san francisco

Almost everyone loves San Francisco; there are a lot of ideals, and there is an incredible unique energy. I'm not that unique; I love it too. But to be fully honest, I have to acknowledge the cons of actually living in the place. At times they can be substantial. The worst: commuting makes everyone mean. Drivers, pedestrians, bikers. They (we) are simultaneously impatient and slow, and everyone's out for themselves. This city is small, and packed. There's no easy way to drive through it. Five or six miles, which is all it takes to go from one end of the city to the other, will take you an hour to drive. Public transportation isn't good. Being a bike-friendly city doesn't mean it's safe to bike, and it's hard for beginners to compete with aggressive, entitled bikers who know that their gear intimidates you.

Close to worst is parking, and the inevitability of being ticketed, often and highly. You'll see as many meter maids as bikes, and this just doesn't seem as friendly as California is supposed to be (an inconsistency that makes the commuter mentality even more frustrating). There are some other bad things about the city (the insanely high cost of living, the cold in some pockets), but nothing compares to the problem of getting around.

But. When you do get around, it is incredible.

One of our intern orientation events was a scavenger hunt around the city. Over the course of a few hours, we sampled flavors with eats, sights, airs, and streets. It was a gorgeous sun-drenched evening; when we started out around 6 PM it felt like early afternoon, and as we finished near 9 it felt like dusk.

We drove along the Embarcadero for beautiful views of the Bay, and the Bay Bridge. We sped down to the Mission district, where we stopped at our leader's house to pick up a pinata (which was on our list, and which she happened to have for a birthday party). We walked through the Mission to Dolores Park, a grassy knoll smattered with families and couples with dogs and teenagers smoking weed. We walked to Bi-Rite Creamery, and had salted caramel ice cream, which felt rich and light and full all at once. I had mine on a cone and we sat in the park relishing the sweet. Then we strolled, looking for tacos among all the Mexican food in the Mission. We decided on a place called Tacolicious, a trendy place packed with happy hour goers. We ordered, and went in search of murals while the food was being made. A few blocks away, a corridor of colorful murals was tucked away, with different styles and sentiments poured on brick. Got so lost in the neighborhood that I forgot about the tacos, and when I found ourselves back there, it was like a surprise to gather fresh, hot tortilla and real-spiced salsa. We walked for awhile, and found a "public parklet," a random, cozy seating area "open to the public" with a booth and stools. There we devoured tacos with a million flavors packed into a handful of food--mine had the sweet and tangy of mango, spice of jalapeno and other peppers, citrus of lime, and natural ocean taste of yellowtail. Full, we drove our way to the other end of the city, to Golden Gate Park. Where we saw bison, waterfalls, and gardens, all along a five minute stretch of road. As we left from the opposite end of the garden, we made our way to Ocean Beach and along the ocean to Sutro Baths, the ruins of an indoor swimming pool complex, now swimming in the ocean. Surrounded by mountains,greenery turned black from silhouettes, pinks in the sky and glassy water from changing light. From there we ordered Chinese take-out by phone, and sped to the Richmond (SF's second Chinatown) to pick up home-made dumplings. We gathered our list of items seen, eaten, experienced and met with everyone at an Irish pub in Haight for drinks and sharing.

So much makes it hard to navigate, but it's not lost on me how much there is.

it's okay

This transition hasn't been too easy so far. It hasn't been crazy difficult, but in all honesty there are waves of anxiety that even when interrupted by calmness contribute to a general undercurrent of discomfort. So it's been important for me to actively breathe after each frustration, remember context, and appreciate. There's been a lot of opportunity to practice this...

I haven't found a place to live. Last week, my first day of physically looking at places threw me into a window of depression that lasted until I decided to block out reality and visit M in La Jolla, stat. That was a beautiful time. During it, I missed getting a place that was the most ideal of what I've seen so far. I was pretty disappointed when I first heard that I didn't get it, mainly due to not being in town (by a matter of one day; this market is even crazier in experience than in rumor). But before that, I'd been anxious deciding over another place. Finding the second one, even though I didn't get it, made it more clear that I was right to pass on the first one. And makes me more open to taking things in stride. It sucks to be starting work next week not having settled into a place yet, but I know it's just a matter of patience.

I don't know a whole lot of what's going on, knowledge-wise and logistics-wise. Our first two days of orientation were BLS and ACLS training, which required an online course to pass before taking the actual class. There was a pre-assessment test, simulations of a dozen patient scenarios that you have to repeat until you manage them correctly, and an exam at the end. I failed all of these horribly multiple times, which fed my general sense of being more unprepared than most, because I've spent the majority of the last two years outside of medical knowledge. But at the actual orientation there was a general consensus that the training had been pretty hard, and I reminded myself that in groups I'm not that different, in either good or bad ways. And also that even if it was harder for me, that's okay too.

Because the online stuff took longer than I anticipated, I was running late to the actual training, which also flustered me for being out of it for my very first day. But I learned how to maneuver the crowded streets of SF more easily, and managed to be only a little late. And when I got there, a nice man who'd retired and was now volunteering at the VA, transporting vets to and from the parking lot to other areas of the hospital, offered to drive me on his cart from the parking lot to where I needed to go. Even though this roundabout drive actually took longer than walking, it was nice to be taken somewhere when I'd just been worrying about figuring things out. And the next day, when I returned to the VA for the second day of training and again running late because I hadn't accounted for how long it would take to find parking, another nice man let me park in a non-parking spot because he knew I wouldn't be able to find an official one. I haven't been very on top of the logistics of these things--I didn't plan for parking, I didn't even know I had to do the ACLS training until a couple days before, and I'd forgotten to check my residency email where apparently a lot of information has been sent. I also lost all of my ACLS online training after I'd completed it. I've sent our administrator no less than a dozen emails, with questions that had often been already answered in previous emails, and with questions about other mistakes (one being losing my ACLS online training), so have concretely established this sense that I don't know what's going on. I noticed that I started becoming like this at the beginning of med school...having things work out in unexpected ways for me in med school made me unconsciously loosen a little of my desire to be in control of everything, and I think that's been a good thing overall. After all, if I didn't know, more than one of my classmates definitely did. In the beginning of a transition like this one, it can be uncomfortable to be out of the loop, but I still got my BLS/ACLS certifications, and I'll figure it out eventually. While I don't think I should drop all efforts to be in the know, I'm also learning to be more comfortable with not being on top of every single thing.

Which brings me to other things I can't control, with the top one currently being the traffic in this city. The drivers here are both extremely impatient and extremely slow, which I don't understand. I find that traffic is the best practice for calming techniques, and even interpersonal relations. I have to remember not to judge too harshly because I'm not the best driver either and I make lots of mistakes like having to switch lanes at inopportune times and interrupting others' lane spaces when trying to get around something. At the same time, I haven't been able to resist getting mad and honking when someone has done something clearly inconsiderate. Turning left to get onto the bridge, when I clearly have the right of way to go straight, just because you're impatient to get on a jammed road? That one really blew my mind. It also made me think that when we're behind, we're so eager to gain inches. Not to say that those inches don't add up; I think sometimes that they do, but maybe are not the worth the expense of principle. Frustration with traffic led me to public transportation, which led to another, unexpected level of frustration that also took some active effort to calm through.

So I haven't felt this underlying anxiety about a phase in my life for awhile. I think a big part of it is that I'm used to things generally working out. I've been incredibly lucky in that sense. But remembering in retrospect is tricky, and I think that a few other factors contribute to my memory of the past. One, I've forgotten the degree of logistical and emotional anxieties. Two, the positives overwhelm the negatives in my memory. Which lead me to now. These anxieties will smooth themselves and in the midst of them I'm still incredibly lucky. I have a luxurious apartment with gorgeous views to stay in while I'm looking for a place, a brother who lets me stay there and supports me through the difficulties. I have a few old friends in the area who look out for me in such thoughtful ways, from seeking out my company when I'm down to checking out apartments for me. I've already met some wonderful people in my program. I live in the Bay Area, and the San Francisco June has been unusually, unbelievably warm and sun-full. M sent me a birthday gift of a framed print of Andrew Wyeth's Master Bedroom: http://www.nytimes.com/2009/01/17/arts/design/17deba.html?pagewanted=all

Before I left La Jolla for graduation, I wanted to spend a little time objectively describing artwork to M, an activity we once did in med school and I found to be useful in sharpening observations. This is one I chose to describe to him; it was new to me at the time, and as we talked about it, we discovered an affection for it. For the simple lines and sentiment. It exudes a calm that's fitting at a time when I'm anticipating--when I don't have a bedroom yet but now have something to place in it when I do. I'm so lucky for this feeling, and for him.

And I get to start.

expectations

Being back in the Bay Area feels less like a familiar flow and more like a sudden dislodging. The feeling arises mostly from a disconnect between the immediacy of expectations and the slow buildup of adjustment. Being home should feel right; graduating should feel like an achievement; starting residency at the place I've been striving towards for a vaguely long period of time should feel exciting. These are the expectations, the kind that everyone reinforces with congratulations and questions of what's next, and the kind that I personally build with the need to affirm my decisions and values (because if I'm not happy, I probably did something wrong, right?). There are waves of rightness, like when I drive over the Bay Bridge or when the moon's so bright it lightens the black ocean at night. But honestly, over the last week as I've been looking for a place to live in the area I grew up, and preparing for the orientation to the career I've been educated for through my twenties--things don't fit.

  I'm pretty surprised and bummed by this, but I momentarily escaped some of it by visiting M in La Jolla, and in conversation with him and thought on my own, I've realized that these feelings feel bad due to some faulty expectations.

  *The expectation that because home remains in one place, my relationship to it would be similarly stable. Growing up in the Bay Area, I couldn't imagine another place I'd rather return to after sufficient exploration of the world. While living on the East Coast, I loved it. I haven't met many people from California who love the East Coast as much as I do. But I always assumed I could leave it for California, seamlessly. In fact, it was the move from West to East that was seamless--the ties to MA and CT and the state I drove in & through, were woven quietly and gradually, and as they were stitched I didn't notice that this tightness was drawn from loosening ties to my childhood home. The bulk of my development, at least as I feel it now, came from the places and relationships of the East Coast. Coming back to California, I expected only the renewal of my old connections to the place but instead there was an abrupt pull of my attachments to the other coast, without anything to immediately replace it.

  *The expectation that the end goal of a process should feel better than the process. The excitement of being a doctor and not a med student hasn't hit me. I was excited on the day of graduation, but somehow I think has that more to do with it being a part of medical school than with it signifying my transition to doctorhood.

  *The expectation that the right decisions should feel right, right away. My decisions to pursue this residency at this place seemed to form naturally over the course of who I am and who I'd like to become. It seemed to me that the result should follow a naturally free-flowing course that just fits. Instead, I find myself having a lot of doubts about whether I'm right for this, whether it's right for me. I feel clumsy.

  Looking over these, some things come to mind. All of these unfulfilled expectations have the potential to seize me with self-doubt and fear...and they have. But recognizing a couple mistakes on my part lessen this power to frazzle me--mainly, that I shouldn't expect so much, and so quickly. Just because these things haven't happened doesn't mean they won't happen at all, and when they have happened in the past they've always taken time. I've just never been as frazzled by waiting, because in the past I wasn't waiting for them to happen. They just did. I've been so spoiled by things falling into place that this time around, I actively expected them to.

  I suppose that's a part of accumulating experiences and having bases of comparison. I know that this step up to MD is seen as a culmination of what's come before, but I think that maybe the best bet is to step into it with a certain blankness, and openness to what might happen instead of what's supposed to happen.

moving (again)

So the last time I blogged was when I was in San Francisco, where M and I spent a month after our cross country trip, enjoying the luxuries of my brother's apartment while living a simple life of sustenance. Now I'm in San Francisco again, back in my brother's apartment, while I look for a place of my own to occupy for the next few years. I don't know if the blogging recurrence after a long hiatus is due to the common city of SF and place of this apartment, or to the common feeling of rest after having traveled far, or my own manufactured value of commonalities, but I think that regardless of source there's some connection.

It feels strange to be somewhere that I'll be for the next three years, instead of the next three months. This past year was all motion, where feeling settled was being in one place for one or two months. At the end of last summer M and I were in the process of settling into commuting between Long Island and New Haven, which lasted a few weeks before we decided to pack up and move to California, which we did a couple weeks later. That fall, we spent a month and a half figuring out in the morning that night's place, which varied from the woods to a stranger's couch to our car. After that, the October of steady nights in San Francisco felt good. We took another road trip through the Northwest, seeing northern California, Oregon and Washington while I went on interviews. We spent Thanksgiving with my family in Denver. We flew back to the East Coast together, me for interviews and him to spend Christmas with his family. I flew back to California to spend Christmas with mine, and he joined me for New Year's. We then packed up, leaving most of our camping gear in storage in Fremont, and took another road trip down to San Diego to start 2012 there. The plan then was to find a place for M to stay while I went to Uganda for January and February, but we had little luck in finding a place. We spent a couple weeks there, again couchsurfing and sometimes resorting to motels, once setting up a futon in a kind stranger's kitchen. I had to fly to Uganda before M was settled in San Diego. He eventually found a non-ideal place, while I settled into the dust of Uganda. After Uganda I visited him briefly in San Diego, and then returned to New Haven for a mandatory class, the last of my med school requirements. At the end of that period, I matched into residency at UCSF on March 16 and the day after, flew back to San Diego to spend my last two months of medical school living next to the ocean with M. In mid-May, I flew back to New Haven for the last time, to graduate. The day after graduation, I started yet another drive cross country, to return here.

I journaled a little during our big road trip, a lot during Uganda, and I wrote intermittently while I was in San Diego. But I spent most of my time in the process of something, instead of processing. And per usual, there's little transition to unravel all that's come before. But I think that in the midst of all this moving around, now that it's time to be in one (physical, at least) place, I will work slowly at wrapping up this blog, and moving onto another.

moving

It's been so long since I've written that I'd forgotten what my last entry was about. It was about the surf contest in New York. M and I are in California now, and in a funny turn of events, a similar contest is taking place here in San Francisco. Neither place was a likely venue for such an event (none had ever taken place in Long Island before and this is the first in SF in thirty years), and the timing worked out that we caught the last one as we were leaving the East Coast and are catching this one just we arrived to the West Coast. Having something bracket our road trip seems to confirm our sense that this decision, which outwardly seems random and spontaneous, is right. Not just in the way that things end up right, but that it was meant to be this way.

To tell people before we left that I was moving, seemed to be a little inaccurate. We spent a month and a half on the road before getting to the Bay Area, we'll be here for a month before I spend half of December on the East Coast going on interviews and he's back on the East then too for the holidays, and then I'll be abroad and back in New Haven for two months, and we haven't planned for much after that. Because we're moving around so much, the end of the move--what characterizes a move--isn't too tangible.

Among the things we share, this flexibility is one of the most valuable to me. Being on the road is special in how easy it is to go somewhere/anywhere. M is actively open and actively adventurous, which gives our experiences an added layer of newness and absorption, a layer that almost becomes the experience itself.

We've established a mini-life in San Francisco. Mini in the sense that we're just here for about a month, mini in the sense that our routine is dictated by our impulses and has the time-feel of a vacation. So even though this feels like settled-ness compared to essentially living in our car, it's not how we would "live" if we were settling down somewhere. Though it's not exactly vacation either, because we're not going out doing vacation things every day. We just do what sustains us on a daily basis: cook and clean, climb and swim(for me)/surf(for him), explore the city intermittently, bum around regularly, be silly with the cat and each other. So sometimes, even with the ability to move anywhere, the choice to stay still for a bit feels pretty liberating.

And so even though I can't really accurately describe to you what we're doing in a label--not quite moving, not quite traveling, not quite nothing--I can say that it's good, very good. And that feeling moves me most.

riding elements

Last week M took me the Long Beach Surf Contest, the first big contest to be held on the East Coast. Not knowing anything about surfing except for his love for it, I didn't anticipate too much. But it turned out to give on all levels--sensation, emotion, thought. If watching surfing for an entire day can do that for a girl who can't swim in the ocean, there's a reason for openness to the unfamiliar.

The first day rainy, the second day sunny, both at times uncomfortably so but mostly just enough to be steadily present. On the hot day I was without hat or sunglasses, and I felt like toast. Even though I'm almost black now, I'm glad for warmth so intense I could feel it under my skin. Watching the water for hours made it seem like a natural movie, and it's interesting to think of a natural place as a venue for something like that, a scene or an event or a narrative. There's the scene of the sky and sand changing character over the course of a day, the interaction between each surfer and water. It was amazing to see shifts in the environment, in temperature, cloud forms, tide coming in; to feel it happening to you and without any regard to you. It was amazing to see how well these people knew the water--how they adjusted for its curves and shapes and speed. And how as a result, there was crazy connection between person and water. I admire the desire and capacity to know something as dynamic, turbulent and feisty as water, especially having recently discovered how different a fluid world is versus a solid one. It changes pretty much everything, and in a way I see an exploration of it as an exploration of elements outside of yourself, that can become so deep that it's more yourself than the ground you were on before.

There is always more to say, and better ways of saying them, than I have ability and energy to write. But I wanted to put it down. Because though I don't have the expertise and experience to know and master the elements of air, water, and so on, I would like to be carried by them. And so, M & I are leaving for a long leisurely drive across country for new adventures in California.

therapy

In the past week I've pursued both physical and mental therapy, with the thought that it's good to be active and mindful of what I want, of what grounds me, and of what pushes me in positive ways. In medical school we're taught how to fix things, and M pointed out that healthcare is often seen as interventions when things have gone wrong. He noted how people don't think about how to optimize their health, even when nothing is concretely wrong. Since I want to go into primary care, with preventative care more appealing than acute care, I was struck by the thought that this is true, that even for people interested in keeping people from being sick, that a lot of care is focused on intervention and even maintenance, instead of active improvement.

I went to physical therapy today for my hip issues. While this seems like, and is, an intervention for a problem I'm having, the problem arose because of poor maintenance. The therapist told me that I have an upslip, which means that my hip has moved up compared to the rest of my pelvis. This can be caused by falls and trauma, or in my case, long history of high-impact motion without proper optimization of the muscles supporting this movement. My therapy will focus on getting the hip back into place, and then keeping it there by strengthening core and thigh muscles.

The therapist asked me what my goal for therapy was, which was a nice and important question to ask. My immediate response was to go back to running and to feel normal again. But as I learned about the exercises and thought about the 6-8 months of weekly sessions that he says it will take for me to achieve this, I realized that I've been desperate for this therapy not just to re-attain my baseline, but to have the potential to be better. Not necessarily just to run faster and longer, but also to learn the nuances of my body better, to pay more attention to those neglected muscles, to more finely tune movements, to learn new things and not feel limited--not even to just my prior baseline.

Recognizing that baseline can always be better was also what made me think about talking to someone about some of the qualities I sometimes feel trapped by. I had a moment recently where I was thinking so strongly that I should do one thing, but was swallowed by feelings that wouldn't let me do what I wanted. It was frustrating in a way I can't articulate. While I've tolerated that frustration in myself for a long time, seeing it visibly affect someone else made me think, I can try to change this. While generally adjustable to my environment and more than satisfied with the state of things, I've always had this tendency to slip into intractable moods that make me less the person I want to be. Because I appreciate the strength of responses--because this contributes to things I like and dislike about myself--it's been hard to target the negative while keeping the positive in tact. As rational and healthy as it sounds, it's hard to selectively control the intensity of emotions.

So I decided to try therapy for that too, which I have never done for anything. It's not something I've talked in-depth with anyone about, in large part because I find it really difficult to express. I think part of what I'm seeking in this process is developing more clear verbal expression of the abstractions I feel. And another part is to understand what this can do for someone. In the same way that physical therapy comes back to my life in medicine, one of my first thoughts about this is that I've recommended therapy to so many patients for such a wide range of things. So wide, that it seems to me that it's not so much a medical prescription as much as it is a natural need.

In that sense, the word "therapy" becomes more nuanced. When talking about receiving talk therapy, a classmate of mine asked, what does it mean when an intervention is something that's good for everyone? It becomes less a solution to a problem. It's not intervention, it's sustenance.

Even though it felt kind of crappy at first to feel like I'm a little mixed up--to have at twenty-seven years old the joints and moodiness of a menopausal woman--it actually mostly feels good to pursue active change. I feel lucky to still be at a stage to feel potential to do things differently, to not be stuck. And as someone who will be recommending therapy, now loosely defined as means of improvement, for my career, it's useful to be on this end of things. It makes me think that care comes not so much from distance between providers and their patients (the distance created by difference in medical knowledge and training) and this idea that one can fix the other, as much from the shared desire to live as well as we can.