autumn

I haven't kept up my monthly post for several months, and haven't kept up with my monthly goals, but it's been worth it to have a real summer. When I came back from vacation and started my new job on September first, I couldn't remember the last time I had been happier. I am so happy to be living in San Francisco, where I have my family and close friends from every phase of my life, seeing the city and bay every day as I commute to Berkeley, doing something I love that is the culmination of so much training but where I am still learning every day, in a clinic that feels just right for me. And hugely, at the same time, see M start med school and dive into his dream and experience the beginnings of this process. It's a crazy circle of remembering the beginnings and seeing the results, and I feel such extreme gratitude for every single thing in life right now. In the midst of it I've been thinking how to weave writing back into this texture and am working on new things. For now, just so much immense feeling for my first real autumn, post a real summer, into real back-to-school into-a-new-life feelings.

breaking habits

So I was going to title this "breaking bad habits," but I thought about it more and felt that context plays a big role in whether a habit is bad or not. Sometimes in certain environments you develop techniques to adapt, and it's not necessarily selling out or giving in, but finding ways to keep other parts of yourself in tact. That said, during residency I developed a lot of habits that I feel are now unhealthy for me and that I'd like to spend conscious time reshaping.

1. Making use of every minute.

In residency there was never down time. I always felt like I should be doing something, so that I could get home earlier, get more sleep, build up minutes to go do something. This was useful to me in residency because when there's so little free time, being productive while at work means you have more time for yourself later. Now, though, I have a lot time to myself and I find that I always want to be finishing a task or making a list of tasks. And it might be efficient, but efficiency isn't so much my priority anymore, at least not right now. I want fullness and surprise, life less edited and manufactured by me or by the system in which I function. I want not to cater constantly to "the system in which I function."

2. Not returning phone calls

In med school I talked on the phone all the time, despite seeing my friends all the time. In residency I was terrible at answering and returning calls from people. I've always been very good at keeping in touch, but when you spend so much of your time with people, and when you've been born a pure introvert and your environment has accepted and encouraged introverted qualities, it is hard to continue conversation after coming home. Especially because as an introvert your role in most conversations is to listen, and even when you love to do this, after you have spent 16 hours listening to patients, nurses, attendings, interns, fellow residents, you kind of just want to quiet down. By you I mean me. So in some ways not communicating with the outside world helped me maintain some reserve so that I could take care of my patients. But I am sorry not to have taken better care of the rest of my personal community, and am looking forward to reconnecting with the important people in my life.

3. Online shopping

I became a little addicted to online shopping during residency, because who has time to go to the mall? But I spent a ton of time repackaging and returning packages, and also way more hours mindlessly shopping to the point of headache, much more so than if I just went to the store. So often I bought a ton online only to keep one of the items. Of course, I said, I can just return them for free, always choosing places I could ship back for free (but often giving into Ann Taylor, feeling that I could return in store, which was always a hassle). But so it ended up that it took hours to buy really just one item. Despite loving clothes I kind of hate both means of shopping, but I do think that the intellectual feeling that online shopping is time-saving is (personally) not borne out by the practical ability to try on something and decide right then and there if you want it. Not going to lie, I'm still going to shop online but I do want to do it less and venture out more. Also, while I kind of hate the mall, several people have pointed out to me that it is a very different environment than my usual places of work, study, and recreation. And it is probably the most valuable thing to me to continually expose myself to life in all forms. That might sound like a stupid way to talk about a mall. But when you spend 90% of your life in a county hospital where, when you're talking in a narrow sense of function, half the people are the highest functioning individuals in society and the other half are the least, it is opening to immerse yourself somewhere in the middle.

4. Sacrificing sleep

M always told me that I should go to sleep. I'd want to climb, or read, or answer emails. He always said that sleep was most important and as much as I tried to listen, I always wanted to be doing things because so much of my day was spent NOT doing things, at least things related to my own life. Or, I'd want to be doing work-things because there was never enough time in the day to finish them and I wanted to be a good doctor. But I just slowly became more and more tired, and I don't think I can accomplish any of the above tired.

To that end, I'm going to bed at 10 PM on Friday night and am really happy about it.

the end of residency

I have a lot to say about completing my residency, but am feeling a little too under the weather to get into much. But wanted to put down some initial thoughts.

Residency was very hard for me, and I think there were a lot of things I feel I could have handled and balanced better. At the same time, as I am enjoying my time off in which I indulge in everything-for-me, I find myself increasingly grateful for three years dedicated to things outside of myself. Throughout it I felt that it was inhuman to force us to be so inattentive to ourselves. I still think this is true, but perhaps to a lesser degree as I think about how amazing it was to be so attentive to others.

During my time off since residency, I have been doing everything that I love and that had shaped my sense of self before residency. I've been active, going to yoga and climbing almost every day, running and swimming outside. I've indulged in the art of creativity of others, listening to hours and hours of music and audiobooks on end. I've been healthy, cooking meals and hydrating myself. I've gotten back into the flexible mindset of being able to travel, which I did in residency but always felt too narrow slipped between weeks of exhaustion. I'm looking forward to all the outdoors and travel I get to do this summer: lush Vermont and New York with M, Denver with my family, and a hiking/camping trip to Iceland with my brother.

I know too that as I throw myself into this, I'll wind down and find a place between these two extremes. This feels like a necessary time after a lot of sacrifice. And the sacrifice wasn't just of stuff-for-me; I was disappointed in how it also felt that I sacrificed some of my interests in medicine in order to do it. In medical school I was interested in geriatrics, palliative care, research and policy. In residency, I sought out very little outside of what I needed to do on a daily basis, and when I did have more time I spent it, reasonably and unregrettably, on the personal aspects of my life. So I hope that after some recovery I will be able to not only re-incorporate aspects of my outside-of-medicine life back into my identity but also revive the inside-of-medicine elements that drew me to it in the first place.

Throughout residency I felt moments of excitement about my growth as a physician, and moments of sadness over sometimes losing my sense of self. Looking back, this was most definitely a singular experience in which I lived what it was like to really put others first. I don't think it should be at the cost of one's own well-being, but it is true that you can go farther for others than you think and I feel incredibly full that I was pushed and was surrounded by others committed to the same. I'm glad that it's over, and I'm glad that it happened.

july 4th recipes

One of my top ten favorite things in the world: going to the farmer's market on Saturday morning and making food for the day with freshly bought foods.

Today for our July 4th meal I made:

1) Thai quinoa salad, recipe below. Such a pretty mix of colors, and I cooked the quinoa in a mix of vegetable broth and light coconut milk and the coconut really complemented the fish sauce and lime. M absolutely loved it, fish sauce and all. http://www.onceuponachef.com/2013/05/thai-quinoa-salad.html

2) This delicious marinade for chicken and tofu skewers; the spices were amazing: http://www.feastingathome.com/grilled-jerk-chicken-and-peach-skewers/

3)And veggie sliders made from chickpeas, from a friend's facebook recipe, which I've just prepared but haven't eaten yet so unclear how my execution of the recipe will be, but looking forward to it.

I love cheap farmer's markets on crisp weekend mornings, especially REAL weekend mornings where I'm not working, just SUMMERING. Happy fourth of July!

surprise / touch / inspire

In the last couple of days of my last couple of weeks of medicine wards at SFGH. I've been fortunate to have an amazing attending, an exceptional fourth year med student, great end of the year interns and then brand new interns enthusiastic to learn and dive in. I always forget how exhausting this work is, which I remember at the end of the day. I often forget how rewarding it is, which I remember at the beginning of the day. We've learned a ton of medicine, gotten to know great patients, and have had a lot of fun. But it is tiring and draining and I haven't had any chance to write. When I come home, I usually eat, shower, and sleep and because often there's half an hour between getting home and sleep, my sleep is fitful and more like an extension of day than a transition into night.

Needless to say there hasn't been much space for processing. I made time today to catch part of a lecture on finding meaning in medicine. She focused on trusting that the things we do matter, and make differences in ways we can't imagine or know. She also talked about reflecting each day on something that surprised you, something that touched you,and something that inspired you.

So for today:

Surprise: When we were called by a nurse saying that a patient had left his room and we went to his room thinking he'd abandoned the hospital. And instead found him covered in a sheet in another hospital bed in the hallway, stating that he was looking for peace and quiet, and promising that he wouldn't leave the hospital.

Touch: When an intern I had worked with a year ago and haven't talked to since, recognized my voice over the phone, and he later told my intern that he trusted my decisions.

Inspire: Supreme Court legalization of gay marriage, and the celebratory response. And also that we have convinced the proud and happy, but seriously ill, patient from the "surprise" anecdote to stay in the hospital despite his desire to leave and join PRIDE on Sunday, which he states will be "the biggest f---ing gay day in history."

last week of clinic

Last week was my last week at my clinic at SFGH, our county hospital, and while I feel ready to finish residency, I would stay in clinic here forever if I could. It can be frustrating, and can feel futile, and much less concrete than other parts of medicine. But saying goodbye to my patients and to the flow of clinic, despite there never really being a true flow to the hectic lumps and bumps of SFGH clinic, was and is hard. We often don't feel the role we can have over the course of intermittent 15-minute visits with people, but bonds form in all sorts of odd ways. And in particular for the patients who have few other support systems in place, I feel lucky to have been able to offer a base, as flimsy as it often was.

I feel so lucky to have borne witness to the paths of my patients. Over three years I've gained about a hundred primary care patients, maybe half of whom who come regularly enough for me to say that I know them; the other half I know of and for that I also feel lucky. I've seen a woman through the diagnosis and treatment of gastric cancer, and seen the strengths and vulnerabilities of her family through it, and seen the anxiety and worry that lingers afterwards. I've seen a man with physically debilitating inflammation of his skin and heart become emotionally debilitated by living with his illness, and see him slowly recover inside and out as he received treatment. I've seen young people my age whose characters have been shaped by a lifetime of battles fought by their bodies struggling through illness and bad environments. I've seen people with about a dozen life-threatening issues to their name continue to plug along, giving hope that we have time and space to tackle each in turn. I've felt so lucky to accept the stuffed animal, orchid, half dollar, scarf, and tears that patients give so, so generously in their farewell visits. Feeling that it is misguided to dismiss these physical gifts as material, because I know how it feels to want to be able to encase so much in something you can hold.

It's true that coming into residency you have little sense of what it is that you're actually going to do, and it's true that a lot of your visions are refuted by reality. But coming into primary care feeling that this is what I want to do because it's the most holistic perspective has proved itself right many times over. This doesn't mean that it always possesses the most holistic solutions, or even individual solutions to all of a person's needs, but it does mean that you see a whole lot of people. I will really miss the people who let me see them.

may

It's interesting that after several years away from the East Coast, my memories of May are what it's like over there--the beginnings of warmth returning. I was a little shocked by our cold San Francisco May, but it was a good month nonetheless.

1. Blogging: I had a lot to record with regular updates on weekly visits to the San Quentin prison. After those very full days that left us sapped of energy, emotional and physical, I was glad that I had a pre-formed space to dump some thoughts. This is something I'd like to return to with more nuance and filling later, so I'm very grateful to be able to put down a few of the details.

2. Recipes: My favorite recipe of May was an Indian fish dish that I was introduced to while I was in Uganda, and remains one of my top ten all time favorite dishes/meals. I tried at various times to replicate it, but there aren't many recipes for it and it calls for mint which I rarely have on hand and is a little pricey at stores to purchase for experimentation. But now that I go to the farmer's market most weeks, there is plenty of fresh, cheap mint, and cilantro, and I was inspired to try it again after finding this recipe: http://www.chillimix.com/indian-recipe/fish-and-sea-food/baked-fish-with-fresh-mint-and-coriander.html. It was very good, though I still haven't attained the divineness of what I tried in Uganda. It's hard to tell whether it's actual taste, or novelty, that I'm missing. Either way, I still loved the fresh mint and cilantro in this. I'm sure I tried other actual recipes to make my two new recipes a month resolution, but am forgetting at the moment, so will note that we also added the mint to our smoothies, making them newly refreshed (redundant? but seems appropriate).

3. Albums: In the vein of getting back into what used to be a major passion for me, I got recommendations from a music-trusthworthy friend and remembered why music is so awesome after listening to Future Islands (Singles) and fka twigs (lp 1), which had entirely different feels and equally unique. Also listened to Sufjan Steven's latest, Carie & Lowell, which felt like the return of an old friend.

4. News: I made significant headway on this, and then halfway through the month I discovered audiobooks, and I became really obsessed (they deserve a separate post). I think I will always prioritize fiction, and I think I will always feel a little guilty about that, and so will continue to incorporate real life into my knowledge base, but also with the acceptance that this is how I'm built.

5. Exercise: After incorporating swimming into my birthday party, I managed to swim twice and remembered how good it feels. Biking is something I still haven't incorporated back into my routine yet, but have decided that instead of making biking and running (which has been hard on my knees lately) long ventures, that I'll make my initial resolution (of biking, swimming, running, climbing and yoga each once a week) possible by biking or running very briefly before climbing. I'm hoping to make strides with this as summer approaches and work recedes...