I suppose if that’s all the medications accomplish, I’m still getting somewhere. For the first time in a long, long time, I actually believe that there’s a good chance that my life will get better. I’m actually looking forward to the future.

The trick here is not to let it degenerate into portentousness and hypomania. As long as I keep this optimistic frame of mind without expecting miracles to happen, I think I’ll do OK.

No more pessimism. No more catastrophizing. If I fail, then I fail, but it shouldn’t mean I’m doomed.

For some reason, while driving, I started thinking about all the major branch points in my life. From a distance, it’s obvious that at each of these junctures, I chose my path. There is probably only one thing that was completely out of my hands, and what can you about love that was not mean to be?

Everything else, I was faced with a decision. My anguish wasn’t really because of being disappointed by the turn of events: for example, when my girlfriend-at-the-time slept with another guy, or the years I didn’t get into med school. My anguish was because I had to choose my path immediately afterwards. It’s been all very existential.

I realize that if I never had a choice, I’d probably be less stressed-out, less anxious. Even if my path had ended up leading me to less than optimal situations. You have to do what you have to do. This is probably the big reason why, most of the time, I don’t feel guilty when one of my patients dies. All the deaths I’ve witnessed were people who were going to die (or, in fact, people who were already essentially dead!) no matter what I did. I’ve felt guilty about little things. Like having to intubate a patient who was never going to get off the ventilator. Or doing chest compressions and cracking the ribs of a patient who was already dead from sepsis. Or really, doing anything invasive and painful, no matter how ultimately futile. I’ve felt bad about those patients who died all of the sudden, except that in retrospect, it really wasn’t all the sudden. The ones that I think of, while they were up and about, walking and talking hours before they died, they had bad, horribly bad diseases. Leukemia in an adult is always bad news. Liver failure is muy malo, perhaps the worst.

Maybe it’s only in the retrospectoscope that it feels like it was going to happen anyway. Call it sophistry. Call it rationalization. I don’t know.

You might ask what sort of choice I had when my girlfriend-at-the-time cheated on me. Obviously, I didn’t have a say in it, but I did have to choose what to do afterwards. I could’ve forgiven her and taken her back. All these years that have passed make it seem impossible to make such a choice, but it was there. Instead, I chose the other path.

Same thing with getting rejected from med school. Each time, I had to choose whether or not I was going to apply again, or whether I was going to just give up and try something else.

That’s where most of the anguish seems to lie, really.

Oh, don’t get me wrong. I was disappointed at the time. Devastatingly so. But when the shit hits the fan, it’s too late to think about diapers, really. What is, is. You deal with it and move on. Maybe the trick is, as time passes, you start rationalizing things. It was meant to be. There was nothing I could do about it.

There is an interpretation of quantum mechanics that posits that each decision creates a new universe. Timelines split like amoeba dividing. Maybe that’s what existential anguish is. The labor pains of birthing a new universe.

Can I say for a fact that the choices I’ve made were the best possible of all choices? Of course not. But it’s hard to examine the choices I have made and imagine where I’d be if I didn’t choose what I chose.

In the end, there really isn’t a branch point that I would change the outcome of.

As I’ve said, the trick is not to go overboard. While I like where I am right now, I realize that change is inevitable. Life is all about growth. If you’re not growing, you’re dying. That’s the long and the short of it.

And just because things have gone relatively well thus far doesn’t mean I can’t fuck up big time in the future. But whatever doesn’t kill you makes you stronger, right? OK, not really, but I guess the point is, why worry if you’re dead? And if you’re not dead, isn’t that a great thing in of itself, regardless of how shitty your situation might be?

I don’t know. I really don’t.

The only thing I know right now is that my heart is at peace, for whatever reason. Maybe it’s just the cocktail of chemicals and neurotransmitters circulating through my cerebrospinal fluid. Maybe I’ve actually figured something out for once.

Maybe the things I thought I saw last week were all in my head. It was fun to imagine, I suppose. But that doesn’t faze me. I’ve been through this quite a few times now, it’s no longer a big thing.

There is something about the coming of summer that makes me want to fall in love. A lot of the times, it becomes a destructive impulse. I easily get obsessed. I easily become dependent. One of these days, perhaps I’ll learn to play the game properly, but today is clearly not that day.

While love is an important thing, certainly one of the three most important things in life, it’s not the only thing. And it’s probably too much to ask for it all.

If I can just hold on to this feeling of hope, if I can get by life’s little disappointments without falling back down into some deep pit of despair, then maybe, maybe it will all be worth it even if I have to journey through the vast uncharted future entirely on my own. There are certainly worse things in life than to be alone.

If I manage to survive another 30 years, I hope that I can look back upon my life and see the major branch points, and still say to myself, those were the right choices.