Skepticism Against Non-Neutrality

This is a follow-up to my previous post, Media, Culture, and Half-Truths.

As I blogged that post, the media in other areas were already aflame with skepticism.  To recap from my previous post, the US CDC is considering a recommendation that medical providers should discuss the benefits of circumcision and offer it to parents and any uncircumcised male teenager and young adult (particularly those in a higher sexual risk group).  This is part of the US CDC's plan to help further reduce the incidence of HIV/AIDS.

And as I blogged in my previous post, this thread of logic is misplaced and damaging.  I even posted a comment on the US CDC's Regulations.gov site.  It's open for commenting between Dec 2 and Jan 16.  The vast majority of the comments on that site are negative towards the new recommendations.  Here's an article that reflects that:

Washington Post: Americans push back against CDC recommendation on circumcision

There is also a nice and succinct article on an Oxford ethics blog, A fatal irony: Why the "circumcision solution" to the AIDS epidemic in Africa may increase transmission of HIV, by Brian D. Earp in 2012.  It basically summarizes my thoughts from my previous post (but more eloquently written).

Again, this is not a new topic of debate.  The US CDC first began considering this back in 2009, but had delayed making notable public announcements until now.  As evidenced by an article in the Huffington Post, Male Circumcision and the HIV/AIDS Myth, by Dr. Ali Rizvi.

Heck, this topic has been covered (albeit tongue-in-cheek) by Queerty!  For example:

• If Circumcision Haves Risk of Spreading HIV, Should All Baby Boys Get Cut?
• So Circumcision Won't Help American Men Stop Spreading HIV?
• Even If Circumcision Helps Prevent HIV Transmission, Good Luck Finding American Guys It Could Benefit
• For Gay Men, Cutting Off Your Foreskin Not As Good As Condoms To Keep The HIV At Bay
• What's All This About The Government Wanting American Teenagers To Get Circumcised?

And to reference my previous post, the media can write about a single topic in two ways.  Queerty is clearly on the opposite side of the articles posted in my previous post.

So anyway, read the links if you desire.  They're there.  I'm a broken record on this topic.  No more on this until the US CDC finalizes its recommendation, one way or the other.  But for the love of democracy, please comment on the Regulations.gov link above if you have an opinion you'd like to share!

Media, Culture, and Half-Truths

This is nothing new.  Just warning you now, this is going to be an epically long post.  I've read about this before and I've discussed it before on this blog.  But this topic resurfaces rather frequently.  I see headlines such as:

Reuters "Male circumcision benefits outweigh risks, US CDC says"

The Verge "Benefits of circumcision outweigh the risks, US CDC says"

Yahoo "CDC: Circumcision benefits outweigh risks"

LA Times "Circumcision cited as defense against HIV in proposed CDC guidelines"

NY Times "Circumcision Guidelines Target Teenagers"

TIME "Feds Say Circumcision Best for Boys"

This is a controversial topic.  There is intense debate among physicians and even residents.  It's a subject that's almost taboo to talk about.  So let's talk about a few things: Media, Culture, and Half-Truths.

Media

I took a course in scientific journalism and media in undergrad, and I walked away from that class appalled.  So much so that I was literally unable to even look at a news article about a scientific or health topic without feeling an intense pang of rage for almost half a year.  Here are some things to know:

The media skews towards catchy headlines.  Sure "Male circumcision benefits outweigh risks, US CDC says" sounds pretty neutral.  But then you have the headlines "Circumcision Guidelines Target Teenagers" and "Feds Say Circumcision Best for Boys," and suddenly those pop out.

The media also has an agenda.  You are supposedly supposed to present both sides of an article (where there are 2 sides to present), but it's almost always skewed and thus almost never balanced.  Take the NY Times article, "Circumcision Guidelines Target Teenagers."  It dedicates a measly 2 paragraphs at the very end on counter-arguments, which although valid, reads as an afterthought.  Take the TIMES article, "Feds Say Circumcision Best for Boys."  There is no mention of any counter-argument.  None.  The LA Times article, "Circumcision cited as defense against HIV in proposed CDC guidelines" is actually the most balanced of the bunch.

The media doesn't understand statistics.  Now, statistics is a difficult concept for even many medical experts to grasp.  So to be fair, the media has no chance.  When presented with numbers, the media will always take the largest numbers presented.  Again, because it's catchy.  For example here, the recurrent phrase that goes "circumcision reduces a man's chances of getting HIV by 50-60%" sounds like a huge deal!  But context is necessary.  That number reported is what's called "relative risk reduction."  What matters to an individual is the "absolute risk reduction."  For instance, let's say the average uncircumcised man's risk of getting HIV is 1 in 1000 (or 0.001%).  So if he's circumcised, his risk goes down by 50-60%, thereby going from 1 in 1000 to 0.5 in 1000 (or 0.0005%).  Well, going from 0.001% to 0.0005% doesn't sound like much of a difference for that individual, and it isn't!  But both numbers could be true.  Going from 0.001% to 0.0005% is a 50% decrease - this is "relative risk reduction," but the "absolute risk reduction" is 0.0005%.  See why the media would choose to report 50% over 0.0005%?  (Note: the average man's risk of getting HIV in the US is WAY smaller than 1 in 1000).

Culture

Culture is such a pervasive and unconscious thing that few people even realize it comes into play.  The US, given his history of higher rates of circumcision, has a cultural bias towards that procedure.  Whereas comparable Western countries (Canada, Europe, Australia) don't have this cultural bias.  This is how everyone can look at the exact same studies, the exact same medical literature, and come out with polar opposite conclusions and recommendations.

Here's an excellent article rebutting the latest AAP (American Academy of Pediatrics) guideline update on this topic: "Cultural Bias in the AAP's 2012 Technical Report and Policy Statement on Male Circumcision." 

People think of medicine and science as containing immutable truths.  Yet in reality the exact opposite is true.  We must constantly challenge and question old scientific truths in order to get ever closer to the Platonic Truths.

Half-Truths

Now on to the merits of what's been discussed/argued for in the articles.  The best quote I could find comes from the LA Times article: 

"Dr. Thomas Newman, a professor of epidemiology and biostatistics at UC San Francisco, says he believes that the medical benefits of circumcision outweigh the risks but that both are small."

This is the closest thing to the truth out there.  Let's look at the arguments on the table:

Pro:

• Circumcision reduces HIV risk by 50-60%.  Well that effect is quite small on an individual level, as illustrated above.  Plus, condoms reduces HIV risk by 90-97% when used correctly.  That "additional" 50-60% is rather meaningless.  Furthermore, circumcision offers zero benefit for those most at risk of getting HIV in the US (men who have sex with men, IV drug users).
• Circumcision reduces HPV and other STI's.  Maybe true.  But we now have a vaccine for HPV that's 98-100% effective.  And again, condoms.
• Circumcision reduces UTI's in boys during the first year of life.  This is actually true, however, the risk of getting a UTI is rather small to begin with.  In a healthy uncircumcised baby boy, the risk of getting a UTI is 1 in 100.  In a healthy circumcised baby boy, the risk of getting a UTI is 1 in 1000.  In girls older than 1 year of age, the risk of getting a UTI is like 5-7 in 100.  And how do we treat UTI's?  With antibiotics.  That said, there is a role for circumcision in a baby boy who gets recurrent UTI's (and usually there is some other anatomic problem as well).

Cons:

• Risk of complications.  I love how they kind of lumped all complications together, and then say that it's about 1% if the procedure is done before 1 year of age, 9% if done between 1-9 years of age, and 5% if older than that.  I don't know about you, but a 5-9% complications rate is pretty high.  And what are these complications?
• Infection and inflammation are a common one.  As with any invasive procedure, there is always a risk of infection.  And think for a moment, this baby's penis is healing while he's in diapers, exposed to urine and poop.  That can't be pleasant.
• Bleeding is another common one.  Well, this could be life-threatening if a baby has a bleeding disorder (like hemophilia).  I'm sure the majority of the time no one does blood tests before the procedure to confirm that a baby does not have a bleeding disorder, and often times a family history can only get you so far.
• Other risks not mentioned?  Adhesions, meatal stenosis, and accidental amputation are ones that probably should be mentioned.
• Adhesions: baby's bodies heal very well.  Sometimes parts of where the foreskin is removed will reattach itself to the glans (penis head).  This can cause not only cosmetic issues, but also functional issues.  Sometimes those adhesions are so tight that erections can be uncomfortable.
• Meatal stenosis: when the opening of the urethra (pee hole) is too small to allow urine to pass.  This problem exclusively happens in circumcised babies and requires surgical correction.  The end of the penis is not meant to interact with the outside world before puberty, and so exposure causes inflammation, which causes swelling, which causes a small hole to get smaller.
• Accidental amputations: yes, very rare, but very very tragic when it happens.  A handful of cases happen each year and it's impossible to remove this risk entirely.  It may be a 1 in a million risk, but if that 1 in a million is you or your baby, and it wasn't medically necessary, you would probably be pissed off.
• Also none of the articles mention studies that support the foreskin being a very innervated area of the body.  Whether those nerves play a role in sexual sensitivity and enjoyment is a topic of debate in and of itself, but logically it would make sense that more nerves = more sensation.

So you see, the full discussion is more nuanced.  And when I counsel parents on this topic, I present it as I do above.  Thankfully the area that I'm doing residency in has a low circumcision rate, so this rarely comes up.  But it does once every few months.  Most parents who do opt for the procedure are not undecided - it's like parents who're against vaccines, their minds are made up no matter what you say.  So I counsel towards less intervention, at least insofar as this topic goes.

Thoughts?  I know I'm biased, but again, no one has a truly neutral stance on this topic.  Which makes it difficult to fully "trust" the CDC's recommendations (or anyone's opinion, for that matter) on the subject.

Where in the World is Aek?

Gosh it's been a long time!  About 3 months since I last blogged!  I would say it's because I've been super busy with residency and all that, but that'd be partly a lie.  Truthfully, I've just been lazy.  Heck, I sat on this post for the better part of a month!  So where in the world have I been?

Well, I've run the gamut from the pediatric intensive care unit (PICU) to outpatient urgent care clinic.  Such a dichotomy in medicine and such different arenas, haha. 

From there I did another rheumatology rotation, but at another institution.  That was an amazing experience!  It was great just being away in a different area, working in a different system, and exploring.  It was also awkward because I felt like I couldn't perform to my full potential because I was learning the system and the hospitals.  It was almost like being a medical student again, almost.

Then I returned and did neonatal intensive care unit (NICU), which sucks as a second year resident, I must say.  You have double the patients to yourself, your patients are way sicker, and you're expected to just know how to manage things.  And on the weekend it can be just you taking care of the entire unit with the attending, which really sucks.

Currently on pediatric emergency department (ED).  It's alright.  I can see why people would want to do it - shift-based hours, sign in/out, lots of potential procedures, patients are in and out rather quick (MUCH quicker compared to adult ED), and you don't have to worry about continuity of care and the frustrations that can sometimes present.  But this is all not quite my cup of tea.  Parents sometimes bring their kids to the ED for really silly reasons.  I mean, if it's not an "emergency" you should really bring your child to his/her primary care pediatrician first . . .  I won't give examples as that may be a HIPAA violation, but if you see and hear the things I have . . .

There's a certain degree of "brain rot" that I feel as a result.  I live for the interesting cases.  The ones that make me think, that make my mind tingle.  On the flip side, as a patient you NEVER want to be "interesting" to a doctor, lol.  And when something could be rheumatic in nature, my mind definitely tingles - like it hungers and salivates for that diagnostic puzzle.

Anyway, to be totally fair, I can honestly understand why some parents bring their kids to the ED even though it's not medically justified.  There are so many factors and when it is YOUR kid, you freak out.  I get that.  I just wished that people utilized primary care as it was intended instead of the ED as their first stop.

Anywho, next post I'll post pics of my adventures.  :-P

The Fastest Longest Year

hospital floors by JESSERZZZ on deviantART

Farewell to intern year, the fastest longest year ever!  It's certainly been a crazy ride full of up and down roller coaster emotions.  And boy did the year finish with a bang!  Time to muse on a few thoughts:

-----

1.  Doctors incognito

I've noticed an interesting trend among us "newer" physicians: we never let anyone in public know that we're doctors.  At least not initially.  We never introduce ourselves as doctors, we never use our hard-earned titles in public, and when asked what we do for a living, we'll say something along the lines of "I work in the medical field" or "I work in the hospitals," but almost never will we say outright "I'm a resident/doctor."  Why is that?

In a twisted way, it's almost like a sense of shame or being marked.  Open your mouth and say that you're a doctor and people instantly treat you differently.  Either they ask you about your opinions on this or that (I get the "Should I get a flu shot?" question A LOT), or they ask you about homeopathic remedies, or their negative experiences with doctors comes out.  I mean, I don't go to someone who says he/she is a lawyer and say, "Man, I really hate all lawyers.  They're all scum."  Or "Are you the kind of lawyer who stands in a courtroom and all that?"

As such, I'm never offended if someone calls me "Mr." instead of "Dr."  Although, an interesting thing to note that in Britain, "Mr." is a title ascribed to surgeons whereas "Dr." is a title ascribed to physicians.

-----

2.  The misunderstood adolescent

I may have said this before - I'm one of the few pediatricians who actually enjoys interacting with teens.  Not all teens, mind you, but in general yes.  Anyway, this bodes well especially if I'm really intent on pursuing peds rheumatology (which skews heavily toddlers and teens).

This may be coincidence or it may be intentional, but most of the teens in my continuity clinic are males.  They're such amusing creatures.  I can get most of them to open up at least somewhat (and a handful almost way too much, lol).  I think it helps to understand where many of them are coming from.  And I may be a bit too . . . liberal in my advice to them.

Anyway, there are 3 things I always iterate to every teen guy: 1.) wash under your foreskin (most of them where I am are uncut - good for them, lol), 2.) monthly testicular self-exams, and 3.) ALWAYS USE CONDOMS.

-----

3.  Rising seniors

As interns we are the lowest person on the totem pole that matters (sorry med students, the hospital functions very well with or without you).  We're often abused - intentionally and unintentionally - by senior residents, attending physicians, nursing staff, etc.  It's a frustrating place to be.  But at the end of every intern year is the promise of becoming senior residents and FINALLY stepping out of the intern role.

And at the end of each intern year, it's an opportunity to reflect on the kind of senior we aspire to become.  I've had the good luck to work with one of the best and by far the most hilarious senior residents I've ever known.  Although the last month was rough, he made every day go by quickly and with enough laughter to sustain us.  I can't say I want to exactly be him, I will aspire to carry on aspects of him.

In less than a week, I'll be considered a "senior resident" and I'll have no idea if I'll be a good one or a bad one.  The best advice I've heard was, "Remember what you liked in your senior residents and do that.  And especially remember what you hated done to you as an intern and don't do that."

Please Don't Misunderstand Me

Please don't misunderstand me, I do love seeing my patients even though for every minute I see them I have 5 minutes of paperwork and other "work" to get things done for them.

Please don't misunderstand me, if I can't make it to your bedside immediately it's not that I dislike you or am lazy, I truly am quite busy doing things behind the scenes for you or another patient.

Please don't misunderstand me, as much as I love thinking and taking care of patients, I lie here right now musing over whether I've made the right choices that can sometimes be literally life or death.

Please don't misunderstand me, if I seem beaten down it's because I've worked a 13+ hour shift for the n'th day in a row often without a single heartfelt thank you. And perhaps I was yelled at for something I did or didn't do for you.

Please don't misunderstand me, as much as I could go back in time and undo med school and residency, it is truly a profession of great privilege and honor.

Please don't misunderstand me, when I say I would not redo all this again it's not out of regret, but rather sadness of all the sacrifices I've made - the art I missed drawing, the music I missed playing, the sleep I missed getting, the opportunities for love and travel.

Please don't misunderstand me, when I discourage others from pursuing medicine it's not because I hate my job, but rather I don't want others to make the same sacrifices without truly appreciating what they'll be giving up.

The Truth Is . . .

medicine by bloodred on deviantART

I attended the pediatric rheumatology conference earlier this month.  It was like a mini-vacation and I learned so much!  My mind was blown at how much there was out there (and how little I knew).  I ran into a resident who's doing her residency back where we did med school, so that was a pleasant surprise.

I just finished my clinic month, which was mostly urgent care.  It was useful and my Spanish got exponentially better (because I refused to use the translator phones after a while, and like 2/3 of the parents speak Spanish-only).  But it was really bread-and-butter and much of it didn't require much "thinking."  I hate to say it, but an NP or PA could easily do what I did this month without much difficulty.  It doesn't surprise me that NPs are trying to expand their "power" and scope of practice.

But the most brutal truth is: if I could go back in time, I would NOT do med school and residency.  This is not worth it.  As much as I love my patients, as adorable as my toddlers are, as amusing as my teens are; the hours, the hospital politics, the paperwork (oh god the paperwork!) is not worth it.  I daydream of what I've given up to become a doctor.  It's not a career I'd recommend anyone pursuing.  And that's the most brutal truth.  Perhaps I'll elaborate on this more later.

I came across the following coming out video and the way the person spoke, the honesty and anxiety in his voice, really resonated with me.

Apologies that this post is all over the place.  I'm on call tomorrow (again, yay) and have to do yet another 13-hour shift.  At least I'm on with good residents who I admire and respect.  The day should hopefully not be too painful.

Right Place and Time

right place right time by Hitomii on deviantART

There is something to be said for being in the right place and time.

There's a phrase my mom says: 这个是天规定的.  The translation is basically, "This is mandated by heaven."  The concept of a "heavenly mandate" is an ancient one.  Heaven decrees that certain things are meant to be, and certain events happen at certain times for a reason.  How we interpret that and what we do with it is up to us.  It's not exactly fate or destiny, but is along a similar line of thought.

I did my pediatric rheumatology rotation last month and pretty much loved it.  Towards the end of the month, one of the rheumatologists told me that he received an email with an application for a resident to apply for an award to attend this year's peds rheum conferences essentially for free!  How could I pass this opportunity up?  Imagine my joy at receiving the award, and I'm off to Orlando for the conferences next week!

If I didn't do that rotation that month, and if I hadn't heard about the application, I wouldn't have the opportunity to attend these conferences.  Right place and right time.  On a larger scale, matching in California for residency is probably meant to be (though it doesn't always feel like it).  And perhaps dating and finding "the one" (out of many possible "ones") is a matter of time and place as well.

That's not to say that this concept means I should be passive about things, like destiny or fate.  But rather, when the right time and place produce an opportunity, I must not let it slip.  For who knows where it could lead?

In Other News . . .

So what's up with me otherwise?  A quick summary:

I passed USMLE Step 3!  Woohoo!!  Really, the odds of me passing were vanishingly slim but you always worry on test day.  I was amused that I did worse as the patients in the questions got older.  Definitely affirms my training in pediatrics, lol.  Also my highest sections were Behavioral/Emotional, Musculoskeletal, and Immune/Infectious Diseases.  Fascinating, because it leads me to . . .

I'm like 95% sure I'm going to pursue fellowship in pediatric rheumatology.  It's definitely one of the least "sexy" subspecialties because: 1.) there aren't many procedures, 2.) it pays less, and 3.) it's not well understood.  But I find it fascinating.  It commonly affects joints (as you'd expect), but it can really affect almost any organ in the body.  And I seem to be one of the few peds residents who kinda likes (or at least doesn't mind) teen patients.  It's also a rather "rare" subspecialty, there only being 26 fellowship programs in the country (for about 60ish spots).  There's an estimate of about 1/2 the number of peds rheumatologists in the country as there needs to be.  As one senior resident described to me, doing this fellowship is basically a golden ticket to practice anywhere in the country that I so desire.  Yeah, I'll make less money.  But to echo one of the peds rheumatologists that I worked with, "I didn't come from money.  So this pay is pretty good to me."

It's astounding how stress and sub-optimal nutrition leads to weight gain!  I seriously gained like 15 lbs in residency so far.  No bueno!  I just started working out and slowly ramping things up.  I'm woefully out of shape, but that's what I get for being on inpatient rotations for 5-6 months in a row, working on average 6 days/week, and up to 80 hrs/week.  Where in there is there time for working out, much less healthy eating?!  For the first time in many months, I have the time and there wherewithal to realign my health to where it should be.  I've been a poor example for my patients.

Today I was eating lunch outside with one of my co-interns.  And she remarked how nice it felt to have the wind blow on her face, how normal it felt, and how sad that she was thinking that in the moment.  But it IS sad.  This residency thing is not something I'd wish on someone else.  Fuck that, if I could re-do things, I wouldn't re-do this.  But I've already come this far and I'm going to see it to the end.  Because at the end of it all, I have a chance to regain normalcy.

Recently got into a new show, Looking.  It centers around 3 gay friends in SF.  It's entertaining.  About halfway through like the third episode, I realize that one of the main characters, Patrick Murray (played by Jonathan Groff), is basically me in a lot of ways.  He wants to have a good sustainable relationship, but sucks at it.  He's conservative in his actions and tends to thinks before he acts (sometimes too much).  Anyway, a good show to check out.  :-)

Dating: A Hesitant Proposition

Dating: a hesitant proposition.

That's what it seems to be with me.  I've had 2 friends hint as much recently, though they didn't explicitly say so.  I'm the kind of person who, when using dating sites, like to get a decent conversation going before meeting up (or giving out my number).  Perhaps I'm too cautious, or slow, or conservative or something.  Not entirely sure.  Here's a brief history of things:

-----

Tristan: Half-Asian/half-Mexican guy.  Pretty cute guy, chatted for a while on the app Jack'd.  Finally met in person at a free outdoor play in a nearby park.  He was rather late, the play was like half over.  Afterwards we went to my apartment to watch a movie.  He loved to kiss and we ended up fooling around . . .  We continued to text for a bit afterwards, but then we both got busy and lost contact.  He recently "resurfaced" on Jack'd after having ended a long-distance relationship (some time after we had met), but hasn't been very responsive of late.  Dead end.

Jack: Asian guy.  He kind of annoyed me, was more sexual in his texts than I wanted.  He was very late when we arranged to meet (like, 2-3 hours late).  I was furious as it totally upended my plans that weekend.  I was internally still mad the whole time we hung out.  And he smoked, that's an instant turn-off to me.  We continued to text intermittently for a while, then stopped.  Dead end.

Dan: White guy.  Rather interesting, as he's like 9 years older than me, and he actually approached me on that app.  Intelligent, sweet, but ADHD (which he legit has as a diagnosis, lol).  Met him at a time when I wasn't really looking for a relationship (other than friends), as I was on a string of super busy rotations.  He was always 15-30 min late (seems like a pattern . . .).  He got into his head that we'd be somewhat friends with benefits, but he took the FWB further than I expected, lol.  He gave great head . . . like, teeth-chatteringly good.  We continued to chat over wine when he's in town.  He's interviewing all over the place and travels a lot, so it's hard to predict where he'll be.  Dead end (of sorts, given the unpredictability of his schedule).

Dean: White guy.  Short (and I'm by no means tall) but really cute.  Is a chef.  Chatted with him via the app, then text and finally had time to meet in person (he has an equally hectic schedule as I do).  Met at a cafe, this time I was about 5 min late because I couldn't find the damn place!  We ended up talking for like 5 hours.  It was really good to connect with something like that.  Alas he smokes, but he's been trying to quit; I guess that helps . . .  Anyway, he seems open to meeting again.  Door cracked open?

Vivi: Asian girl.  Cute, funny, smart.  Is a pharmacist.  Recently got a puppy.  Met at the same cafe as Dean.  I liked how laid-back and funny she was.  We had good conversation until the cafe closed, and then continued for a little while before she had to go home to attend to her puppy.  Probably the best prospect, though her schedule is weird (but at least it's fairly predictable).

-----

I'm honestly not entirely sure how I feel about any of the people above.  The last 2 people have piqued my interest, but I don't know.  There are people I've met in the past who, in retrospect, consumed a large proportion of my attention (one of whom, as I have blogged about recently, abruptly decided to cease all contact with me).  There are people from my past who I still, from time to time, pine over.

Sigh.  I don't know what I'm looking for.  Yet I feel like time is running out.  This wasn't part of the "plan," lol.  I envy the people who "fall in love at first sight."  I mean, what even IS that?  Maybe my personality is just too guarded.  I need to let things go.  Which reminds me, watch this:

Mental Ativan

Today was a down day. Anxieties are flaring.

One. I take USMLE Step 3 in two days. And it's a two-day exam. Eep! I should be ready. I've been studying for the past two months (when I could and had the motivation and energy after work). I've finished the study question bank, all 1000+ questions. I've been diligently learning on my current rotation, which is a general ED (emergency  department) - so I see more adults than kids. I can't possibly see myself being more ready then now. But I still worry about that remote possibility of not passing . . . shouldn't be a problem as I padded the other two Steps soundly. But still . . .

Two. My chief residents have my on cross-cover call every Sunday for the next three months (that or back up call). I'm basically grounded in this city and can't go anywhere for the weekend. When I emailed my chiefs asking about this (diplomatically, mind you), I get a very bitchy 7-paragraph email reply. In it she basically told me to suck it up, that this hairpins to everyone and now it's my turn, I'm being difficult, and that I should be more  professional about this. Whatever. She can crawl into a hole for all I care. Good riddance when she's gone at the end of this year! I'll need to ask my co-interns for some call switches.

Three. My friend (who I've mentioned several times now) started a Twitter account. I followed him just for the heck of it, not that I'd be commenting on it much or whatever. Today I discovered that he blocked me. That hurt. It opened up the old wound. Why is he going to this length to cut off contact with me, all without ever telling me why? I just want to know why so I can have final peace.

Four. In so far away from ago of my good friends back in the Midwest (though some on the east coast now too). I dearly miss them. Facebook is a sad proxy. The other interns and I are often just too busy to hang out with each other, and they like to do their own thing - often with family if they're from this state or with their significant other. Which leads me to . . .

Five. I found out through a my mutual friend that one of my friends from undergrad is engaged. Everyone is getting married! And what do I have to show? Eternal singleness. Each passing year more and more friend are getting engaged and married, and I feel so left behind.

Like the title, I need a mental Ativan to calm me down and small me or of this funk!!

Janus at the Gate

Janus by ~luka-basyrov-art on deviantART

Janus, the Roman god of Gates, whose two faces look towards the past and the future, and for whom the month of January is named after. An very interesting and apropos Roman god for the new year. 

2013 has been a year of ups and downs. Meeting new friends and saying farewell to close ones. A year that marked the end of one era and the beginning of the next. One filled with pride, accomplishment, and excitement. One full of anxiety, doubt, and frustrations. A year I would do all over again and yet would never wish it repeated. 

I left 2013 and entered 2014 on not the best of notes (what with issues with my student loans servicer and a laptop that's crashing far too often). And least of which I was working on both Christmas and New Year's (actually at work now). What kind of year will 2014 be?  Surely one we make, right?

Lately I've been left feeling so out of balance and it's difficult to find the way back, much less time to look for the way. But 2014 needs to be a year where I can center myself, refocus my energy, find my motivation, and let the wounds of 2013 scar over. Time heals all wounds, but the scars they leave serve as constant reminders of what was. 

I have no particular resolutions. I'd just make the same ones as I do every year. Eat healthier. Work out more. Lose weight. Find love. Explore more. Travel more. Easier said than done when I'm still figuring things out day by day, week by week. 

I do not mean this post to be a depressing one. I am a realist, and reality isn't rose colored. There are some positive things to look forward to this year. In many ways, after the first couple months there is only up. But I must not rest my laurels, vigilance is still needed.

If I am so lucky, so bold, maybe - just maybe - I can achieve some that which I hadn't been able to for several years now. Let the new year begin!