I walked down the street, people with their distressed ankle jeans and infinity scarves, black and yellow yoga outfits and strollers, cigarettes dangling from drawling lips. A man wearing a uniform, carrying a brown paper package to our neighbors stops in happy surprise and bends down. “Well, HELLO there!” he exclaims. “Where are you going today?” My daughter stares, openmouthed, after him as he continues to turn and wave his way back to his truck. After he pulls away, she musters her energies and yells “bye!!” with enthusiasm, then trots down the rest of the block.

Everything is filled with such wonder. She stops, every 30 seconds, to inspect a succulent’s soft leaf or a pile of leaves in someone’s driveway. The construction workers pulling shingles off of a roof provide 5 full minutes of 100% attention-absorbing incredulity. She never puts something off until later – no, the present is the only time that matters to her. She searches and runs and jumps and giggles and explores as each thought comes into her mind. And when she is tired, she crashes, happy at the productivity of her day.

She has no concept of tomorrow. The joy, the learning, the attention and activity all happen right now. There is no wasting time or procrastination because everything is valuable, everything leads to novel neural pathways wrinkling her young brain, leading to recognition of today’s favorite song, a new word, the color of a new friend’s hair. She does not sit back and wait to be entertained, but dives headfirst (often quite literally!) into the next adventure.

There is so much to learn from the way she takes on life. Right now holds so much promise, but can so easily flit by, unnoticed, and join a pile of lost moments sinking into graying memory.

Watching children, we learn to take on the best of them, and this is one of the most wonderful of their natural abilities. That said, my goal until my next birthday is to work on making every single moment count. And live in the moment, with her.

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pursuit of gold

These days, I get pulled into watching this pure athletic prowess and accomplishment. I am not the first to note that the true spirit of the Olympic games is pure physical and mental accomplishment, honoring those who have spent countless hours single-mindedly pursuing one goal.

Sitting in my pajamas, the acrobatics of bathtime complete and the little one safely in bed, we shamelessly gorge on dinner in open-mouthed admiration of the feats of excellence on TV. They are, in turn, lithe beautiful figures gliding across a finish line, transcendent blurs of color twisting off a vault, acrobats twisting shockingly close to a platform. Our hopes rise with country flags and anthems brandished high and we drag our leaden feet with disappointments minute to minute.

These games represent individuals who have chosen to maintain a singular focus on one activity, one extraordinary talent, to the exclusion of everything else. Sure, there are those few athletes who maintain an improbably successful and normal life outside of these accomplishments – those kids returning to high school in a few weeks, the athlete who is enrolled in medical school. In general, however, here are the few who have wholeheartedly given themselves to one love, faithfully to one pursuit, despite physical pain, mental anguish, pain, failures and the brash temptation to give up.

It is about trusting in a calling, in one goal, so much that you put aside everything else to achieve it. That admirable depth of excellence in one thing that makes someone the best in the world at something. This is the frequent tension – be excellent at one thing, or be reasonable at many things. I have struggled with this for a long time. I don’t have the talent or the inclination to strive for a place in something like the Olympics, but this resonates with my daily life. As a generalist, I’m reasonable at recognizing patterns of many diseases in clinic. As a researcher, I’ve tried to cultivate a depth – but this process has been more fraught and unsuccessful. The most difficult decision is the one of focus. What area to plan my focus and spend my energy – to be the sought-after advisor or consultant, the recognizable name.

I’m still searching for that track. I suppose late bloomers still can do great things when we find our way.

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Finding my way

We are a society built on small talk. Every minute of every day, the interactions with the young man who happens to take the worn bus seat next to yours, the taxi driver, the grandmother whose grandson is staring intently at the fish tank at the pediatrician’s office, the senior colleague who unexpectedly sits next to you on the plane ride to a conference – these small moments can define relationships. Unfortunately for me, and, I believe, many of us, the art of small talk falls into that dreaded category “networking,” which inspires frozen tongues and heart palpitations.

I have heard many stories about chance encounters that have lead to soaring achievements, the missed connections preceding plummeting promise. In a professional world, how do we make sure that we connect based on shared goals while also succeeding at interpersonal connection? There are several introvert’s guides to networking, all with some similar themes. I’d like to share a few thoughts that I know are goals of mine – my hope in writing this is that I will be more persistent about adhering to them as well!

  1. Commit to an “elevator speech.” Be able to explain your goals in 2 minutes to someone who is not in your field. Adding to that – have a way to explain the implications of this work, and where you want it to go. This is a reminder to myself as much as advice for others. This speech changes over time, as experience and goals shift, but should be enough to lodge your interest in someone’s brain so that they think of you if something comes up that is relevant to your interests.
  2. Tell EVERYONE your interests. If you don’t say anything, no one will even think of you when an opportunity comes up.
  3. Introduce yourself to a stranger even when feels it safer to stay quiet. If it doesn’t go anywhere, then at least they know your name.
  4. Have a short conversation, then follow-up later and suggest a one-on-one chat. These allow you to delve deeper into what you need, and promote deeper connections in an environment that is more comfortable.
  5. Resist the urge to run away and (insert solitary activity here). After the event is over, you can sit quietly and reflect deeply, but just brave the discomfort to make it through. If nothing else, it will provide some fodder for your next journal entry!
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One of my very best friends sent my daughter a package today. A belated birthday gift sweet in its simplicity and immense in its wisdom. The gift is light and lovingly wrapped in pink polka dot tissue paper with a bow holding the surprise inside. It comes a little bit after the birthday, but infused with kindness and thoughtfulness and joy – everything that I wish for her and whisper in her ear night after night before she goes to sleep.

I secretly opened the gift, wanting to know what it is before I let her explore it with curious hands and round wondrous eyes. I can see her, tomorrow morning, rubbing the sleep from her eyes, pulling at the bow and draping it over her little curls, wandering off with the grosgrain ribbon as her prize. How I will have to gently guide her back to the gift, suddenly  a mess of crinkly paper and tape, torn asunder as understanding reveals the book inside.

The book’s story is one that would do us all well to remember every day, and one that I only hope that my daughter will hear and live by. It is a story of a girl with a passion, a girl who does not fit the mold, and who hears only detractors and experiences only negativity and failure in the beginning of her quest. A girl whose tenacity is inspirational, who comes to the attention of a wise teacher and thoughtful friends. A girl who succeeds and through this beautiful moment makes everyone realize that her success is real, true, and leads a shift in public perception and acceptance.

It often seems that simple stories are only written for children, that truths are ignored because the world is too “complicated,” and that stigma aligns with rigidity to drown out any spark or promise and integrity and support that wishes to be heard. These simple lessons are so touching because they seldom appear in adult life, and it is only their innocent rediscovery through especially kind people that brings them back to us.

I can’t wait to read it again with her tomorrow.

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i’m learning

I learn something new every day. Truly, ever day. Well, perhaps sometimes it is more of a reminder of something I once knew long ago, that has had to be dragged from the calm, deep, recesses of my brain and jolted into action. Usually, the formation of this new synapse is from what I consider a mistake. I’ve asked myself at times why experiential learning is so painful. If you don’t recall something that you read in a textbook, you devise all sorts of sensory ways to improve your recall. This failure, however, did not have immense consequences besides frustration with yourself and perhaps a poor grade on the paper (believe me, I know how painful that can be, but there are few real-world sequelae). But if you don’t know or don’t remember something while in the midst of doing it, the experience is all the more acute, and the memory sears deep.

Perhaps people describe mistakes in different ways? For some, those who are bent on achieving perfection, a mistake is a grand tragedy, its occurrence a blemish upon the smooth contour of a successful day, enveloped in guilt and pockmarked by anxiety. A mistake, in my book, is when I am unsure of a path, choose one, then further deliberate and feel that another would have been better. The deep dilemma here, though, is that no one can exist in the counterfactual. Maybe the patient would have gotten better if I had not intervened in that way. Perhaps I should have been more aggressive. Maybe next time i’ll talk to his family before making decisions. Maybe…

In medicine, once you get to the level of reasonable proficiency with day-to-day decisions, there is often a multitude of answers for each person. I often wonder if there is any way that I will come up with a standardized response to those things that take over my brain for nights at a time after seeing certain patients. There are certain factual things that I learn today, and can apply tomorrow. Then there is all the other stuff that takes finesse and understanding of people and their own beliefs and needs, and which doesn’t have one true answer.

I think that bringing up a child is quite the same. There are so many facts to know, then there are  the recommendations, often catapulted at me, accompanied by the iron-clad reason of “experience.” Every decision has some impact, everything could have been done differently. But different is not necessarily better, and for every action, there will be a vehement response from someone that this is, absolutely, the wrong way to do it. How do we survive this, as parents? Choose a few sources of guidance that we trust, use our own common sense, and, if all else fails, turn to the internet.

So I keep learning. My goal for the next year is to cut down on the guilt and increase my retention of what I learn each time. To try and identify when there may not have been one correct path. To share what I feel are my mistakes and ask for guidance from trusted people. And to keep writing through all of it.


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returning to me

some days are tough. sometimes, weeks and months meld into a sticky haze with no defined borders. endless tasks pile into dusty to-do lists, with only the “postpone until tomorrow” button worn down. I used to write to express the thoughts that swirled in my brain but that could not truly be expressed in my work, or that sank down in importance when happy events took over. giving time to these thoughts helped them to form into opinions, to embody ill-defined and difficult emotions, to support my quest to be a better doctor, a better researcher, a better person. they were the questions without simple responses, those that needed time and thoughfulness to produce a path through the  brambleweed of “process” to the clarity of enlightenment.

and then, when I began my most difficult job, and the most demanding time in my life, I abruptly stopped writing. this place, these blog posts, have lain dormant for 2 years. I almost put an “almost” in there, but went back and left it at the stark reality. 2 years. Not almost, but truly.

In the same way that I attempt to de-clutter the wordiness of my writing, I hope that my return to writing will help to clear the roadblocks in my mind, to help me focus, and to leave dedicated time to move forward in my work and in my life.

in the past 2 years, i’ve changed cities, institutions and tiers in my career. my little family has grown, and with it, the capacity for immense love, an elevated responsibility and so much more of the unknown to fear, but also to celebrate.  I  have done what I always wanted to do – to attempt to balance a full-time career with a more than full-time family – and have found it to be the most difficult thing that I have ever faced. I have also lost important people, whose essence permeates everything that I do, and whose legacy I wish to carry on in some small part.

I will write differently going forward. Not to the end of sharing a finished piece of work, but in order to help me to both dream a better reality, and to chip away at the small steps that reality dictates are necessary to reach that dream. starting today.

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I look into empty corners of the windowless office, blowing away the dust that has settled between occupants, scraping the desk on the carpet as I heave it to a friendlier position. The structural transition of my new office is complete.  There is a lockable desk, lock generally unused, with a few drawers containing my administrative introduction to my job which I once studied passionately and now have completely forgotten.  I asked to have the large file cabinets removed – there is so little that we document on paper these days, the written words happened upon only when searching for something else, the multicolored paper tabs denoting and subdividing nostalgia.  There is a red bookcase, empty except for the brave bamboo plant thriving on the shelf, and a colorful postcard with sage mentoring tips to guide me through my next days and years.

In this new life, with this opportunity, I sometimes feel like I am stepping over a doorway whose frame is just a bit too high for my reach.  Still, I know that there have been long years of training that have coalesced into stepping stones, and people on the other side of the doorframe generously reaching through with an extended helping hand.  This is only one of a series of doorways.  Some have been brightly painted and welcoming, with solid oak frames and shiny brass doorknobs.  Some are rusted shut, with evidence that their moments of use were long ago, their timber warped with old regret and missed opportunity.  There are others, coveted yet hidden by deep vines, that open, wondrously, only after the thick brambles have been cleared from before them.

Once open, I want to traverse each doorway gracefully, knowing well that there is an audience just beyond the door, faces alternately friendly, encouraging, skeptical and disparaging.  My face often mirrors their skepticism.  How am I to fluidly cross this barrier – this transition from today to tomorrow?  From novice to expert?  From fellow to attending?

The reality is that any transition is not generally graceful, mistakes grease the hinges, and pure effort clears the path to opportunity.

Once again, I find myself at the beginning of this change. I have trekked across the country, over months and miles and marriage.  I have been here long enough to learn just how generous the people in my new workplace are with their time and their solicited advice, how quick to smile and share their help.  I have drawn up plans and calendars and grant outlines, seen patients and broken bad news.  I have created a routine for myself.  And yet, my office is still bare.

I have learned that it takes time to settle into a new space.  Today, the corners of my office have bits of green from plants designed to perfume and filter the air.  My white coat hangs on a hook, my father’s photography is up on one wall.  As the months go by, as my boxes arrive and I meld my old life into the new, I expect that the tokens of my training and the evidence of my progress will begin to fill the walls and shelves.  The wooden card holder, purchased during my fellowship, will occupy its place on my desk, my medical school diploma will adorn the wall, and the new stethoscope bought just last month will occupy the pocket of the new white coat that bears my name and my new institution.  I imagine that, soon, there will not be a corner left to contemplate, and any extra time will seem fleeting.  Until then, however, I look at the empty spaces with hope – that when they begin to fill with study protocols and patient charts and failures and successes, I will be as grounded and gracious as those mentors standing before me, with hands extended through the open door.

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