Wednesday, February 20, 2019

Retrospective wellness advice for my pre-clerkships self

Two plant pets being raised by Andrew

Currently I am taking an East West Medicine elective, which has been a fascinating way to learn about complementary and alternative medicine (including Traditional Chinese Medicine), and to think about my own wellness state and changes I would like to make.  In many ways it is a formalized continuation of my efforts in making some habit changes as a third-year medical student on the wards.  As I blogged about previously, some of my reflective writing last year is focused on these habits, which I have more or less continued during my fourth year, so here is the promised second post.  Nothing here is revolutionary, and in fact most—if not all—of this is common sense, but I think common sense is often arrived at by circuitous routes.

In the spirit of trumpeting common sense:

1. How to survive [at least one year of] medical training as someone who doesn’t tolerate sleep deprivation well  |  One of my biggest fears about MS3 was whether I would be able to function effectively when sleep-deprived on hospital rotations, especially on surgery, with its frequent 5-6am start times (and sometimes even earlier).  Many older students and residents told me that while their sleep deprivation was real, it was something they got used to, and that falling asleep while actively doing work wasn’t really a concern.  They were right: it’s quite difficult to doze off while walking around the wards, making phone calls, or checking lab results.  Sitting in one place during lectures is more challenging, but that’s where coffee is particularly helpful, as is the collective understanding – or so I told myself – that everyone nods off occasionally.  The overnight calls I took also turned out to be more manageable than I expected, in part because my expectations were dire to begin with, and in part because many of my supervising residents were kind and would tell me to go sleep for a couple hours if nothing was happening.   I could only sleep fitfully, afraid that I would somehow miss a text message or a pager beep, but even a 20-minute snooze helps. I did eventually learn what it feels like to be awake and almost constantly on my feet for 28 continuous hours, plus the time spent getting to and from the hospital: not good, but indeed I survived, and the most exhausting night I had also turned out to be a highly educational one in terms of both the surgeries and patients I saw. 

TL;DR: Sleep when you can and trust that you’ll get through it.  Or, to adapt something one of my early mentors told me, the night always ends, and the rotation always ends.

Brief detour on the topic of studying: Though this is without any kind of formal sleep log, I think I averaged about 7 hours of sleep per night over the entire MS3 year.  I certainly envy those people who truly need only 6 hours or less of sleep each night, but for better or for worse, 7 hours is the minimum I need to feel alert and productive.  Accordingly, I learned early on during MS3 that in the choice between going to bed early enough to get 7 hours of sleep vs. staying awake and studying for the shelf exam, I should go to bed.  I certainly didn’t ace every exam, but I was satisfied with my performance.  Also, on most rotations there were daily episodes of “down time,” such as waiting for new consults, or waiting for a patient to be rolled back to the operating room. I found that fitting in a couple practice questions or reading a few pages during each of these breaks could result in a significant amount of studying being done by the time I headed home.

2. How to exercise when you are prioritizing getting enough sleep  |  I started running during college and eventually discovered that it could in fact be inherently pleasurable, but for me the most important benefit of exercise is that it improves both my mood and my sleep quality.  Between 2.5 and 5 miles is my preferred distance range; any more than that on a regular basis, and I am likely to meet twinges in my knees or hips, not to mention that the workout requires close to an hour

  • Walk to/from work and take the stairs whenever possible. This is obviously some of the most common and boring lifestyle advice ever.  During MS3 most of my rotations were at UCLA’s main campus, which is a 20-min brisk walk from my apartment, so I benefited from 40 minutes of walking on many days.  Follow that with sometimes climbing hospital stairs up as far as the 6th or 7th floor (while wearing a backpack), and that is a pretty respectable mini-workout.
  • Set reasonable expectations for exercise frequency and duration.  I had at least one day off a week, so that allowed me to go for at least one run per week. Sometimes I would get sent home early, and so that would allow for a bonus workout.  Even a 30-minute run was a great way to clear my head and somehow reset my body for the week ahead.  During my surgery rotation at the very end of the year, I started using the Nike Training Club app and found that I like the bodyweight workouts, which are often just 15-30 min long. Occasionally I would tack one on to the end of a short run, but often I would do a short workout on a yoga mat in my apartment.  It’s not as hard to talk myself into a 15-min workout if I can then literally walk 10 steps into the shower.
  • Speaking of yoga, exercise classes are cool, but it’s ok if they’re not your thing.  I have tried both barre and yoga classes, both of which are innumerable in LA.  One of my friends is a SoulCycle devotee, and another loves Pure Barre.  The classes I’ve tried have been nice, but ultimately my preference is to work out on my own for less than an hour at a time.  I also like being able to start and end workouts at my apartment instead of having to walk or drive to a studio.

3. How to eat for health and pleasure when you really just want to eat for pleasure, because you are tired and stressed and cookies are good  |  I have always been an enthusiastic eater who loves trying restaurants and bakeries, reading cookbooks and food writing, cooking, and baking.  I particularly love desserts, though I hesitate to call it a “sweet tooth” because I prefer desserts that are minimally or moderately sweet, and as I get older my tastes are sometimes veering toward the savory.  I am also cognizant that being slim doesn’t make me less prone to diabetes; in fact I have multiple risk factors, being East Asian and having a family history of diabetes.

As my stress level ran persistently high at the end of grad school, I started using food as a source of comfort.  This pattern of stress-eating and fatigue-eating persisted through the start of MS3.  It can be difficult to eat healthily while working in a hospital.  Salads take more time to assemble in the cafeteria and then to eat, compared with sandwiches or pizza.  Bagels with cream cheese are a traditional fuel for medicine teams after an overnight call, and when you are tired, it’s amazing how easily bagels (yes, sometimes more than one) can be tucked away in the blink of an eye.  Afternoon seminars or conferences often include a plate of cookies, and it is so easy to mindlessly grab one on the way to your seat.  I also found it hard to resist the pastries frequently lying about the residents’ workroom during my medicine rotation.  It didn’t help that sometimes these snacks included fresh gourmet donuts from Sidecar Donuts or even cake from Sweet Lady Jane, brought by a particularly generous attending.  

During my second rotation, ambulatory (outpatient) adult medicine, I spent one afternoon shadowing the clinic’s dietitian, who enthusiastically described to me just how many servings of carbohydrate (four!) are in the typical American bagel.  After a visit to my own doctor I realized that my hemoglobin A1c, a marker of blood sugar levels for the prior three months and a useful marker of diabetic status, was creeping close to the pre-diabetes threshold.  Yikes!  In addition to developing a sustainable exercise routine as already discussed, I resolved to make some dietary changes, namely:

  • Reduce intake of starchy carbs during the day and pair carbs with protein whenever possible, to prevent spikes and crashes in blood sugar.  If I choose a lunch of salad with chicken, tofu, or chickpeas, or a protein entree with vegetable side dishes, with perhaps half a serving or less of rice/pasta/bread, I feel a more consistent energy level during the afternoon.  If a sandwich is what is available, I’ll eat less of the bread.  For snacks I like fruit and nuts, or no-sugar-added bars like Larabars.
  • When possible, eat more slowly to reach satiety but not over-fullness (or drowsiness).  Most of the time I try to eat something every couple of hours.  That said, I learned during my surgery rotation, when certain surgeries were very long, that it takes quite a while (over 6 hours) before I actually feel strong physical sensations of hunger.
  • Pay more attention to your actual level of hunger and desire for food; take a moment when faced with convenient but unsatisfactory desserts.  Many of the pastries that are frequently available at work are in fact not that great—a doughy or dry croissant is a sad thing—and I don’t even enjoy them while I am eating them, but it is easy to forget that when standing right in front of the tray.  I am trying to first ask myself if I am actually hungry or actually want that particular dessert.  I also try to remind myself that I am perfectly able to either buy or bake myself a delicious dessert that I can fully enjoy at a later time.
  • Food is for both enjoyment and nutrition, but it’s not the end of the world if you eat a crappy cookie. The frequently touted rule of eating healthily 80% of the time has been somewhat useful for me.  It helps to have that 20% of self-compassionate room: sometimes a middling seminar cookie or slightly stale Danish just has to be eaten.  Conversely, good food will always be one of the most important aspects of my personal wellness.  During a delicious dinner with good company, I love sharing the bread basket, ordering a glass of wine, or trying dessert, and occasionally if I want all three and I truly enjoy all of it, then that is awesome.  Ultimately, I have come to believe that mindful eating, in all its forms, is the most nourishing of all.

4. How to care for your own mental health the way you want your patients to  |  Other than general good health, the biggest blessing in my life is that I have a supportive family and set of close friends.  Living with Andrew was particularly important during MS3, and though our time together was more limited because of my early-to-bed and early-to-rise schedule, we tried to spend intentional time with each other whenever possible.  These days so much of our lives also involve our phones (for better or worse), and I also found that being able to text with my husband, family, or friends during moments of “down time” helped create much-needed mental breaks and moments of levity.

Another enormous blessing in my life is psychotherapy, and I would be remiss if I did not mention in this piece the positive impact that therapy has had in my life.  I started seeing a therapist during my last year of grad school, and continued to work with him on and off during MS3.  We focused primarily on emotional mindfulness and the process of fully experiencing emotional reactions when they occur, actively allowing them to move through me instead of suppressing the thought and storing the emotion for later, often for reemergence at unexpected times.

In an important step a few years ago, my med school established a Behavioral Wellness Center, where medical students, graduate students, and resident physicians can all receive psychotherapy and psychiatric care, fully covered by our student/trainee insurance.  The providers offer early morning and evening appointments to accommodate clinical work hours.  This Center is an amazing resource, one which has benefited me and so many of my colleagues.

In summary  |  I unexpectedly found that I ended my MS3 year in a healthier state than when I began, and with better habits that could continue to fit into my life.

Thursday, December 27, 2018

The mentality of an ex-grad school third-year medical student

I’m now more than halfway through the fourth and last year of medical school, done with most of my residency interviews.  I’m starting to feel close to the end of this eight-year MD-PhD process, and simultaneously the end of the beginning.  Last spring, I started writing about my clinical experience as a third-year medical student, and the remainder of this post reflects on how my mental experience on the wards differed from my experience during grad school.  I also started writing about some of the coping techniques I developed during MS3, which became improved habits I have subsequently tried to maintain; this will be a topic of a subsequent post.

As a primer for anyone unfamiliar with med school structure, the first two years are largely classroom-based; at UCLA we refer to both the years and their students as MS1 and MS2.  The third and fourth years (MS3-4) are hospital- and clinic-based.  After MS1-2, I took a four-year pause for grad school, then started MS3 in May 2017.  MS3 is the year when students start learning how to take care of patients in a practical sense. Over the course of 12 months, students rotate through a variety of hospitals and outpatient settings across LA county, completing clinical courses known as “clerkships” in the core medical specialties: internal medicine (both inpatient and outpatient, a.k.a. “ambulatory”), family medicine, pediatrics, obstetrics & gynecology, neurology, psychiatry, and surgery.  Each clerkship varies in length from four to twelve weeks, and at the end of each clerkship, students must pass a national standardized exam called a “shelf exam.”  Within each clerkship, students often switch between multiple teams of residents and supervising physicians (called “attendings”), and may have different sub-rotations.  For example, my twelve-week surgery clerkship included sub-rotations on vascular surgery, general surgery, ophthalmology, neurosurgery, and urology, each at a different hospital.  All of this makes for an exhausting and demanding year, but it can also be a remarkable catalyst for personal growth.

When I finished grad school and started MS3 I knew I was an older and somehow different person than I had been at the start of grad school in 2013, but I wondered how it would feel to be back on the wards.  Over the course of the year I had amazing opportunities to learn from so many patients, families, fellow students, residents, nurses, social workers, and attendings, experiences for which I am so grateful.  By the end of the year, I had unexpectedly developed a new career dream for myself (psychiatry!), and with a clear understanding of why I was choosing this path.

In comparing my MS3 headspace to my headspace during graduate school, I found myself enjoying my time off much more during the MS3 year.  This is probably because graduate work, being composed of multi-year projects, is both self-directed and changeably structured, without clear demarcations of time “on” and “off.”  Theoretically I could take time off whenever I wanted, but that would just mean that as long as I was not working, my project would not progress.  From day 1, grad students feel the clock ticking, as they themselves are the biggest factor in how quickly and well they finish their program.  I have always found comfort in a structured routine, so despite the exquisite thrill of discovery that original science offers, the persistent unpredictability of grad school was extremely stressful for me.  I could create highly organized schedules for any given day or week, but those schedules were likely to get upended at any point by an unforeseen experimental roadblock, a piece of malfunctioning equipment in need of troubleshooting, or any number of other logistical challenges—indeed, learning to deal with this unpredictability is a significant part of graduate training in experimental science.

At the same time, this unpredictability and my swinging between enthusiasm and frustration meant that even during my “free time,” I felt near-constant guilt at not being more productive, thinking that I could and therefore should always be working longer and more productive hours.  This feeling is common among graduate students, and I think the associated distress is something of a rite of passage.  As my advisor once reassured me, it’s quite typical to question (even multiple times) whether one is on the right path, especially in the latter years of the graduate program, when one gets inevitably stuck in a disillusioning rut of repeatedly failing experiments, before everything somehow falls into place just in time for one’s dissertation defense.  On the plus side, graduate school is a rare time when one has the freedom to explore scientific ideas of one’s own choosing, to think deeply and critically about those ideas, and to benefit from that same schedule flexibility.  I certainly can’t complain about how much easier it was, when I was running my own schedule, to attend a doctor’s appointment or make a phone call to a relative in a different time zone.

My primary research paper from my graduate work was accepted for publication on the very first morning of my first clerkship in MS3.  After all the revisions and resubmissions, I felt relief even more than accomplishment.  One of my biggest anxieties about this paper was whether I would still need to work on revisions once I was an MS3 and had clinical work that would require my complete attention, so it felt like such a stroke of fortune that my research paper made it through its hoops just in time.  Ironically, ten months later I found myself preparing and submitting another paper during my general surgery rotation, when I in fact had the least free time of my entire MS3 year.  This was something I had expressly told myself I would not try to do, and yet, when the time came, I found myself sitting with my laptop in a surgery workroom, waiting for the trauma pager to go off, and actually finding it mentally refreshing to spend a couple hours placidly editing a manuscript.  We rise to meet our own expectations in ways we can’t foresee!  This paper-editing episode also made me realize how much I value having a certain amount of variety in the type of work I do over the course of a week (or a day), including being able to sit with and develop scientific ideas.

Speaking of expectations, another aspect of the MS3 year that is somewhat unique within the medical training pathway is the frequency of evaluation.  Med students are evaluated by attendings and residents multiple times on each rotation.  These evaluations, in combination with the shelf exam scores, result in our clinical grades.  We students do our best to focus on learning as much as we can, integrating into each of our teams, and taking care of our patients, but it can sometimes be hard to forget that we are constantly being graded.  During the first couple weeks of my pediatrics rotation I was particularly anxious about performing well, because I thought this specialty was going to be my career.  However, constantly thinking about how I was being perceived quickly became counterproductive in that it felt acutely uncomfortable, and may even have appeared that way to others.  After I actively tried to shift my perspective for the rest of the rotation, I was actually able to enjoy the experience.

Part of this perspective included returning to the truism that in my career, I will never again have as much time to spend with individual patients or their families as I did during MS3.  From the patient or family member’s point of view, the medical team generally disappears after the brief interaction of morning rounds, only reappearing if something urgent arises or there is a prearranged family meeting.  From the team’s point of view, the vast majority of the day is in fact spent frantically doing work behind the scenes: checking lab results, discussing the patient’s progress with nurses / fellow residents / the attending, adjusting medications, calling consults, coordinating discharge plans with the social workers, and writing notes.  Between these two worlds of the patient rooms and the provider workrooms, MS3 students are able to be a bridge because they may only have 1-3 patients on their “list,” while an entire inpatient medicine team list frequently comprises 15-20 patients.  Unlike the interns or residents, MS3s, while slower to get their work done, have the time to return to the bedside multiple times over the day.

On most inpatient rotations, I liked to see my patients again at the end of the day.  Sometimes the team would do afternoon rounds, but often I would do my own mini-rounds after I was dismissed to go home.  I got to hear how the patients’ afternoons went, say good night, tell them that I’d be back in the morning or the following day, and sometimes answer another question or review the treatment plan one more time.  It was during these informal check-ins, when I wasn’t trying to perform a physical exam or ask “review of systems” questions like whether the patient was having constipation or diarrhea, and when no one was evaluating me and my “clinical skills,” that I got to know my patients and their family members as individuals, far more than people dealing with a certain disease.  I felt like these moments helped me to maintain their humanity and my own, and kept me centered on why I had chosen to pursue medical training.

Simply because of the demanding schedule, MS3 is ostensibly not the best time to prioritize one’s own emotional or physical wellness, but as the year progressed I found myself actively thinking about wellness and trying to incorporate it as a regular part of my life.  This will be the topic of my next post, written as some sort of retrospective survival guide for my pre-MS3 self.

Saturday, March 31, 2018

Scrubbing in and suiting up

Early morning from a hospital hallway

I am currently just over halfway through my 12-week surgery clerkship, just five weeks away from the end of the third year of medical school.  It has been an amazing year of learning medicine and learning about myself, and as I have been reflecting on this year and making plans for the next steps, I have begun putting those thoughts in writing.  Below is part of my "brain-dump," which I thought I would share even though it is relatively unpolished.


***

There is a unique desperation that arises during the medical student surgery clerkship, when the student is confronted with ostensibly simple tasks – such as finding a roll of paper tape, or opening the correct dimension of gauze, or holding a retractor with the right amount of tension – that have suddenly become staggeringly challenging.  Great attention must be paid to the placement of one’s hands when one is doing nothing but standing and observing.  The differentiation between what is light blue (the color of sterility and safety) and not light blue is now the most salient, if one wants to avoid the justified wrath of the scrub technician, to say nothing of keeping alive the chance that one will get asked to hold an instrument or possibly even, if lucky, help close an incision. 


It is safest to keep one’s arms crossed, or forearms folded over one’s stomach, or, ideally, resting on a draped area that is away from the operating field, if the surgeons or a particularly thoughtful scrub tech invite one to step closer.  It is definitely not safe to begin to doze off while sitting on a stool between a patient’s [draped] legs, while watching the surgical proceedings on the screens around the room, to then realize that one has just contaminated one’s gloves by touching the stool.  This may or may not have happened to me in my second week on the inpatient gynecology service, during a six-hour surgery, during part of which I had been told to push in various directions and then isometrically hold an instrument placed in the uterus, while the surgeons used the Da Vinci robot to manipulate parts of the pelvic organs through the abdominal wall.  One of the more surreal moments in my life: being told “Harder!  Push to the right!  No, the patient’s right!,” contorting my shoulder into increasingly uncomfortable angles, seeing on screen the uterus move with my clumsy adjustments, while the surgeons stared into their arcade-like consoles and used carefully calibrated movements of the control knobs to trigger precise adjustments of the articulated robot arms.  For obvious reasons I was extremely alert during that part of the surgery, but all bets were off once my physical and intellectual involvement was over and I was left to watch.

It took well over a week – and if I’m being honest, closer to two weeks – before I felt comfortable scrubbing in, and then just to be a minimally invasive component of the OR milieu.  By the fourth or fifth week, I started appreciating the rhythm and routine around me.  The structure-seeking part of me did find comfort in the repeated ritual of being gowned and gloved by the scrub technician:

After scrubbing for upwards of three minutes, walk into the OR with hands held up in front of you, elbows away from your chest, water dripping downward onto the floor.  Take a sterile towel and, still keeping your elbows up, dry the hands and forearms on one side, then use the other (clean) side to dry the other arm.  Place your arms into the gown which has been held open for you, extending your arms under the arms of the scrub tech with only a slight back bend, and immediately straighten with your hands once again held in front of you, fingers together, so that the arms of the gown can be pulled down just enough.  When the first glove is held open for you, slide one hand down into it, then use those now-sterile fingers to help hold open the second glove that is proffered.  The back of your gown has already been closed by the circulating nurse, but you now ask him or someone else to take the paper card tethering your waist ties, then spin counter-clockwise and pull the other waist tie off with a subtle flourish, so that you can fully close your gown.  You are now enclosed in cleanliness, and you have only to avoid messing it up.  

This sequence of actions, repeated at the start of every surgery, armors the surgeons – and wide-eyed medical students – in a papery, synthetic, fluid-proof, and anonymity-granting suit.  When everyone who has scrubbed is gathered around the draped patient, with only the operating field exposed, they coalesce into a nucleus around which the outside world, the non-sterile and chaotic and hazardous, recede.  Despite interruptions by pages or phone calls, or episodes of chatter regarding weekend plans or how the family is doing, there are always stretches of collective scrutiny on the task at hand.  Sometimes it seems to me that in the OR, the patient’s personhood and humanity are intentionally deemphasized, tucked into the background by the blue drapes.  And yet I also see that in the OR there is a unique dimension of respect for the human body and its natural variations in anatomy and [patho-]physiology, which create the potential for surgical challenges that are not always forseen by imaging studies.  I sensed that the haptic unpredictability of surgery, as well as the monastic focus that must result, is part of what surgeons love about their work.  As an observer and intermittent participant, scrubbing in provides a memorable glimpse into this unique cognitive realm.

Saturday, May 6, 2017

Highlights from Paris and London


Chateau de Versailles

I had a wonderful time in Europe with Andrew, and am so glad that we went on this trip.  Many thanks to my preceptor for pushing me to schedule a "real vacation" before starting clerkships!  I'm happy to share all the details of what I did every day, should anyone ask, but below are my favorites from Paris and London.  We also visited Bruges, but as we were only there for half a day to eat waffles/fries/mussels, drink beer, and buy chocolate, a "favorites" list doesn't seem as necessary.

***

Paris

Boulangerie des Invalides | We stayed in an Airbnb in the 7th, very close to this bakery.  They serve great croissants and other pastries (we also liked the brioche and the chausson aux pommes), good coffee (cafe creme in the morning is lovely), and have a cute seating area.  It was so nice to have breakfast here and see so many locals stopping in, some to sit with coffee, others - including quite a few schoolchildren - picking up a bread roll or pastry to go.

Musee de l’Orangerie | This was our first stop on our first full day, and it was one of the best museum experiences I have ever had.  The Monet Water Lilies collection is stunning, and unlike anything I'd ever seen.  It's overwhelming in a good way.  Tip: we went to this museum right when it opened, so the Water Lilies gallery was relatively empty for the first few minutes we were there, and that was by far the best way we could have experienced it.

A la Mere de Famille | Old, family-run, friendly chocolate shop in St. Germain.

Laduree on rue Bonaparte | Great place for macarons, fancy desserts, tea, and ice creams.  Certainly you pay a premium to sit in the tea salon, but I thought it was worth it.  The Ispahan flavor combination (rose + raspberry + lychee) is fantastic.  We liked the macarons here a little more than the ones from Pierre Herme.

Mariage Freres | Classic tea shop, where I bought some wonderful Darjeeling.

Septime | We went for lunch and enjoyed the tasting menu, which was visually appealing, featured unexpected and new-to-us flavor combinations, and was not too heavy.  Andrew also ordered and enjoyed the cheese plate, and we each had a glass of white wine.  Definitely need a reservation.

Verjus | We went for dinner and liked it even more than we liked Septime.  Dinner only, reservation needed.  We shared one wine pairing with the tasting menu and it was excellent, beginning with a champagne and ending with a gewurztraminer from Alsace.  This was one of our top five restaurant meals (ever).

Cafe Constant | This restaurant gets a lot of internet hype, but I thought it was deserved.  It's a small place that gets very busy, and doesn't take reservations.  There were menu items that were refreshing and had vegetables (not true for a lot of typical French bistro dishes), which was appreciated.

La Grand Epicerie | An epic food store, with every department available in a supermarket, but amped up in aesthetics/quality/price (though not everything was expensive), plus massive sections devoted to chocolate, tea, biscuits, etc.  Good for both shopping to eat that day and shopping to bring back gifts/souvenirs.

Day trip to Versailles | Memorable.  We recommend adding to your ticket the 9:30am guided tour of the “private apartments of the King," since having this tour reservation lets you enter the Chateau separately, without waiting in the same massive line, and also lets you see some rooms not accessible on a standard ticket.  The Chateau is impressive (the Hall of Mirrors and chapel are as eye-popping as one might expect), but so crowded, and we enjoyed the gardens even more than the palace interior.  Having read quite a bit about Marie Antoinette, I was particularly glad to visit the Petit Trianon and Queen's Hamlet.

***

London

Diamond Jubilee Tea Salon at Fortnum & Mason | Another bucket-list experience.  A lovely setting, large but still peaceful, with well-spaced and elegantly appointed tables.  I had picked Fortnum & Mason for tea over one of the various fancy hotels (e.g. the Lanesborough) because the former is open from before noon until the evening, instead of just a couple hours in the afternoon.  This may not be authentic, but it is nice to be able to have tea for lunch or dinner.  The tea and food were both delicious and plentiful, since they offer to refill the sandwiches and scones.  We liked the classic afternoon tea more than the savory tea.  The plain scones with clotted cream and lemon curd were exceptional.  It was also fun to browse the rest of Fortnum & Mason, with its glorious chocolate and sweets section.

Dishoom | Indian food in a fun atmosphere designed to evoke old Iranian cafes in Bombay.  We went to the location in Covent Garden.  Definitely recommend a reservation (they take reservations up to 5:30pm for small groups, and there was a very long line to get in).  Everything on the menu looked appealing, and we especially enjoyed the chicken curry and black dal.

The Palomar | Modern small-plates Mediterranean.  We had lunch here on our last full day, and had some food fatigue at this point, but still enjoyed our meal very much.  The dishes here tend to have a bunch of different flavors and can be a little salty.  Reservations recommended.

Daunt Books in Marylebone | An incredibly charming bookstore, located in an Edwardian building.  The books are organized by country and I had a great conversation with a very helpful staff member, who gave me several spot-on recommendations.  Also, their shopping bags are pretty canvas totes.

The British Museum | A must-visit.  We didn't spend very much time here, but liked seeing the Easter Island sculpture, the Rosetta Stone, the Chinese ceramics gallery, and the Parthenon gallery.

Monday, November 21, 2016

March 2016: Joshua Tree


Hello, after a while!  Here continues my pattern of belated posting, in this case with a post that was actually completed months ago and then nearly forgotten.  I don't particularly like the saying "better late than never," but it does seem to hold for my blogging....

Quite a few months back, Andrew and I took a long weekend trip to the desert.  Even though I'd lived in LA for nearly five years, I hadn't yet made it out to Palm Springs or Joshua Tree.  The latter is a popular weekend destination for grad students in my program, some of whom head there on a yearly camping trip, but the timing has never worked out for me.  Andrew had also visited, but was game to go again.  I think my parents and I may actually have driven past the park during a road trip when I was younger, but my memories of that visit are hazy and colored with the "Are we there yet?" question mixed with the feeling of an Academic Decathlon study binder across my lap.  (That was my typical road trip reading when I was in high school.)

My point being, it was high time for me to check out Joshua Tree for myself.  With an experiment-free weekend popping up on our calendars, we booked an Airbnb in nearby Yucca Valley and drove east from LA first thing Saturday morning.

We drove first to Palm Springs, without specific plans other than walking around and getting a feel for this popular vacation destination.  Lunch at a popular local sandwich shop was our first stop, followed by a hat purchase for Andrew (that desert sun is no joke!).  There was an art festival near the southern end of the Main Street, and we browsed some whimsical, Steampunk-ish robot sculptures made from reclaimed junk parts.  Recently I've gotten more interested in art, especially ceramics and paintings, and am proud of our modest collection of pieces that all carry strong personal memories.  After the art festival, we did our due diligence at the ice cream shops along the main drag - a date shake for Andrew from Great Shakes and a pineapple coconut ice cream with Dole Whip for me from Lappert's.  After this, I concluded that pineapple coconut ice cream is simply better when eaten in a tropical place like Hawaii.  Maybe there is a climate-gustatory synergy to ice cream.

Eventually we realized that since we weren't going to lounge by a pool or shop for mid-century furniture, we had more or less exhausted our options in the downtown area.  To be fair, Palm Springs does have a well-known art museum, but we didn't feel like moving our car.  Instead, to kill time, we chose a somewhat random restaurant (called Trio) and had a drink at the bar. Around 4pm a man walked in, sat down next to us, and loudly ordered an entire bottle of Sauvignon Blanc for himself. That, we decided, could be our cue to continue on to Yucca Valley.


Our Airbnb was a tidy and surprisingly spacious bungalow in the backyard of an artist's main home. I really liked the mint green-tiled kitchen and the colorful living room furnishings.  Notably, the neighborhood - mostly single-story homes on large lots - was blissfully quiet, a welcome change from our apartment building's constant background thrumming of air-conditioners and cars with loud overtones of noisy neighbors.


That first night, we had dinner at Sam's Pizza in Joshua Tree.  This is a unique restaurant in that it serves both very good pizza and very good Indian food, making it the only restaurant that I know of to successfully bridge these two culinary genres (there is even a subcategory on the menu for "Indian pizzas") and certainly the only one for hundreds of miles around it.  We went for the Indian food and were enjoyed our okra and spinach/tofu dishes.  Service was quite slow, but I don't think anyone goes out to dinner in Joshua Tree in a hurry.

For our full day in Joshua Tree, we picked up utterly unremarkable sandwiches at a local supermarket (Stater Bros, which had some of the most unflattering fluorescent lighting I have ever seen) and got a reasonably early start into the park.  The land here is immediately jarring and does, in fact, feel like an entirely different planet.  As such, driving within the park is quite fun, as each curve brings into view a new rock formation or expanse of spiky trees.


We chose the Lost Horse Mine trail, which starts at a tiny parking area a little ways off the main road, and takes you to an abandoned silver mine.  The Joshua trees aren't at their densest here, but the scenery is even more interesting for its range of colors and plant life.




The well-maintained trail felt spacious and only lightly trafficked during late morning, with an occasional lizard moseying into the scrub.



Hiking is one of our favorite leisure activities, and when we have the benefit of a quiet trail, I like it even more.  Without other people in sight (most of the time), music, podcasts, or a strict timeline (e.g. we need to make it back to our car in time to get to brunch before it gets too busy!), the experience starts to feel remarkably intimate, and we often find ourselves in surprising conversational territory.  On this day we ended up talking about our projects quite a bit, but without the minutiae or troubleshooting on which we normally focus and fuss over.  Instead, it was with an eye to the larger ideas which get us excited, and which remind us why we keep at this science thing.

After returning to our car, we continued on to Keys View, a lookout at the highest point in the park.  Here we ate our sandwiches and then gazed out at the valley below: Palm Springs and the wind farms near it, the San Andreas Fault, Mt. San Jacinto, Mt. San Gorgonio, the Coachella Valley, and even a tiny glimpse of Mexico.


We slowly drove back out of the park, stopping at one or two rock formations and short nature walks along the way.





Having filled our quota of sun, we drove back to our bungalow and cleaned off the dust clinging to our calves and ankles.   We drank tea while watching some Aziz Ansari stand-up on Netflix.  Then I spent the rest of the afternoon sprawled on the couch, catching up on back issues of The New Yorker - an activity which, to me, feels like the height of leisure, since I normally read each issue in short snippets at the kitchen table, hurried by the usual undercurrent of Grad Student Guilt at not working.

As the sun was setting, we got back in our car and headed a bit north to Pioneertown, a fascinating enclave of an abandoned Old West film set, a couple ranches, some stalwart local residents, and the famed restaurant/music venue Pappy & Harriet's.


The sunset was gorgeous, and made even more perfect by the sight of a couple horses grazing languidly in the twilight.



Andrew had been to Pappy & Harriet's a while back to see The War On Drugs and had camped overnight in the stables.  Concerts here are made even more memorable by the small scale of the venue and the resulting casual proximity to concert attendees.  Andrew recalls his pleasant shock at walking into the concert area and finding himself just feet from one of his favorite bands as they warmed up.

We were there for dinner and the Sunday night house band, which was less impressive than The War On Drugs but still plenty of fun.  A cheerful crowd of people got up to dance, and chairs and bowls of chips were shared freely.  The food (BBQ chicken, ribs, and sides) was tasty, the atmosphere was relaxed, and a good time was had by all.


The next morning, we drove back to LA.  We have realized that with the types of experiments we work on, it's hard to plan vacations longer than three or four days without needing to shut down everything.  (We don't do "staycations" very successfully, since sitting at home means we are physically drawn to our laptops.)  So from time to time, it's wonderful to get up from our desks, temporarily leave the concrete jungle in the rear view mirror, and plunge into the stunningly different.

Monday, August 1, 2016

Winter 2015 Japan trip: Kaiseki lunch at Roan Kikunoi

When we started making plans for this trip, a kaiseki lunch or dinner was one of my gastronomical priorities.  Kyoto is particularly known for its kaiseki restaurants, a considerable number of which have two or three Michelin stars.  All kaiseki meals emphasize seasonal ingredients, artistic presentation, and a standardized series of courses, but the restaurants span a broad range of styles from the very traditional to the innovative or modern.  We chose Roan Kikunoi for its reputation (two Michelin stars and many recent rave reviews), its balance of traditional and modern style, its moderate price point, and the simple fact that we were able to get a reservation there.  Alternatives we considered were the parent restaurant Kikunoi and Kiyamachi Sakuragawa.

Most kaiseki restaurants require that your hotel make the reservation for you, as foreigners can’t book directly.  Andrew emailed our hotel a few weeks ahead (in both English and Japanese!) and they readily responded in English.  When you request the reservation you also choose your price point from the restaurant’s options, and the restaurant will in turn ask about food allergies: no melon for me and no salmon roe (ikura) for my father.  Considerable advance preparation goes into your menu based on your dietary restrictions and the chosen price point, which determines the number of courses and whether any rare or expensive ingredients are used.


The exterior of Roan Kikunoi is elegant but unassuming, facing a narrow street and a small canal, and our table was ready five minutes early.

The table was set with attractively printed menus in both English and Japanese, a welcome guide and souvenir for this adventure.  Two impeccable servers took care of our table and both of them spoke some English.  New utensils and dishware were arranged meticulously in front of us for each course, including beautiful ceramics and lacquer pieces, then removed with equal poise.  The first course was an "aperitif" of sake with yuzu fragrance, presented in tiny iridescent lacquered bowls that I forgot to photograph.

Amuse bouche: Yuba (tofu skin) with pickled and dried sea cucumber.  The gold round at right is the upturned lid for the vessel.


Appetizers (clockwise from top left): Smoked salmon with camellia flower, grey mullet roe rolled in squid, cod roe terrine with broccoli rabe, miso-marinated tofu with pomegranate seeds, sea cucumber and turnip, and lotus root stuffed with fresh mustard.  This was one of the most memorable courses for the stunning clarity of flavors and how they played off of each other, such as the sharpness of mustard blanketed by the crisp sweetness of the lotus root.


Sashimi: Tai (red sea bream) with chrysanthemum petals and fresh wasabi, buri (amberjack) with Kyoto local radish.  Such fresh fish!  The sea bream was translucent and seductively smooth.


Steamed dish: Guji (red tilefish) steamed with grated turnip, wood ear mushroom, lily bulb, Mitsuba (Japanese parsley), fresh uni (sea urchin) scallop, gingko nuts, wasabi.  It looked like the serving vessels were individually steamed after the ingredients were carefully assembled, since they fell apart with a light touch of the spoon.


Hot pot: Duck breast, duck meatballs, Sansho pepper, and green onion in a savory-sweet broth.  Rich but also clean-tasting.


Rice with ikura and Kintoki carrot (a red Japanese varietal) soup, served with pickles and tea.  For my father, the salmon roe in the rice was replaced with carrot.  Needless to say, the rice was perfectly cooked and seasoned.  Elegant simplicity.  There was plenty more rice left in the cooking vessel, so the server formed the leftovers into onigiri (rice balls) for us to take away.


Dessert of persimmon with yuzu sorbet and tea jelly.


After we finished luxuriating over this meal and paid the bill, head chef Yoshihiro Murata himself came out and thanked us.  We told him what a spectacular meal this was, thanked him, and were graciously bowed out of the restaurant.

It has been over seven months, but I still remember the harmonious flavors and textures, as well as the beautiful presentations.  This was absolutely a bucket-list experience and I'm so glad my parents, Andrew and I got to experience it together.

Saturday, July 23, 2016

This November


apolitical (adjective) (definition from Merriam-Webster)
1:  having no interest or involvement in political affairs; also :  having an aversion to politics or political affairs
2:  having no political significance

For much of my life I thought of myself as relatively apolitical, but this has changed over the past few years.  As a loved one recently pointed out to me, it is a privilege to be able to think of oneself as apolitical, for it implies some ability to be detached from - insulated from - the realities and inequities of the world.  I avoid venturing into the morass that is social media politics, and I also intend to keep my blog relatively free of politics.  That does not mean that I do not have strong opinions.

The night that President Barack Obama was elected in 2008 was one of the most memorable of my life.  It was the fall of my junior year.  I was sitting in my dorm room watching the returns on my computer screen and, with my door open, simultaneously hearing the TV coverage being played in the lounge down the hall.  Right after the election was called, I remember the elation that flooded our building and the tears of two black dorm-mates as they ran past cheering, arms around each other.  I remember feeling that this election result was important to them on a level that I myself would never fully understand, but could respect and be grateful for, and that it helped me believe in greater possibilities.  I remember walking into the lounge and standing with my fellow students as the Obama family walked onto the stage in Chicago, an image of solidarity, love, and renewed optimism.  At that moment I realized that this election was perhaps the most important political event that my generation had experienced.  I will miss President and Mrs. Obama very much.

This year's presidential election is the one for which I am most fired up.  As I read the news and hear about all the outrageous statements made by various politicians, I feel nostalgic for the candidacies of Senator John McCain and Governor Mitt Romney.  I re-watch The West Wing and wish that Arnie Vinick was a real person who could run for president.  I vacillate between anger, indignation, and resolve, and even though the political optimism I felt in 2008 is a memory, I still feel hopeful for a better world.

I am proud to be an American citizen who is also a woman, a Chinese-American immigrant and daughter of immigrants, a scientist, and a future physician.  My deep-seated belief is that our country needs a president who is experienced and tough, but compassionate and classy; a president who balances idealism with practicality, and understands the realities of American politics.  We need a president who values the contributions of immigrants in America, and who believes in women's rights, reproductive rights, LGBT rights, high-quality healthcare and education for all, and biomedical and basic science research.

I encourage everyone to think deeply and critically about what is at stake in this election, to partake in civil discourse about our beliefs, to volunteer for the campaign you believe in, and most importantly, to vote on November 8.