Jean Grey is reborn as...

This is Phoenix. She's my new ride.

This is Dexter. He was my old ride. As you know.

Truth be told, though it kind of feels like I'm cheating on Dexter, I think I like Phoenix better. I thought I'd be fine with an automatic transmission, considering how absolutely adamant I was about not learning to drive a manual until I was in my 20s, but manuals are SO much fun to drive. Additionally, my go to car for a very long time was a 2001 Hyundai Accent that survived until my third year of medical school, though I didn't use it for any of my med school time. And it was a manual, and Phoenix is also a Hyundai Accent, albeit a 2010 model with more features, but the response is exactly like my old car only a little punchier. Also, lights and trunk latches and such.

But Dexter was my first. First new car ever, first financing ever, first total loss/gap insurance payoff.

Let me tell you, if you ever finance a car, get frigging gap insurance. I would have been paying a thousand extra dollars on a car I no longer own because a hoodrat burned it down.

Right, the fire... so... new update. Yes, it was in fact arson. Said arson was committed by a 14 year old boy who was attempting to fight the squatters next door for some giant I-don't-give-a-f*** reason, and when they didn't emerge (because they weren't there), he set their house on fire very deliberately, which subsequently spread to everything else.

As a doctor, I feel like I should understand environmental pressures, along with conduct disorder and other things that create this sort of... child. I know the inevitable progression to Antisocial Personality Disorder in adulthood and all sorts of organic biological nonsense. I get it.

Problem being? I don't care. I lack empathy for the unempathetic. Does that make sense? If you are schizophrenic, and the voices tell you that the girl on the subway is the devil threatening humanity and you murder her to save humanity, you certainly need to be locked up and heavily medicated, but to some extent, I understand that you meant well and you have a demonstrable chemical imbalance that is both putting crazy things into your head WHILE giving you a bonus lack of insight into your own condition. It isn't who you are, and before the disease took you in your teens or twenties, you had a whole other person you were before your dopamine levels went tits up. Got it. And I sympathize. I don't want to be on the subway with you, but I sympathize.

The axis II stuff, the personality disorders, it's harder. The person's bastardry is a part of who they are. When you take the schizophrenia away from a schizophrenic, they're a normal person. When you take the antisocial personality disorder away from a person, you're removing a key part of who they are, which is a jerk. When I did my psych rotation, I could deal with crackheads, gang members, and bipolarity but the antisocial personality disorder people were just GARGGGHHH. And the attempts to manipulate into their own worldview, double GARGGGHHH. I can't take it, and for some reason, the same function that allows me to forgive other behavior just doesn't extend to people who are incapable of being able to have a basic sense of empathy.

So I became a pathologist instead of a psychiatrist, because it's very difficult to treat your patients if you hate them.

The hearing was today. My colleagues, who have already been wonderful, made sure I was covered so I could go. I got a call on Friday from first the fire chief, and then the SC equivalent to the DA that started with "We have you listed as the owner of one of the cars that was damaged?" And I was like "Um... that's kind of an understatement", so I told her our side, and she emphasized that she wanted to see us at the hearing, and I forwarded her all the pictures I took of our home and Dexter, which seemed to make her happy. I thought it was just going to be my roommates and I but there were at least 15 victims of this nonsense, including our landlord, who at the end of all this was like "Oh, I owe you guys your security deposits", which was nice.

We can't name names, obviously. A juvenile hearing is a bit like a bail hearing, except no money in kiddie cases, so it's whether he can be under "house arrest" with his parents (no) or stay in juvie (yes). The fact that this was a possibility made me choke on my coffee, but turns out I should have had a little more faith in the state, because even his lawyer didn't put up any kind of a fight to get him out. I never saw him though; he waived his right to be at his hearing, but his parents were there, and refused to look at any of us. He's likely going to be locked up until the trial, and I'm guessing he's not going anywhere after that. The prosecution passed some of my pictures up to the judge.

I feel an odd sense of closure. I'm not sure whether I should blame general perceptions of the government on the media with the idea that if you're under 18, you can torch half a block and go home to your xbox, but I was actually impressed and feel like justice will be served and all without my having to put on Christian Bale's growly voice and patrol the streets. Which is good, because I can't fight for crap.

Friday was a really bad day for me. It started waking up from a nightmare, as many of the nights this last week have, and then I got lost on my new way to work, causing me to be 15 minutes late to lecture despite leaving well in time, had a bunch of stuff go down on complicated cases at work, and then my insurance company called to say my settlement would be minus a thousand dollars and my rental car was up on Wednesday. This was also the day I learned that the fire was arson. Honestly, before that I felt strangely fine. Nightmare ridden and dyspeptic, since doctors are the kings and queens of somatization, but fine. Friday, the combination of the end of the comfort zone of driving around in a rented Chevy Impala and the new information that this was a motivated attack gave me a full dose of rage-a-hol, which was hard to try to keep under wraps, especially with everyone at the hospital being so wonderful.

And it's gotta be confusing to them.
Day 1: Hey colleague! Funny story, my house burned down, still need a roommate?
Day 2: Thanks for the pick up from the airport! Red wine and Incredible Hulk? Hooray! Look at this awesome bed!
Day 3: Wow, coworkers, this support is amazing! How am I doing? Fine. Nope, haven't seen the house.
Day 4: Yup, saw the house. Nah, figured from the pictures nothing was left anyway. I got a computer and can watch Dexter again!
Day 5-6: Springing Dexter from the junkyard! Wow, look how damaged he is!
Day 7-9: Doop doop, surge path, hmm, not so bad! I'm having fun! I feel like I'm getting it this time around!
Day 10: (*&(*&)(*&@(*&(*!! ******* BURNED MY HOUSE DOWN RAWRRRRRRRR

Friday night, I saw female former-roommate for the first time since the fire, and we drank margaritas and her boyfriend gave me the third season of Arrested Development, because he's awesome at gift-giving and likes to demonstrate it. Seeing them helped a lot. Saturday, I decided to turn my misanthropic bend to the positive of using it to intimidate car dealers since the Wednesday of rental car expiration is not a good day to car shop, nor is it ever a good idea to do your shopping on a day that you're desperate.

So I went to a few dealerships, and test drove a few cars. The dealership where I bought Phoenix had a 2009 Nissan Versa with a hatchback and a stick shift, which was kind of my final opportunity to revitalize Dexter and remake him in an image I actually initially wanted, but were too expensive and not available, respectively. It was even black. But the response was a little sluggish and no features, including no auxillary jack, which is a dumb thing that is critically important to me since five minutes without my iphone causes me to cry uncontrollably and chew my elbows.

I had finally settled on Phoenix as "a car I like and I'm tired of dealerships", which had a price on the window that was hilarious, particularly since someone mentioned in front of me having trouble moving it off the lot because no one wants manual transmission anymore. Dealer fail 101. States he "might be able to come down a little on it".

I'm usually a people pleaser. I don't to offend people or have them be mad at me, which to people selling anything, puts me in a sort of Girl with the Dragon Tattoo position (how's that for graphic imagery?). Fortunately, Friday left me in a state of pissed-offery and the fire taught me to spurn strong attachments to any material item, PLUS I hate shopping and was being forced to do this again, so I rode into Saturday with a rampaging chip on my shoulder. Which is a plus if you're buying a car. Which seemed to carry across, such that he was like "So, you're not from Charleston?" since Charleston is billed as a polite city. I pulled the Brooklyn card, neglecting to mention that I lived in high-gentrification Brooklyn for two years and moved there when I was 29 so it gives me absolutely no objective excuse to be an asshole. I can even fake the accent. I can also fake a Caribbean accent, but it's harder to sell people on. And it's not like my home state of California is known for having manners.

I also don't think I was a lot of fun for them. They kept doing that "Excited about getting a new car???" thing, and I was like "Not really."

I also fortunately have the Kelley Blue Book application on my phone. So I'm idly tapping away on it while he's talking (HIGHLY RUDE) about the car's features. Because I'm entering them one by one. So he finishes, and I turn the phone around and slide it over to him because its "excellent" condition for the same car with the same mileage is 1500 dollars less.

I frigging love technology.

We don't need no water... wait, yes we do

F*** indeed, neighbor.

Went to the scene today and chatted with some of the neighbors, including, I believe, the one that took this video, so we have some record of stuff.

Long story short, absolutely nothing left. I was captivated by the sound of the broken glass and tinder crunching under my new boots. My closet, I was told, fell outward, which sparked a brief hope of finding my bedbug costume, and one of my displaced neighbors, Superman, as we all call him, started climbing through the collapsed stuff to pick through the things that looked like clothes. Half of a pair of jeans, I think.

Lots of people were driving by to loiter, and I didn't really mind that, because it's probably what I would do. I gawked at the house on Rutledge that burned earlier this year. I took some pictures of my place just for the hell of it, not because I think I really need to document anything. But one of the landlords from across the street saw me and the neighbor and were like "do you live nearby?" and I'm like "I'm the third roommate". "Ohh... Was yours the red car? It was a trooper." "No, mine was the black nissan." "Oh... It exploded." "I know." "Do you have a place to go?" "Yup."

I went to the hospital today, one, because one of my attendings kept insisting that I do so, and two, because in an amazing show of foresight, I kept some of my insurance paperwork there, and the degree of support and concern was amazing and humbling. I've only been at my residency for six months but everyone rallied. I got hugs and offers and even though I immediately called a friend needing a roommate as soon as I heard, people were all "Where is she staying" and eager to make sure I wasn't sleeping in a Red Cross shelter. Despite everything, I feel really lucky.

I think that's one of the keys in a residency program too. Not "Who will hug me if my house and car burn down" because that is an oddly specific question to ask at the pre-interview dinner, but just how close knit a program is makes a huge difference in overall happiness. Our department has happy hours, parties, and an open door policy that nurtures an environment where someone could come home from vacation with nothing and find everything she could hope for, to get back on her feet, within her program's walls.

Family has also been absolutely amazing. Getting the news was surreal, and occurred around the small cousins, and it's difficult to know how to react in any appropriate fashion since presumably singing four letter words in the major and minor scales is not recommended for the TV-Y crew. I was helped out, taken shopping, given clothes, and perhaps really importantly, distracted so I couldn't dwell on it.

I'm safe and sound tonight back in Charleston. Things are moving along; I'm trying to release my car to the insurance company and get a lease agreement moving along. Good times.

Eulogy for Dexter

I realized I didn't post a picture of Dex in his prime of life, so here's one of his death. He's behind the mini cooper, who is also totaled.

He was a nice car. He delivered me to Maryland without murdering me and synced my ipod really well. He died in a blaze of glory that was dripped from my house, which was undergoing its own blaze of glory. RIP Dexter. Flights of angels, and the like.

A funny thing happened while I was in Houston...

My house burned down. And the car out front.

As ya do. As they say.

I'm not entirely sure what the proper response is. I'm trying for the dark humor. The "fire sale". The "blackened fish tacos". Everything I own is gone. My new car is gone. The roommate's dog, whom I love, is safe. No one is hurt. But there is decent coverage on all of Charleston's news outlets, that show my home, and everything I own, save the suitcases I have in Houston, up in flames. My neighbors talking about how hard it is on them, because the firefighters evacuated them before saving *their* homes. Not mine. There's only so much they can do. By the news report, I'm the "fifth person", after the Red Cross helped four, who is "out of town", as the news reporter says, "thank goodness". As do I.

I have family. I have friends. I have a general worthlessness to the things I owned. A Wii my mom got me. A regifted futon. An Ikea dresser I got in New York. A computer that was already on the fritz. A brand new car that was engulfed in the front. But I have friends, I have family. I have a job and a place to stay. I have a roommate's big sloppy dog that's not dead. I have... I don't know... a fresh start? It's not a fresh start. It's a charred start that hurts when I think of the emotional losses. The med school diploma. The pictures from Prague. The episodes of hell, Dexter, the show that named my car, who's dripping melted plastic in a parking garage downtown. My external hard drive. I had a flashing minute, before I left for Houston, where I thought "I should put that in my file drawer at the hospital" before I thought "nahhhh, what could happen". The blackmail photos of my roommate and my friends in New York. It's done.

I'm in Houston. I'm not sure what the response is. I'm not sure how I should feel about the arsonist speculation (which I don't really believe) and they claims to my insurance company. I'm moving in with someone I really like. But I feel odd; I feel disconnected. I feel like never going back to pick through the condemned wreckage to see if I can find the necklace I bought in Venezuela, the luck dragon my boyfriend and I got in Chinatown when I was hammered, that I used as a puppet to order tickets to a midnight showing of the Dark Crystal, the few bills of Costa Rican money, my checks that couldn't spell "Union Street" correctly.

Is stuff important? I don't know. I've moved so many times. I frequently joke that every time I move, I want to pile up everything I own and light it on fire, and now that job's been done for me. When I talked to the claims guy for my car, he says "Is your address still on Nunan Street?" and I say "Not anymore" because it's not. The CAT-AT in our living room, the life sized Anakin Skywalker that scared the shit out of the roommate. The fridge with the door that would never close. I'm moved with a suitcase to a nice apartment in West Ashley with a new, different dog and a new roommate and a new life in the same city.

I packed a bunch of my clothes to Houston because I had to check a bottle of port for Christmas. More than I would normally. Dress clothes. An electric blanket.

I don't have scrubs. Those stupid throwaway pieces of cloth the hospital provides us, but we have to return them to the machine to get them back and mine are burned.

But stay tuned for us on the news. We're top billing. They don't know our names or the dog's name, or if the cat I never liked is alive. But they know about the smoke that actually changed the city skyline for a while, the neighbors that were so horrified by our loss, the possibility of the Arsonist At Large, or if you're me, more probably, the Squatters That Were Cooking.

Can I just stay in Houston?

Another month of surg path down

Why are there so many Christmas trees around?

Oh right, the holidays... so today was the last day of work; I raced home, swinging by Charleston Beer Exchange to buy my roommate a "thank you for ferrying me to the airport at the break of day" six pack hand picked by a man with a moustache that said he was up to the job, then home to do the *absolute* worst packing job I've ever done in my life, and now, en route to bed as I wash my last shirt.

Warning to cousins: I may end up wearing bathing suit bottoms and a winter jacket. Not a good packing day for me.

This month has been an interesting one. As I've mentioned, I'm feeling more "getting the hang of it" in surg path. This is partially related to learning how all the systems work and what's supposed to go to what, which is a far greater contributor to competence than... you know... knowing what's under the microscope.

There's a certain logic that's emerging that seems absolutely obvious now most of the time but just wasn't when I started. Example...

My first month on, I had a uterus with potential endometrial cancer. I asked for help and was told to submit as much of the endometrium as possible, since obviously, that's where the cancer is.

So I proudly scraped every bit I could find off to make sure there was no spot unsampled. Bring on sign out... "Do you have any sections showing the depth of penetration into the myometrium?"

"Huh?"

"The most important prognostic criterion?"

"Uh... I scraped it off."

"You SCRAPED it OFF?"

(Puppy frown)

Fortunately, the beleaguered attending was able to salvage some unmutilated sample from the specimen, but not a proud day for me. Looking back, I have no idea what possessed me to think that would be a good idea. I wrote some of it down in my notebook so that I never go fully butt wild on a noob because I'm already realizing how much of an idiot I was a whole three months ago. By the time I'm in fourth year, it's going to be insane.

Part of my increasing, let's say "comfort", with my current lot in life is only now realizing that other people are going through *exactly* the same thing I went through.

Ishie, having mastered the art of "track down the screwed up slides" is charging through the halls between the resident on yesterday and the histo lab, is stopped by colleague who looks close to tears.

Colleague: "Um... do you know anything about... um... pancreas?"

Ishie: "Ah... my archnemesis. Not really. Sucks macro; sucks micro, gotta go".

Ishie sees colleague later, who is on hour 4 of read out or what I like to call "staring impotently into a scope until someone either helps you or you panic and then stop caring".

Ishie: "How'd it go?"

Colleague: "I hate pancreas."

Ishie peers in scope... "Breast, eh?"

Colleague: "I have four more... is it bad... I feel like I just don't care."

Ishie: "Diagnostic inertia."

Colleague: "This isn't cancer. What is that?"

Ishie: "I'd probably hedge my bets and call it sclerosing adenosis. It's probably wrong, but shows you were paying attention."

Female voice from dictaphone: "...Goodbye."

Colleague: "No!! You bitch!"

--------------------

While grossing placentas, which is tedious.

Ishie: "Dammit."

Different colleague: "What?"

Ishie: "This umbilical cord inserts but then, it's membrane bound all the way to the edge, and I don't remember what that's called."

Different colleage: "Where's the actual insertion point?"

Ishie: "Central. What should I call it?"

Different colleague: "Central."

--------------

Other colleague: "This is case SP-76-7872, patient's name is Jane Doe. Preop diagnosis of missed abortion. Specimen A is received in formalin in a container labeled with the patient's name, medical record number, and... wait a minute" (presses rewind)

Dictaphone: "Please scan the bar code."

Other colleague scans bar code: "beep"

Other colleague: "GODS. This is case SP-76-7872, patient's name is Jane Doe." (presses rewind)

Dictaphone: "Please scan the bar code."

Other colleague: "I'm going to break this phone."

I have done every single one of these things. It makes me feel peaceful. It also makes me feel good to be the go to girl among first years for prostate. It's a weird source of pride but there you have it. I'm good at prostates. I looked at so many at Brooklyn Hospital that it just stuck, so now I can scan away on forty slides feeling downright zen despite getting twisted into indecisive convulsions at trying to phrase "This guy has a giant icky infected boil in his arm" into pathology speech.

But enough with that! No more surge path this month or this year, and I'm off to see my family! I haven't seen any of them since I took my step 2 CS and my uncle ironed my white coat for me while my aunt took me shopping and my cousins took me drinking. I'm full of awesome sauce for it.

Happy Holidays everyone!!! May your ovaries all stay manageable sizes!!!!

A Caribbean M.D. is Weird Enough for Me.

See what I did there?

If I had to use one word to sum up what medicine feels like, it would be "Imposter".

Things are weird. Not bad weird. Just weird weird. Sometimes good weird.

I'm not sure if I'm a hipster or a yuppie or just desperately trying to pretend to be one or the other. I scathingly referred to my new brew as "Nut Brown Budweiser", which seems to put me in the hipster category, but I spent the evening at an Aquarium party for who knows what while eating different select cheeses and staring at fish, which seems like the latter. I did that while wearing a seemingly ironic dead alligator purse, which seems hipstery, until it's known that I only did it because it's the ONLY purse I have that can double as an evening purse, and then we're just back at imposter.

My point being, when I think "I'm a doctor", I don't think this:

Hi, I'm a turtle. I have nothing to do with pathology

I'm not sure why this party was being thrown. It was supposed to be impressing something on someone, but I don't think that someone was us. So we drank Chardonnay and watched albino alligators and sea turtles and ate brie, and attempted to do the electric slide, while I fidgeted and adjusted the dress I borrowed from my roommate, pretended to be deliberately avant garde with my eBay dead alligator purse, and made that level of polite conversation you see in movies about social functions like this one. If this had been a movie, you would have seen me through a fisheye lens prattling at the protagonist about sales on purses at Kohl's because the media has taught me that this makes good conversation, and to be fair to them, it totally does.

While a bald eagle squawks in front of the whole purse/shoe conversation because... pathology?

I'm okay with it though. It keeps me in wine and free meals until Christmas.

We had a fancy pants party last week as well, though this one had a more discernible motive and involved our department, but still, everyone climbed into the Charleston finery, went out to a posh venue and sipped champagne and ate sushi and danced the macarena or whatever else uncoordinated white people such as myself do. Of course, then all the residents bailed and went to a dive bar (the hipster is strong with these ones, Obi Wan), but still.

If I were back in Blood Bank, this would be a more natural progression of "nice clothes with a white coat and reviewing charts and occasional (gasp) seeing patients, and feeling all real-doctory and stuff, but I'm not. I'm in surgical pathology again. I live in comfy oversized scrubs that I rank according to how much formalin-soaked uterus juice they have on them on any given day. I run place to place; my pager goes off constantly.

Weirdly still, I'm starting to learn the whole way of it. For visiting newbies, (hi!) this is a marked deviation from my previous coping methodology which was sobbing hysterically into an open specimen until someone helped me.

I'm at 70 hours this week for the first time. And I haven't cried once.

Yesterday, I grossed. I've been getting faster and more efficient at it, so worked through my sheets as quickly as was possible and got it all on my run. This grossing day included some particularly juicy ovaries and placentas that sprayed blood, formalin, and unspeakable evil all over the place. But then... I have one attending whom I really like a lot but I feel like I've been letting her down a bit lately. Mainly because she's been following up cases that are in my custody while I've been attempting to score at least five hours of sleep a night. This is the same attending that's an amazing neuropathologist and has been trying to teach her knowledge to us. It becomes apparent to her through a few lectures that not a single damn person in our residency program has read the damn chapter(me included!) and she's beginning to get pissed.

So we end up with bonus unknown slides. This is essentially the pop quiz of pathology and consists of looking at tissue under a microscope while said image is projected onto a big screen and you have to describe the tissue and get the diagnosis (or something approximating it) while your colleagues stare at you, and the nice ones try to cough answers. Tres stresful. So I want to go home last night but I'm like "I can't even fake neuro, so I'm going to look at these unknowns", and try to cheat by pulling the patient numbers, which are obscured, which just serves to make me study. Two hours later, I realize I've been punked into reading the chapter I was attempting to cheat to avoid reading.

Morning came. 7:30 I'm there for frozen sections. Get a little breakfast. Go to neuro unknown conference. First two neuro cases go... for the second, I'm called up to drive the microscope. I do. My pager goes off after I get as far as "Uhh..." and I'm off to the frozen room. OR 8 needs frozens because their surgeon doesn't understand what frozens are for. I freeze lymph nodes in that time period, because I enjoy destroying diagnostically important tissue that doesn't freeze well. I go back to conference. Five minutes passes, during which I proudly have all my late night-compiled notes in front of me so I can act all gangsta about knowing that the nastiness in that person's skull is from their gonads. Beep goes the pager. Back to the frozen room.

The frozen room is where surgeons bombard you with spare scraps of their patients and expect you, in 20 minutes, to tell them what's wrong. This leads to conflict.

Some surgeons just call you to harass you. Some send an entourage of residents and fellows to come down and troll for blood. If they sense your weakness, you get overwhelmed and apologize profusely for the delay. If you sense *their* weakness for violating your territory, you adopt killer attitude and throw them out.

This used to be prime Ishie-cry territory, but I went with it. Describe the specimen, print the slides, freeze the piece, make the slides, run it to the attending. Rinse and repeat.

I get a tumor bank. No problem. I'm inking stuff and cutting into necrotic horrible looking tumor while the PA cuts other frozens in the background. I got this. I'm smearing awfulness onto a petri dish and dumping a piece of something else in cytogenetics material and running each to its proper place. It's good.

The morning hell cycle ends and I run to my mailbox, which is full of "special stains". My pager goes off three more times because the stuff I need deboned is coming out. Slowly and inconsistently. I grab those. All the stuff I grossed the day before starts coming out.

My attendings from the previous week all want something. Do you have the mesh? The mandible?" The Ki-67? Do you have the new levels? What did you think?

Meanwhile, I'm like... I spent 14 hours in a plastic shirt chopping uterus. Unless what you're talking to me about relates to being in a plastic shirt cutting uterus, I'm less than useful to you.

But I get it. I gather my old cases, start dictating addendums, and start making house calls. "Dr. S. I have the two decal slides that show infiltrating ductal carcinoma and I dictated them but..." etc. Then it's multi-houred "Benign Reactive Lymphoid Hyperplasia" (tonsils) time. I get those out. Throw in some transected fallopian tubes. A positive for cancer biopsy. A Vulvar lesion, grade 3. I dictate it off and keep going. I find myself minus one endometrium, and I wind up elbow deep in uterine fragments, wondering if I should be more worried about there being uterus on my upper arm or the carcinogens said uterus has been sitting in. I turf some stuff; I read up on the immunostains. I chat with the histologist, who calls me doctor.

I get it. Or, I'm finally starting to get it. This whole cycle, and I'm okay with it, hard as it is.

But then I'm running home to change into a cocktail dress so I can look at a bald eagle while eating homemade mac and cheese and drinking wine. Weird.

Meanwhile, stuff heard in the grossing room:

"Dammit, it looks like someone slaughtered a goat at my station."

"Wow! That looks like a honeybaked ham! Jamie!! Doesn't that look like a honeybaked ham?" "That's disgusting."

"Yo, Anna, you happen to see my dead twins around?" "Ah, the Carson kids. They're downstairs."

(after cranking at the cryostat) "Marster! Dinner is prepared!"

"Check it out; it's Godzilla's ovary."

My attending: "More blue." "More blue?" "Don't use the timer. Use the Force."

"Wanna see my carotid body?"

"I'm comfortable enough with my masculinity to wear a pink shirt, but to let another man run his hands all over me? No way. Let me see that uterus."

"Oh my god, I absolutely LOVE Florence and the Machine. Her voice is ama... SHIT, this ovary just exploded on me.

"There's a frozen from OR5." "Tell him to go away. Tell him Tyler went away. Tyler not here. Tell him the gate's closed."

"Can I put my butt warts on your run?"

You want me to tell what to whom?

"I bivalved the uterus. The endometrium looks normal."

"All right, let me come see. Okay, you're calling the OR."

"... what?"

"Call them and tell them."

(Deep breath) "Okay." (picks up phone)

"Wait! What are you going to say?"

"Uhhh... I... this is pathology."

"Do you have a name?"

"Yes."

"Do you have a degree?"

"Yes."

"So use it! Women, we always do this. You're DOCTOR Sancho and you have his results. Now what are you going to say?"

"Um... this is Dr. Sancho from pathology. The... uterus..."

"I examined the corpus and..."

"The endometrium appears benign. There are no polyps or lesions visible."

"Okay."

(Picks up phone) "Hello! This is Dr. Sancho from pathology. I examined the uterine corpus and the endometrium appears benign."

"Oh! This is his nurse. I'll put you on with Dr. ScarySurgeon."

"Hello? This is Dr. ScarySurgeon. You're on speakerphone."

"Meep."

Meanwhile:

Accessioner: "Ooh, that's Dr. ScarySurgeon? Tell him to call ahead on his frozens. I can't, but you can."
Ishie: "I'm a first year. He'll beat me up and take my lunch money."
Accessioner: "You have lunch money?"
Ishie: Dammit.

The elusive monkey

But just when you thought I had a big long blog post prepared for you, I'm back on surgical pathology! Mwa ha ha ha ha. And still without a home computer. I'm looking at a hard drive wipe, but I'm also looking at a device so buggy that it won't avoid the fatal errors for the two days it would take to do a full back up onto my external. Le Sigh.

I'm also left with the quandary of having that Dr. Horrible link come up as one of the first things I see, because I could probably watch Slipping and Bad Horse on repeat for as long as it would take me to fix my home computer.

But instead I'll say, I went to Costa Rica! Woo hoo!! After fruitless years as an anthropology major with an advisor who was a big primatology guy, as well as two years in Grenada and a trip to the Philippines, I'm finally gonna see some frigging monkeys!

Dammit. It's like they know. We went to this one beach where I overheard a guide say to a group "You need to be careful about leaving belongings on the beach. The monkeys will open your bags and rummage through them."

Monkeys are actually a *problem* in this country. But for me? No monkeys.

However, as I was walking through a particularly scenic rainforest, this guy nearly fell on me:

They're not graceful animals.

They also kind of look like Chewbacca and an orangutan had a drunken, regret filled night in Las Vegas. And died the result green.

I heard a cracking noise above me, and something crashed down out of the trees. When I saw it was a sloth, I had a brief insane moment where I whipped my camera out and was like "I need to get this picture before it gets away". Then I took like 25 pictures because... sloth.

We also stayed in a place that looked like this:

And I did this:

So I'm thinking f- the monkeys.

Anyway, I'm late to bed but the short of it is:
Costa Rica= awesome
Blood bank rotation= awesome
Having a week of Xmas vacation over surge path= awesome
Having additional source of income= awesome
Getting to go to Houston for the holidays to see extended family for the first time in forever= awesome
Seeing mom in Maryland over Thanksgiving and learning fun-facts about the Amish= awesome
Being back in surge path= This time will be totally different! What's that ominous music?
Dad back in hospital for Thanksgiving= unawesome

Pending... pending... Thanksgiving loading

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.

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.

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.

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.

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.

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.

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.