Uno mas

So I hate Tampa.

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

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

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

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

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

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

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

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

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

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

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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

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.

Fellowship Achieved!!!!

Huzzahs and the like.

It's strange; a fellowship is a one year commitment where you're not paid much more than a resident, and gives you no guarantee of a full-time position, and yet the overwhelming relief of being able to somewhat relax and focus on my studies and my patients since I now have employment through mid-2016 is pretty great.  I still want to build up my CV and go to conferences,  but now I'm not scrabbling to get publications in during a surgical pathology month because applications are due.

I'm really happy with where I'm going, and I'm really happy with the responses to my applications.

Essentially, I had a fairly solid bet of a cytopathology fellowship at my home program, which is groovy and kept the application process from being as stressful as it could have been (or as expensive, since it meant I only applied to programs that I thought could be a step up from mine rather than "any job"), and my attending pulled me aside to tell me that I was safe, but that I should fly out of the nest if possible to get different training.

But I didn't apply to enough medical schools, particularly for my stats, which weren't bad, but not good enough to put all my money on the California schools, which I did.  I went to SGU, as you know, which is a decision that may be pretty darn expensive, but I don't regret.

I did learn my lesson for residency.  Despite going through the hellishly expensive ERAS program, I applied to 51 programs, got mid 20s interview invites, went on 16 interviews (gah), and ranked 14.

Fellowship, I hedged more, despite it not yet being an ERAS process for most pathology fellowships (thank the gods), and applied to six, two of which I didn't expect a response from, and the four that I was hoping for all offered an interview, and the three where I went (including home), expressed a strong interest in me.

It was hearsay until now, but I do feel like the Caribbean stigma decreases with each stage of training.  Though make sure all your stuff is in order because your biggest skill will need to be your unofficial degree in red-tapeology.  I had a couple of days of sweating for the program where I'm going because some of my rotations weren't greenbook according to this particular state.  For those of you heading for your fourth year clinical rotations, that means doing your rotation in a program that has a residency program *with that residency*.  In other words, orthopedic surgery needs to have ortho residents, not surgery residents.  Most states either don't care at all or allow umbrella coverage (ortho and anesthesia could be covered by a program having a surgery residency) and you should know what those states are, how many weeks are required, and what extra requirements you need.  And if you say "I'll never live in that state", you'd be surprised.

So it's going well.  Also, start all paperwork processes early.  Way earlier than you think you need them.  You need weird extra paperwork or your home state takes 8 weeks to send a birth certificate?  Apply near the deadline, and that's sweat and tears.  Apply 18 months early, and it's vaguely annoying.

Medical school feels farther away.  I'm not sure what Grenada is up to lately, or how much the resources around the school have been built up.  I remember all the residents' and attendings' names from third and fourth year and remember smiling and chatting with the in the hall five months after my rotation, and only am aware now that those residents largely had no recollection of me at all, saw the short white coat, and had the same "how are applications going for you?" conversation that is always a safe bet, because that's exactly what I do now when they wave and smile at me in the hall.  They rotate for two weeks, maybe a month, two or three at a time.  I get that difficult "Oh... um... tomorrow I have a lecture/interview/blood draw/drug test/dean meeting?" question that I remember finding so hard to ask because I was afraid my residents would think I wasn't interested in the rotation and realize now that oh my god, we don't care at all.

I still try to teach them, advise them, show them what I'm doing geared to their specialty, and not scut them too much, but I'd be lying if I said that I didn't call them "short coat" or "medical student" when I'm addressing them if their name tags aren't showing.  We tend to reference them by appearance "hey, did you have giant medical student?  He was amazingly helpful."  Or "Did you have Harry Potter med student?  He wouldn't stop checking his Pinterest app for the entire sign out".  Then I wonder if I had a designation as a medical student, or if I'm the jerk resident that every medical student hates.

I briefly contemplated tutoring the MCAT when specifically asked to, because hey, free money, and upon a rudimentary glance at the study materials, realized there is absolutely no way.  Friction on a bike tire?  Seriously?

Cytopathology is going well, despite constantly having to ditch out on my chosen specialty to fly to interviews, since I thought invites would come *way* later than they actually did.  My attending has been very understanding about it, fortunately.  I managed to complete a successful FNA without bungling it or upsetting the patient.  I'm upping my reading now.

So it's good.  Things are good.  Life is pretty good.

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.