Yuletide in the Foggy City

Grateful for our tree

Christmas will always bring to mind the woman I saw in the Emergency Department last year. She was around forty, had epilepsy, and came in because she had "gone into convulsions" that morning. Her husband brought her in at 4 AM, explained that she had fallen out of bed and bitten her tongue, and then then had gone to work while she was treated. Although it was clearly painful to talk, she wanted to. She told me she had come to our hospital because when she went to the general hospital after a seizure, the staff assumed she was drunk or high because she was Black. "It hurt my pride when they treated me like that," she told me with a bleeding tongue, "I don't abuse my body with drugs or drinking." As she and I talked, it became clear that she had been off her seizure medications because she was saving up for Christmas. "I asked the kids if they wanted a tree or presents more, and of course they said presents. They've been good kids, so they'll get their toys. We'll just do without the tree this year, things have been rough with the money."

Stockings, candles in the grate, and apple pie for Santa

Stories like this always remind me to be thankful for how much we do have -- our health, each other, and more than enough money to live on. We had such a joyful and abundant Christmas, with both a tree and presents, and I only wish everyone could be as fortunate.

Card games around the table

Our traditions vary, but this year my whole family and B (B and I were at his parents' for Thanksgiving and my parents' for Christmas) played a board game around the dining table, Apples to Apples. My father won, which makes this the second year in a row he had won the Christmas game! Well done, Dad. We also spent Christmas Eve dinner together, and my dad had Tandoori chicken, palak paneer, and other delicious food for us to eat. Our Christmas Day brunch was tasty too (but then, I made it and I only made food I like!): whole wheat flapjacks (some with chocolate chips), chicken and beef sausage, garlic and cheddar home fries, and eggs with toast. We were all full on Christmas morning, although I did sneak back for an extra flapjack. We opened presents together in the living room, and it was just a lovely feeling to be together, with B there for the first time.

A thoroughly spoiled Samantha

Even Samantha, my American Girl doll from back when it was still The Pleasant Company and American Girl had not been sold to Mattel, had a new fancy purse and a plush Christmas mouse. After we had all opened our presents, we bundled up and went out to see the new Tin Tin. We used to read the Tin Tin comic books in India, so it was a fun treat. The movie was well made and the visual effects were beautiful. It was a very simple story, and family friendly. There was a camel that was so touchably fluffy with such long eyelashes that I wanted to take it home.

Family Movie

 

Laughter around the food table

We had a gathering in our home the night before New Year's Eve. We were joined by old family friends whom we've known for years. It was so nice to see them all again amid laughter and stories of 2011. We had food and friendship as we bid the old year good-bye. I'm glad to welcome 2012. I hope it will bring us luck. If you look in the middle of the food table behind the grapes, you will see a square gingerbread on a square plate. Here is my Pumpkin Gingerbread Recipe to keep you warm in the chill -- be careful not to over-bake, it is better moist and also better on the 3rd day.

Pumpkin Gingerbread

Pre-heat oven to 350. Take out two large mixing bowls. Into each, add the following:

Bowl 1:

2 cups brown sugar
1/2 cup honey
1/2 cup olive oil
4 eggs
2/3 cup water
1 can pumpkin
1 tbs powdered ginger
1 tbs cinnamon
1/2 tsp cloves
1 tsp pumpkin or allspice
Pinch nutmeg

Bowl 2:

1 cup white flour
2.5 cups whole wheat flour
1/2-1 tsp baking soda (depends on your baking conditions)
1/2 tsp baking powder
1 tsp salt

Mix each bowl separately and well. Fold dry ingredients into wet.
Mix just until evenly blended. Pour into 10x10 in pan or two 9" loaf pans.
Bake 1 hr at 350. Remove to cooling rack when a knife comes out clean. Serve on the 2nd or 3rd day, warmed, with ice cream or fruit.

There were so many parties and potlucks around the holidays, including for work. I am currently trying to decide between Neurology and Pediatrics for a career (potentially Child Neurology). The rules for how to apply to which are quite convoluted. I don't know what will happen, but I hope that it all somehow works out... I will let you know! I need to meet with advisors, write an appropriate resume, and try to get in touch with my former classmates (many of whom are graduating this year, meaning that they are applying to the residency Match right now). Isn't it strange that a computer algorithm determines your post-MD placement? It's a bit scary, but then everything worth doing is. I'll post about what happens.

Office potluck -- everyone digging in

There are so many projects I want to work on all at once. I don't know which to do first. There is the lab work, other work-related projects, career planning, household stuff, wedding wrap-up. It's all wonderful, though, in a sense. My mother was right: it is fun to be a grown-up.

Wet Malamute

We have finally gotten the rain we will need to prevent another big summer drought. As I write this, though, I have a grown-up dilemma: the next-door neighbor's dogs are locked out on their patio, it's pouring, and the younger of the two is chewing up and ripping apart their wooden window blinds trying to get into the house through the window. The neighbors have gone out, or else they aren't answering the doorbell. They've just moved here and I don't have their number. Should I leave them a note? I've told the dog, "No!" but that is all I can do without breaking into their yard (not a good idea with strange dogs). Poor, wet, angry doggies.

I Am Done with Step 2 CK!!

Simulated Exam Screen with Heart Mitral Valve (score95.com)

I haven't written in a very long while, because I was overwhelmed by that anxious, itchy feeling of not knowing how you've done on a very important exam. As you know already, I was wondering what would happen if I did very poorly or didn't pass. But last Wednesday I got my Step 2 CK (Clinical Knowledge) results back, and not only did I pass, I passed comfortably. No 'squeaking by' like with Step 1. What a wonderful Christmas present! And maybe I'll stop making careless mistakes in lab now. A huge weight has been lifted. I'm hungry again. I care about life again. And I'll start posting more frequently now that I have a little more time to devote to writing.

B and I went to LA this past weekend so he could visit old law school friends and I could take Step 2 CS (Clinical Skills). It's an in-person exam set in a simulated clinic. The exam was so odd. We were in a long hallway with over twenty doors, and standardized patients behind every door, and proctors in the hall, and buzzers and announcements going overhead. I felt under time pressure and could not do a lot of physical exam, sadly, so I hope that is okay in terms of whatever grading rubric they use. And it's a pass/fail exam, so I just hope I pass. I don't need a good score :) I am not allowed to say anything about the actual content of the exam, but it was just a weird experience. They are all actors. For one patient, I wasn't sure if he was "supposed" to be malingering -- that is, pretending to have symptoms for some other benefit. But he was an actor, which meant I was pretending to be concerned about his pretend symptoms while trying not to act as though I thought he was pretending to pretend. And they say it isn't an acting exam.

So, in a word: Phew!!

Gingerbread and Counting One's Blessings

Thanksgiving is almost here, and we have more than enough to be thankful for. B passed the California Bar Exam! He was enormously relieved, especially given that two of his twenty colleagues did not pass this time around. B will also be on the East Coast for a few months this spring for an internship, and then will be looking for work. Where he ends up will determine where I seek a residency next year.

Assuming I pass my own exam. Results haven’t arrived yet, so I feel a bit stuck in limbo right now. I keep playing the ‘what-if’ game – what if I failed? What on earth do I do then? What if I never graduate from medical school? Finally, I got so tired of this that I called my own bluff and started to compile a list of alternate careers I could do if medicine did not work out:

Clinical research director. High school teacher. Biostatistician. Medical transcriptionist. Policy analyst. Medical writer. Bench scientist/technician. Guidance counselor (ironic). Riding for the disabled instructor. Any other thoughts?

The clinical skills exam is coming up in mid-December, and I plan to start studying immediately after Thanksgiving break. We are going to his parents for Thanksgiving and mine for Christmas. Things at work are a bit hectic, as well – I feel guilty going anywhere for Thanksgiving because it puts a forced pause in an experiment where no pause should be, and my boss offered to feed my cells over the Thanksgiving weekend. Yuck. There’s nothing like knowing you are putting your boss out to take the fun out of a holiday. I am also hugely inexperienced and am dealing with quite a steep learning curve. I’m sure that I supply the more seasoned scientists with plenty of laughter over my naive mistakes. 

As you can probably tell, I am feeling all out of balance... plans I thought I had made so carefully to schedule things out this year have gone awry, and I just hope that somehow it will all work out. I am learning important things about myself, though – I do not think I want a wildly unpredictable career where I play five different roles and juggle far too many responsibilities. Although I doubt any medical career could ever be low-stress, I would like medium as opposed to very high stress on a daily basis. A little bit of time for family would be nice, as well. I think that this culture really does emphasize doing as much as you possibly can, and de-emphasizes things like family time, sleeping, and food. No wonder obesity has become a problem – poor, stressed-out working people have too little time to cook, so they simply eat processed foods or eat out all the time. And they are so busy working that they are never able to go for a walk. It's a double whammy.

Anyhow, one of the sovereign remedies for the blues is to think happy thoughts. Funny things qualify: the other day, the children who live above us were dancing around while it was raining out. Somehow, the rain amplified their footsteps until it sounded like an army was marching over our heads. Of course, they will now forever be known as the Storm Troopers.

Secondly, one of B's colleagues called Swarthmore College, our alma mater, a "potted Ivy." I thought this was both highly flattering and quite appropriate (but then, I'm biased. I loved Swarthmore).

Another form of happy thinking (appropriate for the upcoming season) is to list the stuff you are grateful for. So here goes... 

Things I am Grateful For: (Here are the ones I can think of right now, in no particular order)

Being happily and newly married.
All the wonderful people who came to our wedding/sent us love.
Living in the same town as my brother!
Having adorable parents fifteen minutes away.
Warm gingerbread with cold milk.
My thirteen-year-old cat, who is still pretty feisty.
The friends I've made in medical school, and the friends from college who stuck around.
Having a job with good colleagues.
A car, a roof over our heads, food, comfortable clothes, and some extra goodies.
Good in-laws. Seriously.

To facilitate putting the attitude of gratitude into practice, I just got one of my favorite things in the world: a new blank journal. It's been a year since I kept one. For $3.99, isn't it worth it to feel as though your life is, once again, a clean, fresh sheet of paper just waiting to be written on? The only feeling that tops it is when you've filled it.

Emerging from the Library

The Step 2 CK exam was yesterday. It was a long, grueling nine hours, and by the time it was over, I was so brain-dead that I have no idea whether I made it or not.  It felt terrible to leave the testing center thinking that I might have done badly after studying so hard. I did feel like I was catching up during my studying, but still. Not a great feeling. And there is quite a lot riding on this exam. It is sickening not to know if my career goals will come to pass. After imagining out every possible scenario and moping around for a bit, I decided that regardless of the outcome, it's going to be weeks until I find out. And regardless of the outcome, I did what I could in the time that I had. It is now in greater hands than mine. So in the meantime, I'll write a bit about what's going on now that the board exams are (for the moment) over.

The grass is greener on the other side.

Catfish the Siamese is home, after spending a little vacation at my parents' so that I could actually get some sleep (she enjoys parading across the bed and meowing for food at 5 am every morning). I went over to my parents' place to collect her right after the exam, and was able to spend a good long time with the family. B came with me, and my brother even stopped by. It was so nice to have an impromptu family gathering.  The weather has been trending towards chilly rain with a generous helping of clear, bright days.

This morning we went to the farmer's market -- there will be just one more next Sunday and then the harvest season will be over. Guess what has come into season whilst I was studying? Fuyu persimmons! We also found fresh cauliflower, tomatoes, onions, and apples. They were selling apple cider but we decided to pass this time around. It doesn't last as long in our house as the apples do! We sliced up our bell peppers onto whole wheat toast (B's home-baked bread) with mozzarella and tomato puree -- our marinara open-face sandwiches were delicious.

B making bread dough.

A golden loaf, fresh out of the oven.

The end product!

We also took a short journey to Golden Gate Park this afternoon to enjoy the November sunshine. There were so many families out walking or boating, and any number of ducks, seagulls, and flowers still in bloom.

A bright yellow blossom seems to say, "Cheer up, cheer up! Life is worth living!"

The moss, trees, bridges -- everything felt fresh and interesting. It was lovely to be outdoors instead of studying. The animals at the lake are used to people and will let you get pretty close, hoping to be fed.

Contented ducks.

The Canada geese were quite docile.

Sleek geese getting nervous before Thanksgiving.

We made friends with an elderly gentleman who was feeding the seagulls -- I was able to catch their excitement as they flew up to catch the breadcrumbs!

Free meals draw crowds.

Whee!

As we drove home, we were treated to a beautiful early sunset against the autumn clouds.

It didn't seem real to us, either.

Speaking of Thanksgiving, I saw an article in the September Education issue of the NY Times Magazine discussing the differencing between raising overachievers and raising children with "true grit" -- the strength of character to succeed in the face of adversity. It really spoke to what I've been thinking about lately and what my boss and I have discussed -- that life is not an IQ test, and that your drive, optimism, gratitude, social skills, curiosity, and sheer gumption will get you a lot farther in life than just intelligence ever could. It's called "What if the Secret to Success is Failure?" I think the title is misleading, though; it's more about whether character can be taught than whether failure is needed for success.

For someone in my particular position (that is, trying to learn a set of skills, earn a degree, and begin a profession), it was a very hopeful read. It's been a more difficult road than I anticipated, for a whole host of reasons, so it was nice to hear that continuing to strive for the goal is worth something in itself.

A red-eared slider at the lake. Slow and steady wins the race.

Happy Halloween!

It's absolutely my favorite holiday of the year, so even though I am studying, I could not help but post a short post in celebration. We put out a jack o'lantern that I painted (okay, with a permanent pen) instead of carved because we plan to (insert evil laugh) eat him.

We had about a dozen trick-or-treaters, with the most popular female costumes being cats and Minnie Mouse, and the most popular male costumes being monsters (all black with a scary mask). Best female costume: Harry Potter! Best male costume: A soldier with a purple heart.

Best group costume: Three Muni trains! If you've ever ridden the Muni in San Francisco, you will understand why it is appropriately scary. They were beautifully detailed, with working headlights, perfect logos, and the correct route stuck on their fronts. They even had advertisements on the sides! Here they are getting derailed...

... and eating their lunches. Trains need fuel. Ironically, these MUNIs chose Subway for lunch.

It was a beautiful Halloween night as the sun set over the sea...

 And here is the Haunted Wood on my way home from work:

Hope you had a Happy Halloween!

To NIH and Back Again

The NIH Clinical Hospital: Every patient is on a research protocol

I recently made a brief journey to the National Institutes of Health for what I believe qualifies as my first-ever business trip! That is, if you consider a 'business trip' to be one that is both mandated and paid for by your employer. It was an incredible trip. I met nearly 100 other medical students also taking a year "off" from school to do research. They represented an incredible range of schools and interests. I took a chance by going to a neurology networking lunch one afternoon, and was invited to do an elective at NIH next year by one of the physicians there! Wow. We also attended presentations about residency selection, balancing a clinical practice with a research career, finding funding, and dealing with student loans.

The keynote speakers were very famous people -- Francis Collins (NIH director, working on aging), Anthony Fauci (he and his PI essentially discovered the treatment for Wegner's granulomatosis and his lab went on to develop AZT, the first antiretroviral, discovered much of the natural history of HIV/AIDS, and convinced three presidents to fund AIDS interventions in Africa), and Marston Linehan, whose lab is responsible for discovering the basic pathways of kidney cancer AND creating new techniques to vastly extend life in patients with kidney cancer. I was in awe that such brilliant people were also such good speakers and seemed very personable. They encouraged us to take over from them in the next generation. What shoes to fill!

Building 50: My Old Lab!

We were housed at the Hyatt in Bethesda -- my roommate was a wonderful person who studies colon cancer risk decisions and wants to be a rural family medicine doctor. I was very glad to have met her. I also reunited with medical students I had met on the interview trail years ago, but had gone somewhere else. There was not too much time to socialize except for the meals --  which were delicious and plentiful. I was very grateful that NIH had organized the weekend for those of us funded through NIH student grants (of which there are many). Bethesda was beautiful in October -- crisp air, deep blue skies, fluffy clouds, and trees just beginning to change. I very much enjoyed being back there after four years away. It was over so soon.

Trees Changing Color at NIH

I flew home and found, to my surprise, that I was sitting next to two medical students from Yale, a year my junior, going to a surgical conference in the Bay Area! We spoke at great length about the Bay Area and medicine versus surgery. We called our little area of the plane 'Medical Student Row,' and were continually being visited by other students on board who were also attending the same conference.

Cat in a Bag

NIH or no NIH, however, there is no place like home. My sweet cat had been moping around, according to B, but she was perky when I arrived, and we found her contently chewing on a receipt in a brown paper bag that evening.

Cactus and Aloe in Window Silhouette

Exam Rose!

Our plants were looking wonderful, the rose B had given me to cheer me up was still in bloom -- and this reminds me that now, and for the next month or so, you will please forgive me if you hear very little from me. I must somehow gear up for all the examinating that lies ahead. There are now only 18 days between myself and Step 2 CK.

Boundaries and Bosses

I have two bosses. They are both incredibly bright, lovely women who happen to have advanced degrees and a lot of clout. Big Boss is the head of our lab. She is one of those people who looks between 10 and 15 years younger than they are. She is very driven, down-to-earth, straightforward, and to the point. She is always juggling several things at once but somehow manages to get all the important things done. She keeps her promises. She doesn't have a lot of patience with personnel drama. However, her husband works in her lab, so I have a window into her world through their interactions.

The second boss I call my Little Boss. She is a young attending physician-scientist who works in the lab, and I'm helping her with her first big research study. She has a three-year grant and has nearly completed the work mid-way through her second year. She has been that kind of worker throughout medical school and her PhD program. However, she and her husband have just adopted a two-year-old boy and she is feeling a powerful maternal urge, I think. She is now planning to leave academia this year for half-time private practice so she will have more time with her son. I do not know that this goal will materialize for her, given the climate of private practice these days. I hope it will, since she feels compelled to leave so soon to pursue it. I have my doubts.

My Little Boss

I have come to realize that in my lab, the blurring of boundaries between work and home is so great that most of the folks who work here could write each others' biographies. Each day, we all sit down to lunch for an hour from noon to twelve, the unwritten rule being: No Work Talk. Every time I have mentioned work at lunch, I have been gently hushed until I, greenhorn that I am, got the message. It is the socializing, networking, debating, and gossiping hour, but never work. It seems so civilized and old-fashioned. It is a far cry from the inpatient hospital world, where sitting down is a crime and chewing (meaning eating) a sin. In addition, Little Boss and Big Boss tell me so much about their lives. I know about their kids', pets, spouses, their home lives, etc. Perhaps the culture is that way because everyone is a parent -- Big Boss has two teens, four others have grown-up kids, and Little Boss as well as two other scientists all have kids under two.

Little Boss says that part of the reason she wants to leave is that she thinks that private practice will have more well-defined hours. For instance, in our lab, she can go home in the middle of the day if she wants to have lunch with her son. But she hates feeling that research is this amorphous entity that could take up 20 hours a day if she allowed it to. She'd rather have the stricter hours of a clinic, knowing that when she packed up for the day, she was not bringing her work home with her. I think the people she works with are far more important than the job description on paper -- if they value family time, that will affect the culture of the workplace. I personally think our lab environment is much more family friendly than the clinics I've seen -- of course, I've only really seen clinics that are affiliated with big hospitals. Perhaps community clinics are more flexible.

I am very grateful for this year. It is giving me a chance to study, think, earn a little money, work hard but sleep enough, and reflect about my future. I really, really needed it after an emotionally overwhelming and academically underwhelming third year. The other day, Little Boss introduced me as her "senior medical student," and I could not help but think that I am really too far behind in my studies to be referred to as such. Then again, that is what my precious year is for.

Today, both bosses were helping me prepare for my lab meeting on Friday afternoon. Big Boss wanted me to include more basic science, more details about the mechanisms, signaling molecules, hypotheses and how we were going to test them. Little Boss was of the opinion that this would put my audience to sleep, and that I needed to clarify the basic principles, questions, and background. The lab meeting is a practice session for the Works in Progress talk I am giving to the other year-long research fellows on Wednesday. That one is a bit more nerve-wracking because there will be another student speaking as well, before me, and one whom I know to be very hard-working. Anyhow, my task now will be to take the advice of Little Boss while somehow also pleasing Big Boss. I am so thankful for all this feedback and attention -- it's far more than I got last year. It is challenging, though, to navigate two opposing opinions -- clearly, Big Boss trumps Little Boss, but I work much, much more closely with Little Boss and want to keep her happy.

My only fear is that I will be pressured to divulge all the personal details of my life while at work. I guess I just have to guard against it. I have already been put in an awkward position a few times because my higher-ups ask me to keep secrets from one another; I don't want them to know enough about me to get under my skin. Ironically, it's safer perhaps to discuss things here, on this online blog, than at work. It's getting late now, so I think I will turn in for the evening. Good-night!

Mountains Ahead

Dolores Park on a warm fall day (Ingrid Taylar)

The Bay Area's hallmark late summer seems to have come at last, three days before the official beginning of autumn. After fog and wind all summer, it's been 80 degrees with warm nights and bright sunshine. It is a cruel trick for visitors to this region that our summer starts as soon as tourist season ends, indulges us for a month, and then gives way to a chilly fall. This morning, I took a minute to look out over the channel where the bay meets the ocean on my way home from work. Stunning. It does make up for missing the brilliant red and gold leaves of the East Coast. I sense that our sunshiny autumn will bring exciting change and mountains to climb!

Clean, white paint instead of baby blue/taupe/coffee.

At home, B has been hard at work to brighten up our ground floor apartment -- he loaded up the storage shelves that we built, which freed up some much-needed room, and then he painted two rooms by himself! We had chosen the colors many weeks ago, but he finally decided that he would paint before he starts work again. The bedroom was a pinkish-beige color; we opted instead for a more neutral golden-cream. It looks beautiful! The bathroom was a tiny, multicolored space with a bright yellow bathtub, so for that we chose a clean, white gloss. It looks like an entirely new place. Apparently, latex paint can take up to a month to cure, so we are camping in our living room for the time being. It's fun to have a makeshift studio.

I have managed to put our little Siamese on a successful diet (she was gaining weight due to her asthma medication), and she looks pleased with our place thus far. She likes to sit in the window seat in the sunshine, or else to guard our front door. I have also found a few minutes here and there to finally hang our pictures and put away odds and ends. Our living room is wood-paneled (including the ceiling), so after the exams I'm going to look a way to bring more light in.

B's delicious home-made whole-wheat flatbread zucchini pizza!

On the work front, B has been approved for his internship! I'm so glad he painted the house already. We were both surprised that he would start on a weekday, but apparently there was a motion to be filed this Friday, so they needed all hands on deck. My own lab project has been challenging, but I finally managed to sub-clone the gene I am working on, so my boss left for her conference on Friday a slightly happier woman. And of course, the boards are coming ever closer. I manage not to be nervous while actively studying, but when I'm speaking with coworkers or attending research meetings, there is a tiny undercurrent of dread always ready to claim my soul :) We (especially B) have been cooking and freezing up a storm in anticipation of my boards studying in the evenings and his working from 6 am -7 pm every day. The feline friend will have to find something to occupy her time with both of us at work all day! Right now, her strategy is to yell loudly anytime anyone approaches the front door.

I guard: No-one in + no-one out = happy cat.

Yoga Calm

I have renewed my yoga practice after a long time away from it. I find that the postures are so flexible -- pun intended -- because they can be meditation, strength training, a cardiovascular workout, or physical therapy, depending on how you do them. Right now, as I get stronger, I find myself very sore after a long (1.5 hr) session, but I hope that as I start practicing at home more regularly, it will be a source of comfort as well. I am currently doing Iyengar yoga, which is a very anatomically precise form of Hatha yoga in which postures are held for minutes at a time and props are used so that people whose bodies haven't adjusted or simply aren't as flexible can do the postures with good alignment and form. When I go to classes, I prefer Iyengar because the certification process for teaching is more rigorous than in some of the other branches, so I trust that my instructors have a good knowledge of anatomy, safety, and theory. Ashtanga is a more vigorous form of yoga that I have tried and enjoyed as well -- I do that at home when I feel energetic and want to sweat.

(And below): Indian Stamp series released in 1991

These different types of yoga are just variations on a central theme, which teaches that learning to move and shape your body in certain strict forms strengthens body, mind, and spirit. If you are tired, you can do restorative poses. If you are stressed, balancing ones. If angered over something, challenging twists or intensive flows can help you release the emotion. In traditional Vedic thought, yoga is also a physical prayer and way to union with the universal spirit which dwells in each person. I really do feel that it is a moving mediation, a workout, and a discipline. I suppose that is why they call it a yoga practice. 

It is strange to be an Indian-American woman learning yoga in the US. I sometimes am concerned about how others perceive me, as though I ought to have a better knowledge of yoga because of my ancestry! I realize that is silly, though. I do notice that the Sanskrit pronunciation of words does feel natural to me, likely because it is close to Hindi, which I heard often around our household (although I can only say a few words). Learning yoga here feels as though I am coming full circle in many ways, to be taught the American interpretation of an Indian practice. It helps me think about the parts of me that are Indian and the parts that are American, and how my family has moved from the old culture to a new culture as first-generation immigrants to this wonderful nation.

I have started a yoga journal -- a small, cloth-bound book I found at a bookstore closing sale (the closing of bookstores is another topic, too poignant to combine with this one). In it, I take note of which poses I did that day, any thoughts I had, and whether I sat for meditation. Sitting for meditation is a lovely, peaceful thing to do in one's day, but it can be challenging -- to sit comfortably, to still the mind into that deep, quiet place, and also to find time! But even ten minutes of intent meditation can feel as refreshing as an hour of other activity. I have not yet come up with a meditation routine or method. I have been told that when you are beginning, you should choose a method that is innately appealing, that engages your mind.

Although most meditation includes awareness of the breath, there are a few main schools of thought. There is mantra, or chant. This is the repetition of a certain phrase that carries significance and which acts as a vessel for your mind to calm itself, whether it is "Om mani padme hum," or the Hail Mary. Another type is lovingkindness, where you move from inward to others to the entire world as you project loving emotion. Still another is introspective, using the question "Who am 'I'?" to move inward and look down on your thoughts from above, so to speak. There is also imagery, such as gazing at an imagined flame with your mind's eye, drawing the details of it as a way to focus on something other than your thoughts. Finally, there is mindfulness, which is awareness of self, others, or the surroundings -- this uses the senses to move beyond the fleeting thoughts.

While I am very far from being able to practice all of this with any degree of consistency or reproducibility, and certainly have not achieved the daily practice I aspire to, yoga is a source of hope and calm that I am very glad to have rediscovered.

Step 2 National Licensing Exam on the Horizon

As some of you who have been reading this for a while know, I feel like I shortchanged myself for Step 1 (the first national medical licensing exam). My studying was not that effective during the short time I had, given my master's thesis work. I think I achieved maybe two weeks of good solid studying, and barely squeaked by at the last minute. I later found that most people start studying months, if not years, in advance! It was too little time given how much exam material was not covered in the curriculum of our first two years, and given how little emphasis was placed on the exam by our program. I was probably naive and should have done my own research about the importance of this 8 hour exam, but when someone you trust tells you that you are worrying over nothing, you believe them. Oops.

Scholarship Exam, 1940

Thinking back, I'm not sure why I believed them. My entire life, people have been telling me that I took my academics too seriously. I have often heard that an exam or a grade was unimportant, only to study hard and then realize that it did make a difference later on. Working for a grade only when it 'counted' seemed wrong to me somehow. Shouldn't we be working hard for the sake of doing our best? What frustrated me about this Step 1 episode is that I did work hard the first two years of school, but I felt my energies were often directed toward irrelevant material, such as alternate therapies, politics, and social concerns. Those things are important, but not at the expense of learning the basics of allopathic medicine! I did not make sure that what I was learning correlated to what I needed to learn; I trusted the school to do that and they didn't. I suppose I wish our program had been, for lack of a better word, a stricter one. I also wish I was a little more realistic about the preparation needed.

This brings to mind another myth you hear when applying to medical schools: that all medical schools are pretty much equivalent during the first two years, because it's the clinical years that matter. In my opinion, this is blatantly false. The first two years are your foundation. The quality of teaching and the strength of the syllabus sets you up not only for your board exam studying, but also for the wards. If I were giving someone else advice about choosing a medical school, I would tell them to examine the syllabus for all four years carefully, and look at who is teaching the basic preclinical courses. Are they PhDs without any clinical background? Are they MDs without any teaching background? Are they junior or senior medical student teaching assistants (who are often great)? Do the same professors teach the course year after year? Lectures? Case-based (not necessarily as effective as it is popular)? Both? How well do preclinical grades predict performance on the Step? What sort of board preparation (if any) do they offer? What is their board exam pass rate (can they give you the actual numbers)? In our case, had I looked into this further, I would have seen some serious red flags in terms of the right fit.

Please don't get me wrong -- I am very grateful for all that I have gained and learned during my time in medical school. I understand that no medical school is perfect, and that often, we only get out what we ourselves put in. There are amazing things about my program, which I won't go into here. However, I do not know if I would recommend my program to other pre-medical students. I have no resentment or bitterness about what we didn't learn, but I do feel the need to be truthful about it to others embarking on this journey. For myself, my goal is to move onward with my life and career using everything I did learn.

Anyhow, my experience with Step 1 was a very high-stress way of taking any exam, especially one that turned out to be so much more important than I realized. I do feel that certain doors are now closed to me in terms of both specialty choice and competitiveness of residency programs, which is sad because I know I could have done much better. Looking on the bright side, though -- there is another licensing exam. While a decent Step 2 score may not entirely make up for a low Step 1 score in terms of residency applications, it would theoretically help. Thank goodness there is another exam! Now the pressure is on to prove myself. From every challenging experience or mistake comes a chance to do better, right?

I still have some time before Step 2, so my plan is to go through all the material once through briefly to get a feel for the scope of the material, maybe review some Goljan pathology or internal medicine, and then do as many practice questions as possible from USMLE world. It seems as though everyone uses some variation of review book + online question bank to study for this exam. However, everyone also says that you only need two weeks to study for Step 2, that it's easier than Step 1, etc. That may be true if you felt well prepared for the first Step. Needless to say, I shall not believe it:)

Many of my classmates have taken Step 2, and many are taking it around the same time I am. I hope we all have a better time of it. I will try to continue blogging as I study. Good luck to those taking the exam, and good luck to all those applying for the spring Match! I hope people end up in places and specialties they love. My plan is to smile and keep on keepin' on.

Maui in August

Oheo gulch waterfall pools

My parents gave us a honeymoon for a wedding present! We had a lovely time in Maui. Of course, the only camera I brought was my cell phone. We flew out last Friday and landed in Maui for dinner, which we ordered to our room (Ocean view! Chocolates! Patio! Stove!) at the Hotel Wailea (we were given a honeymoon upgrade). A yummy Italian meal.

The next day, we explored. We went for a run on the beach, bodysurfed, and then made an architecturally robust sand castle that withstood the tide coming in and impressed a discerning 10-year-old. We had lunch at a cafe by the beach and then swam in our pool before eating dinner, which was ravioli that we found locally and cooked on the stove in our suite. On Saturday, we hiked through the beautiful national park, including a tall, dark, ancient bamboo forest, swam in an enormous waterfall pool at Oheo Gulch (at left), and drove the Hana Highway, a winding highway along one of the most beautiful coasts I've ever seen.

We also saw some of the small towns of upcountry Maui during that trip. Lots of horses, some cows, and abundant sugar cane. You know the brand C&H sugar? California & Hawaii! As we drove, we saw an interesting mix of prosperous and working neighborhoods -- I think most of the inland neighborhoods are houses owned by everyday folk, not retirees or the wealthy. The huge differences between the resorts and the towns really illustrated how much the economy of Maui depends on tourism (and therefore the national economy). Many of the little houses reminded me of towns in India; I was expecting something much more like California. Land is relatively cheap in Maui.

Beach properties everywhere

On Monday, we spent more time at the beach, this time protected by new Quicksilver/Roxy rashguards (such a useful souvenir) that had the Hawaiian flag on them. This was to prevent more of the inevitable tan/sunburn under the powerful Maui sun. While we were out there, I spotted a boy of about 7 or 8 who was unable to get to shore against large waves and the tide, which was going out. We asked if he was okay and he said no, so B swam out to him and brought him closer to the beach, then I swam out to them, and between us all we were able to get to shore. It could easily have gone wrong. Scary. Very scary. That evening, we calmed our nerves over a delicious sunset dinner at Capische.

Iron ore in the hills but no metal in ancient Maui

Tuesday was a treat -- we took horses down into a volcanic crater. The red rock (left), the eerie moon-like landscape, and the stunning views made the strong sun worth it (we were above the cloud level at about 9,000 feet). My palomino quarter horse was named Linus because he likes to suck his tongue. Rocky, B's horse, was an absolutely beautiful bay thoroughbred-quarter horse mix. It was tricky footing, but the equines had sure feet and we had riding helmets. These horses climb up and down mountains at elevation all day -- they are ripped! Look at their muscled behinds!

Well-muscled horses ready to descend into the crater and back

General store high tea

We drove through the upcountry and had a heavy tea at the Haliimale General Store, which is an old store that has been converted into a fancy restaurant and tavern (photo at right). We didn't know that! Luckily it was casual, so they didn't blink an eye when we showed up dusty and smelling faintly of horse.

Later, when we arrived in Kapalua, we checked into the Ritz (the very posh RC). Very, um, ritzy. No celebrity sightings, however. We were greeted by leis and given an upgrade to a club room, which apparently is Ritz for "we'll give you free food and alcohol in an exclusive lounge during your stay." Neither B nor I drink much, but the food! What an amazing treat. And they had gourmet tea, coffee, and cookies all the time. We entered our room to extreme luxury -- marble counters, hardwood furniture, shell trim -- and a big bottle of champagne and chocolate-covered strawberries with "congratulations" written on the plate! I have never felt so spoiled.

Welcome to the Ritz, indeed! With champagne.

At the RC club, we ate a delicious breakfast each day facing the golf course, which gave B the opportunity to tell me about his days on the high school team. It was much more fun to watch golf in person with a personal guide to the game than it is on TV. We saw couples, families, and a few near-pros golfing during our stay. Apparently, someone once had a hole-in-one during lunchtime and the entire club balcony was watching, and started cheering. We saw a man climbing the palm tree here (level with the eighth floor!) to trim it -- which I think is even more impressive.

Our cosy breakfast nook overlooking the golf course

We rented snorkeling gear on Wednesday and played with a sea turtle, only a few meters away from the shore! They are beautiful, endangered, and curious ($2000 fine if you touch one). This guy was about three feet long from tip to tail. He was not at all afraid of us; he would have stuck around all day. The turtle was so graceful in the water, and well-camouflaged because all the green patterns on this legs and shell looked similar to sunlight refracting through water. What a peaceful, amazing sight. The Hawaiian word for sea turtle is Honu. We had a sushi dinner at Kai, a new restaurant. They had the freshest sashimi I've ever tasted.

On Thursday, we braved the waves in Lahaina and took a surfing lesson. It was awesome! We both stood up and I think we each began catching our own waves. I thought the standing up part would be the hardest, but it's not. The hard part is paddling into the wave fast enough to catch it and then steering your board once you're up. There were a few collisions out there, but no major damage done. I loved turning around to find B and seeing him on a big wave! Afterwards, we ate lunch under a huge banyan tree that takes up 3/4 of an acre and fills the town square in front of the marina and old courthouse. It was amazing. It looks like five trees have merged; and then you realize it's all the same tree!

Art fair under the huge, multi-trunked banyan tree in Lahaina town square

The next day, we had a rest from all of our outdoor activities. We drove the winding, tiny north shore highway, which is a coastal road that goes from a two-lane state highway with a guard-rail to a one-lane dirt road hugging the cliff, and no rail. Luckily our Ford Escape did great. Along the way were little turnoffs with fruit stands and even a big food cart -- how they managed to tow the cart up there I have no idea. We ended up in Kahului, at the Maui Megaplex (a tiny outdoor mall with a theater). We ate delicious Thai food in a welcoming restaurant and then heard a Taiko drum troupe in the outdoor courtyard. We drove home full and well-rested and watched a movie in our hotel room (Thor -- lots of fun).

One of the many blue lagoons with coral visible through the water

On Saturday, we decided to go snorkeling again, so we made our way to Honolua Bay. We swam out from shore about 50 yards along some beautiful cliffs that had rocky tide pools and other neat little inlets near their feet. We saw lots of beautiful fish and another turtle! He was grazing on seaweed near some rocks, getting washed around in the water as the waves pushed against the rocks. From time to time, he would come up for air and I would go with him, watching his sleek head break the water.

Sadly, a lot of the coral in this bay was dead, which has been attributed to nearby agricultural run-off from the plantations back in the 70s and 80s. Apparently one drop of round-up is a gallon of poison in the water and can kill an immense amount of coral. However, it was still beautiful and we could hear the crunching of thousands of happy fish feeding on the coral, so clearly it was still appetizing. We went home happy and exhausted.

After tea, we drove into Lahaina, where we selected small souvenirs for our families, and generally relaxed. In the evening, we ate at the Banyan Tree (a restaurant, not the actual tree). We shared a local ale and each had the prix fixe menu with goat cheese salad, hamachi starter, and then B had Ahi while I had Hapu fish. For dessert, B had dense, bittersweet chocolate cake with raspberry dressing, and I had a cheesecake with coffee ice cream. It was a little edgy and easily one of the best meals of my life. The chef there, Chef Jojo, who apparently trained with one of the Iron Chefs, came out to wish us a happy honeymoon. He was so kind! We ended the evening by counting constellations from the hotel pool under a light drizzle.

Our last glimpse of Haleakala, the volcano

On our last morning, we had time to eat our last RC breakfast before we had to check out and hit the road. On the drive, we said a last good-bye to the volcano (left). We managed to return the car and get to the airport early -- about two hours early! So B polled the info desk about what we should do. Of course, they said walk to the beach! The airport parking lot connects to a beach road, where we found kite sailing to watch. It was incredible. Some people were leaping 10 or 20 feet into the air. When it was time for our flight, we went through the security line while being entertained by hula dancers. What a nice send-off! I also thought it was neat that because there had been a canoe competition, so a lot of canoe teams were returning to other islands at the same time. And then we boarded our flight to start the journey home, arriving in SFO by the Monday morning redeye.

It was one of the best weeks ever and a dream come true.

The beautiful Hana coast