Today I’m Grateful

The past few months have a been a tornado. I’m 3 weeks out from finishing my first semester of medical school. What has “med school” meant for me so far? 4 hours or more of studying a day no matter how many hours I spend in class. Showering the formaldehyde smell out of my hair because I’ve spent hours in the cadaver lab dissecting or practicing structure identification. Discussing the ethics of assisted suicide, abortion, and patient consent. Considering how to evaluate research. Practicing physical exams and asking patients about their health.

But, even on days before an exam, when I’m exhausted and uncertain I know half of what I should, I’m excited to be doing what I do. I know how to feel a heartbeat through someone’s skin. I know how to watch a heart contracting using an ultrasound machine. I’ve held human hearts. I’ve explored their chambers and vessels. I know the path blood takes to and from the heart. I know what makes the heart beat. As the days pass, I know more and more about what makes human bodies function, how the body can break, and what we can do to fix it. For this intimate knowledge of life, I’m grateful.

These past weeks and months haven’t only been studying, despite how it feels at times. I’ve spent time with family. I’ve hiked many a mountain in both the sun, rain, light, and dark. I’ve eaten cake on mountain tops, carved jack-o-lanterns, and shared many a meal and snack with friends. I’ve walked up and down the hill from home to school while chatting with kindred spirits.

Friends new and old along with family aren’t all I’m grateful for this season. I also have a lovely home with a roommate with an eye for creating comfortable spaces where I can sip my mate peacefully. And, I have a partner who enjoys pie as much as I do. Helps keep life in order. Tells me my hair looks beautiful even when it’s greasy and fizzy (who knew hair could be both those things at the same time) and cooks me dinner so I can study.

I feel lucky this season. And, I’m grateful to have a few moments to soak in just how kind life can be. I hope your Thanksgiving is spent with people you care about or, at least, surrounded by tasty food. After all, the stomach feeds the heart. 

True Love

Not so long ago in the ED, I was helping a patient in one of the acute care beds. Through the curtain that divided the room I was in from the next patient room, I heard someone reading out loud. Where the reading was coming from, a post-retirement man was the patient and his wife was with him.

I saw through a gap in the curtain that the wife was happily reading a book to her husband. Her voice rose and fell with the emphasis of someone who had read aloud many times. Her voice mixed with the sound of her husband’s snoring. When she stopped reading, he stopped snoring and became restless. Sometimes she paused and looked at him. She’d smile and then continue reading before he fully awoke.

The sleeping husband and reading wife seemed so content and peaceful despite being in the middle of the ED on a day when people around them were having their worst days. The husband could have been very sick too but, unlike many of our patients waiting to be seen, he wasn’t sitting alone staring into space as he waited.

That woman reading to her husband was the clearest example I’d seen of true love in months. We see a lot of couples and families come through the ED every day. Accompanying a sick loved one often brings out the caring side of people, however there was something about the calm, closeness of those two (sleeping and reading) that highlighted the strength of their connection. I was reminded, for the millionth time, that it’s the little things that add up to indomitable forces.

Friendship as a Trendline

When I was young and going through a rough patch with one friend or another, my mother always told me friendships go in waves. Sometimes you’re high on them, doing the most exciting things and seeing each other all the time. Sometimes it’s as though you don’t know each other (except you do, because you remember all the times that are past). I knew she was right, but when I was young I hadn’t had friends for long enough to see what she meant.

These days I’m not old, but I have friends who have been in my life for over 20 years and new ones who just arrived. Each friendship is different; the relationship components undulate as ocean waves do—always the same motion (hi…bye), never the same content (what is said and done, where and when we encounter). It’s only the movement, up and down, that’s constant over these relationships and across relationships.

When I think about friendships as waves, I envision the trendline as straight across with a sine wave tracing the points of each friendship. If you plot every friendship on the same graph, some will have wide peaks and dips, some will have steeper and more frequent slopes. But, regardless of the shape of each wave, when you follow the trendline as a representation of your life unfolding, you find that your time has been filled with moments shared with people you enjoy. Despite all the movement—especially the absences of certain individuals at certain times—you are surrounded by people you consider friends most of the time. In this way, the trendline makes you unshakable when one friendship wave becomes an outliner by dipping too low or dropping off the graph completely. And, also, it’s the trendline that helps you steady yourself if a friend becomes a partner and their friendship wave falls into phase (in sync) with your life wave magnifying your own emotional ups and downs.

For me, the visual of friends as waves (like an ocean view) takes a lot of the pressure off each moment because it makes me see them as part of something larger. It’s reassuring to realize that I can enjoy each crest before it crashes on the literal or metaphorical beach because it will be followed by others.

Finding the Path

We all have bad days. The problem with having a bad day and working in healthcare is that it’s unacceptable for your mood to affect the quality of your care and people are sick every day. The trouble with healthcare on a bad day is that healthcare requires hundreds of human interactions within a shift. Hundreds of moments where patience is required, where you must do small tasks that are annoying and big tasks that are important, and all the tasks between that together help people heal. You notice everything a little more on a bad day. So how do you get through it?

Not so long ago, my shift landed on a bad day. But, there was a patient who turned the shift around for me. He told me how he raised his sons. He was a single father. He had a path he wanted them to go on and he thought his job was to lift them back up to that path when they fell rather than push them down. That’s what he did and he was proud of them. He told me he was lucky.

I think I’d like to approach bad days like this father approached his sons. A bad day is a fall from the right path. It just takes some nudging to get back on track again.

The benefits of working in healthcare on a bad day are the kind, wise patients you’ll likely encounter. They’ll set things right, even though you’re the one that’s supposed to be curing, if you listen to them.

The Rhetoric of -est

As Mother’s Day whizzed by and we race toward Father’s Day I am reminded of one of my favorite Mother’s Day Facebook posts (posted by a fellow Peace Corps volunteer on one of the Mother’s Days we were in Paraguay). She wished her mother a happy day and stated that she didn’t believe she needed to call her mother “best” to tell her how much she loved her.

The post made me think. It is tempting and common to say “the best mom or dad” or the “coolest” or the “kindest” or add “est” to the end of any description we’d like to use for those we love. But, if there is a “best” it implies that there is a worst and that there are many almost bests or not bests.

Ever since my colleague’s post, I’ve actively avoided the description “best” for anyone, even though it is tempting. I don’t think we need to rank humans or suggest a hierarchy as a means of showing someone we love them. I also don’t think there is such a thing as the “best” mom because no two moms are the same.

I believe language shapes our thinking and if we focused more on describing individual’s good traits without comparing them to others we might create a society with fewer divisions based on arbitrary markers and we might be more likely to recognize the good in humans. Is it a stretch to say how we talk about people will change how we view them? Maybe, but I will argue that framing theory supports my hypothesis that the words we use to describe someone shape how we view them. You can test it though. I dare you to change your rhetoric about people in your life and see if it changes how you view them over time. Try a longitudinal study over 3 years. Report back in 2022, I’ll be here.

Q-tips and Time

The road between my father’s house and school had a stretch with small, rolling hills. My father would always speed up the ups so that our stomachs would drop on the downs of the hills. One day, halfway through the hills, we got stuck behind a Q-tip (that’s what we called elderly drivers because all you can see over their car headrest is a white tuft of hair). The elderly driver was going so slowly we didn’t get to enjoy the hills. My sister and I groaned.

My father said, “Do you know why old people drive so slowly?”

“No,” I said, rolling my eyes.

“Because time is moving so fast for them that they feel like they’re moving quickly. Think about it. Each second is a smaller fraction of their life than yours or mine,” he said. “Time seems to go faster as you get older.”

I shrugged then. But, a decade and a half later, I find myself wondering why time runs away from me. I sometimes drive slowly because I feel like I’m rushing even when I have nowhere I need to be. I’ve come to understand what he meant—each second that passes makes every subsequent second a smaller fraction of my life. Funny that time, that constant meter we trust to measure and organize our lives, feels so inconsistent.

Peppermint Patties

When we were young, we usually went grocery shopping with our parents. When my mom took us, we were always allowed to pick out a treat at the end to enjoy on the journey home. My sister and I always mixed up what we got—sometime chocolate, sometimes liquorish, sometimes something completely different. My mom always got a peppermint patty.

Since becoming an adult, I usually grocery shop alone. I almost always get myself a treat for the trip home. I still mix it up, but when I can’t decide I get a peppermint patty.

Not so long ago, I visited my sister in New York City. She’s lived there many years. She and I are still very close, but our lives have taken divergent paths. We grow more different as time passes. We went grocery shopping for snacks during my visit. My sister paid. When we checked out, she grabbed little peppermint patties for each of us. I guess she chooses peppermint patties too. It made me smile. We are different and similar, nothing will change that because we have too many shared roots.   

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.

What You Look for Is What You Find: Look for Strengths

Not so long ago a friend and I were discussing our workplace culture, the individuals in it, and how the people scheduled to work on a particular day determined how hard the day will be (because some people work more than others). It was a discussion after too many hard hours; we were tired and burnt out. We started spiraling down the path of complaining about everything. Halfway down the trail, I paused to remember that all things are a matter of perspective.

It is easy to complain about coworkers. To gripe how so-and-so doesn’t do or know enough or how they make our work lives harder. Sometimes all we need to do before we can move on is vent, which is productive, while other times we get caught fixating on what makes a particular person terrible, which solves nothing.

I believe anyone can change, and everyone does, but only when they want to change and only when they’re ready. As such, we each can defend ourselves and what we believe in, but expecting others to bend to our will is futile for enacting change in my view. I have NEVER seen anyone work harder after I wished they did. On the flip side, I have seen people work harder when complimented on what they do well and asked to join in the fray when they were surrounded by good examples. This is where perspective comes in. Before you can complement a peer or ask them to do something you know they’ll do well, you must know their strengths. The only way to notice strengths is to look for them, which requires quite the opposite type of astuteness used to identify weaknesses. 

We can’t avoid noticing when others seem to be slacking while we are working too hard. But, as we muddle along, we can also strive to notice if those same slackers do a particular thing well. Once you notice a strength in a peer, you can look to and rely on that person to step up in situations where their strength is vital. This is particularly helpful if their strength is a weakness of yours or if they like tasks you dislike because it transforms a colleague that you found difficult into a resource. We are stronger when we play off each other’s strengths, rather than focus on each other’s weaknesses. Of course, noticing strengths doesn’t negate the wearisomeness of having to pick up another person’s slack or negate a personality clash, but it does lighten the burden and give us an avenue to find common ground. You will see what you look for, so I strive to look for the good. When I get derailed, I vent and, then, try again. Usually, I can find something wonderful within any human. I bet we all can if we try.  

Why I Go Back for Each Shift

Not long ago, I walked into an emergency department room (a cube defined by some walls but mostly curtains) to place an IV. An elderly man was on the hospital stretcher. He was there with his son. I began my normal banter—introducing myself, explaining why I was there, and narrating what I was doing as I went. The man might have asked me about my name, about 30%-50% of patients do because it’s unique. He might have asked about my necklace, it’s a wolf and about 25% or so of my patients ask about it.

“I’m going to raise the bed so I don’t have to stoop,” I said. “I need my back for many years to come.”

The patient and his son laughed. “You know what you need, music. Do you listen to music?” the patient asked.

“Not here, it’s not the right place. But, I like to dance, so I do listen to music,” I said.

“My wife liked to dance. She died a year and a half ago,” the patient said.

“I’m sorry to for your loss, sir,” I said.

“We were together 60 years,” the patient said.

“That’s amazing! I don’t think I’ll be with anyone for 60 years at this point. Did you take her dancing?” I said. I maintained a jovial tone because he seemed merry when he mentioned his wife and dancing.

“I did,” the patient said. I looked down to find him crying. I paused and put a hand on his forearm. Giving him a squeeze. I’d recently visited my grandmother. A big part of our visit was discussing how my grandfather, who’d died 2 years prior, was still with us.

“How lucky she was to have you take her dancing! How amazing it must have been to have had so many years together,” I said.

“Sorry, I always cry when I think of her,” the patient said. He half-shrugged and looked away.

“It’s okay. She’s with us still and you’ll see her again, sir,” I said.

“I hope so,” the patient said.

“I know you will,” I said.

The patient and his son nodded. The tears ebbed. I placed the IV. All humans have stories. Sometimes they find space to share them when they visit us in the emergency department.