Aug 31, 2011

The reboot

Hi boys and girls, it's me, your bipolar blogger.

So, lemme see how I can sum up and still get to bed in time to not be miserable during lecture (yes, we still have lecture in residency)...

It sucks. Then it doesn't. Then it sucks worse, then someone jumps on your back when you're at your lowest moment of suck and you feel like it sucks worse than it EVER sucked, and then a few people throw you a life preserver and you get some peace, and then you can't get your stupid character to climb the first stupid rock cliff in Shadow of the Colossus in the ten minutes that you're "taking a breather", and you want to start crying because your video game avatar isn't respecting you and your animated horse ran away.

It's not that I'm miserable all the time. It's that I'll be REALLY happy or even moderately content, perhaps when I'm pouring steaming liquid nitrogen over a piece of uterus while going "MWA HA HA HA" since it's impossible to play with liquid nitrogen without feeling like a mad scientist, and then I'll feel like I'm really a bus ticket away from leaving. Like taking off, leaving, like walking into my program director's office and being all "Sorry, you've been cool, but I am flat out not equipped for this" and then getting on a bus somewhere else and just... waitressing in a border city or whatever people that make decisions like that do on tv.

Also? I'm weird. I get weirder when I get stressed, and I am at my weirdest when I'm stressed-but-putting-a-good-face-on-it, which leads to interchanges like the following:

Histo tech: Dr. Sancho?
Me, taking a minute to realize that means me: ...
Histo tech: (politely rattles off a hundred things I have to do, about fifty of which I don't really understand)
Me: ... uh... I totally know what you are talking about. Here's my tray of pathology things. You are welcome.


Me, thoughtfully: That's the first time in my life I've actually been called 'Dr. Sancho'.
Histo tech: Oh! I'm sorry! Do you prefer 'Dr. First-Part-of-Hyphenated name'?
Me: Actually, I prefer 'Batman'.

(long awkward silence)

Me: But 'Ishie' is fine.
Histo tech: ...Batman... got it.
My brain, to me: What the f***, Ishie. Seriously.

Yeah, that happened.

First month, full on training month. We were never really allowed out without a handler. We spectated a bit, and did stuff, but if we broke down, we had a senior to bail us out immediately. I mentioned this before.

Second month, as I also mentioned before, is when you're somewhat in charge, except you don't know anything. I spent a lot of this last month feeling like I had conned my way into residency and was absolutely not smart enough to be a doctor. I kept reassuring myself that everyone feels as dumb and unskilled as I am, but then had a fellow jump down my throat, question my commitment to everything and say I was unskilled in pretty much every way, which made me cry for half a day. Which is not only demoralizing but frigging embarrassing. Since Irene was chilling off the coast waiting to put the extremely publicized cinch on all my friends and loved ones up north, I blamed it on allergies, specifically the type of allergies that make you sob uncontrollably.

Since I live in the South, which is known for its politeness, the response to this was favorable. Additional note, gender stereotypes be damned, anger + exhaustion + self-loathing = unexpected waterworks. As someone that has belly laughed through Benjamin Button, not a fan of this response.

I honestly toyed around with quitting, like not next year, but just two weeks notice, flat out. I felt unique in this response before talking to My Friend, the Pediatics Resident who not only tried the same thing but was waylaid by the three people that tried it before her. Apparently, residency is hard. Who knew?

I took the advice of one of my peers and approached the next day with my "head held high" which I think took on the appearance of a gargoyle grin the whole day, but it was an effort. The "I'm happy, keep moving" day was punctuated by an unexpected moment of credit to counteract the unexpected beat down. I was staying late trying to get all my stuff done, helped by an attending, and out of the blue, the guy that hadn't said anything in twenty minutes, tells me how he felt awful his first month of residency and that I was working hard and doing a good job.

To my credit, didn't start crying again. Said a "thank you sir" meekly, with ABSOLUTELY NO MENTION OF BATMAN, and went home.

I took the weekend to reboot, and went at it again on Monday. I was greeted with the chief that's been helping me tell me that as the end of the month ritual, he was going to leave me to it and I was going to be in charge of entering all the diagnoses in without help on that either.

Oh, and today, I'd been signing them out officially with the fellow that hates me.

Holy matrimony, Batm... NO MORE BATMAN.

Guys, I actually did it. Yesterday, on the announcement that I was for real on my own, I felt the panic rise, but I was like "I'm just going to do the best that I can", cranked the headphones and the pseudo-happiness up and just pretended I knew what I was doing, walked into sign out today with a smile on my face, prepared to get verbally dismembered or fired or whatever, and frigging did it. I didn't get every diagnoses right by any stretch of the imagination, and I did a couple things that were flat out stupid, but I smiled the whole time, didn't cry, and didn't feel like a complete incompetent. And I went home feeling pretty happy.

Given my residency cycles, this is likely to descend into chaos by the end of the week, but hey, baby steps, right?

In other, related news. They gave me a medical student. Which is the worst idea ever. It's like dangling a vial of crack in front of a junkie. I'm brand new, so I'm not very helpful for teaching, BUT I do have tons of stuff that I take extra time to do because I'm still inefficient and this stuff has no educational value whatever, particularly if someone doesn't want to go into pathology, which 90 percent of people don't. This is known as "scutwork" and it's the bane of medical education existence. So you are going to give me a medical student, who is supposed to do whatever I tell her to, that I can run all over the hospital fetching paperwork to save myself time, that then gets her out of my hair if I scut her, so I don't have to reveal that I have nothing to teach her because I'm a frightened idiot?

GODS. I'm being good, I swear. And this isn't a fourth year crashing into interview months that is more comfortable with disappearing on an August intern. We're talking brand new clinicals, which if my background is any indication, means you think anyone with "Doctor" before their names can and will call every place you hope to apply to tell them you suck while probably talking the USMLE people into taking ten points off your looming Step 2 exam if you take more than 45 seconds to answer a courtesy page.

I even got the "I'm still keeping my options open" answer, which on this end, is adorable. I got asked if it was okay to leave to attend a scheduled lecture. This was the first time in my entire medical education that I realize residents truly don't care if you're there. I got a pager number. I realized that interns really don't know med students' names. I got someone eagerly looking at me for deep medical knowledge and being all "Don't cut yourself on the cryostat. Seriously, that blade has been places that would make Rambo puke."

In my quest to not be a terrible person, I'm trying to do stuff that I would have wanted done for me at the beginning of my third year if I were in a pathology rotation, other than my sage advice of: Get UWorld now. Seriously. Do it while I'm standing here. I'm currently going with "play with the cryostat" (CAREFULLY) since that enticed me pretty early on by being a big machine with a big knife in it. Any other suggestions? I tried "be let out early to study" but they have the afternoon lectures. I remember from third year that "Go study" is helpful to an extent early on, but you don't feel the Step 2 crunch as heavily, and being dismissed for hours when you still have to be at the hospital is tedious.

Laypeople, chip in as well... I'm not around the forensics cases this month, so that's not an option since it's the most obvious "let the student do something fun" choice.

Aug 28, 2011

Dated References

So I spent a lot of the last week like this:

But I'm going to try to spend the next week like this:

We'll see how it goes.

And thanks to R for the tvtropes appropriate update on my profile picture.

Oh, and attention medical students: do not click on that link or you'll be sucked into this.

Aug 25, 2011


Do you have talents outside medicine?

Do you have talents inside medicine but feel like you'd be happy as a PA, nurse, chiropractor, or radiology tech?

Do that.

Aug 22, 2011

Aug 12, 2011

*This* is why I became a pathologist

I was going "back to the bucket" (go back to the original specimen and hunt through formalin soaked tissue scraps) on a tumor which I refer to as this individual's abdomen being full of "unspeakable evil" and the attending said "You did have a rough day on Wednesday" and I made some sort of chuffing noise, and she said "Makes you wonder why you went into pathology", etc.

Same attending, special stains come out on *another* abdomen full of unspeakable evil and everything is negative. This tumor looks awful, is everywhere, and as of right now, cannot be identified. On standard microscopy it looks like generic unspeakable evil, it's not forming patterns; it's hard to even determine what organ it came from. Special expensive stains are sent out which show... nothing.

From my internal medicine days, it was about halfway through the equivalent process that someone would say "mm... cancer.. bad prognosis" and I'd go "What kind of cancer" and they'd say "Does it matter?" or turf it to another specialty.

My attending, on the other hand, begins flipping through her encyclopedic knowledge of zebra and unicorn diagnoses, turns to her wall-o-books and starts hunting for other stains she can do to force this thing into the light.

This scab picking approach to problem solving is why I'm becoming a pathologist. Because when the stains came back negative, I stopped thinking "It's Friday and I want to go home", and started with "We're not giving up, are we?" It's because every pathologist's office is filled with tomes like "The Color Atlas of Bodily Fluids" and "Vaginal Lesions" and papers and slides stacked to the ceiling.

I just need to remind myself of that the next time I'm crying into a bucket of formalin.

Aug 10, 2011

Emo Thelonious Monk

This title is a direct quote from this interchange:
Autopsy tech coming up to the surgpath area: You're still here? Oh you poor thing.
Ishie: (grunt)
Tech: Well, it looks like you're almost done!
Ishie: This is a uterus.
Tech: Ohhh...

(music wails in the background)

Tech: What... is this...?
Ishie: Kid A by Radiohead. Good album to sulk to.
Tech: I... I don't even know how to describe that. It's like... emo Thelonious Monk.
Ishie: That may be the the best thing I've ever heard. Thank you, madam.

So I've been having kind of the miserable day in the middle of a rough couple of weeks.

I hit my milestone today while confirming something I always suspected was true which is that all interns, regardless of how easy their programs are or how cool their coworkers are or how much they like their field WILL have a moment, probably in the first three months, where they start crying at work. This is frequently accompanied by sentiments such as "I don't think I can do this" or "What did I do" or the simple but effective "I can't".

There are varieties of these meltdowns too... pathology is a good field for low nuclear meltdowns because people generally leave you alone; and there are a lot of times you are by yourself and can work it out. For instance, today, quiet crying at the grossing station as you gaze upon your sisyphean task can go practically unnoticed where the sort of meltdown you get in other specialties, which is often brought on by many people yelling at you at once, tends to lead to breaking down in front of your abusers, which is the worst form. Or the "feel it coming, find a hiding place" cry. So far, I've only managed the quiet one, and it was brief, but it was there. I came close a couple other times this week.

We're doctors now. It's official. Training wheels are off and ain't no one else going to handle this crap. If you don't do it, people are just going to get angrier and angrier until it gets done while more work piles on top of it. Your pager goes off in lecture, in grossing, while you're dealing with other urgent matters. I'm running around clutching decal slides in my hand finding the magic person that's supposed to receive them all with this entire realm of "THIS MATTERS". My training is secondary to the fact that I have to do a doctor job now. And that means doctor job, doctor hours, the presumption of doctor intelligence. Machines to monitor, techniques to know, medical knowledge, searching databases and surgical reports. Gah.

It's scary. And right now, I gotta be honest, it kind of sucks. People are generally nice to me; I don't really want to be doing anything else (well... sitting down watching Game of Thrones and drinking a Blue Moon, but you know), but it still kind of sucks. Today, I was at a grossing table for 12 hours slashing away at specimens that only grew in complexity while my scrub pants literally fell off my butt. I didn't eat, I didn't go to the bathroom; I stood there, without taking my smock off, for 12 hours without cease. And I came out and felt like death. And tomorrow, I deal with the consequences of today.

On the other hand... and I've been trying to stay on the other hand, since I can be task loaded and miserable or I can be on the other hand, I've seen a really cool polycystic kidney, got to play with liquid nitrogen, got to screw with the power tools, got to be scared to death of a potentially infection hazard during a frozen section (false alarm) and the rest of it. Cool stuff. That's what I keep telling myself. Cool stuff.

I also have an attending who is super nice and seems to know me by the fact that I fear grin at my superiors and support staff. It's not that I'm a nice person; it's literally something chimps do when they're scared. So I'm the smiley girl. (Who saw that coming???? NO ONE!) So this one attending always goes "still smiling?" and I'm always like "Sure am, sir!" or lately, been lifting my head up, twisting what is probably a deeply disturbing jester leer at him and nodding meekly. He said "Feel like you're handling things"? Yup? LIES. "Getting a bit overwhelmed?" "Oh, sir, you're such a card..." LIES. But what to say? "Help me. I had no idea anyone would ever give me this much power. I am retarded but really good at taking multiple choice tests. Please resign me to a tedious position that can be replaced by robots... sir.

So staying the course. Despite today's waterworks, I'm determined to be happy. I know I have it good, dammit; I'm not going to waste hours in the weepies over getting exactly what I wanted. Time to put on

Or, if you prefer...

Aug 3, 2011

With Apologies to T.S. Eliot

But August is the cruelest month.

July was a training month for us, which means we literally were never without a handler, which is comforting, and in those sorts of situations, you always *feel* like you're learning everything. This is especially true when people are letting you do things, so you feel like you're in charge, but you always have them over your shoulders, often helpfully making suggestions.

I did have one fourth year that made me run a couple frozens by myself, which in itself was a little panic inducing, but still, the fact was I knew that he was there, and the very nature of the whole thing made it so that I knew if things went really wrong or if it were too complicate a specimen, he would rescue me.

July is also when I heard a lot of "I'm gonna be here for a while, so why don't you run on home?" which makes you hear the "go home" and not the "I'm gonna be here for a while".

August, we're let loose on our own. Today was my first grossing day, which is seriously intimidating.

I think I explained this elsewhere but pathology schedule is gross (cut stuff), preview (guess stuff) and sign out (be pwned on stuff).

Grossing seems like simply the grossEST as it's the opportunity to smell like unspeakable evil, splash formalin on yourself and such, but doesn't seem like the hardest. The real difficulty comes in interpreting what you see. The problem being, grossing badly brings down the whole house. If you cut poorly, the slides come out poorly, and the most skilled diagnostician on the planet cannot figure out margins that you haven't inked, false margins you have inked, or specimens that are mangled and only consist of blood clot. This failure not only potentially gets you in trouble with your seniors, but more critically, can directly screw up a patient's care. I can potentially apologize to my higher ups all day long, and they can think "Hey, she's a noob", but some patient could potentially wind up minus a diagnosis or with an additional surgery or whatever because I can't cut and paste.

So no pressure. Being faced with an increasing load of specimens and staring at something relatively simple like a skin lesion, I felt a pretty piercing hint of anxiety. For complex specimens, you page an attending or fellow (which I'm trying to get used to, since medical school taught me to NEVER DO THIS, and pathology residency teaches you to ALWAYS DO THIS. It is always easier to have a pro orient a specimen than have a pro un-fuck one). This leads to someone hand holding you, but under mounting pressure, you do things like "dictate while someone is telling you what to dictate and still forget what they said 30 seconds ago because there's a microphone in front of you".

Gods. In the end, I still feel incredibly lucky. This was probably my worst day of residency so far and the most "not fun" one, and it was still punctuated by not once getting yelled at, having three of my colleagues stop by at different after-hours times to offer help, and having two attendings come by after hours, one to do a complex specimen *for me* and the the other to take the load off, which included him staying three hours after leaving time and dictating half my remaining case loads so that I could leave at a semi-reasonable hour.

I have a less intensive residency than most and definitely a less malignant residency than most. I'm not sure how I would manage if either of those features were not present. But it does make me feel good that at the end of the day, my "bad" day consists of learning opportunities and people helping me. Tomorrow, I find out if my grosses were okay, and I'm really hoping that they were.

Night everyone