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Well, 2022 finally came to an end, revealing itself to be a year of challenges, frustrations, changes, and successes.

Many have continued the fight to improve healthcare, to make sure that all of our patients get exactly what they need exactly when they need it, and I can only hope that we can move this even further in the year ahead, ultimately making all of healthcare so that no one should ever suffer for lack of access to the highest quality care because of their ability to pay.

I missed the last day of 2022 at work, felled once again by the effects of the new COVID-19 booster on my immune system. (I think I missed as much work from my vaccines and boosters as I did from my two bouts of actual COVID-19 illness.)

I scheduled the bivalent booster for right before work on Thursday last week, at the Workforce Health & Safety site across the street from my office. At the end of the day, walking home, I began to feel achy and flu-like, and by 10:00 that night I was desperate to get into bed and burrow deep under the comforter.

As with previous vaccines and boosters, I woke in the night multiple times with severe myalgias, feeling feverish, alternating burning up and unbearably cold, and developed congestion and a cough through the night. Early Friday morning, I woke up and texted my colleagues at work that there was no way I was going to be able to get in to the office and function in any reasonable manner at work that day.

I slept until 3:15 that afternoon, something I haven't done since high school, or at least maybe not since the last time I got a booster. Last night, for New Year's Eve, we had a quiet dinner with some friends -- after everyone tested negative -- and now I'm planning just a quiet day at home doing some chores and planning for the new year, both personally and professionally.

I've never been that big on New Year's resolutions, thinking that somehow that this arbitrary point in time where I suddenly decide I'm going to go to the gym every day or only eat brown rice and tofu for the next 6 months is going to change my life. That never seemed realistic. But the start of a new year can be a time to do some reasonable thinking and goal-setting about where we are and where we want to be, for the short-, medium-, and long-term horizons. Thinking about work, and change, and the mess that our healthcare system is currently in, it's fair to think about small changes, medium-sized interventions, and big wishes for things that need to change.

Every day at work, people stop by my office with an issue about something going on, some way we can work better, be it that our printers never seem to work, the insanity of us having to fax things around to other offices, prior authorizations for medical tests we want to do or medicines we want to give our patients, or the many ridiculous and seemingly insurmountable roadblocks put in the way of our patients, our staff, and our providers when trying to maneuver through the bureaucracy of modern healthcare. Then there is also the imbalance that we see when people get different levels of care because of their ability to pay, because of who they know and who they are, because of what kind of insurance they have.

Systemic barriers that run deep, as well as institutional biases with unclear origins and remedies, present a huge hurdle for all of us trying to take care of our patients. We need to double down on raising our voices to recognize where these injustices lie and how we can move them the heck out of the way -- and how we're not willing to take No for an answer.

I know that fighting these fights, these battles, can be exhausting. It can so often feel as if we're not making a difference. Nurses around the country are threatening to go on strike, healthcare providers are leaving the field in droves, medical students and residents are not choosing to enter primary care, and all of this lies on top of the incredible burnout and exhaustion that the pandemic has gifted us these past few years.

The old quote about insanity as doing the same thing over and over again and expecting a different result often feels like it sums up our lives in healthcare, and the critical battles we choose to take on to try and make things better, to fix these injustices. But if we don't do it, if we don't keep standing up and raising our voices and demanding change, then who will?

Never stop fighting for what is right.

Wishing you all a safe, healthy, and happy new year in 2023.

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