Thursday, December 31, 2020

In Memoriam: 2020

I. 

On New Year’s Day I was getting my Instant Pot off a shelf, when the heavy metal lid fell off, landing on my face and splitting my lip. Even though I didn’t lose a tooth or need stitches, it felt like a bad omen for the new year. Then Australia caught on fire, a preview of the autumn fires of our West coast. There would be more heartbreak and fires during the Black Lives Protests. And of course, the dumpster fire in the White House continued to rage on.  

I pretended everything was fine, starting the year with my usual travels and work. I was busy operating part time at Kaiser Permanente. I spent a week in January and February at the Northern Navajo Medical Center in Shiprock, NM. I stayed cozy at a B&B in Farmington NM, walked foster dogs in Animas Park, found the local movie theatres.  There was some weird green slime coming from the OR faucet, temporarily halting surgeries.  It turned out to be copper residua, not an alien life force.  That would come later.

In February my friend Anne and I went to Panama. We did a day tour of Panama City with a local guide, visiting the Canal, Casco Viejo (Old Town) and the modern center, and Alcon HiIl Viewpoint. The locals were fun and festive, partying like it was 1999. Anne and I then went to the appropriately named Tranquillo Bay eco-resort on Bastimentos, an island visited by Christopher Columbus in 1502. The four days passed quickly, kayaking, snorkeling, stand up paddle-boarding, and hiking. We saw lots of tropical bird, fish, and wildlife, including capuchin monkeys, sloths (2-toed and 3-toed), and stingrays. Little did we know that would be our last international adventure for the year.


I was foolish enough to take a walk in Fairbanks, Alaska in March. It was minus 27 degrees F, enough to freeze my eyebrows and eyelashes. I was visiting with my friends Shilpen and Yuming. We saw the International Ice Art competition, the Alaska pipeline, and the Arctic Circle. We had also come to view the Northern Lights, but the cloudy sky permitted only hazy shadows. The airports felt weird as we headed home to a changed world. It was the last time we would travel without masks, huddled together, sharing stories and food.  



II.

He was always upbeat, a large man in a small store. The Leschi Market is a neighborhood institution with five aisles, one of which is devoted to a well curated wine selection. As the store was next to my condo, I was there several times a week. Steve was the owner, the greeter, the unofficial mayor of Leschi. He had met my niece and asked about her when he saw me. He was interested in my travels and my job. He knew I was a doctor, but never asked me about his own health problems. Of which he had many, too many to survive his ICU stay. This warm, gregarious man became an early Covid casualty, felled by his own sociability.

Seattle became an epicenter of the coronavirus. We were fortunate to have a progressive governor who rapidly instituted public health measures to minimize the spread and prepare for the surge. Our behaviors and language rapidly evolved to deal with the pandemic. The initial panic seems a lifetime ago, but it was only March when the masses hoarded toilet paper, hand sanitizer, and rice. Terms like “flattening the curve,” “social distancing,” and the “quarantini” entered our vernacular. Apparently hand washing was a novel concept for some people. FYI: It’s good everyday practice, not just for special occasions. 

My parents had been planning to leave Kentucky in the spring. Their Louisville house sold in one day in mid-March, just as the national crisis started. Suddenly driving across the country and moving into an apartment building did not seem like such a good idea. Their current house was spacious, private, and peaceful, ideal for social distancing. I had to do some finagling with the real estate agent and buyer to get out of the contract (see Force Majeure). My parents have remained relatively comfortable and physically healthy, but the social isolation is taking its toll.

For the first six weeks of the pandemic, all my orthopedic work stopped. I filled my days with various projects, pretending like I was living a normal life. Every morning I savored the smell and taste of my coffee, watched the sunrise, stretched my body, grateful to be alive and healthy. I checked off tasks on my endless “to do” list (mop floors, change the sheets, organize the pantry).  I cooked all my meals with an increasingly plant-based focus. The rigorous routine was not enough to stave off the daily existential crisis—the hollowness in the chest, the quickening of the breath, the pounding of the heart.  “Is this going to be the rest of our lives, missing the things that make us most human, the things that bring us joy—music, art, theatre, travel, sharing food, intimacy?  Is this all there is?”  It was sadness and grief and loneliness rolled into one wracking ball.  I meditated, did on-line yoga, reminded myself to breath in and out, to keep going. I walked through two pairs of running shoes. 

Books have traditionally been my preferred coping mechanism during troubled times, my lifeline when I am drowning. I read to laugh, to escape, to feel the feels.  So many feels that I read 60 books.  In March I read Victor Frankl’s Man’s Search for Meaning, figuring if he could get through the Holocaust and remain optimistic, I could certainly manage a quarantine.  I re-read Boccaccio’s Decameron and learned how the Florentine nobles wined, dined, and story-told their way through their pandemic. I finally read Anna Karenina and Wolf Hall.  My favorite book from this year was Hamnet, a novel set in Shakespearean England about the Bard’s family, full of joy and grief, poetry and magic.  It serves as a reminder that Shakespeare did his best work during the bubonic plague.  I was lucky if I managed my morning pages.

Although I did not write much, I did throw myself into intellectual activities. I decided this was the time to learn to write code; I lasted one session.  I recertified my BLS and ACLS training, in case I would need to do more than orthopedics.  I completed the annual self-assessment exam for hand surgery; the annual maintenance of certification for orthopedic surgery, wrote a book chapter on global volunteering, and attended many virtual lectures on politics, art, environmental issues. In the fall, I took a Columbia colloquium, revisiting my favorite Core Curriculum classics (e.g. Homer, Sophocles, Virgil). I found myself excited for the weekly sessions, engaging in timeless ideas of morality and leadership, civic duty, transformations, journeys, and self-knowledge.  

While engaging my cerebral side was great fun, I ultimately needed to feel useful. I was happy to go back to medical consulting work after six weeks. The work kept me busy, out of the house, out of my head.  I returned to Shiprock in August, having been away since March. The Navajo Nation had instituted strict curfews and stay at home orders, which keeping the pandemic at bay.  I started doing elective surgeries again, including more complex surgical cases. I felt myself becoming more a part of the community, feeling more accepted by staff, patients, and colleagues. I spent a day hiking and bouldering in Canyonlands. Then the next surge began in November... 



III.

“Hope” is the thing with feathers -

That perches in the soul -

And sings the tune without the words -

And never stops - at all –

Emily Dickinson

I was filled with anticipation the days leading up to my first vaccine dose, and a sense of relief immediately afterwards. Since the presidential election, we have been guardedly optimistic, recognizing that after the man-made and natural disasters of the last year (indeed the last four years), nothing can be taken for granted.   



In 2020, we created lists of silver linings, filled gratitude journals, said farewell to the things we do not miss. We have found our pods, those select people who share our need for connection, our respect for science, and willingness to exercise caution.  And for those not in our pods, we have reached out and re-connected with our core people via Zoom and cellphones.  We have learned to care from afar, to show kindness in non-physical ways, to smile with our eyes. 

                                              


So as we leave this year and move forward, I share with you the Metta meditation:  

May you feel safe. May you feel strong.  May you feel happy. May you live with ease.


More pictures  In Memoriam:2020


Bucket List

This is a piece I originally wrote for the American Society for Surgery of the Hand "Perspectives" in December 2020.  

Bucket List

I put down the deposit last week.  I had checked cancellation policies and insurance coverage before booking the trip to the Pantanal.  2020 has been challenging for everyone; traveling has been one of many casualties.  The year started out well enough—snorkeling and paddling at an eco-resort in Panama in January, the World Ice Art Championships and the Northern Lights in Fairbanks in March.  Then the world shuttered, and travel was both imprudent and impossible.  At this point I would be happy to hug my parents, share popcorn at a movie, and listen to live music.  Modest dreams have taken on Mount Everest proportions. 

I stopped having a bucket list a few years ago.  It wasn’t because I had checked off all the “once in a lifetime” adventures.  It was because several close friends had died unexpectedly.  They did not live to see retirement, to enjoy time with family and friends, to see the wonders of the world.  As physicians we are well aware of the frailties of the human body but don’t always consider our own mortality.  I left private practice and embarked on a self-styled sabbatical to re-evaluate my path.  For six months, I road tripped through ten American national parks, white water rafted down the Zambezi, visited the monasteries of Tibet, and walked along the Great Wall of China.  I operated and taught in Malawi and Myanmar.    

The pandemic has reminded us that our lives are not entirely in our control.  This global crisis has drawn focus to the inter-relatedness of the climate crisis, economic disparities, and public health.  The trafficking of pangolins, a wet market in Wuhan, and international flights can lead to a nursing home outbreak in Seattle and a shut-down of elective surgeries.  The planet is changing in rapidly alarming ways.  In 2006, I visited Antarctica, camping on the permafrost, kayaking through bergy bits, immersed in glaciology and the unique biology of the polar region.  Each penguin species was uniquely adapted to its icy setting.  Five years later, my kayak guide informed me that Petermann Island (a spot we visited off the Antarctic Peninsula) was now green, and the Adelie penguins were gone.  

So while I don’t have a bucket list, I do have a Doomsday Travel list.  I visit sites at risk of losing their unique biodiversity.  Our planet is as fragile as our bodies.   Coral reefs are blanching, rainforests burning, the polar ice caps melting.  Deforestation has resulted in habitat loss for Borneo’s orangutangs and Madagascar’s lemurs.  The indigenous cultures of the Amazon are being threatened by the oil industry.  The Inuits are dealing with shorter winters, less ice, and more open waterways.  I don’t have the answers to these daunting problems, but I can document, educate, and advocate for change.  Next stop, the Pantanal, the world’s largest tropical wetland, spanning Brazil, Bolivia, and Paraguay.  I seek the elusive and mythic jaguar.  I hope I’m not too late…











Friday, March 20, 2020

The Gift of Space

So much can change in one week.  Last week I was seeing patients in clinic in Kaiser Permanente (KP) Seattle, doing cases in the surgery center, getting ready to head to Shiprock New Mexico for my week at the Indian Health Service.  I had been asked to help out with KP clinics in Bellevue.  Sunday I flew to Albuquerque.  The airport and flight were empty, people keeping respectful distances from one another. When I landed I received the text from the Shiprock Chief of Surgery.  He explained he was getting push-back about my coming, that they would prefer I stay in Seattle, a high risk “hot spot.”  This despite my confirming with the Chief two days earlier that I should come.   So I turned around and flew right back to Seattle.  I wasn't entirely surprised; everyone is anxious and afraid.  They think closing borders and building walls will keep out the virus.  Little do they know it is already here.  As of this morning, the Navajo nation has fourteen documented cases of Covid-19.

On Monday I went to KP clinic with the new mandate that non-urgent visits be converted to phone visits.  The CDC guidelines had come out a week earlier and included recommendations to cancel non-urgent surgeries.  Virginia Mason, Swedish, and UW/Harborview had already instituted these changes; now KP was following suite.  So I reviewed my current clinic patients and verified that most visits could be done virtually.  Later that night I received a call from the KP Service Line Chief thanking me for my help, but my services were no longer needed.  As a locum tenens (temporary, part time) surgeon, all my patients are non-urgent.  With the belt tightening and redistribution of resources, I am too expensive for the organization.  I could not even have final phone visits with my post-op patients.  I abruptly went from three jobs to none.  So here I am, taking an unplanned, unpaid sabbatical.  But don't worry about me.  I got this.  I have been training for this my whole life.

Social distancing is my default setting.  Social interaction is an intentional override of my basic programming.   Four years ago when I quit my full time practice, I had planned on taking six weeks off to breath, to think.  Instead, I immediately embarked on a three week road trip.  I start doing independent medical exams.  I spent six weeks in Africa; six weeks in Asia.  When I came back to the US, I start working in Delaware.  Over the last year, I've been doing clinic work in Seattle and in New Mexico, and continuing with IMEs.   I never took the time to reflect, to just be.  Until now.

How will I use this newfound space and time?  First of all, by connecting with other people in this unfamiliar situation.  This blog will be one way of reaching out to people out there, people who feel alone and anxious.  Even though I am a physician, I will not bombard you with medical information.  There are reputable sources out there (CDCWHOJohns Hopkins Public Health).  While there are well intentioned posts on Facebook, many are from untrustworthy sites.  Yes, this is a serious public health emergency, but please don't get overwhelmed.  Take a social media break.

If you do need some simple rules to follow, here they are.  Remember, I am a  (over-educated, under-employed) medical professional.

Wash your hands.  
Cover your mouth with a tissue when you sneeze or cough.
Stay at home.
Don't eat pangolins.
Don't stand so close to me (okay, so this last one is about hot teacher Sting having impure thoughts about a student, but still.)


"Tell me, what is it you plan to do with your one wild and precious life?"
                                                                             Mary Oliver

Here are some thoughts for how to spend a day.

1) Practice gratitude.  Be thankful if you have shelter, food/water, meaning, friendships, family.
2) Reach out (virtually) to those who may be struggling.  The elderly, sick, those shut-in with restless children and surly partners.  Use technology to connect, rather than alienate.  Call someone every day.
3)  If you can, donate to organizations that provide services for those who are hurting.
4)  Read that novel that's been sitting in your nightstand forever.  Start writing that novel that you've always talked about.
5)  Listen to your favorite music (aka desert island discs).  Check out the new shows, music, movies people have been talking about.  Netflix and chill literally.
5)  Practice your instrument, your art.
6)  Do an online exercise or yoga class.   Take a walk (six feet apart).
7)  Take an online class.  Visit a virtual museum.
8)  De-clutter your house (aka clear your space.)
9)  Do your taxes.  Write your will.  Not to be morbid, but we are all going to die.
10) Work in your garden.  Spring is here.

Over the next few weeks, I will try to blog more regularly and share some thoughts on how we get through this crisis.  These are my thoughts, take from them what you will.  We all need to care for one another and ourselves.  I'd like to say every post will be unceasingly cheerful and upbeat, but that will not be the case.   But today I will be positive.

Part of my routine involves a daily walk through my neighborhood (Portage Bay).  Yesterday I strolled to the Arboretum.  Is it me or is the air sweeter since everyone stopped flying and driving?  I breathed in the scent of the creeping clematis.  I noted how the clear blue sky contrasted with the exuberant cherry blossoms.  The elementary school was eerily quiet; just a couple of kids shooting hoops in the playground.  I waved to the elderly couple sitting on their porch.  I recorded the vibrant colors of tulips and lilacs and daffodils.  I gave thanks for the beauty surrounding me.



















Tuesday, December 31, 2019

2019: The Year in Review

Time may be a flat circle, but life is an oscillating wave.  And you don’t know if you are at a crest or trough until you are no longer there, finding yourself on the opposite slope.  In retrospect I can say that 2018 was a trough, and 2019 was a series of peaks.  The start of 2019 found me living in a condo wrapped in plastic and scaffolding, the result of extensive water damage to the building.  Apart from the financial stress of ballooning assessments, the loss of natural light made me depressed.  So naturally I booked a vacation to San José del Cabo (not to be confused with the more raucous Cabo San Lucas).  I spent three days on the beach, snorkeling and kayaking.  I spent three days in a treehouse, practicing yoga in the mango grove and enjoying farm to table meals.  Something shifted in those six days in Baja.  At the treehouse resort, I met writer/teacher extraordinaire Ellen Sussman (more about that later).  On the way home, my real estate agent called to let me know a buyer had made an offer on the condo.



So fast forward through February and March.  I sold the condo and moved into a rental townhouse in Portage Bay.  I was sad to leave my beautiful Leschi home, with its lake view and a deck awash in flowers, but happy to be free of the condo albatross.  The sale gave me freedom to focus on more important things, such as governance work with Orthopedics Overseas and figuring out a healthy work-life balance.  Around the same time, I began a temporary stint at Kaiser Permanente in Seattle (previously known as Group Health Permanente, where I had worked for eight years).  After a 3-year hiatus, I rejoined surgical practice in America.  My muscle memory from 20+ years of operating served me well, and I found myself enjoying orthopedic surgery again.  It helped that I only worked part-time, did not have a commute, and took no call.

After a year of vetting, I got offered an “intermittent, permanent” job with the Indian Health Service at the Northern Navajo Medical Center.  This position is a domestic extension of my desire to provide medical care to underserved communities.  As of July, I spend one week a month in Shiprock, New Mexico.  I take care of the Diné population and live on the reservation.  It’s a dry week: no internet, alcohol, trees, or water.  I have taken the opportunity to explore the Four Corners area of the country, visiting various national parks and landmarks (e.g. Capitol Reef NP, Georgia O’Keefe’s Ghost Ranch, Mesa Verde NP).  As a federal employee, with a recently impeached DJ Trump as my boss, I cannot publicly engage in any partisan political activities.  It’s a weird position to be in, but you can rest assured I continue to advocate as a private citizen.


In June, my friend Elizabeth and I took a Scotland reunion road trip.  Elizabeth and I had met thirty years earlier during our junior year abroad in Edinburgh.  After an emotion filled return to Edinburgh, we went to John O’Groats, the Orkney Islands, and the Highlands.  Orkney was rich in historical sites, influenced by the Neolithic, the Nordic, and the British.  We were there during the annual St. Magnus festival.  On the evening of the summer solstice, we heard the BBC Scottish Symphony perform in St. Magnus’ cathedral.  The Scots treated us like long lost friends, with unflagging helpfulness and hospitality.


In August, I attended my very first writers’ workshop (Sonoma County Writers Camp), co-organized by the above-mentioned Ellen Sussman.  Ellen had seen me journaling in Baja and encouraged me to take my writing more seriously.  The camp was held in a bucolic setting, with yoga, wine tasting, organic vegetarian food, and supportive writing community.  Truly my version of nirvana.  I was inspired by the guest writers, many of whom were women of color.

In October I continued my romance with Italy, embarking on a Tofino Expedition kayaking trip in Sicily.  Everything went smoothly, with glorious days of paddling, hiking, and eating.  The trinity of Mount Etna, the Mediterranean, and the sun has created a volcanic island of abundance—of food, of wine, of stunning shoreline and landscapes.  The influx of migrants and refugees from North Africa, Asia, and the Middle East has both stressed Sicily’s resources and contributed to its diverse culture.  Paddling around Cyclops Island inspired me to re-read the Odyssey; I highly recommend Emily Wilson’s new translation.  I was reminded that Xenos can mean both stranger and guest; xenophobia and xenophilia derive from the same root.
Photo courtesy of Grant Thompson
I took my first trip to the Middle East in November and December.  Egypt tested my traveling fortitude.  The pre-arranged transfer did not materialize when I landed in Cairo at midnight, leading to a series of surreal and inconvenient events.  The following day I met up with my Intrepid tour group.  Group travel involves compromise and tolerance, which is why I usually prefer to travel alone.  For this trip, however, I was happy to have the protection of the herd.  Egypt’s political and economic instability, combined with archaic attitudes towards women, have created an atmosphere of constant harassment which is not abated by the heavily armed police presence.  The glories of the Pyramids and the Sphinx, the Alexandrian library, and the Valley of the Kings are reminders that all great cultures crumble into dust eventually.


The Jordan and Oman legs of the trip had far fewer hassles.  I joined a new group of Intrepid travelers.  We camped in the Wadi Rum desert, swam in the Red and the Dead Seas, and hiked through glorious Petra.  In Oman, I spent most of my time working, since I was presenting at an international orthopedic conference (SICOT).  Work feels much less onerous when the desk looks out at the Sea of Oman.  The biggest decisions involved whether to swim in the infinity pool or in the Sea; whether to have Italian or Persian food.  During my SICOT session, I was the keynote speaker, the panel moderator, and the A-V person, all at the same time, adding to my list of new multi-tasking skills.

I finished the year with a week in Shiprock, a weekend in Santa Fe, and a week with my parents in Louisville.  The winter solstice was spent listening to the Desert Chorale perform in St Francis’ Cathedral in Santa Fe.  It was the first time in many years I did not spend the Christmas holidays in Seattle.  Having lived in Seattle for fourteen years, I have forged my own traditions and created my own community.  Ever the wanderer, even I grew weary of travel.  All year I have reflected on what makes a good host and what makes a good guest.  At the heart of the wandering is the eternal quest for a home.  So wherever the end of this decade finds you, I hope you are feeling welcomed, cared for, and loved.

2019: The Year in Review photos





Friday, May 11, 2018

The Place Holder

Every time I go to Philadelphia I am reminded of my hand surgery fellowship.  My year at the Philadelphia Hand Center was a challenging one, made harder by living in the unfriendliest city I have ever encountered (and I have been around.)  It’s difficult to separate that year from the place, so I wasn’t sure exactly what inspired the dread when I landed at the airport.  After collecting my oversized duffle, I headed to the car reservations counter.  I handed the woman my credit card and driver’s license.  She kept her eyes on the computer screen as she asked, “What is your confirmation number?”  Someone else had booked the car rental for me.  “Do you not have the reservation?” I asked.  “Oh, I have it.  I just want to verify the confirmation number.”  I was about to argue until I realized the woman had no front teeth.  I checked my privilege.  Shuffling through the emails on my phone, I located the reservation and handed her the phone.  “Oh, I can’t read that!  It’s too small.”  Bad dentition and poor vision; no wonder she was miserable.  Welcome to Philadelphia.

After reading her the number, I finally got the car keys.  As I put my bags in the trunk I got a rush of stale cigarette smoke.  The driver’s seat didn’t smell much better; the smoke had taken up residence in the upholstery.  I couldn’t bring myself to go back to the counter.  Instead I drove one and a half hours with nausea and a low-grade headache, navigating down congested I-95 to Dover, Delaware.  When I tried to clean the windshield, I realized there was no washer fluid.  “Why is my life so hard?”   I quickly derailed the self-pity train.  “Are you breaking rocks by the side of the road with a baby strapped to your back?  No?  Then zip it and be grateful you have meaningful work.”  This is my usual internal dialogue when I feel sorry for myself.  

On the road to the Residence Inn in Dover, I passed strip malls and fast food restaurants, liquor stores and check cashing services, a casino and racing track.  The place reeked of hard luck and bad choices.  I felt a wave of sadness, not unlike my reaction to Las Vegas, minus the glitz and glamour of dancing fountains, crystal chandeliers, and Rat Pack nostalgia.   I would spend the next week in Dover, and I would return the following five months for a week at a time.  This was my introduction to life as a locum tenens physician.

Locum tenens is Latin for “Place Holder.”  It is a term employed for a doctor who is hired on a temporary basis—a sort of medical migrant worker.  There are any number of reasons a hospital or group employs a locum tenens physician.  Perhaps one of their doctors is on medical or parental leave.  Perhaps someone takes a sabbatical or leaves the group abruptly.  Jobs are often in places that have difficulty recruiting or retaining physicians.  In Dover, the orthopedic group had recently lost a surgeon and physician’s assistant, and the lone hand surgeon was overbooked.  Patients were waiting weeks to be seen.  I was brought on to help with the clinic backlog and deal with emergency referrals. I was only expected to work in the clinic; there would be no call and no surgery. I would work for a week, then spend three weeks in Seattle.  While initially hired for two months, I ultimately kept this schedule for five.

My first day I met the physician recruiter at the hospital to get my photo taken for my ID badge.  As I wasn’t going to be doing any inpatient or emergency department work, there was no need to tour the hospital. I was taken directly to the nearby orthopedic clinic which was housed in a converted shopping mall.    The Blue Hen Office complex contained several government agencies, along with the IT offices for the hospital. The orientation was brief and efficient.  Fortunately I was already well versed in EPIC, the electronic medical records software.  I was introduced to the clinic and practice managers.  Their brusqueness reminded me again of my Philly days.  Perhaps it's the standard demeanor of the mid-Atlantic region.  The orthopedic clinic was organized into window-less pods with fluorescent lighting and piped-in music.  The satellite station was permanently set to the Sirius “Bridge” station, soft rock from the 1970s.  It was an endless stream of Eagles, James Taylor, Simon and Garfunkel, and Carole King tunes.  While seemingly innocuous, the music would slowly drive me insane.  If I hear “Cat’s in the Cradle” one more time…

I am a creature of habit.  My first week in clinic I worked with six different medical assistants. Nothing is more inefficient than having to constantly train staff, especially during the course of getting oriented myself.  Just when one medical assistant had the system down with rooming patients, a new one would be assigned.  The medical assistants were all competent and pleasant, but I grew weary of explaining paperwork, injection techniques, and patient instructions.  It will surprise no one  that I can be demanding.  Eventually I get matched with Becky, who not only took great care of my patients, but also tolerated my idiosyncrasies.  We mastered the finely choreographed dance of patient flow so that as to provide efficient and expert patient care.

As a locum tenens doctor, I was a contracted provider.  I didn’t work for the hospital or facility; I was paid hourly wages by the company that sent me.  It’s not so different from the temp agencies I worked with after college (remember Manpower?) when I worked as an administrative assistant (a.k.a. secretary).  On my first stint in Dover, new patients (and they were all new patients) were given ½ hour appointments.  On subsequent visits, I requested that new patients continue to be given ½ hour visits, with follow-up patients in 15 minutes spots.  I got some push back from the local administration; apparently other orthopedic providers saw all patients in 10 or 15 minutes slots.  Some doctors would see 40-50 patients a day.  I explained that this would not work for me.

On a few occasions, I noticed patients being placed into 10 minute appointments. I would contact the office manager who would apologize and said it was simply the nature of the “template,” and that they would change it.  This happened multiple times over the next few months.  It reminded me of one the reasons I left private practice.  Doctors are the income generators in the medical system.  The more patients we see, the more money the organization makes.  The push is for quantity over quality.

Having a manageable schedule makes a world of difference for both doctors and patients.  People need time. Medicine is all about making that connection.  As a physician I am privileged to get a glimpse into the most sacred spaces of the human condition.  I listen to stories and create bonds over small things and large.  When we can discuss the beauty of hummingbirds, the best hiking trails, the challenges of care giving for a family member, it creates an atmosphere of respect and trust.  As the saying goes, “Patients don’t care how much you know until they know how much you care.”

People share their stories on their bodies, whether pierced, tattooed, or scarred.  I saw a man who had a partial hand amputation from a gun-shot injury.  Prior to this injury, he had previous hand fracture and had a complex wrist laceration (“someone was trying to steal my bracelet”).  He was a healthy man in his 40s but was not working.  He was frustrated since could no longer support his family or help around the house.  He had once enjoyed fixing cars and maintaining his yard.  Now loud noises scared him.  I gently asked if he had ever spoken to a counselor after his gunshot wound.  Both he and his wife teared up when I brought this up, fifteen minutes into the visit.  This was not a question I could have asked at the start of the conversation.

“I done some bad things when I was young.  I figure this is just punishment.”  I wanted to tell him that’s not how this works.  That acts of violence are cruel and random, and that everyone is worthy of love and forgiveness.  But I didn’t say this 1) because I am an orthopedic surgeon and talk about how to fix broken bones, not how to fix the spirit  and 2) because I cannot presume to speak for his God.  But I could provide him care and compassion, and that takes more than ten minutes.  His wife was relieved that someone had finally noticed her husband was depressed.  Along with the referral for the hand therapist, I included one for behavioral health.

As I had no call or surgical responsibilities, there was no need for a pager and I did not work weekends or evenings.  I slept better than I had in a long time, as I no longer worried about surgical complications or middle of the night consults.  The most stressful part of being a surgeon had always been the unpredictability, and now that was gone.  I led a very ascetic and focused life.  There was a refreshing simplicity in being in a place where I knew no one and was free from distractions.  I was in town to work, nothing more.    The Residence Inn had a functional kitchen, free breakfast, and a fitness room.  My schedule was as follows:

5:30 am     Wake up, make coffee
6:00-6:30 am   Workout in hotel gym
6:30-7:00 am   Shower, get dressed, pack lunch
7:00-7:30 am   Breakfast in the lobby
8-5 pm Work (Lunch 12-1pm)
5-6 pm Break
6-7 pm Charting/dictations
7-8 pm Dinner
8-10:30 pm TV, read, journal
10:30 pm Bedtime

Once I got used to the routine, I started exploring my surroundings.  As Dover is the capital of Delaware (“the First State”), there is an old-timey village green with colonial buildings.  I found nearby Silver Lake, where locals fished and families promenaded.  I would walk there on the way home, a good way of clearing my mind after a day spent in the antiseptic clinic.  I learned that the region was part of the migratory path of birds along the Atlantic Coast.    My bird watching reverie would occasionally be interrupted by a low-flying military plane, a reminder of nearby Dover Airforce Base.

On subsequent trips, I found other nature preserves—Bombay Hook Sanctuary, Prime Hook, Killen’s Pond, all replete with waterfowl, marshes, and birders.  I mentally catalogued the birds:  bald eagles (flying and earthbound), the ubiquitous red wing blackbirds, snow geese, cormorants, avocets, plovers, snowy egrets, and great blue herons.  Driving home at twilight, I escorted green turtles across the road and kept an eye out for rabbits and red foxes.    My last two weekends I discovered the Delaware beach towns—Lewes, Rehoboth, Bethany.   I went kayaking amongst horseshoe crabs and osprey nests around Burton’s Island.

  

Initially I thought I knew no one in Dover, until I got an email from my college roommate Cindy.  It turned out she and her family lived in Dover.  Her husband (another college friend) was a cardiologist who had seen my name in the staff newsletter.  I hadn’t seen Cindy and Dave in many years, and we met several times during my time there.  They helped me discover the better restaurants, recreational sites, and the best market for fresh produce.  Dover was small but had everything I needed.  After living in Seattle for fifteen years, it was reassuring to know that I could live just as happily somewhere else.

One weekend in July, Cindy and Dave invited me to a pool party at their house, inviting another mutual friend who came up from Baltimore.  John was Dave’s closest friend in college and had been my residence counselor sophomore year.  John and I had bonded that year over our shared love of American literature, Trivial Pursuit, and vodka.  We had many drunken debates about who was the superior writer, Hemingway (John’s pick) or Faulkner (mine).  It seems so quaint now that these were the most pressing questions in front of us.  John was going to write the great American novel, and having read his writing, I believed him.  After college he went to work at an investment firm and then on to an insurance company.  He became a numbers man, got married, had children.  I went on to become an orthopedic surgeon.  Life got in the way of our literary aspirations.

Who could have predicted that thirty years later we would reunite around a kitchen table in Dover?  We were all a bit greyer, a bit rounder.  But the mannerisms remained.  John’s boyish grin was the same, as was Dave’s enthusiastic storytelling and Cindy’s shy sly humor.  The music played on Alexa instead of cassette tapes, but the songs were familiar.  We reminisced about friends and family we had lost over the years, some to addiction, others to chronic illness or sudden malignancies.  We reckoned with the passing of time, suddenly aware of our frailties and mortality.

It would be the last weekend I spent in Delaware.  I missed doing surgery and requested to have some designated operating room time.  The hospital policy was that I could not operate unless I took call.  Ultimately I decided that my aversion to call was greater than my desire to operate.  I left my options open, but I sensed I wasn’t coming back.  Our lives are a series of choices, paths we follow and those we leave behind.  All our situations are temporary and subject to change.

For pictures, Dover




Saturday, September 09, 2017

The Greenlandic saga

We first met each other in the screening room of our Reykjavik hotel.  Moira was one of the guides, an enthusiastic young woman from British Columbia.  She would be our naturalist, discussing everything from lichens to whales.  She was an energetic blonde with purple-streaked hair who had a penchant for breaking into song and howls.  That evening she gave us an introductory lecture and had the guests repeat the slogan, “This is Greenland.”  She explained that plans could change without warning.  Standard rules of schedules, weather, and logistics did not apply.  Previous groups had gotten stranded in camp when poor visibility prevented helicopter and boat departures.  There were no roads where we were going…

We had all come for different reasons.  Some people mentioned the wildlife, others the geology, and some wanting to experience something unique.  I came to witness the rapidly changing landscape.  I had read recent articles about the melting of the ice cap, the rise of the oceans, and the opening of northern waterways through previously frozen waters.  (See Elizabeth Kolbert’s article in the October 24, 2016 issue of The New Yorker, Greenland is Melting.)  While Greenland had long been on my doomsday travel list, I had a new-found sense of urgency about getting there.

Most of the guests were travelling solo on this expedition, which created an interesting social dynamic.  Everyone needed to make a concerted effort to get acquainted.  We quickly learned each other’s names—Daphne, her sons George and Andreas, Marilyn, Elizabeth, Michelle, Tom, Norman, and Renata.  Over the next ten days we would hear each other stories, from our origins to our destinations, our hopes and our heartbreaks.  We were a motley crew about to embark on a singular adventure.

Tom was a retired circuit court judge from Michigan and would be my kayak partner.  Renata was a logistician sent from the home office and a fellow vegetarian.  Norman, a retired naval engineer, had once lived in Corvallis, Oregon.  Michelle had a wicked sense of humor, a Canadian transplanted to Boston.  Marilyn was a retired corporate lawyer from the Midwest.  Elizabeth was a medical librarian.  Daphne was a New York City physician in private practice.  George was a junior in high school, Andreas a sophomore in college, each trying to navigate his way in the world.  And isn’t that what we were all doing?

Greenland is a country in flux—not only because of wind and ice and clouds, but also from the influence of outside cultures and technology.  It is the largest island in the world (Australia counts as a continent), and 80% of the landmass is a 2-mile thick ice cap.  The population of 56,000 lives in the green belt on the periphery.  Greenland is an autonomous country, but considered part of the Kingdom of Denmark with associated economic and political ties.



While most people see Greenland from a ship, we would be staying on land at the Greenland Base Camp.  This three-year-old semi-permanent camp is in a channel off the Sermilik Fjord, on the less visited and less populated East Greenland.  To get to the “Arctic Riviera” took the better part of a day.  We began with an airplane flight from Reykjavik to Kulusuk (“place like the chest of a black guillemot”), site of East Greenland’s airport.  The airstrip was originally part of an airbase constructed by the American military in 1956.  The Americans had left, but the airport remained.  From Kulusuk we took helicopters to Tasiilaq (pop. 2000), the largest town in East Greenland.

In Tasiilaq we were met by Daniel, our historian and kayak guide.  He was a lanky dark-haired Australian from the Blue Mountains.  Daniel would later give lectures synthesizing his knowledge of geology and history, including the tale of Nansen’s expedition across the Greenland icefield.  He gave a talk on snow, how it changes with time and pressure, how some ablates and some persists.  He described how a glacier is a moving icefield, carving its signature into the Earth.  The fjords, icebergs, and rocks tell stories of what has past and what is yet to come.  I thought of how cool glacial ice would be in my gin and tonic.

On one of our first nights of the trip, we saw the movie “Palo's Wedding,” directed in 1935 by half Inuit, half Danish explorer Knud Rasmussen.  Inuit culture is hundreds of years old and gave us the kayak, the anorak, and harpoon technology.  The Inuit survived in Greenland while the Norse civilization perished.  Rasmussen wanted to capture East Greenlandic Inuit life, and filmed scenes of polar bear hunting, seal skin preparation, and shamanic rituals.

Despite the age of the movie, it felt remarkably contemporary.  It was the classic tale of two young men vying for a young woman’s affection.  There was a drum dance showdown, filled with expressions of mirth, terror, and most powerful of all, the blank stare.  Stoicism is a highly-prized emotion in this culture.  Ultimately (spoiler alert!) the victor grabs his lady, straps her to the back of the kayak, and paddles away.  The movie showed the sharply defined roles of men and women.  The strongest hunter chooses the woman most adept at domestic skills to be his wife.  Her duties including sewing and embroidery, and preparing seal meat and skin.  Clothing must be both ornamental and functional.  A man is literally sewn into his kayak.  His garment needs to be wind, water, and weather proof.

On another night we met Rasmus, a 25-year old Dane who described his life in Tasiilaq.  He had fallen in love with a local girl while at university and had dropped out of school to settle in her village.  He lived with his girlfriend’s family, raised sled dogs, and was trying to get his tour business off the ground.  He would take intrepid travelers on guided sled trips during the winter.  I thought it brave and romantic of him to choose this challenging life, and I wished him well in his endeavors.

After two days in Tasiilaq, we took a boat to the base camp.  We passed a wonderland of icebergs with all their varied forms and blue colors.  We took turns describing the shapes we saw—opera houses and dragons and faces. The seafaring birds flew overhead:  the fulmars with their choppy wing glides, the colony of common eiders, the glaucous and Icelandic gulls.  We spotted our camp in the distance, a tiny row of tents overshadowed by the mountains of the valley.



We got oriented to the camp, from the Endurance dining hall to the shower tent to the communal yurt which housed the library and board games.  I was impressed by the coziness of our tents.  Our beds had faux fur blankets.  Each tent had its own propane heater.  While it could be stiflingly hot during the day I didn’t complain because I knew we would be warm at night.  I hate being cold.

We were fitted with our Mustang suits which would serve as both flotation devices and protection from the elements.  We strutted like supermodels while looking like Michelin men.  We were quite formidable in our suits.  We gazed warily at the electric fence surrounding the camp, to keep polar bears at bay. We met the sled dogs, Nanook and “Lady.”  They were to alert us if a polar bear was nearby, although since they were chained, they couldn’t do much else.  I found out the “Lady’s” name was the pejorative term for female dog.  Apparently she was friendly towards people but nasty to other dogs.  She and I got along just fine.

We met Julius, one of our zodiac drivers and guides.  He was from the nearby town of Tinit.  While visiting his village, we were invited to his mother-in-law’s home.  She showed us her otak, the knife used to defat seal meat from the skins.  She was renowned in the village for her skills, and proudly passed around her beautiful pieces.  We saw boots, shorts, and jackets made from seal skin, cloth, and intricate beading and weaving.  She showed us an amaud—a woman’s anorak, with an additional strap to hold an infant in place.  A woman could simultaneously work, feed her baby, and maintain warmth for both.

The walls were lined with family portraits, and there was a large screen television in the living room.  This is the challenge, to preserve traditional Inuit values in the face of 21st century technology.  While young children are educated in Tinit, when they get older they are sent to Tasiilaq, and sometimes to Denmark for advanced training.  Julius had spent time in Denmark learning to be an electrician.  While he worked in tourism, he remained committed to teaching his children the hunting and fishing skills necessary to survive this climate.

Julius’ story was an interesting one.  At the age of 4, he had been adopted by an older couple because his biological family could not provide for him.  He described how he had learned to swim, not in the summer, but in the winter because a hunter needed to be fearless and able to handle the cold.  The Inuit culture recognizes the importance of community to one’s survival.  Multiple families lived in a sod houses together, to preserve body heat, to divide up the labor of hunting and domestic work, to share food.  A hunter cannot kill a whale alone.

One can see the result of losing the Inuit values of community and designated roles.  With the loss of purpose comes higher rates of depression, alcoholism, and domestic violence.  Of course, other factors can contribute to mental illness, such as the prolonged darkness of winter and genetics, but feeling isolated doesn’t help.  We visited a small craft shop which donated space and tools for people to create and sell art together, a place to restore some pride and connection.  Tobacco and fast foods are also exacting their toll.  The subsistence diet is being replaced by processed, fatty, and sugar laden foods imported from Denmark.

One morning I woke up with an all-over body ache.  I was faintly nauseated, feverish, and head-achy.  I knew our plan for the day included a long hike and even longer zodiac drives.  I considered staying at camp but when I saw the stunning blue sky, I knew I would regret missing the glaciers.  So I loaded up on tea and anti-inflammatories and bundled up in the Mustang suit with the rest of the crew.  We had the first of several whale sightings.  First we saw a hump-back, later a family of fins.  We stopped for a snack on the edge of one glacier, and had lunch on the ledge of another.  While most the group went off for a hike, a few of us stayed back.

I found myself a private spot from which to contemplate the ice.  I felt like a lizard sunning myself on a rock, and let the heat warm my sore muscles.  I sought quietude to meditate and instead got the cacophony of sounds:  the thunderous glacial calvings, the snap, crackle, pop of the floes below, the startling sound of a bergey bit rolling over.  I heard a sweet chirping sound, and saw a mustard colored bird watching me.  This bird did not look like the snow buntings I had seen.  I noticed how the color of the bird matched the rock.  I was sure I had discovered some new species but later realized that the mustard color was the lens of my sunglasses, and the bird was likely a brown yellow Northern wheatear.

Greenland has the impermanence of a dream.  Water exists simultaneously in all its forms, shifting seamlessly between solid and liquid, exhaling a dreamy mist.  The wildflowers bloom effusively between rocks and over hills:  harebells and fireweed, sorrel and saxifrage.  The bejeweled flowers compete for the pollinators.  In the absence of bees, the mosquitos and flies take over that role.  We would wear mosquito head nets while hiking so as not to be devoured ourselves.  Everything that grows stays low to the ground including the Arctic willow, lichens, and crowberries.

When we did group hikes, one guide would be at the front, carrying a rifle and making noise.  This was in case of an unlikely, though not impossible, polar bear encounter.  We heard in Kulusuk that a teenage girl, listening to music on her headphones, had nearly walked into a bear recently.  The idea of seeing a bear was both thrilling and frightening.  While one guide watched for bears, the other guide would be at the back, making sure no one got left behind.  Being a helper is no less important than being a hero.

Our days were full of sunlight.  It was light when we awoke.  It was light when we went to bed.  One night I set my alarm to sound right before midnight.  I needed to see the moon.  I threw on my fleece jacket and wool socks and stepped into the night air.  From my deck I could make out the far-away lights of Tinit.  The moon was bright and almost full—a waning gibbous.  I looked for stars.  Initially I counted five but the longer I gazed, the more appeared.  Suddenly the sky was full of twinkling lights.

Another night I dreamt about garbage.  My nightmare took place in Manhattan, a recurrent location for many of my night-time journeys.  I was sorting through the recycling, compost, and trash, vainly trying to find a place for everything.   It reminded me of the scene in "Sex, Lies, and Videotape" where Andie McDonald is talking with her therapist about her obsession with garbage, and where it will all go…  Except this was not a movie about a bored American housewife.  I had seen the trash at Kulusuk, leftover industrial wastes and detritus from the defunct American military base.  I had seen litter on the shores at Tasiilaq and Tinit.   There was talk of five-year plans, of relocating the trash to Nuuk in West Greenland.  I don’t have a lot of faith in five-year plans.


While most of our days were packed with activity, we spent an inordinate amount of time eating.  We would leave after a hearty breakfast, eat our picnic lunch perched on rock ledges, have a snack-filled happy hour, followed by a gourmet dinner.  The Inuit subsist on a diet of seal, fish, and whale meat.  There is no agriculture in Greenland.  Our diet was a bit more varied.  We had access to food flown in from Denmark and Iceland.  Our chef Andrea made us homemade bread and pastas, served beautiful salads and risottos.  In the hotels of Tasiilaq and Kulusuk, our meals were served buffet style with plenty of vegetarian options.

As this was a World Wildlife Fund approved tour, the carbon footprint was offset by the cost of the trip.  There was a conscious effort to avoid restaurants that served whale.  At our last group meal, Norm commented that the meat was “curiously seasoned.”  I saw the pink-red piece of meat on his plate.  Then Daphne said she didn’t care for it, and she was having a strange reaction.  Moira and Daniel looked at each other and excused themselves.  They came back quickly to let us know that the meat was whale.  The normally placid Tom nearly spit out his bite.  He then took a sip of his boxed wine, and to add insult to injury, announced that the wine was undrinkable.  I gave the same look I always give when someone announces that they are unhappy with their piece of meat—part embarrassment, part sympathy, part disgust.  The guides were mortified and quickly exchanged plates, bringing over a couple of bottles of California Cabernet.  I continued eating my beet cakes which paired nicely with the earthy wine.

The last full day at Base Camp, I requested one last kayak trip.  I had not yet gotten my fill of the Arctic waters.  Our Zodiac driver and kayak master Ken was enlisted to take out interested parties after dinner. As it happened, most of the group opted to stay in, contented with a day of fjord exploration and sleepy after a multi-coursed dinner.  I layered up for the chilly twilight paddle.  Ken and I talked as we rowed, discussing life in New England, and our decision to live on the other coast.  He was originally from Rhode Island and now made his home in Alaska.  We discussed what it meant to live a peripatetic life, and how that choice determined other choices. We wondered about the names of the snow-covered mountains overlooking the channel, and made up names for the mountains in the style of the Inuit.  The Inuit name their places not after people but rather descriptions.  Sermilik Fjord is “place with glaciers.”    We contemplated the "head of small seal" mountain, near Tinit "where the strait remains open."  Stopping at the intersection of two channels, we sat suspended like jello on a moonless night.  As we paddled back in silence, I breathed in deeply, feeling strong in my lungs and limbs.  When we got back at 11 pm, the moon had yet to rise.

The following morning, we took our last hike in the hills behind the camp.  We stopped first to visit a litter of new born puppies and their mother, another one of Julius’ sled dogs.  They had been brought to the camp to provide food and protection.  We all took turns snuggling (and almost smuggling) the tiny 10- day old pups.  During the hike, I made a conscious effort to notice the clarity of the sky, the crispness of the air, the feel of the boggy ground cover beneath my feet.  I reconstructed the history of the land: how the glacier formed the valley and brought along the fragmented rocks.  I saw how the melting water danced over the brightly painted stones.  Everywhere the wildflowers bloomed.  The rocks were covered in lichens with their unique hues and forms.  I saw the local children bathing and laughing in the pools. Despite taking lots of photos, I knew all the images were inadequate to preserve the scene.

When my late grandmother would receive houseguests, the first question she would ask was, “When are you leaving?”  She was bracing herself for the eventual departure, anticipating the sorrow that would follow.  When I travel, I try to focus on appreciating the current place, not focusing on destinations past or future.  Nonetheless, I do feel a bit melancholy as the trip winds down.  The more remote the place, the harsher the re-entry into “civilization.”  There is something about the polar regions with their desolate and fragile beauty which leaves one disoriented upon leaving.  I felt it when I got to Santiago after Antarctica, Oslo after Svalbard.  It’s the distressed feeling of being alone in a crowd; of suddenly being plugged back into the digital grid after being away.

Once back in Reykjavik, Marilyn and I made plans for dinner.  I was glad for the company and enjoyed our in-depth conversation.  We shared our thoughts about the journey.  After dinner we walked around downtown, exploring the sites of Laugavegur street.  Marilyn headed back to the hotel, but I was feeling restless and wandered into an English style pub.  A duo was singing cover tunes.  So there I was crying into my Icelandic beer, as Pink Floyd’s “Wish you were here” and the Beatles' “You’ve got to hide your love away” played.  I scribbled in my journal, recollecting the warmth of the Inuit people, the crackling of the ice, the sweetness of the puppies.  I would miss this and more.  Nothing this beautiful can last.

For more photos, please go to Greenland photos.


Friday, May 12, 2017

Immigrant Song

I was born in Bhopal, India.  In 1984, Bhopal was the site of the Union Carbide gas leak.  At least 5,000 people died, making it the worst industrial accident in history.  I have always taken a perverse pride in being born in Bhopal, as if by leaving I narrowly averted disaster.  So much of your life is determined by the circumstances of your birth.  My parents and I lived in a modest flat, a tidy house with a small yard.  My father was an electrical engineer.  I remember waiting for him when he came from work so I could ride on his scooter.  Since we were too poor to have domestic help, my mother spent time all her time cooking, cleaning, and doing the washing by hand.  I was toilet trained at eight months, before I could walk, to cut back on the diaper burden.

My life in Bhopal was book-ended by trips to extended family.  I was the eldest daughter of the eldest son of the eldest son, a position of great privilege.  During my early years, I was doted on by grandparents, aunts, uncles, cousins, and servants.  I thought myself the center of the universe, possessing all-encompassing power and unconditional love.  My paternal grandfather was a devoted gardener.  I ran amok in the vast gardens of the compounds, climbing guava trees, eating mangoes, chasing chickens and dogs.  The maternal compound involved roaming around a massive stone edifice, a building full of art and surrounded by exuberant bougainvillea.  This was my young life.


My first memory of America was the International Arrivals terminal at JFK.  I was four years old, clutching my mother’s hand as we disembarked from the Air India flight.  I don’t remember the Trans-Atlantic flight, which surely must have been a long, strange trip.  I remember the arrival.  I felt very small in the huge hall as I looked up at the balcony lined with international flags.  I remember seeing my father waving from above, and I waved shyly back.

My father had left India ten months earlier, a beneficiary of the Hart-Celler Act (aka the Immigration and Nationality Act of 1965.)  This radical piece of legislation was proposed during the Kennedy era and passed during the Johnson administration.  The Act abolished the national origins quota system, opening immigration to non-European nationals.  Priority was given to those from countries affected by war and civil strife (e.g. Cambodia and Vietnam in the 1970s).  The Act also gave preference to certain in-demand professions such as scientists, engineers, and physicians.  Many Asian Americans can trace their roots to the immigration that occurred during this time.  While this migration led to a brain drain in much of Asia, it led to great scientific and technological advancement for the US.

My father had long dreamed of coming to America.  His application process had been expedited by his grandfather, who gave him money surreptitiously and helped him take out a government loan with family property as collateral.  My father was issued a green card on his arrival in New York City.  This card gave him permanent residency in America.  He quickly found an engineering job at American Electric Power on Staten Island.  He had a view of the Hudson River as he worked 10 hour days (with mandatory overtime.)  He rented an apartment in Flushing, Queens.  He and a friend bought a used Impala from the landlord, and my father paid an additional $15 a month in parking fees to the same landlord.  He became part of a community of recently immigrated young Indian engineers.  My father tells stories of their efforts to adapt to this strange country, such as when they tried to boil a turkey on Thanksgiving.  I think their first Thanksgiving meal consisted mostly of beer.

My father is not a foodie, and he lived on white bread and American cheese.  In his first month in America, he developed a boil on his neck.  As he had neither the time off to make a doctor’s appointment nor the health insurance to pay for it, my father used homeopathic remedies which healed the boil.  Thus began his lifelong love affair with homeopathy. My father considers himself the original “Dr. Singh.”  He is nothing if not a frugal man, and he quickly saved enough money to bring my mother and me to the States.  He was first in line at the Indian embassy at 2:00 a.m. so that he could apply for our visas before heading to work.

My mother and I arrived in December.  When you are an immigrant, there is the life before and the life after the move.  And everything is different between the two: the language, the food, the weather, the customs, the people.  Many writers have written about this sense of disorientation and displacement.  Jhumpa Lahiri describes the Indian immigrant experience in her work (see “The Third and Final Continent” from Interpreter of Maladies.)  Her images are poignant—the sari dragging in the snow, the loneliness of young wives separated from their families, the small Hindu deities in home shrines.  These are images I remember from my own life.


In India, there had been two seasons: the summer (dry heat) and the monsoon (wet heat.)  Snow came as a shock.  In America, I always felt cold despite the boots and a winter coat.  We lived in an apartment on Stanford Avenue in Queens, surrounded by concrete and crowds.  There were no expansive gardens and orchards to run around in.

I have a few other visceral memories of my early American life.  I got the mumps shortly after we arrived.  There were no vaccines in India, and my parents had not known to get them in the US.  I can still feel the pain of the swollen glands as I cried in my mother’s lap, holding my head in my hands.  I remember a boy sitting next to me in the cafeteria eating salami and blowing his breath in my face.  I remember getting lost in Rockefeller Center when my father took me to see the Rockettes.  I remember seeing my father only on weekends, as during the week as he would leave for work before I woke up, and he came home after I was asleep.  I remember the strangeness of not seeing my extended family.  I remember making toast and tea for my nauseated mother when she was pregnant with my sister.  I remember her silent sadness which I could neither understand nor erase.

Even in the culturally diverse neighborhood of Queens, I was a stranger in a strange land.  I was not black; I was not white.  My mother tells a story of us passing a group of people and my asking, “Are they laughing because we are Indian?”  I was baffled by American behavior and language.  One time in kindergarten we were told to line up.  I stood behind a girl wearing a halter top.  I was fascinated by this outfit that exposed her bony shoulder blades.  I tapped her scapula and asked why we were standing in line.  “Assembly,” she replied curtly.  “Oh,” was my response.  “You don’t even know what assembly is,” she said as she whipped back around.  She was right.  I fought back the hot tears of shame.  I would ask about that word when I got home.  And every other word I didn’t understand.  There would be many strange words in this language: galoshes, catechism, auditorium, smock.

As I grew up I recognized that despite being educated in English medium schools, my parents retained their accents.  They were not always understood by native speakers.  I remember my mother asking the school for the lunch “me-nu” or my father asking for a “fill-up” at the gas station, their requests being met by baffled stares.  I could understand my parents, why couldn’t other people?  I was fortunate that both my parents were literate in English.  My mother read to me.  I watched hours of Sesame Street and soap operas.  I had access books at home, from my precious Little Golden Books to the Big Book of Science.  I had learned to read and write in Hindi before I came to America, and I quickly became proficient in English.

In first grade, we were required to bring books to read in class.  I always had a book with me but there was a young boy who was usually empty-handed.  I can still see Louis with his big brown eyes and an open, pleasing face.  In retrospect, I suspect his name was Luis.  He didn’t speak English, and he was scolded daily by the teacher for not bringing a book.  One reading period I saw him pull a book out of his backpack.  He looked so proud.  The teacher saw him with the book and accused him of stealing it.  I wanted to intervene, to say, “No, that is his book.”  But I didn’t.  And again I feel the hot tears of shame on my face.  I regret that I kept silent.  Perhaps I was shy or afraid or uncomfortable.  That is no excuse, and I have since learned to use my big girl voice to speak up.

I didn’t consciously set out to master the English language.  I just happened to read voraciously, to the exclusion of all other activity.  I would read anything I could find:  magazines and manuals, novels and dictionaries.  My social life revolved around libraries and bookmobiles, great equalizers of public education.  I did well in English classes and had inspiring teachers.  I ultimately majored in English in college and went on to earn a master’s degree in English and comparative literature.  I recognized early that language is power.  And that those with power have a responsibility to advocate for those who are vulnerable.


We moved away from Queens when I was 7, escaping in our Vista Cruiser station wagon to the suburban oasis of Ann Arbor, Michigan.  We lived in Ann Arbor a couple of years before moving to Gaithersburg, Maryland.  We would move back to Ann Arbor a couple of years after that.  I attended five different elementary schools in six years.  Each move was a mini-migration: new teachers, new classmates, new playgrounds.  Naturally introverted, I was forced to be bold.  Fear was a luxury I could not afford.  I needed to make new friends and learn new rituals as I settled into yet another climate.  This adaptability has served me well as I navigate the world.  The frequent displacement also left me with an existential restlessness.  I am perpetually searching for belonging, for community, for home.

These early memories are the micro-traumas of a five-year-old child, told in retrospect by a middle-aged woman.  Every immigrant has a unique story, one which involves saying goodbye to one life and awkwardly embracing another.  My origin story pales in comparisons to the suffering and sacrifice many immigrants have endured.  Life is not fair.  Wealth and health and human rights are unevenly distributed in the world.  The world has always been full of immigrants and refugees, fleeing tyranny, seeking security and health for their families, hoping to live and worship as they please.  We all want the same things.

In addition to the billion Indians in India, there are countless more dispersed around the globe.  This is the Indian diaspora: the IT prodigies on the campuses of Microsoft and Amazon, the manual laborers in the Middle East and Africa, the shop keepers and motel owners, the doctors and the scientists.  When one Indian recognizes another, there is often eye contact and a slight nod.  Perhaps it is the subtle acknowledgment that we share similar struggles, aspirations, and culture.  We have eaten the same food, recognize our music, laugh about Bollywood movies.  Whether it is the Sikh Uber driver who teaches classical Indian music, or the Fijian hospital workers who share their food, or the Mauritian surgeon who wants me to mentor his daughters, we seek connection within this diverse tribe.

Immigrants face a constant struggle between assimilation and preserving their cultural identity.  Some immigrants keep their heads low, work hard, and try to blend in.  They sense that acceptance is tenuous and can easily be taken away.  America has always had a problematic relationship with its settlers.  This country has prospered on the labor of both willing and enslaved immigrants.  American democracy has been built on shaky ground.  The values of life, liberty and the pursuit of happiness were meant for a select few.  The Constitution was written for and by white men, when Blacks were property, and women weren't even acknowledged.

The current American president has unequivocally denounced immigrants and refugees as threats to the American way of life.  Every day there are more deportations.  I have started carrying my passport and a copy of my naturalization papers.  Anger and xenophobia have led to an increase in hate crimes against minorities.  Recently a young Indian engineer was killed in Kansas.  He was simply having a drink with another immigrant friend.  He left behind a young wife.  This could have been my parents.  Despite this threat of violence, I refuse to be intimidated or keep my head down.

My father’s success can be attributed not only to his perseverance, but also to his grandfather's support and to a progressive US administration.  Talent alone is insufficient; there must also be opportunity.  I have benefited from internships and scholarships which allowed me to attend boarding school, an Ivy league college, and medical school.  My teachers encouraged me to be better, to think bigger, to overcome barriers.  How else could a girl child born in Bhopal become an orthopedic surgeon?

It remains to be seen what the future holds for the American political system, whether it can survive the current climate of polarization and divisiveness.  Democracy is a fragile thing.  I am slightly heartened by the appropriation of its ideals by the Canadian, Scandinavian, and mon dieu!, perhaps even the French.  So much of your life is determined by the circumstances of your birth.  I am grateful to have been born in the right place, at the right time.