Still in the in between...

Not for blog abandonment; just for lack of things to say, really. Though I'm sure I'll remedy that with some rambling!

I got an email today saying I had US health clearance and that was being sent to the clinicals, which means, crossing my fingers, I may get my final placement soon! Woot!

It also means that someone at SGU was working on a Saturday at 9 PM. I'll let that sink in for a minute.


Ready?


My preliminary placement was for Brooklyn, which I really really want. Now, I'm in sort of a scared holding pattern for it, because I've been looking at housing, and it's freaking me out. Grenada offered the safety of the dorms to kind of satellite out the housing options in the area until you inevitably lost the housing lottery or went insane from the construction noise, so you could scurry out to an apartment and scurry back which offset the high cost of living and allowed you to get familiar with the area.

Of course, I say this with the comfort of someone that lucked into an apartment I really really loved that somehow wound up relatively cockroach free and proud despite being in the tropics. Others were not so lucky.

So now reality's back, and it needs a place to live in Brooklyn.

I realized that NYC housing would be a challenge, but figured I'd grown accustomed to astronomical housing rates due to Grenada and I don't have a problem with small spaces or lack of light. On that note, apparently, an apartment that doesn't have an actively running meth lab requires an application fee, a credit check fee, an income, a guarantor, your first month's rent, your last month's rent, a security deposit, and possibly a broker's fee, which is also equivalent to first month's rent. Possibly also your firstborn.

The problem? I don't get my loans until the start of clinicals and I've been off in neverland studying for the step 1, which doesn't give me 5000 dollars worth of free spending money to drop on my first month's rent when I was planning on a much more reasonable month's rent plus security deposit. It would, on an unrelated note, give me enough money to have a luxurious month-long diving holiday in Borneo though. Just saying.

It may get easier once I get the final word on the placement. For the time being, I think part of the stress is in the hypothetical. I can't start ferreting out roommates or arrange appointments until I have an active placement lest risk backing out on someone at the last minute, but I feel the burden of time ticking away, plus I'm in California, so I can't just alleviate my fears by going and *looking* at places, even casually, to get a feel for it in the interim. Google maps street view is helping somewhat. I'm also surfing craigslist, which is kind of inundating me with a billion apartments and roommate options, any one of which could prove either my dream apartment (meaning no roaches, reasonable distance to the hospital, and internet), or could provide me with the opportunity to have to utter the phrase: "Officer, I swear it's not mine!!" or worse, "Why am I in a bathtub full of ice?"

So I've got a little case of the cold feet.

On a not "holy crap I need a place to live" note, I headed up to the little town of Columbia, CA yesterday, which is a pleasant little gold mining town from the wayback that reminds me of a more mountainous version of Old Sacramento. Then, since it was pouring and I was carrying more than one portable electronic device, I headed to the Moaning Cavern, which probably has the distinction of being the only cave in gold country without gold. Since I dislike yellow gold and like limestone, I consider this a plus. It also has the distinction of having a number of people fall through it's cleverly disguised top opening over the last few thousand years, so when it was formally discovered, there was a pile of bones at the bottom of a 160 foot drop. Kind of a "we are the world" moment when you realize the number of people over the centuries that shared the exact same "walking through a fiel ahhhh" moment regardless of class, culture or creed.

For something that's been a tourist attraction since the gold miners went "hey, there's no gold here", it's actually not hokey, the cave itself is gorgeous, and the winding spiral staircase that goes down is old (but tested) and made out of a recycled ship, so I got a more authentic feeling out of it, which I appreciated.

I also got to meet an awesome fellow-guitar player that lives and works up there, so that was a highlight.

Diving on Tuesday, aka Cinco de Mayo, so we'll see what my return to cold water diving after nearly 3 years looks like. I'm guessing it'll involve a lot of shivering.

We're talking mega-ecstasy-bliss

So I was going to write an encouraging blog post about the major depressive episode that is the last few weeks leading up to taking the Step 1, but then some housing stuff went foul for a couple of days and I found myself envying the dead again, so it seemed like a poor time.

But that's resolved, and now... holy crap, there's nothing left to study. I have very very few responsibilities for the next few weeks other than those shared by the general population. It is indescribable.

It's not like right now my life has undergone such a drastic change. I don't know people very close by, I'm lazily packing up my apartment to spend a few weeks back in Cali before the march to Brooklyn, trying to struggle through the school's deathweb of red tape, and spending a lot of time vegetating in front of my laptop.

But prior to the exam, I was experiencing a depression that was creeping up insidiously. Started with just an "oh, I'm sick of studying", but it wasn't even so much that, since I actually liked most of the material I was reviewing and stuff was beginning to mesh together and make sense in ways it hadn't before.

No, it's more that there is this constant and unending pressure. ANY time I wasn't studying, I felt guilty. Days off, I felt guilty. Taking too long to go to sleep. Felt guilty. Watching tv. Guilty. Talking to my family. Guilty. Walking the dog. Guilty. And gradually, while not feeling actively miserable, I was experience what I would call a "happiness black hole" in which normal situations that would induce pleasure no longer did. So I would go out, take my dog for a walk in a beautiful night, look up at the stars, look out at the river near my house, and then walk him up to the town hall, which is still lit up and old style Dickenesque, and think "huh".

And not even "I need to finish off the glycolytic pathway by noon tomorrow so I can get started on the..." or being *distracted* from what I was seeing, since I was far too braindead for contemplation, but more "Hmmmm. That used to make me happy. Ah well." And walk home.

It's sort of like I bypassed acute panic because you just can't suffer from it for 10 weeks or your heart will explode, and went beyond it. Even the morning of the exam or the night before wasn't panic so much as just a more elevated tachycardic depression.

I would recommend after the exam, NOT suddenly having your personal life go to shambles, because it makes the transition more confusing, and that tingling peripheral neuropathy in your limbs and tightness in your chest sticks around.

But then... ahhh... It's beautiful. I enjoy the taste of food again. I enjoy the church bells I can hear from my bedroom (yes, I am currently living in a town *that* quaint).

In the meantime, I'm preparing for yet another fantastic birthday adventure provided by Dave, so I get to meet him this weekend in New Orleans, also notable as being one of my favorite cities outside San Francisco and Prague. Upon my arrival back, I'll be piling into a car and driving cross country (again!). It'll be on I-40 this time, so I'm guessing I'll amass a lot of pictures of bleak nothingness. On the good side, I think the scenery is generally so uninteresting that you're legally allowed to bury the needle on whatever car you're driving to make the time go faster.

My "task" at the moment other than packing, consists largely of sorting out my health forms for SGU. They changed the TB requirements from two in a year (which I had) to two in six months (which I didn't), necessitating two TB tests in two months.

Ohhh, and my varicella titers aren't sufficient (A-FREAKING-GAIN, I can't get chickenpox! Just accept it and stop charging me astronomical amounts of money to stab me in the interest of preventing a disease no one gives a crap about!). Oh, and my still-not-two-years-old mumps part of my MMR underachieved too. I hate my stupid antibodies. Except the Hep B ones; those RULE.

This is also relevant because (and fortunately by harassing the nurse I got this info), had I gotten the MMR and V vaccines *1st* as I initially intended, this would have negated the TB test for the next 4-6 weeks, which is definitely relevant since I NEED TO START CLINICALS THEN. Sigh.

Also fun is that one overpriced chickenpox vaccine isn't good enough; I need two, and they need to be 30 days apart, which starts to cut it close... which adds to the fun because no one wants to give a varicella vaccine to an adult, so even finding a place to overcharge you for it is a rare thing.

I got my TB test read today after spending 48 hours willing there to not be a mark. The one I got a month ago reacted so little, I finally just circled it because you couldn't see where the hole had been. This one got the proper wheal when it was inserted and then... freaking stayed red for a while, so I'm just going "if you false positive me and I have to then arrange a stupid chest x-ray on top of everything else, I am going to cut that section out of my arm."

It was impressed, and retreated. 0 mm! Suck it!

I've also been faxing the physical and first TB test, the receipt from the testing facility for the USMLE, completing my MPNs and all that other fun stuff that reminds me why I wanted to be a doctor and not jobs that involve mass quantities of paperwork. Oops, except doctors do. I also got to do the NY health requirement CE course, a newly introduced (after last term was up) cultural sensitivity class the school made up. This is particularly important because if you are SO thick that you can't become culturally sensitive after attending a medical school that has representatives from like 150 countries, that is actually located in another country, I'm sure a last minute online class administered in your USMLE study period will cement in the love-of-fellow-man. Oh, spoiler alert... if your patient has not-Western-medicine beliefs and you like, point at the patient and openly mock his culture, religion, and ways, that may harm patient communications, and could, potentially, get you sucker punched by a holy man. I hope that doesn't constitute giving away answers.

Oww!

I'm attacking SGU's health history forms, and since I'm currently coughing up for Kaiser (I work through a staffing agency, aka a temp agency, thus don't have health insurance, though I'm told I am entitled to steal office supplies), I discovered the wonder that is 'free' vaccinations.

I also discovered that my ovaries *do* work when it comes to bargain hunting, so I said "Fill er up!" Gimme any damn vaccine you have. I even want the smallpox vaccination... because you never know. Didn't have that one though. I did opt out of the Yellow Fever vaccine, because when "multi system organ failure" is listed as a side effect, I figure I'll spring for the mosquito netting, plus I didn't want to run a 25% chance of being nasty sick for the next 2-5 days. I've got packing to do.

And not to worry, Grenada doesn't have Yellow Fever, but I was thinking of impromptu island hopping and a possible trip into Venezuela because I'm a geek for the rainforest stuff... and not just the gorgeous tropical island variety, but the "microscopic brain slugs and jaguars" variety... all of course when I'm not burning countless hours of med school info into my retinas. I wonder if I could do the reading with a microscopic brain slug... while being attacked by a jaguar...

But I digress.

What this means is after shots for typhoid, tetanus, Hep A, Hep B, and two pretty nasty blood draws from a PIT (Phlebotomist In Training) to check my titers, I feel like I've lost a fight. Oh, and to other Phlebotomists In Training, saying "Why isn't it... Shit... is it the tube? Dammit... I'm gonna try using a smaller needle" isn't comforting... No lie, direct quote, and couldn't you have used a smaller needle to begin with?? It's bad when a blood draw hurts 10 times more than a tetanus shot. Oh, and if you miss the vein, PLEASE PLEASE PLEASE just let it go and restick me as you will eventually need to do rather than rotating the needle 180 degrees in an attempt to rend as much of my flesh asunder as you can before leaving your newly created paint gun cartridge hit-sized bruise on my arm?

Oh, funny side note... while the nurse that gave me the shots (not the PIT) was looking over at something, I leaned slightly out of my chair to 'surreptitiously' look at my file, and she spun around like Bruce Lee, and grabbed for me with big eyes, soon closely matched by mine, because she startled the hell out of me. So don't lean slowly out of your chair when you get your shots because the nurses will think you're passing out and will try to rescue you. Heh.

And I'm due for a full physical, a flu shot (it's free! Free free free free free!), the meningitis vaccine (it's free! Free free free free free!), and a TB test on the 7th.

SGU requires the TB test (it would like it 6 months in advance, or so they claim, but I didn't even GET the health forms 6 months before January), titers for MMR-V (immunization record isn't enough), a tetanus shot in the last ten years (and you need the batch number), and the Hep B series. You don't need the Hep B series to register, but it needs to be complete before you start rotations (and the last shot is six months behind the second one), and again with the free.

You also have to either get a meningitis shot, or say that you are aware of the meningitis vaccine and don't want it because it's usually frigging expensive, and sign off on it. You can't do that with the others. Something about infecting patients, plus I'm sure they don't want you to get anything that will cause you to drop dead before paying off all those loans.

Hep A and Polio are on the recommended list. I opted for Hep A because I'm shameless about what I'll eat (well, within reason; get your minds out of the gutter) and I will eat street meat with impunity though the concept of how one gets Hep A through eating street meat is disgusting (mmm microscopic fecal matter).

Kaiser, in their infinite wisdom, or because they read the above, also gave me a pre-emptive Cipro prescription for the inevitable "bacterial traveler's diarrhea". I'm not going to South America, so I suppose it isn't Montezuma's Revenge... Carib Indians' Revenge? Boo hiss...

All right all right. Enough. Back to packing, and to enjoying the last few days of lumbar supported slumber, since I have a buyer for my bed, which means fortunately, I haven't sold that sleeping bag yet!