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.

Board certified and it feels so good!

So apologies for the delay, but yes, on the last week of July, a mere 12 weeks after taking that nightmare of a test, I received confirmation in the form of a nondescript email (or more accurately by my refreshing the website every ten minutes for 12 weeks and driving everyone crazy) that I was "successful" in both the Anatomic and Clinical Pathology portions of the exam.

So I'm a double boarded pathologist, baby!  At the end of this year, if all goes well in Cytopathology, I'll be TRIPLE boarded, which I believe doubles my mana on all offensive plays.

As far as the fellowship, well, there's no place like home, but I'm getting really spectacular training and experience.  But I do miss my own office and my surrogate Charleston family.

Now, the greatest challenge: Finding that first real pathology job.  Clock is ticking!

But yes, the short version:  I PASSED!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Now is as good a time as any...

I took the AP/CP pathology boards in the middle of May, far earlier, as I mentioned, than I had previously anticipated, and wanted to update everyone, save for a few things.

1.  The ABP is absolutely *insane* about giving any slip of detail about the exam, to the point that they asked us *directly before taking it* if we used rememberances, and better yet, if we knew anyone who used rememberances.  This strikes me as overkill, piles on the stress at a bad time, and has a "are you or have you ever been associated with communists" feel.  It was a continuance of a lecture I received at an event a couple of years ago delivered to us in a tone of voice more fitting for disobedient children than doctors with a minimum age of 24.  The simple fact of the matter is if the variety of honors codes and oaths haven't gotten to us by now, nagging us in the minutes before a 2300 dollar, 16 hour exam probably isn't going to ferret out the evildoers and it's disrespectful to those going through it since the vast majority of us are not poring over half-remembered previous questions for guidance.

2.  It's hard for me to critique the whole process since 1) I like my job and they're the gatekeepers 2) I know some members on the ABP and they're cool people that I can't imagine are responsible for the babytime fun talk 3) I don't know my results yet, so whether that monster of a test bore fruit or not is beyond me.

3.  The end of boards corresponded with having a bunch of administrative nightmarishness drop onto me from the future employment end, which then corresponded with getting a terrific headcold, so I've spent more of the last week curled on my couch crying rather than blogging.  I got better.

Things I can say:

The shorthand.  Pathology residency usually consists of a dual program comprised of Anatomical and Clinical Pathology.  This lasts four years (doing either separately is 3 years), and to be employable in a difficult job market, most people complete a fellowship.  Some fellowships are boarded (like cytopathology); some are not (like gynecologic pathology).  Nearly all pathology fellowships are a year long, contrasted to some of our clinical colleagues that have three year fellowships.  Fellowships are typically compensated like an extra year of residency.  Being board certified in AP/CP pathology is pretty much a requirement to "sign out" anything in pathology, which is, have your name on a report and the report goes into a system.  Since my residency is two parts, I'm technically taking two board exams, which were administered on consecutive days.

Pathology exams, unlike almost every other field, and allegedly due to the microscope requirement, are held in Tampa, Florida.  There are several weeks between May and early July in which whole residency programs are assigned dates to show up and attend.  It's expensive, time consuming, and notoriously difficult.  You are usually at least there with your equally miserable colleagues, as I was.  So knowing that, let's go.

-I was told by everyone that it was an awful experience and virtually everyone feels like they failed.  This in no way prepared me for how bad it would actually be.  I didn't think I'd feel better off than anyone; I just underestimated exactly how heartbreakingly awful the process is.  I mean, few people feel great after the RISE, but this was like being kicked in the gut repeatedly by someone wearing steel toed shoes while another person stood above you describing the details of your dog dying.  Just awful.  I came out too beaten down to cry, but several others did.  The worst part is coming out after your first day feeling like an utter failure and knowing you're going to have to start the whole process over again the next day.

-One of my colleagues and I managed to separately utterly ruin the confidence of other people coming in to take it the day after our last exam by her "that was f-ing awful" (and she never swears) to a man she thought was in business (taking it the next day) and my response to a wide eyed girl in the elevator who said "Did you finish your exams?  Congratulations!" to which I responded "it is definitely wayyyyy too early for congratulations".  I need to stop talking to people in elevators.

-Mild gripe.  This hotel has hosted this exam for a lot of years.  Everyone in the hotel knows you are there to take the pathology exam, and if they didn't, the fact that you're checked in under the exam rate should tip them off.  As such, call me Ms. Sancho if you like, but please don't say "Good luck on your exam, Ms. Sancho".  If you know I'm taking that exam, you know we're all doctors.  Or better yet, don't wish me luck.  Just kick me in the shin as I'm checking in, so I know what to expect.

-That hotel is nice but absurdly dark.  When you already feel bleak, having Fight Club lighting doesn't improve your mood.  And I had a gorgeous "lobby view" which looked out into the across offices.  The only thing worse than working in a cubicle is watching other people work in cubicles.

-Computers broke.  For an exam that costs the same amount as a lower model used car, getting the software on par with the SAT would be cool.

-There are totally other culinary choices than Panera.  Are you people blind?  Or did you think a giant shopping mall doesn't have a food court?  Also, while the hotel is a'ight, their room service ain't not bad and you can get them to deliver a burger to your room during the exam break.

-Everyone I know says Tampa is a really nice place.  I honestly feel so dejected from the exam that I have absolutely no desire to go there again in the near future (though if I failed, I have to go back, and if I passed, I have to go back for the cytopathology exam).  People asked if I was going to stay over the weekend (since I was off Tuesday-Friday) and check out the beaches.  I scarpered back to Charleston as fast as I felt safe to drive (the next morning).  The only reason I didn't leave earlier is I didn't feel equipped to handle a long drive when I was that wiped out.

-Exam study destroys your health.  I may have already mentioned that.  The months leading up to the exam did more damage to my back than if I'd been moonlighting as a crash test dummy, and I had to up my blood pressure meds back up to a full pill.  Feh.  I'll find out I passed both exams the day before I have a hypertensive stroke.

So there's that.  The rest of my non-reporting has been a frustrating flurry of paperwork.

Took ACLS, and not only passed it, but had the instructor out at my honey's wrestling match, in which a man was concussed.  I did about 5 seconds of voodoo "doctor" neurological hand waving in front of the concuss-ee's face before going outside and getting the instructor/former medic to come help, so worth the price of admission I guess?  Still no excuse for training pathologists to run codes.

Paperwork is a nightmare.  It never stops being a nightmare.  Even when you think you are on top of *everything*, something will come back to bite you unexpectedly so prepare for it.

An example:  In between college and medical school (A LONG time ago), I worked a number of odd jobs for money, as one does.  Since there is a noticeable gap between school attendances, I didn't want to just write: "2004-2006: Played Halo.  Ate at Taco Bell".  So I had the main time fillers listed without much detail (since it's completely irrelevant to my present job), and they've been sitting on my CV for nine years, unmolested by SGU, the ECFMG, the Step exams, ERAS, residency, the state licensing board, or the FCVS, thus I had no reason to expect that one 3 month entity, in the interim, was progressively burying any evidence I ever worked there, up to and including absorbing the entire company into another, shutting down the office I worked out of, and possibly salting the earth behind it to ensure nothing would ever grow.

This is where you go from being mildly annoyed that the government is always spying on you to relying on it.  As I scrambled to not fail my employment history, I found that the usual suspect for being up in your business, the IRS, was tied up in hacker attacks.  I briefly considered whether offering some cash up to a Ukranian mobster would get them to relinquish my ancient W-2s from the IRS website, but I put that up as Plan B.  Nothing yet at the social security office, and apparently there isn't a master number where you can just desperately punch in your social security number, caution to the wind, and get a full print out of your work history, shoe size, and social media posts.  Big Brother sucks at being Big Brother.

Fortunately, where the government fails at creating a dystopian nanny state, the internet always has your back, so I was able to sufficiently cyberstalk an old work contact based on a long forgotten forwarded email to get employment verification.

So that was stressful.  Pretty much, spend a few days crawling through all your paperwork, including your CV.  Now pretend you're on an episode of CSI.  If you can't link the soil on your shoe to that barista job in 99, strike it from your CV so it doesn't pop up again to testify against you in court.  I spent a terrifying couple of days convinced I was about to be broke and homeless because the software staffing markets in the early 2000s were someone volatile.

The final date until the move is approaching fast.  I'm really going to miss Charleston, and I've come to think of it like home, but Texas will be a whole new set of opportunities.  Let's hope that somewhere in late July or early August, you'll get the second to last of the "I PASSED" blogs and not a "NO I CAN'T DO IT AGAIN!!!!" blog.

The more things change, the more they stay the same...

So here I am, a full five months after my last blog post.

My moving date to head to Texas is June 19th.  The dreaded boards, moved up for what seems to be the sole purpose of panicking my class, are May 13-14.

I have less than a month to determine whether I learned enough in the last four years to be a board certified pathologist.  I have a month after that to make all my peace with Charleston, do all that stuff I meant to do, and see all those people I've had to put off under the guise of "sorry, I'm studying".

I now have a great deal of real world friends in addition to my fabulous colleagues, so while the colleagues understand "Hey, I'm not going to your Game of Thrones party next weekend because I need to compulsively hit flash cards", the real world friends with jobs and homes and dogs are like "We never SEE you anymore".  And they don't.  And it's sad.

But tests tests tests.  I definitely feel anxious.  I was always on the smarter end of the spectrum where I've been, so while biochem sent me into a self-induced fear spiral and I never quite grasped pharmacology, despite my tooth gnashing and panic, I was in the upper bracket.  My social life was just not really in order.

Now, the situation is set perfectly.  The hospital, upon seeing all the fourth years freak out at the time announcement, pretty much freed us from clinical duties for the duration and sent us to our offices with 10,000 dollars worth of books.  But I'm not the big fish in a little pond anymore.  I'm easily not in the top half of my brilliant colleagues, which is fine, so long as I'm in enough of the top part of the country to pass the exam.

Still, I don't feel the acute panic I have in the past, I think just because I've grown up and I've gotten too tired of always stressing about it, since it rarely helps.

So I have my system, and you know what Vegas says about people with a system.

Every day is a different topic.  I use the new knowledge to make flash cards.  I set alarms for an hour and every hour it goes off, I drop and do 10 push ups, 15 situps and then make a hashmark for both on my calendar.  When I have enough hashmarks and enough flash cards, I can go home.  At home, or at the Barrel, which is even better, I can iPad my way through the flash cards.  Then repeat over and over.

It's dull naturally.  I like the material, but I can't paint a picture of that as being a laugh riot, but it's the whole first year of medical school thing all over again.  Take a big test.  Be afraid because you're going to a new place.  Hope you do well in the new place.  Be prepared to take another big test.

I have my permanent South Carolina license now, so I'm now technically a doctor.  I'm working on my Texas training licence.  More of those infernal steps I told you about.

So then, do my cytopathology fellowship, and then, take another test, apply for a job, and maybe that cycle will finally end, and I can look back at the last 10 years of my life or so and say "Yes, I am now a doctor.  Officially."

Speaking of doctor things, I have to take ACLS now despite managing to never take it at any time in the past.  Having pathologists run codes is a terrible idea, I think anyone can agree on that, so that'll be another 200 dollars and two days, and worst of all, a day of testing the immediate week after the Tampa tests, but what's a girl to do when she needs that J-O-B?

Other things.... I ran the princess marathon, managed to run it the whole way through, and was both really glad that I did, and really glad that I got to go to Universal Studios and Islands of Adventure since I haven't been there in over a decade and everything's all built up and cool.  The princess made me feel like I can accomplish something, so there was that:

You know, even if I wasn't really a princess, but an English school girl, but my point remains valid.

I also managed to squeeze in the Bridge run since I kind of bombed it last year.  My goal was to get a sub hour time, which I missed by 3 minutes, but it still made me feel pretty good about myself, and I didn't throw up.

Committee life has been good also.  We did an extended trip to Key Largo in January, and I got to go scuba diving for the first time in forever.  We've also never been to the keys, so went down to Key West to check out the Hemingway house and all the six toed cats, the conch sandwiches, and 90miles to Cuba, and of course, the sunset.  It was an incredible time, and I got to see a friend from medical school due to the most random of coincidences.  I still miss the connections I had there.

Last month I hit Boston at USCAP and realized the boards were getting to me, because I'd left the boyfriend at home, and it was probably the most depressed I've ever been out of state.  I finally got enough enthusiasm to take a run around the frozen harbor, but it was not a labor of love.  The speakers were great; I made a lot of connections, and I got to crash other programs' parties, but I really just wanted to be home.  I've come to love Charleston so much and it's really sinking in how quickly I'm leaving it.

Lot of paperwork heading for the new place.  We've already been down to pick out our apartment (with the help of my lovely aunt) and it seems like it's going to be a great place to live.  I've already distanced out the Trader Joe's, Whole Foods, and closest Ethiopian restaurant cause I'm 'that guy'.  Then all the paperwork.  Gotta get that ECFMG certificate out again.  Gotta find all those step scores.  Gotta write to the school again and beg for my transcript.  It never ends.

So now it's just study study study drive to Tampa and breathe.  See all my friends, kayak, go out to dinner, go out to parties, and the like, but now, back to the books.  Hopefully by the next time I post, you'll have a "I'M FINALLY A REAL DOCTOR; NO THIS TIME, I ACTUALLY MEAN IT, I'M BOARD CERTIFIED!!!" post. I truly hope, at least.  And we'll see whether a Caribbean MD was really enough for me.

And the beat goes on...

Things that have happened since August...

Well, now I'm halfway through my final year of residency, hurtling toward fellowship.  I have, as of last week, registered for my AP/CP board exams with approval of my license and medical school diploma.  The registration relieved me of 2200 dollars from what is thankfully my now dwindled educational fund.  I spent my last thousand (minus what the hotel costs will be) on a cute small collection of books from the "Biopsy Interpretation of" series, because I know how to have fun.

Thank goodness for that educational fund, man.  When you're interviewing for residencies, find out how much it is.  Even if your salary is higher, that salary is going to be taxed, and if you're doing income based repayment for your student loans, that'll shave it right off, but the educational fund is free of all that.

So between May and June, my colleagues and I will be flying to Tampa to take this heinous double part test, which means I'm in the beautiful time of the year where fourth years begin to prepare for hibernation and become utterly useless for everything else.  And I'll be returning to studying once I complete this blog post, actually.

So the training journey is nearly at an end, minus that whole cytopathology thing.  At that point, there will be *another* licensing exam and I will hopefully stumble out of this whole mess as a triple boarded pathologist who will then be swimming in job opportunities (please?).

It's still a bright scary world out there.  Texas provides at least a stopping point on the road to "being grown" but after that, it's a big black hole.  The man and I kind of fell in love with Denver during the Great American Beer Festival, so maybe they'll open a spot for a youngster in a year and a half.  But still, everything is sort of winding up, and so much faster than seemed possible.  It seems like yesterday I was "covered in bees!" panicking to Grenada, and now I'm trudging toward an exam so far beyond the scope of the Step 1 that it makes the Step 1 look like SAT prep.

I have a weekend left of call... this weekend actually, which I traded for a lovely weekend in Asheville back in August.  Then I can finally do what I keep saying I'll do which is retire the scrubs.

I now have my permanent license in South Carolina.  One is necessary to apply for boards, and that lovely educational fund covers it, so it's official.  State law varies, but in South Carolina, IMGs such as myself cannot apply for permanent licensure until they've completed three years of training, so with that finally behind me, I have the unrestricted medical card.  Of course, I let my DEA license expire in the way back so I can't prescribe any of the fun drugs with my unrestricted license, so sorry guys, no illegal scrips for you.

Really feeling the whole "last of" tour of Charleston.  I've been steadily moving things off my bucket list (carriage ride, rooftop at Vendu, go to the Macintosh) and feeling the kind of "last Christmas here" sadness.  I've also been kind of wandering through apartment listings in Houston, and they seem nice.  Gotta make the commitment at some phase, and I will definitely need to get a bike.

When I'm not buried in microbiology lectures, I've been on kind of a health kick that was initiated by both getting cooking bling (Kitchenaid from last Christmas and NOW an overly expensive Vitamix blender) combined with getting suckered into running a half marathon in Florida in February despite nearly being killed by the bridge run, which was less than half the distance.  Still, I'm running for Save the Children, and they're a good cause, so if you want to toss a couple bucks my way in the name of securing me a permanent knee injury, the address is here.


You even get to see me dressed up like Alice, and I'm contemplating wearing the costume if I can make it without dying.

Running is an insidious creature.  It's been my go-to exercise off and on because it's cheap and easy, and kept me from going crazy (er) in Grenada.  Most of my running save for in Grenada has been on a treadmill, for years even, and it's only been lately that I've been pushing into the great outdoors, and I have to say, I kind of like it.  But I keep getting sucked farther in.  For years, I'd run on the treadmill, go all out for the first mile as fast as I could, and then walk/jog the rest in gasping bursts.  No strategy, definitely a no no for accumulating injuries, and thought a 5K was really all I was ever going to be able to do.

Well, and then a 10K, because the Cooper River Bridge run is a quintessential part of charleston, and why not, right?

Now I'm following my NikePlus trainer and arranging happy hours around when I can get the best mid-dusk run on the waterfront and working toward the half marathon.  Where I'll stop, really.  I won't get sucked into a marathon.  Well, at least I won't get sucked into an ultramarathon.  Check with me in two years.

Doing the training correctly has been helpful though, and now I use the first mile to actually warm up rather than suddenly sprint as fast as I can until all the bits and pieces holding my lower legs together start to snap and pop, and it's allowing me to really again appreciate how beautiful Charleston is (and how dangerous its drivers are).  My longest run so far without stopping at all is 6 miles, and the long runs are starting to feel better and better or at least "not as terrible as before".

And then with the work hours decreasing and the study crunch requiring more "can't sit around or will go crazy" ness, I've been cooking up a storm lately.

Few things... I've been poor for a while, and the story of the last ten years of my life has been accumulating things that 16 year old me would have scoffed at.  150 dollar running shoes?  Please, shoes are shoes.  Yeah... but the glycerines really help my plantar fasciitis.  Artwork for the wall?  So long as Rolling Stone still has full centers of Trent Reznor, you're just a few pieces of tape away from home decor!  Yeah... but frames.  Frames even make counter culture stuff look nice.  Cookware??  I mean, you can get a hand mixer from a store for 5 bucks.  What's up with these stand mixers?  It kneads dough for me.  Well, at any rate, I can tell you I'd *never* pay 500 dollars for a damn blender.

Sigh.  Last year, when I got my kitchenaid, a friend of mine said "The two things that changed my life were my kitchenaid stand mixer and my vitamix blender".  I trust said friend's cooking opinions, so I went home and googled vitamix blenders since I was poor (see above) and had no idea what they were.  My first response was laughter, obviously, because who would pay that for a blender?  In my defense, my blender is a combo gift from my dad and my boyfriend, if that justifies it.  All that's left for my Martha Stewart kitchen is a set of expensive knives and a set of expensive pots/pans.

But I'm liking cooking a lot, and I'm loving the fresh ingredients, though I'm being careful not to be one of "those" people.  "Yes, I'm making a smoothie with pomegranate seeds and chia seeds but I will absolutely *not* refer to either as a "super fruit/food"".  I'm finding a lot of fun recipes and enjoy challenging myself with them.  When I completely run out of medical school/residency related themes for this blog, I'll just start posting recipes.  I'm also having fun making my own flour.  The boyfriend is diabetic so I'm trying to keep the glycemic index low, and you can pretty much grind up *anything* and make fake flour.  There's about three cups of chickpea flour now occupying my cabinet because I found a bunch of dried ones on sale and went "Ooh!!!  This will be like magic!" because I have never had a good blender before, thus the art of changing the state of something (like beans to flour) still stirs a certain sense of magic and wonder in me.

The whole foods approach is also making it easier to make absolutely anything without needing to scrap around for ingredients.  No salsa?  Tomatoes, cilantro, peppers, and onions.  No guac?  Avocado, tomatoes.  No pasta?  Flour, egg, and water through the pasta maker.  No ice cream?  Milk, ice, frozen berries.  No rice flour?  Rice in blender.  I'm a year out from killing my own chickens.

So that's the update.  A six month crunch to boards and moving, punctuated by the growls of "pulse mode" when I'm making my morning smoothies.

Guess who's back, back again

Wow, this may have been the longest I've left the blog, eh?  Apologies, it is not so long and thanks for all the fish, at least not at this point.

It's hard to find a relevant point, to not make a blog intended to be a first hand look at life going through SGU and entering residency as an IMG, and not my personal livejournal and travel blog.

But Grenada is so far away.  I know there are changes on the island, new restaurants, new hotels, new apartments, probably new professors, a new deal in the making, the details of which I have no knowledge of, nor how it affects the school, nor how the teaching is currently going.  I don't know what their current going tuition is or how it compares to other schools in the states, nor what the current fixed interest is on graduate student loans and Grad Plus loans, all centers of my universe and increasing amount of time ago.

New York keeps me closer, and I still get up there, but again, that's all social.. the amazing people I met in Grenada or in Brooklyn and kept as friends.   Those in three year rotations are settling in for their real jobs, one in Maine, one in New Hampshire, others moving around, and I follow them as friends, remembering our times in New York as apartment parties and park walking and bar hopping, rather than as a harried short coated medical student only now realizing that not a single resident I worked with remembers my name, save for the one that miscellaneously showed up in South Carolina to do a fellowship and I ran into him at the gym.

I could talk about the effect of being an IMG on my current residency, but the simple fact is, there isn't one.  Pathology is poorly prepared for in *any* medical school (that's a rant for a different day), and once you're in, you're in.  I have two other IMGs in my class and a DO, and none of the former since (I hope we didn't break them), and unless we remind everyone else, which we will occasionally do with gusto since no one appreciates both the grass clearance and taste of goats, it doesn't flicker on their radar.  I got the fellowship I wanted without a lot of difficulty in the application process, which is considerably cheaper than the medical school and residency processes.  Things still cost a bit more, but that cost is offset by our generous education fund.  So what's life in a pathology residency in South Carolina like as an IMG?  Pretty  much like it is for any other pathology resident in South Carolina.  We eat, we drink, we ill advisedly run over the Cooper River Bridge, and we read books and squint at slides.  And no, don't call us squints.  We've seen Bones too.

And it's been difficult to write as of late because things have been so busy, but largely busy in a completely unbloggable way, though I can do my best.

Someday, I'll get to the end of Nicaragua and Christmas...

I mentioned I'd been accepted onto a committee, which holds meetings four times a year, which is both time consuming and incredibly awesome.  I've now been to three of them (San Diego, Chicago, and Portland) and have enjoyed luxury hotels, fine wine, and eight hours a day in a room with a ring of microscopes hanging with awesome people.  It's one of those things you never really picture in medical school because it seems so ridiculous.  Pathologists travel with microscopes?  These ones do.  So you just sit in a conference room, talk about cytopathology projects, and look at pap smears?  Yup, sure do.

I could attempt to start from the beginning but that would be difficult.  July was a rough month but also marked the meeting in Oregon's wine country, which also featured the nicest hotel I've probably ever stayed in, and it gave me a chance to make some headway on a project I've been working on for them, but it's difficult to do projects at home and projects on the road.

July was also noob month.  It marked the time that someone trusted me to be competent enough to train others in their most difficult rotation.

It was frightening, since I don't feel particularly qualified to teach anyone anything, but it also made me appreciate how far I've come in the meantime.  I'm much faster now.  Still slower than most of my colleagues, but so much faster than first year.  I know what to skip.  I know when to stain.  I joke with the attendings who still intimidate people.  I get praise from attendings who used to intimidate me.  The first years would ask me things that seemed silly.  Not stupid, but just... wow, that used to be me.

So hopefully they came out of it confident, but I know that it did wonders for my confidence.  Now I'm in an elective month, which gives me some breathing time, work on presentations, work on papers, and start the intimidating march to the board exams, which actually seems really scary.  Everyone is so relieved to finish the USMLE series, particularly when it's dragging into the Step 3, but then reality hits you.  Every test is the big one, and failing the dual pathology boards invalidates the others.

You're really all in too.  Fortunately I like my job because the reality of the loans sits in a panic on my chest from time to time where I realize... I can't go blind.  I need my eyes.  I can't get brain damaged.  I need my brain.  I need my ability to work.  I can't have a high risk pregnancy (didn't want a kid, so this is fine), I can't get sick for months on end, I can't rely on the boyfriend to support me (wouldn't want to anyway) and all has to stay on track because there aren't other options.  That's kind of the scary part.  With compound interest knocking my loan figures over 400 grand at this point, it's even more succeed or die than it was previously, but when I finished first term in Grenada, my world, and the maybe 20 grand I'd taken out for that term seemed like the world, and it seemed like my world was crumbling, and that was a moment where it could all go sour and ruin my life.

But twenty grand is nothing, ultimately.  It's in the low range of a new car (which is why I don't drive a new one).  Every value seems a little bit more insignificant once you pass it.  I remember before I started medical school when having bad credit and less than a thousand dollars outstanding seemed insurmountable.  It's weird how it happens when you least expect it.

But things are good with the boyfriend; things are good at home; with a few exceptions, things are relatively good at work.  I try to encourage the new people to talk to me or to talk to each other since I remember being so certain I was going to quit first year, so certain I would get washed out in Grenada, always so certain that each step would mean failure.

But despite the sweat generated by carrying a 400 thousand dollar loan on your back, I can't say I have regrets.  That's a question I get asked a lot as an IMG by prospective students.  Would I recommend others do what I did?  No.  Go to a US allopathic if it's at all possible.  Take out loans to apply to more schools and fly to them.  Don't wait after college.  Don't become a doctor at all.  It's a fiscally irresponsible decision.

But it was also the best decision I've made.  Medical school and residency have given me some of the best friends ever, and it kicked me out of my home state in the most immediate way possible, took away all promises of security and stability, and made me become something else.

Now I'm going to get back to work before I start quoting Arrow (because it's an awful show) but I'm back, kids, hopefully with something of value to say.

Extra Vacation Days? Go to Nicaragua!

I know I know.  I've been a horrendous blogger and haven't updated in a couple months.

First, I was insanely busy, mostly with decoration and planning and trips and all that stuff.  So I'll get into that.

Second, workwise, I've been in a mixed bag bad place.  Not like my first year bad place of "Flee medicine and take up professional scuba diving!  Everyone is horrible!  I'm horrible!"  Instead, it's been a weird mix of mismanagement, schedule horrors, and budget issues that has me regularly swinging back and forth between "I hate this I hate this; this is wasting my education" and "everyone here is awesome and my friends, and every program has drama and this is just our particular brand of it", but I didn't want to do a blog post where I'm like "BADNESS!" when it truly isn't, but I didn't want to do one where I completely ignored work and just posted about how awesome Asheville, North Carolina is, and how their hospital should hire me in a couple of years so I have local access to breweries, hippies, and mountains.

I'm not sure if I should go in chronological order, or if I should go in order of what's probably interesting.  Maybe reverse order.  We'll start here and end with Christmas.  If you get bored before Christmas, you can watch the Game of Thrones season 4 trailer obsessively on youtube until the show starts back up in two months, because that's what I do.  This will likely be divided into at least a couple of posts, because it really has to be.

We'll actually start a couple weeks ago.  Uhh... look!  Monkeys!

I'll also get to them in a minute, but this should hold your interest through the vacational whining I'm about to do.

Nicaragua was amazing and the people there are amazing, despite having the biggest string of difficulties from start to finish.  Ostensibly, we went there for the surfing, since my friends live at Folly Beach, are addicted to it, and I decided I didn't have enough dangerous expensive hobbies on top of ice skating, horseback riding, kayaking, hobie catting, and scuba diving.  I also like the bonus chronic injuries I inflict on myself by running regularly, which is really one of the most abusive things you can do to your body under the guise of good health short of eating unpasteurized cheese and rejecting vaccinations.  I had actually planned on running while in Nica, and we'll also get to why that didn't happen.

Getting there: Oh Atlanta!  Both Delta's main hub *and* completely incapable of dealing with any weather pattern people in the midwest would call "Spring".  There were 11 of us going total.  Two were planning to show up on the 31st.  The rest (us) on the 30th.  Boyfriend was coming back from a business trip, or at least he'd been planning to the day before we were going to leave.  With a stop in Atlanta.  Which is where he got to spend the next day and a half.

Our trip also required a stop in Atlanta, so imagine our shock when despite a thaw in most regions (including Charleston) by our flight departure time, it was delayed delayed cancelled.  No worries.  We're going for nine days.  But there were many of us, so we were getting answers of "Uhh.. some of you tomorrow, some the next day... last person in by Tuesday".  This was unacceptable.  Planner of the trip managed to sober up from our flight-delay bloody mary festival in time to get in touch with the exclusive airline people and managed to find a flight that could take us to Managua through Miami.  By way of Charlotte.  For reference, Charlotte is about four hours away.  With boyfriend still passport-less in Atlanta.

We waited for him to be freed from the deep freeze at Charleston's new Ethiopian restaurant (Oh thank all that is good and wonderful in the world!) and piled 9 into a big van to Charlotte for a cozy late night stay in the local per-hour quality motel.

At the airport, since boyfriend had been in the departure city but was with us, he was booked from Miami instead of Charlotte, which is a problem for about 17 hours worth of reasons, so he managed to get back on an original flight and hit us an hour later.

But we arrived in Managua!!  And got rental cars and made it to our overnight stay there without being stabbed or running over a motorcycle.  Nica beer, rum, and late night gas station snacks were had by all, we met all members of our party and headed out for our incredible beach house in Playa Colorado with its amazing staff.

Near our arrival, surfer #3 aka also "guy getting married on trip" was not doing well, and was confined to quarters with an illness I'm referring to as the "James Island flu" since we apparently brought it with us.

Despite his infirmary, the beach house was kicking:

We hit the pool the first day, because duh, and heard one of our party exclaim from the backyard about the monkeys.  Remember the monkeys?  There were monkeys.  If you've been reading since I went to Costa Rica (you poor poor soul), you know that despite having an anthropology degree with a primatology adviser, everywhere I've gone that you're supposed to see wild monkeys has been utterly monkey free.  Until now!  Ha!  Howler monkeys!  In the trees!  With babies!  And hooting in the morning!  Awesome!!!

We had an awesome woman that cooked for us, provided beer and rum, and cleaned.  I am happily full of rice, beans, fish, and plantains for a while.

We saw our first sunset in Nica, played in the water, and headed for an early bed.  While we were wrestling in the surf, a local warned us to be careful of stingrays.  This was good advice. 

The next day, it was time to rent a surfboard and try out the waves!  The woman that runs the surf shop should be called "the getter".  She's never surfed, but can recommend any type of board, but more critically, she can get damn near anything.  And by anything, I mean cough syrup, flowers, white pants and a jacket, and a Catholic priest willing to marry a Mormon to a Baptist.  This is exactly what I mean by "anything" and yes, that is exactly what we asked for.

So round one of surfing... I was not doing well out in the lineup, particularly since it was full of good surfers and I can't really stand up.  So on the advice of planner, I took my surfboard into the surf break zone to try and clumsily ride the white stuff and get a feeling for it.

I was struggling with it, and my boyfriend was standing next to me in the water (which shows you how well I was surfing) at which point I clumsily kind of fell off the surfboard and stood up (I do everything clumsily on a surfboard) and felt something slash open the bottom of my left foot.  I then jumped off my left foot onto my right foot (as you do), and landed on a surface that felt exactly like a startled piece of wet rubber being yanked out from under you.  Fortunately, the ray I actually fully stepped on was more forgiving than his buddy, and did not light up my right foot.  Then I saw a huge ray with a long sharp looking tail go streaking directly in front of me.

I don't really scream as a rule.  However, it's not because I'm a bad ass or anything, it's just not a sound I make much, which means when I'm scared, injured, and startled, I kind of yell, but was also trying not to step on rays with both feet.  I tell you this, because to my boyfriend, his girlfriend went from being frustrated on a surfboard, to leaping from one foot to the other making angry chicken noises.  He was confused until I said something helpful like "Ah!!!  Ahh!!  Ray!!  F-ing ray!  F-ing stingray!!!" and gesticulated wildly toward the water, at which point a fourth ray went streaking in front of him.

Only I would attempt to take up surfing and wind up doing so directly in the middle of a stingray pride rally.  We shuffled and squawked out of the water where I inspected a large, bleeding, sand impacted gash running directly across the bottom of my foot.  Thanks, jerk.  Fortunately, it didn't leave a barb in me, but it was still starting to hurt, so after... I'll be honest, about a second and a half of trying to flag down my friends to warn them they were going to come in surrounded by venomous pain monsters, we gave up and limped back.

I was rinsing what I'm calling my "ray hole" in the pool when Maria (our housekeeper) came out.  Since I didn't know the word for "ray" in Spanish, I was trying to elaborate that I'd been attacked by a bad fish with a knife when she said "raya?"  Of course.

Then she said "agua caliente?" which didn't sound like what I wanted to pour on an open wound (hot water) but it denatures stingray venom, which is just... a really really good thing to know.  So that helped, and with no barb in, I did not get to experience the "labor intensity pain" of legend, but I definitely wasn't going running any time soon.

So that was all right.  Next day, doofy pink boat shoes on, I headed back to attempt surfing!  Honestly, awful marine life is something I got mentally accustomed to while diving, so I think of that as not really being a surfing thing, but as a "their habitat" thing.  Unfortunately, about ten minutes into attempting to ride waves into shore, I did what's called "pearling" in surfing, only did so in shallow water, so the board was ripped from me and I landed directly on my head, which would be fine, but then my body collapsed on top of me and I heard a popping sound at the base of my skull.

For about half a second, this was my train of thought "That's like C2-C3, that's it.  I'm paralyzed.  This is the moment.  I hope my surfing friends see me in time to pull me out of the water because I wonder if my diaphragm is even going to work and even if I can breath without a ventilator I'm not going to be able to get out of the water and will I be able to and is there an evac chopper I wonder if steroids will lower the damage..." and then my arms and legs moved and I drew a deep breath having only popped a couple fibers in my trapezius (only time I'll be glad to say that) and that was the moment I gave up surfing, because stingrays come and go but being too clumsy in a sport with a steep learning curve and paralyzing yourself or brain damaging yourself on the 9 foot long hard sharp object you're literally tied to is forever.

So that's cool.  Nicaragua's got a lot to offer, hiking trails to limp down, volcanoes, and tiny farm towns, so I'll do that.  We drove to one cute town the same night (one of our party was a massage therapist, thank goodness and worked on my neck) and it must have been the dust on the road because I started coughing.  And coughing.  And sneezing.  And hacking.  And being in denial.

By the next morning, with the fever, I was beginning to suspect my problem was not the dust on the road, but the illness of our party.  So I laid in bed shaking, sleeping, sneezing, coughing, and blowing my nose, for the next 24 hours.  My boyfriend increased his already impressive relationship stock by staying with me the entire time.

The next day, I was getting maudlin.  My foot hurt, my neck hurt, and I was still coughing up cups of crap.  I was well enough to ignore all symptoms so we went out to hike a dry creekbed and climb around for more monkeys and take pictures of dragonflies.

This was also the day of the wedding, or as I say "if you're going to get married, do it this way".  This was essentially, an on-the-fly, licensing already done, let's see what we can do wedding.  We weren't certain we could get a priest that would marry our friends, and certainly not one on 48 hours notice.

Wrong.  For the price of "whatever you wish to donate to the church", we got a priest, Spanish Bible, full Spanish ceremony on the beach at sunset, and then everyone all came back to the house for dinner and drinks and said priest taught us how to do tequila shots in Nicaragua which is "Arriba!  Abajo!  Alcentro!  Aldentro!" and then drink.  That is full service.

But for all the horrors we'd (I'd) faced up to this point, that night was so incredible and special and locally intimate (not like that) that it really made the trip.  We were later joined by some surfers from Spain and a full on party commenced.

So it steadily improved from there.  For me.  I hiked (limped) to an incredible vantage point over the beach and saw tons of wildlife.  We traveled to San Juan del Sur, which is an adorable town with amazing drinks and cheap lobster.  It was just prior to this that boyfriend started looking a little rough so stayed home, while I lowered my girlfriend stock (at his insistence, I swear!) by going to town anyway.  But I bought him pharmacy drugs, so that counts, right?

We wanted to do some horseback riding as it was listed for 20 dollars, so we booked that with the getter!  I didn't realize how much getting there was.  Two hours later, the horse guy appeared... on horseback, trailed by three horses.  Because that's how long it takes to ride that far without a car.  Gangsta.  I was puzzled, because we'd wanted four horses, so he gestured to the four horses, hopped off, and handed off the one he was riding.  And that's the story of how I led a beach trail ride as I was the one with the most experience of us (meaning, I rode horses regularly about 8 years ago), really hoping we wouldn't fall off or get lost.  My horse had a slight attitude problem, as I like them, and a halter as a bit, which makes me a little more nervous.  After the hour, we paid our cowboy, gave him a beer for the efforts, and he began the two hour ride home.  Egad.  And that's the sort of thing that makes me feel bad when I whine that being a doctor can be thankless and annoying.

For reference, by the way, this is what the beach looks like from horseback:

And somewhere in all this, Superbowl (not on horseback).  The night of the Olympic opening ceremonies, we headed to the surf bar for some drinks, and as I sipped my watermelon mojito, my boyfriend timidly said "When you finish your drink, do you mind if we go back to the house", and that's when *he* got to experience the full blown fever mode.  Poor guy.

But we did get to experience sunsets every night that looked like this:

So there's that!

We planned our last night to sleep in Managua again because airport, and decided to hit Granada on the way there because after living in Grenada for two years, how could I miss it.  Granada is an old colonial town with awesome buildings and cheap delicious food:

We branched off in all directions and met back at the three rental cars.  Like educated travelers, we paid a local boy to watch the cars with the promise of half now half later that works decently.  Unfortunately, as we returned, we came back to three cars and two intact passenger side windows.  Someone smashed out our friends car and took their bag.  D'oh.  Oddly, our youth was still around, though wound up going from being confused (which may have been real or not; we still don't know) to having someone pull a knife on him, which we found less likely, particularly since he seemed as surprised as we were by the broken window and the missing bag.

This led to a series I'd like to call "Ishie having to deal with the police in countries where she's unfamiliar with the native language" though we were fortunate enough to have excellent speakers with us.  I'd be more critical of the crime and such, but for one smash and grab in a third world country that could have just as easily occurred in downtown Charleston, we eventually ended up with six police officers and a ride to clarify the report at the police station (for my friends; we eventually bailed when we realized we'd be dealing with darkness in Managua).  For reference, I had one extremely disinterested police officer and a misfiled police report where I was listed as a juvenile for the arguably greater crime of arson in South Carolina, so point Nicaragua.

I know I know.  Arson again.  I bring it up now because when I went to register my car this year upon returning, I was informed that I owe 400 dollars in registration for the arsonized car despite being reported, written off, and disposed off by the state.  This has not contributed well to my state of mind when I mentioned my attitude problem of late about 10,000 words ago.  It's now been reduced to 16 dollars after digging through all my paperwork (yay memories!) and getting my old insurance company to write a letter, but I've reached that point where I'm really wanting to be past it, and it makes me angry.

Other point Nicaragua... despite it being horrible and everything, the cost of the damage on a car that, if it was like ours, had about 5000 miles on it and automatic windows, was about 260 dollars to the rental company.  I may be crazy, but that seems incredibly reasonable.

So it was a weary, well-earned pina colada night in Managua, in which our friends also arrived safely not long after we did.  Managua also not as bad as advertised though I maintain that huge traffic circles in capital cities at rush hour are the most hypertension-inducing creatures on the planet (even before stingrays!)

The boyfriend and I are still coughing up crud, but we're happy and alive, and I would definitely go back to Nicaragua.  Except for the smash and grab (which again, could have happened anywhere), all conflicts were country-unrelated, and the people there were some of the most amazing individuals I've encountered.  Friendly, funny, and helpful, not to mention, they speak Spanish relatively slowly!  Which is extremely helpful for people with a toddler level of understanding, such as myself.

Part 2: "Christmas is Magic" will commence at a later date.  Stay tuned.  Or don't.  Watch Game of Thrones.  Or get someone else hooked on it and record their reaction to the Red Wedding because I never get tired of those videos.  I'm still waiting for old roommate to make it to that point in the third season, because this is a girl that walked out angry during the whole Drogo thing back in season 1.  Mwa ha!

Adventures in Cytopathology

Me (to clinician): "We have adequacy.  I've got abundant follicular epithelium, macrophages, and colloid."
Patient: "And in English, that means..."

Me (in other room): "Yes, as you suspected, this is consistent with metastatic disease from her earlier lesion."
Rads tech (from other room): "Ma'am, you're hypertensive?"
Patient (cheerfully): Yup!  But on a list of two things, that's not going to be the one that kills me.

Clinician: "Whadda you see?  What do you see??"
Me: "The technician staining my slide."

Clinician (leaning on his elbows on the counter next to me about six inches from my face): "Now, don't let me make you nervous."

Clinician: "Well?  Do we have enough?"
Me:  "We have adequacy."
Clinician: "Is it cancer?"
Me:  "It's suspicious.  I haven't seen enough of the groups my attending saw to tip the scales."
Clinician: "Can you tell me what it is?"
Me: "It's suspicious."
Clinician: "If you tell me that it's cancer, we can stop the procedure.  Otherwise we're going to have to go in and get a biopsy."
Me (sweating): "I can't call it cancer at this point."
Clinician: "Well, what would your attending think?"
Me: "Sir, if I knew what my attending thought, I'd be an attending."

Wait, what, already?

Fellowships?  Seriously?  Already?

If I haven't mentioned it before, pathologists are pretty much required to do a fellowship to get a real job in reality land and start paying off those monster loans.

I'm sure I've mentioned *that*.  What I should have mentioned, and been thinking of, is that you have to start applying for fellowships like... uh... now.  Yes, 18 months prior.  And I'm already out one fellowship because you have to start cranking out the paperwork even earlier than that (A program that rhymes with Who Be Ann Sancisco).  So now I'm in the eternal dilemma of whether I stay nestled in the safe bosom of a program that already has done well by me and where I know I like the cytopathology person, or whether I fly out, try to get an in back in my home state, or at least my home coast, and rack up some new experiences.

The fortunate thing is that fellowship applications don't cost money until you book a flight.  This contrasts to residency applications through our match monopoly which cost me 1800 dollars before I left my apartment.  The unfortunate thing is pathology fellowships are far less vetted, since there aren't all that many of us, so I'm throwing my applications into the abyss and hoping they want to grow me into a decent community pathologist, rather than using me for scutwork or ignoring me entirely.

Then the job hunt after that.  Then maybe, I can settle into being an adult with a job and a house and a place that's home rather than living the life of a perpetual student.  Not that I can really complain much other than the six figure debt leavings.

Scary though.  The last two years have flown by, and I by no means feel ready for the next step.  I'm just happy I don't cry during readouts anymore.

I'm at a weird stage though.  I don't feel ready to be independent but I feel far removed from it.  I was attempting to remember who wrote a poem quoted by my attending from a "college English class" and realized I was in college ten years ago.  The antics of the medical students seem immature and their questions weird, despite the fact that I needed to be shuttled home from a bowling alley as recently as two hours ago.  Yet I feel comfortable giving attendings from other specialties update reports.

I'm removed from a lot though.  No one really knows much outside of their own very limited experience so it's hard to know where to go for advice.  Within the hospital, you get "The job market is fine in this academic setting where I've been working".  The other residents are "I have a fellowship in 'x' secured and that's where I'm going, but I'm not an IMG or from California".  People at my level are in the same boat.  The advice on the internet is "JUMP SHIP!! PATHOLOGY IS DOOMED!!  OBAMACARE WILL HAVE US IN POVERTY!  DO ANOTHER SPECIALTY", which is disheartening, but unhelpful.

So I feel a little trepidation.  On the other hand, I think I have a good chance at securing a fellowship if I merely stay put (something not an option in medical school), good friends, a great boyfriend, and hey, kayaks.  So we'll see what happens.

Remember remember the month of December?

Because I certainly don't.  November... clinical chemistry.  The day after November.  Work.  8 AM on December 31.  No longer work.  Party downtown for NYE and then burn rubber for New Orleans before anyone else can page me.

I'll back up.  As I've mentioned previously, now that I'm a high and mighty second year (though since it's a four year residency, still a junior resident), I can take call.

I probably explained this in a previous post, but I'm too lazy to look back, so quick recap.  Most pathology residencies have people take call a week at a time.  You are on call starting at 5 PM on Monday night until 8 AM the next morning and that's the pattern.  You then take call from Friday at 5 PM straight through until Monday at 8 AM.  If there's a holiday during the week (like Christmas), it's like the weekend, you're on for that entire time.

There are two types of pathology call: AP (anatomic pathology) and CP (clinical pathology).  AP is the headache that frequently requires you to come into the hospital.  Surgery is running late or got scheduled on the weekend and they need tumor margins?  AP.  LifePoint has a potential donor kidney but needs to evaluate whether it's viable for transplant at 2 AM?  AP.  Medical autopsy between Friday afternoon and Sunday afternoon?  AP.  Patient is immunocompromised and may have a necrotizing fungus in their lungs?  AP.

CP is all the lab stuff.  Authorize nonstandard or nonindicated blood transfusion?  CP.  Transfusion reaction?  CP.  Stool cultures?  CP.  Oops, someone forgot to label a specimen may I pretty please oh please I swear I know it's the right patient, PLEASE let me come down and relabel it?  CP.  CP is far more likely to roust you from sleep at 3 in the morning, but typically requires a series of exhausted phone calls rather than rushing out the door with wet hair pulling your sneakers on.

For our first year of call, we are supposed to take AP and CP weeks separately so we don't get overwhelmed.  The thing is... you can have a call week with virtually nothing... maybe three phone calls for the entire week and one frozen section that keeps you at the hospital until 6 PM.  OR you can have your pager go off constantly, fill your weekend with complicated autopsies that you're forced to pause to deal with other calls.

For December, I was on my old friend surgical pathology, which really heats up at the end of the year as everyone attempts to get in their surgeries before they have to pay a new insurance deductible.  People also may also have a week off around Thanksgiving or Christmas or have it easier to arrange so they can put their surgeries then (making a depressing holiday, I'm sure).  So December was beating me to death in general.  Just to get to our own office Christmas party required two other residents tag teaming to get all my specimens handled by 6:30 P.M., which was a job that otherwise would have taken me until 10.  Boyfriend was cooking for me a great deal of the time.

But then Christmas week... that was my call week, as the second years tend to get the holidays.  We lost a resident to family stuff who was my co-call person, which meant either take both calls or cost someone their Christmas.  I figured how hard could it be, and had several reassurances that Christmas is a slow week which turns out to not be entirely true.

Here's the thing... the most junior people are the ones stuck on Christmas, present company included, which means the hospital runs at half staff with the lowest people on the totem pole, who are the most likely ones to be calling me with weird questions, a lack of justification for why they're calling me, and reasons for procedures like "My chief wants the values to be X".

So during the week of Christmas, my pager went off 41 times.  I had autopsies and frozen sections and SO many mislabeled specimens and bizarre requests.  As the week progressed and my grinchitude grew dire, I was pretty much saying no to anything that couldn't be considered irretrievable (like lumbar puncture specimens or brain biopsies).  I did the longest autopsy in the history of autopsies just because the darn pager kept going off.  I took to referring to it as "the wife" because it kept frigging nagging me.

My mom also got to be in town for Christmas, which unfortunately didn't leave me much time with her due to the above.  Unfortunately she got to see the absolutely least exciting/sciencey part of my job "What do you mean you didn't label a random urine catch?  No, you can't relabel it.  Yes, you do have to call the patient back." and not the good stuff.  She also saw me swear at my computer a lot since the apps you need to access really like to bug up when you're on a deadline.

During this time, keep in mind that except for the actual holiday, when you're taking call from home, you're still doing your normal duty hours, and except for Christmas Eve, it was kind of a nasty week.

So when I got off call at 8 AM on New Year's Eve and did the official hand off of my cases, I actually said "If anyone has any difficulty with anything I did last week, I don't want to hear it.  My first week of dual call... I am officially above criticism."  And to everyone's credit, I haven't heard a word about it.

But I handled it.  Gone is all the panicky nonsense from last year, replaced by an aggravation by heavy workloads and unrelenting paging, but I overall like my job and feel like I'm getting better at it, which is awesome.

NYE was pretty fun.  Ended up going to a party at a bowling alley/bar/arcade/silent disco (?), had a hotel downtown, and avoided getting completely ridiculous like I did last year (though in my defense, that was a few days after the house went).  But I knew I needed to be unhungover for the drive to Nola via Jacksonville because hooray.  Replaced my hurricane glasses that got torched last year, got some great cajun food up in Baton Rouge, where it's 15 dollars cheaper, and bummed around Frenchmen street listening to great live music that involved songs that were not hacked up covers of Play that Funky Music.

Came back to cytopathology, which I'm loving far more than I expected.  So in surgical pathology, they deal with larger specimens, at least biopsies, so you are not just getting a cell that may look cancerous, but it is in the context of the surrounding tissue architecture.  For instance, your body frequently gets violently pissed off about getting invaded by cancer, so even when you don't initially see the actual tumor cell, you see the surrounding reaction to it.

Cytopathology deals with single cells, either from aspirates from suspicious tissue so that if it's nothing, the patient is only subjected to a deep needle stick and not a full surgery, or fluids that aren't blood (hematopathology's territory).  For instance, urine is supposed to be relatively cell-free.  People with bladder cancer; however, may shed those cells into the urine where we see them and go "AHH  Bad Nucleus!".  Any fluid that's accumulating around the lungs or in the abdomen, we check for cancer or bacteria.

It's teaching me about problems at a cellular level so I'm getting to know the features to look for, which will help me for surgical pathology particularly for sneaky cancers like melanomas, which the surrounding tissue may ignore.

We also see patients when we go on aspirates.  Granted, we barely speak to them and we *definitely* don't tell them what we see other than "this specimen is adequate" since the last thing a patient wants to hear is a positive cancer diagnosis by way of a complete stranger looking into a microscope near your feet and going "Holy crap".  Rapport fail.  The process is important though.  We literally influence the number of times a clinical has to stick a needle into someone's neck.  And they get frustrated with us for it.

What else.. we had a sudden warm snap, which was awesome.  It coincided with a visiting Jersey friend, which led to a beach day, a failed surfing attempt (on my part; not on her part; that crap is harder than it looks), so she finished off the surfing day while I drank beach juice (tm) with Boyfriend and Friends.

So that's what I've been up to.  Another call week is heading up on me, so I'm throwing myself into restaurant week to go out with a bang.  Unfortunately, holiday baking + stressful month + no exercise due to workload + New Orleans + Restaurant Week = the next three months of broccoli and treadmills.

The holiday tweener

I'm not a huge Thanksgiving person.  I think it's because I like neither turkey or pilgrims a whole lot.  I generally only whine about Christmas stuff before Thanksgiving because that's about the level of Jingle Bells I can take without shooting mall Santas.

So roomie and I found ourself in the odd predicament of having our apartment fully decked out for Halloween, but then she and I are taking turns leaving through November, and her boyfriend (re: manual labor) was visiting last weekend, so for practicality's sake, we took down the vampires and tombstones and bloodstained "help" messages on the mirrors and replaced them with a fake Christmas tree, glowing lit up presents, and santas.

I'm oddly okay with it.  As long as there's no music.  It's an odd nostalgia.  I know I said I wouldn't talk about the fire anymore (mentirosa!!), but this was post fire.  I've mentioned before that due to the loving embrace of my colleagues and friends, it took at least a week for the whole business to even sink in, and this is part of why.  I got back home, I believe on the 29th, and new roomie picked me up from the airport and I moved straight in with her.  When I got to her house, not only did I have unexpected furniture, unexpected linens, and unexpected scrubs, but my new abode was completely decked out for Christmas, and these are all the same decorations that greeted me when I first arrived.

So I'm degrinched... but one too many Jingle Bells, and I'll snap.

Speaking of holiday stuff, I carved this pumpkin, and while likely inebriated, sent a picture of it to Poe's Tavern with the message "You make good burgers so I made you a pumpkin", not realizing they have an annual Poe themed pumpkin carving contest which I would have been able to enter had I waited until Thursday.  Ah well.

Halloween was on a Wednesday mid surgical pathology this year, so I did my festivities on Saturday, which included a joint work party/Skinful festival.  I was initially worried my costume was going to be inappropriate for the first, but arrived to the new chief's house to find the entire dining room done up as Dexter's kill room complete with a plastic wrapped blow up doll and her husband, convincingly dressed in the apron and holding a butcher knife, so I worried less about being family friendly.

I was initially going to go as one of four birds, others represented were a flamingo, a peacock, and a bjork-swan, and I had the brilliant plan of being a parrot with a pirate strapped to my shoulder, but upon further evaluation, since I can't sew, this plan was looking at costing me over 200 dollars, but this get up:

was 40.  I am so very cheap.

I got my fall cooking on.  I discovered how to make pumpkin cheesecake, which is the best trick ever, and then followed it up with some pork and squash and a pumpkin risotto.

October was also breast cancer awareness month, otherwise known as "the worst month to be on surgical pathology".  It also was "surgical chiefs go out of town leaving their underlings to attempt horrendous resections that involve five thousand frozens for no specific reason.  But I'm still getting a better hang of it from last year.  I'm starting to get comfortable with my own language on reports rather than desperately grasping for others over the course of hours "how do I phrase 'benign skin and granulation tissue with hemorrhage, acute inflammation, and edema'??"  I'm getting the hang of our very own Halloween trick, the introduction of a new and likely evil computer system, and the rest of it.  I finally found the answer to the question "what if a biopsy shows cancer, and you take the specimen, and you can't find any cancer, but you also can't find the clip or biopsy changes?"  The answer is "first, take all the wax filled cassettes you've put samples into and x-ray all of them at a less-than-thrilled cancer center.  Then, when you can't find it, take the formalin soaked remainder of the specimen, in small color coded pieces back to the even less thrilled cancer center, take countless x-rays of that until you find a clip the size of the head of a pin, and then resample that.

Oh, making friends.  And apparently when we're on surgical pathology, our specimens and us have such a combined aroma that we can be detected through the funk we leave on *other* people's clothing.  I've personally gotten so used to formalin that I don't really perceive the smell unless it's up against my face making my eyes water (it burns!!!) and a vague sense of hunger since it has that disturbing side effect, so no early med students, being hungry after anatomy lab does not make you a cannibal.

Still, clinical chemistry this month is providing a nice break and one that allows me to defect up to Virginia for a hiking trip for my birthday since Christmas will be at the beck and call of my pager.  I'm then going to turn around and go back for that Thanksgiving day and hopefully con some fondue out of the situation because blah, turkey.

Clinical chemistry involves relearning some chem, which is always a treat for me, but my daily activities consist of answering calls, mostly that involve mislabeling or not labeling specimens and I get the daily sob story for why I should allow blood that I don't know came from the patient to be assigned for the patient, and I get to read electrophoresis gels and calculate hemoglobin percentages to catch various hemoglobinopathies (sickle cell, thalassemia, SC disease, etc).  The gels are for a lot of things, but mostly I'm trying to find bands that could correspond with multiple myeloma or any other monoclonal blood cell proliferation that isn't supposed to be there.  It involves peering at a light board and interpreting a wavy graph and tables and then writing a series of important looking codes while signing it all illegibly with my doctor scrawl signature, so it feels very professional.

My lecture attendance is getting better; always a plus, despite having a series of 28 Days Later dread dreams where un-fun zombies chased me through the New York City subway system while killing all my friends.  I'm not exactly sure who did what to my subconscious, but it gets temperamental this way.  It's that thing where you show up at work either mad at your friends for dream-slights or panicked for your friends because you had a dream where they were standing drunk in a black evening dress and then they fell down the stairs and twisted their head all the way around like in Death Becomes Her.  Thanks brain, you sick freak.

I do love October

It's such a great month, that awesome combination of spookiness, good weather, fall, cooking stuff with pumpkin and cinnamon in it.  That's why I skipped blogging in September, you see, just because why?  It's not October, so I kept you on edge.  That, plus I'm lazy.  And was busy while work itself was not blog-interesting.

I'm making a pizza right now, because apparently that's something I can do now.  Mad props to my current roommate, my past two roommates, and the Smitten Kitchen for getting me beyond the scrambled eggs, steak, and ramen stage of my life.  So last effort with the pizza stone was this:

Not bad, eh?

What's awesome about both having a roommate and being an adult and no longer having all your stuff in a flaming pile is you start to accumulate kitchen stuff.  So today, making a pizza consists of throwing the ingredients together that I already have (including honey and white wine) rather than running out and spending more on ingredients than it would have cost to order a pizza.

This is also an awesome effect with the liquor cabinet.  As you gradually accumulate different kinds, you can start making impressive swanky cocktails and improvising new ones.  But it takes time to build without noticing, and once you get there, you feel awesome about it.

Or maybe I do.  I don't live places long.

Reminding me, since I mentioned the fire (when don't I), September brought about the last chapter in you or I ever having to hear about it again, and let me be the first to say "At fucking last" because good lord.

So here's that story.  Right after I returned from the conference (more on that in a bit), I'm back at work for like... three days, when I get a phone call that evening, a missed call from 3 PM that afternoon.  It was the victim's advocate saying the sentencing hearing that would be at 1:30 PM the next day (less than 24 hours notice), and oh, they wouldn't be seeking restitution because the "defense wouldn't go for it."

A long time ago on this blog, I described completely losing my shit and it was in Grenada at Air Jamaica on day 10 or something of aggressively denying me my bags when my loans simultaneously hadn't processed so I had no belongings and no money, so I finally just starting banging my fist on the ticket counter like Nikita frikking Khrushchev until they got tired enough of my yelling that I followed them back into security.  (Cautionary note: Do not do this at American airports for any reason.  You'll get tazed.)  So that's me flipping out.  It's pretty uncommon.  That may have been the last time it happened.  Now I've been overemotional and cried and self destructed and been bitchy, that's normal course.  But unleashing rage?  I hate confrontation.

So yeah, I flipped out.  Since it was after hours at the solicitor's office, I left a pretty choice voicemail, got home rage-addled and sent the advocate an email, cc'd to the solicitor (our DA), etc that was about two pages of my rights, and having to deal with this constantly, and make their case for them and I was tired of it.  That I have student loans and if I call their offices and say the "defense won't go for it", they won't just wipe my records clean and asked them why a convicted felon gets more rights than anyone with a car payment.  That sort of thing.  My big thing was that I haven't gotten anyone associated with the state or with this perp or his family appearing to give half a crap about any of this, and it's galling.

The solicitor responded with wanting to meet with me a half hour before, which kind of ignored my "short notice" point, but whatever.  I spent that morning with one of my seniors aggressively researching victims rights laws and trial stuff in South Carolina, which renewed my hatred of law which is both confusing and tedious.  I never understand "Doctor or lawyer?" versus "Doctor or biological scientist" since they're really different professions.

So I head to the hearing again with an armful of manilla folders full of printed stuff and a bad attitude, and so they spend a half hour talking me down.  Say they can't force the kid to work in prison, but they can make restitution a condition of his parole.  So essentially, once he's out, if he's not actively seeking (legal) work to help pay back his debts, it's a parole violation and he gets thrown back in jail.  And I'm like "Uh yeah, that's all I asked for."

So we wait for another hearing... the LAST hearing.  At first there's some like "Oh, they may postpone it again" which pissed me off again.  But then I overhear the family's attorney saying that they have the "nice judge".  I'm like "Not the nice judge!!  Give them the judge me that gave me the speeding ticket 2 weeks after the fire.  The mean judge."

We get in, same stuff... I have the opportunity to speak first, and choke/chicken, so the only other victim to show up goes first, thank goodness.  The girl that helped me research the law stuff kept saying "No crying, no cursing, no gesticulating", so I kept reciting in my head as the closest thing I get to a prayer.

I'm introduced as "Ms. Sancho" so we're off to a super start, though the victim's advocate corrected and stood up and said "This is DOCTOR Sancho" and I'm like "That's right."  I usually don't play the D card, but this is the occasion.

So my voice shakes a little, but then I speak a bit, and I'm already charged up by the night's crap.  I talk about my stethoscope, my car, my pictures, the dog, the dead cat.  I talk about medical textbooks.  I say I've heard neither a "sorry" or a "guilty" but have to come back again and again to hear the mother wail about what a good boy he is, but that he's not.  That he's demonstrated no regret or remorse whatsoever through any of his actions, without a care for people's rights or property.

The whole time the judge is looking at me and nodding sympathetically, which helped.  It felt empowering.  She asked me if I thought our lives would have been in danger if we'd been home and I tell her absolutely yes.  That boy-roomie might have gotten out by being on the first floor but that the two girls were on the rooms off the porch and the porch caught first.  That I came back to Houston with nothing but my bags.

I think my statement made the kid's mom cry, and I can't lie; I'm kinda proud of that.  Needless to say, she didn't stand up to give the "my boy's a good boy" talk for the thousandth time.  The father stood up and said "First off, I'm sorry" to me.  Which he derailed after that about fighting for his son, and accidents and bad kids and being the fall guy, but I was like "first time anyone has apologized to me since all this started."  After this statement, the solicitor merely says that the reason the boy is "taking the fall" is because he was bragging about it all at school.  How he did it.  So much for "accident".

At that point the judge starts talking and she is not happy.  The VA leans over to me and says "The judge lives downtown".  Downtown Charleston, for what it's worth, is exquisitely flammable.  All the houses are made of heartwood pine and crammed together.  And a few years ago, there was a massive factory fire that killed a bunch of people.  So the "oops, didn't mean it" factor found *no* love.  She kept on about how lucky the defendant was that people weren't killed because he'd be tried as an adult and no one would even think about seeing him before he turned 40, and that the only reason people weren't killed was luck.  So max sentencing.  With restitution assigned on release.  No recommended camps for troubled boys or the like.

So that's it.  We won.  No more last minute hearings.  No more delays.  No more "re-victimization" as the solicitor was putting it as I kept saying I just wanted to get on with my life.  This kid got what he deserved and I even got a half assed apology out of someone related to it.

I've never felt so relieved.  I went back to work on a song, hypercharged with the conclusion of it all and went out to have oyster shooters (my first!) with some celebrants.  I cannot say how good it is, after NINE MONTHS to have this all behind me.

I'm even starting to work on a future apartment, maybe fellowship, by having handy roommate teach me how to redo furniture from craigslist and garage sales and such.  So that in the future, I can really build a home.  I also now have renters insurance along with my (now cheaper) car insurance.

Good times.

This is getting long.  And I haven't started on San Diego.  But no more fire drama right?  Hooray!!!

All right, the conference was awesome.  Naturally, we engaged in scholarly studies for the entire five days so didn't really do much outside of mingle.

 

Well, I mean you have to have some fun, right?  The conference itself was good.  I went to some awesome hematopathology lectures, schmoozed a bit with future fellowship programs, and though people weren't really much stopping for my poster, I felt like it looked really good and like we did a good job, so that was great.

The hotel was gorgeous.  The Grand Hyatt is the one that dominates a great deal of the classic San Diego skyline, and the rooms were jawdropping.  I split one with two other colleagues.

The day I got there, one of my other colleagues and my attending were already there, so we registered, grabbed lunch, and headed to a brewery on Coronado Island via ferry.  The brewery was just aiight but great view, great time.  Met up with the girls as they arrived and went barhopping through the gaslamp district.  The next day, there was a big resident mingling thing, but a friend from my school was in town, so we headed out to the beach and drank in a bunch of the Pacific.  That night our attending took a huge crowd of us (including med school friend) out to a fancy pants restaurant where I stuffed myself full of good wine and scallops because life is good.  We hit a rooftop soon after.

Sunday was quite scholarly.  I had my poster in the mid morning-afternoon session so I hit a pretty solid peripheral blood smear conference in the morning.  There was a good bone marrow lecture on in the afternoon post-poster.  I was craving good Mexican food because I haven't had any in at least five years, so yelp helped me find a decent dive with amazing burritos so we hit it for lunch on Monday between conferences.  Tuesday, we hit a morning conference and a couple of us headed for the zoo, because come on, it's San Diego.  Apparently not only can you drink around the zoo, but they have microbrews because California is awesome.  Californian microbrews usually aren't awesome, but these weren't local.  Sorry Cali; your wine's still good.  At some point we ended up back on Coronado Island having strangely authentic NYC pizza despite looking like "Sbarros by the sea" but apparently they import their water.  Hooray snobbiness!

Wednesday was check out, so the entire trip was just a funly educational whirlwind, but what a great time.  Gotta do the conference thing more often.

What else?  I'm back on surgical pathology.  This may be where some of you recall my having a nervous breakdown last year and contemplating quitting everything because I felt unbelievably stupid.

I feel much more confident this time around, which is fortunate, because we've had a whole new software implemented to control everything and it is working *terribly*.  It's eliminating all of our paperwork, so now slides are going to the wrong people, slides are coming out super late, we're having to stalk specimens, and getting reports dropped.  So the last week has been hideous, busy, and stressful, but now that it's do to external sources than my own crushing insecurity, I feel okay with myself and my lot.  I'm getting interested in my specimens now that I understand more about them and feel like I might be a good pathologist.  Which is a great feeling.  We'll see if that dissolves into existential angst in the next couple of weeks.  Heh.

Well, welcome back readers.  Hope you're having an amazing October. :)