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V S Uma

SELFLESS PURSUITS 🧑‍⚕️🩺👩‍⚕️🥼👨‍⚕️🩻

Daily writing prompt…

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7 days ago · 30 likes · 32 comments · V S Uma

From V S Uma:

Daily writing prompt

What profession do you admire the most ??

I came across this prompt in Wordpress. It was interesting to write my thoughts on the same.

I respect all the professions in this world. Can we name a profession where it is easy to work with ? None of the profession is easy to work. Each and every profession has its own advantages and disadvantages too.

As a student, to be sure about deciding the profession we want to choose to pursue further to pave an accomplished career is in itself a task.

I have respect for all working professionals in this world. Here,I choose to write a few lines about a profession which I feel is truly selfless.

According to me the profession which I admire the most is that of a “DOCTOR”. There are many reasons to say why I hold this profession on high regard.

This journey begins the moment a student decides to pursue medicine. Becoming a doctor requires immense perseverance, grit ,patience and high levels of tolerance among many other qualities. These traits are not to be adopted, for a short period of time, but, has to be deeply adhered to through out their life. There is no definite end point to doctor’s journey, learning never ceases and neither their commitment to providing care to the patients of all ages.

I always had an immense respect for doctors, but there was a particular experience which deepened my admiration to even further.

A close friend of mine had a fall which resulted in ligament tear in her knees. I accompanied her during her consultations with the doctor which gave an opportunity to see a doctor’s routine from close quarters.

What began as initial consultations soon led to series of tests, including a MRI eventually surgery . During this journey, I realised that it is not only one doctor but an entire whole team work tirelessly behind the scenes. Doctors , nurses , lab technicians, Physiotherapists, and ward cleaning staff contribute with dedication and lots of patience at various stages of treatment

It is true that it is a doctor who is highly skilled in their department earns a recognition and builds a strong reputation. However, what truly defines a doctor is his humility and empathy. They cannot afford to be arrogant or dismissive, instead they must listen to their patients with genuine care and understanding .

Every branch of the medicine holds its own significance, as each and every part of Human body is important. Whether it is a gynaecologist, Paediatrician, Neurologist, Endocrinologist, Dermatologist, Dentists, Cardiologist, General Physician, Orthopaedics. Oncologist each plays a vital role in maintaining and restoring health. Surgeons, in particular, perform complex procedures with remarkable precision, confidence, and calmness, ensuring successful outcomes.

We also cannot forget and ignore the COVID era, when the world was gripped by an unprecedented situation. During that time, doctors and health workers, stood at forefront working relentlessly 24X7 despite the risk and uncertainties.

I could go on sharing many more instances that make this profession my most admired one. However, I hope I have been able to convey my thoughts clearly and help readers understand the deep sense of respect I hold for doctors and the entire medical fraternity.

The popular saying, ‘A doctor is a messenger of God, have faith in them, and the rest will be taken care of,’ truly holds meaning, doesn’t it? I hope many would agree with this sentiment.”

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First, V S Uma—thank you for inviting me into your space. It’s an honor to contribute to a platform that reflects so much thoughtfulness and care.

When I chose to co-author this piece it was because, I think we arrive at meaning from different directions, but we’re ultimately exploring the same thing: what it means to really be present in your life. There’s something powerful about placing those perspectives side by side. That being said, I wasn’t expecting such a kind and uplifting opening to the piece.

You described medicine as selfless, and I understand why it looks that way from the outside. But the truth is, it’s not as selfless as it seems. There is meaning in this work—deep, grounding meaning—and I think many of us are drawn to it because of what it gives back to us, too. Not in recognition or praise, but in purpose.

You asked me to write about how being a doctor has contributed to a patient’s life. I’ll be honest—I don’t always get to see the fruits of my labor, so to speak. In the same way cleaning out a closet gets worse before it gets better, many of my sickest patients look worse before they improve. I’m placing breathing tubes, chest tubes, and other various tubes, hoping it all does its job so someone else can remove them later.

Most of my sickest patients won’t remember me specifically. They might remember the ICU doctor who removed the breathing tube, or feel grateful to the person who took out the Foley (and honestly, I’d probably feel the same way). But the patients who are truly the sickest—the ones where I’m using everything I’ve trained for to bring them back from the brink of death—I very often don’t see them again. They don’t remember me. They don’t come back with some grand gesture of thanks. And the truth is, I don’t think I need that.

I have plenty of patients each day who aren’t critically ill—patients who are kind, who say thank you, who sometimes even send food (always a staff favorite). But the sickest ones, the ones who take the most out of you, I don’t hear from. Instead, I find myself chart-checking them—opening their charts days or weeks later just to see what happened. Sometimes they’ve been transferred, and their outcomes are lost to me. Sometimes the documentation is there, but it’s hard to fully understand who they were by the time they left.

Recently, I had a 50-year-old man brought in by EMS, unresponsive, with his wife and daughter at home. He was incredibly sick. As we were getting him on the monitor and starting an IV, he coded (as in his heart stopped beating). We started CPR and brought him back to life. We stabilized him enough to get a CT scan, but while in the scanner, he coded again. We brought him back again. The scan showed a massive pulmonary embolism (blood clot in the lung blocking air from getting in and out the way it should when we breath). Back in the room, as we pushed a life-saving medication, he coded for a third time.

Three times his heart stopped in the ER, and three times we brought him back.

The medication broke up the clot and saved his life. He spent time in the ICU but was eventually discharged with a full recovery—back to his life, his family, everything as it was (maybe just a little more aware of how fragile it all is).

I never heard from him. But one of the ICU nurses told an ER nurse, who told me.

And that’s usually how it goes.

So yes, I do contribute to my patients’ lives—but often in ways that are invisible, fleeting, and unrecognised . I am a small part of a much larger story, stepping in at a moment of crisis and then stepping out just as quickly.

And maybe that’s the part that feels selfless from the outside.

But from where I stand, it feels more like being allowed into the most critical chapters of someone’s life—trusted, for a moment, with something that matters deeply—and then letting it go.

And there is something profoundly meaningful in that.

Not because I am remembered.

But because, somewhere out there, someone is still living their life—and I got to be a small part of why. It is a privilege and it gives my life great purpose. And in that way it is, perhaps, not as selfless as it seems.

If this piece resonated with you even a little, please consider leaving a comment and subscribing to my page. It truly does mean the world to me. Thank you all for being here to the end.

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I can’t explain how I connect with people on Substack in ways that I almost never do in the world. We like each other’s work and have a similar drive, compassion, and sense of humor. I dive deeper, and everyone I feel this way about is a little bit like me. They are not like me, as they come from different places and have different characteristics and wildly different stories. After 10 sentences of conversation with these new connections, I learn why we are drawn to each other. We’ve been through something. We have a depth that only comes from having lived through something that pushed us past our limit. We became something else to get through it. Our soul was scarred from keeping us together when all of our systems signaled alarm at the same time. We got through it. We learned more than we ever should have. We learned to make peace with this knowledge so we could sleep at night. Getting through that thing pushed us in different directions. Our lives were shattered, then pieced back together. We have this connection between us because we have been to the same place. Overload. And the only other thing we may have in common is that we are both still here, and we are taking life one breath at a time.

I don’t evaluate people the way most people do. I admire an author I met in person recently, who retired from financial planning to focus on green living and teaching people how to create food from their land. Out of the group of my friends that went to engineering school together, one of us quit his corporate job already to be an entrepreneur. What an incredibly scary move to leave the comfort of corporate America to do something on his own, especially with a family and the cost of private health insurance. One of his businesses now makes multiples of his previous engineer salary in annual revenue, and another of his businesses is committed to removing microplastics from people’s insides. I admire a unique blend of qualities and skills over their list of accomplishments, and I’ve added additional criteria. What are they doing for others? All of the authors in this series are people who have survived something, succeeded in something, realized there isn’t an exact place for them, and are now trying to create something of their own, while still giving something back to the world.

I admired Dr. Landon Eggleston long before she reached out to me a few weeks ago to guest author in her weekly series The Art of Staying. I am featured in part 4 of Dr. Eggleston’s Clear View series, and the link to that article is here.

Dr. Landon Eggleston is an ER doctor in Chicago. Her title already has my respect. When I first subscribed to her Substack, I expected medical notes, wellness tips, and emergency room stories. Of course, she is full of this knowledge and has these stories, but she is also writing about appreciating life, being present, learning resiliency, and how to align with your purpose.

To be a medical doctor and find time to write, and more specifically, to write in a way that is fully serving others, is not a skillset; it’s a gift. Dr. Eggleston knows that life is precious, that our time here is short and valuable, and that having a clear view is imperative. She offers a unique perspective and one that I am honored to share with you today.

Dr. Landon Eggleston,

Welcome to Through the Meat Grinder.

1. Describe a time that the world has ground you into pieces, and putting yourself back together helped you become who you are today?

In reality the world has done this to me more than just once. Medical training alone feels designed to break you down and rebuild you. But the first time I think matters the most, because it’s the moment you learn you can survive something like that—and once you know that, you carry it with you.

When I was 18, I lost my brother to a drug overdose. We had struggled with his addiction for years, and we thought he had overcome it. He had been sober for eight months before the day I found him in his apartment.

Six months later, I left for college.

Looking back, it felt like a cruel kind of timing—being pulled away from my family in the middle of that grief. But at the time, I didn’t want to delay my education for what I told myself was “no reason.” I remember being surrounded by people my age who were so excited to be starting this new chapter, and it felt like a sick joke. I cried myself to sleep most nights, quietly, so I wouldn’t wake my roommate.

Those first two years of undergrad were some of the hardest years of my life. I was learning how to live in a world without my brother. I was separated from a family system that had been deeply ingrained in me, and beginning to recognize just how toxic some of those dynamics were. At the same time, I was being exposed to new people, new experiences, and new ways of thinking—things I was completely unprepared for, having grown up in a conservative Christian household in Texas. There was a lot of shame tied into that, and I didn’t yet have the tools to process it.

2. What has helped?
That time in my life was a period of breaking and rebuilding, over and over again.

It was also the time I found some of the most important things in my life.

I learned what real friendship looked like. I met people I still love deeply today. I walked into my first hot yoga class and found a practice that saved my life (more than any ER doctor ever could) in that it taught me how to reconnect with my body that I had become accustomed to disassociating from. As a health and exercise science major, I spent countless hours in the gym, learning how to take care of the vessel that carried me and understanding what food actually nourished my body from the inside out. I learned—through trial and error—that alcohol was never something that worked for me no matter how much or how little I drank of it. I was in the honors college, which meant I constantly had my nose in a book trying to keep up with the endless reading assignments, always expanding my worldview.

And for the first time, I started to understand that I had a choice in how I lived my life. I was able to pull away from the passivity with which I had grown up with. The lack of control I felt with my brother’s addiction and my parents’ lack of emotional intelligence was no longer at the forefront of my experience. I was gaining a different perspective by simply exploring what existed in the world outside of what I knew. I think I was lucky in that the specific things I was experiencing— my major, the readings I was assigned, the specific friends I met— happened to be healthier alternatives to what I knew. I wonder if any of those specific experiences had been different, if I would have found myself down a different path. But I knew enough to know that I wouldn’t allow alcohol to be a crutch for my grief. So maybe not.

I think in reality what helped was just getting out in the world and experiencing new things, because it allowed me to come back into my body and learn how to be intentional about what works and what doesn’t. It showed me that the world has so much to offer if I was just brave enough to get out there and try it. I learned that the bubble that I grew up in was not the only space in the world.

3. What hasn’t?

It took me a long time to untangle myself from my family. When those dynamics are so deeply wired into you, it’s not something you just walk away from. I should have been able to lean on them during that time, but instead, I found that they were leaning on me—even from a distance. I began to see how the roles had at some point in my life reversed, how my parents had become the ones depending on me, and I had to learn how to step out of that. It was a painful realization to want to find solace in people who were never truly available to find solace in.

At the same time, being away from my sister was incredibly painful. I had to learn how to set boundaries with my parents while still being intentional about maintaining the relationship with my sister. We needed each other desperately at that time. It felt as if she was the only other person in the world who could understand what we had been through.

I also entered college in a long-term relationship, and I stayed in it longer than I should have. Part of me was afraid that if I left, I would lose the last person who had known my brother. I would never again date a man who had the privilege of knowing my brother. That piece of who I was would be missed by anyone who came into my life after he had gone. When I finally ended it, I moved through a series of unhealthy relationships, largely because I didn’t yet have a strong sense of self-worth. I thought being in a relationship solved something—but it didn’t. If anything, it only ever created more problems.

I avoided drugs because of my family’s history, but I still drank. And even then, I never built a tolerance—I was always a lightweight. News flash— alcohol, in fact, did not fix anything. I know, I know. I am sure every intentional human here on Substack is surprised by that.

Yeah, there were a lot of hurdles that felt like they set me back from my healing. But when I look back on it now I think it was all a part of the learning. I was learning to stand on my own two feet and realizing for the first time that I was actually capable of that. I didn’t need my parents or a romantic relationship to keep me afloat. As much as I would have benefited from more time with my sister and as healing as that relationship was, I also didn’t need that. What I needed, and what I realized through the lack of other options, was to show up for myself.

4. What is one thing you’d like everyone to know so they will be more prepared when the world grinds them into pieces?

Here’s the thing—the world ground me into pieces when I lost my brother. I suffered from PTSD for years after finding him like that. And while I picked up some bad habits along the way, I also built good ones—habits that are still part of my life today.

More than anything, I just kept showing up.

I would try something, realize it didn’t feel right, and eventually let it go. It was constant trial and error. It still is. At first, everything felt impossible. But I stayed with it. And after those first couple of years, I realized something important: if I could survive that, I could survive anything. And I have.

Bad relationships, long hours in medical training, moving across the country—I’ve faced all of it with the same underlying belief that I will make it through. That I will land on my own two feet.

When you show up for yourself over and over again, you start to understand your own resilience. I never thought I could survive something like that— and then I did.

Kintsugi—the ancient Japanese art of repairing broken pottery with gold—feels like the closest metaphor. The breaks aren’t hidden; they’re highlighted. They become part of the story, part of the beauty. Cris informed me he actually has a piece on this beautiful practice too (how’s that for the connection he was talking about at the beginning of this article), check it out here. And I’ll leave you with this:

“Ring the bells that still can ring

Forget your perfect offering

There is a crack, a crack in everything

That’s how the light gets in.”

– Leonard Cohen, Anthem

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Thank you Cris for allowing me into your space and the opportunity to be the very first contributor to this lovely series. Through The Meat Grinder captures something honest about the human experience—how we move through difficulty, how we make meaning from it, how we keep showing up anyway. That’s something I care deeply about in my own work, and it means a lot to be a part of that conversation alongside you. I have greatly enjoyed following along with your work and look forward to seeing more of this series as it continues! And a final thank you to everyone who took the time to read this piece to the end. Grateful for you all as well. If this piece resonated with you at all, please take a moment to leave a comment and subscribe. These small points of connection with other humans on this planet mean the world to me.

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Mentally Mosaic

People Pleasing and the Cost of Belonging

Belonging is one of the deepest human desires. It shapes how we show up in relationships, in conversations, and even in the quiet decisions no one else sees. We all want to feel accepted, understood, and part of something that feels real. There is nothing weak about that need. It is what makes us human…

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18 days ago · 61 likes · 24 comments · Muhammad Faris Khan, Mick, Shah Huzaifa, Dr. Landon Eggleston, V S Uma, Florence Acosta, Chandana Polanki, Vinayak Ramesh, Data Frank, Nishtha, Marie-Christine Oliver, Kyle Gilboy, and Patrick LaRose

Mentally Mosaic

Redefining Success on Your Own Terms

We grow up inheriting a definition of success long before we ever question it…

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2 months ago · 52 likes · 33 comments · Shah Huzaifa, Willemijn, Dr. Landon Eggleston, Danilo Giulio Rosso, Data Frank, Nishtha, Marie-Christine Oliver, Mick, Dido Torchi, Melinda Lloyd, Dr. Deonne Johnson, Florence Acosta, Evergreen Essence Forest, V S Uma, Piyush Achhda, Mansi, The Breathful Way, and Vinayak Ramesh

Mentally Mosaic

Your Opinion Is The Only One That Matters

We live in a world filled with voices. Advice, criticism, expectations, and judgments flow toward us from every direction. Some come from people who care about us. Others come from strangers, cultural norms, or invisible pressures we barely notice but constantly feel. Over time, these voices can become so loud that our own voice fades into the backgroun…

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2 months ago · 75 likes · 28 comments · Shah Huzaifa, Dr. Deonne Johnson, Catherine Durkin, Josh Woll, Kyle Gilboy, Dr. Landon Eggleston, Melinda Lloyd, Mick, Ibtesam, Stacey, Psalmora, Marie-Christine Oliver, Florence Acosta, Mansi, V S Uma, and Chandana Polanki

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Matthias Biehl

The place where you don't have to belong to belong

Today I am thrilled to share the space of Designing Connection with a fellow Substack writer that I hold great respect for: Dr. Landon Eggleston…

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14 days ago · 25 likes · 18 comments · Matthias Biehl and Dr. Landon Eggleston

Today I am thrilled to share the space of Designing Connection with a fellow Substack writer that I hold great respect for: Dr. Landon Eggleston.

She has been in my dear circle of writers for a while, so this is a wonderful treat. Please welcome her warmly and enjoy as she shares how the emergency room and belonging go together naturally.

People assume that I went into the ER because I’m drawn to the drama and chaos of it all. Maybe in some ways that’s true. I do think my upbringing and the trauma I experienced as a child made environments like a shift in the ER feel familiar—like a version of home. There’s a part of me that understood how to function in that kind of energy without needing to be taught. And if I’m being honest, a piece of me resents that that’s even partially true. Because now, after spending so much time healing my inner child, I can see with clarity how much that chaotic energy interrupts the peace I work so hard to create outside of work. So yes, maybe that played a role in the decision—but it was never the whole truth.

The bigger truth is that I fell in love with how inclusive the ER is. I loved that anyone and any situation could show up at any time. I loved that patients couldn’t be turned away and that we would treat anyone regardless of whether they could pay or not. I loved the diversity of patients that would come through the door—how that diversity shifted depending on the neighborhood the department was in, not the building itself. As if the community surrounding the building crafted the culture instead of the other way around.

When I was in undergrad, still trying to figure out what I wanted to do with my life, I took a job as a medical scribe in the ER. I shadowed physicians and documented their patient encounters, which gave me the unique privilege of being in the room while people shared some of the most vulnerable moments of their lives. Even as a young and very naive undergraduate, I recognized how much of a privilege that was.

I was drawn in by how unique every person’s story was, but also how similar they all felt at the same time. Different lives, different circumstances, different paths that led them into that room—but underneath it all, the same human need to be seen, to be understood, to be helped.

I remember my first encounter with a patient in a psychiatric crisis, in full delusional psychosis. At that point in my life, I told myself I couldn’t have been further from that experience. There were no obvious similarities between us. And yet, when I looked at them, I saw the same humanity in their eyes. Not their story, not their behavior—but something deeper that felt familiar. I felt with a deep sense of fear in my gut how close the line was between where I was and where they were. It felt real and tangible and like I could slip off the edge at any moment.

That moment stayed with me.

Maybe I would have gone into a different specialty if I had spent more time somewhere else, but this was what drew me in. And when it came time to decide years later, I never seriously considered changing course.

Now, years into practicing, I still see that same thread running through the work. The ER is chaotic. It’s imperfect. It’s stretched thin in ways that can feel unsustainable. But it is also one of the last places where belonging is not something you have to earn. You don’t have to prove anything to be there. You don’t have to fit a mold. You don’t have to have the “right” kind of problem. You just have to show up, and we will meet you there.

And I think there’s something we can learn from that.

Not because the ER is perfect—it’s not. Every person who works there brings their own biases. Doctors, nurses, techs, administrators—we are all human, shaped by our experiences, our assumptions, and our limitations. The ER is not exempt from that.

But the structure of it is different.

The laws that govern it don’t allow us to turn people away. They don’t allow us to decide who is worthy of care and who is not. No matter who walks through the door, we are required to meet them where they are. (But I mean, don’t show up and be an asshole). And because of that, it creates something rare—a space where, despite all of our imperfections, access is not conditional.

A space where belonging isn’t something you have to earn.

And maybe that’s the lesson. Not that we can eliminate bias entirely—we can’t. But that we can build systems, environments, and communities that don’t rely on individual judgment to determine who gets to belong. Spaces that are designed, at their core, to include rather than exclude.

The ER does this imperfectly, but it does it consistently.

And in a world where so many doors require you to prove yourself first, there is something deeply beautiful about a place that simply says: you’re here, so we will care for you.

Thank you, Matthias Biehl for the opportunity to connect with your beautiful community. It has been so lovely collaborating with you. And to all of his subscriber base, thank you for reading and please keep your eyes out for his contribution to my ‘The Art of Staying’ Series coming in the next several weeks. You won’t want to miss it.

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Monica A Leyva

Between Intent and Infrastructure

Framing the Perspective…

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15 days ago · 39 likes · 47 comments · Monica A Leyva and Dr. Landon Eggleston

Framing the Perspective

What follows is not a single perspective, but a layered one.

Each section is examined through both a systems lens and a clinical lens.

The systems lens reflects the perspective of Monica A. Leyva.

The clinical lens reflects the perspective of Dr. Landon Eggleston.

Core Thesis

Despite growing public narratives that Western medicine prioritizes profit over people, both frontline clinicians and healthcare administrators largely operate with patient well-being as a central intent.

The disconnect arises not from a lack of care, but from structural constraints, competing incentives, and system design that shape how that care is delivered and experienced.

I. The Narrative We Are Up Against

Healthcare is increasingly described through a narrow set of critiques.

It is called profit-driven.

It is described as impersonal.

Clinicians are seen as rushed.

Administrators are viewed as prioritizing margins over people.

These perceptions do not emerge in isolation. They are grounded in real experiences where patients feel unseen, clinicians feel constrained, and systems appear unresponsive.

This piece does not attempt to dismiss those experiences. It examines the conditions that produce them.

II. Frontline Perspective (Clinical)

No one enters medicine to optimize margins. We enter to relieve suffering. What changes over time is not that intent—it’s the conditions under which that intent has to operate.

On paper, care looks linear. A patient presents, we evaluate, we treat. In reality, it rarely feels that way.

I can be sitting at a bedside explaining something serious—sometimes life-altering—while a nurse is sticking her head in the door because another patient is actively decompensating down the hall. I’m making eye contact, trying to be fully present, while part of my mind is already being pulled somewhere else. Not because I want to leave, but because I know I will have to.

That tension is constant.

Time is one of the most visible constraints, but it’s not just about minutes. It’s about fragmentation. Care is delivered in pieces—interrupted, reprioritized, reshaped by what walks through the door next.

The desire to slow down does not go away. It has to compete.

There is also a significant amount of emotional labor that isn’t seen. In a single shift, I might tell one family their loved one is dying, reassure another that their child is going to be okay, and then walk into the next room to address something comparatively minor.

There is no transition time between those moments.

Clinical decision-making is often framed as precise, but much of it happens under uncertainty. We rarely have complete information. We make decisions based on probabilities, patterns, and experience—knowing that we won’t always be right.

Patients are sometimes discharged not because nothing could be wrong, but because the balance of risk and resources requires it.

That’s where moral distress starts to show up.

There are times when I know what would be ideal for a patient—more time, more resources, closer follow-up—but those options don’t always exist.

The decisions we make are often the best available, not the best possible.

Patients see the minutes I spend in the room. They don’t see the time spent reviewing their chart, coordinating with consultants, or carrying the cognitive load of multiple patients at once.

From the outside, it can look rushed.

From the inside, it often feels like trying to do right by each person within a system that doesn’t always allow it.

The intent to care doesn’t disappear.

But it does have to adapt.

III. Administrative Perspective (Systems)

Healthcare systems are often evaluated through the outcomes they produce in individual encounters. Less frequently are they examined through the conditions required to sustain those encounters across populations, time, and constraint.

At the administrative level, decisions are made within a landscape defined by competing priorities.

Resources are finite. Demand is not.

This introduces tradeoffs that are rarely visible at the point of care. Time allocated to one patient must be balanced against access for another.

What appears as restriction in one context is often the result of redistribution in another.

Efficiency, in this environment, is frequently misunderstood.

It is interpreted as detachment or indifference when it is more accurately a response to constraint.

Systems are designed to move care across populations in ways that remain sustainable.

That design can compress time, standardize processes, and limit flexibility in individual encounters.

The system is often described as impersonal.

In reality, it is structured.

Infrastructure does not remove humanity.

It redistributes how and where it can be expressed.

IV. Where the Disconnect Happens

1. Language Misalignment

Healthcare operates through layered vocabularies that describe the same work from different vantage points.

Terms such as throughput, utilization, and capacity describe system performance. At the clinical level, the same work is experienced as time, attention, and care.

The language diverges, even when the goal remains aligned.

This misalignment creates friction.

What is intended as a measure of access can be perceived as a reduction of presence.

Without translation, alignment in intent becomes difficult to recognize in practice.

The language we use to describe problems can actually shape how those problems are addressed.

For example, patients want shorter wait times, so we talk about improving “throughput.” On the surface, that sounds like efficiency—but it doesn’t increase the number of providers available.

In practice, it often means the same providers are expected to move faster.

Once something becomes a metric, it becomes a priority.

And every priority introduces a tradeoff.

2. Incentive Structures

Healthcare systems are shaped by the incentives embedded within them.

Payment models, quality metrics, and reporting requirements influence how care is delivered.

These structures do not eliminate care. They shape its expression.

There are ER models that incentivize higher volumes or more procedures. These are widely known to contribute to burnout.

Most ER physicians, however, are paid a salary that does not meaningfully change based on how many patients they see.

We are not paid more for moving faster.

If anything, most physicians would prefer to slow down.

3. Visibility Gaps

Patients encounter healthcare in moments. A visit, a conversation, a decision.

Those moments carry the full weight of the experience.

Clinicians operate within those moments while navigating constraints beyond them. Administrators operate at the level of patterns across populations.

Each perspective is valid. Each is incomplete.

I don’t see the system from a distance. I see it one patient interaction at a time.

Patterns emerge, but they remain limited to what is visible in front of me.

Patient feedback exists, but it is incomplete and often skewed toward negative experiences.

Even our feedback loops are partial.

What something looks like up close and what it looks like at scale are not the same thing.

4. Burden Shifting

When systems are under strain, work does not disappear.

It moves.

Tasks shift across roles, often concentrating at the point of care or extending into the patient experience.

The cumulative effect is felt as fatigue, delay, and fragmentation.

A significant portion of emergency medicine functions as a catch-all for system failures.

When patients cannot access care elsewhere, they come to the ER.

At the same time, expectations continue to expand.

We are expected to move faster and be more present at the same time.

It is an impossible balance.

We cannot do it all.

V. The Profit Question

Healthcare exists within an economic structure. Financial sustainability is required.

Profit is often structural rather than personal.

Many clinicians and administrators operate with patient well-being as a central priority, even within these constraints.

The presence of profit does not mean the absence of care.

There is a misconception that physicians personally profit from the system.

In reality, most are salaried and do not earn more by ordering more tests.

Decisions are made out of concern, not financial gain.

This misunderstanding shapes how patients interpret care.

VI. Rehumanizing the System

If the disconnect is structural, the response must also be structural.

Rehumanizing healthcare requires designing systems that allow human intent to be expressed more clearly.

Alignment is the starting point.

Infrastructure must support the relationships at the center of care.

No single perspective is sufficient on its own.

Patients want shorter wait times and more time with their physician.

They want lower costs and every possible answer.

These goals do not always coexist.

Every improvement carries a tradeoff.

VII. Closing: Holding Both Truths

Healthcare is often discussed in absolutes.

It is neither fully broken nor fully whole.

It is possible for care to be deeply human at the individual level while constrained at the system level.

Both of these truths exist at the same time.

From the clinical perspective, the intent to care remains.

But it exists within a system that requires speed, volume, and constant adjustment.

What can look like indifference is often the result of constraint.

We are doing the best we can within the conditions that exist.

Progress does not come from choosing one perspective over the other.

It comes from understanding both clearly enough to redesign what sits between them.

“If you’re walking down the right path and you’re willing to keep walking, eventually you’ll make progress.“ Barack Obama

Added to the collection on my website so you can find everything in one place—but you can read the original post here:

LIFE INSIDE MY MIND

Science Meets Sanctuary

Seven years ago, the Emergency Room was the only place I felt safe when my mind became too loud. I was a regular face behind those sliding doors, convinced my body was failing me, only to be told my vitals were perfect. Today, life looks very different. I’ve traded the panic of the E.R. for a life of sobriety, meditation, and presence…

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a month ago · 45 likes · 50 comments · Dr. Landon Eggleston and Life Inside My Mind

Seven years ago, the Emergency Room was the only place I felt safe when my mind became too loud. I was a regular face behind those sliding doors, convinced my body was failing me, only to be told my vitals were perfect. Today, life looks very different. I’ve traded the panic of the E.R. for a life of sobriety, meditation, and presence.

That’s why I am so honored to host my very first guest author, Dr. Landon Eggleston. As an E.R. doctor and the creator of Clear Viewpublication, she sits on the other side of the curtain I used to hide behind. In this piece, I’m asking her the questions I wish I understood back then, bridging the gap between the patient’s terror and the doctor’s truth.

Before we dive into our Q&A, I want to introduce you to the voice behind the answers. Dr. Landon Eggleston is an Emergency Medicine physician who spends her days (and often her nights) navigating the thin line between physical crisis and mental exhaustion. Beyond the stethoscope, she is a writer and advocate for mindfulness in medicine. Her Substack series, The Art of Staying, explores how we can remain present and grounded even when the world or our own internal chemistry feels urgent. She brings a rare, compassionate lens to the internal storms we discuss here, offering a bridge between clinical safety and emotional peace.

The Spotlight Interview: A Conversation with Dr. Landon Eggleston

1. The Silent Language of Anxiety

“When you walk into a room, what are the subtle signs you look for that tells you a patient is experiencing a high-level anxiety event rather than a physical injury?”

When I first walk into a room and look at a patient, what I register first is the gut instinct intuition that my many years of medical training (endless hours immersed in the human condition) taught me. Then there are the other signs— what do their vitals look like on the monitor? Anxious people tend to have very high heart rates and respiratory rates. They are breathing faster, which is triggering their sympathetic nervous system and putting them in fight or flight mode.

The nature of their symptoms is the next indicator. People with anxiety, and specifically those in panic attacks, will experience numbness and tingling, typically in their fingers/hands and around their mouths. They may also have palpitations, chest pain, shortness of breath, lightheadedness, nausea, and a sense of impending doom. And the final piece of this is perhaps the most dead giveaway. The patient will oftentimes straight up tell me, “I think this is a panic attack.”

Now, there are plenty of people who may not know this— perhaps they are in denial, have not yet come to terms with their diagnosis, or are so out of touch with their nervous systems that they do not recognize the level of anxiety they carry with them daily. Maybe it is the first time they have ever experienced such an episode. But probably 50% of the time, a patient will hand the answer to me on a silver platter. No expertise of mine required, they have already done my job for me.

But they aren’t necessarily there for the diagnosis; a lot of times, they are there to make sure they are not, in fact, dying. Because panic attacks can feel just like that. I cannot tell you the countless number of cardiac workups I have done on patients I knew had anxiety. The reality is, I may know exactly what is going on because I have had so many hours and years of training that I have trained my gut to instantly recognize what I am seeing, but my patients don’t have that. The cardiac workup is for them, not me. It’s so that they can rest assured that their heart is one less thing they have to worry about.

2. Redesigning the Chaos

“Emergency Rooms are notoriously loud and chaotic, the opposite of a sanctuary. What is one thing you wish the E.R. environment does differently to better support those in the middle of a mental health crisis?”

Yes, this is very true— ERs are very chaotic. Much too chaotic to be appropriate for our patients with anxiety. In an ideal world, we would have separate areas designed specifically for mental health crises. The ERs I have seen this done in are (no surprise here) affluent areas with a vast amount of resources. These hospitals have a designated section of the ER that is entirely closed off from the rest of the department. It is a group of beds kept open specifically for patients in mental health crisis and in an isolated area where we can quickly respond to any stimuli that may impact this safe space. There is a unique sense of camaraderie in knowing that the people next door to you are also struggling with their mental health. Having a specific section of space for this also signals to patients that we are prepared for this.

Unfortunately, we do not have enough ERs built like this, although I have hope that as the mental health crisis continues, the need for these areas will become more commonplace. In the meantime, I will keep doing my best to place these patients in an area that is slightly isolated from the main chaos of the ER, ensure they have staff available as needed, and try to reduce the stimuli they are experiencing (beeping monitors, people coming in and out of the room, etc).

3. Debunking the Difficult Label

“What is the biggest myth you’d like to debunk about how E.R. doctors view patients who come in with severe anxiety?”

This could be a whole article in itself, but I will try to keep this as brief as possible:

I think people are aware that a mental health crisis exists. I think people know that patients show up to the ER all the time in these states. I think that people THINK that we are annoyed by these patients, which, if I’m being honest, is probably directly related to how some of my cohort interact with this patient population. If you come to the ER with anxiety and you feel like your doctor was a bit dismissive of your feelings, you are probably entirely right.

Firstly- what I think is communicated poorly is that, we as physicians do not intend to be dismissive of YOU. We are frustrated with the SYSTEM. We know that patients experiencing a mental health crisis deserve better than to be in the ER. We are frustrated that we don’t have more control over the environment you interact with when you come in. We are frustrated that we don’t have more resources to give you. We are frustrated because we can’t fix the problem for you and take away your anxiety with a magic pill (although Benzos are somewhat magical). I know my colleagues mean well. Truly. And yet I know we are still missing the mark here.

Physicians want to help people and use their training for good. When you give them a patient with anxiety, they feel deep down that they are actually (probably) only contributing to worsening your condition by keeping you in the ER in the first place. They feel like offering you a cardiac workup is a waste of time because they know it’s not cardiac and yet they don’t know what else to offer you. Their internal system is registering that they are not doing good enough of a job for YOU.

Which brings me to the biggest issue here- that we as physicians do not get enough training in the art of communication. We get very little formal training at all, actually. Mainly only on how to break bad news. Otherwise communication is all learned through experience within our own interactions with patients as we go through the process. But that doesn’t make us good communicators. We have to work to build that skill outside of medicine in order to be good at it, and, well, too many of my counterparts just don’t do that. And so, instead of hearing them honestly relaying our frustration in the system, what you will actually more likely see is dismissive nature. They will leave the room too quickly, they won’t give you time you need to speak, they may tell you a cardiac workup isn’t necessary (I think they don’t give enough credit to the fact that a cardiac workup gives people peace of mind). What their actions are really speaking to is a deeper insecurity about not having enough to offer you. This by default registers as a failure in any physician’s mind.

So that feeling of dismissiveness you feel with your doctor— yeah, I’m not going to gaslight you, that is probably very accurate. They want to do right by you but they lack the communication skills necessary to have an honest discussion about it. I am not going to defend it. It is an area we need to improve on, that’s the honest truth. But know that it comes from a place of frustration that we can’t offer you more, because we know that you deserve it.

4. A Whisper to the Waiting Room

“If you could whisper one truth to every person sitting in an ER waiting room right now, feeling terrified and captivated by their anxiety, what would it be?"

I know you’re terrified right now. What you are feeling is real. I am not going to diminish that. I’m actually quite curious how people go through this world without feeling anxious. There is a lot to be anxious about.

I am going to be upfront with you. I do not have the resources that you deserve to help you through this, and I cannot fix this for you. But here’s what I can do. I can make sure that this isn’t something directly related to your physical health. I can give you peace of mind that you are not dying, even though it feels like it. I can give you the resources that we do have.

I will sit with you for a moment and hear you, because you deserve to be seen and heard. And I will empower you to keep fighting this. Because I know you can overcome this. I know you can find peace in your life, and I want you to know that you are capable of and deserving of that too.

A reminder for your internal storm: You are seen, even in the chaos.

5. The Practice of Presence

“Your series is entitled The Art of Staying. In the high-pressure, high-speed environment of the Emergency Room, how do you personally practice presence? Is there a ritual or a mental anchor you use to stay grounded when everything around you is urgent?”

We have this saying in emergency medicine: “Go slow to go fast.” Our jobs demand that we move very quickly—so much so that it is easy to move so quickly that you get ahead of yourself. We as humans are only designed to move so fast. Our brains can only process information so rapidly. Our training teaches us how to think on our feet and roll with the punches, but at the end of the day, we are only human and our training only takes us so far.

So “go slow to go fast” is a reminder that in order to move quickly, we do still have to move with intention. If you walk into a patient room and speed through questions without slowing down, and then get back to your computer only to realize you missed asking three questions. You then have to get back up to go back into the room to ask those questions. And well, you’ve actually spent more time than you would have if you had just slowed down while you were actually in the room the first time.

I keep this saying with me through every shift and every patient encounter. It is, in fact, very much of an anchor (or mantra if you will) for me because it reminds me that I am human. When I tell myself that in order to move quickly I have to actually move slowly, I give myself permission to sit with my patients a bit longer, to make sure that I truly have all the information I need. I allow myself time for my brain to synthesize the information appropriately.

But the magic here is that I think it also makes my patients more comfortable, too, because they can feel the difference in not being rushed to get their story out. That action has drastic effects on how my patients view me and how the rest of the visit will go for them, because it creates a greater sense of trust. Then, when I don’t come back in the room for the next hour, they still know that I care and will be back as soon as I can. They feel assured that I have not forgotten them.

And that, too, grounds me. Connection with the humans I am treating reminds me why I am doing it at all in the first place. It’s the fuel I need to stay present in my shifts.

A Final Reflection

To close our conversation, Landon asked me a question that stopped me in my tracks. It’s a question that gets to the heart of why I started this publication, bridging the gap between the white coat and the hospital gown.

Dr. Landon: Looking back on your experience going to the ER for anxiety, was there anything you wish had been handled differently or even a small change in how you were received or treated that might have made you feel more understood or at ease in that moment?

My situation was a difficult one for any E.R. team to navigate because I was fighting a war on two fronts: my body and my education. As a nursing graduate, my mind was running through every high-stakes diagnosis associated with my symptoms. I saw my feet turning cyanotic (blue) and I spiraled, shouting for vitals and an IV. My knowledge didn’t save me in that moment, it actually made the storm louder.

Looking back, I felt so much shame when the doctor told me I had simply hyperventilated. But the small change I wish for wasn’t clinical, it was human. I wish someone had just tapped me on the shoulder, looked me in the eye, and told me to slow down. I was alone that night with no one I trusted, and I just needed to know I wasn’t alone in the panic.

We often think of the E.R. as a place of leaving, leaving the pain behind or leaving the crisis. But as Dr. Landon Eggleston showed us today, the real work is in the staying.

Thank you, Dr. Eggleston for the clarity and the human heart you bring to the E.R. This spotlight has been a reminder that the internal storm is something we don’t have to navigate alone. There are experts, like her, who are dedicated to helping us find the clearing.

To my readers: If you’ve ever felt like a number in a waiting room or a loud mind in a quiet body, I hope these words gave you a sense of safety today. We are more than our vitals, and we are certainly more than our panic. 🌷

The Pilgrimaging MD

Letters to the Future

When was the last time you sat down and had a real, unfiltered conversation with yourself about your life goals and dreams…

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a month ago · 13 likes · 8 comments · The Pilgrimaging MD and Dr. Landon Eggleston

When was the last time you sat down and had a real, unfiltered conversation with yourself about your life goals and dreams?

Welcome to a new series called, Letters to the Future, a powerful exercise that serves as a powerful tool for clarity, prioritization, and self awareness.

Read this to learn how to write the letter: [Link to Substack Post].

For our first guest post today, I’m honored to feature Dr. Landon Eggleston, the voice behind the Substack Clearview.

Similar to my work, her blog focuses on helping people move past an aimless existence to find true presence and purpose. Her unique perspective as an ER physician offers a grounded, resilient approach to living your best life, even when things get chaotic. You can follow her and subscribe to her insights here.

Thank you Dr. Eggleston for sharing from the heart. I hope her letter inspires you too!

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Dear 2036 me,

I’m writing this from a version of life that still feels like it’s in motion—like I’m building something I can’t fully see yet, but I have to trust is taking shape.

Right now, my days are full but sometimes also a bit empty. I’m thinking a lot about presence—what it actually means to be here, not just productive. I care about my work, deeply, but I care just as much about who I’m becoming outside of work, maybe more so than ever before. There’s a quiet tension I carry: the pull between ambition and stillness, between wanting more and learning to be enough as I am. Physically removed from residency training but still mentally removing myself from the pace of it all. My nervous system is still recovering from those years that felt endless. I don’t yet know how to live in peace again after so many years without it. Was I ever even really at peace like I think I was?

I’m getting married this year. There’s a part of me that feels deeply proud of how much I’ve grown in my relationships (thank you, exes). And there’s another part that still questions—still wonders if I’m getting it right. I trust myself more than I ever have, but I can feel that trust still stretching, still becoming. Growth doesn’t stop, and sometimes I worry about what that means—whether becoming more of myself could ever mean growing away from the man I love so deeply, the man I’ve chosen. It’s the idea of losing him someday that makes me ache, even though I have no real reason to believe that’s our future. And maybe that’s what love is—caring so deeply that even the possibility of its absence feels like something to grieve.

Some small things I hope you remember: the way a slow morning coffee feels when I actually let myself sit with it. No rush, just the warmth of the cup and my moment of quiet.

The kind of writing that comes out when I stop trying to impress and just tell the truth.

The way it feels when I say the truest and most honest thing that is living within me.

The way my voice sounds when I actually speak. Do you remember this period of time when I was finding my voice in the world after too many years of staying quiet? Is it easier for you now?

The satisfaction of moving my body, of showing up consistently even when I don’t feel like it.

The way moments that feel simple actually feel the most full.

There are things that keep me up, too. Wondering if I’m doing enough. If I’m choosing the right path. If the work I’m putting into the world is actually reaching people in the way I hope it does. I don’t know how all of that turns out for you—but I hope you smile a little reading this, knowing that even in the uncertainty, I kept going.

As for dreams—I hope you built something meaningful. Not just successful, but true. I hope you wrote things that mattered. That you created a space— through your writing and your work—where people felt seen, understood, a little less alone. I hope you found the sense of connection you were looking for. I hope you stayed curious. I hope you didn’t trade depth for speed or meaning for validation.

I hope you traveled the world every single year. Slowed down, consciously chose to slow down, every day. Chose people over productivity when it counted. I hope your life feels full in a way that can’t be measured from the outside.

And I hope—more than anything—that you didn’t lose this part of you. The part that reflects. That questions. That wants to live intentionally, even when it’s hard. The part that knows life isn’t something to rush through, but something to actually experience.

If things didn’t go exactly how I imagined, that’s okay. Truly. We’ve already made it through things we once thought we couldn’t. There’s a resilience here that I trust will carry forward, no matter what changed along the way. I am so proud of that now.

So wherever you are, whoever you’ve become—I hope you’re proud. Not just of what you’ve done, but of how you’ve lived.

And if you’ve drifted a bit from this… come back. You know the way.

With so much love,

Your 2026 self

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If you’re new here, I’m Dr. Landon Eggleston, a board certified emergency medicine physician in Chicago. Clear View explores health and wellness through the lens of someone who interacts with life and death daily- offering a grounded perspective on what it truly means to make the most of your one wild and precious life. If you are looking for where to start, start here. If you want to read more, here’s what I’ve been working on recently: organization tools that were instrumental in my own success, what truly matters at the end of life, why high functioning humans are the loneliest, why crying is so important, and insight into seasonal depression. If perhaps you are here looking for a bit of ER drama, I’ve got you here. If you feel called to live with more clarity, intention, and courage, this space is for you. Subscribe for free to receive new posts and join the conversation.

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Here’s the honest truth— If you are not setting boundaries, you do not have self respect.

“Every time you’re given a choice between disappointing someone else and disappointing yourself, your duty is to disappoint that someone else. Your job throughout your entire life, is to disappoint as many people as it takes to avoid disappointing yourself.” -Glennon Doyle

I used to think, like so many others, that kindness and boundaries were two separate and conflicting entities that needed to be harmonized. After spending a significant (and painful) amount of time learning to establish boundaries respectfully, I’ve come to realize just how crucial they are for my well-being and relationships. Initially, setting boundaries felt unkind or selfish. For instance, when a coworker asked me to switch a shift, I felt an obligation to say yes. Even if I’d been working for ten consecutive days and desperately needed that time to relax, if I didn’t have a scheduled appointment on my calendar, it felt challenging to decline.

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As I began my journey of setting boundaries, I initially opted to refrain from providing reasons for my decisions. Saying, “No, I’m not able to trade that day, I’m sorry,” allowed me to protect my time while minimizing the inevitable guilt associated with needing that break. It was still painful and hard. I overthought it a lot. But eventually that pain point got, well, less painful. I began to notice a balance within myself that felt more aligned with my needs and my values. And I was able to start being even more honest about my reasons: “No, I can’t trade that day; I really need that time off for myself to recoup.” Interestingly, I didn’t receive the push back from my honesty that I expected, instead I was met with kindness and understanding. The response was, “I totally get that, those days are so important,” which not only validated my feelings but also reinforced the importance of self-care for us both. A couple weeks later I noticed that same co-worker declining a shift trade in a similar way to someone else. When we have the courage to set boundaries that reflect our values, it signals to others that it is okay for them to do the same. It creates a cascade effect. Imagine if everyone was acting in alignment with this level of self respect. It sure would be a lot harder for corporations to exploit us.

This cascade of kindness has shown me that practicing boundaries can inspire others to do the same. When we model honesty about our needs, we encourage those around us to prioritize their well-being as well. I’ve come to appreciate that boundaries and kindness are not opposing forces; in fact, they are mutually reinforcing. Establishing and honoring boundaries is, at its core, an act of kindness towards ourselves and those around us. When we allow ourselves to be human and have limits, it signals to those around us that they can do the same.

Actionable Steps to Create Kind Boundaries

1. Identify Your Needs: Start by reflecting on what you truly need. What situations tend to drain your energy? Where do you feel overwhelmed? Recognizing what you need is the first step to setting effective boundaries. The goal is not to put up walls, it’s to relay to others what you need to show up in the world as your best self.

2. Practice Saying No: Begin with small instances where saying no feels manageable. You don’t need to provide elaborate reasons—sometimes a simple “No, I can’t do that” is enough. As you gain confidence, try saying your truest answer. Vulnerability begets meaningful connection.

3. Communicate Clearly: When you do choose to provide a reason, be honest but concise. Short definitive statements without room for interpretation. Saying, “I need this time to recharge” makes it clear that your priority is your well-being, not a rejection of the other person. It also makes it known that it is not negotiable.

4. Be Consistent: Consistency is key. When you set a boundary, honor it. This reinforces your commitment to self-care and helps others respect your limits. If someone takes that text and deigns to have the audacity to ask you to forgo your self care for their benefit, please I beg of you, have enough self respect to realize your boundaries are priority number one.

5. Model Boundaries for Others: Share your experiences of how setting boundaries has positively impacted you. You don’t have to be pushy about it, the more you model this behavior, the more others will feel empowered to do the same.

6. Reflect on Your Experiences: Dedicate time to reflect on how setting boundaries impacts your emotional health. After asserting a boundary, check in with yourself—do you feel relieved, guilty, or something else? Understanding your feelings can help you navigate future situations.

7. Seek Support: If setting boundaries feels particularly challenging, consider seeking support from friends, family, or even a therapist. Having someone to share your experiences with can provide encouragement and accountability.

Clear is Kind

If you take one thing from this I hope it’s that creating and maintaining boundaries is not a selfish act; it is an essential component of kindness towards ourselves and others. Clear boundaries are kind. Clear is kind. Boundaries allow us to cultivate healthier, more authentic relationships and foster a more compassionate community. Embrace the kindness of boundaries—the more we practice, the more connected and fulfilled we all become.

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If you’re new here, I’m Dr. Landon Eggleston, a board certified emergency medicine physician in Chicago. Clear View explores health and wellness through the lens of someone who interacts with life and death daily- offering a grounded perspective on what it truly means to make the most of your one wild and precious life. If you are looking for where to start, start here. If you want to read more, here’s what I’ve been working on recently: organization tools that were instrumental in my own success, what truly matters at the end of life, why high functioning humans are the loneliest, why crying is so important, and insight into seasonal depression. If perhaps you are here looking for a bit of ER drama, I’ve got you here. If you feel called to live with more clarity, intention, and courage, this space is for you. Subscribe for free to receive new posts and join the conversation.

Subscribe now