On the Beauty of Thorns

Jill Gilbert, MD

For someone like me who grew up in New Orleans, New Year’s Day was always a big event, celebrated with cabbage (for good luck) and black-eyed peas (for prosperity). The new year was a time of hope, a time to imagine a better tomorrow.

It also marked the approach of Carnival, a time to revel in life and all its glorious frivolity. This New Year’s Day, however, felt more like Groundhog Day. Although cases counts are dropping, slowly, and governments at every level are lifting mask mandates, hospitals are still struggling. COVID-19 is still killing people who don’t have to die—more than 6 million worldwide at the time this went to press.

I myself am experiencing pandemic fatigue, loss of connection, and frustration at the collapse of the social contract. When the polio and smallpox vaccines were developed in the middle of the last century, people recognized that the good of the whole depended on everyone doing their part.

Sadly, the politicization of the COVID-19 vaccines has upended the social contract. The so-called right of individuals to endanger not just themselves but everyone else is demoralizing to us who have dedicated ourselves to health care. I suspect that many of you feel the same way. Nevertheless, our patients still need care and, most importantly, compassion—even when we feel we have very little left to give.

Late in 2021, I needed…something, even if I wasn’t sure what that was. My mother-in-law provided the necessary boast when she gave me a gratitude journal for the holidays. Such a journal asks you to record and reflect upon the positive things you experience every day. Over time, this practice allows you to recognize the natural ebb and fl ow of life’s events and change how you perceive them.

My mother-in law thought of this gift after visiting us in November, when I was going through a rough patch. I thanked her. I also thought, “Who has time for this?” The journal sat on the kitchen island for 2 weeks.

Then, one day, a colleague happened to mention that gratitude helps him get through difficult periods. The synchronicity struck me, and I picked up the journal.

I soon realized that putting pen to paper allowed me to contemplate the fullness of life rather than just the down moments. Writing down my thoughts gave me perspective. When I find myself focusing on the negative, it helps me see what the 19th-century French novelist Alphonse Karr meant when he wrote, “Some people grumble that roses have thorns. I am grateful that thorns have roses.”

So how does this apply to you? Many of us, myself included, have the unfortunate habit of thinking in binary terms, especially when tired or stressed. It can be hard to find the middle ground in those moments.

Right now, if you’re fi nishing your fi rst year of fellowship, fatigue is setting in. You may even be questioning whether this fellowship or this institution was the right choice. I urge you to write down one thing for which you’re grateful every day. This can restore your perspective, and you’ll see that life, in all its messiness, can be beautiful.

Recently, a young patient of mine who has a terminal illness told me that he wished to die in Medina, the second holiest city in Islam. That night, I wrote in my journal about what a gift it was that he had asked me to accompany him on this most personal of journeys.

Before the journal, I would probably have focused on the fact that my patient was dying and would have succumbed to the sadness that my career can entail.

The journal has given me time and space to reflect, to accept that nothing is perfect or binary. I can often, if not always, find something good among the bad. My hope is that, having cultivated perspective, the thorns of this world will lose some of their sting, and I will be able to replenish my spiritual reserve and renew my compassion.