Life Up Until Now and Later

I turned forty years old in August. Despite really never paying much attention to my birthday in past years this one seems to have had a subtle but appreciable effect on me. Perhaps it is just the number - 40 - that lends one to introspection. Perhaps it is because I realized that being a male in the United States I have less time left to live now than I have lived up until now based upon our 78.2 year expected life span. I think it is more a combination of a few life events though - the near-end of residency within view now which marks the end of a long road of medical training . . . my close friends now have children, most of them, and I see those children growing . . . some friends have traveled through divorces and pain. Everyone I know seems to be substantial now in some new indiscernible way and I too feel different.

When I think think back to my late teens and twenties I am aware of the fact that my life, up until now, has not truly been guided by intentional choices but perhaps more by reaction. When we are young things happen to us and intersections in life are navigated but I now feel it was based more on transitory emotional nudges and blind luck really. Such insignificant variables now seem responsible for such far reaching consequences as marriages, careers and regrets. I cannot claim I accidentally fell into medical school, it was a decision, but it really depends on how you frame it to truly decide if it was conscious choice or random chance. I was running a telescope and working as an astronomer in New Mexico in the late 1990's, trying to make a living after a failed foray into Philosophy, when my opportunity to become involved in medicine found me. I was still trying to untangle my love of science, art, philosophy and creativity while living within the simple natural beauty of the mountains around me when this "choice" found me. My twenties was a series of experimental careers and romances. I jumped from place to place, city to city, person to person hoping that I would find my fit, my career, my love, whatever. Running that telescope was merely a bid for more time while I tried to figure out my path in life. It was only after being badgered by a local EMT to join their rural volunteer department that I found something special, something that knit together several deep needs and talents within me and drove me to pursue medicine. Even after becoming obsessed with rural emergency medical care it was someone else who finally cornered me and said, "Noel... you seem to really like this and you seem smart enough. Why don't you go to medical school?" Why had it not even occurred to me? I did not make this decision, someone else had to hold it up in front of me for me to even recognize it. What if I had not been living in some remote mountain range doing the most obscure job ever? Would I even be in medicine now? Was it truly my decision or blind luck?


Most things in my life, up until now, were not conscious, informed decisions - I see that now. When framed from a distant viewpoint they look more like reactions & reflexes based on fears, hopes and incomplete understandings of the world. This is not something sad or disheartening but merely a canvas to contrast the way I see the next forty years of my life. There is a phrase I heard recently (often attributed to Abraham Lincoln or George Orwell) that resonated. In effect it says, "After the age of 40 every man gets the face he deserves." I imagine this to mean many years are needed before one develops the wisdom and experience to truly understand who they are, or at least obtain the beginnings of that understanding. I feel I am at such a point in my life finally. I am about to leave medical training an embark on a career and what I see as the last decisions of my life. The last large ones anyway. I have decided I am tired of traveling, looking, attempting & trying. I feel that I finally know myself, or at least enough to know that I want and need to stop looking outside because I have enough of what I need inside. It is an amazing, calming, unsettling place to be.


The two most important things to me when it comes to choosing where I will spend my remaining years are community and a sense of place. The first choice facing me as residency ends is location. I never imagined Sacramento as a final destination but merely a decent place to spend 3 years while I finish my medical training which is now coming to a close. My community has always been in Seattle ever since I moved there in 1991. Your close friends, the people that know you and care about you despite your many flaws, are invaluable. You go through so much together in those earlier years when you are all trying to find your life and love, years which will never be repeated - they are unique and transitory. The Pacific Northwest calls to me primarily for that reason, but secondarily because it provides the topography I love, a sense of place. Mountains, ocean, islands, snow and lush green summers. Yes, rain too. The only competitor up until now has been Maine. The location of my earliest community, the summer community that gave me a sense of place and home when I had none. The people are mostly gone now, grown up and in different locations around the country, but the island still feels like home to me - Islesboro. The entire state really. The choice sounds simple, but it is not, especially with the new perspectives I just discussed. In my forties now I feel that I understand the true meaning of these decisions. I will not be merely just "looking for a job" after residency, but planning my community and the environment which will shape me and possibly my children in the years to come. It is about building the memory of years I have not yet lived but that I will reflect upon later in my life. These decisions will provide the raw materials that will make up the man I will be when my years run out and determine if I will, at that time, be satisfied and proud of what I have done. Despite sounding dark or burdensome it is actually quite inspiring and uplifting. I now have the knowledge and wisdom to make my choices with the understanding of the impacts they can engender rather than the haphazard ways of my younger years, usually based on immediate impulse or fantasy. I look forward to my life from this point forward. I feel as if I have finally arrived at the age I have always felt inside but never really understood. I comfortable in my own skin, which does not always mean satisfied, but comfortable. I am wearing the face that I have earned.