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