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Baby Burrito MD, Austin, TX (2026)

12/26/2025

In October, I went to Chicago for some training, and I made a trip to the Art Institute downtown where they have Monet, Van Gogh, Seurat, Hopper, and so many more. I wouldn’t call myself some kind of art scholar, but I appreciated getting to soak in something Austin doesn’t have too much of.

A lot could be said about it, but what struck me this time was when I got very close to a Monet and a Van Gogh, I could see the individual brushstrokes within a large masterpiece. Sometimes even the markings of an individual bristle of the brush was fossilized into the paint.

When I saw that, I felt this electric connection across time with these geniuses. Unearned, to be sure. But here was where Monet decided some purple was needed, and it was like he had just daubed it there an hour ago.

Van Gogh would have made that stroke without even knowing anyone would admire it at all. He died without any recognition in his lifetime. But 135 years later, here is this connection that was and is meaningful to me.

The past couple weeks have been challenging for me in my work, but I have had a precious few patients come in before the holiday and told me, “You really listened to me, you heard me, and you made me feel better. Thank you.” And here is this connection again.

I believe it is connection that most of us are after, a real recognition between two beings which is much harder to realize than we thought when we were younger. To make ourselves understood, to be seen, to display our real selves in the world and for it to be welcomed with safety. So many of these artists had to display this genius in order to display themselves, and some were rewarded and some were not.

But now, whether we’re in the museum or in the clinic, we get real close, close enough to see the marks of history and the blemishes, and we’re blessed if we can drop our guard and our egos enough to see each other, to recognize the greatest thing: we are just two humans in a room.

Merry Christmas.

12/23/2025

A few months ago, by the recommendation of a wise friend, I read “The Status Game,” and it’s helped put a few things into focus for me, both in clinic and out.

As brief a summary as possible: we sort ourselves into siloed groups that are smaller and more powerful to us than we give them credit for. We all play games—mostly subconscious—for rank within these groups, and the need to do so is a very old evolutionary instinct. There are roughly 3 types of games within these groups: dominance, virtue, and success.

If you have watched “There Will Be Blood” (great movie, and actually Paul Dano is excellent), it’s a perfect example of this concept. The oil man (DDL) is playing a dominance game, and the preacher (Dano) is playing a virtue game. By the end, they’re both playing a success game, and DDL gets the upper hand and drinks Dano’s milkshake.

In any case, Christianity is a virtue game in many ways, one that I played semi-consciously for many years. When you’re within that paradigm, it’s hard to imagine any of the other games or see them as permissible/moral. Especially when other Christians played at success or dominance, it was very confusing and seemed hypocritical.

There’s more to say about this, but for now I’ll just say this new framework has at least helped me understand better what’s going on in current events psychologically. I would not say I am completely contained within that Christian silo anymore, and that has actually led to a little less stress without as much to reconcile.

I am hoping that all this will translate into compassion for people I strongly disagree with as well as for myself, even if none of us change our minds. I’m sure I’ll still be writing about that for many more Christmases.

12/22/2025

I read recently that perfectionism is “a heightened sensitivity to signs of failure.” I’ve been thinking about it since then, I guess trying to decide if that’s a perfect definition.

A while back, I read Brene Brown’s “The Gifts of Imperfection,” because I wanted to get into her writing and I thought this one would be easy because “I’m not a perfectionist.” About a third of the way through listening, I remember sitting alone in my car and saying out loud, “Well, sh*t.”

Claiming to be a perfectionist sounds like a coded self-compliment, when really it’s just a gigantic pain in the ass. It’s hard to start something because it will never turn out right, you have no patience in yourself, everything is being graded in real time by meaner versions of the muppets Statler & Waldorf.

But “sensitivity to failure” doesn’t sound right to me. I think instead “heightened sensitivity to shame” is closer.

Failure is just something not working, but shame is much deeper: Wondering what people or God will think of me, dreading a bad outcome because of how it will wreck my identity, the desire to hide myself and my work. It’s all shame-based.

And then, if it’s triggered, the need to work hard again—too hard—both as a logical necessity and as a sacrifice toward the universe shifting the outcome. Because when you’re going for something as ridiculous as perfection, it’s only too tempting to reach for superstition as a desperate lifeline: if I destroy myself, the patient will get better.

Anyway, that’s the form my monster takes. I think everyone’s manifests a little differently, but more and more I see this cycle rooted in shame rather than failure—more social than logical, more emotional than a simple scoreboard.

Once we see the cause, maybe we can address it more directly. Maybe perfectionists need ways to discharge their shame on a more frequent basis than others, and finding ways to be vulnerable in a safe way with safe people has to be the first step of a long-term discipline.

12/21/2025

This year I have been using AI in my clinic. I was hesitant at first, but it creates my notes for me and saves me time. Honestly it has taken off a lot of my mental load between clinic days, and it’s helped me spend more time with my family.

While I joke that intelligence is so hard to find that I will take the artificial kind, I have watched too many Terminator movies to be completely comfortable with where we’re headed.

This year I felt a little smug about the #1 charted Christian song at the time being AI-written, that is until I found out that the (fire) motown cover of an Eminem song on my OR playlist was also AI written. I found out that one of the major insurance companies is using AI to evaluate our authorizations for cases (resulting in convenient-for-them delays).

It’s permeating our lives at a time when there is a touted “loneliness epidemic” in our society. As AI grows, you wonder what effect it will have on our relationships. Will it lead to less isolation or more?

Already we are using it to answer many of our questions on a regular basis, and it’s not going to take too many leaps before it becomes a bit of a mirror to us all, something we bounce every part of our lives off of. The convenience of it is distressing.

It will be easier after all to work with a programmable co-worker than our traumatized, mouth-breathing, problematic, flesh-and-blood models we have now. As those work relationships disappear, will we forget collective action? Will we be easier to divide and terrorize and subdue? Can our caveman brains withstand the emotions and distorted need-fulfillment of this new arrangement?

Clearly I don’t know. As an introvert, it feels odd to advocate for more people-time. But the truth of an unexpected social interaction, the gratitude behind listening to another person share something difficult, the shared achievement of working together toward a goal... these and more mean so much to me and make me more human.

We are entering a phase where we will not have to have these social structures and relationships. It will be up to us to choose to have them instead. How well will we do?

12/19/2025

Most people that know me would agree that I’m not good with time. Absent minded, bad at estimating, inconsiderate, lazy, busy, a surgeon... there are various explanations that I’ve been given.

Patient and thorough are others. (Let the kind ones in.)

There is this thing that I’ve heard called time dilation, where everything feels far away in time and then everything feels real close, sort of unpredictable. It could be a lack of attention or avoidance. It could be flow state.

But there are times when something is so miserable—I’m thinking of a tough surgical case, say—and it feels like it will literally never end.

I have cases or events that I dread, and I become so focused on them that I come to believe that my life will simply not continue past that point. It is hard to see past it, and I focus all my energy on that event, so much so that I’m numb to things before it and I have nothing left afterwards.

When that dreaded thing happens and I do outlive it, there is a bit of a high afterward, like a new lease on life.

I do not think this is healthy. This year, I have been trying to learn ways of grounding myself in the time I’m in. I do not want to live in this cycle of dread and numbing and effort and relief.

Part of my goals for this next year is to feel the time passing. Not so much live in the present, but to find ways to keep it all from feeling it’s happening all at once. To let each hour or day be its own thing, if that makes sense.

To understand better that everything takes time and passes on, to use that feeling to stretch time out on a loom so that I do not feel trapped in it. Maybe I can even enjoy it.

12/16/2025

I have a hard time with news like we’ve had over the weekend: losing Rob Reiner (one of my favorites) in such a violent way, multiple mass shootings, wars and intentional starvation, such ugliness being lobbed back and forth in the aftermath.

And meanwhile a friend’s mom in hospice. And sick patients everyday. And a country on what feels like the breaking point all the time.

Anxiety builds, and sadness is right there. It’s a panicky feeling. These things feel so immediate, as if they are threats to me and my family.

I have had to practice identifying that feeling, both as a doctor and as an American living in this time. One of the toughest things for me is identifying that I am feeling that way, doing all I can do, and then slamming a boundary down between me and what is happening out there or to another person.

It feels like abandonment or complicity, and I worry (almost all the time) that it is. I have to examine again if I truly have done all that I can within my own little sphere of influence, and it is worth checking that twice.

But if I have performed that task, then that boundary has to be there for self-preservation. It is healthy for a time, I think, to narrow our focus to the next couple steps, to the beauty of a leaf in front of us, to one hug from a kid.

I cannot let everything in all the time all at once. I simply cannot do it and survive. To accept this limitation has been hard for me.

But if I do not accept this limitation, then everything that happens or doesn’t happen is somehow my fault—which is not true.

The critical thing is to come out from behind our boundaries again, when it’s safe to do so. To open ourselves up again and accept people in, when we’re ready.

But not right now.

12/14/2025

This year I’ve had a case that’s caused me to lose a bit of my mojo. Nobody died, the patient is doing ok, but the case was complicated and hard to predict. It’s been a painful couple months getting everything sorted out.

It’s made me consider what patients want from their doctors. Of course I worry that my bias leads me to only think of things that I’m capable of giving.

One thing I’ve found true in this situation is that “certainty” is not necessarily one of the things patients want, only what my own perfectionism seems to demand.

Instead “consistency” seems to be enough for my patient—so far—and I do have a consistent desire to help them and a wish to be able to predict what the next couple steps will be like for them. That seems to go a long way.

I’ve had to be vulnerable enough to bring other team members in—who I know are good doctors—in order to help them.

I’ve had to try to let go of the idea that it’s all up to me, in order to endure alongside the patient. Allowing the body to heal as it’s going to heal. Letting time in. Sitting in the discomfort. Finding ways to clear enough space to give both the patient and myself a little compassion.

12/12/2025

As someone who has a wicked and relentless inner monologue, I’ve been a little more careful this year to screen out stories or voices that add drag at times when I can’t afford the extra weight.

It’s also been entirely helpful to find kinder voices to supplant my own with. One of my favorites over the last couple years has been this Irish author, recommended to me by . I keep handing out copies of this one in particular, though I would also recommend “Time of the Child” at Christmas and to doctors anytime.

Some excerpts:
“At the time you’re living it you can sometimes think your life is nothing much. It’s ordinary and everyday and should be and could be in this or that way better. It is without the perspective by which any meaning can be derived because it’s too sensual and urgent and immediate, which is the way life is to be lived. We’re all, all the time, striving, and though that means there’s a more-or-less constant supply of failure, it’s not such a terrible thing if you think that we keep on trying. There’s something to consider for that.”

“Books, music, painting are not life, can never be as full, rich, complex, surprising or beautiful, but the best of them can catch an echo of that, can turn you back to look out the window, go out the door aware that you’ve been enriched, that you have been in the company of something alive that has caused you to realise once again how astonishing life is, and you leave the book, gallery or concert hall with that illumination, which feels I’m going to say holy, by which I mean human raptness.“

12/11/2025

t’s a busy time of year for surgeons, since everyone wants to get their cases done before deductibles start over on Jan 1. It’s a sprint to the end of the year.

Every year it’s an internal fight about how much time I should take off around the holidays, since people want things done and there is this idea that I should be busy. And if I’m not busy, am I doing the right thing? Shouldn’t I be working until I can’t work anymore?

I’ve thought about where this comes from. When I’m busy, I desperately want a break. When I’m not busy, I worry I’m not doing enough.

I took a walk today, and I found myself thinking about what we all know about deciduous trees, as they’re changing color and dropping leaves this time of year. In this ancient way of closing up shop, they decide what stays and what goes, what will help them survive the winter and what’s a liability. And while they certainly look exhausted with their bare branches, really they have defended their own integrity by shedding the unnecessary. They are healthy and lying in wait.

No great metaphor, but I could learn something from them.

There are a lot of reasons why I’ve been taught that working until exhaustion is a supposed “good” thing. But the main goal cannot be exhaustion. That benefits no one.

The main goal has to be titrating work between helping patients and protecting my own health and mood and finances and family time.

Exhaustion is a lazy metric. I need to find ways to better monitor and account for all the other parts of life that are worth surviving for. That will be more work, but it defends the whole. Then, if those parts are violated, maybe I will need to shed some work like a tree sheds leaves.

12/07/2025

Yesterday we celebrated my son’s 12th bday. He’s a wonderful kid, and that can’t be overstated.

The thing he has taught me most this year is about fun.

I am not very good at fun, or at least not routinely and usually not while sober. I get in my head about what fun even is. Do we have fun in order to bond a team together? Am I supposed to be having fun all the time? What do you accomplish with fun?

But this kid came along. And I remember when he was about 3 and we moved into our Prescott house in Houston. The rooms were empty since we still didn’t have much adult-type furniture. I came home one day from work drinking a bottled water, still in my scrubs. And I think at some point G interrupted me talking with someone by kicking the empty water bottle at me. I kicked it back. And then we did that for an hour, kicking this empty bottle back and forth across the empty room. And it was a great time.

I struggle with small talk, doesn’t matter with who. I am always caught asking achievement-oriented or future-oriented questions, and I sometimes find myself doing that with him: “what do you want to get involved with at school?” or asking about his hobbies and what he intends with them. But I think over time he has taught me to quiet that down, to just listen to what comes, to even be comfortably silent next to each other and for that to be ok.

We went to the back of a school near our house not long ago, and it was a beautiful day, and we took the dog. We let the dog run around, and we threw a football and a frisbee, and he tried to make a boomerang work. And at some point I realized that we were just being free. We were playing, and there were no rules, there was no timer, no score. No future prospects, no road to success, no efficiency, no right or wrong way to do it, no winning or losing, no corrections needed.

And I thought, maybe *this* is what fun is.

12/05/2025

As I work on figuring all my own stuff out, I do a lot of thinking about shame.

It’s not a great word, shame. I feel like we use it too loosely, and it’s gathered a lot of extra meanings and connotations. We shame people. We lament shameless people. If you can’t show up to a party, then you get, “ah, that’s a shame.”

I grew up in church hearing that I should be “unashamed of the gospel,” but if I acted out of line with Christian teachings, then “you should be ashamed of yourself.” And I was told that Jesus came to take my shame.

It’s all a mess.

But what I’ve been thinking about lately is how often guilt and shame get conflated. I realized that this confusion was depicted well by everyone’s favorite Christmas movie, Mystic River! I don’t have the characters to get into detail, but the brilliance of this (very sad) script is that it shows people mistaking another man’s shame for guilt, and then punishing him for it.

To me, guilt is a result of a violation of a code of ethics, something sort of earned. Maybe that is what Jesus came to take from us.

Shame can come from guilt, I think, and maybe that’s the confusing part. But on the other hand, it can come from falling short of some standard you set for yourself. Or it can come from something that happened to you that you want to hide. Something unearned, really.

I suppose what matters is that the shame that I feel is often unearned and very often self-inflicted. It does not imply guilt, as I once felt. And as much as I would love it, I don’t think Jesus came to take my shame.

Instead I rely less on prayer and more on community, maybe even church of a sort. Because as I get older, I find that the answer to my shame is to share it out loud with people that I love and who love me. It clears my head, and it clears the air so that others do not see my shame as guilt.

And the truly beautiful thing is that it provides a space where others can share their shame with me. In so many ways, that is what we’re here for.

12/04/2025

Like any ‘80s kid, I have a soft spot for this movie. I listened to a film commentary on Toy Story recently, and it brought up something I hadn’t thought of before.

Woody spends a lot of time throughout the movie trying to convince Buzz that he is in fact a toy and not a Space Ranger. It’s immediately evident Buzz has a lot to learn from Woody if he would just wake up. Woody has been in charge a long time and seems like such a good leader.

Woody is driven near-crazy by Buzz not acknowledging the fact that he is a toy and by Buzz’s ascension (while still believing something so wrong). so much so that Woody hits Buzz with the RC car, a move that appears out of character.

I always identified with Woody watching the movie, really. There are so many people—in clinic and in life—that I would desperately like to tell that they are not a Space Ranger. But I have ignored what Woody had to learn through the course of the story.

Woody is magnanimous, but only when he’s on top, only when he’s in control and respected. Once that position is threatened by Buzz, Woody’s goodwill drops away, and he responds to that vulnerability with aggression. That move with the RC car isn’t out of character. That insecurity has been there the whole time.

By the end of the story, Woody learns that he can have goodwill for everyone in his community even when he’s not the only one on the pedestal, even when he’s just part of the crowd. And in fact being part of a community is more fulfilling and more authentic than clawing and striving for that top spot.

I still identify with Woody. There’s a voice in my head—the one I hear when I feel disrespected or when people aren’t listening to me when I’m trying to help them—that I now picture as a cowboy doll waving his stringy arms in frustration.

I’m hoping that picture helps me remember that I can offer goodwill before I’m respected, when I am still vulnerable, and even when I’m disrespected. I can find real peace in community, even without striving for recognition first.

Maybe it will work. But I know I will need to find a better term for it, because “pulling a Woody” doesn’t seem like something I can say out loud.

Baby Burrito MD

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