If I think about it too much, I will lose my nerve to do these things. The plane is in the air, almost at cruising altitude, and the consecutive bilingual announcements are under way. To have this opportunity, this great fortune of sitting in this snug aisle seat after lugging a backpack full of linen frocks and small tubes of sunscreen through this skinny jet, I have had to move double-time for weeks, and triple-time in my head. Grant sent me off with more enthusiasm than I can ever muster before a voluntary trip for joy, which I seem to need to remind myself this is. One of the reasons I am with him is this excitement unspoiled by dark thoughts that my amygdala churns out at record speed in advance of any big journey. If Grant has an amygdala, it is a pure almond-shaped diamond lodged deep in a very quiet corner of his otherwise very busy brain. Its clarity makes its sole purpose to keep him safe in real times of danger, which have been fortuitously rare for him, and us all. Otherwise it offends no one.
Megan is one of my oldest friends, and is one of three close crossovers from my life before the one I have now. She knew my first husband well enough. She knew me just after I had lost a father, perhaps even when I still had a living one. She knew me when the dream of being a doctor was born. She has helped me pack and unpack for break-ups, medical school, residency, more break-ups, and starting a family twice. Over more than twenty years of friendship, we have exchanged hundreds of gifts. We do almost every time we see each other because we are always on each others minds. She has patiently and non-judgmentally listened to my stories, my disappointments, my excitements and hopes, and has always kept me close. She loves Christmas more than anyone I know, and candy out of proportion to how good it tastes. Where I bring peanut butter and coffee in my backpack, her sole sustenance is a bag of Haribo Twin Snakes. I was the officiant at her wedding to Jeff, after our worlds collided long ago during marathon training, back when we had four to six hours every weekend to run like aimless fools. She is my favorite companion at dinner because her love of food is one of my greatest joys to witness. Her delight in flavors, ingredients, combinations, textures makes for a very entertaining restaurant date and is something we share so profoundly at our core. Food is a love language for the both of us, and we have been speaking that to each other for years. Nevermind she has no body fat and legs till Sunday. When you share a meal with Megan, it is believable that her food excitement is metabolically demanding.
A propos that we find ourselves on our first international trip headed to France. We are going to skip right through the maelstrom of CDG to hop on a TGV to Montpellier, where we will connect with a new friend of mine who lives half the year in San Francisco and the other half in an oyster village along the Mediterranean. Bouzigues is where we will be, surrounded by stone homes older than the United States, eating our way through southern France’s farm to seaside’s finest. Debbie reports that she swims every day until the middle of September, and it has been unseasonably warm this summer like everywhere else in the world. Although this reality makes me want to cry when I think about it, I will be grateful to enjoy my daily baptism in the salty waters of my people, much like my parents did in Beirut until we and war were born. I am so very lucky that my ancestral blood passed down a sacred cherishing of travel, and I am beyond fortunate to have the resources and the partner who make it possible with no external stress. I do not take this for granted ever, but nor can I ignore this part of me without compromising too much of what makes me whole. It’s not that I want to travel, it’s that I need it to be complete. Grant knows that. Shant and Mara know that. My mother, who slipped hundred dollars bills she couldn’t afford into my palms at LAX when I sought off as a teen, has always known that. My friends not only know that, they come along for the ride.
I have left Mara two weeks into a new school, middle school. Two weeks into a phone, two weeks into riding city buses with her friends. Two months out of elementary is feeling like a distant dream. She was born for this moment of freedom, as evidenced by how quickly she abandoned me at the bus stop on day one. “That’s good right there,” she said as she Heismanned me goodbye. “Bye Mama.” Since that day I am realizing that the shock of her suddenly so grown is actually the order of things, and she is ready for it. She has been studying the free wanderings of her brother for years, analyzing his every liberty and taking mental notes. She is prepared to hold us accountable for every allowance he has ever gotten and to collect her due in the way of our trust of her. Grant and I have always trusted Shant implicitly. He has been easy, afraid to disappoint both himself and us, and predictable more or less. Mara is literally building the road she is walking on, one brick at a time. She is creative, ambitious, bold and emotionally razor sharp. She, like her brother, loves to win, but thus far it has come more or less with effort she can easily put forth. But middle school and puberty and this time in her life has put her at the intersection of determination and self doubt, fear of failure and resilience, ambition and complacency. She is hanging there for now, coming to terms with what she desires, and what it will require of her. Raising these two children is not only my greatest privilege, it is my greatest curiosity and conundrum. The scientist in me wants to observe, take notes, dissect how they feel. The mother in me is learning that there is a fine line between protection, safety, and giving them agency. It’s a beautiful restraint, the mothering of teens, which is also probably why a very good time for me to get up and go. Harder to save the day from 8000 miles away, and anyway the only saving they need is from me it seems.
Learning who I am as the kids are peeling themselves off of me, as my career has entered its middle age where retirement is as close as the beginning is far, where our marriage is trying to reframe what a relationship without the preoccupation and convenient distraction of children looks like, calls for one big moment of pause. Most days go by automatically, without much deliberation or effort. Doctoring is not as physically exhausting as it once was. The pace of my current hospital job is a luxurious stroll down the halls most of the days. But the satisfaction of medicine is not as easily discovered either. Diagnoses made, cures rendered, good deaths assisted, bad ones avoided- all that is a siren song to a hospitalist. But with it comes a slowly deafening grind of bearing witness intimately to others’ pain. You eventually become so desensitized to suffering that you are not able to recognize your own when it finally arrives, as it must, in an untenable vocation in a broken system. You either get sick yourself, or you make a desperate change. And with that change comes the compromise. For me it was intellectual and collegial. The patients I care for, be they Veterans or the safety net population of San Francisco, equally call me to service. But the diseases are more social than they are medical, more of mind than of body, more undiagnosable, more untreatable, more relentlessly hopeless now. The glamour is gone, and what remains is the stunning realization that all humans do not have the same chances to thrive. There is way more unfixable misfortune and the luck lies in the tightly gripped fists of the few who can afford to live well, or even humanely.
Medicine is at an inflection point, much like my career. We need to decide as a society how we are going to balance the needs of our planet with the burdensome oppression of its massive population. Climate Medicine is now a rapidly growing specialty, because we have to learn how to care for people and diseases that are a byproduct of a crowded overheated home. The P who shall not be named showed us first hand how nature will attempt to take care of the human problem. The P who shall not biodegrade, is another floating island becoming its own troublesome continent on our collective psyches. Homelessness in San Francisco and other big cities is becoming an accepted backdrop. The streets are full, hospitals are overflowing, and children like Mara and Shant will be bearing the brunt of the irresponsibility of generations before them. The loss of innocence they have had well before the exodus from childhood is being demanded of them. The shrinking of the world through technology has brought with it exposure, awareness, community, but profound isolation. They know too much, but their pre-frontal cortices are not ready for all they are tying to understand. They are luckily far more awake and aware than I ever was in my self-absorbed teen years. Getting away with blue eye shadow was my loftiest goal when I was 12. I wasn’t dreaming up climate solutions for homework assignments or trying to explain my teachers gender pronouns to my confused parents.
For a moment, I have laid all of these burdens down. Life has become a beautiful simple song of the mama seagull protecting her nest on the rooftop across from Debbie’s terrace. The running water of the fountains and spring well in her overgrown garden. The tinkling of wind-chimes in her outdoor kitchen. The clanging of glasses and plates at the set-up and take down of meal after fresh and simple meal. The salty sea air is doing wonders for my skin, and scrubbing the deeper layers clean. Visiting places where Popes vacationed, crusaders schemed, vines we enjoy were planted a hundred years ago, and aqueducts carried water across massive ravines, makes me again realize how insignificant any one person is in the grand story of human existence. At the same time, being here reminds me how very important we all are to one another.