maggie

This semester I pathetically finished one novel (Breathing Lessons by Anne Tyler), only because I read about a third of it while traveling home for break (which, with train ride + subway ride + airtrain + plane flight, all in all takes a crazy 12 hours). Next semester it’ll be short stories, because losing the flow of a book by stealing a few pages here and there when I’m not intellectually or physically or emotionally drained (rarely) pretty much sucks the life out of it. When references were made to little things that came before, I had to neurotically search for the first mention of them because I couldn’t remember. Despite this, the character of Maggie emerged with palpable tenderness, and is now one I hold close. While the story was engaging enough and its feelings nuanced, and there were moments of the kind of writing that surprises with descriptions unusual and perfectly accurate (do you know what I mean? When something you’ve felt is encapsulated exactly right, in a way you’ve never thought before, and you wonder how it can be so far from your vocabulary and thought, and yet so right)…most of that wasn’t too special for me. For me it was Maggie.

Even though she’s a married woman in her late forties, with two grown children and a whole life to look back on and contemplate, in many ways she still lives by a philosophy cultivated before experience set in. To that quality in her I’m attached, if only because I foresee the same for myself, for better or worse. These are the things I love in Maggie, not necessarily because they are good things but because they give shape to strange things I’ve felt, whose tangibility I sometimes question. And more than a relation to myself, the value lies in knowing that they exist, on their own, elsewhere.

disheveled/clumsy: Maggie digs through her purse trying to find the same things that have inhabited it for years, because she’s never formed a system where each thing has its place. I often tell myself that I should just designate a certain coat pocket for my keys, phone, etc., so that I always know where to look, but when it comes down to the moment I reach for whatever feels convenient, which isn’t consistent. Maggie’s husband, Ira, and children sometimes perceive her as bumbling, silly in a way: “She was always making clumsy, impetuous rushes toward nowhere in particular—side trips, random detours.” I’m a little more straightlaced than that, but I can relate to having a messy demeanor, to being not-put-together. And while Ira sees it as not taking life seriously enough, I think it’s that Maggie takes so much to heart, it’s hard to find focus.

not too good at cultivating:Along the same lines, Maggie doesn’t have a knack for taking care of things, like her homegrown tomatoes that are always “bulbous” despite years of trying different kinds. She senses that people attribute the failure to Maggie herself, with her “knobby, fumbling way.” I’m awful at taking care of plants and my possessions in general (much to the chagrin of B. who helps me with each of my computer problems and N. who hates the torn insides of my peacoat), and I worry sometimes about whether this will translate to other things that require care, whether it does have to do with something internal.

she takes care of people: I think Maggie’s scared of the same thing because she tries really hard to take care of people. Instead of going to college, she continues her high school job as an aide in a nursing home, where concrete tasks make her feel capable and she knows when to laugh or nod during conversations. She tries to take care of those around her even when it’s not up to her or outside of her capacity…it’s a significant problem, leading to misunderstandings and misplaced feelings. I think it’s natural to try to impact others’ happiness in part because it affects our own, but Maggie can’t let go of the interconnections.

guilt causes overthinking, and vice versa: She feels bad about things, all the time. When placing a long distance call from another person’s home she considers leaving them some change. After playing a prank on a bad driver, she’s worried he’s been overly affected and makes her husband go back and check on him. Allison once said that she thinks guilt is a good thing, a sign of consideration for others. I think this has truth but I think, for me, guilt can be a kind of copout, a way of trying to keep your good after you’ve done something bad. Maggie, I think, is better than that; her regrets don’t stem from initial selfishness but instead from good intentions gone wrong, or from human responses. Even when she consciously sets out to right her ways, she’s horrible at not repeating her mistakes, because her characteristics are so ingrained, and man do I know something about that.

emotionally neurotic and impulsive: Maggie debates every emotional maneuver, and then in the moment her instincts take over, and they’re not always good ones. An image or thought can take hold of her so completely that she will feel that someone she doesn’t actually know is the most wonderful person she’s ever known, and it will be true because she feels it so.

easily affected: She forms incomprehensibly strong, oft impulsive connections to people removed from her, and she’s easily moved. In a hospital waiting room she encounters an elderly couple and across from them a burly man in coveralls. A nurse is asking the near deaf elderly man for a urine sample, and has to shout, “Pee in this cup!” The elderly woman is visibly embarrassed, explaining how deaf her husband has become, and Maggie doesn’t know what to say. The burly man shifts his weight and comments on how funny it is, he can pick up the nurse’s voice, but really, can’t make out her words at all. At this Maggie tears up. He asks her if she’s okay: “She couldn’t tell him it was his kindness that had undone her—such delicacy, in such an unlikely-looking person.”

acutely aware of presence and loss: On the loss of her cat: “His absence had struck her so intensely that it had amounted to a presence….But here was something even stupider: A month or so later, when cold weather set in, Maggie switched off the basement dehumidifier as she did every year and even that absence had struck her. She had mourned in the most personal way the silencing of the steady, faithful whir that used to thrum the floorboards.”

can’t give up even when it could be the right thing to do: She can’t give up on people she loves, to a fault, because she relies on what she knows they feel, and knows that they feel genuinely and kindly; rather than their actions and words, which are often not so kind. Her husband says that she believes the people she loves are better than they are. I’ve been told I do this too, but I don’t think it’s such an altruistic thing. It stems from the fact that I know my own faults but I like to think I’m still passably okay, and to believe this requires understanding others’ faults. At one point Maggie wonders whether she’s been a bad mother, too forgiving of her children because she remembers so strongly what it’s like to be a child. I really believe in understanding other people’s context, to know why flaws exist and persist, probably because I can get so complicated that I need that sort of understanding from other people. Sometimes, though, in allowing so much room for complexity, you miss the basics that are as much a part of people as the layers.

she believes in romance: Not just the pretty things in the right place romance, but the idea that through all the crap and non-ideals, people will love each other enough to make it work and be consciously happy. Even when she doubts this for herself she thinks she’s just missed out and it’s still to be had in this world. Sometimes you might get the sense that Maggie’s trying to find refuge, making it easier on herself by always trying and not accepting the hurtful truth. But who’s to say what’s reality, or that her refuge is any easier than the accepted reality (sometimes it’s damn harder)? In my own experience there’s been no shortage of crap and non-ideals but I’m grateful for the incredible amount of good that comes along in spite of and because of. My past connections, few and not straightforward but valuable and full, have played part in shaping what I can and should give, and what I seek, want, need. And it’s funny, this makes me think both how hard it will be find, and how amazing it will be to someday have.

**

I don’t know if things really work out for Maggie, and whether this is because of all the above. I get the sense that as you’re reading, you might get annoyed with Maggie’s meddling and desire to right things that aren’t meant to be controlled. You might want to tell her that sometimes beauty is past. You might want to stop her from perpetuating her poorly implemented good intentions, to dread the impending disasters that end in large disappointment for her and those she loves. But that doesn’t work, because it’s not about how fixing flaws would make life easier to accept, or to live. It’s about facing the difficult because you’re trying to preserve value, even if it’s stupid and mistaken and fails. I don’t know if it’s right, but for Maggie it’s true.

cancer, etc.

Hamlet is one of my favorite Shakespeare plays. Besides the richness of language, intense drama, and so many characters with sharp life, I can relate to Hamlet’s obsessive contemplation of his own consciousness. The accepted interpretation that Hamlet destroys himself with this introspection—he thinks so much that he can never act—is my own biggest fear. A major reason I want to be a doctor is to stop only thinking about stories and instead start shaping them. But I also feel that this assessment of Hamlet attributes his failure to one misleading cause—that is, he can’t apply his thoughts to real life. As hard and real of a problem that is for many, I don’t think Shakespeare had everyone die at the end merely to say, “just don’t think; just do it already.” It’s true that the tragedy lies in the disconnect between Hamlet’s interior and the outside world. But the source of that disconnect isn’t only his inability to externalize his desires, to physically do what he mentally feels. It’s also his inability to internalize his surroundings, to absorb what he sees and hears and relate it to himself. Because he never understands what the outside world has to do with him and his identity, he can never become a part of it and so can never make any sort of impact on it.

And so after our oncology module, a compressed period where I wished I could just-do-it and thereby not feel helpless, I’m still not doing, still trying to find time and space to internalize all we’ve been exposed to and were supposed to learn. Learning about cancer comprises a slim two weeks in our curriculum, devoted to teaching us the overarching mechanism of how cancerous cells arise, spread and hurt us, and how we fight back. We received a detailed lecture on breast cancer, as a model for other cancers, and a third of each of our three workshops is a case study of a specific cancer. But mostly we just learn about cancer as a whole. After doing leukemia research and interviewing cancer patients weekly during first year of medical school, cancer remains mysterious to me and I learned anew with this module. In class we learn about it scientifically, what distinguishes it from your normal cells, how it survives, and why it’s so bad. Once as we worked through cases someone asked a question I’d wondered often before: “What actually kills you?” A lot of things, any number of things.

In class we also learn about it emotionally, hearing patients speak about their experiences and physicians lecture on palliative care. We learn big topics in forty minute increments (resting dazed for ten minutes between lectures), eat lunch, and spend the afternoon being exposed to (depending on the day) age, illness, dying and death in hospitals and hospices and nursing homes. We dedicate any and all gaps in the day to studying. It’s made slightly easier and more pathetic by the fact that we’re in a group all doing the same things.

For people in their twenties, we hear a lot about death and all that goes along with that: the preceding disease, the lives that were had and how they changed. It makes me feel I’m on the edge of a world that’s eluded my grasp for so long, that I’m growing up and into real life. Then I learn in class that one way to reduce your risk of getting breast cancer is having a child before you’re twenty-four. I’m twenty-four, and I still am a child, and I wonder what exactly I’m supposed to do with the things I know.

The language of cancer is very distinct, not just a matter of science and technical terms but also a firm foundation of key concepts, containing a lot of m’s (metastasis, malignant, mortality) and rife with percentages and units of time. Like in other areas of science, we personify it. A professor called CML a naïve cancer because it involves just one gene, making it easier to target and eradicate. In pharmacology we learn that even though some drugs eliminate mechanisms that both cancer and normal cells use, they preferentially kill cancer cells because cancer cells get addicted to one mechanism. While a normal cell can rely on other means once one is taken away, a cancer cell has lost perspective and doesn’t know what to do with itself.

I think we personify disease to understand and fight it, but we also get addicted to our language. We talk about the effects of cancer and the success of treatment in terms of five-year survival. Which isn’t a very long time to survive. But no one addresses the instinctive thought that this living five years is almost the opposite of continuing to live, since we’re beyond instinct now. We know that if your cancer hasn’t overcome everything in five years, it either wasn’t that bad to begin with or treatment is good. We know our language so well that meaning surpasses words. I think I pay close attention to words and in a little over a week I forgot how to hear them and I learned this from being told so. During a lecture on palliative care, a kind oncologist whose gray hair and matching eyes projected a natural softness told us about his wife who’d had breast cancer and subsequently acute leukemia. After being diagnosed with leukemia, someone offered her comfort in the fact that 75% of people with acute leukemia have a five-year survival. When her husband came home to find her sobbing over this, he asked her what it was that bothered her, assuming that she’d interpreted the statement as a quarter of people not achieving five year survival. Instead, she told him, “I’m 41 years old. And I only have until 46.” She thought “five year survival” meant that she’d live five more years and then it would be over. Despite that being the words’ most intrinsic meaning, I hadn’t even thought of that possibility.

These thoughts slip me because the days are crammed. One went like this. We begin the morning with a workshop on lung cancer (the cancer that takes most lives, with an overall survival rate of 15%) and brain metastases. If cancer has traveled from your lungs to your brain, they will irradiate your entire brain (our notes remind us that these patients will experience cognitive defects). It’s deemed prophylactic, and after treatment you can expect to live for one year. Following workshop, we listen to the lecture on breast cancer, which feels both scarier and less so by nature of being so prevalent in the population and mainstream culture. I know several people with breast cancer (seems like many in comparison to the number of people I know who have other illnesses, which are few) and somehow that commonness made me complacent. I am surprised to find that despite improved screening and detection, the percentage of survival isn’t as high as I expected. A quarter of women diagnosed with breast cancer die from it. We then hear from a breast cancer survivor, someone in our Yale community, who speaks to us for a near hour about her experience. From this I realize the more significant thing I’d forgotten was the visceral challenge of being ill with something that has any chance of killing you, no matter how positive the eventual outcome. In another workshop our teacher mentioned a procedure having a 5% risk of mortality, which is low, but well, “high if it’s your risk.” It’s true that on a daily basis we all face some slight percentage of dying, but cancer means having this overshadowed by something concrete and pseudo-quantifiable and personal and internal.

One thing I appreciate in medicine is individual context amidst the absolute values of care and quality of life, and there are few places wherein relativity is as palpable as cancer survival. While cure is always the ultimate goal, cancer can be so ominous that small advances are noteworthy. For colon cancer that's spread so that it's incurable by surgery, chemotherapy can prolong life significantly, “in some cases, up to two years.” A new treatment for kidney cancer is seen as an enormous breakthrough because it prolongs survival by 50%—increasing it from two months to four. Of course four versus two is a lot when it’s all you have, and who’s to say how much worth lies in any amount of time. Still, here relativity can feel like a copout.

Later that afternoon, as part of our pre-clinical curriculum we speak to a patient whose care is palliative, meaning being treated not for cure but for comfort. Ours is an 83 year old man with the mischievous sparkle of a teenager, coated with a brand of boyish charm that only comes with experience. He’d been diagnosed with lung cancer that he didn’t want to treat. He’d lived long enough, he felt, and if it’s time, it’s time. Then he came down with some sort of abdominal infection that doctors told him would kill him within a day, and still he didn’t want treatment. He hadn’t been seeking to die, but nor did he seek to live. He said goodbye to his family, and then the infection miraculously cleared on its own, leaving him alive, albeit with cancer still. When we see him, one of the first things he says is that the idea of dying in one or two days didn’t bother him. “Does that bother you?” he asks, pointing at me as I’m still maneuvering to find the right position in a narrow chair. I’m confused as to what he’s asking and I interpret it to mean, does his acceptance of his death bother me? Which is not a normal question to ask at all, but I don’t have the two seconds it takes to overthink the question even more than I already have and realize this isn’t what he means. So I respond with a quick no and during the ensuing chorus line of no’s from my classmates that might’ve just been nervous echoes of my response, I realize what he’d actually meant. And no, I do not want to die in the next couple of days. I’m completely happy with the life I’ve led so far but that doesn’t mean it’s done. If it were to happen, I’d be grateful for all that I’ve had in 24 years. But yes, I would be bothered.

In the evening, I have a meeting for the geriatrics interest group, and after talking to Don about the day he asks why I like old people. They’re different from me and I have no idea what it’s like to be them. I think maybe they’re honest not because they have nothing to lose but because they know what honesty gives. They carry everything with them that I am still looking ahead to, and they carry so much. They’re living with what I work for each day: experience, and they take that with them to each next day, because despite all they’ve lived they haven’t stopped living anew. At the meeting we talk about our screening of Rolling, a documentary where three people in wheelchairs tape their daily lives. None of them are “old.” Dr. Berland, the filmmaker, tells us the film is being promoted by the geriatrics group because it’s about facing change with dignity, and independence. I’m struck by how very different each person is, done not purposefully but truthfully. One tells us in an off-center closeup that he has so many blessings, and that nothing can take those from him. But “being blessed doesn’t mean it doesn’t hurt.” Like that Whitman line about how he’s a contradiction, and that makes sense because he’s large and he contains multitudes. That’s what each day feels like, a multitude.

And all I can do is sit with my books, which can feel empty and wrong even if necessary and engaging. After that day I go to the architecture library to study about breast and lung cancer in detail, making semi-meticulous notes from the textbook and lecture notes and workshop we’d had in the morning, putting together the details of screening, diagnosis, subtypes, staging and treatment. That we have this knowledge is beautiful, but cancer is so mysterious and we know really so little. When we first start learning about diseases we learn what begins them and here often we only know the end. All this crammed in one day, and no time at the end to think about what it means and how to use it. For lack of time and energy, I furiously scribble down events and details, with hopes of returning to fill gaps, but so much will be lost. Another day brings more, the feelings will gain different nuances, the way I started writing about my dad’s truck and he sold it before I finished the story. I’ll forget how it all started, what it was like to not know and to be introduced into these big things, encased in a hospital room and a one hour interview, to learn from these people as med students and as people. If I leave it for too long, I may look back and think I’m past the age to absorb it. As if reflection on the beginning only saves you from a blurry end where you can’t look back and remember, if you do it before you’re twenty-four.

changes and happenings

A lot of things have happened. While not everything has been smooth or even pleasantly rocky, I feel the heaviest kind of lucky. It's quite sappy how consciously lucky I feel every day to have everything I do, how much it holds up even the worst days. To inadequately recap. I spent the summer in Vietnam to work on a public health project. I traveled to the center and south, and lived in the north. I stayed in a rural town for a couple weeks, visited my dad's old village, and lived with my uncle, his son and his son's family in the city the rest of the time. My cousin's wife, quite possibly the sweetest person I've ever met, cried at the airport when I was leaving.

I spent three full days at home in which my dad told me how he planted a near dying cherry tree in the middle of our yard and my mom armed me with hoisin sauce to bring to New Haven. You know how parents are cute to everyone but their own kids? My parents are so cute even I think so. I'm looking forward to Thanksgiving, and having a full week with them (and all the brothers, so I think it might be our first full family Thanksgiving ever). My mom keeps reminding me we'll make the turkey together (she made her first one only a couple years ago) and that she'll make my favorite meal too. She and my dad keep asking me if I need funds, something they haven't done in years. I'm guessing they're asking now because they think I've run out, which I was worried about too, but it looks like I'll be able to ride out at least this next year on residual income and aid, which is another part of the luck. But it's funny to me that my mom tells me not to worry about buying a dress for the semi-formal because she doesn't want me to "suffer" (literal translation).

I drove cross country with Allison. We stopped in Tahoe, Lovelock Nevada, Salt Lake City Utah, Denver Colorado, Wall South Dakota, Madison Wisconsin, Rockville Maryland, Lancaster Pennsylvania and arrived here after ten days, 72 hours which were spent driving. We saw lots of rocks and castles, real and figurative. We saw salt and sunsets and my new nephew. We talked a lot, and laughed an unfathomable amount. We played lame games and took pictures of nothing (on the hour). Silly things happened, like our Wisconsin adventure which included bruises and a flooded bathroom. Beautiful things were seen, like Utah and the beautiful beautiful Badlands, which are not castles but make you feel royal, but also small. I'm so so glad that we took the trip and that Allison was the Thelma to my Louise, because how often do you get to do that and more rarely, have it be quite perfect? When in your life you feel both brave and unsure and open to emptiness, drive across your country with your Thelma.

Upon returning to New Haven, I embarked on a scrambled unique honeymoon with the wife, traveling in a 14-foot U-Haul to retrieve and move furniture. First time I've bought real furniture, first time I drove a U-Haul. It took me a full week to get everything and unpack, a week in which I ignored all things school while realizing in class that we were already supposed to have learned in that week what would've amounted last year to a month of material. But it doesn't matter, because I love our new home almost as much as I love the wife. We live on a street lined with restaurants and little shops like the camera store and the random stuff store and the art store and the Art School, and two coffeeshops, including one that's half a block away and owned by Asians who already know how much I love chai. We're on the first floor of an old brick house with hardwood floors and white walls encased in darker wood, with a big kitchen and the homey feel I knew I wanted when we were looking for an apartment. It's just that much farther from school, and that much closer to downtown. Jen and I cook, and Nupur has a bread machine.

School is intense. I can't learn this much this fast. We're learning in modules this year, and we've started with the heart. One of the most interesting, and complicated. Apparently in a month we're supposed to understand the diseases, know the treatments (what do you give first? what's a last resort? what do you give to diabetics?), comprehend how an EKG works and what it's supposed to look like in every kind of dysfunction of your heartbeat (do you know how many different ways your heart can beat?). All this makes me again grateful for being here, without real exams or grades, so I'm still able to appreciate how intellectually satisfying the science is and remember how lucky and awesome it is to pursue something that works your mind and heart. The year's going to be a bit insular, all of us cooped up studying, which sounds kind of sucky but there will probably never be an excuse again to just be cramming in knowledge (hopefully) without other obligations.

At the very least I like the people I'm cooped up with, and through everything else I feel most lucky for the sheer quantity and quality of the people in my life. My college blockmates are all really happy and kicking ass in their respective areas of work/study, and that makes me really happy, to think of everyone growing through the ups and downs of the post-grad years with such grace. It's even crazier to think on the growth with my high school friends who are still some of the best people I know. And in New Haven I have the family I adopted (or who adopted me), people who really love me and at the lowest points (which have indeed already been experienced in the past few weeks) remind me I have absolutely everything I need. Anything that's been hard reminds me also of how there are things I still don't know about myself, and how the more painful experiences force you to know yourself. How you're built, what you value. I know better that honesty matters to me more than acts, that there are things I know I deserve even as much as we hate to use that word on our own behalf, that for as much as I communicate there's a whole lot I miss about even people I know really well and so I need to work on that, that even if you're supposed to pick your battles I will never be able to give up on a person that gave me reason to start trying in the first place. In the end, even if what you find makes things harder--not so much the realization but you yourself--there's good reason for being how you are, and good reason for how each person is.

Reading this over confirms the sap that gratitude makes you produce. But another point is just--so things are quite different. I don't think I'll be blogging much from now on, because I started writing a tiny bit over the summer and I think I want to try as much as I can to continue that, and this year forces me to choose. I'm not sure what happened, but I think it's been this accumulation of gratitude that's pushed me to finally put some things into stories, or rather, clumps. I'll return somewhere in between clumps.

observations

When a fruit is in season, people eat it everyday with every meal. You eat batches after batches of longans and think it’ll never end, and then one day they’re gone and you understand, and see how defining seasons are. Bowls are never left empty, and if ice cream has melted you eat it as soup. People like to sing. They’ll randomly break out a line when walking across the room. Buses don’t stop at bus stops; they slow down and keep moving. People nap after lunch, no matter where they are. Within few minutes of meeting you strangers will invite you to their homes. It’s not considered rude to push someone out of your way. There’s little sense of individual space. Privacy isn’t important. Vendors hold fast and hard to what they want you to believe about their products even in the face of clear evidence otherwise.

The way people repeat and repeat make me feel like they believe repetition affirms truth, can even will it. What you eat, what you don’t eat, how much you eat, what sauce you choose to dip your food in—all will be noticed. Going out means flooding the streets and hanging out. People aren’t easily bored. They can sit for a long time. Tea is called water. White pants are in style, as are jeans/pants of different colors in general, as are ruffles down the front of your shirt. After walking in post rain streets the backs of my pants and the side of my purse are spotted with large specks of mud. For umbrellas, plaid is their black. People give up their seats for the elderly and pregnant but rarely does a guy give up his seat for a girl in high heels carrying lots of bags. When it rains my aunt rushes out to the balcony to retrieve the laundry.

It rains a lot. When it rains it feels like it will never stop. I haven’t yet experienced rain that you might call a passing shower. It’s always heavy and long, and there is always frequent thunder and lightning. When it rains, things change. People have to stop and find shelter, or are stuck at home. It’s not just an inconvenience; it’s a real thing. People work long hours, but don’t cut short breaks during the day to go home early. If it’s mealtime and someone calls you to eat, you don’t finish what you’re doing, you go; or they’ll keep calling you every other second. Friends are affectionate with one another. They have full conversations via back and forth text messages. People know the names of flowers.

Items are localized in areas. If you want to buy something, there’s a street dedicated to it; things aren't sold mall-style. To lock up your house at night, there’s a lock to the outer gate, an inner gate you pull across your double doors and bunches of little padlocks with different keys. The streets are gritty, and the air is thick with dust and heat. People wear face masks. In the hottest heat girls wear a long sleeve over their T-shirts when going out into the sun. Everyone showers at night. Every day I’m asked whether a dozen different things here are found in America. When a person doesn’t like to eat something, it’s said that he doesn’t “know how to eat” it. In the city it’s assumed you are from somewhere else, so people are always asking each other what their “que,” or countryside village, is.

Distances are significant here. The city feels bigger than it is because of how long it takes to get places. My family’s said that the transition from Hai Ba Trung, the residential district where they live, to My Dinh, the business area of Hanoi, is like going to another country. Rarely anyone has been outside of Vietnam; the majority haven’t traveled to other big cities within the country itself either. People love taking pictures if you pull out a camera and are unabashed about asking to you to take solo pictures of them. People talk to you without introduction. Once a person builds a rapport, which can happen in minutes, they look out for you. Strangers tell you how it is. They scoff when you’ve done something stupid, sound easily annoyed when you don’t do as they think is fitting. It’s not a social disgrace to criticize someone you don’t know because they disagree with you on something like directions or where to put your feet on a bike. Strange things happen, like purple ink splattering my skin through an open window of a taxi. Organization is not consciously valued. With a loose framework things work themselves out.

nyaya health

There are a good number of people who want to do good, who make it a concrete goal, whose careers lie upon this idea, who think about it when making life decisions and when living day to day, weaving it into the background of going to school, making friends, finding love, having fun, getting a job. Then there are a rare few for whom doing good isn’t doing good; it’s just doing. It’s the forefront, the bulk, the background. We have a friend like this. Sometimes I read the blog for his organization, Nyaya Health, and I remember how narcissistic my blog is and how he uses this medium for something outside of himself, which is what I think writing should eventually achieve (in a very different, still narcissistic sort of way). His experiences fuel an anger over injustice that drives him, and never has self-fulfillment played a part. Even though most people don’t do good things mainly for self-fulfillment, it can’t help but be had. For him, he is so invested in others that there’s little room for getting anything for himself from it.

There are lots of reasons to support Nyaya Health, which administers primary care to a rural region in Nepal of a quarter million people that had no doctors or facilities, battling incredibly high rates of HIV, maternal mortality, and malnourishment. It’s committed to immediate care as well as long-term health models to care for those without. It’s not just helping out; it’s thinking about everything: management, infrastructure, microfinance, epidemiology.

But personally the reason I give you is that this person makes other people his life, not in addition to his own. Aud and I talk about how we all receive more than we give (not in a deliberate or selfish way, but in a human way). Sometimes people can be mostly givers, and that’s something worth supporting I think. He’d hate this reason for supporting Nyaya, but I think it’s a decent one.

You can read more about it here: http://www.nyayahealth.org

And you can donate here: http://www.nyayahealth.org/donate_now.html
Money can seem trivial because it can be easy, but I can guarantee any amount will be more gift given than received.

vietnamese-american

I watched Joy Luck Club yesterday morning, and nearly burst into tears about twenty times. My propensity to cry at overtly tear-inducing film scenes depends on my mood, and my general mood these past few weeks has been Being in the Motherland--all the obvious feelings that entails. And hey, that movie is pretty good.

Having many first-generation friends and America being America, in writing my mass emails from Southeast Asia last summer and this one, I got a lot of replies from people about how they related to the cultural aspects of my experiences. From people who felt connected, disconnected, somewhere in between, in relation to their family’s culture. I’m not sure when I started becoming consciously aware of my culture, but I do know that my family has done so well in keeping it a constant presence, whether or not I was aware. And for that I feel such incredible gratitude, it’s tangibly difficult for me to write it accurately. And I feel it’s so important, I so want to get it right.

When I visited Notre Dame Cathedral in Saigon, I sat for a long time in the pews because I was tired from walking all the day in the heat. Mass wasn’t in service but there were a few women in the first row reciting prayers. It immediately brought me back to going to Vietnamese mass with my parents at home, as a kid. I hated going. I hated that it was in the middle of the day, that I had to dress up, that I couldn’t fully understand the sermons, that in the summer it was stifling. But there was one thing I didn’t hate, one thing that with age I actually grew to love, and that was the recitation of prayers in Vietnamese. In English we just say them. In Vietnamese, I wouldn’t say there’s a real melody to the prayers, but the prayers are melodic. There are certain tones that made me enjoy memorizing and reciting them too, purely for the sound and experience, because I’m not religious and not really spiritual either. When I heard the women saying them in Vietnam, they sounded exactly like back home in California, and I found myself saying them too. And I was struck by how this thing, these words and these tones, was carried intact from across the world.

Lately I’ve felt, with a sense of urgency, a need to preserve things about my parents and their history that might fade when they’re gone. To keep through time what they so bravely, carefully transported through place. I want to make my mom’s food, to teach my kids Vietnamese (and have them learn the great amount I don’t know, if they’re not too resistant). And most, to honor all my parents went through to bring me here, by remembering and continuing what they left behind. Because it’s their values from there that made it possible for me to cultivate ones from here. I can feel the question of rationale arising: why does it really matter to remember where you’re from? I don’t have an all-encompassing response, because all my metaphors are too-neat answers. But I think that if one life lived is what provides meaning, and it’s this continuum that makes a single life possible, then there must be some syllogism there.

In America, when people ask you what you are, they mean where your family’s from, because it’s (usually, ideally) accepted that you’re American. In Vietnam, even though my family is Vietnamese, they ask me what I am. They see you by the country you live in, and you’re not considered Vietnamese. And it’s true, because I’m not fully or even mostly Vietnamese. But I’m not just American either. Too often people find themselves choosing between one culture and another, when one of the best things about America is that you can have both (or several). I really dislike the misconceptions of being whitewashed because you’re integrated into American society, or of being super Asian because you have a lot of Asian friends. Because in polarizing things this way, you can forget that you should (or so I personally think) remain connected to both, and can be, despite falling into one of those aforementioned categories. Because that’s what the hyphenation is about. It’s about how one can motivate the other, how you take the best from each, how you incorporate the privilege of perspective into your life, how past and present becomes your future.

D. once talked about the benefits of shared culture, and I saw that in spending a little time with him here, when I felt consciously that the sense of being in between cultures is a culture in itself. One that shouldn’t be separated, because how sad for old things to be lost in a shuffle of migration and opportunity, and how sad for new things to be overlooked by comparison to something else. Culture is such a rich and dynamic thing, and how lucky we are to experience more than one, and to have that combination to claim as ours.

D. also brought up the idea of randomness, that we could’ve easily been brought up in Vietnam if not for certain circumstances and luck and timing. I definitely feel that, especially being here and meeting people my age and comparing where their family was at the time mine left, or others who were born after the narrow window to leave closed. If in 1954 when the Communists uprooted the French, in the small sliver of time that people were allowed to choose communist North or democratic South, my parents hadn’t been able to migrate South, I might’ve been born in Hanoi. If in the years following the fall of Saigon in 1975 my family hadn’t escaped, before nearby countries stopped taking in refugees, I might’ve been born in Saigon. If they hadn’t been picked up by a German boat, sponsored to Germany and then America, I could’ve ended up in so many places. But the one thing that doesn’t change no matter time and place or situation in life, being born to my parents means being born Vietnamese. And if I had to choose only one reason out of the many I feel, it is for that that I love being Vietnamese.

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.

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.

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.

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.

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.

the second time around

Back in the fall, in biochemistry, we learned about Lesch-Nyhan disease. People with Lesch-Nyhan are deficient in an enzyme called HGPRT involved in purine salvage, which leads to uric acid buildup. I remember these details because the other thing about people with Lesch-Nyhan is that they for some reason also mutilate themselves. They bite their own lips and fingers. Completely helpless to stop themselves, people with this disease often bandage their hands to prevent inflicting hurt upon themselves. Our professor referred us to a New Yorker article about a man with Lesch-Nyhan, and how the lack of control in self-mutilation pervades his entire approach to life. Instead of telling someone he loves them, he swears at them. Seeing a sharp pencil induces an uncontrollable urge to take it and do harm. He uses his right hand to grab and restrain his left hand from grabbing a knife and hurting himself or someone else. His intentions and his actions are completely at odds, and they divide his body.

The author of the article framed the disease as the extreme end of a phenomenon of which we are all victim, what Edgar Allen Poe termed "the imp of the perverse." The idea that we all do things that we know are bad for ourselves, like eating too much junk food to the point it's not pleasurable anymore or contemplating swerving your car into oncoming traffic for no particular reason. I remember first learning about this strange, rare disease and thinking that I must have some emotional form of Lesch-Nyhan, where I perpetuate things that I know, in mind and in heart, are not good for me and will hurt me.

Doing it once made me none the wiser the second time around. In a recent lecture about the biological basis of pain, we learned that when you feel a certain kind of pain for the second time, you feel it more acutely because you know its character. I'm not sure about the implications about your recovery and resilience, because I would guess there is also a desensitization process, the idea that pain makes you stronger and more able the next time. But what was clear is that once you get to know pain through first encounter, you are more aware when it hits you again. You don't have to feel around in the dark to learn its edges and figure out how to hold it. You know its contours without exploration.

The professor who lectured on pain did make a mistake, though, when he alluded to Lesch-Nyhan and said that people with the disease don't feel pain when they self-mutilate. I distinctly remember that they do feel pain, but the awareness of it can't stop them from hurting themselves. For them there is no desensitization or increased strength, only a constant fight against recurring pain. But I admired the man in the article, because there was a deliberate fight, a will against what he did to himself even if he knew it would continue.

For all the mistakes that I make twice and three times, growth does lurk in the corners. Despite similar themes, and a similar trajectory of trying not to hurt anyone and in the process hurting everyone including myself--there are different circumstances, reasons, people, feelings, and most importantly, more things learned. It does make me wonder again if I'll ever feel the same as I did the first time around. That used to worry me, but now I know that each thing offers something else, and it's valuable. And if I experience that feeling again, it will still have newness and surprises and a sense of other. It makes me think that for the man with Lesch-Nyhan, each finger bitten is not quite the same, and that even though you know the shape of its pain, you still reach out to find something different.

When I told Guson I was going home before summer because I missed my parents, he said I was maturing. My immediate reaction was to reject that idea, because isn't growing up about not missing home, not needing your parents? But it turns out he was right. There's only been one other time when I made sudden plans to go home. That time was a result of wanting to be away from where I was, a push from there to home. This time, I don't feel a push away from anything--I absolutely love where I am, in all senses--instead, it's a pull from home. That time I felt a little weak and this time I feel stronger. This time around, it's different.

loss

To borrow a sentiment from Steph's blog...God, it fucking hurts again.

*

A couple of weeks ago a graduating medical student was killed by a car outside of our dorm building, at an intersection we've all crossed hundreds of times. She walked along a red light, following a truck that was doing the same, and the car going green didn't see her. I was struck ajar at how much it affected me, the people around me, and the Yale community as a whole. There are many factors, I think--her youth, an emanating sweetness that seemed to touch those to whom she was unknown, proximity and inclusiveness. I don't really have anything new or insightful to say about the tragedy, neither its obvious immensity nor its subtleties. I'm sorry for that, but I'm glad there are many people who will do her memory full justice.

A few days after it happened, I read a short story called Found Objects about a woman who compulsively stole personal items. She didn't steal from stores, just people. She didn't steal for monetary or other gain; she didn't use any of the items she took. She piled them onto a table in her home, separate from all else in her life. She took a screwdriver from the back pocket of a plumber, a wallet left by a woman in the bathroom, bath salts from her best friend. The climax of the story was when she rummaged through the wallet of a one-night-stand and found a scrap of paper, saved through time and place, on it scrawled: I believe in you. She took it and never returned it. You could tell she hated herself for it. And you could tell she didn't know how else to be. It wasn't about the addictive thrill of getting away with the crime. It was about collecting pieces of people, and hurting them and hurting because of it.

It caught my eye in the New Yorker while I was in the waiting room at the pharmacy, because the title made me think of a short column I read once in the magazine about a person who collected people's lost gloves, storing them away in the hopes that someday one would find its other half. Found Objects turned out to have a very different theme, and it wasn't so much about things being found as being lost.

On the same day that we mourned the world losing Mila, I lost something separate and large in my life. It felt selfish, yet fitting at the same time, to be consumed by this multifaceted pain. What I lost, I lost because I was a little stupid, a little careless and not brave enough. Natural things that afflict most, and things sewn into all of us, and things grown out of circumstances and other people's mistakes too. So I'm learning to not place too much blame on myself but that doesn't decrease responsibility or the quite awful realization of your own capacity to cause pain.

I felt a bit like the woman who steals, and it makes me think of the driver of the car in Mila's accident. Granted that no one will ever suffer like those close to her--but the driver must suffer too, knowing what his mistake (and it was no one's clear or full fault) did to a life and having to live with that always. I feel a sort of immense sorrow for him, and I worry this is a little unfair and not right, but it seems to me that pain can't be too relative. It hurts very much to be hurt, and it hurts very much to inflict the hurt upon someone else. The driver on Frontage Street, the woman in Found Objects, and me, different beads on the same string.

Nowadays when I see people crossing that intersection against traffic when the light's red, I get a little sad because they don't know any better. And nowadays, when I do the same, I get a little sad because I do.

backwards

Yesterday I met a baby two days old, and realized that's the closest I've ever come to the concrete very beginning of life. Then we saw another newborn born without a small intestine who, the nurse told us, wasn't going to make it. And that was the closest I've ever come to the concrete very end of life.

Last weekend, I left the rain in New Haven for rain in Fremont. The hills had turned green since I last saw them. There is nothing I love more in my hometown than the green hills on gray days. The greenery is so fresh against the rain. We drove through Niles, a part of Fremont I rarely see; the last time might've been the summer before high school, with the same friends. We drove for two and a half hours to get to Sutter Creek, and drove through numerous new-to-me and lush highways and narrow roads along the way. We passed hills sprinkled with churning windmills, hills strewn with cows, flattened hills that stretched to remote ranch houses. I saw a whole new part of California, with two of my oldest friends as passengers, going to the wedding of a friend whose closeness I still miss. The tears at the ceremony were for him growing together with his one, but selfishly, the feeling that lingered afterwards was our growing apart.

I missed home and family something awful while I was at home, most when they were right there for me. I sometimes get the impression people here don't think I'm attached to them or value these values as much as they do because I don't miss California and my family when I'm away. It's hard to explain that these things are so sewn in me that I rarely feel disconnected from them. Yet for whatever reason this past weekend, the physicality of my parents made me feel there are some things I can't carry as well as they can give me in their presence. When I was leaving, my mom exclaimed, I miss you so much! She often forgets to insert the right tense in her English phrases but her mistake made my nonsensical ache for home while I was there right. I miss missing home.

Last month, Henry visited me at Yale and I talked to him in person for the first time since June 2006 when we graduated, and we had similar conversations as we did then. Or at least similar topics of conversation. He mentioned the people we respectively let go. He called them the birds we let fly...willingly, purposefully. He talked about how hard it was, how he hasn't loved anyone that intensely since then, but focused on how much he's grown since then, and how he didn't think he could've grown in the same way if he hadn't. I agreed but will never make up my mind about a concrete rationale for any of that, no longer want to make sense of my senses. I miss the bird I let go, the one who nodded yes you are a difficult person but I don't find it difficult and want to be there as you figure it out because I love all of you. All of you. I grew with him and I've grown a lot without. I've been incredibly happy in both. Like Henry, I know that I've lived distinctly differently because of that willful, purposeful choice.

But that's a given for anything you choose or anything that happens to you, that it has shaped your life in a certain way that's never quite the same as if you had chosen something else or if something else had happened to you, but you can't judge which is more worthy, and in the end you can only be grateful for having had something and later, something else.

time

To get to the photo lab on Willow Street to develop my film, I take the Green Shuttle from Phelps Gate to Orange and Willow streets. Having gone three times before, I have the timing down. The Green Shuttle comes every thirty minutes, on 5 and 35 of the hour. It takes exactly ten minutes to walk from York Street to Phelps Gate to pick up the shuttle. This route begins at 12:46 PM. In the morning prior to this time, the shuttle comes on 8 and 38 of the hour.

After I found the morning schedule at 11:26 AM today, I scrambled to get ready in 2 minutes so that I could start walking by 11:28 and make the 11:38 shuttle. I made it there at 11:37, and had to wait a couple minutes because the shuttles are always slightly off. I saw the Green coming my way at 11:39...then the driver waved his hand and passed me right by. Thinking that perhaps the morning schedule didn't quite work the way I thought, I waited for awhile longer. Fifteen minutes longer. So when a Blue Shuttle came by, I decided to just take it instead of waiting another 15 for the next Green. Because I can take the Blue Shuttle to Whitney and Canner, which is right near Willow Street. The walk is about twice as long as from the Green Shuttle stop, but I estimated it'd be less time than waiting for another Green.

I got on the Blue, which took me right back to the Med School because the Shuttles don't go back and forth; they travel in loops. When I get there, the driver tells me that he's taking a break and that I have to wait for the next shuttle to get there in 10 minutes. It's near noon by this time, and I figure that if I have to wait another 10 minutes, I might as well walk the 10 minutes from the med school to Phelps Gate, to catch that next Green Shuttle that I didn't want to wait for in the first place. And try to catch the 12:08 Green. Since the 11:38 was on time but just didn't stop for whatever reason; maybe it was a transitional shuttle, I thought.

So I walked back to exactly where I was 20 minutes earlier, having expounded twice as much effort to get there than the first time around. I waited a little bit and saw the Green coming; it always stalls at the red light. I thought I'd made a good choice, even for having wasted a half hour..and then it passes by me again. I swore audibly.

It was another 15 minutes before a Blue Shuttle came by. I took it, again. It brought me back to the med school, again. I waited there for 10 minutes before it took off on its route, again. This time I rode it all the way to the stop and walked the 10 minutes to the photo lab. I finally got there at 1 PM.

When I got there the woman told me that she wouldn't be done developing my photographs until 3 PM, so I sat there and read while I waited. It turned out that I could only develop 2 prints out of 2 rolls (about 24 prints) because something went awry in my camera winder and the prints overlapped, making it impossible to print them. The fact that the Puerto Rico photographs I'd been so looking forward to are now forever encased in negative was bad enough, because I get upset like that. But atop it all my entire morning and early afternoon was taken up with this fruitless commute.

As I walked back, I saw the Green Shuttle pass right by me again and walked on forward to the Blue Shuttle stop, which I did catch. Because there's only one of each colored shuttle for each shift (morning and afternoon), the same driver who dropped me off picked me up. He was a gruff man in his late fifties with scraggly hair who looked through me when he talked to me, but not unkind. In the seat behind him was a boy maybe ten years old, who rode with him. I'm guessing his grandson. His grandson was there on the shuttle I took to the lab, and the shuttle back. He didn't have a book, or a gameboy. He didn't really talk to his alleged grandpa or to anyone else. He just sat in the same seat, looked out the same window, sometimes got up and stood by the driver and sat back down. He didn't look bored or restless. He rode that same route all afternoon.

More than wasting hours on the shuttle and being disappointed with my memories and subsequently my whole day because I get so easily consumed by moments, the image of that boy riding on the shuttle made me hurt. I miss that. I can't even remember when exactly I lost that. The ability to while away, nothingness, without thought to time. Spring break was a slight hint of that, and just this morning I talked for an hour with Dr. Fenn about what I love, and that included writing and stories and traveling, all things that make me distort my sense of time, give me more than what I have concretely, make me think outside those bounds while still feeling their weight.

But from day to day and for the past who-knows but too many years of my life I have been too often obsessed with time. What I could've done instead, whether I was "productive," whether even fun time was spent well. One of my top ten things in the world is commuting. Being a passenger or driving alone, with no real purpose but to arrive. And even that is not quite comparable to this boy on the shuttle. People say it's not the end, it's the journey, but that's assuming there is an end. For the boy, there was no end even. Just the same route.

I'd like to have days I can ride on the same shuttle, even more than twice or three times like I did today, and not be frustrated or think that something has gone to waste or forget to be glad for time itself and not just for what I do with it. I'd like to do absolutely nothing and feel more something because of it, to remove the brackets from time and just go around for a bit.

lub-dub

Last Thursday, on the last day of this year's first month, thirty and some of us sat in a lecture hall with stethophones on our laps and in our ears, listening to heart sounds that a stout doctor committed to principles of the physical exam played for us on a mysterious machine that used infrared waves to contact some rectangular box attached to our devices. His words are clear and serious. You've all been listening to normal hearts. It's important to know what abnormalities sound like. Know murmurs. Here's what mitral regurgitation sounds like. Once you hear it, you'll never forget it. First I'll start out with the normal heartbeat, and then I'll add the murmur.

We listen and wait. Here it comes. Lub-dub. Lub-dub. So soothing and constant and rhythmic and after such a long day, more than a bit sleep-inducing. I see him turn a knob and then whooosh. There's the murmur. Lub-d--whooosh--ub. Lub-d-whooosh-ub. I thought, suddenly--wow. That's it. My life is this lub-dub and I'm that whooosh that's just passing it by.

*

Thursday began with a 9 AM lecture on renal physiology. In college I hated studying the kidney because there are so many parts and each one functions intricately differently. But it's true that repetition helps, because after a very cursory look in college, the first overview lecture here, and the histology lab, I wasn't as intimidated by having to hear someone talk about how the kidney reabsorbs salt and water for an hour. It turned out to be an hour lecture on the proximal tubule (1/6 of the kidney's tubules). Just the proximal tubule. It was surprisingly good. The proximal tubule is a hard worker and very smart.

From 10 AM-1 PM we had our last anatomy lab. It was the most brutal we've had, and yet anticlimatic. I haven't been too bothered by the physicality of anatomy; it's been more beautiful than disturbing. Removing the chest wall, dislocating the shoulder, uncovering the hand muscle by muscle--it's all been for something, even at times we spend more time with dissection than actual visualization. It never seemed disrespectful, and we are reminded so often of what our donor should mean to us, to respect their gift.

This time, the sounds and movements and my own inability to distinguish anything in the nasal and oral pharynxes made the procedure seem unnecessary and made me feel sorry for doing it. It involved sawing the head--skull and all--in half. Through the nasal septum, if you managed to be exact. The sound was in one word, awful. We used a manual saw, and it was worse than the loud grinding of the mechanical one we've had in the past. Because the exertion was so obvious and physical, the back-and-forth and the amount of time was palpable.

Perhaps I should have prepared more, but the fact that I didn't know anything about the nose and mouth and gained very little from the lab made me feel infinitely more guilty for doing this to our donor. I don't attach too much significance to the body after death; I'd like to be cremated and I have some sense of some sort of soul. So it's not like I prioritize bodily preservation, but the sacred the body holds when alive can't help but remain.

I will remember where I saw my donor's ligamentum arteriosum because it made sense based on what I knew about it--I remember Rizzolo forcing us to reason out why it would be there and how satisfying it was to confirm it both anatomically and intellectually. I will remember the long tendons of his arm and hand and moving them to move his fingers, my favorite lab. I will remember the subdural hematoma that engulfed his brain and how that both fascinated and hurt me. But how much anatomy will I remember? Likely little. Are those memories enough to justify everything else? I'm not sure. I'm not sure if it would be enough for me to give myself up, even as a person who thinks little of what will happen to my body after this is all over.

And so, it ended. Not quite with a whimper, but definitely no bang. Allison and I were talking afterwards about whether we'd have strong visual memories of our donors. I said I didn't think so, because we never looked at the body in its entirety. We always covered parts we weren't working on, including the face, which would be easiest to remember. It's hard to really retain vivid images of things in isolation.

Yet--though I don't feel I've solidified an image of his body or even his face, I do know I've acquired, in slow and fast gulps, an entirely new perspective of body. They say anatomy is a rite of passage, and it is. It is, not for all the arteries and nerves and muscles, but for the new and complex and strange and wordless.

After lunch (and no, it's not really strange at all to eat after anatomy lab), I made a quick run to the post-office to drop off my ballot for Super Tuesday; the fresh air was nice. Then I had a meeting from 2-2:30 PM with a professor at the Public Health school. It was one of two required meetings for my application to go to Vietnam this summer. I'm hoping to do a social health project to evaluate the effects of the healthcare system on low-income patients, in terms of their living conditions, employment and education. The professor was helpful in telling me what I needed to do to make the study design tighter--which is the most difficult part of the whole thing. If it pans out, I'd be based in Hanoi, but also live with a family in a rural commune while doing fieldwork. Talking about the finer details made some anxiety about getting it all done re-surge, but I'm hoping very hard it works out.

From 3-5 PM we had Pre-Clinical Clerkship. Since the new semester started, it's been all physical exam. I honestly hadn't given much thought to doing the physical exam prior to this; despite it being a core experience, it wasn't something I associated with medical school like I did with anatomy. I guess I couldn't really see myself doing it. It's been fairly incredible. I feel as inept as ever, but small improvements like actually knowing the names of my instruments and how to hold them makes me feel disproportionately good. The fulfillment of DOING stuff gets so lost in academics, and it's been refreshing to feel things very concretely.

The hardest thing thus far has been using the opthalmoscope to look into people's eyes. You have to get uncomfortably close to a person's face to do so, and keep one eye closed. I discovered what a struggle it is to keep my left eye open when my right's closed. Then seeing the person's blood vessels is surprisingly difficult--finding the optic disc near-impossible. After many, many tries on different weeks I finally saw one, and again the excitement was too large for such a tiny thing.

Dean Angoff introduced our introduction to the physical exam by saying how important it is to feel the discomfort, anxiety, vulnerability of the patient. That by being patients for our partners to practice on, we have some sense of what it's like to have to bare yourself for inspection. I love Dean Angoff, and I love that after so many years in medicine she is still so in tune with people. I have definitely felt anxiety being the patient, and she makes me remember to be thankful to have that feeling to draw upon in the future. I'm not going to lie. Taking my shirt off for the lung and heart exams was uncomfortable. Actually, even having a light shone in my nostrils was discomfiting. And that's with an awesome partner who couldn't be more considerate. I imagine it's worse for a patient, who doesn't even know why we're doing things, whereas we understand why someone's poking us in this place and that.

The physical exam has also added yet another thing to draw our class into a cult, of people who torture each other with bright lights in our eyes and amateur percussing and hesitantly sticking otoscopes in our ears without damaging something in there. I try to step back and look at that from the outside, and it amuses me and find that as awkward as it can be to do this on people you know, it's another aspect of the med student bond. However, I welcome any of you to be my patients for practice.

This week's physical exam practice was supplemented with the heart sounds session I mentioned before. It is amazing to hear something buried in you beating in your ears. It is extremely hard for me to distinguish sounds, which beat is louder at certain places, the timing of a beat and an underlying/overlying murmur. It's such an art.

The day finally officially ended, and I spent my hour before dinner ordering books--Let's Go for PUERTO RICO, and yet more Murakami to read while in PUERTO RICO. After a five-hour planning party wherein ten or so people were in and out of my room on three computers searching for travel deals and spilling tea and yogurt on my sheets, we booked TWO rooms for FOURTEEN people in San Juan. Six nights, six-and-a-half days with packed, co-ed rooms. I am so excited, and so glad that all my good friends here will be together in another country with no med school frenzy.

After a nice dinner (our dorm food is always bad, but company is always good), I thought about doing work, but ended up g-chatting with Allison for a couple hours about boys, school, motivation, friends. Even though we're so busy, I think we all give a lot of thought to our experience here--why and how. It's necessary to stop to consider what we're doing, because it's so easy to get swept up in the rhythm of things.

I did manage to review the kidney lecture from the morning, but that was about it before we headed to PubMed. PubMed is a free party with open-bar on the first floor of our dorm. Its convenience cannot be beat. We got pretty tipsy. Some of our classmates who have formed a band performed several songs. Events like this make me want to grow super arms to hug my entire class at once. They are so goofy and amusing and supportive of one another. I like how, since the first day we went out, we can all dance with each other in complete innocence and fun. He and I had a tiff and a moment, which consumed most of the night but ended with me glad for how people surprise you.

*

I don't write much about daily happenings, because for me they don't give a good impression of how things are. But giving a sense of what medical school is like is difficult. Thoughts and responses clamor for space and it's hard to fully revisit any one of them. Thursday, January 31 was a long day with a smattering of almost every thing that comprises my life here, and one I'd like to remember in detail. I'd like to calm that murmur and listen to the beat of things.

my brother's wedding

My oldest brother got married. The event drove several very obvious things home: marriage is a big deal, life's hard, I've gained a sister and I am still a kid.

Back when they thought they'd have more time to plan the wedding, they took me to look at dresses and rings, and I couldn't really get into that. Flying to New Mexico, I felt little anticipation; I had a sense of going through the motions because of the practicality of the ceremony and its haste. This lasted until the moment I saw my brother and his bride, dressed--he in something other than his normal sweats and she with a winter coat covering the white but still instantly beautiful. He was so happy to see us, kept thanking us for coming; it's been a long time since someone has been that happy for my presence and I felt so lucky to be able to give it to him.

The mass was in Vietnamese, and I couldn't quite get into those formalities either but somehow I found myself near tears anyway. I almost felt like the older sibling--the one who's proud and weepy. Things that are of value are continual; they don't happen in a moment, but there are moments where these things concentrate and come to a point and make you hyperaware of them. You always wish for the happiness of those you care about, but during certain parts of the mass I could feel the strain of me physically asking for it. I'm not going to pretend that I feel that as often as I should, and the tug was like the loving ache a muscle makes after a long time in disuse.

The circumstances of the event weren't ideal, and I so wish that it had been better for the both of them. His wife is balancing school, of which she's missed much lately, their new life together coming into being and something in her old life passing away. I honestly don't know how she finds the strength to do it, and I wonder at how I get overwhelmed with my own life when it is so much easier. The happiness that day should be will always be overshadowed by the sorrow that it was. For me, so invested in memory and story, that would be so hard to accept. Without having any tangible evidence, I sense that she will and gracefully so. She and I get along, but we don't have too much in common and haven't really talked at length about many things. But it's easy to see there is much to look up to and learn from in her, and it hit me for the first time that it will be very different to finally have a sister in the family, and one who isn't actively trying to take care of me but is just showing me by being.

So it happened that marriage, birth, and death--the events of a lifetime--were crowded into the space of one day. I thought about how none of my days in twenty-three years has been quite like that day for her, and I can clearly recall being fazed by the sudden realization that I am a child. And that all the experience I hope for, the majority of it lies ahead and that I shouldn't want to hurry it. It comes hard and fast, and you need all the time before it to brace yourself (uselessly, probably) against the parts that don't fit.

Though he didn't show it, I know it was hard for him too, to have things done this way, having to cut so many corners for something he's wanted for a long time. Yet he adjusted so well, and found happiness in it all. And it made me very glad to have had the opportunity to speak about his selflessness in the speech he asked me to write. Sometimes I forget how much my oldest brother cares about me (much more than I actively deserve), because we only see each other once or twice a year, and neither of us have time to have the frequent conversations we used to have. When he first asked me to make a speech for the wedding, I was a little overwhelmed, because things have been so incredibly busy. In my semi-exploded state, to write something meaningful in a few days about an event we only knew was coming a week in advance seemed like too much to ask, when of course it wasn't and I was just being self-absorbed. As short as it is, it took a long time to write but like with most words that take time, I learned a lot about how I felt in the process of writing. After, I was really thankful and honored that he'd asked me to do it. He so rarely asks me to do anything and it was nice to contribute something concrete to his moment.

So here's what I said.
*
This is the first wedding speech I've ever made, and at first I thought it would be really difficult to write. And well, it was. When I asked Hoang what I was supposed to say, he said to me, "What else is there to talk about? Me and Vy!"...And while that seems obvious, it was helpful to hear.

Because as much as a marriage is about the union between two people, it's about the two individuals themselves. So in thinking about this, I thought about these individuals. One who has always been family, and one who has become family.

While I was growing up, Hoang always felt like a parent to me. Not just because he set my bedtime and wouldn't let me eat too much candy, but because he gave without expecting anything in return. As a child I found this to be natural. But when I got older I realized how rare it is for a person to give more than they take.

So when I met Vy and saw the same generous spirit in her, I knew it was something special. She extended her full self towards our crazy family, and with Hoang, she was unquestionably selfless. And so Vy reminded me as an adult of what Hoang taught me as a child: that a true connection between people is not about, like they say, give and take, but about give and give.

With their marriage, Hoang and Vy give not only to each other. They also give all of us faith that two such caring people do exist, and can find each other. For that and much more, we wish you many blessings, happiness, and much more.
*

The actual speech went about 82% the way I had practiced it--had to give some pause for laughs (I was struck slightly ajar by actual laughter), for having to talk louder because there was no microphone, for a couple slight misphrasings, and for how people started clapping and making noise at "many blessings," leaving the "happiness and much more" drowned in chopsticks against glass. I'm glad that part went 82%. For all the quiet steadiness of life thus far, it's the noise you often remember and you often look forward to.