Joan is Okay: no POCUS

This book is a thought exploration of being a Chinese-American woman in medicine (an ICU intensivist in New York), and we read it for our Rx Reads book club. We arrived at the agreement that Joan is Okay is a book about a flat character void of much emotion and not very emotionally attached to anything. Joan comes off as stiff at times, too straightforward, and probably has a workaholism index of 101%. I do think that Weike Wang brings out a reasonable point of validating some marginal experiences and perspectives. For example, in medicine, people speak of time off and hobbies and life outside of medicine as pristine and it appears to be universally a good thing to strike a work-life balance, which generally speaking, I agree with. Especially just entering medicine, I think this new sense of prioritizing balance is something I need to intentionally ingrain, because long-term, decades of prioritizing work and only work can build up to career burn-out, and fresh, excited eyes don’t see when we enter initially.

Joan, on the other hand, is quite the opposite. Her life revolves around work. She loves work. She sees nothing wrong with that. Weike Wang writing about her in that light is unique, but also validating.

Another interesting digression is on the topic of “stiffness”. Sometimes, yes, I feel stiff in different settings, not knowing what to say, and sort of blending into the background. Like when I shadow. Joan thinks that some Asians seem stiff because of differing cultural norms and expectations, and some Asians seeming stiff does not mean all of them are, so wellness trainings lack cultural sensitivity, is a one-size-fits-all appraoch, and can be a form of institutional discrimination, which I find amusing.

Now, to pick at a few flaws in the book, first, I think there’s a large spectrum of Chinese-Americans writing literature, on this intercultural experience that we are bestowed upon to carry and share outwardly. But I think that this large spectrum encompasses a range of accuracies in portraying the culture itself, noting that Chinese culture already has diversity (see 56 officially recognized ethnic groups in China each with unique culture, traditions, language, and heritage).

Some books are spot-on in encapsulating the legacy of 5,000 years of culture and language, traditional and contemporary. However, often, there are many inaccuracies in translation that surprisingly, editors miss, or lack the acumen to discern. I think plenty of descriptions of the Chinese language and Chinese characters in this book are not entirely accurate, and the characters are broken down so rudimentarily that they seem to have a more exotic flair of symbolism over what they truly represent. I feel like Wang didn’t capture the colloquialisms just right. I’d go and reference how long Wang lived in China before moving, but I don’t want to judge the merit of her writing based on her physical circumstances, and who am I to say.

Second, I think Weike Wang has some tangential experiences with medicine and portrays it again, somewhat objectively. There are some paragraphs that I thought were funny from the view of someone being on the learner side in medicine, like this one.

In any specialty, an attending is expected to lead and guide her interns and
residents along in their careers. To become an attending, I had trained for
twelve years. The job was to teach machine readings, and a question I liked to ask was how is this patient interacting with her machine, what’s the dance there like? If a patient fought, machine and patient became dyssynchronous. If they danced, the two were synchronous. Usually, the patient fought. Our innate drives to breathe and to dance alone are strong.

I taught on average three to five hours a day; the other hours were spent
supervising. Procedures that I did in half the time pre-attending, I watched
someone else do in double. If learning required mistakes, then teaching
required watching different people make the same mistakes. Teaching was
relentless déjà vu but grounding. It cemented the idea that we are all the same — height and weight did not matter, and the possibility of failure (or success) for anyone was never too far off.

But overall, I think a lot of the essence of medicine isn’t captured in this book, from patient interactions to the “life” of medicine itself. Joan seems like a cog in the wheel, working but void of emotion.

Third, I think the pandemic takes time to process as a generation. It was something significant that happened, and we are still adjusting to it and living the remains of the day, before we process it yet again. Joan’s mother is stranded in the states and her father has passed away in China, and she was again called to work in the front lines, which she wore as a badge of honour and a relief to work again. Some significant, traumatic events can take years, or decades to process. The pandemic being a major event in the book as it happened (there is no major conflict throughout, hence no resolution), with the book being published so fervently almost in real-time leaves no time for readers’ processing and reflection. That makes it read like another chore, without novelty. There certainly are important concepts to be explored, and I am certain that the pandemic and the other forms of heartbreak and lives lost around the world as we speak will produce marvellous literature, but this slim book was published too quickly in the midst of the pandemic to conjure real reckoning. So it was a smooth swallow down.

Joan is Okay is an easy book to read, about a few important topics, but explored a little too gently and frivolously, akin to light percussion. We need the POCUS.

POCUS — Point-of-Care Ultrasound, which is a form of medical ultrasonography that is performed and interpreted by the physician at the bedside. It allows for real-time imaging of the body’s internal structures, such as organs and blood vessels, and can be used for diagnostic purposes or to guide procedures.

POCUS is often used in emergency and critical care settings due to its portability and ability to provide rapid diagnostic information.