Hiya guys, lots of stuff lately conspiring to keep me from you. My dad's in the hospital again, my computer's internet has been completely disabled by ZeroAccess and Combofix can't seem to restore it, I'm sick, and I've been in Costa Rica, but now I'm in Maryland with my mom. And then there's the whole doctor thing.
Happy Thanksgiving/murder a hypertrophic chicken day. Specific updates to follow at some point.
Nov 25, 2011
Oct 30, 2011
Happy Pre-Halloween!
I'm stuck inside doing a PowerPoint presentation for Halloween, so figured I'd share some Joss Whedon vaguely Halloweenish action with you guys, since it distracts me from having to screw with fonts.
Enjoy.
Enjoy.
Oct 28, 2011
I'm proud of us as a species...
Last night, I feel like I watched human accomplishment summed up neatly into a three hour window.
You see, RockStar and I decided to watch a horror movie, being all close to Halloween and everything. Since Netflix inexplicably didn't have access to the Ring, despite it turning nine years old this year, we watched Night of the Living Dead.
Then we watched the first episode of the Walking Dead.
Evolution in action people. It's not like Night of the Living Dead just has bad special effects. I feel that's an unfair accusation to lodge against the past. Just everything about zombie culture has improved so significantly. Even our fictional media response. In Night of the Living Dead, we get "The murderers... they seem to be feasting on their victims... more on this as it unfolds", and despite my unfavorable view of our current media, I feel fairly confident that after one morgue attendant got dragged screaming to his death, the first headline would be "HOLY CRAP, ZOMBIES. F'ING RUN. IT'S TOTALLY ZOMBIES. HEADSHOTS KILL THEM"
I object to sequences such as the following:
Useless woman watches nearly equally useless sibling get murdered by zombie while pathologically not helping. Woman eventually runs and trips over high heels, because... chicks, am I right?
Time elapses. Woman is on ground. Woman is not getting up. More time elapses. Woman is screaming and kind of shuffling around. You're like "Aw, that's sad, she must have broken her tibia." Eventually woman gets up and runs like a deer. The directing required to fix this oft repeated scene seems like it would be easily repaired by going "Okay, now fall and then start running again. Like maybe as fast as someone who was out for a casual jog would if she tripped and got up."
Then someone chucked a molotov cocktail about a foot from a car they were using. This is why the younger generation thinks people from the "past" are dumb. This is our resource for behavioral studies on people from the 60s and 70s. Not a good legacy.
I feel like this is a better source for remastering than say... adding a big "NO" to Star Wars. Just saying.
So then Walking Dead... which is frigging awesome. Good cinematography, good acting, still enough human stupidity to be believable. Zombie-win. And it's a network show too, which blows me away. I've been watching a ton of movie channel shows lately and have forgotten what's allowable on network tv so naturally when a small girl holding a stuffed animal gets shot in the forehead in the first five minutes of the first episode, I was like "Hmm, HBO or Showtime?" Nope. I'd just forgotten how much violence we're willing to tolerate at the expense of frontal nudity. But I watch Dexter, so I'm okay with it.
Speaking of zombies, I may have mentioned this, but I've come to grips with the fact that if there is a zombie uprising, I'm dead. Like first 15 seconds of the movie dead. I'm the one in the white coat mucking around the hospital morgue that's like "What's that soun... ARRRGHHHHHHHH!!!!"
When I'm a zombie though, I'm going to totally bite our dog. Because you know what's cooler than a zombie? A zombie with a zombie rottweiler.
ANYway, I'm still in blood bank. Hooray! Blood bank is giving me some interesting "You learn things by teaching" moments. Many of the principles behind what the blood bank does are confusing. Extremely confusing. I'm learning them now as part of the whole rotation, and I have a great instructor and lots of packets to aid my learning.
As the first year resident, when I have the pager, I'm the first one people talk to. I'm not the *last* one people talk to, thank goodness, but I'm the gatekeeper, only *I* get asked the riddles. I'm the anti-sphinx.
In clinical medicine, you largely talk to patients. This is a mixed blessing because the level of patient understanding ranges from not knowing what a liver is and why drinking antifreeze should not be a cost effective alternative to vodka, to being experimental pharmacologists that realize my puny knowledge of antibiotics is inadequate. But *most* patient interactions involve de-med-schoolizing your knowledge to an audience that didn't attend medical school while med-schoolizing their symptoms to arrive at a diagnosis and management plan.
In blood bank, I talk to doctors that almost exclusively are higher on the food chain than I am, and techs that should be. When I'm asked questions, it is almost exclusively stuff I either flat out don't know, or think I know until I start trying to explain it to someone with a medical degree.
Ideally:
Ishie studies material and periodically checks the internet. Pager goes off.
Ishie: "S***" (checks pager. Sees blood bank number)
Ishie: "Whew." Dials.
Blood bank tech: "This is what needs to be done but someone with different letters after their name has to say it needs to be done. Do it."
Ishie: "No problem!" (does it, calls back blood bank)
Ishie: "I did it! They say it's cool."
Blood bank tech: "Good girl. You get a cookie."
Ishie: (wags tail happily)
Sometimes:
Ishie studies material and periodically checks the internet. Pager goes off.
Ishie: "S***" (checks pager. Sees foreign number.)
Ishie: "Double S***" (dials)
Senior resident/fellow/attending in other specialty: "Yes, this is Dr. ScaryName. We have an extremely sick patient named Joe PleaseDontDie, medical record number IHopeYoureHoldingAPenInYourHand and we've already done all the stuff that you learned about in medical school and most of the stuff you've learned about in blood bank, but now we need to know if we need really hard-to-get blood products, or if we can use this type of blood product that you read about a little while ago, but it involved a lot of letters and numbers and while you feel kind of okay about it, you definitely don't feel qualified-to-give-expert-advice okay about it?"
Ishie: "..."
Dr. ScaryName: "Hello?"
Ishie: "Uh... so what is the patient's relevant blood value?" (starts hastily flipping through stacks of papers and pulling up patient history and labs)
Dr. ScaryName: "DangerouslyLowNumber"
Ishie: "Oh! Yeah, that's pretty bad."
Dr. ScaryName: "So... what should we do?"
Ishie: "Vasovagal syncope is mediated by the autonomic nervous system"
Dr. ScaryName: "Did you see that on Scrubs?"
Ishie: "... yes."
Ishie: "Umm... I think you should... let me clear this with my attending first. Are you going to be at this number for a minute?"
Dr. ScaryName: "No. I have to go see sick people."
Ishie: "Ah... well... let me page you in a minute." (hangs up, dials attending)
Attending: "Hello?"
Ishie: "Daddydaddydaddydaddy, this really smart doctor called me and asked me a bunch of questions and I don't want to accidentally kill anyone and then I scraped my knee and the neighbor boy made fun of me."
Attending: "There there. Do this thing. You see, this antibody is causing the problem, but we will need to talk to the Red Cross and they will find a donor and patient will be far less likely to die."
Ishie: "Cool! Thanks!" (confidently gets back in touch with Dr. ScaryName)
Ishie: "Do this thing! You see, this antibody is causing the problem, but we will need to talk to the Red Cross and they will find a donor and patient will be far less likely to die."
Dr. ScaryName: "Okay, thank you. That is very helpful. One question, just in passing... How would that antibody arise when patient was negative for it last time, but we don't have a record of previous transfusions?"
Ishie: "Well what happens is when a patient..." (knowledge decay)
Dr. ScaryName: "Hello?"
Ishie: "Dammit!"
Then I get home from work. This gives me another opportunity to learn by teaching smart people because my roommate will be all "how was your day" and I'm like "incredible (blood bank on a bad day is less exhausting than surge path on a good day) though I had a rough call towards the end of the day" and she'll ask me what happened and then it starts over again, but now I'm explaining the situation to an intelligent layman, so then I realize how incredibly convoluted the entire thing sounds. Blood involves a lot of really difficult concepts to grasp so I found myself at the end of the evening struggling to remember what blood group antigens typically do since most of them have some nebulous function beyond being your body's self destruct button if someone with different blood attempts to help you.
For example... did you know there are different blood groups? Of course you did! You guys are hardcore. ABO, no problem. You may know what blood type you are. You rock stars even know about Rh stuff I bet. Did you know the whole Rh positive negative thing consists of several different genes closely linked, any of which can be different and create conflict? Neither did I. Duffy blood group? MNS? Lutheran? Lewis? Kell? Some are IgG. Some are IgM. Some are IgMs that act like IgGs. Some aren't important. Some *usually* aren't important until they become important. Some bacteria like to temporarily screw around with your minor blood groups because bacteria are bastards, have been here longer than you have, and resent you because your DNA is all locked up in a nice looking nucleus acting like it's better than they are.
Fortunately, I'm surrounded by awesome people that don't make me feel as dumb as I possibly am AND I don't have to take too many calls per day because everyone's pretty good at this stuff and the hard stuff doesn't come up *that* much. But it's still some serious brain strain. Either that, or I'm already a zombie.
You see, RockStar and I decided to watch a horror movie, being all close to Halloween and everything. Since Netflix inexplicably didn't have access to the Ring, despite it turning nine years old this year, we watched Night of the Living Dead.
Then we watched the first episode of the Walking Dead.
Evolution in action people. It's not like Night of the Living Dead just has bad special effects. I feel that's an unfair accusation to lodge against the past. Just everything about zombie culture has improved so significantly. Even our fictional media response. In Night of the Living Dead, we get "The murderers... they seem to be feasting on their victims... more on this as it unfolds", and despite my unfavorable view of our current media, I feel fairly confident that after one morgue attendant got dragged screaming to his death, the first headline would be "HOLY CRAP, ZOMBIES. F'ING RUN. IT'S TOTALLY ZOMBIES. HEADSHOTS KILL THEM"
I object to sequences such as the following:
Useless woman watches nearly equally useless sibling get murdered by zombie while pathologically not helping. Woman eventually runs and trips over high heels, because... chicks, am I right?
Time elapses. Woman is on ground. Woman is not getting up. More time elapses. Woman is screaming and kind of shuffling around. You're like "Aw, that's sad, she must have broken her tibia." Eventually woman gets up and runs like a deer. The directing required to fix this oft repeated scene seems like it would be easily repaired by going "Okay, now fall and then start running again. Like maybe as fast as someone who was out for a casual jog would if she tripped and got up."
Then someone chucked a molotov cocktail about a foot from a car they were using. This is why the younger generation thinks people from the "past" are dumb. This is our resource for behavioral studies on people from the 60s and 70s. Not a good legacy.
I feel like this is a better source for remastering than say... adding a big "NO" to Star Wars. Just saying.
So then Walking Dead... which is frigging awesome. Good cinematography, good acting, still enough human stupidity to be believable. Zombie-win. And it's a network show too, which blows me away. I've been watching a ton of movie channel shows lately and have forgotten what's allowable on network tv so naturally when a small girl holding a stuffed animal gets shot in the forehead in the first five minutes of the first episode, I was like "Hmm, HBO or Showtime?" Nope. I'd just forgotten how much violence we're willing to tolerate at the expense of frontal nudity. But I watch Dexter, so I'm okay with it.
Speaking of zombies, I may have mentioned this, but I've come to grips with the fact that if there is a zombie uprising, I'm dead. Like first 15 seconds of the movie dead. I'm the one in the white coat mucking around the hospital morgue that's like "What's that soun... ARRRGHHHHHHHH!!!!"
When I'm a zombie though, I'm going to totally bite our dog. Because you know what's cooler than a zombie? A zombie with a zombie rottweiler.
ANYway, I'm still in blood bank. Hooray! Blood bank is giving me some interesting "You learn things by teaching" moments. Many of the principles behind what the blood bank does are confusing. Extremely confusing. I'm learning them now as part of the whole rotation, and I have a great instructor and lots of packets to aid my learning.
As the first year resident, when I have the pager, I'm the first one people talk to. I'm not the *last* one people talk to, thank goodness, but I'm the gatekeeper, only *I* get asked the riddles. I'm the anti-sphinx.
In clinical medicine, you largely talk to patients. This is a mixed blessing because the level of patient understanding ranges from not knowing what a liver is and why drinking antifreeze should not be a cost effective alternative to vodka, to being experimental pharmacologists that realize my puny knowledge of antibiotics is inadequate. But *most* patient interactions involve de-med-schoolizing your knowledge to an audience that didn't attend medical school while med-schoolizing their symptoms to arrive at a diagnosis and management plan.
In blood bank, I talk to doctors that almost exclusively are higher on the food chain than I am, and techs that should be. When I'm asked questions, it is almost exclusively stuff I either flat out don't know, or think I know until I start trying to explain it to someone with a medical degree.
Ideally:
Ishie studies material and periodically checks the internet. Pager goes off.
Ishie: "S***" (checks pager. Sees blood bank number)
Ishie: "Whew." Dials.
Blood bank tech: "This is what needs to be done but someone with different letters after their name has to say it needs to be done. Do it."
Ishie: "No problem!" (does it, calls back blood bank)
Ishie: "I did it! They say it's cool."
Blood bank tech: "Good girl. You get a cookie."
Ishie: (wags tail happily)
Sometimes:
Ishie studies material and periodically checks the internet. Pager goes off.
Ishie: "S***" (checks pager. Sees foreign number.)
Ishie: "Double S***" (dials)
Senior resident/fellow/attending in other specialty: "Yes, this is Dr. ScaryName. We have an extremely sick patient named Joe PleaseDontDie, medical record number IHopeYoureHoldingAPenInYourHand and we've already done all the stuff that you learned about in medical school and most of the stuff you've learned about in blood bank, but now we need to know if we need really hard-to-get blood products, or if we can use this type of blood product that you read about a little while ago, but it involved a lot of letters and numbers and while you feel kind of okay about it, you definitely don't feel qualified-to-give-expert-advice okay about it?"
Ishie: "..."
Dr. ScaryName: "Hello?"
Ishie: "Uh... so what is the patient's relevant blood value?" (starts hastily flipping through stacks of papers and pulling up patient history and labs)
Dr. ScaryName: "DangerouslyLowNumber"
Ishie: "Oh! Yeah, that's pretty bad."
Dr. ScaryName: "So... what should we do?"
Ishie: "Vasovagal syncope is mediated by the autonomic nervous system"
Dr. ScaryName: "Did you see that on Scrubs?"
Ishie: "... yes."
Ishie: "Umm... I think you should... let me clear this with my attending first. Are you going to be at this number for a minute?"
Dr. ScaryName: "No. I have to go see sick people."
Ishie: "Ah... well... let me page you in a minute." (hangs up, dials attending)
Attending: "Hello?"
Ishie: "Daddydaddydaddydaddy, this really smart doctor called me and asked me a bunch of questions and I don't want to accidentally kill anyone and then I scraped my knee and the neighbor boy made fun of me."
Attending: "There there. Do this thing. You see, this antibody is causing the problem, but we will need to talk to the Red Cross and they will find a donor and patient will be far less likely to die."
Ishie: "Cool! Thanks!" (confidently gets back in touch with Dr. ScaryName)
Ishie: "Do this thing! You see, this antibody is causing the problem, but we will need to talk to the Red Cross and they will find a donor and patient will be far less likely to die."
Dr. ScaryName: "Okay, thank you. That is very helpful. One question, just in passing... How would that antibody arise when patient was negative for it last time, but we don't have a record of previous transfusions?"
Ishie: "Well what happens is when a patient..." (knowledge decay)
Dr. ScaryName: "Hello?"
Ishie: "Dammit!"
Then I get home from work. This gives me another opportunity to learn by teaching smart people because my roommate will be all "how was your day" and I'm like "incredible (blood bank on a bad day is less exhausting than surge path on a good day) though I had a rough call towards the end of the day" and she'll ask me what happened and then it starts over again, but now I'm explaining the situation to an intelligent layman, so then I realize how incredibly convoluted the entire thing sounds. Blood involves a lot of really difficult concepts to grasp so I found myself at the end of the evening struggling to remember what blood group antigens typically do since most of them have some nebulous function beyond being your body's self destruct button if someone with different blood attempts to help you.
For example... did you know there are different blood groups? Of course you did! You guys are hardcore. ABO, no problem. You may know what blood type you are. You rock stars even know about Rh stuff I bet. Did you know the whole Rh positive negative thing consists of several different genes closely linked, any of which can be different and create conflict? Neither did I. Duffy blood group? MNS? Lutheran? Lewis? Kell? Some are IgG. Some are IgM. Some are IgMs that act like IgGs. Some aren't important. Some *usually* aren't important until they become important. Some bacteria like to temporarily screw around with your minor blood groups because bacteria are bastards, have been here longer than you have, and resent you because your DNA is all locked up in a nice looking nucleus acting like it's better than they are.
Fortunately, I'm surrounded by awesome people that don't make me feel as dumb as I possibly am AND I don't have to take too many calls per day because everyone's pretty good at this stuff and the hard stuff doesn't come up *that* much. But it's still some serious brain strain. Either that, or I'm already a zombie.
Oct 10, 2011
A quick and unrelated gripe
since work is going so well. My blood bank attending is super cool and is a man who spent most of my first interaction with him talking about falconry because as the saying goes, you may think a man is awesome, but you don't KNOW he's awesome until he talks about being in Ireland with a giant f-off bird sitting on his wrist. He spent today going into exquisite detail about blood groups and (drumroll), I actually understood him. This is stuff I didn't even bother trying to learn in medical school because it's so complicated. And... I'm liking it. Between this and veering toward hemepath, I may end up being *that* pathologist.
Speaking of blood, that leads me to my latest gripe. My beloved Dexter is back on, and has named my car. And I love the movie channel shows because they seem to be much better in quality than the other shows, plus, hey, bonus sex, violence, and profanity.
Problem being that these shows often go on extremely extended breaks since there aren't as many episodes in a season, thus spend the entire first 1-2 hour-long episodes expositing awkwardly while having conversations no sane person (or serial killer) would have.
"Remember, we want to go back to being friends again."
"Yes. Like before the divorce."
"Yes, before when we were just friends, but then friends that did it, but then got married, but then got unmarried and hit the reset button."
"I would like that very much. Let's talk about the paths our careers have taken over the past year even then we've both presumably been here every day and have seen each other."
"Yes indeed. I would like that a lot. Isn't it a shame about all those significant events in the last five years that have happened to our friend?"
"Yes! And our tech has interns! He is so wacky. I like how he is sexist but in a benign and humorous way."
"Me too!"
"He is such a quirky contrast to our other friend who is totally normal."
"Yes, it's a shame our normal friend keeps disappearing late at night to go fishing. And says weird pointed things out loud while staring off into space and talking to his dead father about suspected killers who keep vanishing."
"And how!"
"Isn't it great how we're no longer sexually attracted to each other?"
"Sure is!"
Gods, make it stop. If new viewers want to know what happened for the last five years they can:
A. Watch the first "previously, on movie channel show" bit that's like ten minutes long.
B. Reference a Wikipedia page that will cover all the plot points, probably feature pictures of the major characters, and possibly expound on the recurring thematic elements and how they relate to an arcane Elizabethan play, depending on the employment status of the contributor.
C. Watch whatever they missed on Netflix in chronological order.
In other words, PLEASE STOP CATCHING NEWBIES UP AND FRIGGING KILL PEOPLE ALREADY.
That is all.
Speaking of blood, that leads me to my latest gripe. My beloved Dexter is back on, and has named my car. And I love the movie channel shows because they seem to be much better in quality than the other shows, plus, hey, bonus sex, violence, and profanity.
Problem being that these shows often go on extremely extended breaks since there aren't as many episodes in a season, thus spend the entire first 1-2 hour-long episodes expositing awkwardly while having conversations no sane person (or serial killer) would have.
"Remember, we want to go back to being friends again."
"Yes. Like before the divorce."
"Yes, before when we were just friends, but then friends that did it, but then got married, but then got unmarried and hit the reset button."
"I would like that very much. Let's talk about the paths our careers have taken over the past year even then we've both presumably been here every day and have seen each other."
"Yes indeed. I would like that a lot. Isn't it a shame about all those significant events in the last five years that have happened to our friend?"
"Yes! And our tech has interns! He is so wacky. I like how he is sexist but in a benign and humorous way."
"Me too!"
"He is such a quirky contrast to our other friend who is totally normal."
"Yes, it's a shame our normal friend keeps disappearing late at night to go fishing. And says weird pointed things out loud while staring off into space and talking to his dead father about suspected killers who keep vanishing."
"And how!"
"Isn't it great how we're no longer sexually attracted to each other?"
"Sure is!"
Gods, make it stop. If new viewers want to know what happened for the last five years they can:
A. Watch the first "previously, on movie channel show" bit that's like ten minutes long.
B. Reference a Wikipedia page that will cover all the plot points, probably feature pictures of the major characters, and possibly expound on the recurring thematic elements and how they relate to an arcane Elizabethan play, depending on the employment status of the contributor.
C. Watch whatever they missed on Netflix in chronological order.
In other words, PLEASE STOP CATCHING NEWBIES UP AND FRIGGING KILL PEOPLE ALREADY.
That is all.
Oct 8, 2011
Ishie 2.5, the Reboot
Wow, where to even start.
I've been smiling a lot lately. That's been out for a while.
So essentially, as you've no doubt been guessing, the first month of residency was okay, the next two months systematically broke me, and now, I'm building myself back up with a great deal of help from starting a blood bank rotation, aka, "Now you can rest and learn about what you've been doing for the last three months".
The last week of surg path was actually pretty good for me. The surgeons gave me a break, PLUS I finally started to feel a little more confident in my skill level which spelled not getting home at midnight which spelled not getting snarked at by the fellow which spelled being able to get to lectures in the morning which spelled not sobbing uncontrollably into a pancreas.
As part of the whole "I'm not going to be that person anymore" thing, I chopped all my hair off, gave it to Locks of Love, and told the stylist to do whatever she wanted with it so long as it was short and some variety of red, so my 'do looks a bit more like Ed in my profile picture, which I kinda love. My hair's never been this short before, and never this successfully red, since I tried to dye it myself in high school with clairol and it ended badly.
But the big news: I GOT A CAR!!!!!!!!!!!!!!!!
I can't even properly express how big this is to me. I haven't owned any type of car in over two years, and I haven't had regular access to one in over four years. I've had rentals and Zipcars and etc, but never MY CAR which I can do whatever I want to with, with the loan in *my* name. And it's a new car, which I've also never had before, since some variety of witchcraft and the economy has led to used cars holding their value to an insane extent and the financing is better on a new car.
And he's so pretty. I named him Dexter because it sprang to me and it fit, so now he's Dexter forever. He has automatic *nothing*. I was so desperately afraid of getting taken advantage of and snake oiled, since I have *literally* never done this before that I went in with a paper full of Kelley Blue Book values and was like "NO. No power windows. No power locks. No trunk light. You're lucky I'm caving on not having manual transmission. I know the base price of this vehicle and I'm sticking to it" To his credit, the salesman was like "O..kay." When the maintenance guy went through the orientation with me, he kept checking his list going "Uh... well the cruise cont... no.. Um... so... this is how you turn on the air conditioner."
Which was the only feature I care about. Charleston is hot 6 months of the year and excruciatingly hot for another 3 months.
I still bike to the hospital, because it's genuinely faster, but ARGH SO GREAT. I hadn't realized how much I had completely adapted my life to be carless, and how much I would absolutely adore going back to a vehicle life. Example... I can use shopping carts again. I haven't had much of a use for them when people haven't been bussing me around because whatever I can carry in the store is what I need to either shove into a backpack or load up my arms with. Most of the food I've purchased in the last three months has been cylindrical because it fits well in my bag. "Hmm... I'd get this head of lettuce, but that's going to get crushed. More olives, cookie dough and wine. Perfectly shaped."
And I love Trader Joe's and Whole Foods because I'm gradually turning into a hipster f-tard, and in Charleston, they're inexplicably next to each other and now I can fill up my car with fancy schmancy stuff from them and stock the essentials from Costco, on the same trip, without holding someone up for an hour to watch me shop. And as much as I loved those stores, it was totally out of my biking range here, and in New York, anything obtained by them had to be carted home with upper body strength. Even in Grenada, my grocery abilities were limited by how much stuff I could haul onto a bus during a rainstorm.
Can you tell I'm excited? Also on the exciting scale, I got doctor treatment at the car lot, which I didn't even know was a thing since the "Catch me if you Can" days. Usually it seems to be more the assumption that I have way more money than I do with a general thought that my salary (heh) is what's wrong with health care today. My credit got pushed through without a lecture on not spending four years running up revolving debt AND installment debt, and I got a lower interest rate than any average I looked up, and as I tried to look tough in my little blue dress while pretending I know how cars work, the guy was like "Oh... credit check for DR. Sancho. You're a full MD right?" "Uh... yes?" and then boom.
I keep driving across the big bridge in Charleston just because I can now.
Okay, that's it for now. So long story short. Life. Not sucking. Stay tuned.
I've been smiling a lot lately. That's been out for a while.
So essentially, as you've no doubt been guessing, the first month of residency was okay, the next two months systematically broke me, and now, I'm building myself back up with a great deal of help from starting a blood bank rotation, aka, "Now you can rest and learn about what you've been doing for the last three months".
The last week of surg path was actually pretty good for me. The surgeons gave me a break, PLUS I finally started to feel a little more confident in my skill level which spelled not getting home at midnight which spelled not getting snarked at by the fellow which spelled being able to get to lectures in the morning which spelled not sobbing uncontrollably into a pancreas.
As part of the whole "I'm not going to be that person anymore" thing, I chopped all my hair off, gave it to Locks of Love, and told the stylist to do whatever she wanted with it so long as it was short and some variety of red, so my 'do looks a bit more like Ed in my profile picture, which I kinda love. My hair's never been this short before, and never this successfully red, since I tried to dye it myself in high school with clairol and it ended badly.
But the big news: I GOT A CAR!!!!!!!!!!!!!!!!
I can't even properly express how big this is to me. I haven't owned any type of car in over two years, and I haven't had regular access to one in over four years. I've had rentals and Zipcars and etc, but never MY CAR which I can do whatever I want to with, with the loan in *my* name. And it's a new car, which I've also never had before, since some variety of witchcraft and the economy has led to used cars holding their value to an insane extent and the financing is better on a new car.
And he's so pretty. I named him Dexter because it sprang to me and it fit, so now he's Dexter forever. He has automatic *nothing*. I was so desperately afraid of getting taken advantage of and snake oiled, since I have *literally* never done this before that I went in with a paper full of Kelley Blue Book values and was like "NO. No power windows. No power locks. No trunk light. You're lucky I'm caving on not having manual transmission. I know the base price of this vehicle and I'm sticking to it" To his credit, the salesman was like "O..kay." When the maintenance guy went through the orientation with me, he kept checking his list going "Uh... well the cruise cont... no.. Um... so... this is how you turn on the air conditioner."
Which was the only feature I care about. Charleston is hot 6 months of the year and excruciatingly hot for another 3 months.
I still bike to the hospital, because it's genuinely faster, but ARGH SO GREAT. I hadn't realized how much I had completely adapted my life to be carless, and how much I would absolutely adore going back to a vehicle life. Example... I can use shopping carts again. I haven't had much of a use for them when people haven't been bussing me around because whatever I can carry in the store is what I need to either shove into a backpack or load up my arms with. Most of the food I've purchased in the last three months has been cylindrical because it fits well in my bag. "Hmm... I'd get this head of lettuce, but that's going to get crushed. More olives, cookie dough and wine. Perfectly shaped."
And I love Trader Joe's and Whole Foods because I'm gradually turning into a hipster f-tard, and in Charleston, they're inexplicably next to each other and now I can fill up my car with fancy schmancy stuff from them and stock the essentials from Costco, on the same trip, without holding someone up for an hour to watch me shop. And as much as I loved those stores, it was totally out of my biking range here, and in New York, anything obtained by them had to be carted home with upper body strength. Even in Grenada, my grocery abilities were limited by how much stuff I could haul onto a bus during a rainstorm.
Can you tell I'm excited? Also on the exciting scale, I got doctor treatment at the car lot, which I didn't even know was a thing since the "Catch me if you Can" days. Usually it seems to be more the assumption that I have way more money than I do with a general thought that my salary (heh) is what's wrong with health care today. My credit got pushed through without a lecture on not spending four years running up revolving debt AND installment debt, and I got a lower interest rate than any average I looked up, and as I tried to look tough in my little blue dress while pretending I know how cars work, the guy was like "Oh... credit check for DR. Sancho. You're a full MD right?" "Uh... yes?" and then boom.
I keep driving across the big bridge in Charleston just because I can now.
Okay, that's it for now. So long story short. Life. Not sucking. Stay tuned.
Sep 20, 2011
Monday Monday, not as bad as before...
I'm afraid to jinx this streak though since we're on a three day cycle, bad days tend to beget bad days and good days tend to beget good days, but today ruled. I was on top of my game, the specimens were few and far between, and I didn't put stab myself with anything.
My patient car-owning roommate also took me to Costco, which is a store I've been gradually discovering in bits and pieces and am filling more with love for it. I'm also stocked in pasta, meat, and beer for the next month, with the added benefit of not having to bungee it onto the back of my bike and steer it through the ghetto. A twofer.
A short update, but hopefully a more reassuring one.
My patient car-owning roommate also took me to Costco, which is a store I've been gradually discovering in bits and pieces and am filling more with love for it. I'm also stocked in pasta, meat, and beer for the next month, with the added benefit of not having to bungee it onto the back of my bike and steer it through the ghetto. A twofer.
A short update, but hopefully a more reassuring one.
Sep 17, 2011
Friday is a better day to write...
If each of my weeks of surgical pathology were presented as a topic of a medical school lecture, it would be presented as a fluctuating graph, similar to the sort of thing you'd see in LH and FSH curves.
Monday: Okay, this week is going to be different. This week I'm going to be more not-terrible at things and not get overwhelmed and I'm totally not going to start crying in front of colleagues/attendings/patients in the parking lot.
Tuesday: Well, Monday didn't go as well as I'd expected, but I'm still kicking and I have the opportunity to get some learning experience and even if I'm here late, I'm going to salvage these cases and not be an incompetent braying jackass. I'm going to ask the chief resident for some advice on time management without cry... well, not much crying.
Wednesday: OH GOD I'M TERRIBLE I'M GOING TO QUIT MEDICINE THIS TIME I SWEAR WHY AM I SO STUPID UIJNJHjh;iblarghhhhhh
Thursday: Tomorrow is Friday, I just have to make it for today and tomorrow and I'm going to run damage control, but I can't believe I lost it that badly yesterday, fortunately the transcriptionists haven't mentioned hearing my voice break at 11 PM on the dictations because I realized I still had four liver biopsies left and don't actually know what liver is supposed to look like IS THAT CANCER?
Friday: I'm so tired. Did I seriously not screw up these cases as badly as I thought? Is that attending praising me? Life has meaning! I'm going to go sleep for twelve hours...
Saturday: I'm going to get groceries... and do something today. And I have a little time? I'm studying some lung! I feel like I'm finally getting this!
Sunday: Studying dermpath. Slight impending feeling of doom, but I've done some reading! And rested! Next week's gonna be awesome!!
While I definitely feel like the weakest link right now because my colleagues are suspiciously good at this stuff, the early surge path months could best be summarized by the following scenario:
(In a dead quiet room, an intern stares meaningfully into a microscope, scans a slide, stops, frowns)
"What the f*** is that?!?!????"
(Other interns crack up, both in sympathy, and in the realization that their dictation now has someone else's exasperated exclamation in the middle of it. Ponder that the transcriptionists haven't killed us. Other interns gather at the scope. Several appear puzzled.)
Just-studied-that-topic intern: "Normal breast tissue"
(embarrassed silence)
Yeah. It's not a program problem, honestly. There just seems to be no way to be a first year resident and not feel about as useful and intelligent as a squirrel wearing oven mitts.
Speaking of dexterity impairments, I contributed to *last* week by plunging a contaminated scalpel through my thumb. Yeah, *through*. I don't like to screw up small.
Funny thing? I'm constantly overwhelmed by crippling feelings of panic and inadequacy about my overall competency as a physician, yet having a knife stuck in me largely made me feel really really embarrassed about having arranged myself in such a way to get a knife stuck in me rather than being that concerned that there was, ya know... a knife stuck in me.
Here's the thing too.. we wear cut proof gloves... they do not prevent against stabbing with great force, which should both tell you that you shouldn't use them in a joust and that I was doing something stupid.
Situation:
(knife plunges straight down, left thumb is briefly pinned to cutting board)
Ishie, to herself: That probably glanced off the glove and is caught on it. The sharp pain I am feeling is likely due to the blunt force hitting my thumb.
(blood quickly spills through cut gloves and two layers of latex)
Ishie, to herself: Oh.
(pulls up scalpel)
Ishie, to accessioner around corner: Um... If there's an... incident, who should we call about that?
Accessioner: Did you spill something?
Ishie: Sort of.
Accessioner: What do you mean?
Ishie: I cut myself.
Accessioner: Badly?
Ishie, evaluating blood puddle on table while applying pressure: Um... pretty badly.
Accessioner, rounding corner: Oh my god!
Attending from other room: What's going on?
Ishie, to herself: Oh good. Let's bring everyone in on this.
Attending rounds corner, pushes Ishie's hand into sink. Ishie experiences sensation of water running from one side of tissue to other. It feels really weird.
Ishie: Sorry sorry sorry, I was being dumb. It's no big deal.
Attending, simultaneously: Don't worry, infection is really really rare, we'll get it taken care of. We'll test the patient. Was there more than one specimen?
Ishie, to herself: Oh right, I should be worried about that.
Why social stress panics me and trauma doesn't remains part of the deep lurking mystery that is my psyche.
Everything got taken care of really quickly, people came to back up my workload, I was off to the ER, everyone was making phone calls, and it was bam bam bam. Very impressive. And I'm fine. Extremely clean cut, sealed with dermabond, a week and swelling is going down with no signs of infection. Also, the ED at this hospital is really nice looking. While I *love* New York, don't get me wrong, the hospitals tend to have a more, let's say, 'lived in' look that doesn't look as clean even when it is.
So I kind of feel like a mess. I do feel like I'm getting somewhat better at things (except cutting stuff), but really slowly. I'm *really* slow at grossing and usually require a great deal of help, and then I'm doing decently on diagnoses, but it takes me a really long time. And I make dumb errors. Dropping stuff, putting stuff in the wrong boxes, forgetting where paperwork goes even when I've been shown fifty times, being completely incapable of recognizing squamous cell carcinomas anywhere.
Seriously, I hate that cancer so much. And it pops up everywhere. And it's frequently so obvious that the other residents, med students, janitors, and elementary school children that wandered into the hospital are like "Oh, that's an SCC", and I'm like "Where??? Is it behind all that red cancery looking stuff???" Gah.
So that's the update... I'm still dumb, but people are being relatively cool about it. Let's hope the idiocy is low-grade and transient.
Monday: Okay, this week is going to be different. This week I'm going to be more not-terrible at things and not get overwhelmed and I'm totally not going to start crying in front of colleagues/attendings/patients in the parking lot.
Tuesday: Well, Monday didn't go as well as I'd expected, but I'm still kicking and I have the opportunity to get some learning experience and even if I'm here late, I'm going to salvage these cases and not be an incompetent braying jackass. I'm going to ask the chief resident for some advice on time management without cry... well, not much crying.
Wednesday: OH GOD I'M TERRIBLE I'M GOING TO QUIT MEDICINE THIS TIME I SWEAR WHY AM I SO STUPID UIJNJHjh;iblarghhhhhh
Thursday: Tomorrow is Friday, I just have to make it for today and tomorrow and I'm going to run damage control, but I can't believe I lost it that badly yesterday, fortunately the transcriptionists haven't mentioned hearing my voice break at 11 PM on the dictations because I realized I still had four liver biopsies left and don't actually know what liver is supposed to look like IS THAT CANCER?
Friday: I'm so tired. Did I seriously not screw up these cases as badly as I thought? Is that attending praising me? Life has meaning! I'm going to go sleep for twelve hours...
Saturday: I'm going to get groceries... and do something today. And I have a little time? I'm studying some lung! I feel like I'm finally getting this!
Sunday: Studying dermpath. Slight impending feeling of doom, but I've done some reading! And rested! Next week's gonna be awesome!!
While I definitely feel like the weakest link right now because my colleagues are suspiciously good at this stuff, the early surge path months could best be summarized by the following scenario:
(In a dead quiet room, an intern stares meaningfully into a microscope, scans a slide, stops, frowns)
"What the f*** is that?!?!????"
(Other interns crack up, both in sympathy, and in the realization that their dictation now has someone else's exasperated exclamation in the middle of it. Ponder that the transcriptionists haven't killed us. Other interns gather at the scope. Several appear puzzled.)
Just-studied-that-topic intern: "Normal breast tissue"
(embarrassed silence)
Yeah. It's not a program problem, honestly. There just seems to be no way to be a first year resident and not feel about as useful and intelligent as a squirrel wearing oven mitts.
Speaking of dexterity impairments, I contributed to *last* week by plunging a contaminated scalpel through my thumb. Yeah, *through*. I don't like to screw up small.
Funny thing? I'm constantly overwhelmed by crippling feelings of panic and inadequacy about my overall competency as a physician, yet having a knife stuck in me largely made me feel really really embarrassed about having arranged myself in such a way to get a knife stuck in me rather than being that concerned that there was, ya know... a knife stuck in me.
Here's the thing too.. we wear cut proof gloves... they do not prevent against stabbing with great force, which should both tell you that you shouldn't use them in a joust and that I was doing something stupid.
Situation:
(knife plunges straight down, left thumb is briefly pinned to cutting board)
Ishie, to herself: That probably glanced off the glove and is caught on it. The sharp pain I am feeling is likely due to the blunt force hitting my thumb.
(blood quickly spills through cut gloves and two layers of latex)
Ishie, to herself: Oh.
(pulls up scalpel)
Ishie, to accessioner around corner: Um... If there's an... incident, who should we call about that?
Accessioner: Did you spill something?
Ishie: Sort of.
Accessioner: What do you mean?
Ishie: I cut myself.
Accessioner: Badly?
Ishie, evaluating blood puddle on table while applying pressure: Um... pretty badly.
Accessioner, rounding corner: Oh my god!
Attending from other room: What's going on?
Ishie, to herself: Oh good. Let's bring everyone in on this.
Attending rounds corner, pushes Ishie's hand into sink. Ishie experiences sensation of water running from one side of tissue to other. It feels really weird.
Ishie: Sorry sorry sorry, I was being dumb. It's no big deal.
Attending, simultaneously: Don't worry, infection is really really rare, we'll get it taken care of. We'll test the patient. Was there more than one specimen?
Ishie, to herself: Oh right, I should be worried about that.
Why social stress panics me and trauma doesn't remains part of the deep lurking mystery that is my psyche.
Everything got taken care of really quickly, people came to back up my workload, I was off to the ER, everyone was making phone calls, and it was bam bam bam. Very impressive. And I'm fine. Extremely clean cut, sealed with dermabond, a week and swelling is going down with no signs of infection. Also, the ED at this hospital is really nice looking. While I *love* New York, don't get me wrong, the hospitals tend to have a more, let's say, 'lived in' look that doesn't look as clean even when it is.
So I kind of feel like a mess. I do feel like I'm getting somewhat better at things (except cutting stuff), but really slowly. I'm *really* slow at grossing and usually require a great deal of help, and then I'm doing decently on diagnoses, but it takes me a really long time. And I make dumb errors. Dropping stuff, putting stuff in the wrong boxes, forgetting where paperwork goes even when I've been shown fifty times, being completely incapable of recognizing squamous cell carcinomas anywhere.
Seriously, I hate that cancer so much. And it pops up everywhere. And it's frequently so obvious that the other residents, med students, janitors, and elementary school children that wandered into the hospital are like "Oh, that's an SCC", and I'm like "Where??? Is it behind all that red cancery looking stuff???" Gah.
So that's the update... I'm still dumb, but people are being relatively cool about it. Let's hope the idiocy is low-grade and transient.
Aug 31, 2011
The reboot
Hi boys and girls, it's me, your bipolar blogger.
So, lemme see how I can sum up and still get to bed in time to not be miserable during lecture (yes, we still have lecture in residency)...
It sucks. Then it doesn't. Then it sucks worse, then someone jumps on your back when you're at your lowest moment of suck and you feel like it sucks worse than it EVER sucked, and then a few people throw you a life preserver and you get some peace, and then you can't get your stupid character to climb the first stupid rock cliff in Shadow of the Colossus in the ten minutes that you're "taking a breather", and you want to start crying because your video game avatar isn't respecting you and your animated horse ran away.
It's not that I'm miserable all the time. It's that I'll be REALLY happy or even moderately content, perhaps when I'm pouring steaming liquid nitrogen over a piece of uterus while going "MWA HA HA HA" since it's impossible to play with liquid nitrogen without feeling like a mad scientist, and then I'll feel like I'm really a bus ticket away from leaving. Like taking off, leaving, like walking into my program director's office and being all "Sorry, you've been cool, but I am flat out not equipped for this" and then getting on a bus somewhere else and just... waitressing in a border city or whatever people that make decisions like that do on tv.
Also? I'm weird. I get weirder when I get stressed, and I am at my weirdest when I'm stressed-but-putting-a-good-face-on-it, which leads to interchanges like the following:
Histo tech: Dr. Sancho?
Me, taking a minute to realize that means me: ...
Histo tech: (politely rattles off a hundred things I have to do, about fifty of which I don't really understand)
Me: ... uh... I totally know what you are talking about. Here's my tray of pathology things. You are welcome.
(pause)
Me, thoughtfully: That's the first time in my life I've actually been called 'Dr. Sancho'.
Histo tech: Oh! I'm sorry! Do you prefer 'Dr. First-Part-of-Hyphenated name'?
Me: Actually, I prefer 'Batman'.
(long awkward silence)
Me: But 'Ishie' is fine.
Histo tech: ...Batman... got it.
My brain, to me: What the f***, Ishie. Seriously.
Yeah, that happened.
First month, full on training month. We were never really allowed out without a handler. We spectated a bit, and did stuff, but if we broke down, we had a senior to bail us out immediately. I mentioned this before.
Second month, as I also mentioned before, is when you're somewhat in charge, except you don't know anything. I spent a lot of this last month feeling like I had conned my way into residency and was absolutely not smart enough to be a doctor. I kept reassuring myself that everyone feels as dumb and unskilled as I am, but then had a fellow jump down my throat, question my commitment to everything and say I was unskilled in pretty much every way, which made me cry for half a day. Which is not only demoralizing but frigging embarrassing. Since Irene was chilling off the coast waiting to put the extremely publicized cinch on all my friends and loved ones up north, I blamed it on allergies, specifically the type of allergies that make you sob uncontrollably.
Since I live in the South, which is known for its politeness, the response to this was favorable. Additional note, gender stereotypes be damned, anger + exhaustion + self-loathing = unexpected waterworks. As someone that has belly laughed through Benjamin Button, not a fan of this response.
I honestly toyed around with quitting, like not next year, but just two weeks notice, flat out. I felt unique in this response before talking to My Friend, the Pediatics Resident who not only tried the same thing but was waylaid by the three people that tried it before her. Apparently, residency is hard. Who knew?
I took the advice of one of my peers and approached the next day with my "head held high" which I think took on the appearance of a gargoyle grin the whole day, but it was an effort. The "I'm happy, keep moving" day was punctuated by an unexpected moment of credit to counteract the unexpected beat down. I was staying late trying to get all my stuff done, helped by an attending, and out of the blue, the guy that hadn't said anything in twenty minutes, tells me how he felt awful his first month of residency and that I was working hard and doing a good job.
To my credit, didn't start crying again. Said a "thank you sir" meekly, with ABSOLUTELY NO MENTION OF BATMAN, and went home.
I took the weekend to reboot, and went at it again on Monday. I was greeted with the chief that's been helping me tell me that as the end of the month ritual, he was going to leave me to it and I was going to be in charge of entering all the diagnoses in without help on that either.
Oh, and today, I'd been signing them out officially with the fellow that hates me.
Holy matrimony, Batm... NO MORE BATMAN.
Guys, I actually did it. Yesterday, on the announcement that I was for real on my own, I felt the panic rise, but I was like "I'm just going to do the best that I can", cranked the headphones and the pseudo-happiness up and just pretended I knew what I was doing, walked into sign out today with a smile on my face, prepared to get verbally dismembered or fired or whatever, and frigging did it. I didn't get every diagnoses right by any stretch of the imagination, and I did a couple things that were flat out stupid, but I smiled the whole time, didn't cry, and didn't feel like a complete incompetent. And I went home feeling pretty happy.
Given my residency cycles, this is likely to descend into chaos by the end of the week, but hey, baby steps, right?
In other, related news. They gave me a medical student. Which is the worst idea ever. It's like dangling a vial of crack in front of a junkie. I'm brand new, so I'm not very helpful for teaching, BUT I do have tons of stuff that I take extra time to do because I'm still inefficient and this stuff has no educational value whatever, particularly if someone doesn't want to go into pathology, which 90 percent of people don't. This is known as "scutwork" and it's the bane of medical education existence. So you are going to give me a medical student, who is supposed to do whatever I tell her to, that I can run all over the hospital fetching paperwork to save myself time, that then gets her out of my hair if I scut her, so I don't have to reveal that I have nothing to teach her because I'm a frightened idiot?
GODS. I'm being good, I swear. And this isn't a fourth year crashing into interview months that is more comfortable with disappearing on an August intern. We're talking brand new clinicals, which if my background is any indication, means you think anyone with "Doctor" before their names can and will call every place you hope to apply to tell them you suck while probably talking the USMLE people into taking ten points off your looming Step 2 exam if you take more than 45 seconds to answer a courtesy page.
I even got the "I'm still keeping my options open" answer, which on this end, is adorable. I got asked if it was okay to leave to attend a scheduled lecture. This was the first time in my entire medical education that I realize residents truly don't care if you're there. I got a pager number. I realized that interns really don't know med students' names. I got someone eagerly looking at me for deep medical knowledge and being all "Don't cut yourself on the cryostat. Seriously, that blade has been places that would make Rambo puke."
In my quest to not be a terrible person, I'm trying to do stuff that I would have wanted done for me at the beginning of my third year if I were in a pathology rotation, other than my sage advice of: Get UWorld now. Seriously. Do it while I'm standing here. I'm currently going with "play with the cryostat" (CAREFULLY) since that enticed me pretty early on by being a big machine with a big knife in it. Any other suggestions? I tried "be let out early to study" but they have the afternoon lectures. I remember from third year that "Go study" is helpful to an extent early on, but you don't feel the Step 2 crunch as heavily, and being dismissed for hours when you still have to be at the hospital is tedious.
Laypeople, chip in as well... I'm not around the forensics cases this month, so that's not an option since it's the most obvious "let the student do something fun" choice.
So, lemme see how I can sum up and still get to bed in time to not be miserable during lecture (yes, we still have lecture in residency)...
It sucks. Then it doesn't. Then it sucks worse, then someone jumps on your back when you're at your lowest moment of suck and you feel like it sucks worse than it EVER sucked, and then a few people throw you a life preserver and you get some peace, and then you can't get your stupid character to climb the first stupid rock cliff in Shadow of the Colossus in the ten minutes that you're "taking a breather", and you want to start crying because your video game avatar isn't respecting you and your animated horse ran away.
It's not that I'm miserable all the time. It's that I'll be REALLY happy or even moderately content, perhaps when I'm pouring steaming liquid nitrogen over a piece of uterus while going "MWA HA HA HA" since it's impossible to play with liquid nitrogen without feeling like a mad scientist, and then I'll feel like I'm really a bus ticket away from leaving. Like taking off, leaving, like walking into my program director's office and being all "Sorry, you've been cool, but I am flat out not equipped for this" and then getting on a bus somewhere else and just... waitressing in a border city or whatever people that make decisions like that do on tv.
Also? I'm weird. I get weirder when I get stressed, and I am at my weirdest when I'm stressed-but-putting-a-good-face-on-it, which leads to interchanges like the following:
Histo tech: Dr. Sancho?
Me, taking a minute to realize that means me: ...
Histo tech: (politely rattles off a hundred things I have to do, about fifty of which I don't really understand)
Me: ... uh... I totally know what you are talking about. Here's my tray of pathology things. You are welcome.
(pause)
Me, thoughtfully: That's the first time in my life I've actually been called 'Dr. Sancho'.
Histo tech: Oh! I'm sorry! Do you prefer 'Dr. First-Part-of-Hyphenated name'?
Me: Actually, I prefer 'Batman'.
(long awkward silence)
Me: But 'Ishie' is fine.
Histo tech: ...Batman... got it.
My brain, to me: What the f***, Ishie. Seriously.
Yeah, that happened.
First month, full on training month. We were never really allowed out without a handler. We spectated a bit, and did stuff, but if we broke down, we had a senior to bail us out immediately. I mentioned this before.
Second month, as I also mentioned before, is when you're somewhat in charge, except you don't know anything. I spent a lot of this last month feeling like I had conned my way into residency and was absolutely not smart enough to be a doctor. I kept reassuring myself that everyone feels as dumb and unskilled as I am, but then had a fellow jump down my throat, question my commitment to everything and say I was unskilled in pretty much every way, which made me cry for half a day. Which is not only demoralizing but frigging embarrassing. Since Irene was chilling off the coast waiting to put the extremely publicized cinch on all my friends and loved ones up north, I blamed it on allergies, specifically the type of allergies that make you sob uncontrollably.
Since I live in the South, which is known for its politeness, the response to this was favorable. Additional note, gender stereotypes be damned, anger + exhaustion + self-loathing = unexpected waterworks. As someone that has belly laughed through Benjamin Button, not a fan of this response.
I honestly toyed around with quitting, like not next year, but just two weeks notice, flat out. I felt unique in this response before talking to My Friend, the Pediatics Resident who not only tried the same thing but was waylaid by the three people that tried it before her. Apparently, residency is hard. Who knew?
I took the advice of one of my peers and approached the next day with my "head held high" which I think took on the appearance of a gargoyle grin the whole day, but it was an effort. The "I'm happy, keep moving" day was punctuated by an unexpected moment of credit to counteract the unexpected beat down. I was staying late trying to get all my stuff done, helped by an attending, and out of the blue, the guy that hadn't said anything in twenty minutes, tells me how he felt awful his first month of residency and that I was working hard and doing a good job.
To my credit, didn't start crying again. Said a "thank you sir" meekly, with ABSOLUTELY NO MENTION OF BATMAN, and went home.
I took the weekend to reboot, and went at it again on Monday. I was greeted with the chief that's been helping me tell me that as the end of the month ritual, he was going to leave me to it and I was going to be in charge of entering all the diagnoses in without help on that either.
Oh, and today, I'd been signing them out officially with the fellow that hates me.
Holy matrimony, Batm... NO MORE BATMAN.
Guys, I actually did it. Yesterday, on the announcement that I was for real on my own, I felt the panic rise, but I was like "I'm just going to do the best that I can", cranked the headphones and the pseudo-happiness up and just pretended I knew what I was doing, walked into sign out today with a smile on my face, prepared to get verbally dismembered or fired or whatever, and frigging did it. I didn't get every diagnoses right by any stretch of the imagination, and I did a couple things that were flat out stupid, but I smiled the whole time, didn't cry, and didn't feel like a complete incompetent. And I went home feeling pretty happy.
Given my residency cycles, this is likely to descend into chaos by the end of the week, but hey, baby steps, right?
In other, related news. They gave me a medical student. Which is the worst idea ever. It's like dangling a vial of crack in front of a junkie. I'm brand new, so I'm not very helpful for teaching, BUT I do have tons of stuff that I take extra time to do because I'm still inefficient and this stuff has no educational value whatever, particularly if someone doesn't want to go into pathology, which 90 percent of people don't. This is known as "scutwork" and it's the bane of medical education existence. So you are going to give me a medical student, who is supposed to do whatever I tell her to, that I can run all over the hospital fetching paperwork to save myself time, that then gets her out of my hair if I scut her, so I don't have to reveal that I have nothing to teach her because I'm a frightened idiot?
GODS. I'm being good, I swear. And this isn't a fourth year crashing into interview months that is more comfortable with disappearing on an August intern. We're talking brand new clinicals, which if my background is any indication, means you think anyone with "Doctor" before their names can and will call every place you hope to apply to tell them you suck while probably talking the USMLE people into taking ten points off your looming Step 2 exam if you take more than 45 seconds to answer a courtesy page.
I even got the "I'm still keeping my options open" answer, which on this end, is adorable. I got asked if it was okay to leave to attend a scheduled lecture. This was the first time in my entire medical education that I realize residents truly don't care if you're there. I got a pager number. I realized that interns really don't know med students' names. I got someone eagerly looking at me for deep medical knowledge and being all "Don't cut yourself on the cryostat. Seriously, that blade has been places that would make Rambo puke."
In my quest to not be a terrible person, I'm trying to do stuff that I would have wanted done for me at the beginning of my third year if I were in a pathology rotation, other than my sage advice of: Get UWorld now. Seriously. Do it while I'm standing here. I'm currently going with "play with the cryostat" (CAREFULLY) since that enticed me pretty early on by being a big machine with a big knife in it. Any other suggestions? I tried "be let out early to study" but they have the afternoon lectures. I remember from third year that "Go study" is helpful to an extent early on, but you don't feel the Step 2 crunch as heavily, and being dismissed for hours when you still have to be at the hospital is tedious.
Laypeople, chip in as well... I'm not around the forensics cases this month, so that's not an option since it's the most obvious "let the student do something fun" choice.
Aug 28, 2011
Dated References
Aug 25, 2011
Run.
Do you have talents outside medicine?
Do you have talents inside medicine but feel like you'd be happy as a PA, nurse, chiropractor, or radiology tech?
Do that.
Do you have talents inside medicine but feel like you'd be happy as a PA, nurse, chiropractor, or radiology tech?
Do that.
Aug 22, 2011
Aug 18, 2011
Aug 12, 2011
*This* is why I became a pathologist
I was going "back to the bucket" (go back to the original specimen and hunt through formalin soaked tissue scraps) on a tumor which I refer to as this individual's abdomen being full of "unspeakable evil" and the attending said "You did have a rough day on Wednesday" and I made some sort of chuffing noise, and she said "Makes you wonder why you went into pathology", etc.
Same attending, special stains come out on *another* abdomen full of unspeakable evil and everything is negative. This tumor looks awful, is everywhere, and as of right now, cannot be identified. On standard microscopy it looks like generic unspeakable evil, it's not forming patterns; it's hard to even determine what organ it came from. Special expensive stains are sent out which show... nothing.
From my internal medicine days, it was about halfway through the equivalent process that someone would say "mm... cancer.. bad prognosis" and I'd go "What kind of cancer" and they'd say "Does it matter?" or turf it to another specialty.
My attending, on the other hand, begins flipping through her encyclopedic knowledge of zebra and unicorn diagnoses, turns to her wall-o-books and starts hunting for other stains she can do to force this thing into the light.
This scab picking approach to problem solving is why I'm becoming a pathologist. Because when the stains came back negative, I stopped thinking "It's Friday and I want to go home", and started with "We're not giving up, are we?" It's because every pathologist's office is filled with tomes like "The Color Atlas of Bodily Fluids" and "Vaginal Lesions" and papers and slides stacked to the ceiling.
I just need to remind myself of that the next time I'm crying into a bucket of formalin.
Same attending, special stains come out on *another* abdomen full of unspeakable evil and everything is negative. This tumor looks awful, is everywhere, and as of right now, cannot be identified. On standard microscopy it looks like generic unspeakable evil, it's not forming patterns; it's hard to even determine what organ it came from. Special expensive stains are sent out which show... nothing.
From my internal medicine days, it was about halfway through the equivalent process that someone would say "mm... cancer.. bad prognosis" and I'd go "What kind of cancer" and they'd say "Does it matter?" or turf it to another specialty.
My attending, on the other hand, begins flipping through her encyclopedic knowledge of zebra and unicorn diagnoses, turns to her wall-o-books and starts hunting for other stains she can do to force this thing into the light.
This scab picking approach to problem solving is why I'm becoming a pathologist. Because when the stains came back negative, I stopped thinking "It's Friday and I want to go home", and started with "We're not giving up, are we?" It's because every pathologist's office is filled with tomes like "The Color Atlas of Bodily Fluids" and "Vaginal Lesions" and papers and slides stacked to the ceiling.
I just need to remind myself of that the next time I'm crying into a bucket of formalin.
Aug 10, 2011
Emo Thelonious Monk
This title is a direct quote from this interchange:
Autopsy tech coming up to the surgpath area: You're still here? Oh you poor thing.
Ishie: (grunt)
Tech: Well, it looks like you're almost done!
Ishie: This is a uterus.
Tech: Ohhh...
(music wails in the background)
Tech: What... is this...?
Ishie: Kid A by Radiohead. Good album to sulk to.
Tech: I... I don't even know how to describe that. It's like... emo Thelonious Monk.
Ishie: That may be the the best thing I've ever heard. Thank you, madam.
So I've been having kind of the miserable day in the middle of a rough couple of weeks.
I hit my milestone today while confirming something I always suspected was true which is that all interns, regardless of how easy their programs are or how cool their coworkers are or how much they like their field WILL have a moment, probably in the first three months, where they start crying at work. This is frequently accompanied by sentiments such as "I don't think I can do this" or "What did I do" or the simple but effective "I can't".
There are varieties of these meltdowns too... pathology is a good field for low nuclear meltdowns because people generally leave you alone; and there are a lot of times you are by yourself and can work it out. For instance, today, quiet crying at the grossing station as you gaze upon your sisyphean task can go practically unnoticed where the sort of meltdown you get in other specialties, which is often brought on by many people yelling at you at once, tends to lead to breaking down in front of your abusers, which is the worst form. Or the "feel it coming, find a hiding place" cry. So far, I've only managed the quiet one, and it was brief, but it was there. I came close a couple other times this week.
We're doctors now. It's official. Training wheels are off and ain't no one else going to handle this crap. If you don't do it, people are just going to get angrier and angrier until it gets done while more work piles on top of it. Your pager goes off in lecture, in grossing, while you're dealing with other urgent matters. I'm running around clutching decal slides in my hand finding the magic person that's supposed to receive them all with this entire realm of "THIS MATTERS". My training is secondary to the fact that I have to do a doctor job now. And that means doctor job, doctor hours, the presumption of doctor intelligence. Machines to monitor, techniques to know, medical knowledge, searching databases and surgical reports. Gah.
It's scary. And right now, I gotta be honest, it kind of sucks. People are generally nice to me; I don't really want to be doing anything else (well... sitting down watching Game of Thrones and drinking a Blue Moon, but you know), but it still kind of sucks. Today, I was at a grossing table for 12 hours slashing away at specimens that only grew in complexity while my scrub pants literally fell off my butt. I didn't eat, I didn't go to the bathroom; I stood there, without taking my smock off, for 12 hours without cease. And I came out and felt like death. And tomorrow, I deal with the consequences of today.
On the other hand... and I've been trying to stay on the other hand, since I can be task loaded and miserable or I can be on the other hand, I've seen a really cool polycystic kidney, got to play with liquid nitrogen, got to screw with the power tools, got to be scared to death of a potentially infection hazard during a frozen section (false alarm) and the rest of it. Cool stuff. That's what I keep telling myself. Cool stuff.
I also have an attending who is super nice and seems to know me by the fact that I fear grin at my superiors and support staff. It's not that I'm a nice person; it's literally something chimps do when they're scared. So I'm the smiley girl. (Who saw that coming???? NO ONE!) So this one attending always goes "still smiling?" and I'm always like "Sure am, sir!" or lately, been lifting my head up, twisting what is probably a deeply disturbing jester leer at him and nodding meekly. He said "Feel like you're handling things"? Yup? LIES. "Getting a bit overwhelmed?" "Oh, sir, you're such a card..." LIES. But what to say? "Help me. I had no idea anyone would ever give me this much power. I am retarded but really good at taking multiple choice tests. Please resign me to a tedious position that can be replaced by robots... sir.
So staying the course. Despite today's waterworks, I'm determined to be happy. I know I have it good, dammit; I'm not going to waste hours in the weepies over getting exactly what I wanted. Time to put on
Or, if you prefer...
Autopsy tech coming up to the surgpath area: You're still here? Oh you poor thing.
Ishie: (grunt)
Tech: Well, it looks like you're almost done!
Ishie: This is a uterus.
Tech: Ohhh...
(music wails in the background)
Tech: What... is this...?
Ishie: Kid A by Radiohead. Good album to sulk to.
Tech: I... I don't even know how to describe that. It's like... emo Thelonious Monk.
Ishie: That may be the the best thing I've ever heard. Thank you, madam.
So I've been having kind of the miserable day in the middle of a rough couple of weeks.
I hit my milestone today while confirming something I always suspected was true which is that all interns, regardless of how easy their programs are or how cool their coworkers are or how much they like their field WILL have a moment, probably in the first three months, where they start crying at work. This is frequently accompanied by sentiments such as "I don't think I can do this" or "What did I do" or the simple but effective "I can't".
There are varieties of these meltdowns too... pathology is a good field for low nuclear meltdowns because people generally leave you alone; and there are a lot of times you are by yourself and can work it out. For instance, today, quiet crying at the grossing station as you gaze upon your sisyphean task can go practically unnoticed where the sort of meltdown you get in other specialties, which is often brought on by many people yelling at you at once, tends to lead to breaking down in front of your abusers, which is the worst form. Or the "feel it coming, find a hiding place" cry. So far, I've only managed the quiet one, and it was brief, but it was there. I came close a couple other times this week.
We're doctors now. It's official. Training wheels are off and ain't no one else going to handle this crap. If you don't do it, people are just going to get angrier and angrier until it gets done while more work piles on top of it. Your pager goes off in lecture, in grossing, while you're dealing with other urgent matters. I'm running around clutching decal slides in my hand finding the magic person that's supposed to receive them all with this entire realm of "THIS MATTERS". My training is secondary to the fact that I have to do a doctor job now. And that means doctor job, doctor hours, the presumption of doctor intelligence. Machines to monitor, techniques to know, medical knowledge, searching databases and surgical reports. Gah.
It's scary. And right now, I gotta be honest, it kind of sucks. People are generally nice to me; I don't really want to be doing anything else (well... sitting down watching Game of Thrones and drinking a Blue Moon, but you know), but it still kind of sucks. Today, I was at a grossing table for 12 hours slashing away at specimens that only grew in complexity while my scrub pants literally fell off my butt. I didn't eat, I didn't go to the bathroom; I stood there, without taking my smock off, for 12 hours without cease. And I came out and felt like death. And tomorrow, I deal with the consequences of today.
On the other hand... and I've been trying to stay on the other hand, since I can be task loaded and miserable or I can be on the other hand, I've seen a really cool polycystic kidney, got to play with liquid nitrogen, got to screw with the power tools, got to be scared to death of a potentially infection hazard during a frozen section (false alarm) and the rest of it. Cool stuff. That's what I keep telling myself. Cool stuff.
I also have an attending who is super nice and seems to know me by the fact that I fear grin at my superiors and support staff. It's not that I'm a nice person; it's literally something chimps do when they're scared. So I'm the smiley girl. (Who saw that coming???? NO ONE!) So this one attending always goes "still smiling?" and I'm always like "Sure am, sir!" or lately, been lifting my head up, twisting what is probably a deeply disturbing jester leer at him and nodding meekly. He said "Feel like you're handling things"? Yup? LIES. "Getting a bit overwhelmed?" "Oh, sir, you're such a card..." LIES. But what to say? "Help me. I had no idea anyone would ever give me this much power. I am retarded but really good at taking multiple choice tests. Please resign me to a tedious position that can be replaced by robots... sir.
So staying the course. Despite today's waterworks, I'm determined to be happy. I know I have it good, dammit; I'm not going to waste hours in the weepies over getting exactly what I wanted. Time to put on
Or, if you prefer...
Aug 3, 2011
With Apologies to T.S. Eliot
But August is the cruelest month.
July was a training month for us, which means we literally were never without a handler, which is comforting, and in those sorts of situations, you always *feel* like you're learning everything. This is especially true when people are letting you do things, so you feel like you're in charge, but you always have them over your shoulders, often helpfully making suggestions.
I did have one fourth year that made me run a couple frozens by myself, which in itself was a little panic inducing, but still, the fact was I knew that he was there, and the very nature of the whole thing made it so that I knew if things went really wrong or if it were too complicate a specimen, he would rescue me.
July is also when I heard a lot of "I'm gonna be here for a while, so why don't you run on home?" which makes you hear the "go home" and not the "I'm gonna be here for a while".
August, we're let loose on our own. Today was my first grossing day, which is seriously intimidating.
I think I explained this elsewhere but pathology schedule is gross (cut stuff), preview (guess stuff) and sign out (be pwned on stuff).
Grossing seems like simply the grossEST as it's the opportunity to smell like unspeakable evil, splash formalin on yourself and such, but doesn't seem like the hardest. The real difficulty comes in interpreting what you see. The problem being, grossing badly brings down the whole house. If you cut poorly, the slides come out poorly, and the most skilled diagnostician on the planet cannot figure out margins that you haven't inked, false margins you have inked, or specimens that are mangled and only consist of blood clot. This failure not only potentially gets you in trouble with your seniors, but more critically, can directly screw up a patient's care. I can potentially apologize to my higher ups all day long, and they can think "Hey, she's a noob", but some patient could potentially wind up minus a diagnosis or with an additional surgery or whatever because I can't cut and paste.
So no pressure. Being faced with an increasing load of specimens and staring at something relatively simple like a skin lesion, I felt a pretty piercing hint of anxiety. For complex specimens, you page an attending or fellow (which I'm trying to get used to, since medical school taught me to NEVER DO THIS, and pathology residency teaches you to ALWAYS DO THIS. It is always easier to have a pro orient a specimen than have a pro un-fuck one). This leads to someone hand holding you, but under mounting pressure, you do things like "dictate while someone is telling you what to dictate and still forget what they said 30 seconds ago because there's a microphone in front of you".
Gods. In the end, I still feel incredibly lucky. This was probably my worst day of residency so far and the most "not fun" one, and it was still punctuated by not once getting yelled at, having three of my colleagues stop by at different after-hours times to offer help, and having two attendings come by after hours, one to do a complex specimen *for me* and the the other to take the load off, which included him staying three hours after leaving time and dictating half my remaining case loads so that I could leave at a semi-reasonable hour.
I have a less intensive residency than most and definitely a less malignant residency than most. I'm not sure how I would manage if either of those features were not present. But it does make me feel good that at the end of the day, my "bad" day consists of learning opportunities and people helping me. Tomorrow, I find out if my grosses were okay, and I'm really hoping that they were.
Night everyone
July was a training month for us, which means we literally were never without a handler, which is comforting, and in those sorts of situations, you always *feel* like you're learning everything. This is especially true when people are letting you do things, so you feel like you're in charge, but you always have them over your shoulders, often helpfully making suggestions.
I did have one fourth year that made me run a couple frozens by myself, which in itself was a little panic inducing, but still, the fact was I knew that he was there, and the very nature of the whole thing made it so that I knew if things went really wrong or if it were too complicate a specimen, he would rescue me.
July is also when I heard a lot of "I'm gonna be here for a while, so why don't you run on home?" which makes you hear the "go home" and not the "I'm gonna be here for a while".
August, we're let loose on our own. Today was my first grossing day, which is seriously intimidating.
I think I explained this elsewhere but pathology schedule is gross (cut stuff), preview (guess stuff) and sign out (be pwned on stuff).
Grossing seems like simply the grossEST as it's the opportunity to smell like unspeakable evil, splash formalin on yourself and such, but doesn't seem like the hardest. The real difficulty comes in interpreting what you see. The problem being, grossing badly brings down the whole house. If you cut poorly, the slides come out poorly, and the most skilled diagnostician on the planet cannot figure out margins that you haven't inked, false margins you have inked, or specimens that are mangled and only consist of blood clot. This failure not only potentially gets you in trouble with your seniors, but more critically, can directly screw up a patient's care. I can potentially apologize to my higher ups all day long, and they can think "Hey, she's a noob", but some patient could potentially wind up minus a diagnosis or with an additional surgery or whatever because I can't cut and paste.
So no pressure. Being faced with an increasing load of specimens and staring at something relatively simple like a skin lesion, I felt a pretty piercing hint of anxiety. For complex specimens, you page an attending or fellow (which I'm trying to get used to, since medical school taught me to NEVER DO THIS, and pathology residency teaches you to ALWAYS DO THIS. It is always easier to have a pro orient a specimen than have a pro un-fuck one). This leads to someone hand holding you, but under mounting pressure, you do things like "dictate while someone is telling you what to dictate and still forget what they said 30 seconds ago because there's a microphone in front of you".
Gods. In the end, I still feel incredibly lucky. This was probably my worst day of residency so far and the most "not fun" one, and it was still punctuated by not once getting yelled at, having three of my colleagues stop by at different after-hours times to offer help, and having two attendings come by after hours, one to do a complex specimen *for me* and the the other to take the load off, which included him staying three hours after leaving time and dictating half my remaining case loads so that I could leave at a semi-reasonable hour.
I have a less intensive residency than most and definitely a less malignant residency than most. I'm not sure how I would manage if either of those features were not present. But it does make me feel good that at the end of the day, my "bad" day consists of learning opportunities and people helping me. Tomorrow, I find out if my grosses were okay, and I'm really hoping that they were.
Night everyone
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