‘Did you print this yourself?’

So I have discussed my department/bureau of motor vehicles experiences in Saipan before .. Well here’s the contrast.

Today I went for my appointment at the California DMV. Yes, I had an appointment that I had made online about 3 weeks ago. I show up and there is a line out the door but I get quickly ushered to the appointments line and get assigned number A001. Great!

From there, a loudspeaker and a million large flat screens announced numbers and which desk number (of 26 desks) you were being summoned to. I waited patiently, a little glum that I would be giving up my fake looking Saipan driver’s license.

I go to the desk I am called to and produce the numerous documents they required for my license transfer and my vehicle registration. They take my passport (proof of my legal status in the United States) and scan it … And scan again.. And scan again. Nope, apparently the system does not recognize me either because of a computer glitch or maybe because there is some flag on my name or fingerprint!?

So, that was already one thing not to mention they decided to wholly disregard my Saipan driver’s license because they could not figure out how to enter it into their system to check my background check. I’m pretty sure even if they were able to find Saipan/CNMI/MP/Northern Mariana Islands (I gave them every permutation of how it might show up in their system), the computer system from there wouldn’t be connected to theirs here in California. Fortunately I had my old Texas driver’s license on me so they were able to use that and just pretended I never for my Saipan license in between then and now.

Okay, so I knew I wasn’t going to walk out of there with my new driver’s license. Then they turned their attention to my car registration. Besides the fact that I got charged a late fee for not registering my car within 20 days (total, not working days) of it arriving California (the port, not when I had it in my possession) and besides the fact that I took the earliest appointment available….. Besides THAT, they also decided that since my car was from abroad (well, we aren’t abroad people!!) I needed to do a smog check. This is despite the fact that their website says that a new car within 5 years of purchase doesn’t require one. I wasn’t surprised by this and was prepared for all these snafus so I lost my precious place in line and went to get my car inspected and smog checked (for an additional fee of course). After returning, my appointment slip meant nothing anymore so I had to wait in the walk-in line but I was determined to get at least my vehicle registration done today. I waited 2 full hours before I got to the front of the line again when they gave me another slip number to get into the flatscreen queue again. Okay, by this time I am a little tired of standing but am repeating the mantra of ‘patience is a virtue’ in my head and keeping myself calm – nothing to do but keep trying to awkwardly do work on my laptop while waiting for my number to be called. Finally I get to the desk to show the gentleman my packet of material with the newly affixed smog check and vehicle inspection results.

And he flips thru my papers and starts laughing visibly (you know, the quiet but whole shoulders moving laugh)… ‘I’m sorry to have to ask this but.. Did you print these yourself?’ He points to my vehicle title and registration.

‘Uh, no’ ‘Well, I’m sorry miss but we cannot accept these documents’ (you can tell he is still laughing at me and trying to be serious) Hey MISTER, I am an upstanding citizen! I am not a hooligan who is playing a prank on DMV and making up a license and registration from a fictitious island! Well, I put on my most serious face and try to explain Saipan. He is literally still cracking up. I do my best to remain calm and ask him to please ask his supervisor or, for heaven’s sake just google it (no, we cannot access internet on our computers miss). He goes off to make some inquiries and returns to me with a straight face and quietly continues the paperwork processing. He hands me my new license plates silently and says ‘sorry miss.’ To get one last jab in though he goes ‘I guess the fact that it’s printed in color is their security system.’ My response; ‘well yes, that is quite a professional touch on their part.’

Well, that was quite a day so far! I actually do not blame this guy and am sure that it made his day more interesting. And now one more person in the world knows about Saipan!

In the meantime, shhhh keep the secret about my made up island with my fake documents quiet ;)

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More about the transition

And to continue the recordings of my transition back to the mainland United States…

1) still, no one knows where or what Saipan is. I have been gone for two years and I obnoxiously posted beautiful pictures on social media often. Despite this, people who have ‘known me’ aka potentially only as close as you can say a Facebook friend is when you live abroad.. Have no idea really anything about Saipan. If Saipan came up in a conversation, they would say ‘oh yeah, I knew someone who was there once.’ And maybe add ‘it sounds like an awesome place’. But elaborating beyond that would be impossible. I guess there is no reason to suspect why people would know any more about it but it makes me realize how little we know (and maybe it’s a reflection of how little we care). I could see me saying the same thing about one of a number of countries in Africa or Eastern Europe or basically, any place in the world I have never personally been. It reminds me how it is my job to learn more and really listen when people talk about their experiences at other places. And also be willing to share the details of Saipan when people ask rather than talk about the superficial.

2) I find myself rushing. For no reason except that I am here. I have always been the prompt one so this feeling is a little new. I mean that I have been the annoying kind of prompt person.. The one who comes on time regardless and unfortunately makes those who come late feel bad just by the sheer fact that there was someone there on time. I actually got better at this trait of mine while in Saipan. I allowed myself some leeway to be a few minutes late! Now that I’m back here though, I am always rushing. It slipped back on like a second skin. (I’m not saying I like it, it’s just that’s how it is) A prime example of this is my commute. As I mentioned before, it is longer.. Much longer and almost inconceivable in distance/time to someone from Saipan. I allow myself plenty of time.. Not to mention not a soul at work probably cares or even is early enough themselves to know whether or not I am sitting at my cubicle by 8:00:00 AM. But often en route to the BART station or the shuttle stop, I see people doing the fast shuffle or the intense speed walk. For no apparent reason that I can figure out, I literally will copy them and run-walk too! If they are in a hurry, I better be too!! (Or I guess that’s what my mind thinks!)

3) This also translates into an intense need to be efficient. I am efficient. It is possibly one of the three words that describe me. (Again, not proud of this.. It’s just a fact) I won an award for my efficiency actually before! Anyway, in Saipan there was reward in putting efficiency on hold to watch sunset for an hour or tarry after a run to just chat. I was just shedding my ways… And now I’m back. I see it clearly. The fact that I am typing this all out on my PHONE while on my commute home is evidence of this. Really? I couldn’t have waited until I got home? Or to a computer with a keyboard or some kind? Can’t I just enjoy sitting quietly and people watching or the sun setting or the gentle hum of the tracks underfoot?

4) and on a lighter (and less self analytical) note.. I do not feel the incessant need to keep things charged. I don’t know when this developed in Saipan although my guess is after Typhoon Soudelor last year when power was really quite scarce. I bought a portable energy bank and carried it in my purse. I got a second USB charger so that I could keep it in my car to connect my phone .. Even if my car ride was just 5 minutes. I constantly had to keep my things charged! And now I don’t.. It’s gotten bad to the point where I have run completely out of battery multiple times on my phone, which really does need to remain on a majority of the time. And haha, in that twist of fate because I am so bad now in keeping my things charged up .. I carry my charger and power bank with me everywhere I go ;)

(I do still find myself holding out on charging my phone or laptop at home to take advantage of the ‘free’ ability to charge everything up at my office cubicle. It’s ridiculous that I think this way about what I need to pay for, I know!)

more to come!

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More Moving back thoughts!

So, I’ve been here three weeks and I’ve been trying to record all the differences at play that have come up over time. Here are the ones I managed to remember and hopefully will record more as they come up.

a) So…. after that last post, I actually realized I cannot even watch the Olympics here. I don’t have a television here (and seeing as how I survived without one for a long time, and didn’t even have fast internet, I figured it was going to be okay). Well, it wasn’t. Being on US soil means that you can watch but only for a maximum of 30 minutes — like a teaser. After that, you have to log-in with your television provider. Well, I don’t have a television provider since I don’t have a television…. and I used up my 30 minutes of free Olympics watching scrolling through every possible page on the nbcolympics.com website to figure out how to work around it. (Don’t worry, I worked around it with the help of my family.. but only after a number of random panic-y texts).

b) Boxed milk. I don’t drink that much milk or eat that much dairy (although I must say my desire for yogurt (not to mention cheese) did grow quite strong while I lived in Saipan). In Saipan, you drink boxed milk. Why? Because fresh milk was well, not exactly fresh. A gallon or half gallon of fresh milk costs you an arm and a leg but also probably expires in a few days. For those of you who have never made the distinction between milk as fresh milk or non-fresh milk … see! you get the gist. Boxed milk does have its merits I see now though. I couldn’t really discern the difference between tastes first of all. I believe when I was a kid, I went back to Taiwan where they mostly had boxed milk or powdered milk and it apparently tasted unpalatable to me. But, at this point in my life, I couldn’t tell the difference. Anyway, I either drank it with cereal or in my coffee basically. That brings me to the crux of the problem – I don’t drink milk that often. Fresh milk, even though it lasts much longer here, does not last long enough in my refrigerator for me to consume it and draining the milk down the drain feels soul wrenching and difficult. I think I will change to just buying small pints of milk only as needed.

c) On the topic of drinks, I cannot buy boxed coconut water. I just can’t do it. Even though I love the stuff, the idea that it is in a box after I drank it fresh seems just wrong. The rehydrating powers do call to me, so ask me if you see me — maybe I’ll have given in by then. If so, will let you know how it tastes.

d) You can order food on an app on your phone? This I guess it not that far fetched as I do recall ordering things like pizza on the phone. How different is it to type it into an app on the computer. These apps are quite crazy though with pictures of the foods, healthy options, they give you meal plans, gluten-free plans, etc. I still haven’t tried one of these but they strangely intrigue me.

e) I knew inherently that I would order more things online here. Many things have free shipping and it comes much faster, and the idea of needing to return something is not quite as daunting. What I didn’t know was all of a sudden I had to think about the security of my packages — how do they get from the postman’s hands and to my apartment without someone swiping the package? Turns out my place is extremely safe and it seems to go off without a hitch except when no one is at apartment and the postman has no way to get in to drop off the mail. :/¬† (oh, and the keypad to automatically unlock the door from the call box is the only thing in San Francisco that does not use long-distance technology so it cannot connect to my non-local San Francisco phone number)

f) I find myself constantly thinking about how to either save money or save time. More of the latter. No additional comments about that. That’s just how it is here.

g) I feel like I surprisingly quickly acclimated to being here. No, that doesn’t mean I’m used to living here by any means. But, things like my strong craving for strawberries and Mexican food have subsided to almost the dull boredom of the people here — the people who have lived around having everything at their finger tips. I cook mostly at home — mostly similar things to what I ate in Saipan and have not really visited many restaurants. I guess just knowing they are there is enough. (That being said, I have eaten more zucchini¬† (it’s so fresh!) than I have eaten in my whole life probably)

So, lots still a work in progress. Will keep you all posted!

And, a throwback picture for fun..

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The Olympics!

I must post a quick perk of being back in the States.. no longer am I in a place where ‘your country is not recognized’ (see post here)

So, besides the fact that I missed the opening ceremonies which apparently were long and maybe not as great as opening ceremonies are usually billed.. let the live streaming begin!!!

Go Team USA! (and every other country too, I am an equal opportunity cheer-er for all)

(and still, people.. get it together to get the Olympics on TV in Saipan. Who knows? there could be a US medalist from there some day too… don’t you want to inspire those youth??!)

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Commuting

(Just some random observations for now!)

I am commuting (which is totally a word you never would use in Saipan) from the East Bay area of San Francisco into the city to the hospital I work at every day. I’ve successfully done this for a few days now and am starting to look around and notice things. It’s quite interesting — this period of time that strangers all get on public transportation together. It’s very quiet in the morning as everyone sleepily checks their phones or dozes off while afternoon is louder, more boisterous, with some conversations or music leaking out from earphones and a lot more jostling to get in position. When it’s busy, making sure you are in the right line or that you keep your things close to you (so you won’t forget to take them) is important.

In the past two days, I have tried two different routes, one of which is slightly faster and allows me to be sitting for more of the time (aka, less crowded). I was using that method this morning and there were no seats when I got on at my stop (not unusual). The next stop, some people got off so I took a seat and settled in for the next 30 minutes. The stop after that, a couple got on the train car I was in that clearly was going to the airport (luggage in hand) and the wife was clearly pregnant. I watched them look at the people sitting (entranced in their phones) in the handicapped/disabled persons spot and then look around when those people made no eye contact. Even though I was in the middle of the aisle, I stood up to allow the pregnant woman to sit down. I already felt at the edges of my mind the peripheral feeling creeping in — I could just sit here and not give her my seat, now I may have to stand the rest of the train ride. It was a little reminder that perhaps that’s why people consider people not as ‘nice’ or ‘friendly’ in places like this with all the ‘hustle and bustle’ of a hard working environment. Yes, everyone is tired and everyone is making the commute, so while that does not excuse it, I can see why there are less people who jump up to do what may be more ‘right.’

It’s also interesting to watch people on the trains. I haven’t gotten comfortable enough to be able to fall asleep on the trains (for fear of missing my stop) but may soon. In the meantime, I do what I can on my email (it’s hard off a cell phone) and then watch what other people are doing. If people are not sleeping on the way into work, they are on their cell phones — mostly playing games. I actually identified that I saw the SAME person two days in a row because he was playing the same ?baseball MLB game on his phone — or its a popular game amongst middle-aged white guys in suits and I didn’t actually see the same person. Some people play out of boredom, as evidenced by their faces while others play for the sheer joy. Most play out of boredom though.

It’s a big difference going from a maximum 5 minute drive from door to door to calculating the time to walk, the time to get down stairs, the time you have to wait while waiting for a transfer, etc. I am having to adjust my buffer time. Before in Saipan, checking the clock about 5 minutes before to make sure you got out of the house on time was sufficient, but here, it’s more like you need a 15-20 minute buffer to get yourself together to get out of the house on time. Hopefully once I’m more organized at my house and with my routine, it will get faster.

If you have suggestions for things to do on my commute (podcasts likely will become my new friend!), let me know!

And, a throwback picture for you to enjoy:

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A mixture of emotions

Hello all! I am going to try to update this every now and then even though I’m not in Saipan still just to keep track of things and force myself to do fun things worthy of a blog post!

It also will help me remember these moments of this transition period. One of the things that I am intensely feeling now is this sense that I just don’t know what to do. I guess ‘overwhelmed’ is a possible description although I don’t like the negative connotation that comes with that. There are a ton of choices. Just walking up an aisle at a grocery store can turn into an anthropologic commentary running in my mind trying to compare the cultures of being in Saipan to here. I find myself buying familiar brands (i.e. one of the only two greek yogurt brands was available at the nearby grocery store (which feels like a megastore but is only a ‘normal’ one here) amongst the wall of 20 different brands but I couldn’t figure out which one to buy so I bought the one that was available in Saipan). I want to preserve that feeling that ‘I don’t need that’ but also don’t want to be naive and not get anything or be on the other end of the spectrum with buying everything that is new and convenient. There are these feelings at restaurants too when there are so many choices .. you just get a plain burger because the other choices are too much or you are curious and get the weird new eggplant-based gluten-free cruelty-free, etc version.

I will find a happy medium soon but for now, I treasure the moments when I remember that I don’t need everything that’s offered here (while enjoying my special flavored ice cream .. haha!). I want to keep the priorities that were rearranged by living abroad in the best possible way intact. Someone asked me today if I have culture shock and I said, I don’t know yet but I’m pretty sure I will. More to come on that I’m sure as I reenter the work world here in the mainland.

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(and a throwback picture to the reefs at Wing Beach)

Titled: It’s not all black and white… and sometimes you feel like the plain fish amongst the zebras.

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Emergency Exit

As I mentioned in this prior post, I had an emergency exit from Saipan. As I have mentioned before in my posts about transports, these things come up suddenly, but also not so suddenly.

(The following should really be added to my list of transport posts)

Patient transports off the island are one of the tools that we use to be able to get patients to higher levels of care and they happen quickly (kind of). The point of these transports is that at some point, the medical professionals determine that the patient needs some higher level of care. This could be a problem that is happening imminently or a problem that we are dealing with right now. Some of these problems include needing some type of cardiovascular surgery, orthopedic procedure, or subspecialty evaluation and care. In general, we try to send patients when they are perfectly stable and able to transfer on their own but obviously this doesn’t always happen. Of all the transports I have done, almost all of them are amongst newborn babies. It doesn’t happen the minute they are born though, even if we know from that minute that they need to go. The first event that needs to happen after the physician decides to recommend the patient for off island evaluation or treatment is that we fill out a form to summarize the medical condition of the patient for review to the medical referral committee.

This is a committee of providers as well as medical referral office members who meet weekly who decide on approval of if a patient can go off island and where. This is a difficult job as there are limitations in the funds available and lots of needs, as you can imagine. If it is truly an emergency, providers will get approval by walking around the hospital and getting the signatures needed that same day. This paperwork not only includes the medical summary and reason for referral, but details such as what the patient has in terms of medical insurance/payment coverage as well as who will need to accompany the patient on the flight. Then, it goes into the hands of the medical referral office which is separate from the hospital and run by the local CNMI government.

This office has to do a lot — figure out which hospital in the world may accept them to be cared for at that hospital — this includes making sure the hospital will accept whatever form of payment the patient offers. In addition, they need to make sure the patient will be able to travel — for the medically complicated patients, it means that the airline approves of your oxygen use on the plane (or can provide oxygen for the long haul flights), you have the appropriate medical attention involved, etc. Because we do not use air ambulances and instead rely on commercial airlines, we must completely be able to provide for all the needs of the patient (medications, oxygen, transportation (i.e. moving the patient on and off the plane, etc)) and the commercial airline must approve. Obviously they do not want to knowingly put someone on the plane that might have some type of adverse event happen on the plane — certainly they don’t want to have a situation where the plane must land early or be diverted because of a medical problem. Some hospitals will take payment from an insurance agency like the United States’ Medicaid or Medicare, but only up to a certain amount. Some hospitals will not take payment from insurances at all. Some hospitals also do not have the services that you think they have so will not accept them. Usually to allay this, the physicians call ahead to the hospital they think the patient may go to to check. Once, I did this and found out the hospital I was speaking with had a shortage of nurses and so could not accommodate my patient. As you can imagine, this all takes longer than the patient may want.

I have told patients many times — the most important thing is to have an active passport. This is even more important than payment (although unfortunately this can be a limiting factor as well). Getting a passport never happens as fast as you want and sometimes you need a passport to travel to a country for medical treatment, for example, to go to the Philippines. Even to travel to the United States from the CNMI, the most direct route can be via Japan rather than layover in Guam and Hawaii to get to the United States and to transit through a foreign country, you need a passport! All these things are things I learned as I went along. A letter or phone call to the US passport office from me doesn’t speed things along unfortunately. The good news is that patients can get passport pictures now on mobile phones and ipads and in a medical emergency, they can accept pictures with medical equipment attached to their faces, so we usually recommend any patient born with any concerning condition, that the families apply for their passports (After they get their birth certificate) as soon as possible.

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(My last sunset from Banzai)

We had an inkling that this patient, who was born very prematurely, may suffer a complication that required off island therapy. This isn’t guaranteed but you usually prepare the family in advance. This family was local to Saipan and was on top of everything from the beginning. Very quickly after we decided to send the patient off island and got approval from a children’s hospital on the West Coast, we proceeded. For me, it was a little bit like a train wreck in slow motion. I had to slowly watch the process unfold, which, like I said, happens slower than the family usually wants, because I knew my travel would be tied to theirs. In the end, I got the final go-ahead for my flight 36 hours after it left. By that time, I had packed up my things and generally given away all of my major furniture/kitchen equipment. I had a plan in place for my ride to the airport that needed to be changed because instead of going to the airport with my three large baggages, I would be traveling to the hospital to make sure the patient was ready to be loaded onto the airplane, and then needing to check in myself as well as the patient. As I have mentioned before, there is a lot of checking to do before you load the plane. You basically are leaving a full hospital and hoping that you have everything carried in your hands you’ll need for the next 30 hours (it really is a 23 hour journey from start to finish but you always carry extra in case of a plane delay).

IMG_2549 (My life in three baggages)

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On the flight from Saipan to Guam — equipment in tow.

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Taking a break in a lounge, just a little overloaded with stuff, always ventilating the patient and never being able to take your hand off that bag.

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Sunrise on the other side … i.e. America! Well, Saipan was America, kind of.

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Touching down!

As you can see, we made it there. I didn’t really have any time to process that I left and it was a bitter sweet time stepping out of the hospital that last time. You wanted to say ‘bye’ or ‘see you later’ to everyone but at the same time were with a patient who had been waiting desperately to get off the island.

I will miss so many things, one of which will be these transports. I say this because one of the things I as a physician always want to do is give the patient the best possible level of care — a part of that in Saipan is being able to transport them to a higher level of care when it is the best thing for the patient. I can’t believe my trip was cut short this way but, as many people said as I told them about my early departure, what a way for me to go — helping all the way up to the last minute.

 

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