5 Years Later – Quiet Moments

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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

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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

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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?

The Rhetoric of -est

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As Mother’s Day whizzed by and we race toward Father’s Day I am reminded of one of my favorite Mother’s Day Facebook posts (posted by a fellow Peace Corps volunteer on one of the Mother’s Days we were in Paraguay). She wished her mother a happy day and stated that she didn’t believe she needed to call her mother “best” to tell her how much she loved her.

The post made me think. It is tempting and common to say “the best mom or dad” or the “coolest” or the “kindest” or add “est” to the end of any description we’d like to use for those we love. But, if there is a “best” it implies that there is a worst and that there are many almost bests or not bests.

Ever since my colleague’s post, I’ve actively avoided the description “best” for anyone, even though it is tempting. I don’t think we need to rank humans or suggest a hierarchy as a means of showing someone we love them. I also don’t think there is such a thing as the “best” mom because no two moms are the same.

I believe language shapes our thinking and if we focused more on describing individual’s good traits without comparing them to others we might create a society with fewer divisions based on arbitrary markers and we might be more likely to recognize the good in humans. Is it a stretch to say how we talk about people will change how we view them? Maybe, but I will argue that framing theory supports my hypothesis that the words we use to describe someone shape how we view them. You can test it though. I dare you to change your rhetoric about people in your life and see if it changes how you view them over time. Try a longitudinal study over 3 years. Report back in 2022, I’ll be here.

Q-tips and Time

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The road between my father’s house and school had a stretch with small, rolling hills. My father would always speed up the ups so that our stomachs would drop on the downs of the hills. One day, halfway through the hills, we got stuck behind a Q-tip (that’s what we called elderly drivers because all you can see over their car headrest is a white tuft of hair). The elderly driver was going so slowly we didn’t get to enjoy the hills. My sister and I groaned.

My father said, “Do you know why old people drive so slowly?”

“No,” I said, rolling my eyes.

“Because time is moving so fast for them that they feel like they’re moving quickly. Think about it. Each second is a smaller fraction of their life than yours or mine,” he said. “Time seems to go faster as you get older.”

I shrugged then. But, a decade and a half later, I find myself wondering why time runs away from me. I sometimes drive slowly because I feel like I’m rushing even when I have nowhere I need to be. I’ve come to understand what he meant—each second that passes makes every subsequent second a smaller fraction of my life. Funny that time, that constant meter we trust to measure and organize our lives, feels so inconsistent.

Peppermint Patties

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When we were young, we usually went grocery shopping with our parents. When my mom took us, we were always allowed to pick out a treat at the end to enjoy on the journey home. My sister and I always mixed up what we got—sometime chocolate, sometimes liquorish, sometimes something completely different. My mom always got a peppermint patty.

Since becoming an adult, I usually grocery shop alone. I almost always get myself a treat for the trip home. I still mix it up, but when I can’t decide I get a peppermint patty.

Not so long ago, I visited my sister in New York City. She’s lived there many years. She and I are still very close, but our lives have taken divergent paths. We grow more different as time passes. We went grocery shopping for snacks during my visit. My sister paid. When we checked out, she grabbed little peppermint patties for each of us. I guess she chooses peppermint patties too. It made me smile. We are different and similar, nothing will change that because we have too many shared roots.   

On Flowers

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I love flowers. They are beautiful. They are transitory. You usually can’t eat them and they really have no practical purpose. They brighten a room.

The moment flowers are given to you is always special. The moment you buy your own flowers is a personal reward—a reminder that sometimes it’s okay to just enjoy some color without reason. Giving flowers is like giving someone food…expressing caring without giving them another material burden they’re expected to make room for in their home. Some complain that flowers, because of their short lives and lack of function, are pointless. I disagree.

I’ve found that the best things in life—passing time with family and friends, a hug, a kiss, solving an annoying problem that’s been nagging you, uncovering what is ailing a patient, baking the perfect cake, enjoying a mountaintop view, for example—are all short-lived. There’s something in the requirement to be present or you’ll miss it, to live the moment and know you’ll never get it back, that makes these things special. Flowers make you pause and be there with them for a short time. They require that you make time, even only moments, to see, smell, and feel them. They let you feel appreciation, love, and gratitude for just a fleeting moment. A fleeting moment is better than no moment. In fact, life is made up of fleeting moments. Why not let them include flowers?

The Snowy Paths of the Brain

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Imagine a scenario in which there is a steady snow. In this hypothetical, the snow never stops and it has already accumulated several feet on the ground. In this place you have a house, a barn with animals, and a woodshed.

Imagine it is a day filled with the regular chores of a house and barn in Vermont. The first time you trudge out to the barn in the morning it’s hard to blaze the path through the thigh-high snow, but as you go out again and again—to feed the animals, to give them water, to collect eggs, to clean out the stalls—the path becomes more packed and easier to travel with each pass. Even though it’s snowing, the path between your house and the barn stays well-groomed because you travel it so often.

Now, imagine you have to get wood for the woodstove. You start down the well-defined path to the barn and, then, veer off into the snow to go to the woodshed. The first time you go to the woodshed, it’s a tough slog through deep snow. Subsequent trips are easier. You only need to get wood once over the course of the day, even though it took you many trips to get it, so hours after collecting the wood the trail you made is starting to disappear under fresh snow. By bedtime, the path has completely disappeared because you didn’t retravel it that day.

The pathways in your brain are like the trails between the buildings on the snowy property described above (credit for this analogy goes to my anatomy and physiology professor this semester, Dr. Matt). As children, we are building many pathways while at the same time eliminating unused pathways. The amount and rate of forming new pathways and connections in the brain slows with age but, even when we’ve lived long enough to be wise, our brain continues to reshape itself. The formation of new pathways, strengthening of others, and pruning (eliminating) of infrequently used routes in the brain is called “neuroplasticity.”

Neuroplasticity, the resiliency and reshaping of our brain, is one reason researchers worry so much about children who don’t have access to many learning opportunities or live is stressful family situations. These experiences, or lack of experiences, shape the children’s minds for the rest of their lives. It’s easier to be ready for the learning done is school, if before you start your brain is used to hearing stories and practicing words and math. It’s easier to be ready for more school and job responsibility if you were lucky enough to master elementary school. It’s easier to know how to be confident, happy, and kind if you’ve experienced those things many times.

Neuroplasticity is also part of the reason why drug addiction is considered a disease and is so difficult to beat—drugs can change the pathways in our brains. Once someone is addicted to drugs, their brain is literally wired to want, seek, and (even) need the drug to function normally. It’s hard to avoid a path you know well and that has become central to your existence. For example, how often do you change the route you take to work everyday?

Neuroplasticity is also more general in a way I find inspiring. To me, it’s evolution’s way of giving us one more reason to be hopeful. The idea that we can reshape our brains if we’re will to trudge enough times to forge a new connection is awesome. It’s also amazing that if we try hard enough to stop using a pathway, it will weaken. This gives us fantastic opportunity for life-long learning and self-growth. It means we can train ourselves to understand new things, act differently, and even alter our response to specific situations. It means that we can discard habits and build new ones if we are willing to put in the energy to tackle the snow of our mind. Life isn’t static and I find it inspiring that we (individuals) need not be either.

What You Look for Is What You Find: Look for Strengths

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Not so long ago a friend and I were discussing our workplace culture, the individuals in it, and how the people scheduled to work on a particular day determined how hard the day will be (because some people work more than others). It was a discussion after too many hard hours; we were tired and burnt out. We started spiraling down the path of complaining about everything. Halfway down the trail, I paused to remember that all things are a matter of perspective.

It is easy to complain about coworkers. To gripe how so-and-so doesn’t do or know enough or how they make our work lives harder. Sometimes all we need to do before we can move on is vent, which is productive, while other times we get caught fixating on what makes a particular person terrible, which solves nothing.

I believe anyone can change, and everyone does, but only when they want to change and only when they’re ready. As such, we each can defend ourselves and what we believe in, but expecting others to bend to our will is futile for enacting change in my view. I have NEVER seen anyone work harder after I wished they did. On the flip side, I have seen people work harder when complimented on what they do well and asked to join in the fray when they were surrounded by good examples. This is where perspective comes in. Before you can complement a peer or ask them to do something you know they’ll do well, you must know their strengths. The only way to notice strengths is to look for them, which requires quite the opposite type of astuteness used to identify weaknesses. 

We can’t avoid noticing when others seem to be slacking while we are working too hard. But, as we muddle along, we can also strive to notice if those same slackers do a particular thing well. Once you notice a strength in a peer, you can look to and rely on that person to step up in situations where their strength is vital. This is particularly helpful if their strength is a weakness of yours or if they like tasks you dislike because it transforms a colleague that you found difficult into a resource. We are stronger when we play off each other’s strengths, rather than focus on each other’s weaknesses. Of course, noticing strengths doesn’t negate the wearisomeness of having to pick up another person’s slack or negate a personality clash, but it does lighten the burden and give us an avenue to find common ground. You will see what you look for, so I strive to look for the good. When I get derailed, I vent and, then, try again. Usually, I can find something wonderful within any human. I bet we all can if we try.  

Why I Go Back for Each Shift

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Not long ago, I walked into an emergency department room (a cube defined by some walls but mostly curtains) to place an IV. An elderly man was on the hospital stretcher. He was there with his son. I began my normal banter—introducing myself, explaining why I was there, and narrating what I was doing as I went. The man might have asked me about my name, about 30%-50% of patients do because it’s unique. He might have asked about my necklace, it’s a wolf and about 25% or so of my patients ask about it.

“I’m going to raise the bed so I don’t have to stoop,” I said. “I need my back for many years to come.”

The patient and his son laughed. “You know what you need, music. Do you listen to music?” the patient asked.

“Not here, it’s not the right place. But, I like to dance, so I do listen to music,” I said.

“My wife liked to dance. She died a year and a half ago,” the patient said.

“I’m sorry to for your loss, sir,” I said.

“We were together 60 years,” the patient said.

“That’s amazing! I don’t think I’ll be with anyone for 60 years at this point. Did you take her dancing?” I said. I maintained a jovial tone because he seemed merry when he mentioned his wife and dancing.

“I did,” the patient said. I looked down to find him crying. I paused and put a hand on his forearm. Giving him a squeeze. I’d recently visited my grandmother. A big part of our visit was discussing how my grandfather, who’d died 2 years prior, was still with us.

“How lucky she was to have you take her dancing! How amazing it must have been to have had so many years together,” I said.

“Sorry, I always cry when I think of her,” the patient said. He half-shrugged and looked away.

“It’s okay. She’s with us still and you’ll see her again, sir,” I said.

“I hope so,” the patient said.

“I know you will,” I said.

The patient and his son nodded. The tears ebbed. I placed the IV. All humans have stories. Sometimes they find space to share them when they visit us in the emergency department.