Not sure who this is for. Maybe it's a journal.

 

Where to start that hasn't been covered by every news source on earth?

I'm a specialist.  When COVID rises, I lose cases. The ORs get turned into COVID units.  People get scared.  There aren't many procedures.

In 2020, I was convinced I'd be laid off.  People were "Thanking me for my service" (which has to bother the actual frontliners who didn't volunteer for combat detail) while I laid at home on furlough for a week only to return to fifteen minutes of work.

The numbers up north have gone insane.  As the southerners go outside, the northerners go inside and have holiday festivities and now we're back at peak.  Work was slow today, so I pretty much trolled a popular conservative website over "Let's go Brandon" because I needed something that wasn't freaking COVID.

I feel like this has been one extremely long continuous year.  I still remember my NPR international news from February of 2020 talking about a new Coronavirus variant in Wuhan and going "Hmm.  Wonder if that will turn out to be anything".

There are also the horrible people.  I lost friends I thought had been mine for YEARS over the divorce.  Then a lost a few more.  Doctors can have a rough road when you have people that are conspiracy theorists. I lost one during ebola.  My mom was in surgery for endometrial cancer.  This idiot posted an article that ebola had gone airborne and the CDC was covering it up, which I think would be internationally illegal and also as likely, in virus world, as a dog growing wings.

When I brought this up, and that I was in direct contact with the CDC (micro rotation, oh joy), she and a different friend kept on about this.  I mentioned that ebola had been well documented in its form and function since around the 70s and she could hit pubmed for free.  Oh, no, she does her own research. It was likely, but the officials and doctors are hiding it.  I said "You're essentially accusing me of murdering my own lab techs."  She said "don't take it personally".  I said "I take accusations of murder very seriously".  She said "Well, we'll agree to disagree" and I said "whether I'm guilty of potential mass murder is not something I agree to disagree on" and blocked her.  Then I got a long winded message about how I'd thrown away a barely present friendship over politics.

I have friends in pediatrics accused of giving children an incurable terrible disease.

And I just lost another friend.  He was convinced that the vaccine was changing DNA (if we could do that, sickle cell and cystic fibrosis wouldn't exist).  When I explained that Rand Paul is an idiot and what was actually being discussed required a graduate level understanding of genetics, he called me complicit in the lie to please my masters.  When this man was about to be homeless, I offered to let him stay in our home.  He accused me of helping murder hundreds of thousands of americans.

So prepare for this. Choose your friends wisely.  Be prepared to even be stripped of your medical degree if people disagree with you.  The number of people that field demote me because I disagree with on some stupid unrelated thing (I believe in universal healthcare; I like hiking) means I'm not a REAL doctor.  I'm faking it.  Probably work at McDonalds.

So there's that.

The general dismissal of expertise is frustrating.  I've needed lawyers twice in the last year, once for defense (long story, it's fine), one for real estate, since buying a house out here is a nightmare.

I didn't think I was a lawyer.  I asked my boyfriend what to do and he told me what to do in each case, and not THROUGH him, since he does neither type of law.  He told me who to call and what to expect and whether I was being treated fairly.  He doesn't even fake a knowledge of areas of law he doesn't know anymore than I know anything about orthopedic surgery.

The example I use is one of a mechanic, trained or not, (since law and medicine require licenses), but if you've been building engines from scratch from the age of 15, got your business opened at 25 and have 15 years of experience, I am not going to pretend I know more about my car.  For all I know, cars run on elf farts and Santa magic.  So why would I claim mechanics are all wrong?  Are there some bad ones? Sure. Does that make me an expert? No.

I'm also not a climate scientist.  I'm generally of the opinion that if 98% of experts agree on something, they're probably right, and if they aren't, I'm certainly not going to have the expertise to prove them wrong, but I watched an episode of Cosmos, and Neil deGrasse Tyson (the only man my mother and I would fight over romantically) and he explained in with layman's terms in about 20 minutes.  And I was like "Oh. That makes sense.  I'm not an expert, but I understand".

But that's some relic of the past or something.

So this is depressing.  Christmas was great though I went all out to give my boyfriend's son a great Christmas and he wound up quarantined for COVID (he's fine).  So boyfriend did a ding dong dash with all his presents.

We're going to a socially distanced red dress (just me this time) soiree for NYE complete with me having a sparkly red mask.  He said he's so glad he gets to kiss someone for New Year's.  Which was weird, since you always kiss someone on NYE. I've kissed strangers pre covid.

But back to depression. Surprise surprise I have depression and anxiety, which if you follow this blog, you probably figured out.

The SSRI helps (not Prozac, that made me crazy), but as long as I dismissed it, I've been giving CBT workbooks and journaling a try, and for those struggling, particularly those that can't afford a therapist, it honestly really helps, particularly if you're the kind of person who obsesses on the same toxic ideas.  You can just spew that out onto paper and get it out of your head.

I'm on some facebook naughty list where I'm yet again banned for a month.  An antivaxxer said I was ugly and I said "nothing is uglier than willful ignorance" and boom, I'm a bully.  It's probably more of a blessing and a curse. They also banned me for detailing years of emotional abuse and how it affected me and for affectionately calling a fellow diver an animal as a joke.

And back to happy stuff (maybe I'm bipolar 2, who knows).  I'm learning my hobbies again.  I got my guitar restrung and my electric checked.  My calluses are gone but I've played a few songs.  I made an ornament this week.  I'm currently working on an elaborate pen, ink, watercolor, colored pencil falcon.

My boyfriend and I were mourning the death of attention span and we're both bookworms.  We waxed poetic about how we both used to stick a book in a backpack or briefcase.

So I started doing it again.  I'm in the land of not pumping my own gas.  Grab the book.  The surgeon tells me the procedure is starting and then I wait for an hour, but don't have my work with me.  Grab the book.

What's funny though... I was reading a 90s thriller novel with my feet up after a two hour wait on a procedure.  They didn't mean anything but a couple of my colleagues were like "Really working hard eh?"  Yet, before that, I tended to screw around on facebook and reddit.  Staring slackjawed at my screen was considered more "working" than flying through a paperback.

Oh the exciting stuff!!!   After nearly three years of living in this overpriced claptrap electrical deathtrap of a falling apart cheaply made townhouse, we're looking like we're closing on a house mid February (taking care of my mom; my boyfriend is neat and I'm messy; we'd kill each other).

15 minutes from work, 25 minutes from boyfriend in an actual TOWN with actual things to do and a big lake to fish in and kayak on.  A big basement with space for a gym, craft area, and guitar center.  A master on the second floor so as my mom's knees and hips get weaker, she is on the main floor (and we aren't in each other's faces) but I'm close enough to take care of her.  Potential.  A fenced in backyard.  I have so many plans.  New porch, nice door, replace the electric stove with gas and run a gas line to the back for a smoker and a grill (can't use them here).  Big fire pit.  Adirondack chairs.  The real Amish ones.  An herb garden.

My last house was way too much.  I got doctor syndrome and bought a palatial mansion with space we never used that required a housekeeper and organizer thrice weekly just to keep my husband and I married longer.  Over an acre of unfenced land to try to tend.

This?  No.  Other than the unbelievable price, this is nice clean standard middle class living.  Comfortable, cozy, easy to keep up.  Easy to mow the lawn, rake the leaves, let the dog out, sit around the firepit drinking beer.  I'm so excited. Maybe 2022 won't be the two years of continual suckage where the only thing that lets you know time is passing is how many layers of clothes you have to wear.

If any current students are still reading this, I'd love to know what the island is like these days.  Does IGA always have eggs now?  Do they have a chinese restaurant that isn't terrible?  Are the Patels still selling samosas at the top of the hill?  Or the brown van guy?  Is there a roof on the Hurricane Ivan church?  Does the school still sponsor Sandblast?  Is Carib and Ting still the only way to avoid getting poisoned by your water during the rainy season?  Did they pave the dusty highway?

Can you go home again?

 So, my boyfriend has heard enough Grenada stories to want to see the magic.

In truth, I kind of want to see the magic.  I get a weird Stockholm Syndrome about my time on the island.

We're getting close soon.  The interhash (which new students should be invoked into) is in Trinidad and Tobago.  That's as close as you can get to Grenada without enrolling.  I really want to see what's become of us.  What's become of Caribbean medicine.

I'm not taking him to Grenada yet, because I don't have enough reason, but I am taking him to T&T, since I infected him with the hash.  We just got back from the Red Dress Run in New Orleans.  It's weird that the hash has taken me to more places than... medicine.

If anyone is still reading this, particularly any newbs that are arriving for medical school, what's it like?  Do you like it?  Is it modern?  Does IGA still run out of eggs?  Are there more restaurants?  Did you dive the Bianca C?  Are you still bringing Hershey bars to histology?  Do the locals hate us more or less?

Where to start?  Do you care about me?  Or the process?

For me?  My dad died.  Poorly, I believe.  The police in North Carolina were extremely delicate with me, but my time in forensics allowed me to read between the lines and know that they found what we'd roll our eyes about in autopsy and have it ruin our lunch.  His ashes are on my dining room table.  I have a necklace to hold them ordered, despite not believing in second chances or an afterlife, but hoping I'm wrong.

How do you say "I'm an atheist.  There's nothing after this, but I forgive you.  I forgive you 25 years of squandered chances, but I can't maintain a grudge after death, so now I only feel regret?"  I paid for his cell phone, and the plan, so I send text messages into the murk as if they mean something.  But I paid for AT&T, which means I paid for closure.

The boyfriend is a Cityiot by breeding, which makes him long for the outdoors.  We're planning a hiking trip in Maine.  This means the parts of my father that aren't in an "I'm sorry we didn't get along" pendant will be in a halcyon national park when I discreetly scatter him there.  In the meantime, I hefted the inconsequential weight of his ashes in the back of my car today.  I picked him up from the post office.  The ashes weighed so little, but he was in such poor health, it feels like I was hefting his actual weight. 

But you're not here for that; you're here for how doctoring from the Caribbean works out.

Well, it does.  I got grieve leave, despite not being sure whether I need it.  I'm treated exceptionally well.  I swap out procedures and vacation with another St. George's alumnus, who is a good person and doctor.  I get bonuses.  I was kept on through COVID when we had virtually no preventative workup work.  I/m so privileged that I got a shot on Christmas Eve of last year.  I'm looking forward to a booster.

I have vacation.  I have freedom.  And though I'd been once to Mexico, and once to the Philippines (diving) before medical school, the chaos of becoming a doctor in another country gave me the absolute gift of adaptability.

If you can get a US MD, do it.  Don't let snow or cost deter you.  But if you desperately want to be a physician, and foreign travel is your only option, it will change you.  It will age you.  It will allow you to be an adaptable creature where you previously weren't.  It will allow you to change habit and diet to adapt.

That's no bad thing.

I guess it's not the end.

Though I can't imagine anyone still reads this.

Boater Dave, if you're still stalking me from England, please get stuffed and don't comment on me.  Also, while I'll get to why he sucks in a minute, asking if a guy from Queens who happens to be brown is a "Jihadi" put you in the "bad guy category" a long time ago.  He's an asshole, not a terrorist.

ANYWAY.

So, some stuff's changed.

That marriage?  Yeah no.  Helpful hints: don't be someone's third marriage.  There's probably a reason stuff went wrong, and after several years of emotional abuse and deliberately packing weight on me (which is GONEZO along with the 180 lbs of unemployed loser!!!!!).

Pittsburgh is a thing of the past.  To all you newly minted doctors, let me give you some advice.  Your first job doesn't need to be your last job.  Getting out of residency/fellowship, that six figures is just like winning the lottery.

Stuff I put up with: having my PTO literally stolen.  Having the lab director bring a screaming baby in for the entire day because of her perpetual nanny issues at least four times because of things like "my nanny cam showed my nanny (who all had to be from Colombia for some reason) putting my baby in front of the television".  Having the lab director leave nigh daily by 2:30, leaving the rest of any work detail for us.

Periodically forgetting I had told her something (like an international flight had changed and there was nothing I could do about it or telling her repeatedly I had a weird soft tissue tumor, getting her advice, getting updated, updating her, repeatedly updating her, having to send it to two institutions etc), and she would regularly burst into my office screaming her lungs out about some nonsense.  This is not how I resolve conflicts.

Having a lab director talk about me like a high school mean girl directly outside of my door in front of support staff.

Having a lab director diss me to other doctors including at tumor boards, ruining my reputation.

Having a lab director demand that I not seek advice from the ONLY person at that job who was kind to me because he didn't "know their system", despite him doing pathology for fifty years.

So yeah, abused at work, abused at home.

So that's depressing, right?  But six figures?  This has to be as good as it gets?  My husband is neglectful, cheats on me, and expects me to make the money, clean the house, cook the food, be his beer buddy, and maintain the body of a supermodel while sabotaging any attempts at working out or eating well, but it's not like he's ever laid hands on me.

So your first job may be garbage.  Once you've gotten enough experience to start getting recruiter emails or fit the requirements on your hiring lists of choice, MAKE YOUR OWN PATH.  Do not tolerate abuse because you think it's what being a doctor means.  Unless you're an ED nurse during 2020.  Then... your life sucked.

But Monroeville is amazing.  I love the neighbors, I love the free "heart attack" venison.

I'd do the whole 2020 thing, but I think we're all damn sick of it, and there's nothing I can really add to the conversation other than what every other doctor colleague says which is "GET THE DAMNED VACCINE SO WE CAN GET BACK TO NORMAL".  If you're antivax, please avoid the comment section and go back to getting your news from Q.

My vacation foibles are back, so since I suppose I've revived this blog from the dead, I'll post some of those pictures when I get around to it.  Besides, due to that damned fire, this blog is one source of some of my trips and such, so having a backup never hurts.

You can read my experiences at SGU, but keep in mind they're old.  I haven't been back to the island, so what's developed, what the exams are like, what restaurants are there, what the housing is like, I have no idea.  They still have a high USMLE step 1 pass rate and a huge bill, but that's all I know.

But have a great day, ya'll.

The end?

Well, I promised for years I wasn't ending the blog, but now I believe I am.

I passed the miserable cytopathology boards in miserable Tampa.  I am a triple boarded pathologist and so I shall remain for the next nine years until the maintenance of certification exam.

As of last Tuesday, my ACL has been repaired using my hamstring, and I'm beginning the road to recovery.  I'm up, walking, and cooking.  Granted, it's with a Frankenbrace, but it's a thing.

I love my job and colleagues.  I love my new city.  We're closing on our dream house in 32 days.  In January, it'll be time for a dog.

I'm married.  It's fun.  It's weird how nothing much changed.  I still have to self correct calling the hubby "my boyfriend".

So I feel like I've grown up here.  And it turns out, for all the twists and turns, a Caribbean MD was good enough for me and it's gotten me where I am, but there's not a whole lot more I can tell you about it.

When I got to Grenada, it was the 30th anniversary of the school.  Now it's the 40th.  The original graduates spoke of all the changes that had come about.  In their day, cattle and mosquitoes both frolicked freely in lecture tents, and meat was obtained through the "chicken man" who would slaughter a chicken for you.

In mine, there were grocery stores and a new-ish sushi and Italian place.  I'm certain the island has changed.  I'm certain the school and clinical rotations have changed.  Hopefully the tuition has gone down.

I don't have much to tell you all (though I suppose now it's "yinz" other than thank you so much for being with me through this journey.  I won't say "follow your dreams" because that's cheesy, unoriginal, and frequently leads to financial ruin, but sometimes it works out.  It did for me.

I'm playing with the idea of having a Steel City Transplant blog.  It would be recipes, travelogues, meal reviews, and the other minutia of day to day life found on any other blog.  Still not sure if I'll maintain it or if it's worth having.  Not asking for input, just not sure.

Goodbye and good luck.

Sincerely,

Dr. Ishie

Uno mas

So I hate Tampa.

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

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

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

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

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

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

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

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

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

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

Adulting

We have triumphantly arrived in Pittsburgh.  I suppose I'll stick around as a guide to the area/travel blog until ya'll tell me to shut up.

First off, this happened:



I'm a traditionalist so it's really not a wedding unless you're married by Elvis, given away by Thor, and handed to a man wearing a halloween costume made to look like a tux.

Because guess what you don't want to do when you spent the better part of a year in a panicked state?  Plan a wedding?  Correct.  Viva las vegas.  This was immediately followed by a trip in our party clothes on the NY NY rollercoaster.

Sidenote: slot machines are one hundred percent not fun anymore.  They've turned down the winnings *and* they're all voucher plays, so it feels more like a reverse ATM than a game.  At least freemium gaming occasionally gives you some food from the skinner box.

So we went with blackjack.  Play by the book, and you can drink all day and never really gain or lose a lot of money.  Play by the seat of your pants, and you will lose not only your money, but gain the full ire of the rest of the table.

But still, Vegas was fun and Cirque was worth the money.  But you know this.

We managed to get our last minute movers and roadtripped to Pittsburgh.

First stop: Hot Springs, Arkansas.  Lots of bikers.  Beautiful scenery.  Kind of an odd vibe.  Went to restaurant known for its incredible seafood that served salmon, scallops and tilapia.  This is odd for a restaurant in a pensensula of a lake

Second stop: Memphis TN for a deliciously redneck lunch.  Trout tacos.  That's what I'm talking about.  Catch my lunch.  Don't order it from the gulf.

Third stop: Nashville.  Nashville frigging rules.  I've never seen so much musical talent in one place.  Check out the Khromatiks.  We stayed there for a while before driving an hour north to the hotel.

Fifth stop.  Columbus, OH.  We felt like we should explore and wound up exploring a nearby restaurant and an episode of game of thrones.  I feel like it was the right decision.

Sixth stop.  Pittsburgh.  Sat on the porch of our new digs, wandered to the main drag to get an artisanal cup of coffee and met our landlord again for the walkthrough.  This house is so great.  It's so adult.  We have internet speed befitting the century.  I have a gas oven and a gas grill.  Everything is trees and rivers.

I had a traumatic trip to Ikea, as they all are, I suppose.  You wind through, eyes full of wonder, constructing the house of your dreams.  Then you get to that "self serve" aisle where you realize you've ordered 12 thousand pounds worth of crap into a car that only holds 4 thousand.  Employees watch you fail boy scout exams time after time as you attempt to wrap your entire car in twine, yet still that futon frame tries to make an escape for the back exit.

Then they closed all tunnels into the city.  Like think Dark Knight Rises but without ice to walk across.  Needless to say, by the time I got home, I needed a Xanex and a shower.

But the house!  The neighborhood!  The job!  Hooray!

I'm a grown up doctor!

Freedom!!! Freedom!!!

I've been blasting the Pharrell Williams song all over my house on repeat.  Maybe that's why my newly acquired husband chose that moment to go do chores.

Yesterday was the last day of training.  Ever.  Things were so generally chaotic yesterday that it didn't really dawn on me until I'd slept like the dead and woke up at 10:30 this morning.

I'm.  Done.  Sure I have one more board to take for the triple crown, but it's nowhere nearly as soul crushing as the others with lesser the consequences, but that's it.  I'm off to Pittsburgh with a song in my heart, invectives at my overpriced movers on my lips, and an epic party starting in a few hours.

Am I scared?  Oh sure, I have imposter syndrome with the rest.  Will I be able to hold my own as an adult; will everything work out, but that feeling is so overwhelmed by relief and happiness that I can go into it with a positive attitude and excitement rather than fear.

Leaving yesterday was weird.  It's been no secret that my training here away from my happy familiar faces of residency was pretty rough on me.  There were about three people I trusted, and one of them was gone half the year, leaving me lonely, paranoid, and generally regretful.  When I left residency and the now hubster picked me up, I was bawling.  Couldn't stop.  Just sat in the car and cried.  Cried on the attendings.  Cried on the friends.  Cried on the support staff.  Finally got to a nice lunch place where the owner knew us.  Had to excuse myself to cry some more.  Told him the food was fine; I was just losing my mind.

Drove to about an hour out where my Charleston-mom and Charleston-dad were waiting with my Charleston-dogs to say goodbye.  The girls climbed over each other in the SUV to lick my hand as I was presented with a fairly pricy pair of pearl earrings "because you love to dive".  A big platter of lasagna so her baby wouldn't be hungry on the trip to Texas.  More sobbing.

Yesterday as I negotiated phone calls, cleaned out my desk, and went on a signature scavenger hunt, and dealt with the general chaos of having a moving company shift your dates forward by 10 days to the start of work with less than a week's notice for a price that would easily by a CPO used car, and got all my "ducks in a row" as one of the few people there I trust would say, as I careened toward the end of the day and an hour beyond it, I just kind of strolled out.  Gave a tentative hug to a couple people who seemed more upset than I am, and walked smiling out into the humidity.

The party tonight may be a bit more difficult.  I will miss being so close to my family.  I will miss the friends who have adopted us.  But training?  Nah.  I'm good.  35 and I'm finally an adult.  36 and I'll have my own house and a dog.

I'm free.  Bring it on.

Coming full circle

Where to start; where to start?  Should I end?

I can't say I have a lot of advice for you all now starting in Grenada (or in Newcastle) other than good luck, really enjoy the time you have because you'll look back on it fondly (maybe not the harassment but otherwise) and work hard, but the island is so far away from me that it feels like a dream.  Nearly 10 years now since I shipped off, terrified, and a very different person than I am now.

I've alluded to and generally complained about the pathology job market being terrible.  I can officially say I've accepted a job offer that seems like an excellent fit for me, and we're really happy about it.

There's an official "we" now.  I'm engaged.  The impossible has happened, and no, there's no big wedding.  This year has been so stressful that doing anything other than a quick inebriated cakeless wedding just isn't worth the effort or money.

I can continue the "travelogue" portion of the blog to an extent.  For the past few years, my PTO has been used for less fun things - interviewing for a fellowship; the next year moving for fellowship and the year after applying for jobs, but having secured one with a healthy amount of time left, the future husband and I took off for the Belize jungle and had an amazing time.  It was the first I've felt truly relaxed in years.  Amazing country and who knew you could hop on Southwest for less than a flight to San Francisco?

The cytopathology boards are sometime in August.  Not too stressed.  Maybe I'm finally entering a time in my life where the exam difficulty starts going downhill.  Either that or the AP/CP exams just broke me entirely, which is likely.

Everything's winding down.  I'm in my last away rotation, which would be nice except it's been complicated by a knee injury sustained during crossfit, so now I need to get a scope stuck in my knee.  Then it's back to my main hospital to wind up my year and hopefully say goodbye to trainee status forever.  Not that I have any intention of ceasing learning, just that I get a decent salary and am higher than *someone* on a ladder.

So things are working out, for all the pain and difficulty.  It's been an insane ride, but a fulfilling one, and I've been extremely lucky all the way.  I wish a great deal of luck to all of you.

Polite Request

Ahem.

Attention scum sucking spammers.

This blog is not abandoned; however, your goals of making untold fortunes through convincing people to refinance their loans through you probably should be in favor of doing virtually anything else with your lives.  Seriously, go empty that garbage can.  Now empty another one.  Congratulations, you just found something more fulfilling than spamming blogs.

In short, you're dumb and your mother dresses you funny.

We now return to waiting for me to have something relevant to blog about.

Board certified and it feels so good!

So apologies for the delay, but yes, on the last week of July, a mere 12 weeks after taking that nightmare of a test, I received confirmation in the form of a nondescript email (or more accurately by my refreshing the website every ten minutes for 12 weeks and driving everyone crazy) that I was "successful" in both the Anatomic and Clinical Pathology portions of the exam.

So I'm a double boarded pathologist, baby!  At the end of this year, if all goes well in Cytopathology, I'll be TRIPLE boarded, which I believe doubles my mana on all offensive plays.

As far as the fellowship, well, there's no place like home, but I'm getting really spectacular training and experience.  But I do miss my own office and my surrogate Charleston family.

Now, the greatest challenge: Finding that first real pathology job.  Clock is ticking!

But yes, the short version:  I PASSED!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Give me my board scores

Give me my board scores.

Now is as good a time as any...

I took the AP/CP pathology boards in the middle of May, far earlier, as I mentioned, than I had previously anticipated, and wanted to update everyone, save for a few things.

1.  The ABP is absolutely *insane* about giving any slip of detail about the exam, to the point that they asked us *directly before taking it* if we used rememberances, and better yet, if we knew anyone who used rememberances.  This strikes me as overkill, piles on the stress at a bad time, and has a "are you or have you ever been associated with communists" feel.  It was a continuance of a lecture I received at an event a couple of years ago delivered to us in a tone of voice more fitting for disobedient children than doctors with a minimum age of 24.  The simple fact of the matter is if the variety of honors codes and oaths haven't gotten to us by now, nagging us in the minutes before a 2300 dollar, 16 hour exam probably isn't going to ferret out the evildoers and it's disrespectful to those going through it since the vast majority of us are not poring over half-remembered previous questions for guidance.

2.  It's hard for me to critique the whole process since 1) I like my job and they're the gatekeepers 2) I know some members on the ABP and they're cool people that I can't imagine are responsible for the babytime fun talk 3) I don't know my results yet, so whether that monster of a test bore fruit or not is beyond me.

3.  The end of boards corresponded with having a bunch of administrative nightmarishness drop onto me from the future employment end, which then corresponded with getting a terrific headcold, so I've spent more of the last week curled on my couch crying rather than blogging.  I got better.

Things I can say:

The shorthand.  Pathology residency usually consists of a dual program comprised of Anatomical and Clinical Pathology.  This lasts four years (doing either separately is 3 years), and to be employable in a difficult job market, most people complete a fellowship.  Some fellowships are boarded (like cytopathology); some are not (like gynecologic pathology).  Nearly all pathology fellowships are a year long, contrasted to some of our clinical colleagues that have three year fellowships.  Fellowships are typically compensated like an extra year of residency.  Being board certified in AP/CP pathology is pretty much a requirement to "sign out" anything in pathology, which is, have your name on a report and the report goes into a system.  Since my residency is two parts, I'm technically taking two board exams, which were administered on consecutive days.

Pathology exams, unlike almost every other field, and allegedly due to the microscope requirement, are held in Tampa, Florida.  There are several weeks between May and early July in which whole residency programs are assigned dates to show up and attend.  It's expensive, time consuming, and notoriously difficult.  You are usually at least there with your equally miserable colleagues, as I was.  So knowing that, let's go.

-I was told by everyone that it was an awful experience and virtually everyone feels like they failed.  This in no way prepared me for how bad it would actually be.  I didn't think I'd feel better off than anyone; I just underestimated exactly how heartbreakingly awful the process is.  I mean, few people feel great after the RISE, but this was like being kicked in the gut repeatedly by someone wearing steel toed shoes while another person stood above you describing the details of your dog dying.  Just awful.  I came out too beaten down to cry, but several others did.  The worst part is coming out after your first day feeling like an utter failure and knowing you're going to have to start the whole process over again the next day.

-One of my colleagues and I managed to separately utterly ruin the confidence of other people coming in to take it the day after our last exam by her "that was f-ing awful" (and she never swears) to a man she thought was in business (taking it the next day) and my response to a wide eyed girl in the elevator who said "Did you finish your exams?  Congratulations!" to which I responded "it is definitely wayyyyy too early for congratulations".  I need to stop talking to people in elevators.

-Mild gripe.  This hotel has hosted this exam for a lot of years.  Everyone in the hotel knows you are there to take the pathology exam, and if they didn't, the fact that you're checked in under the exam rate should tip them off.  As such, call me Ms. Sancho if you like, but please don't say "Good luck on your exam, Ms. Sancho".  If you know I'm taking that exam, you know we're all doctors.  Or better yet, don't wish me luck.  Just kick me in the shin as I'm checking in, so I know what to expect.

-That hotel is nice but absurdly dark.  When you already feel bleak, having Fight Club lighting doesn't improve your mood.  And I had a gorgeous "lobby view" which looked out into the across offices.  The only thing worse than working in a cubicle is watching other people work in cubicles.

-Computers broke.  For an exam that costs the same amount as a lower model used car, getting the software on par with the SAT would be cool.

-There are totally other culinary choices than Panera.  Are you people blind?  Or did you think a giant shopping mall doesn't have a food court?  Also, while the hotel is a'ight, their room service ain't not bad and you can get them to deliver a burger to your room during the exam break.

-Everyone I know says Tampa is a really nice place.  I honestly feel so dejected from the exam that I have absolutely no desire to go there again in the near future (though if I failed, I have to go back, and if I passed, I have to go back for the cytopathology exam).  People asked if I was going to stay over the weekend (since I was off Tuesday-Friday) and check out the beaches.  I scarpered back to Charleston as fast as I felt safe to drive (the next morning).  The only reason I didn't leave earlier is I didn't feel equipped to handle a long drive when I was that wiped out.

-Exam study destroys your health.  I may have already mentioned that.  The months leading up to the exam did more damage to my back than if I'd been moonlighting as a crash test dummy, and I had to up my blood pressure meds back up to a full pill.  Feh.  I'll find out I passed both exams the day before I have a hypertensive stroke.

So there's that.  The rest of my non-reporting has been a frustrating flurry of paperwork.

Took ACLS, and not only passed it, but had the instructor out at my honey's wrestling match, in which a man was concussed.  I did about 5 seconds of voodoo "doctor" neurological hand waving in front of the concuss-ee's face before going outside and getting the instructor/former medic to come help, so worth the price of admission I guess?  Still no excuse for training pathologists to run codes.

Paperwork is a nightmare.  It never stops being a nightmare.  Even when you think you are on top of *everything*, something will come back to bite you unexpectedly so prepare for it.

An example:  In between college and medical school (A LONG time ago), I worked a number of odd jobs for money, as one does.  Since there is a noticeable gap between school attendances, I didn't want to just write: "2004-2006: Played Halo.  Ate at Taco Bell".  So I had the main time fillers listed without much detail (since it's completely irrelevant to my present job), and they've been sitting on my CV for nine years, unmolested by SGU, the ECFMG, the Step exams, ERAS, residency, the state licensing board, or the FCVS, thus I had no reason to expect that one 3 month entity, in the interim, was progressively burying any evidence I ever worked there, up to and including absorbing the entire company into another, shutting down the office I worked out of, and possibly salting the earth behind it to ensure nothing would ever grow.

This is where you go from being mildly annoyed that the government is always spying on you to relying on it.  As I scrambled to not fail my employment history, I found that the usual suspect for being up in your business, the IRS, was tied up in hacker attacks.  I briefly considered whether offering some cash up to a Ukranian mobster would get them to relinquish my ancient W-2s from the IRS website, but I put that up as Plan B.  Nothing yet at the social security office, and apparently there isn't a master number where you can just desperately punch in your social security number, caution to the wind, and get a full print out of your work history, shoe size, and social media posts.  Big Brother sucks at being Big Brother.

Fortunately, where the government fails at creating a dystopian nanny state, the internet always has your back, so I was able to sufficiently cyberstalk an old work contact based on a long forgotten forwarded email to get employment verification.

So that was stressful.  Pretty much, spend a few days crawling through all your paperwork, including your CV.  Now pretend you're on an episode of CSI.  If you can't link the soil on your shoe to that barista job in 99, strike it from your CV so it doesn't pop up again to testify against you in court.  I spent a terrifying couple of days convinced I was about to be broke and homeless because the software staffing markets in the early 2000s were someone volatile.

The final date until the move is approaching fast.  I'm really going to miss Charleston, and I've come to think of it like home, but Texas will be a whole new set of opportunities.  Let's hope that somewhere in late July or early August, you'll get the second to last of the "I PASSED" blogs and not a "NO I CAN'T DO IT AGAIN!!!!" blog.

The more things change, the more they stay the same...

So here I am, a full five months after my last blog post.

My moving date to head to Texas is June 19th.  The dreaded boards, moved up for what seems to be the sole purpose of panicking my class, are May 13-14.

I have less than a month to determine whether I learned enough in the last four years to be a board certified pathologist.  I have a month after that to make all my peace with Charleston, do all that stuff I meant to do, and see all those people I've had to put off under the guise of "sorry, I'm studying".

I now have a great deal of real world friends in addition to my fabulous colleagues, so while the colleagues understand "Hey, I'm not going to your Game of Thrones party next weekend because I need to compulsively hit flash cards", the real world friends with jobs and homes and dogs are like "We never SEE you anymore".  And they don't.  And it's sad.

But tests tests tests.  I definitely feel anxious.  I was always on the smarter end of the spectrum where I've been, so while biochem sent me into a self-induced fear spiral and I never quite grasped pharmacology, despite my tooth gnashing and panic, I was in the upper bracket.  My social life was just not really in order.

Now, the situation is set perfectly.  The hospital, upon seeing all the fourth years freak out at the time announcement, pretty much freed us from clinical duties for the duration and sent us to our offices with 10,000 dollars worth of books.  But I'm not the big fish in a little pond anymore.  I'm easily not in the top half of my brilliant colleagues, which is fine, so long as I'm in enough of the top part of the country to pass the exam.

Still, I don't feel the acute panic I have in the past, I think just because I've grown up and I've gotten too tired of always stressing about it, since it rarely helps.

So I have my system, and you know what Vegas says about people with a system.

Every day is a different topic.  I use the new knowledge to make flash cards.  I set alarms for an hour and every hour it goes off, I drop and do 10 push ups, 15 situps and then make a hashmark for both on my calendar.  When I have enough hashmarks and enough flash cards, I can go home.  At home, or at the Barrel, which is even better, I can iPad my way through the flash cards.  Then repeat over and over.

It's dull naturally.  I like the material, but I can't paint a picture of that as being a laugh riot, but it's the whole first year of medical school thing all over again.  Take a big test.  Be afraid because you're going to a new place.  Hope you do well in the new place.  Be prepared to take another big test.

I have my permanent South Carolina license now, so I'm now technically a doctor.  I'm working on my Texas training licence.  More of those infernal steps I told you about.

So then, do my cytopathology fellowship, and then, take another test, apply for a job, and maybe that cycle will finally end, and I can look back at the last 10 years of my life or so and say "Yes, I am now a doctor.  Officially."

Speaking of doctor things, I have to take ACLS now despite managing to never take it at any time in the past.  Having pathologists run codes is a terrible idea, I think anyone can agree on that, so that'll be another 200 dollars and two days, and worst of all, a day of testing the immediate week after the Tampa tests, but what's a girl to do when she needs that J-O-B?

Other things.... I ran the princess marathon, managed to run it the whole way through, and was both really glad that I did, and really glad that I got to go to Universal Studios and Islands of Adventure since I haven't been there in over a decade and everything's all built up and cool.  The princess made me feel like I can accomplish something, so there was that:

You know, even if I wasn't really a princess, but an English school girl, but my point remains valid.

I also managed to squeeze in the Bridge run since I kind of bombed it last year.  My goal was to get a sub hour time, which I missed by 3 minutes, but it still made me feel pretty good about myself, and I didn't throw up.

Committee life has been good also.  We did an extended trip to Key Largo in January, and I got to go scuba diving for the first time in forever.  We've also never been to the keys, so went down to Key West to check out the Hemingway house and all the six toed cats, the conch sandwiches, and 90miles to Cuba, and of course, the sunset.  It was an incredible time, and I got to see a friend from medical school due to the most random of coincidences.  I still miss the connections I had there.

Last month I hit Boston at USCAP and realized the boards were getting to me, because I'd left the boyfriend at home, and it was probably the most depressed I've ever been out of state.  I finally got enough enthusiasm to take a run around the frozen harbor, but it was not a labor of love.  The speakers were great; I made a lot of connections, and I got to crash other programs' parties, but I really just wanted to be home.  I've come to love Charleston so much and it's really sinking in how quickly I'm leaving it.

Lot of paperwork heading for the new place.  We've already been down to pick out our apartment (with the help of my lovely aunt) and it seems like it's going to be a great place to live.  I've already distanced out the Trader Joe's, Whole Foods, and closest Ethiopian restaurant cause I'm 'that guy'.  Then all the paperwork.  Gotta get that ECFMG certificate out again.  Gotta find all those step scores.  Gotta write to the school again and beg for my transcript.  It never ends.

So now it's just study study study drive to Tampa and breathe.  See all my friends, kayak, go out to dinner, go out to parties, and the like, but now, back to the books.  Hopefully by the next time I post, you'll have a "I'M FINALLY A REAL DOCTOR; NO THIS TIME, I ACTUALLY MEAN IT, I'M BOARD CERTIFIED!!!" post. I truly hope, at least.  And we'll see whether a Caribbean MD was really enough for me.

And the beat goes on

Time is whipping by really quickly.  I've always been a terminal procrastinator, and that applies to things like "seeing things as being far in the future when they're quickly approaching", if that makes any sense.

In my last post, all the stuff that's either in the past or in the immediate future seemed so far away.  And then it was here.  Christmas with mom-visit, New Year's, call week, dad visit, next week is San Diego.  The week after that is Nicaragua.  Where did the time go?  It makes me think strongly of the board exams coming up in 18 months and how simultaneously long and short that time seems.

It's also 18 months until I leave Charleston, so like my fellow third years, I'm compiling my Charleston bucket list.  Go to the plantations, eat at about 15 different restaurants, run the bridge.  That sort of thing.

I did cross the Biltmore off my list, which is kind of cheating since it's 4 hours from Charleston, but my mom's visit for Christmas went splendidly, I kind of killed myself cooking both because I had the time off (hooray!) contrasted to last Christmas, and because my boyfriend scored a 500$ gift card to Target during his company's gift exchange, and I stole half of it to get a kitchenaid mixer because the older I get, the more dominant that second X chromosome becomes.  So I did prime rib the first night, lobster the second night, and then we hauled it up to Asheville for Christmas banquets, gingerbread competitions and a candlelight tour (and of course, wine tasting) through the Biltmore.  Lovely, truly.  Pricy, but lovely.  Too brief a visit.

Incidentally, the new format for blogger not only tends to kill me but has an incredibly sluggish response speed to my typing.  It's currently listing my last paragraph as a misspelled word, so apologies if this entry seems curt or strange.

The next week I was covering surgical pathology so that others could enjoy a free New Year's week, though I still was able to get out pretty early on New Year's Eve and secure the party at the Alley, as we did last year, though this year without immediately jumping in the car to drive to New Orleans the next morning.  I'd say I feel more comfortable with surg path now, but that's usually the sort of statement I make before everything deteriorates spectacularly, so we'll hold it off for now.

I felt relatively refreshed entering my call week after that, though it does lead to the tricky situation of really eating into the clinical pathology time as I'm frequently consumed with the AP side.  It's important, but I've felt in the last six months like a lot of the lab time becomes expendable, and that's concerning for people that have their eyes on the test prize.  It's something to watch for, certainly.  Anyway, I've been in a odd little work funk lately.  This kind of culminated in my call week.  I feel way more comfortable at each task I'm assigned, but when they overlap each other, I feel like I can't

And the beat goes on...

Things that have happened since August...

Well, now I'm halfway through my final year of residency, hurtling toward fellowship.  I have, as of last week, registered for my AP/CP board exams with approval of my license and medical school diploma.  The registration relieved me of 2200 dollars from what is thankfully my now dwindled educational fund.  I spent my last thousand (minus what the hotel costs will be) on a cute small collection of books from the "Biopsy Interpretation of" series, because I know how to have fun.

Thank goodness for that educational fund, man.  When you're interviewing for residencies, find out how much it is.  Even if your salary is higher, that salary is going to be taxed, and if you're doing income based repayment for your student loans, that'll shave it right off, but the educational fund is free of all that.

So between May and June, my colleagues and I will be flying to Tampa to take this heinous double part test, which means I'm in the beautiful time of the year where fourth years begin to prepare for hibernation and become utterly useless for everything else.  And I'll be returning to studying once I complete this blog post, actually.

So the training journey is nearly at an end, minus that whole cytopathology thing.  At that point, there will be *another* licensing exam and I will hopefully stumble out of this whole mess as a triple boarded pathologist who will then be swimming in job opportunities (please?).

It's still a bright scary world out there.  Texas provides at least a stopping point on the road to "being grown" but after that, it's a big black hole.  The man and I kind of fell in love with Denver during the Great American Beer Festival, so maybe they'll open a spot for a youngster in a year and a half.  But still, everything is sort of winding up, and so much faster than seemed possible.  It seems like yesterday I was "covered in bees!" panicking to Grenada, and now I'm trudging toward an exam so far beyond the scope of the Step 1 that it makes the Step 1 look like SAT prep.

I have a weekend left of call... this weekend actually, which I traded for a lovely weekend in Asheville back in August.  Then I can finally do what I keep saying I'll do which is retire the scrubs.

I now have my permanent license in South Carolina.  One is necessary to apply for boards, and that lovely educational fund covers it, so it's official.  State law varies, but in South Carolina, IMGs such as myself cannot apply for permanent licensure until they've completed three years of training, so with that finally behind me, I have the unrestricted medical card.  Of course, I let my DEA license expire in the way back so I can't prescribe any of the fun drugs with my unrestricted license, so sorry guys, no illegal scrips for you.

Really feeling the whole "last of" tour of Charleston.  I've been steadily moving things off my bucket list (carriage ride, rooftop at Vendu, go to the Macintosh) and feeling the kind of "last Christmas here" sadness.  I've also been kind of wandering through apartment listings in Houston, and they seem nice.  Gotta make the commitment at some phase, and I will definitely need to get a bike.

When I'm not buried in microbiology lectures, I've been on kind of a health kick that was initiated by both getting cooking bling (Kitchenaid from last Christmas and NOW an overly expensive Vitamix blender) combined with getting suckered into running a half marathon in Florida in February despite nearly being killed by the bridge run, which was less than half the distance.  Still, I'm running for Save the Children, and they're a good cause, so if you want to toss a couple bucks my way in the name of securing me a permanent knee injury, the address is here.


You even get to see me dressed up like Alice, and I'm contemplating wearing the costume if I can make it without dying.

Running is an insidious creature.  It's been my go-to exercise off and on because it's cheap and easy, and kept me from going crazy (er) in Grenada.  Most of my running save for in Grenada has been on a treadmill, for years even, and it's only been lately that I've been pushing into the great outdoors, and I have to say, I kind of like it.  But I keep getting sucked farther in.  For years, I'd run on the treadmill, go all out for the first mile as fast as I could, and then walk/jog the rest in gasping bursts.  No strategy, definitely a no no for accumulating injuries, and thought a 5K was really all I was ever going to be able to do.

Well, and then a 10K, because the Cooper River Bridge run is a quintessential part of charleston, and why not, right?

Now I'm following my NikePlus trainer and arranging happy hours around when I can get the best mid-dusk run on the waterfront and working toward the half marathon.  Where I'll stop, really.  I won't get sucked into a marathon.  Well, at least I won't get sucked into an ultramarathon.  Check with me in two years.

Doing the training correctly has been helpful though, and now I use the first mile to actually warm up rather than suddenly sprint as fast as I can until all the bits and pieces holding my lower legs together start to snap and pop, and it's allowing me to really again appreciate how beautiful Charleston is (and how dangerous its drivers are).  My longest run so far without stopping at all is 6 miles, and the long runs are starting to feel better and better or at least "not as terrible as before".

And then with the work hours decreasing and the study crunch requiring more "can't sit around or will go crazy" ness, I've been cooking up a storm lately.

Few things... I've been poor for a while, and the story of the last ten years of my life has been accumulating things that 16 year old me would have scoffed at.  150 dollar running shoes?  Please, shoes are shoes.  Yeah... but the glycerines really help my plantar fasciitis.  Artwork for the wall?  So long as Rolling Stone still has full centers of Trent Reznor, you're just a few pieces of tape away from home decor!  Yeah... but frames.  Frames even make counter culture stuff look nice.  Cookware??  I mean, you can get a hand mixer from a store for 5 bucks.  What's up with these stand mixers?  It kneads dough for me.  Well, at any rate, I can tell you I'd *never* pay 500 dollars for a damn blender.

Sigh.  Last year, when I got my kitchenaid, a friend of mine said "The two things that changed my life were my kitchenaid stand mixer and my vitamix blender".  I trust said friend's cooking opinions, so I went home and googled vitamix blenders since I was poor (see above) and had no idea what they were.  My first response was laughter, obviously, because who would pay that for a blender?  In my defense, my blender is a combo gift from my dad and my boyfriend, if that justifies it.  All that's left for my Martha Stewart kitchen is a set of expensive knives and a set of expensive pots/pans.

But I'm liking cooking a lot, and I'm loving the fresh ingredients, though I'm being careful not to be one of "those" people.  "Yes, I'm making a smoothie with pomegranate seeds and chia seeds but I will absolutely *not* refer to either as a "super fruit/food"".  I'm finding a lot of fun recipes and enjoy challenging myself with them.  When I completely run out of medical school/residency related themes for this blog, I'll just start posting recipes.  I'm also having fun making my own flour.  The boyfriend is diabetic so I'm trying to keep the glycemic index low, and you can pretty much grind up *anything* and make fake flour.  There's about three cups of chickpea flour now occupying my cabinet because I found a bunch of dried ones on sale and went "Ooh!!!  This will be like magic!" because I have never had a good blender before, thus the art of changing the state of something (like beans to flour) still stirs a certain sense of magic and wonder in me.

The whole foods approach is also making it easier to make absolutely anything without needing to scrap around for ingredients.  No salsa?  Tomatoes, cilantro, peppers, and onions.  No guac?  Avocado, tomatoes.  No pasta?  Flour, egg, and water through the pasta maker.  No ice cream?  Milk, ice, frozen berries.  No rice flour?  Rice in blender.  I'm a year out from killing my own chickens.

So that's the update.  A six month crunch to boards and moving, punctuated by the growls of "pulse mode" when I'm making my morning smoothies.