Anticipation

I live across from a café that is also as an event venue. The other weekend, I glanced out my window when music uncommon to my neighborhood wiggled through my window screens. My gaze fell upon empty tables perfectly spaced with little plant centerpieces, lawn games in the parking lot, a grill, and green cones outlining the event space. The event organizers meandered around arranged things, chatting, and smiling. Soon the guests would arrive; the evening would unfold. There was no predicting exactly how it would go, but everything was carefully planned with the hope that good things would come.  

I found myself amused by the scene across the street from my home. I’d seen it so many times before, not only in my personal life, but also in a past job when I was an event planner. I’d seen many physical set ups like this one and, perhaps more often, I’d experienced setups and waiting for nontangible events to unfold. The metaphor for my current state of being was obvious. My wedding will be in less than a month (the planning is done). I apply to residency programs the rest of the year (it’s a long process, please don’t ask). My soon-to-be husband is about to move to Connecticut and start his first job as a nurse. Those are the major events soon to unfold; of course, there are zillions of little events where the music is just about to start too.

Life is full of wind ups, waits, activity, clean up, and recovery on repeat. Some versions of these relentless series take more effort and planning than others. Some have more ways they could go wrong. Some events are set up and then no one shows up. Some events last longer than expected. Some events turn out better than you imagined. That’s life. Having gone through these actions over and over again, I believe waiting is the worst. Clean up is also hard, but waiting is the hardest. While my neighbors wait for the food they prepared to disappear into hungry mouths and the games they set up to spark laughter; I find myself waiting for other things that took many more moments (years actually) than cones, tables, and food to set up.

Echoes from the Third of Medical School

The click-click and rickety wheeze of plastic jarred me back to the present from my thoughts about what I wanted to say about finishing my third year of medical school. Even though it’d been 3 years since I operated an ambulance stretcher, I knew that sound like I knew my own voice. The stretcher sound was among the many I’d learned in the past years.

The third year of medical school was a robot period. A term coined by my sister back in our college years. A robot period is a time when you just do as if you were a robot because sometimes you just must get to where you’re going.

I’d ended my third year of medical school learning that the squeak of premature infants is distinct from the wails of infants born on time. I also learned that the cry if a one-year-old is different from the tears that well silently and then exposed loudly before a 5-year-old boy gets a shot.

Before the crying nuggets served by pediatrics were the perfect one-two, one-two sounds of the hearts I heard in family medicine. Or the easy wooshes of lungs moving air happily. In outpatient internal medicine, I discovered the crackling stiffness of arthritic knees.

Before that there was the more forceful woosh of the ventilator in the intensive care unit. Pushing air into the lungs of someone who was silent. That same person had once been a DJ. How odd it was to see them existing quietly when they’d been mixing beats and filling dancefloors for most of their life. Neurology is a dark specialty.

And there was the sizzle sound and burning flesh smell of the electric scalpel in the operating room. The sound of metal tools on metal trays. The snap of putting on rubber gloves and the crinkling of paper gowns as everyone took their assigned places for the operation.

On internal medicine, there were the patients yelling for help. Some of them knew they were yelling. Some were just trying to reconnect with their minds which were lost in the fog of being sick. The beep of heart monitors. The dull sound of lungs full of junk. Oxygen monitors and bed alarms dinging, dinging, dinging.

Before all that, were the screams of women in labor. Of babies announcing their successful arrival with a gurgle-cry. The patter of footsteps as nurses and doctors ran because a baby was coming faster than everyone thought it would.

And that brings us all the way back to the beginning of the year. To psychiatry, where adult tears fell to the sound of congested voices. Or flat voices trudging along telling the stories of visions that no one else could see.

All those sounds are behind me. Today, I find myself listening to bachata and reggaeton. The traffic hums outside of my window. I’m studying for another huge exam. Exams are old news, but this is my penultimate of medical school. It’s the final countdown at long last. It’s been such a noisy year.

Just before I finished the year, I pulled out my violin. I hadn’t played it for almost as long as I hadn’t operated an ambulance stretcher. The songs that were like oxygen in my teens came back slowly. My fingers were awkward on the strings and bow but the jig I’d always loved most bounced around the room just the same. If you do something enough, you don’t forget. If you practice, you get better. Third year of medical school is about practicing. And the best part of practice is not practice, but what you’ve learned after doing it. That’s where I am now. Really glad to have done the year while also certain I’d prefer to never do it again. I’m grateful for the things I learned and the people I met. But, mostly, I’m excited to move on to the next phase of the doctorhood quest.

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.

Burnt

Her hands had become so numb she could no longer administer the eyedrops that kept the pressure in her eyes from getting too high. If her eye pressure got too high, she’d go blind. So, her eye doctor said she needed surgery if she couldn’t use the eye drops. There were two surgical options. One surgery would take an hour and she’d leave the operating room able to see. One would take 3 hours and she’d leave the operating room blind, requiring 4-6 weeks of recovery before her vision would return. She was lucky because she had family who already helped her a ton because her other health conditions had made independent living hard for her. For some reason, the insurance would only cover the 3-hour surgery that would leave her blind for over a month. The holidays were coming up. The family members that took care of her had kids. She refused to make them care for her while she was blind over the holidays. She postponed the surgery. Would she go blind before she could get her surgery? Is this the healthcare system we want?

~

The patient wasn’t COVID vaccinated. “What will you do to treat me if I get COVID?” she asked. I thought about the patient a resident had told me about. That patient had been dependent on family for care. His family didn’t vaccinate him. He got COVID. He came to the emergency room with trouble breathing and then went to the intensive care unit. He lived on the intensive care unit for a year. Eventually, his healthcare team cut a hole in his neck to put a breathing tube in because he needed it. They did everything they could to keep him alive. The resident said when the patient first came to the emergency room, he was a happy, funny soul. The patient lost his happiness slowly during the year he fought to breath. After a year of an entire hospital trying keep him alive, he died. When exactly did avoiding sickness fall out of favor? Do you ask what firefighters will do if you set fire to your house or do you make a concerted effort to not catch your house on fire knowing that firefighters will do their best to stop a fire if it occurs but are limited because fires are destructive and destroy houses and the people who try to stop them?

~

The patient asked, “Why are so many doctors retiring?” I wondered how he didn’t know the answer to that question already. It seems so obvious. Then, I realized he was not a medical student. Being a medical student is to have a front row seat for observing the current state of healthcare. What had I seen? Why did it seem perfectly logical to me that so many people were retiring from healthcare even as I was striving to make it my career?

Not just doctors and nurses, but everyone in healthcare seems to be retiring…

We report our COVID cases. Our COVID test rates. Our COVID survival rates after hospital admission. Our COVID deaths. Who was there to perform those tests, to care for those people when they came to the hospital, and to close the curtain when the ventilator wasn’t needed anymore? Healthcare workers. But, they were also there for all the other things too. The heart attacks. The stomach pain. The broken bones. The cancer. The normal healthcare screenings. They were there when people looked for help with their depression and their anxiety. Healthcare workers’ hours increased. They worked the job of two, three, four, and five people because the hospital was short-staffed before the pandemic hit. Again, healthcare workers were already working long hours and doing the work of several workers before COVID came. Then healthcare workers got sick. And the ones left standing worked for their sick colleagues, worked for themselves, and worked for the staff who were missing before the pandemic came. Wages stayed the same.

Housing and food got expensive for everyone, including healthcare workers. Healthcare workers missed the same performances, social events, and restaurants that everyone else was missing. Life got more expensive because everything including industry was disrupted by COVID. Healthcare wages stayed the same. Healthcare workers got sick. Sick leave was used up. Shifts were harder because healthcare was short staffed and there were more patients than before. And the patients were dying. And insurance didn’t want to pay for the treatments that patients needed, not that that was new, but it remained disheartening. And there was the need to wear masks at work. And to put on goggles and gowns and for healthcare workers to take extra time to protect themselves from infection. There was the risk of bringing COVID home after working in healthcare. Wages stayed the same.

People got sick. And healthcare workers got tired. Wages stayed the same. Hours were long. Vacations couldn’t be taken like they used to be taken. And just like their patients, healthcare workers got sick, tired, depressed, and anxious. Staff shortages increased in the hospitals and clinics.

People denied that COVID was real. People invented vaccines that helped prevent COVID infection. People refused to get vaccinated. People complained about wearing masks. People got tired of social distancing. People got sick. The intensive care unit was full. The psychiatric ward was full. The cardiac ward was full. Alcohol use disorder, diabetes, high blood pressure, and all the other medical conditions that always exist marched on because they don’t stop during a pandemic. Healthcare workers shouldered the workload of several workers each because some of their colleagues had left, some had died, and some were sick. Wages stayed the same.

In such an avalanche, how long would you have waited to change careers? For many, the answer was between 1 and 2 years.

~

There is always hope and healthcare has been grounded in hope since the beginning. But as a student so excited to become a physician I know that change must happen if hope is to materialize into lives saved. And for my sake and all the people who might need the hospital or a clinic in the coming years, let’s not make it take a healthcare collapse before we seriously consider how we might improve and restructure our healthcare system. I’d very much like some seasoned healthcare workers who are not completed burnt at my side when I start practicing as an independent physician because experience is gold in medicine. I’d also really like to have enough staff to care for patients without having to burn myself and burn my colleagues with the weight of too many lives in each of our two hands.

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.

Betrayal

I didn’t cry but my heart was heavy in November 2016 when I carefully folded up the American flag I’d always hung in my room and placed it safely in a box, making sure it never touched the ground. I folded it the way my father had taught me, which was the way his father (WWII and Korean war veteran) had taught him. As I folded the flag, I looked for tatters suggesting it needed a proper retirement—it didn’t. I swore that I would not hang the flag again until my country made me proud. Until my country no longer betrayed the promises on which it was founded.

The election in 2016 felt different than the others I’d experienced. There was a pit in my stomach about the future after November 2016 even though as a dreamer I am always hopeful about the future. It was uncharacteristic of me to care much about politics. I felt heavy. I told myself to wait and see how things unfolded. I told myself that US institutions were strong so it was unlikely that much would really change.

I was raised to believe the reality of the American dream. I took it as actuality that you could do anything and be anyone if you tried hard enough. However, as I grew older, I came to wonder if that was actually true.

My skepticism of the American dream increased as I worked through college. We all have our own challenges, but it’s hard not to notice how easy it is for rich kids to do unpaid internships and lead organizations that set them up for great success after graduation while poor kids work and try to fit in the internships and organization memberships they know are key to getting their dream job. That’s if the poor kids were lucky enough to go to college at all.

This year I no longer question the American dream because the beat of the American dream fell silent as a heart monitor goes flat when a heart stops forever. What took the place of my old belief that in America hard work is rewarded and anyone can pull themselves up by their bootstraps was a bitter taste. The bitterness was a truth I’d always known but refused to look in the eye: the American dream is an illusion. We don’t all have an equal crack at reaching our dreams. Some of us can climb, but the journey is largely about luck. Hard work pays, but being born the privileged sex and gender, class, and color pays more.

In the past 4 years I’ve seen America steal children from their families and put them in cages and call it justice. I’ve seen men supported and allowed to take positions of power despite overwhelming evidence that they had sexually abused women. I’ve seen the armed forces deployed against citizens, and I’ve seen military members accept that deployment.

I’ve seen so many people of color jailed and killed in the name of justice we could erect a memorial like that to the Vietnam War on the National Mall with their names and it would be more impressive than any war memorial. Just like for the soldiers who died in Vietnam, the people who were killed for their skin would have their names written on panels of black stone. Roses and notes would rest at the panels’ base, a tribute to the years the humans named there weren’t allowed to live and to the loved ones who miss them. When I lived in DC I visited the National Mall and Arlington Cemetery often. I visited these war memorials because it seemed the worst fate was to die and be forgotten. To have your name unspoken and your life discredited.

I’ve seen open fire on people in schools, places of prayer, and movie theaters. I’ve seen cities stopped by a pandemic, a virus that continues to kill and, yet, Americans would rather endanger grandmothers and grandfathers (possibly murder them with their breath) before wearing a mask.

I’ve seen taking part in global organizations and dialogue, environment protection, and offering refuge from persecution declared as no longer American.

Every time I’m bold enough to open the news I see more evidence that the American dream is not only dead but was never alive. Have we always been so cruel and hateful toward people different from us?

And I am angry. I know anger accomplishes nothing. Yet, as it becomes clearer how far America is from a country whose flag I’d proudly wave, I am angry and weary. I’m angry because so many of the horrors we’re seeing unfold today have always been there unaddressed. I’m angry because those in the highest places of power are clinging to the status quo which is one where only a select few are favored. I’m angry because the institutions I thought I could trust are weak.

Somehow, in the middle of a pandemic that has killed many globally and protests demanding equity long overdue, we must continue to live our lives. To love, work, study, and play. In some ways it is so easy to continue as if life were normal, even though 2020 has exposed many things that need our attention. Despite the desire and freedom to ignore what has been exposed this year, it would be an error to pretend that everything is okay. Should we choose to punt addressing our problems to a distant future, then it is not just the American dream but also America that has died. America is a place where all people have the right to life, liberty, and the pursuit of happiness and our country isn’t there yet.

I can’t help but reflect on how my life in a rural town is so different from that of someone living in NYC were people died in droves from COVID-19 and more people than the population of my hometown marched the streets to protest violence and inequity these past months. And just the tranquility of my life this year compared to many of the lives led by NYC dwellers illustrates how far we have to go to ensure that we all have a crack at life, liberty, and happiness.

As I slide closer to my second year of medical school, I continue to wonder what more I can do and what my role is in making America a place I’m proud to call home. When I think of action I am less angry, still weary, and very determined that though it will be a long journey, I might fly my country’s flag again. And while I don’t think I’ll live to see the American dream feel real again, I hope that we will lift ourselves closer to a society where every person is judged more for their work and kindness and less by factors present at birth such as the wealth of their parents and the color of their skin. I think if we can move forward, change, then we might call ourselves Americans with the meaning the American dream implied.

How I Came to Discover That Pronouns Are Like Ants

On my first day of medical school they handed us our badges and had a table full of pronoun ribbons (so, she/her, he/him, they/them) that we could stick to the bottom of our badges. There was a strange pressure to take the ribbons and they were briefly explained, but the whole thing felt forced, abrupt, and confusing. In those overwhelming hours of my first day of medical school, the pronoun thing felt like an attack and was unexpected. I didn’t know that several schools across the country were making moves to include pronouns in name tags and email signatures until I picked up my badge that day.

I had no interest in walking around with “she/her” pasted on my badge. Those are the pronouns I use, but why should I walk around with them on my badge? I also didn’t like the ribbons themselves. They were impractical. They stuck to the bottom of my badge, making it longer and heavier. I was concerned that this extra volume and mass would make my badge more likely to hit me in the face when I was doing compressions. Also, the fabric couldn’t be cleaned with an alcohol wipe like the rest of my plastic badge. It’s important to sanitize things in healthcare.

I decided to not add the ribbon to my badge. But, the idea of pronouns stayed with me. It bothered me. It bothered me that I was uncomfortable by the idea of wearing my pronoun. Why was it uncomfortable to me? Why had some people said we all should wear pronouns? I decided I needed to find answers to those questions.

I would come to learn that pronouns are an important topic because there are people who are either given the wrong one by society and/or who don’t identify as a he or a she and, instead, identify as a they. Using the wrong pronoun is a form of misgendering (assigning someone the wrong gender) and often can be considered a microaggression against that person. Many of the people who use “they” pronouns consider themselves nonbinary, which means that on the spectrum of male to female they don’t fall on one extreme. These groups of people, those that use pronouns that weren’t assigned to them by their parents, often endure others using the wrong pronoun. The idea behind having everyone declare their pronoun was to normalize talking about pronouns and to reduce our tendency to assume we know other people’s gender identities simply by looking at them. All the above made sense to me. I also thought we all should be able to use whatever pronoun we want. But, for some mysterious reason, I was still hesitant to add pronouns to my name badge.

I talked about the pronoun label with some friends. I talk about it with some people I love who are part of the LGBTQ+ community. I thought about the patients I had worked with when I worked in the emergency department and on the ambulance. I thought about the patients who were always called the wrong pronoun. I thought about how thankful they were when I asked about their pronoun or used the right one. I thought about how awful I felt to have someone be thankful that a did something as basic as use a pronoun correctly. Pronouns are pretty basic grammatical elements. But, of course, using the right pronoun isn’t about grammar, it’s about respecting people’s identities…but I’m getting ahead of myself.

Time went on. I put my pronouns on my badge and then I ripped them off again. I kept thinking. What kind of message would wearing a pronoun send? Could I back up and live up to that message?

For all of this year I didn’t include a pronoun on my badge or my email signature. But, my pronoun abstinence wasn’t passive. I kept thinking and observing. A resident with a pronoun pin (not a ribbon) on his badge came and talked to one of my classes. I liked the pin way more than the ribbon. My school had a guest speaker come and talk about being a trans man. His stories about navigating healthcare were unpleasant and demeaning. I’d never want similar experiences and I would never wish the emotional pain he experienced on any of my patients. Then, later in the year, I learned that someone close to me started publicly using they/them pronouns.

As I kept thinking, I realized that I’ve also spent a fair amount of time thinking about pronouns in the past. Why? Because people mess mine up all the time. Not when they see me—my born sex, presentation, gender identity, and societally assigned pronouns and gender have always matched (that means I’m cisgender)—but almost 40% of the time when correspondence is over email people get my pronoun wrong. Why? Because people don’t read carefully. My name is “Jett,” but many people read it as “Jeff.” What’s more, “Jett” is a gender-neutral name. People guess wrong often. I find it funny how many people get my gender wrong because of my name over email. It does not hurt me when people think I’m Jeff the he/him in an email. It doesn’t bother me because I know they’d correct themselves and apologize when they meet me. I know this because that has happened to me on several occasions.  

But, what if people didn’t apologize? What if people got my pronouns wrong when they talked to me, face-to-face? That is the questions I realized I needed to consider. Upon thinking, I realized I’d correct them and be annoyed. I know I am a woman. I’m proud to be a woman. Considering that I am a woman and I want others to see me as a woman too, I came to realize that it does matter to me that people use she/her pronouns when they talk about me. If everyone called me “he/him” I think it would be like a bunch of ants invading my home. One ant (one pronoun) is very little and its bite would sting but it wouldn’t cause much damage. But many ants are quite destructive and add up quickly.

If you’re like me and fit what society assigns you, you’ll never know what stress or pain it causes to be misgendered. But, I challenge you to consider how you’d feel if every time someone talked to you they called you the opposite pronoun from the one you use. That means, if you’re a she/her they called you a he/him (or vice versa). I challenge you to sit and actually think about it. How would you feel?

My last month of school this year I decided to join the pronoun presenters. I ordered she/her pins for my badge. It was $2 a pin, less than a pack of gum to fix the ribbon problem. I decided to order those pins because I know there are people out there who society continually labels with the wrong pronoun.

This country has been talking about systems used to suppress and control certain groups of people a lot lately. One of those systems is language. One of the methods to harm people is forcing them to answer to a pronoun that is not correct. I think of it this way, when someone comes to me and tells me they have a headache I do not say, “no, you have foot pain not a headache.” If I can’t know where someone hurts better than they do themselves, how can I possibly know their gender identity better than they do? How can I know better than they do their correct pronoun?

I decided to get pronouns for my badge because I work in healthcare. I think as a physician I should be a life-long learner. That doesn’t only mean I will keep up with the latest medical knowledge. It also means that I will continue to learn more about the different people who are and will be my patients. In the end, we use medicine to treat people. The key word is “people.” And the identities each person has are an important part of who they are and is, therefore, relevant to their overall health.

Now, after thinking about pronouns for a year, I still make mistakes while using they/them pronouns. I make mistakes when using pronouns that are different from what I originally assigned a person before asking what their pronouns actually are. But, I make fewer mistakes the more I practice. And I do practice. It is important to me that my patients, and anyone in my life, can be who they know they are, not who society has said they should be. So, when I wear my pronoun the message I wish to convey is that I want a society were everyone can use the pronoun that suits them whether or not it is the same pronoun their parents used for them as a baby. The idea I want to support is that each of us has to do our part to be accepting of people who are different from us. It is one thing to say that all people have a right to life, liberty, and happiness and quite another to create systems that support that and to act as if all people have those rights. Getting pronouns right is one tiny thing each of us can do to start to change our biased language system. Remember, the thing about ants is that their power comes from numbers not size.

My Apples Are to His Oranges

In undergrad I worked fulltime and schooled fulltime. There were a few years where I didn’t have a day scheduled off. (I took some, of course, with unpaid vacation.) I pieced together different jobs and internships that would fit around my classes. I worked many holidays because we got time-and-half.

A large period of that time, Starbucks was my main job. I worked the opening shift because it allowed me to have most of the day to study and do internships or whatever else needed to be done. To open the store, we arrived at 5:30 am and unlocked the door at 6 am.

I eventually became a shift manager at Starbucks. That meant I oversaw the floor during my shift in addition to being a barista. It was my job to make sure everyone got breaks, money was handled correctly, and everything else that needed to happen happened.

I had one barista who was a kind guy and a good worker, I’ll call him Joe, but he used to cause me the greatest frustration. If he was scheduled to open the store with me, he almost always came late. Not a little late, but 30, 40, 60 minutes late. I couldn’t open the store until he got there, because our store policy was you need two people to open. This meant we opened late when he arrived late.

I usually asked him why he was late. The answer was usually something about the bus. Or something about the metro. And I thought I understood. Public transportation in Washington, DC is not reliable if you need to get somewhere on time. My solution was always to take a train earlier than the one scheduled to get me there on time. I wondered why Joe didn’t do that too. As it was, I got up way before 5am to get to work on time. That was after staying up until 11pm studying. I did it, he could too.

One day, I was talking to another shift manager about Joe’s tardiness. The other shift manager laughed. “Yeah, it annoys me too,” he said. “But the metro doesn’t open until 5am. There’s only one early bus he can catch. If he misses it there isn’t another one anytime soon thereafter and there isn’t an earlier one. And, if the bus runs late, he doesn’t catch the first train once the metro opens. He’ll be late if he doesn’t catch the first train. You know how the metro is.”

So, basically, Joe needed a perfect storm to get to work on time if he was scheduled to open with me. I thought about it. I didn’t know exactly where Joe lived, but if he had to take a bus to get to the metro and then take the metro he lived far away. The math didn’t add up. He was probably spending his first hour of wages on the bus and metro. The metro charged you by distance.

“So why doesn’t he move to a store closer to his house?” I asked.

The other shift manager shrugged. “There probably isn’t one.”

Starbucks was everywhere in DC at that time. In fact, I’d switched stores shortly before becoming a shift manager because I moved apartments. I switched stores because a 45-minute walk at 4-something in the morning was too much. I moved to a store that was a 15-minute walk from my house.

We’ve been talking about systems since George Floyd’s death.

The woman who ran my store was an immigrant and a brilliant businesswoman. She was supporting her kids back in her home country. She was trying to save up enough to maybe, someday, bring them here. Save up enough to give them the education and experience she wanted them to have. She was gunning for a promotion to regional manager or something like that. She was strict but she understood her employees. Joe was a good worker. She wasn’t’ going to fire him for being late. She knew that if she scheduled him for opening shift, he’d be late. She weighed her options when she made the schedule.

Every person had a story who worked in that Starbucks. And what I learned as I went, was that I had to be forgiving. I had to ask why before writing others off. I had to try to see things from their view, even though our lives were amazingly different.

The system was set up so I could live 15 minutes from where I worked.  I lived a 5-minute walk from the metro. I had multiple bus lines I could take. My life felt hard, but it was nice to know that there were lots of transportation options close to my home and I could find employment near where I lived.

When I left Starbucks, my boss asked if I wanted her to put me on temporary leave. If she did that, it would be easy to come back if I needed a job. I said “no.” I was leaving for a paid internship. The internship was a door to a job. I knew if I worked within the system, I’d get a job when I graduated that used my degree. It was a safe bet. As for Joe, he was trying to save up money to go to school. Unlike me, he didn’t have the option to take out student loans. He wanted to study, but he had to work first. The difference between us was subtle: I studied and worked around my classes while he worked and hoped to fit classes around his work.  

When the system is designed for you, you can trust that things will usually line up nicely. When the system isn’t designed for you, you find yourself working at a shift job where it costs you your first hour of wages to get there using unreliable public transportation. Think about that. Working a whole hour to just make back the money you spent on transport to get there. When the system isn’t designed for you, it’s not a safe bet or an easy decision to leave a job for education. School is important but it doesn’t pay the bills.

We all face setbacks and challenges. That’s life. But those challenges are apples to oranges when you factor in how the system is designed. Let’s move toward a time when my complaints can be compared apples to apples with Joe’s.

Tipping point?

“I’m glad they hired an American,” the woman checking out at the CVS said to me. To my right and left were my friends and colleagues working other registers. That customer had no idea where I was from or where they were from. I was the only white cashier that day.

“What is wrong?” I asked.

“He swore at me and called me slow,” my colleague said. I had served that customer 100s of times. He was rude, but he had never talked to me that way. I was white and my colleague was not.

“I told her she should pick someone else. I ask her why she couldn’t pick a lighter man, so they could have lighter babies,” my friend said to me.

“Is he white?” a friend asked when I was talking about a professor that I was struggling with because his course was unorganized. That was her second question. Her first was the professor’s name.

Above are several times when I had to think about race publicly.

  • What would you do in each scenario?
  • Have you experienced similar situations?
  • How would you approach a situation like these in the future?

The first one, in that CVS, haunts me. Why? Because I was silent. I was so surprised by the comment that I didn’t know what to say. I have often wished that I could go back and tell that woman I was not American. Just to see her reaction. I wish I had complemented my friends for their hard work in front of that woman. I wish I had said something, almost anything, to let that women know I disagreed. But wishing doesn’t change anything.

Every encounter since that one in CVS I’ve said something. My response has never been perfect. Questions and comments about race always surprise me. They shouldn’t, but they do. I review these types of interactions many times after they are done. Most of my responses were weak, but with each one I get better at saying racism is wrong. With each one, I get better saying that I do not believe people should be judged based on the color of their skin.

~

George Floyd was murdered by a cop. He died of asphyxia because a cop knelt on his neck and prevented him from breathing. George Floyd was not the first black person killed by cops. His murder was brutal but not unlike many previous violent acts against people of color in the US. After George Floyd’s murder, people took to the streets in large numbers. Cities across the US are protesting.  

We cannot know the future. But, perhaps, we can make sure that when today becomes history we are not still fighting the exact same fight. Today we find ourselves listing the names of the dead, the hurt, the pushed down because of their skin color. And though the list is too long to complete, many of us have not considered acting until now.

Why is George Floyd’s death the tipping point? Why are we acting now? Why not before? We may never know.

We may feel guilt for inaction in the past. That guilt will remain. But, let’s not feel guilty years from today because of now. Guilt does not fix problems. Actions fix problems.

The most important question each of us must ask ourselves today is: What am I going to do from this point on?

Protesting is one thing. It’s important but it will not, alone, change the status quo. We must do more.

Here are some things I’m already doing/starting. Join me. Or, make your own plan.

Immediate:

  • Protest or donate to bail out funds and organizations supporting and organizing protests.

Ongoing:

  • Vote.
  • Donate to organizations that fight for justice and equality.
  • Be an advocate, get involved in politics beyond voting. I can influence politics and our country’s laws in many ways beyond casting my vote (though that’s a good way to start).
  • Hold politicians accountable.
  • Hold friends and acquaintances accountable.
  • Reflect on my interactions with people who are different from me. Identify my biases. Make and enact a plan to be better. I will make mistakes. I will get better if I continue to push myself to see my shortcomings.
  • When I see racism call it out. Stand up for others. Take the hit. Have the hard conversation.
  • Review the systems I am part of like work and school. Is there bias? How can it be eliminated? Take action to eliminate the biases I see.
  • Push myself to learn from those who are different from me. Diversity is what makes all of us stronger. Seek it out.
  • Realize it is not good enough to be kind. Learn how to be just. Strive to be empathetic. I can not fully understand another person, but I can challenge myself to hear them and see them to the best of my ability.

Friendship as a Trendline

When I was young and going through a rough patch with one friend or another, my mother always told me friendships go in waves. Sometimes you’re high on them, doing the most exciting things and seeing each other all the time. Sometimes it’s as though you don’t know each other (except you do, because you remember all the times that are past). I knew she was right, but when I was young I hadn’t had friends for long enough to see what she meant.

These days I’m not old, but I have friends who have been in my life for over 20 years and new ones who just arrived. Each friendship is different; the relationship components undulate as ocean waves do—always the same motion (hi…bye), never the same content (what is said and done, where and when we encounter). It’s only the movement, up and down, that’s constant over these relationships and across relationships.

When I think about friendships as waves, I envision the trendline as straight across with a sine wave tracing the points of each friendship. If you plot every friendship on the same graph, some will have wide peaks and dips, some will have steeper and more frequent slopes. But, regardless of the shape of each wave, when you follow the trendline as a representation of your life unfolding, you find that your time has been filled with moments shared with people you enjoy. Despite all the movement—especially the absences of certain individuals at certain times—you are surrounded by people you consider friends most of the time. In this way, the trendline makes you unshakable when one friendship wave becomes an outliner by dipping too low or dropping off the graph completely. And, also, it’s the trendline that helps you steady yourself if a friend becomes a partner and their friendship wave falls into phase (in sync) with your life wave magnifying your own emotional ups and downs.

For me, the visual of friends as waves (like an ocean view) takes a lot of the pressure off each moment because it makes me see them as part of something larger. It’s reassuring to realize that I can enjoy each crest before it crashes on the literal or metaphorical beach because it will be followed by others.