Joy

I most remember his rosy cheeks. The humidity and mosquitos hummed around us. We held hands under the shade of widely spaced trees in ferns as tall as our waists beside a beaver pond. There would be many moments I’d attempt to remember from our wedding day – etching them into my memory, writing them down play-by-play in my Spanish journal, and waiting giddily for our photographer to finally send us our photos. But, in those moments between words, I thought about how warm my cheeks felt and how rosy his cheeks were and how it was likely that my cheeks were rosy too.

I was joyful. Some cry when they’re overwhelmed with happiness, but that’s never been me. Happiness spreads across my skin like sinking into a warm swimming hole. The warmth then soaks into my core whereby settling my heart and obscuring all the things that normally zoom through my mind. Happiness is quiet. Contentment. Nothing but his rosy cheeks and my rosy cheeks on our wedding day.

The bright sunlight flickered through the canopy above alighting on my sister, who was our officiant, and our guests. The guests sat amongst the ferns as you might imagine in a scene from A Midsummer Night’s Dream. It seemed fitting that the cupcake shelves hanging from a birdfeeder hook and the brightly colored attire of the wedding guests would float across my mind like a scene from a play. As I gazed at the ferns, I realized that this was my midsummer dream. To make official what my partner and I already knew. These moments would give our relationship a label society understood. But despite the label, he and I knew that no one could truly understand what we meant because every relationship is its own unique product of its unique makers.

Which brings me back to his rosy cheeks. He was wearing his finest suit and the fanciest shoes you’ve possibly ever seen.  The paisley on his shoes and the paisley on his tie had nothing but their name in common, but they each worked well with the stripes of his suit. His tufty blond hair curled above his sparkling eyes and his cheeks were flushed because we were outside, because we had walked through the forest to get here, and because it was a hot midsummer day.

I thought briefly about our guests, the witnesses to the words we were saying. They were the people who had played the biggest roles in our lives since we became a couple. I listened to the words my sister said, then he said, and then I said. We had all thought about, written down, and practiced what we were going to say. Yet, it seemed more improv than rehearsed lines. How could any of us have imagined exactly how this moment would be? We couldn’t. There’s delight in comfortable spontaneity. As I replay those moments now, the rosiness returns. The memory is one of the clearest definitions I have of joy.

Learning to See

Before I moved to me latest city, the people I talked to about the city during my travels through medical school rotations didn’t have anything good to say about it. One person said there weren’t any good food. Others said there wasn’t much to do. When I moved here, someone went as far as to tell me it was dangerous. And, while I listened carefully because I knew little about the city myself, I had a suspicion they were wrong.

When I was a child, I learned to see the trees and birds around me. I learned to name them. I could tell a white pine from a red pine or a sugar maple from a red maple. I could tell you the sound of the chickadee and the hermit thrush. I knew the difference between a red wing blackbird and an oriole or a bluebird and an indigo bunting. This type of seeing was the outcome of growing up in the middle of nowhere while surrounded by women who knew these things and shared them with me.

Early on, I learned to tell the difference between real wood and fake wood. I could identify sloppy joints and beautifully joined boards. I judged furniture and house finishings based on their joints. I could tell you how sheetrock differed from plaster. I understood these things because my father had taught me to notice them. My mom taught me to see colors and how they might be paired. I still notice boldly paired colors and they bring me joy regardless of if I find them in a painting or on someone’s clothes.

As a I grew, I learned to name the flowers in people’s gardens because I worked in a greenhouse. I was trained to tell the difference between a rose and a lily, for example. My parents taught me to notice architecture. What makes a classic New England home look as such and how that differs from an adobe house. I came to understand what a well-built house is.

When I moved to DC, I learned how to see a street for what it was. A pathway to somewhere. I learned how to chart my course and tell if I was safe on a particular path within moments. I learned to see the places, like underpasses, I should avoid at night and the places that were filled with architecture, trees, and flowers. I learned this out of necessity and because I have a savage passion for walking and walking and walking.

When I moved to Paraguay, I learned to see what someone was trying to say because I couldn’t always understand their words. I learned to see if they were lying, or friendly, or joking. I learned to see why some people might follow God. I started to understand why life in Paraguay is different from life in the United States. And I learned to see that difference as both beautiful and challenging.

In medical school I’ve spent years learning to see exactly what a normal breath is and how stretchy skin should be. I’ve learned to see how the heart and abdomen are when all is well and what an infection looks like. I’ve learned to understand almost every part of the body and to see when it is healthy.

All this learning about how to see I carry with me always. And, when I moved to my latest home, I applied my seeing to understand what this city was. I learned that there is a lot to say about Danbury. I found the trails (there are numerous) where I can run and walk among the trees, birds, and flowers. I’ve noted the buildings with outstanding architecture. I found half a dozen murals with beautifully blended colors. I’m mapping out the good eateries—so far, I have a recommendation for every meal of the day plus elevenses and snacks. Much like Paraguay, Danbury is filled with people who don’t look or speak like me. But, when I took the time to observe my neighbors; it became apparent that they are a bunch of people trying to carve out a little space to work, eat, and be merry. I came to understand they were just like me in many ways. And, noticing our similarities, I understood that this city suits me. Seeing is something that takes practice. But once you learn to see you can begin to understand.

Remembering Her This Mother’s Day

This week I lost a kindred spirit. I met her in college, over 10 years ago now, when I visited a college friend’s home over winter break. She was his mom. And in the decade since I graduated, I lost touch with the friend but never his mother. It was her efforts that kept us connected. In my life she was a cheerleader, frequently offering support and sending messages of encouragement.

In the last decade, she was brave – divorcing, taking on new jobs, moving across the country, and entering seminary – all while being a mom and a middle-aged woman with all the challenges that come with those realities. She was a loud advocate for many people including women and people with disabilities. She was a staunch supporter of her sports teams.

Her death was unexpected. This week my thoughts have been with her children who are without her this Mother’s Day. I have also spent the week reflecting on the positive force she was in my life. I admired her for her fiery spirit and her devotion to the people she loved. As she was a dedicated reader of my blog, I wanted to write a post in her honor.

She believed strongly in God. If the world is what we believe it to be, then she is with her God watching over her children and the others she took under her wing from a new vantage point. May she rest in peace.

Home

And the last of three orchids I’d nurtured was sending up new flower shoots. It was the second of two my fiancé had given me when I finished my first medical board exam (about a year ago now). Ironically, I was sliding into studying for my second board exam as these orchids sent vigorous spikes forth with flowers that erupted like fireworks. It seemed my exam schedule was on orchid time.

The orchids weren’t the only plants I’d lugged from one state and town to the next. But, in that moment, their colors overshadowed the perfect leaves of the plants around them. Their colors were competing with the new rug I’d bought when I moved into my fourth (and hopefully last) home of medical school only a week or so ago.

I called it the sunny-side-up rug as it was bright yellow and white like a perfectly cooked egg. Somehow the plants looked greener next to the yellow. The yellow beside the purple African violets and remaining orange blossoms of the Christmas cactus and the orange-salmon ever-blooming crown of thorns was representative of the contrasts in my life. And the complementary colors of the yellow rug and purple flowers reminded me of my roots and my newest stethoscope which I’d decorated with colored zip ties representing the rainbow but paired by complementary color. The stethoscope decoration was an attempt to ward off stethoscope theft and, more importantly, a personal reminder of the same roots for which the contrasting colors in my apartment were a metaphor.

My roots are in the arts and carpentry and the outdoors which is a mix of dirt, water features, plants, trees, and rocks. And my new home reflected my foundation in these things. My time in the clinic and hospital often reminded me from where I’d come. Not so much because anyone I worked with or spoke to in these settings knew my history but because their ignorance of my history was so glaring and central to my relationship with them. It is easy to get lost in the world that is healthcare especially when that world is not even in the universe where you grew up. 

They say home is where the heart is. And when you’re a doctor in training you know that the heart is in the chest. Which complicates things when trying to find your home because your chest is wherever you happen to be. While I don’t think wherever I am is home, my idea of home is not so far off from knowing the heart is in the chest. I’ve had many homes. My tendency toward multiple homes may be a complication of split custody and two homes as a child – though, more likely, the shiftiness of where I call home stems from my personality-defining feature of being a wandering soul. Not wandering in the sense of a gypsy who is constantly moving, but in the sense that one place has never been the only place I called home. My life leading to medical school and through medical school has reflected that. Depending on what you count as moving, I’ve moved over 10 times in the past 10 years spanning two countries, three US states, and several towns in most of those regions and called each location to which I moved home.

When you’ve moved as much as I have, you develop a keen sense for what kinds of places can be called home. And you also learn that some places are easier to call home than others. My new apartment that contains the re-blossoming orchids and the sunny-side-up rug is one of those places that was instantly home. As soon as I opened the front door for the first time, I knew I was home. Home for now and home until I leave. The homy feeling might have something to do with the expansive windows. As a green thumb, the bigger question is not how or why I grow plants but rather if I seek places where my plants will thrive or if seek places where I will thrive. It’s easy growing plants when you need the same thing as they do. Sun. We need lots of sun and sunny days or else we get irritable and fade.

The new apartment was also home because I’d picked it from multiple options. I’d lived in the area for a while and surveyed the land. I’d used the knowledge gathered from my surveying to decide that this new town was the town in which I wanted to live. At least for now. The new apartment was also home because it was the first lease my soon-to-be-husband and I had signed together. It was a new place for us to both start new phases. He, his nursing career. I, my last year of medical school.

Seeing the flowers, the yellow rug, and the ñanduti (colorful Paraguayan lace) I’d placed on every empty surface in the apartment and thinking about the art that could fit on the broad walls made me feel happy in my new place. As I sat drinking my mate in the morning sun, I felt peaceful. As I looked out the windows; thought about how close I was to finishing the third year of medical school, a hard year to say it shortly; and considered all the wonderful things that would unfold in the coming months I felt at home. My literal heart was in my chest and my memories of past homes were in my metaphorical heart and both hearts were here in this apartment. Here, life followed the rhythm of the orchid flower cycle. Here was home because of the colors and sun and feelings that filled the place.

PS: it turns out I’ve written a post titled “Home” before…back in October 2014 when I lived in Paraguay. If you’re curious how my thoughts then compare to now check it out.

My Experience Getting the COVID Vaccine

Disclaimer: If you’re looking for scientific information about COVID or the COVID vaccines, check out the CDC as a starting place for information. This post doesn’t address science or research surrounding COVID; it is simply a recount of my personal experience getting COVID and the COVID vaccines.

I got COVID almost a year before any vaccine was approved. To be honest, I was one of the luckiest people to catch the virus. I hardly had a fever. I did, however, spend hours lying on the floor too tired and nauseous to get up. I had to force myself to eat because every time I ate, I got sick to my stomach. My brain was foggy. My body drained. I didn’t feel short of breath but, breathing took more energy than usual. I thought about breathing more often than I did normally. I didn’t get diarrhea or lose my taste or gasp for breath like others did when they had COVID. Not once did I think I needed to go to the hospital because of the virus. And, as you can tell because I’m writing this, my case of COVID wasn’t fatal. And, since it was the height of COVID closures when I was sick, I hardly had to change my lifestyle to quarantine because I already wasn’t leaving the house. I was lucky because the subject I was studying in medical school at the time was easy, so I was able to study and pass my exams despite spending hours lying on the floor with my mind floating is some other universe. I was lucky because all the pieces that came together for me resulting in me not getting that sick did not come together for everyone who got COVID.

The first Moderna COVID shot was exciting. Finally, we had something to prevent COVID, that terrible infectious disease that had changed my world and threatened to make it impossible for me to study medicine. Finally, we might be able to prevent people from dying. I think I got a sore arm after that shot, nothing serious.

The second Moderna COVID shot was also exciting because it marked a completion of my duty to prevent COVID from spreading as best I could in addition to wearing a mask and social distancing. I felt like I was contributing to humanity while also protecting myself – how uncommon it is to be able to put yourself first while also helping others.

But, also, the second Moderna COVID shot wiped me out. I passed out the night after getting it. To be honest, I knew I was going to pass out, so I lay on the floor before I fell. I lay on the floor for what seemed like an eternity before the chills and nausea passed enough for me to crawl back to bed from the bathroom. That was a rough night, but I knew it’d be over in 24 hours because I wasn’t sick; my body was just doing exactly what it was supposed to do. My body was making antibodies (those protective proteins that help fight off infections). My body was responding to the vaccine. I felt awful, but still thought science was cool. I mean, we can make our bodies build defenses before we get sick—that’s kind of magic.

Recently, I got my booster Moderna COVID shot. It also hit me hard. I couldn’t sit up without feeling nauseous for at least the first 12 hours the day after I got it. All my joints and muscles ached. The feeling of the blankets against my skin was painful. It was 16 or 20 hours after the shot and two very long, hot showers; a day of maximum recommended Tylenol; and some Ibuprofen later when I finally started to feel like a tired version of my normal self. But, despite how awful I felt, the morning after the shot I was relieved because I knew I wasn’t sick. I was relieved because my reaction showed that I still had COVID antibodies. I was relieved because as bad as I felt, I knew it would pass in 24 hours. When we get sick, we don’t know how long it’s going to last. The uncertainty of illness is part of its trying nature. I’ve always like deadlines and end dates.

Everyone has different reactions to the COVID vaccines. I have a strong reaction, but by no means the strongest reaction. When I work in clinic some patients explain how fearful they are of their COVID vaccine reaction. Fear of feeling sick is valid. It sucks to be confined to bed for any amount of time. But when it comes to the COVID vaccine, it’s nice to know it’ll be short-lived. Just 24 hours, maybe 48 hours. When I had COVID my symptoms were mild, however the fatigue lasted for at least a month after the other symptoms subsided. For me, at least, feeling sick for 24 hours is acceptable knowing that I will decrease my chance of ever getting the real COVID again. I also can’t accept not being part of the group of people willing to try to stop COVID. It’s a legitimate feeling to dislike having a reaction to the COVID vaccine but, it’s a sacrifice I’m willing to make to keep COVID at bay. If it takes getting a COVID booster every year that’s a small price to pay to prevent millions more people from dying from a disease we have a vaccine to help prevent.

Ring Reflection

I held my wedding ring in my palm, feeling the weight of it. I put it on and took it off – making sure it didn’t get stuck and testing the feel of it. It was still months until I’d be able to wear it but, I liked having the opportunity to test it out. It had our favorite mountain range on it; an unassuming range that most overlook. Yet, we’d had many true adventures on that range. By happenchance his favorite mountain was on one end of the range and mine was on the opposite, with a slog of a ridge between them.

Someone asked us recently if we were serious hikers and we laughed. Serious? We’re day hikers who find trails whenever time and the fatigue of busy lives allows. Serious? We like showers, feasts, and fireplaces after miles climbed. Serious? We always seem to be bellowing Star Wars and Mighty Python quotes (between giggles) when those scarce other hikers unexpectedly find us on the trail.

My ring felt light and heavy at the same time. A simple band with so many stories behind it. I didn’t want or have an engagement ring, so the wedding ring was the first tangible reality that we were “getting hitched.” Engagement rings are not for me; though I realize for many they are a joyous aspect of their engagement. A thing I’ve enjoyed about not having an engagement ring is my interactions with people who don’t know me – what does it take for me to tell them I’m engaged? As a medical student I interact with numerous people every day, yet only some of them inspire me to share any part of my story with them. It’s an exercise in exploring exactly how humans create trust and connection during encounters the length of medical office visits. You might be amazed by the number of physicians with whom I worked for weeks yet did not tell I was engaged. Not for fear, but simply for lack of connection or reason to share that tidbit of myself.

I looked at the range as it unfolded as I turned my ring carefully. Ranges represent a journey. My fiancé and I had been on many journeys but, overall, we were on life’s journey together. Our path had thus far been calm yet still varied by ups and downs and mud patches. School had been the overarching limitation, much like a heavy pack, of our life as a couple. I’d been in school our entire relationship, and he’d been in school for most of it. We were friends for years before we started dating. In those years, we weren’t in school and had had a more leisurely approach to hiking and feasting, without the pressure of tests and hard study schedules.

We had in common a love of healthcare, yet our approaches were quite different. To be honest our brains perfectly illustrate the difference between the nursing and physician approach to patients and health. He was the matter of fact, nurturing, and patient human you’d want at your bedside hours upon hours when you’re sick. I was the curious one, driven by a desire to understand and then solve problems. I was not the one you’d want to answer your call bell as you tried to live your life in a hospital. However, I was the one you wanted examining your labs and exploring your history to discover how we might wrestle your health to a stable place. Healthcare is a culture and a lifestyle. It is terrible and amazing at the same time. These days it is more of a tragedy than a comedy, yet there remains in those of us soon to enter the field as newly trained members of the team a sense of hope. Hope that we can help. That, somehow, despite the broken system and so many brands of red tape in our way, we can improve (and maybe even save) lives. Hope is powerful.

I put on my ring, again. I looked at it. It seemed to fit. It felt weird. I was excited. I was hopeful. I looked forward to discovering how the days would unfold after I started wearing it. Like all adventures there was fear in my heart as I stood on the threshold preparing to take the first step. But, also like all adventures, I knew that the first step had to be taken. While never a nomad I’ve always been a wanderer, which inherently means I have stepped from many thresholds. Every first step was filled with anticipation and worry about what would unfold. And, yet, I have never regretted where the road took me. I often reflect on the harsh and beautiful meanders I’ve undertaken. I’ve never wished for a different journey.

I guess there’s something significant about the fact that rings are circles which have no end. A symbol of eternity. I’m a staunch believer that nothing lasts forever. I also believe that the basis of life is change. These beliefs make me curious about what it’ll look like to take some wedding vows and say that this jubilant soul I’ve decided to marry is my forever adventure partner.

My ring felt heavy, but not too heavy. I looked at the mountains depicted there. I wondered what mountains we’d climb in the years to come. What valleys we’d rest in. What ranges we’d prance along taking unruly numbers of selfies because we could. Serious hikers? Perhaps not. We’re just two people who share a deep love of the wild places and exploring them together.

Engaged

This year I got engaged. It wasn’t a surprise as it came about after countless dialogues while driving between mountains and feasting spots, while plodding along trails below tree line, while standing next to rivers, and while gazing out at the horizon from mountain tops. Like most aspects of my fiancé and my relationship, the timing of engagement was mutually agreed upon and, once decided, a joint undertaking of finding rings, figuring out the legality of things, and planning a wedding unfolded.

It’s funny to me that I’m planning my wedding as I also undertake my third year of medical school. I am a person of action, but usually my time is spent on professional endeavors. I’ve only chosen careers that are consuming, where even when the day is done the puzzles of work linger, tossing and turning in my mind as I go about the rest of my life. I’ve never considered relationships beyond friendship as required or even goals. I’ve always seen marriage as something I’d consider only if someone fell into my life who made me think of it. “Fell” being the key word. I’ve known for many years that happiness and loneliness come from within. The loneliest years of my life I was in a long-term relationship. My happiest times correlate only with my internal state. I fought hard on many occasions when I was single to be allowed to go about my business as I saw fit. And as I think about marriage, the annoyance of having to explain that I am whole without a partner remains somewhere in my skin. But, yet, as I undertake one of the hardest years of becoming a doctor, I am also signing away singleness.

My fiancé and I have discussed marriage and dreamed about growing old together since months after we started dating. There are people who bring out your happiness, who make you laugh more than most, and who force you to think about the world differently. My fiancé is that person for me. And in our short time together, we’ve weathered many storms. There was the first years of medical school – torturous as the hours of study dragged to the future. There was COVID. There were those times when we could have died in the mountains. Where we literally talked each down the cliffs, teetering on an all-to-real edge. There is this current stretch of doing the “long distance relationship thing.” There were the times we shared with family and friends, where it was so easy to feel connected. How seamlessly he fit in with my people (including when my sister and her partner lived with us for a month starting days after he and I moved in together) and how his people made me feel like family from the beginning (starting with the Thanksgiving dinner where I met his parents and everyone in the extended family all at once).

I knew it was time for us to finally start planning our wedding for two reasons. First, since our first marriage conversation we’ve wanted to get married before he follows me to residency and the clock is ticking until that time comes. Second, the realization popped into my head that I couldn’t imagine being happier with another person.

Engagement is neat in the sense that it brings people together. Our families and friends have offered advice and help as my fiancé and I embark on wedding planning. It’s such a fun thing to have a joyous project to work on. Engagement is as odd as it is neat. There are many norms about engagement and marriage which have stood out to me because I rejected them. I didn’t want an engagement ring. My wedding dress will be red. I prefer small, intimate gatherings. My ceremony must be outside. There will be no registry. There will be no escorting down an aisle.

And as I often do for my career, I’ve spent some time reflecting on marriage. I like to ponder why things are important and worth doing. My younger self often thought marriage was giving up something of yourself for someone else. I’m glad to report that that isn’t the case. Marriage is about two very different people taking on a shared adventure, where there are lots of side adventures together and apart. Marriage is just a formal way of saying “I trust you and want you to be my life-long co-hiker no matter how boggy the trail or how craggy the mountainside.”

And as he said when I read him this post, “’Fiancé’ is a weird word, let’s get married already.”

Pull Up Your Compression Socks

Some of my friends and family have asked how I study so much. Others just give me a funny look, shake their head, and say becoming a doctor is too much school. And, to be honest, I mostly agree.

And that’s were compression socks come in.

When I was studying for my first board exam (aka STEP 1 which is a 7-hour exam that lightly touches most topics in medicine from skin rashes to embryological development) I started wearing compression socks. Every day before sitting at my desk with mate and breakfast and before firing up my computer, I’d spend a few moments pulling on the rainbow or patterned compression socks I’d chosen for the day. I’d never worn compression socks before I started studying for STEP 1 – not while hiking multiple 10-mile plus hikes a week, not while working 10-hour shifts on my feet, and not while training for marathons on city streets.

But studying from well before dawn to well past dark did me in. The truth is that studying all day is terribly grueling in the most passive way imaginable. The body rebels against stillness, and my bodying not only rebelled but went to war. My calves became so tight I could hardly walk. They’d throb at night. They’d throb in the morning. My shoulders and back were full of knots. My hamstrings constricted to a fraction of their normal length. I have a standing desk. It only made my hips tight. And. Yet. The studying had to be done. To help get through the hours, I’d stretched when I could. My workout routine become very consistent because without it I couldn’t concentrate.

The compression socks fixed my calves. I discovered them by accident. My partner wears them at work to avoid varicose veins, and one day I tried on some of his socks. It was a game changer; I could study all day and my legs would be okay. Just okay, but okay was way better than terrible.

It seems a bit dramatic to say it feels like your body is going to turn to stone simply because you sit still too much. “How do you study so much?” family would ask me in the final weeks leading up to my exam. I never exactly knew how to answer. And now I realize why – because studying  in medical school is less about the “how” and more about the “why.”

Why do I study so much?

It comes down to the end. The goal. The reason I bothered to enter medicine at all. It is only knowing where I wish to go that makes studying so much that I must wear compression socks worth it. I didn’t come to medicine because I wanted to study all day. I entered medicine because curing diseases and helping people through sickness is the professional contribution I wish to make to our world. I had plenty of time before starting school to explore many different professions. But, the one that captivated me was medicine. Medicine combines puzzles, science, and true stories. I study so much because every piece of information about symptoms and labs and geography and humans is a tool that might help me understand what is ailing a patient. I don’t study because I like it, I study because I want all the knowledge tools I can fit into my toolbox brain so that when I meet someone’s grandmother, someone’s father, someone’s friend, someone’s brother in a moment when their health is faulting…I know how to help them heal. 

Goodbye For Now Vermont

It had been over 2 years since I’d set foot in the US and almost a decade since I’d lived in Vermont when I returned 5 years ago. In my time away, I’d forgotten that men might choose to grow beards, plaid shirts are stylish in some people’s eyes, and baggy pants on men (and women) are normal in some regions of the globe. I’d just come from a place where those things – beards, plaid, and baggy pants – were only seen on people experiencing homeness and overheating Peace Corps volunteers clearly out of place in the Paraguayan sun.

Yet, despite the plaid, the cold, and the lack of sun Vermont was better than I remembered it. It was nice being in a place where I was confident everyone I talked to knew how many legs a chicken has (I’ve met people in the urban US who don’t). When I arrived, I wasn’t too worried about liking Vermont. I thought that I’d just come back to start my journey to medical school and that was all. Vermont had more in mind.

I started my pre-med classes which can easily be summarized like this: I’d write a lab report then revise it until it was so boring it made me yawn. Only if I was absolutely bored reading a lab report could I be sure I’d get an A on it.

As part of the journey to medical school, I became an EMT. I remember being petrified showing up for me first EMT shift. My nerves eased when my crew chief (who’d started working on ambulances over a decade before I was born) told me in a matter-of-fact voice that the crew would not let me kill anyone. Our crew would have dinner together every shift (unless we got a call and had to jump in the ambulance). We’d talk about patient cases, science, sci-fi, trucks, and cake. We’d get 2 am calls. I learned to write patient reports in the middle of the night. I practiced finding things to talk about with anyone – an important skill when you have a stable patient and a 30 plus-minute ambulance ride to the hospital. I saw hoarder houses. I learned what it looks like when people fall and can’t get up. I saw what happens when a blood sugar gets too low. I reinforced the knowledge that drunk humans are poor historians.

After running all night (that’s what we called being on the ambulance responding to calls), I’d change into my business-very-casual work clothes and go to work. Then class. Then lab. The hours studying merged as they always do. But, as I prepared for the MCAT (an entrance exam for med school) I knew exactly who to ask to explain some of the physics concepts that weren’t sticking – the brilliant kid with the Vermont accent on my ambulance crew. He’d driven trucks almost as long as he’d been walking and hadn’t done much school. He was smart and if he’d wished to follow different stars he could have. 

“I don’t know the physics equations or anything,” he said when I asked if he could explain how hydraulic lifts work and the physics of pistons.

“That’s not an issue, you understand the concepts,” I said.

I could do pages of equations and get the answer, but it was the meaning behind the symbols and numbers I wanted. And as he drew out a dump truck to explain hydraulics, drawing to explain just as my father and step-father always do, I realized that I liked the people in Vermont more than I’d expected I would.

School, my first job after returning to Vermont, and my time on the ambulance ended around the same time. I transitioned to a new job as an EMT in the emergency department (ED). I learned how to place IVs and draw blood. I saw how the brain, heart, and bones can break. I sat with families as their loved ones died. I saw babies be born and people smile despite the unluckiest circumstances. I learned from fellow EMTs, nurses, and other key players in the ED. The ED attracts fiery spirits and I enjoyed being among them. The patients came and went – suicidal thoughts, dog bite, chest pain, weird rash, car crash, fall, stroke, homeless, ski accident, rape, stomach pain – and I learned about humanity. Healthcare gave me a new angle from which to view Vermont. I saw the stoic Vermonters I’d known growing up. I saw people who had just immigrated to this frigid, snowy state. I met people who have the lives that make up the opioid epidemic. I met folks like me and very different from me.

The people of Vermont gave me a window into medicine. I got into medical school and I decided to study at our state school.

While much of my time in Vermont has been centered on learning medicine, that is not all Vermont has been. I rediscovered the mountains and the forests. I spent countless hours walking along Lake Champlain. I heard the hermit thrush sing as I wandered in the forest. I was reminded how both loud and quiet the trees are. Between the mountaintops and the lake, I also found my life partner. We were hiking and feasting buddies at first, but life has a way of pushing the limits of friendship. I also found friends with whom I cackle and giggle, enjoy the sunset and a stroll, and who I know are standing by ready for anything when the going gets tough. And the going is tough sometimes because becoming a doctor is a long road.

Since returning to Vermont, I rediscovered why Vermonters are stubborn, fierce, loving, and independent – just spend a winter here and you’ll understand. And, while Vermont has been so much more than I imagined, I must say goodbye for now. Every time I leave a place, I can not promise I’ll return for good or stay away forever. I can only promise that the people and hidden hallows that shaped me while I was here will always be with me no matter where I am. As I look ahead to the last years of medical school, I plan to complete them in Connecticut (my Vermont medical school has a clinical partnership there).

With excitement that I’m moving once again to a neighborhood where we speak Spanish and with a heavy heart for the dearest friends I’ve left in my home state let me say, “Until we meet again dear Vermont, may the snow be deep in winter and the summer be sparkly and green.”

Resilience

Not so long ago, a couple of brilliant new medical students asked me how many notecards I do a day. “Doing a notecard” means quizzing yourself on its contents and making progress in remembering the information it contains so you can answer test questions on the topic. Talking about the number of notecards we do daily is typical shop talk in medical school—everyone is trying to figure out exactly how to learn the mountain of information that makes up medicine. Almost everyone decides early on in their medical school career that the only way to learn what we must learn is with notecards. But, what is the perfect number to do in a day?

I avoided answering those new medical students’ question about how many cards I do a day. I wanted to help but, it’s an unanswerable question. I am not a robot. If I were a robot, I’d do something like 500-1000 notecards a day. But that’s not how life works. Some nights I don’t sleep well. Some days I have meaningless meetings that take up the best study hours. I gotta eat. I gotta move my body. Some days, it’s just too sunny to stay glued to my desk. Sometimes I’m tired and I retain nothing. Sometimes I get bad news and I’m sad. Sometimes I’m sick. Sometimes I’m on fire and I cruise through notecards like a genius.

We talk a lot about resilience in medical school. Here are the typical discussion questions:

  • What is resilience?
  • Why is resilience important?
  • Can resilience be taught?
  • How does one become resilient?

Thinking about notecards led to me some answers. Here they are:

What is resilience? Why is resilience important?

Google defines resilience as “the capacity to recover quickly from difficulties; toughness.” With that definition, it’s obvious that when you’re doing very challenging things like learning medicine it helps to be resilient. Becoming a doctor is a long process and you’re guaranteed to make a lot of mistakes. The only way you’ll make it to the “end” is by becoming an expert in self pep-talks and getting up when you fall.  

Can resilience be taught?

I don’t think so. Not once, ever, has any class, piece of advice, or discussion made me better able to endure a hardship. Every hardship I’ve endured was because I decided to bear it. I had family and friends who supported me along the way, but the healing and “how to do better next time” was mine alone to formulate. But, while I don’t believe we can teach others resilience, I do believe that resilience is learned.

How does one become resilient?

We become resilient by being challenged. The folks who are most resilient are the ones who have endured the most hardship. That’s not to say all people who have faced many obstacles are resilient; it’s just to say that you can’t be resilient if you never face a challenge. If you’ve never failed or been hurt than you can’t know what it’s like to dust off the dirt from a fall and try again. Without challenge, you can’t learn how to adapt your plan as life unfolds new surprises.

This principle is the basis of the answer to the notecard question I was asked. How many notecards do I do a day? I have NEVER, not once, done as many notecards as I hoped to do in a day. Yet, I have passed all my classes comfortably. In fact, not only have I never completed as many notecards as I wanted to…when I started medical school, I didn’t use notecards. Not using notecards was a grave mistake. When I started using them my grades improved by about 5% and, for the first time in my medical career, I had time to exercise, sleep, and socialize a sustainable amount. I switched to notecards ¾ of the way through my first semester of medical school. I was terrible at making notecards. But, I gave them a fair trial because I knew how I was studying before notecards wasn’t working. I had two choice at that point: sink or swim. Swimming involves adaptability. I decided I would rather be an otter than a rock in the deluge that is medical knowledge.

Deciding to use notecards may seem trivial until you consider that I’ve bet around $100,000 (so far) on becoming a doctor. It seems trivial except when you consider that it took me 6 years (of work) from the time I decided I wanted to become a physician to the day I got to decide how to study my medical school material. It seems trivial until you realize that I still have at least 5 years, probably 8, and many licensing exams between me and practicing medicine. The stakes are high. I could have failed upon switching to using notecards. But, I thought it was worth a try and I knew I would fail if I kept up what I was doing.

This past exam (fast-forward to my second year of medical school) was the first time I finally studied all the notecards I’d made for an exam. It’s been a little less than a year since I starting using notecards to study. I’m way better at using notecards than when I started. But, my journey isn’t over. This spring I take the biggest exam of my life (my first board exam – a national exam everyone who becomes a doctor must pass). How well I do on that exam heavily influences what residencies I can apply to and, ultimately, what type of doctor I’m allowed to become. It’s scary. My daily notecard count is only one part of how I will prepare for that exam. The number of notecards I did daily last year, over the summer, and now is different. How many notecards I do today will be different from how many I do each day when I’m in the middle of studying for that looming board exam.

What challenges and failure come to show us is that things can be done in many ways. They also show us that we can only control ourselves. For example, I can’t change how much information I’m expected to know for an exam. I can decide how to learn the information. Resilience is not complaining about something that never could have been. It’s about deciding to make your dream reality. It’s about jumping into the flood, scared out of your mind, with a willingness to evolve until you get to where you’re meant to be.