Hermit Trail

I tried to sleep at the trailhead after parking at 3 am, but all I could think of was whether or not there were mountain lions in the Grand Canyon. Sitting in my car, waiting in the darkness, I remembered that best practice was to never hike alone. I remembered that if you chose to hike alone, then you should let people know when you expect to return, but my people were down in the bottom of the canyon without cell phone service. My thoughts spiraled… this was a bad idea.

Despite these fears, I laced up my hiking boots and hoisted my pack onto my back. I wasn’t going to let these last-minute doubts ruin all the planning and dreaming that had gone into this moment. Walking into the Grand Canyon from the rim it was pitch black except for the tiny beam of light coming from my headlamp. The silence was broken by my shoes crunching rocks, my breath quick. With each step the darkness slowly lifted and soon enough I turned a corner to see the Earth drop away into the depths of the canyon, while the sun grazed the walls rising around me. I continued to hike, following the trail that hugs the canyon wall while slowly descending deeper, and I felt like someone in “Honey, I Shrunk the Kids”; a miniature version of myself picked up and placed on a topographical replica of something imagined.

After hiking for several hours, I began to wonder when I would run into Leah. According to our newest plan (hatched over the spotty satellite phone connection), she would start hiking on Hermit Trail from Granite Camp at 4 am. We would hopefully pass each other on the trail, she climbing out, me climbing in, but I left the keys at the car. Just in case.

The moment I saw Leah approach me was the moment I was first able to breathe deeply, and a weight lifted off my shoulders. Maybe this crazy thing was going to work out all along. We exchanged a hug, some snacks and I checked in about the first part of the trip while Leah checked in about my exam the day before. We snapped a selfie and departed in our own separate ways.

The next big hurdle was meeting the rest of the group at the beach before Hermit Rapids. I arrived around 9:15 and sat down to wait; stripping my shoes off and dipping my toes into the cold, clear Colorado River for the first time. It was hard to relax (I wasn’t quite on river time yet), so I paced, applied sunscreen and checked to see exactly how squished the cupcakes were that I brought with me for Garrett’s upcoming birthday. They were only **slightly** squished. Around 9:45, I spotted a single raft at the bend in the river. Then two, three … four. Okay, now I could relax and it was going to be an FA day.

Ice…And Tequila?

Alternative titles, “The Big Ditch” or “The Grand Canyon”.

Our trip down the Colorado River was years in the making, starting with a dream and a group of men, who were once boys at Colorado Mountain College together. As a kid, I got the chance to go on a couple of raft trips. The first was also on the Colorado River, but where its runs through Westwater Canyon in Utah. I distinctly remember holding onto the front of the raft and watching the wall of water, wave after wave, come towards my face, while screams of joy erupted from within me.

Time passed and a little over two years ago, while I was returning from Thailand, I started reading the book, “The Emerald Mile” by Kevin Fedarko. A beautiful and gripping tale of the fastest run through the 300 miles of river that cuts the Grand Canyon. It tells the history of the canyon, a story of exploration, destruction, bravery, redemption and revitalization. As I read, I felt as if I was racing through the canyon myself and I knew that I was captivated by the beauty, power and awe of this place I barely knew.

Luckily for me, my dad never stopped dreaming about another trip on the Colorado River. I can now safely say that if you ever get the chance to row [or ride] a raft through the Grand Canyon do not hesitate. Drop everything and run to Lee’s Ferry.

I’ve been trying to figure out how to share about this adventure and I think I’ll do a mini-series. So, hang on to your hats and get ready to high-side because as they say on the river, “We’ll run her down the gut”.

Waiting for the rafts to all clear Bedrock Rapid. It looks like you can go right or left at the top, but if you go left you end up in deep trouble. You gotta pull hard right and glide through the rest of the way.

Stuck

July began in the hospital, with my first week on Internal Medicine. IPIM, or in-patient internal medicine, is our chance to learn how to take care of patients who are admitted to the hospital. We have four weeks spread throughout our third year that consist of 6 days each. The hours are long, and its filled with mountains of reading, thinking about and caring for acutely ill patients.

My first patient presented to the emergency department the day before I arrived with shortness of breath. He was recently discharged from the hospital, after more than 100 days for the same chief complaint. He was back because he was unable to refill the proper medication, and so his chronic obstructive pulmonary disease (COPD) worsened. He needed increasing amounts of oxygen to breath, his legs were swelling, his cough worsening, and his mental status deteriorating. By the time I met him, he was receiving steroid therapy, antibiotics, and more oxygen. I listened to his lungs with my stethoscope, and my novice ears heard wheezes for the first time.

Throughout the week, I would have many firsts.

I had my first patient tell me that I was being mean when I went to examine him. I tried to brush it off, because hey, no one enjoys being in the hospital, and no one enjoys being poked and prodded at 7:30 in the morning.

I had my first patient who wouldn’t talk to me.

I had my first patient who refused almost every recommendation we made. We recommended physical therapy, he refused. We recommended eating his meals sitting up, he refused. We recommended breathing treatments for his COPD, he refused.

Eventually, we got him up for a walk (his first time out of bed in 3 days). His lung sounds, and breathing became easier. He ate dinner in the chair. It felt like we were making progress, and I counted these as small wins.

The fourth day, he returned to his “baseline”, requiring only small amounts of oxygen and the daily medication therapy for COPD that was typical for before his hospitalization. We began to discuss discharge from the hospital.

My patient was experiencing homelessness, and part of the reason he stayed in the hospital so long previously was because social work had difficulties finding someone willing to provide long term care for him. He had been denied from all rehab facilities because of behavioral problems. The case manager recommended that we discharge him to a motel, with medication and oxygen.

The fifth day, social work provided him with a list of motels. He refused to call them. He told me, “you guys are pushing me out of here. I need more time to think.”  

It broke my heart to hear him say those words, because what I heard was you don’t care. I worried about whether I was treating him different than my other patients. I worried about if it was true, that I didn’t care. I wondered about what the role the hospital must play in his life. No one likes staying in the hospital, but if it meant a warm bed, food, safety and constant healthcare, then maybe staying in the hospital isn’t so bad.

What is the big picture role of the hospital? As a doctor, I will work to uphold the ethical principle of justice, meaning I will treat individuals fairly, including through equitable allocation of healthcare dollars and resources. By allowing a patient who is medically stable remain in the hospital, am I fairly allocating the resources with which I am entrusted? I struggled to answer this question, because it felt (and still feels) cruel to send someone into a poor living situation, knowing that it most likely won’t go well and they would be back in the hospital again soon. I will also work to uphold the ethical principle of nonmaleficence, or “do no harm”. If I discharged him, would this bring harm to my patient?

On the 6th day, we discharged him, and he was back in the emergency department 3 hours later with shortness of breath.

The 5 Letter Word

I recently spent a morning on palliative care and I wondered, “How do you deal with so much death and dying?” My preceptor declared that there were many things more terrifying than death. With her patients, she has the opportunity to consider quality of life and contemplate death on a daily basis; things like, where do we go when we die? While it seemed calming to her, it sounded terrifying to me.

We went to visit a patient who was admitted to in-patient hospice. According to the doc, death was near.

She looked comfortable, sedated with pain medication, but to the touch she was very warm. Her heart beat fast, her breathing irregular, her eyes closed. I introduced myself before placing my stethoscope to her skin. Did she hear what I was saying? Did she understand who I was? Her husband sat next to her and held her hand. Their tiny, fluffy dog moved about the room. For just a few moments, it didn’t feel like a hospital.

Death would not happen today, but maybe tomorrow.

So, I asked her, “How do you deal with so much death and dying?”. The doctor said there were things more fearful than dying, and maybe that’s why there are so many books, movies, and bucket lists on death. Maybe the thing we fear more than leaving this earth, is leaving this earth without truly living our lives. Were you present with the people in your life? Did you tell people you loved them? Were you vulnerable in that conversation even though it scared you? Did you take risks, laugh often, cry freely? These aren’t the things that make a life lived-well, but they might mean that you were truly yourself and maybe that makes a life well-lived.

Suction, please

I arrived at the hospital as the sun was rising, the sleep slowly wearing off and the coffee ran through my veins. I planned to sit down at a computer in the office to start reviewing my patients charts before going to see them, but the morning had other plans for me. My doc walked in moments after me saying, “There’s a patient in the ED trying to die on us”. My sleepy brain registered the labs he’s relayed to me – pH of 6.9, base deficit of -10, possible dead gut.

If you didn’t know, now you know, a pH of 6.9 is bad. It’s a measure of how acidic your blood is and normal is ~7.4. When the blood becomes acidic it’s a sign that lactic acid is building up, a sign that there are tissues that are not getting any oxygen.

She needed to go to the OR, stat. He showed me the scans and we took the stairs to the emergency department. There our patient was writhing in pain, conscious, but barely able to answer our questions. I’ve never seen anyone as sick as her and she was sick. My doc was saying she might die, but would she? I wondered how I would handle another patient death so early in my third year. Would it be like the patient before?

There was no time to ponder these questions as we wheeled her to the operating room, scrubbed our hands clean and approached the sterile field. This was going to be quick my doc told me. We were going to open her belly, see what was going on and get out as soon as possible.

That’s what we did. The first cuts through the abdominal wall revealed dead gut, revealed a stench, revealed a new life for this woman. Black tissue popped free the moment we broke through the fat into her abdomen. It was her colon and small intestine that were causing the problem. We removed them both, leaving healthy small intestine behind.

Her abdomen left open and she was transferred to the ICU in order to receive fluids and blood products. She was alive.

We took her back to the OR the next day for another operation. She was still alive.

She would go back to the OR again another day. She is still alive.


The opportunity to save this woman’s life does not escape me. We didn’t really do that much, but what we did do will change the course of her story. It allows her story to continue. It allows her grandchildren to know her more fully, for her family to spend more days with her. Life, it’s a beautiful thing.

Surgery was on my list of possible specialties going into my third year. It’s been at the back of my mind since I was an undergraduate performing surgery on rats, and I suppose since I was a child. My grandma recently reminded me of when I was younger and determined to be an orthopedic surgeon.

I learned this week that my left hand is uncoordinated. I learned that dead intestine smells horrible. I learned that six laparoscopic cholecystectomies can all be different, but every patient will be grateful for the removal of their gallbladder. I learned the three keys to success in surgery –

1. Eat when you can

2. Sleep when you can

3. Don’t touch the pancreas.

I learned that being in the OR is exhilarating and I learned that surgery is definitely staying on my list.

Slow Down, It’s Not a Race

What up World? It’s been a minute! It’s actually been longer… but it sure feels like time sped up and somehow I landed here. A yoga instructor I had the other day talked the whole class about slowing down. It resonated with me and I wonder how many other people feel this pull to race to the finish. Funny enough, I’m not sure what that finish is yet. Is faster better?

In March, I finished up my 2nd year of medical school and started this thing called “Dedicated”. Basically, the school gave us 7 weeks to have focused study time for our first big board exam.  Step 1. It’s a little frightening when the message is to work hard at nothing but this one test.

During dedicated, I tried to cut out as many distractions as possible, and it was probably the most disciplined I have ever been. I’m talking a 9:30 PM bedtime with a 5:30 AM wakeup. I would eat breakfast and then head to the library for 8-10 hours. I did the things that would keep me human – like Crossfit, dinner with family, church, I skied once – but aside from that there was no fluff, and it was hard.

I felt disconnected in many ways from reality.

I tried to go on a date… then when he cancelled, I was devastated. I put on jeans and did my makeup for the first time in weeks. I even put on deodorant. No one should get that excited for a first date – just saying.

Then I watched a documentary called, “Take Your Pills”. It’s about ADHD and Adderall and competition and what we have to do to keep up in this crazy world – forget about trying to get ahead. It sent me down a spiral of wondering if this feeling of disconnectedness was my new norm. What was I sacrificing in order to follow my dream? I texted one of my friends in March saying, “I’m fearful that this will set a tone for the rest of my life”.

I took my test, and no, I don’t know how it went yet.

I’m not as fearful as I was then, but I do wonder sometimes how I plan to approach the many different priorities that will demand my attention. Google ‘physician burnout’ and you get over 9 million hits. Does that seem wrong to anyone else? Why are we killing ourselves for this? And who’s fault is it? Maybe it’s because I’m not doing enough to take care of myself, or maybe there are too many pressures to be the first to arrive, and then to be the best. All the time.

You might wonder why I did all of those things for this one test. It’s because I was playing the game that the national medical community says is important. It wasn’t my values, but the values of the world I wish to be a part of that I was prioritizing. It was a finite period of time, but what’s the future cost? I hope to be part of the conversation that helps to shift the priorities, to slow down. To value humans and to be present. To learn the material because we find it interesting, not because someone high up says that a certain score on step 1 is valuable.

It’s a rush to the finish. I feel my heart beating faster even as I write this and think about the valuable time that I’m “wasting” while putting words on paper.

Is it a waste? I sure hope not.

Hindsight is 20/20

When you think about your own birthday do you feel excitement, dread, sadness? I feel excited for the cake mostly, and also because for 24 hours I get to feel special. I also feel a small sense of dread that no one will remember, or be free to hang out, or that even though it’s 24 hours of feeling special, maybe I won’t? Does this happen to anyone else?

When I turned 21, I remember telling everyone that I was “getting so old”. When I turned 23, I never would have guessed that I would move to Atlanta that year. I continued to believe that I was “so old”. When I turned 24, my friends came to visit me, and we decided the best hashtag for the weekend was “Trap queen 24”. When I turned 25, I made donuts for all of my friends, we sat on the living room floor and drank mimosas. At 26, I studied in a coffee shop. A lot of life has happened since then and I realize how young I was, and how ridiculous it must have been listening to me say that. I give you all permission to slap the senses back into my 21-year-old self.

The musician Maggie Rogers just released a new record and she wrote a little piece about it. She says, “I found my space in the place between knowing who I was and finding out who I am”. This past year has been a gift. It’s most certainly been a rollercoaster of highs and lows, but it’s given me more confidence in understanding who I was, am and who I will be.

Today, I turn 27 and I’m not going to say that I’m getting old because I know that while a lot of life has passed, a lot more life is left to live. I still love brunch, I still love to read and write, to laugh [my most used emoji is the crying/laughing one], and I love to feel the breeze on my cheeks, the silence of snow falling in the trees, and the sound of rain in the middle of the night.

Hind sight is 20/20, but wouldn’t the future be a bit boring if we could see so clearly?

Three Words.

Courage, Patience and Connection, these are my words of 2019. I chose them when I was reflecting on 2018 and I was thinking about what my hopes and dreams are for this trip around the sun. One didn’t fit without the other and I think I’m only just beginning the ways that they weave together.

I chose courage because the second half, of the second year of medical school is notoriously one of the most difficult, all because of this little blip in April. It’s called the USMLE Step 1 and is the first of board certifying exams. Basically, it’s a multiple-choice test in clinical vignette style based on the first 2 years of medical school. Each question goes a little something like this:

A 35-year-old woman presents to the emergency department with acute onset shortness of breath. She states that she recently returned to the United States from a trip overseas when she started having pain in her left calf. She has a 10-pack year smoking history and takes oral contraception. Her labs show…. Which of the following possible risk factors is most responsible for her symptoms?

Do you know the answer? It’s okay if you don’t!


I seek courage to face each day and to look inward at my own strengths. I’m an Enneagram Type 1 and basically that means that I’m constantly striving for perfection. I know that’s an unrealistic expectation, but that’s where courage comes in. I’m looking for courage to make mistakes and to stumble from time to time this year.

I seek patience to trust that the plan I have is the best one I can come up with and that the rest is held safely in the hands of God. Today, I had my first test in the Infectious Disease block. It didn’t go as well as I hoped, and as I looked at my score, I felt this deep sense of frustration that I wasn’t good enough, or that somehow, I’m doing this whole thing wrong. I looked at the average and my mind went to all of the ways that I didn’t measure up compared to them. This comparison game is one of my biggest enemies, so I’m seeking patience to trust in my own learning and in the cycles of ups and downs.

Connection is my final word because I want to hold tightly onto human connection. A few years ago I read this article but it still feels relevant. All of her sentiments ring true and leave me feeling convicted of living life in distraction. I’m seeking to connect deeply this year, with friends, family, patients, the world around me.

Courage, patience and connection. Those are the words of 2019 and I guess I’m a perfectionist that tries to see the world as a glass half full of cabernet sauvignon, full bodied and savory.

Do you have a word? Or two, or three?

Reflect // 2018

Think of this as my virtual holiday card. Happy New Year from me!

2018 began in the midst of glow sticks. My cheeks glistened with sweat and I formed the resolution to say “no” more. This year began with me, first.

In 2018, I have experienced joy from my fingers to my toes, filling up and overflowing from the deepest corners of my soul. I traveled, laughed, cooked and ate my fill. I kicked a** in med school, read a lot and played a lot. I am physically stronger because of CrossFit, and mentally stronger because of life. This year I have also felt tremendously lonely. Waves of bitterness and grief washed over me as I watched friends who I called family continue to live their lives without me. I questioned what I was doing in lecture halls 20+ hours a week when I was perfectly happy with the course of my life before.

At the beginning of my winter break I traveled back to Atlanta for a wedding of a friend and a lot of the trip felt like returning home. Then when I landed in Denver, that also felt like returning home. I think it’s easy to forget the pain and yearning of years past when you feel stuck in the moment. I was content with my life before, but medical school was always a missing piece. I knew there was something more for me. I knew that I was born to do something bigger and sometimes it’s more painful, as we pursue that something bigger, than we imagine. When the days are long, and they blur together, we joke around, sarcastically saying things like, “look what happens when you follow your dreams”, but in all seriousness, look what can happen when you follow your dreams. It’s hard work, but I know I’ll look back on this time with fond memories.

I have been challenged and I have grown. I may have missed the mark at times, but I’m still striving for the bullseye.

This year I have been learning about the power of listening before speaking. I tried to learn to say no, but still said yes, a lot. This will most certainly be another goal for 2019.

I’m hopeful for this year to come.

A few of the highlights from my year —

  • I adopted my cat, Pippa. She hates me and loves me and is more like a dog than a cat. I love her. 2018 taught me that I can be a crazy cat lady.
  • I turned 26, bought myself flowers. If no one else is going to do it, then I will.
  • I participated in the CrossFit Open. CrossFit makes me feel strong, capable and powerful. It reminds me that we can accomplish any challenge we are faced with if we persistently chip away at the work.
  • I went backpacking in Utah at the little-known national park – Capitol Reef.
  • I learned about the heart and gave a speech to my dog. Jk, I gave it to people, but I pictured them all as my dog while standing on stage.
  • I ran my first half-marathon. About a month before, I went to the running store to buy new shoes and I spent the whole time trying them on telling the guy helping me that I hated running. Apparently, it was charming enough for him to ask me out.
  • We finished our first year of medical school and we celebrated with the spiciest Thai food at City Park.
  • I went to Bellingham with the rest of the family to cheer for Leah graduating from Western Washington University.
  • Then we went moose hunting in Winter Park and slept under the stars.
  • I went to London and learned that solo travel is not for me.
  • Back to medical school, more sleeping under the stars, sailing on Carter lake. This was the start of a challenging semester in school.
  • We rang in September by hiking a 14er in the snow.
  • The MS2’s beat the MS1’s in kickball.
  • Successfully completed Neuro and felt closer to my med school fam than ever. This month passed by in a blur of study, eat, sleep, repeat.
  • Snow! More of the blur and Thanksgiving and Med School Prom.
  • A trip to Atlanta.
  • Skiing and lots of cookies.

Cheers to 2018!


October in Review

October in review, for all of the things that I’ve wanted to say this month but haven’t had the time or energy to channel them out into the world wide web.

Maybe it’s better this way. I’m not sure. I’m still trying to figure out how to keep this blog going while in medical school.

October was a challenging month. It started with the end of the neuro block, 8-weeks of grueling coursework in the nervous system. With all of our exams on Monday mornings, it makes it really challenging to take a guilt-free weekend off from studying. By the time we got to the end of neuro I was tired and beaten down, but we picked ourselves back up to start the GI tract the next day. The rest of October passed in a blur of brown-tinged jokes and complaints of abdominal pain. What causes diarrhea you ask? It feels like a million things.

My patience was tested. My focus was tested. My ability to find that elusive balance was tested.

On October 1st, I saw a beating heart. In a human body.

On October 1st, I got the opportunity to shadow a cardiothoracic surgeon while he did an open repair of someone’s ascending aorta. Those are basically all fancy words for the tube that comes off of your heart and sends blood to all of the different organs in your body. It’s pretty important that it is strong and sturdy, but sometimes they become stretched too thin and that’s when we worry about them breaking. So, this surgeon went in and replaced a piece of this man’s aorta with a manufactured tube. It was incredible and exhilarating and humbling, all at the same time. I was also terrified of the possibility of tripping and falling onto the patient the whole surgery. My mantra for the day, “do not fall, do not fall”.

On October 8th, we finished neuro and promptly ate our weight in Denver Biscuit Company.

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On October 10th, it snowed.

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On October 12th, my friends and I went to the ballet, Sleeping Beauty. We put on our fancy dresses, I put on some new lipstick and we pretended to not be medical students for one night. Which was actually pretty difficult because we went to the ballet with the CU School of Medicine Alumni Association… Also, I may or may not have rested my eyes during the first act.

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On October 27th, my 2011 MacBook Pro was considered to be a “vintage machine”. I don’t think they understand what the word “vintage” means, but I bought a new computer anyways.

I had been thinking this month about some of the things I was thankful for because my cousin Katie was running a series on her blog about resistance and gratitude. I sent her 5 things, but I left out one. I’m really thankful for student loans because without them I wouldn’t be able to get through medical school. So, while I have to pay them back eventually, at this moment in time I am able to focus on becoming the best doctor I can be, while not having to worry about where my next meal, rent check or gas money will come from. Because of student loans, I can purchase a new computer. This is a privilege.

All through October, we studied a lot, making tables and graphs of the diseases of the GI tract, and having a little bit of fun along the way. Now here we are, on the edge of November.

This month I was challenged to be faithful; to trust in what is coming and what I cannot yet see. To trust that this hard work will pay off and that the season will change. I am encouraged.

How has October been for you?