Loneliness Lab

It seems fitting to talk about loneliness now. Some things are opening but the COVID19 pandemic continues to close many social spaces and requires people to not only stay home but to physically distance themselves from those who live outside their home. It’s been interesting to watch the Facebook and Instagram evolution of my online network. The pandemic started with cutesy mask photos, ebbed into anger, and now includes random questions to spark online conversation and exercise videos.

There are those who have been gravely affected by the financial toll of losing work or of illness during COVID times. But setting more extreme circumstances aside, I’ve noticed that those who seem most impacted by social distancing are those who are very extroverted, those who live alone, and those who were lonely before the world shut down. I think for many, the slowed pace of life during a pandemic has unleashed an uncomfortable amount self-reflection. I imagine many are grappling with questions like: How do I occupy myself? And, how do I feel connected to those I care about if I can’t see them?

I think the silver lining of widespread feelings of loneliness during mandated social isolation is understanding. You or I may feel isolated today, but it took the extreme circumstances of a pandemic to get us there. Many are unluckier. They feel isolated daily, on normal days, or for long stretches of their lives. Many of those people are our family and friends. I think the pandemic has shown us that people feel loneliness at different thresholds and endure the feeling in varying ways.

We can observe the evolution of our own feelings during COVID, especially if they are new feelings, in the hope that they will provide greater insight into the feelings others in our lives may have at different times.

Thinking about my career as a physician and my role as a member of a community and family, I will always know and meet people who are lonely. I think it is easy to forget how common loneliness is. It is not something that is always worn outwardly and loudly like a football jersey. Often it is subtle. And while we might not be able to drive the loneliness someone else is feeling away, each of us can be an encouraging force for others. We can be present to listen when someone else needs to share. We can be a connection in their lives.

The nice thing about pandemics is they usually end. For many, the end of this COVID shutdown will be a return to normal. It will be easier to travel and socialize again. The feelings of isolation and stress and sadness many feel now will magically lift when social distancing is no longer required for public health. But, for those who feel isolated for other reasons, the struggle will go on. You and I should remember that. Not to be negative and pessimistic but, rather, to remain in touch with people beyond ourselves. Loneliness is a powerful force. If we are feeling it now for the first time, we should take note. We should take note so that we might be more empathetic later when we are not feeling isolated and someone in our network is.

Memory

When it doesn’t occur in an explosion, change often happens in such small increments that we don’t notice it happening. Medical school changed me in both ways. The start of school launched me into a new world of academia. I was pushed to study more efficiently and more than I ever had. I adapted to a new lifestyle. These changes were dramatic but expected. Starting a new job, which is how I view school, is usually that way. However, looking back at my first year of medical school (so far), I changed in unexpected ways that were not obvious in the moment.

Not so long ago I was learning brain anatomy. The topic was interesting and boring at the same time. The individual pieces of information were simple, however, woven together into pathways and functional groups these bits of the brain were quite complex and somewhat indeterminate. As I was considering several parts of the brain involved in forming memories, I found my mind wandering beyond the curriculum. Memory is an interesting thing.

My sister has always had a good memory. She can read a document 3 times and recite in perfectly; this worked well during her acting career. She always remembers things I’ve long forgotten from when we were kids. My memory has never been like hers. As a high school student, I thought that memory was an innate quality. I thought memory wasn’t something that could be trained and changed. I took that belief to college where I worked hard. I’ve always known that most things can be achieved if I work hard enough. Since college and until now, I haven’t thought too much about memory.

Medical school has made me reconsider memory. As I thought about the corticospinal pathway carrying motor signals from the brain and brainstem to the body and the anterolateral pathway carrying temperature and pain signals in a chain of neurons up to the brain, I realized that these things were complicated. But, they didn’t seem as complicated as they would have back in August when I started medical school.

These days, I find myself reading words I can’t pronounce and remembering them. I find myself reading dense documents about the presentation of a disease or the features of a drug and remembering more than I did when I read comparable materials in October.

As I was studying what parts of the brain are responsible for different aspects of memory—working, long-term, emotional—I realized that I have trained my memory since starting medical school. And, while my brain’s approach to remembering is still different from that of my sister’s, memory formation is dynamic. The brain is plastic just like the rest of life. Considering this, I’m curious to see how much my brain will change by the time I reach the end of medical school. Residency. And beyond. 

But, first, time to finish the last 4 weeks of my first year of medical school – hours that will be spent learning many aspects of the central nervous system beyond memory and brain structure.

When do we need heroes?

In movies and books with simple plots heroes have capes and big muscles. They drive decked-out cars and never compromise their morals. They are always good. The problem is, creatures like that don’t exist.

Heroes do exist though. They just aren’t as straight forward and flashy as blockbusters make them seem. We don’t usually notice them. As the saying goes, “A job well done goes unnoticed.”

Heroes use their precious time in selfless acts. Those acts need not be large, but sometimes are. Heroes don’t seek acknowledgement. They don’t expect thanks. They are driven by something within. They are driven by a belief that the world can be better and that helping others is worth some personal loss.

Being a hero always comes with a price. The price isn’t always steep, but sometimes it is. No one is always a hero. None of us are like superman.

Everyone has opportunities to be a hero at different points throughout their life. Those who become heroes step up and take those opportunities to help others more often than they let the opportunity go untaken. Those who can’t act on those hero opportunities aren’t bad—they’re just human.

Few can dedicate most of their time to others. Life is more complicated than that. Personal need is real. That’s why it’s amazing when someone goes out of their way to help others often. Being a hero doesn’t come with a job title. Becoming X doesn’t mean you are selfless. Becoming X may afford you more opportunity than becoming Y does to be selfless. Some jobs are centered around helping others, but only doing the job well achieves that goal. The bigger point is that we all can be heroes. Regardless of what profession we do or place we live or activities we undertake, choices are made every minute of every day in terms of how we act and treat others. What makes some people exceptional on the hero scale is how often they take a loss and lend a hand.

I think it is important to be grateful for acts of kindness and service. Not just now, but always. I also think little acts pile up. It’s worth noticing small acts just as it is worth acknowledging something large like a life saved. We can always thank those who are kind. We can always strive to be kinder. Times like these, when so many folks are sick, make it easier to notice how others are sacrificing for us or our family. But, truth be told, people are heroes every day. Just like someone could use our help always.

The circumstance of COVID19 remind us that we can make a difference in other’s lives. But, the need for heroes will not end with COVID19, just as it did not begin there. COVID19 has given us a window to view our inner strength. It has made us pause and observed those around us. I think hard times renewed our reverence for helping. Let’s keep the value of others sacred long past when the pandemic fizzles. Because, when the pandemic ends, all of life’s other troubles will continue.

The Mountains

These days between the hours of studying, the doctorhood quest unfolding slowly and quickly at the same time, I find myself hiking whenever time allows. It’s difficult to describe what I find in the forest as I climb to a mountain’s peak. Some days I go quickly, not observing the trees and moss as I forge up the trail. Other days I step slowly, methodically looking at the ferns and the rocks and the sun rays that scatter across the forest floor.

Sometimes my mind buzzes with thoughts—of friends, family, and school. Of puzzles I still have left to solve or chores that await me when I get home. But, more often as time goes, I find my mind mostly empty. An uncommon feeling in my daily life in town. As I get lost in thoughtless contemplation, the chipmunks make me smile as they scuttle around me and the grouse make me jump as they burst into flight before I see them. The sound of their wings is in stark contrast to the silent trees around me.

I stop for a sip of water partway up a steep stretch of trail. My forehead is crusted with salt from sweating. I feel my heart pounding. The wind picks up and the trees creek and groan. I look up and see their branches waving. Even a brief pause allows my breath to slow before I hoist my backpack to my shoulders again. Onward.

I’ve done enough trails to know which rocks are most likely to make me lose my footing. I avoid them. Mud jumps from the trail to my pants. The trail gets steeper and I shed a jacket layer. Once taking off the layer, I climb higher and the wind gets stronger. I put the jacket back on. It’s a dance of layers—just enough to stay warm, not so many that I roast. I sweat regardless.

As I climb the final pitch to the mountain top I have on my warmest layer—in summer just a windbreaker and in winter a hefty coat. I hike so much, there are many days when I get to the highest rock and there is no view. Clouds never did bother me, so the clearness of the day doesn’t impact my decision to take to the hills. When it is sunny and clear at the summit, the landscape around my mountain stretches away from me. I think about what all the distant hills and valleys have seen, countless stories they can’t tell me.

Some days the wind threatens to push me over as I pause at the summit. On days when I can see the mountains beyond my mountain, I ignore the wind and take time to watch the sunshine. The rolling hills and fields below are a patchwork of cloud shadows and sun patches. Beyond them are the mountains of some other state. When I hike in Vermont, the mountains beyond are always pointer than the one I climbed. The green mountains were scraped by glaciers and, therefore, have softer features than their neighbors in New York and New Hampshire.

I don’t doddle as I descend to my car. My heart is filled by the fresh air of the summit. I’m ready to return to the hustle of regular life by the time I get back to the parking lot. At the same time, as I turn my car toward home, I’m already daydreaming of my next hike. The mountains don’t let me forget them, no matter what adventures I have waiting for me in the lowlands. 

Burnout

Alarm. Study. Class. Study. Eat. Study. Bed. Alarm. Study. Class. Workout. Study. Study. Bed. Alarm…Repeat. Repeat. Repeat. Sometime in the future substitute work for class and study.

My sister and I have a term for the life leading up to burnout. We call it living like a robot. It’s a life where work and/or school consumes you and sometimes you fit in sleep and things that make you happy. Most of the time in the robot life you simply work and wish you were sleeping.

The robot life is unavoidable sometimes if you have hard goals. I have always justified it by knowing when it will end. I’ve had several bouts of that life with years of rest between. Most of my undergrad I was a robot. My two years of post-bacc, pre-med studies plus all the work piled on top were some of the worst years I’ve known. Medical school is the first time I’ve not worked as I studied since middle school. It’s nice to have one job, just medical school. But, honestly, it’s still hard.

Medicine is cursed with a heavy dose of the robot life. This is partly because physicians have peoples’ lives in their hands, so expectations are high. It is partly because the type of people who become physicians are A types and have high personal goals. It is partly because health is ubiquitous and illness unavoidable. As humans, our ability to reach our full potential is partially determined by our health. If we are in pain or ill, we can’t do all the things we would if we felt well.

Medical school and then working as a doctor are challenging because the hours can be long. They’re also draining because the work is complicated and requires focus and lots of puzzling through piles of clues to find the best answer. The pressure is high because the puzzle directly impacts a human’s life. And depending on the gravity of the puzzle, the answer might impact a whole family.

Time and intellectual challenge aren’t all that makes medicine difficult. It’s a team sport, so office politics and business relationships come into play. But even teamwork isn’t the hardest part of medicine. Medicine is an emotional job. People who come to us as patients die. They lose function. They lose the ability to lead the lives they’ve always led. There are many happy outcomes, but not all patients’ stories end with joy. The sad outcomes add up as time goes on.

My time in healthcare as an EMT showed me that no individual patient impacted me unbearably. However, there are days when I feel the weight of all the patients I’ve helped. For example, I felt heavy after the last CODE I worked before I left the ED for medical school. A CODE is when you do CPR, shock, ventilate, and take other measures to try to revive a person whose heart has stopped.

That night I closed the curtain on a 30-something-year old with a wedding ring who hadn’t been identified yet. He was dead before he arrived, but we did CPR anyway. I was one of the last to leave his room. I never leave a dead patient before ensuring they’re presentable for family. CODEs are messy. If the family isn’t there to see us work, I see no need for them to experience the mess. I knew sometime in the night his partner would learn he was dead.

Tucking in that patient right before I ended my shift was hard. The death rested on top of the morning I walked into the ED to find teens on the phone crying. They, the teens, were calling their family to tell them their mother and uncle had died. Odd to have children deliver news most adults barely can. The sadness those teens felt added to the day I cleaned two CODEd patients back-to-back so they wouldn’t be bloody and dirty when their family arrived to say goodbye. After tucking in the second of these, I walked out of the room to find a visitor approaching. I interceded and joined her, but only upon entering the room did I realize she, the daughter, didn’t know her mother was already dead.

The sad endings add up. But, so do the good journeys and happy endings. The patients who turn our days around by sharing the most amazing stories or giving advice that is perfectly wise. Days in healthcare are brightened by visitors who show raw love toward someone stuck in a hospital bed. I’ve seen true love hiding in ED rooms on multiple occasions. It was working with old couples in the ED that showed me how I’d like to age.

It’s no surprise between the stress of the job and the rigor of the schedule that doctors and medical students burn out. However, knowing our challenges gives us the knowledge we need to persevere. Even within the field of medicine there are many decisions we can make to suit our goals. It begins with specialty and is followed by location and type of hospital. We have the information we need to know how a specialty, location, specific hospital, and extra projects we take on will impact our life or encroach on free time. We can decide, within the scope of meeting our obligations, when we wish to do extra and when we wish to do the minimum. Most importantly, we know that no state is permanent unless we let it be. 

I think at the root of avoiding burnout is being honest with ourselves and checking in with ourselves. There are stretches of school and work that must be survived. The robot life must be lived sometimes. But, amidst the madness we must decide when it will end. We can choose to rein things in when needed. We can choose to prioritize family or life outside work. Of course, to do this, we must know ourselves and what makes us happy. Once we know where we find happiness we can fight for it as fiercely as we fight for our patients. In the end, if we are not well, we can’t help anyone else at the level we can when we are in good health.

People Get Sick – Some Rise and Some Fall When Faced With That Reality

As the COVID19 pandemic continues, it’s brought out the different sides of people directly and indirectly in my life. I continue to be impressed by the many folks who fearfully, yet generously, show up to work at the grocery stores, the hospitals, and the other businesses of service that we can’t live without and can’t be run remotely. I am equally surprised by those who had the opportunity to help and instead fled. Fear is powerful. It makes those who consider themselves generous selfish.

I’ve seen great efforts of humanity from handmade protective equipment to online hangouts bringing people who haven’t talked in years together. I’ve seen folks put on fitness, meditation, and medical school classes virtually—I’m amazed how much can be done over online video chat it a pinch.

I’ve also seen people lash out at people who are sick but not dying, in anger and fear. It is easy to blame those who are sick for their illness and label them as a threat but, like everything in life, it isn’t that simple. It’s worth remembering that pandemics are not the work of individuals; they are the work of collectives. What is more, viruses and other microbes are perfectly simple and wonderfully complex. Nothing made by humans can be quite as clever as they are, so no need to find human scapegoats to blame for a disease they could not have made.

The idea of not knowing if someone has an illness you can catch is scary. But, that’s the nature of many infectious diseases, not just COVID19. And while many of us born in America do not necessarily think of potentially deadly infectious diseases often, that is a luxury people in different parts of the world do not have. It helps give perspective to remember that millions of people die of infectious diarrhea and malaria, for example, each year. And their plight isn’t one the larger world community has committed to ending. It will go on…perhaps as long as humans exist.   

We are strained by social distancing today. Yet, we carry on because we have a sliver of hope that by limiting our interactions we can end COVID19. We believe that we can limit the number who die or get sick. As we hold on to these ideas, we should also remember that social distancing need not make us less compassionate for others. Protecting ourselves does not require that we compromise kindness. I would hope that we all see this time as an opportunity to discover creative ways to help those who are sick while also protecting those who aren’t yet. The infection count is not a numbers game of distant people we don’t know, it is happening right here, today, and to real people with families and a story. Just remember that those numbers you’re refreshing are humans. Don’t forget that, because if you do you just might become apathetic. We have a pandemic to end. It will take the actions of each of us to be successful. Stay engaged.

Today I’m Grateful

The past few months have a been a tornado. I’m 3 weeks out from finishing my first semester of medical school. What has “med school” meant for me so far? 4 hours or more of studying a day no matter how many hours I spend in class. Showering the formaldehyde smell out of my hair because I’ve spent hours in the cadaver lab dissecting or practicing structure identification. Discussing the ethics of assisted suicide, abortion, and patient consent. Considering how to evaluate research. Practicing physical exams and asking patients about their health.

But, even on days before an exam, when I’m exhausted and uncertain I know half of what I should, I’m excited to be doing what I do. I know how to feel a heartbeat through someone’s skin. I know how to watch a heart contracting using an ultrasound machine. I’ve held human hearts. I’ve explored their chambers and vessels. I know the path blood takes to and from the heart. I know what makes the heart beat. As the days pass, I know more and more about what makes human bodies function, how the body can break, and what we can do to fix it. For this intimate knowledge of life, I’m grateful.

These past weeks and months haven’t only been studying, despite how it feels at times. I’ve spent time with family. I’ve hiked many a mountain in both the sun, rain, light, and dark. I’ve eaten cake on mountain tops, carved jack-o-lanterns, and shared many a meal and snack with friends. I’ve walked up and down the hill from home to school while chatting with kindred spirits.

Friends new and old along with family aren’t all I’m grateful for this season. I also have a lovely home with a roommate with an eye for creating comfortable spaces where I can sip my mate peacefully. And, I have a partner who enjoys pie as much as I do. Helps keep life in order. Tells me my hair looks beautiful even when it’s greasy and fizzy (who knew hair could be both those things at the same time) and cooks me dinner so I can study.

I feel lucky this season. And, I’m grateful to have a few moments to soak in just how kind life can be. I hope your Thanksgiving is spent with people you care about or, at least, surrounded by tasty food. After all, the stomach feeds the heart. 

Goodbye 20s

Today I turn 30. I find myself in a place I didn’t dream of when I was 20. I live in a world I couldn’t have imagined when I was 10.

I’m in the throes of my first year of medical school. A whirlwind of biochemistry, anatomy, patient evaluation techniques, nerd jokes, and discussions of ethics and why access to health care is a right. But, that’s not all. This morning, I woke to the smell of cinnamon rolls and a bouquet of flowers. Since August, I didn’t just fall down the rabbit hole of medicine, but I might have fallen in love.

October last year, the last October of my 20s, I was forging through medical school applications. Diving into interviews. Wondering if any school would take me. If I was good enough. If I was going to ever be a doctor. I think the feelings I had while applying to medical school aptly summarize my 20s. The 10 years between 19 and 30, I spent self-doubting, reflecting, and growing. The doubt is largely gone now—for that, I’m stoked. My personality won’t allow me to stop reflecting and attempting to be a better, even as I race toward being old, and I think that’s good.

This October comes with its own challenges and misgivings, but there is something surprisingly settling about 30. It helps that a weight lifted when I started school. And though I spend hours daily learning 3-4 letter acronyms that stand for proteins that stand for whole signaling pathways that keep you alive when they work and make you sick when they go wrong, I’m happy underneath it all. I’m happy because I’m exactly where I hoped I would be last year. I’m happy because where I am feels right. It is not often that life follows the course of my plan, so this birthday I’d like to take a moment to celebrate just being here.

Today, I’m grateful for all the people who make me feel loved. I’m grateful for the friends who are there when I need them and who share my joyous moments, who share my love for jokes only a health science dweeb can begin to find funny, and who listen patiently to the latest episode in the chronicles of kombucha making. I’m grateful for the people who have supported me, helped me learn, and pushed me to think differently and be better.

With the joy of being here in mind, bring it on 30. I’m ready for a new decade.

Last Day in the Emergency Department (for Now)

July 25 was my last shift at the emergency department (ED) as an EMT. It’s hard to believe in a few short weeks I’ll start medical school, and my time as an emergency medical technician will be filed away as part of history. Becoming an EMT challenged me and made me face personal fears. The uncertainty I had when I first embarked seems comical now that I have those years of patient care under my belt.

I couldn’t be more excited (and nervous) to start training to be a medical doctor. But, leaving the ED was bitter-sweet. I’ll miss my crew—the ED is filled with dedicated people focused on improving their patients’ lives. If every team I work on is like mine was in the ED, then my career as a doctor will pass quickly and happily. What also makes me sad to leave the job and start school is that I won’t have many opportunities to work directly with patients for a few years. The first two years of medical school emphasize learning all the facts you need to know to be a doctor and, in years 3 and 4, you start applying that knowledge in real health care settings. I got into healthcare because I want to help people. I find learning thrilling, but my motivation comes from the practical applications of the knowledge I gain. I can’t wait until I am back in the trenches seeing patients and trying to solve real health mysteries.

I became an EMT because it was the fastest certification that would allow me to work directly with patients in a way that required me to assess their signs and symptoms and then make clinical judgements. Becoming a doctor will give me a lot more knowledge and a much bigger toolkit to help my patients than I have now. But no matter where I end up in healthcare, I won’t forget from where I came. As an EMT, I learned to identify a sick human in a split second. I learned how to ask for people’s health stories and focus on the information I needed to help them. I saw firsthand how excellent patient outcomes are the result of teamwork (between all players not just the docs) and that poor communication leads to worse results. I hope these lessons stay fresh as I cram new ones into my brain.

True Love

Not so long ago in the ED, I was helping a patient in one of the acute care beds. Through the curtain that divided the room I was in from the next patient room, I heard someone reading out loud. Where the reading was coming from, a post-retirement man was the patient and his wife was with him.

I saw through a gap in the curtain that the wife was happily reading a book to her husband. Her voice rose and fell with the emphasis of someone who had read aloud many times. Her voice mixed with the sound of her husband’s snoring. When she stopped reading, he stopped snoring and became restless. Sometimes she paused and looked at him. She’d smile and then continue reading before he fully awoke.

The sleeping husband and reading wife seemed so content and peaceful despite being in the middle of the ED on a day when people around them were having their worst days. The husband could have been very sick too but, unlike many of our patients waiting to be seen, he wasn’t sitting alone staring into space as he waited.

That woman reading to her husband was the clearest example I’d seen of true love in months. We see a lot of couples and families come through the ED every day. Accompanying a sick loved one often brings out the caring side of people, however there was something about the calm, closeness of those two (sleeping and reading) that highlighted the strength of their connection. I was reminded, for the millionth time, that it’s the little things that add up to indomitable forces.