Tag Archives: Dreams

Ring Reflection

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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.

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Grateful

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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

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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.”

Medicine of the Mind

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“It’s a privilege to learn their stories…really get to know people,” he said when I asked for his nugget of advice for us students as we continue our medical school journey. “In what time you think you have, try to know them [patients]…exercise your privilege.” Before we get into the weeds, let me clarify what he meant as this quote is just a piece of a longer conversation. By “privilege” he meant the honor of getting to meet patients and having the opportunity to hear their stories. By “exercise” he meant take the time to be a good doctor which includes getting to know people’s stories.

This piece of advice came from a retired psychiatrist who, as rumor has it, retired several times and each time his patients convinced him to come back to practice. The way he carried himself reminded me of my late grandfather – tall but not imposing, with straight white hair that covered just enough of his forehead, and a quiet voice. But more than how he carried himself, his curiosity caught my attention. He was an old human, an old physician at that, who the week before he gave the above advice had comfortably engaged in conversation about pronouns and transgender care. He was a physician who listened to learn when I offered a rudimentary definition of “nonbinary.” I’ve met many a young person, with far fewer years to settle into old ways, who showed less interest in uncovering the nuances of the human experience.

“Really get to know people.” His words made me hopeful because they showed that even at the end of a long career there are physicians who still have a passion for the human story as much as I do at the beginning of the Doctorhood Quest. Being only 5 weeks into working in the hospital as a medical student, I have a long way to go before I can offer advice to students. But, for now, challenge accepted good sir. Let’s see how I do in the coming weeks and years at uncovering stories while also learning labs, diseases, medications, and all the other factoids that will help me reduce symptoms and cure disease in the patients I see.

Pull Up Your Compression Socks

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Some of my friends and family have asked how I study so much. Others just give me a funny look, shake their head, and say becoming a doctor is too much school. And, to be honest, I mostly agree.

And that’s were compression socks come in.

When I was studying for my first board exam (aka STEP 1 which is a 7-hour exam that lightly touches most topics in medicine from skin rashes to embryological development) I started wearing compression socks. Every day before sitting at my desk with mate and breakfast and before firing up my computer, I’d spend a few moments pulling on the rainbow or patterned compression socks I’d chosen for the day. I’d never worn compression socks before I started studying for STEP 1 – not while hiking multiple 10-mile plus hikes a week, not while working 10-hour shifts on my feet, and not while training for marathons on city streets.

But studying from well before dawn to well past dark did me in. The truth is that studying all day is terribly grueling in the most passive way imaginable. The body rebels against stillness, and my bodying not only rebelled but went to war. My calves became so tight I could hardly walk. They’d throb at night. They’d throb in the morning. My shoulders and back were full of knots. My hamstrings constricted to a fraction of their normal length. I have a standing desk. It only made my hips tight. And. Yet. The studying had to be done. To help get through the hours, I’d stretched when I could. My workout routine become very consistent because without it I couldn’t concentrate.

The compression socks fixed my calves. I discovered them by accident. My partner wears them at work to avoid varicose veins, and one day I tried on some of his socks. It was a game changer; I could study all day and my legs would be okay. Just okay, but okay was way better than terrible.

It seems a bit dramatic to say it feels like your body is going to turn to stone simply because you sit still too much. “How do you study so much?” family would ask me in the final weeks leading up to my exam. I never exactly knew how to answer. And now I realize why – because studying  in medical school is less about the “how” and more about the “why.”

Why do I study so much?

It comes down to the end. The goal. The reason I bothered to enter medicine at all. It is only knowing where I wish to go that makes studying so much that I must wear compression socks worth it. I didn’t come to medicine because I wanted to study all day. I entered medicine because curing diseases and helping people through sickness is the professional contribution I wish to make to our world. I had plenty of time before starting school to explore many different professions. But, the one that captivated me was medicine. Medicine combines puzzles, science, and true stories. I study so much because every piece of information about symptoms and labs and geography and humans is a tool that might help me understand what is ailing a patient. I don’t study because I like it, I study because I want all the knowledge tools I can fit into my toolbox brain so that when I meet someone’s grandmother, someone’s father, someone’s friend, someone’s brother in a moment when their health is faulting…I know how to help them heal. 

Resilience

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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

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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

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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

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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?

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“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.