Diary of an Epi Wannabe

10.  You know that means Masters in Public Health, not miles per hour.

9.  When you think about miles per hour, you immediately think of the issue of distracted driving and how you would never, ever text while driving.

8.  You wash your hands obsessively and noisily… I mean, what if someone is looking?

7.  No matter how tough you have to be in your “real” job, the minute someone shows signs of having a real health issue, you suddenly go all warm and caring. 

6.  You use the phrase “total rock star in occupational health” un-ironically. 

5.  You understand the complex relationship between physicians and epidemiologists, and want to make a movie about it.

4.  You are however down to earth and realistic.  You know that only you and your seven friends would actually watch said movie.  However, you can practically recite “Contagion.”

3.  You are a genuinely nice person, but you’re willing to do whatever it takes to solve the country’s (and the world’s) health problems. 

2.  You have a very high tolerance for rejection and frustration, and approach situations that most people would find hopeless with a sense of vigor… curing chronic disease… reforming the US health care system… it’s not a curse, it’s a challenge!

1.  Sure, you could do the statistics yourself.  You got an A in biostats and everything!  But you feel that it is critical to our nation’s health that we find meaningful ways for people to earn a living, and you sure wouldn’t want a statistician to be out of a job!

This is another short chapter from the novel of medical fiction I’ve been writing.  It spans three generations, but this is the first generation, the venerable Dean Aaron Rush of a very famous medical school, and his wife Dr. Sarah Rush, who later becomes a famous cardiologist.  They are the parents of Dr. Jonathan Rush, who eventually cures a rare form of cancer… but that’s for later.  Enjoy!

“Good afternoon, Dr. Cone,” he said, fixing his eyes firmly on hers, very pointedly ignoring the pert, firm breasts.

“Good afternoon, Dr. Rush,” she said, and she didn’t smile.

Who was she?  Where was she from?  Her accent wasn’t familiar to him but that told him nothing.  She had to be in her twenties but she was so slim and small that she looked younger.  How old was she?

These were pointless questions.  Like the condemned man asking who had fashioned the executioners’ sword.  He gave his lecture.

She asked an intelligent question.  He answered it.

He changed into his street clothes and went to the dinner in his honor that night.  50th birthday.  She went home to her tiny studio apartment.  Several letters from her mother had arrived.  She read each one and then put them away in the folder she kept for such communications.  Sarah could not be distracted.

Sarah was the only child of Mr. and Mrs. Cone, of the Greensboro Cones, the ones that Moses Cone hospital was named after.  There was a considerable Jewish community in Greensboro and they were the leaders of it.  It had been assumed that Philip would be a doctor from the time he was born, and she could still remember getting in trouble for coloring all over his anatomy books.

Like many a younger sister, she adored her older brother.  She followed him around, played whatever games he wanted to play, suffered meekly when his friends wanted to play “Cowboys and Indians” and tied her to a tree in the back yard.  She was never really afraid… she knew her big brother would rescue her if need be.

She was eleven when he was eighteen.  She was just a baby, and she had the beginnings of breasts and the beginnings of boys looking at her, but nothing so serious as to require true protection from her older brother.

He had been admitted to Duke.  He would be studying pre-med, of course.

She could still hear her mother screaming.  It was a quiet Sunday afternoon.  She had been playing with her dolls in her room on the second floor when there was a knock at the door.

It was a State Trooper.  Philip was dead.  Struck head on on I-40 by a drunk driver.  He was on his way home from studying in the library at UNC-Chapel Hill.  He had been killed instantly.

The funeral was awful because she was old enough to understand everything.  Her mother’s weeping.  Her father’s stony silence.

Then one morning all of Philip’s anatomy books, the ones she had once gotten in trouble for coloring over, showed up on her dressing table.

Nothing was ever said.  Nothing needed to be said.  They may have been Jews, but they were Southern Jews, and as every Southerner knows, Southernness means never having to say much of anything.

Sarah would be a doctor.  It was a foregone conclusion.

Duke undergraduate.  Not so far from home, but far enough.  Far enough to meet boys who wanted to take her out behind East Campus into the Gardens at night and see how far they could get.  They never got very far.

Yale Med.  The North was a shock for Sarah, but she kept her nose so firmly buried in her books that she minimized the trauma.  The world was going crazy out there, but she had to become a doctor, so she remained focused.

She had dated, of course she had.  A pretty, tiny young girl, her skin so pale it seemed more likely to be from the coldest parts of Siberia than the warmest parts of Greensboro, NC, and beautiful brown eyes that could drive any man crazy, especially one who liked smart girls… yes, she went out on dates.  But in the middle part of the sixties Sarah was the girl who opted out of free love and free sex.  She was saving herself.  Saving herself for her husband.  And on a day to day basis, she was married to medicine.  She had very little time left over.

It was her mother who encouraged her to do her residency in the Bronx.  One of the best academic medical centers in the country, and besides, her mother was hoping she would find a nice Jewish boy to marry.

“That,” she thought to herself as he entered the room, “Is mine.”

Though he looked younger, he was twenty-four years her senior.  He cut a dashing figure in a suit and tie and lab coat, but he was a small man, not more than 5’9″, and thin.  He stood up very tall, and had that air of a man who was used to other men fearing him.  But there was something about him that Sarah saw immediately… some internal warmth, some need the she could fill.

It was absurd, of course, on some level, but Sarah was not easily dismayed.  She had the sense of entitlement that comes with being a rich man’s daughter, and the sense of self-efficacy that came with getting through medical school as a woman in the sixties.  If Sarah Cone wanted something, she was likely to get it.

What she did not know, could not know, was how much Dr. Rush wanted her from the moment he saw her.  She did not know that he did not visit his blonde haired, blue eyed mistress that night, the night of his fiftieth birthday.  That his dreams were haunted by her pale skin, her gold flecked eyes, her carefully restrained black hair.  He imagined her hair, unbound and flowing, touching his chest as he made love to her, with her on top of him and her hair everywhere.  He imagined her tiny little fingers winding around his, holding him up and holding him together as he faced another day.

It was crazy, it was all crazy.  But somehow they had to be together, as their dreams began to intertwine.

Think of something else, he commanded himself, as he got dressed for another difficult day at work.

Think of something else, she thought, as she willed herself to focus on her day ahead at the hospital.

They had no way of knowing… and yet, they should have known.

1.  You  confuse the word “honorific” with “hemorrhagic.”

2.  You wonder why everyone walks away when you start talking about cholera… in the Ikea store.

3.  The only reliable way you’ve ever found to break a panic attack is to draw a two by two table.

4. When asked how you want your cheeseburger cooked, you launch into a discussion of the food poisoning records of local restaurants.  The waitress responds, “I guess that will be well done.”

5.  You are considering getting a bumper sticker made that says “Epidemiology must set policy.  And when it doesn’t, you people are really screwed.”

6.  You have “doctor magnet” glasses.

7. You feel like it’s your fault when people get cancer because you didn’t figure out a way to prevent it… seventy years ago.

8. You explain the difference between risk ratio and odds ratio… as foreplay.

9. You and your partner agree that your intro to epi class was the best couples therapy ever.  (Note: medical researchers and writers make great partners for epis.  I know BatEpi, so do PAs…)

10.  You use the term “confounder” correctly.

At the risk of quoting one of my favorite songs from the eighties, last night I had the strangest dream.*

I was on a trans-Atlantic flight on a giant plane, and I noticed that the flight attendants were resting in comfortable little beds at the back of the plane, covered by those fleece airplane blankets.  “That’s nice that you get somewhere comfortable to sleep,” I said to one.  “Oh, would you like to sleep?” she asked and immediately got up and took me to a part of the plane where she showed me little compartments where people were sleeping comfortably.  On our way there we passed a section where desks were set up and business travelers were on their laptops working away.  A printer whirred in the middle of the section and a copy machine quietly made copies.

A young male flight attendant than approached and asked if I wanted a drink.  “Sure,” I said, expecting him to disappear and re-appear with an airplane bottle of cheap wine and a plastic cup, but instead he walked me to the next section of the airplane where there was a quiet, dimly lit bar with a full selection of wine and liquor and quiet patrons happily enjoying a cocktail (Think Cibo in terminal B of the Philly airport.)  I sat down and got out my wallet to pay for a glass of wine when the quiet, smiling bartender said, “Oh no, everything is free here.”

Okay, I thought, and put away my wallet.  Just as I was finishing my drink another pleasant, smiling flight attendant appeared at my side and asked, “Would you like some fries with that?”

How would they know, I wondered, that while I avoid eating them as much as I can, I actually would like fries at almost any time of the day or night?

So the flight attendant ushered me to yet another bar, this one a more sports bar-like atmosphere, where some men were watching a basketball game on TV and fries, chicken wings, and burgers were served in baskets lined with red and white checkered paper.

This is creepy, I thought to myself, as this seemed like an airplane with way too many amenities and I wondered who was paying for this.

“How much does this flight cost?” I asked the smiling flight attendant, and he replied, in a calm, soothing voice, “Oh, we don’t worry about that here.”

Another passenger, however, leaned over to me and said, “About twenty thousand dollars.”

Uh-oh, I thought, but the glass of wine I had had earlier was just hitting and I decided to think about it later.

“Perhaps you’d like another form of entertainment,” the smiling flight attendant said, carefully putting his arm around me and guiding me through yet another lounge where people were watching television, again miraculously quietly, in big arm chairs with their feet propped up on ottomans.

Through a beaded curtain he ushered me into a room where passengers were clearly smoking pot.  The smell of marijuana hung heavy in the air, and folks were reclining in velour upholstered chairs, stoned out of their minds.

“Not my style, but thanks,” I said.

At this point the plane began its decent, and I took a seat and fastened my seat belt.  I was relieved to be, as it were, coming down to earth.  There was something disturbing, not just about the strange amenities on an airline flight, but about the uniformity of the calm, soothing tone of the staff and their attempts to lull me out of thinking about the price.  What happened to, “We are here for your safety,” the speech flight attendants give as they demonstrate the safety features of the plane.  To the lay person it isn’t obvious, but a friend of mine who organized flight attendant unions taught me about all the ways in with flight attendants are carefully, professionally taking care of our safety, including being quite forceful when passengers do things that endanger themselves or the flight.  Having a bar, a grill, and a marijuana lounge all in one airplane didn’t seem that geared to safety.  All those bottles and chicken wings flying in the air in the event of turbulence?

I woke up thinking about health care.  Now I know it’s a stretch, but after fifteen years of organizing health care workers and two years of working on my Masters in Public Health, I usually wake up thinking about health care.  I immediately was struck by how the eerie similarity of the tone of the flight attendants’ voices and how they used the same phrases every time they guided me to the next location reminded me of one of the creepiest phenomena I’ve witnessed in health care.

I started to see it in the late nineties.  Hospital administrators would fly top managers to a resort somewhere where consultants would (at a high price) train them in “scripts” that they would then teach the nurses and other health care workers to say to every patient.  Usually they went something like, “Is there anything I can get for you, right now, before I leave?  I have the time to provide you with good care.”

The problem was, in the hospitals where these scripts were supposed to be implemented, the nurses were usually so understaffed that they didn’t have the time.

Now the idea of reassuring patients that their needs will be met is a great one, but it was clear in the hospitals where I met with nurses that these scripts were a band aid to cover up true shortages of staff with nice, standardized reassurances that frankly amounted to lies.

Not only that, but nurses were horrified by being told how to talk to their patients.  They went to nursing school to learn not just how to care for a patient’s physical needs, but how to communicate with them in ways that would nurture their emotional needs in a time of crisis.  These scripts were an insult to their professional judgement.

Besides, wouldn’t you find it disconcerting if everyone you ran into in a hospital said the exact same thing, every single time they saw you?

“This isn’t Disney World,” a nurse told me, upon learning that these scripts had been pioneered at Disney.

Perhaps they are effective there… I don’t know.  The last time I was at Disney World was when I was four years old and my only memory is that my mother, on the verge of heat stroke, poured a cup of Diet 7-Up on her head.

Scripts might be effective at theme parks, where people make short visits and expect to be entertained by costumed characters, not healed from life-threatening illness.  But in health care, the best way to make sure that staff communicate well with patients is to create an atmosphere where staff really do have the time to provide good care.  That means hiring enough staff, not hiring consultants to tell them how to cover up the lack of staff.

The most insidious form of scripting I saw was at a hospital that shall go unnamed where nurses were told they had to do hourly “rounding” on their patients.  Basically they were to walk into the room, say, “I’m here to round on you.  Is there anything you need?” and check off on a board that they had rounded.

Good idea, in theory, perhaps.  But these nurses usually had nine or more patients on medical surgical floors.  These patients were not what we in health care call walkie-talkies.  They were bed bound, on multiple medications including IV meds, on heart monitors, and some were on ventilators.  All had desperate needs, all of the time.  If you do the math, you figure out that a nurse simply can’t plan her day, under those circumstances, around the idea of hourly rounds.  She has to plan her day based on her professional assessment of every patient’s needs.  Those needs change by the minute in today’s acute care environment.

At the aforementioned unnamed hospital, the insidious went to inflammatory when the Director of Nursing told the service staff (housekeeping, dietary) that they were to report nurses who missed an hourly round, and for every x number of nurses they reported, the housekeeper or dietary staff member would receive a gift certificate to local stores.  I don’t think I need to comment on the effects of this kind of practice on staff cohesiveness and morale.

Nurses are there for patient safety.  They actively advance the healing process and they are the front line of defense against medical errors, hospital acquired infections, and all those buzz words the folks in quality throw around.  Tons of research demonstrates that more nurses means safer care.  So why are hospitals still cutting nurse to patient ratios, and fighting national nurse to patient ratio law that would take nurse staffing out of competition?

Right now, cutting nurse staffing is one of the quickest ways hospitals can save money.  The hospitals that are the poorest — usually those who serve the poorest — rush to cut nurse staffing in an effort to stay afloat.  This means that the poorest patients — who are often the ones with the most critical medical needs — get the worst care.  If nurse to patient ratio minimum standards were adopted in federal law, or at least state laws, then hospitals wouldn’t have to compete on the basis of who can cut the most staff.

I don’t want a nurse to tell me she has the time to provide me with excellent care.  I want that to go without saying because she actually has the time.

* The song was “Break My Stride” by Matthew Wilder

It was the fall of 1991 when I stared out the door of my calculus classroom in Interlochen, Michigan, listening to Billy Joel’s “Downeaster Alexa” on my Walkman.  It was lunch hour and I was alone because I skipped lunch to work on my calculus homework.

Like all the locals here I’ve had to sell my home
Too proud to leave, I worked my fingers to the bone.

I worked my fingers to the bone.  My mother had gone into debt to send me away to school so I could have a better life, and she bet high but it paid off: I got into Yale and had a shot at a better life.  Back in those days I had no idea that I would be an organizer, I didn’t really even know what a union was.  I grew up in the South, and I didn’t know what a union was until I joined HERE Local 35 at the urging of my Yale resident adviser who said that was a good way to make enough money to cover the outrageous cost of my books.  I remember working in the dining hall my freshman year, and finding a family with those union workers.

“How are you honey?  You doing okay?” they would ask.

The ladies in salad prep were particularly loving.  They took on all of us young women as their daughters.  They knew, somehow, that those of us who were tracked into dining hall jobs at Yale were the ones who didn’t come from money, who didn’t have the cash to go out with the other kids and buy beers and pizza night after night.  They took care of me.

It was no big surprise that in 1996 when our contract was up and Yale wanted to subcontract out our jobs to Aramark or some such food service provider that would have cut the benefits of the last good jobs in New Haven to nothing that I got involved.  I remember picketing outside in the snow and watching as students whose grad school recs had been written by their deans’ clerical staff walked right by them, ignoring us.  But I also remember students stealing cookies from the dining hall and bringing them to the workers.  It was class warfare, ground zero.  I cried with the workers but I also rejoiced with them.  There was no neutral there.  We made our choice and I was sticking to the union.

I remember walking out of my class on Protestant church history when I heard the union’s march outside.  As my professor quoted Martin Luther saying, “Here I stand, I can not do otherwise, so help me God,” I packed my books and walked out to join the march.  We walked by my dorm room and out the window the woman who cleaned my bathroom for three years waved out at us, smiling.  She gave me a thumbs up sign, and I knew I was in the right place.

It must have been the eve of our sit-in when John Wilhelm came to speak to us.  We were a group of student radicals.  I was the normal looking one… I never did look that good in ripped jeans, so while the other radical girls had short hair and jeans, I still wore skirts and my hair long.  I had no way of knowing that my normal looking persona would make me the ideal organizer of nurses… that was years away… but I remember that day that John came to speak to us like it was yesterday.

We were in a conference room of the union office.  There were maybe fifteen of us.  Francis, Jon and I were the leaders.  I was there out of passion for the cause but also out of love for my comrades.  I would have done anything for my fellow union members, those who hugged me and asked how I was when I was a freshman.

It was hot that day.  The window was open.  John’s message was simple: be brave, little ones.  And grow up to be organizers.

I felt brave.  I looked Francis and Jon in the eye and knew that we would stick together no matter what.  They are my brothers, and have been since we were all 21.  We knew we had support but we also knew we were facing expulsion.  My mom and dad had sweat blood to put me through Yale, and I was also carrying the maximum Stafford loan.  I had to pay it back no matter what.

Yet at that moment I knew what I had to do.  I made a decision that would make me who I am, for the rest of my life.

I was the lead spokesperson for those who sat in President Levin’s office.  I had a pre-planned speech, and one thing we were taught was that you stick to your pre-planned speech and say nothing else.  I just found the t-shirt that Jon made me as a 22nd birthday present that has my speech on it.  We mimicked the language of the Yale handbook:

“We are not here in any effort to prevent or disrupt any class or any University function or occupy any University building or part thereof.”

Okay, that’s what I said, but we were sitting in.  There were five of us who had a set meeting with President Levin, which he skipped and assigned to his assistant, Nina.  There were four others who snuck into the building and joined us, the most memorable of them being Sara Marcus, who snuck in by diving under Nina’s arm as she tried to block the way into Levin’s anteroom.

It took a couple of hours for them to figure out what to do with us.  The dean of students came to talk to us about expulsion.  I kept repeating my speech.

Meanwhile, part of the plan was that student protesters would sit on the steps to block them from arresting us, and they would get arrested with us.  At some point Francis held up a sign to the window of the room where we were that said, “There are 26 people sitting on the steps.”  We couldn’t believe it.  It was more than we expected.

Well, we were Yalies.  We got out out homework and sat on the floor of the Yale president’s office, waiting to be arrested and possibly expelled, and we studied. Yes, we really did.  We were waiting to be arrested and we did our homework.

Finally they came to arrest us.  The police asked if we were going to resist arrest and we said no — we had decided in advance not to resist arrest.  They didn’t even handcuff us, we just walked out.  As I was being walked out, I said to Nina, “Nice to meet you.” This has come to be part of the Yale lore, as it is totally absurd and absolutely Southern to tell the executive assistant “Nice to meet you” as you are getting arrested.

I remember walking out and seeing the union members standing around singing “Solidarity Forever.”  Laura Smith, president of Local 34 and one of the most important role models of my entire life, had tears in her eyes.  Nearly ten years later, it was one of the proudest moments of my life when I handed her my card saying that I was a Lead Organizer at HPAE.

I had no idea then that I would fall in love with health care, that my mission in life would be to reform the health care system in the US and fight chronic disease the way I fought the boss.

It is sixteen years later, and I’ve had a lot of victories and a lot of disappointments.  I’ve been frustrated by the tribal nature of the labor movement, and I’ve been lonely on those days when I missed the family I had back in college.  My friends all moved to California and formed their own community, but I stayed East and made a life organizing health care workers, mostly nurses.

Now I am at a crossroads.  I don’t know what the next step will be.  I remember the day that Francis convinced me I could be an organizer.  We walked to the Daily Cafe for coffee and he said, “April, if you want to be an organizer, you can be.”

It is sixteen years later, and Francis is still telling me to believe in my dreams.

I believe in the power of the American worker to transform the health care system.  I believe that I can play a role.  I believe that being a trade unionist and a health care advocate is one and the same.  Health justice is worker justice.  Who but us will lead this movement?

I recently looked at a picture of the Yale 31, those of us who were arrested on April 8, 1996.  I look alarmingly the same.  I am thinner, my hair is longer, and there are a couple of lines on my face that weren’t there, but thanks to sunscreen, not many.

But that girl who was willing to risk everything to stick to the union has stayed the same.  She is just as in love with worker justice at 37 as she was at 21 — she just knows a lot more now.  And in the meantime, she met health care, and fell in love all over again.  She can talk health care like she is a nurse, but she is an organizer to the bone.

Let the river run
Let all the dreamers wake the nation.

– Carly Simon, “Let the River Run”

Our nation needs to be woken up.  Only organizers have the skills to do that.  It’s asking for the taking.  Who are we, as organizers, if we can’t organize around the most important issue facing our country?

I know what I need to do the same way I knew on the eve of the sit in of 1996.  The fight for health justice is the fight for worker justice.  I will be there.

There’s been a lot of coverage this week on NPR (where I get all my news, except of course for Twitter and about fifty thousand newsletters about health policy and ACOs) about the sinking of the Titanic.  A theme that emerges is that those who had a job to do seemed to die with the most calm and the most dignity.  Moving stories of the ship’s crew, doctors, and even the bandmaster who kept the band playing as the ship went down all shared a theme: having a job to do gives meaning to suffering.

I just found out that another friend has breast cancer.  The wife of a close friend, really.  She is about my age… 37ish.  They have been married since their early twenties and had always prayed for children, but gave up after twelve years of trying.  Then BING!  Twins.  In 2009 she gave birth to beautiful, energetic twins, to whom she sometimes refers as “The Toddler Dictators.”  Twins are the perfect model for collective action.  They learn in the womb how to gang up on their parents.  All union organizers should study them.

I fell in love with epidemiology when I found that it gave meaning to the patterns I saw all around me, patterns that terrified me until I could understand them.  Odds ratios, risk ratios, cases vs. controls… they provide order to a universe that had heretofore frightened me.  I see danger everywhere… daughter of a divorced mother in the South in the Reagan years, you get to be that way.  I took epi when I was recovering from what was supposed to be minor chest surgery but turned out to cause such intense pain that I couldn’t take a full breath for a month.  I couldn’t take time off from work, so I had to keep going.  I found that the only thing that stopped the pain, or at least distracted me from it, was my epi problem sets.  Adjustment for age.  Risk ratio.  Odds ratio.  Construct a two by two table.  Hierarchy of studies.  It was as though they were saying, “Don’t be afraid, little one.  There is strength in numbers, but not in the way you (I am a union organizer) knew before.  There is strength in these numbers.  These numbers can heal you, and others.”

I fell in love with the numbers in the way that a Southern girl falls for a Jewish boy from New York (an experience that happened to me with sufficient frequency before I met my partner that it was statistically significant, I’m confident.)  I had never been a “math person.”  I took fractals as my math class in college.  Okay, I took fractals with Richard Hudson, but still… my final project was a story whose plot took the shape of a fractal.  I got an A.  Anyhow, before I took biostats at age 36, I hadn’t taken a math class since age 19.

I fell in love with the way that epi was simultaneously exotic and yet so familiar.  It explained everything, and that which it couldn’t explain it had the tools to explain.  I found I had a common language with epidemiologists.

Yet I realized that I will never be a cell biologist.  I will never spend time in a lab doing anything other than visiting and trying not to knock anything over.

My next class was health policy, and it was falling in love all over again.  Oh how can you passionately love two things so much?  Only by realizing that the divisions are artificial.  Epidemiology is policy, and when it isn’t, that’s the problem.  Epidemiology must set policy, but it won’t unless people like me lead in health care.

I’ve always been a “people person.”  I’ve been a union organizer for 16 years for heaven’s sake!  I can’t lock myself in a lab… but I can apply my organizing skills to the public’s health on a larger scale, always informed by epi, always with my epidemiologist friends sitting on my shoulder (I mean that metaphorically, BatEpi!) and always searching for the truth, especially when it comes to how we fight chronic disease.

And always working with the front line health care workers to improve the quality of care we deliver.  Without the front line worker, no policy change, however beneficial, can work.  The front line workers are the ones who know how to streamline processes and improve outcomes.  They’ll tell you if you ask them.  Those who care, know.  And those who know, care.  It’s a virtuous circle.

We end our yoga classes often with the yogi’s anthem:

May all beings be happy.  May all beings be safe.  And may my words, thoughts and actions contribute to that.

Let me add one:

May all beings be healthy.  And may my words, thoughts and actions contribute to that, to the best of my ability, as long as I am fortunate enough to live.

My step-mother is cancer-free.

After six agonizing months of chemo and then surgery, she is clear.  Free.  She is almost seventy.

I am in the midst of the biggest career change of my life, running off to find my unicorn fantasy ACO and do whatever I can to apply my organizing skills to improve quality on the front lines.

The last two months have been difficult to impossible.  My health has suffered as I’ve done less yoga and my face has been a mask of pain and stress.  Losing two kitties, changing jobs… some good change but some sad… I ran into my current executive director and long term friend while I was grabbing some sushi after work and we had a really nice talk.  Finally I feel like he understands why I’m going where I need to go, and I needed that.  In this work you build bonds that are like family, and I think some part of me needed the approval of the older brother I never had.

The pain and fear are going away.  My step-mother will be fine.  We will find a way to a new life, and I am supported by the most wonderful man on earth who has loved me through all, and who continues to be my rock as he sleeps peacefully in our bed upstairs while yet again I can’t sleep.

I have other rocks too.  Our friend the BatEpi continues to inspire me and help me figure out the future on a practical level.  Our epi friends continue to be my community, and those whom I know I will work with, in some fashion, forever.  My professors and colleagues at Jefferson continue to stand by me and encourage me at every step of the way.

When people ask me what I want to do with my MPH, I say, “Save the US health care system.”

Somebody’s got to do it, right?