A narrow window in a blank stone wall.

Living in Small Spaces

New York is gigantic but the apartments are small. The people are small but the crowds are large. The energy? It’s enormous. All-consuming, even.

Everything about New York is bigger than what I’m used to, except for the space in which people are expected to live. I find the idea of cities to be fascinating — in particular, the amount of effort and technology required to build a space that millions of people can live in. Cities don’t just happen. So many people living together would be a public health nightmare if it wasn’t for sanitation and other infrastructure efforts, all of which require thousands, if not millions, of dollars to build and maintain. Even still, cities are kinda a public health “bad dream,” if you will — with higher rates of mental illnesses and pollution, for example, not to mention the potential for contagious diseases to spread.

The fact that I will be moving to NYC in less than two weeks makes me wonder what life in the city will be like. It’s not just the fact that I, a 22-year-old woman who grew up in a town of <200 people (and since then has never lived in a city of more than million), will be moving to the largest city in the United States. I’m also moving far away from my friends and social supports, and away from the near-constant sun and heat to a city where, in the winter, the sun sets at 4:30PM. My poor plants may not survive the trip, and my cat will certainly hate me after she spends multiple days in the car.

So yes, there are certainly reasons I am terrified of moving to NYC. But I’m trying to think about the ways in which this will be wonderful experience, too.

Namely, I am excited to see how infrastructure works (and doesn’t work) in the city. It may seem so silly, to be as interested in infrastructure as I am, but I really don’t think we realize how much infrastructure makes it possible for us to live and be healthy. I grew up in a place with very little infrastructure. We didn’t have a medical infrastructure — no clinics, no hospitals, not even a single pediatrician in the entire county. The nearest ambulance was stationed over 10 miles away from my house. We didn’t have sewage or municipal water. We did have electricity, but the kind that a single tree or doomed raccoon could take out. Internet was a joke. People survived because there weren’t too many people living in the same square mile, but people also died — of suicide because of the lack of mental health services, in the backseat of a car flying to the hospital 23 miles away, of heart attacks because a train was blocking the only access some people had to the highway.

Keeping 8 million people packed 26,000 to a square mile is no small feat. But the truth is that cities — and the US in general — still fails to keep everyone healthy. Cities are home to paradoxes, like people dying of preventable causes in the shadow of the state-of-the-art hospitals, or mere streets separating people who can expect to live to 85 and people who can expect to live to 76. Some of our biggest advancements as human beings are in our ability to keep people alive, and yet we often manage to keep some people alive and healthy at better rates than others — and where we live often compounds upon this disparity.

New York is going to give me a much different view of healthcare than the one I received growing up in rural Texas. I realize that I have a relatively unusual chance to experience both ways of life — one intensely rural, the other intensely urban — while studying to become a physician that, hopefully, graduates with the tools needed to address failures in our healthcare system. I am very fortunate to have been one of ten students accepted into the Columbia-Bassett program at Columbia P&S, which has a curriculum dedicated to teaching students how healthcare is delivered — and how to intervene when this delivery is harming or denying care to patients. But I wonder how much knowledge this curriculum will impart in terms of infrastructure and how our societies are built, and how that affects our health in ways more profound than the healthcare we receive.

I will continue to look for ways to learn about infrastructure and how the world affects our health and well-being. A Master’s in Public Health, which I am strongly considering, might be a good way to start. But what about city planning? Business? Policy? Politics? Literature and education? There are so many sides to a problem like this that I don’t even know where to start. I’m hoping that this blog will be a good place for me keep track of my thoughts and lessons I have learned. I’d be honored if you would join me on this journey, and let me know any thoughts you have about these topics along the way. ❤️

Photo on Foter.com. Grayscale added by author.

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