On Writing: Marking the Anniversary of a Blog

“I admire anyone who has the guts to write anything at all.” – E. B. White

“All you have to do is write one true sentence. Write the truest sentence that you know.” – Ernest Hemingway

“Writing is easy. All you have to do is cross out the wrong words.” – Mark Twain

“There is no greater agony than bearing an untold story inside you.” – Maya Angelou

“There is nothing to writing. All you do is sit down at a typewriter and bleed.” – Ernest Hemingway

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Dr. Kathy Hughes, Behind the Mask

This is the anniversary of my very first blog post, that day a year ago when I summoned up my courage, took a deep breath and clicked on the “publish” button that first time. I crossed a threshold of sorts in that moment, the start of my transformation into a writer.

A great deal has happened since with my writing and blogging, and my world has changed as a result. I have many people to thank for the support and encouragement, the help and the teaching. When I am asked about blogging and writing I have focused on the who — who helped me, challenged me, inspired me.  I have also spoken about the how — how to do it, getting started, learning the platform or the medium. In my focus on the who, what, where, when, and how, I neglected the why. The why is the most interesting and important part, both the easiest and hardest story to tell.

I was talking with Chris Porter from On Surg a couple of months ago. At the end of an interview, he asked me about blogging and how I got into it. The camera was still on, and I launched in to my usual description of the how and the who. Later I realized that the question was really about the why. That prompted an email, which I expanded for this post. The anniversary of the blog seems the perfect time to share what that conversation inspired.

The truth is, I have always wanted to write. In 6th grade my class was given an assignment, to imagine what we would do/be when we were older.  My answer was, “a veterinarian, or writer, or lawyer” (thinking that lawyers wrote a lot and were masters of language and debate). I remember my Yiayia (Greek Grandmother) in Sacramento, Calif., going out and getting me a T-shirt from University of California, Davis, home of the state’s veterinary school. That shirt became my favorite, the coolest shirt I owned (even cooler than the Peter Frampton one), especially for a kid in the DC suburbs. I wore it out.  I ultimately veered just a little from those goals, ending up in (human) medicine and surgery.

I admire people who write and write well. I love to read, and to read what good writers have written. To me, writing carries importance and immortality. We still read and discuss the works and the writers who are long gone. Writing to me is the Biggest Most Amazing Thing Ever. To aspire to be a writer, to actually be a writer, is a long-cherished dream.

I started writing daily for myself.  I took a creative writing workshop (interestingly, taught/directed by a surgeon) through the Massachusetts Medical Society. The workshop showed me I could create something that moved others, that they responded to favorably. I found that the workshop also broadened my narrow view of what “creative writing” really means. The experience motivated me to keep up with my writing, and to think about writing more than just for myself, planting a seed. When I started this blog, that seed germinated, and has grown.

In considering writing, I didn’t think I had a voice. I wasn’t sure what I could or would or should say, or who would really care what I had to say. After all, I am a surgeon who has spent the majority of her career in private practice in mid-to-small sized hospitals, serving communities of modest (even challenged) means. The prominent and predominant voices and writers around me were big important surgeons from big important academic centers and their large urban hospitals. I was not sure where I fit in. It felt important for me to write exactly because I could not find another voice like mine.

I blog because I do have a voice, and I do have something to say. Sometimes it is fresh, even unique, sometimes I wish it were more original. But no matter what, in this blog I am adding to the discussion. I am sharing my thoughts and stories, sharing a piece of who I am. Yet there is a paradox in this writing approach. I crave to write that perfectly crystallized, novel piece that will capture and immortalize a nugget of truth. But it turns out that writing about the commonly shared experiences is the most gratifying. The revelation that my experiences, struggles, and observations are mirrored in others brings a wonderful sense of belonging. This blog helped identify for me not just other physician writers, but a community who can share in these stories and experiences. I am able to express these thoughts and stories, and to give voice to all of us. I thought I was speaking for myself, but soon felt the rush of realizing that I am speaking for others, too. I felt the rush of the power those words, my words, could convey.

I confess a sense of pride that I can express myself in writing, that people enjoy and appreciate my words, that I am a good writer. I am still learning though, very much. I have many teachers all around me, in the writers I read, the friends who help scan for typos and grammatical faux pas, the mentors who help me hone the skills of the craft itself. Writing mirrors medicine in that regard, in the concept and experience of lifelong learning. We practice medicine. Writers constantly evolve too, and the best would assert that they are still trying attain mastery themselves (there is another Hemingway quote about that somewhere…).

For me, the act of turning thoughts into something tangible is both healing and sustaining. The world of medicine and surgery is exhausting physically and emotionally. We know the calling to care for others is and has always been special and all-consuming. More recently it has become increasingly frustrating as the pace of change accelerates and sometimes overwhelms. Change, both positive and negative, is stressful. Sometimes the negative seems to accelerate faster than the positive. Turning to writing, and the connection and community this has nurtured, has helped me navigate and mitigate these effects. Writing feeds a part of me I hadn’t realized was starving, exercising skills I had let atrophy. I am healing as I am writing.

I want to thank you who are reading this, whether new to my writing or along for the ride over the past year (or more). I don’t think you are really a writer or a blogger until and unless your words are read. So thank you for reading, for sharing, and making me a writer.

“Let me live, love, and say it well in good sentences.” – Sylvia Plath

“A word after a word after a word is power.” – Margaret Atwood

“One day I will find the right words, and they will be simple.” – Jack Kerouac

“Either write something worth reading or do something worth writing.” – Benjamin Franklin

“I was a late bloomer. But anyone who blooms at all, ever, is very lucky.” – Sharon Olds

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Dr. Kathy Hughes, out from behind the mask

Addendum:  It has been a tradition in this blog to start each entry with a quote (from a song/song title, saying, famous person) — or two or three. I went overboard today, because each of these quotes spoke to me and my writing, and in some way reinforce my story and feelings in this piece. And I couldn’t find a good rock-n-roll song to quote. Thank you for indulging me, this time.

Little Miracles

“There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” Albert Einstein

“Miracles happen everyday; change your perception of what a miracle is, and you’ll see them all around you.” — Jon Bon Jovi

“The miracle is this: The more we share the more we have.” — Leonard Nimoy

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Sand and Sky, Summer, Ocean Park Beach, Maine

It is amazing when things in medicine work just the way they are supposed to —  it’s like a miracle.

When I take an antihistamine, I can breathe, and all the itching and sneezing stops. When I get an injection of local anesthetic, I can touch and poke and pinch to test that it is working — and it is. When I had an operation on my knee, an ACL repair, my knee stability was noticeably restored almost immediately, despite the post-op pain and swelling. I know these things work on patients, because books, observations, and experiences have shown me so. As a surgeon I get a kick out of operating on acute appendicitis, where often even in the recovery room immediately after surgery, the patient already feels better.

Yet I still marvel when I notice that this stuff is working on me.

I used to worry that as I entered the world of science, and then medicine, I would lose the ability to see beauty, to appreciate and be amazed and awed by the world around me. I worried that the more I knew about the details of how things worked, that I would not be able to see the glorious whole, the big picture, whatever that big picture might be.  Would the biology and chemistry and biochemistry and physics become like a filter on a camera lens, changing the way I would see these things? As I got deeper into this world of science and medicine, and then surgery, I was concerned that the experiences around me might overwhelm or blunt my humanity,  become mundane. Would I  become callous, detached, dispassionate? Would I still feel? Would I lose my faith, whether in people and humanity, or even more? Continue reading

Snow Day

“When I no longer thrill to the first snow of the season, I’ll know I’m growing old.” – Lady Bird Johnson

“The snow doesn’t give a soft white damn whom it touches.” – e. e. cummings

“Come in, she said, I’ll give you shelter from the storm.” – Bob Dylan

Snowy Day, Winter 2014

Snowy Day, Winter 2014

 I am not that different now than I was as a kid, with the prospect of a snow storm looming in the future. As the storm approaches and the forecast comes in to focus, I feel the spark of excitement building in my core. I can’t help but feel this quickening, the magnitude paralleling the magnitude of the anticipated storm.

Here in New England, we are bracing for a storm of “historic magnitude”, “Top 5” , whatever that means. A nor’easter predicted to blow in and lay down between 2 and 3 feet of snow where I am. What a thrill!

Things are different now, of course, than in childhood. Instead of the delicious prospect of a bonus day off from school, spent “helping” dig out, playing in snow, and getting Mom or Dad to make up some hot chocolate or a warm nourishing comfort-food meal, more practical preparations and planning take precedence.

The planning is ever present. As a doctor, and especially an on-call general surgeon, it is critical that I be able to get to the hospital regardless of the weather. Continue reading

Working Christmas: On ‘Being Essential’, Together

Do they know it’s Christmastime at all? – Band Aid

 

Snowy Wreath

Snowy Wreath

This is for all of the doctors and nurses. For all of the police and firefighters, EMTs and paramedics. P.A.s and N.P.s, techs and aides. You know what I’m talking about.

We are the “essential personnel”, the ones whose work includes nights and weekends and holidays. The ones who go out in the storms, even when everyone else stays home. “Stay off of the streets, except for essential personnel.” Schools close, businesses and banks and government close. Hell, even Dunkin’ Donuts and 7-Eleven close. But no closures or cancellations for “essential personnel.”

We essential types work lots of holidays. Correction, all holidays. Our friends and families miss us, learning over time to make the adjustments and accommodations for the holiday schedules. We hope they understand. If we are all very lucky, we can sneak in an early or late celebration. We sometimes miss it all completely. I think our families get a raw deal out of this; they don’t have the work responsibility to justify the interruptions and cancellations. They sacrifice, too, maybe more.

When Christmas and the holiday season come to the hospital, the atmosphere is festive. Continue reading

The Fragile Surgeon: A Fear for the Heart of the Profession

“You are human and fallible.” -Charlotte Bronte, Jane Eyre

“Alas, the frailty is to blame, not me – for such as we are made of, such we be…” -William Shakespeare, Twelfth Night

“Sha-doo-bee, Shattered…” -Mick Jagger, “Shattered”, The Rolling Stones, Some Girls (1978)

"Heirloom", deconstructed/cut china - Elizabeth Alexander, artist

“Heirloom”, cut china,                artist, Elizabeth Alexander

It seems incongruent, an oxymoron, even slightly disloyal, to refer to surgeons as fragile. Preposterous.

The Image of the Surgeon is synonymous with strength. Surgeons are stereotypically charismatic, commanding, confident, even arrogant. Strong minds, strong bodies, strong wills. Leaders, especially in the operating room; they even act that way in other healthcare teams and committees, even if it is not their official role. Surgeons endure long hours, grueling surgeries, all in addition to full office and clinic loads, and inpatient hospital census numbers on par with their non-surgical colleagues. It is intellectually, physically, and emotionally challenging work. Surgeons seem to relish it, thrive on it.

This is exactly why surgeons are so fragile. All of them.

I had an epiphany at the end my 4th year of medical school, when we were in small group seminars dealing with aspects of life beyond graduation. I don’t even recall what that session was about. But I remember clearly that it struck me quite suddenly exactly how physical my chosen field of surgery really was. That, unlike my friends and classmates who were heading towards other fields, my ability to do my job as a surgeon was going to depend not just on my will and intellect, but on sheer physicality and functioning senses.

A surgeon has to be able to stand at the operating table; both hands and arms need to function. Senses have to work — vision, hearing, speech, touch. Unfortunately, smell too. (I wish I had known about smell, although it probably would not have deterred me, just prepared me.) I realized it is a very, very physical job. Losing the function of any one sense or limb could alter the ability to operate, the ability to be a surgeon. Internists can still practice from wheelchairs or with accommodation for myriad physical or sensory impairments. Other specialties that perform procedures retain their full professional identity and ability to continue in those fields, even with limited ability or inability to perform.

But, what is a surgeon who doesn’t operate? Continue reading

Lessons From Zachary: What a Physician Learns From the Death of a Dog

“You think that dogs will not be in heaven? I tell you, they will be there long before any of us.”Robert Louis Stevenson

 

My dog died three years ago today.  On this day I will remember him, and share a little bit of him with you. These are the lessons from Zachary that I learned during that fall three years ago, on the final leg of our journey together.

Zachary was the first dog of my very own. He was a flat-coated retriever, and a fairly typical example of his breed. Typical of the breed’s “Peter Pan” personality, never growing up. Smart and energetic and goofy and quirky and unique, all of which made him an absolutely typical flat-coat. I could write on and on about his qualities, both endearing and frustrating, and regale you with stories. We would have some good laughs. But let’s save that for another time. We will also hold off on discussing grief, or mourning pets, or the role of pets in our lives.

Let’s just say my dog was a very good dog, and that I still miss him.

He was diagnosed with cancer around September 17, 2011, and died on November 15 of that same year. I learned a lot in that eight weeks. He had malignant histiocytosis, a cancer for which flat-coated retrievers and Bernese mountain dogs share a genetic predisposition, as yet to be defined. It is an otherwise rare cancer, but it is also a rare and difficult-to-treat cancer in people. In fact, there is research at the NIH, as an offshoot of the Human Genome Project (the Canine Genome Project) which studies this cancer in hopes of unlocking the secrets to aid in testing, diagnosis, and cure –for both people and dogs. This research is in part funded by Flat-Coated Retriever and Bernese Mountain Dog breed groups. Zachary was able to contribute to this as a healthy youngster, and again later after he was diagnosed, in his final moments. My choosing to participate offered me some comfort at the time, and still does. Untreated, dogs usually have a life expectancy of 2-6 weeks; with treatment, that can extend up to 6 months, give or take. Zach did not respond to treatment, to put it mildly. He did not tolerate the chemotherapy. He made it 8 weeks from the time of diagnosis.

As a surgeon, I am no stranger to death and dying. I treat cancer patients nearly every day. I have cared for many patients and their families, from the initial biopsy on to the end. I thought I would be well equipped to handle this, given my background and experience. I understood the concepts and differences between treatment and cure, palliation, and hospice care. But I soon realized that I still had a lot to learn. I am still surprised at how much I had to learn, how different it was in dealing with my dog whose life was slowly and inevitably slipping away. Continue reading

Changing the Clocks – Timely Observations

“Let’s do the Time Warp again!”  – The Time Warp, The Rocky Horror Picture Show

 

IMG_1911I am always a little out of sorts in the days that follow the time change every fall and spring.  I find it easier to get up in the morning when it is light out. In the fall, that is only temporary, and the light continues to slip away and fade as we pass into winter, when the days – or at least the daylight hours – are shorter. So changing the clocks only provides transient respite from the coming dark mornings.

I think people might like the idea of adding an extra hour to their day, as we change the clocks in the fall and despite the annoyance of resetting clocks, as much as they dislike losing that hour in the spring. We all imagine a luxurious extra hour of sleep, though that fantasy is usually thwarted by the reality of our schedules and our internal clocks (especially if you have pets or small children, even if your own internal clock can be ignored). Those internal clocks take frustratingly longer to adjust, so you end up simply waking an hour or so early. When we lose that hour in the spring, we almost invariably sacrifice an hour of sleep, as our busy schedules end up  overriding both lost hour and internal clock. We can be out of sorts with a side of zombie as we tackle those first few days.

The view of the time change is a little bit different for doctors, and anyone who must be on call for their job, though much of what I have just observed still holds. I can speak best to my experience of this as a doctor, though, so it is that perspective I will use. I view the time change, and much of my world in fact, through the prisms of being on call and the on call schedule.   Continue reading