prisons

It took me forever to write this because this topic has become so extremely interesting to me, and there is so much to say about it.

In college I took two classes where I ended up writing an essay about prisons and/or prisoners--one in a moral reasoning (because they have to call everything by a different name; this is basically philosophy) and another in a literature class on misfits where I wrote about Kafka's The Trial. These were some of my favorite things I wrote about, mainly because I was pushed to think more deeply and in more nuanced ways about things I hadn't considered much, or had only considered in concrete ways. In the philosophy class, I wrote an essay about whether risoners had the moral right to revolt violently when certain rights were being withheld from them. This seems like it could be a straightforward argument, but being forced to use definitions and structured logic makes things both more complex and more streamlined. It made me think of a number of things more carefully. How is the prisoner different than the average citizen? How are civil rights different from human rights? The prisoner retains some baseline rights, but by definition is deprived of others, and also has more obligations to the state than the average citizen. But likewise, the state acquires different obligations to people when they become prisoners.

In literature, which in some ways is on the other end of the spectrum from philosophy, we also thought about prisoners, some more literal than others but the obvious one being in Kafka's The Trial, where a man is arrested for a crime that is never shared to the reader or known to the man himself. I didn't see it then but looking back, clearly there is a connection between the two disciplines in this topic--I opened my essay about the book with a line from the quintessential philosopher, Foucault: “He who is subjected to a field of visibility...inscribes in himself the power relation in which he simultaneously plays both roles; he becomes the principle of his own subjection.” This was written about the Panopticon, which is a building designed to allow prisoners to be observed without them knowing when they are being observed. A guard can stand in the center and have view of all the prisoners around them, but they can't see him. So even if the guard isn't looking at you, you feel like it is and it's your own sense of this that limits you. I became really interested in how this sense of individuality--that things are centered on you, that you have this singular relationship with the guard, that you forget about the many other prisoners around you (because you also can't see them)--is a source of imprisonment. In our society, individuality is the means of establishing identity, but in this case it can be detrimental to your sense of self. It also poses an interesting contrast to the other essay, where prisoners are asserting their individual rights.

Anyway, that's all to say that I thought a lot about these theoretical and written arguments when I started my rotation at San Quentin prison a few weeks ago and then a few days after that when we visited DeLancey Street which is a residential program for ex-convicts and would-be prisoners. Obviously these are two very different structures for a similar population of people, so it made think again of the nuances and complexity of this slice of life (which is the totality of life for some).

Our day at San Quentin started with a brief tour and an orientation on the language, rules, and etiquette of the place. But before that, the day really started with getting into the prison, which wasn't the easiest thing to do as a "regular" person. You aren't allowed to wear a million different things (blue jeans, green in any form, yellow raincoats...), and I wasn't allowed to bring in my gray hoodie which I had only meant to help me ward off rain until inside. So I had to walk around in the rain and it was freezing. Then we needed to attain what looked like something I'd call tokens but they called chits, which are round gold coins that look like they were used from the time of Game of Thrones. There are various definitions and uses of the word chit, but I think the one that might apply here is "a signed voucher of a small debt (as for food)." We turn in our chits for our key cards, which let us into the bathroom and not much else. Then we needed our alarm systems--a device we were to clip somewhere on us and strictly instructed to keep it vertical at all times--because if it leaned at all from 180 degrees it would set off a prison-wide alarm that wouldn't go off until a guard found you and was sure it was a false alarm. This is meant to alert the system if you were to fall down as the result of an attack. This seemed a little scary, but then another new medical provider set it off three times that day, twice while leaning over and once while going to the bathroom, so it became a bit less intimidating and more annoying in how self-aware it made us. At another point during the tour, a guard yelled at my co-resident for not having his driver's license on him at all times and proceeded to remind him about a half dozen times that he needed to have his ID at all times. These sorts of things gave a small, strange sense of what it might be like to live there.

Then we sat down for an orientation to the prison. I'm not sure what I expected to be oriented to, but what happened was that we were oriented to a microcosm. We learned about the different units, who was housed there and why, and the lingo for what they were called. We learned about the leader inmates of the prison, called "shot callers" who will direct the behaviors of their fellow inmates, from what type of exercises they will do in the yard to organizing hunger strikes to drug dealing. We learned about which medications aren't prescribed in prison that we routinely use in the community because they have black market value in prison.

And we learned about the bane of the primary care doctor in prison: chronos. A chrono is a request from an inmate for some type of accommodation: a cane, a back pillow, and the most common and most coveted: the lower bunk bed. At first, doctors felt happy about their ability to give, and gave anyone who asked whatever reasonable equipment they wanted--and the lower bunk. So much so that they ran out of lower bunks, since everyone wanted one and the prison is already housing 400% more than its intended capacity. And so this has become a political issue in the prison, with people vying in any way they can to attain a chrono for a lower bed, and the majority of the visit between a doctor and patient can become about attaining this form. They liken this to pain medications in the community (which are very much limited in prison), where the relationship can become very strained over different agendas. So much so that they have devised a "Chrono Clinic," which sounds a lot like "Chronic Pain Clinic." No matter how we try to structure and shape an environment, common inherent tendencies arise from anyone and everyone.

When I left for the day, I found myself relieved to turn in my alarm system. I'd felt consciously limited by it all day, trying to make sure I didn't move in ways that would set it off and have an army of guards running to me. I actually ended up loving my experience much more than I'd anticipated, but I also felt more "other" than I anticipated and it was also nice to shed that when leaving. I had that freedom.

books on airplane

On the long flights to and from the Netherlands, I read two pretty good books. They both read quickly, and had some very good moments. They didn't blow me away but I enjoyed them, and wanted to record them briefly. I've found that even though I can recall the impression a book gave me long after I read it, I often forget what actually happens.

The Storied Life of AJ Fikry by Gabrielle Zevin This book is very popular, and was written to be a crowd pleaser. It's about a grumpy man who owns a bookstore, whose life changes when a baby girl is left in his shop. Everything is neatly tied together like a puzzle; there's a love story and each character is shown to be part of a bigger plot; but it's not meant to be realistic. It's meant to be a story, and I liked how much of the book was about the power of stories. Each chapter began with a reference to a story, book, or poem and the book was sprinkled with literary references. As common a gimmick as that is, I like it when it works well (love Gilmore Girls!) and I thought it was done well here. The book was also very funny, which I always appreciate because I can't write anything funny.

All the Light That We Cannot See by Anthony Doerr This is also very popular and is also a National Book Award finalist--and now that I'm looking it up, see that it just won the Pulitzer Prize. It alternates chapters between a blind girl growing up in Paris who flees after its occupation by Nazi Germany and a an orphan boy who grows up in Germany and ends up working for the Nazis by finding and hunting down radio signals of Resistance movements. I liked it, but I didn't love it and thought that another Holocaust novel it reminded me of was much better (Julie Orringer's Invisible Bridge). My brother recommended it as beautifully written but the writing didn't strike me as such. I did like how it explored a number of different characters during this time period and their nuances and circumstances. It made World War II and the Holocaust about very personal, individual stories, and I was invested in each of them, finishing the book in mostly one go on the flight back home. But I found myself thinking too often how the writer was going to develop the characters and connect them; it didn't feel organic to me.

I don't regularly read anymore, another habit that residency has changed, but am always reminded of how much I love it when I get back to it.

march

March was a blurry month that I am happy to say I will never repeat. Night shifts are fun in terms of work and horrible in terms of everything else.

1. Blogging: I did manage to sneak in four entries so roughly once a week, and am really happy about this resolution since it's kept me writing more and I just want to get back in the habit of it.

2. Recipes: Somehow I was able to try several new recipes in March. The theme was sauces, and I tried scallops with a white wine sauce and then to use up the wine, a salmon with white wine butter sauce. Loved both and made the scallops a few times since then. Also tried Emeril's creamy lime avocado vinaigrette, which we used on grilled shrimp. I love grilling and would like to learn more tips for this such as more vegetarian recipes and also figuring out exactly how long to cook things...

3. Albums: March was a month of re-exploring old favorites; sometimes I get caught up in exploring new music that I fall behind on artists I love. The inspiration was finally seeing Stars in concert, and hearing their most recent album, No One is Lost. Then also listened to Death Cab's most recent, Kintsugi. I've enjoyed watching their evolution over the years and I don't think that becoming more mainstream has hurt them; they have new sounds and I try not to mind when lesser known artists become mainstream, because after all when I love some form of art I want to share it. Also listened to Thao Nguyen's We The Common which came out a couple years ago; I heard parts of it at last year's Strictly Bluegrass and was reminded of how much I loved her.

4. News: I did better than in February, but if I had any free time on nights I was usually sleeping, not reading...

5. Exercise: I'm starting to think it's too ambitious to try to do all these different exercises in a week. I can usually easily run, climb and yoga in a week but the biking and swimming are a lot harder to fit in. I'm thinking about starting daily workouts from blogalites, continuing to climb and yoga when I want to since I do those frequently out of pure desire to do it, and running a quick mile most days.

Almost already time for the April update! Life really flies fast in these segments.

amsterdam

It’s amazing how many places there are in the world that I had never given thought to and then fell in love with. The first time I experienced this was Utah; it’s a special memory for me in how new and strong the feeling was. I was absolutely amazed by the beauty, and in particular that I had never even known that Utah had anything in it to see. Then we drove through open roads with red rock flanking us, and my love for desert began and since then moments in the Southwest feel like a gift. Nowadays I talk to people about Utah and everyone nods in agreement, but I had no idea. Even though I played no part in making Utah, I thought this must be what discovery feels like.

Now Amsterdam is another place like this for me. I’ve never thought about visiting the Netherlands, but I’ll pretty much travel anywhere new when the opportunity arises so when my brother suggested it , I got excited about the exploration. But I had no expectations; I had no image at all of what Amsterdam looked like. In fact, my image might have been a little dreary because my only encounters with it were 1) when I passed through it on our way to Prague and I was sad that I got an Amsterdam stamp in my passport instead of a Prague one, and 2) when I read Ian McEwan’s Amsterdam and found it to be too dark and boring.

But, I loved it. Of all the major European cities I’ve visited (London, Paris, Rome, Florence, Venice, Athens, Prague, Brussels, Vienna), it is my favorite. Of course there are lots of countries I haven’t been to that may have competing cities—Ireland, Spain, Portugal, Germany. But as of now it’s Amsterdam. For my brother it’s become second to Paris. While Paris has the unparalleled appeal of mind-blowing big-city glamour and culture, I’d argue for Amsterdam for the following:

1) The water: Water is everywhere, and even though I’d read about canal cruises, I didn’t quite picture how the city is built atop water. People live in houseboats, and on cobblestoned streets lining canals, and there are hundreds of small and large canals and bridges. It’s just really cool to see water everywhere, how the reflections change through the day and night, and see visually how the city has been built around this natural force.

2) Bikes: People bike everywhere, more than any other city I’ve visited, and everything in the city is catered to bikes first. It gives the city a very quaint, freeing feeling, and it also creates a different kind of city community feel when you can see everyone and everyone is outside while commuting.

3) Language: I haven’t heard much Dutch, and thought it was very pretty. It’s less harsh than German, less self-aware than French. Also, everyone speaks English with a pretty accent. I love that the people are open to using English and the idea of being bilingual in general. There’s something about language—that I’m sure linguists have described much more eloquently—that opens up more avenues of thought and experience. I took more French in college not so much to communicate (my accent is pretty horrible and I’d be afraid to talk to anyone French), more to learn about structuring sentences and learning words, exploring nuances that are beyond direct translation. I think it’s nice that people in the Netherlands are so open to this, where I’ve found other countries in Europe can sometimes distinguish one language as superior to another.

4) Low-key openness: I guess this comes from being a less popularized European city, but overall the city is much more relaxed and less touristy than others I’ve been to. Besides that there is a general openness that feels akin to the Bay Area (the first country to have legalized gay marriage; prostitution is a fairly respectable occupation with health benefits and regulation; etc) without some of the judgment against those less liberal that can sometimes be seen in the Bay Area.

Some downsides include that it's a little expensive like other places in Europe, and the food isn't as memorable as other European cities. But overall, it’s just a beautiful, beautiful city with gorgeous architecture (old and modern), and narrow streets tucked full of images that remind me of how much exists that I haven’t yet discovered.

vincent van gogh / anne frank

I've always liked museums dedicated to one person. My favorite museum in Boston, and one of my favorites overall, is the JFK Library. I liked how going through the building mirrored going through his life. I like the idea that one person's life can fill so much--not just because he or she represents a country, a movement, or values that we value, but also because that one person's individual thoughts, feelings, and experiences are valuable.

We spent our first day in Amsterdam in two such places, first the Van Gogh Museum and then the Anne Frank House. Both are pieces of culture that I was first exposed to and loved in high school. They (Van Gogh especially) were the type of things that you first love because it's the first time you discover the ideas they represent, then distance yourself from as you find that everyone loves them too and it seems too cliche, and then return to when you get older and learn that some times are just deserving of universal love.

We waited for an hour in the cold to get into the Van Gogh museum, and even though I knew it would, it was amazing how seeing his art in person oozes warmth back into your coldness. It was surreal to see the famous Sunflowers, Yellow House, The Bedroom, and Irises in person. I especially liked seeing these in person:

The Wheat field with a Reaper:

Van Gogh painted this from the view from the asylum where he admitted himself in the last year of his life. I’ve always loved his pictures of wheat, and of yellow things in general. It was his favorite color, and I think my love of yellow originated there as well (I’m not too original). I learned in the museum that he considered it the color of love. This picture always seemed so vibrant to me, and yet of course it has such dark and bittersweet undertones.

Red Cabbages and Onions:

I hadn’t seen this painting before, and I loved the textures and colors. This doesn’t do justice to the colors, either; and the real painting has also faded from the original purple hue of the cabbages to more blue, but the contrast between the blue and yellow is still really striking.

Gauguin’s Chair: I love this on its own, the weird and compelling mixture of colors and how he uses this object to represent his friend. I also like it as a comparison next to the painting of his own chair, which is less appealing to me as a painting and makes you think a lot about self-perception and judgment.

Seascape at Saintes-Maries:

This made me think of M. Van Gogh makes me think less of water and more of fields, so this painting was striking amidst the collection, and after my new experiences in the ocean thanks to M, I feel the waves in this more strongly. They really look how they feel.

I loved learning details of his life. I didn't realize he was so young when he died--thirty-seven. As my dad pointed out, he looks much older in his self-portraits. My favorite part was reading letters between him and Theo, his brother, and being able to see the fragile paper and handwriting in person. Sometimes, the skill with which he makes us connect to his images ironically makes him bigger than us. Learning about him as a person makes me remember that it's the expression of his feelings, not the feelings themselves, that are unique to him. And maybe the degree to which he felt things. But the base emotions--the desire to have his work be meaningful, his frustration with the struggle, his desire to host friends and be with others, the feeling of pride in certain successes--they are so accessible, palpable. As we ascended through the floors to the top floor that exhibited the work he made in his last year of his life while tucked away in an asylum, I felt so sad for his emotion and at the same time so grateful for his expression. And the latter, I think, is what he really wanted.

The Anne Frank House gave an even more visceral experience of being inside the physical place where such powerful writing happened. Similar to the Van Gogh house, we started at the base and ascended through the house, to the annex where Anne and her family were hidden for two years before they were caught and sent to concentration camps, where all but one died. I was pretty much bawling by the end of it. I read her diary in high school and identified strongly with sentiment of optimism and goodness in the face of such blackness. In the house I learned many more little details that made both her everyday humanness and her extraordinary power so poignant. I learned more about the extremes of people. The good: the four "helpers" who risked their lives every day to not only try to save their lives but to make their imprisoned lives more ordinary, devising ways to get the kids schoolbooks, and bringing them news of the outside world. The friend who tried twice to bring Anne a package to the camp. The bad: the woman who stole Anne's first package from her. Whoever it was who betrayed the family and sent them to their deaths. And how this all springs from the same roots, the same skin and bones that make all of us. Towards the end, in a display about the family's arrest, their individual portraits are posted and behind Anne's endearing face plays a small black and white film with images from Auschwitz--starved bodies died and others barely living. It is of course meant to evoke what it does, but it is also in the spirit of who she was--a bright spirit that wasn't immune to these horrors and not meant to cover it up, but to remind us of it and of what else exists.

The house remains unfurnished; it was the wish of Otto Frank, Anne's father, to remind us how empty these lives were made. The pictures that Anne pasted on her bedroom wall's remain, as do the pencil marks that track the heights of Anne and her sister while they were hidden. Also, there is the original bookcase that hid the entrance to their hiding home. I found that these inclusions were really fitting, and appreciated the amount of thought placed into what to keep, and what to remove. Anne's family didn't have that kind of freedom.

Again, I loved seeing the actual real pages of her diary. Paper can be so moving. Her handwriting was neat and in cursive. No one really writes like that anymore. I cried separate times on each floor of the house but like Anne wrote, as incredibly sad and hard and horrible it all is, the thing that remains heaviest is how much one person can affect others--"in spite of everything."

clinic tidbit

Yesterday I saw for the last time the very first patient I ever saw in clinic during my residency. I don't think she likes me all that much so it wasn't a particularly poignant farewell (Me: I know you don't like seeing the doctor, but I wanted to see you once before I left. Her: Okay. You're a doctor now?). But I love that after three years, I have a panel of patients who I know well, both medically and personally.

The other day in clinic, one patient gave me a stuffed animal and a silver dollar as a farewell gift, another brought me Filipino fried treats, and another asked to take a photograph together when I told him I was leaving. While the nature of this work relies on less concrete rewards, no one is immune to enjoying feeling appreciated.

stress rash

When I started my first month in the hospital as an intern, I developed a rash in multiple areas of my body. I'm pretty convinced that it was from the stress of the work, though at one point I was also worried like every other intern working at the county hospital about having gotten scabies from a patient. Luckily this wasn't the case, but this went on for several months and my skin started to darken where I'd been scratching a lot--over my back, thighs and ankles. I went to the dermatologist who didn't tell me much other than to use steroid cream to prevent scratching, because the darkening could be permanent, and that actually if the darkening hadn't gone away by now it was likely to be permanent. This bummed me out, as probably my favorite thing about my superficial self is my skin tone. But I didn't pay much attention since I don't see my back much, which is where most of the changes were. Recently I've noticed that my skin has returned to normal, so I suppose it just takes awhile to recover.

But in the meantime, as I near the end of my residency and just finished the two hardest months of my training, with 30 hour days and living like a vampire while working nights, I've re-developed this stress rash in a lot of the same places. I'm trying my best to de-stress and recover, but it takes time and I've continued to have the rash despite now being on a normal, human schedule. It makes me think a lot about well-being, and the importance of active self-care. Because during those hard months, you just tough it out and think that it will be over soon, but the effects can be sustained even after the struggle. Your skin might permanently change color from what you did to yourself for a short time.

As someone who does a lot of self-reflection and active planning, I tend to think that I can surmount most things with lists and motivation and hard work. As a result I often take on difficult things feeling like I can get through it and stay balanced and normal, be in perfect shape emotionally, physically, concretely and philosophically. Residency has humbled me a lot, showing me that it's important to be mindful of what I take on and how it's affecting me, because no one can balance their lives during residency. There are many moments where it will be pose barriers to your health, relationships, and self-image.

Moving forward, I think the most important things are: 1) treat your mind and body well after the rough times, to allow it to recover, and 2) look back and see the worth of the sacrifices, because despite the difficulties there is much, much good. So as I have faith that my skin will heal, I also know that any scars are remnants of my battles--battles with some false pretenses and empty goals, but also with deep learning and real effects on other people and my own growth.