January 2025

I’ve been aboard a “choo-choo train” for decades. I traveled to college, to medical school, to family medicine residency, to become an attending physician, then a medical administrator. Each new locale exposed me to a novel culture, with new languages, rules, and personalities—forcing me to learn different ways of thinking and relating to my environment.

My daughter and I sat on her bedroom floor, packing up her soccer gear. We both knew the time had come for her to walk away from the sport she loved. Her chronic illness had gotten the best of her, although she’d fought it as long as she could.

When Haley was 11 years old, she had what we now know was an undiagnosed concussion. It started with dizziness and progressed to frequent headaches, vertigo, nausea, and syncope. She started middle school this way, and by her sophomore year of high school was unable to attend class at all. During this time, she continued to play soccer, sometimes passing out on the field. We knew she was in trouble when she raised her hand and took a knee.

“You know what they say, Dr. Chew—every day above ground is a good day.”

My next patient, for whom this is a mantra, is in the waiting room when I duck out for an overdue bathroom break. Her bleached blonde hair is tangled, her jeans tight and faded, her face mashed like a boxer 20 years her senior. Her gray eyes vigilantly scan the crowded room.

When I was in medical school, a physiology lecturer told us about a book called Pride and a Daily Marathon. This narrative case study, written by neurophysiologist Jonathan Cole, is about the struggles and triumphs of a young man in his quest to live a full life after he awakes one morning having lost all sensation below his neck.

Making it through medical training, an ableist system, with a disabled body, took all the grit I could summon. In residency, I managed severe pain and exhaustion from an autoimmune condition. Work hours were grueling, and I needed to sleep nearly every minute I was not in the hospital. Attending medical appointments or working make-up shifts for peers who covered sick call in my “free time” on post-call days was torture.

As a noun, grit is defined as “courage and resolve, strength of character.” It often emerges in the face of great challenges. We associate grit with heroic figures: army captains holding their ground against tremendous odds, navy commanders saving sinking ships, air force pilots navigating disaster zones. Yet, many gritty individuals remain unsung heroes, quietly shaping lives. My maternal grandfather was one such hero.

My husband and I took care of my Alzheimer’s-ridden mom for five years, and as any caregiver knows, we all have had to develop “true grit.” “Grit” to me is inner mettle and perseverance.

Any disease is difficult to deal with, but with Alzheimer’s, you’re often dealing with an ungrateful stranger, due to the changes in the brain. The “stranger” part didn’t bother me as much as the “ungrateful” part did.