Tuesday, April 4, 2017

Snow in April in New Hampshire

It's not spring in Boston until the Red Sox home opener. Yesterday, Tom Brady threw the first pitch, and it's time for the good people of Boston to retire their Pats beanies until the autumn. Of course it was Tom Brady.


Our class had planned a trip to a cabin in New Hampshire for this past weekend. Forecasts originally declared mild springtime weather, which then changed to snow to the tune of 12-18" in the north. Well, snow did fall on Boston, but never stuck around. New Hampshire, however, was not spared. Out were the plans for a nice spring hike, and in were plans for skiing, snowshoeing, and sledding.


As usual, I have a lot of photos I wanted to share, but not a substantial amount of content to go with it. Instead, I'll do as I have done before and include an assortment of thoughts that I've had lately.


School

I'm having more difficulty with medical school this semester than last semester. I'm not entirely sure why, but I'm working harder and trying to figure out how to improve. On the clinical front, I'm more comfortable interviewing patients and just being in the hospital or in clinic.

I also recently shadowed OB/Gyn on their Labor & Delivery service and saw two births. I think I may enjoy OB/Gyn, but I wonder if that's only because I saw a C-section.


Research

I applied for a grant and I hope I get it. For the application, I had to update my CV, which had been untouched since I applied to medical school. Well, I went trawling through conference program books for all my college contributions and found that my lab in college had "posthumously" presented my project. I was given second authorship, which is the highest I've been yet, but...

...it isn't fair. I had sent my lab emails two months ago asking if anyone had taken up my personal project, and got a resounding NO, that they had abandoned it and that I need not follow up. Now I see they've published it, used my code without my permission for very similar project, and expected me not to notice.

I talked to one of the medical school faculty about it. I should be happy to be able to add things to my CV, but that project was my personal project, and that lab was my home away from home.


Winter

I still get excited for snow. I feel like I got a bit cheated out of my first true winter, but seeing all the snow in New Hampshire that Boston was spared of was very gratifying.


Raw denim, a 3 month update

Remember awhile ago I mentioned I bought my first pair of raw denim jeans? I'm still wearing them, and I'm still...not washing them. The fades are slow to come, the fabric is still stiff, and the men's fit is not very flattering, but I still like them quite a lot. I hang them up and freeze them from time to time. I wear them almost daily, and found that they are warm enough for almost any time and place I am. I should take progress pictures, but I'm simply too lazy.


Blogging

I've recently become disenchanted with some blogs that I used to enjoy, and have found it hard to either stop reading them, or find new ones to read. I doubt any of them read my blog here. Sometimes it's camping on the moral high ground. Sometimes it's sneering at the other girls, the other bloggers. Sometimes the writing is a sermon filled with errors in spelling and grammar and word choice about the vapidity of other bloggers. Sometimes the comment section is an echo chamber. Sometimes they are just mediocre when before, they were a revelation.


Snowshoeing

I would gladly snowshoe again. Next time, I'll look for a longer hike and maybe go off-trail. As snowy as my photos look, there was no wind: a very peaceful snowfall at least until the trees dumped what they collected on their boughs right onto my head.

Snowshoe ownership, even if they are cheap ones, is now a goal of mine.


Friends

I'm still friends with the same people since early in medical school and we're getting closer. What surprised me on this trip was that I'm getting better at taking opportunities to socialize and bond, and that I'm getting better at finding common ground and having fun. In the beginning, I felt like my classmates were unapproachable and unfriendly, but that doesn't seem to be the case at all.


New Hampshire

I've been on a few road trips since medical school began and the little magic of the New England countryside has still not gone. Lots of picture-perfect little towns, ponds, covered bridges, reeds, woods come straight out of a Norman Rockwell painting. The vastness of the American West of my childhood road trips seem completely alien. I sometimes imagine that I could live in rural New England...

...we find a supermarket and do our shopping. I am suddenly aware of the fact that we are likely the only Asians for at least...I'm not sure, but there are definitely no other people of color in the supermarket. The people are friendly and kind, and the cashier asks me where we've come from.

"Boston," I say. That's far, she says.

She welcomes us to New Hampshire. Every time I visit, I wonder a little more if I could call New England home.


Sunday, March 19, 2017

S/S 2017 | Wardrobe Planning

It's a bit odd to think about spring and summer when there's active snowfall and literal piles of snow and ice from a recent blizzard, but it's about time to think about what I'll be buying for the next few months.

In reality, this post was prompted by a recent shopping trip. I wanted to buy a shirt from Uniqlo, went into Uniqlo, and walked out with that shirt and a dress I hadn't planned for. It is a charcoal grey ponte dress with a flare skirt that is appropriate for clinic and any event where I need to look sharp. But still, it was an impulse purchase.

Summer in Boston is hotter and more humid than summer in the Bay Area. Basically, I am looking for linen garments. Read on for more information.
All from Pinterest, sources spotty. The black one is from Ovate




  1. A linen dress, or two - I prefer dresses for warm weather. It's easy to look good and feel comfortable in a dress. It's a single, simple garment. I tried on some linen dresses last summer and loved the texture and the way the fabric moved. For truly sweltering days, I can only really stand to wear dresses. Here is a collection of dresses I've found on Pinterest, but really, the quest for the perfect linen dress is difficult because (1) there aren't many linen dresses for sale and (2) I am fairly picky when it comes to dresses
  2. Dark red high-neck t-shirt, Uniqlo - I like this color on me and bought this to replace the dark red t-shirt I've demoted to workout gear and the unattainable Red Polo shirt of my youth. I liked the look of the charcoal grey and the light blue versions, but the former was out of stock and the latter looked nice, but I am still afraid of light colors
  3. Dark blue sleeveless linen shirt, Uniqlo - I wanted to get one of these last summer, but was unsure about all the bright colors. Maybe this year will be the year
  4. Drawstring shorts, preferably linen - I bought a pair of black linen shorts last summer and they served me well. I wore them maybe a bit too often so another pair seems like a good
  5. Other - already bought the charcoal ponte dress from Uniqlo; I thought about getting a lightweight jacket for spring, but realized that I will probably just end up wearing my autumn outwear or knits; also, I'll probably need to get some thin no-show socks as well. 
I've been wondering a lot lately about ethical consumption and how my own consumption fits in. I mentioned Uniqlo quite a bit in this post -- I've written a bit about the evils of fast fashion, and yet the majority of my clothes come from Uniqlo and other fast fashion-type companies with questionable ethical code and ecological impact. I tell myself that I actually don't consume a lot, and find reasons for the things that I buy.

At the end of it, I think I have reasonable clothing consumption habits, with plenty of room to improve. 

Thursday, March 16, 2017

More thoughts on diary writing


Here is my second post about diary writing. The first one can be found here and concerns the practicality of the habit -- how I do it, with what, and how often.

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I knew that this second post was going to be a bit more abstract than the first so I'm not too sure about the format. Thus, a looser structure is indicated.

Reasons why I write in a diary

I touched briefly on why I began writing, but not why I continued to write, and why I will continue to write every day, once a day, ad infinitum. To be honest, I don't have a concrete answer. It's become habit at this point where I feel discomfort in forgetting to write or not writing adequately. Writing at the end of the night unburdens me from the thoughts I've had that day. It's a conveniently private outlet for the daily stresses and emotions, which I feel could otherwise build up to unhealthy levels. At a more basic level, I write every day because memory is unreliable and writing things down helps me keep them.

I also like my penmanship, and use my diaries as a way to indulge myself there. I also recently bought a fountain pen and ink.

It's not journaling

And I get a bit defensive about that, in real life when people find out about this practice and internally when I see blog posts, YouTube videos, think-pieces, Pinterest posts, etc about journaling. It's a bit of an irrational aversion to the term, but I know that others may see these posts here and code my diary writing as journaling.

To me, journaling suggests deeper emotional content and creativity. A lot of journaling fads I've seen on the internet seem juvenile and hokey, but that's just me being judgmental about things that don't concern me.

If anything, I downplay my emotions in my diary and contrive to keep my entries restrained and cold. I can easily dissect my thoughts and emotions on paper, but seldom let emotions themselves guide my writing. Long story short, I still think I have issues expressing myself and being vulnerable in my diary, but that I really could benefit from taking the 'journaling' road of emotional catharsis. But then again, I do get some kind of catharsis after writing.

It's not meditation, either

Until I think about it.

I'm not really a follower of mindfulness or meditation or any number of techniques and products and self-help media that will help me achieve them. However, once I peel back the pretty social media influencer veneer, I see its value. I really think that setting time aside in the day to be alone with your own thoughts is important. Quiet time for reflection and self-awareness, protected time where self-centeredness and selfishness are mandatory.

For some people, meditation is the way to do this. For me, I need to write it down.

How has it helped me?

I don't know exactly. I have been writing in my diary since I was a teenager and don't know any other way of life. Writing about anger and interpersonal issues helps me prevent arguments and confrontations -- by the way, my cardinal sin of choice is, and has always been wrath. I think I'm a more even-keeled and disciplined person for it, but I have no way of telling that.

However, one thing I do know for certain is that daily diary entries help me identify my personality traits and flaws. I know myself fairly well. It's all written there.

I'm not enlightened

That goes without saying. However, I think that people may erroneously think that writing about yourself will make you a better person. I believe that I would not know myself as well or be as comfortable with self-criticism (or take self-criticism too harshly) if I didn't write in my diary, but I don't know if that has had led to distinct changes in my behavior or personality.

The Lord of Three Realms

The blog and the diary fill different niches and serve different purposes. The blog is a more longitudinal view of myself and my interests and was created explicitly to help me become a better, more advanced version of myself. The Lord of Three Realms as an imaginary entity lives at the end of the staircase of self-improvement. LL versions I through XIV may be distinct and show growth, but the daily variations in the writer are too small to appreciate or care about.

The next post

Let's talk about you instead

Friday, March 3, 2017

Preliminary thoughts on West Coast v. East Coast skiing

This title is a lie: I went skiing once last season at Heavenly in Lake Tahoe and once this season at Killington in Vermont. I had gone skiing a few times in my youth, but not nearly enough to have any authority on the sport. However, I like skiing, want to go more often, and have some thoughts on my different experiences at these two sites, and photos to share.

Beware! Garish colors ahead. I was evidently very heavy-handed with VSCO last year. I promise that the real blue of Lake Tahoe looks astonishingly vibrant in person.

Lake Tahoe, California and Nevada

Last year, I went on a week-long trip with some college friends to Lake Tahoe, northern California's favorite retreat for mountain time. The trip was a lot more than just skiing, with lots of bonding time and board games and such, but I spent three days skiing and want to return. My best friend's family lives in South Lake Tahoe, and a trip to their cabin after high school graduation (and numerous short trips to the Sierra Nevada in my life) made me realize that there are no mountains more like "home" to me.

Lake Tahoe itself

The thing about Lake Tahoe is that it is a massive freshwater lake and shining emblem of the American West in and of itself. Though I've shown its frozen shore, it is blue beyond imagination all seasons of the year and a natural draw for locals and tourists.

Hanging around at the frozen shore

Lake Tahoe sits at 6225 ft above sea level in the Sierra Nevada along the California-Nevada border. An essential part of my Lake Tahoe experience is altitude sickness -- childhood asthma, low O2 saturation confirmed by medical school -- shortness of breath, tightness in the chest, light-headedness. Oh yes, and nosebleeds.


Lake Tahoe is generally pretty dry, and not too cold, as my friends in t-shirts indicate. Though this year gave California far too much precipitation, the recent drought forced Tahoe ski resorts to use man-made snow on the slopes.

Looking towards Nevada

Heavenly is a huge resort. It's expensive, it's expansive, and it straddles the border. I started on the bunny slopes on the Nevada side, played around on the blue intermediate slopes, then took the trails to get to the California side.

Looking towards California out of a dirty gondola window

Heavenly base camp sits at 6255 ft above sea level, which is plenty high for me. I reliably get some shade of altitude sickness in Lake Tahoe, which for me presents as an intense, crushing pressure on my chest, difficulty breathing, light-headedness, and misery.

Pygmy trees! And Lake Tahoe, of course

I challenged myself to take the Sky Express lift to the summit at 10040 ft above sea level. The summit left me literally and figuratively breathless, and that peak, with its variety of very long intermediate runs, remains my favorite.

This place is beautiful

Right turn off the lift to get to California; left turn to get to Nevada. The altitude hit me the hardest on an agonizing flat stretch at >10k ft, which I unfortunately needed to suffer through to get back to my friends on the Nevada side.

Weird colors, but I had to play around with editing because the sunset was kind of strange

My friend below in the orange said that one of his first indulgent purchases after entering the workforce (engineering in Silicon Valley) will be a season pass to Heavenly. That won't be realistic for me, but it's a nice dream to keep in mind.

Unlike some of the snow on the slopes, this is the real deal

Killington, Vermont


Okay. I really liked Killington, but not as much as Heavenly. In short, the great thing about Killington is that the summit of its highest mountain, Killington Peak, is 4241 ft, substantially lower than Heavenly base camp at 6255 ft. I had no altitude effect and could happily ski the day away without thinking about how difficult it was to breathe.

It's cold in Vermont

The other thing about Killington is that the snow is all real, the wind is vicious, and the cold is unlike anything I've ever experienced.

The same snowboarder got in the way of both my photos so I had to do some suspicious copypasta to get rid of him

However, I thoroughly enjoyed the mountain, especially since there was fresh powder from a storm the night before. I also felt like I could get more out of the day because I wasn't having any trouble with the altitude and could breathe comfortably.

At the summit of Killington Peak

As fun as Killington was, it was substantially more crowded than I remembered Heavenly to be.



In short, the tough thing about Killington was how cold it was. My phone stopped working because I kept it in a very superficial pocket, but at the hotel, it claimed a high of 12 F and a low of -1 F, not even considering windchill.

A pretty trivial difference: there are no deciduous trees to be found in Heavenly. The transition between evergreen to barren deciduous trees was a good indicator of how far down the mountain I had gone.

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All in all, this was a fairly brainless post to write, but I had fun skiing this year and last, saw beautiful mountains, took pictures, and my frost-nipped fingers suffered too much not to put them on the internet.

Saturday, February 18, 2017

Scenes from a blizzard in Boston

Weather report: we've had a mild winter. Most days from December until now have hovered in the high 20s-low 40s F range, with several days of rain, sleet, and snow. Last week, we had a blizzard that really showed me what New England is capable of -- the snow from that Thursday is still hanging around.

I guess the point of this post is to share some pictures I took from a foolhardy trek from school to the Charles River during this very blizzard, but also to share a few thoughts that have stuck with me recently. Read on for thoughts on winter gear and medicine so far.


Winter

All season, I've been waiting for the perfect time to photograph our charming campus under snowfall, but this was not what I expected. This particular day was not terribly cold, but windy, which can be worse. The only way to navigate this kind of weather successfully is with ski goggles, wool socks, base layers, and snow boots.

We walked about two miles in total to the river and back, buffeted by wind and taking pictures along the way. The pain of revascularizing frost-nipped fingers is no joke! We helped push a car that got stuck, which was pretty fun.

Oh, yes. The Sunday before was Super Bowl Sunday, and later that week (and before the blizzard), Tom Brady took to social media to proclaim a day of rest in Boston. Well, Mayor Marty Walsh declared a snow emergency when it became clear that this nor'easter was going to be a rough one, all the public schools closed, and finally on the morning of, our classes were cancelled as well.

I shadowed orthopedics call on the Saturday after the blizzard and got some startling facts: on the very icy blizzard-eve (Wednesday), there were 70 ortho consults from the emergency department for ice-related injuries. While I was there, we saw five patients with fractures (four related to ice, one related to ice hockey).


School and research

After a disastrous exam in January, things are looking up. I did very well on my last set of exams, but my academic counselor warned me not to be complacent, but also not to take on too many other things. Those other things are research things, and after a stumble regarding authorship order on an abstract I wrote, I think things are looking up. I will be continuing my project through this summer, working on a manuscript and another conference abstract, and starting two other projects with the same attending surgeon. Research and research acquisition are still mysteries to me, and I fully recognize that I got what I have by emailing the right person at the right time, and by leveling up in "networking" and playing a game whose rules I'm just learning. And, of course, the importance of a paper trail.

I'm pretty lucky to have a mentor who has my back and introduces me favorably to faculty. My next steps are to get funding for the summer, work on the manuscript, and crunch more numbers.


A good surgeon

We have begun our second semester of our clinical medicine class, which now places us under individual mentorship of a doctor affiliated with the school. My preceptor is exactly the kind of surgeon I hope to become, and though I have been practicing my physical exam skills at his clinic, the true value of my time there is in watching him and learning how he interacts with patients.

His patients trust and like him, for one. For those who have been his patients for a long time, he remembers their kids' names and asks how the spouses are doing. When a patient is self-deprecating or despairing, he knows what to say to make them smile. He was able to recognize far before I could that a new patient with many tics and anxieties and worries was not a "difficult" patient, but one with a long history of physical abuse that he needed to (and successfully) gained the trust of. He knew what to say to a family whose patriarch was going to die. He only speaks English, but knows just enough phrases in Spanish or French to make patients laugh. He sketches out surgeries and knows what questions patients have but won't outright ask.

To be fair, I think a lot of his demeanor has to do with the fact that he is older, white, tall, wears a sharp suit to clinic, and looks like a politician. But I've learned a lot so far and know that he is exactly the kind of doctor I want to be.

And, of course, he makes me want to be a surgeon.


Strong women

Earlier this week, we had a dinner panel talk with several female doctors, mostly surgeons. It's too much to describe, but the energy was great, the speakers were all engaging and hilarious, and I felt very empowered. The night eventually became a call to arms for women supporting women in surgery, fighting the patriarchy, and becoming good doctors.

Anyhow, this is something one of the speakers, our favorite trauma surgeon said:
Keep fighting the fight. Fight it in yourself. Fight it in others. Fight it any place you can. Fight it in every place you can.
 Will do.


Dr. Samuel Shem

Consider me starstruck -- Samuel Shem came to speak at surgical grand rounds! The lecture was open to medical students as well and I got there early to make sure I got a seat.

Samuel Shem is the pen name of Dr. Stephen Bergman, the author of The House of God, which has provoked discussion and reflection within medicine for almost thirty years. Though considered satire, The House of God revealed the mistreatment and hardship that medical residents saw in training, and is practically required reading for medical students and interns.

It's rare that I get to hear the author's opinions on their own work. But really, this talk was about a great many things, with an overarching theme of retaining humanity in medicine. A few pearls from the talk:
  • The House of God is about:
    • the fight against injustice
    • the danger of isolation
    • the healing power of good connections
  • medicine is a hierarchy and the group in power is not doctors, but insurance executives and corporations
    • medical students are at the bottom of this hierarchy, but have strength in numbers
  • the only threat to the group in power in a hierarchy is the quality of connections of the subordinate group
  • the only sustainable model of health care delivery in a large, industrialized country is a national health care plan; a private market can only work if it is highly, highly regulated
  • relate to patients as people
  • the best thing about the Trump presidency is the incredible grassroots resistance against it
This was an exceedingly long post, but I had a lot on my mind

My friends demonstrating the depth of snow. It looks like they're holding hands, but I assure you they aren't

Tuesday, February 7, 2017

Assorted thoughts on diary writing

Volumes I to XIII, autumn 2007 to present

I write a daily diary. This is the first in a three-part series about diary writing.

After reading the Diary of Anne Frank at an early age, I thought it would be important to chronicle my life. In fifth grade, our teacher required each of us to keep a writer's notebook, and I distinctly remember one little proto-diary with a blue and brown cover. In it lives my larval political outrage at Bush v. Kerry 2004, a detailed account of a roadtrip to Yellowstone National Park and the wildlife I saw, and my goals for my Pokemon Sapphire progress.

Sometime around that, I received the volume with the blue cats on the cover for a birthday and abandoned my old notebook for it. I abandoned that one, too, when daily writing became a bore. I rediscovered the cat diary sometime in college, where it fell in line as Vol. VIII of my archived life. The first fifteen pages contain the imaginations and ramblings of a ten year-old who hated school, and the rest contains the long-winded agonies of a nineteen year-old studying for the MCAT. The last page contains my score.

I began writing in earnest in August 2007, and then daily in August 2008 at the start of high school. Every day has an entry, whether it was written before midnight, after midnight, the morning after, or in pieces over the subsequent week.

Materials and Methods

I am very fond of beautiful notebooks. Many of the more recent volumes have come from Paperblanks, which have beautiful covers, luxurious paper, and a shocking sticker price. However, it is important to me that these volumes last long, lay flat, and are a delight to write in. Hence, I can justify throwing money at expensive stationery, and am seriously considering buying a fountain pen for the next volume. I currently use any number of pens around my desk to write, but reserve my favorite pens for diary writing.

I write mostly about what happened to me on any given day, anything at all. I don't follow prompts and I don't describe this process as 'journalling,' which is becoming more popular nowadays. I have poured out my heart before, but have also written in exhaustive detail everything I could remember from surgeries that I have shadowed, complete with sketches. During gross anatomy, my entries read more like a dissection manual than anything else; when I was in Germany, it was an itinerary with as much sensory details I could fit in. Memorable patients, memorable places, etc. It varies. I could be more reflective, emotional, and introspective, but those entries are not common.

Rules and Rituals

Over the years, some rules and rituals have emerged. Exceptions are noted if ever applicable.
  • write in pen only
  • begin each entry with the date
  • end each entry with a signature
  • write at night immediately before going to bed, but fill in details the morning after in case I missed something (rarely) -- only under very specific circumstances will I revisit an entry after a day
  • if I am currently writing Vol. n, I am not allowed to read from Vol. n - 1 until I finish Vol. n
  • at the end of Vol. n, I write a postcard to myself to read when I begin writing Vol. n + 7. This began with the end of Vol. VIII
  • include ephemera (ticket stubs, stickers, etc) if they are important or beautiful
  • write legibly, but try not to waste space
  • note the Vol. number on the front page
  • copy a meaningful poem or quote on the back page
  • be HIPAA compliant
  • one entry each day, every day, ad infinitum
Next time: what I have learned from writing a diary, why you may want to consider it yourself, and how it has affected me

Sunday, January 22, 2017

Let the hero born of woman crush the serpent with her heel

Boston Common - cow pasture, witch hanging site, public park, and gathering space since 1634

This Saturday, I exercised my First Amendment rights to freedom of assembly with around 125k others in the Boston Women's March for America. Boston Common was a confluent mass of women and their allies, of all ages and races, with many signs and clever slogans that summarized the tangled mess of thoughts I had one day after the inauguration.

It was an uplifting day, being among the masses of like-minded people who recognize that the rights of women, people of color, Muslims, LGBTQ+ folks, people with disabilities, immigrants, the poor, the marginalized, etc are in peril. I saw Senator Elizabeth Warren, Massachusetts Attorney General Maura Healey, and other women leaders and activists speak. Now more than ever, I know that solidarity and allyship must be key pieces of my role as a citizen, a voter, a peer, and a future doctor.

Some students from my school marched under our school's official banner with white coats on -- our school, even among other medical schools, leans progressive and likes having official presence at events like these. However, I arrived too late to find them and instead marched with one of my friends from college. More eloquent peers and activists and journalists have covered the Women's March, but I'll throw in the last of my two cents here:

This was an exceptionally peaceful, organized demonstration. "Respectability" is a loaded word when it comes to public, highly visible forms of civil expression. "Civil disobedience" and "peaceful protest" do not apply to this march, which, given the sheer numbers of people involved, is probably for the best.

The overwhelming amount of pink pussyhats and images of genitalia made a strong statement about the vulnerability of reproductive rights, but also, an uncomfortable definition of women's rights as the rights of cisgender women. And while this conflation of pink and XX chromosomes and womanhood and feminism did its job to mobilize millions of marchers worldwide, deeper intersectionality is needed if this movement is to move forward.

Intersectional feminism is for everyone. I need to practice it more visibly and more productively from now on. For all my critical thoughts about the march, I am glad that it happened at the scale that it did, I am glad to have participated, and I am proud to be an American.

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This title of the post preceded the post itself. It is a slightly modified lyric from the Battle Hymn of the Republic, one of my favorite patriotic songs. It was written during the Civil War by Julia Ward Howe, an abolitionist, feminist, suffragist, and Bostonian.

My favorite recording of the Battle Hymn of the Republic is by Odetta. There is no comparison.

Very notably, it was sung by the Brooklyn Tabernacle Choir during President Obama's second inauguration. It was also sung at Donald's pre-inauguration, but the GOP still refers to itself as the party of Abraham Lincoln, so there's that.