amaurosis fugax
By: Braeden Sagehorn he/him/his
1. A teenaged girl presents to my CLIC site for their regular health maintenance visit. There in bright red letters on their EMR read, recently lost her mother to cancer. My preceptor made note to tell me that she had passed the year prior, that she was a strong person, and that he missed speaking to someone so caring. For a moment I sat in my chair thinking hard about how best to approach this, and before I knew it, as if possessed by a spirit, had entered the exam room. I began with the standard routine we learn in clinical skills, and continued on until I had reached the sensitive questions. I politely asked dad to leave, who thankfully knew the drill, and waltzed right out towards the waiting room. I saw in your chart that you recently lost your mother. I’m sorry you had to go through something like that. How have you been doing? She tensed slightly, and began telling me about her journey on the trail of grief. Therapy had been going well, so well in fact, that she told me her days felt clearer than before, that she could move through her school days with a half-smile—that there was progress. Yet before she closed out her speech, she let me know that she didn’t think something like this could happen to her at her age, she didn’t think it would be her. I followed up with the only thing I thought I could say: You know I lost my grandmother my senior year of college. She essentially raised me, and so when she passed it felt like I had lost a parent. It’s been almost 5 years now without them, and I can tell you the first couple years are tough, but it gets easier I promise. And I can tell you’re slowly starting to realize that. Then with half-smile, she moved her hair behind her ear and thanked me. Shortly thereafter dad was invited back in, and my preceptor wrapped up the visit—I haven’t seen her since.
2. After everything you’ve been through it feels nice to see you smile.
3. Whether it be from the death of a relative, a breakup, or on the heels of a bad decision, that limbo period that follows can teach you a lot about yourself. Unfortunately, the doors that tragedy opens for us can also lead us astray; oftentimes you need someone else to help you through it all. I didn’t really have that when I lost my grandmother all those years ago. The result was my transformation into a tornado whose destruction whipped back mostly unto myself. Yet during the worst of my depression, a faint light allowed me to remember something—a story. It was one that an acquaintance of mine from high school had written, a story that won her a literary prize, about a man rebuilding his house that fell apart. It was a somber dedication to her friend who had relapsed and passed from an overdose. Quietly then, during my moment of remembrance, a small light burning inside of me could be felt, faintly, for the first time in months. That brief heat is what pushed me to attempt to write poetry, and oftentimes when things fall apart, I remember that story, and slowly, start to rebuild my own home. I reason today that it was the story that lit the fire for me, a sort of slow burn that raged until I could feel it. In fact, I believe I can still feel it to this day.
4. I’m tired, everyone’s tired, and nobody’s tired enough.
5. A few weeks ago, I went to Real Art Ways in Hartford to sit for one of their monthly poetry readings. It’s also one of my favorite parts about Hartford—it’s a small, red brick art space that hosts movies, art exhibitions, and readings for everyone willing to see. I usually tend to go for the readings, but that day there was none. I had arrived on time only to be informed that the poets had caught COVID and couldn’t make it. However, my moment of misery was broken when they informed me that they were screening Poor Things by Yorgos Lanthimos. The movie centered around Bella Baxter, played by Emma Stone, who’s infant brain was placed into the body of her deceased mother by a sort of emotionally mature Dr. Frankenstein. Bella subsequently drinks, eats, fucks, and philosophizes herself through the sinuosity that is life. I envied her innocence. I envied her whimsy in the pursuit of her own becoming. In one notable scene, following her arrival to Paris, she lays lamenting in her brothel bed pondering her situation. You see, from the inklings of horror she witnessed in Spain, to the child death in Greece, and now in Paris as a sex worker herself coming to terms with her own trauma; she succumbs to melancholy. How is it that suffering could exist in such a way? The scene continues with an abrupt entrance by the owner, head to toe in tattoos, to counsel the sad Bella. She explained in a raspy tone, that one must experience these lows in order to appreciate the highs that life has to offer. And this is true, one can’t appreciate the lows without the highs, and hearing this spoken on screen was comforting—grounding in a way. Yet I felt that for Bella the realization was that of the transience of her mood. Her epiphany continued: is mood the only thing that holds impermanence in life? No! History, society, they’re formed of impermanence as well: that which was will not be again, and that which hasn’t can still yet to be. There in Paris she began to embrace the transience of her position. Her time in the brothel would come and go just as it did on the ferry and just as it did when she had left her home. Here she realizes that she can be someone—she can be a force for change only so long as she acts. It’s from these moments then, that she begins attending rallies in France, and slowly builds towards the ownership of her home. It was the first time in weeks I was able to situate my seasonal depression, my loneliness, as a temporary movement in the river of my time. So, I let my feelings wash over me and walked genially back to my car.
6. It feels foolish to fall in love with one place, with one time, with one heart, with one mind, with oneself—for the moment you leave is the moment home too, leaves you.
7. For most of December and January I felt alienated from my body. Occasionally I’d dissociate, mostly during clinical reasoning, and watch what was going on with my ears. Those were most of my Tuesdays actually—staring into the table as if it were hiding something from me. Most days I’d be quiet, which I don’t enjoy, believe it or not I like contributing to discussion. But as of that moment I didn’t want to move my mouth, or my body, or my fingers one bit. The less I spoke the better I felt. That is until I started to remember that I enjoyed speaking, felt bad that I wasn’t, and repeated the cycle. What I really wanted to do was skip the class, but then comes other issues—namely guilt. How could I skip class while the others in my group kept moving through it? Why should I be miserable when they probably feel that same escapist urge? Of course, I can’t read anyone’s mind, and making assumptions like that gets you nowhere, but when you’re left alone to ruminate for so long what else can you do? Ultimately, I decided that a minor protest could work—arriving just on time. Which in retrospect didn’t make me much of a rebel but it did ease some anxiety. Then in those brief moments of release it felt like I could be someone again. It took me until early February to start feeling like I was someone who existed in the world; that I had my own thoughts, dreams, and wishes. I realize now how badly I wish I did speak, how I wish I had arrived a little earlier to talk to the people in class that I did enjoy seeing. Of course, emotion is a powerful force, and when you haven’t meaningfully seen the sun in so long darkness hugs you with a warm familiarity. And the rage. Nobody ever talks about the rage. Whether it's overt or suppressed, and how much it ruins everything at the drop of a hat. You lash out, you do something out of character, you ignore people, you avoid others and so much more. Then suddenly every bridge you ever had is burned—or at least the few you cared about until you feel worse than you did when you were depressed. Unfortunately for most, sorry doesn’t cut it on the path towards repair, only time, and a gentleness towards yourself and others.
8. Ideas for conversation that don’t involve Step 1: Talking about the clouds, the book arrangement in the library, your dinner you cooked last night, your friend’s outfit, your dreams, their dreams, what the trees look like, what you think the birds are singing about, your favorite kind of dessert, your favorite kind of desert (mines the Mojave), interesting new hobbies, your favorite home cooked meal, new music, old music, what you like to cook, old hobbies, old trips you went on, new trips you want to plan, arguments about cheese, why you wished you lived closer to New Haven, why you’re glad you don’t live near New Haven, what’s a New Haven?, names for new colors, who can quote Twilight the most (Bella, where have you BEEN loca?!?!), worst tv characters, weirdest book you read, new ice cream flavors, songs you sing in the car that you still don’t know the lyrics to…
9. Revisitations. According to Maggie Nelson, revisitations to themes in one’s life are what constitute it. But what exactly is a revisitation, and why are we revisiting the theme in the first place? Does a revisitation take years to encounter, or can it be encountered in the short term? As far as preclinical goes, you're in a constant state of revisitation. You’re revisiting material, mistakes, reasoning, mental health, isolation, your ego, and so much more on an almost daily basis. And here changing behavior is an essential part of the game. 10 weeks. You have 10 weeks to adapt your studying habits before the next exam. You have even less time between CLIC sessions. The lynchpin, however, is that in order to facilitate meaningful change, you need to have time to reflect—free time. Which is already an extremely limited asset for our small subgroup of society. Yet without reflection the habit won’t be broken as easily, that's just basic conditioning. Now med school isn't the only thing getting in the way—life, family, society—they get in the way too. Even with therapy you may not be able to understand everything on the first round, and with that lack of full understanding you’ll probably make the same mistake again. Except the second time won’t be as harsh as the first (ideally), until one day you don’t make it again—the mistake that is. But what happens when you don’t encounter your mistake for years? Certainly, you took notes on the first encounter, but with the time that’s passed there’s bound to be some slippage through the cracks. Maggie Nelson then implores us to consider how human it is to revisit these same themes, mistakes, dilemmas throughout our lives despite making them again. That’s not failure, that's life—pure and sweet and painful as ever. Therefore, I find the essence of revisitations to be found in the acceptance of a certain kind of futility. You need time to sit and reflect, you need an openness with yourself to sit and reflect, and you need an acceptance of a present that will one day fade away. One day soon I hope medical school becomes a more habitable space for students to learn and reflect on their own time and in their own way, but that currently feels a distant dream. At least now, for me, having survived preclinical so far, I feel as though I’ve come an inch closer to seeing those bumps more as a friend dressed florid than in a wistful black.
10. The slipperiness of a short life is the unfortunate lack of reference.
11. The first dream—Blue: I sat on my front porch back home in West Haven watching the sunset. In my hand was a hot chocolate, and around my body were layers of clothing so heavy I couldn’t move. I could feel the weight on my thighs as if three, forty-five-pound weights were resting there. Then suddenly a black-red sun began to dip below The Sound, and I noticed something: that it wasn’t water reflecting the black-red rays but sand. Blue sand. Sand whipped up to stand like a finely made whipping cream. There were curves, smooth curves, that only the most delicate of dunes could hope to possess. Great big circular ripples separated our shore from theirs and it was so blue! The darkest lapis I could have ever imagined. I wished I could own a shirt that color of blue. I tried to get up to go inside and tell my mom, but I couldn’t. In fact, I couldn’t even lift my hot chocolate to my mouth. I squinted some more after panicking and saw the ferry careening over the sand; its deep blue clouding around whatever was propelling it through those granulated waves. I couldn’t believe my eyes as the massive vessel charged through the dunes obscuring my gothic sunset. Finally, the sun did set behind Long Island, and I was left alone in the pitch black—not a single lamp on the street was lit. Then with the weight of an elephant keeping me still, the only thing I could hear before awakening was the powerful horn of the ferry chugging along.
12. The waves will wash away the pits, the castles, the drawings, and the statues only to recede into the sea—again a blank canvas for more.
13. In five years’ time, you may be able to rationalize all the pain away, tell yourself that it was all worth it. It’ll ultimately be a pale effort to repaint the past a cooler shade of blue: I suffered a lot then but look how good everything is now! And it’s uniquely human, isn’t it? That ability to delay gratification for so long. A similar notion that many of you had when preparing for the MCAT, or the DAT, or working that job you hated, or begrudgingly taking a gap year. Was it worth it? For just about everyone the answer will be yes. But in those moments when you’re really feeling the pain—I mean really living with a sort of misery you’ve never experienced before, it’s hard not to think otherwise. I can’t say I haven’t had thoughts of wishing I did things differently. But then when the kids smile at me or fist bump me or high five me at CLIC, the world suddenly melts away.
14. Consider the pizza slice. What is the bottom and what is the top? One perspective posits that the pointed end is the bottom, and the crust-end the top. Why is that? To them the pizza slice is irremovable from the whole—once cut, it retains its orientation from its humble beginnings. Next, we meet the second individual who believes the opposite: the crust-end is the bottom, and the pointed end is the top. This thinking has separated the slice from the whole pizza. Instead, this individual believes that the slice’s context to themself is what decides its orientation. Just because it came from the pizza in a certain way doesn't mean that it stays the same from its earlier life—context reigns supreme. A third view posits that the literal lower bread layer of the slice is the base, and the cheese-sauce layer is the top. This thinking entirely redirects our own to that of the construction of the pizza itself. A complete spin on the previous two who ignore its composition and instead favor its “proper” orientation in space. In the end, is it all perspective?
15. Trust the hours to carry you forward. They've done so before, why is today any different?
16. I’m aware that suffering is indiscriminate. I’ve learned all too well that even when you make every “right” decision in the book you can still suffer. Of course, suffering is also relative from person to person—for some there’s a constant baseline level, and then for others it’s like a sine wave. There are even a select few people who claim that they’ve never suffered—at least, according to their own definitions. You know you’ve crossed into problematic levels when mental health declines, when eating becomes sporadic, when the relationships you had with people falter, when you can’t seem to focus for a whole hour, when you get back to your apartment and just want to sit there instead of reading or writing or watching TV. Those are telltale signs of too much suffering. Yet that seems to be the essence of medical school in its current state, or at least ours. The expectations are high, and with how individual this sport can be—isolating. So incredibly isolating. Even studying together with people at a library table can feel isolating. Except you’re not alone, other students are there suffering along with you. They’re suffering from not just the isolation but the academic rigor, the debt, and the feelings of no control. Take for example the recent change in the Leap exam scheduling. Instead of being able to structure your exam day, it is decided that this cannot be, and what little agency you had left is gone. In fact, the wellbeing of the students’ sense of agency is secondary. Now this may seem small to many people, but for me any little erosion hurts. It feels as though I’m an afterthought.
17. A college aged male presents to my CLIC site for their regular health maintenance visit. He has no major concerns. The patient also presents as being so incredibly cool. We talked about everything from Formula 1 to his new mustache to college life. In fact, he even went so far as to insist that my own stache was slowly approaching its own zenith of excellence. I was able to easily maneuver through the rest of the history until finally approaching a concern littered throughout the chart: his weight. When we got to talking about it, with levity, he discussed his behavioral changes: cooking meals, exercising four times a week, and socializing more now that he was in college. He told me he just couldn’t keep the damn weight off. And I was conflicted: he had told me earlier that he felt comfortable in his body, yet he also acknowledged that his weight was an important health issue for him. Was he really then comfortable in his body? I didn’t really know, and realized quickly that this seemingly inner conflict was the true answer after all. Before leaving, I made sure to commend him for the changes that he had made. He responded with a grateful nod, and shortly after the exam, I floated back to my preceptor to report. The studious doctor eventually walked in, chatted him up, and cut right to the chase: he really should lose weight. The patient genially agreed (again), and my preceptor set him on the path towards a program with CCMC. Then as quickly as he came, that jolly mustachioed man, left me with a smile and a firm handshake. I haven’t seen him since.
18. On my road trip two years ago from Phoenix to Denver, I loved to notice the clouds. I remember driving through the East Utah desert to whole football fields of shade made by some of them. Clouds so large and square that it would feel as though they were lingering overhead for hours, a guardian angel, whose absence was realized suddenly when the corona of the sun snapped in your face. Whenever that happened it felt like I had lost another travel buddy. And this for most of the drive up to Moab this is what my friends and I encountered. What struck me later was that we happened to be out just when these large square clouds were—a dance of two travelers. The next day, arriving in Moab, I noticed that the squares were no longer square but white oblong circles spaced evenly against the baby blue, midwestern sky. I felt as though the clouds were letting me know just how diverse the desert truly was: listen New Englander…we have a different kind of beauty out here…and it’s everywhere! Which I found out quickly to be true; the desert did offer a certain mystique when compared to the dark unknown of a New England forest. In the desert, the vast emptiness invites a sort of terror informed by a naive notion of absence whereas the horror of a dark green New England forest pushes forward a notion of presence—that something lurks beyond the pines. What I saw in the clouds over there was my first true impression of a desert vivacity. It was a subtle, feigned picture of absence shrouded plainly under the glamor of an arid beige. From then on, I always made sure to look up and appreciate the clouds as we journeyed back east. I would often think about how when the clouds and I met again in Denver, that they too would be changed like me.
19. Through the eyes of a cloud I fall in love with the world.
20. The second dream—Thunder: I awoke in my bed to a thunder rocking the house and everything inside of it. As I rolled out from under my sheets, I began to assess the damage: everything in my white trapezoidal apartment was tossed around and broken. I turned to the window and saw what looked like a periwinkle sky raining down bricks—literal bricks mind you. So intense was the noise that I couldn’t hear myself think. Then the lighting struck—I paused and stood frozen. Six Mississippi later I was lifted upwards and along with the books, bedding, and minifridge flung across the room. When I finally caught my breath to stand, I could only feel a deep throbbing pain throughout my body. Then with what energy I had, I rushed out the door. I saw that my roommate wasn't across the hall and booked it to the stairs. I didn’t know when the next lighting strike would happen and I knew if I was caught on the staircase when it happened it could, it would, be even more painful. So, I did what any reasonable person would do, I ran. Then with my left foot hitting the third step I froze at the white flash coming through the windows below me; it was six Mississippi last time so I should be good if I—suddenly my face flung forward into the wall overlooking the landing swiftly followed by my slamming into the floor. Once I had recuperated, I managed to at last roll down the remaining few steps to the ground floor. Resting on my belly, I used up what little energy I had left to roll over onto my back. I opened my eyes to the ceiling above—periwinkle, huh…I thought it was white.
21. It was the middle of Block C, and I was sweltering in the basement of South Park for my first clinic shift. Nobody had shown up beside the pharmacy students, me, the manager, the family med physician, and Colin, who we recruited from resident education to help. There was a certain fear and trembling about me, it being my first time there, mostly regarding what to expect. And oh boy, did I not expect the air conditioner to be broken! The first patient I saw was a wonderful lady who needed some ibuprofen, and who did not want to be examined. After some brief negotiation, with help from the physician, I examined her and sent her off with the meds. Next came a tall, silent man, who needed some antifungal cream for their athlete's foot—feet. He was much less opposed to an exam because after a thorough glance at the thick white fungus between his toes, sent him off with his cream. By this point I had lost what felt like 10 pounds of water weight. The next patient who walked in was a quiet, sincere appearing man in a dark blue suit. He carried with him this clear blue box of meds and immediately began sharing his predicament. He started off by telling me about his immigration from Africa, and how he had ended up in Hartford of all places. He continued, finally informing me that he had been hit in the face, out of the blue, by someone and just needed another look. Shocked, I followed up about any police response and he nodded affirmatively, informing me that he did everything he was supposed to do in the situation. I nodded back and set off examining his face. As I examined his lips and eyes I inquired if he was from his country’s capital, to which his face immediately lit up. What do you know about that place? I shook my head, I know ‘of it’, but not much more than that. I quickly took my gloves off and exited the small, sweltering exam room to report back. However, upon my brief exit I witnessed our genial family physician sweating to Colin about having to potentially call an ambulance for their patient; I slinked back into my room. Once inside, the kind man started telling me all about his home country, and the struggles he faced during the civil war there. I remember a sad sort of stirring inside me when he told me about his physician uncle who was killed during the conflict—he told me how much he respected physicians because of him. Then after some time our sweaty family med physician was finally briefed, examined my patient, and sent him off with a firm sweaty handshake.
22. I long to be a pebble on the surface of your sun.
23. Translated literally from Greek, amaurosis fugax means “fleeting dark”—medically it means a transient loss of monocular or binocular vision. Oftentimes it’s described as a black curtain descending from above as if closing out a show. Currently the curtain clings draped over eyes, over a body, over a heart transformed from a museum into a crypt—sat still, time marches forward with a pace too fast for appreciation. I won’t be seeing many of my classmates again for weeks, and after that months even. It saddens me. It leaves me empty. And for a few months until today, the curtain felt as close to ascending as ever, yet there is still loss of a vision and what feels like a loss of a direction; yet there is still a faint feeling of hope. Only time will tell. The curtain descends. The curtain descends with such abruptness that it rattles my body and leaves me wondering why. The curtain descends and the light I saw at the end of the tunnel shrouds itself away in ephemeral glamor. The curtain descends and I’m left blind again to my surroundings. The curtain descends and I am lost. The curtain descends and I stop eating meals. The curtain descends and classes become harder—speech difficult. The curtain descends and I blindly self-exile. The curtain descends and time freezes against me. The curtain descends…but not for long. The curtain ascends. As the curtain ascends, the days will get brighter, the summer heat won’t engulf you but kiss you in the mornings—kiss you at night too if you’re lucky. As the curtain ascends, you’ll be able to see again, sharper, and more confident. As the curtain ascends, you’ll begin to appreciate those awkward conversations and missed opportunities. As the curtain ascends, time will melt more when you laugh with friends. As the curtain ascends, you’ll meet new people and craft beautiful new relationships. As the curtain ascends, you’ll mature and be aware of your limits. As the curtain ascends, you’ll finally be able to cry a sweetness that hugs the lips. As the curtain ascends, you will be loved.
24. Everything that once was solid will one day dissolve into the wind
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