The Last Stop on the Bus Line

I looked out the window. I’d been here before, almost 2 years previously, it was the end of the bus line. Arriving here meant I’d taken the wrong bus. There were several buses with the same number that had overlapping routes but ended in different places. The last time I’d caught this wrong bus was shortly after I moved to my Peace Corps volunteer site in Paraguay. At that time, I was still learning my community and Paraguayan culture. The first time I ended up at this bus line end, I wasn’t sure how I’d get home. The uncertainty made my heart beat faster. I asked the bus driver for directions; he had been able to help. It took several hours but I ended up home, unharmed though slightly frustrated I’d mixed up the buses.

I’d learned so much since I first visited this bus depot accidentally. Since then, Emboscada, Paraguay had become my home. Emboscada was, perhaps, the first place I’d ever lived where I was certain it was home. As the days that added up to the previous two years had unfolded, I’d found a community and made friends. I’d been a schoolteacher and connected with youth over music, English, and dreams. In my Paraguayan community, older friends had died, younger friends had married, and I’d been to parties and celebrations of every variety and magnitude you can imagine.

I looked out the window and I laughed. I was an expert, yet I still took the wrong bus and didn’t realize it until I arrived here at this bus depot. In a few short months I’d leave Paraguay. I’d say “goodbye” to the home I’d found and created. I’d return to my native country and start the Doctorhood Quest. I laughed because arriving at this bus depot wasn’t scary like it had been the first time I ended up here. I knew it would take a few hours to catch the right bus and travel to the bus stop in front of my house. I’d arrive home eventually. My little Paraguayan house would be waiting for me.

This event was about 8 years ago, yet I’ve found myself thinking about it a lot recently. I’ve been reminded of it because I recently turned a page in the Doctorhood Quest that is like what I was turning in my Peace Corps service at that time. I feel settled in my role as a resident physician. I feel comfortable with what kind of doctor I am. I am happy with what I’ve accomplished and look forward to my future goals. I had similar sentiments about my Peace Corps service while I waited for the right bus to pick me up at that last bus stop.

It might seem premature to have such contented feelings about residency. But I know that the remaining 20ish months of residency will be over soon. I have so much to learn in those remaining months. Yet I know I will learn what needs to be learned. For the first time in my journey of becoming a physician, I’m confident that I’m where I need to be. I know how to get home even when I take a wrong turn.

Being an expert isn’t about always catching the right bus, it’s about knowing how to find your way home when you catch the wrong one. It’s about being calm even when things are unexpected. It’s about embracing the journey. It’s about laughing at yourself because experiences that make you grow and challenge you also put you in ridiculous situations.

How ridiculous is it to take the wrong bus after having taken the right one 100s of times? “Quite ridiculous” is the answer. But mistakes are what make us human. We learn from mistakes, even if the lesson is simply a reminder to laugh at ourselves. Life is serious, but not so serious that we can’t appreciate its absurd moments.

Stand Up for Yourself Sister

“Stand up for yourself sister…because if you don’t stand up, no one will.” This was the theme of my thoughts as I walked home recently. I’d learned this lesson over a series of experiences, most significantly the Peace Corps and the 20ish jobs I had before medical school. It’s a skill improved with the help of pivotal women throughout my younger years who showed me how to advocate for myself (not just others). And it’s a skill I’m always improving.

Medical school forced me to practice standing up for myself over, and over, and over again. Medicine isn’t designed to be kind to its trainees. The journey to doctorhood is fraught with unpleasantries. A self-aware and self-confident person can minimize these annoyances if she chooses to face them and address them as they arise.

“Stand up for yourself sister” had popped into my mind after chatting with a younger co-resident who described several instances where she was asked to do work that wasn’t her responsibility by senior trainees and didn’t feel comfortable saying “no.” These instances were like the time in medical school when I found one of my classmates in the hospital hours after her work was done because a resident asked her to do a non-medical errand (meaning it was a personal favor and had nothing to do with the student’s learning). The student had also not felt comfortable saying “no.”

In both of the above cases, if the junior trainee has said “no” to their superiors they would have been in the right and may have prevented their time from being wasted. Further, both cases were examples of misconduct by the senior trainees as defined by the governing bodies that oversee medical trainees. Because of the hierarchy of medicine there are clear guidelines of conduct designed to protect junior trainees from abuse by senior trainees and physicians. The above cases were not reported to governing bodies.

Weird and questionable situations arise all the time. What I’ve learned is that being confident to say “no” is important. It is possible that there will be ramifications when one says “no,” but if one is in the right it is often worth the risk. Further, reporting unreasonable requests to the governing powers in our institutions is another form of self-advocacy that has the added benefit of helping to prevent others from being put in similar situations in the future. I don’t think it was coincidence that the two above examples happened to female trainees.

America calls itself “land of the free and home of the brave.” I find this tagline misleading. One reason is the different way many fractions of America raise their women and men. Even in a place that screams equality as its core value, many American sub-cultures (including my own) teach their boys to be confident, embrace conflict, ask for things, and demand better. At the same time, these sub-cultures (including my own) teach their girls to be cute, create harmony, strive for pleasantness, advocate for others (especially the weak), and be tactful. The lessons we teach girls are fine except they don’t cultivate the skills girls need to stand up for themselves the way the lessons we teach boys do.

American women from these subcultures are then at a disadvantage in many situations including when they negotiate employment contracts, ask for promotions, and define boundaries in relationships. Of course, many girls and women learn to negotiate and advocate for themselves anyway. But, what I’ve noticed, is that these skills aren’t default from culture in America like they are for men. Many of the women I know who stand up for themselves are self-learned after facing challenges or inequitable treatment next to men. A lucky subset of women are great self-advocates because other women took the time to teach them (despite American culture) in the hope of sparing them some frustration.

There are women who never find a way to feel comfortable standing up for themselves. I feel for these women because I know what it is like to be averse to conflict and scared to speak up. I know what it’s like because that is the default American subculture from which I come. But, like I told my co-resident, we can learn new skills and grow our personalities if we choose to do so.

I’m thankful I invested in cultivating my ability to self-advocate. American women are often amazing advocates for others (such as their children, their parents, their patients, their friends, and many other groups) while being uncomfortable advocating for their own needs. But, advocating for oneself is just as important as advocating for others. There is no reason to believe self-advocacy is a fixed ability or a trait only man can have. Even as I write this, I’m still not as good at self-advocacy as my husband is. Thankfully, I have many years left to practice… You better believe I’m striving for self-advocacy excellence.

35 for 35

My white hair is coming in faster than ever, but it hasn’t brightened my dark hair yet. It’s only a matter of time before the salt-and-pepper sets in – a signal to the world of the wisdom I’ve gathered. I’ll miss my dark hair when it goes, but I’ll embrace my wise look when it arrives.

When I turned 25, I posted 25 goals for 25. Below I’ve reviewed them, annotated, refreshed, and added to create a new 35 for 35 goals list.

Key:

  • Italic font: the 25 goals I had at 25-years-old
  • Crossed out: 25-years-old goal that I completed
  • Regular font: annotation
  • Bold font: my goals at 35-years-old

35 for 35, listed in no particular order:

  1. Ask for it. Done. REPLACE WITH: Finesse effective negotiation skills. Remember to apply these skills not just when negotiating for others but also when negotiating for myself.
  2. Initiate: Don’t expect someone else to do it. Done. CARRY FORWARD: Initiate: Don’t expect someone else to do it.
  3. Look for opportunities to be helpful. Done. REPLACE WITH: Advocate for underserved and marginalized populations represented within the patient population I serve.
  4. Focus on living in the moment. Note the positive things. Done. CARRY FORWARD: Live in the moment. Note the positive things.
  5. Take time to be thankful. Done. CARRY FORWARD: Take time to be thankful.
  6. Get my novel ready for review. I did this then I threw it out. I have other novel ideas for the future should I wish to pursue that kind of writing again someday. REPLACE WITH: Create a home to call my own. By age 45 that home should include a plot of land.
  7. Rock the GRE. Done plus the MCAT, all my med school exams, STEP 1, STEP 2, and STEP 3. REPLACE WITH: Pass my Internal Medicine board exam on the first try.
  8. Be diligent about journaling. I journaled throughout my time in Paraguay. I lost the habit after I returned to the US until I started residency. I’ve been journaling at least weekly almost since I started residency. UPDATE TO: Journal using daily short snippets and weekly 1-pagers.
  9. Read more. >> I read a lot of medical writing. UPDATE TO: Read more fiction and nonmedical writing.
  10. Focus on health: Eat less sugar. Control portions. >> This is still a goal and a challenge. CARRY FORWARD: Eat less sugar and control portions.
  11. Exercise every day. >> I’ve learned that exercising every day is not necessary or realistic. Exercise is, however, essential for health. Anything related to health is especially hard during residency. My current hypothesis is that residency shortens one’s life expectancy. I’m trying to dampen residency’s effect on me. I’m also trying to be healthy in general. UPDATE TO: Exercise multiple times weekly such that I feel healthy and strong.
  12. Publish consistently on Connecting the Dots. Rocking it. Hit 10 years blogging in 2023. So far, my blog has documented my entire Peace Corps service, my premedical studies and getting into medical school, medical school, and now it’s recording my thoughts as I chip away at residency. CARRY FORWARD: Publish consistently on Connecting the Dots.
  13. Learn Guaraní. >> I know some phrases, never did become fluent. Learned the important words for me. If I return to live in Paraguay I will reactivate this goal. REPLACE WITH: Stay current on the latest medical information relevant to my practice as a physician. Review uncommon and complex topics periodically to keep them on my differential and understanding.
  14. Become fluent in Castellano. >> I made great strides while in Paraguay. I’ve used so much energy to learn medicine since I returned to the US that I’ve lost some of my Spanish. UPDATE TO: Practice and study Spanish to achieve better fluency with a focus on medical Spanish.
  15. Stay in touch with my US network. Now I have an international network which evolves and changes like all living things do. REPLACE WITH: Create more opportunities to connect with family and friends.
  16. Reach out to friends in Paraguay; don’t always go it alone. Done. Remember that time I lost my key in Paraguay? I didn’t have water and needed a shower in Paraguay? Got an upset stomach and asked my Paraguayan friends for the right herb to sooth my stomach? REPLACE WITH: Get involved in several activities/organizations to diversify how I spend my time and to meet like-minded people.
  17. Hone patience. Done. REPLACE WITH: Work on calm, clarity, and patience in the setting of becoming a better teacher of medicine.
  18. Smile more. Done. REPLACE WITH: Take at least one international vacation yearly. Travel abroad as much as is possible.
  19. Learn biology, chemistry, and math. Done. I also learned medicine. REPLACE WITH: Learn to identify more local plants, trees, and birds.
  20. Make listening to podcasts part of my routine. >> I like this idea, but I don’t think it will ever happen given how I live my life. REPLACE WITH: Learn about herbal medicine and explore what role alternative medicines play in helping my patients achieve their health goals.
  21. Solidify a positive self-image. Done. Seems like forever since this was a challenge. REPLACE WITH: Push myself to learn about people who are different than me to expand my horizons and to understand others better.
  22. Listen to understand, not to respond. Done. CARRY FORWARD: Listen to understand, not to respond.
  23. Share more. Done. REPLACE WITH: Protect time to be quiet and reflect.
  24. Let the little things go. Done. CARRY FORWARD: Let the little things go.
  25. Ask more questions. Done. REPLACE WITH: Remain curious. When things become routine remember to be curious about new ways, new views, and new opportunities.
  26. Explore every national park in the US.
  27. Hike the length of Chile (chunking it is fine, though it’d be cool to do it in one go).
  28. Hike the PCT (chunking it is fine).
  29. Visit every state in the US. A visit is defined as: at least 24 hours with 3 meals, one night stay, and at least one activity other than travel.
  30. Explore every country in Central and South America that is reasonably safe for US citizens to visit.
  31. Start traveling to countries in Asia and Africa.
  32. Retrace Darwin’s path on the Beagle.
  33. Cultivate my nuclear family – which will metamorphose as time unfolds.
  34. Attain financial independence by age 55.
  35. Stay open to opportunities in my career. Push myself. Be brave enough to change and adjust as my goals and priorities evolve.