No, not *those* kind of recreational activities.
This year in Charleston has been... let's say meterologically bipolar, so my celebration of "summer is here!!" after finishing surgical pathology in June was met by about a month of solid rain. This isn't really notable since it's pretty much been raining since February, but then I wanted to *do* stuff.
This led to my roommate, boyfriend, and I finally saying f- it and sailing in the middle of a storm. It went shockingly well. Even saw some dolphins.
At a certain point, I think the endless weather got to my roommate as well. She's a persuasive sort too, so in the last month I've encountered "Let's join a bowling league" (note: I have scored a Zero while bowling, granted, while very very drunk. I have also bowled a 50 while completely sober) and "Let's buy kayaks!!!" (my kayaking experience consists of about four trips out in sit-on-tops and the ownership of an inflatable diveyak whose sole purpose was carting gear). Since I'm a follower, I'm now in a bowling league and own a kayak. Since my boyfriend is apparently even more suggestible than I am, he now owns an SUV.
Yeah, it's a good thing this girl isn't into drugs or something.
Yesterday was the maiden voyage of the kayaks out of Wappoo Cut, which went shockingly well for me. Saw egrets and jumping fish and the boaters were nice to us.
And the bowling league is going well. But that's all fun stuff. I've been continuing my lengthy training for the bridge run (while injuring my calf and being grounded to swimming a week), and periodically attempt to surf over at Folly Beach. I've also been catching up Breaking Bad (god I hate Walter) and the Walking Dead (god I hate Andrea). There's a reunion trip to NYC in a couple weeks to catch up with the medical school crowd and all is well.
So the work stuff. Staffing continues to be an issue, but now that I'm off surgical pathology, it isn't really my problem until next month.
July, I was on autopsy with one of my best friends, who also wants to go into forensics. Despite having one of the most death-spectacular months on record, I'd think, I can't call it anything but insanely fun given the dynamic. Which, I know sounds weird. The combination of our working well together and our general experience now that she has three months of autopsy and I have four absolutely thrilled the attendings, and they know they hooked her before she started, so now they've started working on me.
A forensic pathologist that thinks she can sway you into the field is a bit like a Baptist who thinks you have an interest in Jesus. They are *relentless*. Highlights were "You're gonna push glass! You're gonna be miserable!!" And I'm like "No! I want to go into cytopathology! I want to be a general pathologist! You're not my real mom!"
But still fun. There's also a thing that goes down in autopsy where you get really sick of having dead people with no relevant findings so you have no good answer as to why they're dead, and this happens more than you'd think. Usually toxicology clears it up (sorry CSI fans, but that takes 3-6 weeks), but it's less satisfying. So when your gross examination reveals a smoking gun of a cause of death (ruptured berry aneurysm, saddle embolus, aortic dissection), you get really excited about it, but you can't express that if the surgeon happens to be in the suite with you, which happens occasionally. So you have to wait for him to leave, which usually provokes a dance.
Yeah... it is neat. I'd be more tempted, but as you can probably glean from my previous fire experiences, I *hate* court, and that's part of the job. I will do virtually anything before I spend an hour in court. The entire process just makes me rage like the Hulk. I'm wondering if I can use it to get out of jury duty. "Hi, yeah. I have no opinion on this case, but I'd just like to say, judge, that I hate you, I hate both lawyers, and I hate everyone in this courtroom. Can I go?"
Now it's hemeland, with it's chaotic leukemianess. And we've had a ton of people rotating through so seating is always an issue, but so it goes. That used to be my chosen specialty before I got led away from the fold by cytopathology.
That's the update for now. Next month will be back to surgical pathology. Next few weeks, we'll see if the heme team slows it up a bit. Oh, and fellowship applications need to be consolidated around September 1st. Eek!
Jul 2, 2013
Time flies when you have no time
So, as of yesterday morning, I'm a third year resident. If I were a family medicine or IM resident or many varieties of emergency medicine resident, that would make this my last year.
Pathology residency, as I've explained, is four years, plus a relatively mandatory fellowship, but it means I'm in the last half. There's an end on the horizon. I get the little pay bump every year. I'm now in senior ville. I have a new office downstairs, that I share with two of my closest friends. I start to feel a little more like a grown up.
It's been a little hit and miss lately. I tackled my first month back in surgical pathology at the main hospital in over a year with quite a bit of trepidation. For those taking note, any month of surgical pathology tends to have me tearful and bipolar by the end of that month, and coupling that with the hardest of the surgical pathology months, and being rusty, seemed like evidence for disaster.
I handled it. We've been having an endless supply of administrative and staffing issues lately, which culminated at the end of last month. Three weeks in, I have to say, I was grimly doing well. Usually I go in with a "this time things will be different!!" attitude and melt down around day 9. This time I held a really good pace until things exploded at the end, and even then, I got my cases done, researched them well, and only had one day where I was like "Seriously, no one f-ing talk to me. I can get my work done today and I can do it well, but I cannot do that while being a nice human being, so you can pick one and then get out of my face".
One of my attendings, and I love him, is the warm fuzzy type, kids of his own, grandkids, but he's a "Smile" guy.
I can be smiley. Which is surprising, I know. I'm generally absolutely silly, and my conduct around is largely like my conduct online in that I make a ton of sarcastic jokes and say things that border on inappropriate and periodically dance around when a song I like comes on. When I'm happy, I smile.
I'm also an only child. If I'm not happy, I don't smile. If I want to be alone, I don't smile. I go to my room to cool off and deal with it myself. Telling me to smile when I'm already irritable and pissed off is going to go poorly. I can pretty much manage "dead face" when I'm that angry and irritated, and it's my way of telling you to please be elsewhere unless you have immediate business with me that needs handling. If I were a rattlesnake, this is when you'd hear the rattle.
But otherwise, ever since I got my schedule at the beginning of last year, I thought "June is going to suck. You know what you're going to be doing in June? Nothing, that's what." so with that acceptance, the days I made it home by 8 PM or the weekends I was able to attend old roommate's wedding or awesome attending's wedding were good days. And the weather has obliged my awful on call then surg path schedule by raining since February.
And now it's my summer. And I'm a senior. And tomorrow I fly out to somewhere in Texas that incidentally has rattlesnakes so I can spend the 4th of July with my mom. And there's that.
I'm also dealing with the "grown up resident" stuff now. I'm beginning to compile a list of fellowship institutions to which I plan to apply. I'm working on multiple projects and papers.
Oh, speaking of the latter, I got another CAP abstract accepted so I get a free trip to Orlando and networking opportunities in October, so that's pretty groovy. And speaking of *not* being mature, in September I get to go up to Ashville for something called "Brewgrass" which involves microbreweries and all day bluegrass music at a time of year that's gorgeous. So things are going up. Boyfriend and I are still holding strong, despite my periodically being a terrible person.
So July is an autopsy month, home again of cool stuff that I can't tell you. I can say I'm now 8 autopsies away from our mandatory 50 though. This is required for licensing. And since I'm on my fourth month down there *and* on with one of my favorite people, it's honestly just fun, which probably sounds callous and mean, but there it is. I like the staff, they're not having the issues we're dealing with upstairs, things are pretty relaxed and I know the score of how it runs so I feel confident *and* competent, a rare combo. I'm used to the attendings down there enough to know when to joke with them, even if they're micromanaging my heart dissection.
That's the update. I still advise here and there on going to the Caribbean, though my knowledge feels somewhat more dated, but keep in mind, people going through it, you come out on the other side, and then you deal with all residency stuff. It's hard to picture doing anything else.
Pathology residency, as I've explained, is four years, plus a relatively mandatory fellowship, but it means I'm in the last half. There's an end on the horizon. I get the little pay bump every year. I'm now in senior ville. I have a new office downstairs, that I share with two of my closest friends. I start to feel a little more like a grown up.
It's been a little hit and miss lately. I tackled my first month back in surgical pathology at the main hospital in over a year with quite a bit of trepidation. For those taking note, any month of surgical pathology tends to have me tearful and bipolar by the end of that month, and coupling that with the hardest of the surgical pathology months, and being rusty, seemed like evidence for disaster.
I handled it. We've been having an endless supply of administrative and staffing issues lately, which culminated at the end of last month. Three weeks in, I have to say, I was grimly doing well. Usually I go in with a "this time things will be different!!" attitude and melt down around day 9. This time I held a really good pace until things exploded at the end, and even then, I got my cases done, researched them well, and only had one day where I was like "Seriously, no one f-ing talk to me. I can get my work done today and I can do it well, but I cannot do that while being a nice human being, so you can pick one and then get out of my face".
One of my attendings, and I love him, is the warm fuzzy type, kids of his own, grandkids, but he's a "Smile" guy.
I can be smiley. Which is surprising, I know. I'm generally absolutely silly, and my conduct around is largely like my conduct online in that I make a ton of sarcastic jokes and say things that border on inappropriate and periodically dance around when a song I like comes on. When I'm happy, I smile.
I'm also an only child. If I'm not happy, I don't smile. If I want to be alone, I don't smile. I go to my room to cool off and deal with it myself. Telling me to smile when I'm already irritable and pissed off is going to go poorly. I can pretty much manage "dead face" when I'm that angry and irritated, and it's my way of telling you to please be elsewhere unless you have immediate business with me that needs handling. If I were a rattlesnake, this is when you'd hear the rattle.
But otherwise, ever since I got my schedule at the beginning of last year, I thought "June is going to suck. You know what you're going to be doing in June? Nothing, that's what." so with that acceptance, the days I made it home by 8 PM or the weekends I was able to attend old roommate's wedding or awesome attending's wedding were good days. And the weather has obliged my awful on call then surg path schedule by raining since February.
And now it's my summer. And I'm a senior. And tomorrow I fly out to somewhere in Texas that incidentally has rattlesnakes so I can spend the 4th of July with my mom. And there's that.
I'm also dealing with the "grown up resident" stuff now. I'm beginning to compile a list of fellowship institutions to which I plan to apply. I'm working on multiple projects and papers.
Oh, speaking of the latter, I got another CAP abstract accepted so I get a free trip to Orlando and networking opportunities in October, so that's pretty groovy. And speaking of *not* being mature, in September I get to go up to Ashville for something called "Brewgrass" which involves microbreweries and all day bluegrass music at a time of year that's gorgeous. So things are going up. Boyfriend and I are still holding strong, despite my periodically being a terrible person.
So July is an autopsy month, home again of cool stuff that I can't tell you. I can say I'm now 8 autopsies away from our mandatory 50 though. This is required for licensing. And since I'm on my fourth month down there *and* on with one of my favorite people, it's honestly just fun, which probably sounds callous and mean, but there it is. I like the staff, they're not having the issues we're dealing with upstairs, things are pretty relaxed and I know the score of how it runs so I feel confident *and* competent, a rare combo. I'm used to the attendings down there enough to know when to joke with them, even if they're micromanaging my heart dissection.
That's the update. I still advise here and there on going to the Caribbean, though my knowledge feels somewhat more dated, but keep in mind, people going through it, you come out on the other side, and then you deal with all residency stuff. It's hard to picture doing anything else.
May 21, 2013
I'm gonna go ahead and ask you to not put that over my face
Ah Micro.
The return to the very origins of my interest in medicine. Outbreak, with Dustin Hoffman... a little sprinkling of Hot Zone. And overly ambitious 12 year old.
And I've arrived. I'm currently doing exactly what I wanted to do when I was 12 with the exception of chasing monkey around.
Mornings are on the bench. Today was the urine bench, it was not as awful as you'd think.
Sometimes genital-rectal. Sometimes wound exudates. Sometimes respiratory. They teach, I learn.
Then rounds. Rounds consists of wandering around without a real idea of what's going on, poking you head in to see what's interesting. Then you start the smell game. "Hey, smell this plate!" "No.. I don't wan... yeah, it does smell like rancid juicy fruit. Am I about to die? I feel like I shouldn't be holding this near my face."
I'm not OCD. I feel like I'm going to become OCD.
I've learned about the devious nature of these creatures. They're oxidase positive until they aren't. They behave differently. But clean. Where ever you are, clean. They're under your nails On the faucet handle. You have to watch them.
In between this, the calls. My attending is gone until Thursday so all the spooky day calls fall on me. Can we get more extensive cultures? Can we get susceptibilities? Things I can initiate, but haltingly so.
This is on top of about 6 working days of micro. Sherry, Justin, the Wrestler, and I hit Mexico Beach and had a horrendously good time. I mean...
I mean seriously, add 200$ in hooch to that and you're here
It was amazing. Tons of us, everyone happy and having a good time, and utterly relaxing. Now to this weekend in Vegas where we do the exact opposite of that. Woot!
The return to the very origins of my interest in medicine. Outbreak, with Dustin Hoffman... a little sprinkling of Hot Zone. And overly ambitious 12 year old.
And I've arrived. I'm currently doing exactly what I wanted to do when I was 12 with the exception of chasing monkey around.
Mornings are on the bench. Today was the urine bench, it was not as awful as you'd think.
Sometimes genital-rectal. Sometimes wound exudates. Sometimes respiratory. They teach, I learn.
Then rounds. Rounds consists of wandering around without a real idea of what's going on, poking you head in to see what's interesting. Then you start the smell game. "Hey, smell this plate!" "No.. I don't wan... yeah, it does smell like rancid juicy fruit. Am I about to die? I feel like I shouldn't be holding this near my face."
I'm not OCD. I feel like I'm going to become OCD.
I've learned about the devious nature of these creatures. They're oxidase positive until they aren't. They behave differently. But clean. Where ever you are, clean. They're under your nails On the faucet handle. You have to watch them.
In between this, the calls. My attending is gone until Thursday so all the spooky day calls fall on me. Can we get more extensive cultures? Can we get susceptibilities? Things I can initiate, but haltingly so.
This is on top of about 6 working days of micro. Sherry, Justin, the Wrestler, and I hit Mexico Beach and had a horrendously good time. I mean...
It was amazing. Tons of us, everyone happy and having a good time, and utterly relaxing. Now to this weekend in Vegas where we do the exact opposite of that. Woot!
Apr 9, 2013
Beat them again!!!
I'm on Clinical Pathology call this week. This is the one that can drag you in on the weekends, but usually doesn't require coming in on weeknights, but rather answering complicated questions at 2 in the morning. I'd say I'm getting a much better hang of it, but that will ensure I have a terrible shrill screaming pager night, so I'll say nothing of the sort.
I've had one call so far tonight and the day the attendings of my hospital collectively get together and realize that when they get paged by a Dr. (Generic Half of Last Name) to a cell phone number (I got tired of hanging around the hospital phone like a jilted date), they're getting duped by an aggravated resident will be a much rougher one for me. Apparently the lab had been paging this guy since the mid afternoon with no answer despite increasingly urgent messages, which put me on the case. I used my "get surgeons to call me" trick and my phone lit up within three minutes. Mwa ha ha ha ha.
If you are speaking with a patient or actively cutting things inside them, I am absolutely happy understanding a wait. But ignoring the lab all day because you deem their results unimportant? Considering that the last time I had a full call week, I stripped down during an autopsy *five times* because my pager was going off, I'm not hearing it. When I do get nailed at 3 AM, I jolt out of bed, take long enough to flip my computer open and find a good reception spot, and call back. Because chances are the person calling me doesn't really want to wait up for me to call back at 3 AM either.
Things to know about call... hmm...
1. If you're at a hospital that uses a pager system, there *will* be one specific pager alarm that is awful, shrill, and will wake up anyone, which is why you will use it when you're on call, opposed to your normal "chirp and vibrate" for your waking workday. After a couple of times on call, you will have a visceral awful reaction anytime you hear it. If you're in a conference room and that alarm goes off, *everyone* will reflexively twitch, shudder, and snap for you to change it. If you have a significant other, that individual will similarly be negatively conditioned.
2. Pagers hate showers. You can have three hours of absolutely nothing and the minute you get shampoo in your hair, ring!!!
3. Pagers like reckless driving. Fast moving but heavy traffic between freeway exits is prime pager territory.
4. Pagers LOVE the hour before you were due to get up. This way they can ensure you are short slept while depriving you of any opportunity to go to sleep *or* the potential to try to sleep in since "you're already up".
5. Pages love company. If you get ten pages on a Saturday, they will absolutely all be within a half hour of each other, and the sudden flux will make you so paranoid, you won't leave your desk for the rest of what will no doubt be a dead silent rest of your day.
6. Pagers give off psychic energy. If they cannot psychically compel other people to call and wake you up, they will merely falsely broadcast dreams of them going off. If you don't wake up in a suitable panic, they will up the ante by broadcasting dreams of missing critical pages.
7. Pagers loathe patients. Pagers enjoy afflicting patients with whatever ailment will require the most satellite resources at times when those resources cannot possibly be mobilized, requiring stop-gap measures. Pager favorites are HLA matched platelets on Fridays after the Red Cross has closed and organ donations. I can help, but I can't fix until three different labs in two different cities have opened for business at 9 AM on Monday morning. The pagers of surgeons, I'm told, enjoy introducing simultaneous critical patients that require the same specialist.
8. Pagers are offended by blog posts condemning them. Mine just went off.
These should help guide you all in your own experiences.
I've had one call so far tonight and the day the attendings of my hospital collectively get together and realize that when they get paged by a Dr. (Generic Half of Last Name) to a cell phone number (I got tired of hanging around the hospital phone like a jilted date), they're getting duped by an aggravated resident will be a much rougher one for me. Apparently the lab had been paging this guy since the mid afternoon with no answer despite increasingly urgent messages, which put me on the case. I used my "get surgeons to call me" trick and my phone lit up within three minutes. Mwa ha ha ha ha.
If you are speaking with a patient or actively cutting things inside them, I am absolutely happy understanding a wait. But ignoring the lab all day because you deem their results unimportant? Considering that the last time I had a full call week, I stripped down during an autopsy *five times* because my pager was going off, I'm not hearing it. When I do get nailed at 3 AM, I jolt out of bed, take long enough to flip my computer open and find a good reception spot, and call back. Because chances are the person calling me doesn't really want to wait up for me to call back at 3 AM either.
Things to know about call... hmm...
1. If you're at a hospital that uses a pager system, there *will* be one specific pager alarm that is awful, shrill, and will wake up anyone, which is why you will use it when you're on call, opposed to your normal "chirp and vibrate" for your waking workday. After a couple of times on call, you will have a visceral awful reaction anytime you hear it. If you're in a conference room and that alarm goes off, *everyone* will reflexively twitch, shudder, and snap for you to change it. If you have a significant other, that individual will similarly be negatively conditioned.
2. Pagers hate showers. You can have three hours of absolutely nothing and the minute you get shampoo in your hair, ring!!!
3. Pagers like reckless driving. Fast moving but heavy traffic between freeway exits is prime pager territory.
4. Pagers LOVE the hour before you were due to get up. This way they can ensure you are short slept while depriving you of any opportunity to go to sleep *or* the potential to try to sleep in since "you're already up".
5. Pages love company. If you get ten pages on a Saturday, they will absolutely all be within a half hour of each other, and the sudden flux will make you so paranoid, you won't leave your desk for the rest of what will no doubt be a dead silent rest of your day.
6. Pagers give off psychic energy. If they cannot psychically compel other people to call and wake you up, they will merely falsely broadcast dreams of them going off. If you don't wake up in a suitable panic, they will up the ante by broadcasting dreams of missing critical pages.
7. Pagers loathe patients. Pagers enjoy afflicting patients with whatever ailment will require the most satellite resources at times when those resources cannot possibly be mobilized, requiring stop-gap measures. Pager favorites are HLA matched platelets on Fridays after the Red Cross has closed and organ donations. I can help, but I can't fix until three different labs in two different cities have opened for business at 9 AM on Monday morning. The pagers of surgeons, I'm told, enjoy introducing simultaneous critical patients that require the same specialist.
8. Pagers are offended by blog posts condemning them. Mine just went off.
These should help guide you all in your own experiences.
Apr 7, 2013
Never let your guard down
Not in any kind of dire horrible way, don't get me wrong. I'll explain.
I feel like medicine is full of the general sensation of feeling like you're done, but you really aren't. Got into medical school? Whew! Smooth sailing! Nope. Class rank. Step 1. Step 2. Surgery hours. Trying to scrape in a publication, schmooze with residents, schmooze with attendings, pick a discipline, hope you get a residency in it. And then, you're a resident! Wahoo!!! It's all paid off! Well, hold on a minute there sunshine. Do you want to be chief resident? (No) Do you want to do a competitive fellowship? Is your field a little difficult on hiring?
You're not done taking tests. You're not done studying. You're not done with having projects hanging over you. These aren't necessarily bad things; you have to stay on top of material just to be a good doctor, but that feeling I had in medical school that any time I was recreating I felt guilty still exists.
So the current sequence of events. Pathology has a notoriously difficult job market that really requires a fellowship. You begin applying for fellowships at the beginning of your third year, which seems really far away when you're just starting and now you're like "What do you mean I have to decide what kind of pathologist I wanna be??? I just decided on "pathologist" not that long ago!"
A friend of mine wants forensics, which requires an even greater jump ahead. Fortunately, all forensics people seem to be born knowing they're forensics people. So friend is freaking out because she needs to get in her fellowship applications like.. now. Naturally, as is the way of medicine, this triggers an avalanche of freakouts in her colleagues.
Now, when you're in surgical pathology, you're in surgical pathology. Nothing much else is expected of you other than reining in the urge to kill surgeons if they stand behind you and make snarky comments.
So I got out of surgical pathology... into lighter rotations *and*, just by coincidence, a slew of extremely unfortunate weirdly presenting publishable patients. So I went from having one publication since starting residency, to having a bunch waiting in line for me to try to make heads or tails of them.
In the middle of this, I had been somewhat poorly scheduled for a Journal Club (thirty minute talk), a GME (thirty minute talk), a "Big Meeting presentation" (20 minute talk) and a CP talk (five minute talk). Over the course of three weeks, which also included the RISE exam, which is a way to determine whether you're going to fail boards in two years.
Since this wasn't enough busywork and stress for my procrastination addicted brain, I realized the new deadline for submission of the CAP meeting was in the middle of all that, and I had a doozy of a weird microbiology case, so... I added that workload onto myself.
I also got last minute selected as a delegate, which is actually pretty groovy, am turning in an application for a committee membership in cytopathology, and speaking of cytopathology, finally put on my big girl pants, approached the cytopathologist and begged for case series. So... yeah.
You spend your first year trying to stay afloat and most of your second year finally feeling good about "getting it" and then realize that it's time to boost your CV like NOW.
Speaking of cytopathology, it's still battling hematopathology in my heart, but I think I'm falling into the cyto camp. This also looks like it's going to have me scrounging for jobs in (gulp) Houston, since that's where a few of the good programs are.
So the last three weeks have been me hammering away at various projects and forgoing exercise and other necessities.
Oh! Adding to the fun was that at the beginning of this venture, two things happened: One, I decided to undergo a minor elective procedure which generally has no complications, and two, I had a weekend catch up trip to NYC planned, all of which I had scheduled my crushing paperwork around.
Much to my surprise, said minor procedure led to a week of crippling horrifying, attending-pissing-off pain and the discovery (via emergency room) that all my pelvic organs are in the wrong place and I have an extra bone in my spine. While discovering I'm an awful patient (though really tolerant of any blood draw procedures), once I was past the "AHHHHH" stage of the week, the various workups punched straight through concern and into fascination. I creeped my parents out by thinking they'd think it was cool to have a spinning 3D image of my renal vasculature and sending it to them on my iPhone. I mean, they're my jacked up kidneys; if anyone's freaked out by what is obviously INSANELY cool science, it should be me.
Oh yes, on the attending pissing off... She and I are cool now, but my first week with a new attending was spent not paying attention, unable to focus on work, and periodically passing out while she was actively talking to me. In my 4 am ED email stating I would be missing yet *more* work, I promised her a complete explanation, but I think she put the pieces together and greeted me with "I don't need to know your business", so we're cool now. And I got more out of the rotation that I probably would have initially because I spent the last 3 weeks overcompensating like a mofo.
What else. I ran a 5K that benefits children's hospitals and primarily gets attention by the additional feature that the people organizing it throw colored corn starch at you while you're running and occasionally hit you with super soakers full of paint, which does make it difficult to run. Fortunately, despite being a 5K, absolutely none of it was timed, and instead of a clock, the finish line consists of people holding out more chalk bags so you can hurl them at people. It was groovy. I really underestimated how awesome South Carolina could be when I was considering moving here.
Speaking of things Charlestonian, we just had the Cooper Bridge run (which spawned the "Ridiculously photogenic guy" meme last year). Since I am way too painfully out of shape currently to run a 10K up that ridiculously angled bridge, a bunch of us instead got dressed up in clothes somewhere between old Charleston and the Kentucky Derby and went bar hopping. I finally got a ridiculously floppy hat and a mullet sundress, so I feel proper.
So that's the update. I'm also on CP call starting tomorrow, which I'm cautiously optimistic about and will likely have an apocalyptic breakdown somewhere around Wednesday after I get called about amylase at 4 in the morning for the 5th time. But Game of Thrones is back on, so that will make me happy just about always.
Happy Spring! FINALLY!
I feel like medicine is full of the general sensation of feeling like you're done, but you really aren't. Got into medical school? Whew! Smooth sailing! Nope. Class rank. Step 1. Step 2. Surgery hours. Trying to scrape in a publication, schmooze with residents, schmooze with attendings, pick a discipline, hope you get a residency in it. And then, you're a resident! Wahoo!!! It's all paid off! Well, hold on a minute there sunshine. Do you want to be chief resident? (No) Do you want to do a competitive fellowship? Is your field a little difficult on hiring?
You're not done taking tests. You're not done studying. You're not done with having projects hanging over you. These aren't necessarily bad things; you have to stay on top of material just to be a good doctor, but that feeling I had in medical school that any time I was recreating I felt guilty still exists.
So the current sequence of events. Pathology has a notoriously difficult job market that really requires a fellowship. You begin applying for fellowships at the beginning of your third year, which seems really far away when you're just starting and now you're like "What do you mean I have to decide what kind of pathologist I wanna be??? I just decided on "pathologist" not that long ago!"
A friend of mine wants forensics, which requires an even greater jump ahead. Fortunately, all forensics people seem to be born knowing they're forensics people. So friend is freaking out because she needs to get in her fellowship applications like.. now. Naturally, as is the way of medicine, this triggers an avalanche of freakouts in her colleagues.
Now, when you're in surgical pathology, you're in surgical pathology. Nothing much else is expected of you other than reining in the urge to kill surgeons if they stand behind you and make snarky comments.
So I got out of surgical pathology... into lighter rotations *and*, just by coincidence, a slew of extremely unfortunate weirdly presenting publishable patients. So I went from having one publication since starting residency, to having a bunch waiting in line for me to try to make heads or tails of them.
In the middle of this, I had been somewhat poorly scheduled for a Journal Club (thirty minute talk), a GME (thirty minute talk), a "Big Meeting presentation" (20 minute talk) and a CP talk (five minute talk). Over the course of three weeks, which also included the RISE exam, which is a way to determine whether you're going to fail boards in two years.
Since this wasn't enough busywork and stress for my procrastination addicted brain, I realized the new deadline for submission of the CAP meeting was in the middle of all that, and I had a doozy of a weird microbiology case, so... I added that workload onto myself.
I also got last minute selected as a delegate, which is actually pretty groovy, am turning in an application for a committee membership in cytopathology, and speaking of cytopathology, finally put on my big girl pants, approached the cytopathologist and begged for case series. So... yeah.
You spend your first year trying to stay afloat and most of your second year finally feeling good about "getting it" and then realize that it's time to boost your CV like NOW.
Speaking of cytopathology, it's still battling hematopathology in my heart, but I think I'm falling into the cyto camp. This also looks like it's going to have me scrounging for jobs in (gulp) Houston, since that's where a few of the good programs are.
So the last three weeks have been me hammering away at various projects and forgoing exercise and other necessities.
Oh! Adding to the fun was that at the beginning of this venture, two things happened: One, I decided to undergo a minor elective procedure which generally has no complications, and two, I had a weekend catch up trip to NYC planned, all of which I had scheduled my crushing paperwork around.
Much to my surprise, said minor procedure led to a week of crippling horrifying, attending-pissing-off pain and the discovery (via emergency room) that all my pelvic organs are in the wrong place and I have an extra bone in my spine. While discovering I'm an awful patient (though really tolerant of any blood draw procedures), once I was past the "AHHHHH" stage of the week, the various workups punched straight through concern and into fascination. I creeped my parents out by thinking they'd think it was cool to have a spinning 3D image of my renal vasculature and sending it to them on my iPhone. I mean, they're my jacked up kidneys; if anyone's freaked out by what is obviously INSANELY cool science, it should be me.
Oh yes, on the attending pissing off... She and I are cool now, but my first week with a new attending was spent not paying attention, unable to focus on work, and periodically passing out while she was actively talking to me. In my 4 am ED email stating I would be missing yet *more* work, I promised her a complete explanation, but I think she put the pieces together and greeted me with "I don't need to know your business", so we're cool now. And I got more out of the rotation that I probably would have initially because I spent the last 3 weeks overcompensating like a mofo.
What else. I ran a 5K that benefits children's hospitals and primarily gets attention by the additional feature that the people organizing it throw colored corn starch at you while you're running and occasionally hit you with super soakers full of paint, which does make it difficult to run. Fortunately, despite being a 5K, absolutely none of it was timed, and instead of a clock, the finish line consists of people holding out more chalk bags so you can hurl them at people. It was groovy. I really underestimated how awesome South Carolina could be when I was considering moving here.
Speaking of things Charlestonian, we just had the Cooper Bridge run (which spawned the "Ridiculously photogenic guy" meme last year). Since I am way too painfully out of shape currently to run a 10K up that ridiculously angled bridge, a bunch of us instead got dressed up in clothes somewhere between old Charleston and the Kentucky Derby and went bar hopping. I finally got a ridiculously floppy hat and a mullet sundress, so I feel proper.
So that's the update. I'm also on CP call starting tomorrow, which I'm cautiously optimistic about and will likely have an apocalyptic breakdown somewhere around Wednesday after I get called about amylase at 4 in the morning for the 5th time. But Game of Thrones is back on, so that will make me happy just about always.
Happy Spring! FINALLY!
Mar 6, 2013
Breaks between surgical pathology
Hmm, what can I say to you lovely people that won't be boring and predictable? More about life in a pathology residency? Or more about life in a pathology residency if you're me?
My schedule since December has pretty much been to be on call every three weeks. This overlaid February, which was one of the worst surg path months I've had to date, which also led to getting piled on by people nitpicking my after-hours work.
Don't be that guy, people. If you know your colleague has been at the hospital for over 70 hours, don't be the jerk in the morning that goes "You didn't get my protaste marginnnns!!!' and certainly don't be the one that whines to the chief about it.
This kind of covers a spectrum too. If you see anything that's clearly a result of a fatigued oversight (so long as it doesn't hurt the patient), like a lid not closed, or a sticker placed on the wrong thing, or an uncleaned scalpel where all the other instruments are clean, put on your big girl panties and just move on with your life. If you find something particularly offensive, talk to the person who did it directly. If they throw you tude and refuse to stop, THEN run and find someone to tattle to, but otherwise, just be a grown up.
Anyway, so the month of February generally sucked. I also still find myself reading out late into the night where I feel like I should be getting better at all this, but on the plus side, my reports have been improving markedly, so I do have that. The last week of read out, I was actually doing better, and I'm feeling at home with the ART specimens, since I've dealt with them three months so far this year. Breast, bowels, lungs, got it.
Breasts are nebulous pathological creatures. You can rarely call a "benign breast" because there's always something going on in them even if it isn't a scary something. So you get good at recognizing all the little halmarks of proliferative fibrocystic change diseases, biopsy site reactions. Your apocrine metaplasia, columnar cell change, florid ductal hyperplasia, usual ductal hyperplasia, etc ad infinitum.
Lungs are more simple. The complication comes with how much the surgeon mangles it, and how many extra structures (heart, ribs, bowel wall) you unexpectedly get.
While dealing with this, we've also been dealing with our new system. This was put in place in October in time for Halloween, because the best "trick" in "Trick or treat" is the one that never goes away. Communications with the new system finally reached a new low when I was on a Friday call with things going on simultaneously at two hospitals, requiring me to pack up my remaining work and bring it over to the main hospital. It was about this time that the new system quit and refused to print anything I needed. I had started this week on Monday going "I'm not going to let call get to me this time. I'm going to really try a positive attitude and remember that I love my job" and ended with my sobbing in front of this uncaring machine, begging for it to let me go home.
In other news, I'm off all that now, and get to spend three months pulling my self esteem back together before breaking it all over my June surgical pathology month at the main. Right now is immunopathology, which means playing with electron micrograph images, actually learning to read flow cytometry, and playing with the immunostains that light everything up. Kidneys are weird business, and a lot of immuno-relevant stuff happens to them. The process of their transplant and removal is somewhat fascinating as well. Jam them into the abdomen, leave the old ones in place, the whole nine yards.
What else... I traded call so I could go to Brewvival on a wet and miserable Saturday following the Friday where I broke down, so got to try a number of exquisitely well made (if overly barrel aged) beers while watching shirtless men mud wrestle.
This weekend, I get to go back (and freeze) in NYC to show a new friend how to correctly negotiate the hedonistic trends of the city. I'm excited about it, though it'd be difficult to compete with my last trip there. May will be Vegas and Mexico Beach, the first with new Boyfriend, the second as a re-crash course into sailing once the season begins. Roommate and I are trying to learn to turn faster, though the weather is currently not cooperating with our attempts to do *anything*.
I'm learning the surgeons I like, the surgeons I don't like, and the surgeons I wouldn't let operate on a cat. One who did not belong in the latter category came down one lovely call night as I was attempting to leave the hospital and said "If you get the right answer, we all get to go home", and damn did I like those odds.
I saw Skyfall in the way back (hooray James Bond!) and Django Unchained in the more recent. I'd recommend the first to anyone. I'd recommend the second to any Tarantino fans because it's a Tarantino movie. It's like he signed every scene.
Now that the crushing holiday season and its fall out are over, I can get back to exercising. Surgical pathology plus crappy weather plus call plus stress equals horrendous weight gain and fatigue.
I'm getting my doctor's appointments in (never do anything that relates to your own hospital; I am dealing with absolutely jaw dropping lack of concerns for HIPAA from hospital administration which has required me to run around my own department asking for favors), trust me. Hoping for dentistry next month, since it has been an embarrassingly long time.
So everything's kind of in a holding pattern. I'm leaning toward cytopathology now more for fellowship but time will tell, my second year is starting to wind down in a way that's terrifying since I don't feel smart enough to be an upper level in July, and I wonder if there's ever going to be a time where I don't feel afraid of my own finances or of my own knowledge.
To those of you entering the final countdown of the Match, I wish you good luck. It will seem awful at times, and then hopefully, you'll have those moments when you regret nothing.
My schedule since December has pretty much been to be on call every three weeks. This overlaid February, which was one of the worst surg path months I've had to date, which also led to getting piled on by people nitpicking my after-hours work.
Don't be that guy, people. If you know your colleague has been at the hospital for over 70 hours, don't be the jerk in the morning that goes "You didn't get my protaste marginnnns!!!' and certainly don't be the one that whines to the chief about it.
This kind of covers a spectrum too. If you see anything that's clearly a result of a fatigued oversight (so long as it doesn't hurt the patient), like a lid not closed, or a sticker placed on the wrong thing, or an uncleaned scalpel where all the other instruments are clean, put on your big girl panties and just move on with your life. If you find something particularly offensive, talk to the person who did it directly. If they throw you tude and refuse to stop, THEN run and find someone to tattle to, but otherwise, just be a grown up.
Anyway, so the month of February generally sucked. I also still find myself reading out late into the night where I feel like I should be getting better at all this, but on the plus side, my reports have been improving markedly, so I do have that. The last week of read out, I was actually doing better, and I'm feeling at home with the ART specimens, since I've dealt with them three months so far this year. Breast, bowels, lungs, got it.
Breasts are nebulous pathological creatures. You can rarely call a "benign breast" because there's always something going on in them even if it isn't a scary something. So you get good at recognizing all the little halmarks of proliferative fibrocystic change diseases, biopsy site reactions. Your apocrine metaplasia, columnar cell change, florid ductal hyperplasia, usual ductal hyperplasia, etc ad infinitum.
Lungs are more simple. The complication comes with how much the surgeon mangles it, and how many extra structures (heart, ribs, bowel wall) you unexpectedly get.
While dealing with this, we've also been dealing with our new system. This was put in place in October in time for Halloween, because the best "trick" in "Trick or treat" is the one that never goes away. Communications with the new system finally reached a new low when I was on a Friday call with things going on simultaneously at two hospitals, requiring me to pack up my remaining work and bring it over to the main hospital. It was about this time that the new system quit and refused to print anything I needed. I had started this week on Monday going "I'm not going to let call get to me this time. I'm going to really try a positive attitude and remember that I love my job" and ended with my sobbing in front of this uncaring machine, begging for it to let me go home.
In other news, I'm off all that now, and get to spend three months pulling my self esteem back together before breaking it all over my June surgical pathology month at the main. Right now is immunopathology, which means playing with electron micrograph images, actually learning to read flow cytometry, and playing with the immunostains that light everything up. Kidneys are weird business, and a lot of immuno-relevant stuff happens to them. The process of their transplant and removal is somewhat fascinating as well. Jam them into the abdomen, leave the old ones in place, the whole nine yards.
What else... I traded call so I could go to Brewvival on a wet and miserable Saturday following the Friday where I broke down, so got to try a number of exquisitely well made (if overly barrel aged) beers while watching shirtless men mud wrestle.
This weekend, I get to go back (and freeze) in NYC to show a new friend how to correctly negotiate the hedonistic trends of the city. I'm excited about it, though it'd be difficult to compete with my last trip there. May will be Vegas and Mexico Beach, the first with new Boyfriend, the second as a re-crash course into sailing once the season begins. Roommate and I are trying to learn to turn faster, though the weather is currently not cooperating with our attempts to do *anything*.
I'm learning the surgeons I like, the surgeons I don't like, and the surgeons I wouldn't let operate on a cat. One who did not belong in the latter category came down one lovely call night as I was attempting to leave the hospital and said "If you get the right answer, we all get to go home", and damn did I like those odds.
I saw Skyfall in the way back (hooray James Bond!) and Django Unchained in the more recent. I'd recommend the first to anyone. I'd recommend the second to any Tarantino fans because it's a Tarantino movie. It's like he signed every scene.
Now that the crushing holiday season and its fall out are over, I can get back to exercising. Surgical pathology plus crappy weather plus call plus stress equals horrendous weight gain and fatigue.
I'm getting my doctor's appointments in (never do anything that relates to your own hospital; I am dealing with absolutely jaw dropping lack of concerns for HIPAA from hospital administration which has required me to run around my own department asking for favors), trust me. Hoping for dentistry next month, since it has been an embarrassingly long time.
So everything's kind of in a holding pattern. I'm leaning toward cytopathology now more for fellowship but time will tell, my second year is starting to wind down in a way that's terrifying since I don't feel smart enough to be an upper level in July, and I wonder if there's ever going to be a time where I don't feel afraid of my own finances or of my own knowledge.
To those of you entering the final countdown of the Match, I wish you good luck. It will seem awful at times, and then hopefully, you'll have those moments when you regret nothing.
Jan 14, 2013
Remember remember the month of December?
Because I certainly don't. November... clinical chemistry. The day after November. Work. 8 AM on December 31. No longer work. Party downtown for NYE and then burn rubber for New Orleans before anyone else can page me.
I'll back up. As I've mentioned previously, now that I'm a high and mighty second year (though since it's a four year residency, still a junior resident), I can take call.
I probably explained this in a previous post, but I'm too lazy to look back, so quick recap. Most pathology residencies have people take call a week at a time. You are on call starting at 5 PM on Monday night until 8 AM the next morning and that's the pattern. You then take call from Friday at 5 PM straight through until Monday at 8 AM. If there's a holiday during the week (like Christmas), it's like the weekend, you're on for that entire time.
There are two types of pathology call: AP (anatomic pathology) and CP (clinical pathology). AP is the headache that frequently requires you to come into the hospital. Surgery is running late or got scheduled on the weekend and they need tumor margins? AP. LifePoint has a potential donor kidney but needs to evaluate whether it's viable for transplant at 2 AM? AP. Medical autopsy between Friday afternoon and Sunday afternoon? AP. Patient is immunocompromised and may have a necrotizing fungus in their lungs? AP.
CP is all the lab stuff. Authorize nonstandard or nonindicated blood transfusion? CP. Transfusion reaction? CP. Stool cultures? CP. Oops, someone forgot to label a specimen may I pretty please oh please I swear I know it's the right patient, PLEASE let me come down and relabel it? CP. CP is far more likely to roust you from sleep at 3 in the morning, but typically requires a series of exhausted phone calls rather than rushing out the door with wet hair pulling your sneakers on.
For our first year of call, we are supposed to take AP and CP weeks separately so we don't get overwhelmed. The thing is... you can have a call week with virtually nothing... maybe three phone calls for the entire week and one frozen section that keeps you at the hospital until 6 PM. OR you can have your pager go off constantly, fill your weekend with complicated autopsies that you're forced to pause to deal with other calls.
For December, I was on my old friend surgical pathology, which really heats up at the end of the year as everyone attempts to get in their surgeries before they have to pay a new insurance deductible. People also may also have a week off around Thanksgiving or Christmas or have it easier to arrange so they can put their surgeries then (making a depressing holiday, I'm sure). So December was beating me to death in general. Just to get to our own office Christmas party required two other residents tag teaming to get all my specimens handled by 6:30 P.M., which was a job that otherwise would have taken me until 10. Boyfriend was cooking for me a great deal of the time.
But then Christmas week... that was my call week, as the second years tend to get the holidays. We lost a resident to family stuff who was my co-call person, which meant either take both calls or cost someone their Christmas. I figured how hard could it be, and had several reassurances that Christmas is a slow week which turns out to not be entirely true.
Here's the thing... the most junior people are the ones stuck on Christmas, present company included, which means the hospital runs at half staff with the lowest people on the totem pole, who are the most likely ones to be calling me with weird questions, a lack of justification for why they're calling me, and reasons for procedures like "My chief wants the values to be X".
So during the week of Christmas, my pager went off 41 times. I had autopsies and frozen sections and SO many mislabeled specimens and bizarre requests. As the week progressed and my grinchitude grew dire, I was pretty much saying no to anything that couldn't be considered irretrievable (like lumbar puncture specimens or brain biopsies). I did the longest autopsy in the history of autopsies just because the darn pager kept going off. I took to referring to it as "the wife" because it kept frigging nagging me.
My mom also got to be in town for Christmas, which unfortunately didn't leave me much time with her due to the above. Unfortunately she got to see the absolutely least exciting/sciencey part of my job "What do you mean you didn't label a random urine catch? No, you can't relabel it. Yes, you do have to call the patient back." and not the good stuff. She also saw me swear at my computer a lot since the apps you need to access really like to bug up when you're on a deadline.
During this time, keep in mind that except for the actual holiday, when you're taking call from home, you're still doing your normal duty hours, and except for Christmas Eve, it was kind of a nasty week.
So when I got off call at 8 AM on New Year's Eve and did the official hand off of my cases, I actually said "If anyone has any difficulty with anything I did last week, I don't want to hear it. My first week of dual call... I am officially above criticism." And to everyone's credit, I haven't heard a word about it.
But I handled it. Gone is all the panicky nonsense from last year, replaced by an aggravation by heavy workloads and unrelenting paging, but I overall like my job and feel like I'm getting better at it, which is awesome.
NYE was pretty fun. Ended up going to a party at a bowling alley/bar/arcade/silent disco (?), had a hotel downtown, and avoided getting completely ridiculous like I did last year (though in my defense, that was a few days after the house went). But I knew I needed to be unhungover for the drive to Nola via Jacksonville because hooray. Replaced my hurricane glasses that got torched last year, got some great cajun food up in Baton Rouge, where it's 15 dollars cheaper, and bummed around Frenchmen street listening to great live music that involved songs that were not hacked up covers of Play that Funky Music.
Came back to cytopathology, which I'm loving far more than I expected. So in surgical pathology, they deal with larger specimens, at least biopsies, so you are not just getting a cell that may look cancerous, but it is in the context of the surrounding tissue architecture. For instance, your body frequently gets violently pissed off about getting invaded by cancer, so even when you don't initially see the actual tumor cell, you see the surrounding reaction to it.
Cytopathology deals with single cells, either from aspirates from suspicious tissue so that if it's nothing, the patient is only subjected to a deep needle stick and not a full surgery, or fluids that aren't blood (hematopathology's territory). For instance, urine is supposed to be relatively cell-free. People with bladder cancer; however, may shed those cells into the urine where we see them and go "AHH Bad Nucleus!". Any fluid that's accumulating around the lungs or in the abdomen, we check for cancer or bacteria.
It's teaching me about problems at a cellular level so I'm getting to know the features to look for, which will help me for surgical pathology particularly for sneaky cancers like melanomas, which the surrounding tissue may ignore.
We also see patients when we go on aspirates. Granted, we barely speak to them and we *definitely* don't tell them what we see other than "this specimen is adequate" since the last thing a patient wants to hear is a positive cancer diagnosis by way of a complete stranger looking into a microscope near your feet and going "Holy crap". Rapport fail. The process is important though. We literally influence the number of times a clinical has to stick a needle into someone's neck. And they get frustrated with us for it.
What else.. we had a sudden warm snap, which was awesome. It coincided with a visiting Jersey friend, which led to a beach day, a failed surfing attempt (on my part; not on her part; that crap is harder than it looks), so she finished off the surfing day while I drank beach juice (tm) with Boyfriend and Friends.
So that's what I've been up to. Another call week is heading up on me, so I'm throwing myself into restaurant week to go out with a bang. Unfortunately, holiday baking + stressful month + no exercise due to workload + New Orleans + Restaurant Week = the next three months of broccoli and treadmills.
I'll back up. As I've mentioned previously, now that I'm a high and mighty second year (though since it's a four year residency, still a junior resident), I can take call.
I probably explained this in a previous post, but I'm too lazy to look back, so quick recap. Most pathology residencies have people take call a week at a time. You are on call starting at 5 PM on Monday night until 8 AM the next morning and that's the pattern. You then take call from Friday at 5 PM straight through until Monday at 8 AM. If there's a holiday during the week (like Christmas), it's like the weekend, you're on for that entire time.
There are two types of pathology call: AP (anatomic pathology) and CP (clinical pathology). AP is the headache that frequently requires you to come into the hospital. Surgery is running late or got scheduled on the weekend and they need tumor margins? AP. LifePoint has a potential donor kidney but needs to evaluate whether it's viable for transplant at 2 AM? AP. Medical autopsy between Friday afternoon and Sunday afternoon? AP. Patient is immunocompromised and may have a necrotizing fungus in their lungs? AP.
CP is all the lab stuff. Authorize nonstandard or nonindicated blood transfusion? CP. Transfusion reaction? CP. Stool cultures? CP. Oops, someone forgot to label a specimen may I pretty please oh please I swear I know it's the right patient, PLEASE let me come down and relabel it? CP. CP is far more likely to roust you from sleep at 3 in the morning, but typically requires a series of exhausted phone calls rather than rushing out the door with wet hair pulling your sneakers on.
For our first year of call, we are supposed to take AP and CP weeks separately so we don't get overwhelmed. The thing is... you can have a call week with virtually nothing... maybe three phone calls for the entire week and one frozen section that keeps you at the hospital until 6 PM. OR you can have your pager go off constantly, fill your weekend with complicated autopsies that you're forced to pause to deal with other calls.
For December, I was on my old friend surgical pathology, which really heats up at the end of the year as everyone attempts to get in their surgeries before they have to pay a new insurance deductible. People also may also have a week off around Thanksgiving or Christmas or have it easier to arrange so they can put their surgeries then (making a depressing holiday, I'm sure). So December was beating me to death in general. Just to get to our own office Christmas party required two other residents tag teaming to get all my specimens handled by 6:30 P.M., which was a job that otherwise would have taken me until 10. Boyfriend was cooking for me a great deal of the time.
But then Christmas week... that was my call week, as the second years tend to get the holidays. We lost a resident to family stuff who was my co-call person, which meant either take both calls or cost someone their Christmas. I figured how hard could it be, and had several reassurances that Christmas is a slow week which turns out to not be entirely true.
Here's the thing... the most junior people are the ones stuck on Christmas, present company included, which means the hospital runs at half staff with the lowest people on the totem pole, who are the most likely ones to be calling me with weird questions, a lack of justification for why they're calling me, and reasons for procedures like "My chief wants the values to be X".
So during the week of Christmas, my pager went off 41 times. I had autopsies and frozen sections and SO many mislabeled specimens and bizarre requests. As the week progressed and my grinchitude grew dire, I was pretty much saying no to anything that couldn't be considered irretrievable (like lumbar puncture specimens or brain biopsies). I did the longest autopsy in the history of autopsies just because the darn pager kept going off. I took to referring to it as "the wife" because it kept frigging nagging me.
My mom also got to be in town for Christmas, which unfortunately didn't leave me much time with her due to the above. Unfortunately she got to see the absolutely least exciting/sciencey part of my job "What do you mean you didn't label a random urine catch? No, you can't relabel it. Yes, you do have to call the patient back." and not the good stuff. She also saw me swear at my computer a lot since the apps you need to access really like to bug up when you're on a deadline.
During this time, keep in mind that except for the actual holiday, when you're taking call from home, you're still doing your normal duty hours, and except for Christmas Eve, it was kind of a nasty week.
So when I got off call at 8 AM on New Year's Eve and did the official hand off of my cases, I actually said "If anyone has any difficulty with anything I did last week, I don't want to hear it. My first week of dual call... I am officially above criticism." And to everyone's credit, I haven't heard a word about it.
But I handled it. Gone is all the panicky nonsense from last year, replaced by an aggravation by heavy workloads and unrelenting paging, but I overall like my job and feel like I'm getting better at it, which is awesome.
NYE was pretty fun. Ended up going to a party at a bowling alley/bar/arcade/silent disco (?), had a hotel downtown, and avoided getting completely ridiculous like I did last year (though in my defense, that was a few days after the house went). But I knew I needed to be unhungover for the drive to Nola via Jacksonville because hooray. Replaced my hurricane glasses that got torched last year, got some great cajun food up in Baton Rouge, where it's 15 dollars cheaper, and bummed around Frenchmen street listening to great live music that involved songs that were not hacked up covers of Play that Funky Music.
Came back to cytopathology, which I'm loving far more than I expected. So in surgical pathology, they deal with larger specimens, at least biopsies, so you are not just getting a cell that may look cancerous, but it is in the context of the surrounding tissue architecture. For instance, your body frequently gets violently pissed off about getting invaded by cancer, so even when you don't initially see the actual tumor cell, you see the surrounding reaction to it.
Cytopathology deals with single cells, either from aspirates from suspicious tissue so that if it's nothing, the patient is only subjected to a deep needle stick and not a full surgery, or fluids that aren't blood (hematopathology's territory). For instance, urine is supposed to be relatively cell-free. People with bladder cancer; however, may shed those cells into the urine where we see them and go "AHH Bad Nucleus!". Any fluid that's accumulating around the lungs or in the abdomen, we check for cancer or bacteria.
It's teaching me about problems at a cellular level so I'm getting to know the features to look for, which will help me for surgical pathology particularly for sneaky cancers like melanomas, which the surrounding tissue may ignore.
We also see patients when we go on aspirates. Granted, we barely speak to them and we *definitely* don't tell them what we see other than "this specimen is adequate" since the last thing a patient wants to hear is a positive cancer diagnosis by way of a complete stranger looking into a microscope near your feet and going "Holy crap". Rapport fail. The process is important though. We literally influence the number of times a clinical has to stick a needle into someone's neck. And they get frustrated with us for it.
What else.. we had a sudden warm snap, which was awesome. It coincided with a visiting Jersey friend, which led to a beach day, a failed surfing attempt (on my part; not on her part; that crap is harder than it looks), so she finished off the surfing day while I drank beach juice (tm) with Boyfriend and Friends.
So that's what I've been up to. Another call week is heading up on me, so I'm throwing myself into restaurant week to go out with a bang. Unfortunately, holiday baking + stressful month + no exercise due to workload + New Orleans + Restaurant Week = the next three months of broccoli and treadmills.
Nov 9, 2012
Literalism
For those of you who've read this blog for a while, you may have noticed a sort of hyperbole and psychotic flowery quality to my language. I'm also a bit of a philosophical hedonist, if you haven't picked up on that.
This is by no means limited to the written word and is actually quite a bit worse in person since I can't backspace over terrible things and it's how I both entertain myself and cope with stressful situations. Also why it's great to be in a profession populated by people who can handle me.
I'm telling you this to tell you about a birthday present. Several months ago, I was wine tasting with my roommate and her boyfriend in one of those cute types of shops with wine and wine accessories and lots of sort of expensive things that allow you to say "I enjoy drinking". And I do. My roommate is a type that tailors things to herself and her interests quite well and brings it all together in a way that is fashionable, individual, and fun. This is less how I roll. So when we got on the topic of wine glasses, I said something along the lines of "I'd love to have a wine glass that really says *me* all over it, but they don't make them with naked werewolves on them", then promptly forgot the comment.
Flash forward:
Speechless. I mean. It's a wine glass of shirtless Alcides. No one else on earth has a wine glass of shirtless Alcides. She and her boyfriend conspired to create something so perfect for me that if I left it in a cafe in Bali, weeks later I would get an email saying "We found your glass." If archeologists dig this glass up in a thousand years, they will be able to perfectly derive everything about my personality from this single artifact. They'll probably even be able to guess that I was a pathologist.
This brings me to a few conclusions. One, the idea that all my glib comments can be brought to life is both wonderous and terrifying, because while it does mean I will indeed die as I am buried alive under a mountain of double chocolate porter, Butter Lane cupcakes and shirtless dudes, it *also* means that a seven foot palmetto bug will, at some point, pin me against a wall and take my purse.
Other conclusions... I have heard a lot of roommate bitching from the masses since living alone is something only the 1% can continue to do, but I have been blessed by the great roommate god on high because I have lucked out every single frigging time.
Grenada: First roommate, from the islands, shows me around, makes kingfish curry, is generally cool despite me living in a phobia clad sleep deprived geek cloud.
Prague: Find roommate from lower term off facebook within about 24 hours. Wind up with roommate who makes coffee every morning and saves it for me and who speaks (and is) Russian so can translate. Also introduces me to Hoegaarden, because she wasn't being great enough.
New York: I live with the cooking, cleaning, decorating oracle of party finding awesomeness and spend two years in a cloud of burlesque and happy hours. Started learning about fashion.
Fire house: two roommates. One can cook everything from scratch and is eager to teach the same. The other is a die hard Star Wars aficionado with an awesome dog who finds chicken and waffle diners and likes to have bonfires in the back yard and play Mario Kart.
Current house: Makes me wine glasses with naked werewolves on them.
I'm holding out that my fellowship roommate will carry me on his/her shoulders at all times while making horsey noises, but that could be asking a bit much.
This is by no means limited to the written word and is actually quite a bit worse in person since I can't backspace over terrible things and it's how I both entertain myself and cope with stressful situations. Also why it's great to be in a profession populated by people who can handle me.
I'm telling you this to tell you about a birthday present. Several months ago, I was wine tasting with my roommate and her boyfriend in one of those cute types of shops with wine and wine accessories and lots of sort of expensive things that allow you to say "I enjoy drinking". And I do. My roommate is a type that tailors things to herself and her interests quite well and brings it all together in a way that is fashionable, individual, and fun. This is less how I roll. So when we got on the topic of wine glasses, I said something along the lines of "I'd love to have a wine glass that really says *me* all over it, but they don't make them with naked werewolves on them", then promptly forgot the comment.
Flash forward:
Speechless. I mean. It's a wine glass of shirtless Alcides. No one else on earth has a wine glass of shirtless Alcides. She and her boyfriend conspired to create something so perfect for me that if I left it in a cafe in Bali, weeks later I would get an email saying "We found your glass." If archeologists dig this glass up in a thousand years, they will be able to perfectly derive everything about my personality from this single artifact. They'll probably even be able to guess that I was a pathologist.
This brings me to a few conclusions. One, the idea that all my glib comments can be brought to life is both wonderous and terrifying, because while it does mean I will indeed die as I am buried alive under a mountain of double chocolate porter, Butter Lane cupcakes and shirtless dudes, it *also* means that a seven foot palmetto bug will, at some point, pin me against a wall and take my purse.
Other conclusions... I have heard a lot of roommate bitching from the masses since living alone is something only the 1% can continue to do, but I have been blessed by the great roommate god on high because I have lucked out every single frigging time.
Grenada: First roommate, from the islands, shows me around, makes kingfish curry, is generally cool despite me living in a phobia clad sleep deprived geek cloud.
Prague: Find roommate from lower term off facebook within about 24 hours. Wind up with roommate who makes coffee every morning and saves it for me and who speaks (and is) Russian so can translate. Also introduces me to Hoegaarden, because she wasn't being great enough.
New York: I live with the cooking, cleaning, decorating oracle of party finding awesomeness and spend two years in a cloud of burlesque and happy hours. Started learning about fashion.
Fire house: two roommates. One can cook everything from scratch and is eager to teach the same. The other is a die hard Star Wars aficionado with an awesome dog who finds chicken and waffle diners and likes to have bonfires in the back yard and play Mario Kart.
Current house: Makes me wine glasses with naked werewolves on them.
I'm holding out that my fellowship roommate will carry me on his/her shoulders at all times while making horsey noises, but that could be asking a bit much.
Nov 6, 2012
The holiday tweener
I'm not a huge Thanksgiving person. I think it's because I like neither turkey or pilgrims a whole lot. I generally only whine about Christmas stuff before Thanksgiving because that's about the level of Jingle Bells I can take without shooting mall Santas.
So roomie and I found ourself in the odd predicament of having our apartment fully decked out for Halloween, but then she and I are taking turns leaving through November, and her boyfriend (re: manual labor) was visiting last weekend, so for practicality's sake, we took down the vampires and tombstones and bloodstained "help" messages on the mirrors and replaced them with a fake Christmas tree, glowing lit up presents, and santas.
I'm oddly okay with it. As long as there's no music. It's an odd nostalgia. I know I said I wouldn't talk about the fire anymore (mentirosa!!), but this was post fire. I've mentioned before that due to the loving embrace of my colleagues and friends, it took at least a week for the whole business to even sink in, and this is part of why. I got back home, I believe on the 29th, and new roomie picked me up from the airport and I moved straight in with her. When I got to her house, not only did I have unexpected furniture, unexpected linens, and unexpected scrubs, but my new abode was completely decked out for Christmas, and these are all the same decorations that greeted me when I first arrived.
So I'm degrinched... but one too many Jingle Bells, and I'll snap.
Speaking of holiday stuff, I carved this pumpkin, and while likely inebriated, sent a picture of it to Poe's Tavern with the message "You make good burgers so I made you a pumpkin", not realizing they have an annual Poe themed pumpkin carving contest which I would have been able to enter had I waited until Thursday. Ah well.
Halloween was on a Wednesday mid surgical pathology this year, so I did my festivities on Saturday, which included a joint work party/Skinful festival. I was initially worried my costume was going to be inappropriate for the first, but arrived to the new chief's house to find the entire dining room done up as Dexter's kill room complete with a plastic wrapped blow up doll and her husband, convincingly dressed in the apron and holding a butcher knife, so I worried less about being family friendly.
I was initially going to go as one of four birds, others represented were a flamingo, a peacock, and a bjork-swan, and I had the brilliant plan of being a parrot with a pirate strapped to my shoulder, but upon further evaluation, since I can't sew, this plan was looking at costing me over 200 dollars, but this get up:
was 40. I am so very cheap.
I got my fall cooking on. I discovered how to make pumpkin cheesecake, which is the best trick ever, and then followed it up with some pork and squash and a pumpkin risotto.
October was also breast cancer awareness month, otherwise known as "the worst month to be on surgical pathology". It also was "surgical chiefs go out of town leaving their underlings to attempt horrendous resections that involve five thousand frozens for no specific reason. But I'm still getting a better hang of it from last year. I'm starting to get comfortable with my own language on reports rather than desperately grasping for others over the course of hours "how do I phrase 'benign skin and granulation tissue with hemorrhage, acute inflammation, and edema'??" I'm getting the hang of our very own Halloween trick, the introduction of a new and likely evil computer system, and the rest of it. I finally found the answer to the question "what if a biopsy shows cancer, and you take the specimen, and you can't find any cancer, but you also can't find the clip or biopsy changes?" The answer is "first, take all the wax filled cassettes you've put samples into and x-ray all of them at a less-than-thrilled cancer center. Then, when you can't find it, take the formalin soaked remainder of the specimen, in small color coded pieces back to the even less thrilled cancer center, take countless x-rays of that until you find a clip the size of the head of a pin, and then resample that.
Oh, making friends. And apparently when we're on surgical pathology, our specimens and us have such a combined aroma that we can be detected through the funk we leave on *other* people's clothing. I've personally gotten so used to formalin that I don't really perceive the smell unless it's up against my face making my eyes water (it burns!!!) and a vague sense of hunger since it has that disturbing side effect, so no early med students, being hungry after anatomy lab does not make you a cannibal.
Still, clinical chemistry this month is providing a nice break and one that allows me to defect up to Virginia for a hiking trip for my birthday since Christmas will be at the beck and call of my pager. I'm then going to turn around and go back for that Thanksgiving day and hopefully con some fondue out of the situation because blah, turkey.
Clinical chemistry involves relearning some chem, which is always a treat for me, but my daily activities consist of answering calls, mostly that involve mislabeling or not labeling specimens and I get the daily sob story for why I should allow blood that I don't know came from the patient to be assigned for the patient, and I get to read electrophoresis gels and calculate hemoglobin percentages to catch various hemoglobinopathies (sickle cell, thalassemia, SC disease, etc). The gels are for a lot of things, but mostly I'm trying to find bands that could correspond with multiple myeloma or any other monoclonal blood cell proliferation that isn't supposed to be there. It involves peering at a light board and interpreting a wavy graph and tables and then writing a series of important looking codes while signing it all illegibly with my doctor scrawl signature, so it feels very professional.
My lecture attendance is getting better; always a plus, despite having a series of 28 Days Later dread dreams where un-fun zombies chased me through the New York City subway system while killing all my friends. I'm not exactly sure who did what to my subconscious, but it gets temperamental this way. It's that thing where you show up at work either mad at your friends for dream-slights or panicked for your friends because you had a dream where they were standing drunk in a black evening dress and then they fell down the stairs and twisted their head all the way around like in Death Becomes Her. Thanks brain, you sick freak.
So roomie and I found ourself in the odd predicament of having our apartment fully decked out for Halloween, but then she and I are taking turns leaving through November, and her boyfriend (re: manual labor) was visiting last weekend, so for practicality's sake, we took down the vampires and tombstones and bloodstained "help" messages on the mirrors and replaced them with a fake Christmas tree, glowing lit up presents, and santas.
I'm oddly okay with it. As long as there's no music. It's an odd nostalgia. I know I said I wouldn't talk about the fire anymore (mentirosa!!), but this was post fire. I've mentioned before that due to the loving embrace of my colleagues and friends, it took at least a week for the whole business to even sink in, and this is part of why. I got back home, I believe on the 29th, and new roomie picked me up from the airport and I moved straight in with her. When I got to her house, not only did I have unexpected furniture, unexpected linens, and unexpected scrubs, but my new abode was completely decked out for Christmas, and these are all the same decorations that greeted me when I first arrived.
So I'm degrinched... but one too many Jingle Bells, and I'll snap.
Speaking of holiday stuff, I carved this pumpkin, and while likely inebriated, sent a picture of it to Poe's Tavern with the message "You make good burgers so I made you a pumpkin", not realizing they have an annual Poe themed pumpkin carving contest which I would have been able to enter had I waited until Thursday. Ah well.
Halloween was on a Wednesday mid surgical pathology this year, so I did my festivities on Saturday, which included a joint work party/Skinful festival. I was initially worried my costume was going to be inappropriate for the first, but arrived to the new chief's house to find the entire dining room done up as Dexter's kill room complete with a plastic wrapped blow up doll and her husband, convincingly dressed in the apron and holding a butcher knife, so I worried less about being family friendly.
I was initially going to go as one of four birds, others represented were a flamingo, a peacock, and a bjork-swan, and I had the brilliant plan of being a parrot with a pirate strapped to my shoulder, but upon further evaluation, since I can't sew, this plan was looking at costing me over 200 dollars, but this get up:
I got my fall cooking on. I discovered how to make pumpkin cheesecake, which is the best trick ever, and then followed it up with some pork and squash and a pumpkin risotto.
October was also breast cancer awareness month, otherwise known as "the worst month to be on surgical pathology". It also was "surgical chiefs go out of town leaving their underlings to attempt horrendous resections that involve five thousand frozens for no specific reason. But I'm still getting a better hang of it from last year. I'm starting to get comfortable with my own language on reports rather than desperately grasping for others over the course of hours "how do I phrase 'benign skin and granulation tissue with hemorrhage, acute inflammation, and edema'??" I'm getting the hang of our very own Halloween trick, the introduction of a new and likely evil computer system, and the rest of it. I finally found the answer to the question "what if a biopsy shows cancer, and you take the specimen, and you can't find any cancer, but you also can't find the clip or biopsy changes?" The answer is "first, take all the wax filled cassettes you've put samples into and x-ray all of them at a less-than-thrilled cancer center. Then, when you can't find it, take the formalin soaked remainder of the specimen, in small color coded pieces back to the even less thrilled cancer center, take countless x-rays of that until you find a clip the size of the head of a pin, and then resample that.
Oh, making friends. And apparently when we're on surgical pathology, our specimens and us have such a combined aroma that we can be detected through the funk we leave on *other* people's clothing. I've personally gotten so used to formalin that I don't really perceive the smell unless it's up against my face making my eyes water (it burns!!!) and a vague sense of hunger since it has that disturbing side effect, so no early med students, being hungry after anatomy lab does not make you a cannibal.
Still, clinical chemistry this month is providing a nice break and one that allows me to defect up to Virginia for a hiking trip for my birthday since Christmas will be at the beck and call of my pager. I'm then going to turn around and go back for that Thanksgiving day and hopefully con some fondue out of the situation because blah, turkey.
Clinical chemistry involves relearning some chem, which is always a treat for me, but my daily activities consist of answering calls, mostly that involve mislabeling or not labeling specimens and I get the daily sob story for why I should allow blood that I don't know came from the patient to be assigned for the patient, and I get to read electrophoresis gels and calculate hemoglobin percentages to catch various hemoglobinopathies (sickle cell, thalassemia, SC disease, etc). The gels are for a lot of things, but mostly I'm trying to find bands that could correspond with multiple myeloma or any other monoclonal blood cell proliferation that isn't supposed to be there. It involves peering at a light board and interpreting a wavy graph and tables and then writing a series of important looking codes while signing it all illegibly with my doctor scrawl signature, so it feels very professional.
My lecture attendance is getting better; always a plus, despite having a series of 28 Days Later dread dreams where un-fun zombies chased me through the New York City subway system while killing all my friends. I'm not exactly sure who did what to my subconscious, but it gets temperamental this way. It's that thing where you show up at work either mad at your friends for dream-slights or panicked for your friends because you had a dream where they were standing drunk in a black evening dress and then they fell down the stairs and twisted their head all the way around like in Death Becomes Her. Thanks brain, you sick freak.
Oct 7, 2012
I do love October
It's such a great month, that awesome combination of spookiness, good weather, fall, cooking stuff with pumpkin and cinnamon in it. That's why I skipped blogging in September, you see, just because why? It's not October, so I kept you on edge. That, plus I'm lazy. And was busy while work itself was not blog-interesting.
I'm making a pizza right now, because apparently that's something I can do now. Mad props to my current roommate, my past two roommates, and the Smitten Kitchen for getting me beyond the scrambled eggs, steak, and ramen stage of my life. So last effort with the pizza stone was this:
Not bad, eh?
What's awesome about both having a roommate and being an adult and no longer having all your stuff in a flaming pile is you start to accumulate kitchen stuff. So today, making a pizza consists of throwing the ingredients together that I already have (including honey and white wine) rather than running out and spending more on ingredients than it would have cost to order a pizza.
This is also an awesome effect with the liquor cabinet. As you gradually accumulate different kinds, you can start making impressive swanky cocktails and improvising new ones. But it takes time to build without noticing, and once you get there, you feel awesome about it.
Or maybe I do. I don't live places long.
Reminding me, since I mentioned the fire (when don't I), September brought about the last chapter in you or I ever having to hear about it again, and let me be the first to say "At fucking last" because good lord.
So here's that story. Right after I returned from the conference (more on that in a bit), I'm back at work for like... three days, when I get a phone call that evening, a missed call from 3 PM that afternoon. It was the victim's advocate saying the sentencing hearing that would be at 1:30 PM the next day (less than 24 hours notice), and oh, they wouldn't be seeking restitution because the "defense wouldn't go for it."
A long time ago on this blog, I described completely losing my shit and it was in Grenada at Air Jamaica on day 10 or something of aggressively denying me my bags when my loans simultaneously hadn't processed so I had no belongings and no money, so I finally just starting banging my fist on the ticket counter like Nikita frikking Khrushchev until they got tired enough of my yelling that I followed them back into security. (Cautionary note: Do not do this at American airports for any reason. You'll get tazed.) So that's me flipping out. It's pretty uncommon. That may have been the last time it happened. Now I've been overemotional and cried and self destructed and been bitchy, that's normal course. But unleashing rage? I hate confrontation.
So yeah, I flipped out. Since it was after hours at the solicitor's office, I left a pretty choice voicemail, got home rage-addled and sent the advocate an email, cc'd to the solicitor (our DA), etc that was about two pages of my rights, and having to deal with this constantly, and make their case for them and I was tired of it. That I have student loans and if I call their offices and say the "defense won't go for it", they won't just wipe my records clean and asked them why a convicted felon gets more rights than anyone with a car payment. That sort of thing. My big thing was that I haven't gotten anyone associated with the state or with this perp or his family appearing to give half a crap about any of this, and it's galling.
The solicitor responded with wanting to meet with me a half hour before, which kind of ignored my "short notice" point, but whatever. I spent that morning with one of my seniors aggressively researching victims rights laws and trial stuff in South Carolina, which renewed my hatred of law which is both confusing and tedious. I never understand "Doctor or lawyer?" versus "Doctor or biological scientist" since they're really different professions.
So I head to the hearing again with an armful of manilla folders full of printed stuff and a bad attitude, and so they spend a half hour talking me down. Say they can't force the kid to work in prison, but they can make restitution a condition of his parole. So essentially, once he's out, if he's not actively seeking (legal) work to help pay back his debts, it's a parole violation and he gets thrown back in jail. And I'm like "Uh yeah, that's all I asked for."
So we wait for another hearing... the LAST hearing. At first there's some like "Oh, they may postpone it again" which pissed me off again. But then I overhear the family's attorney saying that they have the "nice judge". I'm like "Not the nice judge!! Give them the judge me that gave me the speeding ticket 2 weeks after the fire. The mean judge."
We get in, same stuff... I have the opportunity to speak first, and choke/chicken, so the only other victim to show up goes first, thank goodness. The girl that helped me research the law stuff kept saying "No crying, no cursing, no gesticulating", so I kept reciting in my head as the closest thing I get to a prayer.
I'm introduced as "Ms. Sancho" so we're off to a super start, though the victim's advocate corrected and stood up and said "This is DOCTOR Sancho" and I'm like "That's right." I usually don't play the D card, but this is the occasion.
So my voice shakes a little, but then I speak a bit, and I'm already charged up by the night's crap. I talk about my stethoscope, my car, my pictures, the dog, the dead cat. I talk about medical textbooks. I say I've heard neither a "sorry" or a "guilty" but have to come back again and again to hear the mother wail about what a good boy he is, but that he's not. That he's demonstrated no regret or remorse whatsoever through any of his actions, without a care for people's rights or property.
The whole time the judge is looking at me and nodding sympathetically, which helped. It felt empowering. She asked me if I thought our lives would have been in danger if we'd been home and I tell her absolutely yes. That boy-roomie might have gotten out by being on the first floor but that the two girls were on the rooms off the porch and the porch caught first. That I came back to Houston with nothing but my bags.
I think my statement made the kid's mom cry, and I can't lie; I'm kinda proud of that. Needless to say, she didn't stand up to give the "my boy's a good boy" talk for the thousandth time. The father stood up and said "First off, I'm sorry" to me. Which he derailed after that about fighting for his son, and accidents and bad kids and being the fall guy, but I was like "first time anyone has apologized to me since all this started." After this statement, the solicitor merely says that the reason the boy is "taking the fall" is because he was bragging about it all at school. How he did it. So much for "accident".
At that point the judge starts talking and she is not happy. The VA leans over to me and says "The judge lives downtown". Downtown Charleston, for what it's worth, is exquisitely flammable. All the houses are made of heartwood pine and crammed together. And a few years ago, there was a massive factory fire that killed a bunch of people. So the "oops, didn't mean it" factor found *no* love. She kept on about how lucky the defendant was that people weren't killed because he'd be tried as an adult and no one would even think about seeing him before he turned 40, and that the only reason people weren't killed was luck. So max sentencing. With restitution assigned on release. No recommended camps for troubled boys or the like.
So that's it. We won. No more last minute hearings. No more delays. No more "re-victimization" as the solicitor was putting it as I kept saying I just wanted to get on with my life. This kid got what he deserved and I even got a half assed apology out of someone related to it.
I've never felt so relieved. I went back to work on a song, hypercharged with the conclusion of it all and went out to have oyster shooters (my first!) with some celebrants. I cannot say how good it is, after NINE MONTHS to have this all behind me.
I'm even starting to work on a future apartment, maybe fellowship, by having handy roommate teach me how to redo furniture from craigslist and garage sales and such. So that in the future, I can really build a home. I also now have renters insurance along with my (now cheaper) car insurance.
Good times.
This is getting long. And I haven't started on San Diego. But no more fire drama right? Hooray!!!
All right, the conference was awesome. Naturally, we engaged in scholarly studies for the entire five days so didn't really do much outside of mingle.
Wednesday was check out, so the entire trip was just a funly educational whirlwind, but what a great time. Gotta do the conference thing more often.
I'm making a pizza right now, because apparently that's something I can do now. Mad props to my current roommate, my past two roommates, and the Smitten Kitchen for getting me beyond the scrambled eggs, steak, and ramen stage of my life. So last effort with the pizza stone was this:
Not bad, eh?
What's awesome about both having a roommate and being an adult and no longer having all your stuff in a flaming pile is you start to accumulate kitchen stuff. So today, making a pizza consists of throwing the ingredients together that I already have (including honey and white wine) rather than running out and spending more on ingredients than it would have cost to order a pizza.
This is also an awesome effect with the liquor cabinet. As you gradually accumulate different kinds, you can start making impressive swanky cocktails and improvising new ones. But it takes time to build without noticing, and once you get there, you feel awesome about it.
Or maybe I do. I don't live places long.
Reminding me, since I mentioned the fire (when don't I), September brought about the last chapter in you or I ever having to hear about it again, and let me be the first to say "At fucking last" because good lord.
So here's that story. Right after I returned from the conference (more on that in a bit), I'm back at work for like... three days, when I get a phone call that evening, a missed call from 3 PM that afternoon. It was the victim's advocate saying the sentencing hearing that would be at 1:30 PM the next day (less than 24 hours notice), and oh, they wouldn't be seeking restitution because the "defense wouldn't go for it."
A long time ago on this blog, I described completely losing my shit and it was in Grenada at Air Jamaica on day 10 or something of aggressively denying me my bags when my loans simultaneously hadn't processed so I had no belongings and no money, so I finally just starting banging my fist on the ticket counter like Nikita frikking Khrushchev until they got tired enough of my yelling that I followed them back into security. (Cautionary note: Do not do this at American airports for any reason. You'll get tazed.) So that's me flipping out. It's pretty uncommon. That may have been the last time it happened. Now I've been overemotional and cried and self destructed and been bitchy, that's normal course. But unleashing rage? I hate confrontation.
So yeah, I flipped out. Since it was after hours at the solicitor's office, I left a pretty choice voicemail, got home rage-addled and sent the advocate an email, cc'd to the solicitor (our DA), etc that was about two pages of my rights, and having to deal with this constantly, and make their case for them and I was tired of it. That I have student loans and if I call their offices and say the "defense won't go for it", they won't just wipe my records clean and asked them why a convicted felon gets more rights than anyone with a car payment. That sort of thing. My big thing was that I haven't gotten anyone associated with the state or with this perp or his family appearing to give half a crap about any of this, and it's galling.
The solicitor responded with wanting to meet with me a half hour before, which kind of ignored my "short notice" point, but whatever. I spent that morning with one of my seniors aggressively researching victims rights laws and trial stuff in South Carolina, which renewed my hatred of law which is both confusing and tedious. I never understand "Doctor or lawyer?" versus "Doctor or biological scientist" since they're really different professions.
So I head to the hearing again with an armful of manilla folders full of printed stuff and a bad attitude, and so they spend a half hour talking me down. Say they can't force the kid to work in prison, but they can make restitution a condition of his parole. So essentially, once he's out, if he's not actively seeking (legal) work to help pay back his debts, it's a parole violation and he gets thrown back in jail. And I'm like "Uh yeah, that's all I asked for."
So we wait for another hearing... the LAST hearing. At first there's some like "Oh, they may postpone it again" which pissed me off again. But then I overhear the family's attorney saying that they have the "nice judge". I'm like "Not the nice judge!! Give them the judge me that gave me the speeding ticket 2 weeks after the fire. The mean judge."
We get in, same stuff... I have the opportunity to speak first, and choke/chicken, so the only other victim to show up goes first, thank goodness. The girl that helped me research the law stuff kept saying "No crying, no cursing, no gesticulating", so I kept reciting in my head as the closest thing I get to a prayer.
I'm introduced as "Ms. Sancho" so we're off to a super start, though the victim's advocate corrected and stood up and said "This is DOCTOR Sancho" and I'm like "That's right." I usually don't play the D card, but this is the occasion.
So my voice shakes a little, but then I speak a bit, and I'm already charged up by the night's crap. I talk about my stethoscope, my car, my pictures, the dog, the dead cat. I talk about medical textbooks. I say I've heard neither a "sorry" or a "guilty" but have to come back again and again to hear the mother wail about what a good boy he is, but that he's not. That he's demonstrated no regret or remorse whatsoever through any of his actions, without a care for people's rights or property.
The whole time the judge is looking at me and nodding sympathetically, which helped. It felt empowering. She asked me if I thought our lives would have been in danger if we'd been home and I tell her absolutely yes. That boy-roomie might have gotten out by being on the first floor but that the two girls were on the rooms off the porch and the porch caught first. That I came back to Houston with nothing but my bags.
I think my statement made the kid's mom cry, and I can't lie; I'm kinda proud of that. Needless to say, she didn't stand up to give the "my boy's a good boy" talk for the thousandth time. The father stood up and said "First off, I'm sorry" to me. Which he derailed after that about fighting for his son, and accidents and bad kids and being the fall guy, but I was like "first time anyone has apologized to me since all this started." After this statement, the solicitor merely says that the reason the boy is "taking the fall" is because he was bragging about it all at school. How he did it. So much for "accident".
At that point the judge starts talking and she is not happy. The VA leans over to me and says "The judge lives downtown". Downtown Charleston, for what it's worth, is exquisitely flammable. All the houses are made of heartwood pine and crammed together. And a few years ago, there was a massive factory fire that killed a bunch of people. So the "oops, didn't mean it" factor found *no* love. She kept on about how lucky the defendant was that people weren't killed because he'd be tried as an adult and no one would even think about seeing him before he turned 40, and that the only reason people weren't killed was luck. So max sentencing. With restitution assigned on release. No recommended camps for troubled boys or the like.
So that's it. We won. No more last minute hearings. No more delays. No more "re-victimization" as the solicitor was putting it as I kept saying I just wanted to get on with my life. This kid got what he deserved and I even got a half assed apology out of someone related to it.
I've never felt so relieved. I went back to work on a song, hypercharged with the conclusion of it all and went out to have oyster shooters (my first!) with some celebrants. I cannot say how good it is, after NINE MONTHS to have this all behind me.
I'm even starting to work on a future apartment, maybe fellowship, by having handy roommate teach me how to redo furniture from craigslist and garage sales and such. So that in the future, I can really build a home. I also now have renters insurance along with my (now cheaper) car insurance.
Good times.
This is getting long. And I haven't started on San Diego. But no more fire drama right? Hooray!!!
All right, the conference was awesome. Naturally, we engaged in scholarly studies for the entire five days so didn't really do much outside of mingle.
Well, I mean you have to have some fun, right? The conference itself was good. I went to some awesome hematopathology lectures, schmoozed a bit with future fellowship programs, and though people weren't really much stopping for my poster, I felt like it looked really good and like we did a good job, so that was great.
The hotel was gorgeous. The Grand Hyatt is the one that dominates a great deal of the classic San Diego skyline, and the rooms were jawdropping. I split one with two other colleagues.
The day I got there, one of my other colleagues and my attending were already there, so we registered, grabbed lunch, and headed to a brewery on Coronado Island via ferry. The brewery was just aiight but great view, great time. Met up with the girls as they arrived and went barhopping through the gaslamp district. The next day, there was a big resident mingling thing, but a friend from my school was in town, so we headed out to the beach and drank in a bunch of the Pacific. That night our attending took a huge crowd of us (including med school friend) out to a fancy pants restaurant where I stuffed myself full of good wine and scallops because life is good. We hit a rooftop soon after.
Sunday was quite scholarly. I had my poster in the mid morning-afternoon session so I hit a pretty solid peripheral blood smear conference in the morning. There was a good bone marrow lecture on in the afternoon post-poster. I was craving good Mexican food because I haven't had any in at least five years, so yelp helped me find a decent dive with amazing burritos so we hit it for lunch on Monday between conferences. Tuesday, we hit a morning conference and a couple of us headed for the zoo, because come on, it's San Diego. Apparently not only can you drink around the zoo, but they have microbrews because California is awesome. Californian microbrews usually aren't awesome, but these weren't local. Sorry Cali; your wine's still good. At some point we ended up back on Coronado Island having strangely authentic NYC pizza despite looking like "Sbarros by the sea" but apparently they import their water. Hooray snobbiness!
What else? I'm back on surgical pathology. This may be where some of you recall my having a nervous breakdown last year and contemplating quitting everything because I felt unbelievably stupid.
I feel much more confident this time around, which is fortunate, because we've had a whole new software implemented to control everything and it is working *terribly*. It's eliminating all of our paperwork, so now slides are going to the wrong people, slides are coming out super late, we're having to stalk specimens, and getting reports dropped. So the last week has been hideous, busy, and stressful, but now that it's do to external sources than my own crushing insecurity, I feel okay with myself and my lot. I'm getting interested in my specimens now that I understand more about them and feel like I might be a good pathologist. Which is a great feeling. We'll see if that dissolves into existential angst in the next couple of weeks. Heh.
Well, welcome back readers. Hope you're having an amazing October. :)
Aug 26, 2012
I'm not quite dead...
That's a topic I've undoubtedly used before, but despite buying an Autopsy Scully action figure *and* inexplicably watching episodes of My Little Pony: Friendship is Magic, I need the nerd street cred that quoting Monty Python affords me.
Why haven't I blogged? July was full of autopsy, so again, full of mystery, intrigue, but I can't share any of them with you because nyah nyah, I know something you don't.
Seriously though guys... don't wear ironic t-shirts if you're about to embark on something stupid and dangerous. The emotion between "that's tragic" and "that's hilarious" is like "smelling purple" or "hearing cinnamon" and it's uncomfortable to experience since they don't let us drop acid. On the plus side, if hell exists, I'm reserved for the VIP lounge.
August has just been full. I've been on blood bank, which is usually a good opportunity to catch up on back projects and read webcomics, but it's decided to envy autopsy's weirdness and just stepped up the game this month so I've been putting out fires every day.
Speaking of which... if you're not actively in surgery, and I page you, call me the frick back. I went to medical school, I have your status, and I'm getting ticked. If I need to clear something with you, and I need your authorization, you have made me a servant to my phone, requiring me to ask someone to babysit it if I use the restroom, and makes me paranoid about having to use it to call the other four clinicians that are ignoring me later.
So because I'm a bastard, I tuck in my heels. Here's the story, ladies. If you need authorization that requires special attention, your patient isn't actively bleeding to death, and you need product, and you haven't called me back yet to explain WHY you need product despite your patient's numbers being adequate, NO. I don't care how many times your nurses have called in the order to the blood bank despite providing no further information, the answer is no. Now, you can repeat page other residents into relenting because they're sick of getting paged for authorization, but I'm not one of them. Oh yeah, and I will *keep* paging you. And I'll call the department you're in, talk to your staff, and confirm whether you're in the OR. And depending on the rarity of the order, I may speakerphone you in there. And if you're not in the OR, NO.
Usually, the matter can be cleared up in under three minutes. "Oh, you want the platelets above 100 before you discharge the pati... NO." "Oh, the patient is going in for neurosurgery today? Useful information, fellow doctor! Absolutely yes! Wouldn't that have been easier to tell me three hours ago? Because you know giving people useless blood products causes them to develop antibodies that make them hard to transfuse later right? And although rare, transfusions expose them to infectious disease risk? Which is why we're being obnoxious about this? You didn't?? Wow, guess you should have called me back. I'm full of useful information. Ask me about how useless it is to dump platelets into uremic patients. Addendum, I'm not authorizing more platelets for your uremic patient. Dialysis is your friend."
Addendum in chemistry: If you call me at two in the morning because you don't want to retake a patient's blood sample, and you got a specimen kicked back because it has the wrong label on the tube in a bag with the right labels, ABSOLUTELY NO. For two reasons: One- the petulant, I can't believe you're waking me up with this. Two- the 'this is my patient too', new studies have shown that 30% of relabeled specimens do not match the DNA of the patient you super pinky best friend swore to me is the right patient.
And so help me, if I found out you restuck them after saying "Sorry we have to do this: Pathology lost the specimen", I will hunt you down and make you spectate a decomp autopsy. And there ain't no Vicks up in our house.
So that's the fun work stuff... now some play...
A few weeks back, our knowledge of meteorology and sailing were both tested heavily. As Roommate, Friend We Drag Into This Weekly, and I were having a pretty solid run around the harbor, we saw two other hobie cats hauling ass back towards us, and more critically, to the launch site. This would be a clue to most people but we were like "Hmm. Curious."
A quick word about our launch site. Despite our miles of beaches around here, we can only find one rocky, heavy ship traffic site where we're allowed to launch for less than 2000 dollars a year (literal number). This site is extremely susceptible to tides so we are in a perpetual balance between "three girls drag the boat and trailer over a hundred yards of beach" to having just the dirt parking lot, rocks, and *no beach*. At the time all this was going down, we were at *no beach". Our plan, since we got out late, was to wait out the tide, and head back with a nice strip of beach but not a long one. Brilliant, right? Work smart, not hard.
Unfortunately, as we obliviously sailed onward that day, we saw lightning streak down over the city. And then another. And another.
"Rut roh," we thought calmly, realizing we were now the sole 20 foot lightning rod in the middle of angry seas, as we spun the boat around and ran screaming back to shore with the ever increasing wind coming up. Since the wind was now gusting, we had to continuously kill our momentum to prevent "pitch poling", which is a cute name for what happens when the front of your boat starts to dip down and then that's the last thing you see before being catapulted at launch speed into your mast like Wile E. Coyote. Not good.
We get to the rocks and since we do not want to punch a hole in our boat (as the people did the week before), we are attempting to drop the sails in the water before we get it on the trailer on the back of the car because it is one hundred percent possible to capsize on land. And so while "Why did I sign up for this?" girl is desperately holding onto the front of the boat while simultaneously getting beaten up by it and the ocean, Roomie is running to bring the car, and I am clinging to the trampoline (the 'deck' of a catamaran) mid motion sick trying to yank down the sails. A few other guys who were in line to get out of the water helped us and we were able to push the boat onto the trailer after a near catastrophe, pull it out, and drop the mast about 10 minutes before the storm hit us.
We kind of skulked home broken and drank beer. Sailor fail.
So that was that. I decided to take a break from near death weekend leisure so spent the next two weekends traveling.
First stop, final farewell to one of my closest friends up in Charlotte as she departs Americaland for the great uncharted northern region known to some as "French Canada (is the best Canada)". She gave me many things, among which was a collection of X-Files DVDs (woot!), a Jagger shirt, and the chair for my fabulous new Ikea desk, since Charlotte contains that sweet sweet piece of Swedish ingenuity that Charleston still lacks. And Waffle House breakfast because it's the cure for beer all night.
Took a two day vacay from blood bank over the next weekend and headed back up to NYC for an impromptu class reunion, and got to stay with my wonderful NY-roommate.
While there, I had a rather odd request. You see after that way back fire, everyone really came together for me, but one attending in particular totally blew my mind. This attending also comes through for everyone, to extremes. You become afraid to ask him for help because if you accidentally page him at home (which he's never at home), if you ask him to look at something with you casually, he will drive to the hospital and help you until you're helped. He's that guy.
So tech and I were trying to figure out to do for this man since it's impossible to give him anything because he'll give it away. He likes a textbook that happened to be written by a man who is still alive and practices at Bellevue. Which is coincidentally, about three blocks away from my favorite Indian restaurant.
So roomie and I, and roomie has never met this attending, navigate the... interesting corridors that comprise Bellevue's emergency room as I clutch my book to get signed.
Lemme tell you... it's a close call, but I think dodging a "Code Brown" to ask a physician for a picture and autograph may even be geekier than the time I asked Mitch Pileggi to hug me, but it's a close call.
The author was an exceptionally good sport, and we put a chuck on a flat surface so he could sign the book without getting it coated in partially dried blood.
The follow up to this was on Monday, I also smuggled back some Russ and Daughters bagels since this guy likes NY bagels/pizza (who doesn't??) too. I like to multitask my vacations.
The rest of the weekend, which included a trip to the Jersey shore (not that one) to see even more friends from NY years was kind of an indulgent blur of massive quantities of excellent wine, excellent food, excellent entertainment, half a glass of gin spilled over the top of my head, and about ten seconds where I thought a burlesque dancer's albino burmese python (not a euphemism) was going to bite me in the face.
Me: "Gods, I need to wash up before I go to bed."
Roomie: "Do you? You still look fine."
Me: "I have simple syrup in my hair."
But we got this sunset!!
So yes. Need to get up to NYC more often.
Speaking of travel, I'm also heading to San Diego in the near future, which is a work thing, but come on, San Diego. And airfare/hotel covered. I'll take more pictures there. I've been terrible about photos lately, and managed to escape from NYC with two. Literally.
What else. Another fire update! This freaking thing has more parts than the USMLE, and the USMLE is 2.5 steps too long.
Anooother call with little notice from the victim's advocate office! And it'd be super helpful for me to be there! So more time off work! And boy-roomie would be coming, and he totally didn't! So I got to sit for an hour hoping he would! And then got to go into court again and talk about how much it sucked which totally makes it hard to *move on* despite it having been months! And his brother (who was involved but they can't prove it) smirked at me the whole time I was talking! And he pleaded no contest which means "I'm guilty but I'm not going to say it!" followed by his mom standing up and talking about how he's a good boy who fell in with the wrong crowd, and (drumroll) learned his lesson! This boy's lesson is so unlearned he won't even say the word "guilty" or "I'm sorry" or "I'm a terrible human being that is going to wound up doubtlessly being shot by someone in self defense" but he's certainly learned it! So his mom's asking for leniency!
Now I'm not certain what the actual leniency could be because there's another sentencing hearing (which it would be super helpful if I showed up for!) 45 more days after that.
I feel like I'm trapped in a Mystery Science Theater 3000 episode screaming "End. End! END!!!!!" at the screen. I want this boy to be punished strongly, particularly since he's an unrepentant, life-endangering, cat murdering repeat offender, but I'd also like to never hear about him or the fire ever again. I pretty much never thought about it these days and then that popped up and now it's not that it's dragging me down, it's just always on my mind again. I get telling me what's happening because I have a right to know, but why is my input needed every other month and why always with like a week's notice maybe? I was never asked for a formal "please read this in court" victim's statement though I am now still being asked for faxed copies of GAP insurance payoffs and such for restitution which should be to my insurance company (the uninsured stuff was what he owes *me*) which even so, they keep assuring me "I probably won't see that money", which I know well, so why are you asking me for anything and dredging this up again? Go away. Do your job. Make that boy print license plates and quietly deposit the money split among all the victims for the next 300 years. Or don't. I don't care.
I super duper hate the term "victim's responsibilities". Remember in school or the military or whatever and some kid was screwing off, and *everyone* got punished for it? Fifty push ups, pop quiz, whatever? Now imagine that guy punched you in the face... but then you still had to do fifty push ups. And only you. The rest of the class watches and talks about how you should have ducked faster. It's like that.
Ugh, but that shit's depressing. Let's talk about something else.
Ooh! I made this tonight:
There's this awesome trend lately... I'm not sure if it's a local southern thing or a nationwide thing, but you go to a studio with an appetizer and a bottle of wine and they teach you how to paint something while you drink wine and giggle about not knowing how to paint. You get to wear the apron and everything. The results tend to be pretty cool. Roomie did an octopus and I fell in love with the Burton style adaptation of the Sullivan's Island Lighthouse so went with a colleague, had an amazing time, and will go back again and again, possibly sans the amped up girl next to me that kept nudging my painting arm and saying "A girl's half inch ain't a guy's half inch, amiright????" Oh, it never gets old!
But Pinot Noir and I made the chocolate boozy cupcakes again because I am a one trick pony.
Amiright?
Why haven't I blogged? July was full of autopsy, so again, full of mystery, intrigue, but I can't share any of them with you because nyah nyah, I know something you don't.
Seriously though guys... don't wear ironic t-shirts if you're about to embark on something stupid and dangerous. The emotion between "that's tragic" and "that's hilarious" is like "smelling purple" or "hearing cinnamon" and it's uncomfortable to experience since they don't let us drop acid. On the plus side, if hell exists, I'm reserved for the VIP lounge.
August has just been full. I've been on blood bank, which is usually a good opportunity to catch up on back projects and read webcomics, but it's decided to envy autopsy's weirdness and just stepped up the game this month so I've been putting out fires every day.
Speaking of which... if you're not actively in surgery, and I page you, call me the frick back. I went to medical school, I have your status, and I'm getting ticked. If I need to clear something with you, and I need your authorization, you have made me a servant to my phone, requiring me to ask someone to babysit it if I use the restroom, and makes me paranoid about having to use it to call the other four clinicians that are ignoring me later.
So because I'm a bastard, I tuck in my heels. Here's the story, ladies. If you need authorization that requires special attention, your patient isn't actively bleeding to death, and you need product, and you haven't called me back yet to explain WHY you need product despite your patient's numbers being adequate, NO. I don't care how many times your nurses have called in the order to the blood bank despite providing no further information, the answer is no. Now, you can repeat page other residents into relenting because they're sick of getting paged for authorization, but I'm not one of them. Oh yeah, and I will *keep* paging you. And I'll call the department you're in, talk to your staff, and confirm whether you're in the OR. And depending on the rarity of the order, I may speakerphone you in there. And if you're not in the OR, NO.
Usually, the matter can be cleared up in under three minutes. "Oh, you want the platelets above 100 before you discharge the pati... NO." "Oh, the patient is going in for neurosurgery today? Useful information, fellow doctor! Absolutely yes! Wouldn't that have been easier to tell me three hours ago? Because you know giving people useless blood products causes them to develop antibodies that make them hard to transfuse later right? And although rare, transfusions expose them to infectious disease risk? Which is why we're being obnoxious about this? You didn't?? Wow, guess you should have called me back. I'm full of useful information. Ask me about how useless it is to dump platelets into uremic patients. Addendum, I'm not authorizing more platelets for your uremic patient. Dialysis is your friend."
Addendum in chemistry: If you call me at two in the morning because you don't want to retake a patient's blood sample, and you got a specimen kicked back because it has the wrong label on the tube in a bag with the right labels, ABSOLUTELY NO. For two reasons: One- the petulant, I can't believe you're waking me up with this. Two- the 'this is my patient too', new studies have shown that 30% of relabeled specimens do not match the DNA of the patient you super pinky best friend swore to me is the right patient.
And so help me, if I found out you restuck them after saying "Sorry we have to do this: Pathology lost the specimen", I will hunt you down and make you spectate a decomp autopsy. And there ain't no Vicks up in our house.
So that's the fun work stuff... now some play...
A few weeks back, our knowledge of meteorology and sailing were both tested heavily. As Roommate, Friend We Drag Into This Weekly, and I were having a pretty solid run around the harbor, we saw two other hobie cats hauling ass back towards us, and more critically, to the launch site. This would be a clue to most people but we were like "Hmm. Curious."
A quick word about our launch site. Despite our miles of beaches around here, we can only find one rocky, heavy ship traffic site where we're allowed to launch for less than 2000 dollars a year (literal number). This site is extremely susceptible to tides so we are in a perpetual balance between "three girls drag the boat and trailer over a hundred yards of beach" to having just the dirt parking lot, rocks, and *no beach*. At the time all this was going down, we were at *no beach". Our plan, since we got out late, was to wait out the tide, and head back with a nice strip of beach but not a long one. Brilliant, right? Work smart, not hard.
Unfortunately, as we obliviously sailed onward that day, we saw lightning streak down over the city. And then another. And another.
"Rut roh," we thought calmly, realizing we were now the sole 20 foot lightning rod in the middle of angry seas, as we spun the boat around and ran screaming back to shore with the ever increasing wind coming up. Since the wind was now gusting, we had to continuously kill our momentum to prevent "pitch poling", which is a cute name for what happens when the front of your boat starts to dip down and then that's the last thing you see before being catapulted at launch speed into your mast like Wile E. Coyote. Not good.
We get to the rocks and since we do not want to punch a hole in our boat (as the people did the week before), we are attempting to drop the sails in the water before we get it on the trailer on the back of the car because it is one hundred percent possible to capsize on land. And so while "Why did I sign up for this?" girl is desperately holding onto the front of the boat while simultaneously getting beaten up by it and the ocean, Roomie is running to bring the car, and I am clinging to the trampoline (the 'deck' of a catamaran) mid motion sick trying to yank down the sails. A few other guys who were in line to get out of the water helped us and we were able to push the boat onto the trailer after a near catastrophe, pull it out, and drop the mast about 10 minutes before the storm hit us.
We kind of skulked home broken and drank beer. Sailor fail.
So that was that. I decided to take a break from near death weekend leisure so spent the next two weekends traveling.
First stop, final farewell to one of my closest friends up in Charlotte as she departs Americaland for the great uncharted northern region known to some as "French Canada (is the best Canada)". She gave me many things, among which was a collection of X-Files DVDs (woot!), a Jagger shirt, and the chair for my fabulous new Ikea desk, since Charlotte contains that sweet sweet piece of Swedish ingenuity that Charleston still lacks. And Waffle House breakfast because it's the cure for beer all night.
Took a two day vacay from blood bank over the next weekend and headed back up to NYC for an impromptu class reunion, and got to stay with my wonderful NY-roommate.
While there, I had a rather odd request. You see after that way back fire, everyone really came together for me, but one attending in particular totally blew my mind. This attending also comes through for everyone, to extremes. You become afraid to ask him for help because if you accidentally page him at home (which he's never at home), if you ask him to look at something with you casually, he will drive to the hospital and help you until you're helped. He's that guy.
So tech and I were trying to figure out to do for this man since it's impossible to give him anything because he'll give it away. He likes a textbook that happened to be written by a man who is still alive and practices at Bellevue. Which is coincidentally, about three blocks away from my favorite Indian restaurant.
So roomie and I, and roomie has never met this attending, navigate the... interesting corridors that comprise Bellevue's emergency room as I clutch my book to get signed.
Lemme tell you... it's a close call, but I think dodging a "Code Brown" to ask a physician for a picture and autograph may even be geekier than the time I asked Mitch Pileggi to hug me, but it's a close call.
The author was an exceptionally good sport, and we put a chuck on a flat surface so he could sign the book without getting it coated in partially dried blood.
The follow up to this was on Monday, I also smuggled back some Russ and Daughters bagels since this guy likes NY bagels/pizza (who doesn't??) too. I like to multitask my vacations.
The rest of the weekend, which included a trip to the Jersey shore (not that one) to see even more friends from NY years was kind of an indulgent blur of massive quantities of excellent wine, excellent food, excellent entertainment, half a glass of gin spilled over the top of my head, and about ten seconds where I thought a burlesque dancer's albino burmese python (not a euphemism) was going to bite me in the face.
Me: "Gods, I need to wash up before I go to bed."
Roomie: "Do you? You still look fine."
Me: "I have simple syrup in my hair."
But we got this sunset!!
So yes. Need to get up to NYC more often.
Speaking of travel, I'm also heading to San Diego in the near future, which is a work thing, but come on, San Diego. And airfare/hotel covered. I'll take more pictures there. I've been terrible about photos lately, and managed to escape from NYC with two. Literally.
What else. Another fire update! This freaking thing has more parts than the USMLE, and the USMLE is 2.5 steps too long.
Anooother call with little notice from the victim's advocate office! And it'd be super helpful for me to be there! So more time off work! And boy-roomie would be coming, and he totally didn't! So I got to sit for an hour hoping he would! And then got to go into court again and talk about how much it sucked which totally makes it hard to *move on* despite it having been months! And his brother (who was involved but they can't prove it) smirked at me the whole time I was talking! And he pleaded no contest which means "I'm guilty but I'm not going to say it!" followed by his mom standing up and talking about how he's a good boy who fell in with the wrong crowd, and (drumroll) learned his lesson! This boy's lesson is so unlearned he won't even say the word "guilty" or "I'm sorry" or "I'm a terrible human being that is going to wound up doubtlessly being shot by someone in self defense" but he's certainly learned it! So his mom's asking for leniency!
Now I'm not certain what the actual leniency could be because there's another sentencing hearing (which it would be super helpful if I showed up for!) 45 more days after that.
I feel like I'm trapped in a Mystery Science Theater 3000 episode screaming "End. End! END!!!!!" at the screen. I want this boy to be punished strongly, particularly since he's an unrepentant, life-endangering, cat murdering repeat offender, but I'd also like to never hear about him or the fire ever again. I pretty much never thought about it these days and then that popped up and now it's not that it's dragging me down, it's just always on my mind again. I get telling me what's happening because I have a right to know, but why is my input needed every other month and why always with like a week's notice maybe? I was never asked for a formal "please read this in court" victim's statement though I am now still being asked for faxed copies of GAP insurance payoffs and such for restitution which should be to my insurance company (the uninsured stuff was what he owes *me*) which even so, they keep assuring me "I probably won't see that money", which I know well, so why are you asking me for anything and dredging this up again? Go away. Do your job. Make that boy print license plates and quietly deposit the money split among all the victims for the next 300 years. Or don't. I don't care.
I super duper hate the term "victim's responsibilities". Remember in school or the military or whatever and some kid was screwing off, and *everyone* got punished for it? Fifty push ups, pop quiz, whatever? Now imagine that guy punched you in the face... but then you still had to do fifty push ups. And only you. The rest of the class watches and talks about how you should have ducked faster. It's like that.
Ugh, but that shit's depressing. Let's talk about something else.
Ooh! I made this tonight:
There's this awesome trend lately... I'm not sure if it's a local southern thing or a nationwide thing, but you go to a studio with an appetizer and a bottle of wine and they teach you how to paint something while you drink wine and giggle about not knowing how to paint. You get to wear the apron and everything. The results tend to be pretty cool. Roomie did an octopus and I fell in love with the Burton style adaptation of the Sullivan's Island Lighthouse so went with a colleague, had an amazing time, and will go back again and again, possibly sans the amped up girl next to me that kept nudging my painting arm and saying "A girl's half inch ain't a guy's half inch, amiright????" Oh, it never gets old!
But Pinot Noir and I made the chocolate boozy cupcakes again because I am a one trick pony.
Amiright?
Jul 11, 2012
NO MORE USMLE EVER
There are not enough emoticons, anigifs, or any other advanced mid 90s technology sufficient to express the joy I field.
Oh, I'll do the path thing. How many points did you drop? I dropped 22!! LOL! I dropped 30! So I dropped quite a bit but within a safe margin, considering my study strategy only got going during the end.
So fare thee well clinical medicine. Nice knowing you. I may see you sometime in the future when someone goes "IS THERE A DOCTOR ON THIS PLANE??!!!!" and I turn my headphones up cuz NOT MY JOB babies!
Noooooo more step. Gods, half the stress of the whole process revolves around those bloody tests. And now all my tests will be path.
Wait... all my tests will be path???? Oh god, to the textbooks!!!!
Oh, I'll do the path thing. How many points did you drop? I dropped 22!! LOL! I dropped 30! So I dropped quite a bit but within a safe margin, considering my study strategy only got going during the end.
So fare thee well clinical medicine. Nice knowing you. I may see you sometime in the future when someone goes "IS THERE A DOCTOR ON THIS PLANE??!!!!" and I turn my headphones up cuz NOT MY JOB babies!
Noooooo more step. Gods, half the stress of the whole process revolves around those bloody tests. And now all my tests will be path.
Wait... all my tests will be path???? Oh god, to the textbooks!!!!
Jul 1, 2012
I no longer have my "intern" excuse
For I now rank among the second year residents.
This is a bit of a mixed bag. I don't feel completely "NO MORE INTERN YEAR!!!" because we're relatively unabused pathology residents and I've been on clinical pathology rotations for the past few months so I've been particularly unabused.
We had a couple parties today: one a path party at one of our seniors' houses to celebrate the new residents/fellows and say bye to the remaining ones, and the other was the same awesome mixer at the marina, which we showed up at the end. We made friends with two fellow SGU grads (one med; one vet) and upon leaving they were like "You're path people! Why are you bailing at 9 PM?" and we had to very honestly say "We have to get up early tomorrow. We're going sailing."
Yeah. Hard times.
Because of the ACGME (residency police) regulations set in place last year, first year pathology residents don't tend to take any call. Essentially, they made it so that newbies would no longer work 24 hour shifts, which is critical when you're a surgery resident trying to not develop a meth habit, but less critical when your call consists of going home and maybe answering your phone a few times. What does this mean? It means welcome to taking call, mofo. I drew the straw of being the first resident on Anatomic Pathology call this year, so Monday to Monday, I'm the late night frozen section and weekend/4th of July autopsy girl. It's mildly intimidating, but we have a decent support network. I will at this point reiterate the advice of "try to avoid going to teaching hospitals as a patient the first week of July".
I will be back on autopsy next month, which critically means getting to wear nice breezy scrubs instead of people clothes during the 100 degree month, which, hooray.
Last few weeks... hmm... due to Step 3 and my Journal Club and my CP talk melting my brain, I had forgotten that as part of my last month's rotation in molecular pathology, I had to give a talk at what they call the Big Meeting.
So about ten days before that, our attending mentions it offhand, and I'm like "Uh oh", and casually ask him to *remind* me how long this thing is supposed to be. Apparently like 20 minutes. The two talks a year that we spend weeks preparing for is 30 minutes. I spend 8 hours at the hospital over 5 minutes. So I'm like "No problem! (AHHH)"
A short time after that, at our afternoon meeting about Extremely Difficult Things, he's like "Oh, apparently I have to go to a meeting at 5 to discuss a new machine with the heme onc docs. Wanna come?" and I'm like "N... sure!" because I am spineless enough to barely qualify as a vertebrate.
This impromptu meeting turned out to be incredibly cool. It was all new technology-esque with abilities to sequence hundreds of genes for the same cost as five, and then they were getting into interpretation and marketing and it was all very Future of Medicine like and I got super excited about it. Unfortunately for me.
I expressed my enthusiasm to my attending and he thought it was great and suggested I present it as my topic at the Big Meeting since the techs would love getting a look at a machine that might be implemented over the next year or so. I wholeheartedly agreed. Heck, half the work had been done for me and it all seemed really cool anyway.
Holy crap. This stuff is HARD. The difference between briefly explaining the implications of a new technology to doctors that don't work with it and explaining how the machine that uses it works when you don't even know is just wow...
Even the company website was taunting me. "It's simple! It works just like any other microchip!"
OH DOES IT REALLY? Dude, I still think my iPhone runs on elf blood.
Wikipedia took an absolute beating. "The technology uses next generation PCR". (sigh) Wiki. "next generation PCR." (sigh) Wiki "DNA beads". Wiki "Emulsion PCR" Wiki. "PCR". Wiki "DNA Sequencing". Wiki "DNA".
"The DNA beads are then loaded onto the chip, which is made out of a silicon boule."
(sigh) Wiki. "Boule".
The whole thing gradually built into this mental house of cards on which my entire understanding of this technology rested. I was thinking so hard that I felt like I was working out. When roommate's boyfriend came home, I was squint-glaring at my computer screen and wouldn't greet him because I was afraid the fragile base of my knowledge would crumble into dust if I deviated my glance for a second.
So the presentation comes, and I was told the meeting was very casual and no big deal, which is what is colloquially referred to as a complete lie. Fellow resident and I actually showed up at the wrong conference room because we thought it would be our three attendings and a couple lab people and some sandwiches, and everyone would probably be eating and doze.
Wrong. We end up at our morning conference room, and it is *packed*. We don't have that many people for the real morning conference. I've met about half the people. It ranges from the general techs, that do sciencey stuff all day long and work with the type of machines I'm about to try to explain to different types of techs to doctors to god knows who. There's also some PhDs thrown in for fun. Ya know, those people that were learning this subject specifically and writing papers on it while I was screwing up IVs and taking blood pressure. I mentioned very recently that I don't tend to get stage fright for this stuff, and this proved a notable exception. This was more like that dream where you have to take a calculus exam in your underpants.
I was in such a hurry to unload the giant ball of painful information in my head that I even forgot to introduce myself. Possibly as an unconscious defense mechanism in case I screwed up.
It actually went really well. In jamming the data into my limited capacity to understand it, I had inadvertently created a presentation that was apparently easy to follow while getting deep into the subject since it was the only way I could create a presentation on it in the first place.
I would say this taught me an important lesson about how to do this in the future and how to pick topics that I find extremely challenging, but hell no. Brain drain.
So happy July to all of you, and congratulations to all my fellow travelers at your various stages of progress. May your powerpoints never crash.
This is a bit of a mixed bag. I don't feel completely "NO MORE INTERN YEAR!!!" because we're relatively unabused pathology residents and I've been on clinical pathology rotations for the past few months so I've been particularly unabused.
We had a couple parties today: one a path party at one of our seniors' houses to celebrate the new residents/fellows and say bye to the remaining ones, and the other was the same awesome mixer at the marina, which we showed up at the end. We made friends with two fellow SGU grads (one med; one vet) and upon leaving they were like "You're path people! Why are you bailing at 9 PM?" and we had to very honestly say "We have to get up early tomorrow. We're going sailing."
Yeah. Hard times.
Because of the ACGME (residency police) regulations set in place last year, first year pathology residents don't tend to take any call. Essentially, they made it so that newbies would no longer work 24 hour shifts, which is critical when you're a surgery resident trying to not develop a meth habit, but less critical when your call consists of going home and maybe answering your phone a few times. What does this mean? It means welcome to taking call, mofo. I drew the straw of being the first resident on Anatomic Pathology call this year, so Monday to Monday, I'm the late night frozen section and weekend/4th of July autopsy girl. It's mildly intimidating, but we have a decent support network. I will at this point reiterate the advice of "try to avoid going to teaching hospitals as a patient the first week of July".
I will be back on autopsy next month, which critically means getting to wear nice breezy scrubs instead of people clothes during the 100 degree month, which, hooray.
Last few weeks... hmm... due to Step 3 and my Journal Club and my CP talk melting my brain, I had forgotten that as part of my last month's rotation in molecular pathology, I had to give a talk at what they call the Big Meeting.
So about ten days before that, our attending mentions it offhand, and I'm like "Uh oh", and casually ask him to *remind* me how long this thing is supposed to be. Apparently like 20 minutes. The two talks a year that we spend weeks preparing for is 30 minutes. I spend 8 hours at the hospital over 5 minutes. So I'm like "No problem! (AHHH)"
A short time after that, at our afternoon meeting about Extremely Difficult Things, he's like "Oh, apparently I have to go to a meeting at 5 to discuss a new machine with the heme onc docs. Wanna come?" and I'm like "N... sure!" because I am spineless enough to barely qualify as a vertebrate.
This impromptu meeting turned out to be incredibly cool. It was all new technology-esque with abilities to sequence hundreds of genes for the same cost as five, and then they were getting into interpretation and marketing and it was all very Future of Medicine like and I got super excited about it. Unfortunately for me.
I expressed my enthusiasm to my attending and he thought it was great and suggested I present it as my topic at the Big Meeting since the techs would love getting a look at a machine that might be implemented over the next year or so. I wholeheartedly agreed. Heck, half the work had been done for me and it all seemed really cool anyway.
Holy crap. This stuff is HARD. The difference between briefly explaining the implications of a new technology to doctors that don't work with it and explaining how the machine that uses it works when you don't even know is just wow...
Even the company website was taunting me. "It's simple! It works just like any other microchip!"
OH DOES IT REALLY? Dude, I still think my iPhone runs on elf blood.
Wikipedia took an absolute beating. "The technology uses next generation PCR". (sigh) Wiki. "next generation PCR." (sigh) Wiki "DNA beads". Wiki "Emulsion PCR" Wiki. "PCR". Wiki "DNA Sequencing". Wiki "DNA".
"The DNA beads are then loaded onto the chip, which is made out of a silicon boule."
(sigh) Wiki. "Boule".
The whole thing gradually built into this mental house of cards on which my entire understanding of this technology rested. I was thinking so hard that I felt like I was working out. When roommate's boyfriend came home, I was squint-glaring at my computer screen and wouldn't greet him because I was afraid the fragile base of my knowledge would crumble into dust if I deviated my glance for a second.
So the presentation comes, and I was told the meeting was very casual and no big deal, which is what is colloquially referred to as a complete lie. Fellow resident and I actually showed up at the wrong conference room because we thought it would be our three attendings and a couple lab people and some sandwiches, and everyone would probably be eating and doze.
Wrong. We end up at our morning conference room, and it is *packed*. We don't have that many people for the real morning conference. I've met about half the people. It ranges from the general techs, that do sciencey stuff all day long and work with the type of machines I'm about to try to explain to different types of techs to doctors to god knows who. There's also some PhDs thrown in for fun. Ya know, those people that were learning this subject specifically and writing papers on it while I was screwing up IVs and taking blood pressure. I mentioned very recently that I don't tend to get stage fright for this stuff, and this proved a notable exception. This was more like that dream where you have to take a calculus exam in your underpants.
I was in such a hurry to unload the giant ball of painful information in my head that I even forgot to introduce myself. Possibly as an unconscious defense mechanism in case I screwed up.
It actually went really well. In jamming the data into my limited capacity to understand it, I had inadvertently created a presentation that was apparently easy to follow while getting deep into the subject since it was the only way I could create a presentation on it in the first place.
I would say this taught me an important lesson about how to do this in the future and how to pick topics that I find extremely challenging, but hell no. Brain drain.
So happy July to all of you, and congratulations to all my fellow travelers at your various stages of progress. May your powerpoints never crash.
Jun 8, 2012
The halfway point!!
Geeze these exams are long. By the end you're just skimming questions because you're like "This isn't the Hunger Games! Why am I here?"
Step 3, as mentioned, is two glorious days of overpriced MCQ (and case scenario) pwnage. Ostensibly, I could be using this time to review notes and antibiotics and such, so instead, I'm blogging while my powder-pink toenail polish dries, cuz priorities.
The stress level has significantly decreased over the course of the exams, as, weirdly, my distance from the exam center. This feature is unrelated, but just kind of nifty.
Step 1: As an IMG (also AMGs, but not half as much), this exam makes or breaks you. It is stressed again and again how well you need to do, and specifically how well you need to do relative to your AMG cousins. It was a nightmare to study for. My hours were long but poorly planned, spent frequently skipping from reading textbook to textbook over the course of about three months during which I was not tasked with doing much else. I had the all important "unintentional weight loss", the anhedonia, the overwhelming stress, the blood pressures that jumped to about 160/105 regularly toward the end. I was crashed out in North Carolina, far from fellow sufferers. Dressed in whatever filthy rags I scraped together, drove an hour and a half to Greenville to the exam, and sleepwalked through it while running to my locker at every break, trying to eat something, and cramming Red Bull. Got my foam earplugs taken away and got distracted by my heartbeat for the whole thing. Walked out feeling numb and apathetic. Did well.
Step 2 CS: Not so stressed about this one, since... pathology. Also, no score other than P/F. I don't really count it among the classic Steps, since it's not the standard "Prometric" center. If it didn't cost as much as a 60" LCD TV, it could be fun. Practiced for a week with hilarious results, flew to Houston, stayed with my lovely family, had my uncle iron my white coat because I'm useless at household anything, wore nice clothes because it's required, saw fake patients, had a nice lunch, saw more fake patients, and hung out in Spring, TX. Groovy.
Step 2 CK: Important, yet somewhat less so unless you have to compensate for Step 1. An hour longer so you really reach the "hit the wall" feeling. Living up my little hedonistic lifestyle in New York with my similarly hedonistic med student roommate. Took about seven weeks off rotations to study, which later translated into a long loan-check-less summer. Studied alternately at home and at the new Brooklyn Bridge park.
Studied a reasonable number of hours a day, did not obsess over tons of textbooks, and pretty much just stuck to UWorld while making sure to rush downstairs to Maria's with regularity to get my evening cocktail. Finally moved the exam up about a week and a half because I was tired of studying for it. Took the subway and strolled to the exam at lunch time. Jeans and a (probably) clean t-shirt with a (maybe clean?) sweater. Due to the nature of the testing center, had to sneak food into the bathroom and hastily consume sandwiches and Red Bull. Walked out feeling numb. Did well.
Step 3: Seriously. If you're not trying to get a competitive IM fellowship, just pass the stupid thing. You have a job. If you're a pathology resident, try to not be stupid and take it early in your first year. If you're a path resident and your program doesn't force you to take it your first year, for gods sake man, take it early in your first year. The stories I've heard. Took a week off (paid!!!) during which I also worked on presentations that are moderately more stressful since I actually have to impress my colleagues. On other weeks, did quite a bit of studying in the form of QBank on my iPhone and perusing flashcards by the pool. Made time last week for this:
And no, that's not me, though I certainly wish it were. You can't let studying interfere with the *annual* southeastern beard and mustache festival.
Half through so far. At the testing center, they were super friendly, encouraged me to bring my foam earplugs (WAHOO), and were like "Oh, have a cup of coffee", and referred to me as "Doctor" or "Doc" about fifty kajillion times, which, kinda awesome. Didn't feel rushed on breaks. Had lunch at a normal hour, no Red Bull (wha?), and ate it out in the sunshine. Walked out feeling.. fine? Staff encouraged me to come back nearly an hour early tomorrow so I'm out sooner. Can't lie, I don't miss the stress.
Not that this means I'm doing well. It could mean quite the opposite. Especially since it's soooo long. I think it's so long that you don't dedicate as much mental energy to it because you're just "blah blah blah... uhh.. C. Sure."
But the constant crushing career-rides-on-this, every day you take is money lost feeling is gone and good frigging riddance to it for three more wonderful years until the monster that is the double day dual certification AP/CP path board exams that our glorious leaders are currently suffering through.
But tomorrow... tomorrow.... the end of the USMLE cycle for EVER tomorrow.
Step 3, as mentioned, is two glorious days of overpriced MCQ (and case scenario) pwnage. Ostensibly, I could be using this time to review notes and antibiotics and such, so instead, I'm blogging while my powder-pink toenail polish dries, cuz priorities.
The stress level has significantly decreased over the course of the exams, as, weirdly, my distance from the exam center. This feature is unrelated, but just kind of nifty.
Step 1: As an IMG (also AMGs, but not half as much), this exam makes or breaks you. It is stressed again and again how well you need to do, and specifically how well you need to do relative to your AMG cousins. It was a nightmare to study for. My hours were long but poorly planned, spent frequently skipping from reading textbook to textbook over the course of about three months during which I was not tasked with doing much else. I had the all important "unintentional weight loss", the anhedonia, the overwhelming stress, the blood pressures that jumped to about 160/105 regularly toward the end. I was crashed out in North Carolina, far from fellow sufferers. Dressed in whatever filthy rags I scraped together, drove an hour and a half to Greenville to the exam, and sleepwalked through it while running to my locker at every break, trying to eat something, and cramming Red Bull. Got my foam earplugs taken away and got distracted by my heartbeat for the whole thing. Walked out feeling numb and apathetic. Did well.
Step 2 CS: Not so stressed about this one, since... pathology. Also, no score other than P/F. I don't really count it among the classic Steps, since it's not the standard "Prometric" center. If it didn't cost as much as a 60" LCD TV, it could be fun. Practiced for a week with hilarious results, flew to Houston, stayed with my lovely family, had my uncle iron my white coat because I'm useless at household anything, wore nice clothes because it's required, saw fake patients, had a nice lunch, saw more fake patients, and hung out in Spring, TX. Groovy.
Step 2 CK: Important, yet somewhat less so unless you have to compensate for Step 1. An hour longer so you really reach the "hit the wall" feeling. Living up my little hedonistic lifestyle in New York with my similarly hedonistic med student roommate. Took about seven weeks off rotations to study, which later translated into a long loan-check-less summer. Studied alternately at home and at the new Brooklyn Bridge park.
Studied a reasonable number of hours a day, did not obsess over tons of textbooks, and pretty much just stuck to UWorld while making sure to rush downstairs to Maria's with regularity to get my evening cocktail. Finally moved the exam up about a week and a half because I was tired of studying for it. Took the subway and strolled to the exam at lunch time. Jeans and a (probably) clean t-shirt with a (maybe clean?) sweater. Due to the nature of the testing center, had to sneak food into the bathroom and hastily consume sandwiches and Red Bull. Walked out feeling numb. Did well.
Step 3: Seriously. If you're not trying to get a competitive IM fellowship, just pass the stupid thing. You have a job. If you're a pathology resident, try to not be stupid and take it early in your first year. If you're a path resident and your program doesn't force you to take it your first year, for gods sake man, take it early in your first year. The stories I've heard. Took a week off (paid!!!) during which I also worked on presentations that are moderately more stressful since I actually have to impress my colleagues. On other weeks, did quite a bit of studying in the form of QBank on my iPhone and perusing flashcards by the pool. Made time last week for this:
And no, that's not me, though I certainly wish it were. You can't let studying interfere with the *annual* southeastern beard and mustache festival.
Half through so far. At the testing center, they were super friendly, encouraged me to bring my foam earplugs (WAHOO), and were like "Oh, have a cup of coffee", and referred to me as "Doctor" or "Doc" about fifty kajillion times, which, kinda awesome. Didn't feel rushed on breaks. Had lunch at a normal hour, no Red Bull (wha?), and ate it out in the sunshine. Walked out feeling.. fine? Staff encouraged me to come back nearly an hour early tomorrow so I'm out sooner. Can't lie, I don't miss the stress.
Not that this means I'm doing well. It could mean quite the opposite. Especially since it's soooo long. I think it's so long that you don't dedicate as much mental energy to it because you're just "blah blah blah... uhh.. C. Sure."
But the constant crushing career-rides-on-this, every day you take is money lost feeling is gone and good frigging riddance to it for three more wonderful years until the monster that is the double day dual certification AP/CP path board exams that our glorious leaders are currently suffering through.
But tomorrow... tomorrow.... the end of the USMLE cycle for EVER tomorrow.
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