Aug 29, 2016

Uno mas

So I hate Tampa.

For clarification, and to avoid the wrath of a few Tampa Bay Ray fans, I've been to Tampa like... once.  And it was to take AP/CP boards.  And while I passed it, it was one of those experiences you get through much like you get through a divorce or the death of a pet.

Tomorrow, I get to head back to take what better damn well be my last major (1800 dollar) exam for the next nine years.  The cytopathology boards.

I'm not filled with dread.  I probably should be, since adulting has made me far less interested in cramming algorithms for post pap screening into my addled brain since I *literally* have an app for that.  So I'm doing a great deal of studying tonight to attain that ever sought triple board status.

There are a few pathology unicorns out there with quadruple boards.  Some are MD/PhDs with multiple subspecialties because they just hate making a livable salary that much or just really love knowledge, I don't know.

But I feel like a grown up.  I have a mortgage loan pending.  I took a tea tasting class.  I successfully argued a case against one of my colleagues (nicely).  I nailed a diagnosis that was reinforced to be correct after the chief surgeon made me sent it to Hopkins.  Despite crawling bleeding and broken from the bottom of the totem pole a mere eight weeks ago, exams already feel like this weird thing of the past.

Until Wednesday.  Then they're very much of the present.

I'd say more, but despite being a staunch materialist, doctors are superstitious creatures.  More info once everything is secured.  Until then, I have books to study so I can memorize information that doesn't need to be cluttering up my brain.  Keep in mind, I never plan to stop learning and adding to my information.  But I'd much rather be learning about new stains that have better sensitivities for tough diagnoses and recognition of rare disease patterns rather than things I can look up in 20 seconds.

In a sense, though I tend to do all right with them, I truly hate the whole multiple choice approach to medicine.  My diagnostic capability is not based on whether I can recognize a tyrosine crystal in a single poorly 2D image from a pleomorphic adenoma slide.  What is my triage method?  What tests do I run on a scant specimen?  If I have a malignancy of unknown origin in an elderly woman's pleural fluid, I don't need to have the "second leading cause of malignant pleural effusions" memorized and then try to figure out whether the questions as written ten years ago or ten months ago and whether a few things switched places on the charts.  I need a basic, streamlined workup that is most likely to lead me to the correct diagnosis for the least money and waste of specimen.  I need to know when to ask for help, when to ask for flow cytometry, and when to get a cell block and what stains to order on the cell block, and when to stop throwing money and time down the drain and call the clinician to ask for repeat collection.

That's what I do.  I don't parrot algorithms because if that were all there were to medicine, machines could do it and we wouldn't need doctors.

Such is life, and at least for now, it's a happy one.  So tomorrow I'm off to the land of evil and fairly solid beer (thanks Cigar City brewing).

Jun 28, 2016

Adulting

We have triumphantly arrived in Pittsburgh.  I suppose I'll stick around as a guide to the area/travel blog until ya'll tell me to shut up.

First off, this happened:



I'm a traditionalist so it's really not a wedding unless you're married by Elvis, given away by Thor, and handed to a man wearing a halloween costume made to look like a tux.

Because guess what you don't want to do when you spent the better part of a year in a panicked state?  Plan a wedding?  Correct.  Viva las vegas.  This was immediately followed by a trip in our party clothes on the NY NY rollercoaster.

Sidenote: slot machines are one hundred percent not fun anymore.  They've turned down the winnings *and* they're all voucher plays, so it feels more like a reverse ATM than a game.  At least freemium gaming occasionally gives you some food from the skinner box.

So we went with blackjack.  Play by the book, and you can drink all day and never really gain or lose a lot of money.  Play by the seat of your pants, and you will lose not only your money, but gain the full ire of the rest of the table.

But still, Vegas was fun and Cirque was worth the money.  But you know this.

We managed to get our last minute movers and roadtripped to Pittsburgh.

First stop: Hot Springs, Arkansas.  Lots of bikers.  Beautiful scenery.  Kind of an odd vibe.  Went to restaurant known for its incredible seafood that served salmon, scallops and tilapia.  This is odd for a restaurant in a pensensula of a lake

Second stop: Memphis TN for a deliciously redneck lunch.  Trout tacos.  That's what I'm talking about.  Catch my lunch.  Don't order it from the gulf.

Third stop: Nashville.  Nashville frigging rules.  I've never seen so much musical talent in one place.  Check out the Khromatiks.  We stayed there for a while before driving an hour north to the hotel.

Fifth stop.  Columbus, OH.  We felt like we should explore and wound up exploring a nearby restaurant and an episode of game of thrones.  I feel like it was the right decision.

Sixth stop.  Pittsburgh.  Sat on the porch of our new digs, wandered to the main drag to get an artisanal cup of coffee and met our landlord again for the walkthrough.  This house is so great.  It's so adult.  We have internet speed befitting the century.  I have a gas oven and a gas grill.  Everything is trees and rivers.

I had a traumatic trip to Ikea, as they all are, I suppose.  You wind through, eyes full of wonder, constructing the house of your dreams.  Then you get to that "self serve" aisle where you realize you've ordered 12 thousand pounds worth of crap into a car that only holds 4 thousand.  Employees watch you fail boy scout exams time after time as you attempt to wrap your entire car in twine, yet still that futon frame tries to make an escape for the back exit.

Then they closed all tunnels into the city.  Like think Dark Knight Rises but without ice to walk across.  Needless to say, by the time I got home, I needed a Xanex and a shower.

But the house!  The neighborhood!  The job!  Hooray!

I'm a grown up doctor!

Jun 18, 2016

Freedom!!! Freedom!!!

I've been blasting the Pharrell Williams song all over my house on repeat.  Maybe that's why my newly acquired husband chose that moment to go do chores.

Yesterday was the last day of training.  Ever.  Things were so generally chaotic yesterday that it didn't really dawn on me until I'd slept like the dead and woke up at 10:30 this morning.

I'm.  Done.  Sure I have one more board to take for the triple crown, but it's nowhere nearly as soul crushing as the others with lesser the consequences, but that's it.  I'm off to Pittsburgh with a song in my heart, invectives at my overpriced movers on my lips, and an epic party starting in a few hours.

Am I scared?  Oh sure, I have imposter syndrome with the rest.  Will I be able to hold my own as an adult; will everything work out, but that feeling is so overwhelmed by relief and happiness that I can go into it with a positive attitude and excitement rather than fear.

Leaving yesterday was weird.  It's been no secret that my training here away from my happy familiar faces of residency was pretty rough on me.  There were about three people I trusted, and one of them was gone half the year, leaving me lonely, paranoid, and generally regretful.  When I left residency and the now hubster picked me up, I was bawling.  Couldn't stop.  Just sat in the car and cried.  Cried on the attendings.  Cried on the friends.  Cried on the support staff.  Finally got to a nice lunch place where the owner knew us.  Had to excuse myself to cry some more.  Told him the food was fine; I was just losing my mind.

Drove to about an hour out where my Charleston-mom and Charleston-dad were waiting with my Charleston-dogs to say goodbye.  The girls climbed over each other in the SUV to lick my hand as I was presented with a fairly pricy pair of pearl earrings "because you love to dive".  A big platter of lasagna so her baby wouldn't be hungry on the trip to Texas.  More sobbing.

Yesterday as I negotiated phone calls, cleaned out my desk, and went on a signature scavenger hunt, and dealt with the general chaos of having a moving company shift your dates forward by 10 days to the start of work with less than a week's notice for a price that would easily by a CPO used car, and got all my "ducks in a row" as one of the few people there I trust would say, as I careened toward the end of the day and an hour beyond it, I just kind of strolled out.  Gave a tentative hug to a couple people who seemed more upset than I am, and walked smiling out into the humidity.

The party tonight may be a bit more difficult.  I will miss being so close to my family.  I will miss the friends who have adopted us.  But training?  Nah.  I'm good.  35 and I'm finally an adult.  36 and I'll have my own house and a dog.

I'm free.  Bring it on.

Apr 12, 2016

Coming full circle

Where to start; where to start?  Should I end?

I can't say I have a lot of advice for you all now starting in Grenada (or in Newcastle) other than good luck, really enjoy the time you have because you'll look back on it fondly (maybe not the harassment but otherwise) and work hard, but the island is so far away from me that it feels like a dream.  Nearly 10 years now since I shipped off, terrified, and a very different person than I am now.

I've alluded to and generally complained about the pathology job market being terrible.  I can officially say I've accepted a job offer that seems like an excellent fit for me, and we're really happy about it.

There's an official "we" now.  I'm engaged.  The impossible has happened, and no, there's no big wedding.  This year has been so stressful that doing anything other than a quick inebriated cakeless wedding just isn't worth the effort or money.

I can continue the "travelogue" portion of the blog to an extent.  For the past few years, my PTO has been used for less fun things - interviewing for a fellowship; the next year moving for fellowship and the year after applying for jobs, but having secured one with a healthy amount of time left, the future husband and I took off for the Belize jungle and had an amazing time.  It was the first I've felt truly relaxed in years.  Amazing country and who knew you could hop on Southwest for less than a flight to San Francisco?

The cytopathology boards are sometime in August.  Not too stressed.  Maybe I'm finally entering a time in my life where the exam difficulty starts going downhill.  Either that or the AP/CP exams just broke me entirely, which is likely.

Everything's winding down.  I'm in my last away rotation, which would be nice except it's been complicated by a knee injury sustained during crossfit, so now I need to get a scope stuck in my knee.  Then it's back to my main hospital to wind up my year and hopefully say goodbye to trainee status forever.  Not that I have any intention of ceasing learning, just that I get a decent salary and am higher than *someone* on a ladder.

So things are working out, for all the pain and difficulty.  It's been an insane ride, but a fulfilling one, and I've been extremely lucky all the way.  I wish a great deal of luck to all of you.

Oct 1, 2015

Polite Request

Ahem.

Attention scum sucking spammers.

This blog is not abandoned; however, your goals of making untold fortunes through convincing people to refinance their loans through you probably should be in favor of doing virtually anything else with your lives.  Seriously, go empty that garbage can.  Now empty another one.  Congratulations, you just found something more fulfilling than spamming blogs.

In short, you're dumb and your mother dresses you funny.

We now return to waiting for me to have something relevant to blog about.

Aug 13, 2015

Board certified and it feels so good!

So apologies for the delay, but yes, on the last week of July, a mere 12 weeks after taking that nightmare of a test, I received confirmation in the form of a nondescript email (or more accurately by my refreshing the website every ten minutes for 12 weeks and driving everyone crazy) that I was "successful" in both the Anatomic and Clinical Pathology portions of the exam.

So I'm a double boarded pathologist, baby!  At the end of this year, if all goes well in Cytopathology, I'll be TRIPLE boarded, which I believe doubles my mana on all offensive plays.

As far as the fellowship, well, there's no place like home, but I'm getting really spectacular training and experience.  But I do miss my own office and my surrogate Charleston family.

Now, the greatest challenge: Finding that first real pathology job.  Clock is ticking!

But yes, the short version:  I PASSED!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Jun 8, 2015

Now is as good a time as any...

I took the AP/CP pathology boards in the middle of May, far earlier, as I mentioned, than I had previously anticipated, and wanted to update everyone, save for a few things.

1.  The ABP is absolutely *insane* about giving any slip of detail about the exam, to the point that they asked us *directly before taking it* if we used rememberances, and better yet, if we knew anyone who used rememberances.  This strikes me as overkill, piles on the stress at a bad time, and has a "are you or have you ever been associated with communists" feel.  It was a continuance of a lecture I received at an event a couple of years ago delivered to us in a tone of voice more fitting for disobedient children than doctors with a minimum age of 24.  The simple fact of the matter is if the variety of honors codes and oaths haven't gotten to us by now, nagging us in the minutes before a 2300 dollar, 16 hour exam probably isn't going to ferret out the evildoers and it's disrespectful to those going through it since the vast majority of us are not poring over half-remembered previous questions for guidance.

2.  It's hard for me to critique the whole process since 1) I like my job and they're the gatekeepers 2) I know some members on the ABP and they're cool people that I can't imagine are responsible for the babytime fun talk 3) I don't know my results yet, so whether that monster of a test bore fruit or not is beyond me.

3.  The end of boards corresponded with having a bunch of administrative nightmarishness drop onto me from the future employment end, which then corresponded with getting a terrific headcold, so I've spent more of the last week curled on my couch crying rather than blogging.  I got better.

Things I can say:

The shorthand.  Pathology residency usually consists of a dual program comprised of Anatomical and Clinical Pathology.  This lasts four years (doing either separately is 3 years), and to be employable in a difficult job market, most people complete a fellowship.  Some fellowships are boarded (like cytopathology); some are not (like gynecologic pathology).  Nearly all pathology fellowships are a year long, contrasted to some of our clinical colleagues that have three year fellowships.  Fellowships are typically compensated like an extra year of residency.  Being board certified in AP/CP pathology is pretty much a requirement to "sign out" anything in pathology, which is, have your name on a report and the report goes into a system.  Since my residency is two parts, I'm technically taking two board exams, which were administered on consecutive days.

Pathology exams, unlike almost every other field, and allegedly due to the microscope requirement, are held in Tampa, Florida.  There are several weeks between May and early July in which whole residency programs are assigned dates to show up and attend.  It's expensive, time consuming, and notoriously difficult.  You are usually at least there with your equally miserable colleagues, as I was.  So knowing that, let's go.

-I was told by everyone that it was an awful experience and virtually everyone feels like they failed.  This in no way prepared me for how bad it would actually be.  I didn't think I'd feel better off than anyone; I just underestimated exactly how heartbreakingly awful the process is.  I mean, few people feel great after the RISE, but this was like being kicked in the gut repeatedly by someone wearing steel toed shoes while another person stood above you describing the details of your dog dying.  Just awful.  I came out too beaten down to cry, but several others did.  The worst part is coming out after your first day feeling like an utter failure and knowing you're going to have to start the whole process over again the next day.

-One of my colleagues and I managed to separately utterly ruin the confidence of other people coming in to take it the day after our last exam by her "that was f-ing awful" (and she never swears) to a man she thought was in business (taking it the next day) and my response to a wide eyed girl in the elevator who said "Did you finish your exams?  Congratulations!" to which I responded "it is definitely wayyyyy too early for congratulations".  I need to stop talking to people in elevators.

-Mild gripe.  This hotel has hosted this exam for a lot of years.  Everyone in the hotel knows you are there to take the pathology exam, and if they didn't, the fact that you're checked in under the exam rate should tip them off.  As such, call me Ms. Sancho if you like, but please don't say "Good luck on your exam, Ms. Sancho".  If you know I'm taking that exam, you know we're all doctors.  Or better yet, don't wish me luck.  Just kick me in the shin as I'm checking in, so I know what to expect.

-That hotel is nice but absurdly dark.  When you already feel bleak, having Fight Club lighting doesn't improve your mood.  And I had a gorgeous "lobby view" which looked out into the across offices.  The only thing worse than working in a cubicle is watching other people work in cubicles.

-Computers broke.  For an exam that costs the same amount as a lower model used car, getting the software on par with the SAT would be cool.

-There are totally other culinary choices than Panera.  Are you people blind?  Or did you think a giant shopping mall doesn't have a food court?  Also, while the hotel is a'ight, their room service ain't not bad and you can get them to deliver a burger to your room during the exam break.

-Everyone I know says Tampa is a really nice place.  I honestly feel so dejected from the exam that I have absolutely no desire to go there again in the near future (though if I failed, I have to go back, and if I passed, I have to go back for the cytopathology exam).  People asked if I was going to stay over the weekend (since I was off Tuesday-Friday) and check out the beaches.  I scarpered back to Charleston as fast as I felt safe to drive (the next morning).  The only reason I didn't leave earlier is I didn't feel equipped to handle a long drive when I was that wiped out.

-Exam study destroys your health.  I may have already mentioned that.  The months leading up to the exam did more damage to my back than if I'd been moonlighting as a crash test dummy, and I had to up my blood pressure meds back up to a full pill.  Feh.  I'll find out I passed both exams the day before I have a hypertensive stroke.

So there's that.  The rest of my non-reporting has been a frustrating flurry of paperwork.

Took ACLS, and not only passed it, but had the instructor out at my honey's wrestling match, in which a man was concussed.  I did about 5 seconds of voodoo "doctor" neurological hand waving in front of the concuss-ee's face before going outside and getting the instructor/former medic to come help, so worth the price of admission I guess?  Still no excuse for training pathologists to run codes.

Paperwork is a nightmare.  It never stops being a nightmare.  Even when you think you are on top of *everything*, something will come back to bite you unexpectedly so prepare for it.

An example:  In between college and medical school (A LONG time ago), I worked a number of odd jobs for money, as one does.  Since there is a noticeable gap between school attendances, I didn't want to just write: "2004-2006: Played Halo.  Ate at Taco Bell".  So I had the main time fillers listed without much detail (since it's completely irrelevant to my present job), and they've been sitting on my CV for nine years, unmolested by SGU, the ECFMG, the Step exams, ERAS, residency, the state licensing board, or the FCVS, thus I had no reason to expect that one 3 month entity, in the interim, was progressively burying any evidence I ever worked there, up to and including absorbing the entire company into another, shutting down the office I worked out of, and possibly salting the earth behind it to ensure nothing would ever grow.

This is where you go from being mildly annoyed that the government is always spying on you to relying on it.  As I scrambled to not fail my employment history, I found that the usual suspect for being up in your business, the IRS, was tied up in hacker attacks.  I briefly considered whether offering some cash up to a Ukranian mobster would get them to relinquish my ancient W-2s from the IRS website, but I put that up as Plan B.  Nothing yet at the social security office, and apparently there isn't a master number where you can just desperately punch in your social security number, caution to the wind, and get a full print out of your work history, shoe size, and social media posts.  Big Brother sucks at being Big Brother.

Fortunately, where the government fails at creating a dystopian nanny state, the internet always has your back, so I was able to sufficiently cyberstalk an old work contact based on a long forgotten forwarded email to get employment verification.

So that was stressful.  Pretty much, spend a few days crawling through all your paperwork, including your CV.  Now pretend you're on an episode of CSI.  If you can't link the soil on your shoe to that barista job in 99, strike it from your CV so it doesn't pop up again to testify against you in court.  I spent a terrifying couple of days convinced I was about to be broke and homeless because the software staffing markets in the early 2000s were someone volatile.

The final date until the move is approaching fast.  I'm really going to miss Charleston, and I've come to think of it like home, but Texas will be a whole new set of opportunities.  Let's hope that somewhere in late July or early August, you'll get the second to last of the "I PASSED" blogs and not a "NO I CAN'T DO IT AGAIN!!!!" blog.

Apr 17, 2015

The more things change, the more they stay the same...

So here I am, a full five months after my last blog post.

My moving date to head to Texas is June 19th.  The dreaded boards, moved up for what seems to be the sole purpose of panicking my class, are May 13-14.

I have less than a month to determine whether I learned enough in the last four years to be a board certified pathologist.  I have a month after that to make all my peace with Charleston, do all that stuff I meant to do, and see all those people I've had to put off under the guise of "sorry, I'm studying".

I now have a great deal of real world friends in addition to my fabulous colleagues, so while the colleagues understand "Hey, I'm not going to your Game of Thrones party next weekend because I need to compulsively hit flash cards", the real world friends with jobs and homes and dogs are like "We never SEE you anymore".  And they don't.  And it's sad.

But tests tests tests.  I definitely feel anxious.  I was always on the smarter end of the spectrum where I've been, so while biochem sent me into a self-induced fear spiral and I never quite grasped pharmacology, despite my tooth gnashing and panic, I was in the upper bracket.  My social life was just not really in order.

Now, the situation is set perfectly.  The hospital, upon seeing all the fourth years freak out at the time announcement, pretty much freed us from clinical duties for the duration and sent us to our offices with 10,000 dollars worth of books.  But I'm not the big fish in a little pond anymore.  I'm easily not in the top half of my brilliant colleagues, which is fine, so long as I'm in enough of the top part of the country to pass the exam.

Still, I don't feel the acute panic I have in the past, I think just because I've grown up and I've gotten too tired of always stressing about it, since it rarely helps.

So I have my system, and you know what Vegas says about people with a system.

Every day is a different topic.  I use the new knowledge to make flash cards.  I set alarms for an hour and every hour it goes off, I drop and do 10 push ups, 15 situps and then make a hashmark for both on my calendar.  When I have enough hashmarks and enough flash cards, I can go home.  At home, or at the Barrel, which is even better, I can iPad my way through the flash cards.  Then repeat over and over.

It's dull naturally.  I like the material, but I can't paint a picture of that as being a laugh riot, but it's the whole first year of medical school thing all over again.  Take a big test.  Be afraid because you're going to a new place.  Hope you do well in the new place.  Be prepared to take another big test.

I have my permanent South Carolina license now, so I'm now technically a doctor.  I'm working on my Texas training licence.  More of those infernal steps I told you about.

So then, do my cytopathology fellowship, and then, take another test, apply for a job, and maybe that cycle will finally end, and I can look back at the last 10 years of my life or so and say "Yes, I am now a doctor.  Officially."

Speaking of doctor things, I have to take ACLS now despite managing to never take it at any time in the past.  Having pathologists run codes is a terrible idea, I think anyone can agree on that, so that'll be another 200 dollars and two days, and worst of all, a day of testing the immediate week after the Tampa tests, but what's a girl to do when she needs that J-O-B?

Other things.... I ran the princess marathon, managed to run it the whole way through, and was both really glad that I did, and really glad that I got to go to Universal Studios and Islands of Adventure since I haven't been there in over a decade and everything's all built up and cool.  The princess made me feel like I can accomplish something, so there was that:

You know, even if I wasn't really a princess, but an English school girl, but my point remains valid.

I also managed to squeeze in the Bridge run since I kind of bombed it last year.  My goal was to get a sub hour time, which I missed by 3 minutes, but it still made me feel pretty good about myself, and I didn't throw up.

Committee life has been good also.  We did an extended trip to Key Largo in January, and I got to go scuba diving for the first time in forever.  We've also never been to the keys, so went down to Key West to check out the Hemingway house and all the six toed cats, the conch sandwiches, and 90miles to Cuba, and of course, the sunset.  It was an incredible time, and I got to see a friend from medical school due to the most random of coincidences.  I still miss the connections I had there.

Last month I hit Boston at USCAP and realized the boards were getting to me, because I'd left the boyfriend at home, and it was probably the most depressed I've ever been out of state.  I finally got enough enthusiasm to take a run around the frozen harbor, but it was not a labor of love.  The speakers were great; I made a lot of connections, and I got to crash other programs' parties, but I really just wanted to be home.  I've come to love Charleston so much and it's really sinking in how quickly I'm leaving it.

Lot of paperwork heading for the new place.  We've already been down to pick out our apartment (with the help of my lovely aunt) and it seems like it's going to be a great place to live.  I've already distanced out the Trader Joe's, Whole Foods, and closest Ethiopian restaurant cause I'm 'that guy'.  Then all the paperwork.  Gotta get that ECFMG certificate out again.  Gotta find all those step scores.  Gotta write to the school again and beg for my transcript.  It never ends.

So now it's just study study study drive to Tampa and breathe.  See all my friends, kayak, go out to dinner, go out to parties, and the like, but now, back to the books.  Hopefully by the next time I post, you'll have a "I'M FINALLY A REAL DOCTOR; NO THIS TIME, I ACTUALLY MEAN IT, I'M BOARD CERTIFIED!!!" post. I truly hope, at least.  And we'll see whether a Caribbean MD was really enough for me.

Dec 15, 2014

And the beat goes on

Time is whipping by really quickly.  I've always been a terminal procrastinator, and that applies to things like "seeing things as being far in the future when they're quickly approaching", if that makes any sense.

In my last post, all the stuff that's either in the past or in the immediate future seemed so far away.  And then it was here.  Christmas with mom-visit, New Year's, call week, dad visit, next week is San Diego.  The week after that is Nicaragua.  Where did the time go?  It makes me think strongly of the board exams coming up in 18 months and how simultaneously long and short that time seems.

It's also 18 months until I leave Charleston, so like my fellow third years, I'm compiling my Charleston bucket list.  Go to the plantations, eat at about 15 different restaurants, run the bridge.  That sort of thing.

I did cross the Biltmore off my list, which is kind of cheating since it's 4 hours from Charleston, but my mom's visit for Christmas went splendidly, I kind of killed myself cooking both because I had the time off (hooray!) contrasted to last Christmas, and because my boyfriend scored a 500$ gift card to Target during his company's gift exchange, and I stole half of it to get a kitchenaid mixer because the older I get, the more dominant that second X chromosome becomes.  So I did prime rib the first night, lobster the second night, and then we hauled it up to Asheville for Christmas banquets, gingerbread competitions and a candlelight tour (and of course, wine tasting) through the Biltmore.  Lovely, truly.  Pricy, but lovely.  Too brief a visit.

Incidentally, the new format for blogger not only tends to kill me but has an incredibly sluggish response speed to my typing.  It's currently listing my last paragraph as a misspelled word, so apologies if this entry seems curt or strange.

The next week I was covering surgical pathology so that others could enjoy a free New Year's week, though I still was able to get out pretty early on New Year's Eve and secure the party at the Alley, as we did last year, though this year without immediately jumping in the car to drive to New Orleans the next morning.  I'd say I feel more comfortable with surg path now, but that's usually the sort of statement I make before everything deteriorates spectacularly, so we'll hold it off for now.

I felt relatively refreshed entering my call week after that, though it does lead to the tricky situation of really eating into the clinical pathology time as I'm frequently consumed with the AP side.  It's important, but I've felt in the last six months like a lot of the lab time becomes expendable, and that's concerning for people that have their eyes on the test prize.  It's something to watch for, certainly.  Anyway, I've been in a odd little work funk lately.  This kind of culminated in my call week.  I feel way more comfortable at each task I'm assigned, but when they overlap each other, I feel like I can't

And the beat goes on...

Things that have happened since August...

Well, now I'm halfway through my final year of residency, hurtling toward fellowship.  I have, as of last week, registered for my AP/CP board exams with approval of my license and medical school diploma.  The registration relieved me of 2200 dollars from what is thankfully my now dwindled educational fund.  I spent my last thousand (minus what the hotel costs will be) on a cute small collection of books from the "Biopsy Interpretation of" series, because I know how to have fun.

Thank goodness for that educational fund, man.  When you're interviewing for residencies, find out how much it is.  Even if your salary is higher, that salary is going to be taxed, and if you're doing income based repayment for your student loans, that'll shave it right off, but the educational fund is free of all that.

So between May and June, my colleagues and I will be flying to Tampa to take this heinous double part test, which means I'm in the beautiful time of the year where fourth years begin to prepare for hibernation and become utterly useless for everything else.  And I'll be returning to studying once I complete this blog post, actually.

So the training journey is nearly at an end, minus that whole cytopathology thing.  At that point, there will be *another* licensing exam and I will hopefully stumble out of this whole mess as a triple boarded pathologist who will then be swimming in job opportunities (please?).

It's still a bright scary world out there.  Texas provides at least a stopping point on the road to "being grown" but after that, it's a big black hole.  The man and I kind of fell in love with Denver during the Great American Beer Festival, so maybe they'll open a spot for a youngster in a year and a half.  But still, everything is sort of winding up, and so much faster than seemed possible.  It seems like yesterday I was "covered in bees!" panicking to Grenada, and now I'm trudging toward an exam so far beyond the scope of the Step 1 that it makes the Step 1 look like SAT prep.

I have a weekend left of call... this weekend actually, which I traded for a lovely weekend in Asheville back in August.  Then I can finally do what I keep saying I'll do which is retire the scrubs.

I now have my permanent license in South Carolina.  One is necessary to apply for boards, and that lovely educational fund covers it, so it's official.  State law varies, but in South Carolina, IMGs such as myself cannot apply for permanent licensure until they've completed three years of training, so with that finally behind me, I have the unrestricted medical card.  Of course, I let my DEA license expire in the way back so I can't prescribe any of the fun drugs with my unrestricted license, so sorry guys, no illegal scrips for you.

Really feeling the whole "last of" tour of Charleston.  I've been steadily moving things off my bucket list (carriage ride, rooftop at Vendu, go to the Macintosh) and feeling the kind of "last Christmas here" sadness.  I've also been kind of wandering through apartment listings in Houston, and they seem nice.  Gotta make the commitment at some phase, and I will definitely need to get a bike.

When I'm not buried in microbiology lectures, I've been on kind of a health kick that was initiated by both getting cooking bling (Kitchenaid from last Christmas and NOW an overly expensive Vitamix blender) combined with getting suckered into running a half marathon in Florida in February despite nearly being killed by the bridge run, which was less than half the distance.  Still, I'm running for Save the Children, and they're a good cause, so if you want to toss a couple bucks my way in the name of securing me a permanent knee injury, the address is here.


You even get to see me dressed up like Alice, and I'm contemplating wearing the costume if I can make it without dying.

Running is an insidious creature.  It's been my go-to exercise off and on because it's cheap and easy, and kept me from going crazy (er) in Grenada.  Most of my running save for in Grenada has been on a treadmill, for years even, and it's only been lately that I've been pushing into the great outdoors, and I have to say, I kind of like it.  But I keep getting sucked farther in.  For years, I'd run on the treadmill, go all out for the first mile as fast as I could, and then walk/jog the rest in gasping bursts.  No strategy, definitely a no no for accumulating injuries, and thought a 5K was really all I was ever going to be able to do.

Well, and then a 10K, because the Cooper River Bridge run is a quintessential part of charleston, and why not, right?

Now I'm following my NikePlus trainer and arranging happy hours around when I can get the best mid-dusk run on the waterfront and working toward the half marathon.  Where I'll stop, really.  I won't get sucked into a marathon.  Well, at least I won't get sucked into an ultramarathon.  Check with me in two years.

Doing the training correctly has been helpful though, and now I use the first mile to actually warm up rather than suddenly sprint as fast as I can until all the bits and pieces holding my lower legs together start to snap and pop, and it's allowing me to really again appreciate how beautiful Charleston is (and how dangerous its drivers are).  My longest run so far without stopping at all is 6 miles, and the long runs are starting to feel better and better or at least "not as terrible as before".

And then with the work hours decreasing and the study crunch requiring more "can't sit around or will go crazy" ness, I've been cooking up a storm lately.

Few things... I've been poor for a while, and the story of the last ten years of my life has been accumulating things that 16 year old me would have scoffed at.  150 dollar running shoes?  Please, shoes are shoes.  Yeah... but the glycerines really help my plantar fasciitis.  Artwork for the wall?  So long as Rolling Stone still has full centers of Trent Reznor, you're just a few pieces of tape away from home decor!  Yeah... but frames.  Frames even make counter culture stuff look nice.  Cookware??  I mean, you can get a hand mixer from a store for 5 bucks.  What's up with these stand mixers?  It kneads dough for me.  Well, at any rate, I can tell you I'd *never* pay 500 dollars for a damn blender.

Sigh.  Last year, when I got my kitchenaid, a friend of mine said "The two things that changed my life were my kitchenaid stand mixer and my vitamix blender".  I trust said friend's cooking opinions, so I went home and googled vitamix blenders since I was poor (see above) and had no idea what they were.  My first response was laughter, obviously, because who would pay that for a blender?  In my defense, my blender is a combo gift from my dad and my boyfriend, if that justifies it.  All that's left for my Martha Stewart kitchen is a set of expensive knives and a set of expensive pots/pans.

But I'm liking cooking a lot, and I'm loving the fresh ingredients, though I'm being careful not to be one of "those" people.  "Yes, I'm making a smoothie with pomegranate seeds and chia seeds but I will absolutely *not* refer to either as a "super fruit/food"".  I'm finding a lot of fun recipes and enjoy challenging myself with them.  When I completely run out of medical school/residency related themes for this blog, I'll just start posting recipes.  I'm also having fun making my own flour.  The boyfriend is diabetic so I'm trying to keep the glycemic index low, and you can pretty much grind up *anything* and make fake flour.  There's about three cups of chickpea flour now occupying my cabinet because I found a bunch of dried ones on sale and went "Ooh!!!  This will be like magic!" because I have never had a good blender before, thus the art of changing the state of something (like beans to flour) still stirs a certain sense of magic and wonder in me.

The whole foods approach is also making it easier to make absolutely anything without needing to scrap around for ingredients.  No salsa?  Tomatoes, cilantro, peppers, and onions.  No guac?  Avocado, tomatoes.  No pasta?  Flour, egg, and water through the pasta maker.  No ice cream?  Milk, ice, frozen berries.  No rice flour?  Rice in blender.  I'm a year out from killing my own chickens.

So that's the update.  A six month crunch to boards and moving, punctuated by the growls of "pulse mode" when I'm making my morning smoothies.

Aug 14, 2014

Guess who's back, back again

Wow, this may have been the longest I've left the blog, eh?  Apologies, it is not so long and thanks for all the fish, at least not at this point.

It's hard to find a relevant point, to not make a blog intended to be a first hand look at life going through SGU and entering residency as an IMG, and not my personal livejournal and travel blog.

But Grenada is so far away.  I know there are changes on the island, new restaurants, new hotels, new apartments, probably new professors, a new deal in the making, the details of which I have no knowledge of, nor how it affects the school, nor how the teaching is currently going.  I don't know what their current going tuition is or how it compares to other schools in the states, nor what the current fixed interest is on graduate student loans and Grad Plus loans, all centers of my universe and increasing amount of time ago.

New York keeps me closer, and I still get up there, but again, that's all social.. the amazing people I met in Grenada or in Brooklyn and kept as friends.   Those in three year rotations are settling in for their real jobs, one in Maine, one in New Hampshire, others moving around, and I follow them as friends, remembering our times in New York as apartment parties and park walking and bar hopping, rather than as a harried short coated medical student only now realizing that not a single resident I worked with remembers my name, save for the one that miscellaneously showed up in South Carolina to do a fellowship and I ran into him at the gym.

I could talk about the effect of being an IMG on my current residency, but the simple fact is, there isn't one.  Pathology is poorly prepared for in *any* medical school (that's a rant for a different day), and once you're in, you're in.  I have two other IMGs in my class and a DO, and none of the former since (I hope we didn't break them), and unless we remind everyone else, which we will occasionally do with gusto since no one appreciates both the grass clearance and taste of goats, it doesn't flicker on their radar.  I got the fellowship I wanted without a lot of difficulty in the application process, which is considerably cheaper than the medical school and residency processes.  Things still cost a bit more, but that cost is offset by our generous education fund.  So what's life in a pathology residency in South Carolina like as an IMG?  Pretty  much like it is for any other pathology resident in South Carolina.  We eat, we drink, we ill advisedly run over the Cooper River Bridge, and we read books and squint at slides.  And no, don't call us squints.  We've seen Bones too.

And it's been difficult to write as of late because things have been so busy, but largely busy in a completely unbloggable way, though I can do my best.

Someday, I'll get to the end of Nicaragua and Christmas...

I mentioned I'd been accepted onto a committee, which holds meetings four times a year, which is both time consuming and incredibly awesome.  I've now been to three of them (San Diego, Chicago, and Portland) and have enjoyed luxury hotels, fine wine, and eight hours a day in a room with a ring of microscopes hanging with awesome people.  It's one of those things you never really picture in medical school because it seems so ridiculous.  Pathologists travel with microscopes?  These ones do.  So you just sit in a conference room, talk about cytopathology projects, and look at pap smears?  Yup, sure do.

I could attempt to start from the beginning but that would be difficult.  July was a rough month but also marked the meeting in Oregon's wine country, which also featured the nicest hotel I've probably ever stayed in, and it gave me a chance to make some headway on a project I've been working on for them, but it's difficult to do projects at home and projects on the road.

July was also noob month.  It marked the time that someone trusted me to be competent enough to train others in their most difficult rotation.

It was frightening, since I don't feel particularly qualified to teach anyone anything, but it also made me appreciate how far I've come in the meantime.  I'm much faster now.  Still slower than most of my colleagues, but so much faster than first year.  I know what to skip.  I know when to stain.  I joke with the attendings who still intimidate people.  I get praise from attendings who used to intimidate me.  The first years would ask me things that seemed silly.  Not stupid, but just... wow, that used to be me.

So hopefully they came out of it confident, but I know that it did wonders for my confidence.  Now I'm in an elective month, which gives me some breathing time, work on presentations, work on papers, and start the intimidating march to the board exams, which actually seems really scary.  Everyone is so relieved to finish the USMLE series, particularly when it's dragging into the Step 3, but then reality hits you.  Every test is the big one, and failing the dual pathology boards invalidates the others.

You're really all in too.  Fortunately I like my job because the reality of the loans sits in a panic on my chest from time to time where I realize... I can't go blind.  I need my eyes.  I can't get brain damaged.  I need my brain.  I need my ability to work.  I can't have a high risk pregnancy (didn't want a kid, so this is fine), I can't get sick for months on end, I can't rely on the boyfriend to support me (wouldn't want to anyway) and all has to stay on track because there aren't other options.  That's kind of the scary part.  With compound interest knocking my loan figures over 400 grand at this point, it's even more succeed or die than it was previously, but when I finished first term in Grenada, my world, and the maybe 20 grand I'd taken out for that term seemed like the world, and it seemed like my world was crumbling, and that was a moment where it could all go sour and ruin my life.

But twenty grand is nothing, ultimately.  It's in the low range of a new car (which is why I don't drive a new one).  Every value seems a little bit more insignificant once you pass it.  I remember before I started medical school when having bad credit and less than a thousand dollars outstanding seemed insurmountable.  It's weird how it happens when you least expect it.

But things are good with the boyfriend; things are good at home; with a few exceptions, things are relatively good at work.  I try to encourage the new people to talk to me or to talk to each other since I remember being so certain I was going to quit first year, so certain I would get washed out in Grenada, always so certain that each step would mean failure.

But despite the sweat generated by carrying a 400 thousand dollar loan on your back, I can't say I have regrets.  That's a question I get asked a lot as an IMG by prospective students.  Would I recommend others do what I did?  No.  Go to a US allopathic if it's at all possible.  Take out loans to apply to more schools and fly to them.  Don't wait after college.  Don't become a doctor at all.  It's a fiscally irresponsible decision.

But it was also the best decision I've made.  Medical school and residency have given me some of the best friends ever, and it kicked me out of my home state in the most immediate way possible, took away all promises of security and stability, and made me become something else.

Now I'm going to get back to work before I start quoting Arrow (because it's an awful show) but I'm back, kids, hopefully with something of value to say.

Feb 14, 2014

Extra Vacation Days? Go to Nicaragua!

I know I know.  I've been a horrendous blogger and haven't updated in a couple months.

First, I was insanely busy, mostly with decoration and planning and trips and all that stuff.  So I'll get into that.

Second, workwise, I've been in a mixed bag bad place.  Not like my first year bad place of "Flee medicine and take up professional scuba diving!  Everyone is horrible!  I'm horrible!"  Instead, it's been a weird mix of mismanagement, schedule horrors, and budget issues that has me regularly swinging back and forth between "I hate this I hate this; this is wasting my education" and "everyone here is awesome and my friends, and every program has drama and this is just our particular brand of it", but I didn't want to do a blog post where I'm like "BADNESS!" when it truly isn't, but I didn't want to do one where I completely ignored work and just posted about how awesome Asheville, North Carolina is, and how their hospital should hire me in a couple of years so I have local access to breweries, hippies, and mountains.

I'm not sure if I should go in chronological order, or if I should go in order of what's probably interesting.  Maybe reverse order.  We'll start here and end with Christmas.  If you get bored before Christmas, you can watch the Game of Thrones season 4 trailer obsessively on youtube until the show starts back up in two months, because that's what I do.  This will likely be divided into at least a couple of posts, because it really has to be.

We'll actually start a couple weeks ago.  Uhh... look!  Monkeys!







I'll also get to them in a minute, but this should hold your interest through the vacational whining I'm about to do.

Nicaragua was amazing and the people there are amazing, despite having the biggest string of difficulties from start to finish.  Ostensibly, we went there for the surfing, since my friends live at Folly Beach, are addicted to it, and I decided I didn't have enough dangerous expensive hobbies on top of ice skating, horseback riding, kayaking, hobie catting, and scuba diving.  I also like the bonus chronic injuries I inflict on myself by running regularly, which is really one of the most abusive things you can do to your body under the guise of good health short of eating unpasteurized cheese and rejecting vaccinations.  I had actually planned on running while in Nica, and we'll also get to why that didn't happen.

Getting there: Oh Atlanta!  Both Delta's main hub *and* completely incapable of dealing with any weather pattern people in the midwest would call "Spring".  There were 11 of us going total.  Two were planning to show up on the 31st.  The rest (us) on the 30th.  Boyfriend was coming back from a business trip, or at least he'd been planning to the day before we were going to leave.  With a stop in Atlanta.  Which is where he got to spend the next day and a half.

Our trip also required a stop in Atlanta, so imagine our shock when despite a thaw in most regions (including Charleston) by our flight departure time, it was delayed delayed cancelled.  No worries.  We're going for nine days.  But there were many of us, so we were getting answers of "Uhh.. some of you tomorrow, some the next day... last person in by Tuesday".  This was unacceptable.  Planner of the trip managed to sober up from our flight-delay bloody mary festival in time to get in touch with the exclusive airline people and managed to find a flight that could take us to Managua through Miami.  By way of Charlotte.  For reference, Charlotte is about four hours away.  With boyfriend still passport-less in Atlanta.

We waited for him to be freed from the deep freeze at Charleston's new Ethiopian restaurant (Oh thank all that is good and wonderful in the world!) and piled 9 into a big van to Charlotte for a cozy late night stay in the local per-hour quality motel.

At the airport, since boyfriend had been in the departure city but was with us, he was booked from Miami instead of Charlotte, which is a problem for about 17 hours worth of reasons, so he managed to get back on an original flight and hit us an hour later.

But we arrived in Managua!!  And got rental cars and made it to our overnight stay there without being stabbed or running over a motorcycle.  Nica beer, rum, and late night gas station snacks were had by all, we met all members of our party and headed out for our incredible beach house in Playa Colorado with its amazing staff.

Near our arrival, surfer #3 aka also "guy getting married on trip" was not doing well, and was confined to quarters with an illness I'm referring to as the "James Island flu" since we apparently brought it with us.

Despite his infirmary, the beach house was kicking:



We hit the pool the first day, because duh, and heard one of our party exclaim from the backyard about the monkeys.  Remember the monkeys?  There were monkeys.  If you've been reading since I went to Costa Rica (you poor poor soul), you know that despite having an anthropology degree with a primatology adviser, everywhere I've gone that you're supposed to see wild monkeys has been utterly monkey free.  Until now!  Ha!  Howler monkeys!  In the trees!  With babies!  And hooting in the morning!  Awesome!!!

We had an awesome woman that cooked for us, provided beer and rum, and cleaned.  I am happily full of rice, beans, fish, and plantains for a while.

We saw our first sunset in Nica, played in the water, and headed for an early bed.  While we were wrestling in the surf, a local warned us to be careful of stingrays.  This was good advice. 

The next day, it was time to rent a surfboard and try out the waves!  The woman that runs the surf shop should be called "the getter".  She's never surfed, but can recommend any type of board, but more critically, she can get damn near anything.  And by anything, I mean cough syrup, flowers, white pants and a jacket, and a Catholic priest willing to marry a Mormon to a Baptist.  This is exactly what I mean by "anything" and yes, that is exactly what we asked for.

So round one of surfing... I was not doing well out in the lineup, particularly since it was full of good surfers and I can't really stand up.  So on the advice of planner, I took my surfboard into the surf break zone to try and clumsily ride the white stuff and get a feeling for it.

I was struggling with it, and my boyfriend was standing next to me in the water (which shows you how well I was surfing) at which point I clumsily kind of fell off the surfboard and stood up (I do everything clumsily on a surfboard) and felt something slash open the bottom of my left foot.  I then jumped off my left foot onto my right foot (as you do), and landed on a surface that felt exactly like a startled piece of wet rubber being yanked out from under you.  Fortunately, the ray I actually fully stepped on was more forgiving than his buddy, and did not light up my right foot.  Then I saw a huge ray with a long sharp looking tail go streaking directly in front of me.

I don't really scream as a rule.  However, it's not because I'm a bad ass or anything, it's just not a sound I make much, which means when I'm scared, injured, and startled, I kind of yell, but was also trying not to step on rays with both feet.  I tell you this, because to my boyfriend, his girlfriend went from being frustrated on a surfboard, to leaping from one foot to the other making angry chicken noises.  He was confused until I said something helpful like "Ah!!!  Ahh!!  Ray!!  F-ing ray!  F-ing stingray!!!" and gesticulated wildly toward the water, at which point a fourth ray went streaking in front of him.

Only I would attempt to take up surfing and wind up doing so directly in the middle of a stingray pride rally.  We shuffled and squawked out of the water where I inspected a large, bleeding, sand impacted gash running directly across the bottom of my foot.  Thanks, jerk.  Fortunately, it didn't leave a barb in me, but it was still starting to hurt, so after... I'll be honest, about a second and a half of trying to flag down my friends to warn them they were going to come in surrounded by venomous pain monsters, we gave up and limped back.

I was rinsing what I'm calling my "ray hole" in the pool when Maria (our housekeeper) came out.  Since I didn't know the word for "ray" in Spanish, I was trying to elaborate that I'd been attacked by a bad fish with a knife when she said "raya?"  Of course.

Then she said "agua caliente?" which didn't sound like what I wanted to pour on an open wound (hot water) but it denatures stingray venom, which is just... a really really good thing to know.  So that helped, and with no barb in, I did not get to experience the "labor intensity pain" of legend, but I definitely wasn't going running any time soon.

So that was all right.  Next day, doofy pink boat shoes on, I headed back to attempt surfing!  Honestly, awful marine life is something I got mentally accustomed to while diving, so I think of that as not really being a surfing thing, but as a "their habitat" thing.  Unfortunately, about ten minutes into attempting to ride waves into shore, I did what's called "pearling" in surfing, only did so in shallow water, so the board was ripped from me and I landed directly on my head, which would be fine, but then my body collapsed on top of me and I heard a popping sound at the base of my skull.

For about half a second, this was my train of thought "That's like C2-C3, that's it.  I'm paralyzed.  This is the moment.  I hope my surfing friends see me in time to pull me out of the water because I wonder if my diaphragm is even going to work and even if I can breath without a ventilator I'm not going to be able to get out of the water and will I be able to and is there an evac chopper I wonder if steroids will lower the damage..." and then my arms and legs moved and I drew a deep breath having only popped a couple fibers in my trapezius (only time I'll be glad to say that) and that was the moment I gave up surfing, because stingrays come and go but being too clumsy in a sport with a steep learning curve and paralyzing yourself or brain damaging yourself on the 9 foot long hard sharp object you're literally tied to is forever.

So that's cool.  Nicaragua's got a lot to offer, hiking trails to limp down, volcanoes, and tiny farm towns, so I'll do that.  We drove to one cute town the same night (one of our party was a massage therapist, thank goodness and worked on my neck) and it must have been the dust on the road because I started coughing.  And coughing.  And sneezing.  And hacking.  And being in denial.

By the next morning, with the fever, I was beginning to suspect my problem was not the dust on the road, but the illness of our party.  So I laid in bed shaking, sleeping, sneezing, coughing, and blowing my nose, for the next 24 hours.  My boyfriend increased his already impressive relationship stock by staying with me the entire time.

The next day, I was getting maudlin.  My foot hurt, my neck hurt, and I was still coughing up cups of crap.  I was well enough to ignore all symptoms so we went out to hike a dry creekbed and climb around for more monkeys and take pictures of dragonflies.

This was also the day of the wedding, or as I say "if you're going to get married, do it this way".  This was essentially, an on-the-fly, licensing already done, let's see what we can do wedding.  We weren't certain we could get a priest that would marry our friends, and certainly not one on 48 hours notice.

Wrong.  For the price of "whatever you wish to donate to the church", we got a priest, Spanish Bible, full Spanish ceremony on the beach at sunset, and then everyone all came back to the house for dinner and drinks and said priest taught us how to do tequila shots in Nicaragua which is "Arriba!  Abajo!  Alcentro!  Aldentro!" and then drink.  That is full service.

But for all the horrors we'd (I'd) faced up to this point, that night was so incredible and special and locally intimate (not like that) that it really made the trip.  We were later joined by some surfers from Spain and a full on party commenced.

So it steadily improved from there.  For me.  I hiked (limped) to an incredible vantage point over the beach and saw tons of wildlife.  We traveled to San Juan del Sur, which is an adorable town with amazing drinks and cheap lobster.  It was just prior to this that boyfriend started looking a little rough so stayed home, while I lowered my girlfriend stock (at his insistence, I swear!) by going to town anyway.  But I bought him pharmacy drugs, so that counts, right?

We wanted to do some horseback riding as it was listed for 20 dollars, so we booked that with the getter!  I didn't realize how much getting there was.  Two hours later, the horse guy appeared... on horseback, trailed by three horses.  Because that's how long it takes to ride that far without a car.  Gangsta.  I was puzzled, because we'd wanted four horses, so he gestured to the four horses, hopped off, and handed off the one he was riding.  And that's the story of how I led a beach trail ride as I was the one with the most experience of us (meaning, I rode horses regularly about 8 years ago), really hoping we wouldn't fall off or get lost.  My horse had a slight attitude problem, as I like them, and a halter as a bit, which makes me a little more nervous.  After the hour, we paid our cowboy, gave him a beer for the efforts, and he began the two hour ride home.  Egad.  And that's the sort of thing that makes me feel bad when I whine that being a doctor can be thankless and annoying.

For reference, by the way, this is what the beach looks like from horseback:



And somewhere in all this, Superbowl (not on horseback).  The night of the Olympic opening ceremonies, we headed to the surf bar for some drinks, and as I sipped my watermelon mojito, my boyfriend timidly said "When you finish your drink, do you mind if we go back to the house", and that's when *he* got to experience the full blown fever mode.  Poor guy.

But we did get to experience sunsets every night that looked like this:




So there's that!

We planned our last night to sleep in Managua again because airport, and decided to hit Granada on the way there because after living in Grenada for two years, how could I miss it.  Granada is an old colonial town with awesome buildings and cheap delicious food:




We branched off in all directions and met back at the three rental cars.  Like educated travelers, we paid a local boy to watch the cars with the promise of half now half later that works decently.  Unfortunately, as we returned, we came back to three cars and two intact passenger side windows.  Someone smashed out our friends car and took their bag.  D'oh.  Oddly, our youth was still around, though wound up going from being confused (which may have been real or not; we still don't know) to having someone pull a knife on him, which we found less likely, particularly since he seemed as surprised as we were by the broken window and the missing bag.

This led to a series I'd like to call "Ishie having to deal with the police in countries where she's unfamiliar with the native language" though we were fortunate enough to have excellent speakers with us.  I'd be more critical of the crime and such, but for one smash and grab in a third world country that could have just as easily occurred in downtown Charleston, we eventually ended up with six police officers and a ride to clarify the report at the police station (for my friends; we eventually bailed when we realized we'd be dealing with darkness in Managua).  For reference, I had one extremely disinterested police officer and a misfiled police report where I was listed as a juvenile for the arguably greater crime of arson in South Carolina, so point Nicaragua.

I know I know.  Arson again.  I bring it up now because when I went to register my car this year upon returning, I was informed that I owe 400 dollars in registration for the arsonized car despite being reported, written off, and disposed off by the state.  This has not contributed well to my state of mind when I mentioned my attitude problem of late about 10,000 words ago.  It's now been reduced to 16 dollars after digging through all my paperwork (yay memories!) and getting my old insurance company to write a letter, but I've reached that point where I'm really wanting to be past it, and it makes me angry.

Other point Nicaragua... despite it being horrible and everything, the cost of the damage on a car that, if it was like ours, had about 5000 miles on it and automatic windows, was about 260 dollars to the rental company.  I may be crazy, but that seems incredibly reasonable.

So it was a weary, well-earned pina colada night in Managua, in which our friends also arrived safely not long after we did.  Managua also not as bad as advertised though I maintain that huge traffic circles in capital cities at rush hour are the most hypertension-inducing creatures on the planet (even before stingrays!)

The boyfriend and I are still coughing up crud, but we're happy and alive, and I would definitely go back to Nicaragua.  Except for the smash and grab (which again, could have happened anywhere), all conflicts were country-unrelated, and the people there were some of the most amazing individuals I've encountered.  Friendly, funny, and helpful, not to mention, they speak Spanish relatively slowly!  Which is extremely helpful for people with a toddler level of understanding, such as myself.

Part 2: "Christmas is Magic" will commence at a later date.  Stay tuned.  Or don't.  Watch Game of Thrones.  Or get someone else hooked on it and record their reaction to the Red Wedding because I never get tired of those videos.  I'm still waiting for old roommate to make it to that point in the third season, because this is a girl that walked out angry during the whole Drogo thing back in season 1.  Mwa ha!

Dec 3, 2013

And now the month of Christmas can begin...

It's been quite the fight this year, and I've really had to dig in my grinchy heels because the hospital put up all their lights and decorations up a week before Thanksgiving this year; they go all out, and it really does look lovely, so when I left after dark (which, thanks to winter, is usually), was just like "nope.  Not appreciating it.  Nope, grinch!"

But then our wonderful clinical pathology coordinator took in my boyfriend and I for Thanksgiving, complete with 20 lb suspiciously moist turkey and traditional stuffings, and with the final death of Thanksgiving, I can look around and go "ahhh" and start enjoying the holidays rather than feeling assaulted by them.

The news... after nearly two wonderful years with the roommate that took me in after the fire, I took the big step with the boyfriend and am now the proud decorator and resident of a three bedroom apartment that is both closer to work *and* closer to the beach.

Ah milestones.  This is the first place that's really been mine to mess with.  My apartment in Grenada was solidly mine too, but it was pre-furnished and all that could be added to it was the 50 lbs of luggage I reserved for books and toothpaste, but this is *mine*.  I won Battle: Christmas Tree and am the proud owner of a real one, since spending an hour cursing into the pine needles shoved in your face while your arms get continually scratched up and pitch-covered as you attempt to wedge a tree trunk into the ill proportioned metal grasp of a stand whose designed hasn't changed since the pagan era just makes you appreciate the magic more when the bastard finally stands up on its own.

The boyfriend's never been one for Christmas, thus spent a great deal of this time swearing that the tree stand wasn't made for a trunk like this one and so naturally I'm like "Oh, silly boy.  No tree stand is made for a tree.  The notion is preposterous."

Of course since I owned nothing of substance for obvious reasons, and he was the spartan type, this meant that most of my post Thanksgiving holiday shopping (sans the morning of Black Friday because I have pride, dammit!) was done for me and largely spent trolling craigslist for bar stools (mission: accomplished).

This reminds me of another important point about medicine.  Milestones.  First real apartment and hosting of Christmas?  Yeah, I'm 33 years old.  Despite being beacons of the community (if you live in a small town in 1955), doctors tend to lag behind in our maturity and lifestyle because we live in a state of being perpetual students that really lasts through a great deal of residency with both the lifestyle that entails (hello roommates!) and the mindset "I can't be a dad.  I have a test to study for."  So that's fun.

Other news, I was improbably elected onto a cytopathology committee, which means January-February are going to be busy travel months for me since I'm getting sent to a meeting in San Diego (rough life) and then am burning the rest of my vacation days until July (since I'm on surgical pathology from March through the end of July and can't take time off) by going to Nicaragua!  It's been two years since I left the country so I've been feeling itchy, and going with nine people (see above) means a pretty damn cheap dream vacation.

Other other news.  I'm officially the bad patient.  Since I seem to officially be old despite my maturity level stating otherwise, my blood pressure has me grounded to ACE inhibitors until my doctor stops being angry at my deep levels of self-neglect.  Exercise and healthy eating shall commence until my pons and/or kidneys stop being in danger of imminent explosion.

The bad reading has happened a couple of times, though this is the first time medication has been attempted, but I always know it's going to be bad news when the nurse starts taking the pressure, frowns at the cuff, and then pumps it back past the diastolic again, and then looks down at me accusingly or asks if I'm stressed.  Since I'm newly employed through 2016, have a new house, and finally transitioned to a more relaxed rotation, I'm kind of like "mwa shrug?" which is what a vocal meh sounds like.

So that's obnoxious.  But hey, I need to be bathing suit ready in less than two months, so also working toward not having a catastrophic stroke ten or twenty years in the future can't hurt, right?

Nov 21, 2013

Fellowship Achieved!!!!

Huzzahs and the like.

It's strange; a fellowship is a one year commitment where you're not paid much more than a resident, and gives you no guarantee of a full-time position, and yet the overwhelming relief of being able to somewhat relax and focus on my studies and my patients since I now have employment through mid-2016 is pretty great.  I still want to build up my CV and go to conferences,  but now I'm not scrabbling to get publications in during a surgical pathology month because applications are due.

I'm really happy with where I'm going, and I'm really happy with the responses to my applications.

Essentially, I had a fairly solid bet of a cytopathology fellowship at my home program, which is groovy and kept the application process from being as stressful as it could have been (or as expensive, since it meant I only applied to programs that I thought could be a step up from mine rather than "any job"), and my attending pulled me aside to tell me that I was safe, but that I should fly out of the nest if possible to get different training.

But I didn't apply to enough medical schools, particularly for my stats, which weren't bad, but not good enough to put all my money on the California schools, which I did.  I went to SGU, as you know, which is a decision that may be pretty darn expensive, but I don't regret.

I did learn my lesson for residency.  Despite going through the hellishly expensive ERAS program, I applied to 51 programs, got mid 20s interview invites, went on 16 interviews (gah), and ranked 14.

Fellowship, I hedged more, despite it not yet being an ERAS process for most pathology fellowships (thank the gods), and applied to six, two of which I didn't expect a response from, and the four that I was hoping for all offered an interview, and the three where I went (including home), expressed a strong interest in me.

It was hearsay until now, but I do feel like the Caribbean stigma decreases with each stage of training.  Though make sure all your stuff is in order because your biggest skill will need to be your unofficial degree in red-tapeology.  I had a couple of days of sweating for the program where I'm going because some of my rotations weren't greenbook according to this particular state.  For those of you heading for your fourth year clinical rotations, that means doing your rotation in a program that has a residency program *with that residency*.  In other words, orthopedic surgery needs to have ortho residents, not surgery residents.  Most states either don't care at all or allow umbrella coverage (ortho and anesthesia could be covered by a program having a surgery residency) and you should know what those states are, how many weeks are required, and what extra requirements you need.  And if you say "I'll never live in that state", you'd be surprised.

So it's going well.  Also, start all paperwork processes early.  Way earlier than you think you need them.  You need weird extra paperwork or your home state takes 8 weeks to send a birth certificate?  Apply near the deadline, and that's sweat and tears.  Apply 18 months early, and it's vaguely annoying.

Medical school feels farther away.  I'm not sure what Grenada is up to lately, or how much the resources around the school have been built up.  I remember all the residents' and attendings' names from third and fourth year and remember smiling and chatting with the in the hall five months after my rotation, and only am aware now that those residents largely had no recollection of me at all, saw the short white coat, and had the same "how are applications going for you?" conversation that is always a safe bet, because that's exactly what I do now when they wave and smile at me in the hall.  They rotate for two weeks, maybe a month, two or three at a time.  I get that difficult "Oh... um... tomorrow I have a lecture/interview/blood draw/drug test/dean meeting?" question that I remember finding so hard to ask because I was afraid my residents would think I wasn't interested in the rotation and realize now that oh my god, we don't care at all.

I still try to teach them, advise them, show them what I'm doing geared to their specialty, and not scut them too much, but I'd be lying if I said that I didn't call them "short coat" or "medical student" when I'm addressing them if their name tags aren't showing.  We tend to reference them by appearance "hey, did you have giant medical student?  He was amazingly helpful."  Or "Did you have Harry Potter med student?  He wouldn't stop checking his Pinterest app for the entire sign out".  Then I wonder if I had a designation as a medical student, or if I'm the jerk resident that every medical student hates.

I briefly contemplated tutoring the MCAT when specifically asked to, because hey, free money, and upon a rudimentary glance at the study materials, realized there is absolutely no way.  Friction on a bike tire?  Seriously?

Cytopathology is going well, despite constantly having to ditch out on my chosen specialty to fly to interviews, since I thought invites would come *way* later than they actually did.  My attending has been very understanding about it, fortunately.  I managed to complete a successful FNA without bungling it or upsetting the patient.  I'm upping my reading now.

So it's good.  Things are good.  Life is pretty good.