First Turns of the Season

After a late night out and a long week, it would have been nice to sleep in this morning....but instead, I crawled out of bed bleary eyed, scraped off the windshield of the truck and headed up toward Bridger with some friends. There weren't many folks in the lot; today was the infamous Cats v. Grizzlies game, so I can only assume that much of town was keg and egging instead of skiing. I think I skied Bridger Bowl once 10 years ago, but driving up the canyon was unfamiliar and strikingly beautiful. The canyon floor was wide, with gentle walls that rounded up to steep, rocky ridge lines. We started skiing in the shade with frozen fingers, skins gliding over packed, wind buffed crud and hoar frost. As the sun rose higher in the sky, I ascended too, fingers thawing. When we crested the ridge, the views to the west opened. The flat, brown fields rolled out in small square parcels. To the east, there were several distinct mountain ranges which deserve further exploration. We dug a quick pit to examine the layers of snow and saw a firm layer 8 inches down, another crust several inches deeper, and sugary, unstable layers above the ground. The snowpack in Montana is quite different from Washington. The days of high pressure between storms dry out the surface crystals and compromise the snowpack. But today, the top layers were solid enough for a nice descent. Our path was slightly tracked powder, and the turns flowed smoothly (except for the occasional piece of barely covered rock). I'm sure with a bit more coverage the possibilities are tremendous. And even with the thin snowpack, the turns put a smile on my face. It is officially winter.

Intimacy vs. Isolation

In 1959, Erik Erickson described psychosocial phases of development that he believed all humans pass through from birth to death. He believed that personal development was a conflict between the needs of the self and the needs of society; each of his stages reflect this view. Erickson believed that successful completion of each stage led one to a higher level of self-awareness and better functioning within society.

The stages are:

Stage Basic Conflict Important Events Outcome Infancy (birth to 18 months) Trust vs. Mistrust Feeding Children develop a sense of trust when caregivers provide reliabilty, care, and affection. A lack of this will lead to mistrust. Early Childhood (2 to 3 years) Autonomy vs. Shame and Doubt Toilet Training Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt. Preschool (3 to 5 years) Initiative vs. Guilt Exploration Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt. School Age (6 to 11 years) Industry vs. Inferiority School Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority. Adolescence (12 to 18 years) Identity vs. Role Confusion Social Relationships Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self. Young Adulthood (19 to 40 years) Intimacy vs. Isolation Relationships Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation. Middle Adulthood (40 to 65 years) Generativity vs. Stagnation Work and Parenthood Adults need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world. Maturity(65 to death) Ego Integrity vs. Despair Reflection on Life Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair.

Ericksonian stages are the stuff of first year med school last minute cramming. And they are also on my mind as I look forward to the years of medical training ahead of me. Working all day every day isn't conducive to good interpersonal relationships outside of the hospital. And I do think there is some truth to the conflict between society and self in my current stage of Intimacy vs. Isolation. I do want strong relationships. Society reinforces the belief that we should all be partnered, possibly with children. As I get older (and ostensibly progress through this stage) I do feel a sense of isolation from not remaining in the same city for long, from not having a stable life. This isolation does not consume me, but it is no surprise that psychologists have recognized a somewhat fundamental need for humans to be connected to each other. It does cause me to reflect on how fortunate I am to be connected to many people in my life. So, while I may be off in the middle of the mountains, I am also seeking that which we all seek, intimacy in the face of isolation. And someday I may stay a while.

Things we would laugh about.

That the sticker over the electrical box in my apartment says "We still hang bike thieves in Wyoming."
That the first person I met when I got to town was on their way home from skiing and invited me to drop by anytime.
That the bar across the street from my house has a doorman whose name is John. I know because he was wearing a sweatshirt with a picture of himself on it that said "My name is John."
That the only other cyclist I saw on my ride was an older gentleman with a large gray mustache.
That my house has two bottle openers and a ski waxing bench but no can opener.
That the hotel in town has been "fluffing your pillow since 1978."
That the storm is blowing in so hard I can't tell the difference between falling leaves and falling snow.

When medicine is enough

Some days I leave the hospital and I'm almost shaking with excitement. When I roll down the hill toward town I hardly notice the giant, cold induced rifts in the pavement. Those days I know the diagnosis, I can find the treatment, my clinical decisions help guide patient care. Yesterday was one of those days. I was on the inpatient service, my patients were sick, but not too sick to talk with me, and not too sick to get better.

I've realized over the course of the past few months that treating the long, intractable course of a disease like hypertension takes a special kind of doctor. And that I may not be that kind of doctor. I find satisfaction in getting my hands dirty, in fixing a discrete problem. Maybe I'm terrified by the commitment that being someone's internist or family doc implies, or maybe my brain is wired for immediate reward, maybe both.

Yesterday, I was glowing. Today, I was completely stymied by a patient with terrible chronic pain with a clear organic, yet untreatable cause. I can't make his pain go away. I can't even make it a little better. And that's frustrating.

On days like today, I come home to a house that's not mine, in a town where I know one person, and it's hard. And I spend the night studying so I can repeat the process again the next day. It makes me wonder why I wanted to do this in the first place, why anyone would do this. My life has narrowed in the past three years as medicine crowded out things I used to love. I've been uprooted, skipped countless powder days to study, and felt an underlying current of uncertainty about passing exams, choosing a specialty, picking a residency. And yet there are days like yesterday. Yesterday, I came home from the hospital with the conviction that doctors really could help people. Yesterday I wanted to learn more about medicine. I wanted to read journal articles, devour everything I could find that might explain what I saw at the hospital earlier in the day. On those days, medicine is enough.

So I rode across America...and just now remembered to blog.

The Ride has been over for months now. Almost exactly 6 months, if you're counting (if any of you are still there).

I wondered what I would carry with me from the 67 days on the road; now I've had sufficient distance to appreciate how much the Ride Against AIDS has meant to me. I see it in subtle ways: how I can recover easily when the slippery Seattle pavement threatens to bring me down, my decently fast flat changing abilities, the way my laugh has become a bit more like Audrey's.

Some changes are not so subtle. I feel strong, not in that my toothpick arms have gotten huge, but more that I can get through hard times and laugh like I mean it, laugh until my belly hurts. I'm not sure I would have ridden across the country in a saner year, but I know I needed to do it, and that it helped. Riding broke my year long spell of sleeplessness, it gave me time to be silent with my thoughts, to feel my legs burn, to feel truly tired, and to be mentally renewed. And now, I miss my ride mates and being on the road, but the calm has remained. I sleep, I ride my bike, I study, I laugh, I remember those I've lost, and I smile. I'm grateful. Thank you for your love and support.

For Contrast, Things We've Grown to Dislike

Bars (any sort of energy or granola bar)
Sprinklers (when they drench us in the middle of the night while camping)
Train track crossings
Bad street signage
Pushups (because we do them every time we stop for a water break)

Semi trucks

Flies

The vans

The much too small bike racks

Places without ice cream

The fact that there's less than 2 weeks left!

Things We've Grown to Appreciate on the Road

Ice Cream
Seeing friends and family along the road
Chocolate milk
Hot (or even warm, or sometimes cold) showers
A dry floor to sleep on
Bushes (to pee behind)
Milkshakes
Clouds
Tree-lined roads
Shade
Dipped cones
Paved bike paths
Dried mango
Nutella
Ice
Washer and dryers
Egg casserole for breakfast
Gas station ice water
Root Beer Floats
Bike lanes
Shoulders
Rest days
Cycling
Public transit
Small towns
The entire midwest
Soft serve (especially chocolate vanilla swirl)
The Quadruple (def. the act of having ice cream four times in one day)
The Wee Fee (known as WiFi to most people with the exception of Nancy from Johnson Lake, NE)
Wool socks (nearly odorless, always comfortable)
Chamois Butter
A+D diaper rash ointment
Local bike shops
Costco (because we eat lots and lots of food)
Music (though I've grown sick of everything I own and have begun to trade with teamies)
Podcasts (including This American Life, Radiolab, Savage Lovecast, the Moth, Slate Political Gabfest, and Dirtbag Diaries)
Smartphones (and their magical navigational abilities)
Smoothies
Fruit
Sports
Church gyms (which many congregations have generously allowed us to sleep in)
Puppy Chow
Vegetables
The riders of RAA 2012 (otherwise known as the Iron Horse AIDS Fighting Riding Team)

List compiled by Meghan, Flannery, Alice, and the RAA team