The sun sparkles in my windows and alights on the forest of plants I nurture in my apartment. I’m recovering from a whirlwind trip to Oregon to celebrate the wedding of a long-time, dear friend. I stepped away from reading about acid-base disorders, electrolyte abnormalities, and the general unruliness of the kidney to write this post. Residency programs started reviewing applications yesterday; I wait for interview invites to trickle in. By this time next year, I’ll be in the throes of residency and I’m sure medical school will feel like a distant memory. But today, a few days before my 33rd birthday, I’m still in medical school.

Looking at the blue sky and the trees with leaves that are turning red, orange, and yellow, I’m reminded of the mountains that are hidden beyond the horizon of buildings that I see. The mountains are quiet from a distance, but hum with streams, wind, and birds when I embark on their paths. I’ve done 57 hikes (not all in the mountains and some trotting more than walking) since my last birthday.

This has been a long year filled with joy and determination. The number of hikes I’ve done reflects finding a balance between those two forces. Medicine consumes. Yet, since starting my last academic year of medical school, the harrowing nature of academia has dampened and the delight of caring for patients, solving medical mysteries, and contriving medical plans have returned to my lived experience. As I begin my residency interview season, I find myself thinking about life beyond school again. It’s a relief to be nearing graduation.

This year marked a big change; I got married. It’s interesting to shift from plotting my activities and setting goals to stepping back and thinking about sharing my life’s journey with another person who has their own activities and goals. To balance the individuals and the team who form a marriage is a daily endeavor. Of course, my partner and I have been unified for some time now, but something about making our union official and forever makes our collaboration seem more central to daily life.

Birthdays are my favorite time for reflection because they mark my personal new year. I looked back at the previous birthdays I’ve written about – 30 (happy and grateful), 28 (excited), 26 (seize the moment), and 25 (goal oriented). Thinking about their themes, what’s this birthday about?

When I walk along a ridge gazing out at the sky on either side or down a woodland path, I find myself quiet. Quiet in the sense of calm and content and, also, in the literal sense that there is less noise in the natural world than in the cityscape. I hope to hold the quiet I find on the hiking trail in my soul no matter what activity I’m undertaking. The hospital bustles with a din and the street outside my window screams with activity. Yet, I believe coexistence of noise without and quiet within can always be achieved; the way, however, seems as varied as the trails I’ve explored this year. Varied by person and varied by situation.

It’s fitting to focus on quiet movement as I wait to start a new life chapter, the chapter where I close the door to official school (potentially and likely forever) and open the door to learning from a new job. I love new chapters with that accentuated first letter, hopefully a quote, the foreshadowing of the chapter that just ended, and the delights hidden behind crisp pages. I can’t wait to see what this palindrome year brings. At the very least, I know it will bring change, for which, I’m grateful.