It’s my birthday today.  I am 41.  How did that happen?  In the mirror I can see silver in my hair.  It shines like the gold my hair used to resemble, when I was seven and the world was a magical, beautiful place.  Now the sparkle in my tangles reflects the life I have led until now, the highs and the lows, the love and the pain.  It becomes steel that guards me until the workday ends, and I come home to my safety.

When I get home from a long shift these days my head aches with the stories of others.  It used to be that my heart was shielded by a wall that I erected, when I worked as an ambulance medic through times of terrorism and fear in Israel.  I built that barricade when I realized how soft and sweet I was, how young and innocent, trusting and naïve.  I kept it up so that no one could interpret my emotion as weakness; I girded myself against judgement.  That fence around my heart became a dense thicket that kept the reality of medicine at bay; it forced the daggers of others’ suffering to turn away from injuring my soul.

When I became a mother, my carefully constructed mechanisms for shelter crumbled.  Exposed, I could no longer hide behind my shields.  I had to become open, available, unguarded.  My children needed access to all of me, so the armour fell away with a shiver.

Now, I am defenceless.  I am vulnerable.  My patients’ pain finds its’ way into me, and though I may not show it nor feel it during the moments I care for them, their journeys weave silver tendrils into the twists of my ponytail.

So, here I am at 41, and the weight of my life’s choices sit heavy on my heart.  I know I do what I do because I am good at it, and it makes a difference in peoples’ lives.  I save lives.  But I also change lives.  I am the face they see when a diagnosis is given.  It’s my voice that echoes in their nightmares.  It’s my hand that sits hot on their shoulder as I give a life sentence.  They meet me once, and I destroy their souls.  I know, it’s not me, I don’t cause the illness.  But I introduce them to their destiny.  In so doing, I chip away bit by bit at the parts of me that still believe in a higher power.  Every time I see a young person, an innocent, struck down with the lightning of fatal illness, I question.  When I read a radiology report of a new ovarian cancer in a thirty year old mother of three, I feel sick; when I used to raise my eyes to a heaven and ask why, I now look inside and wonder who I was asking to begin with.

41.  At the cusp of losing my faith, at the cusp of gaining my faith. It seems that life is not what I thought when I was seven.  It’s not simple.  And sometimes I wonder what it is at all?  Does what we do each day matter?  When I ask myself those things I feel a real fear, that all that I believed and all that mattered to me meant nothing.

Then, I look at my children.  My incredible, spectacular, interesting, innocent kids.  And I remember – they came from somewhere.  Somehow.  They make 41 the best age of my life.