Half measures: minimalism game 1-15

The Minimalism Game is likely new information for absolutely nobody, but the spirit of it is to get rid of (give away, donate, recycle, trash) n items for n = 1:15 consecutive days. I participated because though I think I have been pretty good about keeping my consumption in check, I do have clutter that I am sick of seeing. I also didn't have a good sense of how much extraneous stuff I had, and wanted to challenge myself to purge my space of things that do not have a place. As much as I like Marie Kondo's methods, I understand that where I have the most room to shrink is the komono = "miscellaneous things" category, and not so much the others. So these first 15 days of the Minimalism Game, 15 non-consecutive days over several months, was my ease into decluttering.

I don't think I ever embarked in any massive full court press decluttering campaign before, maybe because I always favored a slow fade. I revisited a blog post I wrote in January 2016 where I was clearly overwhelmed by stuff in my apartment, and am glad that the feelings of being trapped and being despaired by a space have never resurfaced. I think too that even now, I use minimalism as a framework to process my need for control in a life that often feels out of my control. Those feelings in January 2016 came mere days before I was accepted to medical school, at the peak of what may have been my closest scrape with depression. The past few years of medical school have not had nearly the same ups and downs as college, yet I'm still coping with the old ways: trying to exert control over my life through what I own.

I read something on Reddit recently about the very topic: minimalism cult as a proxy for coping with depression and anxiety, and perhaps there's some truth to it. But take my participation in this game as lighthearted tidying up and self-improvement. Practically speaking, I am moving next year somewhere unknown across this country - hopefully because I have matched at an orthopedic surgery residency program. I actually am now in Virginia for a month for an away rotation enjoying the lovely 3-story home of some medical students who own an order of magnitude more things than I do (but I do appreciate the Southern hospitality) while some other medical student rents my room in Boston (the tidiest it's been in a year, Chinese hospitality). 

Last photo is not relevant, but just needed something to complete the line since I lost one of the photos

Anyhow, maybe an excessive amount of words for an insignificant post. Somewhere around day 10 I decided to fuck all the random pieces of paper I was counting and just recycle them all. So, all in all, I needed the kick in the ass to get rid of the detritus in my room.

And lastly, a sentence from the last post: A general goal that I have is for each item in my possession to have its specific, designated location.

I'm closer to that goal, and I still think the same. Minimalism Game will resume with the much more challenging half when I return to Boston in November.

Finally a breather - and something about Spanish

Somewhere in Boston, there is a garden

So, getting used to being a third year has kept me away from writing, but here I am in a more relaxed rotation, ready to write.

The first thing: I got my Step 1 score back. Some combination of disbelief, relief, joy, fear, and anticipation. I will be going full steam ahead towards orthopedic surgery. My score is below average for ortho, but still within striking range. So now what lies ahead is doing my best on my rotations, keeping up with research, maintaining my relationships with my mentors, and looking far ahead at Step 2 and away/audition rotations.

I finished my first rotation, Obstetrics & Gynecology, a few weeks ago, and am just as many weeks deep into Family Medicine. I think I will eventually write more thorough, thoughtful update and reflection posts on each specialty, but that those will come eventually, much like my posts about my trip to Germany in summer 2016, and my Grand Canyon hike. Someday.

The changes in my life, other than the shift from pre-clinical to clinical education and the new three digit number that identifies me are my (1) new apartment and my (2) improvement in medical Spanish.

For the first one: I moved in with two of my classmates into their apartment, where there is a larger, more home-like common space, a smaller kitchen and bathroom, and a smaller bedroom for me. In strict terms of real estate, it's a downgrade, but I realized that my old digs were not great for my wellbeing. I got along fine with my old roommate, but I also tended much towards being asocial and a shut-in unless there was a place for me to specifically go or people I wanted to specifically see. My new apartment is a lot more like my college one, where I interact with my roommates more, and we get along.

That said, a big thing that I realized about myself is that I really miss my college friends. Like terribly so. Maybe it's that we're all scattered out at different rotations, but I don't feel as connected as I used to with my med school friends. We don't actually have that much in common, whereas I felt I was very close with my college friends (and in love with one, who is not my ex-boyfriend). So lately I've found myself really keeping in touch with old friends, and old-old friends (my best friends, the ones I've had elementary-middle-high school + two years of college, and I'm lucky to have two of them).

Hollyhocks will always make me happy

And I guess the last thing I'll say is that my improvements in Spanish have probably been what I've been most proud of in terms of soft clinical skills achieved. My Family Medicine clerkship is at a community health center where probably 90% of the patients are either from El Salvador, Guatemala, or Colombia. 5% more are probably from the Dominican Republic. The others are old white Italian-Americans. So I've had the very special challenge and privilege of learning primary care en español, which means going in to see patients on my own, collecting a history and doing a physical exam, reconciling medications (with some patients illiterate in English and Spanish), distracting the little people accompanying parents to their visits, seeing patients as young as three days old to as old as ninety years old. In the past three weeks, I've perhaps spoken English to ten patients. I feel a lot more confident and competent as a clerk and as an hispanohablante. I am making progress.

I've been getting good feedback as a third year student, but I get really proud when the attending physicians (all of whom speak Spanish themselves, running the gamut of gringa to fluent) ask me where and how I learned Spanish. Even better feedback is when the patients grill me about where I'm from and are surprised to learn I was born and raised in the United States with parents from China, and not Peru or Puerto Rico or Mexico where the Chinese diaspora has also touched. That's the best trophy I have in the road towards professional Spanish fluency.

So I think I feel a lot of things, and I think I need to write a longer post about this. But I now speak medical Spanish much better than I speak medical Mandarin, which makes me feel very guilty on one hand, proud on the other. The next step will be to actively seek out learning or patient care opportunities where I will use those languages.

This year will be one of many changes. I already has been. I'm growing a lot. I loved OB/Gyn, and though I don't love primary care, I look forward to every clinic day. And I'm ready to get back in the operating room. A lot has changed, but really, a lot has not.

Late autumn updates

Do I even live in New England if I don't post pictures of the foliage? Autumn came and is on its way out. We got a tiny moment of snow last night. It is starting to get cold. We're making another turn around the sun.

Clothing, cosmetics, personal finance, and minimalism

Clothing

I bought another flannel from L.L. Bean, and plan on revisiting my review of it from last year, now that I have a brand new one to compare to a year-old one. I have plans to buy another pair of professional-looking trousers, but am waiting for sales. I also have some socks and underwear to replace. This means Black Friday/Cyber Monday shopping, which I have deliberately avoided for years. I am possibly also deferring my black leather shoe (or boot) purchase for another year. I just haven't found one that I really like.

How do I build my professional wardrobe while keeping consumerism in check? As much as I try to limit myself in how much money I spend or how many items I buy, it's also important to limit how much time I spend thinking about or planning what I'm going to buy. On the other hand, isn't having a plan better than not having one? Either way, I am not satisfied with the amount of mental space I routinely use thinking about purchasing stuff. There's got to be some kind of a balance (obviously I haven't found it yet).

I also finally (finally) washed my jeans that I bought in January. It sounds disgusting, but I wore them only in <50F weather, freeze them on the weekends, and they held up well. Raw denim cult, my friends. I'll write something about them soon.

So here's something a little disappointing: my friend group talks about shopping a lot. They really love Uniqlo, and as someone who owns a lot of Uniqlo clothing, this normally doesn't bother me. And it really is a minor annoyance, but they incessantly talk about sales at Uniqlo, make multiple orders a month on Uniqlo, and joke about lacking self-control from buying at Uniqlo. I only noticed this recently because they went crazy over a specific scarf that one of them had. Two others bought the scarf immediately. Something about that makes me uncomfortable, despite how many Uniqlo garments I personally own.

Cosmetics

I'm getting back into makeup again. My goal is to have a bare bones makeup kit of items that I love and use regularly. Currently, I have holes in some parts of my kit (skincare, base), and excess in others (eyeshadow). It makes me feel more professional and put together. I will be patient in editing what I have, adding and subtracting, until it is perfect. It is 100% consistent with my personality that I am hyper-focused on what I look like. What I mean: I love my face without makeup, but if I do wear makeup, I am extremely critical about how it looks when I put it on, and how it wears throughout the day. I must still look like myself. I use very little makeup, but what I use must matter.

Personal finance and minimalism

I fell down the rabbit hole of personal finance and financial independence blogs, especially those written by residents and attending physicians. This is something I must learn.

Regarding minimalism: I'm trying. More now than ever, I realize I need to get my perspective in check before I go about trying to 'minimize' any other part of my life. I recently went to talk to one of the deans about how hassled I was by people gossiping about me (mostly my research) and he repeatedly asked me why I cared. Why did it bother me so much? I don't think I had an answer. He told me to read Meditations by Marcus Aurelius (because I told him my sibling told me to read it years ago), talk to my friends and family, and keep doing what I'm doing. If there are people gossiping about my work, then I must be doing something right.

In other fronts, I'm working on reducing waste in my life. Still trying to go low waste, it's hard. But this is important to me so I'll work harder at it.

Step 1

This is the first part of the United States Medical Licensing Exam (USMLE) that will determine whether or not orthopedic surgery is magical thinking or a real option for my future. So I am studying. I am doing better in school than last year, studying better, but there is still so much room for me to improve.

I've been thinking of potential vacations to go on after I take the exam in May. The dream vacation is to do a rim-to-rim hike of the Grand Canyon, but that is a far reach of a vacation. More realistically is Katahdin in Maine.

Research and scholarly pursuits

We're finally writing the manuscript. Our project won a prize at a hospital poster session. I'm glad that something I worked hard on since this time last year is finally coming to fruition. And now, I'm looking for more research projects. I want to continue working with my same mentor, and I feel more and more strongly about orthopedic surgery.

At the same time, I am more and more curious about general surgery as well.

..speaking of my mentor and orthopedic surgery, I shadowed him in clinic this week and it was awesome. It was a lot more fast paced than the surgical oncology clinic I normally go to, but I really like his style. Straightforward, to the point, but super comprehensive about all the options a patient could have, non-operative and operative alike. Orthopedic trauma has truly a crazy spread of patients, from little old ladies to a guy my age shot several times over a basketball game, joggers hit by cars, custodians falling from ladders, etc, etc. Vastly different patients with vastly different injuries, needs, goals, and lives. More than learning about how to care for fracture patients, I have another role model for how to talk to patients, how to listen to patients, and how to identify when they have questions, reservations, or things they don't understand.

Recreational reading

I took Thanksgiving break to read as many books as I could. Sabriel (Garth Nix); The Two Towers, The Children of Hurin, and part of The Return of the King (J.R.R. Tolkien); and The Hot Zone (Richard Preston) are all great. I'm not a book reviewer, but I can recommend all of the above.

Thanksgiving

I have a lot to be thankful for

• my family loves me and supports me in every way: emotionally, financially, in small ways, in big ways
• I am exactly where I want to be doing exactly what I want to do
• I have great friends, old and new
• I am healthy and happy
• I have great mentors that push me to do strong work and let me see and do cool things
• I am finding time for creative pursuits and personal enrichment

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

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.

--

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.