All Grown Up

The best part about being an attending physician is being able to act like a grown up. 

I get to make my own schedule! I get to say when I need a day off or want to work more. They ask me what kind of patients I want to see, and then they schedule those patients. I have some actual control over my life. I don't really know what to do with that kind of power. 

Studies show that a lack of control over one's schedule is the leading cause of burnout for physicians and I am starting to understand why. The sheer joy I feel at being able to click a button and be off, without much in the way of having to explain myself or why I need time away, is unspeakable. After years and years AND YEARS of being told exactly when and where to be without my input or personal life considered, this is a breath of fresh air. It's a hurricane of fresh air and I love it. 

I know that I will get busier and feel much more pressured. I understand that this euphoria I am rolling around in will become mundane and that I will grumble like everyone else. So when that happens, I hope to reflect back on the freedom I feel now and remember how much I wanted to be where I am, how hard I worked to get this much control, and the sacrifices I made to have these privileges. 

But most importantly, I never want to lose sight of how incredibly lucky I am to be here. 

Adult-ing

Just recently - like, REALLY recently - I started my first attending position and started seeing patients.

Do you know what that means? Do you understand the gravity of that statement? I'm sure you do, but let me just highlight a few things.

First, I am officially, no question about it, a grown up now. I have my grown up job, I live in a grown up house, I regularly attempt to parent growing up children, and people expect me to adult on a regular basis.

Which brings me to point #2: patients are now trusting me to be their real life doctor. They ask me questions and want advice

Tomorrow

I'm being induced tomorrow.

I am to arrive at the hospital no later than 7am, at which point I will be admitted to the hospital, given an IV, and started on medicine to initiate contractions.

I have been told that all expected pain relief will be available to me as I wish, but that the contractions should be no more painful than those not caused medically. However, the contractions are often more intense and/or more frequent than natural contractions, often leading to an earlier epidural.

As a medical student, I have been a part of numerous induction procedures by a variety of methods. The one selected for (and by) me is one which has a high success rate with low complication rates. While labor is never fun, under any circumstance, there is no reason to believe that there is anything at all to be concerned about.

Which does not explain why I am completely frazzled, unreasonably anxious, and, if I'm being honest, a little terrified.

First, as has been the case lately, I have not been sleeping well, especially last night. There is so much to do. I've been orienting all week for residency, which has been fun and lovely and informative but not conducive to resting and nesting. The lack of sleep hit me hard this evening, when I was preparing Colin to spend the night with friends (so as to avoid the trauma of leaving the house at 6am) and I completely lost it saying goodbye.

I want to say it was the sleep, but I think it was more than that. Colin is two. Two little, short years, though full of love, are not enough to give him the capability to understand what is about to happen. His life is going to take a sharp left turn tomorrow, one that I do not think any amount of preparation would help keep his head from smashing into the window. I feel guilty, truly. He has led such a charmed life these last two years, receiving all the love that we could muster. It doesn't seem very nice to snatch it away.

Though I consider my sisters to be among the greatest gifts life has given me, I expect that I did not feel that way when my first sister was born. My first memory, in fact, is of preparing to go visit her in the hospital. My father helped me dress in a new navy blue velvet track suit with red piping, an outfit specially chosen to meet my new sister. We went to Wendy's before visiting the hospital, where I promptly spilled ketchup all down my front.

I distinctly remember watching the thick red ketchup drip onto my shoes and I blamed my sister. I was angry for caring at all that my outfit had been ruined, something that normally would not matter had it not meant so much to my family that I look sweet to meet my new sister. Stupid sister, who probably wouldn't even care about my navy blue track suit as she would be busy stealing my parents attention and affection.

This is entirely aside from my anxiety about being induced. I never published my birth story from Colin, largely because it was five pages long when I wrote it, but it was lovely. Though it was not a "natural" birth from a pain management standpoint, it felt organic and natural and beautiful (in retrospect). It was a lovely surprise to awake to find myself in labor and then to progress all on my own. And then to produce such a perfect, perfect little child...

Part of the problem here is that I have been praying to NOT go into labor for the last three months. I have spent an entire season worrying about going into labor and delivering entirely too early. I have been on medicine and received various medical interventions to keep me pregnant. Worrying so constantly has taken the joy out of the process and, combined with the pain of the constant contractions and the crippling joint issues, has made me look forward to Not Being Pregnant more than actually meeting my baby.

Dropping Colin off, leaving him with our good friends, I suddenly realized what was happening. THIS is happening, my life, my new child. My family is about to complete itself and I'm over here in the corner, a sopping mess of worry and sleep deprivation. I am not normally one to dwell on the details, but Patrick isn't packed yet and the car seat is in the kitchen instead of the car as well as missing the head stabilizer part. There are dishes in the sink that will be crawling with ants when we get back if I leave them there. I still can't find the power cord to the baby monitor and the swing is broken.

How did I let this happen? How is it that I am so unprepared, though I have been preparing for the birth of this child for more than three months? How could I be so short-sighted to think that having another baby was going to be an easy process?

Now that we're here, contracting away on the night before the induction, I am struck by the luck of it all. I didn't deliver early. The baby has been wonderful all along, never a problem or complaint. Colin will undoubtedly be the world's greatest big brother. Maybe life and parenthood is about learning to wing it, getting used to dealing with what comes at you, be it an army of ants in the sink or a squirming baby girl, full of life.

Here's looking at you, kids. Both of you.

Celebration and the Grumps

I know I have been pretty quiet about this pregnancy here (and everywhere). To see me in person, there is absolutely no question about what is going on up in here. I have the waddle, the awkward and constant rubbing of the belly, the weird balance, and the difficulty in moving at all. However, discussing it, even in person but especially online has been difficult for me. Partly because all I want to do is complain. Seriously. I have nothing good to say right now about anything. I am grumpy and sleep-deprived and my body hurts, all making me a very unpleasant person and not someone you really want to hang out with a lot.

But even more than my annoying habit of voicing everything that is wrong with me right now is this underlying nagging, constant fear that I currently live with. I have had issues with this pregnancy. The baby is fine, has always been fine. But my body does not want to be pregnant, and hasn’t for some time. So much so that I’ve been on medicine for the last month or so to try to stay pregnant, in spite of my body’s wishes and actions.

Though I love my doctor, my visits give me heartburn and make my blood pressure skyrocket because I am terrified of what she will say. I am scared my body is overcoming these stupid pills I take everyday and pushing the baby out against my will. Today, I saw my doctor again and she, in doing her job and keeping my and my ladybug’s health in her best interest, shot my worry to a new level by taking my concerns seriously enough to give me steroids. “Just in case the baby comes in the next few days or week.” OH MY GOD ARE YOU KIDDING ME I NEEDED YOU TO TELL ME I WAS CRAZY NOT THAT I WAS RIGHT.

I know she is just being cautious. I know I am hyper-vigilant. I know that things will, in all likelihood, be just fine. But I can’t help being scared all the time. And there is nothing that will make it better. Just time.

In other news, I graduated from medical school on Saturday. It is highly possible that the graduate in the picture below is me, but it is difficult to say for certain.

Patrick’s hair pretty much stole the show, if we’re being honest about things.

We had a party at our house that was super fun. By the end of it, Colin had turned in to a Cake Zombie and was walking around the house with dilated eyes and a chocolate goatee attempting to climb up anyone’s leg who still possessed cake.

“UP UP CAKE UP PEEEEEEES UP CAKE”

Good times. 

Graduation was lovely, albeit a little long. While most people prayed that they wouldn't trip and fall while crossing the stage, I prayed the my water wouldn't break on stage. My mother told me after the ceremony that she heard a very, very young baby cry at one point, and she panicked for a split second, thinking that a brand newly graduated doctor in my row had to deliver my baby for me. Thankfully, we all made it through intact and I can now listen to the ailments of my friends and neighbors with the confidence of a doctor and can tell them to go see a real doctor. 

Better Things

How about this? How about we skip the "I'm sorry I dropped that Ball o' News on you and then disappeared for a month" speech and just get on with things? No? Well, I understand that you're feeling toyed with and it is only appropriate to expect an apology. You're right, as usual.

That was totally mean of me to drop that big, long, heavy post on you and THEN drop that big news that I'm actually super pregnant, surprise! and expect you to then dismiss my absence for the last few weeks as flighty and endearing. I'm sorry.

Now! On to better things.

I have officially finished and passed all the required rotations and exams for medical school. I am TOTALLY GOING TO GRADUATE next month and then be a doctor! And I even have a job for afterwards! It is all very exciting and also incredibly overwhelming, especially given that we're throwing a new baby into that already ingredient-heavy mix. It has been difficult for me to even get my head around all the swirly excitement that is going on and so, instead, I spend my days tidying my house and sending emails and hosting parties for various events for school. Essentially, I am delaying taking on this massive responsibility for as long as possible. Also, I'm tired.

I was talking to a friend the other day who was saying how nervous she is about starting residency, what with all the responsibility and such. This has barely even crossed my mind in any serious fashion, as I have so much to do before then, including but not limited to birthing a child, that it is difficult to see past this afternoon much less all the way to AUGUST when I will presumably start working.

That is the way things are looking, by the way, and it simply could not look better. I was so torn about what to do in regards to announcing this pregnancy while going through the interview and match process. In the end, Patrick and I decided to keep it an absolute Eyes-Only secret in the hopes that I would match on my own merits and then apologize after I had a legally binding contract. We worried incessantly about the aftermath of withholding such information and constantly re-evaluated the decision. ("I think if I black out again tomorrow, I have to tell him so he doesn't think I'm a flake in the OR.") ("I need to tell my program something, otherwise I'll lose all of my vacation time since I haven't taken any yet this year.") But we always came to the same conclusion: there would be no way to prove that the pregnancy influenced any decision and it would be better to deal with it after the fact.

The day after I matched, I sent an apologetic but truthful email with all the details. I probably spent an hour drafting it up and I was so nauseous when I sent it that I considered my body was trying to avert a crisis by sabotaging the endeavor. However, I got a reply not twenty minutes later all but saying "Yay for you! No problem, we deal with this stuff all the time. See you soon!" And that was that.

Since then, I have heard from so many people that everyone is excited for me, no one is mad at me, and, specifically, no one questioned my choice of keeping my news to myself until after all the business had been done.

In the meantime, at home, Colin has no idea what is going on, but we've talked up his Baby Sister so much that now he claims to have a baby brother in his own belly. He points to his crib (the "baby bed" and says that his baby sister will go there, but his baby brother will sleep in his Big Boy Bed with him. When asked what we should name his Baby Sister, he has some great ideas, like "Food" and "Nap Time". Santa brought him a little baby in his stocking for Christmas, certainly with the hope that this would help introduce the concept, but now he thinks that THIS is the baby that everyone is talking about and doesn't understand why we keep saying "when the baby gets here". He runs to his room to fetch his baby doll and holds it up, as if he were the stork. Trying to discuss these things with him often makes me feel like I'm in a British comedy - the jokes don't make any sense, sometimes you can't even understand what's being said, but damn it is funny.

Patrick is simply not adjusting to the idea of having a girl. He's just not. I think the hang-up is the cars, and his thought that the only reason that he and Colin get along so well is the shared obsession. I argue both that his new daughter might also enjoy cars, so that does not entirely remove that topic of conversation forever, as well as the fact that there are other things in life that he might choose to share with a daughter, like perhaps cooking or computers or hoarding goodwill clothes or other such hobbies. People keep reassuring him that having a daughter is really no different for the first several years, during which time you can prepare yourself for the dreaded teens, but he seems rather set in his terror.

As for me... I'm actually not sure what to say. I'm thrilled to have another baby, happy in ways that I can't even begin to describe. That we're having a girl gave me joy I didn't even know was possible, like I am filling a previously unknown but inherent desire. But this pregnancy has been incredibly hard, and not only because I couldn't talk to anyone about it. My pregnancy with Colin was like butterflies and ice cream on a summer day compared with this one and I spend a lot of time in a good bit of pain. It's hard to feel grateful and excited and joyful, all things I do genuinely feel about this pregnancy, when you're in pain, and that has made these last few months difficult. On top of all that, being alone in it, unable to share what I was going through with anyone, made it a tough winter.

But now it is spring! My exams are done! No more call until after the baby is born! I matched! My baby is healthy, Colin is nothing short of a walking bundle of love (except for those tantrums - ugh TWO!), and the weather is warm and sunny again! Life is good again, and I'm happy to be able to share all of that with you.

Match Day News

Yesterday was the match. THE MATCH, the big day that I have been working towards and stressing about for the last several years. As those in medicine already know, Match Day is the biggest, most important day in medical school, certainly bigger than graduation, and yesterday didn't disappoint.

I remember from Patrick's Match Day (the first one, when he was going into general surgery) how completely overwhelming it felt, even to an outsider like me. We were sitting at a table with a bunch of friends and some were thrilled with their results, jumping up and down and screaming with joy, while others were disappointed and cried openly at our table. Patrick and I were perfectly fine with his results, but the absolute outpouring of emotion was awful. Whether happy news or not, it felt invasive to watch our friends and their significant other's intimate emotions as they dealt with this. I begged to leave as soon as possible.

A few years ago, when Patrick went through the match again for Medicine, it was completely different. We were alone in my tiny little office, clicking refresh on his email, waiting for the email to arrive. I wrote about it all the time, both here and as guest posts elsewhere, and immediately posted the results everywhere I could. I felt the need to involve my online friends because we were alone in it otherwise. When everything turned out the way we wanted, it couldn't have been more joyous.

Finally, it was my turn to go through the match. Throughout the last few months, I found it more difficult to talk about the match at all. Because of my family, I only applied to and interviewed at a few programs and then only ranked a very few programs for me to match into. It was a very real possibility that I was not going to match at all, simply because I didn't have many options. Even so, I was hopeful that things would work out. But the closer it got, the less confident I felt.

And finally it was Monday, the Yea or Nay day. I was post call, but couldn't sleep anyway, I was nauseous all morning through rounds just trying to get out of the hospital. I felt shaky and distracted and completely unfocused. And finally, it was noon, the email was probably in my inbox, but I didn't want to see, not feeling like that and without sleeping. I knew I wouldn't be able to keep it together if I hadn't matched, and I didn't need to be pitied.

But I did match! Now it was just a matter of getting through Tuesday and Wednesday and Thursday morning to find out where I was heading.

As I said, I only listed a few places. In fact, I only listed three. (Note: this is insane and not recommended.) Two were in town, meaning I wouldn't have to move, wouldn't have to leave Colin and Patrick here while I left to pursue my career. One would mean a great opportunity but would require me to pack up my clothes and books and drive away, out of the state, away from my family. Everyone going through the match has ties to someone somewhere that inform their rank list, but that did not comfort me for that long wait from Monday to Thursday.

Thursday morning my mean, mean school made us sit through two and a half hours of mandatory financial aid exit counseling. God, that was painful. Following that agony, the entire class crossed the street to to auditorium where the ceremony would be held. We met with our spouses or parents or whichever person could join us. Patrick hoped he could make it, but was coming from clinic and might not.

It started exactly at noon with five random names drawn to come up front to the stage, get their envelope, and read its contents to the audience. One of the names was my friend E, who was not yet present as she was at the bar getting whiskey to take the edge off. She came running in and, as she did, threw her glass into my hand before running onto the stage to call off her new program.

I paced and waited for Patrick to come. The atmosphere was fun and full of excitement, but it was a thin veil for the sickening feeling of a fate soon to be known, just around the corner. It seems ridiculous to say it in words, but the pressure and wait are enough to make the steadiest hand shake.

My name was called in the fourth group. I looked around frantically for Patrick before I had to go up; he had just walked in the door.

"They just called my name! Oh my god!"

"I know, I heard! Go! You'll be fine!"

I ran up to the stage and opened my envelope.

My first choice. Here. Home.

I'm not sure if I was even coherent when I read my results into the microphone, but I knew and Patrick heard me. As I made my way back to him, I couldn't keep the smile off my face and didn't care. I tackled him in a giant bear hug and we breathed a sigh of relief together.

He later reflected how intrusive he felt watching everyone's emotions, including mine, be wrung out before him and the entire audience. I, for one, am so glad that whole thing is over and that my family can stay together for the next four years. I am overwhelmed with gratitude for Patrick and Colin.

Also, for the 25 week baby girl that is growing inside me, currently kicking me in the liver, and living this stress with me. (Surprise!)

Congratulations! You have matched.

I MATCHED!

You guys! Someone actually picked me! There is a cohort of OB/GYNs that came together as a group and said, "Katie! We want her. We think she'll make a good OB and we want to be a part of her training. Put her down as a Yes."

I'm a Yes! I'm going to be a doctor (if I pass my Medicine shelf at the end of the month, which will require exactly 13 more Marathon Rounds) and then I get to be an OB/GYN resident! ME!

What is an almost-OB resident going to do with her post call afternoon, you might ask? Well, I just got out of the shower where I scrubbed off all that worry and sweat and abject terror that I've been carrying around the last few days/weeks/months. Now I am in pajamas and considering watching an episode of House, where I will undoubtedly beat them to the diagnosis because HELLO! FUTURE OB/GYN HERE!

HOLY CATS

Hey, guys. How are ya? Yeah, I'm good. Nothing new, really.

SO THE MATCH RESULTS COME IN TOMORROW AND WE FIND OUT YEA OR NAY (not where yet, that has to wait until Thursday) AND I AM A COMPLETE STRESS BALL OVER HERE.

So there's that that's new, I guess. You know, my fate hangs in the balance and I'll know in about 18 hours if I have a job in July or if I need to find a job at the Gap. Nothing big. Then, on Thursday, I'll find out if I have to move away from my beloved husband and son to go pursue my dreams and stuff. Not really a big deal.

HOLY CATS YOU GUYS. I MIGHT THROW UP.

Sorry I haven't talked about this much here. I've been writing about it over on Medscape, which seems like a really horrible idea now since I just want to hide in a cave until this whole thing is over and, for sure, NOT TALK ABOUT IT. Alas, I signed a contract.

I hope you are all having a lovely Sunday. Please think fondly of me in my crazy.

Conference Battle

I have spent the last week at my very first national conference, my first “business trip”. From a professional standpoint, it was an honor to be invited to participate and attend. I presented research that I did over the summer in the form of a poster, which was displayed in one of five poster sessions in a large conference room with approximately 50 others. I stood in front of my poster, dressed in heels and a conservative sweater, wearing my best I’m Smart But Please Don’t Ask Me Questions smile, while conference-goers milled by and occasionally stopped to read what I’d brought. The experience was singularly odd, in that I felt overly pressured and stressed by the questions while feeling completely slighted by those who passed me without comment.

I presented details and results of a new obstetrical procedure that the attending I worked with in June was investigating. I had scrubbed in on a few of the cases, but by no means knew the intricacies of the procedure or the details about the training required to perform such a feat. This made me an odd choice to be the one to stand in front of the poster to field questions. But, I wrote up the series of cases and I created most of the poster (with a lot of help) and so I was the representative.

Before the session started, I sat in the lobby going over my numbers and justifications and had a good chunk of time to spend fretting. I watched people from the conference leave the hotel in search of coffee or sightseeing and I was secretly glad that their departure would lower the number of potential stumpers I would get in my session. I hung my poster three hours early and returned to it three times to make sure it was still there and in the right spot. I spent the first fifteen minutes of the session hiding. I wasn’t far away, just beyond the radius that one might assume a person was representing the poster in question. I watched people’s reactions to the poster and overheard their comments. Some people thought it was innovative, others thought it was ludicrous and wasteful. Some uttered questions to their friends about my project, some of which I knew the answers to, but I was afraid to jump in for fear that my answers would lead to deeper, more complex questions, which then I couldn’t answer. I was paralyzed and feeling incredibly insecure.

But then I remembered that I can talk to anyone about anything - it’s kind of what I do – and this was something that I actually knew something about and had worked hard to get presented here. It occurred to me that this session was no different than an attending pimping students on the ward; mostly people wanting to talk about their own experiences, not really ask questions about what I was presenting. I found that the legitimate questions that did surface were mostly ones that I could answer, confidently even. People could then decide if they liked the idea or not, but their decision had nothing to do with me or my presentation (to say nothing of my knowledge or self-worth). By the end of the session, people were complimenting me on my command of the material and congratulating me on presenting a poster as a medical student at a national subspecialist convention.

Final Tally:

Katie!   1       Self-Doubt Demons   0.5  (I was HIDING. Shameful.)

News for You

I don't know if this will be a shock to you or not. It was - and still is - for me. I am not sure why it all seems so unbelievable to me, but here I am, unbelieving. 

About a month ago, I was contacted by a lovely woman at Medscape, which is the medical professional sister of WebMD and eMedicine. She asked me to contribute to Medscape. As in, write things that would then be published on their website. Write things that would represent that well-respected name and also they would link back here, to my home base. 


I can't really express how excited I am about this. I've only told a few friends, and when I did, I tried to play it cool. I'm not very good at playing it cool, which I normally view to be a personal strength (hence the exclamation point after my name here), but in this case was difficult. I wanted to play it off as No Biggie, just another thing to do, blah blah. But I really couldn't. MEDSCAPE! I look stuff up there! I went there for advice studying and for where to go to med school and for how to survive! Now people might go to my little corner of medscape and read what I have to say and be inspired by it! Granted, that is clearly best case scenario, but still, it could happen. 


The topic of my new home away from home is, as you might guess, The Match. I guess I talk about it kind of a lot already, so they figured they were getting someone who's had some practice at this. Regardless, I posted my and the blog's first post tonight. Here's an excerpt for you:

Truthfully, I hate wearing white coats, but there is nothing more that I want than to be a part of the Long White Coat Club. That coat denotes an important difference between the student/learner/observer/me and the real doctor/them. The difference is not just in graduating and earning a degree in medicine, but it is a public acceptance into the professional medical community. This is a future physician’s biggest and most career-defining moment, a culmination of everything accomplished or failed to achieve to date. This is the time where emotionally powerful music should be playing in the background at all times to emphasize the gravity of the situation.

If you're like me (and I kind of hope you aren't) you may be wondering: So you're going to be talking about the match as you go through the match. Huh. So what happens if you don't match? 


First off, are we even friends? That is not the kind of attitude that I need right now. Second, OMG I KNOW. I have no idea. Hopefully we won't have to deal with that (OMG) but if we do, I guess that will make for a very... informative post.


Don't worry, friends. Most of my neurotic ramblings will still be here and any news I have will be reported both places. Don't feel like you have to go there. But it would be cool if you did!

(P.S. I fixed the link up there. Sorry! This internet thingy is hard sometimes.)

Second Best

I started a new rotation with the new month and new year and, I really hate to say this, but I’m already kind of done with it. It’s an elective rotation in infectious disease, which I picked because I never feel comfortable with antibiotics so I thought immersing myself in them for a month might force me to deal with that. I expected to see patients who had some sort of infection, maybe one or two a day, have plenty of time to read up and figure out what was going on and what to do about it, and be home in time for an afternoon walk with the pups. Honest in intention and pure of heart, that’s me.

Unfortunately, there are a few problems with my plan.

First, there are the patients. I guess that most people already know what to do with the normal infections, the ones I wanted to learn about like pneumonia, and so they only call the infectious disease team when there is something really crazy going down. Also, there are a metric ton of these kinds of patients, which means that not only do I not know the first thing about what is going on or what to do, but I don’t have time to figure it out because there are three more people that still need to be seen and (not) figured out before rounds in twenty minutes. We’re there all day and all evening trying to get things going for these people who have mystery fevers, bizarre little bugs growing from their blood, and symptoms that don’t go away when we tell them to. There go all my goals.

Second, things that I thought were incredibly bizarre and crazy are really just shunted to the specialty teams. My very first patient was one with HIV and disseminated histoplasmosis. Holy cats! I didn’t think that even happened anymore since, like, ever or something. Wow, this is a case of a lifetime! Except that the girl I am with on the service has a patient who also has HIV and disseminated histo, and then, two days later, we were consulted on a newly diagnosed HIV patient who was found to have – you guessed it – disseminated histo. Throw that “rare” thing out the window.

And third, and this is much more petty, but the other student that I’m with this month is going into internal medicine, and might in fact specialize in infectious disease. As in, for her career. She loves this stuff and is excited every minute we are at work. She goes home excited to read about her patients and comes in the next day saying things like, "I was thinking about this last night and I came up with a new idea." Me? Little ol’ me over here? I’m just an OB hopeful who’d like to know how to treat urinary tract infections and the occasional pneumonia. If I ever get any of these patients, know what I'll do? I'll call the infectious disease doctors. What I’m saying is that I am WAY out of my league and it shows. I'm just here to learn, but it's like I skipped the 101 class and went straight to grad level.

If I’m being honest, I think that is what I dislike the most about this rotation. It is certainly not the patients, and it isn’t the work. It isn’t even the hours, though I would be happy with fewer of them. It’s that I’m not the best, not by a long shot.

Let’s be clear. I have never been the top score on any exam, maybe ever. (With the notable exception of my first organic chemistry quiz – top score. It was a total fluke that has never been repeated.) But I usually do very well when it comes to clinical interactions with both patients and other medical people because I like to talk to the patients, which makes it easy to get all the information. I pride myself on getting a complete history and being able to answer the most obscure of questions about a patient and their medical background. I like talking to other medical personnel, so it makes rounds fun, a social and entertaining time, instead of the dull time-suck that many perceive rounds to be.

Something is just not clicking on this one, though. The other girl is rocking it out, nailing recommendations and making herself invaluable to the patient’s care, just like you are supposed to. I just can’t seem to get it together. Instead, I feel like I’m floundering through my presentations, in the dark about important things, and like a total jerk. Worst of all, I don’t know how to fix it.

I know part of it is motivation. She’s excited by these problems where I am intimidated. She has experience with these drugs and infections, where I am clueless. It’s an inherent difference, and I need to deal with that.

But the rest of it is totally fixable. I need to find time to read more, be faster with my interactions with patients so I have more time to look up their problems and medications. I need to think like a medicine doctor and, as the popular medical saying goes, broaden my differential. I can totally make these things happen. I just need to find the motivation to do it.

And that motivation needs to be something other than petty competitiveness.  

Treading Water

I haven't been writing much the last few months, and I apologize.

For one, I have been busy. The normal school related things that keep me hopping have been subject to the ever changing and complicated madness that is interview season for fourth year med students. That is part of why I haven't been in touch - no time.

The other part, as you might guess, is that I'm nervous to talk about these things online. I've never had to keep anything private online before, and I actually really hate it, but I am worried about writing things online that programs will see that will then affect how I am ranked. This, in itself, is a reflection of how much I want to be an OB/GYN when I grow up, as I am not one to bow in fear to an unknown. But look at me now, as I dance around the topic of where I've been, what I liked, and how I plan to rank my options.

To catch up those of you who are not medically-employed, fourth year medical students apply to residency training programs in the fall, then are (hopefully) invited for interviews over the winter months. The students rank the programs in the order that they want to go to them and submit that list to a computer system. The programs do the same for their applicants. Then, mid-March, the computer algorithm does some magic voodoo and spits out each applicant's "Match". I like to take the technology out of it, and imagine Fate typing up everyone's future and sealing the envelopes with one of those water sealers from the post office. Regardless, it is a crazy way of trying to "match" up a zillion applicants and a zillion spots. This whole program is called "The Match".

I have written about it before, both here and other places, but have never gone through it myself. The whole thing has me terrified, but since I've been worrying about this for so long now - going on three years - it is mostly subconscious. It is manifested in snapping at Patrick or disappearing into a stupid TV show or, mysteriously, completely forgetting to pay all of the bills last month. (Oops.) The stress of the matter has made me both lose sleep and oversleep, has made me eat too much and lose my appetite. It is crazy, how this process has worked its way into my psyche and makes every tiny, insignificant things seem directly related to my future job, earning potential, and then, as a natural extension, my ability as a wife and mother.

For now, there is not much to do but wait. Wait to hear from programs that have me on their waiting list, wait for spring to come, wait for Match Day, wait for my life to sort itself out, wait to be able to breathe without choking again. People say that the last year of medical school is a cake walk. I think it has to be. I can barely get through the mornings without being sick with the pressure of it all. I shudder to think what would happen if I had to actually learn something right now.

Recover

While I hate being away from this space for so long, I’m glad that I didn’t write more in November. It was a completely terrible month, spent in an absolute unmoving funk and, while you are such a supportive bunch, you do not need to be subjected to my foul, foul mood for that duration. That is what Patrick is here for. (Ha! I kid!) (Actually not.)

But Yay! Now it is December! Not only is Christmas drawing nigh, but I am back amongst my people in the world of OB/GYN and if I wasn’t convinced before that that is where I belong, I am on the Believer Train now. I love these people. I love the patients and the work, too. But when I walked into Grand Rounds the other day and was surrounded by the residents, I felt like I had come home. Though many of those particular people are still strangers, they feel like future friends. These are the kind of people that I want to be around all the time. I can’t wait until July. (Well, March 17th, Match Day. Then July.)

In other happy, not-grumpy news, Colin has grown up enough to finally provide me Funny Things My Kid Said stories! Can I share a few? Just a few, I promise.

1. He is learning to throw, and getting better at aiming. However, he throws on four. One… Two… Three… FOUR!

2. Identifying colors continues to be a challenge (I swear it is because he just isn’t paying attention) but he knows the names of all the colors. We sing various songs to him constantly with made up lyrics involving his name, and my current favorite is “I love my Colin/Oh, yes I do!/I love you so much/you know it’s true./When you’re not near me/I’m blue./Oh, Colin, I love you!” I know, I know, could you just die from the cuteness? Anyway, he came up with what I think is his very first joke: when he sings along with us, he changes the color, “When you’re not near me/I’m PURPLE!” and proceeds to absolutely die laughing.

3. This isn’t a specific story, but just a moment in awe of the language explosion. It is seemingly neverending. He now says, “Come on, Mommy!” and “What are you doing, Mommy?” (in this really condescending tone that never fails to make me cackle) and “I did it!”, among a thousand other new, expressive things that connect him to the world.

I hope you all had a lovely holiday, if you in fact had a holiday, and are looking forward to December excitement. Peace to you all.

Empty

That last post, where I wrote about being totally rejuvenated at the mere sight of Colin, was a description of a momentary breather in what has otherwise been an atrocious month. Tomorrow is Thanksgiving: know what I’m thankful for? That Emergency Medicine is almost over.

This specialty once held some allure for me. I liked the shift work aspect, of course. I liked the possibility of trauma and high stakes situations where my training would matter if someone lived or died. I liked the idea of being the one to diagnose people, and get them to the right specialist.

So far, I haven’t seen any of that in the ER. Instead, I am asked to stay late, hours after my shift. I haven’t seen any trauma, but see 14 patients per shift who almost all go home with no medicines and instructions to follow up with a primary care doctor. I haven’t diagnosed anyone, but I have done countless expensive and useless workups to rule out catastrophic things that might be causing someone’s chronic belly pain that they randomly decided to get checked out at 2am on a Wednesday because they weren’t doing anything else.

While this post is not a treatise on health care or the reform that is so necessary, I will simply say that no where is our health care so clearly seen for the broken, dying thing that it is than in the Emergency Department. Always open, turning no one away, it is a physical embodiment of the scapegoat and the fool. Physicians dump their patients there on Friday afternoons or while they are busy in clinic. Patients come seeking “second opinions” and then require an unnecessary repeat of their entire workup. People come looking for drugs, food, shelter. Instead of seeing people who are emergently sick, we see people who walk in off the street with questions, needs for refills, longstanding illnesses that they are simply tired of tolerating. The resources we waste in the ER is absolutely staggering.

I’m not sure exactly when I lost my zeal, but it was around the middle of the month. The schedule itself is grueling, never working the same shift twice, constantly switching from days to nights, never knowing when you’ll sleep, eat, or see your family. I was excited at first, as everyone always is at the beginning of a rotation. I looked forward to being the very first physician-like person to see the patient, to suggest and start the workup of the problem, to diagnose the patient and treat the disease. How satisfying!

After I didn’t see Colin for several days in a row because of my schedule, my enthusiasm waned. While the patients relentlessly rolled in, I watched the clock and counted the hours until I could go home. I was constantly hungry, tired, and missing Colin. I hoped that picking up OB/GYN patients would make things better, as I love those patients and those problems are ones I’m likely to keep dealing with (better to learn now!). But after the tenth first trimester miscarriage, I stopped fighting for those patients. As much as I wanted the patients to have good care, especially during such a potentially devastating time, I needed a break. I didn’t get one, instead starting a run of patients who’d attempted suicide. After a handful of that presentation, my emotional reserve was completely depleted. Sad situations, difficult patient issues, or urgently sick, I had no empathy. I had none left. There is only so much sadness I can feel before shutting down. The last time a patient came in with one of these devastating issues, my first thought was, “Damn, I’m going to be here forever, and I’m starving.”

Regardless of why the patient is there, be it something truly emergent or just for pain medicine, they deserve my attention and my compassion. I think that is the least of what I owe them, actually, but is a bare minimum. What does it mean that I could not even do that? I heard what they said, ordered them pain medicine or scans or fluids or whatever they needed, but I couldn’t care about their plight. I desperately needed to refill my compassion tank, but there is no time. No wonder ER doctors work shifts only 16 days of the month. Who could stand any more than that? I certainly cannot and I am counting the moments until my time is up and I can walk out of the ER for good.

Lessons

In a way, I’m glad I haven’t fallen in love with Emergency Medicine because it would be a downright shame to get confused in the Future Me game this far in. It is nice also that I don’t hate it 100%, since I was quickly tagged as the Future OB and thus get all reproductive aged women with belly pain. Thus, I have practiced the pelvic exam and rehearsed my counseling for nearly every single OB/GYN complaint.

The benign: Bleeding. Not bleeding. Pain. Problems having sex.

The emotionally charged: You’re pregnant. You’re not pregnant. Sexual assault. STD.

The devastating: Miscarriage. Cancer.

It has been a difficult few weeks, made harder by my schedule. Working the late evening shift kept me from being present in the morning or evening, meaning I went several days without seeing Colin awake and only talking to Patrick on the phone when I could steal a minute in a bathroom.

Without them, I found it incredibly difficult to motivate myself. I am a naturally energetic, happy person and I gain energy from interacting with people – the very definition of an extrovert. While I am normally happy to go to work and pleased to meet new people, I found that I could not force myself to be interested in complaints that I deemed unworthy. All I could think that this person’s selfish refusal to take care of themselves and/or see (get) a primary care doctor was the reason I was away from my family. (Obviously this is totally untrue. I would be there anyway, even if not a single patient showed up all night. But that logic was ineffective on my attitude.)

So I got to practice another type of counseling. Self pep talks.

This is not about them. This is about you. You want to be here, because this is a step closer to who you are becoming. Patrick and Colin love you, even if you’re not home right now, so you need to focus on being present for this patient. It is not their fault that you are tired and haven’t eaten and haven’t seen your family. They think they need to be here, so give them what they deserve.

Repeat, ad nauseum.

Finally, Friday, I caught a break. Our schedules lined up so that I could keep Colin home from school and Patrick would be home before I went to work. I can’t say it was the most meaningful morning that Colin and I have ever spent together – it mostly consisted of playing cars and watching Bob the Builder – but that night, after spending the morning with Colin and a few hours in the afternoon with Patrick, I was a different person. Suddenly, I felt full of compassion for the patients. Even the most horrific abuse of the emergency department system was met with warmth and smiles from me, because my soul was full again.

Burn out is not to be taken lightly, and working odd shifts which keep people from their families is an express train to Meltdown Town. Just a few hours with my beloved boys all but fixed my emotional ailment. (Imagine what a weekend would do!)

I subscribe to the notion that we are always learning through our experiences, the bad ones usually more full of lessons than the good. This month has so far been full of dozens of patients, each with an important point for me to see and a story for me to understand, but the most important story has been my own. Learning to live without my family is not feasible, but easing the time away from them is accomplished by cherishing the time we’re together.

What a month to learn this lesson of gratitude and thankfulness.

Lap of Luxury

Just to avoid any unnecessary suspense, we bought a car.

This one:

[Ed: This is not actually my car, but a googled image of a similar one. My car is already dirty and full of Matchbox cars and Nutrigrain bar wrappers.]

It is a Lexus hybrid SUV, an older one with a zillion miles. I whittled my list down to two: the Lexus or a previous generation Subaru Outback. My pro and con list shaped up as follows:

Lexus:

Pros: Grrrreat mileage, tons of space, safe, fun to drive, lots of gadgets and perks

Cons: Eeew Lexus yuck

Outback:

Pros: Yay Subaru! Eco friendly company that is sort of local and values the marriage of design and living with the planet’s interests in mind, nice to look at vehicle

Cons: Horrendously boring to drive, terrible mileage by comparison, subpar visibility, “tin can” feeling

In the end, I went against the brand and chose based on needs. Even though I felt that I fit better with the Subaru brand, I just couldn’t justify the mileage for a car that was such a snooze to drive and didn’t even feel that safe. As much as I believe in design and matching your values to the companies to whom you give your money, in this case, the values that were portrayed in the “branding” of Subaru just didn’t come across as much as in the Lexus.

I have always wanted a hybrid car, ever since they came out with the teeny, goofy little Insight. It means a lot to me to invest in technology that I believe in (though Patrick is quick to point out that no one cares if I’m “investing” in a very used model) so this ranked high on my list. Also, the space in the back seat is quite impressive. We’ve been driving around The Best Toddler Nephew Ever the last few days as the Baby Mama makes her final prep to be a Mom o’ Two, and the two kids can’t even touch each other or the seats in front of them. Take it from me, this is SO GOOD.

And so I find myself in this awkward Lap of Luxury, tooling around town in a top-of-the-line (90,000 miles ago) car. Though I am greatly enjoying it so far, I still explain myself away anytime I am asked about it. I don’t regret the decision, but I wonder how I will park in the Health Department and County Hospital parking lots to go in to work, or how to go to Health Fairs and talk to people who have not eaten today and probably won’t. Do I tell them about the hybrid engine, saving the earth, and the great big back seat that can hold three car seats? Do offer the backseat to them to stay a night or two if they need? Or do I bite my lip and hope that no one pays that much attention to me and what I drive?

I hate the Lexus branding. The dealership is a vortex of Gross, and I think I met the Boss of Yuck when test driving a car at The Dealer. The commercials reek of consumerism and overspending, not to mention celebrating being a spoiled, entitled brat.

But, branding isn’t everything. Patrick, as I have mentioned, will never drive anything but a luxury car. He thinks that he deserves it. The difference in him, however, is that he thinks that everyone else deserves it too. Why wouldn’t you drive a luxury car? If you can’t afford a new one, get an old one. They’re still better than a new Tin-Can-of-a-Car. He loves the history of the European luxury brands, but even he is influenced by branding. However, instead of being suckered in to the Newer is Better, he secretly thinks that the young hot shots who drive the new models are Jerk Faces who don’t – or can’t – appreciate what they have. Don’t tell him I told you.

It can be hard to convince others that you don’t necessarily go into the same box that the car does. I make an effort to include everyone, to reach out to those who populate the edges, to care for my world for all of us. If it were up to me, all the car companies would be required to have Zero Landfill Factories, just like Subaru. I think that we are all each other’s responsibility, the earth included. Let’s all hold hands, do some yoga, and hug afterwards, shall we?

I don’t really think that I am the target audience of Lexus. But their product won me over their branding. Go figure.

Countdown

Study days until Step 2 CK: 4

Projects for school due before then: 1

Other tests before Step 2: just finished Radiology midterm

Percent of USMLE question bank left: 22

Strategy: keep taking happy pill, try to get some decent sleep, finish question bank, review notes, remain calm.

Bottom line: take care of my brain so it treats me right on Wednesday.

Rays

In all honesty, radiologists are really pretty cool. They usually have some interesting hobbies or cute, overprotected kids. They’re pale, sure, but are not blinded by the sun when they see it, nor have they forgotten what it looks like. They are funny and like to listen to music while they work. Looking at images is exciting to them, and gratifying. They are able to see what the clinicians can’t, look beyond the pain and words and sweat and grimaces to focus in on the causes. The pictures show them the answers and they see it first.

And they breathe a sigh of relief that they are not the ones who have to call the patient.

This is where I leave them. This disconnect between diagnosis and patient, between disease and person, is not why I went to medical school. I do not pursue this business to be safe or protected from the bad things in the world, nor do I want to shield myself so completely behind a wall of professionalism and order that I no longer recognize a human being in pain. I want to be the one to deliver that news, because I might be able to make it a slightly less awful moment that it might have been.

I went to a conference for the radiologists where images were shown on screen in relatively rapid succession and the attendants had to interpret the image, one after another down the row. It was a radiology version of Show and Tell, as the images were some of the biggest and baddest things they had seen and collected. It is certainly interesting, and requires an incredible breadth of knowledge to be able to recall the anatomy of the entire body as well as the specific disease processes and terminology of all the specialties. And I saw how quickly the patient aspect falls away when the images go by so quickly.

Normal chest x-ray, next.

Normal abdomen-pelvis CT, next.

Normal, next.

Normal, next.

Normal, next.

Then, lymph nodes look big. There is some swelling. Looks like some invasion around that structure. No blood flow here. Architecture is distorted. Hm. Interesting. Highlight of the day! It’s cancer!

The images went by and the budding physicians trained their eye on the abnormalities. Spinal fracture. Testicular torsion. Ruptured appendix. Cardiac anomaly.

Then, "Ooh! Here's a good one..."

I was in the back with my friend, another OB hopeful. Our eyes widened with excitement when we saw it, something rare, a treat for us: a CT of the abdomen and pelvis of a very pregnant woman. We looked at the fetal skeletal outline, clear as day, encased in the belly of the patient. Unusual because radiating a baby is bad form, but indicated in an unrelated emergency.

They had been in a car accident, said the staff doctor, who sees the problem here?

Both of us saw it before the radiologists. We knew what to look for, recognized it immediately. Abruption. The placenta, the lifeline for the baby, was coming away from the uterus because of the force of the accident. A true, terrifying emergency.

The radiologist on the “hot seat” for this case slowly saw the problem. “Is that blood behind the placenta? Separated a little from the uterine wall?”

“Bingo! This is a devasularized placenta, meaning there is no longer any blood flow. This baby is dead, we never saw a heart beat, died before this scan. Great job! Moving on the next case… what do you see here?”

I saw nothing after that, nothing but that dead baby on the screen. Felt nothing but my mouth drying up from hanging open and my stomach moaning from the extra acid. I heard my friend try to breathe, but fail.

This is why I will stay up all night and all day and the next night, come in on my days off, skip meals, miss family get togethers. I will do this so that a woman who had a living baby just this morning, but now has to deliver a dead one, will have someone to hold their hand, cry with them, and acknowledge the moment. This may not be the reason I went to medical school, but it is the reason I want to be a doctor.

Rejected

Personal Statement Topics that have Gone By The Wayside:

Rejected Topic #1: My own birth story (July in a teaching hospital)
Reason it Sucked: Saying “I was probably some new OB intern’s first delivery and I turned out okay!” just didn’t do it for me. Also, hard to work in a discussion of my strengths when my initial point was that I was lucky to make it out alive.

Rejected Topic #2: Former musician, now doc-to-be
Reason it Sucked: I’ll sing the best “Happy Birthday” rendition to your new baby that you’ve ever heard! Also, I used to dress up beautifully and sing songs for people, now I shower less frequently than I should, don’t wear makeup, gave up on contacts, and wear scrubs because I get blood and bodily fluids on myself all the time. Pick me!

Rejected Topic #3: I rocked out my own pregnancy and delivery
Reason it Sucked: I’m probably not the only one to have ever had a baby on the planet before, so it doesn’t need to be my reason for being and the impetus behind every single bloody choice I make. Get over yourself and your adorable, perfect kid already and quit rubbing in how cute he is.

Possibly Rejected Topic #4: Women are awesome
Reason it is currently sucking, although not enough yet to totally reject: Waaaaay melodramatic, feel like I need to mention kid to assert my heterosexuality, no way to talk about me because I’m too busy talking about how women are sooooo cooooool.

Future Rejected Topic #5: TBA

Postpone

I’ve been on vacation this month, this hot, humid, terrible month of August. The vacation was supposed to give me plenty of uninterrupted time to study and do really well on my Step 2 exam (otherwise known as THE BOARDS: REVISITED). As does usually happen when I have a single task to accomplish, other stuff comes up.

It’s not that I didn’t study, believe me I have studied, it’s that Colin kept getting sick and I was already home, so of course he stayed with me. And that Patrick was super-duper busy last month and was gone for 12 or 14 hours a day on the days that he even came home, meaning I had sole house/bills/food/pets/kid responsibility. Even though I made myself a schedule and tried to accomplish everything else while sticking to that damn schedule, I kept falling off track.

And OBVIOUSLY it isn't Patrick or Colin or anyone else's fault that I feel so under-prepared. Life happens (though I feel like it happens kind of a lot, you know?) and you just have to do what you can to get by. Am I right? Am I?

I don’t know why I feel so defensive about this. It’s a little weird, actually.

All this is to say that I postponed my exam. I moved it back a few weeks so I feel better prepared when I take it. I was supposed to sit for the exam on Thursday, but over the weekend and especially this morning it became abundantly clear that doing so would be a horrible idea. I’m on Radiology next month and it’s notoriously light and laid back. And so, since my date was so close, I shelled out the cash and moved the date.

I feel a little better now that that’s done. I had a minute to sit and tell this to you. I still have a clanging headache and my hate for all things Law School Library (where I’ve been studying) rages on, but that tightness in my chest eased up a little. I wrote my family to tell them that I would been AWOL for a few more weeks, but hopefully be slightly less insane and said that though I felt like a spineless coward by delaying the inevitable, hopefully they could address me as Dr. Coward in a few months. (Not that I'll make them call me by that, of course.)

On my newly revised to-do list includes finishing (erm, starting and finishing) my personal statement, sleeping for more than 5 hours at night, eating more than granola bars and coffee, and going outside. Also, study my ears off and rock that exam.

I have high hopes for September.