Tag Archives: Daily Life

Thankful

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This post comes after a several-month blogging hiatus. The break wasn’t intentional, but life has a way of carrying us forward in unexpected ways. The past few months I continued to write, but in a different genre. I drafted several novels. I have two fantasy series that occupy my imagination currently. I’m not done with them. Novel writing is a long-term project, like most things in my life. Yet, despite stories unfinished, the flow of my days has brought me back to this blog. Afterall, the doctorhood quest isn’t over. It begs the question of whether the doctorhood quest will ever be over as there is always more to learn, but that introspection can be left to the future.

The past few months oscillated between easy schedules with plenty of time to contemplate life and my least favorite part of residency, night shift. I’m gleeful to report that I finished my last scheduled night shift of residency last week. Of course, I’m in residency. Another week or so of nights will sneak into my schedule before I graduate. Such is the way of residency, unwelcome and unfriendly work schedules. I skipped Thanksgiving because I was on night shift. I celebrated Christmas on November 30 because December is a doomsday schedule in my residency program. I wrote this blog at 3 o’clock in the morning because my sleep-wake cycle was still upset from night shift despite a week of day shifts under my belt. Schedule challenges aside, December is a month of reflection and giving thanks. I find myself in an interesting place – seeing how far I’ve come while also noticing a long road ahead.

I have 7 months left of residency. I have a job for post-graduation (more on that in a future post). I completed the administrative hoops to get official physician’s licenses. I scheduled my last exam – the board exam. Once I pass the board exam, it signals that the past 9 years of training taught me what I need to know about doctoring…at least on paper. Completing those tasks is enough to be grateful for without needing to look below the surface or consider the complexity that made them possible. But giving thanks is more than checking off one’s to-do list. So, let me dive deeper into some of the things I’m most grateful for currently.

On the top of my “thankful for” list are the countless people who helped me get to where I am. Many of these people are unnamed and their time in my life was brief. Together they made me the doctor I am. I must first give a nod of thanks to my patients. They have taught me more than they know. To be a patient is to be vulnerable, and they navigated that vulnerability with bravery. Next, I give a nod to my professors and peers in medicine. Medicine is a team sport, anyone who tells you otherwise is lying. Every day I learn something from my colleagues in medicine. Collaboration for the better good is one thing I love about the medical field. And last, but not least, I’m thankful for the friends and family who have supported me on this journey. They are the force that keeps me on the path forward. I will not imagine what this journey would have been without them. 

After the people in my life, I’m thankful for my circumstances. I’m thankful to live in the sunny city of Richmond where native passionfruit and pawpaws hide in the park. Where the river flows under and around osprey in the summer and ducks, geese, and cormorants year-round. Where snow falls occasionally in winter and daffodils bloom in February. Where cultures born of many pasts and futures come together, not always smoothly but always with hope. I’m thankful for my apartment where I can track the exact location of the sunset throughout the year – knowing the season by the building behind which the sun dives first. I’m thankful for the plants that dominate my living room. They ensure that there is no day without a flower blooming in my home. I’ve always said that I’ll know I’m rich when I can always have a fresh bouquet of flowers without concern for budget. When I thought of that definition of wealth, I didn’t realize that tending plants would make me rich faster than working. In retrospect, I should have realized that “wealth” is a nebulous term.

And finally, I’m thankful for my experience. My experiences on the doctorhood quest and in other aspects of life. I have never had a job that is as consistently rewarding and infuriating as being a physician. Most days the reward outweighs the frustration, which is why I continue to return. I had over 20 jobs before entering medical school, some were fun and others inspiring, yet I would not return to any of them. Apart from work, this year’s vacations, day trips, and glorious hours lounging I cherish. As December unfolds, I’m thinking about the experiences I’ve had and those ahead. There is never a dull moment when one accepts that the only constant is change. With the days of 2025 numbered, I’m thankful for what this year was and the hope next year holds.

Remarkable People

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Movement at the periphery of my vision caught my attention as I sat at a stop light on my way to work. The movement was a person standing on the sidewalk. Perhaps they were dancing in their mind. Their movements were rhythmic but not in the way most people move to a beat. Something was wrong. Then I realized they were foaming at the mouth and a string of drool hung from their chin. Their eyes were open, but I wasn’t sure they saw the world around them. The explanation didn’t take a medical degree to deduce: Drugs. Likely cocaine or another stimulant. Opiates make people sleepy, not interested in dancing on a street corner.

That day in clinic I had a new patient scheduled who hadn’t been seen by a doctor in several years. The patient was young. They had a history of substance use disorder. The last notes in our system, from several years prior, said they’d stopped using drugs. Previously, they’d used almost every class of drug: alcohol, tobacco, cocaine, benzos, and opiates. As I waited for their appointment to start, I wondered how they were doing, now years later.

The patient entered my clinic calm, clean, and collected. They were articulate and respectful. They had cool hobbies including gardening and beekeeping. “Last time you saw us, you hadn’t used drugs for a few years. Is that still the case?” I asked.

“Yeah, I don’t use drugs anymore. Haven’t for years. I still smoke cigarettes though,” the patient said.

The conversation about their health unfolded. I looked at my computer to go through the never-ending reminders the healthcare system required me to complete with my patients. The reminders for the current appointment included cancer screening and offering nasal naloxone (maybe better known by its brand name “NARCAN.” It’s a nasal spray that reverses the effects of opiates and, if given soon enough after an overdose, saves lives).

“I know you said you don’t use drugs, but I have a reminder here for naloxone. Would you like free naloxone just in case?” I asked.

“No. I’m good. I used to have it. It saved my life twice…and I saved the lives of two other people. I had a friend that said over his time, he saved 60 people with NARCAN,” the patient said.

“I’m glad you were able to do that. I’m glad you’re still with us,” I said.

I finished going through the reminders. We finished our appointment. The patient was healthy and didn’t even need any blood tests.

I thought about the patient as I walked to my car. Beekeeping is awesome. I hoped I’d get back to gardening someday too. As I put my car in reverse, I remembered the person I saw foaming at the mouth on my drive to work. The contrast between the person I saw on the street corner and my patient that day was stark. The contrast reminded me how life is nonlinear. I thought about how the patient had saved their own life and the lives of two others. The patient I’d seen was a remarkable person. The phrase popular for healthcare workers during the COVID pandemic came to mind, “Not all heroes wear capes.” I decided the phrase was accurate but needed modification. Perhaps a better phrase for remarkable people in the world is, “Not all heroes wear capes, but they have baggage and have learned to carry it with grace.”

I hoped the person I saw dancing to drugs and foaming at the mouth would turn down a different road in life. Maybe that person on the street corner would someday tend their own flowers and suck honey from honeycombs too. Maybe the person I saw on the street corner had saved a life right before I saw them. Maybe their life had been saved by an unknown remarkable person. Afterall, the only thing that makes people remarkable is what they’ve done. Every day each of us can decide to do something new. Every day we can evolve and refresh. That’s the most exciting thing about life: The only constant is change.

The Tired Mind

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The foundation of medicine is curiosity. Desire to understand how the human body works – how those workings can break and malfunction and then, how they can be fixed again. Interest in the human experience. Wonder about how the mind can influence the physical. Joy in the triumphs of human capabilities. Humility in the shadow of human limitations. Thrill in the story of each human life. Medicine is built on questions and the pursuit of their answers.

At its best medicine is cutting-edge. Exciting. Grounded in the clearest understanding of the world the best science has thus far provided us. Yet, medicine isn’t always at its best. Medicine, after all, is a profession performed by humans. And humans are fallible. Medicine doesn’t stand above or beyond bias and money. And physicians, like all human beings, get tired.

The tired mind is a weak medicine mind. The tired mind processes slowly. The facts stand right in front of a tired mind, yet the mind is too weary to see them. The tired mind makes mistakes. Rushes when it shouldn’t. Forgets. Gets distracted by unimportant details. The tired mind is more likely to cut corners. Tired minds place patients in boxes of diseases rather than notice the nuances that make each patient unique. The tired mind is about clocking in and clocking out. The tired mind doesn’t ask questions. Because questions must be answered. And answering questions takes time. The tired mind has used up its time.

I think about the mind often at the wee hours of the morning on nightshifts or when my dayshifts drag on in a string of events. Not necessarily unfortunate events but overlapping and clashing events that make up a typical day in medicine. As shifts pile on top of each other, the events of each shift blend creating fog within the mind.

I know when my mind is tired because medicine isn’t interesting during those times. When my mind is tired the wonder of medicine evaporates. The wonder is replaced with drudgery as many tasks become repetitive and the clock ticks. When fatigue prevails, work hours are reduced to time that feels stolen. Stolen in the sense that work hours become hours I can’t sleep, can’t see the sun, can’t visit people I love, and can’t do hobbies I enjoy. When my mind is tired work hours are exposed as time spent looking at numbers that almost tell the story of human existence. I know that life is more than the sum of the numbers that describe it but, when I’m tired, I can almost believe life is no more than numbers.

When my schedule eases and balance between work and free time is restored, the wonder of medicine returns. The thrill of seeking the answers to mysterious questions – the function of medications, the disease behind a constellation of symptoms, and the life experience that led a patient to the hospital or my clinic – takes center stage again. When there is balance and my mind isn’t tired, medicine is thrilling. Thrilling because few other professions let one spend their day unraveling mysteries. Hearing the stories of real humans and decoding what those stories mean from a wellness and health perspective.

As my days as a resident dwindle, I find myself thinking about what it will take to minimize the tired mind and maximize curiosity during the next phase of my career. It was my love of stories and my delight in solving riddles that carried me through the 8 years of medical training I’ve already completed on the doctorhood quest. One more year and I’ll be an independently practicing physician. Even if I’m called to do more training, no future training will be like medical school or residency. Nothing can be. Medical school and then residency are times of growth, but they involve too many hours spent with a tired mind.

I plan to make the next step not the way of medical school and residency. How do I find or create a job that serves me as well as my patients? How do I ensure my work fosters curiosity and promotes wonder? How do I make work more than task completion and income earned? How do I make sure that the formulation of questions and the pursuit of their answers remain at the center of my work? To answer these questions I must explore the nuances of the profession; a wholly different pursuit than gaining the medical knowledge required to become a physician.

Count Down

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The sun sparkled through the bright green leaves of late spring. The osprey floated overhead, having returned to Richmond at the first signs of spring months earlier. The James River still roared because summer’s dryness hadn’t set in yet. My morning soundtrack was birds singing, then replaced by the bustle of slow Richmond when the city finally awoke. The late morning sky was speckled with swallows. The crows cawed. The birds that flew past had nest material in their beaks. I drank mate as the day lazily passed.

When the sun returns and the days are warm and humid, I think of Paraguay. The land of the Guarani; a place that hasn’t been my home for years yet, somehow, is where I’m grounded. When I have slow moments, my mind slips back to the breeze in the mango trees and the sun dancing on the red dirt. I think of my Paraguayans neighbors and friends who smiled so easily and were quick to laugh. In Paraguay the music always blasts too loudly and at the wrong hour. The motos zoomed up the road, their riders helmetless. In Paraguay, the days were slow even when they were fast. I thought the pace was because of the heat when I lived there. But, perhaps, there is more to the calm that sits it the lowlands around the Paraguayan River than just the temperature.

Virginia summer is like Paraguay. Maybe that’s why I like it here. Or I could like it because Virginia is a warm version of Vermont. Vermont, my original home with its harsh winters, perfect summers, and rugged greenness. It’s also possible that I like Virginia just because I do. Richmond, the city no one’s been to. A hidden gem of sorts – not too big and not too small. It’s home to a diverse assortment of people. Richmond feels very southern but not lost in the south. Odd, given its history. I feel at home here despite having a New England constitution and a Vermonter’s tenacity for liberty. Liberty of spirit, body, and mind…something I’ve noticed our country has been undermining recently.

The late spring unfolding to summer is a transition time. It’s a change of season. And for me, along with every other medical resident, it’s also a transition from one residency year to the next. In a few short months, I’ll start my last year of residency. As such, it’s time to start planning my next steps. I’ve been thinking about the job I hope to have after residency and how I might find it. Medicine is for planners, everything in medicine takes a long time and requires strategy. I’m a planner so I fit right in. But I’m also a dreamer. Not all doctors are dreamers, yet I am. I’ve been dreaming of birds singing all day, never to be replaced by noisy cars and music I didn’t pick. Dreaming of grass between my toes and the quietness of trees. I’ve been dreaming of trails yet to be explored and reflecting on the trails I’ve already walked.

I’m always counting down to things that will come. Some counting is more meaningful than other counting. My residency countdown is meaningful. It was for the “after residency” phase of being a physician that I went into medicine. I’m finally almost there. Just 14 months left of the doctorhood quest. A year-ish is a short time when I remember that I’ve been chipping away at the doctorhood quest for 8 years already. What an invigorating thing to look for a job again rather than think about school. I’m excited to have a job that allows more time than I have currently to sip mate and contemplate if the sun is prettier here or in Paraguay. There isn’t enough time allocated to such contemplation during residency.

Hospital White

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The stretcher looked different from the 100s of others I’d seen. It was empty and it had an unexpected metal bar at the head of the bed. I glanced in the room outside which the stretcher had stopped. On the bed was a white bag, zipped up, and just the height and length of a sleeping human. I realized the stretcher was there to take a body to the morgue.

Death has been present on many of my hospital shifts – especially in the ICU (intensive care unit) where this sighting occurred. Yet, until this moment, I hadn’t seen the patients who died taken out of their rooms. I’d pronounced them dead. I’d seen patients’ families crying at bedside. I’d seen the closed doors with butterflies on them marking that someone was dying or dead. I’d seen the strangely empty and freshly made beds where those who had died once lay.

The body in the white bag was lifted onto the stretcher. White sheets surrounded them. Then they were wheeled to the morgue – their family wouldn’t see them again. Of course, the person’s soul was gone well before the body was put in a white bag. Off to a better place. If nothing else, watching many people die has made me certain there is a soul which leaves when death calls. To where the soul goes after death, no one knows.  Long ago, I decided to believe souls always go to a better place when the body dies. No one can prove my theory wrong, so no need to worry about the journey of souls.

The sighting of the white bag made me sad. It wasn’t the kind of sadness that made me feel like crying. It was more of a sinking feeling placed on top of an already crummy night. Heaviness on the chest and shoulders. We had multiple sick patients. My co-resident had pronounced dead a patient almost every night that week. Somehow, he’d gotten that burden. I had not pronounced anyone that week; I was caring for people who were staying alive (for the time being). It was night shift, making the already dreary worse. A string of unpleasant nights with one-way transport of white bags out of the ICU. Some of these nights were so busy we only just managed to do the things most necessary. Our patient list was younger than it should have been. It’s easier to accept death when people have lived a long life. Of course, there were a couple happier cases; those patients would make it out of the ICU and then the hospital.

I don’t think one can ever get used to witnessing death. One can come to peace with it. That’s what I’ve done as my years in medicine accumulate. There is an intrinsic link between life and death. The two cannot be separated and are not whole without each other. In the US, black usually represents death. In many other places, death is represented by white. The more time I spend in the hospital, the more I think white is the most representative of life’s end. Hospital white. A blank sheet. All the shades of light together. The absence of physical color. It seems fitting that death is represented by light and not physical being.

The image of the white bag lingered in my mental peripheral vision for the night. I didn’t know anything about the person whose body was in the bag. Sometimes, one doesn’t need to know the details to understand. Death is like that. Simple once it happens. How we arrive at death is what is complicated. Everyone eventually arrives there at their own time and in their own way. Death is one of the most unifying features of being human. But that doesn’t make it easy. Some things are never easy.

No Alarm Today

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I woke up because my body was ready to leave dreamland behind and start the day. There was no beeping alarm or bright light from my sunrise alarm clock jolting me awake. Today my schedule is fluid. I have a to-do list (I always have one) but today I can ignore every item on the list if I want to. It is a rare day with no objective and no place to be. I could, if I really wanted, lie in bed and watch the day start without leaving the warmth of my covers. Or I could get up and sip mate for several hours. I could sit on the couch and watch the plants grow. I could go for a walk, do a workout, or write. I could do anything or nothing. The lack of expectations and requirements for today is freeing.

No alarm days are rare and lovely. Having spent the past many years in medical school and then residency my life has been filled with productivity and hard work. But, just as too much free time makes me stir crazy, too long spent with an overly packed schedule depresses me. Letting the day begin spontaneously reminds me of my years in Paraguay. In Paraguay, most days flowed in a semi-planned way. My life was free in Paraguay. Even though I had work, obligations, and social activities in the Peace Corps, I’ve never had as much free time during my adult life as I did in the land of the Guarani.

Sometimes, when the sun shimmers into my apartment and my houseplants glow with the joy only photosynthesizing entities have in the sun, I’m transported back to my Paraguay naps and meditations under the shade of the mango trees with the nearby palms swaying in the breeze. On those mental journeys, I’m reminded that quiet is an underappreciated aspect of life. Of course, us humans need purpose and connection to be happy. But every moment needn’t be assigned. The happiest folks I’ve met are those who embrace the slow days when they come, sometimes even setting aside calendar days for nothing. I want to be among the ranks of the happiest people. I think this goal starts with no alarm days. My no alarm days are for basking in the strange meandering that occurs when I decide to let spontaneity determine the agenda.

Today is a no alarm day. The sun is shining. The mate is perfect as the steam curls up from each pour of water over the yerba leaves. The yerba is fresh and so it bubbles. The plants in my house look good. Maybe I’ll water them later because it’s sunny and they’ll need it. Some of my orchids are blooming, some will bloom soon, and some are pondering their future (deciding if they will flourish or die for no reason). My house trees seem tall today. Beyond my plants, through the window, and past the balcony the cranes move. Richmond is constructing several new tall buildings. There are 4 cranes to watch from my balcony. The cars bustle below, sometimes their music is loud. Life continues. I sit. Today is a no alarm day. I’ll probably go for a walk later. But this moment is for drinking mate and observing my plants. What a beautiful moment it is.

Over 48 Hours Without Running Water in the City of Richmond

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“See these?” my mom asked flexing her biceps, “Hauling water.”  

When I was young, my family lived in rural Vermont in a hunting cabin without running water. My parents hauled water from the stream for bathing and we filled jugs at my dad’s work for drinking water. Those years in the woods prepared me for life as a Peace Corps volunteer in rural Paraguay where amenities were often lacking.

When my mom visited me in Paraguay, I flexed my biceps. “See these?” I asked. “Washing clothes by hand.” But it wasn’t just that. In Paraguay the water and electricity went out often. Just as my parents had done when I was a child, I developed ways of conserving water and making do when the utilities were down. One of my kitchen walls was lined with 2-liter bottles (recycled soda bottles) filled with clean water – so I was ready when the water went out. Some of my Paraguayan friends had different water sources from me and therefore often still had water even if I didn’t. My friends in Paraguay were used to the water outages and had a communal approach to getting through those annoying stretches. I could count on them to invite me to shower or to wash clothes at their homes if my water was out for more than a day.

When I returned to the US after completing my Peace Corps service, I figured my only time without running water would be when I was backpacking or camping. Self-imposed in those cases and short-lived. But Richmond surprised me this winter. In classic southern fashion (being from Vermont, I must poke fun at how the southern US handles snow), all went awry when Richmond was hit with a true snowstorm and sub-freezing temperatures. One of the city’s water pumps broke, multiple backup systems failed, and fixing the problem was harder than officials expected. As such, almost the entire city lost water for just over 48 hours and had to boil water for drinking for almost a week.

In the grand scheme of things, no running water for 48 hours and a boil advisory for about a week are insignificant compared to the water hardships many people around the world face. However, I found it interesting that such a utility failure could occur in a modern US city in the absence of a natural disaster. My husband and I (both from New England and used to winter power/water outages) were prepared. We filled pots and buckets with water just before the city turned the water off. We refilled our buckets in the river as needed to ensure we could flush our toilet. I took a baby-wipe bath one day. I washed my hair in the sink another day when the water was starting to come back but we still didn’t have enough water pressure to run the shower. I’ve known how to take a bucket bath since I was a child. Though it is a nuisance; it is simple.

48 hours did not restore the bicep muscles I’ve lost since returning to the US and living with modern, reliable running water and all the amenities that come with it. Yet, during Richmond’s water outage, I found myself flexing my biceps and thinking about the many people across the globe who have unclean water or minimal access to water daily. In the US reliable utilities are taken for granted. Richmond’s loss of water was a good reminder of how precious functional utilities are. I expect Richmond officials to review how the system failed and take steps to ensure such a failure doesn’t occur again. I also consider the water outage an opportunity for myself and other citizens to reflect on the event. In a world faced with global climate change which is leading to more severe weather and more chance for disasters that could cut-off utilities, how prepared are we if the systems we take for granted fail? How does one function without running water? Without electricity? What do we need to learn to be better prepared to navigate these situations when they arise? What can we do to prevent utilities from failing? How can we protect our water resources?

Is It Luck? Is It Privilege? Or Is It Something Else?

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She was in my thoughts more than I expected for how little time we’d spent together. She and I crossed paths while I was volunteering for a local organization. We were born the same year. Yet, she was born in Afghanistan and I in the US. She can’t read any language, as she reminded me, women are not allowed to attend school in her country. As a US physician, I’m among the most educated in the world. She has multiple children. I have none. We do not speak any common languages. Despite the differences, I noticed a few commonalities between us beyond our birth year. We are both married. We are both women. We both drink tea.

Soon after meeting her, I read updates in The Economist about the Taliban. Summarized, the Taliban issued more limitations on women in Afghanistan. It is so difficult to be a woman in Afghanistan that the EU has made being a woman from Afghanistan a criterion for asylum – no other qualifications necessary. 

Yet the horrors that I’ve heard about Afghanistan and the complex interconnected history of the US and Afghanistan are not how I want to know this Afghan woman. Life has taught me that the stories the media tell are not the stories of individuals. The negative thoughts and the sadness I have about how different my life is from this Afghan woman I know originate in my biases and my ignorance of her.

I do not know enough to guess what she thinks or feels about her history and her future. I do not know her story while living in Afghanistan. I do not know her story of coming to the US. I do not know what she thinks of her life in the US.

We were born the same year. Was it luck, privilege, or something else that I was born in the US and she in Afghanistan? How can one compare two lives so different? What does she think about when she has a quiet moment? What does she dream of? What does she enjoy? What makes her happy?

I interact with many people who have different backgrounds and cultures. But this woman and I seem even more different than most people I encounter. The Peace Corps taught me that difference is not better or worse just different. It also taught me that what I believed to be laws of humanity were theories – theories with counter theories, and most importantly, not proven to be true or correct. I know this Afghan woman and I have more in common than I can see now while also acknowledging that our views of the world are likely as different as views can be.

As I write this post, I wonder if I will ever have the chance to learn more about her. I hope so. I have grown most profoundly when given the opportunity to learn about new cultures and about new people. It is the diversity of humans that makes us so remarkable. And while I imagine her story is one marred with sadness, I know she has things she is proud of, moments of joy worth remembering, and stories of success. I hope that someday she can choose which stories and things I know about her, rather than my limited knowledge of her culture fabricating a story of her. Reality, I’ve found, is always sadder and more beautiful than imagined worlds.

I’m grateful that being born in the US allowed me to become a doctor and choose my own path. I hope that the US is as generous to her, whatever her hopes and dreams upon coming here are. The future is one we are each molding in our own way. Be it luck, privilege, or something else clearing the path.

The Last Stop on the Bus Line

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I looked out the window. I’d been here before, almost 2 years previously, it was the end of the bus line. Arriving here meant I’d taken the wrong bus. There were several buses with the same number that had overlapping routes but ended in different places. The last time I’d caught this wrong bus was shortly after I moved to my Peace Corps volunteer site in Paraguay. At that time, I was still learning my community and Paraguayan culture. The first time I ended up at this bus line end, I wasn’t sure how I’d get home. The uncertainty made my heart beat faster. I asked the bus driver for directions; he had been able to help. It took several hours but I ended up home, unharmed though slightly frustrated I’d mixed up the buses.

I’d learned so much since I first visited this bus depot accidentally. Since then, Emboscada, Paraguay had become my home. Emboscada was, perhaps, the first place I’d ever lived where I was certain it was home. As the days that added up to the previous two years had unfolded, I’d found a community and made friends. I’d been a schoolteacher and connected with youth over music, English, and dreams. In my Paraguayan community, older friends had died, younger friends had married, and I’d been to parties and celebrations of every variety and magnitude you can imagine.

I looked out the window and I laughed. I was an expert, yet I still took the wrong bus and didn’t realize it until I arrived here at this bus depot. In a few short months I’d leave Paraguay. I’d say “goodbye” to the home I’d found and created. I’d return to my native country and start the Doctorhood Quest. I laughed because arriving at this bus depot wasn’t scary like it had been the first time I ended up here. I knew it would take a few hours to catch the right bus and travel to the bus stop in front of my house. I’d arrive home eventually. My little Paraguayan house would be waiting for me.

This event was about 8 years ago, yet I’ve found myself thinking about it a lot recently. I’ve been reminded of it because I recently turned a page in the Doctorhood Quest that is like what I was turning in my Peace Corps service at that time. I feel settled in my role as a resident physician. I feel comfortable with what kind of doctor I am. I am happy with what I’ve accomplished and look forward to my future goals. I had similar sentiments about my Peace Corps service while I waited for the right bus to pick me up at that last bus stop.

It might seem premature to have such contented feelings about residency. But I know that the remaining 20ish months of residency will be over soon. I have so much to learn in those remaining months. Yet I know I will learn what needs to be learned. For the first time in my journey of becoming a physician, I’m confident that I’m where I need to be. I know how to get home even when I take a wrong turn.

Being an expert isn’t about always catching the right bus, it’s about knowing how to find your way home when you catch the wrong one. It’s about being calm even when things are unexpected. It’s about embracing the journey. It’s about laughing at yourself because experiences that make you grow and challenge you also put you in ridiculous situations.

How ridiculous is it to take the wrong bus after having taken the right one 100s of times? “Quite ridiculous” is the answer. But mistakes are what make us human. We learn from mistakes, even if the lesson is simply a reminder to laugh at ourselves. Life is serious, but not so serious that we can’t appreciate its absurd moments.

Stand Up for Yourself Sister

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“Stand up for yourself sister…because if you don’t stand up, no one will.” This was the theme of my thoughts as I walked home recently. I’d learned this lesson over a series of experiences, most significantly the Peace Corps and the 20ish jobs I had before medical school. It’s a skill improved with the help of pivotal women throughout my younger years who showed me how to advocate for myself (not just others). And it’s a skill I’m always improving.

Medical school forced me to practice standing up for myself over, and over, and over again. Medicine isn’t designed to be kind to its trainees. The journey to doctorhood is fraught with unpleasantries. A self-aware and self-confident person can minimize these annoyances if she chooses to face them and address them as they arise.

“Stand up for yourself sister” had popped into my mind after chatting with a younger co-resident who described several instances where she was asked to do work that wasn’t her responsibility by senior trainees and didn’t feel comfortable saying “no.” These instances were like the time in medical school when I found one of my classmates in the hospital hours after her work was done because a resident asked her to do a non-medical errand (meaning it was a personal favor and had nothing to do with the student’s learning). The student had also not felt comfortable saying “no.”

In both of the above cases, if the junior trainee has said “no” to their superiors they would have been in the right and may have prevented their time from being wasted. Further, both cases were examples of misconduct by the senior trainees as defined by the governing bodies that oversee medical trainees. Because of the hierarchy of medicine there are clear guidelines of conduct designed to protect junior trainees from abuse by senior trainees and physicians. The above cases were not reported to governing bodies.

Weird and questionable situations arise all the time. What I’ve learned is that being confident to say “no” is important. It is possible that there will be ramifications when one says “no,” but if one is in the right it is often worth the risk. Further, reporting unreasonable requests to the governing powers in our institutions is another form of self-advocacy that has the added benefit of helping to prevent others from being put in similar situations in the future. I don’t think it was coincidence that the two above examples happened to female trainees.

America calls itself “land of the free and home of the brave.” I find this tagline misleading. One reason is the different way many fractions of America raise their women and men. Even in a place that screams equality as its core value, many American sub-cultures (including my own) teach their boys to be confident, embrace conflict, ask for things, and demand better. At the same time, these sub-cultures (including my own) teach their girls to be cute, create harmony, strive for pleasantness, advocate for others (especially the weak), and be tactful. The lessons we teach girls are fine except they don’t cultivate the skills girls need to stand up for themselves the way the lessons we teach boys do.

American women from these subcultures are then at a disadvantage in many situations including when they negotiate employment contracts, ask for promotions, and define boundaries in relationships. Of course, many girls and women learn to negotiate and advocate for themselves anyway. But, what I’ve noticed, is that these skills aren’t default from culture in America like they are for men. Many of the women I know who stand up for themselves are self-learned after facing challenges or inequitable treatment next to men. A lucky subset of women are great self-advocates because other women took the time to teach them (despite American culture) in the hope of sparing them some frustration.

There are women who never find a way to feel comfortable standing up for themselves. I feel for these women because I know what it is like to be averse to conflict and scared to speak up. I know what it’s like because that is the default American subculture from which I come. But, like I told my co-resident, we can learn new skills and grow our personalities if we choose to do so.

I’m thankful I invested in cultivating my ability to self-advocate. American women are often amazing advocates for others (such as their children, their parents, their patients, their friends, and many other groups) while being uncomfortable advocating for their own needs. But, advocating for oneself is just as important as advocating for others. There is no reason to believe self-advocacy is a fixed ability or a trait only man can have. Even as I write this, I’m still not as good at self-advocacy as my husband is. Thankfully, I have many years left to practice… You better believe I’m striving for self-advocacy excellence.