lemongrass & plums

The best thing about my clinic months is having weekends. One of the best things about having weekends are the natural morning wake up, and time to make brunch at home. It makes me feel so much more human to make our own meals instead of relying on cafeterias and frozen goods. Lately I've been going to the Alemany farmer's market on Saturdays, and both the experience of shopping there and the experience of making food from what I get there make me incredibly, tangibly happy. Because it's cash only, I take $15 with me each time and buy necessities and indulgences until that runs out. And because it's one of the best deals in the city, for that amount on one occasion I bought three bushels of garlic, three limes, a box of strawberries, a bushel of chard, a bulb of fennel, a pound of okra, and (my indulgence for that day) a quarter pound of shiitake mushoom; and another occasion for about $8, four stalks of lemongrass, a bushel of kale, half pound of ginger, three of the best plums we've ever had, and two eggplants. And most of these are organic. Besides the price, I enjoy: 1) being outside and seeing the scents and textures and colors of non-processed, unpackaged raw foods. 2) trying new meals because of new things I buy. Made M a lemongrass coconut curry chicken and made myself bhindi okra 3) the incomparable sweetness of the fruit. M doesn't eat much fruit but when I gave him a plum he devoured it. I feel lucky that I can feel so lucky about the simple elements of food.

heartbeak

August was my last full month of inpatient medicine at SFGH, our county hospital and place I feel most at home in terms of work. I was lucky to average 80-90 hours a week, having a relatively lighter load of patients than some of my colleagues working at the same time, several of whom had a slew of many 12+ hour days in a row. In the end, I think no matter how well your body holds up against this unhealthy amount of work, your heart inevitably breaks when spending a month at the General. Not because you feel more than slightly less than human when you skip meals and sneak candy to fuel yourself and can’t sleep at night because you’re too wired from the day and wake up even earlier than the before-light time that you need to because you’re worried—this is all true. But when things happen to you, you feel like you can make sense of them (whether this is actually the case, who knows, but you feel like you can). When you see other lives un-crumple and re-crumple, you cling to edges and cut your fingers, and these seemingly slight wounds pretty much broke my heart. In that concomitant temporary it-will-be-over-once-the-month-is-over and permanent lingering what-do-I-do-with-this kind of way.

There is so much dichotomy that the pieces you break into are often in battle with one another. In these patients lies the kind of stubbornness that inspire extreme awe in the power of people to keep going, and extreme frustration in how things can continue in the same way for so long. Their situations are so fragile, yet their dispositions so resilient, that you scramble to figure out what it is that you’re trying to support.

I had to near-force one homeless man in his seventies with terminal cancer and without family to leave the hospital, to slowly bleed from his illness on the street, because he’d exhausted all of the options for a homeless patient. This was not wholeheartedly the result of a system that failed him—it was, as many providers who cared for him deeply and knew him well, also a result of his own self-damaging perseverance in remaining homeless over going to a hospice facility. I was told by other providers, deeply kind providers, to consider our resources: our hospital beds, our shelter beds, our rescue centers are scarce and he had consumed much of them already, and we had to use our resources they were meant to be used, not to bend to the will of a charmingly, frustratingly independent patient who selectively discarded rules. His actions may have been for the protection of his family, or for fear of dying, but many rational, reasonable justifications were clouded in unyielding decision-making that I could understand but never truly feel. When distressed, his face was all wrinkles, and through these creases, eyes closed, he said to me, “How can I go, like this?” All through the morning, I demanded, then begged, him to leave early so that he would have the best chance possible of attaining a shelter bed (the lines start early). I had worked hard the night before to ensure that everything was ready first thing in the morning. He refused and refused, until by the time he finally left it was likely too late for him to find any refuge for the night. I offered him again the option of hospice, and again he refused, yet he wanted to stay in the hospital, where he no longer met any criteria to stay, where I had already fudged a note to cover an additional night. Spinning in this cogwheel taught me helplessness.

But, not only did I see the same type of hospitalization he’d had many times before unravel during my time with him, I saw it come to an end. The day after we forced him to leave, he returned, and made his way to hospice. Even when he made this decision, he didn’t make the way easy. It took me almost an hour to place a tuberculosis test on his arm, a necessary procedure before he could go to hospice. All the while he pleaded with me to leave him alone. I guessed that he was scared, of needles and of the idea of needing to be tested and the sense of actively dying. I ask myself after all this, what was it that broke my heart? The human resilience that caused such damage, or the act of it eventually giving way to the world?

I could be ironic and say the latter. But then I think of the young man with crippling untreated HIV with a severe brain infection who, when I meet him, refuses to speak to us. His co-existing psychiatric illness, homelessness, past trauma, substance use, and only he knows what else, makes him distrusting of us, and child-like in his assessment of the world. To him everything is unfair, and I grapple every day between agreeing without interfering, and wanting to shake into him some recognition of what he could still gain despite all that has been taken from him. We spend two weeks with him, daily administering medication that will save his life temporarily and daily trying to gain his trust so that he can live beyond this acute infection. We make strides: one day as we speak to him about a procedure needed to reduce his symptoms and treat his infection, he refuses to answer any questions and the only words he speak are to say that he will hurt us if we continue in our attempts to do this procedure; a few days later, he apologizes for his behavior. After awhile he allows us to do things he’d initially refused, like drawing his blood for labwork daily. Our medical student spends hours getting to know him, contacting the few people in his life, communicating with other providers taking care of him, bringing him his favorite foods, and trying in all the ways any one person can to validate him. On morning rounds, I underscore her efforts—look at how much patience and endurance can achieve.

But two weeks, though long in terms of a hospitalization, is short in one’s life. Minor things still set him off and off the course we’d try to reset for him. We work incredibly hard to find a safe place for him to go after leaving the hospital, and manage to get him into Medical Respite, a place for homeless patients to go after being discharged where they could be housed and could continue to attain any necessary medical care for a brief time. We are hopeful that they can help re-engage him in care, get his medications started for his HIV, and possibly get him into housing, which he cites as the main source of his problems. This was actually the place that the previous patient had most wanted to go to, but who could no longer take him given the scarcity of resources and their need to take care of patients like this one, with an acute need for medications. For several days I prime this patient for going to Respite; he is enthusiastic; he asks questions about where it was and what the rules were.

On the morning he is scheduled to go there, I’m paged by the nurse as I have been many a time before for him (“Refusing medications. Wants to speak about it.” “Refusing labs. Please see him.” “Would like chips.”). This time: “Upset that he cannot find his shoes. Refuses to go to Respite.” The shoes he had come to the hospital wearing have been lost, and can’t be found in our pile of donations. This angers him so much that he no longer wants to go to Medical Respite. He lashes out, falls back into the distrust that holds him back into a child-like view of how things work (centered on him, yet against him). I find it hard to believe that he can’t see how much we care, and I’m desperate. I find myself doing crazy things like offering to purchase another pair, which I know is both unproductive and damaging. It takes a long talk to convince him to at the very least take his medications with him, and he walks away without his instructions, his appointments, or a goodbye. After all the daily battles in trying to keep him in tact despite himself, the blocks I’ve built up inside of me to do this job slide out of place and I lose my shape.

At the end of the day and end of the month, I place faith in self-malleability, and know that even if I never retain the same self after experiences like these, the pieces are there and are mine to arrange. And that power is what I think people would want most for others, and what underlies this revolving door of the hospital. As much as the entrance and exit look the same, I hope with everything that something lies between.

substance

Alcohol, cocaine and vitamins: the kind of mix seen in places like San Francisco, and in the course of a clinic day at the General Hospital. Over the course of a few hours, I see an alcoholic faced with the possibility of liver cancer; a recovering alcoholic who is so meticulous about his health that he has come up with every way possible to be medication-free; a woman asking for prescription pain medications which I can't give because last month her urine contained cocaine and this month she offers urine with a cool temperature giving away its falseness; and a woman with crippling headaches who has transitioned to an entirely yogurt-based diet with a variety of supplemental vitamins and herbs to help her pains. All this natural and unnatural (something I have to group because so often I can't tell what falls into one or the other) makes me think of the human body as more of a garden than as a laboratory. As I try to explain why I can't mix cocaine with oxycodone, this metaphor floods my brain and I think of all the plants I've killed (or let die?) in my life. In medicine we're not taught to reflect much on how we treat people like soup, throwing in spices here and there and adjusting to our taste. It's something that M has often brought to light, with his careful thoughts on how we carelessly alter physiology. Sometimes as I'm prescribing or not prescribing I realize this, and often when I'm speaking to patients about what they use I realize that we all do this to some degree. Patients are doing something to themselves with all of these substances, we are doing something to them with ours. And with what knowledge, what understanding of what soil is best? How do we even choose a soil when there's so much disagreement on what comprises growth? This isn't to say that everything is gray; I really don't want any of my patients using cocaine. At the same time, I hope I don't lose a sense of the substance that lies in what each person cultivates.

turning thirty

Turning thirty might be the ultimate challenge in ignoring society. On the one hand, you don't want to buy into the notion of getting old and not meeting certain milestones by being married with three babies by this time. On the other hand, you don't want to feel bad about not having a dirty thirty showing off how hot and young you still are. Like any girl (meaning someone who, on not an extreme but still tangible level, appreciates belonging and certain quintessential life experiences as defined by television and movies), it took some rationalizing to be comfortable with these things. To help settle comfortably into the new skin of thirty, I wanted to have a special day on my birthday, and thanks to M as well as to an amazing co-resident who helped cover me on the wards, I had the most perfect day.

We started by biking from the Ferry Building and Bay Bridge, along the Embarcadero, thorugh the Presidio and Crissy Field, over the Golden Gate Bridge to Sausalito. The day started out classicly San Francisco: gray and foggy, and we stopped in the Presidio to capture the iconic image of our city. As we started to bike over the bridge, the skies cleared and made the waters more blue, and soft sun brightened our path. This trek was somewhat stressful for me, since I'm still not great at navigating on a bike--I fell off after trying to stop at the top of a hill, made another biker stop because I didn't veer to the side quickly enough, and still have trouble getting back on after stopping at a crosswalk. But it was a good balance of effort and ease, and I felt grateful for thighs that could get me up steep hills and for desensitizing to fast steep down hills, and I felt good about doing something that scared me on a day that kind of scared me. I also love doing things as weather changes. I loved this about Kilimanjaro, that we progressed from tropical humidity on the first day to freezing snow on the last. I loved this about the skies in Arizona, where one half was shrouded in thick gray and other half was bright sun, and watching as one stretched into the other. It gives this heavy sense of story, and I'm so thankful for being able to feel so much narrative in the space of hours, a day, a mountain.

As we biked into Sausalito, water opening up by the road stopped my breath. It's such a good feeling to see water ahead and beside you all of the sudden, and it was a beautiful clear blue water rimmed by hills formed from trees and homes. We got sandwiches from a local deli and ate on a bench outside; I had avocado and brie on Dutch Crunch, and we shared a stuffed egg that is like a more full deviled egg. We talked about the quiet peace of Sausalito, finished our lunch, and got back onto the bikes to make our way to sea kayaking.

We had talked about trying out stand up paddle boarding, but it was extremely windy and the people renting boards didn't recommend trying it in the open water. So we rented two single kayaks, and in the theme of clumsy direction I ran myself into a big boat before I got used to steering, again something I took to be positive on this day--continuing things that feel unwieldy at first. I love kayaking because of how close you are to the water, how light it feels, and how the view changes so much from the surface of the water. We saw dozens of seals lazying about, house boats, and absorbed the beauty of the hills above us. On the way back, we kayaked against wind and at one point it was so strong that I was paddling like mad just to stay still. I was proud of staying the course, and felt the energy from all the nature circulating in my limbs.

We then tried stand up paddle boarding for a little bit, just in the small cove before the water opened up. I asked them several times whether we should wear something protective in case we fell, and they kept assuring us that it was very uncommon to fall. To me it seemed so likely--we were standing on water, after all. But I guess having a board in between makes a huge difference, because they were right and I felt very stable standing up, which was a very cool feeling. Of course the wind and current promptly carried me into a corner where I got stuck for several minutes before I was able to maneuver my way out. This was pretty embarrassing, but given the goal to increase self-comfort, it presented a good challenge.

We recovered from the day's activities with a luxurious dinner at Sushi Ran. The black cod was probably one of the top ten most delicious things I've ever eaten. The texture was incredibly smooth and buttery, and the seasoning was savory in that way that magnifies with the seconds the taste rests on your tongue, and then lingers as it leaves. We celebrated with hot and cold sake, and especially then I appreciated how pure and natural sake tastes compared to other alcohol. By the time we were biking to the ferry to go home, I was more than full with the senses of the day. We had some time to wait for the ferry, and as we sat watching the waves I felt the layers of the day settle by their weight, like sediment. The lightness of kayaking and biking floating on top, the weight of the physical activity and battling wind and hills grounding the bottom; the lightness of a relaxing meal laced with umami and alcohol wafting at the top, the weight of the food in my stomach and diffusing its way through my body anchoring the bottom.

I tried to let this all sink and lay where it might as we traveled on the ferry back to San Francisco, with the softening sun creating an awesome sky over the water, behind us as we rode forward to the port and skyline. It was honestly so gorgeous that I couldn't believe this is where we live and that this wasn't a faraway trip part of a vacation but just a day off, just a birthday in my home. I felt so incredibly grateful.

We completed the day by soaking our muscles in the hot tub at my brother's apartment complex, which is something we do often on other days but felt especially like a treat on this day where I faced new adventures. Thinking back, it really was a perfect day that combined so much of what I love in my life: nature, food, movement, new things, and experiencing it with M. In this one day I found my sought-after comfort with this upcoming year--a sense that when so much has already been given, everything else is just more.

shotgun lovesongs

On the plane ride from California to New York, I read Shotgun Lovesongs by Nickolas Butler, a beautiful compact novella that takes place in Wisconsin. It's narrated in turn by five friends who grew up in a small rural town together, one of whom is very loosely based on Justin Vernon, lead singer of Bon Iver. I loved the book in part for this, and for the description of Bon Iver's music, which is very near and close to my heart. The writer of Shotgun Lovesongs went to high school with Justin Vernon, but hasn't spoken to him in twenty years and what's told in the book is not based on their actual friendship. But he writes about Bon Iver's music as if from Justin Vernon's perspective, and it touched me to think that this is actually speculation based on what Butler feels from his music. Listening to Bon Iver's music, Butler weaved it into the fibers of his own narrative and thoughts--I was blown away by the power of one person's art on another. And it fills that gap you don't realize is there until someone else resonates with something in the same way that you do. He writes about the sounds and sentiments of this music in a way that encapsulates how it makes me feel. You always think your personal responses to something are so personal, want to feel they are unique to you. And sometimes you want to keep it that way, but I think the best art is the kind that's strengthened when shared, and that's how I felt reading someone else's interpretation of this music that I really feel is a part of me.

The book itself felt much like this music. When I acquired my very first iPod, I was obsessed with playlists and added all of my favorite songs to different themed playlist. My all-time favorite songs always ended up in the "winter" playlist. Those were the ones that embodied that sort of cold warm ache that, during that period of my life when I'd moved to the East Coast, I could finally attach to the tangible experience of an actual snow and ice winter. This book also felt like winter. It loves wide expanses of space, and also understands how within that people draw close. And what can happen as a result. Stories about simple lives really show how much can be held in the rawness of people, that it doesn't take much other than the daily act of trying to survive and co-exist together to reveal the depth of what we can feel.

Part of the book talks about Justin Vernon's character becoming rich and famous, and moving to New York after marrying a beautiful actress. He returns after their divorce, and spends a lot of time writing songs about Wisconsin and talking about the difference between the two places.

I'm always excited to come to New York, the city I've visited likely almost a hundred times by this point but have never lived in. Excited to see my friends who feel so far when I'm back west, and excited to have new experiences because every visit here is so different. From the Cloisters in the winter, to waterfalls in Central Park in the spring, to running in Prospect Park and biking along the Hudson all the way to the Brooklyn Bridge in the summer--I've been lucky to have so many bites of life here.

I also forget until I arrive, the chaos and noise of this huge place. Staying in my friends' apartments I hear and feel trains, parties, and cars. It takes an hour to get from one end of the airport to the other. The highway signs are designed to confuse more than clarify. There are tons of cars on the road at 10 PM on a Sunday. I step out from the house into busy streets lined with shops, surprised to suddenly be hit with a community having been in private space one second ago. I do love that there are fruit stands open at all hours, and that within a few blocks of this apartment there are a dozen small markets where I can buy food to make fresh lunches, and that there's so much within walking distance. But it is a jarring contrast to the quiet, intimate space of my book and its images of rural Wisconsin.

I've always been too defensive when becoming labeled as anything general, and I think part of that comes from feeling like so much of me and of any person lies in different places. I'm really not sure if I'm a small town or a big city person; sometimes I feel adaptable to the point of not having an identity. I think that the most important thing is to be able to come back to yourself wherever you end up because it's as easy to get lost in the emptiness of Wisconsin as it is in crowds of New York.

thirty

So a lot of people write about things they'd like to accomplish before turning thirty, and I love reading about what people choose and what they do. In the immediate years preceding my turning thirty, I focused mainly on maintaining some semblance of a life, so my goals were not more ambitious than eating and sleeping normally when at all possible. I didn't even think about making a bucket list, and after my birthday passed I regretted this a little bit. But on my birthday, which was an amazing and perfect day of nature, adventure and food that I hope to write about soon, M reminded me of how much experience I've been lucky to have in my thirty years even without predefined thirty-before-thirty goals. Here are the thirty things I am most grateful for in my thirty years--some are concrete experiences, but most reflect what these experiences have broadly given me:

1. Taking five cross-country drives and seeing completely different parts of the country in completely different ways

2. Growing up with four older brothers and being cherished and nurtured

3. Spending my twenties on the east coast and exploring every state in New England

4. Falling in love at different periods of my life, and being with M during a time when I can absorb, become better and stronger from his presence and care, and try to offer him the same.

5. Living in our Chapel Street apartment in New Haven and being a second home and haven, late night kitchen, spare couch and bed, hosts of potlucks and parties, for our friends and classmates

6. Being Vietnamese and having parents with lives remote from mine and an intangible history to draw upon

7. The lifelong opportunities value the wonders of language and thought processes through reading books, and writing, from this blog and what it's intermittently recorded, to long email exchanges, to journaling, to essays

8. The hard and beautiful hikes that time, health, companions and resources have enabled me to do: Mount Washington, Kilimanjaro, the Lost Coast

9. Mark teaching me to bike and swim, and discovering childhood pleasures and mistakes as an adult

10. Having clinic at San Francisco General where an afternoon of patients transports me to a dozen different realities

11. Discovering the pleasure in composing a photograph, having a versatile camera, and sharing images

12. Experiencing music in that way where it sinks into you and doesn't leave, with people who feel it too, when seeing live Damien Rice, Iron & Wine, and the National

13. Being exposed to a wide range of foods and feeling the immediate nuanced pleasures of an indulgent meal, the warmth of meals cooked together, and the daily regular effects of a healthy diet

14. Knowing so many people whose kindness, rawness, openness, flaws, and thought continue to amaze me after years of knowing them, and being so lucky to have their lives fit mine

15. Reading Haruki Murakami, and how much that can mean

16. Completing p90x and realizing how good it can feel to be strong and how that can change so much about your life

17. Camping and the feelings of how living minimally is living fully

18. Going to medical school in a place that gave me the time and space to reflect and grow

19. Living in San Francisco for residency

20. Rock climbing and the strength, pure pleasure, and ambition the activity provides; and the perspectives that it offers, from sprawling views of Durango Colorado to falling from rocks to sandy shores along the California Coast

21. Many, many trips to NYC, where every time feels like an amazing vacation because of the many close friends and because I always experience something different from the time before, from day trips to week long ventures

22. Going on spring breaks with groups (Las Vegas and Puerto Rico) where the combination of freedom, carefreeness, and warmth lend closeness and openness

23. Witnessing so many definitive moments in other people's lives: birth, surgery, illness, death

24. Being able to speak at length with people at the end of their lives, and hear what it was feels like to have your physicality slip from you, and hearing from those people who much it means to share this

25. The disinhibition, laughter and warmth that comes with being altered with those closest to you

26. The pain of choices, choices that though are objectively poor ones, are also the most defining, deeply felt and sincere. This of course refers to romance and all its forms.

27. Being thin, tan, and healthy, and the ability to feel comfortable and capable in this body

28. Having flaws that are real flaws, not just the kind that can be positive, that present continual challenges and a reminder that every honest self-narrative is a spectrum of qualities, desires and limitations

29. Being humbled by Harvard and learning what it means to go there and also what it doesn't mean

30. Living life with M, linked in all ways from daily routine to adventuring, and discovering how much is heightened when shared.

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.