Monthly Archives: June 2023

Bones on the Trail

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Each year, July 1st is the infamous day when new doctors who just graduated from medical school (called “interns”) start taking care of patients for the first time as physicians. This year I’m among these new doctors. It’ a momentous day for the interns because it’s a huge milestone and a huge transition. Some words that come to mind in anticipation of the experience are “excited,” “terrified,” “happy,” and “ready.”

I’ve been mulling over what I think about starting residency. As I’ve reflected, a story from a hike I did in New Mexico came to mind. I think it captures my mixed feelings of starting this phase of the Doctorhood Quest.

New Mexico, June, 30, 2021

My partner and I arrived at our lodging place in the late afternoon so we had just enough time for a short hike but not so much time that we could dillydally. We looked up some nearby trailheads and settled on one just down the road. We were staying in a flat valley lined by near mountains on one side and far-off mountains on the other. It was spring so even though there was no mistaking that we were deep within the New Mexico desert, the shrubs were as green as they could be. The cactuses were blooming.

We started off walking across the flat valley floor following a road through the shrubs. We stopped often to take pictures of the desert flowers that lined our path and kept a lookout for elk because there were many in the area. We laughed and joked and chatted as we often do when hiking. Our mood ranged from jolly to ecstatic. The beige and browns of the dirt and rocks contrasted against the blue sky; sage-green shrubs and cactuses; and yellows, pinks, reds, and purples of the flowers.

The road neared the bottom of the mountains and narrowed to a wide footpath. We didn’t know the trail, but we had a GPS map and a general sense of the trail’s course. We were timing ourselves to ensure we turned around with time to get back to our car before complete darkness. We knew before starting that we wouldn’t be able summit if we wanted to be home by sunset. It was our first hike together in New Mexico, the western US states, and mountain lion country.

We wanted to have fun while also exercising caution. We’d learn later that trip exactly how scary things can be in the big mountains, but that would be a lesson learned on a different hike. We were experienced hikers, but we’d primarily hiked in New England and never in the western US (except as children under our parents’ watchful eye). The short mountains of the northeast are different beasts than the giants of the US west.

As the trail narrowed, we entered the woods and left behind the shrubs and flowers of the open desert. We soon crossed a small stream. There, on the far side of the stream was an elk carcass in the middle of the trail – it was mostly skeleton, almost picked clean. We paused and became quiet. The bones were a reminder that there were big predators in these woods. We debated if we should continue and decided we would. We stayed loud and watched our surroundings more carefully than before. We were especially attentive to our timing and made sure we got back to our car before darkness fell.

We had the skills and knowledge foundation to successfully complete the hike. The difference was the terrain and responsibility/higher stakes that came with a more complex hiking environment. Hiking in new, more intense territory isn’t such a bad analogy to becoming a resident after being a student – just like with hiking, as a resident I’ll draw on previous skills and knowledge as I take on more responsibility and learn more about my craft.

Yes, I Can

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I listened to a song about a job interview that went poorly on repeat while I struggled to complete a new workout that I’d written for myself that day. Perhaps the song about the interview resonated with me because I was in my own transition or, perhaps, I just liked the beat. The workout would have been easy for certain versions of my past self. However, recently I’d led a life that didn’t involve intense workouts like this one and, so, the workout was challenging me. “Back to the beginning,” I thought.

I couldn’t ignore the metaphor of my physical fitness and learning medicine because the parallel captured the sentiment I’d been hoping to write about as a reflection of what, exactly, medical school had been like in a broad sense. I’ve had a few months between finishing my medical school classes and starting residency. It’s been a time of celebration and doing things I didn’t have time for during school and won’t have time for during residency. I’ve also taken time to reflect on my medical school experience. “What exactly was the utility of medical school?” I’ve asked myself often during these months of the happy stillness between.

You can guess what medical school was like on a superficial level – it was school. I spent hours studying and hours listening to people instruct me on all kinds of things. I spent more hours practicing skills as varied as suturing cuts shut in the operating room to writing patient medical notes. I attended lectures, engaged in simulated patient interactions, and I worked with real patients and physicians in real hospitals and clinics. I took written exams of various lengths that were proctored by various organizations. Through these actions I learned how the body works and breaks and how we try to make bodies function better with medications and interventions like surgery.

Yet, while learning about the body and how to improve health was the backbone of my medical school learning, it wasn’t the heart of it. The heart of medical school was the exercise of continually starting at the bottom, a place of not knowing much, and climbing to some place of better understanding. Medical school is a lot like the process of doing a hard workout after not working out for a long time and being unable to finish it, then engaging in a few weeks of intent and thoughtful exercise, and finally being able to do the original workout and more.

Medical school taught me that I can learn anything with time and effort. The hardest concepts can be cracked. The first year, I struggled to understand how the body worked. The second year, I expanded my knowledge from how the body worked to how it can go wrong and what we can do about it. Then, years three and four, I learned more about how different specialties in medicine address different diseases and injuries. Each year built on the year prior and then expanded beyond what I knew to things I didn’t yet know. Each time the curriculum expanded I felt like I was starting over. Much like starting in the beginner exercise class and working my way to the advanced class…repeatedly.

I bet you’ve had the experience of riding the rollercoaster of being excellent then falling to subpar and then, through sheer will, climbing to a place of excellence again. And if you have experience doing that in any area of life, then you can imagine what medical school is like. Because it’s just like that. Every month or so you start at the bottom of one area of medicine and climb to the top just to fall again and start the process all over in a different area of medicine.

Medical school is an exercise in being mediocre with a drive to be extraordinary. Each lesson helps move your personal dial from mediocre to better, but there’s a catch. Medicine is founded in science and research and, as such, it’s forever expanding and changing as we (humans) learn more. And so, there is no possible way to ever know everything. To be a physician is to be forever learning while also mastering the knowledge that you explored before. There is no end to medicine, no time when you can’t get better.

Medical school taught me that I can learn anything while I can’t know everything. It taught me not to be intimidated by an obviously hard road, but to take it one step at a time just like I take my plank exercises after a long time not engaging my core. Medical school taught me that experts are built with time and effort. It also taught me that experts remain humble and equally aware of the things they know and the things they don’t know. Medical school taught me that I can do whatever it is I choose to do if I’m willing to put in the effort. The heart of medical school for me was learning that when faced with a challenge to think “yes, I can” instead of “maybe it’ll work out.”

They Said It Would Change Me Forever: Now Almost 10 Years Later

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I recently returned to Paraguay after 5 years away – COVID delayed my return. It’s the third time I’ve been back since finishing my Peace Corps service there. I also realized during the trip that 2024 will mark my 10-year anniversary of first arriving in Paraguay as a just-starting, excited, and (yet) terrified volunteer. What I remember most about the pre-departure materials and pre-departure orientation speakers for the Peace Corps is how often they said that my service would change me forever.  At that time, I thought their message was a bit sentimental and dramatic.

It would take 27 months for me to understand how right they were – aka it took exactly the duration of my Peace Corps service. I remember returning to the US after more than 2 years away and realizing that the person who lived in the US before (pre-Peace Corps me) didn’t exist anymore.

When I returned from Paraguay after my service, US life hit me like an overloaded moving truck. There were glorious aspects such as being able to throw toilet paper in the toilet rather than into a trash can next to it, no days without running water or power, and not having to run around to unplug everything at the start of a rainstorm in case the power surged. Yet, there were also terrible things about returning. Perhaps the worst was that I lost the community that I’d built over the years, which had become central to my life. I transitioned to a cold region of the US where few people spoke Spanish – two things that made me sad because I find joy in the sun (and its warmth) and the interesting way that Spanish captures our thoughts.

Now having had a decade to think about my Paraguayan self and my US self, I’ve come to understand how the Peace Corps in Paraguay changed me. Thinking about it, I’m not remorseful if I sound a bit sentimental and dramatic because, perhaps, I’m appropriately both of those things.

Having just graduated medical school I can say with a certain amount of pride that my Peace Corps service remains the hardest experience of my life as well as the period where I learned the most (more reflection on my medical school experience to come in future blog posts). This may be because my Peace Corps service came first so I applied what I learned from it to my medical school experience, but I suspect that the challenge the Peace Corps poses is unique and may still have outcompeted medical school even if it came second.

I should clarify that hard doesn’t mean miserable. By “hard” I mean an experience that pushed me to problem solve frequently and on the fly, find new ways to tackle obstacles because every known way didn’t work when I applied it, challenged me to revise and revisit ideas, placed me face-to-face with my own preconceived notions so that I could consider how they may not be absolute truths, forced me to define my values, and required me to look inward both to reflect and to find strength.

When I say “learned the most” I don’t mean I sat and studied all day (I did do that sometimes in medical school though). What I mean is that finding a way to navigate two second languages (Spanish and Guaraní) and to operate in a culture that wasn’t my own required unlearning, relearning, and new learning behavior, vocabulary, customs, traditions, and systems that may have been similar or completely different form my native equivalent and may (or may not) have been in line with my belief system.  

The Peace Corps in Paraguay stretched me to look at things differently. It forced me to decide what parts of myself I was willing to give up to assimilate into Paraguayan culture and what parts I would keep even if they accentuated my otherness. Living in Paraguay was a give and take between, on one hand, being open to new ideas and experiences that required flexibility because often situations were unpredictable or not completely understood and, on the other hand, defense of individual needs and goals that did not fit nicely into Paraguayan life.

The experience of navigating conflicting parts of daily life in Paraguay and shifting self are what changed me so much during my Peace Corps service. It showed me that I have multiple identities that come together to form me and how the pecking order of those identities shifts depending on the situation and the activity I’m doing. Also, the amount of self-reflection I engaged in during the Peace Corps (both as a factor of my strange schedule there and as a byproduct of living in a different culture) is what made me who I am today. No time before or after the Peace Corps (so far anyway) has given me so much time to look inward and examine who I am and how that relates to who I hope to be.

When I returned to Paraguay after 5 years away, I was struck by how much I’ve grown since I finished the Peace Corps (and last visited Paraguay). I was surprised and content that who I am today (a doctor about to start residency) is still grounded in the self I created in Paraguay starting now almost a decade ago. When they said my Peace Corps service would change me forever, they undersold exactly how much. Even now, having done and achieved many things since returning to the US, I find my mind drifting back to those days in the land of the Guaraní as a volunteer and falling back on the strategies of perseverance I developed then to help me through rough patches now. These days, I remain skeptical when someone tells me that something will change me, but I also remain humble and open to the possibility because Paraguay taught me that one experience has the capacity to change everything.