How I Came to Discover That Pronouns Are Like Ants

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

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.

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.