Lets Unite, Wear Masks

Today is 100 days since the first recorded covid-19 death in the US. Now we’re at a shocking 88,890 deaths (that number has jumped 600 since I first started writing this morning). We’ll be over 100K in a week or two. I am sure. I used the adjective “shocking,” because I personally think this number is out-of-this-world-jaw-dropping. It terrifies me to my core that this is the death toll despite insanely interruptive lockdowns and limits on socialization- with virtually complete closure of all schools, innumerable business closures, millions working from home, cessation of sporting events, closures in places of worship and parks and barbershops and breweries and restaurants and dentists, with preventing families from celebrating graduations and birthdays and weddings. Eighty eight thousand, eight hundred and ninety. But it is a number that many just respond with a nonchalant shrug, a so-what attitude. I challenge you to imagine this already shocking number without ALL of these difficult disruptions. An unfortunately intelligent and efficient virus has crept into our communities and stolen loved ones from nearly 90K families, while millions of us sat at home with the sole purpose of interrupting its spread.

This pandemic has already taught us so many important and difficult lessons, many new and many old that persist and need reminders. Many lessons are worth highlighting.

* The disproportionate toll on people of color reveals how chronic and deeply pervasive injustices contribute to social determinants of health.

* The devastating numbers among Native American communities reveals the ignored systemic consequences of historical trauma.

* The rise in child abuse and domestic violence reminds us that home is not a safe haven for everyone, and allows us to value teachers for an often forgotten role they play as mandatory reporters.

* It is profoundly hurtful to blow off the virus just because it “only” kills those over 65- a whole generation of people with generations of people who love them dearly; a generation of people who may have another 30 years or more left to live; and a generation of people that we rely on as essential workers (New Mexico has the second oldest workforce of doctors), as caregivers to our children, as teachers of our history and language and culture, and as friendly faces in our neighborhood. “Sacrificing the old” is not only hurtful, but deeply disturbing.

* This virus reminds us that many are one checkup away from a chronic condition that would put you at risk. The health of our nation has never been sicker when it comes to chronic conditions. When was the last time you had your blood pressure and glucose level checked or calculated your BMI (many deaths in young people have been in individuals with obesity as their only risk factor)? Even if you are healthy and not at risk, you are not invincible. And if you were invincible to death this one time, you are not indestructible to the morbidity associated with this virus. There’s a phenomena called post intensive care syndrome where, simply put, people who recover are not whole. They suffer emotionally, their muscles have atrophied, the secondary infections and antibiotic exposures have long lasting consequences on the GI system and susceptibility to multi-drug resistant organisms, their cognition is slowed, they may have scars and aches from tracheotomies and feeding tubes and central lines. They may leave with a new opioid dependence, reliant on dialysis or with permanent neurological deficits like inability to speak or walk. We’re now learning that children may suffer from a debilitating inflammatory process that leads to organ failure in their tiny, healthy kidneys and hearts. We can only predict the long term consequences these little ones will endure, and my scientific guess is grim. Yes, these people are recovered, but they are scarred and weak and may never return to their pre-covid state. Morbidity is equally important to mortality and should not be ignored.

* The job security of many healthcare workers and the “heroic praises” we are awarded during a public health crisis, our type of war, is not without risk of exhaustion, threat to our own health, threat to our family’s health, and irreversible injury to mental health. Those healthcare workers on the front lines are suffering- they see patient after patient die alone, they are under-resourced and overworked, and they are isolating themselves in such a despairing moment when hugs and kisses would be majorly welcomed, just to protect you and your families. They may never recover from their time on this battlefield.

* This pandemic is not just teaching us a lot about a virus and injustices of society, but it has also taught us a lot about ourselves and how deeply divided we are as a nation. This lesson has been truly difficult for me to digest. Of course this divisiveness has been apparent in leaderships’ willingness to accept science and data, the media’s portrayal of the seriousness of the virus, and widely varied approaches local governments have when it comes to systematically flattening the curve. But something so small that for me demonstrates how heartbreakingly divided we are is the task of wearing a mask.

As a doctor who performs c-sections sometimes lasting hours, I am no novice to the discomforts of wearing a mask- the shortness of breath that inevitably exists, the anxiety of confinement, the itches you can’t scratch, the uncomfortable warmth of your face baking in its sweat, the condensation that leaks onto your eye protection, and to top it off once I have sterile gloves on I cannot adjust my mask, pull it off for a quick breather, or swiftly place it in a more comfortable position. You can often take a break to pull your mask off, but I might have a briskly bleeding patient relying on my undivided attention to the task at hand, a task which doesn’t even allow a minute away to readjust my mask. Sure you can say I signed up for this, but that would be an unfair statement. I signed up to deliver healthcare, to care for families, to keep people healthy. I wear a mask because I have to for your safety. It is an uncomfortable duty that comes with the job, like being a citizen of this world comes with the duty to also do no harm to your fellow citizens.

Wearing a mask is not foolproof. It is not comfortable. And and it is certainly not convenient. And recent changes in societal norms and the outrage that has ensued is clear evidence how people react when they are uncomfortable and inconvenienced. Unfortunately we cannot always cater to the convenience and comfort of the general population at the expense of suffering and death to others.

Wearing a mask is not foolproof, comfortable or convenient, but wearing a mask is many many other things. Most importantly, It is compassion, safety, and compromise. While its use is not perfect, it does provide significant reduction in the risk of transmission. But it works best when all parties wear masks and they wear them consistently. How silly would it be if only some surgeons wore masks or some decided to only wear it when they felt like it? With a disease as unrelenting and ever evolving as covid-19, why not take any simple task to prioritize safety? Consider the hundreds of other laws and rules that exist to prioritize your health and the health of others, like wearing seatbelts and helmets, and requiring vaccines for school entry and babies to be buckled in carseats. Consider how smoking is prohibited in public places and in airplanes and how age restrictions exist for purchasing tobacco and alcohol products and there’s limits to how much you can drink and drive. Remind yourself that it is required by law to have insurance on your car and a medical license to perform surgery. We are all subject to these small inconveniences for the large health benefits of the general population.

If you think demanding mask usage is a threat to your civil liberties then you should shout your gratitude from the rooftops that you are not a woman, that you are not gay, that you are not an immigrant or black or disabled or incarcerated or non-English speaking or poor. Because if being required to wear a mask is so threatening to your existence and happiness then be thankful that your privilege has protected you from discrimination in applying for housing and jobs, being unable to vote, marry, patron any business of your choosing, access to healthcare and reproductive choice, access to a fair trial and a just sentence. There are real civil liberties that are threatened and curtailed on a daily basis and I assure you that mask usage doesn’t begin to compare to what many of your fellow American and human beings experience.

Like I said, wearing a mask is also compassion and compromise. If not for you, then why not for others? It is easy to tell people who are elderly or immunocompromised or simply scared to stay home, but let’s be honest with ourselves, these stay at home orders are affecting all of us, every single one of us independent of race, political affiliation or health status. Just because you are elderly or immunocompromised does not mean you also have the privilege of staying home without fear of economic devastation or mental health deterioration. It does not mean that you aren’t in need of the non-essential comforts of a Home Depot run or an ice cream cone. It does not mean you enjoy being home or even have the means and capabilities of staying home. We are all humans dying for connection. We are all humans suffering the consequences of the lockdown. And we are all human, more safe in the public when we all wear masks. It’s not as easy as stay home if you’re at risk or scared. And a so-what-if-I-get-sick mentality ignores the people who will have to care for you as your rehabilitate, the nurses who lose sleep over your tenuous recovery, not to mention the many people you infect along the way. Right now, it’s not just about you.

Please do not make wearing a mask partisan. I assure you that just like seatbelts protect Republicans and Democrats equally, a mask will too. Please do not mock this “threat to your freedom.” Real injustices exist and interfere with the true pursuit of life, liberty and happiness everyday. And please leaders of our great nation, do not say that wearing a mask sends the wrong message or shows fear, because I promise it is quite the opposite. It promotes compassion for your neighbor and compromise for a uniquely difficult situation we are in. There’s an incredibly lethal virus circulating and the only way to stop it is darkly grim with mass and complete closures and an economic devastation from which we would never recover, so let’s at least slow and control its spread with the simple task of mask usage along with the more complex tasks of testing, contact tracing, systematic quarantining, and therapeutic and vaccine development. Wearing your mask will not be foolproof. It will not be convenient or comfortable. As someone who has been wearing a mask for the last 10 years, I can guarantee you this. But please know that it is compromise for opening our communities, it is compassion for those around you, and it is some degree of safety and security that you can take into your own hands. And if all goes well and we continue to stick to the recommendations of our public health leaders, then this too shall pass. The uncomfortable task of wearing mask will be temporary.

One Year

On August 12, 2017, I scrambled out of the giant king bed I was sharing with my little sisters. I rushed to window, drew the curtains back quickly and my eyes darted to the sky. It was sparkling blue and there was not a cloud in sight. I exhaled a sigh of relief. Our rehearsal dinner had been the night prior and we were showered with rain, we walked in puddles and mud, and the clouds obscured the bright ball of fire that reigns in the sky. For the rehearsal dinner, I tried to shake off the implications that rain showers would have for our outdoor wedding. So on that beautiful and bright August morning, I no longer had to worry those worries. The sun would shine bright on mine and Aaron's nuptials, the warmth would fill our hearts and the rains would have to pour another day.

Our wedding was honestly perfect. In fact, the only difficult part of the day was waiting until 5pm. If I had to change anything, I would make it an earlier wedding, because I spent the entire day yearning to see my future husband. A delayed start time only made this worse. Delayed because it takes a ridiculously long time to filter 350 guests into a single entrance. I was so eager. I couldn't wait to hold my groom, to kiss him and to finally become husband and wife. I wanted to enjoy our mushroom-themed decorations. I wanted to adore the fresh smells of our hundreds of arrangements. I wanted to see our guests in their Sunday best. I wanted to dance to Cuarenta Y Cinco, watch the Butterfly dance performed by local tribal members, listen to the Mariachis, pose for our incredibly talented photographers, eat our aunt's creations, and indulge in our decadent cake. It was the culmination of months of planning, our savings spent, and the teamwork of two families who would soon unite.

We chose our venue wisely. Delancey Street Foundation is a drug treatment facility. Professionally, I have chosen a field in which I can work with pregnant women through their addiction. It was incredibly special to be able to do something personally in this realm as well. I felt honored that my wedding day expenses could go towards such an important cause as opposed to someone's pocket of profit. It was also the most beautiful venue a bride could hope for with a pond for a centerpiece, ivy and willows serving as a green backdrop, and the unique touches of southwestern adobe walls nestled in the land of Aaron's upbringing.

Our food was prepared in a familiar kitchen. It was made wholesome with the love of family who literally worked day and night to create a meal that would fill both bellies and hearts. The bread was baked in the hornos that dot the back of Aunt Norma's Ohkay Owingeh home. Every slice of meat was cut by the hand of Uncle Hutch, who also blessed us with a prayer of well wishes in Tewa.

The decorations were Jessica and Deidra's masterpiece. I am so blessed to have two older sisters who make dreams come true. Cousins by relationship, sisters by circumstance, that is. For the weeks leading up to our special day, we shared pinterest posts, we spent way too many hours in craft stores, we sent texts back and forth until we all agreed that each piece flowed with the next. I'm not gonna lie, these two were far more picky than the bride and for that I am eternally grateful. I let them take the reigns and run wild, since there is no one else in the world I would rather trust with my special day decor than my big sisters. I knew they would treat my wedding as if it was their own.

In the end, it was the little things that won the hearts of the crowd. It was the handmade wooden mushroom piece that won the prize for uniqueness. It perched atop our forest fairyland cake after I redecorated it to match our theme. It was the frog that hopped up to me as I posed for my bridal portraits. It longed to be kissed and so together we gave our bridesmaids a show and filled their lungs with laughter. It was Nolan, my ring bearer and favorite little man, who nearly dropped our rings in the pond and our flower girls, who surprisingly all made it down the aisle without a single tear, that evoked the oohs and awes of the crowd. It was the blue velvet heart that the Baca's had sewn and embroidered into my dress to sit close to my heart. It was a heart cut from the skirt of my dear grandma Flora who would have danced the night away had she been alive. It was my jewelry made by an old friend, the bridesmaids earrings made by the late-mother of my mentor, and the very last minute hairstyle idea that provided fashionable statements. It was the vows we exchanged, Aaron's short and sweet and mine longwinded as I am known to be, that provoked the tears and cheers of the crowd. The vows were filled with heartfelt emotion as Aaron promised to cheer on my Broncos and travel the world searching for mushrooms. It was my vows to be his rock as he followed his dreams in return for the steadfast support he has given to me as I follow my own. It was the words of Dr. Joel Charles as he remarked on our journey that he has become intimately familiar with during our three year journey in California. And as a cherry on top it was pure happiness that floated through the air, vibrating and invigorating not only the particles of our atmosphere, but the hearts of our guests.

It was our family. Those who share our New Mexico born blood and those with whom we have built familial bonds through unwavering friendships. It was the presence of long lost brothers, tenderly aged uncles, friends with whom we've shared journeys abroad and journeys in our own backyards that made for a distinctive gathering of strangers all connected by their relation to us. It was the group of rambunctious men who sang "Wagon Wheel" to the tune of their guitars and the women who encircled us with their dance moves that symbolized the camaraderie we have fostered throughout our lives. It was the moms and dads who blessed us with toasts filled with stories of their most cherished childhood memories of each of us, and the sharing of first dances, that added a historical perspective about the children we once were. It was our best man, Aaron's brother, and our maid of honor, my sister Jelly, who made sure everything went perfectly, they were the structure behind the scenes. It was the residency family who flew and drove in from across the US to experience a New Mexico wedding filled with la marcha, the dollar dance, and the rancheras of a local band. It was all these people that surrounded us and poured their love into our success as one.

And none of it would have been possible without the perfect man to marry. Aaron, my main squeeze, my critter bug, my soulmate, you made our August 12th wedding undeniably the most beautiful wedding I could have ever imagined. You filled it with emotion and sincerity. Your tears as my dad walked me down the aisle, the creak in your voice as you professed the vows you committed to memory, the smile slash smirk you rocked in our photos, the way you held me as we danced, the joy you embodied as we made memories with our loved ones, it was all of this that made our day an engraved memory in my mind and heart. It was sharing a gift hours before the wedding separated by ivy covered walls that made the wait unfathomable. It was the perfectly fitted blue suit that flashed in my daydreams of my husband-to-be as I sat in my bridal suite waiting to be reunited with you. It was the start of a lifetime together, the first scene of a love story, and the fairytale New Mexico wedding we had dreamed of that sparked an intense sensation of feeling whole. Today, one year later, I long for the perfection of that day. Oh how I would go back and dance with you to every song, how I would walk alongside you by the swan filled lake surrounded by the cool shade of weeping willow trees, hand-in-hand and heart-in-heart. But then I am reminded of how beautiful our everyday life is, how waking up to your snuggly warmth and your unending dedication to our story keeps me livened with everyday perfection. We share so much joy in our day to day life that while our wedding day was a high that we rode for months to follow, life with you is the real and unfiltered journey that people dream of, the true and unmistakeable warmth of trust and safety, the late night talks and the good morning giggles that will birth our future and our happily ever after. You are my rock, my love, my peace.

Race Day

Race Day.

It is the climax of all that you’ve been training for. It is the consolation for your sore muscles, deranged toe nails, and overworked bronchioles. It is a culmination of all your mileage, of every run you aimed for a certain distance or a specific pace. It is a celebration of every extra effort to peel yourself from a cozy couch. It’s RACE DAY and with that you have transformed into a different being. 

You wake up hopefully feeling hydrated, because the day prior you downed liters of water despite your bladder telling you that it had had enough. You’re more awake than you should be at this godforsaken hour, surely more awake than if your destination was work. The race day nerves manifest in poor appetite, belly butterflies, ten bathroom trips for only one ounce of urine, and if you’re lucky a nice big poop! You get a little snack in and if you’re anything like me, a caffeine zealot, you obsess about drinking enough coffee but not too much, because your body doesn’t do well without it’s good morning juice but you know overdoing anything on race day can lead to that unwanted heaviness, an extra grumble in your tummy, or the cramp that cramps your pace. And then in the coolness of the morning, you join fellow runners crazy enough to be underdressed for the weather. You bounce and huddle. Your eyes admire everyone’s crazy cool running styles- some people wear tutus which would be overly complicated for you, some have knee-high socks and barely-cover-the-booty shorts. There’s neon colors galore, from the headbands that cuddle ears to the packs around wastes to the mud splattered shoes. 

It’s race day. Your eyes are wide awake soaking up the first bits of sunshine, while your muscles, on the other hand, have only begun to yawn. So you do a little runner’s dance bouncing from one foot to the next while you wait for a porta potty to open up. Hundreds of people wait to occupy that snug and stinky box (only half of whom need to go, the other half just wanna try because there’s nothing good that comes with a full bladder or bowel while racing). You hope the potty will be stocked, but inevitably you’ll get the last sheet of TP and a drop of hand sanitizer if you’re lucky. You touch your toes here and there, you skip some high knees while you make your way to the start line, your shoulders move up and down, and your trunk twists right and left. “Warm up, you got this,” you give your body a pep talk. “I promise, this is the last time I make you wake up and run 13 miles for fun,” you lie. 

Part of being a runner is preserving a little crazy, embracing a little race day mania, and surrounding yourself with people just as mad as you, so that you can joke about how much fun running 13 miles is gonna be... yes, joke about how excited you are to finish off that toe nail that hangs to only half of the nail bed, how excited you are to borderline freeze for the first mile so that you’re not overheating the next dozen, excited to stress your muscles to a uniquely euphoric exhaustion. Us runners, we’re a crazy bunch, but a bunch of crazies together makes for one heck of a time. It makes for words of encouragement from the stranger who huffs and puffs alongside you at mile 11 with a hill ahead, it’s makes for sincere joy as you cheer on the fellow runners crossing the finish line using up their last bit of glycogen stores to appear much faster than the previous 12 miles, it makes for an ecstasy inducing denouement to walk around standing tall with your shiny finisher’s medal posing for pics with your reindeer-red noses and dried sweat streaks decorating your face. Its huddling with your friends to stretch and snack and revisit each mile play-by-play with joy in each word. It’s all worth it. I’ve done it four times and I’ll do it another four for that natural high that only race day can bring, that sense of accomplishment by physically pushing yourself to its limits, that inner competitive ego that aims for personal bests and promises next time to shave off that extra minute here or there. Race day is intoxicating, so much so that you plan your next race before you’ve even finished this one. 

The Glacier Half Marathon was no different, just a bit more exhilarating than usual. I mean except for the five mile incline right out the chute and the weatherman’s prediction of 100% chance of rain and <50 degree weather threatening hypothermic conditions for half naked runners, it was an unforgettable race day, my favorite race day yet. The Blackfeet Nation sent us off to the beat of their drums, and Mother Nature only sprinkled us at miles 6 and 8, and atop that 5 mile climb was breathtaking landscapes of a treasured National Park. It was the sound of eager feet on the paved road with nature playing harmony in the background. It was the smell of rain in the surrounding forest and fresh air permeating into the depths of your alveoli. The kind of air that you can’t find behind hospital doors. It was the feel of flying faster than you prepared to fly with the reserves that only race day can offer. It was the taste of a well deserved post race cappuccino juxtaposed with a crisp cup of water and electrolytes as you sit in the historic lodge with a century old railroad stop nearby. It was the sight of flourishing forests and crystal clear waters, the sight of runners of all shapes and ages prioritizing health, the sight of each mile marker zooming by becoming not only a memory but a conquered feat. 

Race day is one of the biggest reasons I run. I mean I love the health implications and the stress reducing benefits, but when all is said and done it’s one of my favorite jubilation inducing methods. Race day is truly a celebration for your body and your mind, an appreciation for your health and endurance, and a procurement of a great sense of pride.

Thank you to all my running buddies who made training happen despite a hectic work schedule, especially Laura R. Thank you to Aaron who reminds me that I am indeed a good runner and celebrates my 76th place finish among 1,279 women as fervently as if I had won the olympics. Thank you Gary, (Laura K’s dad) for being our biggest fan at the finish line, keeping our bellies fed, and courageously wielding bear spray on our post-race hikes. Thank you, Glacier and Blackfeet Nation for bringing so much beauty and tranquility to race day. Thank you Laura K and Tami for being the brightest, most energized faces to wake up to at 3am, and for being lovers of nature and movement. Until next time...

A Tribute to Santa Rosa

Today my life in Santa Rosa ends. My friendships will continue; the knowledge I've gathered will last as long as my mind allows; my passion for mushrooms of the northern California coast and my enjoyment of vineyard speckled landscapes will surely endure forever. But my heart will mourn for many of my dear patients who will more than likely remain in poverty and my eyes will shed tears for the company of family that embraced me over those joyful but strenuous three years.  

When I set out for Northern California in 2014, I expected to develop a sophisticated palate for local wines, but rather I contracted a heightened taste for IPA craft beer. I expected that I would go to Santa Rosa and obtain a solid education in family medicine, but did not anticipate to be educated deeply on the effects of racism on health, the harms of structural violence from society and our governments, and the expansive job description of physicians requiring us to fight for social justice. I expected I would find friends to have dinner with and vent over long and busy shifts, but how could I have predicted that I'd find the warmest souls and brightest adventurers to endure the pains of practicing medicine, the heartache of patients' deaths, and the injustices against our community. I was certain I'd be surrounded by passionate people, but little did I know their passion would supersede our shared love of family medicine. With them, I would discover bold and overflowing passion for animals, equality, nature, climate, religion and faith, exercise, diversity, youth mentorship, and food. I've learned so much from them and have learned even more about myself on this three year journey. 

I learned how courageous I can be, how strong my voice is, how my duty as a physician is far larger than my ability to practice good medicine. I learned that reflection, either through writing, facilitated group check ins, or with relationships, is powerful and healing. I learned that I can accept help without the intense sensation of being indebted, because not every act of kindness necessitates repayment. We must merely continue to pay it forward. I learned how to appreciate my hardships as lessons and character building, as a means to connect and an opportunity to grow. I learned that I am sensitive. Well I already knew this, but I can say I've grown to embrace it. I learned to appreciate and prioritize wellness and self care by making most of my meal choices healthy ones and by gifting my body, so intricately designed by God to be agile and capable, with movement. I afford my muscles an opportunity to strengthen and my cardiovascular system a test of endurance. I've grown as a leader, sharpened my skills as a writer, and emboldened my mind to better advocate for myself in moments of conflict. And most importantly, I learned that I need to be more gentle and forgiving when I fall short, that I must continue to value and strive for balance, and that quite simply, I am still a work in progress. 

As a doctor, I blossomed, but am still young. As a child, my perception of a doctor was an all-knowing savior with earned privileges. As a pre-med student, it shaped into a hard working individual with a commitment to the health of people. As a medical student, I was tested on the tenants of being a physician, to do benefit and no harm, to allow autonomy and ensure that our services are just. And after my tutelage in Santa Rosa, my understanding of this role has not only broadened but deepened. My role as a doctor is to recognize the shortcomings of my patients, but to convict the unfair circumstances promoted by society, to understand the cycles of poverty and addiction, and to appreciate the desire to be healthy but rarely being equipped with the resources to succeed. My role is to promote health with close attention to mental health, to be adept in communicating with those whose education is minimal so their minds can be armed with information, to be compassionate to the mind hijacked by drugs and alcohol, to find middle ground for the difficult personalities that often reflect decades of abuse and neglect. My role is to do my best when we're asked to practice in resource poor settings, when our patients' compliance is compromised by things outside of their control, and when there is not always a single right answer. I learned that patients expect a smart doctor, but even more so yearn for compassion and communication. I learned that every day my patients are slaves to judgement and that they don't need it from the healthcare system. My job description has lengthened far greater than I ever imagined.

In residency, I was constantly living in a world of dichotomies. Sometimes it was as simple as having an overwhelming and pure love for what I do, but other times absolutely despising it (often provoked by extreme fatigue that prevented me from loving it in a foolproof manner). And sometimes it was as complex as delivering a stillborn and providing support to the mother as she quietly cried, and then being tasked with finding an inner joy to step into the next room to deliver the baby of ecstatic new parents. Then there were days when I fantasized about the long white coat trailing me as I quickly marched through the hospital halls and there were other days when the heavy burden of doctoring felt like the weight of a thousand worlds sitting on my shoulders. There were episodes of seemingly unforgivable regret in choosing a sometimes thankless and emotionally taxing specialty and other times when I praised my triumphs and moved forward with the belief that my work could save the world. The emotions were often so starkly divided that it took intense dedication to understanding valleys that are not always vindicated and clutching peaks that symbolize the efforts and sacrifices of everyone involved. I have learned so greatly, and so precious is the knowledge that I never want to stop learning. 

I am incredibly gracious for the lessons of Santa Rosa. I am thankful my patients who shared their vulnerabilities with me and worked by my side, often as teachers of human nature and mentors in patience, as I cared for them. I am thankful to all my mentors who imparted far more than the science of medicine, but also kindly shared their wisdom regarding the art of medicine. I am thankful to the entire team who works to care for patients alongside me, particularly my medical assistant who welcomed me into her life and always gently nudged me in the right direction. I am thankful to this small city for providing a home to me and Aaron as we grew in our partnership. Santa Rosa provided abundant opportunities to explore the diverse living world around us- among ocean fronts and atop breathtaking mountains. I am thankful to have discovered the world of fungi and their beautiful fruiting bodies, mushrooms. Like me, the mushrooms sprouted when the conditions of the environment were prime and with an intense network of mycelium and comensal relationships intertwining beneath to support its unique beauty. 

And to Aaron who ventured west with me, you are my soulmate. You are the love that gives me strength and the calm that brings me peace. This would not have been possible without your unwavering support. Over the last month, I would say we have successfully celebrated our life in Santa Rosa. We have spent precious time with our friends, we celebrated graduation with a perfect ceremony attended by my family, we celebrated love and marriage, we traveled flawlessly in a large group to Hawaii. 

And most notably and from the bottom of my heart, I am thankful to my friends for loving me and my weaknesses. If not for you, I wouldn't have endured the death of the precious but fatally sick newly born baby, the suffocating need to know every answer, and the immovable sadness of inequality. Thank you. I am honored to have trained by your side and among the shepherding of the Santa Rosa Family Medicine Residency. 

This post is in honor of nostalgia and introspection, but mostly nostalgia.

One Victory at a Time

The implosion of Trump's AHCA was but a small victory in the fight for healthcare. The process of developing this so-called healthcare act unveiled a horrifying reality: that republican legislators are willing to gamble with the lives of Americans, they are willing to prioritize politics over people, the president has no intentions of keeping his promise in regards to healthcare and that they underestimate the power of the resistance. 

The Affordable Care Act has been an excellent step in the right direction, but just a step and not the answer to all our needs. It has done wonders and extended access to millions who were without insurance. But it was compromised in order to satisfy bipartisan goals. Big pharma and the masses of lobbyists employed by insurance companies further impede progress for quality, affordable, and accessible care. It is for these reasons, that a replacement is incredibly difficult and that repair is more viable. If not repair, only single payer will satisfy Trump's promises and the needs of Americans. 

Yesterday, I marched alongside my fellow HPEACE members (Health Professionals for Equality, Advocacy and Community Engagement), or rather doctors, nurses, midwives, therapists and medical assistants which span specialties and generations, but unite for our communities, for health and for justice. Know that there are thousands of people who believe in a better system for everyone and that we'll continue to fight until we have it! 

Until then we must not only march, but act. 

We need them. They need us.

We need immigrants and they need us.

Many communities in our nation suffer greatly because of doctor shortages. In fact, New Mexico is among one of the most affected states. Approximately 20-25% of Family Physicians are graduates from outside of the United States. Our healthcare system and our country depend greatly on the contributions of immigrants and refugees. Clinics, hospitals and ultimately patients suffer with bans such as Trump's. To be honest, the world suffers.

Unfortunately, many people have a negative views of Muslim men and women. The media is in part culpable, because the portrayal of Muslims is predominantly negative and almost always weaves in terrorism. I'm hoping Trump supporters and their distaste for the media can at least agree with this fact. I wish everyone had the opportunity to meet the kind, loving and devoted immigrant and refugee people who I've had the opportunity to meet. I am honored to have studied with and worked alongside many Iranian and Iraqi individuals throughout various portions of my medical training. I wish everyone had a more realistic idea of the people coming to our country seeking opportunity. Perhaps your fear of the unknown and your hatred for an entire population would dwindle.

People claim that this ban is similar to the actions of previous presidents. First, we must recognize how much the vetting process has improved and second, we need not forget that former presidents were reacting to particular events. In this case, there was no acute threat requiring us to combat. It is truly out of the blue and excessively harsh. Some people claim it is not a Muslim ban, but all seven countries are comprised mostly of Muslims. Plus the ban's preference for religious minorities (i.e. Not Muslims) further suggests otherwise. Some people have even mocked our intelligence for not recognizing the safety that this ban brings- this is where I challenge you to truly study the evidence. These countries have not produced any terrorists since at least 9/11. Our vetting of visa holders and refugees is already very rigorous and working tremendously well. And finally, we must realize we are incredibly blessed to live in a country where the chance of dying at the hands of a foreign born terrorist is 0.00003%.

So if your priority is a safer America, then you need to consider the true threats. Our efforts are needed elsewhere. We need better access to healthcare, since lack of healthcare claims 45,000 lives annually. We need better gun control, since gun violence has already claimed over 1300 lives in 2017, 53 of which were children. We need access to a solid education, because low educational attainment is associated with 4 times higher mortality rate compared to individuals with a high school diploma. And we need access to healthy foods, clean air and recreational space. Strokes, lung disease, Diabetes, kidney disease and cancer are among the leading causes of death in Americans. These disease are directly associated to poor diets, lack of exercise and exposure to environmental toxins. Yes, we need a safer America. Yes, there is a lot of work to be done and many areas for improvement, but immigration is not one.

Women- The Fight Never Ended

Today I marched and for those of you who don't understand why protesting is important and for those of you who question the need to fight, let me explain. 

Let me attempt to answer your questions. Let me give you a history lesson. Let me outline our expectations. And let me introduce you to a big thing called hope. 

Many have asked why the Women's March is so important and many of you have even mocked our efforts. It is critical, because many great protests have lead to great change. It is vital because it is hope, it is unity, and it is what we need in this moment of despair. Protest does not mean that we are done and it certainly does not mean that our goal has been accomplished. Protest is not a destruction of property. It is not violence. And sure as hell is not whining. So do not confuse our march with the acts of angry rioters. 

Protest is a powerful tool. Look at the great leaders who inspired through marching, demonstrating, and protesting. Martin Luther King Jr marched against discrimination and his efforts ultimately led to the Civil Rights Acts of 1964; Cesar Chavez organized farm workers, which led to higher pay and improved (but still not ideal) working environments; Gandhi and Nelson Mandela, two of the most respected world leaders, used protest to fight for independence and human rights. The people of our precious country have been demonstrating since we were founded. The Boston Tea Party is one example. Factory workers and laborers have used protest since we were just 13 colonies in an attempt to fight against greed to earn a wage that could support their families. The suffragettes rallied for a woman's rights to vote. Not long ago, our Native American brothers and sisters in North Dakota peacefully stood against the construction of a dangerous pipeline. If you still don't get it, pick up a history book. (Might I recommend A People's History of the United States.)

And now we use protest for our cause: to fight for women and continued efforts towards equality. These are not new issues and this is not a new fight, but this is a response to a new administration, specifically a new president, which has a horrible track record when it comes to the treatment of women. We are marching as a tool to accelerate change, to advertise our demands for respect, and to display our numbers. It is our opportunity to show the pride and passion that unite us. The Women's March was monumental in our century long revolution. We are introducing America to the masses of men and women who fight alongside us. It is an opportunity to see the diverse faces of our resisters. It is our time to come together, create ideas, share our vision, and network with people who want to get involved. It's time set aside to sing the sorrows of our heart, praise the work of our revolutionary ancestors, and shout the agenda of our movement. 

If you do not argue with the value of protest, but rather question the existence of inequalities and injustices of women, then you may not recognize the threat of our current administration, you may not be watching closely enough. All women are affected. Muslim women are labeled as terrorists, or harshly judged if they choose to wear the hijab. Black women are labeled as criminals. Native women are denied access to their land and water. Brown women fear their families will be torn apart by deportation. Women are more often on the receiving end of violence, like intimate partner violence and sex trafficking.  Lesbian women worry their marriages will be denied. Young women may lose full access to reproductive health. Old women may lose their health insurance. Future women will grow up in a world where "locker room talk" is normalized and sexual assault goes unpunished or under-punished . Little women in elementary will have funding stripped from their schools, women in high school will dream a little less because of that damn glass ceiling, women in college will be objectified as sex symbols, women in careers will be denied equal wages for equal work. And even Mother Nature is threatened with the greed of the fossil fuel industry. Women are your mothers and grandmothers, your sisters and daughters. Women are humans and our rights are in danger and the work that has already been done is at risk of being rewinded. That is why this protest mattered. 

And if still you argue with the core of our mission that women are not yet equal to men, then I am glad you have been protected from the harassment of men on the street, the legislative efforts to make decisions on our behalf, and the lack of societal expectations for women. I am glad that your wages are on par with that of your male peers and that your leadership potential has never been questioned because of your continuously alternating hormones. I am glad that you have never been discriminated against for your desire to bear children, or your desire or inability not to. I am glad you have had access to affordable childcare and that you have never been charged higher insurance premiums for merely being a woman. I am glad that your breasts can openly feed your children, because your body is not objectified as a sexual symbol. I am glad that you have never felt pressured to keep every hair on your body perfectly manicured and that you’ve never compared yourself to the photoshopped models of magazine covers. I am glad that your husband assumes equal responsibility of childcare, household chores and meal preparation. I am glad that you  can walk down the sidewalk free from catcalls, groping, and pleas for a smile. I am very glad you’ve never been raped, because a man feels he has the right to your body; I am glad you’ve never felt pressured to lose your virginity, because you can’t be considered a prude; and I’m glad you feel bold enough to be open with your sexuality without fear of being reprimanded as a slut. 

And if you live your life without oppression, then I am glad that your privilege has safe guarded you. I am truly, honestly, wholeheartedly glad, but please reconsider joining those of us who still have to fight. And if you've realized your privilege isn't bulletproof, then join me in holding all Americans to a higher standard. Do not be satisfied with the right to drive, to vote, to bear children and to work even if the wage is on average less than your male counterparts. I will challenge you with a quote from one of the greatest female leaders, Harriet Tubman, who said, “I have freed a thousand slaves. I could have freed a thousand more if only they knew they were slaves.”

It is for all these reasons, that I proudly marched with the women and men of my community. If you are doubtful of the power of protest, then continue to hold us accountable so that we proceed with action. If you deny the inequalities we face, then I challenge you to raise your standards, and plea that you will continue to learn more about the issues that your fellow women face. As for me, I will continue to march for hope. I will continue to unite for the equality of women, so many beautifully different and incredibly strong women.