Holding a Brain in Your Hands

My first semester of medical school I went to the anatomy lab 2, 3, 4, sometimes more times a week. Sometimes twice a day. In our anatomy lab we were split into groups and each assigned a cadaver for dissection. Cadavers are people who donated their bodies upon death to science, we call them “donors” in our lab. The 20 donors in our lab were once 20 people who had the vision to let us, 120 aspiring doctors, disassemble the human body so that we could intimately understand how it fits together.

The idea of cutting apart a human, even if they are dead, is disgusting to most people—including all of us who showed up to anatomy lab the first day. It never got easier to dissect my donor. I spent a little bit of each hour in lab wondering who my donor had been in life and if she had any idea what happens in an anatomy lab when she decided to donate her body. Yet, now that I’m done with anatomy lab and have had months to stew on my experiences there, I can’t imagine not dissecting a cadaver as part of my training to become a physician. Let me share one, relatively low on the gruesome scale, experience to illustrate how profoundly moving and informative it was to be able to explore a human body piece-by-piece.

Toward the end our months in the anatomy lab it was time to open the skull and see the brain of our donor. Weeks before that we had dissected the spine, opening up the vertebral column so we could see what the spinal cord looked like. Each week of lab leading up to the day we opened the skull was spent tracing nerves from the spinal cord and brain to each section of the body we had examined. Nerves look like strings, specifically they look like white, cotton strings soaked in oil. We spent many hours memorizing the names of those strings (the nerves) and their paths through the body.

So, on the day we finally got to open the skull we understood how the brain was connected to every muscle and structure in the body. We knew intellectually how they were connected but, also, physically how they were connected. Our hands had followed the course of many nerves until their routes were as familiar as the path of a zipper on a favorite jacket. We could imagine the journey of the nerves through the body without seeing them. Hence, we felt ready, excited, and nervous to meet the globe that controlled it all. We were ready to see the brain.

You can hold a brain in both your hands. It fits there comfortably. It weights about 3 pounds. In other words, it’s about the size and weight of an average cantaloupe. Such an unassuming structure for the burden it carries. It is our brain, in the end, that makes each of us who we are. It shapes our personality, our feelings, and our behavior. Without our brain we simply take up space. We can’t even breathe.

When I held our donor’s brain in my hands, I knew it would be the first and last time I held a human brain. I didn’t hold it for long, but I felt its weight. Its actual weight as gravity pulled down on it, but also the weight of the life it had traveled. Whoever my donor had been in life, it was the brain in my hands that had guided her. Every person has a brain something like the one I was holding. We each have our own globe of cheese, an organ science still doesn’t know much about, that pretty much decides everything in our lives. To think, I was holding the center of human nature in my hands. The feeling isn’t something I’ll forget.

When They Told Me She Had Died

The years pass quickly. Already, Paraguay hasn’t been home for 4 years. But my mind often still wanders back to the 27 months I lived there. When I see the sun dancing in the summer I am always transported to the homes of several women who made my time in the land of the Guarani exceptional. I think of those women when I drink my mate each morning. Even when I’m excited about the amazing things I’m doing and discovering in the US, part of me longs for our quiet mornings, afternoons, and evenings together sitting under the mangos or by a wood cooking fire. Since living in Paraguay, I’m always pulled between my type-A, American self and the person I got to be in Paraguay.

A few years ago, I received a text from a Paraguayan friend telling me a tía (an aunt) had died. It took me until I visited Paraguay later that year to confirm who the friend was talking about because many people in Paraguay use many names. My friend had used a name for the tía that I did not know.

The woman who had died was a dear friend of mine. We were one of those odd pairings of a woman in her 20s and a woman in her 60s. The name I called her was Estelva. She is the quietest heroine of my Paraguayan story. She could easily be forgotten, but to leave her out of the story would be to leave a gaping pit in my journey. Today, the sun is shimmering on my living room floor and reminded me of her.

Estelva was a woman of work. She was a baker and I’d joined her many afternoons to help bake chipa, cake, and pastries. For most of my time in Paraguay, she cared for her bed-ridden husband. He was very sick. He had a lung disease from working in the quarries and perhaps other ailments. She also helped support one of her daughters and her daughter’s 3 sons. One of the 3 sons was a hard worker as was the daughter, but Estelva’s work ethic was unlike anyone I have ever seen. She’d rise early and she’d still be working when I walked home after 10pm at night. Her feet and body would ache and she would continue, hardly a word of complaint.

Estelva was a quiet woman. We’d spend many afternoons with few words. She struggled to understand my accent and I hers. We didn’t really need words. She was one of those people who could just feel what was going on. Early on in my time in Paraguay, I needed somewhere safe. Somewhere calm. Because, where I was living wasn’t any of those things. No, I wasn’t in danger…but, the first few months I lived in my Paraguayan community were hard.

Estelva had rescued a giant dog left behind by a previous Peace Corps volunteer. The dog was 4 times larger than any other dog in the town and had no business being in Paraguay, but she had rescued it anyway. She fed it well and spoke to it often. She loved that dog, just as she had loved the volunteer who left it. She would tell the dog often that her mother, the volunteer who left it, would visit them soon. That volunteer has not visited since I’ve known the community.

Often when I arrived we’d drink terere together on her patio. We’d work hours. We’d knead chipa dough, sweating from the heat that streamed in through the tin roof of the bakery. On rainy days, the tin roof was deafening as the raindrops pounded down. The walls of the bakery had recipes taped to them, written by the same volunteer who left the dog. Estelva never used nor needed those recipes. The bakery was part of a cooperative that included bakers and other crafts women like the women who wove hats, baskets, and fans from palm leaves.

Estelva ensured that I never left her home empty-handed. She’d send me with chipa or pastries we’d made. She’d send me with guava jelly she’d cooked in a huge pot over a roaring wood fire in her patio.

Many times I would sit and do the rosary with Estelva at the alter that was set up in the corner of the bakery. We were usually doing the rosary on behalf of her husband, praying for his health to improve. Sometimes when I arrived, she was dressed in her nicest shirt and we had to cancel because she was preparing to bring her husband to the hospital (a 2-plus hour bus ride) because he’d gotten worse during the night.

At the end of my time living in Paraguay, her husband died. It was both sad and a relief. Estelva’s life had centered on caring for him for many years. It’s hard to describe the toll caretaking takes on a person, especially in a place where there are no resources and in a family where all money is hard-earned and travel in the sweltering heat is by bus. I remember Estelva’s sadness during the days of prayer after her husband’s death. I also remember seeing her look rested for the first time in the weeks thereafter. She even slept in until 7am some days.

Sometimes, when we were sitting waiting for the next project, Estelva would tell a story.

On one occasion Estelva stared out across the room, glancing at me, but mostly lost in her thoughts. “The children always loved him,” she said of her husband. “He was so loving and boisterous. It was so easy for him to show love.” She paused. “I have never been that way.”

Her words settled like dust, floating on sunbeams to the floor of the bakery. Her love was a quiet, diligent one. The kind of love that makes you strong. The kind of love that if you don’t look, you’ll never notice just how big of a difference it has made in your life. She was right. Her children and community would always think of their fond memories of her husband.

But, how would I remember her? Would I remember her? I knew she was asking me those questions. And, I had known my answer long before she’d asked.

How I Came to Discover That Pronouns Are Like Ants

On my first day of medical school they handed us our badges and had a table full of pronoun ribbons (so, she/her, he/him, they/them) that we could stick to the bottom of our badges. There was a strange pressure to take the ribbons and they were briefly explained, but the whole thing felt forced, abrupt, and confusing. In those overwhelming hours of my first day of medical school, the pronoun thing felt like an attack and was unexpected. I didn’t know that several schools across the country were making moves to include pronouns in name tags and email signatures until I picked up my badge that day.

I had no interest in walking around with “she/her” pasted on my badge. Those are the pronouns I use, but why should I walk around with them on my badge? I also didn’t like the ribbons themselves. They were impractical. They stuck to the bottom of my badge, making it longer and heavier. I was concerned that this extra volume and mass would make my badge more likely to hit me in the face when I was doing compressions. Also, the fabric couldn’t be cleaned with an alcohol wipe like the rest of my plastic badge. It’s important to sanitize things in healthcare.

I decided to not add the ribbon to my badge. But, the idea of pronouns stayed with me. It bothered me. It bothered me that I was uncomfortable by the idea of wearing my pronoun. Why was it uncomfortable to me? Why had some people said we all should wear pronouns? I decided I needed to find answers to those questions.

I would come to learn that pronouns are an important topic because there are people who are either given the wrong one by society and/or who don’t identify as a he or a she and, instead, identify as a they. Using the wrong pronoun is a form of misgendering (assigning someone the wrong gender) and often can be considered a microaggression against that person. Many of the people who use “they” pronouns consider themselves nonbinary, which means that on the spectrum of male to female they don’t fall on one extreme. These groups of people, those that use pronouns that weren’t assigned to them by their parents, often endure others using the wrong pronoun. The idea behind having everyone declare their pronoun was to normalize talking about pronouns and to reduce our tendency to assume we know other people’s gender identities simply by looking at them. All the above made sense to me. I also thought we all should be able to use whatever pronoun we want. But, for some mysterious reason, I was still hesitant to add pronouns to my name badge.

I talked about the pronoun label with some friends. I talk about it with some people I love who are part of the LGBTQ+ community. I thought about the patients I had worked with when I worked in the emergency department and on the ambulance. I thought about the patients who were always called the wrong pronoun. I thought about how thankful they were when I asked about their pronoun or used the right one. I thought about how awful I felt to have someone be thankful that a did something as basic as use a pronoun correctly. Pronouns are pretty basic grammatical elements. But, of course, using the right pronoun isn’t about grammar, it’s about respecting people’s identities…but I’m getting ahead of myself.

Time went on. I put my pronouns on my badge and then I ripped them off again. I kept thinking. What kind of message would wearing a pronoun send? Could I back up and live up to that message?

For all of this year I didn’t include a pronoun on my badge or my email signature. But, my pronoun abstinence wasn’t passive. I kept thinking and observing. A resident with a pronoun pin (not a ribbon) on his badge came and talked to one of my classes. I liked the pin way more than the ribbon. My school had a guest speaker come and talk about being a trans man. His stories about navigating healthcare were unpleasant and demeaning. I’d never want similar experiences and I would never wish the emotional pain he experienced on any of my patients. Then, later in the year, I learned that someone close to me started publicly using they/them pronouns.

As I kept thinking, I realized that I’ve also spent a fair amount of time thinking about pronouns in the past. Why? Because people mess mine up all the time. Not when they see me—my born sex, presentation, gender identity, and societally assigned pronouns and gender have always matched (that means I’m cisgender)—but almost 40% of the time when correspondence is over email people get my pronoun wrong. Why? Because people don’t read carefully. My name is “Jett,” but many people read it as “Jeff.” What’s more, “Jett” is a gender-neutral name. People guess wrong often. I find it funny how many people get my gender wrong because of my name over email. It does not hurt me when people think I’m Jeff the he/him in an email. It doesn’t bother me because I know they’d correct themselves and apologize when they meet me. I know this because that has happened to me on several occasions.  

But, what if people didn’t apologize? What if people got my pronouns wrong when they talked to me, face-to-face? That is the questions I realized I needed to consider. Upon thinking, I realized I’d correct them and be annoyed. I know I am a woman. I’m proud to be a woman. Considering that I am a woman and I want others to see me as a woman too, I came to realize that it does matter to me that people use she/her pronouns when they talk about me. If everyone called me “he/him” I think it would be like a bunch of ants invading my home. One ant (one pronoun) is very little and its bite would sting but it wouldn’t cause much damage. But many ants are quite destructive and add up quickly.

If you’re like me and fit what society assigns you, you’ll never know what stress or pain it causes to be misgendered. But, I challenge you to consider how you’d feel if every time someone talked to you they called you the opposite pronoun from the one you use. That means, if you’re a she/her they called you a he/him (or vice versa). I challenge you to sit and actually think about it. How would you feel?

My last month of school this year I decided to join the pronoun presenters. I ordered she/her pins for my badge. It was $2 a pin, less than a pack of gum to fix the ribbon problem. I decided to order those pins because I know there are people out there who society continually labels with the wrong pronoun.

This country has been talking about systems used to suppress and control certain groups of people a lot lately. One of those systems is language. One of the methods to harm people is forcing them to answer to a pronoun that is not correct. I think of it this way, when someone comes to me and tells me they have a headache I do not say, “no, you have foot pain not a headache.” If I can’t know where someone hurts better than they do themselves, how can I possibly know their gender identity better than they do? How can I know better than they do their correct pronoun?

I decided to get pronouns for my badge because I work in healthcare. I think as a physician I should be a life-long learner. That doesn’t only mean I will keep up with the latest medical knowledge. It also means that I will continue to learn more about the different people who are and will be my patients. In the end, we use medicine to treat people. The key word is “people.” And the identities each person has are an important part of who they are and is, therefore, relevant to their overall health.

Now, after thinking about pronouns for a year, I still make mistakes while using they/them pronouns. I make mistakes when using pronouns that are different from what I originally assigned a person before asking what their pronouns actually are. But, I make fewer mistakes the more I practice. And I do practice. It is important to me that my patients, and anyone in my life, can be who they know they are, not who society has said they should be. So, when I wear my pronoun the message I wish to convey is that I want a society were everyone can use the pronoun that suits them whether or not it is the same pronoun their parents used for them as a baby. The idea I want to support is that each of us has to do our part to be accepting of people who are different from us. It is one thing to say that all people have a right to life, liberty, and happiness and quite another to create systems that support that and to act as if all people have those rights. Getting pronouns right is one tiny thing each of us can do to start to change our biased language system. Remember, the thing about ants is that their power comes from numbers not size.

On Love

When from out of the blanket burrito you’ve created, like extra salsa, your blue eyes emerge, blinking and dazed as if they’ve never seen light. You seem stunned as if you didn’t expect the sun to rise as it has every other day. I’m glad you’re here.

When we each sit, heads bent over our studies, the sun dancing across your hair and alighting on our plants—we created quite a jungle house when we moved in together—I smile before diving back into the world of medicine.

When you scamper away, a mountain goat of a human, taking off when you see a steep incline with rocks on the trail ahead, I chuckle. I’ll find you at the top of the pitch, eyes glistening, waiting. Maybe a kiss before we forge onward. And when we get to the summit we see the world unfold before us. Each of us thinking our own thoughts, but knowing somehow our thoughts fit together like the parts of an ice cream sundae—dazzling all on their own but grander together.

When I’m sitting on the couch, studying or writing, and you ask “Are you hungry darling?” As I light the candle for the dinner table I’m already full.

It’s those times when love seems like such an obvious thing. And, as happy as I am alone, I’m glad you decided to journey with me.

My Apples Are to His Oranges

In undergrad I worked fulltime and schooled fulltime. There were a few years where I didn’t have a day scheduled off. (I took some, of course, with unpaid vacation.) I pieced together different jobs and internships that would fit around my classes. I worked many holidays because we got time-and-half.

A large period of that time, Starbucks was my main job. I worked the opening shift because it allowed me to have most of the day to study and do internships or whatever else needed to be done. To open the store, we arrived at 5:30 am and unlocked the door at 6 am.

I eventually became a shift manager at Starbucks. That meant I oversaw the floor during my shift in addition to being a barista. It was my job to make sure everyone got breaks, money was handled correctly, and everything else that needed to happen happened.

I had one barista who was a kind guy and a good worker, I’ll call him Joe, but he used to cause me the greatest frustration. If he was scheduled to open the store with me, he almost always came late. Not a little late, but 30, 40, 60 minutes late. I couldn’t open the store until he got there, because our store policy was you need two people to open. This meant we opened late when he arrived late.

I usually asked him why he was late. The answer was usually something about the bus. Or something about the metro. And I thought I understood. Public transportation in Washington, DC is not reliable if you need to get somewhere on time. My solution was always to take a train earlier than the one scheduled to get me there on time. I wondered why Joe didn’t do that too. As it was, I got up way before 5am to get to work on time. That was after staying up until 11pm studying. I did it, he could too.

One day, I was talking to another shift manager about Joe’s tardiness. The other shift manager laughed. “Yeah, it annoys me too,” he said. “But the metro doesn’t open until 5am. There’s only one early bus he can catch. If he misses it there isn’t another one anytime soon thereafter and there isn’t an earlier one. And, if the bus runs late, he doesn’t catch the first train once the metro opens. He’ll be late if he doesn’t catch the first train. You know how the metro is.”

So, basically, Joe needed a perfect storm to get to work on time if he was scheduled to open with me. I thought about it. I didn’t know exactly where Joe lived, but if he had to take a bus to get to the metro and then take the metro he lived far away. The math didn’t add up. He was probably spending his first hour of wages on the bus and metro. The metro charged you by distance.

“So why doesn’t he move to a store closer to his house?” I asked.

The other shift manager shrugged. “There probably isn’t one.”

Starbucks was everywhere in DC at that time. In fact, I’d switched stores shortly before becoming a shift manager because I moved apartments. I switched stores because a 45-minute walk at 4-something in the morning was too much. I moved to a store that was a 15-minute walk from my house.

We’ve been talking about systems since George Floyd’s death.

The woman who ran my store was an immigrant and a brilliant businesswoman. She was supporting her kids back in her home country. She was trying to save up enough to maybe, someday, bring them here. Save up enough to give them the education and experience she wanted them to have. She was gunning for a promotion to regional manager or something like that. She was strict but she understood her employees. Joe was a good worker. She wasn’t’ going to fire him for being late. She knew that if she scheduled him for opening shift, he’d be late. She weighed her options when she made the schedule.

Every person had a story who worked in that Starbucks. And what I learned as I went, was that I had to be forgiving. I had to ask why before writing others off. I had to try to see things from their view, even though our lives were amazingly different.

The system was set up so I could live 15 minutes from where I worked.  I lived a 5-minute walk from the metro. I had multiple bus lines I could take. My life felt hard, but it was nice to know that there were lots of transportation options close to my home and I could find employment near where I lived.

When I left Starbucks, my boss asked if I wanted her to put me on temporary leave. If she did that, it would be easy to come back if I needed a job. I said “no.” I was leaving for a paid internship. The internship was a door to a job. I knew if I worked within the system, I’d get a job when I graduated that used my degree. It was a safe bet. As for Joe, he was trying to save up money to go to school. Unlike me, he didn’t have the option to take out student loans. He wanted to study, but he had to work first. The difference between us was subtle: I studied and worked around my classes while he worked and hoped to fit classes around his work.  

When the system is designed for you, you can trust that things will usually line up nicely. When the system isn’t designed for you, you find yourself working at a shift job where it costs you your first hour of wages to get there using unreliable public transportation. Think about that. Working a whole hour to just make back the money you spent on transport to get there. When the system isn’t designed for you, it’s not a safe bet or an easy decision to leave a job for education. School is important but it doesn’t pay the bills.

We all face setbacks and challenges. That’s life. But those challenges are apples to oranges when you factor in how the system is designed. Let’s move toward a time when my complaints can be compared apples to apples with Joe’s.

Tipping point?

“I’m glad they hired an American,” the woman checking out at the CVS said to me. To my right and left were my friends and colleagues working other registers. That customer had no idea where I was from or where they were from. I was the only white cashier that day.

“What is wrong?” I asked.

“He swore at me and called me slow,” my colleague said. I had served that customer 100s of times. He was rude, but he had never talked to me that way. I was white and my colleague was not.

“I told her she should pick someone else. I ask her why she couldn’t pick a lighter man, so they could have lighter babies,” my friend said to me.

“Is he white?” a friend asked when I was talking about a professor that I was struggling with because his course was unorganized. That was her second question. Her first was the professor’s name.

Above are several times when I had to think about race publicly.

  • What would you do in each scenario?
  • Have you experienced similar situations?
  • How would you approach a situation like these in the future?

The first one, in that CVS, haunts me. Why? Because I was silent. I was so surprised by the comment that I didn’t know what to say. I have often wished that I could go back and tell that woman I was not American. Just to see her reaction. I wish I had complemented my friends for their hard work in front of that woman. I wish I had said something, almost anything, to let that women know I disagreed. But wishing doesn’t change anything.

Every encounter since that one in CVS I’ve said something. My response has never been perfect. Questions and comments about race always surprise me. They shouldn’t, but they do. I review these types of interactions many times after they are done. Most of my responses were weak, but with each one I get better at saying racism is wrong. With each one, I get better saying that I do not believe people should be judged based on the color of their skin.

~

George Floyd was murdered by a cop. He died of asphyxia because a cop knelt on his neck and prevented him from breathing. George Floyd was not the first black person killed by cops. His murder was brutal but not unlike many previous violent acts against people of color in the US. After George Floyd’s murder, people took to the streets in large numbers. Cities across the US are protesting.  

We cannot know the future. But, perhaps, we can make sure that when today becomes history we are not still fighting the exact same fight. Today we find ourselves listing the names of the dead, the hurt, the pushed down because of their skin color. And though the list is too long to complete, many of us have not considered acting until now.

Why is George Floyd’s death the tipping point? Why are we acting now? Why not before? We may never know.

We may feel guilt for inaction in the past. That guilt will remain. But, let’s not feel guilty years from today because of now. Guilt does not fix problems. Actions fix problems.

The most important question each of us must ask ourselves today is: What am I going to do from this point on?

Protesting is one thing. It’s important but it will not, alone, change the status quo. We must do more.

Here are some things I’m already doing/starting. Join me. Or, make your own plan.

Immediate:

  • Protest or donate to bail out funds and organizations supporting and organizing protests.

Ongoing:

  • Vote.
  • Donate to organizations that fight for justice and equality.
  • Be an advocate, get involved in politics beyond voting. I can influence politics and our country’s laws in many ways beyond casting my vote (though that’s a good way to start).
  • Hold politicians accountable.
  • Hold friends and acquaintances accountable.
  • Reflect on my interactions with people who are different from me. Identify my biases. Make and enact a plan to be better. I will make mistakes. I will get better if I continue to push myself to see my shortcomings.
  • When I see racism call it out. Stand up for others. Take the hit. Have the hard conversation.
  • Review the systems I am part of like work and school. Is there bias? How can it be eliminated? Take action to eliminate the biases I see.
  • Push myself to learn from those who are different from me. Diversity is what makes all of us stronger. Seek it out.
  • Realize it is not good enough to be kind. Learn how to be just. Strive to be empathetic. I can not fully understand another person, but I can challenge myself to hear them and see them to the best of my ability.

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.