don't you waste me in the ground

Strange things I've realized of late. For one thing, revelations always seem to occur when I work in the ICU. Let me be clear- I don't enjoy being in the ICU. It's not my thing, patients that are that sick and that tenuously sick- in the sense that they may, at any moment, turn the corner from sick to threatening to die. And yet, aside from working with cancer patients, the ICU is the only other experience I have with talking so openly and frequently about death.

A woman today said, "I don't know how you all do it," and it was meant to be a compliment, but I could not stop thinking about it as also a little bit of a criticism. The woman was the wife of a patient we were taking care of, who was not doing better, who had been quite clear about his intentions and wishes, and who we had just decided to extubate to let nature take its course. People have this impression that when you are "on life support," it is simply a matter of turning off the machine or taking the tube out, and then death follows. But like everything, it's not often that simple. I had just finished explaining what the process of taking the tube out would look like, what might happen afterwards, although we often can't even predict that. There is so much research out there in medicine, and yet that moment of death and dying remains mostly a mystery- people hang on unpredictably or pass just as unexpectedly.

But here's the other odd thing I've learned during the course of my residency. It's not really about what's happening, the details of it. As physicians, especially when we're in training, we have this tendency to fixate on that, the specifics of the problems a patient has and how we are failing at fixing them. This morning, the intern on the team presented the patient's problems and our plans while the patient's wife stood nearby. His wife then turned to me and said, "I didn't understand a word of that." After explaining to her what was going on, I went back to see her with the attending, and that's when we talked about his overall goals, and decided it was time to focus on his comfort. When she said, "I don't know how you all do it," she was grief-stricken and wondering how we saw such things regularly and treated it like a matter of course. I wanted to tell her that inside, it doesn't get any easier. That it haunts us too, that we couldn't make him better. That every patient we admit afterwards, we treat with all the more reverence, knowing how challenging healing can be in the very, very ill patient. I wanted to tell her too that sometimes I don't know how I do it either-- not in a conceited way but in the sense that I don't know why I'm not in therapy or in a deep depression over the things I have seen. Let me tell you- the ICU is 50% hopelessness, 25% idiocy, and 25% success. That's probably a generous estimate of the latter, by the way.  I can't explain why, in the process of training, you learn to just deal with these realities of treating patients.

In the end I didn't tell her any of those things, because yet another thing you realize about death is that, as a physician, it's definitely not about you. Your job is to walk the balance between being there and staying out of everyone's way in those final moments.

Of course, then I go home and bake three dozen cookies, and realize that, oh, all of this does most definitely affect me. Which brings me to the much smaller realization which dawned upon me today. Lately, some of my friends/co-workers have been suggesting coming over to bake with me, or for me to come bake with them, and the thing is- I don't want to. I'm not trying to hide trade secrets or anything. It just occurred to me today that I don't really like sharing the process of baking with anyone because I find it relaxing, and it's one of those selfish things, almost like my form of meditation. I can't really imagine finding it so peaceful if someone else was there. Which probably says a lot about me and my attitudes about people, come to think of it.

Anyway, more navel-gazing at some future date. I have some more hopelessness, idiocy, and (hopefully) success to face in the morning.

no single bite could satisfy

Lately I haven't been traveling to faraway places. I have not really had much vacation time, but also the motivation has been sorely lacking. There are lots of reasons. Probably, primarily, just sheer exhaustion from residency. It's tiring and I don't like to drag when I'm at work-- so I will work my 30-hour shifts, while grumbling all the while, mind you, but at some point, it all catches up to me, and when I want to decompress from it, the idea of going on an involved vacation seems more wasteful than anything else.

But not to whinge. Because honestly, I am well aware of my good fortune. It just so happens that I live in a place that allows me to get to plenty of what I want and need. A stay-cation is all the way justified around here, because a short drive gets me to the ocean, the mountains, the vineyards, and my niece.

Even then, I did some real staying. Some time at home in my kitchen, and now I am well aware of my age, because I was much more pleased to spend a day tinkering around with making pie crust than I would have been flying somewhere.

I bake a lot because it's something that's actually become rather expected. And that's fine, because it still doesn't feel like an obligation, but rather a routine, that has a soothing quality to it from the very rote of it. But every so often, the scientist part of me itches to experiment, and I want to learn some new technique or try some new recipe. It matters to absolutely no one; I have no delusions otherwise. It's not like I'm becoming an expert at anything, and it's not like anyone else cares about any of this.

But that's part and parcel of the decadence of it all. It feels like the height of luxury, the day I spent rolling out pie dough, and learning to make pastry cream. I might have cursed at how small my wooden rolling board is, and how one of my whisks malfunctioned. Maybe I groaned at the batches of macarons that failed before I got to one that was passable. You would think that would make for more frustration than relaxation, but for some reason I have made my peace with failure. At least in the kitchen, I look at every failure as just a finding from an experiment- troubleshoot, tweak, try again. It's actually a comfort now when something fails the first time I try to make it-- then when I've figured out why and gotten it to work, I know it wasn't just a fluke. I know I can write it down and it will keep.

But still. A person likes to feel some sense of hope. So I ended that day by cooking up an industrial batch of salted bourbon caramel, which I knew would turn out - because I had failed at it in the past, of course.

it's my dream but it's yours if you want it too

The arrival of my niece has not changed my life. I didn't meet her and suddenly have a baby-fever type of revelation. She didn't make me question all of my choices and doubt all the decisions I have made in my life. She turned up, all six pounds of her, to happy parents, and I laughed at almost every thing that came out of the bro-seph's mouth. When she was a day old, he remarked "she's got a really chill personality," and I didn't have the heart to tell him that actually she was just a newborn baby. My mother turned up 4 weeks later and complained that the baby didn't play much, that she slept all the time. The woman has started her unrealistic expectations now, so I fear for that baby's adolescent years.

She looked like a wrinkly alien when she arrived, my niece. She wasn't some angelic perfection (shh, don't tell my brother and sister-in-law). And also, she's not the first baby born to people I love. I have two godsons, and many of my dear friends have had children, and I am happy for every single one of them.

But when my niece showed up and settled into my arms, I did have a strong reaction all the same. Funnily enough, before she was born, I had this irrational thought that maybe my brother and sister-in-law would hoard her, and would find me an annoyance. It was completely and totally and absurdly irrational, as it turns out. Because, for one thing, there was something my brother and I learned growing up-- there is simply no such thing as too much family.

We grew up surrounded. Two uncles, two aunts, their spouses and children, all living in a one mile radius of us. My brother and I were the oldest but it didn't detract from the importance of their presence. There was quarreling alternating with teasing. There were equal measures of tears, bruises, and laughter. And I remember, when I was younger, finding it all very suffocating-- like nothing I ever did was mine, because so many other people were involved, talking about it, their expectations adding more pressure, their bragging about anything I'd done somehow diminishing anything I did as wholly my accomplishment.

My niece arrived, and I knew I wanted to be geographically close to her if at all possible, because my brother and I grew up with the idea that you needed as much back-up as you could gather around you. And the problem then was that I wasn't sure I'd actually be able

to stay around, because that was somewhat out of my hands. Some friends, trying to make me feel better, kept telling me that being away from my niece for a couple of years would do no harm. "They don't remember anything at that age" and all that. But thing is- I knew that to be false. I can't tell you why, I don't even understand it myself, but I can tell you I'm very close to those twerp cousins who I cradled and played with and babysat in my teenage years-- they're adults now and we all live far apart, but when we get together, there's an unmistakable closeness that I treasure.
Circumstances are what they are. I would have had to deal with it, had I not lucked out, had I not been able to stay. I learned that from my extended family too- time came and they had to do what they had to do. I struck gold though with this little niece of mine. I've got a brother and sister-in-law who want her to know her foi as much as possible, and I get to stay near enough that I can see her frequently enough to be a part of her life. Looking at that kid, I did feel a sense of responsibility- to not drop her, to hold her when she fusses even if it's spoiling her a bit, and all that other unconditional stuff that comes with family. But also there's a different kind of responsibility- to find as much joy in my life, to share that with her and as many others as I can.

So the little pipsqueak did teach me something already. She reminded me what I already had known- that there is no such as too much family. Her arrival coincided with some big news in my life that was good (actually, great), and when there was this amazing outpouring of sincere happiness on my behalf, I realized what an idiot I was when I was younger and found sharing my accomplishments to lessen them. It's exactly the opposite as it turns out: knowing that so many people have supported me, have cheered me on, have held their breath on my behalf, have known what this means to me-- it's actually amplified my own happiness, and made me feel wrapped in a collective embrace that I had not known was there.

Some of that family who've been part of that embrace, they're family not by blood but by love. Some of them are you.

sometimes is seen a strange spot in the sky

Well who knows where to begin and how to end, and whether this is any kind of beginning or if it's time to end. Just three days ago, an Indian-auntie type was trying to console me "you know how people of our culture say that things work out in the end."

And I responded, like I wasn't blatantly quoting The Best Exotic Marigold Hotel, "and if it's not working out, then it's not quite the end, right?" Which earned me a nice hearty Indian-auntie cackle. She thought it was an original quip and I felt like a fraud, but it got me out of the conversation- I was tired of getting these kinds of pep talks by then.

There's some truth to it. But what of its converse? Life is not a movie or a novel, and sometimes it's such a letdown that it's not. Because I've had some drama in my life, I've had my lows, and then I have these moments-- these amazing, cinematic happy endings. Everything has come together, it's all worked out, the heroine has emerged victorious, and you could end scene and roll credits and it would be so beautiful, it could play Sundance (I keed, I keed).

Except life is not like that. Which is why this stupid blog continues on. There is this thought that in our youth, we are confused and angst-filled and struggling. Then we clear some hurdle and everything settles down, we settle down, and there is no further questioning ourselves. That's the thought, but I mean to tell you it's 100% false. Either people stop examining their lives, or they just stop publicizing all their quandaries, but there all of those doubts remain, stewing within.

Or maybe that's just me, I don't know. I thought about saying goodbye this week, to the blog, to social media, claim my happy ending, and end this story. Yet, there are still things to want in life, things to strive for, things to dream about. And so much more to experience. So instead of bidding it all adieu, I think it's better to take a moment and really savor how precious the present tense is, when you reach one of these chapter ends. When the cliffhanger will-they, won't-they ends with a kiss. Knowing that life is not like this, it is best to be grateful for the beautiful moment when you do get to proclaim "I am no man!" and stab the Witch King dead. And just like The Return of the King, there are many fake-out endings ahead, I suspect.

to find our way home, to break in these bones*

Having grown weary of a seemingly endless string of flights for the past two weeks, I opted to drive from Northern California to Southern California (and back) this week. It was illogical, really, and many of my friends told me so. But I reasoned that I'd neglected to buy a plane ticket, and now it was too expensive to fly.

I was writing down directions for the way home (I get annoyed trying to use my phone to navigate, and I do not have GPS, so yes, the world and all of its advances have passed me by), and scrawled down "then drive up I-5 until your eyeballs fall out." It is a straight shot like that. And even though it is a long, almost interminable drive, it is also mindless, and thus allows your mind to wander.

It was much needed. I had to exorcise a bunch of negativity and demons, reset my brain, examine what lies ahead. I didn't arrive at any epiphanies, not even close.

California is beautiful. There is no state like it. But then, there is no place like any other. California, I realized, has become home for me, and that long drive up and down I-5 reminded me that this might be a swan song. A goodbye, or a farewell for now. The only thing that changed along that drive is that I became more comfortable with all of the uncertainty. Take a deep breath, breathe in the sunset that tinges the sky purple against stretches of farmland and mountains, stretch that imagination and consider a different life, a new dream. But I'm just not sure of anything.

I came home, and slept, and when I woke up, I was a year older. So busy with the plates sliding beneath my feet that I didn't have time to acknowledge the passing of another year. I could have made cookies or a cake, some sure fire, trusty standby. But that's not the kind of space I'm occupying these days. So I revisited macarons, which are the most temperamental m*@!$* that a person can bake. I've already previously accepted that macarons are one of the few items that I think are worth shelling out the cash for, rather than trying to recreate at home, because they are so involved.

But I was feeling up for failure. I was feeling that sense of daring-- that willingness to roll the dice for high stakes. I was feeling extreme- I could have gone for a good, hard cry or a joyous victory dance. I was ready to accept my fate. I was ready for it to all be for nothing. And only, only when I feel like that, I think, is this possible:

There were some happy feet in my house that day.

It's not a long drive, or the baking of macarons, or any one thing that will help make this all clear. I see that much now. It's just the necessary turning myself inwards, filtering out the background noise, the external voices of right and wrong. And if I stand very still, while the macarons are baking, while the sun is setting, while the music is playing games with my heartbeat, then I'll feel the right path.

* Maybe because I am old and so an 80s vibe does nothing but make me giddy, the new Killers' single Shot At the Night is owning me right now.

I will dare

I'm a different kind of tired. Usually, these days, I am tired because I am tired- because I have worked a long shift, been awake for too long, have been running around the hospital, have been writing notes and answering pages. That kind of tired, it's an easy kind of tired in a way. All it takes is a little rest, a little sleep, and for the most part, it goes away.

This is not that. I am the kind of tired that involves waking up at 3 am in a panic, that involves never feeling quite well-rested, that involves a churning sensation in the stomach, a steady state of anxiety. There's a fatigue that comes with that. The constant nerves eventually translate to pure exhaustion, but not the kind that can be relieved by sleep alone.

I'm so close, I'm so close I'm afraid to even name it, I'm afraid to want it. I want it that badly that I'm afraid to say it out loud. Does that make any sense?

That's the kind of pit in my gut that I've been grappling with this week. Yesterday, I had my first interview, and it should have been the easiest, but it was actually the one which worried me most, because, again, it has to do with wanting, and being afraid to want, and of course, at the end of it all (and haven't we all felt this at one time or another?) the fear of not being good enough. It had gotten to a fever pitch the night before, and I was nearing hysteria. I was bouncing around the house unsure what to do with myself.

I could have prepared in the traditional way. I could have read through my CV, reviewed possible questions I could be asked, all the things they say you should do. But I'm not so sure that would have done anything to help, not for me, and my miswired brain, my weird way of coping. So instead, last night, when I really felt my fears bubbling past the surface, threatening to boil, I decided to just face a completely different fear instead-- the terror of homemade pasta.

It is ridiculous, I am aware. But when you distill it down, the fear of making pasta from scratch is really just as ludicrous and just as justified as most of my other fears. My fears regarding pasta are many. Do I have the necessary ingredients- do I have what it takes? Do I have the necessary tools? How will I know if it is right? Will it form, will it all come together? And the biggest fear of all-- will it be any good?

This recipe had coincidentally been posted that allayed a lot of my fears, as orecchiette does not require a pasta maker. Don't get me wrong. I have wanted a pasta maker, have I ever, but I haven't been able to justify getting one when I don't even know how to make pasta. I divided the recipe by 8, because this was just a test batch. This was for therapeutic purpose, strictly. And while I kneaded the dough and then tried to make the coins curl into pasta, everything within me focused on that. I calmed down.

So maybe I won't get what I want. Maybe nothing will work out. Maybe I'll continue to bash my head against the proverbial brick wall. But not all endeavors end in failure. As evidenced by the orecchiette. Was it perfect? No, not even vaguely. However, it tasted good, and I knew what I needed to do to make it better next time. And in short, I was no longer afraid.

just try to understand, I've given all I can

Closing time. That's what it has felt like recently. Not insofar as this blog goes, though I know it's mostly dormant these days. It's not a particularly deep song, but those lyrics have lodged into my head because they're apt right now- you don't have to go home but you can't stay here.

I've been trying to get my head right about leaving this part of the country, because the chances are astronomically high that I will no longer be a resident of this golden state for much longer. If this were the best of all possible worlds, then I'd live in the Bay Area, and live affordably there on the meager salary of a fellow, and be in a decent program training. But life gets complicated, the more you want, the more your heart is set on something.

Sometimes I think that love is a test. And that applies to love of work too, especially for me, because work and life are tied inextricably together for me. Don't ask me to be exuberant if work is going poorly, I can't do it, and I'm not sorry about that. Sometimes, I worry that some physicians don't take their job personally enough. But anyway, these choices end up being made. Really, you love this? Do you love it enough to leave the part of the country where you dreamed about living?

Once, the bro-seph and I were standing on the rooftop of a party in the Mission. It was clear and sunny and from that height, we could see across the city. I was floating. I gestured around and half-joked to my brother: "I think we've reached the promise land!" It did feel that way.

But it's weird. First of all, San Francisco doesn't make me feel that way anymore, I am sad to report. It's become not unlike New York in some ways. Beautiful, indisputably. And I will always hold it dear. But it's become a place exclusively for the have's of this world, and I find it hard to relate to places like that past a certain point. Moreover, though, San Francisco made some things plain for me.

I stood on that rooftop and I made that proclamation, but there was still a yearning in my heart. There was still more that I wanted, something I was searching for, and that something means I might have to move far, far away. And I wonder if all of this, everything that has happened to this point, has been a preparation for this next move.

None of it really matters. We like to think we have some control, we like to prepare, we like to think we've learned so much and are so world-wise. But in the end, change comes one way or the other and it doesn't really care whether you're ready for it or not. I'm just trying to remember that I've watched my life change numerous times, some by my choosing, some not so much, and it hasn't beaten me down yet.

But there are scenarios I would prefer, and I'm trying to convince myself to dream.

***

In other, more musical news, two Border Lines have earwormed me recently. The first is courtesy of a very funny episode of The Mindy Project. Yes, when I first heard it, I had a major nostalgia overload, but the Flaming Lips and company really prove that covers can reinterpret things in ways that are welcome.


The second Border Line, of course, is the new single by Goldspot. These lyrics really feel like the best ones the band have written to date. And even if some of their songs sound like cousins of each other, Goldspot has a distinct sound, one that tells you they're not afraid to incorporate Indian influence into their music but also that it's really woven into their fabric, not a device used for the purpose of kitsch.

even in a hurricane of frowns

One of my favorite clinic patients is in her 60s, widowed, never had any children. She sounds like a tragedy, but she's not. She has hardly a medical problem, which is impressive at my clinic. And though she lives by herself, she does not let it get her down. She gardens, she walks to church every day. She has friends- "they're like family to me," she says when I ask her about some friends who are visiting. She exudes a certain joy that I usually attribute to the young, but it's somehow all the more charming with age.

She told me she was trying to lose some weight by exercising more. I asked her what she does to exercise and she said, "I turn on the radio and dance in my living room for 30 minutes or so." Oh yeah, make fun of prancersing or whatever it's called all you want. I don't care, I found it adorable. In fact, I realized- I aspire to be that woman, with her guilty giggle as she defends herself- "The music is so good- why not?"

And in that spirit, I will ask you the same as you check this out:

come on, let your colors burst

A conversation with a patient (whose diagnosis is perplexing and eluding me right now, but that's of no interest here):

Him: Where are you from?
Me: New Hampshire
Him: What?!? My mother's from Concord.
Me: Oh, it's pretty up there.
Him: Really, New Hampshire?!?
Me: Yeah. I know, no one ever guesses.
Him: You know how I would have guessed? If you asked me what state you were least likely to be from, I'd have said- the state my mother is from.

He didn't go on to ask me where my parents were born or what my ethnicity was, so I guess this counts as progress.

But you know, parts of me are very, very New Hampshire. Very much so. People have trouble believing that because I happen to not look like most of the general population in my home state.

Oh well. Live free or die. Happy 4th and all that.

well I want to fly above the storm

Look, I'm no perfect daughter, and my dad is no perfect father, and I think that's more the case than one would be led to believe if Twitter and Facebook were the only measures of things.

My father taught me a lot of things. Probably the biggest thing he taught me was generosity. For all his faults, and he has oh-so-many, the one I never considered a true fault was his generosity. Time, money, an ear, he was willing to give it freely to anyone (sometimes to my mother's chagrin). I could see that even when I was a child, and I know that sense of wanting to be useful, wanting to feel needed, that's all from him. Even if he didn't give very useful advice, he puffed up with pride if someone wanted to talk to him about a problem. And that's part of what I learned from my father-- it's not even necessary to have a solution, you just have to be there.

He had a good sense of humor about himself when he was younger, when I was growing up, and that was another thing I learned from him. That there wasn't a lot of point in rage, and that even the things which should have legitimately earned some anger were a lot easier to take with laughter instead. He taught me how to find the absurdity in bad situations, and sadly, he forgot that lesson himself later in life.

He also taught me to value an education and learning and seeking truth. When I was young, we would argue for hours to get to the bottom of an issue, and he taught me to question things, even if he learned to regret that later. And despite being Indian and male and chauvinist about a million other things, never once did he discourage me from any academic activity.

He taught me plenty of bad habits too. Doubting myself, handling failure poorly, falling into melancholy, I learned those things from him too. I've unlearned some of those bad traits, some of the good traits too. My relationship with my father is as complicated as life. It doesn't fit some tidy package, like anything you examine closely enough. Yet it doesn't make it any less precious.

***
And speaking of fathers, and tales of fathers, well, I have had to face up to the fact that I'm a Superman apologist. Yes, I absolutely am. I recall being woefully disappointed in Superman Returns, but when I went back and looked at what I'd written about the movie when I first saw it, I found the movie flawed but not unwatchable.

My friend CS turned to me and declared, "That was absolutely horrible, I am disappointed!" as the credits rolled to Man of Steel. And truthfully, I couldn't really fault her for that review. But it didn't leave a lot of room for discussion. The thing about being a Superman apologist is that all you want to do is discuss, discuss, discuss.

Everyone relates to Batman, I suppose, and Iron Man, these flawed men who rise to greatness. I guess they can project hopes and dreams on those men better than Superman. While I enjoy watching the Batman movies and Iron Man, I don't really understand what the real message of such movies are. On the other hand, I've always liked the message of Superman, of someone sent from another place, raised on Earth, trying to bridge two worlds. That's, I suppose, the influence of my father, who loved, loved, loved the saccharine-sweet adage that my brother and I were lucky to be raised here because we could "have the best of both worlds."

Superman I & II, of the Reeves' era, on re-watch are pretty ludicrous movies. The first one is really beautiful and epic, but let's not forget it ends with Superman reversing the orbit of the earth and in so doing turning back time (wut?). In both I & II, Hackman chews scenery left and right. Lois Lane says and does ridiculous things (including not deducing that the bespectacled journalist with amazing typing prowess is the same guy who flies her through the sky). Reeves is a boy scout as Superman and a bumbling uncertain fool as Clark Kent. It all worked though, maybe because of Reeves' unsinkable likability and also because of the overall message of Superman wanting to help people.

Now that some years have passed, it seems the weakness of Superman Returns was two-fold. It was too mired in the past, too wink-wink to Reeves' Superman. It was trying to pick up where the last movies left off (while conveniently ignoring Superman III & IV, which is fair, given that all Superman enthusiasts try to pretend those movies never happened). And it lacked in Brandon Routh a real superhero type, as he seemed to just be doing a Christopher Reeves impersonation for much of the movie (also Kate Bosworth is without a doubt the worst Lois Lane of all Lanes ever cast). But then it tried to pull itself into the present, and that didn't really work either.

The latest edition has some merits and some big flaws, and I wonder how I'll feel about it in five years. I was struck by how American this Man of Steel really is, though that's not necessarily a compliment- thinks he's good, tries to do the right thing, but stages a huge battle that endangers lives and demolishes cities, all in the name of the greater good. Destroys a drone that is trying to spy on him, but takes no issue with those drones as a general concept. Yes, it's very realistic, very modern, very American. But it's not a great message. And it's not really what Superman has previously been about- which is about being an example of being better, doing the harder thing, making sacrifices. Moreover, I suspect I'm giving Zach Snyder way too much credit that he's even considered this aspect of things. It's more likely that he just wanted to make a movie on an epic scale, which is too bad because in so doing, it lost what could have been epic about it.

(As a massive side note, nothing, and I mean nothing was more problematic for me in this movie than the use of the beautiful song "Seasons" by Chris Cornell, because that song is so tied into memories of the 90s and the Singles soundtrack that I was just waiting for Matt Dillon and Campbell Scott to wander onto the screen, and for Cavill to start working at a coffee shop.)

More confusing yet, though, is the truth that I would see this movie again in a heartbeat. The movie is brilliantly cast. Russell Crowe and Kevin Costner can play fathers and convey what those fathers' intentions are despite a clunky script, such that it doesn't matter that the dialogue made my friend CS's eyes roll. Amy Adams is so good at portraying determination that I saw what she's trying to get across as Lois Lane even though she's given little time or words to say it, and even if it goes against the traditional role of Lane, I liked that she was in on everything right from the beginning. Henry Cavill left me wishing someone had let him actually be Superman a little more than once in a while in the movie- because when he has one simple moment where he rescues a man from falling to his death, deposits him safely to the ground, and asks him if he's okay, he embodies more of who Superman is than he does when he is stuck in epic battles with Zod for what seemed like hours of the movie. Superman is supposed to be that earnest hero who cares about the little guy, who has amazing powers but uses them in paradoxically gentle ways. He is not supposed to be a guy who destroys everything in his path without remorse. Maybe that says something about how we view being American these days. My foolish, Superman-centric buoyant hope where all things Superman are concerned is that there will be a sequel that addresses these problems rather than compounds them.

the worst things come from inside here

I don't even know and am not going to pretend to know, I'm really not.

But I thought of something last night right before I was nodding off to sleep and I realized it's something I'll carry with me always.

Because see, I grew up in New England. All my formative years were spent in the vicinity of Boston. I'm forever tied to that place, there are streets that I know in my bones. I hear echoes of that city when I'm elsewhere. It's the place I first learned what company you can keep with a city, how you might never be lonely if you let the river and the winds nudge you along.

It's not the same now, nothing ever is. But some things come back to you. And this is hard to write. Because I grew up in New England, and to some extent, I'm of that land and of those people.

And to some extent, I'm not.

It makes me cringe to recount it, but it's what popped into my head last night and it wasn't some random thought. When the towers fell, the next day, the company where I worked held a moment of silence, but then demanded we all participate in a rousing rendition of the Star Spangled Banner in the cafeteria. I should have felt united with my coworkers. I should have felt we were one. But I didn't. As soon as it happened, as soon as everyone solemnly but angrily slapped their hands against their chest, a chill ran down my spine.

I stupidly confessed to my friend KP that the entire exercise had made me nervous. When tragedy strikes, everyone wants to talk about the outpouring of support and good will that occurs, but the first, palpable emotion in the air is often pure, angry hate. There was so, so much hate in "the rockets red glare" that I foolishly told KP that I was scared I couldn't walk around by myself at night in my little town in NJ. It felt, even moreso than all of my upbringing in EBF, like an us vs. them moment.

And I wasn't part of the us anymore.

I recount the confession as a foolish one because it caused irreparable harm. KP gave me an impassioned lecture about my self-absorption and paranoia and how I was making this whole thing about me when no one would have associated some brown girl from EBF with any of this tragedy. No one would blame me. She said it over and over again, and eventually I told her she might be right, and maybe I was being an a$$hole, because after all, people had lost their lives, and that was a true tragedy. That was certainly more tragic than me feeling nervous about walking to Trader Joe's.

Then the next day, in a town 25 minutes from mine, an Indian girl was heckled, called a terrorist, and was hit in the head with a brick.

KP called me, sobbing, and apologized, and I realized it was the first time that she really, truly understood that she and I were not the same. We may have grown up in the same area, we may have majored in the same subject, we may have had the same taste in music. But at a moment like that one, the difference between us was shoved right in her face in a way that she could not ignore. I couldn't ignore it either.

And despite having some of the closest friends ever in my years in NJ, I felt starkly and terribly alone that week.

I have very young cousins who live in Boston. They grew up completely unaware of the idea that there is an us and them, and I never had the heart to explain this to them. Yesterday, when I heard the news about Boston, I was worried about them at first because I was worried they might have been injured in the explosions. But when that worry subsided, I had a worsening dread, and I worried about their safety for a different reason. I wanted to tell them to go home and not to come out for weeks, for months, until it was safe. I don't want them harmed. I'm hoping I am wrong. That I am old and that times have changed. That there isn't such a line between people anymore, that being a Bostonian trumps all.

Last night, though, when that memory flashed into my head, I knew that for some of us, the line can never be blurred and we'll never feel entirely comfortable. Which is a tragedy too.

most of the time

First- let me say that I am horrible at editing. Writing something down, sign me up. I can give you verbal vomit for days (to which those who have ever read this blog can attest). Make me edit it into something suitable, worthy, succinct, FML (to which those who have ever read this blog can even more heartily attest).

Second-

"Best cure for heartbreak is (meaningful) work. Though it will not be easy- that's the point." - Joyce Carol Oates

Who says Twitter is full of nonsense? Well, actually, most of the time I do, but there are exceptions, like the above noted quote.

I don't know how to believe in those words more than I already do. It's not that the work replaces heartbreak either. It's a strange phenomenon that way. It doesn't take its place.

There are a number of large blood vessels which supply the heart- the coronary arteries. Over time, with hard living, too much cholesterol, whatever, one of these coronary arteries can become completely occluded. It can happen with major coronary arteries- the ones on which the heart relies upon the most to keep beating. But often times, the heart finds a way. Without any intervention externally, the heart finds a way, it builds a collateral circulation, and learns to function, bypassing that original occlusion altogether.

It's like that.

This work, it's deeply satisfying. It's oftentimes other things too, other things less glamorous. But most of all, it's deeply satisfying. Every time our team went to see a patient this week, an old woman with a rare type of leukemia, she told us the same thing when we asked her how she was doing: "I am content."

I thought to myself, that's how I feel too.

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.