“A pivot is a change in strategy without a change in vision.” — Eric Ries

From June 1, 2020, the term "pivot" assumed a profound significance in my life. The journey began abruptly in the middle of the night while I was on a business trip in Amarillo, Texas. As a practicing neurosurgery physician assistant, I was asked to assist a cardio-thoracic surgeon for one day, expecting to return home within 48 hours. As I was alone, asleep around 12:30 a.m., a violent tonic-clonic seizure suddenly awakened me, rendering me unable to call for help. Struggling with loss of motor control and an intense burning on my left side, I was unable to dial 911. As a result of the intense seizure activity, I fell off of the hotel room bed and onto the floor. As I was lying on my back, I reminded myself to stay calm and breathe through it. I could not ascertain what was happening, but I could focus on each breath. I prepared myself by thinking that each passing breath could be my last. Between each breath, I prepared myself for death.

I only had a few moments to reflect on what mattered to me. What mattered to me was one thing: Did I leave anything unsaid? Do those in my care know how much I love them? Nothing else mattered. One breath led to another, and after several more breaths, I realized the value and magnitude of one breath. How grateful I was to continue to breathe. Before I knew it, I fell fast asleep. Once again, I was awakened by another seizure, followed by a deep state of rest. Amid my terrifying seizures, I was in survival mode. I did not know why I was experiencing loss of motor control, intense burning on the left side of my body, and uncontrollable shaking. After experiencing the two seizures, I was completely stunned and confused as to what had just happened; however, my priority was to stay alive rather than to diagnose the problem. I awoke to the morning sunshine and was entirely thankful to be alive. I assumed I had a stroke, so I took two aspirin, and jumped in the shower, with a plan to see patients in the morning and go to the emergency room on my lunch break. Obviously, I was not clear-headed.

I arrived at the clinic and was seeing patients when, around 10:30 a.m., I experienced extreme nausea. I informed the practice manager that I had an emergent issue that needed to be addressed, and I asked if somebody could take me to the emergency room. I was unsure what to expect, but I knew it was serious. I was terrified on the inside; however, I remained calm and optimistic on the outside. A prompt CT scan revealed a sizable mass in the right frontal/parietal regions of my brain, necessitating immediate neurosurgery. I was flown from Amarillo, Texas, to Phoenix, Arizona, where I underwent an emergent craniotomy at the Mayo Clinic. As per the chief neurosurgeon at Mayo Clinic, the surgery was complicated as the brain mass was very large and embedded in scar tissue and adhesions. My neurosurgeon prepared me for an uncertain outcome relative to my left-sided physical abilities and the potential for cognitive and intellectual challenges. I remained hospitalized for seven days at Mayo Clinic, followed by inpatient rehabilitation to strengthen my left-sided function. I was diagnosed with a meningioma brain tumor, which I later named ‘Ruby.’

I was told Ruby had grown for ten years, which explains her size. Since Ruby made herself at home in two lobes of my brain, there was extensive collateral damage following the tumor resection. For the past two years, I have been in neurological and physical rehab. I have been blessed with the most amazing neurological rehab teams at Mayo Clinic for 18 months, followed by Barrows Neurological Institute for five months. The first day of the rest of my life began after my brain surgery as I was recovering in the hospital. Recovery unfolded as a paradigm shift, marking the inception of my new normal. I realized that my new normal would be vastly different than what I knew before the surgery. I knew I would need to be patient and trust the process. There were many lessons to learn, and to this day, I continue to have many Ruby “winks” throughout each day.

Ruby, my unexpected companion, became a catalyst for invaluable life lessons: For there is no strength where there is no struggle. I would not trade Ruby for anything. She has taught me priceless life lessons.

Courage: Ruby has reminded me of the importance of making changes that must be made today instead of tomorrow. Ruby has taught me the courage to act on what I believe. Ruby has taught me to permit myself to live in harmony with my True North, whatever the cost.

"Adversity does not build character; it reveals it.” — James Allen

Patience: Ruby has indeed taught me patience. In 2020, I was initially told that my brain injury would be 100% restored, which sadly was not the case. However, there is always a silver lining: A greater appreciation for patience and long suffering.

Surrender: Ruby has taught me the power of surrender. At its core, surrender is the willingness to meet life as it is and stop resisting the now. Surrender begins where strategies end. Surrender arrives when we know we cannot think or see our way through where we are. When everything we're doing, saying, and making is no longer aimed at controlling the future and producing a specific result, we can drop into the present moment and experience it directly as it is. To let go and surrender is more about undoing than it is about doing.

Vulnerability: Ruby has taught me the impact of vulnerability by continually reminding me about the fragility of life. The only consistent things are change and impermanence. As we remain in the presence of curiosity and awe, we will sense a deeper connection to and appreciation for the world around us.

Work-Life Balance: Ruby has reminded me of the importance of slowing down and maintaining work-life balance. Because of Ruby, I have damage to both the frontal and parietal lobes of my right brain. Damage to these lobes presents cognitive issues such as sensory overload, information processing, memory recall, and word finding. Before June 2020, I had five hamsters running on their wheels. I rarely stopped to smell the roses as I continually ran from job to job, from kid to kid, and from appointment to appointment. As a result of my slower pace, I am finding more significant meaning in the mundanity and the simplicity of life. I remind myself to remain mindful of my inner voice. Instead of arguing with reality, I find purpose and peace in the pain. In the end, pain is inevitable, but suffering is optional.

No Regrets: Ruby has taught me never to have regrets. Either I adopt an abundant mindset and unapologetically live my life out loud, thriving under pressure and trusting the process — or I adopt a deficit mentality saturated in defeat, frustration, blame, and fear. For me, I choose the former. I am strengthened and resilient, and because of Ruby, I am a much better version of myself.

Gratitude: Because of Ruby, my level of appreciation has increased immensely. Is this happening to me or for me? I am grateful for the simple blessings of life, the silver linings, and everything in between. One of my favorite mantras is: It is possible to not only survive, but thrive, and not despite our hardships and challenges but because of them.

“Gratitude turns what we have into enough” — Aesop

Death: Ruby has invited me to be intimate with death and uncertainty. Death is not only about our physical forms dying. Death also means going to the full depths of things, hitting the bottom, going beyond where we are in control, facing uncertainty, etc. Death and impermanence also put things in perspective and remind us of what matters. I let go of distractions, drama, difficulties, nonsense, and ruminations of the mind. I let go of judgments. I let go of clinging. I let go of anything that was not edifying or uplifting me. Suddenly, all the noise was just not as important as it once was. Suddenly, I felt more alive, forgiving, tolerant, and accepting.

Being Comfortable with the Uncomfortable: We do our best to manage our lives according to our expectations. We want to minimize inconveniences and stressors, and all the while, we want to dictate our duties and our decisions comfortably in a very safe and predictable bubble. The word “change” typically refers to new beginnings; however, transformation more often happens not when something new begins but when something old falls apart. The pain of something old falling apart, disruption, and chaos invites the soul to listen deeper. It asks and sometimes forces the soul to go to a new place, because the old place was either no longer working or was taken from us.

I am a passionate student of Stoicism and Greek philosophy. The Stoics believed living a life of comfort was akin to death. Seneca repeatedly talked about the importance of adversity, embracing the struggle life throws at us, and actively seeking out that difficulty to be stronger and more prepared.

“A blazing fire makes flame and brightness out of everything thrown into it.” — Marcus Aurelius

Tough times do not last, but tough people do. Indeed, in the middle of a hardship or setback, it may feel challenging to keep the faith and patiently trust the process. I recall being tempted to choose the low road many times because it was easier. However, I made a personal commitment to choose the high road because it was simply too crowded on the low road. With this personal commitment came a choice to remain grateful, a choice to work hard, and a choice to be comfortable with the uncomfortable. With this commitment came a choice to maintain a healthy detachment from outcomes and circumstances, a choice not only to accept but embrace my personal Plan B, and a choice to pivot with grace and poise, all with an end goal to do better, to be better, and to serve better. Today, I am a first-year doctoral student living in Phoenix, Arizona. Despite a divergent Plan B, my commitment to completing my doctoral degree in three years remains unwavering. Grateful for the unexpected twists in my journey, I am resilient in my academic pursuits, embodying the spirit of gratitude to my unforeseen companion, Ruby.