Not so far away from cornfields ripe for harvest, the pinnacle of Nebraska’s beauty unfolds each October around a two-lane crevice through a section of Omaha. It is the envy of all streets in the Happy Hallow neighborhood, yet it is not boastful. I do not reside on it, but I get to enjoy its bounty nevertheless. In summer, kids play football in yards and sell lemonade and rocks. While other seasons offer their views–spring with its purple blooms and winter with its holiday fanfare–it’s the October evening air that bestows a magical weightlessness.

As anyone in health care knows, work has been difficult this past almost-two years. There are layers of dysfunction and disconnect. Despite our collective fatigue and overwhelm, however, we show up and do our best. We apologize for the system, the lapses in care, the way that everything feels complicated. This emotional work is heavy. Sometimes I have the image of myself, like Atlas supporting the globe, hunched forwards with my patients piled on my back. I am carrying them to higher ground.

According to Oprah Winfrey, it’s when we feel least thankful that we are most in need of what gratitude can give us: perspective. The neurologist Oliver Sacks expressed a similar idea; his reflections on what it means to live a worthwhile life were published posthumously in a book titled Gratitude. Diagnosed with a terminal illness, Sacks wrote that his predominant feeling was one of gratitude, expressing appreciation both for what he had been given in life and what he had been able to give in return.

I wasn’t looking for a new dog. I had recently lost my best friend of over sixteen years, a beloved terrier mix. My sister had dragged me into the shelter so that she could get a new cat. So, while she looked at cats, I decided to pet all the dogs, lingering a little longer with the ones that looked the most sad.

The shelter staff began to follow me like I was a shoplifter. “Can we help you find a dog?” “What kind of dog would you like?” “Would you like to meet that dog?” Desperation tinged their inquiries.

Late one evening, in Open Heart Recovery, my seventy-five-year-old patient’s temperature shot up from 98 to 103. I gave her Tylenol suppositories, double-checked the blood she was getting and called her surgeon. Dr. Vance instructed me to repeat the Tylenol, add intravenous steroids, then quickly hung up the phone. He needed some sleep after performing cardiac bypass surgery all day and on-call.

Mrs. Smith’s elevated temperature both worried and puzzled me. She might be having an allergic reaction or malignant hyperthermia.

I was on the 36th hour of a 48-hour ambulance shift. We had been up all night and had remained busy all day. I was starving, so I ran into a deli for a quick fix. The kid behind the counter told me they were closed. I paused, jaw dropping in disbelief.

“Just kidding, boss,” he cackled.