5 years later

Somehow five years have passed since I finished residency and since my dad's retirement party (though he had the party, he has yet to fully retire). The passage of time is a funny thing...often when I'm running behind in my clinic schedule or when a patient arrives at 10:30 for their 8:15 appointment, I'll say something about time being a social construct or, "What even is time?" One of my coworkers and I often misquote Friedrich Nietzsche by saying, "Time is a square circle," which is our way of saying that time is meaningless or nonsensical. (I have just emerged from a deep dive into the Friedrich Nietzsche Wikipedia page where I learned or was reminded that the actual quote is "time is a flat circle" meaning essentially that history repeats itself.)

Philosophies about the nature of time notwithstanding, for some reason I've decided to write a post. (Incidentally, I now have a 3-year-old daughter who occasionally uses the phrase "for some reason.") I started working at the Community Health Centers of Burlington in August 2016. Despite the quotidian challenges of working in primary care in a medical system that puts all its resources into tertiary care (in spite of clear evidence that increased spending on primary care improves health outcomes), most days I really enjoy my job. I have wonderful colleagues, and I get to work with a fascinating and diverse group of patients, from a 95-year-old who has lived in Vermont since she was born to a newborn first generation American whose Somali mother recently immigrated to the U.S. after 20 years living in the Dadaab Refugee Complex in Kenya. I get to share their joys (welcoming new babies into the world!) and their successes (quitting smoking, getting a new job, becoming a U.S. citizen!), often caring for multiple generations of the same family and figuring out the connections and relationships among people I meet individually. It is always humbling and simultaneously either inspiring or heart-breaking to be trusted with people's stories. I will never cease to be amazed by my fellow humans' capacity for both abject evil and great resilience. 

Today, I was talking with a colleague who has recently learned of the untimely losses of two of her patients to what have been called "deaths of despair." We reflected on the suffering and tragedy that we so often see, often as a direct or indirect result of trauma. Visible and invisible wounds inflicted on a person by the horrific actions of other people beget more horrific and tragic actions: a cascade of trauma from one generation to the next. As I was walking to my car after work, I got a call from an ER doctor who was letting me know about one of my patients who was there following a terrible incident which I believe occurred as a result of their exposure to the trauma of a civil war. The ways in which people respond to trauma vary, but as psychiatrist and trauma researcher Dr. Bessel van der Kolk posits, "the body keeps the score."

It can be easy to fall into a pessimistic or fatalistic view of the world when, day after day, one hears of the awful things that people do to one another. But there are also so many kind and thoughtful people who are working to make things better. When I start thinking that humanity is irredeemably flawed, I try to turn my thoughts to the wonderful people I've met who are now scattered around the country and the world. There are those with whom I have only crossed paths briefly but whose warmth and motivation continue to inspire me. And, even if I don't get to see or interact with them regularly, I think of how grateful I am for their existence. How happy I am that the world has the benefit of such beautiful souls so devoted to helping others. 

I also try to remind myself of my belief that we all have capacity for both good and evil actions and that "each of us is more than the worst thing we've ever done." I try to retain optimism while retaining the motivation for action; all the positive thoughts in the world won't help anyone without thoughtful and timely action. And yet, some days, between work and two young kids, it feels like there aren't enough hours to fit in everything that needs to be done. So I'll keep doing my best and keep misquoting Nietzche. Time really is a square circle.

Overlook Park - South Burlington, VT