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:

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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).

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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!