Tag Archives: Daily Life

Listening to the Birds

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As our appointment was ending, I congratulated the patient on getting fitted for new hearing aids earlier that day.

“Yes, we are looking forward to the new hearing aids,” the patient’s spouse said. The hearing aids would be shipped to them soon. “They love hearing the birds. They know all the birds’ names.” The spouse paused. “I miss them telling me which birds we hear. Now I’ll say, ‘Hear that bird?’ and they’ll say, ‘What bird?’ because they can’t hear it singing.”

As my patients like to tell me, “Getting old is not for the faint of heart.” Being not as old as them, I don’t know what it feels like to be their age. But, having worked with hundreds of people as they age, I’ve had the opportunity to observe what getting old is like. Perhaps the most interesting thing is that no two people experience aging the same way. Despite the variation, there are some truths I think are universal about aging: 1) one cannot do everything at 80 that one could do at 20, 2) life experience cannot be erased, and 3) attitude matters.

The happiest old people I’ve met are those who embrace aging as life’s reality. They are flexible and willing to adapt their goals and expectations to meet their ever-changing body and mind. For some people this means that they give up the independence they once cherished. They turn in their car keys forever, accepting that their slow reflexes and poor vision have made them dangerous drivers. For others, they let their children or other trusted people help them navigate new technology that they don’t understand because navigating that technology is essential for life admin (like bills) and connectivity (communicating with others). Others relinquish their identity as the one who cares for everyone else and accept help from people they previously cared for. Going from the person everyone depended on to the one that depends on everyone else is one of the hardest transitions I’ve witnessed my patients make. Whatever transitions people go through as they age, they are huge and require self-reflection and grit.

And while aging is a lot about the mind, it is also about accepting that our bodies change with time. The most resilient old people I’ve met are the ones who are flexible not just with how they approach life, but also with what they expect of their body. Many elderly people remain healthy and independent until they die. But even in healthy old people, their bodies are not what they were at 20. They simply move slower and, perhaps, are less physically strong. The happiest old people I’ve met know that their slowed body is not a sign of weakness, but a sign of wisdom. The happiest old people I know, continue to challenge themselves in new ways that they could not have imagined in their youth. They do not have the same expectations of themselves that they did at 30 because they already mastered being 30.

As people age, it is common for them to interact with the health system more than they did in their youth. Regardless of how many diseases and ailments an elderly person develops, I’ve noticed that the ones who endure the hospital and their doctors’ appointments best are those who accept that caring for an aging body takes lots of time. They dislike spending days in the hospital, but they also know that sometimes that is an adventure they must undertake. They weather their healthcare interactions with inspiring patience and endurance.

My clinic day ended hours after the patient who couldn’t hear birds anymore left. As I walked to my car, I thought about how much I loved listening to birds sing. I thought about how hard it must have been for that patient to realize, perhaps all at once or perhaps over time, that they couldn’t hear the birds anymore. I hoped that their hearing aids would help them. What a strange goal to have, the goal to hear birds again. The goal of regaining something previously taken for granted. I wondered what my goals would be when I was that patient’s age. I hoped I had as much perseverance as they had.

Lost to Follow Up

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Two different cancer screening tests came back positive. The patient needed additional testing to see if they had these cancers, but the threat was real and could be life changing. As the months went on, the referrals I had put in for the follow up tests came back – “unable to reach patient,” “failed scheduling effort,” and finally “referral canceled as unable to reach patient, reorder if still clinically indicated.” The patient missed their follow up appointments with me. I saw, however, the ongoing social work notes in the chart. Half of these notes stated they couldn’t reach the patient and half suggested contact. Perhaps it made sense that this patient wasn’t attending to their cancer diagnosis/rule out follow up appointments. This patient had big fish to fry without cancer. They were struggling with drug addiction, didn’t have secure housing, and weren’t sure where they’d get their next meal. The electronic chart, filled with short notes attempting objectivity written in the same font used in 1980s faxes, told a story. The story was both an epic and a tragedy.

This patient was lost to follow up. Would we ever find out if they had cancer? Did it matter? Would they die before medicine could help them? Was medicine really what they needed? As I watched the story unfold, Maslow’s Hierarchy of Needs surfaced in my mind. This patient’s basic needs weren’t met – food, safety, and a place to stay. Cancer was so high up the pyramid of needs it seemed silly to discuss. Though, was it really that high up the pyramid? I know what cancer can do.

Health is multifactorial. Only one piece of health is access to quality healthcare. This patient was focusing on several nonhealthcare pieces of health – safety and security of the physical body. Perhaps they were also focusing on finding their next meal. Perhaps the recreational drugs they used were treating demons of a past filled with trauma. This patient was part of a healthcare system with robust social services to help with social problems like housing and food insecurity. Interestingly, the social services this patient could access are exceedingly rare in the US. Most health systems don’t provide these services and most insurances don’t cover them.

I hoped the patient’s basic needs would be met. I hoped that when those needs were met, they’d return to clinic so we could start the cancer investigation process. I hoped it wouldn’t be too late. Even as a physician I don’t get to write the story of other people’s lives. As the story in the chart unfolded, I was grateful that the patient was receiving social services. I was frustrated that in most other US healthcare systems a different patient in the same situation would receive no help of any kind.

“Lost to follow up” is the phrase we use for patients who disappear from healthcare. It’s a term that provides a label, but it doesn’t explain where these patients go and why they disappear. The label can have negative connotations because it’s easy to be frustrated when patients don’t want to take our (their doctors’) advice and follow our carefully designed plans. It’s easy to forget our patients (just like us) are products of the social determinants of health. It’s easy to forget (just like us) they have lives filled with complex situations regardless of their use of healthcare.  

I’ve found that it’s worth stepping back and trying to see why patients decide to become lost to follow up. When I do this, I often discover that they aren’t lost at all. Rather, they are fighting for the most important things in their lives at that time. And the important things they see are usually different than the important things I see. Since patients are the experts in their own lives, they are often right about what’s most important. Frequently nonmedical things have a greater influence on patients’ decisions than their health needs as dictated by their doctor.

As the alerts came to my inbox for missed tests, I thought about the patient the first (and only) time I met them. They had answered all my questions thoroughly and without hesitation. I wondered if I’d see them again. I hoped they returned to clinic before anything devastating related to their maybe cancers happened. I cleared the alerts. The patient would write their own story; I’d be here if they invited me to partake in another chapter of it. Even tragedies sometimes have plot twists and happy endings. I always (and unwaveringly) root for happy endings no matter how stormy the story becomes. 

References:

Wikipedia on Maslow’s Hierarchy of Needs: https://en.wikipedia.org/wiki/Maslow%27s_hierarchy_of_needs

Article on the importance of the different determinants of health: https://pubmed.ncbi.nlm.nih.gov/26526164/

HHS overview of the social determinants of health: https://health.gov/healthypeople/priority-areas/social-determinants-health

WHO overview on the determinants of health: https://www.who.int/news-room/questions-and-answers/item/determinants-of-health

The Doctor’s Dilemma

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Being a physician is a career that can become one’s life. There are many reasons for this including the 24/7 need for healthcare, the pressure from healthcare business for productivity, the need for advocacy to improve the system and increase health equity, and the desire to help others. There is also the added stress that medicine literally deals with people’s lives and wellbeing. Given these career features, being a physician historically was a way of life, not just a job.

Despite the historical trend that being a physician was a way of life and an identity that trumped all others, there has been a shift in recent years. This shift started some time ago and was, perhaps, expedited by the COVID-19 pandemic and the severe toll it took on all healthcare workers. The shift is that newer ages of physicians don’t just seek to be doctors – they seek to be partners, parents, athletes, cooks, travelers, readers, vacationers, relaxers, and gardeners to name a few identities they claim beyond the physician identity.

As a member of the newest generation of physicians I find myself caught between the old dogma that to be a physician is to prioritize it above all other aspects of life with the newer view that to be a physician is to be a person with a serious career. I think of these completing identities of “way of life” vs “profession” as the “doctor’s dilemma.”

Sometimes self-imposed and sometimes externally-imposed the training physician (and all physicians really) are driven to do more. More reading and learning, more shifts, more leadership roles, and more research. It’s hard to balance the forces urging me to do more with the desire to also do nonmedical things like spend time with my husband, hike, and write. My medical training has taught me to hustle, be efficient, and work for long durations of time with high focus. As my training continues, I’m also learning how to say “no” and pump the break. Of course, these learnings are contradictory. The pendulum falls sometimes more on the hustle side and sometimes more on the relax side.

As I finish my 1st year of residency, I’ve been thinking about the doctor’s dilemma because in the remaining years of residency I’ll make decisions about my post-residency career path. While I contemplate my career’s trajectory, I also find myself thinking about other things in life. For example, living in a city apartment has made me miss walking barefoot on grass. I don’t suspect I’ll own a house anytime soon, but missing grass has made me think about homeownership more than ever before.

What do I put on hold and what do I pursue? What opportunities if not taken now will disappear? Where do I want to be in 5 years?

While wellness preaches “live in the moment” heavy careers, like doctorhood, require forward thought. Doctorhood requires the balance and blend of one’s professional dreams and identity with one’s personal dreams and identity. During my 2nd year of residency, I’ll become a team leader and gain more independence. With this greater responsibility doctorhood feels more serious than it did as a new resident when I had more people guiding me. As my training continues, it is my turn to step up with the answers. Patients will depend on me. Each choice, like whether to study or run, has a ripple effect on my future and (perhaps) on my patients’ futures. There simply isn’t enough time to “do it all” at the same time. Choices must be made along the way. The choice options are what pose the dilemma.

Space

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I often think about space, specifically taking up/claiming space. My most conscious ponderings about space are while I’m running in the park near my house. I’ve observed that people are more likely to step aside for a male runner than me, a female runner. It’s so blatant that when my husband and I are running or walking together we strategically put him on the outside because people move over for him and not me. It’s an annoyance. I’ve started to run strong and serious. I’ve learned that a confident stride and a squared shoulder do help remind people that women also deserve to run without stride interruptions.

Guarding my lane while running is a newer claim of space for me. The first time I claimed space was changing how I sat. Changing my sitting stance was a project that took the better part of my twenties. For some reason women in my culture are taught to sit small and closed. I’ve found that sitting small is counterproductive. It has (perhaps) made it easier for males to harass me on public transportation and (definitely) made it easier for my colleagues in healthcare to ignore me. These days I try to sit large and open, just like my culture teaches their boys to sit. I don’t take the inside seat on the train/bus (that’s more for safety as I’ve learned the hard way) and I take up my whole seat even when it’s wider than I am broad. If there’s a seat at the table in a conference room, I take it. Which brings me to medicine, my most recent occupation (both meanings of occupation, wink, wink).

I have a very distinct memory from medical school related to being a female in medicine. I was mid-sentence presenting my section of a group presentation when a male member of my team cut me off, talked over me, and started his section of the presentation without letting me finish. It was so rude that several females in the class texted me in solidarity. The experience made me think about why seats at the table are not enough on their own. Seats must be claimed and, sometimes, defended.

Being a first-year resident brought with it a whole host of interesting space claiming challenges, many simply related to being a new doctor and some related to being a female physician. Filling the role of physician involved learning how to defend and explain my medical decisions, striving to take the high road and set boundaries when other members of my interdisciplinary team did not, and observing how physicians I admired conducted their doctoring and led their teams so I could model their techniques.

The challenge of being a new doctor exists for all new doctors. But filling the role of a female physician comes with its own occupational hazards. Here are some concrete examples from the past year of times I was reminded that I was female while at work:

  • I frequently must remind my patients that I am not their nurse — a challenge that my male counterparts don’t have.
  • My name is gender neutral, so nurses often think I’m male when communicating electronically with me before they meet me in person. (We have a secure chat in our electronic health record system that we use in the hospital). It is interesting to see how nurses’ tones change after they discover I’m female when they originally thought I was male. At times the tone change is dramatic and frustrating because I get more pushback as a female than as a male physician.
  • I have been lectured by a male supervising doctor about what clothes a doctor should wear. The lecture was somewhat confusing given that all the female residents wear exactly what all the male residents wear… scrubs of similar fits, styles, and colors. I doubt any male resident teams have been subject to such a lecture, but my all-female resident team was.
  • Several times I have found myself uncomfortable on rounds (that time of day when you talk about all your patients with the supervising doctor) because the male supervising doctor was very good at looking at my chest but never made eye contact.

The above situations illustrate that there are additional features of the medical terrain that female physicians must navigate that their male counterparts don’t experience.

As my second year of residency approaches (starts July 1), I’ll soon find myself no longer a first-year resident. In my second year of residency, I’ll start to be a team leader and I won’t be the new kid on the block anymore. I’m excited about this next step in my training. I feel ready to take on the challenge knowing I’ve learned a ton already and have a ton more to learn as a physician. I continue to have much opportunity for growth on my journey to lead with humility and excellence. As I wait for my second year to begin, I’m curious what the phase of “senior resident” (my title during my second and third (last) years in residency) will be like and the space challenges it will present. All adventures have space challenges however they present themselves in different ways.

The State of Being Human

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Being human is an uncomfortable affair at times. No one, perhaps, knows the state of being human better than the internist (internal medicine, my residency) who passes between managing patients in the primary care setting and the hospital setting.  As I gallop toward the end of my first year of residency, I can say with growing certainty exactly what the normal state of being human is.

Being human involves hemorrhoids, knee pain, and back pain. It involves debates (whether internal or external) about what to eat throughout every day and whether to exercise. And if exercise is on the menu, the question becomes: What kind of exercise should one do? Being human involves the occasional-to-frequent stuffy nose and nonspecific ache. It involves external stress such as work, family, and accidents as well as internal stresses like low mood (all the way to depression), anxiety, and difficulty sleeping. Being human involves getting older day by day, grumbling about this certainty, and knowing that the only alternative is death.

One role of internists (and emergency medicine doctors) is helping people sort out if their current uncomfortable state is on the normal spectrum of the human experiences or is out-of-the-ordinary enough to be life-threatening or to cause lasting impairment/injury. Take the classic question, “is my chest pain because my heart is injured?”

The answer is “maybe.” Moving the maybe to “unlikely” or “likely” a heart attack is where medical training and medical tests come in.

If you’re 20 years old and two days ago lifted the heaviest weights you’ve ever lifted and come to me with chest pain, I’ll start by pushing on your chest. If you then tell me that pushing on your chest makes the pain worse that’s enough information for me to say that your pain is likely soreness in the muscles that you worked out and does not involve your heart. To be safe, I could order some tests to confirm my hypothesis. I might not need the tests but if I see you in the emergency room, I’ll probably order them.

If you’re 60 years old and you don’t really have chest pain but, rather, mid-chest pressure as if someone is sitting on your chest…you’ve caught my attention. And if you then tell me that this chest pressure used to only occur when you mowed the lawn but now also occurs when you walk from the couch to the bathroom my concern for a blockage in the vessels that feed your heart is high. I will most definitely order some tests to explore my hypothesis.

I’ve heard hundreds of chest pain stories. With a story I can sort chest pain into categories including “likely normal life chest pain” and “likely heart chest pain.” I have exams and tests to further help me determine if the chest pain is directly related to heart injury. If I’m still concerned even after my first tests are negative, there are additional tests I can order.

One of the most satisfying aspects of being a doctor is helping people move past the uncomfortable affair of humanness so that they can maximize the joyful aspects of being human. Because being human also involves doing well. It also involves getting promoted at work and having kids. It also involves traveling and parties. It also involves loved friends and family. Being human also involves adventures and creative undertakings. It also involves feeling good and achieving goals. It also involves sitting on the pouch relaxing and glorious naps. It also involves conversations while sitting on the couch or at a café. It also involves sipping favorite beverages in favorite places on perfect evenings.

The state of being human is one of contrasts. Medicine occupies the space between the uncomfortable and joy of being a human with the aim to tip the scale back toward joy when things go awry. Medicine doesn’t have all the answers, but it outlines a system for exploring physical and mental discomforts and offers possible solutions. Part of what makes a good doctor is knowing exactly what the normal states of being human are so that we can quickly identify situations that deviate from the range of normal and intervene.

How Strange to Be Unable to Name a Daffodil

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“We saw daffodils!” I said. My voice sang with an enthusiasm that only such a definitive sign of spring could coax from me on such a rainy, gray afternoon in February. My co-resident looked at me blankly. The importance of a daffodil passing through their genius brain just as the medical terminology doctors like to use pass through patients’ ears – jargon without meaning, hardly in and definitely right out. “You know, it’s one of the first flowers of spring. I saw it in the park.  They’re yellow…” I gave up and the conversation moved on to other topics.

Doctors are more diverse than we once were, but our makeup doesn’t come close to mirroring the population we serve. My visible profile is common in the medical world – white (always very common) and female (slightly more females are entering medicine than males these days). Yet my unseen profile, my story before medicine and path to medical school, is unusual for a doctor.

Sometimes I’m reminded of my different background when it’s easier for me to relate to patients than my colleagues who come from medical families and have never known what it is like to not know what “coronary artery disease” and “hypercoagulability” mean. Other times I’m reminded of my different background when it’s easier for me to understand the social determinants of health such as why someone might not have transportation to appointments and why medications might not be worth the monthly bill to a specific individual. Where I grew up if you didn’t have a car you went nowhere; further, I solely used public transportation for most of my 20s. I’ve also run a tight budget most of my life which has given me a lot of practice deciding where my money will and won’t go.

It’s not just my economic background that makes me different from many of my co-residents (though I’ve come to realize more with each passing year that economic background is a mountain that dominates world view). The nuances of my difference from many of my colleagues present themselves at unexpected times such as on slow days when making small talk with co-residents and supervising physicians.

I grew up in a world where medicine was minimally understood, mysterious, and (perhaps) feared. The distance of medicine was partially possible because my family was healthy and required minimal medical care; it was also who we were. Our lack of medical knowledge did not mean, however, a lack of knowledge. For my colleagues who have known the medicine way of life since childhood as they watched their parents (many doctors and some nurses) come and go from work, the hospital system is familiar and almost second nature. I didn’t grow up knowing the hospital. Yet, I know other things that are part of who I was, am, and will be.

For example, I know the birds, trees, and plants of my childhood and I’m learning the ones of my new home in Virginia. I know how to grow plants indoors or in a garden because I grew up in a culture where we all knew how to tend plants. In a similar way, I don’t believe cows are cute because I’ve been almost late to school chasing them after they got out of the fence. I know how to stack 6 cords of wood in a day, use power tools and wood tools, and change my car tires because these are skills that were necessary in the world where I grew up. I notice architectural details, complementary colors, and other design elements because these were some of the themes of my childhood.

Being an older resident with a different background and careers prior to medicine is isolating at times. A small portion of my co-residents can relate or are interested in where I’ve been before medical school. I’ve become accustomed to this. My life extends beyond the hospital. I have family and friends who understand the nonmedical aspects of my life just as my co-residents understand the Doctorhood Quest in a way non-physicians can’t.

I have so much to learn about medicine from my co-residents and supervising physicians regardless of whether they understand any aspect of my life outside of residency. But, on days such as when I find a resident who can’t name a daffodil, I’m torn between amusement and sadness. In my world it’s ridiculous to be unable to name one of the most common spring flowers in the US. The realization that there may be many doctors who can’t name a daffodil reminds me just how different we all are. It also reassures me that there is much I can teach my co-residents too. And, perhaps more importantly, it reminds me how much physicians can learn from our patients and non-doctor colleagues if we find time to listen.

The Winter Doldrums

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Winter in Virginia is quite nice from a weather perspective. Most winter days this year have been in the 50-70s and sunny. Yet, despite the loveliness of winter in Virginia, spending so much time in the hospital (as us residents do) means I only catch glimpses of it. Like a plant kept too far from the window, I feel like I’m missing the sun’s warmth. I’m in the middle of a several-month stretch of hospital rotations where either I have one day off a week or am working nights – which is the perfect environment for the winter doldrums to flourish. So, it comes as no surprise that I’ve found the doldrums creeping in around the edges of my life like a vignette Instagram filter darkens just the outer edges of photos.

My doldrums is a weariness that hovers below the surface and presents itself in small ways. Forgotten facts like place names and life tidbits that were once second-nature. Moments at work feeling longer than eternity and moments at home passing faster than light moves. Waking up tired after sleeping enough. Sitting on the couch sipping mate and watching my plants grow more often than I usually do. Contemplating where I’ve been and missing Paraguay as I trudge home from long shifts. Like most moods, I’ve taken some time to observe my doldrums. It seems stable and temporary, especially knowing better times will be here soon.

Learning medicine is a long journey where knowledge builds with each passing situation, decision, and interaction on the job. Now that I’m over 6 months into residency, residency (itself) is familiar. My focus has shifted from learning my new role and how to complete tasks to growing as a doctor and deepening my knowledge.

The doctorhood quest is a process with a high level of granularity. I make daily tradeoffs between learning more and undertaking life (chores, fitness, rest, etc.) – sometimes the pendulum falls on the side of learning and sometimes it falls on the side of life. Everything can’t be done at once, or ever really, but progress is made step by step.

The upside of the doldrums is that it’s a contemplative state which is suited for winter when the days are too short to maximize outdoor time. I’ve been thinking about what kind of doctor I hope to be by the end of residency. I’ll be done with residency sooner than it seems on these long winter nights. Just as winter will soon be replaced by spring. With the start of spring, winter and its moods will fade. The doldrums will melt away leaving a summer state of mind. Moods and periods of life are nothing more than a type of season. What a lucky thing that summers are long in Virginia and the winter doldrums finite.

In the Quiet Presence of Plants

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“Some people look for a beautiful place, others make a place beautiful.”

~Hazrat Inayat Khan

I’m a keeper of plants. Some might call me a gardener but, having grown up in the rural US, I reserve the term “garden” for plants that root in the ground. And so, I’m a keeper of plants because all my plants are rooted in pots.

I have over 75 plants in my smallish apartment. Some of them have followed me through 6 moves. Some joined just this month. The only common feature among them is that they prefer Virginia to any place we’ve lived before. I attribute this to the sparkly sun here which was a key feature that drew me to the state in the first place.

My plants are as diverse as Richmond. There’s the Norfolk pine I’m growing as my Christmas tree. There are begonias adding their clashing leaf patterns to the balcony-dwelling jade plant, banana plant, snake plant, umbrella tree, and palm. On my desk is a battalion of orchids, most of whom bloom in spring. There are calatheas, peperomias, and bromeliads mixed in with the succulents and cacti. The coffee plants, passion fruit vines, and lemon trees are some of the newest additions. A dear friend got me a money tree for luck, around the time I got a lucky bamboo – it was a period of much change, so luck was needed. These lucky plants keep on growing. My crown of thorns hasn’t stopped blooming since I got it 5+ years ago. The fig, rubber, and dragon trees all were recently decapitated to encourage side branches (so far these experiments have been fruitful).

The plants sit along the windows and in layers such that those that need the least light live in the middle of my apartment and those that need the most are on the balcony for the summer or reside on the wide windowsill between my bedroom window and the blackout curtains necessary for daytime sleeping when I’m on nightshift. I know each plant’s light and watering preferences. I have a strategy for keeping each one alive when I leave for vacation.

Sometimes I wonder if it’s silly to have so many plants because I work such long hours outside of my home. However, when I come home to find a new flower bud or a fresh leaf unfurling, I’m reminded that it’s not silly but genius to have so many plants. The plants add a different beauty to the apartment than art (I have that too) and their quiet company is something I enjoy. With my plants even the most frustrating day can be softened when, upon sitting on my couch, I notice just how much the peace lily likes its new spot or how much the Chinese evergreen has flourished since we arrived in Richmond only months ago. And when I see the plants that I’ve potted up at least 3 times threatening to outgrow their current pots, I remember how we all change and grow with time. Sometimes our process of growth is too slow to see from day-to-day and only can be realized when we compare month-to-month or year-to-year. Yet, just as surely as my plants are renewing their roots and leaves, I’m also growing as the days of residency pass.

First Impression of Richmond, VA

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The James River winds through Richmond, VA and serves as the city’s playground. On a sunny day you’ll find folks lounging on river rocks; testing the rapids in rafts and kayaks; and biking, walking, and running on the riverbank trails. From the numerous walking bridges across the river, you can watch osprey dive, great blue herons fish, and geese and ducks eat bottoms up.

When you turn away from the river you find yourself wandering along streets lined with old brick buildings including row houses and factories-converted-to-apartments. Murals are scattered throughout the city. Parks and green spaces are more numerous than tall buildings.

Downtown Richmond is quiet. There isn’t much traffic – even at the peak of rush hour the traffic is manageable. There’s a boarded-up window or “for lease” sign every couple of storefronts on the primary street at the heart of the city. Neighborhoods with different vibes sit like cars on a Ferris wheel around Richmond’s often sleepy downtown.

Richmond could be called the city of highway sampling. Numerous highway bridges crisscross through the city. Under these bridges are blocks filled with restaurants and parks. When you use Google maps to navigate almost anywhere in or around Richmond, you’ll find yourself driving on several highways for less than 1 minute each.

Richmond is easy living. It’s urban enough that there are big name shows yet it is quiet enough that you can often hear birds singing. Without many tall buildings, Richmond feels more like a large town than a big city. I suppose “big city” is relative. I like having a 6th floor apartment that feels like a penthouse because a 6-story building is tall in my neighborhood.

From my mini balcony I have a lovely view of the sunset. From my apartment windows, I can watch the numerous lightning storms that come from the south-west to dazzle the city. I guess living in a hot and humid place leaves ample opportunity for any cold front to make the air zippy-zappy. I’ve never seen so many lightning storms in such a short period as I have living here.

After about 3 months in Richmond, I’ve found my favorite ice cream place and some go-to walking routes. There’s still a lot left to explore and learn about the city, but it already feels like home. It doesn’t usually take me long to settle in a place, but Richmond was an especially easy transition.

The Happy Stillness Between

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I find myself sipping mate and gazing over my desk and plants out at a new skyline. Several days ago, I moved to Richmond, VA from Danbury, CT. The move was a grueling 28-hours of loading the truck, driving overnight, and unloading the truck. My partner and I took only a 30-minute nap to get us through the driving, knowing that there are an infinite number of less tiring ways to move, we wanted it done as quickly as possible. Our main hiccup was finding a way to navigate the ~400 miles along the East Coast on highways that allowed trucks because our U-Haul was quite robust. We learned that there is no setting on Google maps for truck routes. Luckily, we know how to read maps despite the prevalence of technology in our lives and found a route using our brains, yes unusual.

We’re mostly unpacked now, just a few more projects to do before we will be completely settled. We’re chipping away at these tasks, such as hanging paintings and donating no-longer needed items. Knowing our apartment is in a good place, my focus has shifted to the next adventure. Later this week we travel to Paraguay to visit my friends there. It’ll be my partner’s first time to the country where I did the Peace Corps and where my mind always wanders when time slows. Slow as it is now.

Medical school, at least as it is organized at my school, is a sprint that comes to a halt not at graduation but at Match Day, several months before graduation. It’s not a bad system. It leaves time for vacation and residency onboarding tasks while also giving us students a moment to enjoy non-medical pursuits before we plunge into the rigors of residency. But, when one is accustomed to a sprint too fast to breathe, as those of us in medical school are, the slowness of these days between Match Day and residency is as strange as a journey to a new, very different country. I’ve read more books for fun these past few months than I have in years. I’ve hiked and slept and pondered life. I started baking again, something I hadn’t done since I returned to the US from Paraguay in 2016. I’ve planned trips and moved.

I wanted to come to Richmond early, many of my peers won’t move to their residency locations until weeks prior to our start date this summer. I’m a person who centers at home, regardless of how new the home is to me. I like moving, but I also like time to settle before I’m expected to excel in life pursuits. I like time to find the grocery store and walk the neighborhoods that’ll be my stomping ground. Yesterday I did both of those things – I found a grocery store which had nice spinach (the primary way I grade grocery stores) and I strolled through a giant cemetery not far from my house with trees that had new, full leaves and singing birds.

It’s beautiful in Richmond and the politeness of the South is a welcome kindness after living in New England for years. New Englanders don’t, for example, say “hi” when you pass them on the street in a city or let you cross the street without threatening to run you over, even though there’s a red light for oncoming traffic. I’m too new to Richmond to have major complaints, but so far, the things that bothered me in Connecticut aren’t present to the same extent. I do admit, I’m not used to having streets named after important people from the Confederacy. I don’t yet fully understand how those imposing names from the past will impact my life though I know they already do and will in new ways here.

Richmond is green and quiet for a city. My apartment is high up without taller buildings around it. It has ample windows. What this means is that I’m surrounded by sun and have a stunning view of the sky. My few days living in Richmond have taught me that it’s a place of expressive skies – which is something I always loved about Paraguay too. The clouds cross the sky with bright colors and exciting shapes. The morning, afternoon, and evening look different in the clouds and sky of Richmond. My apartment, specifically, has a magnificent view of the sunset.

I lived in Washington, DC for 6 years before I did the Peace Corps. And while Richmond is distinct from DC, coming back to the DC-VA-MD area feels like returning home. I’m happy to be back. I’m happy to have arrived when the weather is absolutely perfect, just before the humidity and heat of the summer set in. I have about a month to explore Richmond before I start work. Richmond feels completely different from Vermont or Connecticut. I’m happy to uncover the opportunities hidden in this new place. Opportunity to learn to be an excellent doctor but, also, opportunities to explore life beyond medicine. I’m excited to reconnect with the urban passions I have and to find new ones that suit me in a green, urban home. And small mountains aren’t too far away in Shenandoah. I’m grateful for the slowness of these days so that I can sit with my happiness. Life has taught me that, much like sorrow, complete happiness is fleeting. So, I’m pleased to have time to revel in this happiness storm until the next emotion rolls in.