nANIMOv

It all started with a bang

The Big Bang to be precise

From an infinite singularity, all of existence exploded into being

For why and for what is anyone’s guess

But from that moment, every particle, every atom that creates the world we know, shot out in every direction imaginable

Each off to their “forever” yet entangled (at least for a time) with one another by their birth

Particles moving, colliding, interacting — seemingly random — caught in a stochastic waltz.

But there were rules to this dance.

Order in entropy.

Rules that made some interactions more likely to occur and others damn near impossible.

Rules that can be boiled down to one simple idea: save your energy, don’t work too hard

And with this commandment, matter settled into spheres, creating the stars, the planets, the moons (don’t tell me about asteroids)

Not out of ambition, but because the rules of the universe saw it energetically favorable to do so

When I look up at the night sky, I can’t help but admire this lazy intentionality that created the cosmos.

I then think about the matter that makes up my own body.

Which somehow organized itself into cells, each containing a microcosm whose complex processes seem far removed from that original directive

But the rules never changed

So each replication of my DNA, each translation of a protein, each impulse sent down every nerve, across every synapse

Every movement, every thought, every feeling,

is just particles arranging themselves at random, but in accordance with the laws of that same lazy universe.

Out of all that motion, all that statistical noise, and infinite “forevers”

The universe found it favorable to bring us here

To this moment

To you and me

I’ve been struggling a lot thinking about the role AI will play in the future of our world and in my own life. On one hand it is a remarkable tool that can be used to help people. On the other hand it’s having negative impacts on the environment, fundamentally changing the workflow of nearly every industry in some way, and subtly changing how we interact with each other as humans.

AI has become so good at imitating human language and creating hyper-realistic images further blurring the lines between whats “real” and what’s manufactured. It’s in this landscape that I find myself more and more actively seeking out human authenticity, and what I often find that equates to is authentically human “mistakes.”

Not 100% sure what I mean by this. I think part of it is similar to how we purposefully undo autocorrects when texting. Texting is inherently inhuman. We lose a lot of the emotion and non-verbal cues that come with face-to-face interaction. Having abbreviations, emoji, phonetic spellings, beats, help bring some humanity back to the cold medium that is texting.

I was at a game night with some friends and we were playing Bananagrams and one of my friends had the idea of playing a version where every word had to be a misspelling or slang version of a real word. This was one of the most fun I’ve ever had playing Bananagrams, and honestly probably more fun than a lot of actual board games I’ve played recently. It not only required individual creativity from each of us, but a shared imagination (one of the most human qualities I can think of) for us to understand what each person is trying to say despite the “mistake,” and while this definitely was not the intention or active thought behind this version of the game, I think that’s a big piece of why it was so fun… it felt human.

The pandora’s box that is AI has already been opened and there is no stuffing it back in. This isn’t the first time that technology has threatened our human identity and challenged our ideas of what it means to be human.

Similar to how the camera contributed to a creative liberation-of-sort for artists to depict the word through an “anti-real” lens (e.g. impressionism, cubism, abstraction, surrealism), I feel like AI is going to lead to a revolution in human experience as we make a desperate attempt to declare our humanity in a era of increasingly convincing imitations.

Entering 2026 after having now completed my 30th lap around the Sun, I feel like I ought to have things figured out by now. That’s 30 years of experiences, 30 years of mistakes, 30 years of lesson that I should have learned. But to be honest I don’t feel all that different than I did 5, 10, or even 20 years ago (at least from what I remember). I still carry with me a lot of the same insecurities. I still have a lot of social anxiety. I still fall pray to bad habits. I am still afraid of making mistakes, and I still do make mistakes.

What has changed is how I’ve learned to deal with these feelings and these fears. I’ve learned to give myself a bit more grace and I’ve come to some understanding of why I am the way I am (some bits in more depth than other bits). I’ve learned that overcoming these things isn’t a one-time battle, but a lifelong struggle. I don’t feel different because I am a work in progress, constantly growing and changing, hopefully for the better.

There is a lot going on in the world right now, especially as of this writing on January 3rd, 2026. But I wanted to make sure I took a second to reflect on my own headspace before I go out and concern myself with others and with the world. Am I where 5-year-old Niko thought he would be at 30 years old? I don’t think so (though to be fair 5-year-old Niko had a lot of crazy ideas). Would I go back and change things if I could? I think it’s a worthless exercise. I’m a product of my choice and my decisions, and I’m content with who I am today. I of course still have room for growth, but chasing that potential in balance with an appreciation for the present moment is one of the beautiful challenges of this life.

Working in healthcare, especially with everything going on with the new CDC vaccine recommendations, is a little scary and frustrating. A few things have come up for me as I listen to the things anti-vaxxers say and how some people in the medical community respond. One that has been on my mind is whether it is worthwhile to debate conspiracy theorists and some of these staunch anti-vaxxers. The common argument is that it’s not worth it. You are not going to change their minds, and you are giving a platform to baseless and completely meritless ideas. The cynical part of me agrees with this and thinks there are more valuable ways to spend time and attention.

That said, I’ve always wanted to believe in the better nature of other people, and I do believe that at each person’s core is someone who wants to do good based on the information (and intellectual capacity) they have at a given moment. And that anyone can be convinced of anything with enough information (one way or another). The idea that someone’s perspective is beyond reproach or without merit is, I think, arrogant and contributes to a harmful culture of discourse, something that I think significantly plagues progressive movements. Progressive ideas are heralded (by progressives) as these absolute moral high grounds, and if you don’t agree with them, you are a “shit person,” which is usually not the case.

Some of the words of Dr. Paul Offit, vaccine champion and legend over at CHOP, helped sway me back towards the idea that it is worthwhile to debate the “undebatable.” He argues that these are not opportunities to convince the “undebatable” person, but rather to educate those who witness the debate.

There is a Jubilee series (which is somewhat controversial) called Surrounded, where 1 person from one POV takes turns debating 20(?) people from the opposing (often at the far extreme) POV, or vice versa. People make the argument that I mentioned about giving a platform to meritless ideas. I was watching clips from one of the recent episodes with Dr. Mike vs. MAGA/RFK Jr. people. At least from the clips I saw (I still need to watch the whole thing), Dr. Mike does a good job of addressing the concerns of the people without being judgmental or condescending. He finds common ground and areas of agreement and then builds his arguments from there. He acknowledges the validity of people’s concerns and fears, which is key—if not for the 20 people in the room, then for the millions of people who are watching at home. I imagine the Jubilee viewership is predominantly left-leaning, but based on the comments, there are some viewers from the extreme other side that likely will not be convinced. This indicates to me there are more moderate people in between that may be swayed if Dr. Mike did a good job, because, at the end of the day, I do believe that facts and consistent reasoning win out in the hearts and minds of most people.

When I am in clinic talking to patients and parents about vaccination (either childhood vaccines or adult vaccines), there is no audience watching that I am trying to convince; there is only the patient (or parent) in front of me. I will say a huge number of them are not open to discussion when they decline vaccines. They don’t have questions; they don’t want information; they just say no. While that is within their right, I can’t help but think about if there is anything I can do to create a more open environment in which they would be comfortable enough to share their fears or help me understand their point of view. A lot of that comes from trust that is built over a long time, which is hard to do as a resident, but I will keep trying.

There is so much going on in the news right now, in particular with respect to the federal government, and idiotic things that are happening that feel so backward and that seem to defy all rationality and logic, making it feel like we are living in the darkest timeline.

For someone like me who has lived a relatively privileged life (through the work and strife of my parents and their parents before them), the impacts of some of these actions and threats are minimal. And as has always been the case throughout human history, this makes myself and people with similar privilege susceptible to an attitude apathy towards terrible things happening around the world.

One of things that makes us human though is our ability to not only empathize (which itself is not a uniquely human trait), but to empathize and have compassion for people and things beyond our direct human experience, to anticipate needs and suffering, and to abstract the experiences of others.

However to do any of that we need to open ourselves up to the lived experiences of others. That is why it’s so important for people with privilege and people with power to be cognizant of what is happening in the world and to engage in community outside of their usual spheres.

I have patients who are dependent on SNAP. I have patients who are afraid to come to their clinic appointments because of ICE. I have patients who refuse to get vaccinated because they were told it would make them sick or parents who refuse to vaccinate their children because they were told it would give their child autism. I have patients who are going to lose coverage for life saving medications. I have patients who have uncontrolled chronic illness because they have the competing priority of just trying to stay alive on the streets.

These stories from the clinic and from the hospital and the stories I hear with street medicine and when I’m out in the community are reminders of how much work we have to do.

Being a resident training in both internal medicine and pediatrics, I often feel like I am behind my categorical colleagues. Throughout my first year-and-change as a doctor I have had about half the amount of direct clinical time spent with adults as the internal medicine residents, and the same can be said on the pediatrics side. And it certainly does not help that I spend the majority of my time working along side categorical residents who are all so brilliant and quick, making void that I perceive to exist between us even greater.

I recently watched a TedEd video based on a Ted Talk about how most people become “good” at something. The speaker David Epstein argues that there are multiple paths to mastery and in many cases it can involve a meandering journey and a breadth of seemingly unrelated/ indirectly related experiences. He brings up this concept of frogs, who spend their time down in the mud seeing things in great details and birds, who may not see all the minute details but integrate a wider point-of-view into a cohesive picture.

As someone who has always had a wide variety of interests (and sometimes a short attention span), this resonated with me, especially as the world feels like it is becoming increasingly focused on specialization, with medicine being far from an exception to this.

I went into Med+Peds because I love to learn. I wanted to continue learning the art and practice of medicine for both kids and adults. Because I like tying together disparate ideas and experiences together and to think of problems from various perspectives. So on days like this when I’m feeling particularly inept, it just a good reminder that my journey is my own.

I really wasn’t sure what to expect when traveling to Singapore or Malaysia. This whole trip was kinda very loosely planned with minimal expectations.

One of the most interesting things from this trip was learning about the pre-colonial, colonial, and wartime histories of these countries and their respective paths to independence and current trajectories.

Part of that history is preserved in the buildings of these cities. You have ultramodern skyscrapers right next to old shophouses with architecture from multiple different cultures. I particularly loved wandering around Georgetown in Malaysia. In many ways it felt like a city frozen in time, as if my experiences walking those streets wasn’t too far off from the experience of people 50+ years ago (of course minus the all the cars and other modern technologies). But then when I entered the various shophouses lining the streets I never knew what to expect. Some embraced the rustic charm with distress walls (some with more intentionality than other) and handmade furniture. Others were portals back to the 21st century with minimalist, concrete interior design and chrome fixtures. There was so much creative use of these old spaces that were now being reclaimed for use in the modern era.

Just because something has been around long time, does not mean that it needs to stay the way it was from when it was created. The worlds changes, people adapt, ideas evolve. That said, the past is full of opportunities to learn and grow, and in that way can never be fully be rejected, but instead can be reclaimed.

This is my last week on pediatric pulmonology. Something a lot of people say when you are applying to a pediatrics residency is, “Wow how can you do that, it must be so sad.” And it’s true, we see heartbreaking stories and children with severe, debilitating, sometimes terminal diseases all the time. But we also get to be participants in stories of intense joy and hope.

During this rotation I’ve had a chance to work with a lot of patients with cystic fibrosis (CF). These patients often can get very sick. There was one patient who I had a chance to see a few times in clinic and peripherally once in the emergency department. He is only about 6 months old around the time I’m writing this, but in his first few visits after he was born he just wasn’t gaining weight the way we would expect. He got admitted a couple times because of this, but his poor weight gain kept being attributed to poor feeding at home. Eventually he did get a work-up and diagnosis of CF, but it took way too long and something that I will continue to reflect on and think about throughout my career. I serendipitously had a change to see him in CF clinic while on this rotation and see him now getting proper treatment and growing well and looking healthy fills my heart so much.

We have another kid on the inpatient side who came in very sick and just has severe pulmonary disease due to his CF. He is only 3 years old. When I first saw him and he was still early in the course of his acute illness, he was just not a happy camper, understandably. Over time I’ve gotten to see him perk up and be more playful and interactive. Today he wanted to borrow my stethoscope and wanted to listen himself and then listen to me. He’s been smiling and happy, saying hi to us and bye to us enthusiastically these past few days and I just melt.

It’s these stories that keep me going. Especially for these kids who spend so much time in the medical system, in and out of clinic appointments and hospital stays, we as medical providers have an opportunity and privilege to try be a part of their reality, and hopefully bring some joy into situations that others may see as tragedy.

Telling you how I really felt
would only making letting you go that much harder.

But for you, when I say dude
what I mean is, I want to be the mirror that reflects the light from your bright, starry window.
What I mean is, I want to turn you into my first tattoo so I can keep you clinging to my arm.
What I means is, I want to be the story hidden in your perfect smile.
What I mean is, I want to lift you up to scale the wall to your future, even if it’s a place I can’t follow.

So for now I’ll wave to you from down below
twisting my mouth into a smile of my own
to keep my heart from calling out.

I’ll put a dream catcher above my bed
laced with magic from when we met
in hopes that your energy finds it way back to mine.