Clinical Equipoise

We discussed the concept today. Definition of equipoise

The state in which there is no clear knowledge of the answer to a question. I find myself resting in this state for most of my life about many questions, like does God exist? Do I give dollar bills to street performers? Is it better to read the Times or a Pulitzer Prize winning novel?

A professor told us today that watchful waiting is often the wisest decision for these times. Wait for the next big randomized control trial to confirm the last, for a trial even bigger and well-designed than the ones before.

Then there are those moments when I finally do decide: Yes, I WILL give dollar bills (but not five's) to street performers and the homeless, but only when they seem to me at first glance as 'good' people; Yes, reading the Times IS better than reading a novel, but only on Fri, Sat, Sun when I get my Weekender on my doorstep; Yes, there IS a God!

I have to say these are moments worth celebrating, the endings of a dark yet wonderfully confused time full of possibilities. With each of these moments I feel a bit older, more chiseled and hardened. It's relieving to finally stand for something. Although it's hard to attribute these moments to randomized controlled trials at all, or even to personal experience. Perhaps they were the product of my impatience at being young and malleable, although I hope it was more magical than that.

More likely I decided when I was finally cornered by circumstances: when faced with street performers 3-4 times a day, when faced with the choice of reading material on every subway ride, when overhearing discussions about God and the lack thereof over beers and martinis one too many times. I like that feeling though, of only deciding when forced to. It's a bit like being shoved into the role of a leader not because I chose it, but because it chose me. Yes, to be chosen by my choices. In some ways that's the only way I would be convinced my choices were right. How else could I be justified in breaking clinical equipoise without randomized controlled trials?

One day I will miss the darkness of this state of questioning. It is, after all, the realm I was always drawn to: the frontiers of knowledge that the annoyingly bright headlights of science have not yet penetrated. But I suppose my choices, even after they're made, unlike science - or like science for that matter, sheds no additional light into these beautiful chasms at all. It's comforting to know that the darkness will always be there, and that all I will ever do is to paint my own stars within it.

The Heights

Yes, I live there now. A place called Washington Heights. It is what most people call the borderless area between about 145 and 190th streets on the west side of Manhattan - what I've started to call 'nosebleed' section of the city - because they're the parts so far north that some people cringe when they hear that you live there and immediately hope that you could eventually afford to move to some place more sensible like the upper west side or the lower east side. Here in 'the Heights' liquids of various smells and colors run in the grooves between the concrete blocks that piece together the sidewalks, so I step carefully. There are piragua carts and fruit stands selling pineapple and mangoes on sticks at many a street corner.
what is piragua
Even the Indian pharmacist who works at the drug store and the Chinese man who runs the take-out place speak a few phrases of Spanish out of necessity. Boys, girls, men, women, and elderly sit along the wall lining Riverside Drive and on the doorsteps of the apartment buildings or bodegas on sunny afternoons commenting on the people passing by, namely the women. The clothing cling brightly and tightly to their full and rounded bodies, behaving perfectly as they claim the streets beneath their stilletos and platforms with their confident swagger, featuring the tantalizing sway of their ever-so-distracting hips. They stare, I stare, everyone stops to stare. These pauses make up the natural syncopation in the passing of the days around here. The streets are always alive with chatter, occasional yelling, and the beats of bachata, reggaeton, salsa, or merengue blasting out of wide open apartment windows or sedans parked along the side of the street around which young and older men hover.

I am unfortunately still an outsider here. I give the occasional apprehensive smile in answer to 'oye, chica.' I wonder just how out of place I appear. I attempt to emulate the commanding strut that even the ten year old girl appears to possess and wonder if I could ever be successful at owning these streets like they do. I am humbled, no - outright intimidated by the connectedness the residents seem to have to the place, how well they know each street corner and lottery ticket vendor. I believe it may take a lifetime, or several, to build up that kind of bond. These days, I take joy in the smallest of victories, like finding out which subway exit to climb out of to place me at the optimal street corner, finding the absolute closest bodega to my apartment in the case of an emergency when I'd be out of toilet paper, and learning to tell from the sound of the cables which floor the elevator is on and whether it would be more prudent to take the stairs. I may never be a Dominicana, but I suppose I will enjoy the steep learning curve for now.

Bitten

Einstein, my hamster, bit me today. I was trying to get him to crawl into his exercise ball and he wasn't moving, so I grabbed him. He turned his neck around immediately upon contact and stuck his two front teeth into my index finger. I felt a surge of animalistic rage at being physically attacked. This was followed by a more civilized sense of guilt, hurt, and disappointment that my pet has turned against me. I'm sure I will feel this same sequence of emotions with my children one day.

In the future, I shall 'herd' him as prescribed here:
http://exoticpets.about.com/od/hamsters/f/hamsterbiting.htm

On Blogging

I always ask myself these days who I am writing to here. I ask because I write here so much more often than I have in my journals since the time I was thirteen. I check the counter on my blog compulsively, to see if he who I'm writing to has seen what I've left for him. I hope relentlessly that this may just be the day that he has decided to write back a 'new comment.'

If I could describe 'him,' I suppose he would be my perfect friend...that imaginary friend some of us may have had at one time. The one who always listened, understood, was thirsty to hear more, loved me not just despite but for my faults, etc, etc...

There is a filter that comes with writing here. I'm sure there is an unofficial bible of what is 'bloggable' and what isn't already posted on the web. Actually, http://www.tipjunkie.com/2008/05/blog-etiquette-or-blogtiquette.html.

It's a fascinating medium actually, something apparently so honest and raw, yet possibly deceivingly so. It is, after all, for my best friend whose opinion I treasure deeply. I want him to know the real me, yet I want so badly for him to keep loving me the way I imagine he does.

The Metro

One of my favorite activities here in NYC is to sit on the subway by a window and stare out at the passing stations, columns, flickers of light between the columns, people waiting with their hands in their pockets or on their iphones...I think of how many times this path in the ground has been taken, by how many forms of life, in how many situations and for how many purposes. I think of how many stories I pass by, how many dreams are being dreamt alongside the bright yellow paint lined gutters, how many songs are being heard through white budded strings. It is all too familiar: that alternating light and darkness streaked by the speed of time over the damp image of a man standing still at the side of the rails, looking in the direction of the train he awaits. It is a typical photograph, or scene from a movie. It had been archived into my library of emotion-soaked visions before, but it is now real, everyday. But what's more, I am now part of it.

Graduating

I walked down the stage, shook the swine-flu-hazard hands, and took hold of the cardboard-stiffened envelope bearing the sacred single sheet that declares me a doctor.

It's a paralyzing feeling: to have the most vivid memories behind me and the most blankest of slates ahead. For the intensity of what has trespassed here, I have alarmingly little to say about it. Perhaps it is something I'd prefer to say with a wink or a sly smile to he and she who was here, as though it is our little secret. Perhaps it is something I've been saying all along here on the page, and I am drained dry. Perhaps it is something that I'm afraid to lock down into a cliché, or exaggeration, or idealism. Perhaps it will just take time for the lack thereof it to settle in before I know what it ought to be called.

If someone asks me what this was all about, I would say 'searching.' I searched for success, purpose, heroes, faults, love, challenges, and friendship. Sometimes I found something, most times I just learned. Perhaps what I learned most was to be patient with searching, as I finally promised to myself that it will never be done.

If someone asks me how I feel, I would say 'lucky.' Lucky for the 'how are you doing?' at morning lecture, the 'we're meeting at Whiskey's at 10' on Friday nights, the 'talk to me' when I would first hold back, the 'I'm here if you need anything' when Dawn passed away.

I congratulate myself for stumbling upon the profession that will save lives, particularly my own. Like the boy next door, I've realized it's much more perfect for me than I had originally thought. It humbles my narcissism, redirects my selfishness, fortifies my wobbly self-worth, and focuses my fickle passion and purpose. Most of all, it surrounds me with the warm, steady hands of those who have chosen to give a little more than take from the world and each other.

Yes, I trust them with my fragile heart.