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Personal Essays

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Kinship Amidst Cacti


The desert around Tucson is not what I imagined. 


You can tell from far above that there is little water here, and few places to hide from the midday sun. There are yellow grass clumps and wandering bushes of creosote, whose feathery leaves cradle gray furry beads. There is chapparal, low clumps of cacti, an assortment of dusty greens and parched plants offering colors that aren’t evident from a distance. And above the riotous sea of scrappy vegetation, saguaro cacti rise with admirable confidence, each standing resolute and solitary.


For all that I worry about the lack of water, I find myself awed. Much more than scrub brush and desolation, this desert thrums with variety.


I meet up with a group of women I have not met in person before. This is a phenomenon of the times we live in: I have “known” them online for the better part of four years. We are doctors who love horses, who offer one another the kindness we thirst for in our professional lives. We who know what it takes to care for these sensitive animals also know we get back more than we give to our equines. We cannot say the same for our work. 


We hunker here in the shade of porticos, eyeing the trail horses we might get to ride, talking less of medicine than of the mares and geldings we left behind, our riding aspirations, the difference in climate between home and here. 

We ride together, the horses nose-to-tail as we share stories, awed by the close-up sight of the saguaro – those iconically tall emblems of the desert – that are hundreds of years old. Scarred and hardened by the elements, they remain undaunted. The soil beneath them is bleached white, seemingly bereft of moisture. They still bud new limbs and reach for the sky. 


Gradually, as the dust makes its way into our pores, and we bake under the same sun for a few days, the talk turns toward what we do at home, the patients who trouble us or make us laugh, the strain of feeling trapped in a profession that often feels thankless. 


Multiple times a day, my eyes sweep this dry landscape, picking out the many greens and golds and noticing how the plants and cacti arrange themselves to fill space, to stand apart and yet together. Viewed from a little elevation, it’s evident that even the independent saguaro belong here.  


Like the flora around me, the women I meet are individuals: gritty, strong, capable. The dirt may be so dry it crunches underfoot, but to look at the plants, you would not know it. I worry that our climate warming will reach unsustainability; one could argue that in an ecosystem of for-profit practices, our medical system is similarly doomed. But I draw inspiration from the alliance that blooms here, however improbably.


The sun sets in November like it has someplace to be, pausing ever so briefly to add a golden tinge to the landscape. Before disappearing, it offers a kind of halo around the saguaro cacti, illuminating the spikes from behind like fine little hairs, offering each cactus a glowing outline above the mottled scrub beneath. That their thorns are also their beauty seems fitting somehow; as apropos as the invisibility of the scabs on their skin with the sun at their backs.


The moment is breathtaking, and then it is gone. If not for the women beside me, I might suspect I imagined it. If not for the women beside me, I might suspect I am the only one feeling like medicine and the desert have a lot in common. 

Fall 2020


Three times in the last week I found myself walking the trails at Hidden Falls, entranced by the way light illuminated yellow leaves behind black tree trunks, the way the sun hovered low even in the morning, even at midday. The grass was dead, but new shoots were already showing, making the ground sometimes dry wheat-colored and then again, green with promise. 


I felt myself alternately worried and optimistic, confused by the juxtaposition of what I knew to be happening elsewhere against the sensation of wandering freely in the woods, breathing in the smell of damp soil, moss, granite, leaves. Sometimes my way was shadowed by a hillside, chilly in the shade; then without warning the trail would cant upward, letting warmth bake my cheeks and relax the swing of my arms. Often my mind traveled the paths it knows too well: the precautions we can take against a virus, reasons the children should go to school, how to handle a holiday and friendships and keep my parents safe. But not always. An unexpected rustle in the dry leaves made me muse about the loud sounds made by small threats: a squirrel in the brush is much louder than a mountain lion’s approach.


Yesterday was different, not only because I chose to explore on horseback, but because I thought I had grown tired of those well-loved trails. Instead of continuing on my route as usual, in a little-used corner of the park I veered right and let my horse run. Eyes watering, legs burning as I held on, I felt her surge first to a gallop and then to a breakneck speed, haunches tucking under with every stride as she powered us on. She didn’t care where we were going. She was running for the sheer joy of it, wind on her face, freedom fueling her long-legged stride. 


When we topped the hill and had no choice but to slow to a trot and then a walk, breathing hard but still basking in the exhilaration, we turned back to the loop we had started. I’d be lying if I didn’t admit it scared me, hurtling over rocks and sticks with only my trust in those 4 skinny legs to keep me afloat. But I realized, as we resumed our trek, that my mind had been forced out of its rut. Reluctant as I had been to take this journey, pulled on by the thousand things I needed to do to make my upcoming work week go smoothly, I had found what I needed most: a complete and total distraction. 


Not everyone is an adrenaline junkie. Many can meditate, whether sitting still or in the hypnotic rhythm of exercise, or making music, or sitting down to write. I am ever surprised that a familiar trail can offer contrasting details each time I take it, even if I end up in the same place. What matters isn’t the direction I turn, or how fast, but getting outside at all. We are more than eight months into a pandemic that is worsening by the minute. We owe it to ourselves to offer breaks - offer beauty - to our ever-churning medical minds. 



Lately, in this time of COVID-19, I have come to think of decision-making like preparing soup. Maybe that’s because I mostly have time to think while I am cooking, but the analogy feels right. To the knowledge we have, I add the usual ingredients - a dash of prudence, a few shakes of perspective, a pinch of zest for living.  Then smell - have I considered the bitterness of the roots, the slow softening of the grain? What if there may be something in the soup gone bad? It’s likely okay; but perhaps if I am wrong, it could be fatal. Should we eat the soup? It depends. Do we have anything else to eat? Will the hunger be worse than the small chance we take by eating it? In real life (whatever that is), I might toss it and not take the risk. But in this strange simulation we are living, there may not be the ingredients to make another. 


The particular soup that prompted this essay is the question of seeing my parents. They are in their 70s and well enough to take care of themselves, but also fragile enough that COVID would likely kill them. They  have been careful, but they are getting tired of the isolation. They miss their grandchildren. They want to visit. 


And the answer should be no, or at least most would say so. But then, they live in a higher risk area than I. They could contract the virus and die from it (or something else) any time, not having seen us in 6 or 12 or 18 months. We would not be able to get there, and not be allowed to see them in a hospital. Which is the greater risk - leaving them where they are, or bringing them here?


The question could just as soon be youth sports - should I let my son play soccer? Are kids suffering unduly from the social isolation this virus imposes? How much risk is really involved in a brief face-to-face tussle for the ball - weighed against the importance of mental and physical fitness in middle school? Maybe too much. How can I know? 


Like so many other clinicians, I find myself pouring over the tidbits of knowledge we are able to glean from medical study, and from other countries. Separating out the bits that are digestible and putting them on to simmer, I trim off the stems and toss the roughage. Some ideas bought too long ago need to be tossed. The meat of the matter is taking too long to come off the bone.


Even in the office, I offer soup. Perhaps it reads like a menu, “We have a base of hand-washing and mask-wearing complemented by a hearty six feet of separation and chunks of advice on cleaning, heated to 170 degrees to release the aroma outside into the sunlight, where the vapor can dissipate readily and soup is most safely enjoyed.” 


But to the difficult questions, the what-should-I-do questions, there is often no savory answer. Knowing we lack evidence to go by does not make decision-making any easier. Instead of nourishment, I offer broth and a variety of ingredients. Everyone has to season their own. It is so much worse if the soup I make poisons someone. 


I am from many places. 

From a small college town.

From southern California.

From an Ivy League college.

From a position of ignorance.

From personal experience.


My parents are moving, finally leaving my childhood home - and their home of 40 years. They have talked about it for years, and the pandemic gave them the push to move closer to their children. The place I am most from will become someone else’s.


Their decision surprised me at a time I was truly occupied thinking about other things (coronavirus, the Blacks-Lives-Matter movement, work), and even when they bought a house near me I didn’t think much about it until they started talking about their moving date. 


Suddenly I felt a little bit of uncertainty, the ground rocking like it would in little earthquakes several times when I was a child. Truly, at my age, this is silly - I have lived at least 12 places since I left home over 25 years ago, 3 in other countries. But I have also returned more times than I can count, for visits short and long, digging toes into the soil of my upbringing. I have always known it is there.


I realize how exceptional it is that I have been able to revisit my childhood - a happy one overall - through so many years. That I have the place and all its creaks and peculiarities memorized does not make it easier to let go. Like a long-held belief, the complicated patchwork of memories and experiences and smells and feelings must be folded and put away. When I think of my parents I will no longer picture that child’s den of hiding places and culinary comfort, but a different house entirely, divested of the emotional landscape so familiar to me. 


How does a home become just a house again? 

How does a belief become just an idea?

Isn’t this something we all need to do sometimes?


My mind blurs the boundaries of what it is mulling over. I’ve been listening to podcasts about white fragility and anti-racism. I’m remembering my white neighborhood. My brown friend chased into our pool by my little dog, offering comic relief. Was that his way to fit in? We never talked race. My white friends and I sunbathed. We talked about nothing. How I loved that backyard, walled in and tucked behind houses, and safe. 


My parents are moving. 

A home can become a house.


Things that happened long ago are my roots, but not my anchors. In the national call for reexamination of how our society implicitly and explicitly supports racism, there is a similar call to let go of what we thought we knew. Across the country many are sitting back and reexamining; just as many are grabbing on to the childhood quilt of beloved beliefs and refusing to let go. 


It’s okay to move on. 

It’s time. 

The Baby Shower

A few months ago, I quit social media. It was absolutely the right decision for me - I needed my time back. So many little moments of beauty and consideration get skipped when my brain follows one feed after another and loses track of time. 


But every now and then, when I have ten minutes to kill, I will check in. Usually I go right to a group of women physician equestrians I am part of, or a pediatrician mom group, or physician writers. Sometimes a post I am “tagged”  in, and less often my randomly presented friends’ posts. 


Last night, before I clicked away, photos of a baby shower popped into view. Startled by the vision of so many people packed together for a group photo, indoors, maskless, I could not help but feel my heart sink. While the mom-to-be looked radiant, I could not help but feel terrified for her. And then angry. And then confused. Do they still think COVID isn’t real? 


Taking a step back, it’s true that most people do fine with COVID. They will survive and not even have lasting effects. How I envy them their confidence! I cannot be the only clinician feeling like Cassandra, warning of danger others don’t seem to see. Wanting to be right and not-right at the same time. Feeling left-out of the opportunity to gather with other people and be silly and carefree. I was invited to the baby shower. We all knew I wouldn’t go. 


It’s hard to sort through the feelings these pictures brought up. Months ago, when it became clear these were people who would insist on their facial freedom even in the grocery store, I felt hurt by their rejection of medical advice. Then angry: that my friends are people so selfish as to not think of others’ vulnerability when deciding not to wear masks. Frustrated that reasoning made no difference. Sad that our friendship may never recover from the rift in point of view. Intrigued by the confidence they project, and perhaps their greater acceptance of mortality. But no, I cannot accept making that decision for others. It isn’t knowledge that drives their decision, it’s faith in something wholly outside science. They simply believe themselves invulnerable.


Here’s the bitter pill: they might be right. Because I wish them well, I hope they are. But my pride wants them to be a little bit wrong, too. Most of all, if I am honest, I feel envy. Wrapped in our obligation to know as much as possible, we clinicians surrendered our bid for innocence long ago. I simply cannot suspend knowledge and go enjoy a baby shower, or a Christmas party, or even dinner with friends. Some days practicing medicine gives me wings. Sometimes it feels more like a cage. 


I have spent decades trying to marry spirituality and science. The problem is, while you can always gain more of both, the science can never be unlearned. 


So the only way forward - as it always is, with grief - is acceptance. We cannot control what people choose to believe, and we can’t deny what we know. They are living in the best way they know. So am I. It’s not about being right or wrong, it’s just sad we can’t be together right now. Life is humbling to all of us. Hopefully we will come together on the other side.

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