Uncertainty

It was just another day at the outpatient plastic surgery clinic where I am training as a medical student. A middle-aged man walked in with multiple scars on the back part of both hands. At first glance, they looked like bite marks. On closer inspection, I saw exposed bone. What was I seeing? This didn’t make sense.

“What makes the desert beautiful . . . is that somewhere it hides a well.” — Antoine de Saint Exupéry

That summer night in the desert a few weeks before my seventh birthday is etched in my memory forever. We met our smuggler around sunset, when he came to our motel room to pick up my mom and all six of her kids, each of us with some degree of ailment—a broken arm, a bacterial eye infection, a cough. We followed the smuggler into the Tijuana-San Diego desert through a hole in a metal fence. By nightfall, we were hiding from helicopter lights above looking for people like us.

The enormity of what was happening was palpable: my mom was risking our lives for “the American Dream.” This was a single night in our long story of resilience in the face of uncertainty. Life adversities can build character but can also tear it down. Growing up in minority communities that met trauma with resiliency also meant I witnessed the deadly impact of living with a lifetime of cumulative stressors. 

In the 1990s, I took care of patients presenting with chest pain to the ER, and our mantra was “time is muscle.” We raced against the clock to deliver oxygen and medicines to patients and, hopefully, prevented permanent heart damage.

But not all heart attack sufferers complained of crushing pain the way they do on TV. The ER physician couldn’t risk giving heart attack medications for non-cardiac conditions like gastric reflux or gallbladder attacks. Oddly enough, some people in our care died from heart attacks whose only symptom was a twinge of discomfort. While others, screeching in pain, didn’t have cardiac problems at all.

The only thing that seems certain these days is uncertainty itself. I am in the process of preparing educational materials for the general public to address some of the misinformation related to the COVID-19 pandemic. How does one address all the misinformation out there, especially when people’s lives are concerned?

“All of us are overworked, tired, and frustrated, but today it’s only us who can help. This is our call. So be brave and work without complaining.” The chief of our COVID ICU was briefing new staff assigned to the COVID ward before they started their shifts on Monday. I was there as the pediatric COVID consultant on call for the coming week. We were seeing only a small number of infected kids, but the thought of entering the COVID ward wearing full PPE kit was still unsettling. With so many health-care personnel getting infected, admitted, or quarantined every day, nobody knew who would be next.

When their ambulance is dispatched to a 9-1-1 call, paramedics attempt to cherry-pick a diagnosis based on the age and the one-sentence description they get of the patient’s complaint. We occasionally nail it, most times not, with humor, sarcasm, gloom or fatal cheer. There are often curveballs; it’s hard to streamline individual patients and their array of needs with our quick-and-dirty prehospital tools.

When my oncologist reassured me “Your exam is normal,” I wasn’t convinced I was okay. Neither was he. Unwilling to wait and see whether my worrisome symptoms improved with time, he handed me a requisition for a scan.

All I could do was hope for good news, a response as reflexive as squinting in blinding light. It never occurred to me to question whether “good news” was the best thing to hope for.

I don’t know when I’m going to see my daughter again. When she left with her family this morning after a two-month stay, she hugged me tight, sobbing softly into my shoulder. Trying to keep my own tears in check, I reassured her that I’ll visit soon. “We’ll find a way,” I whispered. Though neither of us knew exactly what that might look like in a few weeks’ time, we held on to hope as we let go of each other.

Telehealth mental health or in-person mental health? That is the question. There are mixed opinions among my colleagues, just as with other areas of specialization. As a psychologist in private practice, I’m on my own in this decision-making morass.

Back in 1956, after completing my first year in a rotating internship, I had a few months off before reporting for duty in the US Army. I spent six weeks of that time covering a busy, primary care practice.

As the doc headed for the door, he stopped long enough to advise me on two points. First, he said, “One, all you need for record-keeping is a few 6 x 8 cards. Onto those cards you can write the patient’s whole story. Two, NEVER let the patient know that you don’t know something.”

I’ve spent the last eight years as a foreigner in the U.S. My last two years of medical school, I did my rotations in the Washington, DC, area, but had to leave the country every six months to renew my visa. Each trip, I would think, Will they let me back in this time? My stomach would migrate to my throat every time immigration officers directed me to secondary clearance. I felt like a criminal. They scrutinized the letter from my school validating my credentials, looking for a reason to kill my dreams.

I thought things would be different once I was a resident. But no one had told me that if I wanted to travel “freely” I would have to leave the country to renew my visa stamp every year. Who has the time or money for that on a resident’s salary? I traveled back home just once during my three years of residency. Imagine not seeing your family for two years, praying they stay well until you can hug them again. But when an officer yet again inspected my documents with doubt and scrutiny, he could not seem to look past “Immigrant” to see my “MD.” The uncertainty surrounding being

Tim sat across from me in the small exam room. He was a friend, a colleague, and my doctor. He’d seen me for many years. “We’re walking a tightrope,” he said. Tim’s words rang true. We were balancing my many, complex medical problems.

For me, each day had bocame a carefully choreographed dance. Medications, IV antibiotics, a feeding tube, breathing treatments. A series of precisely coordinated steps, all to forestall my death. I learned to duck under the terror, to tamp down my fear.