1 + 1 = -7

This year has been a son of a bitch for a lot of people I love.  Fires leaving hills burnt to blackness.  Hurricanes, earthquakes, elections, the fallout of the exposure of our American underbelly.  Life has not been easy.  Our private heartbreaks seem to pale in comparison, but they still matter.  Recently, I was asked kindly if I missed my old life. It was a life built on 17 years of memories and adventures.  It was a life built on a truly epic myth of connection, magic, and love.  I loved my myth.  Very much.  And when it ended and fell apart, as marriages do, there were many things that hurt.  The lies, the money lost, the affairs.  Those were the real things I could tell over a drink to the wide-eyed terror of those who had loved me and my husband.  What hurt most was the end of that mythical love.  But that is not what I miss.  What I miss most is much simpler.  When I was married, cocooned in the life I had built piece by piece, the world made sense.  1 + 1 = 2.  The laws that governed safety, that governed the future, that wove together the past and soothed the hurts applied to me.  They don’t anymore.  Now 1 + 1= -7.

What I miss most about my marriage is the security it gave me that the future was sure.  Things, literally, added up.  What was hard about being married fit in the equation.  What was good fit in the equation.  When I was bored with my life, it fit in the equation.  When I was frustrated, or happy, or excited, or scared, it fit.  There is a reason people stay in difficult situations.  The equation brings with it something that we need: safety.

And although divorce is common, the end of my marriage wasn’t.  It wasn’t the slow unraveling of love.  It wasn’t distance or fighting that drove a wedge so stiff that there was nothing left to save.  I was in love when I found out my marriage ended.  We were planning on adopting a child.  We were redesigning our house.  We were celebrating our anniversary.  And although the details of how this all ended are juicy and horrible, they aren’t interesting to me now.  What has become interesting to me, after a year of crying and smoking and surviving, is how to live in a world where nothing makes any sense anymore.

And right now, in some way, we all have to face this.  We have to answer an eternal question about impermanence.  I feel like the veil of safety was removed from my life.  And although it is scary to wake up to that, it is also much, much better than false safety.  The world is scary.  The world is violent.  People hurt us.  We hurt ourselves.  We are imperfect.  We are, most profoundly, impermanent.  Maybe learning to live with this is how we change what is broken in our world.  Because I have found that living in a world where nothing is safe, where nothing is real, where words are worthless, has made me much, much, much kinder.  I am easier to be around now.  It’s much easier to be kind when you have no idea what the future holds.

I was talking to a sweet friend who has held me down this year.  I told her, “I can’t get my feet on the ground, I can’t get traction, I can’t settle down”.  She said to me, “Honey, that’s because you are walking on water and you don’t want to get your birkenstocks wet”.  This has made me laugh for weeks.  Because it’s true.  If we want to face the world for all it’s bitterness and glory, maybe we all need to learn to walk on shifting ground. Impermanence may be the way we find a path to more kindness, more listening, and less judgement of each other.  After all, we are in this together,  whether we know it or not.

Glad to be writing again! May I keep it up.



Over the last two years, I have slowly stopped writing  There are a lot of reasons for that, but I think in general there has been a slow quieting of my life.  Writing used to be a way that I would express my thoughts and I felt entitled to share them, whether anyone read or not.  That has changed.  And I would like to tell you why.

I am a cancer nurse.  I am now a cancer nurse practitioner.  I am experienced in the world of bad news.  I am comfortable being with people in times of great sadness and confusion. I am also used to great escapes and great surprises.  It is the thing I love most about my job; living in the reality of a situation, being with people at these moments, both good and bad.  If only this had prepared me for my own recent challenges.  I have struggled now with fertility issues for about 1 year.  Although I understand the big chasm between fertility and cancer, there are similarities that are there that have struck me. I have kept very quiet about my struggles.  I have not shared about it.  I have felt great shame about it.  And now I am ready to talk about it  

Obviously, cancer is an incredibly stressful diagnosis to cope with.  Patients ask “Why me?” and the only answer is we don’t really know.  Patients ask “What did I do wrong?” and the answer is usually nothing.  Well meaning friends and colleagues who find out about a cancer diagnosis say dumb things without meaning to be hurtful.  The internet suggests magic cures that provide hope but also add to confusion.  The diagnosis of infertility is reported to be as stressful as the diagnosis of cancer, AIDS and heart disease.  My personal response has been the same.  Why me? Who knows.  What did I do? Definitely nothing. Friends say cruel things, the internet promises a cure in a pill.

What  I would like to share is what I have seen in my own experience and in the experience of my patients.  After 5 years of seeing people face cancer, I have been privileged to witness some of the lessons learned. Now that I have struggled, I feel that there are some similarities that are worth mentioning.   I have seen what we lose and I have seen what we gain.

What you will lose:

  1. You will lose some relationships along the way: This is true for me and for my patients.  Not all relationships are for the bad times.  And when I started managing this new challenge in my life it became obvious that there were people I loved that were not coming along for the ride.  Some people were blatant.  I told them, they stopped calling or reaching out.  Some people were more subtle.  I told them, they couldn’t relate and didn’t try to.  They made no room for me at the table to be in the place of challenge that I was.  My patients tell me the same thing.  There will be friends that will not or cannot  make room for you at the table.  
  2. You will be seen as a something to fear: This is hard to swallow.  In the midst of a scary diagnosis, you become something to fear.  People don’t want to be around illness.  My patients tell hilarious stories about still being whispered at “How’s your cancer?”  We laugh about this.  This rejection, this fearful judgement is something I now know. I have felt this when I overheard a conversation about someone who was newly pregnant and felt scared to tell me. I understand that this was well meaning, but to be seen as something scary because of what I was dealing with was alienating and sad.  And it made me not feel safe to share anything. If I was a fearful infertility monster, the least I could do was keep my mouth shut.
  3. You will lose your sense of the future: Everyone loves to plan for the future.  We spend most of our lives doing it.  A diagnosis like cancer or infertility puts all that on hold.  All of the sudden, the days and hours become much more precious and the future becomes much more unknown.  This can be disorienting, especially for those of us who have always been planners.
  4. You lose control of your body: What was once ours is now the doctors’.  We turn our bodies over to the shots, the meds, the procedures.  We turn over the implicit trust we have for our bodies over to a new trust in our doctors.
  5. You will be blamed:  No one wants to admit this, but limited people in your life will blame you. What did you do wrong? You were too angry? You were too controlling!. Healthy people will find a way to blame you. So with fertility issues you will be blamed. I once heard a woman explaining the failure of her friend’s IVF this way, “Well, she and her husband had so many issues with sex it was inevitable”. I don’t think I have ever heard anything crueler.  I hear this from my patients that some people subtly or blatantly blame them for their diagnosis.  Nothing, absolutely nothing, is crueler than this. 

What you will gain:

  1. Your A-Team: You will find that as the friendships that are not strong drop away, other ones deepen.  People you know will step up in ways you never imagined.  Siblings and  friends become more important than ever.  These people, near and far, in person or over texts, become the lifeline to sanity.  They will laugh and cry with you.  They will give you advice and listen.  They will celebrate and grieve with you.  They will reveal their true colors.  They will show themselves as the kind, loving, giving, awesome people that they are.  There were quite a few people who surprised me with this.  And this is truly one of the gifts of disease: the ones who stay are the ones who matter.  They are the ones that will make your life better and will make you stronger.  Who can really ask for more?
  2. A better relationship with your partner: Going through illness with a spouse or partner puts enormous strain on things.  But it can also be the cauldron that burns up the bullshit that ruins most relationships.  I think about the many spouses I have seen that lovingly care for their sick partners and laugh about the indignities of chemotherapy or surgical recovery.  This brand of kindness is exceptional to see.  It is also exceptional to experience.  My husband and I are kinder, sweeter, nicer and better to each other than I could ever have imagined.  This is the kind of blessing that I was not expecting.
  3. All you have is the present moment: With time slowed down and the future on hold, there is nothing else to do than notice how sweet life can be.  If I can get out of my head, then I notice the dew on the flowers, the sun shining, the beauty of a song, the sweet taste of food.  With a hard diagnosis, it often hurts too much to think and worry and there is only relief in the present moment.  I have always wanted to trust in the moment and now I do.  Now I know it’s probably the only thing I can do.
  4. Surrender:  In the end, a rough diagnosis is all about surrender.  Sure, we try to “fight” and we say “this sucks”, but the reality is the only way through this is acceptance.  Surrendering control to something larger, whether that is science or faith, is the only way to move through this.
  5. You will be a resilient badass: Bad news means showing up. There is nothing like a bad scan or bad labs to make you show up for your life. Only those of us who have been there know what it is like to walk out of a doctors office with bad news and feel the sun and think, “Ok, what are we going to eat for lunch?”  That is resilience. That is facing the day. I see it every day with my patients. I have been there too. 

I want to take a moment and say that I get cancer and infertility are two very different diagnoses. But they are still two things that are clouded with shame. My patients have shown me how to face hard news and continue to live. If you are struggling with a rough diagnosis, just know that you are about as badass as it gets. Nothing will make you stronger. Nothing will make you more vulnerable. 

Finally, I will tell you that I have recently had a miscarriage.  I was so lucky to get pregnant and we were so happy.  To have lost the baby after such a long struggle to get pregnant seems like a cruel joke.  But I know it is not.  I know that I am accompanied in this journey, even in this very hard loss.  I have my A-team, I have my faith, I have my partner and I have hope.  Even on the worst days, like today, I still have hope.

Thank you for reading.  Thank you for kindly hearing my words. If you have a kind word to share or some love for me, please comment.  I find that with this recent loss, I really need people to reach out.

PS: need help  dealing with infertility? I owe so much of the gifts and strengths I found to Rosanne Austin. Please check out her website: frommaybetobaby. 

True Grit

It’s funny to never write and then return.  I miss this little blog, mostly written just for me.  Thanks for reading, even if it’s only twice a year.  Maybe one day I will get back to some consistency. 

When I was a teacher working in NYC in the mid 2000’s, there was a burgeoning field of study that was quickly being translated into educational reform.  The basic theory set forth that kids did not need to learn to read and write as much as they needed to learn grit and resilience.  In other words, all educational achievement was fairly worthless if kids did not know how to tough it out and grow some balls.  That was the first time I was introduced to the idea that resilience and grit was something that could be cultivated.  I thought resilience was something you either had or didn’t.  I was wrong.  I have learned that grit is built from falling down and getting back up so many times that falling is no longer a bump in the road, it is the road.

At work, I get to meet a lot of young people who are using their current positions as holding spots for their future.  They want to be researchers, doctors, public health masters and nurses.  Because I like to talk, I get to know people and their hopes.  Recently I was talking with a guy who is waiting to hear from schools about acceptance into a program he has worked years to get ready for.  He told me about his first rejection and how down he was.  I have been there before, wanting that acceptance or that goal to set the next path in place, and feeling that the rest of it was just wasted time.  I remember the many times I moved, applied for school, applied for jobs, tried a new project, and took on new responsibilities and waited for things to work.  And waited.  And waited.  And that waiting, all that fucking waiting and patience, taught me what I know today about resilience and grit.

Although existential doubt and confusion about our paths provide us all with plenty of angst, that is not what I am talking about.  I am talking about knowing, naming and working for something and having the world ask you to be patient to get it.  Those nights when you drag yourself after work to school to check off pre-recs, when you risk moving towards something new by saying farewell to what is safe, when you juggle twelve things so that you can even get to the next small step towards something bigger.  That is what builds grit, slowly, sometimes painfully, but with the daily commitment to your far-off hopes.

I thought about it and spoke with this guy.  I told him what I knew.  I told him that I have seen many people in medicine and in life who get what they want easily.  They are supported to take the next step and the doors open.  They cross the next threshold and move forward.  Their paths are set and supported for them.  Their risks are not great, even if they achieve great things in their life, because they started out with such a huge advantage that the achievement was inevitable.  I have seen people rely on their families to pay the costs of setting up an adult life.  I have seen people who have large, wide and inherited safety nets, which help them meet their goals.  And I spend most of my time not liking these people and feeling resentful and jealous that I am not one of them.

What I know, though, is that not getting what you want right away is how you develop grit.  It is precisely these times in life, when we don’t get what we want right away, that matter.  These times of waiting, of patience, of checking our email for acceptance, of waking up every morning and putting one foot in front of the other, of showing up at a job that isn’t for us, these times matter.  These times of transition to the next steps or goals in our life matter.  It is not wasted time.  It does not mean we are losers for waiting.  It means that we are getting resilient.  That we are getting grit between our teeth and showing up for life.

And what I also know is that seeing others get what they want, get what we want so much and don’t have yet, is ultimately what births and feeds compassion in us.  It is what loosens resentments and jealousy.  I see people who struggled in life, and didn’t have things handed to them, show deeper kindness and compassion than those who had the doors opened for them.  This is especially easy to see working with providers in medicine.  I see those same people of privilege struggle with even the simplest obstacle or annoyance.  I see patients, young and old alike, who have faced unthinkable things, but still laugh and enjoy their life.  We look at people like this and wonder “how” and the answer is, without a doubt, grit and resilience.  They developed it listening to their doctors tell them their prognosis.  They developed it when they turned over their bodies to the invasion of medicine.  They developed it going through treatments. And I am learning, through my own invasion and my own fear and fragility, that I have grit and that I am getting more of it everyday.

So to those of us out there who didn’t have things go quite as we wished, who struggle with fear and uncertainty, who wait, who show up everyday to live the life we do have, who wait, who don’t have that net to catch us, who pay our own way, who wait, who try to find joy in the interminable patience we have to have, I salute your resilience.  To my brothers and sisters in the liminal trenches of transition, I will be there to wipe your gritty, dirty, filthy face if you promise to wipe mine too.


Just a note: Thank you for reading! I never really write anymore because I work 11 hours a day, 5 days a week.  That really cramps my style.  But this is a topic that has banging around in my heart lately and I wanted to write it out.  Hope you are well in your life!

I live in the Bay Area. I am a New Age Hippie at heart, despite the leather jackets and sarcasm, and have always believed that challenges are presented to us to grow and learn.  The idea that things happen to us to teach us lessons or push our boundaries is common place and probably somehow instinctively human.  We want to make sense of the things that hurt us.  We want to make sense of the darkness and loss that colors our lives.  As a younger person, I wholeheartedly believed this.  When my life became difficult, I thought about what I could learn from it or how I could use it to grow.  But beneath that belief was something a little harder to grapple with: that I deserved it, that I had done something to deserve it, that I was somehow complicit in the causes of my suffering because I hadn’t learned my lessons yet.

I am working with cancer again.  I started my nursing career with cancer and now am back.  It is the right fit for me and for my personality.  I like the complexity, I like the integrity of the providers, I like the patients.  But working with cancer has provided me a lot of time to contemplate this idea of using challenges to grow and change.  And by believing in this, how do I make sense of blame or fault.  When I was a night-shift nurse on the leukemia floor, I had a lot of chances to listen to people grapple with this.  With a diagnosis like cancer, patients and their families inevitably ask “why me? what did I do?”.  I learned to listen to this question with curiosity.   People reacted differently to their treatment and diagnosis.  People bore the weight of it in silence, were angry, prayed, cried, accepted, hated it.  And many people questioned God.  People questioned their higher power.  As they should.  What kind of God does this? What kind of God allows for this awful disease? And these are questions we ask all the time about war, injustice, poverty, abuse.  What kind of Higher Power would let this happen?

This is a hard question to answer.  Then one night, around midnight, I got an answer that has stayed with me for 3 years.  I did not understand the answer at all.  But, it was so confounding that it stayed with me.  There was a patient who had a rough diagnosis, but he wasn’t going to die.  He was a regular guy, kind of quiet and reserved, but we became friends and I found out that he was a lay minister in a Protestant church.  I told him about being a religion major and we got to talking.  That night he was not tired.  He was up and so was I.  So we talked about books, about saints, about mystics, about the problems in the world caused by religion.  He was happy and removed from the world of illness.  I took a risk to ask a question that had nagged at me for a long time.  I watched so many people pray and question God.  People made shrines in their rooms and one woman even brought in a flag with the Virgen de Guadalupe and hung it up on the window.  God was very present on that floor: questioning, believing, beseeching this higher power.   So I asked this lay minister my question: How do you make sense of your God and your belief now that you have cancer?

He answered: “Oh, Beca.  God has nothing to do with my cancer?”

We talked a little more about that, but that phrase stuck with me.  How could this man who devoted his life to God and his church believe that God had nothing to do with his cancer or mortality? I have thought about this for some time and have recently come to understand what he meant.

Working with sick people has taught me some things.  One thing that most bothers me is the tendency for healthy people to immediately blame the sick person for their disease.  I don’t know if this is cultural or not, but it certainly is common.  I think about the young guy who was diagnosed with bad cancer and the first conversation is what he had done wrong to get this disease.  Or the assumption that stress is the direct cause of illness.  Or that someone is “crazy” and that is why they have Crohn’s disease.  Healthy people say and do horrible things to the ill.  They put distance between themselves and the illness by blaming the patient.  And I have seen how devastating this is for people.  Can you imagine being sick and scared and having so many people asking you what you did wrong?

I understand why healthy people do this.  I have done this.  I have wanted to make sense of the devastation of illness.  I have blamed sick people for their illness because it was easier than feeling the impact of their diagnosis.  And underlying this tendency is the belief that these challenges are placed in someone’s path to teach them a lesson about their wonton ways.  That these challenges are here to push us to grow and change.  And that we have done something to deserve it.  You have cancer! Stop stressing out!  You have an auto-immune disease! Heal your childhood hurts!  You have chronic pain! Stop being so mean to everyone!  The list goes on and we all do this.  I did this for a long, long time.  But I don’t anymore.

Here’s what I believe now.  God has nothing to do with my or anyone else’s bad luck.  God has nothing to do with this.  I get what this man said to me 3 years ago.  God or my higher power or my destiny or my karma does not place challenges in my life so I can learn from them.  That is not how it works.  And the difference is subtle, at least for me and I struggle to explain it.  But I will try.  As I face difficult challenges in my life that come out of the blue, like illness or loss, I may learn something from them.  I may grow.  I may change.  I may expand my understanding and deepen my wisdom.  I can look for a reason to embrace the challenge and use it as a springboard for change.  But that is not why it is happening.  It is not happening to me for a reason. There is no higher reason. It is just happening.  It is just bad luck? Maybe.  More likely though is that it is just life.  Life is hard and full of challenges.  For everyone.  We are not exempt because we are working on our shit or trying to grow.

And here is why this is important to me.  If I believe that my higher power has placed challenges in my path to grow and change, then when a challenge comes along that is devastating then I lose my faith and love of God.  I have to.  I have to hate my higher power when the challenge is overwhelming and unfair.  But, I now believe that God has absolutely nothing to do with my difficulties.  God and faith and a belief in something larger will help me get through hard times.  That faith will buoy me up through the grief and sadness of difficult times.  But God did not cause this.  God did not put this in my path.  I no longer believe this.

I believe we may grow from challenges.  But I no longer believe challenges are put in our way to make us grow.  Although we have a personal responsibility to take care of ourselves and reduce our risk of disease or heartache, there are many challenges that come out of the blue and hit us in the face.  Those unlucky blows like cancer, loss, grief, pain, illness, unexpected diagnoses are not put in our path to grow.  Because if I believe that, then I believe somehow that it is also my fault.  That I was not grown up enough to prevent this.  And that is not how it works.

I’m not talking about the things in life that are our responsibility.  Taking care of ourselves, being responsible with our speech, fighting with our loved ones, becoming mature, not being a dick, not being a narcissist.  I’m talking about the shit that hits you on a Tuesday without any warning.  I’m talking about the stuff we do not expect.  And that stuff of life now means something different to me.  I look out at the world and see suffering and I think: this is life.  this is the shit that happens.  As De la Soul says: “I love life, man.  You know.  Life is beautiful.  It’s just the shit in it that’s fucked up.”

And that is what I believe now.  Life is fucked up, a lot of the time.  There is some stuff we control, and some we don’t. And the challenge that I face now in my life is not my fault.  I didn’t do anything to deserve what is happening.  And neither did my patients.  When I hear the subtle blame that is directed at those of us who are suffering with illness or difficulties, I now call it out as what it is: cruel.  There is not a higher reason for suffering.  Suffering is suffering.  So maybe we can stop blaming people for their difficulties and be kind.  If I had a magic wand, that is what I would do.  I would ask that we stop hearing the bad news that surrounds us and embrace the gray: there is often no reason for the sad things that happen in life.  Grow from them or don’t.  It’s your choice.  But don’t look for the reason why someone is suffering, because most likely there is no reason.  At least no higher reason.


Growing up in the crisp New England culture, I often felt like an outsider for my more unusual beliefs.  As a kid, I did not gravitate to reason or logic. I believed in magic.  I believed in God.  I grew up in a home where God was welcomed, but he certainly wasn’t invited.  But I invited him.  I believed in past lives, rituals, spontaneous healing, crystals.  I perused the one small shop in our state that had books that felt like they contained secrets that turned the falling leaves into dust and back.  I believed.  I believed that the universe sent me signs.  When I saw many blind people on the street, I interpreted that as a sign that I was being blind to something.   I majored in comparative religion and studied mystics.  I read Carolyn Myss.  I read Shakti Gawain.  I read any book that promised freedom on the other side of a ritual.

This was a secret part of me that came out with certain friends and in certain ways. I read tarot cards.  I did astrological charts. With enough wine, I could read a stranger’s past and future.  I prayed.  I swayed.  I believed.

I realized recently and somewhat abruptly, that this part of me has slowly faded away.  It has quietly buried itself, retreating under something else.  I didn’t notice this.  It was a quiet flickering and extinguishing of the flame, the chispa inside me that I protected and in turn protected me from the world.

Recently, in an attempt to create a meaningful life, I signed up for a monthly weekend yoga immersion program with a teacher who I love.  She is grounded and real and funny.  She is a teacher that I feel safe with.  She is genuine.  And I sorely needed to find a place in the world that was mine away from my life and worries.  In my first two weekends of this retreat, I sat there learning.  She and her invited teachers are presenting a world to me, again, of magic, of chispa. Rituals, connections to larger meanings, reminders of universal patterns.  And I sit there and wonder, “huh, didn’t I used to believe in this and know this?”  It is only by surrounding myself with others who are still connected that I realized how I am no longer a part of this world.

I recently took a vacation, the first in many years, and I jumped in the crystal ocean and walked on the white sand.  I looked at the night sky and saw the most beautiful moon rise I have ever seen.  I was surrounded by meditators.  People meditated in the morning, wrapped in beach towels against the cool dawn.  People meditated between beers and cigarettes.  But I didn’t.  I looked at them, and again, asked myself “huh, didn’t I used to do that?”.

And I have been struck the last few weeks at how much I have let that part of me go.  And it is not that I do not believe in these things anymore or that I think they are silly.  I do not.  I believe that these things create boundaries and meaning for life.  In the rough and tumble universe, anyway we can do that is worth nurturing.  And this was a way that I gave meaning to my life and created depth and connection.  I am just so struck how this part of me has hushed.  After all those years of flourishing and painting bright colors across my life, it has packed itself up and shuttered the windows.

The question I faced on the beach, between some cigarettes and beer, was why? Why had I walked away from something that once brought me so much joy.  And I think there is an easy answer.  It is not maturity.  It is not awakening.  It is suffering. Not my own suffering though.  It is being a witness everyday to the deep, profound, true suffering of others.  As a teacher for 10 years, I saw suffering but it was so balanced by the hope and beauty of the classroom.  Then when I signed up to be an oncology nurse and caught more glimpses of this.  But I had so much luxurious time off that I think I was able to balance something.  Then I moved into being a nurse practitioners and the pace, speed and suffering tripled.  There was no longer time to process.  There was barely time to chart.  These harsh challenges of modern medicine have been well documented by people smarter than me.

What I am struck with is that I am not yet resilient enough to take the onslaught of suffering that I see everyday.  I do my best.  I take care of myself.  I show up for my patients. We laugh together and take steps towards healing.  I am a good co-worker.  I crack jokes.  I try hard.  But being such a close witness to countless stories of fear and suffering have slowly stripped away the magic that I once held so dear.  I feel whitewashed, bare, barren actually.  I feel empty.  There are many names for this like burnout, vicarious trauma, and the optimistic “trauma stewardship”.  But I am not burned out.  In fact, I am engaged.  I am just shocked.  I am truly shocked at how hard things are for people.  Now I was never naive.  I didn’t grow up believing in fairy tales or fantasies.  I grew up with stark realities, but I did not know this level of suffering.  One life is rarely witness to this.  But medicine, many parts of medicine, is a wide-eyed witness.  It is a world designed to hold and try to cure pain and suffering.  And I signed up for this.  I thought I was tough enough to take it.  And maybe I eventually will be.  Maybe eventually I will find a way back to candles and altars.  These parts of me are so ingrained that I can conjour them up when I need them.  And I want to find them again.

I did not come to this life to be tired and worn out.  I came to be engaged and alive.  And I have to figure out a way to do that even in the face of what I see from 8-6 everyday.  Although I don’t know how to do this yet, I believe that by figuring it out I am contributing the future of medicine.  We cannot expect providers to be heartless and we cannot expect them to carry this burden alone.  I wish I had more answers.  I wish that I was made of stronger stuff already.  Maybe eventually I will be.  Until then, I will keep some candles and my spirit animal close on hand just in case the chispa strikes me again.

Mi despedida

Yesterday was my last day of work at my first job as a nurse practitioner.  I worked 24 hours a week seeing my 1000 patient panel and spent the rest of the time being the clinic manager.  The details of what came to pass over the last 18 months are many and multiple.  Walking away from that job has felt like a step in my maturity.  I left what didn’t serve me.  I didn’t stay even though I was good at it.  I didn’t stay to win over the people who still, after all that work, didn’t really like me.  I didn’t stay even though I found true love and friendship in the trenches.  I didn’t stay even though I was doing the work that formed my nascent fantasies of healthcare.  I had a million old parts of myself that insisted I stay.  And a few new parts that gently said, “Go”.  

I have always prided myself at being good at goodbyes.  I come from a culture that rejects and spurns weakness.  Being strong for me has meant always being ready to pick up and leave.  And I’ve been good at that.  I am not afraid of the new.  I am not afraid of starting new relationships.  I have often thought that I am best the first few months you know me.  I am funny, I have great stories, I am charming.  But after that, maybe not so much.  I have left many jobs in the past.  I left my sweet, amazing crew at Ford Boulevard as a teacher and cried as I passed the East LA exits driving home to the East.  That was a good goodbye.  I left the place that raised me and taught me what it meant to be a professional in NYC for more adventure.  That was a really good goodbye.  I left being a RN confused, loving my patients and the friends I made, but never really fitting in with the floor.  That was not a very good goodbye.  

And yesterday I said goodbye to a group of people who have come to define the day for me.  There were many things about this last job that were hard, but it was not hard to love the women that I shared my day with.  I don’t know if all bosses feel this way, but I really came to love and appreciate the women that I got to work with.  They taught me and I taught them.  When I was down, they clapped and lifted my spirits.  When they were down or needed a hand, I clapped and did my best to lift theirs.  Over my drawn out 4 week goodbye, we all got a chance to say what we needed to say.  We all got to cry together and laugh together.  We all got to appreciate what we had done together.  That was a very sweet, very beautiful goodbye.  

I have spent most of my life looking for a place where who I was could be seen and accepted.  I have tried to create family where one shouldn’t have been.  I have turned friends and family into other people to meet my needs for belonging.  I have been blind to things in the drive to be seen and belong.  And what I will take from this experience is that for a few hours everyday at this very crazy clinic, I belonged.  I was loved.  I was seen.  I loved and saw.  And that has changed me.  My crew laughed at my jokes, asked for advice, gently made fun of me, worked hard with me, and protected me.  I got to do the same.  I got reminded to love God freely.  I got reminded to take things less seriously.  I got reminded of my strength and drive.  I got seen for my vision and leadership.  

And although there are many things that I could say about this experience- issues with class, poverty, non-profit dysfunction and many other things I have spent so much time struggling with- leaving means that I get to write the ending of all of this.  And the ending is love. The ending is friendship.  The ending is deep appreciation.  I may not have this at my next job, but I will carry this experience with me.  I feel fundamentally different, changed, shifted, from this great love that I was given.  And that is what love should do.  It should change us.  I have only the deepest, gentlest, and most profound gratitude for that.  To those women who made my day everyday, I can only say thank you.  


I haven’t written a single word in over six months.  I haven’t had the time or the space or even the interest to sit down to write.  And although this little blog is just for me, writing has helped me get through the last five years.  Writing my experience, trying to craft a short story that captured a moment of my life, has been a way to shape and understand my experience.  And as I have tried to restart in the last few days I have found myself rusty, so so rusty.

Writing is not something I pretend to have a talent for.  It is not a goal or even a fantasy to write a book or get noticed for what I produce.  I write because I found joy in it at a time when I hated everything else, including breathing.  I started to write as a way to document my travel adventures at a time when blogging was not even close to a job you could do to earn money.  I continued to write when my life fell apart and no one I knew or who had known me called and life was too lonely to make sense of my place in it.  And writing helped me find a way out of what felt like the end of my life.  Writing then became a way for me to live in the profession of medicine, illness and death.

I am a loud person.  I am opinionated and probably a little too harsh sometimes.  And although this may be who I am for the world and the persona I cultivate, I am vulnerable to the opinions of others.  I have spent much of my life asking others to define me, to validate me, to decide who I am for me so I didn’t have to do the hard work of owning my life and opinions.  And writing has helped me move away from that.  It has helped me decide what I think and feel.  It has helped me define the life that I want to live.  And that is a gift.

In the last year since I started my life as a primary care provider and manager of a crazy clinic, I have lost track of my opinion and myself.  I have found myself very vulnerable to the opinions of my colleagues and put myself in situations that have been incredibly hurtful.  I have been blown around by the dysfunction of a deeply ingrained corporate culture that I didn’t create.  And because I haven’t written, I have gone back to the parts of me that valued others opinions much more than my own.

The other day, at the end of my 13-hour Wednesday workday, I sat with my last patient of the night.  For some reason, I wasn’t rushing through the visit, desperate to finish so that I could submit the charts and review the labs and follow up on the guy with a bad disease and evaluate the clinic data and call the on-calls for support the next day and  respond to my part of the state and local deadlines for funding.  For some reason, I took my time.  And this last patient was new to me and hilarious.  He was from a small town in a distant country.  He spent most of his life growing crops and had come to the US to take care of his kids and send them to college.  His children, 6 of them, were teachers, engineers, and designers.  And he showed me their pictures on the his internet phone and laughed about what had happened to him.  He worked so hard that he literally ripped his muscle.  And this chance to get to know someone, to sit with someone and hear their life, reminded me that I am so far, on a daily basis, from what made me love my job as a nurse and nurse practitioner.

Primary care is set up for people that have talents that I don’t.  It is set up for people who enjoy things that I don’t.  And the things that make me happy about working are usually not available to me in this setting.  And I can’t help but think that not continuing to write over the last year, not being interested in my own opinion, has allowed me to get so far from what makes me happy.

Transition is coming again.  It’s not defined yet, but it’s on its way.  I am back in front of the keyboard today because maybe by writing again I can figure out a way forward.  I have faith.  It’s worked before.  I think it will work again, even if it will take some time to clean off my tools from the cobwebs and rust.

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