I bought my first digital camera in October of 2001. And the photographs I have of New York before then are pretty scarce–film cost money, after all. So most of the day-to-day life that I remember of the city live only in my memory. With every trip back, I keep trying to find remnants of that past and photograph them, in perhaps an act of preservation, or even resurrection.
All I usually end up with, however, is evidence of how much the city has changed, and while this evidence of the ever-changing urban landscape would otherwise mean that I could never want for things to photograph, I leave the city feeling even more distant from the New York I remember.
The essence of life in the city has not changed, however, and even though the backdrop may change, with the landmarks I remember long disappeared and new exteriors in their place, I think I’ve managed to find examples of it and capture it.
I used to work summers in the financial district. A few of my classmates did, too, and every so often we’d get together during lunch breaks and find somewhere outside to sit, eat, and chat. We were surrounded by the thousands of other workers doing the same thing. Any place that can be sat on, will be sat on, turned into an ad hoc meal table. It’s something I think is quintessentially New York, made unique by the sheer density of humanity that’s found on a summer day anywhere in Manhattan. Sometimes, we sat in the plaza of the World Trade Center for our lunches. A perfectly common activity, unworthy of saving it on film.
It’s okay that I don’t have photographs specifically of those moments. The memories, the feelings they evoke, are the key. But I’ll continue trying to save proxies for those memories, for their potential to trigger those memories. I guess you could say that’s just my motivation in general, why I photograph what I do.
Fifteen years ago, I was studying in New York to be an engineer. Were I any other place, were the Towers not to come down, maybe today I’d be doing just that. But because I was so close to tragedy and could do nothing to help, could not help with communications despite having become a licensed amateur radio operator for just that reason, last night, on my last night float shift for the month, I was directing resuscitation for a young patient in shock and close to dying.
I do miss engineering. But this… this is a privilege. The sum total of my four years in New York helped steer me here, shaped who I am, and for that I don’t need a photograph to remind me.
I’ll be up front. It’s been a painful year. No big surprise—residency has a tendency to suck, intern year especially. No one who goes into this enterprise is unaware of this. Coping mechanisms are essential—hobbies, friends, family. Alcohol’s in there somewhere, too. Social media tends to be a double-edged sword — I would feel on some superficial level connected to the family and friends I’ve left behind, but my conclusion after checking my Facebook or Instagram feed for the twentieth time that day was that everyone is spending all their time vacationing in exotic locales and eating exquisite food. (That’s an exaggeration, of course, because no resident has time to putter around on the Internet that frequently. But the end result is the same.)
The first half of the year wasn’t too bad. Catching babies, practicing intubations, practicing ultrasounds. Getting past the hump of “I should check with my attending before I order fluids/Tylenol/that hand X-ray for a guy who clearly injured it.” A short vacation to see an old friend. The days were still long enough that there was still plenty of sunlight waiting for me when I went home. I would go back to Chicago when I could. Spend time with Mom and Dad. Making up for lost time.
Depending on where you start counting, it was anywhere from thirteen to sixteen years that I’d been gone from home. I missed out on a lot of the day-to-day with them. There were the semi-regular visits when I lived in Waukesha, but it wasn’t until moving back to Chicago for medical school that I was able to see them more often and, in comparing them now to my memories of them as a kid, see just how much time had passed. With every visit, all I would see is how much they had changed, all I would think about is how sad I was to see this. The thoughts consumed me so much that I could never be in the moment with them and really truly enjoy the time I was being gifted with them.
Medical school gave concrete goals to work toward, tasks to get lost in, distractions from the reality of parents with less spry in their step. In the end, it paid off—in a time where a common refrain from emergency medicine residents was “I’m glad I’m not applying for residency this year,” it’s no small thing to match into EM, let alone at your first choice. It was an intense relief after spending much of fourth year worrying. Mom and Dad and my brother were there at Match Day, my parents proud at their son becoming a doctor, and Robert just overjoyed that his little brother, long separated for over 20 years, would be close by again. I moved away again, though Milwaukee had never felt too far away (according to the sign outside a pub near Wrigley Field that I spotted one day, Milwaukee is Chicago’s largest suburb) that I couldn’t visit when I wanted to.
So I did the 90-minute drive when I could. I’d also text one or two med school friends to see if they were free, knowing more often than not the answer would be no. And every once in awhile, I’d also get to see some of my other “age-appropriate” friends, the ones here in Wisconsin and also those still in Illinois. Those visits came with their own baggage, in the form of reminders of things I wasn’t doing with my life—marriage, kids, home ownership—which nurtured an intensity of emptiness within. And every visit with Mom and Dad compounded a sense of guilt—guilt at not being able to provide the kind of support they need, guilt at not being able to be the dutiful son.
What was turning out to be a severe existentialist crisis had an added dimension from grinding, grueling inpatient months kicking off 2016, with a single month in the emergency department providing the sole interruption. It promised to provide some respite, a reminder of why I chose this profession, but it failed to deliver, instead only bringing frustration, exasperation, a growing cynicism, and feelings of failure. Cap off intern year with two intensive care months that reinforced the truth of the fragility of our existences, and apply that lesson to your own life, and to the lives of those you love, and you feel exquisitely the pain of every precious moment you are missing out with them.
When you see people your parents’ ages with their life’s fortunes turned on a dime, struck suddenly with infection, with head bleeds, when every intervention only puts them through more pain and you are praying their families realize the same; when you see yourself starting to resent the people that come to the emergency department that make you ask, “Why are you even here?,” when there is no end to the people who demand more from you than you’re able to give, when you see yourself depersonalize in a desperate attempt to stave off a complete internal emotional collapse, when you fear waking up because you dread the thought of what awaits you at the hospital, when you wonder what it was that led you to abandon your first career, a career that took time to get good at, that provided a measure of security and stability–
I want to leave this all behind. Run away home and take care of Mom and Dad. With every day I waste in a role feeling less than capable, I wonder what was the point of it all.
Oh. Hi, burnout. Yeah, I saw you coming. I saw you when one of the staffers in the ED remarked to me, “You’re not as chipper as you usually are.” I know you’re there. You are what makes me resist falling asleep, because sleep brings another day on the hamster wheel. But fatigue wins, and it’s not long before I plead with my alarm clock for a few minutes more, it’ll be all better with just a few minutes more; but it never is.
Coping mechanisms are essential. Hobbies, family, friends. My photographs have been uninspired and I’ve barely had time for family and friends.
Then Orlando happened, and—okay, I think I remember why I thought this might be worthwhile. Maybe I remember the nurse who stopped me to relay a family’s thanks for the care showed to their father, who had to make the impossible decision to let go of his wife of so many years.
I suspect, I hope, that it will get better. Yes, my parents are getting old; and who knows what each day will bring for them; but for right now, if I scrutinize the picture I took of them on my last visit home, they are happy with what they have, they are happy with what their younger son is doing with his life, and they are even happier when he comes to visit, and I have to treasure the moments I do get to spend with them. I have to keep myself open to the experiences that made me choose to be an emergency physician, and let that be what motivates me to go to work in the morning.
First year. It started out as a joke. “I left my career for this?!”
Med school and I were still on our honeymoon. There was a lot to study, but I remembered enough from my prerequisite science courses and I learned enough physiology on the job that it was bearable. There was still free time, time to volunteer, time to hang out with friends and family. It was almost like being in college again.
Second year. The fire hose of knowledge that one is expected to handle was wide open. The stack of pancakes that is daily studying grew high enough to rival the tallest buildings. People were unhappy with the recent changes to the curriculum. Negativity was everywhere. The stress of studying for our first board exam was wearing everyone down. I was worn out. “I left my career for this?!”
It wasn’t that I loathed my job or that I wasn’t good at it. I was good at it. My manager’s manager told me up front, in an effort to get me to stay, that there would be an irreplaceable void in the team when I left. But the truth is that it took me a long time to get to that point, to develop competence and credibility.
And here I was starting all over again.
It was easy back then to rationalize it. There was only me. I didn’t have a wife, children, anyone, who would be impacted by my decision to start all over again, to trade in a good-paying job with good benefits so that I could accrue an amount of debt equivalent to a decent home in a reasonably affordable mid-sized metropolitan area, to trade in my nights and weekends of freedom for nights and weekends of working and studying until my eyes bled, to trade in a life (albeit somewhat temporarily), all because of the notion that I could accomplish more doing something different. Hell, I was still in my twenties. Things looked different on that side. There was still a lot of time. Lots of time to do everything I want to accomplish. Be a doctor. Get married. Have kids. Buy a house. The usual.
I turned 30 and then a few months later left my career as an engineer behind.
Third year. Over halfway through it. Days spent essentially working at a job. Nights spent studying. Learning, learning, learning. Getting the tiniest bit competent. Once that happened, it was time to move on to a new rotation. Like clockwork. Time to start all over again. And so that feeling of “hey, I think I might know what I’m doing” has been nothing but fleeting. It has been a losing battle to not let the anxiety and worry over looking like an idiot in front of the people who write my evaluations render me insensitive to those meaningful moments when I might actually contribute something positive to someone’s care, to the point where “burned out” feels like an understatement. And now that I’m approaching the phase where I need to start thinking about what I want to specialize in and applying for a residency and all of the advice people give you basically distills down to “be better than everyone else” and I’m earning passing grades in my rotations but is that really enough because my board scores weren’t stellar and I swear everyone’s better and smarter than me and residencies are getting more and more competitive will I really succeed?
…I left my career for this?
oh hell I’m going to be turning 33 soon and why do things look so differently than they did four years ago and dear god what the hell have I been doing with my life when will I ever have time to do everything else I want to accomplish*
I’m not going to quit, but maybe this is as low a point as I’ll ever reach.
* * *
Lately, though, maybe the universe has been dropping me messages to suggest that I might be doing all right:
Night float week on pediatrics. Last day. I have a new-to-me intern. We get to talking. Turns out she also majored in engineering, still has the engineer’s mindset, had the studying mindset of an engineering major: problem sets. Lots of them. Full of math. Lovely math. Calculus and linear algebra and all the wonderful things. Logical and algorithmic.
She related to me her own experience in med school, the paradigm shift involved in studying through reading and memorizing. It was like she was recounting my own story. We talked about ways the engineer can find a niche in medicine. She described an attending she once had who was a former engineer and how he would articulate his thought processes on rounds and no one else seemed to grasp it but she did because she had the same mindset. It was reassuring.
Thanksgiving dinner. Curious to see how much of my aunt’s piano lessons still stuck, I sat down in front of my brother’s keyboard, confronted with “Jingle Bell Rock.” Slowly, tentatively, I sounded out the notes and chords in front of me. My fingers weren’t used to playing more than one note at a time, and they clumsily moved about from key to key in a way that reminded me of painfully awkward grade school dances.
My brother came into the room. “Do you want to borrow my keyboard?” I shrugged.
“You should.” He paused. “You have an artist’s heart. I can see it in your photography. And I can hear the joy in your voice when you sing. … You’re going to be entrusted with people’s lives. It’s going to be stressful. You need this.”
Pediatrics intensive care unit week. Last day. In the middle of morning rounds, we hear, rather loudly: “CAN I GET SOME HELP HERE?!” We start to hurry in that direction. The attending asks which patient it is. On hearing the name, she runs quickly ahead of us. It was a patient of hers that she’s taken care of for his entire life, a baby who’s only ever known the hospital.
I had been running towards the call for help for a couple of seconds before remembering the right people to help were on their way. I found a spot where I’d be out of the way but where I could still observe and provide manual labor if an extra pair of hands was needed.
In those minutes the team worked together to give a critically ill child every chance at living.
“Why did you decide to be a doctor?” she asked. “And don’t tell me you wanted to help people.”
I was exhausted. I sat on the edge of Mandi’s bed. “It’s true,” I said. “I want to help people.”
“Ha!” She poked a mound of vanilla pudding with a fork. “That’s what they all say.”
–“A Fire, Deliberately Set,” Peggy Sarjeant
I was reminded of the long, 5,000-character essay I was required to write on why I decided to become a doctor. Superficially, it probably boiled down to that same clichéd declaration. “I want to help people.” But I really tried to get beyond that.
I’d always wanted to do something useful, something that mattered. … Simply put, I believed God had given me gifts that I was expected to use. Helping others through medicine had somehow become the obvious choice.
That is probably closer to what I wrote. But I read on, and I wondered if there wasn’t something more.
I finished the story of the pediatrician who learned she could never be distant and be a doctor at the same time. I finished the story of the resident, dealing with his first malpractice suit, realizing the detail he missed that could have saved a life. I finished the story of the med student dealing with her cadaver in anatomy lab, and on and on. Nineteen stories of becoming and being a physician; nineteen stories of what awaits me. Nineteen stories written by the doctors themselves.
As I read them, I felt something. It was the same feeling that drew me to take a poetry class in high school, that drew me to acting while in college. Each was an expression of the human condition; authors, poets, and playwrights, illuminating the drama of life, beckoning, engaging. I came to understand that what I was feeling was that connection, a belief that I had found the meaning of life, a notion long absent in a staid existence. It was stronger than before, knowing that these were not mere stories, but snapshots of autobiographies.
Maybe that feeling was the reason I was looking for.
