So Here's To Hope

I'm pretty sure I cried straight through the first half of 2020.

In my defense, I was having an objectively tragic year. I left not just my job but my career under the unrelenting pressure of my worsening disability. My husband and I moved, again, this time for a job I knew I needed but wasn't sure I wanted. Two close family members developed devastating chronic illnesses. And I realized that I'm gradually losing my ability to walk and use my hands. All this against the backdrop of, y'know, the raging collective trash fire that has been 2020.

All I was was sad, all the time. I couldn't even talk to anyone about it, really. I just cried every day.

Midway through the year, a close friend sent me a link to a book and informed me we were going to read it together.

I clicked on the link and was greeted by a bright yellow cover with - of all things - an enormous smiley face on it. The Happiness Advantage, the cover screamed. How a Positive Brain Fuels Success in Work and Life. I snorted and texted her back some version of absolutely not. I wasn't about to buy a yellow smiley book on being happy. I don't like yellow. Or being told how to feel. I'm not even sure I like happiness. I find it suspicious a lot of the time, schmaltzy and commoditized, and often exhausting. A forced smile in a toothpaste ad. No. 

When it arrived a mere two days after I ordered it, the book and I stared at each other for a bit. I can't believe I'm reading this stupid book, I texted my friend. Don't ever doubt my love for you. She responded in the cheerfully assumptive manner of someone who never has: we should discuss once a week. Do you want to do one chapter at a time or two?

I truly didn't expect this book to change me so much.

The breakthrough came when we got to the chapter about gratitude. Gratitude: another word I have learned to eye suspiciously, given its cachet with trendy influencers and people who like motivational posters. It conjures up carefully posed social media posts full of product placements - cynicism lacquered in toxic positivity. This was different, though. The author gave a simple hypothesis: maybe the brain can be trained to be more optimistic by marking the good things that are already present in one's life. Invoking the power of accountability, he suggested telling a close friend or loved one three things you are grateful for each day, things that didn't have to be profound but did need to be specific. This appealed to me. It seemed practical and attainable. Maybe we could try it?

So we began. Every day, we would tell each other about a great cup of coffee or a glimpse of beauty, a moment of laughter, a kindness we received. For the most part we kept it small. Almost immediately, we realised that just hearing about the other's happy moments brightened our own day. We didn't anticipate this recursive loop of happiness, but we embraced it, and it became its own self-reinforcing system. We would reach out to each other greedily in the evenings, sometimes simultaneously: tell me about your day! What are you grateful for?

Some days it was a real stretch. It's 2020; a lot of crummy things happened. And nothing about this exercise changed the essential facts of my life. But with practice, we learned that even on the worst days, there was something to feel legitimately grateful for.

This may sound basic, but consider its effects. In the manner of a river slowly changing its bed, my focus has gradually eroded away from the major obstacles I face, instead eddying around bits of happiness. I'm learning to better appreciate small pleasures. And I'm finding that I'm emotionally stronger for it. Far from this change being a distraction or a waste of time, when I turn back to the big challenges they are somehow less overwhelming, because I recognize now that my life will always have a wealth of good things in it. I just have to take the time to notice them.

It's my prayer that in 2021, we would all be able to apply this lesson. There is joy trickling through all the little cracks in our lives, and this next year I hope to settle into that understanding further. It's a small goal, but I'm satisfied with that. A change, no matter how incremental, can gather a curious momentum of its own with time, gradually pressing through the mud to find hope.

So here's to hope.

Happy New Year.

(Sporadic) Money Update: 2018, or, Imagine Me Rolling My Eyes

I am so sick of paying down debt.  So let's talk about it!

My husband and I are in the middle of this debt-paying thing.  At this point we have completed several of the most important steps:

- figured out how much debt we actually have, which is horrifying but necessary
- refinanced all of our loans for a lower interest rate (which will save us approximately $40,000 over the life of the loan)
- sucked it up and started paying ridiculous amounts of money on our loans

That means that we are in the "paying ridiculous amounts of money" stage.

Uncertainty, or, 2019: Midnight Tracks

I love planners; I'm a bit obsessed with them, really.  I've always had one.  I think by nature I'm a plan-maker, someone who takes the long view.  Years of practice and training have taken my penchant for journalling and turned me into a list-maker as well.  At this point, if I don't have a formal planner, I eventually clutter up my life with piles of to-do lists and thought fragments.  This year, when it became fatiguing to write, I tried to abandon my paper planner for digital alternatives that I can talk into, but it's not the same.  So a 2019 paper one it is.  Usually I get something with monthly and weekly pages, and room for notes - pretty standard.  My planner choice* is different this time, though.  For the first time, I want a goal-setting planner, I think for several reasons.

Uncertainty, or, 2018: A Retrospective

What a year.

Did anyone else have a really eventful 2018?  I certainly did.  The time passed so quickly that I'm tempted to say not much happened, but that is completely wrong.  Enough happened this year - and enough is happening next year - that I've decided to do something I've never done before and try to look back on the year as a whole.

Tired.

It was so hard to get my sorry self to work yesterday. I had the flu a couple of weeks ago - I don't recommend it - and the cough and fatigue have lingered. I entered this stretch of shifts feeling sluggish and still a little short of breath. My coworkers cracked good-natured jokes the whole weekend about how I needed to check in as a patient. Considering I've spent most of the last two weeks first feverish and vomiting, then alternately passed out and hacking up a lung, it felt more accurate than amusing. I'm pretty tired.

A Break In The Darkness

I have a little eclipse story to tell.

My husband and I were lucky enough to live within driving distance of the path of totality, where the moon would completely blot out the sun.  As soon as I found that out, I decided we were going to have to make a day of it and drive north to see THE REAL THING.  I perused blogs and astronomy websites; I purchased multiple sets of eclipse glasses (after the first set turned out to be fake - thanks Amazon); I had happy daydreams about laying out in the sun in a green field, slowly watching the moon eat the sun, and then perfectly witnessing all of the crazy things happen during a total eclipse.  I was especially excited to see the eclipse itself.  I badgered my husband into taking the day off.  We may never get to see this again!  It will be amazing and it's only a few hours away!  Pleeeeeeeeease.  Pleaseplease.  

The night before, I checked the forecast one last time and found to my dismay that essentially everyone in the path of totality was going to have a spotty view of the eclipse except people living just east of the Rockies, which we do not.  Weather in our town was meant to be perfect, but of course without the chance to view all of the amazing phenomena that come with a complete eclipse.  My husband and I talked it over and decided to take the chance.  Better to potentially see THE REAL THING than to definitely not see it.

Cut to the morning of.  We left late, first of all, which - although I'm not a very nervous person - sent my nerves through the roof.  It's not like the moon is going to hold off on beginning the meeting because there are still some stragglers coming in.  Then the clouds started gathering as we drove.  At first it was just some cheerful light clumps, but after a couple of hours it was clear we were heading into a storm system.  My husband got one glimpse of the very beginning of the eclipse while we were on the road.  Then, nothing.  Clouds.

My pastor recently had been teaching us about improbable prayers.  He pointed out that in Acts when Peter was headed for execution, the church prayed for his release and he was indeed broken out of prison by an angel.  When he showed up at the house where they'd been praying, they were amazed!  His point was this: pray for things so incredible that if they happen, you will be shocked.  Pray for improbable things.  Give God that chance.

Well, why not, I thought.  Driving that morning, every time I looked up at the dense cloud cover, I prayed.  I know this isn't particularly important, Lord, but please.  Please clear the weather so we can view this spectacle.  In fact, clear it so everyone can view it.  Please make a way in this.

And you know what happened?  It started raining.  Yeah.  Raining.  On and off for the last hour or so of the drive, it sprinkled and poured by turns.  We didn't see another glimpse of the sun that entire time.  I kept praying but my mood gradually soured.  Come on, God, please?  Let everyone see the eclipse during totality, including us!  Matt kept an eye on the radar, but there was no chance that we could outrun the huge bank of clouds in the region, no chance that we could cut east or west and find a clear spot within our little slice of totality.  We were stuck.  So we kept to the original plan, although there was no happiness in it for me anymore.

When we got to the park I'd chosen, it was dark, cold, and wet.  The rain had settled into a steady light shower.  There was no way to tell if the appearance of things was from the storm or the developing eclipse, but you can guess what my suspicions were.  We found a low hill with good visibility only because Matt insisted.  I was ready to sit in a low parking lot and read a bloody book just to spite the stupid eclipse and the rain and the day and everything.  I pulled out my knitting, for goodness' sake, because why not?  There was nothing to see.  I can see clouds and rain whenever I want.  There was certainly no way to appreciate anything else.

I let myself talk to God about the whole endeavor one last time.  I asked you for such a little thing, God.  I've been looking forward to this for weeks and You know that.  You couldn't have given me this?  Thanks a lot.

Matt opened the car door.  "Get out.  You can see the sky, Zoe, get out of the car."  Well, duh, I thought.  Of course you can see the sky; you can always see the sky.  I want to see the sun.  But I abruptly got sick of my own bad mood and decided to play at being a good sport.  I got out of the car and peered up into the rain.  Sure enough, there was an odd-looking dark grey patch briefly visible through the clouds.  Matt nudged me.  "I think that is blue sky."  The more I looked, the more I thought he must be right.  

It got darker all of a sudden.  Darker.  Then, still darker.  A cold wind blew across the hill.  People started to murmur, wow, so cool, how about this.  Suddenly the horizon looked like it was on fire - all the most amazing sunset colors at once, spread out in all directions.  Diffused as it was through cloud cover and distant rainfall, the effect was especially mysterious.  Crickets started chirping and all the birds landed.  I grudgingly thought, okay God, this is pretty cool.  Thanks for this at least.  

Then people started screaming. 

I mean really screaming, in a way that was frightening and seemed out of their control.  We heard more screaming from across the park and even, faintly, the nearby town.  I realised everyone was pointing up.  And there, right overhead, the dense clouds had cleared perfectly in the right spot for us to have a great view of the total solar eclipse.  We got to see about thirty seconds of perfect corona leading into the diamond ring signaling the end of totality.  It was uniquely beautiful and unsettling in a way that eludes description.  We all felt a brief, hot wash of sunlight as totality truly ended.  Then the clouds closed up again.

I cried, of course.  Not at the eclipse itself, although it is something I will remember for the rest of my life.  I cried because God reminded me that a faith that endures is one that endures to the end of hope, through the disappointment and rain, trusting that there will be a break in the darkness.  He could have whisked all of the clouds away and left us with a "perfect" cloudless sky and the chance to see the entire eclipse process without interruption.  He chose not to.  But did He not answer my prayer (and surely the hopeful prayers of many others) in spectacular fashion and in a way that imprinted the event into our minds forever?  Cold, darkness, and rain!  A sense that time was running out!  Then - the clouds opening!  A perfect glimpse of THE REAL THING!  The return of the warmth of the sun!  End scene.  

Amazing.  Never doubt God created the concept of dramatic tension.

I am really sorry that I gave up on God answering my prayer too early.  And how kind of Him to package my subtle rebuke as a rare, beautiful gift and reminder of His faithfulness and majesty. 

The lesson is this: if He cares enough and is powerful enough to even just move the clouds so we can see something cool, how much more able and willing is He to help with the things that truly matter?  At the same time, when I pray that He would get rid of all the clouds and give me a nice sunny sky, I have to remember that often that is not His way, because when He does that I learn nothing and do not grow.  I thought that day that THE REAL THING was having good weather and seeing the full eclipse.  But in this, as in all things, that was just a cipher for what the Lord was truly doing for me that day - teaching me to trust Him more and being willing to risk disappointment and loss based on that trust.

A Little More On Burnout

Thank you to everyone who reached out.  The response I got was surprising both in its volume and its sincerity, but my surprise is really just a reflection of my lack of objectivity at the moment.  In reality, I know a lot of cool people.  I have done some reaching out myself of late, and I'm working on finding good outlets and learning to do my part to lift this darkness.

Speaking of.  Been doing a lot of digging over the last few weeks regarding depression and physician burnout, and surprise! there's not a lot out there.  But it seems to be something people are talking about more in other fields.  I found one person's observations particularly useful.  His name is Carey Nieuwhof; he's a pastor so his insight is based in the field of Christian ministry, but what he says holds universal value.  Below are some posts of his; the things he says align with what I've read elsewhere and add his really honest tale of wrestling with these same symptoms and coming out on the other side.  I'm putting these links here partly for my own reference and partly because, as I said before, I'm not that special so I doubt I'm the only person wrestling with this.

Pre-burnout warning signs

You're probably burned out if...

Damn it, you're already out of gas.  Now what?

If I can ask for prayer, please pray that I would be able to complete my work properly.  It's very hard to find the motivation to stay on top of the more tedious parts of my job.

Blog name and address change

Hey, in honor of all of the new ridiculous stories I'm going to have as a resident, I'm changing my blog name and address.  This matters because this blog will no longer exist under the old address/ name.  So:

old name - Almost a D.O.ctor; doctoralmost.blogspot.com

new name (!) - Practically a D.O.ctor, doctorpractice.blogspot.com

A friend suggested the clever name change to accompany the change in status.  I will really be practicing being a doctor now, in the sense that I will have to try to work out patient care on my own and in large part my attendings will exist as a safety net.  This is quite different from how you work as a medical student, where you have really no autonomy and there is always someone looking over your shoulder.

I will change the site name in about one week.  It doesn't look like there's a forwarding service that I can set up, so don't forget!

Let's talk a bit about my brown privilege

[TL;DR: there are some undeniable perks to being brown.  Also, widespread initiatives to help those with need should not be race-based, but rather based on socioeconomic status, to keep selfish pigs like I was from taking advantage of the system.]

It took me a long time to even accept that I am, technically, a black American.  (Well.  Half-black, which technically makes me 'light-skinned' but I am not even going to go into unofficial black castes here today.  ANYWAY.)  It's such a big label; there's so much weight of racism and oppression and anger and race-based aspiration behind that.  Also, a lot of people think that label denotes being African-American, which I am not.  And yet, when it came time for college applications (of course), I saw the many opportunities that I could take advantage of for no better reason than because I was brown.  Would you like to be listed as a minority, or some such question.  Suddenly it made good financial sense to own my skin colour.  In my home state, when it comes to scholarship recognition, it's a rough crowd because there are a lot of Ph.D.s in that area which means a lot of good schools and kids who practice for their SATs and whatnot.  I was just another one of those kids.  Immigrant, educated parents who work hard, middle class.  And I'm smart, but not intellectually special - but certainly smart enough to notice that the bar for black people is set much lower than the race-blind bar, or even the Hispanic bar (I am half Colombian).  So I was suddenly not smart in the wider pool, nor even smart enough to count on my right side, but my left side - the black side - was top of the dogpile.  Yes, thank you, I would like to be listed as a minority in order to use this leg up that I really don't need because I'm not the person you were pityingly thinking of when you created this race-based legislation.

[I am well aware that the honourable thing to do would've been to not declare my minority status, but the truth is before I accepted Christ I was nothing if not a self-centered opportunist.  Being black had never worked for me before that point.  When it came to getting kickbacks from the government, however, suddenly racial identity had utility.  And man, did it have some serious utility.]  

That changed my entire life.  I was able to go to a private university tuition-free in a totally different part of the country, a place with a nearly 100% acceptance rate into medical school.  With odds like that, all I had to do was stay with the pack and I was basically in.  And once you're in medical school, barring a personal disaster you are definitely going to be a doctor. But it also changed me to click that box.  Suddenly I was black, or mixed, or Afro-Caribbean-white-Latina-with-some-indigenous-Colombian, or whatever.  I had this really confusing ethnic identity with all its baggage, and I didn't really want it, but once you pick it up you apparently can't put it down.  So instead I've sort of learned about this set of racial privileges that I have.

...That was probably a surprising statement to some of you.  But did you not think minorities have race-based privileges?  Totally do.

This is what I've found so far:

1. I am allowed to have a Voice.  This is actually backwards from how most people think it is.  Most people think it is still how it was fifty years ago, when a black person was denied a voice by dint of being black.  It is not that way anymore.  Now, white people are not allowed to have voices. What I mean by this is that those of Caucasian descent can't simply have something distinctive to say.  Have you noticed this?  It's especially true in areas concerning ethics, social justice, etc.  They can make small observations on things, but those observations always have to be bookended with, "but-I-am-drowning-in-invisible-white-privilege-so-I-can't-have-any-idea-what-I'm-talking-about-I'm-sorry-for-speaking-out-I-just-thought-maybe-I-noticed-something."  There's a fair amount of talk about how white people can't even have an accurate point of view on something because they are inescapably speaking from a place of privilege, which invalidates everything they say.  Sound familiar? 
   
   Sometimes white people who talk about social issues even get mad at other white people for daring to just say something.  They must be shamefaced about it.  They must internalise that they cannot possibly have a valid point of view, because they are white, and white existence is homogenous and vaguely oppressive.  I never have that problem.  My observations on the social issue of the day are always treated as legitimate.  It's the same with my personal experiences; my contributions to a conversation on racial or social issues are generally treated as somehow truer than a white person's, regardless of background.  In fact, I can literally (and yes, I mean literally) say any ridiculous thing I want, and I will only ever get so much criticism.  This is entirely because my skin is brown.  Here's an example.  White man goes on about hating black people?  He's a monster, but all the black people who go on rants about white people every day are normal and just acting out from the depths of their terrible oppression in our horrible capitalistic society.  Honestly, my pedigree makes me basically untouchable in a conversation if I want to be.  I'm a female double-minority first-generation immigrant.  This means I have the most legitimate point of view there is.  If I claim this label in a conversation with silly people, it's as though I just said, "Well, 2+2 = 4."  All argument stops.  Whatever I have just said is obviously now fact.
   
2. People think I'm awesome for doing normal things.   I mean, I'm black.  My life must have been hard, right?  And actually, there have been hard times, but not in any way that isn't true for all immigrants when they first get here, and later not in a way that can't happen to anyone.  I haven't faced any special pushback from The Man due to my race.  "But Zoe!  Stop being so insensitive!"  you say.  "There are many oppressed black people in our country!  Your experience is not the norm!"  No, it's not.  But there are also many oppressed white people in our country, and no one talks about them because they're meant to have some fancy white privilege (that somehow doesn't lift them out of poverty).
   I have graduated college and I will soon graduate medical school.  I'm pretty excited about that.  But some people, when they find out what I'm pursuing, get inordinately thrilled.  Not everyone can be a doctor.  I'm not disputing that.  So in the sense that I've done something unusual, people are right.  But let's consider my family situation, something that most people don't do.  My mother has two degrees in nursing.  My father has a Ph.D. in physics.   I am not even the first in my generation with multiple degrees; my cousin already beat me to that distinction.  The point I'm trying to make is that at this point I'm dynasty.  I have an educated family; this is normal for us.  Except apparently not, because my brownness means I must have overcome a ton of naysayers, so I'm extra impressive.  I get so many verbal accolades for my hard work, even though some of my white colleagues are the first people in their ENTIRE families to get ANY degree past high school, and yet they fought their way to the professional level.  Good thing their white privilege made it so easy for them, especially the ones who had to work a job in order to make it through medical school.
   
3. I have membership in the Black People Club.  I used to hate this, but I've learned to love it.  Want to know where something is in a hospital?  Don't ask a doctor or a nurse.  Ask a housekeeper or orderly or transport person.  Oh, except you can't, because most of them are black and you're not, so to a lot of them you don't count all the way as a person.  I do, though.  I'm brown.  All of the support staff in my hospital love me for NO other reason than that I'm the little black medical student.  I am every black person's sister or daughter.  They don't know, or care, that I don't have whatever experience we are meant to share that supposedly brings us super close and makes me worth helping.  They also don't know that many of the white doctors and students they don't greet or talk to much have a lot more in common with them than I do.
   
   I've always thought it was very interesting that black people and Latino people are allowed to be openly racially exclusive but Caucasian people cannot do the same without being labelled racist.  Consider the collective chummy media eye-roll when Beyonce said she makes music for black people.  Consider my first college roommate who told me she had to get away from all the "whiteness" on campus and be with "our people" sometimes - even though her father was a dean.  Now imagine if a white person had said those things.  Suddenly much more shocking to you, I'm guessing.

It's really sad that so many Caucasian people accept this assertion that they are less interesting and valuable - that their experiences are less notable or their conclusions less correct - because their skin is pale.  And it's also really sad that so many minority people in this country have internalised the language of racial isolation and race-based struggle on top of whatever personal hardships they may have.  Now everyone loses.

On Catastrophes.

From my personal journal, edited slightly for anonymity.

This is actually my second time in the town where I'm currently rotating.  I guess it will always hold a little place in my heart because even if I successfully go on to do disaster work as my career, this town was the first place where I grabbed my work gloves and dug in to help other people whose lives had just been wrecked.  I showed up with a group a few days after the disaster to do general cleanup and hand out supplies.  I know now that I really should have found out where the medical tents run by the hospitals were and gone there to help, but I was uncertain enough of my skills that I didn't have the courage.  They could have used me.

Someone recently told me the area had been "totally cleaned up," so I was deeply surprised to see how destroyed it still looks.  There are a lot of new little houses, but nothing like the density of homes that was there before.  All the dead trees are still there.  There are still blue tarps around, for goodness' sake.  The two things that moved me most were seeing all the power/ telephone poles, which were all downed the last time I was here, and seeing how the foundation for one of the destroyed hospitals has been removed.  When I was here, everything was a flat, even layer of shredded insulation and fragments of levelled houses...  It was nightmarish.

Remembering back to how awful that whole scene was, for a moment today I couldn't help but wonder why I even want to go into disaster relief.  But part of the answer settled into me as I looked out over the scarred hillside this morning.  This, this brutality and overwhelming power, is how the world truly is.  And the way we deal with these crises - how we crumble, how we push back - is how we truly are.

The New Old Normal, or, Sometimes I Am Very Foolish

Okay so Matt is home.  And it's wonderful.  It's wonderful to see him, to wake up beside him, to have good conversations with a sane person face to face.  A deeper sense of peace has yet to settle in, though; I'm instead getting little fragments of the realisation that he doesn't have to leave again.  Like: I am working in the hospital this week, yet he will be here.  I associate the hospital with loneliness, but I don't have to anymore.  Maybe never again.  Or: I will have to continue to buy groceries for two people.  Or: I don't have to buy groceries by myself anymore!  Understanding that there is now a second person in my life is such a complex process that I can't even force it - it's all situational.  I can't have the thoughts about groceries before actually going and getting groceries and thinking, "What would Matt like?" and then feeling shock.

But whatever.  I dig it.

What I do not dig is giving up my space.  Yeah, I said it.  And I know that is totally selfish.  I'm working on it - it's only been a week! - and I'm not suggesting I deserve any sympathy.  But literally the only pleasure in living by myself the last year was having whatever schedule/ routine I wanted and always doing things my way.  Now I have to, like, share the Xbox.  And not turn on the closet light in the morning because that would throw light directly on Matt's face, and no one should wake up at 6 if they don't have to.  Or if Matt opens something in the kitchen in a way I wouldn't, then a short while later leaves a light on, then doesn't answer a phone call because he doesn't feel like it - crap like that is undeniably petty, but nevertheless frequently builds up to the point where I need to take a moment and consciously untense my shoulders.  I'm not used to noise.  I'm not used to dishes I haven't dirtied or a towel being wet before I try to use it.  I'm not used to asking someone else if they would like to do the thing I would like to do.  Amazing how I didn't even realise I was getting used to all of this, yet clearly I was.

I mean, I'm an idiot.  I'm being a total idiot when stuff like that gets to me.  I know.  And the majority of the time I look at him and am overwhelmed with gratitude to God that He brought Matt through the deployment and back home.  I have this sense that despite all the changes that I went through in the last year, my life was nevertheless mostly in a holding pattern, and now Matt and I can Get Back To It.  That's exhilarating.

I just have to relearn how to compromise.  And hopefully stop being addicted to chocolate.  But more on that later.