The day began like any other in my OB-GYN rotation. A few hours before rounds, I approached a patient who’d just returned from an emergency Cesarean section. I began asking routine questions, until my senior gently nudged me. “Be careful what you ask,” he whispered. “She doesn’t know her baby died in utero.”

Denny was one year ahead of me in grad school and a close friend. We shared so many plans about our future! I knew he was gay, but his bisexual partner was the only other person in on that secret. This was the 1960s, and coming out wasn’t an option back then if you planned to be employed in certain professions.

Has it all come down to this, after a lifetime of quantifying success against arbitrary goals? To achieve, whatever the cost? A competitor by nature, I prefer victory to failure.

Retired and sixty-six, I see my oncologist every month. Just when I’d hoped to be free of success by someone else’s calculation, I’m checking for lab results in my electronic medical record.

Yesterday, I learn that my numbers are climbing up.

The personal question patients used to ask me was “Are you pregnant?” Recently, a patient inquired, after sharing that his wife had started menopausal hormonal therapy, “Do you also take this?”

I have indeed started what I call my Menopause Trifecta: an estrogen patch, a progesterone pill, and a testosterone gel. Estrogen made me miserable during puberty; helped me become a mother of two children; and drove cyclical cravings, cramps, and crying. But my ovaries no longer produce estrogen. My “childbearing potential” is gone. Unused menstrual supplies gather dust in a cabinet.

The chart said that she came into the Emergency Department after an overdose. An older woman, disheveled, who had been found down on the ground. She had a history of schizophrenia and not taking her meds. The Emergency Department stabilized her and then admitted her to psychiatry. On paper, she was like so many other homeless patients: chronic psychosis and layers of trauma buried under ICD codes that adorned her chart.

I was in a good mood. I had just been dismissed early from my shift at the hospital, and I looked forward to an empty house where I could eat lunch, watch reality TV recaps, and take a nap in peace. The sun shone brightly as I drove down the freeway, which was surprisingly free of the infamous Miami traffic. I love my fourth year, I thought to myself. The upperclassmen weren’t kidding when they said that the fourth year of med school is the best. Nothing beat being free from the obligation to study for exams after a long day at the hospital.

“Nice clean cut,” the resident marveled as he examined my wound.

“Sabatier,” I responded with pride.

Back in those days, we lived in a cramped tenement apartment with a shabby, dark kitchen. But at least our low rent gave us enough financial wiggle room to slowly build up a decent batterie de cuisine. It was one of our early acquisitions, a pricey knife, that had sent me to the emergency room.

A son is studying eight hours away from his rural home in Bangladesh. He’s at university, building a name for himself, paving a path not trod by his forefathers. He meets peers who have known only cities. He hones his formal Bengali, shedding his informal dialect. In a nationwide civil service exam, he ranks in the top percentile and earns a coveted merit placement. He leaves behind the swampy farmlands of his youth to forge networks in the big city.

The nation is still rebuilding two decades after its Liberation War, infamously referred to as a bottomless basket case. One day, he receives a letter: his father is ill. He drops everything for the rocky seven-hour drive on unfinished roads and marshy soil back to his ancestral village.