Category: Seattle

Categories
Education Lessons Medicine Nonfiction Reflection Seattle

It’s Good to be Busy.

It was a busy day:

There was the guy who spoke with enthusiasm about his doctrine of RUL (“Righteous Unconditional Love”); the man who stared through me after I asked him about whether he had eaten that morning; the fellow who made no efforts to hide his nose-picking while expressing his frustration with the court system; the young man who wouldn’t let me inspect the wound on his hand, though I soon recognized that he had crafted the wound out of a packet of juice crystals; the man who hadn’t taken a shower in several months, though the odor bothered me more than it bothered him; the guy who boasted about his abilities to run a mile in two minutes; the man who refused to acknowledge my existence; the fellow who advised me that he would prefer to take his medications in the morning because that’s what his nurse practitioner told him to do; the man who apologized for masturbating, but argued that he is young and “that’s what young people do”; the fellow who said that after he used “bad heroin”, he realized that his parents aren’t actually his parents; the guy who found lithium energizing and was in the process of tapering off of methadone; and the man who simply said, “I’m not sick,” when I asked him why he hadn’t been taking medication that the state psychiatric hospital had prescribed to him. Nurses paged to ask for orders for medications to reduce the discomfort of heroin withdrawal, medications that patients had asked for three days ago, medications that patients took before they entered jail. The phone rang as callers shared information about diagnosis, treatment, and next steps.

I tipped my head back in the chair, stretched my arms up, and sighed.

“You okay?”

It was my second year of residency and I was the only psychiatrist in the hospital that night. My duties included addressing any issues that occurred in the psychiatric unit and providing care for any patients that came to the emergency department with psychiatric concerns.

My classmates had warned me about a particular emergency medicine attending physician who was working that night:

  • “Last week he told me I was useless.”
  • “He rolls his eyes at me all the time.”
  • “He’s just angry. He won’t ever thank you for anything you do.”

“Hi, Dr. Angry,” I said around 7pm. “I’m the psychiatry resident on call tonight.”

After glancing at me, Dr. Angry grunted.

Well, I guess that’s how it’s going to go tonight.

Less than three hours later, after Dr. Angry referred four patients to me, he muttered in my direction, “I’ve got another one for you.”

Shortly after midnight, a patient’s husband was pulling her out of the ED while she was screaming at me.

“I’M GOING TO GET YOU FIRED FROM HERE! YOU’RE A TERRIBLE DOCTOR! I KNOW THE PRESIDENT OF THE HOSPITAL! YOU CAN’T DO THIS TO ME!”

I was shaking, but I wasn’t going to admit her to the hospital. Dr. Angry caught my eye and nodded once. I wasn’t the only person who knew I was shaking.

It was close to 3am and I had already seen seven patients.

Dr. Angry had a slight smile on his face as he approached me while I was slogging through my notes.

“Dr. Yang, there’s another one for you to see.”

please make it stop

“Thank you. Who is it?”

As I was beginning my note around 6am for the ninth patient I saw, Dr. Angry stopped by.

“Dr. Yang, you did all right. Thank you.”

“You’re welcome, Dr. Angry.”

I tipped my head back forward in the chair in the jail and dropped my arms.

“Yeah, I’m fine,” I replied to my colleague. “It’s busy, but it’s good to be busy. And when I think about my intern year, this isn’t bad at all.”

Categories
Nonfiction Observations Seattle

White Glove Treatment.

In addition to five-star accommodations and world-class spa appointments in Portland and Seattle, each [Lamborghini] owner and their guests will be treated to private meals along the Pacific Coastline and the Puget Sound. Expect white glove treatment at every encounter, and curated excursions exclusive to Giro and the region. – GIRO 2017 PNW

The first Lamborghini I saw pulling out of the driveway of the parking garage in downtown Seattle was either yellow or orange. Its engine rumbled for all to hear even though it was in low gear. I stopped walking when I reached the driveway, waiting for the sleek and shiny car to pull into the street.

A few moments passed and another Lamborghini pulled out of the parking garage into the driveway. This one, another bright color, didn’t even stop before it turned left into the street.

The pedestrian waiting on the other side of the driveway was dressed for work: Short-sleeved summer blouse, pencil skirt, dark flats, and bangles on her left wrist. She shifted her weight to her right hip and looked into the garage.

A third Lamborghini zoomed out of the parking garage and swerved left into the street. There were now three or four pedestrians on the other side of the driveway waiting to cross the entrance of the parking garage.

In the street were two women, probably no older than 25, who were wearing white polo shirts and denim shorts. With some anxiety they looked down the street, watching for oncoming traffic. They waved their hands at the garage, beckoning more cars to come forth. They ignored the pedestrians on the sidewalk.

The fourth Lamborghini had a mirrored surface. The morning sunlight gleamed off of its sides. The driver was an older man who was losing his hair. In the passenger seat was an older woman with bright yellow hair and sunglasses that covered half of her russet face. This mirrored car coasted out of the driveway without pausing.

“Oh, come on,” I muttered. The Woman Dressed for Work on the other side of the driveway rolled her eyes and heaved a sigh that was seen, not heard.

More Lamborghinis poured out of the parking garage, parting the Red Sea of pedestrians. The traffic light farther up the street was still red, though, so the parade of Lamborghinis was slowing to a halt in a single queue.

Yet another Lamborghini was approaching the exit of the parking garage. Empowered by annoyance and self-righteousness, I walked forward. Would the Lamborghini let me, a mere pedestrian, have the right of way?

The pedestrians on the other side of the driveway followed suit. The fancy car lurched to a halt as we foot commuters walked in front of it. We all heard the loud, idling engines of more Lamborghinis in the garage waiting for us to pass. Even though some pedestrians slowed their gait, everyone looked straight ahead.

Good manners go a long way. Status alone doesn’t earn white glove treatment and respect.

Categories
Informal-curriculum Lessons Medicine Nonfiction Reflection Seattle

Crossing Streets.

I didn’t mind that I had to wait to cross the street. The yellow-white light of the Spring sun shimmered in the infinite depths of the lapis lazuli sky. The afternoon breeze lifted the fragrance of sweet flowers over the concrete and fluttered the short sleeves of my summer blouse.

Then I heard a man. He seemed to aim his voice, full of gravel, towards me.

“WOOOO WHEEEE!” He chuckled. “Lawd have mercy!”

ignore him don’t turn your head ignore him don’t look ignore him stay still

My peripheral vision saw his tall figure approach me before I heard him: “Doctah!”

okay he is probably talking to you take a breath

I turned. Though his pants, tee shirt, and jacket were all too large for his frame, it was a stylish look on him. His baseball cap was on backwards and pinned his dreadlocks away from his face.

“How you doin’?” he greeted, his smile revealing several missing teeth. He extended his right fist, a wordless invitation to extend my fist for a bump.

“So what are you supposed to do when you see your patient out in public?” We all looked at the professor with great expectation.

“What do you think?” (Of course a professor of psychiatry would answer a question with a question.)

“Well, you want to respect the patient’s privacy, so you probably shouldn’t say anything.”

“But what if your patient sees you first? And says hi?”

“It seems rude if you don’t say hi back. But if your patient is with another person, that could get awkward fast. What if the other person says, ‘How do you two know each other?'”

“I’d probably go out of my way to avoid my patient. I’d cross the street or something.”

“But that’s weird, too. Your patient might wonder why you’re avoiding them.”

“Or my patient might appreciate that I am keeping the boundaries clear.”

“If my patient said hi to me first, then I would probably say hi back and then try to get away as soon as possible.”

“What do you think they do in smaller communities? Doctors and patient see each other all the time when they shop for groceries and stuff.”

“That might be embarrassing: I don’t want my patients seeing me in sweats when I’m shopping for food.”

“Why are we assuming that patients would want to talk with us in public, anyway?”

The group reached a consensus: If you see your patient, but your patient doesn’t acknowledge you, don’t acknowledge them. You have a duty to keep things confidential. If your patient says hello to you first, be a person and say hello back, but keep it superficial and brief. And the next time you see each other, ask the patient how s/he would like to proceed in the future if you two run into each other again.

“I hope I never run into my patients,” someone mumbled.

The most memorable patient run-in I’ve had in a public setting occurred on a bus.

I was sitting in the back half of a double-length bus. Most of the seats were occupied and a few people were standing in the aisle. The grassy trashy odor of marijuana wafted from the rear of the bus. A young woman, who was under my care several times at a crisis center, and a young man boarded the bus. She saw me first.

“Hey! Doctor! How you doing?” she shouted at me. I nodded back at her. The older woman sitting next to me shot a glance at me, then sighed.

The young woman grabbed the young man’s hand and pulled him down the aisle. The two or three people ahead of them had no place to sit, so they halted and turned around. The young woman was thus about six feet away from me; she couldn’t get any closer.

As the bus lurched into motion, she leaned around the two or three people and raised her voice over the rumble of the engine: “Hey, Doc! I’m doing better these days! I haven’t been to the crisis center in like a month!”

“That’s good,” I replied. Maybe this will be the end of the conversation.

“I still take the Seroquel and Depakote now,” she continued. “Those meds really help. I take them every day.”

There was no street for me to cross. Okay, I guess this is really happening.

“But the meds are expensive! I want to keep taking them, but they cost a lot. Do you know where I can get meds for cheap?” Her eyes were eager.

The older woman sitting next to me heaved another sigh and closed her eyes.

Okay, if we’re going to do this, let’s really do this, then. I took a deep breath.

“Target has a four dollar list and those medications might be on that list. So, best case scenario, each medication will only cost $4 a month. Costco also has medications for cheap, sometimes medications that aren’t on the Target list. You don’t need a membership to use the pharmacy there.”

“For real? I can get medications at Costco without being a member?”

“Yeah. It’s a good deal.” Maybe someone else on the bus can use this information, too.

“Okay, cool. Target and Costco. Thanks, Doc!” She turned to the young man and began planning where they would get food for dinner.

As I stepped off the bus a few stops later, she called, “Bye, Doc! Thanks again!” I smiled and waved.

“Hi!” I said to the man with the gravel in his voice. you look familiar but how do I know you jail yes you were my patient in jail and what is your name what is your name wow you look so different but of course you do because you’re wearing regular clothes and you’re smiling and you’re outside on this beautiful day

I extended my right hand. We bumped fists.

“I’m doin’ real good, Doc. I take my meds every day and I live here.” He pointed to the handsome brick building down the street. “I ain’t picked up in a while and I’m takin’ care of myself. Things are good, Doc.”

“I’m glad to hear that.” I smiled.

“How you doin’?” he asked again, the gravel rattling in this throat.

“I’m well, thank you.”

“Well, you have a blessed day and you take care of yo’self!” He laughed and pointed at me while he walked away.

The white walking man appeared on the traffic light. I crossed the street. I was still smiling.

Categories
Nonfiction Observations Seattle

Bridges, Frustration, and Coping.

The longest floating bridge in the world is in Seattle. It is 7,710 feet (2,350 meters) long and spans beautiful Lake Washington. Locals call it the “520 bridge” and, in its current incarnation, only cars may use the bridge.

Yesterday, the Washington State Department of Transportation hosted the grand opening of the new 520 bridge. On the bridge were several food trucks, booths with information related to the engineering and construction of the bridge, and equipment and heavy machinery used in its creation.

To get to the event from Seattle, people had to take shuttle buses that originated at the University of Washington campus. The buses drove about three miles on the old bridge and delivered the crowds to the start of the new bridge.

Tens of thousands of people took the opportunity to walk across the bridge and enjoy the surrounding views that, prior to then, one could only enjoy by car.

In the early afternoon hundreds of people got in line to get back to Seattle. A young man wearing an orange vest carried a sign that read “End of the Line Here”. He folded the line back and forth to compress hundreds of people into a narrow area while we awaited the shuttle buses.

Behind us were two women who appeared to be in their 60s. One wore a visor that pushed her short white hair out of her face. The other had a greying bob.

“This is ridiculous!” Visor exclaimed. “This isn’t organized at all! We’ve been waiting in line for over 30 minutes and I don’t see any buses coming!”

“I know!” Grey Bob agreed. “We haven’t moved at all. This is terrible. This is ruining the entire event!”

Thin white clouds were streaked across the bright blue sky. A refreshing breeze swept around us. Mt. Rainier stood in the distance, a lenticular cloud atop its peak like a floating hat.

“OH MY GOD we’re actually moving!” Grey Bob squealed as the line shuffled forward. “We might actually get off this bridge!”

“I’m not going to be that optimistic,” Visor replied. “I’m going to wait until we actually get to UW before I say that.”

Shimmering white light danced on the dark blue ripples of Lake Washington. As the clouds dissolved under the sunlight the snow-capped peaks of the Cascade Mountains revealed themselves. A media helicopter, less than 100 feet above us, drifted past.

“HELP US!” Visor screamed at the helicopter.

When we could no longer hear the helicopter, Grey Bob sighed, “It’s been over 45 minutes. This is unacceptable.”

“If I have to wait in line any longer, I’m going to jump over the side of the bridge and kill myself,” Visor squawked.

Grey Bob laughed before commenting, “The barriers aren’t that high. Someone could really jump over. It wouldn’t be that hard.”

“Oh yeah, you’re right,” Visor said, her voice non-plussed. “That’s not good.”

At around 55 minutes the line was no longer still. We walked in quick strides towards five buses. Two of them faced West to go to UW. Three of them faced East.

“All the buses are gonna go to Seattle,” the event planner shouted at us. “Get on any bus on the other side of the barrier. All the buses will go West.”

I smiled as I watched my father scramble over the barrier—while not a spring chicken, he is still spry—and my husband and I made a point of scurrying away from Grey Bob and Visor. The three of us got on a bus facing East.

Nearly 100 of us packed into the bus. My father sat to my right. A woman in her 50s wearing a bicycle jersey sat to my left. My husband gave up his seat in an act of chivalry for her. He stood near the rear exit of the bus.

The bus headed East towards the fancy-pants neighborhoods of Medina and Hunts Point. Once the bus was off the bridge, it passed an exit. Then another.

“WHAT?” Bicycle Jersey exclaimed. She leaned forward and barked at her friend, an older woman with glasses reading a newspaper, “Why is the bus driver not turning around? Doesn’t the driver know that we’re supposed to go to SEATTLE?”

Someone pulled the wire to signal the bus to stop. People snickered.

The bus slowed to a halt at an intersection with several other shuttle buses. It did not move for nearly 15 minutes.

“This is so disorganized,” Bicycle Jersey said. “This is not worth it. This has ruined the entire day for me.” Her right thumb scrolled through an article by Nick Kristof: “When Whites Just Don’t Get It”.

The bus then crept north towards Kirkland.

“WHAT?!” Bicycle Jersey shouted. “Why are we going to Kirkland? We’ve been on this bus for over half an hour! We should’ve gotten on a bus that was going the other way. They’re already back home.”

“I never take the bus,” a woman standing over my dad said to no one in particular. “I’m never doing this ever again. Unless it’s a shuttle bus at a really nice wedding. And I mean a REALLY nice wedding.”

A young man with facial stubble near my husband hugged a pole. “We’re almost out of water. We’re going to die on this bus.”

“It’s like we’re hostages on this bus,” Bicycle Jersey spat.

The bus stopped at the Kirkland Park and Ride, but not at the curb.

“He better not make us get off this bus,” Bicycle Jersey said.

One man got off the bus.

“Did we come all the way here just for that one guy?” Bicycle Jersey continued. “What about the rest of us?”

The bus rolled back down the hill and stopped at an intersection.

“WHY WON’T THE DRIVER GET BACK ON 520?” Bicycle Jersey shouted. “TURN RIGHT HERE.”

“We’ve been on this bus for almost an hour,” Facial Stubble announced.

When the light turned green, the bus turned right and we were back on 520.

“We’ve been on this bus for almost an hour,” Facial Stubble announced again.

The bus rolled past the line of people waiting for buses. It was nearly a mile long now.

“DON’T GET ON A BUS HEADING EAST,” Bicycle Jersey shouted at them. None of the windows of the bus were open. The bus was going over 40 miles an hour.

“We’ve been on this bus for an hour now,” Facial Stubble said. “This is the worst mistake of my life.”

Some people have to wait over an hour every day just to get food and water.

I’m going to guess that you ate breakfast this morning. I’m also going to guess that you’re going home. Because you didn’t have to work today.

You’re not showing any overt signs of dehydration. Shut up. You’re not going to die.

The only person holding you hostage right now is you. Your bitterness isn’t going to make us get back to Seattle faster.

If you are joking about suicide because you’ve been waiting in line outside on a beautiful day for 45 minutes, how do you deal with actual stress?

Maybe you sustained a brain injury in your frontal lobe and that’s why you have low frustration tolerance.

Maybe your prefrontal cortex hasn’t fully developed yet. That process isn’t complete until your mid-20s, at which point you’ll hopefully have better impulse control.

Maybe no one ever taught you emotion regulation and distress tolerance skills. So maybe this is a skills deficit.

Maybe you’re having a rough time in life right now. Maybe a relationship you value is ending. Maybe someone you care about is sick and dying. Maybe, under different circumstances, you’d exercise more patience.

Maybe you’re a victim of specific operant conditioning: Maybe you’ve learned that people only pay attention to you and value what you say when you’re expressing snark or distress. And that people will only take you seriously the louder you talk.

My dad shrugged.

“We just had bad luck today.”

Categories
Observations Reflection Seattle

10,000 Windows.

“I think I can see 10,000 windows,” my dad said as we looked out of his apartment. On the other side of the glass was a view of downtown Seattle.

“10,000?” I did not mask the incredulity in my voice. “Is that a good thing?”

“Yes, it is,” he replied. “More windows means more people. We all need people in our lives. According to feng shui, the more windows you can see, the more influence, more popularity you will have.”

“But 10,000?” I asked again.

“Yes,” he said. “I can see the Columbia Tower and that alone has several hundred windows. Think about all the other windows of the skyscrapers….”

“Yes,” I said. “10,000 windows.”

We had lunch at a hole-in-the-wall restaurant in Chinatown. He expressed his pleasure with the food to the waitress. She had immigrated to the US about ten years ago. My father had immigrated to the US nearly 45 years ago. When he spoke to her in Mandarin, he used a phrase to describe his immigrant status that I didn’t understand.

“There’s a special term for us,” he said. “We were born in China, so when we fled to Taiwan [to escape the Communists], we were considered ‘mainlanders’. We were different. Not everyone from Taiwan had the opportunity or means to immigrate to the US. So we were considered different again. When we immigrated to the US, we were considered ‘Chinese’ and still different—”

“—an alien no matter where you went,” I finished.

“Yes!” my father exclaimed with a smile.

My father always insists on picking up the bill when we go out to eat. He and the waitress began talking again:

“Have you lived in Seattle since you immigrated?” the waitress asked.

“No, I moved up here to be with her,” my father said as he pointed to me. “She’s my daughter. My wife passed away last year.”

“Oh. She was born in the US, wasn’t she?”

“Yes, I was born here,” I answered in Mandarin. “That’s why my Chinese isn’t very good.”

“It’s not that your Chinese isn’t very good. You speak with an American accent,” the waitress said to me. Turning to my father she continued, “She’s very well-mannered. I could tell when you both walked in.”

Suddenly, I was eight years old again. I sat still, said nothing, and kept my face neutral. This is what you’re supposed to do when your elders say nice things about you.

My father nodded and smiled. “She is courteous; she has class.” After taking a sip of tea, he continued, “My daughter is also a doctor.”

I winced. They only saw me blink.

Daughters must be humble so their parents can show their pride. I swallowed my embarrassment with my tea.

My mother used to do that all the time, too: Out of nowhere she would tell strangers that I was a physician.

“Why do people need to know?” I used to complain. It never changed their behavior, so I stopped sharing my objections with them.

There are now other things I don’t share with my father.

“How’s work?” he asks.

“Work is fine,” I say. Work is always fine. I don’t tell him the terrible things patients have said to me. I don’t tell him about the injustices of the system: Was it designed this way? Are these perverse outcomes from good intentions? I don’t tell him that I hustled him into a restaurant to avoid an encounter with a patient I worked with in jail.

Every time we see each other I tell him I love him—a brash thing to do in a culture that values stoicism. I don’t tell him how anxious I feel when he doesn’t respond to my text messages within an hour: Did something happen to him? Is he okay? Did he die?

I don’t tell him how I still feel sorrow for the the death of his wife. I simply cannot imagine his loss.

He must know, though, just as I know about the heartache he still feels. It’s in his face, the way he looks into the distance, as if the past was just beyond the horizon.

We instead go out to lunch. I let him buy it for me and listen to him speak of the beauty and power of 10,000 windows.