It started with him. The third brother, with two older, two younger, and one older sister. His parents, farmers in Taiwan that spent all their days in the rice fields. They raised pigs too. Their pigs ate predominately sweet potatoes. Sweet potatoes were cheap. And so their entire family ate lots of sweet potatoes too. Meat was expensive, so an ordinary meal may be a pot of soup with sweet potatoes and shreds of pork. The six kids fought with chopsticks in the pot over the thin slices of pork mixed in with big chunks of sweet potatoes and greens.

When he was older, he really loved school. But electricity was a luxury they couldn’t afford. So in the evening, when it was pitch black and the lanterns had burned out, he would drag his table out to the sole street light and study until he fell asleep at the rickety four-legged makeshift desk.

Later on, he tested into medical school, the hardest field to test into. But money wasn’t fluid, and his parents couldn’t afford to let him go. He found a full-ride out of the country to study mechanical engineering in America.

America. A far away dream for so many. And here he was. The fourth child of six, from a farming family in Taiwan, making his way to America.

He spent every waking moment working on his English. The language in which he would obtain his PhD in mechanical engineering. He would write and defend his dissertation in a language he only learned in his 20’s.

It started with her. The second daughter of a wealthy family. She and her sister and five brothers lived in a nice home with their parents and a live-in helper who made their meals and cleaned their home and watched after the kids. Her mother owned the local convenience store and spent seven days a week there. Her father, a government official, spent his days at work. They lived a life of luxury. Affording to buy and eat entire apples, a luxury only the rich could afford. When she was of age, she had many suitors. But she was not interested. She pursued music and became a music teacher. She loved to sing.

Then she met him. A poor son of a farming family. He was moving to America. A country one only planned for in their dreams. She didn’t speak the language. She couldn’t teach music in America. But they had fallen in love. Her parents strongly opposed and would not provide her a cent for her departure.

So, they married. No extravagant wedding. And with two suitcases in hand, they came to America. They had the stipend offered to a graduate student, and lived in a studio apartment. She found odd jobs that didn’t require her to be yet fluent in the language. She welded together computer parts and collected and sold seashells she found on the beach to local distributors.

This was a foreign land, and the first time it snowed, she didn’t know anyone else, so she called her husband with tears in her eyes. She’d never seen anything like it.

She had never heard of a sandwich, but this is what Americans packed for lunch. She took two slices of bread, and found canned peaches and sliced pickles and packed this lovingly for her husband. He ate this every day for a year without complaint.

After he graduated, he had his PhD in mechanical engineering. But landing a job after graduating, was difficult. He had been bright and graduated with ease. But on the other side, was the real world. Was it his thick accent that kept people from wanting to hire him? The color of his skin? His lack of fluidity in American culture? He ultimately found a job in a field he was not prepared for—computer programming. It didn’t pay much, but it was a good job. He was smart and learned quickly.

After graduate housing, they found a place to live. It was more of a large shed like building, with a makeshift kitchen and bathroom. Just one large space. Their landlord lived on the property’s house. And when they were late paying their rent, because it was difficult to make ends meet, she would turn off their electricity.

In this home, they had their first son. It was difficult to provide for him. And when she went to the local store to buy milk and came short the cost of the milk, she was turned away. She felt desperate and humiliated and her heart ached for her hungry son. She cried with him.

He had his first friend over and was beyond ecstatic to have a playmate. After their play date, his friend said he wasn’t allowed to come back to their house because it was too small and they made foods that smelled weird. She understood that their poverty and Taiwanese meals were not welcomed into this American dream. Her heart again ached for her broken-hearted son who just wanted to belong and be accepted.

Some days he came home in tears because someone would say he had slanted Chinese eyes and that his lunch was gross and they wished he would sit alone and eat his yucky Chinese food.

Over time, they saved and made extra money however they could. It was hard to get hired—was it because she was still viewed as a foreigner? She was determined to find her American dream for her kids. Seven years later, they had their second son. Three years after that, they had their daughter.

Along the way, there have been hurdles. Though fluent, there have always been backhanded comments and racist remarks made about their spoken English. The hardware store cashier that has exasperatedly said to him, “WHAT? I can’t understand a word you are saying.” The man at the store, that has glared at her speaking in her native language to her children. “Speak English”, he spat at her. This has been part of their American life that has been less than the dream they planned, but it is part of these lives they have had to come to expect and handle.

There are always questions along the way. The disrespect and blatant acts of disgust absorbed, as to keep their kids safe. It has braided its way into how they conduct themselves and react, or choose not to react to racist comments and behaviors.

They have taught their children to stick together, be one another’s best friends, and try harder, be kinder, be better always, because you have more to overcome than your fellow Americans. Never take for granted anything you are given. It must be earned. Always be cautious because while we are legal citizens, not everyone perceives it that way, so tread lightly as if you were standing on someone else’s land at all times.

So this family of five put their heads down and worked as hard as they could. They learned to speak English. They went to American schools and found American jobs. They made American friends and paved their own American way. Both sons became lawyers and settled with their wives and kids. Their daughter became a doctor and settled with her husband and their kids.

They have become interwoven with the community that surrounds them. They are as American as the next. But the racism is there. In backhanded comments and sideway glances at best. They are aware and know they must always be.

But their story is beautiful. How it began. How it struggled. How it evolved.

To those that hear my father’s accent and judge him. To those that hear my mother speaking loudly to me in Taiwanese. Think before you hate. My parents have overcome to provide for me and my brothers this American life they dreamed of for us. I couldn’t be more proud of how we got to where we are. And I couldn’t be more proud to say, with all our history in tow, my parents, my brothers, our families—we belong here. Just like you.

Recently, I sat with coffee in hand with a dear friend. Winter starting to melt under the sun’s warm, uplifting brightness. Those rays filling us with a sense of new beginnings, deep breaths, letting go, and moving forward. 

We cupped our coffees, a residual comforting habit from those frosty mornings from winter’s frigid abyss. We let ourselves thaw, letting go of weighted heavy layers, unfolding those cocoons we had weaved around ourselves from colder days. 

It has been a long season, we agreed. The temperature being the last thing on our minds. There have been lows and highs. Sometimes, the low lows dipping farther and staying longer than we could have anticipated. Sometimes, finding the path out the other side more winding and less paved than we hoped. 

In this time we sat together, we let go of any “I’m fine” neighborly banter. We never discussed the weather. We told our truths. We led each other into the hard and let it be known that we were not in fact holding everything together behind a shiny bow. Our bows were loose, worn, fraying at the edges. 

There is undoubtedly so much good and so much to be thankful for, but sometimes it is okay to acknowledge that what has brought you to the other side of a season, what has broken you down and left you with pieces to mend is just part of your truth. Those feelings are valid. We have all been through it to varying degrees. We are all getting through it.

I think back to a year ago. Keeping patients comfortably breathing, keeping them alive, keeping the rest of us safe and healthy was an unbearable responsibility that filled me with crippling anxiety. It flooded into my nights and the low, pounding bass of my insomnia was untamable. These feelings that had never been a prominent part of my emotional vocabulary now clutched tightly to me and held me captive. My ability to compartmentalize becoming my most deployed and essential tactic, like gasping breaths to keep me afloat and steady.

Over time, with the help of dedicated scientists, medicine, hard working essential workers, improved PPE stockpiles, and the community that has surrounded me, those gasping breaths have calmed. Sleepless nights have become full nights again woken by an alarm. 

During these times, what kept me strong was the immense amount of love that enveloped me and held me upright. The love of my husband and the inevitably contagious joy of my kids that filled me from my toes on up. The kindness and care I received from my community. The check-ins, the front door drops, the uplifting messages that let me know I was not alone. I was supported, lifted up, and most importantly, I never felt alone. That was truly the greatest fuel to keep me strong. Sure, it was messy and never picturesque, but I was part of a greater community that let it be known that they were walking right alongside of me. So I moved forward, because this grind required all of our wheels to keep moving forward.

But I have wondered, what if I did not have this community? What if I did not have this dear friend here to talk about truths and let me cry? What if I leaned and there was nothing to lean on and I fell farther down a deep hole? Or worse, what if a community surrounded me but I still felt unheard and unseen? What if I felt like I could not let anyone in and no one knew I was falling?

Last night, I learned about the passing by suicide of a young, brilliant physician. A mother, a wife, a vibrant member of a community. This loss hit me in the chest and sucked away my breath. I did not know her personally, but every female healthcare provider is part of the same united community. We are here for each other. We know the hard is hard, and also that the good is beyond rewarding. The challenges of being a female provider are a collection of nuanced uphill climbs that make a collective steep mountain for us to summit. The boulders that have been placed in our way this last year have made it all that much of a rockier terrain, as it has for everyone in so many ways. 

This year has also been one that has placed a much-needed spotlight on mental health. Mental illness is an unapologetic part of so many worlds. Whether loud or whispered, acknowledged or ignored, it is ever present. May we allow it to be spoken about in a safe space so we can start to better understand how it significantly affects those we love and our community. 

On the other side of this year of greater hardships has been a slow release. The pressure grew, expanded and now, it is starting its tentative release. The hiss initially quiet grows louder. Sometimes, this slow release of pressure explodes. It becomes unmanageable and those breakthrough tears are more than just that. I have no insight into what led to the suicide of this female physician within my local community. But I imagine that maybe her slow release became too strong and overwhelming. I often think about one of my colleagues who said in passing, “post-traumatic stress disorder is identified as post-traumatic for a reason.” 

On the other side of adrenaline, stress, and getting through any trauma is a let down of everything you have been holding tightly to your chest. It is a let down that has sometimes brought me to tears. It is a let down that has sometimes sent waves of sadness over me. It is a let down that has allowed those compartmentalized memories to become disorderly and break down the iron doors at the gates. 

People have died. Loved ones have been lost. People have struggled to breathe, cope, and endure. Sometimes they have won after weeks and months. Sometimes they have lost. There has been despair. There has been anxiety. There has been unknown which breeds the worst kind of fear. There has been isolation and loneliness that has left people feeling broken. 

I have taken each of these pieces of tragedy that I have encountered and cupped them in my hands. I have soothed them and placed them gently and carefully in a compartmentalized box. Once in awhile, they spill out, and they remind me of all the sorrow that has left dark staccato spots throughout the filmstrip of this year.

As we all process the events of this last year, a new set of emotions has surfaced to greet us. For some, it is filled with insurmountable grief, loss, and tragedy. For some, it is knowing where to begin to heal from this past year’s fear, anxiety, and loneliness. For some, it is hope. 

As I look back, I am reminded of recent coffee with my dear friend. We talked a lot about holding space for those we love and what that means to us. Holding space is letting go of judgment. Not trying to “fix” or change anyone. Holding space is letting go of comparisons. It is being present. It is seeing one another. Hearing one another. Validating all the emotions that exist in a person’s truth. Holding space is creating a safe space for one to be him or herself. No questions. No criticism. Just friendship with no strings attached. I have found this to be the thing I have needed most this past year. A rope for which I can steady myself and that helps pull me forward. Not a tug of war that leaves me doubting and exhausted. 

In processing this all, a few things are clear to me. Let’s be careful with one another and listen. Let those around you know you are ready to be present for them. Know that your emotions are valid and worth talking about. Everyone has been through something, big or small. My hard may look vastly different from your hard, but each is laced with a complex set of emotions and coping. We truly don’t know what we are each managing on a daily basis, so let’s just hold space for one another. 

Cardiac arrest. I am ready. Infant with a fever and seizing. I know what to do and how to reassure his parents. Unresponsive heroine overdose. I know how to treat her. Arterial bleed from a dialysis fistula. I have done this before. A two year old with an unknown foreign body up her nose. I can get it out. A teenager suffering from depression now with suicidal thoughts. I can help. A belligerent intoxicated patient with a bloodied face. I can manage. A fish hook accidentally caught in the scalp or dog bite to the ear. I can fix it. A mother with ongoing bleeding after giving birth. I can take care of her. No matter the unexpected nature, however things went terribly wrong, I am ready. I got this. I am steady, prepared, and nothing can possibly shake me, because there is a plan for every possible scenario. 

Before I even step foot in a patient’s room, the chief complaint written down at triage has created at least two dozen pathways in my mind. Like a choose-your-own-adventure, of sorts. Within ten seconds of being in the room, that choose-your-own-adventure has been widdled to one pathway with a few minute adjustments. 

This is the world of emergency medicine. Day in, day out. We open our arms wide to the wildly unpredictable open fire hose of anything and everything that comes through our doors. We are prepared for the unexpected. We absorb information, we assess, we create a plan, and we act. All before you finish your initial story of telling us why you are here. 

We are the experts at being prepared for absolutely anything. There is a calm steadiness that allows us to work deftly under pressure, to adapt to absolutely anything, against time with efficiency and precision. 

I do not know how to start to explain how COVID-19 derailed me more than anything has in my over a decade of practice. 

Let me take you back to March. 

A searing pain cuts through my left eye and spears through to the back of my neck. I wince and squint to keep the light out. My head is heavy, throbbing. The pain gives me sweats and makes me sick to my stomach. I want to curl up in my bed and not move, stay in the dark. Stay in the silence. 

This is how the beginning of this pandemic started for me. Sleepless nights leading to crippling migraines. My mind racing long after the house was in a silent slumber. A feeling as if I was on a ship built for a quiet fishing lake in the middle of the thundering ocean watching the looming clouds around me turn that ominous dark gray, bright flashes of muted blinding lightning, the wind starting to pick up, tiny ice cold pelts of rain whipping against my skin. It’s a feeling as if you are trying to stabilize on this tiny rocking ship, ill-equipped, knowing the storm is inevitable, and preparing with the flimsy life jacket and buoy at your side, knowing that this will not be enough, knowing you will soon be gasping to stay afloat. 

There were so many texts and messages from friends, close and distant, asking me how things were. How I was feeling through all of this. I stared at these messages, wondering how to answer. Knowing my voice was reflexively one of reason, one of calm, one of steadiness. But now, I felt undone. I felt unsteady. I felt scared. I felt paralyzed. I did not know where to start to explain what was keeping nights long and the storm untamed. 

That is what it felt like when this went from surreal to reality. 

I am that person that lays down, head hits the pillow, and I’ve long been in a deep sleep ten minutes later. Since this pandemic came to be, this has been far from the case. A million thoughts come alive in my mind and light up behind my closed eyelids as I try to will myself to sleep. But it doesn’t come, and next thing I know, it says 5 am on the clock. I start thinking about my work day ahead and start mentally and emotionally preparing. To distract from my mounting anxiety, I pour over articles, what little research there is, methods and protocols at centers ahead of us in this pandemic. I read as much as I can to learn as much as I can. This is the only way I know how to best prepare right now. 

There is tightness in my chest as I drive to work. It’s a feeling I am not familiar with. Nothing about work gives me anxiety. There is always a path. There is always a method. There is always a way to get from chaos to stability. I have trained for it all. No patient walking through those doors is one I cannot care for. I have always felt well equipped. There is a plan A, plan B, plan C, plan D to every condition. I have a plan for everything. 

But this. This is different. There are guidelines on disaster relief, mass casualty protocols. Every year we manage the influx of seasonal viruses. We manage the surge of influenza illnesses. But a novel pandemic. Where do we begin? 

I am starting with my basic building blocks to create my plan A. I go back to my training and experience. Start from the beginning. I can stabilize any patient, but with what resources? With what action plan? With what first back-up plan, second back-up plan, third back-up plan? What is the best way to resuscitate a patient from this illness? How will I keep my staff safe? How will I keep myself safe? How will I keep my family safe? How do I do this if I don’t even have the equipment I need? The testing I need? Everything is on shortage. How will I ration out in an emergency? This is the fuel to the fire of my anxiety. 

I stand tall, I move with purpose, but inside, there is a small rocking ship bracing for a storm it is not equipped for. 

This was a little over two months ago. It’s hard to believe how far we have come in a little over two months. With immediacy, but with what felt like the energy it would take for a thinly assembled group of people to move a heavy piece of machinery from a locked position, all hands came together, and pushed forward—straining, using every muscle, demanding forward movement. We scrambled to gather information. We scrambled to understand as much as we could about this new illness, about how to manage it, how to treat patients inflicted with it, how to protect and keep ourselves healthy so we could keep working. We scrambled to understand the magnitude of its affect on our country and on the world. We scrambled to know how to best prepare our emergency departments, our hospitals, our community, ourselves. 

Every day, protocols change. Every day, new information is learned. Every day, protocols and management of patients is developing and becoming more streamlined. We realize what resources and equipment is needed, and we are procuring, stocking up, making ourselves as well equipped as possible and ready for every possible circumstance. We are troubleshooting and fine-tuning. We were fortunate enough to have the ability to do these things, rather than being overwhelmed by volumes of acutely ill patients. 

Every day, we learn more about this virus. We are learning, unfortunately from those that have been undone by it before us. We are learning how it affects the lungs, the immune system, the cardiovascular system, and all other organs. We are seeing what therapies and management strategies have been most effective. We are building our best practice, our best protocols. There may be some trial and error. But with our unquestionable commitment, our unwavering dedication to what we do, we are steadily starting to put down the brick pathways that we can walk on safely. We are accumulating knowledge, resources, safety equipment, plans of action.  

All of this has been made possible by the guidelines set forth by our state government encouraging social distancing, staying at home, discouraging gatherings. This has given us time to build an infrastructure that allows us to care for all of you. I know it has been beyond challenging. It has been hard to keep away from the people you love. The people that make your life whole. It has been hard to give up all the daily little things that bring us joy. But in doing so, you have given us—your medical community—the time we need to develop the best and safest way to take care of you, should you need it. This gift of time has been invaluable.

I will continue to go into work with my colleagues by my side. We will continue to dedicate our time and efforts to you. But now, I will do it with far less anxiety, better rested, better protected, and with a plan, a back-up plan, and a back-up, back-up plan to do the best I can for you. 

What I came here to say, is thank you. Thank you for every sacrifice you have made to help you and I and our family and loved ones stay as safe and as healthy as we can. We may still have a long way to go, but I want you to know your sacrifices have not gone unnoticed. You have allowed us to make large strides in managing this pandemic. Regardless of who we are, we are in this together.