Paimana

I keep a satchel by the door that never quite closes. The leather took its polish from years of early mornings, when coffee steamed against winter windows and the hallway light fell in a thin, faithful band. Inside the satchel, tools live beside their critics. A stethoscope curls around a compass. A foldout map lies under a sheet of lab values. Between them sits a thin booklet titled “On Silence,” full of marginalia and coffee rings. The day reaches in and takes what it needs. Some days it selects the compass and the booklet. Other days it reaches straight for the numbers and leaves everything lyrical behind. I let the day decide, then I argue back. 

Open the satchel and categories begin to talk. Ethics confers with measurement. Mercy checks the stopwatch. I like clean lines, yet I am drawn to wilderness where lines dissolve into a living edge. So I keep two notebooks and move between them without apology. One carries axioms and first principles, sketched with pencil and a ruler. The other collects exceptions, edge cases, and stories that resist reduction. I have learned to write in both books at once, cross‑referencing a proof with a parable and letting each correct the other’s excesses. 

Physics taught me early that reality keeps more than one register. Light behaves as wave and as particle, and the shift is less betrayal than responsiveness to the way we ask the question. I carry that lesson into ordinary hours. Before noon, I love significant figures and the satisfaction of a clean calculation. After dusk, I hold the report up to the lamp and study the error bars. They no longer look like defects. They look like humility printed to scale. If a life ever deserved a proper lab report, one of the sections would be labeled “Ambiguity: Methods and Results,” written carefully in ink. 

Contradiction often gets accused of moral laziness when it demands the opposite. The work lies in sustaining more than one loyalty at a time. Patience and urgency sit at the same table and share a plate. Justice and mercy carry each other’s coats. Fidelity makes room for revision when new evidence appears. Every solitary virtue, left to wander without company, grows sharp and hungry. So I pack counterweights. When zeal climbs into the bag, tenderness rides along. When tenderness begins to blur into indulgence, I set firmness beside it and ask them both to walk. 

Time makes the contents stranger. The person I was at nineteen writes me emails in unsophisticated fonts, full of stomp and sparkle. The person I hope to become replies with a slower pen, composed and wary of spectacle. They both live in me when I stand at a bedside or a blank page. On some afternoons, minutes stretch and thicken. My inner narrator clicks the stopwatch, then looks out the window and decides to let it run while I take stock. Ambition shakes hands with exhaustion. The medical part of me wants a linear course and clean inflection points. The metaphysical part makes a note in the margin: the patient called time “a loop with a flavor of iron.” I keep yesterday’s confidence with today’s revision and tomorrow’s caution in the same pocket. They bump elbows until they learn to walk in step. 

Clinic days sharpen the argument. On rounds, a patient with advanced COPD sits forward in bed, eyes set with the specific fatigue that follows a night under hard ceiling lights. The guideline whispers one number for oxygen saturation. The person in the bed asks for a slower adjustment and a break from the mask. The calculator in my head runs through the trial data. The listener notes the tremor in the patient’s hand when she reaches for water. I stand half a step to the left of what the algorithm would prefer, and I stand there on purpose. There is a reason we learned to count and a reason we learned to look. Good practice requires both. When I walk out of the room, I feel pride sharpened by unease. Pride alone goes dull. Unease alone cannot cut. Together they become a blade that respects what it touches. 

Another patient asks for antibiotics to soothe worry as much as symptoms. Stewardship taps the clipboard. Harm reduction clears its throat. I explain resistance, side effects, and the body’s capacity to settle with rest and time. The conversation is longer than a prescription would have been. It is also medicine. Before I leave, I write instructions that take the family’s work schedule into account, and I underline a phone number. If worry wins the night, they can call. The rule lives. The exception breathes. The chart looks ordinary. The day feels honest. 

Faith rides in the satchel too, although it has learned to queue like everyone else. When a patient declines further intervention, I think about courage and about the court of heaven, then I chart what matters in language that meets the standard of care. On quieter nights, I read theology beside an anatomy atlas. I keep both within reach of practical tools: a small flashlight for days of doubt, a rough map for seasons when longing disguises itself as certainty, an index card that says, “Do the difficult good gently.” Prayer has become a habit of attention rather than a vending machine for outcomes. Reason has become a habit of mercy rather than a competition for prestige. Both keep me from the laziness of superstition and the cruelty of cleverness. 

The satchel contains language as well. Words tend to change clothes depending on whom I am speaking with. In the clinic, sentences aim for clarity and proportion. At the desk, they sometimes grow taller and try on ornamented jackets. I let them experiment, provided they do real work. A metaphor that carries no weight goes back on the hanger. A statistic that signifies without context also returns to the rack. My favorite sentences split the difference: a poet’s ear for cadence married to a scientist’s love of precision. I avoid the clotted certainty of slogans and the soft fog of vagueness. When a paragraph hums, it does so because every line earns its place. 

People sometimes ask how I decide what stays and what leaves. I have an organizing rule that behaves more like craft than dogma. Keep the things that enlarge attention. Remove the things that turn attention inward until it only sees itself. A piece of doctrine that narrows compassion does not make the cut. A perfectly cut irony that closes the window on wonder goes on the shelf and waits. Certainty that increases responsibility earns a spot. Doubt that lengthens patience earns one too. I sort the bag at the end of the week, and the zipper either sulks or glides. The zipper tells the truth. 

Contradiction also shows up in study. I love systems that claim to explain everything, and I have learned to let them fail in my hands without drama. On Monday, the system looks convincing. On Thursday, a single case study draws a red line through three confident chapters. Instead of despairing, I annotate. The annotation might read: “Persuasive under ideal conditions; brittle at the bedside; amend with lived texture.” A theory that survives my notes becomes a companion rather than a tyrant. The companions travel well. They know they will be revised and still keep me company. 

Relationships demand the same repertoire. The friend who needs directness at noon needs gentleness at midnight. The student who thrives on blunt critique during one rotation blooms under a slower hand during another. I once equated consistency with enforcing one tone; experience has shifted that meaning toward staying faithful to the person in front of me while keeping faith with the principles I carry. The calibration is never casual. It takes attention, and it takes the humility to apologize when attention slips. 

There is also the matter of work and rest. I come from people who admire endurance and sometimes mistake exhaustion for virtue. The older I get, the more I see that endurance is a tool, not a shrine. Some seasons call for long hours and a second wind. Others call for stepping off the gas, or for leaving a sentence unfinished so that tomorrow can find it breathing. When I forget this, my sentences grow brittle and my listening grows impatient. When I remember, the work deepens. Rest becomes part of the method rather than an indulgence stolen from the task. 

Every so often I reorganize the satchel. I take out a tool I have carried for years and realize my hands no longer reach for it. Sometimes I put it on the shelf with gratitude and a note about the seasons when it saved me. Sometimes I pass it on to someone who is walking the stretch I just left. In its place I add a new habit. Lately I have added a practice of asking better questions at the outset of any hard problem. What would success look like for the other person, not only for me. What cost feels acceptable today but will embarrass me in a year. If I choose speed, who pays. The questions do not slow me down. They spare me from false efficiencies that cost double. 

I have tried for tidy synthesis and discovered that synthesis rarely appears on demand. Coherence arrives more like a tide than a decree. It gathers, recedes, returns with a little more shoreline each time, and leaves behind patterns that only make sense when you climb a dune and look back. So I keep walking the same stretch, collecting shells and scraps and data points, then editing. Some days the beach is ruin. Some days it is a draft of paradise. Most days it is both, and the walking itself supplies a kind of logic. 

If you ever borrow the satchel, you will find practical things tucked among the abstractions. A coil of tape for quick fixes. A small packet of almonds for when the late clinic runs past dinner. A folded page with a line I am trying to live by that week, handwritten so slowly the ink looks thoughtful. You will find implements: some sharp, some soft, some calibrated to the millimeter, some tuned for silence. They have been chosen with care for a world that keeps changing shape while insisting on consequence. 

I still wake early, pour coffee, and watch the hallway light move across the floor. The satchel waits by the door, humming almost imperceptibly, as if the objects inside have learned to speak to one another overnight. I listen for a moment before I lift it. The hum once read as dissonance; over time it has come to sound like instruments tuning in a darkened pit just before the curtain rises. The day begins, and I carry the music out.

~ Raza