Tag Archives: Dreams

Waiting Impatiently

Posted on by

The gray of New England spring hung low as I traveled home from the airport. In short time, March would deliver the snow-rain I know the month for in the region where I grew up. I learned that the cold and gray, which can span 9 months out of the year here, was not for me when I left New England the first time. I stayed away for almost a decade until a desire deeper than my love of sun brought back to the state my parents chose for us so long ago, Vermont. I wanted to become a doctor. Medical school takes a forest of strong trees by your side – it takes a lot of willpower on your part coupled with family and friends to complete. Something made me pause when my medical school acceptances gave me the option to leave New England again. I didn’t leave then, choosing to stay close to my parents, my siblings, and my new Vermont friends. My compromise was a plan to move to southern New England, Connecticut, for the second half of medical school because my school had a clinical campus there and it suited me better than their Vermont campus.

I think the choice to stay close to family worked. As I write this, I’m waiting impatiently because in a few long days I learn where I’m headed for residency and, unless I’m gravely mistaken, I’ll leave New England once again. As a side adventure during the Doctorhood Quest, I scooped up a New England-grown husband. I often wonder if understanding the winters here is an important thing he and I have in common or if it’s just everything else that makes us a good match. I’ve also gotten to see my parents and sister more during medical school than in the almost decade leading up to it. I have good friends who saw me through the worst days as a medical student. I’ve come to call my Connecticut town home, even if the designation is fleeting.

This March’s late rain and snow squall isn’t unique to this region at this time of year – though it would seem other places where snow is unusual are getting slammed, weather patterns are becoming more and more confusing as climate change forges on. And while my roots are familiar with the snow and the cold, a few days ago I returned from 7 weeks in Puerto Rico so the coldness and gray is particularly unpleasant this week. It stands out to me how miserable March is here as I look out my window over my flowering orchids and assorted houseplants, many of which grow as weeds in Puerto Rico. It was at the ripe age of 18 that I learned how much I love the sun and living in sunny places even though I require sunblock, shade trees, hats, and other sun protection to enjoy the sun without turning into a lobster.

On Monday this week, I and many medical students across the country found out we matched into residency. And now, in a typical medical school approach of drawing things out longer than is reasonable and with no efficiency and minimal logic, we are all waiting until Friday until we learn the magic WHERE we matched. The day we learn where we will go for residency is called Match Day. Transitioning from medical school to residency is a boring process that makes little sense, so don’t ask about it. Just know that this week is moving at half the speed of any other week these past 4 years and that my excitement for Friday’s discovery is exploding. My excitement even makes the cold and gray outside acceptable though not welcome. Residency is the next and the last phase of the Doctorhood Quest before I am a doctor. I could, of course, continue onto fellowship after residency but that would be to further specialize. Residency will give me the skills needed to practice as an independent generalist in internal medicine (in my case, those pursuing other medical paths might finish residency as surgeons, psychiatrists, or neurologists to name a few areas of medicine that can start after residency).

I’m excited for what’s to come. I made a picture frame for taking pictures at my Match Day party with “Adventure Awaits!!!” written on it. Perhaps you get the Up reference. The picture frame is a party feature that’s a throwback to my Paraguay days. Paraguayans know how to throw a good party. At my Match Day party, there will be an ice cream cake, food, a banner, and streamers. And, of course, I’ll celebrate with my family. I’ve been working towards this day, the day I get into residency, for 10 years. It’s hard to believe I’m here, but it feels real. I can’t wait for it to be Friday, March 17 aka Match Day 2023.

Advertisement

Back In the Operating Room

Posted on by

The patient was undergoing emergency surgery for an aortic dissection (when blood gets between the layers of an artery wall) with an aneurysm (dilation/ballooning out). The aorta is the largest artery in the body. It comes off the top of the heart and then travels through the chest and abdomen until it splits into two big arteries that feed the legs. It has many branches along its path. Because this patient’s dissection and aneurysm were close to their heart, without surgery the dissection could spread and damage their heart. Further, if the aneurysm wasn’t fixed and then ruptured, the patient would likely bleed to death.

Conducting this surgery was one surgeon and one physician’s assistant (PA); they were supported by an anesthesiologist, a resident anesthesiologist, 3-5 nurses, and 1-3 surgical techs. Surgeries are always a team effort. This surgery was complicated, the stakes were high, and bad outcomes were more likely than for many other surgeries (but without surgery death was almost certain). For the first 6 or so hours of the surgery the surgeon and PA worked without a break – no water, no bathroom, and no food. After the most time-sensitive part of the surgery was done, the surgeon sipped some water through a straw that a nurse carefully threaded behind his mask. The nurse joked that he was like a gerbil – no one argued with that analogy.

In all, the surgery would take about 11 hours. As the surgeon was finishing up his work, he looked around the room and thanked each person there for their help. He then looked up at me. I’d been watching the surgery for the better part of 8 hours. “What are you? A resident?” the surgeon asked.

“No, a medical student,” I said.

“God bless you,” the surgeon said. He paused. “My son is a third-year resident. I tell him to remember that you’re not supposed to enjoy residency.” The surgeon paused again. “But I still say I would never have wanted to do anything else.”

This surgeon had started working as a surgeon at this hospital when I was 8 years old. Assuming he’d done about 8 years of training to become a cardiothoracic surgeon and that he’d spent his entire career at this one hospital, he’d been operating about as long as I’d been alive.

I reflected on his sense of fulfilment in being a surgeon. I wondered if I’d end up liking my path in medicine as much as he liked his. I wondered if it was possible to enjoy one’s path in medicine as much these days as it was when he started.

~

Medicine has changed a lot in the 30+ years I’ve been alive. We’ve made lots of amazing advancements, but health disparities remain staggering. Work conditions are variable hospital to hospital and clinic to clinic. I love medicine, but I can’t ignore how strained our healthcare system was before the COVID pandemic and how much worse it has become even after the COVID vaccine reached the US public. I also know that my path in medicine will be quite different than that of a surgeon.

I am pursuing a medical career that does not involve surgery or procedures and, therefore, is not a hospital money-maker in our current healthcare system. Money gives power even in healthcare, as such, I’ll neither have the high pay nor inherent influence on hospital administration that surgeons do. All physician roles have amazing components and are important for patient care however to say each physician’s place in the system is the same is not simplification, it’s erroneous. I’ve come to feel the differences between physician types more thoroughly as each new step of my doctorhood quest unfolds.

As I wrap up my time as a medical student, I’ve been reflecting on what I’ve learned and seen in healthcare so far and where I want to end up as a physician. As a student, I’ve seen more parts of the patient care system than I will in any other capacity during the doctorhood quest. I’ve participated in countless conversations throughout the inpatient and outpatient healthcare settings. I’ve been a fly on the wall for even more conversations than I’ve participated in. From insurance navigation nightmares to cool medical cases, from nurse-to-patient ratios to supply chain issues I’ve come to understand that healthcare is a complex group sport where the field and rules change based on geographic location (because of geography itself, demographic composition, and regional laws), insurance status, medical society guidelines, government funding, hospital and/or clinic revenue generation, supply chains, ability to hire healthcare professionals, and many other factors.

I start residency in about 6 months. At that point, I’ll continue to learn what I need to know to be an independent physician. After 3 years, I could graduate residency to work as a hospitalist or primary care physician or I could continue my training to further specialize. I’m excited and hopeful about these rapidly approaching adventures. I wonder what I’ll tell a medical student about my journey 30 years from now. I dream that my message will be as positive as this surgeon’s message was to me.

Welcoming 2023

Posted on by

Fog

by Carl Sandburg

The fog comes

on little cat feet.

It sits looking

over harbor and city

on silent haunches

and then moves on.

2022 was a year of achievement. I finished my last exam and clinical rotation of medical school. I applied for residency and got cool interviews. I went to my first medical conference. I got married. I re-combined houses with my husband after he graduated from nursing school and started his first nursing job. I did some of my longest hikes. I feasted frequently.

2023 will be marked by change including finishing medical school and starting residency in a place yet-to-be-determined. I started with Carl Sandburg’s “Fog” because quietness, absorption, and forward movement are the 3 themes I think will get me through the whirlwind of transitions that will unfold in the coming months.

Quietness

Life is loud whether visiting with friends and family, undertaking adventures, or working. In all pursuits, inner quietness can act as a grounding point. This year my primary goal is to cultivate my inner quietness.

Absorption

Residency is a huge leap of responsibility from medical school. It’s the first time I’ll get paid to be a physician, but with more responsibility comes a ton more to learn. In this context, I’m planning to tap my inner sponge and absorb as much knowledge as I can.

Forward Movement

Whether the days are long or short each one is a step forward. This can be difficult to remember in the moment. As I work through the joyful and unpleasant times of 2023, I hope to remember that my efforts are moving me along life’s adventure even if it’s not readily apparent how each piece fits together.

Finding Purpose and Meaning

Posted on by

The patient was nicely dressed and collected. They sat with elegance as I chatted with them during their checkup. By most accounts they were doing well. They didn’t have many aching joints or the other common issues of people their age. But, as we finished going through all the normal appointment questions and checklist items for a primary care visit, the conversation turned to the main issue at hand: meaningful existence. 

The patient had recently moved from the south to the north to be close to their adult children. In moving, they had left behind the hair salon where they’d worked for many years and where they continued to work until moving. Nobody in their new, northern community would hire them as a hairdresser because of their age. This disappointed them. They were very energetic. They were involved in many clubs and had many social engagements weekly, yet, they found themselves depressed, tired, and empty. Nothing they were doing gave them the sense of purpose that working had.

We brainstormed together. If not work, could the patient volunteer? Where might they like to volunteer? Our town had many opportunities for volunteering. The patient jotted down a few nonprofit ideas and smiled. They said they’d consider it; it seemed better that sitting around doing pointless things.

Depression is common in the elderly. Among other things, it’s postulated that feelings of isolation and loss of purpose can contribute to depression. On an anecdotal level, I’ve heard many elderly patients describe feeling alone, especially when they’ve moved to be close to adult children and left behind an existing community their age or that they had been part of for a long time. Even children who visit frequently aren’t the same as having a whole community – especially a community that has also lived through the same decades and seen the same changes in the world. What’s more, many elderly people are retired or decrease their activity in work and volunteering. It’s easy to say that retirement and less work is good and that these wise people have worked their whole lives and deserve a rest. This is true; however, what I’ve also noticed anecdotally among the hundreds of patients I’ve met as a medical student, is that the happiest people are the people who have meaningful projects regardless of age.

This elderly patient is an example of someone who was driven to work well after they reached retirement age. Their case showed me that perhaps encouraging and supporting our elders to be active participants in their community would be helpful for their wellbeing. This seems especially important in a place like the US where many families are scattered all over the country and generations tend to live separately. There are many elderly folks who find meaning in caring for grandchildren as I’ve seen in other places like when I lived in Paraguay. However, we must remember that there are many elderly people who didn’t have children or who don’t wish to spend their days caring for their kids’ kids and that their need for meaningful activities is also valid. As we forge forward as a society, it seems prudent to keep this in mind and continue to support and develop programs that help an aging population remain active in their communities’ productivity and progress if they would like to be. Be it work, volunteering, or other projects in and out of the home.

Anticipation

Posted on by

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.

Home

Posted on by

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.

Together

Posted on by

Repost of a post I wrote for the Global Health Diaries, the blog of the Global Health Program at the University of Vermont Robert Larner M.D. College of Medicine and the Western Connecticut Health Network. Find the original here.

“Here, you can just about always find an internal medicine resident who speaks the patient’s language,” the resident I was working with said, smiling, “It’s amazing.” Another resident had just stopped by to say that one of their colleagues did, in fact, speak that obscure Southern Asian language the translation service did not cover that they needed for an acute patient. I smiled because it was amazing. This was exactly the type of place I’d wanted to train to become a physician.

It was standard that everyone on my teams during my internal medicine rotation had a different accent. And when two of us did have the same accent, our divergent places of origin and cultural backgrounds made up for the lack of difference in how our English sounded. What I liked most, was that in this hospital everyone came from different places – the patients, the nurses, the residents, the physicians, and the other hospital staff. Even in modern America, it’s somewhat uncommon to work in a hospital where the physician diversity almost reflects the diversity of the patients. The hospital where I did my internal medicine rotation in Connecticut was very close to having its physicians reflect the different groups of people who made up the greater community of the hospital.

One thing I found interesting upon returning to Vermont after almost a decade away was how much I missed the accents and the challenge of finding connection across cultural differences I’d experienced during my years in the Washington, DC and Paraguay. There was a subtle feeling of stagnation, almost boredom that crept into my professional life as I began my medical career in my home state. Of course, Vermont has pockets of diversity of all kinds but it’s not like living in an urban area or a foreign country.

After my second year of medical school, I moved to LCOM’s Connecticut campus. As I settled into my new community, I learned that where I lived in Connecticut was a melting pot that buzzed and hummed in ways that more homogenous communities do not.

What better time to dive into a diverse medical community than right after the release of the COVID vaccines? As I listened to the accents of the residents and attending physicians with whom I worked during my Connecticut internal medicine rotation, I was struck by how the medical community is just as connected as the general human community is connected. Afterall, COVID has definitively illustrated how communicable diseases can spread easily around the world. But, also, the speedy development and dissemination of the COVID vaccine showed how we humans can solve dire problems when the minds of people all around the world come together.

There was something unique about how my internal medicine teams came together to solve patient problems. Of course, good medicine transcends culture – some medications and interventions just work. But, in terms of decisions about how to interact with patients and their families, each of us brought our own cultural beliefs and backgrounds to our practice of medicine.

One of the neatest things about working with team members who aren’t like you, is that you’re forced to reflect on your own ways. You’re forced to examine other ways of being. And, in medical school where it’s easy to get caught up in the nitty-gritty of disease states and medication dosages – I was grateful to be reminded of the humanness of the residents and attending physicians around me. And, also, to be reminded that my patients brought their humanity with them when they came to the hospital.

Most of the hours spent on internal medicine were dedicated to identifying the best course of treatment for our patients. But as rounds ended for the day, there was often the lucky opportunity to hear what medical school was like in other countries and how physicians from all round the world had come to find themselves in Connecticut. The walls of the hospital seemed less limiting when I realized that it had taken a global community to staff the hospital itself.

Ring Reflection

Posted on by

I held my wedding ring in my palm, feeling the weight of it. I put it on and took it off – making sure it didn’t get stuck and testing the feel of it. It was still months until I’d be able to wear it but, I liked having the opportunity to test it out. It had our favorite mountain range on it; an unassuming range that most overlook. Yet, we’d had many true adventures on that range. By happenchance his favorite mountain was on one end of the range and mine was on the opposite, with a slog of a ridge between them.

Someone asked us recently if we were serious hikers and we laughed. Serious? We’re day hikers who find trails whenever time and the fatigue of busy lives allows. Serious? We like showers, feasts, and fireplaces after miles climbed. Serious? We always seem to be bellowing Star Wars and Mighty Python quotes (between giggles) when those scarce other hikers unexpectedly find us on the trail.

My ring felt light and heavy at the same time. A simple band with so many stories behind it. I didn’t want or have an engagement ring, so the wedding ring was the first tangible reality that we were “getting hitched.” Engagement rings are not for me; though I realize for many they are a joyous aspect of their engagement. A thing I’ve enjoyed about not having an engagement ring is my interactions with people who don’t know me – what does it take for me to tell them I’m engaged? As a medical student I interact with numerous people every day, yet only some of them inspire me to share any part of my story with them. It’s an exercise in exploring exactly how humans create trust and connection during encounters the length of medical office visits. You might be amazed by the number of physicians with whom I worked for weeks yet did not tell I was engaged. Not for fear, but simply for lack of connection or reason to share that tidbit of myself.

I looked at the range as it unfolded as I turned my ring carefully. Ranges represent a journey. My fiancé and I had been on many journeys but, overall, we were on life’s journey together. Our path had thus far been calm yet still varied by ups and downs and mud patches. School had been the overarching limitation, much like a heavy pack, of our life as a couple. I’d been in school our entire relationship, and he’d been in school for most of it. We were friends for years before we started dating. In those years, we weren’t in school and had had a more leisurely approach to hiking and feasting, without the pressure of tests and hard study schedules.

We had in common a love of healthcare, yet our approaches were quite different. To be honest our brains perfectly illustrate the difference between the nursing and physician approach to patients and health. He was the matter of fact, nurturing, and patient human you’d want at your bedside hours upon hours when you’re sick. I was the curious one, driven by a desire to understand and then solve problems. I was not the one you’d want to answer your call bell as you tried to live your life in a hospital. However, I was the one you wanted examining your labs and exploring your history to discover how we might wrestle your health to a stable place. Healthcare is a culture and a lifestyle. It is terrible and amazing at the same time. These days it is more of a tragedy than a comedy, yet there remains in those of us soon to enter the field as newly trained members of the team a sense of hope. Hope that we can help. That, somehow, despite the broken system and so many brands of red tape in our way, we can improve (and maybe even save) lives. Hope is powerful.

I put on my ring, again. I looked at it. It seemed to fit. It felt weird. I was excited. I was hopeful. I looked forward to discovering how the days would unfold after I started wearing it. Like all adventures there was fear in my heart as I stood on the threshold preparing to take the first step. But, also like all adventures, I knew that the first step had to be taken. While never a nomad I’ve always been a wanderer, which inherently means I have stepped from many thresholds. Every first step was filled with anticipation and worry about what would unfold. And, yet, I have never regretted where the road took me. I often reflect on the harsh and beautiful meanders I’ve undertaken. I’ve never wished for a different journey.

I guess there’s something significant about the fact that rings are circles which have no end. A symbol of eternity. I’m a staunch believer that nothing lasts forever. I also believe that the basis of life is change. These beliefs make me curious about what it’ll look like to take some wedding vows and say that this jubilant soul I’ve decided to marry is my forever adventure partner.

My ring felt heavy, but not too heavy. I looked at the mountains depicted there. I wondered what mountains we’d climb in the years to come. What valleys we’d rest in. What ranges we’d prance along taking unruly numbers of selfies because we could. Serious hikers? Perhaps not. We’re just two people who share a deep love of the wild places and exploring them together.

Grateful

Posted on by

I found myself lying on the floor. The sun had set but it was still early – a tragedy of New England once the summer fades. I was not tired or sad. My to-do list was as robust as ever and my goals circled high above my head, seemingly in the clouds. Yet, I was lying on the floor not even stretching. No music, podcast, book, or movie playing. To be fair, I spent a fair amount of time sitting on the floor (my preferred studying location is at my floor desk) so lying on the floor wasn’t that much of a change. It was the stillness and purposelessness of the activity that was unusual for me.

There was a period of my existence when I could not be still and had to always be actively engaged in something. However, the need for constant stimulation dissipated when I was in Paraguay and, I’ve often thought, “good riddance.” I recall my early 20s. I worked fulltime, studied in college fulltime, trained for marathons, went to parties, and built my first career. It was exhausting. It was the way of life I knew. The way of becoming successful. Of fulfilling the American dream. Then I moved to Paraguay where everything seemed so slow. Hours sitting and drinking terere in the shade. Hours spent sitting and sometimes chatting, often staring into space silently, sometimes cooking or napping. I came to enjoy rainy days where it is common for rural Paraguay to shut down. Rainy days were filled with lounging and drinking mate. I precisely remember the moment I realized that when the Paraguayans told me they were doing “nothing,” they meant it. What an odd thing nothing is.

I’ve reached that point in medical school where I’d rather it was over. That point when the hours of studying, sitting in the hospital, trying to learn everything I can, and testing to see if I know enough to care for my patients are quite tedious. I do NOT say this out of despair; I still know medicine is exactly what I want to do professionally. I still love patients and the puzzles they present, but I’m ready to be good at something again. I recall a similar feeling junior year of high school, junior year of college, 6 months into my first professional job after college, and 6 months into my life in Paraguay. There’s a time in all learning curves where it’s truly a terrible slog. That time when you’ve learned an unfathomable amount, still feel mediocre at managing what you know, realize you still have a ton left to understand, and know that it will still be a while before you’re “good at it.” Whatever the mysterious “it” is.

And that’s where the gratefulness comes in. I’m grateful these days because I’ve played this game before. I’m grateful because I know myself better than I did last time I played the game of learning something completely new. I’m grateful because I know already that I’m attracted to activities that seem impossible yet, at some point (after many days of struggle), I do wind up being excellent at them.

So, I found myself lying on the floor. It was junior year of medical school. It was the breaking point. It was about to be a landslide into graduation. In a couple of blinks, I’d start residency. I was closer to becoming a physician than I’d ever been. I lay on the floor contemplating the joy and misery of learning. I thought about some patients who had changed my worldview ever-so-slightly. I thought about the amazing teachings and mentors who I’d encountered while wandering about the hospital wards. I thought about the first day I showed up to work on an ambulance (my first clinical experience), years ago now. “I won’t let you kill anyone,” my chief had said then. I contemplated this. Soon, it would be I who had to prevent patients from dying if it could be done. That was kind of a big deal. I felt humbled. I had much to learn despite having learned so much. I was grateful for this moment of pause while lying on the floor. Life is quite a whirlwind when you seek out challenge. The secret, therefore, is to be grateful for the moments of calm when they come. Even the worst storms have eyes; I remind myself of to look for them.

Engaged

Posted on by

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.”