So last night I slept from 11-3. Have you ever been so tired that you felt sad and emotionally fragile and vaguely nauseous? Well, I have. Getting snappish from undersleep is one thing but I bypassed that state today and went straight into actual distress. Luckily, we were ahead of schedule on our agenda for day 1 of the training.
We'd thought to have at least a day or two to prepare after our arrival but no such luck, so we sucked it up, spent all yesterday afternoon and (in my case) a couple of hours this morning preparing, and powered through (1) Intro to USAID, given by Caryn; (2) Intro to the Project, given by Karim N.; (3) Intro to 22 CFR 226, given by me, with many questions from the 13 other participants; and (4) review of the compliance checklist, tag-teamed by me and Caryn.
Then, at 3, jet lag hit with the force of a thousand milligrams of benadryl. (Diphenhydramine hydrochloride. Fun name. Diphenhydramine.) I excused myself around 3:40, spent 30 minutes waiting to get my weekly pass for the Serena business complex so I won't have to check in every morning from now on, came back to the hotel, and slept for an hour and a half. That's probably too long but thirty minutes was just not going to cut it.
That level of exhaustion was a new or at least unremembered feeling for me. And I've finally gotten to the thrust of Awakenings, the chapter after all the patient descriptions in which Sacks lays out his case for the treatment of sick patients as people, giving equal weight to the "objective" facts of their disease (the parts that make their "case" a case -- same word as used in law, as he points out with stunning insight) and to the metaphysical questions around their state. "How are you?" Sacks says, is a metaphysical question, one not answerable factually but only by example and allegory. Those examples, those allegories, are central to understanding patients and their response to disease. And modern neurology, and modern medicine in general (in 1972, when he was initially writing, and presumably still in 1990, when my edition came out) has largely abandoned those vital elements in favor of the brutally quantifiable. Post-encephalitic Parkinsonian patients and their reactions to L-DOPA, the description of which fill most of the book, provide unusually rich territory for exploring the necessity of treating patients as whole people.
I'm just going to quote him at length, because, well, POWER.
Now I'm awake and sort of ready to face the rest of the day. I actually feel alright now. Going to visit the tailor down on the first floor and maybe go to the pool for a bit. It's oppressively hot, but I think that would be okay as long as part of the time outside is spent underwater.
To conclude on a somewhat related note, here are a couple of songs I've been listening to a lot the last couple of weeks. The first one requires a hat tip to Gabby, the second I found just stumbling around YouTube and subsequently bought the album it's on.
Ambassadeurs - "M.O.P.E."
Ryo Fukui - "Early Summer"
We'd thought to have at least a day or two to prepare after our arrival but no such luck, so we sucked it up, spent all yesterday afternoon and (in my case) a couple of hours this morning preparing, and powered through (1) Intro to USAID, given by Caryn; (2) Intro to the Project, given by Karim N.; (3) Intro to 22 CFR 226, given by me, with many questions from the 13 other participants; and (4) review of the compliance checklist, tag-teamed by me and Caryn.
Then, at 3, jet lag hit with the force of a thousand milligrams of benadryl. (Diphenhydramine hydrochloride. Fun name. Diphenhydramine.) I excused myself around 3:40, spent 30 minutes waiting to get my weekly pass for the Serena business complex so I won't have to check in every morning from now on, came back to the hotel, and slept for an hour and a half. That's probably too long but thirty minutes was just not going to cut it.
That level of exhaustion was a new or at least unremembered feeling for me. And I've finally gotten to the thrust of Awakenings, the chapter after all the patient descriptions in which Sacks lays out his case for the treatment of sick patients as people, giving equal weight to the "objective" facts of their disease (the parts that make their "case" a case -- same word as used in law, as he points out with stunning insight) and to the metaphysical questions around their state. "How are you?" Sacks says, is a metaphysical question, one not answerable factually but only by example and allegory. Those examples, those allegories, are central to understanding patients and their response to disease. And modern neurology, and modern medicine in general (in 1972, when he was initially writing, and presumably still in 1990, when my edition came out) has largely abandoned those vital elements in favor of the brutally quantifiable. Post-encephalitic Parkinsonian patients and their reactions to L-DOPA, the description of which fill most of the book, provide unusually rich territory for exploring the necessity of treating patients as whole people.
I'm just going to quote him at length, because, well, POWER.
There is nothing alive which is not individual: our health is ours; our diseases are ours; our reactions are ours -- no less than our minds or our faces. Our health, diseases, and reactions cannot be understood in vitro, in themselves; they can only be understood with reference to us, as expressions of our nature, our living, our being-here (da-sein) in the world. Yet modern medicine, increasingly, dismisses our existence, either reducing us to identical replicas reacting to fixed 'stimuli' in equally fixed ways, or seeing our diseases as purely alien and bad, without organic relation to the person who is ill. The therapeutic correlate of such notions, of course, is the idea that one must attack the disease with all the weapons one has, and that one can launch the attach with total impunity, without a thought for the person who is ill. Such notions, which increasingly dominate the entire landscape of medicine, are as mystical and Manichean as they are mechanical and inhuman, and are the more pernicious because they are not explicitly realized, declared, and avowed.I thought about that today as I realized that my ailing state earlier today was clearly shaped as much by my own reactions to exhaustion in the context -- determination to finish the day's work, unwillingness to appear weak until I actually couldn't fake it anymore, and so on -- as by the fact of my not having slept very much for days and the upset that caused to my body's chemistry.
Now I'm awake and sort of ready to face the rest of the day. I actually feel alright now. Going to visit the tailor down on the first floor and maybe go to the pool for a bit. It's oppressively hot, but I think that would be okay as long as part of the time outside is spent underwater.
To conclude on a somewhat related note, here are a couple of songs I've been listening to a lot the last couple of weeks. The first one requires a hat tip to Gabby, the second I found just stumbling around YouTube and subsequently bought the album it's on.
Ambassadeurs - "M.O.P.E."
Ryo Fukui - "Early Summer"
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