2026

It takes guts to show up for your medical appointment and meet a new provider about whom you know nothing. Perhaps this one will stay longer than the last three primary care providers you have been assigned. Perhaps this provider will use your correct name and pronouns and will not deadname or misgender you. Perhaps this PCP will not dwell on the fact that you are trans when gender identity is irrelevant to your chief complaint. Perhaps you will not be asked the dates of your last menstrual period when you were born without a uterus. Or, perhaps support staff will think twice before asking about menses, as the word “menstrual” triggers dysphoric feelings, and you have had breakthrough bleeding when you’ve been unable to obtain a testosterone prescription.

My son is at the sink washing wet, sticky tissue paper off his hands (a four-year-old’s experiment).

I flash back to his surgeon’s voice saying that a preemie’s intestines are like wet tissue paper.

The surgeon repeats this phrase as she explains the exploratory intestinal surgery she would be performing. She describes the process with confidence, as I sit there thinking it might be easy to sew wet tissue paper back together.

While most 16-year-olds have parties to celebrate turning “Sweet Sixteen,” my memories of that birthday are of a disinfectant-varnished hospital.

One morning while I was studying physics, my observant surgeon-dad said, “Let’s look at your neck.” I thought it an odd request. “You have a thyroid mass,” he said. Within moments, I was weighing treatment options. Ironically, my dad’s thesis during his surgical residency was on thyroid disease: one of life’s wry twists.

My first thought was “Is this cancer? Will I be dead by 17?”

As I think back on that morning over 40 years ago, I’m pretty sure he was a medical student. I had come to the clinic weeks before after experiencing a sharp, intermittent pain in my stomach; I’d felt sure it was something that needed to be fixed. In part because I was attending a university with a well-known medical school, I’d been offered several tests to try to figure out what was wrong. All of the results were negative.

So now I found myself sitting across a table from a medical student who still had all of his curiosity and empathy intact. “Tell me a little about your life,” he said.

I sat in the back of the chapel and shrank.

At the funeral of a friend who had lived with cancer for eleven years, the words rose around her like banners: fighter, warrior, fierce, relentless. She was a mother of three. She never gave up, they said. Their praise was full of steel.

I have stage IV cancer. I go looking for treatments that might hold it at bay. Not cure—just delay. Just slow the animal down. Let me keep my place here a little longer. Let me wake again to sunlight on the kitchen floor. Let me have one more ordinary Wednesday.

When I was ten years old, I was stretching in my Houston Ballet class when I felt a sharp pain in my back. At first, I ignored it. But over time, the pain began radiating down my right thigh whenever I walked or sat too long. I knew something wasn’t right.

I mentioned it to my parents only twice. I’ve never been much of a complainer, and during the COVID-19 pandemic, they were working long hours in clinics and hospitals. I didn’t want to add to their stress. So I masked my crooked gait, compensating with different muscles, forcing myself to stand straighter. Secretly, I was afraid of what a trip to the doctor might reveal.

I found my father’s training notebook on his nightstand.

At first, it reads like data. Dates on the left. Heights on the right. The record of his jumps, measured carefully, almost clinically. March, May, June, July, and so on. Page after page.

Then, the pattern shifts.

There are stretches where the entries thin out, then stop altogether. Blank pages. And then, suddenly, they return. New dates, new numbers, written with the same deliberate hand, as if nothing had been interrupted.

My mom spearheaded a move for her and my dad from New York to Florida, because northern winters were getting too uncomfortable. My mom looked forward to warmer winters and year-round golfing.

Their friends said it took guts for them to move, because they’d be leaving their core group of friends and family. My dad was initially reluctant to move because of this reality, but my mom’s persistence prevailed and move they did.

They liked the weather, which was indeed conducive to year-round golf. For my mom especially, golf was like gold. She joined a ladies’ golf league and enjoyed the camaraderie, the fresh air, and the exercise.

It’s a gut feeling.

That’s what my mother always says. Confidently, like a fact.

Her childhood in the Dominican Republic, full of domestic violence and poverty, tried to convince her that that would be her reality many times. However, she always had a feeling her life would change.

I didn’t understand what she meant.

It began in junior high when a group of neighborhood girls decided they were better than the rest of us. They wrote a song about their looks and personalities; they sang this every morning on the bus to school and every afternoon on the return trip home. These girls made me feel worthless and invisible.

I wish I had had the guts to stand up on the bus and silence them by telling them the harm they were causing. But I didn’t have that moral courage.

Dear readers,

When I think about which parts of my medical training required guts, what pops into my head is my very first clinical rotation: surgery.

You might think that I’d have been most fearful of what I’d encounter in the operating room–spurting blood and writhing intestines.

In truth, the thing that roiled my own guts was the hour that I’d have to report. The thought of getting up at 4:30 AM–to shower, dress, have breakfast, catch a bus to the hospital and trudge to the surgical ICU–filled me with despair.