Oct 29, 2016

The end?

Well, I promised for years I wasn't ending the blog, but now I believe I am.

I passed the miserable cytopathology boards in miserable Tampa.  I am a triple boarded pathologist and so I shall remain for the next nine years until the maintenance of certification exam.

As of last Tuesday, my ACL has been repaired using my hamstring, and I'm beginning the road to recovery.  I'm up, walking, and cooking.  Granted, it's with a Frankenbrace, but it's a thing.

I love my job and colleagues.  I love my new city.  We're closing on our dream house in 32 days.  In January, it'll be time for a dog.

I'm married.  It's fun.  It's weird how nothing much changed.  I still have to self correct calling the hubby "my boyfriend".

So I feel like I've grown up here.  And it turns out, for all the twists and turns, a Caribbean MD was good enough for me and it's gotten me where I am, but there's not a whole lot more I can tell you about it.

When I got to Grenada, it was the 30th anniversary of the school.  Now it's the 40th.  The original graduates spoke of all the changes that had come about.  In their day, cattle and mosquitoes both frolicked freely in lecture tents, and meat was obtained through the "chicken man" who would slaughter a chicken for you.

In mine, there were grocery stores and a new-ish sushi and Italian place.  I'm certain the island has changed.  I'm certain the school and clinical rotations have changed.  Hopefully the tuition has gone down.

I don't have much to tell you all (though I suppose now it's "yinz" other than thank you so much for being with me through this journey.  I won't say "follow your dreams" because that's cheesy, unoriginal, and frequently leads to financial ruin, but sometimes it works out.  It did for me.

I'm playing with the idea of having a Steel City Transplant blog.  It would be recipes, travelogues, meal reviews, and the other minutia of day to day life found on any other blog.  Still not sure if I'll maintain it or if it's worth having.  Not asking for input, just not sure.

Goodbye and good luck.


Dr. Ishie

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


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.