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 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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(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.


(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.


(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)


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


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.


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


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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The Impression of Saipan

I left earlier than planned because of an urgent medical transport with a baby to San Diego but find myself having penned this in my head over the last 36 hours of sleep-deprived insanity. (Will write about this later) I started thinking about what to write as I watched the sun set in Saipan but decided to take it in rather than clutter my mind.

Saipan has made quite an impression on me .. a lasting thumbprint with visible ridges and a pattern unique and complete all its own.

As I listened to a podcast to stay awake on the transport, (Click here to read about my experiences on transports) I listened to a podcast about the impressions people can have about other people — sometimes largely misguided and sometimes very accurate. This applies specifically to first impressions but can apply to any impression you have about anything or anyone. As you get to know something better, you hope that your impression of that thing or that person is becoming a more accurate impression but sometimes time causes biases that dig themselves deep and steer your impression in the wrong direction. I think it takes time and space to be able to see that clearly – or – in my case, what feels like a very abrupt separation from that thing to be able to see it clearly … aka Saipan.

My impression of Saipan (as mentioned above and hopefully as evidenced by my many blog posts) is one of that feeling of ‘home’, that feeling of being appreciated and garnering perspective from that, that feeling that the things you think are everything are not really as important as it seems and that some little things that you may do every day may be more important than they seem.

I worry and write about this because Saipan’s impression as of late, specifically in the last year, is starting to change before our eyes. In the last year, a casino (reportedly already one of the top five or ten grossing in the world) being developed, gun licensing, outside developers coming in and buying out property and many of the local political power people, significantly increased drug use (as evidenced by seeing babies affected by mother’s using drugs) all have led to what can be a very biased opinion of Saipan. It’s one that makes me anxious because it paints a picture of an island running off of the spoils of a casino where children grow up to work at the high paying casino rather than seek an education, where preserving the island is not a priority for the sake of a quick source of money now, where the benefits of living in Saipan become centered around economic benefits of a boom rather than the life benefits of being able to head to a pristine and empty beach after work. This year has brought to light significant issues with the visa/permit status for many outside workers who have made their lives (and their children’s lives) in Saipan. A cap has prevented many people from getting a renewal of their work permits/living permits and is forcing people to leave Saipan until their new contract can be submitted when the new fiscal year starts. Children are being either taken out of school so they can accompany their parents as they are forced to be ‘exiled’ until their new permit kicks in in October or are a cause of significant anguish as parents scramble to find temporary childcare for their kids while they leave the island. This cap affects not only my patients but my nurses at the hospital, a specialized group of people who have a certain skill set that local nurses have yet to acquire at the fault of who-knows-who. Can you see the impression that this is building? The front pages of the newspaper are splashed with stories about large company investments or failure of the basic infrastructure of Saipan (one example is CUC – aka the power/utility company – falling apart because of lack of funds and plans on investments in technology that is expensive and does not improve the problem). And there is a lot that isn’t reported in the paper too which makes it easy for those that live there to have a singular view about how things are going.

I have an entirely different impression – one born out of time in one place, lots of quiet time of reflection, and wonderful friends that are encouraging and uplifting, who believe in you no matter what comes or what transpires. They come from different walks of life with different worldviews at times but the shared experience of the ups and downs of a simpler life reminds us all of the simpler joys of just being friendly, neighborly and grateful for what we do have. In a place where any favor I need is a phone call away or a five minute drive, it will certainly make it difficult to return to the ‘real world’ but I take with me my impression of Saipan. I am glad that the intense good outweighs the bad, that I was able to give so fully to the island, and receive so fully as well.

Everyone asked me if I had some last things I wanted to do and the answer was already ‘not really’ (p.s. Blogs coming soon of an amazing four day itinerary of Saipan). I really wanted to spend time with people but I know I have done that already. I wanted to be outdoors and swim and run and drive with my windows open and watch the trees fly by and hear the birds, but I have done that already. For now a total of three years, I have learned to live fully and work fully and I will bring that with me wherever I go. I could not ask for a better impression to take with me.

So, see you soon Saipan! Thank you to every single person and thing that made me feel this way. I know many of you spent a lot of time thanking me in the recent weeks but that gratitude only helped me see and appreciate my gratitude more. I wish I could do a better job of expressing how much I want to thank you but there are no words. I hope you know how loved you are.






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A high compliment

Sorry for being MIA — I’m quiet busy right now and will probably post more when I have time. I recently had relatives over from Taiwan to visit for four days — so plan to post an action packed 4 day itinerary for you all soon.

It’s been a hard past two weeks of a combination of good bye’s, busy work, and just being plain old tired. But, I knew I had to record this for myself. After I sent my car (click here for more on how), it really hit me that I was leaving since every time I got in a car it was not mine and it was borrowed. I saw one of the two remaining other bright red Mazda 2’s on island and thought, there’s one less on island than there were before. It’s quite common here to be recognized by your car and I’ve gotten many a text because my car was spotted in some parking lot .. “are you at ____? I just saw your car!”

As this has set in, I find myself thinking back to when I first moved to Saipan 4 years and 3 days ago according to the side bar. I can remember my first beach — I drove to Pau Pau and was there in my jeans and a tank top and I had someone take a picture and they told me there was a clump of blue starfish. (I don’t think I’ve ever worn jeans to the beach every again since that day) — but I cannot really remember that feeling. I don’t remember what it’s like to not know Saipan. It’s totally engrained in me now. I find myself trying to capture a mental image of what it looks like to drive down certain roads – not because I haven’t done it often but because I’m afraid I will forget what I take for granted on a daily basis.

So, I thought I should record some of these feelings so I wouldn’t forget them later on.

The other day, I was at the optometrist doing a follow-up check-up and an employee was helping me. From behind the machine as I stared at a little yellow dot, trying not to lose my concentration (or tear up which was really what was happening), she said:

I know I haven’t seen you much with my kids, but with you here, I have felt so much more comfortable, less stress, just knowing that you are here.

It just hit me then — not that it hasn’t before — I can mostly think of many examples of people who I have been influential towards, events that I have participated in in the community, policies, etc that I helped change, opinions I shaped, etc but it’s hard for me to quantify anything else. How much have I been influenced, moved, my worldview altered by the non-quantifiable things that my friends and second family here have had on me in Saipan. I was talking with my cousins and they asked me how I knew so many people from so many different walks of life — of different ethnicities, socioeconomic backgrounds, age groups, from different areas of employment (laywers, teachers, business people, service industry, etc). I didn’t realize until then how many people that I interact with all the time that are different than me. These differences have made me see positives in people that I may have midjudged prior, they have made me realize things in me that I want to improve to be more alike with them, they have revealed how truly similar people are at their core.

Suffice it to say, I will miss this place. Not that this cannot be recreated elsewhere, but I am thankful for what it has done to me thus far and am so fortunate to have experienced and lived these three years here.

More to come I’m sure..


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