Monday, July 16, 2012

The Old Man

The old man stood about a foot shorter than the others gathered in his clinic. This made the tarnished streaks in his silvery hair easy to spot, but he still combed it so that the thin ivory strands stretched across the barren areas of his scalp.  It was like this every morning.  Perhaps what time and experience had not provided him in stature, it had offered back in depth.  Years of refinement and wear—buried in his eyes.  It was such that his age reflected most profoundly not from the specks and the creases of his skin, nor from the tarnish in his hair, but from a shadowy well within those eyes.  A flickering, rippling depth that you could catch brief glimpses of, magnified through the thick lenses framed upon his nose.  And it was with those eyes, and in spite of his height, that he peered keenly down at those around him.  He spoke bluntly, moved deliberately, and gave orders without wasting words on common courtesies.  His thick Vietnamese accent delivered his speech in rolling jabs that never quite crossed the line into rude.  But his presence—his quiet, cavernous presence—brushed uncompromisingly against my senses.  It was the entirety of this old man’s presence that irritated me from day one.
Together, we were perhaps nothing if not an ill-formed match.  An intense, eager, yet green medical student teamed with an intense, stubborn, and seasoned family physician.  It was determined from the start that I would prove myself to this old man.  And from the start, I quickly realized this man had no desire to prove anything to anyone.  The pace and fashion in which he worked was fixed, mechanical—like a piston, or maybe a turbine set long ago—still steadily driving and being driven by the charts, the exams, the prescriptions.  With a quick flurry of questions, a few inquisitive glances, and a practiced touch, he moved from patient to patient until the lights in the waiting room dimmed and it was time to clock out.  It was an inertia built up over a lifetime.  And the unwavering force with which it moved caused everything around it to bend.  I imagined how in his twenty-seven years of working at the same clinic, he had witnessed everything around him evolve.  Computers being installed, electronic records being implemented, new systems, new nurses, new policies, and new technology—all buzzing in a colorful blur around him.  And I imagined him standing calmly in middle of it.  An aging yet unmoving constant.  Like an ocean carving fissures into the side of a mountain, the old man’s steady presence swelled up against those around him, causing all of us—patients, nurses, and me—to bend and abide.
“Good morning, Doctor Pham.”  I offered the same greeting each morning as he walked into the clinic.  A brief nod and a thin smile indicated his readiness.  For six weeks, we operated just as we were—two entities set into motion sixty years apart.  We clocked in at the same time each day and clocked out one right after the other each night. Yet in all the time and space bracketed between these choreographed bookends, we managed to operate side by side, but never quite together.  It was as if the inner workings of his faded exterior hummed in constant disharmony to some of my most basic values.  And as a result, my frustration simmered beneath a thinning patience.  Only behind closed doors and beyond the old man’s ear would I allow it to escape in harsh whistles from every pore of my skin.  But for the most part, I kept my grievances a secret smolder, hidden from the old man yet fanned daily by watching him practice his stiff, spindling brand of medicine.  There was something in the jaded physician’s disposition that must have been forged fiercely long ago, and as a result presented itself more rigid and ill-fitting than might otherwise be expected.  For patient after patient left the clinic having battled in those hurried moments to steal from the man some small resolution to their private concerns, only to be blown backwards by the invisible force of his forward-churning style.  It was a style driven by the weight of his unbending disposition which he yielded with a mechanical ease.  And it stood upon that oceanic depth which pooled within those black eyes, guarded behind the thick frames which he cleaned intermittently on his coat sleeve.  The grand effect was an undertow that remained placid at the surface, but swept rippling hues of frustration through the old clinic and clean out the door.  In a way, I drew a strange comfort from noticing this.  Every clenched jaw and furrowed brow meant that the agitated secrets which bristled beneath my fa├žade were being shared among others who happened into the old man’s dusty wake.
I turned the ignition and with one last pained sigh, my truck pulled out of the parking lot, away from the faded white building and the sunburnt sign that simply read “clinic.”  I didn’t look back as I drove away that final time, and seldom have I since.  The irritation that circulated within me for six weeks gradually dwindled and eventually vacated altogether.  Perhaps to haunt some other host.  But every now and again, I can’t help but think about the old man.  In my less restful nights, I wonder if maybe it wasn’t really his disposition or demeanor that clashed so harshly against my own, but rather the injustice of time itself—strewn across his every wrinkle and draped in his every movement.  It was an injustice largely shifted in my favor during the snapshot of our interaction, and magnified by the coincidence of our proximity.  By the nature of my youth, time still presented itself as a dimension soft and moldable, like clay.  Yet being next to the old man provided proof that this would not forever be the case.  For the old man, his allotment had already been shaped.  Only the last intricate details remained to be sculpted, and as we stood beside each other in that clinic, we stared from opposite ends of time’s unforgiving canyon, eyes fixated on different sights within its depths.  And perhaps it was exactly this difference in perspective—this ever-shifting injustice—that irritated me most deeply.  When I think back to the old man, I wonder if all the discomfort I harbored poured forth from a more basic anxiety.  A fear that the time grasped before me might solidify before I can mold within it a fraction of my dreams.  It seems to me that youth has an easy way of staring into the canyon of time, giving little notice to the ledge on the other side, and the old man who will one day stand upon it.

Thursday, June 21, 2012

Paging Dr. Einstein

About a year ago, I was having lunch with a friend when the subject of finding a good doctor came up.  What makes a good doctor?  What qualities are most valued?  My friend leaned forward and asserted, “I really don’t care if my doctor is nice and all that stuff, I just want the freakin’ smartest doctor I can find.”  I pressed my lips into a half-smile.  I didn’t agree with her at the time, but I found my ability to counter lodged somewhere between my heart and my throat.  The truth is, when I started medical school, I felt much the same way.  Who cares if a doc pats you on the shoulder and comforts you?  Who cares if she smiles and asks you about your wife, kids, and pet zebrafish?  To me, all this was much like the toy that comes with your kid’s meal—a delightful bonus, but not the real substance of medicine.  I just wanted someone to do the right tests, give me the right meds, and send me on my way—fixed up and ready to go.  But even in the first few months of my training, I could see that my initial impression of good medicine was rather short-sighted.  It seemed odd that on one hand, I was a proud member of a fraternity that prides itself on stratospheric test scores and intellectual acrobatics.  Yet on the other hand, I was beginning to see that brute intellect plays only a small supporting role in medicine’s celebrated script.  For many of us, this comes as a hard pill to swallow.  But the truth is it doesn’t take a genius to be a great doctor.
Part of the problem for both patients and providers alike is that we often view illness as a technical difficulty. If our computer crashes, we expect the whiz at Apple to uncover the problem and provide the restorative reboot.  If our car crashes, find us a skilled mechanic who can dive under the hood and give it new life.  Hell, if the economy crashes, we believe the officials we elect to office should have the power to tweak a few policies, rejigger the interest rate, and get our GDP rocketing skyward again.  And why not?  We are of a bold generation that has always viewed even the most complex problems as a giant brain away from happy resolution.  But what if a loved one gets sick?  And what if it’s my child—not my computer—who’s crashing?  Often, our initial intuition is the same.   Employ the smartest doctor in the hospital to swap a few meds, execute some elaborate surgery, and restore everything back to normal.  A doctor’s job is to fix our cracks and mend our leaks so we can get on with our lives.  And presumably, the smartest ones are also the best fixers.  But of course, matters of life—and death—are never quite so simple.
Despite whatever value we assign to our beloved gadgets, laptops don’t think, and cars don’t feel.  They also don’t dream, aspire, believe, defy, invent, or imagine.  It’s the fingers that touch a keyboard that possess the ability to translate the ideas and emotions of a brazen mind.  Cars carry passengers, but it’s the passengers who carry a lifetime of joys and sorrows.  And when an economy crashes, it’s the people who suffer, not the GDP.  So while flawed devices and failed policies can be restored and renewed, they can also be discarded.  Human beings—well, not so much.  This is the real grit of medicine.  We can preserve health, but not indefinitely.  We can treat pain, but we don’t cure misery.  Despite all our medical advances, more often than not, our job is not to fix, but to advise, to advocate, and to comfort when suffering has already established a foothold.  The brilliant engineer must decipher when old parts should be abandoned and outdated systems replaced.  The great physician—she must walk with the worn, and sit with the broken.  And it’s not that we should disregard the breadth of her knowledge.  It’s just that there is truly no replacement for the depth of her compassion.
For those of us who still view illness as technical blip, it’s likely because we have never been truly sick or cared for the gravely ill.  Yes, we’ve probably taken antibiotics for a throat infection or received x-rays for a broken bone.  Maybe even gone through surgery and rehab for certain injuries.  But the most common and costly diseases afflicting Americans are the unsexy, life-sapping diagnoses that prompt years, even decades, of suffering.  Diabetes, depression, heart disease, cancer—all chronic diseases without cure.  If you spend enough time around doctors, you will hear them refer to treatment as “medical management.”  Because in cases of long-standing illness, it isn’t about coming up with dazzling answers or pondering over a mysterious case until reaching that single “aha!” moment.  You work with patients to juggle a dozen prescription pill bottles.  You remind patients why they can’t eat their favorite foods—the ones they’ve grown up enjoying.  You even prepare patients for how chemotherapy will cause them to lose their hair, their hearing, their sex drive, and much of their independence.  And you help them understand why once your health leaves you, it doesn’t often come back.   Because for patients whose lives are marred by poor health, medicine becomes more about dedicated support, compassionate care, and constant education.  It turns out the ability to perform high-flying mental acrobatics is really just a bonus.  Like that toy that comes with your kiddy meal.  When you are truly famished, your focus shouldn’t be on the toy.
The truth is that for many patients, they come to a doctor sick, and leave sick.  And for 365 days a year, they are the ones taking care of themselves.  Physicians don’t get to play miracle healer as often as they’d like.  Instead, the challenge is how to better empower patients to choose for themselves the lives they want to live, even when illness has become a part of everyday reality.  I know if someone I really cared about got sick, there are some people in my class I would trust without hesitation.  Not because they are brilliant, though most of them are.  But because they are the type of people that you can trust to carefully guide you while understanding that your diagnosis is not your defining characteristic.  For those who are truly ill, there are often many tough decisions with few good outcomes.  And the “right” decision is different for each individual.  Because after all, we aren’t just a collection of moving parts, all mass-produced from the same mold.  We harbor unique thoughts, values, and aspirations.  And all of these things play into excellent care.  Clearly, amputating a pinky finger might mean one thing to me, and something very different to a concert pianist.  Simply put, there are “good” answers, and then there is true guidance.  The latter is what distinguishes the outstanding physician.  It may not require the gift of pure genius, but it demands a level of human compassion that is perhaps every bit as rare.

Thursday, June 7, 2012


“It doesn’t have to look pretty,” my resident grinned as he slipped out of the room, pass the sliding glass doors.  I looked up from the half-tied knot that was securing the gown to my waist.  “Alright,” I nodded.  Around me, the whirlwind of alarms that compliments most ICU beds had ceased.  I lifted a needle holder off my patient’s lap, grabbed the needle that had been laid out for me, and loaded it.  The room was now dim, aside from the lamp that hovered at arm’s length above me.  It draped white over my shoulder and onto the wound I was prepared to close.  My gaze slid along the serrated fibers of muscle which framed a crude window cut between two ribs.  There, through the gaping slit in this man’s side, a piece of the lung stared out at me.  And at the top corner of this window, just beneath the breastplate, a fleshy corner of his heart peered out as well.  I lowered metal to flesh and watched the needle take its first bite.  His body was still warm.
Wednesday 9:12 p.m.  My trauma pager had gone off.  Instinctively, I squelched its beeping, shuffled to the nearest elevator, and descended down to the emergency room.  There, I met up with the rest of my team and listened as a nurse on the phone provided updates.  A patient had been found down by the side of the freeway.  He was en route by helicopter.  We stationed ourselves around the designated room, waited, and made small talk.  Fifteen minutes went by.  Then a pale, unresponsive man was wheeled into the trauma bay with a medic crouched above him performing CPR.  “This is a thirty-year-old John Doe… jumped out of a vehicle moving at highway speeds… unresponsive with agonal breathing when first responders arrived… heart stopped beating in transport.”  As the medic gave his report, a curtain of providers descended in a synchronized flurry upon the patient.  From my position at the edge of the room, I watched as the trauma resident grabbed a scalpel, sliced open the chest, swept the lung aside, and began compressing the heart.  The patient’s intrinsic heartbeat returned and within seconds, we were in an elevator on our way to the operating room.
I could hear the steady rhythm of my breaths cycling beneath my facemask.  It was punctuated momentarily by the click of my needle holder as it seized the metal tip at the surface of the skin.  I pulled another stitch through, gave it a tug, and felt the thread bite into my palm.  Slowly, the edges of the wound began to ease together.  Across the man’s chest, the suture spiraled silver—diving in and out, back and forth, from the breastplate to just beneath the nipple before jumping off the skin and onto the needle at the end of my instrument.  The rest of the wound stood open from this point.  It widened underneath the armpit before tapering back down to a corner where the patient’s frame rested against the bed.  I looked at the half that remained open, re-angled the light above me, and continued working.
A bead of sweat dripped down the side of my cheek and dissolved into my facemask.  I fastened one last knot, cut the remaining suture, and set my instruments down.  With a damp cloth, I wiped the dried blood off the newly closed wound.  I stepped out from underneath the lamp light and glanced at the closure.  The suture that held the incision together resembled the seam of a baseball, only knotted within the flesh of this man’s chest.  In some ways, it looked every bit as unnatural as when it lied open with organs visible between flaps of skin and tissue.  I turned toward the door, shed the protective layering I had on, and stepped back into the heart of the ICU.  My resident looked up from his seat.  “I’m done,” I informed him.
Thursday 12:53 a.m.   I propped myself on a step by the patient’s chest.  He had made it through surgery only to have his heart stop twenty minutes after arriving in the ICU.  My resident was calling out orders from his position at the bedside as nurses zipped in and out of the room.  I could hear the practiced calm in his voice.  “Alright, take over,” he instructed, stepping away from the bed while continuing to run the code.  I began chest compressions.  Our attending surgeon slipped into the room, exchanged a few words with the resident, and moved to re-open the patient’s chest.  I took my hands off the breastplate.  Reaching for the lamp above me, I focused it on the thoracotomy.  The attending cut the sutures, spread the ribs apart and reached in.  A nurse handed him a small paddle connected to a defibrillator.  He positioned it on the heart’s surface and everyone stepped away from the bed.  A shock was delivered.  Nothing.  The attending stuck his hand back in the chest and resumed cardiac compressions.  After two minutes, we tried the defibrillator again, followed again by internal CPR.  Still nothing.  “Fuck,” I heard someone whisper.  After nearly thirty minutes the doctor stood up.  “Let’s call it.”  The bustling stopped.  A nurse’s voice floated above the whirring and beeping of machines, “You want me to hold the epi, then?  Okay, we’re calling it.  Everyone, time of death: one twenty-three.”  We all stripped off our gowns and filed out of the room, quietly.
Out of the corner of my eye, I could see where my patient’s body lay beyond the glass pane—motionless under the glow of the examination light I had forgotten to turn off.  My resident stepped into the room, took a cursory look, then popped back out.  “It looks good, man.”  I smiled and thanked him.  It seemed strange accepting a compliment for placing stitches in a dead man.  But before I could mull it over, two women led by a nurse entered the ICU.
One was older, and the other much younger—maybe a mother and a sister.  I couldn’t be sure.  The nurse led them to the room’s entrance, slid the glass door open just wide enough, and whispered something inaudible.  The guests nodded and the nurse stepped away, leaving them alone.  I eyed the older woman as she paused at the doorway.  The younger one—she must have been the daughter—took her mother’s hand and together they stepped into the room.  Both paused a few feet from the bed.  Then deliberately, the sister glided right up to the bedside and slipped her hand over his.  I watched her tremble and for a moment I tried to focus my gaze elsewhere.  Then the sister lowered her face into the man’s shoulder and began to sob.  This time, I looked down at my keyboard and didn’t look back for some time.  But I could hear her faint whimper through the opening in the glass door.
Thursday 2:10 a.m.  I was slouched in front of a computer in the ICU.  My fingers scampered in syncopated bursts across a keyboard and underneath the weight of my eyelids, the ICU faded out… then in… then back out again.  Through this sweet haze of thinly formed sleep, I heard the approaching footsteps of my resident.  “You want to close the thoracotomy?”  The fluorescent lights of the unit rushed back into focus.  “Yeah, I’ll do it,” I heard myself respond.  It was almost a reflex.  I had never closed a thoracotomy before, but as a student, I wasn’t in the habit of passing up such opportunities.  “Okay, everything you need is already in the room when you’re ready.  Let me know if you need help or anything, but it’s pretty simple.  I mean, it’s just got to stay closed.  Don’t worry about making it pretty, you know.”  He picked up a chart and continued walking.
The exam light remained illuminated in the dim room, its single beam never wavering from the wound that I had closed.  Even as family members mourned in the darkness, I could see every insignificant detail of my suture gleaming from behind the glass.  Under the spotlight, the wound seemed to glow as some strange memento of our hollow impact.  All our efforts had amounted to essentially nothing.  And as officials from the coroner’s office sealed the body bag, I held in my head images of his dropping blood pressure, his frenzied surgery, the rosy color of his lung, and the numbers on the clock when we pronounced him dead.  These things I knew, but really I knew nothing.   I knew nothing of how a story of thirty years had unfolded.  Or what thread held together the chapters of a life I had watched unravel in a few dark hours.  I was only there to place the last few stitches, and stand in the shadows as fresh wounds opened in the lives of those who knew enough to mourn.
Eventually, the night faded into nothing, and with it our empty efforts.  Yet all the details remained imprinted in my mind as a reminder of medicine’s harsh reality.  I’ve been lucky enough to stand alongside heroes who pour their hearts and minds into providing some small amount of healing where it is needed most.  I’ve seen them labor and sometimes limp in their efforts to create some meaningful impact in the lives that intersect with their own.  All the while knowing that the stakes are high and their best may in large part be forgettable.  But they push forward in spite of this.  If for no other reason than because it is their singular privilege to do so.

Saturday, February 11, 2012

What You Could Learn From Eating a Cheeseburger

Somewhere between the physical inactivity that comprised my internal medicine rotation and the animalistic gluttony that comprised my holiday vacation, I acquired a sneaky 7 or 8 pounds.  I hadn’t even realized what new travelers were stowed away beneath my belt until out of curiosity I stepped on a scale five weeks ago.  All of a sudden, I found myself standing in a spot that was not so familiar or comfortable—but one shared perhaps by a good many of us.  From my view up above, the blinking digital numbers beneath my feet were flashing a disappointing message over… and over… and again.
So I started something that I’ve never tried before.  Something that I’ve asked many patients to take a stab at, but had no previous experience with.  I decided to change my diet.  I didn’t tackle a heart healthy diet, or a weight loss diet, or even a low fat diet.  I knew I wasn’t going to be one to count calories or weigh my celery sticks.  Instead, I tried something that a friend of mine in college had suggested to me years ago.  I elected to cut out meat and non-whole grains from breakfast and lunch.  I liked this idea, first of all, because it sounded doable.  Secondly, by cutting back on my carnivorous blood thirst, I felt like I could do my small part to help out the environment.  And finally, I figured that since I had been skipping breakfast for most of my adult life, anyway, all I had to do was make it to dinner, and then all bets would be off.
I do not greatly exaggerate when I say I almost starved to death on the first day of my new diet.  Per usual, I skipped The Most Important Meal of the Day, and found myself stuck with a salad and some yogurt for lunch.  Driven by the memory of how my stomach raged on that fateful initiation, I swore to myself that I would start eating breakfast and I did.  And that, kids, is the story of how I rekindled my old love for Quaker Oatmeal Squares.
Aside from a newfound appreciation for a meal once relegated to middle-child status, my experience has also given me a bit more insight into how difficult it is to make bona fide lifestyle changes.  I’ve never been one to write off patients who continue to smoke despite croaky, gurgling lung disease; or those who have difficulty taking two, three, or three dozen pills on schedule.  I’ve always believed that people possess a unique set of strengths and weaknesses, and live under unique pressures and circumstances.  What I may view as a simple task could be undeniably difficult for someone else.  But that was exactly it.  I considered non-compliance—medical speak for patients not listening to divine orders handed down by MDs—a problem of those other people.  I felt I had appropriate pity for all the portly parents and their now puffing-up-so-fast pediatric population.  But honestly, I’ve always figured that if I ever had diabetes, I would check my blood sugars, eat healthy, lose weight, and give myself insulin injections without fail.  And it wouldn’t be that hard.  You know, for me.  
But surely enough, even on my self-proclaimed “easy” diet, I realized that my touted compliance sometimes didn’t have the balls to stand and defend the paint when a McDonald’s craving was driving down the lane to slam home a juicy cheeseburger (March Madness is around the corner, sorry).  There was a day last week when my tomato basil soup and hard-boiled eggs just weren’t making the cut.  I remember listening to the radio during my lunch break and dreading the next 4 hours because it was an especially slow day at the clinic.  So I justified my rendezvous with the drive-thru by telling myself it would be cruel and unusual to have to spend the second half of my day succumbing to boredom AND hunger.  Thus, I welcomed the delicious melt-in-your-mouth taste of non-compliance.  And I asked for extra ketchup.
I guess in truth, we are all non-compliant.  Ask my college roommate.  I am non-compliant with putting my socks in the laundry bin.  Ask my classmates.  I am non-compliant with staying awake in class.  And God forbid you ask my girlfriend, who will tell you I am non-compliant with taking out the trash, doing the dishes, and remembering who has the parking spot tonight.  But fortunately for me, I don’t have to check in monthly with an expert to provide updates on all my worst habits.  If I did, though, I would hope my expert wasn’t so out-of-touch and condescending as to think she was beyond an occasional misplaced sock or dirty dish.  Yes, we are all non-compliant and it is part of this broken humanity that we get to share with one another.  For me, I just find it funny that reminders can sometimes come in the form of a cheeseburger.

Friday, January 13, 2012


She talks louder, words spilling as from something overflowing deep inside her, built up over the years. I just sit and smile. I make eye contact with my attending. God, he must think I’m stupid. With the sun at high noon, a question was posed and once again I find myself on the losing end of a draw. Because I was a half-second sluggish, because I stuttered reaching for my weapon, because I paused to contemplate the kill, I now graciously accept her onslaught. Her words—that fiery lead that pours forth from her pistol—pour through me, so I stand. And smile. They say thinking will kill a man. Ah yes, I guess I have always been enticed by the sweet smoke of Death.
So I counter with exacting nods. Appreciating her more well-aimed points—tearing through my spleen, my kidney, my shoulder. But always missing my heart. I counter with a smile and a precise yet subtle cock of my eyebrow whenever she misses. And maybe she misses often. But who cares how many shots were fired when one lays open your leg? So she talks louder. I nod. Faster. I raise an eyebrow. Ammunition rips through my insides. I smile. Then a brief moment of silence.
I seize the repose. I lurch to un-holster my bloodied wit. To fire a few words of my own, steady and true. And I hear the empty click of my barrel as our engagement comes to an end. My attending looks and nods. I force myself to sit a bit taller. My wounded pride clutched beneath the table is dripping crimson between my fingers. Everything is calm up above. There is placid triumph painted on her face. Bold resignation on mine. I smile. Very good, he says. God, he must think I’m stupid.

Thursday, January 5, 2012

The Ride

It was during this season fourteen years ago that my family first moved to the golden shores of California.  All the way from Tallahassee, Florida, my family ventured three thousand miles from sea to shining sea, stuffed snugly in a small yellow moving van together with our belongings.  I remember it fondly for being a great family adventure.  Truth be told, all road trips are exciting to an eleven-year-old, but this trip would take us through Baton Rouge, San Antonio, and even the Grand Canyon.  And we—meaning my brother and I—gorged ourselves on fast food every day, which was a rare treat that we both eventually grew tired of.  To this day, when I’m stuck in traffic on the I-10 freeway, I think of how my dad drove this pavement from its four-lane existence in small-town Florida to its infuriating twelve-lane girth in bustling Southern California.  If I’m in no special rush, this happy remembrance coupled with a tune on the radio will often do nicely when I find myself a single scale on the snake of brake lights slithering out from underneath the LA skyline.
Moving vans normally only seat two people.  This becomes a mathematical conundrum if you are relocating a family of four.  Of course, my dad circumvented the impossible by slyly renting a van that had a small sliding door allowing the driver access to contents in the rear hull.  We shoved our beloved forest-green faux leather sofa up to the front of the hull, facing forward, so that when we slid open the square access, we were greeted warmly by an opening above the middle cushion.  For my eleven-year-old self and six-year-old brother, it was practically faux first class.  And lucky for my parents, we didn’t move a year later, because my body was just small enough to fit through that cubby-hole of a door.  For the majority of our trip, this door remained open to allow both light and communication to flow freely into our makeshift rear seats.  But I do remember on two occasions experiencing the unruly thrill of deception when my dad slid shut the door, leaving us in dark silence as our van stopped at checkpoints along the southwestern stretch of Interstate 10.  In the windowless hull of our moving van, I could hear my heart beat quicken as I felt the truck squeak to an aching halt.  I would tuck my body against the familiar arm of our sofa and imagine the guard outside with hand raised, quickly inspecting our vehicle.  All the while, I sat in brave anticipation for the gentle jolt of acceleration to signify deception’s triumph.  In these moments I was an eleven-year-old on the lam—I pictured myself having freshly committed some unspeakable act, now sidestepping justice in my escape to the west.  Yes, defiance is never as sweet as when savored by a child’s probing palate.
Yet, as exciting as the actual journey turned out to be, I wasn’t always so keen about the move.  I still remember the tension that hovered over my family in the weeks after my dad first lost his job in Tallahassee.  He would be gone for days at a time, interviewing in new cities across the country.  I told my mom that I wanted Dad to find new work locally—that I didn’t want to leave.  She would reach over to hold my arm and tell me that he was trying.  But Tallahassee was where I learned to swim, to run, to ride a bike and read a book, to throw a spiral and a punch.  I’m not sure what kind of god I believed in at that time, if any, but I prayed to Not Sure What that my family would be able to stay.  I was a shy kid and friends didn’t come easy.  And this was the only city I knew.  I had memorized the sound of the streets, the smell of the public library, and the way the light reflected off the pond beside my home.  It was everything a boyhood should be and my mom knew this when she came to pick me up after swim practice on the day she told me that we would be moving to California.
We pulled out of the parking lot and the gravel crunched underneath our tires as I laid my seat back.  I always rode in the front passenger seat of our black sedan with the seat reclined all the way back.  It made me feel cool and hidden at the same time, and to me, this combination felt powerful and rare.  My mom seemed unusually quiet as she passed me my congee soup.  It had become my routine to indulge in sweet red bean congee soup after swim practice because it satiated that unnatural appetite that boys get after swimming just enough so that it wouldn’t resurface until dinnertime.  It was raining that day and even though I had but eleven years under my belt, I understood there was something poetic and peaceful about staring at the squiggly path of rain drops running across a car window.  My mom cleared her throat and broke the news that my Dad had found a new job in San Diego.  “I’m sorry,” she said.  I watched the rain weave across the clear pane above my nose in silence, and stared out at the grey skies, which were the same color as the pit in my stomach.  But I knew it wasn’t raining because the universe cared anything for an eleven-year-old’s sorrow.  It was just condensation and Florida gets a lot of that.  We were leaving the pool where I first learned to perform a dive and a flip-turn, and we were headed home.  And then we were going to leave that home and go to California where there was very little condensation.  I told my mom that I would try my best not to be too sad when we pulled into the driveway, and try to be happy for Dad.
We packed our belongings and moved a few weeks later, and by the time I was helping to push that green sofa into the back of our moving van, the initial cloud of sadness I carried with me had condensed into droplets of nervous excitement.  They wormed their way across my insides.  What would California be like?  Would I make new friends?  And what about school, and swimming, and would I survive all the earthquakes?  Now, fourteen years after I sat quietly in that black sedan watching the rain slide sideways; after our yellow van first crossed into the city limits of San Diego and we took in for the first time California’s freeway overpasses and mountainous desert terrain, I see only a landscape of fond memories where there once was so much uncertainty.  When it comes to new beginnings, often it’s the view backwards that provides the greatest scope.  So during a season where we turn our attention to family, friends, and fresh starts, I’m reminded that in life—despite all the anxiety we harbor over what direction we’re going and where we’ll end up—it’s often the ride we’ll remember the most.  Maybe it doesn’t really matter where you are going as long as you carry with you the right things and go with the right people.  Especially if you remember to stick the green sofa in the back.

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