On Saturday M and I take a short road trip to Rhode Island, the one New England state we didn't visit on our early summer road trip. Our windows are down the whole time. The drive is mostly on 95, then for awhile along a smaller road with trees whose freshness we can smell. We drive over the bridge leading to Newport. We pass by the mansions, and look for a beach with waves. After some logistical hodgepodge of parking, coins, inquiries, beach-hopping, and so on--we make it to a warm beach with some waves where M can surf and I can be a bum. The water is chocolate brown, the brown coming not from chocolate but from massive amounts of algae. It feels good to be in it; it's been so hot. M catches one very long wave which makes him happy and a good amount of other ones too, and it's nice to see him happy in this way. After he gets out of the water he sits looking at the water while I fall asleep with his hat over my face, and when I wake up we walk out onto a cliff of boulders by the sea. There's a large one with three sides from which you can climb up, so we clamber over it for awhile and this is my favorite part--the confined yet endless exploration. Then we throw the Frisbee around, to warm up to get back into the water. He wants me to get comfortable going underwater in the ocean. So we jump into waves for awhile, one hand in his to keep from dying and my other hand over my swimsuit which slips too easily. After several of these, M looks at my back and tells me we have to get out. I follow, and seconds later feel the urgency of his return to shore--the algae living in the water is host to tiny crawling worm-like bugs that bite. We spend a good twenty minutes trying to wash them out in the same water where they swarm. We find a "shower"--a two-second stream of water giving about a fourth the volume of a faucet. There's only one, so we take turns, pressing the button for second and third streams before giving it up to someone else waiting and getting back in line for more. I can't do much about the algae now growing entwined in every strand of my hair, until we're at home and I shampoo it out half a dozen times. To get there, we drive home, in the dark now, still smelling the same trees through the windows.
On Sunday we do three loads of laundry and get groceries. M has completely run out of shirts, and I've eaten my last egg and piece of bread. And our things from the beach need much cleansing. I stock up on fruits and veggies, and he buys masala sauce and naan to make our own chicken tikka masala dish. I'm glad to have the basics in abundance, and eat two peaches, handfuls of grapes, an orange and an apple. Our attempt at Indian food is good but needs more cream added to the sauce, we decide. Next time we'll buy cream.
Monday, July 25, 2011
Friday, July 22, 2011
adjustments
I've had hip pain for the past few months, which started after a run where I tried to increase speed, after months of steady running. I'd had this type of pain before and back then I went on a long running hiatus, and even after getting back to it after half a year or so, hadn't gotten back to where I was. So it was frustrating to have it happen again. This time around, I was able to get back to running sooner than last, but the pain stayed, happening during other stretching and exercising. So my classmate referred me to a friend of his who's completing the physical therapy program at USC. I talked to her, and one of her classmates, last night for an hour about my hip. They got my history, watched me do some squats, and diagnosed me with hip impingement. They told me that I need to work on strengthening the smaller muscles involved in dynamic movement like running, and that I need to stretch my hip flexors to open up the hip joint, especially since so much of my exercise entails hip flexion.
I tried the exercises today before p90x and already noticed a difference. And like with other chronic pain, the absence of pain is noticeable; normal becomes prominent. It will take longer to go away completely, but I'm very happy with the change made by this attention to small motions and interactions.
*
I had another interview with an ALS patient today. It was a full day venture, as his home is an hour drive from here, and our interview lasted two hours, and I stayed for lunch. He talked about how he notices sudden differences in his motion. One day he can stand on his tiptoes to hang home decor, three days later, he can't do it at all. He first suspected problems when he developed foot drop. When going down the stairs, he can't flex his feet and his heels come down hard on each step. The trick, he said, is to walk downstairs backwards.
I tried the exercises today before p90x and already noticed a difference. And like with other chronic pain, the absence of pain is noticeable; normal becomes prominent. It will take longer to go away completely, but I'm very happy with the change made by this attention to small motions and interactions.
*
I had another interview with an ALS patient today. It was a full day venture, as his home is an hour drive from here, and our interview lasted two hours, and I stayed for lunch. He talked about how he notices sudden differences in his motion. One day he can stand on his tiptoes to hang home decor, three days later, he can't do it at all. He first suspected problems when he developed foot drop. When going down the stairs, he can't flex his feet and his heels come down hard on each step. The trick, he said, is to walk downstairs backwards.
Monday, July 18, 2011
one-time meetings
Being a quiet person and someone that doesn't usually register on anyone's radar on first meeting, I believe in the need for time and multiple interactions to get any significant sense of someone. It goes without saying that you usually need more than a first impression to get to know someone, but I think that it's hard to base even small things on a first interaction, depending on circumstances. M thinks you can get more from this than I give credit, and I think it's true that I should give more credence to these things, even as staying open to what else might inform your perception and understanding of someone.
Two interactions today made me think of this even more. The first was meeting with the person who will be writing a letter for my residency application. Residencies require a letter from the chair of your department, and if you aren't so naturally inclined to networking like me, you might not have met this person before you need a letter from them. So they set up a meeting to speak with this person, so that they might get to know you enough to write a letter about you. The person reads your CV, personal statement, has a conversation with you, and writes the letter that same day. Going into this, it felt like a routine part of the process, something to elicit skepticism but something needed to be done. Afterwards, I was surprised at how much was exchanged and received, and how glad I was that this person would be writing about me. I don't know if he has always had this ability or has cultivated it over a lot of people interaction, but at the end of the forty minute meeting, he had picked up on different themes important to me and connected them in the same way I perceive and feel them. I was glad on the one hand that some of my thoughts had been conveyed in my personal statement, which at the time of writing felt a little distant. On the other hand I felt that a lot of this understanding came from him--what he noticed, what he listened to, what he asked. It was a pleasant surprise to feel that an important part of me had been shared, and it is something to aspire emulating.
The other was an interview with a patient, for my research on terminally ill patients. It was the first time I'd met anyone with amytrophic lateral sclerosis (AML, or Lou Gehrig's disease). This disease affects a person's muscles, such that there is progressive decline in the use of your arms, legs, throat, and lungs. Most people die from respiratory failure several years after diagnosis, after losing the ability to walk, eat, talk, and finally breathe. Knowing rationally how devastating this must be, I was a little unsure what to expect. In the hour of speaking with him and his wife, an incredible couple, they shared a part of their story not yet voiced to anyone else. He had never talked about dying before, and as he did, a lot seemed to pass between us--not just the sadness, but also the lighter moments, had weight. As hard as it was, I felt pretty lucky to receive so much from meeting a stranger. I suppose this is the nature of all interviews, when you expect to get some sense of someone from an interaction structured to do so, but always having been skeptical of this notion, I was surprised.
Maybe I wouldn't have trusted the second interaction in the same way if I hadn't had the first one; after all, who can say what we observe is true or what bulk it comprises. But so it often goes, that each meeting is isolated and connected.
Two interactions today made me think of this even more. The first was meeting with the person who will be writing a letter for my residency application. Residencies require a letter from the chair of your department, and if you aren't so naturally inclined to networking like me, you might not have met this person before you need a letter from them. So they set up a meeting to speak with this person, so that they might get to know you enough to write a letter about you. The person reads your CV, personal statement, has a conversation with you, and writes the letter that same day. Going into this, it felt like a routine part of the process, something to elicit skepticism but something needed to be done. Afterwards, I was surprised at how much was exchanged and received, and how glad I was that this person would be writing about me. I don't know if he has always had this ability or has cultivated it over a lot of people interaction, but at the end of the forty minute meeting, he had picked up on different themes important to me and connected them in the same way I perceive and feel them. I was glad on the one hand that some of my thoughts had been conveyed in my personal statement, which at the time of writing felt a little distant. On the other hand I felt that a lot of this understanding came from him--what he noticed, what he listened to, what he asked. It was a pleasant surprise to feel that an important part of me had been shared, and it is something to aspire emulating.
The other was an interview with a patient, for my research on terminally ill patients. It was the first time I'd met anyone with amytrophic lateral sclerosis (AML, or Lou Gehrig's disease). This disease affects a person's muscles, such that there is progressive decline in the use of your arms, legs, throat, and lungs. Most people die from respiratory failure several years after diagnosis, after losing the ability to walk, eat, talk, and finally breathe. Knowing rationally how devastating this must be, I was a little unsure what to expect. In the hour of speaking with him and his wife, an incredible couple, they shared a part of their story not yet voiced to anyone else. He had never talked about dying before, and as he did, a lot seemed to pass between us--not just the sadness, but also the lighter moments, had weight. As hard as it was, I felt pretty lucky to receive so much from meeting a stranger. I suppose this is the nature of all interviews, when you expect to get some sense of someone from an interaction structured to do so, but always having been skeptical of this notion, I was surprised.
Maybe I wouldn't have trusted the second interaction in the same way if I hadn't had the first one; after all, who can say what we observe is true or what bulk it comprises. But so it often goes, that each meeting is isolated and connected.
Tuesday, July 12, 2011
daily happiness
There's something about continued, sustained small reasons for gratitude. Currently, I'm happy for summer dress weather, the company of an ever-encouraging friend while I doggedly, slugglishly write my personal statement at the library, red cheeks so hot after a workout that a cold shower feels delicious, and having him at the end of the day for thoughtful conversations and silly brawls.
Monday, July 11, 2011
being back
I've been back in New Haven for little over a week now, and already feel full of things. This sensation is familiar, and I'm glad for familiarity of such a nice feeling. The sense that a lot has been done, a lot to be done. I'm writing a little rambly and frazzled right now, as warm-up for writing my personal statement for my application to residency. I have less than a year left at medical school, and part of that year will be invested in trying to get somewhere after that year is over.
But it's also a year to have on its own. Since being back, M has started teaching me how to swim, which has been an experience to rank among my top in life...it might seem silly that something so common becomes like that, but I think there's a lot to that, that I'm saving up somewhere to put down somewhere at some point. Continuing to p90x and to climb, and building stamina even as much of it is still hard. My right hip, which started acting up after a run a few months ago, still feels funny, makes me feel old, and presents a concrete reminder of effort and movement.
Hoping to see as much as possible this year, more road trips and more farther trips and also more local exploration, with a list of new places to run. There will also be trips to interview, and new hospitals to see, cities to see in new contexts. Through that, would like to keep the old growing and close.
But it's also a year to have on its own. Since being back, M has started teaching me how to swim, which has been an experience to rank among my top in life...it might seem silly that something so common becomes like that, but I think there's a lot to that, that I'm saving up somewhere to put down somewhere at some point. Continuing to p90x and to climb, and building stamina even as much of it is still hard. My right hip, which started acting up after a run a few months ago, still feels funny, makes me feel old, and presents a concrete reminder of effort and movement.
Hoping to see as much as possible this year, more road trips and more farther trips and also more local exploration, with a list of new places to run. There will also be trips to interview, and new hospitals to see, cities to see in new contexts. Through that, would like to keep the old growing and close.
Friday, June 10, 2011
while being away
I guess that I've been away, or really that New Haven has been away from me. In either context, things are happening, which is the nice thing about doing things in compact spaces of time/place. Like on trips, when so much seems to happen in a week, by nature of changing routine and scenery. While in California, there have been blocks of things contributing to an intense, fragile balance of being fulfilled and seeking out.
In the morning before work, I get up to do the p90x workout of the day. Before this I've never considered exercise to simply strengthen. I like activities, and liked them a lot when young, but early in life, learning overshadowed playing games, and so now, when I feel a bit too old to be learning anew, throwing myself into activities seems more of a priority than developing strength and flexibility and balance. But not only do those contribute to being active, they also feel good on their own. My brother said to me, why does a girl need to be strong? It was said with slight real sexism; and it's true in a way. A girl doesn't usually need to be strong to attract a guy, or to beat up another girl. I've discovered that I really like feeling strong, for no real reason other than to know you're capable. It is also a little odd to see your activities make concrete changes in your body, and like all physical things I enjoy, it strengthens a lot of mental processes and approaches.
I take the bus to my rotation at the San Francisco Free Clinic. Walking to the bus stop, riding it, and walking to clinic takes about an hour. It goes by pretty fast, and doesn't bother me in terms of time since clinic hours are usually 10-5. I like navigating the city this way; I also use the bus to meet up with friends, go to the rock gym, go shopping and run errands. I often don't know from which side of the street I should be waiting for the bus. But I have more time to figure it out than I would in a car. And I'm by myself so only I have to deal with my spectacularly awful sense of direction, and only I can feel how rarely this can feel less of a confusing burden and more of a freeing confusion. A lot of old people ride the bus, and there are so many Asians in this city; I alway forget this. I'm not sure yet how the difference in population has affected me, but it's something that made me take notice. On the bus I read books, and I've gotten into Agatha Christie, as there are several of her books at my brother's. I was never into genre novels--fantasy, sci-fi, mystery. But I've gotten into Christie because the books are fun and easy to read, and because over time I've organically gotten better at paying attention to details, which makes both the book and life outside of the book more enjoyable.
The patients at the clinic, which provides primary care to the uninsured, have made for an amazing experience. Each one has subtly strange qualities, strange in that they are rare, not always that they are extreme. Because of that, I have a much stronger sense of each one after a day of several patients, than I have in other primary care settings I've experienced. Each one makes me think, or cling onto a characteristic or word or facial expression, or share our conversation with someone else. More on this as it goes on, can't fully describe the gratitude for such exposure and absorption of things outside of how I am/what I know.
In the evening, I eat dinner with my brother in his beautiful apartment lined with floor-to-ceiling windows that open up to the ocean. The water can be blue, green, gray, or mixes of those, and colors the rest of the house with its lighting. During the ab exercises from p90x, we sit up from painful crunches to see the sun setting diamonds on the water. The dinner is often something my mom has packed up for us. I'm glad to be in easy comfort with my brother in the same apartment, my parents across a bridge, not a day-long flight away. If I have an early day or extra time, I take the bus to the rock gym to boulder, since I can't climb by myself...I miss the style afforded by being attached to a rope, but bouldering is pretty mentally challenging. It requires a lot of initial strength that I don't have, and also a lot of overcoming fear (since there is no rope), which I've found very hard, especially alone. But it feels really, really good when at one moment it happens, especially after a lot of stalemate and frustration. On some evenings I spend time with friends in the Bay Area; it is a place containing people from different phases of my life. I'm lucky to have so many people with whom I want to share the mixed-up self I bring back to home, a person away.
At night I share the bed with Mikey the cat, whose personality has been branded dog-like. He follows you everywhere, showers you with affection, licks and bites you lovingly, stares at you with huge green eyes of neediness. I've pretty much fallen in love with him, and his strangely perfect combination of cat and dog.
It's also at night that I think of being away. Immediately before coming here, M and I went on a fantastic week-long road trip through parts of the East Coast. Coming straight from that to another experience, I might find it easy to forget the smell of fires, fresh early summer mornings, new sun emerging from weeks of rain, long drives of lush green, five kinds of rain in five minutes, a beautiful rest stop and unassuming cove of space and lucky discovery on the search for a bathroom, a beach wrapped in fog, revisiting a home in perfect weather--but I haven't. The sensations resurge in small moments and strong waves, and I feel incredibly lucky to have so much here, and so much away.
In the morning before work, I get up to do the p90x workout of the day. Before this I've never considered exercise to simply strengthen. I like activities, and liked them a lot when young, but early in life, learning overshadowed playing games, and so now, when I feel a bit too old to be learning anew, throwing myself into activities seems more of a priority than developing strength and flexibility and balance. But not only do those contribute to being active, they also feel good on their own. My brother said to me, why does a girl need to be strong? It was said with slight real sexism; and it's true in a way. A girl doesn't usually need to be strong to attract a guy, or to beat up another girl. I've discovered that I really like feeling strong, for no real reason other than to know you're capable. It is also a little odd to see your activities make concrete changes in your body, and like all physical things I enjoy, it strengthens a lot of mental processes and approaches.
I take the bus to my rotation at the San Francisco Free Clinic. Walking to the bus stop, riding it, and walking to clinic takes about an hour. It goes by pretty fast, and doesn't bother me in terms of time since clinic hours are usually 10-5. I like navigating the city this way; I also use the bus to meet up with friends, go to the rock gym, go shopping and run errands. I often don't know from which side of the street I should be waiting for the bus. But I have more time to figure it out than I would in a car. And I'm by myself so only I have to deal with my spectacularly awful sense of direction, and only I can feel how rarely this can feel less of a confusing burden and more of a freeing confusion. A lot of old people ride the bus, and there are so many Asians in this city; I alway forget this. I'm not sure yet how the difference in population has affected me, but it's something that made me take notice. On the bus I read books, and I've gotten into Agatha Christie, as there are several of her books at my brother's. I was never into genre novels--fantasy, sci-fi, mystery. But I've gotten into Christie because the books are fun and easy to read, and because over time I've organically gotten better at paying attention to details, which makes both the book and life outside of the book more enjoyable.
The patients at the clinic, which provides primary care to the uninsured, have made for an amazing experience. Each one has subtly strange qualities, strange in that they are rare, not always that they are extreme. Because of that, I have a much stronger sense of each one after a day of several patients, than I have in other primary care settings I've experienced. Each one makes me think, or cling onto a characteristic or word or facial expression, or share our conversation with someone else. More on this as it goes on, can't fully describe the gratitude for such exposure and absorption of things outside of how I am/what I know.
In the evening, I eat dinner with my brother in his beautiful apartment lined with floor-to-ceiling windows that open up to the ocean. The water can be blue, green, gray, or mixes of those, and colors the rest of the house with its lighting. During the ab exercises from p90x, we sit up from painful crunches to see the sun setting diamonds on the water. The dinner is often something my mom has packed up for us. I'm glad to be in easy comfort with my brother in the same apartment, my parents across a bridge, not a day-long flight away. If I have an early day or extra time, I take the bus to the rock gym to boulder, since I can't climb by myself...I miss the style afforded by being attached to a rope, but bouldering is pretty mentally challenging. It requires a lot of initial strength that I don't have, and also a lot of overcoming fear (since there is no rope), which I've found very hard, especially alone. But it feels really, really good when at one moment it happens, especially after a lot of stalemate and frustration. On some evenings I spend time with friends in the Bay Area; it is a place containing people from different phases of my life. I'm lucky to have so many people with whom I want to share the mixed-up self I bring back to home, a person away.
At night I share the bed with Mikey the cat, whose personality has been branded dog-like. He follows you everywhere, showers you with affection, licks and bites you lovingly, stares at you with huge green eyes of neediness. I've pretty much fallen in love with him, and his strangely perfect combination of cat and dog.
It's also at night that I think of being away. Immediately before coming here, M and I went on a fantastic week-long road trip through parts of the East Coast. Coming straight from that to another experience, I might find it easy to forget the smell of fires, fresh early summer mornings, new sun emerging from weeks of rain, long drives of lush green, five kinds of rain in five minutes, a beautiful rest stop and unassuming cove of space and lucky discovery on the search for a bathroom, a beach wrapped in fog, revisiting a home in perfect weather--but I haven't. The sensations resurge in small moments and strong waves, and I feel incredibly lucky to have so much here, and so much away.
Monday, May 9, 2011
outdoors
Last Saturday, I went on a retreat organized by one of the professors here, an internist who teaches the patient-centered interviewing curriculum. He wears a long braid, glasses, and sandals, which makes him easy to parody in our Second Year Show, but also makes his warmth and openness sincere. Like the pastures of the abbey where the retreat took place, he shares with and accepts from anyone. To get there, I drove an hour through woods on both sides. The theme of the day is Ora et Labora, or prayer and work. The idea is to make one like the other, or an indistinct continuation. To work at prayer, to make work more mindful. I'm not at all religious, but medical school people and experiences have really made me value both mindfulness of the present and a sense of things outside of the immediate. Physical labor is beautiful when it's a choice. Clearing the landscape, in this case a grassy field freshly green and lush with smell and color, is pretty naturally therapeutic. Part of doing that required gathering branches lined with thorns, and I learned how damn annoying tenacity can be, when imbued in compactness. The thorns penetrate clothing, and cling to areas on, behind, around you as you try to maneuver them. It was frustrating work, tedious, forcefully thoughtful. That made it a good experience, to tuck away for future writings and perspectives, but honestly I liked loading heavy firewood onto trucks better. The nuns are hardy, of course, and on the assembly line of log holders, they would toss the logs to me. An older man would bend over, pick them up, and unable to hold them long enough for someone else to take them, set them back down, a bit closer to the next person in the assembly line. We took a break with the best hummus I've ever eaten (homemade; could have eaten it plain with a spoon). The evening prayers took place in a wooded church, that smelled and looked like fresh unpainted wood. The wood was interrupted by continuous glass panels, for effortless sunlight. The day was shared by a group of people in different phases of their careers, all still incredibly open with their points of view and their feelings, all still incredibly kind, welcoming, warm.
This past Sunday, we had our first rock-climbing venture outdoors, in a little park off the side of the road, 40 minutes east of here. It was very different from indoor climbing, to not have a route to follow, but indoor climbing has given us an intuitive sense of where to place our hands and feet. I also felt something similar to what I felt hiking on glaciers in New Zealand--a feeling of how dynamic, organic the environment is. It sprinkled and showered on and off while we were climbing, and the wet changed the rocks, made the same climbs different. When I was up on one particular climb that we all tried, and failed with extreme frustration, the sun came out and warmed the rope, the face of the rock, and my own face. Elements evolve with seconds, and nothing can be experienced the same outside those slivers. The woods were lightly greened with trees, which made for bright contrast to gray clouds, with jarring breaks of sun.
M and I talk a lot about sacrifices made for medicine, how the intellectual can take away from the environment. I understand and have felt the danger and consequences of that. But I also feel strongly about how medicine, and the people to whom I've connected through it, make stronger, more poignant, more full, the tie between outside and internal. I think the openness medicine pushes you to give, if you want to enjoy it and value it, begins to apply to everything. And this opening can create a path between all that you do, so that things meld, the strength in one supporting vulnerabilities in the other, much like working on land to connect labor with prayer, or climbing a rock to connect routes with freedom.
This past Sunday, we had our first rock-climbing venture outdoors, in a little park off the side of the road, 40 minutes east of here. It was very different from indoor climbing, to not have a route to follow, but indoor climbing has given us an intuitive sense of where to place our hands and feet. I also felt something similar to what I felt hiking on glaciers in New Zealand--a feeling of how dynamic, organic the environment is. It sprinkled and showered on and off while we were climbing, and the wet changed the rocks, made the same climbs different. When I was up on one particular climb that we all tried, and failed with extreme frustration, the sun came out and warmed the rope, the face of the rock, and my own face. Elements evolve with seconds, and nothing can be experienced the same outside those slivers. The woods were lightly greened with trees, which made for bright contrast to gray clouds, with jarring breaks of sun.
M and I talk a lot about sacrifices made for medicine, how the intellectual can take away from the environment. I understand and have felt the danger and consequences of that. But I also feel strongly about how medicine, and the people to whom I've connected through it, make stronger, more poignant, more full, the tie between outside and internal. I think the openness medicine pushes you to give, if you want to enjoy it and value it, begins to apply to everything. And this opening can create a path between all that you do, so that things meld, the strength in one supporting vulnerabilities in the other, much like working on land to connect labor with prayer, or climbing a rock to connect routes with freedom.
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