Taking my leave...

Graduation came and went with its traditional flavor of near-miss fulfillment. It was accompanied by the same unlocatable sense of unease I've long recognized when wrestling with the moments we're taught will linger in memory when lights dim, voices hush. It was wonderful seeing my entire family, although try as I might, I couldn't shake the fatigue from behind my eyes. The fundamental truth of my life boils down to this simple observation:

I am very tired.

Not depressed. Not ungrateful for the amazing opportunities that have come my way, nor the incredible job I have managed to negotiate for myself. Not unaware of how blessed I am to have the wife I do, or the kids who've moved into our lives with attendant clutter and din.

Just tired.

I am grinding through the last days of my current contract trying to espouse the values I cherish most in other physicians: dedication, attention to detail and awareness of the patient's needs. I am trying to be the kind of doctor my father would respect, but as with any marathon near its end, I find myself a little short on inspiration. So I am left trying to marshall what resources I have and do my bit to make things better in the small ways one can in the ICU.

I am also looking forward to three months to recharge the battery and set the table for a smooth transition into my new adventure. But mostly, I am working hard to ensure I leave on a positive note. Although training at times has been frustrating to the point of disgust, I voluntarily signed on for eight years of it, and most of that time has been educational, productive and purposeful. The trick in these matters is to make sure you hold your tongue regardless of the provocation, and refrain from sharing your parting shots with anyone. Nothing to be gained in burning a bridge in medicine. The path a career may take is convoluted these days, so I am trying.

But this challenge has its moments. Like I said, I could use a nap.


Midlife, midnight...

I spent yesterday afternoon accompanying my beautiful girl to the funeral of her friend. Our friend really, but U knew her much better than I. She was only 40, and had 2 very sweet and brave boys. Like many others I have met over the last 12 years, she fought a long, impassioned battle against her disease before finally succumbing.She was lovely and sweet, enjoyed her kids, really felt at ease in her own skin. She, like my wife, was the kind of woman the line "she walks in beauty" was inspired by.

My wife and I met her because she was the wife of a colleague. As a man who loves his girl, and a Dad who lives for his kids, I recognize a kindred spirit in my widowed friend. I tried to process the idea of a life without my wife, having to guide my kids through the unsettled waters of adolescence without her there to steady the oar, and my brain refused to cooperate. It is simply not possible she could ever die. I will not be without her. And it wasn't to willing to contemplate my own mortality. But with the image of our friend's 6 year-old boy constantly going over to the open casket to check on his mom, his photo resting gently in her hands, it didn't seem much of a reach to imagine my son, now 4, looking on as I lay there without motion, wondering why I wouldn't open my eyes.

I will remember that funeral years from now, for the weather colluded with our little tragedy to try to show me something. The sun was bright, and the sky peppered with clouds, but open to the blue canopy freshly tinted. It should have been a perfect day. Beneath the vault, at ground level, as I walked arm in arm with U, a wind both chilled and unflinching bored straight through us. Its pierce did not relent the entire walk; a monotonous, clinical ache that even the van door could not quite deny. That instructive, unhappy walk felt much like life broken down to its truest units. Beautiful yes, but also painful, unsettling, and intrinsically unknowable. Almost every religion I have studied, including Islam, has made the somber observation that our life is a veil, an illusion. Pitifully, that is about the best we mortals can do; that God is real, and waiting to transform us into something immortal. We then allow that all the suffering we encounter (and I have encountered plenty in the last decade), and all the love we struggle to learn to give and receive approaches only the smallest part of our truer reality, a single star held up against the backdrop of the cosmos we become. We inherit infinity, rendering mortality a consummation devoutly to be wished. Assuming, of course, we don't spend that infinity on a lake of fire or in a river of tears. After all, what mortal crimes exist, which when held up against an infinite suffering would not lead even the faithful to wonder at the code of justice the stars wheel upon?

The alternative saddens me every time I allow an eye to turn to it. That I and you, and those miracles we raise and love beyond ourselves are each of us doomed. That there is just this one quick breath, fleeting, inspired, frantic, and then it's back under, into that unspoken dark we were briefly rescued from. Each of us fundamentally lost to each other; our only consolation being our inability to speak the name of that loss any longer.

We sat in our seats, lost in our thoughts, she weeping softly, I fighting off my training, which insists on intellectualizing my sorrows. It can be a useful skill when you take care of people who die, but it has no role when you are a participant in the drama - one who cares and should care about the lost, and moreso, about the ones grieving the lost. I was eventually unsuccessful in that battle, and felt my inner light growing smaller, my mind calmer and detached in a heartless, infuriating way. I did my best to hide this from U, but she knows me too well, and didn't seek me out once the whole way home.

I didn't see her smile again until she held our daughter later that evening. M is the very imbodiment of a grand, flamboyant soul who exists to take a huge chomp out of life. She possesses the innate, robust confidence that comes from understanding we are by definition immortals, and are sojourning together now in order to chose companions for a longer travel to be embarked on down the road. I too felt warmed by her presence and held her face close to mine for reassurance and comfort. I was rewarded with her singular laugh.

Today I turned 35.


Beyond the beginning of an end...

Another lunar orbit and I find myself missing my blog enough to put digits to keys and make the out-of-tune music that passes for an entry.

This is my life after telling my mentors I am leaving academic medicine to take a job closer to home (Toronto). My current status as a wayward son came about unevenly. Considering my strength has generally been an ability to understand people's needs and communicate mine clearly, I am disappointed in how poorly I drafted my exit. The dread of the complexity paralyzed me. Instead, I allowed circumstances to dictate the moment of my announcement. My plan was to craft a goodbye that was considered and considerate. I did not.

It went wrong from the start - with me breaking a promise. I had told my program director, who has come to be a mentor and friend, that I would tell her first whether I was turning down the job with them. It wasn't to be. Although there were no new developments (in fact I still haven't signed on a dotted line), my chairman, called me into his office to touch base. I had promised him I would let him know by the 15th of April and hadn't done so. I procrastinated a week because I just didn't want to deal with hanging around for 2 months with everyone feeling I let them down, or was rejecting them. But I could dodge it no longer, and to his inquiry of "any developments?" I told him the simple truth. "Yes - I haven't signed anything, but assuming they deliver a contract that looks like what we discussed in our last meeting - I am going to take the job in Buffalo."

I know. Buffalo. I am in one of the most in-demand subspecialties in Medicine and could go anywhere in the U.S. My wife is in another such field, so presumably the world is our oyster. And I am moving the oyster to Buffalo. The answer isn't in the doubling of compensation - though a few have made that somewhat snide assumption. The answer lies in who I am, and what I always wanted. I am getting to live 2 hours away from my Canadian home, and be closer to my mom & dad, at a time in my life when it feels like that's the right place to be.

Plus, as a Torontonian, I've been a Bills fan since before the streak of Superbowl heartbreaks began. So that's something. And the fact that I'll have my weekends off and 6 weeks a year to get my life back. If it unfolds as hoped, it should be a great deal. Mind you, I still haven't signed anything. So I could just as easily be back in the boss' office, asking for the job back...talk about humiliations galore...

Anyway, I told the Big Man I was going, and he was warm and kind about it, indicating the door would remain open just in case. But he also emailed my other mentors the minute I left the office to tell them they would need to press on with recruiting because I have given them an official "no". Understandable, but put me in a tough spot since I was unaware of this fact.

Needless to say, you can't tell everyone something first. But if you tell someone you're going to tell them first, you can expect them to be fairly cold when in fact you tell them second. Or can you? I am still conflicted about my director's chilly reception the next morning when I went to her office to tell her. "Yeah I already heard. That's fine." was about the gist of it, only half-facing me before returning to her monitor without a goodbye. We've since patched things up, but that response really confirmed for me that I was taking a necessary step; out of fellowship and way out of my comfort zone to go it on my own for the first time in a long time. I think I needed a little nudge to pull the trigger, and that interaction was the key. I smiled as I left her office, and was actually laughing like a parolee as I left the hospital that day. "Onward and upward", I thought. And still so hope.

The next day I arrived earlier than usual and packed up the vast majority of my books and folders and moved them to my '99 Camry [don't mock the ride - for the brunt of training I've been cruising in a '93 Maroon Corolla]. I had two months to go, but in the pre-dawn light I tore down a cluttered and memento-rich cubicle I had occupied for five out of the eight years of my training in less than 2 hours. I intend to walk out on my last day without even a lab coat, not even an extra piece of paper in my pocket. And I want anyone wandering by my desk from now on to be clear on the idea that I might be here, but I am going, going, gone.

And so I float through these days, calling patients I've known for years, telling them what an honor it was to know them and try to help them a little. I listen (patiently I hope) as they express regret over my departure, and concern about who will care for them now.

I have seen this Departure Play before, and I know with certainty that I am eminently replaceable. This hospital has stood for a century or so and will stand for many more to come. I was part of a great idea and was proud to be so, but I am going nonetheless, without a worry that things will work out fine at my medical alma mater.

I can't deny I feel good. I feel clean and free like I did when high school had finished, but university with its unyielding realities had yet to happen. Perhaps I am free to reconceive myself this one last time, before adulthood and its unrelenting hold finally settles itself on what it is that I am.

Fair enough.

Edit: on a related note, I am going to indulge my Peter Pan conception of retirement by visiting Vegas this fall, as well as playing in some live and online poker tournaments. To Wit:

Poker Tournament

I have registered to play in the PokerStars World Blogger Championship of Online Poker!

This Online Poker Tournament is a No Limit Texas Holdem event exclusive to Bloggers.

Registration code: 7330476


wherever you go, there you are

There must be something about mid-month that has me checking my blog and thinking I should update. Experience is teaching me a little respect for the process and I would now guess that once a month is more likely an update schedule for me. Not that I don't enjoy writing here, but my machine is so slow typing the words feels tiring and forced at times.

But sometimes not, and I like the idea of an older me and/or an older version of the kids we now have getting curious about what I used to sound like. So this was me, spring 2006, at the end of fellowship and holding something very much akin to a Golden Ticket firmly in my hand. No, that's not a metaphor for anything too unseemly - I just received a Fed/Ex with the final terms of agreement for a job in Buffalo that has become too good to refuse.

Today is the day I say goodbye to my medical home for the last 8 years. With 76 days to go until my fellowship formally ends, but after 8 long, frustrating, and often amazing years, today is truly the end of training. The study I write in is deliberately adorned with the products of U.'s and my time here; a synchronicity of degrees, licenses, certifications and of course, all important Boards. I'll admit no small satisfaction looking at them, but mostly they remind me of the resolute [crazed?] optimism that drove us to keep training. I look at these framed trophies of the last decade, shields taken in battle, now mounted as witnesses to a youth now fading and its true, I smile. Which is reassuring, because if we did sacrifice our 20's on an altar, I know it wasn't in vain. We both get to do work that is rewarding and useful, so Thomas the Tank Engine would be pleased with both of us I think.

There's a book in these last eight years, and I've already found its title. The rest will follow, I hope, if for no other reason than this next generation of physicians is waiting for a story that will speak to them. Yeah, they could just watch Scrubs, like we all do, but it can't go on forever. Besides there's only two kinds of doctors in this world: those who really wanted to be architects, and those who really wanted to be writers. At least my half of the guild can always get a late start on the dream job. I also wouldn't mind making a final table at the WSOP, but that's proving tougher than originally anticipated.


the what's what in so many words...

So I've noticed I don't update much.

2 reasons, one good, one not good and if there are more they're inscrutably Freudian and would take a more introspective mind than this one to reveal.

The Good:
I am living a pretty full life these days. The melancholy I can see in my last post is nowhere to be found in my head these days. Z arrived safe and sound and began her journey with us. She's amazing and smiles brightly and lightly. We could use a low-key introvert around here, but from the looks of it she's not going to fit that description very well. She already looks at you like she knows...you know. She just knows. And I love that she knows. Too good, too good.

In addition I think I've finally accepted fellowship is coming to an end this June, and with it my time here is likely drawing to a close. Mentally it's been like I'm preparing to leave a marriage, and I guess that's a good analogy because I've seen more of the Towers than U over the last 8 years. The Powers that Be made me a strong offer and I was set to take it until Buffalo provided an alternative that is just too good to say no to. As far as problems go, that's a good one I know. A genuinely flattering one. For the first time in a while, everything's is humming along nicely. An interesting note (to me at least): since I started to consider leaving the nest, I've begun to eat healthier and exercise again....that has to mean something...

The Bad:
My computer is very slow. No doubt I've downloaded a dubious file or two in my time (insert my standard "Red-Blooded Canadian Boy" defense here), but this is ridiculous. I feel like formatting the hard drive and starting from scratch. It really has made it a chore to log on and blog, despite my alleged DSL connection. But I am pushing through and going to challenge myself to try to write something, anything everyday for a week. This has already been a pretty amazing 3 months of my life and years from now I'd like to be able to sift through this ephemera and celebrate my depudgifying self with the clarity that only my insightful prose can provide. Naturally you, my loyal subjects/readers/fans will have this opportunity as well through the glory of my archives.

But not before I format this frakking harddrive and start from scractch.

Actually maybe I have hit on Reason Number 3. I feel the need, even if only for myself, to write well here, and be entertaining if possible, again if only to myself years from now. With the hours I keep and my odd schedule there has been a reluctance to sit here with less than a full tank and try to make it work. Until I hit on the solution:

Screw quality and just go for daily entries of varying stinkiosity confident that statistically something brilliant has to come out in the end.

So for anyone still passing by, the Merdstorm of posts is upon you. Good night and Good luck.


the year ahead

I've waited so long to post again, all of you who initially checked in and left comments or emailed have probably assumed I've given up on this project. Reasonable, but as it turns out, I like this occasional creative outlet and actually think about it when stuff happens around the homestead. If it turns into nothing more than a record for a guy who's good with medical details, and lousy with personal ones, then that alone would make it worth the effort. So welcome to 2006, and on with the show...

To start, I am now officially Board Certified by the A.B.I.M. for my second specialty. Some of you may have heard me addend the phrase with A.L.B.L. [At long bloody last]. The other thing that pops into my head is 2 down [IM, GC] and 1 to go [EP - coming to a computer terminal near you November 2006]. There was a moment of personal euphoria when I found out - I stepped outside myself on some level and timed it at about 15 minutes, but mostly the satisfaction came from the reaction of my wife - an enthusiastic hug and kiss that made me feel truly joyful, like I did when we were a little younger and were taking our USMLE exams to get residency spots. Equally uplifting was the warmth and celebration of my friends and family. As cranky as I get about the process, it does provide incontrovertible proof that I am fortunate to be surrounded by quality people who genuinely care about me. After a day of heart-felt congratulations and hugs, it felt like these things really mattered.

Which as everyone knows, they do and don't. Fail something like this, and the reattempt will feel like you're climbing Mount Improbable -doubt is not only palpable but a taste that never leaves the mouth. Pass one though and very quickly, despite your best attempts to stave it off comes the inevitable sense of ennui, the undeniable instinct that nothing could adequately compensate you for the valuable time, work and anxiety you invested into the effort - least of all another piece of paper for the wall. But this is the game, and it still feels good to know progress in some limited form, is being made.

On the homefront, we're still waiting on Z. Life is an anticipitatory lull, cleats in the blocks, breathing quicker, just waiting on the gun.

The other two just get more interesting with each day, L is reading and M is quickly catching him on verbal skills, so the house is full of talkers, opining on everything from the observation that I watch too much TV to the fact that I haven't used my Smith Machine in over 3 months. Which is true...the other day in the CCU, a nurse who's known me since I was an intern greeted me with the so-true-its-painful: "Doctor, you are getting tubbier every day." Moments like that I try not to lose sight of what an odd guy I am, and try to and enjoy that about myself. Equally so, I like to have something to work on. So I guess I'll go work out. Pray for me!


Santa's little helper caught redhanded

Works in progress...

No small amount of time has gone into this kitchen update. We don't plan on living here forever, so we didn't gut the place and start from scratch, but instead tried something more in the spirit of restoration, or reimagination. It's been fun - laughing and joking as we surreptitiously snuck out of the house for a couple of hours to look for brushed nickel hinges, trying nonstop to one-up each other with endearing tales of Mr. Man and Little Miss.

We aren't done yet...looks like after the new counter and sink go in I'll need to repaint. This makes me glad I used the lasts-till-Doomsday Behr Premium Plus 12 months ago...very glad....

Where was I? Oh yeah, restoration. The whole house has been like this: an exercise in what's reasonable, what's possible, and finding a great deal of enjoyment - mixed with an uneven assortment of some of my more irrational moments - found in the act of reshaping things. For what it's worth, the image in my mind's eye is slowly coming into focus, and that's rewarding in its own right.

More importantly, the whole process of making this 1950's bungalo intended for a family of three, modified to accomodate four, and now housing five of us - soon to be six! - our home has reminded me how singular a women my wife is. This renovation has been the easiest out of the many projects we've worked on (could it be because I've done the least actual work on it?) and its reminded me that we're still having fun, and she's definitely still the one. It's hard to find a good girl, and even harder to be worthy of one. But it's a good problem to have.