chicago

I love long travels, and also weekend trips. A few days away, revisiting a city and a friend, contains much more in memory than in actual time. On Friday, I flew out on one of the very flights that had not been cancelled to Chicago. Someone in an air traffic control building at O’Hare airport had set it on fire, and thousands of flights departing from and arriving in the city were cancelled. Mine wasn’t, and I felt lucky.

My friend Pete picked me up in the car he had driven in high school, with a license plate that sported his last name and football jersey number. He drove us to a neighborhood that had been recommended to me earlier that day, Pilsen. I was struck by how the streets exuded both a big city feel and a cozy small town feel; there was a lot in the surroundings but it was easy to navigate. We had dinner at a place called Dusek’s, a spacious restaurant coated in warm browns and chic lighting. He had a flight of beers that also came with a shot, and I had a bourbon cocktail that was too strong for my taste but good. We chose small dishes, that did some of the things that I find most amazing about food: gave taste simply from being fresh and simple, and also packed a range of subtle array of flavors in compact spaces. Broccolini with a light sauce and white raisins, bay scallops sliced thin and buried below a too-bright delicious green sauce, charred baby octopus atop green couscous, and a dessert of salted caramel churros aside dark chocolate sorbet.

We then met some of his friends at a bar, which again surprised me with its space. It was an unseasonably warm September weekend, and tall good-looking girls wore short, low-cut dresses. The bar played good, popular music in short segments so everyone was dancing. We left after another drink, and hung out at his friend’s place nearby. It reminded me of med school, and the time we spent just hanging out then. These days, we go out to dinner, we do activities, we make plans; I realized how much I missed just hanging out, at our apartment, at the guys’ apartment. At his friend’s place, we drank a shiraz named the Butterfly Effect and talked about the butterfly effect and how the man who lit himself on fire affected the travel plans of thousands (except mine).

After the late night I slept in until noon. Pete’s loving mom made us breakfast, and we drove into the city. We had Dunkin Donuts coffee, which I haven’t had in years; I had mine with cream and sugar and savored it. We walked around Millennium Park, and I took pictures of the skyline and of the Art Institute, whose glass and bright white angles I loved. It might have been partly the weather and how gorgeous and big the clouds and sky were, but I felt that of all downtown buildings that I’ve known deeply (New York, San Francisco, Boston) I liked Chicago’s best. They felt clean and fresh and refreshing, less dominating and more comforting in their height. We wandered around the bean, gardens where a wedding party was taking photographs, and made our way into a market where we had too much sushi. After the food we decided to go swimming, so went back to his friend’s place which has an outdoor pool. There was a gorgeous view of all of Chicago, and dusk settled in with pinks and stray clouds holding their own against the setting sun. On the first lap across the pool I promptly lost one of my contacts. Pete and his friend wanted to race across the pool holding our breath, and despite being blind and having to close my eyes, I joined. This is how I learned how important vision is to proprioception; closing my eyes to avoid losing the other contact, I couldn’t swim straight and I promptly rammed myself into the side of the pool, bringing my breath back quickly.

Blurry eyed and disoriented, I left the guys and went to dinner with a high school friend who lives in Chicago, who will be getting married in California in a couple of weeks. I hadn’t seen her in a couple of years at least, but as with all revisits of this sort, it was easy and warm and made me happy. It was nice to see her happiness in person, and to have one-on-one time with her before the wedding, when you feel close but far from the couple because everyone else does too and there’s only one of them. Afterwards Pete and his friend picked me up to go to yet another bar, where I bit the bullet and took out my one contact so that my vision would match and spent the rest of the night virtually blind. It was okay because I sat and talked to Pete which didn’t require much vision, which reminded me of the ease of friendship. Back at home he tried to show me the genius of Comedy Central with skits of men impersonating sorority girls, and we found out I’m not hip enough to find this funny.

On Sunday I slept until noon again, and we took our time getting out of the house, eating breakfast, sitting in the backyard, then talking for awhile to Pete’s neighbors who are like a second family to him, playing with their chocolate lab and talking to the daughter about her first year of college. We made our way into the city again, and debated on how the best way to get to Lake Michigan and Lakeshore Drive. Finally deciding to bite the bullet and drive there, Pete got antsy being in the car for so long while it was gorgeous outside, but we were lucky to find a parking spot. At a fast food place we stopped to use the restroom and got a free falafel. With that in our stomachs we set off for a run by the lake.

I haven’t run outside in a long, long time and it was unreal, the clear blue and huge clouds, the waves quietly lapping the shore, the skyline in the distance, the ferris wheel past that. It was such a deeply filling place to run, and I felt so lucky for my legs and lungs (despite my weak speed and Pete flying by me). We stopped after a couple miles to walk the touristy navy pier, and walking all the way at the end we walked along an edge where no others were, and I was surprised and touched by the gardening there. There were heavy mixes of flowers all along the walkway, and I liked how varied they were (not just different ones next to one another, but a real conglomerate all in one space) and how carefully groomed they were, despite no one around to look at them. We ran another two miles back to our beginning, as the sky deepened in pinks and then faded into midnight blues. We then promptly treated ourselves to first creamy ice cream (I had peach biscuit cream and almond brittle) and then a whole chicken’s worth of wings (that was all Pete). I was wiped out from the movement and food and nature, so we headed home and we both skyped with M for two hours.

On Monday, I slept until noon for the last time, and we spent the last hours of my vacation at home in the backyard. We read stories by Murakami, Cheever and Eggers, and I taught Pete and his mom some yoga on the grass, and Pete’s mom grilled us tuna steaks before we sat in traffic to get to the airport and I almost missed my flight but didn’t.

It was the kind of weekend that stretches its fullness well past its three days, and I feel lucky for the minutes of its present and the memories I place here and have been placed in me.

lemongrass & plums

The best thing about my clinic months is having weekends. One of the best things about having weekends are the natural morning wake up, and time to make brunch at home. It makes me feel so much more human to make our own meals instead of relying on cafeterias and frozen goods. Lately I've been going to the Alemany farmer's market on Saturdays, and both the experience of shopping there and the experience of making food from what I get there make me incredibly, tangibly happy. Because it's cash only, I take $15 with me each time and buy necessities and indulgences until that runs out. And because it's one of the best deals in the city, for that amount on one occasion I bought three bushels of garlic, three limes, a box of strawberries, a bushel of chard, a bulb of fennel, a pound of okra, and (my indulgence for that day) a quarter pound of shiitake mushoom; and another occasion for about $8, four stalks of lemongrass, a bushel of kale, half pound of ginger, three of the best plums we've ever had, and two eggplants. And most of these are organic. Besides the price, I enjoy: 1) being outside and seeing the scents and textures and colors of non-processed, unpackaged raw foods. 2) trying new meals because of new things I buy. Made M a lemongrass coconut curry chicken and made myself bhindi okra 3) the incomparable sweetness of the fruit. M doesn't eat much fruit but when I gave him a plum he devoured it. I feel lucky that I can feel so lucky about the simple elements of food.

heartbeak

August was my last full month of inpatient medicine at SFGH, our county hospital and place I feel most at home in terms of work. I was lucky to average 80-90 hours a week, having a relatively lighter load of patients than some of my colleagues working at the same time, several of whom had a slew of many 12+ hour days in a row. In the end, I think no matter how well your body holds up against this unhealthy amount of work, your heart inevitably breaks when spending a month at the General. Not because you feel more than slightly less than human when you skip meals and sneak candy to fuel yourself and can’t sleep at night because you’re too wired from the day and wake up even earlier than the before-light time that you need to because you’re worried—this is all true. But when things happen to you, you feel like you can make sense of them (whether this is actually the case, who knows, but you feel like you can). When you see other lives un-crumple and re-crumple, you cling to edges and cut your fingers, and these seemingly slight wounds pretty much broke my heart. In that concomitant temporary it-will-be-over-once-the-month-is-over and permanent lingering what-do-I-do-with-this kind of way.

There is so much dichotomy that the pieces you break into are often in battle with one another. In these patients lies the kind of stubbornness that inspire extreme awe in the power of people to keep going, and extreme frustration in how things can continue in the same way for so long. Their situations are so fragile, yet their dispositions so resilient, that you scramble to figure out what it is that you’re trying to support.

I had to near-force one homeless man in his seventies with terminal cancer and without family to leave the hospital, to slowly bleed from his illness on the street, because he’d exhausted all of the options for a homeless patient. This was not wholeheartedly the result of a system that failed him—it was, as many providers who cared for him deeply and knew him well, also a result of his own self-damaging perseverance in remaining homeless over going to a hospice facility. I was told by other providers, deeply kind providers, to consider our resources: our hospital beds, our shelter beds, our rescue centers are scarce and he had consumed much of them already, and we had to use our resources they were meant to be used, not to bend to the will of a charmingly, frustratingly independent patient who selectively discarded rules. His actions may have been for the protection of his family, or for fear of dying, but many rational, reasonable justifications were clouded in unyielding decision-making that I could understand but never truly feel. When distressed, his face was all wrinkles, and through these creases, eyes closed, he said to me, “How can I go, like this?” All through the morning, I demanded, then begged, him to leave early so that he would have the best chance possible of attaining a shelter bed (the lines start early). I had worked hard the night before to ensure that everything was ready first thing in the morning. He refused and refused, until by the time he finally left it was likely too late for him to find any refuge for the night. I offered him again the option of hospice, and again he refused, yet he wanted to stay in the hospital, where he no longer met any criteria to stay, where I had already fudged a note to cover an additional night. Spinning in this cogwheel taught me helplessness.

But, not only did I see the same type of hospitalization he’d had many times before unravel during my time with him, I saw it come to an end. The day after we forced him to leave, he returned, and made his way to hospice. Even when he made this decision, he didn’t make the way easy. It took me almost an hour to place a tuberculosis test on his arm, a necessary procedure before he could go to hospice. All the while he pleaded with me to leave him alone. I guessed that he was scared, of needles and of the idea of needing to be tested and the sense of actively dying. I ask myself after all this, what was it that broke my heart? The human resilience that caused such damage, or the act of it eventually giving way to the world?

I could be ironic and say the latter. But then I think of the young man with crippling untreated HIV with a severe brain infection who, when I meet him, refuses to speak to us. His co-existing psychiatric illness, homelessness, past trauma, substance use, and only he knows what else, makes him distrusting of us, and child-like in his assessment of the world. To him everything is unfair, and I grapple every day between agreeing without interfering, and wanting to shake into him some recognition of what he could still gain despite all that has been taken from him. We spend two weeks with him, daily administering medication that will save his life temporarily and daily trying to gain his trust so that he can live beyond this acute infection. We make strides: one day as we speak to him about a procedure needed to reduce his symptoms and treat his infection, he refuses to answer any questions and the only words he speak are to say that he will hurt us if we continue in our attempts to do this procedure; a few days later, he apologizes for his behavior. After awhile he allows us to do things he’d initially refused, like drawing his blood for labwork daily. Our medical student spends hours getting to know him, contacting the few people in his life, communicating with other providers taking care of him, bringing him his favorite foods, and trying in all the ways any one person can to validate him. On morning rounds, I underscore her efforts—look at how much patience and endurance can achieve.

But two weeks, though long in terms of a hospitalization, is short in one’s life. Minor things still set him off and off the course we’d try to reset for him. We work incredibly hard to find a safe place for him to go after leaving the hospital, and manage to get him into Medical Respite, a place for homeless patients to go after being discharged where they could be housed and could continue to attain any necessary medical care for a brief time. We are hopeful that they can help re-engage him in care, get his medications started for his HIV, and possibly get him into housing, which he cites as the main source of his problems. This was actually the place that the previous patient had most wanted to go to, but who could no longer take him given the scarcity of resources and their need to take care of patients like this one, with an acute need for medications. For several days I prime this patient for going to Respite; he is enthusiastic; he asks questions about where it was and what the rules were.

On the morning he is scheduled to go there, I’m paged by the nurse as I have been many a time before for him (“Refusing medications. Wants to speak about it.” “Refusing labs. Please see him.” “Would like chips.”). This time: “Upset that he cannot find his shoes. Refuses to go to Respite.” The shoes he had come to the hospital wearing have been lost, and can’t be found in our pile of donations. This angers him so much that he no longer wants to go to Medical Respite. He lashes out, falls back into the distrust that holds him back into a child-like view of how things work (centered on him, yet against him). I find it hard to believe that he can’t see how much we care, and I’m desperate. I find myself doing crazy things like offering to purchase another pair, which I know is both unproductive and damaging. It takes a long talk to convince him to at the very least take his medications with him, and he walks away without his instructions, his appointments, or a goodbye. After all the daily battles in trying to keep him in tact despite himself, the blocks I’ve built up inside of me to do this job slide out of place and I lose my shape.

At the end of the day and end of the month, I place faith in self-malleability, and know that even if I never retain the same self after experiences like these, the pieces are there and are mine to arrange. And that power is what I think people would want most for others, and what underlies this revolving door of the hospital. As much as the entrance and exit look the same, I hope with everything that something lies between.

substance

Alcohol, cocaine and vitamins: the kind of mix seen in places like San Francisco, and in the course of a clinic day at the General Hospital. Over the course of a few hours, I see an alcoholic faced with the possibility of liver cancer; a recovering alcoholic who is so meticulous about his health that he has come up with every way possible to be medication-free; a woman asking for prescription pain medications which I can't give because last month her urine contained cocaine and this month she offers urine with a cool temperature giving away its falseness; and a woman with crippling headaches who has transitioned to an entirely yogurt-based diet with a variety of supplemental vitamins and herbs to help her pains. All this natural and unnatural (something I have to group because so often I can't tell what falls into one or the other) makes me think of the human body as more of a garden than as a laboratory. As I try to explain why I can't mix cocaine with oxycodone, this metaphor floods my brain and I think of all the plants I've killed (or let die?) in my life. In medicine we're not taught to reflect much on how we treat people like soup, throwing in spices here and there and adjusting to our taste. It's something that M has often brought to light, with his careful thoughts on how we carelessly alter physiology. Sometimes as I'm prescribing or not prescribing I realize this, and often when I'm speaking to patients about what they use I realize that we all do this to some degree. Patients are doing something to themselves with all of these substances, we are doing something to them with ours. And with what knowledge, what understanding of what soil is best? How do we even choose a soil when there's so much disagreement on what comprises growth? This isn't to say that everything is gray; I really don't want any of my patients using cocaine. At the same time, I hope I don't lose a sense of the substance that lies in what each person cultivates.

turning thirty

Turning thirty might be the ultimate challenge in ignoring society. On the one hand, you don't want to buy into the notion of getting old and not meeting certain milestones by being married with three babies by this time. On the other hand, you don't want to feel bad about not having a dirty thirty showing off how hot and young you still are. Like any girl (meaning someone who, on not an extreme but still tangible level, appreciates belonging and certain quintessential life experiences as defined by television and movies), it took some rationalizing to be comfortable with these things. To help settle comfortably into the new skin of thirty, I wanted to have a special day on my birthday, and thanks to M as well as to an amazing co-resident who helped cover me on the wards, I had the most perfect day.

We started by biking from the Ferry Building and Bay Bridge, along the Embarcadero, thorugh the Presidio and Crissy Field, over the Golden Gate Bridge to Sausalito. The day started out classicly San Francisco: gray and foggy, and we stopped in the Presidio to capture the iconic image of our city. As we started to bike over the bridge, the skies cleared and made the waters more blue, and soft sun brightened our path. This trek was somewhat stressful for me, since I'm still not great at navigating on a bike--I fell off after trying to stop at the top of a hill, made another biker stop because I didn't veer to the side quickly enough, and still have trouble getting back on after stopping at a crosswalk. But it was a good balance of effort and ease, and I felt grateful for thighs that could get me up steep hills and for desensitizing to fast steep down hills, and I felt good about doing something that scared me on a day that kind of scared me. I also love doing things as weather changes. I loved this about Kilimanjaro, that we progressed from tropical humidity on the first day to freezing snow on the last. I loved this about the skies in Arizona, where one half was shrouded in thick gray and other half was bright sun, and watching as one stretched into the other. It gives this heavy sense of story, and I'm so thankful for being able to feel so much narrative in the space of hours, a day, a mountain.

As we biked into Sausalito, water opening up by the road stopped my breath. It's such a good feeling to see water ahead and beside you all of the sudden, and it was a beautiful clear blue water rimmed by hills formed from trees and homes. We got sandwiches from a local deli and ate on a bench outside; I had avocado and brie on Dutch Crunch, and we shared a stuffed egg that is like a more full deviled egg. We talked about the quiet peace of Sausalito, finished our lunch, and got back onto the bikes to make our way to sea kayaking.

We had talked about trying out stand up paddle boarding, but it was extremely windy and the people renting boards didn't recommend trying it in the open water. So we rented two single kayaks, and in the theme of clumsy direction I ran myself into a big boat before I got used to steering, again something I took to be positive on this day--continuing things that feel unwieldy at first. I love kayaking because of how close you are to the water, how light it feels, and how the view changes so much from the surface of the water. We saw dozens of seals lazying about, house boats, and absorbed the beauty of the hills above us. On the way back, we kayaked against wind and at one point it was so strong that I was paddling like mad just to stay still. I was proud of staying the course, and felt the energy from all the nature circulating in my limbs.

We then tried stand up paddle boarding for a little bit, just in the small cove before the water opened up. I asked them several times whether we should wear something protective in case we fell, and they kept assuring us that it was very uncommon to fall. To me it seemed so likely--we were standing on water, after all. But I guess having a board in between makes a huge difference, because they were right and I felt very stable standing up, which was a very cool feeling. Of course the wind and current promptly carried me into a corner where I got stuck for several minutes before I was able to maneuver my way out. This was pretty embarrassing, but given the goal to increase self-comfort, it presented a good challenge.

We recovered from the day's activities with a luxurious dinner at Sushi Ran. The black cod was probably one of the top ten most delicious things I've ever eaten. The texture was incredibly smooth and buttery, and the seasoning was savory in that way that magnifies with the seconds the taste rests on your tongue, and then lingers as it leaves. We celebrated with hot and cold sake, and especially then I appreciated how pure and natural sake tastes compared to other alcohol. By the time we were biking to the ferry to go home, I was more than full with the senses of the day. We had some time to wait for the ferry, and as we sat watching the waves I felt the layers of the day settle by their weight, like sediment. The lightness of kayaking and biking floating on top, the weight of the physical activity and battling wind and hills grounding the bottom; the lightness of a relaxing meal laced with umami and alcohol wafting at the top, the weight of the food in my stomach and diffusing its way through my body anchoring the bottom.

I tried to let this all sink and lay where it might as we traveled on the ferry back to San Francisco, with the softening sun creating an awesome sky over the water, behind us as we rode forward to the port and skyline. It was honestly so gorgeous that I couldn't believe this is where we live and that this wasn't a faraway trip part of a vacation but just a day off, just a birthday in my home. I felt so incredibly grateful.

We completed the day by soaking our muscles in the hot tub at my brother's apartment complex, which is something we do often on other days but felt especially like a treat on this day where I faced new adventures. Thinking back, it really was a perfect day that combined so much of what I love in my life: nature, food, movement, new things, and experiencing it with M. In this one day I found my sought-after comfort with this upcoming year--a sense that when so much has already been given, everything else is just more.

shotgun lovesongs

On the plane ride from California to New York, I read Shotgun Lovesongs by Nickolas Butler, a beautiful compact novella that takes place in Wisconsin. It's narrated in turn by five friends who grew up in a small rural town together, one of whom is very loosely based on Justin Vernon, lead singer of Bon Iver. I loved the book in part for this, and for the description of Bon Iver's music, which is very near and close to my heart. The writer of Shotgun Lovesongs went to high school with Justin Vernon, but hasn't spoken to him in twenty years and what's told in the book is not based on their actual friendship. But he writes about Bon Iver's music as if from Justin Vernon's perspective, and it touched me to think that this is actually speculation based on what Butler feels from his music. Listening to Bon Iver's music, Butler weaved it into the fibers of his own narrative and thoughts--I was blown away by the power of one person's art on another. And it fills that gap you don't realize is there until someone else resonates with something in the same way that you do. He writes about the sounds and sentiments of this music in a way that encapsulates how it makes me feel. You always think your personal responses to something are so personal, want to feel they are unique to you. And sometimes you want to keep it that way, but I think the best art is the kind that's strengthened when shared, and that's how I felt reading someone else's interpretation of this music that I really feel is a part of me.

The book itself felt much like this music. When I acquired my very first iPod, I was obsessed with playlists and added all of my favorite songs to different themed playlist. My all-time favorite songs always ended up in the "winter" playlist. Those were the ones that embodied that sort of cold warm ache that, during that period of my life when I'd moved to the East Coast, I could finally attach to the tangible experience of an actual snow and ice winter. This book also felt like winter. It loves wide expanses of space, and also understands how within that people draw close. And what can happen as a result. Stories about simple lives really show how much can be held in the rawness of people, that it doesn't take much other than the daily act of trying to survive and co-exist together to reveal the depth of what we can feel.

Part of the book talks about Justin Vernon's character becoming rich and famous, and moving to New York after marrying a beautiful actress. He returns after their divorce, and spends a lot of time writing songs about Wisconsin and talking about the difference between the two places.

I'm always excited to come to New York, the city I've visited likely almost a hundred times by this point but have never lived in. Excited to see my friends who feel so far when I'm back west, and excited to have new experiences because every visit here is so different. From the Cloisters in the winter, to waterfalls in Central Park in the spring, to running in Prospect Park and biking along the Hudson all the way to the Brooklyn Bridge in the summer--I've been lucky to have so many bites of life here.

I also forget until I arrive, the chaos and noise of this huge place. Staying in my friends' apartments I hear and feel trains, parties, and cars. It takes an hour to get from one end of the airport to the other. The highway signs are designed to confuse more than clarify. There are tons of cars on the road at 10 PM on a Sunday. I step out from the house into busy streets lined with shops, surprised to suddenly be hit with a community having been in private space one second ago. I do love that there are fruit stands open at all hours, and that within a few blocks of this apartment there are a dozen small markets where I can buy food to make fresh lunches, and that there's so much within walking distance. But it is a jarring contrast to the quiet, intimate space of my book and its images of rural Wisconsin.

I've always been too defensive when becoming labeled as anything general, and I think part of that comes from feeling like so much of me and of any person lies in different places. I'm really not sure if I'm a small town or a big city person; sometimes I feel adaptable to the point of not having an identity. I think that the most important thing is to be able to come back to yourself wherever you end up because it's as easy to get lost in the emptiness of Wisconsin as it is in crowds of New York.

thirty

So a lot of people write about things they'd like to accomplish before turning thirty, and I love reading about what people choose and what they do. In the immediate years preceding my turning thirty, I focused mainly on maintaining some semblance of a life, so my goals were not more ambitious than eating and sleeping normally when at all possible. I didn't even think about making a bucket list, and after my birthday passed I regretted this a little bit. But on my birthday, which was an amazing and perfect day of nature, adventure and food that I hope to write about soon, M reminded me of how much experience I've been lucky to have in my thirty years even without predefined thirty-before-thirty goals. Here are the thirty things I am most grateful for in my thirty years--some are concrete experiences, but most reflect what these experiences have broadly given me:

1. Taking five cross-country drives and seeing completely different parts of the country in completely different ways

2. Growing up with four older brothers and being cherished and nurtured

3. Spending my twenties on the east coast and exploring every state in New England

4. Falling in love at different periods of my life, and being with M during a time when I can absorb, become better and stronger from his presence and care, and try to offer him the same.

5. Living in our Chapel Street apartment in New Haven and being a second home and haven, late night kitchen, spare couch and bed, hosts of potlucks and parties, for our friends and classmates

6. Being Vietnamese and having parents with lives remote from mine and an intangible history to draw upon

7. The lifelong opportunities value the wonders of language and thought processes through reading books, and writing, from this blog and what it's intermittently recorded, to long email exchanges, to journaling, to essays

8. The hard and beautiful hikes that time, health, companions and resources have enabled me to do: Mount Washington, Kilimanjaro, the Lost Coast

9. Mark teaching me to bike and swim, and discovering childhood pleasures and mistakes as an adult

10. Having clinic at San Francisco General where an afternoon of patients transports me to a dozen different realities

11. Discovering the pleasure in composing a photograph, having a versatile camera, and sharing images

12. Experiencing music in that way where it sinks into you and doesn't leave, with people who feel it too, when seeing live Damien Rice, Iron & Wine, and the National

13. Being exposed to a wide range of foods and feeling the immediate nuanced pleasures of an indulgent meal, the warmth of meals cooked together, and the daily regular effects of a healthy diet

14. Knowing so many people whose kindness, rawness, openness, flaws, and thought continue to amaze me after years of knowing them, and being so lucky to have their lives fit mine

15. Reading Haruki Murakami, and how much that can mean

16. Completing p90x and realizing how good it can feel to be strong and how that can change so much about your life

17. Camping and the feelings of how living minimally is living fully

18. Going to medical school in a place that gave me the time and space to reflect and grow

19. Living in San Francisco for residency

20. Rock climbing and the strength, pure pleasure, and ambition the activity provides; and the perspectives that it offers, from sprawling views of Durango Colorado to falling from rocks to sandy shores along the California Coast

21. Many, many trips to NYC, where every time feels like an amazing vacation because of the many close friends and because I always experience something different from the time before, from day trips to week long ventures

22. Going on spring breaks with groups (Las Vegas and Puerto Rico) where the combination of freedom, carefreeness, and warmth lend closeness and openness

23. Witnessing so many definitive moments in other people's lives: birth, surgery, illness, death

24. Being able to speak at length with people at the end of their lives, and hear what it was feels like to have your physicality slip from you, and hearing from those people who much it means to share this

25. The disinhibition, laughter and warmth that comes with being altered with those closest to you

26. The pain of choices, choices that though are objectively poor ones, are also the most defining, deeply felt and sincere. This of course refers to romance and all its forms.

27. Being thin, tan, and healthy, and the ability to feel comfortable and capable in this body

28. Having flaws that are real flaws, not just the kind that can be positive, that present continual challenges and a reminder that every honest self-narrative is a spectrum of qualities, desires and limitations

29. Being humbled by Harvard and learning what it means to go there and also what it doesn't mean

30. Living life with M, linked in all ways from daily routine to adventuring, and discovering how much is heightened when shared.

broken windows

We live on a street that's on the border of a nice area and a not-so-nice area, such that M always has me carry pepper spray walking home. Our car has been broken into so many times, I literally can't remember if it's three, four or five times. The first time was my first month here; I'd been naive and left my bag in the seat. It wasn't actually taken because all it had were my climbing shoes and harness. I didn't even notice the window was smashed until I'd been sitting in the car for a few minutes and noticed the draft. This had never happened to me before, and I was pretty startled. I looked up places to replace the window and was surprised to see how easy it was to replace it--then understanding this happens often. When it happened a second time, when nothing was in view in the car and again nothing was taken, I already knew what to do and where to go. It seemed routine. But the next few times wore on us a bit, especially the time when we couldn't repair the window right away, and someone came again and cleaned out everything in our trunk and compartments. Everything from our car registration, to our boulder pad that was so big that we hadn't thought to have to bring it in (who would steal that?...someone, anyone). That time, I think we felt particularly violated, knowing that our things had been rummaged through and that something valuable had actually been taken.

We came to expect this from our street, and have been extra careful since then to only park it in certain areas and keep it entirely clean. Then it happened to us again, somewhere else. We drove to Oakland and stopped at a place to get sandwiches before a hike in the Oakland Hills. M had his backpack in the backseat, and I thought briefly of bringing it in, but it was daylight (ten in the morning), we were in a crowded parking lot, and there were people sitting outside. So we left it there, and went in to grab sandwiches. We were gone for less than ten minutes, and when we came out, our window had been smashed--for the fourth, fifth or sixth time. His backpack was gone, but luckily nothing valuable was in it and our more valuable things in the trunk weren't taken. I think something inside us wilted then, feeling so taken advantage of in a very unexpected moment. But, we again found it very easy to replace the window, and had our car back within an hour of this happening.

I get amazed at how easily our windows are broken, when we think of the inside of our car as so safe. I'm surprised at how violated I feel, how bruised my own insides get from this trespassing. But I get more amazed at how easily replaceable it is, how I soon forget. Though the remnants of those shards linger, I remember at the end of that day (which turned out to be hard in many ways) feeling lucky for still having in my possession those things that aren't so replaceable. Experiences. Values. People. Love. And I think that sometimes our windows break not so much to depress us with fragility, but to remind us to look the other way for the strength of things that hold steady against external weight.

breakfast & dinner

Last month for M's birthday we celebrated with two very different meals, both fabulous. We started the gray Sunday morning with German beer and pancakes in Hayes Valley, and ended the evening with California style Eastern European cuisine in the Mission.

Suppenkuche: We have been meaning to go here for a long time, but dissuaded by crowds. A friend of ours works there on Sunday mornings and gave us the tip that this is the best time to go. It started filling up very quickly after opening, so getting there right at 10 AM was key, and it also feels like a pretty luxurious time to start drinking. Luckily our friend and server dispelled any slight guilt we might have felt about Sunday morning beer by introducing us to a breakfast beer. It was light and refreshing in the way of a mimosa but grounded in the way of all beers. Then we had two varieties of Helles beers whose names I don't remember now, alongside potato pancakes sweetened with applesauce and pretzels with a mustard sauce and some sort of dark berry sauce. Starches, sugars, and alcohol--tastes that are innately comforting and familiar, and the wooden, boxy restaurant encased their warmth perfectly, especially as it drizzled outside.

Bar Tartine: After resting our stomachs the rest of the day, we ventured out again for dinner. In contrast to the communal table we had at Suppenkuche, we had a cozy corner by the window looking out onto the street, which felt both intimate and open. Here we experienced combinations of flavors we'd never had before, and I'm always really impressed by how people can make the unfamiliar so palatable. It's kind of a random comparison, but the food reminded me of Bjork's music--incredibly creative mixes that are unusual and somehow so good, and make you think, how did someone know to do that? We had the smoked potatoes with black garlic (the smokiness felt like another layer of potato), potato flatbread with garlic and sour cream (the dill and green onion really made this one), and cheese dumpling with nettle sauce (where I learned that nettle is an herb but now forget the taste except to know it was distinctive). For dessert I chose the black sesame pot de crème with brown butter. The intensity of the indulgent flavor was everywhere, from the thin toasted sesame cracker to the smooth cream floating in butter.

It was one of those days punctuated by the very human pleasure of savoring meals. When eating can sometimes fly by as part of a daily routine, I feel lucky to sit, enjoy it, and enjoy it with someone who absorbs it. It felt special to celebrate with two meals out; one in the beginning, one in the end; the bookends seem to fit.

howl

My full day clinic yesterday was punctuated by the howls of three very different patients: a middle aged man with schizophrenia who screamed for me to remove the micro-chips that have been causing his entire body pain for years; a young woman anxious about her first gynecological exam after recently losing her virginity; a tall man with low back pain upset with me about his disability forms. A couple of weeks ago, we walked around North Beach, looking at books at City Lights and remembering when we watched the movie Howl and envisioning what the atmosphere was like when Ginsberg read aloud. So many days I'm reminded of how each of us expresses our voice. There is a lot of complexity in hearing and processing what comes from others, especially for me as a quiet person who tends to write more than I say, but I try to read how people use their speech in the way I might write. In this way medicine is a pool in which to collect the textures, sounds and tones of these voices. While the volume sometimes overwhelms my capacity to contain them, I feel the ease and effort of stretching myself, in the way we're taught in yoga. It hurts to be pushed, but the next day when you can reach farther, the consciousness of being limber is amazing.

open

We drove down to Southern California during a four day weekend I had this past week, to some lesser known beach cities north of Los Angeles. On the drive down I brought old CDs of mine from the days when I bought CDs by the dozens. They took me back to a time when music was very important to me, to when I felt like albums were my best friends. Most can relate to certain music framing periods of their lives, and it was so easy to return to former versions of me through listening to these albums. A core love of mine is things that occupy long lengths of time--long drives, long runs, full albums. It takes me awhile to settle, and then I really love settling in. The end of medical school began my drift from music, and residency cemented it. Gone are long stretches of time searching for new music, and the long stretches of time it requires to really savor albums. After our drive, I decided to return--in the same way as this blog, without strict guidelines for frequency, just with the intention to return when the inclination arises.

So today while doing taxes I listened to Rhye's "Woman" and quickly fell for the first song, "Open." I don't tend to be curious about the lives of musicians (M looks up everyone whose art/work/thoughts he enjoys or respects, to get a feel for their development and histories) but I wanted to remember how I came across this album in the first place. In reading about Rhye, I found out that the song "Open" was a debut single. I also found out that the singer is a man, and that I'm not alone in mistaking him for a woman. His voice is gentle and sultry, and classicly feminine. Apparently the duo has also been very secretive about their identities in general. All of this information made me appreciate the music even more. In the way that we sometimes interpret others' art to suit our own perspectives, I saw this song as a sentiment to an openness to each person's spectrum of being.

Something else I think we do as people is create narratives from the little things that happen to us, and I find it suiting that this was the first album and song that I discovered on my return to music. In addition to inspiring me to seek out music, our trip to Southern California made me more open to that place. I feel very open to most places--I love cities, countryside, the coasts and the middle of nowhere, desert and forest. But in the midst of the North versus South debate, I lie closer north--I have more ties here, and am generally weary of the excess, and laxity that comes with it, associated with SoCal. While M loves the Bay Area and appreciates the liberal mindset and diversity here, he's also naturally drawn to the ocean and sun of SoCal. But, as M reminds me, there is depth to most things, including superficiality. Thanks to him I've found a lot of fullness in Southern California. Living in La Jolla is a very happy memory for me, of running beneath trees with the sprawling branches that became Dr. Seuss images and in the scent of jasmine along the coast, of living blocks from the beach and having blue ocean and orange sun and white sand cliffs at our toetips. Driving down to SoCal for a long weekend feels like a real escape. It made me happy to watch him surf along long waves whose discreet beauty has been unveiled to me by him. The expanse of everything there (the blue, the water, the coastal drive) is a natural openness that makes me push for my own.

grateful

In the second and third years of residency, we're on a schedule where for two months we're working in the hospital with tough hours, then switch to two months of a clinic schedule where we get weekends off and work more 9-5 weekdays. Some of my co-residents get a little restless during these more regular, free months (which are like normal-people-schedules), and miss the hospital in some ways. I appreciate my hospital months, but I don't miss them at all. The months of normalcy never, ever get restless for me. I'll forever be grateful to Yale, and the personal growth and exploration that its flexible system allowed us. Because of it, it's hard for me to ever have enough free time or at least time in which I have the freedom to structure work and life how I want to. So I'm grateful for these clinic months, when not only do I get to the kind of patient care I love most but also indulge other parts of myself.

A list of things I've really enjoyed these past two months of being a normal person:

A new schedule

M and I have started having a regular schedule of sleeping early and waking up around seven, which before daylight savings was when it would start to get light. It's such a luxury to actually be able to have a regular schedule. I love not having to set an alarm, because this well before I need to get up for work, and the light naturally wakes me on most days. I love being up early, but not so early it's depressing like during the days of my tougher schedule. I love being able to go to morning yoga, and I love experiencing all hours of daylight. Lots to love.

Three Junes by Julia Glass

I read this on the plane ride to Kilimanjaro last month, and it was beautiful from page one. Since residency doesn't offer much time for pleasure reading, it can be a risk to start a book without knowing how much I'll enjoy it (this makes me sound practical to the point of being robotic, which can be true). So I was actually excited about the 30 hour plane ride, the long stretch of nothingness with time to experiment, and bought a bunch of books for the plane ride. This was the first one I read, and by far the best. The first section takes place near the water, and the book itself felt like water: fresh, filling and layered despite being incredibly easy to take in.

HIV Clinic

I've been able to spend a half day each week in urgent care of the HIV clinic. A big part of Three Junes is about AIDS in the 80s, and we also recently watched Dallas Buyers Club, and in contrast to those narratives HIV care now is more about longitudinal primary care, less dramatic catastrophes. Though we still see a lot of end stage AIDS and HIV complications in the hospital, the patients I see in clinic are able to live with their illness with all the medications out there. The publicly insured population is a diverse and at times eccentric one, but the HIV population in San Francisco is pretty unique and one that I don't get to see in my primary care clinic since there is a specialized HIV clinic. I appreciate learning things specific to a condition. I think this is something we all value as people, the ability to cater towards something, to feel that familiarity with the unique contours of something helps you to know some of the inside.

Runner's high

After hiking Kilimanjaro I took a break from running because the climb down felt really hard on my joints. But after lots of yoga to recover and with beautiful weather beckoning, I started in again with an hour through Golden Gate Park on a Sunday morning. We don't spend much time there since we live on the other end of the city, but I was craving greenery so drove there. Because it was Sunday morning, there was no traffic and I could take in all the hills and corners that make this city so gorgeous. Golden Gate Park was full of kids playing baseball, people walking dogs and riding bikes and power walking and running. The smells hung heavily in the air, making me forget that it smelled any different anywhere else in the city. The first miles of running were glorious, the middle got choppy and then turned the kind of amazing that makes people wonder why you're smiling so hard to yourself. I'm not fast and my endurance is in the middle depending on the comparison, but I love that that doesn't matter--you can still get the high as long as you go far enough.

Cooking

One of the things that makes me feel less human during my inpatient rotations is the amount of frozen dinners I eat. It's been really nice to cook almost every day, even simple meals. I hate grocery shopping, but with M's help I've grown to like it by getting a bit better at it. Developing certain routines has made me feel very normal and happy and natural. Little things like cleaning out the fridge when we just got new groceries, choosing a new cheese each time we go to the store, placing leftovers in a certain place to remember to eat them. Some recipes we've enjoyed are Alaskan salmon with dill, healthy cinnamon roll pancakes, sesame turkey meatballs (tofu for me) sometimes with an orange glaze, and different kinds of pesto, lentils, quinoa. I like being comfortable enough with certain recipes to vary them every so often.

High school friends

This month I was able to spend more time with Kristina, one of my best friends from high school, and also saw Richard who was visiting from Seattle and who I haven't seen in several years. We got to cook for Kristina and Wayland, and had a long cozy dinner at home. M often talks about how our younger selves can be a pure version of us, indicators of what we want when untethered by expectations and responsibilities. Spending time with people from high school reminds me of what we desired then, of what we naturally gravitated towards, and reminds me to seek those in my life. Kristina's regular blogging during a period of facebook abstinence inspired me to return to this, and her presence made me think of my own, of what I want to make from myself.

So, thank you to all this.

relations

Clinic days are the days I feel most at home in medicine and also most out of sorts. This morning, it was my turn to present a difficult patient case to the rest of our primary care program. These cases are meant to discuss challenging patient interactions and personal management rather than clinical questions. As I narrated the one year course of a relationship with a patient who has presented multiple complex challenges for me, and listened to others' questions, thoughts, and suggestions, I felt the weight of this one relationship. I don't mean weight as a burden, though it's clearly been hard for me to navigate, but more objectively as an observation. In learning about one person there's a lot there, and also a lot of gaps in perception and understanding. It overwhelmed me to think about it.

Later that afternoon I had actual clinic, where I saw four patients. One of them asked how many I see in an afternoon, and I told him somewhere between four and six, and we commented on how that wasn't that many. But I always feel like it's a lot; each person is a different place and there's always so much to process. What strikes me is how much of medicine is about developing these relationships. You know this is a cliche beforehand, but living it is so different (also a cliche). What strikes me even more is how ill-prepared we are for developing them, especially at a place like the county hospital where the patients are so very different from the doctors taking care of them. I think of how much different life they have experienced, and how much of my time has been spent in books in order to help them deal with these lives that exist in a totally separate realm. M and I talk about this all the time, but now that I'm actually responsible for people, it hits hard the flaws in our book learning and even our patient-centered learning. But even as I flounder with it, I'm incredibly grateful to encounter so many diverse people, and to have a relationship even when unable to relate.

coming back

I've been going to yoga a lot lately because I've consciously felt the need for physical and mental recovery. At the beginning of our class today the teacher spoke about the distractions that kept her from her daily morning practice that morning. Instead of being at her mat, she would find herself at her desk with her computer or on her bed with her phone. Each time she would come back to the mat. "Don't feel guilty," she suggested. "Just keeping coming back."

I spent the last year and half away from this blog, playing briefly and intermittently with another one centered on monthly updates of my rotations, since my residency schedule has me thinking of my life in terms of what I'm working at for four weeks at a time. It never became a flow or an escape in the way that this place was for me in medical school, for different reasons. Obviously, I've had less time, space, and energy. Less obviously, I've realized that this kind of compartmentalization isn't really me. When I started this blog, I painstakingly re-entered entries from my previous blog onto it, to maintain a continuity (one that no one else but me experienced). I thought that with the move and graduation I should start over and grow. But what I've wanted most is to come back.

In some ways this makes it easier to make space for something that I don't want to lose--my desire to record, process, and share by writing. During some rare but strongly felt times, I think I didn't commit enough to something that's felt most natural to me, and I get sad. I think about writing silly stories on the typewriter as a kid, about the long afternoons with the high school newspaper, the intense focus on essays as an English major, and most personally this blog. And I wonder, was it worth it to have sacrificed such a big part of me, a part I never had to force for any external reason? And I find it hard to admit that I never thought it would've had to be sacrificed to such a large degree. But it turns out that medicine is hard, and that many parts of it don't come to me as naturally as it may for others, so I'm left with less reserve that I anticipated. And with that reserve, I've found it easier to invest in being physically active, prioritizing climbing and running over sitting down to write.

This is partly because medicine has been so emotional for me, that it seemed both easier and healthier to use any free time letting movement seep that from me, than to steep it more deeply into words. And while I don't regret using those moments that way, I look back and feel a lost link. Now that I've looked, I won't feel guilty and I won't look anymore. I'd just like to continue.