Tag Archives: People

Remembering

Posted on by

I don’t remember them because their case was sad, though it was. Nor do I remember them because their case was complex or unique. I remember them because they were a DJ even though they were well beyond middle age. Who knew you could be a DJ when you were that old? Well, I learned after meeting them that you could be.

I learned of their DJ career when I met them briefly after their first stroke. The stroke was thrombotic (caused by a clot that blocked a blood vessel in the brain). Their balance was severely affected, but they were doing well, despite the stroke. There was no way to predict if they’d get their coordination back, but there was hope that they would recover if they made it past the first couple of days after their first stroke without another stroke. There’s the highest risk of another stroke in the days following a stroke.

When I saw them days later, they were not well. Their stroke had converted from thrombotic to hemorrhagic (caused by bleeding in the brain) and they could no longer speak, had limited movement, and were unaware of the world. I was struck by their deterioration. Lost in my reflection on how much the patient had changed and who they were before their brain filled with blood, I included the fact that they were a DJ in my report to the physician supervising me. I think the physician was looking for a focused medical history, but I slipped in the patient’s profession anyway. The physician teaching me paused and then said, “It’s good to get to know something about your patients as people.” It was the physician’s way of giving me positive feedback, but I found myself thinking, that would seem to go without saying.

As I continue my training, I’ve come to understand why this physician pointed out the importance of knowing patients as people: It’s easy to only ask questions related to diagnosis when you’re crunched for time and are actively thinking about what next tests, exams, medications, and treatments you should do to help the patient with their medical concern. Which is to say, the more responsibilities I have as an aspiring physician, the harder it becomes to emphasize getting to know patients beyond their medical conditions.

And, yet, when I do and can learn a tidbit about people’s lives (pets, careers, grandchildren, or whatever they bring up about their life), I’m always grateful I did. Grateful because it helps me remember each patient’s story and because it reminds me why I do medicine in the first place – to help people.

Medicine is awesome because uncovering diseases and making treatment plans involves solving complex puzzles. But the coolness of solving medical challenges is not enough to get me through all the terrible aspects of working in healthcare. My patients do keep me coming back even after the worst days on the job. Even though our interactions are brief, my patients and I have the potential to learn and achieve so much together. And, without a doubt, every patient is a person with an amazing story that I’m excited to hear a tiny bit about.

The “seasoned” DJ will never be a DJ again. This makes me even more glad that my last memory of them included them as a DJ, not just an ICU (intensive care unit) patient with a likely life-ending stroke. I think they’d have preferred to be remembered as a DJ (something they were very proud of) rather than a sick person. I know, if I were dying in the hospital, I’d want the last people to see me to know something about who I had been before I got sick.

Advertisement

Happy Birthday Soul Sister

Posted on by

“Mbaé’chepa means How are you? ” I said. They repeated after me.

“Ipora is the response, it means good,” I said. They practiced. I smiled at their pronunciation; it was great by my ears, but they probably had my accent in Guaraní which would make every Paraguayan laugh.

A few of the dengue field researchers I was working with in Puerto Rico had asked me to teach them some Guaraní words when I told them I learned Spanish in Paraguay. Spanish speakers always want to know where I learned my Spanish because it surprises them. Whenever I say I learned Spanish in Paraguay I also explain that it’s a bilingual country because it’s important. I was happy because even though I was from New England and the gringa of all gringas (the whitest Anglo) and currently in Puerto Rico, I was teaching Guaraní while speaking Spanish. (The above conversation was in Spanish.) It was fitting, and the timing couldn’t have been better.

Recently one of my Paraguayan mothers, best friends, and soul sisters turned 70. I ached because I couldn’t be there. We would have danced until the wee hours of the morning, so late I’d have spent the night at her house because leaving would have seemed silly. She’d have danced with a one-liter glass bottle on her head, perfectly balanced, as I cheered her on. We would have feasted. There would have been a cake. Luckily, she sent me pictures which proved that she had all those things and more without me. It was the quinceañera she never had, she told me. She deserved it. She looked radiant in her yellow shirt. Her hair was short for the first time ever; it was always well past her butt when I lived in Paraguay. She sent me a video of herself dancing on a chair. 70 looked good on her.

My soul sister was on my mind before her birthday. I’m in a sunny place with palm trees – it’s the kind of situation that always reminds me of Paraguay and makes me long to go there again. As I drink my mate alone in the morning and tereré alone in the afternoon I know that if I were in Paraguay, I’d be drinking them with her.

When I lived in Paraguay and I told her I was single (Paraguayans always asked my relationship status, sometimes before my name), she was among the few to say “good for you” even though she had had one or two kids by the age I was at that time. She’d raised one daughter so independent that her daughter adopted a couple of children which is unusual in my Paraguayan community; her daughter went to college; and her daughter left the men she didn’t like, something my soul sister’s generation didn’t always do.

My soul sister only finished the sixth grade, but she spoke perfect Spanish because she’d worked in Paraguay’s capital city, Asunción. Usually, folks from her generation and the countryside (as she was) spoke mostly Guaraní. When she was young, she took a bus to Brazil without her mother’s permission. She came back eventually. On one hot afternoon she told me about her trip while we drank tereré and she cooked.

My soul sister is the only person in Paraguay who came looking for me when I needed finding. Culture shock is real, especially when you’re trying to build a life in a new country. The Peace Corps is the wildest emotional rollercoaster I’ve ridden. Which is to say that some days in Paraguay I needed real finding. She’s the one who knocked on my door and told me to come out and have lunch. She’s the one who welcomed me into her home whether I felt like talking or not. She can fill the silence as much or as little as needed. It’s her cooking I think of when I miss Paraguayan food.

She sometimes walked me part of the way home after our days that ran into evenings together. Always she blessed me and said a prayer for my safety when I left her home, even though for about half my time in Paraguay our houses were 50 meters apart and kitty-corner across a street.

I dreamed of seeing her mother one last time. But COVID and medical school delayed my return too long. We lost my soul sister’s mother before I could visit again. My soul sister was her primary caretaker. She was devastated when her mother died, but she’s also freer now. The grandson she’s raised is a teenager now (he was a kid when I lived there). I like to think it’s easier being a grandma raising a teenage grandson than a child grandson; but I don’t know if it is. Perhaps I’ll find out when I visit. I’m also overdue to see that same grandson who was like a baby brother to me. I was supposed to go back for his 15th birthday, but COVID squashed that plan. I’ve always had a sweet spot in my heart for that kid; it’s funny because my husband, who I met years after Paraguay, has the same name as my soul sister’s grandson. I wonder if I’ll recognize her grandson now that he’s almost a young man.

And just as she did when I lived across the street, my soul sister checks in now and again even though I’m seemingly lightyears away. She always asks when I’m returning to Paraguay. I’ve been back twice since I moved to the US, but that’s not nearly as much as I would have liked. Life doesn’t follow the course you expect. But when she sent me birthday pictures recently, I had a real answer: I’m visiting the first half of this year. Si Díos quiere (to use the Spanish phrase so popular in Paraguay, “If God wants”). I’ll bring my husband so that my soul sister and my other Paraguay friends can meet him. I also want him to see the country that stole my heart. I’ll visit my soul sister during her 70th year even if it’s not on her exact birthday. Luckily, Paraguayans are more flexible about time than Americans.

Did the Jones Cheat?

Posted on by

I strode along one of my most frequented paths which combines my town’s main street and a side street that parallels it. I like the route because it represents two separate worlds despite their proximity. The main street is scattered with restaurants reflecting the many Central and South American cultures that comprise a large portion of my town’s heritage, hair salons, family-owned gift shops and clothing boutiques with their signs as much in Portuguese and Spanish as English, churches, places to learn English and send money orders, and empty store fronts. The side street is lined with one-family homes so large that if I lived in them, I’d need a map to navigate them and an intercom to find my family members in the far reaches of rooms and floors away from me.

As I crossed a four-way intersection, navigating the streetlights (including their left turn arrows) as I always do because I don’t think the walk signal ever turns on, I came upon the first house in the row of mansions. I slowed my pace. There was a landscaping crew. This was a common sight on this street and in many places in Connecticut – people spend lots of money on their lawns here. You always know a landscaping crew because they have big beaten-up trucks with letters painted on the side and a big trailer behind. What made this crew different was that they didn’t have mowing equipment, pruners, or leaf blowers from what I could tell. They weren’t even looking at the plants in the yard. THE LANDSCAPE CREW WAS HANGING CHRISTMAS LIGHTS AND CHRISTMAS WREATHS FOR A PRIVATE HOME.

I thought of that scene in The Grinch where one neighbor is using the Christmas light gun to decorate her house and the other neighbor is blowing electrical fuses to try to get her Christmas light display to just turn on. It never occurred to me that people might pay someone to hang their Christmas decorations at their home. Businesses obviously do that, but a private home having someone else decorate for Christmas?

On a later night, I passed the house of the family who had paid a crew to decorate for Christmas. Their house looked fantastic but in my heart of hearts the decorations were empty. I found myself wondering:

  • Is decorating for Christmas more about the quality of the decorations or is it more about the combination of annoyance and joy of putting them up and then criticizing and loving your own work until you must go through the added chore of taking the decorations down again?
  • Is decorating for Christmas about the quality of your house decorations or the conversations that go into convincing various family members or friends to help you hang decorations or the determination required to hang them all by yourself?

I found myself leaning toward the belief that decorating for Christmas was a lot about the journey and less about the end. Having decorated many a Christmas tree I cut down in the middle of my dad’s woods as a child, which is to say that we had untrimmed trees in all their asymmetrical glory, I find myself solidly believing that what makes home Christmas decorations special is that they were done by amateurs in the spirit of holiday cheer, family fun, and acceptance of an imperfect final product. It’s not that I faulted this family who paid to have their house decorated for Christmas, it’s just that their approached seemed business-like. Much like the Christmas displays on 5th Avenue in NYC, the house with decorations hung by a hired crew was beautiful.

I found myself chuckling about the concept of “keeping up with the Jones.” I found myself glad I grew up in a space and time where lawns were sometimes mowed by teenagers, often not mowed recently, and sometimes mowed by livestock. I’m not sure why the imperfection of unprofessionally maintained homes warms my soul, but it does. And as the holiday season unfolds, I find myself thinking about what exactly is most important in creating holiday spirit.

Heartbroken

Posted on by

Tears fell down their cheeks. There was a long pause. “My heart broke and I’m just having trouble processing that,” the patient said. They’d been hospitalized for a heart attack several months earlier. I was seeing them at a primary care visit long after discharge. On paper they were recovering well, but they didn’t feel that way. They felt broken.

This interaction resurfaces in my mind periodically because it shows a side of illness that isn’t often seen in the hospital (where I’ve spent most of my time training). This patient had experienced an acute illness (heart injury). They had recovered their functionality. By medical definitions, they were a success story. Yet, they were miserable. How could that be?

In medicine we organize diseases into buckets with specific treatments and endpoints related to the organs affected by each disease. For example, this patient had a disease of the heart which might include endpoints like their ability to tolerate exercise or their heart rhythm. These endpoints are a simplicity required to synthesize something as complex as the human organism. However, as this story shows, looking at only specific endpoints can lead to missing things related to the illness that aren’t listed as clear endpoints to track. In the case of this patient, the heart is connected to the brain which is an organ of personality, mood, and feelings (among other things). While the functionality of this patient’s heart met all medical endpoints, their mood/feelings were severely affected by the experience of surviving a heart injury.

This patient’s experience reminds me that the diagnoses we make and interventions we do have lasting impacts on patients. Remembering this motivates me to provide information and support that I think will empower patients in their processing of what happened to them while they were hospitalized. I often wonder what conversations this heartbroken patient had with their care team while they were in the hospital recovering from their heart attack. Was there anything that their care team could have done differently to lessen the patient’s distress after discharge or was the patient’s feeling of heartbrokenness inevitable? I’ll never know the answer.

With this patient’s experience in mind, I try to ask myself if there is anything missing or left unclear before I discharge a patient. Healthcare is far from perfect (it’s quite broken actually) yet, even in a broken system, we can choose to communicate and help as best we can.

Sometimes People Step Up to Be Heroes

Posted on by

The patient sat with a blanket over their head. They were a little goofy and fairly expressed their distaste of their bed and various lines (IVs, urinary catheter, etc.). I didn’t blame them for not liking the hospital; nobody wants to get sick. The patient answered many questions correctly – they knew their name and their spouse’s name – but they couldn’t tell me where they were, why they were there, or what month it was. Yet, to see them sitting there alert and able to talk with me was a miracle that I was humbled to see.

The patient’s spouse and child had saved them. The patient had a cardiac arrest (their heart stopped) after going to bed one night. Their spouse noticed, pulled them to the floor, and started chest compressions. Sometime in that whirlwind, 9-1-1 was called and their teenaged child helped the spouse do compressions. The spouse and child did compressions for 45 minutes, just the two of them, until an ambulance showed up. Once the ambulance crew arrived, the patient received a couple of shocks and then, the patient’s pulse returned.

When I started as an EMT, my first medical experience, my crew chief told me cardiac arrest is death. All we can do is try to give the person’s whose heart stopped a chance at a cat life by doing CPR to pump blood while the heart isn’t pumping, delivering shocks (if indicated) to jumpstart the heart, and giving medications that sometimes help the heart restart. 

It’s important to realize that getting a pulse back isn’t the end of cardiac arrest. After getting a pulse back the main question is whether the heart stopped so long that the brain was irreversibly damaged by lack of blood flow. The likelihood of brain damage from lack of blood increases the longer the patient remains without a pulse. 45 minutes of CPR, especially CPR by non-medical people who don’t have access to a device that can deliver a shock, is a REALLY long time.

Most people won’t wake up after 45 minutes of CPR. But this patient did. They woke up and their brain was well enough to talk and move their body. It was too early to know if they’d fully recover to the mental state they’d had before their heart stopped. However, what was obvious when they woke up was that they were mostly there. Their brain had survived 45 minutes without a pumping heart thanks to their spouse and child.

When we successfully get a pulse back after CPR and the patient doesn’t immediately wake up, usually they are sedated and put on a ventilator (breathing machine) for 72 hours. This gives their brain time to rest after not receiving good blood flow. Usually after those 72 hours of rest, we decrease their sedation (medications used to put people to sleep while on a ventilator) and see how their brain is working. This patient underwent this process of sedation and then wakening after 72 hours.

It’s impossible to know exactly what the patient’s spouse and child felt as they waited those 72 hours to see if their loved one would wake up. What I can say from seeing them sitting at the patient’s bedside and sleeping in the hospital waiting room, is that the experience changed them. Once the patient woke up, the stress floating away from their family members was almost tangible. The spouse and child had saved the patient’s life; they had stepped up when the powers that be asked them to step up. They had given the patient a second chance at life. They were, by all definitions I know, heroes.

Listening in Medicine

Posted on by

This patient was always cheerful. Despite approaching a month in the hospital. Despite extensive injuries for which they required multiple procedures, surgeries, and a long course of antibiotics. Every time I checked in, they had a visitor, were listening to mass, or were simply doing life things.

One day when I stopped in, the patient was different. Still as pleasant as ever, but their cheer was guarded. I noticed that their voice was heavier. That their eyes were drooping at the edges. Their smile seemed more effortful. “Is everything okay? Are you okay?” I asked. In the minutes I was with the patient, I asked these questions periodically. Interleaving with the normal questions about signs and symptoms and physical exams I needed to do. I’ve learned that if you create space for things that haven’t been said to be said, sometimes patients share what’s bothering them and you can do something about it.

I paused as I was preparing to leave and asked one more time if the patient was okay. They started crying. I waited. “It’s just I haven’t seen my children. I miss my children,” the patient said. I’d come to learn that they had two young children who they hadn’t seen since their admission. They video called them but, obviously, that wasn’t the same as seeing their children and giving them hugs.

Since COVID, hospital visitation policies have become more restrictive. There are reasons for these restrictions, however the unintended consequence is patient social isolation which is bad for patient mental health to put it simply. At the time when I was seeing this patient, the hospital I was in was not allowing children to enter the hospital as visitors. Rules, though, usually have exceptions. I spoke with the nursing staff, as they steward hospital floors, and they were able to arrange for the patient to see their children.

This patient interaction reminded me how listening is critical in medicine. The hospital is a difficult place to have a good conversation as patient. The hospital is confusing and foreign to most people; there are unintentional power differences that exist as medical knowledge and understanding are uncommon among those who didn’t study medicine; there are many faces with different roles in the hospital so it’s impossible to keep track of who is the right person to ask for what; and the hospital is busy and short-staffed, so healthcare workers are doing their best but they are always running behind. Given these barriers to communication, the burden falls not on the patient but on their care team to ensure that time to hear patients’ needs is made. To do this doesn’t necessitate longer patient interactions, necessarily, but it does necessitate listening for more than reports of a fever or bowel changes.

It can be hard to listen for things that don’t directly relate to changing a patient’s care plan. Yet, patients are more than carriers of disease and, therefore, to best support them in their journey to better health we in healthcare must listen to all ailments. Sometimes we can lessen a burden and sometimes we can’t. Arranging for a parent to see their children after weeks in the hospital is something we can solve easily. I was glad I was able to help this patient see their children, but I wondered how long the patient had suffered from missing their children. Perhaps, if one of us from their care team had listened more carefully earlier, the patient wouldn’t have had to wait almost a month before seeing their children. To me, it seemed unreasonable to add the burden of missing loved ones to this patient’s burden of healing from an accident that had almost killed them and injuries that would likely change their life. Being sick is hard enough; let us in healthcare not forget the human things, like social supports, that can help make healing less daunting. 

Windows to the Soul

Posted on by

I looked into the eyes of a patient for brief moments when they opened their eyelids before falling asleep again. Their eyes were like wells, but there was no sparkle in them like there is in a healthy person. The patient had a bacterial infection of the blood that had attacked their heart resulting in a large vegetation (collection of bacteria and other gunk) on one of their heart valves. Pieces broke off this vegetation, traveled through the blood vessels, and seeded infected clots in the patient’s lungs and spleen. That wasn’t all though. Their body was so inflamed some of the proteins in their blood were destroyed, consumed, or their production reduced. At first, the patient needed transfusions of red blood cells and platelets to survive.

In other words, the patient was sick. They were not just sick, their chance of death within 30 days increased by 16% each day their blood had bacteria in it according to one study.1 Their chance of death was about 40% by another estimate.2 It took us about a week of antibiotics to clear the infection from the patient’s blood, but that wasn’t the end of the patient’s need for antibiotics because of their heart infection and septic clots. They would need at least 6 weeks of antibiotics and likely several procedures and surgery to fix their heart.

I looked into the patient’s eyes each day, hoping to see a sparkle there that would suggest they were awakening from the depths of illness. I hoped and yearned to meet them rather than just examine their feverishness. I was rooting for them. I root for all my patients, but this patient’s eyes were so empty I knew they needed my thoughts more than the other patients I was caring for at the time.

It would take over a week, but one day the patient’s eyes shone with the flame that I think of as the soul, that spark of life. The patient was here with me. They could tell me their name and what was going on. They were awake! How the weeks ahead would unfold could not be predicted. In medicine, we don’t have a crystal ball that tells the future any better than a meteorologist can forecast the weather 10 days out.

My rotation would end before the patient was close to healthy enough to leave the hospital. They were sleepy when I last saw them because they were recovering from their first heart procedure. I touched their shoulder briefly and looked into their eyes. They were so strong and so brave. I reminded them of this and of how much they’d healed since we met. I told them to hang in there. It wasn’t much, I knew, but it was the best I could offer as I prepared to join a different medical team.

In the hospital, we often meet people at the worst crossroads of their lives. We do our best to help them navigate to a destination of better health, but we often don’t get to see where our patients end up after we care for them. We must be comfortable with unfinished odysseys. So, to conclude my telling of this patient’s story, the last time I saw the patient with the wells for eyes, their eyes shown with the brilliance of victory. I will remember them by that brilliance.  

References:

1. Minejima E, Mai N, Bui N, et al. Defining the Breakpoint Duration of Staphylococcus aureus Bacteremia Predictive of Poor Outcomes. Clin Infect Dis. 2020;70(4):566-573. doi:10.1093/cid/ciz257

2. Kuehl R, Morata L, Boeing C, et al. Defining persistent Staphylococcus aureus bacteraemia: secondary analysis of a prospective cohort study. Lancet Infect Dis. 2020;20(12):1409-1417. doi:10.1016/S1473-3099(20)30447-3

Joy

Posted on by

I most remember his rosy cheeks. The humidity and mosquitos hummed around us. We held hands under the shade of widely spaced trees in ferns as tall as our waists beside a beaver pond. There would be many moments I’d attempt to remember from our wedding day – etching them into my memory, writing them down play-by-play in my Spanish journal, and waiting giddily for our photographer to finally send us our photos. But, in those moments between words, I thought about how warm my cheeks felt and how rosy his cheeks were and how it was likely that my cheeks were rosy too.

I was joyful. Some cry when they’re overwhelmed with happiness, but that’s never been me. Happiness spreads across my skin like sinking into a warm swimming hole. The warmth then soaks into my core whereby settling my heart and obscuring all the things that normally zoom through my mind. Happiness is quiet. Contentment. Nothing but his rosy cheeks and my rosy cheeks on our wedding day.

The bright sunlight flickered through the canopy above alighting on my sister, who was our officiant, and our guests. The guests sat amongst the ferns as you might imagine in a scene from A Midsummer Night’s Dream. It seemed fitting that the cupcake shelves hanging from a birdfeeder hook and the brightly colored attire of the wedding guests would float across my mind like a scene from a play. As I gazed at the ferns, I realized that this was my midsummer dream. To make official what my partner and I already knew. These moments would give our relationship a label society understood. But despite the label, he and I knew that no one could truly understand what we meant because every relationship is its own unique product of its unique makers.

Which brings me back to his rosy cheeks. He was wearing his finest suit and the fanciest shoes you’ve possibly ever seen.  The paisley on his shoes and the paisley on his tie had nothing but their name in common, but they each worked well with the stripes of his suit. His tufty blond hair curled above his sparkling eyes and his cheeks were flushed because we were outside, because we had walked through the forest to get here, and because it was a hot midsummer day.

I thought briefly about our guests, the witnesses to the words we were saying. They were the people who had played the biggest roles in our lives since we became a couple. I listened to the words my sister said, then he said, and then I said. We had all thought about, written down, and practiced what we were going to say. Yet, it seemed more improv than rehearsed lines. How could any of us have imagined exactly how this moment would be? We couldn’t. There’s delight in comfortable spontaneity. As I replay those moments now, the rosiness returns. The memory is one of the clearest definitions I have of joy.

Neurocysticercosis

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.

Recently, I treated a patient with neurocysticercosis. While infection with Taenia solium is not common in the US, neurocysticercosis is not a zebra in Danbury, Connecticut because many patients are originally from countries where Taenia infection is a threat. The patient I saw was young and presented after having a seizure. Though they had received their diagnosis several years earlier at another US hospital, the disease course had started long before. Initially after their diagnosis, antiseizure medications were effective. The latest seizure occurred after a series of unfortunate events caused the patient to stop the medications.

The CT scan showed speckled calcifications throughout the brain. MRI revealed several enhancing lesions convincing us there was a need for antiparasitic and steroid treatment. The patient did well after treatment initiation and was discharged home to complete their albendazole and steroid course with a plan to follow-up with neurology. Their case lingered in my mind. It lingered not because of sadness or complexity, but because it reminded me of how connected our global population is and because the patient had impressed me with their calmness.

COVID-19 has highlighted how easily communicable diseases can travel and how important the health of the global community is for the health of our local communities. And while Taenia solium is an infectious disease, it does not spread like COVID-19. My chances of infection with Taenia solium are meager while living in Danbury, CT. Yet, we have patients with neurocysticercosis because people are mobile. I find it fascinating that the mix of diseases that are the most common in a particular hospital is not only dependent on the vectors and circumstance of life in the hospital region, but also the experiences and diseases prevalent in the places from which the people who make up the community around the hospital came.

As I contemplated our connectedness, the patient impressed me with their politeness and trust. Here was a person who was sick and did not speak English, yet they had complete faith that we could help them. I found myself humbled remembering that patients rely on us, the medical community, to guide them to better health when disease strikes. The patient’s calmness spread to anyone who spoke with them. There is something impressive about patients who can impart positive feelings on those around them despite being sick. I thought about the patient’s history and all the roads they had traveled so that our paths crossed during my medical training. Mobility is an amazing feature of the human experience. It both connects and separates us.

Learning to See

Posted on by

Before I moved to me latest city, the people I talked to about the city during my travels through medical school rotations didn’t have anything good to say about it. One person said there weren’t any good food. Others said there wasn’t much to do. When I moved here, someone went as far as to tell me it was dangerous. And, while I listened carefully because I knew little about the city myself, I had a suspicion they were wrong.

When I was a child, I learned to see the trees and birds around me. I learned to name them. I could tell a white pine from a red pine or a sugar maple from a red maple. I could tell you the sound of the chickadee and the hermit thrush. I knew the difference between a red wing blackbird and an oriole or a bluebird and an indigo bunting. This type of seeing was the outcome of growing up in the middle of nowhere while surrounded by women who knew these things and shared them with me.

Early on, I learned to tell the difference between real wood and fake wood. I could identify sloppy joints and beautifully joined boards. I judged furniture and house finishings based on their joints. I could tell you how sheetrock differed from plaster. I understood these things because my father had taught me to notice them. My mom taught me to see colors and how they might be paired. I still notice boldly paired colors and they bring me joy regardless of if I find them in a painting or on someone’s clothes.

As a I grew, I learned to name the flowers in people’s gardens because I worked in a greenhouse. I was trained to tell the difference between a rose and a lily, for example. My parents taught me to notice architecture. What makes a classic New England home look as such and how that differs from an adobe house. I came to understand what a well-built house is.

When I moved to DC, I learned how to see a street for what it was. A pathway to somewhere. I learned how to chart my course and tell if I was safe on a particular path within moments. I learned to see the places, like underpasses, I should avoid at night and the places that were filled with architecture, trees, and flowers. I learned this out of necessity and because I have a savage passion for walking and walking and walking.

When I moved to Paraguay, I learned to see what someone was trying to say because I couldn’t always understand their words. I learned to see if they were lying, or friendly, or joking. I learned to see why some people might follow God. I started to understand why life in Paraguay is different from life in the United States. And I learned to see that difference as both beautiful and challenging.

In medical school I’ve spent years learning to see exactly what a normal breath is and how stretchy skin should be. I’ve learned to see how the heart and abdomen are when all is well and what an infection looks like. I’ve learned to understand almost every part of the body and to see when it is healthy.

All this learning about how to see I carry with me always. And, when I moved to my latest home, I applied my seeing to understand what this city was. I learned that there is a lot to say about Danbury. I found the trails (there are numerous) where I can run and walk among the trees, birds, and flowers. I’ve noted the buildings with outstanding architecture. I found half a dozen murals with beautifully blended colors. I’m mapping out the good eateries—so far, I have a recommendation for every meal of the day plus elevenses and snacks. Much like Paraguay, Danbury is filled with people who don’t look or speak like me. But, when I took the time to observe my neighbors; it became apparent that they are a bunch of people trying to carve out a little space to work, eat, and be merry. I came to understand they were just like me in many ways. And, noticing our similarities, I understood that this city suits me. Seeing is something that takes practice. But once you learn to see you can begin to understand.