This Time in Our Lives
La Jolle Beach, San Diego November 2018
“What happens when you die?” – my 5 year old sister Kate. She asked me this for the first time over the summer. Initially, I was tempted to give her the ever zealous response I had received “well if you’re good then you go to heaven where everything is perfect and if you are bad, you burn in hell.” But then I remembered how that answer didn’t sit right with me –like we only do good things here on earth so we can chill out in heaven after we die, not a good reason to do good and not an explanation for what comes after. As if this life wasn’t enough, as if we had to spend every day on this wonderful planet waiting to go to a true home. And maybe we do, maybe that is what is going to happen. Don’t get me wrong – I’m a pretty spiritual person and I’m not saying I don’t believe in heaven or know at all what happens after we die (I go to mass every Sunday, pray every day, started a bible study group, etc.) but to give that answer to a 5 year old who has never had time to think about her own religious/world/life views, didn’t seem right. Plus, I knew my grandmother & step-mother had already given her that and it hadn’t helped. I said “well we really don’t know, maybe nothing happens and everything is black –like when you close your eyes and lay down – or maybe you go to heaven and you can do all your favorite things. The only thing we do know is what is happening right now.” I understand children’s cognitive capacities are limited, but somehow that made her smile and say “okay so we should go play because you’re never here.” She didn’t ask about death anymore, but it made me start thinking about how death gives meaning to life –it forces each moment to truly matter and if that’s the case then shouldn’t we try to maximize our time here on earth? But how can we do that wisely, taking into account our short term and long term goals, truly living each day without being necessarily scared of death? Seems hard & like I had to let it sit for 6 months before I tried to write about it. Short answer: it's different for everyone and there's no universal answer.
My little sister had recognized how to adequately spend her next 4 hours by understanding her desires and using that to allocate time – because she loved me, because I was never home, because she enjoyed playing: the next couple of hours would be spent playing with me.
When we are children, sometimes each day seems like forever, each year is a whole new world. But now, that I’m 23, in medical school and lucky enough to be in this porcelain bubble of a world surrounded by ivy league grads/students with rigorous/prestigious/high stakes jobs/lives/challenges –each minute can easily be occupied by something that feels important. But is it?
For what I think makes a complete life check out my previous posts on general wellbeing (it's made up of a variety of factors friends/family, career, community, health etc.). It’s an interesting balance we would do well to come to – realizing that we have our whole life to accomplish our goals/spend time with our family/ get to know ourselves and whatever else we might want to do –it feels like forever in some respects and like not long enough in others. This post is inspired by my sister, my own life experiences/reflections and three pretty different books– the biography of Sam Walton (Walmart founder), Being Mortal (Atul Gawande) and 21 Lessons from a 21st Century (Yuval Noah Harari). Once again this is really just my own thinking infused with some concepts from the aforementioned books, there will be no citations. Always open & willing to chat about anything that this makes you think about.
Constant Variety
Here I am as a speaker at the APHAs national conference in San Diego, taken on a series of 4 weeks where I wouldn’t spend more than 6 days in a place. Definitely a test in how to spend my time, maybe a time I was close to pushing myself too far. November 2018
Short story: you can make the argument that life is always full of decisions to make, but I believe that ages 22-35 contain the most important choices one will make in setting up how your life will run. It doesn’t mean you need to accomplish everything you want to before you’re 30something and have a family. Of course you can still do whatever you want after this age and you’re always the captain of your own ship but, these years are some of the highest impact if you so choose them to be.
Great, so you’re in some of the most crucial years of your life. Now what? Setting priorities based on what matters helps, so let's take a look at what matters:
1) To older people – under the premise that those who have lived the longest have accumulated from their years of being alive a “wise” perspective, and that since they’re closer to death maybe they’ll have some important insight
2) In the 21st century aka our world today –maybe by understanding what needs to happen in the world to make it better we can guide our own life, by dedicating it to a higher cause. This may work for some and it may not for others – maybe that Ferrari is all that will make you happy, and that’s okay. cellspacing="0" cellpadding="0"
After this I’ll share how I personally spend my time as a current medical student who has decided to get involved in school activities, attempts to have friends, strives to maintain family ties and still seeks to spend time engaging in different sorts of projects/ thinking about life.
Older People
In his book Being Mortal, Atul Gawande, discusses current practices in geriatric medicine/care and how many nursing homes are not adequately set up to maximize quality of life and are instead focused on quantity of it. Think about a day in your life vs a day in a nursing home.
The situation above is highly generalized and perhaps exaggerated in some respects. Further it should be noted that here I am not criticizing doctors for striving to extend the life of their patients – no this is the way the system has been set up and it needs to change but they are not “bad” doctors in any sense. Moreover, the idea that these homes are “bad” for focusing on keeping the elderly safe and trying to extend their lives is not correct. Bad and good are not accurate terms. This idea is simply misguided and not really based on what people want. With technology we can keep them alive forever, but at what cost if they’re not able to enjoy their lives? Instead we can all spend time re-thinking how we want to treat our elderly in general and at the end of their lives. Some general points:
Diversity of the day: As a 20-something your old you are constantly engaging with a wide-range of people and doing a diversity of different activities. Maybe you won’t like some/most of the people/activities but there’s definitely room for exploration and change.
Basic autonomy: A 20-something is in control of basic elements in their own life à sleep/wake/eating patterns. You make the choice for better or worse each day. The elderly may not.
Free time autonomy: A 20-something is in control of their entertainment/free time. You can choose to binge watch Netflix all day or to go out with your friends and binge drink. Neither are particularly healthy but you can choose. In a nursing home, people may not have the autonomy to dictate their own life.
Contribution to & purpose in our world: You can make contributions to society, our economy/world/capitalist state of being whatever you want to call it depends on most of the young people getting up and doing something each and every day. Young people are needed for the world to function at all. Old people are not. Perhaps you can’t wait to get to that age to “relax” but #1 you can relax right now if you so desire, and #2 think about how awful that can feel for some people – knowing their time to contribute to the world is done and being sidelined into a home where nothing you do really matters to anyone.
Close vs extensive superficial social networks: As a young person you can go a whole year without seeing your family and still be busy/ have human interaction -I definitely have. Sure it wasn’t as fulfilling but you can and many do. As an old person, you’re generally either out of opportunities to meet new people or not particularly interested. You have your circle of family/friends you enjoy keeping up with and since you know your days are numbered that’s all you really desire.
Knowing this, smart and caring people have innovated new ways of taking care of the elderly that maximize autonomy and address the above points. For example:
Allowing an individual to make their own dietary choices allows them to feel more in control and hey maybe with enough education they will end up choosing the well balanced oatmeal every day for breakfast (like I do).
Giving individuals plants increased their sense of well-being and purpose. Let’s all remember, humans need purpose to live.
Mentoring programs where older people can consistently talk to young children, teaching them how to read, color, etc. has increased quality of life, happiness and age of death in some institutions.
Definitely cool stuff to think about – and maybe even inspire you to talk to your family members about what they really want in their old age/ how they want to be taken care of. However, what struck me the most was the differences in how we spend time when we’re short on it vs where it seems eternal in regards to family/stability vs new experiences/instability/quantity over quality.
Left: South Carolina Nov 2018, cousins I grew up with since day 1, understand my family side
Right: NYC Ballet Dec 2018, new med school friends, share my passion for health + understand career ambitions. The former know me in ways that the latter may never know, the latter understand my career ambitions in ways that the former cannot. It’s always interesting to think about how different all of the people that I care for are from one another, how different their balance for well-being is and how we can connect in spite + because of it.
When we’re young, we want to go into the world, make all the connections, learn everything, see everything, work hard and put ourselves out there as much as possible despite the risk of failure/rejection – or at least I definitely do. Everything is interesting in some way shape or form and everyone has something to offer. It’s fun to keep a large/diverse/varied set of friends even if they may not be that deep. You make plans and have dreams about all the things you can do in the world and are okay embarking on career paths that will take 10-20-30 years to pan out.
However, when we’re older or even when patients are told they only have weeks to live that all changes. You’re no longer interested in talking to that one friend who you only talk to when you want to go to that one bar in that one place, instead you want to fly back to your middle-of-nowhere hometown and spend it with the same 20 people you grew up knowing. Even though when you were 18 you killed yourself to get out and swore you’d never return. It doesn’t mean you don’t like that one bar or that one friend anymore. So what does it mean? The phrases: live like today is your last day & live like life is eternal are often thrown around in songs/movies/books, but which is it? We can clearly see when we are short on time our desire for having & engaging with new experiences/ people/ projects decreases. We turn our attention to familiar faces, spaces and activities enjoying every single moment. So it seems like that really matters right? So why not spend every single moment like that? Why ever leave, why have that desire for novelty/recognition/variability?
Well some people don’t. As I’ve learned from speaking to my own family members, friends in Bolivia, patients, etc. some -I dare say perhaps most – people do not stray far from their homes. Does this mean they are happier? Not necessarily. I think it really depends on your personality/ potential/ambitions/purpose/desires. For me, it would not be sustainable to spend each day for the rest of my life in my mother’s home in Florida or with my father’s 35 person family in South Carolina. It’s not because I don’t love them or because I don’t have a great time when I’m there. I also know that if someone told me I only had a month to live I would definitely drop everything and find a way to spend time with all of them. However, as someone who truly does want to dedicate their life to using all of the privileges God + life + nice interviewers have awarded me, to cause large-scale, positive impact in the world. By devoting my life to this higher cause it gives me purpose, meaning and fills me up every single day. Allowing myself to push myself harder and truly enjoy each new experience – even the difficult ones, viewing them as learning moments, all geared toward my ultimate goal. What if I end up dying tomorrow? Are all my efforts in vain? Well, aside from the impact I’ve already caused in the world I’d argue no it wouldn’t be in vain because that mindset let me really enjoy life while I was living it.
For example, one of my goals is to live in as many different places as possible before I’m 30 -not because it’s particularly easy but because the benefits do outweigh the costs. Because I know that my current balance between new experiences/larger contribution to the world and family/familiarity/stability will shift as I age. Different priorities will take the stage, but it doesn’t mean that any one of them ever disappears completely. For example, right now my goal is to see someone in my family once a month and I do. Some of my friends in NYC make fun of me for going home so much and other’s are shocked that I ever left South Carolina at all, and either perspective is okay. Everyone’s balance is different.
When thinking about time an interesting exercise may be to think about how you would spend your last month on earth and how/if that should influence how you spend your current time.
Here’s me and my mom after we jumped out of a plane together, she’s one of my best friends and there’s still no one else I’d rather do almost anything with. Also fun fact having new experiences with people helps maintain/form relationships + makes them stronger.
June 2018
The 21st Century Needs…
Like I’ve said before, I think anybody can enact positive change (especially if you set aside things like prestige and recognition as drivers) and I especially think that my highly educated/well positioned peers can and will cause an incredible amount of impact in the world. So what does the world need? So many things. Pick your battle honestly. Even though the situation has improved in the last 100 years and I genuinely believe/ know the world is getting better (check stats on poverty, malnourishment, disease burden to name a few) there is still much to be done.
Climate change is real, ever looming and already having disastrous consequences à flashfloods, glaciers melting, ocean life diminishing
Global Health à we have already designed drugs to some of the biggest killers, however dissemination and getting enough political will to fund/manage essential public health interventions is needed.
Wealth distribution à regardless of which economic theory floats your boat, the distribution of wealth at the moment is not ideal and it can be distributed for the better
Whatever your heart desires à immigration/refugee, corruption in politics, justice, law, business, hospitality, transportation, technology, artificial intelligence, etc. There are ways to improve almost everything.
Refer to my previous posts on how to think about what specific cause you’d like to devote yourself too.
The 21st century needs a lot, but most importantly the 21st century needs you to be your very best self, your most focused self so that whatever you may choose to do with your life you can actually do it. Awesome another post where Claudia tells me to increase my well-being. Well, I think it is important. In order to accurately manage your time + accomplish your goals + be well (which once again does not mean being happy every day) it’s essential to at least try knowing yourself. Meditating is one of the most interesting ways I think you can do accomplish this goal by.
Try sitting down for 10 minutes, not moving, closing your eyes and just feeling your breath. You can place your hands on your stomach to ground you even more. This is actually a shockingly hard exercise for most people (including myself). Lots of things can happen:
You can fall asleep, since your body is so used to being on all the time the first break you give it, it just shuts totally off. This isn’t really the point so try again when you’re more well rested.
You can feel: anxious/restless, sad, calm, mad, happy, and all the other in-between slew of human emotions we possess. It’s interesting to recognize them, and just let them be. Don’t get angry that you feel anxious, just try to think “oh wow I feel anxious today,” maybe you can even uncover where that’s coming from.
You can start thinking and feeling about: how much you love your boyfriend, that fight you had with your mother, that paper that’s coming up next week, how today you have to have lunch with your professor, your meetings today, that vacation you took last year to China, that thing your dad said to you when you were 5 or literally anything else. Your brain is capable of a million different emotions and literally time travel. We are rarely ever “in the moment” because it’s so easy to slip into any of the thousands of moments we have already experienced/felt or think about those that are to come.
You can think about nothing: your mind draws a blank, and that’s okay too.
For me, starting off each day with a bit of meditation is nice to see where my head is at and thus treat my body and mind accordingly. Somedays you wake up feeling anxious/grumpy/sad etc and that's okay, it helps to recognize it and approach the day accordingly.
Basic picture? Sure but don't knock it till you try it. Yoga + meditation for 10 minutes a day help me a lot. Recommend: Calm, headspace, yoga with Tim.
Fort Myers, FL
Sept 2018 (went back for my moms' birthday)
Me, Myself and I
First off let me tell you medical school is in fact time intensive, rigorous, interesting and worthy of spending a significant amount of time on (who knew right?). I’m glad I’ll be there for four years. Secondly, because medicine is such a fascinating field and Columbia med has such incredible faculty/research/clubs/committees and students it’s fairly easy to go to campus at 9am, leave at 10 or 11pm every night and have every second filled with people/activities/work . And sometimes I do that – generally it’s a conscious choice but sometimes it’s not and that’s something I’m working to reduce. Third, NYC is a pretty engaging city. Well named as the city that never sleeps, if you have time/money/friends you can definitely spend 4 years without having to repeat a single activity once – theater, museums, any cuisine you desire, nightlife, awesome rock-band style church masses, whatever you want. With so many different people and activities it would be simple to engage in purely superficial but pleasurable experiences all the time. Superficial key word - they're still awesome to experience but I think without forming real human connections it's a different kind of experience and so I try to spend my time between engaging in those very fun experiences (experiences I may only be able to have right now) and spending time/ seeing/talking to my loved ones in Ecuador/South Carolina/Florida, my friends scattered throughout the US and my work in Bolivia.
Left: Me and some of my new med school friends attempting to enjoy wholesome pumpkin carving 3 days before our exam week.
November 2018
Right: College friends in downtown on a Wednesday, ft: an all too classic look of me wearing a backpack in downtown NYC. Cost benefit analysis of going home to drop it off vs carrying it around never fails to make me look like a student.
October 2018
Without further ado here’s my latest and somewhat ever-changing life structure:
Wake up: 6:30-7am
Nice to do given that I’m lucky enough to have a massive window overlooking the GW bridge, also fun fact sleep/wake times matter almost as much as # of hours slept so I try to keep to this even if I sleep later than desired.
Morning Routine until 9am:
Yoga for 5-10 minutes. Meditation for 5-10 minutes. Cardio for 25-40 minutes, bodyweight/weights for 10-20 minutes if time (definitely skip out on the weight stuff more than I should but there’s always room for improvement). Breakfast + walk to class.
Yoga is a new addition that I’ve found helps more than adding an extra 30 minutes at the gym, helps with focus, staying calm and elevating my mood for the duration of the day.
Class/Meetings/Extra cirrics: Much of my day
I’ve recently decided to be the VP of student council, take on Columbia Med’s Business club (name pending) and work in + to improve a student run clinic. In addition I try to not fail out of medical school and keep up with my old non-profit, ties in Bolivia and mentor/advise as many groups as possible (s/o to Dursafe in Virgina for being one of them + Blue Oceans Watch for allowing me to be on their team).
Studying: 2-4 hours a day depending on the day, goes along with my theory we can only do 4ish hours of work every day –check out the free audiobook Deep Work on you-tube to find out more (ty for the rec Akshay). Sometimes on Sunday I do 6 hours.
9-10/10:30pm
Call family member (mom, dad, cousin, 3 best friends) + walk back from wherever, wash face/brush teeth/etc., continue to harass my loved ones/ pretend to watch a documentary or bad Xmas movie if its’ December/ research new opportunities/jobs/ read cool articles/ check personal email, finally read for 10-30 minutes until I feel sleepy.
Exciting stuff huh. Well either way some of the important things I generally try to hit each day:
Mental wellness --> yoga + meditation, something very extreme would have to happen for me to not do at least one of these each day
Physical fitness --> 5x a week at least for at least 40 minutes a day. Again only wouldn’t do in extreme situations like being in below 20 degree weather and having no access to a room or gym.
Family + friends aka long standing/ deep relationships -> text/call someone each day, maybe this makes them feel good but I’ve found it increases my quality of life exponentially
Being done by 9pm --> setting a time that I am done is essential for sustainability
Reserving at least 5 minutes a day for new thought/ reflection à reading, writing, or just thinking about my day/life in general at the end of each day is incredibly rewarding. Sometimes it’s nice to think about all the things I’m grateful for, to have time for introspective/personal thought or to think externally about whatever new topic I’m reading about/ someone mentioned to me that day.
And of course once again I try to go to either Florida or south Carolina once a month to see my family, it builds me up and reminds me of the varied aspects of wellness and varied ways one can live life and experience joy and I love it.
Of course no one’s perfect and I’m definitely not even close, so in the spirit of 2019 new year's resolutions some things I’d like to be better at include:
Picking a meal to eat mindfully: sometimes I find myself eating to survive or eating too quickly because I haven’t set aside enough time to do so. Eating is one of the consistently beautiful and enjoyable things that we do.
Continuing to understand myself: a never ending journey really that will involve more self-reflection and care.
Increasing my sense of patience and empathy, especially when it comes to listening to others complain: sometimes when I hear people being negative about our school/weather/life in general it makes me want to shake them and say “wake up, don’t you realize the world has real problems and the fact that you got a 75 on your exam or that your shoes don’t match your socks today aren’t on that list! Maybe if you’d stop complaining and actually do something to change the world it’d be better!” The faces of the people that I’ve worked with who struggle to make ends meet each day flash in my mind as I listen to people I consider to be far more privileged, well resourced and are still complaining and that generally makes me angry. However, anger is never the solution and is definitely counter-productive to me even attempting to convince others that perhaps their life isn’t so bad. Moreover, we all have these “fake problems” –something that matters 0 to me can wreck another human’s day. Every person is their own reality, filled with constant positives/negatives. I don’t really care if my bed sheets don’t match my bed cover when I go home but maybe my mom does because it was her way of showing that she loved me and since it’s wrong then she feels she’s not adequately preforming her duty as a mother. You never know what’s going on under the surface. Maybe if everyone’s biggest problems were world hunger, wealth disparity and global health inequalities then the world would be better – but they’re not and it’s unrealistic to think that they can be when the very act of daily existence comes with a whole slew of emotions/experiences. Thus, I will work on being patient with others and actually listening to their problems, as my anger contributes nothing and everyone deserves love and kindness.
Conclusion
And so there are my thoughts on time. I hope it made you think or at least that you enjoyed some of my general musings/anecdotes or that it inspired you to check out some of the things I cited. In summary:
Death gives life meaning and even 5 year old’s think about this
Autonomy, new experiences, friends/family + purpose/contribution to the world are things we all desire to different extents when we’re 20-something and in nursing homes & maybe thinking about it as a 20 year old/ talking to a older adult about it will increase everyone’s quality of life.
Extending someone’s life may not be worth it if it’s not a life they want to be living: having a conversation with them may help in end of life care
Know yourself even a little bit and in addition to having an increased quality of life you can (if you so desire) help tackle some of the biggest dilemmas in our wonderfully complex 21st century
Maybe time isn’t endless and maybe it is, either way putting some thought into figuring out what you value the most and structuring your day around it may lead to a more fulfilled life.
At the end of the day, if you ask me all that matters is making the world better somehow or at least not making it worse and your own quality of life + well-being (in that order, so if maintaining your quality of life is hurting the world maybe rethink) .
I hope your 2018 went well and best of luck in 2019!
Message me any q’s and follow me on social media if you so desire to get even more life musings (insta: @claudsinclouds).
Happy living! (:
-Claudia ![endif]--![endif]--![endif]--![endif]--![endif]--![endif]--
PS: Yes that's my 5 year old sister.
Nov 2018: Thanksgiving, yearly soccer game with the restaurant where someone tore his PCL and I actually know what that means now.