Shouldn't I be done with rejection?

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!

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!

Everyone's leaving :(

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

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!!!!

No more interviews for me!!!

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.

Ow ow ow ow...

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...

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!

Good news

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.

Hopping along the interview trail...

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.

Derm. Is. Awesome.

See above.

More Hijinks

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.

Success is... expensive

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.

Personal Statement Blues...

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...

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.

Too true

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...

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.

As soon as it was over...

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

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.