Found and Lost

.Lost and found. by Nonnetta on DeviantArt

I've become worse and worse about posting.  Sorry.  Residency has been busy and I've been too tired/lazy in what little free time I have to reflect.  But as I'm on vacation this week (and my original first and second plans fell through), here's Part 1 of several updates.  Without further ado, Part 1: Found and Lost.

So in my last post, I mentioned Pikachu.  We did end up going on a trip to the Big Sur area.  It was an amazing (albeit too short) trip.  I'm always stunned at how gorgeous the coastlines of this state are!  Here are some pics (from just the first day):

Big Sur coastline

Bixby Bridge

Valley View

Pfeiffer Beach (yes, parts of the sand are purple)

More stunning coastline!

And the iconic McWay Falls

We had a great time!  Yes, we did fool around a bit in bed at the hotel.  That was not planned but practically expected.  I won't elaborate much here, but suffice to say he's a passionate kisser and left me with a few hickies (which was a bit of a problem hiding behind my collar in clinic the following Monday, lol).  More than anything sexual though, it was just nice to lie next to someone and cuddle.  It's a wondrous thing, the sensation of touch.

Suffice to say, by the time we parted ways I had fallen for him.  But then an odd thing happened.  His work really picked up speed and he became very stressed out and distant (presumably from all the work he had to do).  We had gone from texting/Skyping almost every other day to just a couple times a week.  I continued to say "Hi" and "Good morning" almost every day for a while with a scarce reply.  I was beginning to wonder what was going on.

When we finally carved out some time to chat on Skype, I confessed that I really liked him in a way that I hadn't felt towards many other people before.  He took it as a compliment but didn't elaborate much more.  Later he would go on to say that long-distance never works out.  He was referencing a friend and her long-distance relationship, but I took it as a sign that we weren't meant to be (at least, not at this time).  The distance between us is about 2.5-3 hours' drive, and he categorically refuses to come to my part of the state.

And so perhaps that was it.  It almost felt like things evaporated away.  We still text and chat from time to time, but it's mostly me doing the initiating.  I feel the gulf of distance and at first it ate away at me.  Yeah, I still have feeling for him and I wonder if I were to match fellowship near him, would we have a chance?  Or would he find someone else in the intervening time?

I let my guard down.  I let a mask fall.  I let myself feel vulnerable.  And things didn't go as I had hoped.  I hate this feeling.  And what's worse is the feeling that I may very well end up alone anyway.  My 20s are quickly fading with each advancing day - is there any hope for this remaining time?  Or will I find what I seek in my early 30s?

Happy Single's Awareness Day

Singles Awareness Day by Ayame-Kenoshi on DeviantArt

Wow, it's been about a month and a half since I last posted!  I suppose a few things have happened in the interim . . .

So I guess the focus of this post will center on this guy.  I'll call him Pikachu because he likes Pokemon.  So I met Pikachu back at the end of December 2014.  We had chatted on/off for months on a dating/hook-up app (no, it's not Grindr) but since we lived about 3 hours away from each other, we never had the opportunity to meet until December.

Since then, we've been texting each other almost every day.  More recently over the past 2 weeks, we've been Skyping about every other day; sometimes it's only for 10-15 minutes but other times it's been over an hour.  I've got a vacation planned for the end of this month, and we're planning on spending 2-3 days together on a mini trip/hike of the Big Sur area.

I think I'm beginning to really like him.  It's been quite a while since I've thought that way about anyone.  I've chatted with both guys and girls on/off via online dating sites/apps for the past 2 years.  A few of them (mostly girls) have made it past that to texting.  But then it fizzles out when my schedule becomes busy.  They don't initiate conversation and I can't sustain it one-sided.  But with Pikachu, he texts me in the morning to say "Hi" or "Good morning."  Simple as that.  But it keeps things going.

I was feeling the Single's Awareness Day tonight, and I texted him if he wanted to Skype.  At some point during our conversation it came up that I was bi.  Although I'm like 95% sure I had mentioned that fact to him when we first messaged on the dating app, he must've forgotten.  But his reaction was predictable, understandable, and . . . unfortunate.  He was taken aback a bit and seemed unsure for a moment.  He explained that he didn't mean it but stated that "biphobia" does exist in the gay community.  He had dated a bi guy within the past several months and it didn't go well (it didn't get very far either).

This brought up all sorts of insecurities for me.  I wasn't expecting that.  I thought I had moved past that.  I guess not.  On a spectrum of 0 to 10, with 0 being 100% straight and 10 being 100% gay, I place myself somewhere between 7 and 8.  In general, I'm more physically/sexually attracted to guys (girls have a narrower range), but I'm more emotionally/intellectually attracted to girls.  Pikachu is the first guy in a long time - possibly ever - who I've felt a romanto-emotional connection to.  And a part of me feels just broken after his reaction to me clarifying that I'm bi.  And honestly, I'm not even sure how well that label applies to me anymore.

I'm not sure how to navigate these feelings.  No, that's not accurate - I don't know how to navigate these feelings.  It's easy for me to just box it up and store it away, but that's not what I should do.  It's easy for me to tell myself the same advice I offer my patients, but it doesn't feel easy to follow.  It could be just me, but I feel like the fact/label of being bi has changed the relationship dynamics in ways that can't be undone.

Sigh.  :-/

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."

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.

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:

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!

An Inner Peace

Inner Peace by *MistyTang on deviantART

This vacation has been much needed to decompress, de-stress, refocus, and recharge.  It has also been useful to help me re-center myself find an inner peace again.  I've been so off-balance the past 4-5 months it's scary.

-----

This morning, just before waking up, I had a dream.  Bear with me for a while.  In this dream, I was seeing maybe a 16-year-old black/Latino teen in clinic.  He had a history of cancer, now in remission.  He was complaining of abdominal pain and had a large laparatomy-type scar.  I do my exam and summon my attending.  She brings in another attending, who cuts open the surgical scar to peek underneath (this never happens in real life, btw).  His organs looked good but we were shocked to not find any rectus muscles or even a peritoneal sheathe.  The attending closes him up, wraps his abdomen with bandages, and send him to the procedure room where I would suture/staple his wound close.

He manages to hobble over there, obviously in some pain.  I gather my supplies and head over there.  I enter the room to find him face-down on the ground, barely conscious.  I run over to him, turn him over, and check the ABCs (airway, breathing, and cardiac).  He was breathing and had a pulse, but was in some pain.  The first attending stopped by the door where I call a code.  She goes off to assemble a quick team (this also never happens in real life, an attending won't just up and leave like that).  It being the end of the day, practically no one was around.  It was just me and this teen, barely conscious, in pain, but breathing and heart beating.

A respiratory therapist comes by and gives me a bag and mask, which at that point my patient stops breathing.  I resuscitate him with the bag and mask, while checking his pulse.  A third-year resident comes by and assesses the situation, and by now my patient has regained consciousness.  I was able to give him some pain meds, staple his wound close, and send him out the door (also doesn't happen in real life, you don't send a critical person home).

-----

Although unrelated, something about that dream triggered a moment of clarity and an inner peace.  I realized that I must have been, in some way and to some degree, in love with my friend (who's been mentioned a few times now).  This was why I dwelt on him for so long, why it felt like a slow painful heartbreak.  What we had shared in the past felt right, and may have been right at that time.  But not now.  Not when we're on opposite coasts and there's an age gap and he has a boyfriend.  Perhaps he too felt this tug, and decided to cut off contact to "rip off the bandage" as it were and get it over with.  I will likely never know.  But I'm at peace with it now.

Why should I cling to something so ephemeral when reality dictates that it wasn't meant to last?  I will always remember the friendship we had shared and that time together.  I'm okay that he's decided to close contact on his end, but I may still intermittently send him a warm text or message.  I'm okay being a friend in the shadows, available if/when he decides to contact me again.

I feel, for the first time since all this started, I can move on yet still hold on to what we had.

P.S. Bonus points to whoever catches the reference in the deviantART pic shown above.

I Survived . . .?

I survived by ~CasheeFoo on deviantART

Somehow I survived my first block of wards (and my second inpatient block, the first being NICU).  Wards is basically what you would imagine hospital medicine to be like, the kind of thing you see on "House" or whatnot.

The first day I was handed 6 patients I knew nothing about, one of whom was a cluster-fuck of complicated medical problems.  The rarity and severity of her illnesses terrified me.  Within a day or two I was expected to know her inside and out.  I was literally running around the hospital trying to figure my way around and see all my patients before meeting with the rest of the team for rounds.  This was far worse than any experience I had as a med student, because as a med student you're still under the aegis of your resident who protects you - more than I had previously appreciated.  And oh yeah, I had to basically learn an EMR (electronic medical record) and use it by the end of the first day.  Not cool.

I felt so overwhelmed that by the end of the second day I was ready to throw the laptop I was working on out the window and run out of the hospital screaming at the top of my lungs and quit on the spot.  I somehow, not sure how, held it together.  The med students arrived the third day.  I held it together.  For them.  I could not show my weaknesses in front of them - I had to give them the impression that peds was a great field (it still is).  Luckily I had inexplicably hit my stride as well and starting doing alright after that.

Having a med student by my side did wonders for my morale.  I'm not entirely sure why.  I guess I just wanted someone to talk to and bounce diagnostic ideas off of who won't judge me or think I'm an idiot.  Also once I discovered the most efficient path forward for me, nothing stops me.  As a med student I really struggled with finding that path, as it's not a med student's job to be efficient.  On the contrary, med students are supposed to be exceedingly thorough.  My sub-I as a M4 student kicked my ass, but in hindsight I was only able to survive wards now because of that experience.  I dare say I became the most efficient of the 4 interns on during this block.

-----

In other news, guys here kind of suck.

I've been stood up on a couple dates or otherwise had plans change/get delayed.  It's okay if you're going to be 10-15 min late, but 2-3 hours?!  Come on, that's just rude.  Makes me want to give up looking (as if I had the time anyway, ha!).

Been chatting with a few people, hopefully something goes somewhere.

The Next Stage

Wow.  Graduation is in less than a week.  In less than a week I'll have my MD.  And in a month from yesterday I'll start orientation for residency in a state across the country (at least it's not as far away as Alaska or Hawaii? lol).

The last 3 months have flown by.  It's like I blinked and I'm here.  Doesn't help that it's still a bit cold outside even now in May, haha.  I'm not sure I'm mentally ready for this next stage - for financial independence, for having a real job, for being responsible for the life (and death) of patients.  It's only in retrospect that I can appreciate how far I've come, but I've still got a ways to go in so many respects.

I was never one of those people who hurried to grow up.  In fact, just the opposite.  I did NOT want to grow up.  Childhood is so short, adulthood is so long and fraught with issues that no one else can solve but you.  Maybe this is part of the reason why I'm doing pediatrics, who knows.

At these critical junctions I find myself reflecting in nostalgia - what would and could have been if my life had taken a different path.  What if I decided to take a year off and complete my MPH?  What if I decided not to pursue medicine?  What if, instead of being paralyzed in fear and confusion, I had decided to date her in undergrad?  What if I had decided to come out to my parents?

I have little regret in the things I have done.  I only regret the things I haven't done or haven't been able to do.  They say that medicine is one of the ultimate delayed gratifications.  You spend the majority of your 20s studying your ass off, working long hours, often putting life and health on hold.  This continues (or perhaps worsens) in residency, and in the blink of an eye, you're in your 30s.

It's okay though.  There's still some of my 20s left.  Sure I may not have much time off each year, but that just makes each day off that much more precious.  With my salary, with my own money, I will have the ability to do many of the things I want without having to consider the debt looming over my head (which will get paid off in time).  And with the new duty hour limits of 80 hours/week, I may even have time to develop a social life if I'm efficient.

So it's alright, I can't stop the flow of time just as much as I can't reverse it.  I have just begun creating a bucket list and I'll be damned if I'm unable to do every one of those items!  This wasn't the post I originally meant to write, but here you have it.  Sorry for the scattered thoughts.

To Be Wanted . . .

It's such a weird feeling (for me) to be wanted.

What I'm most caught off-guard by during these residency interviews is just how much the program wants me (I suppose that makes sense, otherwise they wouldn't invite me for an interview).  Still, I'm left awkwardly speechless when an interviewer enumerates the various things I've done in med school and react amazed when I describe them.  It's almost embarrassing.

Up until now I've received little recognition outside my circle of friends and faculty advisors for the things I've done.  Everything I've done felt like it was being quietly conducted in the shadows outside the glowing praise of my institution at large.  I never received an award or anything of that sort, and I doubt I ever will - I simply don't have the overwhelming popularity to bring visibility to the things I champion.

But at almost every interview I've been asked to describe (in some detail) the community advocacy work I've done for the Asian and LGBT communities.  Some interviewers are more keen on hearing about the health literacy project I did in the Asian-American community, others are eager to hear about the cultural competency training I forwarded in LGBT health education, and still some want to hear about my involvement on a state policy level.

At one of my recent interviews, my interviewer asked me, "How are you able to do all this?"  And I began to reply that I was lucky and these opportunities fell into my lap in such a way that I couldn't turn them down.  He cut me off and corrected me that I instead "seized the opportunities."  I never thought of it that way, but I suppose he's right.

As these interviews wind to a close, I'm more and more certain of what I bring to a residency program.  This wasn't crystal clear at the beginning, but now I know.  Programs didn't choose me because of my grades or Step 1 score (verily, I'm positive that many programs rejected me based on those criteria), but rather the extensive community outreach and advocacy work I've done.  I'm glad that the 11 places that chose to interview me saw beyond the numbers to something more important that I can bring.

-----

P.S. For anyone applying to residency programs, everything you write in your ERAS application is fair game for interviewers to ask you about - and they will ask you about them, so know your application stone cold.

Interview Trail - Part 1: First Impressions

H DeVos Children's Hospital 2 by ~dharvell on deviantART

I hope everyone's had a happy holiday so far and looking forward to the New Year!  Almost as soon as 2013 starts, I hit the interview trail again.  But before that, some first impressions on Part 1.  There are things I've come to realize that are personally important to me when choosing a residency program, as I'll be stuck where I match for at least the next 3 years.  So in no particular order:

-----

1. Location

Location, location, location.  This is huge.  More so than I initially thought.  You want to be in a city and an area of the country you can see yourself living in for the next 3+ years.  Weather and geography are major filters for many people.  Some people really want to live on the west coast, or the east coast, or NYC in particular (not entirely sure why . . . no one can survive there on a resident's salary).  Others, like me, cast a wide net over huge swathes of the country to see what might fit best.

2. Hospital

The hospital you'll be working in is very important.  Is it old?  Recently renovated?  New?  Does it have readily accessible computers?  Does it use an EMR (electronic medical record)?  Are there good ancillary staff (nurses, pharmacists, etc)?  What is the patient demographic?  One of my filters is that I only chose free-standing children's hospitals because I felt that I'd get the best pediatric training at those tertiary referral centers.  Also, children's hospitals are all so colorful and friendly!  Adult hospitals are dull and depressing in comparison (particularly the VA).

3. Residents

You'll be working up to 80 hours/week with your co-residents.  You'll interact with them more than you do your friends or family.  They will become your family.  What kind of residents are at the program?  Do you mesh and fit in with them?  What kind of person are you?  While everyone in pediatrics is universally nice, I can definitely see myself fitting in with the residents at some programs more than others.

4. Curriculum

The ACGME dictates the fundamental curriculum for all residents.  The money is in the details.  Some programs are well designed, with a ward structure that residents are happy with, and a ton of flexibility to explore interests.  Other programs are rigid or else in so much flux it makes one anxious.  I've definitely come across some interesting and innovative ward structures.  Also the size of the program can be important.  There are small (1-9 residents) programs, medium (10-19 residents) programs, large (20-29 residents) program, and ginormous (30+ residents) programs.  In what environment might you thrive?  Does it matter to you at all?

5. Benefits

A residency is a job, and it behooves the applicant to have some inkling of the benefits.  How much do they pay their residents?  Does the hospital cover medical/dental insurance, or do the residents pay a portion out of pocket?  Amount of vacation/sick leave?  Is there free parking?  IS THERE FREE FOOD?!  I didn't realize how important the latter was to me until I encountered a program that did not feed its residents.  All the applicants looked at each other and were like, "What is this? An adult program?"

6. Gestalt

At the end of the day, trust your gut instinct about a program after you've visited it.  Some of my friends have created Excel spreadsheets to "objectively" score programs to determine their rank order list.  But the gestalt of a place trumps all that.  I've walked away from programs feeling very good about them - they treated the applicants well, I enjoyed my interactions with residents and faculty, they gave a nice tour of the hospital, they answered all our questions and more - whatever it might be, it's definitely a good sign when you walk away from a program feeling really good.  I've also walked away from programs where I'm like "Hmm . . . not sure what to think about this place" or "I really can't seem myself working here."

-----

I'm only in the middle of mine.  I've heard from many other applicants that after about the 4th one they're just like, "Okay, I'm tired of this now.  Everything's blurring together."  But here I am after my 6th one and I'm still excited to go on my remaining 5 interviews and each hospital stands out fresh in my mind (we'll see if that changes later, lol).

I think the reason why is because I listened to my advisor's advice (that's what they're for, right?).  And he said that I'll get competent training anywhere because the ACGME demands it, so it's more about how I feel about the place.  Thus I try to explore the city a bit the day before the interview and really feel out the residents and see what makes them tick and whether I "belong."

Residency interviews are so much better (and more fun) than med school interviews (at least for pediatrics/internal medicine - not as much for surgery I've heard).  You are selected for an interview because they want you there.  The interviews are mostly a get-to-know-you and to convince you to go there.  To be honest, it's weird to be complimented and feel wanted, that what you've done outside the classroom and outside rotations mattered.  I can't even count how many times I've been told that the whole process favors the applicant (as long as the applicant isn't a dick).

P.S. The hospital in the picture above is very nice on the inside.  And the people are amazing.

Redefining the Republicans?

As we all know, President Obama won re-election and Democrats solidified their majority in the Senate, with the House of Representatives still Republican dominant.  And as much as I dislike politics, I couldn't help but read some post-election commentaries, such as this, "Christian Right Fails to Sway Voters on Issues."

The current Republican party is so far to their end of the extreme it's no wonder that they failed to win the election.  This got me thinking.  What is meant by "conservative" and what is meant by "traditional?"  These in and of themselves aren't sinister terms that should be tabooed.  Indeed, many people may consider themselves conservative or traditional but still be alienated by the current gestalt of the Republicans.

Economics

I've read that Republicans tend to favor market forces and believe in individual responsibility.  These are things that many people can rally behind.  They are less in favor of government hand-outs and give-me's, and as such are likely to be more restrictive on social safety nets for the poor or disenfranchised.  Still people can rally behind that notion when they believe they shouldn't "rely" on the government to pull themselves up or have seen others abuse the system.

Taxes
Republicans generally are in favor of less taxes on (preferably) everyone, but the current Republicans want tax cuts for the wealthy to a fault. Wealth is really a matter of perspective.  How much does one need to live comfortably?  How much does one need to enjoy life?  Yes, money is hard-earned, but taxes exist for a reason and without them, many things in society would simply cease to function.

Health Care
Republicans are united against "Obamacare."  Fine, I get that.  It's not a perfect bill.  But if you're going to attempt to repeal it, you better have a viable alternative ready to go as soon as it's gone, because the status quo isn't benefiting anyone.  Is health care a right?  Is it a basic right?  A civil right?  Is it a privilege?  Is access to health care a right?  These are philosophical questions that our society must determine.

Abortion
Alright, Republicans are generally anti-abortion.  Fine.  But I take issue when they say they're "pro-life."  They are not pro-life.  If you're going to oppose abortion, you better set up a support system for the children and mothers whose lives are affected.  If you're going to oppose abortion, you must make it okay for a single mom without a high school degree to give birth.  This takes investment, time, infrastructure, and of course money.  If you're truly pro-life, you'd campaign to have all kids vaccinated.  You'd campaign to have every child be in programs such as Head Start and Birth to Three.  You'd campaign to help single parents find jobs or tax credits for education.  You'd campaign to offer prenatal care at Planned Parenthood, not cut its funding across the board.  This is truly pro-life.  But it all costs money, and where does that come from?  Taxes.

Family
Republicans are pro-family.  But really, aren't we all?  Their problem is that they haven't kept up with what a "family" can be these days.  Yes, a family may be the nuclear family of parents and children.  But it can also be an extended family, where one lives with aunts, uncles, and/or grandparents too.  It can be a single parent home.  It can be a gay or lesbian couple.  All studies suggest that it matters less what kind of structure the family consists of, and more the love and care provided by that family.

LGBT
Republicans are against LGBT rights at large, but particularly gay marriage.  It doesn't hold much water with me from a legal perspective.  There is a difference between a civil marriage and a religious marriage.  Churches and other places of worship may refuse to consecrate a gay marriage, but that doesn't mean that the state should refuse as well.  In America where we profess to be open, accepting, and tolerant of all religions - where we believe in separation of church and state - where is all that here?  The same arguments made against gay marriage is exactly the same arguments made against interracial marriage several decades ago.

Minorities
The Republican party has a dearth of minority representation, and it has so far made little to no attempt to attract minorities.  It's really a shame.  Many African-Americans, Asian-Americans, and Latino-Americans likely agree with the Republican's economic stances and their sentiments about family.  Yet the Republicans have managed to alienate all of these groups.  Immigration reform, if done well, would begin to sway some Asians and particularly Latinos to the Republicans.

Environment
Republicans should be truer to the word "conservative" when it comes to environment.  The US has one of the greatest natural resources on the planet, and while it's something that we should tap into, it's also something that we should protect and cherish.  Investment into alternative energy would definitely open up job opportunities and drive innovation.

Education
There's a distinctly anti-education sentiment in the Republican party these days.  I do believe everyone should have the opportunity to attend college/university if so inclined.  I do believe we should invest in recruiting more people to become teachers, and to hold schools accountable (to a degree, this a very complex topic sufficient for its own post).  Teachers and their unions shouldn't be made out to be the bad guys.  It's not easy being a teacher.  If the Republicans don't do something to advance education, the US will continue to slide further and further behind.

Anyway, this post is long enough.  The point I wanted to make is that the Republican party, at its core and true to its moderate members, is not a bad thing.  But they've drifted so far from where they should be that they've become hypocritical.  Perhaps this election has kicked their butts sufficiently to see that what they're doing isn't working and will never work.

And this is a nice article to end on, "The Great Experiment."

Re-examine

Re-examine by ~Meow2puchiko on deviantART

On Saturday I went to a friend's wedding.  It's the 6th wedding I've been to in the last 5 years.  It was a small, intimate, outdoor wedding of family and close friends.  Though the forecast threatened scattered thunderstorms, the weather couldn't have been more perfect.

I sat (as I usually do) next to friends I knew in undergrad - some of them married, many of us single.  My friend sitting next to me remarked, "Every time I come to a wedding, I feel like I have to re-examine the course of my life."  And I sympathize with him 100%.  It seems like friend after friend has been getting married, and where am I?  Where are the rest of us?  Even if it's not entirely true, it feels as though we're lagging behind in "life progress."  It's rather unsettling at times.  I'm so far from marriage that I can't even see it in the distant horizon.

At least my other friends (married couple) spoke the truth that as we get older, our dating pool only increases (formula: minimum age of dating partner = 1/2 your age + 7).
-----
The following day I met up with another friend (also married) on my way back from the wedding.  We chatted for a while on politics and catching up and all that.  He always relished my medical stories, especially the gory ones, haha.  His wife was a trooper too with my descriptions.

After a while when it was time for me to go, he gave me the location of his brother's grave, the same brother I had considered one of my closest (and longest) friends.  It felt strange driving to his grave.  I found it rather easily.

There I stood on the road, looking between two small stone walls along rows of graves.  The sun was bright, the sky blue, and the trees and grass green.  At the far end stood a statue of Martin Luther.  And there I saw his sign, a temporary placement for his headstone not yet finished.  Standing at the foot of his grave, I could see it was a recent-ish burial as the grass had not fully grown in the spot.  I had brought no gifts, no tokens.  I saw a single black feather and placed that under the sign.

And I began to say my last words.  It was weird, talking to no one but the breeze.  I wasn't even sure of what to say, my ramblings barely coherent even to myself.  And then I teared up as I admitted that I was bi, something I never got around to telling him while he was still alive.  The words choked, stuck in my throat as I said, "I know I never told you, but I thought you should know . . . I'm bi, probably more gay than straight but I'm working on figuring it out.  I know you would've been okay with it, you would've helped me figure it out in your own way, but there's no way to know now, eh?"

It was awkward, but what does that say?  What does that mean?  That even now, even talking to no one but the air, those words would be so damn hard to say?  I suppose I really haven't changed too much since the beginning of this blog.  I don't see an endpoint.

Having too much time makes idle thoughts wander, too much time to re-examine and yet still do nothing.

Hardest Month . . .

Precocious Patient by ~ThirstyEye on deviantART

M3 year has flown by.  Sometimes I still can't believe I an M4 now and on my pediatrics sub-internship.  This is by far my most difficult month of med school yet, more so than even surgery.  I literally act as a functional intern on one of the pediatrics ward teams, except all my orders have to be verified by my senior resident.

There are rewarding moments.  There are moments and areas that I feel I shine at.  But all that is overshadowed by this constant anxious feeling that I'm not doing enough, or not doing things the right way, or not thinking fast enough.  It's terrifying.  Being the one responsible for a child's care in the hospital is daunting.  It's not that I don't basically know what to do, it's that I'm unable to instantly anticipate all possible (worst) outcomes and prepare for it.

I'm able to prioritize tasks fairly easily, to do what needs to be done, but I can't prioritize my thoughts as quickly when someone asks me a question or I'm asked to present a patient.  The information is there, but it's not organized the way I (later) type it up and it's unfiltered because I just ramble all the information - pertinent and non-pertinent.  I don't know why I'm getting flustered and blanking.

I'm now 2 weeks in to the rotation, about half-way done.  And I feel like I haven't significantly improved despite working my ass off.  Today was the worst day.  I showed up and was instantly handed 5 patients I didn't know, didn't have sufficient time to read through their chart, and on top of that I was the one admitting a new patient and had to do her whole work-up.  I was a mess and constantly second-guessing everything I said the whole day after that.  It took me way longer to catch up than it should.

Words can't express how defeated I feel right now.  How stupid I feel.  How slow I feel.  How not cut out for this I feel.  Maybe I should consider switching fields.  This was not how I expected to start M4 year, and definitely not how I expected this month to go.

Ending with the Crazies

Ya know, I could say how I've been busy and whatnot.  But that'd be a lie this time.  I've just been lazy.  The year has been winding down for some time and I just couldn't be bothered, lol.  And as it is, I end the year with the crazies (aka, psychiatry).

It actually wasn't a bad rotation.  Spent 2 weeks on child/adolescent psych, 1 week on eating disorders, and 1 week on adult psych.  As the director of the place told us several times, "Most of these patients ain't dumb, they ain't crazy, they just have had crazy things happen in their lives and couldn't handle it, and that's why they're here."  On about day 3 I realized how true his words rang.

The vast majority of psychiatric patients I saw aren't crazy.  Most of them aren't schizophrenic, they don't hear voices other people don't hear, they don't see things other people don't see, they aren't foaming at the mouth or anything (that said, the couple of schizophrenics who weren't taking their medications really were sometimes kinda scary crazy).  Most of the people I saw actually had mood disorders - anxiety, depression, irritability, etc.

The best way I can describe most patients' situations is that crazy things happen in their lives - a kid is witness to domestic violence or is abused (verbally, physically, emotionally, and/or sexually), a teen feels out of control when her parents divorce and start restricting her eating, an adult couldn't handle the pain from multiple surgeries and turns to drugs - and their minds just can't take it.  Something inside breaks and they snap.  These people try to resolve things and find an outlet for the trauma of their minds and find themselves repeatedly bashing their heads against a proverbial wall.

And when they're at their lowest, when there's not much further down to go, they come to us at an inpatient psychiatric hospital.  Here we control the environment, take the responsibility out of their hands for a time, talk to them, counsel them, prescribe medications.  And these medications often work (it may take some fiddling around to find the right drug and dose for the right person, but it works out more often than not).  They kind of reset the imbalance in the brain and allow people to think clearer, calmer, and more rationally.  They smooth out the edges of emotions so one doesn't soar as high or dip as low.

Mental health.  It's a real thing.  Sometimes all one needs is some counseling, and sometimes it requires medication.  In that regard, it's not really any different than diabetes or hypertension.

-----

Oh yeah, I'm 3/4 of an MD now!  :-D  Unfortunately the other aspects of my life have been less interesting than the things I witness when I'm in the hospital.  Still a few things here and there worth blogging about in posts to come.

Oh yeah, PPACA (aka, Obamacare) survived the Supreme Court ruling.  Thoughts?  Also for another post, lol.

The Past Few Months

It's been a while since I last blogged.  I could easily claim that I've been busy (which I have), but it's just as much my fault for being lazy.  Blogger has changed in this interval time (I kinda like the old version better, lol).  I've seen and learned a lot these past few months in the various rotations I've circulated through.  Each month presented a different slice of medicine.

-----

Family Medicine

Truthfully, this was easily one of my favorite rotations.  I worked in a clinic with a preceptor, no residents on site, and I got to do a lot.  It was almost like a continuation from outpatient pediatrics the month prior and I loved it.

Family medicine is the "jack of all trades, master of none" field insofar as it sees the full spectrum of ages and patients, and can do a little bit of everything but is unable to narrow down into most sub-specialties (e.g. cardiology, pulmonology, etc).  But you see the bread-and-butter of everyday illnesses and do things like lance boils, freeze warts, do a little physical therapy, and things like that.

But the one thing I most took away from family medicine was my preceptor's outlook on life.  He spent his career nurturing his perfect work-life balance, and it was something he reiterated to me over and over again.  He didn't mind earning a little less money than the other physicians in the practice because the flip side was that he got to spend more time with his family and kids.  It all comes down to priorities.

One life philosophy that was parroted by his son one day is, "Have a good day, or not.  The choice is yours."  And he told that to more patients than I could count that month.
-----

Pediatric Infectious Diseases

Peds ID was something I was almost certain I would do coming into med school.  My background almost perfectly set me up for it - a year of public health, focus in genetics and molecular biology, interest in HIV/AIDS, etc.

But then something curious happened.  I loved outpatient pediatrics.  I loved family medicine.  I loved pediatric rheumatology.  I could no longer choose or peg myself down for something so narrow as pediatric infectious diseases with a focus in HIV/AIDS.  I found myself wanted to become more general.

That said, I still enjoyed the month.  I got to know my patients in the hospital (they didn't always know me, several of them being babies or else mentally handicapped).  I got to understand the work-up for an infectious etiology.  And every Wednesday at the weekly conference where all the staff physicians in peds ID got together to discuss the treatment plans for all the patients on service, they would all go at each other.  It was one of the most entertaining, and intellectually stimulating, things to sit through.  I was entertained, anyway.

-----

Perioperative Medicine

Aka, anesthesiology (with bits of trauma and emergency medicine tossed in).  I knew I'd like this rotation.  I liked doing things with my hands and doing small procedures (not surgeries though).  I didn't expect to love it but I did.

In anesthesiology, you put patients to sleep in the OR (operating room), keep them alive throughout the surgery, monitor pain, and wake them up.  Your job is one of the most important jobs because you are directly responsible for someone's life.  You control every aspect of their physiology - their breathing, their heart rate, their muscles (via paralysis), and their consciousness.  My resident asked me, "Who is in the best position to kill the patient?  The surgeon?  No, it's us, the anesthesiologist.  Without us the patient can't breathe.  And if we make a mistake with a medication, the patient may never wake up."

There was a sense of immediate gratification and power in anesthesiology.  I got to put in several peripheral IVs (didn't miss a single one I'm proud to say).  I really liked putting in IVs . . . I got to monitor and chart the patient's course in the OR.  I got to breathe for patients.  I attempted to intubate a few (intubation is quite difficult for me, grrr).  I got to help prep and push drugs that slowed a person's heart rate down when it got too high, or boost a person's blood pressure when it dipped too low, or reinforce paralysis when a person began to twitch in the middle of surgery (always under the direct watchful eye of a physician, of course).

-----

Obstetrics/Gynecology

I . . . didn't really like ob/gyn. I mean, it was okay.  Not as brutal as surgery.  I just don't think I could stand women and pregnant women all day.  The vast majority of the residents are women as well!  That said, I did like participating in vaginal deliveries.  Got to catch a couple babies too!  They're just as slippery as you'd imagine.

The one thing I REALLY disliked about ob/gyn is that you spend almost zero time with the baby once it's out of the womb.  You hand the baby off to the nurse or the neonatologist and don't bat an eye at it again.  I found myself lingering more at the baby's side than the mom's.  Yeah . . . it's a sign.  Babies are so cute (even right after they're born and are all slimy and malformed-looking)!!

One other thing - you don't truly appreciate blood loss until this rotation.  In surgery you think you've seen someone bleed during surgery.  Just wait until a birth or better yet, a C-section.  A woman is expected to lose one liter of blood during that procedure - one liter!  The vast majority of women do just fine afterwards though, because their bodies have spent the better part of up to 9 months prepping for that loss.  Still though . . .

-----

Neurology/Psychiatry

Well I just finished neurology and will be starting psychiatry tomorrow.  Neurology was okay.  I was on an awesome team with great residents and good attendings who taught quite a bit.  But I saw a very small slice of neurology as I was on the neurovascular (aka, stroke) team.

We saw many patients with strokes or suspected strokes.  The neurological deficits are interesting to see when they're there.  What's nice to know is that most people recover and do just fine after a relatively small stroke.  It's the large ones that really take out half your body that're devastating.  There were a few devastating strokes on our service in our short time there.

So public service announcement: exercise some, eat healthy, take your blood pressure/high cholesterol medication if you need them, do not smoke.  A stroke is a scary thing to have happen to you, especially when you're young (less than 65 years old).  There are a lot of things we can do to reduce that risk.

Uncertain Crossroads

Crossroads by ~Nadja18 on deviantART

Last week my application for re-admission to complete my MPH (Master's in Public Health) was approved. Initially I was ecstatic because I had been talking about this moment for over a year, about how I loved/valued the program, etc. Now for the past week or so, I'm not so sure - I've been getting some cold feet and doubting whether I will actually go back and finish what I started. The conviction which I had held for the past 1-2 years is gone. And it all hinges on "uncertainty."

I am uncertain that:
1. I will get funding to finish my MPH (I do NOT want to tack on any more to my growing student loan debt).
2. I really need to finish my MPH to do what I want to do.
3. I still want to do what I had originally set out to do when I began med school.

Here's how those primary uncertainties are being addressed at the moment. 1.) I stand a fairly decent chance of getting funding via teaching undergrad courses as a grad student. It was reassuring that the professor I taught for was very willing to write me a letter of recommendation and remembers me so well. 2.) I do not need to finish my MPH to do what I want to do. Would it be useful? Perhaps, but it depends on what I end up doing. Which brings me to, 3.) Without even realizing, I've changed. I had set out to be the so-called "triple threat," that is the doctor who sees patients, does research, and teaches students. Now I'm not so keen on the research bit, haha. Also I had set out to do ID (infectious diseases), and while that's still on my career list, I've begun to shift away towards primary care or another specialty like rheumatology.

My MPH degree is very specific towards a particularly ID-oriented skill set. With my degree I would be better equipped to understand infectious diseases, conduct laboratory "bench" research, and create surveillance programs relating to infectious diseases and the agents to treat them. And prior to med school, that was one aspect I had wanted out of my career. Now I don't know.

Now a few things are certain and have remained certain (if not strengthened) over the past several years: 1.) I want my career to be clinically focused on treating patients. 2.) I want my career to have a public health/community engagement component. 3.) I want to teach students (doesn't have to be med students). 4.) I want a good work-life balance. None of those require an MPH - or more specifically, my focused MPH program.

So I'm in a bind. Will I regret later down the road for not having finished my MPH? If I get my MPH and never end up going into an ID field, will I feel like I "wasted" a year? I can see myself going either way, and neither road is superior to the other (not really, anyway). I can convince myself to go either way and I've been changing my mind on almost a daily basis for the past week. Ugh.

Talking to one attending physician who basically does what my MPH would prep me to do, he asked me, "What do you want to do?" And I said either peds or something within peds, like peds ID. And he emphatically said that I did not need an MPH to do peds or peds ID, and it wouldn't necessarily help me that much. What matters most is not how many letters I had after my name (so long as I had letters at all); what matters most is talent, hard work, and good networking. That said, if there's something I wanted to do within medicine that requires an MPH (or practically requires it), then I should definitely get it.

Anyway, what do you all think? I've talked to so many friends and several faculty, and I keep ping-ponging between the two options. I can't delay my commitment too much longer, have to make a final decision soon!

Mask of Loneliness

Loneliness by *MikaTrta on deviantART

Of all the ways to express loneliness, why have I chosen a picture of the empty park bench above? The world around it is bright and sunny, the trees and grass a luscious green, people and life moving about in the background. Precisely because it's the kind of loneliness I'm experiencing . . . and have been all along.

That bench is like my Mask of Loneliness. It sits there, alone, in a vibrant world waiting for someone to occupy it and linger for a while. To a passerby it doesn't appear "sad" or "happy," it simply is. Only when one takes pause to notice and contemplate the situation can one appreciate the loneliness. And so too it is with me. My Mask of Loneliness often appears invisible, even when worn directly in front of you. I'm surrounded by friends and peers. I have few enemies and I get along with most anyone. I wear my Mask of Smiles even when I don't feel like it. I can now interact and blend in so flawlessly that you'll probably never notice that I'm alone.

But I notice. I feel the Mask of Loneliness on my face. I'm painfully aware that several of my friends are now married, at least one of whom now have kids. Though I don't show it, I'm actually rather awkward when I'm one of maybe 3 people in a group who're single. And though you don't notice it, I don't really care to hear about your relationship problems with your girl/boyfriend/spouse.

And no matter how much I tell myself that we all go at our own pace, how I still have time, how my busy-ness is only "for now," I can feel this Mask begin to harden on my face. It is, after all, partly my fault. I don't make a particularly concerted effort to "get out there." And the longer I wait, the more excuses I make and the easier it becomes to make them.

Lately I've begun to feel that I'm "undatable." I hung out with Drew on Sunday (he's seeing someone else now, figures) and it was . . . rather awkward. Neither of us had any particularly good conversation topics. We were just on two completely different pages the whole time. I felt like I had become so one-dimensional as the conversation topics I brought back either drew from a subset of things I knew well or otherwise drifted towards the medical. Even I wouldn't date me.

Lol, I suppose I've become more like that park bench than I thought. At first glance, I'm just made of wood - one-dimensional. But if you happen to come closer, you'll see the words etched into that wood and read the stories of my past, present, and future. And it's not like I'm intentionally hiding, I'm right here in front of you! I hope you linger a bit and keep me company, and take from me my Mask of Loneliness.

Until then, may this quote ring true:

"Pray that your loneliness may spur you into finding something to live for, great enough to die for." ~ Dag Hammarskjold

Yes, I've used that quote before in this post (if you recall).