“My patience is for my patients and those who suffer. For the benefit of all living beings.”

I write this little phrase most days before I start studying. Some days it is an affirmation. Some days it is a needed reminder of why I am to sit for the next hour or so. Other days it is a prayer. Most of the time I forget to write it all together.

With a careful flick of my electronic pen on the god-like technology of a Windows Surface, I seek to tie the strands of privilege and duty. An affirmation/reminder/prayer that threatens ‘Dad Joke’ yet imbued with enough Buddhism to set an intention seemingly larger than myself.

Medical school in a world plunged in pandemic is strange. During lockdowns, shielded behind the reflection of a computer screen and carolled by daily ZOOM incantations, the distance between patience and patients looms as wide as the distance between different University lecturer’s video conferencing competence. The patience expected of a medical student, almost a pre-requisite to digest the mentally calorific density of textbooks, lectures and online videos, has been compounded by the fear and uncertainty of COVID-19.

“My patience is for my patients and those who suffer.” Patience for what? Whose patients exactly? And what suffering?

Part 1: Patience

I stare at the wayward triangle I have drawn in the middle of the screen meant to resemble the human liver. Coloured arrows and circular lobules fractal as I attempt to reduce the complexity of the human detoxification centre into two dimensions. Mornings like these, in the quite of my study table, with the warm yet quickly cooling companionship of Dilmah tea, I find patience. Or rather, I test patience. It can be difficult to accept that the abstraction of liver physiology has any relevance to taking care of sick humans. It is hard to understand that I am attending medical school in my underwear in my bedroom. In the world outside my bedroom, it is difficult to settle into the reality where you can’t cash in a warm smile under an anaesthetic-blue mask. The last person I hugged was probably my family when I left for Sydney at Auckland airport. Infection rates, false positives, vaccine rollouts, traffic light systems, talking heads, ICU beds, all fall into the fractals of abstraction as I wait patiently behind my Windows Surface pen.

The most powerful lesson I learned in the first half of medical school, as the lockdowns began to descend, is to sip tea slowly. Tea teaches me patience. It doesn’t matter which kind. Black in the morning to reflect the sun of the day. Chamomile at night to flower forth dreams of the sun. Sometimes I choose liquorice, with its surprising sweetness stolen from sugar canes and stowed in its roots.

“How many years until you are Doctor?”

“Oh, and THEN you can specialise?”

“Gosh that’s a lot of study!”

My patience is a sip of tea punctuating morning breaths and obscure liver physiology. I came to medicine based on an impulse strong enough to feel like instinct (and of course a GAMSAT score passing a standard based on god-knows what). My patience is for my patients, and perhaps this year, and the next, and maybe after that too, I am my own patient. A patient to the doctor of time that muses at me with “hmms…” “ahhhs…” as I scribble stick figures and scandalous acronyms onto my tablet screen.

Part 2: Patients

I remember the first week in clinical school. We went into the emergency department. I expected the urgency of emergency. Instead, there was a strange hum of stillness. The whirring of the machines breathed, and monitors beeped, punctuating the stale air. The robots had taken over the job of living.

The nurse began to show us the computer system. The system had some clever acronym that spelled out a name. JONES or OLIVER, I can’t remember which. A seemingly innocuous Christian name enveloping a long technological acronym.

As I linger in the hallway, still confused by the deadening silence of an emergency room, movement suddenly erupts. The patient in the room in front of us begins to slowly writhe. Tubes probe his mouth like aliens. Then, he starts to move violently. His eyes are dark with shock and widen to a deep gaze as if they are lost in a dream. Two nurses rush to him trying to figure out what dose of tranquilizer will appease the monitors, to usher silence back into the ward.

“What happened to him?” I vacantly ask the JONES computer.

“He was in a car accident” The nurse replies, also staring at the screen.

The patient’s terrific clamours, muffled by plastic nasogastric tubes, suddenly make more sense. It was as if he was still stuck in the trauma of the accident, reaching for safety. While the robots and monitors kept the body alive, the mind still was walking the tightrope between life and death, survival and tragedy.

Patience. Who’s patience? The emergency department ward seemed extremely patient. The metronome of vital signs seems to patiently count points gained of life against death. The patient’s patience? The man whose mind still mines the past trying to find a way out of chewed up car. Whose patience? The two nurses who remain in states of overslept and under-wept, trying to appease the beeps of monitors by bartending tranquilizers.

I knew that my understanding of patience, and indeed patients, would grow more mysterious after my first week in the wards. I wish I could neatly package away what it meant to be a medical student, or a doctor, or a patient, or even just a human. Like the acronym of the JONES computer system, I hoped to give it a name. The truth is this time as a medical student on the path towards a degree and apparent training, is a practice of patience for further mystery. I hope to remain curious, yet ignorant, in the face of this mystery.

Part 3: Suffering

I wonder what cardiologists think about love. Somewhere in the fluid dynamics of blood flow, pressure mechanics in muscled chambers and the rhythmicity of the electrical nodes, there must be a clue of why on earth the heart is related to love. Maybe love is an arrythmia.

Late in the university year, I developed arthritis. My left index finger accrued a debt from intense martial arts training. To be more precise, my first distal interphalangeal joint was inflamed by repetitive stress injury from holding Gi grips. Every day, sometimes twice a day, and especially during the week of KAT assessment, I would go to the dojo religiously. I was training as though I was preparing for a fight that was never going to come. Tape up the finger.

Afterwards, while in the loo or taking a shower, I would wiggle my finger and explore the inflammation. Poking and prodding. Comparing to my right finger. Clinical and curious. As I would go to my bedroom to stretch and prepare for the unwelcoming strangles of sleep, the pain would descend.

It reminded me of MSK block. Not the study of it – well maybe a little bit of the pain of anatomy – but the many arthritic patients we saw in hospital. We saw a handful of Rheumatoid Arthritis and Osteoarthritis patients. Every single one of them was a lady above the age of 45. Some had a long laundry list of inflammatory disease. All had had some hand deformities. One poor lady named Ruth had such pain in her ankle she had elected to fuse the joint, trading in pained movement for stillness.

I sit on the yoga mat at the foot of my bed. It is 10pm and usually at this time I too try to welcome some stillness. But I can’t stop wiggling my finger. Interweaving my interphalangeal joints. The pain reminds me of Ruth. Ruth, and many of the arthritic women we met on the wards, seemed to have a story of suffering beyond their joints. Ruth told us her joints would flare up during times of stress. That her first major flare up happened when she lost her child in a car accident.

I notice that when I extend my finger there is pain which is relieved when I flex my finger. Holding the Gi during training involves gripping material with curled fingers. This makes me think that although extension hurts, maybe it is necessary to stretch my finger in this range or motion to counterbalance the hours spent with closed fists. I wonder what my finger would look like under the piercing gaze of an X-rays. Osteophytes from osteo-fights.

There is a classic Zen Koan that gently asks: “What is the sounds of one hand clapping?” As I think of arthritic hands on my yoga mat, this phrase echoes in my mind. I remember the partners and husbands sitting at the bedside of the arthritic patients. They were the patient’s extra pair of hands. Some had been together for 40 years. These partnerships were palpable amongst the obvious pain, distress and suffering in the room. I can’t imagine what it would mean to fuse my finger joint. Or if it hurt so much that I couldn’t dress myself, let alone train martial arts again. I start looking around my bedroom for an extra pair of hands, just in case.

The sound of one hand clapping is silence. Until your hand finds the hand of the world; the hand of another to hold, celebrate, clap, hand-dance with. My diagnosis of excessive martial arts leading to arthritic pain is the sound of one hand clapping through the pain of losing someone I love. COVID-19 cut short the time we began to know and celebrate each other. We were abseiling down the uncertain rockface of romance, gently knowing we may part ways when we reached the ground, but the pandemic cut the cord. No one really taught me what to do in this state. Not at my all-boys public school, not at my college fraternity, and certainly not the cardiologists at med school. So, I resorted to cuddling on jiu jitsu mats under the pretence of arm-locks and chokeholds.

I wonder if Ruth’s frozen ankle reminds her of the child she lost. Frozen in time, the pain captured in stillness.