getting my life back...in order

i don't like disorder (but mostly in a larger, life-picture sense). my room is always messy, i tend to make piles, and i often enlist the help of chris to find (or remember) where i've placed various objects. however, there is always a grand plan in the works.

over the past few months, my grand plan was derailed a bit. everything was on track until i didn't do so hot on a standardized test. this caused me to rethink the life plan for the year and decide to:

1) Not graduate from med school this year and
2) Not match until 2009.

because of this decision, i had to figure out something to do for 1.5 years. as i had always been toying around with the idea of getting another degree, i decided to jump in and explore my options. again, there were many options:

1) Master in Public Policy (MPP) at Michigan's Ford School of Public Policy
2) MPH at Harvard's School of Public Health (SPH), Johns Hopkins SPH, or UM SPH
3) Apply for another fellowship like Doris Duke to go abroad for a year
4) Work!

this was a really tough decision for me but on the advice of some mentors, i decided to stay at michigan since it was the only place i could get my MPP in the time frame i had. the MPP requires three semesters (rather than two) and gave me more opportunities to explore and be exposed to topics i haven't covered before (like economics and health care financing). don't be fooled into thinking this was purely a career-based move, however. in fact, this decision was one of the hardest decisions i've made because it was one of the first major decisions where i actually took something else besides my educational/career goals into account.

growing up, i always thought my education and career would come first. i was confident my family would support me and didn't think too much about where my partner at the time would fit in. usually he would come along or be supportive and if he wasn't, i wouldn't let that get in the way. working against my love life, i left home, went to swarthmore, then china, then thailand. boys would never hold me back.

it looked as if a wedding wouldn't stop me. i was gone for months in geneva and then bethesda leading up to my own wedding in michigan. chris was truly committed, buying a printer and sending out all our wedding invitations (he even kept track of RSVP's!) the day after we got back from our honeymoon, i got on a flight to thailand to start my fogarty year.

even though thailand was a second home to me, chiang mai was new territory. the id fellow (poo) and her fiancee at the time (p'nui, now her husband!) took me under their wing and i definitely love them for it. it was weird to be alone. i missed chris a ton and wanted him to share in the experiences i was having in thailand. a few months later, he quit his job and came to live with me. everyone thought it was crazy, but we had a wonderful time overall. and chris got a new job when he got back!

when all this decision-making was happening, chris was completely supportive. he wanted me to make the decision that was best for my career. my parents were gung-ho about harvard. as asians, they passed along their love for name-brand education + prestige to me. i don't like to admit it, but there is a part of me that does buy into academic elitist thought. even if it wasn't the best program or the program that met my needs the best, i couldn't dispute the importance and the wealth of connections to be had there. friends offered to talk to people. i was paralyzed by the choice i needed to make.

in the end, i only applied to the Ford School. i convinced myself that i wanted the MPP degree, and this was the place i was going to be able to do it. i'm the first MD/MPP candidate here and am excited about it. people have been incredibly supportive at the Ford School, which is a nice change from some of the challenges i've had to deal with from the med school side of things.

honestly though, what it really came to down to was putting my family first. staying at michigan meant staying with chris and being able to see my parents every weekend. even though chris volunteered to fly to boston or baltimore or wherever i ended up for the year and my parents totally thought i should do it, i knew it wouldn't be good for us. and it wouldn't be good for me.

even though i do feel like i'm mostly an independent woman, i am really much happier when i'm with chris. this was really highlighted to me when both an american friend and a thai friend noted the difference in how i was as a person before and after chris came to thailand. was this a sign of weakness? i used to think so, but not so much anymore.

a high-ranking indian doc in the UN came to speak to a group of med students a few months ago. i asked her how she balanced her career and her family. her answer was:

"i've always told my husband: children first, career second, husband third." she smiled. i laughed, and said i would tell my husband that, but it made me sad. i know i couldn't do the things i do without chris's support. sure, he wasn't who i envisioned i would necessarily end up with - he wasn't an activist, or an intellectual. he WAS a fraternity leader and he was actually pretty conservative. over time, he's definitely come around (no more shopping at Wal-Mart for starters!) and he helps me do the work i do. most importantly, he's never made me choose (or feel like i had to choose) between our relationship and the time i sometimes over-commit to education, activism, or service.

in the end, who are you without the relationships you have with people? i am eternally grateful for the relationships i have with my family and my friends. i'm pretty confident i'll continue to have a productive career, but i don't want it to be at the expense of who i am.

i've had this discussion with a lot of close girlfriends over the past few months who are making similar decisions about residency, or whatever next stage they're moving to in their lives, and i think we're all moving in this direction, recognizing that there are different things that can make you happy and feel fulfilled. most importantly, it's not copping out to make decisions based on these things, even if it's not found on your CV or something that's going to go on any application. more than ever, i've come to realize that mental health and overall life satisfaction/happiness is way more about the intangible things (like friendship) than i used to ever want to give them credit for.

maybe it's taken me awhile to realize this (as i strive to be an overachiever), but it's becoming easier everyday that i continue to work on it. thanks to everyone who's been so supportive! :)

two sad things, one happy thing

i have a few unfinished blog posts rolling around, but i wanted to take a little time out to share these three things.

first, the sad things:

1) after an elderly family member of a patient i saw in clinic found out i was interested in health policy, he proceeded to share his views on health care with me. the highlight of this conversation was (and i QUOTE)

Man: "I don't believe anyone dies from lack of health care."
Tanya: "Really? That's an interesting thought."
Man: "Yes. Everyone can afford insurance but they choose not to buy it. Who can't afford their medications?"
Tanya: "Well, I see lots of people who can't afford their medications."

Conversation ends when the actual patient returns to the room from a bathroom break.

2) two other med students (and myself) attended an evening session called 'Malaria Boot Camp' hosted by Nothing But Nets, a campaign co-sponsored by the UN Foundation and inspired by a campaign started by Rick Reilly, a columnist who writes for Sports Illustrated. His 800 word column asking people to donate $ for nets raised hella money from a segment of the population (men) that were largely previously inactive in global health. At the malaria boot camp, a famous scientist from MSU spoke about how he helped develop a new long-acting insecticide treated net with the private sector. this was cool because the net didn't need to be retreated & lasted for about 5 years, among other things. In the Q&A session, i asked a question (surprise, surprise).

Tanya: 'Dr. Wilson, you've dedicated your career to trying to help those who suffer from malaria around the world. My name is Tanya and I'm here with a group of students from Universities Allied for Essential Medications. Have you considered humanitarian licensing or have you taken other steps to ensure that the fruits of your research will be available to those who need them most?"

Dr. Wilson: 'I really don't have control over anything because it's completely funded by the private sector. I hope our net is brought to market, but that's not my choice.'

Tanya: 'Do you retain any control over the patents or intellectual property used for the invention of the net?'

Dr. Wilson: 'Unfortunately not; the company retains all the rights."

Dr. who is running the whole panel and is the Director of Global Health: 'Excuse me. Public health people like Dr. Wilson who are dedicated to researching issues like malaria do not concern themselves with marketing. We are out there to try to help people, not market things." He says this kinda huffily and turns around nodding to the other panelists like they should back him up.

I was totally offended! As a leader in public health, how can he say that marketing is totally not relevant? An analogy to medicine would be that we only care about treating our own individual patients and improving their health but don't care at all about the health systems we work in. After I told this story to my brother, he even said, "What's the point in inventing an awesome net if it's never distributed to the people who will actually benefit from it?"

Frustrating.

Happy things:

Thiru nominated me for 'Most Likely to Make a Difference' on Facebook. Small, i know, but it totally made my day.

Patients also make my day a lot in clinic. Sometimes I know it's ridiculous to gain so much ego boost from little comments people make, but it seriously does go a long way. Some of my faves from this month:

"She is the best med student in the whole med school!" - from a professor to a patient after she offered me a position in her husband's cardiology practice.

"Hey doc, she's really good." My attending looks around, confused. The patient points to me. "She knows how to explain things so that I can understand!" Attending: "Oh, she has to be good. She's a Michigan medical student." (Thanks, Doc)

"You better be here when I come back! I only want to see you." Sorry, I'm rotating off - and I'm just a med student.

even when i don't know the answers to questions when i'm getting pimped, i know that i'm good with - and take good care of - patients. clinic is also a lot more fun than i thought (props to all you people in primary care!)

things that have made me smile recently (and boy, there have been a bunch!)

trying to get back into blogging and realizing part of the beauty of it is that i can just write little tidbits of things rather than drawing out some large parallels between my life and the great truths of the world...er, you know what i mean.

it's 7:30 am. i'm starting outpatient cards today after being out of the hospital for a month. should be a nice switch from the MICU, but not such a sweet change from 'vacation' (ie studying and doing AMSA stuff like crazy month). since there's not much time, im making a list and going back to the topic of my blog - things that have made me smile recently. these are in no particular order.

1) i always thought i wasn't really good with kids, but decided to volunteer as a 'big sister'/'mentor' for this adopted asian girl anyway as part of a pilot program called GIFT (Growing in Friendship Together). most of the mentors are college kids that are also adopted, and all the mentees are Asian girls who have been adopted. we have group activities about once a month and then we also meet with our mentees separately. last month was the first month where both me and my mentee were able to join the group activity, where i met the other girls.

a month later, i emailed one of the moms who was helping out with this month's event (the Moon Festival, or zhong qiu jie, held last Friday night) for directions. she emailed me and said:

Hi Tanya,I've attached the flyer. Also--funny thing. K. just got a stuffed leopard and she named it Tanya. I asked her why Tanya and she said "Mom, you know--Tanya like the cool woman from mentoring?" She is such a watcher, she's clearly checking out all the mentors even while hanging out with her own.

That totally made my day! I was kinda feeling out of place before since I was one of the oldest mentors, but it's cool how something little like that can definitely make you feel like you're doing something right. later, at the Moon Festival, each pair of girls had to make a poster with pics and tidbits of what we liked doing together, what we learned about each other, etc. my mentee wrote (verbatim) 'I like evrything about Tanya!'. yay mentoring (and being a role model) for other young girls!

2) Finishing Cecil's. Yep, I read all 1100+ pages of the 'Essentials' version. I think I'll try to skim again, but it was not bad after you got into the groove of it.

3) AMSA family. Ah, AMSA is like a drug...gives you the high, but then you can never escape it. I spent a long weekend at AC Exec/GHLI and I totally got sick afterwards from not sleeping enough and being in intense meetings for a ridiculous number of hours each day, but it was really amazing. A shortlist of things that made me smile (will continue later since Chris is dropping me off at the hospital in five mins):

-getting lost in Dan's truck on the way to the retreat center with CJ and Dan Murphy. Fresh baked goods from Mom's Apple Pie Bakery. Trying to squeeze in and still drink our morning coffee.
-im'g/googlechatting with dan and vishad during the super long meeting
-late-night conversation and franzia sangria (with sliced apples) courtesy of julia
-encouraging people to listen to their hearts. kicking certain people out after it was way too late.
-writing my own global health vision statement.
-driving and walking with flavio for lobby day in DC
-late night talks, leftover chinese food, and capoeira performances at the AMSA townhouse
-having some really short (but valuable) quality time with rishi in the 10 mins we overlapped at ghli
-eating a homemade meal prepared by a lot of the male partners at ac exec - so nice to get out of meetings and have yummilicious food waiting for you
-teamwork (on a huge number of levels)
-watching 'the office' parodies done by med students about small group

ok, gotta run. more to come soon! it feels really good to blog again :)

continued from cards clinic (where I was actually sent on an unofficial consult to the hospital with the other med student on service..):

i'll continue on AMSA later. but, other things:

4) liz's eval of me (see 'comments' under previous blog entry). i dunno why, but evals like that make me feel so good about myself! am i a nerd? yeah, totally. do i like it? yeah, a lot :)

5) meeting up with suhani for sushi at DTW. i am starting to really get into airport dates. my first was with dan a few months ago at Dulles, where we had dinner and chatted, and this was my second official one with suhani. i havent seen her since she moved out to madison, and it was awesome to catch up, get some hugs, and to just spend some time with an old friend.

6) spending time with sup and karlo (two Ford School of Public Policy grads and APA caucus peeps) in dc, and grabbing dinner with davekumar. i was in dc a few weekends ago for this hiv psychiatry training and the american psychiatric association fall components meeting. the training was pretty good, but the highlights were definitely hanging out in a hotel room at jw marriott downtown, going to the adams morgan street festival with karlo and sup, visiting them in their place near dupont circle, and eating dinner with dave. i also met some cool people who are into global psych and caught up with roxanne, who was a global health fellow in geneva.

7) seeing patients again. a friend questioned if i was still into clinical medicine, and i have to say, i am! i saw a consult today in the hospital and really enjoyed looking up the history, taking notes, and talking with the patient. although im taking a year off, a mentor told me that i should try to keep my clinical skills as intact as possible, and i think i'm going to try to work with docs i respect in clinic if i stay here on my year off (which im really leaning towards doing).

8) family time! i see my parents almost every wknd if i'm around. they've been super supportive and really never fail to put a smile on my face, especially when we're ragging on my dad for being his silly self.

unchecking some boxes and shaking things up

so i haven't blogged in a long time. i have been busy, but i've also been thinking a lot about where i am and where i'm going down this pathway of life. i've been reflecting on failure, on what that means to me, on what has to be different the next time around. thanks to all of you who listened to me in call rooms, on the phone, in your living room, or over instant messenger. im always impressed by how forgiving and supportive friends and family are when im confronted with their reactions and compare them to my own.

it's interesting how failure can overshadow all the other successes in your life. it's irrational, but it's the way many of us, especially in med school culture, are programmed to work, our self-worth tied not to how well we take care of patients or our relationships with others, but on evaluations, standardized test scores, grades. i try to remind myself to judge myself by other criteria too, but no one is giving me an end-of-the-month evaluation on what kind of leader, friend, wife, or daughter i am. i don't get graded on what i contribute to the community, the number of emails i send, or how i love. one thing ive definitely realized through my most recent setback is that i love my life and i love the communities i live and work in. ive also become a lot more comfortable talking about failure and not being embarassed about it. indeed, i think that admitting to failure and dealing with it (both privately and publicly) is one of the hardest things i've had to do.

when i found out that i failed, i felt as if i had taken a majorly wrong turn in the maze of life and i wasn't sure if i was going to be able to recover, to advance to the next level (power up!) or to put a band-aid over my damaged self-worth. luckily, my go-get-em personality and overwhelming desire to make to-do lists took over. is it painful to know that some boxes you checked off with a flourish must now be unchecked? yes. however, is it fun to make a whole new series of boxes and schedules with different permutations because you suddenly have a lot more time than you had originally anticipated before graduating? TOTALLY. yes, i am a nerd, and yes, i do think that it is super awesome.

since im not graduating for a whole another year (spring 2009), i am applying to a series of dual degree programs. right now, im pushing to try and do a MPP (master's in public policy) over an MPH (master's in public health), but will be happy to also do an MPH with a concentration in health mgt and policy. i had originally thought to pursue these degrees sometime during residency/fellowship, but am super excited about doing them now. yesterday, i went to an information session at the Ford School of Public Policy (here at UMich) about the Science, Technology, and Public Policy graduate certificate and became totally pumped about being a graduate (and not professional) student. more on this to come!

to-do lists

ive always had an affinity for to-do lists. i think this started in high school, or even before, when i felt like i had a lot to juggle and needed lists to keep it all straight. my mother is primarily responsible for my obsession with multitasking, as she thought it was important to sign me up for every extracurricular activity available in a 1-hr radius of our little island hometown. if you dont believe me, here is a list of all the activities i participated in as a youngster: taekwondo, ballet, tennis, piano, art, writing, swimming, soccer, t-ball, basketball, community service clubs, tutoring, buddhist school....ah, the list goes on. ever wonder why im so involved (or obsessed with instant messaging while im on the computer)? ask my mom. even as a now-married pseudo-grown-up, ive taken multi-tasking to a whole different level.

i think this multi-tasking will serve me well as an intern, where my life will be filled by to-do lists, check boxes, and (somewhat) predefined tasks. in the past couple weeks, i have felt satisfied at checking off many (large) boxes centered around finishing up requirements for 4th year, applying for internal medicine residencies, and living life. presented in classic sign-out form, here are the highlights for you below:

Work:
[X] Step 2 (my last test of M4 year!)
[X] ERAS (Electronic Residency Application)
[X] Letters of recommendation for ERAS x 2
[X] Dean's letter appt and review (this letter sums up how you did in med school & talks about how cool you are)
[X] Internal medicine appt with Dr. Grum (for the Department letter, since i'm applying in medicine)
[X] CCMU (Critical Care Medicine Unit, or the MICU) - 2 calls down, 5 calls to go. I guess I really shouldn't really check off this box, but it feels good anyway, so I will, for right now.


Play (mostly):
[X] Celebrated our one year anniversary in Western Michigan. Chris and I stayed at a local B&B, ate some good food, and went shopping in Holland. We also got fabulous peach pie from Crane's Pie Pantry in Fennville.
[X] AMSA COC (Chapter Officers Conference). Lots of QT here with my some of my fave AMSA peeps, including Catherine Jones, Dan Murphy, Andrea Knittel, and Rishi Rattan. I also got to visit with Jay Bhatt.
[X] Hanging out with some fellow M5's, M3's, interns, and residents. It's been awesome to meet new people at different levels in the hospital and hang out with them on the outside. (I'm not sure Chris is as thrilled about this new development, but he humors me anyway. I appreciate it!)

Random fun stuff:

[X] I was found by Cooper, an organizer at Blogher, online. She contacted me about BlogHers Act!, an initiative you can read more about here. Women bloggers from all over voted on global health as an issue they want to tackle this year, and cooper asked me to speak at the unveiling of this way exciting topic. Unfortunately, it was the weekend before Step 2, so I couldn't, but I wrote a letter that she read to the assembled bloghers at their national conference. Fun!

[X] Kevin, a former GHAC chair, nominated me to be profiled at this upcoming exhibit at the Ntl Library of Medicine on leaders in global health. I'm still filling out written interview questions for this thing, but I did a phone interview where I talked about AMSA, Thailand stuff, and organizing. The exhibit goes up next spring/summer and will also have an online component. Hopefully, I can convince other people to get involved. It's also humbling (and heartwarming) to have people you work with respect what you do (and think about you when things like this come up.)

Enough signout for now. I've been a slacker about updating, and it's hard to get back into the groove of blogging, so I thought I'd start with what I do best - a checklist. All you intern readers out there - hope you enjoyed :)

NB- For all you non-med people out there, 'sign out' is something you have to do when you leave the hospital everyday if you're on an inpatient service. This consists of a blurb on your patient(s), why they came in, what you've done for them in the hospital, and then a list with little boxes (as above) for things you need your cross-covering intern (the intern on call) to do while you're gone. This usually consists of checking labs or following up on (specialty service) consults you have put in on your patient for a specific problem they might have. It also has fun tidbits on how to handle certain situations should the nurse call in the middle of the night. For example, one of my patients had this on her signout:

Note: Patient's BP falls to the 80's when she sleeps. If this happens and people are concerned, wake her up. Her BP will return to normal.

a day at the va spa

my attending went away for the weekend and so the chief of ID at the Ann Arbor VA covered for her yesterday. the chief of id is my kinda pseudo-advisor and i had some email conversations with her while i was still on my fogarty in Thailand and then later talked to her in person at the VA. she is hugely famous and is one of the world's most foremost experts on fungal and yeast infections. for medical people out there, let's just say that when i went to read about a patient i had with Candida parapsilosis, Dr. K. was the author of the Up-to-Date article "Overview of yeast infections." i was trying to explain how crazy that is to Chris, to have your attending be the primary author on numerous Up-To-Date articles in the field that you're hopefully going to go into. anyway, she's a big deal, but really down-to-earth and into teaching and giving good advice. basically, she would be a woman version of a nice dr. cox (on scrubs) but dr. kelso's age. i just got the feeling that that was a terrible analogy, but im free-writing, so i'm going to keep it anyway.

in any case, yesterday was pretty slow. i got one consult for a patient who had Bacteroides fragilis growing out of his blood cultures but E. coli in his urine, and we were asked about the source of his infection and on recommendations for treatment. i learned a lot with my senior resident (who was also interested) and hopefully made a good impression. i was surprised that i i didnt feel as intimidated as i thought i would and also was psyched to learn a few things on rounds, which always includes a trip to the microbiology lab, where i smelled some S. mutans on a plate. There was a vote on whether the S.mutans smelled like butterscotch or butter popcorn and I voted for popcorn (it ended up being a tie). who knew micro lab could be so fun?

later, we went to change a dressing on a wound. i went to help get supplies and had tape to keep the dressing in place (which i can never tear). dr. k. watched me struggle with the tape briefly and then took it from me and ripped a piece off without a problem. her advice to me: "you have to be bold!" the patient's wife (who was learning how to do the dressing) interjected that she always had a problem with the sticky tape so i didn't feel so bad. granted, i still am decades younger than either party though. note to self: practice tape-ripping skills for further ID work.

after rounds, i went to work on my note. during that time, i got excited since i received an email from an administrator at Johns Hopkins saying that the Fogarty International Center funds from their center would pay for me to go back and spend a month at Dr. Cynthia's clinic in Mae Sot, on the Thai-Burmese border. this means that i will return to Thailand twice this year, once as a OC Hubert/CDC Foundation scholar and once with Fogarty. I'll be spending about a month in Thailand each time and be based in two different places (Nonthaburi, outside Bangkok, for the CDC, and Mae Sot/Chiang Mai for the Fogarty). Maybe fourth year will turn out to be more like my "year off" than I originally thought. :)

in any case, this email got me really excited. when i went to leave for the day, i stopped by Dr. K's office and told her about it and the projects i was going to be working on in thailand. we talked about how medical education was changing at michigan (some medico-legal officer doesnt think student notes should be allowed in the medical record anymore?!) & the differences between thailand and the us. i brought up that the Fogarty Center had solicited a piece about "the need for patient education and health literacy in the health care system, drawing from your experiences in Northern Thailand" after reading my article in The New Physician. i was kinda offended although i'm not totally sure why, but i feel defensive about people just being like "can you comment on the plight of the poor?" or the sentiment of "please draw from your exotic experience and perspective as a first-world person working in the third world." it's not like people in the US don't need health literacy too, although i don't think the woman who emailed me was implying that they didn't.

i ended up writing the article, which i posted on my friend's health-care related blog, cure this!. it will also be published in the July issue of Global Health Matters (the Fogarty newsletter), but decided to compare my experiences in the US and Thai health care systems instead of just focusing on Thailand's shortcomings. Dr. K. and I talked about this for awhile, and i was really struck by a comment she made when I noted that my close friend (and ID fellow) would see a ton of patients in clinic and not really have a ton of time to talk to them or write the best ever notes in the chart, but she was still providing good medical care. Dr. K corrected me - "excellent medical care" and noted that Thailand's health care system may not be perfect, but the docs over there were truly saving lives.

as i prepared to leave, she said that she was excited for me to return to Thailand and advised me to take malaria prophylaxis, adding, "You should go back - it's a privilege to be in a place where you can really practice medicine."

i sometimes wonder if mentors know how much students look up to them, and how a little comment can really go a long way.

i am an immigrant in a country of immigrants

i started id consults today. besides myself, my team consists of another 4th year med student who was originally in my class, a third-year in her last month of internal medicine residency, a fellow from Romania, and the attending. dr kauffman introduced me to my attending (dr malani) last month and i met with her to talk about possible research projects a few weeks ago. besides having a common interest in id, we also discovered that i lived in the house across the street from her childhood home until i was eight years old. the world is small, and the island i grew up on is even smaller. in any case, we decided that i was going to work on writing a review of HIV care in the elderly patient with her and another fellow & plan on publishing it in a geriatric journal. im super excited about it and think ill learn a lot! yay for side projects :)

back to id consults and my team. i think the first couple days on a team are always interesting because you're getting to know people because you're sitting in small rooms with them. of course you're talking about patients part of the time, but (if you have social skills) you're probably talking about life-outside-the-hospital for most of the other time while writing notes, waiting for phone calls, or just doing busy work. as a team of almost all women, the subject of families (and children) inevitably came up early on. all of us are married except the guy on my team, so we talked about husbands and husband's jobs and whatnot. i also found out that my resident went to a liberal arts college and did post-bac at bryn mawr (yay tri-co). she noted that she thought we (as michigan med students) had to work way harder (and learned more) than she did during med school but that it probably didnt matter in the long run. i told this to post-call liz today and she confirmed the widely-believed rumor that michigan med does totally prepare you for internship, so at least i know the q4 is worth it :).

in the afternoon, i got a chance to bond with the fellow who just started at u of m last week. she is originally from romania, where she completed medical school and trained in id. she admitted she was nervous about starting (arent we all, regardless of what stage of training we find ourselves at at any moment in time). we talked about our backgrounds. she talked about moving to america six years ago when her father was approved for a green card and the decision on whether to leave her career and her husband's career (as well as their homeland and life) behind. in the end, they decided to try it for their children who were six and two at the time. she vividly remembers taking her son to first grade in october, when they arrived in america. he did not speak a word of english, and the first day of school he asked his mom "what should i do if i have to go to the bathroom?" talk about resourcefulness and resilience. when she told this story, she was proud of him and proud of his struggles. they all struggled at the beginning, working jobs that paid less than $8 an hr - a big change from their professional lives back at home. eventually, she started studying, got into a residency, and matched into id at u of m. her eyes lit up when she talked about it, saying that she suffered from a lot of inferiority issues as a international medical graduate, didn't think she would get in to an IM residency in the US, much less fellowship. getting into michigan was a "cherry on the top", in her own words. i felt privileged to hear her story and to work with her. it reminded me of how lucky i am to be educated in this country and of the opportunities i have. she also gave me the opportunity to share my story with her.

i am second generation thai-american. i am the daughter of immigrants. i grew up in an almost exclusively white neighborhood on an island and was one of two or three asians in my graduating class.

i wanted to be white for a long time (i didn't really talk about this part with my fellow though). i was frustrated that my parents had rules that my friends didn't, like family dinner everyday with no tv and talking about everyone's lives. i had the same curfew from 9th grade-12th grade until i threw a fit my senior year and got it extended to 1 am (but if i was out, i still had to call to check in). even now, as a married woman and almost-doctor, i still try to call my parents everyday.

identity was a hard thing for me to figure out and was definitely a learning and growing process throughout my young adult life. my parents were always supportive and adamant about being not-american (which they equated with being white). sometimes, it was okay to be american because it was good to blend in and win at their games (academic ones, of course). i distinctly remember my mom saying, 'if another kid in your class gets 95%, you have to do better than that because you are asian (and your work won't count as much).' she thought it was also important that we were able to succeed in an all-white environment since she figured that was what our workplace would look like in the future. interesting message, but one that stuck with me for a long time - fit in, but remember, we are not like them.

i spent a lot of my adolescence fighting with my parents who were raising me 'thai' which meant no going out after darkness and no boyfriends (for girls). obviously i rebelled against all these rules, but i have to give it to my parents for trying. in retrospect, i can say it was okay to be raised 'thai' (and many thai people, including all the nurses i worked with at the repro health clinic in Chiang Mai, approved).

as an adult (it's weird that i am no longer considered to be in the 'youth' category, although 26 is the cusp), i am proud to be the daughter of immigrants. i think my parents demonstrated incredible strength and recognize their sacrifices to give us the lives that they didn't have. i think it is super awesome to come from two worlds, to be thai, to be asian, to be american. i feel like being the daughter of immigrants gives me an unique perspective on language, culture, and struggle. chris and i have talked about our children and how they will be third generation, and that i am sometimes sad that they will not be children of immigrants. i used to think that so much was lost from generation to generation, and sometimes i feel that is still true, but i think a lot is gained too. my parents wouldn't speak out or protest at a rally, but they do donate money to causes (like MSF, or Doctors Without Borders) that they think are cool. i do both, and i try to actively pursue social justice in my life and career (hopefully my kids do too!) with privilege comes a lot of power, and im trying my best to use my privilege to do good in the world. i think it's working so far :)

at my fellow said, 'i came here for my children - if they are ok, i will thank god and know that i made the right decision. i have no regrets." i said, "i think my parents feel the same way and i think your children will be good and make you proud." when i left, she said "thank you for sharing your experiences with me." i smiled and said, "thank YOU!" i think it is really brave for people to share their stories and be honest and admit to their insecurities with others, especially at the first meeting.

it was nice to have that conversation to set the tone for the month, and to remind myself that i do make my parents proud in both traditional (yay my kid is going to be a doctor and my life is complete!) and non-traditional (what is this social justice you're always talking about?) ways. i tried to re-enact this whole conversation with my mom tonight (in the middle of writing this blog entry) but she was watching a korean soap opera (i could hear the music in the background) so she didn't contribute much to the conversation. go figure.

US Social Forum and my identity politics

a good friend and past amsa pres was supposed to speak at the US Social Forum in Atlanta about access to essential meds and pharmfree but couldnt make it at the last minute. i was chosen to go in his stead. i didnt really have any background about the US Social Forum at all and tried to hurriedly make plans to get myself down there and find a place to stay. it was pretty stressful. my last-minute ticket cost almost $500 and none of my friends or contacts could offer me a place to stay. i ended up splitting a hotel room downtown with a college student my age from DePaul in Chicago whose class was centered around the US Social Forum. The trip overall cost over $800 for me, but i was able to use my savvy fundraising skills and get most of it covered through IPHU & Global REACH at Michigan. i am thankful for those who support students to attend conferences like these because they really give you a chance to ground yourself in what you're doing. at the same time, my experiences at the USSF really pushed me to go beyond my limits in thinking about not only my identity as a woman of color, but also about the politics that inform my work and my life.

it has been a long time since i've been to a non-health related - or even non-academic -conference. although amsa is awesome and has really helped me provide me with a community of like-minded peers throughout my medical school experience, i was reminded in not-so-subtle ways during the USSF that being a future physician made me part of an elite community. i was no longer a 'college student' or a 'community organizer.' i was not 'youth'. sometimes, i was a representative of the 'broken health care system' or 'the medical establishment.' comments on the first day of the IPHU (International People's Health University) brought back vivid memories of me not feeling XXXXX enough in college. Not Asian enough, not poor enough, not radical enough. i felt frustrated because i didn't like the way i was being judged. i am working hard in the best ways i know how to fight for health care and social justice. med school has not been an easy road for me, but sometimes i need to be reminded that my life has been one of extreme privilege. i struggled with that fact in college for a long time. feeling guilty and not knowing how legitimate i could be in fights for social justice. discounting my parents' struggles because i was angry and felt like i didnt have any of my own to share. growing up and realizing how insulting that was to my parents who worked around the clock to give me all of those things that they never even knew existed in rural Thailand. appreciating them for sending me to Swarthmore, where i began defining social justice for myself, and being okay with bearing their hopes and dreams while still trying to figure out the ways in which i wanted to infuse and live my own life, but not totally ready to believe that my life was partially theirs too.

i remember a conversation i had with a friend, rafael, in college. i was in my i-will-not-go-to-med-school and my-parents-cant-make-me stage of my pre-med career, and he was really adamant about me taking agency and doing what i wanted with my own life. "Screw your parents!" he said. "It's your own life; you're the one living it!" "What would your parents do if you didn't do what they wanted? Disown you?" i had never thought of things to that extreme but just knew that i really felt guilty disappointing my parents in any way. i also felt like i had a big responsibility to prove to them that everything they had done for me was worth it (my mom was never hard-pressed to compare our family to others to prove how committed she was to us). looking back on my childhood (and even at my life now), i have to give it to them though. i had every lesson - ballet, TaeKwonDo, ice skating, roller skating, swimming, piano, and more - that my mom thought would make me a well-rounded person. i went to summer school or camp as soon as i was old enough. my parents' lives were consumed by working at their family practice to save up money for lessons, for school, for medical school. their dreams were a big thing to carry. sometimes, i think they still are, but ive learned many things over the years that have made it a little easier.

i had dinner with a friend and family physician, anjali, where we shared stories of our second-generation histories, stories of how our parents had shaped our lives and stories of how they could be the most supportive people in the world or how they could crush the fragile (independent) identity you thought you had built for yourself. anjali asked if my parents had been supportive of my 'years off' (particularly this last one). i think so, i said, but i prepped them for a long time so they knew it was coming. i have learned to use their language and to frame my decisions in terms of things they value and understand. in college, my parents valued getting into medical school, and now, they value getting into residency. i frame almost everything i do into these contexts and they're okay with it. i've also had a decent track record so far, so i think they've learned to trust me (although they were a little shaky about the whole majoring-in-Chinese thing and organizing in Philadephia's Chinatown in college). i often talk about karma with my parents as well. good karma through my actions is good karma for my parents. to me, it also means that im using my privilege to try and make a difference while i have the chance to do so. i wake up everyday and think about how lucky i am. i hope that i am living up to my past lives and my past karma as well, and pouring water and not salt into the mix. (see analogy from a Buddhist monk in the entry.)

back to identity politics. after being totally overwhelmed by the number of workshops offered at the USSF (about a hundred for each time slot), i decided to center my didactic experience around asian-american issues, attending workshops set up by NAPAWF (National APA Women's Forum) and CAAAV (Coalition Against Anti-Asian Violence). i contributed to the IPHU and to conversations about health care access by presenting about what is going on with Thailand and Abbott, but did not go to any other health-focused workshops after that. i heard amazing presentations from groups like the Asian Pacific Environmental Network, the Bus Riders Union, DRUM (Desis Rising Up and Moving), the Chinese Progressive Alliance, and the API Women and Family Safety Center. i participated in discussions about trafficking, heard stories from workers in sweatshops, and was excited to see and be around tons of progressive APA youth. i felt the need to move to california to be a part of these movements, this organizing. i remembered what it felt like to be comfortable in a room where everyone looked like me. i realized that my days of asian-american organizing were not over, that it was silly to think that i had grown up and moved beyond identity politics because i had already figured out how to be proud of being Asian-American. i finally thought about immigration and diversity and about a lot of things that were coming down around me and how this connected to our struggle as a people and to many other struggles as well. i remembered the moments i had become excited about going to medical school when i saw that health care was a basic right that people needed and i thought that as a doctor (like Dr Siu in Philadelphia) i could provide that. not having health care came up over and over again when people were sharing their stories. all of this resonated with me, and a part of me came alive again.

throughout the four days i spent in Atlanta, i had long conversations with people i cared about and met some new friends as well. i thought about priorities, about what i want out of a residency program, about what kind of community i want to be a part of and how i could build that. i shared my perspectives and my stories and made commitments to help people process where they were going and what they were doing whenever i could. i was happy to come home and didn't feel guilty about it. i thought a lot about how i could be a part of the asian-american movement while being in the midwest. i thought about how, when one of the organizers of the workshop got people to stand up in groups and cheer when he called out where they were from, he didn't know to call out after saying "California" and "NYC" and how the Midwest and South and Northeast just all got lumped together. i briefly felt not Asian enough, but then thought about the necessity of representing my own community that was not based in LA or the Bay Area. i reminded myself not to be ashamed of being, as F.Omar Telan refers to himself as, suburban fabulous.

i briefly shared some of my thoughts with chris when i got home pretty late at night and tried (unsuccessfully) to re-enact the CAAAV workshop with all the different speakers sharing their stories in different Asian languages. before we went to bed, i told chris that i maybe wanted to move to california. he smiled.

june meeting

amsa june meeting has been a part of my life since M1 year. it's basically a big meeting where most everyone on national leadership (board of trustees and action committees) get together and plan the rest of the year. it's also a space to be inspired, rejuvenated, and to love and be loved for your work and your commitment to health justice. my amsa friends have definitely been some of my closest friends over the past four years and it's been great to have a national network/family behind you.

this is the first year i've been a chair (or project manager, as it's known in corporate america) on the action committee side of things. this means that i make sure work gets done among my five coordinators (all fab, of course!), offer support to them and others in national leadership throughout the year on issues of policy & programming, and represent GHAC at-large on the AC Executive Committee. it's a big job, and i'm happy to fill it, although i did waver back and forth on whether to run from abroad quite a bit. (thanks to chris for listening to me do this and continuing to bear the brunt of my vacillation on all things AMSA). overall, i LOVE AMSA and think it's really super awesome, but sometimes it's difficult to keep things in perspective while also being a fourth year med student, wife, daughter, and friend, among other things.

june meeting was AMAZING in a lot of ways. i finally got to meet my committee and run my first meeting as ghac chair. i think i did the best job i could, but know there's a lot of room for improvement, and really need to work on following-up with people to make sure deadlines get met. the best thing about committee time is that i think that our committee really bonded together and that we gained an appreciation for each other not just as friends, but also as activists. ghac continues to grow bigger and better as the years go on, and i'm very excited to be a part of the energy with a brand new group of coordinators as we start off another academic year. i feel like i have so much to learn from each person on my committee and that i'm very inspired and excited to support them in all their work this year. being a chair is also a great chance to reflect on my experiences within AMSA leadership, and i was reminded even more of this when i looked over my speech to run for chair, which i've cut and pasted below for those of you who weren't at national convention this past year:

Hi everyone! Thanks for coming to GHAC org time, whether it’s to run for a national position, support a friend that’s running, or just to check things out. I really appreciate all of you being here, especially since it’s near the end of conference, and you all must be exhausted from speakers, workshops, meeting new people, and hopefully, being inspired by fellow students and activists. I’m really sad that I can’t be there in person today (this is the first conference I haven’t been to since 2004!), but my thoughts are all with you from Chiang Mai, Thailand. If you haven’t noticed yet, being part of GHAC usually means you have friends to visit in cool places.

My name is Tanya Wansom and I attended my first national conference three years ago, ran for the HIV/AIDS coordinator position, and never looked back. I’ve been involved with GHAC for the past three years as a coordinator for two years and an editor for Global Pulse this past year. AMSA has given me a lot of opportunities to grow – as a leader, an activist, and a community organizer – and I’m excited at the prospect of running for GHAC Chair, where I can support the future generation of AMSA leadership using my past national experience and also make sure that the general membership keeps getting more involved.

As chair, my main duties are to support my coordinators, represent GHAC to the larger national AMSA leadership (including the president, Board of Trustees, and other AC committees), and make sure the general membership at large knows what’s going on and how to get involved. I’d like to bring back general GHAC monthly newsletters on the listserv and look into starting an AMSA GHAC blog where everyone can post articles on different topics and activities that are going on in different regions. Also, I’d focus on institutionalizing many of the liaison positions we have with other professional global health organizations (and expanding them) to make sure there were more opportunities for students to study, work, and find mentors abroad. Most importantly, I’m happy to hear about what you – as a GHAC member – would like to see GHAC working on or doing in the coming year.

GHAC has, and will continue to be, a powerhouse in AMSA. I hope you give me the opportunity, as chair, to build on the work that so many people have contributed to over the years. Thank you.

AMSA has definitely been one of the defining experiences of my medical school career. I'm especially happy to serve on AC Exec with many friends from over the years, including some of us who had taken a year off (Catherine Jones, Community & Public Health Chair & Vishad Sukul, Humanistic Med Chair). Michigan Med also has an amazingly strong presence this year on AC Exec with three members on the board (me, Michelle Debbink, HPAC Chair, and Andrea, LGBT CHair). Andrea and I had the opportunity to get to know each other *a lot* better after spending five hours waiting for a flight together, which ended up getting delayed to the next morning due to 1) a tornado and 2) a computer glitch that shut down everything on the East Coast. andrea and i also roomed together with Catherine and Laura (also on LGBT HAC) and affectionately named our room the 'lame-o' room as we are all not so into partying, drinking, and staying up really late (although we inevitably do anyway). we are into changing into our pajamas really early, trying to go to bed early, and waking up early to eat breakfast (hence the lame-o term).

anyway, besides being a lame-o at amsa meeting & riding the grandma bus home early after actually going out to washington, dc, i was really happy to meet new AMSA peeps and reconnect with old ones. i really like the group of people im working with on AC Exec this year and feel loved and supported by most of them. i also got to see some of my old fave peoples (albeit briefly) at June meeting including Casey (RT), Davekumar, and Kevin Burns. being back into the AMSA swing of things has helped me readjust to my life back in the US and given me a place to channel a lot of my energy and enthusiasm for the year. it's also been a source of some (good and bad) stress, namely in the forms of trying to set up basecamp (this online networking tool) for my committee and also as a last-minute invite to speak at the US Social Forum in Atlanta this coming up week. I'm totally honored to be asked to be one of the AMSA reps at the USSF, but it was really stressful to buy a ticket, find a hotel room at the last minute, etc. In any case, I'm excited to participate in the International People's Health University, a four-day short course on health justice and organizing, and to speak at an Access to Medicines panel at the conference itself. I will also be meeting up with fabulous AMSA peeps Dan Murphy (now the legislative affairs director), Anjali Taneja, Kevin Burns, and Catherine Jones. Hopefully I won't have as many problems getting to Atlanta as I did going to Philly & DC on earlier trips this month.

ups and downs

since my sub-i has ended and i've been on a 'vacation' month (meaning im not registered for any rotation at my school), i've felt like i've really run the gamut of emotions since i've actually had time to think about being back in the US, process a little about Thailand, and get used to my role(s) as daughter, medical student, sister, and friend again. nothing too extreme, though. my life has definitely been in a lot of flux lately - starting fourth year with a different class, sending many of my friends off to different areas of the country, and figuring out what my responsibilities are (and what i want them to be) regarding the million-and-one extracurricular activities that i have gotten myself into over the past four years. a lot of times these activities - especially AMSA - are the ones that have kept me sustained and focused throughout my medical school career, bu they can also be the source of stress, frustration, and the feeling that i've gotten myself into deep.

my year off was good to give me a sense of perspective. i didn't keep that perspective for too long though and jumped back into a VA sub-i, where i was kept busy for most of the hours of that one month rotation. when it ended, i realized i had a lot more free time (which was supposed to be used for Step 2 studying), but ended up being devoted to what i affectionately refer to as 'life maintenance' instead. don't get me wrong - im definitely studying for step 2 - but im also traveling A LOT (more than i would like). during the month of june, i will have been to Philadelphia, Washington, DC, and Atlanta, all on separate trips. more on each trip below:

1) Philadelphia. i attempted to go to my five-year college reunion at Swarthmore with Chris almost immediately after i got off last call at the va. our flight ended up being delayed a few hours due to weather on the East Coast and then cancelled altogether. chris got a flight attendant to schedule us on a direct flight for the next day (Saturday) arriving at 3 pm. i was exhausted and frustrated with the whole ordeal and really wanted to eat breakfast at one of our fave ann arbor spots, northside grill, the next morning. we ate there and then hustled to the airport to catch our flight. in the airport parking lot, i (finally) noticed that i had accidentally left my purse at the restaurant and did not have any id. we tried to call my brother to have him pick up the purse to no avail. chris was less-than-happy and tried to go talk to an agent about getting on another flight. i felt like maybe it wasnt meant to be and we shouldnt go at all.

the agent said i could fly without an id (you just had to go through secondary screening). i was stuck in secondary screening for awhile and had to run to the gate. i almost missed my flight to philadelphia (where i had been upgraded to first class). this whole incident reminded me of the first time i met chris (less the id part) since it involved running in an airport, chris arguing with a flight agent, and us sitting on opposite ends of the plane.

the swarthmore reunion was okay but i had missed 90% of the events for the weekend and we ended up not being in the philly area for very long - a little over 24 hours. a lot of my friends from swarthmore that i haven't seen since graduation also were not able to make it. however, i did get to hang out with some of my favorite people from tri-co, had a little reunion with people in medicine from my class, and spent some QT with bryan. highlights of the weekend included:

-just being on campus again and being super jealous of the new science center and wondering what happened to parrish (nice student lounge, though!)
-eating a huge bowl of pho for $4.95 at xe lua in philadelphia's chinatown
-breakfast at java joe's in woodlyn
-buying more swarthmore paraphernalia (chris even got a swarthmore t-shirt...the swat fever is taking over :) )
-meeting geoff semenuk, the associate director of alumni relations, who ive been chatting with online for the past month or so. he introduced me to some cool alum who are at the CDC that gave me interesting advice/perspectives about different ways to pursue public health careers.
-catching up with some of my old bio profs
-walking in the crum woods with chris
-a wawa sub and lemonade-iced tea
-king of prussia shopping spree

overall, a good weekend, but a little disappointing in terms of timing, not being able to see all my friends, and wishing i couldve spent more time in philadelphia.

next trip - AMSA june meeting, reston, va. (im doing this as a separate post because i think things will get wayyy too long).

va sub-i and the fun of fourth year

so, if you're one of my loyal readers (and a former/current med student), you probably remember me being a *little* freaked out about starting back on the wards on a VA medicine sub-i. you may even wonder if i have survived this sub-i month, considering i fell off the face of the earth, am no longer allowed to obsessively IM people (the VA blocks a lot of sites!), and haven't updated. of course, the month is going great (like everyone said it would); i survived my first day back on call (also my first day of 4th year), and have become a pro at CPRS (the VA computer system) in no time. i'm confident about my ability to take care of patients, generally admit 2 patients every call night (we take q4 with the interns), and follow-up on their issues with a daily note and orders until they're discharged. i still think it's going to be crazy to take care of 9 patients all at once as an intern, but so far am doing fine with three. i've remembered a lot more than i thought i would, and actually am looking forward to have everything come together and hardcore study for step 2 to get it over with.

i have to say, it is GREAT to be a fourth year. the interns and attending treat me as part of the team, i don't have to round on the entire census, and im more in the loop regarding what's going on with my patients since i take more responsibility for their care (ie getting studies done, etc). i also feel like im contributing to the team because the interns have to take one or two less patients on call (although it may be more work for the senior). she's been awesome though (AND she's going into ID) so it's been good times.

i'm always really lucky when it comes to teams (knock on wood) and this one was no different. our interns switched last week, but my first two were great, really supportive, and gave me some tips on the interview trail and their impressions of different programs. we celebrated the end of their va month with a trip to dominick's post call. the cashier at dominick's was kinda funny when he was taking our order and said he hoped we weren't going back to the hospital to save lives after downing our order in dirty scrubs. no worries - after i drank both beer and sangria and didn't eat lunch, i promptly fell asleep when i got back home (waking up with a hangover four hours later). fun times post-call.

speaking of post-call, my schedule has also worked out surprisingly well for making graduation parties, bbq's, and other fun gatherings my friends have planned before many of them leave ann arbor for good. so far, i've attended Emily's graduation party at Al-Ameer, Lori's graduation party at Andiamo's, Susie's Memorial Day BBQ, and more - all post-call! the highlight of susie's bbq/bonfire (held saturday night) was definitely getting to meet little Noah, who is almost walking at seven months and just a really happy baby. i've decided that maybe i do like kids a little more than i thought, and i'm looking forward to the day chris and i have our own, although that shouldn't be for a couple of years (the fortune teller in Bangkok said we *could* have an accident this year, but we're doing all we can to make sure that DOESNT happen).

back to the va. the new interns on our team are super nice, and i know one of them from AMSA days, so it's been nice to catch up. we had a super slow call day over Memorial Day Weekend (i got my first - and only - admission of the night at 10:30 pm) and i got a chance to bond with my team, tell the story of how chris and i met, listen to the story of how other people met their partners, and get advice on 4th year/residencies/etc. ive been really happy with all my medicine experiences at michigan and am strongly considering staying for residency, but will definitely try to interview broadly and see what's out there. my parents (esp my mom) are of course thrilled about this and i'd definitely be happy about staying close to home, esp for when we are thinking about having kids. as always, chris is super supportive about my career and although i think he would be happy going back to cali, he would also be really happy not having to move and pay a million dollars in rent every month. we'll see how he likes his first year at his new job and what he's thinking about re: grad school, but it would definitely be awesome if he did his MBA at michigan. it IS great to be a michigan wolverine - we're excited about getting partner football tix for this season after not having them since M1 year. bring on the tailgates :)

pentwater!

note: i never finished this entry but i decided just to post it now anyway because it's long overdue. next entry: update on va sub-i, which is more than halfway over (only 3 calls left to go!)

after a blissful, relaxing weekend in pentwater at the eaman house, i returned to ann arbor for a few days and hit up the Class of 2007's graduation before starting my internal medicine sub-i at the VA yesterday. im post-call as i write this, so y'all are going to have to bear with me, but i wanted to get some stuff down before i got wayyy behind in my blogging life.

pentwater was really good and the first time (in four years!) that suhani, liz, and i really just ran away from all our responsibilities and devoted 24-7 to hanging out with each other. all of us were super lazy, but we filled our days browsing the few open shops downtown, eating, napping, eating more, watching scrubs and america's funniest home videos, and going to the beach. the most strenuous activity i engaged in during our 2.5 day stay in pentwater was climbing 'Mt Baldy', or a seriously tall sand dune behind the Eaman house overlooking the beach (and Lake Michigan), which was more than enough exercise for me :)

on the way home from pentwater, we stopped in grand rapids to meet suhani's mom for lunch at noodles & company (suhani's mom kindly took all of us out!), admired phone pics of suhani's mom on a pimped-out harley davidson, and went on mad shopping sprees for graduation accessories at a local mall. it decided to pour intermittently all the way home but liz was a great driver and we all made it home safely.

home sweet home

if any of you have been obsessively checking my blog to read about my safe return to the us, i apologize for being a slacker about updating. however, anyone who knows me really well also knows that i never plan on any downtime when coming back to the us and usually just throw myself into whatever commitments i have (ie med school orientation). this time was a little more relaxed, as i had 1.5 days in between getting back to ann arbor and getting on a plane to washington dulles airport for amsa exec, but im back on EST and back in action.

saying goodbyes in bangkok was not as difficult as it has been previously because both myself and all other parties involved (nan, krit, maddie, amalee, etc.) knew that i would be coming back sometime within the next year. that being said, there were no tears involved, although i did feel (as i was going through immigration) that a part of my life was coming to an end. in a previous conversation with sural, a friend who is going abroad to lima, peru, this upcoming year (yay fogarty!), she asked me about the impact this year abroad has had on my life. both sural and i had spent a year abroad in between college and med school and now were also taking a break between M3 and M4 year to go abroad again. my reflections on the difference between the two were that as a recent college grad, i felt the whole world was open to me and i didn't have any great expectations about the work i would accomplish or the difference i would make on the world (although i did care about the impact my actions had on other people). i was more concerned about finding a direction for myself, learning about what it was like to live (and work) abroad, get in touch with my thai roots and build relationships with family, and just experience and try to get my head around what things like 'HIV/AIDS', 'commercial sex work', and 'IV drug use' really meant in people's lives and lived experiences. my fulbright year was defining for me because it gave me a direction and a purpose, and helped me define what my priorities would be in my medical school career. it also helped me put things in perspective while i was struggling through my preclinical years at michigan, not feeling really smart enough and not doing really as well as i would have liked, and gave me a place to come back to, not just emotionally and mentally, but also physically as well.

the past year was not as life-shattering or ground-breaking for me in terms of figuring out what i wanted to do with my life but it was valuable in a lot of other ways. whereas previously i had felt that the whole world was open to me (and sometimes i still do), i have recognized that being a physician gives me unique power (and means of) contributing to a larger fight for social justice. although im not saying that being a physician restricts me in any way, i think it does circumscribe the areas in which i can effectively (and knowledgably) make a difference. it took me a long time to realize this, and i struggled with the question while at the WHO in Geneva a lot, but i think it's nice to realize that you can't do everything for everyone (or even for yourself) and that's totally fine. this year helped me to define how i want to contribute as a physician (or public health practitioner), what i want my career to look like, and helped me identify what areas i needed to address to help me achieve my goals (anyone want to teach me stats?). personally, a year off (and abroad!) also gave chris and i the opportunity to explore what it would be like to live abroad together, and grow as a married couple. i now have a more defined direction regarding what i want to get out of training (and what i want to do with my training when im actually finished), and chris and i have a stronger relationship and foundation as husband and wife (i don't feel so weird saying husband anymore!) :).

in any case, i was thrilled to be done with the ridiculously long plane ride back to the US. both flights were packed and i had no layover in tokyo (i seriously ran off the plane, went through security, and then boarded the tokyo-detroit flight). i also had the pleasure of sitting in a section where the air hostess was unbelievably rude (esp to people who didn't speak english as a first language, where she became increasingly loud and rude when people didnt understand her questions such as 'chicken or beef') and wouldn't clear the trays of this chinese couple sitting next to me for over an hour. service on american airlines is really ridiculously bad (maybe ive been spoiled by living in thailand for the past year, but UGH!!). ok, enough about the plane ride. it took me a long time to get my baggage and clear customs in detroit (thank god they didn't send me to inspect my bags) and chris came to pick me up. i ate a bellacino's grinder for lunch on the way back home to Grosse Ile, which took an inordinately long time since it was the first day that the free bridge closed for repairs. still being incredibly jetlagged, i took a nap at home, played with dogs, and ate dinner with my parents (but i wasn't hungry, so i didn't really eat). this came back to bite me later on in the night, when i dragged chris to denny's for buffalo chicken strips because i was starving. all in all, a standard day back at home in michigan.

the next day, chris and i went to northside grill for breakfast (yummy!!); i ran into some med school classmates, and we went shopping for our celebratory BBQ at costco and meijer. we also stopped briefly at briarwood and i bought some lancome foundation for an awesome free gift (i think i may try to wear some makeup like p'noi taught me at red earth in bangkok) and then we went home to get ready for the bbq. as usual, it was a never-ending potluck, and i had fun catching up with many friends that i hadnt seen for a year or so. i did feel kinda time-warpy in a a way though as many people are moving on (graduation, residency, etc) and i felt like i had missed a lot of the big milestones of the year (like match day!). it's all good though, and i feel like i'll have a harder time adjusting when many of my friends, like liz and suhani, move away for real in the coming weeks. highlights of the bbq were eating lots of american food, chris being proud of himself for grilling some kickass organic beef hamburgers and hot dogs, watching grey's anatomy and scrubs, and feeling at home again (and enjoying the space!!).

post-bbq, i had to pack and get ready to go off to amsa exec in reston, va. this year, i am the global health action committee (or GHAC) chair, and serve on the AMSA Action Committee Exec Committee with seven other action committee chairs, the Action Committee Trustee, and the Director of Student Programming (all med students). i arrived friday afternoon, hung out with some SOS (student office staff), met with Pete from The New Physician about my piece i submitted to 'Letters from Afield', and then went to dinner at Chris's cousins' house in Maryland. it still never ceases to amaze me at how good chris is with kids (he played with karen, lucas, and matthew, ages 6-9, for hours) and i know he'll be an awesome dad!

saturday and sunday were jam-packed (as usual) with agendas, meetings, discussions, and the like. what's really exciting is that many of us have taken a break from amsa and have returned as chairs, and that there's also new leadership (and action committees) in the house. i was particularly excited to see catherine jones, the community and public health action chair from tulane, who i interviewed for this piece in Global Pulse about doing work post-Katrina, but really felt thrilled to meet new friends and colleagues and catch up wtih old ones. i got some terrific hugs (and welcomes) from people which i've missed while being away (hugs, especially between the sexes, are not so common in Thailand). i also discussed the use of public space (and trying to get used to strip malls ad nauseaum) with cjones, sadly ate dinner at an overpriced thai/chinese restaurant, and happily went to bed early with many other 'lame' ac exec members who like to stay in. thanks to everyone who made it a memorable weekend - i do feel energized and excited about amsa again, and am happy that i started my time back in the US in a place where i feel like i'm part of a family and a movement that helps me contribute (and achieve) things i believe in.

i am currently writing this from liz's dad's house in pentwater, michigan, where i'm spending a few days with liz and suhani before graduation (this friday!) and the beginning of my sub-i at the VA (may 14th!). i love weekends (or pseudo-weekends, like this one) in western michigan, and will write more about our fun adventures and relaxation here once i get pictures from liz and suhani. yay being back!!

goodbye, chiang mai

for me, goodbyes are always anti-climactic in a way and sometimes a little awkward. how do you sum up a year's worth of experiences in a short conversation, make sure that the other person got to say nice things (and then coming in to make sure it's not soo awkward), and then saying nice things yourself without sounding like a complete doofus, etc. sometimes i feel that it's too bad that people, including myself, don't always feel comfortable receiving praise or having nice things said about you by people you really care about. my response is usually smiling and saying 'thank you' but sometimes i wonder if i look/sound totally sincere (even though i am). it's different when you're standing up on some stage somewhere receiving an award, or whatever. i dunno why.

so goodbyes generally engender such nice (yet awkward) conversations. i've had a couple of these over my past week in chiang mai, but am past the awkwardness of it all and actually really appreciated the honesty, sincerity, and opportunity to also say thank you to people who've made a difference in my life over the past year. some snapshots of goodbyes:

kae's birthday/goodbye, tanya - i've had three really good friends from the MA study this year (ying, kae, and aum). aum moved to bangkok about a month ago to start working as a nurse at bangkok hospital, so i'll see her when i go down over the next few days.

kae and ying weren't going to be in chiang mai at the same time (kae had just come back from a job interview in bangkok, and ying was going on thursday night), so we planned to eat suki (hotpot) wednesday night. other ma people couldnt make it, so it was a small group - me, ben, noom, ying, and kae. as soon as we finished, it started thunderstorming like crazy outside, so we hung out for a little while waiting for the rain to let up.

following suki, noom decided he really wanted to sing karaoke. ying, on the other hand, wanted to go to a bar and drink because she was nervous about her upcoming interviews/tests in bangkok. we ended up going to karaoke and having a really good time. noom is actually super into it, so it was good to have a boy voice. later on in the night, gig joined us. we danced, drank, and sang until midnight, and i was surprised at how many thai songs i knew.

i'd kinda forgotten that this was my goodbye to ying, which i said to her hanging out of gig's car in the parking lot of the karaoke place. ying was super nice and i'll definitely miss her - she's a true character and we had a lot to bond about over the past year.

i'll also miss kae. she is hardworking and her heart is always in the right place. last night, she accompanied me to wualai walking street (much smaller than the sunday craziness in the old city) and helped me pick up some silver bracelets (i couldn't leave chiang mai without some silver!), a shawl/scarf for the strapless dress im (hopefully) wearing to graduation, and some souvenirs/gifts. we had fun talking to this 65 y/o grandma at one of the silver shops, who thought it was super cool that i could speak thai even though i grew up in the US (and that i cared about thailand at all). after walking street, we joined maddie at 8 inch, and stuffed ourselves with pizza and pasta. yum!

poo and p'nui - thursday was my last day at ID clinic this year, and it wasn't as crazy as i thought it might be. i saw some interesting cases of hardcore lymphadenopathy (Burkholderia psuedomallei, or meloidosis, toxoplasmosis, and histoplasmosis in two different patients) and lots of HIV/hepatitis B and/or C co-infected patients. i also got to have short conversation with Aj. Thira about my future plans (medicine, ID and maybe psych...he was like, what??, lol) and took one picture of clinic before two nurses who didn't know me went kinda crazy on me. (i said poo said it was ok). afterwards, i went to lunch at black canyon with poo, p'nui, and p'nui's co-worker. i got to talk to poo for a long time when p'nui and his friend went off to run errands and she apologized for not being around for the latter half of the year, but i was totally like, dude, that's not your responsibility ( to be taking care of me) when you're working full time (x2), trying to do research for your thesis, and on call to save $$ for her wedding. she was really sweet anyway though and said that i was an inspiration to her and thought i carried myself like a grown-up and had grown-up kinds of thoughts. this may sound funny to you as you read it, but it was really nice (in thai), and i probably am not translating it in the best way.

on friday night, poo and p'nui took ben and i to a popular restaurant ('the good view'), on the river ping. we had a smorgasbord of thai food, including som tum (green papaya salad), pla neung manao (fish steamed with lime), tod mun goong (fried shrimp cakes), tom yum talay (seafood spicy/sour soup), chicken wrapped in banana leaves, and crab fried rice. to top it off, we had mangos and sticky rice for dessert (it's mango season!) we also enjoyed the live music and drank some singha beer (poo didn't because she was post-call). after i got home, poo talked to me on googlechat for awhile and said that i was one of her best friends and that she (and another doc) thought i was 'born to be an infectious diseases doctor'. im not sure if she said what she meant to in english, but either way, it was pretty cool. i hope i see her and p'nui at the airport today!

lara - i met up with lara and family at khun chuen, a local vegetarian restaurant and (all-you-can-eat lunch buffet) yesterday. we were all a little exhausted from the heat, but raksi got to play bingo with his parents and we made our way through the yumminess of the buffet. i also drank two glasses of iced bael tea and felt refreshed. rung was really tired so i didn't get to talk to him much, but he said that chris and i should come in for a live portrait the next time we were back in chiang mai since pictures didn't capture the true feeling/spirit of a person (and were two-dimensional). yet another excuse to come back :)

lara and i talked a little bit about work/the year/the future at lunch and then i accompanied her to her friend's house to pick up raksin's soul brother for a movie. lara had originally convinced me to go watch smith family robinson with them (i think it's a take on swiss family robinson and a cartoon? i have no idea) but after we hung out for awhile at her friend's house, i was like, maybe i should go home (and seriously pack). we said our goodbyes in her car in front of chiang mai rama hospital, and she thanked me for my support and friendship over the past year. i think it's really gratifying when you can do something to help those you care about around you, like giving advice on how to treat Enterobius (for all your medical nerds out there), which Raksin was telling me (in detail) about. He had some pretty awesome theories about the pathogenesis and stuff as well, including two of my faves:

"The worms are having a party in my butt!"
"The medicine isn't working because the worms are babies and too small for the medicine to see. Second theory: Medicine isn't working because the worms are at war and shooting cannons at it!"

Kids should help write medical textbooks. How awesome would that be? Maybe I could stay awake for more than half an hour and actually concentrate on it. ;)

as an MD2B, i've really had some awesome (and often intense) opportunities and experiences to help both patients and friends with health-related issues this year. i want to thank everyone who trusted me enough to let me participate in their process of getting (or staying) well, in whatever way that 'well' was defined. thank you for letting me into your lives and for helping me learn more about myself - and how i would like to practice medicine - in the future.

last day at RIHES

today is my last full day in chiang mai, and ive been (surprisingly) able to part with many papers and pack most of my stuff for tomorrow. yesterday was my last day at RIHES and i felt super nostalgic at one point (during the tea ceremony ill talk about below) but kept it together and successfully made it through the day.

yesterday, i ended up waking up at 430 am, mostly due to a thunder/lightning storm that really helped cool things off in chiang mai (i think we've reached108 degrees in the past few days). for some reason, i couldn't fall asleep again even though i usually love thunderstorms so i sorted through lots of papers, started packing clothes, and getting things ready for the last day. in honor of our departure, the RIHES admin staff organized a tea party for us. ben and i were hoping it would be a small affair, but there were more people there than i expected. i'd met most of them before, but because i wasn't really affiliated with any big study this year, i really didn't feel like part of a team (although i have a lot of friends who work on the MA study, but i don't think they were invited). so basically, it's this conference room with snacks/tea in the middle and chairs lining both walls.

when ben and i arrived, Dr. Thira and Dr. Suwat gave us their seats (which i was really embarassed about) and then oiy started the program with a pretty formal speech welcoming everyone. Next, Dr. Thira gave a speech about the Fogarty-Ellison program and said some nice things about us and hoped we had a good experience while in Thailand. Of course, he then chose me to stand up first and give an impromptu speech (i didn't prepare at all even though i had already gone through this at the reproductive health clinic...i think i sometimes do better off-the-cuff). I could've spoken in English but spoke in Thai anyway, using many of the incorrect pronouns as expected (I apologized for this at the beginning). Although there were few people there that I was close to, I said thanks to everyone for being helpful, welcoming, and supportive. I also said that I had never really wanted to come to Chiang Mai because I didn't have any family or friends here, but at the end of these eight months, I really felt like Chiang Mai was like another home for me. Thinking about this made me a little sad, but I'll likely be back. Noom took some pictures for me during this event.

After Ben spoke, Dr. Thira presented each of us with silver plates that say "Given in appreciation for your contribution to the HIV/AIDS Research Program, Research Institute for the Health Sciences, Chiang Mai University, 27 April 2007" and certificates of completion from the Fogarty-Ellison program. Ben and I noted that the certificates were printed on regular copier paper and were just very unofficial-looking. We were both a little disappointed by this fact - although I'm proud and happy that I participated in this program, I would definitely not be proud of displaying that certificate.

In the 'party' that ensued, I felt a little awkward because I didn't really have a team (like Ben) to hang out with or talk to, but did get a chance to talk to Dr. Suwat for a little bit about the situation with the Thai CL (compulsory license) and received some gifts from study teams that I had helped out with (re: translation, or whatever). Afterwards, Ben and I were taken out to lunch by Utaiwan (one of the Thai Fogarty-Ellison fellows) at this restaurant overlooking Chiang Mai and stuffed ourselves with Thai food. This is a common theme when people are going to leave...goodbye dinners, with LOTS of food, and as the guest of honor, you don't have to chip in. Sometimes I feel bad about this, but lots of times I just enjoy the food. :)

In the afternoon, I had a short meeting with Dr. Suwat about the QOL manuscript and then said goodbye to Vit, our on-site mentor, RIHES admin staff, and walked to the hospital to say goodbye to Dr. Kuanchai and P'Wilai (the head ART nurse). Unfortunately, P'Wilai was attending a conference in Bangkok, but I got her email and will keep in touch with her. Hopefully I'll be able to work with her to help put a manuscript together for the QOL study she did among patients at the ARV clinic but right now we're just waiting to see about IRB approval that Dr. Thira's going to facilitate. It's kinda ironic, but as I'm wrapping up my time here and getting ready to leave, I've never felt busier in terms of potential projects/work that I'm going to be working on with various people here. Vit sent me an email today with the same sentiment, and wrote "Still can't believe your stint here is up! Anyhow, as I told you at the start of this (not so long ago!) that don't equate being here for 10 months with working on projects based here for 10 months!" So true!! Many of my projects are just beginning, but I look forward to seeing them through. A shortlist of what I'll still be working on post-Fogarty time here include:

1) My reproductive health study at the clinic (cross your fingers for JHU IRB exemption!) We're almost ready to submit, but I can't believe how many hoops I had to jump through to submit a proposal...new human subjects research training (they changed their rules to have to do this new training on May 1, 2007), creating a special account for JHU IRB student investigator status, uploading documents, blah blah blah. Good to experience, though.

2) QOL manuscript with Dr. Albert and Dr. Suwat. (Note that I'm now into the Thai tradition of using first names - I like it, and it reminds me of college). Dr. Albert said my last draft was excellent and I just need to find someone to help me with some stats back at Michigan and then it should be done and ready for submission :)

3) QOL manuscript with P'Wilai (talked about above).

4) Crypto study with Poo. Poo is having a resident help find more info (charts are crazy here), but will likely create the database and do the analysis here. I may help, but my main role will be writing it up. This might take a few months for all the data to be collected though.

5) Editing/rewriting some papers from the conference I attended in Jan (co-sponsored by the Center for Public Health and Human Rights at JHU) on infectious diseases issues in the border regions of Myanmar/Burma for a supplemental issue of the Journal of Conflict and Health. The first paper that was assigned to me is really interesting and studied risk behavior and susceptibility to HIV of boatmen from Bangladesh who travel back and forth between Bangladesh and Burma. I'm really excited to work on this paper and will likely be listed an author, so that's also very cool.

So, even though I'm leaving (very!) soon, I feel that I'll maintain a strong connection to RIHES and people in Chiang Mai. I was sad leaving yesterday, being like 'This is the last time I'll be in the hospital, or in RIHES, or wherever' but at the same time, I know it won't be too long before I'll be back. Next entry: farewell to friends this past week in CM.