this is a non-smoking zone.

During discussion of a student’s case presentation

Skeptical Attending: Why did you automatically jump to the conclusion that this patient’s stroke was drug-related??

Me: Because uhhh her boyfriend brought her to the hospital then LEFT HER THERE TO DIE!

Whoa, feelings (AKA gratuitous brain unloading, tl;dr, etc.)

I recently made a preliminary decision* to go ahead with pursuing a general surgery residency spot. Why? Because after a few weeks on Internal Medicine (clinic visits, med dose changes, TALKING a lot), I knew that I would never be happy with a career outside of the operating room and would hate myself for spending so much time/money/energy to end up not doing what I enjoy most. Now, why is this decision stupid?

• My Step 1 score and basic sciences grades lie below those of the average general surgery applicant pool (not as unreachable as say, dermatology, but still relatively competitive). I work extremely hard and am recognized for it by attendings during rotations, but once again my worth/intelligence/capabilities is defined by how well I perform on multiple choice exams! Luckily emphasis is placed more on clinical performance (which I enjoy more, thus make better grades in), so with some confidence and more hard work I think I’ll make it across these damn hoops.
• Of all residencies to choose from, I pick the one most notorious for the workload. If that’s not self-destruction, I don’t know what is! I already give 110% to school (I mean, DUH, this is all I write about!) with inadequate results, so at this point, it seems like I’m just figuratively asking to get raped and tortured…figuratively.
• Personalities can be malignant in this field. I mean, although they’re no where near TV show malignant (actually, just forget EVERYTHING you see about it on TV), people tend to be more assertive, which often gets confused with tougher/meaner. And if you’ve met me or HEARD me, I don’t strike anyone as tough. But assertive, YES! I might need a stool or two in the OR (the kind you step on, not the poop kind lolz), but I can get the job done. Convincing other people to look past my appearance will be the hardest part since I plan on using my small hands to be the best hand-assisted laparoscopic surgeon ever (to make up for their likely inability to detect a rectal cancer)! Plus I know a few surgeons who are way nicer than me, and I’m pretty nice when I’m not hungry, sleepy, or hot.
• This is a selfish decision. 5-7 more years of training means at least a few more years of not making big-eared babies for Tommy, not making any money to support my parents, and overall not being there for anyone but myself (um, and all the patients I ultimately help, right?). And the funny part is they have all been extremely supportive of this decision. Partly because they know it makes me happy, and partly because they don’t realize how long I’ll be broke.
• I’ll be broke forever. Seriously. Tommy calculated that our net earnings (after loans and shitty pay during residency) will be THE SAME 30 years post-high school, except my total working hours will likely almost double his. Moral of the story? Love something else! Or not love what you do. I respect either. In fact, I’d prefer it if my happiness was independent of work/school. But I bust my butt with no end in sight because I believe one day I’ll have BOTH. Greedy, delusional, or all of the above? 
• I initially envisioned myself playing more of a primary, preventative role because I was and still am passionate about access to healthcare and preventative medicine, but the immediate satisfaction of surgical therapy coupled with getting to cop a feel on internal organs excites the hell out of me. Fortunately, I met a couple of surgeons who feel the same way and will mentor me into being involved in other aspects of preventative service. 

Regardless, after thinking long and hard since the first day I stepped into the OR, I met with the residency program director from my school. Letting him know I actually existed was my form of personal commitment to this goal. It’s been pretty exhausting/terrifying/exciting planning what I’ll have to do next in order to get where I need to be (the faculty at my school like to say shit like “only 14 more months until you know what the rest of your life will be like!”). Of course by listing some reasons why this is a stupid idea, it sounds like a pretty stupid idea and very well could be. But it feels so right and I’ve never been this happy before, so this matters more to me (OBVIOUSLY).

*I call this a “preliminary decision” because I still have to do my OB/GYN rotation, but somehow I feel like my disinterest in the vagina won’t be reversed after seeing them daily for 6 weeks. 

Started to read a classmate’s blog posted on their facebook

After judging them on some things they wrote, I decided to work on covering up my identity (no photos of myself, no association with my institution). That way, I can write whatever I want without consequences of incidental blog traffic. Fun stuff!

Note: My plan is to try to limit the amount of old posts I read (and keep to laugh at later) so that I don’t get hyperthermia from too much cringing.

random updates on (surprise!) school

• I start my general surgery rotation on Monday.
• Just finished my surgical subspecialty elective, which was inconveniently scheduled BEFORE general surgery, but I had an amazing experience regardless.
• In an unexpected twist, surgery is at the top of my list (as of now, since it seems as though I like everything so far). Remember when I kept saying that I definitely don’t want to be a surgeon? I’ve actually been trying to convince myself that I didn’t like surgery because I dread the 5 additional intense years of training (plus possible 2 years of fellowship) and further putting MY LIFE on the back-burner, but every day for the past 3 weeks has brought me more joy than I’ve ever had in all my years of med school. I’m holding my breath that I’ll like something more compatible with my life outside of medicine.
• Of course, maybe I had such a great time because my elective rotation was more laid back, but being so excited about something means a lot of me. I’m sure general surgery will be exhausting, but I still look forward to it.
• How exciting is it? I get to do jack squat as a student, besides from holding a retractor, suctioning, and the few skin closures. But if that’s exciting, imagine how exciting removing a lung would be! Don’t even get me started on the adrenaline rush that comes with the aorta squirting blood at you with every heart beat…
• During my previous family medicine rotation, my preceptor told me I lacked confidence on initial impression, which led her to think I was less competent than I really was. Eventually she realized I wasn’t an idiot and gave me a great evaluation, but she encouraged me to project more confidence AND be less “cute” since I already lack the natural stature and prominent voice for others to take me seriously. I went home and cried that day, but god, was that slap in the face SO worth it!
• Faking confidence seems to be helping. In fact, my resident commented on how “surprisingly confident” I was. Good, I guess. Wish it was real confidence. I still feel completely inadequate, not to mention how transparent it probably is.
• Speaking of lying, a few helpful attendings mentioned that I should tell every other attending I work with in the future that I want to do what THEY do. For example, I should have told the vascular surgeon that I want to be a VASCULAR SURGEON when I grow up. Again, how do I do that without feeling completely transparent??

My dad always told me he wanted to die when he turned 40 because he didn’t want to live as an old man. I’m pretty sure he also predicted that his lifestyle choices would make him age ungracefully. But now he’s almost a whole decade older than his estimated time of departure, and he’s still alive, making the same ole shitty choices as he did before. Deteriorating? Yes, but slower than he thought. So slowly that you don’t even realize it until you notice the deep-set wrinkles and the protruding belly that used to be a quite coveted six-pack when he was in his 30s (seriously, I always wondered why I didn’t “inherit” his six-pack). But since the pains of aging come so stealthily, maybe it’s hard to convince yourself you’re too old to do the things you used to do. For example, I still dance around like an idiot, watch trashy TV, and cry when I don’t get what I want, all the while struggling to convince my attendings, colleagues, and patients I am a 25-year old woman capable of being a trusted professional. Or Tommy the engineer at a big dog company playing computer games and maintaining his high school haircut .  We just age too slowly to accept it! Can I even blame my dad for not realizing he is just too old to keep making babies? Or be irritated at Tommy for being reluctant to acquire more “adult” hobbies? Maybe I’ll try my best to not get frustrated at people I love for being totally immature.

Me on my pediatric clerkship:

• First day:  Wow, not too bad.
• A few days later:  Yea, I like peds.
• A few days later:  I could totally be a pediatrician.
• A few days later:  Wait, I wanna be a pediatric rheumatologist.
• A few days later:  Ok seriously, I’m gunna be a pediatric nephrologist.
• A few days later:  Pediatric urology. Interesting…Wait, what? Ew. Hellz no!
• Today: I’m going to run a pediatric ER one day.

I’m loving my first rotation. Although to be honest, I probably should have stayed in New Orleans for this one since the program I am rotating in is currently undergoing some major changes due to political figures (one’s name rhymes with Slobby Lindal) closing down the pediatric ward at the school’s hospital. It’s a huge mess. But the teachers are amazing, and they make me feel like I could actually be a decent doctor one day. Despite early long days (including some weekends) in the clinic/wards, I am happier than I ever was since starting school. Hopefully all of the other rotations will be just as satisfying. But just to be real here, they probably won’t be, and it’s ok because I know I enjoy SOMETHING (which was my biggest fear prior to starting clerkships–not finding anything I could see myself doing for the rest of my life).