Category Archives: About Me

Thankful

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This post comes after a several-month blogging hiatus. The break wasn’t intentional, but life has a way of carrying us forward in unexpected ways. The past few months I continued to write, but in a different genre. I drafted several novels. I have two fantasy series that occupy my imagination currently. I’m not done with them. Novel writing is a long-term project, like most things in my life. Yet, despite stories unfinished, the flow of my days has brought me back to this blog. Afterall, the doctorhood quest isn’t over. It begs the question of whether the doctorhood quest will ever be over as there is always more to learn, but that introspection can be left to the future.

The past few months oscillated between easy schedules with plenty of time to contemplate life and my least favorite part of residency, night shift. I’m gleeful to report that I finished my last scheduled night shift of residency last week. Of course, I’m in residency. Another week or so of nights will sneak into my schedule before I graduate. Such is the way of residency, unwelcome and unfriendly work schedules. I skipped Thanksgiving because I was on night shift. I celebrated Christmas on November 30 because December is a doomsday schedule in my residency program. I wrote this blog at 3 o’clock in the morning because my sleep-wake cycle was still upset from night shift despite a week of day shifts under my belt. Schedule challenges aside, December is a month of reflection and giving thanks. I find myself in an interesting place – seeing how far I’ve come while also noticing a long road ahead.

I have 7 months left of residency. I have a job for post-graduation (more on that in a future post). I completed the administrative hoops to get official physician’s licenses. I scheduled my last exam – the board exam. Once I pass the board exam, it signals that the past 9 years of training taught me what I need to know about doctoring…at least on paper. Completing those tasks is enough to be grateful for without needing to look below the surface or consider the complexity that made them possible. But giving thanks is more than checking off one’s to-do list. So, let me dive deeper into some of the things I’m most grateful for currently.

On the top of my “thankful for” list are the countless people who helped me get to where I am. Many of these people are unnamed and their time in my life was brief. Together they made me the doctor I am. I must first give a nod of thanks to my patients. They have taught me more than they know. To be a patient is to be vulnerable, and they navigated that vulnerability with bravery. Next, I give a nod to my professors and peers in medicine. Medicine is a team sport, anyone who tells you otherwise is lying. Every day I learn something from my colleagues in medicine. Collaboration for the better good is one thing I love about the medical field. And last, but not least, I’m thankful for the friends and family who have supported me on this journey. They are the force that keeps me on the path forward. I will not imagine what this journey would have been without them. 

After the people in my life, I’m thankful for my circumstances. I’m thankful to live in the sunny city of Richmond where native passionfruit and pawpaws hide in the park. Where the river flows under and around osprey in the summer and ducks, geese, and cormorants year-round. Where snow falls occasionally in winter and daffodils bloom in February. Where cultures born of many pasts and futures come together, not always smoothly but always with hope. I’m thankful for my apartment where I can track the exact location of the sunset throughout the year – knowing the season by the building behind which the sun dives first. I’m thankful for the plants that dominate my living room. They ensure that there is no day without a flower blooming in my home. I’ve always said that I’ll know I’m rich when I can always have a fresh bouquet of flowers without concern for budget. When I thought of that definition of wealth, I didn’t realize that tending plants would make me rich faster than working. In retrospect, I should have realized that “wealth” is a nebulous term.

And finally, I’m thankful for my experience. My experiences on the doctorhood quest and in other aspects of life. I have never had a job that is as consistently rewarding and infuriating as being a physician. Most days the reward outweighs the frustration, which is why I continue to return. I had over 20 jobs before entering medical school, some were fun and others inspiring, yet I would not return to any of them. Apart from work, this year’s vacations, day trips, and glorious hours lounging I cherish. As December unfolds, I’m thinking about the experiences I’ve had and those ahead. There is never a dull moment when one accepts that the only constant is change. With the days of 2025 numbered, I’m thankful for what this year was and the hope next year holds.

Spying on Birds

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A flash of color. A movement out at the edge of my peripheral vision. A song so sweet it lingers in the mind after it’s done. These are the taunts of the birds as I try to spot them. Brown. Gray. Yellow. White. Black. Sometimes bright colors. Blue. Green. Red. Orange.

Birding, the act of watching birds, can be passive or active. In the passive form one simply observes birds that flit or swore on the path of one’s normal travels. In the active form the purpose is to see birds, discover their hiding places, and learn their names.

Growing up my mom liked birds and knew the names of most of the ones we saw in our rural home. My mom’s side of the family was a bird-loving side. As such, bird names – blue jay, cardinal, chickadee, hairy woodpecker, osprey, red-tailed hawk, wood duck, mallard, etc. – were part of my normal vocabulary. Just like, I imagine, brands or celebrities’ names were part of the vocabulary of other children. I didn’t know it was unique to know birds by name until I moved away for college. There I found myself on an urban campus where I wasn’t convinced that some of my colleagues could identify a live chicken.

Life unfolded. I stayed urban for a time. Then I moved abroad where there was too much to learn to also learn new birds. And then the doctorhood quest took off like an ultramarathon – slow and steady but always busy in its own way. Fast forward. I found myself in Virginia. Virginia and Vermont share many birds. And some of the birds Vermont sees only in the summer Virginia sees at other times of year. As I wandered the forest and wetland trails on my days off from residency, I started to notice the birds again. Somehow, having spent 10 years learning other things and more than that away from my childhood home, the birds I knew as a child resurfaced. Old knowledge was not lost despite filling my brain with an additional zillion factoids on medicine and the human body. Birds. I still know the song of the hermit thrush – Vermont’s state bird. I remembered the nuthatch and the tufted titmouse.

I have a good partnership. My spouse likes to take pictures of birds and I’m good at spotting them. My binoculars are my superpower. The only challenge is that when one starts actively spying on birds it’s hard to stop. My spouse and I now seek out birds on our vacations. I find myself toiling over bird books and using Merlin Bird ID.

Birding escalates. It starts with just trying to see birds. Then it’s about naming them. Then it’s about finding rare birds and memorizing new bird names. A harmless pastime. Another excuse to be outside. Another reason to love wild places. Another reason to also learn about the trees and plants that birds, themselves, adore. What fun it is to go on a walk and be able to name the birds, trees, and plants I see. Almost everyone used to be able to do that. Now it’s a dying art. Funny how the world changes. It’s never too late to circle back on the knowledge we once had. It’s never too late to learn something new. Just ask the birds migrating on ancestral routes and adapting to new cityscapes. They’re experts in learning.

No Alarm Today

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I woke up because my body was ready to leave dreamland behind and start the day. There was no beeping alarm or bright light from my sunrise alarm clock jolting me awake. Today my schedule is fluid. I have a to-do list (I always have one) but today I can ignore every item on the list if I want to. It is a rare day with no objective and no place to be. I could, if I really wanted, lie in bed and watch the day start without leaving the warmth of my covers. Or I could get up and sip mate for several hours. I could sit on the couch and watch the plants grow. I could go for a walk, do a workout, or write. I could do anything or nothing. The lack of expectations and requirements for today is freeing.

No alarm days are rare and lovely. Having spent the past many years in medical school and then residency my life has been filled with productivity and hard work. But, just as too much free time makes me stir crazy, too long spent with an overly packed schedule depresses me. Letting the day begin spontaneously reminds me of my years in Paraguay. In Paraguay, most days flowed in a semi-planned way. My life was free in Paraguay. Even though I had work, obligations, and social activities in the Peace Corps, I’ve never had as much free time during my adult life as I did in the land of the Guarani.

Sometimes, when the sun shimmers into my apartment and my houseplants glow with the joy only photosynthesizing entities have in the sun, I’m transported back to my Paraguay naps and meditations under the shade of the mango trees with the nearby palms swaying in the breeze. On those mental journeys, I’m reminded that quiet is an underappreciated aspect of life. Of course, us humans need purpose and connection to be happy. But every moment needn’t be assigned. The happiest folks I’ve met are those who embrace the slow days when they come, sometimes even setting aside calendar days for nothing. I want to be among the ranks of the happiest people. I think this goal starts with no alarm days. My no alarm days are for basking in the strange meandering that occurs when I decide to let spontaneity determine the agenda.

Today is a no alarm day. The sun is shining. The mate is perfect as the steam curls up from each pour of water over the yerba leaves. The yerba is fresh and so it bubbles. The plants in my house look good. Maybe I’ll water them later because it’s sunny and they’ll need it. Some of my orchids are blooming, some will bloom soon, and some are pondering their future (deciding if they will flourish or die for no reason). My house trees seem tall today. Beyond my plants, through the window, and past the balcony the cranes move. Richmond is constructing several new tall buildings. There are 4 cranes to watch from my balcony. The cars bustle below, sometimes their music is loud. Life continues. I sit. Today is a no alarm day. I’ll probably go for a walk later. But this moment is for drinking mate and observing my plants. What a beautiful moment it is.

Over 48 Hours Without Running Water in the City of Richmond

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“See these?” my mom asked flexing her biceps, “Hauling water.”  

When I was young, my family lived in rural Vermont in a hunting cabin without running water. My parents hauled water from the stream for bathing and we filled jugs at my dad’s work for drinking water. Those years in the woods prepared me for life as a Peace Corps volunteer in rural Paraguay where amenities were often lacking.

When my mom visited me in Paraguay, I flexed my biceps. “See these?” I asked. “Washing clothes by hand.” But it wasn’t just that. In Paraguay the water and electricity went out often. Just as my parents had done when I was a child, I developed ways of conserving water and making do when the utilities were down. One of my kitchen walls was lined with 2-liter bottles (recycled soda bottles) filled with clean water – so I was ready when the water went out. Some of my Paraguayan friends had different water sources from me and therefore often still had water even if I didn’t. My friends in Paraguay were used to the water outages and had a communal approach to getting through those annoying stretches. I could count on them to invite me to shower or to wash clothes at their homes if my water was out for more than a day.

When I returned to the US after completing my Peace Corps service, I figured my only time without running water would be when I was backpacking or camping. Self-imposed in those cases and short-lived. But Richmond surprised me this winter. In classic southern fashion (being from Vermont, I must poke fun at how the southern US handles snow), all went awry when Richmond was hit with a true snowstorm and sub-freezing temperatures. One of the city’s water pumps broke, multiple backup systems failed, and fixing the problem was harder than officials expected. As such, almost the entire city lost water for just over 48 hours and had to boil water for drinking for almost a week.

In the grand scheme of things, no running water for 48 hours and a boil advisory for about a week are insignificant compared to the water hardships many people around the world face. However, I found it interesting that such a utility failure could occur in a modern US city in the absence of a natural disaster. My husband and I (both from New England and used to winter power/water outages) were prepared. We filled pots and buckets with water just before the city turned the water off. We refilled our buckets in the river as needed to ensure we could flush our toilet. I took a baby-wipe bath one day. I washed my hair in the sink another day when the water was starting to come back but we still didn’t have enough water pressure to run the shower. I’ve known how to take a bucket bath since I was a child. Though it is a nuisance; it is simple.

48 hours did not restore the bicep muscles I’ve lost since returning to the US and living with modern, reliable running water and all the amenities that come with it. Yet, during Richmond’s water outage, I found myself flexing my biceps and thinking about the many people across the globe who have unclean water or minimal access to water daily. In the US reliable utilities are taken for granted. Richmond’s loss of water was a good reminder of how precious functional utilities are. I expect Richmond officials to review how the system failed and take steps to ensure such a failure doesn’t occur again. I also consider the water outage an opportunity for myself and other citizens to reflect on the event. In a world faced with global climate change which is leading to more severe weather and more chance for disasters that could cut-off utilities, how prepared are we if the systems we take for granted fail? How does one function without running water? Without electricity? What do we need to learn to be better prepared to navigate these situations when they arise? What can we do to prevent utilities from failing? How can we protect our water resources?

Hello 2025

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The Red Wheelbarrow

By William Carlos Williams

so much depends

upon

a red wheel

barrow

glazed with rain

water

beside the white

chickens

~

2024 was a toilsome year interspersed with joy and success. My themes were quietness, pause, and connectivity. It was the first calendar year spent 100% in residency: the lack of time off, no control over my schedule, and too many hours worked made me weary. Yet, despite these challenges, my year was fulfilling. I took several amazing vacations – a highlight was going to Costa Rica which included a 4-day trek in the mountains. I’ve enjoyed camping, sharing moments with family and friends, and completing my first half-marathon since I started medical school. I added back a few non-medical activities I’d put on hold when I started residency because (back then) I didn’t have the bandwidth for them. It’s exciting to have tangibly more time simply because I’m more efficient than I was in the beginning of residency (hard work paying off). This year I’ve seen my ability as a doctor grow and am proud of my progress. I feel more confident in my clinical decisions and more able to help my patients than ever before. I’ve also started to envision my career after residency – I can’t wait to be an attending physician.

2025 will be the second (and last) complete calendar year of residency. I’ll be halfway through residency on January 1, 2025. On December 31, 2025, I’ll only have 6 months left. 2025 will be a practical year for me. I’m hoping to solidify my medical knowledge and my abilities so I’m ready for residency graduation. By the time I write a post welcoming 2026 it’s highly possible I’ll have a job lined up – amazing how time flies. Yet, while I’ll focus on professional development in 2025, I’ll also work to maximize my life outside of work. On the nonwork side, my focus will be cultivating time with loved ones, embracing non-medical pursuits, and spending as much time outdoors as possible. My themes for 2025 are curiosity, resilience, and gratitude.

Curiosity

Now that I’m settled in Richmond, residency, and my 30s I’ve found that I’ve fallen into a routine of familiarity. This year I’d like to shake up that routine by jumpstarting curiosity. I’d like to see things through new eyes and challenge myself to answer questions I’ve brushed aside because they aren’t central to my daily trudge. I’d like to dig deeper and challenge myself to learn and do new things.

Resilience

Residency is hard and I feel worn down. Further, I find the negative aspects of healthcare sit heavily –examples are healthcare’s money focus and its inequity. When I’m baseline tired because of work I find it hard to flourish in non-professional aspects of life. I think 2025 is a good year to acknowledge how hard residency is and find ways to turn its challenges into strengths. While I don’t have the energy or time to do everything I’d like – I have so many opportunities. I think working as a doctor is a privilege because it allows me to touch people’s lives. I’d like to take 2025 to emphasize the good things residency offers. These good things won’t make up for the negatives but focusing on the good will help me remember that incredible growth occurs during challenging times.

Gratitude

In 2025 I’d like to take more time to be grateful. I’ve achieved my dream – I’m a doctor. I have an amazing husband, a lovely home, and a sunny place to be. It’s easy to forget to be grateful when I’m busy. I’m looking forward to carving out time for it this year.

The Last Stop on the Bus Line

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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.

35 for 35

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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.

The Doctor’s Dilemma

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Being a physician is a career that can become one’s life. There are many reasons for this including the 24/7 need for healthcare, the pressure from healthcare business for productivity, the need for advocacy to improve the system and increase health equity, and the desire to help others. There is also the added stress that medicine literally deals with people’s lives and wellbeing. Given these career features, being a physician historically was a way of life, not just a job.

Despite the historical trend that being a physician was a way of life and an identity that trumped all others, there has been a shift in recent years. This shift started some time ago and was, perhaps, expedited by the COVID-19 pandemic and the severe toll it took on all healthcare workers. The shift is that newer ages of physicians don’t just seek to be doctors – they seek to be partners, parents, athletes, cooks, travelers, readers, vacationers, relaxers, and gardeners to name a few identities they claim beyond the physician identity.

As a member of the newest generation of physicians I find myself caught between the old dogma that to be a physician is to prioritize it above all other aspects of life with the newer view that to be a physician is to be a person with a serious career. I think of these completing identities of “way of life” vs “profession” as the “doctor’s dilemma.”

Sometimes self-imposed and sometimes externally-imposed the training physician (and all physicians really) are driven to do more. More reading and learning, more shifts, more leadership roles, and more research. It’s hard to balance the forces urging me to do more with the desire to also do nonmedical things like spend time with my husband, hike, and write. My medical training has taught me to hustle, be efficient, and work for long durations of time with high focus. As my training continues, I’m also learning how to say “no” and pump the break. Of course, these learnings are contradictory. The pendulum falls sometimes more on the hustle side and sometimes more on the relax side.

As I finish my 1st year of residency, I’ve been thinking about the doctor’s dilemma because in the remaining years of residency I’ll make decisions about my post-residency career path. While I contemplate my career’s trajectory, I also find myself thinking about other things in life. For example, living in a city apartment has made me miss walking barefoot on grass. I don’t suspect I’ll own a house anytime soon, but missing grass has made me think about homeownership more than ever before.

What do I put on hold and what do I pursue? What opportunities if not taken now will disappear? Where do I want to be in 5 years?

While wellness preaches “live in the moment” heavy careers, like doctorhood, require forward thought. Doctorhood requires the balance and blend of one’s professional dreams and identity with one’s personal dreams and identity. During my 2nd year of residency, I’ll become a team leader and gain more independence. With this greater responsibility doctorhood feels more serious than it did as a new resident when I had more people guiding me. As my training continues, it is my turn to step up with the answers. Patients will depend on me. Each choice, like whether to study or run, has a ripple effect on my future and (perhaps) on my patients’ futures. There simply isn’t enough time to “do it all” at the same time. Choices must be made along the way. The choice options are what pose the dilemma.

A Letter to My Intern Self

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Dear About-To-Be-Intern Self,

Intern year (as the first year of residency is called) is going to be tough. At times, in fact, it’s going to be downright awful. There will be stretches where you don’t see the sun and can’t remember the last time you felt anything but exhausted. The trend you noticed in medical school, in which current physicians and administrators don’t value your time (and waste it) and then wonder why your mental health is poor, will persist. You will be told by some to do more because “you’re a doctor now” and you’ll be belittled by others because you’re new and you don’t know what they think you should know.

You will be impressed by how your health deteriorates intern year. You are welcome to take some of the blame for your decline if you’d like, but the truth is that everything about intern year is the opposite of the wellness advice we give our patients. From your sleep schedule to your stress level, or from the food the residency program gives you to your work hours, there is very little healthy about intern year. It would be misleading to ignore these negative things that will unfold, one way or another, as they have for every intern. They manifest a bit differently for each person, but their occurrence is a guarantee.

Like all things in life, the negative of intern year is paired with the positive of these 12 months. First off, you’re paid – a huge victory after 4 years as a medical student. Your salary will be meager compared to your future salary (and it will be poop if you calculate the hourly rate) but remember that the intern salary is higher than the average annual income of Americans. Second, you are a doctor now. A real doctor. This title, alone, allows you to meet the most extraordinary people and hear their amazing stories. People will tell you things they never told anyone else. Your kind patients and your brave patients will be beacons helping you through intern year.  Focus on remembering the kind and brave patients more than the hard and mean patients; it’s the opposite of what your mind will want to do. I assure you that remembering the kind and the brave will help you more than you realize.

There will be difficult senior residents and supervising physicians; there will also be amazing ones. Take a moment to appreciate the inspiring senior residents and supervising physicians and reflect on why you respect them. You’ll be in their shoes before you know it and you can learn from them. Let the degrading and unkind supervising physicians and residents bounce off you; let them be a lesson of what you do not wish to become. The same goes for the nurses and other staff in the hospital. Nurses will be your biggest nightmare and your biggest savior throughout intern year. A knowledgeable and respectful nurse is gold. Thank the hard working and thoughtful nurses. Learn how to navigate the mean and not patient-focused nurses. You’re a doctor now and, once intern year is over, you’re going to be a team leader. Intern year is about getting ready to be a leader.

No one is good at being an intern when they start. Every intern gets better at medicine, navigating the healthcare system, and working with the interdisciplinary teams of healthcare. You won’t notice how much you’re learning at first. The days will pass slowly and the weeks quickly – before you know it, you’ll wake up and realize that you are a new version of you. You’ll blink and a new July 1st will be just around the corner. Then, intern year will be behind you…forever. I’m not delusional enough to say, “enjoy it while it lasts.” I am delusional enough to say fight for your health (because you’ll need to) during this year and soak up as much knowledge as you can. In the end, intern year exists to help you get closer to becoming the best doctor you can be. Intern year will force you to grow. It will challenge and push you to a new level. Always remember that intern year is finite and only one small phase of the Doctorhood Quest. It will pass.

You go this. I know you got it. At the end, you’ll know you got it too.

Yours truly,

Jett

Space

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I often think about space, specifically taking up/claiming space. My most conscious ponderings about space are while I’m running in the park near my house. I’ve observed that people are more likely to step aside for a male runner than me, a female runner. It’s so blatant that when my husband and I are running or walking together we strategically put him on the outside because people move over for him and not me. It’s an annoyance. I’ve started to run strong and serious. I’ve learned that a confident stride and a squared shoulder do help remind people that women also deserve to run without stride interruptions.

Guarding my lane while running is a newer claim of space for me. The first time I claimed space was changing how I sat. Changing my sitting stance was a project that took the better part of my twenties. For some reason women in my culture are taught to sit small and closed. I’ve found that sitting small is counterproductive. It has (perhaps) made it easier for males to harass me on public transportation and (definitely) made it easier for my colleagues in healthcare to ignore me. These days I try to sit large and open, just like my culture teaches their boys to sit. I don’t take the inside seat on the train/bus (that’s more for safety as I’ve learned the hard way) and I take up my whole seat even when it’s wider than I am broad. If there’s a seat at the table in a conference room, I take it. Which brings me to medicine, my most recent occupation (both meanings of occupation, wink, wink).

I have a very distinct memory from medical school related to being a female in medicine. I was mid-sentence presenting my section of a group presentation when a male member of my team cut me off, talked over me, and started his section of the presentation without letting me finish. It was so rude that several females in the class texted me in solidarity. The experience made me think about why seats at the table are not enough on their own. Seats must be claimed and, sometimes, defended.

Being a first-year resident brought with it a whole host of interesting space claiming challenges, many simply related to being a new doctor and some related to being a female physician. Filling the role of physician involved learning how to defend and explain my medical decisions, striving to take the high road and set boundaries when other members of my interdisciplinary team did not, and observing how physicians I admired conducted their doctoring and led their teams so I could model their techniques.

The challenge of being a new doctor exists for all new doctors. But filling the role of a female physician comes with its own occupational hazards. Here are some concrete examples from the past year of times I was reminded that I was female while at work:

  • I frequently must remind my patients that I am not their nurse — a challenge that my male counterparts don’t have.
  • My name is gender neutral, so nurses often think I’m male when communicating electronically with me before they meet me in person. (We have a secure chat in our electronic health record system that we use in the hospital). It is interesting to see how nurses’ tones change after they discover I’m female when they originally thought I was male. At times the tone change is dramatic and frustrating because I get more pushback as a female than as a male physician.
  • I have been lectured by a male supervising doctor about what clothes a doctor should wear. The lecture was somewhat confusing given that all the female residents wear exactly what all the male residents wear… scrubs of similar fits, styles, and colors. I doubt any male resident teams have been subject to such a lecture, but my all-female resident team was.
  • Several times I have found myself uncomfortable on rounds (that time of day when you talk about all your patients with the supervising doctor) because the male supervising doctor was very good at looking at my chest but never made eye contact.

The above situations illustrate that there are additional features of the medical terrain that female physicians must navigate that their male counterparts don’t experience.

As my second year of residency approaches (starts July 1), I’ll soon find myself no longer a first-year resident. In my second year of residency, I’ll start to be a team leader and I won’t be the new kid on the block anymore. I’m excited about this next step in my training. I feel ready to take on the challenge knowing I’ve learned a ton already and have a ton more to learn as a physician. I continue to have much opportunity for growth on my journey to lead with humility and excellence. As I wait for my second year to begin, I’m curious what the phase of “senior resident” (my title during my second and third (last) years in residency) will be like and the space challenges it will present. All adventures have space challenges however they present themselves in different ways.