don't wave no goodbye

The end of the year arrived with little warning. I do not feel like celebrating, though I should. The year has been momentous, in good and bad ways both; it has been an extreme year. So I am ending the year tired, just uncertain of whether the intensity of the past year is something sustainable.

It is tempting to wallow because I am so tired, to breathe a sigh of relief, and be glad this tiresome year is over. But maybe that is what age has taught me, to be a bit more measured. I don't try to keep tally anymore, I do not try to calculate a balance sheet, whether the year was a good one or a bad one. It was another year. It was another year that makes me who I am.

Maybe residency has been the ultimate lesson in realizing that nothing is black and white. There are so many exhausting and terrible things about residency, so many problems with it, and there are maybe just a few truly amazing and magical things about it. But I'm not sorry to be a resident. Which is some tricky math.

If there was another big lesson I learned this past year, it was that you never stop learning new things about yourself, and about others. I really thought I had a lot of things figured out the year before, but I can see now that I still have so much to learn. And that part is not exhausting, not tiring. That part fills me with a sense of wonder.

Anyway, the year is nearly over, and I have been much remiss when it comes to blogging, writing. I hope, now that I've passed the halfway mark of internship, I'll have a bit more of a chance to breathe and reflect. But I know better than to make a bunch of resolutions.

In the meanwhile, here are 11 random things about 2011:

When I broke work hours (>80 hrs/week or >16 hrs in a shift by the new rules), I listened to Helena Beat by Foster the People to keep me going, and it was like rocket fuel.

My 4-year old, adorable godson came to visit and his father taught him to call me Doctor, which is both annoying and comical.

Even though there were probably better movies out there, I really loved Drive and would gladly watch it again, gore and all.

It turns out I sort of like yoga, except that I took it up at the height of allergy season and found the breathing-through-your-nose part really tricky.

Amy Poehler, Melissa McCarthy, Tina Fey, Martha Plimpton and company all bum-rushing the stage for best comedy actress was probably the best thing that has ever happened on an awards show, and definitely the only inspired awards show moment of last year.

I sort of knew things weren't going to work out with S and I when he failed to find Ron Swanson a) the most amazing and b) the most hilarious man on television.

Though it was published much earlier than 2011, I finally picked up The White Tiger by Aravind Adiga after failing miserably at trying to read those stupid Girls with the Whatevers books (I'm sorry, I tried and tried, and I am sure the plot is fascinating but I could not get past the blah prose that did not engage me though I tried time and again to read the books). I don't get to read novels too often, but that was a good place to spend my reading quota, that's for certain. His writing is new and fresh and just what I want to be reading these days.

Months and months later, the FNL series finale's closing moments remain burned in my memory- what a gift it was to have that show for so long. Justified and Terriers were so amazing last year, and sadly only one will be back (but at least that one happens to have Timothy Olyphant on it!). The Walking Dead was infuriating in wasting such initial potential, and The Killing was just infuriating.

The bro-seph officially entered permanent grown-up-ville, and went and got himself married at an over-the-top destination wedding, which was, all told, quite lovely.

Das Racist's Michael Jackson is mesmerizing- how something can seem both so profound and nonsensical at once is modern art at its purest form in my opinion.

I nearly purchased a home this past year, but then realized what I really wanted was space. Now I live in a comfortable (rented) house with a spacious kitchen. Unfortunately, that resulted in a major war with ants at one point last month, but I triumphed. Chocolate ganache, macarons and marshmallows in 2012!

A Happy and Safe New Year's to any of you reading. Since I am working in the ICU these days, a special emphasis on the safe part.

I read again between the lines upon the page

The bro-seph is getting married next week, and I really should be making preparations for that. But frankly, given time off from internship, I've found that instead all I keep doing is tucking myself into a cocoon. It's one of the good and bad thing about my new abode. I love the place, which is great because I am happy when I am at home, but slightly less great because it increases the activation energy required for me to leave the house. I am on the verge of needing an intervention.

It has not helped much that it has been raining, announcing the onset of winter in this neck of the woods, encouraging me to put on warm slippers and drink a glass of red wine. Or that some drama got kicked up in my life just when I was starting to feel even-keeled about things.

Today I've been distracted by other thoughts. Like the very serious question of how it is possible to take two hilarious people, put them in a movie together, and make a wholly un-funny film. I never went to see Due Date when it came out because the trailers did not seem very promising, but it's amazing how humorless it turned out. Galifianakis, who I still enjoy watching when he visits Conan, maybe needs to take a break from all the movies. And I don't even know what to say about RDJ, who if I'm being totally honest with myself hasn't really been charming since Iron Man (not 2). Maybe the movie just revealed the problem with these two actors.

Anyway, you won't believe it, but this actually beats pondering other questions in my life.

Sometimes I wish I was wired a bit differently. I wish I were more casual about things, that I didn't take so much so seriously. I wish my feelings were a bit more transient, a bit more pliable.

But the problem, of course, is that I don't actually wish that. I think what I really wish is that this characteristic occasionally served as a blessing instead of a curse.

everything is temporary anyway

I don't have any pictures to post, but maybe that's a good thing, because I seem to only be worse at taking pictures.

It's okay, because on other fronts, I am improving. At least, so I would be led to believe if the adage holds true that one can age like fine wine. Most of the time, for my birthday, I will bake myself a cake. It may sound pathetic, but I have always enjoyed it, and, well, who are we kidding? I pretty much do what I want.

I'm not so good at keeping to patterns and traditions and all of that. So I didn't bake a cake today. I made a pizza, with fresh mozzarella, and basil that I'd been growing for the past few weeks, and homemade whole wheat crust. All of it was what I wanted- the mindless rhythm of kneading dough, the fresh smell of basil leaves, the cute plump balls of mozzarella which spreads as you bake it. It wasn't a cake, but it was what I wanted and I made it.

It's been sort of an important thing for me this past year, reclaiming the certainty that I can be in charge of my own happiness, that I can stay content with life, that I can provide myself with the things I need to get by. Doesn't mean there aren't advantages and equal pleasures to sharing one's life. But it's always important to know that the basics hold true.

Anyhow, then I ventured, and had some failures. First, last week I was having a wave of nostalgia for the East Coast and EBF, and thinking about how no one ever sells maple syrup candy around here. Mind you, when I was growing up, the only time we ever got maple syrup candy was when we were visiting Vermont to show relatives the sights. But still, I loved the simplicity of maple syrup transforming into this simultaneously creamy and grainy candy that was bursting with maple flavor. I decided to give it a go on my own last week, and I forgot the first rule of maple syrup- use your biggest pot and keep your eyes trained on it. At least now I have a clean stove? Second, I was brewing iced tea today, as I do every week, but in my rush to do five things at once, I shattered an entire bottle of iced tea on the floor of the kitchen. On the up side, my kitchen floor is now clean?

Then I decided to go for the full experiment. I did not feel up to baking a cake today, but I have become increasingly interested in the aesthetic aspect of baking. I also had some leftover strawberry marshmallows. I had made them from fresh strawberries, and they were quite good. But it turns out, there are only so many things you can do with strawberry marshmallows, and I had not made them at a time of year compatible with hot chocolate. Anyway, the leftovers had gone slightly stale. But I had been reading recently about the concept of making homemade fondant from marshmallows.

I've never messed with fondant. For one thing, I don't know anyone who likes the taste of fondant, that smooth stuff that wraps up cakes, but that people invariably flick aside when they are eating the cake. Plus, most people I've known who have opted to tangle with fondant have bought the fondant from the store.

I did not want boring white fondant, nor did I want to make them from storebought marshmallows. I had my doubts that I could even get it to work. Truth be told, I'm still not sure I did. I have a little ball of fondant sitting in my fridge right now. It's smooth and elastic, and a pale pink. I suspect it has a hint of strawberry flavor.

Mostly, I was starting to imagine it. A chocolate cake, or a lemon one. Chocolate frosting, or vanilla. With little fondant flowers. Or a petite cake, the kind I actually like making most, a little 5" cake. Chocolate on the inside, a layer of strawberry jam and perhaps something chocolatey, fondant covering it. I have some ideas. Let's see if I can make any of them actually happen. But that's for my next day off.

you must leave now before the sunrise above skyscrapers

Sorry, this has nothing to do with anything that I usually even mention on this blog, but I figure maybe 1-2 people are reading this thing anyway, so it's just echo-space for my silly ramblings. So ramble away I will. This afternoon, soaking up my day off, I could not resist the temptation, and went to watch Drive, because it's the sort of movie that seemed worth seeing in a theater.

It was. I won't gush about Ryan Gosling or the very strong supporting cast, or how the movie subtly enriches an otherwise unoriginal story. I am not much of a film critic, and ever since I went into medicine, I find myself drawn to increasingly mind-numbing entertainment, so one should probably not listen to my opinion anyway.

But the film is set in LA, a place of which I've never been particularly fond. I lived in Southern California for about a year. There is something the movie portrays that really struck a chord. The film is set right in LA, but the characters are quite isolated. They seem to have their little sphere, but are fairly solitary. Now granted, some of this is the constraint of storytelling and keeping things focused. But some of it also seems true.

I used to drive a lot in Southern California, it's a place very well-suited for driving despite the horrific traffic at times. There are so many people living here in California. In some ways, it wasn't even that different from my early days living in San Francisco, when I hadn't yet found my footing. Everywhere around, people, but yet, so many people were alone.

Me, I don't feel so lonely. I like being by myself most of the time, and when I don't, I'm fortunate in that I'm not in want of a friend when I'm in need. But it's an interesting juxtaposition, this concept of being surrounded, of being in densely populated places, and yet, being isolated.

Maybe I've been thinking about this even more because medicine is like that. All day long, inundated with people- fellow residents, attendings, nurses, patients and countless others. But it's a bit of a ruse, much like living in a city. During work hours, you are surrounded, but the work itself can isolate. Just something I'm pondering.

***

In other, more familiar news, big shock- I spent some of the day baking. I'm still fooling around with frosting cupcakes. I don't know why suddenly this has become a thing for me, but apparently it has. Anyway, here is my latest, weak attempt:

It probably would have helped if I had attempted this with something other than caramel frosting. I really should probably concentrate on actually getting the taste of cupcakes down before I start messing with the decorations, but as usual, I don't know how to do things in a stepwise process. Head first, dive in, make a mess, fudge it, shrug, and try, try again.

we require certain skills

It did not get particularly cool, not in absolute terms. But it's September, and several days had hit the triple digits. And finally, I had a real day off. Oh certainly, I get one day off a week, it's required these days (cue the remarks from various members of the old guard chiming in with 'back in our day, we worked 3 weeks straight without a day off and we weren't allowed to sleep and there weren't any residents to consult' walking-to-school-up-hill-both-ways shenanigans). But this was the first day in a long while that I wasn't distracted wondering about what was going on with my patients, or using that precious day off luxuriating in the opportunity to catch up on laundry and bills.

No, yesterday, there was a slight breeze in the air, and it occurred to me, how fast it's all going by. It's almost the end of September. I still feel like I am at the beginning of my training, but yet some things are becoming intuitive. And I finally had a chance to breathe.

This is not meant to be a woe is me post. I chose this course, and knowing full well what it entailed. And though it's rigorous, I still make time to do what I please. I haven't broken my track record of once-weekly baking excursions (though, unlike in my previous blog-life, I rarely spare a moment to snap pictures of baked goods these days). But yesterday felt like the end of the summer. It wasn't quite the right time to start bringing out the apples and the pumpkins, even though in some parts of the country, it probably feels perfectly appropriate to do just that. I know it's technically more of a spring type of thing, but it felt suddenly like an orange kind of day.

So I bought myself some carrots.

It amazes me how many people love carrot cake. Me, I always had an aversion to it as a child, because I hate raisins baked or cooked into anything. So it was always a profound disappointment to start to bite into a slice of carrot cake and then suddenly be assaulted by soggy raisins. I wasn't too crazy about the overly sweet and thick, coat-your-tongue frosting either. In short, I was not a fan. Maybe there were just no good carrot cakes to be had in EBF.

I'm still a little suspicious of carrot cake, as it mostly to me seems like making a good spice cake. But for some reason, I was in the mood to give it a shot yesterday. There are a few important things I've learned about carrot cake over time. One is that you cannot use coarsely grated carrots. The extra time to shred them super-fine is a bit of a chore these days, but it is worth it. The second thing is that carrot cake is best when slightly spicy and sweet (the latter being an easy task given that carrots have natural sugar in them and then you add some sugar into the batter to push it over the top), but the frosting that accompanies it is best when slightly tangy and just mildly sweetened.

The stakes are a little higher nowadays. I laugh just writing that, because actually, no, they're not. But it reminds me of one of my patients, a 22-year old with sickle cell trait. I was encouraging him to take a walk around the floor today so that he doesn't get too conditioned and so that he doesn't develop clots from lying around all the time. He waved at his hospital gown from top to bottom and said, "I can't walk around like this, I got my image to think about!" It was actually a completely in-character thing for a 22-year old college student to say, but for some reason the nurses and I were in hysterics about it for the rest of the morning. It just struck us as humorous, to worry about your rep when you're in the hospital.

So no, the stakes aren't really higher; that's just as silly as what my patient said this morning. But there are certain things I make now because I know they're reliable. I save the experimental stuff for these true days off, because I know I'll have time to make some boring, standard cookies if the experiment ends in fiasco.

It's funny. When I bake, I miss some people, I really do. I'll bake something and think oh, he would have liked that or she used to ask me to bake this for her or it's too bad he's not around to taste this, it's his favorite flavor. But the lovely thing about baking, and maybe about life in general, is that new people show up. They don't fill the void, they don't replace anyone. They are just new, and somehow, room gets made for them. Just new people, who ask if I knew that carrot cake was their favorite kind of cake. And all I need do is shrug, push a cupcake towards them, and make a mental note to bake them some more at a later date.

p.s. in case it isn't obvious, it is about time for me to give up my ancient relic of a digital camera and upgrade. If anyone has a suggestion for a reasonably priced one, suggestions are welcome.

don't wish it away, don't look at it like it's forever

I have no pictures to share for this post. Right before I started internship, I realized that my digital camera was purchased in 2001. I'll pause for a moment and let the few folks reading recover from hysterics.

There. Anyway, I'm horrible at the taking of photographs as it is, and even worse at remembering to take a photograph when it might come in handy. I guess, in the current age, that makes me something of a weirdo. Well, that among other things. And it is interesting, because every once in a while, I start to wonder if some of the strange absurdities of my life really happened since I didn't document it onto Facebook or commit it to film or photograph.

Luckily, I always have the words. If I didn't write the words, then it must not have been very important is my thinking.

So let me write these words. Two sentences, stated. And then maybe I'll ramble some more.

1) I made cinnamon cupcakes and frosted them with chocolate ganache and they were met with enthusiasm.

2) Internship is, indeed, a rollercoaster ride.

About the first point, there is little to say except I wish I had taken a picture of the little things. Even though the macaron class I took was probably way beyond my expertise and even though I'll likely never successfully recreate the macarons the way I was taught during that lesson, I did learn from that class to get over my illogical fear of pastry bags. Yes, I've now become quite comfortable with piping frosting. I don't think I'll ever be an expert decorator or anything, but it's nice to be able to at least frost a cupcake with a little swirl, that was described by one of the more humorous residents as "professional-like."

About the second point, there is much more to write, but nothing which would be in any way novel or interesting. I suspect every intern feels like this during the beginning of their year. Every time you think you have figured a few things out and you may actually be getting the hang of things, something happens that makes you feel incompetent and makes the learning curve seem hopeless. It's quite the contrast to 4th year of medical school, during which the powers that be act like you are a genius if you can manage to speak without drooling out of the side of your mouth. Now, there's always this feeling of "why don't you know this?" pervading every piece of feedback I've gotten daily.

And every day, I have to stop and realize that this is a universal feeling, and I don't know why everyone acts surprised every year that the interns are clueless. No one has really been prepared for the job, no matter how hard you work during medical school. And even if, by some miracle, you learned how to do your job properly at some point, too bad, because you get whisked off to another rotation before you've had a chance to really get your bearings.

Every day, I have to stop and remind myself of my goals. I have to remind myself that I'm not striving to be a meticulous note-taker, or to be so efficient that I can round on eight patients in 30 minutes in the morning. Yes, these are necessary evils which one must somewhat master during internship, but it's not where my focus is, nor where it will remain, in the long-term.

Then I have to also remind myself that I'm only 4 weeks into working inpatient medicine, which means, I am still in the preemie/newborn phase of internship. There's still a long ways to go, and I, as well as it, will get better. My real goal is to learn how to care for patients properly, and to do that while still maintaining a personality and an ability to interact with people as if they were human beings and not medical record numbers. I just have to keep reminding myself of that.

am I really who I was?

I'm post-call, so perhaps a bit delirious, but I don't think that's what's causing this reaction.

It's just that sometimes I want to curse at Ryan Adams.

Adams best exemplifies my inclination towards knowing as little about an artist's personal life as possible. I try to pretend that I don't know that he can sometimes throw temper tantrums during shows. It would be best if I didn't know he was married to a movie star, or that he had a substance abuse problem.

Unlike some artists, though, Ryan Adams is insidious. You can think "enough of this whiny sh*t, I'm not falling for that schtick again." And then along comes a song like Lucky Now (link in the sidebar if you're interested) and the bastard has got you in his clutches again. I know the way I'm describing it does not sound very complimentary, but sometimes I really do hate Ryan Adams' knack for writing these songs that just stab you in the heart and floor you. I was just minding my own business, experimenting with malted milk and brownies in the kitchen, trying to regain my footing from working my first serious overnight shift, fairly involved in the world of electrolytes and diabetes and sepsis, when this song comes along and destroys me.

Destroys me in a good way, mind you. This is, actually, how I express my love, which might tell you something about my issues in life. Right now, I work a lot. It's so tempting, I can't describe how much, to just dissolve into the world of work, to become singular in focus, to drown in it. It's controlled and safe, that kind of drowning. Ryan Adams' latest single perfectly encapsulates the problem with following that impulse, though. It's a melancholy song, even sad, vague about whether things work out or not, filled with doubts, but then it throws in this little line:

and the night will break your heart
only if you're lucky now

That's the thing. It is the things we can't control, the things that we make ourselves vulnerable to- those are the things that mark our good fortune. And Adams knows the part that everyone conveniently overlooks- most of the time, taking that risk, making that move, most of the time it ends badly. But that's exactly the point.

There are other things that make this song beautiful- the way he throws in small details that paint a beautiful backdrop, that smooth voice of his, the deceptively soft-rock quality of the music which tricks you into thinking you're engaged in easy-listening. But mostly, he takes you down a road, tells you about all the potholes, the bandits and the wild animals you'll encounter, but just as casually remarks:

if the lights draw you in
and the dark can take you down
then love can mend your heart
but only if you're lucky now

Sometimes it works out, sometimes it doesn't. Either way, count yourself among the lucky. Ryan Adams has no right to be that insightful.

In other news, I have a new GBF, though he doesn't know it. He is the cashier at the cafeteria. He only works nights, but I am grateful for that, because there is nothing like running down to the hospital cafeteria at 3:30 in the morning, dead-tired, grabbing a bowl of soup, and encountering this dude blasting Superfreak. This morning, he said, "what's your deal, honey, you married? You got a man?" I said I didn't and he started running through a list of hot surgeons in the hospital. I played along, and he said "next time you come by, I'll point them out to you. Don't you worry, I'll take care of everything." I think this is the beginning of a beautiful friendship, people.

you make me better

It's only been a month and a half, but I'm really starting to question whether I will get out of residency with my humanity in tact. I will have to think about that some more and expand upon it in another post. But for now, I'll just say that I am always angry- angry at the residency program and how it is set up, angry at the government and politicians and how they are creating a system that is going down the tubes, and finally, yes, it's true, angry at certain patients. And I haven't even done anything truly taxing yet in residency, so I have legitimate reason to be worried if I am already feeling that way.

Anyway, in other news, guess what I did? I made a horrible, tasteless, bland-as-cardboard, disappointing birthday cake recently. I got away with it for two reasons. 1) It looked like this:

Points for presentations, folks, apparently. You can google zebra cake if you want to find a recipe, but I warn you- this cake is so sadly tasteless. Nothing that visually remarkable should be such a letdown. I am currently contemplating how to adjust this cake such that the taste matches the aesthetic. However, there was another reason you are viewing a half-eaten cake and that is 2) homemade chocolate ganache.

I don't feel strongly about all that many things these days, but I feel strongly about chocolate ganache. For example, I think it is a crime to try to make frosting out of cocoa, butter and powdered sugar. You can try whatever ratio and method you want, but you are never going to get a very chocolaty frosting with those ingredients. Object if you like, but I contend there is only one acceptable frosting in this world, and it is chocolate ganache. Beautiful, tasty, glossy (if you add just a dab of that notorious rascal corn syrup to it), and most important- bursting with chocolate flavor. If you don't make chocolate ganache frosting, I guess my only question is- why do you hate chocolate?

Though I made a batch of chocolate ganache to disguise the disappointing zebra cake, I had a solid jarful leftover. Want to know another lovely thing about chocolate ganache? It can serve many purposes. I spiked it with a minimal amount of chocolate liquor, and stored it in the fridge, and now I have a homemade fudge sauce. I served it with some strawberry ice cream (from the last post) to the broseph and he may have lost his mind.

In other news relevant to things about which I feel strongly, I am trying to watch Mad Men again. But I think I am never going to get into that show. I doubt I'll ever find it fascinating to watch a show celebrate an era during which I would not have been permitted to inhabit even a semblance of the life I currently lead. Blerg to that.

we want to make him stay up all night

A semi-surreal moment this morning well encapsulated my last 24 hours. As I was walking to the parking lot, undoubtedly wobbling and weaving, a red sports car rolled backwards up the street until it was beside me. The window rolled down and the GI attending called out my name and I stopped to chat with him, wandering into the middle of the street as if I wasn't at any risk of getting mowed over by oncoming traffic. He asked me how it was. I told him it finally felt real.

It was my second week of internship, but my first night of being worked like an intern. I probably should have been more afraid, but I was obliviously tinkering around yesterday in the kitchen. I made a batch of chocolate chip cookies, and then I churned this up while reading about how to place central lines:

That, by the way, is the bomb. My friend RR had advised me some years ago that strawberry ice cream is the best choice when considering homemade ice cream, as he felt the fresh ingredients shone the best. As usual, I ignored his sage words until I'd finally found myself confronted with a ridiculous amount of strawberries and a kitchen that called out to be utilized. But let me tell you, this is the way to go.

After that, I marched off to the hospital, and got my world turned upside down in the best way possible. The last two weeks, I'd been a doctor, technically, but was still treated like what I classified as a "baby intern." Last night, I was prescribing meds and admitting patients and pronouncing death. Last night was the real deal.

I won't go into too many details, because it will come across as whining, but I rather enjoyed it. Besides which, I think it's the sort of thing that's not nearly as interesting as I think it is. What's probably more worth documenting, remembering and relating was a conversation I had with one patient.

He was 80 years old, sharp as a tack despite a stroke that had left him partially paralyzed on one side, but he'd come in with a fever and chills and a likely urinary tract infection. He was accompanied by his daughter. It's interesting to me, to hear how families come together in old age. After the stroke, the patient had been moved from his home in Missouri to California, where his son was living. At the same time, his daughter moved from Massachusetts to California to also be close to her father. The patient was going to be staying at an assisted living facility, but both of his children wanted to be close by to see him as frequently as possible.

His daughter was very involved in his care; she was the sort of person you dream about having accompany a patient to the hospital- a veritable journal of his past medical history and medications. As she was rattling off one detail after another, her father, my patient, said to me, "I don't know where I'd be if it wasn't for her."

I smiled and turned to his daughter, to make sure she had heard. She smiled, unphased, and simply said, "well, I don't know where I'd be if it wasn't for you, Daddy-o, so let's call it even."

Nothing fancy, no big swelling scenes with tears and drama. Just a simple exchange. But as any of us with complicated family relationships know, it's a precious gem to have that sort of relationship.

And I thought today that, yes, there was a lot that happened last night, a lot that I could colorfully relate to my co-interns when they asked me how my first night float was. The sort of stories that are badges of honor, that earn you your stripes in your training. But what I really want to remember, what I want to keep lodged in my memory years from now, was that little moment in the chaos and cacophony of the emergency department.

there's so many different places to call home

I was going to start this post by writing that I sometimes wish I didn't take baking so personally. And then I called shenanigans on myself, laughed, and realized how absurd a statement that is.

Very simple things, like flour, butter, sugar, and eggs have brought me great peace, have filled me with a contentment that I only otherwise get from my chosen profession, and have made me feel productive when I am at my most laziest. Baking has humbled me, and it has given me confidence.

I tie a lot of emotion to baking, which sounds hokey, but I do not really care. I own my weirdness about it. I bake when I get stressed, but when I get too stressed, too upset, really down in the dumps, I can't do anything in the kitchen because I am paralyzed. And that just makes it all the more satisfying when I make amends with the mixing bowl.

There is an unnecessarily dramatic story behind a Kitchen Aid Stand Mixer that entered my life. I have had it for about eight months now, and only today did I finally allow it to be part of my kitchen. Even when I moved into a new place, I put the mixer straight into the garage, until today, when I realized I was holding onto something I shouldn't.

I've never been one to ease into anything. In medical school, I became fond of experiments to do with yeasted things- pizza, rolls, bread. Things that required a rise and a fall, firm kneading and patience. On one such experiment, I madly ignored everything I had read and thought I could attack the making of brioche with nothing but my own elbow grease. And oh my, how wrong I was. It was a spectacular failure. Brioche failure stings even more because it requires such a lot of butter and eggs that it feels more wasteful than other kitchen disasters. The handmade failure brioche, I could not accept it was a fiasco, so I kept at it, and even tried to bake it into individual pain au chocolat, which only resulted in wasting good chocolate in addition to all of the butter and eggs.

Well, when I finally put that stand mixer on my counter today, I knew there was only one thing to be tackled. The brioche dough is now on its second rise, and looks to be turning out exactly as planned. The only question is what to do with it- simple brioche loaf, sticky buns, little pillows of brioche with chocolate inside? So many possibilities.

Update: I opted for a few different options, but here is one of the best- cinnamon rolls made with brioche dough:

I hope it will not be my last opportunity to bake this year...

tables they turn sometimes

Life has weird shifts, sometimes predictable, sometimes not. Even though I knew this good time was coming, even when I was in the dumps, it still surprised me when it arrived, the sudden nature of it and the intense contrast.

Even though it is coming on scorching season here, I sat down with a sweater I'd been working on ages ago. It was something I had started at least a year ago. I would work on it a bit, and then set it aside, then pick it up again. The yarn was very fine in weight, which meant it took forever to make any progress. But eventually, it also became clear that I kept putting it down because it wasn't really working. The variegated yarn wasn't quite meshing with the patterned stitches, and the sizing seemed off. But it seemed like something I'd been working on for so long that I'd hesitated to give it up.

Sometimes salvaging is the right call, other times ripping. A lot of the good things that happen in life are from salvaging a less-than-ideal situation; I've certainly had my share of making lemonade from lemons (or, in the case of last weekend, making chocolate dipped brownie truffles when a pesky batch of brownies stuck to the pan). I had stared at that sweater-in-progress for a while- lengthen it, shorten it, make it short-sleeved, make it a vest? I had considered lots of different angles, but nothing seemed to fit the idea I had in my head of what I wanted the sweater to be.

And finally, I ripped the whole thing back down to skeins. Yes, I had invested a lot of energy in the sweater up to that point, but I had not rushed into destruction. I had assessed. It was a losing proposition. It was time to let go.

So today, when I had a free morning, I felt a sense of validation. I had re-knitted the entire sweater in an eighth of the time it had taken me the previous time, and the moment of truth had arrived. I stitched all the pieces together and the finished product was exactly as I had wanted it to be.

Speaking of which, here is a picture of rose macarons:

Being a little (ahem) taken with baking and challenges, I had become intrigued with macarons over the years. So I was surprised that a lot of my friends had never heard of the little wonders. They sound simple, and therein lies the peril of the macaron. The cookie shells are made of ground almonds, sugar, and egg whites. Just three ingredients. How complicated could it be? Answer- very complicated. The suckers are notoriously finicky, sensitive to humidity and the batter consistency. A slight imprecision in measurement can also cause an epic fail. I had read on the interwebs so many tales of horror regarding these cookies that I had avoided giving them a go for years. But my friend SP nudged me into it recently by presenting me with a macaron making class as a graduation present. It was phenomenal. I got to make and pipe this batch of macarons myself, though truth be told, I'm still skeptical as to whether I can recreate them in my kitchen. I should probably try again soon, before the wave of good juju rolls on by.

I think I'm in love but it makes me kind of nervous to say so

It is the end of what may seem to some an uneventful day. In the morning, I transferred frozen tilapia to the refrigerator to thaw. Since everyone has been moving away, I have been inheriting all sorts of things I would never usually use- thus, tilapia. Then I baked a batch of chocolate chip cookies under the guise of needing to test out my new oven. I did a load of new laundry in my new washer. I went to my old apartment and packed some final boxes, then returned to the new place and unpacked them.

Having cried uncle by the late afternoon, I asked AP to come help me position some of the more awkward items (ladder, a large framed Modigliani print, the usual stuff) into my car. She came over in the late evening, and we both had a hearty laugh at how ridiculously sweltering it was in my old apartment.

Sometimes you do not realize how bad things were, or how your circumstances were affecting your happiness until you've moved on. That has been a big theme of late for me. I could not explain why I felt so much happier the past few days, or why I was sleeping like a rock. It did not occur to me until AP and I were sitting at the dining table sipping iced tea (if ever you should be looking for a good choice for making Iced Tea, wow, Good Earth is fantastic for this purpose), she nibbling on the cookies I had baked, me playing with the table mat while urging her to watch Justified. Only then did I realize how much happier I am now than I have been, perhaps for the past few years.

It's so inexplicable, how we go from a place of deep sadness, to numbness, to contentment, to sudden, sincere happiness. The progression is a mystery. Medical students used to joke fake it til you make it, and I wonder if there is not some component of that to life in general.

AP begged off, and it was late, but the tilapia were waiting, thawed. I roasted them in the oven while making mashed potatoes. When the filets emerged from the oven, I placed one hot on a bed of baby spinach. I stood at the kitchen counter for a moment, staring at the plate. And then I sat down and had dinner, and felt a wave of all sorts of emotions. I can't really explain it in any other way except to say: I'm back.

if somehow you moved from point A to point B

As everyone around me starts to rocket launch out of the orbit of school, to their respective next steps, it's strange to stay here in the center, to move on without moving. It was my choice, which is a fortunate thing, but it leaves me (surprise) contemplative.

The strange thing is that, four years later, a lot has changed and not much has changed at all. The bloom is off the rose, I suppose; I don't have romantic visions of what medicine is or will be for me. But then again, I'm not convinced I had such idealized notions at the start. I just knew it was what I wanted to do, and, four years later, nothing has altered that. Whatever else has happened, keeping that part, that certainty, that has been more than enough- that's been everything.

But just as with any large stretch of time passing, I remain mystified at how little I know, how much more there is still to learn. About medicine, about life, and even more oddly, about myself. I do not mean to frighten anyone heading into the hospital, but I feel like it will be quite some time before I feel confident that I know what I am doing as a physician. Some people dread it, but I welcome internship as that slap of reality that will hopefully, finally shape me into a real physician.

Then, strip aside the knowledge aspect, and still there remain other things to learn. I had plenty of difficult conversations prior to starting medical school, I had plenty of experience chatting with people in a professional setting. But I have noticed I still have a ways to go when it comes to the physician-patient relationship. Sometimes I talk too much, occasionally I interrupt too much, sometimes it takes me a bit too long to understand what the patient's objectives truly are, and I can still feel the hesitation when the conversation is turning towards something the patient does not want to hear. All of those things, though, worry me far less. The whole point there is to pay attention to your deficiencies.

In that way, it's not that different from any other relationship. It can be easy to say, especially the older we get, this is just how I am. That, however, is some weak sauce. A remark like that is a cop-out. You have to own your decisions in life, but you have to own your behavior too. It's easy to conclude I'm not good at having conversations about dying, but that's also an easy way to close yourself off from being a good doctor. No one is born able to have a mature, informed, sensitive discussion with a patient's family about their loved ones' health. It comes with time, and, unfortunately for patients, it comes with experience. Some people have more of a natural inclination towards it than others, but it really does a disservice to medicine to not push yourself to be better, to be competent.

I feel that way about my other little quirks. Some of them, I own. I don't find it strange to go off the grid occasionally, to take some time to myself, to spend a morning experimenting in the kitchen. But there are other things I have learned to change. I forgive people and friends now in a way that I did not before. I've become better at giving people extra chances without letting them off the hook. And I still have other things I need to change, like the way that sometimes I still have trouble accepting help, sometimes I still have trouble recognizing that I am being disrespected. I am no longer content saying that's just how I am. If anything, I guess in the past year, I have learned to want more, to be comfortable with wanting more. Shouldn't we all want that?

alright already, the show goes on

Some other things, though. B's comment on my last post reminded me of another epiphany that I had over the past month. I congratulated myself, but I did not acknowledge the full strength of vulnerability. This may seem cheesy, but the amazing thing about drawing up the willingness to ask for help is how quickly people come to your aid. Even someone who has spent the better chunk of her life creating a persona of self-reliance, even I had people around me who rescued me.

Some of them weren't even around. A few weeks ago, AL called me, and we did not even talk about the less fortunate aspects of my life. He did not know the beginning, the middle, and so there was no point in telling him of the end. He had just called to say hello and we just had a good chat. But beyond that even, friends like B and countless others, I felt them. They are the good thoughts around you that tell you that you will weather any storm, that you are worth knowing. They give you the confidence to move forward, the encouragement to forge new relationships. They remind you to be grateful.

I went back to San Francisco last week. For the past year, when I went, it had not felt like my city anymore, like I was no longer connected to it the way that I once was. But when I returned this past week, it felt like I had truly returned. I walked from Potrero Hill to the Mission, the sun and the wind my companions, alone on the path once again. It felt right. It always feel right, like I am coming back to a center, as I saw the fog start to settle on Twin Peaks. It did not matter that the neighborhood was teeming with bachelorette parties, that things had gotten more expensive, that some bars had disappeared and others had risen up in their wake. The city keeps on moving, keeps on changing, forces you to acknowledge that life is by its nature dynamic.

And just as the city forces you to acknowledge that time stands still for no one, so do children. Years can pass by between friends, and you may feel that no time has passed. But when years pass by with a child, the kid has transformed when next you meet. RR and I coordinated our schedules to meet, and as a result, I got to see my godson. It had been at least two years since the last time I saw him; at that time, he was shy and very attached to his parents, not very interested in interacting with anyone new. Now he is nearly 5 years old, and while still charmingly shy, he warms up quickly. His mind is fascinating and inquisitive, brimming with questions, including the whopper "why does the ocean make waves?" (I gleefully wished my friend RR good luck breaking that one down.) We spent a few hours at the beach, building sandcastles which his little sister took absolute joy in smashing, filling buckets with water, and marveling at the little creatures that came in with the tide. My godson tired of the futility of sandcastles, and started to draw train tracks in the sand, occupying himself. RR and I started talking about heavy subjects, and the contrast struck me- happiness gets increasingly complicated as we get older.

But then again, as we got off the beach and all piled back into the car, the kids were getting buckled into their carseats, and my godson turned to his father and asked if I could sit in the back with them. He has only ever asked if his grandmother can sit back there. Funny how at that moment, happiness was just that simple, just as simple as a little boy asking you to sit next to him for the car ride home.

all that was there will be there still

I keep wanting to write ridiculously trite statements about how my professional life is going very well, but my personal life less so. It never seems honest, because the fact is I take my profession very personally.

In my last post, I wrote a statement of some premonition about my life looking very different in a short time. I had no idea how true that would be, or in what ways it would look like such a changed world. It is a strange thing, indeed, when the rug is pulled out from underneath you, when the ground crumbles beneath your feet, but you remain in the very same place, and it was where you wanted to be.

Taking stock of everything now, I find that I am getting by. There were many fits and starts over the past month. I am so excited about starting residency; as frightful as the concept of taking on responsibility for the care of a patient, what a privilege and fortune it is. I do not take that for granted, and for that I am immensely grateful. Getting out of medical school with one's perspective somewhat in tact is, as it turns out, a challenge.

I do not take myself for granted either. It sounds a bit pompous, but I had no idea how strong I really was until the last month. Strength for me has become about more than maintaining a stiff upper lip or seeming unmoved. Those were old coping mechanisms, I had outgrown them. That was no way to live. So, instead, I found strength in getting thoroughly crushed, getting heartbroken but good. There's something strong in it, accepting that kind of overwhelming emotion and pain as part of the spectrum of what is possible, then moving on anyway. It sounds crazy, but I have no regrets.

Also, I have completed medical school feeling very confident about my ability to bake a foolproof chocolate chip cookie. I use more than one variation of a recipe, because it depends on how much effort I want to put into it, but sometimes it is nice to know that, whatever else may come to pass, you can count on butter, brown sugar and flour to do its job.

let's not try to figure out everything at once

Everyone kept telling me that fourth year of medical school is the time when you unwind and do all the things you've been putting off for the rest of your medical training. Thing is, I wound up keeping myself far more occupied than usual this year. Between clinical rotations that helped clarify my future, applying for and interviewing at residency programs, embarking on and maintaining a (gulp, ick) relationship, q5 baking, and keeping up with the rantings of Charlie Sheen, I feel like I have been so busy this year that this weekend was one of the first times I actually have had a moment to contemplate what soon lies ahead.

One more week, and that's it. No more clinical rotations. Officially, I'm done.

In two weeks, I find out where I'll be spending the next three years.

And until this past week, I have been industriously avoiding all of my natural tendencies towards churning about all of this. I can see how actually it is quite momentous, but it is as if my brain just knows it is better to watch the chips fall rather than plan out various scenarios and contingency plans.

I could be living an entirely different life in just a month.

But I guess, when I think about it, when I have the time and give myself the allowance as I do tonight, medical school did not change the things about me that I did not want to sacrifice. Even though I was not as wide-eyed and pliable as my classmates, still, these years have been formative. Yet I still feel very much me, if that makes any sense, and that seems to be of comfort when I think of what the future might hold.

And while I could tell you some stories about my rotation in the ED that took a few bites out of my idealism, I still enjoy patient care, in ways that I will not cheapen by nattering on about. I am not a physician yet, not even close. And even though I will have a medical degree in a few months, it will still be a while before I become anywhere near a competent physician. But I am starting to get an idea of the sort of physician I want to be. So I have not really been thinking about any further details, and maybe, for once, that is just fine by me.