For me, Election Day begins with a code.

Our patient, sprawled in the middle of the floor, seems frail next to the 200-lb paramedic who is performing chest compressions. A female supervisor is directing the well-coordinated resuscitation, and another medic is placing an airway. Along the room’s periphery are several lounge chairs, in which the other patients continue on with their dialysis treatments.  They don’t look as concerned as I might imagine, seeing as they are watching their future fate unfolding in front of them. After a few rounds of epinephrine and CPR, the medic feels a return of a pulse. The cardiac monitor now shows an organized heart rhythm where a flat line had once been.  In the past, cardiac arrest was largely seen as non-survivable, but thanks to scientific progress and organized training efforts, survival rates can be as high as 50%. We easily lift our patient onto the stretcher and let the hospital know we are on our way.

Later in the afternoon, I find myself in a downtown office, participating in a meeting with San Francisco Fire Department (SFFD) representatives and a multinational business team. Their members have traveled from Canada, India, Belgium, France, and China in order to learn from SFFD: how have they enacted change? Unified a diverse group of employees and interests? Adapted to unfolding disasters that don’t “follow the textbook?” Various statistics are bounced around, such as SFFD has the largest percentage of female uniformed members of any fire department in the country. After 90 minutes of discussion, we shake hands, exchange business cards, and joke about how crazy this election has been.

Although I leave the work day feeling like we are making progress, I feel an unsettling energy pulsating through the city, a quiet buzz of anticipation. The East coast polls are starting to close, but we still have two more hours left to vote.  By the time I get off the train in Oakland, the sun has set. There is a woman in a pantsuit passing out last minute fliers for a local candidate. There is a man in layers of dirty clothes standing on a pillar, preaching “The end is near,” and advising us to follow Jesus.

We bike to a neighbor’s house to eat dinner, drink a few beers, and watch the election results trickle in. She smiles as she greets us at the door, the light reflecting of the “Fight like Hill” pin that is attached to her “I’m with Her” shirt. We fill up our plates and find our seats.

But things don’t play out as we had expected. North Carolina, Florida, and Ohio go to Trump. Michigan and Minnesota also show him leading. I can’t believe this is happening. A woman with decades of international political experience and clear policy plans is losing to an unqualified, but vocal, reality TV star whose campaign has run on fear, hate, misogyny, and racism. This is not the America I thought it was. I’m genuinely scared of what this means for my patients and coworkers, friends, the economy, and humanity.

Where our path forward had seemed so clear just a few hours prior, it is now replaced by an uncertain future. Much like the dialysis patients watching as life slips away from one of their own, it feels as if we are watching as the destruction of America begins to unfold.  As I return home in tears, the protests begin. Garbage bins are lit on fire and windows are shattered. The nearby BART shuts down. Clinton continues to lead in the popular vote, but Trump is declared the winner.

The day after, there seems to be a cloak of mourning draped over Oakland. I wonder what teachers will tell their students. What parents will tell their children, especially their girls. I have flashbacks to all the times when I’ve been told that I can’t succeed because I am a woman working in a male-dominated field.

I wish I could end this essay with a nice, neat solution. A hopeful message. But I don’t have one. This election has shown me that as a country, we haven’t moved as far forward as I had believed. As such, we have a greater responsibility to use our position as medics, nurses, and physicians to be the change we wish to see in the world.  As providers in the safety net of the 911 system, we are uniquely situated to work for expanded access to healthcare, a more coordinated and multidisciplinary approach to illness and health, social justice, and equality.  We also have a valuable skillset to offer — we are used to practicing flexibility and adaptability when our patients’ conditions change.  So after taking pause to grieve, we need to get busy – we’ve got a lot of work to do.