since we found out that anything could happen

Well, my batting average is way off. I've still wanted to write, but sometimes now my thoughts get so ensnared in medicine and I don't care to dwell on that in this space, at least not all the time, and as a result, I haven't had much to post. It's not medicine, but medical training that sometimes engulfs me a bit too much.

But I don't feel like complaining about medicine right now, or really ever.

It's spring here, which is beautiful and heady and intoxicating. But like many an intoxicating thing, not so great for me. With spring comes pollen, and with pollen comes clogged up sinuses, headaches, and watery eyes. So the spring often turns me into a shut-in.

There are advantages of course. In the spring, the weather's not so hot here that I feel guilty about baking. And since I'm stuck inside, it's a good excuse to take on some new experiments. I'm not someone who ever becomes an expert at baking much of anything. For me, the process and the experiment is most of the fun. Last weekend, when the allergens first infiltrated the air, I got it into my head to bake cream puffs.

It should be noted that I don't eat cream puffs, I've never been inclined towards them. The broseph loves cream puffs- he was the first person to rave about Beard Papa back before it was the mainstay it now is. But I have to admit that I didn't set out to make cream puffs because I'm a good sister. Besides which, my brother's really become a full blown San Franciscan, which is coming to mean that he talks about pastries and decadence but actually consumes kale juice and quinoa. So, no. I took on cream puffs because of the reason I take on most projects. I thought I couldn't do it.

And what that usually means is that I can't actually do it. Not at first, at least. Cream puffs, like most French pastries, are temperamental. You have to get the dough (which is cooked before it's baked) just the right consistency, and then it has to bake just so, after which, you hold your breath and hope it's light and airy enough to live up to its name. The first attempt last weekend seemed to be going well. I thumbed my nose at all those reports of puffs being difficult to bake. Twenty minutes later, when I was staring at deflated hockey pucks of dough, I was singing a different tune. Well, in fairness, I wasn't singing, I was cursing.

Macarons are a major French mind****. They involve a lot of ingredients, and multiple complicated steps, and so messing them up makes you really see red. Cream puffs, on the other hand, are deceptively simple- butter, water, flour, sugar, salt, eggs. So I was not that daunted, because, and I know this sounds weird, but those are staples I always have in abundant supply in my kitchen.

So yesterday, after nasal rinses and antihistamines and whatever else I could think of to clear the allergies out of my system enough to think straight, I tackled cream puffs again. I went on faith, which is what you must do. Half of the recipes out there for cream puffs tell you to beat enough eggs into the dough "until it looks right" which always cracks me up- because how are you supposed to know what the dough is supposed to look like if you've never successfully made it before?!? No matter. I channeled the force and went for it, crossed my fingers while they were baking, and finally opened the oven door with one eye shut. Only to discover they'd turned out exactly the way I'd wanted them. Puffed up, hollow inside, perfectly golden. There may have been some fist-pumping in the air, and an Elaine Benes-worthy dance in my kitchen yesterday. Filled up with whipped cream, drizzled with caramel sauce, and the next thing you know- cream puffs!

Were they the most beautiful cream puffs ever made? No they were not. Did they taste okay? Heck if I know, I don't even eat the things! I brought them over to a friend, CS, who likes cream puffs, and who was having a rough day at work. She reviewed them favorably, but that's probably why I dropped them off to her- her bar was considerably low as she needed any form of a pick-me-up. We had tea while she had puffs and filled me in on her horrible day. Then we laughed. And I will most certainly be making cream puffs again.

keep myself riding on this train

There is this amazing thing that residents drool over called a golden weekend. It is an infrequent but cherished occurrence.

It is what everyone else calls - the weekend.

I'd just had a very long day today that ended a very long week. Today was a particular whirlwind, a mixture of insanity in the hospital followed by chaos and madness in the clinic. And all day today, I had been telling myself- well, at least you have a golden weekend. I kept telling myself that I'd get to sleep off this exhausting week if I could just get through this day.

And then I got paged tonight, and my dreams of a golden weekend vanished. One of the other residents fell ill, and I got called in to cover for them.

Just earlier this week, a former resident was having dinner with me. He, a to-the-bone Midwestern guy as masculine and together as they come, told me that he cried during his intern year. You think that the tears come during residency when people die, but that's not usually what triggers it, actually. For him, it was a very bad day in clinic, during which he encountered a patient who had a ton of problems, none of which he could fix. The frustration reached its tipping point, and the tears followed. At dinner, we were talking about how weird it was that I got through all of intern year without shedding a tear. My friend A concluded jokingly that perhaps I was dead inside.

Today, when I got that page that was just the culmination of badness in a tsunami of badness, I thought- ah, my time has come. I came close. I was telling another resident about my day, and I was getting more and more frustrated with how unfortunate I was. I still had a lot of work to do at that point, and I realized I was just getting upset sitting in clinic, so I went home to finish my work.

When I got home, I was still deflated about my weekend disintegrating into thin air. There's this thing that happens when you're tired and you feel overworked or overwhelmed. You start to feel like you have very bad luck and the sky is crashing on you and the whole world is against you. And it's very easy to just wallow in that and feel like you've been wronged and spiral down further and further.

I don't know if it's so much better, my maniacal approach. But I just snapped at some point tonight and started thinking HAHA- you cannot bring me down, residency! Nice try!! I shall caramelize onions and make cookie dough and frost cupcakes and you will bend to my will! I mean, who am I really fighting besides my own demons and negativity? But it makes me feel better. It makes me feel strangely victorious. Now if you'll excuse me, I have to make sure those onions don't burn. And by the way, despite chopping them up tonight, still no tears.

use your intuition, it's all you've got

Expecting big revelations is the hope of youth. Little secrets seem bigger now. Small realizations are all the more precious because they are fleeting, they light up the sky like transient lightning, illuminating your surroundings for a moment. But not blinding.

Some of my fellow residents were chatting with me today, and we were talking about restaurants. Somehow, it came up, that S only really would ever tolerate going out to eat at about four different places (Chipotle being one of them). Prior to this year, people would ask what went wrong. Today, it was all turned on its head, and everyone was more curious as to what had brought us together in the first place.

That's where the soft glow lit up through the gloom. Medical school, ugh. It's an odd thing. I love residency almost as equally as I disliked medical school. It makes no sense, because it should all be part of the continuum. But somehow, during those four years, I felt a constant pressure to keep my mouth shut, to hold my thoughts as my own, to make no big waves. I was indistinct, a speck of dust, a smudge on the windshield, and it was with great effort that I strived to be that inconsequential.

And in that state, all turned inward, compromising, resigned even, in that state, of course it would come to pass that I would settle. Of course.

None of this is a tale of woe. As soon as I earned my wings and became a physician, as soon as I started residency, I immediately became true to myself again. I was lucky, because to crush someone's personality for that many years in their 20s can be a permanent thing. It was not difficult at all for me to reacquaint myself. And everything I innately knew about myself, finally, after a long drought, others started to know too.

But it's just the flash of a camera, a temporary flicker of light. Some days, you feel known and understood, and you feel quite fortunate indeed. Other times, not so much. Life- I am getting used to it.

and in the instant we are

Plenty of more interesting topics to write about, I'm sure, and this is not exactly setting a good precedent for the new year. However, it is a good demonstration of that old adage- the more things change, the more they stay the same. Here's a recent text message exchange:

NG: Superbowl party at my place, be there.
NG: It's not optional.
NG: Don't ignore me woman!
me: Okay- as long as the Pats don't make it, I'll be there.
NG: What if they do?
me: Then for the sake of the free world, I'll be watching at home alone. Anyway, if I come, what should I bring?
NG: I don't know, I kind of like the idea of seeing you angry.
NG: Bring something sweet.
me: Yeah, except it's anger that turns into a tearful meltdown, which I don't care to share publicly.
NG: Oh yeah. No crying.
me: Yeah. I'll drop something off at any rate, if by some chance the Brady Bunch make it.
NG: Haha, fair enough.

In other news, I'm on vacation right now. I had toyed with going places, but in the end, I realized what I really wanted to spend my time off doing. I wanted to rest and get healthy. So the past week, I've been going to the gym and hanging out with good friends and just feeling a lot less rundown. There will be time for adventures in the future. Or so I hope.

Also, I'm not going to go on a rant about HBO's Girls, but I am going to share Santigold's Girls video. I think it actually points out the disconnect between what the show seems to purport being about (new! now! this generation! new york!) and what it's actually about (privilege! aimlessness! first world problems!). It's like Santigold wrote the song before she'd actually seen an episode. Either that, or she saw the show, and decided to write/create a video in response to it. Whatever the roots, it's classically infectious like Santigold can be. 2013 might not be so bad.

Yet again we're the only ones

Well, let's get it in before the end of the year, because here it is. The year came to a close quickly, before I could really wrap my head around it. And this is maybe the funniest year of them all, with the joke being on me, since I have to go to bed prior to the transition of 2012 to 2013. Such is the reality of my two week stint in the ICU.

About that I'm not sorry though. The holidays put on too much pressure, demand too much conformity, and I have no use for such things nowadays. Besides which, the ICU teaches you all about perspective. Family meetings every day, bad news broken on a steady schedule. Updates that end with hope or heartbreak. And of course, patients falling apart right in front of your face.

Some people have bad luck. Some people keep making the same mistakes over and over again. Some people are the few fortunate ones. Then there are those of us who get to watch it all unfold, who see that entire spectrum, and there is a certain privilege in that.

But the amazing thing I've learned is that perspective only comes to you if you are receptive to it. Even the anvils that the ICU deliver upon your head can go unheeded by those too caught up in their own nonsense to pay attention to it.

This year was so very necessary. That's the only way I can really describe it. I'm starting to understand how much the low points in life are intertwined with the higher ones. Despite my Eeyore-like exterior, my handle is brimful and the song which is the inspiration of my namesake is a pun about hope. This is the secret I keep for you and for myself. This is me, equal parts realist and dreamer, equal parts resigned and reaching. I have the capacity to be kind or to be cruel, and I try, try, try to do the right thing, to make the right choices. But I understand why sometimes others would see it differently. This is me, equal parts deeply flawed and perfect. None of that would be so, if it weren't for this past year.

I hear the bells

Sometimes I think my continued insistence of posting here is much like those cantankerous old writers who insist they only ever use a typewriter. But I still think there's too much brevity in the new world. And I refuse to believe people are only interested in soundbite-sized thoughts. Some thoughts require more explanation. None of my thoughts, mind you, but some thoughts.

Here are some thoughts I have had this week:

In geriatrics clinic yesterday, I heard the best stories. The first involved a retired police officer who had developed dementia. His younger wife is his primary caretaker, so we were asking her how things have been going. She told a story of how her husband had wandered into the neighbor's house one day and told them that a crazy woman was in his house, trying to order him new clothes. She shrugged and said, "in fairness, it was Cyber Monday, and I had tried to buy him a lot of new shirts." They'd had a laugh about it. She finds it hard- her husband had just retired five years ago, and they had plans to travel and enjoy their time together, but the dementia had changed all of that. But she was remarkably amused by all of it. The next patient I saw had more advanced dementia. He was mostly non-verbal. His wife and I sat down for a while to chat about how things had been going. She almost made me cry three times, and I don't have a heart, let me tell you. She takes care of her husband every day, helps him bathe, takes him with her everywhere because he can't be left alone. But she was so remarkably serene about it all. She said it wasn't that bad a task, because her husband is very sweet and he doesn't ask for much, and his suffering seems much worse than hers, in her opinion, and after all, he tells her every day that he loves her very much. Geez oh pete's, you guys. I'm not made of stone.

Every time I hear the melody of "Castle on a Cloud," I turn into a 14 year old dork, unreasonably excited about Christmas day. There was a time, in high school, after I'd gone to New York for the first time, and seen the Broadway production of Les Miserables that I was full-on geeked out on the musical. Then I thought I'd pretty much gotten it out of my system and that it had been an adolescent thing. Then I watched NPH and Jason Segel reenact The Confrontation and giggled, and just thought I found it amusing. Then I saw Jackman's determined expression as Jean Valjean, and I realized, nope, I'm still a geek. I'm going to be that annoying person in the theater, I can tell already.

Even though I rarely wear dresses or get dressed up in general, I have somehow become obsessed with sweater dresses. I own three now. I've been forcing myself to actually wear them, which is actually a bigger undertaking than it should be. Here's the thing- I'm happiest when no one makes any remarks about what I wear, good or bad. But the problem is, there's standard issue attire I've become known for over the years, because I don't like a lot of fuss. So when I wear a skirt or dress, there are usually no less than 17 comments made about this, and I want to run out of whatever bar or restaurant I'm in and change into jeans and a sweatshirt. I really should be more comfortable with myself, and I am about a lot of things, but not apparel, apparently.

I hope someone will yell at me if I don't come through on all these stupid holiday baking plans I have. I have lots of thoughts in my head, people. Thoughts about marshmallows and caramels and cookies and tartlets. But my head is often in the clouds, and a lot of these ideas often end up not happening. I really hope that doesn't happen this year. Otherwise, I will be mighty ashamed.

I've been at war with ants ever since the rains arrived. I'm winning, but the battle continues.

Also, there is a matter of much drama and peptic ulcer disease in my life, and I'm really glad that I've been separating myself from it. One of my married friends has been exhibiting some highly inappropriate behavior towards a guy, and it has been giving me angina for a while now. It's nice at this point in my life to trust my instincts enough to know that, even if you can't put your finger right on something, you have a good sense of what is right and what is wrong. And even though I feel badly that this friend is no longer really a friend, I don't miss all that unnecessary discomfort associated with it.

maybe just half a drink more

Yesterday was a less hectic work day and some of the other residents and I were gathered in the work room, getting some notes squared away. One of the residents put some Pandora holiday station on, and the work room became Christmas carol central. I'm not exactly a grinch. I don't like all the fuss about most things in general, but I like the holiday season. I like getting in the spirit.

One of my co-residents grilled me for 20 minutes yesterday because I recognized Rufus Wainwright in less than 4 notes. And until yesterday, I can honestly say that, although I am fond of song lyrics in general, I did not know that Baby It's Cold Outside included this gem:

at least there will be plenty implied  

if you caught pneumonia and died

That's a bit morbid!

I don't know if the carols got me in the spirit. It might have been all of us in the work room, chatting gaily, and laughing from our bellies. This time of year, I reflect on how lucky I am, even when I sometimes have this pang of self-pity. Whatever I have to complain about, I do have the privilege of having a job that I love-- and it is true love, which means that sometimes I want to spit and scream at it, and other times I am swooning, but either way, we are meant to be. I like what I do, I enjoy my co-workers, and though I might sometimes come down with annoying coughs, I have my health. My loved ones are well.

I don't know. I saw a patient in clinic today, who I quickly learned had been battling depression for a long time, and my preceptor asked him when he was last happy. He said, "never" and it wasn't a ploy. But then he said he had a period of a few years when he felt an "interior sense of joy," and that stuck with me. It seems like a good thing to have. I guess I always assumed that, should one achieve that state, that sense, that it would be permanent. I guess nothing is.

But I don't know if I believe that either.

Anyway, getting to the point. This year, I'm free enough to do a little baking in December. So I got myself in the true holiday spirit in the only way that would work for me. I made a batch of molasses spice cookies, because nothing reminds me more of the holidays than those. And I fixed myself a Domaine Canton with ginger ale. And then it was 'tis the season and all of that.

trapped between two lungs

I'm almost done yet another stint of working in the hospital (as opposed to the clinic, where I spend the other portion of my time), and it's been a strange week. After that last call that landed me a missed Thanksgiving day, I got progressively sicker. It started with an itch of the throat and some sinus congestion, then it turned into sinus congestion and a cough. Then it turned into one of the worst coughs I've ever had- at one point, I actually wondered if I'd forgotten that I have an extensive smoking history (I've never been a cigarette smoker) because I sounded like a 75 year old veteran with emphysema. At another point, after my last call, the coughing fit got so bad that I could not sleep, and my abdominal muscles were actually sore (so at least I got a work-out as a consolation prize).

It's just a virus. I know that. I tried to treat the symptoms with benign over-the-counter medications, none of which really helped. I finally started to feel better when I just gave up and drank copious amounts of Good Earth decaffeinated tea and water, and tried to catch up on sleep. I still have this barking, alarming cough that is scaring most of my patients. And I'm still wheezing, which makes me feel a bit sorry for myself.

Except medicine gives you little room for that. As a general rule, physicians won't call in sick during residency unless a limb is falling off, there's intractable vomiting or uncontrolled bleeding in play. Otherwise- suck it up and soldier on. And if you are even thinking about feeling sorry for yourself, one of your patients will set you straight.

Yesterday, that patient was a young guy, a decade younger than me, who had been diagnosed with testicular cancer this past year. He had undergone surgery, and then he had started chemotherapy because there was still some evidence of leftover disease, and each chemotherapy cycle had taken its toll. Then after his third cycle of chemotherapy, he started developing difficulty breathing, and after an extensive evaluation, it had been determined that he had a bad reaction to one of the chemotherapeutic agents. This had resulted in lung toxicity. So now this 20-something kid with a very treatable cancer is facing respiratory failure. His lungs are totally shot. Over the past month, he went from being what one of my colleagues calls a "walkie-talkie" to being unable to move without oxygen. When I saw him this morning, he was breathing shallow and couldn't say more than a word at a time without running out of air. The frail young boy that was in the bed before me just said we should do what we need to do, he was up for whatever we thought was best. It's one of the hardest things to see a patient exhibit that kind of bravery, that sort of will to live, when you know they are facing something that is largely untreatable.

So, in the end, there wasn't much to lament about my stupid cough.

home, that's where I long to be

It's black Friday, allegedly. It's times like this in residency that I feel quite disconnected to the outside world. I've no concept of black Friday. It doesn't sound like my cup of tea, though, to be sure.

It's black Friday and I'm home after a long day, and I'm worried. It's something they never tell you about medicine when you get into it. How much you worry. Constant and diverse too. Worry about the patients you just admitted, two of which don't look so hot despite your best efforts to 'fix' them before you left for the day. What if I had worked 18 hours instead of 16? Maybe then I could be sure those patients would be okay? Worry that the other resident worked late, even though I was trying to get her out early. Worry that I haven't been teaching the medical students. Worry that the attending thinks I'm incompetent. Worry that I'm losing my grip on humanity, what with the gallows humor and the complaints about 'lame' admissions. Worry that I'm coming down with something, worry that I'm not going to get enough sleep tonight to beat whatever it is that's brewing in my lungs. Just endless worrying. It's a bottomless cup. At some point, you go home and just try to think about something else. Mostly that just leads to more worrying about whether this worrying will ever subside.

Thanksgiving was a bit of a bust this year. It seems to be a running theme. That things fall apart, tend towards entropy, and I can't find the energy to be worked up about it. I was on call the night prior to Thanksgiving, and it was busy. When I got home on Thanksgiving morning, I channeled some surge of sleep-deprived delirium, and baked a pecan pie. It turned out really well, better than any previous version (50% corn syrup, 50% maple syrup, people, it is magic). Then I told myself I would take a quick nap, wake up and make apple pie. That quick nap was supposed to be 2 hours. It wound up being 7. Oops. Missed Thanksgiving dinner, couldn't come up with the energy to even bring over my stupid pecan pie to the party, because I was too tired. Brought it into work the next day, and it was consumed nonetheless. Oh well. One year without turkey and whatever will certainly not kill me.

This time of year, I am reminded of how much life has changed, I suppose. There was a time that Thanksgiving meant sitting around the table, around a big, crazy meal. Even though my family did not really get the whole Thanksgiving thing in my earlier years, when I reached adolescence I was so obstinate that we ought to celebrate things in what I considered to be a traditional manner that we all rallied together to make it happen. My mother, a strict vegetarian, even prepared a bird one year, though most of the time, we settled on buying a pre-cooked one. But the sides and dessert, we made as an entire family. In addition, we always cooked a big vegetarian spread for all of our parents. My cousins and I used to take over the kitchen on Thanksgiving and Christmas, and I have both pleasant and stressful memories of trying to herd the cats that were my crazy cousins so that we could all, together, make these meals. I saw my cousin C last weekend, and she still fondly remembers the apple crumble pie we used to make together -- and by make together, I mean that she would peel the apples, and after slicing one in a less-than-satisfactory manner, she would relinquish the rest of the task to me. I doubt it would taste as good to her now as it did to her then, but she still talks about that pie, it's etched in her memory.

One year, my aunt made us go around the table saying what we were thankful for, and it took an hour and a half, and we all complained. Some people said silly things, other people said passive-aggresive things (hi, mom), and other people said sentimental things- and of course, we teased the latter mercilessly.

We kept creating traditions in our family, and I still have fond memories of them, even though we are all scattered too far and life is too hectic and wild for us now to all be together. And as crazy and non-traditional as those Thanksgivings probably were, they were ours, and it makes me feel like home, and everything else really seems like a lame substitute. So I find I can't really be that heartbroken over sleeping my way through Thanksgiving this year.

I belong with you, you belong with me, you're my sweetheart

I could tell you a sob story about how Sandy thwarted my attempts to go on vacation. I could, I could, but I'm just not in the mood. Besides which, it would be rather ungrateful, considering all that happened to me was a change of plans. Sandy did make me sad to be so far away from the people I care about on the East Coast, but then, the East Coast might as well be another universe right now.

Instead, there's this bordering country that's become foreign too. Because, you see, it's been many years since I've been a resident of San Francisco. More years than I realized until this weekend. And every year, as I get a little older, my remarks become more vague when the subject of returning to San Francisco burrows its way into conversation. Every year, the conversation involves more "but"s than the previous year, more arguments for why not instead of for why.

It's weird, I know, to have a relationship with a city. But I do, I did. That city, I don't know how to explain it. Except to tell you that this past weekend, CS and I decided to finally make a day of it and go into Alameda to visit St. Georges' Spirits. That place was in existence the entire time I lived in San Francisco. I tasted Hangar One for the first time in San Francisco at a shoddy bar on Sixth Street, right before heading to Bhangra SF. That place was in existence the entire time I was in medical school. A friend of mine then, who has since severed ties because that's the unfortunate price of break-ups sometimes, CC had told me about it and we had talked and talked and talked about going. But we never went.

But then last week was stressful and Friday night, CS and I admired bar shelves of artisan liquor, and a plan was hatched. The next morning, it was spectacularly clear out, unseasonably warm for October, and we drove to Alameda. And suddenly, it wasn't 2012 anymore. I don't know. Suddenly, I wasn't this me, I was a different me. CS and I navigated our way to the distillery, which is in a former naval hangar, prompting us to make jokes for a solid hour about how a zombie attack was imminent, and if not, wouldn't this be a spectacular place to film a zombie apocalypse? We went searching for food prior to going into the distillery, so that our heads wouldn't be swimming later, and we marched confidently into a building with no signs just because we saw someone standing by a piano in the doorway. It turned out to be a private party for who knows what, and we took two steps in, contemplated crashing for a while, and then left, leading to another series of jokes.

The distillery seemed to be created for us. The person pouring liquor was gregarious but not obnoxious. We liked him because, despite the proximity to Halloween, he was the only one behind the bar not in costume. We liked him because he let us taste reserve liquors. We liked him because he was amused by our utter joy at tasting gin spiced with cinnamon and cloves, and coffee liquor that was so smooth it made me wonder why I didn't like coffee. We liked him because he liked Barcelona. We liked him because we were flying, flying, soaring happy, high.

We sat and ate a late lunch in the adjoining picnic area, looking out onto the water and the bay, the sun still bright, the bay teeming with sailboats, trying to get in one last seasonal hurrah. We watched as a woman not quite as adept at holding her ethanol fell right on her butt on the gravel outdoors, and we suppressed our laughter. Then we walked through a tour of the distillery, returning back to the earth, gravity bringing us back. Sober and happy and pleased with ourselves, we drove home.

And that's how I remembered the argument for why. We weren't in San Francisco, but this was what San Francisco was to me. Little discoveries, little bursts of happiness. Messy, messy, but with splashes of vivid perfection. Nowhere else, it seems, am I ever so happy. That was something long since forgotten. Because I've been happy here, I am happy most of the time. But that bubbling joy, that soaring feeling- it's a specific thing, and it's there, always there. Someday, I suppose, I shall have to figure out what to make of that. But not today.

joyful girl

You. Guys. I cannot even deal.

Here, I'll just say it. It's my birthday today. And let me tell you, from a certain angle, there is no reason to get so excited about that. It's just another year. No special milestone. No particular excitement. Last year, I took a test on my birthday, no one in my program knew it was an unusual day for me until after the fact. I made a homemade pizza, experimented with maple syrup candy, contemplated a cake, and accidentally shattered a perfectly good bottle of iced tea. I was turned very much inward, and it was fine. I don't put too much thought into my birthday until the day arrives, and most of the time, I just take stock and shrug and carry on. No reason to get so depressed or so ecstatic one way or the other, in my opinion. Sometimes I might treat it a little like New Year's, and consider what I want to accomplish for the next year.

I didn't think last year's birthday was pathetic or anything. Really and truly. And I certainly didn't have any expectations about this year's birthday.

There was this thing I'd been considering this past year. You know, it's part of this whole I bought you that ring because I never was cool feeling- something about that changes as you get older. I've worked this past year on becoming a more authentic version of myself. That sounds incredibly precious, I know. But if anyone examines their youth, I am certain they can identify times when they made choices which were not entirely true to themselves- choices that were compromises, that compromised some essential part of themselves. And I think, in the year leading up to residency, when I had decided to make do in a place where I did not quite fit, I settled so much and made so many compromises- feebly justifying all of them in order to get right with the decisions- that at the end of that year, I didn't know entirely what I had wanted or what I had hoped or anything much at all.

But the one thing, this insistent voice in my head, all of that year, that demanded to be heard was the nagging feeling that I should pay close attention to where I was choosing to do my residency and to pick the right program, the one that fit me best, the one where I would be happiest. It's funny, because it's that decision which ultimately did reveal how shallow and unimportant some of my relationships were that year. These so-called friends came at me and criticized my choices because it did not suit their perception of what was best for me. And I'd given in on so much by that point, but the nagging feeling, the persistent voice demanded I make the right choice for myself.

And it worked, don't you know. Internship was so hard, but also so rewarding. I grew closer to my fellow residents than I ever did to a single person with whom I attended medical school. I found my people, at a time when I had concluded the very notion of 'my people' was an utter myth. I really enjoyed working with these people, I really appreciated every moment I spent with them. I baked and baked and baked, fueled by all those good feelings.

None of these residents made me compromise who I am. They got to know me, dealt with all my crazy quirks, schooled me when I needed schooling, listened to my whining, whined to me. We were all true to each other. They put up with my bad days. They put up with my need to be inclusive; they might have even liked me for it.

So. Today is my birthday. I was barraged with messages all morning. My pager went off in the morning, and when I called back, three residents were on the other end of the line, calling just to wish me a happy birthday. Random residents walked into the work-room hugging me. I don't like fanfare. I don't like productions. I don't like a lot of fuss or attention. But I have also learned in the past few years that sometimes celebrations are not about you- they're about your friends, and giving them a chance to let them express what you mean to them. My friend MG is about to pick me up, and we are headed to get a GG&T before a ridiculously large gathering for dinner. It astounds me- how last year's birthday and this year's birthday can reside in the same person's experience. Even though I have to admit that this outpouring of affection is extremely touching, I'm not ungrateful enough to be down in the dumps if next year should revert to a quiet night alone. As my friend CS told me yesterday, half joking, half serious- "congratulations, you survived another year." And when you strip everything else away, there's the bare truth, and really the only correct emotion is a big crashing wave of gratitude. So today- consider me crushed.

one more time with feeling

My schedule has gone erratic again, filled with the new joy of 30-hour shifts. Fun times. Actually, they really are in some ways. It won't mean much to you if you don't work in the medical field, but I actually much prefer working a 30 hour shift than a 16 hour one. Sure, you lose sense of what time it is, what day it is, when you're supposed to be sleeping, personal hygiene. But you do get a chance to breathe in the hospital, to really think about the overall plan for your patients and how best to treat them, because you're actually around the entire day watching their clinical course.

Anyway. The down side is that all I do is work, bake, drink random alcoholic beverages (I'm loathe to admit I've been branching out from my usual GG&Ts, and recently went so far as to drink something called a Lion's Tail-- worst part is that I actually liked it!), and do laundry. Not exactly an exciting existence, definitely not one that merits much in the way of documentation.

I'm working at the VA right now though, and that place always makes my blood pressure sky rocket. Not because the vets are super-conservative and occasionally borderline racist and oftentimes borderline perverted-- none of those things ultimately bother me because the vets are possibly my favorite patient population out there. No, what drives me crazy is that no one else seems to be interested in their health besides the residents. Getting anything done there requires cutting through 15 layers of red tape, and usually involves losing your temper, and even then, things barely get done. Ultrasounds don't get done on the weekend. It tends to drive me crazy. One of the senior residents last year told me that the VA is where residents go "to develop sass"- and let me say, for the record, the sass is now in full effect.

But the up side of sass is that it in turn breeds rage, which in turn breeds baking. People are starting to catch on to my deal, and my friend CC, who knows how frustrated I've been with both the VA and a particularly lackadaisical intern, decided to innocently send me a link to a recipe for pumpkin cinnamon rolls yesterday, knowing full well that I would take the bait on my day off. Yeast-based baked products are not usually things I tackle on a work day because you never know exactly how long things will take to rise and fall. I had to be patient with these rolls because the recipe called for a type of yeast I couldn't be bothered to go out and buy.

Sometimes I get bored with my own baking. Cupcakes, cookies, blah blah blah. I think I've optimized and I can make what I make and I won't ever be able to improve from there. I've still yet to figure out how to make macarons properly, and it feels like a losing proposition. But on the other hand, I was reminded that I tried to make pumpkin cinnamon rolls several years ago and it was a complete failure. They turned out the weight and density of hockey pucks, and I remember being really angry that I wasted not time, but so much flour. That's not cheap! But that was a while back. This time, the result was a bit different:

They may not look like much but they are gooey and soft and light. And the cream cheese icing on top will get rid of any shortcomings they might have. So it was a good reminder that it's worth giving things a second, third, fourth, fifteenth try.

And maybe I can use the muffins at the VA this weekend to bribe someone into drawing a blood count on my patients.

we're in the wrong band

Before I tell these stories, let's just acknowledge that it is 2012. There are now at least as many women as men in medical school. You know, it's not like women are completely suffering in silence in medicine these days. However, can I just tell you a few things that I have witnessed?

• A classmate of mine in medical school was already accepted into a surgical training program. Her director actually said, "I've never had any women in my residency program have babies, and I don't expect to start now." Keep in mind that her surgical training is a five year program.
• Another classmate of mine wanted to defer a clinical clerkship in his third year, because his wife was having their second child and he wanted to be home with the children. He was fine with making up the time later, possibly even graduating later. One of the deans told him, "you've already seen one baby born. There's really not that much for the dad to do." He ultimately got the rotation off, but had to argue with three different male administrators before getting it approved.
• In residency, two of the women interns in my program are pregnant. While male residents who have children have been congratulated and slapped on the back, these women have been called 'thoughtless', 'inconsiderate' and 'deceptive' (though of course behind their backs)- and some of the people making the comments were other women.

Now, again, I'm not saying that women are downtrodden in medicine. But I've been thinking about these issues lately, and it blows my mind how messed up the whole thing is. It's an institutional, structural problem, and it's so deep-seated that even the women within the system are supportive of it. The problem is that, if you do the math, women who are in medical school and then residency are going through these things during their child-bearing years. Why are they expected to set aside that reality and deal with the consequences later in their lives? I feel like I can speak about this since I quite certainly have no dog in this race. But that decision has nothing to do with my career decisions, nor should it really.

Men are congratulated when their wives have children. Women are whispered about, painted to be selfish. There's no other way to describe it but wrong. The problem is that residency programs and medical schools do not account for people making very natural life choices during training. They don't staff residencies with enough trainees to cover if one or two people go out for maternity leave. Of course, the programs can't legally forbid women from having children, so instead, they just create this untenable burden on all the other trainees when the women need that time off. This in turn breeds all kinds of resentment, and, in the end, what you have is massively messed up thinking.

I'm sort of amazed, because I worked for so long before I trained, and in the workplace, a friend of mine and I used to joke about inventing made-up children, because women who had children were always excused to go pick up their children from daycare or working late or traveling to places they didn't want to travel. And maybe that extreme was no good either. But on the other hand, we were just kidding around, whereas my co-residents are quite dead serious when they take big objections to women having children during residency.

This all sounds like a completely a-political problem. But consider this- Medicare and the government subsidizes the large chunk of residency salaries and thereby controls the number of spots residency programs can offer. It's funny because when the soundbite came out about Romney and the 47%, I thought 'well, I'm not part of the 47% and Romney doesn't really care about my vote either.' But then I realized that I am part of the 47% because I am a resident. And if you think a resident salary is a handout, hahahaha- that's all I've got to say about that.

In other news, I went nuts last week, and baked a cake. A friend of mine invited me to his house for dinner, and I haven't seen him in a while. Last time I went to his house, I brought over an experimental sorbet that had a little too much ginger in it, and he had to politely swallow it down, so I became obsessed with making a cake beyond reproach. Well, it wasn't a pretty cake. You bake a really big cake (15" x 11" or so) and then you cut it into strips. Then you rush around frosting it because you've gotten home from clinic at 6 and you have to be at dinner by 7:15. Luckily, I'd made the frosting in advance- there are layers of caramel and dark chocolate ganache, and a pillow of milk chocolate buttercream to top it all off. Even though I warned him it was rich, my friend RS demanded a second slice, and then clutched his stomach, pregnant now with cake. Here it is, in all its messy glory:

hit the ground upright

Maitri in her usual kick-ass manner posted a comment that said everything that I could ever want to say about all the hesitation I've had for so long:

"I always wish folks Good Luck before things like this (even if I have only the slightest clue about what you're about to embark on), because whatever the outcome, dithering about it is worse. Whatever the outcome, poop or get off the pot. A lot of life is simply and honestly pressing forward into that cone of uncertainty."

Indeed, indeed, and I am here to report that pressing forward has never felt so good. I guess that's how I am. When I come to an end, I've already hashed it out and come through so many false starts and stops that I am well and truly done, all the way. I don't mind that about myself- maybe it takes me longer to get to where I need to go, but I can live with myself better as a result.

And success and failure are blurred lines sometimes. An end can seem like a failure when in fact it is a success. One train may hide another.

Either way, there's just no denying- now I am happy, relieved and happy. Out of a holding pattern, able to fly forward. And it wasn't anger or misery that brought this to a resolution. It was calm and contentment and an appeal to compassion. Which was one route I'd never previously tried, and wow, what have I been waiting for all these years?

I know I'm being aggravatingly vague; that's sort of my thing. I've removed a toxic substance from my system, and I knew I wasn't strong enough to purge it myself. So I asked the demon to show a little pity- and it did. I guess I should have been crushed, or heartbroken, but I wasn't. I felt for the first time in a long time like I was truly free.

Then I made a goat cheese, caramelized onion, and mushroom tart, and my friend MG and I drank home brewed sweet tea vodka with freshly squeezed lemonade. And life felt very, very right.

I've been here before and I deserve a little more

Wish me luck, because tomorrow is going to be something of a reckoning.

It's a mess of my own design. An agreement to walk through fire, even though it won't be enough, won't change anything.

Strangely, though, it's sandwiched, buffered with love. In the morning, I'm to go to the farmer's market with a close, old friend. In the evening, my brother and sister-in-law are paying a visit. There are others too. I'm not nearly any semblance of alone. And for that, I am so, so grateful, and feel so, so safe.

So I should not be so scared. But the heart, regardless of how strong it may seem outwardly, logically, is a fragile thing, and it won't take much to crack it a tad more. And having just rediscovered this belly laugh, the one that comes from within the heart and tells of exuberant, unfettered joy without any 'except for's, I am not so inclined to lose it.

As a talisman, my kitchen's become a tornado zone. I made cookie dough, but I had much bigger aspirations. There was orange juice left over from a recent brunch, and it's been taunting me in the refrigerator for the past several days. I'm a little bit of a priss- anything but fresh squeezed orange juice gives me pretty bad stomach aches, so I avoid it myself. A little web research and I had found an orange cupcake recipe to hack. I already have made a light, subtly citrus-y frosting ready. I've become really taken by meringue buttercream frosting, probably because it is a bit labor-intensive, but also because it is smoother than most other homemade frostings and involves none of the nuisance of sifting confectioner's sugar. It's also excellent for icing, which has also become a thing that is a welcome distraction (update: the results below! Not very orange-y, but not bad for a first attempt.). All in all, not a bad way to keep my mind off things.

this beat was bubblegum, so I had to chew it

On a lighter note:

• The ICU nurses were huddled together near the nursing station last week in the afternoon. They saw me coming, and one of the more seasoned nurses beckoned me to them and said, "maybe you'll know," which I immediately took with a grain of salt, because the ICU nurses usually know more about everything in the ICU as compared to the residents. Especially the ones with some experience. But still, I figured I would give it my best shot. She asked me, maintaining a grave expression on her face the entire time, "can you teach me how to dougie?" It's ludicrous moments like that which make inpatient medicine a magical place.
• An elderly woman came to clinic for the first time. She had not seen a doctor in five years, she lives alone, she has no children. In getting to know her, I asked her what she did for exercise. She said, "not much, but when I feel like I'm too lazy, I put on a CD." I asked her if it was an exercise CD. She said, "No! I just put on a CD and dance alone in my apartment until I'm tired!" and burst into giggles like a 15-year old would. I really hope I'm like that when I'm her age.

There's some more ominous stuff going on. It's the balance of things. I've been waiting for something to disrupt my contentment, and here it is. But it's just a little rumble, not a true earthquake, not anything that will cause a break. At least that's what I tell myself, and if I tell myself enough, it might turn out to be true.

all you can do is do what you must

There was a time, and it's not really worth mentioning when the time was, but during that time, AL and I were roommates, and we had some friends who were marooned. They could not get back home. We had a big enough house at the time, and we invited anyone who was stuck to come on over. They went shopping in our neighborhood for a spare set of clothes, and took showers in our guest bathroom, and we fed them, then we made them extra beds, and they slept in our living room so they could go to work in the morning.

But even before then, this was something we knew in our bones. In my family, we stayed over each other's houses if something needed repairing or wasn't working. We thought nothing of it. In college, there was a chemical spill, and the largest of the dorms had to be temporarily evacuated. People were eventually placed in hotel rooms, but until they had arranged for it, there were students sleeping on the floor of my dorm room, using my bathroom, sharing our space.

It seems like the most basic of human instinct to me, this notion of, when things have gone wrong, offering shelter. And often, we can't really give it in the place where it's most needed, for various reasons. But it can still be extended when it might be of use.

I've a comfy brown couch, and a ceiling fan that keeps the air calm and breezy. In the last two weeks, four different people have come by and proceeded to pass out on that couch. It's not that comfortable. My visitors were just very tired and in need of a rest. Sometimes it's not enough, it doesn't make everything better. But it's something, and it's the something that I have the capability to do.

That's all you can really do, I find. Help the people around you, the ones willing to take your help, and hope it's enough to distract you from the other people- the ones you don't have the means to help or the ones who refuse to accept your help.

resurrection fern

Who knows whether the circumstances of my life dictated who I became. All I know is that when I'm a little sad, I yearn for company. But when I'm really in the dumps, just low down and completely inconsolable, I just want to be alone.

Maybe it's because I've had this fight before, the one between me and my demons. Maybe it's because the demons are unpredictable- they'll show when you least expect them, and conveniently when others might not be around. Maybe it's because if I rely on someone else to cheer me up when I'm at my lowest, it puts me in peril if I should happen to hit rock bottom on a desert island.

Or maybe I'm just wired this way.

I was at my very lowest over a decade ago. I remember it well. I was marooned in Southern California, and the entire length of ground beneath me had crumbled. I was in big trouble. I was as alone as alone could be. There were people around me, friends even, of a sort. But not old friends. Not true friends. Not friends I've spoken of or to since.

I was already a scientist by that point. In fact, that was the whole problem- I was a scientist who had just been heartbroken regarding science. I wasn't sure I still loved it, not after what it had taken from me. And I was all alone, and even if I hadn't been, I'm not sure anyone else would have understood. I had a strange sort of math going on in my head.

Back then, there wasn't much in the way of an internet. I didn't even have a computer at home. So I visited the stacks. That's what I started doing. Every day, each morning, I would sit in the science library with the yellowed pages smelling deliciously ancient, trying to find it again. Trying to fall in love.

The trick was not to try. Eventually I stopped trying, and eventually I started reading about things which sparked my curiosity, which made my heart beat again with purpose. Then I was saved. Which I cannot explain, and nor do I care to explain. It's one of those selfish secrets that I may never share outside of these confines.

What I do, when I'm at my worst these days, when I'm having a rough time of it, is find something I love to read. Not just something I love to read. It can't be something I just love to read- because then it would be TS Eliot or Anna Akhmatova or something which would plunge me even deeper down into the blues. No. What works for me is to read about oncology. Which, I realize full well, sounds insane.

I was yelled at today because it's Saturday night and I refused to go out for drinks and instead I chose this:

First of all, Saturday night means nothing when you are working in the hospital. I worked all day today and I'm working all day tomorrow. Saturday night is just another work night. But also, I had a miserable day. A day that needed to get better. Or else. All the way bad. I should have read about Cardiology. That's what I should have done. But that wouldn't have soothed me, wouldn't have fixed what ailed me. So I turned to what I knew would work for me.

And I think that's the trick. That's the trick to everything in life, and that's what Van Gogh must have been talking about:

Love many things, for therein lies the true strength, and whosoever loves much performs much, and can accomplish much, and what is done in love is done well.

That's how I feel. When I'm at my very worst, it's not really that I need to feel loved. It's that I need to love something. And there's so much out there that's worthy, given half the chance.

anywhere else now seems like a million miles away

At my house today, brunch was had. It was had by many.

There was a trial run last week, but that one was different. It was the first time in a while that I'd tidied up enough to have people over, and it had morphed into a gigantic gathering. Everyone descended at once (a total of 12 people, which was far too much for my 6 person dining table) and it was a little chaotic. After I finished cleaning the kitchen, 2 stragglers showed up and ate leftovers while visiting. It was a fun day, but that brunch was somewhat stressful- it's been a while since I've had that many people over (my previous residences for nearly the last 10 years would have burst at the seams with that many people in my house), and I was out of practice for entertaining for that many as well as estimating how much food to make. Everything worked out and there were a ton of leftovers to spare, but I felt a bit tired after all the commotion settled down.

Today was different. Last night, I prepared almost everything needed for the brunch. This morning, maple pecan scones were already sitting on the counter, a strata was ready to be baked, and waffle batter that spent the previous night rising was waiting to be finished. It was all so simple that I started to worry that there were additional things I should have made. The first person, GN, came over at 9:45. He looked like a wreck. He had overnight call and was just finishing a 30 hour shift when he arrived. I made him two waffles while he was gobbling up scones. He ate the waffles hot and tried some egg strata, and then promptly took to my couch, where he completely passed out for twenty minutes. By then, the next person arrived.

She brought over a coffee maker because I don't drink coffee, and I do not really know how to make it, in truth. We chatted, making coffee, and eventually GN awoke from his temporary slumber, drank some orange juice and joined our conversation.

My friend who brought the coffee maker is vegetarian, so I made her a scramble with spinach, parmesan cheese, and mozzarella, which she dutifully ate while the rest of the waffles were cooking. Another couple of friends came, and brought big bowls of fruit. A few minutes later, another friend and her husband came with a Hawaiian dish.

We sat around the table eating and talking and laughing. Another friend stumbled in, hungover. We fed him, and he got a call from another friend, so we beckoned him to join us, which he did. A few friends left. Ultimately, the party did not disperse until 3 pm, and people left with little packages of food to take home with them. A few of us lingered in the kitchen together, talking of when we would all get together next.

This may seem all very commonplace and boring. The strange thing is I think I would have found this all very commonplace and boring ten years ago. But since then, my life changed so much, the focus of my life was so different, that I didn't realize how much I missed it until just today. Everyone had told me that I'd find lasting and long friendships in medical school. I didn't entirely believe them, because my experience inherently was bound to be so different than the typical. And sure enough, I have only a handful at most of people from med school who I even feel friendly towards- and of them, only 1 or 2 who I feel truly connected to. So I honestly didn't expect what happened this past year. It turns out that, as stressful and frustrating it sometimes it is, this residency program was the right one for me. These are my people. Not all of them, of course. But way, way more than I ever would have imagined.

It occurs to me, that maybe I have cobbled together the life I have always wanted to lead. And it's not to prove it to anyone else, or because I think it's what life should be. It's because this is what I actually, truly want in this moment, and I have it. The moment will pass. Of that, I'm sure. Life is not much fun if you are not in want of something. But still- at such moments, belly full and pleasantly sore from laughter, new waffle recipe recorded in my little book of keepers, dishwasher about to start running, I just want to hold onto the present tense and be glad for it.

that solo's awful long, but it's a good refrain

The Guardian and some friends of mine pointed me towards a project that tries to capture the essence of a person through the songs with which they identify most. It was a good excuse to dust off the blog, and also, I found the assignment a little stupid because some of the questions/categories are not reasonable to distill down to one song. So I cheated as usual, but at least I'm posting for a change.

The first song I ever bought:
Thriller, Michael Jackson- Obviously, because of my impending senior citizen status, I did not purchase a first song, I bought a first album. And of course, given my age range, and how old I was before my parents would allow me and my brother records, we were united in our desire to obtain Thriller with the money we'd amassed over months. We were not sorry. Even though it heralded an increasingly commercial and ridiculous time that would culminate in Jackson morphing into a completely bizarre entity, this album will never seem like anything less than a revelation.

Song that always gets me dancing:
Just can't get enough, Depeche Mode- A silly one but true. I should point out, though, that it doesn't take all that much to get me dancing. There are a number of guilty pleasures that I could include in this list (It takes two comes to mind).

Song that takes me back to childhood:
Centerfold, J Geils Band- Look, I was probably seven or eight when I heard this song on the radio. It was one of the first songs I heard on the radio. I had no idea what the song was about, and probably even after it was explained to me, I didn't really get what it was about. But it always reminds me of being a kid, sitting on a bus, with a bunch of other kids, singing along to a song we didn't understand.

Perfect love song:
A tie between Thank You by Led Zeppelin and Nice work if you can get it by Ella Fitzgerald and I believe by Stevie Wonder and about a million other songs- just tell me that you wouldn't swoon for someone who said 'mountains crumble to the sea, there would still be you and me.' On the other hand, Fitzgerald's song lacks all angst, is so matter-of-fact about love that in some ways it is more perfect than anything else could be. And on the other other hand, Wonder's song is breathtakingly beautiful and hopeful. But honestly, I feel like there are so many songs I could include and then maybe I would have covered every good love song out there.

Song I would want at funeral:
Wishlist, Pearl Jam- if it were really my funeral, I wouldn't want dirges. And this song has a lot of yearning associated with it, which I've always related to life in general. Because I've always thought that's what this song is about- that life is all about wanting, even if it's something as simple as breathing, even if it's ungrateful to keep wanting more (thus my favorite line of 'I wish I was as fortunate, as fortunate as me').

A song that makes me, me:
Galileo, Indigo Girls- the obvious Cornershop song also comes to mind, but first and foremost, holy smokes, I am a f***-up. That's what I'm all about, underneath whatever facade I may be able to pull off in public. I am a failure. I am that person who falls in potholes, who trips right into ravines, who slips on black ice and lands smack on her bottom. But the thing about all of that failure is that it's made me who I am. You can smash me into a million pieces on the sidewalk, and I'll emerge like that oozing metal of Terminator 2, reformed, revived. I like to think all of those rather graceless face plants led me to who I am and what I am doing now. And somehow, all of that makes me think of this song.