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!

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.

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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).

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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.

Last Man Standing

Last Man Standing by *Cute-And-Bright on deviantART

Yeah yeah, I know it's been months since I last posted.  In my defense, it's been such a crazy ride I don't even know where to begin!  This residency thing is no joke, with all the days that I just want to break down and punch a wall.  To anyone contemplating medicine, my advice is: do not do it if you can see yourself doing anything else with your life.

Anyway, I've basically been on 5 inpatient rotations back-to-back, starting with NICU, then wards, then 4 weeks of night shift (6:30pm till 8am), then back to wards, then to newborn nursery (which, despite the benign-sounding name, has inpatient hours - 6:30am till 7pm).  That's basically 5 months straight of working 13-14+ hours a day, averaging 6 of 7 days a week.  I've had to work 19 days straight twice already!  Those 19 days are brutal.  And even that's an understatement.

At the end of each day I'm just exhausted.  I barely have time to take care of errands, much less myself!  My chief residents wonder why I don't feel "happy and excited to go to work every day."  Gee, it's not rocket science.  If you basically work twice the "normal" 40 hours/week and have half the number weekend days off in a month, would you be happy and excited even if it's something you love doing?  Likely not, I think.  It's not that I don't love my patients and families - I do.  They're why I haven't quit (well, one of many reasons).  And there are rare moments of joy in my day, but it's so hard to really feel "happy and excited" when it feels like you're just nose to the grindstone every single day.  At least I'm not a surgery resident . . . I'd probably have quit or committed suicide by now.

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On another depressing note, I think I may have lost a friend.  Even back in June I hadn't chatted with him in like a month or so.  Now it feels like all communication has been cut off.  He doesn't respond to Facebook messages, texts, IM's (actually, he doesn't even show up on IM or Skype anymore, leading me to think he has either deleted or blocked me), Tumblr messages, etc.  A couple weeks ago I noticed that he unfollowed me on Tumblr and blocked me, such that none of his posts showed up on my dashboard.

I'm at a loss for words and thoughts.  I don't know what I did.  I know he has a boyfriend who he's quite involved with, is busy with school and work, but it just doesn't explain why he doesn't respond to any mode of communication.  I even called him once or twice and left a voicemail.  I don't know what to do.  I haven't really tried to communicate with him much over the past several weeks, to give him some space.  I'm just at a loss as to why he cut me off like this in the first place.  Maybe it's partly cuz of what we did when we met in person, and given he has a boyfriend now?  Idk.

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On a happier note, I was lucky to have Thanksgiving off so I could go visit my family (I work both Christmas and New Year's).  It's always nice to see my grandparents and my little cousin.  It's such a world removed from work.

And now I'm on vacation visiting my brother in Texas for a few days.  Huzzah!  It's nice to sleep in.  :-)  I'll try to find time to post some pics later this week when I return to my apartment.  After 5 blocks of inpatient rotations back-to-back, these 2 weeks of vacation are sooooo well-deserved.  And I fear it'll fly by quicker than I can blink . . .

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.

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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.

All the Babies!

Sorry for the lack of posting, it's been quite hectic (but manageable, sorta).

I just finished a block of genetics subspecialty outpatient clinic.  Genetics is a fascinating subject as always, and I must say, this block reignited some of my former interest in the field.  I'm not sure if it's enough to make me want to pursue it as a fellowship and career, but it's back on the radar, lol.

In the middle there I did a week of nights.  I got pretty good at assessing normal healthy newborns, haha.  But man there's such a learning curve when you haven't done it in like 2 years!!  I was lucky enough to get some sleep most nights, but the schedule of nights (6:30pm to 7am) is still rough.  Takes a while to adjust and adjust back.

Now I'm in the NICU (neonatal intensive care unit).  I was terrified of it at the start, but it actually turned out to be a really nice rotation.  I'm definitely learning a lot about taking care of premature babies, often with other health problems too.  After a while they mostly become "feeders and growers," that is they're just eating to gain enough weight to go home.

Anyway, up until now, the majority of my experience has been with babies.  All the babies!  Haha.  They're pretty cute, I must say.  One just has to get on the good side of their territorial and protective nurses, lol.

I've had the privilege to see some weird and rare things, which is really cool.  I mean things that we should not be seeing because current routine medical care should have picked up these things earlier, but there are always babies that slip through the cracks.  It's quite unfortunate when a baby could be otherwise perfectly normal and healthy sees us and by then it's too late to stop the worst of it.

Anywho, enough rambling.  Must sleep.  6:30am to 7pm schedule is pretty rough too.  Unfortunately that's my schedule for the next several months . . .  As one of my senior residents said to me, "Oh wow, I'm sorry.  But the Lord doesn't give us more than what we can take."  I hope she's right.  Still, I'm soooo glad I'm not a surgical resident.

An . . . Interesting Start

A few updates are in order I do believe, lol.

1.  Moved across the country!!  Changed my driver's license, car registration, and car plates to this new state.  All within 3 hours (the DMV lady who helped me was SUPER understanding and helpful).

2.  Visited my relatives!  I had my car shipped to my grandpa's place ahead of me so I didn't have to drive across country.  That would've been brutal!  Visiting relatives is fun, I like hanging out with my little cousin here.  My grandpa is just now really seriously starting to push that I be in a relationship and hopefully marry in the near-ish future, before he gets too old and such . . . sigh.

3.  Moved into a new apartment!  It's nice having a 1-bedroom apartment to yourself.  I actually think this apartment is somewhat larger than my old 2-bedroom, 1.5-bath that I shared with my roommate in med school for 4 years, lol.

4.  Met my co-interns!  My co-interns are all super nice and funny people.  And they don't take themselves too seriously, which is good considering we're all pediatricians, haha.  Definitely a group I can see us bonding together and hanging out with during our (borderline non-existent) free time.  Only thing is that most (all?) of them are either married or in long-term relationships, so the significant others will be a major factor in our social gatherings.  I really need to get on that . . .

5.  Had an . . . interesting start to orientation.  We had PALS (pediatric advance life support) training the first 2 days.  On the first day, 6 of us (half the intern year, mind you) came back from lunch about 5 minutes late and the mean stickler instructor lady refused to let us back in.  She told us we had to reschedule and pay for it out-of-pocket . . . that's $250!!  She was totally being unreasonable.  Our program coordinator tried her best to help us sort out the situation and when the Chair of the Pediatrics Department found out how poorly she treated us, he was furious.  It's likely that the program won't be using them next year . . .

6.  Haven't talked to my friend (mentioned in post here) for a LONG time.  I miss chatting with him.  He's out of school for the summer and started a summer job that leaves him tired at the end of the day.  I frequently see him online for short periods of time, but he rarely responds to my messages or texts anymore.  In fact, we haven't chatted in almost a month!  Not for a lack of trying on my part.  I know he's also busy with a few other things, including hanging out with his close friends who're also out for the summer, but still - it kinda hurts.  It really does feel like he's ignoring me as much as he can.  I've decided to just back off for the next few weeks/months and see if he comes around.  Hopefully so, because I do miss chatting with him.  :-(

Phew!  I think you're more or less up-to-date now.  Why're all the girls I'm interested in either married or in long-term relationships, and all the guy's I'm interested in so far away (aka another state/country)?!?!  Sigh.