Monthly Archives: May 2025

The Tired Mind

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The foundation of medicine is curiosity. Desire to understand how the human body works – how those workings can break and malfunction and then, how they can be fixed again. Interest in the human experience. Wonder about how the mind can influence the physical. Joy in the triumphs of human capabilities. Humility in the shadow of human limitations. Thrill in the story of each human life. Medicine is built on questions and the pursuit of their answers.

At its best medicine is cutting-edge. Exciting. Grounded in the clearest understanding of the world the best science has thus far provided us. Yet, medicine isn’t always at its best. Medicine, after all, is a profession performed by humans. And humans are fallible. Medicine doesn’t stand above or beyond bias and money. And physicians, like all human beings, get tired.

The tired mind is a weak medicine mind. The tired mind processes slowly. The facts stand right in front of a tired mind, yet the mind is too weary to see them. The tired mind makes mistakes. Rushes when it shouldn’t. Forgets. Gets distracted by unimportant details. The tired mind is more likely to cut corners. Tired minds place patients in boxes of diseases rather than notice the nuances that make each patient unique. The tired mind is about clocking in and clocking out. The tired mind doesn’t ask questions. Because questions must be answered. And answering questions takes time. The tired mind has used up its time.

I think about the mind often at the wee hours of the morning on nightshifts or when my dayshifts drag on in a string of events. Not necessarily unfortunate events but overlapping and clashing events that make up a typical day in medicine. As shifts pile on top of each other, the events of each shift blend creating fog within the mind.

I know when my mind is tired because medicine isn’t interesting during those times. When my mind is tired the wonder of medicine evaporates. The wonder is replaced with drudgery as many tasks become repetitive and the clock ticks. When fatigue prevails, work hours are reduced to time that feels stolen. Stolen in the sense that work hours become hours I can’t sleep, can’t see the sun, can’t visit people I love, and can’t do hobbies I enjoy. When my mind is tired work hours are exposed as time spent looking at numbers that almost tell the story of human existence. I know that life is more than the sum of the numbers that describe it but, when I’m tired, I can almost believe life is no more than numbers.

When my schedule eases and balance between work and free time is restored, the wonder of medicine returns. The thrill of seeking the answers to mysterious questions – the function of medications, the disease behind a constellation of symptoms, and the life experience that led a patient to the hospital or my clinic – takes center stage again. When there is balance and my mind isn’t tired, medicine is thrilling. Thrilling because few other professions let one spend their day unraveling mysteries. Hearing the stories of real humans and decoding what those stories mean from a wellness and health perspective.

As my days as a resident dwindle, I find myself thinking about what it will take to minimize the tired mind and maximize curiosity during the next phase of my career. It was my love of stories and my delight in solving riddles that carried me through the 8 years of medical training I’ve already completed on the doctorhood quest. One more year and I’ll be an independently practicing physician. Even if I’m called to do more training, no future training will be like medical school or residency. Nothing can be. Medical school and then residency are times of growth, but they involve too many hours spent with a tired mind.

I plan to make the next step not the way of medical school and residency. How do I find or create a job that serves me as well as my patients? How do I ensure my work fosters curiosity and promotes wonder? How do I make work more than task completion and income earned? How do I make sure that the formulation of questions and the pursuit of their answers remain at the center of my work? To answer these questions I must explore the nuances of the profession; a wholly different pursuit than gaining the medical knowledge required to become a physician.

Count Down

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The sun sparkled through the bright green leaves of late spring. The osprey floated overhead, having returned to Richmond at the first signs of spring months earlier. The James River still roared because summer’s dryness hadn’t set in yet. My morning soundtrack was birds singing, then replaced by the bustle of slow Richmond when the city finally awoke. The late morning sky was speckled with swallows. The crows cawed. The birds that flew past had nest material in their beaks. I drank mate as the day lazily passed.

When the sun returns and the days are warm and humid, I think of Paraguay. The land of the Guarani; a place that hasn’t been my home for years yet, somehow, is where I’m grounded. When I have slow moments, my mind slips back to the breeze in the mango trees and the sun dancing on the red dirt. I think of my Paraguayans neighbors and friends who smiled so easily and were quick to laugh. In Paraguay the music always blasts too loudly and at the wrong hour. The motos zoomed up the road, their riders helmetless. In Paraguay, the days were slow even when they were fast. I thought the pace was because of the heat when I lived there. But, perhaps, there is more to the calm that sits it the lowlands around the Paraguayan River than just the temperature.

Virginia summer is like Paraguay. Maybe that’s why I like it here. Or I could like it because Virginia is a warm version of Vermont. Vermont, my original home with its harsh winters, perfect summers, and rugged greenness. It’s also possible that I like Virginia just because I do. Richmond, the city no one’s been to. A hidden gem of sorts – not too big and not too small. It’s home to a diverse assortment of people. Richmond feels very southern but not lost in the south. Odd, given its history. I feel at home here despite having a New England constitution and a Vermonter’s tenacity for liberty. Liberty of spirit, body, and mind…something I’ve noticed our country has been undermining recently.

The late spring unfolding to summer is a transition time. It’s a change of season. And for me, along with every other medical resident, it’s also a transition from one residency year to the next. In a few short months, I’ll start my last year of residency. As such, it’s time to start planning my next steps. I’ve been thinking about the job I hope to have after residency and how I might find it. Medicine is for planners, everything in medicine takes a long time and requires strategy. I’m a planner so I fit right in. But I’m also a dreamer. Not all doctors are dreamers, yet I am. I’ve been dreaming of birds singing all day, never to be replaced by noisy cars and music I didn’t pick. Dreaming of grass between my toes and the quietness of trees. I’ve been dreaming of trails yet to be explored and reflecting on the trails I’ve already walked.

I’m always counting down to things that will come. Some counting is more meaningful than other counting. My residency countdown is meaningful. It was for the “after residency” phase of being a physician that I went into medicine. I’m finally almost there. Just 14 months left of the doctorhood quest. A year-ish is a short time when I remember that I’ve been chipping away at the doctorhood quest for 8 years already. What an invigorating thing to look for a job again rather than think about school. I’m excited to have a job that allows more time than I have currently to sip mate and contemplate if the sun is prettier here or in Paraguay. There isn’t enough time allocated to such contemplation during residency.