A Halloween Sonnet

When ghosts fly haunting through the misty air,
When skulls and ghouls and vampires fill the night,
We don our masks of creatures foul and fair,
In hopes of turning heads and giving fright.

I ask my daughter what she wants to be -
A zombie walking, rotting, down the road,
A jack-o-lantern, or a spry palm tree,
A flying pixie or a hopping toad.

Or hey, why not a knight or dragon strong,
A princess brave and smart, a doctor kind,
An skillful bard who plays a spooky song,
A teacher tending gardens of the mind?

I ask her who she wishes to become,
And hear her bright imagination hum.



Some brief thoughts:
On Halloween, we put on masks not only to scare, but for many other reasons ranging from the social to the inspirational. Groups of friends and teams of coworkers dress in themes, bonding and becoming something greater together. Some people's favorite part is the making of costumes, whether to express their creativity or their love for someone who cannot make one themselves. Children in particular only sometimes pick their costumes based on their impact on others. This holiday offers them a chance to be who they want to be, or who they dream of becoming some day.
(Caveat - I don't have children, and can only speak from personal experience and observation.)

#MedLimericks, Part 1

Inspired by: @DShadowgazer

For headache without complication,
A brain scan has no indication.
In such cases you’ll see
That a good H&P
Is more helpful than irradiation.
(http://www.choosingwisely.org/societies/american-college-of-radiology/)
 
If potassium’s staying too low
And you feel like there’s nowhere to go,
Please remember that you
Need magnesium too,
For together their levels may grow.

When sleep apnea’s troubling your rest
CO2 fills your blood and your chest,
But with CPAP at night
You’ll stay up when it’s bright
And your mood will not be so depressed!
(http://jcsm.aasm.org/ViewAbstract.aspx?pid=30173)

Many doctors remain unaware
Of the power of palliative care.
It’s not just for the dying,
But for anyone crying
In suffering, pain, or despair.

Of All My Heart

My heart is an impossible zoo,
Transplanted a few centuries ago
From the left side of my chest
To the middle of my head.

Curiosity races through dense grassland
As judgment towers high above,
Bending down to drink from pools of memory
While watching for anger and fear lurking below.

Yet as all things do with time,
The long edges grow fuzzy,
The habitats stretching loosely
Down my neck, my back, my toes.

Swarms of shame flutter in my stomach
And worry hops from wrist to shoulder
To forehead, where anxiety sits,
Waiting to squeeze and paralyze.

Still, at least you can still find love and bliss
Galloping together from my ears to my eyes,
Their rhythmic steps blurring worry’s path
So that it gets lost along the way.

And you might hear gratitude and calm howling
So loudly that all the predators hide away,
Letting joy perch safely in my cheeks
As care swims down to my hands.

Hope is a handed-down drum

Hope is a handed-down drum,
Worn out over decades of use.
I hold it in my hands, over my head
And let the rain pound down upon it
The music drowning out the deluge,
Letting me walk through the storm.

Sometimes, after a fierce hail,
Some wayward drop will pierce
Right through the battered top.
Suddenly I fear any light shower
Might fill it up till the water’s weight
Breaks through and drowns me.

I rush to the nearest friend
And ask for shelter and fabric
And time to piece it together,
Until I can spend the hours I need
To repair my drum properly
Once I am safely at home.

Poetry is a Mad Mirror

I wrote this in response to poet/teacher Taylor Mali's MetaphorMonday on 8/6/18 (and ended up winning!). As you can see, he has made these Metaphor Dice that make the hardest part of poetry - starting - a little easier. This metaphor is particularly rich, and it was much fun to reflect upon.

Consistency

consistency, n: 

1. Solidity, substance, firmness

2. Condition, degree, quality

3. Agreement, harmony, compatibility

Identity x vision is our compass, 

Paving the path we must walk 

To move from who we are 

To who we want to be. 

Must our professional 

And personal identity 

Be one and the same? 

Or might it be sufficient to 

Have two compasses, distinct 

But consistent, to point the way?

Knight of the Round Wing

I kneel before you
Gowned and gloved,

Yet you bless me still

With a gallant kiss

To the hand you hold

With more gentle care

Than it has to give.

Barrier precautions

Preclude contact,

Yet you touch me still,

Lips through latex,

Warmth into skin and veins

Flowing upwards to

Somber, smiling cheeks.

I knelt before you,

Humble and distraught,

No more cures to offer,

No way to raise the sun

On your tomorrow,

Yet you blessed me still,

And still you remain.

Health is not about Medicine

"Water-borne diseases are not caused by lack of antibiotics but by dirty water, 
and by the political, social, and economic forces that fail to make clean 
water available to all; heart disease is caused not by a lack of coronary care 
units but by the lives people lead, which are shaped by the environments 
in which they live; obesity is not caused by moral failure on the part of 
individuals but by the excess availability of high-fat and high-sugar foods."

- WHO’s Commission on Social Determinants of Health, 2008

Medicine may be about health and illness, but health is not about medicine. It is about the lives people lead, and the world in which that happens. Medicine can save lives, sometimes miraculously. It can improve quality of life, sometimes significantly. But we know now, or perhaps have re-learned, that health is determined by all sorts of factors far more than medicine or health care. (Not to mention how all those factors affect access to care.)

This 2012 infographic from the Bipartisan Policy Center's Lots to Lose illustrates the gap between what matters and what we spend on. What it does not show is the extent to which healthy behaviors and environment are themselves dependent on social, economic, and political factors. 

 It is hard to eat healthily when the closest supermarket is over a mile away and you have no car. It is hard to get an education when your family needs you at home to work or take care of younger children. It is hard to enjoy activity and sleep when you might be arrested for loitering and being homeless. It is hard to find a home when your prior incarceration prevents you from finding a job.

Is it any surprise, then, that the United States performs so poorly compared to other high-income countries? We are among the most unequal nations in the world, and our social institutions (including health care systems) are far from equitable. Our best hospitals can work magic to save patients from heart attacks and strokes, but our impact on chronic disease is tepid at best. Our impact on what causes chronic disease is not tepid, but instead profoundly detrimental. Public health matters, so public policy matters. As is often said in the quality improvement world, "every system is perfectly designed to get the results it gets."

Further reading:

1. "Tools for Putting Social Determinants of Health into Action." CDC, 2018.
2. "It's an Unequal World. It Doesn't Have to Be." New York Times, 2017.
3. "Poor Health: When Poverty Becomes Disease." UCSF News Center, 2016.
4. "Criminal Justice, Homelessness, and Health." NHCHC, 2012.

Fireflies, Part 4: Playing Around with Poetry

Whenever I'm asked or inspired to write poetry about a particular topic, there are a few short forms that I often play with to get my synapses firing. They each have their own constraints, and it is a fun puzzle to write within them. So, here are examples of all three from the last week of fireflies. :)

Haiku
A traditionally Japanese form, haiku has 3 lines with 5-7-5 syllables. They usually involve a juxtaposition of two subjects with focus on nature or seasons.

Dancing in darkness

A lightbulb flickers off

The firefly unseen

Limerick
A 5-line poem with an AABBA rhyme scheme, where the 3rd and 4th lines are usually shorter. The meter is mostly anapestic (duh-duh-DAH). Often humorous, sometimes bawdy, it arose in 18th century England.

Our love letters used to be mail 

Sent at speeds seeming slow as a snail. 

Now as fast as we think, 

Like a firefly’s blink, 

We can send light-speed text and email! 

Acrostic
A literary form where the first letter/word of each line spells out another word or message. This is one of my favorites because when not highlighted, it can be a kind of code.

Falling fairies shower their dust 

In tall grass under taller trees 

Radiant in their summer green 

Ecstasy for the warmest season 

For a longer day and shorter night 

Loving the twilight in between. 

You ever see a firefly in sunlight? 

More Firefly Posts:
Fireflies, Part 1
Fireflies, Part 2
Fireflies, Part 3

Fireflies, Part 3: On Communication and Arguments

Do Fireflies Fight?

Lovers’ spats sparking from missed messages - 

sorry it was a black hole behind that tree 

…can you see me now? 

Fire and fury on one side 

Flashing out in public for anyone to see, 

Yet unnoticed by the other, in their own world. 

Head turned away, distracted by other lights, 

Or just looking for peace and darkness 

To recover for a bit? 

where are you going? 

Sending thought after lonely thought - 

will you look at me when i’m talking to you!? 

And when communication fully fails, you find not

 Silence that makes you feel invisible,

But darkness - 

where are you? 

So complete that you feel utterly alone 

As if no one else exists for you, or ever will again.

More Firefly Posts:

Fireflies, Part 1

Fireflies, Part 2
Fireflies, Part 4

A Firefly Bonus!

Fireflies, Part 2: An Existential Lament

Letting My Light Shine

They tell me to let my light shine, that it’s who I am. 

What do they know of my life?

Of the years I’ve spent in the dirt, 

Working and growing, maturing and waiting 

Until I finally have a light worth shining 

And others worth showing it to? 

Would they truly have me believe 

My past is no part of my present, 

When my past is all that I am?

And what about my daytime life,

And my unlit midnight moments too?

 The hours I spend eating, positioning myself
Just so beneath this tree, in the tall grass,

Are these to be consigned forever to darkness?

I am more than my light in these seconds of splendor,
More than most people will ever get to see.
So make not the foolish mistake that you know me
When all you see is my light shining under this tree.

A few reflections here...

• For most people, most of the time, we are not just the part we play in a given moment. We are the sum of our past - experiences, memories, genetics, relationships - and our present (and perhaps our future?). Indeed, what we bring uniquely to a present situation, as opposed to anyone else, is exactly what our pasts have made us.
• How much of our identity is based on our public persona, versus how we act in private or with close loved ones? Should it be different? Is it even correct to talk about only these two, when we may have many public and private facets? Are we a weighted average of these? A summation? A product?
• Fundamental attribution error: explaining others' behavior with undue emphasis on internal traits rather than external factors, in contrast to judging our own behavior. When we know someone only in a single context, e.g. a professor at school or a manager at work, it is far to easy to assume that how they act is how they are in all situations.
• If you would like to learn more about the full lives of fireflies, here are a few places to start!
• Facts about Fireflies | firefly.org
• The Firefly Life Cycle | ThoughtCo
• Fireflies | National Geographic 

More Firefly Posts:

Fireflies, Part 1
Fireflies, Part 3
Fireflies, Part 4 

Fireflies, Part 1: An Introduction

It's firefly season!! Magical in their transient bioluminescence, as full of symbolism as light itself, fireflies are fantastic in every sense of the word. In the Great Smoky Mountains, members of a certain firefly species (Photinus carolinus) synchronize their flashing lights for their few weeks of summer dancing. They are the only species in the US to do this, and so the spectacle is a rare natural wonder in both space and time.

One member of the poetry group I meet with won the lottery to go this year, and so I was given inspiration to write some firefly poetry! As this is the first Part of perhaps four, here is the first poem, written about my first firefly encounter this year...

Falling Away

Computer left forgotten in the reading room 

So I’m walking back in the dusk and gloom 

When a sudden spark brightens the night 

Veering through the dark, vanishing... 

Reappearing, as if I were stirring 

A pot of hot embers in the air 

Loosing fire, and lighting 

My way until they 

All fade away 

Fall away

Other Firefly Posts:
Fireflies, Part 2
Fireflies, Part 3
Fireflies, Part 4

And as a bonus, here is a beautiful firefly video made by a talented firefly photographer:

Radim Schreiber, http://www.fireflyexperience.org/

Things I Think, Things I Know

"In ancient Chinese, Egyptian and Mesopotamian literature, Smith found 

repeated references to enemies as subhuman creatures. But it's not as simple 

as a comparison. "When people dehumanize others, they actually conceive 

of them as subhuman creatures," says Smith. Only then can the process "liberate 

aggression and exclude the target of aggression from the moral community.""

- Less Than Human, by David Livingstone Smith

This has indeed been recorded over and over in history, and it is more than just association. I don't think it is possible to justify or rationalize certain actions - experimentation without consent or true information, forcibly separating children from parents, mass murder - unless the subjects of those actions are excluded from the moral community. There is no shortcut around that exclusion. Not that there needs to be. Othering followed by exclusion is terrifyingly easy for the human brain.

Granted, it's not sufficient, even if it is necessary. There also needs to be some reason to harm those excluded beings. Self-defense? Destruction of evil? Greater good? For an animal rights activist who includes other animals in the moral community, separating an unwanted male calf from a dairy cow or the mass slaughter of hens is understandably unacceptable. Yet even those who eat meat are disturbed by such images. They would never condone killing a bird, even humanely, for no reason. It is accepted as a necessary evil for the greater good of creating chicken as a food, whether explicitly or implicitly.

Likewise, those opposed to recent actions of the current US administration generally include undocumented immigrants (often explicitly) in the moral community. Those in favor of these actions must not only at least implicitly exclude them, but also have some reason for the violence.

That might be thinking of them as evil, as rapists or killers or criminals.
It might be done in self-defense, such as perceived protection of jobs or family or culture.
It could be ostensibly for the greater good, as in Tuskegee or Natzweiler or Harbin.

But it has to be something, and something more serious than taste or craving. No matter how much some humans may exclude other humans from the moral community, they are not quite so excluded as animals grown for food (as opposed to kittens or giraffes). Unfortunately, humans are today much easier targets of fear and anger than other animals, and these two are some of the strongest motivators for action that exist.

So, what to do? How to reaffirm someone's membership in the moral community? The simplest way is to just say so, as people do on Facebook or blogs, in speeches and discussions, in emails to representatives. The most forceful way is to demonstrate suffering, especially by image or video. The hardest path, but perhaps the greatest, is to engineer meaningful interactions.

As terrifyingly easy as it is for us to other and exclude beings, it is also incredibly hard for us to do so when we know their story. Even if we can only know their mind and emotions and experience incompletely, that imperfect understanding can still sometimes be enough. Not always, of course, and the closer the relationship the better.

I do not know how to create this hardest path. I doubt there is one best way, when we other and exclude beings along a myriad of dimensions - age, gender, race, species, nation, language, income, incarceration...

I know interacting with generous listening helps, being curious and non-judgmental.
I know a cosmic perspective helps, seeing the earth and humanity from the viewpoint of space.
I know ferociously reading fiction helps, opening ourselves to other worlds and lives.
I know self-aware mindfulness helps, examining our own thoughts and assumptions.
I know sharing others' joy and sorrow helps, becoming emotional on their behalf.

So, I don't know much, but these things I know. Please, help me know more.

Of a Girl and her Grandmother

I was lucky enough on my second flight back to Nashville to sit next to a curious girl, perhaps 8 years old, and her grandmother. It seemed like it might be the girl's first time flying, and the way she looked around the plane and out the window was both cute and inspiring. After years of flights to and from home, I'd lost much of the joy and wonder of flying. Yet as she stared out the window at clouds, I also stared at the fluffy oceans and mountains. As she watched glowing cities that sprawled underneath us that night, I sat mesmerized by the grids of lights, the veins of roads, the ant-like crawl of cars.

I listened with renewed interest to the safety video, pondering the reasons behind placement of emergency exits and lights. And this: "Always put your own mask on first before helping others." What a sentence! How often I forget to take care of myself before helping others. How often I put on a mask (not to mention a physical one for droplet precautions) before talking with patients, and wonder whether I ought to distance myself so.

Plus, the girl and her grandmother were just wonderful to sit next to: exchanges of food and inside jokes, questions and answers about the wide world, hand-on-shoulder cheek-to-cheek gazing out the window. And then there was the problem-solving.

I typically try to be a actively helpful passenger. On my first flight, for example, I noticed my seatmate talking with a woman across the aisle and asked if they'd like to sit together. (Yes, of course.) As the girl and her grandmother boarded next to me, I offered to place overhead a bag they were having trouble fitting under the seat. (Thank you, but no, it's full of snacks we'll need.) I then watched as the grandmother worked it as far as possible under the seat in front of her, leaving no leg space. Fortunately, the girl graciously allowed her to share the window seat's leg space, and all was well.

Besides being absolutely adorable, it reminded me of something Sterling K. Brown had quoted from Lao Tzu at Stanford's commencement the prior day: "A good traveler has no fixed plans, and is not intent on arriving." He used it in the context of battling perfectionism and enjoying the process of work. But on this flight, it spoke to the value of the journey itself. Maybe if they had agreed to let me move the bag, they'd have missed out on this bonding experience.

So for the rest of the flight, I just waited and did nothing.

When the grandmother dropped a napkin and groped around in the dark for it, I could have turned on my overhead light or my phone's flashlight. But I did nothing. The girl bent down to search, and her wide eyes and nimble hands soon found it.

When the grandmother was scrolling through city after city to add Nashville to the clock app, sometimes swiping too low and bringing up a notifications screen, I could have helped her use the search function. But I did nothing. The girl giggled and closed the unwanted screen each time it popped up, and they eventually reached Nashville together.

When we had landed and the grandmother struggled to fit everything back in the bag, I could have helped add weight to let her zip it. But I did nothing. The girl picked out a few nearly-finished snack boxes and finished them. The rest fit, and the bag closed.

There were more such instances. In each, I did nothing and watched them figure it out together. I watched their journey unfold without rushing them to their final destination. I might have watched experience turn into traveling skills and cherished memories. Perhaps, my help would not have been helpful after all. Always put your own mask on first before helping others...and give them time to maybe help themselves. The journey might be worth more than the destination.

These are a few of my favorite things...

After an especially special and super-packed month-long break, this was my first week back from CA, back to school! These are a few of my favorite things this week, things that inspired me, moved me, surprised me, or just made me feel joy and love.

Monday:
- Collapsing on top of my giant panda after a red-eye flight and my first day of neuroradiology
- The enthusiasm and joy of my friend, while trading stories of the past month

Tuesday:
- A neuroradiologist who, rather than leaving after their lunch hour work, stayed to teach us for almost two hours
- Discovering, while walking back to the reading room at 8:30pm to retrieve my forgotten laptop, that there were now beautiful fireflies dancing all along the path from my apartment to school

Wednesday: 
- Cooking a garlicky pea & mushroom curry (based on this awesome cooking blog)
- Catching up with my mentor after much travel on both our parts

Thursday: 
- Giving feedback and getting meta-feedback on my feedback
- My best friend's perseverance in the face of illness, frustration, and potatoes

Friday:
- Birds chirping a symphony in the trees outside
- A jovial and helpful CT tech who remembered me from last year and was just as happy to have us students around

Review of Ken Liu's The Paper Menagerie and Other Stories

The Paper Menagerie and Other Stories by Ken Liu
My rating: 5 of 5 stars
[Note: I give 5 stars to a book if and only if I both love it and it really changes the way I think or feel - about my life, the world, the universe...]

tl;dr - Read this book. You will be moved, inspired, enlightened, transformed, or some combination thereof. And perhaps more.

It feels hard for me to write a review for this collection of short stories, because I feel like I could write a review for every one individually. (I’m sure the title short story has had hundreds of reviews written about it alone, as the first fictional work to win all 3 major SciFi awards: Hugo, Nebula, and World Fantasy.)

So I looked back at my review of Ted Chiang’s Stories of Your Life and Others, and I’ll start there, with the broad similarities. Both books are collections of incredibly mind-expanding and thought-provoking stories. Both are fundamentally speculative, asking “What if…? If only… If this goes on…”, as Neil Gaiman puts these fundamental questions. Both reminded me of my life and brought new meaning to it.

Both are breath-taking in scope. This book ranges from the architecture-based thinking of a microscopic species to the human creation of a trans-Pacific railway to journeys of many light-years. It immerses the reader in romantic and filial love, tells tales of courageous and mythical heroes, sings odes to books and cognition. It made me laugh; it made me cry. It made me think; it made me wonder. It made me stop in my tracks; it made me turn figurative page after page (I listened to the audiobook, which I highly recommend).

One significant difference is that the latter half of the stories are more firmly grounded in Ken Liu’s Asian and American experience. While I enjoyed every story in the book, these held a uniquely poignant and historical power.

Stories that I particularly loved:
The Bookmaking Habits of Select Species, State Change, The Paper Menagerie, An Advanced Readers Picture Book of Comparative Cognition, The Waves

Spring

 

Birds chirp in the trees overhead,
Congregating on one, then the next.
Trading stories of hunger and fear,
Envy and rage, love and joy.
I lay in the waving grass below
And lose myself in their chattering music.

White magnolias and cherry trees,
Like bright clouds on the ground,
Lift my eyes up through their branches
Into the gray-blue skies above.
Petals float past me weightless,
Magically freed by the slightest breeze.

How little I give you!

A pot on a plate on our table

To sit in with your soil.

A minute of time every week

To pour you water to drink,

And a few minutes more

To admire and think.

Blinds left up to let indirect light

Stream through the window from dawn until night.

And suddenly, a bud! A bloom!

However little you consume,

By some alchemy you transmute

Golden sun
Into golden petals

To crown your leafy head.

What rewards you offer

For what little you are fed!

Aged 99

Age is just a number, they said.

99 years of life, just a number.

99 years till a timely death,

For some definition of timely.

I took a walk some years ago

Through hills and woods and snow

And found a cabin sitting still

On a path long untraveled

1 door, 4 doorways,

1 table, 3 plates,

1 bedroom, 2 beds,

1 fireplace, just numbers.

A 50-50 chance I make it

To another year, another number.

A 4-month median survival.

But I’m not a number, they said.

 I took a walk some years ago

Through the trees into a meadow,

And I found a piece of glass

Shining in the grass, in the sun.

6 sides, an irregular hexagon,

Its past forgotten, its future unknown

To me, but even to itself.

Perhaps especially to itself.

6 more months to another number,

Those months to be forever unknown.

Because time is up, and my clockwork heart

Rang out its final tone.

A day's clinics in limericks

 Specificity 

I have seen this test everywhere, 

in so many stroke patients' care.

But in a new one for me, 

she named "cactus," "glove," "key," 

and then "French provincial chair." 

Seasonal Affective Disorder 

No matter how gloomy you're feeling, 

you'll find antidepressants quite healing. 

Plus with good sleep at night, 

and the day's Happy Light, 

you will soon feel as high as the ceiling! 

Cold Front 

Tonight it is 60 degrees, 

but I'm starting to feel some unease. 

As my fingers turn blue,
We'll fall past 32... 

I had better take care or I'll freeze!