The Ties that Bind and the Weight of Connection

Traevelling 30,000 feet above the ground on my way back to Chicago, it’s hard not to think about distance and space. How people in the same room can still feel worlds apart while others can be physically separated by hundreds of miles and still be intimately connected. Traditional modes of measurement fail when it comes to matters of the heart. I feel the push and pull of these forces currently at play within me as I sit on a plane, wanting to distract myself with some mindless movie or loud music or just close my eyes and sleep. The plane, at its current altitude, disconnects my phone from the pages, texts and alerts waiting on the ground, freeing me for a short while from their intrusion.

To be intertwined with someone else. To belong to something greater than yourself. A family or community? To have purpose beyond ourselves. To give and receive. To be connected. These thoughts lead my brain back to chemistry and physics and learning of forces and attraction between molecules. I recall the weaker ionic bonds, able to be disrupted by water alone.  I remember organic chemistry and the tight sharing of electrons between carbon atoms, and its strong covalent connection. I think of the ultimate overwhelming gravitational force of a black hole from which nothing can escape.

In the past, those descriptions were just notes jotted down on paper. Simple lines to memorize to later regurgitate verbatim on a test or quiz. At the time, I did not have the capacity to truly understand those ideas. Now I find deeper meaning in these concepts. The invisible attraction exerted by gravitational forces and tight bonds cause visible and tangible effects. We learn of the “potential” within these bonds, to hold and store power and energy which I have felt in the pounding of my heart and in the heat of my salty tears. The paradox being that the strength within the bonds of connection that help withstand stress and strain can also cause disruption and damage.

How then to find equipoise and balance? Where this connectedness provides stability and strength to move forward, instead of collapsing under its own weight.

It is in this space that I am floating at the moment. Physically, 30,000 feet above the earth, yet right next to Madison in Southern Oregon and Maya back home in Northbrook. Can they feel me with them right now? Do they know how much they are in my thoughts? Do they feel the same tug on their hearts and in their core? And if so, does it feel safe and warm and a source of comfort and confidence? Or is it heavy and weighty and overwhelming and constricting?

The change of pressure on my ears signals the beginning of the plane’s descent back to earth. The thirty minutes or so left on this flight leaves nowhere near enough time to climb out of this rabbit hole in which I find myself.  But this is why I chose to go part-time. To find time and space to wrap my mind around these questions. It was too infrequent and rare to have the emotional energy and capacity to sit with and work through these issues

The plane lands and Becky and I disembark, still a bit disoriented with my ears plugged and cumulative fatigue of the weekend. I find myself adjusting to the changing forces of connection, now that I am two thousand miles closer to my daughter, but that much farther from my son.  But I sense this is a new theme in my life. Navigating time and space with those you love and balancing the benefit of the power of connection with the weight of its strength. And in this moment, these invisible forces couldn’t be more tangible,  as my heart is pulled in all sorts of directions.


Snow Day

I woke up to a blanket of white covering the ground. Unlike in childhood, this was not met with excited anticipation. Forced to skip my morning coffee, I layered up in my thermal gear and put on my boots, the blister on my heel reminding me to buy a pair that fits properly. I struggled to find gloves and settled on a mismatched pair as I braced for battle with the cold. I tried not to tweak my back while repeatedly yanking the starter cord on our stubborn snow blower. As I began to clear the thick snow off the driveway, the layer of ice hidden below was a reminder that I was not quick enough to clear the driveway last time. Obstacles and challenges now loomed ahead as I anticipate colder temperatures, icy windshields, hazardous driving, and ill-fitting boots and blisters.

When did snow become the enemy? When did it become a chore? When did it become something that added to the weight of my day?

I was nine years old when one of the biggest blizzards in Chicagoland history hit. My school day was replaced by a snow day. Multiplication tables and PE class were swapped for snowballs and snow angels, while mini-mountains of snow popped up all over the neighborhood.

I remember the frustration of trying to make a snowball out of fresh powder, the crystals sliding through my fingers like weightless sand. And finding success with heavier packing snow, hearing the scrunchy sound made while rolling it to form a giant snowman.

I remember hot chocolate in my stomach any money in my pocket after shoveling driveways in the neighborhood.

I remember a blizzard in Madison, Wisconsin. A snow day in college, of all places! Playing tackle football in powder up to my knees, my quads and hamstrings burning. Hot and sweaty, despite the cold air, and the sting of snow on my face after a tackle. The pleasure of finding that perfect balance, not falling backwards on my ass or forwards on my face, while skitching on the back of a car all the way down Langdon street.

I remember the joy in my son’s eyes the first time we went sledding, on a snowy day in Michigan City, Indiana. The cold air was no match for the warmth of Madison’s smile.

When I was younger, snow was white and light, scrunchy and fun. An invitation to play. An opportunity to explore. A far cry from its impact on me now.  Snow is now an obstacle to be shoveled, a hazard for my teenage drivers, slush and salt to erode the underside of my car. It’s work now.

My thoughts turn from snow to my relationship with medicine. Another area in my life that has evolved from joy and excitement to frustration and challenge.

I remember the first time I put on my short, white coat and entered a real patient’s room to take my first history. I was hesitant to cross the threshold, nervous I’d be discovered as a fraud, an imposter. But excitement trumped anxiety as I stepped into the room, introducing myself as a student-doctor for the first time.

I remember the pride of wearing a stethoscope around my neck. The thrill of learning and doing each new procedure, pushing through my fear of causing harm. My growing sense of accomplishment as I read up on an unfamiliar disease or diagnosis adding to my knowledge base. Each patient a potential puzzle of signs and symptoms to piece together, not knowing what the ultimate picture would be. It was unknown and exciting. A snow day.

Somewhere along my path, medicine, like snow, got flipped on its head. More electronic medical records and charting than direct patient care. More patients to been seen but not more hours available in a given day. Journals and review articles pile up, still left unread. And instead of hot chocolate waiting for me at the end of a long day, there are only unfinished documentation and lingering worries over difficult decisions made.

More work than play. More obstacles than challenges. More conflict and tension than excitement and possibility.

The other day, a medical student I’d hardly noticed on my ICU service asked to see a new admission. I looked up, and saw the enthusiasm in her eyes. And, for a brief moment, I saw what she saw. A giant snow covered sledding hill ready to be climbed up and slid down. And I longed to be there on that hill, launching myself off the edge and feeling the cold air stinging my face, not knowing when I might finally come to rest. Ready and eager to race back up to the top and do it again and again, until I no longer felt my fingers and toes.

And it feels like a snow day again in my ICU.


Seventeen-years-old and into the Great Wide Open..


Into the great wide open..
 Under a sky of blue”
                  -Tom Petty

In the absence of moonlight, the summer lake house had been pitch dark when we arrived. The five of us had made a spontaneous late-night decision to drive from the northern suburbs of Chicago to Michigan City, Indiana. Now, as dust particles dance in the glow of the morning sun streaming through the windows, I wake up in the large room known as the “dorm.” In other far too small single beds, three of my friends are refusing to acknowledge the start of the day.

The bed squeaks as I swing my feet onto the floor and walk outside to the concrete patio. The house sits on top of a bluff overlooking Lake Michigan. The cool morning air has not yet given way to the sun’s warmth. Peter is already up, coffee in hand. Slowly, the rest of the crew makes their way outside to sit on the stone steps that wind down to the street; Lake Michigan and the beach just on the other side. Hungry, we dig into a box of day old Dunkin Donuts brought from home.

It is the summer after our high-school graduation and we are at Peter’s summer house for a few days. A weekday or weekend? It doesn’t matter. Every day now feels the same. High school is behind us, yet college still feels far ahead in the distance. For the moment, there are no homework assignments, or grades to worry about. The ninety-minute drive to the beach house is as much a declaration of our growing independence as it is a fun forty-eight-hour getaway to squeaky white sand and mid-summer sun.

Still in our shorts and sweatshirts from yesterday, we eat the donuts and drink bad coffee. We talk about the Cubs and summer jobs. We retell inside jokes and repeat favorite movie lines. The afternoon will be filled playing catch on the beach, with the Cubs game on the radio, and cooling swims out to the sandbar. Our personal journeys lie ahead, but for the moment, we are carefree and at ease.

The memory of drinking coffee on the patio before spending the day on the beach is still vivid thirty years later. The cool rock on the back of my legs. The bitterness of that flavored coffee. The hot sand squeaking under my feet. My shoulder, sore from throwing the baseball all day long. The sun’s heat burning my back while lying on a sandy blanket. Swimming to the sandbar. Nowhere to be, nowhere to go. My future completely unwritten.

I didn’t recognize the significance of that day, or that summer, in real-time. I guess that’s the nature of being young and feeling immortal. Maybe it’s the slow and gradual accumulation of responsibilities that come with a job or marriage or children, that enable us to appreciate the days when we could just lie in the sand and bake in the sun. That summer, listening to the Cubs game on the radio with friends, the weight of future responsibilities had not yet entered our world.

Thirty years later, I am, once again, at a place in my life where things are yet unwritten. After 13 years as a pulmonary critical care physician, I chose to start working part-time in July. I have already encountered a few hiccups and speedbumps along the way, but this time I am able to appreciate the freedom and opportunities that lie ahead.

I am attending a TEDMED conference this week. Within the overarching theme “Limitless,” the talks highlight issues of medicine, both directly and tangentially. I am eager to see which talks will directly apply to me and what I can bring to the table. What mix of critical care medicine, parenting, water polo, and writing brief narratives stories related to those topics might spark a conversation with my colleagues? I am no longer a seventeen-year old kid lying in the sun, with no real responsibilities, but my future does require a similar shift in my mindset. And as I hear Tom Petty’s voice singing in my ear, I am focusing, not on what limits me, but on how limitless the possibilities are.

A Family Reunion in Seattle and Newton’s Law of Attraction

Doc, I don’t see why I need all these meds. Can’t I stop them? Any of them?”

I hear this often from my patients. Sometimes they are right. They are on too many meds and don’t need them all. But sometimes it takes removing a medication for a period of time in order to truly appreciate its benefits.

It’s a crisp morning in Seattle. The sun is trying to break through the scattered clouds and there are waning remnants of fog coming off the harbor. I walk the three blocks to Pike’s Place and the public market, which is half empty as the fishmongers are making their way in. The rest of my family is still asleep, having all slept under the same roof for the first time in months. Months. That is what’s on my mind as I walk this morning. Thinking about plane rides, hugs, siblings and reunions.

I grab a few essentials for my sleeping crew: gluten free breakfast food for my daughter, a razor for my son, my own Venti Americano, Coke Zero for Becky, milk and cereal. I make my way back to our rental unit, buzzing for the start of our day. Our family of four. Four individual orbits that have come together here in the Pacific Northwest for a precious forty-eight hours.

We take the Link Light Rail across the city away from the harbor and skyscrapers, and make our way to the University of Washington and its traditional campus architecture. It is truly a picture-perfect fall day for a college tour. As I walk with Maya, I try to picture her among the students walking through the quad, the red square, and the union. Becky and Madison head in a different direction to enjoy some time together.

While Maya is occupied listening to our tour guide, my mind is free to wander. The day is truly magnificent. A perfect mix of cool temperatures, warm sun, a light breeze and a backdrop of trees with leaves full of fall colors. Discrete patches of thick white clouds move quickly across the sky. Not as static shapes, but dynamically altering their form as they twist and tumble, with a three-dimensional complexity I find fascinating. On the surface so simple, but with depth and layers that are mesmerizing. Their future as unpredictable as Madison and Maya’s.

We all meet back outside the Union. There is silly chatter, pictures and piggy-back rides. We joke and tease and smile. Yesterday’s travel to get here, and tomorrow’s departure, forgotten for the moment. There is a levity surrounding all of us, with no expectation or agenda other than simply enjoying each other’s company. The four of us are not just in close physical proximity to each other. The rhythms of our interactions are in sync in a way that has been missing for quite a while. Our individual orbits, for now, have become one.

Newton’s law of universal gravitation states that a particle attracts every other particle in the universe. In high school physics, I struggled with this concept, that the person ten feet away was exerting a gravitational force on me. But now I do appreciate the pull of my family’s orbits. A few months ago, the intensity and depth of our connection was present but not felt. Similar to my patients who appreciate the impact of their medicine  only in its absence, I am now more aware of the forces that bind and connect my family. And for the moment my world is perfect.