Mask of Loneliness

Loneliness by *MikaTrta on deviantART

Of all the ways to express loneliness, why have I chosen a picture of the empty park bench above? The world around it is bright and sunny, the trees and grass a luscious green, people and life moving about in the background. Precisely because it's the kind of loneliness I'm experiencing . . . and have been all along.

That bench is like my Mask of Loneliness. It sits there, alone, in a vibrant world waiting for someone to occupy it and linger for a while. To a passerby it doesn't appear "sad" or "happy," it simply is. Only when one takes pause to notice and contemplate the situation can one appreciate the loneliness. And so too it is with me. My Mask of Loneliness often appears invisible, even when worn directly in front of you. I'm surrounded by friends and peers. I have few enemies and I get along with most anyone. I wear my Mask of Smiles even when I don't feel like it. I can now interact and blend in so flawlessly that you'll probably never notice that I'm alone.

But I notice. I feel the Mask of Loneliness on my face. I'm painfully aware that several of my friends are now married, at least one of whom now have kids. Though I don't show it, I'm actually rather awkward when I'm one of maybe 3 people in a group who're single. And though you don't notice it, I don't really care to hear about your relationship problems with your girl/boyfriend/spouse.

And no matter how much I tell myself that we all go at our own pace, how I still have time, how my busy-ness is only "for now," I can feel this Mask begin to harden on my face. It is, after all, partly my fault. I don't make a particularly concerted effort to "get out there." And the longer I wait, the more excuses I make and the easier it becomes to make them.

Lately I've begun to feel that I'm "undatable." I hung out with Drew on Sunday (he's seeing someone else now, figures) and it was . . . rather awkward. Neither of us had any particularly good conversation topics. We were just on two completely different pages the whole time. I felt like I had become so one-dimensional as the conversation topics I brought back either drew from a subset of things I knew well or otherwise drifted towards the medical. Even I wouldn't date me.

Lol, I suppose I've become more like that park bench than I thought. At first glance, I'm just made of wood - one-dimensional. But if you happen to come closer, you'll see the words etched into that wood and read the stories of my past, present, and future. And it's not like I'm intentionally hiding, I'm right here in front of you! I hope you linger a bit and keep me company, and take from me my Mask of Loneliness.

Until then, may this quote ring true:

"Pray that your loneliness may spur you into finding something to live for, great enough to die for." ~ Dag Hammarskjold

Yes, I've used that quote before in this post (if you recall).

Mask of Ideas

i used to have great ideas by *Formor on deviantART

"We are told to remember the idea, not the man, because a man can fail. He can be caught. He can be killed and forgotten. But four hundred years later an idea can still change the world. I've witnessed firsthand the power of ideas. I've seen people kill in the name of them; and die defending them."

I just watched V for Vendetta (finally) last night. It's definitely one of the best movies I've seen. I can't believe it's taken me this long to watch it! I love the premise of the movie. That an idea can be so powerful and consuming is certainly thought-provoking.

And so I ask: what was the last idea that you felt was worth fighting for? The last idea that was worth risking something for? Sacrificing something for?

While there are few ideas of mine that involve much risk, ideas have been consuming my time of late. Before this year, I never considered myself an advocate of much. There were few ideas that I felt passionate about to actively champion. But here I am, advocating for change and improvement. That ideas can be so enrapturing and form a mask is very real.

As I may have alluded to in the last few posts (or maybe not, I don't know), the idea of "diversity" has become my cause. Diversity competency has been slipping from the medical curriculum here, and that's not a good thing. It's such an easy thing to cut since with advances in medicine, there's more to learn and as they saying goes, "Something's gotta give." But as the patient population becomes more diverse, we must be keeping pace with being comfortable and competent to treat any patient that walks through our doors. As such, I've been working with the Office of Diversity, with the student Diversity Committee, with other students in the AMA (American Medical Association) to push for resolutions in the state medical society, and within my own student organizations.

And I never imagined I'd be doing what I am now, that this would be my idea and cause. I always thought that someone else with greater passion than I would take care of it. Clearly it hasn't been done, and so I step up.

But in that same quote above, follows the next line:

"But you cannot kiss an idea, cannot touch it or hold it. Ideas do not bleed, it cannot feel pain, and it does not love."

And this makes me wonder. What am I missing/sacrificing? That line rings true. I can't kiss, touch, or hold my ideas. They're intangible thoughts and only their actions can be become manifest, not them themselves. And sadly, I haven't experienced this thing known as "romantic love." I don't really know how to go about it. I run into walls and barriers every time I try. Have I, perhaps, diverted that energy towards an idea/cause bigger than myself instead? Who knows.

And coming back from school today, I thought to myself: what is the idea behind our white coats? What does it mean and symbolize? All I see is something that gets dirty incredibly easily but fortunately has a ton of utility (in its many pockets). The white coat doesn't make me better or smarter than anyone else, I am no different, it doesn't make me impervious to anything, so is there an idea behind there that I can rally behind?

Because you see, in pediatrics, few people (residents and beyond) wear their white coats and they often seem relieved to not have to . . .

Such existential questions behind this mask.

Re-Introduction: The Masks We Wear

Mask by *Samurai-PET on deviantART

Many of you have followed this blog for some time since its inception 4 years ago. Some of you may be new followers or just stumbled across this. I've witnessed the rise and fall of many blogs, and somehow mine endures and survives the tests of blog-time. Though lot has happened in these last few years, this blog's purpose is still unfulfilled; thus, it endures. And so, a re-introduction to The Masks We Wear.

I'm Aek (my pen-name here), an Asian-American born and raised in the Midwest USA (and still slowly clawing my way out of this frozen north). I'm 24-years-old, and that makes me old enough to have friends getting married and to have witnessed the deaths of a few friends and acquaintances. Life is a stubborn yet tenuous thing. And I feel older than I should be.

Over these last few years I've worn or displayed one of several of my masks, each tailored for a specific situation or to reflect/hide a different aspect of me. And through these years, I've slowly witnessed several of my masks consolidate or else become supplanted by my Mask of Medicine (accursed med school!).

Where I've been, how far I've gone, how far I've yet to go, you're all welcome to read - to join and follow along as I begin to take off some of these masks. But you see, there are some masks that lie underneath my outermost masks. Will you see more than my eyes this year? I wonder.

Mask of Smiles

It seems I'm within arm's reach of that wall - that glass wall that easily cracks with the slightest touch and the gentlest breath. I thought I had survived, that I can trudge through this last stretch. But now I'm not so sure. And yet, I'll smile.

So many things depend on me to move forward. Decisions to be made, emails to be sent, things to delegate, people to coordinate, people to talk to, people to smile at. But I'm slowly crumbling inside. And yet, I smile.

I say I'm tired, that I'm exhausted, that I'm stressed. You agree and say "What a long week it's been or going to be." But I can see that you don't really share my frustrations. You don't share the same burdens of responsibility or whatever it is with me. You certainly must think "Oh, it can't be that bad." Because I smile, because I'm smiling. And you can't see past that. Deep down perhaps you don't believe me. It's okay, no one really hears what I say when it matters.

Right now I wish I were the patient and you are the doctor who comes and heals me, fixes me, mends my cracks. Someone to hold my hand and say "It's okay" and walk me through this step-by-step. Someone to give me a hug or at least a reassuring hand on the shoulder. Someone who knows what's to come and will be there with me. Someone who sees past the mask of smiles and asks those questions to open the box of answers that I cannot freely give to just anyone - perhaps not even to myself. Ask me for my innermost secrets and darkest fears. And show me, not just tell me, what I'm supposed to do.

Until then, I'll keep up this Mask of Smiles. Because at least then it's only I who suffer. Because at least then I can pretend that I'm not so close to that breaking and crumbling wall. And because it's a test that you must pass to let me know that you truly know and care without me having to say it first.

And because you read this, you've already failed. These false smiles shall persist yet.

This Really IS Happening

Wow. This really IS happening. o_O

All of this feels surreal still. Tomorrow, Friday, next Monday, next Wednesday, and next Thursday through next Saturday. Things will be okay, they'll work out.

It seems I've bought a ticket to San Diego, CA, for the GLMA Conference next week. And it seems that Dr. P is paying for everything but the plane ticket. I'm not sure how this is all going to work out, but I need to tell myself that things will be okay and they'll work out.

I should be grateful, and I am. More so than anything. I should be ecstatic. But I'm not - why do I feel unworthy of this extreme generosity? Why do I feel so nervous? Why do I feel like crawling under a rock?

It's okay, it's not like any of you will see the above on my face. Like an oncologist delivering bad news, we in the medical field out of necessity develop great masks to hide our own feelings outwardly. I just hope mine doesn't crack.

And I'm still waiting for that one thing that'll bring me back to normal. But if I told you it wouldn't happen. And so I wait.

Behind the Masks

Behind the Mask by =roundarosie on deviantART

Sometimes I wonder . . .

Sometimes I wonder if there was ever really a face to the person behind the masks. Sometimes I wonder if the person forgets that he is wearing masks, like people wearing glasses sometimes forget. Sometimes I wonder if the person remembers that he is an independent entity apart from his masks. Sometimes I wonder if this person is able to separate himself from his masks . . .

I've blogged for so long now that it has itself become a mask - one through which I allow people who I've never met become my friends, one through which I let strangers glimpse some of my most personal thoughts and memories, and one through which I let the world read my secrets. Reflecting on this blog, it has seldom been me at my least restrained. More often than not, my posts are mere amplifications of my many masks.

Can I even dissociate myself from the masks I wear? Is there Aek without a love of biology, languages, and music; without medicine; without desire to help; without inner sexual conflicts; without confusion; without secrets embedded deep inside? Am I these things, or are they me, or is it both?

As children, the mind is amorphous and does many things - all things - simultaneously. As we age and become adults, the mind solidifies onto certain paths, narrowing options while enforcing those paths. And so I wonder, has parts of me been slowly chipped away by time and age, such that all that's left are the parts of me still attached to my masks? What is Aek when he's not a med student? What is Aek when he's still not sure if he's bi/gay/other? What is Aek behind the masks . . . behind that name?

Though it may not seem like it, though I may not always say it . . . there is still much vulnerability and insecurity to the face behind the masks. I'm still waiting for someone to take them off and look me in the face.

Face of Broken Solitude

I think it's time that I show one of my faces behind the masks. You may have seen the eyes peering from behind, but now I'll let you see the raw flesh. For all intents and purposes my masks have covered and hidden this face of mine to my satisfaction.

You see, my masks are my defenses. They allow me to transform insecurity into confidence, exhaustion into energy, unease into comfort, vulnerability into strength, and sadness into apparent happiness. My masks are as much a part of me as anything else. Perhaps they are more of me than I realized. Perhaps I can no longer tell apart my masks from my faces, as that distinction is blurred. Indeed, this may not even be a face but yet another mask; but if it is, it's not a mask I let others see.

I've learned from a young age to put up walls of emotional defense. If I must, I can attain an almost Vulcan-like clinical mind. As such I've created masks to show you what I feel (and want to feel) and what I want you to see. You may have noticed that the bulk of my posts since August have centered almost exclusively on my life as a med student, under the all-encompassing Mask of Medicine. You may have felt me delve into issues that no one else cares much about, dedicating my Mask of Caring to some purpose that may or may not be greater than myself. And perhaps my posts read like a documentary, as I'm not the most emotional writer, even without my Mask of Stoicism. What's left to hide, I hide under my Mask of Silence. It was all for some purpose, but so that you now see, here is me defenseless, here is me vulnerable. This post may be longer than my usually long novelette posts, but realize my difficulty in articulating that which I can't even stand to see.

To reiterate, you may first want to read this post on Straight as the Arrow Flies. Deep down, beneath the masks and the walls, is a fragile insecurity that's always on the edge of breaking. As true as it was since I started this blog, I am alone in every romantic/sexual sense possible. Though I may have moved on to the next stage in my life and career, that part of me has not matured since perhaps the 7th grade. Dating and seeking a relationship, quite frankly, unsettles me to the point of emotional paralysis. Even thinking about it makes me feel exhausted and heavy. I'm being held back . . . by myself.

It truly is all my own damn fault. I don't make much of an effort to get out and explore. I generally dislike going to clubs or bars, and I certainly will not go alone. But even if I did, I don't know how to approach someone and I'm too shy to express interest. It's so easy to make excuses; after all, the Mask of Medicine pretty much dictates the majority of my life right now.

I am scared that I've become numb to my own feelings, that I wouldn't recognize love even if it were in front of me. What does it feel like? How do I know? How do I act on it? I'm not sure I'm able to separate out love from infatuation from lust. I've spent too long brushing aside such feelings in pursuit of other achievements.

And I am tired. Lately, every now and then, I laugh in the shower. I laugh at my own pathetic-ness and how nice it feels to have water flow over my body, to pretend to have something wash away my unease and hide my tears (in case I have any). And the nights I crawl into bed cold (because it's getting cold here), and alone, and wonder what it must feel like to get into bed with another person and wake up next to him/her.

For the most part I guess I'm too good at hiding this face. I wish just once someone would call me out on it. I wish every now and then someone would hug me, long and sincere, and tell me that things will be okay. I wish I could hug back and not feel awkward. I wish someone would call bullshit on my excuses and drag me out somewhere I've never been (and probably somewhere I'd never be able to find on my own). I wish I were invited to more social events and activities. And I wish I didn't have to initiate and feel pathetic doing so.

Today in anatomy lab, we were having our usual conversations and gossip. But then somewhere along the line it hit a nerve, I felt a crack and felt my face showing. Our conversation drifts, as it often does, towards relationships. And every time I feel alone, left out, unable to contribute - for I have no experience, I've had no relationships. Virginal in all aspects to this subject that my peers were well-versed in.

Perhaps you think I'm silly, or pathetic, or perhaps you haven't even read this far. But this is how it is. And even now, I feel that invisible hand grasping my heart and the dense gravity in my legs. I'm no saint, I'm not some confident med student, I'm not even always on steady ground. But this much you can count on - so long as someone else needs me, so long as others suffer, so long as you have a complaint that I'm willing to hear - I won't tell you my own issues. Because it's my duty to put aside my problems for you, an aspect of medicine that I find relief in. It's my job to care but not yours to reciprocate. My masks and I are for you, even if no one's there for me. There are other people and bloggers who write more emotionally than I, who expose more of their problems than I, and who receive the love and praise of the world. I don't ask for it and I don't expect it because I don't bring it up, but you know what? It does make me sad, and I suppose envious.

I guess med students and doctors are human after all. Time to go to bed, alone and heavy with this broken solitude.

Mask of Medicine

It's curious that I've been talking about my adventures in med school a lot recently (most of my posts since August), and yet I've failed to explicitly discuss the Mask of Medicine that practically all med students, residents, and doctors wear. Unlike my other Masks, this Mask has some physical manifestations as a white coat, scrubs, and/or stethoscope.

This is a Mask that trumps all other Masks. When it's worn, next to nothing else matters. Time melts away, personal dramas are set aside, and you push through drowsiness and exhaustion - all that matters is that person in front of you. To say, "How can I help you?" or "What brings you in today?" and have a total stranger tell you some of his most intimate details of his life, to place his trust in you, how can you even dare think about anything else but that person in that very moment? All you care about, all you should care about, is helping that person the best you can. And when you do your best and you know that, you feel a distinct sense of achievement.

I'll be the first to admit I'm not the best med student in the class, book-wise. Heck, even with a 95% on one of my last exams I was still below average (or that my 82% on another exam is below the average of 89%)!! Nothing stings more than knowing that, though you've passed and actually did quite well, many many more students did better yet. But medicine is so much more than book smarts, so much more than memorizing pathways and facts. And so far I've taken consolation in that.

There are students who fail so badly at medical interviewing that you pray they decide to go into radiology or pathology, where they never have to see patients face-to-face (or at least, not much). There are students who desire to do the least amount of work possible and aim for the "lowest tier" of medicine. And there are many who scoff at evidence-based medicine (EBM) - who scoff at epidemiological study designs, biostatistics, and valuable critical thinking and analytical skills. I have a friend who feels he'll be too busy to read medical literature when he becomes a practicing doctor, saying he'll only read the abstract and the conclusions of the studies and base his judgments on that; I worry for his future patients.

And then I realize that at the heart of the Mask of Medicine is an extension and amplification of the Mask of Caring. My roommate accuses me of "thinking too much" about medicine, about the issues that we may face in the future in clinical care (then again, he's just a bum). That I think about how I can better improve how I interact with patients; about how the ability to read, interpret, and critically evaluate medical literature is more important than any amount of biochem learned throughout a single semester; about how important cultural awareness is when dealing with a population as diverse as the US; about how "unfriendly" most medical practices are to LGBT persons (mostly unintentional); and about how we can all personally improve how we conduct care - perhaps I do think too much . . . perhaps I do care too much. I'm not saying I'm the best med student to grace the clinics - far from it. If there's anything this Masks shows me, it's that I've a long long way to improve in all respects.

The Mask of Medicine is all-consuming, it often dominates the majority of my days. Medicine, as preached to me by every physician I've spoken to candidly, is more than a job. The doctors who treat medicine as "just a job" are not good doctors and are rarely happy being doctors. This Mask is an exhausting one, but often also a rewarding one.

---TANGENT---
Last night I watched a gay-themed movie called Eating Out 3. It's a rather silly film - a bit over-the-top, but also hilarious and had some pretty hot scenes. Interestingly, all 6 of the main male characters are gay, and read an interview with them here. One of the main characters, played by Chris Salvatore, is simply gorgeous:

He's also a singer/songwriter with his own myspace and YouTube pages. I listened to some of the songs at those 2 sites, and actually liked some of them. So head over and listen to some tunes. And watch the movie if you're feeling up for a laugh and maybe a couple "awww" moments.
---END TANGENT---

Mask of Genetics

Genetics is a mysterious and complex realm, a field that frustrates and scares many. I've never explicitly explained why genetics is a field that fascinates me and motivates me. If you told me 4-5 years ago that I'd be so interested in genetics now I might've laughed at you. If you told me that I'd be wearing my Mask of Genetics now I might scoff at the thought. Why then is it such a focus of mine? Truth be told, I kind of "fell" into this field of interest and here's how it began.

I did a lot of research in undergrad. I first worked in a pharmacology lab that focused on the Ras oncogene (genes that are over-expressed in cancer) pathway - in particular its role in neurofibromatosis and breast cancer. Then I worked in a human genetics lab on genetic deafness. With some genetics research under my belt, I had a decent grounding before I even took the intro to genetics course. I continued in my one-year foray into grad school by working in a colorectal genetic epidemiology lab.

Also in undergrad, genetics was emphasized in many of my biology courses. It was taught as being the "thread" that united and wove through all of biology, and all of life. Through genetics we can better understand evolution, development, and disease. It helps to connect things such that things that wouldn't otherwise make sense starts to make sense. It's not perfect (is anything?) but it gets the point across pretty well.

Research!
Evolution Class
Mask of Biology I
Mask of Biology II

I then began to pursue my interest in genetics further, in grad school. I took several courses with genetics as the focus - how genetics was utilized in public health, how the public views genetics, how physicians view genetics, how med school education shies away from genetics and how this can be improved, etc. My friend, AG-F, is a genetic counseling student. So having her perspective had a huge impact on me.

At this time, with the more I learned about genetic diseases and cancer genetics, it began to become a bit more "real." I had a friend whose cousin had/has colorectal cancer in his early 20s. And towards the end of the semester my friend, RZ-F, calls me to tell me someone who used to live in her hall sophomore year died of colorectal cancer. At age 22. I had vaguely known him. Something like this was obviously genetic in nature. In fact, with my (public heath) knowledge I could diagnose that without even having to think. How could it have been missed? How could his doctor(s) not notice? Did they not take an accurate and detail family history? Was he adopted? So many questions, so many frustrations that I could know "so much" and be able to do absolutely nothing.

Apparently genetics is something most physicians avoid or forget easily (or never learned it well in the first place). As such, genetic conditions are often missed or misdiagnosed. I had endeavored then, as I had all semester long, to continue to teach my undergrad students about genetics with a health "twist" so that even if they never take a genetics course again, it lingers in the back of their mind. The least I could do (at that point) was educate the generation or two of potential physicians and researchers after me about the emerging importance of genetics in health and medicine.

Just Gotta Press On
Too Epic
Mask of Teaching

Perhaps above all, genetics holds this kind of awe and mysticism for me. It's difficult to explain, but there's something to be said for genetics to be a literal and metaphorical link between all people and all organisms. That we share over 99% of our DNA with the person next to us, that we share the same building blocks as the food we eat, as the diseases that make us sick, as the grass and the trees and the animals. And DNA operates without consciousness, it just continues to work almost flawlessly every second of every minute of every hour of every day.

0.01%
Life is for the Living
Masks of Sexuality I
The "Gay Gene" Part I
The "Gay Gene" Part II
The "Gay Gene" Part III

Hopefully after this one would have a clearer view of my Mask of Genetics. If not, read the links in this post to all my past posts with a heavy genetics emphasis to them (and likely there are a couple I missed). It's clear that genetics permeates many posts in my blog and blends into several of my other Masks. I suppose in a sense it's also the "thread" that binds parts of my blog and some of my Masks together with me.

Under the Shadow of Leaves

It is a good day.

I sit on a stone bench under the shadow of leaves, the sun poking through as if light were leaking through the green canopy. Looking out, the sky is clear blue except for the presence of a few wispy clouds. The day is bright and full of colors forgotten in the seasons prior.

I close my eyes and hear the sounds of toddlers and children laughing, of students talking, of many feet walking by. I wonder, how many hundreds of thousands of people have passed this point? What were they thinking as they passed by? The birds above sing their chorus in a language I cannot decipher. Far off a group of people are playing some instruments - a guitar and some drums. Though unrefined and unpolished, the sounds mix organically into carefree music.

A breeze blows by, carrying with it the scent of approaching summer. It is the smell of leaves, of living wood, of flowers, of the stone buildings - sentinels that resist the wear of time. It is the smell of life itself, and nourishes my lungs in a way I had taken for granted. I hold out my hands and arms into the breeze, as if to slow it down or capture it. Instead, the invisible force flows up over and down under my arms. It flows between my fingers, eddying slightly and briefly into an almost tangible ball in the palm of my hands. It feels as though I was almost able to grasp the breath of the world.

Something speaks to me, faint just beyond the detection of my senses. I see nothing, hear no words, smell no source, touch no object - but it is there. It surrounds me like an emotion but is not an emotion. Suddenly it feels as if things will be okay. And all those times I have tried to believe, to rationally seek answers to the mysteries, to understand that which cannot be tested, all this does not matter. It is there, it is here, and somehow I know things will be okay.

I open my eyes and walk away from my stone bench, away out from under the shadow of leaves. I am cloaked in the day and the moment and the world and this mystery. I will be okay.

It is a good day.
-----
A small prose passage. A memory - a snapshot capturing what I feel on the best of days. It is curious how I never expect it but always welcomed, replenishing my inner strength.

You may have noticed my new blog title banner thing. I'd like to give a HUGE shout out to J of Southern Inebriation for designing it for me at my request (he's an art major, can you tell?). I will explain the 5 panels of this banner from the left to the right:

The first panel is of Chinese opera masks and the Great Wall. It represents my background: being Chinese, culture and language has been a huge influence in my life (sometimes good, sometimes bad). The second panel is of a stethoscope on a book. It represents my future, my goals and aspirations: for a long time I have worked my ass off towards getting into medical school and (hopefully) I will come out poised to be an excellent doctor. The third panel you should all recognize as the smiley face banner I had previously. It represents outlet and others: it is this blog and all of you who read, and all of you I talk to. The fourth panel is of a flower I took while visiting a clinic in China. It represents life: I was a biology major in undergrad not primarily because it's the "easiest" path to medical school, but because it can give one an appreciation for life - for all its complexities, and mysteries, and frailty, and endurance. The last panel is of a ghostly mask of sorts. It represents conflict and struggle: all the uncertainty and frustration that being bi/gay brings and a kind of loneliness that comes with an inability to find "the one."

Finally, to conclude this post, I would like to give a shout out to the following 3 blogs that I've had the pleasure to read fully on. They may need no introduction as many of you already read them, but if not, do go over and say hi! And they are:

Enjoying the Journey
Hellogenation
Overrated Integrity

Mask of Teaching

At 6pm on Wednesday, April 29th, I completed my last duty as a GSI (graduate student instructor, for those who don't remember what that stands for): proctoring the Intro Genetics final.

One of my students (upon turning in her final exam) said to me, "You're literally the BEST GSI I've ever had. I'm not even kidding, seriously."

Later another one of my students (upon turning her final exam) said to me, "I just wanted to let you know that you are probably THE best science GSI I've ever had. One of my friends actually transferred into your section because his GSI sucked and I told him that you were amazing."

At one point, the professor came into the lecture hall where we were proctoring and whispered to me, "Several students in my office hours tell me that you do a great job explaining things to them. Good job, I thought I should tell you."

Much later, a friend (whose friend is in one of my discussion sections) told me, "So my friend K says you're her favorite GSI."

Clearly I must be doing something right, right? I mean, I somehow achieved the highest section attendance (almost everyone came to my later sections) out of all the GSIs, and discussion sections were completely voluntary so no one had to come. Funny story about that actually: on the day of my last discussion, one of my students (a male nurse who's older than me) brought his two little kids - around age 3 to 5 - to my discussion section. Somehow he felt that my discussion sections were necessary enough to attend, even though he could've easily skipped to take care of his kids? (Btw, his kids were adorable, and I just so happened to bring cookies that day, and they loved them.)

The Mask of Teaching, I LOVE wearing it. It brightens my day (usually) when I have to go in to teach my discussion sections. And it feels pretty damn good to receive such high praise and comments about the way I teach. I don't know what it is I do exactly, I just sort of teach on-the-fly with a very bare-boned lesson plan in my head. I do what I feel like would most benefit them in the 1 hour (well, 50 minutes) we have together. I have, however, identified a few things I think have helped a lot:

1. Make it relevant.
Students tend to not like the theoretical stuff. They need a way to take the concepts learned and integrate them into something they can relate to on a personal level. I often used the example of cancer genetics, because it fits so well with many topics. I also tried to link up some concepts to things like cardiovascular disease, family history, etc.

2. Organization.
It definitely helps to know what you're doing, what order you're doing it in, and how long you expect it to take. Even better if you've internalized that organization so you don't have to always have it in front of you.

3. Reflecting questions.
As I work out a problem on the board or present a concept, I constantly ask my students about the next "step." What happens now? What do you think I should do? Why do you think this is? How do you think this works? Etcetra. They may not always answer (and in one of my classes, they rarely do), but they are thinking and considering. This is much more effective in office hours where they have "nowhere to run." I force the students to try to solve the problem on their own, with me basically giving them sign posts and clarifications - only give directions if they're lost.

4. Visual learners.
I always draw up a diagram on the board and describe what I draw as I draw. Genetics is not a very tangible subject, so you have to somehow make things visual so they can more easily and readily comprehend it. Also, you have to actually draw it out, it does no good to just flash a picture or a diagram up. You need to walk through how the diagram's constructed, what makes it tick, so to speak.

5. Understanding their needs.
I think one of my greatest assets is that I understand where many of them are coming from. It wasn't so long ago that I was "in their shoes." I understand what many want out of the class (that is, nothing to do with it) and I hoped to make them actually interested in genetics so that things stick in their heads. So I put myself in their shoes, "If I were taking this course again, what would I want to learn? What would make it interesting and relevant? What do I want to take out of it?" With that in mind, I try to meet them at that level. The professor actually remarked (with a hint of sarcasm), "No wonder why they liked you. You're a pre-med GSI for pre-meds."

Anyway, I seriously LOVE teaching. I'm a little sad that it's over now. :( I taught a mini-course with JW-M a year ago on HIV/AIDS to 10 or so freshman undergrads. We discussed the social, biological, cultural, and political aspects of this disease (well, I did biological and cultural; JW-M did social and political). And now Intro Genetics. It's rather fulfilling, I find. You see that glimmer in their eyes, and you know you've reached someone, you've piqued someone's interest. And perhaps that someone will take that interest and do something great with it.

Teaching >>> research, hands down. Seriously, it's kind of hard to describe how much I've enjoyed teaching. While it was my job, it certainly didn't feel like one.

China III: On Assignment

I sincerely apologize for not having posted in so long. It's been a hectic month. It's about time that I finish my China posts, only 2 more to go! This post is about the reason why I was in China in the first place, and is of great personal interest to me, though some/many(?) readers might find it boring.

As I've already mentioned, I went with 11 other students as a part of a trip sponsored by the school of public health. Our principal goal was to observe and experience another health care system and immerse ourselves in another culture. I was a part of the measles vaccination group.

On the second day (Sunday) in China we met with officials at the National China CDC (Centers for Disease Control). The building was cold and pretty old, and the hallways were unheated. Interestingly, though there was a "No smoking" sign immediately upon entering the lobby, a couple employees were smoking under the sign! That kind of stunned us. We were then guided to a meeting room (actually heated!) where we were served hot tea. Constantly. It was really nice, actually, as the tea kept you constantly at the edge of wakefulness.

We learned a little about the history of the China CDC. Though it had existed for decades, it had received very little funding. Then SARS hit. Suddenly, the government put a lot of money into the public health infrastructure and the CDC was basically built over the span of 2 years. In these 2 years, China was able to do things that our US CDC has failed. China has also been preparing for the avian flu for quite some time now.

The pinnacle of their achievement was a real-time surveillance system of all diseases occurring within their borders. Doctors and hospitals would report any communicable diseases to the nearest level branch of the CDC, that then relayed the report to higher CDC levels until it reached the national-level CDC. Thus, as soon as a communicable disease was diagnosed, it would be reported to the National CDC within hours. By the next morning, there would be a report of the previous day's disease occurrence on the desk of the health minister. The ability to know where and when diseases occur is an amazing achievement, especially for a population as large as China's. Our CDC had contemplated creating such a system, but after the bio-terrorism funds were pulled from the CDC some time after 9-11, all progress in this technology has stopped. As such, we have rather poor disease-tracking ability here in the US compared to China.

Later that day we went to the Tianjin CDC about 2 hours' drive away. It was much newer and in better condition than the National CDC (though, they're going to be completing the new National CDC facilities in the next 1-3 months now).

We were shown around the Tianjin CDC, which was really nice on the inside as well. Too bad many of my pics of the inside were deleted. I did, however, manage to get this pic from the lobby of the Tianjin CDC:

Chinese New Year ftw! Year of the ox!! :P

Monday through Friday was spent learning about how the Tianjin CDC (TJCDC) measles campaign worked. In December 2008, the TJCDC undertook a massive measles vaccination campaign. There were billboards, songs, poems/rhymes, advertisements, and text messages notifying people to get free measles vaccinations. Note: In China, people get 4 measles shots, 2 that're bundled into the MMR shots like here in the US, and 2 stand-alone shots. The result? They were able to decrease the incidence of measles of 500+ cases in the first 7 weeks of 2008 to less than 20 cases in the first 7 weeks of 2009 in Tianjin. All in the timespan of a month! I doubt we could achieve this level of efficiency (or public reach) in the US.

It was intersting to note that most vaccines are free to the Chinese citizens. In fact, they were very surprised that the US didn't offer free vaccines to anyone (only at a reduced rate for low-income, and/or paid for by insurance or out-of-pocket for everyone else). They were a little taken aback when we told them that the HPV vaccine (for genital warts/cervical cancer in women) wasn't free. I believe it's not even covered by most insurances in the US.

On Tuesday, we designed questionnaires to ask parents of infants on whether or not their child received the measles vaccine. On Wednesday, we went to the local CDC in Dagang (大港) District. From there we went to a vaccine clinic. After doctors administer the vaccine, infants and children go to an observation room for 30 minutes to make sure there are no adverse reactions to the vaccine. (We don't do this here in the US - you get vaccinated and then sent along your way, if you have a reaction, go to the ER.)

Baby in the observation room.

Then we went to a nearby hospital. Interestingly, there was someone smoking near the "No smoking" sign in the lobby. Seriously, what's wrong with people?! Here we looked at hospital charts and records to see if infants were being vaccinated in the hospitals. There are 3 places to receive vaccinations: hospitals, clinics, and health/wellness centers.

Hospital charts.

Before we left the hospital, we saw the "floating baby" room. Basically, parents would bring their young infants (a couple weeks to 2 months old) here and their babies would float in a tub of water at a specific temperature. The nurse would attach a flotation device to the baby's neck so the baby could move around in the water. After "playing" around in the water for a while, the nurse would give the infant a massage. The whole point of this was to get young infants moving to promote movement and general health. It makes some sense, and allowing babies to float in water allows for movement with no impact.

In the afternoon, we located an infant with measles. Measles is so rare now in the US that doctors being trained today are likely to misdiagnose it as something else. Crazy, huh? Since we only had 2 measles shots as opposed to 4 (2 should've sufficed for us anyway), the CDC people who accompanied us didn't want to take chances; so they had us wear face masks.

It's hard to see (the red rashes), but this smiling kid had measles.

After we had examined the child, we went into a nearby neighborhood with our questionnaire to sample parents with infants at random. Every child has a record of his/her vaccine record in a little red book that is usually kept by the parents (relatively few parents in the US have a record of their children's vaccine records). Thus all parents and doctors have a copy of which vaccines had been given, as well as the dates of when future vaccines are due. Doctors will then call to remind parents to bring in their child when a vaccine shot is due.

On assignment, looking for babies to interview.

The little red book of vaccines opened up.

On Thursday we did the same thing in Jixian (蓟县 - Ji County). Again, we went to a local clinic.

However, we didn't end up doing much more than that, because we had a LONG lunch where we also had white wine. Okay, seriously, that stuff will mess you up. It's not actually wine. It's more like, vodka with 32-50% alcohol content. I had like, 2 double-shots of that stuff and I had to stop (I could've handled more, but I ate WAY too much). We were NOT in good shape after lunch to interview people. And it was getting late. Friday was basically a debriefing.

If there's one thing that impressed me about China's health care system, it is the close relationship between the health fields. All the health fields - medicine, nursing, public health, etc - are united under a common banner. Members of the different health fields spend part of their time training together and getting used to working with each other. In the US, each field is separate and independent of each other. No wonder why doctors, nurses, and public health officials sometimes don't get along very well. There's certainly an air of efficiency in China. Sure, our hospitals are generally in much better condition; sure, our medical technologies blow China's out of the water; but at least they know how to work together to get a job done.

Mask of Caring

---DISCLAIMER---
This post is a continuation of my last post, here. Be careful when reading this post. The tone of this post may not come out as I intend. It is not with sadness or loneliness that I post. For now it's merely an observation, a musing over the last several days. This post is rather long.
---END DISCLAIMER---

The more I come to realize about myself, the more I realize that my life is not always my own . . .

What I'm about to say I've never told anyone, and I doubt anyone remembered the event at any rate. When I was around 7-years-old or so, I wasn't all that well-behaved (are there any well-behaved 7-year-olds?). Once, my mom got so pissed that she swore at me in Chinese. It was the phrase 该死 (gai1 si3). I didn't know it meant "Damn it" as the second character, 死, means "death." I thought that she wanted me dead or something. So I went to the kitchen, took out a knife, walked back upstairs, and gave it to my mom. And told her to just kill me as clearly my life was causing her problems, and that if she didn't do it, I would. Of course she freaked out and never said that about me (or later my brothers) again.

Flash forward a decade or so. In high school and in my undergrad, I was the friend that others went to for help. I may not have been at the top my class (particularly so in my undergrad), but I had a way of explaining things that others understood, even if I myself didn't quite completely understand. Many of my friends weren't as eloquent at explaining things back to me, so I didn't get much out of this. My mom found this very annoying actually, and she would often say, "Why does so and so ask you for help? You always help them, but they never help you back! You're always giving them knowledge and get nothing in return. You need to be more shrewd and say 'I don't know' every now and then, you can't just let them take everything you know and then do better on the exams than you."

Even now this rings true, perhaps more so. And yet I continue to do it. I continue to help. I think my one jewel, perhaps my one defining characteristic and curse is that I sometimes care too much for others I know and get relatively little in return. Ironic how it's almost eerily similar to the doctor-patient relationship: you want a caring doctor who listens, yet you're "done" with them once you leave the office. This then, is my Mask of Caring.

When I was in high school, I would wake up an extra 20 minutes early or so and make breakfast and pack lunches for my brothers. Everything would be ready by the time they woke up, brushed their teeth, and came downstairs. I would proof my brothers' college application essays. I was the one to truly push and motivate them where my parents failed. In my own small way, I guided them without forcing them (unlike my parents, lol).

I'm no saint by any means. I hardly do much volunteering anymore. In high school I would volunteer for all these community service clubs, but I found too many of them shallow and purposeless. I would do things but never interact with - or even see - the people I was supposedly helping. I've found that in some respects, such undergrad service clubs are similar. Instead I did biomedical research. Although I'll never see the faces of the people my research may one day (in the distant-ish future) help, I know that it will help someone, someday. I've had a hand in breast cancer research, human genetic deafness, and colorectal cancer. These are not uncommon things that plague society. Yet I know I will never gain any glory (aka first authorship) from my research.

And whenever a friend needed help with something, no matter how reluctant I was, I would do it unless I had a legitimate excuse that trumped (which doesn't come up often, except during finals week). I was the one constant, the "rock" in people's lives. JW-M would rant to me, RZ-F would rant to me, SR-F would vent her frustrations to me. I took it upon myself really - no matter how much they didn't want to tell, I would elicit it out of them because I knew they needed to talk to someone. For a long time I was able to listen, passively, stoically, process, then give advice. I let things pass through me so they didn't affect me personally.

Then things changed, I don't know when. When someone was down, I became down. When someone was happy, it would temporarily lift me out of whatever state I was in. Reading the events surrounding other bloggers the last month or so has been rougher on me emotionally than I even realized. It was difficult to study for my final exams. I may sit here passively, stoically on the outside, but inside I cared. And it hurts, almost physically, when I find out a person can't confide in me. And although it's easy to just ignore my Google Reader while I studied, I had to know what's going on if at all possible.

It's easy for me to care less (aka, not think about) people I've never met, don't know in any way, and are removed from my life. But once a person enters my life, even at the very periphery, I can't help but care. Even if they don't talk to me much, don't reveal much to me, I will care. I don't know what it is, it almost feels like a duty for me to care. As if caring is a duty that we as humans owe to each other - to care unconditionally, without any real thanks even. How many times my friends have asked me why I cared about x, y, and z. Because I do, because I must.

I don't reveal much about my inner self, not even on this blog where I'm quite open, considering. I wonder how many people care to find out. I wonder what readers out there think about me - if I'm just talking out of my ass or actually being sincere. I know I don't come across as the most emotional blogger. That's just how my writing is. In caring for/about others, I've left little room for myself. Hence, my life is not always my own . . . I live, in a good part, for others I think.

And again, I don't really get much out of it. It's not like my brothers help me much. Actually, they try to get out of helping me wherever possible, lol. And despite helping others - in my lab, my friends, etc - it's not like I'm rewarded. Heck, most of the time I'm not even invited to things as they simply "forget" to invite me. Even the best amongst my friends - JW-M, SR-F, RZ-F, etc - will sometimes invite me as almost an afterthought at the last moment.

It's all okay, I suppose. I don't dwell on this much. I suppose the one thing I want most in this world is someone in person to love and care about who cares and loves me enough to want to figure out everything about me, and then reflect my care back on to me. I think, that's the only way I can truly care about myself in a positive way. At any rate, my Mask of Caring is almost a duty I undertake - to care almost unconditionally about others that I personally know.

---TANGENT---
So, for the last 2 days, I've been relentless catching up on two blogs in particular. Two blogs that many bloggers who read mine are well-acquainted with. They are:

Mirrorboy's Blog
Right Time and Place

If you haven't had a chance to go over and say hi, I suggest doing so. :P

Also, I'm still fighting for my A in Pathophysiology. The ONLY way I could get an A- is if they "standardized" the letter grades, which is weird and unfair. I can't let the ONE class I actually really CARED about give me an A- when the average according to the average points on my exams give me an A. Grrr.

I also read something in the news that made my blood boil. I won't talk about it here, that's for another post in the future.
---END TANGENT---

Mask of Friendship

I just talked to my friend SA-F online. I rarely get the chance to talk to her because she goes to a different university than I do and she rarely signs online to chat. She's been having difficulty with getting into nursing school. Her grades aren't high enough as a pre-nursing student and she just found out that recently most nursing schools require so many hours of community service in a health care setting. Although the community service isn't a problem at all, as she was going to do it anyway, she still wished she had known ahead of time.

Being the worried person I am, I helped her think of options. Plan alternative paths to nursing, if you will. She's clearly passionate about becoming a nurse and helping people, it's just that classes like orgo daunt her (and really, when will a nurse need orgo anyway?). I helped her look at ways to change her major, so she could improve her GPA as well as buying her more time to stand out from a community service point-of-view. She apologized for ranting about her problems, but I don't really mind. I mean, really, as a future physician, isn't that what patients do? And isn't it a doctor's job to listen to all that and then help determine the best course of action? In any case, she thanked me for listening and helping her come up with ideas.

I don't know, I'm pretty much always willing to listen to a real issue if a friend brings it to me. I kind of pushed her to tell me more so I knew enough to be of some (albeit, potentially minor) help. Maybe that's part of my Mask of Friendship, part of that package when one becomes friends with me. Or perhaps it's just some underlying need to help, I don't know. In any case, my Mask of Friendship is an ironically lonely one sometimes. See, the reason is that I distinguish between multiple levels of friendship. I have many friends at the "acquaintance friends" level, where it's great if we hang out and talk, but neither of us will feel pained if we don't see each other for months or even years at a time. I have several friends at the "good friends" level, where I will sometimes actively seek out to hang out and such. I have a few at the "close friends" level, a group of friends who I'll see at least once a week and talk to many more times than that. If you were to consoladate everyone in the "close friends" level, you would create my "best friends" level. However, I don't think I have anyone I could call a "best friend."

Part of it might be my fault, I've spent all my life keeping a part of me distant from everyone that perhaps I've never let anyone close enough to develop that "best friends" relationship. It could also be my inane idiosyncrisies. I have a very eclectic tastes in all my interests that it's hard to find a single person who can talk about anything at length in all those many subjects (but perhaps I'm being too picky). It's even possible that I do have a best friend without even knowing it.

And so, let me recount my relationship with two friends who I consider the closest to the "best friends" status. Warning: long post below.
----
1. JR-M
I've been friends with JR-M since I was about 7- or 8-years-old. He was my next door neighbor for about 8 years and he was a year younger than me, and thus a grade below me. We would often play after school in our made-up fantasy/sci-fi/adventure games. We had a rather vast imagination encompassing magic, mutant powers, Power Rangers, sci-fi technology, etc. Our interaction was mostly thus for all of our childhood. We've had our deep discussion about life and school and the future and such things, but the lasting memory of our friendship was one of outdoor fun.

I was also friends with his older brother, TR-M, who was in my grade. I believe I became friends with JR-M first simply because I met him first before I met either of his older brothers. Often it would be JR-M, TR-M, me, and my two younger brothers playing one great game for hours outdoors. To an adult I'm sure it looked like a strange game of tag with an attempt at acrobatics and sometimes with racing back and forth. Truly, it was a wonderful thing that there were no fences or barriers separating our backyards.

I also believe our relationship might've gone further and deeper had my parents not been as Asian-strict. Often my brothers and I were limited in how long we could spend outside playing, and were always yelled at and called inside to do homework and extra work. For a long time I envied the perceived freedom of my next door neighbor friend. If he had been allowed in our house and had I been inside his house more, who knows. Yeah, it was strange, come to think of it, as our friendship only really existed outside in the backyard and around the neighborhood. The thing about his house was that at the time both his parents were heavy smokers and I could not stand to be inside his house, or near where I could smell smoke, for a very long time. I would hold my breath (and still do) when I'm near smokers when they're smoking (and if they reek of smoke). One can only hold one's breath for so long.

When I moved away we drifted apart quickly. We seldom called each other and neither of us had email back then (and really, what use would it have been with dial-up connection?). He visited me a few times and I visited him a few times and that was that. The next time we saw anything of each other was in high school where we both attended. His schedule was - unsurprisingly - different from mine and so we didn't interact all that much. He had his group of friends and I had mine. He also had a single steady girlfriend for most of high school. This separation grew somewhat after high school as we attended different universities in the state and pursued different majors.

There was really only one thing binding our friendship, and that was (and probably is) an unfinished book. See, in middle school, TR-M and I were bored in class. So we decided to draw little stick figure aliens attacking each other on the brown paper bag covers of our books. We eventually developed different physiologies for our aliens, different technologies, different names, etc. When we went home (this was before I moved) we would tell JR-M about it. He soon joined in with a race of his own. We decided it would be an interesting idea if we were to write a book, with each of our aliens comprising its own chapter through a rotation.

Over the years apart, we have each thought more and more about our created aliens. We developed culture, architecture, language, customs, more "realistic" sci-fi technologies, etc. Meanwhile JR-M took over the writing of the book itself and now it's become his project. None of us cared as he had writing style most suited to writing a book anyway. In a way, our dorky sci-fi aliens tied us back to a childhood together. I have missed his company over the years and I've grown a little reserved around him of late . . .

But when we talk about "the book," and eventually about life, future plans, etc, it's as if we were never apart. True we are updating on each other's lives, but it feels as if nothing had fundamentally changed all these years. There are few people who I've felt such little change in friendship over the years, especially with the distances that separate us - both physically and communication-wise.

2. JW-M
I met JW-M randomly. We were roommates freshman year. I suppose one might say our meeting was thus fated. We had been looking forward to meeting each other ever since we were give the other's contact information. He was a poli-sci major who was also taking Chinese. And I was a biology major and Chinese. Also, he had taken Calculus 3 and that was one of the courses I was worried about first semester freshman year (it turned out he was useless for help in Calc 3).

I don't know what kind of first impressions either of had when we physically met. Here we were, two overweight dorky freshmen, not knowing what to do with ourselves on campus (at least I didn't have the inconvenience of lusting after him). We got along surprisingly well. True, we had our little annoyances - I think I had more qualities that annoyed him than he had that annoyed me - but we never had any real problems. We even had our morning schedules syncronized somewhat.

Let me explain. We both had our first classes either togethere or at the same time all of freshman year. We set our alarm clocks about 5 minutes apart, both to NPR (he got me into NPR . . . also it was the only decent radio station we got in our dorm room). Mine would go off, I would hit snooze. 5 minutes later his would go off, and then mine would go off again shortly afterwards. We then got out of bed at about the same time, went to the bathroom, brushed our teeth, got dressed, and went to class. All of this taking about 15 minutes. We had mastered getting up later and close to when we had to be in class. We were always on time too.

At night we would go to sleep very late. It was unusual for either of us to get more than 6.5 hours of sleep a night. You see, while we both would've dearly loved to go to sleep before 2am, that simply was not possible most nights. And if we stayed awake until 2:30am, the drunken people from other floors would migrate to our hall and stand very near our door, and sing very loudly and off-key. For about half an hour to an hour. It was like they were trying to serenade us to death or something. So we had to wait until they left. It also didn't help that one of our neighbors across the hall had a tendency to wander around with his guitar singing badly - we think he thought it attracted the girls (which surprisingly, it did attract a few, they must've been hard of hearing).

One night we went to bed around 2:15am or so, and the drunken people hadn't arrived. We were cleared to sleep - if we could sleep before they came, then we were both out until our alarms the next morning. Well, just as we turned off the lights and our heads hit our pillows, they arrived. Oh how we cursed. Instead we decided to have a chat because we tended to be very busy throughout most of the day, and we often studied in the room together in silence. We found out that we both loved Arby's (a fast food chain here in the Midwest, and probably elsewhere in the US, for those who don't know). That was an instant bonding moment that we would forever remember. No seriously, if you asked us now the one bonding moment we had together, that would be it.

After freshman year we were no longer roommates but we remained very good friends. While we were in the dorms sophomore year, we would knock on each other's door to eat lunch and dinner down in the cafeteria. That year we also started going to the campus gym on and off together. We might've gone more if we didn't have to trek about 20 minutes across campus in the snow and biting wind during the winter months. Nevertheless, our friendship grew into a strange one that our personalities fed off each other only in each other's presence.

For example, he would begin to act really silly around me. For the last two years, whenever I went to his apartment to study, he would spontaneously break out in made-up song. His songs usually included my name and phrases in English and Chinese that made no sense when placed together. Throughout the course of my undergrad, I've been given my own theme song no less than 2-3 times. One of them was a very cheery one about me being the Lord of the Underworld. In any case, I would often stop him with my Asian glare (the one where the eyes narrow to slits very rapidly). I believe he did these silly things to elicit a reaction out of me. It was all in fun though.

We had our deep conversations and we hung out quite a bit. For the last year or so we went to the gym quite frequently (I should hope so as we lived literally right next door for the last year). He was a very intellectual fellow who I could talk about anything non-biology. Too bad biology and medicine consisted a large part of my discussions with people sometimes. I had often asked him if he found me or my presence annoying. I asked because we would sometimes complain about other mutual friends who we could only stand in small doses, and if we were around them for too long, it would make us want to suicide ourselves or kill them. Okay, I exaggerate, but I hope you get the idea. His response was that I knew when I become too annoying and I stop whereas others keep going. So my presence never made him want to vomit and at least I could hold intelligent conversations at length. I'll take that as a compliment.

He's been a good friend these last 4 years. He was actually one of I believe 3 people I came out to. My relationships with everyone I've come out to hasn't changed at all, and in fact, it's as if I never came out. But he's been supportive when I needed him these last 4 years and I've been there to listen to his problems too. Thankfully he always had the answers to his problems so I never had to help him with anything. I think I'm a kind of wall that he can rant to sometimes. In reflection, meeting him has been a good thing. I've changed a bit thanks to him. I've loosened up a little, I've been able to hold more intelligent conversation, and I've become more tactful in what I say. He's truly a friend amongst friends, and everyone who's friends with him feels that way. Too bad it causes him to be stretched thin amongst his friends sometimes (many of them mutual friends).

You know, there were things I wanted to say to him, things to thank him for. But in such instances I'm always at a loss for words. Perhaps that last handshake said it all. Some of his last words to me in person before he left for China to study abroad this year were, "Well, you're officially more knowledgeable [in medicine] than any of us, Dr. Aek." I must say, that elicited a sincere smile.
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I apologize that this post has been so long. I just kept typing, haha. I don't know, perhaps I've had best friends all along, though neither of us have used that terminology about the relationship we share.

The Labeled Masks

I've a feeling that I might potentially be blogging a lot in the next few days. For some reason I get into this "mode" where I just think/muse a lot and have tons of things on my mind. I need to do a mind-dump. Some of it is random, some of it weird, some of it deep, and some of it just stupid.

This has been something I've been thinking a lot lately. I was IMing Mike from Random Thoughts In My Life a week or two ago, or something like that. In short, I had been in a rather depressive mood for weeks, an episode that has been going on and off all of my last semester of undergrad. I confessed to him that I felt very conflicted internally.

You see, when I started this blog I had pretty much settled on that I was bi. But from time to time, I'm just not sure. And I hated myself for this. I don't personally have a problem being bi, or gay, or whatnot. I do, however, have a problem with not knowing with absolute certainty. And there's really no way for me to "find out" during these summer months when school is so devoid of people, and then I'll be home where there's nothing to do. I need to know, and I can't.

Mike brought up an interesting point. Why should I care right now? Why should I confine myself to a label? Why should I call myself bi, or gay, if I'm obviously uncomfortable as such? It's a valid question. Why must we define ourselves? I've read this on almost every blog in my blog roll, the question of identity and labels. Oh how we would all prefer that we wouldn't have to apply labels to ourselves.

Well, I personally think labels can be very important. They are a function of language, of distinguishing things about ourselves and in the world. We have words to describe nearly everything we come across. How could we function as humans in this world if not for some kind of language? Some way of distinguishing things and communicating that to others? Because we're not telepathic or whatnot, language and the labels they create are sort of a necessary evil, if you will.

To that end, each person carries several labels. It's a pretty fundamental concept in psychology and anthropology. The question is, how do these Labeled Masks affect us? They help us orient ourselves in the world, they give us a reference point from which we can relate and interact with others. Lately I've been having a crisis of sorts with my Labeled Masks on a level I never thought I'd ever have to encounter. Let's take an obvious Labeled Mask - I am an American. That is obvious by birth, education, life experience, etc. Another one, for example, is that I am male. That is obvious by anatomy, activities (many/most of them), gender role, blah bah blah.

A more ambiguous one is that I am Chinese. What does this mean? What does "Chinese-ness" mean? I am Chinese by ethnicity, Chinese by language (but not fully?), Chinese by cultural heritage. But I am not Chinese by birth, education (for the most part), and life experience. I've never set foot on mainland China. How Chinese could I be? For example, would - let's say - an African by "race" who was born in China, raised in China, is more fluent in Mandarin than I am, is more literate in Chinese than I am, be considered "more Chinese" than me?

There is also an interesting thing to be said when things cross languages and cultures. For example, I could call myself a 中国人 (zhong guo ren), which means "Chinese person." I could call myself a 海外的中国人 (hai wai de zhong guo ren), which means "foreign-born Chinese person." Or I could call myself a 华人 (hua ren), which is the term Chinese people give themselves. Which Labeled Mask would be most accurate? Which one should be worn more often? In another sense, should I be Chinese American or American Chinese? Is there even a difference or not? This is but one of the many thoughts that plagues me from time to time. I suppose language here is inadequate to explain my frustration on this issue.

Again it brings me to the question, why should it matter? Would "allying" myself with one Labeled Mask or another cause me to behave any differently? Would it cause me to act sympathetic towards others of the same group? Would there be a kind of kindred spirit between others who wear the same Labeled Mask and myself?

Going full circle, to this end I am still not fully sure whether I would feel more comfortable wearing the Labeled Mask of bisexuality or homosexuality. Currently I wear no such mask, at least not publicly. To the best of my knowledge, except those I've explicit told, no one knows anything. And so it defaults to straight even though I don't actively wear this mask. Truth be told I am completely cut off from the bi/gay world. I know abysmally little about it. Because in truth, it's not a world I had concerned myself with for the vast majority of my life, it's not a world I had ever sought. And now, without a base to set off from, I feel like an isolated island.

Of course, the argument goes, why should it matter? Sexuality is almost certainly a spectrum. Why limit yourself to either "extreme" or the center? Why apply a Labeled Mask at all? I would counter - we call north, south, east, and west directions. These are arbitrary applications. When does north become northwest? When does south become southeast? There is nothing on earth that definitively says "This is northeast." However, without these it would be very difficult to find our way around. We could wander lost for a long time without knowing which way to go.

And so, a Labeled Mask for sexuality might do the same. At least, I hope it would achieve to this effect for me. With it, I could begin to progress towards a more open and happy life. But first, I must figure out which way to walk. Until then, I will wear none.

---TANGENT---
I've done a lot of reading on others' blogs lately. Here are 3 more that I'll add to my blog roll:

Just me
charlie's blog
Tranquil Time

Enjoy! More to be add soon hopefully.
---END TANGENT---

I Don't Know

But this much I do know . . .

My efforts in volunteering at the hospital by playing trio music in their lobby is starting to pay off. It sure took me a long time to set up and get going, and I (we) had wanted to give up more than once before it even started. But we're all glad we're doing it now. Last week and this week, for just a few minutes during the hour we play, a few people - patients and/or their families - actually sit down and listen to us. One of the people who work there is even telling her friends that "there's this trio that plays in the lobby." I'm so glad when someone says something like that, as it means what we're doing is having a positive impact and people appreciate that. However, I do feel self-conscious and a little embarrassed that we're only amateur musicians - we make several random mistakes each week. Even if no one else but us hears the mistakes, the fact that we can makes me a little embarrassed. I want nothing less of our best each time, but stage-fright sets in whenever people actually pay attention.

I also know that I'm quite annoyed and even a little pissed at a few of my friends. They spent a week convincing me to get back into WoW. By the time I started up again, they were over 20 levels higher than me. By the time I catch up to the point where I could actually maybe do something with them, they're no longer interested in playing anymore. Then why did I even bother! The whole point was so I could play with them, together. Not with strangers (though there are many nice and competent players) and not by myself soloing things. Done that, been there. No, I wanted to specifically play with them as I've always wanted to, but last time they quit before I even really got WoW, and now they're doing it all over again. I should just delete WoW from my computer, as I'm clearly not having as much fun as I should. But I did pay for a 1-month subscription, $15, and that expires 6-27-08. So I now feel almost obligated to play till then. Sigh.
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What I don't know . . .

Is why I've been feeling so crappy lately. And by lately I mean the last several weeks, and prior to that the last few months. I'm beginning to think that 2-3 weeks of not feeling crappy was just an illusion, a fluke. I can't even pin an emotion on this - loneliness, sadness, frustration, anger, exhaustion? How about all the above. Let's see if I can think this through.

A few times a week I wake up wanting to cry but being unable to, as if I forgot how. There doesn't seem to be a reason behind this. I just wake up and feel like the day's going to suck. A week or two back, the "death" thoughts came back. Thankfully they came and went quickly this time. I must make a clear distinction that I only think about what it's like to be dead, not what it's like to die or how to kill myself. But still, they're by no means comfortable thoughts.

I know I'm sexually frustrated and lonely. Here I am, 22, and have never fallen in love, never kissed, a virgin in practically every sense. I sometimes wonder what it's like to even just touch someone without feeling embarrassed, without feeling like I've invaded their personal space or violated some unwritten rule. Even hugs feel awkward for me. The fact that I don't seem to be losing weight (or gaining for that matter, thankfully) doesn't help. It seems no matter what I eat, no matter how much I exercise, I can't seem to lose any more weight than what I'm currently at. Generally, I run a mile on the track, lift some weights, then run 2.5-3 miles on the Elliptical machine. And I do this at least every other day. I know I have a rather low self-image, and it's almost always been like that. And I hate that feeling of not being comfortable in my own skin, as if my body's just some awkward clumsy thing I just happen to be stuck in.

Although I have friends who know I'm bi, I've never since talked to them about it. What do they know? What do I know for that matter? What can we talk about? What can we discuss? Such matters fall so far outside the normal realm of stuff we talk about that this invites nothing but awkward silences. And I want someone to talk to, someone to relate to, someone to help me sort out this confusion. All this leads me to feel dissociated and even disconnected from my friends. I used to love my privacy and solitude, but these days I almost can't stand to be alone. But when I'm with friends, I feel silent as if I've nothing to contribute, as if I'm just a body sucking up oxygen in the room. I feel like I have nothing to say, though there's lots I want to say but I don't know or think I can. I feel distant and I hate it.

I know I'm exhausted as I don't get much sleep. They're doing construction on the dorm across the street from me, and they start early in the morning with plenty of loud noises. As I tend to go to sleep way too late, they wake me up relatively way too early. I've been feeling myself falling asleep at random throughout the day. Not good. This in itself almost makes me want to cry.

And of course there's the waiting, the everlasting waiting to hear back from med schools. I try not to think about it, but it's ever gnawing at me in the back of my brain. There's nothing I can do, I'm at the complete mercy of "the system" and I hate it. I feel like maybe I didn't give it my all, or maybe I'm not good enough, not worthy, what-have-you.

All of this, all of it, is affecting me at my jobs and I can feel it. I feel tired and unmotivated at research. Some days I'm really productive, others (like today) I literally got nothing done despite being there for 3 hours. At my group tutoring thing, I feel disorganized, unfocused, and unable to direct or answer questions. And if they start to feel it, they'll stop coming, which makes it harder for me and those who do stay. I don't even really try to hide these problems but no one's mentioned anything. No one - not one of my friend's - has asked me if I was okay, or if anything's wrong, or pried into it. Am I that good at instinctively hiding this? Is the Mask of Stoicism that foolproof?

I sit here every day and night trying to make the next day better, but it never seems to be. I seem to be waiting for something, but since I graduated, I feel like what I'm waiting for is a future that's foggy at best. Sometimes it's almost graspable, other times it's like a mirage and seems to fade when I get closer. I don't expect anyone to read this, especially this far. This is more for me to have it out, to have it confessed, so it doesn't fester inside me. Hopefully, this has helped me. I'll find out when I wake up in the morning.

Mask of Biology II: Evolution

Evolution. Survival of the fittest. Darwin and natural selection of the most adaptive traits. If only it were so simple. This was what I once thought as well, despite being a biology major. It's an elegant and beautiful theory, but it's a theory in the same way that gravity's a theory. It has so many subtleties that are just now being explored. In the span of a single semester, I've had exposure to but only a fraction of evolution's complexity.

While I realize that few reading this might find this particular post interesting, I hope those that do can see my appreciation and awe of nature, and the humbleness it brings through my Mask of Biology. I don't know if my words will do any kind of justice to how I feel, but if it conveys even a little bit, I will count it a success.
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1. Not always selection of the most adaptive
There is the tendency to think that the traits that are most adaptive and beneficial will always get passed on whereas detrimental traits will be eliminated. This is a rather gross over-simplification. Firstly, mutations are the ultimate source of variation. Most mutations are neutral, meaning that they don't impact the organism or its offspring at all. Some are harmful and some are beneficial.

Neutral mutations are passed on from generation to generation; over time, enough accumulate to make a difference in the genome (complete set of genes) of that organism. There are also varying degrees of detrimental and beneficial. The most detrimental (resulting in death before reproductive maturity) gets purged from the population rather quickly. Then there are some traits that are bad . . . but not so bad as to be worth eliminating. The opposite goes for beneficial traits. Some are so marginally beneficial that they might "accidentally" get lost. Sometimes really beneficial traits get "fixed" in the population, meaning that most individuals in that population will carry that trait.

This has been fairly straightforward so far. Now there's something called "linkage disequilibrium," another is called "positive selection sweep." In linkage disequilibrium (LD) it basically means that 2 traits are almost always seen together because they're physically very close to each other on chromosome. So if a mildly bad trait is next to a really good trait, chances are that you'll see both of them at the same time. Positive selection sweep is a means to detect whether or not positive selection (selection for a positive, aka beneficial, trait) has happened. Like LD, sometimes the trait being selected for is "so good" that it carries along bad traits with it as it "sweeps" across the genome.

Interestingly, it should also be worth noting that just because a trait's good, doesn't mean it'll reach fixation (again, where most individuals in the population carry the trait) on the first try. In fact, many/most such traits must arise independently several times before it can reach fixation. In a way, it's more or less the roll of a die.

2. Order matters
What evolves first and what evolves second matters. A good example is bat wings. 2 things must happen in the evolution of bat wings: elongation of finger bones and maintenance of skin webbing between the fingers. Both require evolution of different regulatory mechanisms, the question is, which came first?

In another paper, scientists "forced" bacteria to evolve from one state to another by making them adapt to a new food source and environment. So let's say the bacteria evolve from Species 1 to Species 2, and it required mutations A, B, C, and D. They went back and painstakingly made each mutation in different combinations (i.e. ABCD, ACDB, BCDA, etc) to see what happened. Surprisingly, they found that only a handful of combinations are able to evolve the bacteria from Species 1 to Species 2.

So back to the bat wings, just a sample of its complexity. The expression of the gene bmp4 increases bone growth, so it increases finger length. However, it also prevents interdigital webbing (skin between fingers). So another set of 2-3 genes are required to turn off bmp4 expression between the fingers. So again, which came first? Repression of bmp4 between fingers, or increase in bmp4 expression all around? No one knows.

3. Large vs. small mutations
There has been a debate between "large" mutations and "small" mutations. Large mutations are mutations that causes a sudden or significant change. For example, the alteration of 3 genes can change cells from growing cells to growing scales or feathers. Small mutations are mutations that on their own don't do much, but the sum product of them create large changes.

This is related to sudden change theories, like punctuated equilibrium or "hopeful monsters," to gradualism promoted by Darwin. There are clearly evidence of both throughout natural history. Sometimes you get a freaky mutation that just so happens to work, so it does. And other times small changes accumulate over many generations, and things gradually change from one thing to the other.

So even in the way things evolve there is no consensus.

4. Canalization
There are several concepts in evolution where diversity is somehow hidden or limited. This seems counterintuitive as generally evolution is thought of a driving force for change, for creating diversity, and not for maintaining the status quo. Why might this be? Well, for some things you really really don't want mutations to occur. For example, if a bad mutation occurred in the formation of the brain, that organism's brains will be scrambled. So you want brain formation to stay more or less the same throughout evolution. There are several biological mechanisms that prevent mutations or at least mask their effects from showing.

One is canalization, which is any genetic mechanism that reduces phenotypic diversity. Phenotype is what's actually expressed and seen. Again, genotype = what the genes actually say, and phenotype = what's actually seen. So a phenotype might be brown eyes when that person really has the genotype for brown and blue eyes.

Canalization acts kind of like a rug that hides things underneath it. What this means is that there's some genotype or genetic trait that acts like a rug. And it hides other genetic mutations under it, so the phenotypes for those mutations aren't seen. But, if conditions are just right, the rug can be pulled aside or shifted. And some of the phenotypes that were hidden under it can be seen.

5. Developmental System Drift
This is one of my favorite concepts. Basically you have a phenotype, but for that phenotype there are more than one genetic mechanisms that create it. At one point there may have only been one genotype for that phenotype, but over time, small mutations occur until eventually, you have 2+ different genotypes that still express the same phenotype.

I think I've used this analogy before. Let there be two genotypes "Shawn" and "Sean." Both are spelled differently but have the same pronunciation (aka, the same phenotype). Now, "Shawn" and "Sean" are considered two different species. So if they interbreed, the offspring would be an infertile or inviable hybrid. This is one way different species similar for a particular trait(s) speciate, or become different species from one another.

Developmental system drift (DSD) also allows the appearance of different phenotypes arising from a single one. For example, from "Shawn" you can get to "Shown" and from "Sean" you get to "Dean." Each only requires one "mutation" to get from something that's pronounced the same to two things that're different.

6. Genetic Constraint
There's a concept that there are simply limits on life. That there are only so many ways to develop along a path once it's been established. There are constraints on how things develop and constraints on what develops.

For example (and this will be a bad example) the evolution of legs favors even numbers. Once the evolutionary path to create legs has been established, legs will always be created in even numbers. This is a limit on what can develop. Then there are limits on how something develops. For example, the brain must develop in a certain way and a certain order. If it goes out of order, bad things happen. So nature constricts how a brain forms.

This leads to an interesting thought-experiment. If we were to back in time and restart the Cambrian explosion, would life on Earth today look the same? Or, if on another planet, conditions were exactly the same as they are here, would life look similar? This concept may not answer these questions. But what it does say is that, once a path has been laid out, there are only so many places it can go. So if life had favored a different set of beginning traits, things might've looked different.
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So yeah, don't know how much of all the above people actually understand. But, if you got through it and even if you don't understand a word of it, I hope you might still be in awe of what the hell it could mean. Of course, this is nothing. "You ain't seen nothing yet" when it comes to evolution. We live in a world of constant change, and I think it's always good to see where things came from and how far they've come (or not).

Anyway, this is all the free-flowing biology for now. If you have any questions about evolution, or something biology, don't hesitate to ask. I may not know the answer (and many times I simply won't), but I think my B.S. in Biology affords enough knowledge to at least make a damn good guess. It's weird to be a graduate now. More on that later!