A Caribbean M.D. is Good Enough For Me!

Wow, that was dark

2012-01-28T04:38:00.001-04:00

See title. Goodness.

So, sorry about that last one folks. I contemplated deleting it and as I said at the intro to that post, didn't even initially post it, but then left it for the sake of honesty and completeness I suppose?

I asked my mom for her opinion, and it was like, med school/residency is the ups and downs, which is a point for leaving it up. Then I'm like, this is a very specific situation for which it's hard to imagine anyone looking for advice. Grenada's rock fever with study darkness with fulminant breakdown? Sure. That's at least half the student body and everyone that has a medical school related meltdown feels like they're alone in it and everyone else is succeeding. Same with residency. Normal stuff. We laugh about it now at work because we were all in various stages of it without knowing the others were suffering it. Doctors seem to be bred with a specific blend of arrogance and self doubt that starts a spiral of "I'm smart and med school/residency shouldn't be hard. I am struggling. Therefore, I am stupid and everyone around me is smart and ohmigod."

This peculiar blend of impotent rage I feel intermittently in this really specific situation? Not so much relatable. At least I hope not.

But enough of that. Tonight was really really good. We had a mini spontaneous surgical pathology girls' night bitch-a-thon, and it was a bunch of fun with great people that did, I admit, involve some poking fun of surgeons. Lighthearted, I assure you. My mom sent me a hard drive that I got today that has all of my diving pictures and California pictures and the like salvaged so I did not lose those, and that was really incredible. The response of you guys, as I've mentioned, has been fabulous, and it helps me quite a bit. Surgical pathology ends in three working days (but who's counting) and I'm pretty excited about it. While being the bread and butter stuff, it's really work intensive, so it'll be great to have a break working more normal hours. I am getting a lot more of the diagnoses and have a general idea of logic and workflow, which I've mentioned before.

Good stuff. I'm planning a trend of increasingly positive blog posts to follow, but right now, I'm crazy tired. Night all.

Good few days, bad few days

2012-01-27T02:40:00.000-04:00

Okay, I wrote this yesterday night when I was in a *really* dark place, so I almost didn't post it, but figured it's honest, so I'd go ahead. I'm feeling better now, I am. It's almost the weekend; people are being nice to me, I pulled doctor-card on a surgeon and John Legend got properly replaced by Nina Simone, but DAMN, was I feeling nasty yesterday, so:

So here's the reverse.

Call it PMS. Call it delayed anger. Call it whatever, I'm feeling it. Maybe I'm just feeling tired, and I'm at the culmination of two months of surgical pathology...

I've been getting really nasty sleep lately, hence the 1 AM post, worse than usual. The week after the fire, it was nightmares and anxiety dreams, and I could pinpoint and be like "Yes, that dream I had where the insurance company repossessed the rental car and yelled at me was likely stress related to this situation" but lately it's just like "Wake up for no reason at 5 AM sucka!"

So I try to wind down again, and I miss lecture AGAIN and I wonder how my eval is going to go with all that crap missing, and I struggle to make it from new home in new car on time to at least get my duties done.

This morning, I got my first speeding ticket since I left for Grenada. My fault, of course. I overslept (again) because I couldn't sleep (again) and was racing to work (again) so I could make sure I was there for frozen sections and I got busted.

The whole where are you going in such a hurry, and I don't even really make eye contact with people or emote anymore because I DON'T CARE, so the second I hit "I'm a doctor and..." I get the instant cop-black-out, the "rich doctor", the "I'm the problem with health care" and nothing else I have to say matters like "my pager is going off" and "I'm in scrubs" and "This car costs less than yours" and "The address on my license is no longer valid because that address burned down" (he asked if my license info was accurate, and when I said 'no, it was burned', he got busy writing down... my old address.

Fine, ticket, whatever. My insurance company needs more money anyway. They just took a 13 thousand dollar loss.

I was following a car most of the way to work (before the ticket) with a bumper sticker that said "God doesn't believe in atheists". I haven't put similarly anti stickers on my car because A... I haven't had a car that's lasted more than 3 months, and B... people who put stickers like that on their cars are assholes and I'm trying not to be an asshole.

Things God believes in in Charleston:
-Shooting a 5 year old in the face
-Burning down three houses and killing a cat
-Letting an arsonist go free for NINE YEARS with dozens of fires
-More unsolved homicides than Dexter has to clean up in Miami

Things God doesn't believe in in Charleston:
-Me

Cool, we've nailed God's priorities. God doesn't have to like me. Lots of people don't like me. God seems to like the Patriots. I'm thinking of putting *that* sticker on my car, but I'm guessing someone would then cause yet *another* insurance hit on it if I did.

This whole asshole thing has been eating at me. When I got my new car, I went asshole mode because I was honestly so livid about having to shop again that I didn't care who I offended, and in doing so, managed to circumvent the type of people that would try to eke an extra two grand out of an arson victim.

It's a weird title to wear. As I left the parking garage today, having had a last minute surgeon dumb of specimens that kept me three hours late, I decided that in lieu of jumping off said parking garage, which crossed my mind, I would put in one song on my iphone... put it on repeat, and BLAST it. just freaking BLAST it.

That song turned out to be Stereo by John Legend. Is it a good song? I don't know. Probably kind of. Do I like it? I don't know. Does it have a really loud obnoxious baseline that you can jar the city with for no other reason than you're an asshole? Yes it does.

So I did that. No "I hope I'm not bothering anyone" or that crap, just one song, on repeat, for 25 minutes. Loud enough to hurt. Loud enough for people at home to have a brief moment of irritation and rage and assume that I'm a 16 year old ethnic kid outside, and I can say "I'm causing that feeling in you because now I'm the one with power and you're not, and I'm tired of being nice".

Amazing, that is. There's a truly almost zen moment where you can look at everyone else and go "Hmmm... nope, don't care".

That seems to lead to enlightenment or flipping out. I'm not sure which path I'm on

Our landlord is being fined by the city to tear down his eyesore. No one has contacted us. No one seems the least bit curious as to why we'd want to see if we had anything left. I found out our landlord is trying to tear it down by hand because of our local yellow journal. People are in the comments section saying "Just bulldoze it!!!" That's OUR STUFF, motherfuckers, why don't you go bulldoze your pets? Why don't you go bulldoze your face. John Legend in your house, how's that? Like the bassline on that?

It's just stuff! It's OUR stuff. Clothes and pictures and memories and niceties and handiness and long nights talking and playing Mario Kart stuff! Just stuff. Not just their stuff.

Did you have renter's insurance? NO. I did not have renter's insurance, so fuck me. This is the first question, which they might as well rephrase into "Is this your fault?

Wow, that sucks, well your parents' homeowners...
WHAT DID I JUST SAY?

"Mmep. Oh"

People are being different levels of helpful. There's pure help: "Hi, here's a hug/check/gift card. I'm sorry this happened. See ya" There's the Monday morning quarterbackers.. Gods are there... why didn't you get insurance? Why didn't you put your external hard drive in a safety deposit box? Why did you live in the ghetto? Why were you speeding? Why didn't you set your alarm sooner??

That voice already lives in my head. It's called "Crippling self doubt" and it's an old war buddy of mine that likes to sleep on the fold out. Crippling self doubt doesn't need your help. We go WAY back. Crippling self doubt has been with me from the start, and you have no hopes of taking his place, so you might as well just put yourself on Team Supportive and stop giving me advice that isn't advice. "You should have" isn't advice. It's superiority seeking.

I'm half contemplating hulking out at my court date, since now the arsonist and I both get one, but I don't want to go to jail because my toilet wine always lacks complexity but there's a huge part of me that says "Everything in my life has turned to shit since I moved to your town. Transport me somewhere safer, like back to Brooklyn."

But that's that, I suppose.

A good few days

2012-01-17T01:50:00.000-04:00

I'm kind of cautious about characterizing my days, because there are some spectacularly good ones to spectacularly bad ones and it's not always easy to tell which they are.

This weekend, new Roomie made chili qualified as "f'ing amazing". I got my Xbox, which was my "thank goodness this was belated" Christmas gift, so we set up with work friends and played Just Dance 3 for an embarrassingly long time. Which was awesome. Last night, Rock Star contacted me to see if I wanted one of his guitars since my beloved Takamine solid top got turned into firewood, so I met him downtown for tea and now I have a guitar so I can start work on the "Ratboy blew up my economy car" blues. It's gonna have four chords, all of which are 7s, and start with "I woke up this morning". Wait for it to show up on Pandora soon.

I've been putting off and rehashing an HLA presentation for about two months now. Pathology is difficult and studious and such. Blood bank is confusing, immediately consequential, and has a lot of letters and numbers. HLA beats up blood bank every day and hangs it on a locker by its underwear.

So I had a five minute presentation that was killing me. I did a first version of it about a month ago, which was extraordinarily bad, and I didn't know any of the case details. I got last minute belled out of doing it, and then was hacking some stuff together (which also sucked) which then got burned up by the fire. This last one I did on an extended weekend sleep deprivathon that was more my MO in college.

Unless my colleagues are being really forgiving, which is likely, it didn't suck. Despite my rambling it on 4 hours of sleep. So then I had sign out, but my attending got detained at the main hospital for over an hour and I didn't have many cases anyway...

So I propped up a chair to put my legs on in the sign out room and threw my sweater over my face. The accessioner pops her head in at some point where I'm halfway to Edward Norton's house, and I startle up a bit and act... I dunno, normal?

Her comment? "You know these lights have a dimmer switch?" and dims them.

Guys, that is as close to authorized naptime as you can get without having a yoga mat on the floor.

So nap at work. Frigging awesome. And almost no real work to do in the afternoon so I could get caught up on my other stuff. It's going to get me back tomorrow though. I'm getting all the breast cases in the land.

What else... music at work is interesting because a lot of us listen to music while we're grossing because we can. I'm included in that. It gets weird when we need an attending to come help orient a specimen, but we don't turn the music off because I am not laying a greasy Hep C liver covered finger on my precious iPhone.

Leading to this:
Attending: Okay... the stitch is here, so... this.. yes, this is anterior
Shirley Manson: I'm waiting... I'm waiting.... I'm waiting
Attending: So if we whip this around like this, I'm thinking this is the uncinate process
Shirley Manson: I'm waiiiiiiiting. I'm waiiiting.
Attending: And we can dissect the pancreatic duct from this axis.
Shirley Manson: I'm waiiiiiiiiiiiiiting
Attending: She's waiting.

Greasy finger exceptions are for F*** You, White America, and ANYTHING by Tenacious D. Jack Black is killing me. An hour of Pearl Jam goes by but the second I need an attending, I start to hear the beginning of "Ya don't always haveta f*** her hard..." and I'm going "Excuse me! Hold on... gloves off... fast forward!" "What was that?" "Nothing!"

I do really like my new car guys. It's all RRRRRRRRRrrrrrrrrRRREEEEEEEEE when I take off in traffic.

Jean Grey is reborn as...

2012-01-10T00:26:00.000-04:00

This is Phoenix. She's my new ride.

This is Dexter. He was my old ride. As you know.

Truth be told, though it kind of feels like I'm cheating on Dexter, I think I like Phoenix better. I thought I'd be fine with an automatic transmission, considering how absolutely adamant I was about not learning to drive a manual until I was in my 20s, but manuals are SO much fun to drive. Additionally, my go to car for a very long time was a 2001 Hyundai Accent that survived until my third year of medical school, though I didn't use it for any of my med school time. And it was a manual, and Phoenix is also a Hyundai Accent, albeit a 2010 model with more features, but the response is exactly like my old car only a little punchier. Also, lights and trunk latches and such.

But Dexter was my first. First new car ever, first financing ever, first total loss/gap insurance payoff.

Let me tell you, if you ever finance a car, get frigging gap insurance. I would have been paying a thousand extra dollars on a car I no longer own because a hoodrat burned it down.

Right, the fire... so... new update. Yes, it was in fact arson. Said arson was committed by a 14 year old boy who was attempting to fight the squatters next door for some giant I-don't-give-a-f*** reason, and when they didn't emerge (because they weren't there), he set their house on fire very deliberately, which subsequently spread to everything else.

As a doctor, I feel like I should understand environmental pressures, along with conduct disorder and other things that create this sort of... child. I know the inevitable progression to Antisocial Personality Disorder in adulthood and all sorts of organic biological nonsense. I get it.

Problem being? I don't care. I lack empathy for the unempathetic. Does that make sense? If you are schizophrenic, and the voices tell you that the girl on the subway is the devil threatening humanity and you murder her to save humanity, you certainly need to be locked up and heavily medicated, but to some extent, I understand that you meant well and you have a demonstrable chemical imbalance that is both putting crazy things into your head WHILE giving you a bonus lack of insight into your own condition. It isn't who you are, and before the disease took you in your teens or twenties, you had a whole other person you were before your dopamine levels went tits up. Got it. And I sympathize. I don't want to be on the subway with you, but I sympathize.

The axis II stuff, the personality disorders, it's harder. The person's bastardry is a part of who they are. When you take the schizophrenia away from a schizophrenic, they're a normal person. When you take the antisocial personality disorder away from a person, you're removing a key part of who they are, which is a jerk. When I did my psych rotation, I could deal with crackheads, gang members, and bipolarity but the antisocial personality disorder people were just GARGGGHHH. And the attempts to manipulate into their own worldview, double GARGGGHHH. I can't take it, and for some reason, the same function that allows me to forgive other behavior just doesn't extend to people who are incapable of being able to have a basic sense of empathy.

So I became a pathologist instead of a psychiatrist, because it's very difficult to treat your patients if you hate them.

The hearing was today. My colleagues, who have already been wonderful, made sure I was covered so I could go. I got a call on Friday from first the fire chief, and then the SC equivalent to the DA that started with "We have you listed as the owner of one of the cars that was damaged?" And I was like "Um... that's kind of an understatement", so I told her our side, and she emphasized that she wanted to see us at the hearing, and I forwarded her all the pictures I took of our home and Dexter, which seemed to make her happy. I thought it was just going to be my roommates and I but there were at least 15 victims of this nonsense, including our landlord, who at the end of all this was like "Oh, I owe you guys your security deposits", which was nice.

We can't name names, obviously. A juvenile hearing is a bit like a bail hearing, except no money in kiddie cases, so it's whether he can be under "house arrest" with his parents (no) or stay in juvie (yes). The fact that this was a possibility made me choke on my coffee, but turns out I should have had a little more faith in the state, because even his lawyer didn't put up any kind of a fight to get him out. I never saw him though; he waived his right to be at his hearing, but his parents were there, and refused to look at any of us. He's likely going to be locked up until the trial, and I'm guessing he's not going anywhere after that. The prosecution passed some of my pictures up to the judge.

I feel an odd sense of closure. I'm not sure whether I should blame general perceptions of the government on the media with the idea that if you're under 18, you can torch half a block and go home to your xbox, but I was actually impressed and feel like justice will be served and all without my having to put on Christian Bale's growly voice and patrol the streets. Which is good, because I can't fight for crap.

Friday was a really bad day for me. It started waking up from a nightmare, as many of the nights this last week have, and then I got lost on my new way to work, causing me to be 15 minutes late to lecture despite leaving well in time, had a bunch of stuff go down on complicated cases at work, and then my insurance company called to say my settlement would be minus a thousand dollars and my rental car was up on Wednesday. This was also the day I learned that the fire was arson. Honestly, before that I felt strangely fine. Nightmare ridden and dyspeptic, since doctors are the kings and queens of somatization, but fine. Friday, the combination of the end of the comfort zone of driving around in a rented Chevy Impala and the new information that this was a motivated attack gave me a full dose of rage-a-hol, which was hard to try to keep under wraps, especially with everyone at the hospital being so wonderful.

And it's gotta be confusing to them.
Day 1: Hey colleague! Funny story, my house burned down, still need a roommate?
Day 2: Thanks for the pick up from the airport! Red wine and Incredible Hulk? Hooray! Look at this awesome bed!
Day 3: Wow, coworkers, this support is amazing! How am I doing? Fine. Nope, haven't seen the house.
Day 4: Yup, saw the house. Nah, figured from the pictures nothing was left anyway. I got a computer and can watch Dexter again!
Day 5-6: Springing Dexter from the junkyard! Wow, look how damaged he is!
Day 7-9: Doop doop, surge path, hmm, not so bad! I'm having fun! I feel like I'm getting it this time around!
Day 10: (*&(*&)(*&@(*&(*!! ******* BURNED MY HOUSE DOWN RAWRRRRRRRR

Friday night, I saw female former-roommate for the first time since the fire, and we drank margaritas and her boyfriend gave me the third season of Arrested Development, because he's awesome at gift-giving and likes to demonstrate it. Seeing them helped a lot. Saturday, I decided to turn my misanthropic bend to the positive of using it to intimidate car dealers since the Wednesday of rental car expiration is not a good day to car shop, nor is it ever a good idea to do your shopping on a day that you're desperate.

So I went to a few dealerships, and test drove a few cars. The dealership where I bought Phoenix had a 2009 Nissan Versa with a hatchback and a stick shift, which was kind of my final opportunity to revitalize Dexter and remake him in an image I actually initially wanted, but were too expensive and not available, respectively. It was even black. But the response was a little sluggish and no features, including no auxillary jack, which is a dumb thing that is critically important to me since five minutes without my iphone causes me to cry uncontrollably and chew my elbows.

I had finally settled on Phoenix as "a car I like and I'm tired of dealerships", which had a price on the window that was hilarious, particularly since someone mentioned in front of me having trouble moving it off the lot because no one wants manual transmission anymore. Dealer fail 101. States he "might be able to come down a little on it".

I'm usually a people pleaser. I don't to offend people or have them be mad at me, which to people selling anything, puts me in a sort of Girl with the Dragon Tattoo position (how's that for graphic imagery?). Fortunately, Friday left me in a state of pissed-offery and the fire taught me to spurn strong attachments to any material item, PLUS I hate shopping and was being forced to do this again, so I rode into Saturday with a rampaging chip on my shoulder. Which is a plus if you're buying a car. Which seemed to carry across, such that he was like "So, you're not from Charleston?" since Charleston is billed as a polite city. I pulled the Brooklyn card, neglecting to mention that I lived in high-gentrification Brooklyn for two years and moved there when I was 29 so it gives me absolutely no objective excuse to be an asshole. I can even fake the accent. I can also fake a Caribbean accent, but it's harder to sell people on. And it's not like my home state of California is known for having manners.

I also don't think I was a lot of fun for them. They kept doing that "Excited about getting a new car???" thing, and I was like "Not really."

I also fortunately have the Kelley Blue Book application on my phone. So I'm idly tapping away on it while he's talking (HIGHLY RUDE) about the car's features. Because I'm entering them one by one. So he finishes, and I turn the phone around and slide it over to him because its "excellent" condition for the same car with the same mileage is 1500 dollars less.

I frigging love technology.

We don't need no water... wait, yes we do

2011-12-30T23:11:00.000-04:00

F*** indeed, neighbor.

Went to the scene today and chatted with some of the neighbors, including, I believe, the one that took this video, so we have some record of stuff.

Long story short, absolutely nothing left. I was captivated by the sound of the broken glass and tinder crunching under my new boots. My closet, I was told, fell outward, which sparked a brief hope of finding my bedbug costume, and one of my displaced neighbors, Superman, as we all call him, started climbing through the collapsed stuff to pick through the things that looked like clothes. Half of a pair of jeans, I think.

Lots of people were driving by to loiter, and I didn't really mind that, because it's probably what I would do. I gawked at the house on Rutledge that burned earlier this year. I took some pictures of my place just for the hell of it, not because I think I really need to document anything. But one of the landlords from across the street saw me and the neighbor and were like "do you live nearby?" and I'm like "I'm the third roommate". "Ohh... Was yours the red car? It was a trooper." "No, mine was the black nissan." "Oh... It exploded." "I know." "Do you have a place to go?" "Yup."

I went to the hospital today, one, because one of my attendings kept insisting that I do so, and two, because in an amazing show of foresight, I kept some of my insurance paperwork there, and the degree of support and concern was amazing and humbling. I've only been at my residency for six months but everyone rallied. I got hugs and offers and even though I immediately called a friend needing a roommate as soon as I heard, people were all "Where is she staying" and eager to make sure I wasn't sleeping in a Red Cross shelter. Despite everything, I feel really lucky.

I think that's one of the keys in a residency program too. Not "Who will hug me if my house and car burn down" because that is an oddly specific question to ask at the pre-interview dinner, but just how close knit a program is makes a huge difference in overall happiness. Our department has happy hours, parties, and an open door policy that nurtures an environment where someone could come home from vacation with nothing and find everything she could hope for, to get back on her feet, within her program's walls.

Family has also been absolutely amazing. Getting the news was surreal, and occurred around the small cousins, and it's difficult to know how to react in any appropriate fashion since presumably singing four letter words in the major and minor scales is not recommended for the TV-Y crew. I was helped out, taken shopping, given clothes, and perhaps really importantly, distracted so I couldn't dwell on it.

I'm safe and sound tonight back in Charleston. Things are moving along; I'm trying to release my car to the insurance company and get a lease agreement moving along. Good times.

Eulogy for Dexter

2011-12-29T03:07:00.000-04:00

I realized I didn't post a picture of Dex in his prime of life, so here's one of his death. He's behind the mini cooper, who is also totaled.

He was a nice car. He delivered me to Maryland without murdering me and synced my ipod really well. He died in a blaze of glory that was dripped from my house, which was undergoing its own blaze of glory. RIP Dexter. Flights of angels, and the like.

A funny thing happened while I was in Houston...

2011-12-28T23:01:00.000-04:00

My house burned down. And the car out front.

As ya do. As they say.

I'm not entirely sure what the proper response is. I'm trying for the dark humor. The "fire sale". The "blackened fish tacos". Everything I own is gone. My new car is gone. The roommate's dog, whom I love, is safe. No one is hurt. But there is decent coverage on all of Charleston's news outlets, that show my home, and everything I own, save the suitcases I have in Houston, up in flames. My neighbors talking about how hard it is on them, because the firefighters evacuated them before saving *their* homes. Not mine. There's only so much they can do. By the news report, I'm the "fifth person", after the Red Cross helped four, who is "out of town", as the news reporter says, "thank goodness". As do I.

I have family. I have friends. I have a general worthlessness to the things I owned. A Wii my mom got me. A regifted futon. An Ikea dresser I got in New York. A computer that was already on the fritz. A brand new car that was engulfed in the front. But I have friends, I have family. I have a job and a place to stay. I have a roommate's big sloppy dog that's not dead. I have... I don't know... a fresh start? It's not a fresh start. It's a charred start that hurts when I think of the emotional losses. The med school diploma. The pictures from Prague. The episodes of hell, Dexter, the show that named my car, who's dripping melted plastic in a parking garage downtown. My external hard drive. I had a flashing minute, before I left for Houston, where I thought "I should put that in my file drawer at the hospital" before I thought "nahhhh, what could happen". The blackmail photos of my roommate and my friends in New York. It's done.

I'm in Houston. I'm not sure what the response is. I'm not sure how I should feel about the arsonist speculation (which I don't really believe) and they claims to my insurance company. I'm moving in with someone I really like. But I feel odd; I feel disconnected. I feel like never going back to pick through the condemned wreckage to see if I can find the necklace I bought in Venezuela, the luck dragon my boyfriend and I got in Chinatown when I was hammered, that I used as a puppet to order tickets to a midnight showing of the Dark Crystal, the few bills of Costa Rican money, my checks that couldn't spell "Union Street" correctly.

Is stuff important? I don't know. I've moved so many times. I frequently joke that every time I move, I want to pile up everything I own and light it on fire, and now that job's been done for me. When I talked to the claims guy for my car, he says "Is your address still on Nunan Street?" and I say "Not anymore" because it's not. The CAT-AT in our living room, the life sized Anakin Skywalker that scared the shit out of the roommate. The fridge with the door that would never close. I'm moved with a suitcase to a nice apartment in West Ashley with a new, different dog and a new roommate and a new life in the same city.

I packed a bunch of my clothes to Houston because I had to check a bottle of port for Christmas. More than I would normally. Dress clothes. An electric blanket.

I don't have scrubs. Those stupid throwaway pieces of cloth the hospital provides us, but we have to return them to the machine to get them back and mine are burned.

But stay tuned for us on the news. We're top billing. They don't know our names or the dog's name, or if the cat I never liked is alive. But they know about the smoke that actually changed the city skyline for a while, the neighbors that were so horrified by our loss, the possibility of the Arsonist At Large, or if you're me, more probably, the Squatters That Were Cooking.

Can I just stay in Houston?

Another month of surg path down

2011-12-24T01:16:00.000-04:00

Why are there so many Christmas trees around?

Oh right, the holidays... so today was the last day of work; I raced home, swinging by Charleston Beer Exchange to buy my roommate a "thank you for ferrying me to the airport at the break of day" six pack hand picked by a man with a moustache that said he was up to the job, then home to do the *absolute* worst packing job I've ever done in my life, and now, en route to bed as I wash my last shirt.

Warning to cousins: I may end up wearing bathing suit bottoms and a winter jacket. Not a good packing day for me.

This month has been an interesting one. As I've mentioned, I'm feeling more "getting the hang of it" in surg path. This is partially related to learning how all the systems work and what's supposed to go to what, which is a far greater contributor to competence than... you know... knowing what's under the microscope.

There's a certain logic that's emerging that seems absolutely obvious now most of the time but just wasn't when I started. Example...

My first month on, I had a uterus with potential endometrial cancer. I asked for help and was told to submit as much of the endometrium as possible, since obviously, that's where the cancer is.

So I proudly scraped every bit I could find off to make sure there was no spot unsampled. Bring on sign out... "Do you have any sections showing the depth of penetration into the myometrium?"

"Huh?"

"The most important prognostic criterion?"

"Uh... I scraped it off."

"You SCRAPED it OFF?"

(Puppy frown)

Fortunately, the beleaguered attending was able to salvage some unmutilated sample from the specimen, but not a proud day for me. Looking back, I have no idea what possessed me to think that would be a good idea. I wrote some of it down in my notebook so that I never go fully butt wild on a noob because I'm already realizing how much of an idiot I was a whole three months ago. By the time I'm in fourth year, it's going to be insane.

Part of my increasing, let's say "comfort", with my current lot in life is only now realizing that other people are going through *exactly* the same thing I went through.

Ishie, having mastered the art of "track down the screwed up slides" is charging through the halls between the resident on yesterday and the histo lab, is stopped by colleague who looks close to tears.

Colleague: "Um... do you know anything about... um... pancreas?"

Ishie: "Ah... my archnemesis. Not really. Sucks macro; sucks micro, gotta go".

Ishie sees colleague later, who is on hour 4 of read out or what I like to call "staring impotently into a scope until someone either helps you or you panic and then stop caring".

Ishie: "How'd it go?"

Colleague: "I hate pancreas."

Ishie peers in scope... "Breast, eh?"

Colleague: "I have four more... is it bad... I feel like I just don't care."

Ishie: "Diagnostic inertia."

Colleague: "This isn't cancer. What is that?"

Ishie: "I'd probably hedge my bets and call it sclerosing adenosis. It's probably wrong, but shows you were paying attention."

Female voice from dictaphone: "...Goodbye."

Colleague: "No!! You bitch!"

--------------------

While grossing placentas, which is tedious.

Ishie: "Dammit."

Different colleague: "What?"

Ishie: "This umbilical cord inserts but then, it's membrane bound all the way to the edge, and I don't remember what that's called."

Different colleage: "Where's the actual insertion point?"

Ishie: "Central. What should I call it?"

Different colleague: "Central."

--------------

Other colleague: "This is case SP-76-7872, patient's name is Jane Doe. Preop diagnosis of missed abortion. Specimen A is received in formalin in a container labeled with the patient's name, medical record number, and... wait a minute" (presses rewind)

Dictaphone: "Please scan the bar code."

Other colleague scans bar code: "beep"

Other colleague: "GODS. This is case SP-76-7872, patient's name is Jane Doe." (presses rewind)

Dictaphone: "Please scan the bar code."

Other colleague: "I'm going to break this phone."

I have done every single one of these things. It makes me feel peaceful. It also makes me feel good to be the go to girl among first years for prostate. It's a weird source of pride but there you have it. I'm good at prostates. I looked at so many at Brooklyn Hospital that it just stuck, so now I can scan away on forty slides feeling downright zen despite getting twisted into indecisive convulsions at trying to phrase "This guy has a giant icky infected boil in his arm" into pathology speech.

But enough with that! No more surge path this month or this year, and I'm off to see my family! I haven't seen any of them since I took my step 2 CS and my uncle ironed my white coat for me while my aunt took me shopping and my cousins took me drinking. I'm full of awesome sauce for it.

Happy Holidays everyone!!! May your ovaries all stay manageable sizes!!!!

A Caribbean M.D. is Weird Enough for Me.

2011-12-17T01:30:00.005-04:00

See what I did there?

If I had to use one word to sum up what medicine feels like, it would be "Imposter".

Things are weird. Not bad weird. Just weird weird. Sometimes good weird.

I'm not sure if I'm a hipster or a yuppie or just desperately trying to pretend to be one or the other. I scathingly referred to my new brew as "Nut Brown Budweiser", which seems to put me in the hipster category, but I spent the evening at an Aquarium party for who knows what while eating different select cheeses and staring at fish, which seems like the latter. I did that while wearing a seemingly ironic dead alligator purse, which seems hipstery, until it's known that I only did it because it's the ONLY purse I have that can double as an evening purse, and then we're just back at imposter.

My point being, when I think "I'm a doctor", I don't think this:

Hi, I'm a turtle. I have nothing to do with pathology

I'm not sure why this party was being thrown. It was supposed to be impressing something on someone, but I don't think that someone was us. So we drank Chardonnay and watched albino alligators and sea turtles and ate brie, and attempted to do the electric slide, while I fidgeted and adjusted the dress I borrowed from my roommate, pretended to be deliberately avant garde with my eBay dead alligator purse, and made that level of polite conversation you see in movies about social functions like this one. If this had been a movie, you would have seen me through a fisheye lens prattling at the protagonist about sales on purses at Kohl's because the media has taught me that this makes good conversation, and to be fair to them, it totally does.

While a bald eagle squawks in front of the whole purse/shoe conversation because... pathology?

I'm okay with it though. It keeps me in wine and free meals until Christmas.

We had a fancy pants party last week as well, though this one had a more discernible motive and involved our department, but still, everyone climbed into the Charleston finery, went out to a posh venue and sipped champagne and ate sushi and danced the macarena or whatever else uncoordinated white people such as myself do. Of course, then all the residents bailed and went to a dive bar (the hipster is strong with these ones, Obi Wan), but still.

If I were back in Blood Bank, this would be a more natural progression of "nice clothes with a white coat and reviewing charts and occasional (gasp) seeing patients, and feeling all real-doctory and stuff, but I'm not. I'm in surgical pathology again. I live in comfy oversized scrubs that I rank according to how much formalin-soaked uterus juice they have on them on any given day. I run place to place; my pager goes off constantly.

Weirdly still, I'm starting to learn the whole way of it. For visiting newbies, (hi!) this is a marked deviation from my previous coping methodology which was sobbing hysterically into an open specimen until someone helped me.

I'm at 70 hours this week for the first time. And I haven't cried once.

Yesterday, I grossed. I've been getting faster and more efficient at it, so worked through my sheets as quickly as was possible and got it all on my run. This grossing day included some particularly juicy ovaries and placentas that sprayed blood, formalin, and unspeakable evil all over the place. But then... I have one attending whom I really like a lot but I feel like I've been letting her down a bit lately. Mainly because she's been following up cases that are in my custody while I've been attempting to score at least five hours of sleep a night. This is the same attending that's an amazing neuropathologist and has been trying to teach her knowledge to us. It becomes apparent to her through a few lectures that not a single damn person in our residency program has read the damn chapter(me included!) and she's beginning to get pissed.

So we end up with bonus unknown slides. This is essentially the pop quiz of pathology and consists of looking at tissue under a microscope while said image is projected onto a big screen and you have to describe the tissue and get the diagnosis (or something approximating it) while your colleagues stare at you, and the nice ones try to cough answers. Tres stresful. So I want to go home last night but I'm like "I can't even fake neuro, so I'm going to look at these unknowns", and try to cheat by pulling the patient numbers, which are obscured, which just serves to make me study. Two hours later, I realize I've been punked into reading the chapter I was attempting to cheat to avoid reading.

Morning came. 7:30 I'm there for frozen sections. Get a little breakfast. Go to neuro unknown conference. First two neuro cases go... for the second, I'm called up to drive the microscope. I do. My pager goes off after I get as far as "Uhh..." and I'm off to the frozen room. OR 8 needs frozens because their surgeon doesn't understand what frozens are for. I freeze lymph nodes in that time period, because I enjoy destroying diagnostically important tissue that doesn't freeze well. I go back to conference. Five minutes passes, during which I proudly have all my late night-compiled notes in front of me so I can act all gangsta about knowing that the nastiness in that person's skull is from their gonads. Beep goes the pager. Back to the frozen room.

The frozen room is where surgeons bombard you with spare scraps of their patients and expect you, in 20 minutes, to tell them what's wrong. This leads to conflict.

Some surgeons just call you to harass you. Some send an entourage of residents and fellows to come down and troll for blood. If they sense your weakness, you get overwhelmed and apologize profusely for the delay. If you sense *their* weakness for violating your territory, you adopt killer attitude and throw them out.

This used to be prime Ishie-cry territory, but I went with it. Describe the specimen, print the slides, freeze the piece, make the slides, run it to the attending. Rinse and repeat.

I get a tumor bank. No problem. I'm inking stuff and cutting into necrotic horrible looking tumor while the PA cuts other frozens in the background. I got this. I'm smearing awfulness onto a petri dish and dumping a piece of something else in cytogenetics material and running each to its proper place. It's good.

The morning hell cycle ends and I run to my mailbox, which is full of "special stains". My pager goes off three more times because the stuff I need deboned is coming out. Slowly and inconsistently. I grab those. All the stuff I grossed the day before starts coming out.

My attendings from the previous week all want something. Do you have the mesh? The mandible?" The Ki-67? Do you have the new levels? What did you think?

Meanwhile, I'm like... I spent 14 hours in a plastic shirt chopping uterus. Unless what you're talking to me about relates to being in a plastic shirt cutting uterus, I'm less than useful to you.

But I get it. I gather my old cases, start dictating addendums, and start making house calls. "Dr. S. I have the two decal slides that show infiltrating ductal carcinoma and I dictated them but..." etc. Then it's multi-houred "Benign Reactive Lymphoid Hyperplasia" (tonsils) time. I get those out. Throw in some transected fallopian tubes. A positive for cancer biopsy. A Vulvar lesion, grade 3. I dictate it off and keep going. I find myself minus one endometrium, and I wind up elbow deep in uterine fragments, wondering if I should be more worried about there being uterus on my upper arm or the carcinogens said uterus has been sitting in. I turf some stuff; I read up on the immunostains. I chat with the histologist, who calls me doctor.

I get it. Or, I'm finally starting to get it. This whole cycle, and I'm okay with it, hard as it is.

But then I'm running home to change into a cocktail dress so I can look at a bald eagle while eating homemade mac and cheese and drinking wine. Weird.

Meanwhile, stuff heard in the grossing room:

"Dammit, it looks like someone slaughtered a goat at my station."

"Wow! That looks like a honeybaked ham! Jamie!! Doesn't that look like a honeybaked ham?" "That's disgusting."

"Yo, Anna, you happen to see my dead twins around?" "Ah, the Carson kids. They're downstairs."

(after cranking at the cryostat) "Marster! Dinner is prepared!"

"Check it out; it's Godzilla's ovary."

My attending: "More blue." "More blue?" "Don't use the timer. Use the Force."

"Wanna see my carotid body?"

"I'm comfortable enough with my masculinity to wear a pink shirt, but to let another man run his hands all over me? No way. Let me see that uterus."

"Oh my god, I absolutely LOVE Florence and the Machine. Her voice is ama... SHIT, this ovary just exploded on me.

"There's a frozen from OR5." "Tell him to go away. Tell him Tyler went away. Tyler not here. Tell him the gate's closed."

"Can I put my butt warts on your run?"

You want me to tell what to whom?

2011-12-15T01:49:00.000-04:00

"I bivalved the uterus. The endometrium looks normal."

"All right, let me come see. Okay, you're calling the OR."

"... what?"

"Call them and tell them."

(Deep breath) "Okay." (picks up phone)

"Wait! What are you going to say?"

"Uhhh... I... this is pathology."

"Do you have a name?"

"Yes."

"Do you have a degree?"

"Yes."

"So use it! Women, we always do this. You're DOCTOR Sancho and you have his results. Now what are you going to say?"

"Um... this is Dr. Sancho from pathology. The... uterus..."

"I examined the corpus and..."

"The endometrium appears benign. There are no polyps or lesions visible."

"Okay."

(Picks up phone) "Hello! This is Dr. Sancho from pathology. I examined the uterine corpus and the endometrium appears benign."

"Oh! This is his nurse. I'll put you on with Dr. ScarySurgeon."

"Hello? This is Dr. ScarySurgeon. You're on speakerphone."

"Meep."

Meanwhile:

Accessioner: "Ooh, that's Dr. ScarySurgeon? Tell him to call ahead on his frozens. I can't, but you can."
Ishie: "I'm a first year. He'll beat me up and take my lunch money."
Accessioner: "You have lunch money?"
Ishie: Dammit.

The elusive monkey

2011-12-02T01:24:00.002-04:00

But just when you thought I had a big long blog post prepared for you, I'm back on surgical pathology! Mwa ha ha ha ha. And still without a home computer. I'm looking at a hard drive wipe, but I'm also looking at a device so buggy that it won't avoid the fatal errors for the two days it would take to do a full back up onto my external. Le Sigh.

I'm also left with the quandary of having that Dr. Horrible link come up as one of the first things I see, because I could probably watch Slipping and Bad Horse on repeat for as long as it would take me to fix my home computer.

But instead I'll say, I went to Costa Rica! Woo hoo!! After fruitless years as an anthropology major with an advisor who was a big primatology guy, as well as two years in Grenada and a trip to the Philippines, I'm finally gonna see some frigging monkeys!

Dammit. It's like they know. We went to this one beach where I overheard a guide say to a group "You need to be careful about leaving belongings on the beach. The monkeys will open your bags and rummage through them."

Monkeys are actually a *problem* in this country. But for me? No monkeys.

However, as I was walking through a particularly scenic rainforest, this guy nearly fell on me:

They're not graceful animals.

They also kind of look like Chewbacca and an orangutan had a drunken, regret filled night in Las Vegas. And died the result green.

I heard a cracking noise above me, and something crashed down out of the trees. When I saw it was a sloth, I had a brief insane moment where I whipped my camera out and was like "I need to get this picture before it gets away". Then I took like 25 pictures because... sloth.

We also stayed in a place that looked like this:

And I did this:

So I'm thinking f- the monkeys.

Anyway, I'm late to bed but the short of it is:
Costa Rica= awesome
Blood bank rotation= awesome
Having a week of Xmas vacation over surge path= awesome
Having additional source of income= awesome
Getting to go to Houston for the holidays to see extended family for the first time in forever= awesome
Seeing mom in Maryland over Thanksgiving and learning fun-facts about the Amish= awesome
Being back in surge path= This time will be totally different! What's that ominous music?
Dad back in hospital for Thanksgiving= unawesome

Pending... pending... Thanksgiving loading

2011-11-25T03:48:00.000-04:00

Hiya guys, lots of stuff lately conspiring to keep me from you. My dad's in the hospital again, my computer's internet has been completely disabled by ZeroAccess and Combofix can't seem to restore it, I'm sick, and I've been in Costa Rica, but now I'm in Maryland with my mom. And then there's the whole doctor thing.

Happy Thanksgiving/murder a hypertrophic chicken day. Specific updates to follow at some point.

Happy Pre-Halloween!

2011-10-30T15:46:00.000-04:00

I'm stuck inside doing a PowerPoint presentation for Halloween, so figured I'd share some Joss Whedon vaguely Halloweenish action with you guys, since it distracts me from having to screw with fonts.

Enjoy.

I'm proud of us as a species...

2011-10-28T21:06:00.006-04:00

Last night, I feel like I watched human accomplishment summed up neatly into a three hour window.

You see, RockStar and I decided to watch a horror movie, being all close to Halloween and everything. Since Netflix inexplicably didn't have access to the Ring, despite it turning nine years old this year, we watched Night of the Living Dead.

Then we watched the first episode of the Walking Dead.

Evolution in action people. It's not like Night of the Living Dead just has bad special effects. I feel that's an unfair accusation to lodge against the past. Just everything about zombie culture has improved so significantly. Even our fictional media response. In Night of the Living Dead, we get "The murderers... they seem to be feasting on their victims... more on this as it unfolds", and despite my unfavorable view of our current media, I feel fairly confident that after one morgue attendant got dragged screaming to his death, the first headline would be "HOLY CRAP, ZOMBIES. F'ING RUN. IT'S TOTALLY ZOMBIES. HEADSHOTS KILL THEM"

I object to sequences such as the following:

Useless woman watches nearly equally useless sibling get murdered by zombie while pathologically not helping. Woman eventually runs and trips over high heels, because... chicks, am I right?

Time elapses. Woman is on ground. Woman is not getting up. More time elapses. Woman is screaming and kind of shuffling around. You're like "Aw, that's sad, she must have broken her tibia." Eventually woman gets up and runs like a deer. The directing required to fix this oft repeated scene seems like it would be easily repaired by going "Okay, now fall and then start running again. Like maybe as fast as someone who was out for a casual jog would if she tripped and got up."

Then someone chucked a molotov cocktail about a foot from a car they were using. This is why the younger generation thinks people from the "past" are dumb. This is our resource for behavioral studies on people from the 60s and 70s. Not a good legacy.

I feel like this is a better source for remastering than say... adding a big "NO" to Star Wars. Just saying.

So then Walking Dead... which is frigging awesome. Good cinematography, good acting, still enough human stupidity to be believable. Zombie-win. And it's a network show too, which blows me away. I've been watching a ton of movie channel shows lately and have forgotten what's allowable on network tv so naturally when a small girl holding a stuffed animal gets shot in the forehead in the first five minutes of the first episode, I was like "Hmm, HBO or Showtime?" Nope. I'd just forgotten how much violence we're willing to tolerate at the expense of frontal nudity. But I watch Dexter, so I'm okay with it.

Speaking of zombies, I may have mentioned this, but I've come to grips with the fact that if there is a zombie uprising, I'm dead. Like first 15 seconds of the movie dead. I'm the one in the white coat mucking around the hospital morgue that's like "What's that soun... ARRRGHHHHHHHH!!!!"

When I'm a zombie though, I'm going to totally bite our dog. Because you know what's cooler than a zombie? A zombie with a zombie rottweiler.

ANYway, I'm still in blood bank. Hooray! Blood bank is giving me some interesting "You learn things by teaching" moments. Many of the principles behind what the blood bank does are confusing. Extremely confusing. I'm learning them now as part of the whole rotation, and I have a great instructor and lots of packets to aid my learning.

As the first year resident, when I have the pager, I'm the first one people talk to. I'm not the *last* one people talk to, thank goodness, but I'm the gatekeeper, only *I* get asked the riddles. I'm the anti-sphinx.

In clinical medicine, you largely talk to patients. This is a mixed blessing because the level of patient understanding ranges from not knowing what a liver is and why drinking antifreeze should not be a cost effective alternative to vodka, to being experimental pharmacologists that realize my puny knowledge of antibiotics is inadequate. But *most* patient interactions involve de-med-schoolizing your knowledge to an audience that didn't attend medical school while med-schoolizing their symptoms to arrive at a diagnosis and management plan.

In blood bank, I talk to doctors that almost exclusively are higher on the food chain than I am, and techs that should be. When I'm asked questions, it is almost exclusively stuff I either flat out don't know, or think I know until I start trying to explain it to someone with a medical degree.

Ideally:

Ishie studies material and periodically checks the internet. Pager goes off.
Ishie: "S***" (checks pager. Sees blood bank number)
Ishie: "Whew." Dials.
Blood bank tech: "This is what needs to be done but someone with different letters after their name has to say it needs to be done. Do it."
Ishie: "No problem!" (does it, calls back blood bank)
Ishie: "I did it! They say it's cool."
Blood bank tech: "Good girl. You get a cookie."
Ishie: (wags tail happily)

Sometimes:

Ishie studies material and periodically checks the internet. Pager goes off.
Ishie: "S***" (checks pager. Sees foreign number.)
Ishie: "Double S***" (dials)
Senior resident/fellow/attending in other specialty: "Yes, this is Dr. ScaryName. We have an extremely sick patient named Joe PleaseDontDie, medical record number IHopeYoureHoldingAPenInYourHand and we've already done all the stuff that you learned about in medical school and most of the stuff you've learned about in blood bank, but now we need to know if we need really hard-to-get blood products, or if we can use this type of blood product that you read about a little while ago, but it involved a lot of letters and numbers and while you feel kind of okay about it, you definitely don't feel qualified-to-give-expert-advice okay about it?"
Ishie: "..."
Dr. ScaryName: "Hello?"
Ishie: "Uh... so what is the patient's relevant blood value?" (starts hastily flipping through stacks of papers and pulling up patient history and labs)
Dr. ScaryName: "DangerouslyLowNumber"
Ishie: "Oh! Yeah, that's pretty bad."
Dr. ScaryName: "So... what should we do?"
Ishie: "Vasovagal syncope is mediated by the autonomic nervous system"
Dr. ScaryName: "Did you see that on Scrubs?"
Ishie: "... yes."
Ishie: "Umm... I think you should... let me clear this with my attending first. Are you going to be at this number for a minute?"
Dr. ScaryName: "No. I have to go see sick people."
Ishie: "Ah... well... let me page you in a minute." (hangs up, dials attending)
Attending: "Hello?"
Ishie: "Daddydaddydaddydaddy, this really smart doctor called me and asked me a bunch of questions and I don't want to accidentally kill anyone and then I scraped my knee and the neighbor boy made fun of me."
Attending: "There there. Do this thing. You see, this antibody is causing the problem, but we will need to talk to the Red Cross and they will find a donor and patient will be far less likely to die."
Ishie: "Cool! Thanks!" (confidently gets back in touch with Dr. ScaryName)
Ishie: "Do this thing! You see, this antibody is causing the problem, but we will need to talk to the Red Cross and they will find a donor and patient will be far less likely to die."
Dr. ScaryName: "Okay, thank you. That is very helpful. One question, just in passing... How would that antibody arise when patient was negative for it last time, but we don't have a record of previous transfusions?"
Ishie: "Well what happens is when a patient..." (knowledge decay)
Dr. ScaryName: "Hello?"
Ishie: "Dammit!"

Then I get home from work. This gives me another opportunity to learn by teaching smart people because my roommate will be all "how was your day" and I'm like "incredible (blood bank on a bad day is less exhausting than surge path on a good day) though I had a rough call towards the end of the day" and she'll ask me what happened and then it starts over again, but now I'm explaining the situation to an intelligent layman, so then I realize how incredibly convoluted the entire thing sounds. Blood involves a lot of really difficult concepts to grasp so I found myself at the end of the evening struggling to remember what blood group antigens typically do since most of them have some nebulous function beyond being your body's self destruct button if someone with different blood attempts to help you.

For example... did you know there are different blood groups? Of course you did! You guys are hardcore. ABO, no problem. You may know what blood type you are. You rock stars even know about Rh stuff I bet. Did you know the whole Rh positive negative thing consists of several different genes closely linked, any of which can be different and create conflict? Neither did I. Duffy blood group? MNS? Lutheran? Lewis? Kell? Some are IgG. Some are IgM. Some are IgMs that act like IgGs. Some aren't important. Some *usually* aren't important until they become important. Some bacteria like to temporarily screw around with your minor blood groups because bacteria are bastards, have been here longer than you have, and resent you because your DNA is all locked up in a nice looking nucleus acting like it's better than they are.

Fortunately, I'm surrounded by awesome people that don't make me feel as dumb as I possibly am AND I don't have to take too many calls per day because everyone's pretty good at this stuff and the hard stuff doesn't come up *that* much. But it's still some serious brain strain. Either that, or I'm already a zombie.

A quick and unrelated gripe

2011-10-10T21:54:00.000-04:00

since work is going so well. My blood bank attending is super cool and is a man who spent most of my first interaction with him talking about falconry because as the saying goes, you may think a man is awesome, but you don't KNOW he's awesome until he talks about being in Ireland with a giant f-off bird sitting on his wrist. He spent today going into exquisite detail about blood groups and (drumroll), I actually understood him. This is stuff I didn't even bother trying to learn in medical school because it's so complicated. And... I'm liking it. Between this and veering toward hemepath, I may end up being *that* pathologist.

Speaking of blood, that leads me to my latest gripe. My beloved Dexter is back on, and has named my car. And I love the movie channel shows because they seem to be much better in quality than the other shows, plus, hey, bonus sex, violence, and profanity.

Problem being that these shows often go on extremely extended breaks since there aren't as many episodes in a season, thus spend the entire first 1-2 hour-long episodes expositing awkwardly while having conversations no sane person (or serial killer) would have.

"Remember, we want to go back to being friends again."
"Yes. Like before the divorce."
"Yes, before when we were just friends, but then friends that did it, but then got married, but then got unmarried and hit the reset button."
"I would like that very much. Let's talk about the paths our careers have taken over the past year even then we've both presumably been here every day and have seen each other."
"Yes indeed. I would like that a lot. Isn't it a shame about all those significant events in the last five years that have happened to our friend?"
"Yes! And our tech has interns! He is so wacky. I like how he is sexist but in a benign and humorous way."
"Me too!"
"He is such a quirky contrast to our other friend who is totally normal."
"Yes, it's a shame our normal friend keeps disappearing late at night to go fishing. And says weird pointed things out loud while staring off into space and talking to his dead father about suspected killers who keep vanishing."
"And how!"
"Isn't it great how we're no longer sexually attracted to each other?"
"Sure is!"

Gods, make it stop. If new viewers want to know what happened for the last five years they can:

A. Watch the first "previously, on movie channel show" bit that's like ten minutes long.
B. Reference a Wikipedia page that will cover all the plot points, probably feature pictures of the major characters, and possibly expound on the recurring thematic elements and how they relate to an arcane Elizabethan play, depending on the employment status of the contributor.
C. Watch whatever they missed on Netflix in chronological order.

In other words, PLEASE STOP CATCHING NEWBIES UP AND FRIGGING KILL PEOPLE ALREADY.

That is all.

Ishie 2.5, the Reboot

2011-10-08T23:22:00.000-04:00

Wow, where to even start.

I've been smiling a lot lately. That's been out for a while.

So essentially, as you've no doubt been guessing, the first month of residency was okay, the next two months systematically broke me, and now, I'm building myself back up with a great deal of help from starting a blood bank rotation, aka, "Now you can rest and learn about what you've been doing for the last three months".

The last week of surg path was actually pretty good for me. The surgeons gave me a break, PLUS I finally started to feel a little more confident in my skill level which spelled not getting home at midnight which spelled not getting snarked at by the fellow which spelled being able to get to lectures in the morning which spelled not sobbing uncontrollably into a pancreas.

As part of the whole "I'm not going to be that person anymore" thing, I chopped all my hair off, gave it to Locks of Love, and told the stylist to do whatever she wanted with it so long as it was short and some variety of red, so my 'do looks a bit more like Ed in my profile picture, which I kinda love. My hair's never been this short before, and never this successfully red, since I tried to dye it myself in high school with clairol and it ended badly.

But the big news: I GOT A CAR!!!!!!!!!!!!!!!!

I can't even properly express how big this is to me. I haven't owned any type of car in over two years, and I haven't had regular access to one in over four years. I've had rentals and Zipcars and etc, but never MY CAR which I can do whatever I want to with, with the loan in *my* name. And it's a new car, which I've also never had before, since some variety of witchcraft and the economy has led to used cars holding their value to an insane extent and the financing is better on a new car.

And he's so pretty. I named him Dexter because it sprang to me and it fit, so now he's Dexter forever. He has automatic *nothing*. I was so desperately afraid of getting taken advantage of and snake oiled, since I have *literally* never done this before that I went in with a paper full of Kelley Blue Book values and was like "NO. No power windows. No power locks. No trunk light. You're lucky I'm caving on not having manual transmission. I know the base price of this vehicle and I'm sticking to it" To his credit, the salesman was like "O..kay." When the maintenance guy went through the orientation with me, he kept checking his list going "Uh... well the cruise cont... no.. Um... so... this is how you turn on the air conditioner."

Which was the only feature I care about. Charleston is hot 6 months of the year and excruciatingly hot for another 3 months.

I still bike to the hospital, because it's genuinely faster, but ARGH SO GREAT. I hadn't realized how much I had completely adapted my life to be carless, and how much I would absolutely adore going back to a vehicle life. Example... I can use shopping carts again. I haven't had much of a use for them when people haven't been bussing me around because whatever I can carry in the store is what I need to either shove into a backpack or load up my arms with. Most of the food I've purchased in the last three months has been cylindrical because it fits well in my bag. "Hmm... I'd get this head of lettuce, but that's going to get crushed. More olives, cookie dough and wine. Perfectly shaped."

And I love Trader Joe's and Whole Foods because I'm gradually turning into a hipster f-tard, and in Charleston, they're inexplicably next to each other and now I can fill up my car with fancy schmancy stuff from them and stock the essentials from Costco, on the same trip, without holding someone up for an hour to watch me shop. And as much as I loved those stores, it was totally out of my biking range here, and in New York, anything obtained by them had to be carted home with upper body strength. Even in Grenada, my grocery abilities were limited by how much stuff I could haul onto a bus during a rainstorm.

Can you tell I'm excited? Also on the exciting scale, I got doctor treatment at the car lot, which I didn't even know was a thing since the "Catch me if you Can" days. Usually it seems to be more the assumption that I have way more money than I do with a general thought that my salary (heh) is what's wrong with health care today. My credit got pushed through without a lecture on not spending four years running up revolving debt AND installment debt, and I got a lower interest rate than any average I looked up, and as I tried to look tough in my little blue dress while pretending I know how cars work, the guy was like "Oh... credit check for DR. Sancho. You're a full MD right?" "Uh... yes?" and then boom.

I keep driving across the big bridge in Charleston just because I can now.

Okay, that's it for now. So long story short. Life. Not sucking. Stay tuned.

Monday Monday, not as bad as before...

2011-09-20T00:23:00.002-04:00

I'm afraid to jinx this streak though since we're on a three day cycle, bad days tend to beget bad days and good days tend to beget good days, but today ruled. I was on top of my game, the specimens were few and far between, and I didn't put stab myself with anything.

My patient car-owning roommate also took me to Costco, which is a store I've been gradually discovering in bits and pieces and am filling more with love for it. I'm also stocked in pasta, meat, and beer for the next month, with the added benefit of not having to bungee it onto the back of my bike and steer it through the ghetto. A twofer.

A short update, but hopefully a more reassuring one.

Friday is a better day to write...

2011-09-17T03:08:00.000-04:00

If each of my weeks of surgical pathology were presented as a topic of a medical school lecture, it would be presented as a fluctuating graph, similar to the sort of thing you'd see in LH and FSH curves.

Monday: Okay, this week is going to be different. This week I'm going to be more not-terrible at things and not get overwhelmed and I'm totally not going to start crying in front of colleagues/attendings/patients in the parking lot.

Tuesday: Well, Monday didn't go as well as I'd expected, but I'm still kicking and I have the opportunity to get some learning experience and even if I'm here late, I'm going to salvage these cases and not be an incompetent braying jackass. I'm going to ask the chief resident for some advice on time management without cry... well, not much crying.

Wednesday: OH GOD I'M TERRIBLE I'M GOING TO QUIT MEDICINE THIS TIME I SWEAR WHY AM I SO STUPID UIJNJHjh;iblarghhhhhh

Thursday: Tomorrow is Friday, I just have to make it for today and tomorrow and I'm going to run damage control, but I can't believe I lost it that badly yesterday, fortunately the transcriptionists haven't mentioned hearing my voice break at 11 PM on the dictations because I realized I still had four liver biopsies left and don't actually know what liver is supposed to look like IS THAT CANCER?

Friday: I'm so tired. Did I seriously not screw up these cases as badly as I thought? Is that attending praising me? Life has meaning! I'm going to go sleep for twelve hours...

Saturday: I'm going to get groceries... and do something today. And I have a little time? I'm studying some lung! I feel like I'm finally getting this!

Sunday: Studying dermpath. Slight impending feeling of doom, but I've done some reading! And rested! Next week's gonna be awesome!!

While I definitely feel like the weakest link right now because my colleagues are suspiciously good at this stuff, the early surge path months could best be summarized by the following scenario:

(In a dead quiet room, an intern stares meaningfully into a microscope, scans a slide, stops, frowns)

"What the f*** is that?!?!????"

(Other interns crack up, both in sympathy, and in the realization that their dictation now has someone else's exasperated exclamation in the middle of it. Ponder that the transcriptionists haven't killed us. Other interns gather at the scope. Several appear puzzled.)

Just-studied-that-topic intern: "Normal breast tissue"

(embarrassed silence)

Yeah. It's not a program problem, honestly. There just seems to be no way to be a first year resident and not feel about as useful and intelligent as a squirrel wearing oven mitts.

Speaking of dexterity impairments, I contributed to *last* week by plunging a contaminated scalpel through my thumb. Yeah, *through*. I don't like to screw up small.

Funny thing? I'm constantly overwhelmed by crippling feelings of panic and inadequacy about my overall competency as a physician, yet having a knife stuck in me largely made me feel really really embarrassed about having arranged myself in such a way to get a knife stuck in me rather than being that concerned that there was, ya know... a knife stuck in me.

Here's the thing too.. we wear cut proof gloves... they do not prevent against stabbing with great force, which should both tell you that you shouldn't use them in a joust and that I was doing something stupid.

Situation:

(knife plunges straight down, left thumb is briefly pinned to cutting board)

Ishie, to herself: That probably glanced off the glove and is caught on it. The sharp pain I am feeling is likely due to the blunt force hitting my thumb.

(blood quickly spills through cut gloves and two layers of latex)

Ishie, to herself: Oh.

(pulls up scalpel)

Ishie, to accessioner around corner: Um... If there's an... incident, who should we call about that?

Accessioner: Did you spill something?

Ishie: Sort of.

Accessioner: What do you mean?

Ishie: I cut myself.

Accessioner: Badly?

Ishie, evaluating blood puddle on table while applying pressure: Um... pretty badly.

Accessioner, rounding corner: Oh my god!

Attending from other room: What's going on?

Ishie, to herself: Oh good. Let's bring everyone in on this.

Attending rounds corner, pushes Ishie's hand into sink. Ishie experiences sensation of water running from one side of tissue to other. It feels really weird.

Ishie: Sorry sorry sorry, I was being dumb. It's no big deal.

Attending, simultaneously: Don't worry, infection is really really rare, we'll get it taken care of. We'll test the patient. Was there more than one specimen?

Ishie, to herself: Oh right, I should be worried about that.

Why social stress panics me and trauma doesn't remains part of the deep lurking mystery that is my psyche.

Everything got taken care of really quickly, people came to back up my workload, I was off to the ER, everyone was making phone calls, and it was bam bam bam. Very impressive. And I'm fine. Extremely clean cut, sealed with dermabond, a week and swelling is going down with no signs of infection. Also, the ED at this hospital is really nice looking. While I *love* New York, don't get me wrong, the hospitals tend to have a more, let's say, 'lived in' look that doesn't look as clean even when it is.

So I kind of feel like a mess. I do feel like I'm getting somewhat better at things (except cutting stuff), but really slowly. I'm *really* slow at grossing and usually require a great deal of help, and then I'm doing decently on diagnoses, but it takes me a really long time. And I make dumb errors. Dropping stuff, putting stuff in the wrong boxes, forgetting where paperwork goes even when I've been shown fifty times, being completely incapable of recognizing squamous cell carcinomas anywhere.

Seriously, I hate that cancer so much. And it pops up everywhere. And it's frequently so obvious that the other residents, med students, janitors, and elementary school children that wandered into the hospital are like "Oh, that's an SCC", and I'm like "Where??? Is it behind all that red cancery looking stuff???" Gah.

So that's the update... I'm still dumb, but people are being relatively cool about it. Let's hope the idiocy is low-grade and transient.

The reboot

2011-08-31T00:02:00.001-04:00

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.

(pause)

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.

Dated References

2011-08-28T22:19:00.002-04:00

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.

Run.

2011-08-25T22:25:00.002-04:00

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.

Gah!

2011-08-22T19:02:00.000-04:00

Residency summarized...

2011-08-18T22:06:00.002-04:00

I'm the blond one...

This is why I became a pathologist

2011-08-12T17:24:00.001-04:00

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.

Emo Thelonious Monk

2011-08-10T23:58:00.002-04:00

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...

With Apologies to T.S. Eliot

2011-08-03T00:13:00.000-04:00

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

Social Reality Check

2011-07-21T00:12:00.000-04:00

So I was wandering around the interweb before bed and discovered this thread, granted an old one: Dating a Medical Student. I focus on what medical school is like and the whole doctor scene, because hey, I'm self centered, but this is the whole "Other" view.

I'm not a student anymore woot, but it wasn't so much just the original post that paused me, but all the comments. It seems like dating us requires the same level of support group as one needs to, say, cope with being in love with a meth addict... who gambles... with babies.

Now, if I'm on youtube or something, I feel confident in the fact that the average commenter makes less sense than a monkey smearing feces on the keyboard, but this whole thing consists largely of well thought ideas and whole trends I see rampantly in myself, and previously defined more as "Weird independent female" and less "medical student stereotype". Are we that insufferable? Are we really that inevitably well defined?

Medical mysteries in action...

2011-07-19T00:45:00.000-04:00

You creep around the corner of the kidney, and there you see it, a throbbing gelatinous evil blob of tissue. You've fought this beast before. You bring your scalpel down and it screams. You grab it with the forceps so it can't wriggle out of reach and stab it again, cramming its protesting pieces into separate cassettes, so it can't reform vampire style.

Sighing, you resheath your blade in the curiously inefficient "safety" device used for them and take a deep breath. "Looks like I just blocked *your* flow", you say smirking, as hot lab ladies flock to your sides.

The next morning... the hearing... you're hungover... those ladies wouldn't entertain themselves after all, and with gams up to where their gams go, well, you don't tell em no. Still, no reason to ruin a good day. You stroll up to the corralled kidney tumor and throw its body under a microscope, give its family a good funeral, give a little lesson to is brothers... but wait... your blurry vision clears... you clean the scope.

That's not your tumor. It's a stranger. You look through the books on em, maybe bluff him a bit. Yeah, tumor. We know about you. We know about your brother. You're rare huh? Must be sitting here thinking you're pretty badass. So rare that the dregs down at county won't know what to do with you eh? I tell ya what, punk? I put condor eggs in my gin fizzes. That give you an idea what I think of rare? I spat in his face. You make me sick. And you're going down. I stormed out of the lab, before he could see he was getting to me.

As I brushed through the doors, the secretaries hastily fought for my arms. "Don't go!", they were flapping. The dames could wait. I had a book to read.

Skills to learn...

2011-07-18T19:49:00.000-04:00

For the past four years, I have not regular access to what people would conventionally call a "kitchen". Not that I was an exceptional cook before that. In Grenada, after a semester on campus with a stove top, I got my wonderful little apartment that featured a propane stove that my former Peace Corps working friend had to show me how to use, the oven was too small for almost anything, and two of the burners worked. The settings on those burners was "large open flame" and "No large open flame". Could make the hell out of some old fashioned popcorn though.

Moving onto Brooklyn, I graduated to a surprisingly similar gas/two burner functional half kitchen, which my roommate used enviably, but I mainly lived off of takeout, both as a function of kitchen size and laziness.

Now I live in a large three bedroom house that has a ginormous kitchen with an electric (gasp) stove. Roommate 1 cooks like a mofo. Like "Oh, these peaches are about to go bad and bazam restaurant quality pastry." I also have a yard now so the first thing I did upon having access to a vehicle was buy a grill because if there's one type of cooking I can do it's "Char things over fire" (thanks, Grenada!).

So I'm finally trying to cook quality food. I am pretty pleased with my blackberry cobbler and tonight, upon being too lazy to stop at the Piggly Wiggly (yes, really) on my way home from work, concocted a stir fry out of rice noodles and pale ale (no sherry) and it (drumroll) didn't suck!

I consider this further evidence of my whole "medical school delays maturity" hypothesis. By next year, I'll be buying car insurance and all matter of other things that most people master around age 25.

Free pizza remains awesome

2011-07-16T02:38:00.000-04:00

Yeah, I pretty much talk about food and booze. If you're looking for decent medical advice, this may be the time to StumbleUpon elsewhere.

The patient-information-free update... soooo difficult.

If this entire process has made me anything, it's paranoid. Not mature, by any stretch of the imagination, but I start to think "You know where I went to school; you know where I'm doing residency; if I tell you the cases I'm grossing, you'll know who my patient is, and you'll HIPAA until I cry uncle."

So, pathology seems to be a two way street. If you guys are complete science dorks with a love for a full night's sleep, this is seriously the way to go. I spent time today trying to think of a residency that generally has better hours, and I couldn't think of one. On the minus side, it's very hard to tell anyone what you do. You will either bore them or horrify them. Possibly a little bit of both. In completely unrelated news, the roommate that now knows how I spent the day thinks I'm hardcore metal, but I believe may be a little wary of me. I went to a bar for my Friday night fuel, and generally introduced myself to the young and innocent by saying "I work at the hospital". One, because they're all youngsters and I seem to get carded enough to pass for one of them, and two, because "I'm a doctor" both carries with it snob weight *and* requires a little explanation of what I do... which may involve either "I sat at a microscope for ten hours" (boring to the public) or "I (censored) a baby and now you're horrified, and I have to be all "Oh, but... it wasn't cool. Except it was. Sigh. Who wants a free round?"

For those of you that can't connect the dots (hopefully most of you), I'm in a University program now, and it rules. Every day, we get "zebra cases". It's not that we have a bunch of the same rare stuff, but whether I'm grossing (cutting up surgical specimens), previewing (pretending I know what these things are) or signing out (having the attending demonstrate that I don't know what these things are), it's always some bizarre things, because pathologists just don't do that much normal.

Today I got to really have control of dictation for the first time. It is the most intimidating thing. English is genuinely my first language. I always got A's in the subject matter; I worked as a frigging technical writer, and public speaking does not give me hives. When you stick a specimen in front of me and a microphone in my face, it's magical. I literally forget how to name colors. I will be looking at a pink strip of skin and thinking it's a pink strip of skin, and my dictation will read "Uhhh... (rustling) Uhhh... Specimen A is... uh... submitted in formalin... and... uh... is... a... color... I think it's pink... that is.... 5... by 2 by zero point 3.... centimeters... wait.... zero point four.... centimeters... in... uhhh.... aggregate... and consists of... a... uhhh... puce fragment of... sorry... addendum... my name's Ishie... I work for ya'all."

It's like pulling teeth.

So that's a life lesson. All the times where you thought acting or reading or any other performance based field was a stupid overpaid profession, just to let you know, you probably suck at it. A lot. Like, you should feel bad, you probably suck so much.

Along with dictating, I'm grossing. I'm learning how to cut specimens so that they show me what I'm interested in. Tumor margins, type of tissue, how the normal tissue looks, whether it's near the blood vessels, that's all based on my decisions. The negative side is that it's stressful. I don't want to sample a curiously benign scrap of tissue only to have the rest of it be malignant horror cancer. The positive side is that I feel like by the end of the year, I'll be a kickass sushi chef, and won't have to pay 2 bucks a slice for scallops.

Reading/signing out... it is difficult to describe how tired this makes you. My friends are working from 6 AM to 10 PM six days a week, and I am decidedly not. But after about hour 6 on the scope, you start to go cross eyed. You feel dumber than usual. You require the department's free pizza for brain carbs. Yeah.

I can't complain too much though. I was talking about this on the phone with my mom today. I am doing exactly what I wanted to do since I was a tween. It's fucking cool; I can't lie. I cut up a case today that I was uncertain about because it was a complete mess, and on section, it was absolute textbook of a condition that fascinates me. I hope I never stop realizing how lucky I am to be where I am, in a program that's awesome and not malignant, and just be at this whole stage of my life. I can see how people would start in this field and completely hate it; I do. If you want to "help people", as we all wrote in our personal statements, and then are counting the mitoses in a high power field, you may not feel very doctory, particularly when you're trying to pick up a history major that's 9 years younger than you, but whatever you do in medical school, if you love it? Freaking do it. Your residency will be so much better by virtue of it.

White coats obtained, time for a three day weekend

2011-07-03T01:42:00.000-04:00

So I dunno how much of this blog is like "Shut up with your whining already" and how much is like "Shut up with you're 'my life rules' crap", so I'm just going to go with the latter because on the odd periods that I give in to complete egocentricity and reread previous entries, the whiny ones are where I want to slap myself the most. Plus, I don't feel whiny right now, because dude... I'm not sure when the other "this residency can't be this good" shoe is going drop, but it hasn't yet, and they're long past the point of needing to lie to us.

It's various stuff coming together too. I've had some nastiness in my life where it seemed like the forces of nature converged to make everything suck. Oh, you're out of money? Well, this seems like a good time for your car to break down. While you're walking to a phone booth (they had those back in my day, you damn kids)? Good time for someone to yell stuff out a window at you and then it starts raining.

This is like the reverse of that. My colleagues are awesome; I like all of them. Unless you count the discriminating finesse of the match (aka, the blind dartboard of chance), the hospital has nothing to do with that. The hospital is gorgeous. The other residents are nice. The attendings are friendly. They have parties, like, a lot. The hours aren't horrible. My insta roommates on Craigslist turned out to be great in a house I like, a situation which I really threw myself into without much of a safety net, and easily could have ended in a spectrum of awful from "meth lab" to "human skin suit". Stephen Colbert randomly shows up the day I start residency.

It's not *completely* random, granted. Homeboy is from here, and the school has a Colbert library for a reason, but I tried for two years in New York to cross him off my NYC bucket list along with the Daily Show to no avail, and boom, he shows in Charleston on July 1st.

Scored tickets to that, because, really? and then as I was sitting in the best altitude sickness seats that thirty dollars could buy, the interviewer came on stage and said "Stephen would like to welcome everyone to the lower seats" or something like that, so I ended up 5-10 rows from the stage. And he talked for two hours. And did a song and dance from Strangers with Candy. The whole time I had a complete doofus grin on my face.

Today was the full GME party (as opposed to the outgoing residents' party, the welcome to our department party, and the late fourth of July party next week) and it was held at a marina. After discovering the open bar and caterers walking around, I walked to the end of the pier to a pod of dolphins that was just chilling.

I keep expecting to wake up in some dystopian nightmare strapped to a wall explaining to a man in a metal clown mask that I was in a beautiful world where I could tie Stephen Colbert and dolphins together logically without performing questionable genetics experiments.

Awesome ones though. Note to self: satirist/dolphin hybrids. Good idea or great idea?

Farmers Market and beach, also quite nice.

But enough of that. Residency.

Like in your fourth year of medical school, once you've decided on a specialty (or have matched into a specialty), you become intolerant of anyone distracting you with stuff that's unrelated to it. This is a problem during orientation because if you're not in primary care, you are going to spend a lot of time trying to surreptitiously check facebook while being taught the software for assigning prescriptions to the outpatient clinic, a skill I will need precisely never. Similarly, orientations involve a lot of stuff that is probably important in some broader scale, but the people at whom they are directed are not going to take them seriously either, so everyone just ends up pretending to pay attention. Examples? Drug abuse and sexual harassment. Is it important not to steal drugs from the anesthesia cart while asking your patient what she's got under her gown? Certainly. Is a talk going to deter someone? Probably not.

Our sexual harassment guy was pretty cool though. Not only did he focus on the bizarre problem of hair touching (WT-holy-F), but he referenced Sexual Harassment Panda. On the first thing, despite the answer of "When is it appropriate to touch a colleague's hair?" being "NEVER", I feel like my answer "When it's dangling into a patient" should have gotten at least half credit.

But let this all be a lesson to you people out there. Do not pet the hair of people you work with. Addendum, you're freaks.

July 1st was the official start date, so we got oriented to our actual departments so that was extremely exciting. We got our laptops (my Grenada laptop made it to the end! Against all frigging odds!!! Infected by viruses with *no* battery left and unable to close, it lived long enough to see me to a departmental laptop. Rest, sweet, computer. You have earned it.). We got books and a microscope. We have an interns' pen to ourselves that has about eight cubicles that are large and have a ton of desk space, and the common area has a fridge, microwave, two coffee pots, and a water cooler just for us. It is fantastic. I did sign out with an attending and resident in the morning, which reinforced how much I need to study (Mystery tissue. Fallopian tube. Mystery tissue. Mystery tissue. Thyroid. Mystery tissue. Fallopian tube. That can't be normal. And no, dorks, not struma ovarii). Different cases.).

Afternoon, I had frozen sections but the day before a holiday weekend is not generally a heavily hit surgery day so spent part of my time learning how to click around Windows 7 at my desk, and the rest of the time haunting the gross lab to see how things are done.

Here's a thing I realized about myself that I'm trying to fix. I feel like book-smart wise, I can handle it. If I don't know how tissues look, I can study them effectively. If I don't know how to gross a spleen, I'll ask someone and learn and do it well. I can learn diseases and be good at all that.

I am absolutely *useless* at the general functional stuff. I was that medical student that wandered wide-eyed around the hospital clutching a piece of paper that had been passed off to be by someone because I had no idea where to put it, who to give it to, or who to ask. I get lost in hallways. I have no idea what the chain of command is. These are things that take me from seeming smart to seeming completely infantile, and usually, it leads to someone yanking whatever I'm holding away after I've had it for two hours, going "Oh for goodness sake!" and then putting it in a file basket that was five feet from where I started and has a sign on it with red font that says "ISHIE, PUT PAPER HERE" and a clip art image of me slamming my head against a wall.

So my New Year's resolution, since for residents, the New Year is July 1st, is to observe the day-to-day function stuff carefully and deliberately early on, so that I may be less of an idiot later. We'll see how it goes.

In other news, I continue to hate confrontation passionately, because I like fulfilling the stereotypes of my specialty. I live in a for-real house now that features a side yard that has a gate to it from the sidewalk. Today, Roommate B and I heard a lot of rummaging we mistook for the mailman that turned out to be a guy that had helpfully let himself through the gate into our side yard and was scavenging the trash because someone in our place just moved out, so he was collecting cds and perfume and such.

After several minutes of careful deliberation on how to handle someone trespassing and scattering garbage, and discounting such barbarous behavior as simply yelling "Hey jackass; get off our property" out the window, we decided that the most polite and ladylike way to handle the entire unpleasantness was to let Roommate C's Rottweiler out the back door.

In our defense, there was still another fence between the guy and the dog.

So let that be a lesson to you. Ms. Manners says, "Release the hounds."

First day of doing stuff

2011-06-27T23:46:00.000-04:00

Albeit, not a lot of stuff.

Computer training today, which was about 4 hours of learning how to use a lot of charting techniques I'm probably not really going to need, but it wasn't bad. Entering scrips and having to sign them "MD" in the system adds a level of importance that probably isn't warranted. Had a fabulicious dinner out on Johns Island with some of my co-interns. My colleagues are taking turns on the "provide transportation for Ishie" charity, of which I am the sole beneficiary. I swear, I will eventually get a car.

Next up, pager training on Wednesday. The for real stuff starts on Friday, but then we get the fourth off, so I'm kind of feeling like a bum, but in a good way.

In other news, Charleston has a crapton of mosquitoes. Like more than Grenada. It's amazing. I've counted thirty bites on my legs *tonight*. Time to put that bottle of DEET back by the door.

Requisite Grad Shots

2011-06-25T14:45:00.000-04:00

How could I forget?

Today I found an amazing farmers market at Marion Square, thus continuing my increasing love of Charleston. Said market included a roti stand (!!!!?????), banh mi, and beignets. So much for losing weight here. Though the bike helps.

So everyone's just nice here?

2011-06-25T01:51:00.000-04:00

Is that the way it works?

I lived in Charlotte, NC when I was in high school and aside from making some amazing friends, mark it down as one of the absolute worst periods of my life. The concept of "nice" when I lived there seemed less to do with nice and more to do with "being completely and often hostilely in my business for no particular reason". I recall specifically an incident where I was wearing the standard issue Nine Inch Nails shirt that EVERYONE in my age bracket owned and a woman walked up to me with "You know that band worships the devil".

So when people say a region is "nice", I generally snort derisively. Which probably isn't nice.

People here are NICE. Like not kidding around nice. And it leads to my getting way more things done in a day than I thought possible. If I don't have this paper or that paper, it's "Oh, well, let me see what I can do... well, we can do everything else today and you can just bring that in on Monday", "Oh, that's fine, your driver's license will be just fine. California? How exciting!" Bam, conversation, bam out. Waitresses, Rite Aid techs, employee health.

So today I managed to get my third, count em, THIRD TB test in as many months, pop onto my bike, take out money from one of my accounts (without a bank card), put money into the other account, get my rent check out of it, pick up a back rack for my brand new bike, and fill a prescription. In about two hours. I don't even know what to do with the extra time. And the feeling of well being. I did spend some of it attempting to put the rack on my bike, which was way harder than it looked, so that drained my goodwill, but then my roommate refilled it, only instead of goodwill, she used moussaka, which I think is an acceptable substitution.

I have another resident mixer party tomorrow. I feel more like I'm courting than working, but I'm certainly not complaining.

I'm hoping for a beach trip this weekend.

Home sweet home in the lowcountry

2011-06-20T00:56:00.000-04:00

Sorry for the lack of updates; I've been busier than I've perhaps ever been and having to make a number of spot decisions that have all ended up working out better than anyone could reasonably expect.

Graduation. Awesome. Really had a good time, and saw so many people, some of whom I hadn't seen since Grenada, and it was fantastic. My dad flew up from North Carolina, I took him to see Mary Poppins (on Broooooooaaaaaaaadway), and I got to parade around in my cap and gown (which we actually got to keep this year) plus a hood. They kept the speeches fairly brief and to the point. I'm sure this is horrible sounding to Ivy Leaguers, but after enduring hours of drone in UCD's gymnasium, a succinct presentation that felt like it was *to* us rather than *at* us at Lincoln Center was greatly appreciated. I did get hooded upside down, but I don't think most people would be able to tell. Most importantly, I WALKED WITHOUT A CANE OR A LIMP. WOOOOOOOOOOOOOOO. Weirdly, despite nearly everyone at graduation having both a job and a diploma in hand already, no one took the opportunity to do anything weird.

Incidentally, they played Grenada's national anthem. To the surprise of most, it was not Temperature by Sean Paul.

So the pomp! The circumstance! The OMG I need to move to SC this week and either find a place to live near my hospital and buy a bike or find any place and buy a car!

That bit was a little nerve wracking. My initial living plans fell through so then I thought "I don't have anything to do until a physical/drug test on the 22nd, and then some social stuff, and then orientation the 27th, so I'll find a place when I get there since I have plenty of time." Which is true, but when you're in a moving van driving to a Motel 6 and honestly don't have a real address to give them, it's freaky.

I'd been surfing Craigslist, and found a few leads; contacted one agency that specializes in matching people with roommates, was wandering around roommates.com, and so forth, but then found a place on Craigslist that's biking distance from the hospital, costs half of what my rent was in Brooklyn, and comes complete with one of my new roommates' huge friendly Star Wars-named dog. And available this weekend, which is a plus when you're returning the van on Monday. And y'all... (I can say y'all now that I have an address in the South), this place, which is a for-real house, which I have not lived in since I was 12, has a washer/dryer (the holy grail), a backyard with a fire pit, a balcony, a walk in closet (!!!!), a giant pantry, and a giant kitchen. No words. If these two can be half as cool as my last roommate, I'll be happy, since I got all emotional and weepy when he left.

Dropped by to meet people, confirmed no one was a serial killer, signed the lease, made out the check, rented a storeroom for some of my mom's stuff, hauled that around (Charleston was about 96 degrees today; there were a couple moments where I honestly thought I was going to die), bought a bike, tossed it in the back of the much emptier moving van, went back to the house, dragged everything upstairs while nearly getting killed by my futon (no more bunk bed!) and drove back to the motel.

Whew. It's... done. I have an address in Charleston, a job starting up, I'm a doctor and it all happened. And this particular move even happened without a whole lot of drama or stress, which is completely unheard of in a move. I was much more frazzled and emotional moving from Park Slope to Sunset Park for six weeks because our lease was up.

I have a bicycle! I haven't had a bicycle in four years. I feel so environmentally conscious. Or more realistically, broke, and I don't want to deal with car payments and insurance for a while, though for graduation, my mom gave me enough money for a sizeable down payment. Thanks mom!

So now, the only thing that stands between me and employment is my ability to pee in a cup on demand. Better start drinking!!!!

Lincoln Center's met its match

2011-06-11T00:09:00.000-04:00

Grad ceremony today! I get loads of ridiculous looking bling and the hunter green cape/trim thing plus a funny hat and everyone's all "She's a doctor" and I'm all "that's right".

Something like that. Gotta be better than Davis graduation in the rec center with minimal air conditioning and a tortilla fight. I think I get to keep my robes too, so I'm thinking of just wearing them for the foreseeable future, except for a South Carolina summer, it'll probably be hot.

In other "is she a real doctor yet?" news, I got my South Carolina limited license approved today! Wheeeeeeeeeee!!!!!!!!!

Another milestone? So soon?

2011-06-08T00:48:00.000-04:00

I think of these events as unique moments that resonate with me specifically and have a simple and precise meaning that I have never experienced before and that others couldn't possibly understand. Perhaps, because I believe that I'm still in high school. Fortunately, there are previous blog entries to remind me (yes, I'm one of those people that occasionally reads her own blog) that I am not unique, this is not unique, and I am going through the exact same cycle of emotions that I do with the onset of any new type of change, and the gradual sinking gut-sick is the exact same level of intestinal ambivalence that it was when I experienced it for my biochem retake. Or when my parents first caught me in a lie.

New York, how I've loved you. I love your people; I love your constant circus, I love the everloving hell out of your food and nightlife; I love my time here. During my stay, I got to live in a place I loved, do largely what I liked, and have the best frigging roommate anyone could want. Having been here for two years now, I even love being all exasperated and snooty about slow-walking tourists.

Grenada, you and I had our fights and our differences. I did threaten to ram inanimate objects in animate humans on multiple occasions and for multiple reasons during my stay in your lush arms, but how much hate can there be when finding a bottle of Ting or Carib in the states sparks a holy grail. And when Grenada Chocolate came to Whole Foods, I thought we were going to launch the Grenada reunion tour right there in the middle of Union Square. I have to love your turtles and your beaches, your hashes and visibly drunk bus drivers.

So now I'm off soon to heart Charleston. Soon. With, predictably, a spurious game plan that requires a lot of begging and luck. And then my four year venture of medical school will be over, and we can only hope that the title of this blog will be "A Caribbean MD WAS good enough for me." Then it's all resident stuff. Orders and charts and such. Deep manly doctor coughs.

And, like any other time that any change affects my life, I get embroiled in nostalgia and other useless things. Tomorrow is my last day at Other-Job. I have an awesome boss. I do a lot of stuff I like. I have decent autonomy. I like my coworkers. But it has to end. Graduation is on Saturday and a new crop will come in to replace the ones that defected. Do I want to stay? I want to start residency. With all the new challenges that faces.

But I'll do it. I feel, if meekly, ready to take on the world.

Never fear, the crippled doctor is here

2011-05-30T01:41:00.000-04:00

So I'm crashing with my mom for a while until the big move... She's a nurse, for context, which keeps my doctor god complex in check while allowing for all the other complexes to seep in.

As you know, I injured myself and have been transitioning from full crutches to one crutch to "f- it; I hate crutches" so I was hobbling around on a camwalker, which was hurting a bit, but not enough to put me back on a crutch. Since I was too cheap to justify buying a cane for myself, mom got me one.

OMG you guys, I'm House. It took four long years, and I didn't get a cane when I sprained my ankle because it's Grenada, but now I have one, and I already feel more curmudgeonly and like I can hit people on the subway in the shins with it. Not because they've done anything... just cuz.

Helps too.

Anyway, I was on my way to dinner in the city when my train refused to leave the station because while the people on public transportation have been awesome to me, the public transportation itself has been almost purposely screwing with me lately.

I thought this unscheduled delay was due to a fairly aggressive panhandler on the train being hunted by the conductor who was on his radio and going up and down the stairs leading off the platform, so I moved to the window to get a better gawking view and saw... horizontal legs. Sigh.

So I said to my mom "Someone's down" and we wandered off to see what we could do. Different homeless guy was seizing so my mom moved him onto his side and I knelt behind him to stabilize. Mom was like "I'm a nurse; she's a doctor" to the conductor and I considered making that wishy washy "sort of" hand motion. An off duty police officer kept people from stepping on us, because they were certainly trying to, while I tried to get a history from the dude who was coming around because during clinicals, I was told (re: yelled at) many times that a good history is the most important part of being a doctor. I overheard the conductor say into the radio "Yeah, we have a doctor as a good samaritan".

Two things. One, I outranked my mother sufficiently to bump her from the billing, despite that she's been a nurse of over 35 years, despite being a greenhorn that's entering a specialty that has less patient contact than a hospital janitor. Two, the whole 'good samaritan' thing that kept me feeling warm and fuzzy back when I could do CPR with impunity is now mildly terrifying since it can have different implications for doctors.

Another thing I learned is that medical conditions are far less terrifying when you've studied them and seen them before. Quick! What do you do when a man near you has a seizure??? Panic! Hold them down! Put something in their mouths! Call an exorcist!

Or roll them on their side and if they're really thrashing, try to keep their head from hitting anything solid. Wait. Hope they breathe shortly. They almost always do. Talk to them as they come out of it. Collect data. Ask about conditions, medications, and previous events. Make sure they're oriented to time place and location. Ask if they hit their head when they fell or if anything hurts. Standard stuff. Mostly it's just waiting around and trying to get bystanders not to step on your patient.

About that last thing... I've been concerned that New York has turned me into more of an asshole than I previously was, which is no small feat. I have, at times, seen someone down but that was surrounded by paramedics that looked like things were under control, and kept right on jogging. I have used my ipod as a defensive weapon since I got it.

However, I have yet to argue with a police officer (he put his badge around his neck) about train schedules while attempting to step over a large half conscious sick guy and two kneeling women. Oh, for and the next person that hassles me for not being more understanding about moms dragging strollers up the stairs, a couple lifted their stroller over this guy to avoid using the other stairwell, while the cop was yelling at them. Family bonding? "This, Jimmy, is how you ignore the homeless. They're not real people, and you must never let them divert you in your quest for killer Thai food. Try not to hit the lady that has the cane on your way over, because she may smack you in the shin with it like that mean man on television."

Bandwagon

2011-05-22T00:40:00.000-04:00

Blah blah blah Rapture.

Yes, I laughed a lot. Yes, I'm going to a Left Behind BBQ tomorrow (it's a place that serves *amazing* Cajun food, so there's no way I'm missing that), and yes, I drank a beer at 6 PM (my last drink ever was going to be Singha; is that sad?). I'm easily amused, and jump on any meme but lolcats with impunity. I should probably insert a picture of Sad Keanu here with Kanye West's "Imma gonna let you finish" over it to make my point.

Graduation is coming up, and I got my dad's ticket forwarded from Christmas to apply to this one because back in December, one of Orbitz's employees in India spent 45 minutes on the phone with me, Delta, and his manager to apply a refund to my ticket even though it was nonrefundable, because he's frigging awesome and he felt bad for me.

Speaking of human compassion, I tend to be fairly skeptical, and I tend towards social awkwardness as a default, plus I deliberately isolate myself in public places by the enthusiastic use of electronic devices. I'm currently living in the supposedly scariest borough (Brooklyn is gradually being gentrified beyond recognition, so it doesn't really earn me any street cred) of one of the cities in the world that's most known for being populated by rude, miserable people. All that being said, I'm learning if that you ever want a "faith in humanity" refill, crutches.

I know I mentioned this before, but I've been rocking these murder stilts for over a week now, and I'm still astounded every day by how out-of-the-way compassionate EVERYONE is. A guy in Long Island flipped his car around across a double yellow line to give me a ride to work in the rain. A woman drove me from the train station on another day. My coworkers fairly regularly get my coffee from the breakroom, which requires not only making it, but throwing in an extra shot of espresso. I have gotten a seat on trains, subways, and buses EVERY single time. Today, I was rocking the one crutch so I could carry a bag from Target, and had people opening doors left and right, even turning around to go back to help me, and coming up the subway steps, had a guy grab my bag and go all the way up with it without ever taking his ipod off (my kinda guy). People smile at me, chat with me, etc. I'm honestly not sure if that last part is because I'm gimpy or because this is the first time I've made eye contact with strangers deliberately since I moved here, but it makes me feel warm and cuddly.

In other news, being a foreign grad gives me extreme paperwork paranoia, though possibly to my favor. One of the worst things about being an IMG is not 'the stigma', and it's not having the same "Where is Grenada?" conversation with *everyone*, it's the degree of red tape you have to cut through to get anything done. Taking the licensing exams? Costs more money AND you have to be approved through the ECFMG with subsequent paperwork. Graduating from school? Still need that ECFMG certificate. Everything needs backup confirmations, our transcripts still have to be mailed directly and verified for everything. Through the years, you have to manage travel documents, student visas, airfares, apartment leases in other states, weird tax forms, residency applications, loan paperwork, etc. None of the stuff that needs to get done is really in the same place, too. And getting all your health stuff? Good luck. Drug screens? Some hospitals have it, some don't, how it's set up can be difficult. You have all your initial stuff at a hospital; you may have different requirements when you go to different hospitals... argh!

So then you get a residency, and you get sent a package that contains a brick of paperwork, and you're thinking that this process is going to be exactly like school. Half of it won't make sense, most of it will have to be self arranged, and a third of the stuff you send out will not make it to its intended destination. Threats will be held over you. I recall madly faxing paperwork from Canterbury because my loans hadn't been processed because of the hyphen in my name, only to arrive back in Grenada to discover they still weren't through and I was borderlining a leave of absence if I couldn't get this stuff straightened out by way of panicked phone calls to New York from the Chancellery.

But... they tell you the timeline. You send in your application for licensure. You send in the benefits package... I keep waiting for the other shoe to drop. I have a set appointment for my physical, titers, and drug screen. I thought I was going to need to scramble to find a BLS class, but they handle that. I keep thinking I've forgotten something and I'm going to show up and they're going to say "Oh, we canceled your residency because we emailed you form L14-A0987 and you never responded, so we assumed you weren't interested anymore." But nope, so far, the coordinator's just emailed me in response to my "DO I NEED _______? OMG" forms with pleasant missives that she's looking forward to meeting me.

It might be time to relax :) How often do you hear that pre-residency?

Ends like it began

2011-05-13T23:24:00.000-04:00

Naturally, since having a diploma, an ECFMG certificate, my transcripts, my paperwork in (minus my benefits package, which I have to overnight) is not enough to really *end* the process of being a student at SGU, I figured I'd do what I did when I entered medical school... which is... be on crutches.

Shit. For reference:

One of my earlier posts from the island

I would have said, prior to ripping my plantar fascia, that being on crutches in Grenada is one of the biggest pains in the ass on the planet. Now, I will correct that notion and say that being on crutches in NYC is one of the biggest pains in the ass on the planet. Do you have any idea how many stairs there are in this city? It's obscene.

It's giving me a few perspectives though.

1. While crutches do a great deal to alleviate the pain in your actual foot/leg, they make your upper body feel like you've been rock climbing while an obese child rides you piggy back and periodically kicks you in the stomach.

2. Spring in New York feels like summer in the Sudan to your foot when you have a brace on it.

3. In the NY metro systems, crutches trump visibly pregnant ladies trump old people. Seriously, in a place known for the general malignant nature of its populace, I had crackheads leaping out of the way to surrender a seat to me. It doesn't make me any more of a fan of the Bhutan death march that is getting from the R train to the LIRR at Atlantic terminal, but it still gives me the warm fuzzies.

4. If you're wearing anything with a lower cut than "overalls" or "mom jeans", you have to stop, move your crutches to one hand, and haul the pants up and your shirt down every 10 feet.

5. Dude, you can't carry *anything* with these stupid things. Coffee? Gotta hoof it like Tiny Tim with a caffeine addiction. Purse? Gets caught. Groceries? Yeah frigging right.

6. Handicap bathrooms... so THAT'S what those bars are for.

7. I'm a good little newly minted doctor, thus I don't ride the crutches with in my armpits because I don't want to lose the use of my hands. The result? Extreme rib chafing.

So that's my whine.

Meanwhile... I saw a Broadway show (not Spiderman), which was on my NY bucket list, by taking my mom to see Phantom of the Opera. There was quite a bit of drama on obtaining the tickets, because the ticket broker is operated by imbeciles and the theater doesn't really care since they're not really going for the repeat business. But I managed to get them, and so it was actually really cool. I may have the bug for it, though next time I get tickets, I'm going to see if these bad boy crutches earn me a front spot at TKTS so I can forgo the whole online ticket thing. We also ate at Sardi's, because we had a Groupon and that place is expensive. I discovered my ability to recognize celebrities based on their caricatures is even less impressive than my ability to recognize them when I walk by them (I have poor facial recognition).

What else? Yadda yadda rooftop bar. Yadda yadda endless paperwork for starting residency.

Nomadic drawbacks

2011-04-24T01:17:00.000-04:00

I am a nomad, and have been since I was a child, which is why when people ask where in California I'm from, I say "the North", and they think I'm being coy. I try to be more specific with "somewhat orbiting the Bay Area", and they think I'm nuts. Then I say I went to high school in the South, and suddenly, I'm "from the South". It's very difficult to explain to people that grew up in one to two locations, and then have a family home and a place to go, what it's like to kind of be from nowhere except a vague region.

Ultimately though, I sing the praises of being nomadic, and forwarded it to program directors when they were asking me why I suddenly wanted to move from NYC (my "town" of about two years, which is my average staying time) to their town. More often, they assumed I was going "back" to California, which is a safe enough I assumption, since I do love my home state, excepting that I have no family there so other than nostalgia, it doesn't really offer me any reason I'd choose one residency there over one at Other-Desirable-Location.

I've also 'lived' in a lot of places for somewhere between one and three months, which leads to the question "What is your definition of residence?" I had a flat in Prague for a month for a medical selective. Did I "live" there? My mom's a traveler, and the one I stay with when I'm between residences, but she's rarely in the same place for a long time, so if she doesn't "live" there, do I "live" there? It's confusing.

I bring this up because I'm filling out what is known among scientific communities as a metric s*** ton of paperwork. Among this are applications for my state medical license, a background check, medical paperwork, tax forms, and so forth. List residences for the last seven years? Gods. Where do I start? My dad's address is frequently listed as my permanent address, but I don't live there... My roommate's name is on the lease and mine isn't. I lived in a country for two years that doesn't so much have addresses as locations, so some poor investigator is going to have to try and figure out how to pull up paperwork for "In the Cool Runnings apartment building on the Dusty Highway". When I told people to send stuff there, they got upset and thought I was kidding. When I wasn't in Grenada, I was in and out of different states (or countries) for anywhere from two weeks to three months.

And it continues. I don't have an address for new town yet. I'm moving out of this apartment next week and crashing at my mom's place in Brooklyn until it's time to move... this results in my initial paperwork being sent to this address, my future licensing paperwork being sent to her address, and my tax forms being listed under my dad's address because that'll be more relevant after I start residency, and as mentioned, don't know where I'm living.

If all of this certification, licensing, tax paperwork goes through without a hitch, I'll eat an okra and canned tuna sandwich. If all that doesn't gum the gears, I'm sure Old Reliable, aka, my wonky last name, will seal the "you have to resend this with ___________" deal.

Please refer to me as Dr MD... btw, I'm a doctor...

2011-04-22T00:29:00.001-04:00

Oh wait... but I said I was going to talk about other stuff.

Fair enough. I'm starting to feel so far removed from medicine (actually studying it, not rabbiting on about it) that it's kind of frightening.

Stuff I've done in the last few months:

Watched: Usual Suspects, Super Troopers, Run Lola Run, Requiem for a Dream, Lolita (Jeremy Irons version), Sweeney Todd, the Birdcage, the King's Speech, Gattaca, the first season of the Walking Dead, nearly all of Cowboy Bebop and I'm restarting the X-Files. All on the train. I'm thinking of writing a slow ballad dedicated to my iPhone called "I love you more than I've ever loved anything (club remix)".

I'm also just now realizing that my list of recently watched media is kind of disturbing fired off like that. King's Speech may be the sole source of "Not weird". I like Modern Family. That's normal, right? Why am I thinking about this?

Marched through Times Square in search of student rush tickets for Broadway shows fruitlessly. If someone can score me 30 dollar seats to Book of Mormon or American Idiot, I'll... seriously... don't ask. Walked past the Spiderman theater and snickered.

Eaten: Cuban, Mexican, Ethiopian, South Indian, North Indian, Indo-Caribbean, vegan kosher Indian (I have a problem).

Attended: Baby shower, comedy shows, burlesque, several birthdays, few music places.

~~Studied for Step 3~~.

You'd think I could crack a book somewhere between the first half of Kick-ass (couldn't do it; audio didn't sync and I still want to punch Nicolas Cage in the mouth any time he's onscreen) and episode 17 Inuyasha but nope. Hoping that instinct to learn *anything* kicks back in. I balk when someone tries to teach me any factoid at this point. "Hey, you know that movie was based on a true story about..." "NO LEARNING!!!!! MUST MAINTAIN IGNORANCE SPIRAL!!! MUST TYPE IN ALL CAPS!11!11!!omglol"

But the title... I got my residency contract today (woot!) which not only gives me a paperwork to-do list, but it's the first time (aside from my diploma, which rocks) that I've seen my for-real name with abbreviations and prefixes and such other than a few mistakes with the USMLE letters and a few interview invites.

And the best thing is that while I don't know if it's standard for contract language, because let's be honest, none of us have read a contract since you were able to click the "I Agree" button on your computer in 1996, but it's written out insanely often. "Dr. Ishie, MD. Contract for one year of being a physician, a PGY-1, a doctor, at our hospital, which employs doctors, where she will be doctoring the doctor stethoscope white coat malpractice DEA license."

Incidentally, do I need a DEA license? I can't imagine a scenario where I could use it that wouldn't end with a ride in the back of a police car. I'm similarly curious about the ACLS training.

And this time, it's for real-for real

2011-04-08T23:05:00.000-04:00

So, I'm a real M.D. now.

I'm getting excitement-overloaded, if such a thing exists. Black Monday, woot, Match Day, woot, last day of clinicals, woot, file closed out, woot, diploma date, woot. It's like if Mardi Gras were once a week. Going from "Congratulations!!" to "Congratulations? Right? Are you a doctor yet? No? Good god, how much paperwork can there be?"

April 8th? Diploma date. Which is good, because between March 25th (last day of clinicals) and now, I really didn't know what to call myself. Was I a student? Not really; I wasn't in school. Was I a doctor? Not really. Hadn't reached my graduation date. The graduation *walk* is in June, so that'll be another woot (though I'll get a few months rest in between), but that's so I can see if the third time's the charm for not tripping over a too-long gown in heels.

This may mean that over the course of the next few months, I may... possibly, be able to start talking about things other than school, the Match, patients, and so forth. It's like a whole new social realm has opened up to me. I can talk about... Futurama again, if the bastard ever shows a new frigging episode. Seriously, seen A Clockwork Origin like five times. I need a fix.

Then residency will start, and I'll be able to bore people in an even more specialized niche. Learning medicine with goats on your lawn could at least be conceivably interesting to people not doing it. Classifying seminomas? Oh, get ready friends and family... Come July, I'm going to take you to EPIC boredom. We're talking longing for filibuster boredom. Last half hour of 2001: A Space Odyssey boredom. Yes, I went there.

Seeing as that last remark probably pissed off a good half of you, I figured this would be a good time to beg for help again. Anyone know any tried and true method of purging a particularly insidious Google redirect virus without using Combofix? The program won't run because there's some lurking AVG file haunting my computer despite my disabling it and then uninstalling the full app. TDSS Killer isn't touching it, Malwarebytes keeps helping me with the stuff it tries to download onto my computer when I space out and click a google link (I can remove Windows Security with my eyes closed by this point), but the redirect remains. And I didn't realize HOW MUCH I google random crap until I can't click on it anymore. I'm not above mucking with the registry. Just call me the latchHKey kid.

And users of better computers, have at me for not having a Macbook. I will keep my infection-ridden Dell computer duct taped together until July if it kills me. Which it may. Didn't some of these bad boys catch on fire?

Sigh...

2011-04-06T23:46:00.000-04:00

This turned into rain cancellation.

Plus side, I have tickets to some future Yankees game, and I got to see the stadium, which was pretty cool. They were selling Cracker Jacks in the stand and everything. And who can turn down $11 Miller Lite? Don't answer the last one.

They played a ton of rain related music, which is good, because it turns out I like a lot of songs about rain. The Rain Song, by Led Zeppelin, No Rain, and a bunch of others whose names I don't remember right now.

So wah, first Yankees game a wash, but I'm going to get to one before I leave NYC. It's on the bucket list. Since I'm venturing into the Bronx now, I'm probably also going to try to squeeze in a trip to the zoo sometime now that they found the cobra.

Rain rain go away!!!

2011-04-06T19:34:00.000-04:00

First Yankees game ever and it's threatening to rain us out??? Nooooooo!!!!!

Rock Fever Revenge

2011-04-06T00:45:00.001-04:00

Maybe it's the disgusting weather, but I've been really getting sappily nolstalgic for Grenada this last couple of weeks. Maybe it's also because people are leaving the area, so it reminds me a lot of those last weeks of Grenada.

And I really did have fun my last year. That encompassed my Prague trip, late night swim trips to Grand Anse beach, wrestling in Morne Rouge. I've been going through my pictures and getting all smiley and such. Then I feel like I've really been lucky as a person to get to do all this stuff and come out of it, and then I feel a touch of guilt for being such a whiny little prat so much.

Stay tuned for whiny prathood! Next week!

In the interim, here's some pictures that made me feel all sweet and fluffy. I'll probably post more occasionally now that I actually have time to sort, and to make up for the fact that I haven't been posting pictures in forever. So Grenada...

And here's a little taste of Prague... This was the view down the street from the place we met for conferences and to meet up to go to the hospital.

If I could give some Monday morning quarterbacking to the people in the midst of this... I spent a lot of time miserable. Not all of it, by any remote bit, but too much. I focused on how much this that or the other thing was screwing me (as noted on my blog), how hot it was, how nasty the men could be, interrupted by childish bickering with people.

If you're on the island, take a deep breath every now and again and just look at it. Think about where you are and how few people get to do what you're doing.

Then go back to remembering how much you loathe learning cancer treatment drugs. (I'm realistic in my nostalgia). Enjoy!

Adjusting to life outside the hospital...

2011-04-05T00:48:00.000-04:00

Wow, it's so bright out here in the light of day... no hospital; no digging my ID card out frantically as I race up the escalators with the 15 second window I've given myself, it's like... it's like a new world.

Either that, or this winter is ending, which is spectacular, because I was beginning to think that I was going to end up on The Road with Viggo Mortensen and he is way better at rocking the hobo beard than I am. Plus I'm worried I'd go cannibal too fast.

Oh to all of you happy clickers, thank you!!! You all are the best.

My future adopted city is sending me enough literature on it to make me think they're going to elect me mayor. I'm also getting a lot of correspondence from real estate agents who seem to be drastically more optimistic about my credit score than I am. I just need a car. Perhaps one I can live in.

I'm also in a car vs motorcycle debate with myself.

Car: Pro: It has a roof. Palmetto bugs can't fly into my face. I can take stuff home from the grocery store in it. Cons: Expensive. Gas sucks.
Motorcycle: Pros: 75 miles per frigging gallon! Are you kidding me??? Looks badass. Easy to park. Cons: No carrying capacity. Will probably smear me across the pavement like an oddly shaped butter knife.
Our runner up, Vespa: Pros: Hipster street cred. Seems safer even though there's no reason it objectively would be. Cons: Still expensive, can't take on freeway, more embarrassing death.
6 speed BMW wagon: Pros: have you been in this thing? It's like being in the space shuttle. And it keeps your butt warm. Cons: Selling both my kidneys wouldn't cover a down payment on this thing. Plus I'd need dialysis.

I'm feeling my NYC countdown more and more. There's so much stuff to do here that it's just reminding me of all the stuff I missed. Broadway show is on the list, though to be fair, I've tried that one, but can't score a ticket for under 70 bucks. Sigh. Groupons are directing me, so I'm getting a bit more bang for my buck, and my mom seems to have read my Christmas List from... forever, and got me a groupon to Evolution. This is a store filled with articulated rat skeletons and 5000 dollar dead peacocks. If there were a food court with a dosa guy and some Butter Lane cupcakes, it would just be called the Ishie Emporium.

Incidentally, some of those skeletons cost as much as my desired car (I'm actually thinking of seeing if I can score an Elantra. Thoughts?). How much does an attending make? I want something practical to shoot for, like a chimpanzee skeleton. The secret to success is setting realistic goals, so I think I'm improving.

Sometime, between working, geeking out over deceased fauna, and grouponing my way through Manhattan, I managed to attend my first baby shower. It probably says something about my friends that I was 30 before this milestone. It also highlighted how immature I am, because it's still strange that one of my friends is having a baby. That's like... something grownups do. I was going to pair my first baby shower with my first surfing excursion (bad Californian! Bad!) but couldn't squeeze my NYC pizza butt into the thick wetsuit, so I'm going to have to learn to surf out the Jersey Shore on another day.

Capitalism marches on...

2011-03-31T01:18:00.000-04:00

After some end of school celebration (and what may be a case of pink eye), I decided one of my first acts as a doctor should be to attach something mercenary to my blog with the sole interest of getting money in the bank. If anyone wants me after this, I'll be overcharging Medicaid for unnecessary tests and double billing the whole thing. Bwa ha ha ha!!!!!

But for now, I'm keeping it to the google ads, which incidentally, if you click on them, I get money. If you do not click on them, the money is given to a fund dedicated to sucker-punching blinded war orphans. I know, I thought it was extreme too.

So that's my little plea to you fine people. Feel free to ignore it as readily as I ignore the little punks at Atlantic terminal that want 20 bucks from me for their "team uniforms".

In other news, I'm... working, speaking of capitalism. Friday, I'll be hanging, and Saturday, I'll be helping with and attending my very first baby shower. And no, it isn't for me. Any suggestions from you seasoned partyplanners? I'm told these things don't usually involve three crates of homebrewed beer and male strippers, so my hands are just completely tied here.

Shouldn't I be done with rejection?

2011-03-29T02:47:00.000-04:00

Back when I was unsuccessfully applying to American medical schools, paper still ruled and the fact that I got an email from my home program rejecting me 6 months after I sent them my application (from the same city) was a source of puffed up ire for me.

Now, the fact that ERAS (and I imagine, AMCAS) has gotten everything into a neat package to be emailed around at whim is extremely convenient, and I do not miss paper in the slightest. That being said, the ease with which emails are sent leads to things like the the following:

-Rejection a week before the rank list was due.
-Predated invitation to a highly desirable and unlikely to interview me program sent the day after the rank list was due.
-Apology for fake emailed predated invitation.

Now...
-Interview rejection more than a week after Match Day! Slow clap, Colorado. Stay classy.

Tomorrow!

2011-03-25T00:16:00.000-04:00

Last day of school EVER.

I mean, all right, residency is an endless learning process and there's still tests and such, but this is the last time, unless I invest in some adult education classes down the road, that I have to pay for work. With the exception of a few lulls, I've been in school since preschool. And since I was about 13, I've wanted to end up, well... here.

If all the paperwork goes through on time, I should be a doctor-fo-life as of April 8th.

I keep thinking a truck's going to hit me or something. It can't all be over with so little... whatever after literally decades of going at it. I mean, tomorrow, I'm probably going to go in, watch my attending round, have her forget about me for an hour, so I'll watch the rest of Wall-E on my iPhone, and then I'll follow her around a bit more, ask her to fill out my form, run the last paperwork up to my clinical coordinator, take my short white coat off, stuff it back into my Urban Outfitters bag (I threw up in my Trader Joe's bag; more on that in a second) stick my headphones in my ears, and take the train home. Same as any other day. Except I never have to do it again, and then I'll move to South Carolina where the weather is warm, the rents are cheap, and the palmetto bugs are terrifying.

To hinder my celebratory airs a bit, I got quite suddenly attacked by what seems to be a rollicking case of either norovirus or adenovirus. I was out at Other-Job, which is WAY the heck down on Long Island. Great job; long commute.

Suddenly, intense nausea, like run for it nausea, and I end up the one with my face against the tiles in the bathroom, because that seems to be the best medical treatment for vomiting - bathroom tiles to the face and a friend outside the door going "you okay?".

The problem? I'm an hour an half from home. There is NO easy way to get there. It takes over an hour by car when the weather has not been yet again set to "Apocalypse", so I'm forced to make a last minute run for the only train for the next hour.

It required four years of college and four years of medical school to bring me to this conclusion but:

Running + Extreme nausea = Bad

The doors close on the train with the characteristic Boooomp Boomp! Which is precisely how much time I have before freeing the beast into my grocery bag onto my white coat.

Sigh.

I had just been planning on burning the thing, but I suppose covering it in bile and partially digested peanut butter crackers works toward the same goal.

I collapse into the big bench seats with my feet up (not allowed) and I'm starting to get a good fever on by this point, so I'm lying there shaking and periodically vomiting and just REALLY hoping that the conductor will just take my ticket and not kick me off the train into the thunder-snow-hail because he thinks I'm drunk.

The train wasn't that crowded (thank goodness) but I became truly appreciative of the polite indifference of everyone in this city... The conductor took my ticket like normal, without comment, but didn't make me sit up, pull my feet off the seat, or... stop throwing up on his train. Other passengers left me alone pretty much entirely. Benevolence by indifference. I'm for it.

It still may have been about the worst 90 minutes of my life though. I've seen commercials for reality shows that seem designed to embarrass fat people into not being fat, and there's always a clip of a 300 pounder collapsing after her 10th sit up, and a personal trainer is yelling at her, and she's just going "I can't.... I can't" and crying?

I now have more sympathy for those people because when you're still retching uncontrollably LONG after all fluids have left your body, that's how it feels. Your abs are contracting against your will and you're weeping and going "I can't!!! I can't!!! No more involuntary sit-ups!"

So that was fun. But I did manage to get home and now I'm trying to brush it off in time for my partying to begin tomorrow night. Let's see how it goes.

One more day!

First choice!!!!!!!!

2011-03-17T16:26:00.000-04:00

Pathology in Charleston, SC. Mega ecstasy bliss!!!!!!!

Partying now!!!!!

Brief synopsis...

2011-03-17T01:20:00.004-04:00

The timeline of all this stuff comes out through this blog if you read from the beginning, of course, but who on earth wants to do that? Thinking back on everything, and with prospective students I talk to, the entire process of becoming a doctor is frigging confusing.

In other news, after over a year of my mother's pleading, I have a new profile picture. Kagome is dead. I'm probably going to give her about a month of peace before I switch to Ed from Cowboy Bebop, because that's how I roll.

The cliff notes of what I've been doing:
-finish bachelor's of sciences in US while taking MCAT (difficult but moderately priced test)
-2 years of basic sciences in the Caribbean. A more clever blogger than I referred to this as the Bob Marley School of Medicine.
-USMLE Step 1 (giant expensive test)
-1 year of core rotations (internal medicine, pediatrics, surgery, psych, OB/Gyn, etc) at a hospital in Brooklyn;
-USMLE Step 2 CS/Step 2 CK (two giant expensive tests)
-1 year of elective rotations at varying hospitals (okay, still in BK; I'm lazy)
-Graduate with Medical Degree
-Obtain ECFMG certificate (that's a bonus for us foreign kids)

FWI, you're still paying for all of this at this stage. For the last two years, you work in a hospital, but you are a paying student.

During this time, you must secure a residency for when you are out of medical school or you can be a doctor all you want, but you can't practice. A residency is additional training, for which you are paid, and this is what trains you to your specialty. Anyone graduating medical school is a doctor, but only people completing a pediatric residency are pediatricians. The process of securing a residency (since everyone's applying for them at the same time) is called the Match.

The Match:
-September through February of last academic year, choose a medicine specialty you want to practice and apply through a paid central database to programs you select.
-During this time, those programs that want to interview you grant you dates for them. You attend as many as you are able
-Mid February: submit a rank list. This is your favorite programs in order from top to bottom of your preference. How you rank stuff is up to you... location, training, prestige, hotness of fellow residents, etc. The programs are simultaneously ranking you.
-February to March: The central computers match up (get it?) applicants to programs. Programs with unfilled residency spots lose thousands of dollars for having those spots vacant. Applicants with no programs are jobless for a year while their loans go into repayment. Stakes are high. The computer uses an algorithm that tries to match the highest ranking applicant to the highest ranking program. If Pediatrics at Tulane loves Lucy and Lucy loves Tulane, and neither Tulane nor Lucy love anyone more. Match. This takes a while.
-Third Monday in March: Black Monday. The computers release whether students have successfully matched. Location is not disclosed.
-Tuesday-Thursday: Scramble: A list of the programs with unfilled positions is released to the unmatched applicants and a predictable clusterf-- of frantic emailing, faxing, and calling ensues. Applicants may have to switch specialties and explore other geographic regions to ensure a job.
-Thursday: Match Day. At noon EDT, the names of the programs are released to the people that matched there. Most American medical schools have a large ceremony to commemorate this. Some friends and I are making our own.

The name and specialty that is released on Thursday is where you are contractually obligated to go on July 1st of that year to begin residency training. The first year of residency (which used to be more of a transitional year, though now there are still transitional years and preliminary years) is what most people think of when they refer to "interns".

Usually, after your first year of residency, you take USMLE Step 3 (giant expensive test).
Near the end of your residency, you take the board exams (massive excruciatingly expensive tests) for that specialty. You also start a version of the Match all over again around then if you're applying for a fellowship, which is yet another 1-2 years of training for subspecialty fields (like pediatric cardiology).

So there we go... a probably largely unnecessary "Becoming a Doctor for Dummies" guide. Now back to being excited for the big reveal in ten hours.

Much love

2011-03-16T01:20:00.002-04:00

to you guys in the trenches that are having to deal with this scramble nonsense this year with the server crashes. I can't even imagine what that must feel like, but my thoughts and hopes are with you. Good luck!!!!!!!!!

America! F- yeah!!

2011-03-14T12:37:00.001-04:00

I MATCHED!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

WOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOT

After March 25th, I am done with school forever, and I have a big-girl doctor job waiting for me in July. On Thursday, I find out where I'm going, but I did it!!!!!!

Everyone's leaving :(

2011-03-06T23:09:00.003-04:00

Since I'm January class, people are finishing their clinicals at vastly different times since you can do anything from back to back everything and finish by December 31st or stretch the pain out until the beginning of June if you want scads of time off.

Everyone's also running really low on cash since all that extra time gives us loan check-less windows, so people are gradually dispersing back to their respective homes, which is sad. I know I'll see them again at graduation, but still. It's Grenada all over again; I get busy for a few days and then three people have left and I'm like "Wait... you're... gone? For reals? Oh..."

As of March 25th, I'm done with school. Forever. That is extremely frigging weird.

Less than two weeks until Match Day now. There's just really not much to say.

So what have I been up to then... I got to make and bottle my own beer for the first time, so now I'm the proud owner of 20 22oz bottles of dark beer, an amsterdam style and a wheat beer. I was part-creator of the wheat beer.

I'm doing radiation oncology, which is hitting me in the face with a whole new realm of medicine I knew absolutely nothing about, barring the words "prostate cancer". Usually I can BS along when being pimped, but this week's question was "Do you know what a linear accelerator is?" In what was probably the most intelligent answer, I've *ever* given, I cleanly stated "No." Not even going to try, homeboy.

I've gotten to be in the room where they actually give the radiation (not *while* they give it. In contrast to most of the giant intimidating machines in radiology, this one not only says "Danger" on the door, but "GRAVE Danger". Yikes). In fairness, the patients come out of it with little to few symptoms. In set up, it looks like a room where someone would try to kill James Bond.

This rotation has its own physicist... like PhD only, locked in a dark room surrounded by books with more diagrams than words and computers physicist.

I think this also may be the one field of medicine I genuinely couldn't do. While pathology is my life's love, I feel like with appropriate training, I *could* be a proficient surgeon, internist, dermatologist, hell, even pediatrician, but if you stick me in a room with the hard sciences and ask me to run quality control on a computer that is calculating frequencies and wavelengths on gamma rays that are being aimed at genitals, I am absolutely one hundred percent going to kill someone. I can't even divide a bar tab.

On a related note, anyone know anything awesome going on in NYC for Mardi Gras that's cheap? And no, $40 isn't cheap.

Official ROL Due Date

2011-02-24T01:29:00.002-04:00

Medical school is full of all sorts of little pseudo holidays, particularly at this time of year, since short of Valentine's Day and Presidents Day (ew and snore, respectively) we're lacking on real holidays.

As of February 23rd, at 9 PM EST, our rank order lists were due, as are the rank lists of the programs. This means that everything is now in the hands of a computer algorithm and there's nothing anyone can do about it.

Spooky, but also removes the stress of reordering your list every ten minutes because you had a beignet craving at 11 PM and thought "Maybe that New Orleans program wasn't so bad", and then you panicked and changed it back.

March 14: find out if you have a job day
March 15 and 16th: Scramble days. This is a holiday the way a Christmas Eve where your wife leaves with your best friend, taking the kids and the dog with her is a holiday.
March 17: Match Day. Find out WHERE you have a job day. Incidentally, St. Patrick's Day. Incidentally, probably going to be "Stomach pumped" day.

Good luck everyone!!!!

Rejections...

2011-02-16T22:45:00.002-04:00

Dear Program Directors,

While it's always good to send out your rejections early, as well as keeping some 'rejections on hold' because you never know when someone's going to cancel an interview and you're forced to send out an invite to your back up island-students, sending out rejection letters mid February is something of a... well, let me put this professionally, a "dick move", if you will.

If you haven't contacted me by January 31st, way before that actually, even if you have not *formally* rejected me, I have long since accepted that you're probably not going to interview me past the date that some programs are sending in their rank lists. I'm cool with that. While having a formal "hell no" email, or in UCSF's case a written "OH hell no" letter is always nice, a void on the other end of my computer is already a good indication that you do not wish to be graced with my dengue-soaked presence. Noooo problemo.

But why send out the noreply email via ERAS? They don't even have a subject line at this point.

Let me point out the converse side... there are some interviews I didn't take because I got a good initial response and the programs were too far away.

Now these guys may have sent an invite back in early December... now picture a student NOW emailing them going "Dear ________, gee whiz, I got so many interviews that I can't interview with your program, but I wish you the best of luck finding good students on Match Day."

Douchey, right?

Apologies to the MTA

2011-02-13T00:40:00.003-04:00

Only for the stuff I was saying about them today. That whole part where they jacked up the unlimited pass price by twenty dollars while continuing to cut service? Drastically uncool.

So here's a thing... I was going out to Jersey today to meet some friends to brew beer, because the interview season was so frigging exhausting that I have to start making my own hooch (I'm not adding centipedes to it like the moonshine in Grenada)... We're supposed to catch a train out of Penn Station at 10:11.

900: Home station closed because f- you, that's why.
900 - 915: Walk to next station
920: Board 2 train.
930: Why aren't we moving?
935: No seriously, why the f- aren't we moving?
936: Attention passengers. This train is being held due to a police investigation at Times Square. Atlantic Avenue is the last stop on this train. All passengers leave the train.
936-937: WTF? What police investigation? If this is someone leaving a GD Macy's bag under a GD bench and that sets off a GD bomb scare, I'm ballisticizing on someone. Why is stuff at Times Square sufficient to shut down service in Brooklyn?
938: Let's take the Q train!
939: Q train closes door in face; takes off.
939: *&(*&(*&#)&(*&!!!!!!!!!!!!!!!!!!!!!
950: Q train arrives. Maybe we can still make it.
952: Q train running local. Profanity ensues.
1010: Let's get off at WTC and take the PATH train.
1015: Due to track work, the PATH train is running on a 20 minute schedule. Please plan extra travel time.

We made it, thanks to the willingness of one of our benevolent Jersey-side drivers to be willing to book it to Newark to pick us up, but naturally the 2 hours it took to make what would have normally been a 45 minute trip led to my attempting to think of any service that regularly ticked me off more than the public transit. Possibly whoever was responsible for clearing the roads after the Boxing Day blizzard.

While we were on the way out to the brewery, we were googling any possible justification for shutting off access to some of the busiest train stations in the world, and came across the early breaking version of this:

Suspect in Brooklyn Stabbing Spree Is Captured

So apparently, we couldn't take the train going uptown because while we were sitting on our train, they were taking down a guy that was, among many many many *many* other things, stabbing train patrons.

Okay, MTA. Good call.

No more interviews for me!!!

2011-02-01T00:44:00.003-04:00

As of setting foot off the R from the N from the M60 from Laguardia, I am officially DONEZO with interviews. I can actually unpack the carry on bag (f- you, airlines, and your 25 dollar check bag fees for something you're gonna lose anyway) that's been always at a state of ready in the center of my room. I've made it through countless hotels still bedbug free. I have told literally dozens of people what I want to be when I grow up, why I want their specific programs, whether I'm an only child (???), and what my five year plan is.

Weirdly, I've seen more dead bodies than I have in years. What do you do on your job interviews?

I have bounced enough climates to be perpetually congested. I've given the Alamo in Union Square more money than an actual car payment would have cost. I have walked through more hospitals than the casts of ER, House, Grey's Anatomy, and Scrubs combined. I have consumed 50 thousand calories worth of free lunches. I've shaken more hands than a politician. I have rocked my black suit and used it to get my way at cheap hotels because it gives me a fake businesswoman street-cred. I have changed in the public restrooms of said hotels into beaten up jeans and strutted on the way out.

Since I'm a procrastinatey McProcrasterton, I finally submitted my final four week schedule, which will complete my 80 weeks of rotations, which finalizes my schedule and means that so long as I don't kill anyone in the next eight weeks, I'm solid gold.

Hell yeah.

Unusual plug

2011-01-21T01:18:00.002-04:00

Okay, I don't usually just flat out post links, but all the subways are wonky in my neck of the woods (including a shutdown of one station which fortunately isn't mine), and this post was too funny for me to pass up. I wish I'd written it:

FIPS dislikes the new standard

Yes, that's the name of the actual blog. Know it, love it.

Ow ow ow ow...

2011-01-19T21:48:00.002-04:00

So I just did my first time ever ten mile run in a triple loop around Prospect Park, an adventure that seemed like a grand idea until the moment I stopped and went "Wow! That was great; I don't even feel particularly OH MY GOD AAAAHHHHHHHHH", as every muscle in my body took that moment to celebrate the lactic acid build up they'd been accruing for the better part of two hours.

In other news, my attending seems peculiarly proud of me for going into my chosen field, which is a warm breath of fresh air. "You have no interest in my profession? Good for you!!!" He's also a Radiohead devotee, which makes surgery *so* much nicer. And everyone he's done brain/neck/back surgery on so far has been able to move all appendages halfway through anesthesia wake-up and no one's died, so I'm thinking that's a plus. It's less messy than all the abdominal stuff, but gets that bone/bovie/dentist office smell pretty far back in my sinuses, which kind of makes me nostalgic for my bone assembling days.

I also managed to at last secure a thyroid shield during surgery today. This is something that's irked me for a while. There are several types of surgery that require repeated x-rays during the procedure to make sure you don't wedge a tube through someone's kidney or stick a screw into their spinal cord. It also means you can see what you're doing in such spaces without needing to create a huge, infection prone, aesthetically unpleasant hole to do so.

Despite shooting anywhere from two to three dozen images, for the patient, this still doesn't amount to a huge dose of radiation. When you're scrubbed in and are leaning into thirty x-rays day after day, this starts to become a little much. As such, everyone in the room wears heavy-ass lead aprons. And they're good about enforcing that. I actually had to de-scrub and re-scrub one time because I forgot to put mine on after I'd gowned up. The circulating nurse was friendlier than most and made do with only one exclamation about where my brain was.

Problem being, at every hospital, there seems to be a dearth of thyroid shields for the med students, and when I went into urology to try to find one (because I knew they were there because I've seen their stash), was actively told they didn't have *any* back there while the nurse locked the door where four were visible (so I couldn't jack one, which honestly, I would have, though I would have put it back). The I one I found elsewhere, apparently *also* belonged to urology, but I was scrubbed in with it on by the the time someone told me, so ha ha, finders keepers.

The idea of aprons is great, but I have no plan to use my ovaries in the near future. Know what I am using? My thyroid!

This is also contributing to my continued blackheartedness against urology. When I did my mandatory rotation in it during surgery, I got assigned to a complete bastard of an attending that not only went to the Dr. Cox school of teaching but compounded it with sexist crap "Oh, going into pediatrics? Ob Gyn? You want to do Pathology? Oh, so you have time to have a family?" Seriously, guy? Just because you're around dicks all day doesn't mean you have to be one. It's not like being a werewolf.

Annnnnyway, my current attending is a lot nicer. Only two interviews left to go, weather permitting, and I'm officially registered for the 2011 match. Gotta start arranging my match list, which is kind of a tall order. Almost all the places where I've interviewed have had really great people there and they pull in different things. One place will have a ton of compensated offsite electives so you can audition for fellowships; one place has computer software that allows you to view some of your cases from home; one place sends home microscopes with residents; one place has ins with the coroner's so they're never wanting for autopsy numbers; one place has a tight association with a major cancer center, so you get crazy cases, etc etc. Most have warm fuzzy program directors and a pleasant group of residents.

Decisions decisions... a lot of it may just come down to where I want to live, which is also something I'm not sure about since I'm really evenly ripped between wanting to be in a lot of nature and being so spoiled by living in NYC that I wonder if I can get by anywhere smaller than... I dunno, Boston.

And a lot of it will be determined by the way the match operates. Path is a fairly small field, so instead of having 15-20 openings in a moderate sized program, like you'd see with IM or peds, you may have 2-4. Even if they like you, that doesn't leave a lot of room.

Drinking and brain surgery...

2011-01-14T00:27:00.002-04:00

It has been recently brought to my attention that I have increasing time between blog posts, to which I responded something like "I'm not doing anything interesting right now... just drinking and brain surgery... er, not in that order". I'm also losing sight of what constitutes interesting. When I was on the island, at least if people reading this are anything like I was reading other people's blog, I was hanging on every word of people's daily activities because you're in another country. Where I ate, where I shopped, where I did laundry, that is all relevant information.

Now, I live in Brooklyn. Finding awesome things is as easy as throwing a rock in any direction, having the person you hit with the rock flip you off and scream stuff before rooster tailing you with snow, and then look at the business their car was in front of, and boom. Awesomeness.

I'm also not sure how relevant my interview shennanigans are. I ate oysters in New Hampshire, walked around in the Chicago blizzard, walked around in the NYC blizzard, and took a vacation from all this blizzard nonsense to interview a couple of times in New Orleans. The first time, I slept at a hostel in the Garden District, opened my toe in the shower and tracked blood all over the place. The second time, I went with two of my closest friends and stayed at an extremely opulent hotel while drinking hurricanes in a rooftop hot tub, because damn, medical school can be awesome sometimes.

But is that like medical schoolish? Is it Caribbean MDish? Is it travel blogish? I've always kind of wanted Samantha Brown's job.

My father had the whole heart attack thing, and that sucked, to put it in medical terms. I added a trip out to North Carolina for that in the middle of the Snowmagedopocalype of the Century and holy crap why did no one plow? It's frigging LaGuardia for chrissake. And there's the news worthyness of simply being in yet another Brooklyn insane weather moment. There was over a foot of snow on top of my *air conditioner*. There were taxi cabs stranded everywhere and it looked like the Day After Tomorrow. I tried to take a stroll through Rockefeller Plaza to see the tree and possibly take a skate because when the weather alerts on my phone say things like "GET OUT!!! SAVE YOURSELVES!! LEAVE THE CHILDREN!!" I think "Nah... they don't mean me."

Now I'm back in rotations and the interview trail is stammering to a close with a couple more out of state trips and then the blissful rest until March. I think it's going well. I'm doing neurosurgery so I got to touch someone's brain, so that's pretty awesome. No one in NS seems to begrudge my chosen field, which is particularly awesome, since I had one guy in family actually say the phrase "What can I do to keep you from going into pathology?" "Uhhh.... Give me Samantha Brown's job?" I'm also not cut out to wear lead vests. That crap is heavy. For the next surgery, I may just let the x-rays fry my eggs. I don't know how cops and rads techs do it. And lead vests while scrubbed? Good god, they should do that to prisoners. No wonder neurosurgeons and urologists make so much frigging money.

In other news, my doctor is more concerned with my thyroid than I am because apparently it was throwing off some abnormal levels in July, and being a responsible medical student, I ignored it until I needed a prescription renewed. Then my doctor was like "Oh, you need to come see me" which meant "I'm going to recheck your thyroid levels if I have to drag you into this office myself and no more baby-ex for you until you do.". I'm not sure why it's important because so long as it's not flashing in the danger zone, it's not like I'm going to do anything about it. He also seemed really surprised by my reaction to having my blood drawn because first he said "Don't look", and I'm like "Uhhh... no?" And then he said "You weren't scared at all!" "I'm 30. And a medical student. Now give me my Dora the Explorer sticker."

Next month I'm doing anesthesiology because... uh... yeah. Then a couple two week electives, some paperwork, and wow. Lincoln Center. My mom's already planning to cry at the ceremony. I'm just hoping they have a steel drum band. Grenada repreSENT!

Am I violating some kind of law?

2011-01-03T23:49:00.004-04:00

Happy New Year!

Few things...

1. I spent a great deal of my impressionable youth watching a channel known for putting Music on TeleVision film parties at various locations and was convinced I would never be as cool or as in-crowd as the people at those parties who were always screaming, always having a good time, for HOURS.

2. WAY less fun than it looks.

3. Good god, being 18 is boring. I'd forgotten.

4. Cheering actually less spontaneous and more "we're going to do this again until you bastards get this right. Then, we're going to turn the music back off and go back to standing for forty-five minutes with the kind of silence usually reserved for art museums and funerals."

5. Disclaimer: *Crowds may include children, small dogs, and grandparents who wandered by to see who was making sporadic bursts of noise.

6. No alcohol. You monsters. If I weren't doing this partially as some kind of half-ironic, fun with friends, vaguely hipster New York representer, you would have ruined the entire point of going.

7. This town makes Davis look like Miami. Seriously, where the heck can I get some food?

8. Oh good... the next town over has food. Oh man... do not eat fat sandwiches while sober. Scratch that, do not eat fat sandwiches.

9. I really have only the faintest idea who this vodka-drenched gremlin is, but she needs to share whatever's in that cup. I mean "WOOO!!! OH MY GOD!! IT'S THE CHICK FROM TRUE BLOOD!!!!! Wait, that's Sookie. Wait, so Sookie's not coming?"

10. "11:59 on December 31st" looks creepily similar to "about 9:30 on a Thursday night".

11. I think SGU actually approximates the parties I expected in my youth twice a year at a shindig called Sandblast. As a jaded fourth year, I'd say those were also "way less fun than advertised", but that's a complete lie.

Good news

2010-12-26T22:11:00.002-04:00

My dad got discharged from the hospital on Christmas Eve; he's doing much better, sounds really positive, and is making all those lifestyle changes the majority of my patients refused to consider, so that's a huge load off my shoulders, and I get to go see him in a couple of days before burning back to NYC just in time to conscientiously avoid Times Square for New Years.

Speaking of Times Square, I was there today, because I was trying to score Broadway tickets but gave up because they're expensive even on discount, and more importantly, scoring those tickets would have involved standing in an outside line during that whole blizzard thing we're having today.

Because on my mom's time off work, I spent a great deal of it either interviewing or lying in my house in a useless deep depression prior to Christmas, I decided we'd go out today to Midtown 'in the snow', maybe ice skate a little, and do it up. "In the snow" is quite different than "in a blizzard". Today while... let's say... fording a path through Rockefeller Center to see the tree, the wind and temperatures were such that my scarf actually froze through solid. I also had the same little faux-fur lined hood black parka that *everyone* in NYC owns, and that caked with snow and froze too.

It was a good reminder that though I typically avoid Midtown, I actually do like Grand Central Station a lot, which is where we ducked for cover for a while to "see the holiday decorations and eat", by which I mean "get out of the 40 mile per hour blinding snow, and was that thunder and lightning, holy crap get inside".

Christmas was nice; my mom came along with two of my friends and I cooked a massive feast thanks to a generous contribution of fake talent both from allrecipes.com, plus Yoshie taking on my roommate's usual role of following me around the kitchen cleaning dishes and trying to keep me from lighting stuff on fire.

The menu:
Spinach salad with mandarin oranges, dried cranberries, red onions, balsamic vinegarette and feta.
Rosemary lamb chops with balsalmic reduction
Yams with sugar and orange peel stuffed inside a shelled orange and coated in a caramel pecan sauce
Cashew broccoli
Ice cream sandwiches from Bierkraft (they're amazing; I can't top them)

This is probably more detail than anyone wants, but my cooking usually amounts to searing a steak or boiling ramen water, so I was pretty pleased with myself. Plenty of Christmas movies, wine, beer, and eggnog too. Traditional route.

Christmas in NYC reminds me of why it's going to be so hard to leave NYC. Well, currently, it would be difficult because I'm snowed in, but yesterday, we managed to procure lamb chops, eggnog, and beer on Christmas Day. On Christmas Eve, I was able to snag gourmet macaroons at night. I'm spoiled completely rotten. I kept saying the adage while I was cooking of "If I screw this up, we can get take out." How can I live elsewhere?

I'm off rotations right now for interviews and the holidays but start up again after New Year's. The whole reality of not being a medical student anymore after April keeps hitting me intermittently.

A pause, not one that refreshes

2010-12-19T03:36:00.003-04:00

I was out earlier screwing around with my friends, eating one raw oyster from a good oyster bar because they were too expensive to order more, drinking, waiting two hours so that we could have fries at the Breslin, and getting mysteriously screwed out of the hot chocolate we'd planned on.

We're goofing about baby names due to one of the party having a bun in the oven, and that became the conversation as my roommate and I did our nightly home stuff... in the kitchen:

"Maleficent"
"Gertrilda"
"Diamond"
"I knew a girl that wanted to name her baby Diamond Katana. I begged her to have her tubes tied."
"Swaziland."
"Oh, that's pretty."

My phone rings and it's my dad, and sounds bad on the phone and I'm punchdrunk and slaphappy at this point and I say "TELL me you are not flaking out of coming down here on Christmas".

At which point, I get to feel like a complete asshole because the man's just had his first heart attack, is in the CCU, and he's scared, and no one's telling him things, and he really wanted to see me. For that last part, he sounded like he was crying, and I never see my dad cry. People barely even see me cry.

I'm split in two. I'm that family member calling the desk and wondering about prognosis, and if I were able to be at the hospital right now, I'd be the one looming around. Since I'm not there, I'm the bastard family member just leaving someone in their hour of need. "Daughter," they'll say. "Hasn't seen the guy in over a year. Bet now all of the sudden, she starts threatening litigation and all other manner of crap. What a scumbag".

The split was my first year medical school split. My maybe I can help even though I can't do anything. My maybe having the knowledge of what exactly happened will secure it in my mind so I know... well, I don't fucking know, how worried I should be?

So my first questions to my dad are who his doctor is, if I can speak to him, what was the quality of the heart attack. I call the charge nurse, apologize for bothering him, explain that I'm a medical student, so he'll dish me the dirt... STEMi, for starters. Shit. 100% occlusion of the left anterior descending artery. (roommate's response: that means he must have crazy collateral circulation) (Me: way to make lemonade out of those lemons). Stint in place, thrombolytics pushed within 90 minutes, standard stuff. Watching him in the CCU. Quick, med student. What's the most common cause of death within 24 hours of a heart attack? Arrhythmia. What complication arises within 3-5 days? When will the patient be able to return to physical activity? I'm getting pimped by my own fucking subconscious.

Through that din, which without the personal involvement, is similar to my normal mental din, is the thought that I don't want my daddy to die. I don't want him to miss Christmas. I want him to come to NYC so I can take him to nice places to eat, maybe a show on Broadway, show him the tree at Rockefeller Center, because turista nonsense or not, it is beautiful, and skate for him at the same center, because he always wanted me to when I was a kid and I couldn't. I want him back to NYC in June, when it's not horrendously cold, so he can see me graduate, become a doctor for the rest of my life, everything I've worked for, and I want him to be embarrassing me from the audience by yelling my real name too loudly when I walk across the stage.

Med student me knows that while this period is critical, it is also frequently survived. People live years and years post heart attack with little incident. A scare tactic to really motivate you for your diet. I know all this because I've seen all this. I've disinterestedly draped a stethoscope over all this. "You're stable, sir. Please relax. Turn your phone off. You're in the CCU. No, I cannot talk to your daughter right now to tell her everything's fine. I'm a doctor. I'm busy."

But for now, Dartmouth looms, as do a bunch of important travel decisions. I really really want to just go back to before that phone call.

Devon...
Madison
Bongwater
Esmerelda

Hopping along the interview trail...

2010-11-22T17:57:00.008-04:00

My five year plan? Fellowship. Maybe two. Ten year plan? Good question. Should have an anwer to it. Don't. Why did I go to a good undergraduate program, excel in it, and then head to the Caribbean? No money for AMCAS stuff at the time. Do I want to go back to place-of-birth? Don't care. Am I applying to other specialties? No. What brings me to _______? You agreed to interview me. Why pathology? I love it. How long pathology? I dunno. It became apparent once I realized "medical science geek" was an actual job. Usually you don't find that kind of career specificity outside of "chocolate taster in a stripper factory". What did you learn during your pathology rotations? That gout is waaaay less disgusting under a microscope. Tell me about your research. Apparently, it's weird enough to gross out people that do this for a living. Do you have any questions for us? I've been stalking your program on the internet, but I'm still going to ask about your board pass rates. How many other programs have you applied to? Many. I mean, only yours. What are you looking for in a program? One that will hire me. Please note that I am, in fact, wearing a suit. This should adequately convince you that I totally don't spend the vast majority of my life wearing running shorts, tank tops, and penguin holiday socks (my feet get cold).

This is a brief summary of interviewing... that, plus becoming intimately acquainted with every form of public transportation ever conceived by man. And I'm sure with my upcoming air transit necessity, I'm going to become intimately acquainted with some TSA agents. Blah blah blah, relevant news. I'm actually trying to read the New York Times right now because there's a free app for it, I have a lot of downtime on trains, and I'm running out of ways to launch angry birds at pigs.

I've been running down my NYC "to do" list. I cheered for a friend in the NY marathon (that's the closest I'm going to get to running one, guys), had a fabulicious birthday weekend in Atlantic City, got smushed in the Greenwich Halloween parade while appropriately dressed as a bedbug, saw dancers reenact multiple seasons of Dr. Who, all while getting my hospital rotations on and obsessively checking my student email account every 16 seconds for the remote possibility of an interview. I've gone from fastidiously trying to impress attendings with my intrinsic knowledge of their field to trying not to get them too pissed off by missing too many days for interviews. I've come to accurately read the expression on their faces as they start to explain patient management algorithms to me, remember that I'm going into pathology, and trail off hopelessly as I lean forward and nod politely. I'm fighting the dregs of senioritis while being more aggressively 'scheduled' than I have perhaps ever been. I've developed a term for this period of my life known as exhaustilerating.

Reeeeejected!

2010-11-19T23:40:00.003-04:00

Oh Harvard; you and I could have been so close. I mean, I know I'm from the wrong side of the tracks; I've been around, and if your parents had ever found out, there'd have been hell to pay... I mean, I'm a shark; you're a jet. I'm not even a shark... I'm a goldfish, but baby, we could have made something work in the end. When the love is there.

But I get it. You want to be left alone. No more 3 AM phone calls from the bar begging you to reconsider. No more violated restraining orders. No more facebook friending Yale and asking about you to see how you're doing. It's okay. I just hope... one day we can be friends... you know, maybe when fellowship season rolls along in a few years. Hey, I'm just throwing it out there. That's cool. Love ya.

Derm. Is. Awesome.

2010-11-11T20:25:00.001-04:00

See above.

More Hijinks

2010-10-26T11:13:00.008-04:00

So, there's often talk about us medical types being impossible to talk to by anyone not specifically ensconced in our field, because we're dorks with god complexes who can't fathom anyone not being interested in our "most disgusting/disturbing digital rectal exam" stories at dinner.

In an attempt to derail myself (usually unsuccessfully) from this white coated stereotype, I'm trying to get an appreciate of the arts. It still makes me insufferable, but a different kind of insufferable, and that's all I'm going for.

One of our friends is a dancer, thus has known about this adaptation of the usually mind-numbing (sorry) Swan Lake. After confirming that would would be able to get the cheap nosebleed seats (last student loan ever!), we made a Wednesday of it.

The reinterpretation looks something like this:

As far as art, an interesting adaptation bringing swans more into their actual role as aggressive nasty creatures rather than the ballet's traditional role, which has them as fluffy females helplessly waiting on a handsome price.

As far as my own perspective, replacing tutu clad ballerinas with hard bodied males wearing nothing but feathered capri pants and extended guyliner wins two enthusiastic thumbs up.

Because I like emotional whiplash, Thursday we headed to the Oktoburlesk celebration at our local Gowanus dive bar. They also featured an accordion/alpine horn player and I did something I referred to as "polka" but to the untrained eye, probably looks more like spastically hopping around on one foot while wearing heels. No sprained ankle this time.

Also, sometime in the weeks before, I finally managed to get the tickets to the Daily Show. That's have been on my New York bucket list since I got here. With Sam Harris as a special guest, which gets me street cred for something. Now, onto the Colbert Report. And yes, when Jon Stewart walked out, I screamed and clapped like a Jonas Brothers fangirl. Yes, he is that hot (and short) in person. We had a guy warming up the crowd that was fantastic, and we all got free audiobooks, which was an unexpected bonus, plus directions to the Jon Stewart-approved BYOB Thai restaurant we later attended.

Oh, the life of a fourth year would be sweet if I wasn't about to eat about two grand worth of airfare. On that note, I'm still really thrilled about how interviews are coming, and I get to go to New Orleans, which is always exciting, made more exciting by going in the dead of NY winter.

Speaking of fourth year, I'm actually enjoying Family Medicine more than I expected. Though it will hardly divert me from my desired route back to microscope-hugging, it's the closest I've come to feeling like a real doctor because it has all the associated doctor framework. I thought Internal Medicine would feel that way, but IM seems to be more constructed from existential angst and despair. Outpatient clinics get the have patient, check patient's wellness, provisionally diagnose patient, possibly refer patient to specialist. Follow patient's progress. Check on patient in a week to a month to gauge problem list. Doctoring. I enjoy it a lot; I'm just not sure I'll enjoy it in twenty years, nor will I enjoy the absolute necessity of setting up my own practice for it, failing miserably because I have no business sense, and waiting tables at Applebee's (I'm your server, DR. Ishie) due to my inability to run a practice.

Oh yeah, and I like pathology a heck of a lot.

In other news...

2010-10-15T16:52:00.002-04:00

I forgot in my last blog, but remember that tornado I told you guys about um... last month? Well, this last week we had an unexpected torrential hailstorm that dropped about an inch of quarter-sized ice pellets onto our porch. WTF is going on in Brooklyn?

Success is... expensive

2010-10-13T19:54:00.004-04:00

Hi all, it's your regularly absentee blogger again, stumbling from the hours-crunch of "trying to have a night job" to "partying for fourth year". Plus there's the whole: "I don't want residency directors to figure out who I am, spend the next week reading this blog from start to finish because they have nothing else to do and then figure I'm too unprofessional to ever give a job in a desirable location, ie, the place in the middle of the Venn diagram that encompasses "places close to a large body of water" with "places where cockroaches can't fly". Or something.

But my title... I'm getting interviews! Wahoo!!! In many different places!! Wahoo! Where I have to fly to... um.. wahoo... during scheduled clinical rotations... hmmm... hope they don't mind that... in the middle of the holiday season... ooh... off my last loan check, which is supposed to last me until July... ergh... hurk.

No, it's exciting though. It really is. I'm actually applying for a job as a doctor. Which is really frigging bizarre, and I feel like the gap between my position and the residents is shrinking. When I started my third year rotations, I was scared of interns. Little things keep emphasizing to me that it's next year. Before next season clears up this season's story arc on True Blood? Doctor. Before my lease is up? Doctor. Half the stuff I receive through my school account is addressed to "Doctor", because, eh, close enough. I even played the doctor card to get my stuff back at one point, because I figure if an airline loses belongings that have a stethoscope and a white coat in them, it's fair game.

And it's a title change thing. Since I'm fundamentally afraid of marriage, I never really thought about the Miss/Ms/Mrs transition, but once I get this degree, I get "Dr" before my last name for the rest of my life, even if I spend the rest of my life selling Amway. It's extremely weird.

Meanwhile, I spent yesterday in conference, teaching me a number of things.

1. Trapping medical students in conference while you spend an hour talking about the hospital's financial restructuring has become an obsolete form of torture due to the invention of the internet phone. I never got a chance to read Crime and Punishment in high school, and it's actually pretty darn good. My colleagues seem to equally be enjoying video games, Facebook, email, and a USMLE question prep app. The residents, similarly occupied. Seriously, no one cares.
2. Despite being in conference, "I just came in for ______ and these expletives want to get all up in my expletive" is a far more common primary patient complaint than I would have expected. All I ask for in my doctor is that he not lecture me about biological clocks when I tell him I've never been pregnant. I'm easy that way.
3. Why must every conference room either be as hot as the surface of the sun or as cold as a meat locker?

One the plus side, drug company visit during conference plus radiology company visit during clinic today meant free lunches *two days in a row*. To a penniless interview-scheduling med student, this is the frigging moneyload. I also got to work with my favorite surgeon despite being out in other-Brooklyn and not being in a surgical rotation. Sweet.

Roommate and I are having an October horror-month. Paranormal Activity is freaking scary. And no, I don't believe in the paranormal, and my current favorite show has a serial killer as a protagonist. Still freaking scary.

Update: it is both wonderful and unfortunate (calorie and money-wise) that I live near the food mecca of the universe. Half the places roomie and I regularly frequent seem to be featured on the Food Network. This is going to make it very difficult to leave NYC.

Blow me away...

2010-09-21T23:16:00.005-04:00

For the uninitiated, that there below is Brooklyn. More specifically, it's near the part of Brooklyn *I live in*.

And that, over on yonder screen, is a frigging tornado.

I try not to ask for much, guys... I mean, some school-love every now and then, a pat on the back from an attending, unchecked wealth and power... what I'm saying is I'm an ask-not sort of gal.

But I don't think it's asking too much to ask *tornadoes* to stay out of my hood.

I lived in California; I accepted that earthquakes are part of the package.
I lived in North Carolina; I accepted that hurricanes are part of the package.
I lived in Grenada; I accepted that hurricanes are part of the package though we inexplicably got an earthquake too. Maybe it's me.
I live in Brooklyn, I accept crime, the warm smell of dog piss on the streets in the summer, and the potential to freeze to death in the winter if you can't find a cab. My point is, TORNADOES ARE NOT PART OF THE EQUATION.

And in truth, tornadoes are rarely the part of any of my equations because they scare the crap out of me.

So basically, while I was passing hours on call down at Coney, just as I was let out (of course), I hear what I had believed to be a truck backing into a loading dock. Turns out that was just the thunder. When I get home to my street, the front of one building is off, there's tree wreckage everywhere, the fence has been blown up the street, and my walls had dirt streaked on them because the wind kicked up the dust from the screens. Whoa.

In other news, I'm doing my medicine sub internship right now, which is a rough commute, topped by trying to get a job at night, topped by scheduling residency interviews (it's that time, kids!), which leaves me no time to do laundry.

On the residency front, I kicked out 57 applications for that field that I love and am just waiting for my letters of recommendation to be scanned in so that my application can finally be complete. Huzzah! I've heard back from three programs so far, two offering interviews, and one stating they will schedule and interview for me when my LORs come back in, so I'm calling that one a half interview.

Tales from the Crypt...

2010-09-02T21:10:00.006-04:00

Day 1:

Ishie: Ooh, an autopsy in the basement! What a wonderful learning experience!

PA: You two go down and label the cassettes. We'll be down soon.

(an hour passes)

(morgue phone rings)

Other med student: Um... hello?

Voice: SEVEN DAYS.

Just kidding.

Voice: Oh... are you guys still down there? We're doing the autopsy tomorrow.

Day 2

Ishie: Ooh, an autopsy in the basement! What a wonderful learning experience!

(PA unlocks door. Grenada sized roach runs across floor.)

Ishie: AHHHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!!

(Other med student smashes roach. Roach flips on back in center of floor)

PA: So, you won't need too much protection for this one... just a gown, gloves and shoe covers... you can come get them...

(Ishie remains pinned against far wall with arms crossed across chest. PA looks at her and looks at roach)

PA: You're a pathologist!!

Ishie: I'm not an entomologist!!

(PA sighs, takes broom and shoves roach through drain in floor.)

PA: They come up through it; I push them back through it.

Ishie: AHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!!!!!

Personal Statement Blues...

2010-08-27T13:13:00.002-04:00

So that whole application season thing is coming up again and like most of the red tape involved in becoming a doctor, it's a headache.

I've never had too much trouble writing, and it used to be the normal way I occupied my free time before I discovered beer, boys, and youtube...

Where I do have trouble is selling myself. I have no particular idea how to actually convey to others that I have qualities worth hiring without sounding like a tool or downplaying myself to such a degree that I can't even figure out why anyone would hire me.

I also find my best writing comes out of either humor or anger or a combination of both, neither of which are qualities befitting a personal statement. Hire me because when stuff sucks, I'll make cracks about your program that make the other residents laugh. But rest assured, it'll be at your expense.

I also have trouble conveying why I love something, because while I can write a dissertation in iambic pentameter about why I hate something (war, construction workers jackhammering outside my apartment at 11 PM, Nicolas Cage), my general way of describing something I like is that it's "awesome".

So, this means my most natural personal statement would read... "Pathology is so so awesome. I love seeing what the problem is under a microscope because it's the closest anyone will ever come to a diagnosis. I'm fine with bodies since they complain far less than living people and I love genetics and microbiology, even though anyone with half a conscience shouldn't trust me with the former. I did a couple pathology rotations and they were awesome. I used to work at the Donated Body Program and that was super awesome too. They let me play with bones a lot and I got to do forensic research no one will ever be interested in. You should hire me because I think pathology is as awesome as you guys probably do. Peace. PS, I've never seen a single episode of CSI so please don't think I'm trying to jump on the bandwagon. -Ish"

Less than convincing... immature, unprofessional, all those lovely qualities I embody, but you're not supposed to put them a personal statement.

Instead, I currently have something that is pleasantly wishy washy and sounds insincere even though it isn't. I didn't have any one event that led to my pursuing pathology. I didn't have a beloved grandfather who just would have been saved if some go-getter had diagnosed his _____ correctly. I wasn't on a plane where a passenger collapsed and someone screamed for a pathologist, and they ran up, did a biopsy and the patient lived to see another day.

When I was a girl scout, I wanted to diagnose labs instead of people. When I was 13, after abandoning my dreams of marine biology because I get so seasick I envy the dead, I wanted to be a virologist. Probably due initially to Dustin Hoffman. Then when I was a candy striper, I got sick of wheeling patients around and providing comfort around day four and spent the rest of my time there organizing slides in the path lab because it made me happy even though I had no idea what anything was. I found fourth term WAY more fun than second term because I like path and hate physio. I'm a lifer. But expressing that in any form either sounds like I'm lying or like I'm severely socially maladjusted.

Pathology makes me content. I don't run home with awesome stories largely because no one would be remotely interested in what makes my day fantastic, and my best shareable stories from it tend to be disgusting enough to significantly limit my audience. People are excited by stories about gunshot wounds and CPR... hell, I am, and I've run home enthusiastic when they've happened in my other rotations... but once that adrenaline wears off, I'm left with... what? Surgery was cool until it wasn't. Once the excitement of a case wore off, I wasn't left feeling content; I was left feeling bored and frequently frustrated. No answers and no diagnoses. When I'm doing mind numbing number crunching in the gross lab and entering standard templates into the computer, I feel a general sense of peace and satisfaction in the downtime that I have not found anywhere else. Why is that so hard to commit to paper?

Oh right, the test...

2010-08-16T01:46:00.003-04:00

This sort of thing gets weirder and weirder that farther you get in medical school, once stress gives way to apathy and exhaustion.

I got a Wii!! At long last! I can lately join the awesome gaming generation as my treat for finishing that 9 hour beast of an exam. I also had friends take me out to Chip Shop the next night so I could cram some deep fried Reese's and a few English pints. I'm not even sure which is worse for you, but I'll post from the hospital over whether my heart's failing before my liver is.

The exam... boy howdy is it long. Like LONG. Like kind of over any stress you were experiencing and "I wonder how many points I'd lose if I just went and saw a movie in the middle of this nonsense" long. The questions are long. The whole test time is long. The fact that you get 45 minutes of the day to do anything you need to do and it takes 5-10 minutes to sign in and out means it's long and you're hungry. Or dyspeptic from trying to swallow an entire peanut butter sandwich and then trying to shove it a sufficient distance down your esophagus by pouring Red Bull on it and hoping the bubbles will dissolve some of it. Hell, the stuff tastes like battery acid anyway; it should make some headway.

I took it afternoon until night, as I mentioned, which was awesome, though I closed out the place, and lo and behold the place is right across the hall from the offices for Air Jamaica, which is nice because I guess if you do badly enough, they can send you straight back to Grenada without ever letting you set foot on New York soil again.

To be fair, the people at the testing center were really nice, very chill, and the temperature was good. I was able to bring my own foam earplugs (call ahead and ask your center) which is great, because the silencers provided are identical to the ones that they use at shooting ranges which makes them heavy and tight on your skull. Good for drowning out the .45 in the next booth. Overkill when you're trying to think while drowning out the keyboard sounds in the next booth.

Despite the preventative measures, I would recommend taking as many breaks as feasible. Get water, go to the bathroom, cram some calories and get back in. Stretch your back and legs, make a Home Alone face in the mirror, chuckle to yourself and go for round 2, 3, 4, 5, 6, 7, or 8.

Don't overthink the questions because they give you a lot to overthink. If it seems right, just pick it. If you're clueless, pick the most likely (eliminate the obviously wrong) and move on, mark it later.

Getting in and out is starting to encroach on the airport's turf for security overkill. I had to get frisked before going back into the testing center each time, and though she did the job right in front of the security camera, I have a feeling the girl responsible for feeling me up felt as ridiculous about it as I did. That made me feel better about the whole thing. They didn't make me take my shoes off though.

Looking back, I don't really know what I would have done differently studying-wise. It seems like any moment I didn't have my head buried in UWORLD questions was a wasted one. There were still a lot of wishy washy weird judgment call questions, but I don't think any resource could really get you ready for them.

How do I think I did? Geeze, I have no idea. I think I passed, but once I'm getting below an 80 on a test (which I'm guessing I did on this one), I have *no* clue how I do. My mom's set on 261, which I think is about as probable as my riding into a residency at UCSF on the back of a unicorn, but it's a nice thought.

Also, with the exception of recalling some questions almost in entirety (though I was better about that on Step 1), I get massive testing amnesia. I go in... I vaguely remember things like "Oh, block three was really sticking it to me" and "Oh crap; out of time" and "AAAHHHHH MATH!!!" and then I walk out nine hours later feeling puzzled, brain-enema'd and occasionally vurping up bits of Red Bull. I wonder what happened. I go home, watch Futurama and go to sleep. I party the next day and then I sleep solidly for the two after that. Not hungover; not wildly stressed; just completely mentally erased.

So there you have it folks. Taking Step 2 CK is like getting roofied, waking up hours later with a hangover and your kidney missing and the only clue left behind is a note someone's written in lipstick on the mirror and it says "Your testing session for USMLE Step 2 Clinical Knowledge has ended. Thank you for participating in the United States Medical Licensing Examination. Close. (follow the white rabbit)"

And you're just surprised you can still read.

Oh, it's here

2010-08-10T02:43:00.002-04:00

With considerably less holy crapping than the first... but time will tell.

I'm taking the Step 2 CK later today, so naturally that will be followed by probably very little helpful information since the USMLE wranglers have me so paranoid that if I say to a friend something like "Whew!! Should have studied more epidemiology!" (that's just an example; I swear I haven't taken it yet!! Don't kill me!), I'm convinced I'll hear the opening to Ride of the Valkyries and black helicopters will swoop down, whisk me away and strange men will waterboard me... or feed me okra or something. And the last thing anyone will ever hear of me will be an email from my clinical coordinator saying "You STILL haven't written your personal statement?"

Bored now...

2010-08-06T01:32:00.003-04:00

The problem with being an intrinsic night owl the second you're deprived of an attending who would take you not showing up at a rotation until 3 PM somewhat amiss, is that you start studying late thus your study breaks come around... oh, say, now, rather than at a time where you can spend them doing anything fun.

So my Step 2 CK is in four days, and I'm trying to stay motivated, which is difficult because as noted above, I'm bored. I seem to have weaned myself off the crippling levels of stress that kept my blog so um... colorful... through my early med school days, but losing that overwhelming anxiety is also killing my drive to do things like study straight through for 48 hour blocks. That's probably a good thing. I also live in NYC with an awesome roommate, which means at any given time (even now), I *could* be forgoing this study thing entirely and replacing it with whatever the heck I want. Live music, transvestite burlesque shows, 2 AM cupcake delivery, microbrewery sampling.

But whine whine, that all ends on Tuesday and then I have some relaxation. By relaxation I mean, do a case write up in the hopes of squeezing a last minute publication under the wire, write my personal statement, and upload all my crap to ERAS because I'm a horrendous procrastinator that can only focus on one task at a time. Sometimes not even one.

Oh, though speaking of awesome NYC stuff plus night owl stuff, I'm actually taking my exam starting at 1 PM, because holy crap, that was an option. That means instead of spending the first three hours of the exam feeling shaky, exhausted, and smelling of Red Bull and fear, I can sleep until my normal hour, stroll to the testing site grabbing some tasty lunch treat along the way and be at my best when I'm actually at my best. Granted this will leave me strolling Brooklyn after dark, but for the luxury of sleeping in on board exams day, I will gladly sacrifice a maxed credit card or three to the urban jungle.

What else... I'm still in maximum amounts of love with my phone and it's letting me play with Wikipedia with enough speed and dexterity that I can study in places that aren't "in front of my computer where I'm getting foot drop from having plastic-chair ass".

That seems like a good place to end.

Too true

2010-07-28T00:27:00.003-04:00

Hello all, I'm in USMLE study hell again though I'm taking a little bit of a turn from last year's Step 1 hell and making my current experience less hell and more "I don't have to be at the hospital! PARTY!!!!" Weirdly, it seems to be working pretty well though the actual exam will tell, but stress has always been my big killer on exams and enjoying life is making the gears run smoother. Plus I spent a great deal of this last year transferring a number of hospital lunch breaks into UWorld time at the library because sometimes that cafeteria pizza is just so gnarly that it's better to cram a granola bar and surf a computer.

Due to that tendency, I actually completed all 2200+ questions on USMLE World last night after a year long subscription to that brain-ripping, ego-destroying program, which felt a bit like this:

Of course, the actual test still comes at the end of this, which is sort of like defeating Mario Brothers only to discover that King Koopa is real and lives in your bathroom.

Speaking of random youtube videos, I chased this link thinking it was an actual tutorial on heart sounds because I suck at them and the brand new audio feature I experienced on Step 1 emphasized that to me. I admit, I loled.

And yeah, that's pretty much what I did on Step 1.

Anything else? NYC (as well as a great deal of the rest of the country) spent the last couple weeks being miserably unbearably hot. Like a good medical student, I chose to attempt to run Prospect Park on a day where the heat index was 105, which fortunately, at a mile and a half, my body saved me the hospital trip by crapping out on me entirely and made it difficult to even walk home. If my life were a USMLE World question stem, it would have read:

"A 29-year-old female with no documented medical problems is brought into the Emergency Department unresponsive, seizing, and with a body temperature of 109. She had previously been running in an unshaded section of the park despite an actual weather alert advising against doing exactly that. Despite aggressive management, she codes. What is the physiological mechanism behind her cause of death?"

If you picked anything regarding temperature regulation mechanisms or denaturing proteins, you're wrong. The answer is "mind-blowing stupidity". It's actually a more common cause of death than the usual statistics indicate.

So I consoled myself at my favorite bar with True Blood because damn, I'm hooked on that show and I don't get HBO at home because I'm cheap. Sookie.

Ways to make a good impression...

2010-07-12T23:45:00.004-04:00

1. Come early
2. Don't leave until you're told to go. This may periodically involve staring at your attending an hour past leaving time like a dog waiting to be fed.
3. Ask questions at appropriate times
4. Don't write vitriolic, misspelled, profanity-laden hate mail to your entire department

Wait, what?

Yeah, so apparently some resident thought it'd be a swell idea to do number 4. Now, I grew up in a beautiful world where the internet was increasingly providing a veil of anonymity to flame warriors and Thundercats fanfiction authors, but how dumb can you possibly be? The resident pool within a department is not *that* large... you are in a group of people that has gotten to know you over years, including your mannerisms when you're at your worst (2 am post-scut) and your personal idioms, and if that isn't enough to protect you, blasting nearly everyone else in the department including your colleagues is probably going to narrow the suspect pool to the cat not mentioned in the letter. Not rocket science. Or brain surgery. Or garbage collection.

And yes, I realize the irony of pointing this out in a blog... but I've also been relatively cautious not to email said blog to any of my superiors with "RE: YOU SUK AND SO DOS EVERYONE YOU LUV" in the subject line. Plus I'm relatively sure most of my superiors already know exactly who I am and thus can avoid my application letters with impunity. I'm also hoping someone with a love of sarcasm and path-geeks will embrace me into his/her grasp and give me a job with the caveat that I'm not allowed to talk to others without a handler. Which I think is fair.

What else... ummm... I'm studying for that pesky exam that comes after Step 1 and before Step 3. I have 10 percent of the questions on UWorld left to do and am finally beating the clock by a fair margin while skimming the questions going "blah blah blah useless" and then reading the last line. I think after you do the first 1800 questions, you just stop caring, so I think I'm going to avoid my pre Step 1 anhedonia, but time will tell. The increased time on UWorld is also giving me an appreciated bit of quality time with my iTunes playlist so I'm discovering some new bands, by which I mean "bands that have been occupying my hard drive for half a decade".

I've been studying with a friend at various locales in the interim to try and mix it up. We had a conversation at an Asian fusion place (tres chic) about preventative screening measures because I'm useless at it, so we really know how to live it up. This is sort of a running theme from my "stercobilin in the line for the Finding Nemo ride" from a few years ago.

This is my last week of heme/onc, which I've really enjoyed despite having kind of a soul-crushing day that will make me more appreciative of being on the other side of the microscope.

I'm also learning that while I don't particularly care for Spongebob despite being a cartoon focused adult, he is absolutely hypnotizing to children. Like forget Lidocaine; the second they hear "He lives in a pineapple under the...", you are effectively dead to them.

I've also learned that I can be puked on without moving my hand or relaxing my grasp, which was a useful little piece of information about myself I had not previously been privileged with. Oh, the little bits of medical school that aren't in the brochure.

Summer got a little miserable so I've been basking in finally having an A/C and occasionally venturing out to hit concerts in Prospect Park or wander off to see True Blood in a place with both HBO and and cheap nachos. I drew the line at Twilight though. Shirtless werewolves? No thank you. Shirtless werewolves with extremely gratuitous violence? Shakespearean.

I also joined the Apple cult of iPhone because I'm a weak weak person and I'm too destructive to be affected by the network problems because everything I own already requires a case lest I spill stuff on it. Just ask my (miraculously still working) laptop, which survived the great Grenadian cornflake barrage of 2008.

Oh well whatever nevermind

2010-06-23T00:42:00.002-04:00

Against all odds, my bag was recovered today AND the people on the phone through AA's lost luggage line were nice and polite. I had pretty much kissed off seeing my stuff again and also figured I'd have to get and finish a residency and hire a lawyer before I'd see any compensation.

I also sacrificed another year of my life to get a new phone. It's shiny. I'm getting used to having manual keys to type again.

In even more unbelievable news, today I... comforted a child. Somewhat successfully. I feel like now I should be in a CS advertisement jumping up in the air and high fiving something, since my usual response to human suffering is profound and visibly awkward discomfort. Maybe that studying paid off.

Luggage gone again...

2010-06-22T00:17:00.002-04:00

Hmmm... brief synopsis that will be elaborated on later because my days up until yesterday were spent studying for Step 2 CS, flying to Houston to take my CS, and then hanging with family in Houston, and since then I've been alternately trying to figure out how to get my luggage back and how to get my insurance to give me a new phone since mine's broken. Which makes getting luggage back more fun...

So... CS: stressful, but not as stressful as I was expecting considering forced human interaction with people who are judging me is where I excel least (hello pathology!). Can't detail too much on the exam because they threaten us with death or something equally bad like not being allowed to take CK or something. Wait...

Also, practicing for CS is not only a good idea, but fun. I got to treat my boyfriend for 'lady bits problems' and discovered a crashing deficit in my bedside manner when I was practicing on my friend... you see, the chief complaint that was yelled to me (our version of the doorway information) was "fatigue". I open my door and there is my friend sitting there with my silk robe on backwards and her eye blacked out with makeup. After my first staccato burst of laughter, I extend my hand and find both of her arms similarly darkened.

So my response to the investigation of domestic violence is to laugh uncontrollably for 15 minutes while attempting to conduct an interview and being completely unable to look at the patient's face. FAIL.

Seeing family: Awesome! My little cousins are people now. They're also more polite than I am and address me by name and title, whereas I usually get people's attention by either saying "Hey!" or more frequently, by wandering obliviously down the street attached to my ipod until someone who wants my attention has to physically grab me.

The littlest one also wants to be a doctor because she wants to give shots, and asked if I brought any. Which is absolutely not weird. The older one shares my Wii addiction and my unnatural love of the show Avatar: the Last Airbender. I'll add in that my love of True Blood fills out my diet with enough mindless sex and violence that it justifies my addition to a Nick toons show, thus I maintain my legal status as a grown-up. My big cousins plied me with wine and explained the whole oil crisis since as a proper medical student, I have absolutely no idea what's going on in the outside world at any time and my grasp of the BP situation involved a vague depression and pictures of dead pelicans.

In other news, hi guys!

My aunt and uncle took me to a little place called Spring which I liked and reminded me of Woodstock, if someone turned the thermostat up 20 degrees. I also ate BBQ with gusto since it tends to be of not fantastic quality and prohibitively expensive in NYC. I also got to make multiple car trips to the store which is a convenience I had not realized how badly I missed until I was tucked safely and comfortably in the backseat of an air conditioned ride rather than rammed up against a hobo and a busker with my food for the next week determined by how much upper body stength I have (spoiler: none).

I shopped before I left and I shopped while I was in Texas. This is relevant because it allows me to say that pretty much *everything* lost in my carry-on luggage was brand spanking new. And I very rarely shop for clothes, so it was a particularly harsh blow.

I've had luggage lost so many times that by the time I flew to NYC for my current stay, my luggage was labeled all over with Sharpie marker with my contact information, had ribbons tied on the handles, and was wrapped in fluorescent duct tape. I'm not making that up. Since flying now carries the added fun of a 25 dollar fee and I'm tired of losing my shit, I put everything in carry on. Including my stethoscope, white coat, PD kit, and all that fun stuff (that I needed today!). So imagine my surprise when as I went through the gate to my flight, my carry on (fortunately not my purse) as well as most other people's was marked "Valet" and stuck in the side of the plane. Since I never planned on letting that bag leave my sight, it wasn't well labeled.

So naturally, as soon as I got to Dallas, someone grabbed my bag instead of his and apparently disappeared off the face of the planet, leaving his bag with me, which I promptly turned over to lost luggage in Dallas because I'm a moron unfamiliar with the art of blackmail. Best part is... since it was never formally 'checked', I can't actually prove I ever had it. So I may be out the possibly ~800 dollars worth of stuff in that bag that was of a cost and emotional value which they recommend you don't check... *which is why I didn't*.

I put all of that aside to go out to watch True Blood at a bar with my friends last night, cause you know, you gotta prioritize, at which point my phone went from "almost dead" to "dead". So I end up having to call others so they can call my voicemail to listen to my messages to determine whether my bag's been found.

ARGH.

But whatever. I started pediatric heme/onc today and it's pretty cool, features an insanely nice nurse, plus nothing minimizes an extraordinarily aggravating couple of days like seeing 6 year old cancer patients. It's hard to even stay really pissed off. "I'm having the worst day with my luggage and my phone and I had to circle LGA for an hour and..." "My hair fell out but they gave me this great wig. Can I watch Ratatouille during my chemo sessions?" "Uhhh.. have a cookie." "I can't; I'm NPO."

Oh, in that direction, while practicing for the CS, the First Aid gives you these often off-the-wall 'patient questions' that are designed to throw you off guard to determine your response to being put on the spot. They range from "am I going to die?" to "What does 'ultrasound' mean"? They dispense with the normal answers of "No" and "it's a test" in favor of a paragraph of feel-good that I found rather silly.

Until today. Had a "Will I be able to make the trip" question that sounded like it was lifted directly out of the pages of the First Aid, and then not one but two "Why does she keep complaining of being cold and shivering when her temperature is so high?" that wasn't in First Aid, but should have been. Hopefully the practice paid off for something, because I felt like I could give pretty good answers and empathized well. And even for real empathy. Also, heme/onc moms seem to be a relatively forgiving lot and are used to medical students asking them a crap-ton of questions they've answered seventeen billion times, so it worked.

When is an emergency not an emergency?

2010-06-10T01:54:00.003-04:00

Naturally, the second I have a week off, I revert to my midnight owl schedule, which put me at my prime study hour just in time to hear annoying jangling outside my window for long enough that I finally looked out it.

In time to see one of our friendly neighborhood street rats brandish his giant novelty-sized bike-lock pruning shears, put them away, and ride off on his newly found prize.

Bah... so I uttered an ineffective "Hey!" out the window, tempted to run him down swatting him in the head like our falafel guy did when someone tried to jack a bike out of our apartment (love you, Mohammad, seriously, and your shwarma is the frigging bomb), but by the time I got jeans on and went outside, he was already ineffectively weaving up the street...

Leaving me with a dilemma... this is not my bicycle thus I can't really identify it or prove it isn't this kid's (though the shears might), and the perpetrator is currently escaping with slim odds, I would think, that someone is going to pull up and catch him by the time I run upstairs and call the police.

So who do you call? The last time 911 and I had a friendly chat, it was for a three year old that was sans a heartbeat, which tends to be the level of emergency I do not want getting preempted for bike theft. So I called 311, due to their effectiveness at shutting up noisy buttholes at my friends' place, but then they promptly forwarded me to 911, who seemed interested but vaguely confused as to why I was calling them. Then they called me back three times to get a better description, so I guess they care after all. But if you see a blurb in the paper about some high strung female who called 911 due to seeing a kid with bike clips outside her apartment, don't blame me. I called information.

Another test already?

2010-06-07T02:38:00.003-04:00

But I just took the Step 1 like... oh, over a year ago. But still.

I'm going to take the Step 2 CS in about a week and a half. This is a really different exam than all the others in that it costs nearly twice as frigging much and I actually have to play doctor with actors rather than banging out multiple choice questions on a computer screen.

The problem with this exam is that it has a really high pass rate, which sounds like a good thing, but that ends up serving to make you feel really bad if you're in that 10 percent that fails it, and given my proclivity to blurt out nerdy inappropriate jokes when I'm stressed, that just has "train wreck" written all over it.

Nah, but it's all good. It's an opportunity to go to Houston and finally see family again! Huzzah! And I'm actually really excited about that. So fake patients do your worst. Actually, don't. Be nice to me so I can play with my cousins.

Because I don't want to blow off the exam and I was being creative with my scheduling, I now have a week off post-pathology rotation, which I'm going to dedicate to practicing and studying for the test so I can enjoy my Texas time. I'm also going to enjoy the opportunity to sleep in and *not* have a 45 minute train ride each morning.

Not that I can really bitch about my last rotation. It was pretty awesome, everyone was nice to me; everyone showed me around; I got to see all the labs, and since path is a heavy laboratory specialty, the staff offset my expected cost of eating disgusting overpriced hospital food by bringing goodies in damn near every day. In unrelated news, I'm upping my run-time in Prospect Park despite the stifling humidity because I refuse to buy new jeans to accommodate an expanding posterior surface.

I started getting confident with the microscope, which makes me happy. I'm not confident with diagnosing what's on the microscope (though now I can find H. pylori!) but I can swap those lenses out and zoom in on problem areas with ease. I got to see an autopsy, which kept me hovering near the back room like a vulture for half the day because I didn't want them to start without me. I stayed late a lot largely because I wanted to make a good impression on the denizens of my future career, but also because I had access to my own microscope, a computer, and air conditioning.

Speaking of that last one, I caved. I can't do another summer, particularly with all New Yorkers talking about how mild the last one I suffered through was. Home Depot was having an online sale and now I'm just checking the order status every five minutes to see if they shipped my A/C yet. I'm giddy with the anticipation. Especially with a late summer several-week study session for the Step 2 CK (the computer exam), I'm going to be sweating enough from the mental beating UWorld gives me; I don't need to add constant sticky heat and sleeping on ice packs.

Being in the specialty of my dreams didn't keep me from recreating though... I went stereotype NYC for Memorial Day by escaping the city on a camping trip up to the Adirondacks, which was phenomenal and refreshed my desire to apply to residency in some more rural locations to get my nature vibe back. I also went with the most prepared camper in the world, who not only brings the stuff I forget (like flashlights, maps, tent poles, and similar little stuff) but a tournament beer pong table, an air mattress that is larger and more comfortable than my actual (bunk) bed, and three dogs.

The weekend before that was Jersey pool party weekend... Now this weekend was... uhhh... let's just say it involved Williamsburg, Zombie Hut, an insane hunt for pommes frites, and dozing off in our deck's new pool at 4 AM. And by pool, I mean "We now have a plastic kiddie pool on our porch that we fill from the sink." Looking at that plus the 6 and a half foot plastic mannequin standing vigilant over it, my roommmate muttered something to the effect of "We are such hipster trash." Heh.

As soon as it was over...

2010-05-10T23:04:00.003-04:00

it begins again!

Except this time, I'm chasing the specialty that I want... ah, the beginning of fourth year. It seems like not too long ago (Friday), I was a lowly third year, new in the ways of the world before a new day dawned (Saturday) and all the wisdom of the profession was passed down to me.

Or something. Plus I went to Fat Cat so that Lori and I had a contest over who could suck more at pool. Then my boyfriend stepped up and was gracious enough to not destroy me immediately.

Whenever I feel like I don't know enough in medicine and I'm not studying enough and I'm dumb and stupid and I'll never be a real doctor, I need to play pool, because holy crap, I can cram decent knowledge into my brain when I have to, but I have the hand-eye coordination of a brain damaged rhesus monkey. Another good reason not to go into surgery. My real life scratch on the eight ball could have me jamming a kelly clamp into someone's hypothalamus, and I'm told the hospital's insurance company frowns on that.

But I started my pathology rotation at a new hospital! The path part was cool, but I'm discovering a few things... I'd say that being at a new hospital is like being the new kid in school, except it's more like being the new kid in school if you started in the middle of summer vacation. The crop of third year clinicals don't start at that hospital for another one or two weeks and most of my now fourth year colleagues were smart enough to give themselves a break now, so I was virtually the only medical student wandering around this giant hospital, and the only one in my rotation.

I'm also discovering that while I love love love looking at slides while attendings teach me (!!!), I need some damn Bonine or something because I was getting seasick. I actually had to close my eyes a few times while we were reviewing pap smear slides because I had that icky feeling I got when I went up the windy road to Fish Friday. Is there any way to man up your middle ear? That's pathetic.

The attendings are really nice so far, and they already know that I'm almost certain I want to go into their profession. This lays on the extra pressure of my being the only student *and* I don't have the "I don't need to know this" excuse, because even if it is too high tech for the boards, I'm going to need it in the long run.

I'm already mourning the loss of our free meal passes at my old hospital too. I was bone dead tired this morning so ran down to the cafeteria to pay for my coffee... later pay for my lunch... the horror! After nearly a year of running to the grocery store virtually never, the first thing I did on my way home was stop and get portable lunches. Momma needs rent money, and that is not going to go to paying 8 dollars a day for crappy hospital food.

Holy crap; I'm a fourth year

2010-05-08T03:19:00.003-04:00

AIIIIIIIIEEEEEEEEEEE

Seriously, wow... when I first came to Grenada, I was staring at second termers in awe because they were... wait for it, almost a year into medical school! Now, with the completion of my surgery written exam, I'm officially done with third year. Like donezo. Like applying for a residency this year. Like going to have "MD" after my name in a year. Like... actually will be able to draw a paycheck rather than just hemorrhaging Citibank's money in the hopes they'll never cut me off.

I'm not sure if I'm going to feel more ready to be a doctor in a year. I think I expected some sort of transition through medical school where I felt like a doctor at the end of it, or near the end of it, but instead it's just sort of an insidious thing that creeps in while you remain petrified that you have no real doctoring skills and feel just as inept as you did after your freshman year of high school. But I find it harder and harder to have totally un-medicine related discussions. I have a bunch of interests, but stuff creeps in... there's analogies... "man, this song is so bad, I'd rather hold retraction for a whipple on a 450 lb patient than listen to it again"... ya know, normal stuff.

I also have moments of "Hey the training paid off clarity" when I'm in clinic and a patient begins to describe a symptom, and I can rattle off all the other symptoms they're about to say in my head because I know what they have. Then some friend or family asks me some extremely simple question (So why do you get that stitch in your side when you run?) and I just look at them blankly and wonder where all my money (by which I mean Citibank's) is going.

Bahhhhh but no more surgery! No more third year! Conceivably I don't have to be on call again unless I schedule a rotation that requires on call time. I'm "studying for CS" and "taking a month off for interviews" and the rest of the fourth year lexicon. I'm pass/fail for the next year. Weird. I'll be the highest level of short white coat in the hospital, which still has me outranked by... everyone except the third years.

Naturally, this even required celebration, meaning that pretty much immediately after the exam, we migrated en masse to a student's rooftop to do what carless medical students do when they celebrate... To give you some idea of the day I've had, we got out of the exam around 11 AM and I just got home, albeit the last hour was largely influenced by the F train's insistence on sucking. Three trains and a shuttle later, that I wound up getting off in... let's just say a part of town where I didn't feel snuggly and warm standing by myself on a corner in a bright red dress, so I caved and took a taxi. The horror.

Oh, which reminds me of my latest pet peeve. Everyone has GPS. I even have a GPS and I don't have a car. WHY have the last 12 taxis I've gotten into (and having me get into a taxi is relatively rare) asked me how to get to my location? And it doesn't matter where. "Brooklyn Bridge please." "Oh, how do you get there?" "Um... drive downhill until you hit water; I don't frigging know." To me the city is a series of completely disconnected epicenters around subway stops. I have no idea how to logically connect them, and certainly not within the framework of legal traffic patterns. And every minute you sit in a cab (like frantically pulling up the directions on your phone), you're paying. I'm also not a fan of the phenomenon of getting a cab in Brooklyn and having them waffle, refuse to take you, or try to charge more if you're going to another place in Brooklyn. Manhattan is amply served by subways. Areas of Brooklyn, less so. Just drive me to my destination and shut up. I'm not paying you forty dollars to take me to Manhattan slower than the subway takes to get there. Except the F train.

Monday I start my official pathology rotation (rather than the unofficial one I was making out of surgery), and I'm excited. My first rotation of fourth year! Celebration will continue through the weekend, so long as mother nature doesn't conspire to ruin it.

Life's little truths

2010-04-28T00:02:00.004-04:00

This isn't mine, but I wish it were...

It's drawing near...

2010-04-21T22:44:00.002-04:00

The end of surgery! (and third year)

Surgery's kind of a mixed bag in that we have a pretty slack rotation as far as surgery rotations go, but apparently an even *more* slackass group, so we keep getting in massive amounts of trouble with no conceivable way to end it since as the slackers keep slacking, eventually everyone sort of gets a "f- it; why am I doing the scutwork of two people when you're at home doing nothing" sort of attitude which compounds the slacking which compounds the trouble.

I feel the students' guide to slacking is to not slack in ways that screw over other students or sticks them with excessive amounts of work in your absence. Otherwise, slack at your own risk. If not, the whole group dynamic changes and people get angry, bitter, and defensive. I feel a lot of this is also a function of simply having too many students on this rotation. The statistical likelihood of shameless slackery goes up simply with the number of people, plus since there is an overflow of students that lessens the workload, it creates an impression that you can do *nothing* and others will pick up the slack. This is partially true, but creates a tremendous amount of resentment.

If you are going to slack, the worst way to do it is the slack-and-schmooze. This is a brilliant technique wherein your colleagues are left with thankless scutwork while you flash the glistening smile at the attendings of someone that's racked up an adequate amount of sleep. To be fair, this technique seems to frequently pay off gradewise (leading to a similar phenomenon observed in residents), but your classmates will want to kill you even more than if you were the simple shameless slacker that could not be less interested in ________ rotation, and has no problem showing it. Be advised.

Lest anyone get the idea that I'm claiming to be a good little worker bee when half this blog has been dedicated to my various non-medicine related exploits, I'm not. I tend to refer to myself as a lazy buttmunch with frequency, but moderation people; jesus.

Anyway, so that's that bit. Otherwise, surgery's mixed on its own because as a lazy buttmunch, I detest long hours, and in particular, early mornings, which surgery has in abundance. I'm also fidgety and get hot easily, both of which are not fantastic qualities when you're scrubbed into surgery leaning over a heated air cushion and not allowed to touch your face. On the other hand, you get to do what I generally associate with "medicine" such as "Hear patient's complaint. Use prohibitively expensive education (or Wikipedia) to diagnose complaint. Remove complaint. Hope removal of complaint doesn't lead to minor complications such as wound site irritation or massive blood loss. Discharge happier patient sans complaint. Make bed of money and roll around in it."

Okay, not that last part. For anyone reading this that thinks becoming an MD is an efficient, effective way to make money, that is the same logic as deciding to get a piece of cake by working your way up at Duncan Hines starting as a janitor and eventually buying stock in the company fifteen years later so you can sell it to buy cake.

I'm also finding kind of a mixed bag on the whole surgeon personality thing, which I was initially warned about and expected to be far worse than it was. I've found surgery people more prone to tantrums than your average other-doc and during conference, they're absolutely brutal to each other, but they also seem to possess far less soul-crushing existential angst than other branches of medicine indicating a certain level of happiness. On an individual basis too, I've found most of them to be fairly friendly and nice to students (with a few rather drastic exceptions). So that's cool. Procedures are also interesting. I'm also learning a surprising amount of real medicine because diagnosis is key when screwing up leads to the definitive "uh oh" moment of opening the wrong thing. So they aren't the mindless scalpel jockeys of legend either.

Surgery possesses some amazing gadgetry too, even at county hospital level, which I assume is largely around based on surgeon-tantrums so maybe they have a purpose. For every engineering inconvenience in the human body, there is a tool that's made to deal with it. Wanna remove a section of cancerous bowel and snap the healthy ends back together in such a way that gets you out in time for lunch AND keeps the patient from having to carry their waste in a bag for the rest of their life? There's an app for that. Wanna see where that obstruction is without having to saw through that large important artery? No problemo. So far the only drawback other than the huge cost of manufacturing the most specific articles on the planet (this tool is made to see around gallbladders!) is that then you have to learn the names of all of it. Or if you're a med student, the suture scissors, since that's generally what your tool is. And we take it seriously too.

I'm on ENT now, which is particularly nice, and am almost comfortable enough with the staff to ask them to clean my ears, since after a few patients and the standard procedures of doing a standard ear exam on people without significant symptoms, going "hmm", and still pulling out giant disgusting gobs of crap, I'm paranoid. Though I suspect the root of my gradual hearing loss is far more likely embedded in the fact that I'm in physical and emotional connection with my ipod every second that I'm not at the hospital or asleep, as it protects me from having to talk to people on the subway.

ENT is also proving more interesting than I expected. Lots of allergies and sinus infections naturally, but also some crazy frigging tumors.

Still, pathology calls. There was some downtime in SICU last week that coincided with helping out in the gross lab and an autopsy so I got to make productive use of the time and got to practice some suturing where I can't do damage, which enhances my confidence greatly. When I wasn't fixing the computer.

Lemme just take this opportunity to again rail at frigging virus makers, since the SICU computer got hit with an almost exact variant of the virus I had, which is the only reason I knew half where to start with it having dedicated an entire Saturday to it previously (thanks, jackasses!). So not only are they stealing your credit card information, they're also trying to hinder medical care to your loved ones. Please remember that the next time you happen to catch yourself in a dark alley with one of them.

Speaking of peaceful hippie love, I went to Woodstock and the nearby lighthouse this past weekend so I could give my mom an urban escape for her birthday. I would highly recommend that for anyone who needs a break. What I would not recommend is what I did last year, which is using Woodstock as a staging ground to get lost in the Catskills at night, but I managed to refrain from doing so this time around.

Bedtime. Tonsillectomy in the morning, so I can finally see what was done to me as a child...

Anesthesia is sweet...

2010-04-08T23:59:00.002-04:00

Though I suck at pulmonary physiology and pharmacology, so I think I'll keep on towards path. Plus path makes me really gloriously happy, which causes me (and others) to doubt my sanity.

So in surgery, we have several weeks of 6 AM rising and cranky residents interrupted by anesthesia, which seems to be a specialty that was licked into existence by unicorns. They leave early; they're chill (getting to sleep does that to you) and given the long periods where there is virtually nothing to do, they enjoy talking and teaching, and periodically, dismissing med students to take long lunches mid surgery, because hey, what the hell.

We still tend to have late lectures, which has often left me several hours at the hospital, forced to do something productive like (gasp) study for Step 2. I actually have a date for the CS, which I decided to take in Houston so I could finally see my family again, to whom I've been a distant memory since before I left for Grenada. I'm also studying for the CK, whose date is "sometime in August", doing the delicate balance between giving myself time off to study and rock boards while being well aware through the entire time that our loan distribution is contingent on our actual enrollment in rotations, so eek. Studying or working, I still need rent, people!

But I'm being oddly productive lately because I've started to run out of creative ways to procrastinate. I'm trying to save money by not... oh, going out to bars and overpaying for drinks, but I still like to get out of the house, so I'm running a ton, including a 6.7 mile double loop through Prospect Park today. So my days are largely consumed by working, studying, and exercising. I'm so ashamed.

It's also gotten hot recently, rather abruptly, so we went from snow on the ground to "Holy crap, it's time for me to buy an air conditioner" weather, which is actually really fantastic. I hit the Brooklyn Botanic Gardens last weekend where everything is threatening to bloom, the cherry trees are all opening up and I feel a strange emotion that was probably, oh, licked on by unicorns. I also got Easter off at the last minute when I was *supposed* to be working a 24 hour call by myself, so I'm feeling pretty good. Except my last run is leaving me acutely aware of what "lactic acidosis" feels like.

In other school news, through anesthesia, I finally got in on my first fresh frozen specimen. This and autopsies are really the only thing most pathologists are on "call" for. Essentially, you're in a surgery and you need the results on something to decide how to proceed. In this case, it was lymph node. The pathologist flash freezes it, shaves off pieces in something that looks remarkably like a miniature deli slicer, throws it through the H&E stain, and in minutes, determines whether it's malignant or not. This determines whether the surgeon will close up the patient or perform a multi-hour axillary dissection. While they were dissecting out, I was doing mature things like shifting from foot to foot excitedly and going "When they take it out, do you mind if I follow it to the lab? Pathologists are also a cool lot who seem unused to students giving half a crap about what they do, so ours readily explained it to me while moving at the speed of sound. And I got to run the papers back to the room with the results. I resisted kicking the door open like Batman and shouting "CLOSE HER UP, DOC! IT'S BENIGN!" but only just.

Also, I'm such a dork that finally seeing the H&E staining process was like meeting a rock star. "Oh my gosh... I've heard about you since histology... I love your work in the gallbladder. I never thought I'd actually see you in person. Can I have your autograph?"

Yeah, so I think it's official. It's even so official that I've stopped giving the flip-flop craven med school response of "Oh, I'm keeping my options open, but I really like surgery" and just blurt out "I like pathology". This usually invites a sort of "Um... oh. Well, someone needs to do it!" response, or the haters, who just think I want sweet hours so I can occupy my time making babies, or something. The rest just go with the general assumption that I wasn't hugged enough as a child.

So I'm on teams now...

2010-03-22T22:40:00.003-04:00

Which may explain a thing or two... the skinny, before having to get to bed late (the horror)...

6 AM to 5-6PM.
Run in the park.
Watch Inuyasha (I know it's marketed to 8 year old Japanese girls; I can't help it).
Bed.

Oh, and there was the sake bombing Saturday night, but ya know...

This week I have two straight weeks of teams with a Saturday call in the middle. I would be more pissed off about it (though I've been griping about it for a while now), but we're only on call every 9 days versus the every 3-4 days at some hospitals, so it's hard to be *too* upset, and I got this last beautiful weekend off AND was post call on Friday, so kind of a three day weekend.

Weirdly, the difference between a good surgery and a bad surgery lies in the people you're with. First two lap choles, awesome, I am a camera-holding goddess; circulating nurse being nice; good procedures. Exact same procedure; different doc; I am worthless at everything, the OR nurse hates students, and any med student holding a camera is trying to make some hideous Cloverfield/Blair Witch crossover. I also almost got kicked in the head by the patient. Fun for all.

Also, while I'm on the hardest team now, I like the chief and have scrubbed in with him before and he (gasp) likes to teach. Let's see what tomorrow brings.

Anti Powerpoint Rebellion

2010-03-05T19:49:00.003-04:00

Though apparently I'm late on the bandwagon and there's already a group of anti-establishment Luddites that have taken this position, but I'm over PowerPoint. This hit me last night.

I'm not saying PowerPoint doesn't have its uses, like all three of them. As someone that's infatuated with pathology, you need PowerPoint (or some kind of visual projection device) to teach it. Diagrams are also useful, particularly in surgery, where they tend to do procedures that connect stuff to other stuff you wouldn't necessarily expect, and you kind of need a diagram representation of what GI anatomy looks like after you've put in Tivo and a hot tub. Or something. So yeah, if you need something that isn't "words", hooray for PowerPoint.

I was kind of indifferent to PowerPoint for a long time. I laughed when people put in the "funny" slide or the unnecessary slide effect, as you're supposed to, and the really bad PowerPoint presentations stand out as really bad PowerPoint presentations, so I hadn't really chalked them up to the program, but to people's inability to understand the concept of margins, grammar, or choosing colors that don't provoke seizures, and that's valid.

But two things happened yesterday. One, it was conference day, which pretty much means around 7 hours of PowerPoint. Some lecturers are good; some are not. But I realized that the second they dimmed the lights to put up the projections, I had a Pavlovian reaction. I pulled out my Surgical Recall to study.

So essentially, I don't mind PowerPoint because it offers me the opportunity for self-directed study unmolested without the distraction of an engaging or novel lecture. And books tend to be more significantly higher yield, probably because they're not in PowerPoint format. And they're in normal English because the authors presumably have not been doing language gymnastics to avoid direct plagiarism. And I realized the only way to actually pull me OUT of reading my book is to have a lecturer that is either distractingly good or distractingly bad. But most fall under the "okay" line of droning information that is already on their slides with topics they know well, but are no longer capable of presenting in an interesting fashion.

Then I watched one of the really good, extremely knowledgeable residents get the crap pimped out of her on topics that were already later addressed in her presentation, which in fairness, wasn't bad. But you have no flexibility in the direction you're going with PowerPoint because it's already on the slides. And then if the attendings toss you in another direction by ripping you apart with questions, you're still left having to come back to your presentation and plod through slides they may have just explained to make a point, at which point you just kind of stare blankly at the screen, glance at the audience, say "uhhh" and then flip quickly past an hour's work, most of which probably consisted of spacing out the bullets and changing the fonts. Your audience is bored, you've lost your mojo, and more importantly, an hour of your life you will never ever get back.

Everyone thinks about the bad PowerPoint lectures because they're hilarious. But then I thought long and hard about the last GOOD lectures I've had. I've had plenty of perfectly functional decent lectures, including by other students, even when I was forced to pay attention, because text on screen is still text with information, even if it's a wildly inefficient way to get it.

But even this rotation, the GOOD lectures? Half of them were rounding with attendings. The SICU chief who kept vividly maiming our patients when we strayed in the wrong direction: "After spending four hours convincing Anesthesia to actually let you do this procedure, the patient codes on the table. They're resuscitated AGAIN. Systolic pressure is 50". "Uhhh... well, I'd order..." "40." "I'd explore the..." "30." "AHHHHHHH!!!" "Patient begins pouring feces out of the incision site." "AHHHHH!!! Is that a real thing???? Yes?? AHHHHHHHHH!!!"

The lectures with our attending that tells dirty jokes and pimps us... the impromptu question reviews, even when I think they aren't going to be relevant because they're surgical resident question reviews and I haven't studied adrenal anatomy in 8 months. Almost none have used PowerPoint. The ones that do have either been almost exclusively image-oriented or the speaker has barely referenced them and flips through them in the middle of an interesting lecture because a PowerPoint presentation was required or he doesn't have a pen that writes well on the back of his hand. (I'd make one of many easy cracks at Sarah Palin here, but since I totally do that too, I can't.)

And why do the funny effects or that humorous cartoon, or the serene picture of the beach entertain us? Because PowerPoint lectures are so mindnumbing that we need the emotional break from wanting to kill ourselves.

Which finally brings me to my second point. I had to present an excruciating article for surgery today and was up late doing it (because I was late in a lecture and spent a good part of the day listening to an attending bitch and moan about medical students not 'being around' because we're unreasonably 'post 24 hour weekend call' or 'in mandatory conference'). The article was almost exclusively statistical analysis on other statistical values about a topic that wasn't really easy when you stripped it to the original condition, and because I'm not a statistician (nor am I good at arithmetic), I had to Wiki half the terms in the freaking thing.

So I *finally* was able to understand the article, its point, and the original topic it addressed, and interpret the numbers.

But THEN I *still* had the task of taking all the information I had in my head AND the organization and logical follow through, and then turn it into a deadpan samey boring ass PowerPoint presentation despite having no idea which way the attendings would direct it. Plus doing PowerPoints gives me complete mental constipation while I struggle to elaborate on bullet points without reading text off the slide like the listeners are illiterate children rather than board certified freaking surgeons. In addition, the article was virtually incapable of being made interesting by anyone nor to anyone, and the only way you can make it less interesting is by taking all those statistics and copying them onto a PowerPoint slide.

So I kind of rebelled. I put together like 5 slides with the main points on them (particularly since the entire point of the article is summarized neatly in the title and the entire paper is merely justifying why they aren't full of crap) and just talked about it, summarizing the key findings without blasting numbers on a screen at 7 in the morning, and pretty much ignored my own slides. I think I was stuttering a bit because I'd gotten four hours of sleep and was presenting to a group of attendings without the mental crutch, but no one seemed pissed, so who knows.

Surgical call...

2010-02-21T04:50:00.002-04:00

sucked.

How can I be on surgical call for over 24 hours, two of which we were allowed to sleep, be busy for most of the night, and not see any... surgeries? Honestly, I barely know what was wrong with half the patients, though I certainly know what their labs were. OB-Gyn call could suck in that it was long and hard and you got scutted a lot and you were the definitive vitals/labs bitch, but all that stuff was punctuated with somewhere between 1 and 7 deliveries/c-sections a night which they insisted students be in on, so calling it "OB Call" was as advertised.

But guys, seriously. It's called "COMPUTERIZED CHARTING". For the love of all that is good and beautiful in this world, institute a program with more patient-organizing power than Office 97. That goes for about three quarters of the hospitals in this city. Why progress notes are still being scrawled illegibly on easily lost or damaged charts that have to be fought over by all the attendings, residents, medical students, and nurses who need them at the exact same critical times escapes me. And med lists... freaking... list every single medication a patient is *currently on*, changes to medication with date/time, and electronically attach that data to the patient's name. And to add an extra stage of programming that could be done by a precocious 12 year old with a Warcraft habit and his own 4chan meme, throw up a caution if any drug is prescribed to which a patient has an allergy or if there's a hazardous drug interaction. No, have some on the paper copy of the medlists, some on the computer, some in a different part of the chart (which you often can't check because the nurses, who have to dispense the medications, understandably need that chart as much if not more than you do), confirm by occasionally having medical students check to see what's in the IVs. WTF?

I know this *can* be done, because it *has* been done. Not only is the lack of electronic charting really irritating to medical students (and everyone else) that then has to dedicate hours and hours to rewriting information that is in one place into other places (if they can read it) or hilariously, *typing* information from one excel list to another, but it's unnecessarily hazardous.

Anyway. On the plus side, all the people in surgery I've met so far since I've been on surgery have been really nice, which has been an unexpected surprise. Surgical staff is not commonly associated with uh... social grace, or a particular love of our grimy, wound-contaminating, instrument-dropping ilk so not getting yelled at has been a bonus and I really like the main attending we've been introduced to, so not all bad.

And early in the night, the resident was showing us some bedside procedures which I didn't get in internal medicine, which I think is where I was supposed to. I got to drop an NG tube in ED (which was awesome), but last night I did get to listen for the gurgle to ensure proper placement, which was loud enough to be startling, so I'm finally getting some use out of my stethoscope beyond putting it on a patient's chest, listening intently, frowning, and then lying when the attending asks me if I can hear the murmur. At least I always remember to have the earpieces in.

Another rotation rolls toward a close

2010-02-10T21:07:00.005-04:00

And it's a snow day! It's hard to believe that in two years, I went from this:

to this:

Pretty sweet, eh? Makes me feel bad every time I'm a whiny-butt, which is often.

So the blizzard of the century or whatnot finally hit us after bathing the rest of the east coast in it, and so far, it hasn't been too bad. The salters and plows were out almost instantly, my subway was still running, and it was way less of a pain in the ass than the one that hit right before Christmas. It was also nice that it hit *today* rather than destroying the weekend, as they were expecting, which meant instead of getting stranded in Manhattan, I was peacefully in the pediatric ED discovering that while getting a nail jammed into a foot only causes minimal tears in a child, that tetanus shot that follows it is an act of hideousness Mother Nature herself couldn't concoct. To be fair, those things do burn.

The NYC population seems to have responded to the storm by whipping out garbage can lids, cardboard boxes, and anything else remotely flat and sledding down hills on them, so I suppose the winter horror isn't affecting the public morale too badly. I was way more responsible after work and responded by tossing snowballs at my colleague and then pushing her into the snow after she refrained from doing so to me because she thought I might have a laptop in my backpack (I didn't). It's this level of maturity that's going to make me such a good doctor.

But alas, not all can be snow play since I have my oral exam for peds tomorrow and my written exam on Friday. Then I get three glorious days of reckless winter merriment before surgery begins and my life effectively ends in a blaze of retractor-holding, 4 AM-rising joy.

Asthma

2010-01-27T02:19:00.000-04:00

You thought "asthma" was going to have to do with pediatrics, eh? Well no. I'll get to that in a minute...

But first, for why you come to my blog... Ishie's 30 second movie review of things everyone else has already seen.... Casino Royale!

First impression: Not bad
Second impression: I'm calling sissy. Not for your average movie hero, obviously, but for James Frigging Bond. Sean Connery would have killed everyone Venice had ever loved before the archvillain got one of his socks off. Being tied naked to a chair helplessly before you and your disposable ladyfriend are rescued just isn't in the cards. Even if the aces are.
Third impression, and hence my title: Asthma is one of the least badass illnesses an archvillain could have, possibly topped only by fecal incontinence and a lisp. Even tied naked to a chair, if my tormentor had to take a drag off his inhaler every five seconds before punctuating his threats with inspiratory wheezing, I'd probably start laughing too.

Anyway, there hasn't been much to report in the hospital scene lately because I've spent very little of this last week at the hospital and even less of it seeing children. We have a 'study week' in pediatrics, which is one of the best ideas ever, and finally poses a solution to that endless dilemma medical students have where they're expected to be constantly as the hospital seeing patients, but also expected to study sufficiently to know all the enzymes in a kid that can break (hint: all of them). Essentially, last week, I studied. Which isn't exciting to report on, though I loved it and got a ton of crap done.

Oh, except Monday we actually got off thanks to our heroic clinical coordinator pushing for our holiday time, so Monday, I spent less time "studying" and more time "in a cabin in the snow playing bumper pool and visiting microbreweries." But the rest of the week, I studied.

And this is the point I was at in my post before where the puppetmasters in partial control of my computer decided it was shutdown time.

A little aside on this whole virus thing... I've finally gotten to a point where I'm not tech-unsavvy, which is probably why my computer isn't a smoking pile of plastic (yet), though honestly, this one's been living on borrowed time since I spilled half a bowl of cereal on it in Grenada (d'oh!) a couple years ago. Essentially, this virus keeps reviving itself for the last week, but I've been gradually winning battles if not wars. It managed to disable my ability to restart Windows in safe mode and defaulted to the blue screen of death (*(&(*&!!!) when I attempted it, disabled my internet connection at one point, deleted the essential files for my spyware and malware programs so they wouldn't work, and when I'd restored my internet, defaulted all my google search links to its evil little fake webpages. It also bugged up system restore, infiltrated my registry and a bunch of other stuff that quite frankly, could usually be only be accomplished by Sean Connery's James Bond. If I weren't so earth-shatterly pissed off about the whole thing, I'd be impressed. Fortunately, some experience with the interweb plus an internet phone when my computer *really* went off the rails has proved useful, providing such clues as re-downloading and renaming all the executable files of my antivirus/antimalware so the devil program can't find and snuff them. It's like a witness protection program for bits of code.

To get an idea of this thing's general effect on my life, despite the fact that my downtime tends to consist of either drinking or vegetating, I instead got to spend 7 hours of my Saturday testing how many times my computer could survive a cold boot without the processor grinding to a halt.

But babies. Cute little pink babies. My week's actually been going well. Last week I got a lot done on the study horizon, but could get absolutely nothing accomplished in any other venue. My loan status was unknown/pending, which is something that's had me on edge and driving everyone I know crazy for the last FIVE WEEKS. This one's not actually on the school, but on a medical bill of which I was unaware that got stuck on my credit report like ten minutes before I had to submit my loan application, so I did a lot of runaround, talked to the original billers and found that my insurance hadn't gone through, so resubmitted paid the extra, and was assured they'd take it off. Which they did. So when I called them to go "Uh homies? This shiz is still on my credit report as an open collection", and the lady very nicely told me that it was taken off and I could get a letter from them stating it, but that it could take as long as 30 days for the credit reporting bureaus to take it off.

So my opening statement to people asking how I was doing for that thirty days (which was past tuition due date for my session) was "Oh ya know... probably going to get kicked out of school."

I was also getting blocked at a prescription refill for yet another insurance related reason, and could not figure out for the life of me whose problem it was.

I was also trying to reclaim a locker from someone that put a lock on my locker, removed my nametag from it, and then removed all the notes the clinical coordinator put on it telling him/her to get the crap off and the lock off.

So that was Friday.

Tuesday.... my loan has been approved and dispersed and I'm waiting on the check, my prescription was worked out, and the lock got cut off my locker! And I beat my record time for jogging the 3.35 mile Prospect Park loop by a minute. It's a good time.

Oh, now that I'm back in baby land, I can tell you medical stuff again. I spent the first two days in the newborn nursery. This is a mixed bag...

Pros: the kids are healthy and happy and usually people are glad to see them. You don't see any sick ones because the second a kid even starts to breathe funny, they're shipped upstairs.
-nice doctors
-nice nurses
-scrubs and no white coat. It's a twofer.
Cons: Newborns are squicky. I'm sorry. I know they get cute when they're two, but they're not now.
-Babies scream. A lot. One baby screaming sets off the others. This has been proved by science to be one of the most annoying noises possible. Long exposure to high decibels of baby-scream has caused people's brains to explode out of their heads with some regularity. It's science, people.
-You have to check a lot of things on babies, because they're new to the world, and like a car built by blind people with ADD, you need to do checks most people don't expect. Two of these checks are disturbing. In one, you get to determine whether a boy baby's dropped both his sinkers down, and in the other, you have to make sure the baby's butt is properly connected to the outside world.

If you think there's expensive exhaustive medical instruments for doing those checks, guess again. It involves medical students having to cradle baby testicles and then, worse, peek inside the rear end to make sure there's a hole there, because *sometimes there isn't*. Yes, imperforate anus, possibly a candidate for one of the disorders the next James Bond villain can have!

After nursery this week, we have different specialty clinics each day. Yesterday was child advocacy clinic (re: child abuse) which was really interesting and the only two cases we saw had a minimum of soul crushery, so that was nice. The stories the director told though, geeze. People are freaks.

Today was pediatric heme/onc, which like child advocacy clinic, was way less depressing than I expected. The attending was really cool and let us interview the two kids that came in for check ups. Since peds heme/onc is an area with a lot of path, they had a monster microscope in the back with a ton of slides so at downtime, I asked if I could play with it and was promptly tied up with playing with iron deficiency slides for the next hour while trying not to break them. Damn 100X lens!

As I was back in the lab, I was overhearing a patient interview, significant in that it concluded with a ton of people making a ruckus in the hall. I poked my head out in time to see a pretty blond woman accompanied by a guy in a giant fox suit lean over to the last patient and say "Do YOU like basketball???" to which the child responded "Um... no?"

See, moments like *that* are when I love children. Not when I'm having to examine their nether regions. So the woman, undeterred, said "Well, you will!!!!"

Apparently we had a visit from the Nets. As an Ovarian American, I had no idea who the heck they were, but they were passing out signed baseball hats and we got a picture with the mascot, so cool. Unfortunately I don't think they realized that despite the potential for changing some frowns to smiles in a place called "Pediatric Heme/Onc", all the sick kids were downstairs and we had two kids, both of whom were perfectly fine and only in there for ten minutes for a follow up visit. And one of them doesn't like basketball.

Well, good night!

Justifications for violence

2010-01-26T01:10:00.002-04:00

I have a nice long blog out there waiting for you people, but it's put on hold because of the above, and the recurrence of a virus I've been fighting off solidly for three days and off and on for a week has made a sick and cowardly surge that severed my connection briefly, so I will, be brief...

I prefer to live in a civilized society where people settle things with discourse, and barring that, insults against the opponent's mother. That being said, the unique creators of Internet Security 2010 virus need to be hauled out of their mothers' basements by an angry mob of syphilitic wolverines, otherwise known as the closest thing to women these f*tards are ever going to get, have a team of angry medical students rip their naughty bits asunder with lemon-tipped dull scalpels, and then get beaten to death with the same buggy Dell computers they've rendered useless in their relentless pursuit of my credit card information before having their corpses spit on with smug satisfaction by all the mac users saying "Oh, our computers don't get viruses".

I'm reasonably sure that if I can televise the demise of the Internet Security 2010 virus assembly crew, I will make enough off the proceeds to buy an insanity plea AND a sparkling new Macbook.

So, off to sleep so I can head off to another day of working with children. Let that one roll around in your heads for a while.

Children and zebras...

2010-01-12T00:45:00.003-04:00

Okay, for those of you who watch House (hopefully all of you), you've heard the medical cliché "If you hear hoofbeats, think horses, not zebras" which pretty much summarizes the syndrome medical students have where we want to diagnose people who have diabetes as being infected with a silver-bellied Peruvian brainworm. And the only reason we have this syndrome is because we've been infected with a silver-bellied Peruvian brainworm.

Thing about kids is they have zebras. Obviously I can't go into strategic detail because HIPAA doesn't have a clause to make exceptions in privacy settings for crap I think is cool... though they totally should, but since starting peds a week ago, I've probably seen 4 kids that have syndromes that were filed in medical school under "Why do I have to learn about stuff that only affects 1 in 40,000 people?" Oh, because those 40,000 people are more likely to go to the hospital than others, and when they're kids, they're still ironing out the details of how to manage the condition, so bam, hospital.

And then there's the kid who has, at present, stumped everyone on the floor, required consult by a specialist whose contribution included not having seen a case like this in umpteen years of practice and that if we had any thoughts, we should feel free to input them because f- if they know. So they're running more tests.

What I'm liking about peds is that in peds so far, they seem way more interested in puzzling out what they're dealing with. I don't know if it's because they like kids, like medicine, or just watch as much House as I do, but it's refreshing. And the stuff they're dealing with is frequently really interesting, which helps.

Then there's the seventeen thousand babies with bronchiolitis. But then those kids don't tend to present with the spectrum of baggage adults have so their cases are fairly straightforward. They're also far less inclined to yell at me for taking too long during an examination before demanding drugs.

And so far exams on kids hasn't been too bad. The sort of expectation of crying helps, but then they don't really hold grudges, and they're easy to placate afterward. And what's wrong usually shows up as what's wrong rather than oh, these skin lesions are from an untreated fungal infection, and there's existing diabetic peripheral neuropathy and blah blah blah.

Of course, the fact that kids are being less difficult than I expected means it sucks when they get really sick, so that can be a stone cold bummer.

And I'll talk briefly about the staff... while I can't count myself as being someone described by anyone as "someone that loves kids", the people that choose to go into pediatrics seem to, which seems to instill a refreshing position in them of being patient advocates, so I think we all get slightly less cynical as a result of it.

Though no worries; surgery will beat it straight back into us.

And lest anyone think I've gone soft on path for peds, recall that one of the reasons I'm liking the crap out of peds (minus the hours) is because I get to see weird stuff, which is not really the motivation most parents want their pediatrician to have.

New Year; New Rotation

2010-01-05T18:44:00.002-04:00

Greetings people-recently-incarcerated-on and people-recently-freed-from Grenada! And all you other lovelies as well.

I just started my pediatrics rotation which is screwing me up by being way more difficult than I thought, while having attentive and interested attendings and residents, which makes me actually want to try hard at it, despite my love of things that are dead and jammed under a microscope, while this rotation has an abundance of loud squirmy pink things. That all have bronchiolitis. I'm giving myself about 3 days before I'll inevitably catch the upper respiratory tract grown-up version of it from the little tykes.

But now, it's my fabulous roomie's birthday, so yet again, I'm off.

Hope you're all having a wonderful new year!

The review you've been waiting for...

2009-12-20T02:55:00.003-04:00

I know I know; not enough blog updates and all that, but I figured after such a long hiatus, I should at least get in the *important* information.

Avatar didn't suck. I know! I saw the whole Smurf Trail of Tears thing and was extremely skeptical, expecting to be, at best, "World of Warcraft: the Movie" (not necessarily a bad thing, mind you), but was pleasantly surprised, and ended up getting drawn in, predictable plot and all. And heads up for the Xena war cry for all you 90s babies out there. But blah blah; google it. I can't think of any more positive reviews that haven't been said and I can't think of anymore jokes about the alien cat creatures that weren't made a month ago, so hey.

Annnnnd I finally got to see my boyfriend after months and meet his parents, which is one of those weird things you don't think about until you realize you've been on the Rock or in different states for the better part of three years and relationshipp-al milestones get delayed or shifted around. Oh the hazards of medical school.

Speaking of medical school, a couple of you readers out there who haven't given up on me and didn't get here by googling "Avatar" and "World of Warcraft" (greetings, fellow geeks!) might be curious as to that whole OB-Gyn thing I was doing for the last six weeks.

Well, for starters, there's a reason I haven't been out for weeks and it's because I haven't been out for weeks. Well, except when I've been sleeping, which is when I've been out. And the stories to tell are quite like when I worked in a morgue in that by the time I've tamed down the disgusting for a regular audience, there's nothing left to tell. I can compare OB-Gyn to being in an anatomy lab by saying that preserved bodies are WAY less goopy than giving birth. I can think of only two occasions in the lab despite four years of being there where I felt like I could get hit with a literal wave of something disgusting, but in OB, that was a daily concern.

On the other hand, people in OB-Gyn tend to be far happier. Even in the gyn department because there's stuff that goes from being a daily quality-of-life-destroying ordeal to pretty much fixed with a surgery and a few office visits. Not all, mind you, but certainly more than get fixed in a morgue.

I also ended up with three calls rammed very close together through a combination of factors, which had me working resident-hours. On those calls, weird crap seemed to go down so rather than having a few hours to sleep, there'd be a crash section or an ectopic pregnancy or something like that because women simply cannot have issues at any normal time of day. Still though, it was awesome. What's nice about OB-Gyn too, at least at my hospital, is you frequently feel useful. MORE useless if you aren't good at something because you were attempting to perform a necessary function, but if they say hold retraction on a surgery, they actually need someone to do it. Granted, it's always a medical student, but if you aren't there, someone will get stuck doing it. They sometimes need us to help interview people in triage if they get backed up. They need scut stuff, which can be annoying, but also gives you something to do and makes you feel like part of the team.

So I was a fan. Not enough of a fan to give up my love of microscopes, definitive diagnoses, and avoiding talking to annoying patients face to face (ie, pathology), but enough to keep me entertained. The oral exam was a little frightening, but I felt like I held my ground. But the hours were also heinous enough that the coming two weeks of holiday time not only makes me leap with joy, but at times, I barely know what to do with myself because I have free time again. Probably study for peds. The bastards broke me.

But winter... it's SNOWING! Like a LOT. Like feet and feet of it. Like having to get home from boyfriend's parents' hotel required a driver with a car that looked like it was used to transport heads of state. Like I need to buy boots that aren't suede *tomorrow*. And I know I'll incur the wrath of all native New Yorkers here, but it's cool! It probably won't be cool mid February when I'm trudging through the snow at 5 in the morning for my surgery rotation, but for Christmas? Woot!

Another video break

2009-12-10T01:59:00.001-04:00

We're still running content light here. To give you an idea, I'm midway through a 90+ hour week.

Enjoy!

Nerdy hooray

2009-11-30T23:39:00.003-04:00

After a long hiatus of becoming utterly and inexplicably incapable of blood draws/IVs, I nailed two in a row. Solid hits. No hunting, dithering around in the skin, or trying to pawn off the job on nurses because I got cold feet from a string of misses. Just blammo-in and blammo-in.

I also managed to be scrubbed into a surgery for 3 hours without touching my face, knocking something over, contaminating someone else, or sawing off my finger with the Bovie. It was a good day.

So... wow...

2009-11-28T23:37:00.003-04:00

OB-Gyn has been a killer, and NYC is a killer but in a good way (mostly). So much to talk about, so little time; so much procrastination, and hey, I'm on call for somewhere between 14 and 24 hours tomorrow, so that'll be a breeze. On the plus side, I've had a three day glorious vacation, helped by getting to go home early on Wednesday, so kind of a three and a half day vacation.

To briefly summarize what's been happening, to expand upon later when you guys finally descend on me for being a poor blogger-updater:

Started OB/Gyn residency:
-Wow, there's a LOT more hours than in IM. Holy hell. And they expect you to do stuff, possibly because the nurses there let you do stuff rather than snarling at you.
-Helped catch a baby. Whoa. It's like Alien, only everyone's really happy about it... and it seems more painful. But it's actually cool, and cooler than I thought.
-Scrubbed in on two c-sections. Got to do stuff like cut sutures and retract, which for now, is freaking awesome. I've heard that by midway through the surgery rotation, it is much less awesome, hence the term "Retractor Bitch". Saw some others.
-On vaginal childbirth vs c-section, I have to grudgingly admit that thus far, the 'natural' way seems to produce more kids that are pink and screaming, which is ideal. C-section, on the other hand, has the bonus of not being a vaginal birth.
-24 hour call is way better when you have things to do. I hit the wall around 4 am, got license to "go sleep" (yeah right), and ended up moonwalking around the halls near the library and giggling because I felt so fried.
-Somehow I wound up with quite a bit of time off call and now heading into three weeks of call every three days or so, which is so going to suck... Goodbye, friends and family.

Had my whole "birthday/Roman festival" thing, which pretty much consisted of a 50 hour binge. Wow. I blame this on spending the first 8 hours of my birthday on call and then crashing and waking up at 4 PM.
-Lorrie came for 8 days; woot! Discovered I can't actually navigate NYC particularly well when I'm completely exhausted. Walked around Union Square twice before finding the same chocolate shop I've walked by seventeen thousand times.
-Grace came out from NJ to join me on my birthday night starter at McSorley's, the oldest continually operated bar in NYC. We ran into two guys that helped us navigate the only food item there: crackers, Irish cheddar, horseradish, and onions. Clearly this was make out night for no one. There are also only two kinds of beer at McSorley's; light and dark. They serve them two at a time and they're insanely cheap. Matt and Chelsea were leading the expedition through the underbelly of the East Village.
-Follow the nuns. We had some sisters not only bless McSorley's, but wind up getting into Burp Castle to bless the place as well. They had a jet black nun van. It was like Batman if Batman were a group of nuns.
-Pomme Frites. They are delicious... And they soak up McSorley's beer, crackers, horseradish, onions, and cheese.
-"Cheap Shots". A place recommended us by our partners in crime at McSorley's. They have this thing where if it's your birthday, all your drinks are free the entire night. They also have this thing called a "Mystery Beer" on tap, which is a dollar. The latter makes you regret ever bitching about Bud Light. The former makes you wish you'd never been born.
-Crif Dogs: Have you ever been eating a hot dog and thought "This would be way more awesome if it were wrapped in bacon and then had eggs and cheese wrapped around it?" No? Well, go to Crif Dogs anyway.
-Karaoke. The only karaoke bar I've been to was in Grenada and no one was really doing it; it was just sadly playing the words to "La Bamba" on the screen while we ate rice and beans. So we found one, and heard Journey's "Don't Stop Believin'" about seventy gajillion times. Which still beat listening to anything by Oasis.
-Pool hall until last call shut us down as I was actually about to win a game of pool. To people who know me, this happens about as often as a full solar eclipse, so I was greatly disappointed when everyone got thrown out.
-We ended up following a random guy to the upper east side (via taxi, GRRR) on the promise of a place with a pool hall that was open late. Lies!
-Due to this long jaunt to a burb that is over an hour away from my neck of the woods, this landed us at Grand Central Station around 6:30 or 7 in the morning. Since Lorrie hadn't seen many of the joys of midtown, I decided this was the perfect opportunity to show her around.
-This started as just a tour of the upper hall of Grand Central, since it's all famous and such. Then the outside of Grand Central because it looks cool. Then Radio City Music Hall, then Rockefeller Center to see if the skating rink had been laid down yet (yes).
-Rockefeller had three camels being led around it. At 8 in the morning. With nothing to indicate that this was for tourists or anything else to explain why three big ass old school camels were wandering around. Lorrie finally ventured the question to the dead eyed handlers. To which they replied "For the Christmas show".
-I'm a secular type. It actually took me around 12 hours to make the connection between "Christmas show" and "nativity scene", so until the dawning of that, I had just pictured Santa Claus and the Rockettes jamming away with random camels roaming around the set. Then I felt stupid.
-St. Patrick's cathedral. Love it. It can compete with the European ones. There are also only a few feelings of "shame" that rival "touring a church in the morning when you've pulled an all nighter."
-MTV studios... I haven't seen MTV since Kennedy was on it. The annoying VJ, not the president or senator. Long story short, MTV studios are in Times Square, thus, like most of Times Square, they are not "all that".
-Broadway. Phantom of the Opera marquee and a greatly needed trip back down to the subway station to crash at 10 am.

(sleep hiatus)

To the famous Beergarden in Queens, for my *official* birthday celebration. I spent the first 45 minutes of it with a big Czech pint of beer in front of me going flat while I drank ginger ale. Heh. It's a Bohemian place, so they have Czech beer and Czech food, which is fantastic, so we got to all have Prague flashbacks. It was also raining and hellishly cold so we spent the vast portion of the evening inside, but lots of friends, all lined up at the table old school, drinking pitchers of Staropramen and eating dumplings. Hooray! Then the weather finally relented enough to go to the outside Beergarden and resume festivities, albeit tucked into a blanket.

I figured that would be the end of things, because... come on... but then got invited to Dumbo (home of that scene of the Brooklyn bridge that is in EVERY movie about NYC) at 11 am the next morning (or the same morning, since it was 2 AM) to eat Grimaldi's pizza in the park, followed by Jacques Torres hot chocolate, so I had to hit that up, because...

That Sunday night, I think I crashed at about 7 PM. Wow.

What else? Hmm... I saw part of Wolfmother but had to bail about halfway through the set because they came on late, I had to work the next day, and I am that much of a dork. There's only so much tired a girl can take.

I saw the Macy's Thanksgiving Day Parade, after making an extremely half-assed last minute decision to go, since I'd planned on avoiding it. This embarrasses me, but it was actually really cool, and I don't regret going at all. Plus now I can avoid Times Square on New Year's with a clear conscience since I've done two definitive NYC holiday things, and that's enough. I would add the tree lighting at Rockefeller, but I'm on call. :(

After the parade, booked it to NJ to spend Thanksgiving dinner with Ashley, who cooked a massive feast for us, and I got some dog therapy, since my dog died a few months ago and sometimes you just need to flop some ears around and go "WHO'S A GOOD BOY". Then she actually *drove* me back to Brooklyn from NJ. Dang, hostess with the mostest there.

Yesterday I vegetated and studied, which was inexcusable for more than a day, so today I went to the Met after discovering that the 20 bucks to get in is "suggested". I got awesomely excited over mummies, because apparently, I'm 5 years old. But... mummies are cool.