Technologically Adverse

Playing with the iPad I was given for hanukah is reminding me exactly how technologically adverse I really am.  Any advice of how to use an iPad to streamline my life and optimize the potential of it?!  Please advise liberally!

And the nightmares begin...

I had my first residency nightmare last night.  I don't remember all of it but there was an element of not getting ob/gyn interviews, having apply in another specialty I don't want to apply in, and not knowing what specialty I was going to match into come match day.  There were also lots of tears shed in the dream.  What in the world does crying in one's dream mean?!

It doesn't help that today was another interview day for the program I'm spending my year with.  The marching line of black suits, my peers, flowing throughout my daily rituals at work were a constant reminder that I'm not there yet and have so much longer to deal with uncertainty...  After spending his year with some of the top, best, and brightest in ob, I'm going to feel pretty awful if I end up unable to match.  BUT, I have a year plus to go.  I sure as hell better not be having these nightmares straight through until March 2014! 

In other news, I need to learn Spanish.  Or remember the Spanish I used to know plus learn some medical terminology. Something.  It is a huge goal for this year and while I'm nearly halfway through my research year, I haven't even begun.  All the residents here speak Spanish.  I think I can, I think I can, I'm [not so sure] I can...

What are you going to do to make sure it doesn't?

Quoting Lori Freedman, in "It could happen here" (The Huffington Post Blog, 11/19/12):

This death sentence for Savita is exactly what the U.S. House of Representatives prescribed in the Orwellian-named Protect Life Act, which it passed in October of last year. Thankfully, it died in the Senate and President Barack Obama had vowed to veto it.

But, suppose a handful of U.S. Senate races and our close presidential election had gone Republican. Savita's tragedy could have foretold many American women's funerals.

Kid, you are very right

Conversation that just happened between one of the attendings I'm working with this year, her 3 year old, and me as we were trying to put away supplies from the papaya workshop she did:

kid: "I want to play with them!"
to kid: "these tools are for doctors"
me: "maybe one day you'll have your own set"
attending: "[physician activist] is going to be a doctor one day soon"
kid: "Why?"
attending: "because she's very smart"
kid: "runs away laughing out loud..."

Yep, sometime I too want to run away laughing when I realize that I'm going to be a doctor.

Maine, Maryland, & Washington

As the executive director of the Gay & Lesbian Medical Association just emailed out “Today, GLMA joins with supporters of equality from across the country to celebrate yesterday’s historic election results, which set the stage for a new era in the quest for LGBT equality.” On one hand I’m glad that 3 more states passed “marriage equality” yesterday.  Between these 3 states, Minnesota’s voting down on marriage discrimination, Tammy Baldwin’s win, and the re-election of Obama, yesterday was a big victory for queer rights. 

On the other hand, I am beyond angry and hurt.  How is it a victory when we are still letting other people vote on MY RIGHT to get married and have a family?!  How is that not, in it’s very essence, discrimination?  And while these amendments are being billed as “marriage equality”, we are still far from equal, even in states where gay marriage is legal. 

If I am to fall in love with someone overseas and get married in a country where it is legal, I have no rights to get them citizenship or protection in the US.  If I fight in the US military and live in a state where I’m legally married, I still cannot offer military partner benefits to my wife.  Even if I file my taxes as a married couple on the state level, my federal taxes will still be filled as single, creating a huge f*ing mess.   This isn’t even separate but equal… this is straight up inequality!

 

I think these state measures are a Band-Aid.  They are hiding the real problem and leading the general public to believe that the LGBT community is finally gaining equality.  But we are not!  As long as the public gets to vote on my personal rights, I am very much not equal and I will not be satisfied by placation of a few new state amendments.   I still have no national recognition of my love.  I still don’t have the ability to adopt my (theoretical) children if born to my (theoretical) wife in many states in this country.  Hell, I can still be fired from my job or openly discriminated against for my sexual orientation in some states.

The Supreme Court needs to finally rule on prop 8 (this mess has been going on for 4 years now).  DOMA needs to be overturned.  We need to stop letting the public vote on the rights of minority groups.  We need to expand anti-discrimination policies and regulations.  We need to give queer kids hope for their future… Come on people, we can do so much better.  

What a difference 4 years makes

Election night 2008 is a vivid night in my memory.  I arrived back at my house around 6 or 7pm from 2 long days of medical school interviews to find a house full of friends watching the TV and an envelope from a school I had recently interviewed at.  I opened my first acceptance letter surrounded by the love of my community and with the optimism of change in the air.  The night was spent intensely watching returns, having both light hearted & deep conversations, coloring in maps, and day dreaming about what the future would hold.  I went to sleep with the certainty of Obama’s victory and my long awaited admissions ticket to medical school in the fall. 

[However, learning about the prop 8 results when I woke the next morning was heartbreaking and felt like a personal attack.  And now, 4 years later, we’re still trying to untangle the mess it created.  Hopefully, tonight’s vote on marriage have an opposite outcome as prop 8 did.]

4 years later, I am wrapping up medical school.  I would be on the interview trail again right now had I not elected to take this year for research.  I am anxiously awaiting the news tonight will bring in a new city with a new community.  I am uncertain about my future – about what our healthcare system will look like tomorrow and how it will affect my career.  While the economy is likely to continue to improve (assuming we don’t start another war), healthcare, women’s reproductive rights, and queer communities in the United States are resting on a precarious ledge. I pray that I go to bed tonight with the same optimism and certainty that I did 4 years ago. 

Surprising twist

In a surprising turn of events, all of my allergy skin testing yesterday was negative. I was negative for all 69 triggers that they tested. The doctor was baffled and I was [pleasantly] shocked. My clinical picture very much pointed towards allergies being the culprit for a lot of my generalized 'yuck'. That said, after some pulmonary function tests and a significant improvement post administration of albuterol, I was given the [equally] surprising diagnosis of "asthma / an asthma spectrum breathing issue" and a 1 months sample of asthma management drugs to see if there is any improvement.

The doctor also discussed emerging research supporting local IgE response in both the nasal tract and gastric mucosa- which would mean that one is actually allergic to something but that there is no way to easily test for it as there will be no response to skin or blood testing. Local IgE?! This challenges everything I learned in immunology... given immunology was the pre-clinical class I struggked most with.  However, reviewing some scholarly articles on the subject today proves him right, that this is an emerging belief in the allergy and immunology world. They have no way to test for these triggers and so I may never know if this is in fact what is going on with me. Maybe I actually am allergic to something(s) (which I suspect to include dust and mold) or maybe I'm just a paranoid hypochondriac? 

Health care blues

We had a discussion yesterday on the Affordable Care Act and how it affects women's health care, especially contraception.  I left the talk totally depressed.  This was further amplified by watching the 3rd presidential debate last night. 

I recognize that the ACA is not perfect, but it is a HUGE step towards affordable and comprehensive health care in this country. I believe that health care is a right, not a privilege.  I also know that we can not continue to afford the rising cost of health care as we can't even currently afford it.  I'm sickened by the fact that politicians play political chess with people's health.  I can not understand that level of disregard for another humans welfare; but I guess that is why they are politicians and I'm a (future) health care provider.

In the discussion yesterday, we were shown a slide from the New England Journal of Medicine article "A watershed election for health care (2012)".  The chart dives up the likely results to the ACA depending on the election outcomes.  It is no shock that Romney winning would be a very large step back for health care in the US (a long with LGBT rights, abortion rights, and so many other things), but what did give me pause was what happens if Obama is reelected with a republican house and senate.  "Maintenance of near pre-ACA levels of uninsured Americans; no substantial growth in levels.  Less aggressive implementation of ACA health system provisions".  Shit.  So basically more political chess with people's lives at stake.  Nothing will be accomplished, will still be stuck in the middle of nowhere.  Lovely.

Needless to say, I'm very worried about this election.

I am also so grateful to be an insured American with unlimited access to quality care. This year off from medical school has been full of many more doctors' visits than I would have imagined. After the horrible car accident with trip to the emergency room this summer, I'm now dealing with a whiplash, a pinched nerve (upper trunk of my brachial plexus), and radiculopathy. Weekly chiropractor appointments in attempts to fix that. I'm also finally address my chronic anemia, fatigue, and constant general yuckyness by figuring out the trigger. A round of visits to a GI and a abdominal CT have ruled out my celiac as the culprit. [Even if I did read my CT as having a "speckled colon and a titled uterus" - thankfully a radiologist who actually knew what he was reading righted my incorrect paranoid diagnosis.] Good to know that I'm not being accidentally glutened. The GI's answer to this was that I'm probably allergic to something (or many somethings) and so I should take a low level steroid to blunt my immune system. Um, no thanks. I'd rather just figure out what the cause is so that I can avoid it. So, today I am finally getting much need allergy testing. Thank G!d that my comprehensive trusty health care insurance is along for the ride.

Voting for Big Bird

Last night's presidential debate was awful.  Romney was totally charismatic in an absolutely condescending way.  I couldn't decide if I wanted to hug him, or slap him.  I also kept imagining a thought bubble of loose associations over Obama's head.  I am not sure where he was but he clearly was not present at the podium. 

There were nonsensical sentences.  There were long run on thoughts that led in a circular manner towards nowhere. There were lies and empty promises followed by more lies.  The discussion was harder to follow than those of my floridly manic patients when I was on my psych clerkship!

There was one sentence in particular that sat very poorly with me though: "I would like to take the Medicaid dollars that go to states and say to a state, you're going to get what you got last year, plus inflation, plus 1 percent, and then you're going to manage your care for your poor in the way you think best."  Let us just quickly look at two case examples.  Alabama wants to take care of their poor by using medicaid as the sacrificial lamb for their budget issues.  Louisiana took care of their poor by cutting $329 million from their state healthcare, and by closing one of the state's 3 psych hospitals, likely adding more strain to the hospital and jail structure.   Two shinning examples of how one should take care of valued citizens.  I totally feel confident that allowing states to have sole decision making power on the nations healthcare will solve all our finical issues and improve the health of ever individual American... Not.

I'm voting for Big Bird.  I'm voting for ObamaCare.  While not perfect, it is a start.  I have to believe in something.

6th Annual Women Leaders in Medicine Awards and Reception

"Do you know a female physician who is changing the world?
Nomination Submission Deadline: October 1, 2012 (5pm ET)

The Women Leaders in Medicine (WLIM) awards were created by AMSA in 2007 to recognize women physicians and educators who are changing the face of medicine through their lives, their professions, or their teaching. These women deserve recognition for their accomplishments and dedication to fostering tomorrow’s women leaders in medicine.

We are currently accepting nominations for the 2013 WLIM awards. All medical and premedical students are encouraged to fill out the simple online form and tell us about an inspiring woman who has influenced the student's medical career. They could be professors that you’ve had or they could be women who you have never met but have impacted your careers through their amazing work.

The recipients will be invited to attend the AMSA Annual Convention in March 2013 to receive their award at a special reception. Many of our past awardees have considered their Women Leaders in Medicine award a truly meaningful honor because it comes directly from the voices of students. At AMSA, we hope to give back some recognition to these amazing women in addition to generating awareness about the importance of fostering leadership in medicine that promotes healthy change and equality in care and professional opportunity for all physicians-in-training.

This year will be an extra special reception as it will coincide with the International Federation of Medical Students’ Associations (IFMSA) 62nd General Assembly in Washington DC. In honor of this momentous gathering, special attention will be paid to nominees who have had an impact on the global stage. We hope you will join us at AMSA's Annual Convention for the Annual Women Leaders in Medicine reception as we announce this year’s recipients!"

http://www.amsa.org/AMSA/Homepage/Events/Convention/WLIM.aspx

Step 2 CS

I'm taking step 2 CS this weekend.  I keep waffling between feeling completely confident in my ability to rock it, and totally scarred that I'm going to majorly f*ck up somehow and screw myself over.

I did more than fine on my school's OSCE exam.  I did well with all my 3rd year clerkship rotations.  I've had 3 years of practice with standardized patient encounters.  I know how to speak English and have a decent amount of empathy. 

Yet, I haven't touched an actual patient in 2.5 months.  I have no real motivation to study, working through First Aid for CS at a snail's pace... not sure I'm going to finish it before the exam.  Concerned I'm going to forget how to take a comprehensive history, come up with a differential, or write a note.

Ugh!  Medical school = one humbling hurdle and/or act of hazing after another.  I can do this, right?!

Right brain approach to healing

(image is a Mercedes-Benz add, taken from http://www.andrewkeir.com/right-brain-vs-left-brain/)

Science is often though of as a left brain thing.  Art is the right brain.  But what happens when you combined them?  What happens when a man with brain cancer begins to think outside the box?  What happens when the man has the ingenuity and skill set to crack code, redefine healing and cure, and appeal to a larger, global, audience?

You have Salvatore Iaconesi.  You have an OPEN SOURCE CURE.  In his poetically beautiful words, here is his plea:

"There are cures for the body, for spirit, for communication.

Grab the information about my disease, if you want, and give me a CURE: create a video, an artwork, a map, a text, a poem, a game, or try to find a solution for my health problem.

Artists, designers, hackers, scientists, doctors, photographers, videomakers, musicians, writers. Anyone can give me a CURE."

This is an absolutely beautiful reinvention of medicine.   This is the art I am proud to be learning, practicing, and bearing witness in the lives of all my patients (past, present, and future).   

There is a big purple elephant standing in the corner of the US healthcare system

In simple terms, IOM stated today that US healthcare sucks.  It is about time someone addressed the elephant in the room.

"In a lengthy report out Thursday, the IOM wrote that U.S. medicine wastes roughly $750 billion per year, permits tens of thousands of needless deaths and bungles its mission in ways foreign to other industries." -The Hill's healthwatch blog commenting on the IOM report released today

Existential Crisis

My research year has started like this: 4 weeks of work (in which my grandmother died & my car was totaled), followed by 2 weeks abroad for a conference, followed by a week road trip with my girlfriend. 

This week was my first week back, and the first week where it became clear that I'm here to stay, at least for the year anyway.  This week was also slow.  Painfully slow.  S-L-O-W.  I felt like I wasted hour after hour, day after day, doing absolutely nothing productive.  Research projects are in various stages of stagnation for various reasons- mostly sitting on other peoples' desks waiting for their necessary contribution.  I know, I know, this is the way research rolls.

Too much free time spent surfing the inter-webs meant that I began questioning my decisions.  Why did I decide to take a year off?  What if waste this whole year and get nothing accomplished?  What if I walk away with no abstracts and no manuscripts, nothing tangible to show for my year?  How many hours can I really spend on facebook, words with friends, and the sudoku app before I kill myself from going stir crazy?  I'm just slowing down my life- an extra year before I potential don't match in OB (even having taken a research year), another year in a long distance relationship (if it survives distance) with a megaphone of a biological clock, another year before I can settle down in one city and actually began making a real community... another damn year!

I'm still hoping this was the right choice.  The opportunity to live in a kick ass city.  A year to have some free time with priorities on improving my health and learning Spanish before residency.  Maybe I'll finally get around to fine-tuning my basal rates after 16 years on an Insulin pump!  A chance to reconnect with my Jewish identity.  A chance to engage in some pretty novel, and interesting, research with some of the best in the field. 

For now though, I'm hoping a restful shabbos will silence my existential questioning.

"Method of conception"?!

This man might be a single heartbeat away from president.  WTF?!

In other news, this was one of many signs I saw on my cross-country road trip last week.  It welcomed us to Michigan.

(taken from: http://www.conversationchamber.com/viewimage.forum?u=http%3A%2F%2Fi31.servimg.com%2Fu%2Ff31%2F15%2F01%2F44%2F35%2Fdsc01710.jpg)

 

Yes.  I do support both gay marriage and abortion.  I don't vote republican, thank you. 

The History of Contraception

I can't figure out how to embed a handout, so ya'll should go to this website and download it.  Titled "Contraception and Abortion in the Ancient World", created by a MS4C extern, it is an amazing and beautiful history of contraception for the past 4000 years. 

The point of this is to say that contraception is HUMAN.  Just like sex is human.  Just like the need for community and interpersonal relationships are human.  Just like all of us are human.

If you don't believe me, read Sex at Dawn: The Prehistoric Origins of Modern Sexuality by Christopher Ryan, Ph.D. & Cacilda Jethá, M.D.  I'm not all the way through it yet but thus far it has proved to be a total mind trip, causing me to rethink everything I've been taught about what is human nature vs. what is animal instinct.  On the scale of mind-blowing books, it falls along side Everything You Never Wanted Your Kids to Know About Sex (But Were Afraid They'd Ask).   If only I could make all of society read these books and then hold room for communal intellectual discourse... it might just be revolutionary!

Research year reminder to self (RYRS) #1

Only speak kind words about my home institution. Package any criticism constructively, in between a cushion of high-lights & complements.

I imagine that no one is going to want to take a resident who will throw their institution under the bus.

One too many moves

The funeral/memorial service for my grandma was a lot more difficult than I thought it would be. Actually, the service was lovely. The weekend on a whole was difficult. So much undiscussed stress & tension running amuck within my [biological] family dynamics. So much pretending to be fine while passively addressing the weighted history that plagues us all.

Now I'm making my way home, to the new home I moved to last week. I'm so emotionally & physically drained. Having just moved here, I'm feeling particularly lost & empty. I don't have familiar comfort zones to turn to. I don't really have a "home" & "family" here to hide in or lean on. I'm feeling as if life has taken me on one too many moves away from the familiar. While I'm grateful for the journey I've been on, I'm currently a little pisses off that I have a few/many moves left (4th year, residency, fellowship &/or a job?) before I can finally claim a home of my own.

A glimpse of balance

An extra blessing in taking a research year is that I am currently in transit home for my grandma's funeral. There was no mess of rescheduling, fuss of preceptors, or paperwork to fill out. When I asked my PI about taking tomorrow off of work, she considered me crazy for even asking as if it should have been intrinsically known that I should have as much time as I need.

I take this as a promise that I can have a medical career with clearly established priorities, & that family CAN be at the top. I just have to finish med school & get through residency first...

For now, I'm spending a long weekend with my family. Exactly where I'm meant to be.

White [coat] privilege

Today I learned that medical students are not actually the lowest rung on the totem pole.  Research assistants happen to fall below them.  I became acutely aware of patients not wanting to me around and of staff feeling similarly.  It's funny though- nothing has changed about who I am, how I interact with everyone, my attitude, and my attempts to be helpful.  The staff very much knows that I just completed my 3rd year of medical school.  This being very much an academic institution, they are very aware of what that means, and that it puts me at the education level of a sub-i.  All that has changed is that I'm not wearing my white coat and my badge now reads "research assistant". 

I can't help but ponder why this is.  Is it that they're protecting their own students' education first?  Is it that they don't yet know and trust me?  Or, is it that people are just afraid of and/or intimidated by the white coat, and that we take full advantage of the privilege and authoritative knowledge that comes with it?  If so, how do we best own & deconstruct this privilege?

Let the research begin!

I had a weird dream last night about applying for a research year and realizing that I was running out of time and would graduate before I had the opportunity to do it.  There was a lot of anxiety in realizing that I had missed my opportunity to do funded research before getting my MD and moving on to residency. 

Then I woke up to remember that I'm actually here, now, starting my research year!  Sub-I was successfully completed (though evaluation of exactly how successful is still pending), cross country road trip accomplished, room unpacked, first shabbos in the new home experienced.  Side note:  shabbos here felt like the promised land: beautiful weather, a nap outside on the back porch, lots of lovely people, having excellent conversations, delicious local food, everything labeled gluten free.  Tomorrow I start work!  Now I just need to figure out how exactly I'm getting there in the morning.  I also need to figure out how not to make myself look like an idiot in front of some of the smartest/best/most accomplished academic OB/GYNs in the country.  So excited to see what this year brings!

sub i

so. exhausted.

Telepathy, divine inspiration, etc.

I'll take it!

I will take any and all information the world wants to throw at me while I take USMLE step 2 tomorrow.  Specifically knowledge relating to pharm, neuro, cardio, and heme/onc.

See you on the flip side where, after a month of intensive sub-i, I will hopefully be back on my political soapbox!

Thank you Dr. Willie J. Parker

Taken from this article, "Why I perform abortions: A Christian obstetrician explains his choice":

"In listening to a sermon by Dr. Martin Luther King, I came to a deeper understanding of my spirituality, which places a higher value on compassion. King said what made the good Samaritan “good” is that instead of focusing on would happen to him by stopping to help the traveler, he was more concerned about what would happen to the traveler if he didn’t stop to help.
I became more concerned about what would happen to these women if I, as an obstetrician, did not help them."

Amen. 

The relative speed of time

It is amazing how quickly each month on rotations flew by.  Especially, in contrast to how slowly this month of step 2 studying is going.  With a week to go until the big day, I'm growing ever more impatient to get back to my regularly scheduled life.  It seems the I should have taken the 2 months, 2 weeks, 2 #2 pencils more to heart when I scheduled my exam... oh well.  Here is to hoping that this extra time will pay off with a higher score. Also hoping that I don't burn myself completely out over the next week as I'm pretty sure that burning out is problematic for my performance.

Step 2 study bubble

I'm currently submerged in the USMLE step 2 CK study bubble.  There is so much going on in the world to blog about: Obama's support of gay marriage, more anti-women's health legislation being introduced across the country, the national discussion on student debt, engagement announcements, friends' weddings, finding out about [multiple] divorces (what?! how am I old enough to have peers getting divorced already?), plans for my upcoming cross country move, preparing for a year "off" doing research, my OSCE exam, etc... but alas, my life is consumed by step 2 studying.

I probably wont get a chance to blog about it, but I'm acutely aware of my 22nd diabetes-versy this Saturday, 5/19/12.  Having had an endo & opto appointment this week, I feel so blessed to be here, healthy, and to be going into medicine.

On the bright side, step 2 studying is much more exciting than step 1 studying was.  I am actually *gasp* kind of enjoying it.  So at least now you know that I am off having fun while neglecting all of you out here in the blog-spher.  I should reemerge after June 1st!

[More] pretty colors highlight [more] sad truth.

Similar to my previous post, Pretty colors highlight sad truth, another chart has been created highlighting the dispersion of rights across the United States. 

Image taken from"Gay rights in the US, state by state", Guardian in America interactive team, guardian.co.uk, Tuesday 8 May 2012 11.12 EDT at http://www.guardian.co.uk/world/interactive/2012/may/08/gay-rights-united-states?fb=native.


This chart is really cool.  The whole article is.  It is interactive, allowing for stratification of rights based on location and specific laws.  It totally brings out the nerd it me. 

Amendment 1 in North Carolina today means that one more state refrains from lighting up.  I certainly hope that, in my lifetime, this whole map fills with bright colors.  I like bright colors.  I also firmly believe that all humans deserve equal rights regardless of who they happen to love.  Yes, being queer does make me bias, but I'm pretty sure I'd feel this way regardless.  Even the [very mainstream / sometimes conservative] American Medical Association (AMA) believes that LGBT rights are essential for optimal health.  Isn't it 2012?

Time flies when you're [in med school]

At 10am this morning, by handing in my psych self exam, I officially completed my 3rd year of medical school.  I am now 3/4 of the way to my MD!

However, I am also officially taking a year off to do research next year, which means I'm on the 5 year medical school path.  So I guess I'm really just 3/5 of the way to my MD.  I'm really excited about the research I'll be doing and the city I'll be living in.  I'm a bit relived that I now have a little more time, and will have more exposure, before having to faithfully decide on obgyn.  Plus, it is allowing me to feel like I'm doing everything in my power to make up for my [first attempt] failed step 1 score.  I'll never actually know if it'll make a difference in my life path, but at the same time I can't imagine that it'll hurt anything! A year to re-learn spanish, exercise, sleep regular hours, travel, cook/eat healthy, socialize with friends, be close to family, ....  what is not to love?! 

I can't believe it has already been a year since I started on the wards!  A year since I wrote this post.  A year later, I still struggle with empathy, compassion, and time management.  While I still feel like I know nothing, I can also tell that I've become more proficient in presenting patients and writing progress notes.  I am better at answering questions.  I have learned to suture, catch a baby, drive a laproscopic camera, do complete neurological and psychological exams, and so much more.  I am also learning to forgive myself when I make a mistake, make an idiot out of myself, and when I have a visceral emotional response to my surroundings.  One year down on the wards and a life time to go.  Every day I spend with patients, I become more and more excited that this is my life!

Sundowning

According to wikipedia: "sundowning, also known as sundown syndrome, is a syndrome involving the occurrence or increase of one or more abnormal behaviors in a circadian rhythm. Sundowning typically occurs during the late afternoon, evening, and night, hence the name. It occurs in persons with certain forms of dementia and psychosis, such as seen in Alzheimer's disease. Although not widely surveyed, sundowning has been estimated to occur in 45% of persons diagnosed with Alzheimer's disease"

I feel like my current emotions reflect a sundowning effect.  I seem to get more frustrated, more teary, and more depressed as the night wears on.  My guess is it relates to the point in the evening where I used to trade in studying to video chat with the [now ex-]girlfriend.   I have cried more the last few nights then I have over the entire past year combined.  I have even succumb to sending desperation text messages to her before I could think better of it.  Thankfully my lovely roommate has agreed to take my phone away before I belligerently text her again.  My emotions are unyielding as my new reality begins to sink in.  I'm nearly as emotionally liable as my patients on the inpatient, locked, psych ward. 


The hardest paradigm shift to accept relates to my future.  I no longer have a magnetic force pulling me towards residency in a specific geographic location.  I no longer have a built in support system that will accompany me to wherever I happen to match.  It is both a relief and a curse.  It takes some pressure off of the decision to take next year off.  However, I used to be able to tell people that I was hoping for certain residency programs because it would allow my partner to have a job though I also used to worry that I'm not competitive enough for the state she is BARed in.  Now I worry that I wont match in a location with a viable singles community, a community with dating options.  How many cities are there that have large, intellectual, activist, queer, Jewish, communities?  When ever I would freak out about not matching, and ramble about some crazy scenario of scrambling into some super conservative [and boring] location, she would affirmatively respond that "we'll be okay there", "we'll make it work".   I don't know that I can do it on my own.  


At the conference last weekend, when I was asked over and over again where I was hoping to go for residency, I fought back tears while trying to explain that my perspective was recently flipped and I no longer know.  I'm pretty sure that all 1000+ conference participants were exposed to my verbal vomit about recently being dumped.  I sincerely hope that I can pull off a slightly more composed persona at the conference I'm going to this coming weekend, though I'm not holding out much hope.  When my current psych patients respond like I have been, they get dinged for over-sharing and missing social ques.   At least I still have my insight and perspective intact.  I am learning first hand that a very fine line divides the process for accepting a major life change and the diagnosis of a mental illness.

Full circle

Pesach is over.  How did that happen?  I blinked (and cried) and the week flew by.  Clinical duties, studying, break ups, and the rest of life very much got in the way of observing the holiday with true kavaneh this year.  Instead of "next year in Jerusalem", this year I'm saying "next year with more kavenah and ruach."

This weekend I'm presenting at an activist reproductive rights conference. This annual conference is where I got my start.  This is the place where I decided I wanted to be a doctor and an abortion provider and where I learned to be an activist and advocate for the whole complex plethora of women's health issues.  It is somewhat surreal being back here, surrounded by old familiar faces and young bright-eyed budding activists, coming full circle with my roots.  It is also re-energizing.  I'm filling my senses with everything reproductive health related.  Currently I'm fixated on unpacking an amazing workshop I went to this afternoon on "pink boys": how to break down gender binaries in education, how to parent non-conforming children, the importance of media literacy, and so much more.  Hopefully, if I successfully process all that I learned in those 2 hours, I'll be able to post more about. 

In the meantime I'm going to do a few psych questions and then crash for the night.   Life as a medical student: studying trumps all, even when I'm away at a conference, even when I'm reliving my good ol' college days.

And life marches on

Break-ups suck.
Trying to keep it together, so I don't look all teary like my psych patients, is hard.
Life keeps marching on.
Is this a clue that I'm supposed to give up my dreams of having a family to throw myself into medicine entirely?
On the upside, at least my roommate & friends are amazing.

VSAS,

Why do you have to be so confusing?  In this age of technology I would have appreciated an easier, streamlined, and transparent way to apply for audition electives.  Alas, you are overly complicated and frustrating, just like everything else in medical school.

Love,
me

Maybe pathology?

Me to my roommate, while asking questions about psych pharm: "Becoming a doctor is hard." 

What else is new?

Maybe I should go into pathology so I wont have to deal with pharmacology.  I wonder if I could match in path.  Pretty sure I'd fail at proving interest and dedication to the specialty... oh well.

On the upside, day 1 of the psych rotation was very enjoyable!  It should be a good month.

More input, more confusion

I spoke with a long-time mentor who is an academic obgyn this morning.  She currently has a career that I imagine myself wanting for my future.  The gist of a long conversation is that she thinks I should seriously reconsider OB, and should opt instead for peds or family medicine.  She thinks my personality would do better in something truly primary care.  According to her, too many OB programs are malignant and for good reason.  She also stated that she would reconsider family for herself if she could do it all over again.

It's looking like a research year might be the only option.  Not necessarily to build up my CV, but to buy myself another year before having to make this decision.

Bad news from my dean

He is worried that I wont match in OB.  He said that no one from our school with a failed step 1 has matched in OBGYN for the past 5 years.  He wants me to lower my expectations of the type of program that I may end up matching in.  He also wants to make sure I don't end up screwed. 

Options:
1) apply in both obgyn & peds or in ob & family
2) forget ob and just apply in peds or in family
3) take a year off to make connections and strengthen my application (which means looking for new funding sources)

Ugh.  One stupid test...

Another MD voice in the conversation

I really appreciated reading "Rated R, or perhaps NC-1" over at gravity circus.  She's pretty wonderful and also someone I'd be more than happy to have as my own doctor.  I believe that the more medical voices are out there in this conversation, the better.  

Dear Doctor Anonymous,

Thank you.  Thank you for this post on state mandated transvaginal ultrasounds.  Thank you for expressing your outrage so eloquently in writing.  Thank you for remembering that the patient is the one and only priority in this equation.  Thank you for remembering your responsibility to your patient as their physician. 

As a patient, I hope that all physicians I see are like you, focusing on evidence based medicine practices and not on conservative politics.  As a future physician, and a future provider, I hope to be like you.  I pray that I don't forget the power of my actions, a problem that I have seen some physicians fall victim to.  I hope that, like you, I can keep my patients in the focus and remember that a little civil disobedience can go a long way when necessary.

Thank you,
me

update: A friend pointed me to another article

'We Have No Choice': One Woman's Ordeal with Texas' New Sonogram Law posted in the Texas Observer on March 15th, that is very much worth the read.

Anxiety about next year

The uncertainty about next year is making me slightly ill.  I was hoping to know by now if I'll be taking a research year or going on to 4th year, but alas, nope.  Having not been offered a fellowship in the first round of selections, I get to keep waiting until all the spots are officially filled up.  Who knows how long this whole process will last...  It is so much worse than sitting by the phone for a date to call!

My peers are fervently filling out VSAS (visiting student application service) applications for audition rotations.  Rumor has it that spots fill up super fast and one must be very strategic about these things.  I haven't opened the email sent from my dean about registering for VSAS.  I have yet to figure out where I'd even want to do an audition rotation!

To make matters worse: my experience speaking at the conference of Friday, seeing where the 4th years matched, and a conversation between ob-headed peers and an OBGYN attending we greatly respect have me wondering if I should go into peds instead.  I LOVE obgyn.  I love everything about it and like what my life could look like.  I can do perinatal care, high risk OB, adolescent health, trans reproductive health, provide abortions, surgery, and the list goes on and on... But a lot of obgyn programs are malignant, conservative, and have seemingly unhappy residents.  I also worry that the all female environment will bring out the competitiveness in me.

I like peds a lot.  I can still do adolescent reproductive health, medical education, trans health, and public health based work.  I can maybe, probably, also provide abortions.  The pediatric community is all so happy, nice, and welcoming.  If I'm going to have my own family, peds will allow for a better balanced life.  Plus, I have many a connection that will help me get into a good peds residency.

Taking a year off would slow down the process a bit, but it will also slow down the process a bit.  Translation: I'll buy myself a little more time before making a decision.  I'll make more noteworthy connections in the obgyn world that should help me for residency.  However, I'll be 30 when I graduate medical school!!!  Yes, yes, I know that age is only a number.  But 30 is a really big number.  It'll also mean that I'll spend the next 2 years nomadicly as I move for the research year and then travel all around for 4th year.

Anyone have a crystal ball?

Match day 2012

Good luck 4th years!  Hoping that tomorrow brings only joyous news as you embark on the newest phase of the medical education adventure!  Crazy to think it is already your turn to match and our turn to be 4th years...  how quickly med school is flying by.  I'm so very excited to see where you all end up [and wise enough to avoid all hospitals come July].

(stolen for facebook)

The line has been crossed = time to protest!

This political attack on women's bodies and personal medical decisions has gone too damn far.  It is one thing when Mitt Romney takes a stance to defund planed parenthood if elected president; while far from desirable, no one is in immediate danger.  However, it is totally crossing a line when state legislators vote on whether a doctor can straight up lie to his/her patient in order to ensure she doesn't opt for an abortion. 

This all seems way too similar to the ethics lecture I recently heard: "Deadly Medicine in the Nazi Era: What Turned Physician Healers into Killers?" (this article touches on some of the factors that were discussed in the talk).   The idea that doctors are following this moral extremism with disregard for reality, not realizing or not caring that their moral belief is directly harmful to their patients... so damn scary what power and knowledge in the wrong hands can lead to.

Anyhow, I'm more frustrated at the politicians who we are currently paying to sit in office and debate away our right to choice, education, and honesty.   They are wasting our time and our money.  They are degrading women all across America by belittling us into a category of those incapable of thing for our self.  They are putting us at risk for unplanned pregnancies, incomplete healthcare, and clandestine abortions.  They are personally pissing me off!

What can we do about it?  VOTE.  Get these fools out of office.  However the election is a little while away so in the meantime there is a National Protest Against the War on Women being planned for April 28, 2012.  Taken from facebook:

National Protest Against the War on Women
Saturday, April 28, 2012 
10:00am until 2:00pm
State Capitols in all 50 States and DC
Join our organizing page: http://on.fb.me/wBUDYu

Organize your friends and go take a stance!  For the medical students and professional out there, please please please wear your white coat when you do.  It makes a difference for people to see that we're fed up with this BS.

Busy week

-Last weekend I was away at a national conference.  While it was amazing and inspiring, being stuck at the airport for 12 hours on the way back due to weather drained the little energy I had left.
-This Friday I'm presenting some of my past research at another conference (that conveniently happens to be just a short drive away).  I'm a bit terrified about this as I've never done this type of platform presentation before! Hopefully they only ask questions I know the answer to.
- The neuro shelf is a week from Friday.  I'm feeling totally unprepared and overwhelmed with studying.
- It's match week!  While this isn't my year to match, it's so exciting to watch all my 4th year friends.  I can't wait to hear where everyone is going!  It's crazy to imagine that this may be me next year.
- In theory, research fellowship responses are to be released this week.  Crossing my fingers that I'm accepted for the one I want.  Either way, I should hopefully know soon if I'm taking next year off or continuing on to 4th year.
-My mom's birthday.  I can not forget to call her!

Bentching gomel

There is a Jewish tradition to publicly acknowledge when you've survived a dangerous situation (eg serious illness, long travel, childbirth, etc).  It is traditionally done at one's first opportunity in front of a minyan and often done with a Torah present.

Last Friday night I was driving home around 8pm when I heard a loud bang and my car rattled.  [Aside: Yes, I know it was already shabbos, but after working a long week and having to work through the weekend it was the only time I had to run the errands that desperately needed to happen. Story of my life as a med student.]  I was on a pretty well traveled 4 lane road in a safe area, though there weren't really any other cars directly around me.  It took me 2 or so blocks to realize that my entire back windshield had shattered and another two or so blocks to realize that I probably should pull over.  I was in complete shock and baffled as to what had happened.  I then pulled into the first driveway I saw which happened to be a well lit grocery store & restaurant with people around.  Thank G!d!!!

Though I'm in my late 20s, and nearly a doctor, the first thing I did was to call my mom in tears.  While on the phone with her, still sitting in my car in shock, a sketchy silver car pulled into the lot, quickly turned around, and speed back out onto the street.  I thought it was strange but didn't make anything of it.  I called the police who came out to write an incident report.  The best idea we all could come up with was that maybe some kids were messing around with a BB gun or that a car in the opposite direction kicked up a big rock.

I have subsequently learned that an hour or two later that evening, on the same road, a friend of a friend's tire blew out while he was driving.  He pulled over immediately to see what happened. When he got out of his car he was jumped by 4 men.  They had thrown a brick at his tire.  He was badly beat up, robbed, and car jacked.  The police later told him that it was a gang initiation.  Thank G!d he's still alive. 

While it is possible that these two events are unrelated, it is pretty likely that they are directly linked.  I have no idea how many other people, if any, were injured or had property vandalized that night.  However, I'm pretty sure that had I gotten out of the car, as a single female in the dark, I would have fared a lot worse than the $250 it cost to replace the glass.

Birkhat Ha‑Gomeyl

 
hebrew from http://www.berachot.org/hebrew/hagomel.htm

"Blessing: "Blessed are You, LORD, our God, King of the Universe, Who bestows good things on the unworthy, and has bestowed on me every goodness."
Congregational Response: "Amen. He Who has bestowed on you every goodness, may He continue to bestow on you every goodness. Selah."