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Wilkommen to my blog - if you're looking for ramblings on life as a junior doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. I normally live and work as a doctor in the UK, and I'm currently taking a year out to do research in the USA. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Tuesday, 21 April 2015

Proud to put the 'I' in Immigrant

Like the lifting of some kind of dark mist, the optimism and fresh joy that has come with the arrival of Spring is almost tangible.  The buds on the trees are swollen to bursting, and there is a certain positive energy in the air - it is time for a fresh start.
And that's how you do Spring.  

Clearly the political calendar agrees, and I have been observing with interest the debates and discussions happening in the UK as the general election approaches.  It seems likely that any fresh starts are going to be a bit of a mish-mash of different parties rather than an outright winner.  But to me one of the stand-out issues is that 'I' word - Immigration.

Food exploration - post-half
marathon.  Surely food = one
of the best parts of migration.
Thanks also to these brunch
guys for the copious ice packs
for my knee!  
I am SO fed up of hearing the political rhetoric around 'these bloody immigrants' and 'what it means to be British'.  Ok, so what does it mean to be British?  Sitting around drinking cups of tea?  Whinging about the weather?  Being white? Never wanting to leave our little island because nowhere else could possibly be better?

As an immigrant myself at the moment, the product of a Euro/UK union, and as a doctor and scientist(-in-training), I find the obsession with immigration frankly embarrassing.  At the same time that everyone is complaining about immigrants stealing 'our' jobs, hundreds of migrants are dying in the Mediterranean fleeing from conflicts we have decided are not our business.   The NHS would fall apart without doctors and nurses migrating into the UK.  Science is full of people willing to move across oceans to spend a few years working abroad - every lab I have ever worked in has been populated mostly by immigrants, contributing to science in a way that will ultimately benefit the UK population.  

These immigrant knees are
good enough for her. 
Of course, I've heard the argument that these are the migrants we want or need, but this suggests that immigrants are like computers without lives and families, dreams and aspirations.  How arrogant of us to want to 'import' what we need for as long as we need it, only to be ready to discard them the second their purpose has been served, despite allowing them to create an entire life and career in our country.  As Frankie Boyle (not someone I admittedly always agree with) puts it in this article, we have no right at all to be so snobby about the rest of the world given our own role in its history.  

You know what?  We could emigrate too!  Perhaps we can apologise for the fact treating Brits in Europe costs 5x more than treating European tourists in the UK in the process.  Most Europeans I've met over here, or indeed when I was in the UK, spend their 20s comfortably and enthusiastically moving all over Europe studying and working.  And if learning another language is really so awful (I realise I'm massively biased, but really, it's not), there are other places in the world worth exploring.  With a significantly better climate.  

As an immigrant myself at the moment, I find myself increasingly embarrassed of my British passport, and the sighs of envy that sometimes come from other immigrants when they hear my British accent.  I've heard stories of Eastern European researchers leaving the UK because they got so tired of being looked down upon because of their nationality.  What a loss not only to that research field, but also our conscience as a country.  

Manhattan as seen from Queens.
Last weekend I was sat gazing over the New York skyline with three other immigrant chums ahead of my half marathon, musing about, despite any personal and professional traumas, how ridiculously sweet our lives were at that exact moment and feeling that we had no right at all to complain or worry about anything.  I had no control over where I was born, and so far, I suspect largely thanks to my passport, have had little restriction on where I go in the world by virtue of said passport.  How can we judge others in such snobbish fashion for wanting the same opportunity to build a life and career abroad, and why on earth are we so reluctant to do so?  As this African proverb tells us:
If you want to go fast, go alone.
If you want to go far, go together.
 - And I'm all about the team game.  

I've just booked my flight back to the UK, and I only hope that my fellow voters will vote with sense rather than misplaced emotions in the interim so that I still like the country I'm going back to.  Immigrants of Britain, I am with you.  

Thursday, 16 April 2015

Permanently the doctor on call (apparently!)

Thesis writing while waiting
for my clones to grow... and
not a stethoscope in sight...
Right, that's it.  I am outing Big Sister P.  No amount of ocean has been able to disrupt this one fact: I am her on-call paediatrician.  In fact I'm not always sure she wants to chat and catch up, or just borrow my medical brain in relation to my baby niece... With the assistance of WhatsApp and FaceTime, I have given advice on everything from rashes and medication queries to coughs and vomiting issues.  Folks, I decided long ago that paediatrics was not for me, but it turns out that picking your specialty professionally does not mean everyone else stops treating you like a GP.

... while (dinner) partying Spring
style; dragon fruit and time to put 
another shrimp on the barbie...

I wrote a while ago about the time I was called upon to be all doctor-y on the London Tube last summer, and almost all of my medical friends have some story to share about 'this one time' when they were out running, or on a plane, and someone needed 'A Doctor'.  That's fine.  I think I'm fairly comfortable with the divide of 'this is life threatening' and 'this is probably not' for most clinical specialties. 

But really, where can I draw the line?!  The last time I did paediatrics, obstetrics, ophthalmology or ENT was when I was at medical school.  So I did the on call shifts, helped to deliver a few babies, assisted in a couple of cataract operations and contributed to relieving a few people of their tonsils; I am not an expert.  And yet regularly people ask me 'I know it's not your field, but can I just tell you about this rash...'  In the USA, I am usually saved by the fact that, aged 26, most Americans assume I'm still a medical student, and I'm not going to be that moron that introduces themselves to everyone as 'Dr Purshouse'.  The major exception to accepting my role as a doctor over here is in relation to my fellow foreigners with terrible health insurance.  A friend of mine gave up trying to get a GP to see him after he slipped on the ice and thought he'd fractured a rib; no-one would see him with his insurance, so he ended up asking me.

The shorts are back ON! Hello long lunches
on the grass in the sunshine :)
In Big Sister P's defence, she describes me as The Barometer - i.e. how much should she panic.  Fair enough.  I don't have children and I found it pretty terrifying having sole responsibility over my niece in NYC for one afternoon and evening (new respect for solo parents - the subway plus buggy on your own presents a neat little challenge).  But what if I give the wrong advice?  What if I don't see that rash properly, or do some calculations wrong?  Especially having been out of the clinical game for 7 months now (7 months in the USA! It is just zooooooming by), I am scared enough about going back to clinical work in some competent fashion three months from now without being quizzed about unfamiliar specialties in-between.  Often I feel I'm just stating common sense advice, and almost invariably feel like someone who has had children (like, oh, I don't know, my own mother..!) might be a better bet.  But of course I'll do it, within my own comfort limits - perhaps my niece represents just one person that won't turn up unnecessarily at a GP surgery or A+E, and if we all think about it like that, we might just start addressing the attendance crisis facing these frontline health services.

My weapon of choice
The first opera I ever watched was 'Die Zauberfloete' - 'The Magic Flute'. I guess I was 9 or 10, and my parents will tell you that I thought I'd find it really boring, even bringing a stash of books with me to read (What a brat, eh?!). However, I was completely engrossed and loved it from start to finish. For years to come, whenever a room was redecorated in our house, and it became all lovely and echoey in the absence of carpets or furniture, my mum, sister and I would take it in turns to recreate the Queen of the Night Aria (or more accurately - 'Der Hölle Rache kocht in meinem Herzen' - hell's wrath boils in my heart - yikes!) - which features one of the highest notes in the soprano vocal range, and therefore we were really little more than squeaking.  My violin duetting partner and I recently laughed til it hurt recreating this in string form.

Moral of the story?  I love singing, and I love singing all kinds of stuff.  But that does not make me an opera singer.  Much like being a doctor does not make me a paediatrician, an obstetrician or an orthopaedic surgeon. So ask away if you must - but please take all advice with a piece of salt.

Perhaps I should start charging a small fee - a friend suggested I should charge by the hour plus the time difference... genius.  Start forming an orderly queue, please.  

Monday, 13 April 2015

The Opposite of Curiosity

Curiosity is both my greatest friend and biggest enemy.  My curiosity has in recent weeks been well and truly on a leash - but in 'restraining' it, or rather, allowing curiosity to find me, I feel I've been able to appreciate what's going on around me with fresh eyes.

This has been vastly facilitated in part by having various visitors which has therefore required me to SIT STILL and NOT MOVE (well...perhaps it's more accurate to say that I have stayed in the tri-state area and moved a lot within that... the Spring countryside is just irresistible!).  Visitors and American friends alike have taken my enthusiasm for world-merging with great spirit, and hopefully enjoyed sharing a world for a while. But - I shall take my own advice, pipe down and say little more about it other than provide a few snapshots of recent joys, which I hope will speak for themselves.

Probably the one part of a New York brunch I could leave,
but at least I'll try anything once.  Plus, nothing
can taint my love of Brunch.

Pecan pastries.  If I weren't doing so much running/squash/you-name-it atm, I would be getting very, very fat.  I can safely say Easter was a feast in every meaning of the word: thanks Team America.

This was randomly stuck on the window of a shop that is being renovated near my flat, and just tickled me. True, as exemplified by this previous post! But also, said post is a reminder that there can always be more great bike rides :) 
Transatlantic Easter-ing.

Surely the best $8 I have spent in recent times.
Beyond therapeutic to do a quick sketch when
a spare five minutes presents itself.
Spring is fighting through! Perfect for my morning runs
although my right knee currently does not agree.
Ageing sucks.

These are just a few little things.  I played my last concert here recently; the beginning of 'lasts' but we're not thinking about that just now!  Letting life happen to me rather than making it happen myself is not something I am historically very good at, but perhaps I should try harder to let it be so.  It's pretty lovely.  (Although spoiler alert - such notions will be fairly imminently paused - despite having a thesis to write and brain cancer to cure, I have a country to explore here, after all.  But you know.  After that.)

Thursday, 2 April 2015

Failure is Always a Good Way to Learn

Music seems to be a heavy theme of recent blogs.  Isn't it amazing how music can influence and reflect your mood?  I have been blasting everything from Einaudi, Brahms and Arvo Part to Phoenix, Bloc Party and Arcade Fire on the lab speakers of late.  Recent concert highlight (hard to pick just one...) - Liszt's Piano Sonata in B Minor - what a journey!

As I've just jumped the 'unlucky' 13 (000! Thanks, lovely readers, whoever you are!) mark on this blog, I thought I'd tackle all-things unlucky and find a positive spin.  The title of this blog post comes from one of my favourite bands when I was a teenager - and now - Kings of Convenience. The lyrics pretty much define why the outdoors are such an important place for me; a place where there is no blame or retribution or, well, failure.  Here are some of the highlights:

I wish I could travel overground
To where all you hear is water sounds,
What do you think of our high-quality arts and crafts?
See, scientists can be creative...
Lush as the wind upon a tree.
I wish I could travel overground
To where all you hear is water sounds,
To capture and keep inside of me.
Failure is always the best way to learn,
Retracing your steps until you know,
Have no fear your wounds will heal.

I have just had to throw three months worth of lab work in the bin, literally (slightly anxiety-inducing given that I have a thesis due in two months), and hands down the worst thing about living overseas is feeling like a friend failure for those back home.  The risk of failure is everywhere, from big things like jobs and relationships, to little ones like missing a phone call or forgetting to send a birthday card.  Big fat failure lies at every turn.

My research in beer form.  What a find from the boss...
I maintain that a bit of failure is good and healthy, and it is constant.  I fail at stuff all the time; just thinking about my funding for coming to the USA, I applied for a whole bunch of grants and scholarships, and got precisely none of them apart from the Fulbright. Well, of course I am grateful and glad for the one I DID get; but there is nothing more soul destroying than weeks of preparing an application, only to be told in three lines that you, yes YOU, weren't good enough.  When I applied for my first job after medical school, I got rejected without interview at most places I applied.  Lab work is utterly soul destroying when it isn't working, again because it feels like a very personal, individual failure - I feel like the world's suckiest scientist at the moment.  More generally, I cringe all the time remembering things I have said (or not said); surely speaking before thinking is one of my biggest faults.  Don't even get me started on my failures where my friends, family and the rest are concerned (but you'll forgive me if I keep them to myself!).  People often assume that stuff just 'works' - I'll concede that overall I've been very, very lucky thus far, but really - if only.  It's just easier to avoid talking about the failures, and as a result they remain unseen.  Damn that game face.

Clinically, I harbour my own guilt of bad decisions made and failures that I have come to accept and live with.  That once meant telling a patient I had made a prescribing mistake that fortunately didn't affect their care, but could easily have done.  On another occasion it meant telling a relative that their husband had died after they suddenly had a heart attack which we couldn't save them from despite 45 minutes of CPR - so no active failure, but it certainly feels like it when you've been crying about it in the patient's toilet for fifteen minutes and then have to get your face and professionalism together to talk to their family.  There's been a photo doing the rounds of a doctor after he lost a patient - I have certainly pulled that pose more than once.

A bit of the Bindra lab!
But in time I have come to realise that failure is really how one chooses to see it.  Without wishing to get too profound, perhaps we allow what society dictates as success and failure to cloud our judgement.  As a girl with a career (shocking!), there are many views I encounter about my work/life balance and society's expectation that my ovaries dictate my every move.  Clinically and particularly scientifically, I must accept that sometimes I will fail, in someone else's eyes even if not in my own (although one of my other major faults is usually seeing it the other way round).  Failure is a part of life, and I have learned in time to try and forgive myself and others - like an alcoholic, I guess acceptance is the first step to recovery.  And maybe that makes me seem like a pushover - well, whatever.  I feel quite the opposite about it.  Of course, all easier said than done.

I only have to cast a glance at any newspaper to know my failures are of absolutely no import.  So I'll take comfort from the successes, however small, and focus on them instead, all the while trying to live and learn, and maintaining some bigger world perspective.  Case in point - realising the happiness of taking my stresses out on the pages of a journal or in the park when I'm out running - and the peace of keeping them there (as opposed to letting them come out of my mouth!).  The overworrying - well; that's a work in progress...

NB: The photos are from a bit of recent lab-success celebrating - good to stay positive even if my lab stuff isn't working at the moment :)
N 'in più' B: Just to round off the music theme - I've been reading a Gershwin bio recently to accompany listening my way through his back catalogue - turns out there's a rather large coincidence between Mr Gershwin and my field of science research...

Saturday, 28 March 2015

Going Home: The unspoken part of the 'Grown Up' Gap Year

In the General Assembly hall at the UN.  SO. EXCITING.
Despite the fact that it's snowing AGAIN today, nothing will destroy my ongoing joy and excitement about visiting the United Nations recently.  One of THE best things my performing-arts-focused high school did was to get a bunch of us to participate in the UK version of the Model United Nations, and I credit those experiences entirely with any confidence I have in public speaking and my belief that knowledge is power (as opposed to shouting the loudest!).  So going to the real thing was extremely exciting.  Didn't quite get to meet Ban Ki-moon, but hey, that's for next time!
A Nancy Reagan gift at the UN

It also gave me the opportunity to catch up with some lovely Fulbrighty types too.  The end of our American adventures is rapidly approaching, and apart from causing us all to get incredibly stressed about work, trying to get everything done before we leave, it has also prompted us all to ponder 'going home' and what this even means.  Safe to say we're already plotting an 'American Re-migrants Support Group'; because I find myself incredibly sad that my time abroad is coming to a rapid end.

I thought this year would cure me once and for all of my enthusiasm for the almost annual moving around that has come to characterise my 20s; one final fling of my rucksack around the world and then I'd be content to settle myself a little in one place.  In reality, and to my surprise, it has had quite the opposite effect.  Discussing this with other friends who have temporarily emigrated, we all have this strange sinking feeling of 'safety' with returning home, almost like we're not totally sure where we belong anymore.  I know I am incredibly lucky to be returning to a country where I can continue to work in my fields of interest, a luxury not bestowed upon all of my immigrant buddies.  Not just that - I have an amazing job to go home to!  Much as I enjoy research, I have come to really, really miss being a clinical doctor and I am really looking forward to combining research with medical practice again.  Research on its own, whilst awesome (when it works), is only half of my professional soul, and I miss the other half!
Finally submitting DNA for deep seq!
The first thing to go right for a while.
We were excited.  

And yet - I really enjoy living overseas, and in the advent of Skype and FaceTime, missing home really doesn't bother me as much as I thought it might.  Of course I am missing all kinds of stuff - my sister's 30th birthday, my niece's first steps, the occasional wedding, a hug from Mother P.  But as my bestie from med school reassured me - when it comes to close friends and family, they will always be there, regardless of where I am.  I realise talking to a face on a screen isn't the same, but I feel like I am almost more in touch with key people - I just make more effort. At the same time, I love the mentality that has been integrated in my brain as an immigrant - an even greater enthusiasm for exploring this damn beautiful world, a greater degree of self reliance (and resilience), talking to strangers and making friends.  In the latter, I have been more than richly rewarded in the great people I am lucky to call friends on this side of the pond: friends who have helped me through all of life's ups and downs, and even more wonderfully, are willing to rely on me as a friend in return.  Living abroad has raised more questions about life than any of my immigrant chums and I ever expected - all of which I'm still processing and digesting.  But it feels very healthy to allow all this thinking to happen.
A chunk of the most quoted text in the world
I remember my family commenting to me a few years ago that they had long feared I might settle abroad when I 'grew up', and I had scorned this at the time.  Now, I'm not so sure... However, I will say this: if I emigrate again for however long, I'm going somewhere warmer - this winter is just never-ending.

Homemade mango pickle
nom nom nom...
But I'm not yet a grown up - that's a few years away.  In the mean time, I'm excited for the job I'm going home to, the research I am still doing here and my currently rather insane work:life balance (read: doing both at 100%) - although I am getting way better at enforcing occasional hermit-ness.  I've had some truly wonderful friend-merge dinners recently (I LOVE friend merges) - possibly a favourite was Keralan curry night, complete with mango pickle (see right!) and my #1 wine from my Californian trip which I managed to find in a CT wine shop (no arsenic in sight...).
I just wish someone had told me that remigrating home is looking likely to be way harder than leaving it in the first place.  Yes, I know.  #firstworldproblems.  Don't worry, I do count my blessings every day. 

Wednesday, 18 March 2015

The Middle Ring - how to avoid Vanishing Neighbours

Spring in Rhode Island
I have it on good authority that the cherry blossom in the UK is in full bloom - we have a way to go here in Connecticut, but Spring is definitely in the air, finally.  The walk to work feels fresh rather than freezing - hurray! - and means people are a bit more willing to offer a 'hi there' and 'hello'.

Middle Ring embracing at Brown.
I recently went to a talk by an American scholar, Marc Dunkelman.  I'm still working my way through his book, 'The Vanishing Neighbo(u)r', where he talks about how the traditional relationships that make up (American) society have evolved and the consequences of this evolution.  He describes how we, as individuals, are like planets with rings of people around us.  We nurture the rings close to us (our closest friends, family etc), and those far away (aspirational ones - things we are aiming for or want, from people we likely don't know); but these are at the expense of the middle ring - people we know in the 'ish' sense - people we work with, the people who live in the same building, the guy who owns the coffee shop, the postman etc.  So for example, I came home on Sunday evening and quickly Skyped my mum (Mother's Day!) - but pre-Skype I couldn't have done this and instead might have said hello to my neighbour.

'Spring' in windswept NYC
Does this resonate with you?  I have certainly pondered it. I have come to think I have two levels of middle ring - the people who are in my immediate vicinity such as neighbours, the shopkeeper etc; and the second level of middle ring - people who could easily be inner ring were it not for timing, geography and hours in the day, such as the new friends I made at a Fulbrighty seminar I went to last weekend with 130-or-so new friends, or indeed travel friends from the past.  I feel pretty content with the Middle Rings - I appreciate and nurture them as much as I possibly can, the latter often with the help of social media and an open-minded attitude to friendship.  An inevitable consequence of my globe hopping?  I suspect so.  But I don't believe it's a bad thing.  It just makes the world a much smaller place.
As evidence of its magical power, here, in no particular order, are a few recent musings from both Middle Rings in my world.

- Coffee.  I came back from Cali and it's all I crave.  Best parts of this are fun encounters at my new favourite coffee shop (which has a tree inside!) and the lovely couple who own it (MIDDLE RING ALERT).  For me, the UK's #1 tea fan, this is RADICAL.

@AS220 print shop
- People love a British accent.  No.  People love MY British accent.  Given that in the UK, my weird stunted Scottish twang is often confused for Irish/Canadian/American/Swedish, this is quite an adjustment to be told by the Middle Rings that I sound 'incredibly British' which in turn is 'so cute and wonderful'.  As anyone who knows me and my feelings about compliments, this is... challenging and hilarious.  I don't think I've ever been called cute in my life (apart from in reference to my sneezes) and I didn't think the British accent was held in particularly high regard - apparently I was wrong!

- Brits everywhere - we really do apologise too much.  A new Argentinian friend told me that every time I want to say 'I'm sorry' I must instead say 'I'm happy'.  I thought that was pretty neat.  Sometimes the Middle Ring just tells it like it is.

- Being a Fulbrighter is like giving the Middle Ring a perma-hug - but what does being a Fulbrighter mean to me?  I'd say many things, but will boil it down to two taken from that recent seminar - it means having only a two hour break during a full day and night of activities, but still finding a bunch of people who want to use that time to go running with you, and discovering that even if the club you end up at is fantastically awful, you will still have everyone embracing it 100% with not a hint of snobbery.  Probably with some traditional dancing going on, even though what's playing is some dance music disaster.  And obviously, assumed friendship.

- The world is full of incredibly kind people who shift inevitably between Inner and Middle Ring, and I'm just kind of mega blown away by that.  I will never change being open to people and sharing worlds whenever I can, and hope I will continue to channel that in both my personal and professional lives, because the inner/middle continuum is a great one.

- I was nowhere near as embarrassed as I should have been when singing away to the radio at the top of my lungs whilst in the tissue culture room, thinking the lab was empty, when my boss peered round the door to say he's 'enjoying' my musical contribution.  Not even a blush when the repair man came in as I bopped away to Gershwin.  Perhaps lack of concern at Middle Ring embarrassment is a sign of comfort in life (as one should never feel embarrassed around the inner ring, and you shouldn't care what relative strangers in the outer ring think anyway!).

- I have instigated a new activity every time someone has a science success - it's called 'Learn a Ceilidh Dance'.  With much arm twisting, I got two of my lab people to learn the Gay Gordons to celebrate a much-wished-for successful Western Blot, and have the promise of a dance with my current lab collaborator should our experiment work next week.  Perhaps the Middle Ring lends itself particularly well to Cultural Exchange?

@AS220 Youth piece
As an emigre, I guess I must accept that to an extent, I neglect the first level of the Middle Ring because I sometimes prioritise the inner ring with the help of Skype and so on.  But equally, it is phenomenal how happy and glow-y I am when I have that chat with the coffee shop couple, or the lady at the post office, or play squash with a lab friend, or whatever.  Regarding the second Middle Ring, well I think it's pretty telling that I have just made my first social activity plans for my return to the UK with the friends I made a decade ago in Ghana for our 'ten year anniversary'.  So Middle Ring does not mean neglect if you don't want it to.
Pawtucket Cotton Mill

So I guess the Middle Ring is one I embrace as much as I can given the international spread of my friends and family, and it's been pretty damn good to me.  Maybe the Middle Ring is more about just making an effort, being more ready to say hello, and keeping the door permanently open?

Thursday, 12 March 2015

A Man's a Man For A' That?

The first lines of Rabbie Burns' poem will be well known to anyone who grew up in Scotland.

Is there for honest Poverty
That hings his head, an' a' that;
The coward slave - we pass him by,
We dare be poor for a' that!

I recently read the memoir of a woman who had been exiled to Siberia from Poland during the Second World War.  Near the end, she talks about how hunger, a theme that is interwoven at every stage of her tale, is the worst form of torture.  She describes how hunger eats away at your soul, takes your energy and removes your hope.  When I was a 22-year-old living in London, I lived on £1 a day for a week to increase my understanding of the impact of hunger.  One week of carbs and not much else allowed me to empathise with hunger and poverty in a way I could scarcely have anticipated beforehand.  After just one week I felt tired, fed up, focus-less, disinterested and out of steam. I couldn't believe the all-encompassing impact hunger would have on my ability to do even the most basic tasks, let alone study or work.  And I only had to do that for one week - I am clearly not suggesting I can relate to the long-term suffering experienced by the woman I was reading about in the book, or the many millions of people in the world who are hungry everyday.  Hunger is torture.

Every day I walk to work through the centre of my Connecticut town.  Usually it's a quiet walk; a few others head to the medical laboratories on foot.  But as I cross the two main roads near the hospital, I usually encounter a few of the city's homeless community.  The hospital resides in one of the more troubled areas of town, and we are advised not to venture beyond the other side of the hospital for our own safety.  When I finish late in the lab, I get the university shuttle bus to my door because it is apparently too dangerous to walk home alone.

Despite my travels and clinical experience in a few developing countries, poverty in the USA exists in a way I have never seen before.  This is not just the lot of my city of residence - I don't think I've taken a single ride on the subway in New York without being accosted by someone begging with a speech in the tube carriage.  Homeless people live on many a San Francisco street corner.  Many have mental health issues - which is worth noting given the recent shooting of a man in Los Angeles who was homeless following treatment for mental illness.  The chasm between rich and poor feels enormous, and intensely along racial lines. Is it like this back in the UK and I just haven't noticed?  Having trained to be a doctor in one of the most deprived parts of the UK, perhaps, but nowhere near to the same extremes.  In my as-yet brief medical career in the UK, I have seen many sides of society through my patients, and feel we can relate to each other in some way, regardless of wealth, poverty or anything else.  Here it feels like the divide is astronomically bigger.  Add gun control (or lack thereof) to the equation and it's a toxic mix that feels very much like 'us' versus 'them'.  When you have nothing, I guess what is there to lose?

The political divide here reflects the manner in which people do, or don't, want to deal with this.  I guess it's basically socialism versus conservatism - is the state responsible for supporting everyone to give them a fair shot, or is it up to the individual?  Personally, I find it very hard to stomach the latter argument; when the abandonment from society is so complete with regards to housing, education and healthcare, where is the individual supposed to start when they can neither shave nor wash, buy new shoes never mind a suit, or be adequately nourished to the point where one can think straight?  If this was a country struggling to make ends meet I would understand - but this is the wealthiest country in the world, no?

We are made to feel like we don't matter as individuals all the time - either by people who we know (argh!), or by the bigger institutions that rule the world (double argh!).  I hate it when people make me feel like I don't matter - not because I think I'm the most important person in the world, but because I'm a person with feelings, ideas and thoughts, and in my old age have learnt my worth in the world.  I struggle to know how to deal with living in an environment where so many people must feel like no-one cares, and to know what I can personally do about it.

As Spring seems to finally be arriving in Connecticut, and the piles of snow beside the road finally have a chance to melt, I am relieved also for those who call the frozen pavements 'home' for the night that warmer times are coming.  Certainly more so than in the UK, I give up my spare dollars when I have them, accepting this is a short fix, and that the reasons for this divide are far more complex than this blog has space for.  I can't change an entire social set up on my own, as a foreigner, in nine months - but feel utterly dissatisfied with the apparently rhetorical question of 'well what can I do?'.  I'm running a half marathon next month in NYC.  I'm not doing a formal fundraising thing, but if you are so inclined, I would much appreciate your throwing a few pennies/cents to Columbus House which is based near where I live.

On the wall by my mother's desk at home is pinned a prayer that has always resonated with me, increasingly so as I get older (written by Reinhold Niebuhr, American theologian who, as it turns out, studied at Yale Divinity School.)

'God grant me the serenity to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.
Living one day at a time;
enjoying one moment at a time;
accepting hardships as the pathway to peace...'

I hear what he's saying. But when it comes to poverty, it's overall rather depressing to think that we haven't progressed much from Robert Burns' sentiments, despite the fact they were written over 200 years ago. And when it comes to the USA, it is this powerlessness to help one's fellow man that is probably the number one thing that stops most Brits I have met from contemplating a long term emigration to this side of the Atlantic.

 America, land of the free. Well, if you can afford it.