Its been a long time since I have posted from the medical world of Dr Wright. I am now in Albuquerque New Mexico, Land of Enchantment and Liver Disease. So many dying ciswomen in their 30s suffering of liver failure here, and transwomen too. I have been pleased with the cultural competency for trans and non binary folk in this city so far! My hospital’s respect for the transfolk and their pronouns I have seen come through the door at UNMH has been heartwarming. The work is never done, but the foundations are in place thanks to those who have done this work before me.
There are so many things I could write about it feels overwhelming. Like
- how does one deal with anxiety in a productive way that does not encourage substance use?
- how much does good food really influence health
- and
- the value of death: vs life. what is a life well lived
- what is a good death
As an internal medicine doctor I know part of my life is to facilitate death. This is the job of the warrior; and as a hospitalist I tend to those as they fight in their own particular battlefield . I have been privileged to sit with Death, and she is a mistress no one wants to see. And yet, often such a sweet gift.
I wish that hospital medicine could embrace healing meditations and buddhist lectures. Imagine folks watching these daily in their hospital beds instead of cooking shows and NCIS? These are a few of my faves:
Anything by Pema Chodron as well: I look for ones longer than 45 minutes
I certainly haven’t mastered the art of effectively handling my own stress without turning to food, or alcohol, or any thing that distracts me from the what-feels-like intolerable levels of emotion building up inside. So, I have empathy for my patients that use this coping mechanism to get through their life. What is the difference that has me as a privileged white woman in my 40s still strong and healthy foundationally, vs their 30 year old bodies that are broken down by alcohol? Genetics is certainly a piece of it. The Navajo, Zuni and Pueblo folks here have what must be a genetic succeptibility to liver failure secondary to alcohol use disorder. They are too sick, too young, and too many of them to have it be environment alone.
I cant help but feel these women are carrying the trauma of generations of dominance, trauma and oppression and it is manifesting as this alcohol sickness – a genetic trait passed from white rapists to their progeny and concentrated in generation after generation. Tie that to poverty, a lack of fresh fruits and vegetables, and ongoing systemic depression and it makes complete sense that we have these women dying, daily, in our hospital.
It is a helpless feeling, this system oppression and individual illness. This is certainly a piece of the burnout of becoming a physician. We do our best to hold together the pieces of survival for each person, holding the hope, while also titrating the reality of recovery.
As a person very new to this state I have very little working knowledge of the cultural climate of health care here and even what resources are available. As a new resident and hospital based physician, I have basically no time to investigate and advocate for this community at the ground level. All I can do is hold the space for the sickest of the sick and even in that I don’t have time to be present for their stories or their traumas.
Dandelion and Milk thistle, turmeric are not native botanicals to this part of the country, so I doubt they are used in traditional medicines? I wonder how much early liver protection with these herbs, as well as anger management, trauma based care, and other integrative therapies could be used to protect and heal the liver in the teens and twenties for these folks? My acupuncturist said New Mexico is the land of wind, and heat, both properties of the liver meridian. This would argue for an environmental component to the imbalance as well. Food, Water, Emotions, Genetics, Trauma, Environment, Substances – so many nuances to health and to disease. And I, as a doctor, am depressed with the minimal amount of time I have to explore these facets with each individual that may lend insight into prevention before these women end up in our hospital beds.
