Onto the Next Adventure

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It’s been a few months since I wrote. The time passed quickly for me. On June 30, 2026, I finished internal medicine residency. Earlier this month, I took my internal medicine board exam (national exam proving what I learned during residency). Finishing residency and taking my board exam marked the end of the #DoctorhoodQuest. The Doctorhood Quest was a 10-year journey starting with pre-medical classes, then medical school, and (lastly) residency and my national board exam. In those 10 years, I worked with 100s of doctors, 100s of patients, and did 1000s of exam/practice exam questions. Next up, the #DoctorTrail. In just a week, I begin my first job as an independent doctor. I’ll be a primary care physician in the Richmond, VA area.

I thought about writing often as the past few months passed; yet I needed to get through the end of the quest before I could share my thoughts. The day I turned in my residency badge and walked out of the hospital where I did residency was like the day I finished my Peace Corps service and I got on a plane to return to the US after years living in Paraguay. One door closed forever while another actively sprung open. My emotions were a mix of pride, excitement, nervousness, and hope.

Every doctor has their own reason for starting the Doctorhood Quest. Mine wasn’t because I wanted to go to medical school or do residency. Despite the amazing people I met and the unprecedented amount of knowledge I gathered during my years of doctor training, the journey was long and mostly unpleasant. I started the Doctorhood Quest for this new phase: to be a doctor. Being a doctor captivated me because of the opportunity to positively influence others’ lives and change the world with one micro-action at a time. I’m also excited to be a doctor because no other profession I know of holds my attention as well as the ever-changing world of medical science. Today, and until I retire, I am on the #DoctorTrail. I’m not sure what that trail will be like. I imagine that it’ll be steep and harrowing at points. At other times stunning. And at others it might be boring. Just like the 100s of miles I’ve hiked in my free time, no two miles will be the same.

My residency program had us write a letter to ourselves a few days before we officially started our resident duties. The program director gave us the letters at graduation. We often think about the expertise of doctors. Yet, it’s important to remember the human side of doctors too. So, here’s the letter I wrote before I launched residency. The advice I gave myself then holds true now as I prepare to start the latest adventure: primary care physician.

June 29, 2023

Dear Future Self,

You start on the wards* as an intern** in 2 days. You’re a mix of nervous, excited, happy, and terrified. Despite the mix of emotions, the overall mood governing these days of anticipation is positive. You’re looking forward to gaining the confidence, knowledge, and experience to manage most patients on your own. You’re looking forward to belonging to a team, being part of a community, getting paid, and having ownership of your work. You’re worried about balancing the long work hours of residency with the rest of your life. Especially because “the rest” involves so much and is central to who you are – exercise, writing, David, food, travel, friends, art, and the natural world to name a few things that make up “the rest.”

It’s hard to give your future self advice. I’ll just tell you some things that seem important as I write this and that I hope you remember.

  • I hope you keep with you, at the core of your work, how much you love patients, their families, and their stories.
  • I hope you remember the joy that comes with working in a team when each member bothers to care.
  • I hope you remember your love of balance.
  • I hope you remember how brave you already are.
  • I hope you remember that calmness is the best place to start, even in the worst situations.

I can’t wait to see what you accomplish by the time you read this.

Stay strong,

Jett

As I say goodbye to the #DoctorhoodQuest and begin the #DoctorTrail, I’m reassured that I accomplished the goals related to learning that I set out for myself at the beginning of residency. Of course, there is always more to learn. The endless potential for growth is an important reason for why I entered medicine. The trail will be challenging as I settle into my new role as an independent physician. But I know that I’m ready. I find myself happy and excited. I remember why I’m here and what’s important. My trail shoes are tied. My pack is full. I’m stoked for the adventure that awaits on the Doctor Trail.

*Wards = hospital unit where a team of physician cares for a specific group of patients

**Intern = first year resident

Dr. House (from the TV show) Is Fictional

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The patient had an extensive workup. The imaging, labs, and other studies were resoundingly negative and reassuring. The patient’s symptom of concern was a real experience yet, having no identifiable cause, it could not be treated with modern medicine. The negative workup and their medical stability indicated that the patient should return home because the hospital had nothing to offer them. Further, their life was thankfully not in danger from a medical problem. Of course, they needed to follow up with their long-term providers like their primary care physician and outpatient specialists.

We discharged the patient. The patient appealed the discharge. That gave them several extra days in the hospital. Days where we did nothing for them because there was nothing for us to do. Right before their appeal was denied and they left the hospital, the patient stated, “We’ve gone to so many hospitals about this issue. No one has found anything. We thought you would be like Dr. House from TV and figure out what is going on.”

Popular TV shows about medicine like Dr. House and Grey’s Anatomy are undoubtably enjoyable to watch. Yet, as riveting as they may be, they are fiction. They are neither scientifically accurate regarding disease states and medical treatments nor are they real representations of any role in medicine from doctor to nurse or patient to family member in the hospital.

Medicine is constantly changing and advancing. We do incredible things. We can put new livers, hearts, lungs, and kidneys in people thereby giving them years to live. Before we could transplant organs, people simply died when their heart or liver failed. We can restart people’s hearts, put them on breathing machines for short periods while their bodies fight severe illness, and use machines to do the work of kidneys (that’s what dialysis is). We have medications that can lower people’s risk of heart attack and stroke. And that’s just the tip of the iceberg in terms of what medicine can do. But as much as medicine can do, it has real limitations. And while we can answer many questions, we also leave many questions unanswered.

As a physician I love solving mysteries and helping people feel better. Several of the hardest things to learn when I started the Doctorhood Quest were that not all mysteries have answers, not all symptoms have a well-defined cause, and not every discomfort a person experiences can or should be treated with medications or interventions. My job as a physician is to investigate symptoms thoroughly for causes that I can treat, ensure people’s lives are not in danger from a medical condition that I can intervene on, and offer symptom relief if it’s available and if the benefit of treatment outweighs the risks of treatment.

Not every symptom has a clear-cut cause. A runny nose might be from a virus we can’t test for. It might be from allergies. Aches and pains might just be explained by normal life, or they might be a sign of something treatable or serious. Minor lab abnormalities might be nothing or might be the beginning of something – if the subsequent workup is negative, they’re likely nothing. The list goes on.

I think it would be cool to solve medical problems with the flair that Dr. House on TV does. He’s portrayed as brilliant – all of us in medicine aspire to be geniuses. But when I think of Dr. House, I recall that he is incredibly rude to patients. These days, patients don’t put up with that kind of treatment (and they shouldn’t either). When I think of Dr. House, I recall how many scenes show him misusing drugs right before work. In real life, that behavior would lead to him losing his medical license. When I think of Dr. House, I think of how poorly he treats fellow. Physicians who treat fellows like that get negative evaluations and are encouraged to change or not teach. Dr. House is a fictional character. Medicine, conversely, is incredibly real. As much as I wish real-life medicine could solve everything fiction can solve, we can’t. Sometimes, when the tests are negative and a patient’s condition is stable, it’s best for a patient to accept medicine can’t answer their question or cure their challenge. It’s incredibly dissatisfying. But, sometimes, medicine has nothing to offer, and no additional testing will change that.

Goodbye Medicine Wards

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If a person is admitted to the hospital for any reason other than surgery (or illness requiring critical care) then they likely end up on a medicine hospital ward. General medicine wards are run by internal medicine physicians. Since internal medicine is my residency path, I’ve spent close to 50% of my time in residency on general medicine wards.

Recently, I finished my last shift on the medicine wards…possibly forever. As a primary care physician, I won’t work in the hospital. There are things I’ll miss about inpatient medicine – like the fast pace and the medical surprises. But, mostly, I’m glad to be done.

On the medicine wards I enjoyed investigating acute illnesses and how to help people feel better. I liked the pressure of trying to solve medical problems and overcome challenges efficiently. I enjoyed the variety of pathology. On the wards I’ve seen my share of rare and unusual cases. Moreover, after years on the wards, I’m comfortable managing the common medical conditions that bring patients to the hospital from infections to heart failure exacerbations and abdominal pain to new confusion. Being comfortable makes me confident that it’s time for the next phase of my career.

The art of preventing medical conditions in the first place (preventative medicine) and managing conditions before they require hospitalization is different than the art of treating acute illness requiring hospitalization. I look forward to shifting to 100% preventative medicine and management of chronic health challenges. I can’t wait to get to know my patients over years in my clinic rather than only briefly during a terrible time of their life (like when they’re admitted to the hospital).

I felt a pang of sadness as the medicine ward doors closed behind me after my last shift there. But the sadness was brief. Hospitals will be there if my career takes an unexpected turn and takes me back inpatient. Until then, I’m thrilled for clinic life.

Goodbye medicine wards – to the excitement and the headache. To the physicians who remain on the medicine wards, I know you’ll take good care of my patients when they’re admitted. Please send them back to me in clinic without too many changes to their outpatient blood pressure medications. Leave the chronic medication tinkering to me.

Spring Ponderings

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Springtime has arrived in Richmond with flowers galore and the tiniest of new leaves already on the trees. Warm weather and the sunshine return to Virginia sooner than Vermont, which is one reason I moved here. While the earth is waking up – the birds singing and soaring and the pollen exploding – I find myself taking a breath of relief.

Even in Virginia the winters are gray. This year we had a period of fierce snow and ice for the first time since I moved south. I’m excited to see the osprey on the James River again. They’ll stay for the summer. Their chicks will be visible soon in their nests; they look like little dragons until they grow true feathers. I never thought I’d live in a city that had osprey screaming overhead, but I’m happy I do. I also look forward to scouting for native passion fruit and pawpaws this summer. And, of course, looking for bats overhead at dusk in the downtown park. There’s something joyful about nature finding a way to thrive in the heart of a city.

I embrace spring cleaning. The literal interpretation – organizing the house, rearranging the plants, reviewing my wardrobe. And the metaphorical one – brushing away the cobwebs that settled around my innovation and motivation when sunshine was scarce. This is a more exciting spring than usual. April 1st marked 90 days left of residency. This spring I’m reflecting on what I’ve done these past 3 years of residency and what needs to change once I graduate.

Becoming a doctor is a sacrifice. It takes years of dedication, intentional work, and intense focus. I’ve found that the most challenging part about the journey through medical school and residency is that the process limits one’s freedom. Freedom to choose one’s schedule. Freedom to choose one’s location of work. Freedom to decide how to spend one’s day. Freedom to have energy and time to do other things.

This spring I’m preparing for my next step in the doctorhood quest – passing my board exams and starting to work independently. I’m also taking time to look at the other parts of my life. It’s time to remember my hobbies – the ones that have been sitting dormant for years as there was no time to pursue them. My other goals like personal health, social activities, and world improvement that have all atrophied during residency. This spring isn’t just when the earth rejuvenates, it’s the spring I rejuvenate too.

2026 Is My Year

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“Hope” is the thing with feathers

By Emily Dickinson

“Hope” is the thing with feathers –

That perches in the soul –

And sings the tune without the words –

And never stops – at all –

And sweetest – in the Gale – is heard –

And sore must be the storm –

That could abash the little Bird

That kept so many warm –

I’ve heard it in the chillest land –

And on the strangest Sea –

Yet – never – in Extremity,

It asked a crumb – of me.

***

I’ve waited so long for 2026. This year, I graduate residency! It’s only taken 9 years of medical training.

In January 2026…well also February and now most of March… I was busy working long shifts in the hospital, drafting a novel, and waiting for the sunshine to bring us spring. I also adventured through some of the eastern US’s fabulous swamps. A tour I called “swampin’.” So, though conceived months ago and already implemented, just past the first day of spring is the time to share my themes for 2026. It’s a big year. The first half is dedicated to the end of residency. The second half will be my first months as an attending physician.

Hope

This is my central theme for 2026. My last day of residency is June 30, 2026. I have so much hope. Hope about what I’ll learn between now and then. Hope of passing my boards. Hope about settling into my new life as an independent primary care physician. Hope for the nature of my life when I no longer have a residency schedule. Hope for all the things I’ll accomplish outside of medicine.

Growth

As I finish up residency, I’m among the most experienced residents. As a senior resident, I help junior residents and medical students learn what previous senior residents taught me. Yet, come July 1st, I’ll drop from the most experienced resident to the least experienced attending physician. I can’t wait to see how much I grow when I start practicing medicine on my own.

Independence

Medicine is accumulative. Each year of medical school and residency I’ve become more confident in my knowledge. 2026 marks the beginning of practicing medicine without a supervisor (though senior physicians and colleagues will always be there to help with complex medical cases). I’m ready to see where independent medical practice brings me.

Hey, are you my doctor?

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It was the end of my inpatient hospital shift. I’d worked many days in a row and was eager to get home. It was drizzling; I walked with determination as I scurried to my car. I passed a person walking into the hospital but didn’t pay them much attention. Several steps later I heard someone call, “Hey, are you my doctor?”

I paused and turned. “Yes! I’m your primary care doctor,” I said, smiling. I recognized the patient as one I’d seen for several years. The patient was visiting a family member who was admitted. My patient and I chatted briefly before we went our separate ways. Interactions like this are why I settled on primary care as my next career step.

After I finish residency, I’ll work as a primary care physician. That’s not where I thought I’d end up. Yet, after experiencing almost every niche in internal medicine during my residency, primary care was the best fit. I like the longitudinal relationships primary care physicians have with their patients. Over the 3 years I’ve followed my panel of patients in my primary care resident clinic, I’ve learned so much about their lives. My patients and I have achieved goals and faced challenges. I’ve seen some of my patients’ health decline with age or new illness and other patients improve their health immensely. It’s been fun growing and changing together.

In residency, we spend more than half our time working in the hospital with patients who are admitted for illness that can’t be managed at home. One thing I’ve noticed is that many hospitalizations might have been avoided if patients had appropriate access to good primary care. Working in the hospital, I save lives (literally). It’s gratifying. When I work in primary care, I can shape people’s futures in subtle and positive ways. For example, if I can help a patient prevent diabetes and control their high blood pressure, they might not have a heart attack. Maybe they’ll never develop heart failure or kidney dysfunction. Maybe they’ll never need to be admitted to the hospital. The chance to help people avoid potentially threatening, serious disease is rewarding.

There are other reasons I like primary care that are more logistical. I like working only business hours, having holidays off, and having weekends off. In residency, I’ve worked every hour of every day at some point. Obviously, I don’t work 24-7. I do, as a resident, work holidays, weekends, nights, and weekdays throughout the year. I also like that one can do primary care anywhere. It’s exciting to have a job that I could do around the world, in urban or rural communities. I contrast the geographic flexibility of primary care to some medical specialties that are so specialized that physicians in those fields must be near a large academic hospital to provide treatments and interventions that aren’t available at small hospitals and clinics. For example, oncologists (cancer doctors) often must be near larger hospitals to offer many types of chemotherapy.

About a week after my encounter with my primary care patient while walking home, I was admitting a patient to the hospital from the emergency department. The patient I was admitting was in a bed next to other beds with only a curtain between them. As I was leaving that patient’s area after examining them, I heard someone call, “Doctor Jett!” I turned around to see who had called my name. A different one of my primary care clinic patients was in the bed beside the patient I was admitting. I said “hi” and wished them well. I found myself smiling again and hoping my clinic patient would get better soon even though I wasn’t involved in their hospital care.

There’s something incredibly fulfilling about being a positive force in people’s lives. Even if I’m a small force. Even if I’m limited by a broken healthcare system. Even if most of what a primary care doctor does is like saving for retirement – accumulative. The benefits often aren’t seen until years after the effort is made.

Thankful

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This post comes after a several-month blogging hiatus. The break wasn’t intentional, but life has a way of carrying us forward in unexpected ways. The past few months I continued to write, but in a different genre. I drafted several novels. I have two fantasy series that occupy my imagination currently. I’m not done with them. Novel writing is a long-term project, like most things in my life. Yet, despite stories unfinished, the flow of my days has brought me back to this blog. Afterall, the doctorhood quest isn’t over. It begs the question of whether the doctorhood quest will ever be over as there is always more to learn, but that introspection can be left to the future.

The past few months oscillated between easy schedules with plenty of time to contemplate life and my least favorite part of residency, night shift. I’m gleeful to report that I finished my last scheduled night shift of residency last week. Of course, I’m in residency. Another week or so of nights will sneak into my schedule before I graduate. Such is the way of residency, unwelcome and unfriendly work schedules. I skipped Thanksgiving because I was on night shift. I celebrated Christmas on November 30 because December is a doomsday schedule in my residency program. I wrote this blog at 3 o’clock in the morning because my sleep-wake cycle was still upset from night shift despite a week of day shifts under my belt. Schedule challenges aside, December is a month of reflection and giving thanks. I find myself in an interesting place – seeing how far I’ve come while also noticing a long road ahead.

I have 7 months left of residency. I have a job for post-graduation (more on that in a future post). I completed the administrative hoops to get official physician’s licenses. I scheduled my last exam – the board exam. Once I pass the board exam, it signals that the past 9 years of training taught me what I need to know about doctoring…at least on paper. Completing those tasks is enough to be grateful for without needing to look below the surface or consider the complexity that made them possible. But giving thanks is more than checking off one’s to-do list. So, let me dive deeper into some of the things I’m most grateful for currently.

On the top of my “thankful for” list are the countless people who helped me get to where I am. Many of these people are unnamed and their time in my life was brief. Together they made me the doctor I am. I must first give a nod of thanks to my patients. They have taught me more than they know. To be a patient is to be vulnerable, and they navigated that vulnerability with bravery. Next, I give a nod to my professors and peers in medicine. Medicine is a team sport, anyone who tells you otherwise is lying. Every day I learn something from my colleagues in medicine. Collaboration for the better good is one thing I love about the medical field. And last, but not least, I’m thankful for the friends and family who have supported me on this journey. They are the force that keeps me on the path forward. I will not imagine what this journey would have been without them. 

After the people in my life, I’m thankful for my circumstances. I’m thankful to live in the sunny city of Richmond where native passionfruit and pawpaws hide in the park. Where the river flows under and around osprey in the summer and ducks, geese, and cormorants year-round. Where snow falls occasionally in winter and daffodils bloom in February. Where cultures born of many pasts and futures come together, not always smoothly but always with hope. I’m thankful for my apartment where I can track the exact location of the sunset throughout the year – knowing the season by the building behind which the sun dives first. I’m thankful for the plants that dominate my living room. They ensure that there is no day without a flower blooming in my home. I’ve always said that I’ll know I’m rich when I can always have a fresh bouquet of flowers without concern for budget. When I thought of that definition of wealth, I didn’t realize that tending plants would make me rich faster than working. In retrospect, I should have realized that “wealth” is a nebulous term.

And finally, I’m thankful for my experience. My experiences on the doctorhood quest and in other aspects of life. I have never had a job that is as consistently rewarding and infuriating as being a physician. Most days the reward outweighs the frustration, which is why I continue to return. I had over 20 jobs before entering medical school, some were fun and others inspiring, yet I would not return to any of them. Apart from work, this year’s vacations, day trips, and glorious hours lounging I cherish. As December unfolds, I’m thinking about the experiences I’ve had and those ahead. There is never a dull moment when one accepts that the only constant is change. With the days of 2025 numbered, I’m thankful for what this year was and the hope next year holds.

Helping to Decode a New Language

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She wrote the number “8” smoothly. Months prior, it would have taken her five tries to get it. She was close to remembering all the colors of her home country’s flag. She wrote her name and birthday without issue – things she hadn’t yet learned when we started working together. Her English vocabulary was expanding. She understood simple words and phrases I said often during our classes together. Perhaps the progress was slow, but she was learning English and how to write.

For the past year I’ve taught English to a new American. I’ve taught English as a second language before, on multiple occasions, but she was my first student who couldn’t read or write. She was also my first student who couldn’t speak Spanish fluently. The lack of Spanish mattered since it was the only language I spoke other than English. She and I had no language in common, but we came together over her desire to learn English and my hope to teach her English. We came together over her desire to learn how to read and write and my belief that such knowledge is a human right.

Before she and I started working together, I’d never taught someone the alphabet or how to write. I found it interesting how her writing progressed just like children’s writing does. At first, her letters and numbers were large and sloppy. With time the shapes of the letters and numbers became more precise and smaller. At first, her spacing was off – she frequently ran out of room on our little whiteboard halfway through a word. Now, word spacing is seldom a challenge for her.

She impressed me with her focus and hard work. It was apparent she studied between our weekly classes. She studied English despite running a household and raising four children – three of whom were in middle school or younger. While helping her learn important things, like her birthday so she could fill out forms, I discovered we were born the same year.

Our life journeys have been different despite sharing a birthday year. Yet, our paths intersected over English. I wish that we could communicate better. I want to learn more about her. I want to hear her thoughts about the world. Perhaps, someday, we’ll be able to have such a conversation.

Patience with Patients

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The patient had stage 4 lung cancer which meant it was advanced. They’d already been admitted to the critical care unit (ICU) several times because they couldn’t breathe. There was one test to determine if the patient’s cancer had spread beyond their lungs pending. Given their rapid decline, I suspected that it had. The patient’s cancer doctors recommended chemotherapy. Yet, the patient wasn’t sure they wanted chemotherapy. When I saw the patient, they were taking a medicinal herb and a medication they bought online to treat parasites. They explained, not entirely incorrectly, that cancer is a parasite of sorts.

Autonomy is a guiding ethical principle in medicine which states that patients have the right to decide what happens to their bodies. I believe that autonomy is one of the most important ethical principles in medicine. I also think that it differentiates modern medicine from historical medicine. This patient’s story provides an example of autonomy in action.

On the one hand, my heart dropped upon hearing the patient’s plan. There is no research to suggest that the herb or anti-parasite medication they’d opted to take would slow or cure their cancer. There is robust evidence behind radiation, chemotherapy, and surgical treatments cancer doctors recommend to treat cancer. There was the hard truth that if this patient’s disease progressed as expected, they’d be dead within the year without science-supported treatment. There was a risk that if the patient waited too long before starting chemotherapy that they’d be too weak to survive chemotherapy treatment, making it no longer an option. On the other hand, chemotherapy is extremely hard on the body regardless of how strong a person is when they start it. And there was a chance that chemotherapy would make the patient feel terrible and fail to save their life or even prolong it.

When I saw the patient, they felt okay. They needed oxygen at night but, overall, were able to function almost normally. They’d taken steps to improve their health by decreasing the amount of alcohol they drank and the number of cigarettes they smoked. There was no research saying that the herb and anti-parasite medication they’d decided to take were harmful.

I collected my thoughts. My job as a doctor is to provide advice. My goal is to provide enough information so that patients can make their own informed decisions about their health. When I spoke, I acknowledged the dearth of research to support the over-the-counter treatments the patient had chosen for their cancer. I reinforced the truth that they had control over their body. I discussed the reasons their cancer doctor recommended certain treatments. I cautioned that there might come a time when they would be too sick to endure the treatments their cancer doctor recommended. I also reminded them that a middle ground was possible where they took the herbs and medications they chose on their own while also taking the treatments their cancer doctor recommended.

The patient decided that they would think about their options while continuing only their current home remedies. It’s seldom that there is only one right path in medicine. I felt that the patient understood enough to make their own decision. I worried about the patient, but I also knew that they were balancing all aspects of their life while I was mostly focusing on their medical conditions. I, undoubtedly, didn’t know some parts of their story. Only they could decide the best course of action for their body.

The doctors I’ve grown to respect throughout my training are the ones who have patience with patients. I strive to be that kind of doctor – one who isn’t scared to have hard conversations but is respectful of the path patients chose for themselves. In the end, the patient with lung cancer’s life was only theirs to live. I would be there to offer advice as we gathered more information and time went on. I would be there to offer an encouraging word and support. But I was not the one living in their body each day as the end of their life unfolded. Their cancer was theirs, alone, to fight. And though I was an expert advisor, their cancer battle strategy was theirs to decide.

Remarkable People

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Movement at the periphery of my vision caught my attention as I sat at a stop light on my way to work. The movement was a person standing on the sidewalk. Perhaps they were dancing in their mind. Their movements were rhythmic but not in the way most people move to a beat. Something was wrong. Then I realized they were foaming at the mouth and a string of drool hung from their chin. Their eyes were open, but I wasn’t sure they saw the world around them. The explanation didn’t take a medical degree to deduce: Drugs. Likely cocaine or another stimulant. Opiates make people sleepy, not interested in dancing on a street corner.

That day in clinic I had a new patient scheduled who hadn’t been seen by a doctor in several years. The patient was young. They had a history of substance use disorder. The last notes in our system, from several years prior, said they’d stopped using drugs. Previously, they’d used almost every class of drug: alcohol, tobacco, cocaine, benzos, and opiates. As I waited for their appointment to start, I wondered how they were doing, now years later.

The patient entered my clinic calm, clean, and collected. They were articulate and respectful. They had cool hobbies including gardening and beekeeping. “Last time you saw us, you hadn’t used drugs for a few years. Is that still the case?” I asked.

“Yeah, I don’t use drugs anymore. Haven’t for years. I still smoke cigarettes though,” the patient said.

The conversation about their health unfolded. I looked at my computer to go through the never-ending reminders the healthcare system required me to complete with my patients. The reminders for the current appointment included cancer screening and offering nasal naloxone (maybe better known by its brand name “NARCAN.” It’s a nasal spray that reverses the effects of opiates and, if given soon enough after an overdose, saves lives).

“I know you said you don’t use drugs, but I have a reminder here for naloxone. Would you like free naloxone just in case?” I asked.

“No. I’m good. I used to have it. It saved my life twice…and I saved the lives of two other people. I had a friend that said over his time, he saved 60 people with NARCAN,” the patient said.

“I’m glad you were able to do that. I’m glad you’re still with us,” I said.

I finished going through the reminders. We finished our appointment. The patient was healthy and didn’t even need any blood tests.

I thought about the patient as I walked to my car. Beekeeping is awesome. I hoped I’d get back to gardening someday too. As I put my car in reverse, I remembered the person I saw foaming at the mouth on my drive to work. The contrast between the person I saw on the street corner and my patient that day was stark. The contrast reminded me how life is nonlinear. I thought about how the patient had saved their own life and the lives of two others. The patient I’d seen was a remarkable person. The phrase popular for healthcare workers during the COVID pandemic came to mind, “Not all heroes wear capes.” I decided the phrase was accurate but needed modification. Perhaps a better phrase for remarkable people in the world is, “Not all heroes wear capes, but they have baggage and have learned to carry it with grace.”

I hoped the person I saw dancing to drugs and foaming at the mouth would turn down a different road in life. Maybe that person on the street corner would someday tend their own flowers and suck honey from honeycombs too. Maybe the person I saw on the street corner had saved a life right before I saw them. Maybe their life had been saved by an unknown remarkable person. Afterall, the only thing that makes people remarkable is what they’ve done. Every day each of us can decide to do something new. Every day we can evolve and refresh. That’s the most exciting thing about life: The only constant is change.