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August 1, 2020

Vision Board


It was a new year's resolution to make a vision board. During this time when I suspect we are all losing some sense of self, I felt compelled to finally complete this.

I knew I wanted it to be fairly minimal, as it's pretty easy to pare what I want and value to a few major things.

From top left working clock-wise:

Stories and images: When I was little, I had a tiny plastic yellow chair on which I placed my "prized possessions." I didn't use it as a chair (when I tried, it cracked).  It didn't serve any function other than being a display for what I loved. The rest of my room was a mess, but I neatly arranged everything on the chair. As an adult, I generally don't have many things. As anyone who's been at our place knows, much of what I own are gifts because I often don't consider buying items that might add more function or ease to my life. This desk was my friend Diana's and we kept it when she moved because I loved its antique and artsy feel, and how it's an old thing in a very modern apartment. We don't actually use it because it's rickety, but I've put all my favorite creative items on it - photo albums from when I used to print photographs, a Holga camera, all the moleskin journals I wrote obsessively in during med school (one for each clinical rotation), G's painting materials and journals, a couple envelopes from my best friend in high school with delicate lettering and stamping, a portrait of G when he did his solo JMT trip, some books whose aesthetics and languid language I love, and a box that used to be vibrantly colorful and whose backside turned blue in the sun so I rotated it in the sun until all sides matched blue. It's not so much any one thing, but a representation of how much I value words and images: capturing my own, gathering ones others create, and absorbing and sharing stories.

Sharing ice cream: I google imaged "sharing" and felt this image was pretty perfect for how I feel about sharing: the importance of giving what we have. It's not always easy to be mindful of the immensity of what I've been given, even in work where we have constant interaction with people with less, so I want a good reminder that there is nothing more to do with our gifts than to give them. A white boy sharing with a little girl of color is pretty fitting for being aware of personal privilege and the vulnerability of others. And ice cream is my favorite too.

G Looking into a Georgia O'Keefe Sky: I love this picture of G and the moment of capturing it. I've never met anyone who has given me as much space as G, who lets me have so much room for everything I hold on the surface and keep underneath. When I brought up the idea of living in New Mexico, he came with me to explore it with openness and curiosity, and I like how this comes across in this photo of him peering into a picture. I'd like to give him the same space, to be as open and sensitive to him as he is to me, to value him as a person independent of what he gives me.

Blank Space: Though I'm moderately minimalist with things, I cram a lot into my life. With people and endeavors I love, but as an introverted overthinker I could use more emptiness. I made this the center of the board, and when G saw it he asked if it represented space for more to come. I think yes, and also space for nothing and a reminder that that is okay and important.

A Cheesy Community: This photograph is a collection of name tags from my last birthday party, in which each of my friends brought a different cheese to share. So the tags have each person's name with the cheese they brought. I hold my friends very close, as individual people and as a community, and this image captures how much each one gives me and also the connection they create when they come together. It will remind me of the nourishment of friendship. And because cheese is my other favorite.

My Parents in Vietnam:  I thought a lot about how to best represent my family and what I value and want to sustain about them. I chose a photo of my parents, because everyone else I love stems from them - my brothers, nieces and nephews. But also they are what we have in common.  My brothers don't always get along, but they each love my parents more than anything, in their own ways. Growing up, they always impressed upon me how much my parents did and do for us, and it has been the driving force for everything I have and want and share.  I also want to see more of who they were before us, which is why I chose a photo from their wedding. I want to know their history and infuse my future with it. It will remind me of the privilege of coming from another culture, one that has rooted into us a faith in family and sacrifice.

Panorama from Red Rock: This is a view from my favorite place where I first climbed outside. There is so much to love about climbing, but if I had to describe it in one sentence, it would be that it gives this wide spectrum of perspective, experience and emotion. This spectrum is what I want in every part of my life, and climbing makes it very visceral and easy to see when I forget it in the midst of my day to day.

April 18, 2020

All the COVID Feels


If there's a unifying principle for what I do and seek in my life, it would be the goal to feel as much as possible. The spectrum of emotion and perspective we can experience feels layered, wide and deep, and the thing most distinctively human. It's why I love books, seeing patients, and climbing--the opportunities to access so many views outside of my immediate realm of seeing.

And so while I will always wish COVID never happened, I do have to thank it for the immense and unprecedented diversity of emotion it has bestowed upon me. When I evaluate how I've felt during this last month of COVID, I think: what did I not feel?

I feel the dizzying weight of worry pulling in so many directions. We worry as we see all at once the million ways one person and many people are fragile. It's hard to know where to begin and to continue, how to make decisions and how to allocate resources, system wide and my personal mental and emotional reserves.

I'm constantly consumed by frustration with people whose positions of power distance them from what is happening on the ground. It's draining to experience barriers of this kind, the kind that feel like they could crumble with the right reach for connection yet persist with the hardness of metal.

I'm slammed with the sudden surprise of joy. We started the mission to test our patients with a supply of 350 tests for a patient population of 65,000. The immense work for this tiny effort was both a source of hope, and a source of distraction from our actual inability to truly care for people. When this leads us to the chance to provide true access for our community, it feels like a miracle. As hard as we always work, I've never fooled myself into considering the care our patients receive as truly equitable. To shift from rationing to active outreach is new, and the trigger for my first cry of the month.

I'm stalled by panic. I don't do well with speed. I dislike the emergency room and downhill skiing. It has been draining to react and adapt to rapidly and continually changing circumstances, as I'm not naturally built for this work. I've seen hours of work washed away, replaced with gaps to be filled until that filling is pulled too. It's been good learning to develop a skill not for putting things in place, but for continually moving out of place.

I'm depressed by the ways we enclose ourselves, how it led to disaster and contributes to disconnectedness as we wade through this together and apart. Because we are all reasonably tired and protective of our individual selves, when facing others we so quickly defend, push back, stare straight ahead.

I'm connected, overwhelmed by an extreme sense of community. In this time of social distancing, I've met the highest concentration of people than I ever have. Of amazing, creative, compassionate people within and outside our organization. Anyone who knows me knows much I love my clinic co-workers; COVID gave me the chance to meet other clinics, see their different characters and same sense of deep connectedness. I'm floored by how much and in how many ways people help, how many times a day I hear that "we're in it together," and by the team that organically came together from a shared drive to be of use.

I long for so much. I miss my parents, my brothers, and my nieces and nephews. I zoom with the three kids in Colorado, each of them on their own tablet and square on the Zoom grid. All at once one dances a choreographed sequence to Baby Shark, one reads with a stuffed bear twice his size, and one tells me about his school project to start a caramel-making business. I wish I could see my newest niece grow from her babyhood to toddlerdom, mark her first year in this strange world. I miss my co-workers and our shared space, my girlfriends and our climbing and conversation and cooking, my pieces of heart in other corners of the country.

I literally ache for climbing, and mourn the relationship with rock. As days get longer, I hate my computer more and more. I remember anew how important this specific type of movement is to me, and how absolutely irreplaceable it is. I think about how I had silly thoughts of projecting 5.12 outside and now I would give a lot to do 5.6 just to be making my way up a wall. I try not to think about how long it might be before it's returned to me.

I love G and his ability to support and nourish with ease and without question. Somehow he never shows any frustration with my long days, complaints and moods, and unpredictable needs. Because I express it very little with others, he becomes a receptacle for the pressure build up of all my negative and dark feelings...thank you and I'm sorry.

I'm frustrated and am frustrating to him. It's not easy for either of us and there are eruptions of difficulties we internalize. There are pulls of distance and closeness, and gratitude for stable ground as we move.

I feel guilty that I'm absent in the relationships I prioritized prior to COVID. All the interaction that work requires drains my introverted self so much that I've been too tired to stay connected to my friends, to be really present for the little time I do have with G. I still "see" some patients with telephone visits, but I've cut down my patient time by more than half. I'm disconnected from what is happening at my home clinic where I'm supposed to be a watchful source of support, and it wasn't until a breakdown that I was aware of how much my co-workers were struggling.

I'm compelled by creativity and newness, as everyone has had to be resourceful and different in this new state of existing. I've written before about how novelty maintains plasticity, physically and mentally. I haven't pursued new hobbies, but I love seeing others do so. I have learned so much about areas of weakness for me in work, from technology to leadership, and while I long for my old job I am grateful for new skills.

I'm even more sensitive than usual to stories; my primary break these days are long runs while listening to audiobooks. I'm healthiest when I balance my book reading with real life, when the window into worlds outside of me helps me relate to the world I have. Too many books without visceral connection puts too much in my head and lends itself to sleeplessness. But it's hard to stop when the long, beautiful narratives pace and soothe my insular life. I try to think of them as building an arsenal of understanding for when I can live outside my mind again.

I'm so tired. The fatigue is unlike anything else. It's reminiscent of medical residency, with its the lack of control over when you can take a break. I'm writing this on the first day off I've taken off in a month, knowing that something could potentially interrupt my intention to disconnect at any time. Beyond that, there's the way that this virus has seeped into every crevice, such that nothing seems like true space.

At the same time its pervasiveness is maybe why this space holds so much, and I know that it will change and give more and new every day. So here's to feeling all of it.

January 5, 2020

Reading : Books for Healing


During a few rough weeks this past winter, I found the most space and comfort in reading. Other than work and basic activities of daily living I forewent every other activity and chose solitary reading over most other interactions and events.  These books are pretty different from each other, an assembly of my needs that changed moment to moment.  Each book had a different personality and gave me something different. In this way, they are like people, which is my excuse for being a hermit recently.

The Heart's Invisible Furies by John Boyne
This is my favorite type of audiobook: very long and very funny.  It's 21 hours long and even though it was immediately funny and entertaining, it wasn't until about a third of the way through that I was emotionally hooked. It's Forrest Gump like in the way that it traverses the history of one country (Ireland), with a focus on the evolution of LGBTQ rights, through the narrative of one person. It does what I love most about fiction--show how much the life and feelings of one person can contain, and shares it with humor, understanding, and insight without judgment. When you get this attached to a character and his narrative, reading becomes immersive and it was helpful for me to fully enter someone else's world. It also presented a comforting approach to pain, confronting suffering with humility and laughter.

The Art of Living by Thich Nhat Hanh
This book was the most directly comforting to me, and I felt substantially, tangibly better after reading it. I haven't read much actual literature on mindfulness, feeling like perhaps they would be redundant, but the few books I have read have always been excellent.  I don't think there was any concept in this book that was entirely new. But Thich Nhat Hanh has a way of unearthing the complexity of seemingly simple concepts.  At the same time, he distills down how to practice these principles in a way that makes them less intimidating and more feasible.  I particularly appreciated how he speaks in the first person, putting himself into the concepts that he espouses.  When he talks about the idea of inter-being, that there is no confined sense of self but that we are all part of the same substance, he gives an example of a man who rapes a young girl and murders her father.  He acknowledges that he is both the criminal and the victim, and uses "I" statements to put himself in the place of the criminal.  This really helped me feel less angry with all the forces that create injustice, that I'm not separate from those people.  It doesn't mean that we don't continue advocating for social justice, but that we remain connected and happy in the face of it.  He encourages being joyful in every moment not just as a source of happiness for yourself, but as a way to create positive energy for everyone.  It's deeply reassuring to think of your happiness as contributing to that of others; and that even in times of suffering and supposed helplessness, your capacity to feel joy can be helpful to others. He reframes death as a continuation, explaining how because we are all connected and transformed and re-manifested in one another and in our environment, nothing is ever lost.

Everything Everything by Nicola Yoon
This was basically a mindless young adult page turner, which was helpful in distracting me from complicated thought rabbit holes.  I love good YA for its ability to advocate idealism when first coming to face with the notion that the world is complex.  YA reminds me of my high school self and essays I wrote about books like Pride and Prejudice when my thesis was that happiness comes from a balance between mind and heart.  Anyway, this was excellent YA with a charming heroine, Madeline, whose integrity and idealism have been shaped by a sickness that keeps her inside at all times, isolated from the outside world.  Until she falls in love with the cute boy next door (I found the romance equal parts sappy and believable).  I really enjoyed the nuanced whimsy of this love story which is really about Madeline's evolving perspective on what her life is and should be.  Until the end, which I hated, but would still recommend this as a beach read or when you're in need of idyllic diversion from difficulty.

The Warmth of Other Suns: The Epic Story of America's Great Migration by Dina Gilio-Whitaker
Broadly, this incredibly well researched book is about the migration of blacks from the South to the North from 1915-1970.  Specifically, it is about three individuals who leave their homes in Georgia, Mississippi and Florida for new lives in New York, Chicago, and Los Angeles. It's hard to read about the extent of blatant and subtle racism that drove blacks from the South, and continued in different forms in the North. It's unlikely new to anyone, but the book so skillfully details the depth of racism alongside the personal assault of it. And it's likely new to consider how this migration has shaped everything about our society and community now. In particular, it's challenging and important to see how African-Americans became immigrants in their own country. Recent events have made me re-evaluate what I'm doing in work and life, and reading about people forced to move to attain basic needs reminds me of my privilege of choice.

The Diary of a Part-Time Indian by Sherman Alexie
At a time when I'm searching for the roots of trauma to better know how to heal, I so value the perspective of an adolescent discovering the spectrum of human feeling and capacity. In this story of Junior, a teenager who leaves his Spokane reservation to attend an all-white school, Alexie encapsulates the angst of your average teenager within the specific challenges Junior faces. Here prejudice and hurt assume many faces, and so does generosity and growth.  I love how a young voice, with his honest language and telling drawings (Junior is a cartoonist), with its first experience and anticipation of the future, can offer so much more insight than lifetimes lived.  Also, it is very funny.

December 19, 2019

World : Squamish, British Columbia


I'd created a lot of hype for our summer trip to Squamish, melded from a mix of anecdotes, photographs, and my own acquired love of long summer days of climbing.  When the forecast flashed a row of raindrops for the week, I held onto this hype, convinced that our experience would match my vision.  And maybe it was a tiny bit of this mindset that made it true, but really it's that Squamish is so special. 

The Place


Squamish is a small town an hour north of Vancouver in British Columbia, Canada.  Sitting at the northern end of the Howe Sound, it's overlooked by the Stawamus Chief.  The Chief is a 2300 foot granite monolith, and is the reason that people describe Squamish as the Yosemite of Canada.  The sound shines blue-green, and the rain creates a lush forest green that reflects off the gray days as strongly as sunny ones. The rain punctuated our days: a strong storm placing a definitive period to end our climbing; scattered ellipses that let us climb during the gaps; a day where a comma separated our rainy afternoon in Vancouver and our ecstatic climbing in the dry evening (the reverse of Nabokov's "picnic, lightning"); and semi-colon stretches of dryness that let us climb all light long.  The times the rain forced us away from direct contact with rock were some of my very favorites of the trip, especially the runs.  Once, we ran in the rain. As four of us ran side by side, someone commented that we could be a commercial for tourism in Squamish. You know those ads that show a huge truck revving up in mud, spraying splatters of brown against greenery and amidst rocks?  That's how it felt, like we were the truck with slickly gritty wheels paying no mind to the water coming down, or at least I pretended we had this power as I huffed slowly up hills.  The Chief loomed over our trail in the distance, and I felt its haven in a way that maybe I can't when we are climbing on it.  Once, we ran after it had rained the night before.  This eight mile trail run in Alice Lake Park was one of my favorite runs of my life.  The ground was damp but not muddy, the perfect soft texture that made me aware of the surface and able to skim over it at the same time.  The air was quiet and fresh from rain, and the lakes were glassy, and I was grateful to G for his capacity for parallel play.  And once, we hiked to the top of the Chief, ascending steep stairs and slippery slab, to shroud ourselves in an opaque mist obscuring views of the sound. It's interesting to experience one mountain in so many different ways.

The Climbing


Even though water permeated our experience, we were able to climb every day except for one and by the end of nine days my body was fairly (totally) wrecked. The weather forced us to slowly acclimate to the rock, which was good for balancing my various physical tweaks with my desire to go hard right away.  My absolute favorite thing was that the accessibility and variety of climmbing meant that on one day, we could climb six pitches of trad until early afternoon, then project hard sport until early evening (that day also ended with particularly delicious pizza and beer, so I was pretty much bursting at the seams with fulfillment).  The first day that we attempted a multi-pitch climb, I became irrationally spooked by wet granite, having some PTSD from my previous injury. If I've learned anything from getting older, it's that memories linger so much longer and in so many more crevices than I can anticipate. I told myself it was okay to just follow instead of lead that day, which was a tough decision for me to make in the moment. But it meant that we climbed a route harder than we initially had chosen, and the safety of following helped me focus on technique (instead of how to avoid falling at all cost). It's really humbling and in some ways freeing to suck so much at crack climbing, such that every little bit of progress feels like infinitely more than before.  This experience also prepared me to later swap leads on two more multi-pitch climbs, including a couple pitches that felt at my limit but comfortable now that I was in a better mindspace.  It was the first time I led 5.8 since falling on 5.8 in Yosemite, so it was a big mental milestone for me. Besides that, I felt so lucky to scale a small piece of this massive rock, and to see the sound from above, stretching away and toward us.  

The sport climbing also presented some mental challenges, from mantling on wet rock to awkward starts to stamina intensive routes. While much of Squamish's beauty feels naturally given, the climbing didn't feel that way.  It was hard, loving work and it felt luxurious to have the time to return to projects, and to work on routes together as a group.  While these difficulties are a huge part of what I love most about the sport, one of my favorite experiences was an easy climb we did over the Cheakamus River.  We climbed it less for the actual climbing and more for the environment it took us to, because this is what it looked like:

The Food
We alternated cooking at home with eating out, and the diversity of the food and the company made nighttime an especially memorable time for me. Because people were coming and going throughout the week, the dinners ranged from big group barbecues to quiet cozy gatherings.  We consumed so much good: grilled veggies and corn bathed in buttery green onions, cheap Indian food, real fruit (berries) ice cream, IPAs so good even G liked them, a mediocre taco truck that we enjoyed by extolling its mediocrity, and our staple black bean soup.  I don't love cooking when at home, partly because I don't enjoy the experience enough to appreciate it outside of functionality; I generally enjoy it best when cooking with other people, so I value vacation for that opportunity.  I also treasured the warmth of delicious vegetarian dim sum on our rainy day in Vancouver, and felt so welcome by the ample choices for Asian food, vegetarian food, and vegetarian Asian food.  

The People


I loved Squamish most for the feeling of having the community of home despite being away on vacation.  Our friend Kai hosted us for a few days, and he was so generous in every possible way: purchasing new towels for us, cooking dinner for us (he's the genius behind the green onion corn), lending us guidebooks, showing us around all the climbing areas.  It was fitting to spend our first and last day climbing with him.  Because summer in Squamish draws a lot of people, friends came and went through the week.  I felt so lucky to have quality time with each of them individually and also quality time as a group where people from different parts of my life were able to connect (one of my very favorite things). It was special to have a morning of climbing with the person who I started climbing outdoors with, that bond of being there from the beginning always growing stronger.  It was the first time I'd climbed outside with two friends who I climb with regularly indoors, and this lent itself to a deeper relationship by way of extended time and expanded environment.  It was an unexpected treat to connect with a friend for whom climbing is a relatively new passion and to be a part of that discovery, and to make a new friend through him.  And some of my favorite times were solo time with G, climbing multi-pitch and running and having coffee. His easy acceptance of me in any form I take makes it easy to submit to the ups and downs of climbing, which is the challenge and overwhelming joy of it.


December 14, 2019

Health : Vulnerability



Two of my doctor friends and I signed up for North Face's Endurance half marathon race this year.  We did our internal medicine residency together, which for me has been the hardest test of endurance in my life, so it seems fitting that we continue challenging our stamina together.  We've all done half and full marathons before, but this trail run is known for its beautiful strenuous steepness, and we were excited for the challenge.  In some subconscious show of solidarity, all three of were unable to run it due to injury and illness.  The goal, and the factors that forced us to relinquish it, have made me reflect on what endurance means, what it gives and what it takes away.

I stupidly dropped a bike lock on my toe over the summer.  When the initial x-ray was read as not having a fracture, I continued my regular activity.  My threshold for seeing someone for the persistent low level pain is pretty high, because it's hard to find a convenient time to see the doctor when you're a doctor.  After a couple months of this, I cave and schedule an appointment for a time when I'm not seeing patients.  The appointment is cancelled, and I don't reschedule it until there's an opening during another time I'm not seeing patients.  When I'm finally sitting at Kaiser waiting for the foot doctor, I get a text from my doctor friend and running partner: "Are you around to pick me up?  I'm about to get a cast and can't drive my car home."

We realize that we're attending foot appointments in buildings right next to each other, both getting bad news.  When I leave my appointment to get to hers, we commiserate over the prospect of immobility.  Movement being a primary source of self-care, we know it's going to be hard.  She tells me how the worst part of it is that she kept running with pain because she could tolerate it, kept delaying seeking care because she wanted to do her job.

As I've written about often here, I love endurance.  I love endeavors that take a long time and require patience, and this is true for me on all levels: mentally, emotionally, physically.  It's why I like audiobooks more than podcasts, novels more than short stories, cross country more than sprints.  And in my work, why I chose primary care, for the languid slow change that happens over long periods of time getting to know people.

My instinct is to equate this faith in endurance with an aversion for rest.  Over four years at my job I've accumulated over 260 hours of sick time because I hate staying home.  I do take full advantage of holiday weekends and vacations to climb and travel, but I have trouble taking time off for the pure sake of being away from work.  My dad worked 16 hour days managing our liquor store every day of the week, only taking a few hours off on Sunday morning to attend church.  My mom worked her job all day and then joined my dad at the store in the evenings.  I have absolutely no memory of them ever taking sick days.  Besides having that endurance as a role model, I already have so much more choice and liberty than they did; it's hard to be idle.

Honestly, I have an incredibly supportive, loving work community who is always encouraging me to take more time off, so I can't blame the environment.  My co-workers actually gifted me a spa day for Thanksgiving, and not trusting that I would actually take the time to use it, schemed with G to make sure that I would actually make it to the spa (you all are the BEST and I did make it to the spa and it was amazing).

I'm trying to trace the deeper roots, because lately I've become angry with whatever it is that makes rest and endurance mutually exclusive, especially for women.  Specifically: mental, spiritual, emotional rest.  I exalt this keep-going mindset to a degree where I personally feel like I'm being negative or self-pitying for simply being tired.

For a good half year of therapy, I spent the first ten minutes of the hour in silence or asking my therapist how she's doing, because I didn't know how to talk about "negative" things.  I told her I didn't like to complain.  Although she gently re-framed that language, she also told me at one point that she was looking forward to me complaining.

When I was having a particularly rough time and wrote my last post, my very kind and insightful co-worker told me she was working to be more vulnerable and appreciated my vulnerability.  She said to me: "Vulnerability is very different from complaining."  I'm grateful for her capacity to see my fear without my ever explicitly expressing it, and for her generosity in dispelling the foundation for that fear.

Because people are kind and because I'm very lucky, during this time so many people in my life have reminded me that it's good and important to feel anything that arises.  That even if what arises is sadness, anger, impatience, or something else on the spectrum of heavy, it doesn't mean that I'm disappointing or discouraging others.  And that this attention to myself is ultimately what keeps me bound to other people.

So for all the people out there who value going the distance, I just want to explicitly tell you what I've learned from those who love and care for me. That the pace changes along this path, and that even if it seems that something external is forcing you to alter your speed, you are not weaker. That to endure is to rest.  Because with rest comes the space to be vulnerable,  and this baring of your pain and fatigue gives so much strength to the world.
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