Monday Monday, not as bad as before...

I'm afraid to jinx this streak though since we're on a three day cycle, bad days tend to beget bad days and good days tend to beget good days, but today ruled. I was on top of my game, the specimens were few and far between, and I didn't put stab myself with anything.

My patient car-owning roommate also took me to Costco, which is a store I've been gradually discovering in bits and pieces and am filling more with love for it. I'm also stocked in pasta, meat, and beer for the next month, with the added benefit of not having to bungee it onto the back of my bike and steer it through the ghetto. A twofer.

A short update, but hopefully a more reassuring one.

Friday is a better day to write...

If each of my weeks of surgical pathology were presented as a topic of a medical school lecture, it would be presented as a fluctuating graph, similar to the sort of thing you'd see in LH and FSH curves.

Monday: Okay, this week is going to be different. This week I'm going to be more not-terrible at things and not get overwhelmed and I'm totally not going to start crying in front of colleagues/attendings/patients in the parking lot.

Tuesday: Well, Monday didn't go as well as I'd expected, but I'm still kicking and I have the opportunity to get some learning experience and even if I'm here late, I'm going to salvage these cases and not be an incompetent braying jackass. I'm going to ask the chief resident for some advice on time management without cry... well, not much crying.

Wednesday: OH GOD I'M TERRIBLE I'M GOING TO QUIT MEDICINE THIS TIME I SWEAR WHY AM I SO STUPID UIJNJHjh;iblarghhhhhh

Thursday: Tomorrow is Friday, I just have to make it for today and tomorrow and I'm going to run damage control, but I can't believe I lost it that badly yesterday, fortunately the transcriptionists haven't mentioned hearing my voice break at 11 PM on the dictations because I realized I still had four liver biopsies left and don't actually know what liver is supposed to look like IS THAT CANCER?

Friday: I'm so tired. Did I seriously not screw up these cases as badly as I thought? Is that attending praising me? Life has meaning! I'm going to go sleep for twelve hours...

Saturday: I'm going to get groceries... and do something today. And I have a little time? I'm studying some lung! I feel like I'm finally getting this!

Sunday: Studying dermpath. Slight impending feeling of doom, but I've done some reading! And rested! Next week's gonna be awesome!!

While I definitely feel like the weakest link right now because my colleagues are suspiciously good at this stuff, the early surge path months could best be summarized by the following scenario:

(In a dead quiet room, an intern stares meaningfully into a microscope, scans a slide, stops, frowns)

"What the f*** is that?!?!????"

(Other interns crack up, both in sympathy, and in the realization that their dictation now has someone else's exasperated exclamation in the middle of it. Ponder that the transcriptionists haven't killed us. Other interns gather at the scope. Several appear puzzled.)

Just-studied-that-topic intern: "Normal breast tissue"

(embarrassed silence)

Yeah. It's not a program problem, honestly. There just seems to be no way to be a first year resident and not feel about as useful and intelligent as a squirrel wearing oven mitts.

Speaking of dexterity impairments, I contributed to *last* week by plunging a contaminated scalpel through my thumb. Yeah, *through*. I don't like to screw up small.

Funny thing? I'm constantly overwhelmed by crippling feelings of panic and inadequacy about my overall competency as a physician, yet having a knife stuck in me largely made me feel really really embarrassed about having arranged myself in such a way to get a knife stuck in me rather than being that concerned that there was, ya know... a knife stuck in me.

Here's the thing too.. we wear cut proof gloves... they do not prevent against stabbing with great force, which should both tell you that you shouldn't use them in a joust and that I was doing something stupid.

Situation:

(knife plunges straight down, left thumb is briefly pinned to cutting board)

Ishie, to herself: That probably glanced off the glove and is caught on it. The sharp pain I am feeling is likely due to the blunt force hitting my thumb.

(blood quickly spills through cut gloves and two layers of latex)

Ishie, to herself: Oh.

(pulls up scalpel)

Ishie, to accessioner around corner: Um... If there's an... incident, who should we call about that?

Accessioner: Did you spill something?

Ishie: Sort of.

Accessioner: What do you mean?

Ishie: I cut myself.

Accessioner: Badly?

Ishie, evaluating blood puddle on table while applying pressure: Um... pretty badly.

Accessioner, rounding corner: Oh my god!

Attending from other room: What's going on?

Ishie, to herself: Oh good. Let's bring everyone in on this.

Attending rounds corner, pushes Ishie's hand into sink. Ishie experiences sensation of water running from one side of tissue to other. It feels really weird.

Ishie: Sorry sorry sorry, I was being dumb. It's no big deal.

Attending, simultaneously: Don't worry, infection is really really rare, we'll get it taken care of. We'll test the patient. Was there more than one specimen?

Ishie, to herself: Oh right, I should be worried about that.

Why social stress panics me and trauma doesn't remains part of the deep lurking mystery that is my psyche.

Everything got taken care of really quickly, people came to back up my workload, I was off to the ER, everyone was making phone calls, and it was bam bam bam. Very impressive. And I'm fine. Extremely clean cut, sealed with dermabond, a week and swelling is going down with no signs of infection. Also, the ED at this hospital is really nice looking. While I *love* New York, don't get me wrong, the hospitals tend to have a more, let's say, 'lived in' look that doesn't look as clean even when it is.

So I kind of feel like a mess. I do feel like I'm getting somewhat better at things (except cutting stuff), but really slowly. I'm *really* slow at grossing and usually require a great deal of help, and then I'm doing decently on diagnoses, but it takes me a really long time. And I make dumb errors. Dropping stuff, putting stuff in the wrong boxes, forgetting where paperwork goes even when I've been shown fifty times, being completely incapable of recognizing squamous cell carcinomas anywhere.

Seriously, I hate that cancer so much. And it pops up everywhere. And it's frequently so obvious that the other residents, med students, janitors, and elementary school children that wandered into the hospital are like "Oh, that's an SCC", and I'm like "Where??? Is it behind all that red cancery looking stuff???" Gah.

So that's the update... I'm still dumb, but people are being relatively cool about it. Let's hope the idiocy is low-grade and transient.

The reboot

Hi boys and girls, it's me, your bipolar blogger.

So, lemme see how I can sum up and still get to bed in time to not be miserable during lecture (yes, we still have lecture in residency)...

It sucks. Then it doesn't. Then it sucks worse, then someone jumps on your back when you're at your lowest moment of suck and you feel like it sucks worse than it EVER sucked, and then a few people throw you a life preserver and you get some peace, and then you can't get your stupid character to climb the first stupid rock cliff in Shadow of the Colossus in the ten minutes that you're "taking a breather", and you want to start crying because your video game avatar isn't respecting you and your animated horse ran away.

It's not that I'm miserable all the time. It's that I'll be REALLY happy or even moderately content, perhaps when I'm pouring steaming liquid nitrogen over a piece of uterus while going "MWA HA HA HA" since it's impossible to play with liquid nitrogen without feeling like a mad scientist, and then I'll feel like I'm really a bus ticket away from leaving. Like taking off, leaving, like walking into my program director's office and being all "Sorry, you've been cool, but I am flat out not equipped for this" and then getting on a bus somewhere else and just... waitressing in a border city or whatever people that make decisions like that do on tv.

Also? I'm weird. I get weirder when I get stressed, and I am at my weirdest when I'm stressed-but-putting-a-good-face-on-it, which leads to interchanges like the following:

Histo tech: Dr. Sancho?
Me, taking a minute to realize that means me: ...
Histo tech: (politely rattles off a hundred things I have to do, about fifty of which I don't really understand)
Me: ... uh... I totally know what you are talking about. Here's my tray of pathology things. You are welcome.

(pause)

Me, thoughtfully: That's the first time in my life I've actually been called 'Dr. Sancho'.
Histo tech: Oh! I'm sorry! Do you prefer 'Dr. First-Part-of-Hyphenated name'?
Me: Actually, I prefer 'Batman'.

(long awkward silence)

Me: But 'Ishie' is fine.
Histo tech: ...Batman... got it.
My brain, to me: What the f***, Ishie. Seriously.

Yeah, that happened.

First month, full on training month. We were never really allowed out without a handler. We spectated a bit, and did stuff, but if we broke down, we had a senior to bail us out immediately. I mentioned this before.

Second month, as I also mentioned before, is when you're somewhat in charge, except you don't know anything. I spent a lot of this last month feeling like I had conned my way into residency and was absolutely not smart enough to be a doctor. I kept reassuring myself that everyone feels as dumb and unskilled as I am, but then had a fellow jump down my throat, question my commitment to everything and say I was unskilled in pretty much every way, which made me cry for half a day. Which is not only demoralizing but frigging embarrassing. Since Irene was chilling off the coast waiting to put the extremely publicized cinch on all my friends and loved ones up north, I blamed it on allergies, specifically the type of allergies that make you sob uncontrollably.

Since I live in the South, which is known for its politeness, the response to this was favorable. Additional note, gender stereotypes be damned, anger + exhaustion + self-loathing = unexpected waterworks. As someone that has belly laughed through Benjamin Button, not a fan of this response.

I honestly toyed around with quitting, like not next year, but just two weeks notice, flat out. I felt unique in this response before talking to My Friend, the Pediatics Resident who not only tried the same thing but was waylaid by the three people that tried it before her. Apparently, residency is hard. Who knew?

I took the advice of one of my peers and approached the next day with my "head held high" which I think took on the appearance of a gargoyle grin the whole day, but it was an effort. The "I'm happy, keep moving" day was punctuated by an unexpected moment of credit to counteract the unexpected beat down. I was staying late trying to get all my stuff done, helped by an attending, and out of the blue, the guy that hadn't said anything in twenty minutes, tells me how he felt awful his first month of residency and that I was working hard and doing a good job.

To my credit, didn't start crying again. Said a "thank you sir" meekly, with ABSOLUTELY NO MENTION OF BATMAN, and went home.

I took the weekend to reboot, and went at it again on Monday. I was greeted with the chief that's been helping me tell me that as the end of the month ritual, he was going to leave me to it and I was going to be in charge of entering all the diagnoses in without help on that either.

Oh, and today, I'd been signing them out officially with the fellow that hates me.

Holy matrimony, Batm... NO MORE BATMAN.

Guys, I actually did it. Yesterday, on the announcement that I was for real on my own, I felt the panic rise, but I was like "I'm just going to do the best that I can", cranked the headphones and the pseudo-happiness up and just pretended I knew what I was doing, walked into sign out today with a smile on my face, prepared to get verbally dismembered or fired or whatever, and frigging did it. I didn't get every diagnoses right by any stretch of the imagination, and I did a couple things that were flat out stupid, but I smiled the whole time, didn't cry, and didn't feel like a complete incompetent. And I went home feeling pretty happy.

Given my residency cycles, this is likely to descend into chaos by the end of the week, but hey, baby steps, right?

In other, related news. They gave me a medical student. Which is the worst idea ever. It's like dangling a vial of crack in front of a junkie. I'm brand new, so I'm not very helpful for teaching, BUT I do have tons of stuff that I take extra time to do because I'm still inefficient and this stuff has no educational value whatever, particularly if someone doesn't want to go into pathology, which 90 percent of people don't. This is known as "scutwork" and it's the bane of medical education existence. So you are going to give me a medical student, who is supposed to do whatever I tell her to, that I can run all over the hospital fetching paperwork to save myself time, that then gets her out of my hair if I scut her, so I don't have to reveal that I have nothing to teach her because I'm a frightened idiot?

GODS. I'm being good, I swear. And this isn't a fourth year crashing into interview months that is more comfortable with disappearing on an August intern. We're talking brand new clinicals, which if my background is any indication, means you think anyone with "Doctor" before their names can and will call every place you hope to apply to tell them you suck while probably talking the USMLE people into taking ten points off your looming Step 2 exam if you take more than 45 seconds to answer a courtesy page.

I even got the "I'm still keeping my options open" answer, which on this end, is adorable. I got asked if it was okay to leave to attend a scheduled lecture. This was the first time in my entire medical education that I realize residents truly don't care if you're there. I got a pager number. I realized that interns really don't know med students' names. I got someone eagerly looking at me for deep medical knowledge and being all "Don't cut yourself on the cryostat. Seriously, that blade has been places that would make Rambo puke."

In my quest to not be a terrible person, I'm trying to do stuff that I would have wanted done for me at the beginning of my third year if I were in a pathology rotation, other than my sage advice of: Get UWorld now. Seriously. Do it while I'm standing here. I'm currently going with "play with the cryostat" (CAREFULLY) since that enticed me pretty early on by being a big machine with a big knife in it. Any other suggestions? I tried "be let out early to study" but they have the afternoon lectures. I remember from third year that "Go study" is helpful to an extent early on, but you don't feel the Step 2 crunch as heavily, and being dismissed for hours when you still have to be at the hospital is tedious.

Laypeople, chip in as well... I'm not around the forensics cases this month, so that's not an option since it's the most obvious "let the student do something fun" choice.

Dated References

So I spent a lot of the last week like this:



But I'm going to try to spend the next week like this:



We'll see how it goes.

And thanks to R for the tvtropes appropriate update on my profile picture.

Oh, and attention medical students: do not click on that link or you'll be sucked into this.

Run.

Do you have talents outside medicine?

Do you have talents inside medicine but feel like you'd be happy as a PA, nurse, chiropractor, or radiology tech?

Do that.

Gah!

Residency summarized...

I'm the blond one...

*This* is why I became a pathologist

I was going "back to the bucket" (go back to the original specimen and hunt through formalin soaked tissue scraps) on a tumor which I refer to as this individual's abdomen being full of "unspeakable evil" and the attending said "You did have a rough day on Wednesday" and I made some sort of chuffing noise, and she said "Makes you wonder why you went into pathology", etc.

Same attending, special stains come out on *another* abdomen full of unspeakable evil and everything is negative. This tumor looks awful, is everywhere, and as of right now, cannot be identified. On standard microscopy it looks like generic unspeakable evil, it's not forming patterns; it's hard to even determine what organ it came from. Special expensive stains are sent out which show... nothing.

From my internal medicine days, it was about halfway through the equivalent process that someone would say "mm... cancer.. bad prognosis" and I'd go "What kind of cancer" and they'd say "Does it matter?" or turf it to another specialty.

My attending, on the other hand, begins flipping through her encyclopedic knowledge of zebra and unicorn diagnoses, turns to her wall-o-books and starts hunting for other stains she can do to force this thing into the light.

This scab picking approach to problem solving is why I'm becoming a pathologist. Because when the stains came back negative, I stopped thinking "It's Friday and I want to go home", and started with "We're not giving up, are we?" It's because every pathologist's office is filled with tomes like "The Color Atlas of Bodily Fluids" and "Vaginal Lesions" and papers and slides stacked to the ceiling.

I just need to remind myself of that the next time I'm crying into a bucket of formalin.

Emo Thelonious Monk

This title is a direct quote from this interchange:
Autopsy tech coming up to the surgpath area: You're still here? Oh you poor thing.
Ishie: (grunt)
Tech: Well, it looks like you're almost done!
Ishie: This is a uterus.
Tech: Ohhh...

(music wails in the background)

Tech: What... is this...?
Ishie: Kid A by Radiohead. Good album to sulk to.
Tech: I... I don't even know how to describe that. It's like... emo Thelonious Monk.
Ishie: That may be the the best thing I've ever heard. Thank you, madam.

So I've been having kind of the miserable day in the middle of a rough couple of weeks.

I hit my milestone today while confirming something I always suspected was true which is that all interns, regardless of how easy their programs are or how cool their coworkers are or how much they like their field WILL have a moment, probably in the first three months, where they start crying at work. This is frequently accompanied by sentiments such as "I don't think I can do this" or "What did I do" or the simple but effective "I can't".

There are varieties of these meltdowns too... pathology is a good field for low nuclear meltdowns because people generally leave you alone; and there are a lot of times you are by yourself and can work it out. For instance, today, quiet crying at the grossing station as you gaze upon your sisyphean task can go practically unnoticed where the sort of meltdown you get in other specialties, which is often brought on by many people yelling at you at once, tends to lead to breaking down in front of your abusers, which is the worst form. Or the "feel it coming, find a hiding place" cry. So far, I've only managed the quiet one, and it was brief, but it was there. I came close a couple other times this week.

We're doctors now. It's official. Training wheels are off and ain't no one else going to handle this crap. If you don't do it, people are just going to get angrier and angrier until it gets done while more work piles on top of it. Your pager goes off in lecture, in grossing, while you're dealing with other urgent matters. I'm running around clutching decal slides in my hand finding the magic person that's supposed to receive them all with this entire realm of "THIS MATTERS". My training is secondary to the fact that I have to do a doctor job now. And that means doctor job, doctor hours, the presumption of doctor intelligence. Machines to monitor, techniques to know, medical knowledge, searching databases and surgical reports. Gah.

It's scary. And right now, I gotta be honest, it kind of sucks. People are generally nice to me; I don't really want to be doing anything else (well... sitting down watching Game of Thrones and drinking a Blue Moon, but you know), but it still kind of sucks. Today, I was at a grossing table for 12 hours slashing away at specimens that only grew in complexity while my scrub pants literally fell off my butt. I didn't eat, I didn't go to the bathroom; I stood there, without taking my smock off, for 12 hours without cease. And I came out and felt like death. And tomorrow, I deal with the consequences of today.

On the other hand... and I've been trying to stay on the other hand, since I can be task loaded and miserable or I can be on the other hand, I've seen a really cool polycystic kidney, got to play with liquid nitrogen, got to screw with the power tools, got to be scared to death of a potentially infection hazard during a frozen section (false alarm) and the rest of it. Cool stuff. That's what I keep telling myself. Cool stuff.

I also have an attending who is super nice and seems to know me by the fact that I fear grin at my superiors and support staff. It's not that I'm a nice person; it's literally something chimps do when they're scared. So I'm the smiley girl. (Who saw that coming???? NO ONE!) So this one attending always goes "still smiling?" and I'm always like "Sure am, sir!" or lately, been lifting my head up, twisting what is probably a deeply disturbing jester leer at him and nodding meekly. He said "Feel like you're handling things"? Yup? LIES. "Getting a bit overwhelmed?" "Oh, sir, you're such a card..." LIES. But what to say? "Help me. I had no idea anyone would ever give me this much power. I am retarded but really good at taking multiple choice tests. Please resign me to a tedious position that can be replaced by robots... sir.

So staying the course. Despite today's waterworks, I'm determined to be happy. I know I have it good, dammit; I'm not going to waste hours in the weepies over getting exactly what I wanted. Time to put on



Or, if you prefer...

With Apologies to T.S. Eliot

But August is the cruelest month.

July was a training month for us, which means we literally were never without a handler, which is comforting, and in those sorts of situations, you always *feel* like you're learning everything. This is especially true when people are letting you do things, so you feel like you're in charge, but you always have them over your shoulders, often helpfully making suggestions.

I did have one fourth year that made me run a couple frozens by myself, which in itself was a little panic inducing, but still, the fact was I knew that he was there, and the very nature of the whole thing made it so that I knew if things went really wrong or if it were too complicate a specimen, he would rescue me.

July is also when I heard a lot of "I'm gonna be here for a while, so why don't you run on home?" which makes you hear the "go home" and not the "I'm gonna be here for a while".

August, we're let loose on our own. Today was my first grossing day, which is seriously intimidating.

I think I explained this elsewhere but pathology schedule is gross (cut stuff), preview (guess stuff) and sign out (be pwned on stuff).

Grossing seems like simply the grossEST as it's the opportunity to smell like unspeakable evil, splash formalin on yourself and such, but doesn't seem like the hardest. The real difficulty comes in interpreting what you see. The problem being, grossing badly brings down the whole house. If you cut poorly, the slides come out poorly, and the most skilled diagnostician on the planet cannot figure out margins that you haven't inked, false margins you have inked, or specimens that are mangled and only consist of blood clot. This failure not only potentially gets you in trouble with your seniors, but more critically, can directly screw up a patient's care. I can potentially apologize to my higher ups all day long, and they can think "Hey, she's a noob", but some patient could potentially wind up minus a diagnosis or with an additional surgery or whatever because I can't cut and paste.

So no pressure. Being faced with an increasing load of specimens and staring at something relatively simple like a skin lesion, I felt a pretty piercing hint of anxiety. For complex specimens, you page an attending or fellow (which I'm trying to get used to, since medical school taught me to NEVER DO THIS, and pathology residency teaches you to ALWAYS DO THIS. It is always easier to have a pro orient a specimen than have a pro un-fuck one). This leads to someone hand holding you, but under mounting pressure, you do things like "dictate while someone is telling you what to dictate and still forget what they said 30 seconds ago because there's a microphone in front of you".

Gods. In the end, I still feel incredibly lucky. This was probably my worst day of residency so far and the most "not fun" one, and it was still punctuated by not once getting yelled at, having three of my colleagues stop by at different after-hours times to offer help, and having two attendings come by after hours, one to do a complex specimen *for me* and the the other to take the load off, which included him staying three hours after leaving time and dictating half my remaining case loads so that I could leave at a semi-reasonable hour.

I have a less intensive residency than most and definitely a less malignant residency than most. I'm not sure how I would manage if either of those features were not present. But it does make me feel good that at the end of the day, my "bad" day consists of learning opportunities and people helping me. Tomorrow, I find out if my grosses were okay, and I'm really hoping that they were.

Night everyone

Social Reality Check

So I was wandering around the interweb before bed and discovered this thread, granted an old one: Dating a Medical Student. I focus on what medical school is like and the whole doctor scene, because hey, I'm self centered, but this is the whole "Other" view.

I'm not a student anymore woot, but it wasn't so much just the original post that paused me, but all the comments. It seems like dating us requires the same level of support group as one needs to, say, cope with being in love with a meth addict... who gambles... with babies.

Now, if I'm on youtube or something, I feel confident in the fact that the average commenter makes less sense than a monkey smearing feces on the keyboard, but this whole thing consists largely of well thought ideas and whole trends I see rampantly in myself, and previously defined more as "Weird independent female" and less "medical student stereotype". Are we that insufferable? Are we really that inevitably well defined?

Medical mysteries in action...

You creep around the corner of the kidney, and there you see it, a throbbing gelatinous evil blob of tissue. You've fought this beast before. You bring your scalpel down and it screams. You grab it with the forceps so it can't wriggle out of reach and stab it again, cramming its protesting pieces into separate cassettes, so it can't reform vampire style.

Sighing, you resheath your blade in the curiously inefficient "safety" device used for them and take a deep breath. "Looks like I just blocked *your* flow", you say smirking, as hot lab ladies flock to your sides.

The next morning... the hearing... you're hungover... those ladies wouldn't entertain themselves after all, and with gams up to where their gams go, well, you don't tell em no. Still, no reason to ruin a good day. You stroll up to the corralled kidney tumor and throw its body under a microscope, give its family a good funeral, give a little lesson to is brothers... but wait... your blurry vision clears... you clean the scope.

That's not your tumor. It's a stranger. You look through the books on em, maybe bluff him a bit. Yeah, tumor. We know about you. We know about your brother. You're rare huh? Must be sitting here thinking you're pretty badass. So rare that the dregs down at county won't know what to do with you eh? I tell ya what, punk? I put condor eggs in my gin fizzes. That give you an idea what I think of rare? I spat in his face. You make me sick. And you're going down. I stormed out of the lab, before he could see he was getting to me.

As I brushed through the doors, the secretaries hastily fought for my arms. "Don't go!", they were flapping. The dames could wait. I had a book to read.

Skills to learn...

For the past four years, I have not regular access to what people would conventionally call a "kitchen". Not that I was an exceptional cook before that. In Grenada, after a semester on campus with a stove top, I got my wonderful little apartment that featured a propane stove that my former Peace Corps working friend had to show me how to use, the oven was too small for almost anything, and two of the burners worked. The settings on those burners was "large open flame" and "No large open flame". Could make the hell out of some old fashioned popcorn though.

Moving onto Brooklyn, I graduated to a surprisingly similar gas/two burner functional half kitchen, which my roommate used enviably, but I mainly lived off of takeout, both as a function of kitchen size and laziness.

Now I live in a large three bedroom house that has a ginormous kitchen with an electric (gasp) stove. Roommate 1 cooks like a mofo. Like "Oh, these peaches are about to go bad and bazam restaurant quality pastry." I also have a yard now so the first thing I did upon having access to a vehicle was buy a grill because if there's one type of cooking I can do it's "Char things over fire" (thanks, Grenada!).

So I'm finally trying to cook quality food. I am pretty pleased with my blackberry cobbler and tonight, upon being too lazy to stop at the Piggly Wiggly (yes, really) on my way home from work, concocted a stir fry out of rice noodles and pale ale (no sherry) and it (drumroll) didn't suck!

I consider this further evidence of my whole "medical school delays maturity" hypothesis. By next year, I'll be buying car insurance and all matter of other things that most people master around age 25.

Free pizza remains awesome

Yeah, I pretty much talk about food and booze. If you're looking for decent medical advice, this may be the time to StumbleUpon elsewhere.

The patient-information-free update... soooo difficult.

If this entire process has made me anything, it's paranoid. Not mature, by any stretch of the imagination, but I start to think "You know where I went to school; you know where I'm doing residency; if I tell you the cases I'm grossing, you'll know who my patient is, and you'll HIPAA until I cry uncle."

So, pathology seems to be a two way street. If you guys are complete science dorks with a love for a full night's sleep, this is seriously the way to go. I spent time today trying to think of a residency that generally has better hours, and I couldn't think of one. On the minus side, it's very hard to tell anyone what you do. You will either bore them or horrify them. Possibly a little bit of both. In completely unrelated news, the roommate that now knows how I spent the day thinks I'm hardcore metal, but I believe may be a little wary of me. I went to a bar for my Friday night fuel, and generally introduced myself to the young and innocent by saying "I work at the hospital". One, because they're all youngsters and I seem to get carded enough to pass for one of them, and two, because "I'm a doctor" both carries with it snob weight *and* requires a little explanation of what I do... which may involve either "I sat at a microscope for ten hours" (boring to the public) or "I (censored) a baby and now you're horrified, and I have to be all "Oh, but... it wasn't cool. Except it was. Sigh. Who wants a free round?"

For those of you that can't connect the dots (hopefully most of you), I'm in a University program now, and it rules. Every day, we get "zebra cases". It's not that we have a bunch of the same rare stuff, but whether I'm grossing (cutting up surgical specimens), previewing (pretending I know what these things are) or signing out (having the attending demonstrate that I don't know what these things are), it's always some bizarre things, because pathologists just don't do that much normal.

Today I got to really have control of dictation for the first time. It is the most intimidating thing. English is genuinely my first language. I always got A's in the subject matter; I worked as a frigging technical writer, and public speaking does not give me hives. When you stick a specimen in front of me and a microphone in my face, it's magical. I literally forget how to name colors. I will be looking at a pink strip of skin and thinking it's a pink strip of skin, and my dictation will read "Uhhh... (rustling) Uhhh... Specimen A is... uh... submitted in formalin... and... uh... is... a... color... I think it's pink... that is.... 5... by 2 by zero point 3.... centimeters... wait.... zero point four.... centimeters... in... uhhh.... aggregate... and consists of... a... uhhh... puce fragment of... sorry... addendum... my name's Ishie... I work for ya'all."

It's like pulling teeth.

So that's a life lesson. All the times where you thought acting or reading or any other performance based field was a stupid overpaid profession, just to let you know, you probably suck at it. A lot. Like, you should feel bad, you probably suck so much.

Along with dictating, I'm grossing. I'm learning how to cut specimens so that they show me what I'm interested in. Tumor margins, type of tissue, how the normal tissue looks, whether it's near the blood vessels, that's all based on my decisions. The negative side is that it's stressful. I don't want to sample a curiously benign scrap of tissue only to have the rest of it be malignant horror cancer. The positive side is that I feel like by the end of the year, I'll be a kickass sushi chef, and won't have to pay 2 bucks a slice for scallops.

Reading/signing out... it is difficult to describe how tired this makes you. My friends are working from 6 AM to 10 PM six days a week, and I am decidedly not. But after about hour 6 on the scope, you start to go cross eyed. You feel dumber than usual. You require the department's free pizza for brain carbs. Yeah.

I can't complain too much though. I was talking about this on the phone with my mom today. I am doing exactly what I wanted to do since I was a tween. It's fucking cool; I can't lie. I cut up a case today that I was uncertain about because it was a complete mess, and on section, it was absolute textbook of a condition that fascinates me. I hope I never stop realizing how lucky I am to be where I am, in a program that's awesome and not malignant, and just be at this whole stage of my life. I can see how people would start in this field and completely hate it; I do. If you want to "help people", as we all wrote in our personal statements, and then are counting the mitoses in a high power field, you may not feel very doctory, particularly when you're trying to pick up a history major that's 9 years younger than you, but whatever you do in medical school, if you love it? Freaking do it. Your residency will be so much better by virtue of it.

White coats obtained, time for a three day weekend

So I dunno how much of this blog is like "Shut up with your whining already" and how much is like "Shut up with you're 'my life rules' crap", so I'm just going to go with the latter because on the odd periods that I give in to complete egocentricity and reread previous entries, the whiny ones are where I want to slap myself the most. Plus, I don't feel whiny right now, because dude... I'm not sure when the other "this residency can't be this good" shoe is going drop, but it hasn't yet, and they're long past the point of needing to lie to us.

It's various stuff coming together too. I've had some nastiness in my life where it seemed like the forces of nature converged to make everything suck. Oh, you're out of money? Well, this seems like a good time for your car to break down. While you're walking to a phone booth (they had those back in my day, you damn kids)? Good time for someone to yell stuff out a window at you and then it starts raining.

This is like the reverse of that. My colleagues are awesome; I like all of them. Unless you count the discriminating finesse of the match (aka, the blind dartboard of chance), the hospital has nothing to do with that. The hospital is gorgeous. The other residents are nice. The attendings are friendly. They have parties, like, a lot. The hours aren't horrible. My insta roommates on Craigslist turned out to be great in a house I like, a situation which I really threw myself into without much of a safety net, and easily could have ended in a spectrum of awful from "meth lab" to "human skin suit". Stephen Colbert randomly shows up the day I start residency.

It's not *completely* random, granted. Homeboy is from here, and the school has a Colbert library for a reason, but I tried for two years in New York to cross him off my NYC bucket list along with the Daily Show to no avail, and boom, he shows in Charleston on July 1st.

Scored tickets to that, because, really? and then as I was sitting in the best altitude sickness seats that thirty dollars could buy, the interviewer came on stage and said "Stephen would like to welcome everyone to the lower seats" or something like that, so I ended up 5-10 rows from the stage. And he talked for two hours. And did a song and dance from Strangers with Candy. The whole time I had a complete doofus grin on my face.

Today was the full GME party (as opposed to the outgoing residents' party, the welcome to our department party, and the late fourth of July party next week) and it was held at a marina. After discovering the open bar and caterers walking around, I walked to the end of the pier to a pod of dolphins that was just chilling.

I keep expecting to wake up in some dystopian nightmare strapped to a wall explaining to a man in a metal clown mask that I was in a beautiful world where I could tie Stephen Colbert and dolphins together logically without performing questionable genetics experiments.

Awesome ones though. Note to self: satirist/dolphin hybrids. Good idea or great idea?

Farmers Market and beach, also quite nice.

But enough of that. Residency.

Like in your fourth year of medical school, once you've decided on a specialty (or have matched into a specialty), you become intolerant of anyone distracting you with stuff that's unrelated to it. This is a problem during orientation because if you're not in primary care, you are going to spend a lot of time trying to surreptitiously check facebook while being taught the software for assigning prescriptions to the outpatient clinic, a skill I will need precisely never. Similarly, orientations involve a lot of stuff that is probably important in some broader scale, but the people at whom they are directed are not going to take them seriously either, so everyone just ends up pretending to pay attention. Examples? Drug abuse and sexual harassment. Is it important not to steal drugs from the anesthesia cart while asking your patient what she's got under her gown? Certainly. Is a talk going to deter someone? Probably not.

Our sexual harassment guy was pretty cool though. Not only did he focus on the bizarre problem of hair touching (WT-holy-F), but he referenced Sexual Harassment Panda. On the first thing, despite the answer of "When is it appropriate to touch a colleague's hair?" being "NEVER", I feel like my answer "When it's dangling into a patient" should have gotten at least half credit.

But let this all be a lesson to you people out there. Do not pet the hair of people you work with. Addendum, you're freaks.

July 1st was the official start date, so we got oriented to our actual departments so that was extremely exciting. We got our laptops (my Grenada laptop made it to the end! Against all frigging odds!!! Infected by viruses with *no* battery left and unable to close, it lived long enough to see me to a departmental laptop. Rest, sweet, computer. You have earned it.). We got books and a microscope. We have an interns' pen to ourselves that has about eight cubicles that are large and have a ton of desk space, and the common area has a fridge, microwave, two coffee pots, and a water cooler just for us. It is fantastic. I did sign out with an attending and resident in the morning, which reinforced how much I need to study (Mystery tissue. Fallopian tube. Mystery tissue. Mystery tissue. Thyroid. Mystery tissue. Fallopian tube. That can't be normal. And no, dorks, not struma ovarii). Different cases.).

Afternoon, I had frozen sections but the day before a holiday weekend is not generally a heavily hit surgery day so spent part of my time learning how to click around Windows 7 at my desk, and the rest of the time haunting the gross lab to see how things are done.

Here's a thing I realized about myself that I'm trying to fix. I feel like book-smart wise, I can handle it. If I don't know how tissues look, I can study them effectively. If I don't know how to gross a spleen, I'll ask someone and learn and do it well. I can learn diseases and be good at all that.

I am absolutely *useless* at the general functional stuff. I was that medical student that wandered wide-eyed around the hospital clutching a piece of paper that had been passed off to be by someone because I had no idea where to put it, who to give it to, or who to ask. I get lost in hallways. I have no idea what the chain of command is. These are things that take me from seeming smart to seeming completely infantile, and usually, it leads to someone yanking whatever I'm holding away after I've had it for two hours, going "Oh for goodness sake!" and then putting it in a file basket that was five feet from where I started and has a sign on it with red font that says "ISHIE, PUT PAPER HERE" and a clip art image of me slamming my head against a wall.

So my New Year's resolution, since for residents, the New Year is July 1st, is to observe the day-to-day function stuff carefully and deliberately early on, so that I may be less of an idiot later. We'll see how it goes.

In other news, I continue to hate confrontation passionately, because I like fulfilling the stereotypes of my specialty. I live in a for-real house now that features a side yard that has a gate to it from the sidewalk. Today, Roommate B and I heard a lot of rummaging we mistook for the mailman that turned out to be a guy that had helpfully let himself through the gate into our side yard and was scavenging the trash because someone in our place just moved out, so he was collecting cds and perfume and such.

After several minutes of careful deliberation on how to handle someone trespassing and scattering garbage, and discounting such barbarous behavior as simply yelling "Hey jackass; get off our property" out the window, we decided that the most polite and ladylike way to handle the entire unpleasantness was to let Roommate C's Rottweiler out the back door.

In our defense, there was still another fence between the guy and the dog.

So let that be a lesson to you. Ms. Manners says, "Release the hounds."