Grace

The first book that I've read in 2011 has gotten the year off to a beautiful start. Some background: I'm going to be reading an absurd number of short stories this year, because I am trying to work on my own craft in that (manageable while in medical school) genre. In order to make that possible, I've been amassing volumes to keep me busy, and I've picked up several collections over the last couple of weeks and months. One of these is Sherman Alexie's War Dances. I found this collection of poetry, short fiction, and difficult to classify but nonetheless stunning prose as a bargain book at the FABULOUS Tattered Cover in Denver, where I got to spend several very happy hours reading and browsing on New Years Eve while my husband took care of some of his groomsman duties. (We were in Denver for a wedding.)

Alexie won the 2010 PEN/Faulkner Award for this book, but I had literally never seen it on a shelf before. That's a tragedy, it's a fantastic collection, and people should be reading it. You should be reading it. I'm sure that your local library has a copy handy. It's moving and powerful writing, and more than once while I was reading it, I found myself having to look up and take a moment to collect myself. I almost cried on the bus this morning. It's been a long time since I've been moved to tears in a public place by a piece of fiction. If you're a reader, pick this up and give it a go, and let me know what you think.

Of course, pretty much everything that I have said so far sounds like it belongs in my reading blog. So why am I talking about it here, in my writing and medicine blog?

I'll tell you, in the final story in the collection, "Salt" a senile and lonely widow tells our narrator the story of burying her cat, and praying by his graveside. As she scatters salt over his body to speed his trip to heaven, he seems to come back to life. When she calls her doctor (not her veterinarian, but her physician) to report the miracle, he calls her vet, and they both make a house call. She is thrilled by this, "Imagine! Two doctors on a house call. That doesn't happen anymore, does it?" In response, the narrator thinks:

"It happens when two graceful men want to help a fragile and finite woman."

And that, my friends, might be the most beautiful sentence on humanism in medicine that I have ever read. It's what I hope to be. Graceful. What a beautiful word to describe the art of knowing what a fellow human needs, to tell us about the gift of going to great lengths to bring comfort beyond physical healing. The elegance of that sentence stopped me in my tracks. It simultaneously brought me near to tears and gave me hope. I imagine that I will remember reading this story for the rest of my career. I hope that I will, and that I will be able to use it as a touchstone, as a reminder. We are all fragile and finite, and grace is a beautiful thing to strive for.

Even if you don't want to read the rest of War Dances, read "Salt." It's only 17 pages, but it lays bare in that tiny span the fragility of humans, young and old. It's a powerful piece of writing, it will make you think. But maybe don't read it on the bus, because I think that it will likely also make you cry.

The Never Ending Reading Train

The AMSA Book Discussion group is scheduled to read The House of Hope and Fear: Life in a Big City Hospital for discussion on July 24. This is mostly amusing because the book is not scheduled to be released until August 1. I admit, those of us that read in medical school are an efficient bunch, but even we can't read things before we get them. If I was determined to have Dr. Young, the author as one of the speakers in this series, I might have suggested waiting until the book actually came out, or using her earlier book, What Patient's Taught Me: A Medical Student's Journey but who am I to judge. (In all fairness, that book could be awful, I haven't read it yet, but it's coming to me with love from the Cincinnati Public Library, so I'll let you know.)

Instead, it seems like the discussion is going to focus on writing in general (apparently including a writing exercise) and a JAMA article she wrote a couple of years ago "The Hospitalist's Story" JAMA, Nov 1, 2006, vol 296, pp 2067-68.   That article, thankfully, is available now (at least to those of us who have easy access to JAMA).

I can't actually attend this webinar, because when it takes place I will be in Colorado for the MD/PhD conference. I'm a little bummed about this, because I feel like the discussion that involves a writing exercise might be the one that I would most enjoy, but I don't think that there's anything that I can do about it except hope that I can access it online after the fact. Such is the life of a busy person.

I did download the article though, it's interesting enough, about working with patients with chronic illness who seem to use the emergency room and the hospital as their primary (and in many cases, only) healthcare, and the frustrations that come with treating indigent patients, and with people dying from things that should be treatable or preventable with good primary care that they seem unwilling or unable to access. Nothing revolutionary, but generally interesting.

What I really want to talk about though is not the article. Instead I would like to take you inside my head for a moment and talk about a little problem that I like to call "The Never-Ending Reading Train."

My interaction with this article provides an excellent example of this particular issue that I have with life. Here's how it happens:
1.) I get the email about this book discussion webinar, glance at it, realize that I can't attend, but because I am thinking about taking the reins on getting groups together to talk about medical humanities at school, I decide to see if I can get the book from the library.
2.) I run a search for the book on the library webpage, don't find it, but do find another by the same author, which I place on hold before I go back to the email to see how recently the actual discussion book came out. I notice that it's not out yet, and that instead they'll be discussing the article.
3.) I go to PubMed find the article, download it and take a look. The pdfs of articles from JAMA have an extra title page, and this one has a feature which I have never noticed, under the topics listing, there is a link which reads "Contact Me when new articles are published on this topic" which in this case happens to be "Humanities."
4.) I click on this link, thinking that it will be glorious if JAMA emails me when they are going to print interesting things. I am taken to a page where I am able to select from a LONG list all the topics that I would like automatic emails about. Reading down the list, I choose all the topics that seem particularly likely to produce blog or discussion/debate worthy articles (ethics, policy, humanities), as well as my particular areas of medical interest, psychiatry and neurology. The resulting list is not a short one. Subscrbe.
5.) I go back to the article, read it, and then realize that it is a part of a recurring series "A Piece of My Mind" which seems to be short essay type articles about a number of issues in medicine, just the sort of thing that I like.
6.)I run a PubMed Search for the article series, and begin looking through the past options to see if any are particularly interesting.
7.)I read the first paragraphs of six or seven, all the way through 5 others, and download three that I think I might want to come back to in blogging or reflection.

So what's happened here? I got an email, and that email has led me to two books, five or six articles read, four actually downloaded articles, three blog entry ideas and a subscription to email lists that will inevitably lead to hundreds more articles and emails just like the one that started all this.

This is not an isolated incident. I think that if I stopped what I was doing right now, and committed to reading, full time, for the next five years, I still wouldn't get through my current, "To Read" pile. Maybe not ten years, maybe not for the rest of my life. And for someone that wants to write, I find the writing portion of the deal sometimes doesn't happen, gets lost in my idea that I need to read EVERYTHING on a topic before I can write ANYTHING. I don't think that it's a good way to go, but it has it's advantages. I found wonderful books and very interesting articles on the third or fourth cars of one of these trains of thought. And I would be lying if I claimed not to enjoy the process… but where's the limit? Or where should it be?

Or course, if I knew the answer to that question, my browser window might not be complicated by two New York Times articles in tabs kept open for possible future blogging. My list of library books might be much shorter, but I also might be missing things that have really spoken to me.

I'm not sure how to balance it, because there's not enough time in the world, and this really is the prime example of how my particular road to my particular hell (the ring of always, always feeling like I am behind) is paved with the very best of intentions.

I am reminded of Italo Calvino's If On a Winter's Night a Traveler (one of my favorite books of all time) and a quotation that I will have to hunt down later that pretty much sums it up.

Which reminds me, I'd like to read the rest of Calvino...