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.