skin check

One cool thing about living in the desert is that when you have a string of cool, drizzly grey days in the middle of summer, everyone looks around in wonder and says, “isn’t this weather amazing?” I’ve gotten rained on three times in the last week, and still I don’t carry an umbrella with me. Being outside in the rain is pretty beautiful, and anyway this is desert rain: it dries off before too long.

And then there’s rainbows! Every afternoon we’ve had these enormous rainbows that stretch across the whole entire sky, literally from horizon to horizon, in every possible color; sometimes two on top of each other, glimmering brilliantly like mirrors. The first three or four days these rainbows came out, I ran outside, stood in the middle of the street like a little kid, and said “Whoa! No way!” Now I’m afraid of getting spoiled by the onslaught of so much ridiculous beauty. Really, what more can you possibly even imagine when you’re being bombarded by enormous crazily beautiful rainbows every single day?

I’m doing dermatology at the VA and I actually love it. I’m not sure why there’s such a pervasive compulsion in medical culture to complain enthusiastically about the VA, but I feel at home there. The one here is like a carnival. Every morning the lobby is full of volunteers making popcorn, and four-foot-tall old ladies serving people teeny cups of coffee and exactly one vanilla sandwich cookie behind the Information desk, and old-timers in those huge baseball caps with the pins on them that say “Korea War Veteran,” sitting on benches and nodding wisely together; and—yes—a Mexican folk band made up of about 27 people, at least 11 of whom have either crutches or wheelchairs, and they’re all joyously singing songs like “De Colores” and amiably squinching out of the way whenever people need to get by them. Every morning! How can you possibly be in a bad mood when this is what greets you upon entering your workplace every day?

More importantly than the sideshow in the lobby, which I could really sit and watch all day, are the veterans I get to work with, who are so beautiful and sad and dignified. The vast majority of them are men in their seventies and eighties who are coming for routine skin checks. Many of them have had skin cancer before, and we biopsy suspicious lesions on at least half of the ones we see. We examine them, inch by inch, sometimes with magnifying glasses and penlights, from the waist up. It’s a strange, incongruous, overly scientific gesture for the setting, because ultimately there is something so human and humbling about an eighty-year-old man with his shirt off. The belt, the suspenders, the coarse hairs in surprising places, the way age has settled the belly. The pale tender places the sun doesn’t touch. We carry our histories in our skin: the scars the world has bestowed upon us, and also those hidden vulnerable untouched places even the most gnarled and weathered among us still have. I don’t take these careful examinations lightly.

One of the last people I saw on Friday was a guy about my age who came back from Iraq about seven months ago and has had no end of health problems since his return. “Yeah,” he sighed, leaning deep and long back into his chair. “I’ve never been the same since that deployment.” He sustained significant head and leg injuries and has been unable to work steadily since then. Because he hasn’t been able to work, or sustain his former level of physical activity, he’s been sitting around the house a lot and he gained 50 pounds, and now he has hypertension and diabetes even though he was, up until recently, a completely healthy man in his early thirties. In addition, he’s been hospitalized twice for severe skin infections requiring IV antibiotics, and the day I saw him he came to the derm clinic with strange lesions on his legs suggestive of skin manifestations of TB. That’s a lot for a young person to take on.

“How are you doing, just in general?” I asked him.
“I’m depressed!” he said cheerfully. “Ya know? I’m not the person I used to be and it’s frustrating. But what am I gonna do? This is how it is. I could mope around forever or I could just keep going.”
We sat in silence for a while.
“Know what I realized the other day?” he asked.
“What?”
“I’m so thankful to be alive. Even after everything, you know?” He looked down, picked at the cracked vinyl arm of his chair. “That’s something.”

great joy

Tomorrow’s my last day on the newborn service; I’m gonna be sad to leave. Every day there was like being in the middle of a hopeful prayer. It’s such a beautiful honor to witness some of the absolute first moments another person spends in the world.

One amazing thing about working with newborn babies is that you just can’t be down for long. I knew a resident in San Francisco who visited the newborn nursery and held a brand-new baby every time a patient died. These last few weeks, every time I’d feel exhausted, frustrated, or like the dumb new intern who doesn’t know anything, I’d pick up a baby and hold them by a big window that looks out onto the mountains. Babies are so scrawny and wrinkly—some of them are downright reptilian-looking, really—and we think they are so beautiful! It’s an amazing thing to remember, the enormous capacity our hearts have, how much we can overlook if we put the big things where they belong.

Something awesome that happened was that one of the brand-new parents told me she wanted me to be her little one’s doctor, so they’re gonna come see me in clinic next week! I’ve had people say they wanted me to be their doctor before (to which I’ve always responded with, “Really? Are you sure?” or, “I’m not really a doctor yet…”), but this was the first time that I could say, “Great! Come see me in clinic next week!”

I’m so excited to watch this one grow. Yay!

One of the first days I was working there, I was holding a baby after I’d finished examining her, and her eyes popped open and she looked straight into my eyes and I realized I was one of the very first human beings this little person had ever had eye contact with. I felt a huge sense of responsibility that I still can’t fully explain: commitment as a person and a doctor to be fully present in the lives of the people who share their intimate, sacred parts with me; a renewed sense of devotion to the world around me, a reminder to keep plugging away, step by step, toward justice and respect for those of us who are here.

I think there’s a reason I got to start my life as a doctor here, with all these brand-new perfect little people. I think it was a gift for my spirit, and I am so grateful. Recently I’ve been remembering a christening my brother and I stumbled upon a couple of weekends ago when he was here visiting. The priest, a gigantic man with a barelly voice and hands as big as dinner plates, took up the baby and said, “God has welcomed you into this world with great joy!” Without realizing it, I’ve been thinking those words toward the new babies every time I pick one up to check for sacral dimples or listen for murmurs. I hope I can keep this blessing central with all of my patients: the crotchety old ones, the apathetic preoccupied ones, the ones who are like most of us: too sick and tired and old to be flawlessly beautiful anymore. God has welcomed you into this world with great joy, I hope to remind myself, about each and every one.