Spring into summer update

View of the green, green Colorado River from the South Kaibab trail

None of these pictures are in order. I think my dad took most of these. But since I'm probably going to take an eternity writing up a post about the Grand Canyon hike itself, here are some pictures.

Hello from third year of medical school. I'm starting on OB/Gyn and like it so far. Still waiting nervously for my Step 1 score and having catastrophic thoughts of not scoring high enough for my dream specialty. Felt all kinds of sadness and guilt and inadequacy when my research attending and some of the ortho residents I worked with last year said hello to me on the day I thought I would get my score back (they're delayed and I have to wait longer). Felt something similar when the resident who mentored me since first year called me volunteering advice for my surgical rotation (and then gave me some advice as a new parent whose wife delivered her baby on the floor I'm working on right now). Keeping an open mind is surprisingly not hard, since OB/Gyn is really cool, but it's also not hard to remember how happy and excited and home I felt in orthopedics.

I'm learning some things about myself. I'm getting better at talking to patients. I like our patient population (safety net hospital, non-white, non-rich, many immigrants, many complications). I have more role models now: two gynecological oncologists whose patients trust and adore them. Gyn-onc doc #1 speaks fluent English and Spanish, and proficient Haitian Creole and Cape Verdean/Portuguese Creole. Gyn-onc doc #2 speaks fluent English, Spanish, and Mandarin. About 1/3 of the patients that go through our hospital don't speak English (most common languages Spanish, Haitian Creole, Cape Verdean, Vietnamese...I would have lost my fucking mind if I had heard Doc #1 speaking Vietnamese). I don't think I'll go into OB/Gyn, but I do think I'll eventually work somewhere where I'll need to speak Spanish on the regular. Eventually I'll find my way.

My Spanish is getting good. I thought it was good until I heard Doc #2 speaking with perfect, perfect grammar. Subjunctive tense, correct yo forms of irregular verbs in all tenses, correct conjugation of mandates and everything. The feedback that I treasured most from last week was when a patient I interviewed asked me where I was born and raised, and if my parents were from Latin America. Like everything in third year, I'll get better at the things I want to improve on if I actively seek out opportunities to try. So on I go.

I'm moving into my new apartment at the end of the month, and I'm doing it slowly over the next few weeks. Always kind of been into ~~~minimalism~~~, but I've accumulated some junk during my first two years in Boston and am downsizing. Namely, I'm giving away some of my plants, since I propagated too many of them.

Lastly, I was really affected by Anthony Bourdain's suicide. I loved his shows, and his overall attitude and approach to life. He, too, spent some of his formative years in Massachusetts, and I'll spare the details so you read Kitchen Confidential. Part of this was because it came after the death of one of my friends and mentors from the free clinic I was part of in college. The O was the coolest almost-octogenarian I've met. He helped me find my feet when I was struggling with new leadership and more responsibilities in the running of the clinic. He gave me lots of solicited and unsolicited advice. I owe a lot to him, more than he knew. Wouldn't be in med school if it weren't for him, wouldn't have even wanted to become a doctor if it weren't for him. He said he'd thought he'd die in his 20s, then in his 40s, then went quietly a few days after a stroke pushing 80, surrounded by friends. I wish I could have seen him again.

Early spring update: loose leaf tea, greenery, and what's next

It's been a long time since I last posted. I'm finishing my second year of medical school soon with our last exam, then taking the next 1.5 months for my dedicated study period for Step 1. And then it's off to a great hiking vacation with my dad for a few days: Grand Canyon, South Rim to Colorado River and back up again. Down 4860 ft the first day, camping at Bright Angel Campground. Then up 4460 ft the next day.

I went home for a week earlier this month and saw old friends, and replenished my stash of loose leaf tea, which I get from Berkeley Bowl. I went back to Berkeley with my parents and sibling and had a good time showing them around, revisiting my old favorite places. I miss many things -- maybe most things -- about Berkeley. Seeing old friends from college reminded me of that, and though I'm very happy pursuing my dream career on the other side of the country, spending time with familiar faces does remind me of what I lost by living so far away. And I did lose a lot. More than a perfect day hike, long car rides, and nostalgia could give back.

We were planning on hiking a notable summit in the Bay Area, but rain got in the way and we went up and down some killer muddy hills in a local park. Still worth the effort, mostly because of present company.

I don't want to dwell on the past, but it's hard not to. And it's also hard not to be nervous about my future, uncertain as it is now. I still want to do orthopedic surgery, but to do that, I need to absolutely kill Step 1. And to do that, I need to stay disciplined and healthy and smart and study better than I ever have. And to do that, I need to focus.

So, after the Grand Canyon trip, I'll come back to Boston and start third year. Clerkships -- it's been a long time coming. What I'm saying is I'll be off the blog until mid-May, and probably sit on editing what I expect to be mediocre pictures of the most beautiful landscape on Earth. Before that, I'll probably have something to say about building my professional wardrobe, and my spring/summer shopping list for clothes. I haven't made a lot of effort in these things, but I'll need to, given how imminent rotations are.

And that's all for now. I hope you're having a good week so far, and that the snow melts sooner rather than later. I thought I put my parka away for good last week, but I was wrong.

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

Beehive and Precipice | Acadia National Park 2017 part II | Maine

Note the iron rungs on the rock behind my head. The trail continues when you climb up them

Here I am with the second installment of my mini-vacation to Acadia National Park back in early October. I can only imagine how the landscape must look in the full blaze of autumn. Can you imagine sitting on this cliff overlooking a flaming red, orange, and yellow pit of foliage below? I tried to imagine that, and I imagine it would feel as if I were escaping from the pits of Hell. But the leaves were just barely beginning to turn when we went, and I can only imagine.

At Acadia, we went on two steep, strenuous hikes. All of us were fairly in shape and thoroughly enjoyed ourselves, but I would caution against anyone not accustomed to hiking, or hiking with improper footwear. The first of these hikes was the Beehive Loop, which has an elevation gain of 534 ft over about half a mile (the loop is 1.3 miles long, but the descent is much, much milder). Short and very sweet, with gorgeous views of the land and the sea. I deliberately did not include any photos that included the big cruise ship.

It is me

Beehive consists of a steep ascent from the forest floor up the side of a cliff, with narrow, rocky, and steep switchbacks and sections of ladders with little thin iron rungs. In this picture, I am cautiously lowering myself to sit down. It's a straight drop from there.

Don't look down. Or look down and try to spot the cairns

Barely getting started. The trailhead is at the elevation of the road, with a mild ascent to the cairns in the exposed rock at the upper right quadrant.

I read that this trail is reminiscent of ferrata hiking in Europe, which sounds very appealing and exciting.

This was about as summit as it got, and I admit that the views were not as awesome as I would have hoped for. But in this hike, the journey is the fun! We were a large group on this hike, and passed two families. It's a popular, but congested trail and we sped through it to thin out the group. I wish we could have been a smaller group and taken it a bit slower.

Next, we went along the ocean trail to check out the local wonder, the Thunder Hole (kind of cool, and the ocean trail was pretty cool).

As you can see, there were plenty of these jumbles of boulders to climb up and over, which we did with glee.

Climbed up high to get a view of the shore. The rock is an orange-ish color.

Another deceptive photo -- I am about 20 ft above the shore

The Thunder Hole was crowded with people and not worth photographing.

Down to Precipice!!

On the second and last day of the trip, we hiked the Precipice Trail, for which Beehive was the warmup. This was the coolest hike I've done in New England. In a half mile ascent, we went up 1072 ft, double that of Beehive in almost the same distance. Very steep. Very thrilling. I'm getting riled up just thinking about Precipice.

Shortly after we began the hike, we came upon the first challenge: a huge tumble of boulders to scramble up and over. Need I say it again? I love scrambles. This was just a taste of what was to come.

What was great about Precipice was that this trail essentially took us up the side of a cliff, meaning the views were always there, and getting better by the moment.

The first of the ladders. There were more than double the amount of ladders on Precipice than Beehive. After this point, it was steep, steep, steep all the way up. If you get to this point and find yourself exhausted, it is safer to turn back.

Interestingly, Precipice is closed for significant parts of the year for peregrine falcon nesting. We were lucky to come here when we did!

A rare flat stretch...and a precarious drop

Regrettably, I didn't take too many photos of the truly steep portions. The simple truth is that there wasn't really a place where I felt safe to do it. Between this photo and the last were crazy steep and narrow switchbacks, long ladders, and mere inches of rock between us hikers and a deadly fall. Admittedly, we were on a tight schedule and really booked it up the mountain (recommended at least 2 hours for an ascent, but we got up there in 1.5). We were exposed, exhausted, and I don't think my heartrate has ever been higher.

I admit, I had a dangerous light-headed moment when I was clinging for dear life on a ladder on an exposed cliff face, and looked over my shoulder.

But this photo is cool. I scampered up to the next highest boulder to take a picture of my friends seemingly emerging from the depth of the mountain.

The summit!

The views were worth all the effort.

There are a few other trails -- longer, less steep -- that lead up the mountain. But I was very happy we picked this one. How much more thrill could you pack into half a mile?

We took a long descent that still managed to be tough on the ankles and knees, but that's New England hiking for you. Here is a photo of the cliff from the parking lot. How exhilarating it was to climb up that exposed rock. It was the highlight of the trip.

Muir Woods National Monument | California

"Here in this grove of enduring redwoods, preserved for posterity, members of the United Nations Conference on International Organization met on May 19, 1945, to honor the memory of Franklin Delano Roosevelt, thirty-first President of the United States, chief architect of the United Nations, and apostle of lasting peace for all mankind." - memorial plaque in Cathedral Grove Muir Woods, 1945

Here is a post of many photos and few words. I think these are the best photos I have ever taken. I went on a hike in Muir Woods National Monument last July right before I moved out here to Boston. Somehow I never got around to editing the photos or sorting through them, but just looked at them when I felt homesick.

I already waxed poetic about Sequoia sempervirens, the coast redwoods, true icons of the Californian Pacific coast, on a previous post about Big Basin State Park, so I'll just leave these photos here.

Doe and fawn

Californians and non-Californians alike: please visit this place. Please hike beyond the first 1.5 miles of the park. The next time I come here, I'll hike to the beach. I hiked here alone and realized I'm seldom out in nature by myself. These are the most beautiful trees on Earth.

Take a look at these big ass trees

Here we enter Cathedral Grove, where some of the largest, oldest trees in this forest stand. This is probably as close as I will come to a spiritual experience, and this forest is probably as close as I will have to a house of worship.

Looking through these pictures, I feel a bit overwhelmed with homesickness for California. In college, I lived in a treehouse-like apartment in a redwood grove. My apartment in Boston is on the sixth floor a block away from the so-called "Methadone Mile." Though Boston has certainly grown on me (bricks and bricks and bricks and bricks and the ability to walk across the city easily, I know that the East Coast is not home. Somewhere out West is home.

But thankfully I'm back in the San Francisco Bay Area for awhile longer. This summer has been exhausting but so much fun. I have had the most wonderful experience doing research that I believe in, and learning as much as I can from the residents and attendings on the orthopedics service.

"Not only would this focus attention upon this nation’s interest in preserving these mighty trees for posterity, but here in such a ‘temple of peace’ the delegates would gain a perspective and sense of time that could be obtained nowhere in America better than in a forest. Muir Woods is a cathedral, the pillars of which have stood through much of recorded human history. Many of these trees were standing when Magna Carta was written. The outermost of their growth rings are contemporary with World War II and the Atlantic Charter." - Secretary of Interior Ickes letter to President Roosevelt, February 1945

“These great redwoods at Muir Woods National Monument are the most enduring of all trees. Many of them stood here centuries after every man now living is dead. They are as timeless and as strong as the ideals and faith of Franklin D. Roosevelt.” - Edward R. Stettinius, Jr., U.S. Secretary of State, 1945

The park is heavily trafficked near the entrance, but much quieter farther off. I'll go farther next time.

As much as I think I want to live somewhere else, looking at these photos reminds me that California is my home.

I didn't track my mileage or elevation gain, and don't have numbers to share. A bit more on logistics: I took a $5 shuttle from Sausalito to Muir Woods, which gave me a lot of time to look out the window and daydream about owning a cottage looking out over the Pacific Ocean, with redwoods on my property and within hiking distance.