v. v. belated work anniversary

it's been more than a year since I graduated from residency, more than a year (17+ months, to be exact) that I've been blissfully and sometimes frighteningly wholly responsible for my own schedule, day-to-day activities and income. The anniversary of my graduation slipped by this past July with nary a thought, but now that I've realized that I've passed this dubiously momentous occasion, I think I should commemorate it somehow with- what else?- a list. without further ado...

Things I Have Learned Since Graduation from Residency
1. Freedom is intoxicating. So, my entire adult life thus far has been spent in school or training, and therefore based upon an external schedule... until this past year. Regardless of how productive or fulfilling or educational or entertaining my time has been for this past year, I can say that it was spent 99% of the time on things that I specifically chose to do as opposed to things I was required to do. Phew... just writing about it gives me a heady rush. It's wonderful.

2. I have much to learn about just about everything. Every single clinical encounter serves as a reminder of how much I don't know about medicine or the human condition at large, and humbles me. I have yet to get a clear sense of the community and county resources available to my patients, for both mental health and primary care. My private practice is still in its infancy, but requires me to think like a small business owner. I'm still in the process of looking for a house, which as it turns out is not as easy as I had thought (see my last tortured entry) and requires a huge amount of specific knowledge that I would never have known I needed before we began contemplating home-ownership. I think Socrates said it best when he said, "The only true wisdom is in knowing you know nothing." I'm reminded a lot that I don't know anything, so I guess I must be getting pretty wise.

3. Work can be lonely. I really miss our residency precepting room format, particularly as a per diem. I totally get the appeal of having one's own office, desk, decor, computer, etc... totally got it during my 3rd year of residency at the Wong clinic, and definitely understand why it's nice to have your own space at work. However... that lovely private space is also quite isolating. I have definitely had half days when I've spent the whole time without ever seeing or interacting with another clinician... and of course every time I work I have the privilege (usually) of working with great support staff and nurses, but that camaraderie doesn't take the place of bouncing ideas off of, commiserating with, or picking the brains of another physician/clinician. I've been so incredibly fortunate to find and work with excellent clinicians in psychiatry- one in particular whom I use as a sounding board for all things private practice or psych, which definitely helps... and I come home and debrief with Andy every day, who functions as my "attending" in many ways (e.g. all things Kaiser), but still... it's not the same.

4. I can't have it all. I know, I know, totally loaded statement... here's what I mean. The flexibility and ease of my part-time/per-diem/make-your-own-schedule/pick-your-own-adventure jobs come at the cost of a steady paycheck and definitely at the expense of my pocketbook. I get paid much less as a per diem than I would, all things told, as an employee. Though I do not have the weight of an inbox or calls on my shoulders, I also don't get to build longitudinal relationships with my family medicine patients- many of whom I'd love to have on my panel! I love seeing peds patients, but feel somewhat uneasy every time I see one (particularly the ones who can't talk to me yet) because they are so few and far between. I love procedures but usually don't have the time to do routine lumps/bumps in a same-day clinic. I miss being in an academic environment, but don't miss the politics. Anyway, you get the picture. After 17 months post-training, I'm acutely aware of these trade-offs but I'm also much closer to coming to terms with them. There's no such thing as a perfect job, but I'm trying to take the long view and realizing that for right now, and for where I am in my career, I've found the perfect jobs. Yes, I've had to give some things up, and that's okay. Which really represents growth for the woman who chose the broadest possible training to avoid giving anything up...

Hazards of HGTV

I think becoming a homeowner is a rite of passage for adulthood... a milestone I've been striving towards for the past 10+ months. Arg, I'm irritated just TYPING 10 months- why is it so hard to find a house ?!?! Ok I digress... As such, like any other rite, it comes with its own set of rituals, its own language, its own customs and standards- notwithstanding the considerable variability in each individual journey. HGTV could be a helpful Beatrice (or Virgil, depending on your view) for this passage... or so I thought! Without further ado, my thoughts on how HGTV is ruining this process for me:

1. Enough with the house hunters who want 4+BR, open gourmet kitchen, huge backyard, walk-in closets, 3 car garage, etc etc etc... all with a budget of $200K. I hate you, I don't even care that you're looking for a house in BFN (which means your budget is actually realistic) as opposed to the artificially ridiculously inflated markets of Orange County, I just don't want to hear it. 

2. Not all houses can be renovated and decorated into gorgeous dream homes, so stop raising my hopes, HGTV!! You have created these unrealistic expectations, such that I as a first-time homebuyer have actually considered massive fixer-upper projects as viable options. I do not have the Property Brothers or Hilary Farr (of "Love It or List It", a Park family fave) in my corner, so whatever magical changes I have planned will come at great cost and effort... Not within the span of an hour-long tv show.

3. I do not have a house yet, but even if I did have a house, I don't know that I'd be able to furnish it. Why? Because I fear that I will be paralyzed by style indecision. Like many others trying to make it in our brave new world of social-media-soaked living, I have dutifully been collecting, pinning, curating pictures of rooms/decor that I like on Houzz, Pinterest, etc... in addition to frantically trying to mentally catalogue design tips from every HGTV home makeover show. Yet to what dubious end? When I'm actually faced with the prospect of buying something to place in my new home, will I be able to overcome the paroxysms of doubt about what a particular piece says about my overall taste and aesthetic? I don't have the answers... because I don't have a home, but dangnabit you all the same, HGTV (and Pinterest and Houzz!!!!).

Kauai Vacation Thoughts Part 2

Like A Kid Again.
One of the most fun moments of last week's vacation was when I went down a waterslide for the first time in 20+ years. Also, eww- I can say that it's been 20+ years from something. Anyway, so the Grand Hyatt has these amazing pools- there's an "adult" pool/lazy river which winds around the hillside complete with waterfalls and grottos, a salt water lagoon with sandy beaches, and then their piece de resistance- a surprisingly twisty and fast water slide!! (all pictured below via the internet)

I made the hubs go first, as I am wont to do with most dicey situations, and after seeing him complete the journey safely, I jumped in. Mind you, this required some not insignificant amount of courage as we were the only adults that I had seen going on the slide, and I was also aware that I might create a mini-tsunami at the end of the slide due to my tremendous *ahem* momentum, which would not go unobserved- for some reason, there were a number of people just hanging out at the edge of the pool where the slide ended. Also, though I don't claim to have any expertise in water slides, I knew that it was not uncommon to lose one's bottoms at the end of it all, which would have caused unnecessary trauma all around. But, pushing all these doubts aside, I went down the slide. I can't say it was the most graceful of rides, given that I awkwardly tried to go down in a sitting position, then as the speed built up I panicked somewhat and got some mild friction burns on my elbows, but it ended happily with no water up the nose and bottoms securely attached. Oh and a lovely little jolt of adrenaline, which was enough to count this as an adventure in my risk-averse, safety-loving book.

Slather That Coconut Oil.
I'm not a massage person. I tell myself this is because I don't think I carry a ton of tension in my neck/shoulders, and because I tend to cringe with any greater pressure than a light squeeze, and of course massages are not cheap... however I found myself questioning all of these assumptions after a lovely day at the Anara Spa at our hotel. We sprang for a couples massage (though carefully timing it during the 2 hour window in which we'd get a loyalty discount), and it was worth EVERY PENNY. Also, I've realized that as I'm getting older I'm enjoying the spa environment- peaceful, luxurious, private- all these things which seemed frankly boring or unnecessary when I was younger. I don't think we'll become spa enthusiasts, taking a trip specifically with a spa destination in mind, but at the very least I know I'll be thinking about trying to design my future bathrooms with these experiences in mind. And also looking into good massage places in Orange County.

Sunrise, Sunset.
It's funny, I could watch the sunset if I wanted to on most days of the workweek but it never occurs to me. I go on vacation and suddenly it's a priority to find the best possible sunset vista every single night. We've been fortunate enough to see some spectacular sunsets in our travels, but I think the sheer fact that we have the time to sit and watch the sun dipping down over the horizon just to appreciate the beautiful sky is the real treat. That being said, though we didn't get to see the sunset from the St Regis bar in Hanalei Bay, which is supposed to be "the best", we had some great views of the setting sun from the west side of the island near Waimea, and also at the Beach House restaurant.

Lost Chances Mean Future Opportunities.
We were really hoping to have two different experiences while in Kauai that we ended up not being able to do- one was kayaking the Napali Coast, an all-day affair which apparently ranks as the #2 Adventure in the US by National Geographic, behind kayaking the Colorado River in the Grand Canyon. The other was an open-door helicopter ride, also to see the Napali Coast among other things. Kayaking was a no-go because it's the end of the season and no one was going out in the high swells that were present for most of the week. The helicopter ride was canceled because of thunderstorms which rolled in to prove the weather forecasters all wrong, on the morning of our departure- too late to reschedule. As even a waterslide counts as an adventure in my book, these experiences would certainly have caused some palpitations for me but I'm still determined to have them at some point... just means we have an excuse to visit again.

Lilikoi Everything.
Enough said.

Kauai Vacation Thoughts, Part 1

We've been down in SoCal for 10 months now, and ever since starting work in January, the hubs has not had a break... which is quite a stretch for us, since residency made us accustomed to taking two two-week vacations per year. I can't say that it's been as much of a struggle for me, given my lovely customizable schedule- have I mentioned how much I love my jobs? But anyway, we were long overdue for an extended period of free time together, so last week, we decided to have a relaxed getaway to an old standby- Hawaii. I mean, you just can't go wrong with Hawaii. 

Kauai was the only major island, other than Molokai, that we hadn't yet visited so our week-long trip was on the Garden Island. Fun facts about Kauai: it has a history of isolation, and it was the last island to be incorporated into the Kingdom of Hawaii. Also, they are resistant to large-scale development, such that there are no buildings taller than a coconut tree on the island. For this reason, among others, the island feels... more WILD than the other islands. It's lush, green, everything else one would expect from a tropical paradise but with many more swaths of untouched nature than it seems that other islands have, e.g. the beautiful Napali Coast, which is only accessible by hiking or boat. We enjoyed ourselves tremendously, which is pretty much always the case with any vacation, but herewith I shall share some of my favorite memories and meals:

Stalking Gabrielle Reece, unintentionally. 

Ok so that doesn't sound right as a "favorite" memory, let's just call it a memorable moment. So at Lihue airport, whilst waiting for our luggage upon arrival, there was this tall blonde lady waiting alongside us. She was absorbed in her phone, and mainly I noticed her shoes- she was wearing Tieks, which I'm semi-obsessed with but not enough to actually spend the money to see what the fuss is all about. Anyhoo, these shoes intrigued me and I started to spin all sorts of conjectures about who this woman was- clearly a wealthy lady, perhaps here on her honeymoon for a 2nd (or 3rd) marriage? Then, I started to think, she looks familiar from somewhere... she must be a celebrity! After wracking my brain a bit, shortly after we pulled our luggage and went to get our rental car, it hit me- so I confirmed by googling (her family splits their time between Malibu and Kauai, apparently). I was mighty satisfied with myself and happy with the dorky frisson of excitement I get from celebrity sightings, and that may have been the end but then at our very next stop at the island's only Costco (because doesn't everyone start their vacations with a Costco visit?), we saw her again! This time shopping with her family (celebs! they're just like us! cue Us Weekly article!), pushing a loaded cart around and standing in line (like everybody else!) at the tire center. I don't approach "celebrities" for photos or autographs, more quite frankly because I feel too shy than because of my rationalization that they'd like to be left alone, so I did nothing again... just averted my gaze and walked past this famous Amazonian beautiful woman so she could get her errands done and so I could start my vacation.

The Yum Factor.

I spend probably the most amount of time in terms of trip-planning on the food that we should eat at a given destination. I troll on Chowhound, Yelp, solicit suggestions from friends who've already been, etc... So basically none of my favorite food moments were unexpected finds, but delicious nonetheless. Here's my list of BEST BITES from our trip- I should preface this by explaining that I was so excited to eat many of these bites that I didn't take any pictures, but see FB for whatever I did document:

- lilikoi chiffon pie at Hamura Saimin, a lovely light, fluffy tropical meringue concoction. 

- tiger butter ice cream sandwich at Papalani's Gelato, because white chocolate/peanut butter gelato is crazy good

- veggie egg white omelette at the breakfast buffet at Ilima Terrace, the Grand Hyatt hotel restaurant, because fresh made-to-order omelettes are the best, but also awesome when executed to perfection with fluffy eggs surrounding creamy cheese with perfectly cooked veggies inside

- fried chicken and pizza with island twists (teriyaki chili pepper sauce on the chicken, pizza with coconut water crust) at Ching Young Village in Hanalei

- the freshest tasting poke and taro chips enjoyed with a lava flow at sunset on our hotel terrace

- short-rib dumplings/mini-steam buns with smoked pepper creme fraiche that just melted on the tongue at Josselin's

- the inevitable loco moco with a surprisingly delicious gigantic fluffy pancake for local breakfast at Kountry Kitchen in Kapaa; we especially loved the coconut syrup which was less sweet than maple, and not overpoweringly coconut-y

- Dondero's version of minestrone with island sweet potato, ?taro, and other perfectly cooked vegetables in a clear broth

When I Almost Died... Or Felt Like Dying.

There's this hike on the Kalalau Trail which is notoriously strenuous if one goes the entire 11 mile-stretch to see the Napali Coast. Like, you're supposed to camp mid-way or something because it's not meant to be done in a day. It's rocky, muddy, slippery, steep, and you have to cross multiple streams. The initial 2 miles are not supposed to be so strenuous, and in retrospect were certainly challenging but still what I would call a "moderate" hike, but somehow my body decided within the first 10 minutes of the hike that I was NOT having it. We reached our first lookout plateau and I suddenly felt light-headed. I sat down, stuck my head between my knees, and tried to breathe slowly but still felt quite presyncopal. Eventually the feeling passed after 5 minutes or so, and I decided to push on which I must say I'm very proud of myself for doing. I've never had this happen to me before on a hike (or with any physical activity in general) and I wasn't quite sure what was going on, but I was fine for the rest of the time and was rewarded by some amazing views. I also must say that this hike brought out some of my favorite aspects of our relationship, including my husband's unflagging positivity and support, and our slow but steady collaborative approach to difficult obstacles in our path. I recommend it to all couples as a team-building exercise :)

raindrops on roses, whiskers on kittens

these are a few of my favorite things... from my recent trip to SF for the APA annual meeting.

- the inordinate amount of glee that I experienced from unlocking/locking my zipcar with a card, then extending my reservation with an app on my phone. ain't technology grand?

- listening to a very famous and respected psychiatrist at a "distinguished psychiatrist" lecture as he recommended lying, if need be, on documentation to get your patients the medications/treatment that they need to get better... because bottom line is, we're in the business of getting people better. he also said that psychiatrists have to get over not being the best and brightest, who mostly went into dermatology and radiology. bold (and hilarious) words.

- b patisserie. samovar tea lounge. king of thai noodle house. miette + blue bottle. tartine + mission chinese + birite. zaré at fly trap. ame. amber india. sushi tomi. basically, everything i ate is my favorite thing. i was an indulgent piggy indeed.

- the tableau of scantily, randomly, irreverently-clad hordes of people run/walking down the street while psychiatrists stood observing and occasionally videotaping from the sidewalk. yay for bay to breakers!

- protesters in russian nesting doll costumes. why? wherefore? it doesn't even matter.

- taking the muni like a "local"

- hearing our APA president introduce Bill Clinton by hoping that he will be the husband of our 45th American president

- i know they say new friends are silver, old friends are gold, but i think my friends are platinum. hands down, spending time with them was the best thing ever. thank goodness i learned something along the way at the conference ;)

the other half of me

... that is to say, it's about time to chronicle my new adventures as a board-certified, totally graduated psychiatrist, otherwise known as how I've been spending the other half of my time apart from being a family doc. Nevermind that the distinctions between the two halves of my training are fuzzy most days...

Anyway, so I've been having a grand ole time working at the UCI campus at their counseling center a few afternoons a week as one of their two staff psychiatrists for the past 2 months or so... love the staff, am really excited about the patient population, just stoked in general. There's a kinetic, infectious energy on a college campus that's just so unique as a work environment, or at least something that I can appreciate so much more now that I feel like a decrepit middle-aged lady. Every time I walk by the student groups pounding their hippity-hop music at their booths or enthusiastically chatting up some innocent underclassperson, I'm hit with a heady mix of nostalgia and relief. I MISS college, and I'm also SO GLAD I'm not a student anymore.

I've also been unexpectedly busy with a new endeavor... one that I totally hadn't expected to undertake, ever. Yes folks, I have started a private practice. You can see the initial, very preliminary, yet-to-be-completely-constructed fruits of my collaboration with a design firm on my website here. (As a selfish aside, I emphasized the preliminary piece because it's still very much under construction, so if you've got suggestions, please share them with me!!) I say that this was unexpected because, well, I just never thought I'd ever go out "on my own". I'm not inclined towards business at all (imagine a British pronunciation, emphasis on 'tall), and in fact have several issues that I intend on working out in my own therapy about this somewhat distasteful process of being paid by the patient for patient care. That being said, I've realized that this is pretty much going to be the only way that I can continue doing psychotherapy as a psychiatrist because none of the other jobs that I've looked into offer realistic chances of maintaining a therapy practice. And I do so enjoy therapy... so very very much. So anyway, here I am after a few well-timed nudges and job transitions and advice from valued friends. As my dear friend E put it, I don't know why I didn't think of this sooner but it totally makes sense now that I've done it. The hubs is quite smug, given that he's been subtly steering me towards this option since graduation- knowing me as well as he does, he realized quite early on that I would be most happy as my own boss. It's definitely been an exhilarating journey, starting up a business, and I suppose time will tell if it's actually financially feasible but for now, I'm having FUN. Which makes me feel like the luckiest shrink/family doc in the world.

The first two weeks of the rest of my life

**Late post** I started working as a family medicine doc for the first time since residency last week, and for the first time ever as a graduated board-certified one. Prior to my first shifts I had a lot of apprehension and anxiety, which I vocalized quite vociferously and indiscriminately, but now that I'm into my second week I thought I'd document some thoughts on this transition into "attending" life.

1. Family medicine, quite simply, is the bomb. I am so happy to be seeing the full spectrum of snotty-nosed kiddos to spry old folks in wheelchairs. I had a long discussion about breast health as related to breast feeding which led to a discussion of introducing solids and parenting at large the other day, and thought - man, I'm so lucky to get to see and treat and learn about pretty much the entire gamut of human health. A scheduler at one of the clinics came by and said, "I heard you'll take anything with a pulse!" To which I replied, "Yup, even the ones with two!" However, that being said...

2. Family medicine is freakin' hard. I've had many encounters over the past few weeks where I've had to discreetly excuse myself from the room to run into my office then frantically look something up or call a specialist to ask a question... Not because my skills are rusty, as I feared before I started, but because it's stuff I'VE NEVER SEEN BEFORE! It's challenging and frustrating at times and humbling... but I'm always learning something new. I suppose there's an extra tinge of fear or apprehension now that it is my own license on the line, as opposed to an attending's, but to be honest I don't think about it very much... Which perhaps speaks to my level of neurosis and anxiety about patients even before my career was on the line with every independent decision I make :P

3. Per diem is great in terms of finishing notes on time and getting out on time but... I miss continuity. I want to see what happens after I've ordered that scan or referral, and I wanna know that my patients got better. I want that feedback in terms of the technical aspects of my craft, but also as a means of developing that most important piece of being an effective physician- the therapeutic alliance. I'm okay with not having an inbox though. Waaaay okay with that.

sorry Thomas Wolfe, but you can indeed go back home again

The definition of a first world problem: I don't think that my kids will be inspired/humbled by my gritty tales of growing up as a privileged upper middle class brat in Orange County, the way that I am by my father's tales of growing up as a street urchin in Pusan, trolling the crawlspace under buildings for stray pennies.

It seems that my life is full of these first world problems since moving down to SoCal... I gripe about non-open-concept floor plans and perseverate about which of my many part-time jobs I'd like to keep or cut. I enjoy grousing about things as (globally) insignificant as traffic or the Santa Ana winds which mar otherwise perfect sunny 75 degree weather (in January).

All this to say that I am self-aware enough (just barely) to realize that I'm monumentally blessed to have only such matters cluttering up my consciousness.

My new year's resolution? Thankfulness and gratitude on a moment by moment basis.

welcome to SoCal?

The scene: our local Home Depot, in the kitchen section. The hubs and I are excitedly discussing countertop options in an insufferably yuppie/wannabe-hipster fashion, e.g. "They make recycled eco-friendly options?! Awesome!!" or "I really do prefer the look of granite..." A Random Home Depot Dude (henceforth referred to as RHDD), a petite metro-looking young male, approaches.

RHDD: Excuse me, are you interested in remodeling?

Me: Oh, maybe eventually, but we're just looking around.

RHDD: Do you own a home?

Me: [thinking that these are intrusive questions and hoping he will just get to the point] Not yet, but hopefully soon!

RHDD: Do you know who I am?

Me: ... [should I?]

RHDD: I'm the guy from the Home Depot commercials.

Me: ... Well, we just moved down here so if they air locally, we wouldn't have seen them.

RHDD: No, they're national...

Me: ... [awkward pause]

RHDD: Well, it's okay, I'm not that much of a celebrity. Anyway, you just missed out because I'm giving away free designer packages for remodeling.

Me: ... uh, okay. ["that much"?? who are you??!]

RHDD: Alrighty, you folks have a nice evening.

The RHDD strolls away, ready to accost another innocently browsing customer, and I am left to wonder... even Home Depot employees in SoCal are aspiring actors???

ugh.

moving is the WORST. this is a snapshot of the general state of disarray that is reigning over the Park household at the moment. even though we are taking advantage of a professional moving service for the first time ever, courtesy of hubby's new gig, there is still so much to do! organize, sort, throw away, donate... and, this is our most epic move ever, given that neither of us has ever lived in one spot for this long. the sorting process has led to accusations of packrattery (I just made that up) aka hoarding on both parties, yet strangely not accompanied by any actual action (i.e. throwing things away) to refute such claims. thankfully, my long-suffering and ever-loving mother came up this week to help with the process and took matters into her own hands, so I may never know just how much got tossed out... which is probably for the best.

to make matters worse, I was hit with what may have been the most painful 24-hour bug of 2012 yesterday, which incapacitated me during this crucial pre-move week and prevented me from spending this precious remaining time with friends. I had flashbacks to my bout with dysentery in Ecuador... it was that bad. however clearly I'm recovered enough to blog about it cheerfully, and am hoping that I'll be hale enough to weather the rest of this move.

in other, more maudlin news, I was reminded of just how blessed our family has been over this past weekend after spending time with some of our closest friends. I remember distinctly worrying when moving up here that I would never find the kind of friends I've had the privilege to have- particularly after the warm, fuzzy cocoon of Loma Linda. And yet, five years later, I'm leaving Sacramento firm in the knowledge that we've made friends for life up here... people that have enriched our lives in so many ways. ugh. so maybe what I mean to say is, saying goodbye is the WORST.