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July 13, 2017

Health : Humble Warrior

A common icebreaker in yoga classes is asking about your favorite pose.  I think I have different favorite poses for different categories--a favorite comforting pose, a favorite challenging pose.  But my overall favorite is humble warrior.  I love the idea of blending strength and humility.  Your legs have to be strong to keep you stably rooted to the ground, and at the same time you bow towards the ground.  It's one of my favorite feelings, this balance between the embrace of individual power and the acceptance of a bigger force.

Most recently during our climbing trip to the Emeralds, I realized this feeling is the main reason rock climbing is so powerful for me.  People (myself included) often ask why I actively seek doing something that often terrifies me.  Usually I talk about how it's good to be challenged, that it's satisfying to climb against fears of falling, how this translates to real life, etc etc.  It all sounds kind of reasonable, but these explanations don't really capture what I feel.  And maybe that's because there's so much immediate to think about when climbing that I'm often not mindful of what underlies the movement.

Lately, as I've been focusing on the mental and fear-based aspects of climbing, I have found the most growth in fully believing in contrasting concepts--that I have the capacity to complete climbs that are scary for me, and that I'm ultimately subject to the nature of the rock and the physics of motion.  Agency over my movement on the one hand, and the immutability of my environment on the other.  I'm kind of love with this, because it combines the height of what I can do with the depth of the world I live in.  The power of person alongside the power of place, this feels more like a coalescing and less like the collision that characterizes most battles of force.  

In many ways, this is the physical manifestation of how I feel about my work in medicine and life in general.  That we should recognize our immense power to have impact on other people and our environment, while respecting the limits of our efforts against the course of history and human development.  For me, the closest I've come to real purpose is throwing myself into this dynamic, of continually, humbly creating strength and re-creating it when one force overcomes another.

I've written before about how valuable and healthy it is to feel strong. I'll never understimate how much of my love for rock climbing has to do with how much I love feeling strong.  But I know now it's more about how that strength fits into the pockets of what I'm climbing--sometimes these crimps and crevices give way to our hands, and sometimes we collapse into them.

Zion, Utah

July 11, 2017

Reading : Missoula - Rape & the Justice System in a College Town by Jon Krakauer

Our patients face different kinds of trauma in their lives, and the chronic stress leads to coping mechanisms and a way of interacting with the world that can be difficult to understand if you haven't experienced the same.  Very often, past physical abuse and emotional trauma emerge as severe anxiety, mistrust, and physical pain.  As providers caring for these patients, it's easy to find empathy for the former, but it can be really hard to treat the latter.  Sometimes the anxiety means that patients ask for a lot of tests that aren't needed for a diagnosis or won't change their treatment. Sometimes no matter how many tests come back with normal results, patients perseverate on what's wrong and why we can't find a reason.  Often, treating the pain means long, repeated conversations about how we don't have any immediate fixes, and there's disappointment and frustration for both patient and provider.

To be honest, these interactions can leave me really impatient and irritable.  As much as I concretely know about their lives, I can't really understand why patients have these feelings and pains that don't straightforwardly follow the cause-and-effect science of my medical training.  And so I don't always know what to offer them, which of course damages your ego as someone advertised as a source of help.  It's all around complicated and uncomfortable.

But this is also really what I love about primary care--that it's hard, that it requires patience and openness in order to be there for people who can be really different from us.  And that these are skills that take learning and training to really develop.  

Part of this learning that has been really helpful for me lately has been to read more about trauma in different forms.  I'll always rely on my favorite form of writing for a window into people--fiction.  Like this book that shared so much about how much history one person can contain.  Non-fiction has the benefit of a broader scope.  What I really appreciated about Jon Krakauer's account of rape culture in Missoula is that it captured this scope while remaining intensely personal.

Krakauer tells the story of five victims of rapes that occurred on college campuses in Missoula, Montana between 2008 and 2012.  Kaitlyn Kelly is raped by Calvin Smith in her dorm room.  When the police detective interviews Kelly and Smith, Kelly is asked why she didn't scream, while Calvin is reassured that he will not be prosecuted.  When Kerry Barrett tells the police she's been raped, one of their first questions to her is whether she has a boyfriend, because they've been taught that 50% of rape allegations are false and that the reason for this is often to cover up cheating on a significant other (the rate of false allegations per the FBI is closer to 8%).  Kelsey Belnap is gang-raped by four football players, and her best friend urges her not to say anything that would get the team in trouble. "Cecilia Washburn" is raped by quarterback Jordan Johnson, waking up to sheets and clothes covered in blood.  Allison Huguet is raped while asleep by her childhood friend and star member of the University of Montana football team, Beau Donaldson.  Despite a taped confession where he admits to assaulting Allison, he receives a sentence where he's eligible for parole after two years in prison.  Though all the others also try to prosecute, hers is the only one that's taken to court.

More than the men accused, the women face intense scrutiny.  And the same questions comes up over and over: why would a non-consenting woman act that way?  It just doesn't make sense, so her story must not be true.  

Krakauer does an amazing job of dissecting each step of the assault, eliciting not just the personal explanation of the victim but also drawing upon larger studies about the psychology and behavior of trauma victims.  Which are not the same as someone who is not a trauma victim.  This might seem obvious.  But I can see how it's a complex idea for people to accept, because we all like to think that we can empathize and judge other people's situations.  It's something I struggle with at work.  But there are some experiences are so impactful that they change our "natural" paths of thought and action, and so we just can't empathize unless we've been through it too; and often these experiences are the ones most removed from our everyday experience.

Olympic National Park, May 2017

Having had an experience of violation much, much less severe, I found myself relating to a very small degree to what Krakauer describes.  

During my first trip to Vietnam, the summer after my first year of medical school, I took an overnight bus.  The kind where your seat kind of reclines so you can kind of sleep.  As the drive started, a guy my age started aggressively talking to me and at some point asked for my phone number.  He made me really uncomfortable.  But because I didn't want to offend him or make the rest of the ride awkward, and I knew that we wouldn't see each other after the ride so it didn't really matter, I gave it to him.  In court, the question would be: if he made you that uncomfortable, why would you do that?  In life, I very much relate to what Krakauer researched: that women tend to want to be non-confrontational and accommodating.  In an uncomfortable or scary situation, they will often try to appease even if someone else is being inappropriate.  

I was able to ignore him after that, and a couple hours passed before it was time to sleep.  I knew it'd be hard for me to sleep on the bus and I wanted to have the energy to do things once we arrived in the morning.  So I took benadryl to help me sleep (I know, I know).  In retrospect and in court, there's the subconscious and direct judgment of putting yourself in a vulnerable position.  In life, we should be able to do what we want--I should be able to drug myself to sleep and college students should be able to drink at a party--and the onus should be on others to not take advantage of that.

The memory of this moment is hazy becuase of the benadryl.  I just remember being woken by a sensation of his face close to mine.  On it, but very briefly (or at least what I can remember of it was brief), because I shook my head, bothered and confused.  I opened my eyes and he was standing next to my seat looking back at me.  I didn't say anything, and covered my whole self with the blanket and hoped he would just go away.  Luckily for me, he did.  In court, the question would be: why didn't you say anything, ask for help among the many other passengers on the bus?  In life, there's paralyzing shock.

In the morning, I got off the bus as quickly as I could. I called the person I was dating at the time.  I gave him the facts, but I wasn't sure how to express how violated I felt.  In court, I'd be seen as not appropriately affected.  In life, I was really confused, and I was also tentatively seeking validation before making myself even more vulnerable by sharing.  And in life, I didn't get it.  My boyfriend seemed more annoyed at me than anything else, and it made me second guess what had happened (contributory to our dissolution as a couple soon thereafter).  In Krakauer's account, one victim asks her friend, "Was it something I did? Could I have prevented it?" In court this cast doubts on whether a crime had really been committed.  If it had really been a crime, why would you question your blamelessness as the victim?

So the main point I took away from the book, which I feel on some level every day at work, is that we can never fully understand how trauma affects people and we can't judge them based on our worldview.  Both in the moment and in the life after, trauma changes people.  It makes them less secure in their memories and feelings, more passive in their initiative and responses.  We can't judge the thought processes and behaviors of these people in terms of what we would feel or do in those situations, because we're not in those situations.  And it's not something in which you can pose a hypothetical--because a hypothetical assumes that you are the same person in that hypothetical situation as you are outside of it, and that just isn't true.

It's extremely helpful to be reminded that there are some things that make us very different from one another, and that we need to be humble about our ability to understand other people who have been hurt in ways we can't fully imagine.  The best we can do is to listen to the many people who have had this experience, and trust what they tell us, especially when there are repeated patterns among them.  Jon Krakauer does a really excellent job at giving voice to their experience.  And when you consider that 80% of rapes go unreported, it seems we owe it to these people to listen.

Olympic National Park, May 2017

June 20, 2017

Reading : Books about Refugees

Since my parents and brothers are refugees, I obviously like stories about the refugee experience.  I feel both very connected to it because of my family, and disconnected because I was born in America.  In general I think most people are interested in narratives about movement and change, because we all experience and appreciate displacement to varying degrees. Here are some books I've read this year on this theme.


The Refugees by Viet Thanh Nguyen
This is a collection of short stories that I read after I tried unsuccessfully to finish his other book, The Sympathizer, which won the Pulitzer Prize and got rave reviews.  I stopped after about 100 pages of that one; I just couldn't get into the narration and it was taking me forever to read in ten page intervals.  So I tried The Refugees instead, which is a very quick read.  With stories that feel like vignettes, the book shares how people have experienced Vietnam and the Vietnam War from different perspectives: a family who escaped the communist regime by boat and lost a child to a pirate attack; an American pilot who fought in the war and visits the country after his daughter moves there to teach English; a young man sponsored to live in the United States by an American couple; half-sisters who grow up apart, one in Vietnam and the other in America.

I like how the book speaks very little about the war itself, which can feel distant to both the characters and the readers.  Instead, it describes the subtle ripples of that event on people living at that time and the people who followed. I generally really like story collections that do this, because it connects our day to day with the past, and puts our lives in the context of a spectrum of history (my favorite is Murakami's After the Quake about the earthquake in Kobe in 1995).  I wasn't blown away by the language or storytelling in The Refugees, but I really value the voice and intent.

(Note: I've started The Sympathizer over and trying to finish it this time, because everyone is saying it's one of the best books about the Vietnam War yet.  Sometimes, I feel like this hype is more related to the topic but I'll have more of an opinion when I finish it. If you have curiosity about the subject, I'd start with The Refugees or The Best We Could Do, below).

Exit West by Mohsin Hamid
I've read Moth Smoke (enjoyed) and The Fundamentalist (not as much) by Mohsin Hamid, and had heard great things about Exit West. It's my favorite of the three and would be my first recommendation if you haven't read anything by him before.  It tells the story of a young couple, Saeed and Nadia, living in an unnamed country where a civil war between the government and religious rebels forces people to flee their homes for fear of their safety.  

The dangers and violence are concrete, which contrast with the unreal way Saeed and Nadia escape their country and enter others: through magic doors that transport them to Greece, England, then America.  This seeming ease of migration is undercut by the obstacles of assimilation that Saeed and Nadia face in each place.  As their environment changes, they change as individuals and as a couple.  I love how intimate their story feels, even as they traverse large spans of time and geography:

"Saeed and Nadia knew what the buildup to conflict felt like, and so the feeling that hung over London was not new to them, and they faced it not with bravery, exactly, and not with panic either, not mostly, but instead with a resignation shot through with moments of tension, with tension ebbing and flowing, and when the tension receded there was calm, the calm that is called the calm before the storm, but is in reality the foundation of a human life, waiting there for us between the steps of our march to our mortality, when we are compelled to pause and not act but be."

Hamid is an amazing writer, and this book has the perfect combination of powerful story with powerful words.  He has this unbelievable skill of packing abstractions into sentences that feel close, real, and beautiful even when they are hard because they're so true.  The sentences are long, carrying along until you start to feel breathless too.  I listened to the book on audio, and as some of you know I tend to listen to audiobooks at increased speed.  But the language in Exit West was so loving that I listened to it at normal speed, and I often listened to it without doing anything else at the same time.  Also, Hamid narrates the audiobook and besides having the perfect voice to match the story's depth, it's always an added layer to hear the story told by the source.  If you haven't tried an audiobook before or have had bad experiences with it in the past, this one is rich and beautiful, and it's short so it's easy to get through (though I was sad it was so short).

A Constellation of Vital Phenomena by Anthony Marra
This book takes place in Chechnya, a republic of Russia I knew very little about before reading this. Chechnya fought two wars with Russia in the 90s and early 2000s.  Chechnens suffered awful brutalities that forced hundreds of thousands of them to escape.  There aren't many Chechnens in America, because we resettle very few refugees from that area.  Most of us probably first heard of Chechnya after the Boston Marathon bombings, orchestrated by two Chechen-American brothers, in 2013.  By then, Chechnens had been tortured and killed for decades.

In A Constellation of Vital Phenomena, the story goes back and forth in time and in characters' point of views, but its anchor is set at a hospital run by a surgeon named Sonja.  She's the only doctor for all the patients, who are rebels fighting in the war and refugees trying to escape the war.  A one-woman factory, she cuts off limbs and digs at wounds with rapid precision.  The immediate physicality of her work reminds me of how lucky we are here.  I often complain about how healthcare doesn't prioritize primary care enough, but we're really lucky that our society is structured so that it's even important to advocate for long-term primary care.  That we expect that we'll have time--years--with our patients so that their chronic illnesses matter.  I can't imagine a life where none of that even matters because thousands are dying daily from acute injuries and trauma.

Sonja reluctantly takes in Akhmed (another, much less skilled doctor whose real calling is art) and an eight year old girl named Havaa whose father, Akhmed's friend, has been abducted by the Russian government.  The plot is complicated as Marra introduces the nature of the characters in piecemeal and their connections take time to mainfest: Sonja's sister Natasha who is forced into prostitution and whose disappearance is one of several running mysteries in the book; Ramzan, the informant who is responsible for the capture of Havaa's father; Khassan, Ramzan's father who writes a thousands-page-long history of Chechnya that no one else cares about.  They each live and cope with their inhuman circumstances in ways that are never judged by Marra, only observed and shared.

The Best We Could Do by Thi Bui
I was lucky to receive a signed first-edition copy of this graphic novel, because the author is the sister of one of my co-workers.  This is the first graphic novel I've read (!), and whenever doing something for the first time it helps if there's a sense of familiarity (choosing a book you've already read for your first audiobook, writing your first story about something that happened to you in real life). I didn't get too distracted by the new medium of art in a novel, because it was so easy to personally connect to this book. It's an autobiographical account of the author's family history--her mother's story, her father's story, and how they converge into hers.  It reads the way we wonder: about who our parents were before us, how they brought us here.  In Bui's case, this is forcefully impacted by the Vietnam War and her family's escape from the communist regime.

The book couches the individual stories within the larger context of the Vietnam War in a way that feels like how it might have been lived: with the big explosions of war, and the quiet ones of family struggle.  There are so many details sewn into this story that are concrete parts of my family and my life: the way Bui's parents dealt with her live-in boyfriend situation by pretending it didn't exist (my parents did this for so long I started to think they really didn't know I was living with a boy), how people changed their birthdates at refugee camps to make themselves older or younger (my mom did this too).  As much as I relate on an emotional level to all sorts of books about all sorts of people, there's something extremely powerful about seeing these very specific details of your personal life and cultural background expressed in something published and public.  In my daily work, we're so focused on trying to understand our patients' lives that we forget that it's important for us to feel understood too.  I forget the effect of growing up in a way that can feel foreign to most people I meet.  I usually don't feel the absence of shared experience until I'm surprised by its presence.

I've been especially grateful this year for being able to relate to characters in books and TV (I could go on and on about my love for Aziz Ansari's Master of None, but luckily the internet has amplified this sentiment a hundred times over.  I might still go on and on about it at some point in the future).  Recently, I had a conversation with a friend where we talked about how growing up in a white-centered environment affected us.  I've always felt incredibly lucky to grow up in the Bay Area, which is not only diverse but values diversity.  Still, when I was a kid, I remember consciously wishing I were white because everyone on TV and in books is white and if I wasn't white, how could I be pretty and popular?

So I'm really grateful to Thi Bui to writing this story and making it visual, rendering tangible so many elements of my background that really are often kept in the background.


I'm happy that these books are popular in large part due to their foreignness, that people value and are interested in stories of lives grown elsewhere and among circumstances different from theirs.  At the same time I know that personally we're seeking stitches of ourselves.  For me, I want to stay connected to the things that led me here before I was aware of them.  Seeing how others followed the same trajectory makes it feel less unique in a way that's much more filling than being special.  And learning how the trauma of displacement can persist and resurface makes us remember that place isn't always grounded, that people aren't always whole, and that we need to be there for each other in whatever piece we find each other.

June 15, 2017

World : Environment

Last weekend I went to Yosemite, and being there always makes my heart break a little in a good way. This time, in the midst of withdrawal from the Paris Climate Accord, the heartbreak was more of the conventionally sad kind, thinking of just how much threatens our environment.

I know we've all been thinking lately about what we can do when so much is happening out of our control.  As I struggle with that, I consider what we can do in small ways in our daily lives.  For me that's been the motivating factor for being vegetarian. As most of you know, I stopped eating meat in medical school, last year started to cut down on seafood, and then after the election cut it out altogether.

One part I dislike about being vegetarian is making other people accommodate my choices.  I've never been a picky eater--before vegetarianism, I would literally eat and try anything, and now I sometimes feel guilty for being difficult, especially in meat-heavy cultures and groups.  So if I don't thank you enough for accounting for me, thank you!

The other part I used to dislike was sharing the rationale for my choice.  People ask all the time why I became a vegetarian, and I appreciate the curiosity if it's coming from an open place.  But I don't want to present the choice as something I think everyone should do, or make anyone feel uncomfortable with their preferences.  I really don't care what other people eat.

I also dislike when the question comes from a place of judgment, especially from people whose opinions I value.  I've had good friends and family shake their heads, tell me they could never do it, comment on how hard it must be.  I can feel their sizing me up as typical Bay Area, and while that stereotype is not untrue, it can annoy me in its dismissiveness.  I think in some ways, it's tied to the above--even though I really truly don't judge anyone else's diet, my reasons for vegetarianism can come off as a judgment of non-vegetarians and this creates some defensiveness.

Lately though, in light of how much personal greed is trumping respect for our environment, I feel less uncomfortable and more grateful for voicing the choice to not eat meat and seafood.

My choice started with reading a book called Eating Animals by Jonathan Safran Foer, lent to me by my good friend Caitlin.  It's a well-researched book about animal cruelty in the food industry, and the insane effects of the meat and seafood industries on the environment.  This wasn't new news, but what struck me most was the idea of being mindful about your daily choices.  Eating is a basic thing we do every single day, multiple times a day.  Because of its regularity, we often stop paying attention to it.  But because of its regularity, it's an ideal avenue for remembering values we might otherwise forget.

For me, the value I want to keep close and daily is that there is a world bigger and more important than my needs and pleasures. Honestly, I used to think that the environment was one of those impossible issues because at some point we're inevitably going to destroy it.  While I still believe that to a degree, I've stopped thinking that absolves us from mindfulness in the present.

People often say, what's the point, it doesn't make much difference, it's not like everyone is going to stop eating meat.  It's really not about any of that for me.  It's just nice to do something every day that makes you feel that your tiny slice of life can take into account the world in which it sits.  And that filters into the rest of my life.  Maybe it's what prayer is like for religious people--a way of connecting to a larger force, that removes you from yourself, grounds you into living for others.

People ask all sorts of questions about the difficulties: How do you get your protein? Your B vitamins?  How does it work with your family, partners, friends?  Isn't it hard?

I usually tell people that it's really not that hard, and it really isn't.  But yes, it does cause inconveniences.  And that too is part of it.  The reminder that certain values are worth inconvenience.  That when I'm this lucky to be so comfortable in so many parts of my life, I can deal with some discomfort that reminds me of my privilege and how to use it to stay connected to the many things privilege can obscure.

Another part of vegetarianism that's hard for me is its ties to my culture.  I feel bad that my mom can't nurture me in the way she knows best, by feeding me traditional meals.  I feel bad that other people enjoy signature Vietnamese foods while I choose not to.  I feel bad that other people judge me for sacrificing this part of my roots, considering it a privileged hipster thing to do, and subconsciously see it as selling out to another kind of mainstream culture.

It is a privilege to have this choice, and that's another reminder to me about our agency.  We all encounter different cultures in our lives, and they often conflict.  The most important thing to me about this is to be aware, to question aspects of each culture and know that I have the choice to own what I want and this doesn't make me any less Vietnamese.  (And on the day I'm writing this, I watched the Religion episode in season 2 of Master of None, where Dev questions why he can't adopt some principles of Islam, like kindess to others, while straying from others, like not eating pork.  Really relate, and recommend).

People then ask, well why not just give up everything that causes harm?  Stop driving your affordable Honda and bike everywhere (have you seen me bike? do you want me to die?)?  Become a vegan and join the protesters cheese outside of Cheesboard Pizza (mmmm, yes I can eat an entire one of those to myself)? Where do you draw the line?

It's true that it's hard/impossible to do everything.  The ask that I have of myself is to not let that overwhelm, and to consciously choose what I can and can't do.  And that's why I don't judge what anyone else eats, because I don't think this has to be the one way for everyone to live more mindfully of our environment.  Everyone has their own ways, and I'd like to write more soon about the individual ways I've learned from others.

For now, this is one way I remind myself that we're lucky to be able to choose, and that when a place like this is given to us, we can choose to give back.

June 13, 2017

People: All the People

Birthdays have gotten sweeter as the years pass.  Every year brings a sense of new things experienced, old friendships growing, the context of ourselves deepening.  In a world that glorifies youth, I feel really lucky to find this fullness in getting older.

So much of young life centers on your circle of friends.  Over the years, this circle loosens as people migrate and shift, geographically and personally. I have loved watching my friends grow over the years, and on birthdays it's the best gift to be with and hear from them. There's comfort in the persistence of the qualities they had when I first knew them, and there's the quiet surprise of how they've changed their lives from those we had lived together.  That the old remains true, and that there's always room for newness, has been a discovery that can only come with age.  Thank you to all the kind, loving, thoughtful people I've known through the years who give more every year just by continuing to be present.

My oldest friend is someone I know from elementary school. We've been friends since the fourth grade, and we've stayed in touch even though we stopped going to the same school after seventh grade.  While I see him the least frequently of the people in my life, our shared way of processing our separate lives has created a connection independent of shared cicumstances. And distance means that we rely on written communication, which has always been my preferred means of expression ever since I could write. From notes passed in class, to AOL instant messages, to snail mail (he introduced me to tiny letters), to rambling introspective emails, there have been long gaps in communication, but always bridges.

My friends from high school remind me of the beginnings of our self-identities.  In them, I see how much of what we valued back then persevered through years of personal challenges.  As vividly as I remember us as giggly girls, it's natural to see one become a mother and another build a home, because their capacity to nurture was in their bones before we grew to our full heights. And while much feels familiar, the shapes of who we were have become etched in more deeply and more has branched out from the roots, and I've been so amazed to be witness to that.  Through it all, we share the wonder of still trying to figure it all out, learning long past the concrete marker of graduation.

I really miss my college friends because most of them are on the East Coast, where I first knew them, and they are so much of the reason that a Californian like me has so much love for the other coast.  From them, one of many things I learned is the extreme privilege of those four years, and the desire to pay respect to everything we've been given by our families and the luck of life.  In a place that could be dominated by entitlement and ego, I met the most humble people who looked out for others often more than for themselves.  And over the years, we've let go more and more of all the stressful burdens of that time, seeing how those worries of our early twenties have proven insignificant against all the good that's grown.  It was with them that I first cried hard, like on-the-floor, carry-me-home hard (which we now laugh on-the-floor hard about). This vulnerability persists through all the slices of time since then, and for this I feel luckier with each year that we collect more moments, painful and happy.

In medical school we started referring to our group of friends as family. One of the best parts of my life so far has been having a home where people came in and out unannounced all the time. There's something so warm and loyal about spontaneous meals, kitchen conversations, treks to the waterfall (as common a hangout as our apartment). And this is a phase in my life that I most strongly associate with falling in love with being outside.  One birthday, one of our most nature-doting friends made me a waterfall, constructed from a tree log and rocks from our actual waterfall and a spout that actually streamed forth water. Every year I feel this sustenance more strongly, because it formed so much of the basis for everything else that's happened since then.  This water that's been the capacity to wash away, to carve out, to pool together.  I feel so glad for these people who helped build the elements of who I am, and for being the kind of people who constantly build for others.

I think that a big part of my unhappiness during residency was the lack of time and space to develop the same relationships, which mostly comes from my own trouble adjusting to the contrast between the freedom of medical school and the restrictions of residency. I'm immensely grateful for the people I did spend time with, who I've connected to differently and more deeply now that I'm out of the fog of residency.  I don't think there's anyone else who can really understand the loss of self that comes from this period of life that demanded so much sacrifice, and so with them I share the experience of now reclaiming ourselves and the reminder that we're much more than the structure of medicine.

Now post-residency, working at a real job, I'm incredibly happy to have co-workers who are also my good friends.  They give such good care to our patients at work, and to me outside of clinic (and many times during, at those moments after patient interactions or bureaucratic hoops when I feel my head or heart or both exploding). I really value the diversity of their paths to this work, and paths to where they are in life.  In a place where you often feel like you're constantly tending to the needs of others, it's so important to be around people with whom you swap everything, from book and music recommendations to stories about our therapists to drinks at happy hour (that's mainly me giving mine away because I'm an ultra lightweight).  It's not something I realized I should be looking for when I was interviewing for jobs, but something I'm ecstatic to have found.

And one of the best surprises of age has been forming connections outside of all these regimented phases, knowing that there's all this development and potential and newness well after people tell you you're done.  The people I've met climbing have opened for me a kind of generosity and support, different and just as strong as in other parts of my life.  I love that I've met people who are so different from me, who I never would have come across in my daily life, who share this common passion.  I've seen in so many ways how this commonality leads to a natural desire to share, and I'm always blown away by how people go out of their way to be there for each other, in climbing and life outside of it.  I'm not sure what I imagined after I finished my medical training, but I anticipated some sort of end to things.  And I think that as we get older, we subconsciously feel a little less appealing and less able to make new connections.  I'm glad to know that there's no end to interesting, giving people entering your life.  Old friends are so comforting in their persistence despite changes, and new friends feel so refreshing in the reminder that things can still change.

And of course, there's the family who have been there since the very first birthdays and early days that they remember more than I can.  On my birthday this year, a friend asked me about my favorite birthday party from childhood.  I think he felt bad when I said that we didn't really have birthday parties growing up.  But I didn't feel bad, and I never have.  Because everything good in my life started with the care from my parents and brothers, and each year older just reminds me of how far their sacrifices have gone.

Lately we've been getting into this routine of jokingly griping about getting older--more prone to injury, less able to heal, biological clocks ticking, earlier bedtimes, quicker hangovers or none at all.  And these are real annoyances, but more than anything else, I feel so lucky to have had another year of experiences with great people.  Not that all the experiences were great--this year was personally pretty painful, which makes me especially attune to what's kept me afloat--but that I can continue to make space for them, to become more.  And that depth has given me way more strength and energy than physical time can take away, making me actually really glad for the stacking of years.  Thank you so much for every person I know for being responsible for that.

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