing in the process of bearing witness.
Our days here are numbered. Starting the mental preparation for returning home, angry with the wasted hours of self-pity, the tortured ridiculous soul searching about where I have been and where I am going. I guess it was necessary—certainly not under my control. That said, there are so many things I should be writing about, thinking about, processing. It does mean something, this trip.
In all of my writing about Uganda, I never process the role of my father in this journey, his omnipresent curiosity, encouragement, acceptance, his indolent passive disgust for the inequality in life. I wonder what this trip means to him. It is a true gift to travel with my father like this. It always has been–to experience this world intensely with one half of oneself, one half daughter, one half father. Generating a future, reconciling a past.
Had dinner with one of the RVCP students who is now doing pediatrics residency. It is absolutely incredible to meet these students now that we are all physicians, practicing medicine in very different places and very different ways. I feel such kinship towards them and I am proud—proud of them, proud of myself. They are my colleagues in the true sense of the word and I feel like I have so much to learn from them.
I think the disconnection has finally happened….of course, this happens towards the end of my time here.  Disconnection from what I do not know yet, but disconnection from something at home, from the overwhelming oppression of residency. The most personally lonely period of my life. Suddenly wanting to hold on to every second of my time with my father, to bottle up the intimacy of our relationship. I am crying. I will come again next year.
I miss Jake. It is a simple thing to say but I miss him with all of me, the way he fills me with laughter and makes me think. Bigger Bananas!, the answer to malnutrition in Africa.
April 27, 2013
Philadelphia, PA
Spring. Trees blooming. Chilly breath of morning whispering the warmth of the unfolding day. Mind drifting back to the last night in Uganda, the violent storm outside, curled up like a fetus against soft pillows, protected within a net, within the loud snore of my father. Back home, breathing a sigh of relief punctuated by the dread of reality. Good to be home. Although I like the transiency of traveling….the lack of commitment to one place or period of time, change imminent and inevitable.
An essay developing in my head….a commentary of the meaning of global health and family medicine, the meaning of my life course and how to use the skills I have gained and how to forgive myself for the wasted years of my life. How to move forward and not look back unless I am forced to, a promise to myself that I will not return to that man in the mud house, on the ground dying in pain like an animal, a promise to myself that I will not get lost in the insecurity I felt as a college student, a promise to myself that I will try not to regret the choices I have made.
I started the trip totally focused on myself, on working through the multitude of uncomfortable emotions that are bottled within the experience of becoming a doctor, a healer. Working through the full realization of what I have known for the past 12 years—that I don’t really want to be a doctor, that I do not want to be tied to the overwhelming responsibility of caring for patients, to be smothered by the everyday realities of practicing primary care family medicine, of confronting other people’s emotions more often than confronting my own. Working through the fact that this is OK and moving through the guilt, disappointment, sadness that I experience when I dream of pushing this last 12 years of education into latency. But where do I go from here? How do I find myself in these carefully constructed layers of a life that I don’t want to be a part of? How do I walk away when I don’t know where I am walking to?
Have I said goodbye to Uganda? Have I confronted those many variations of myself and found out who I am? I have not. I revisited most of the places that haunt me, re-evaluating them with the same eyes, changed by the experiences of the last 3 years. I have gained an appreciation for the practice of medicine, the complications of medicine, the skill and patience required to teach medicine. I brought my membership in a brotherhood of healers that transcends the limitations of geography and culture. I brought my voracious curiosity. I brought my compassion. But, I also brought the darkness–the feelings of inadequacy and the fear of failure, the weight of disappointment that I have in myself and in the world around me.
As I sit thinking about the “essay” that I want to write as part of this experience, I am struggling with how to weave together my personal narrative with a critical evaluation of what is it means to be a global family medicine physician. I feel like I have no right to comment on this, that my distaste for the field of medicine makes it impossible to think critically. My narrative is too longitudinal, itself too intertwined with mental illness and the evolution of identity. That is what this is all about, though. My Identity. I entered into this profession without a sense of identity and I emerge without a sense of identity. I guess it is always good to start with who I am not—and that, I have discovered. I am not a physician.  I saw a dying patient in the hospital (well, frankly many dying patients). Instead of being paralyzed by this patient’s pain, instead of wanting to know the details of his pathology, instead of wanting to treat this man, I wanted to scream…..I wanted to know, immediately–why is this man dying of something treatable, why should he be dying in pain without the necessary medications to keep him comfortable, why I was standing there watching this gross violation of a person’s right to live and die with dignity. That is what poverty does–it obliterates a person’s dignity. I feel responsible as doctor, as a healer, to protect the most vulnerable, to recognize the dignity of life not through the medical skills I have learned, but through my voice, my activism, my writing. It is the best skill that I have been given, the only skill that I have that makes me feel free. I have always told myself that I can write in addition to any career that I choose, that many physicians are writers. But sometimes, most of the time, I feel like I give up too much of myself as a doctor, that I don’t have the capacity to fully engage in the world of medicine and then come home and access the part of me that I need to in order to write. And then sometimes I think—well, in academic medicine, I will do a lot of writing….writing of proposals, of papers, of grants. Ehh—not exactly what I want to do, but closer. I am a thinker, not a doer. I am passive in my advocacy, passive in my compassion and appreciation for people.
And so residency ends and fellowship begins.

Last Thursday

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Last Thursday-A Day in Residency
7:40am:Checked my clinical tasks. There are a lot of them and most of them have red unhappy faces next to them. It’s going to take me at least two hours to get through those ugly little unhappy faces.
8:00am:I walked across campus to a symposium on health disparities organized by two of my fellow residents. The speaker was the very eloquent chief medical officer of the American Cancer Society, Dr. Otis Brawley. He both made me laugh and think differently about race, health disparity, and the politics of healthcare. He made me want to read again and relearn history through a new perspective. I felt empowered by my curiosity.
9:30am:Despite this being protected learning time, I could only stay for the first hour of the symposium. I had fifteen minutes to make it to city hall. My initial feelings of empowerment faded as I thought about health statistics and the misguided violations of human rights throughout history that have forced us revise our societal definitions of humanity. My empowerment turned to anger.
This is what I felt as I neared the lawyer’s office to sit in on, as an observer, the deposition of one of my favorite graduated residents. The deposition was her defense of her medical decision-making around the death of a patient we cared for together, as a team.  I sat in silence, feeling her anxiety, feeling my own creeping anxiety, seething with resentment for the lawyer who looked like he was 25 asking her the same question over and over again using slightly different dialects of legal language.
12:00pm:I left the deposition after 2 hours for resident lunch. The lawyer was only about half way done with his questions.
Walking down Market street, I returned a call from a local hospitalist who admitted one of my patients, an Iraqi refugee mother with profound mental health and pain pathology. The doctor was struggling to understand what was wrong with her because she couldn’t find an answer in any of the imaging and testing she had done over the course of 4 hospital days. This patient is and will always be thought of as one of my most difficult patients. So relieved that the call went straight to voicemail.
Then I called my mom and all that anxiety began to seep out in frantic tears and quick, shallow breaths. My worst fears rising to the surface, facing the moment when I am exposed for the terrible doctor that I am. The moment when I have to defend my decisions during a 24-hour in-house weekend call that happened in the fourth month of my intern year over 2 years ago. The responsibility is Real.  Keep It Together. I am accused of negligence. That is the word that stands out to me more than the twenty or so other accusations. It makes my heart ache, twists it up in a ball, a knot of resentment, anger, insecurity and profound sadness. Since that fateful call, I have spent thousands of hours working and contemplating the profound privilege and responsibility associated with caring for patients and neglecting the things that fill me with life.
Resident lunch. Rarely ordered salty Chinese food. I felt left out because I missed the rest of the symposium. 
1:30pm:The afternoon begins. The last long roadtrip to the suburban nursing home, coming less than a week after a Mothers Day trip to see my nonagenarion grandparents. My grandfather fell during our trip. From the deck of the porch I was standing on, he looked like a baby on the ground, curled up in almost a fetal position, fragile and proud and vulnerable and bleeding.
We were asked to help with an admission beginning with the recording of the history of a different nonagenarion grandfather who fell out of bed and went to the hospital with hematuria. He got an MRI, kyphoplasty for a compression fracture of indeterminate age, a bone biopsy, and a blood transfusion. He went into the hospital able to dress and bathe and he was discharged to sub-acute care, after 10 days, completely dependent. His daughter’s goal was to have him back to baseline before he comes home.
He reminds me of my grandfather on exam, almost deaf despite hearing aids. I think of Jake and his genetic predisposition for hearing loss and the way he always asks me to turn up the television.
Ankles without cartilage supported by braces, sitting in a wheelchair. A stroke took away his left arm and his ability to walk 18 years ago.
When questioned, he looks confused, and calls out to his wife for the answer. But she died over five years ago. His daughter quickly changes the subject but the air had already become impregnated with the grief her father would experience in reliving this loss.
Our attending begins the code discussion and the daughter tenses. No machines. Chest compression? Cracked ribs that will most certainly meet a machine. The daughter is Not Sure, not ready to talk about it, sitting on the bed, the age of my parents but seemingly older to me, looking a little stunned–like she never truly contemplated the way her father was going to die. My grandfather is now frail. This makes my dad vulnerable. I thought of the fear of my dad falling off a motorbike on a dirt road in Uganda. Then I thought about Jake’s parents and the moment of his mother’s death. I considered what my grandparents must talk about at home. Do they talk about death? Do they share their fears with each other? They have lived a life together and now they are dying together in the slowest way possible. The room felt warm and I was ready to go.
4:45pm:I escaped from the car into the bright sun a couple of blocks away from my house. Everyone was out. It was a beautiful Spring night. Home early to sit on the roof in the treetops watching the sunset across the cityscape, the colors of the leaves changing with the day’s last exhale of hazy voluptuous purple light. I experienced a moment of deep respect for nature and then a deep appreciation for the complexity inherent in the profession of medicine.
And then my final moment of deep appreciation for the fact that Jake was on his way home.

A Night on Call

I am so tired. Falling in and out of restless sleep. On my last night of night float. It is 3am, early July. The three pagers are silent next to me, staring at me, taunting me. I am so close to be finished, so close to be done with this week of transient existence pushed forward by anxiety, exhaustion, and apathy. I think about the new intern down the hall curled up with a different pager–transmitting the details of clinical care, the stool regimens and diet orders and restraint orders that require careful negotiation with the challenges of compassion, respect, confidence, frustration, and power. I am stuck somewhere between fully awake and physically asleep. It is a space that is occupied by insecurity and responsibility, haunted by imagined errors and unfinished tasks and the awareness that outside this space is a page or phone call–that, in the end, is a call to confront vulnerability. 3:30am, the pager vibrates. A 20 day-old neonate, a Nepali refugee. A clinical history about turning blue, feeling warm, and looking scared, about a mother who is far from home in a cold emergency room whose history must travel through a plastic phone to a stranger seemingly unable to effectively translate across the linguistic, cultural, and social ocean between us. I realize what lies before me, a procedure that I am uncomfortable and unequipped to perform that requires me to explain why it is necessary to insert a large needle into this infant’s back and what sepsis and meningitis represent in a child this young. The sun is rising somewhere outside this windowless world and there is an infant crying out with his whole being as fluid is pulled from around his spinal cord and his observant mother crowds the space beside me. It is 5:30am and would like this twilight space between night and day to end, to move out of these shadows of illness and into the warm, intense sun of the summer morning. By 7am, the day team arrives and the responsibility is transferred and the experience crawls into my exhaustion and starts to sleep.

A Weekend in Istanbul

Easter Weekend, Istanbul

Spring in Istanbul—damp and clean and cool with pulses of warm light filtering through bold bright red and yellow tulips…..the wind smelled like rain and sun and life and home….I inhaled the air, allowing the hope inherent in Spring to invade me…it was hydrating, invigorating and I was flooded with childhood memories of the Easter holiday, of running through wet grass searching for Easter eggs and stuffing myself with peanut butter chocolate bunnies and jelly beans. I felt very far away from those Easter memories as I wandered around the New Mosque and indulged in Turkish delights. Very far away indeed…At the same time, I was a little relieved to be out of the Middle East, to be in a city where I could disappear into the crowds without feeling slightly nervous, slightly guarded, to be in a city where I recognized some of the elements of my own culture…..

Jake and I spent our first days in Istanbul wandering around, stopping periodically for doner and kofta and baklava and freshly squeezed orange juice, admiring the vibrant European city bustling around the incredible mosques and bazaars, trying to avoid the Easter crowds. I think that Istanbul is my favorite city—its unique and ancient history palpable and alive in its monuments, its people, its food…..its architectural wonders that tell stories of religion, culture, politics and power and how the tension between these constructs have shaped the world as it is today. I could have been perfectly happy getting lost in Istanbul forever.

When I remember Istanbul, I will see only fragments of cityscape…..deep blue painted tiles, imposing arched domes, soaring minarets, silk headscarves, flowering trees, curving alleys, stray cats, sun showers, delicate tea glasses, the Turkish flag blowing in the wind….and, of course, a sea of colorful carpets…..

During one of our afternoon wanderings, Jake pulled me into a carpet gallery….let’s just look, he said, knowing I would hesitate…..Due to the fact that I have an almost pathological aversion to buying things (especially when we travel), Jake had to use all of his skills of persuasion to get me to sit down and accept the little glasses of tea they offered us as the gallery owner proceeded to unroll one after another of incredibly beautiful woven carpets. Silk on silk, wool on wool, wool on cotton, double knot vs. single knot…..deep blues and reds and yellows…..flowers and geometric patterns, small and big, old and new……symbols of love, fertility, protection…..The dowry rugs were the most extraordinary…representing intricate and intimate female expressions of self, skill, and love to future husbands….. It was one of these dowry rugs (one that we carefully chose together based on its symbolism) that Jake gave to me as a promise of a future life and home together. We quietly made a commitment to each other over this piece of woven art, one that will provide a foundation for and be worn with the footprints of our life together. In that moment, we made a commitment to marry and my life was forever changed. Under a warm Spring sun and surrounded by tulips, we celebrated with a box of Turkish delights. Yes, I could have been perfectly happy getting lost in Istanbul forever.