A Palindrome Birthday

The sun sparkles in my windows and alights on the forest of plants I nurture in my apartment. I’m recovering from a whirlwind trip to Oregon to celebrate the wedding of a long-time, dear friend. I stepped away from reading about acid-base disorders, electrolyte abnormalities, and the general unruliness of the kidney to write this post. Residency programs started reviewing applications yesterday; I wait for interview invites to trickle in. By this time next year, I’ll be in the throes of residency and I’m sure medical school will feel like a distant memory. But today, a few days before my 33rd birthday, I’m still in medical school.

Looking at the blue sky and the trees with leaves that are turning red, orange, and yellow, I’m reminded of the mountains that are hidden beyond the horizon of buildings that I see. The mountains are quiet from a distance, but hum with streams, wind, and birds when I embark on their paths. I’ve done 57 hikes (not all in the mountains and some trotting more than walking) since my last birthday.

This has been a long year filled with joy and determination. The number of hikes I’ve done reflects finding a balance between those two forces. Medicine consumes. Yet, since starting my last academic year of medical school, the harrowing nature of academia has dampened and the delight of caring for patients, solving medical mysteries, and contriving medical plans have returned to my lived experience. As I begin my residency interview season, I find myself thinking about life beyond school again. It’s a relief to be nearing graduation.

This year marked a big change; I got married. It’s interesting to shift from plotting my activities and setting goals to stepping back and thinking about sharing my life’s journey with another person who has their own activities and goals. To balance the individuals and the team who form a marriage is a daily endeavor. Of course, my partner and I have been unified for some time now, but something about making our union official and forever makes our collaboration seem more central to daily life.

Birthdays are my favorite time for reflection because they mark my personal new year. I looked back at the previous birthdays I’ve written about – 30 (happy and grateful), 28 (excited), 26 (seize the moment), and 25 (goal oriented). Thinking about their themes, what’s this birthday about?

When I walk along a ridge gazing out at the sky on either side or down a woodland path, I find myself quiet. Quiet in the sense of calm and content and, also, in the literal sense that there is less noise in the natural world than in the cityscape. I hope to hold the quiet I find on the hiking trail in my soul no matter what activity I’m undertaking. The hospital bustles with a din and the street outside my window screams with activity. Yet, I believe coexistence of noise without and quiet within can always be achieved; the way, however, seems as varied as the trails I’ve explored this year. Varied by person and varied by situation.

It’s fitting to focus on quiet movement as I wait to start a new life chapter, the chapter where I close the door to official school (potentially and likely forever) and open the door to learning from a new job. I love new chapters with that accentuated first letter, hopefully a quote, the foreshadowing of the chapter that just ended, and the delights hidden behind crisp pages. I can’t wait to see what this palindrome year brings. At the very least, I know it will bring change, for which, I’m grateful.

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.

Learning to See

Before I moved to me latest city, the people I talked to about the city during my travels through medical school rotations didn’t have anything good to say about it. One person said there weren’t any good food. Others said there wasn’t much to do. When I moved here, someone went as far as to tell me it was dangerous. And, while I listened carefully because I knew little about the city myself, I had a suspicion they were wrong.

When I was a child, I learned to see the trees and birds around me. I learned to name them. I could tell a white pine from a red pine or a sugar maple from a red maple. I could tell you the sound of the chickadee and the hermit thrush. I knew the difference between a red wing blackbird and an oriole or a bluebird and an indigo bunting. This type of seeing was the outcome of growing up in the middle of nowhere while surrounded by women who knew these things and shared them with me.

Early on, I learned to tell the difference between real wood and fake wood. I could identify sloppy joints and beautifully joined boards. I judged furniture and house finishings based on their joints. I could tell you how sheetrock differed from plaster. I understood these things because my father had taught me to notice them. My mom taught me to see colors and how they might be paired. I still notice boldly paired colors and they bring me joy regardless of if I find them in a painting or on someone’s clothes.

As a I grew, I learned to name the flowers in people’s gardens because I worked in a greenhouse. I was trained to tell the difference between a rose and a lily, for example. My parents taught me to notice architecture. What makes a classic New England home look as such and how that differs from an adobe house. I came to understand what a well-built house is.

When I moved to DC, I learned how to see a street for what it was. A pathway to somewhere. I learned how to chart my course and tell if I was safe on a particular path within moments. I learned to see the places, like underpasses, I should avoid at night and the places that were filled with architecture, trees, and flowers. I learned this out of necessity and because I have a savage passion for walking and walking and walking.

When I moved to Paraguay, I learned to see what someone was trying to say because I couldn’t always understand their words. I learned to see if they were lying, or friendly, or joking. I learned to see why some people might follow God. I started to understand why life in Paraguay is different from life in the United States. And I learned to see that difference as both beautiful and challenging.

In medical school I’ve spent years learning to see exactly what a normal breath is and how stretchy skin should be. I’ve learned to see how the heart and abdomen are when all is well and what an infection looks like. I’ve learned to understand almost every part of the body and to see when it is healthy.

All this learning about how to see I carry with me always. And, when I moved to my latest home, I applied my seeing to understand what this city was. I learned that there is a lot to say about Danbury. I found the trails (there are numerous) where I can run and walk among the trees, birds, and flowers. I’ve noted the buildings with outstanding architecture. I found half a dozen murals with beautifully blended colors. I’m mapping out the good eateries—so far, I have a recommendation for every meal of the day plus elevenses and snacks. Much like Paraguay, Danbury is filled with people who don’t look or speak like me. But, when I took the time to observe my neighbors; it became apparent that they are a bunch of people trying to carve out a little space to work, eat, and be merry. I came to understand they were just like me in many ways. And, noticing our similarities, I understood that this city suits me. Seeing is something that takes practice. But once you learn to see you can begin to understand.

The Night Chef

Overnight, the hospital halls are quiet; all the administrative areas are closed. There seems to be endless dark ends of corridors where no one is. There is the constant beeping of heart monitors and other hospital machines. The night shift’s laugher periodically fills the space – the nurses and others making sure patients get what they need overnight. Of course, if you’re a patient and trying to sleep it seems loud and it’s annoying because you’re woken frequently for vital signs checks and other things.

Some folks chose night shift. Some folks like the autonomy that a less full hospital affords. Some do nights so they can be with their kids during the day. Some do it for the higher pay. Others are just night owls. I do night shift out of necessity – either when the budget requires it or there’s no way out of it. And that is how I found myself in the hospital when I met the night chef. I was on a rotation that had a week of night shifts.

The night chef is the man who runs the grill of the only cafeteria open overnight at the hospital where I train. When your shift is overnight there’s not much to be done but have lunch at midnight. If you’re like me and prefer to be asleep well before midnight, midnight lunch is daunting. On my first night of nights, one of the residents I was working with reassured me that the night chef was one of the best things about night shift. I was curious what she meant.

The night chef can make anything. He’s gregarious and happy despite working at odd hours of the morning. When I met him, I could not understand why he was working in the cafeteria. He is one of those people who could sell anything. You know, one of those lively talkers who connects with anyone. Why had he chosen to be a hospital chef at night?

He welcomed me and the resident I was with when we entered the cafeteria. He listed the delicacies he had imagined that evening. And despite the terrible hour of day, I found myself smiling and feeling only a little guilty for turning down the pizza with gobs of meat he gloated about for a different option.

During my first week of nights, it became routine to visit the night chef at some point. I never bought his most creative dishes, but I did enjoy his cheer.

Eventually my stretch of nights ended. On my last night, I stopped by the cafeteria on my way home. “Will I see you again tomorrow?” the night chef asked.

“No, I’m going back to days.”

“Ugh, too bad,” he said. “But… I understand.”

I went on my merry way wondering if I’d see him again. And, of course, I did soon thereafter because I started my day shift before his night shift ended. He was jolly as ever, even at 6 in the morning after having cooked all night. “Where have you been?” he said the first time I saw him again. “Nice to see you.”

“Nice to see you again too!” I said. I meant it. It doesn’t take much to make someone’s day and his happy greeting made mine that day. The night chef is a master at brightening his customers’ shifts. Perhaps that is why he had chosen to be the hospital night chef. Night shift at the hospital needs him most.

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.

My Experience Getting the COVID Vaccine

Disclaimer: If you’re looking for scientific information about COVID or the COVID vaccines, check out the CDC as a starting place for information. This post doesn’t address science or research surrounding COVID; it is simply a recount of my personal experience getting COVID and the COVID vaccines.

I got COVID almost a year before any vaccine was approved. To be honest, I was one of the luckiest people to catch the virus. I hardly had a fever. I did, however, spend hours lying on the floor too tired and nauseous to get up. I had to force myself to eat because every time I ate, I got sick to my stomach. My brain was foggy. My body drained. I didn’t feel short of breath but, breathing took more energy than usual. I thought about breathing more often than I did normally. I didn’t get diarrhea or lose my taste or gasp for breath like others did when they had COVID. Not once did I think I needed to go to the hospital because of the virus. And, as you can tell because I’m writing this, my case of COVID wasn’t fatal. And, since it was the height of COVID closures when I was sick, I hardly had to change my lifestyle to quarantine because I already wasn’t leaving the house. I was lucky because the subject I was studying in medical school at the time was easy, so I was able to study and pass my exams despite spending hours lying on the floor with my mind floating is some other universe. I was lucky because all the pieces that came together for me resulting in me not getting that sick did not come together for everyone who got COVID.

The first Moderna COVID shot was exciting. Finally, we had something to prevent COVID, that terrible infectious disease that had changed my world and threatened to make it impossible for me to study medicine. Finally, we might be able to prevent people from dying. I think I got a sore arm after that shot, nothing serious.

The second Moderna COVID shot was also exciting because it marked a completion of my duty to prevent COVID from spreading as best I could in addition to wearing a mask and social distancing. I felt like I was contributing to humanity while also protecting myself – how uncommon it is to be able to put yourself first while also helping others.

But, also, the second Moderna COVID shot wiped me out. I passed out the night after getting it. To be honest, I knew I was going to pass out, so I lay on the floor before I fell. I lay on the floor for what seemed like an eternity before the chills and nausea passed enough for me to crawl back to bed from the bathroom. That was a rough night, but I knew it’d be over in 24 hours because I wasn’t sick; my body was just doing exactly what it was supposed to do. My body was making antibodies (those protective proteins that help fight off infections). My body was responding to the vaccine. I felt awful, but still thought science was cool. I mean, we can make our bodies build defenses before we get sick—that’s kind of magic.

Recently, I got my booster Moderna COVID shot. It also hit me hard. I couldn’t sit up without feeling nauseous for at least the first 12 hours the day after I got it. All my joints and muscles ached. The feeling of the blankets against my skin was painful. It was 16 or 20 hours after the shot and two very long, hot showers; a day of maximum recommended Tylenol; and some Ibuprofen later when I finally started to feel like a tired version of my normal self. But, despite how awful I felt, the morning after the shot I was relieved because I knew I wasn’t sick. I was relieved because my reaction showed that I still had COVID antibodies. I was relieved because as bad as I felt, I knew it would pass in 24 hours. When we get sick, we don’t know how long it’s going to last. The uncertainty of illness is part of its trying nature. I’ve always like deadlines and end dates.

Everyone has different reactions to the COVID vaccines. I have a strong reaction, but by no means the strongest reaction. When I work in clinic some patients explain how fearful they are of their COVID vaccine reaction. Fear of feeling sick is valid. It sucks to be confined to bed for any amount of time. But when it comes to the COVID vaccine, it’s nice to know it’ll be short-lived. Just 24 hours, maybe 48 hours. When I had COVID my symptoms were mild, however the fatigue lasted for at least a month after the other symptoms subsided. For me, at least, feeling sick for 24 hours is acceptable knowing that I will decrease my chance of ever getting the real COVID again. I also can’t accept not being part of the group of people willing to try to stop COVID. It’s a legitimate feeling to dislike having a reaction to the COVID vaccine but, it’s a sacrifice I’m willing to make to keep COVID at bay. If it takes getting a COVID booster every year that’s a small price to pay to prevent millions more people from dying from a disease we have a vaccine to help prevent.

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.

One Example of Sexism in the Operating Room

Often enough to be considered a pattern, the men in the operating room chose to discuss the annoyance of the hospital’s anti-harassment yearly training videos and anti-harassment policies when I was the only female in the operating room with them or when it was just an older female nurse, them, and me. And while I also find the hospital’s anti-harassment training videos frustrating (for entirely different reasons than my male counterparts), I did not appreciate when a surgeon said he could get tips from the scenarios in the video. I did not appreciate his comment (despite his humorous tone) because the truth is that harassment doesn’t just occur in training videos. It occurs all the time and in all settings of women’s lives.

And I found it interesting that these men were complaining when most of them are fathers of daughters, and many are fathers of young daughters. And if the risks weren’t so high for me, I would have asked them the questions I pose now, “How old do you think your daughter will be when she first gets cat-called so badly she feels unsafe? How long riding public transportation will it take before she has a set of rules she follows because of the physical and verbal harassment she experienced from male passengers?” The use of “when” and not “if” is intentional.

You see, women close to me have been strangled and shoved into walls. I’ve sat by as a younger woman asked for advice from an older woman about what to do because her husband raped her every night. I’ve been called by friends in tears because they were cat-called so badly they were shaken. I’ve sat with women as they hid behind dark glasses waiting to get photos of their bruises to use in court. On my first day of one of my first jobs, my preceptor told me how to use the printer and warned me to be careful of our male boss. He left the company before I had to worry about exactly how careful I had to be. By the time I’d worked in healthcare two years, two of my female friends had been groped by male patients. I’ve only been training in the hospital as a medical student for six months and already two female physicians have taken time out of their busy schedules to have lengthy conversations about how to keep my head up and build my career despite disrespect from male colleagues and male patients.

And the reason I would ask the fathers of young daughters the questions above is because I know they love their daughters. And I know they can’t fathom that they are being exactly the type of men who will get in their daughters’ way as they reach for their dreams. And I would ask the fathers of young daughters these questions to remind them that they cannot protect their daughters from the future. And, truth be told, they will likely never know the harassment episodes of their daughters’ life. And I would ask these questions to recommend that they learn how to respect women so that they can set an example for their daughters of what it’s like to be respected. That way, when their daughters do experience disrespect, they know it is not their shortcomings but the shortcomings of the disrespectful one. In other words, it’s worse to be a daughter of a father who doesn’t know how to respect women because he sets a poor example of the male gender. And the behavior of these men in the operating room made it clear that they still had much to learn about respect despite surgeons being among the most highly educated people around. What an unsettling reality to have so many years of education and still lack competency in a basic principle like respecting all humans.

You can look up the statistics in the US for harassment and rape of women (and other demographics) if you’re curious. It’s an easy Google and the numbers are almost as bad as the news that makes the front page of the newspaper. If you want to get really dark, look up statistics related to intimate partner violence. The numbers are horrific. And the numbers always surprise me because all women are daughters and perhaps sisters, mothers, and partners. Fathers and mothers see the statistics and are inclined to tell their daughters to be careful. To not drink too much. To not wear too revealing clothing. To never set down their drink. To not walk alone at night. To not live on the first floor. To lock their windows and doors. To always go out with friends….the list goes on. But the question I always wonder when I hear these statements of warning is why don’t parents just tell and teach their sons that “no” means “no,” “stop” means “stop,” respect applies to all people regardless of genitalia, and that drunk or not you are responsible for your actions? Because all men are sons, and many are brothers, fathers, and partners. It would seem more helpful to prevent the problem of people harassing others, than react to the problem by telling the victims to avoid harassment.

I also find parents’ lectures of caution stifling because they do not address so many of the manifestations of sexism their daughters will experiences. Yes, there is the risk of rape and physical abuse. But for those women going into competitive or historically male professions many of the troubles we face as women are more subtle and persistent than acts of violence. The times we’re told we’re mean or bossy when a male counterpart with the same behavior is considered strong. The times we’re ignored, spoken over, interrupted, and discredited despite consistently being correct. The times (like in the operating room when men decided to complain about harassment protection for women) when we’re othered and made to feel like demanding respect isn’t a right, but a burden we place on our male counterparts. The times we’re underpromoted, underpaid, and passed over simply because we are women. The times we must dig deeper than our male counterparts not because of shortcomings but because our parents taught their daughter to be cautious and taught their sons to be bold.

And as these fathers of daughters discussed sexual harassment policies as an annoying restraint placed on them, I thought about their daughters. I knew when they’d be cat-called. I knew how long it would take on public transportation before they developed their safety rules. And I hoped for those daughters’ sake that they would have men that set an example of what it’s like to be mutually respected. It had made such a difference for me to coexist with many men who looked at me as a person and not some different creature. You see, it’s helpful to know respect is possible because at times it seems like a fictional concept. I thought about those young daughters one day standing where I was. I sent them strength. As much as I hoped the world would change in the years between us, I wasn’t sure it would because these men I stood with in the operating room would still be here. And their sons who had them as role models would be here too.

And I was once again weary, not so much because of the long hours I was spending studying or the fact that I was scoring equal or better to many of my male counterparts in medical school while also getting cat-called and navigating colleague and patient sexism, but I was weary because these men in the operating room, like so many others, stood in the way of my father’s daughter. They stood in my way because they made things more difficult for me than my brothers simply because of my genitalia. None of this was new or surprising, but it did make the hours in the operating room seem especially long. And if the operating room had been a safer place for me, I would have told these fathers the reason I didn’t like the hospital’s anti-harassment videos was because they were triggering for those of us who have been sexually harassed and spoke of a justice system that I have not found anywhere I’ve worked. And I’ve worked in many places.

Engaged

This year I got engaged. It wasn’t a surprise as it came about after countless dialogues while driving between mountains and feasting spots, while plodding along trails below tree line, while standing next to rivers, and while gazing out at the horizon from mountain tops. Like most aspects of my fiancé and my relationship, the timing of engagement was mutually agreed upon and, once decided, a joint undertaking of finding rings, figuring out the legality of things, and planning a wedding unfolded.

It’s funny to me that I’m planning my wedding as I also undertake my third year of medical school. I am a person of action, but usually my time is spent on professional endeavors. I’ve only chosen careers that are consuming, where even when the day is done the puzzles of work linger, tossing and turning in my mind as I go about the rest of my life. I’ve never considered relationships beyond friendship as required or even goals. I’ve always seen marriage as something I’d consider only if someone fell into my life who made me think of it. “Fell” being the key word. I’ve known for many years that happiness and loneliness come from within. The loneliest years of my life I was in a long-term relationship. My happiest times correlate only with my internal state. I fought hard on many occasions when I was single to be allowed to go about my business as I saw fit. And as I think about marriage, the annoyance of having to explain that I am whole without a partner remains somewhere in my skin. But, yet, as I undertake one of the hardest years of becoming a doctor, I am also signing away singleness.

My fiancé and I have discussed marriage and dreamed about growing old together since months after we started dating. There are people who bring out your happiness, who make you laugh more than most, and who force you to think about the world differently. My fiancé is that person for me. And in our short time together, we’ve weathered many storms. There was the first years of medical school – torturous as the hours of study dragged to the future. There was COVID. There were those times when we could have died in the mountains. Where we literally talked each down the cliffs, teetering on an all-to-real edge. There is this current stretch of doing the “long distance relationship thing.” There were the times we shared with family and friends, where it was so easy to feel connected. How seamlessly he fit in with my people (including when my sister and her partner lived with us for a month starting days after he and I moved in together) and how his people made me feel like family from the beginning (starting with the Thanksgiving dinner where I met his parents and everyone in the extended family all at once).

I knew it was time for us to finally start planning our wedding for two reasons. First, since our first marriage conversation we’ve wanted to get married before he follows me to residency and the clock is ticking until that time comes. Second, the realization popped into my head that I couldn’t imagine being happier with another person.

Engagement is neat in the sense that it brings people together. Our families and friends have offered advice and help as my fiancé and I embark on wedding planning. It’s such a fun thing to have a joyous project to work on. Engagement is as odd as it is neat. There are many norms about engagement and marriage which have stood out to me because I rejected them. I didn’t want an engagement ring. My wedding dress will be red. I prefer small, intimate gatherings. My ceremony must be outside. There will be no registry. There will be no escorting down an aisle.

And as I often do for my career, I’ve spent some time reflecting on marriage. I like to ponder why things are important and worth doing. My younger self often thought marriage was giving up something of yourself for someone else. I’m glad to report that that isn’t the case. Marriage is about two very different people taking on a shared adventure, where there are lots of side adventures together and apart. Marriage is just a formal way of saying “I trust you and want you to be my life-long co-hiker no matter how boggy the trail or how craggy the mountainside.”

And as he said when I read him this post, “’Fiancé’ is a weird word, let’s get married already.”

Update from Labor and Delivery: Non-Surgical Edition

We worked to the rhythm of the fetal heartbeat, ticking along at 140 beats per minute.  We hadn’t met the baby yet, but the baby was getting ready to come out and greet our world.

The soon-to-be-mom wasn’t in as much pain as she had been last time I saw her. The epidural took the edge off her contractions. She could talk to us again and was even happy (albeit also tired).

The team got ready to start pushing. The contractions were the right distance apart and strong. The cervix was dilated to 10 centimeters. We explained the process of pushing the baby out – for each contraction she’d push 3 times, each for 10 seconds. While pushing she’d pull her knees out and back toward her ears because that opens up the pelvis and helps the baby fit through. The first contraction we practiced. Not many laboring humans get the pushing thing perfect on their first try. But, it didn’t take this soon-to-be-mom long to learn what to do.

Birth is trepidatious, exciting, and boring all at the same time. First there is a lot of wondering about how the whole process will go. Then there’s a lot of wondering what the baby will be like. Parents are excited to meet their child for the first time. From the health care perspective, there’s a lot of standing around. A lot of blood and mucus and other types of goop. The work comes in waves, as the contractions come and go. Between contractions the laboring human rests and the rest of us wait. It’s really all about the laboring human. The rest of us are just accessories and moral support. On this occasion, the soon-to-be-dad was a great team member. He was encouraging without being overbearing. He was engaged without hovering. The support people the laboring human brings with them aren’t always that good, but you’d be stressed too if your partner was doing all the work and all you could do was stand by waiting.   

This soon-to-be-mom tapped her tummy and sang to her baby in between contractions. She had made up a song for the baby that involved the baby’s name. She told us she had spoken to the baby throughout her pregnancy. She explained that she had told the baby when they were eating. She told us that the baby knew that they ate yogurt every day at 2:30 pm.

The soon-to-be-mom worked hard when the contractions came. The baby moved down the birth canal. As the baby came closer to meeting us, the soon-to-be-mom became more uncomfortable. If you’ve had a baby via vaginal birth you might know what the pressure of a baby’s head is like as it makes its way out – the rest of us can just imagine. The soon-to-be-mom had a good epidural, but it didn’t’ take away the pressure of the baby’s head. It didn’t take away the pain that came with tissues stretching.

We saw the baby’s hair for many minutes before we saw the baby’s head. Head then shoulders and then the rest. I helped deliver the placenta – best described as a warm squishy sac.

The baby cried upon entering our world, a sign of lungs waking up. The baby started covered in white wax and slightly gray, but soon turned pink. The baby snuggled up on the mom’s chest. The baby was perfect, as all babies are. All babies are both perfect and look like aliens if you ask me. Regardless of babies’ alienness, you still tell the parents congratulations on having their baby (this is very important).

Mom rested. She then sang the baby’s song. Once the placenta came out, we made sure the bleeding stopped. We made sure any tears (they’re common apparently) were sewed up. The obstetricians tell me vaginal tissue heals quickly. Life is a curious thing, especially the beginning and the end.

Mom and dad were lost in staring at their baby as we cleaned up mom. The nurses made little ink baby footprints on a certificate for the parents and on hospital paperwork. They took baby’s vital signs – baby was doing well with its itsy-bitsy everything.

We left their room. Time to return to our station. Many little hearts running between 110 and 160 beats per minute bopped along on our monitors counting down the hours until their parents got to meet the baby they’d made. We joke that labor and delivery is the only floor in the hospital were pain is a good thing, only because it means that it might be time to have a baby.

Birth is trepidatious, exciting, and boring all at the same time. I’ve seen the toughest cry at the sight of their child. I’ve seen smiles and laughter and looks of amazement and terror at being a new parent. And I’ve only been on labor and delivery for a few weeks. Imagine what it’s like to make a career of helping people bring their babies into the world.