I started writing regularly upon receipt of a journal for my thirteenth birthday. The cloth covering the book was adorned with pale pink and maroon flowers against a beige background with black vertical stripes. The pages had wide-ruled lines, a generous margin, and a soft feel against my fingertips.

It became my first “serious” diary.

Every night before I went to bed, I opened this cloth-covered book underneath the lamp with the dusty paper shade. Using a mechanical pencil (5mm HB lead), I wrote the date in the upper right hand corner of the page. In the upper left corner of the page I opened with “Dear Diary”. (Followed by a comma, not a period. And not a colon either, as I would readily hug my journal.)

For nearly every single day for next five to six years, I wrote an entry in my journal. The cloth-covered journal was the first volume; afterwards, I used spiral-bound, college-ruled notebooks (more lines means more text).

I stopped maintaining a journal during my first year of college. By then, the journal was the 25th or 26th volume in the series.

My college roommate (hi Maria!) and I discussed the termination of my journalling.

“College is busy,” I remarked. (I probably said something else, though the sentiment matters more here than the actual words used.) “There are so many things to do: There’s all the studying, and there’s all the time I spend in band (hi Justin!), and there’s stuff I want to do with friends, plus I want to spend time with the guy I’m dating… and I’d rather do all of that than write, you know what I mean?”

I was ambivalent, to be sure. Maintaining a journal helped me to think about the events of the day, reflect on ideas, and ruminate on problems. It was part of my bedtime ritual, something I would do to exorcize the stress of my day before going to sleep. Furthermore, I had been doing this for six years! This commitment to myself had produced a sizable collection of stories.

However, the exercise was starting to become just that: exercise. I no longer looked forward to writing in the journal. Instead of invigorating me, instead of bringing satisfaction and joy, writing in the journal seemed more of a chore, an obligation.

So I stopped.

Though I didn’t actually stop writing. The internet and e-mail were becoming popular. Here was a medium that cultivated my interests in the written word—and I type much faster than I write. And how I love(d) letters; I had spent the past six years writing letters to myself and now, I could dash off letters with ease. Letters were just long enough to require some sustained attention, but short enough that they did not require a huge investment in time. And anything can go in letters: Lists of facts; directions; greetings; and, of course, stories.

I have always enjoyed the narrative. The story is a powerful means of communicating ideas and information. It is compelling, thoughtful, and persuasive. Furthermore, sharing stories from my observations of the world around us and within me helped me to think about the events of the day, reflect on ideas, and ruminate on problems.

So I wrote a lot of letters. And many recipients told me they liked them. “You’re a really good writer!”

That’s as far as I got in typing this entry—this entry that was meant to end my blogging—today while waiting for patients in clinic. (None of them attended their appointments. This vexes me.) My intention was to elaborate upon the cycle of writing in specific contexts, getting tired of it, and then writing in another context. And how the same motif runs through it all: thinking about events of the day, reflecting on ideas, and ruminating on problems. And, of course, the power of the story.

Do not misunderstand: My love affair with writing continues. I enjoy the craft immensely. (Dare I call it a craft? Am I qualified to be a “writer”?)

One can write without blogging. I sense that blogging may be transforming itself into a chore and really, no one likes to do chores.

Joshua invited me to join him to attend the Hello Health clinic opening this evening. (Hi Joshua!) In addition to speaking about the current goings-on in his life, he encouraged me to keep writing. (He also introduced me to some people and used superlatives to describe my stuff here. It was embarrassing. Just to be clear.)

Indeed, I have found great satisfaction in writing here (see the triumvirate above). I’ve also met some interesting people that I would have not otherwise ever met (hi Jesse, Branille, Graham, Joshua, Justin, Bardiac, Brock, Amanda, Yasmine, Molly, Terry, Philip, Michael…!). Then there are all the people I would like to meet that I would not have otherwise ever heard of were it not for the blog (hi Rowan, Dr. Charles, Kevin, Andrea, Yaser, amongst others…!). And then there are all the people who knew me and now follow my blog, which is flattering in its own way (hi Maria, Matt, Kyl, Justin, Lynn, and other lurkers who have yet to identify yourselves…).

And then there’s the minor detail that I met The Beau through the blog. And that’s a story of epic proportions. People use terms like “amazing”, “unbelievable”, and “incredible” and phrases like “that’s like a movie”, “that’s better than a movie”, and “that is like the most romantic thing ever” upon hearing that tale. I kid you not.

My writing frequency has fallen off, I know. And I rather pride myself on keeping my commitments. I’m neither committing to writing nor committing to not writing. (And no, things don’t have to be that rigid, but you know what I mean.)

I don’t know what I’m going to do. The consequences are all intangible if I keep writing or if I stop. I continue to mull. Or stall, really.

And, by the way, I’m still gawking at New York. It takes a lot of time to gawk. This place is unbelievable.

(Yes, comments for this post are off. If you want to say something to me, e-mail me.)

The smells of salt water muck and car exhaust enveloped me. My nose crinkled involuntarily and I felt my diaphragm resist a full, deep breath: The air smelled noxious.

This will pass, I reminded myself. I had encountered into the same malodorous swirl during the first half of my run; Pig Pen’s cloud hadn’t accompanied me the entire way.

It was only 5:30am, but the temperature was already near 80 degrees. In addition to smelling like a polluted lake, the air was heavy and thick with moisture. I felt like I was breathing through a soggy, soiled wool sock. My running shirt and shorts, which had wicked sweat so effectively from my skin in Seattle, were now clinging to my damp skin like that last noodle lingering in the almost soupless bowl.

I was not sweating alone, though; other residents—humans and dogs—in New York were watching the sky alight with the morning sun. A few other runners plodded along; several couples walked hand in hand; cyclists sans helmets zipped past. Several individuals in various states of undress occupied benches. Some had slept there all night. Some were watching the sky, as if waiting for a celestial message.

Encouraging myself to actually smell the air, I took in a breath, timing my respirations with my footfalls. My eyes focused on a bench about thirty yards away: You can make it to that bench.

I had noticed him during the first half of my run. His arm was slung around the slender shoulders of the young woman leaning up against him.

Now, he had risen from the park bench, leaving his faceless sweetheart behind. I noticed him noticing me. He noticed me noticing him. I saw the impish smile form on his face.

When I passed him, he began to run and, within a few steps, was running alongside me. As he approached, I instinctively began to run faster out of alarm, though it was soon seemed that his intentions, though unclear, were probably not malicious.

(… though one never really knows for sure.)

“This is hard,” he commented in a Middle Eastern accent. His loose pant legs rustled against each other as he tried to maintain my pace.

“This is true,” I replied between breaths, playing along. A random stranger just started to run with me at 5:30am in New York City.

He smiled again and mumbled, “How do you do this?” before decelerating. He was soon walking and, presumably, returned to the park bench and the object of his previous affections.

I passed the bench that I had mentally marked earlier and selected the black gate that was about forty yards ahead.

I don’t know. Though I do know that none of this would have ever happened in Seattle.

Brain Dump.

1. It terrifies me that I could be an attending physician.
2. I still have a lot to learn.
3. Errors are ripe learning opportunities, but it’s scary that sometimes, I (we) commit mistakes and only then does the lesson present itself.
4. Humility is good.
5. Feeling petrified from fear is not.
6. It’s all about balance.
7. Balance can be hard to find.
8. It’s a moving target.
9. Just like the pedestrians who jaywalk across the streets and taxis are roaring straight towards them.
10. Is there an initiative for taxis to convert to hybrid power?
11. Why yes—Google tells me that by 2012, all taxis in New York City must be hybrids.
12. Hybrid cars seem to have less power than gasoline-powered vehicles.
13. That means that the pedestrians have more time to dash across the street. (Maybe.)
14. Instead of “jaywalking”, occasionally I “jaydance” across the streets.
15. Why yes, I look foolish. But I do it because I can.
16. I miss teaching.
17. But I am going to change that.
18. Sometimes, one must create and cultivate her own opportunities. Particularly when the other complementary parties welcome the opportunities.
19. (I hope I didn’t set expectations too high!)
20. This is more of an internal brain dump, I know. I’ll try to write more about the city.
21. I had my first Dunkin’ Donut earlier this week.
22. What was it called? Not a “donut hole”, but a “munchkin”.
23. We just call them “donut holes” on the West Coast.
24. I also had a cup of Milky Way Hot Chocolate.
25. It was like 85 degrees outside. When I drank the Milky Way Hot Chocolate.
26. Yeah, I know.
27. Everyone brags about the public transportation here in New York City, which is excellent, no doubt, but I don’t know that it’s actually that much more efficient.
28. Since there are so many people here, everyone ends up waiting for everything.
29. Which, on the one hand, explains why people get so impatient with things and other people and events and whatnot…
30. … but also explains, I think, why people can also be remarkably tolerant.
31. … and wonderfully gracious when one extends patience towards them.
32. It’s empathy training.
33. We could all use it. All of us.
34. People can be pretty profane here, too.
35. Some people habitually use the word “um” or “like”.
36. Here, some people habitually use obscenities in all types of company.
37. Like on dates.
38. Or when speaking to physicians.
39. And with this hot weather, people dress less.
40. There’s a lot of cleavage in this city. I’m talking boobs, not division of cells.
41. (Though that is happening, too.)
42. Frankly, I’ve never seen this much cleavage in any one city in my entire life. Even when I lived in Los Angeles.
43. And the men here! When some of them look at said cleavage, they really look at the cleavage.
44. They practically fall into the Canyons of Cleavage.
45. And then they take a good, long look when the Cleavage walks away.
46. And then they talk about the Cleavage and associated backside of the Cleavage with their buddies.
47. Or, if they’re by themselves, with themselves.
48. I smirk on the inside.
49. I also take a lot of mental notes of my observations on the inside.
50. Perhaps soon, I shall convert these observations into written narratives for the outside. (cf. #18)

1. I’m still not tolerating the humid heat well. It shows, too. The whole “Women don’t sweat; they glow” does not apply to me.
2. My calves are going to look great by the end of the year from all the walking I am doing.
3. Services ask for a lot more psychiatric decisional capacity evaluations here than they ever did in Seattle. I don’t know if this reflects a heightened “cover your @$$” practice or what.
4. The hierarchy is maintained through scrub colors: Nurses wear white scrubs, physical therapists wear blue scrubs, assistants and other techs wear beige scrubs, and the physicians wear blue scrubs. Everyone wore blue scrubs back in Seattle.
5. The long white coats help, too.
6. People are more receptive to smiling here in New York City.
7. Note the word “receptive”. Ain’t no one initially smiling at me, but when I flash that Winning Smile, watch those faces blossom!
8. So my experiences with hospital staff have been pretty good, actually.
9. Some of the notes are still hand-written. And they are still illegible.
10. I stood in the very first subway car recently.
11. So I watched the subway rumble through the dimly-lit tunnels.
12. Do the subway operators find the Manhattan subway rides dismal? It’s darkness for the entire length and width of the island! (”I work in the dungeon, thank you.”)
13. I like it when young men give up their seats for elderly women on the subway.
14. Do you know about the “Bridge and Tunnel” crowd?
15. Apparently, the “Bridge and Tunnel” crowd come in from Long Island and New Jersey on Friday night and leave Sunday. They go out and do stuff in the city all weekend.
16. Manhattanites, apparently, go out the nights of Tuesday, Wednesday, and Thursday.
17. There’s good food in this city.
18. I’m compiling a list with some help. Maybe I’ll post the better places in the future.
19. Public performance is pervasive here.
20. I don’t know how much of this is merely driven by the need for money or if there is a cultural component to it, too.
21. I’m running a race through Central Park soon.
22. I don’t know what I was thinking when I signed up for this race. It’s going to be hot and humid.
23. Yes, I’m complaining.
24. I don’t think New Yorkers actually complain more.
25. I think they just talk more.
26. I’ve heard more conversations about nothing here than I have heard in my life.
27. And I don’t mean “nothing” in a bad way; I mean people are just talking for the sake of talking.
28. Like about the locations of locksmiths.
29. That’s not exactly “nothing”, but the context was totally unrelated. You’ll have to trust me on this one.
30. I tried my first bowl of matzo ball soup recently.
31. It apparently wasn’t very good. (I have no yardstick for this.)
32. People perceive me as “laid back”. They attribute this to my “West Coast” upbringing.
33. Because people on the West Coast never get agitated about anything.
34. Though it is true that West Coasters don’t honk our horns with the same frequency that people do in New York City.
35. I am grateful for fans.
36. The coolest part of the day is the early morning.
37. When I say “early”, I mean around 5:00am.
38. That’s when I go running.
39. Other people go running at that hour, too.
41. A lot of people run in this city.
42. I like the diversity of runners here.
43. A friend and I watched people in Central Park today.
44. There were people slogging along and running in the heat.
45. And a lot of people just laying out in the sun.
46. It’s like an instant community. We’re all sharing common space.
47. I wonder how territorial people are in New York City compared to other cities.
48. I’m still trying to settle into my routine. I believe I live here now, but I’m still not sure how I am going to live here.
49. It’s complicated.

“Under fasting conditions, the oral bioavailability of paliperidone (the “new and improved!” risperidone, though it’s actually just an active metabolite of risperidone—and both paliperidone and risperidone are equally efficacious, which means paliperidone is not “better”) is only 28%, but this can be approximately doubled by taking it with a high-fat, high-calorie meal.” [Biological Therapies in Psychiatry (a useful, concise newsletter that does not have any drug company ads), July 2008: Vol 31, No 7]

Antipsychotic medications are already associated with a metabolic syndrome that consists of weight gain. How can anyone justify prescribing a weight-inducing medication that essentially requires a weight-inducing meal for absorption? Particularly when it is no “better” than its soon-to-be generic older brother?