The Snowy Paths of the Brain

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.

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

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

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.   

The Sunny Side

Last week I flew to Chicago for my last (most likely) medical school interview. I had the window seat on the plane and, surprisingly, wasn’t sleeping as we approached Chicago. I was excited to spend 24 hours in the city and get a feel for a place I hardly knew. I gazed out the window as we started our decent.

Before we decreased our altitude, we zipped along above the clouds, through a bright blue sky with sparkling sun. A thick layer of clouds was below us. The view of bright blue above white divided by shining sun rays conjured images of every version of “seeing the light” imaginable—end of the tunnel, heaven’s gates, nirvana…to name a few. The clearness and stark lines between the blue and white were beautiful.

Slowly, the plane’s path dipped so that we began to approach the clouds. We must have been far above them because it took us a while before we got close to the wall of white. I knew the clouds were a penetrable, gaseous/small particle entities, but they looked solid and impassable. We approached them quickly, and soon the sunny view of blue was obscured and the windows were masked in white. We were in the middle of the clouds and there was nothing to see.

Our journey continued rapidly and, in no time, we were below the clouds, a snowy and gray scene was visible below us. The sun seemed to have vanished, leaving a stark winter city scene. There were no leaves on the trees and the buildings added to the gray of the air between the land and the clouds. It looked cold and brooding. If I hadn’t just observed the sunny blue above I wouldn’t have known it could exist in the same place as we now were.

I smiled as I stared at the houses and streets, a bird’s eye view of the cityscape. I guess it’s just a matter of knowing where to look to find the sun. I held the vision of sunlight within me as I caught the train from the airport to where I’d spend the night before my interview and school tour. I’d been nervous before starting my trip, but I wasn’t anymore. I felt lucky.

Mental Health and the Emergency Department

Checking into the ED for a psychological complaint

When a person comes to the emergency department (ED) with suicidal thoughts or another mental health state that could be a threat to themselves or others (ex. extreme paranoia, homicidal thoughts, mania, etc.) the processes is simple. They change into paper scrubs and their clothes and belongs are locked in a secure closest, returned upon their discharge from the hospital. A hospital staff member sits outside of (or just inside) the person’s ED room conducting constant observation—which includes observing the patient at all times and recording their location and general behavior every 15 minutes. The constant observation is to ensure that the patient does not try to hurt themselves, try to leave, or try to hurt anyone else during their ED stay. Many people who check in for psychological evaluation are not allowed to leave the hospital until their mental condition has been cleared by a psychologist, meaning they are forced to stay in the ED until a doctor says that they will be safe returning to society. Patients suffering from psychological conditions that require more treatment than the ED can provide remain in the ED until a bed in a specialize treatment facility (or in the hospital psychology unit) opens.

One way to define “a national mental health crisis” in the US

When I think of a mental health crisis in the US, I think of all the people stuck in the ED waiting for a psych evaluation and then waiting for a bed in a facility that specializes in psychological treatment. I think of the patients who remain on lockdown in the ED for 100s of hours because if they leave they might knowingly or accidentally hurt themselves or someone else. These patients have no other safe place to wait for an in-patient bed. I think of the people who come to the ED and, even under the watchful eye of our staff, try to kill themselves. I think of the people who end up in restraints, literally tied to a bed, because their condition escalates to the point that they try to escape, attack hospital staff, or harm themselves. To me, the mental health crisis in the US is that we don’t have enough 24-7 services and specialized treatment facilities to keep patients with mental health conditions out of the ED. To me, mental health is just like any other aspect of health. We need to bolster our programs to help prevent acute mental health problems, but we also need adequate mental health treatment programs for those struggling with psychological conditions. The crisis, I think, is a lack of preventative care and readily available treatment, not the existence of diseases.

The ED does welcome mental health patients as we do all patients, but the ED is not equipped to find long-term solutions for any health condition. It is true that the ED can help with acute symptoms, which is all some patients need for a short period of time, but we don’t have a calming environment nor do we have the staff to provide intensive treatment for mental health conditions. We serve as a gatekeeper to specialized treatment and as a place to go when there is nowhere else to go. Just like the ED is not an appropriate place to perform and recover from surgery, it is not the right place for those who need in-depth evaluation or long-term treatment. The ED was designed to keep patients for ideally a few hours or, at most, for part of a day before sending them home or to an in-patient facility. But, what happens with some of our gravely ill psychological patients is that they must stay in the ED for days, even weeks, because there are no openings in specialized facilities.

Conclusion

Using the ED as a long-term home for people suffering from psychological conditions is neither therapeutic for them nor is it a cost-efficient design of the health care system. We need more mental health treatment facilities in the US. We need more programs designed to help those coping with mental health conditions manage their symptoms at home. We need more people going into the psychology fields and social work. In summary, we need to dedicate more resources to mental health in the United States. I think to do that we need to start by acknowledging how many people struggle with mental health and how weak or absent our treatment options currently are for those people. Next, we need to make mental health a budget and policy priority at all levels of government and in private health care systems. Right now, EDs are serving as the catch-all. They are not the solution. While the ED might be the right place for folks in any kind of acute health crisis to go initially, the ED only works if there are specialists and specialized facilities to refer our patients to once we’ve identified the sustained medical care they need. It’s times we prioritize mental health as we have heart health, lung health, and cancer-free health so that no patient is held in the ED because they have no other safe place to go.  

Closing 2018, Opening 2019

If I had to pick one word for 2018 it would be “success.” I finally got a job taking care of patients, this officially marked my transition from a communications career to a health care one. With each passing day, I grow more certain that I’m headed in the right career direction. I finished my pre-med requirements, took the MCAT, applied to medical school, and got into several medical schools. I made some awesome new friends and visited some of the best long-term ones. The farthest friend visit was to my beloved Paraguay (I also visited friends in DC and Atlanta).   

This New Year’s finds me at a crossroads. In the coming months, I will decide where I will go to medical school. I feel incredibly lucky to have options, especially because I only applied to schools about which I am excited. The cost of school and if I should move to a new state weigh heavily on me. Starting the next chapter in the doctorhood quests is simultaneously overwhelmingly exciting and completely petrifying. But, change and moving are nothing unusual for me.

Earlier this year, I wrote about “name the fear and conquer it” as my general approach to life. A huge part of that is identifying when I’ve fallen into a mindless routine and, then, breaking that routine. I’m the type who as soon as they learn something new looks for how to become better and how to expand my knowledge. I think this trait will serve me well in medical school. It’s served me well in everything else I’ve tackled. But, as I think about these traits and the exciting goals that are coming to fruition this year, I find myself thinking that my biggest New Year’s resolutions have little to do with my career ambitions and a lot to do with the rest of my life.

I have high expectations and hopes for myself as I begin medical school, but I know I will put my best self forward in pursuing those regardless of my New Year’s reflection. Therefore, as we slide out of 2018, my New Year’s resolutions are to focus more on relationships and adventure. In that vein, here are my top 5 resolutions:

  1. Do a better job of staying in touch with old friends, family, and contacts even in the midst of school mayhem. This may include taking more time to visit friends who live far away, writing letters, texting, emailing, or social media-ing.
  2. Focus on developing new friendships. The challenge for me is always ensuring I leave enough time to spend with friends even when school work crescendos.
  3. Travel outside of the country, to a new place, at least once in 2019.
  4. Travel or visit somewhere new (even if it’s a day/partial day trip) at least once a month.
  5. Join some initiatives/groups that don’t directly relate to my budding career in medicine. Ideas I’ve pondered before or relate to interests I have include: joining a gym (I currently workout at home), ballroom dance classes/club, hiking club, book club (currently in one), or writers’ group; taking a yoga or martial arts class; becoming a youth mentor; and/or joining a choir.

Besides the New Year’s resolutions, I plan to continue my daily struggle to smile more, see the best in people, and be the kindest person I can be. I wish you the best of luck in 2019—I’ll be taking it one day, one week, and one month at a time. Happy New Year!

Below the Surface

A pre-holiday Paraguay visit is to blame for the blogging hiatus this December. It had been 2 years since I last visited Paraguay, the country where I lived for 27 months while serving as a Peace Corps volunteer. My Paraguayan friends were amazingly generous. They fed and housed me. They brought me on adventures around their lovely country. We spent hours chatting and eating—recalling old times, catching up on times spent separately, and dreaming about the future. I was reminded of how easily Paraguayans show affection—through food and time given to others. I was reminded, as I’ve been hundreds of times, of how lucky I am to have stumbled upon my Paraguayan community and how spoiled I feel to enjoy the company of my Paraguayan friends.

During this visit as I walked back from church one evening, after attending the celebration that marked the closure of the Christmas in Families (which is where people go to family homes to share passages from the Bible and prayer for 9 days in the month leading up to Christmas), I was reminded of a story shared at my favorite Paraguayan mass years ago. I don’t remember the occasion for the mass or who gave the sermon, but I remember the story the priest shared. I think, regardless of religious beliefs, it reminds us that we must look carefully and patiently to see what’s hidden below other’s facades. It’s what was hidden below the surface that made me fall in love with Paraguay. It was the journey of looking deeper at the land of Guarani that taught me resilience and showed me how to find hope no matter the circumstances. Here’s the story from that mass:

A Ride in a Car

There once was a young man whose rich brother gave him a fancy new car. The young man was so proud of his car, he loved to drive it all around town. One day, the young man had to park his car in a poor neighborhood while he was running an errand.

As the young man walked back to his car after finishing his errand, he noticed a boy circling his car. The young man worried that the boy was trying to find a way to enter or damage the car. The young man hurried to his car and asked the boy what he was doing by the car.

“I’m just looking at your car! It’s so nice. I’ve never seen one like it. I hope one day I will have a car like this one!” the boy said.

The young man explained that his brother had given him the car. “Wow!” the boy said. The boy and the young man talked about the car at length. The young man scolded himself for thinking the boy had been up to no good.

“Since you don’t have a wealthy brother to give you a car, would you like to take a ride in my car with me?” the young man asked the boy after they had talked for some time.

The boy jumped with excitement and jumped into the car. They drove a little way, then the boy asked if the young man could pause in an alleyway because the boy had to deliver a message to someone. Once they stopped, the boy asked the young man to wait for him to return, promising to be right back. The young man agreed to wait for the boy, but again had doubts. He wondered if the boy was getting someone to help him steal the car. The young man waited nervously, thinking of all the bad things that could happen. He thought about leaving before the boy returned, but something made him wait.

After several long minutes, the boy appeared in the doorway of a building in the alley. The young man squinted, the boy had something in his arms. The boy approached the car. Once the boy was close to the car, the young man noticed that the boy had a sickly, disabled child in his arms. “Sir, this is my brother! Can he take a ride in the car too? I want to show him the car. I have just promised him that one day when I am rich, I will buy him a nice car just like yours.”

The young man agreed to take both boys for a ride. The young man scolded himself not only for distrusting the boy, but for thinking the boy was envious of his car.

Friends Forever

I’m an introvert and a dreamer. As an introvert, I have a few close friends rather than a large circle of lukewarm friends. I think of my friends often, like to know them well, and consider them family. Being an introvert also means that I like to have a large dose of time alone. When I’m alone I daydream about the escapades I’ll go on throughout my life. As a dreamer, I think of solo quests and I hash out perfect adventures to go on which each of my friends, knowing every friend’s unique virtues and nature.

Each period of my life has given me one or several wonderful people to add to my friend family. These days, I’ve been thinking a lot about friendship–largely because I’ve stumbled upon some outstanding new friends. But, also, it’s been a long time since I’ve visit some of my friends who live far away; I’m thinking I might move in the next year; and I’m visiting Paraguay soon. Friends of my past, present, and future geographic locations are always on my mind.

Whenever I think about friendship, I remember a conversation I overheard 3 years ago. I’ve decided to repost (again, it’s not the first time) because it’s my favorite description of what true friendship is. While not everyone believes in Heaven, I think the lesson this scene teaches is universally applicable.  

Overheard in Paraguay: Friendship
Repost from October 19, 2015

We sat in a half circle around the grill. The men were cooking large slabs of meat (ribs and some unidentifiable cut) for the mother of the family’s birthday dinner. The husband of one of the birthday mother’s daughters sat by the grill passing one can of beer among the men there. A nephew walked up to the daughter’s husband. The husband was around 30 and the nephew was about 11.

The husband hugged his nephew first with one arm and then the other, squeezing him. The nephew squirmed, and they both smiled. The husband held the nephew at arm’s length and put on an almost serious expression. “Will we always be friends?” the husband asked.

“Yes,” the nephew said.

“Even when I am old and you are my age?” the husband asked.

“Yes, even when you are old and I have kids,” the nephew said.

The husband smiled and pulled the nephew into another hug. The nephew pulled away again and they looked at each other, the husband still squeezed the nephew’s shoulder with one hand.

“Even when you are in Heaven and I am old we will still be friends,” the nephew said earnestly.

The husband laughed. “And I will look after you from Heaven.” They hugged again. “And, when you come to Heaven, we will be friends in Heaven. We will be friends forever.”

The boy nodded and ran off to find his playmates.

Countdown to Visiting Paraguay

It’s been 2 years since I last stepped foot in Paraguay, that little country at the heart of South America where I lived for 27 months as a Peace Corps volunteer. But, I’m going there for 2 weeks this December. It’ll be the second time I’ve gone back to visit since returning to the US.

I find myself falling into a reflective mood as I think about the long journey south. My trip comes at the best time, when snow and cold have descended on Vermont. I need a break from winter even though it’s only just arrived. I’m reflective because I’m a very different person than the one who left Paraguay almost 3 years ago. I won’t bore you with the details of thrusting myself into pre-medicine and the whirlwind of building a new life in Vermont, both adventures that have consumed my time since I moved back to the States. What I will say, however, is that I’m excited to see the red dirt of Paraguay again. I look forward to their fatty foods. And most of all, I can’t wait to sit with the Paraguayans I call my family and friends and discuss the weather and life…and crack jokes. Often, the jokes are about my singleness or professional focus (aspects of my being that are particularly distinct from the Paraguayan way of life) but not always.

Many of the kids I taught in Paraguay have graduated or are soon to graduate high school. I see their Facebook photos of college study and adult life. Many of them have lost parents to illness. Some of those parents I knew and spoke to on my almost daily walks to the school. Many of my students have their own babies now. Few are married yet.

Some of the elderly women I used to spend the afternoons with have passed away since I last visited. Others, I’m not sure if they’re alive because they don’t have cell phones. What I know is that the señoras in my Paraguayan community will welcome me into their homes with just as many smiles and just as much generosity as they did when I was their neighbor. Those women took me in as their daughter. I think they were always torn about what kind of daughter was. On one hand, I didn’t know anything about the right way to navigate life in Paraguay, but, on the other hand, I knew how to travel from my country to theirs and I have so many dreams and goals.

In many ways life in Paraguay is the same as here. But, as I think about going back I’m also reminded by just how difference it is. The food and smells—meat and real animal fat mix with the smell of live chickens, pigs, and cows who idle close to the houses. The topics of conversation vary, but there is something unique about the gossip of families who have lived by one another for so many generations no one remembers any other place they called home. They speak in a mix of Spanish and Guarani (the indigenous language); the sounds of those languages together bring back many memories of the best two, but also the hardest two, years of my life so far. The soundtrack of Paraguay is different—the rhythms of bachata, polka, cumbia, and reggaeton fill the air on hazy, hot weekend days and weekday nights.

In many ways, Paraguay has the indomitable nature of never outwardly changing in any significant way, just like my home state of Vermont. But, just as Vermont, there are the subtle differences of life moving forward. One of my dearest friends has returned to law school (she’s already a lawyer) for a specialty degree and she is now a mother—both new accomplishments since I last saw her. Another friend finished his military training and now works for the Paraguayan Navy—he still visits his family’s home whenever he gets a stretch of days free from duty. Another friend started a local clothing store. All of us are older than we once were. The babies I knew when I lived in Paraguay are now children. The children are almost adults.

As I drink my daily mate alone in Vermont, I often think about my Paraguayan friends. I miss them every day. I miss them because no other people I’ve encountered is so good at sharing time with each other. So good at making you feel welcomed and loved. Their culture has built in values and rituals that allow friends and family to sit together and share a drink or a meal without any other obligation. I miss my Paraguayan families because they are so good at seeing the bright side of everything. So good at ignoring the bad things that happen, almost to a fault.

The nostalgia I feel for Paraguay is one where all the bad aspects of living there are forgotten and I remember only the good. Of course, both the light and dark sides of Paraguayan life will confront me when I land again in that country…but somehow that doesn’t bother me.

I remember the first time I flew to Paraguay, not knowing what awaited me there. It was exciting and petrifying. This time when I go back, I know the communities and families who will greet me again with open arms. I can’t wait to see them. I can’t wait to eat chipa and sip terere in the shade of tropical trees because it is absolutely too hot to do anything else. I can’t wait to walk around my old community and say “hi” to every human I pass because that’s the Paraguayan way. I can’t wait to be reminded there is more than one way to live life, none better or worse than the other, just different.

5 Things I’m Grateful for this Holiday Season

This was a big year for me. I finished my pre-medical classes, took the MCAT, applied to medical school, and then I got into medical school. My youngest brother graduated college. My grandfather was buried in Arlington National Cemetery. I got a new job in the emergency department where I get to spend most of my day caring for patients. One of my dear friends had her first baby, and I’ll get to meet him this December (because I’m visiting my beloved Paraguay!!).

The laundry list above is just a sampling of the year. I’ve also made some great new friends, met some amazing people, done a tiny bit of national travel, and spent good hours learning new things. I could fill pages about the year, but I won’t just now. Instead, as the holidays approach, here are 5 things for which I am grateful:

1) My family who made it possible for me to get into medical school. They’ve listen to me gripe. Told me to stop whining and act. Shared my excitement for small victories. They’ve cooked, visited, hosted, taken me out to dinner, pitched in when I was in a pinch, made me laugh, talked me off the edge of tears, and helped me keep going when I wasn’t sure if going was an option.

2) The friends who stay in touch even though we live lightyears apart in separate, though equally chaotic, universes. The new friends who have joined me in sweating over biochemistry, hiking through Vermont’s woods, undertaking food adventures, and soaking in the quiet moments of life. The hardest part about moving as much as I have is that many of my favorite humans live far away. It’s a testament to their greatness that despite our distance they remain a positive force in my life.

3) The folks at my new job who reminded me what being part of a good team feels like. Who taught me the tricks of a new trade. Who show up every shift ready to do what needs to be done and between saving lives have energy for a smile or laugh.

4) The mentors and teachers who taught me all I know about medicine and science. But, also, my life mentors—the ones who have been there since undergrad (or before), the ones who’ve shown me the ropes of being an EMT, and the ones who set an example of what kind of old person I aspire to be.

5) Vermont. Sometimes my little home state is cold (actually, it’s usually cold). Sometimes Vermont is too homogenous and too isolated to quench my love of the new. But, this year, I’ve basked in perfect summer days where the sun is just right. I’ve soaked in the smells and silence of the forest and absorbed the wind that makes waves on Lake Champlain. I’ve reflected on the mountains that guard the horizon. I’ve enjoyed creemees, apple orchards, and maple syrup. I’ve watched the rain fall with mate in hand. I’m from Vermont. And while I don’t often call Vermont my home, it is the place where my roots have always been and always will be.

I’m grateful for the moments I’ve had to enjoy all the people and places that make life worth the sweat. I’m thinking about those moments as the holidays approach.