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Baby Burrito MD, Austin, TX (2026)

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.

12/03/2025

And here’s Part Two of the Mortals in Medicine talk on Impostor Syndrome. The last part talked about the problem. This one gives 3 thoughts/tips/springboards to try and help with this feeling over time.

I can’t say that giving this talk means I’m all better. 😂 But I would say that it was good to consider how far I’ve come, and it was beautiful to hear other people’s stories. I felt a lot of solidarity with other medical people through this experience of sharing.

I hope that by sharing, maybe you’ll feel a little of that solidarity too.

12/03/2025

It’s Advent! And most years in the lead up to Christmas, I try to share some of what I’ve learned this year.

In May, I had the opportunity to share about impostor syndrome with a group called Mortals in Medicine, based here in Austin through the Center for Resiliency. I am told that I am often the kind of person who will use 0 words when 2 would do, and so this was a pretty big leap of faith for me. I was and am thankful for the support of my wife and my colleagues before, during, and after the talk.

I’ll share this in two posts. I hope it gives you something to think about. More to come.

10/01/2025

Last week I went to Guatemala with all of these crazy people at Operation KidDocs and Centro Moore. I’m still processing it all, and I’m sure I’ll write more about it soon. Lots of tonsils/adenoids, a couple sinus surgeries (with a urologic cystoscope and some orthopedic instruments), and so many good memories and new friends. My Spanish even improved… un pocito. One family traveled 9 hours to get their kid’s recurrently infected tonsils out. Pediatric Surgery and Urology also did a lot of real life-changing work on the trip.

After a little sleep and a lot of advil, I’m back at work in Austin. I thought my cold dead heart would quickly move on, but I think these kids and these people cracked it open a little and poured some life in. I’m thankful for that.

Also thankful that my daughter let me leave over her birthday for this. She made some bracelets for the kids, and they sent some gifts back to her. It has been very sweet.

09/15/2025

At the end of an appointment with my patient and their dad, the dad had “one more question.” He asked, “what do you think about ivermectin being offered over the counter?”

The tension in the room was suddenly palpable. I felt like I was being evaluated, but I also felt like he wanted to hear what I thought. I had actually helped his kid, after all, and I think that counted for something.

Everything is political these days, everything. There’s no sense in raging about it, that’s just how things are right now.

What I thought about in the moment was that the same crowd that is intensely interested in ivermectin is also very suspicious of the medical establishment. I have spent a lot of time and read many books trying to figure out why that is so, and I’m still not so sure that I understand it completely.

But what I do find as a common thread is that in this political morass that we’re in, it is always immediately tempting to use evidence as a weapon, to use expertise as control, to fall back on the authority that was sold to us on our job descriptions of being doctors.

And I have done that before, possibly. If you knew me through COVID, then you know how much I struggled (along with everyone else) during that time to know what to do and how to guide people I cared about.

At very least, we’re in a different time now than a novel virus epidemic. At very least now we can take our time to disarm and try to understand each other, rather than control each other.

And so I responded truthfully: “I don’t mind that ivermectin is offered over the counter, because it seems like a pretty harmless medication most of the time. Do I believe it has the benefits they say it does? No, not unless you have a parasite. Otherwise, it will give you diarrhea and that’s not too big a deal. But I don’t mind that you have access to it.”

The man nodded and thanked me for my opinion. I have no idea if I passed the test, but I felt good that I did not simply dodge the question, that I offered him the dignity of choice, and that I preserved the relationship. Maybe trust will come from that.

08/14/2025

We just got a new dog a couple days ago, and we’re all very excited. She’s already a great fit with us, and the kids are taking her on walks and taking on chores for her. We’re happy.

And in the midst of that, my wife and I have both mentioned this familiar feeling: what if the worst happens? Are we too happy?

Apparently there is a name for this feeling. Dr. Brene Brown calls it “foreboding joy.” Brown describes foreboding joy as a shield we put up against vulnerability. We tell ourselves we cannot be too happy or our hearts will be broken when it ends. I do think that’s true, but there’s more to it, at least for me.

At one point I thought it was merely cynicism or pessimism, something I thought was natural to me. It is that, yeah, and it’s what Michael Scott would call “not superstitious... but a little stitious.” It’s not just a shield but some level of searching for control. If I act a certain way, if I’m nondescript about my wants and desires, then the universe won’t take them away from me. Maybe it’s southern culture or maybe it’s Old Testament belief, but I’ve noticed it.

It begs a lot of questions, but one of them is what are we really responsible for? What are we really in control over? Can we protect ourselves or not?

I am trying to get to the place where I can admit that (1) I’m actually not in control of much at all, and (2) I can be ok with that.

Really, my main responsibility in this case is to take care of my family’s needs and health, in common sense, everyday ways. After that’s done, the only thing that’s left is to simply enjoy their company and the electric feeling of their excitement.

Everything is fleeting. Everything comes to an end. Someone once said that the most worry does is make you suffer twice: once while you dread something and again when it happens. Love coexists with loss all the time, and to love means to come to terms with that. I hope that learning to love will bring with it some happiness too.

04/16/2025

Resilience takes a lot of forms, and the word is deployed in many ways.

What I absorbed as I grew up was that resilience was the ability to withstand. All you had to do was stand still and take it, and you could be the strong and silent hero. Last man standing. It was very defensive and isolating, and I wonder if this is a case of winning a battle but losing a war.

Instead, as I mature and see my own limitations, I am reminded of something I learned in New Zealand. They have beech trees there that long ago scaled mountain sides and covered them. As the seed breaks open and the tree grows, its roots meet and intertwine with its neighbor’s. The neighbor’s roots help stabilize the soil and give the growing tree strength to stay in the rocky ground until it is ready to stand on its own and do the same for the next tree. This is how a beech forest climbs a mountain.

These days, this is where my resilience comes from. I do not stand on my own. My roots are intertwined with the roots of my family and coworkers and patients and weird internet people. I am supported by artists and authors from down the ages, who 100 years ago thought the same “original” thought I just had in the shower. My brain is shaped and wired much the same as yours and the same as so many others across the millennia.

My resilience does not come through isolation but by connection. Not by conflict but by open-hearted collaboration.

If I face hardship, then there is a strong chance that so many others have faced the same hardship and survived. Our roots span across family and borders and time and belief. Back and back, much farther back in time than we learned in school or church. We are a communal species, on the one planet we know that harbors such rare life and ubiquitous death.

I do not have to rely on my strength alone. I am held up by you, and you are held by me.

It is an honor to be alive on our lucky planet at the same time as you.

03/14/2025

Lately I have been looking for hope, and I found it in a place that annoys me frequently: the clinic room.

I have written about power and how I worry it defeats truth as an enemy. The clinic has its own power struggles sometimes. At times, a patient has maybe too high an opinion of their own medical knowledge, and sometimes the doctor has the same. Egos clash. What can happen?

I have had a string of these lately. And whether through skill or blind luck, I have put my ego down, only to see the patient reciprocate. And we meet there in the clinic, two vulnerable humans, laid open before our common mortality and the little we can do together about it.

It becomes a thin space then, a liminal encounter, full of the spiritual. What else can you call it? There is little other reason that we would meet, other than because of their problem that I have made my own, and because of my own fears that led me to this profession. And now here we are, bound for a little while.

To me, this is getting back to the fundamentals. Two people connecting over a common problem. Truth is here.

It is not scalable. It is not the answer to our society’s woes. But it is also not nothing.

The experience—day after day, with all sorts of different people—continues to change me in ways I am still learning about. Occasionally, I can see it and be grateful.

10/27/2024

Last week, I had the chance to have a really transparent conversation with someone at the very beginning of their medical career. These are chances to say to someone else what you wish someone had said to you.

Acknowledging they are just as likely to listen to you as you were to listen to some other old adult about life. 🤪

One of the things that this person wants to do is mission work, moving off to a distant country to work with kids. A very noble desire, very sacrificial, very mindful, very demure.

I know a lot of lovely people who sacrifice every day. So many are burnt out. A stubborn few keep going.

One thing we talked about was something I still discuss in therapy: that idea of nobility. It’s a deep magic, probably steeped in me by the baptismal waters of the church. An idea that the best of us give ourselves away to those less fortunate.

What I’m beginning to understand is that idea of nobility propped up my self esteem for a long time, when I had very little. I may not have been much, but I gave to others.

That sort of noble self esteem seems to me now a “near enemy” of healthy self love. A near enemy means something that we have been taught as ideal, but misses the true mark.

We talked about how sacrificing ourselves can be beautiful and even necessary in the short-term. But if we’re talking about a career that should last decades... in order to sustain that sort of effort over that sort of time, then we have to make choices that feed us rather than starve us.

To the idealistic, that seems selfish. But. If we can find a job that we are truly passionate about—or if we leave enough time and resources for some life-giving relationships and activity for ourselves along the way—then we can gain the sort of skills that can be used to help others while also retaining our own humanity.

It’s when we are filled up with dignity and love that we can provide compassion.

When we are starving for such things ourselves, then even when we give compassion, it often builds up a residue of moral resentment. So often, that will lead to burnout and a lack of self esteem, even when our intentions are so good.

07/11/2024

Despite our reputation, many surgeons are “nice” people, particularly when we started training.

And then we learned to be “mean” the same way a monkey is taught to dance, through a lot of pain.

Considering people still label me as “nice” (me: sorry I was mad earlier. Them: you were mad?), I’ve had time to consider this spectrum. And I reject it.

It’s just that “nice” and “mean” are trash-can terms that encompass too many things to be specific. Society can label someone nice in the same way a cat calls a mouse nice. And people are so quick to call someone mean when they finally start standing up for themselves.

Too many “nice” people are caught between (1) a lack of awareness or suppression of their needs and (2) an inability to ask for what they want. Usually there is societal and family pressures producing and enforcing both of those. The mismatch between those barometers over time can build up into a whole thunderstorm of rage and discontent.

That rage does not simply dissipate, not in my experience. It either explodes outward or it turns inward. Outward toward innocent bystanders or behind the backs of people/systems we should be facing. Inward toward depression and paralysis.

We have all sorts of voices telling us ways to change these barometers and why, and it’s maddening. Like many, I’ve been reading some stoic philosophy (tldr: you don’t need all the things people say you need) lately, which would adjust #1. While I feel it’s helpful, I can imagine the anger I would feel if a hospital administrator prescribed it for me. Meanwhile there are all sorts of campaigns telling us we should ask for what we want or grab it for ourselves—this is consumerist America, after all.

In the end, we have to work out a balance of these two. We have to identify our needs, find ways to believe in their validity, and we have to develop ways of comfortably and consistently articulating what we need in time for it to matter. Otherwise we subjugate ourselves below the powers of others.

We don’t want niceness. We want peace of mind, and that’s the way we find it.

Baby Burrito MD

12/07/2025

12/05/2025

12/04/2025

12/03/2025

12/03/2025

10/01/2025

09/15/2025

08/14/2025

04/16/2025

03/14/2025

10/27/2024

07/11/2024

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