It's been such a long time since my last entry that it feels a bit strange making time to sit down in front of the screen and sort out my thoughts... A quick update would be that I'm now specializing in Emergency Medicine after finishing my two years of basic training. I entered my fourth decade of life as I experienced failed relationships that left me slightly more unencouraged and less confident each time, and perhaps making me all the more persistent to pass the US licensing exam to confirm that efforts really did matter, and to regain control in my life again. I carried around a thick textbook whose heavy weight eventually became a reminder of how much the small challenge meant to me. It was February 2020 by the time I literally got it off my shoulders, and the world had entered the age of the Corona pandemic which ended up exposing various weaknesses and strengths of our societies.
My experience in EM so far has been closer to urgent care, so I haven't had to deal with moral dilemmas of choosing one life over another. Up till now the closest I've gotten to the virus have been when a patient comes in with a totally different complaint and unexpectedly has pneumonia; his condition would sometimes unexpectedly worsen to the point where he has to be intubated and sent to another hospital with a CV line, by an ambulance that "kind of" quarantines the patient under a plastic tent that has an opening around the patient's head so that the doctor can check on him while the car drives to an available hospital that's forty to sixty minutes away...
But then while I worked through those shifts and rewrote my CV in the hopes of maybe applying for a new hospital, my uncle a couple prefectures away had a brain hemorrhage, Haruma Miura committed suicide, and two physicians got arrested assisting the death of a woman suffering from ALS - the latter two happening this month and urging me to come back here to write this entry.
Earlier this month, I had received a call early in the morning from a wife of a patient who was apparently experiencing symptoms that sounded like paralysis. After checking his chart and finding out he lived more than an hour away from our hospital, I suggested they call an ambulance and go to a nearby hospital, which they did - except that the doctors found nothing new on the MRI. He was sent back home, only to start seizing thirty minutes later, which is what I found out when I got another call from the wife around five pm, asking what to do. I suggested another ambulance call, and this time, the EMS decided it wasn't a stroke, and came all the way to our hospital where he'd had regular visits for other conditions. He was unconscious in a decerebrate state by the time he arrived.
The neurologist who came down to the ER happened to be one of my attendings during my neurology rotation three years prior, with whom I had worked on a case study of a patient who died of a rupture of dolicoectasia, a vascular malformation. It turned out to be a very interesting coincidence, as the ER patient happened to have the same vascular malformation, which caused a brainstem infarction, and ended up with locked in syndrome.
When I visited the patient a week later, communication was minimal as the only parts of the body he could move were his eyes, eyelids, and vocal chords. His tongue and mouth movement were not enough to pronounce words. He would blink every time the answer to my question was "yes", and would cry uncontrollably when I mentioned the words "wife" and "family". My former neurology attending told me that the patient had told his wife beforehand that he did not want any life prolonging measures to be taken if this kind of situation occurred. "It's really heartbreaking; he can't even commit suicide," the neurologist said, as we headed back to each of our departments. I didn't ask if he had actually had a talk with the patient to find out if that was what he truly wanted at that point.
I don't remember what the case was for the young protagonist diagnosed with ALS in the Japanese TV series, "The Time I was Here". I probably wouldn't have even recalled the series had the actor, Haruma Miura, not died the other day, alone in an apartment building only a few minutes away from the hospital I work at. In spite of the fact that I wasn't particularly a fan of his, the news evoked sadness as if an old classmate had committed suicide. I was shocked, and even a bit hurt. I woke up in the dark, thinking of his unbearable loneliness; imagined him trembling as he hung himself in the same darkness. Some people might say it was wrong; I think he may have focused too much on himself while he stayed home during quarantine, he may have saved himself with a tiny change of perspective, but who are we to judge his judgement? He was the only one who could live his life - success, failure, loneliness and all. It was his life, and he'd had the right to end it on his own terms.
Which takes me back to the issue of euthanasia. Marieke Vervoort, the Belgian athlete who ended her life last year said she may have committed suicide had she not had the option of euthanasia. The knowledge that she could end it all gave her mind a sense of peace and helped her live up to her limits despite her intolerable pain.
ALS doesn't cause physical pain like what Vervoort went through but the psychological pain is unmeasurable, as each patient has different scales: some people decide to live with a ventilator; needing help from other people and machines may not necessarily deprive them of their dignity -- perhaps they're very good at redefining their identity. But to some people, not being able to do things on their own feels like losing a big part of themselves.
I still haven't had the chance to meet my uncle after his stroke, but my grandmother gave us a call telling us her son has been rejecting rehabilitation; he still has a long way until he accepts his new self, if he ever will... The biggest problem I find in the recent assisted death in Japan is not exactly that the woman chose euthanasia but that the two doctors (one of which wasn't even a doctor) didn't follow the proper steps in evaluating her will. There seemed to be much more room for discussion, and she also could've changed her mind at the very last moment, but there is no way to confirm at this point.
Regarding my own life, I don't think I was terribly happy during the past three years. After spending a particularly depressing time last year both career-wise and relationship-wise, one thing I've been trying to remind myself lately is not to be too greedy. It's better for my mental health not to chase after chances I don't get, people who walk away, things in the past I was too young to see the true values of. There will always be another chance, another person that would come to me, maybe not now, and maybe not in the form I expect, but I must believe there will be a better future when I'm not quite happy with my current situation. Because good things take time.
The following passage is from an article I came across when I ended my last relationship ("After the Beginning, depression or disappointment"): "There's nothing like thinking that you have failed at love to sharpen your knowledge that life is uncertain and the clock is relentlessly ticking. One tends to ask oneself, if this relationship won't work, will I ever find one that does? Disappointment measures the passing of time as a fall. It is one of our harsh reminders of solitude and aging and mortality."
The writer continues: "Here's where the difference between depression and disappointment becomes crucial. Faced with the prospect of loss, the depressed bypasses disappointment and rushes to the end of the story, even before the story begins. All is failure, decay, rejection. When spring begins, the depressive is already dreading the leaves turning brown and falling off the trees... ...it's a way of saying this imperfect difficult world is not good enough for me. Give me paradise or give me death... ...depression makes the world utterly gray and uninteresting. Then you can tell yourself, what's the use of trying?"
"The disappointed person lingers, however painfully, in the middle of the story, even though paradise has slipped through his fingers. Disappointment keeps you connected to life as it continues to unfold and places an important choice in front of you... ...Neither a utopian outcome nor easy success nor bliss in love is just around the corner. Life is more difficult than you thought. The question is, what next? Are you going to take on the vital forces of life, despite limitations and imperfections, or pull the covers over your head as an exit strategy? ...with disappointment, the plot is still taking shape, even though there may be hard work to do."
A couple weeks ago I stumbled upon a book review on amazon while I sat at the hair dresser for the first time in eight months. It was the most popular review on a Japanese best seller book about a half Asian half Caucasian teenager boy dealing with bullying, learning to accept others and himself, and finding hope despite all the problems we face, written by the boy's Japanese mother. The review was partly about the reviewer's perspective, how she had decided to bring her own half Asian half Caucasian son to Japan instead of raising him in the UK because she didn't want her son to experience racial discrimination; "It's great to think about racism and fight against it, but what kind of parent would want her child to actually experience it first hand in order to overcome it?" She wrote.
This remark definitely has a point; I'd want to protect my future child the best I could. But at the same time, I don't think I'd like to live my life to end it without a single bruise or a cut. When my life comes to an ending, I'd like to be proud of myself despite the numerous ugly wounds (--some I may never recover from); I'd like to be able to love the world as it is despite the numerous suffering it imposed on me. That, I feel would bring a deeper, greater satisfaction, compared to what one would experience from a life lived in a happy bubble. Death may indeed feel like a reward when one reaches that kind of deep love despite the suffering or even because of it; that emotion would connect one to the world and enable one to become truly part of it even in the face of, or after one's death -- the deceased will go on in the form of a greater entity, that is, the world he truly loved.
So I guess my motto has slightly changed from the time I started this blog -- until the day comes, I'll try to dance like nobody's watching, love like I've never been hurt, sing like nobody's listening, and live accepting it's not always heaven on earth but still believing it deserves all my love.
