A one-bag minimalist sprint for interview season

First of all, the itinerary:

• 1/9 AM - travel to NYC from by bus
• 1/9 PM - interview social for Hospital #1
• 1/10 PM - interview at Hospital #1
• 1/10 PM - travel to Boston by bus, sleep at home
• 1/11 AM - interview at Hospital #2
• 1/11 PM - interview social for Hospital #2, sleep at home
• 1/12 AM - travel to California by plane
• 1/12 PM - interview social for Hospital #3
• 1/13 AM - interview at Hospital #3
• 1/13 PM - travel to parents' house by car, sleep at home
• 1/14-15 - sleep at home
• 1/16 PM - travel to LA by plane
• 1/17 - Hospital #4 interview and interview social
• 1/18 AM - travel to NYC by plane
• 1/18 PM - interview social at Hospital #5
• 1/19 PM - interview at Hospital #5
• 1/20 AM - travel to ABQ by plane
• 1/21 PM - interview social for Hospital #6
• 1/22 AM - interview at Hospital #6
• 1/23 - sleep all day in ABQ
• 1/24 AM - travel to PHX by plane
• 1/24 PM - interview social for Hospital #7
• 1/25 AM - interview at Hospital #7
• 1/25 PM - red eye flight back to Boston

And now, what I packed:

• Suit
• Blouse
• Grey dress
• Black wool shirt
• Grey Uniqlo heat-tech shirt
• Grey t-shirt
• Black gym shorts
• Black tights
• Nude tights
• Heels
• Black ankle boots
• Navy blue Uniqlo ultra-light puffy jacket
• Watch
• Black Fossil handbag

...and necessaries like underwear, computer, Kindle, chargers, toiletries, chocolate. Surprisingly everything fit comfortably and the bag was always accepted for United Basic Economy, whose luggage restrictions are one single item that can fit under the seat in front. I am very proud of being able to make the trip with such lean, lightweight luggage. In fact, I think such a trip would have been bearable only with such little burden.

Why did I do this to begin with? Mostly to save money and save the hassle of keeping track of all my stuff, at the cost of having a perpetually wrinkled suit. Some of it was a challenge in seeing if I could do it, kind of prideful, I admit. The bottom line: I did it, and it was convenient. And now it's done. This two weeks of travel coincided with a nasty upper (eventually lower) respiratory infection for the same duration, complicated by sore throat and very diminished voice in the beginning.

And now it's done, and I get to rest and agonize over my future.

I wrote this post in February and it stewed in my drafts for all this time. I matched into orthopedic surgery! I'm going to be an orthopedic surgeon! I'll find out where on Friday, but for now, I'm just happy happy happy that I've fulfilled a dream of almost eight years. More coming soon!

Lessons in minimalism: month in Rhode Island, out of a suitcase

My room, my suitcase, my sleeping bag. Missing in this photo is the other identical chest of drawers and the other identical broken landline

I spent the second month of my Internal Medicine rotation at a community hospital in Providence, Rhode Island, about an hour away from Boston by train. I took this as an opportunity for a minimalism challenge, and as a trial run for the three months I'll spend this year on away rotations for orthopedic surgery. Here was my attempt at packing light, with the safety net of easy trips back to Boston for things I forgot to bring in the first place, and things I didn't need to bring and took back to my apartment. Despite learning very little in this hospital (in fact, the medicine practiced there is comically bad), I did learn a bit about minimalism (in this very specific context). Namely, I can get by with not a lot, I have room to trim away, and I can sleep in a sleeping bag very comfortably for a month. Read on...

Clothes for a month

In brief, here is what I brought:

5 blouses for wards, 1 of which I never wore
3 t-shirts for exercise and for lounging
1 flannel

3 pairs of trousers for wards
2 pairs of shorts for exercise and lounging
1 dress for the wards, which I never wore
1 pair of jeans

Black boots, boat shoes, and running shoes

Not pictured are my raincoat, undergarments, socks, etc. Essentially, I got by fine this month with this limited wardrobe, but we had laundry in the house provided. Looking back, I could have done with less for the wards, and probably more for exercise since I found myself hand washing after every run. For my orthopedic surgery away rotations, I can shrink this down to one outfit for clinic, a suit, a set of scrubs just in case there is a delay in getting hospital-provided ones, and obviously at least another set of workout clothes, as this is, after all, orthopedic surgery.

As lean as I thought I was packing, there were some leftover items - my green silk blouse and grey dress - that I thought were just too formal for the wards. That's something I've found for myself, that the order of formality of dress code that I've seen is: surgical clinic (business formal) > medical clinic (business casual) > medical wards (business casual) > surgical wards/OR (scrubs). At least that's how I perceive it.

Left: the shoes | Right: perhaps the first and last time I show a stethoscope on this blog

As for shoes, I think darker soled boat shoes would work in almost any medical situation in New England (I say that with some humor, but actually I've gotten away with even these beaters). The black boots will come back in the winter, and my black pumps will come with me for away rotations. The stethoscope will become trauma shears and I'll bring a smaller bath towel next time.

While I was unsurprised that I could tolerate and enjoy sleeping on a bare mattress in my sleeping bag for a month, I was surprised that I so quickly reverted to convenience foods, fats and refined sugars, disposables and take out so easily. I gained weight and was eco-unfriendly, ate more meat than I'm proud to say, and indulged myself a bit too much. This is obviously not ideal since I normally cook all my meals and prepare them mostly with my health in mind, and I do have months of chaotic schedules and new living situations before I need to wear my interview suit. A suit that I wore at age 20-21 interviewing for medical school.

Despite having my metal tumbler, which I did use for all coffee, tea, and water, I treated myself to many disposable plastic bottles of juice provided in the emergency department (??? not going to question it). These kinds of things are my weakness so though I'll Refuse as much as possible, it's more likely Reduce and Reuse that will justify this behavior

So, less a collection of lessons than incoherent rambling, as per usual. I think I may try to pack everything into a backpack and a piece of checked baggage for my aways, and prioritize maintaining diet and exercise for the next few months and the rest of my life. Minimalism is a proxy for the lifestyle habits and changes that are in line with my values, etc, etc. 

An update about medical school

My big plant, this time last year (it doesn't look like this now, unfortunately)

I am two months away from finishing my third year of medical school: two months of internal medicine before I take Step 2 CK, take a one month pit stop in anesthesia, and then four months of orthopedic surgery. Home and three away rotations I am (yet) applying to. Research has been stagnant. My mentor believes in me more than I believe in myself. I scarcely feel ready to apply for residency, but here I am, at the edge of it.

I agonize enough over this process on my own, so I won't belabor it here. Essentially, I haven't changed my mind about orthopedic surgery. I haven't changed my mind about orthopedic trauma, specifically. I am more afflicted now with impostor syndrome than ever before. I have never been more uncertain of my abilities and my talents and every other qualification I may or may not have than right now. At the same time, I have toured most of medicine as a student and determined that nothing is close to orthopedics, and that it must be my future.

I finished my neurology clerkship, which was one of the good ones. Unfortunately, I saw three people die in one day in the Neuro ICU/SICU. All were inevitable. Two were peaceful, with family around them. The third was a futile, but all hands on deck resuscitation attempt of a gentleman who was hemorrhaging all his blood and bags upon bags of more blood from his dural venous sinuses (could not be repaired). I felt kind of useless because of my inexperience and because of the futility, but I made myself helpful by running supplies around, measuring and dumping blood from his hemovac, cleaning up, and finding chairs and tissue.

I've withdrawn a lot from my first friends in medical school and leaned in to others, namely my roommate and our mutual friends, and other students applying in orthopedic surgery. I take care of my plants. I clean my room. I make food for myself, ignore my other roommate, and sleep when I can. Two of my patients on internal medicine are dying, one in a matter of days and the other in weeks. Time just moves on.

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.

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

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. 

An update and some late autumn hiking

I am neck deep in our neuroscience module now and have two exams on Friday, after which I will go directly to the airport and fly back to San Francisco. Where did this semester even go?

I have a few updates I'd like to mention in this post, some important and some not. This post, of course, is also to share some photos I took of a recent hike in Middlesex Fells Reservation, which I visited in the early autumn. Taking pictures of the outdoors and fiddling around on VSCO is one of my favorite hobbies nowadays.

I also realize that I've included a potentially graphic story of a surgery I saw, so be warned.

I lost my LL Bean flannel on this very hike, actually. It was a bit warm so I put it in my backpack and fell out somewhere along the way. When I realized it was gone, we had already gone seven labyrinthine miles through the park and I was certain I could not find it again. I usually take pretty good care of my things so I was very annoyed and disappointed at myself, but I eventually did repurchase the same shirt. I liked it quite a lot and have realized that there is no way I can survive a Boston winter short on long sleeves. That's how I justified it.

School is going pretty well. I realized that I never wrote a summary or reflection post about gross anatomy, which is probably one of the most unique aspects of medical school, and one of the oldest and most arcane parts of medicine. I have time during winter break and should really do that. I also recently went to two talks: one about the history of surgery as told through advances in anatomy, anesthesia, and antisepsis; the other about the ethical transgressions in medicine and anatomy during the Third Reich. I have more research to do in both those topics.

My actual research is going well. I have a plan, a good mentor, a pile of work to do, and an abstract to revise. The project is something very important to me, and is in orthopedics, a specialty that I have long wanted to enter. I have shadowed the residents on call a few times and like the culture, like the work they do, and like their perspective. Of course, the surgery itself is cool beyond my wildest dreams.

I wrote back in the springtime about being utterly starstruck and sick with dreams after attending an orthopedics conference. I felt similarly after observing a trauma case that went to the OR. Long story short, a man in his 30s presented with a proximal and open distal femur fracture, a proximal tibia fracture, and lateral compartment syndrome. I'll spare the details for another post, but I was completely absorbed into the scene, the jagged ends of the femur sticking out of his bloody thigh, bits of plastic and glass removed, the red and yawning gash in his calf from the fasciotomy, the methodical placement of all the rods and pins and spacers to externally fix the limb...if this is bread and butter orthopedic surgery, I am all in. I've retold the story a dozen times and still go over the details. It was some parts carpentry, some parts butchery, all surgery. I want to see more.

For next semester's clinical skills class, I was placed with a general surgeon at our hospital. General surgery is second on my list for specialties and I am very excited to meet my preceptor.

Last week, some friends and I won a prize in our school's gingerbread house contest. A few hours later, some of more of us began our first Dungeons & Dragons campaign of medical school. We spent the week reading the player's handbook, building our characters, and telling each other how excited we were. Having a regular board game group has been great fun, but D&D will be even better.

Lastly, good luck on exams if you are taking them, and have safe travels if you are going somewhere.

It's me again

I'm taking a break from the Germany posts to do something different. It's high time I introduced myself on the blog, which has mostly been unladen by personal information or identity for the year.

Left: typical white coat ceremony photo
Right: Cape Cod

I'm Lulu/LL/Lo3R. I'm a first year medical student in Boston. School started a few weeks ago; so far, so good. I'm in the right place doing exactly what I want to be doing.

I have always wanted to be a surgeon. In four years, I will be a surgeon.

I like the great outdoors, architecture, rocks, plants, art, literature, and history.

The Lord of Three Realms, as a blog, is my commonplace book, my photo album, my captain's log, my soapbox, and my personal quest for becoming a better version of myself. The Lord of Three Realms, as a concept, is an embodiment of that better version of myself. It's not a reference to religion, but an inside joke from college. The Lord of Three Realms is me. The three realms are whatever you want them to be.

A few things that have happened to me recently:

1. I moved from the SF Bay Area to Boston to start medical school, but also took day trips to Cape Cod and New Hampshire recently. I'm very slow on social media and am probably the last person in my class to put up photos from the white coat ceremony (eventually, I'll do it)
2. Boston is an interesting place so far. One article that has been circulating around school is Life and loss on Methadone Mile, a piece from the Boston Globe that examines Boston, and Boston Medical Center, as a critical point in the opiate crisis, structural homelessness, and health care issues in this country
3. I may be donating bone marrow this year. The patient I have matched with is still considering treatment options, but my HSCs and I are on deck in case they need a transplant. Go here for more information, or to enter the registry if you are interested in donating
4. I ordered and received my winter boots from L.L. Bean and I'm excited about buying a flannel. Winter is coming and this Californian is scared

Anyhow, that's who I am and a brief life update. Needless to say, I'm beginning a new chapter in my life and likely the content I post will change, but I'm not entirely sure how. Who really knows? The whole purpose of this blog is to document my process of becoming a better version of myself. Know thyself, better thyself. Thanks for following along.

And just to humor the future me, here are the top 5 specialties I am interested in:

1. Orthopedic surgery
2. General surgery
3. Obstetrics & gynecology
4. Emergency medicine
5. Internal medicine

On hiatus!

I just got back from a quick trip to Washington and took many pictures of our nation's great federal buildings and museums. I'm now on my way to Germany for the next three weeks, and will probably not post while I'm away. Goodbye for now!

Other people's gardens

A specimen of Genus Echeveria. Very fitting considering how much time I spent in Etcheverry Hall during college.

During the last two weeks, I found myself with an absurd amount of time on my hands. All my projects had been submitted, I was sufficiently secure in both my classes with final exams, and I had no urgent tasks. I used this newfound time to go to the gym, read for leisure, and take long walks in the hills north of campus, making sure to stop and admire the flowers.

Berkeley is a town of contrasts. In the north, houses are large and with personality. Architecture is clever, hills are steep, and gardens are lavish and just a bit wild. The North Berkeley hills, edging into Tilden Park and the Lawrence Berkeley National Lab, are easy to get lost and get tired in. Fortunately, this is my neighborhood, and I am acquainted with it.

I am a frequent recommender and visitor of the UC Botanical Gardens, which is uphill from the southeast end of campus, but sometimes, that's a hassle to get to, with very uniform views on the hike up. The northside hills are an easy getaway from the College of Engineering, and beautiful gardens and interesting houses, tucked-away side streets and terraces are quick to encounter. 

It may be easy to tell that these photos come from different hikes: different weather, different times of day. I'm collecting "specimens" for if I ever want to paint botanical still life in the future.

Though I don't think I'll have the space for a garden in my near future, all this wandering and stopping to admire other people's gardens has inspired me. What I don't think I can communicate through these photos, but seems very clear to me just walking through the neighborhood, is that North Berkeley's gardens give it an air of mystery and magic. Given the terrain, plain lawns are uncommon. Flowers are more elegant and ornate, with strange colors. Irises, daffodils, roses, and succulents are heavily featured.

These lovely ones are downhill on the northwest end of Berkeley.  I messed around on VSCO because I am challenged by lighting, but I tried to represent the color as accurately as I saw them.

Carpets of succulents from two ends of northside. The one on the right comes from the same garden as the Echeveria featured above.

This stretch of sidewalk is actually a deliberate garden. Many of the plants are labeled, and there are notices about his landlord forbidding him from keeping this exotic garden. He is the owner of the succulent garden on the left in the preceding picture.

There is a public rose garden on northside as well, where rarer, more elegant cultivars are grown and shown. Among them are the yellow and white bicolor roses on the right, and a pink and yellow variety not shown here.

Houses near the rose garden often have their own roses as well. Rose Street nearby has a terraced, staircase path lined with roses. Lots of roses, roses everywhere, etc.

Yet more roses, the ones on the left close to my apartment, the ones on the right from the Berkeley Rose Garden.

And lastly, one of my favorite gardens in Berkeley, located a stone's throw away from the original Peet's Coffee & Tea. I make it a point to encounter this extraterrestrial and its spacecraft (with a "BERKELEY OR BUST" bumper sticker) when I walk to the supermarket. This is one of the many oddities about this strange town that I will miss.