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.