Sevy's Guide to Nothing: A Textbook of the Unknown and a Compilation of Their Stories

I wouldn’t say I’m predictable, but there are many things about me that I know for certain. I really despise ironing and my dryer is too far to throw clothes into for some unwrinkling, so I turn on the iron only to roll over the most wrinkled part of the outfit and then I stop. I’m not tough enough to drink black coffee, so instead I use the sweet creamer and lots of sugar. There are simple things in life that make me overly excited like the smell of freshly cut grass, cruising my bike even for short distances, and sleeping in flannel pajamas. Being alone is refreshing. My car is a safe haven, it inspires me to sing at the top of my lungs and cry when I need to experience the relief that tears bring. I pass in the right lane… frequently. I post pictures of my vegetables on facebook like people post pictures of their pets. And finally, I was made to be a doctor.

The clinic- To many it is a building to receive medical care, to draw blood and get medications, to receive new diagnosis, and to develop plans for your healthcare. The clinic is many things to many people, each with different expectations, but each wanting the same outcome- una vida saludable- whether or not the desire or resources are available to achieve such a daunting task. To me the clinic is the people. It is a building of people, for people and by people. It reminds me of a woman who meandered in and out of the clinic purely for social reasons. For her it was a place to stop by and exchange greetings, update the nurses on the upbringing of grandchildren, and of course metotiar about her son’s new girlfriend. The clinic- a place I’ve grown fond of and a place where I have witnessed life, but also a place where I was repeatedly challenged with the reality that life does not follow a textbook and up until now that’s all I’ve ever studied. 

The bittersweet lives of pregnant teens, the dichotomized lives of Cubanos who willingly forgot their home country and Cubanos who would return in a heat beat, the dangerous lives of the cleaning ladies in hotels across Central Avenue, the defeated lives of Vietnamese mathematicians who can no longer teach because they do not know the language so they suffice by painting nails, and the weary lives of viejitas and their husbands. Their stories have all been chapters in my life’s storybook, or rather my very own textbook, a textbook that continues to teach me how to be a better doctor, a textbook where I will never depend on finding the answer because of the individuality each case brings. But it’s a textbook I’ll continue to develop nonetheless.

In southeast Albuquerque, there lies a clinic, which is the medical home to generations of families and cultures from around the world. It wasn’t an ordinary day if I hadn’t worked with a Vietnamese or African language interpreter or relied on my very own and ever-improving Spanish speaking skills. The walls of the hall are decorated with portraits of Albuquerque families representing a smorgasbord of countries and unique familial compositions. My welcome into a diversity like none I had ever known began in this clinic, and I embraced every minute of it. The Latinos made up a large majority of my patients- this somewhat generic term incorporates the Cubanos who talked my ears off and the Mejicanos who felt like family, and ranged to just about every other Latin American country. The Vietnamese population contributed to a big bulk of the clinic, and with each interaction I bravely dove into a culture I knew absolutely nothing about. Intermingled throughout the day’s schedule were individuals from Thailand, Congo, Kenya, Pakistan, Iraq and more.  The globe, a once massive and incomprehensible structure, was slowly becoming smaller in my eyes as I witnessed the unifying abilities of medicine. And, of course, the burqueno locals, made up the remainder of patients.

CHAPTER 1: Sacrifices

I entered the room only to be engulfed in the smell of lingering smoke and the presence of a Cubano in his 60s. He wore what looked like every piece of gold jewelry he owned on his fingers, wrist and neck. His button-up shirt was unbuttoned to the 4^th or 5^th button and he held his walking cane loosely between his legs, which were covered with long socks and sandals. He didn’t speak a word of English and his Spanish was more rapid than that of an auctioneer. The ends of certain words were abruptly dropped and he quickly embellished his expressions with hand movements twirling back and forth and up and down. His wife, a pleasantly plump lady, and her grandson accompanied him, but spoke minimally. They had brought along a gift for the doctor’s daughter, who they had remembered recently celebrated a birthday. El Cubano Loco had begun each sentence with “Doctora” despite me telling him I was merely a student, and he completed each sentence with a facial expression to match his recent statement. He went on about how his wife wanted to dance and how his worsening back pain had prevented him from accomplishing such a task. He told me how Albuquerque has been his home since the moment he stepped off the plane from Cuba in the 70s, and how his wife has been back to visit but he refuses. I was happy to share my home with this family, but saddened that his wife had to sacrifice the comforts that only Cuba could offer. As he sauntered on about his home country, I couldn’t help but let my imagination wander. I suppose I’ve seen too many movies, because I was inappropriately being stereotypical, as I let my mind create a history for this man I had met only once. In my story, I imagined him escaping a criminal life as a head honcho never to return to Cuba for fear of relapse or worse- retaliation.

My other Cubano favorito, which I remember with fondness because he complimented my Spanish accent, was a middle-aged man with a bad case of the sweet-tooth. He had two of the worst diagnoses as far as diet are concerned, and this nearly brought the man to his knees begging for a break or better yet a cure, none of which I could offer. He had gout preventing him from consuming meats and alcoholic beverages and he had Diabetes, which we know limits ingestion of all the simple pleasures in life. He had told me there was nothing left in the world that he could eat, and a sense of sorrow beamed through his facial expressions, a look I had never seen associated to something as relatively miniscule as food and I love food. He then lost connection to reality and his Cuban Spanish, as quick as a gushing fountain, began to list off the types of oranges from Cuba, the sweet, the bitter, and the in between. I didn’t realize mouth-watering could be so contagious. I let him enumerate his fruits like Bubba when he listed of the different types of shrimp to Forrest Gump. When I asked him what he eats in an average day, he surprised me by telling me his daily breakfast consisted of drinking a can of condensed milk. The thought was so sweet I nearly got a tummy ache just listening to it. I left that interaction feeling hungry and somewhat defeated that this man’s pleasures in life were stolen from him and recognized the sacrifices we must pay for health. 

Textbooks tell me to treat Diabetes with low sugar diets.

Life tells me that the simple pleasures keep you happy, and without happiness life is not pleasurable.

Lesson- I will meet my patients in the middle.

CHAPTER 2: The Power of Prayer, The Power of Tears 

My beautiful grammita passed away during my family medicine rotation, so when my 85 year old patient broke down into tears because she missed her grandkids so much, I couldn’t help but let the tears stream down my face. She was your typical grandma; she kept all her annual appointments and had been coming to the same doctor for years. She went to church on Sundays and sometimes Wednesdays, and she knitted little matching hats and dresses for every little girl she knew even if only remotely. She prayed for her children daily and even lit a candle and said a few rosaries when times got tough. But when I reminded her that she had to schedule an appointment with the cardiologist to follow-up on her heart condition- her strong and happy-go-lucky mentality melted into a story that quickly lodged old memories into the front of my mind. By this time my supervising doctor had joined me, and unbeknownst to me she had also recently lost her grandmother. My little grammita patient began to tell me of her son's recent divorce and how her ex-daughter-in-law had taken the kids. She was spending her days praying. Praying first thing in the morning, praying before meals, praying before novelas, praying at bedtime. She was on a praying binge.She had went from seeing them daily to sparingly, and she was consumed with heartbreak.  I was reminded of the tormenting few years when I first moved away from the brick house that sat cozily next to my grandparents’ home, in which I could easily trot down the sidewalk for a quick visit, some cookies from the endless supply in the cookie jar and peas from the garden. My grandma would inevitably be making dish towels or rolling tortillas with ease. The three of us sat there in tears, and together we reminisced of the past, we held tighter to the memories and we put medicine aside for a much needed moment of tears. It was a reminder that grandmas make the world a beautiful place and that healing comes in all shapes and sizes. Healing is not only distributed in a pill form, but also with the release of tears and the invaluable moments of conversation. I am thankful for the endless nights of prayer that many wise women in my family have devoted their time to. Rest in peace Leonor Gurule.

Textbooks list the stages of grief and use words to describe the indescribable process.

Life has taught me that grieving can begin in a clinic room with strangers and that medical care gets in the way of times for grandmothers to pray.

Lesson- Grieve and encourage grief, it may take years but you’ll be happy you did.

CHAPTER 3: Addiction vs. Coping: Only One Will Win
 

The clinic has many sub-clinics, if you will, within it and one is devoted to the care of pregnant women who also happen to be addicted to drugs, often prescription pills. It’s associated with a home where these women live and grow together. They often become inseparable friends throughout this time and face their challenges as a team. While working in this clinic one Friday morning, I was surprised by the women I saw. I must admit, embarrassingly so, that I had some preconceptions on how that day would unfold and I was pleasantly wrong. The first young lady that I saw was a beautiful and bubbly woman, who was due any day. She had a list of questions to be answered and a good fifteen minutes worth of pregnant yoga shenanigans to divulge. We chatted away and quickly bonded, despite being previously advised to not be offended if the patient didn’t open up, because these women tend to be attached to their doctors. She readily told me how she was really busy making plans for her baby, who would be taken by her sister after delivery because she was leaving to prison for robbery and illegal possession of a weapon. She wore sorrow and embarrassment on her face, but the gravity of her circumstances didn’t penetrate the bubbly girl that she was. I recognized in her eyes that she knew she was paying the consequences for her actions, and she learned a lesson far greater than any. She also shared her troubles regarding the program, as she was torn between the rehabilitation opportunities and spending time with her visiting son, who had come from the west coast. The program denied her request to leave for a bit to stay with him and he couldn’t stay in the house, so she was tossing around the idea of leaving but fear kept her from once again entering a life where she could easily access the poison that had put her in this situation in the first place. Somehow all my problems seemed so benign. The final woman that I had the privilege of working with was pregnant with her first child, something that caused her to ooze with excitement. I also immediately sensed some mania-like characteristics upon entering the room; She was quite the talker and chatted away about any and every thing. She caught me up on drama in the house and I couldn’t help but imagine her life was like an episode in Jersey Shore. Her update ended with a story of one of the other girl’s in the house and her brave attempts to prevent relapse. The other girl was also pregnant and lost the baby shortly after it was born. All the women in the program attended the funeral and at the end, this young patient thought it best to follow the grieving mother and sadly her suspicions were true. My patient had followed the girl out behind the church only to stumble upon a drug deal. The mother who had just lost her day old baby was returning to her old coping mechanisms, which sadly is not coping at all. Drugs are a method of blunting emotion and removing oneself from reality only to ignore the unwanted truth. It was a solution far from ideal, but a solution so natural to her. My young patient sobbed and I silently sat there remembering the lives I’ve seen destroyed by drugs. I felt defeated once again by the power I would never cease, the power to cure addiction, a power I have always desired to wield, but one that is non-existing. 

Textbooks offer an array of anti-abuse medications, and attempts to perform motivational interviewing.

Life has taught me otherwise, addiction is pervasive and follows no rules. As an outsider looking in you will be helpless and you will be angry, but somewhere behind that mask of drug-addicted bewilderment is a person who depends on you.  

Lesson: The power to yield change will never be as simple as the book teaches. Try anyway.

CHAPTER 4: Cleaning Just Got Messy

The old cleaning lady who spends the majority of her life on her knees and feet cleaning up after people had a face warped with deep crevices haphazardly strewn about. She appeared much older than her stated age, but she had the energy of young woman. She was bold and eagerly shared her torments of being a cleaning lady for hotels along Central. She had told me about the various dead bodies she had discovered and the eerily unique positions she had found these once living people. She was jaded to the subject and I knew that my own career would be one filled with death, but one augmented by the technologies of medicine. My eyes were opened to the realities that our patient’s face, the darkness that fills their lives, and the things I could never comprehend. I had hundreds of hours of lecture and not a single one would prepare to counsel a woman who saw the things this lady saw. If I reached back into the most distant of memories, I could not recall that lecture entitled "The Struggles of  a Housekeeper on Central Ave." Ill prepared? Possibly, but surely the medical school curriculum committee could not have anticipated such a scenario.

Textbooks are invaluable sources of knowledge.

Lives have infinite opportunities for exploration, leading to infinite opportunities for distinct outcomes. I could teach you for centuries and you would still be untrained for the challenges of your patients.

Lesson- Learn every day, because you will never know enough.

All in all I met mothers and fathers, their children, the grandparents, the lone rangers and the lost. I had been asked in a psychotic tone what a Diabetic coma felt like, and I had to tell a young Vietnamese boy that his exam was worryingly abnormal. I had a grown man cry like a child when I tried to discuss with him the importance of keeping his Diabetes under control, and his wife aggravated the situation by forcefully reminding him that she could not raise the entire family on her own if something were to happen to him. He told me he felt like he had cancer and it was the first time I realized the seriousness of a Diabetes diagnosis for a family in near poverty. I counseled a young woman who had just lost her best friend and warned her that that void would never be filled, but that our loved ones leave with the hope that we will not die with them. I shared tears with her when I told her of my very own losses. In the end, my textbook is filled with the lessons of life. It is malleable. It has to be. And it comes with a giant sized eraser and sticky notes. There’s room for impromptu additions and the pages are durable enough to endure sketches that have been erased and redone. My patient’s don’t read the textbook, so of course they cannot follow it. So my textbook allows for mistakes and creativity alike. It is a textbook of reason and not one of rule, it is a textbook of suggestions and not one of guidelines, and finally it is a textbook with lessons to learn from lives already lived.