August 12, 2022

by Dr. Plastic Picker

Yes! I’m blogging while taking the PALS (Pediatric Advanced Life Support) Pre Course Assessment. It’s an every 2 year course that most pediatricians take, and all trainees take. Since it’s been almost 19 years since I graduated medical school – this must be the 9th time right?

I’m right now on Section 3 on question 8/29. Since it’s the pre-course assessment, I can toggle back and forth between blogging and answering questions. So far so good.

But I really wanted to take this morning while I’m on my PALS journey again for the 9th time, to use a play on words and think of the real PALS in life. This week has been one of self-reflection. I’ve been asked and asked myself, what if I was asked to lead again? And the honest answer is, there has been a silence from the other side and I now realize that it was meant to be. I think initially I was a bit hurt, but now I know it came from a place of love. I was honest and open about my burn out, and why I chose an alternate path. I’ve blogged about it at least 700 times. I realize now that when I articulated my hurt, that I was listened to. And those that were higher than me with responsibilities, understood and have left me alone. Sitting here taking PALS for the 9th time. I truly appreciate it.

I was with my daughter at her physical yesterday morning, and I chatted with her doctor and my friend. My daughter’s pediatrician is the remnant of my Assistant Boss times, the one that I’ll keep in contact with. We talked about my daughter, and in general my family’s health and I had a stark realization yesterday. The kids are healthier since I voluntarily stepped down from Assistant Boss. I’m healthier. And I think as evidence from this blog, the earth is healthier. I took time for myself yesterday and visited my brother’s family, and laughed with my nephews and my sister-in-law. We ate carbohydrates and knew that was part of a our healthy life, because we were creating food memories yesterday. And I didn’t do that before. The way I’m wired at work, is that when I commit to something I commit with my whole heart. And honestly 90 fractious pediatricians to love with my whole heart, was breaking it. I couldn’t understand why sometimes when my whole goal was just to make everyone’s life a little bit better by reducing after hours shifts and managing the part-time doctors and trying to find the perfect schedule for everyone, that sometimes folks would lash out. Or at least I felt they were lashing out at me. Those comments still hurt, and I’ve dealt with it and just put distance between myself and them. Now that I have no official position, it’s easier.

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August 6, 2022

by Dr. Plastic Picker

There was an important lunchtime regional meeting I needed to be at. I had to mentor the family practice residents and was mentoring also one of our premed Eco-America interns on our climate and art project. I was a good doctor in the morning, listening to my patients – some of them I have known since birth. In my new office in the new hallway of the clinic I have worked essentially my entire general pediatrics career, I’m allowing myself time to practice the way I think pediatrics should be practiced. I want to fundamentally heal children and families and that means taking time. The residents too take time. They deserve teaching and my consideration, as does my premed student.

But the only one I can control is myself, and my own time and my own efforts. This is partly why I’m satisfied to have finished my 5 years as Assistant Boss and not be beholden to anyone outside of my clinical duties, which I’m paid for. But in that balancing act and trying to get patients in, I didn’t finish into well into lunch. The regional meeting I wanted to present the #fightfor1point5 divestment talk finished early. I did get the opportunity to talk to our regional leads and review some of my thoughts.

My confusion today and yesterday is – will it really be just one slide? Will one slide or 5 slides be enough? I can put the rest of the slides in an appendix for sure, but is it really going to be that easy? I actually think it might be, because that is sometimes how great change happens. It’s the tide of history and the arc of collective human thought that bends toward justice, toward right – and I just happen to be within this tide this arc of history. It feels like the world knows what it needs to do. I don’t mind being the one to bring the proposal up. Everyone has leant forth some advice and basically said these big decision makers have just a few minutes to hear us, and keep it short and your request simple. But is divesting from fossil fuels really that simple? My request is simple, but it’s huge.

But perhaps it’s because they’ve been thinking about it too. This has been brought up before and in a more contentious way. I realized now I did dodge a big bullet by doing it my way. My son calls it weaponizing cuteness and working within the system. You can’t burn the entire institution down, and it’s not in my collaborative nature anyway.

So I’m here this morning and going to proceed with other projects and I need to do our taxes and be a volleyball mom this weekend. But I’m still confused but oddly think that this is meant to be. It’s probably going to take just one slide and the weeks I spent on my thought process and talking and preparing, was probably meant for my own growth and not to be showboated in front of others. That would be the greatest irony, because I was ready to talk and to change hearts. But the hearts were always there. And that is the beautiful thing about being open to nature, to emotions and to love – you see those hearts and can recognize it in others.

I still think I’m going to include this slide though. I just love it.

August 5, 2022

by Dr. Plastic Picker

I’m choosing to be brave today. My eco-avatar me and the real me, that holds a position and a job. I have been working on this powerpoint for the last 2 weeks. It was mostly me sorting through my emails and messages from others, and collating my thoughts and furthering my understanding about fossil fuels and the importance of divestment.

My body was tired yesterday, but I realized after reflecting how much I had grown in my understanding of fossil fuel divestment and how involved I’ve been in this at the state level and nationally. My emotional fatigue and brain fatigue was well earned. I shut it off last night, and found a new sweet (but not too addictive) early 2010 K drama to watch. I slept deeply last night. When I do real impactful earthwork, that it what happens.

I posted around social media and the Facebook groups about the talk that I am giving. It’s more for me to remind myself to be brave in this work.

On our internal MD Facebook group, I was open and honest. And the positivity is real. The camaderie is real.

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August 1, 2022

by Dr. Plastic Picker

I’m still trying to process it all. It was such a beautiful day yesterday. Michael Tran who was our leader back in our undergraduate days was the Co-President of the Harvard Vietnamese Association and Director of RYSE, Refugee Youth Summer Enrichment. Mr. Plastic Picker and I had been involved with BRYE, Boston Refugee Youth Enrichment. Both had largely served the Boston Vietnamese refugee community back then. Dr. Michael Tran organized a reunion for Harvard Vietnamese Association alumni in California. A lot of people came. I mean A LOT!

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July 27, 2022

by Dr. Plastic Picker

This is my emotional journal through burn out, climate grief, and the difficulties of being a middle-manager MD mother. This is me documenting what it’s like to be on the other-side. I’m happy these days and that happiness is important to me and the earth. It’s only by knowing myself and trying to know people and understand them, that I can try to nudge them to help me save the earth.

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July 24, 2022

by Dr. Plastic Picker

I was feeling sorry for myself the last blog post. Thank you for the blog sympathy. I realized I hadn’t been blogging much and on the blog timeline, it must seem like I’m wallowing in my own self-pity of being a lone litter picker trying to save the earth. Underappreciated, hence the title of the last blogpost https://drplasticpicker.com/im-feeling-underappreciated-but-i-now-know-i-need-to-appreciate-myself-the-earth-taught-me-that/. That is untrue and I wanted to correct any misconceptions about the length of my self-wallowing.

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July 20, 2022

by Dr. Plastic Picker

The best blog posts come when I’ve working through emotions and I’m working through a lot of emotions this early morning at 5am. My body is getting back to a regular schedule, as the toll of binge-watching Kdramas has taken. I’ve honestly watched most of the really good ones, and I’m going through Kdrama withdrawal. Even good things can be bad for you, when they are consumed in great quantities. But I’m sleeping more on schedule and the earth is pulling me back into my normal circadian rhythm. I haven’t done an early morning plog to the beach in months, and I think I may head out this morning to get some quiet time for myself.

But yes I’m working through a lot of emotions this morning. I’m royally peeved because I bought this Matcha Green Tea Mix at Trader Joe’s and I realize I bought some sort of latte mix that is mostly just sugar, and only some tea. I usually buy the matcha green tea at Costco, but we’ve been trying to vary our routine and buy a larger variety of food. I shouldn’t be surprised because honestly Trader Joe’s is a lot of packaging and plastic wrapping. My latte doesn’t have the quality of matcha that I’m used to, and when you mess with Dr. Plastic Picker’s matcha- you better matcha watcha out! It’s certainly could be blamed on me for buying the latte mix but I just had high expectations of actually more matcha in the matcha green tea mix. My morning cup doesn’t look the pretty green that I’m used to. It’s a poor imitation.

This goes for unknown groups/persons that I’ve tried to pull into climate work. I’m not going to go into more details because I don’t want to be hurtful, and the climate movement needs everyone whatever they can give. Let’s just say there are groups or persons that want the accolades and as I dive into climate work, don’t put in the work. They want the pats on the head, and what I can give them – but I’m unimpressed with the work. And then there are others that I’m in awe of the care and consideration that they place on their projects. I think this is a reminder to me that I need to focus on the local, and ones I can meet in person.

That’s it. I realize some of it is that I am in general feeling like many women leaders underappreciated. Subtle phrases and emails, folks don’t mean anything by it – but we’ve been preprogrammed as women to be people pleasers. We all are. I’ve talked to some friends who are the most green of the green heroes that I know, and they are also feeling underappreciated and feel the imposter syndrome. And if they feel that, what chance do the rest of us mere mortals have?

I honestly just need to take time for myself. I’m going to start building my endurance a bit more and exercise. I felt like I was being criticized for how I was cleaning the rug in the kitchen by my mother-in-law, and that was just a ridiculous thought. And this is a ridiculous post but it’s the honest ramblings of an pediatrician trying to save the earth. I’m working on big important projects and everyone of those projects is more than anything else anyone else has done, yet I feel underappreciated? Isn’t that ridiculous?!!! And I realize that all of us need to learn how to appreciate ourselves and it makes it less exhausting and more sustainable for everyone. In the end the earth appreciates me, and I am part of the earth and I need to appreciate myself.

July 16, 2022

by Dr. Plastic Picker

I never knew Mr. Plastic Picker’s surname has a Chinese and Vietnamese equivalent. Per Wikipedia “It derives from the Chinese character 尹 also used for the Chinese surname Yǐn and Doãn in Vietnam.” My surname is the most common surname in Vietnam. I’m attached to it and did not change it. But it doesn’t carry the gravitas and responsibility that my husband has for his surname. My husband is the only son of the only son. Therefore our eldest son is the only son of the only son of the only son – in a family and culture that is still patriarchal.

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July 11, 2022

by Dr. Plastic Picker

I don’t talk about physician burn-out as much anymore. But as I get further from needing to talk about it, my own teen daughter brings it up here and there. I never realized how close we were to the other alternate reality of if I had not decided enough was enough – it was time to pick up trash and go to the beach. Then it was that decision a few months ago when everything was honestly fine with middle management and Assistant Boss, but I decided I wanted more time to work on climate work and spend time with family. I decided 5 years was enough of Assistant Boss, and as quietly as I could left without burning any bridges.

We are having a slow summer. It’s that beautiful time that I know will be gone in a moment, when both of our young people are here at home and still dependent on us. Our son is studying for his drivers permit and at 17, still has to ask for a ride. He’ll be driving soon enough and I’m happy to keep this one connection still strong between him and the adults in the house. Our daughter has friends that are traveling throughout the world, and she is here having a slow summer of mornings in the ceramics studio, afternoons practicing volleyball, reading and keeping herself busy. And I am still miraculously one of the people she still wants to be with.

So yesterday afternoon Mr. Plastic Picker had to again work extra shifts in the hospital, because that is what happens in his department. He’s still in the thick of middle management and surviving because I’ve decided I need to focus on him. I dropped our son off at a friend’s house for one of an endless stream of teenage summer get-togethers. They are seniors now and hanging out at the mall, beach, and doing innocent things like taking pictures with their shirts off and reenacting Lord of the Flies around a La Jolla backyard propane fire pit. I know because our son is close enough to us to text us some pictures, that his sister playfully threatens to keep as backup blackmail evidence. It’s a beautiful glimpse into a Southern California Suburban childhood that we wanted when we left Cambridge and our dreams of Harvard academic careers.

But after dropping off our son at his friend’s house, my now 14-year-old daughter was feeling restless with our relatively quiet weekend and wanted to DO SOMETHING. So I said, let’s keep the earth in mind and do something relatively close to where we are. We headed to Balboa Park and it was 430pm on a Sunday afternoon. We’ve been there before perhaps 6 months ago at 430pm on a Sunday afternoon, and I think it’s my favorite time to go there. There is parking as the days visitors are leaving. You can see the remaining stragglers who are still grasping the last moments of their well-planned weekend. There were couples sitting outside coffee shops that had already closed. There were families speaking Korean on skate boards around the plaza. New fancy restaurants were closed that were so fancy, that I cannot believe this is the same town I grew up in. I had forgotten my wallet and we only could find $5 in the car, and that is all we had. Only having $5 and knowing that we wanted only to drive as far as my electric hybrid car would take us but still remaining on the electric powered mileage part, had us wandering around the park on foot as San Diegans and tourists ended their day in Balboa Park.

As we walked hand in hand, and she was chatting her thoughts and I daydreamed about her future – she told me again what makes me sometimes sad but at the end grateful. I remember mommy when you were so busy, and angry sometimes. You would yell at us at times in the car, and I remember seeing a book on the table called “Stop Physician Burn Out.” And then you went to the beach and started picking up trash and you were happier. And in the context of her telling me this, she wanders into her volleyball tryouts and her new work-out strength regimen and how she realizes the running part she can stop at 30 minutes. She wants to concentrate on getting more touches into her volleyball regimen. I don’t comment on her body purposefully as I’ve seen too many mothers do this, and the downstream consequences of focusing on body image. And she talks about food in a beautiful way. We had just $5 and we bought a $4 ice cream. She wanted most of it, and she made sure we both had a good simple dinner at home which she cooked. And she mentioned off-hand that she realizes among the beauty tips on facial care that she is watching and the new hair cut she is planning and the new wardrobe that she is dreaming of, that at dinner it’s important to just add some tomatoes and fruit and it makes her body feel better and full.

That is the reality I live in. And I realize that the alternate reality was frightening closer than I imagined. Children especially teen girls need attention from their mothers. Tangential thoughts of your local litter picking pediatrician. It was a very nice weekend with only $5 to spend.

July 9, 2022

by Dr. Plastic Picker

It happened. I had been asked to contribute a short article to Sketches, San Diego Audubon’s quarterly magazine https://www.sandiegoaudubon.org/news-events/sketches-magazine.html. It was a short piece, and I was writing another piece with one of our students for a popular science magazine in the Yucatan. But during that time, I wrote from my heart. I’m writing and publishing more now than I ever imagined possible. I’m mostly just documenting my evolving thoughts as a pediatrician awakened to the climate and health crisis – and how I’m trying to help stop this existential crisis. Meeting so many interesting people with different ideas and training backgrounds, and then it percolates in my brain with my experiences as a litter picker – and something happens. And this article happened. Thank you San Diego Audubon. This article is a spring board to further bend the arc of history toward a livable planet for birds and kids.

ReWild: What’s Good for Birds Is Good for Kids

Wetland conservationists and pediatricians have a lot in common. The conservationists work to preserve habitat for endangered birds. Pediatricians advocate for a built environment that promotes children’s health. We also have in common the northeast corner of Mission Bay, which is critical to the health and well-being of birds and children. The ReWild wetlands site is a literal nursery for juvenile fish and bird species and is the figurative nursery we seek to make available for children to improve their health. This is how the collaboration formed between San Diego Audubon and the American Academy of Pediatrics (AAP) San Diego.

I work through the AAP California Committee on Environmental Health, trying to help move legislation to protect the environment as it relates to children’s health—a pediatrician’s prime responsibility. Climate change is a pediatric public health crisis. The long-term health consequences of climate change have disproportionately affected children, with increasing cases of asthma and higher rates of premature
birth. Children are the most vulnerable victims to climate-related natural disasters. Air pollution, heat waves, and water-born pollution affect little bodies more because their organs are still developing.
A child’s greater body-to-surface area of epithelium to total body surface area exposes them to more environmental toxins. Children will suffer the most due to climate change, especially those who live in
environmental justice areas.

Our communities need to commit to ReWild Mission Bay. The local climate change math does not add up unless we maximize wetland restoration. But when I think of the ReWild work, I also think of the possibilities of how this area can function to improve the physical and mental health of children. AAP San Diego has officially joined the ReWild Mission Bay Coalition to bring healthcare voices to wetland
conservation. Pediatricians as a group have spent many hours with wetland conservationists at this site. Working together, pediatricians and wetland conservationists are imagining how we can collaborate
and make this wetland part of community healing.

It is well established that reflective time in nature improves mental health. There is now a national call to document adverse childhood events (ACES). Children who have suffered more ACES have higher levels of toxic stress. This has been associated with adverse health outcomes like asthma, heart disease, and poor mental health. Programs that combine nature bathing, mindfulness, and mentoring from caring adults like healthcare professionals and scientists would be a nature-based solution to ACES. Rather than building more concrete clinics, would it be possible to practice medicine on the wetlands? Meandering the wetlands with children, together listening to the sounds of the marsh, noting the anatomical details of our bird friends, and then checking our own vital signs? I think we will all find what studies have shown—our subjective well-being and stress levels are improved. I imagine affordable and accessible primitive camping opportunities for local San Diego children, as camping is shown to be one of the most effective ways to address the sleep problems facing our increasingly digitized young people. AAP San Diego invites
you to come and meet us on the wetlands and let your imagination wander. Join us in this important work. For me, the northeast corner of Mission Bay has been a literal nursery—where I’ve brought
pediatric patients and my own teenage children to wander and heal. And this is where I realized after meeting wetland conservationists, that what’s good for birds is good for kids. San Diego Audubon and
AAP are aligned and working together for the Wildest option for the northeast corner of Mission Bay.

Vi Thuy Nguyen, M.D., is Assistant Chief of Pediatrics at Kaiser San Diego. She is a Fellow of Environmental Health as part of the American Academy of Pediatrics and serves as Co-Chair of San Diego’s AAP Climate Change and Health Committee