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February 15, 2018

People : Chunk of Change

As I get older and the people around me get older, I see two general trajectories of personality: we become more stuck in our ways, or we mellow out and become more open.  One of my general ongoing goals in life to be more of the latter, especially because stubbornness is pretty rooted in my genes.  Once, a friend said to me: "don't be stubborn," and another friend responded, "that's like telling her, don't be."  Another part of getting older is distinguishing when a quality is beneficial to myself and others, and when that same quality is harmful to myself and others.  I've found that I learn the most when listening to things outside of myself, which is one of the things I love most about a job that exposes me to people so different from me, pasts and futures so off my own path.

At the same time that I'm changed by our work in primary care, I try to stay mindful of its primary purpose: to promote increments of change for other people.  Recently, I was telling someone about how a big part of keeping this work sustainable is accepting the small scale of change we can effect.  Otherwise we're discouraged and disappointed.  So I've learned to keep my expectations low, and be glad for the small and the slow.  He asked me a question that I don't think has ever been asked of me before: "Are you okay with that?"

I knew instinctively that my answer was yes, but I wasn't sure how to articulate why. I thought maybe I'd never fully processed the reason for myself, and if that was the case, was my answer valid?  I continued to think about the question for awhile.  

Soon after, I saw Passion Pit in concert at the Fox Theater (one of many reasons for my lapses is writing is because I'm not good at transitions, but I promise this is related).  I loved this band back in medical school, but hadn't listened to their music in years.  They played most of their famous songs, but it was a song from their lesser known EP Chunk of Change that really made me re-feel my love for them.  They sang "Smile Upon Me" and I kind of wanted to cry. It felt really familiar and also far away; I hadn't listened to that album in so long, and the reunion made me pay attention to the words and sounds in a way I hadn't the first time around listening to it.  

It made me think of another friend who often comments on the lyrics of the songs I play in the car, who made me realize that for all my love of language I rarely pay attention to what songs are literally saying.  I went home and listened to Chunk of Change in its entirety.  And discovered that in addition to the gorgeous sounds that always made me feel so much, the lyrics are incredibly kind and loving in this way that feels raw and scary, like when you're sharing something personal you know everyone can relate to but no one talks about.

Then that made me think of the title of the overall album, whose meaning I can honestly say I've never considered other than as a way to refer to the album.  It also helped to look at the cover art.  It's a smattering of hexagons in different colors with unequal sides, superimposed on one another.  Each shape is one-dimensional on its own but when layered on each other, and connected with straight lines that cut across the shapes, create a three-dimensional structure.  

The album is short (6 songs) and songs in general are short (a few minutes), and Passion Pit recognizes that for all that we put into our work and our creations, they're just thin slices. They're stray pennies and nickels (Marie Kondo tells us, throw away that spare change, stop saving it up because you'll never use it and who gets real joy from small coins).  But these things that occupy very little space, that have maybe little tangible value--they can carry a weight independent of their thickness or quantity.  They also shift, and show up in different places at different times, and they change us.

Which is how I feel about work, and about our slight interactions with people who deserve way more than we can give.  Each encounter is a layer, shed or accumulated.  Because it's little, we can miss it or neglect to nurture it.  We forget to trust that the things pressed upon us don't always leave concrete impressions, to have faith that caring has ineffable effects, to let go of the need to achieve successes in a conventional, direct way.  I'm not just okay with small increments of change--I love this process more than anything else.  It's the most natural way we progress, and we too often dismiss it for the promise of something shinier, something more immediate, something more definable.

Which is why one of many lines that I love from Chunk of Change is "I cry tears like diamonds."  A reminder that we arbitrarily assign value to things whose heft we can hold, and dismiss the weight of things that lack form unless they're running down our faces and even then, they're wiped away.  I love the difficulty, and the complexity, of searching for color and line in those things.

And for my own process, I'm really grateful to all the people and experiences in my life that promote layers of change, of re-framing.  Grateful for the person who asks a question of me to re-consider work I've done for years, for the person whose intuitive way of listening makes me actively re-listen to music I've loved for years, and for all our patients who challenge us every day to push our sphere of living and theirs too.

February 5, 2018

People : Our (In)Humanity

For Christmas my dad gave me all of Viet Thanh Nguyen's books--one of which I've read and didn't love (The Refugees), one of which I've tried to read twice but couldn't finish (The Sympathizer), and one which I hadn't read (Nothing Ever Dies: Vietnam and the Memory of War).  So I started on the last one with somewhat low expectations, and it turned out to be one of the best things I read in 2017.

In Nothing Ever Dies, Nguyen argues that a different mindset is required to prevent war and its traumas.  This mindset must be inclusive of all people affected by war; it must recognize the humanity and suffering of each and every side, including people who are not our own.  At the same time, he points out the danger of focusing only on humanity.  He points out that conventional anti-war sentiment often emphasizes the humanity of the victims, of the other side.  Which is very important, because it's natural to ignore the effects borne on people but because this perspective sometimes cast victims as "other," and different, it can actually undermine their status as humans equal to everyone else.  We view victims only as subjects of dehumanization, rather than as whole beings with the same capacity for good and bad as everyone else.

Because an inclusive mindset also means recognizing our inhumanity: the capacity of each and every side to inflict suffering.  We often view the people who fought on our side as committing noble sacrifices.  Nguyen doesn't deny the need to respect this courage, but he argues for a more complex view of people, one where a person can both selflessly give and inhumanly take.  It's only when we see our own capacity to harm others that we can really prevent wars from happening again.

This gave me a lot to think about in terms of war, and it also made me think about our daily work in clinic.  We often advocate considering our patients in the context of what society takes from them: equal opportunities in health, education, and safety.  This reminds us to be cognizant of our own privilege, and to share it as much as we can.  This reminds us of the humanity of those who are most vulnerable, whose humanity can be masked by the outward visibility of poverty, homelessness, language barriers, gaps in education, substance use and mental illness.

At the same time, maybe seeing them only in the context of what society denies them, denies our patients something else important: the full spectrum of who they are and can be.  Both good and bad.

We tend to feel a certain sense of guilt when our patients frustrate us: when they have demands that seem unreasonable and assert we aren't doing enough, when they seem to disregard our efforts and assert we aren't doing enough.  I think it's partly because we feel like we can't and shouldn't get angry or impatient with people who have been subjects of so much injustice and trauma.  Reading Nguyen's book made me realize that these emotions are okay to feel, because it recognizes that suffering doesn't change your innate humanness.  That to really respect the humanity in people who have suffered, means to recognize that they still have and elicit the whole range of human emotion and qualities.  I feel strongly that we should still be aware of a person's context and how it influences their behavior, so that we can provide more patient and effective care even when we're frustrated.  But instead of perceiving these frustrations as things to overcome, I'd like to accept them and see them as reminders of our patients as whole, complex people.

It's also a reminder that I'm whole--that I have the same capacity to frustrate other people, to harm other people.  The very term "provider" suggests that we are always giving, which we know isn't always the case.  I sometimes (often) find myself internally defending myself against a patient's frustrations with me, thinking I work so hard, I just want to do the best for you.  But this isn't always true.  There are times I don't want to go out of my way, when I'm tired, when I'm not sure it's worth it, when I cut corners.  When I'm like this, at best I'm not actively providing and at worst I'm taking away.  I think an important part of preventing harm is to recognize this in ourselves, not to self-deprecate, but to be honest and accepting and better.

January 7, 2018

Reading : 75 Books of 2017

Last year I set my Goodreads reading challenge to 75 books, mainly because it would remind me to always have books on hold and on hand, instead of waiting until I finished a book to look for another. I didn't actually think I'd be able to read 75. While I was able to do it, in 2018 I will definitely aim much lower so that I'm not rushing through books or evaluating them by their length.  With all that happened in 2017, I'm incredibly grateful for these steady pages of empathy, imagination, investigation and independence of thought.

My top five books are here, then a full list below. I thought awhile about how to categorize them, and at first was just going to list them in order of rating, but realized as I was going through them that there are some themes.  Which may be helpful if you're looking for a certain topic or feel (if you're drawn to the same topics/feels as I am).

** means I listened to the book on audio 
(#) the number is my goodreads rating (out of 5 stars)


The Mothers - Brit Bennett
This novel about a woman whose life is shaped by an abortion she had as a teenager is one of the most loving things I read this year. There's clear, open love for women and what they face, a kind of love that's accepting not because it's simple but because it's complex.  And it's just so beautifully written. 
(full review)

A Little Life - Hanya Yanagihara
About four friends but centered mainly around Jude, a man who suffers such severe abuse as a child that he spends his adult life constantly wondering if anything can be made of his fragments.  Obviously this is at times so painful to read, but it is so worth it.  It returns to me in some positive and full form every day, the reminder of how much each person carries. 
(full review)

**Missoula: Rape and the Justice System in a College Town - Jon Krakauer
Krakauer understands so well the steps to understanding an injustice you haven't personally experienced, and always keeps sight of what he/we can never really know. Deliberate removal of assumption, careful listening, and acceptance of how mind and experience aren't straightforward.
(full review)

**Nothing to Envy: Ordinary Lives in North Korea - Barbara Demick
Written by a journalist living in South Korea based on her interviews with North Koreans who have escaped, this book gives such a nuanced narrative of individuals as well as a country most of us know little about (and should be terrified of).  The books I own are mostly fiction and it's rare that I'll buy a nonfiction book, but I had so much respect for the people in this book, and for Demick's research and writing. 

Nothing Ever Dies: Vietnam and the Memory of War - Viet Thanh Nguyen

This was the last book I read in 2017, and one of the best. So many important and (for me) new lessons, about how to consider our perceived enemies, how to re-consider ourselves and our capacity for good and bad, how our identities can be actively shaped, how to really forgive and how to make peace present instead of just making war absent.


And the rest, in categories:

People Who Have Been Displaced

What is the What  - Dave Eggers (5) 
I absolutely love the premise, and the execution, of this book. That is, giving voice to a suppressed one, not by overtaking it or assuming guilty responsibility for it, but by respecting it, listening to it.  Over years, Dave Eggers worked with Valentino Achak Deng, one of the Lost Boys of Sudan who escaped their home country during violent civil war, to tell his story of fleeing on foot and what he continues to flee when he eventually arrives in America.

The Best We Could Do Thi Bui (5)
My first graphic novel, this book made the familiar story of a Vietnamese refugee family fresh and newly vivid for me.
(full review)

The Underground Railroad - Colson Whitehead (4)
Southern slaves use a physical underground railroad to escape, facing different terrains and different kinds of inhumanity at each stop.

**Behold the Dreamers - Imbolo Mbue (4)
An undocumented immigrant from Cameroon builds a life for his family in New York City. I liked the straightfoward storytelling, leaving us to judge what it means to migrate and rebuild.

**Exit West - Mohsin Hamid (4) 
The story of a young couple living in an unnamed country where a civil war between the government and religious rebels forces people to flee their homes. I really recommend listening to this on audio, because Hamid's voice and language are so beautiful. 
(full review)

A Constellation of Vital Phenomena - Anthony Marra (4) 
Among many other things, about a woman single-handedly manning a hospital in war-torn Chechnya, that made me re-consider the expanse of medicine and healing.
(full review)

Lucky Boy - Shanthi Sekaran (4)
A young woman from Mexico loses her son while she is held in detainment, and he's adopted by a young couple in Berkeley who can't have their own biological child.  Very driven by individual characters with a lot to say about bigger issues of immigration and America's relationship with it. It made me really angry and really sad--good fuel to question the impact of our needs and wants.

Half of a Yellow Sun - Chimamanda Ngozi Adichie (3)
Adichie narrates very different lives happening at once during the Biafran War, a civil war between the political state of Nigeria and the seccessionist state Biafra. As always her characters and language are strong, but maybe not so much as in Americanah so I was a little disappointed.

The Refugees - Viet Thanh Nguyen (2)
I appreciate the moving away from model minority stories to reflect a broader spectrum of identity among Vietnamese refugees (and others involved in the Vietnam War), but didn't love the writing.

**The Leavers - Lisa Ko (2)
The son of an undocumented Chinese immigrant, Deming is adopted by an American family when his mother disappears. I felt like this book treated the characters too much like people to play certain roles in order to tell a certain kind of story.


People Who Have Been Marginalized

Native Speaker - Chang Rae Lee (4)
A Korean-American spy is hired to gather information about a Korean-American politician, bringing to the forefront what it means to be Asian in America. Maybe it's something about spy stories (like how I couldn't finish The Sympathizer) that I initially found it hard to get into this character. But I loved the language and quiet power of the story.

This is How It Always Is - Laurie Frankel (3)
A couple has five boys, and the youngest, Claude, is transgender. I admired how Frankel delves into many of the subtle and obvious challenges of this, but I didn't like how this was countered by a too storylike ending.

**Citizen: An American Lyric - Claudia Rankine (3)
Technically really powerful reflection on microaggressions and their magnitude, I think I need to get back into poetry and unconventional prose to really appreciate this one.

Small Great Things - Jodi Picoult (1)
A white supremacist couple accuses a Black nurse of intentionally harming their child.  I hated this book so much that I'm hoping to write about it soon.


On How People Experience Trauma

Hunger: A Memoir of (My) Body - Roxane Gay (4)
After being gang raped as a young girl, Gay eats to cope and to protect herself. She speaks clearly and honestly about how little we know about invisible trauma (our experiences), as well as the uninformed ways we judge what seems visible (our appearances).

**The Hate U Give - Angie Thomas (4)
A Black teenager lives in a predominantly Black neighborhood and goes to a predominantly white school, a conflict that comes to the forefront when her friend is killed by the police. Another one that is exponentially better heard than read; the voices of the characters give so much texture.  

Exit, Pursued by a Bear - E.K. Johnston (4)

A young adult book about the captain of a high school cheerleading squad and how she changes after being raped at her cheerleading summer camp. 

**Beartown - Frederik Backman (3)
In a small town in Sweden whose identity is strongly tied to its high school hockey team, a girl is destroyed in multiple layers when she is raped by the star hockey player. I'm really glad how much we are talking about rape on a mainstream level, but I had real issue with the ending of this book. Backman's tendency to tie up endings reinforces our natural desire for closure, and doesn't allow us to sit with the discomfort of uncertainty, of the permanent consequences of trauma. It makes it too easy for us to passively sympathize and feel like it's enough to read this and feel bad. I would still recommend it for the insights into how rape happens (and its interest in this how, instead of questioning the occurrence).


On (The Suckiness of) Being a Young Girl/Woman

A Tree Grows in Brooklyn - Betty Smith (5)
A classic coming of age story I never read as a kid, and felt lucky to stumble upon as an adult.

A Tale for the Time Being - Ruth Ozeki (4)
A novelist discovers the diary of a teenager who wants to document her great grandmother's life before ending her own life. 

Pachinko - Min Jin Lee (3)
This can also be under "people who have been displaced," or "people who have been marginalized," which speaks to the broad themes of the book.  But what sticks with me is the sacrifice of women through generations. People really loved this book, but sometimes I felt like it was trying too hard to make me sad.

The Bed Moved - Rebecca Schiff (3)
Darkly funny stories about young women dealing with all the roles women play--daughters, sexual beings, caretakers.

Marlena - Julie Buntin (2)
This story of two teenage girlfriends, one inexperienced and the other broken, feels a little of the same old and more attached to the idea of tragedy than to the actual people.


On the Struggle and Power of Being a Woman
While the above speak to gender-specific obstacles by telling fictional stories, the below tackle feminism directly.

**We Should All Be Feminists - Chimamanda Ngozi Adichie (4)
Loved hearing Adichie read this aloud in her rich, powerful voice on the audio version. At first it seemed like I’d heard this before, then I realized I was just late to the party & it’s that so much that has been written about feminism in the past few years reflects what she’s voiced here. Bonus: this is what Beyonce plays in her "Flawless" video.  

**Dear Ijeawele, or a Feminist Manifesto in 15 Suggestions  - Chimamanda Ngozi Adichie (4)
Unfortunately this audiobook wasn't narrated by Adichie.  But I love the reminder that these are values we need to instill in boys and girls early in life.

**Bad Feminist - Roxane Gay (3)
I loved Gay's anecdotes about Scrabble competitions and reading Sweet Valley High books, and the overall commentary about culture and consumption, but it didn't linger for me in the same way as the above.


Funny, Thoughtful Books about Older People

They May Not Mean To, But They Do - Cathleen Schine (5)
A really funny story of an elderly woman and the impact of her aging on her identity, her life, and the lives of her children. It's rare to have older characters take center narrative, and this book did such a good job of showing the layers we accumulate over the years. 

Autumn - Ali Smith (5)
A little abstract and really poetic, Autumn uses language and imagery to build a friendship between a young girl and an elderly man through the years. It's less plot, and more mood, driven--which is usually what lasts for me.
(full review)

Lillian Boxfish Takes a Walk - Kathleen Rooney (4)
Over one night of physically traversing the streets of Manhattan, 85 year old Lillian Boxfish also crosses all the phases in her life.  It flows naturally, so that you're surprised you've covered so many years in the short time it takes to read and walk.

A Man Called Ove - Frederik Backman (3)

A grumpy man commits multiple attempts at suicide after his wife dies, but a pregnant woman and a cat keep getting in his way. Similar to Beartown, I don't love Backman's unrealistic endings but at least in this case it's a little more harmless.


Books for Kids & Young Adults That are Good to Read as an Adult

The Fault in Our Stars - John Green (5)
A book done well for both adolescents and adults, about teenagers with cancer and how they live and love each other.

Wonder - R.J. Palacio (5)
I bought this book about a 10 year old boy with severe facial deformities to read to my 9 year old nephew. But he'd already read it, so I read it myself and did that "I laughed! I cried!" thing. More later on why I love well-done kids' books, but for now--this book has everything.

**Chronicles of Narnia - C.S. Lewis ( 5)
Loved these as a kid, and listening to these was comfortingly familiar and deliciously new.

Raymie Nightingale - Kate DiCamillo (4)
I loved this whimsical, sweet story meant for elementary school readers about three girls competing in a talent contest and becoming friends in their parallel desires to be seen.


Books that Directly Address Mental Illness

Dear Fang, With Love - Rufi Thorphe (5)
Vera, a 17 year old with divorced parents, has a psychotic episode that brands her bipolar disorder. As an escape and a way to delve into their family history, Vera's father takes her to Lithuania. They alternate telling the story, which is just one of many ways this book shows how difficult it can be to get at the "real" perspective.  It seems unfair to say it's one of the best books I've read about mental illness, because it so deeply shows how much "mental illness" is just about people.

I Know This Much is True - Wally Lamb (3)
The story of twin brothers, one burdened with schizophrenia and the other burdened with taking care of his brother. I appreciated the complexity given to the latter, kept wanting to know more about the former.

Eleanor Oliphant is Completely Fine - Gail Honeyman (3)
Eleanor doesn't know how interact with the world and doesn't know that she doesn't know. She doesn't recognize her isolation or her inability to process her childhood trauma until she makes her first real friend.  I think these last two books are good at presenting certain issues but simplify their solutions.


The State of Our Country

**Losing Our Way: An Intimate Portrait of a Troubled America - Bob Herbert (5)
Very concisely and movingly draws a picture of the major problems facing our country: unemployment, unequal distribution of wealth, the lack of investment in physical infrastructure.  Herbert makes these accessible through stories of individuals bearing burdens that aren't uncommon but aren't commonly considered.

**Evicted: Poverty and Profit in the American City - Matthew Desmond (4)
Desmond lives among the lowest-income residents of Milwaukee to learn how the housing system and poverty are an impenetrable cycle. He gives valuable insights into why these communities live, work, spend, move the way they do, reminding us these are questions to ask, not answers to assume.

**The Unwinding: An Inner History of New America - George Packer (3)
By exploring the trajectories of individuals working in different industries (factory work, politics, tech, business), Packer shows how our inequalities have developed and how our founding values have dissolved. He weaves in narratives about cultural figures, snippets from songs of the time, and news headlines, and I found it a little hard to follow.


The Dynamic Between Groups of People (Family, Friends)

The Nest - Cynthia D'Aprix Sweeney (3)
Siblings from a dysfunctional family all need their family trust fund in their own ways. Having four siblings, I wanted to like it more than I did but couldn't get into the characters.

Why We Came to the City - Kristopher Jansma (3)
About a group of friends in NYC whose lives change when one gets sick. Also without super memorable characters for me.


Fluffy Fiction

My Lady Jane - Cynthia Hand (3)
Bookworm Jane marries a man who's a horse by day and man at night.  (Note the title of this category of books).  Silly but fun, and book-reading heroines are always secretly a soft spot.

Landline - Rainbow Rowell (2)
I thought Eleanor & Park was so creative and well done, but this story about a woman who is able to go back in time and talk to her husband during a time when they still dating, was just really cheesy.


Listened to most of these on audio, which I always prefer for memoirs, especially if the author is reading it.

**Long Walk to Freedom - Nelson Mandela (5)
This audiobook was something like 27 hours long, which felt appropriate.

Funny in Farsi: A Memoir of Growing Up Iranian in America - Firoozeh Dumas (4)
These stories about being a first generation child in an immigrant family are so simple, funny and relateable. I couldn't find this on audio but bet it's even better aloud.

Laughing Without an Accent: Adventures of an Iranian American, at Home and Abroad - Firoozeh Dumas (3)
I read this immediately after Funny in Farsi because I enjoyed that one so much.  This one is enjoyable but without some the same punch.

**I Am Malala: The Story of the Girl Who Stood Up for Education and Was Shot by the Taliban  Malala Yousafzai (4)
The title summarizes it, and the book fills in so much more about how brave and forward Malala is.

**Naked - David Sedaris (4)
One of his more vulnerable memoirs.

**The Girl with the Lower Back Tattoo - Amy Schumer (3)
Probably one of the comedian memoirs I liked best this year, because she really makes fun of herself so sincerely.

**Little Victories: Perfect Rules for Imperfect Living - Jason Gay (3)
I feel like so many books by comedians are just packaged slightly funny common sense advice.

**Brain on Fire: My Month of Madness - Susannah Cahalan (3)
A healthy young woman becomes psychotic and the doctors can't figure out why.

**Talking as Fast as I Can: From Gilmore Girls to Gilmore Girls - Lauren Graham (2)
Disappointed by this one because I thought there'd be more insight into the experience of Gilmore Girls, but mostly Graham talks about how great everyone is and how great it was to work on all her sitcoms.

**Option B: Facing Adversity, Building Resilience and Finding Joy - Sheryl Sandberg (3)
Some valuable but not new lessons for coping with tragedy.

**Shoe Dog: A Memoir by the Creator of NIKE - Phil Knight (2)
This was less interesting than I thought it'd be, and about as misogynistic as expected.

Dress Your Family in Corduroy and Denim - David Sedaris (2)
Not as funny or vulnerable as Naked but probably Naked was funnier because I listened to it on audio.


A Couple Books about Guys
I wrote my college thesis on Hemingway and my favorite writer is Murakami who has only written one book with a female protagonist, so I'm not opposed to books about men. But of all the stories out there, it seems most worthwhile to seek the less spoken. That said, I did moderately enjoy these two.

Stephen Florida - Gabe Habash (3)
I kind of like stories about sports even though I don't like watching them or really doing them. It's interesting to see the intensity and mindset that goes into training and competition and self-identity. Stephen Florida is a wrestler who drives himself crazy physically and mentally while trying to win his division during the last possible year to do so, and it's pretty dark.

Black Swan Green - David Mitchell (3)
A funny glimpse into the life of a teenage boy through stories of 13 year old Jason Taylor and his speech impediment, the unraveling of his family, crushes on girls with boyfriends, and dares that turn dangerous.


(with the disclaimer that I'm not really into thrillers)

**Dark Matter - Blake Crouch (3)
A man wakes up to a world where no one knows him as he knows himself; he's acquired an entirely different identity.  The twist is pretty interesting and spirals quickly, deeply and darkly.

Do Not Become Alarmed - Maile Meloy (3)
Two couples and their families go on vacation, and their four children are kidnapped in Central America.



The Rock Warrior's Way: Mental Training for Climbers - Arno Ilgner (4)
My friend gave this to me for my birthday, and in the immediate aftermath of reading it I became much braver about taking falls while climbing.  Then I forgot, so something to come back to.

How to Climb 5.12 - Eric Horst (3)
I read this not because I'm anywhere near climbing 5.12 outside (extremely far from it) but because I like the idea of pushing what we think is possible for us to climb.


 A Couple Strays

OriginalsHow Non-Conformists Move the World - Adam Grant (3)
Stories of unusual ways of pushing innovation and gaining success. I don't love these books that use one case study to make generalizations, but the stories were interesting.

The Essex Serpent - Sarah Perry (1)
I was so bored by this love story between a widow and a vicar, who have different opinions about a mythical serpent.

January 1, 2018

2017: Climbing

While spending New Year's Eve with a friend I've known for 15 years, she asked me what my word for 2017 would be, and it was easy: climbing.  And if I had to choose one defining picture, it would be this one, of us climbing in parallel.

I'm so incredibly grateful for climbing in parallel with such strong, giving women this year.  On rock, in medicine, in all the life between and around.

I know that a lot of my friends this year are grateful for giving birth to daughters, as they should be.  On my end, I'm grateful for all the women in my life who give birth to so much love.

Thank you to all the women who pushed and supported each other to climb hard and face fears and take falls--I honestly cannot think of happier times than the days spent with you outside.  Except maybe for the long drives to rock talking about everything, the after-climb pizza and (sometimes warm) beer and (always cold) ice cream, the ladies' nights spent in your company with nothing else needed.

Thank you to my women co-workers who take such good care of our patients and of each other, who feed each other and affirm each other and remind each other of why this climb is always worth it.  For using what we've been given to lift others, even when we hit bottom and further than bottom.

Thank you to my girlfriends, people I've known for over two decades, for over a decade, for over a year, who are all equally loving and generous and accepting.  Who are close, who are a country's length away and remember each other's presence all the same.  Who have never once made me feel lesser for my neuroses.  Who during a time when so much of us is being torn down, so naturally build for and with each other.

Thank you to the caregivers in the families in my life--my mother, my sisters-in-law, my cousins--who quietly and powerfully sacrifice so everyone else can climb.

Thank you to every single woman in my life who loves and climbs in your own individual, strong way. You are so many and so much.  I love you so much.


January: South Africa

Climbed to these viewpoints in South Africa with a friend from residency, to visit a friend from residency working in a rural hospital, lucky to know a woman dedicated to helping people different from herself, lucky to be accompanied by a woman who actively pursues adventure.

February: Bishop CA

Drove through terrifying snowstorms to climb in Bishop, the anniversary of a climbing trip with an old friend and the first climbing trip with a new friend, the beginnings of a connection that defined the rest of the year.

March: Mount Saint Helena CA
A beautiful day with beautiful ladies, ending in pizza, beer, brownies, and ice cream.  

April: Red Rock Nevada

Saw how far we'd come since our trip here a year and half ago when we really didn't know what we were doing.  Wheedled our way into swimming pools, used carabiners to open beer bottles, and shed our clothes for the heat of this amazing place.

May: Olympic National Park Washington

 Reunited with my best girlfriends from medical school with a trip to Olympic National Park where we hiked to snowy mountains, foggy overlooks, and sunset beaches. Remembered where we began and how we've fulfilled our goals and still working on others. Celebrated my birthday with 33 desserts, orchestrated by my ever-giving girlfriend who filled the venue with flowers and love, and attended by my med school wife who changed a plane flight to make it to the party, and my co-workers who crossed the bridge from East Bay to San Francisco on a weekend night for me.

June: Yosemite

A shoutout to the men who support women, knowing we can do the same and better.  To my old friend who took me on my first trad climb a year ago, and to a stranger who taught me without any expectation of return, both making possible my independent trad climbs later in the year.

July: Emeralds CA & Boulder Colorado

When we got lost (again), swam, camped and also climbed a lot.  Celebrated July 4 by feeling lucky for our independence as women who will (eventually) navigate to our destination, start fires, and get dirty.

The Colorado trip where we crossed rivers to climb roofs, and I climbed my hardest grade outdoors yet (11d), in huge part because these ladies said: try it.

August: Lovers Leap CA

Spent a weekend leading my first traditional climbing routes, absolutely terrified and ecstatic.  Especially lucky to climb them with my colleague and friend, who amazes me every day with her patience and kindness.  She spends hours with her patients, in and out of clinic, and still manages to hug everyone else in life.

September: Lovers Leap & the Emeralds & Yosemite (All Again)

The month where we returned to previous places, progressing and changing.  Growing in strides with each other. The lake, with its receded tides, looked and felt entirely different.  And so did we.

October: Red River Gorge Kentucky

When we told ourselves we're not limited to being grade 10 climbers and we all climbed a gorgeous 11a together. When we committed to different styles of climbing, tackling crimps and overhangs, finding that our hands can shift and diversify.  When we saw fall colors change gradually and dramatically over the course of days.  And also drank a lot of bourbon.

November: Red Rock Thanksgiving

A return to one of my very favorite places in the world, the Gallery at Red Rock.  Four days of climbing in yellow sun and red sunsets on red and orange rock.  In which I fell when rock broke, climbed down and climbed back up to finally get a frustrating move, and said yes I will begin that without knowing whether I would finish.

December: Sonora CA

Took three trips to Sonora this month, in which I tried and bled.  I colored my partner's hot pink rope in bright red blood, trying over and over to finish a climb and falling twenty feet over and over.  I left blood on rock while trying to climb real outdoor cracks for the first time, feeling humbled and happy doing something I was really bad at.


We cried so much in 2017, and it blows my mind how much I received while so much is being taken away.  What I take away most from all I've been given in 2017 is the need to climb togetherThank you for letting me be there and for making room, giving me hope for all the space we can create.

December 10, 2017

People : Nuance

Red River Gorge Kentucky, October 2017

Once, several years ago, a friend and I are driving in a car and see a jogger go by.  My friend says, "That person is running really slowly."  I respond: "Maybe he's been running for ten miles and this is the end of a long run."  My friend responds: "That doesn't change the fact that he's going really slowly."

I remember this because it brings up questions that years later I still consider every day in work and life.  We have a conversation about the difference between making an objective observation, and forming a subjective narrative.  He argues that he was just making a comment, and it's true that objectively the person is running more slowly than your average jogger.  But I responded the way I did, because I think it's pretty rare to withhold all judgment from any observation.  This doesn't mean that the judgment is bad or wrong, just that we form thoughts about the things we see so immediately and instinctively that we don't recognize the jump from observation to judgment.  So what we think is an "observation" almost always carries some connotation in its statement, or opens itself up to connotation.

I also responded the way I did because context matters even when making what seems to be an objective statement, since something like speed is relative.  How long the runner has been running does change the fact of his speed, if you're talking about an adjective and not just a number.  You might see, and say, something entirely differently if you knew that slow runner is an ultra runner who is on mile thirty.

I've been told by a number of people that I make too many excuses for people (most often, our patients).  Most often it's a loving joke.  But in other contexts, this comment assumes a lot: that I'm naive, that I dismiss personal responsibility, that I let people get away with things, that this is harmful to not just me but to the people for whom I "make excuses."

It's true that I've had people take advantage of me, as we all have, but I'm glad to have pushed the boundaries of giving people the benefit of the doubt to see how far that can go. I'm also not blindly imagining a world outside of the confines of our clinic; I'm making a conscious decision to remember that that world is more real than this artificial space we've created.  So I'm not naive and I understand the dangers of trying to analyze why someone is an hour late to an appointment, or yells at me for no apparent reason, rather than being straightforwardly strict about those behaviors.  My co-workers who see me go through it and go through the same things themselves know that we strive for a certain balance of boundaries, of support and tough love. They also know that I very often tell patients in the moment that these actions are not okay and that I try very hard to not give into unreasonable demands.

But I think that this type of response to the effort to contextualize--the "you're making excuses for them"--is just another example of why it's so important to contextualize in the first place.   Don't assume that just because we can imagine a lot of stories, that we believe all of them.  Or that just because we can imagine a lot of reasons, that we ignore the implications.

We just believe in the importance of imagining, and in appreciating how much nuance every action possesses.  When we imagine all the possible reasons for an action, we're not necessarily saying that the action is justified, or that it can't/shouldn't be changed, or that people shouldn't be held accountable.  We just want to acknowledge how much we don't know.

When I find myself frustrated--with something in clinic, in the world, in my personal life--and try to figure out what exactly is frustrating me, the source is most often a lack of nuance.  People are hardwired to make so many assumptions, and we all trust in our own judgment above all else, and sometimes this makes me really angry.  I know that this happens for evolutionary and human reasons, that immediate judgment is part of a survival skill set.  But when we are comfortable and have the resources and space to consider the world beyond our personal survival, instead of accusing someone else of making excuses, I'd ask what is our excuse for not imagining the depth and complexity below our observations?

If I had to choose one thing I am most grateful for in my education, and the one thing I'd wish most for in our education system, it'd be the value that books give in imagining this depth and complexity.

I recently read Beartown by Frederik Backman, which is a fictional novel about a very real, frequent occurrence: the rape of a teenage girl by a prized athlete in a small town whose livelihood relies on the sport.  After having so many patients suffer from this kind of trauma, I've read a lot about it this year (Missoula is a must-read for anyone interested in this topic).  This has taught me so much about how to re-evaluate how we judge, how reluctant we are to admit our gaps in understanding and knowledge.  While I had a lot of issue with the ending, I thought the beginning of Beartown does an excellent job letting us slowly get to know its characters and how many factors converge to create tragedy, such that there are many ways to answer the inevitable question of "How could this happen?"  It also shows the ramifications of not imagining, of simplifying people and situations.

There's little that drives me crazier and makes me angrier than this closed thinking.  It doesn't come from a cruel place, but can lead to such cruel consequences.  I know that when I'm busy and tired and overwhelmed (often), I do it too.  So it takes active energy and reminding to stay open, renewing the intention over and over when we fail.  With so many unimaginable things happening in the world right now, the least and best we can do is to hold ourselves accountable to imagining why and how.
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