I started reading again: 18 books in 2019

Somewhere in Sacramento

Looking at the title, this seems a pretty pitiful number, but certainly much better than previous years (close to zero). Despite four months of 90-100+ hour workweeks, this year I have had more free time than all the other years of medical school, and suddenly began to read for leisure again.

I remember what it was like to be a voracious reader as a child and a teenager, and was increasingly disillusioned with myself for numbing my brain with endless social media. I even throw podcasts into this since I definitely use them as a way to pass time without really gaining anything from them. So my month in Chicago kickstarted what will hopefully be a habit of reading more, writing more, and being more critical and deliberate with the content I consume, and how I choose to use my precious free time.

Bolded and highlighted titles are those that I strongly recommend. Italicized titles are those I am currently reading and expect to finish before the year is over.

1. The Hazel Wood - Melissa Albert
2. I'm Not Dying with You Tonight - Kimberley Jones, Gilly Segal
3. The Priory of the Orange Tree - Samantha Shannon
4. The Seven Husbands of Evelyn Hugo - Taylor Jenkins Reid
5. Big Little Lies - Liane Moriarty
6. Becoming - Michelle Obama
7. The Woman in Cabin 10 - Ruth Ware
8. An Enchantment of Ravens - Margaret Rogerson
9. The River at Night - Erica Ferencik
10. Little Fires Everywhere - Celeste Ng
11. Six of Crows - Leigh Bardugo
12. Murder on the Orient Express - Agatha Christie
13. A Little Life - Hanya Yanagihara
14. This is Going to Hurt - Adam Kay
15. Brain on Fire: My Month of Madness - Susannah Cahalan
16. No Exit - Taylor Adams
17. The Outsider - Stephen King
18. Everything I Never Told You - Celeste Ng

I expect to keep up this pace of reading into the first quarter of 2020 since I'll be traveling for residency interviews and not socializing with my classmates while I'm on the road. I don't really have a set TBR, but here are some of the books I definitely intend to hit in 2020.

1. The Secret Commonwealth - Phillip Pullman
2. Dear Girls - Ali Wong
3. House of Leaves - Mark Z. Daneilewski (RR)
4. Crooked Kingdom - Leigh Bardugo
5. Catch and Kill - Ronan Farrow

What does the future hold for me, and this blog? I really don't know that answer (other than I seriously hope everything works out and I match into orthopedic surgery), but hopefully I can use this space to log my books and talk about them in manageable batches. Looking at this list, it definitely seems my tastes are shifting away from fantasy and science fiction and towards contemporary mysteries and thrillers. Additionally, my goal is to read more medical humanities since my medical school library has an abundance of them (and everybody is too busy studying to read them for fun, except the graduating students).

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

Sartorial lessons from surgery

As an introduction to clinical medicine, we first years were individually placed with various school-affiliated physicians around Boston. I feel very, very lucky to have spent my Wednesdays at a surgical clinic at our teaching hospital, with a preceptor and mentor (Dr. M) who I hope to become one day. I could fill an entire blog post on clinical knowledge, surgery knowledge, life knowledge, and how-to-be-a-doctor knowledge I have accumulated, but this post is about the sartorial lessons.

In this clinic, the surgeons wear dark suits, ties, monograms, polished shoes, and no white coats. All other MDs and MDs-to-be wear white coats. What did this mean for me? These three outfits represent the only things I thought appropriate to wear to clinic, where male M3s in pastels and khakis looked exceedingly out of place.

Purple top - Ross | Trousers - Banana Republic (too fitted?) | Shoes - Fitzwell | Maroon blouse - NY&Co | Dress - Uniqlo | Watch - Casio

Lesson #0: I am a first year medical student unaccustomed to dressing professionally and have no idea what I'm doing

Lesson #1: when the attendings wear suits and look like bankers and politicians, go as formal as possible without wearing a suit

For me, this meant charcoal grey and quiet jewel tones. The sleeveless tops were fine because I always wore my white coat (not true for all placements). I generally dislike collared, button-down shirts because fit is so fickle with them. Blouses are more forgiving and read a bit more formal. I think I was in the minority of my female classmates who regularly wore a dress to clinic, but I am much, much more comfortable in a dress than in trousers. This one was long enough where sitting, standing, kneeling, etc were all very comfortable.

Lesson #2: accessories and layers matter. Comfortable shoes and a watch are necessary.

On top of these base outfits, I wore a black cardigan and black tights to stay warm during the winter. Because I had a locker at school, I never had to commute far in these clothes and could easily walk to clinic without snow boots, even in blizzard conditions. Because I err on the side of being too formal, I usually wore a dark grey overcoat instead of a parka.

Corollary to #2: an anecdote

Though I spent most of my time in clinic, I often accompanied Dr. M around the hospital to talk to radiologists or other services. Following around a much taller person while wearing heels can be a chore: the dress + low block heel made it manageable.

Dr. M's advice from one of these occasions: "I noticed that you're always walking a few steps behind me. Don't walk behind attendings, walk next to attendings. When a young female medical student walks behind a male attending, it looks subservient, especially if you're the only one there."

How does one young female medical student follow an attending around without looking subservient? Wear comfortable shoes and take longer strides.

Also Dr. M: "Always wear a watch."

Lesson #3: details matter when trying to look like a competent, clean, and professional adult

I got a lot of this kind of advice from my high school job at an ophthalmology clinic where my primary grooming objective was to not look like a high school student. I think that patients may be less inclined to trust someone who looks quite young and unkempt, and attendings less likely to take one seriously. I combed my hair and made sure my makeup looked okay before clinic, and that I wasn't tracking in salt, snow, slush, or ice. Unlike these pictures, I did try to make sure my white coat look like I had not just dug it out of my backpack.

Lesson #4: dress for the job you want?

These are just thoughts I've had from my placement at a surgical clinic where the surgeons wear suit. But also, I haven't seen what female attending surgeons wear when not in scrubs. Yet another thing: I want a woman surgeon as a mentor.

Any advice on how to dress professionally? Thoughts on how to succeed as a young female in a male-dominated field?

Mt. Monadnock | New Hampshire

I realized that since coming to Boston, I have blogged very little about the city of Boston, ye, the state of Massachusetts. Instead, a good portion of my content has been excursions to Vermont and New Hampshire. Here is another one of those adventures from earlier this month.

Mt. Monadnock is one of the only geological points of interest in New England that I knew about prior to moving to New England. It has featured in the poetry of Ralph Waldo Emerson, Henry David Thoreau, and (quite curiously) H.P. Lovecraft. While internet sources disagree about precisely how many people climb Mt. Monadnock each year, it is generally agreed that it is one of the most summited mountains in the world, trailing Mt. Fuji.

We took the White Dot Trail up to the summit. It's a 3.8 mile loop with an elevation gain of 1771 ft, to the summit at 3165 ft. Mt. Monadnock is not a particularly tall mountain, but it is the most distinguished feature of the landscape by far.

I very wisely wore many layers and my fancy hiking boots. The hike begins with very modest uphills, and then very abruptly transitions to some steep scrambling over boulders. We kept a brisk pace because the clouds looked ominous and we definitely did not want to be caught in the rain during the ascent. I personally really enjoy scrambling and thrive on steep, steep uphills...but rain would have made the ascent very precarious. I'd say that this hike is one where good traction and ankle support are especially important.

We hiked up in short, fast bursts on major uphill sections, taking in the rolling New Hampshire valleys under threat of rainfall with each break. Because I use my iPhone for all my pictures and generally go nuts editing on VSCO, I am prone to sort of amateurish landscape photography. I'm also not used to taking pictures under such ominous clouds and mercurial sunshine (or lack thereof), so please forgive the visuals.

The second major snack break

There are two major stretches of steep scrambles, and at the end of the first was where we had a major snack break. This stretch of flat was perfect for boulder hopping, looking at all the trees growing between rocks, and stretching out. We rested a bit and then made our last push to the summit, which was a bit farther than we had initially thought.

Looking for stunted trees at the second major snack break

Lunch at the summit, which was ridiculously crowded but still very enjoyable. I can see why Mt. Monadnock is one of the most-climbed mountains in the world: it's very close to Boston, it's fairly accessible to novice hikers, and they pay-off is wonderful, both in the summit itself and the feeling of digging in to get there. I don't know if any of my photos can express how steep it was in some sections, but it took real effort, perhaps more than any of the hikes I've documented here so far.

Getting ready for the final push to the summit, which was farther than we thought

We didn't spend quite as much time at the summit as I had wanted, but it began to drizzle and we wanted to get some of the steep, scrambly descent behind us before it poured. It never did quite pour but the rocks were at some points completely covered with rain, and some of our party did slip. The descent is more anxiety-inducing, and my joints did take a beating...but luckily, I didn't fall.

Some trees on the way up. I tend to write before I edit photos, and am still not great at spacing things out. Here, the text describes the descent and I haven't even gotten to the summit pictures yet!

All in all, we left Boston at around 9 AM, stopped at McDonald's, got to the mountain and hiked up and down, went to Taco Bell, and returned to Boston at around 5 PM. I chipped in $7 for the rental car, bought hash browns for $1, bought a honeydew for $3 near Taco Bell, and mooched off some of the junk food that someone was too full to finish.

The summit

• Location: Mt. Monadnock, in Mt. Monadnock State Park in New Hampshire
• Distance/duration: 3.8 miles loop, about 2 hours to the summit
• Elevation gain: 1771 ft
• Difficulty: moderately strenuous thanks to the really steep, really fun scrambles; could be harder in rain or winter or hotter weather
• Points of interest: that sweet, sweet view
• Overall: this was a really fun, satisfying hike. The scrambling was tough, but entirely worth the pain. I can see why this place is so popular, but at the same time, the trail and summit are very crowded.

By the time I got around to editing the photos and finishing the honeydew (I froze some of it), I realized that my first year of medical school was just about over. How do I describe this first year? I can't articulate it well in this addendum to a blog post about hiking up a mountain, but here are a few thoughts about this year and the summer to come.

My first year of medical school was a lot of things. It was an affirmation in that I know more than I began that I am where I want to be doing exactly what I want to do. It was a challenge, academically and professionally, but I learn best in challenges and in failure. I made some good friends, and had more fun than I am used to having. I also found mentors: a resident who wants me to succeed, an assistant dean who let me cry in her office twice and then helped me find my courage again, a preceptor and role model who taught me not just about surgery and how to care for patients, but how to be more confident and capable.

I think I always had an impression of Boston being some kind of intellectual ivory tower of medicine, and it kind of is. However, our hospital is decidedly blue collar, safety net, and deeply concerned with the intersection of medicine and social good. I was lucky to have found and stayed on the same research project since the autumn, and will work harder at it this summer. It's about both medicine and social justice; orthopedic surgery and opioids. The opioid epidemic in New England (and the Rust Belt and Appalachia and small town America) runs deep. It's systemic and demands policy at all levels of government. It's a fight I have been waiting to enter.

As far as Lord of Three Realms goes, I have a few posts waiting in the wings. I also realized that I have half of my Germany posts from last summer yet to be written. I hadn't expected my blog to turn into New England day hike report central when I first started medical school, but I do have some hiking planned this summer, and I will take pictures and write about them. More recreational reading, and more excursions out of my culinary comfort zone (I have recipes to try).

Last thing: I'm thinking about working on the blog itself...like actually adding headings and categorizing things reasonably.

And that's it.

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.