The end is here

I planned to post months, then weeks, ago but time flies and now we find ourselves post residency, days away from my first official day of independent practice in Mill Bay

A couple highlights you missed:
- I passed my board exam aka the last big exam I'll ever have to write
- My research project with my research partner, Tharuna, was voted best out of the projects from my site based on voting by our peers. We've been approached by junior residents to see if they can carry on from where we started. We've also been approached by higher up faculty about moving forward with funding. To give context, our project was creating a study protocol to collect data on the complication rates of lower body surgery in transgender males. To date, there is no Canadian data on these surgeries. Until recently, these operations were only available in Montreal and partnered sites in the States. However, Vancouver will soon be offering the procedures in province. So it's very important to have a protocol in place in collecting and publishing the data so that we have something as a baseline to compare local complication rates to. This is important research and I'm so happy we started it even though we knew it would be a huge task.
- We had a our grad ceremony and I gave my "valedictorian" speech as co-chief and it was a wonderful time to express hope for the future while reflecting on the past.

Credit - Armando Tura

To come to this point in my career/life is monumental and I do feel the weight/relief (the paradox is palpable). It has come with a cost and I know I've always stressed putting people first because they're always more important. Moving is a natural part of life and as I've said in the past, the distance is something we are used to and I'm confident relationships won't suffer. I will admit though that God has a thing for timing when I'm about to leave. Interestingly enough, it all revolves around the 3 most important women in my life.

I think of Nadine because she has been so steadfast and loyal and I always hate the idea of leaving her consistent love, this time more than ever. We got together whenever we could for drinks, meals, beach dates, or movies. We recently saw The Farewell (which I highly recommend) where I once again ugly cried as I had done with her when we saw the documentary - Won't You Be My Neighbor. I feel so safe around her. I wish I could stay around her longer, but I will trust God and hope and pray that she and Jeff will move to the island.

I think of Courtenay because of what seems like deja vu. After 2nd year in med school, I came home quietly to attend her brain surgery and be present for her recovery before taking off to start 3rd year. This time around, my initial plan was to leave for Mill Bay the weekend of July 13th until Court informed me she'd be having brain surgery for the second time on July 16th. So the plan changed. I stayed in town for the surgery where I spent the entire day at the hospital with her family - the nervous hours while she was in the OR, followed by hours while she was in the recovery room, followed by some relief when we discovered she'd be moved up to the Neuro ward and we started doing our visits two at a time. The first two days she was unconscious most of the time, trying to cope with pain and nausea. Then she started perking up, talking more, eating more, walking, and eventually discharged home in a few days.  I'll be leaving before I have any idea as to whether this surgery was successful, but so long as she's alive, I can wait an eternity. It's a very vivid reminder of what the journey has been, what this person means to me, and how far we've come.

I think of Erin because she's my longest friend who has now been away for close to a decade. I got to briefly see her and her 2nd little bundle of joy when I picked them up from the airport, and I had it in the back of my mind to visit her this month, but the timing didn't work out. She's the only one where I really hate the distance. I've wanted so many things for her and I know she's a strong woman content with what she has, but gosh my heart aches for her, and all I can pray is that she is cradled in love and feels it. 

As for the rest, I was able to gather them in one place for a bbq to say goodbye, to express my appreciation for them and enjoy hugs. It's a big joy in my life to have friends meet other friends, to be able to put faces to names. It reminds me of when my Island Family met Genny, and introducing Genny to Angela and them eventually living together in Chicago. That stuff makes my heart mushy. For those who couldn't attend the gathering, I was able to do some solo dates with. Meg and I had a standard "Meg and Kirsten Date" complete with Indian take-out, beer, cigars, good music, and great talk. 

I finished my last night in Vancouver with a Cousins Dinner which seemed very apropros. The next day, I had lunch with my grandmother who I've prepped as much as possible for my departure and yet it was still a shock to her that this would be our last weekly meal together. Much of sentiments in The Farewell ring true for me with respect to my grandmother. After our lunch, I took the ferry over to the island and spent the evening with my aunt and uncle who were unable to attend the bbq.And then the next morning I headed for my new abode and started going to work to make it a home.

A workspace with a view

Prime Canucks game viewing setup

So this is it. This is the final goodbye. Med school is over. Residency is over. The beginning of the rest of my career is about to start and I won't be returning to this blog for that. To those that stuck around, kudos for having the stamina. May God bless you with some better reading material. It has been a long adventure and I'm glad I experienced it despite the valleys and hardships. 

"The Lord bless you and keep you;
The Lord make His face shine upon you and be gracious to you;
The Lord lift up His countenance upon you and give you peace."

Love,
Kirsten

In the rearview mirror

I know I left the last post on a bittersweet note. Processing it through this blog and conversations with friends, family, and my small group is so important. Important not in the sense of being justified in my fury, but in recognizing that the anger was no longer useful. A perk of coming back home was returning to church and feeling legitimate conviction (not condemnation; there's a difference). My heart was desperate for some holy truth after 2 months of hardening. The Sunday I returned we went through Galatians 5:13-15. Verse 15 stood out for me. I was being consumed by my anger. I was convicted to get to a place where I could love Tofino to pray for them and soften my gaze upon them. I asked anyone I trusted to pray for me and God is good because He has faithfully provided people to do just that. The redeeming love of Christ is a beautiful thing especially when you can view it outside of your own redemption from sin, when you recognize that Christ is in you and thus you are capable of offering the same redemptive love to others. I want to be clear. This is not me saying I'm ignoring the truth about Tofino and the sin there. This is me acknowledging Tofino's inadequacies but hoping and praying for them out of sincere love and desire to see them become better. 

Life back in Vancouver is seen through a different lens as my time here dwindles and I start mentally preparing to leave in just a few months. I look back at the relationships I've had through residency, and what's lasted or lacking. Residency continues to be a barrier at times. This time it's gotten in the way of seeing my best friend, her precious newborn girl, and being able to help them out. It'll also get in the way of celebrating my grandmother's 90th birthday (though whose decision was it to celebrate on a Thursday night?). Despite being on vacation for two weeks, I've filled it up with call shifts at Women's Hospital, chief resident meetings, other residency meetings/sessions, studying for the licensing exam, and looking at accommodations on the island. Past vacations I've managed to take off to Texas, Prince Rupert, or Whistler. This time I'm entirely in Vancouver. I've purposely booked a couple massages and a doctor's appointment so I can say that I'm taking care of myself on vacation. Also borrowed a couple books from the library: "Getting to Yes - Negotiating Agreement Without Giving In" and "Emotionally Healthy Spirituality". The first recommended by a preceptor with respect to talking with patients. The second recommended by a friend from church.

After seeing my doctor, I headed down to Grounds for Coffee for the best cinnamon buns ever. I will only get them if I'm nearby and thankfully, my doctor's clinic is nearby. Of all wonderful coincidences, one of the MOAs, Hannah, from my clinic in North Van was placing her order while I was giving mine to the next attendant. We did a double-take and then laughed. Hannah's in her 20s with dreams of being a physician herself. I didn't know much beyond that because when we work together, we don't get to shoot the breeze (that's probably the biggest criticism of my main clinic - the high volume made me work my butt off that in 1.5 years I didn't know much more about Hannah and still mix up the names of the other 4 MOAs). It was good timing because Hannah wasn't having a great day. I won't go into detail, but I related to much of her stress and anxiety she was experiencing. We had a good long chat, gave her a pep talk, a couple hugs, and my contact info if she ever needed anything. She kept remarking at how our encounter was perfect timing. I'll take her word for it and hope she's feeling better, but at least I know how I can be praying for her or encouraging her the next time I see her. I wish I could have known more about her earlier as opposed to in the last couple months of residency. It's moments like these that are so rewarding that you wonder how much you could have accomplished if you had known earlier, so you could have been more purposeful with your time together. 

And if you're like me, you'll think back to all those you've loved and left - from elementary school, high school, college, university, NDEFC, BackCheck, and med school, soon to be followed by residency - whether you did what you could. The magic of social media means you have a digital thread that maintains a semblance of a legitimate connection. I was reminded of an acquaintance and checked Facebook to see she hadn't posted in a while. So I checked Instagram and realized we weren't connected through that medium. I sent a request and it was immediately reciprocated. Her latest post was last week and detailed a literal once in a lifetime event. While in Tanzania on safari, she left her tent midday to meet up with the group (a minute walk away). When she rounded the corner onto the path, she was confronted by a male elephant. She was trampled. She lived through it, miraculously, and remains as optimistic as before. Her words have always been uplifting and inspiring. Her mere existence is life-fulling. Given this near-death experience, I didn't think twice about messaging her.

For some context, we went to the same high school. Our circles didn't overlap much. She was popular and had the ditzy personality to go with it, but she was academically smart. We were in the same advanced math classes. After graduating, I opted to go to Kwantlen instead of UBC. Unbeknownst to me, so did she. We had many classes together and learned to appreciate each other. Then I went to UBC and she to SFU. We have yet to see each other again in person, but remain in touch through Facebook, encouraging our pursuits - me in medicine, she in environmental conservation/sustainability. She developed remarkable eloquence. Her personality, warmth, joie de vivre is all in the text. It's a gift and the sincerity is palpable, and I don't hesitate to acknowledge and thank her for it every time.

Fast forward to this reconnection where I know that even though she's resilient and full of life, she's still digesting what's happened to her. The simplest thing I could do is what I've consistently done over the years - tell her I'm touched by her articulation despite the circumstance and I'm grateful she's alive. What followed was a series of messages back and forth of struggling to reconcile this reality of recuperating as a result of respecting untamed nature, and being overwhelmed by meaningful love. I don't know why our love means so much, why we're so special to each other. We don't have the history nor the foundation that we have with our other friends. We just have this unashamed admiration for each other and take the time to express it and soak it in reciprocally and that somehow created an understanding. Kindred spirits. That's the term we've landed on. We acknowledge we don't make sense, but we've decided to accept and enjoy the gift we are to each other. 

And so on the heels of that, I wonder if I'll have the same luck with any of the people I've met in these two years of residency. Will Hannah be one? Will she be another exception to reason? Or will she be left behind? What about Maddy or Amanda? How will we fair with the distance (Amanda will be practicing in Steveston, Maddy in Calgary). I'm not stressed about it. It's just a lingering curiosity. I'll still take the time to look behind to see how those I've left or passed by are doing, while moving forward and anticipating what lies ahead. The truth remains that love abounds regardless of if it's expected or not and I take great solace in that.

Oh and P.S. - this is where I'll be living on the Island. It meets all my criteria: no roommates, no shared walls, no tenants above or below. I will sing my guts out in that hallowed space. 

All that glitters is not gold

The Tofino sheen has worn off. It was pretty quick unfortunately. This is definitely a tourist town that says "Come! Stay long enough to enjoy the scenery and surf, but short enough to not notice the people we pushed out from here". Eat at the fancy restaurants, visit the craft brewery - all staffed by white people, much like the doctor's office and hospital. 

For context, the demographics of the "locals" are the well off white, and the Indigenous. Guess which one I look more like? My hobo-chic style was initially met with double takes and hesitant smiles upon entering the hospital. Now the staff are familiar with me so no more inquisitive looks or questions when I walk into the nursing station and start logging into a computer. Of course I've also adapted by ensuring my ID lanyard and stethoscope are around my neck and visible as I enter the hospital. And I have no intention of visiting the brewery again. The barmaid, who maintained a 10 foot distance close to the other 4 (white) patrons already tended to, got flustered when I approached the cooler and asked if they had a schwarzbier that I saw on their website (and my second dad is German so you're damn sure I pronounced it correctly). It wasn't until she walked closer to me that she changed her tone.

Maybe it's when I'm bundled up with scarf, toque, and fingerless mittens, that you can't tell I'm Asian, so the natural assumption is that based off skin and hair colour I must be Indigenous until proven otherwise. What's insulting is that when you realize I'm not, your walls come down without a hint of subtlety. The softening gaze and sincerity in smile, while in general are pleasant appearing, are disgusting when I know what mental process took place to get you to change your demeanour. To clarify, I'm not upset for being mistaken as Indigenous. I'm upset at the stance people instinctively have towards the Indigenous population. I'm actually grateful to have experienced it, so that I have a sliver of understanding of what they face.

The Tuesdays working in Ahousaht have been eye-opening and humbling. The living conditions are awful, yet the people are wonderful. Lisa is our MOA (Medical Office Assistant) in Ahousaht. One Tuesday, she told me that her daughter caught a 20 pound salmon fishing along the coast the other night. So they gathered friends and extended family to have a feast together. Juxtapose that to friends I have who go on fishing trips to catch a shit-tonne of salmon, pay to have it prepared in various forms (smoked, candied, or simply de-boned and portioned), vacuum-sealed and stored in the deep freeze for the year or longer. The appreciation in Lisa's voice as she recounted the communal feast and hopes for equally delicious leftovers later that night was so beautiful to hear and see. True gratefulness for the things given - and that's probably the best part. Yes, her daughter went fishing with hopes of catching something which she did, but it is still a gift. She did not earn it because she had a rod and went out to the water. Perspective. 

A rainbow over Ahousaht

God loves a humble posture. I try to remind myself that the things I have are not my own - they have been given to me and it's my responsibility to be a good steward of it. My body, mind, voice, influence, career, money. I exercise, eat well, respect sleep, try to be purposeful with my words and actions, help others pursue wellness, and I've already talked about the various things I do with my money. The grocery store here is a co-op meaning if you're a member, at the end of the year, you get a portion back of what you've spent there. I don't have a membership, but the prices are the same for everyone. I was in line for groceries and as the Indigenous gentleman before me was gathering his bags, he heard I didn't have a membership number so he gave his. Now I use it every time because it's the least I can do to help him and his family. I haven't eaten out at any of the fancy restaurants (because I know who owns them) and as stated earlier, I'm not going back to the brewery. I've grabbed a few bites at a cash-only cafe/bakery because their staff is diverse. 

I thankfully got some reprieve over the Family Day weekend as I escaped to Nanoose (my frequent place of refuge) where I met up with Katelyn and enjoyed her invigorating passion for revival in BC. Her innocence and unconditional love is healing. 

If you know her, you know she's got a big smile on her face here

As my time winds down in Tofino, people have asked how I've found it here. I try to be gentle, but the overall sense of disappointment comes across. Tofino is gorgeous for it's natural beauty, but has a heart of darkness. Some locals have been understanding, affirming that it can be a lonely place if you don't "fit in" and that it's a place where you don't have to grow up. That sentiment could not be more true here. Life is fucking easy when you have the cloak of white privilege. 

The nicest thing Tofino's said to me

UBC's residency program has periodic reviews every 4 months and before each review you are required to submit a reflective "paragraph" (mine tend to be a page long) focusing on a core facet of family medicine. I wrote mine today (a week before I leave this awful place) focusing on Health Advocacy. I described a recent premature delivery of a baby in Ahousaht, the delay in access to care, and the various factors that led to it with the underlying systemic disadvantages in place for the Indigenous population. I poured out my frustration with this broken unethical health care system voicing my hope that one day this level of care would be a thing of the past, but finding some solace in knowing this was an official submission as part of an official UBC process, that faculty would have to read this as part of the evaluation that I meet graduation standards. You see, I've been commended on past reflective paragraphs and had them used as examples for new residents. So with that understanding, I took liberties to toe the line of professionalism by critiquing the industry I work for. I don't expect to be disciplined beyond the previous messages of "you might want to watch your tone" from higher-ups (all male no less). Granted, those instances have always taken place in the context of chief resident responsibilities. These periodic reviews are always with a female faculty member who seems to like me. So I might get an "are you ok?" from her instead. We'll see. 

As negative as this experience has been, I promise you it is a positive for my future patients in Mill Bay. I am more determined than ever to ensure that such inequities do not exist for my Indigenous patients there. And if I had any doubt that my influence was minimal, I just received this email from a med school graduate I mentored this past summer.
Yeah, I'm fucking inspired.

Much to be thankful for, much to look forward to

The Christmas holidays were kind to me. I was able to catch up with people, get some good rest in, eat delicious food, and consume some tasty brews. I only buy beer when I'm out with friends/family. This means that over the years, all three Deutsch girls have definitely seen me drink and have had some of their first drinks with me. Pop Deutsch works for the Molson Brewing Company. So it comes as no surprise when my gifts from all of them were 5 different craft brews, in addition to some other wonderful gifts. Of course the annual Christmas Eve raclette dinner with them is a highlight every year.

Christmas Eve morning I saw one of my old youth group girls off at the airport. Katelyn was heading off for a missions trip to Afghanistan. I saw her a couple nights before for a worship and prayer night that had me reuniting with other ND folks and managing to squeeze in a solid cuddle session with Mac.

As a year ends, and as per tradition at the Yip household, we reflect and say what we're thankful. Some talked about health, others said consistency, others stability. I'm thankful for God's hand over my career and how He has so obviously blessed me in my medical pursuits. Furthermore, having had the opportunity to catch up with my "girls", I am so thankful that they are all doing well. They are alive, smart, independent, kind, respectful, and they all still love Jesus. Given how others from church have lost faith, it really is something I am overwhelmed with deep gratitude for. I know the credit is not mine to take because they have incredible parents and God is good. Just simply being able to witness the growth of these women is a gift. To share in their joys, to pray over their challenges, to love them so dearly - it's like getting front row seats and backstage passes to your favourite band. I have no idea how I got this lucky, but I do not take it for granted. It never fails to move me to tears.

After Boxing Day, I was back to work by putting in a couple weeks in the Geriatric Psychiatry unit at Mount St Joseph's Hospital. It was very manageable as I was essentially a medicine consult to the psychiatrist. But it was a sobering image seeing what mentally unwell individuals look like when they're old. 

A couple weeks into January, I had the opportunity to interview candidates for UBC's Family Medicine program. As part of the selection committee since Spring of 2018, I helped co-write one of the questions used for the interview, select the remaining questions, and create a scoring rubric. Up until a month ago, I was the only resident representation on the committee that consists of the UBC program director, multiple site directors (including my site director), and various other faculty members. It's an intimidating crowd but after a couple meetings and with the encouragement of our program director, I felt able to contribute and challenge thoughts. In the end, it's satisfying to know I influenced how residents are selected for our program and to know that I kept my integrity even if it meant butting heads with people who have far more power and authority than I do. While the responsibilities of being a chief resident have been exhausting, it's things like this that help me see the level of impact you can have in the role. 

After helping with interviews, I took off to Tofino where I'll be for 2 months as part of a rural rotation. So far I've worked in the clinic and ER (across the street from each other). Time isn't nearly as important here. The patients are used to waiting as the doctors bounce back and forth between the clinic and ER. Every Tuesday, I fly via seaplane to a First Nations clinic in Ahousaht. I only have one day a week that's dedicated solely to the clinic. It's definitely a different pace and style. You have more autonomy and need to be more discerning given the lack of health resources you have available. It's a good challenge. Mill Bay will be something in between what I have at St Paul's and what I have here which is comforting. Then of course, there's the beauty of the island and being in Tofino certainly affirms my decision to work on the Island. Hard to compete with these views so readily available along the coast. 

Landing into Ahousaht

Leaving Ahousaht

View from the Tonquin Trail, Tofino

Lighthouse Loop Trail, Ucluelet

Purchasing Power

Let's opt for something completely unrelated to medicine or residency. Given the Christmas season and the materialistic aspect that comes with it, I wanted to dedicate a post to purchasing power. Whether you live comfortably or paycheque to paycheque, there are many ways you could be mindful and purposeful in your expenses. I try my best to align my values with my purchases. 
My main overriding values are the following:
- environmental impact
- philanthropic aspect
- ethical impact
- local/provincial/national support
- frugality to save money for above 

Here's my approach to some major categories:
Transportation: cycle if weather permits, public transportation, borrow my mother's car, or use Evo (car-sharing program with hybrids). When I finally buy a new car for myself, it will be an electric/hybrid car.

Fashion accessories: 90% of the shoes I wear are TOMS. That's been the case for the past 10+ years. TOMS donates a pair of shoes to a child living in poverty for every pair sold. They expanded their model to eyewear where for every pair of glasses they sell, they provide eye exams, surgery, and eyewear to those in need. I've used my first and only pair of TOMS sunglasses since 2012. Sticklers for price points need to remind themselves that they're essentially buying two pairs of shoes, but giving one away.

Clothing: Reduction is my main goal here. I have a simple style. I buy new clothes to replace worn out clothes, and I let my clothes go a while before deciding to replace them. I wore a grey hoody until my elbows wore through the fabric, then Bailey sewed elbow patches on, and that gave me a few more years until I wore through the patches and then I bought a new grey hoody. Another important factor that can't go unstated is that I'm disciplined about my body proportions (i.e. diet and exercise) which allows me to keep wearing the same items. Cycling season makes my legs, butt, and lower back larger which makes pants fit tighter, but if it's reaching a limit and the season isn't going to end soon, I adjust my riding pattern to be less interval-based (stimulates muscle growth) and more paced (maintains muscle tone). Typically the off-season is long enough for me to lose muscle mass before I would need to buy the next size up.  

Food: My stance is frugality and environmentally conscious without sacrificing nutrition. For me that means drinking water (not juice, tea, or coffee) and not buying meat or cow's milk at the grocery store. The agricultural industry contributes to green-house gas emissions, deforestation, and water pollution and thus global warming at a greater amount than the energy (coal, nuclear) sector and transportation industry. The majority of land cleared for agriculture is to grow feed for animals, which we then eat or their byproducts. Another not so fun fact, the vast majority of antibiotics used in the world is in agriculture. Same concept applies to humans in that the use of antibiotics is to fight off disease because the animals are raised in disgusting conditions where infections abound. I still eat meat, but only when I eat out. When I move to Mill Bay (and start making more money), I'll participate in a CSA (community supported agriculture) program to support local farmers and add some variety of fresh produce to my menu. For residency, my menu is the following
Breakfast: oatmeal, blueberries (frozen fresh from BC farmers' summer harvest), ground flax seed, all natural peanut butter, and a splash of unsweetened almond milk
Lunch: I rarely get to eat this meal. So it's typically quick snacks like unsalted pretzels (from Bulk Barn), roasted almonds (bought raw from bulk, roast at home, no added salt), baby carrots, and hummus made fresh by a local restaurant.
Dinner: one week black beans (bulk dried), bell peppers, corn, brown rice, quinoa, salsa, baked with cheese. Another week: spaghetti squash with whatever I want to mix with it (usually bell peppers) and a tomato or pesto sauce. Another week: baked pasta. No added salt in any dish. Garlic in every dish. 
Treats: Girl Guide Chocolate Mint cookies. I buy a case (12 boxes) each year from a friend's daughter to support her, but also to get a year's supply of delicious cookies. 
Scheduled meals out: weekly dinner with Grandma, Sunday family dinner, once a month Perogy Friday with Yan. Beyond that, I typically have a meal with Kurtis, a Deutsch, and residency friends at least once a month each.  
Alcohol: I love beer, but only buy it when I'm out to eat or for social events. I do not buy beer to consume at home. 

Media/Arts: I stream songs on Spotify to determine which songs/albums I like then I buy it on iTunes. I go to the theatres to see new movies. I use Netflix for older movies or I buy it if Netflix doesn't have it. I don't have cable so I use YouTube to see Stephen Colbert's latest monologue, Seth Meyer's latest "A Closer Look" segment, and if I want to watch an episode of something like SNL or The Good Place (the only network shows I moderately follow), I go to Global TV's website to watch it. All online methods are licensed with ads and count toward ratings. If my favourite bands are playing in Vancouver, or if a play/musical by the Arts Club or Bard on the Beach, or a show by the VSO tickles my fancy, I'll buy tickets to see them. My guitar is a Norman (Canadian) and my favourite drum sticks were Ayotte hickory 7As (Canadian) until they stopped making them. Paying for and supporting the arts has been very important my entire adult life.
The one minor exception I make is with books and that is where I use the library, not because I'm cheap, but because it's my way of proving to the government that library's are vital to communities. If something is important, use it and make sure you're counted whether it's buying the ticket/song/album, streaming the reputable service, or scanning your library card - the numbers matter. Of course I buy books as gifts and also for myself if I particularly enjoy a book I borrowed. 

Housing: I know for residency I just need a place to sleep and sometimes eat, meaning I don't mind having a roommate to split rent with. When I move to Mill Bay and need a place to decompress and be at ease, I'll live on my own. I layer, wear slippers, use lights only if I'm home and need it to be on, use energy efficient bulbs, hand wash dishes and air dry them, use the toaster oven instead of the big oven, never overfill the fridge or freezer. All this reduces hydro usage. My mattress is an Endy (Canadian company) and the best sleep ever. All my other furniture is second hand ($30 for my desk, $10 for side tables, loveseat & wardrobe from my aunt, drawers, book shelf, and mirror from my parents, coat rack from a clothing store going out of business, and still using my childhood double bedframe). Still using my Dyson vacuum that I got when Nadine and I first lived together in 2005.  

Gifts: Admittedly this is the area where frugality goes out the window. This is intentional. I will always be frugal in spending on myself so that I can be more generous to others.  Christmas time, I always hit up Ten Thousand Villages, a non-profit volunteer-run shop that sells artisans' creations that are fair trade. For chocolate lovers, there's Thomas Haas (local world-renowned and socially conscious chocolatier), Rogers' Chocolates (BC-based, fair trade), and Purdys (Canadian, less focused on fair trade and environmental impact). I buy my Unicef Christmas cards from Pier 1. I have some special people who are "experience" people, so I typically buy them gift cards to local businesses for various shenanigans (escape rooms, archery classes, rock climbing, straight razor shaves, delicious meals).

So there you have it. By no means am I saying everybody should be like me. There's lots of room for improvement on my end. For instance, I'd like to start buying clothing from fair trade more ethically based brands. I also acknowledge that I have different tastes from others. I don't wear jewelry (don't have pierced ears), but that can be a way to buy locally and ethically. I don't drink coffee, juice, or tea and again that's an opportunity to buy local and fair trade. I hope you can incorporate some of these strategies into your spending (or lack thereof) or at least think about how you can use your purchasing power toward a greater good.

The little things

I saw this post shared on Facebook by multiple friends and it gave me a good reason to keep my account active (other than it being a birthday reminder): https://www.cbc.ca/news/canada/british-columbia/gia-tran-daily-donations-1.4852982
There's something to be admired about a person who willingly subjects themselves to a stigmatized action daily so they can contribute to a good cause. Imagine if we started tithing (those of us who tithe) daily. How much of a physical reminder to be thankful that would be. With technology, my church gets an automatic deposit from my account every month. I don't notice it until I review my bank statements. It's said that automated deposits are the best way to invest because you don't "miss" the money because you're not physically going to a bank to invest it. There's no effort. I think that's what's happening with my tithing. I don't notice it and while that means I don't miss it, it also means I don't purposefully and intentionally think about giving it to God, and that's the most important part of tithing.

On a different note, I highly encourage you to see "Won't You Be My Neighbor". It's a documentary on Fred Rogers of Mr Rogers' Neighborhood, the childhood TV show that was on PBS. It's a great documentary that shows the level of genuine good that can exist in the world, untarnished. It was inspiring and heart wrenching at times. I saw it with Nadine in the theatre and we could not look or talk to each other for a solid 5 minutes after the movie ended. I was full on ugly crying, complete with hyperventilating. Never done that at a movie before, not even as a kid, not when Mufasa died. Fred Rogers was a man who was consistently good, an incredible example of how truly genuinely good people, can exist in this world. I'm being serious when I say he's the best example I've seen in my lifetime of a Christ-like man. 

A lot of us who are generally good tend to have vices and use them as a way to bring ourselves down often with the intention to make others feel at ease. I'm absolutely guilty of it. I'll be the first to admit I enjoy the catharsis in cussing. It gets an easy laugh (when used appropriately) and it tends to relax others who are new to me. Other times, when in serious conversation I use it to punch home a point. Is it necessary? No. Can I accomplish my goals without it? Absolutely. Ellen Degeneres is a great example. She is kind and preaches kindness, but watch a random episode of her talk show and I bet you she'll make a joke about drinking alcohol. As a physician, I know the damage alcohol can do. There's actually no healthy amount of alcohol you can consume. There are levels at which the average healthy person should be able to tolerate and recover from the damage alcohol does, but the cons outweigh any benefits alcohol can provide. It is responsible for the most accidental deaths in the developed world. I know we harp on smoking a lot because of its proven correlation with lung disease, but you can't accidentally kill someone because you smoked more cigarettes than usual. Alcohol really is no joking matter, but it's so easy to, even if you're America's lesbian sweetheart. What makes Fred Rogers stand out is that he was approachable and good through and through. He didn't need to compromise his morals in order to be liked. He was on the receiving end of misguided hate and hurtful lies, and he just took it and kept being kind. I think that's what made me cry so much - the fact that a man like this existed in such a cruel world and there has yet to be anybody else like him. I hope people recognize his legacy and are inspired to be better because of him.

Since my last post, I've completed an Addictions Medicine elective at the hospital,  "enjoyed" a two-week vacation, and attended two conferences. I had a two-day exam in the middle of my vacation, which made rest a bit hard to come by. I felt nonchalant about the exam and remain so. Within 24 hours after my exam, I packed up my belongings and flew to Austin, Texas. I had booked my vacation time so I could be in Texas for my cousin's wedding. Unfortunately the exam dates were released after I booked my vacation time. So I missed out on the wedding but flew into Texas in time to have dinner with her and her husband before they took off on their honeymoon. Naomi (my sister-in-law) wanted to stay in town after the wedding to be a tourist and I wanted to see my med school friend Diane who is finishing her pediatric residency in Temple, Texas. So it all worked out. Seeing Diane was such a joy. I didn't realize how much I missed her. I last saw her in LA in early Spring 2016 when we were doing electives. She still gives great hugs. Of course in my desire to soak in Diane's company, it completely slipped my mind to take a picture. Next time.

Coincidental meeting in Austin

Literally across the street from Mr Rogers. Quite the juxtaposition. Austin wanted Beto

I hadn't spent an extended amount of time with Nayo before so I was excited and nervous for our time together in Texas. Excited because we're similar in that we're both smart successful independent women who are charismatic and outgoing, but also appreciate silence. Nervous because I know we're also different but didn't know to what extent. The first night, we talked about our childhood and what big events developed our personalities and relationships to be what they are. The next day we talked about boys with Diane. More low-key but still requires vulnerability. The rest of the trip I was able to see what's characteristically Nayo. There's always a place to eat, a thing to see, a hike to do, etc and you can count on Nayo to do her research about what experiences await.

Despite all the activity, Nayo worked throughout the day - answering emails, getting updates via text or calls. It comes with the job and she's paid well, but the cost is that you don't actually get to have a day completely off. As someone who's spent the last half year turning off my cell phone before I sleep, I get anxiety at the thought of being semi-glued to my phone while hiking, eating, lounging, flying. On our 4.5hr flight back to Vancouver, she was using her phone the entire time. Meanwhile, I listened to my Easy Listening playlist (180+ songs of audio gold), read poetry ("Milk and Honey" by Rupi Kaur), enjoyed snacks and gingerale, got up to stretch and use the washroom 3 times, napped, and mentally digested thoughts (I know it sounds weird, but I highly recommend setting aside time when it's just you and your thoughts). 

This is probably our biggest difference. I like staying in one mode at a time and soaking in it. Nayo partially watches TV shows while answering emails. She takes the shortest showers I've ever witnessed. She listens to podcasts while driving. I can watch a movie or binge a show and never look at my phone. I take long showers and sing while I get clean (Shower Playlist). Music's also playing when I drive (Road Trip Playlist). On mornings off, I can lay in bed for hours listening to music. I soak in time with a reliable soundtrack complementing the process, whereas Nayo switches gears at a moment's notice with an ease I could never attain. It's like I'm playing checkers while Nayo plays multiple games of 3D chess simultaneously. It's a remarkable skill, but it has its trade-offs and while there are times I wish I could juggle things as well as she can, I wouldn't want to at the cost of incomplete rest. Naturally, the day after returning from Texas, I headed off to the island to spend a couple days all to myself. Rest is so important to me. 

After that I was back to work for a week and then spent the next two weeks at conferences. The first conference was in Toronto. It was a jam-packed tiring week where reconnecting with Maddy (who also attended the conference) occurred over lunch and one dinner, and catching up with my Uncle Ron and Aunt Carol was accomplished over a few dinners, one brunch, and the quick moments after Carol arriving home from a performance (she's a professional violinist) just in time to hug her goodnight as I headed to bed. After the conference, I flew back to Vancouver in time for another conference where it's been MOTS (more of the same - haven't used that one in ages) but a good time socializing with my CMG colleagues whom I don't get to see nearly as much. Also saw the familiar faces from InspireHealth which was wonderful. It turns out that the preceptor I worked with at the Vancouver location has recently moved to Victoria and will be at that location. We were both delighted knowing we'll be close by when residency is over (Mill Bay is a 40 minute drive from Victoria) 

Admittedly, work has been in the back seat for the last month or so and I've been able to enjoy the people in my life which has been wonderful. It's shown me that I keep company with a plethora of kind individuals no matter where I am. A significant number I didn't know 1.5 years ago and even though we're all dispersing after residency, I know I've enjoyed the connections and know new ones await in Mill Bay. The time spent together is brief in the grand scheme of life, but when you take the time to appreciate the goodness despite the brevity, it adds up to a remarkably happy life. It's the little things.

Gonna check out the mill by the bay

I signed a contract to do my two-year Return of Service (ROS) in Mill Bay on Vancouver Island. As soon as the list of available communities was released, I was drawn immediately to the Island. It has always held a special place in my heart as I've retreated to Parksville/Nanoose Bay for months at a time in the past, and as you may recall, I did a rural rotation in Parksville earlier this year. I'm very happy and relieved. Amanda got the Richmond position and I'm very happy for her too. Half of our class has signed a contract. The other half are a mixed bunch who didn't interview as well or who are too picky. I applied relatively broadly (with the exception of the Lower Mainland sites) and did enough telephone interviews to have an idea of the different opportunities to know that some of our classmates aren't applying everywhere. One classmate made the complaint that if he'd known he'd be "pigeon holed" into a clinic for his ROS, he would have chosen to do his residency in another province. I told him if he applied to Terrace, he'd have the opportunity to set up his own clinic if he didn't like any of the clinics there. I essentially exposed his limited scope and he wasn't happy about it, but better he knows he's being too picky now than be a doc without a job at the end of residency. To clarify, international medical graduates (IMGs) have to do an ROS to the province before they can carry on practicing wherever they want in whatever capacity they want. It's exclusive to IMGs. Canadian medical graduates don't have to do an ROS. It's discriminatory for sure, and yes, legal action is being taken.

A lot of the remaining IMGs are saying they'll hold out on this year's remaining opportunities, will locum around the Lower Mainland until the next list of communities comes out. I don't see this working in their favour, not to mention it creates larger competition among our current R1s (who will be R2s next year) which I think is unfair. Others say they'll buy out their ROS contract which has a ~$250,000 price tag. That's certainly not something I can afford. I'm actually hoping that by the end of my ROS, I'll be back in black as I'm just under $250,000 in debt now. With loan forgiveness for working in a rural area, plus rural signing and retention bonuses, while making at least double what I'm earning now, I hope I can be rid of that debt while still maintaining my investments. I have no plan to increase my cost of living any time soon. Getting out of Vancouver will help with that. 

I'm proud of the way I've handled my finances thus far. To paint the picture, I was ~$280,000 in debt after med school. Residency pays $50,000/year gross. After taxes, malpractice and disability insurance, and other mandatory residency fees, I walk away with $39,000 net. Each month in addition to rent (+utilities), cell phone, I tithe 10%, donate $30 to UBC Science bursary fund, $50 to Power to Change, invest $300 into my TFSA, and pay off $500 in debt. I save by living below my means with regard to accommodations, transportation, groceries, and clothing. I sacrifice some privacy, convenience, and variety, but I can cope (and nobody cares that I rotate through the same 4 pairs of pants and assorted tops for work). I got a great tax return (thanks to tuition credits) and put that toward my debt. I am happy knowing that I'm paying off debt, investing, contributing to charitable causes, and living comfortably at the same time. 

I celebrated my 32nd birthday a few weeks ago. Another opportunity for inflection. I know how much I've accomplished and what I've sacrificed. I've worked hard to hold people with open hands, to love generously, but also, I've been purposeful about maintaining my own wellness. I've often opted for no pomp or ceremony for my birthday, or spent it with someone who has no idea it's my birthday. This time, I chose to spend it with someone who I believe God has chosen to show me purposeful kindness and love without me initiating anything. He has always been an absolute gentleman who loves adventures and being inclusive without a hint of selfishness. I've never felt like I owed him anything in return. After a day of work, we met up and took in a Vancouver Whitecaps game, then had dessert and drinks, and all of it was effortless. It was one of the best birthdays I've spent with someone and I feel absolutely no guilt about how I soaked in that day.

In continuing to make me a priority without shame, I decided I'll find a place just for myself in Mill Bay. A space where I can play my guitar and sing loudly without fear of disturbing others. That has to be one of the biggest downsides to living in an apartment. Don't get me wrong, music fills the apartment when I'm home, but it's from a sound system. There is a physical, mental, emotional, and spiritual relief that comes from making a joyful noise with abandon and I only get to tap into that when I take my guitar with me to Whistler or the Island for personal retreats. The idea of being able to do this daily, whenever I need to or want to, brings tears to my eyes. The longing in my soul has had to be tempered with low-key church services and strung along since residency started and I so look forward to that day when it won't be the case anymore, when I can release that caged energy into my guitar and from the depths of my being whenever I'm inspired to do so. 

I look forward to finishing out my residency, to leaving the Lower Mainland, to practicing medicine on my own, and in the words of my good friend, Meg, "Mill-ing about the Bay".