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Summary:

New Years Day reflections on doors opening and closing.

I scour the beach as I walk intent upon my goal. I am looking for stones to use as door stops. My doors always seem to be closing of their own accord, sometimes blowing shut with a startling bang or closing gently until the latch clicks and you can’t see into the room anymore. When doors close it’s as if you have lost something. The potential that existed on the other side disappears. I want to keep my doors open. I ponder shapes and sizes. The bounty of the ocean lays its infinite choices at my feet. I run on tip-toes into the wet sand and breaking waves, to hold them up and examine the possibilities.

There are a surprising number of people on the beach today likely due to the unusual balminess of this New Years Day. People pass by in groups, calling out “Happy New Year!” others pass quietly with a nod or a smile. It is a pleasure to see faces without masks. Walking on the beach, digging your feet into the sand, facing into the wind and getting lost in the sounds of the ocean, seems like the perfect way to start a new year. One that, dare I hope, will bring some better times. I’m not one for New Years resolutions but I do like the idea of starting the year with an intention rather than a goal. Last year I recall feeling giddy with optimism. A vaccine! A new president! So much promise. But things have been harder than expected and I am more cautious this year. It feels less like a celebration and more like a time to reflect.

I have been thinking a lot about keeping doors open. I like the idea that possibility still exists and keeping an open mind might bring about positive change. I recently engaged the services of a financial advisor and the question that kept popping up was when was I going to retire. This is not something I have really considered despite a thirty year career in Emergency Medicine. This is part denial part genetics. My mother worked until she was eighty-nine and hates retirement. My father worked until he died at ninety-four. Also, I love taking care of patients. I love writing and bringing the humanities into medicine. But my job is physically and mentally exhausting and has become more so with time. The crisis in health care and the corporatization of medicine combined with the pandemic, has made it harder and harder to do the job of taking care of patients. At my age there are fewer doors to choose from. Some have closed permanently, others are harder to get through. Still, I have more to go through while I can.

The arrival of a sudden late day fog brings a smell that lights up my olfactory bulb and stirs memories. I love that salty, briny odor. It reminds me of low tide, digging for clams and summer vacation. I feel relief wash over me as I walk, inhaling deeply. Relief from the overwhelming exhaustion of the last few weeks. Relief from the stress of the holidays. Relief from the onslaught of COVID cases, another traumatic death, and a waiting room such as I have never seen before, packed every night with people needing to be seen or simply seeking a warm place to stay.

The Emergency Department doors are never closed. But what does that mean when there are no hospital beds, severe staff shortages, another pandemic surge, lapses in routine care leading to a sicker population, and the ongoing opioid crisis? It means that those of us inside those doors are working beyond our capacity. This is not sustainable. We need to find a way forward that improves patient care and provider wellness. Where administrators are not asking for more and giving less. I am so grateful to new generations looking for ways to make meaningful change. It is time to close the door on health inequities, racism, gender discrimination, homelessness, provider burn out and so much more.

I carry one large rock in each hand. One is a smooth gray stone shaped like a calcaneus with a thick white stripe of quartz running around the middle.  One is a large orange quartz full of angles and crevices that sparkles and has a wide flat bottom. Both will make excellent door stops. Today was the start of a new year. Tomorrow I will walk through that big sliding glass hospital door and go to work. I will continue until another door opens and I can place a rock on a new threshold and step inside.

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