Resilience

Not so long ago, a couple of brilliant new medical students asked me how many notecards I do a day. “Doing a notecard” means quizzing yourself on its contents and making progress in remembering the information it contains so you can answer test questions on the topic. Talking about the number of notecards we do daily is typical shop talk in medical school—everyone is trying to figure out exactly how to learn the mountain of information that makes up medicine. Almost everyone decides early on in their medical school career that the only way to learn what we must learn is with notecards. But, what is the perfect number to do in a day?

I avoided answering those new medical students’ question about how many cards I do a day. I wanted to help but, it’s an unanswerable question. I am not a robot. If I were a robot, I’d do something like 500-1000 notecards a day. But that’s not how life works. Some nights I don’t sleep well. Some days I have meaningless meetings that take up the best study hours. I gotta eat. I gotta move my body. Some days, it’s just too sunny to stay glued to my desk. Sometimes I’m tired and I retain nothing. Sometimes I get bad news and I’m sad. Sometimes I’m sick. Sometimes I’m on fire and I cruise through notecards like a genius.

We talk a lot about resilience in medical school. Here are the typical discussion questions:

  • What is resilience?
  • Why is resilience important?
  • Can resilience be taught?
  • How does one become resilient?

Thinking about notecards led to me some answers. Here they are:

What is resilience? Why is resilience important?

Google defines resilience as “the capacity to recover quickly from difficulties; toughness.” With that definition, it’s obvious that when you’re doing very challenging things like learning medicine it helps to be resilient. Becoming a doctor is a long process and you’re guaranteed to make a lot of mistakes. The only way you’ll make it to the “end” is by becoming an expert in self pep-talks and getting up when you fall.  

Can resilience be taught?

I don’t think so. Not once, ever, has any class, piece of advice, or discussion made me better able to endure a hardship. Every hardship I’ve endured was because I decided to bear it. I had family and friends who supported me along the way, but the healing and “how to do better next time” was mine alone to formulate. But, while I don’t believe we can teach others resilience, I do believe that resilience is learned.

How does one become resilient?

We become resilient by being challenged. The folks who are most resilient are the ones who have endured the most hardship. That’s not to say all people who have faced many obstacles are resilient; it’s just to say that you can’t be resilient if you never face a challenge. If you’ve never failed or been hurt than you can’t know what it’s like to dust off the dirt from a fall and try again. Without challenge, you can’t learn how to adapt your plan as life unfolds new surprises.

This principle is the basis of the answer to the notecard question I was asked. How many notecards do I do a day? I have NEVER, not once, done as many notecards as I hoped to do in a day. Yet, I have passed all my classes comfortably. In fact, not only have I never completed as many notecards as I wanted to…when I started medical school, I didn’t use notecards. Not using notecards was a grave mistake. When I started using them my grades improved by about 5% and, for the first time in my medical career, I had time to exercise, sleep, and socialize a sustainable amount. I switched to notecards ¾ of the way through my first semester of medical school. I was terrible at making notecards. But, I gave them a fair trial because I knew how I was studying before notecards wasn’t working. I had two choice at that point: sink or swim. Swimming involves adaptability. I decided I would rather be an otter than a rock in the deluge that is medical knowledge.

Deciding to use notecards may seem trivial until you consider that I’ve bet around $100,000 (so far) on becoming a doctor. It seems trivial except when you consider that it took me 6 years (of work) from the time I decided I wanted to become a physician to the day I got to decide how to study my medical school material. It seems trivial until you realize that I still have at least 5 years, probably 8, and many licensing exams between me and practicing medicine. The stakes are high. I could have failed upon switching to using notecards. But, I thought it was worth a try and I knew I would fail if I kept up what I was doing.

This past exam (fast-forward to my second year of medical school) was the first time I finally studied all the notecards I’d made for an exam. It’s been a little less than a year since I starting using notecards to study. I’m way better at using notecards than when I started. But, my journey isn’t over. This spring I take the biggest exam of my life (my first board exam – a national exam everyone who becomes a doctor must pass). How well I do on that exam heavily influences what residencies I can apply to and, ultimately, what type of doctor I’m allowed to become. It’s scary. My daily notecard count is only one part of how I will prepare for that exam. The number of notecards I did daily last year, over the summer, and now is different. How many notecards I do today will be different from how many I do each day when I’m in the middle of studying for that looming board exam.

What challenges and failure come to show us is that things can be done in many ways. They also show us that we can only control ourselves. For example, I can’t change how much information I’m expected to know for an exam. I can decide how to learn the information. Resilience is not complaining about something that never could have been. It’s about deciding to make your dream reality. It’s about jumping into the flood, scared out of your mind, with a willingness to evolve until you get to where you’re meant to be.

Betrayal

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How I Came to Discover That Pronouns Are Like Ants

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My Apples Are to His Oranges

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tipping point?

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

“What is wrong?” I asked.

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

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

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

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

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

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

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

~

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

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

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

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

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

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

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

Immediate:

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

Ongoing:

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

Goodbye 20s

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

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

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

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

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

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

Making It

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

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

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

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

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

The Snowy Paths of the Brain

Imagine a scenario in which there is a steady snow. In this hypothetical, the snow never stops and it has already accumulated several feet on the ground. In this place you have a house, a barn with animals, and a woodshed.

Imagine it is a day filled with the regular chores of a house and barn in Vermont. The first time you trudge out to the barn in the morning it’s hard to blaze the path through the thigh-high snow, but as you go out again and again—to feed the animals, to give them water, to collect eggs, to clean out the stalls—the path becomes more packed and easier to travel with each pass. Even though it’s snowing, the path between your house and the barn stays well-groomed because you travel it so often.

Now, imagine you have to get wood for the woodstove. You start down the well-defined path to the barn and, then, veer off into the snow to go to the woodshed. The first time you go to the woodshed, it’s a tough slog through deep snow. Subsequent trips are easier. You only need to get wood once over the course of the day, even though it took you many trips to get it, so hours after collecting the wood the trail you made is starting to disappear under fresh snow. By bedtime, the path has completely disappeared because you didn’t retravel it that day.

The pathways in your brain are like the trails between the buildings on the snowy property described above (credit for this analogy goes to my anatomy and physiology professor this semester, Dr. Matt). As children, we are building many pathways while at the same time eliminating unused pathways. The amount and rate of forming new pathways and connections in the brain slows with age but, even when we’ve lived long enough to be wise, our brain continues to reshape itself. The formation of new pathways, strengthening of others, and pruning (eliminating) of infrequently used routes in the brain is called “neuroplasticity.”

Neuroplasticity, the resiliency and reshaping of our brain, is one reason researchers worry so much about children who don’t have access to many learning opportunities or live is stressful family situations. These experiences, or lack of experiences, shape the children’s minds for the rest of their lives. It’s easier to be ready for the learning done is school, if before you start your brain is used to hearing stories and practicing words and math. It’s easier to be ready for more school and job responsibility if you were lucky enough to master elementary school. It’s easier to know how to be confident, happy, and kind if you’ve experienced those things many times.

Neuroplasticity is also part of the reason why drug addiction is considered a disease and is so difficult to beat—drugs can change the pathways in our brains. Once someone is addicted to drugs, their brain is literally wired to want, seek, and (even) need the drug to function normally. It’s hard to avoid a path you know well and that has become central to your existence. For example, how often do you change the route you take to work everyday?

Neuroplasticity is also more general in a way I find inspiring. To me, it’s evolution’s way of giving us one more reason to be hopeful. The idea that we can reshape our brains if we’re will to trudge enough times to forge a new connection is awesome. It’s also amazing that if we try hard enough to stop using a pathway, it will weaken. This gives us fantastic opportunity for life-long learning and self-growth. It means we can train ourselves to understand new things, act differently, and even alter our response to specific situations. It means that we can discard habits and build new ones if we are willing to put in the energy to tackle the snow of our mind. Life isn’t static and I find it inspiring that we (individuals) need not be either.

Closing 2018, Opening 2019

If I had to pick one word for 2018 it would be “success.” I finally got a job taking care of patients, this officially marked my transition from a communications career to a health care one. With each passing day, I grow more certain that I’m headed in the right career direction. I finished my pre-med requirements, took the MCAT, applied to medical school, and got into several medical schools. I made some awesome new friends and visited some of the best long-term ones. The farthest friend visit was to my beloved Paraguay (I also visited friends in DC and Atlanta).   

This New Year’s finds me at a crossroads. In the coming months, I will decide where I will go to medical school. I feel incredibly lucky to have options, especially because I only applied to schools about which I am excited. The cost of school and if I should move to a new state weigh heavily on me. Starting the next chapter in the doctorhood quests is simultaneously overwhelmingly exciting and completely petrifying. But, change and moving are nothing unusual for me.

Earlier this year, I wrote about “name the fear and conquer it” as my general approach to life. A huge part of that is identifying when I’ve fallen into a mindless routine and, then, breaking that routine. I’m the type who as soon as they learn something new looks for how to become better and how to expand my knowledge. I think this trait will serve me well in medical school. It’s served me well in everything else I’ve tackled. But, as I think about these traits and the exciting goals that are coming to fruition this year, I find myself thinking that my biggest New Year’s resolutions have little to do with my career ambitions and a lot to do with the rest of my life.

I have high expectations and hopes for myself as I begin medical school, but I know I will put my best self forward in pursuing those regardless of my New Year’s reflection. Therefore, as we slide out of 2018, my New Year’s resolutions are to focus more on relationships and adventure. In that vein, here are my top 5 resolutions:

  1. Do a better job of staying in touch with old friends, family, and contacts even in the midst of school mayhem. This may include taking more time to visit friends who live far away, writing letters, texting, emailing, or social media-ing.
  2. Focus on developing new friendships. The challenge for me is always ensuring I leave enough time to spend with friends even when school work crescendos.
  3. Travel outside of the country, to a new place, at least once in 2019.
  4. Travel or visit somewhere new (even if it’s a day/partial day trip) at least once a month.
  5. Join some initiatives/groups that don’t directly relate to my budding career in medicine. Ideas I’ve pondered before or relate to interests I have include: joining a gym (I currently workout at home), ballroom dance classes/club, hiking club, book club (currently in one), or writers’ group; taking a yoga or martial arts class; becoming a youth mentor; and/or joining a choir.

Besides the New Year’s resolutions, I plan to continue my daily struggle to smile more, see the best in people, and be the kindest person I can be. I wish you the best of luck in 2019—I’ll be taking it one day, one week, and one month at a time. Happy New Year!

Below the Surface

A pre-holiday Paraguay visit is to blame for the blogging hiatus this December. It had been 2 years since I last visited Paraguay, the country where I lived for 27 months while serving as a Peace Corps volunteer. My Paraguayan friends were amazingly generous. They fed and housed me. They brought me on adventures around their lovely country. We spent hours chatting and eating—recalling old times, catching up on times spent separately, and dreaming about the future. I was reminded of how easily Paraguayans show affection—through food and time given to others. I was reminded, as I’ve been hundreds of times, of how lucky I am to have stumbled upon my Paraguayan community and how spoiled I feel to enjoy the company of my Paraguayan friends.

During this visit as I walked back from church one evening, after attending the celebration that marked the closure of the Christmas in Families (which is where people go to family homes to share passages from the Bible and prayer for 9 days in the month leading up to Christmas), I was reminded of a story shared at my favorite Paraguayan mass years ago. I don’t remember the occasion for the mass or who gave the sermon, but I remember the story the priest shared. I think, regardless of religious beliefs, it reminds us that we must look carefully and patiently to see what’s hidden below other’s facades. It’s what was hidden below the surface that made me fall in love with Paraguay. It was the journey of looking deeper at the land of Guarani that taught me resilience and showed me how to find hope no matter the circumstances. Here’s the story from that mass:

A Ride in a Car

There once was a young man whose rich brother gave him a fancy new car. The young man was so proud of his car, he loved to drive it all around town. One day, the young man had to park his car in a poor neighborhood while he was running an errand.

As the young man walked back to his car after finishing his errand, he noticed a boy circling his car. The young man worried that the boy was trying to find a way to enter or damage the car. The young man hurried to his car and asked the boy what he was doing by the car.

“I’m just looking at your car! It’s so nice. I’ve never seen one like it. I hope one day I will have a car like this one!” the boy said.

The young man explained that his brother had given him the car. “Wow!” the boy said. The boy and the young man talked about the car at length. The young man scolded himself for thinking the boy had been up to no good.

“Since you don’t have a wealthy brother to give you a car, would you like to take a ride in my car with me?” the young man asked the boy after they had talked for some time.

The boy jumped with excitement and jumped into the car. They drove a little way, then the boy asked if the young man could pause in an alleyway because the boy had to deliver a message to someone. Once they stopped, the boy asked the young man to wait for him to return, promising to be right back. The young man agreed to wait for the boy, but again had doubts. He wondered if the boy was getting someone to help him steal the car. The young man waited nervously, thinking of all the bad things that could happen. He thought about leaving before the boy returned, but something made him wait.

After several long minutes, the boy appeared in the doorway of a building in the alley. The young man squinted, the boy had something in his arms. The boy approached the car. Once the boy was close to the car, the young man noticed that the boy had a sickly, disabled child in his arms. “Sir, this is my brother! Can he take a ride in the car too? I want to show him the car. I have just promised him that one day when I am rich, I will buy him a nice car just like yours.”

The young man agreed to take both boys for a ride. The young man scolded himself not only for distrusting the boy, but for thinking the boy was envious of his car.