Resolute

Embrace it. Live it. Love it.

I don't wanna wait

ME

Hey! Dude! Your name! You're missing a 'der'!!

DUDE

What do you mean?

ME

Because your name is James van Beek. And that actor from Dawson's Creek is named James van der -- oh, you were being sarcastic.

DUDE

No really - you're the first person to ever point that out. Ever!

ME

There you go again with the sarcasm.

Let it snow

To those who are wondering about the Boston vs Mayo question, I ended up choosing Mayo.

I choose Mayo because it is the stronger program. The last time I was in Boston, I was very aware that unless you were at THE Mass Gen, your hospital was viewed as inferior. The other hospitals were just OSHs, sending their patients to MGH, or taking care of MGH patients who had stabilized and needed to be moved on out. And minus one Amy (who will be at the aforementioned MGH), I wouldn't know anyone in Boston. So heck, what's the difference? Me and my television can become even better friends over the next several years in Rochester, middle of nowhere, Minnesota.

And that's only if they'll have me.

Many thanks to everyone for contributing to the discussion. I'm very aware that Boston has far more real-life things to do, and infinitely more foodie places and crazier sports fans. But Mayo is Mayo, and if there's one thing I want to be in three or so years, it's a damn good psychiatrist. And that means seeing the whole spectrum of patients. Being at the hospital where the OSHs refer patients to. Even if it means lots of snow and no romance.

So if I end up at Mayo, I'm going to expect you all (especially everyone who voted for Mayo), to send me care packages filled with Asian foodstuffs.

-------

ME

If I end up in the middle of nowhere, will you send me food? And mail out a couple of boytoys every now and then?

THE AFOREMENTIONED AMY

HAHAHA, I'll get you an inflatable.

ME

That'd be great, thanks!

Do they know it's Christmas

I love the Boston Pops. And I love that they're able to carry on just fine with a hotshot celebrity guest conductor who clearly had no idea what he was doing, but faked it pretty well. Hahaha, I didn't know whether to cringe or applaud.

They were conducted by Shaquille Freaking O'Neal!! Who came up with this idea?? Hahahaha. I imagine the conversation went something like this:

Man, did you see that Celtics game?

Yeah, Shaq is awesome!

Hey, we should have Shaq come in and conduct a piece for our holiday concert.

Why??

Why not? Besides, it's Christmas.

Because, at Christmas, anything is possible.

Merry Christmas, everyone! Stay warm and cozy and full of hot cocoa and good cheer! I'm sending you all very merry tidings and lots of love from sunny California.

Though, I gotta admit that I'm kinda missing all the winter wonderland-y Chicago goodness today, as blasphemous as that statement may be.

More than words

At a recent interview, they asked us to go around and introduce ourselves, with a one-word description of ourselves. I was first.

Hi! I'm Michelle, and I'm wholesome!

Wholesome.

Of all the words in the entire English language, I choose "wholesome." Not gregarious or hardworking or efficient or responsible or dedicated or any of the other various words that are all interview-stamped approved. Heck, someone said he was "laissez faire," so technically, I could have said something in a different language as well. Even MORE words I could have chosen from to describe myself.

Nope, I chose "wholesome."

Of all words. Wholesome.

I basically branded myself as a terribly boring homebody who doesn't know how to let her hair down and have a night on the town.

The one upside? One of the applicants said she was "sacrificing." Which, I don't think is a good thing to claim unless you're Jesus. So at least "wholesome" was better than that.

Here with me

I first saw Love Actually with J when it initially came out. And then I saw it again with Lisa. And then every subsequent Thanksgiving and Christmas, I'd watch it another three to five times, sometimes deliberately, other times just barely knowing it was playing in the background. It's the quintessential holiday movie, the go-to that will make you cry and laugh and nostalgic all at once.

Anyway, whenever I think of Love Actually, I think of the Marc + Juliette (+ Peter) story. Because it's so sweet in its angst. Although, I wish she hadn't kissed him. That part rang a little false to me. Even if it was to cap off the end of his love story with her. She shouldn't have kissed him.

Regardless, I love the scene where she comes over asking for the wedding tape, and then as the video plays, she slowly realizes that he's been mean towards her and avoiding her because he's actually madly in love with her. So he leaves, because what else can he do in all the awkwardness of that moment? And then he does the swirly do-I-go-back-or-do-I-leave dance 3.5 times outside his entrance, before eventually pulling his sweater zipper up, and deciding to go on his way, as the beginning strains of Dido's song starts to play.

"It's a self-preservation thing, you see."

Sigh, it still breaks my heart, every single time.

[Click here to play scene. Really, it's so so amazing, you must watch it.]

Again, sigh. So good. Such perfect editing with the music and the pulling of the heartstrings and the gorgeousness of London in the background.

I am convinced all the half zipper sweaters that became so popular made their comeback because of this scene. Heck, Lisa and I bought J one of those sweaters for Christmas '03. And he would do the manly zipper pull-up every now and then for us. Sadly, it was always for laughs, as it never quite had the same sexy resonance as it did in the movie.

This post has no point. Except I saw a promo for The Walking Dead and the lead of that show plays Marc in Love Actually, which reminded me of this scene. And that reminded me of all those times J did the stupid zipper pull for our amusement. Man, I miss Lisa and J. I miss spending the holidays with them, doing silly things of absolutely no importance, just hanging out and enjoying each others' company.

I miss them, and I wish we weren't so far-flung across the country.

Dilemma

I have a dilemma and I need you all to weigh in to help me make this decision. I have 2 interviews on the same day, and unfortunately since I can't cut the baby in half (a la King Solomon), I need to decide which one to go to.

MAYO CLINIC

• Pros: really awesome program (ranked #8 for psych), will get amazing training and will be able to diagnose and treat EVERYTHING when I finish, they're paying for my hotel, flights will be ~$120, they've also been actively recruiting me.
• Cons: it's in freaking Rochester, MN. Seriously. SO MUCH SNOW. SO MANY MARRIED PEOPLE.

BOSTON UNIVERSITY

• Pros: good program (unranked, but highly regarded), it's BOSTON!!!
• Cons: got my invite now (read: I'm much lower on their prelim rank list), flight ~$350 (in addition to the $150 fee from American Airlines to cancel my flight to Mayo), hotels are also $200 a night - and I don't know anyone who can host me (J&V will be on their honeymoon). ACK, SO MUCH MONEY I DON'T HAVE.

So now, where do I go? What do I do? Vote now, because I'll need to tell them later today. Because while Boston just gave me the invite today, they also want me to RSVP by the end of the day as well. So considerate.

--

Also, I apologize if this post makes me sound like THAT guy from the forums. You know, the person who agonizes over whether to go to Mass Gen or John Hopkins or Stanford, when in reality, he's just trying to brag about all the awesome places he's got. That's not my intent at all. These two programs were definite surprises for me in that I didn't expect to get invites from them (in fact, my program director told me NOT to apply to these places as it'd just be a waste of money), and now I honestly don't know how to choose which one to go to. Anyway, just wanted to clear the air because I really don't mean to be Douchey McDoucherson, and I apologize if the above post came off as so.

We go together

First monthiversary together in a while.

I didn't realize how much I've missed him.

Back to December

I told him I loved him, on our last night in Europe. We were in Rome, strolling along the Tiber River, the gorgeous St. Angel's Castle lightly lit behind us. I told him I loved him, and all he could say was "okay." He was my first big crush, and my first big heartbreak. We were both sixteen.**

Fast forward ten years, and here I was, about to see him again.

And standing there, on the doorstep to nostalgia, I was more than aware that in the game that we all play in our heads - the game where you determine who's done better for themselves since you'd seen them last - he had tallied up far more points in the WIN column than I had. He was MD/PhD at Harvard, discovering the better cure for tuberculosis, all while going on mission trips to South Africa. And he was getting married to a girl at Harvard law. Whom he'd dated for the last six years of his life. And along with paying for the wedding all on their own, they had also just bought a gorgeous apartment in the cutest little neighborhood Boston has to offer. Win win win.

Me? I couldn't even muster up a 2nd place win in the looks department, since I was tired and haggard from traveling all day after being completely demolished by my ICU test and OSCE. And I was very aware of the giant pimple just waiting to burst, conveniently located exactly right between my eyes, that I could swear pulsated on its own volition.

Really, just shoot me now.

But I rang the doorbell. And he and his very adorable fiancée came to greet me - he taking my suitcase up the 5 flights of stairs, and she taking my coat. And even though I hadn't arrived until midnight, thanks to layovers and delays, we stayed up until 2am, catching up and getting to re-know one another.

It could have been awkward, but it wasn't. And that's to his credit. Even after the Roman disaster, we had stayed friends. Mainly because we were forced to, as the powers to be decided that we would continue to be standpartners for another 2 years, but also because he made an effort not to make things awkward.

So now I'm going to his wedding. And I'm determined to not make it awkward. Because it's not, and it shouldn't be.

---

**Man, re-reading that first paragraph, I'm realizing that it's very similar to something hackneyed Taylor Swift would sing about. Seriously, you could probably sing those words to Love Story. "We were both young when I first saw you..." Anyway, I apologize. Teenagers and their heartbreaks, you know.

I'm missing you like candy

As some of you may know, I have a ferocious appetite. My friends are always amazed by how much I eat, and what I eat. I am not one of those salads + fruit kinda gals. I like my meat. And I usually like it medium rare.

And when I'm studying, the amount of food I eat goes disproportionately up up up. Disproportionately, because well, it doesn't make any sense; I'm sitting at a table studying, and presumably not using up many calories at all. But I eat, and I eat a lot of crap like Twizzlers and chips, because heck, if studying is not a time for comfort food, I don't know when is. So yeah, I eat my weight in potato chips, chocolate, candy, and wash it all down with some caffeinated soda.

So this morning, I realized that my supply of Twizzlers was getting dangerously low, and it was starting to affect my practice test scores. So I rang up my mom, who was conveniently at the grocery store, to ask her to bring some back for me.

MOM

Twizzlers? More??

ME

Yeah, I only have like 2 sticks left.

MOM

I can buy you some healthier snacks, like grapes or bananas or something....

ME

[bratty]

No. I want Twizzlers!

MOM

But...see, the thing is...Michelle, you're getting a little chubby.

ME

[loud audible gasp]

Mom!! Did you just call me fat?!?!

MOM

[defensive]

But it's cute! [realizing that's the wrong thing to say] I mean, I'm just joking!

SISTER

[who is with my mom, cracking up in the background]

Hahaha - no you're not. And only babies can be chubby and still cute.

ME

Whatever. I still want my Twizzlers, thanks. Cherry flavor, please.

I'm taking Step 2 soon. And apparently, the only way I'm going to pass is if I'm 20 pounds heavier. So bring on the Sunkist. And definitely bring on the Twizzlers.

A little fall of rain

This was my view of Portland, on my way up to the hospital via sky gondola. Yes. A sky gondola. Like a Disneyland tram ride. Or a ski lift.

Ladies and gents, we took a freaking gondola to get to the hospital. Talk about fancy.

Also, it was very gray. I don't think it stopped raining/drizzling/whatever-they-call-that-constant-damp at any point during the three days that I was there.

**Shoutout to the very awesome Nancy (NU c/o 2009) for not only hosting me and picking me up at the airport and then personally driving me to my interview and thus was late for her own clinic, but also for taking me to THE BEST TAPAS RESTAURANT I've ever eaten at. Yum. Man, I'm seriously thinking about ranking OHSU higher than I would have initially thought, purely for the food. For THAT food.

Lifelines

[while taking a tour of the premises]

PGY-2

So here is the Institute for Genetics - you'll only go into this building for didactics. I don't even know if that's the actual name...I just know you go in the doors, go up to the second floor, and we're in that giant lecture room. Upside is, the seats are real cozy. Oh, and fun fact! The building is shaped like a chromosome!!

APPLICANT 1

No way!

PGY2

Yeah - if you were to look down on the building from space...or an airplane, you'd see the legs and the centromere and all that stuff.

ME

Haha, so if you guys wanted to expand the building, you could change the focus to Huntington's.

APPLICANT 2

Or Fragile X!

APPLICANT 3

Or spinocerebellar ataxia!

APPLICANT 4

Oh man, this is TOO much nerd humor. You guys need to stop.

APPLICANT 2

Awww, way to be the stop codon.

APPLICANT 1

Actually, is this the only building? Or is there a sister building somewhere?

APPLICANT 2

Haha, like the daughter chromosome?

APPLICANT 1

Well, if there's only 1, this building is like Turner's syndrome, right?

PGY-2

I'm speechless. Absolutely speechless.

I'll just say goodnight...(part 2)

Seriously?

I mean, really. Seriously?!

At Program That Shall Not Be Named, there were 25 applicants in one day. In other words, a crap load of people. It was nice in some aspects, because I ended up seeing a lot of applicants that I had met before. And it's always nice to catch up and see how the interview process has been going for them. And then it's not so nice, because you end up seeing a lot of fellow applicants from before. [See prior post on slightly strange applicants.]

So anyways, the program director, the chair, the director of this and the director of that, all gave us welcome spiels, and it was all very nice until they asked us to go around the table, introduce ourselves, say a little bit about ourselves, and a quick snippet of "why psychiatry."

We started going around the table, and then I quickly realized I would be giving my spiel after my friend sitting to my right. I would have to give my bland "I'm just a medical student who was fortunate to live in a house all my life" 2-minute intro after THIS guy.

I never thought I'd ever be ashamed of having a roof over my head. Until now.

Seriously. Why, why, why!

I should have just walked out the door, but I actually really really really want to go to this program.

Like, with a cherry on top.

Man, what luck.

What crap luck.

Freak the freak out

There are a lot of interesting characters that you meet along the interview trail way. And while most of them are pretty normal and awesome, there are a few that just seem a little bit...off.

The Gunner Applicant: At one program's pre-interview dinner, one applicant sat down next to one of the chief residents, and proceeded to tell him all about his CV, while the rest of us tried to interject the typical questions about living in the area and attending/resident relationships. Then, halfway through the dinner, he stood up, took his dish and without so much as an adieu, moved to the other table where the other chief resident was sitting - and per the grapevine - he then proceeded to repeat his entire resumé to that table.

The Sexual Harassment Suit Waiting To Happen: While we were going on a tour of a particular program's amazing facilities, we walked by what our tour guide fondly referred to as the Bariatric ICU, since that's where all the CPAP patients go after surgery due to their "impressive girth," she said. This particular applicant then nudged me and whispered, "I have impressive girth. I can show you later tonight." I was so flabbergasted I didn't know what to say, so I just replied, "Erm, you don't look that overweight to me." To which he said, "Oh I was referring to something else..." I chalked that up to him just being awkward - he was from a rather impressive and prestigious East Coast medical school after all, and we all know that the more prestigious the program, the more awkward the students - but then he continued to make comments laced with sexual innuendo. One conference room didn't have enough chairs, so he made the offer, "The pretty ones can sit on my lap...it's nice and hard." Also, he winked. A lot.

The Possible Serial Killer: She was super quiet throughout the entire interview day, choosing to merely observe the conversation instead of being part of it. Which would be fine, except there were only four of us, and her silence and lack of smiling was uncomfortably obvious. At the end of the day, she finally said the first words of the day to me, when I mentioned that I was taking a cab back into the city. Could she share a cab with me? Of course. So we got into the taxi together, where she proceeded to mouth off on everyone we had met that day - from residents' perceived dirty looks, to subtle insults the program director had apparently directed towards her. It was all the stranger because she had seemed like such a quiet plain Jane, and her taxicab rant was filled with f-bombs and see you next Tuesdays.

The One Who Personally Needs Ritalin: So I feel a little bad posting about this applicant, because he's actually quite nice. Very pleasant and easy to talk to, and I wouldn't mind being his co-resident. But when we went on a tour of the psych hospital - full of locked doors and doubly locked units - he would wander off and get distracted by random things, so that our tour ended up being a huge game of hide and seek. He got lost not once, not twice, but THREE times on our hour-long tour.

And of course, at the interviews where there's no one outwardly weird, I start worrying that I might be the token strange applicant. Because there's always gotta be one. And if you can't identify that person, it's probably you, right?

J'adore

Reason #37859 why I desperately want to come back to SoCal:

Macarons. Lots and lots of macarons.

Sigh. I could eat them all day.

And I love that there's a specialty store in LA dedicated to selling just macarons, seemingly personally catering to my every macaron need and desire.

I'll just say goodnight, and I'll show myself to the door

Going into psychiatry, you know you're going to hear some crazy stories. That's part of the reason why I like asking people why they ended up in the field. Everyone has such great responses - whether it be memorable patients or memorable personal experiences. But I've only ever asked residents and attendings that question, so I've never really heard my fellow applicants' stories, even though that's one of the standard interview answers that we know we're required to give.

I recently had to participate in a duo interview. It was me and this other applicant (hence the "duo" part of the duo interview). Both of us simultaneously being interviewed by the chairman of the program. He quickly outlined how this was going to work. It was to be a conversation, so he wanted us to start off with some introductions and how we ended up sitting here in this chair, in this office, in this suit, and this particular moment in time. And then we'd go from there, he said.

Easy peasy.

I had gotten this question multiple times already, so I went into almost an autopilot mode. My name is Michelle. Born in Arizona. Moved to California when I was little. Essentially raised by my grandparents. Went to Northwestern for the HPME program. Yada yada yada.

It was the typical applicant response, and I knew it. But this was just fodder for further conversation, so I didn't think it mattered if I hadn't seen my first psychotic break patient by age 7.

I smiled, indicating that I was done, so then my fellow applicant started his story.

"So my parents are very religious, so I was born and raised basically in a LDS compound. I was homeschooled, forced to wear hideous clothing and eat very bland food, and every day I had to follow religious doctrines that I didn't necessarily believe in."

I was impressed. This was a story I wanted to hear. It was intriguing.

He continued. "So given all that, I ran away at age 15. And hitchhiked my way to Philadelphia where I busked to feed myself. "

Cue open gaping mouth amazement.

"Of course, that didn't lead to a whole lot of money, so I worked a series of very odd jobs as well. I was a ladies nylons traveling salesman at one point. But anyways, I ended up being a janitor in a mental health hospital, purely because it meant I could get out of the snow and wintry conditions at the time."

Cue realization that this guy is the next Lifetime movie special.

"After a few months of working there, the attending psychiatrist actually took an interest in me, and after hearing my story, instead of being impressed as I thought she would, she essentially yelled at me and asked me what I was doing with my life. And that really resonated with me. So I got my GED. And I applied - and got! - a full scholarship to a small community college. And from there I went to Temple University Med School. And you know, my experiences in the mental health institution always stuck with me. The psychiatrist's words always stuck with me. And so now I'm here. Where I will hopefully get great training, and I will be able to work in community psychiatry and help out the homeless, seeing as I used to be one of them."

He finished his story to complete silence. I didn't know whether to stand up and give him a standing ovation or to start slow clapping, that's how good his story was. I might have had tears in my eyes at the conclusion. And I wanted to know more. That's when I quickly realized that my application had basically been tossed out the window. I might as well not have been sitting there. Where was the door?, because I could let myself out. This program was definitely gonna take him over me.

I never stood a chance.

That's not my name

I'm interviewing at Program That Shall Not Be Named this Friday. And minus the very first interview request email, all of the follow-up emails have addressed me by a different name. Dear Melissa. Dear Ms. Lupsa. Dear Dr. Tung.

So now the real question is, when I show up this Friday, what name do I check in with? Because frankly, I have a real fear that my real name might not be on the list anymore. I'm very strongly tempted to introduce myself as "Hi, I'm Melissa Tung Lupsa - but all my friends call me Michelle."

Actually, now that I think about it, the first interview request email just addressed me as "2010 Interview Applicant."

Don't stop believing

Well, now we know that it's not just all post-production. Glee is just as good singing live. This was amazing. Sing it, Miss Amber Riley - you show Simon what a fool he was for passing you over on American Idol.

I should also be studying, instead of blogging and youtube-ing. Bleh. Don't stop believing, right?

My kind of town

So during my travels, I've taken to asking taxi drivers about the city I'm visiting, to get a better idea of what's there, what the locals tend to do, where I should visit, so on and so forth. All the cabbies have been super effusive, heaping praise over their respective fair cities. And then I got to Boston.

ME

So sir, how long have you been in Boston?

CABBIE

Too long. Too long.

ME

Aw, you can't mean that. You don't like Boston?

CABBIE

Well, Boston's fine. It's okay, you know? But I've been to a lot of other cities - New York, San Francisco, Atlanta, Chicago - oh Chicago! Now, THAT'S a great city. Beautiful, you know? Where you flying in from?

ME

. . . um, Chicago.

CABBIE

Chicago! My beautiful Chicago!! Why are you here? I turn this car around and take you back to the airport, yeah??

ME

Haha, no no. Just onwards to the hotel, thank you.

CABBIE

You're crazy for choosing Boston over Chicago. Crazy.

Raise your glass

Celebratory welcome-back-to-LA/post-interview drinks with my boy at Urth --

We both asked for swan designs, but apparently he got the ugly duckling.

The only exception

I don't quite know what to think.

I interviewed at a pretty prestigious program recently, and man, I was super intimidated by all the Ivy Leaguers in attendance. Because let's face it - for all that the Northwestern faculty says about Northwestern's name getting us places, it really doesn't amount to much.

So yes, I'll admit it - I was going in with a major inferiority complex. Then, during one interview with an attending, he basically told me that my scores and resume were crap, and I was not the typical applicant they usually interview. Cue total and complete deflation of ego. However, he continued, my personal statement was so well written, the committee is convinced that I'm going to write a book at some point in my career, and they would like for it to say that I went to Northwestern University Feinberg School of Medicine, and trained at [insert their program name here]. In fact, the attending basically promised me a book deal if I were to do residency there, even though I'm pretty sure he has no say over in the literary world, no matter how much of a hotshot psychiatrist he is.

So does that mean they want me? Or they don't? Or that it's all contingent on me securing a book deal within the next 3 months?

Hands all over

My neighbor nudged me awake, "Hey, there's something going on up there." I nodded, still half-asleep, my headache still raging, and put my head back down on my tray table. "Hey, hey," he nudged me again, "Shouldn't you go do something?"

He had seen me reading my Step 2 Secrets book prior to takeoff, and so of course had asked me all about medical school, how many months it would be until I would officially get my M.D., and then proceeded to describe his chronic constipation to me in excruciating detail. I finally lied and told him that I had a terrible hangover when really, all I was was tired, just so that he would stop telling me his vomit-inducing stories. And now he was nudging me. Poking me. Loudly ahem-ing at me.

There was a bustle of commotion at the front of the aircraft. And then came the announcement overhead that I was dreading. "If there is a medical doctor on board, please identify yourself and come to the front, thank you."

I stayed in my seat. I wasn't a doctor - I was just a medical student. And god knows what was going on. What if I couldn't do anything? Or worse yet, what if I did something wrong?? I could barely remember my BLS training. Was it 30 compressions and 2 breaths, or was it just continuous compressions now? I wasn't equipped to help out. Or at least, that's the excuse I told myself.

My neighbor stared at me, judgement written across his face. "I'm not a doctor yet!" I protested meekly. "I'll go if there's no real doctor on the plane," I promised. But as the seconds ticked by, it became evident very quickly that there was no real doctor on the plane. My neighbor just continued to look at me every now and then, and although he didn't say anything, I could hear him going tsk tsk in his head. The flight attendants were now fumbling with large headsets, trying to connect to a medical center on the ground. And then, overhead again, another request, "If there are any medical personnel on board, we'd appreciate your help at this time."

I swear my neighbor's head snapped so quickly to look at me again, he must have pulled a muscle. I unbuckled my seat belt and made my way to the front of the aircraft.

There, a woman was protesting that she didn't need anything, that she felt fine, that she didn't need the oxygen mask that an older woman was trying to slap on her face. Another woman was trying to take her blood pressure, but the cuff was inside out. And in the seat next to the patient were stethoscopes, reflex hammers, pen lights, tongue depressors, IV tubing, glucometers, bandaids, and everything else you could possibly imagine. It was as though a doctor's office had regurgitated its entire contents onto the unwanted middle seat. And now this older woman was trying to place AED pads on the patient.

And then, somehow, someway, my training kicked in, and I thanked my physical exam instructors for forcing us to go through the SEGUEway at every patient encounter. I stepped in, quickly got a history from her, as I took over blood pressure duties from the overwhelmed retired nurse who had come forward. She had gone out drinking the night before, had way too many drinks, had thrown up way too many times, and was late for the flight, so she hadn't had anything to eat or drink all morning. No past medical history except for anxiety. And maybe some possible claustrophobia. And so when the plane took off, she got a little anxious, then realized she forgot her Xanax in her carry-on that was now out of reach, and then started freaking out more. And that's when she started hyperventilating, and then passed out for maybe a couple of seconds.

I immediately took off the oxygen mask, and waved off the woman who still wanted to shock the patient, for some reason. "She needs fluids," the retired nurse kept interjecting, her own anxiety projecting onto all the flight attendants. "Let's put an IV in her!!" The flight attendants all nodded, and handed me a 500cc bag of normal saline, along with the IV kit.

I haven't put in an IV since Intro to Clinical Clerkships, which was less than a year and a half ago, but might as well have been a lifetime ago. And although I might try to forget it, I remember that I pretty badly bruised up my IV partner. And I was still trying to figure out the history and the best next course of action. I looked at the patient, worried that she could see the fear in my eyes. "Are you nauseous, or do you think you could drink something?" She nodded at me. And with that nod, the nurse started yelling out commands, "Let's get her some water!" "Actually," I interjected, "Let's get her some orange juice."

She was fine. More mortified than anything. Her blood pressure was low (90/60), she was breathing a little fast, and she was a little tachycardic - although I couldn't be positive that I wasn't just feeling my own pulse. The color was coming back into her face, and like she said, she felt fine.

The head flight attendant looked at me. "Do we need to make an emergency landing?"

"No no," I replied, hoping with all my might that I was making the right call, and that the woman wouldn't pass out again. "She's just a little tachy, but I think --"

"SHE'S TACHY!!!" one of the flight attendant freaked out, before the other flight attendant quickly reassured her, "That just means her heart rate's a little fast." "Oh," said the first flight attendant, now considerably calmer, "I thought that meant she was having a heart attack or something like that."

Things now under control, I went back to my seat, telling them to come get me if anything else happened. Nothing else did, thank the lord. And once we landed, she was whisked away in an ambulance. I grabbed my carry-on, and as I de-planed, one of the flight attendants pressed a few coupons into my hands - and now I can pay for a round of alcoholic beverages for everyone on my next flight!

Only girl (in the world)

No way! his fiancée laughed, shocked by his complete lack of relevant pop culture. He blushed, embarrassed by his obvious obliviousness, but still genially helping me tell the story.

Six or so years ago, he was part of the Welcoming Committee for his Yale college. Everyone was interacting and talking and eating munchies, but there was a girl sitting off to the corner. People would periodically look over nonchalantly (or so they thought), but no one was really talking to her. So Jason, being a good committee welcomer and not knowing what was going on, went over, sat down and struck up a conversation.

JASON

Hey - I'm Jason, what's your name?

GIRL

Oh it's Sarah.

JASON

Awesome name! How're you liking Yale so far?

GIRL HENCEFORTH TO BE CALLED SARAH

Oh it's good. My roommate seems pretty nice.

JASON

Oh good good! ...Um, so what do you like to do for fun?

SARAH

Oh I ice skate.

JASON

Very cool! There's an ice rink near me - Escondido...I don't skate, but I've driven by it a couple of times.

SARAH

Oh yeah, I've skated there a few times.

JASON

Nice. What else do you do?

SARAH

Um....I play violin.

And with that, Jason was off, talking about everything and anything from the Suzuki Method to orchestra opportunities at Yale to favorite composers and songs. She nodded and mmhmm'd along, glad to be talking to someone. They chatted for a little bit longer, and then Jason noticed something from the buffet was low, and excused himself to go replenish the spread.

And that's when his friends came over to congratulate him on his cojones.

You see, Jason had been talking to THE Sarah Hughes - just a year out from winning the 2002 Olympic Gold Medal.

We laughed as we finished telling the story, probably a little louder than we intended, drunk on friendship and white wine.

Well, his fiancée laughed, wiping tears from her eyes, I guess I should be proud that you didn't mention Michelle Kwan when you were talking to her about ice skating. Could you imagine? 'Oh you ice skate? Don't you love Michelle Kwan? - so sad that girl has never won gold!'

No hands

"Michelle?"

I looked up and smiled brightly, "That's me!"

I had done my stalking the night before, so I recognized him from the program's website. I was apparently meeting with the residency director first. "Dr. Waggert - so nice to meet you!" I stuck out my hand, pleased that I was able to show him that I had done my research, that I knew who he was.

He stared at my hand, mumbling and stumbling over his words. "I- I uh, no - I um, no - uh, I uh, I-don't-shake-hands. Mmhmm, no hand shaking. No no." He shook his head at my outstretched arm, as I hastily processed what he was saying to me and withdrew the offending hand away.

I followed him into his office, still completely taken aback by that exchange.

But it only got worse. Much worse. He asked me ridiculous questions - about policies the nation should enact to protect the environment, to decrease our dependence on fossil fuels. And then he started asking me about Northwestern's psychiatry program. How many attendings we had. What type of research they were doing. What papers had been recently published by Northwestern faculty.

And the whole time, he was sitting there, blatantly reading my application for the very first time.

Then when it came time to dismiss me, he didn't shake my hand, but instead said, "Well, we were very impressed by your application, and we hope you will consider our program. Nice meeting you again, Melissa."

I smiled politely. "It was a pleasure meeting you too sir, and just so you know, my name is actually Michelle."

What's my name

I think a residency program just broke HIPAA by telling us that there's someone quite famous in their world-renowned addiction program right now. Especially when all their clues rather ostentatiously and obviously point to a Disney child star.

I did love that my fellow applicants immediately thought Lindsay Lohan. (Which is wrong, just in case you were wondering.)

Maybe I do want to come here after all!

Lose my head

I haven't been blogging too much substance lately, and for that I apologize.

I could give you a million excuses - SICU's draining (emotionally and physically), studying's mindless, interviews, interview jitters, interview stress, not getting interviews stress - but at the end of the day, I know that my posts have been bitter and few.

Big shout out to the boyfriend for being so understanding, so good at the whole listening bit while I cry and rage against all my perceived injustices, all while he's on a notably difficult month of cardiothoracic surgery.

Big shout out to my family for keeping me fed. Thank you to my momma for making sure my fridge is always stocked with something homemade (and therefore delicious). No thank you to my momma for keeping me so well fed that I'm no longer able to zip up my suit skirt all the way. Thank goodness for longer suit jackets that cover up less forgiving figures.

Post on the way about my most recent interview - let's just say that it was a foray into awkward and then even more awkward. And then I'm off to Boston and Phoenix, before bringing it all on home to my glorious southern California.

See you on the flip side.

Forget you

You know, I probably would have thought this was so romantic circa 2006, but today, when I was reading it on PostSecret, all I could think was that this card is selfish.

What if the girl has moved on with her life and is done with you, wants nothing more to do with you? And now you're just gonna show up on her door and be like, marry me? The fact that he doesn't know if he's too late, means that he hasn't talked to her, doesn't know what's going on with her life. And he wants to marry her? No, he wants to marry some ideal that he's created in his head. Ugh, and that whole "I'm ready" makes it seem like he's the one holding all the cards, and now that he's ready, she'll just jump into his arms.

I hope she turns him down. Girl power!

I guess I've become very jaded when it comes to romance. And that makes me feel old.

Start me up

Pansy.

I hate that term.

It irritates me to no end when guys use that term to describe other guys. And of note, it's only ever guys who do this. No girl ever calls another girl a pansy. And no girl ever calls another guy a pansy. Nope, it's just the boys insulting each other.

"Oh look at that guy carrying that girl's books."

"Oh man, what a pansy."

"Ha ha ha!"

And then they do that annoying thing where they walk by the aforementioned boy and girl and pretend cough/say "pansy" all at the same time?

Gah. It reminds me of all the horrors of high school just picturing it.

Worse yet is when they don't even have that exchange, but rather just walk by and make that whiplash sound. You know what I'm talking about. BBFFFFF-shhhhhhh. The supposed universal sound for, 'dude, where did your manhood go?'

The whiplash sound has thankfully gone the way of frosted tips and boy bands, but today, I was rudely reminded that the thinking behind it is still very much 2010.

All because someone used pansy as a derogatory term.

I dunno if it was a trigger word for terrible high school memories and consequently post-traumatic stress or what, but regardless, my skin started to crawl.

Like I said, I hate that term. I hate the thinking behind it.

Here's why. There is nothing wrong with doing something nice for a girl. There's nothing wrong with cooking a girl dinner or going out of your way to do something for her - especially when you know that she's coming home from a difficult rotation, and you're doing this to be nice. There's nothing wrong with washing the dishes without having to be asked. And there's nothing wrong with having to excuse yourself from dinner to say goodnight to your long-distance girlfriend over the phone. There's nothing wrong with saying I love you in public, where others (gasp!) might hear. There's nothing wrong with holding a girl's books. And there's definitely nothing wrong with being a grown man, standing in line at H&M, holding baby clothes your fiancée wants to buy for your mutual friends.

I find it very hard to believe that any girl would look at that list and think that the boy's balls had been cut off and handed to a girl on a silver platter. And I find it very hard to believe that there's any girl out there who wouldn't appreciate being on the receiving end of anything on that list.

It's called being nice. Being considerate. Showing your affection.

It's NOT being whipped. It's not as though you boys are some untamed beast that needs to be tamed. You wear ties for crying out loud. If that's not a figurative and literal leash, I don't know what is.

The point is this. You've already been tamed. By work, by society, by your mama. Doing nice things for girls isn't emasculating, it's just plain being nice. So don't go disparaging on other guys and their "masculinity" when maybe it's just you who needs to grow up and realize that nice guys do finish first.

Because niceness is always appreciated and rewarded.

Empire state of mind

Interviewing is a bit like going on a first date. With a really hot guy. A really really hot guy (i.e. one who makes you swoon if he so much as looks at you).

But look at you, he did. And now you're going on a date with him!

And you're nervous. And excited! But mainly nervous.

You desperately want him to like you, so you try on 15 different outfits and arrive 30 minutes too early. And every little bit of you hopes that he turns out to be not douche-y; that underneath the good clothes and the witty repartee, there's a deeper guy who understands you and will think your awkwardness is endearing. And let's face it - you already know you're more invested than he is. So at the end of the night, you linger before leaving, hoping he'll say the magic words, that he wants to see you again.

I went to my very first interview last Monday. And I was an absolute wreck. I couldn't sleep at all the night before because I was so nervous I would oversleep and miss my interview, so I woke up at 20 minute intervals to compulsively check my phone alarm and clock -- to the point that my phone needed to be plugged in again in the middle of the night. I bought 5 different shirts to wear under my suit, and spent almost 2 hours trying to figure out which one would be most appropriate. I left the apartment at 7am for a thirty minute cab ride to a 9am interview, because I didn't want to get stuck in traffic and be late. And every second of every minute that I was there, I prayed and hoped that they would like me.

See - I was in New York! And I love New York. And the more I heard about the program, the more I fell in love with it. Twelve residents per class! An AWESOME first-year salary! Paid-for meals every day! Protected patient census counts! Subsidized housing! Weekend get-aways to faculty cottages in Niagara Falls or the Hamptons!

And then I talked to the residents and fell in love even more. Dedicated didactic days. One-on-one supervision. And here's the kicker - the residents actually enjoyed their CL months, notoriously known as THE WORST ROTATION EVER across the psychiatry board. And it was amazing seeing how well the residents all got along. As though they genuinely all liked each other and were happy there. And it was impressive to see how many of them came to talk to the applicants; there were at least 30 people crammed into that small conference room for the lunch meeting.

Add to that how much I love New York. And I love my friends who are there now - from undergrad, from my childhood. And what other city perfectly fulfills my absolute dependence on public transportation? And the food! Oh my god, the food! I would gain twenty pounds in a month if I lived here.

Anyways, all of this emoting just to say one thing -- I hope they like me. I really hope they like me.

(With Thanan in Central Park!)

(Domo arrigato, Mr. Roboto!)

Special shout-out to Yulee for taking me to her mom's spa and beautifying me up, and to Thanan (who doesn't even read my blog) for letting me crash in his apartment on the Upper West Side and trying to make sure I had a good night's rest and a solid breakfast before seeing me off to my interview. Thank you also for forcing me to walk in the Halloween Parade, because even though my feet wanted to kill you at the end of the night, it was a definite conversation starter.

Splice

Happy Halloween!

Hate my life

Wow, I had forgotten how much I absolutely hated my third year surgery rotation.

Except, it feels like I'm right back on it again. I'm on my ICU month, and the 8-ball rolled against me, and I got placed in the SURGICAL ICU.

I didn't think it would be that bad. But I forgot that I'm working with surgeons. Who don't smile. Who think that students are merely there for scutwork, not teaching. Who think that students merely get in the way.

And I had gotten used to nice medicine residents. Nice medicine attendings. Residents and attendings who want to help the students. Teach us.

Adding surgeons to my fear of ICU machines? I'm bound to fail.

My ICU attending (or should I call her my trauma surgeon attending?) makes us prepare presentations. And we gave our first presentations this morning. I dunno about you, but when I think of presentations, I think of handouts and imparting clinical pearls and key facts about the topic to the group at hand in a tidy 3-5 minute presentation. Apparently, per my attending, presentations mean that we read about the topic, and she grills us until she's satisfied that we did enough research and reading. So really, today was just a giant pimp fest. And I still have no idea about any anything my fellow students presented -- or rather, were supposed to present. Wow, I learned so much today.

My chief resident just likes to tsk tsk at us. The list wasn't updated? Tsk tsk. But sir, we updated the information on our patients. How about everyone else? ...But we don't know what's new with them. Tsk tsk. I especially loved how he rolled his eyes at us when we told him we had to go to class. A mandatory one at that.

I just spent a month being a sub-intern. I'm used to being in charge, getting to make decisions, learning, and feeling like an integral part of the team. But it looks like I need to brush off my yes'sirs and do as I'm told and regrow that tough thicker skin that I somehow acquired. I'm back to feeling like I'm just constantly in the way.

Damn, I hate surgery.

Raise your glass

The Guggenheim and YouTube got together to find the top 25 most unique, most ground-breaking, and in my opinion, the most artistic and AMAZING self-created videos, to create a new kind of art exhibit - YouTube Play.

This one's my favorite - probably because I have a love affair with food and bright beautiful colors. That said, I think they're ALL amazing. Go to youtube.com/play to see all of the jury selections.

Kinda spectacular, right?

True colors

ME

I'm not chic enough for New York.

LEE-ARNG

You're pretty hip though.

ME

Am I?

LEE-ARNG

Totally.

ME

I think you haven't seen me in a while - I am the total antithesis of hip.

LEE-ARNG

Maybe you're hiphop.

ME

Maybe I'm hip to the not.

LEE-ARNG

Well, dress to impress. I suggest suspenders. Makes you look scholarly.

ME

Mmmm, I always did like the Larry King look.

Doppelganger

So in December, I'm going to be walking through these doors for an interview.

Yes.

For reals.

I am interviewing at Seattle Grace...or rather, the hospital that pretends to be Seattle Grace every Thursday night on ABC.

I'm kinda excited.

You're looking at me

After 15 months of being on the wards, I think I've become rather good at schmoozing. I know how to be a team player. I know how to keep rounds serious, but fun. And I know how to make my residents and attendings like me.*

Until now.

I swear my attending hates me. He doesn't smile when I crack jokes during my presentations. He doesn't give me any feedback whatsoever. But every time I look up, he's staring at me. Disapprovingly.

I dunno if any of you read Sister Carrie in high school or beyond, but she gets her big breakout role as an actress for standing in the back of the play, looking on in consternation. Disapprovement.

And that is the look my attending gives me. Without fail. Every second of every moment of every minute of rounds. It's uncomfortable. And it's intimidating. I almost want to stop in the middle of my presentation to ask him to please stop, but I can't imagine that could possibly go over well.

It doesn't make any sense at all. My attending's young (and supposedly hip) - and we should be having a grand ol' time on rounds. He used to be a resident just 3 months ago. And a med student just three years before that. So why the dour faces? Why the stoic expressions? Why does he hate me?!!?

Two more weeks. Two more weeks.

*True there was that one terrible month of surgery, but I like to pretend that whole month was just a really bad dream.

Smell like a monster

Man, I don't remember Sesame Street being so hip and current back in my kindergarten days.

This is too awesome.

Gonna get this

My pager went off. Riva's BP is 70/40. Please advise.

I called up the nurse and held her antihypertensives.

My pager went off an hour later. Riva's BP on recheck is 68/38. Please advise.

I stared at my patient's LVEF of 35% and then told the nurse to give a 500cc bolus, and reassess as soon as it was done.

BP 64/38.

Miss Riva stared at me in bewilderment every time I came in. I feel fine, she kept insisting. But the rapid response nurse kept taking her blood pressure. And I kept staring at her med list and her EKGs, chest xrays, CTs, and echos, trying to figure out what I was missing.

After six hours of continuous vitals monitoring and 3L of fluids, my senior resident finally decided that we just didn't know what to do, and sent Ms. Riva down to the medicine ICU.

I feel like a failure. I just can't figure out what we could have possibly missed.

Me against the music

THIRD YEAR MED STUDENT

Happy Birthday Michelle!

ME

Thanks!

M3

So, how old are you now?

ME

Twenty-six!

M3

Oohhh, are you bummed about getting older?

ME

Nah. It is what it is.

M3

Well, you know, now you're closer to thirty than you are to twenty!

ME

... thanks.

So real

On my junior medicine OSCE, for one of the standardized patient stations, we were instructed to go in, interview the patient, get some labs halfway through the encounter, interpret them for the patient, and then tell them what the next steps in management would be.

I knocked, introduced myself, and got the HPI. The patient had classic symptoms of unstable angina. Chest pain? Check. Shortness of breath? Check. High cholesterol? Check. Family history? Check and check.

This was going to be so easy, I told myself. I'd probably have to look at an EKG and tell the patient he likely needed to get an echocardiogram, with the possibility of a reflex cath, if it were abnormal. This I could do. So I started going through the motions. Finished the interview. And then set the stage. "Well sir, it looks like we did some tests and labs. Let me get those results, and we can figure out what the next step should be."

I opened the door and grabbed the lab tests that were sitting in the folder outside. Oh your physical exam was unremarkable and your EKG was normal - so good news, you're not having a heart attack! And your chest xray shows ... oh...a 3.4 cm lung mass... indicating...ummmm, cancer.

My fake patient went into hysterics.

And I agree. That was probably the worst way ever to tell someone they have cancer. True, I should have read the results outside before coming in. True, I should have gone through the 6 step protocol on "how to deliver bad news." And true, I should have done all sorts of things that I didn't do. Instead, I essentially said, good news! you're not having a heart attack! Bad news! You have lung cancer! I'm sure the way I said it - hesitantly and all drawn out - only made the situation inherently more awkward.

Fast forward to my sub-i, and I have a 40 year old guy who comes in with what seems like indigestion, only to find out that he actually has metastatic cancer of unknown origin. Someone in the ED had told him, but had not gone about it properly. "Hello sir, well it doesn't look like you have gallstones, but we need to admit you to find out where your cancer is coming from." "My what???"

It was a rough morning that day, as he became a part of my team's census, and I was assigned to his case. It was rough seeing his wife and father jump on the first plane out so that they could be by his side. And it was rough seeing him break down, every time he thought about how he should have spent more time with his family when he had a chance.

They teach us how to deliver bad news in med school, and they even have us practice it. But the truth is, reality is so different from those structured exercises. How are we supposed to set the stage and determine how much the patient wants to know? What are you supposed to say? "Sir, your CT results are back...but first, why don't you tell me what you want to know?" Honestly, what is a patient going to say to that?

I dunno what I'm gonna do or say when it comes time for me to personally break bad news to a patient first. Heaven knows I completely botched it for a fake patient, what will happen when it happens to a real person? With real feelings and real families and real everything?

Burning out (running on emptiness)

During one month of junior medicine, I wrote 8 H&Ps.

It's now been one week of senior medicine, and I've already written 6 H&Ps, 4 discharge summaries, and 8 discharge instructions.

I can't believe I still have over 3 weeks to go.

Help.

Find your love

Seriously, the psych kids in the partial hospitalization program are the best. They make me smile, without fail, every day.

We've started taking care of this kid named Ben. He has autism and gets very paranoid about things, and as a result will order people around. "DON'T EAT THAT!" "STAND OVER THERE!" "DON'T COME NEAR ME!"

Now, again, he has autism so we can't really teach him that many social skills, and he's also paranoid, so he has a reason for demanding all these things. But we try anyways, and for the past couple of days we've been trying really really hard to get him to ask for things nicely. And you know what? He's been pretty teachable. He now knows to say please and ask for things. Except, to hear him, you wouldn't believe it. He still says everything as a command, and tacks on a please as an afterthought. "DON'T EAT THAT PLEASE!" "STAND OVER THERE - PLEASE!" "DON'T COME NEAR ME PLEASE!" "THAT'S MINE, PLEASE!"

But hey, it's a start, right?

Every day in the PHP is an interesting day. I pretty sure I'm going to love my future.

Hold my heart

I like to check up on my patients, even after they've left the hospital. Sometimes it's because I'm honestly concerned that if they don't get a reminder phone call, they'll forget about that appointment that I set up for them. Sometimes, it's because I want to ensure that they're taking the right medicines at the right times. But most times, it's because I've formed bonds with my patients, and even though curiosity might have killed the cat, I just want to know how they're doing.

So I keep a list (hospital-sanctioned, of course), with all my patients' names, ranging from people I've just started taking care of, to my very first patient. Now, I usually only call them once - no more than two weeks after discharge - and after that, I just stalk their hospital chart every now and then, to make sure they're doing okay.

Today, I was filling out my patient log, and I started thinking about my patient with pancreatic cancer, wondering if she was able to hold her daughter's hand and coach her through childbirth, or if she and her husband ever got to go on that cruise as a one last hurrah. See, they had bought into the homeopathic and so-called "organic" treatments that Cancer Treatments of America were offering, especially after we had told them there was very little left we could do. She had stopped coming to our hospital, so I had stopped checking her chart.

But today, something told me to recheck, and so I opened up her chart.

The last entry for her was dated in January. Just a couple weeks before her daughter's due date. And the discharge plan at that time was home hospice. Prognosis? Days.

I only spent three or so days with her, but seeing that discharge summary, seeing that prognosis, I broke down and cried for a good five minutes. Because even though we're surrounded by dying patients every day, we're still very much shielded from the actual event of death. Because, besides the occasional code, where everything and everyone is in a panic with chest compressions and intubations, and the patient is already flatlining when we get to the room, I haven't seen anyone actually die.

People come to the hospital for care, and we send people out the door on the premise that they're getting better. And even though I knew last year that she was going to eventually die, finding out that she actually did, was still numbingly shocking to me.

Candy shop

All I really need to study:

1. My computer

2. An outlet

What I think I need when I study:

1. My computer

2. An outlet

3. Hershey Bliss dark chocolate

4. M&Ms

5. Peppermint - in the form of ice cream or York chocolate patties

4. Twizzlers

5. Almond Joy pieces

Just went out and bought it all, so that I can have a productive Saturday. I've got my fingers crossed that I'll finally get some work done, and the inevitable stomachache in T-2 hours isn't too painful.

Heaven can wait

NINE YEAR OLD BOY

Hey! Dr. Michelle!

ME

Hey, what's up?

NINE YEAR OLD BOY

How old are you?

ME

Well, how old do you think I am?

NINE YEAR OLD BOY

Ummmm, I think you look maybe...um, nineteen?

ME

Hahaha, do you think that's old?

NINE YEAR OLD BOY

Well, a little. So, am I right? Are you nineteen??

ME

Actually, I'm 25.

NINE YEAR OLD BOY
[falling off his chair]

WHOA! You're twenty-five?! That's SUPER old! I was going to say you look like you're twenty! But that's OLD, and I didn't want to hurt your feelings, so I said you look nineteen! But you're TWENTY-FIVE?!!?!?!?!?

ME

Hey! Twenty-five isn't that old.

NINE YEAR OLD BOY

My mom has a friend who's twenty-five. And she's married! And she has 2 kids! Are you married????

ME

Haha, no, I'm not married. And guess what? I don't have any kids either.

NINE YEAR OLD BOY

Well, what are you waiting for?? Don't you want to get married?

ME

Haha, have you been talking to my mother?

NINE YEAR OLD BOY

What? Noooooooooooooooooooo, I don't even know her!! Why would I talk to her?? You're so weird!

ME

And old?

NINE YEAR OLD BOY

AND OLD!!

Cast of cooks

I shouldn't be watching, but Top Chef is on. And it's on my tv.

And just a couple of things (no worries, no spoilers since I'm only halfway through the episode) --

1. Hung is AMAZING. Holy crap. Angelo lucked out, big time! Best sous chef ever!

2. I think all of Ed's dishes are seasoned with his sweat. Seriously, it kinda grosses me out how much that guy sweats, and you can just see it dripping off his face...as he's cooking and plating.

3. Ilan has got to be the least-liked of all the Top Chef winners. What did Ed say about him? Something along the lines of "well, he's a prior winner.......so.....I guess I can respect that?"

4. Should Angelo really be tasting things if he's that sick?

5. Forgive the bias, but I'm really pulling for Angelo to win, if only so he can finally bring his Russian fiancée to the US of A. I'm a sucker for true love.

Man, ramen for dinner is absolutely no good when you're seeing all this deliciousness on your TV.

Hesitation blues

There are days when I wonder if I'm going into the right specialty. Specifically, the days where I look down at my shins, and I have 3 new bruises from kids kicking me as we take them off to seclusion. Or when I look at my forearm and wonder if that kid bite from earlier this morning is going to become infected.

But then there are moments that make my heart hurt for these kids.

After almost a full two weeks of child psych, I was finally allowed to lead one of the groups. Specifically, the "Talk About Feelings" group. We filled out our feelings card appropriately, and went around talking about why we felt nervous, or frustrated, or scared, or whatnot. And then, I brought out a plastic genie lamp from the 99 cent store, and told them to tell me what their three wishes were.

One kid wished for more video games.

Another kid wished for a puppy.

One girl wished for a million more wishes and a thousand dollars.

An oppositional kid wished for the genie to be free so that we wouldn't have to play this stupid game.

But the last kid's comments almost killed me. "I wish I didn't have Tourette's, because it makes my mom really anxious, but even though I try to stop my tics, it's really hard. I try really hard...but sometimes, they just come out."

He looked down forlornly, and my heart just about broke into a million pieces.

He's only five, mind you.

I just submitted my residency application.

So why won't my heart stop pounding?

Disarray

My attending nudged me. Oh my, look at that complex tic. This might be the only time you'll see it - it's SO rare!

I stared at the classroom. Who was she referring to? Which child had Tourette's? There was one girl in the corner singing songs, or was she vocalizing? Her singing was pretty poor and pitchy, after all. There was another kid who kept thumping his chest. Another boy kept twirling his hair around his finger. And then there was another boy, sitting at the table drawing, but shuffling his feet back and forth, occasionally grasping his elbow during his awkward chair and table dance.

Today was my first day of child psych. And while I was completely lost on what I was expected to help out with, and answered questions completely incorrectly, the time flew by.

I'm keeping my fingers crossed that I love this upcoming month, because this is what I supposedly want to do for the rest of my life.

P.S. My personal statement is officially done and uploaded into ERAS. Praise the powers to be.

Diamonds are a girl's best friend

Martin got me a present for our 28th monthiversary.

And because he loves surprises, but knows I hate them, we compromised - he told me a hint each day that would lead me to the answer.

Hint 1: Like LPT not height or size/but in its lack of cornered sides

Hint 2: Twinkles lightly like a star/but closer to you than they are

Hint 3: It was first found amongst the rocks/ now you can add to your pink box

Hint 4: Almost time to end this game/it's coming from a sister's name

Hint 5: Just one last hint for your list/this present should go on your wrist

And then the next day I got a nondescript brown box from New Jersey. And inside was my gorgeous diamond charm bracelet from Tiffany's!

I love it.

For the record though, I was expecting a cinnamon sugar pretzel from Auntie Anne's.

The boy is mine

Martin visited for two weeks, and it was absolutely wonderful.

But then he left, and my stress ulcer grew back.

Boarded doors

While other teams complain about rocks, we keep getting bounce-backs. One in particular.

Mr. Parise is an alcoholic. He'll go out and drink a liter or two of vodka and then stumble into our ER, where he always complains of the same thing - pain in the epigastric region that extends around to the back. And he says the magic textbook words - "like a rubber band."

Then he gets admitted for pancreatitis.

And we give him fluids and pain medicine.

Even though he doesn't have any abdominal pain when distracted. Even though he can change positions easily, but then has severe pain if we so much as try to poke him. Even though his CT scan shows no evidence of chronic pancreatitis. And his lipase and amylase are all within normal limits. And he's starving, asking for 2 trays of food, while we all know that patients with pancreatitis normally don't even want to think about putting anything in their mouths.

But I get it. Pancreatitis can present in different ways, and this guy has the number 1 cause of pancreatitis in men - alcohol. So we have to treat the patient - not the imaging, and not the lab results.

Yet, inevitably on day 2, when we start to decrease the frequency he receives his pain meds, he freaks out, and demands that we go back to what it is, or he'll leave AMA (against medical advice). So then we have a huge long discussion with the patient, telling him that he doesn't require such high doses of meds, but it's important for him to remain NPO (nothing by mouth) to prevent further inflammation of his pancreas.

He then asks for an AMA waiver, signs it, and heads out.

Then, 3 hours later, or if we're lucky, 2 days later, we get a call from the ED saying that our patient is back, reeking of alcohol, and complaining of the exact same symptoms.

And I know this probably makes me look like a terrible doctor-to-be, but I gotta wonder when it stops. If someone signs out AMA and then comes back complaining of the same exact symptoms, I feel like there have to be some repercussions. Especially when we have an ED full of people, and no beds for any one.

Cheater cheater

The secret's out.