I have almost constant anxiety about mom getting sick with COVID. Texas numbers are high. The community is not exactly being safe (ha). The politicians there have treated it differently than our new home state of Washington and watching the difference has been... very difficult. 

Biden was elected. Trump is still fighting it. There are supposedly thousands of people who are going to refuse the inauguration. It feels like a fracturing of democracy, which is the worst part of this presidency. In the context of this worst year for America in many. 

It's hard to find things to be positive about in the world, but at home I'm surrounded by it. Lila and I are happy, we have pets and plants and maybe in January will be starting the adoption process. We're ready for a baby and that's both exciting and terrifying. I get my COVID vaccine tomorrow. We're both working from home more and on those days we see each other so much more and it's wonderful. I cannot help but be thankful. 

But I miss my mother, my cousins, my family. I miss Lila's family. It's so far away and that has been the biggest revelation for me of this pandemic. Maybe too far. We shall see. 

I know this isn't the most poetic or exciting update of updates. But life is just moving along. Being in healthcare right now means your working your ass off. There's not always time to stop and reflect so when you do it has to be purposeful. When I do, I am trying to be purposefully grateful. Intentionally mindful. Wish me luck. 

Pandemic

I want to make sure and take a moment to stop and breathe, to relieve my own anxiety and document what is happening in the world so that I can remember it clearly to discuss with my children, with our children. 

The last year has been one of such growth for me as a person; I got married to the beautiful Dalila, I became a more confident family physician, I started working on my own personal health. 

And in the wake of the beginning of a new decade, this novel virus - this brand new organism in human lives- slowly began spreading. We suspect as a medical community it likely started a few months ago- in 2019. The first case in WA, my new home, was 1/15/2020. We know it's basically endemic at this point in mid-March and we are waiting for the explosion of respiratory cases to hit the hospitals. 

On a FB board for MD's, several of my NYC peers are comparing it to being at the hospital waiting for survivors to be brought in after 9/11. The anxiety, the fear, the unknown. For them, the grief of no one ever arriving because of the total destruction of life... a trauma that likely also reinforces their fear now. I had never heard these stories - the stories of the people who take care of the mass casualties, the lingering emotional trauma. 

We as a profession are dedicated to life, to health. We are functioning in a system that is far from being at its best. No one knows that more than a burned out physician, an underpaid nurse or even the registration person who barely gets a mask. And yet, we continue to love our patients, show up daily, feel the strength and bond of our medical community as a alliance, a fellowship in times of emergency. That is the most beautiful part for me. Hearing from people who weathered the storm of medical school and residency with me at Texas Tech all week as we prepare for the unknown - knowing that they care, not just about what to do to save as many lives as possible, but about me personally and my health and family... I cannot tell you what it feels like to have that history and that collegiality as a bond. And the most beautiful part -- it crosses borders. Seeing the Chinese, South Korean, and Italian doctors reach out through FB, the media, published articles, online resources.... desperately trying to prepare the rest of the world with info they did not have, with help they did not get... It's a beautiful truth about medicine that we need to reinvigorate and invest in more. Something that humanity as a whole should invest in more. 

As for the pandemic, Italy is losing >300 people a day at this point. A day. People's family members. It's not fair. It's not right. I hate it. I want to hit it with my fists and scratch my nails down it's face. I want to protect our people from it... our poor, American elderly who already fight social isolation and poor food and un-stimulating nursing homes, the powerless... they don't deserve what is coming and it makes me cry angry, frustrated tears. My patients who I think about after work, on weekends, at holidays... not having visitors and struggling to get groceries. What are they doing right now? How will they survive? 

I'm scared for my peers. Young physicians with no co-morbidities who are being intubated, who we're fighting to save. I'm scared for me. 

But I'm also beyond proud - of the physicians, scientists, NP/PA, nurses, LPN, MA, CNAs, Respiratory Therapists, etc who are rushing to the front lines, caring for people, fighting to make sure those who come after them are better prepared for the fight, even if they can't be. For the FB groups of doctors spreading accurate information as quickly as they can. For organizations like University of Washington for putting together detailed protocols of what they're doing for every aspect of care from ER to ICU to OB care. For the hospice teams who are going to be overwhelmed - you are so very needed and appreciated. We may be understaffed, underfunded, underprotected... but we as an entity are functioning in ways that make me proud. 

I hope that you can find your way to help in whatever capacity that may be. That you can support those who will struggle. That you will stay safe. I hope you all get to feel the oneness with a team of humans the way I have been able to in this time. The camaraderie of humanity. Its a beautiful thing. We are one people.  It's taken a worldwide pandemic to remind us of it, but we are one. Let's make sure we hang on to that. 

For now, the standard sign off at this moment: stay at home and wash your hands :) And reach out if you need help. We are one. 

Vision of Hope

I have a favorite poem.

Salutation of the Dawn, attributed to Kalidasa. It's a poem from a Classical Sanskrit poet and dramatist who could capture the emotion of life with words far more precisely and succinctly than I dare try. It's been in my head that last few days and I can't help but think yet again of it's power to me on a day like today.

It's been one of those days. Residency can be hard. I have it relatively easy in my program. But that doesn't make the hard days any less demanding, draining, and gut-wrenching. From being misinformed from the beginning about a patient, to spending multiple more hours in the ER than usual stabilizing someone who is not doing well, to watching the family grieve someone who was well less than 24 hours before a conversation about end-of-life care. To go from a room with the above scenario to getting feedback for being slow on rounds makes me want to cry.

Deep breaths.

Look to this day, for it is life, the very life of life.

To be honest, this family reminded me of my own. The spouse had a kindness that reminded me of my father and the daughter had the same shock I know I must have had in a very similar situation. I haven't had that yet- the flashback to personal loss- until today. There was something in their sweetness, their innocence that brought it out. Something in the love that was so clear. I will never be able to express what growing up in my family was like- there are not enough words. Love was so clearly expressed. In the end, I am so thankful for that, because like this family - there was no regret, only love and fear of loss. Fear of a future without a beloved family member. I know what tragedy comes for him. Going home alone. Planning a future alone. The absolute and soul killing loss of having the future you did have planned pulled out from under you. It is a wound that never heals. He shook my hand and hugged me. He thanked me for all that I did. All that I did. What I did.

Deep breaths. Let it pass.

In it's brief course lie all the verities and realities of your existence.

At the same time, I look around what I now consider my workplace and see how my work intersects with people's lives in the most severe and abnormal of ways. I see people on their worst days. I break the worst news. People live in parallel to the hospital, glimpsing it occasionally as they pass by to other life events, until they need it... and when they enter it's doors they come in contact with us. It feels like the strangest frontline for raging a war on health. There's always little cases - stable people you know will be in and out and on with their lives. But then there's the people who will never go home again. Case management for placement. Hospice. And then today. The people who don't make it out of the ICU. 

I find the interaction of our realities the most interesting. The hospital can be dehumanizing for us. Sleep deprivation, personal frustration with our own inabilities, frustration with patients who won't take care of themselves or who are working the system, emotional turmoil of patients whose lives will be forever changed because of a simple hospital visit. Despite all of this, there is a daily dose of empathy and compassion from listening to patients stories or fighting insurance for them, of interacting with the family and hearing the burnout, the sheer overwhelming nature of their family members health on their and their family's lives. You get to know hundreds of people in deep and meaningful ways in such a short amount of time. And if they're lucky (and not your clinic patient), you will never see them again.

The bliss of growth, the glory of action, the splendor of achievement.

And in the midst of all of that is the personal growth. Even on the rough days, you can see yourself grow. As a doctor, there are so many aspects that continuously develop. From competency to confidence, compassion and efficiency. To say we work hard is an understatement. To see myself objectively work that hard, that quickly is comforting from a development assessment side. It's strange to have such diverging abilities to assess yourself- an emotional, empathetic nature and a cold, objective nature. Despite the oddity, they work together to make me a better physician.

For yesterday is but a dream, and tomorrow is only a vision.

It's surreal to be home, bathing the dogs, laughing and cooking dinner on a post-call night with my family and be getting text messages about a family I care about and their impending loss. How to separate that to be able to function in life? It happens naturally. I think of them. I draw them up in my memory, I surround them in whatever loving energy and vibes I have in me, and I say goodbye. I am surrounded by amazing people who I know I can count on to support the family, to make good decisions. By people who tell me, as I'm walking out on one of the hardest days, that they learn from me every time they work with me (thank you. thank you in a million ways with a million words, thank you). The people I work with make the schedule worth it. The family and friends I come home to make the ups and downs a passing event. They allow it to not be a part of my soul that effects by ability to function. It's self-preservation, true. But how much easier to know that you're actually just well supported by the people around you. What more could I ask for?

Deep breaths. 

But today, well lived, makes every yesterday a dream of happiness, and every tomorrow a vision of hope.

Every day is a new start. A new patient, family, situation. A new chance to learn. A new chance to get better. A new day to clear my vision. It allows me to take on that family that exuded love and whose hearts broke today without fear and with the ability to help, in whatever way I can. Find beauty in the way the world interacts, in the way lives intertwine. Find joy and peace in the tragedy and comedy of life. See love in the heartache of loss.

Deep breaths.

Life, updated.

There have been so many changes in the last year... from buying a house to graduating from medical school... becoming a real doctor with people's health outcomes depending on my decisions... entering into a relationship that surprised me but has one of the most gratifying and fulfilling parts of my life... there's just so much to share. 

Being a Doctor
is scary, wonderful, fulfilling, empowering, emotionally/mentally/physically exhausting, and is a career that promotes personal and professional growth. I have both loved and hated being a doctor at multiple different times this year, but luckily my feelings towards residency are almost completely positive. Except for the pay and the hours. But Lila keeps reminding me that it's only temporary. Sometimes I feel like that's my mantra. I am about to start my second out of three years of residency - that means I will be an upper level and that the new interns will look to me for help. I think that might scare me more than almost anything else. What if I don't know the answers? What about when I am terribly wrong? What if I just keep messing up and don't become a good physician? I frequently hear my peers joke about the same sentiments... it's interesting to see some of the smartest people who work so hard feel so insecure. The opposite side of that coin is that when you do things well - when you really get a complicated case, when you think of a diagnosis that is off the wall but correct, when you catch something early, when you do well on your ITEs (In-Training Exams), when your patient's symptoms are well controlled or they feel so much better... you feel so good. Like I said, scary, wonderful, and fulfilling. 

Graduation

Resident Retreat with my fellow FM peers.

Personal Life
I am doing so well in my personal life that it trumps my professional life regularly. I look forward to coming home. I am now a homebody. Lila and I have built gardens, started projects, gained hobbies (Lila's is walking stick making and wood burning, and mine is gardening and making our house more green). We have traveled extensively over the last year- we went to Colorado to visit Lila's best friend Robin (who is awesome), to Columbia to see my peer get married (love you, Catalina y Juan), to Taos for a weekend away (snow snowmobiling for the win), and most recently to the Pacific NW coast. We were blow away by the beauty of nature that they have there. I swear, the essence of wildness resides in the Pacific NW. 

Estes Park, CO - the chipmunk loves us!

Cata y Juan's wedding in Columbia

Bogota, Colombia

At the wedding.

Taos, NM

Taos, NM - snowmobiling!

Taos, NM

Hurricane Ridge, Olympic National Park, WA

Lake Crescent, Olympic National Park, WA

Madison Falls, Olympic National Park, WA

We have two puppies - Jax and Murphy. They are basically the most ridiculous dogs on earth. Jax has an anxiety disorder. We took him to the vet and they tried to tell us repeatedly that we needed to exercise him more (we tie him to our bikes and run him like 6 miles and he still has anxiety). We had them try to trim his nails... they came back with an already filled prescription of sedatives for when he gets too riled up. Ha. Murph was given to Lila at Amarillo College (where she is a professor... Anatomy & Physiology I & II, Intro to Chemistry... yeah, we're nerds). This is the coolest and most adorable dog ever. Except he likes to chew on our shoes and underwear. And he sometimes pees on the carpet. We are still working on him. 

Dalila and Jax

Murphy

Until next time my friends... do not hesitate to reply with how you all are doing! I love hearing about it even when I don't get to call or write everyone. Have mercy!

Japan

There are so many stories to be told about Japan.

First- the story of my family. Growing up an "only" child - with three half brothers all 14+ years older who never lived with us - family has always been something of which I wish I had more. Most of my grandparents passed when I was young and Dad passed in 2003. So having family around has always been one of my goals. I'd like to end up near them, end up marrying someone with a huge family, and end up making a big family as well. So, going to Japan to visit my brother Scott and his wife, my nephew and his wife, and my niece with Mom was worthwhile beyond measure. Scott has been in the Navy for 25+ years and he was being celebrated at a Change of Command for the USS Lassen in his final days as the commander. It was amazing getting to see him in his professional setting, uniform and all, and hear what his men had to say about his leadership abilities. Spending time with Sonja and getting to really know my nieces and nephew, their personalities, and the type of people they've become was priceless.

My family fights dirty! ;)

Wrapping paper roll ninjas!

On top of that, we were in JAPAN. We went to as many temples as possible. We ate as many different types of Japanese cuisine as possible. And we payed SO MUCH IN TOLLS. Seriously. The tolling is ridiculous.

I don't have near enough time to write any of my stories, but I wanted to share some of the photos. It was like being deaf and blind. The street signs made no sense to me. No one spoke English (nor do I think they should- I'm just saying it was a tad bit overwhelming- my first Asian country). And there are literally people everywhere. There is no alone time except maybe in the temples. And space is a luxury only for the extremely wealthy. Superficiality is an issue there. So is suicide. The children are quite independent at a young age and you will see 5 & 6 yr olds by themselves on mass transit going to and from school. People are very polite. No one talks on the train... no one. It's silent (except for the McClelland family, of course). My favorite temple was the Bamboo Temple (will add pics later). I got my temple book there - which you get monks at each temple you visit to sign- and it's so beautiful signed.