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.

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.

belief

One of the recurring themes in Power's "Problem From Hell" is how response to genocide is often hindered by an inability to believe. This is distinct from an accusation of lying. It's not that, when confronted with the notion that people are being tortured, raped, killed, humiliated, on massive massive scales, that people say--I don't believe you because you're lying. It's that they say, I don't believe you because I can't believe you. It's so awful, people can't imagine that it would actually happen. Even the victims themselves would hold out hope, make up for themselves excuses, that what was happening wasn't really, that it wouldn't reach them eventually, that they would be different. In many ways, this is an instrument of survival, but in other ways it keeps us in a damaging narrowness.

On Park and Crown, there is a building whose brick wall has recently, for some reason, been covered by a black and white mural of Anne Frank's face. In the corner it tells us, as she did: "Believe in people." I remember reading as a young girl, her diary of a young girl, and being struck by the same sentence that made her famous--"in spite of it all, I still believe that people are really good at heart."

My own sense of disbelief arises more in response the inability to believe in bad, than in response to the bad itself. I've always thought of myself who believes in people too, but lately I find myself thinking more that it's not a belief in goodness or the opposite, but an openness to the full spectrum in between. I believe in capacity. People are capable of incredible good, and that is incredible; they're also capable of incredible bad, and that is also incredible. I don't think recognizing one negates the other. Regardless of which way you think people tend to lean, the most human thing is that they can lean any which way, depending on what is supporting or not supporting them.

I think one of the nicest things about doctoring is the opportunity to know people, not kind friendly grateful people, but all people in whatever it is that they have become. This isn't to say that there aren't things to dislike; I dislike a million things about a million different people. But if we marvel at our own humanity and wonder at how it is that we can accomplish so much, I think it's important to recognize that the root of it all is the same range of possibility that gives rise to inhumanity and how it is that we can destroy so much.

history

Yesterday I spent an hour of my day sitting quietly and asking about things around the room--paintings on the wall, books and photographs on the coffee table. My company was a quiet woman whom I found to be really lovely on first meeting, and more so on subsequent visits. We talked about travels--she's been to Siberia, the only person I've met to take the Trans-Siberian railroad, and she was in her seventies when she went. Nowadays she finds most fit nestled in a chair, reading. She worked as a librarian for most of her life, and now spends most of her days with a book. She likes history.

I've never been half as interested in history as in literature. It's one of the main reasons I abandoned thoughts of journalism freshman year of college, after spending the latter half of high school toying with the idea. For me, fiction over fact. But one general life goal is to seek stories in real life, and not just real life in stories. To be less in my head and more engaged with the outside. And, while I associate literature with more nuance than other areas, sometimes it's not so good to be immersed in detail.

Have been reading Samantha Power's book on genocide, Problem from Hell. One thing that strikes me in her portrayal of America's inaction in regard to all major 20th century genocides, is how much we evaluate things based on what's around it and often falsely call this considering context and learning from history. She brings attention to how our experiences affect our responses: how we didn't want to intervene in Cambodia because we'd just failed in the Vietnam War, how we didn't want to stop Iraq because we were scared of Iran. And we hear it in the news all the time now: we can't help Libya because look at how badly all of our other Middle Eastern ventures have gone. And we link everything together: why not help Syria too then; we can't help everyone.

The irony in calling this taking lessons from the past is so suffocating, it's hard to first read about in history and secondly consider how perpetual it is. Of course there is always context we need to consider, but if you really want to give credence to context, consider the individual situation and present time. Cambodia isn't Vietnam, Libya isn't Syria, or Iraq. And if you want to look at patterns, why not focus on what actually is similar--that Cambodia's Khmer Rouge was as deadly as Hitler's Nazis, that Libya's Qaddafi is as brutal as Iraq's Hussein. The politics and convenience of choosing what to take from history's patterns and what to dismiss from them, and the inability to evaluate the nuances of a particular situation, makes for such mess and incompleteness. That's a little of what I get from the bigger picture.

This perspective, and many miles from my own doorstep, helps to bring the narrow of my life into better focus. I've taken on one of the harder endeavors I've devised for myself, with a little push from M whose point of view I trust and respect, who believes that persistence really does overcome even natural incapacities. Which is considering my own patterns that aren't so useful or pleasant. Instead of imposing these often illogical patterns on my life, I want to more rationally approach situations as they arise. To consider the context that matters, to discard misapplied context, to leave room for what's new and different, to learn from what's old and recurring. This is pretty damn hard when you are both the evaluator and the object of evaluation, but probably one of the worthier goals to pursue.

From the woman and her books, I admire that someone at the end of her life can seek more to be learned from the past. From Samantha Power, I admire the ability to learn about facts as distinct components and part of a larger whole. From M, I admire the drive to try at whatever you want, the belief that you never have to feel trapped by your own self. And so for me, and for every person really, lies the process of taking what you value and living it.

only girl

My advisor, who I love meeting each week for the pure reason of being with the type of doctor I'd like to someday be, once said that one thing she loves about being a physician is being what people need, which changes for each person. Some people need her to be stern, others need her to be lenient. Some people need affection, others need distance. It's not just personal preference, but about what's best for personal character. At first this might seem like playing a part to cater to someone, but I think that after awhile, if you train yourself to remain open to whatever someone brings to you, you naturally adopt different parts of them and different corresponding parts of them.

This might sound like advocating against being your own person--to be malleable and different depending on who's around you. But I don't think that necessarily has to be the case. I think being open to how another person can change and shape you, can mean drawing on resources within you that you aren't used to reaching for, haven't had to assume in the circumstances you've been in, aren't part of the general personality you've developed. Doing things, saying things, feeling things outside of your usual self aren't always less you than what you do everyday. You own all of it, including what you accept from others.

I thought of this today when Rihanna's "Only Girl" came on the radio. I'm a big fan of that song, and of Rihanna whose voice I love for its slight twang and high power. I thought of it because my friend C and I blasted this song throughout our cross country drive from Connecticut to Arizona, and back. And C is a person who makes me think of how different people bring out different things in me that I wouldn't always offer on my own. She's extremely expressive, while I find it pretty difficult to show when I'm really excited or happy about something. We've grown up in different environments, we respond to our current environments differently. I love in her all of these things that make us different, and she's open to me despite them, and I think that's the one and only thing I require in a friend, a certain openness to how I am and to how people are in general, that makes it easy to connect even if you're very different.

C and I both love this song, and other fun pop songs, and any time we heard one of our favorites, she'd go crazy in the car, and it would make me go kind of crazy too. This one song being iconic, whenever I hear it, I remember those free-for-all moments: all the windows down on a dark road in the desert of New Mexico, with flat-topped mountains fading into the black of night so that you can't see any shapes but think how beautiful it must be during the day; singing over the words over a straight road flanked by cotton fields in the middle of Arkansas which is full of deep reds and pale greens; dancing in the seats of the car through the wide therapeutic nothing of Texas with its surprising pink-tinged wheat and beauty.

And when she blasted the radio on full volume, put the car in park at a stop sign, jumped outside and danced barefoot on asphalt, in some residential southwest neighborhood already asleep. How I didn't hop out after her, but hopped out at the same time, as though I'd already absorbed the energy to fulfill a previously dormant whim. To feel something in you slip out of its cover is almost like to create something new, and there's so much in people to make you feel new.

moth

In our house the kitchen is in the center. It's adjacent to the living room, where my roommate dwells most of the time along with a handful of her many friends, and with our regular visitors, our neighbor across the street and our neighbor down the street. It shares a door with my bedroom, and it provides a door to the outside as well as to my other roommate's room. I get a phone call while making dinner, so I take it in the kitchen. While listening to a friend's new findings on an old romance, I get a phone call on the other line--the neighbor across the street wants to eat his rice krispies at our place. He starts a conversation in the living room about how things have been the same over and over, each day, calling out to me sporadically for input. The kitchen door to outside swings open, and it's a friend who's been watching a movie in my other roommate's room. Pulp Fiction. My roommate says, oh I need to watch the ending of that. My friend says, oh it's at the end now. My roommate says, but I've forgotten the middle. We laugh, and my friend watching the movie goes to the bathroom, and returns, and asks everyone if they've eaten. Let's go to dinner. It's late, but we haven't eaten. I've already made food, I say. I'm still on the phone, listening to how a story we thought went one way went some other way, but at least now we know and we can leave it be. My neighbor with his rice krispies shouts about how we've been separated from our mothers, and that's all that really mattered. My hungry classmate says, let's eat. The person on the line says, What's going on, and I try to think of a description. And then I see a white flutter--a moth--fluttering outside my bedroom door--the source of the mysterious bug smell in our kitchen, which I'd discovered to be moths, but I hadn't seen one in the kitchen until now. Motion with no noise, unnoticed by anyone. And I think, that's nice.

dancing

My stomach's hurt all day, have spent most of the day in bed. As often when I have a physical ache or pain, I feel old. I'm getting older, of course. I'm almost 27, and this means a lot of things, like slowing metabolism and decrease in agility. I often feel I need to catch up on a lot that's physical (learning to bike, swim), and I also worry I won't be able to keep up at the things I feel semi-able to do. These worries will all come to fruition, of course. That's age.

A hip hop song on the radio made me consider, when will I no longer be able to dance? Not even just physically, but socially. Those older folk getting down, even as they must be having fun, aren't seen as belonging there. And maybe that shouldn't bother me, but of course part of the fun of dancing in a crowd is being a part of the crowd. Most girls love to dance, and I'm not exception to many things girly. I've loved to dance since we were taught in the sixth grade to dance the Macarena, and though we learned that dancing is just moving, some of the boys at our first dance would dance that choreographed move to every song whether it resembled the Macarena or not. I love the inherent desire to move, the work you build up, and the freedom. When will it no longer be okay, when will we no longer look like we're dancing, when will we be just, too old? It feels kind of, sadly, soon.

As M would say, good thing I still look seventeen! Or less.