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.

My Thoughts on Inauguration Day

Yes, I am still mad that the man who ascended to the highest office in our country rose to power by promoting hate and violence, and exploiting the fears of Americans. Yes, I understand democracy and I do not question the fact that he won the presidency, so save your explanations. Yes, I am still mad that a demagogue and a textbook racist will lead our country. I am still mad and I will not get over it. 

I am worried that he lacks the decency to show respect to human rights activists, lacks the willpower to avoid twitter wars with celebrities, and lacks the humility to trust the experts who are there to support him. I am worried he will normalize xenophobia, which is real and dangerous. I am worried he will threaten the equality of women, which has come so far, but still has a ways to go. I am worried that with he has immediate capabilities of launching nuclear warfare. I am worried he will ruin the families of mixed citizenship households. I am worried that Dreamers, who are doing so much for their communities, are at risk of deportation if the rights afforded to them through DACA are revoked. I am worried his Vice President will single handedly demolish the rights of the LGBTQ community and promote legislature that treats them like second class citizens. I am worried that his ignorance of science will irreparably damage our efforts to combat climate change and preserve a big, beautiful world for my grandchildren. I am worried that he promises to repeal and replace the ACA simultaneously, to preserve every dollar of Medicare, and even to ensure healthcare for all, but nominates a Secretary of Health who antagonizes all these efforts.

You will criticize me for not being American enough to hail my president, but his disregard of diversity and justice jeopardizes all that I believe in. You will criticize me for being a spoiled millennial, but know that I have struggled and every day I witness the struggles of my patients whose obstacles might resemble your worst nightmare. You will criticize me for being a privileged liberal, but know that I recognize my privilege as a highly educated physician, but refuse to allow the privilege I have to become blind to the consequences for those who lack it- those who lack the privilege of being white, the privilege of being male, being straight, being US born, being educated, being free of disability and illness. You will criticize me for not giving him a chance. 

Well I considered his first chance an an opportunity to “drain the swamp.” And look where that has left us. Education has been plagued with inequality since the beginning of time and his actions thus far will further worsen the disparity. The poor, the underrepresented minorities, those who live rurally, the first generation students, those with disabilities- they will suffer the most. He has nominated someone who will recklessly manage what little funding our schools have! He has nominated someone who believes guns belong in school! He has nominated someone who is disgustingly under qualified. And therefore he has already started to fail. He is allowing this woman to risk the lives and future of our children, knowing well that the vulnerable will suffer most. To hell with that!

Education is fundamental. When it is lacking, health is in danger. When it is lacking, opportunities dwindle. When it is lacking, justice isn’t served. 

So Mr Trump, don’t you dare make promises to your billionaire friends at the expense of your constituents, because as president, your allegiance is to all Americans. Don't you dare prey on the poor. Don’t you dare gamble with the fate of our children. 

I will pray for you, but I will also hold you accountable. I will respect you, when you have earned it. You will be my president, but I will not be a slave to the fear and hate you spread. If you endorse injustices, I will fight and resist every step of the way. 

Sincerely,
Sevy Gurule
A Female, a Physician, and a Force that believes in equality for all and is prepared to fight for it.