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Graham Greene once said that life was lived in the first twenty years and the remainder was just reflection.

- When Breath Becomes Air

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Because I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I’m dying, until I actually die, I am still living.

- When Breath Becomes Air

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Life isn’t about avoiding suffering.

- When Breath Becomes Air

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It occurred to me that my relationship with statistics changed as soon as I became one.

- When Breath Becomes Air

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Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know when that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients.

- When Breath Becomes Air

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What makes life meaningful enough to go on living?

- When Breath Becomes Air

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When Breath Becomes Air

Ruby & Jess read "When Breath Becomes Air" and will be posting our reflection & favorite quotes soon! Have any of you read it? What were your thoughts?

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real-life adult 2016

It’s really interesting to look at yourself in the middle of transition - that’s how I feel about this year. Highlights (good and bad) of the year:

Got my driver’s license!

Received a surprise “Jess’ Big Night” from some really thoughtful friends

Went to Japan with Tom (my first trip with a significant other :O)

Went abroad on my own for the first time

CLERKSHIP

wherein I got to deliver some babies

held so many hands and comforted crying people

lost my first patient

Spent my first Christmas away from my parents

I think this is the first year that I feel myself tangibly changing and maturing.

I was daunted by getting my driver’s license (I put it off for like, 7 years) but nothing is as good of an incentive as obligation. Now I drive every day and have finally started driving on the highway. It sounds so silly and mundane when I say it out loud, but it hit me momentarily when I was driving to work this morning that I was doing the thing that had caused so much anxiety just last year.

I felt obligated to challenge myself, so I did.

These past few months in clerkship I have felt the most incompetent, the most embarrassed and the most unintelligent I have ever felt in my life. So I embraced it - started signing myself up for cases that I know I am unfamiliar with, so that I can become better at it.

The fear, the anxiety, has slowly drained out of me over time. After you are stumped by a question ten times in front of your superiors, it starts to get easier to say “I don’t know.” I’ve been comforted by the fact that I have survived through it. At the beginning of nearly every rotation I felt off-kilter, like a fish out of water and by the end I am reminded of how adaptable we can all be when we simply persevere.

I find myself being completely sucked in and enchanted by the profession. I have been living and breathing it for the past few months. It is reflected even in this entry I’ve written - I’m completely revolving around medicine right now.

I also suddenly just feel like such an adult all of a sudden. Holding hands of people more than twice my age because they need someone right now; explaining to people’s grandmothers and grandfathers why they are sick and what we are going to do about it.

Even driving makes me feel suddenly so grown up.

Despite this crazy, rollercoaster of a ride this year has been, it has taken its toll. I’m so tired out by the end of my days that I haven’t been cooking as much, and basically getting zero exercise apart from the stairs I run up and down to get between floors every day. I get sucked into a cocoon on my couch with a blanket, in an endless loop of Netflix the moment I get home. I still manage to get some studying in but I definitely haven’t been putting as much effort into my personal health as I ought to.

My hope for this year is to find balance again. I might actually need to start drinking coffee. 

- Jess

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on 2017, take two

It has been exactly a year since a motivated new years resolution formed this book club between us three beady-eyed, highly optimistic, and busy 20-something people. Since then, tumblr has dropped further into the black hole of the internet, Trump has won the election, a few more planes have fallen out of the sky, and we are all happily on our way to being uncomfortably close to that quarter-life check in point (crisis) - yay! 

  Ok but in all seriousness, let’s reflect on the year. 2016 has left everyone feeling pretty weird. I mean, I’m 23 so I think I just feel weird all the time it’s called transitioning, I’ve been told. But I’m saying 2016 has been some chaotic collision course between what’s happening in the outside world, what’s happening in and around my life, and what’s happening in my head. Talk about complexity, am I right? 

  I spent a good two hours today trying to figure out how I was going to slice and dice this reflection piece, which proved to be pretty difficult - hence the “take two." In facing that challenge, I’ve just decided to make a list. In 2016, I boarded a plane 14 times, landing in San Francisco, Boston, Vancouver, New York, Houston, Amsterdam, Prague, and Budapest. I went to 7 concerts, taking in the pure pop magic of Justin Bieber, Adele, Blink 182, Daughter, Beyonce, Sia, and Kanye West. I met up with my best friends once a week - that’s 52 times - to have funny, meaningful, difficult, and sometimes awkward conversations about everything from Chinese history to the meaning of flowers - but really they were conversations about our roots, our beliefs, our outlooks on the future and the impact we could have on the world. I organized a bunch of surprises, got lots of laughs, lots of hugs, and a few good tears out of people I care about. I one-upped myself and one-downed myself, tasting some of Toronto’s best foods while simultaneously losing touch in keeping up with new restaurants. I moved downtown like I said I would and became a true Torontonian, running yellows like a barbarian on my mighty bicycle. I became Allison’s maid of honour - what an honour. Amidst all of this seemingly fulfilling shit, I decided to quit my job and leave the country - because like I said, I’m 23 and I just feel weird all the time. 

  In 2016, I’ve been forced to reconsider half the stuff I thought was true about life and really observe the events transpiring around me. Friendship feels different because people feel different - and people feel different because without the structured institution of a university, keeping us all in tempo, it has become more salient than ever that I beat to the beat of my own drum. Loneliness feels different, because we all are truly alone now, left to our own devices, to do whatever  wants to - that’s what freedom means, right? Success feels different, because the notion of success lies among life’s most ambiguous and controversial concepts, with no right answer at all. Conversations feel different, because we talk for so many different reasons and the nuances between expressing yourself, persuading someone, or actively listening have become significant. Time feels different, because we always have less and less. The competing priorities of physical health, mental health, socializing, working, and breathing become tangled leaving us wondering how 24 hours can go by so quickly yet so slowly. I feel different, because I have had another 365 days to get to know myself - and my changing my mind every five seconds doesn’t really help. 

  And so off I go to seek something in 2017. Some think I’m running away, some think I’m having a crisis, others think I just want to travel, and while I think everyone is wrong - I’m not really sure what I think. I’m leaving in search of silence and inspiration, and hoping to come back with the childlike wonder I’ve always carried for life rather than the isolation and monotony I currently feel. (Harsh, I know, but I’ve never been one for euphemisms) This is meant to be a free reign exercise, but I’d like to approach it with process without the restrictions of a defined outcome. So on that note, I do have some resolutions for this new year. 

  focus I get distracted easily. I like too many things, but I also get bored easily. Once the route to attaining a goal involves simply magnitude of effort rather than diversity of skills or challenges, I lose interest. It’s too easy, if I wanted that, I could have it - right? People want houses, they want nice things, and they want to take long vacations and indulge in exotic experiences - I’m not criticizing these goals on superficiality, I am in fact by nature of millennial privilege pretty much a fan of all of those things - but to me they’re simple to obtain. It just means working more, taking more vacation time - and that’s just boring. But here’s the thing - I do want to accomplish things that require volume. I just need a reason to overcome boredom, putting patience and perseverance in place of distraction. So while I’m in the process of defining what that reason is, I can certainly shape up on the discipline required to focus and get there. 

  say no I need to understand how to really prioritize - I’m always going to want to do things equally as much and complaining that I don’t have enough time isn’t going to give me more time. I need to take care of my personal health, so time devoted to that needs to be put ahead. I need to stop making excuses - I used to think if I had a boyfriend I could be more socially grounded and find it easier to focus on things - but why do I need a boyfriend to take care of myself first? write shit down writing more 

I’m super grateful that Klick pushed me into the wonderful realm of writing. It’s a different medium and I’m just starting to understand it. So my last resolution is to explore it more, starting with this. - Lisa

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Bye Felicia~

According to Chinese astrology/cultural belief, 2016 was going to be an unlucky year for me (and a lot of my fellow Monkey zodiac peers) because it is our 本命年.

Usually, I don’t really give much credit to these kind of things, but man has 2016 been just goddamn awful. Aside from all the tragedies and disasters around the world, it has been personally very shitty:

My uncle passed away (age 49) and left behind a wife and two kids

My grandmother was hit by a car while walking across the street (age 92) and is currently in the hospital (although so far it seems like she’s recovering well!)

A family friend committed suicide

However, some good things happened, too:

I got promoted at work

I joined a gym and have been regularly exercising 3x or more a week

I have been continuously learning via this book klub

Did all of my health check-ups and have all my shots up to date

Finally put my business school to good use and invested some of my savings instead of leaving it all in my savings account at the bank

So, besides “unlucky” and “crappy”, the other word I would use to describe 2016 is “stagnant”. I’ve felt that overall - things are pretty much the same as 2015 with no big successes or accomplishments. And in a way, I wonder if that is what “adulting” is supposed to be like? Where everything is basically the same and you just celebrate the small wins? It’s very different from being in school because each year is different and you feel progress by moving forward and getting closer to your diploma. Anyway, I’m not a huge fan of this “stagnant” feeling so I’m going to have to figure out how to keep progressing forward (still TBD).

I’m 100% ready to put 2016 behind me, but what’s the good in doing that if I’m not being actionable in making 2017 better? I mean, obviously shit happens/some things are out of my control… but what could I do to make 2017 a 10/10 fan-fucking-tastic year?

[Actually] figure out my “career” or next steps

Re-evaluate and prioritize my friendships - did you know it costs $1.15 USD to send a Christmas card internationally?

Read real books - goal: 12 books in 12 months

Do something outside of my comfort zone/say yes to something I would normally say no to (yes, this is vague on purpose)

Do not procrastinate Christmas shopping

Make a “3 things to do before you turn 30” list since I will be turning 25 in February

For everyone reading who is looking for things to add to their New Year’s Resolution or “2017 Goals” or whatever you want to call it, here are some ideas:

Prioritize your health - aka get all your health check-ups done. It’s mostly admin work (making appointments, going to your appointments, go to follow-up appointments, etc.) Good news - most hospitals/doctors are keeping up with technology and have websites that aren’t completely shit where you can email your doctor, see blood test results, ask for refills on prescriptions, etc. Some hospitals even have apps!

Exercise - like, actually. This one has been on my to-do list every year but I finally made it happen in 2016! 2017 can be your year!

Prioritize your finances! Whether that’s investing money, setting aside $X in savings, etc. Whatever it is, do it! Your future self will thank you. Seriously.

Stay updated on REAL news (don’t fall for that fake news crap, and make sure to call people out when they re-post that shit!)

Get rid of anything that doesn’t add value to your life. This can be any sort of relationship (work, friends, acquaintances), junk lying around that you can donate or throw out, old/expired cans/sauces in your fridge or pantry, etc. 

Join a wine club because wine is your friend.

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As the year comes to an end, the 3 of us will be posting our reflections soon! Stay tuned! For the time being, check out this awesome video Google Search made.

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http://winefolly.com/wp-content/uploads/2013/10/basic-wine-101-guide-infographic-poster.jpg

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Wine 101

Watch these 2 great documentaries on Netflix to learn more about wine: Somm (2012) about becoming a Master Sommelier and Somm: Into the Bottle (2015) about wine

Fun fact: Wine has been linked to religion because the altered consciousness (#winedrunk) was thought to help you become closer to God. Now you know.

Wondering how pros taste wine? Check out this video

1) Always use a decanter (for all your wine, but definitely necessary for reds). Decanting allows for aeration (airing, breathing). Wines with high tannin levels require more aeration time.

2)Are there supposed to be sediments? Yes! Sediments are dark residuals in glass/bottles. They are safe to drink, and occur when wine matures in the bottle.

3) How do you hold a glass of wine? Always hold it by the stem so you avoid warming the wine with your hand.

4) How long does wine last after it’s been opened? Wine can be kept for max 1 week, but best to drink within 2-3 days. There are fancy ways to vacuum pump out the air and add inert gas. The traditional way to store it is to put it into a smaller bottle to reduce the oxygen in the bottle and cork it.

5) Which wines are we supposed to be “aging”/keeping around?

Wines capable of long aging (8+ years): Premium Bordeaux, California Cabernet Sauvignon, Barolo, Barbaresco, Rioja Gran Reservas, Hermitage (Syrah), Grand Cru Burgundy, Amarone, Vintage Port.

Wines best enjoyed between 3-5 years:  Everyday Bordeaux / Cabernet Sauvignon, Burgundy / Pinot Noir, Chianti, Zinfandel, Merlot, Brunello, Rioja.

Wines meant to be enjoyed immediately: Gamay / Beaujolais, Valpolicella, Bardolino, Carignan, light Zinfandel, table / box wine.

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Someone’s excited for the National Bison Legacy Act! The recently signed legislation declares the American Bison as the national mammal. 

This image was published in Birds and Nature as part of an article on the decimation of bison in the few short decades in the middle of the 19th century.

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experiments in learning & painting, part two

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Lisa and I were talking today about the importance of envisioning the future you want to live in - being as grand and hopeful about it as you want.

Four years ago I worked in a lab that was focused on DIPG research. All I knew about this tumour was the heartbreaking nature and finality of the diagnosis.

To hear that they’ve made progress astounds me and reaffirms my faith in humankind’s ability to create better.

-jess

(2/2) “You have to have faith and keep working. Back in the 70’s and 80’s, all of us were hoping for just a single survivor of stage four neuroblastoma. It was a rare cancer and we just couldn’t cure it. But eventually we figured it out. Recently over five hundred people attended a party we threw for neuroblastoma survivors. So change does happen. It just happens slowly. I have a colleague who lost hope recently. He’s been working on a brain tumor called DIPG, and he’s had nothing but three decades of negative outcomes. Dozens and dozens of failed trials. We just couldn’t touch the tumor because it’s in the main center of the brain. But my colleague stayed optimistic. He kept cheering us on. But he finally lost hope. After three decades of losing kids, he asked to not see any more DIPG patients. Then guess what happened. We finally have a survivor on our hands. Our neurosurgeon Dr. Souweidane figured out how to insert a catheter directly into the tumor. And we now have a girl that is 3.5 years from diagnosis. It’s still early, but it’s promising. She plays tennis. She plays violin. And she is gorgeous.”

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Factweiser* - facts about alcohol

1.)    Alcohol can be used as a cure for people who have antifreeze poisoning. [1]

Methanol and ethylene glycol are in things like antifreeze, windshield wiper fluid, solvents, fuels, etc. Some people who don’t have access to alcohol can use this stuff to get a buzz on but – it’s super toxic. There was a case where a group of people accidentally ingested some antifreeze at a party (mislabelled bottle – they thought it was Granny’s homemade punch) and led to a death and several poisoned guests. [2]

Basically methanol and ethylene glycol gets metabolized by an enzyme in your liver to these poisonous metabolites à and these metabolites kill you.

In places where you don’t have the drug cure available (fomepizole) – you can use ethanol (the main type of alcohol found in alcoholic drinks). Alcohol also binds to these same enzymes and with enough ethanol, you basically prevent any of the methanol and ethylene glycol from getting metabolized. You can either give it via IV (using pharmaceutical ethanol) or orally through whisky, vodka, or gin. Your patient will be drunk, but you know, they’ll live.

2.)    Withdrawal is a killer [3]

Alcoholism is bad for you in so many ways. A reason why it’s so hard to quit is because of the killer withdrawal. Literally a killer – the withdrawal can kill you.

How?

Alcohol is one of those drugs that has stimulant and depressant qualities. In high enough doses, it’s mostly a depressant. When you drink a lot, every day, for years on end, your brain gets used to this kind of depressant effect – and fires more and more in order to try and equilibrate itself.

When you suddenly remove the alcohol, your brain gets in this hyper-excitable state – leading to symptoms like shaking, sweating, anxiety, nausea, progressing to confusion and hallucinations, tremor, and possibly to seizures (which can be fatal).

3.)    ALDH2*2 makin’ you blush (and makin’ ya sick.)

This is an enzyme variant that is found in certain people – and it’s this variant that causes that lovely Asian glow that all the friends I grew up with get. Facial flushing occurs in around 36% of East Asians (holy cow that is a lot). [5]

When alcohol gets into your body, it gets metabolized (like almost everything else you eat and drink). Alcohol –> Acetaldehyde –> Acetate. ALDH2*2 is important for the second step of metabolism – which is super important because Acetaldehyde is actually very toxic and bad for you (i.e. causes cancer!)

High levels of acetaldehyde brings out all the not-so-fun parts of drinking: the nausea, the pounding heartbeat, you know that awful sick feeling. So it’s believed when you have this enzyme variant, drinking is so damn awful for you that you’d never get addicted to it [4]. It’s also been suggested that if/when these people do drink, the health consequences of doing so are worse than people without it – particularly that they are at higher risk of esophageal cancer from drinking alcohol.

*Other potential titles were “The Absolut Truth,” “Fluid Facts,” and “Real Talk-qila.” These gems were all coined by my dear friend Arlan.

[1] Brent, J. (2001). Current management of ethylene glycol poisoning. Drugs,61(7), 979-988.

[2] http://www.canada.com/nationalpost/story.html?id=92b27794-f73d-4836-8e3c-a83bafa6b363

[3] Trevisan, L. A., Boutros, N., Petrakis, I. L., & Krystal, J. H. (1998). Complications of alcohol withdrawal: pathophysiological insights. Alcohol Research and Health, 22(1), 61.

[4] Li, D., Zhao, H., & Gelernter, J. (2012). Strong protective effect of the aldehyde dehydrogenase gene (ALDH2) 504lys (* 2) allele against alcoholism and alcohol-induced medical diseases in Asians. Human genetics, 131(5), 725-737.

[5] Brooks, P. J., Enoch, M. A., Goldman, D., Li, T. K., & Yokoyama, A. (2009). The alcohol flushing response: an unrecognized risk factor for esophageal cancer from alcohol consumption. PLoS medicine, 6(3).