Wednesday, June 11, 2008

first day

To get to my uncle’s house you have to walk through a narrow winding road not open to cars. To get here I traveled twenty hours, thirteen of which were on an on the whole unpleasant plane flight from San Francisco to Taipei, and if I had to leave today it would have been worth it.

My cousin (my mom’s brother’s first child of two) brought his little girl (seven years old) to the airport to meet me, and it was wonderful to see them. I’d met my cousin for the first time back in high school when he visited California, before he was married, and he looks the same. I remember my brother told me that he’d taken my cousin to Universal Studios and when he saw King Kong during one of those tram car rides, he jumped out of his seat and exclaimed, WOW. Now I feel like him and every thing I see is King Kong.

My uncle (my mom’s eldest brother) looks older than I imagined he would. He’s in his late seventies, but still I imagined him to be sturdy, like my grandparents on my dad’s side. Which makes no sense since they’re not related, but that’s what I thought. Comparing my parents and relatives at home to others here, I see how living here versus America does make a difference in how you age. My uncle is frail, with my mom’s nose and warm eyes with his eyelids folded towards the middle so they look like they slant. He has trouble sleeping, like my mom too. My cousin-in-law is super friendly and sweet, though her Vietnamese has a different accent and can be hard to follow. Their daughter is adorable, already a quietly strong person who refuses to admit she’s motion sick or complain about it. My other cousin (my mom’s brother’s second child of two) has a daughter too, six years old. The two of them make me so glad that I could visit while they’re still young. Even though they keep only slight memories of you (as I assume, from what I remember of visits from people when I was a kid), it’s nice to know that you met during that time in your life, because it passes so quickly. Like how I met my half-German cousins when they were a few years old and now they’re teenagers and it’ll never be the same when I see them again.

I’ve always been so close to my immediate family that for a long time I hadn’t given much thought to my extended family, also because they are really extended, all over the world. Somewhere along the line that changed. A lot of my drive to come here, and what’s already been affirmed in small and substantive ways, is that roots really are roots.

Living in this home is like a friendly version of the Simple Life. Things are less comfortable, but not un-so. There’s no air-conditioning, but several fans. It is as hot and humid as my parents promised (90 degrees with 75% humidity), but surprisingly I don’t find it that bad. I like humidity. My parents were worried about how I’d survive without AC, but if it stays like this the fans are more than adequate. As long as I can shower. As far as that goes, the hot water runs out, but there is hot water. There’s no shower head, just a teeny stream of water so you have to squat and actively place water where you need it. This sounds un-ideal but somehow felt as nice as what we have in America, I think because I was more aware of being dirty and hence more aware of getting clean. The bathrooms are bit gritty but the linoleum is shiny and cool to the touch. We budget on electricity but there it is and the biggest surprise, my cousin wired me to the internet, old-school. Can’t use the phone while on it, but it’s there. All in all, nothing that requires more than once to get used to. I am grateful to our Southeast Asia trip last year, because most things feel nice in comparison to having a mouse crawl up your arm in the middle of the night, trekking outside in pitch dark to use the restroom, and having electricity go out on you at an unknown time of day. And the Cambodian bus ride from hell nearly desensitized me to insistent honking, which is also the norm here.

Also, today I had mangosteen and lychee and dragon fruit. It is good to be here.

Monday, June 9, 2008

packing

Due to a traumatic experience with too much luggage in high school, I tend to be a minimalist packer. I've told this story a bunch of times, even though it's not at all interesting or important, but it really did affect me. It was my first time away from home, for a summer program following junior year. Six weeks in Ithaca New York, and I had no sense of what I needed for a compact time away. I took everything with me. I rarely had to wear an outfit more than a couple times, I brought pictures to decorate my room and CDs for my desk even though I had nothing to play them on. I put all of this into one big luggage, thinking that it would be no sweat since it was one you could pull. It didn't come to mind that everything has its limits. It was so heavy that the pulley broke, on the way to Ithaca. On my way back home, with my bag a bit heavier from accumulating books, it was the biggest pain to put it in the car, transport it, check it, retrieve it. Since then I've been much wiser about what I need, and I lean to the other extreme of bringing the bare minimum.

In the late summer and early fall of 2002, after high school, I packed one very large suitcase and a couple duffel bags and that was everything I took with me to start college. In the late summer and early fall of 2007, I sent about 11 boxes of varying sizes from San Francisco to New Haven to start med school. I also took the suitcase and duffel bags with me on the plane. My packing philosophy hasn't changed much, though after living out-of-school I definitely wanted a feeling of home in my next place, and brought more than the bare minimum for med school. But having packed and moved in some form every year in between, I have learned a few things about packing.

Each year I re-learn, and learn more so, that I have to throw stuff away. I hate it but I have to. I still keep mementos but not as many multiple scraps from the same event. I throw away programs unless they're significant and just keep the tickets. I threw away my one fork and one spoon. I can't keep half-broken (but still usable) plastic trashcans anymore because their shapes are sadly not conducive to fitting in boxes. Yes, I threw away the dried leaves from my Halloween costume. I've given away things like my stereo and fridge. It makes me feel better when things I can't take with me are used by someone else, including toiletries. Gave Jey my detergent once, and Don my toothpaste, Amy my shampoo.

No matter how I try to stick to a system of organization, I never pack quite the same way each time. I knew from the beginning to mix my clothes and books (haha), but there is never a "best" way to package everything else, like shoes and desk stuff and files and vases. There are ways to make them fit that make sense, but there isn't one way that I know to do it every time. Plus there are slight changes in content. So I re-think and re-pack each time. The boxes change, too, of course. I try to re-use them as long as possible and I always over-tape to hold them together, but moving just isn't good for stability and they fall apart.

When you pack, you have to consider everything. You get your big things out of the way, but you have to get rid of those paper clips on the sink, pack the souvenir cup on your bookshelf so it doesn't break, find a place for postcards people have sent you. You go through every inch of your material life whether you want to or not.

Somehow the time and energy it takes increases with each year, even when the amount of stuff stays similar. I used to be able to pack stress-free, even during exams--finish in a day and move by myself in an hour and a half. Last year I remember it being a struggle, deciding what to bring, send, leave behind. Moving this year, it took me a day and several nights to pack, and I enlisted the help of four friends and two cars to move. There seems to be more of me and correspondingly, others.

And in the same way I'm writing minutes before leaving for Vietnam, as time passes I find myself packing up until the end, scrambling when before I could take my time. Things feel semi-incomplete and not fully articulated because I didn't have as much time to think through it all, but it's packaged up anyway and I go on. As heavy as they get, my boxes push me forward.

Sunday, June 8, 2008

people part two: patients

I came to medical school for real people stories. Blogging by nature is self-involved and I usually have little to write about other than myself, which in college I found to be the main thing I wanted to change about my life. The first year of school has been fulfilling in huge part to feeling that, albeit very slowly, I'm on the way to doing that.

We've been introduced to patients in different ways. One of my favorite classes this past semester was Biological Basis of Behavior, which had us study a small corner of psychiatry on a neurobiological and personal level. After each lecture a patient with an illness related to the lecture came in to talk to our class for an hour. This included PTSD, drug addiction, schizophrenia, OCD, binge eating, depression and narcolepsy. The thing that really struck me about them, overall, relates to something Allison once said about how psychiatric disorders are on the extreme end of a spectrum that we're all a part of. For these people, the things we all do were greater in degree and longer in duration.

It was hard to see how memories plagued the Vietnam veteran with PTSD so longer after the war. I always thought my memories lingered abnormally long, but here was a person defined against his will by his past. The man with drug addiction was a doctor, whose career had been put in jeopardy because of his problem. He had real insight into his disorder; he seemed to understand its character so well, even as he knew that despite that knowledge, it was still a struggle to battle it. Don mentioned that his articulation was a function of his education, and that perhaps this insight doesn't come across as clearly with other patients. I hadn't thought of that, and makes me wonder how much expression really conveys comprehension, and what I need to learn to see people beyond what they're capable of showing. I wrote a little about the woman with schizophrenia in the last entry. She was shaking slightly as she spoke to us, I remember her sitting on her hands, and she shared the big and little of her life with us. The narcoleptic person talked about not being able to keep a job, how he was often let go. He said, "I should've been more of a fighter when it came to doing things for myself. I just thought it was time to move on." The man with OCD was a lawyer, whose disorder seemed to pervade his life but he also said no one but his wife and mother knew about it, said that he was good at hiding it. Made me think that patients' relationships with themselves, and with their disorders, are pretty complex. He had an incredibly patient wife, to whom he would relate all the little things that drove him nuts, each night. He'd list the things throughout the day that he obsessed about--did he lock that key, did he mail that letter. And she'd listen, and tell him he was being ridiculous. I remember being frustrated with the interview with the man with a binge eating disorder, because the questions asked of him weren't at all conducive to getting his story. Afterwards a few students came up to him to ask him more, and in those few moments we learned a lot. The absence of something made me feel a little better what I seek.

The man with depression gave us something singular. The other patients told us about their illnesses, but this patient experienced his illness right in front of us. He shed tears continuously through the interview, often without any stimulus. His wife had passed away in the eighties, and he had symptoms of depression back then but it didn't come on full-strength until a few years later and has lasted since then. When asked by a student whether he had any long-term goals, he interpreted the question as asking him what kept him going, in the face of such debilitating depression. He said that that day, his goal was to get to our class. On some days, it was to brush his teeth. He said: "Do I think it's strange that it's been so long, that it hasn't gone away? Yes. Why haven't I given up? Is there something? I don't know." After a few moments, he said, "I hope to get better."

This question brought me back to a conversation I had with the classmate who asked it, a bit earlier, after our pre-clinical clerkship session at the nursing home. Another way we've been introduced to patients and patient care is through pre-clinical clerkship, weekly sessions that expose us to different areas of medicine. We've learned to do physical exams on newborns, interviewed child/adolescent patients, examined and described art to hone observation skills.

My favorite this semester was the geriatrics session, where we performed mini-cognitive tests on the residents. I was bit blown away by how every group discovered cognitive deficits in their residents; I've been so used to practicing the neuro exam on my classmates who have mastered saying the months backwards. The patients we saw couldn't draw clocks that depicted 4:30, or think of more than a few words that started with A. The person my group spoke to knew it was April, but when asked what season it was, she paused. Instead of looking back through the window behind her for a clue from the weather, she stared ahead and I wondered what she was looking at or for. Then she said, fall and I think all of our hearts broke a little.

On the shuttle ride back to school, the classmate and I talked about the session. He'd found it depressing, because he placed so much value on cognitive ability, our capacity to think about our lives and what they're for. I told him I agreed, but that I also liked geriatrics. In the most kind way, he asked me what the point was. I didn't have too good of an answer then, aside from my usual perspective of trying despite an end, because isn't that what everything is on a large scale. Talking about it afterwards, I realized that it's about experiencing things, more so than thinking or expressing. I can't really say what those geriatric patients feel or think, but they must experience. Even if I can't ever understand it or connect to it in a conventional way, it feels worthwhile, maybe all the more so because it's fragile and remote. It feels more moment to moment, rather than continuous with memories and goals and future. With the person with depression, he didn't seem to be thinking about purpose. He just wanted to get through each moment. He just wanted to experience the next second.

Wednesday, June 4, 2008

people part one: classmates

Back in college, my roommates and I ate frozen yogurt in cake cones voraciously. I love cake cokes and defend their superiority over sugar cones (which I do like but are just not the same) every chance I get. The yogurt or ice cream softens the cone as you eat; you still get the crunch, but it's molded into the texture of the ice cream so that you get everything in one bite. The flat bottom of the cone is divided into squares, so the ice cream fills the space between and it amplifies the effect of the upper cone and gives it something new too. As we ate our cones with each other and in contentment, and got to the bottom, we'd say, this is the best part. Without ever saying it explicitly, we adopted this as a mantra for what was the best part of college--each other. In thinking about the first year of medical school, it's true again that the bottom of my cake cone is the people, on several levels, one of them again being my classmates.

A woman with schizophrenia came to talk to us in one of our classes who made me think about my friendships. When asked if she had friends or people close to her, she said that she'd never had many and currently she had one. When then asked how that was for her--to have just one friend--she said, "I feel really lucky to have the one, because it's so hard to find people who really care about you, who want the best for you." It took one friend--and maybe because it was just one--for her to so sincerely feel the value of friendship. It made me feel overwhelmingly lucky, to have met and gotten to know and become friends with the people in my life.

I don't become close to people or let them get to know me very easily. It took me a year and a half in high school before finding the people who were my friends at the end, and I was no good at the orientation thing in college. So coming here I was a little worried, because I didn't know if med school would give me the luxury of time to cultivate closeness amidst my shyness and introversion. I was doubly surprised. Early on, I found kindness and openness and humor. As the year went on, after the usual threshold when comfort sets in and you stop seeking, I found more.

My friends here are wonderful. No matter how I'm feeling, they make me laugh without fail. For this reason I've gotten a reputation for laughing at everything. As I've explained to them, I laugh at things that aren't really funny but that are characteristically them, things that make them endearing and amusing and there's so much of that. They pay attention and they really care. They come to my room when I look upset in the elevator, ask how much sleep I've gotten when I look awful, patiently listen to me ramble and overthink and overfeel, bring me notes when they notice I'm not in class and food when I don't want to go out for dinner. I go to class and linger at the worst cafeteria in the world for their company and any time spent in conversation with them feels full. And beyond and independent of what they do for me, they are just good people, the kind that don't have to do anything for you in particular to make you feel that you're glad to know them.

One night I was telling Jen that I can remember exactly how I met most people in our class. I can see clearly in my mind where I was and what was said. During SAY (pre-orientation), we sat in a circle for one of those icebreakers where we had to repeat the names of the people sitting next to us. I remember thinking it was just my luck to be phonetically challenged...and have Prathap on my left and Bibhav on my right. Looking back, how lucky I was to have met my good friends on my first day at Yale. Bibhav was always smiling, and Prathap became part of my PCC group though for a long time I was intimidated by how nice he was. I also met the rest of my PCC group, and Henry and Nupur at SAY. I met Macdale at the barbecue right before the icebreaker and remember feeling that maybe he didn't find me very interesting but he would always say hello to me after that so I got over it. I met Don that first day too, sitting across from him at a blue table next to Harkness lawn, one of the ones in the middle. I remember not knowing whether he was a first or second year because he exuded a sort of laid-back quality and didn't force his presence as a newcomer. My next interactions with him over the coming weeks centered around being Vietnamese. I remember standing outside the Harkness door in a halter top on a warm night to go out and talking to him about going to Vietnam, how we both wanted to go there next summer. Then I remember him turning from his row in front of me during White Coat to tell me that his parents asked him about the one other Vietnamese person in our class, and then how his dad saw me afterwards and asked me in Vietnamese whether I was Vietnamese.

I remember meeting Allison at another blue table, this time in the corner close to the walkway, on a later day of orientation and how she told me about her California/Northwest road trip and how she ate a lot of food in the Sunset district and how we found out we'd both be orphans for the white coat ceremony and would be going to the orphan dinner together. And she came up to me after the ceremony and said, Hi orphan, and I remember feeling glad she remembered. Narae, I knew about beforehand from Albert, and when I saw her walk by (while sitting on yet another blue table), I was excited to have something automatically in common to bring up with a stranger. Haha, I remember she said, Oh yeah, I know about you, then went on her way, and we didn't have a real conversation until the next semester. I sat next to Jen during a talk for SAY, in Marigold's, where we discovered I was from the same town as her then boyfriend. She came with me and Allison to Ikea the next weekend and later told me she found it awkward because she didn't know how to talk to girls. She told me this post-Indian-food-debacle in the winter, which is when we actually became friends. I don't know how long these images will stay with me so it's nice to write them down.

I am grateful to those small moments that have grown, for the people. For one who supports his friends in so many ways, offering help in the endeavors we undertake like going through all his pictures for the sake of my magazine, is so passionate about the well-being of other people, who perceives so much from afar and comes close only when he thinks it will help, never for his own reasons. And who never gets tired of the same joke. Another who I can call when I'm sick on Saturday morning and will go out of his way to get me medicine, but who above all is fair and gives everyone the benefit of the doubt and listens to anything and everything you have to say. I'm glad for the friend who checked out all the coffeeshops in New Haven, asks me questions, doesn't judge me for my foolish choices, never makes me feel that our conversations are cutting into her time because it's genuinely what she cares about, who always reminds me of not school but life. And for the friend who values honesty and straightforwardness and rationale but still loves me for the complications and emotions, and who sees the immensity of small things and small gestures. And the one who makes me smile just by the way she answers the phone, who is fiercely loyal and tells it as it is without qualms, who tells me when I did something right and when I did something wrong. I'm glad for the one who's made me grow and be more patient, more accepting, who wears everything on his sleeve and makes it natural to ask things of people, who surprises me with what he remembers and how he tries.

We'd say, this is the best part, often, because once you get to the bottom there's still more.

Sunday, June 1, 2008

soundtrack

I am in love and I already know I can't do it justice but I have to proclaim it anyway. Thao Nguyen comprised the soundtrack on repeat to my hours and nights of packing and if I miss anything about packing it's that. Her songs paint an image of a person I would like to know and would like to be. Charming but disingenuous, sensitive but strong, knowing but open, messy but together, brassy and effortlessly thoughtful. Her voice is deep and full and husky, but lilts into a lightness. It meshes with her folksy guitar and catchy beats, and then it stands on its own even as the background continues. She bares her insecurities and heartbreaks and not once seems weak for doing so. She does it so naturally and above all, honestly. In Chivalry, my favorite, she sings: "An offer of me you politely refused/Is it that my heart beat too loud/Is it I did not bid it calm down...I am tired/I am through/When I love I will love so hard." She draws out each "I," her voice up and down, and then comes the fast, beautiful plucking of guitar that forces you to keep up with her feeling, which you might've missed if you hadn't been listening because the song is light.

Those few lines make me think of one of those rare very true things that feels like a revelation when you learn it, something Hussain told me once. I was telling him how I worried that I was behind everyone else, because I kept believing in certain things that experience would then contradict and I would be surprised, how I still think about things that people get over, how I will never fully accept the idea of loss. I was worried that the ideals I thought were strong were actually naive. That maybe I hadn't matured and was left behind in the growth curve. He said that maybe maturity isn't about experience breaking down ideals, but about "having gone through that pain and hurt and all that without giving up your sense of self, without being jaded and cynical and giving up on people." And so I love Thao Nguyen for being tired now, but loving hard later.

I like the title of her second album, We Brave Bee Stings and All, her appreciation of a small, intense sensation of a bee sting. In her songs she says geography will make a mess of her, that she's a superhero, that she doesn't know, how she stings and how she's been stung. She talks about rainy seasons and big kid tables. And yes it is doubly awesome that she's a Vietnamese-American with voice. People describe her music with words suggestive of movement: bounce, jangly, poppy, vibrant. It's true that the beat draws you in first. But even amidst all the motion of her words and notes and voice and instruments and thoughts and sounds, there is a constant expression of something real and felt, and that takes you all over but really, holds you still in one place.