Friends Forever

I’m an introvert and a dreamer. As an introvert, I have a few close friends rather than a large circle of lukewarm friends. I think of my friends often, like to know them well, and consider them family. Being an introvert also means that I like to have a large dose of time alone. When I’m alone I daydream about the escapades I’ll go on throughout my life. As a dreamer, I think of solo quests and I hash out perfect adventures to go on which each of my friends, knowing every friend’s unique virtues and nature.

Each period of my life has given me one or several wonderful people to add to my friend family. These days, I’ve been thinking a lot about friendship–largely because I’ve stumbled upon some outstanding new friends. But, also, it’s been a long time since I’ve visit some of my friends who live far away; I’m thinking I might move in the next year; and I’m visiting Paraguay soon. Friends of my past, present, and future geographic locations are always on my mind.

Whenever I think about friendship, I remember a conversation I overheard 3 years ago. I’ve decided to repost (again, it’s not the first time) because it’s my favorite description of what true friendship is. While not everyone believes in Heaven, I think the lesson this scene teaches is universally applicable.  

Overheard in Paraguay: Friendship
Repost from October 19, 2015

We sat in a half circle around the grill. The men were cooking large slabs of meat (ribs and some unidentifiable cut) for the mother of the family’s birthday dinner. The husband of one of the birthday mother’s daughters sat by the grill passing one can of beer among the men there. A nephew walked up to the daughter’s husband. The husband was around 30 and the nephew was about 11.

The husband hugged his nephew first with one arm and then the other, squeezing him. The nephew squirmed, and they both smiled. The husband held the nephew at arm’s length and put on an almost serious expression. “Will we always be friends?” the husband asked.

“Yes,” the nephew said.

“Even when I am old and you are my age?” the husband asked.

“Yes, even when you are old and I have kids,” the nephew said.

The husband smiled and pulled the nephew into another hug. The nephew pulled away again and they looked at each other, the husband still squeezed the nephew’s shoulder with one hand.

“Even when you are in Heaven and I am old we will still be friends,” the nephew said earnestly.

The husband laughed. “And I will look after you from Heaven.” They hugged again. “And, when you come to Heaven, we will be friends in Heaven. We will be friends forever.”

The boy nodded and ran off to find his playmates.

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Countdown to Visiting Paraguay

It’s been 2 years since I last stepped foot in Paraguay, that little country at the heart of South America where I lived for 27 months as a Peace Corps volunteer. But, I’m going there for 2 weeks this December. It’ll be the second time I’ve gone back to visit since returning to the US.

I find myself falling into a reflective mood as I think about the long journey south. My trip comes at the best time, when snow and cold have descended on Vermont. I need a break from winter even though it’s only just arrived. I’m reflective because I’m a very different person than the one who left Paraguay almost 3 years ago. I won’t bore you with the details of thrusting myself into pre-medicine and the whirlwind of building a new life in Vermont, both adventures that have consumed my time since I moved back to the States. What I will say, however, is that I’m excited to see the red dirt of Paraguay again. I look forward to their fatty foods. And most of all, I can’t wait to sit with the Paraguayans I call my family and friends and discuss the weather and life…and crack jokes. Often, the jokes are about my singleness or professional focus (aspects of my being that are particularly distinct from the Paraguayan way of life) but not always.

Many of the kids I taught in Paraguay have graduated or are soon to graduate high school. I see their Facebook photos of college study and adult life. Many of them have lost parents to illness. Some of those parents I knew and spoke to on my almost daily walks to the school. Many of my students have their own babies now. Few are married yet.

Some of the elderly women I used to spend the afternoons with have passed away since I last visited. Others, I’m not sure if they’re alive because they don’t have cell phones. What I know is that the señoras in my Paraguayan community will welcome me into their homes with just as many smiles and just as much generosity as they did when I was their neighbor. Those women took me in as their daughter. I think they were always torn about what kind of daughter was. On one hand, I didn’t know anything about the right way to navigate life in Paraguay, but, on the other hand, I knew how to travel from my country to theirs and I have so many dreams and goals.

In many ways life in Paraguay is the same as here. But, as I think about going back I’m also reminded by just how difference it is. The food and smells—meat and real animal fat mix with the smell of live chickens, pigs, and cows who idle close to the houses. The topics of conversation vary, but there is something unique about the gossip of families who have lived by one another for so many generations no one remembers any other place they called home. They speak in a mix of Spanish and Guarani (the indigenous language); the sounds of those languages together bring back many memories of the best two, but also the hardest two, years of my life so far. The soundtrack of Paraguay is different—the rhythms of bachata, polka, cumbia, and reggaeton fill the air on hazy, hot weekend days and weekday nights.

In many ways, Paraguay has the indomitable nature of never outwardly changing in any significant way, just like my home state of Vermont. But, just as Vermont, there are the subtle differences of life moving forward. One of my dearest friends has returned to law school (she’s already a lawyer) for a specialty degree and she is now a mother—both new accomplishments since I last saw her. Another friend finished his military training and now works for the Paraguayan Navy—he still visits his family’s home whenever he gets a stretch of days free from duty. Another friend started a local clothing store. All of us are older than we once were. The babies I knew when I lived in Paraguay are now children. The children are almost adults.

As I drink my daily mate alone in Vermont, I often think about my Paraguayan friends. I miss them every day. I miss them because no other people I’ve encountered is so good at sharing time with each other. So good at making you feel welcomed and loved. Their culture has built in values and rituals that allow friends and family to sit together and share a drink or a meal without any other obligation. I miss my Paraguayan families because they are so good at seeing the bright side of everything. So good at ignoring the bad things that happen, almost to a fault.

The nostalgia I feel for Paraguay is one where all the bad aspects of living there are forgotten and I remember only the good. Of course, both the light and dark sides of Paraguayan life will confront me when I land again in that country…but somehow that doesn’t bother me.

I remember the first time I flew to Paraguay, not knowing what awaited me there. It was exciting and petrifying. This time when I go back, I know the communities and families who will greet me again with open arms. I can’t wait to see them. I can’t wait to eat chipa and sip terere in the shade of tropical trees because it is absolutely too hot to do anything else. I can’t wait to walk around my old community and say “hi” to every human I pass because that’s the Paraguayan way. I can’t wait to be reminded there is more than one way to live life, none better or worse than the other, just different.

5 Things I’m Grateful for this Holiday Season

This was a big year for me. I finished my pre-medical classes, took the MCAT, applied to medical school, and then I got into medical school. My youngest brother graduated college. My grandfather was buried in Arlington National Cemetery. I got a new job in the emergency department where I get to spend most of my day caring for patients. One of my dear friends had her first baby, and I’ll get to meet him this December (because I’m visiting my beloved Paraguay!!).

The laundry list above is just a sampling of the year. I’ve also made some great new friends, met some amazing people, done a tiny bit of national travel, and spent good hours learning new things. I could fill pages about the year, but I won’t just now. Instead, as the holidays approach, here are 5 things for which I am grateful:

1) My family who made it possible for me to get into medical school. They’ve listen to me gripe. Told me to stop whining and act. Shared my excitement for small victories. They’ve cooked, visited, hosted, taken me out to dinner, pitched in when I was in a pinch, made me laugh, talked me off the edge of tears, and helped me keep going when I wasn’t sure if going was an option.

2) The friends who stay in touch even though we live lightyears apart in separate, though equally chaotic, universes. The new friends who have joined me in sweating over biochemistry, hiking through Vermont’s woods, undertaking food adventures, and soaking in the quiet moments of life. The hardest part about moving as much as I have is that many of my favorite humans live far away. It’s a testament to their greatness that despite our distance they remain a positive force in my life.

3) The folks at my new job who reminded me what being part of a good team feels like. Who taught me the tricks of a new trade. Who show up every shift ready to do what needs to be done and between saving lives have energy for a smile or laugh.

4) The mentors and teachers who taught me all I know about medicine and science. But, also, my life mentors—the ones who have been there since undergrad (or before), the ones who’ve shown me the ropes of being an EMT, and the ones who set an example of what kind of old person I aspire to be.

5) Vermont. Sometimes my little home state is cold (actually, it’s usually cold). Sometimes Vermont is too homogenous and too isolated to quench my love of the new. But, this year, I’ve basked in perfect summer days where the sun is just right. I’ve soaked in the smells and silence of the forest and absorbed the wind that makes waves on Lake Champlain. I’ve reflected on the mountains that guard the horizon. I’ve enjoyed creemees, apple orchards, and maple syrup. I’ve watched the rain fall with mate in hand. I’m from Vermont. And while I don’t often call Vermont my home, it is the place where my roots have always been and always will be.

I’m grateful for the moments I’ve had to enjoy all the people and places that make life worth the sweat. I’m thinking about those moments as the holidays approach.

Go Vote on November 6

Elections are November 6. That’s a few days from now. If you haven’t registered, there’s still time. There’s also time to figure out where to go to vote. There’s time to review the candidates and pick which ones you want to lead us. Now’s the time.

Recently, a friend shrugged when I encouraged her to register to vote and fit a trip to the polls into her busy Tuesday. Elections are this Tuesday, November 6, 2018. “I haven’t been affected by the current president,” she said.

“Are you sure?” I asked. I wondered how she hadn’t noticed the ways in which our leaders’ decisions were posed to shape American lives for generations. I wondered when we thought the only person we voted for was the president. I wondered about the apathy of the masses. I wondered when we had forgotten how much politics matter.

We don’t only vote for the president. We vote for the school budget and those who decide how our towns and cities and states should be run. We vote for congress men and women every 2 years and we vote for senators every 6 years…and those two groups make up the Legislative Branch. The Legislative Branch is important because it’s a counterweight, a check and a balance, to the Executive Branch (the president) and the Judicial Branch (the judges, picked by the president on the national level).

US democracy only works if you care about all 3 governmental branches because the 3 keep each other in check. US democracy only works if you care about federal, state, and local politics because they work with and against each other in a constant tug-of-war between different beliefs. When one fraction of the government is ignored by most voters, the voices of a few predominate, and those vocal individuals then make decisions for other people whose lives they don’t understand.

But, let me stop ranting. I have a few points that are more concise. A few issues to keep in mind. A few things I remember when elections come.

  • What’s the price of gas these days? Did you know tariffs and trade agreements made by our politicians can lower the price of gas for the period leading up to elections?
  • What is your voting district? Did you know district borders are drawn by politicians? The lines are often drawn to ensure the current party always wins.
  • How do you feel about access to health care? For the elderly? For the poor? For those who have pre-existing conditions (those who are already sick)? Access to and education about birth control? Your politicians decide how hard it is to see a doctor and get the medications you need to feel well.
  • What is love? Who are you allowed to marry? Who gets legal rights to visit a loved one as they lie dying in a hospital? Who can adopt children? Your politicians decide.
  • Who’s protected by civil rights laws? Your politicians get to set legal definitions of things like gender, sex, and race. Did you know children used to not have protection under the law? They had fewer rights than animals. Politicians changed that—with pressure from lobbyists and people who thought it was wrong to beat children or make children work.
  • Where and when do we go to war? How to we care for veterans? Who do we allow to join the armed forces? Your politicians set those guidelines. What are we doing in Iraq and Afghanistan now? What are American soldiers doing in Syria? Are we going to attack Russia or China? It’s your government that makes those decisions.
  • Are billboards allowed? Billboards are illegal in Vermont, thanks to local politics. Vermont depends on tourism…so were billboards banned for economic reasons or was it because some politicians thought billboards were ugly?

The above are just the beginning. There are so many other things that depend on politics. The price of food, for example. The minimum wage. Life is a complex web. Claim: our immigration policies influence the price of oranges…can you puzzle out why?

The thing about politics is that it permeates life in subtle ways. In the US, we are lucky because political decisions don’t often lead to obvious shortages of essentials or the disappearance of dissenters (we don’t have camps where we hold people prisoner, or do we?). It’s naïve to believe that everything from our wallets to privacy or marriage to jail terms are not shaped by the decisions our legislators, judges, and political leaders make.

My point is simply that your opinion matters. Make yourself heard and go vote. Take part in democracy. Be a citizen of the US and go vote. Go vote because it’s what you should do. Go vote because it’s what others are doing. Go vote because you can. Go vote because your country needs you to vote. Go vote.

Leader vs Boss

The many teams I work on (of varying sizes) throughout my shift in the emergency department have provided ample opportunity to experience different team leads. And, in recent weeks, I’ve been reminded of a lesson I once taught my Paraguayan students (I taught life skills classes to grades 7-12 as a Peace Corps volunteer in Paraguay for 2 years). The lesson was during our leadership unit and it was on the difference between a leader and a boss.

Lesson

I started my class with the following image:

I defined the differing titles as follows:

Leader

A leader is someone who leads by example. They are skilled, trustworthy, and levelheaded. A leader is confidant with their abilities, but they are willing to change their tactic if any team member has a better idea. A leader gets their hands dirty. A leader reminds you of your strengths and approaches weaknesses as learning opportunities not permanent shortcomings. A leader is willing to have that hard conversation or make the decision no one else wants to make. A leader makes every team member feel like the project belongs to them, not just the leader.

Boss

A boss is someone who leads by giving orders. They think their way is the only way and expect others to follow them. A boss is an expert, but they are not someone you go to when you’re having a problem. A boss is the first to address a shortcoming or mistake and says little when a job is well done. A boss stands above the work, but tells you how you should complete each task. A boss makes all the decisions, but when something goes wrong blames it on the team. A boss expects you to pledge allegiance to their project.

Reflection

It’s not the breadth of knowledge or the level of skill that distinguishes a leader from a boss. They are differentiated by how they approach their colleagues. When I was a teacher, I asked my students to reflect on which type of team lead they’d rather follow and they always picked the leader. I asked them, then, how they were going to be leaders rather than bosses.

“Listen and be kind,” they said.

We could all remember my students’ advice. For some it comes easily while others have to remind themselves to listen and be kind. However, as long as the end is reached, it’s okay if being a leader doesn’t come naturally at first.

When work is slow, the opportunities to dish out compliments are obvious and abundant. Amid the chaos of a high census (lots of tasks all at once) or when faced with a critical patient, it can be harder. Leaders always find a way to lift us. That’s why we follow them. When the going gets tough, leaders bring us together while bosses push us apart.

Choose to be a leader. Your team needs you.

Work-Life Balance

Why do some people always seem to have time for vacation, camping trips, and concerts while others always seem to be working? How do some people function on what seems to be no sleep? What exactly is work-life balance? Is being a workaholic a problem or just one way of giving life meaning?

Some Case Studies

Hospitals

Health care is full of people who work almost around the clock—nights, weekends, and holidays are fair game. But, for example, the shift work of nursing can allow for many days off every 2 weeks. Plenty of nurses I know take advantage of 36-hour, full-time work weeks (broken into 3, 12-hour shifts). A sample biweekly work week is 3 days working, 1 day sleeping, 3 days working and 7 days off. Despite the exhaustingly long shifts, these nurses enjoy 4 more days off every 2 weeks than a person who works a job Monday through Friday.

My American Family

In my immediate family, there are many models of work. Several of my family members are self-employed. They may work every day but they might also take long stretches off. Some days are long; some days are short. My sister is a trainer and fitness queen. While she often works fewer than 40 hours per week, her hours are spread out across every day of the week and at different times of day such that taking even one day off requires scheduling magic. There’s my step-mom who has the stereotypical workaholic, business schedule which is based on an 8-hour slot Monday through Friday. Of course, a few hours are tacked onto each day and she works additional hours over the weekend. In the end, she works something like 80 hours a week even though she’s on paper for 40—and, stepping away for any stretch of time seems impossible.

Paraguay

In Paraguay, holidays are sacred, summers are lazy, and commutes are so long they seem unreal. Except for the man I knew in the Navy and some small business owners, no Paraguayan I met while living there worked during a national holiday. Perhaps that’s different in Asunción (the capital) and in major hospitals (of which there are few) but generally Paraguayans don’t work holidays. Additionally, few people work on Sundays. Almost nobody works past midnight. While many Paraguayans have long commutes to work and work long hours, the number of days off they have in a year dwarfs the number of days off many Americans choose to take.

Paraguay vs US

In Paraguay, family comes first for most people. Most people work to support their family and buy nice things. Most Paraguayans prioritize time off visiting, eating, celebrating, and watching soccer over working endless hours. Most Americans prioritize working. Many Americans bank hundreds of vacation hours that they cash out or lose entirely. Of course, these are stereotypes…but, during my experience living in both countries, the stereotypes of family-first for Paraguay and work-first for the US seemed justified. I’ve often asked myself, “Who has it right?”

The Perfect Balance

The balance between work and other activities isn’t static. The perfect balance, the one that yields the greatest happiness, is unique for each human. Neither the Paraguayan approach nor the American life approach is better, they are just different. Paraguay taught me the importance of downtime while the US emphasizes overtime and constant production. Regardless of who you are, there are times when work should come first and times when family, vacation, rest, or anything else must come first.

Winning the balance comes down to being willing to reflect on your life and to make changes. For example, when one of my friends frequently complains about working too much or is always exhausted, I often ask if it’s time to scale-back or change their work schedule, job, or approach to working. When another friend often talks about being bored at work or not making enough money, my thought is that it’s time for them to invest more effort in professional growth. Is it easy to change things up and move toward something different? No.

It’s hard to reflect on your life and make meaningful changes. What I do to face the challenge is break my life into chapters and then identify what made me happiest and saddest during each chapter. I use what I identified to inform my guesses about what I need to do today to tip the scale more towards happy going forward. I tend to be work-centered (mostly because I love learning and feeling productive). As a result, the life side of my balance always requires more attention and energy than the work side. Knowing this, I put extra effort into “life” to keep my scale level. My scale often dips one way or the other, but I try not to let the off-kilter stretches jar me. Rather, I make small adjustments until I waver around a mix of experience that feels right for the time.

On Not Becoming Jaded

One night a coworker in the emergency department, who also aspires to be a doctor, asked me if I was worried about becoming jaded as I worked in health care. I answered confidently that I wasn’t worried about becoming jaded, my hope for humanity waning, or burning out like so many medical professionals do. He was skeptical, but I am certain of only that one aspect of my future.

Defining Jaded

Especially late at night when most patients are tired and grumpy, the drunks roll in after exhausting the bars, and the patients held for mental health evaluations decide to spend the early morning hours holding yelling matches that involve nonsensical accusations against staff, it’s easy to see how one can grow tired of working in a hospital (and specifically the emergency department). In medicine, we take care of everyone, even if they’re jerks to us, because the fundamental principle of health care is that we serve all people.

Not so long ago I was greeting patients in the waiting room at the emergency department. We had around 20 folks waiting for rooms, the rooms weren’t changing over, and the wait times for many were over 2 hours. That’s a recipe for an unpleasant experience as a greeter, and the recipe was rich that night. I had a parent repeatedly insult the staff, including me, and ask why we hadn’t brought her child to a room yet. That was annoying, but manageable. What got to me was when she stormed up and demanded to know why we brought back “a drug addict” (her words, not mine) before her child. Her argument was that her child had a bright future while that person was a lost cause. Of course, I couldn’t tell the hysterical mother just how awful it is to watch a person go through withdrawal shakes and then seizure. That’s something you can only understand once you see it. I couldn’t tell her about the alcoholic who came to us one night shaking so badly he couldn’t drink water from a cup. I couldn’t tell her how he had looked me in the eye and told me he wasn’t human anymore. That mother was choosing to believe him, but I knew that that patient was human even if he didn’t feel like he was. That angry mother in the waiting room clearly had never seen a person beat an addiction—winning the daily fight to not give in to a drug or alcohol for years. I have.

It’s not the job of medical professionals to pass moral judgment. Sometimes we are weak and tired, and we do judge our patients’ life choices. But if we were to slip into a world where we used our personal morals to decide who should receive care, we would betray the heart of medicine. Medicine was never meant for only a select few.

In my view jaded is another way to describe losing empathy. There are many presentations—impatience, anger, and hating work to name a few. These feelings come when we are too tired and too worn out to see patients as humans. They come when we no longer find joy in the small things about the job that are awesome. And jaded becomes the norm when we give too much. It’s easy to work hours no one else would dream of working when you’re in health care. Each hour is rewarding because we help someone feel better, but the hours take a toll on the giver.

Considering all the above, how am I so certain I won’t become jaded?

  1. My empathy comes from selfish sources, so I don’t expect that it will fizzle. The first source is curiosity and the second is a love for stories and puzzles. Each human has a story. Each sick person is a puzzle. The curious mind can’t help but wonder about the story plot and the answer to the puzzle. These two factors are some of the main reasons I veered down the medical path in the first place.
  2. I know that I’m brave enough to step away and recharge as well as to shake things up when caring for patients under specific conditions becomes wearisome.

How do I know I am brave enough? Paraguay. While living in the land of Guarani, I cultivated an ability for self-reflection and the bravery to face fears because they were required to survive the Peace Corps. Paraguayans also showed me the value of letting yourself be still. In America, we are so determined to be productive we schedule every moment. I think running around all the times makes everyone miserable no matter what their profession. I also think those who become jaded forget to reflect and change. They fail to see that their job is draining them until it’s too late and, then, they lack the courage to change their work so it’s fresh again. It comes down to the best professional advice I was ever given. When I asked a presenter in one of my undergraduate classes how she knew when it was time to leave a job (she had an awe-inspiring, lengthy job history) she said, “You’ll know. You know when it’s time to leave.”

She was right. We do know when it’s time to mix things up. The hard part is taking the steps to act upon what we know. But, if we do take those steps, then jadedness can never catch us. The moment she gave me that advice, years ago now, I promised myself I’d be strong enough to change my course whenever I “knew” it was time. That strength sent me to Paraguay and brought me back to Vermont. So, no, I’m not worried about becoming jaded. I’m just excited to see where my adventures in medicine bring me.

Human Side of Medicine

Not so long ago I worked a code (cardiac arrest = patient’s heart stops and they neither have a pulse nor are breathing) in the field. The patient was middle-aged and had a complex medical history. The patient’s father, visiting from out-of-town, found him unresponsive, started compressions, and called 911. We did all we could—did compressions, ventilated, pushed epinephrine and other medications, and analyzed for a shockable rhythm. As we worked the father knelt at his son’s head. The patient’s fiancée sat outside the house. As it became clear that we were not getting our patient back, my crew chief reviewed, outload, all we had done. She asked us if we could think of any other interventions we hadn’t yet done and then she engaged the father, explaining why we were going to stop resuscitation. Once we had stopped she went outside to talk to the fiancée.

As heartbroken as the patient’s family was, they were calm when we stopped CPR. They had seen us sweat over their loved one, try everything we could, and ask for suggestions. We included them in our decision to stop our efforts. We lingered after our care was done to answer questions and offer condolences. This call showed me how it is within the pauses between action that we connect with our patients.

The human side of medicine comes through when we take time to ensure our patients understand what is happening and our plan for treatment. It comes when we include our patients and, when appropriate, their family in decisions about their care. And it’s completed by taking a moment to share their feelings, whether of relief after a successful procedure or sorrow after the loss of a loved one, before we scurry on to our next case.

Amid medical histories and assessments of signs and symptoms that lead to differential diagnoses it can be easy to let the presence of a disease or condition consume our attention. We can focus so intently on the disease that we forget humans bear the illness. But, below the clammy skin and wheezing is a person with a family and life experience just like you and me. And, what the patient will remember from their time during the flurry of a medical crisis is how someone treated them. It’s the offering of a kind word or an act of kindness on the worst day of someone’s life, not just the hope and likelihood that we have a cure, that defines good medicine. I try to remember to take advantage of the pauses by offering a blanket or bit of conversation to my patients. There aren’t always many pauses in my day, but when there are I don’t like letting them go to waste. It’s in the shared moments between points A and B that we build our humanity, but we must be attentive or we’ll miss the opportunity.

In Arlington Cemetery

This summer we held a memorial for my grandfather in Arlington Cemetery. His name will be on one of the niches in the columbarium. He was in the Navy and served in the Korean War. The service was short and concise. I think its precision and simplicity was well suited to my grandfather who was a high school and college math professor and liked things to be just right but not conspicuous. The chaplain was empathetic and caring and the soldiers who performed the flag ceremony were on point. As we said our formal goodbyes a trumpet’s song floated in the air above us.

My grandmother used to comment how they enjoyed when I visited because I’d sit all day and laugh as my grandfather told stories. He was a particularly gifted storyteller with the dry wit that ignites my science-loving and logic-focused brain. He told stories of the Navy (usually when he and his comrades were causing trouble), his struggles as a student (he went for a doctorate in math but didn’t finish his thesis because of a disagreement with faculty), or his adventures as a teacher (he had many years of teaching from which to draw).

In EMT lingo, my grandfather had an “extensive cardiac history.” When I called my grandmother after hearing of my grandfather’s passing she told me, “The EMTs who responded to my call were wonderful. You do good work.” She said that even though they couldn’t get him back. His heart had stopped and he had no cat-lives left. When my grandfather died, I’d been volunteering as an EMT for several months.

I’m still an EMT and I also work in an emergency department. An interesting thing about providing emergency medical care is that your mission is to lessen pain and ward off death, but you end up seeing a lot of both. You end up being there when medicine meets it limits and the time of death is pronounced. I sometimes wonder what the EMTs at my grandfather’s death thought. I wonder how they ran their emergency call. What did they do to make my grandmother feel like they’d done the right thing? I hope the families of my patients have the same impression when we determine it’s time to stop CPR.

I used to visit Arlington National Cemetery periodically when I lived in DC. I like cemeteries because I enjoy walking the tombs and imagining the histories of the people they memorialize. Now when I visit Arlington, I won’t have to invent my grandfather’s story because I know it. I’m a product of it. I think of him often, partly because I wish he’d send me some of his math-genius as I continue my medical studies. Mostly, I think of him because he is one of the few people I know who successfully and completely built a life he loved. His only unfinished business is the family he left, especially his wife, but we’ll join him again one day if afterlife exists. Until then, we’ll keep making stories worth telling just as he always encouraged us to do.

Photo Credit: Mary Lou (family friend)

Christof

There’s a guy, Christof, in my neighborhood who collects returnable bottles from the recycling we put out on the corner for the city each Friday. One day when my father was visiting me, he struck up a conversation with Christof. One of Christof’s daughters went to college and the other didn’t–Christof joked that the daughter who finished college doesn’t have a job while the other one does. He collects bottles to help both of them.

I don’t often drink anything that comes in a redeemable bottle, but since chatting with Christof, my father started saving his seltzer bottles…he drinks a lot of seltzer. My father brings the bottles to my house (even though I live about 2 hours away) when he visits so I can give them to Christof.

I work nights, so it’s challenging to put out the recycling before Christof passes. One morning I saw him, though, collecting from the neighbors. As he walked by, I ran out and asked him to wait a moment. He paused, a smile lighting his face. I handed him 2 huge trash bags of bottles I’d squirreled in the garage for a few weeks. He thanked me a million times, wished me a blessed day, and was on his way.

At first, I thought my father was ridiculous for saving bottles for Christof. But, that morning when I saw Christof’s face after I handed him our bags of bottles, I realized that my father was right. We can get so caught up in all the big things we should do that we do nothing. Christof reminded me that it’s the small things that add up in the end. And, luckily, life is full of small things.