Goodbye 20s

Today I turn 30. I find myself in a place I didn’t dream of when I was 20. I live in a world I couldn’t have imagined when I was 10.

I’m in the throes of my first year of medical school. A whirlwind of biochemistry, anatomy, patient evaluation techniques, nerd jokes, and discussions of ethics and why access to health care is a right. But, that’s not all. This morning, I woke to the smell of cinnamon rolls and a bouquet of flowers. Since August, I didn’t just fall down the rabbit hole of medicine, but I might have fallen in love.

October last year, the last October of my 20s, I was forging through medical school applications. Diving into interviews. Wondering if any school would take me. If I was good enough. If I was going to ever be a doctor. I think the feelings I had while applying to medical school aptly summarize my 20s. The 10 years between 19 and 30, I spent self-doubting, reflecting, and growing. The doubt is largely gone now—for that, I’m stoked. My personality won’t allow me to stop reflecting and attempting to be a better, even as I race toward being old, and I think that’s good.

This October comes with its own challenges and misgivings, but there is something surprisingly settling about 30. It helps that a weight lifted when I started school. And though I spend hours daily learning 3-4 letter acronyms that stand for proteins that stand for whole signaling pathways that keep you alive when they work and make you sick when they go wrong, I’m happy underneath it all. I’m happy because I’m exactly where I hoped I would be last year. I’m happy because where I am feels right. It is not often that life follows the course of my plan, so this birthday I’d like to take a moment to celebrate just being here.

Today, I’m grateful for all the people who make me feel loved. I’m grateful for the friends who are there when I need them and who share my joyous moments, who share my love for jokes only a health science dweeb can begin to find funny, and who listen patiently to the latest episode in the chronicles of kombucha making. I’m grateful for the people who have supported me, helped me learn, and pushed me to think differently and be better.

With the joy of being here in mind, bring it on 30. I’m ready for a new decade.

Last Day in the Emergency Department (for Now)

July 25 was my last shift at the emergency department (ED) as an EMT. It’s hard to believe in a few short weeks I’ll start medical school, and my time as an emergency medical technician will be filed away as part of history. Becoming an EMT challenged me and made me face personal fears. The uncertainty I had when I first embarked seems comical now that I have those years of patient care under my belt.

I couldn’t be more excited (and nervous) to start training to be a medical doctor. But, leaving the ED was bitter-sweet. I’ll miss my crew—the ED is filled with dedicated people focused on improving their patients’ lives. If every team I work on is like mine was in the ED, then my career as a doctor will pass quickly and happily. What also makes me sad to leave the job and start school is that I won’t have many opportunities to work directly with patients for a few years. The first two years of medical school emphasize learning all the facts you need to know to be a doctor and, in years 3 and 4, you start applying that knowledge in real health care settings. I got into healthcare because I want to help people. I find learning thrilling, but my motivation comes from the practical applications of the knowledge I gain. I can’t wait until I am back in the trenches seeing patients and trying to solve real health mysteries.

I became an EMT because it was the fastest certification that would allow me to work directly with patients in a way that required me to assess their signs and symptoms and then make clinical judgements. Becoming a doctor will give me a lot more knowledge and a much bigger toolkit to help my patients than I have now. But no matter where I end up in healthcare, I won’t forget from where I came. As an EMT, I learned to identify a sick human in a split second. I learned how to ask for people’s health stories and focus on the information I needed to help them. I saw firsthand how excellent patient outcomes are the result of teamwork (between all players not just the docs) and that poor communication leads to worse results. I hope these lessons stay fresh as I cram new ones into my brain.

True Love

Not so long ago in the ED, I was helping a patient in one of the acute care beds. Through the curtain that divided the room I was in from the next patient room, I heard someone reading out loud. Where the reading was coming from, a post-retirement man was the patient and his wife was with him.

I saw through a gap in the curtain that the wife was happily reading a book to her husband. Her voice rose and fell with the emphasis of someone who had read aloud many times. Her voice mixed with the sound of her husband’s snoring. When she stopped reading, he stopped snoring and became restless. Sometimes she paused and looked at him. She’d smile and then continue reading before he fully awoke.

The sleeping husband and reading wife seemed so content and peaceful despite being in the middle of the ED on a day when people around them were having their worst days. The husband could have been very sick too but, unlike many of our patients waiting to be seen, he wasn’t sitting alone staring into space as he waited.

That woman reading to her husband was the clearest example I’d seen of true love in months. We see a lot of couples and families come through the ED every day. Accompanying a sick loved one often brings out the caring side of people, however there was something about the calm, closeness of those two (sleeping and reading) that highlighted the strength of their connection. I was reminded, for the millionth time, that it’s the little things that add up to indomitable forces.

Climbing Mountains

One year when I was young we celebrated my mom’s birthday by hiking a nearby mountain. Our family has loved mountain adventures since our beginning, so it seemed like a perfect way to celebrate another good year.

The hike was beautiful and challenging and magical in the way hours spent in the woods while climbing a slope always are. When we got to the top we settled on the peak rocks to enjoy the view, eat snacks, and let our heartrates drip back to resting. Us kids sat down, pulling out our normal fare—peanuts, bread, cheese, among other easy-to-pack items.

My mom wore a happy smirk as she opened her backpack. First, she unpack a stack of plates and forks. Then came some bags containing several layers of chocolate cake. Then came the Tupperware with the sauce for between the cake layers. And then the whipped cream…She’d also brought sparkling cider.

My mother had secretly packed and carried an entire black forest cake up the mountain. That’s dedication, determination, and the proper way to start a new era.

I’m turning 30 this year, so I’ve been thinking about birthdays a bit because it seems like ending my twenties might be a big deal. I can’t really think of a better way to nod goodbye to my first complete decade of adulthood than cake on top of a mountain. There is something about icing that makes the horizon seem promising and clarifies the path you’ve already trod.

Friendship as a Trendline

When I was young and going through a rough patch with one friend or another, my mother always told me friendships go in waves. Sometimes you’re high on them, doing the most exciting things and seeing each other all the time. Sometimes it’s as though you don’t know each other (except you do, because you remember all the times that are past). I knew she was right, but when I was young I hadn’t had friends for long enough to see what she meant.

These days I’m not old, but I have friends who have been in my life for over 20 years and new ones who just arrived. Each friendship is different; the relationship components undulate as ocean waves do—always the same motion (hi…bye), never the same content (what is said and done, where and when we encounter). It’s only the movement, up and down, that’s constant over these relationships and across relationships.

When I think about friendships as waves, I envision the trendline as straight across with a sine wave tracing the points of each friendship. If you plot every friendship on the same graph, some will have wide peaks and dips, some will have steeper and more frequent slopes. But, regardless of the shape of each wave, when you follow the trendline as a representation of your life unfolding, you find that your time has been filled with moments shared with people you enjoy. Despite all the movement—especially the absences of certain individuals at certain times—you are surrounded by people you consider friends most of the time. In this way, the trendline makes you unshakable when one friendship wave becomes an outliner by dipping too low or dropping off the graph completely. And, also, it’s the trendline that helps you steady yourself if a friend becomes a partner and their friendship wave falls into phase (in sync) with your life wave magnifying your own emotional ups and downs.

For me, the visual of friends as waves (like an ocean view) takes a lot of the pressure off each moment because it makes me see them as part of something larger. It’s reassuring to realize that I can enjoy each crest before it crashes on the literal or metaphorical beach because it will be followed by others.

Making It

The past couple of weeks have been challenging in the same way my first weeks after graduating high school and college or swearing out of the Peace Corps were. Starting a new chapter  because you achieved a goal after hours, days, months, and years fighting for it forces reflection as you hit the reset button. My distilled thought process follows this line, “Well, you’re here, now what?”

When I finished high school and college I was proud, but still unsure of who I’d be or what I wanted to do with my life. When I finished the Peace Corps, I was petrified that I wouldn’t be capable of learning science, getting into medical school, and (ultimately) becoming a doctor. There was so much uncertainty accompanying those transitions. My confidence, not without nervousness, as I get ready to embark on the next phase of the #DoctorhoodQuest is a new feeling for me. Finishing medical school is NOT a guarantee, nothing in life is a guarantee. However, the trust I have in myself to weather the quest unless derailed by forces beyond my control is new and I like it.

I never thought I’d get here, but as I race towards 30 I feel like I know who I am, the values I’ll fight for, and the battles I always avoid. For the first time in the midst of a major professional transition, I’ve focused on setting up all other aspects of my life more than the transition itself. The questions I’ve asked myself include: What do I want my living situation to be like in this phase? Who do I need to visit before school starts? What are my priorities when I have free time? What do I want my work-life balance to look like? What’s missing?

I’ve taken this calm before the storm to bask in the reality that I’m happy. I’ve taken time to think about the things that make me happier and do them or prioritize them. For the first time, I feel 100% content with my professional standing. For once, I have time to focus on every aspect of life. For once, I have a schedule and geographic location that allows me to go hiking multiple times a week and to walk, bike, and run every day if I want.

I find myself asking often, “what’s missing?” Things are always missing, but right now the answer to that question doesn’t include anything major. I have many goals that are years away from being realized. There are things I’d like to add to my life that aren’t even a spark yet. But, for once, I can say “I’ve made it.” I’ve made it to a point where I believe it when I say that life is pretty grand. These days before I take my quest for knowledge to a level I didn’t know existed when I graduated high school and college, I’m enjoying the sunny days and the starry nights of a fresh Vermont summer. I’ve made it to a happy phase and I’m grateful for that.

Home Lab: Kombucha

This winter I started brewing kombucha. Kombucha is a fermented, non-alcoholic drink that (like yogurt) has probiotics that are helpful for your gut. It’s made from tea, sugar, and a SCOBY (symbiotic culture of bacteria and yeast). There are many ways to flavor kombucha, but I use herbal teas—mostly fruity ones.

Kombucha is a little tangy, a little sweet, and a little bitter. When all goes well it’s wonderfully fizzy. The fun part about making kombucha is every batch is a little science experiment. The goal is to produce a drink with a nice flavor combination and delightful carbonation—but it all depends on how happy the SCOBY is. The teas you use, the temperature, the amount of sugar, and the time you wait all influence the kombucha outcome. If you wait too long, the batch turns out very much like vinegar. If you’re too impatient, the kombucha is too sweet (because the microbes haven’t had time to eat it) and flat.

I’m just getting used to brewing in the summer, where the temperature is much warmer and the process goes way faster. Today when I checked my bottles, I had to put each one I opened in the sink because they had so much fizz they overflowed like a shaken soda bottle!

The kombucha process changes the flavor of the tea you use—sometimes for the best, sometimes for the bitter. For example, I DON’T like peach tea, but when I turn it into kombucha it’s quite yummy and not as painfully sweet as I find straight peach tea.

There’s something highly satisfying about cultivating microbes to produce something healthy. Many of us only think of bacteria when we get sick or when we want to kill germs—which makes us forget how many microbes are working for us each and every day. I like the meditation of thinking about microbes as my teammates.

Brewing kombucha has made me think more about the good microbes in my life, and it’s also made me feel better. A glass of kombucha a day, seems to keep the stomach aches away. I noticed this when I traveled in Spain for 2 weeks on vacation recently—many days my stomach hurt even though I was eating healthfully. I think it was a combination of my gut missing kombucha and my digestive system wanting to know where the yerba mate was (mate also changes how you digest food and I drink a lot of mate too). Not entirely by accidentally, the beverages I enjoy daily (mate and kombucha) both help with digestion. When I was younger I used to have a stomach ache almost every time I ate. I almost never do now. It could be growing up. It could be the microbes. Regardless, I enjoy the challenge of making my SCOBY happy so it works for me—I figure one more symbiotic relationship in my life can only be good.

5 Years Later – Quiet Moments

About five years ago I moved to Paraguay. I wasn’t sure what would come of a continental move, but I was ready for a challenge and I wanted a break from the American rat race for a few years. I had high hopes but no clue what to expect. I’d first learned of the Peace Corps when I was in 7th grade and known since then that I needed to do it.

I’m sure I’ve said this somewhere in a pervious post, but living in Paraguay and among Paraguayans changed me. People are always changing, but there are life experiences that expedite change—the Peace Corps (and living abroad for a few years) is one of them.

Living in Paraguay changed my self identity, my daily priorities, and the way I thought and saw the world. My experiences in Paraguay fine-tuned my values. Being a foreigner, the only white girl, the only American, the lunatic who liked to go for runs and hour-plus walks, the veggie addict, the advocate for sex ed and separation from abusive partners, the outspoken supporter of love regardless of gender mix, the not catholic, the woman with unpainted nails, the single one, the over 25 and still childless woman, the one who wouldn’t wear short shorts and small shirts, the female who refused to dance in heels, the one who disliked pork and large amounts of meat…being the odd one in the fish bowl forced me to think about the battles I wanted to pick and those I’d leave for never.

Of all the things I learned, what stays with me is the internal calm and confidence the women in Paraguay shared with me. Life is ridiculous most of the time, but Paraguayan women have a natural grace and pride that is humble and unwavering. I certainly didn’t luck out and get their grace, but what I did learn is that we (humans) are better and happier when we make time for quiet moments. I’ve been thinking about the secret to Paraguayans’ love of life and happiness for these 5 years, and I’m pretty sure it comes down to making time to be still. Everyone has their way of doing this, but mine has come to be drinking mate. I learned to drink mate in Paraguay.

Mate is a tea-like drink made from yerba mate. It’s loose-leaf tea that you put in a cup. In the cup is a metal straw with a filter at the end. You pour hot water over the leaves and drink through the straw almost immediately. With a little practice your lips get used to the hot straw and you don’t burn your tongue on the hot water.

Yerba mate has some caffeine in it, but I mix the yerba mate with so many other herbs (peppermint, hibiscus, lemon grass…) that it hardly has any. I don’t drink it for the energy boost. For me, mate provides moments to reflect. For me, it’s the symbol of my time in Paraguay, personal growth, and the people I care about. Mate is usually a shared drink. Since returning to the US I always drink mate alone (because people here don’t drink it), but I still think of the Peace Corps volunteers and the Paraguayans who shared it with me. I also think of the other people in my life, currently and in the past, who are shaping my world even if they’ve never sipped mate.

Five years later I still drink mate because I learned happiness is in the still moments. I learned that people are where joy comes from and that I am the best human I can be when there is time for mate in my life.

As I write this my mind is quiet, but deep down the excitement and nerves of starting medical school this August are bubbling. I’m about to embark on another journey like none I’ve done before—the expedition of learning and mastering the ways of the human body. The challenge of becoming a medical doctor. But, as hard as medical school is, I know living in Paraguay was harder and I already did that. And though there will be days in medical school when I’ll skip mate, I know that it’ll be quiet moments drinking mate that will propel me through the countless exams, the high stress of learning more than seems possible, the life-or-death decisions, and the sadness of seeing people suffering. Everyone, I think, has their grounding mechanism. It turns out that mine is a dried herb I buy 6 kilograms at a time and often sip before most other people’s morning alarms have started snoozing.

Finding the Path

We all have bad days. The problem with having a bad day and working in healthcare is that it’s unacceptable for your mood to affect the quality of your care and people are sick every day. The trouble with healthcare on a bad day is that healthcare requires hundreds of human interactions within a shift. Hundreds of moments where patience is required, where you must do small tasks that are annoying and big tasks that are important, and all the tasks between that together help people heal. You notice everything a little more on a bad day. So how do you get through it?

Not so long ago, my shift landed on a bad day. But, there was a patient who turned the shift around for me. He told me how he raised his sons. He was a single father. He had a path he wanted them to go on and he thought his job was to lift them back up to that path when they fell rather than push them down. That’s what he did and he was proud of them. He told me he was lucky.

I think I’d like to approach bad days like this father approached his sons. A bad day is a fall from the right path. It just takes some nudging to get back on track again.

The benefits of working in healthcare on a bad day are the kind, wise patients you’ll likely encounter. They’ll set things right, even though you’re the one that’s supposed to be curing, if you listen to them.

Empathy

One busy day in the emergency department (ED) we had a psych patient in a hallway bed. I don’t remember if he was visiting us to stay safe while struggling with suicidal thoughts or if he had come to the ED for some other mental health reason. We try to put patients with mental health complaints in a room as soon as possible, but sometimes the hallway is all we can do for a few hours. This patient fled even though his condition required him to stay in the hospital. He outran hospital security and escaped hospital grounds. Police brought him back to the ED.

I’d seen him sitting on a stretcher in the hall before he fled, staring into space calmly. When the police brought him back, he was slumped forward in a wheelchair with blood running down his shins. He hadn’t had those scrapes before he fled and they caught him. I knew they must have tackled him, but I couldn’t say because I wasn’t there. Later, I’d rinse those scrapes and the ones on his torso, arms, and hands. Nothing too deep, but the iron smell of blood was strong. The patient was NOT angry about the scrapes; he just didn’t want his mother to see him until he was clean again. I couldn’t help thinking that sometimes the price seems steep for safety and medical treatment.

It was a terrible feeling to see someone start in the ED without a scape and then end up with many before their stay was done. I was shaken. I spoke to a coworker about it. I like to discuss things during shift so everything that happened stays at the hospital when I leave. My coworker listened to me carefully and acknowledged the challenging aspects of the situation. It’s always hard to see someone’s mind betray them and, in their worst moments, need restraint from medical staff or police. It’s hard knowing that the violence is part of the route to recovery. My coworker said, “It’s okay to be bothered. If you weren’t, then you’d know it was time to leave this job. When you don’t feel empathy anymore, it’s time to change careers.”  

Empathy is a harsh beast. I believe most of us are able to ignore empathy at least some of the time because it is too much to always feel our emotions and, also, those of someone else. Which has led me to ask several questions about empathy’s nature. How is empathy turned on and off? Is there a time when empathy is out of place? Is it right to push empathy aside to protect oneself? Why are some people more empathetic than others? What does being very empathetic say about a person? Can empathy be taught and untaught?