His Great-Grandfathers’ Boy


“Why in the world would you let your son buy a book about war?” This was the question posed to me at a thrift store by the well-meaning woman behind the counter.  I looked down at my son, then seven years old, gamely clutching his pick with two hands.  The World War II Encyclopedia cover was graced with black and white pictures of tanks, uniformed men, and flags, and looked heavier than my son, skin and bones that he is.  His large brown eyes looked back at me, unblinking, sure that his mother would persevere in buying him a book, because when had I ever refused any child of mine a book?

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What she didn’t know was that unlike his sisters, for whom words are the keys to Neverland, incantations to the spell of transformation that leaves you blinking not to see wings when you stretch out your arms, for him books were still mysteries.  For me, reading meant figuring out how to get my constant-motion machine to sit still long enough for the magic to enmesh him.  That he had picked a book, instead of a gadget with moving parts or a brightly colored toy was a revelation to me, at least until I saw the title of the book.

You see, though my husband was one of three brothers, thusfar the weight of carrying on the family name rests solely on my baby boy. He has always known of the meaning of his first name, which is actually my mother-in-law’s maiden name, just as my name echoes my mother’s maiden name. I believe strongly in the power of names, and the legacy bestowed by the double burden of carrying both of his great-grandfather’s names (and his father’s) is one I think was worth passing on.

I never knew the benevolent gaze only grandfathers can give until I met my husband’s.  Our family is blessed with strong-willed women, and my mother’s mother is ever-present in my earliest memories, but the towering legends of my grandfathers were passed down in bits and pieces through stories of their fierceness.  My father’s father was stoic, unsmiling in black and white photos, a patriarch in war when his sons were pursued by Japanese soldiers through the mountains of Korea.  My mother’s father was a religious man felled by a stroke, then lifted up by inner strength and determination to walk again to the church the Communists worked to take away from him.  I never met either of these brave men, dead long before I drew my first breath.

My husband’s grandfathers though, were kindly, white-haired men who patted my hand, accepting me into their families without a word.  The Vietnamese word for grandpa was not even in my immediate lexicon, and my husband had a nickname for one of his–his PaPap.  He was a quiet man, one who never spoke of his service until shortly before he died, of landing on the beaches of Normandy the day after, of being part of the “clean-up crew.” I knew him only as the very quiet man who opened his home on Christmas Eve. I always felt comfortable with him, as he was reserved like me, an oasis in the maelstrom of preternaturally good-looking cousins whipping quips and insults with equal wit and precision at one another.  I cherish especially 2 memories of him, one of dancing with him at my wedding, and the last in which I was able to bring my baby boy to him at the nursing home before he died, so my husband and I could tell him that our little boy shared his name.

In my everyday work, I meet veterans who have served all over the world in many different wars, but I have a special place in my heart for World War II veterans.  This is because of my husband’s PaPap, but also because they are a special breed.  One veteran who was in the Battle of the Bulge spoke of being lucky because he was able to get a warm jacket from one of his Air Force flying buddies, while everyone else had summer gear in the brutal winter that ensued.  He was seeing me for frostbite 70 years afterwards, being treated for the first time ever for the residual effects.  He had mentioned it in passing to his primary provider that perhaps the numbness and tingling might be from the frozen toes he had suffered while in Germany by way of explanation, and not complaint. I was mesmerized by his stories, of men and boys unprepared for the long battle. Seeking words of wisdom, I asked him, “How did you do it?  How did you survive?” His answer, like so many other WWII vets, underscores what sets them apart:  “We endured.” There was no drama, no entitlement, just a simple, succinct statement in which he counted himself as part of the whole, doing what had to be done.

When the boy who would become my husband told me that if he could be like anyone, he would like to be like his grandfathers, impeccable in actions and words, I wondered what it would be like to have flesh and blood heroes.  I wanted that for my son.  And knowing this, knowing that he chose this book to learn more about what his great-grandfathers had experienced, I would not have spared him a “a book about war.”  My girlfriend’s first child is a boy. In the way all mothers have, she wished to protect him from the evils of the world, and so asked family and friends to refrain from giving him any toy guns or weapons. In the mysterious way of many boys, he fashioned guns out of paper and ran around the house shooting at imaginary enemies despite minimal exposure to these things. Neither her son nor mine are brutes or sociopaths, both of them animal-loving, gentle souls who love to be snuggled by their mothers.

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My little guy standing in the back of a C130, the plane in which we fled Vietnam.

As I looked at this woman, I considered all of these stories, trying to figure out how best to answer her.  How did I tell her that if not for one war, I would never have existed? How to tell her that my parents grew up in war time, their parents figuring out how best to protect their families, and perhaps her parents doing the same, so that one day I might have the chance to stand here and debate with her about the appropriateness of reading material for my son? How to tell her that though peace is what we all crave and would wish for our loved ones, the reality is that war exists, and to pretend that I could shield him from this is to deny the sacrifices that better people than she and I had made?  How did I show her that though we have been blessed since the Civil War not to have war in the United States, it is through the remembrance of those battles and those veterans, that we can hopefully prevent bloodshed here?  Did I tell her that though I would never want my son to have to know what it is to spill the blood of another, I would proudly call myself the mother of a soldier if he so chose to follow that path?

Unfortunately, I did not. As is always true for me, the words sat in my mouth, angled edges weighing down my tongue. Instead, I said only, “His great-grandfather served in World War II.” She frowned disapprovingly at me, and reluctantly took it from my son’s hands to wrap it.  Today you can find this book on my son’s bookshelf. The pages are bent in some places where he has stopped to bookmark something compelling to his little boy brain. When he reads it, his brows furrow in concentration as he pores over the black and white pictures, and I can see the generations of men in the lines of those furrows, stretching far back into the past.

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Today I am thankful to live in a country where little girls like myself can grow up to carry on their father’s names, for grandfathers and great-grandfathers living and dead who inspire us to be impeccable and fierce, and for the unique gift of being the mother of a son who has been blessed to grow up under the loving eyes of both his grandfathers and grandmothers.

Has a stranger ever questioned your parenting choices? How did you respond? Have you had qualms about what is and isn’t appropriate reading material for your children? Do you have a story about your grandfather or great-grandfather that you’d like to share?  If so, I’d love to hear it.

Triskaidekaphobia


The first time I was truly afraid of a patient, I was standing in an outpatient family practice clinic in Detroit.  If you’ve ever felt mind-numbing fear, you know that it creates a dividing line between that moment and the next. Strange details imprint on your brain, like the heft of the chart in your suddenly damp hands, and the musty smell of an exam room suddenly grown tinier.  Grown men have told me that part of the attraction for going to war is learning if they have what it takes when confronted with the fear that is part and parcel of combat.  When we watch movie characters stumble into bad situations, we have the prescience that comes with being an observer, and tell ourselves that we would never, ever go into the dark house after the psycho or get in the car with the charming serial killer.  In actuality, how often do we do dangerous things and not realize how close we stand to the precipice?  As my childhood friends will tell you, I had what I considered a charming unawareness for these types of situations (until, of course, I became a mother), and perhaps it came from my innate belief that all people are good.  When I was younger, I traipsed into places and talked to people that now I would never let my children associate with, but again, I really didn’t think anyone wanted to hurt me, and I trusted that I would know it if they did, but perhaps that was hubris or plain dumb luck that I never got hurt.

This time though, the analytical, writer part of my brain was coolly noting that, for once, I was actually not only assessing the situation accurately, but also responding in what I thought was a very calm and non-threatening manner, though the other animal instincts in my brain that had made the fine hairs on the backs of my hands prickle within the first 2 minutes of meeting this patient, were screaming “Run! Get out of there, right now! Do not pass go, do not stop! Get out!”  It was like, and I kid you not, the good buddy in movies, you know, the sensible one like Velma, or actually more like the hyper-panicky one Shaggy, tapping on my shoulder and whispering “I don’t think this is a good idea.”

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Having grown up in the suburbs of Detroit, in a town where everyone looked so familiar I would have trouble placing the face as being someone I knew from church, the gas station, school, or work, going to PA school in “the city” was exciting to me.  I knew I’d be exposed to situations I’d never experienced, and like my combat veterans, wondered if I’d have what it took. I wasn’t afraid of the crack addicts or gang-bangers. I was afraid that I wouldn’t know how to react, wouldn’t have what it took in the face of an emergency to do what had to be done–chest compressions, suturing, bandaging, reading EKGs accurately. I thought I’d be most afraid in the ER at Henry Ford Main, or during my psychiatry rotation where I was on the inpatient consult service for Detroit Receiving and Sinai Grace, because of the out of my control aspect of those situations.  In an outpatient clinic, I naively thought, at least you could kind of predict what kind of day you were going to have.  Appointments are scheduled, and you can predict what kind of patients you will see, unlike in the ER, when you can have a heart attack, gunshot wound to the hand, and head cold all walk in at the same time.  It was a controlled environment, I thought, and control of my environment is key.

All of us desire control. It begins when we’re learning how to talk and walk.  This is where the terrible twos (and threes and fours for some of us) get their name.  The desire to exercise our will on the environment is innate.  We want to be able to choose our path. We want to believe that we have control, though in reality, we have very little. Today is Friday the 13th, a day many fear, though most of us find it superstitious.  We scoff at people who would have “silly fears” of things like the number 13, but in reality, don’t we all pause for just half a second, if we have an interview or date that gets set for Friday the 13th or we’re placed in hotel room #13? It doesn’t stop us from continuing on with our lives, but given the choice, just to be on the safe side, wouldn’t we change the date or room number, if we could?

As children, many of the sayings that we grew up with enforce those beliefs: Step on a crack, you’ll break your mother’s back–so we avoid walking on the cracks, just in case. It’s part of the mistaken belief, these superstitions, that we can control our destiny. We believe that by following all the rules, we can control our circumstances.  As children we pray, if I promise to do all my homework next time, please let me pass this test. As adults we pray, if I promise to be a better mother, please let her be OK.  Fear is irrational, it compromises our illusion of control, because it shows us how little power we actually have.  When we see through the eyes of fear, nothing is in our control, and that is the most frightening thing.

The unkempt woman in the musty exam room looked right through me.  All of us want to be seen, truly seen for who we are, and when others do not see, it can be frustrating, and make us doubt ourselves.  When she did not respond to me, I wondered for a brief second, did I not speak loudly enough? I had read her chart before coming in the room. It was supposed to be a routine follow-up for her annual gynecological exam.  Her list of medications gave me clues to what was missing in the 1 sentence description of why she was there.

“Have you been taking your Clozaril?” I asked.

“My mother has blue hair. Do you see them? People walk on buses,” she said.

Being alone in a room with a schizophrenic patient off her medications is not a place for a green PA student.  My very first rotation was psychiatry on the inpatient wards. Ingrained in us were several rules: Make sure to always be between the patient and the exit.  Make sure that someone knows where you are at all times.  Make sure that you wear long hair pulled back so a patient cannot grab you.  I had seen schizophrenic patients on their medications, discharged them home to the loving care of family or friends, after seeing them admitted off their medications, when they could not distinguish between their reality and ours.  Most were not violent, but what was frightening was their inability to see us. To them, I could have been a 300 lb body builder threatening to take away their most prized possessions, and as anyone who’s ever been threatened knows, fear will make us strike out to protect ourselves.

Fear will take a perfectly reasonable person, and turn them into a knife-wielding, gun-toting, hate-speech throwing part of a mob like those we’ve seen on the news.  It turns off the reasonable, logical parts of our brains, and takes us back to the child we all were once, vulnerable and at the mercy of others.  When we point our fingers at others, tsk at the behaviors that we, of course, would never engage in, scoff at superstitions and phobias, we forget to look at what prompts them.  We forget to look deeper. We forget to ask ourselves what are they really afraid of–and what am I afraid of that I am too blind to see them for who they really are.

“You know what? I think I left your bloodwork outside. I’ll be right back,” I lied, and briskly walked out of the room, straight to my preceptor’s office, and explained the situation to him.  I never saw that woman again, but I’ll never forget her eyes or the trembling of my hands afterward.  Have you ever been truly afraid? Do you have any phobias or fears that may seem irrational to others? I’d love to hear about them. I discovered an irrational fear of heights when I climbed up on a ladder to explore an old B52 bomber, and could not make my legs work to climb back down the ladder I had just ascended 10 minutes prior.

Today I am grateful for reminders that all of us have fears that lie behind the facade of control we all cling to. I am thankful for the friends who kept me from making irrevocable mistakes in my innocence when I didn’t have enough fear, and hope my children will have such good friends as they make their way through a world filled with too many choices.

And because I’m a giant nerd who loves words:   Triskaidekaphobia is derived from treiskaideka, the Greek word for thirteen + phobia, fear of = a fear of thirteen.Pi

Holding Hands


My father has hands like bricks, reddened and hard, fired through years of tilling Michigan clay, lifting dirty tires in February winds on the narrow shoulders of freeways, and sanding smooth the doorways of the house in which he has lived since 1977. I never thought much about his hands, except as a kid when I’d done something wrong and feared his wrath. In the days before time-outs and worrying about self-esteem, my father’s hands were scarier than a belt or a “wisdom stick”. My grandmother and mother used switches we had to pick ourselves from the two oak trees in the front yard, but my father’s hands were tough enough to make us think twice. Punishment meted was swift and painful which we earned often enough between the four of us, mischievous and curious as we were. We didn’t view it as abuse, given the nature of corporal punishment at the time, in fact, preferring a swat on the behind to being grounded or other non-corporal punishments.

My hands look more like my mother’s, slim with longish fingers for the small hands that I have. I always wanted bigger hands with longer fingers, thinking them elegant and more agile for things like playing piano or building things. Having small hands can be advantageous though, as I discovered the first time I participated in an exploratory abdominal surgery. Surgeons will frequently talk and joke during surgery, but during this one, as I stood very still trying not to contaminate the sterile field while holding retractors, one of them asked who had the smallest hands in the room. Surgical gloves are sized from 5.5 to 9 and specific to right and left. OR techs and nurses know what size and type a surgeon prefers to wear and everything is set out prior to the procedure. If you are new, they will ask you what size glove you wear, then help you to put them on to maintain sterile fields. I wear a 5.5 or 6 depending on what is available, and so the nurses pointed to me. Because I had the smallest hands, they asked me to insert my hands into the patient’s abdominal cavity to break up adhesions around the liver. The feeling of sliding my hand around someone’s liver was incredible, smooth and strangely slick, and thrilling to me.

I never thought much about anyone’s hands until the day my future husband asked to hold mine. When I was young and dreamed about the man I might someday marry, I never thought much about what he would look like, let alone what his hands would look like. As little girls, my next door friend Amy and I would hum the marriage song as we processed across the family room, holding a worn bunch of plastic flowers. The husbands we married were incidental, a necessary part of the process to get to the next step which was stuffing a baby doll up our shirts to pretend we were going to be mothers. This would be followed by pretending to be Princess Leia or Lady Jane from GI Joe. Our summers were filled with acting out fanciful scenarios of heroines and heroes with our brothers. I never pretended to hold hands with anyone though, never realizing what a lovely part of being with someone that it is.

In romance novels, a lot of the descriptions center on kisses between the main characters. Rarely do they talk about the sweetness of holding hands.  It is said that the handshake evolved from the ancient custom of a showing of hands empty of weapons. I think the knowledge ascertained from holding another’s hand in yours can be greater than just knowing they do not hold weapons. In my present work, I check hand-grip strength on patients regularly. It is a part of our diagnostic tool set, telling us if there is weakness or tremor, but patients will look at my hands, concerned that they will squeeze too hard.  I’m learning not only about grip strength though when I hold their hands. I can tell what kind of work or hobbies they do, if there are lesions that haven’t healed, if they bite their fingernails, or if nerve damage is present, among other things.

When I held hands with my husband for the first time, I was struck by the similarities between his hands and those of my father’s.  Though we were largely strangers to one another, his hands were familiar to me.  I understood instinctively what kind of person he was, though I could not have put it into words at that moment as young as I was.  Once while we were dating, he apologized for the state of his hands, rough from the work he had been doing.  I told him what I still believe today, that there is no shame in hard work.  His hands are never raised in anger to our little ones, though they are just as mischievous as I ever was.

The church in which we worship holds hands during the Lord’s Prayer, an act which always makes my children a little wary.  They don’t want to hold hands with someone who is not part of our family, and I never force them to, but they are frequently rewarded with a smile from an elderly person who might be sitting near our less-than-angelic children.  Some might call this practice unhygienic, and in fact, there are times when they are ill or someone else is that we don’t hold hands, but in that there is still a lesson about how we care for others in the community by respectfully declining.   They are learning too what it is to be connected, to know the feel of someone else’s hand, to be gentle in the way they grip arthritic fingers, and not to fear the unknown.

There is something powerful in the act of holding hands. It is an act that literally and figuratively connects us. As mothers we have known the secret feeling of children dancing within our wombs, like stars slowly spinning within the nebulae of our own personal gravity, but for our men, it is the grip of their baby’s tiny hand around their finger which shifts time and space.  As I watch my children grip their grandfather’s hand walking with him on a mountain hike, his other hand gripping the walking stick shaped with loving care by my husband’s hands, it occurs to me that I stopped holding my father’s hands after childhood, when I no longer needed his help to walk.  I remember the feeling of my hand in the crook of his arm as he walked me down the aisle of our church and the way it felt when he put my hand in my husband’s, like a blessing and an absence all at once, and I know it is too soon to let go.

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My little guy hanging onto his grandpa.

Today I am thankful for all the hands that shaped my life along the way. I am grateful for silly internet pictures of otters holding hands to remind us that we are all connected, and pray for the strength to hold on, for as long as we are blessed to have those we love in our lives.  I’m wishing my father a blessed 80th birthday, and praying for many more birthdays like this.

Love, Despite


 

Before I married my husband, I told him to make sure that he was marrying me for who I was that day, and not for any future changes he hoped to have wrought in me through the “transforming” power of marriage. Though we were both young, I had seen enough unhappy marriages to make me wary of the institution, and who wants to be institutionalized, really?  I had no question that I wanted to spend the rest of my life with him, but I wanted us to start off with as little illusion as possible.  I wanted to know that he saw me, and not some airbrushed version of a girl to be placed on a pedestal.  It is easy to fall in love if you believe all the fairy tales and movies.  Beautiful women with flowing hair and flawless skin meet muscled men with pure hearts and chivalrous intentions and they ride off to his manor with servants aplenty to watch the perfectly well-behaved children gambol across the lawn.

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Real life, though, is grittier.  The muscled boy that you met at 18 will have to help you get to the bathroom after giving birth to an almost 9 lb baby, change that baby’s first meconium-filled diaper, and not comment on all the broken blood vessels across your face from pushing to get that giant-headed child out. Those flowing locks that you used to have time to tame into submission, will subside into their normal frizzy state, then fall out during pregnancy so you look like an alien who accidentally swallowed a giant watermelon.  The manor will actually be a tiny little starter home surrounded by other tiny little starter homes where you can hear your neighbors argue and flush their toilets. Those perfectly well-behaved children will kick a soccer ball right through your basement window after being sent outside so you can think in silence for 2 blessed minutes before you erupt into acid-spewing dragon mama mode, yet again.

What is not easy, is staying in love, loving, actually choosing to love, when face it, there are times when we are not lovable.  When we are angry at the burned beef stew and there is not a single, flipping thing ready to eat in the house and everyone is hungry.  When we are frustrated at piles of bills and broken car innards, and then the dentist says your child needs braces and it’s going to cost you exactly what you planned to spend on the car repairs.  When we are already late to church for the umpteenth time, and we scream hurry up at the child who has to go to the bathroom right now.  When we slam the phone down multiple times, because once is just not enough.  And does anyone else agree that hitting the end button on our cell phones multiple times is just not the same?!  We are so often not at our best, so often not that serene  image of our best self that we aspire to, and carry around in our heads.  And yet, and yet, we continue to love one another, despite. We continue to hold on, in a world that does not value the sanctity of marriage or family or friendship.

Last Sunday’s Gospel described Jesus’ tranfiguration on the mountain.  Every time I hear this passage, I giggle a little to myself at Peter’s response to the incredible change he is witness to, but then wonder myself at what I might have said or done in his shoes. In reality, though, we see one another every day transformed. We see past the imperfections and flaws–frizzy hair, receding hairlines, extra pounds, impatience, frustration, and love one another.  That is the tranfigurative power of love, and we do not have to look to the mountaintops, or what others refer to as those thin places where the divine is closer to us mortals, to see that transfiguration.  We see it everyday when we choose to love despite and not because. We do it everyday, when we call one another Mình ơi, or sweetheart, when we are definitely not being sweet nor acting like the best reflection of our selves.

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Today I am thankful for love that echoes the divine, that transforms us into our most ideal selves. I pray for the fortitude to keep trying to love despite and not because.  I am grateful for the lack of illusions that makes marriage a safe harbor despite all my fears to the contrary, and for books which not only enthrall us, but also give us inspiration through words of wisdom which are gifts unto themselves.

“It had flaws, but what does that matter when it comes to matters of the heart? We love what we love. Reason does not enter into it. In many ways, unwise love is the truest love. Anyone can love a thing because. That’s as easy as putting a penny in your pocket. But to love something despite. To know the flaws and love them too. That is rare and pure and perfect.”
Patrick Rothfuss, The Wise Man’s Fear


The Opposite of Tenebrific


A career in medicine is one that has many lures–the ability to touch lives,  fascinating medical phenomena, and the knowledge of the complexity that comprises the human body, among other things.  Yesterday, every single one of my patients reminded me again of why I became a PA.  One patient asked my advice on what to do about a lost love connection spanning over 20 years.  Another had such an intricate medical history, it had me stretching my brain for information I’d learned long ago in school.  One funny patient and I talked about our love of words, and I shared with him an app on my phone which gives me a new word to learn every morning. Every patient thanked me for being easy to talk to, and I was loathe to walk each of them to my door because I had enjoyed our visit so much.  It was a day sorely needed. Last week, the last patient of my day made me cry.

As anyone who knows me will tell you, making me cry is not actually difficult. I confess to a small sob while watching the movie Aladdin (which is a cartoon I know, but that Genie gets me every time).  aladdin genie

Someone else crying causes me to tear up.  Even writing a sentence about crying will cause what my son calls my “shiny eyes.” I’ve cried with patients numerous times, with a touching story or in shared grief. But this time, it was different.  I was crying tears of anger.  I am cursed with full-on waterworks if I’m extremely angry, which I would love to be able to control. It’s hard to be taken seriously if you’re wiping away tears while trying to make a point, and even harder to carry on a patient evaluation when you are doing everything you can to remain professional in the face of hostility.

This patient began our encounter angry before he had even met me because his appointment had been rescheduled with another provider. Where I work, I’m used to dealing with angry patients on an almost daily basis.  To some of them, solely on the basis of where I work, I am the face of all of the bureaucratic bean-counting, soul-sucking paper-shuffling nonsense that prevented them from seeking care in the first place. I am part of the system that denied them benefits, told them PTSD did not exist, and denied their right to be seen as a person, and not a number. So I understand the frustration and the anger that comes as part of the baggage of just getting to the appointment.  I understand that part of my job is to lift that burden of frustration, and make them feel like they are seen, and heard.

As patients, we come to our appointments carrying the invisible baggage of our history–the memory of an aunt who died on the operating table, medication reactions, a fear of bad news-“What if it’s cancer?” As providers, we know this, and try our best to gauge those worries and try to alleviate them if possible.   Sometimes though, the actions brought about by those fears and worries are inappropriate, and other times, even criminal.  Fears have been running high in our department because one of our sister facilities suffered a tragic shooting.  A patient shot and killed one of the providers at the hospital in El Paso.  He worked in the same type of department in which I work.   Meetings about safety measures, active shooter scenarios, and how to deal with violence in the workplace have been laced with tension-filled voices.  One of our police officers tried to help us dial back the emotions.  “Let’s not call it a panic button. I prefer the name duress alarm. We don’t want to have panic,” she said.  I’m not sure that changing the name makes a difference, though I do advocate for the power of words.

But the words I mean are those we use when dealing with patients.  As peace-loving as I try to be, I am not immune to the effects of violence. I trained in the city of Detroit and saw the ravages of drugs and violence on the faces and bodies of our patients, treated gunshot wounds and stab wounds, and saw families ripped apart by random acts of killing.   People argue that our patient population is more dangerous because as veterans,  our patients have all been trained on how to use weapons.  I argue that if anything, that makes us safer, because they were also trained in how to defend those in need, in how to stand and fight for those who could not or will not because of an oath to heal or religious convictions or even conscience alone.  I will defend our veterans as patients just as worthy of our compassion as any other patients, if not more, and not to be considered a source of fear.

Last Friday though, I was afraid, and if I were a superstitious type, might have seen the word of the day, “tenebrific,” as a portent, as it means producing darkness. My patient arrived upset, out of control, and angry with me and everyone else in his vicinity.  I stand a whopping 5 foot nothing, and so to me, everyone is tall.  This man though, stood a good foot taller than me, and weighed over 2 times what I weigh.  I tried every tactic I had ever used to deal with a difficult patient, but I could not connect with him.  The power of words failed me.  He kept standing up while I was attempting to gather his history, and the sight of this very large man gesticulating wildly between me and the door gave me a qualm every time he stood up.  Between his wife and I, we tried to calm him down, but nothing seemed to work.  He alternated between insulting me and denigrating the system, and I bit my tongue and tried to smile pleasantly until it reached the point that he started to use expletives.  I firmly told him that this kind of language was unnecessary.  At this point he demanded to see someone else because he thought I was “belligerent and argumentative.”

My hands shook and my heart was pounding as I escorted him to the appointment desk to be rescheduled, and then I returned to my office and promptly burst into tears. I was angry and upset, mostly at my inability to control the situation and at the fact that I had not been able to get him to see beyond me as the face of an organization, to see me as someone who cared about his well-being, and at myself for feeling intimidated by a patient.

I believe strongly that all patients deserve good health care, the best that I can provide if possible.  To come to a point where I could not do so, made me realize that as providers we also have the right to be treated with dignity.  When we in good conscience have done all we can to do right by our patient, we also deserve to be seen and heard. We deserve, as our patients do, to work in a place where we should not fear for our lives for doing our jobs.  My heart goes out to those in El Paso, and especially the family of the man who was killed trying his best to help others.

Today I am thankful for work which allows me to be present in the lives of others in the midst of their pain and suffering. I pray for the strength to continue to be the opposite of tenebrific as much as possible.  And I am grateful for all of the wonderful patients I’ve met along this journey.

I would love to hear any of your stories of how you’ve either dealt with a difficult person or tactics on how to keep the tears from flowing when you don’t want them to.  I hope and pray that you have someone taking care of you with whom you can laugh and cry. Let them know you appreciate them if you do.  They might really need to hear it today.

Do What You Love: Top 7 Things You Never Knew About Physician Assistants


Growing up, my dream list of future occupations was varied: Supreme Court justice, Shirley Temple stand-in, crime-fighting assassin/journalist, astronaut, and finally, Nobel Prize-winning brain researcher. Alas, Sandra Day O’Connor took my seat, Shirley Temple grew up, being Catholic put the nix on the whole killing people gig (even if you only kill the bad ones, the Church frowns upon that–see Commandment #6), my 5 foot even height makes me too short to be an astronaut, and no matter how much I loved studying the brain, I found I really dislike research. However, I was blessed to work with stroke patients in my research work, and it turns out, I love people. So in 2003, I became a physician assistant (PA).

If you know any PAs, this is a logical conclusion. As a whole, PAs love people–helping them, taking care of them, and making a difference in their lives. I had never heard of the PA profession until shortly before I applied to PA school, when I met one while working with a surgeon who did not particularly like people (but that’s a story for another blog post).  That PA was, and is, a paragon of compassion and competence. She said and did all the things I had always associated with physicians, and her patients loved her and asked for her by name. Not by doctor but by Jennifer, because as she said, “If I cared about titles, I wouldn’t have become a PA.” Inspired by her quiet example, I researched the profession (all that time in research wasn’t wasted), and was astonished by what I learned.

1. PAs have been taking care of Americans since around the time of the Vietnam War.  The first PA class graduated October 6, 1967 from Duke University. In fact, PA training was based on the fast-track model of training doctors in World War II because of the health care shortage at that time, and the fantastic Navy corpsmen and their wealth of knowledge from the Vietnam War–necessity being the mother of invention and all. And in a time of civil unrest, one of the examples Dr. Eugene Stead used for the PA-physician team model was a white physician and his African American assistant, Henry Lee “Buddy” Treadwell, who capably managed the clinic while the physician was out of town, and whom “the richest man in town would rather have. . . sew him up than [the physician] because he can do it better. . .” as quoted by said physician.  As a female Asian American PA, I can’t think of any better testament to the founder of our profession than that he was progressive enough to recognize quality health care and not care who was delivering it, in a time when Jim Crow laws still existed.

2. PAs work collaboratively with physicians and other members of the medical team to provide quality health care in all fields of medicine. Yes, all.

3. PAs can write prescriptions for what ails you. And when there is no prescription, you can count on us to listen and be present, and fight like hell for you. I mean, advocate strongly for you.

4. PAs not only work in all branches of medicine, they can be found in a variety of settings. We don’t just deliver health care in hospitals, operating rooms, and private practices, we also teach at universities, work in prisons, practice in schools (not the same thing, no matter what you might recall about middle school), perform research (I suppose someone has to), lecture around the world, serve our country in the military and in the White House, own our own practices (in some states), publish in medical journals, care for nursing home residents, and work in industry. The sky is the limit in terms of opportunities available for PAs–literally. I’m still trying to figure out how to work the astronaut angle–first astronaut PA anyone?

5. PAs have to bring similar prerequisites for medical school to the table when applying to PA school, and to be competitive they usually need 2-3 years of healthcare experience to even be considered. My dual degrees in biology and neuropsychology from the University of Michigan were not sufficient. I had to go back and take more classes than I needed for a medical school application, just to be able to apply to PA school. Suffice it to say, I would have taken those classes in medical school if I had gone, but PA school expects you to come loaded for bear so you can be out practicing medicine upon graduation. The time I spent in the healthcare field before PA school was helpful in navigating through the intensive onslaught of information during PA school, and has made me a better PA now that I’m practicing because I had already worked as part of a healthcare delivery team prior to becoming a PA.  The PA who has helped clean patients in nursing homes before PA school knows to be on the lookout for decubitus ulcers from first-hand experience, just like the PA who was a paramedic before PA school is acutely aware of the possibility of tension pneumothorax in a patient with blunt chest trauma from an MVA.

6. PAs can be found practicing medicine internationally. Besides those serving in the military for the United States, the PA concept has spread to Canada, the United Kingdom, the Netherlands, Ghana and South Africa. The Russian feldsher was a forerunner to the physician assistant profession dating back to the 17th and 18th century and introduced by Peter the Great to the Russian military in the setting of a physician shortage–not a new problem as you can see. PAs also work in disaster relief and with medical mission groups across the entire world, and many PA schools offer international rotations. One of the best experiences I had in PA school was going on a medical mission to Honduras. Nothing makes you more grateful or humble than knowing that patients have walked miles carrying their shoes just to see a medical provider in order to show up wearing their best clothes. Seeing ingenious providers treat patients in a clinic without reliable electricity inspired me to be more aware of how I allocate our health care dollars, and to hone my physical exam/diagnostic skills.

7. PAs are required to have both national certification and state licensure, and must recertify every 10 years by passing a national exam covering the following areas of medicine: surgery, pediatrics, cardiology, pulmonology, orthopedics, dermatology, psychiatry, neurology, infectious disease, hematology, genitourinary, gastroenterology, endocrinology, and otolaryngology (see #2 above).  In addition, we must remain up to date by earning 100 continuing medical education credit hours every 2 years. So even though patients ask us frequently when we are going to finish our schooling and become physicians, the answer is never, because we will never stop learning and we love being PAs.

National PA Week starts today. Even though I never did win a Nobel Prize, travel to outer space, or learn to dance like Shirley Temple, I am blessed to do what I love. Being a PA has been a more rewarding career than I ever dreamed possible. I am thankful for all the patients who have allowed me the privilege of caring for them, listening to their life stories, and sharing their journeys. I am humbled by the incredible trust they place in my hands, and strive like all in the medical field, to be worthy of it.

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Where Were You on 9/12?


Images of planes crashing into the Twin Towers flash behind my eyes, as I listen to the veteran before me haltingly describe his flashbacks from the IED explosion that changed his world forever. Years have passed for all of us, and nothing remains the same. It is the question of our generation: Where were you on 9/11?

I was a physician assistant student. As anyone who has survived PA school will tell you, there is no lower person on a medical team than the PA student. Scut work and long hours are the norm, and I had not yet even earned the privilege of standing in scrubs as the lowliest member of the team. I was still in that first long didactic year, where Socrates’ words held sway: I was learning all that I did not know. Navigating the streets of downtown Detroit, inhaling the acrid perfume that cadavers wear, and desperately memorizing the biochemical pathways that make us human, I despaired of ever knowing all that I needed to know to care for others.

Back in class on 9/12, a Wednesday, my helplessness multiplied. There were so many hurting, and in need, and I was a lowly student without the tools to help anyone. Like everyone else, I had spent the day before numbly watching the unlikely images of planes gliding into skyscrapers, gaping holes in the Pentagon, and ash-covered firefighters kneeling in prayer. I stared at my hands, pen in hand, aching to grasp the skills that could bandage or suture or make a difference, somehow. Laying my hand on my daughter’s head that night, I wondered what the world would bring for her, and for all of us. I resolved to learn all I could to make the world a better place for her and others.

The question we should ask of ourselves, and others today is this: Where were you on 9/12? If 9/11 was the day the world changed for us, 9/12 was the day each of us took stock of where we stood, and took the steps into a new future. What resolutions did you make that day? What changes did we make that have led us to where we stand now? And now, so many years later, I wonder at the journey that we as a nation have made, and look back at the person I was, and marvel. Since that day, my husband left his lucrative, but unsatisfying job to become a firefighter/paramedic, and I, like all firefighter’s spouses, lie in bed waiting for the call that he is safe. I know there is more innocence and laughter in the world, because I have brought two more children into it.

And today, I sit before this veteran who has served our country in the fight against terror, and the tools I use every day, are the tools I had then, though I did not know it. I did learn how to suture, and bandage, and administer medications that will heal and soothe, but what I have learned since 9/12 is this: The single greatest thing I, and anyone else privileged enough to be present in the healing process can do, is listen. Though these hands have finally acquired the skills I so longed for as a student, today they grasp the hands of the soldier in front of me, in gratitude, and somehow, it is enough.

Today, I also had the privilege of handing out awards to PAs from around the state. As part of my committee work for my state PA society, I learn about all the good work being done by PAs around the state through nominations by other PAs. It is humbling and gratifying to see all that others do every day, without thought of recognition. I am proud to be able to recognize all these paragons of our profession, and share their good work with others. Many are working in rural clinics, taking care of underserved populations, and making a difference merely by their existence. It truly is a blessing, and I am grateful to be surrounded by such inspirational people. It gives me hope for our world to be in the presence of all these good people. Our state PA conference honored them, as well as all those we lost on 9/11. All of us reflected on where we were on 9/11, and we had several PAs who are either veterans or are currently serving in the National Guard. Perhaps it is my own bias, but I feel blessed to work in a profession where serving others is our priority. Many tonight spoke of the same resolve to be part of the change to make the world a better, more peaceful place. Please feel free to share your story of where you were on 9/11, and what you changed on 9/12 that led you to where you are today.

Groundhog Day


I’m laying in bed wishing my life were a movie, and unfortunately Groundhog Day is the one that keeps coming to mind. Today was a day when I could not get it right. I could not be kind or patient or even grateful for all the blessings I have. I walked out of the house this morning without even kissing my family goodbye, distracted by all the things I needed to accomplish before the day began, and tired, instead of rejuvenated by the weekend. This Monday felt like the end of a long week, instead of the beginning, after six days with the husband gone elk hunting, and then headed back today on shift at the firehouse, and I could not see my way to Tuesday. If only we could hit the rewind button, or live the day again, but do it better. This is what comes of being a perfectionist, wishing to do things over and over again until I get it right, instead of letting today go, so tomorrow can begin.

Haven't we all wished once we could be Bill Murray, and live our day over again right this time?

Haven’t we all wished once we could be Bill Murray, and live our day over again right this time?

Perfectionists don’t look like you think they might. They are not all perfectly-pressed pristine paragons of pulchritude (wordies of the world unite!). The first time I read that most perfectionists are procrastinators, I felt someone had opened up my half-empty diary and read the scribblings within. This fear of imperfection stops up creativity and progress. This folly is what has my blog littered with drafts “that just need a little more tweaking,” languishing in the junk drawer of my mind. I don’t blame Pinterest or all the other parenting blogs with their professional-looking pictures of crafts I could never master or perfectly clean homes that don’t have piles of clean laundry that still need folding. I was born this way, and have unfortunately passed this trait on to my kids, with Daughter #1 wailing at age 3: “But I can’t make it perfect”, while trying to tie her shoes. I can’t be Bill Murray today, so in an effort to let go of this ideal of perfectionism, I am sharing this sad, largely unedited tale of how I picked my self-pitying self up and kicked myself (metaphorically, of course) in the dupa as the Polish say. (You can’t grow up where I did in Michigan and not pick up a few useful Polish words, another useful one being paczki).

Sometimes, we live the Pinterest life, or at least give the appearance of doing so. Last night we dined on bone china eating grass-fed husband-hunted grilled elk steaks with a side of organic brown quinoa, and garden fresh-picked kale stir-fried with onions and nitrite-free bacon. Here is a picture of that lovely meal.

Pinterest-worthy, don't you think?

Pinterest-worthy, don’t you think?

Most times we don’t though. Today, I picked up dinner from Wendy’s (by request from my little guy–not sure if that makes it better or worse) on the way home so we could get started on the hours of homework I knew lay ahead of us. My kids ate their Kid Value Meals (“with toy from Dreamworks!”) while I prayed that the fumes in my tank would get us through the line at the gas station, hoping the gas light would not start blinking like the robot in Swiss Family Robinson. I’m sure the bacon on the Junior bacon cheeseburger was not nitrite-free. There is no picture of that meal.

When we got home, Dragon Mama reared her ugly head, and the battle of the homework began. My middle daughter has no great love of math, and a summer in which we did not review multiplication tables is bearing all of its tearful fruits now. As I sat there, wishing the husband was home so I could tag out for a few minutes like those old WWF wrestling matches, I wondered if perhaps I am the cause of her dislike of math. Not a great motherhood moment. I walked away to sit on our patio swing, in the hopes that it would give me some perspective. This would be the moment I discovered the dog had found something delightful in the compost to string all over the yard. I have to admit, there was nothing Zen-like about this outdoors experience, and the swing would likely be more calming if it weren’t powered by angry feet, rocking wildly off its foundation.

This is me on a bad day.  Note the mouth made for spewing fire.

This is me on a bad day. Note the mouth made for spewing fire.

My spirits thusly fortified by the brisk swing, I felt up to the homework battle, in which the phrases “No, it would not be easier to add it 36 times, just MULTIPLY!” and “Yes, it is still wrong! Add it again.” were uttered. This is why I would be horrible at home-schooling my children, and why I believe teachers should be paid exponentially more than they are. At the end, we negotiated how to dole out the last 6 problems of Sunshine Math for the rest of the week given a full schedule of baseball, soccer, dance, scouting, and, of course, work. That was when my middle daughter said, “I really hope Daddy will be home for at least some of those days.” “Me, too,” I thought to myself.

In the middle of this, my husband called back to apologize for our earlier conversation in which I had retorted, “I don’t understand why we’re yelling when we agree with each other.” I had the good sense to also apologize, though not very graciously, and then he shared the news which made every single grumpy moment seem ridiculously banal. Our friend has cancer, and the outcome is uncertain.

On a day when I managed to yell at my kids just trying to add and multiply, my husband while trying to agree with him, and the dog for doing what dogs do, this news made me drop my head in shame. I looked at my self-pitying soul, and resolved to live better. We get no second chances, this not being a movie set and all, and so, we said our bedtime prayers, I apologized for being a dragon Mama, and we had a cuddle session which put them past their bedtimes, in the hopes it will all balance out in the end.

Tonight I’m thankful for second chances and forgiveness. I’m grateful for Wendy’s Junior bacon cheeseburgers and elk steaks. And I’m thankful for all the teachers who spend hours a day teaching our children with patience and skill. I’m praying for all the other dragon mamas (and papas) out there who have to parent alone all the time. I’m praying tonight for our friend, and for all of us out there who are struggling to live each day with grace, whether it is our last day or our first, again.

7 Reasons Why I Love Working at the VA


If there is a word that means the opposite of a news hound, that would describe me. I get my news in small bits on my drive into work, but lately because I work at the VA, the news has been coming to me. People I barely know have been asking me with furrowed brows, real concern and almost prurient curiosity in their voices, “Sooo, how’s everything going at work?”

The funny thing for me is that not much has changed. I still listen to my patients’ stories and examine them with the same amount of care I always have. In fact, I would say, other than the comments I get from others because it is all over the news, there has not been much change in my practice. For everyone else I know that works at my facility, I would venture a guess that this is true for them as well. We are all doing the work we came here to do, despite news media reports, despite protestors, despite changes in leadership, despite insufficient staffing and budgetary concerns, because it must be done.

Coming from private practice, I will admit I had some trepidation about coming to work at the VA. As with any large hospital system, I was worried about fitting in after coming from a small community office. My fears were allayed on the first day of orientation. I knew very little about the military before coming to the VA even though my parents met on a US Army Base in Vietnam. I expected to get educated about rankings and how best to address people. In fact, none of this occurred. Instead the emphasis was put on serving veterans, those who have put their lives on the line for our freedom and our liberties. It didn’t matter where they served, in what capacity, what their rank had been, if they were a part of our military, they had in the (paraphrased) words I heard for the first time in orientation, “in effect, given the United States a blank check, payable up to and including their very lives.” Sobering, isn’t it? I have always admired those who were in the military, but after working here I have an even greater respect for them. As a PA, I owe my career to those who served in Vietnam and World War II. With the job market for PAs in its boom phase, I could get a job anywhere, so why do I work at the VA?

I work at the VA because:
1. There is nowhere else I’ve ever been where patriotism is not only seen everywhere, it is expected. I believe despite all the detractors, sarcastic comments, and negative reports, that this is still the greatest country in the world. There is a reason everyone still wants to come here, a reason why people risk their lives trying to cross borders and flee across seas filled with pirates and rapists to get to this country. Are there countries with less crime? Yes. Are there countries with better educational standards? Yes. Are there countries with less poverty? Yes. Is there any other country in the world, where we can have people protesting outside the gates of a hospital where we are taking care of our wounded warriors, and the only comment made by hospital administration is, please don’t stop to talk to the protestors as it will impede traffic through that gate. Why? Because these wounded of ours fought for our rights, including the right to free speech, even if it is to used to say they think you are wrong. As an immigrant, I am proud to call myself an American, and proud to serve our veterans.

2. I love working at the VA because I am surrounded by others who love taking care of veterans. I am blessed to work in a place where people are happy to be here. Many of them will be even happier once we get more providers to help take care of the many veterans who are signing up every day to be seen, but even despite being overworked, patients tell me everyday that they can sense how happy everyone is who works here. These patients talk about the smiles on the faces of workers here, the friendliness of all the people who stop to ask them if they need help. It is bred into the culture of this hospital, from the very first day of orientation, that it is our job to take care of all veterans, whether they are sitting in front of us in an examining room or wandering looking lost in the hallways. Many of the employees here are veterans themselves, so patients feel a kinship with them, bonding over stories of boot camp and battles.

3. History comes to life at the VA. From World War II veterans who endured the Battle of the Bulge to Gulf War veterans who were there when they pulled down the statue of Saddam Hussein, I’ve met so many people who were part of history from patients to administrators. Just walking through our hallways is a history lesson. Though we have our fair share of generic abstract hospital artwork, these are far-outweighed by the pictures of veterans, memorials and other landmarks that commemorate their accomplishments. And if you are willing to listen, there is nothing like hearing first-person accounts of what really happened behind the scenes by the men and women who had boots on the ground

4. The world becomes more global at the VA. Hearing their personal stories of exposures to radiation on Bikini Atoll, trudging through days of pouring rain during the monsoons in Vietnam, and life on board ships in the Pacific brings the world into my little office. Most veterans have been stationed in places I’ve never had the pleasure of going, and just asking them their favorite place to be stationed always yields surprising answers. I’ve learned about clear cockroaches on Marshall Island, hamlets in Germany found intact after the bombing ended, and blinding dust storms in Iraq.

5. Good quality health care is given here. When I worked in private practice, it was my responsibility to keep countless algorithms and guidelines for clinical practice in my head. A 65-year-old man with any history of smoking? I had to remember to schedule his abdominal aortic aneurysm screening, EKG, and cholesterol check. Here at the VA, electronic alerts for recommended screening pop up to remind us. Providers with years of experience are coming to the VA, tired of the same dwindling fee for service, pressure to succumb to the almighty dollar, and rising malpractice costs that are driving people away from and out of medicine in general. People forget that innovative research and groundbreaking discoveries were done first at the VA, including the first implantable cardiac pacemaker and the first successful liver transplant. In the wake of all the negative media attention, I’ve had countless veterans making a point to thank me (!) for helping them. Two of these veterans shared their stories of how their lung cancer and colon cancer was diagnosed early here, after coming from private practice, essentially saving them from much worse outcomes. Our hospital is a teaching hospital, like the one in Detroit where I did my internal medicine rotation, and the one in Ann Arbor where I did my first undergraduate research with the University of Michigan. Everyday, eager students from nursing, medicine, OT, PT, psychology and countless other disciplines come here to learn from people who are taking the time to teach others how best to care for our veterans.

6. The electronic medical records system here actually helps me to get my job done as opposed to impeding it. That is not to say that I love EMR, but being able to easily access records for a veteran who is sitting in front of me makes my life and the patient’s life a lot easier. I get alerts about patients’ labs, imaging, and consultations sent directly to my account on my desktop. This is more efficient than keeping a list in my head of all the patient results I needed to check on throughout the day. Veterans also can sign up for a program called MyHealtheVet which allows them to look at their own labs, notes, and reports through a secure gateway, enabling them to take charge of their own health.

7. And most importantly, I get to help heroes every day. In the grocery store, you and I might walk by these men and women without a second glance as we run in to pick up a gallon of milk. Every day I have the privilege of meeting, talking, and hearing from people who though most of them would not call themselves so, are heroes. They have saved lives, built bridges both literal and figurative, done acts of diplomacy under scrutiny in foreign countries, and done this for those of us who get to sleep peacefully in our beds. I look at the world very differently, realizing there is a story inside every one of us ordinary-looking people.

I know there will be many, and have been many who say this system is damaged. My answer to that is that all of medicine needs to be revamped, and if closer scrutiny is what it takes to make our healthcare system more efficient, then it is a good thing and I am thankful for it. This scrutiny involves recognizing what works and fostering this, especially so those who are doing the work don’t lose courage to keep fighting for good healthcare for our veterans. What does not help, and will never help, is negativity without action. And so, I ask all of you to share your stories of what works and what does not, and perhaps then we can use those pointing fingers to lift the burden instead of making it harder to bear for those of us doing the best we can.

The Ides of May for Those Who Grieve


It is there in the quiet lament of drooping branches after the tsunami.  We find it in the jagged edges of chaff in the harvest.  The echoing stillness of new-fallen snow in the dawn tells its story. Iridescent rainbows in brackish puddles of fuel and mud reflect it.  It stalks us through dreams, tracking our movements in stealth as we move unknowing away from moonlight.  Like the lightning on the mesa, it crackles through each hair like fire, leaving us bereft in its wake.   The cry of an infant in darkness waters its bloom in the hollow chambers of our chests.  The wedding toast is sour on our tongues because of it. We listen for the quiet flutter of salvation’s wings, and the silence burrows into the marrow of our bones.  The chill of untouched sheets bites the tips of our fingers.  Where can we find solace when everywhere our eyes rest and every sound the earth makes reminds us of it?

Each inhalation then is an act of courage, a willful acknowledgement of its lack of power over us.  We exhale into the grey mist that threatens to submerge us, and emerge drenched and stained, but standing.  And when we have gained the strength to open our eyes, we see the hordes of trembling others on this shore, and know we have never been alone.

Today I am grateful for those who stand beside us as we mourn, who hold our hands when we grieve, and for those who have been on that shore too many times and still have strength to teach us how to breathe.
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