So long and thanks for all the fish...

 But wait, there's more!

For those who have followed me all these years, I thank you so much for journeying with me through my missteps and foibles.  I hope you've gotten something from it, and I hope I helped some students going through their own medical school journeys.

But HIPAA prevents me from discussing my workday, and I haven't been back to Grenada in years, though I plan to go back and take my current boyfriend for him to see what it was like and for me to see what's changed.

It's not all goodbye though, I've started up a new blog, as I mentioned in my last post as my interests have pulled towards cooking and travel of late, so if you wish to follow my misadventures, feel free to do so here.

So long, farewell, auf wiedersehen goodnight.

Work-Life Balance N'at

 This is not a post about pathology, medical school, how to become a doctor, or any of that, though it may come out a bit.  I feel like I've kind of contributed what I can to that.  I tentatively wandered over to Grenada just a little over 15 years ago.  Out of school for 11 years.  Out of training for about six.  Unable to much tell you what I'm doing because HIPAA.

If I follow my family's decent history of longevity if we stay away from cigarettes and guns, I've got about half my life left.  In the first half of my life, I learned to speak English, ice skate, ride horses, how to add numbers, semi-socialize, get cootie shots, categorize human and animal bones, enough anatomy to perform professional dissection, learned medicine, pathology, craft beer, hashing, monkey taxonomy, kenpo, avoiding toxic or abusive relationships, guitar, knitting, drawing and a thousand other things.

So what now?

For the uninitiated, into what is baffling Pittsburgh-ese, "N'at" kind of refers to a conglomerate of "etcetera" and "subsequent parts".

I'm in my new house.  I'm closer to work, closer to love, and surrounded by things I like.  I'm hoping this remains my home until I'm ready to expatriate someplace warm and near a beach.  That's what I thought before, of course... final home final man, but let's hope I'm right this time.  If not, you'll get more updates on it, I'm sure.  Hopefully without vitriol.  I'm trying to rid my life of vitriol.  Call it the nine thousandth time I've gotten banned from facebook for being at loggerheads with some anti vaxxer or soccer mom or Trump supporter or another, or call it having way too many intrusive thoughts from perceived wrongs, it's pretty exhausting.

What to occupy that time with?  That lost time of overeating or dwelling or facebooking or whatever?  Everything.  I've been obsessively making lists of things I want to do, improve, outdoor things, indoor things, date ideas, stuff out of town, stuff that's seasonal, stuff I already did or things I've never tried.  These things range from rooftop bars in NYC with the new man (well.. the 2 year relationship guy) to improving guitar to hunting to foraging to modge podge to journaling to cross country skiing.

It's a long and varied list.  It is definitely a short attention span dabbler's list.  It seems daunting, but less daunting when I consider I have as much time to nibble each bit as I have the first half of my life.  And for most of that time, there weren't youtube videos explaining how to do the things I learned, nor google so that "which species of New World monkey does that again?" required a plunge into the Dewey Decimal system.

My MAIN focus at present is unpacking and organizing all my crap, sorting it, and then mildly Konmari-ing stuff so that I can actually find it and use it.

Other foci:

Guitar: I've been a self and friend taught plucker of acoustic strings and user of cheap theatrical tricks since I was 15.  I bought a PRS electric a few years back with the goal of "shredding" if you will, and have not really learned much other than playing it like an acoustic or plugging it into my Xbox.  So I'm actually taking classes and learning some (gulp) theory.  Stay... heh... tuned.

Reading: I love it and have loved it and it fell by the wayside too many times to the evil tendrils of facebook and reddit.  I want it back.  I have reading nooks stationed throughout the new house like NY/NJ has train stations.

Journaling: Well, you're experiencing some of it.  Helps get the crazy out of my head.

COOKING:  Why the all caps?  I'm obsessed with it.  Have been for some time.

Through my life, I've collected many things but my nomadic wandering has left most of these collections in garage sales, goodwills, garbage heaps, or in one spectacular example, beneath an ash mound of burning possessions.

I love cookbooks.  I love the stories, the pictures, and the recipes.  It's official.  I heart them.  I collect them.  I found a spot, eatmybooks where I can reference and use them all.

I'm an 80s 90s former latchkey microwave dinner and takeout kid that then was a poverty ramen and potato eater.  I didn't learn to cook even a little until I was 30 and got shamed by my 21 year old roommate.

Now?  I'm getting pretty good.  I have an abundance of spices and oils and sauces from around the world.  I'm familiar with the fundamentals of eating, if not cooking, most cuisines (my attempt at injera was an unmitigated disaster).  I've gardened my own harvest and am about to do it again if Father Winter ever knocks it the hell off.

Because cooking and gardening and screwing up doesn't much involve a Caribbean MD, I'm spinning off a blog, because it's the hip thing to do.  If I don't update it, well, you've already been trained by this blog to anticipate disappointment.  In my defense, I issue more blog posts than George RR Martin issues chapters of Winds of Winter, so that's a bonus, right?

I'm still setting it up.  It'll be called "The Semi Reformed Nomad" so stay tuned.

Crazy Cat ladies

 Gods I hate mornings.  I have never have been a morning person and it's been endless.

If you've been here for a while, or went to school with me, you know this.
Once Sonic Foundry (records the lectures) debuted in Grenada, people that weren't in my small groups legitimately thought I had dropped out of school.

I dealt with it through my clinical rotations in Brooklyn by being situated almost on top of a bagel shop that opened at 5.  So for surgery and OB, I'd have my face pressed against the glass like a little kid, because dammit, if I'm going to be up that early, I want my bagel straight out of that delicious municipal water.  Also the dean threatened to slit all our throats over something someone else did, and I sincerely believed him, so I didn't mess around.

So let's see... colleague needs coverage... no problem.  Which led to 6 am Friday, Monday, Tuesday, and now I'm just wearily watching my phone AND I'M ON CALL this weekend.
And the workload is back (though abruptly broke for lunch, as it tends to), directly coordinating with early procedures, which is oh so much fun.  If I'd had this work a couple weeks ago when I could wake up after the sun rose, I wouldn't have had to put an entire police system on high alert because I wouldn't have been bored.

So it's another COVID year, so I'm seeing both if I still have some days off and if there's any way in hell I should be getting on an airplane because teenage me was so wrong.  I HATE WINTER.  So I'm having my first world problem temper tantrum of "I wanna go to Mexicooooooooooo".  And February's when I tend to F off to warmer parts but it's omicron time.

So treadmill (I already blew my right knee to pieces long ago, so I am not running in this nonsense), indoor stuff, binging Squid Game (#subsnotdubs), reading journal articles, but even just walking outside during the lunch hour is like... no.

Closing is going down on the house, so that's something that's exciting, stressful, gives me some sense of purpose at home, plus gives me projects to plan since while the place is not a "fixer-upper", it's definitely an "improver".  Gas, not electric, gas outlets outside, fix the fence, sod two parking spaces, change the front door, add window panels, etc etc etc.

And it's not that big.  The old place had an entire floor we used like... three times for friends who'd have been equally comfortable on futons.

Big kitchen for me to cook in.  Small yard, for the dog to run in and to grill and smoke in.  Easily manageable without hired help.

Anyway, the title.

So I tend to keep my personal and professional life fully apart since fellowship; just my preference.  My colleagues are nice, but don't know much about me, more than that I have a motivational print out of the David Goggins book cover on my wall, and I'm dead certain they don't know who he is.

So the first year, a kind colleague gave me a cat calendar.  I use wall calendars and still like to have "YOU HAVE A PROCEDURE" in front of me rather than on silent mode when I'm ignoring my phone.  So I used it.

The next year, I bought a goats in trees calendar.  Doesn't give a lot away, but more my speed.

This year, I was JUST about to bring in my "awesome scenery from around the world" calendar in, and she got in and was like "I know you love cats, so I got you this!!!" and gave me a calendar, that is not simply cats; it is like aggressively lovey pictures of cats like nuzzled against a teddy bear and stuff.

So I'm insane for cats.  Maybe I should have brought in just one photo framed and had it be of my dog?

Updates

Well, I haven't heard much more, other than that my network has its own police department and they're on it.  Any contact, and arrests will be made, so that's good.

My lab director and I don't get on, but she made good and the entire PD is waiting for any hint.  Not sure if she's scared for herself, me, or just hates stalking in general (she's attractive and from a country where that was probably obnoxious for her as a young'un) but hey, people aren't necessarily all bad.

Friday sucked in its own way.  I am aggressively not a morning person (I consider this still night and just woke up in the middle of it).  My favorite surgeon (and he is; we tend to swap diving stories), but he LOVES early morning procedures so I got two on Friday and now one on Monday.

So Friday was essentially a solid 12 hour day and I was addled from being up so early so just was trying to save enough brainpower to keep going through a day, that had I gotten a week ago, I wouldn't have been bored into picking up a stalker.

In a sense, it's a good thing, though not one I love after getting up at 6 am, since I get the big caseload, which means experience, AND potential bonuses.

But I was near delirium last night after how much work I'd done.  And then I get to do it again on Monday.

Sigh.  This is one of the reasons I'm not a surgeon.  Also I have flat feet, hate danskos (they're heavy and uncomfortable), so while I can walk or swim forever, I cannot just stand.  I'd have been terrible in the military.  (Stop shifting on your feet or you'll do pushups  I'd rather do pushups!!!)  But those early mornings.  Ick.

It's weird.  I'm considered to have a pretty plushy job, yet I look at grocery store clerks with absolute respect because in the US, they aren't allowed to sit down, and I couldn't do their jobs.  I can do my job, but stand for 8-10 hours as a clerk?  Nope.

I can walk or swim for pretty much forever.  I can stand still for about 20 minutes before those arches start on me.  My only comfort are Brooks.  When I lived in BK I discovered Jackrabbit sports and they filmed me running on a treadmill, and finally arrived at Brooks shoes, which, naturally, are like 150 bucks.  My boyfriend laughs that my highly expensive shoe collection is less "I'm a woman" and more "this is the only way I can be comfortable".  They're also why my doctor thinks I'm two inches taller than I actually am.  That's how much padding I need.

I'm running again and with the above, that means my middle toenails are blackening and about to be absent, but on Wednesday, we went for absolute decadence, so pedicure (I play guitar AND have psoriasis which manifests as severe dandruff and laminate nails, so no manicures), tanning, and pho.  It was a desperately needed good day.

What else?

Hmm... COVID is an issue, but work around it.  Get your freaking colonoscopies, even if you have to wait a year.  I hate seeing stage four tumors that would have been clipped off as adenomas ten years ago.

Just don't smoke.  If you vape, there's early indications of lung damage, but smoking the old fashioned way reliably causes lung, renal, and bladder carcinomas, with the additional potential for the killer of my family, emphysema.

I've been watching 9/11 videos.  I don't know why.  But all I can think when I see those poor people covered in ash is "pull your shirt off and wrap it around your face!!!!"  But that's far too late to say now.

So nothing of much import.  I'm obsessed with Candide (in English) because it's the driest wit I've experienced since Jonathon Swift.  I've also learned it's the source of "the best of all possible worlds".

Still learning Spanish, so not trying Voltaire in French, which is like Spanish if you trailed off each word without finishing it.

So not much to report.  Gonna watch Cyrano tonight probably (since Peter Dinklage is the GOAT), but not a lot else.

There are three omicron variants.  I'm on team "let this replace delta because it's so much less deadly" but who knows?  I have big travel plans for the year but I regularly F off someplace warm in February (last time was the DR), and COVID has destroyed that so I'm left cranky in the frozen north with no Mexico in sight.  Sigh.

I know, first world problems.

So I tan instead, because every doctor needs a bad habit, but MAN does UV light feel good when you don't see it in the morning or evening.  Like, I'll take the small risk of melanoma, but I'm less pale and and less miserable in the winter.

As a former goth kid, I was always like "Yeah, remove the sun".  In the Carolinas.  Then I moved north and was like "winters are the f'ing worst and I never want to deal with them again."

When I first moved out of CA, I was like "Oh, we had winters.  In SF, even summers could be winter", which is both true but also, even in July sticks to like 40 degrees.  So that sucks right?

No, what sucks is walking your rottie and having your hair freeze to your head like you're in Titanic.  Which is reality at present.

But stay safe, ya'll.  And if you're stalked, have an entire police department at your back.

Cease and Desist.

First of all, I have notified my employers, their attorney, my personal attorney (no, not my boyfriend), my friends and family, and know your identity.  Internet reverse tracing works both ways.  You weren't lying though.  You are a very dangerous individual.

I also will not be filing a restraining order.  After figuring out who you were, I figured you probably wouldn't sacrifice everything you have to hunt me down thousands of miles away and kill me, but certainly would if I cost you your business and guns.  Every threatening post has been screenshot, including those after I posted what I am posting now which is this:

This serves to fulfill legal notice that your intentional and repeated harassment and stalking of me constitutes unlawful RCW 9A.46.020 Harassment, RCW 9A.46.110 Stalking, RCW 9.61.260 Cyberstalking and furthermore your conduct must immediately stop, this includes your use of your third parties, friends, associates, and your use of Fox news pseudonyms to threaten women.  

You are prohibited from contacting me, my friends, family, or employers including use of your third parties, friends, and associates by telephone, electronic communication, social media, Yelp, mail delivery services, internet-based communications, pager service, and electronic text messaging, and any other form of communication either written or electronic.  

I nor my employer nor my friends and family do not want to be contacted by you.  Your conduct has and is causing substantial emotional distress, deliberate tortious interference with commerce causing economic harm, and damage to reputation.  Please stop.  Your use of your companies resources to track down a woman is stalking and you have made direct and repeated threats in violation of Washington state law as well as the laws of my state.

If you persist in threatening me, you have already done enough that I can not only get a full on restraining order, but have you arrested for persistent harassment, cyberstalking, and your threats to upgrade to full on stalking.

Your record appears to be stellar in your past.  I'm not sure what exactly went on that caused you to flip out, but is it really worth sacrificing your entire future, and sully your past achievements (which seem fairly laudable) over an argument on the internet?

You have succeeded in making me fear for my life.  Hopefully that is enough.

Yeesh

 Dave, we're on okay if unsteady footing.  Once FB get its head out of its butt, we'll see how it goes.   I apologize for telling you to get stuffed now that the stalker is dangerous.

For the stalker, I've filed a complaint with his company.  He's currently trying for my "financials" which makes his crimes federal rather than local.

What else?   I want more cases.  I get bored easily and while I don't love giving death sentences (ductal pancreatic adenocarcinoma), just give me anything that isn't soft tissue, derm, or medical liver, because I suck at those.

We got the house with repairs included.  Thersn't an emoji on earth that shows that relief;  I can take care of my mom, have the master suite on the second floor so her knees aren't impacted.  And I can gradually improve.  The palatial mansion was not a good idea but I had doctor syndrome.  This place I can gradually improve, will be absolutely mine, without those previous delusions of grandeur.

What do I want? For realz?  A porch, a firepit, a smoker, a yard.  What do I want for mom?  To not be "roommates" but I want her comfortable. I don't need what I once had.  What I need is a space that's mine. To be close enough to finally teach Seth how to f'ing swim. To take care of the mother that has ALWAYS had my back (my aunt Pam too, though my cousin is so rich, I doubt its an issue); to get her to senior centers so she has friends.

It's all so soon (so good luck stalking me mid move, psycho), but this is so good. Everything I've ever wanted is coming to pass.   I thought I wanted that gorgeous mansion to impress the worthless husband and the close friend that killed himself (So yes, psycho, after that happened I saw a therapist), but this middle class, closed in yard living?  Yes please. Turns out I don't want a palatial mansion with too much ground to cover.  I want a safe middle class, periodically upgraded general life, close to work, and close to love.  It can't provide shelter to 11 drunks with their own beds, but it doesn't need to.

Give me simplicity and nice vacations and a yard where I can grill and smoke meat and I'm a happy camper.

Awww I picked up an incel stalker.

 Not you Dave.  I'm willing to give you one last chance.

So if anyone sees this guy around:

The person in question may look a bit like this.  Said individual has been denying I'm a doctor for weeks while he works himself into a froth and has now started stalking me and is probably reading to try to figure out where I live.

Update, actually I know who he is and where he works.  Blogger lets you see where your page views are.

In case I suddenly disappear, this man has said I'm attractive, spent a week stalking me, and is a weapons instructor bragging about how many guns he has.  Right now, he's just threatening through the employer (which would... I don't know... annoy them?  My cases have been done for hours), but he has made his actual intentions well known.

This is why I promote liberals taking advantage of the second amendment.

ANYWAY, work is still slow as heck due to the post NYE COVID boom (hospitals get lag time), leaving me bored.

It is giving me time to pack for the new house, but the sellers appear to be morons who want me to pay for structural damages my contractor discovered to which after some back and forth, my real estate lawyer issued them a legalese ultimatum.

Like one of the issues is electrical.  Losing everything in ONE house fire was quite enough of that.

What else, boyfriend and hash trail this weekend!  It's a long term thing to look forward to, but since I HATE HATE HATE moving, I'm making this one nice and slow so I don't have much in the way of plans since that "they're here!  Quick, throw a half empty tissue box, a half empty garbage can, an oscillating fan, and a blanket into this box!" feeling is one I'm happy leaving far behind me.

What else, I got to hang with my favorite surgeon (though they're all lovely) and swap dive stories (I'm so jealous of his whale shark experience), so that at least kept me occupied.

Oh, to those who have anxiety and depression through the COVID years, according to the dude above, you're bonkers.  This message is NOT brought to you by a healthcare professional.  If you need or want help, get it.  Also regularly exercise, 30 minutes of cardio a day provides the same benefit as a low dose SSRI.

My right knee has been tweaking on me thanks to a combination of this gawdawful winter and freaking crossfit, so I'm bracing to get my running regimen back up to speed.

I registered for Disney's Dopey Run (5K, 10K, half) (why?  Because I'm insane) THREE YEARS AGO.

Did they ever reschedule the Cooper River Run?  We were going to do that.  Then it was in August (who TF in Charleston thought that was a good idea???).  Then it was cancelled again.  Then probably again.

I do the virtual runs but it's just not the same for me.  It gets my mom walking and she likes any source of bling, but so far the only runs I've done were accidentally doing the Beast (trail runs and regular runs are NOT the same, AND we'd just been hit by a storm knocking all the leaves down), so I think I managed to eat shit four times on that trail and come in damn near last, and one around Central Park, which was a LOT better but man I forgot that Harlem Hill is a bitch and a half.

The last one was fun for the whole Christmas in NY thing, despite Macy's just absolutely phoning in their displays this year.  Thank goodness for Sak's, something I never thought I'd say in my life.

What else?  Other than "yay Ozark with boyfriend!", most of the business at present is not dying outside in the unrelenting freeze, and real estate nonsense.

What particularly sucks is that while we are Caribbean bound in April, February is when I typically F off to someplace warm, yet this year, nope nope, gotta move.

Still, can't argue with Dio de Los Muertos in Puerto Vallarta, though I can wonder why children were dressed as the guys from Squid Game.  The Spanish translation must have omitted a lot and they'd have to photoshop in a big bounce house at the bottom of that tug of war.

Well, back to my ten minutes of work.

See you psycho.  Enjoy reading about someone with a better life (well, when I'm not fighting with an idiot seller).

Not sure who this is for. Maybe it's a journal.

 

Where to start that hasn't been covered by every news source on earth?

I'm a specialist.  When COVID rises, I lose cases. The ORs get turned into COVID units.  People get scared.  There aren't many procedures.

In 2020, I was convinced I'd be laid off.  People were "Thanking me for my service" (which has to bother the actual frontliners who didn't volunteer for combat detail) while I laid at home on furlough for a week only to return to fifteen minutes of work.

The numbers up north have gone insane.  As the southerners go outside, the northerners go inside and have holiday festivities and now we're back at peak.  Work was slow today, so I pretty much trolled a popular conservative website over "Let's go Brandon" because I needed something that wasn't freaking COVID.

I feel like this has been one extremely long continuous year.  I still remember my NPR international news from February of 2020 talking about a new Coronavirus variant in Wuhan and going "Hmm.  Wonder if that will turn out to be anything".

There are also the horrible people.  I lost friends I thought had been mine for YEARS over the divorce.  Then a lost a few more.  Doctors can have a rough road when you have people that are conspiracy theorists. I lost one during ebola.  My mom was in surgery for endometrial cancer.  This idiot posted an article that ebola had gone airborne and the CDC was covering it up, which I think would be internationally illegal and also as likely, in virus world, as a dog growing wings.

When I brought this up, and that I was in direct contact with the CDC (micro rotation, oh joy), she and a different friend kept on about this.  I mentioned that ebola had been well documented in its form and function since around the 70s and she could hit pubmed for free.  Oh, no, she does her own research. It was likely, but the officials and doctors are hiding it.  I said "You're essentially accusing me of murdering my own lab techs."  She said "don't take it personally".  I said "I take accusations of murder very seriously".  She said "Well, we'll agree to disagree" and I said "whether I'm guilty of potential mass murder is not something I agree to disagree on" and blocked her.  Then I got a long winded message about how I'd thrown away a barely present friendship over politics.

I have friends in pediatrics accused of giving children an incurable terrible disease.

And I just lost another friend.  He was convinced that the vaccine was changing DNA (if we could do that, sickle cell and cystic fibrosis wouldn't exist).  When I explained that Rand Paul is an idiot and what was actually being discussed required a graduate level understanding of genetics, he called me complicit in the lie to please my masters.  When this man was about to be homeless, I offered to let him stay in our home.  He accused me of helping murder hundreds of thousands of americans.

So prepare for this. Choose your friends wisely.  Be prepared to even be stripped of your medical degree if people disagree with you.  The number of people that field demote me because I disagree with on some stupid unrelated thing (I believe in universal healthcare; I like hiking) means I'm not a REAL doctor.  I'm faking it.  Probably work at McDonalds.

So there's that.

The general dismissal of expertise is frustrating.  I've needed lawyers twice in the last year, once for defense (long story, it's fine), one for real estate, since buying a house out here is a nightmare.

I didn't think I was a lawyer.  I asked my boyfriend what to do and he told me what to do in each case, and not THROUGH him, since he does neither type of law.  He told me who to call and what to expect and whether I was being treated fairly.  He doesn't even fake a knowledge of areas of law he doesn't know anymore than I know anything about orthopedic surgery.

The example I use is one of a mechanic, trained or not, (since law and medicine require licenses), but if you've been building engines from scratch from the age of 15, got your business opened at 25 and have 15 years of experience, I am not going to pretend I know more about my car.  For all I know, cars run on elf farts and Santa magic.  So why would I claim mechanics are all wrong?  Are there some bad ones? Sure. Does that make me an expert? No.

I'm also not a climate scientist.  I'm generally of the opinion that if 98% of experts agree on something, they're probably right, and if they aren't, I'm certainly not going to have the expertise to prove them wrong, but I watched an episode of Cosmos, and Neil deGrasse Tyson (the only man my mother and I would fight over romantically) and he explained in with layman's terms in about 20 minutes.  And I was like "Oh. That makes sense.  I'm not an expert, but I understand".

But that's some relic of the past or something.

So this is depressing.  Christmas was great though I went all out to give my boyfriend's son a great Christmas and he wound up quarantined for COVID (he's fine).  So boyfriend did a ding dong dash with all his presents.

We're going to a socially distanced red dress (just me this time) soiree for NYE complete with me having a sparkly red mask.  He said he's so glad he gets to kiss someone for New Year's.  Which was weird, since you always kiss someone on NYE. I've kissed strangers pre covid.

But back to depression. Surprise surprise I have depression and anxiety, which if you follow this blog, you probably figured out.

The SSRI helps (not Prozac, that made me crazy), but as long as I dismissed it, I've been giving CBT workbooks and journaling a try, and for those struggling, particularly those that can't afford a therapist, it honestly really helps, particularly if you're the kind of person who obsesses on the same toxic ideas.  You can just spew that out onto paper and get it out of your head.

I'm on some facebook naughty list where I'm yet again banned for a month.  An antivaxxer said I was ugly and I said "nothing is uglier than willful ignorance" and boom, I'm a bully.  It's probably more of a blessing and a curse. They also banned me for detailing years of emotional abuse and how it affected me and for affectionately calling a fellow diver an animal as a joke.

And back to happy stuff (maybe I'm bipolar 2, who knows).  I'm learning my hobbies again.  I got my guitar restrung and my electric checked.  My calluses are gone but I've played a few songs.  I made an ornament this week.  I'm currently working on an elaborate pen, ink, watercolor, colored pencil falcon.

My boyfriend and I were mourning the death of attention span and we're both bookworms.  We waxed poetic about how we both used to stick a book in a backpack or briefcase.

So I started doing it again.  I'm in the land of not pumping my own gas.  Grab the book.  The surgeon tells me the procedure is starting and then I wait for an hour, but don't have my work with me.  Grab the book.

What's funny though... I was reading a 90s thriller novel with my feet up after a two hour wait on a procedure.  They didn't mean anything but a couple of my colleagues were like "Really working hard eh?"  Yet, before that, I tended to screw around on facebook and reddit.  Staring slackjawed at my screen was considered more "working" than flying through a paperback.

Oh the exciting stuff!!!   After nearly three years of living in this overpriced claptrap electrical deathtrap of a falling apart cheaply made townhouse, we're looking like we're closing on a house mid February (taking care of my mom; my boyfriend is neat and I'm messy; we'd kill each other).

15 minutes from work, 25 minutes from boyfriend in an actual TOWN with actual things to do and a big lake to fish in and kayak on.  A big basement with space for a gym, craft area, and guitar center.  A master on the second floor so as my mom's knees and hips get weaker, she is on the main floor (and we aren't in each other's faces) but I'm close enough to take care of her.  Potential.  A fenced in backyard.  I have so many plans.  New porch, nice door, replace the electric stove with gas and run a gas line to the back for a smoker and a grill (can't use them here).  Big fire pit.  Adirondack chairs.  The real Amish ones.  An herb garden.

My last house was way too much.  I got doctor syndrome and bought a palatial mansion with space we never used that required a housekeeper and organizer thrice weekly just to keep my husband and I married longer.  Over an acre of unfenced land to try to tend.

This?  No.  Other than the unbelievable price, this is nice clean standard middle class living.  Comfortable, cozy, easy to keep up.  Easy to mow the lawn, rake the leaves, let the dog out, sit around the firepit drinking beer.  I'm so excited. Maybe 2022 won't be the two years of continual suckage where the only thing that lets you know time is passing is how many layers of clothes you have to wear.

If any current students are still reading this, I'd love to know what the island is like these days.  Does IGA always have eggs now?  Do they have a chinese restaurant that isn't terrible?  Are the Patels still selling samosas at the top of the hill?  Or the brown van guy?  Is there a roof on the Hurricane Ivan church?  Does the school still sponsor Sandblast?  Is Carib and Ting still the only way to avoid getting poisoned by your water during the rainy season?  Did they pave the dusty highway?

Can you go home again?

 So, my boyfriend has heard enough Grenada stories to want to see the magic.

In truth, I kind of want to see the magic.  I get a weird Stockholm Syndrome about my time on the island.

We're getting close soon.  The interhash (which new students should be invoked into) is in Trinidad and Tobago.  That's as close as you can get to Grenada without enrolling.  I really want to see what's become of us.  What's become of Caribbean medicine.

I'm not taking him to Grenada yet, because I don't have enough reason, but I am taking him to T&T, since I infected him with the hash.  We just got back from the Red Dress Run in New Orleans.  It's weird that the hash has taken me to more places than... medicine.

If anyone is still reading this, particularly any newbs that are arriving for medical school, what's it like?  Do you like it?  Is it modern?  Does IGA still run out of eggs?  Are there more restaurants?  Did you dive the Bianca C?  Are you still bringing Hershey bars to histology?  Do the locals hate us more or less?

Where to start?  Do you care about me?  Or the process?

For me?  My dad died.  Poorly, I believe.  The police in North Carolina were extremely delicate with me, but my time in forensics allowed me to read between the lines and know that they found what we'd roll our eyes about in autopsy and have it ruin our lunch.  His ashes are on my dining room table.  I have a necklace to hold them ordered, despite not believing in second chances or an afterlife, but hoping I'm wrong.

How do you say "I'm an atheist.  There's nothing after this, but I forgive you.  I forgive you 25 years of squandered chances, but I can't maintain a grudge after death, so now I only feel regret?"  I paid for his cell phone, and the plan, so I send text messages into the murk as if they mean something.  But I paid for AT&T, which means I paid for closure.

The boyfriend is a Cityiot by breeding, which makes him long for the outdoors.  We're planning a hiking trip in Maine.  This means the parts of my father that aren't in an "I'm sorry we didn't get along" pendant will be in a halcyon national park when I discreetly scatter him there.  In the meantime, I hefted the inconsequential weight of his ashes in the back of my car today.  I picked him up from the post office.  The ashes weighed so little, but he was in such poor health, it feels like I was hefting his actual weight. 

But you're not here for that; you're here for how doctoring from the Caribbean works out.

Well, it does.  I got grieve leave, despite not being sure whether I need it.  I'm treated exceptionally well.  I swap out procedures and vacation with another St. George's alumnus, who is a good person and doctor.  I get bonuses.  I was kept on through COVID when we had virtually no preventative workup work.  I/m so privileged that I got a shot on Christmas Eve of last year.  I'm looking forward to a booster.

I have vacation.  I have freedom.  And though I'd been once to Mexico, and once to the Philippines (diving) before medical school, the chaos of becoming a doctor in another country gave me the absolute gift of adaptability.

If you can get a US MD, do it.  Don't let snow or cost deter you.  But if you desperately want to be a physician, and foreign travel is your only option, it will change you.  It will age you.  It will allow you to be an adaptable creature where you previously weren't.  It will allow you to change habit and diet to adapt.

That's no bad thing.

I guess it's not the end.

Though I can't imagine anyone still reads this.

Boater Dave, if you're still stalking me from England, please get stuffed and don't comment on me.  Also, while I'll get to why he sucks in a minute, asking if a guy from Queens who happens to be brown is a "Jihadi" put you in the "bad guy category" a long time ago.  He's an asshole, not a terrorist.

ANYWAY.

So, some stuff's changed.

That marriage?  Yeah no.  Helpful hints: don't be someone's third marriage.  There's probably a reason stuff went wrong, and after several years of emotional abuse and deliberately packing weight on me (which is GONEZO along with the 180 lbs of unemployed loser!!!!!).

Pittsburgh is a thing of the past.  To all you newly minted doctors, let me give you some advice.  Your first job doesn't need to be your last job.  Getting out of residency/fellowship, that six figures is just like winning the lottery.

Stuff I put up with: having my PTO literally stolen.  Having the lab director bring a screaming baby in for the entire day because of her perpetual nanny issues at least four times because of things like "my nanny cam showed my nanny (who all had to be from Colombia for some reason) putting my baby in front of the television".  Having the lab director leave nigh daily by 2:30, leaving the rest of any work detail for us.

Periodically forgetting I had told her something (like an international flight had changed and there was nothing I could do about it or telling her repeatedly I had a weird soft tissue tumor, getting her advice, getting updated, updating her, repeatedly updating her, having to send it to two institutions etc), and she would regularly burst into my office screaming her lungs out about some nonsense.  This is not how I resolve conflicts.

Having a lab director talk about me like a high school mean girl directly outside of my door in front of support staff.

Having a lab director diss me to other doctors including at tumor boards, ruining my reputation.

Having a lab director demand that I not seek advice from the ONLY person at that job who was kind to me because he didn't "know their system", despite him doing pathology for fifty years.

So yeah, abused at work, abused at home.

So that's depressing, right?  But six figures?  This has to be as good as it gets?  My husband is neglectful, cheats on me, and expects me to make the money, clean the house, cook the food, be his beer buddy, and maintain the body of a supermodel while sabotaging any attempts at working out or eating well, but it's not like he's ever laid hands on me.

So your first job may be garbage.  Once you've gotten enough experience to start getting recruiter emails or fit the requirements on your hiring lists of choice, MAKE YOUR OWN PATH.  Do not tolerate abuse because you think it's what being a doctor means.  Unless you're an ED nurse during 2020.  Then... your life sucked.

But Monroeville is amazing.  I love the neighbors, I love the free "heart attack" venison.

I'd do the whole 2020 thing, but I think we're all damn sick of it, and there's nothing I can really add to the conversation other than what every other doctor colleague says which is "GET THE DAMNED VACCINE SO WE CAN GET BACK TO NORMAL".  If you're antivax, please avoid the comment section and go back to getting your news from Q.

My vacation foibles are back, so since I suppose I've revived this blog from the dead, I'll post some of those pictures when I get around to it.  Besides, due to that damned fire, this blog is one source of some of my trips and such, so having a backup never hurts.

You can read my experiences at SGU, but keep in mind they're old.  I haven't been back to the island, so what's developed, what the exams are like, what restaurants are there, what the housing is like, I have no idea.  They still have a high USMLE step 1 pass rate and a huge bill, but that's all I know.

But have a great day, ya'll.

The end?

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

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

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

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

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

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

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

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

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

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

Goodbye and good luck.

Sincerely,

Dr. Ishie

Uno mas

So I hate Tampa.

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

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

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

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

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

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

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

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

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

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

Adulting

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

First off, this happened:



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

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

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

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

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

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

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

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

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

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

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

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

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

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

I'm a grown up doctor!

Freedom!!! Freedom!!!

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

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

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

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

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

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

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

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

I'm free.  Bring it on.

Coming full circle

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

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

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

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

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

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

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

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