In late summer, in the vineyards around Fresno, raisin grapes are cut by hand and laid on sheets of paper on the ground between the vines, where they dry in the sun for two or three weeks. The San Joaquin Valley grows almost all of the raisins produced in the United States, and for a few weeks each year a good share of that crop lies out in the open, in long rows, being turned slowly into something that will keep. There is an obvious comparison to be made with resident physicians, and I intend to resist it. The conditions are similar. The heat is comparable. I will leave it there.
I came to Fresno in 2008, after my intern year at the University of Arkansas for Medical Sciences in Little Rock, to complete my second and third postgraduate years with UCSF Fresno at Community Regional Medical Center. Put like that, it is a sequence: one year done, two to go. Sequences are how a curriculum vitae thinks. They are not how a person arrives anywhere. A completed year is evidence of work, and it promises nothing about whether the next stage will feel like a continuation of the last. What interests me now, eighteen years on, is the slower process the sequence leaves out: how a place that was first a training site, a hospital and a set of roads to it, becomes a place one knows, and what a doctor’s work allows him to see of it and what it hides.
I should say plainly what this essay will and will not claim. It does not describe an arrival day, a first apartment, a first drive into the valley or a first patient, and it does not say what the man who came in 2008 expected or planned. Those would be easy to supply and impossible to stand behind. What I can offer is what the years since have taught me about the act of learning a place, which is a subject with more in it than a scene would hold.
The Second Beginning #
Beginning again is different from beginning. A first beginner has nothing to unlearn. A second beginner arrives with experience, and some of it travels well. The rest turns out to have belonged more closely to the place where it was learned than he had realised: how a particular hospital ordered its day, which questions it expected to be asked and which it considered settled, where it kept its information and whom it trusted to retrieve it. Sorting the portable knowledge from the local kind takes time, and it cannot be done in advance, because the only way to discover that a habit was local is to carry it somewhere it does not fit.
The portable part is real, and worth naming so as not to make a second-year resident sound less prepared than he is. The grammar of examining a patient travels. So does the structure of a presentation on rounds, the habit of checking a dose twice, the instinct that a patient who looks wrong usually is, the knowledge of which complaints deserve haste. An intern year teaches a doctor how judgement degrades with fatigue, and that lesson travels with him. In all of these the second hospital is simply another room in the same house.
The local part is less visible and more humbling, because it concerns the world outside the hospital rather than the work within it. A plan made at a bedside has to be carried out somewhere, and the somewhere is a region. Which towns lie an hour’s drive away, and whether a patient from one of them can return next week. Which clinics serve which communities, and in which languages. Which roads close or slow in winter fog. How the agricultural calendar bears on when a person who works in the fields or the packing houses can afford to come back. Which pharmacy in a small town is open on a Sunday. None of this is medicine in the textbook sense, and all of it decides whether medicine reaches the person it was meant for. A resident who knows a great deal about heart failure and nothing about the distance between a hospital in Fresno and a farm town on the valley’s west side knows half of what his plan requires.
Every hospital has heard the sentence At my last place, we…, and every hospital has developed a facial expression for it. The sentence is most tempting in the second year of training, when a resident has exactly one previous place and it has not yet been diluted by others. A beginner is tempted to borrow confidence from the appearance of knowing. A slightly more experienced doctor faces a subtler temptation, which is to let the previous year answer questions that still need asking. Either way there is little room left for the hospital actually in front of him. A different way of doing something is, at first, an invitation to curiosity. It need not become a contest between old and new, and the new place is not right merely because it is the one he is standing in.
There is a dignity in being a beginner at the next thing, when the next thing matters enough to deserve fresh attention. Familiarity has to be earned again in every new building. Earning it a second time is less frightening than the first, and in one respect more humbling, because one had expected it to be easier.
Learning the Year #
A place becomes home slowly, and the process, I think, has less to do with addresses than with time. One learns a place by learning its year, and one learns the year less by its scenery than by its consequences.
Fresno’s year is written in agriculture and weather. The summers are long, hot and dry, with many days above a hundred degrees Fahrenheit, and the paper trays appear in the vineyards at the end of them. For the weeks the grapes lie drying, a whole industry watches the sky, because an early rain on the trays can spoil a crop that was perfect the day before. Heat in a valley like this is not a mood. It changes when work begins and ends, when errands are run, which hours are lived indoors, how far an older person will walk to a bus stop in the afternoon. The law has learned this calendar too. In 2005 California became the first state to adopt a rule protecting outdoor workers from heat illness, requiring employers to provide water, shade and rest, and the rule has since been strengthened. A regulation of that kind is local knowledge written down. It records that in this place, in these months, the ordinary conditions of work are themselves a hazard, and it makes someone responsible for that fact.
Autumn comes late and leaves early. Then, from November through March, the valley has its fog season: tule fog, named for the tule reeds of the wetlands that once spread across the valley floor, a dense ground fog that forms on still winter nights and can cut visibility to less than six hundred feet, sometimes changing abruptly from one stretch of road to the next. The fog too is learned by consequence. It sets the speed of a morning drive, delays school buses and deliveries, closes the distance a person can see to the length of a few cars, and then, by midday, may lift as though it had never been.
In the middle of February the orchards east and south of the city begin to flower, almond and plum and apricot and peach, and the county marks a driving route through them called the Blossom Trail, whose season, by the county’s own account, usually runs from mid-February to mid-March. It is very beautiful, and a newcomer who has learned the valley from its summers can be ambushed by it. That beauty has a literary history worth keeping in mind. The twenty-fifth chapter of Steinbeck’s The Grapes of Wrath opens with the sentence “The spring is beautiful in California,” and spends a page on blossom and on the skill of the men who graft and prune. Then it follows the same fruit to harvest in a year when prices are too low to pay for picking it, and describes the fruit left to rot while the people who might eat it go hungry. Steinbeck’s San Joaquin was the valley of the 1930s, and the economy he described is not the economy of today. But the shape of his chapter is a permanent warning to anyone who writes about this place. The blossom is real, and it is also the surface of a working landscape. To describe the one without the other is to treat a region as a postcard.
After a winter storm has scrubbed the air, the Sierra Nevada can appear to the east, white and startlingly close, as if it had arrived overnight. It has been there all along. The haze was simply in the way. No image of the valley seems to me truer to the experience of learning it. A great deal of what a newcomer eventually sees was present from the first day, and became visible only when the conditions changed.
None of this is remarkable to people who grew up here. To a newcomer it is a curriculum, and the curriculum has no shortcut. You cannot learn the fog in July. A place starts to feel like home, I suspect, at about the point when its calendar begins to run inside a person without consultation: when the first fog of the season is unsurprising, and the bloom is expected rather than discovered.
Through the Hospital’s Doors #
A resident encounters a city through an unusual set of doors, and Fresno’s own literature has a book about exactly that kind of knowing.
William Saroyan was born in Fresno in 1908 to Armenian parents, and as a boy he worked for a time as a telegraph messenger. The Human Comedy, published in 1943, sets that work in a town called Ithaca, California, which is Fresno lightly renamed. Its hero, Homer Macauley, is fourteen, and he carries telegrams during the war, some of them from the War Department to mothers whose sons have died. Homer learns his town through the doors he knocks on, and he knocks on many of them at the worst hour those houses will ever know. Saroyan does not let that hour stand for the town. Around the telegrams he builds a world of ordinary comedy and kindness, a small brother who watches trains, an old telegrapher who drinks, neighbours, a library, a race at school. The book’s sentiment has not worn equally well everywhere. Its moral shape has. The boy who sees Ithaca’s grief must also be shown, and must learn to see, that grief is not what Ithaca is.
A hospital is a building full of such doors. It makes certain parts of a region intensely visible: the person who has become ill, the relative who can arrive only after work, the practical problem that has grown large enough to enter a medical conversation. Other parts it does not show at all. The people who are well, the ordinary weekday, the arguments and celebrations and friendships that make up most of anyone’s life, none of these come through the emergency department. A hospital can teach a newcomer a great deal about a place while encouraging the illusion that he has seen the place whole.
It also teaches geography in a peculiar order. A large hospital in a valley city draws patients from towns across several counties, and a resident learns the names of those towns as addresses before he has seen most of them: Selma and Sanger, Reedley and Kerman, Mendota and Firebaugh on the west side, Madera to the north. The region assembles itself first as a list of places people come from when they are ill, with the distances between them measured in the time it takes a relative to drive in after work. It is a real map, and it records something true about how far care can be from where people live. But it is a map drawn by misfortune. The towns on it have football games and harvest festivals, family businesses and city councils and arguments about water, and none of that appears on an admission sheet.
Even the city’s name is local knowledge of this kind. Fresno is Spanish for the ash tree, after the ashes that grew along the San Joaquin River. The fog is named for reeds that most people here have never seen standing in a marsh, and Tulare County and its lake take their names from the same reeds. A newcomer learns these names as labels. Only later does he notice that each is a small record of what the land was before it was farmed, and that the valley has been describing itself, in its place-names, all along.
The illusion of having seen the whole has a professional form, and I think it is the strongest objection to any physician’s account of a region, including this one. A doctor writing about the Central Valley is tempted to let his patients stand for it: the farmworker for the farm economy, the patient who came in late for the arithmetic of wages, the person without a car for the geography of poverty. Each of those portraits may be accurate. Together they make a region look like a set of problems awaiting treatment, with its people cast as illustrations. The people who need care are not illustrations of a region’s difficulties. They have lives in which the hospital may be a brief and unwelcome interruption, and their work, preferences and opinions do not exist to explain the Central Valley to a visiting doctor.
I can see three kinds of knowledge mixed together in what I know of this place, and they ought to be kept apart. There is what I learned in and through institutions, which is partial in a particular direction. There is what I have read, history and literature and the work of people who studied the valley properly, which is borrowed. And there is what I have absorbed simply by living here for many years, which is ordinary, unsystematic and in its way the most reliable. A physician who writes about a place owes his readers some honesty about which of the three he is drawing on at any moment.
What Work Is #
The other great Fresno writer is a poet who came from somewhere else, and whose example complicates the idea of arrival in a way I find useful.
Philip Levine was born in Detroit in 1928, worked in its car factories as a young man, and came to Fresno in 1958 to teach at what is now California State University, Fresno, where he taught for more than three decades. He became one of the country’s essential poets of work. His collection What Work Is won the National Book Award in 1991; he later served as Poet Laureate of the United States, and he died in Fresno in 2015. What strikes me is where his most famous poems are set. The title poem of What Work Is takes place in Detroit, in the rain, in a line of men waiting outside a Ford plant for the chance of a day’s work; the speaker thinks of a brother he loves and has never told so, and the poem turns its title against the reader at the end: “you don’t know what work is.” That book was written by a man who had lived in the San Joaquin Valley for some thirty years. For much of his life in Fresno, Levine’s imagination kept returning to the city he had left.
I do not read that as a failure to belong. I read it as an honest picture of how belonging works. A person can live in a place, teach in it, build a life in it, and still have his deepest material elsewhere, and the place can still be home. Arrival is not a single event that either happens or does not. Levine did write about the valley in time, and his classroom at Fresno State shaped a generation of poets from the valley itself, among them Larry Levis, who grew up on a farm near Selma, and Gary Soto, who was born in Fresno. A place is sometimes repaid by a newcomer in ways he would not have predicted, and over a span of decades rather than in the first year.
Levine’s line also turns against a doctor, and I would rather hear it than not. A physician learns a great deal about work from its injuries: the back that gave way, the heat a body could not shed, the cough after a season in dust, the shift missed for an appointment and the wages lost with it. That is knowledge of work’s cost, gathered at the moment the cost is paid. It is not knowledge of the work itself, of its skill and pace and pride and tedium, of the hours that did not end in a clinic. A doctor in an agricultural region who knows what work does to the body may still not know what work is. The distinction is a useful humiliation. It keeps clinical knowledge in its place, which is a real place and a narrow one.
A Valley of Arrivals #
Fresno is a city made largely by people who came from elsewhere, and its literature knows it. Saroyan’s earlier book, My Name Is Aram, published in 1940, gathers stories of a boy growing up among the Armenians of Fresno, who had been arriving since the late nineteenth century and many of whom took up vineyards and orchards around the city. In the first story, “The Summer of the Beautiful White Horse,” the boy and his wild cousin Mourad keep a farmer’s stolen horse hidden for weeks, riding it at dawn; when the farmer, an Assyrian named John Byro, comes upon it, he studies the animal, says it is the twin of the horse he lost, and declines to believe that a family famous for its honesty could have taken it. The boys return the horse. The story is a comedy of poverty and pride, of a community that defines itself by its honour in a place that did not always honour it. It is told from inside. Nobody in it is an example of anything.
That inside view is what an arrival cannot have at first and may spend years acquiring. The valley holds many such communities, Armenian, Mexican, Japanese, Portuguese, Hmong, Punjabi and others, each with its own decades of arrival, its own losses and its own map of the city, and a newcomer’s first map of Fresno contains none of them. They appear gradually, in shop signs, in names, in the churches and temples on the edge of town, in the languages heard in a corridor, and they appear as neighbours long before they can be understood as histories.
One of those languages is mine. Punjabi Sikhs have farmed in the Central Valley since the early twentieth century, and the community has grown a great deal since; a recent estimate puts the number of Sikhs and Punjabis in Fresno County at about forty thousand, and the Central Valley has some fifteen gurdwaras. That history deserves its own telling, and it will have one elsewhere on this site. What belongs here is smaller. In a county where tens of thousands of people speak Punjabi, my first language is not a private keepsake; it is in public use, in shops and gurdwaras and on the street. A familiar language lowers a wall, and it also sets a trap. It invites a newcomer to assume a kinship and a sameness that are not there. The Punjabi spoken in the valley belongs to people who came in different decades, from different districts, by different routes, some of them through Canada or Britain and many of them born here, and their relationship to Punjab, to faith and to each other is their own. Hearing one’s mother tongue in a hospital corridor in Fresno is not hearing Amritsar. It is hearing a language at home somewhere else, with its own valley vocabulary, and it has to be learned as a local language too.
The landscape sets a similar trap for a newcomer from Punjab. The Majha, where my family’s roots are, is canal country, a flat plain of wheat and rice watered by channels cut from rivers, and the San Joaquin Valley is a plain of orchards and vineyards watered by canals carrying snowmelt from the Sierra. Both are hot in summer and foggy in winter. A person from one can find the other uncannily legible: the straight roads, the irrigation ditches, the anxiety about groundwater, the rhythm of a farm year. The resemblance is real. It is also a source of error, because resemblance invites one to read a place with the categories of another. The valley’s water comes from different rivers under different law, its crops are sold into different markets, and its fields are worked by people whose histories are not Punjab’s. Recognition can begin understanding without replacing it, and a landscape that looks familiar may take longer to learn than a strange one, because one stops looking sooner.
Arrival is a word that needs care in this valley, because the valley was not empty when the arrivals began. The Yokuts peoples lived on the valley floor, along its rivers and around the great tule marshes and Tulare Lake, for a very long time before Spanish soldiers, American settlers and the railway came, and the foothills to the east were the home of other nations. The marshes that gave the fog its name were their country, and most of that country was drained and ploughed within a few generations of the newcomers’ coming. A city of immigrants tells its history most comfortably as a succession of arrivals, each welcomed or resisted by the ones before. The older history is a reminder that a valley can be someone’s home long before anyone writes it down, and that beneath the story of how newcomers came to belong lies a story of how others were made to belong less.
The Partial City #
A resident’s city is a partial city. For three years it consists largely of a hospital, a route to it, a place to sleep and a few errands fitted into the hours between. That is not a complaint; it is the nature of the work, and it is shared by everyone in training. But it means that a resident can live in a city for some time and know mainly a commute.
A place on a commute and a place one has entered as a neighbour are different things. The first is a sequence of landmarks seen at the same hour, usually early or late. The second has weekdays and weekends, seasons of its own, opinions, quarrels about its future. Fresno in 2008 had all of these, and few of them would have come through a hospital door. That summer, Fresno State’s baseball team, an unlikely contender, won the College World Series, and the city celebrated something that had nothing whatever to do with illness or agriculture. That autumn the housing collapse spreading across the country fell with particular weight on the Central Valley’s newer neighbourhoods, and in November California’s voters approved bonds for a high-speed railway whose route would run through the valley and through Fresno. Downtown, the Fulton Mall, a pedestrian street laid out with fountains and sculpture in the 1960s, was still closed to cars. These are the facts of a civic year, of the kind that residents of a city argue about at dinner. They are not medical facts, and that is their value. They are the city’s own calendar, running beside the hospital’s.
The distinction matters for what belonging can mean. Knowing how to move through an institution is one achievement, and a resident gains it quickly because his days depend on it. Becoming less certain that the institution is the centre of the surrounding world is another achievement, slower and less often rewarded. It means recognising when a person is a neighbour rather than a case, and when a familiar language is part of someone’s ordinary life rather than a cultural clue to be interpreted. It means allowing a place to exceed the questions one’s work teaches one to ask. A physician can go on learning that second thing long after residency has ended, and probably has to.
Fresno also has a monument to the problem of arriving, though its builder would hardly have called it that. Early in the twentieth century a Sicilian immigrant named Baldassare Forestiere bought land north of the city intending to grow citrus, and found beneath the topsoil a hardpan that would not take an orchard, and above it summers that drove him underground. Over some forty years he dug a warren of rooms, passages and courtyards beneath the surface, cool in the worst heat, and planted fruit trees in pits open to the sky, so that their roots live below ground and their crowns reach the light. The Forestiere Underground Gardens are now a historic landmark. I do not want to make the man a symbol; he was a person with his own reasons, and the gardens are a strange and particular achievement. But no image I know captures better the difference between looking at a place and learning it. He did not wait for the land to suit him. He found out what it was, and made a life in the form it would allow.
The Line Seen From Here #
Seen from 2026, the dates make a tidy line: Fresno for residency from 2008 to 2010, practice in California from 2010 onward, Fresno still my home. Such lines are drawn afterwards. They credit the newcomer of 2008 with a plan he may never have had, and they erase the uncertainty that is part of any second beginning: whether the place would suit, whether the work would continue, whether the city was a stage on the way to somewhere else. I cannot honestly say what that newcomer believed, and I would rather leave his uncertainty intact than tidy it into a destiny. A place can become important before a person knows how long its importance will last. That may be the usual way.
Kierkegaard put the difficulty in his journal in 1843: life must be understood backwards, but it has to be lived forwards. The sentence is usually offered as consolation. I read it as a caution about authority. The backward understanding is real, and it is mine to give; it is not evidence of what the person living forwards knew. When I say that Fresno became home, I am describing a pattern visible from 2026, and the man of 2008 is entitled to have lived without it, as everyone lives, a year at a time and without the ending.
The city has drawn its own lines since then, and they are no tidier. The railway approved in 2008 has concrete viaducts standing in and around Fresno, and is still being built. The Fulton Mall reopened to traffic as Fulton Street in 2017, after a long argument about whether a pedestrian landscape could be both preserved and made to work. In the spring of 2023, after heavy winter snows, the water returned to the bed of Tulare Lake to the south, once among the largest freshwater lakes in the western United States and long drained for farmland, and for months the valley’s older geography reappeared beneath its newer one. Even the fog has changed. Researchers at the University of California, Berkeley reported in 2014 that winter fog in the valley had become markedly less frequent over the preceding three decades, which matters to the orchards that depend on winter chill. The calendar a newcomer learns is not fixed. It was already changing while he learned it.
That is the deeper lesson of a place learned by its year. The year itself moves. Learning it is not something one completes and then possesses; it is a relation kept up by attention, and it lapses if attention lapses. A person who has lived somewhere for two decades can still be wrong about it in ways a newcomer would not be, because he is measuring the present against a version of the place he fixed some time ago.
A Place Learned More Than Once #
Punjabi has two verbs that English would translate in much the same way. ਰਹਿਣਾ (rahiṇā) is to stay or to live somewhere, and it is what one uses to give an address. ਵੱਸਣਾ (vassṇā) is to dwell or to settle, the verb for a village that is inhabited and thriving, and it carries a sense of flourishing that rahiṇā does not. Its opposite is ਉੱਜੜਨਾ (ujjaṛnā), to be deserted or laid waste. A common Punjabi blessing, ਵੱਸਦੇ ਰਹੋ (vassde raho), wishes a person to go on dwelling in this fuller sense, as though a person, like a settlement, could be inhabited and alive. One can rahiṇā in a place from the first night. To vassṇā there takes years, and it is not entirely in one’s own gift. The place has to let you.
I think a physician comes to dwell in a city partly through his work and partly in spite of it. The work gives him doors into the lives of strangers that few other people are offered, and it gives him a usefulness that is a real form of belonging. It also tempts him to mistake those doors for the city, and to see the region chiefly as the sum of what goes wrong in it. The correction comes from outside the work: the fog that is merely weather, the team that wins the tournament, the language heard in a supermarket rather than a corridor, the books written by people who knew the place before he came and will be read after him. Saroyan’s messenger boy had to learn that his telegrams were not the town. Most doctors learn some version of the same thing, and have to learn it again from time to time, because the work keeps teaching the opposite.
Saroyan himself is a reminder that belonging need not be single. He spent much of his life away from Fresno, in San Francisco and New York and, in later years, Paris, and he came back to the city in old age and died there in 1981. His ashes were divided: half were buried in Fresno and half in Armenia. I find that division more truthful than most stories of homecoming. It does not pretend that a person belongs to only one place, or that a second place must cancel the first. It suggests that a life can be dwelt in more than one ground, and that the honest thing is to say so.
So I would not describe Fresno as a place I arrived at in 2008 and have since come home to. I would describe it as a place I have been learning since 2008, and expect to keep learning, which seems to me a more credible kind of belonging than the completed sort. Experience comes with a person into a new place. It does not spare him the work of arriving, and the work turns out to be renewable. The tule fog season, by the usual reckoning, opens on the first of November. As I write this, it has begun again.
Evidence and Editorial Note #
Documented findings. Public biography: PGY-1 at the University of Arkansas for Medical Sciences, 2007–2008; PGY-2 and PGY-3 with UCSF Fresno at Community Regional Medical Center, 2008–2010; practice in California since 2010; Fresno as home; Punjabi as first language. Raisin grapes laid on paper beneath the vines and sun-dried for two to three weeks, and the San Joaquin Valley’s production of almost all US raisins: California Bountiful (California Farm Bureau), January/February 2010. Tule fog as a radiation fog named for the tule wetlands, its season of November 1 to March 31, and visibility often under 600 feet with abrupt changes: standard reference sources (Wikipedia, “Tule fog”). Fresno County’s Blossom Trail, its usual mid-February to mid-March season, and its almond, plum, apricot and peach blossoms: County of Fresno (linked). John Steinbeck, The Grapes of Wrath (1939), chapter 25: its opening sentence and its movement from blossom to unharvested fruit and hunger; quoted once and otherwise described. William Saroyan (born Fresno, 1908, to Armenian parents; a telegraph messenger as a boy), The Human Comedy (1943; Ithaca, California; Homer Macauley as a wartime telegraph messenger) and My Name Is Aram (1940; “The Summer of the Beautiful White Horse,” with Aram, Mourad and the farmer John Byro): standard literary reference, described rather than quoted. Philip Levine (born Detroit, 1928; taught at Fresno State from 1958; What Work Is, National Book Award 1991; Poet Laureate of the United States, 2011–2012; died in Fresno, 2015), the setting of the title poem at a Ford plant, its closing line quoted once (under fifteen words), and his students Larry Levis and Gary Soto: standard literary reference. Armenian settlement in Fresno from the late nineteenth century and the city’s Mexican, Japanese, Portuguese, Hmong and Punjabi communities: general historical knowledge. Sikh settlement in the Central Valley from the early 1900s and some fifteen gurdwaras in the Central Valley: Central Valley Community Foundation. The estimate of about 40,000 Sikhs and Punjabis in Fresno County: GV Wire, December 2020, citing a Sikh Coalition guide. Fresno State’s College World Series championship (June 2008), the Central Valley’s severe exposure to the 2008 housing collapse, California’s approval of high-speed rail bonds in November 2008 (Proposition 1A) and subsequent viaduct construction in the Fresno area, the Fulton Mall (opened in the 1960s) and its reopening to traffic as Fulton Street in 2017, and the reappearance of Tulare Lake in 2023: general public knowledge, stated without figures. Baldassare Forestiere and the Forestiere Underground Gardens: general historical knowledge. California’s 2005 heat illness prevention standard for outdoor workers (water, shade, rest), the first of its kind among the states, later strengthened: general regulatory history, stated without section numbers or thresholds. Fresno as Spanish for ash tree, and the naming of Tulare and the tule fog for the tule reeds: standard reference. The Yokuts peoples of the valley floor, the tule marshes and Tulare Lake, and the draining of the lake and marshes for farming: general historical knowledge. Kierkegaard’s journal entry of 1843 on understanding life backwards and living it forwards: paraphrased, not quoted. Saroyan’s later years between Paris and Fresno, his death in Fresno in 1981, and the division of his ashes between Fresno and Armenia: standard biographical reference. The reported decline in Central Valley winter fog (Baldocchi D. and Waller E., Geophysical Research Letters, 2014): general knowledge of the published study, stated without figures. The Punjabi verbs ਰਹਿਣਾ, ਵੱਸਣਾ and ਉੱਜੜਨਾ and the blessing ਵੱਸਦੇ ਰਹੋ: standard Punjabi usage. Vendor representations. None.
Recollection and tradition. The author’s training sites, dates and home are his published biography. No arrival scene, route of travel, housing, first impression, colleague, patient, outing or particular day is described, and the essay deliberately makes no claim about what the author expected, planned or witnessed in 2008. The civic events of 2008 are given as the city’s history, not as the author’s experience of them. Descriptions of the valley’s seasons and of a resident’s working life are general, not recollections of particular days.
Analysis and forecast. The idea of the “second beginning,” the distinction between portable and local knowledge, the view that a place is learned through the consequences of its calendar, the readings of Saroyan, Levine and Steinbeck, the three kinds of knowledge, the reading of Forestiere’s gardens and of Saroyan’s divided burial, and the reflections on the Punjabi language in public use and on rahiṇā and vassṇā are the author’s present-day interpretation as of November 6, 2026. Independence. This essay is not sponsored by any institution, company, health system or technology developer.
About the Author #
Kanwar Partap Singh Gill, MD, traces his family roots to Khadur Sahib in Punjab’s Majha region and grew up in Amritsar. He attended Spring Dale School and completed pre-medical studies at Khalsa College in 1994–1996. He earned his MBBS from Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar in 2002.
He completed PGY-1 at the University of Arkansas for Medical Sciences in Little Rock in 2007–2008, and PGY-2 and PGY-3 with UCSF Fresno at Community Regional Medical Center from 2008 through 2010. He has practiced medicine in California since 2010.
His career has crossed four distinct information eras: predominantly paper-based medicine, early and fragmented electronic records, the integrated-EHR era, and the emerging age of generative and agentic artificial intelligence.