nothing

I've been working really hard, nonstop outside of meals and this will continue for the week so I can finish my research and concentrate on school which I've neglected for quite some time. In the midst of it big things are happening like my talented brother winning second place at the WPT and choosing to lose one of my best friends and a 3 month countdown to the Boards. On top of it my foot has been pathetically stress sprained and I have costochondritis--"harmless chest pain" that is not a myocardial infarction or pneumonia but makes me clutch my heart when I breathe in and when I laugh. I look wryly upon the feelings of my heart's literal ache and the refusal of my feet to take me anywhere.

Yesterday I rediscovered Kirin milk tea. Summer before last my brother Stephen and I were wandering thirsty in some garden in Japan and came across a vending machine with Kirin tea (there are a lot of vending machines, very few trash cans, and inexplicable cleanliness in Japan). That was the first time I had it and it was soooooo good. Thereafter we'd instinctively look for it passing by any vending machine. When she returned home from Japan, Aud brought me a pack of powdered milk tea packets that I rationed for the whole semester. That was last year and I haven't had it since then. Until yesterday when I was roaming the Asian grocery store with Allison and randomly saw it and immediately bought it. In the car she commented on how I don't seek things out but am happy with what's given to me. It made me realize that it's an interesting dichotomy, how tied I am to the past and how I adapt to the present. I also believe strongly in appreciating where you've been and where you are at the same time you're trying to go elsewhere--not with one as compensation for the other, but both equally valuable and inextricable.

One main reason I'm not as stressed about the Boards (yet) as I was with the MCAT is because even though things weren't ideal back then they've turned out well. The year of worry about where I'd go to school was useless; I didn't end up where I thought and it's been wonderful. I always seem to end up where I fit. I'm not always sure whether that's because it's really that way or because I make it that way, but that's irrelevant at the moment. Even though there are definite negatives, I'm grateful to have had such space and good people here to make me grow.

Working away in our living room yesterday, in the comfy pink Queen Anne chair Jen found on Craigslist, surrounded by snacks from the Asian store and basking in my milk tea--the image of our night driving back from New Hampshire came to me all of the sudden. That night Allison asked if we could look for stars, and we drove off to find the darkest nothing we could find. We'd point to directions where there seemed to be nothing so that we could see the night light best. We found some fair amount of darkness. The stars weren't too spectacular, but I remember crisply that night and the desire to go towards nothing.

There are a lot of things I've wanted to write about in the recent past, and always. One of my happiest patient interactions thus far being a very sad case of a person just a few years older than me with a few years to live. The photography exhibit of nursing home residents and of very ill people, reminding us that if we don't actively do art it won't happen. Being tested and videotaped doing a full history and physical exam. The second year show. My family.

I want to unravel and relish everything but I would also like nothing for a little while. While writing this, iTunes fell on Jimmy Eat World's "Goodbye Sky Harbor," wherein after a normal beginning, a continuously repeating riff sets in and constitutes much of the very long song (four times as long as most songs designed for our byte sized pleasure). A., who listened to music completely different from me but was open to my preferences and quickly fell in love with J.E.W, once talked about how much he loved this song, how you could listen to it even intently and still be immersed even though the tone doesn't change at all.

So much so that when the 16 minutes 14 seconds are over, I repeat.

present

Recently reminded of the value of being fully present in each minute even as we scatter here and there, I list all the things that made me feel today in the order they happened. Specifically, things that made me very happy, for balance and because that's what I have.

1. Got an email from G. about art/photography in response to inquiring how he liked the Nicholas Nixon exhibit yesterday.
2. Watched the video of the Goodies/Rizzilicious danceoff from Second Year Show. I messed up timing several times but it was nice to see from the other side, and feel again pride and affection for our class.
3. Despite already knowing how perceptive he is, was impressed anew by a good friend's ability to pick up on how I am.
4. BB sent an email to organize a potluck, complete with a link to a website where we can post the days we are free and list what we're bringing.
5. Ali turned bright red while arm wrestling Nupur and we laughed so hard everyone in the cafeteria turned to look and laugh.
6. Found out that my youngest brother Binh is in the final ten of what was originally 696 players in a World Poker Tour Tournament. At one point he was #1. I'm so so proud! Of his dimple (prominent in the video clips I watched) and smarts. I feel privileged to have been his poker guinea pig as a kid.
7. Laughing too much at the library with the family.
8. Dinner with Ali: he was made incredibly happy by Ben & Jerry's raspberry chocolate chunk ice cream; he asked me questions like what kind of person I'd like to marry and what was my favorite thing in the whole world (when I explained, he burst into a smile and said That's beautiful! I never would've thought of that in a million years); he rode his bike slowly next to me as I walked (when I said, just go home it's cold, he said, I got my clothes on). This item should really just be: Ali...an extremely strange, extremely kind person.
7. My mom's wonderful voice advising me to go to sleep, when it was 10 PM.
8. Finally having time to do questions on our endocrine module, and feeling like I'm learning even if not retaining.
9. Taking out the trash.
10. My two brothers in CA wanting to go to LA tomorrow to see Binh play poker.
11. The Magnetic Fields - "The Way You Say Good-Night."

Good night.

iatrogenic

Learned today that before insulin was discovered, the treatment for diabetes was starvation. If you ate normally, you'd die from ketoacidosis (without insulin, your body makes too much acid, a process which pretty much messes up everything that's regulated by acid-base balance in your body and kills you). So people could choose, our teacher told us, a slow death of starvation over the quick one of diabetes. Then they found a way to isolate insulin and use it as treatment. Now, though there are still awful consequences of diabetes, it's possible to have it relatively under control. This all reminded me of how I recently learned the meaning of the word iatrogenic. This describes harmful, unintentional consequences of medical treatment. This doesn't quite exactly apply to the starving diabetics thing, but the extreme of a "treatment" directly causing death made the idea resurface.

It's something I've been thinking about for awhile. I've probably heard it before but the first time I remember it, and remember understanding it, was when I met a patient whose esophagus was perforated while receiving anesthesia for surgery for bladder cancer. This caused life-threatening inflammation of everything in his middle chest area. That was a mistake, which is what iatrogenic refers to. But somehow I take it to encompass all the fundamental harm medicine knowingly and necessarily inflicts, in order to treat illness. Last semester I met a patient with malignant bone cancer, a frank man in his thirties who managed to be friendly without smiling. He'd done a lot of research on his chemotherapy treatment, and told me that after he'd agreed to it, he read that there was a slight chance of developing leukemia from the chemo. He said he'd wished he'd been told that before. When I asked him whether it would've changed his decision, he said quite possibly, because why fight one bad thing to just acquire another.

I'd taken it for granted that one would choose to go through the treatment, especially for one so young. This is how I'm personally built, and in some ways how medicine is built. To try your damned hardest to do everything you can to fix people and situations and lives. But sometimes there's no insulin to be discovered, and trying too hard can mean starvation.

I wrote a long time ago about Jonathan Franzen's "The Corrections" and recently about "Breathing Lessons," both of which deal with the futility of our efforts to change things, and the irony of our solutions creating or worsening the problems they seek to resolve. I don't know myself how to get out of that cycle, sometimes. Despite complete understanding and direct acknowledgment of the reality of things, of the net gain or loss of happiness from my choices, of the same recurring hurt that results--I refuse to stop trying. I have found so many ways to see the value in things that are unpleasant, painful, non-ideal, but I have never reconciled myself to loss. And I mean, really. I think about it almost every day, and it is not just a matter of time or out of sight for me. People say that loss isn't your fault; it's natural, so you shouldn't try to resist so much. But I think it would be easier if it were our faults, because as reasonable and obvious as it is, the reality of loss as natural and incorrigible is incomprehensible to me sometimes. In the few connections I've had, I've fought so hard to preserve certain aspects, even when the process chipped away at me, that I ultimately have to let it all go if I want to keep myself together. I end up with a loss greater than the one I was trying to prevent.

I read Norwegian Wood during a time of all consuming ache, and one of the passages that meant most to me then comes to me again often and particularly now when I ache again: "Things will go where they're supposed to go if you just let them take their natural course. Despite your best efforts, people are going to be hurt when it's time for them to be hurt. Life is like that....You try too hard to make your life fit your way of doing things....But who can say what's best? That's why you need to grab whatever chance you have for happiness where you find it, and not worry too much about other people. My experience tells me that we get no more than two or three such chances in a lifetime, and if we let them go, we regret it for the rest of our lives."

I felt this to be so true and something that fit right into me at the time, but of course I didn't listen, not then or now. So here I am, a girl who for some inexplicable reason hates losing people more than anyone I know, turning away from a friendship that means so much to me. Giving up a connection in its entirety because not wanting to give up anything before, wanting to fix to make you and thereby myself happy, put me in a place to hurt you and be hurt. In the end it's true that this is right because we all deserve the same happiness, and it's true that we have a choice in our own happiness and I have to be the one to think of my own. Still, I'm sad.

amy / new york / french

This dinner (one year ago to this day) was my best Valentine’s Day. I traveled to and from NYC in the same day, since that year Valentine’s fell on a weekday, for a night with one of my best friends from college (from neighbor to blockmate to roommate). I remember seeing Amy sitting at the bar from the window and thinking she looked very cosmpolitan with her cocktail dress, hair swept in a ponytail and wineglass in hand. (I on the other hand was carrying a big book bag and had to change out of my jeans in the bathroom. Am also sure that that infamous knot in my hair was present). The restaurant, Nice Matin, was intended to be modeled after a place you might find in the French Riveria (haha, Nice perhaps), perfectly fitting. The food was heaven. I had sole, which is rarely anything special, but here it was so flavorful. We shared a dessert whose name and ingredients we didn’t recognize but we went for it and it was so worth the risk. Creamy and subtle and sweet and textured. This was all in the company of a girl I could talk to for hours whether it’s been forever or just a day since we’ve talked. Our conversations are always honest, which cultivates humor and emotion. Having experienced together the onset of anxiety attacks concerning Purpose, Love, Family, etc., these are topics we continue to share in comfort. We went for coffee afterwards and talked more until the last minutes I could get my train, and I traveled back feeling much love for and loved by.

untitled

In Connecticut, a morning in January and a morning in March don’t look too different when you look outside for help with what you should wear that day. Usually it’s bright and there’s often unplowed white on the sidewalks and people shuffling in layers. Even if there aren’t, you know enough about this coast to know that your scarf is not accessory but requisite. I came here from California, where warmth is numbing. Here winter occupies half the year, and the seasons are stitched together. Sometime in April someone starts pulling the thread. White turns to gray to yellow, a familiar and welcome flow. As capricious as the outside can be, even if it’s cold when sunny or if twenty degrees separate two consecutive days, we sense its character. And so, the oft elusive weather becomes part of our concrete knowledge.

This is why, when testing a patient’s cognitive function, we ask them what season it is. It’s supposed to come naturally. Our patient is seventy-eight, and the deeply pressed lines of her face change what I consider natural. As she furrows her forehead in an effort to find the “right” answers that she so badly wants to give us, the rain falls steadily harder outside. Watching her sit and speak in front of the weather, the bus ride we took to the nursing home feels farther away in time. I’m suddenly aware of my socks wetly clinging to the inside of my shoes.

When asked, our patient tells us the correct month—April. It’s only when she says this that I realize how far into the year we are. Only a couple weeks ago stacks of muddy ice tinged with white still created tunnels on the street. Not so long did thirty degrees feel warm. At some point in that winter the snow glazed over and made a varnish still visible at night and worthy of ice skating. During the day a friend commented that he liked how bright it was, when the snow was fresh and the sun piercing. This year it all ebbed into spring slowly so there was no time for embrace or longing. But we still remember.

When then asked what season it is, the woman sharing with us her presence hesitates. She doesn’t consult the window behind her, even though I look past her to the outside. Instead she looks ahead and I wonder at what or for. I think the sound of her delicately mouthed April has faded. Then she says, “fall,” and I think our insides break a little.

Would she have known, if we had been sitting outside to let the falling water slip off our cheeks, rest in her creases? What if the season had been the stronger one of few weeks past, and she could hear the salted snow stuck in the grooves of our shoe soles as we walked across the room to her? Or if she’d walked long enough for the water to seep into her socks? It’s out of grasp to feel what touches her, much less link sense with thought.

And fall here is not far from spring, anyway; what does it mean to mix and match transitions? It’s solemn on the ride back to school. My classmate sitting next to me confesses some depression over what he’s seen. In not these exact words he says that life is for interaction with experience, and to not know your experience takes away purpose. It’s funny to me that this sounds and is often true, when I came to medical school with the purpose of meeting experience.

But our windows tell us little, and what we feel of the outside is inexplicable. For the woman giving us her words, the layers of expression have been shed, and the experience left so bare that it’s gone from our view. Without even the frayed threads of winter past to twist around her fingers, it’s still spring.

february & 2009

I dated something the other day 2008, and afterwards told myself that we're well into February now. I think taking most of January to consider 2008 is about as far as I can stretch it, and besides, February is a good time to consider 2009. Because it's a packed month. This month is finishing my research project, the second year show, and planning the rest of the year because they kind of make you do that.

A year ago I was still writing the proposal for this project in Vietnam, and now I'm frantically writing everything up. The three main categories of findings are household consumptions (when confronted with health costs, what items on which households then spend less--including food, education, farming expenses), coping strategies (how do households without financial resources pay for healthcare--which we found to be mostly borrowing and a cycle of debt), and insurance (is the relatively new insurance system decreasing the economic burden of healthcare). It's been satisfying to put it all together, but it's also taking much more of my time than I'd like. Mostly, while public health as a concept is essential, I'm still averse to the need for research and theory to prove it.

Just as I can't believe it was one year ago that we started this project, I can't believe it's been one year since last year's second year show. The second year show is a string of skits, dances and videos that make fun of our faculty, traditions, phrases, and other Yale Med specific quirks. It's a nice thing to do as an entire class, reminiscent of our high school spirit weeks. It means setting up and practices and such, over the next couple of weeks. So it's an event to anticipate and to overwhelm (us).

So that's February in its active form. The part that lurks is the planning part. 2009 is split into halves: the Boards and the Wards, both of which are punctuated by travel. These things bring to mind some of the new vocabulary I've learned in med school that I hate. They will come up as I go.

The Boards consists of three steps, all required to attain a medical license. I'll be taking Step 1, the most important of the three, at the end of May. Step 1 is a 7-hour exam with 350 multiple choice questions that tests everything we've learned (and haven't learned) for the past two years. Off the top of my head, that includes biochemistry, anatomy, stats, immunology, microbiology, pharmacology and most importantly, physiology and pathology of all organ systems. Med word I hate #1: high yield. This refers to bytes of knowledge that will likely appear on an exam, things that will give you the most bang for your study time. I know it's realistic to think in terms of yield, but I also think that sometimes medicine is too entrenched in the approach of thinking about what gives you the absolute most. I know waste is not good, and I don't have a rational logic for why this would bother me except that perhaps the measurement of what has value is so regimented.

The reason this is the most important Step is because it's the main factor in applying for residencies after med school. If you want to go into something competitive, it matters a lot, and it matters a lot to most of my class. Med word I hate #2: gunner. Gunners themselves don't bug me that much as long as they don't shortchange other people to get ahead, but it is a little bothersome that the general impression of our culture is that we're all gunning for...something? At this point nothing I'm interested in is competitive (apparently 2% of graduating med students go into primary care these days), but who knows what I might end up enjoying, and I would like to pass. More than that, I would like to feel that I'm doing relatively well in what I'm consuming my life with, and I would like to know things.

The latter part is why I'm looking forward to going home to study. We get six weeks off school to study, and by studying, they mean something like ten hours a day, six days of the week. Though I doubt both my ability to study for that long and that the amount of time's sufficient to learn everything, I look forward to a routine of learning. I look forward to morning runs in Fremont, a consistent study schedule, meals at home, quiet nights and the one day a week of nothingness. It might sound sad to compartmentalize a month and a half of your life to not really living, but I'm in school to learn these things and I haven't done a great job of it thus far, so I'll be glad for an excuse to try.

Besides, afterwards comes the punctuated travel, to Prague!

Then comes the rest of June and the second half of 2009, the Wards. The wards are when we enter as the lowest rung in the hospital. We "rotate" to different areas of medicine, like ob-gyn, surgery, pediatrics, and so on. So we leave behind the realm of no responsibility and re-discover on a whole new level how little we know. Med word I hate #3: pimping. This means being drilled by your superiors in the hospital, and in my case 99% of the time, not knowing the answer. I'm very much looking forward to patients and active learning and doing the history and physical exam for the patient's sake instead of ours, but I'm not looking forward to being pimped, thanks.

But after the beginnings of that comes a month off (December), half of which will be spent lovingly at home and half of which will be spent in travel to somewhere to be decided!

In any case 2009 is a hefty year. I'm not ready but I think I will remember to write 2009 from now on.

tanvi / chicago / indian

I once started writing about my top ten meals of all time, a good meal being one of my top ten favorite (semi)concrete things in life. I couldn't write about them all at once, so will post them as they were experienced, every so often.

**
T and I met as the only freshmen in high school biology and have never stopped giggling and neuroticizing together since. Well, there was a gap towards the end of college where we didn’t keep in touch as well, but nothing was lost. Yale gave us a week off for Thanksgiving (what novelty!) so I visited her in Chicago. She took me on honestly one of the best dates ever, with the best Indian food ever. Devon is the Indian & Pakistani neighborhood of Chicago, and streets were lined with Indian restaurants one after another. It was the first time I had Indian style okra (perhaps any kind of okra). I don’t remember the name of the place or what we talked about but I do remember being in awe of how she’d grown, so beautifully, inside and out. I remember that it was very cold outside, that inside was a warm brown haze, and that our table was small; she sat facing a window to outside and I sat facing the restaurant; we were in a corner. Afterwards she took me to a jazz club called the Green Mill. The sounds coating the walls and drenching the silhouettes between chairs, tables, stage, drinks on the table, made me sharply, dizzily aware of fullness.