We have long since graduated from the phase in our children’s lives where we celebrated firsts. First steps, first solid foods, first haircuts, first lost teeth, first cruise around the cul-de-sac without training wheels. There was no abrupt moment when I noticed, but with time, those firsts have become more spaced out, less prominent, faded into new routines. 

Last night, I lay curled up on my son’s beanbag chair. I racked my brain and could not recall the last time he had asked me to stay in his room as he was falling asleep.  He had been at a friend’s house and watched a horror movie that left him a bit more affected than he’d like to admit. There were no words spoken to ask me to stay, but when I offered, his body relaxed, and while he would never admit it, there was a slight nod before his head dropped onto his pillow.  I re-adjusted and found myself a little nest in his large foam ball of a chair and closed my eyes, letting my mind wander as I tried to recall the last time I had done just this exact same thing. And then I tried to remember other lasts. The last time I had drawn him a bath with bubbles. The last time I had laid out his clothes on his dresser for the next day. Lasts never celebrated or identified until they had faded unnoticed even faster than memories of firsts. 

This intersection of childhood and the first tastes of a new transition into becoming fully independent has been one that we have been trying to navigate by trial and error. Sometimes we do not realize until it is too late that we got it all wrong, and sometimes, we skate by and think we got it right. We are fully aware that some days we like our kids less than we love them, and that is part of the process. But we are trying to remind ourselves to savor every last minute of this clunky, unceremonious transition. As these lasts come and go without us even realizing, we want to remember how much we enjoy our relationship with them in its ever-evolving form at this moment in time.  

I do not remember the last time I brought my 12-year-old daughter to dance and stayed for the duration of all her classes. But I’ll remember how she used to light up when she tumbled out of one class and saw me sitting there, holding up her water and snack and helped her take off her ballet shoes and tied her tap shoes. 

I cannot recall the exact date when I last helped my son put on his baseball belt and tuck in his baseball uniform, but I’ll remember the absolute joy he exuded those first times his bat made contact with the ball on the field. 

At some point, that first contact of the bat to the ball turned into the memory of when he hit a walk-off run in a play-off game, flipped his bat with the most knowing confidence and advanced his team, with the memory of his baseball buddies meeting him out in the field and tackling him, ending in him making sand angels next to the first base plate.

While those firsts were exhilarating as new parents experiencing it all for the first time, the memories continue all the same with unequivocal emotions of adoration and absolute pride. 

So, as I lay with a growing cramp in my side, curled up on that foam beanbag chair, I’ll do what I can to remember this mundane evening of waiting for my son’s breaths to deepen until I know he is fully asleep. Maybe it won’t be the last time he will, in his own way, want me to stay until he falls asleep. But I suppose there is no way to be sure, so I’ll store away this memory just in case, knowing tomorrow will bring new turns as they continue to leave behind the firsts of childhood. Rather than mourn the sadness of lasts, I’ll sit present in this moment, eager for the joy in the To Be Continued yet to come.

Bricks to Share

Today I sat over coffee with a friend I love so dearly. It has been months since I’ve seen her and sat with her, face to face. But with her, there is no front. I don’t know how you learn to trust the people you trust, but you just do. And we heaved right in. Because there was so much hard to sift through. So much we needed to share to unfold and refold in the shaping of our lives. Because with the people you trust, you want them to walk alongside you, and know your truth. You want them to know the way she knew when she asked me how I was, and I said I was okay, that I was not in fact okay. She knows who I am, not because we share countless experiences, but because we trust one another to come into each other’s space and be real and see each other’s truths.

She is brave and I am thankful she is where she has found herself on this day. With a lightness in her breath and a freeness in her laugh. She is letting go and moving forward. She is seeing her worth on the other side of so much heavy. I can see there is still struggle to climb through. I hear it in the cracks in her voice and see it in the welling in her eyes. But I am so proud of her and her strength. I am so proud she is choosing to always stay above where the ugly could drag her. Friend, you are mighty, and your kids will look back, wide-eyed, and always feel your love and know you will always be their constant. You will always be their home.

We talked about the often times unbearable amount we shoulder. The home, the meals, the kids, the work, the everything. It is too much and we are breaking. Under all this multi-tasking superhuman proficiency, we are being chipped away. We are weathered. When and how will we crack. You don’t understand unless you understand. I’m not in a space where I can articulate it more than that.

So, we turn to one another.

I remember when I felt like I just could not another moment. My son was sick. I was working an insane stretch. I felt like I couldn’t take in an entire breath. In that moment, it was the community of women that shoulder their own weight that leaned over to hold up mine. I never asked, but they knew. They leaned in with meals, carpooling, texts, and care packages. And every single piece of themselves they invested in me, gave me the air I needed to keep taking full breaths.

It’s hard. I never feel like I can’t do it all. I know I can carry all the bricks up that mountain, and do it well. But when my community shows up to offload this weight one brick at a time, my shoulders lighten. My back hurts less. I have more strength in each step.

This week, I feel more grounded. I feel as if I have the energy to carry an extra brick. I know my community well enough that I know they will not solicit for help in the same way I will not solicit for help. So in the same way they showed up for me, I show up for them. In care packages, in homemade pasta and meatballs, in texts, and in coffee dates. I need them as much as they need me, and that is what true community has taught me. Lean on me and I will lean on you. And when everything feels too heavy, we will lighten one another’s load, one shared brick at a time.

Permission Granted

Today, I am giving myself permission to acknowledge yesterday. I am giving myself permission to say that I feel overwhelmed and sometimes it is too much.

Saying this out loud in itself feels overwhelming. Actively broadcasting feeling overwhelmed means that I don’t have it all together. It feels like an admission to weakness and feeling incapable of handling all the things with command and poise. It sweeps the I-don’tknow-how-she-does-it-all wonderment from right under my legs. This is not who I am–Overwhelmed. I scoff it off. Bury it deeper. Just keep powering forward.

I am juggling it all, with grace, with an eloquent efficiency, and without flinching–not one bit. I can take care of my family, manage my Joanne Gaines curated home, invest in my friendships, be career-driven, and give back to my community, and bear the unexpected without the blink of an eye. These are the delusions I crowd my mind with to push out any doubt.

Overwhelming shouldn’t have a seat at my table.

Last night was one of those nights. I had to stare Overwhelming in the eye. My day began unexpectedly–as I have come to timidly expect these days–with my son waking up with a fever. My husband swamped with work. My girls moving around slowly and forgetfully as if this “getting ready for school” thing was a new wonderment they have never ever, ever experienced. My day, derailed as I preoccupied myself with caring for my sick child, picking up meds, cough drops, disposable masks, soup, crackers and all other things to tend to my son’s cough, sore throat, fatigue, and body aches.

I can see now what I was doing. I was trying to stuff my feelings of having to leave for the night and not be there for my son by over preparing. By overcompensating.

By the time I thought about dinner, my girls were off the bus and barging through the door, wet snow splattering into our front entrance as they dropped their bookbags, kicked off their snow pants and boots and started rummaging the pantry for snacks. One daughter to get ready for dance, the other for hockey, and Mom can you register for the school fundraiser right now and what are we eating for dinner and should I bring a snack or are you packing me a dinner and where is my water bottle? I fought with myself whether I could insert a nap before my overnight shift. I felt as if all the pieces were all tipping on the edge of a wobbly waitress tray. The slightest trip and it would all come tumbling down.

I felt dramatic. I wanted to stop. I wanted to not leave for work. I wanted to be by my son’s side. I wanted to sit on my couch. I wanted to cry. I wanted my daughters to be able to find their water bottles by themselves and remember to have everything they needed for hockey and dance without me scrambling to find the odds and ends. I wanted to be strong. I wanted to be calm and in control. I wanted to not raise my voice or sound exasperated. I wanted to handle all the things and not have these emotions. I just wanted to all together give up on tonight. Maybe tomorrow would be better. But there was still so much to push through. I hated how this was all making me feel. Overwhelming, please get up and leave.

Maybe it wasn’t even the events of today that was making me feel so taxed. Maybe it was the culmination of tiny stressors day in and day out. Absorbing each small event and inadvertantly depleting my reserve until there was barely anything to pull from. The reserve is empty. The Overwhelming is sidling loudly and disruptively into its place.

As the queen of compartmentalizing, feeling these emotions bubble over felt irritating and I judged myself for being so dramatic. Emotions are consuming, and there is not time for more consuming things.

So, I tell myself to breathe. One task at a time. One thing at a time. It is not the end of any world. It’s just Overwhelming here to sit alongside you. Shake its hand. Say hi. You can work through this. You will always get to the other side.

Christmas Day Magic

The alarm’s deafening, staccato siren cuts into the thick cloud of sleep and jolts me out of the soft warmth of my sheets. It is 4 am and time to get up for work. The ache in my lower back from wrapping presents and transferring them from their hiding place to under the tree is a reminder that today is Christmas Day. I fumble in the pitch black to find my bearings and ready myself. 

Once I am dressed, packed to go, with my coffee mug security blanket in hand, I feel the sleep that once clung on my eyelids slink away.

I sit in the dark, blanketed by silence. The glow of the Christmas tree reminding me that on the other side of this work day is magic with my family. 

Working holidays is a non-negotiable in my profession, as in many professions. We take our turns, and we are exponentially grateful for the holidays we are off when our colleagues share the load to allow us time with our families. On holidays I am on, I remind myself that it is not the time of day or date that will make the Christmas magic come alive for my family, but the togetherness and traditions we foster, whether in the earliest parts of Christmas morning, or when my work day has ended. 

Once I am in my car, coffee thermos still close by, music turned up, I have fully transitioned to the mental calm I need for the day ahead. With the unpredictability of each day in the Emergency Department, all I know to do is to set a consistent, steady mindset and be prepared for anything.

Christmas Day is no exception. Just like work days do not stop for holidays, neither do illnesses, traumas, and all things unexpected. 

My day starts with a toxic Tylenol overdose closely followed by a patient with COVID-19 struggling to breath. As we work quickly to reverse the damage she has done to her liver with the massive amount of Tylenol she took and simultaneously try to stabilize his breathing three rooms down, I am summoned to the ICU where another COVID-19 patient, who has been on life support for 4 weeks, has suddenly collapsed a lung and is downward spiraling. The family has been called to say their goodbyes. 

The ICU team has been working to expand her lungs with a chest tube. They have called down to the ER looking for backup. I focus on the task at hand, quiet the busy around me, and methodically place a chest tube. Her lung re-expands. Her oxygen levels rise. She lives through Christmas Day.

How much difference I made in her long-term prognosis is yet to be determined, but I am forever grateful that my training and experience let my hands move reflexively and quickly in that moment. She was sedated on life support and may never know I was there that day, and her family may never know I was there either, but I am hopeful this has allowed the magic to stay alive on Christmas day for those that love her. She is a mother, a wife, a daughter. They may never know me, but I will remember her, this day, and have thought about her often since Christmas. 

Death around the holidays has always been a heaviness that we carry with us in the ER. A time of togetherness shattered by loss. The heartbreak magnified by feeling isolated in your feelings of devastating grief when the world around you appears to be swept away in festivities and joy. It is not lost on us in the Emergency Department. We are fighting alongside you to keep the holiday magic alive.

I open the door when I arrive home and I hear my kids’ footsteps pounding down the hall to me, their loud excited voices echoing in a capella. My son yells, “STOP! Don’t touch Mom!” They know the drill. Before they can hug me, I will rid myself of the day’s worth of germs. My seven-year-old halts in her tracks, and trails closely behind me, brimming with anticipation and giddiness, trying to practice patience in her every electric, bounce.

“How was work?” my son asks, as he always does. 

“I saved a mom’s life, so it was really good.” I respond. 

“Is that why you HAD to go to work today?” my seven-year-old asks.

“Yes. That is exactly why.” I tell her. 

I can see now that the magic did not begin at the end of my work day, but started the moment I woke up on Christmas Day. I can walk through my day and be thankful for every minute I was gifted. As our family Christmas morning traditions officially started that day at 4 pm, the day’s events filled me with gratitude for family, for love, and for the lives that would make it through the magic of Christmas day.

My Daughter’s Favorite Tree

My seven year old has a favorite tree in our backyard. It is an expansive tree with full branches of lush waxy, dark green leaves, providing the best shade on sunny, cloudless days. When every other mature tree was cut down to build our new neighborhood, it was somehow spared, and left to thrive in our backyard. My daughter lies in the hammock under that tree on hot, summer days and reads or swings and sings songs (loudly). The strong breeze on this hill we live on whips the leaves and makes a melodic swishing noise on days when it is fiercely windy. It’s expansive power and the way it takes up space is mesmerizing. It seems this majestic tree is sturdier than most things when the storms come through.

But last week, a storm crashed through unannounced, uprooting rows of the most beautiful old, pine trees that lined familiar worn streets and lay flat large trees on the roads. We awoke in the morning and saw that my daughter’s favorite tree had lost some of its fullest branches while other branches were left sagging and nearly splintering off the trunk. The leaves still remain green and lush on the branches that survived, but this amazing, steadfast tree full of shade has taken a hit. It is slightly sparser and slightly weaker than before. Maybe if you didn’t know the tree like we do, you wouldn’t notice. You wouldn’t notice these branches that once lifted up towards the sky are heaving low and nearly touching the ground. My seven-year-old hopes that it heals and returns to the way it used to be. I hope so too, but I’m not so sure.

It is the day after an evening shift and I am so tired. I am spent. I think about my over-a-decade of practice in Emergency Medicine. It has never been like this. I have always felt pride for the steadfast rhythm of our emergency departments; we have always provided shade for every patient we see. We have had extensive branches, full of leaves and life and have been unwavering. We have weathered winds and storms and bounced right back without blinking. But this storm is really taking its toll. Every shift leaves us slightly more weathered. 

I cannot pinpoint or describe to you in one concise sentence what we are experiencing on a daily basis. It is a litany of factors that beat down on us like the cold, sharp, pelting raindrops in a torrential storm. It is the patients that have had to delay their surgeries or medical care that are now desperately and emergently in need. It is the extra weight thrown on those that show up of being short-staffed and lacking essential resources. It is every single hospital being well over capacity, with no place to admit patients that are suffering from the delays in care. It is the ambulance crews that work tirelessly to reach every patient in crisis in the community and bring them to hospitals already overstretched and struggling to manage the load. It is the backlog of patients piling up in the waiting room that are in distress. The waiting. The anxiety. The emergencies that are stacking. The limitless time stuck in a holding pattern.

We all make our own choices about vaccines. We all have strong opinions and will unlikely be changing our minds based on the information we have interpreted as truth. But in the ER, we have no choice but to absorb all the repercussions of opinions and choices that present as shortness of breath that feels like suffocating, fatigue that leaves people devoid of energy to perform daily tasks, body aches that grip patients’ every joint, vomiting that leave people craving for a sip of water to stay down, the unbearable internal heat of uncontrolled fevers, weight loss and muscle loss from not being able to eat, unrelenting intolerable headaches, severe chest pain that causes insomnia, coughs that won’t abate and leave lungs burning and permanently scarred. In the most devastating of cases, we internalize the heartbreak of death, loss, and loneliness. We treat absolutely everyone no matter how their beliefs and adamant choices have affected the condition in which they present. But it is undeniable that what our patients choose has greater than a simple ripple effect—it is tidal wave after tidal wave that is crashing on our shores. They grab hold of us and pull us down with them in this steep downward spiral they have inadvertently chosen. We continue to show up and are unquestionably here to support and temper this downhill slide, but only time will tell if it is too late or if they will make it up from this downward side of the coaster.

We are doing this all while we are navigating our own steep hills. All of this is wearing on us. We are leaning on our own communities and family that carry our weight through this heaviness. We have spirits and stamina of steel. But much like my daughter’s favorite tree, our branches are heavy and sagging. We will show up daily, provide our shade, and stand upright and tall and do what we methodically know we are trained to do with everything we have behind masks, eye shields, facemasks, gowns and gloves. But even the sturdiest of trees will meet its storm.

Our roots are deeply secured and extensive. We hope this storm will pass and not leave us uprooted.

Buying Shoes in Barcelona

Twenty years ago, we walked amongst the bustling crowds on those Barcelona streets, surrounded by the mosaic, winding lines of Gaudi’s breathtaking architecture. We were in our early 20’s, uninhibited by the weight of anything but midterm exams and making it to class on time. Your Spanish—a broken cacophony of mispronounced inflections and hopeless garbled half English-half-Spanish words.

I remember we met that first day as my roommate and I re-arranged the furniture in our hotel room in fits of sweat, trying to perfect the flow of this 12 x 12 space that would become our home base for the next three months of our study-abroad program. You were this lanky blonde kid in glasses with your roommate inviting us to join you for a movie down the street. We shrugged you off, more interested in getting our room into tip-top shape and excited to set out to explore the city on our own.

If I’m being honest, you didn’t particularly catch my eye—I was too enamored and wide-eyed over this new city, this new language, this new culture, this life over 4,000 miles away from any place I’d ever called home. My only comfort being forty other college students from our University, only a couple of whom I had previously known back home. 

It wasn’t until those shoes you needed to buy that I even thought twice about you. Walking together on those paved, Barcelona streets after class in a slow, oblivious, inconvenient gaggle of American students. You loudly solicited for any poor soul willing to help you buy some shoes as the ones you had brought were falling apart and your Spanish was choppy at best. I volunteered, eager to put any of my Spanish to use. And so this is how our love story began. Buying those black Camper walking shoes in the back corner of the mens’ shoe department in Barcelona. I never left your side that day. We bought the shoes, we laughed the whole way home, we went to dinner, and we stayed up talking until our eyelids were barely keeping themselves open.

A friendship began and strengthened as we were left alone on a week long break where all our other study abroad peers jet-set to France and different parts of Spain. We explored Barcelona during the day, and fell asleep in your room to the winter Olympics of 2002 at night. I remember falling asleep next to you on your bed. Half asleep, I remember how you gently lay me down on your bed, and then plopped yourself on your roommate’s twin bed across the room. I remember trusting you so wholeheartedly and thinking nothing of it, but now I see how that 21-year-old boy that showed me so much respect as my 21-year-old self would always be there to be my gentleman and stay here right by my side. 

Even at that time, oblivious to what was to come, I thought of you as a friend. But a friend I could spend literally every waking minute with. You made me smile, you made me laugh, you made every day so much more fun. The only time I left your side that week was to stop by my room to shower and change clothes. It felt so easy, so natural, as if this is where our script together started and interweaved and this is how it was always meant to be written. 

Something in the air changed that day my friend and I decided to recreate the sorority event we were missing with our sorority sisters back home. She selected you as my date, and it was the little nudge we needed to see each other in a different light. Nothing and everything changed, and our hearts started falling faster towards one another. Our hands seemed to naturally fold together like perfectly created origami and we breathed each other in with electric excitement and passion.

I emailed my best friend back home. “I think I’ve met someone . . .”

We were transformed, we were inseparable, we were better together and now better as ourselves than we were without one another. Each day was lighter and fuller with you there. 

Here we were, on the edge of the beginning of our lives, so lucky to have found our person. We fell in stride alongside one another as we continued to pursue our biggest dreams and goals. We only made one another stronger and more determined. Each hardship only further cemented our relationship. This is what it was like to have an unconditional love that would be there with me to face the greatest challenges, pain, hurt, pride, joy, laughter, love, and so much unexpected along the way. Through everything we have experienced, this—you and me—is the one thing in life I cherish the most. 

We have seen one another through two college graduations, one law school graduation, one medical school graduation, one residency, three law internships, innumerable cities across the country, endured anxious first-time meetings with parents and siblings, developed two careers, wept through the loss of miscarriages and loved ones, moved into new cities and homes, made new friends, experienced the indescribable joy of meeting our three kids for the first time, learned the true meaning of sleepless nights as first-time parents, and since watched our kids become these amazing humans we are so insanely proud of. There is too much to recount, but no matter what it has been, we have been unwavering. Your hand in my hand, my hand in your hand, it has always been you and me. 

This morning, on our 13th anniversary as a married couple, I rolled over in bed and kissed you and told you I loved you, like I’ve done a million times over. But everyday, I could not mean it more. I am so thankful you were too helpless to buy your own shoes 20 years ago in Barcelona. I likely would never have given you the time of day if you hadn’t needed help. (Kidding!!!) I don’t know the perfect recipe for a successful marriage, but I know there is no one  more perfect for me than you. There is no one else I’d rather experience this life we have created with. You are my one and only. I love you forever. 

We Belong Here

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.

Holding Space

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. 

In the Thick of It

It isn’t uncommon that my mom friends try to mother me during this time. They check in. They ask how my shift went. They ask when I work next. They ask when I get a break. They ask if they can feed my family. Or bring me a glass of wine. They ask if they can pick up my kids or bring them home from dance or hockey or baseball. If it wasn’t for this community of mothering moms around me, I would have fallen hard with no soft landing of hot soup on my porch, home-baked cookies, bottles of wine with chocolate, or simply the love and support they infuse me with through text messages and funny memes. I need it so much. I am deeply thankful and know I am incredibly fortunate to have this community that lifts me up and keeps me upright.

The question I get asked so much right now is, “How are you doing?” I truly don’t know how to answer that. Saying “okay or good or great” seems to not honor what life is like right now. Saying okay or good or great gives no part of what me and my colleagues and my team are doing justice. There are highs and there are lows and what COVID-19 has done to our nation and our world should not be responded to dismissively. What it has done to communities and families needs to be respected. “Doing okay” has no place in describing what we are doing right now. 

Every day I go to work where there is a mountain of emotions among our patients and their families. There is sadness. There is loneliness. There is desperation. There is fear. There is anxiety. It breathes the air we breathe and it occupies more space than it has since that very first day I stepped foot in an Emergency Department over a decade ago.

So many days, our hospitals are at capacity. They are overwhelmed. The shadows of dark feelings grow and expand and shift to fill every inch it can occupy. Gray turns to black as anger creeps in. Anger that there is so much waiting. That there are no beds. That there are hospital transfers. Anger that there is unknown as we wait for hospital rooms and Emergency Department beds to open up.

On the ground, my staff works tirelessly. Endlessly. They push down those overwhelmed feelings. They absorb the anger of patients and their families. They sit at their patients’ bedsides and diffuse their anxiety. They help their patients make those dark feelings as small as they know how.

The Emergency Department team works methodically. Problem solving and finding a way with every challenge. We navigate within our own natural rhythm amidst the chaos of our every day. This is our routine, and no one can handle it better than we can.

But it isn’t easy, and by the end of the day, we have used everything we have. The physical exhaustion is nothing compared to the emotional and mental exhaustion. The thick skin and problem solving minds that we have confronted each miniscule and monumental uphill challenge with doesn’t come without a price. But it is a price we willingly pay today, tomorrow, yesterday, because we wholeheartedly believe in the value of what we do.  

The Emergency Department staff. They are a force. A force you want taking care of you when you are struggling with COVID-19. When you have a heart attack. When you are in a car accident. When you break your arm. When you have appendicitis. When you are having a miscarriage. When your toddler cuts his lip. When your grandmother has a stroke. When you have an infection in your bones. When you are feeling suicidal. When you overdose. When you have an unbearable headache. When your loved one needs to be on hospice. When you can no longer take care of your elderly family member at home. When your infant wakes up in the middle of the night and is gasping to breathe. When you have intractable vomiting and diarrhea and are feeling weak. When your are in heart failure. When you are trying to escape domestic abuse. When you have a dog bite. 

And this is a small sampling of one day in the Emergency Department. 

We are feeling the stress of COVID-19. We are overwhelmed but I assure you, we are stronger than most. As patient numbers rise and hospital capacity reaches its limits, we are still here 24 hours a day, 7 days a week, doing everything we can. We are taking care of patients affected by the pandemic and those that are being seen for all the illnesses we normally treat. We are being stretched to the greatest of our abilities, and our abilities are great. We are in the thick of it. 

To my community that has been blanketing me for the past 10 plus months with so much love and support, my heart is so full of gratitude for you. To my colleagues and Emergency Department family for being undoubtedly amazing every day without fail, it goes without saying, I could not do any of this without you.

I suppose when you ask me how I am doing, I think I speak for all of us when I say, “We are in the thick of it.” We willingly and feel thankful that we can be here for you, your family, and our community, but know that it is not easy. We are rising to the challenge, and we will continue to work tirelessly to do our best.

Mama Heart

A sticky blue flurry with tangled, blonde hair attack-hugs my leg as I open the garage door, home from work after an exhausting day. It’s my 6-year-old daughter. It’s as if she’s been waiting by the edge of the mudroom all day, ready to pounce at the first sound of our mudroom door alarm open.

The force of her weight on me is the human embrace I need to let me know I am home.

I am home.

I am home. 

It is the deep, long sigh I need to start to wash the heaviness away.

I gently peel her off my leg, promising real hugs and snuggles once I am clean. I obsessively wash my cracked, dry hands one more time. Shower. Put on clean clothes. I am so tired, but now I feel safe, and now I feel I can pick her up, smoosh her face against mine, and tickle her neck with my nose.

My mind starts to quiet, my adrenaline starts to still, and my heart transitions through its rollercoaster of emotions. My 6-year-old sits curled up in my lap. She holds my cheeks with her sticky, sweaty hands. Half holding my attention, half distracted by the fun of squishing my cheeks. “Mommy, when I’m a doctor, can I come to work with you?” she tilts her head and looks up at me.

My heart soars and sinks. I don’t know how this is possible, but the way a mom’s heart can stretch and bend, isn’t something science can explain. I am so proud of this little girl that has ambition, and knows she can do anything her mind and motivation set forth to do, but I cannot help but wonder what challenges she will face in adulthood that parallels that of a global pandemic. 

I think about my own mama’s heart. How her heart burst with the greatest pride to see me give a speech in front of my medical school class on graduation day. How her heart soared with me when I matched at the residency program of my dreams. How her heart felt full the first time she saw me in a white coat with stethoscope slung around my neck. How her heart felt joy seeing me walk down the aisle in a white dress. How her heart expanded to make room for more the first time she held her grandkids in her arms. 

Then I think about what this pandemic has meant for her heart. How her heart has pounded so fast on sleepless nights worrying about if I have the PPE I need to keep me safe. How her heart has brimmed with crippling anxiety waiting for my call on my way home from work, because that is the reassurance she needs to know that I am okay. How her heart has ached with hollowness over the last 10 months of missing me and not being able to see me in person and hug me. How her heart has sunk down low alongside mine when she has caught me in a drained, helpless, or defeated place, weighed down by the patients that have affected me that day.

It’s been over a year since I’ve seen my mom. It goes without saying, I have never gone over a year without seeing my parents. And it breaks my heart, but I love them too much to suggest putting them at risk. My mom is 76-years-old. I have seen 76-years-olds struggle in ways I will never forget. I’ve seen them struggle to breathe, struggle to keep food down, struggle to live. 

My mom, who is not on social media, sees my face only on Facetime, and I see half her forehead and one eyebrow as she tries to figure out where this mysterious hidden camera is in her phone. She inspects my face and tells me how I need to pat my face after each face wash so the skin around my mouth isn’t so dry and flaky. She dismisses my protests that I can’t help what my mask does to my face. She rapid fire gives me instructions for recipes of “quick easy meals” I can make so I can have something at the ready to eat at work, thinking quick easy recipes will combat the fact that I need to keep my N95 mask on and physically and logistically simply cannot eat for the duration of my work shifts regardless of what recipes I make. 

Every time I call her—she doesn’t dare call me, she is convinced I must always be working or sleeping, and both would be terrible to disturb—she asks me if I am still seeing “the COVID-19 patients” and if I ate yet today. “Yes Mom. From when you asked me yesterday, I am still seeing them today. And yes Mom. I eat everyday.” She tells me she knows, she knows, but she just has to ask. This is her way of telling me about her mama heart, that it loves me, misses me, worries about me, and is proud of me, with every single beat. 

I think about how my mom’s heart stretches and bends to hold all her emotions right now. I think about its immeasurable strength. I think back to my flushed-cheeked 6-year-old sitting in my lap with her baby teeth still all intact. I think how her ambition makes me so proud of who I will watch her become, and for the first time, with the rollercoaster of this pandemic, fill me with a new trepidation. 

There will come a time, when all of this will be part of our world history. Standing on this side, where ahead of us is a blindingly bright star, coming into focus in the silhouette of a vaccine, I am full of hope. I am comforted by this residual soreness in my left arm where the Band-Aid over where I got my first dose of vaccine still sticks. 

I am full of hope because it is true and because I need to be full of hope to keep moving forward. 

This will be a part of our history, our greatest teacher. I hope when my mama heart is alongside that of my own mom, I’ll be able to feel more pride than fear for my little girl, out to change the world. 

My Son’s Hair

Today was a day I don’t want to forget.

It’s been a summer of navigating a new way of living. What is our new social normal. What is within our comfort zone.

My son’s baseball practices and games being one of the things that has given us an excuse to be outside for long summer days and electric summer nights under the lights. I watch as my son plays this sport he loves so intensely, and my husband puts his heart into coaching our son’s team. I’m not sure who is having more fun. He is his dad’s son, and their passion for baseball falls into step like one heart beating.

As my son grows older, I notice how his passions pull him more in line with my husband. I notice how our common interests start to gain the slightest distance. He is still my sweet boy that asks me every morning how I slept or asks me how my work shift was. He is still my sweet boy who wants to help me at dinner time or play board games. But that deep childhood dependency—that need to be right within arms reach and a glance away from me—have fallen loosely to the margins. Long gone are the days when he needed constant holding, when he sat on my right hip, or when he cried when I put him in his play space behind a gate in direct view of the kitchen, frantically searching for a hot minute to make dinner. And yes, I am more relieved than not that those hard, hard days of raising toddlers are past us. And yes, this is as it should be. I am so proud of this confident boy that searches the neighborhood for a ball game of any sort to join or buries himself in the latest MLB baseball statistics or Cubs game. He is independent, he is self-assured, he is responsible, and I trust him.

But there are days when the bittersweet thoughts that tomorrow he will need me less than he needs me today creep shadows over my heart and weave my breaths with this tinge of sorrow. I don’t know if this is true, but I am fearful I am right.

But today. Today our family huddled up in a cabin up north. We watched a movie inside on a wind-whipping day as the lake side white caps crashed along the shore outside our windows.

The movie was full of suspense and sometimes scenes that made the kids shudder. And halfway through, I found my son squatting next to my seat. Then fully laying his head against my arm. I peeled off his baseball cap which is normally cemented to his head, and I ran my fingers through his hair. It felt gritty, dry, full and thick. Like the hair of a boy that has lived a summer on the baseball field, sliding and kicking up sand, sweaty, and free.

Today, my son needed me to be his security blanket through this movie. I remind myself that perhaps it’s not that he will need me less tomorrow, but he will lean on me differently as our mother-son relationship evolves.

What I’ll remember about today is what his hair felt like, because when the movie ended, his cap was back on, and he was back running outside in the brisk cold, swinging his bat at imaginary 96 mph pitches and daydreaming about that ball soaring past the fence.

In this ever changing climate we are currently living in, there is one constant that will always hold true. This is him now at this stage, and as this stage grows into the next, I simply could not be more thankful to be his mom.

The Rise

Dear Max, Sofia, and Claire,

There is a man name George Floyd. He is an African American man that law enforcement had been called to investigate. The details of this interaction are yet to be clear. But Mr. Floyd was a Black man, and he suffered extreme and unnecessary consequences, and ultimately died. He did not deserve what happened to him. This was not right of the police. This happened because Mr. Floyd was African American. His skin color was different than that of the police. Can you believe that someone can be killed because of their skin color? It is hard to talk about, it is hard to understand, but it is real life. It happens. And as much as I want you to live in your childhood, I also want you to grow up to be adults that see justice and fight for humane and respectful treatment of all people.

Because of the wrongful way Mr. Floyd was treated, our nation is currently undergoing great chaos. It has triggered in citizens of our country great unrest. Because, unfortunately, this is not the first time this has happened. This has happened time and time again to many African American people. Their lives are often in danger because of the color of their skin. Think about your friends at school that are African American. Do you know that many of them have to live with this fear that their life can be in danger if they interact with the police? Can you imagine if your life was in danger every time you encountered the police? What if someone went for an early morning run, like Daddy often does, but his skin was black, so he had to fear for his life because he was running before it was daylight outside and his skin was a different color? Can you imagine if someone pushed you to the ground, punched you in the face, kicked you because of the color of your skin or the color of your hair or the way you talked? Doesn’t that seem wild? But it happens all the time. And this is why people are angry and want our country to change the way people of color are treated.

I know this can be confusing. Police officers are people that are trained to protect others and keep us safe. But all police officers are people of varying beliefs, just like teachers, doctors, nurses, lawyers, mail carriers. Just like neighbors, friends, moms and dads. And among all these different people with different jobs, you will find people with great flaws that allow them to make bad decisions because of their clouded judgment. This does not mean all police officers are bad people. All people make mistakes. But when mistakes become a pattern and puts the lives of others in jeopardy, that needs to stop immediately.

We are living during a time of revolution in our country. As you grow older, you will become familiar with the phrase that sometimes, we have to hit rock bottom before we make progress forward. This feels like our country’s rock bottom in our lifetime. Right now, in our country, there is passion for change. There is anger. There is peaceful protest against the unjust way people of color have been treated for centuries. There is rage that has fueled violence and destruction. There is brokenness and heartache that has brought people together to restore and love through support of one another and our communities. There is fear that has channeled distrust and retaliation. There is persistence, resistance, and standing together.

All of this is happening right now. It is a reminder of our ingrained human imperfections and the need for change to ensure these dark human flaws do not do as they have done time and time again and lead to the unlawful punishment and death of people of color.

Racism is real. Racism is seeing people that look differently than you, act differently than you, have different cultural and religious beliefs as you, as less than you. Feeling as if you have the power to control them, degrade them, or shower hate on them for absolutely no valid reason.

You will, at some point, be the subject of racism. Mom is Asian and Dad is Caucasian. Some people look down upon people of different colors and races being married. They may look down on you, make fun of you, be mean to you because you are an Asian American. How you feel when this happens, is a fraction of how African Americans feel when people are racist towards them. You may feel anger, hurt, small, and sad. But African American people also fear for their lives and the violence that may be inflicted on them. Can you imagine being afraid right now that someone would hurt you because Mom is Asian and you are too? Think about what that feels like, and think about how you can use that to be strong and be strong with other people that feel that and more.

What I want you to do, is open your eyes. Listen with your ears. See how your friends are different than you. See how their hair is different, their skin color is different, their clothes are different, their lunches are different. And see how much you like to play with them because of who they are. These differences don’t make them less your friend. They make them who they are. Every person is someone’s friend. Every person is someone’s son or daughter. Every person has people that love them. That is because of everything that makes them them. Their black hair, their brown eyes, their brown skin, their red hair, their green eyes, their white skin. See the beauty in these differences.

Too often, people are quick to judge the things that they are not familiar with. Things that we are not familiar with often make us uncomfortable. It’s like before you, Claire, try a new food. You scrunch up your face and say “EW”! And Max and Sofia, you know that this food Claire has never tried is delicious and encourage her to try it. Sometimes she does, and then she loves it. Sometimes she never does, and she doesn’t get to enjoy this new thing that you guys love because she has rejected it before ever trying it. We urge her to try it, because it is usually healthy and will provide her body the nutrients it needs to grow, but also, what if it ends up being her favorite food? Sometimes, it is easy to not want things you are uncomfortable with in your life. But just like it is hard for Claire to try new foods, I want you to push yourself outside of your comfort, observe and ask questions about them. Get to know them. Think about the friends you have made. What if you didn’t push yourself to get to know them? What if they weren’t in your life right now? Wouldn’t you be less happy? Connecting and embracing how we are all different is what makes our country thrive. It is what makes our country healthy and allows it to grow. It is this tie-dye mixture that makes our country’s heartbeat colorful and strong.

If you notice someone being pushed aside or made fun of because of their differences, be the one to stand by their side. Be their friend. Be their second voice against someone that doesn’t value their differences. The more voices that stand together, the louder we are. Maybe they will start to make fun of you. Maybe they will push you aside too. People that put you down for that reason will need to face their own flaws. Remove that from your shoulders. It is not your burden to carry. Imagine if you were to stand alone and be made fun of and there was no one to stand by your side. Know that those that stand their ground and help others stand their ground are always the strongest.

Right now in our state and in our country, people are standing together. They are protesting what happened to Mr. Floyd. Mr. Floyd died because racism is real and because he is a Black man. In no place is this the right thing to have happened. Mr. Floyd is not the first man to die because he is Black. But this should never happen. This should never happen. And now, we have hit our rock bottom with Mr. Floyd’s death. So people are standing by their friend. They are saying this is wrong. They are demanding that no person like Mr. Floyd ever be subject to extreme punishment or death because of the color of their skin. Some people are doing this with peaceful protest. Some people have turned to violence and destruction.

Now, I want to be clear. I never want you to turn to violence and destruction. Violence and destruction, no matter how mad, how angry you are, is never the answer. It is never going to be the right thing to cause more pain, put more people in danger, destroy things that people depend on like food and medications and people’s property and business that provide them shelter and their livelihood. This will never, never be accepted by your mom. Ever.

But I do want you to know that this is the time to open our eyes and stand with those that are standing by Mr. Floyd, Ms. Taylor, Mr. Arbery, Mr. Castile, Mr. Sterling, Mr. Garner, Mr. Scott and all the other people that were treated with brutality because of their color.

Max, Sofia, and Claire. I love you more than anything I can imagine. All these people that have been harmed because of the color of their skin also have moms and dads that love them more than they could imagine. I want you to be part of the good in the world. The healing and the strength, because I need as many moms and dads hearts to be protected as possible.

Our country is at its rock bottom. Let’s be part of the rise. It starts now and it starts with us, my loves.





My Thank You to You

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.

Revolving Worlds

My twins were two years old. My husband and I were leaving for the first time for an extended trip. I can’t remember the details of where we were going or why. What I do remember is the deep ache that ballooned in my chest as we rolled our luggage to the garage door. Their little faces with red-rimmed eyes and Rudolph the reindeer noses, tears smeared across flushed cheeks as they wiped them on our pant legs. Sticky hands grabbing at our hips begging to be clutched tight and not let go. My heart pounding and willing the rest of me to protect them from their heartbreak.

Since then, I’ve realized that those instincts to shield them from hurt and that unraveling that starts in my chest and billows through to my toes as I see them in pain will always be a part of how I mother, but even back then, I knew that leaving them to honor other commitments was part of parenting. A good part of parenting.

As parents, our greatest desire is to ensure our kids know we love them. That we are here for them. That we are present and we support them. In this world that goes a mile a minute, it is hard to feel as if we are giving them our undivided selves, because that is simply not reality. We are divided. We are divided with our professional careers, with upkeep of our homes, upkeep of our daily lives with groceries and meal-planning, with upkeep of our relationships with extended family and friends. Like an elastic toy, we are stretched to extremes, each corner pulling us hard in every direction. Our hearts tethered in the middle like the mid-section of a well-worn tug-a-war rope. 

But this is okay. This is truly okay. This is better than okay. This is what we should be showing our kids. I remind myself to let go of the guilt of being a mom with multiple shoes to fill. I’ve allowed myself to invite my kids into my world rather than living in their world.

I allow them to see how dedicated I am to the things that color my life and make it full. I show them that I am one hundred percent committed to my profession. I tell them about my patients, about what I did during the day. About what was hard, about what broke my heart, about what was exciting or astonishing, and what made me proud of what I did at work. I tell them when I am excited to take a trip with their dad or go on a date night. I tell them when I am having a girls night with friends and how girls nights with my friends are just as fun as when they have play dates with their friends. I bring them along when we drop off things for someone in need and tell them how important it is for us to not only show up for each other but also for our community. I let them know when I am going to exercise and remind them that this is time when I need my complete space to just help my body stay strong and healthy.

In each and every one of these moments, I am taking time away from my kids and giving it to another part of my life. What I want them to see is that I love them and despite them being my greatest priority, my life does not revolve solely around them. That this world does not revolve around them. There is a world outside of them, starting with the world their very own mom lives. And outside of that, there is a greater community thriving and breathing. I want them to see the importance of independence, self-sufficiency, and working hard. I want them to realize I will always be here for them. I will be their safety, their net. That I am their greatest support, but I am also so many other things to so much else in this world. They are the most enriching part of my life, but there is so much more that fills it up and makes it whole.

And this is okay. This is better than okay. 

Now, more than ever, the mom-guilt can be crippling. So many of us are working from home and having to divide ourselves without the help of physical space to have our kids in school and us in our work buildings. Now more than ever, we are aware that our kids are in need of our attention with home-schooling and being all ever present at home. We are having to tell them to wait their turn as we focus on other obligations. The glare of our inability to provide them with undivided attention is fierce. The shadow that this guilt casts on us inevitably grows taller and more pervasive. I definitely have found myself more irritable, brisk, and wild-eyed at my kids on a more frequent basis, but I try to remind myself that it’s okay to ask my kids to be patient and to let them see that there are other priorities that matter.

They will always be my number one, but that doesn’t mean I can drop everything to cater to them with their every desire. You are here. You will always be here for them. But let them see you in all your color and life. They are watching, and they will learn from this. They will see that you are strong, self-sufficient, and upholding your value as your own self, your value in your family, and your community. As their mom, they see you as one of the strongest presence in their life. What a beautiful thing for them to see you as the whole person you are.

I know there is guilt. I am right along you with the daily ugly mom-moments that we criticize ourselves harshly for. But your kids know you are the foundation of love that underlies all of this daily noise. They know you are theirs and them yours. Even on your lowest days and hardest moments. Give yourself grace to work through this day by day, and know that there is tremendous strength and beauty in letting them into your world and not just revolving around theirs.

This New Path

The alarm pierces our slumber. We step into our starting blocks, leaning into the fire that is about to burn in our muscles as we sprint into the day. Round and round the track we’ll go. Get kids ready for school. Breakfast. Homework. Lunches. Gloves, boots, snowpants. Backpacks. And did you brush your teeth??? Out the door to the bus stop.

During the day, we continue around the track, whether it be at work or at home. The kids get home and it’s a snack, our cackling voices rushing them along, hurrying and getting them ready for this activity and that activity,out the door, picking up this neighbor for carpool, remembering your daughter’s water bottle and favorite stuffed panda, your son’s baseball glove, bat and helmet, your other daughter’s dance shoes or choir book.

On Friday night, maybe there is an occasional date night. Maybe a family grill out with close friends. Maybe your daughter’s hockey game to sit in the stands and hoot and holler for your team with all the other fellow parents. Sunday brunch at your favorite bustling spot. Sunday night, you ready for another push through the week. Pack bags, homework done, and then all over again.

We heave and we push, and around the track we sprint. It seems the pace never slows, and it is seemingly never ending, doesn’t it?

It seemed never ending, didn’t?

Now. Now we settle. We scramble to figure out this new homebound life. We blink hard, take a deep breath, and adjust.

School is cancelled. Activities are cancelled. Commuting to work in an office building is cancelled. Social events are cancelled. Sporting events are cancelled. Choir concerts are cancelled. Our sense of physical social togetherness and community is cancelled.

Our anxiety heightens as we watch daily reports of illness rise. The death tolls rise. We worry about grandparents. We worry about are loved ones far away. We worry about those that are less equipped for illness, for this financial crisis.

As if in a dream-like state. Is this real? Are we truly on this ledge, scampering for resources to prop ourselves up? Desperately trying to keep ourselves protected and from losing our balance and tipping over?

We count the days, the hours, the minutes. They change as quickly as they arrive.

I feel undeniably thankful for the role I have been given in all of this. To love and protect my family and friends. To extend support to my community. To care for people in need. At times, these exact privileges overwhelm me with great anxiety and exhaustion. At times, I am beyond grateful for this life my husband and I are so lucky to live. At times, I count down the minutes to the end of the day and break down in tears because I don’t know how else to process my emotions. At times, I feel ashamed and guilty about my own reactions, feeling what I am doing is largely not enough. That there are people struggling with so much greater than my anxiety, like where their next meal will come from or how they will continue to provide a sustainable life for their families.

I share all of this with you to let you know that you are not alone. It is okay if we all have moments big and small. High and low. It is okay if you suddenly have tears in your eyes and feel like you don’t have it all together. We have all been there. It is also okay if you are secretly happy to slow down with no one to rush, to enjoy your family at home, and stay in your pajamas all day.

None of us have ever done this before and there is no wrong way. Give when you can, support your community as you can, reach out for all those exact things when you need them too.

Most of all, be gentle with yourself and allow yourself grace.

As my family and I step off the track and put the starting blocks aside to walk down this much slower, open path that is yet to be paved, I am overcome with all the emotions. The joy, the peace, the anxiety, the wearing of my patience, the exhaustion, all of it. Some days are better than others and some days are a revolving kaleidoscope of all the feelings.

Let’s support one another. Does your friend mama have a color-coded home school schedule complete with solar system diorama and clay ceramic-making art class? Like what. That’s freaking amazing. Did your other friend mama splurge and subscribe to Disney plus and three new video games to occupy her kids? Awesome! How much fun for them.

Let’s allow one another to do what we can as we try to find our new footing. Let’s acknowledge that we will feel how we feel and let it be okay and enough. Let’s meet each other where we are and gently, steadily, with so much love, we will get through this.

Dance Moms

Dance Moms. Just that simple two-word title triggers guttural reactions in most.  It stirs up connotations of a middle-aged woman with frumpy hair and stretchy pants.  A coffee in one hand and an extra-large can of extreme-hold hairspray in the other.  It stirs up connotations of a once-was, or even worse, a never-was dancer way past her prime beaming on stage left, clapping emphatically and slightly maniacally for her daughter. It stirs up images of this shiny, bedazzled daughter of hers in a starch-stiff tutu adorned with silver sequins, hair in a high bun matted concretely to her head with an entire squeeze bottle of gel and bright pink lipstick outlining bright white teeth.

I know what you think. I know what you see.  It makes me laugh, because at times, when I’m not paying attention, I could mistakenly see what you see.  Those Dance Moms!  But fortunately, I’ve realized what Dance Moms really are.

My daughter was five when she announced she was ready to join her friends in their rhinestone leotards accessorized with large, bobbing, sparkling hair bow headpieces on that dance stage.  I shrugged my shoulders.  It wasn’t different than anything else we had tried.  A summer camp of basketball here.  A community T-ball season there.  A high school led soccer class there.  Dance?  Sure.  Let’s do it.  I went into it with no idea.  I imagined it would be a class once a week, and an adorable recital at the end of the year.  What’s the harm in that?

I imagine this is how most Dance Moms are created.  Eager moms and dads in this helicopter-parenting era, ready to encourage their sons and daughters in yet another endeavor.  Was I crazy to consider this?  No.  Ha.  I was just a sucker like the rest.

And so it began as I expected.  We signed up for a recreational dance class.  One class once a week.  A recital on the horizon.  My son joined too.  Why not?  But it wasn’t long before my daughter was invited to join the competition world, and my son, wise beyond his years, sniffed that there was something not for him about this place we had been bringing him every Thursday, and graciously bowed out.

Competition dance? Most definitely!  Why not?  My daughter smiled from ear to ear.  It sounded like a fantastic idea.  Slightly more rigorous classes with a couple competition weekends thrown in here or there?  Yes.  She was on board.  I was on board. This sounded like a great idea.

Ha.  Sucker.

I’m not quite sure where to start without diving right in.  Competition dance is not for the faint of heart.  It is for the diligent, the passionate, the committed. Because there isn’t anything that I have done on behalf of my children in these early years as a parent that has defined commitment as much as dance has.  It is a pure labor of love the things I have found myself doing that I never, in a million lives, would have imagined myself doing.

Putting 186 rhinestones on one dance outfit?  Been there.  Sewing appliqués onto sequined tiny tops?  Done that.  Wrangling my seven-year-old daughter’s long, straight hair into two perfectly tight buns on top of her head at 4 in the morning? Yep.  I’m raising my hand.

But here’s the truth. The real truth.  Underneath all those superfluous, flashy distractions you see on the surface is hard work.  So much hard work.  I’ve never seen girls this age work like this.  These girls that commit after school evenings to dance class then practice at home on their days off.  These girls that show up at 6:30 in the morning on a competition day and do not go home until 11:30 at night, only to get up at 6 am the next day, and do it all over again.

I remember one moment last year—my daughter was 7 years old.  She had literally been at a competition going on hour 14.  And there she was, doing cartwheel after cartwheel after cartwheel across the gymnasium practice floor.  Why?  Because she was loving every single minute of it. The early mornings, the late nights, the long days, the dance after dance with costume changes and intricate hair changes, she did it all because she was exactly where she wanted to be.

This past weekend, my daughter, now eight, had a full day of competition, snuck in a six-hour night of sleep, and at 6 am the next day, was up and ready for the next day of competition.  There was no complaint in any of her still-waking-up muscles.  She sat straight as I pulled her hair into a tight high bun.  She proceeded to go on to stretch, practice, and compete, giving it her all.  And every time I witness her in one of these moments, I just know.

This girl.  This girl of mine has grit.  All these dancers have grit.  They have passion. They have so much love for what they are doing. They are determined and strong and have so much bravery to go on that stage with those blinding stage lights and perform.  There is no doubt in my mind, that I am that mom standing on the sidelines, clapping emphatically, and yes, yelling slightly maniacally for my daughter.  For my friends’ daughters.  For my daughters’ friends.  I do this not because I was never a dancer and I am living vicariously through the powerful grace of this gorgeous girl of mine, but because I know what it took for her to get here.  The hours, the commitment, the practice, the right attitude.

I beam and can’t help bubbling over not because I see my life through her, but because I see the life this brings to her. I follow her around with extreme-hold hairspray, because that is the very small part of the competition that I contribute to in this bigger lesson I hope she is learning.  Work hard.  Work so hard.  Don’t forget the details.  Know that effort pays off.  Acknowledge that you are exhausted, but continue to carry yourself with grace and do what needs to get done.  And if your emotions get the best of you, let them come, and then let them go, and then pick yourself up and find your strength again.

This is what it means to be a Dance Mom.  To be the grit behind the grit.  Make no mistake—my daughter and her dance life do not define me, but part of who I am is most certainly Dance Mom. I am the support beam behind a very brave girl that feels empowered to live her passion and most importantly, is learning the importance of work ethic, a good attitude, and where it can get her on that stage and beyond.

To all my Dance Moms. I’ll happily and proudly be called a Dance Mom right alongside you.

And. Make no mistake. I am wearing stretchy pants.



Bring Your Daughter to Work

It was one of those slippery moments of working mom-hood, when childcare slipped through, back-up childcare slipped through, and I was left at a crossroads.  How do I get myself from point A to point B and what do I do with my four-year-old in need of supervision?  Thankfully, my day of commitments was a day of meetings.  A day of meetings was far more flexible for me than a shift at work seeing patients.  That would have been more of a figure-it-out, you-must-show-up-to-work no-nonsense scenario.  At least with these meetings, I could call-in, though it wasn’t as meaningful to just call-in.  But what other choice did I have?

I sat there, my morning coffee already heading towards its lukewarm destiny.  My four-year-old in her shimmery batman dress and cape, crawling in my lap, the crayon in her hand daring to leave marks on my sierra sand colored couch.  And as I sat there in a silent tantrum, not wanting to miss my department meetings, but feeling as if I had little choice, it dawned on me that there was an alternative.  I could just bring her with me.  I compiled a list of ways to approach this.  I could shoot my boss an email and apologize and let him know I was bringing my daughter.  I could show up with her and apologize and explain how childcare fell through.  Or, I could just show up with my sidekick.

I watched as my four-year-old mimicked my every move.  Sipping her milk and declaring how her coffee was hotter than mine. Drawing a panda version of me, picking my favorite blue color for the panda’s belly.  And at that moment, I decided there was truly no other way to show up than with her at my side.  Unapologetic and with assertion.  Because there was no denying that this is my life: I am a mom and a physician, and I care about both and I will show up for both the best way I can.  And more importantly, this is what I want my four-year-old to see with her little eyes.  I want her to know the unique privilege of being a woman. I want her to see that we can be parents and also contribute to the workforce. It may be a balance to strive for, but we do it the best we can.

The best way I can today means a purple backpack with daffodils stuffed with my iPAD with downloaded Disney movies, pink kid headphones, my daughter’s Leap Pad, a pencil bag of crayons, coloring books, snacks, a rainbow unicorn water bottle, and a stuffed animal.  And my hospital work badge.

So, that’s what I did.  It was a meeting I prioritized and if it meant bringing my daughter, then that is exactly what I would do.  No apologies.  This is how it is.

My little spunky four year-old, sat at my feet, because laying on the ground watching a movie was more fun than sitting at the rectangular shaped tables in stiff conference room chairs.  She watched episodes of Doc McStuffins, part of Sing, she played some preschool app games, she colored, she drew, she ate cereal, she only needed a potty break twice.  And all the time, she knew I was right there part of her world and part of my work world.

It felt like a small victory, but a victory nonetheless.  I chose to bring my daughter to the meeting because the alternative was missing out on important decisions, updates, and discussions.  I brought my daughter to the meeting because daycare is unpredictable.  But mostly I brought my daughter to the meeting because I wanted her to know that this is unapologetically who I am.  A working mom that certainly doesn’t have it all figured out, but is managing the best I know how.  I want my daughter—and all sons and daughters for that matter—to grow up tearing down the judgment and stigma that follows that of a working mom.  We can work, we can raise a family, and we can do it with no less confidence and competence than the next person.


Finding Margins

This weekend was like any other.  Kids’ activities, work, home improvement projects, social gatherings to allow ourselves the joy of connecting with other adult human beings.  It was a fluid mix of “I’ll drop off here and meet you there and so-and-so will pick up there.”  All the pieces like well worn, slightly beaten up and bent puzzle pieces. That subtle mix of knowing all the pieces should fit exactly as coordinated with that undercurrent of anxiety that we may get to the end and one piece will have gone missing from the tattered, but structurally sound box of collected pieces.

It seems astounding that every fifteen minutes, ten minutes, five minutes, three minutes counts in this interweaving of a family’s schedules.  There was the moment when I was getting ready for work; my husband was corralling our son and youngest daughter out the door to pick up our other daughter from a birthday party on the way to bring our son to baseball practice.  With thirteen minutes on the clock until the end of the birthday party and twenty-eight minutes until the start of baseball, he pulled out all the ingredients for beef stew to throw into the pressure cooker.  Beef, potatoes, carrots, soup mix.  I looked at him wild-eyed.  “What are you doing??”  “Making dinner” . . . with the kids climbing in the car and thirteen minutes until pick-up.

No. Just no. Go.

So. There are countless moments like that.  The wind tunnel that funnels us mercilessly in forward motion as time lapses quickly and impatiently.

These are not the moments that keep me fueled and running.  No, not these harried punctuated moments of start times and end times.  But instead, all the hidden, quiet in between moments.  The Margins.

It’s peeling myself out of bed twenty minutes before the slumbering haze of morning lifts to make coffee, shaking off the dizziness of sleep and orienting myself towards the day ahead, and maybe even catching a glimpse of the sunrise.  It’s the pain of getting my four-year-old to hockey early on a Saturday morning, only to find myself sitting solo, in silence, with nowhere I’d rather be than on those chilly bleachers, hugging my thermos of caffeine while watching with fireworks of pride as my daughter’s tiny four-year-old body glides across the ice with fierce determination.  It’s the forty-five minutes after lunch and before baseball on Sunday that I chose to sit and read and not scramble and trip over household chores while my two eight-year-olds built Legos.

It’s intentionally clearing space on these tightly organized, highly chaotic days with a myriad of demands.  It’s finding these margins and allowing myself this time to be present.  It was in that brief forty-five minute margin when my eight-year-old son asked me to help him find that one specific blue Lego piece in the sea of Legos.  I was startled by my own reaction.  My usual irritable, impatient, don’t-you-see-I’m-busy self was cast aside, and to my own shock and astonishment, I put down my book and helped him scour all the piles of tiny Legos.  With not even one iota of a mumbling nag of how he needs to keep track of his own things. We searched for a solid handful of minutes.  When we came up empty pile after pile, he finally conceded and said, “That’s okay.  I’ll just use something else.”  He paused pensively, and with sincerity added, “I love you mommy.”

That moment hit me. It confirmed to me that margins matter.  By choosing to create space to allow the impossible finding of a Lego to be my way of seeing my son—that moment mattered as much as, if not more than any other moment.

Margins—the clearing of space and time to allow and acknowledge your presence and the presence of others.  The time to be thankful that when we strip away all the orchestrated to-do’s, must-do’s, should-do’s, scheduled-do’s, that we see each other. That we see ourselves.  That we see our kids.  That we see our friends.  That we see our partners.  That we see those we love.  That we appreciate ourselves not for our busyness, our achievements, our productiveness, but for just being me.  Being you.  Being us.

I’ll keep finding margins because they matter.  They help preserve my stability, my sanity, my fuel for the rest of it all.

She’s Back

There is a list of names in every Emergency Department that is well known to each individual that works and fuels that ER. And I’m telling you, it is never a good thing when you are the patient with the name that we immediately recognize upon popping up in our waiting room. For the most part, it indicates that you are chronically sick and chronically in need of emergency healthcare.  This runs the gamut of chronic illness.  You may have a weak heart that frequently gets overloaded and you end up short of breath with fluid filling your lungs.  This may mean you have failing kidneys that cause your electrolytes to go dangerously high as they cannot be filtered through your kidneys. This may mean you are an alcoholic with poorly managed diabetes coming in with abnormally high blood sugars. This may mean that you have mental illness that causes unmanageable panic attacks or leaves you feeling unsafe and suicidal.  This may mean that you have chronic pain and frequent exacerbations of uncontrolled pain.  This may mean you are addicted to narcotics and doctor shop for refills on pain prescriptions. This may mean you look for providers that will give you IV medications to give you the high that some pain medications can provide.  Whatever the reason, a familiar name in the Emergency Department is never a good thing.

On this particular day, I stepped into the chaos of an already bustling Emergency Department.  My colleagues mid-hustle, moving swiftly and deftly about the chaos of a busy day.  And there, waiting to be seen was a name I was all too familiar with. She is a mother, a wife, a member of our community, a person who struggles with mental illness and self-harm.  Triggered by events that send her stress into an insurmountable wall.  I don’t pretend for one second to know what she lives through on a daily basis.  I don’t pretend to understand these uncontrollable urges.  I don’t pretend to understand what it must feel like to come to the same emergency department, see the same healthcare providers, anticipating how they may react, judge, or act. I don’t pretend to comprehend how difficult, how humiliating, or how much courage that must take. What I know is that she comes into our emergency department on a regular basis with undeniable self-inflicted wounds that take a prolonged period to repair.

There was a time when I called for social services every time she came in.  She always gently declined their services.  Even when they came to talk to her anyway, she dodged and ducked out of their way.  She will assert how she has a therapist appointment right around the corner. That her therapist knows she is here.  That she is working through some very hard things.  I’ve called her therapist on occasions and she has corroborated what she has told me.  It is a difficult case, her therapist tells me.  During one instance, she was admitted to the hospital for a more intensive mental health evaluation and management.  It turned out, this only snowballed her mental illness and made her spiral deeper down a dark hole.

I’ve seen her enough to know she means it when she says she is not suicidal.  She often greets me cheerfully.  Talks about the weather, about her day and her week and her kids, as if she wasn’t there for self-inflicted injuries, but just for a regular slip and fall. In the same conversation, she gives instruction and suggestions on how she would like her repairs done.  I slow my breathing and try to wrap my head around how I should act.  This is not normal and I cannot help her normalize this behavior.  On the other hand, she is a mother, a wife, a member of a community that is deserving of basic human courtesies and respect.  She is a human being that is struggling.  Struggling so hard to just live a daily life accepting all the triggers and finding a way to assimilate them in a healthy fashion.

If I am being one hundred percent honest, it can be hard for us with patients we see frequently to not see them through a lens of judgment.  The patient with a weak heart that is on a low salt diet that eats ham and gravy over the holidays with his family.  The patient with failing kidneys that routinely misses one or two rounds of dialysis and is in need of immediate intervention to ensure his heart doesn’t go into a lethal rhythm.  The alcoholic patient that has uncontrolled high sugars and will continue to drink when he is discharged from the hospital.  The young patient with debilitating anxiety convinced he is having a heart attack that comes in monthly to have it checked and is in need of persistent reassurance.  The patient with chronic pain that comes in with abdominal pain regularly and requests large doses of narcotics.  The patient who has been to every Emergency Department in the local vicinity in the last week, accumulating narcotic prescriptions, who yells aggressively when confronted.  My patient who inflicts harm on herself on a regular basis and wants us to do nothing but fix her wounds.

It is easy to make quick judgments. It is easy to feel as if they are less than.  It is easy to push all the fault on their shoulders.  But who are we to judge?  We come from a place without heart failure where we can excitedly enjoy an unrestricted holiday meal when reuinited with our families without worrying about our breathing.  We come from a place without three day a week dialysis, a place where we are sober, a place where we are not crippled with anxiety, a place where chronic pain doesn’t have a vice grip on our lives, a place where we haven’t fallen to the addictive properties of narcotics, a place where we have never experienced or worked through mental illness that urges us to harm ourselves.

Who am I to judge? I am no different. I am a person with my own issues; I am just exceedingly lucky my issues do not lead me to the Emergency Department on a regular basis. So, I’ll work harder to challenge myself.  I am not here for judgment.  I am never here for judgment.  I won’t fault myself for being human, but I will check myself and know the bottom line is that my patients are in need.

They are in need.

Whatever that need may be, in the Emergency Department, we are better equipped to help them navigate it at this moment than they can do by themselves.

That day I took a deep breath.  I checked my judgment.  I repaired all of her injuries.  The Emergency Department outside her room was bursting at the seams, but she deserved my full care like everyone else.  It took me about an hour.  I looked her in the eyes, mother to mother. Wife to wife.  Human being to human being.  I asked her openly if there was anything else I could do for her today.  “No”, she said.  “That is all.”

Never How it Should Be

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When a baby arrives dead in your emergency department

When a baby arrives dead in your emergency department

When a baby arrives dead in your emergency department

The world stops. You stop breathing. You are gasping for air.

She is limp, she is cool, she is pulseless.

Chest compressions on the tiniest 6 month old I have ever met are done with the finger pads of my index finger and middle finger. Quick, synchronized beats. I look at her blue, blue lips. It should never be like this.

Her eyes are fixed and dilated telling me that she has been like this for quite some time.

We stop and check for a pulse. No pulse. Chest compressions resume, we work to put a tube in her mouth to help her breathe. It is how I imagine a doll’s airway must look like. Stiff, tiny, a small pink flap over the throat.

There is a cool calm, a cool horror, a cool this-is-never-how-it-should-be. We work deftly to bring her back. But she is gone. She was gone before she arrived. She is gone now. She is gone.

There is hysterical sobbing heard by the family. Our insides are gutted. Our hearts, shattered. But the emergency department keeps pulsing, and we need to keep it afloat.

I meet my nice gentleman with the irregular heart beat in the 160’s. I check on my patient with the migraine headache. I discuss at length with my patient with the extraordinary high blood pressure and horrible headache the need to do a lumbar puncture to rule out a head bleed. She ultimately leaves against medical advice despite my coaxing and persuading. I evaluate a diabetic with intractable vomiting and abdominal pain. I see a sweet woman with severe pain who is now wheelchair bound and whose 80-year-old husband can no longer care for her at home. His shoulders relax and his eyes sigh in relief when I tell him I am going to admit her to manage her pain.

Throughout all of this, the weight of a dead 6 month-old suffocates me and holds me captive. My heart is in pain, and I am devastated, and this is too catastrophic to set aside to mourn later, but I do. I do, because this is what I do. This is what we do.

I’ll never forget walking into this. That sweet purple, lifeless, limp 10 pound baby on a huge white stretcher. The tiniest of chest compressions giving her heart an external beat. For those suspended moments in time, she was all of our child. We loved her, we ached for her, we didn’t want anything to harm her. We will all weep in our own ways over the days, weeks, months to come. Not even the usual armor that we constantly garner will keep these feelings at bay. This is one that will rattle us. Keep us jarred.

Because there is nothing natural

When a baby arrives dead in your emergency department