Apr 7, 2013

Never let your guard down

Not in any kind of dire horrible way, don't get me wrong.  I'll explain.

I feel like medicine is full of the general sensation of feeling like you're done, but you really aren't.  Got into medical school?  Whew!  Smooth sailing!  Nope.  Class rank.  Step 1.  Step 2.  Surgery hours.  Trying to scrape in a publication, schmooze with residents, schmooze with attendings, pick a discipline, hope you get a residency in it.  And then, you're a resident!  Wahoo!!!  It's all paid off!  Well, hold on a minute there sunshine.  Do you want to be chief resident? (No)  Do you want to do a competitive fellowship?  Is your field a little difficult on hiring?

You're not done taking tests.  You're not done studying.  You're not done with having projects hanging over you.  These aren't necessarily bad things; you have to stay on top of material just to be a good doctor, but that feeling I had in medical school that any time I was recreating I felt guilty still exists.

So the current sequence of events.  Pathology has a notoriously difficult job market that really requires a fellowship.  You begin applying for fellowships at the beginning of your third year, which seems really far away when you're just starting and now you're like "What do you mean I have to decide what kind of pathologist I wanna be???  I just decided on "pathologist" not that long ago!"

A friend of mine wants forensics, which requires an even greater jump ahead.  Fortunately, all forensics people seem to be born knowing they're forensics people.  So friend is freaking out because she needs to get in her fellowship applications like.. now.  Naturally, as is the way of medicine, this triggers an avalanche of freakouts in her colleagues.

Now, when you're in surgical pathology, you're in surgical pathology.  Nothing much else is expected of you other than reining in the urge to kill surgeons if they stand behind you and make snarky comments.

So I got out of surgical pathology... into lighter rotations *and*, just by coincidence, a slew of extremely unfortunate weirdly presenting publishable patients.  So I went from having one publication since starting residency, to having a bunch waiting in line for me to try to make heads or tails of them.

In the middle of this, I had been somewhat poorly scheduled for a Journal Club (thirty minute talk), a GME (thirty minute talk), a "Big Meeting presentation" (20 minute talk) and a CP talk (five minute talk).  Over the course of three weeks, which also included the RISE exam, which is a way to determine whether you're going to fail boards in two years.

Since this wasn't enough busywork and stress for my procrastination addicted brain, I realized the new deadline for submission of the CAP meeting was in the middle of all that, and I had a doozy of a weird microbiology case, so... I added that workload onto myself.

I also got last minute selected as a delegate, which is actually pretty groovy, am turning in an application for a committee membership in cytopathology, and speaking of cytopathology, finally put on my big girl pants, approached the cytopathologist and begged for case series.  So... yeah.

You spend your first year trying to stay afloat and most of your second year finally feeling good about "getting it" and then realize that it's time to boost your CV like NOW.

Speaking of cytopathology, it's still battling hematopathology in my heart, but I think I'm falling into the cyto camp.  This also looks like it's going to have me scrounging for jobs in (gulp) Houston, since that's where a few of the good programs are.

So the last three weeks have been me hammering away at various projects and forgoing exercise and other necessities.

Oh!  Adding to the fun was that at the beginning of this venture, two things happened: One, I decided to undergo a minor elective procedure which generally has no complications, and two, I had a weekend catch up trip to NYC planned, all of which I had scheduled my crushing paperwork around.

Much to my surprise, said minor procedure led to a week of crippling horrifying, attending-pissing-off pain and the discovery (via emergency room) that all my pelvic organs are in the wrong place and I have an extra bone in my spine.  While discovering I'm an awful patient (though really tolerant of any blood draw procedures), once I was past the "AHHHHH" stage of the week, the various workups punched straight through concern and into fascination.  I creeped my parents out by thinking they'd think it was cool to have a spinning 3D image of my renal vasculature and sending it to them on my iPhone.  I mean, they're my jacked up kidneys; if anyone's freaked out by what is obviously INSANELY cool science, it should be me.

Oh yes, on the attending pissing off... She and I are cool now, but my first week with a new attending was spent not paying attention, unable to focus on work, and periodically passing out while she was actively talking to me.  In my 4 am ED email stating I would be missing yet *more* work, I promised her a complete explanation, but I think she put the pieces together and greeted me with "I don't need to know your business", so we're cool now.  And I got more out of the rotation that I probably would have initially because I spent the last 3 weeks overcompensating like a mofo.

What else.  I ran a 5K that benefits children's hospitals and primarily gets attention by the additional feature that the people organizing it throw colored corn starch at you while you're running and occasionally hit you with super soakers full of paint, which does make it difficult to run.  Fortunately, despite being a 5K, absolutely none of it was timed, and instead of a clock, the finish line consists of people holding out more chalk bags so you can hurl them at people.  It was groovy.  I really underestimated how awesome South Carolina could be when I was considering moving here.

Speaking of things Charlestonian, we just had the Cooper Bridge run (which spawned the "Ridiculously photogenic guy" meme last year).  Since I am way too painfully out of shape currently to run a 10K up that ridiculously angled bridge, a bunch of us instead got dressed up in clothes somewhere between old Charleston and the Kentucky Derby and went bar hopping.  I finally got a ridiculously floppy hat and a mullet sundress, so I feel proper.

So that's the update.  I'm also on CP call starting tomorrow, which I'm cautiously optimistic about and will likely have an apocalyptic breakdown somewhere around Wednesday after I get called about amylase at 4 in the morning for the 5th time.  But Game of Thrones is back on, so that will make me happy just about always.

Happy Spring!  FINALLY!

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