Goodbye 20s

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

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

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

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

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

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

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Last Day in the Emergency Department (for Now)

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

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

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

Making It

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

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

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

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

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

Peppermint Patties

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

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 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.

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.

Marathon Goals

I remember the conversation I had with my best friend that sealed my desire to become a doctor. We were in our relatively new apartment, in the living room that was an extension of the kitchen. The city sun of Washington, DC filtered in the large windows and onto the bedraggled plants we had lined along the window sills. I’d been contemplating the idea of entering medicine for months. The thought came to me shortly after I started working in health communications. What I liked most about health communications was the medical research, knowledge of life, and opportunities to interact with people. I wanted to find a way to fill my days with those things rather than dabble in them. My friend worked in a primary care office, on the administrative side. She encouraged me as I talked about possibly switching careers. “You’d be a good doctor,” she said. Thus, began my marathon goal to become a doctor, a process I call “the doctorhood quest.”

That conversation was 5 years ago. Recently, what started as a thought became a real possibility. I’ve been accepted to medical school. There’s still the question of financing and survival, but with an acceptance to school, there is hope that the rest of the journey will fall into place. I will be a doctor.

Marathon goals. I’ve always been a planner and as a runner I prefer long distance. But, there is something uniquely challenging about making goals that will take over a decade to accomplish. There is no way to know the future, and absolutely no way to predict a future as distant as 10 years from now. But, somehow, the uncertainty and hidden challenges that the doctorhood quest presents have not deterred me. I reflected on the prospect of doctorhood during my years of Peace Corps service and, once back in the States, I started jumping through the hoops of medical school applications (I had no science background when I began). The long wait to medical school acceptance has only made me more excited to start my studies. The doctorhood quest isn’t even half over—medical school, residency, and board exams will be the longer leg of the journey. Yet, as I sit on an acceptance letter and wait to hear back from more schools, it’s thrilling that I’ve come this far.

People around me, to me or to others, often comment on how intelligent one must be to get into medical school. I usually remain silent, but smirk inwardly. I believe “smart” comes in many forms and not all are suited to medicine. I’m disinclined to suggest one person is smarter than another because life has shown me that humans have different gifts and society needs all of them to function. But, more specifically, my journey has shown me that medical school admittance has less to do with how smart someone is and more to do with how resilient they are. The doctorhood quest requires you to be gritty and determined. It demands that you jump up and try again each time you fall while tackling the perils of the road.

If resiliency and grit is the secret to pursuing marathon goals without losing hope, how does one get those? Experience and inward reflection are my guesses. We learn by doing and we expand our scope of understanding the more different experiences we have. Nothing proved this more to me than my years in Paraguay. I am not the same person I was when I first stepped off the plane in that hot, humid country. The people there showed me how they found happiness; they defined respect and God and love in ways completely different from any definition I’d ever encountered for those things; and, above all, they exposed me to foods, ways of life, and shared moments I could never have imagined.

Experience is the foundation for growth, but to truly grow one must reflect on those experiences. Paraguay, once again, taught me reflection. It is impossible to describe just how lonely and hard it can be to be the only one from your culture in a foreign place unless you’ve experienced it. Your world is turned upside-down and every definition and rule you ever thought was a given is no longer in play. Your default becomes mild confusion and curiosity about the new culture in which you have fallen. Most importantly, you are forced to examine how your culture does things and why. Once you start picking apart your host and native cultures, it’s an easy, logical jump to start evaluating and thinking about different aspects of your personal life—like your interactions, feelings, and activity choices. Once you build in time to reflect on experience you can start to shape your path more purposefully.

The secret to marathon goals is accepting you can’t know the future, but you can influence the present. The secret is celebrating small victories, making educated guesses about the best course of action today, and seeking out the people, places, and experiences that rejuvenate you when your hope falters. We do not achieve marathon goals alone (it takes many helpers) but it is only from within ourselves that we find the strength to withstand what’s hidden behind each bend in the road.

Golden Leaves and Golden Sun

Autumn in Vermont is like a pendulum; it swings between cold rainy days and bright sun that reflects off the yellow, orange, red, and brown leaves soon to fall off the trees. The damp days and frost-laced evenings are a prelude to the winter soon to come. The strong sun on the loveliest days of October is not only a reflection of the summer just past, but also particularly appealing because it contrasts with the brisk wind and cool damp air inherit of autumn.

Earlier this October when the sun looked like a flood of gold as it reflected off the hills, I set out with a friend on an easy, wandering hike through the woods, past beaver dams, and up the tame slopes of a hill with an outstanding view. The shade and wind carried the hint of frost, but the sunlight danced so joyfully through the birch, beech, and maple leaves that I didn’t feel cold while wearing only a light jacket. The pleasantness of the day penetrated through my slight haze. The previous weeks had been a whirlwind of adventure, topped off by working the night shift the night before our hike and running a half marathon with my sister two days earlier. But, as we parked the car and started walking I didn’t feel tired. My mate had kicked in and the day was too charming to pass inside. There’s something about the woods in Vermont…they recharge me more than anywhere else. [Text continues after image.]

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I grew up in Vermont, but moved to the city for college and work and then moved abroad. I’ve been back a few years, enjoying the time until more schooling picks my next home. I imagine, just as I did as a new adult, I have more city turns and many places to live before I sleep for good. I imagine many of those places will be about as different and as far from Vermont as possible on our small planet. While I never really miss the Green Mountain State in its entirety, when I live elsewhere I periodically find myself aching for the quiet woods that always awaits me here.

The woods in the fall are my favorite. Fall is my favorite season in Vermont for its smells—piles of leaves, apple cider, wood smoke, and pumpkin baked goods—and perfect temperatures. The leaves already fallen rustle underfoot and the tangy, earthy smell of the soil and crisp foliage tingles your nose in an only pleasant way. The natural world is getting ready for sleep and a long stretch of harsh weather. The chipmunks and squirrels are in overdrive, jumping about like bunnies with cheeks full of nuts. Wild apples, acorns, cherries, and berries adorn the trees, weighing the branches down and feeding the deer and other woods dwellers. There’s an influx of geese and other migrating birds—their flocks fill the ponds and trees and raise a chorus of excited chatter about their long journey south.

The forests of Vermont aren’t epic like those of California and Washington state. They aren’t misty, exotic, and lavish like the Amazon or the jungles of Central America and Africa. Nor are they tangled and concealing large snakes, jaguars, and anteaters like the forests in Paraguay. In contrast, it’s their humble scale and unassuming beauty that brings thoughts of the Vermont woods, my childhood haunts, to me when I’ve spent too long away. I always know when those thoughts percolate it’s time to visit.

My friend and I paused on the hilltop to enjoy the view and take in a few golden rays before our descent back into the forest. I sat, knees pulled up against my chest, and gazed out over the rolling patchwork of gold, green, and bronze. The stone face on which I sat was slightly warm thanks to the sun. We were shielded from the breeze. No one else was around. There was a quiet that’s forgotten even in the smallest of towns. The calm was a relief after the rush of work in a hospital and traveling for medical school interviews—places full of complicated thoughts and human interaction. In those moments on the hill, I was thankful for the forest. I also felt a pang of bitterness about the cold winter soon to come, but I know (as I’ve said before) that the cold is one thing that keeps people from flooding Vermont. And, anything that keeps the autumn woods here quiet so I can sneak away and meditate on life’s challenges is welcome.

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Name the Fear

My stepmother’s friend used to play a game called “Name the Fear and Conquer It” where she identified things that scared her—like bungee jumping— and then did them. My sister has a philosophy about hesitation: If you hesitate because you don’t like something then it’s okay to abort, but if you hesitate because you’re scared you ought to dig for courage and forge onward.

The above thoughts are good summaries of how I, too, approach undertakings that make me nervous. The difference is that I don’t necessarily seek out thrillers like sky diving. I prefer to look around me so I can maximize normal life, avoid falling into mindless routines (I like to break them when they form), and daydream about the next challenge I’m going to tackle. Here’s an example.

Wrestling uncertainty was something I did when I became an EMT. I distinctly remember my tumultuous beginning. I threw myself into a condensed EMT course, having no clinical background, that moved so fast it didn’t even have lectures. It’s one of the only classes, and the only one since sophomore year of undergrad, that made me cry. I didn’t know if I’d survive the class. I didn’t know if I’d pass the licensing exams. I didn’t know if I’d like running on an ambulance. But, I made an educated guess and decided it was worth the gamble.

At first, I felt uncomfortable touching strangers—a necessity when you’re taking a pulse and blood pressure or doing a physical exam. I had to coach myself to be still and not run away when my classmates practiced taking a pulse on me. Understanding how the lungs and heart worked wasn’t intuitive. And, for my mind, memorizing isn’t enough. I must understand. I spent many hours reading and rewriting notes.

I lived through the class. Some tears, but I mostly just buried my nose in my textbook and practiced as much as I could during our practical classes. Despite my efforts, I failed a few stations of the psychomotor exam (physical skills) the first time I took it. I couldn’t concentrate and I messed up things I knew on several stations. (The traditional student in me came through though, and I passed the computer portion of the exam in one shot). I almost quit after failing the psychomotor exam. But, I asked myself, “If you can’t be an EMT how on earth are you ever going to be a doctor?” I practiced more. I gave myself many pep-talks. I passed everything on my second try because I focus on how much I wanted to start working with patients and how certain I was that I was pushing myself in the right direction.

I was so nervous thinking about starting as an EMT that I can’t recall my voyage to my first EMT shift. Despite my panic, though, running on an ambulance started way better than my EMT class had. My crew captain assured me he wouldn’t let me kill anyone. Further, he and the rest of the crew went above and beyond to show me the ropes (well, actually, they showed me the tubes, the gadgets, the bandages, and all the other gear that fills the numerous nooks of an ambulance). Time would show that I enjoyed being on an ambulance. I loved the puzzle of figuring out what was wrong with patients and how to treat their condition. I loved chatting with patients when there was nothing to be done but ride to the hospital. Patients almost always have amazing life stories to tell.

About a year after becoming an EMT, I took another leap. I left my communications job—my undergrad degree was in communications—and dove professionally into health care. I began working as an EMT in the emergency department. Yet, despite the major change, this professional jump wasn’t scary like my EMT class had been. During my first couple of months on the job, I learned a ton of new skills like how to place IVs. While I wasn’t an expert at anything new right away, I knew I’d get there if I focused and practiced. My EMT course proved that.

EMTing pushed the boundaries of my comfort zone. This surprised me because I have a wide comfort zone. After all, I’ve moved and built a life in two completely new countries (once as a student and once as a Peace Corps volunteer) and I’ve moved from the country to the city and the city to the country–which is to say I’m comfortable with change. I think the hands-on work and using assessment to inform treatment of living beings challenged me most when I started learning clinical skills. However, I’m so glad I pushed through the bumpy beginning of my career in health care delivery because medicine is the most fulfilling professional pursuit I’ve undertaken to date.

It’s easy to avoid things we’re bad at because they make us uncomfortable. But, as I told myself many times leading up to round two of the EMT exam, if everything was easy then life would be boring. With that, I leave you with a quote from Amelia Earhart:

“The most difficult thing is the decision to act, the rest is merely tenacity. The fears are paper tigers. You can do anything you decide to do. You can act to change and control your life; and the procedure, the process is its own reward.”