lazy sunday SF musing..

Downsizing: the new apt in Noe Valley/Mission/Bernal

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October 26, 2013. I have relocated from Portland, OR, to San Francisco, CA. Following the stint in Brooklyn, NY when this blog began, I have now circled back on my journey through America and the hipster hubs of America, back to my home state. Since leaving Stanford in 2002, I have not lived here for 11 years. The city has changed immensely since visiting the broadway-laguna crash pads that kolstad, katie, shaneeda and co once lived many years ago, or the 24th st mission apt that plowman, and brett lived in. I came to the city battered and bruised from a the departure from Portland, unanswered questions, closing the book on an epic residency of highs and lows but always enjoyment and learning and fun, great co-residents and co-workers.. the daily commute from Pearl District on the bike, through Flanders St, crossing Broadway gingerly, at some point turning right on 3rd or 4th street and turning another left onto Davis to get to the parkway and the riverfront esplanade- cross the sidewalk, avoid the bumbs just waking up from their slumber, and then racing down the waterfront along with runners, other bikers, and the like. Run it down by the portland spirit, the fountain, the beautiful hawthrone bridgeway looking up one sees 20-50 bikers commuting from across the east side to the west with the same clockwork movement that seems to underlie sleepy grey portland. Speeding toward Tom McCall park where Jazz fest will play in a few days after I leave, making a right and maybe pump a bit to get speed up the gradual incline-- geese in the field below congregating watching us as we watch them. Now biking into the street further down the waterfront then onto the last section of the road prior to Southwest waterfront- a mass of flat fields and constructions that 5 years from now will likely be very different from the concrete tubes and dirt that currently are in place. Cruise down the newly constructed walkway and the dental buildings to my left and see the Portland TRAM. Valet the bike, take a breath, Ride up the tram and the daily meditative view I was lucky to appreciate--and I'm ready for the day. The days were blurs, but come 5 or 6, left with an exhausted look and down the tram, to the bike rack, and back the way we came from. Though maybe pop over the hawthorne bridge to have a beer and eat at Lardo or head to northeast to mississippi and alberta for something at migration or Amnesia... that was the best part- easy rider............now the bike is packed in a POD packed with no where to put it. Debated putting the girlfriend into the POD, but thats for another time. A future less clear. The drive was painful/tearful. What the fuck am I doing? why? did i need to get out? i felt i was being forced out. by my program, by my career directions and opportunities, by my friends, and by my own decision and indecision. the last 3 years have been a blast- sad to go... time to move on... 

sentinel band: the walkmen

Sentinel Bands. Friends, I have again lapsed in keeping up with the blog. Alas, the life of a resident. But the past week and the next one or two weeks will be some exciting turn of events- will be deciding where I spend the next 1-2 years of life post-residency in a general medicine research fellowship. This past week I finished my last inpatient rotation at the VA, the VA ICU-- I will miss that place as I enjoyed working there with the staff, good teaching, and great patient population-- veterans are a unique group and I'm honored to participate in their care. But on to the real reason I am writing. the Walkmen played Portland this past weekend! The walkmen have been around a while now, one of my all time favorite bands, and their upcoming performance made me think about those bands or musicians that one really connect/identify with because their music evolution seems to parallel whatever's happening in one's life. I'll call these bands sentinel bands. Their not just great bands with great music. By happen stance, they arrive at a time point in one's life where you're most likely to be 'imprinted' with their music or you identify with their music. I tend of think of my friends who are older than me (particularly my friends who i met who lived in Atlanta/GA and who went to Athens for college) who lived through college when REM started happening and have identified with the band as they have matured and lived their lives, just as the band has matured and lived their lives. I love REM, but was born too late to really find that type of attachment to them. I tend to think sentinel bands form their impression on you during the vulnerable/impressionable years-- college or high school, some young adult age. So they have to come out on the scene around this time. I first heard the walkmen just after college 2002 or so, when one might feel lost, energetic, angry-- so maybe songs like the Rat or something, I identified with and I loved their raw energy, the wurlitzer, the drummer kicks ass, the vocals of Hamilton Leithauser, all of that. So timing is everything for a sentinel band. They play music that favors the disposition you're in at that time. the second criteria is that they have to have longevity-- they can't have 1 album and then fade away obviously, so the Walkmen have put out a couple more disks since then, some i've enjoyed more than others, but they are always in the picture. So when Lisbon came out, I had just moved to portland and they played the Music Fest NW and played a great show, made moving to portland that much more fun. But Lisbon was a much more mellow work than their prior albums and I sensed that; I enjoyed it. The point being is that my personal evolution seems to parrallel a bit with the bands evolution and so I continue to be impacted by the music in someway more than just enjoying the song. Now with their newest album, and having just heard a couple of their songs, it seems to continue that trend; but no matter -- whatever type of music the Walkmen put out, I'd still probably like it because of that initial attachment/connection made back when.. any other sentinel bands out there for people? ...b

Year 2 and Wilco

Hello loyal readers,
Its been a while since I have posted. Year 2 of Im residency at OHSU is going by too fast. We're in February, which means I am over halfway through general residency. But time flies when you're having fun right? Which it has been, despite the long hours and rough days. In general the 2nd year has been a year of transition for me--- new responsibilities (managing a ward service, managing interns, medical students), higher expectations, and new questions from attendings about what I'm going to do with my life. Which is a good question that is yet unanswered for me. Lifewise, a couple co-workers have gotten married, my college roommates Ryan and Andy both got engaged (not to each other by the way, if you know them), and Jessica is back in Brasil for now. But I digress.

Currently in the VA ICU, after a brutal month on the wards where our team had the full complement of complex/interesting cases, social disposition nightmares, and a couple "rocks" (those patients that just can't leave the hospital-- including a guy on day 180 hospitalization). The VA ICU is a bit more turnover, at least. in anycase, nights in the ICU are about to start for me, which at least gave me a day off Thursday as I make the switch... My day off coincided with Wilco coming into Portland Wed night. Wilco and I go way back, but with medical school and residency, it had been a while since I had attended a show. Long gone are the times I could scour the web for 'via chicago' blogs and wait in line for tickets before the mass rush and inevitable SOLD OUT status. This was the cases initially when I initially looked into tickets several months ago. However, as I'm finding out in Portland, people either can't afford their tickets or have weird excuses about why they suddenly cannot go to the show; their loss is someone else's gain and I was able to find tickets to attend the show at "the Schnitz" in Portland. Other co-workers were also able to get last second tickets and we were treated to a great show.

I didn't really know what to expect-- I had the new album and listened a couple times but again, with work, its hard to find time to listen to stuff thoroughly anymore. One thing that was never in doubt is their showmanship and ability to put on a live show. From the simple but striking background set, the lighting, the typical Jeff Tweedy banter, it was the same as a show 10 years ago, even with all the different lineup changes. While we were waiting getting beers, they started out w/ "one sunday morning," off the new record which immediately led us back to our seats as the sound was so good. Other highlights off the top of my head included a Poor Places, Via Chicago, Impossible Germany (unlikely japan), War on War (still my personal fav). They even through in some AM (Box full of letters) and I think probably played 2 from each of the newer albums, including a cool version of Spiders that sounded like Dash 7. Perhaps the most interesting song was "Art of Almost," off their newest album which has this almost radiohead like hypnotic danceable synth beat that is unlike anything else they played, plus the lighting almost gave me a seizure. But thats the great part of this band, a lot of different sound. Aside the music, the venue has a great sound to it, though I'm not a fan of seated venues. All in all, a good way to kick off a break from work.
- stay tuned to this space.

The Central City Concern.
Portland has an overabundance of nicknames-- just to name a few: p-town, bridgetown, stumptown, rip city, the rose city... it goes on and on. There's one name to add to this list. Central City.

During this month I have had the opportunity to learn more about Central City Concern as a resident. The intersection between homeless Process group meeting today at Central City. Today one of the members of the group, "Kevin*" (*names substituted) graduated. I was touched by how complex his story was, as he relayed it to our group leader, "Roger*," who stood at the white board writing every milestone between his addiction (age 14- runaway/homeless) and to today. In between was a cycle of addiction, run-ins with the law, labeling of the dirty 30" (which i learned is a portland term for a group who constantly got arrested and released), homelessness, failed treatment groups and homes, and repeating the cycle over and over again. The way that the group leader facilitated this meeting was impressive. The end product after multiple cycles of relapse and denial? Several months of being clean. On the surface, that doesn't seem much. The odds are against this now 30 yo man. But after hearing his story, his words, I came away touched.

The stories that are heard in those walls on Burnside are similar. The power of the story is to hear that story in that group, with others who are in the similar situation. When Roger asked others in the group to comment on Kevin's story, the support was clear. Appreciation for those struggles; the observation that Kevin had worked hard in groups and outside of group to stay clean and to avoid those temptations that led him back in the cycle. I finally was asked to comment. I knew it was coming. What does one say? Several things cross my mind:

that A.), I could not empathize w/ Kevin's story. I doubt many physicians could really picture themselves in a similar scenario, of growing up w/ little opportunities to succeed, and multiple opportunities to fail; of growing up w/ addiction to crack, that led to petty crime/theft, harm to others. We may have experimented in the past, but in the end, I had opportunity to attend good schools and college, and had the support of my parents to attend medical school. Unfortunately this day in age, such education is not a right, but a privilege that a few get.

That B.) that there is a perception that the medical community is "fighting" against the addicted community. That physicians believe that addicts just want pain meds, or opiates to abuse; on the flip side, those afflicted w/ addiction believe the physician treat them differently from the elderly lady from the nursing home w/ chest pain, or that there is mistrust that the physician really understands the nature of addiction.

All I could really say then, was that I felt fortunate for the opportunities I did have, and that I would try to use that opportunity to help those less fortunate than me, including those w/ addiction. And that I would do my best as a physician to understand addiction, and by understanding, not forget that those struggling w/ addiction are humans that are touched by disease, and fighting a disease that is not well described in texts books and not well taught in our medical curriculum. That though I did not know Kevin but 1 hour ago into the group session, I was extremely touched by his story.

I felt lucky to have that opportunity to learn about addiction that morning. We can all watch "trainspotting" several times, or read about it in UpToDate or Harrison's, but it was much more educational spending that 1 hour w/ this group. Who knows, perhaps "Kevin," by the time I write this will have relapsed to using crack again, homeless, and on the streets. But I like to think not.

"Life happens when you make plans."

Hello All-

To my loyal readers (of which there are few), I apologize for the long hiatus. Intern year has flown by quickly. It has been an extremely busy but rewarding year. Sometimes the only way to get through it is to consume yourself in it, live and breath it, with all its long hours, the off days, the reading. During the doldrums that accompany the winter, the rain, and the inevitable burnout, I have survived possibly by plowing through the months, commiserating the days and hours with my fellow cohorts and the few friends I have been fortunate to meet outside of work. However, several big events have prompted me to further self-reflect and that leads to this. One, is that I finally had a vacation-- the first since my Thanksgiving vacation. In retrospect, it was too long a wait for vacation-- though I managed to survive the winter relatively intact, I too, was running on fumes by the time it had come around. Vacation itself was spent with friends, family. While relaxing, also led to anxiety and self-doubt about my actual progression through the year. Two, is that my cousin Viv was married last weekend, prompting a trip (not on vacation) to Vancouver and family reunion. The fact that it was first one on that side of the family and involved my eldest cousin made it of even more significance. Three, a close and special friend will be leaving Portland soon; a person who to me has shaped my first year in Portland significantly outside the hospital. And Four, tonight was a celebration of Dr. Cooney, our venerated program director who stepped down after 20+ years as the leader of the OHSU residency program.

Why these milestones in my life have all occurred at once, I have no idea. For several weeks I have been pondering the significance of the fact that life is happening all around us, despite our best efforts (misguided) to separate it out of our medicine work, especially intern year. Dr. Cooney summed up my personal feelings and questions best tonight w/ a remark "Life happens when you make plans." Dr. Cooney's dinner tonight brought it all together; the celebration of a person's academic achievements cannot be separated from the personal achievements. His work as program director touched so many people from colleagues, to residents, and of course, his patients. As one of the residents who probably know Dr. Cooney the least in terms of years knowing him, I can still say that he's already influenced me in so many ways, as a teacher, a role model physician, a leader, and a mentor and friend. Lofty descriptions but these are all apt. A living legend who continues to exude energy and passion that is extremely motivating and inspirational for a young physician trying to make a mark. Its a feeling that excites me about medicine and why I love this career.

first vacation, almost 1/2 done w/ PGY-1

Sitting at the oakland aiport waiting for the connection to Portland after spending some qt with the family in San Diego. Always good to see my parents and my brother-- it was nice to actually see sun. Between early hours of work, long days, daylight savings, I really haven't seen or noticed any sun in Portland lately... kind of depressing. Even in New York, one will see sun, even if its a bit colder. On top of not seeing the sun, it has been cold these days in PDX, with light snow right before I left. So San Diego was a welcome respite if only temporarily. Not thinking about ekgs, and cxr's also a welcome break; though now I'm afraid I'll forget everything I've learned.

Between posts I was in the midst of a busy 2 months of ward + ICU which was a great experience for me. Good people to work with and interesting patients. Definitely learning to make decisions on my own and getting a bit more efficient. One piece of feedback that I keep getting is how my quote unquote "laidback" nature can prevent me from demonstrating medical knowledge. Not really sure how it connects, but I've heard it a couple times from attendings I respect, so there's something to them; or at least something to take from them. Which brings me to the dilemma-- how do I address it. I probably have gone through life with the same nature and personality-- in fact i value it as a strength. Im not a yeller; I see myself as a leader, but leading through example and my work, not necessarily by showing off that I know the mechanism of action of aspirin, or by talking loudly: which appear to be the possible ways to improve upon these concerns. I say this because in asking about how I can improve, one comment was that I should read more, as I might have lacked knowledge; another suggestion was to be more decisive in decisions-- even if its the wrong decision/answer. To me, it seems like it means that for me to be a good resident (not nec a good doctor, though it stands to reason that a good resident makes a good doctor), it is important to be able to demonstrate knowledge to others. But how does one do this if one is again quote unquote "laid back." (which by the way I am not a fan of this characterization of me)

In thinking about this, I look to other mentors and physicians and their personalities. It seems to me that those physicians who do well, are respected fall broadly into two categories. Those who are "laid back," "soft-spoken," etc etc and do well are those who are geniuses-- they're the the ones who got a phd, published the mechanism of action for aspirin; they're the doctors that everyone holds is high regard because they're "nice," "calm and collected," and brilliant. Then there are those good doctors that people respect who are loud, intimidating, but decisive-- they are necessarily genius' but they do their homework, read up and then show it off by talking big and acting tough; and those doctors get respect too, because they often have larger than life personality, are somewhat obnoxious, but exude confidence and make the right decisions more often than not. Then there are the cross overs between personality and knowledge, so those who are obnoxious, loud and cocky AND who are brilliant... so what about the doctor who is calm and collected, but not necesarily a mensa member?

Its way too simplistic a model for categorizing physicians, but it is a starting point as someone who will hopefully be an attending in the next couple years. And for the pgy-1 who is not that sure of their decision making, and who knows himself well enough to know he isn't a genius (and not delusional enough to think that he is-- though am I shortchanging myself by thinking this?), and fits the "calm and collected," mode (or the "laid back" bs), striving to show others that I know something is the goal of the next half year... or forever...

suggestions welcome. (i'll be reading and memorizing harrisons)
Channy.

2 mos goes by fast...

Wow- how fast can the summer go? its now raining on a oft-daily basis, and the weather has got a little chillier tinge to it. The summer sun is fighting off the 9 months of rain that will soon encompass the sleepy town of Portland. In the meantime, I finished ER month, and about to finish Ambulatory month.

1. My cousins from our cousins in the north, canada, graced me with their presence for a beautiful NW weekend. How coincidental that Viv and Gord decided to come down on a little gettaway the same weekend that Winnie and her girlfriends decided to have a fun trip to Portland. Both emailed me about their plans without knowing what the other was doing. In anycase, good food (the screen door is amazing), good company, and the Mt. Tabor Soap Box derby day later, the weekend was a blast. Its the best part about moving back to the West Coast- Family.

2. Next big event was MFNW. 4 days of wide variety of music. from the weird to the standard. Kyle and I had ambulatory month- which mean basically we were free to catch any show we wanted at any of the venues around PDX. Checked out wonder ballroom in NE for Washed Out and Phantogram; then Crystal Ballroom for Panda Bear (yawner btw). Friday night college buddy andy came into town and we hit up the bars, then okkervil river at crystal ballroom, then some random warehouse party in god knows where, having to hitch hike home with a girl from Berkeley no less..... Saturday Brady came in and the wknd is too much of a blur btw Decemberists, the Walkmen, and the National, seeing Nick and pregnant Libby, and eating good food... well you get the picture......a fun wknd had by all. i think??