Completing my second year as an attending during a pandemic has been, well, interesting. It has brought up a variety of emotions. It’s all you’ve dreamt about for the past 7+ years of training, finally making it — the ability to “call the shots.” It is exhilarating yet mortifying, all wrapped in one!

You have those occasional cases you have never been exposed to during training. You lean on colleagues for advice and reach out to friends in their respective specialties to ensure you are doing the right thing for your patient. There are days you spend educating on lifestyle changes, how narcotics, although quite the magical drug, aren’t safe for long-term pain management and why we care so much about your A1c number so that your kidneys don’t irreversibly go on strike.

Training does not prepare you enough for the unrelenting, slow, but steady mistrust of patients and how the Google search becomes an opportunity for “research” and lends itself to contention on medical management. Or, as I have observed, it’s a defensive dance similar to the tango.

Sometimes you go in already losing, walking into an encounter where your patient already has a clear agenda. Despite inviting an open dialogue to peek at the root of this mistrust, it’s quite perplexing how a 20-minute interaction can discount your countless hours spent banging your head into your medical textbooks.

There are weeks where your efforts feel like clockwork — trying to plow through emails and lab results inbox before your first patient, between patients, during your lunch hour, and after dinner when you are at home. I was once told by a mentor, “To be in primary care, you have to be OK with always running late.” This means encounters may run over the 20-minute allotted time. It is out of your control if patients show up late or, god forbid, you need to send someone to the ER and call in a warm hand-off. You roll with the punches. I would be lying to say that my “why” is not questionably blurred at times.

During our monthly department check-ins over a table full of goodies and sweets, we discuss themes: “what is your purpose,” “teamwork,” “showing up,” and “what is your why?”

Occasionally, we are treated to our incredible medical assistant’s marvelous homemade cupcakes. I picked one with a little note that read: “Life is just better with sprinkles.” I smiled. Sprinkles: they remind me of my inner child and bring back fond memories.

The week had been incredibly mentally and emotionally draining. Coming home late and ordering take-out, reduced time with my son, limited exercise/self-care, going to bed at midnight trying to respond to 50+ emails, addressing lab results, and closing out my patient notes for the day.

Walking into my 9th exam room, I was pleasantly surprised to find a 71-year-old Latina woman eagerly waiting for me. She was a bit anxious. I could tell in the cadence of her speech, her demeanor and her body language.

Inadvertently, during your training, you learn how to read the room, a concept in psychiatry known as “transference.” The way patients project their emotions is moved or transferred into your own mirrored response.

She was initially shy, but as she began speaking in Spanish, her posture relaxed and eased up, her voice less trembly. The conversation focused on her recent COVID-19 infection one month prior, despite being fully vaccinated.

“When I heard about my positive test result at my age, I thought it was going to take me out.” She began to cry. “I was scared I could get my family sick. I had to be strong and not show how terrified I felt.”

It reminded me of my beloved tios who had recently passed away right as vaccinations were beginning to roll out. Would they still be around if that vaccine had come out sooner for them? I teared up, apologized, and shared why her comment had moved me so much.

Somewhere along the discussion, she looks over and says, “Ay gracias por verme, me dio tanto gusto que eres de nosotros, eres de nuestra cultura.” (“Thank you for seeing me, I am so happy you are one of us and of our culture.”) There’s nothing like expressing yourself in your own language, describing yourself in words that do not exist in English or are translated correctly. She shared her immigration story to the U.S., settling roots in the Bay Area, noting what each of her daughters were up to now as adults.

She was delighted to say her grandson studied at “UC El Lay.” She asked me about my son Elias, and I showed her a picture of him. I was running late, yet spending twice as long on this encounter was refreshing. I needed this.

I soon realized this was my sprinkle. Although she wanted to give me a hug, in COVID times, we opted for the fist bump instead.

These moments are one thing I have always held onto dearly during medical training, residency, and now in practice. These are what I now call “sprinkles.” They show up seemingly when we most need and least expect them.

This type of underappreciated and bidirectional healing in the patient-physician relationship is something we should discuss more with one another. In such unprecedented times, where isolation and mental health issues are at their peak due to the pandemic, it’s imperative to find these sprinkles no matter how subtle they can be. Particularly in primary care, it can help significantly transition the tango undertones into moments of synchrony, grounding, and resetting as you find yourself waltzing from room to room.

I have now made it a point when running chronically late, the workday is long, and when it seems difficult to shake away the fatigue or impending burnout, instead of asking myself, “What is your why, Karina?” I make a mental note of reflection: “What are your sprinkles?”

Karina Chavez is an internal medicine physician.

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