A life of pie.

Earthen Only
9 min readFeb 18, 2021

A friend of mine who works as a lawyer described the rat race of law as “a pie-eating contest, where the prize is more pie.” The harder you work, the more efficient you are, and the higher you climb in the promotions ladder, the more work you are tasked with and the less time you have for yourself. The story sounded eerily familiar.

Physician-hopefuls are subjected to grueling pre-med prerequisite courses surgically designed to “separate the wheat from the chaff,” as one organic chemistry professor proudly proclaimed on syllabus day. They sit in lecture halls with sometimes a thousand other nuggets (my intro bio course was regularly 1100+), with each successive year in the premed gauntlet narrowing their ranks to less than a hundred. Then they sit for the MCAT, hoping their scores place them in a percentile range competitive enough that their application isn’t tossed out immediately. Some have the (albeit unpleasant) privilege to afford incredibly expensive MCAT prep courses, and others have to make do with class notes and prep books borrowed from the library, covering half the page so they don’t see some stranger’s pre-circled answers. Then they shill out hundreds of dollars to apply and hundreds more to fly for interviews (probably also a hundred or two to dress like a standard yuppie), all while usually taking a gap year.

For the segment that get into med school, they work even harder than they ever have before. Regularly there is a number of students each year in every med school who cannot match into any of the residency programs they interviewed for, and have to scramble for any remaining open spot in the country, no matter what the specialty. For those who make it to residency, they work hours that put stockbrokers to shame, for wages that put hospitals to shame. The journey stretches ever onward: for star residents, they can sub-specialize with fellowship tracks (more years of training), take on administrative work, or teach at a university hospital. The more pie you eat, the more pie you get.

These days I stare at my spreadsheet of residency programs, asking myself for the first time in a long time, “What do I want?” Of course, I was asked on almost every interview where I saw myself in ten years, and my answer was true, yet incomplete. “I see myself working in a community shop emergency room, with enough expertise to handle anything that comes through my door even without specialist backup. When I’m not working, I want to be actively involved in local legislation that affects social determinants of health. I hope also to donate time to humanitarian medical relief.” Translation: I hope to eat tons of pie at this program so that I can eat even more pie throughout my career. But as to the rest, the non-pie details? Am I reading up on health care policy while a toddler screams in the background? Am I living in a sleek high-rise with overpriced groceries and restaurants a block away, or a ranch-style home with backyard and an old hybrid car? Do I want gloomy winters or sweltering summers (or good ol’ NYC with both)? Do I risk wildfires or hurricanes or (God forbid) the big one as climate change accelerates into a new decade? Do I want a church community of hundreds, or a few dozen? Do I see myself living within less means to dig myself and my family out of debt? Most importantly, will I ever get to take cool-as-heck vacations that involve trains?!

In my conversations with friends and mentors, most agree that I could get to my imagined future through any of the programs on my list. The tricky part then is to wade through all the unimportant things, like imagined prestige, number of shifts, etc. to reach God’s will. And to this end, I have to have an inward measure of how much pie is enough. How many years should I take to get my license? While I’m in residency, how much time can I give in His service? How much of my life will be career, and how much will be the rest? And if I’m to eat at least some pie for the rest of my working life, how much do I eat so I don’t get tired of pie?

I’ve been working evenings at the psychiatric emergency department for the last few weeks, and I’ve been inspired by the people I’ve met. I’ve been thinking about two of them more than the others, though.

One night, I went in to interview a man brought in by police. The police record said he called the cops on himself, as he had locked himself in the bathroom with a gun, after smashing two holes in the living room drywall and breaking a shelf in the fridge. “I want to die so ******* bad,” he said to the 911 operator. The notes in the computer said that shortly after entering the holding area for patients, where they waited to be evaluated, he had gotten impatient, pacing restlessly, and began to shout, “I am going to destroy this place if someone doesn’t see me NOW!” An aide talked him down and convinced him to take calming medication. And now I, eight hours later, two hundred pounds lighter, about a foot shorter, headed into the room where he lay napping to wake him up and perform a psychiatric evaluation.

“Mr. X?” I asked. Not loud enough. He kept snoring. I got louder. “Mr. X?” Still no response. I almost shouted in his ear, “MR. X?” So I did what any reasonable person would do with a large, formerly angry sleeping person: I asked the nurse on staff to wake him up for me. She prodded his shoulder (I inwardly winced). “Hey Mr. X. Can this young lady talk to you for a moment?” He nodded and got up. I led him to the evaluation room. He brought his blanket with him, slinging it up over his head so he looked like a heavily-muscled dementor. Once we got to the evaluation room and he sat down, he promptly fell asleep against the wall. I guess his calming meds were too calming. It took another two tries and more prodding (done by other nurses) to get him back to bed.

Then I called for collateral information. Standard procedure in psychiatric emergencies is to get a story from the patient as well as from family, friends, or whoever brought the patient in. That’s when I met his girlfriend. For over an hour, she talked about the years of this patient cycling in and out of drugs, jail, cheating, rape, and violence. She had first met him when she was overweight and insecure; he had been tall, handsome, and exciting. She told me how for years she gave him a place to stay and paid for his excesses, and how every few months he would blow up at her and slam her head against the wall or give her black eyes. “He comes from a dark, dark past. I understand him,” she told me. “But this time, he’s not coming back to my house from the hospital. You have to tell him he can’t live with me anymore.” When I pressed and asked why, she said that this week was her final straw. “He can threaten me and hurt me, and he can threaten to hurt himself, but this week he raised a hand at my daughter for the first time. I won’t allow him to hurt my daughter.” I asked my attending if the hospital was allowed to prohibit a patient from returning to his original address, but it wasn’t possible. I returned to the call. “Unfortunately ma’am, the only way to keep him from staying with you is to file an order of protection.” She paused for a long time. “I’ll have to think about it.”

And she was right to hesitate. The stats on orders of protection, or restraining orders, are awful. Analyses have shown that 40–60% of the time, the restraining order is violated. 21% of the time, a restraining order just intensifies the stakes of the situation, and provokes more violent retaliation. They’re difficult to enforce, and by the time they’re enforced, violence has already occurred. But there was no recourse I could give her.

The next patient I saw was a young girl, a middle-schooler who wanted to die because her best friend had told her to kill herself. She told me about pervasive bullying at school—someone had sent around nude pictures and said it was her, and all the boys of the eighth grade class were pestering her for sexual favors. She had blocked them all, more or less unruffled. She had been through much worse than that, she told me, with physical abuse from her parents as a kid, immigration troubles, and more. But her best friend, a boy she had grown up with through family crises and homelessness, had now turned on her as well, and was pressuring her the same way the other boys from school were. What’s more, in the last few years he had insulted her weight and appearance, had kicked her a few times, and manipulated her through cycles of treating her well and then threatening to commit suicide (or worse, call ICE on her family) if she stopped being his friend. All in all, not “best friend” behavior. She explained to me, “He’s always been such a good person. I remember when he was the only one who was nice to me in elementary school. He’s just going through a lot, and I’m his only friend.”

I spent a long time talking her through the reasons why she should stop being friends with him and focus on her good friends. She was strong, smart, and had a tight-knit group of girls who cared about her. It was her compassion that kept her loyal to her “best friend,” no matter what. As it turned out, everyone for the last few years, from her granddad to her therapist to her school counselor to me, knew that the boy was trouble (and troubled) and she should cut him off. We sent her home with her promise to stop talking to him, but I couldn’t shake the feeling that she had the chance to become a woman just like the one I called on the phone: strong, compassionate, loving, but for all those reasons, unable to escape the nightmarish cycle of abuse.

The next evening, I got a call back from the first woman. She wanted to let me know that the police were coming to serve her boyfriend with the restraining order—and to thank me for listening to her story. It wasn’t until she had laid it all out that she became clear about what she had to do.

At the end of the two weeks, I went home to Queens for the first time in a long time. After R fell asleep, I laid in bed listening to his quiet breaths, feeling how large the world was, and how many tragedies and miseries it held, and feeling grateful for having a calm in the storm.


The best part of evening shifts is walking home through the mostly empty hospital. Someone had hidden little baby Yodas all over the emergency department, and I found at least one new one every night. A radiology tech told me that it was an I-Spy activity for kids getting wheeled to their CAT scans or X-rays. If they were busy looking for baby Yodas, they didn’t get as anxious. Here are a few:



Earthen Only

False dichotomies, errant wordsmanship, slapdash musings.