Saturday, February 14, 2009
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.
Thursday, February 12, 2009
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.
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.
Sunday, February 8, 2009
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.
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.
Sunday, February 1, 2009
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.
**
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.
Tuesday, January 27, 2009
path of least resistance
Told wife today that one reason I didn't pursue journalism was a fear of reality. I don't write anything about the world, mostly because I don't have much new or original to say. The only thing I know any more about than anyone else is my own life, sadly. But in addition to all the immediate coverage, reading the flurry of links sent about Israel & Palestine from friends the past day or so, well, I still don't have anything new to say...but it does make me think about choices and how things we do on a daily basis seep into the world as a whole.
It is unbelievable to me how natural it is for people to cling to status quo even, and even especially, in the face of overwhelming reason to change. And how hard it is to commit to a principle rather than a side. To realize that though context does affect what's right and what's wrong, there are absolute rights and wrongs we have agreed upon. Among some friends the phrase "path of least resistance" has come up some times this year, not in relation to current events, but I find it apt for the awful craziness of what's going on in the Middle East. And back here, we continue the way we've been because it's easy.
The phrase came up in relation to me as a person. In recently asking a wonderful friend for some reassurance, of a kind thankfully rarely needed, he told me I'm a crazy person, a mix of immediate relentlessness and everlasting patience. It's true that this doesn't make for an easy personality, that patience simply being a euphemism for the neurotic relentlessness. Aside from pure stubbornness, I hope that the difficulty stems from certain value, and I am thankful every day for the people and things in my life that make me feel that. I've never been and probably will never be the path of least resistance. And I don't want to be, even if were to make me the path that's taken.
But for the world, let's not make this an exception, let's please take the harder route this time and the next.
It is unbelievable to me how natural it is for people to cling to status quo even, and even especially, in the face of overwhelming reason to change. And how hard it is to commit to a principle rather than a side. To realize that though context does affect what's right and what's wrong, there are absolute rights and wrongs we have agreed upon. Among some friends the phrase "path of least resistance" has come up some times this year, not in relation to current events, but I find it apt for the awful craziness of what's going on in the Middle East. And back here, we continue the way we've been because it's easy.
The phrase came up in relation to me as a person. In recently asking a wonderful friend for some reassurance, of a kind thankfully rarely needed, he told me I'm a crazy person, a mix of immediate relentlessness and everlasting patience. It's true that this doesn't make for an easy personality, that patience simply being a euphemism for the neurotic relentlessness. Aside from pure stubbornness, I hope that the difficulty stems from certain value, and I am thankful every day for the people and things in my life that make me feel that. I've never been and probably will never be the path of least resistance. And I don't want to be, even if were to make me the path that's taken.
But for the world, let's not make this an exception, let's please take the harder route this time and the next.
Thursday, January 15, 2009
my mom
My mom turns 67 today. It was only recently that I realized that she was three years older than her officially documented age (this changed her age to me by two, since I'd previously thought she was only one year older than her official age). Growing up in Northern Vietnam while the Communists were fighting to oust the French, she stopped going to school for a few years during the fighting. When it was time to return, they tried to put people back in the grades corresponding to their age, but they were all behind. My grandparents lowered my mom's age, so she could be in the grade in which she belonged. Growing up, she was a daddy's girl, and later, she tells me, she had many suitors (I believe her). She worked as an accountant for the government for awhile and married my dad, and then taught high school history, and somewhere in there gave birth to four boys in seven years. She took them, carrying the baby whom she fed powdered milk, through fields and marshes and sea to Thailand and to Germany and eventually to here. Her dad passed away in Vietnam before she left, and her mom passed away there too, but when my mom was in America, when I was five and remember her crying in the hallway. In California she made clothes, helped my dad run the bakery and then the convenience store and then the wine store, was and is still a receptionist at my aunt's pediatric office, and gave birth to me. When I was a kid she worried I'd never grow much hair. Once when I was in elementary school and she found out about something really bad I'd done, she didn't yell with anger; she cried with disappointment. In high school before I could drive and I wanted to volunteer at a hospital 40 minutes from home, she'd take me there after school and wait there for three hours until I was done, to take me home. When she saw me off for college, she wouldn't leave to go to the bathroom until after I passed the security gate. In med school when we had to interview a relative with an illness I talked to her about the heart surgery she had when I was thirteen, when she stayed home for a few months and we gave her a bell to call us if she needed anything. She doesn't like chocolate, butter, sweet things or any non-Vietnamese food. She likes jewelry, watching National Geographic and Animal Planet, posing for pictures, and talking to anyone. I don't know that many concrete details about her life before the time that I noticed details, and it took a long time after noticing before I started asking. I hope to know.
Tuesday, January 13, 2009
intimacy
We just finished a week long obstetric-gynecology module, and I really enjoyed it. Before school ob-gyn never crossed my mind and upon entering, I didn't imagine it being something that would appeal to me. But it was the perfect subject to greet us post-break, a point of all time low as far as motivation goes. Because ob-gyn makes very apparently clear one of the elements of medicine most valuable to me--intimacy. It does this in large part because it deals with sexuality, which people immediately connect to intimacy in mind and practice. I once called our high school lockers "intimate" because we were in block of 8 half-lockers in a small space, and my friends laughed at the connotation. But in learning this past week, I'm reminded that intimacy doesn't stem directly from physicality at all. Intimacy is feeling safe when vulnerable. And that vulnerability comes in many forms. Ob-gyn makes it obvious with physically uncovering what we normally protect, but that's just a conduit for all the other things we keep close, things that are there whenever you become connected to someone else.
In workshop we had a case on a miscarriage, and after going over the symptoms of abnormal bleeding and the treatment required to clear her system, I realized that I'd never fully considered what a miscarriage entails. I thought of it in simple terms of something going wrong that prevents you from continuing your pregnancy, and then it's gone. But I never once thought of the fact that there was something inside of you, that is no longer living, and it has to go somewhere. Meaning that the place that once held it, has to let it go. And not to be graphic but for reality, there's blood, and pain, and someone has to open you and physically remove what they call "products of conception" (your baby), and it's less like plucking an egg out of a basket and more like undoing the interlaced weaving. How visceral, how traumatic. Without ever having had gained or lost anything quite like that, to imagine hurts.
When doing the pelvic exam, I was really nervous to be given responsibility to handle what's intimate. At one point we were told that we'd "feel the uterus between your hands." I was a little taken aback by how amazing I found that thought. My hands? The ones that a few minutes of chipping icy snow off my windshield render red and dry? Yes, mine. The ones that also felt the pulse of the ovarian artery. Besides the fulfillment that comes with learning concrete things after so much academia, these solid things are tied to people...their relationships with their bodies, the notions of family and your ties to others known and not yet known to you, the intricacies of conception and its complications and emotions, or even just those of being made to conceive.
I've felt safe at my most vulnerable rarely enough to remember and feel the feeling distinctly and vividly. To find a presence with whom you are able to bare yourself, in whatever sense that might mean to you, and then to feel safe, without ever losing the sense of fragility and value that made safety necessary in the first place. I've only known that to happen for me after long cultivation with time and trust and test. Now, to think of that as a mutual goal for every stranger you meet as your patient, closes some of the distance and isolation that studying can nourish. In broadening something defined by smallness, I find I have more of it.
In workshop we had a case on a miscarriage, and after going over the symptoms of abnormal bleeding and the treatment required to clear her system, I realized that I'd never fully considered what a miscarriage entails. I thought of it in simple terms of something going wrong that prevents you from continuing your pregnancy, and then it's gone. But I never once thought of the fact that there was something inside of you, that is no longer living, and it has to go somewhere. Meaning that the place that once held it, has to let it go. And not to be graphic but for reality, there's blood, and pain, and someone has to open you and physically remove what they call "products of conception" (your baby), and it's less like plucking an egg out of a basket and more like undoing the interlaced weaving. How visceral, how traumatic. Without ever having had gained or lost anything quite like that, to imagine hurts.
When doing the pelvic exam, I was really nervous to be given responsibility to handle what's intimate. At one point we were told that we'd "feel the uterus between your hands." I was a little taken aback by how amazing I found that thought. My hands? The ones that a few minutes of chipping icy snow off my windshield render red and dry? Yes, mine. The ones that also felt the pulse of the ovarian artery. Besides the fulfillment that comes with learning concrete things after so much academia, these solid things are tied to people...their relationships with their bodies, the notions of family and your ties to others known and not yet known to you, the intricacies of conception and its complications and emotions, or even just those of being made to conceive.
I've felt safe at my most vulnerable rarely enough to remember and feel the feeling distinctly and vividly. To find a presence with whom you are able to bare yourself, in whatever sense that might mean to you, and then to feel safe, without ever losing the sense of fragility and value that made safety necessary in the first place. I've only known that to happen for me after long cultivation with time and trust and test. Now, to think of that as a mutual goal for every stranger you meet as your patient, closes some of the distance and isolation that studying can nourish. In broadening something defined by smallness, I find I have more of it.
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