nuval – Anthony Nuval

fifteen

Lunch break in the financial district, New York, NY 2 May 2013

I bought my first digital camera in October of 2001. And the photographs I have of New York before then are pretty scarce–film cost money, after all. So most of the day-to-day life that I remember of the city live only in my memory. With every trip back, I keep trying to find remnants of that past and photograph them, in perhaps an act of preservation, or even resurrection.

All I usually end up with, however, is evidence of how much the city has changed, and while this evidence of the ever-changing urban landscape would otherwise mean that I could never want for things to photograph, I leave the city feeling even more distant from the New York I remember.

The essence of life in the city has not changed, however, and even though the backdrop may change, with the landmarks I remember long disappeared and new exteriors in their place, I think I’ve managed to find examples of it and capture it.

I used to work summers in the financial district. A few of my classmates did, too, and every so often we’d get together during lunch breaks and find somewhere outside to sit, eat, and chat. We were surrounded by the thousands of other workers doing the same thing. Any place that can be sat on, will be sat on, turned into an ad hoc meal table. It’s something I think is quintessentially New York, made unique by the sheer density of humanity that’s found on a summer day anywhere in Manhattan. Sometimes, we sat in the plaza of the World Trade Center for our lunches. A perfectly common activity, unworthy of saving it on film.

It’s okay that I don’t have photographs specifically of those moments. The memories, the feelings they evoke, are the key. But I’ll continue trying to save proxies for those memories, for their potential to trigger those memories. I guess you could say that’s just my motivation in general, why I photograph what I do.

Fifteen years ago, I was studying in New York to be an engineer. Were I any other place, were the Towers not to come down, maybe today I’d be doing just that. But because I was so close to tragedy and could do nothing to help, could not help with communications despite having become a licensed amateur radio operator for just that reason, last night, on my last night float shift for the month, I was directing resuscitation for a young patient in shock and close to dying.

I do miss engineering. But this… this is a privilege. The sum total of my four years in New York helped steer me here, shaped who I am, and for that I don’t need a photograph to remind me.

on the consequences of this career change

life, Medicine, Ho!

I’ll be up front. It’s been a painful year. No big surprise—residency has a tendency to suck, intern year especially. No one who goes into this enterprise is unaware of this. Coping mechanisms are essential—hobbies, friends, family. Alcohol’s in there somewhere, too. Social media tends to be a double-edged sword — I would feel on some superficial level connected to the family and friends I’ve left behind, but my conclusion after checking my Facebook or Instagram feed for the twentieth time that day was that everyone is spending all their time vacationing in exotic locales and eating exquisite food. (That’s an exaggeration, of course, because no resident has time to putter around on the Internet that frequently. But the end result is the same.)

Continue reading “on the consequences of this career change” →

the first

Non-Fiction, Reflections

On morning rounds, my attending asked me a question. “How long do you think he has?” It wasn’t the usual test-your-knowledge pimping that we’ve gotten used to as doctors in training. She genuinely wanted to know what I thought.

* * *

I’ve been privileged to stand witness only twice.

Six years ago, I drove down to McHenry from Wisconsin to be with my aunt. With her family—her sister, my mom and dad, my brother and his wife–we stood at her bedside as the ventilator was switched off. It was anticipated and planned, for as much as such a thing could be planned given that it was only two weeks earlier that she had successfully had a heart valve replacement and her room was decorated with the well wishes of “get well soon” balloons that were still there.

I really hate those balloons.

Four years ago, we—Scott’s friends—were in the middle of working out a schedule so that one of us would always be around to provide support for his mom, who had been with him every minute of his hospital stay. It was nighttime and I was getting ready to go back home to Wisconsin to show my face at work before coming back for my scheduled support shift, but our plans were soon to become moot. I don’t know what his prognosis had been—did he have hours? days? weeks? months?—maybe I was being purposefully ignorant—but we had been preparing for the long haul.

Scott had a group of close friends that had been with him since high school, but he and I only became friends many years later. They were present for his passing, with the exception of Joe. I asked Michael why I should have been there and not Joe.

“You needed to be there to get the story,” just as he so often is, to be the keeper of the story.

* * *

I wasn’t present when he passed away. I arrived at the hospital in the morning and asked my intern if he had seen him yet. “He passed away about an hour ago.”

When my attending asked me how long I thought he had, I sighed and shook my head. I thought of my aunt. I thought of Scott. “I don’t know. Maybe a day.”

Sometimes, there is no reward in being right.

your mileage may vary

life, Medicine, Ho!

First year. It started out as a joke. “I left my career for this?!”

Med school and I were still on our honeymoon. There was a lot to study, but I remembered enough from my prerequisite science courses and I learned enough physiology on the job that it was bearable. There was still free time, time to volunteer, time to hang out with friends and family. It was almost like being in college again.

Second year. The fire hose of knowledge that one is expected to handle was wide open. The stack of pancakes that is daily studying grew high enough to rival the tallest buildings. People were unhappy with the recent changes to the curriculum. Negativity was everywhere. The stress of studying for our first board exam was wearing everyone down. I was worn out. “I left my career for this?!”

It wasn’t that I loathed my job or that I wasn’t good at it. I was good at it. My manager’s manager told me up front, in an effort to get me to stay, that there would be an irreplaceable void in the team when I left. But the truth is that it took me a long time to get to that point, to develop competence and credibility.

And here I was starting all over again.

Continue reading “your mileage may vary” →

2012 post-mortem

life, Medicine, Ho!

With just over three days left in the calendar year, I caught up with Joe, an old friend from my post-bacc. It had been about four months since we last hung out, but with the way life has been going, it might as well have been ages. “How’s it been?” he asked.

I said, “Well…I’m still standing.”

Finishing up M1 year wasn’t too bad. If you asked me then, I would say that it wasn’t easy, but everything’s relative, of course. In this case, relative to our first block of M2 year, the first time my school was doing a block/systems organization for M2 year, M1 year was a cakewalk. Slogging through that first M2 block was like having to partake from a fire hose dispensing not water but pancakes at high pressure, which you might attempt bravely to eat but all that happens is you end up as the battered, worn-down survivor of flapjack-force trauma and maybe, hopefully, you ate enough to pass the exams.

With no time to recover between blocks, with stressed-out friends all around, the rest of the semester was spent treading water (or is it pancakes), not really being able to focus on anything but the immediate (and not even doing a good job at that). In the face of the ramped-up stressfest that M2 year was proving to be, maintaining my usual outward composure was coming at a high internal cost when I already had little emotional reserve to spare. I tried to remember how I handled things the last time I felt this way. I thought of Scott. I thought of the price I was paying for this change in direction in my life, the seven years (minimum) I was giving up in order to retrain; the lost income, the down-prioritization of friends, of family, of love. The implications of changing careers felt quite different now that I was firmly on the other side of 30.

Over Thanksgiving break, I finished a couple of books I had begun to read before first year started.

“To go through medical training, you have to resign yourself to long periods of time when you will simply do an inadequate job with all the people who mean most to you.” –Perri Klass, A Not Entirely Benign Procedure

“Life is bigger than what the trajectory of our medical careers will allow. And just because medicine tries to consume our entire lives doesn’t mean we have to willingly hand them over.” –Michelle Au, This Won’t Hurt a Bit (and other white lies)

If I read those words before starting school, they wouldn’t resonate quite so palpably. Those other things–otherwise stated, the more important things in life, the things taking a back seat to school–are what makes this worthwhile, what makes it possible to dedicate oneself in turn to the service of others.

The end of the semester eventually came, and with it no failing grades and a temporary reprieve from school, but no real resolution, for the cycle would only start anew in due time–and it only gets worse. All I can say is that this is the new normal–and hopefully I figure out how to reclaim what’s important in my life from this all-consuming beast that is medicine.

the unwritten personal statement

September 11

It was nearing the end of our shift in the mobile medical van. “It’s doubtful anyone will show up towards nine,” Geoffrey said, “but you never know what’ll happen.”

On a sunny Tuesday morning in September, I sat in my studio apartment in Queens and, on a thirteen-inch television screen, watched the two tallest buildings in New York fall, while friends only a few miles away watched in real life. Definitely didn’t know that would happen.

I nodded. “Gotta be prepared.”

I became a licensed amateur radio operator when I was younger to be able to help with communications in emergencies. There was a call for hams to help with the rescue effort at Ground Zero. Only my radio was at home in Chicago. Not ready to help at all.

The bridges and tunnels were shut down. I went to a blood center on Long Island and found a line many blocks long. A man asked to borrow my cell phone so he could call his family. At least I could do that.

Sadly, it turns out, even those in a position to assist were powerless. Doctors, nurses, everyone at area hospitals readied themselves for the worst, waiting for victims that were already beyond saving.

But looking at what they could have done, if they had the chance–I want to be there, too.

where my thought’s escaping

life

Since moving back to Chicago, on nearly every Sunday, I take the CTA to the old neighborhood to see my parents for Mass and lunch. I ride rails and buses that I’ve known since childhood. I pass both tourist landmarks and landmarks of my life. I remark at the changes that have taken place since I was away and embrace the reassuring constancy of what has remained. But most of all, there’s a part of me that’s still in a measure of disbelief that I’m actually home again. The excuse of my birthday got me to reflect (more so than usual) on just where I’ve been in these few decades and wonder just what I thought, during those times, I would be doing with my life. I’m not exactly sure that I had any concrete thoughts about where I’d end up, honestly, but at the very least, that certainly means I never thought I’d be back home. I mean, when it was time for me to go to college, moving Very Far Away From Home was no insignificant motivation; and it seems to me that a lot of my decisions subsequent to that were driven by the desire to establish Clear Separations between me and the life I left behind.

But all that seems somewhat silly now. My parents aren’t getting younger, and someone needs to watch over them…and maybe there’s some feeling of a need to make up for lost time. And, as much as I love and miss New York, and as much as I learned to love Wisconsin (and PA, too, I guess…), there’s no denying that there’s really only one place I consider to be truly Home, and it’s not a bad thing to come back to it. And if I consider that this all started with an invitation to interview received well after I had considered my application cycle as complete and had already begun planning for another four years in Wisconsin…I think I was incredibly fortunate. Weird, how these things work out sometimes.

two years late

Memory Lane

Tragedy, I think, tends to whitewash the canvas of our memories, leaving only itself in its wake. The fun times I had in New York are hard to remember through the filter of September 11. My memories of a dear friend of mine from those days are discolored by the time I spent in earnest with him during his final days in the hospital. I promised myself I would write a remembrance of him, as so many did when he passed, but I was never sure what to write. Two years later, motivated by an excellent memorial penned by another good friend of his, despite the piles of studying awaiting me once I finish this post, I figured I should just sit down and recover what was lost before another year goes by.

Continue reading “two years late” →

2012: project 366 kickoff

life

(1/366)

So many days have gone by since starting school and it’s all a blur to me. I think this is what happens when something–in this case, studying–is so consuming as to nullify any awareness of the world around you. On one level, this perception of the passage of time is a good thing, as I want nothing more than to be out of the classroom and in my clinical rotations, learning how to do the stuff I actually want to do; but on another, every day that goes by without so much as registering in my consciousness feels like a waste of a day. And days aren’t exactly an infinite commodity.

There were ways to slow things down that I used to do a lot of. Write. Take pictures. Only nowadays it seems like I don’t have time for that because of school. Well, that’s not entirely accurate. I could make the time, but I need to improve my studying discipline: it presently sucks.

I think I’m going to try to write more in addition to this (and I’m definitely going to have to make sure I’m on the ball with my studies), but because my earlier Project 365 seemed to work brilliantly, here goes one for 2012. And because 2012 is a leap year, it’s actually a Project 366. The aim is the same, though.

So. Let’s begin.

first quarter review

Medicine, Ho!

One quarter down, five exams completed, five passing grades. So far, so good. P=MD. That doesn’t mean that it was easy (not that I was expecting it to be), but I could definitely do without that sense of uneasiness over the question of “did I pass?” after each exam, the likes of which haven’t been seen since organic chemistry (for which, in those days, the prescription was this drink). I don’t recall noticing it back in undergrad, but I suspect that’s because studying engineering exercises a completely different part of one’s brain (mmm…math). As a practicing engineer, life consisted of analysis and problem-solving (and let’s not forget the metric tons of documentation generated) instead of memorizing and regurgitating. And so, there’s a bit of an adjustment period. Eventually, I’ll get to use more of those brain muscles, but first I have to learn the language. And it is basically just that–you have to learn the alphabet, then simple words, then simple sentences, before you can start to begin to think critically.

(On the other hand, if I want to be really cynical, I could say that learning about the human body is like trying to reverse-engineer a system for which no one from the original design team is still employed and zero requirements or design documents exist and you’re like “who the hell designed this shit” and you have a gazillion customers with broken systems all demanding they be fixed and you can’t just tell them to buy the upgrade.)

But the mechanics of studying and doing well on exams are fairly straightforward. It’s simple enough to analyze what I’m doing wrong and devise a corrected plan of action. (Following through on that plan is another story.) I’d much rather deconstruct the psychological aspects of being a med student who went the non-traditional route. First, some words of wisdom (from an Internet board that shall go unidentified):

…I actually had a board member pause the interview just so he could advise me not to lose the identity I’ve developed (as a non-trad with a career) because apparently many non-trads “regress” (as he put it) once they’re in med school surrounded by much younger students.

For non-trads, the difficulty is that you’re not just developing your adult identity, you’re taking on a new adult identity on top of the one(s) that you already have.

I read these quotes at the start of the quarter, but it’s not until now that they’ve started to ring true. It’s all too easy (especially for someone who doesn’t look all that different from his new peers) to assimilate into the culture and thus feel like one’s identity is being lost. Maybe that’s why I feel the need to assert myself as that old fogey of an engineer every so often; but doing so may also have the detrimental effect of creating too much of a separation between my classmates and me, or perhaps coming off as having airs when that couldn’t be further from the truth. And sometimes it’s hard to contribute the perspective of someone who’s had a bit more time to percolate and has a bit more experience without sounding preachy or condescending. So, there’s a balance that must be struck.

I don’t even have a clue as of yet what this new adult identity is that I’m crafting.

But in the end, it’s just an interesting thought exercise that I won’t get any credit for. For now, the order of business is to relax, rest, and recharge, ready to hit the ground running when the next quarter begins. (And given that it’s the cardiovascular/pulmonary block, if I don’t ace it, I should just quit right then.) Here is one more quote I found hilarious:

But the life arc is undeniable. I couldn’t stay in a night club with 18 to 25 y/o’s with sh!tty music pumping unless I was seven different kinds of loaded. And I’m not into that anymore. So.