Pride

I was sitting in the car this afternoon with my mom on the way home from the airport (I'm home for a quick weekend between finishing my research year and resuming MS4), when she retold a story about an encounter that happened this week where someone wanted her to sign a "gay rights" petition.   She retold how she told the organizer "yes, I support gay rights, my daughter's gay."  

I've been out to here for 13 years and never once have I heard her say those words.  What a long way we've come...

Happy pride ya'll!  Instead of going to dyke march & pride, I'm spending this shabbos resting and enjoying some quiet time (& kick the cold that has been trying to attack all week).  The next 11 weeks are going to bring a whole heck of a lot of transition back to med school and being my best on away rotations.  Time to rest up before the fun begins!

Where will I be in August?

Fifty percent of my away rotations (July) have been settled.  August seems to still be up in the air though.  I got a loose offer from one Midwest program and then a formal offer from another.  The latter is where my now ex-girlfriend is on faculty.  I had applied in hopes of being with her, and then in stubbornness of wanting to prove to her that she made a mistake in dumping me, but now am starting to think wiser.  I imagine it will be tricky to do well on an audition rotation while also navigating being in the same space as someone whom I am deeply in love with and want to make a life with, but who doesn't love me back.  Plus, I'm pretty sure she's the only queer Jew in the city that I'd want to date - meaning that even if I LOVE their program - the city doesn't hold much promise for other parts of my life such as, um, dating.  

The first program isn't as strong as the program with my ex, and I'm not as interested in it.  It does come in a city with more queer Jews though.  Also, while the first program sent me an email offering me a space, there has been no formal follow up and they aren't responding to my attempts to gain more information.  I need to give program #2 an answer by Friday. 

I was just informed that a program I was holding out hope for is filled for my first choice for August, and was instead offered Oct, Nov, or Dec - none of which work for me.  I called the coordinator back who has put me on a wait list for another August rotation in ob/gyn at their program, but I wont know about that until at least Monday.  Two other programs I have applications in for wont even begin reviewing them until next week. 

What do I do?!  Anyone have a crystal ball I can borrow? 

The wheels on the bike go round and round

I did it!  I rode 65 miles on my bicycle over the past 2 days.  Sure, I walked some hills, and swore as I struggled to ride up others, but I still managed to do it!  I gained confidence on the downhills and learned to appreciate the modernity of flat roads through cow pastures.  There was only one small, almost comedic, fall off the bike on the second day when I was way past exhausted.   And you want to know what?  I got up and rode 16 more miles afterwards. 

All and all it was a beautiful weekend and a successful ride.  I challenged myself to do something I never really could have imagine doing before.  I gained confidence on my bicycle.  I embraced being completely cut off from cell service and email for a full 3 days.  I ate copious amounts of delicious food that was very locally produced and cooked with intention, in a room full of Jewish environmentalist.   I led a tisch Friday night that filled my spirits with songs, torah, and blessings.

At one point over shabbat, I realized that I was very much surrounded by the community that I have built over this past year.  This research year really has brought a lot of unexpected joy and connection.  Such a wondrous experience to end a year of personal growth.  I feel so very grateful.  Sore.  And grateful. 

Now, what next big ride should I train for next? 

Goal: stay up right, don't get hurt

The charity bike ride is this weekend.  It will be the biggest physical challenge I think I’ve ever attempted.  That is assuming that I ride more than 20 miles.  Therefore, I’m terrified.  I am so touched that my friends and family have donated so much money to support me, which I interpret to be either because they believe I can do it or they are in shock that I’m even trying. 
 

Seeing as I was basically a non-bike rider at the start of this (not learning to ride a bike until I was 19, never having ridden more than 2 or 3 miles at a time, and not having been on a bike in 3 or 4 years) I have 2 main goals:

1)      Stay on my bike

2)      Don’t get hurt

Actually, as long as I don’t get hurt, I’m not really sure staying on my bike is even that important.  The full ride is either 80 miles or a 120 depending on the course you choose.  My housemates are all doing the shorter 80 mile option and so that’s what I’m planning on too.  Even if I only make it one day, 40 miles, that will still be a new achievement for me.  Need to focus on small victories and not be disappointed when I don’t complete all 120 miles… that can be next time, right?

I just want to have fun.  Really, I want to not be anxious about this ride and to have fun.  Sun, endorphins, friendship & comradely, a post-ride massage scheduled – this really could be fun! 

Away rotation purgatory

Somehow it is May and I am in my last few weeks of my research year.  How did that happen?  Seriously, how? 

My last month here is overly scheduled: trip home for mother’s day, presenting preliminary research at a conference, charity 120 mile bike ride, finishing my public health thesis, and scheduling next year.  That last one is turning out to be a painful.  

I, like most medical students, am a type A planner – a control freak.  Scheduling away rotations leaves no room for control.  No transparency, no answering of emails or call, and no standardization of timelines.  Whoever thought of VSAS, and whoever decided aways are important for the residency application process, clearly finds pleasure in torturing medical students. 

So many moving pieces depend on if, when, etc. I schedule aways.  When do I leave the city I’m living in?  Do I drive, do I fly?  What happens to my car?  Where is all my stuff going?  Will I be able to keep the rest of the schedule I have booked with my home institution?  Or will everything need to be flipped around to make time later for aways… Ugh!  Uncertainty = anxiety. 

I’m just looking for 2 “yes”s.  July. August.  Two little away rotations at two different places.  Hopefully in ob/gyn.  So far I’ve been given “no”s from two places for July.  “Yes”s will come after “no”s, right?

UPDATE (5/20/13): July has been scheduled!  So, unbelievably, relieved.  Now I just need August to work out.

Dear ACGME,

As a 4^th year medical student I highly value the work that you do in ensuring my training in residency will be sufficient.   However, I am horrified to learn that you are proposing the removal of family planning training guidelines for family practice residents.  Many US women go to a FP as their primary healthcare provider for comprehensive health care – from the treatment of acute sickness to the delivery of their babies and everything in between.  The vast majority of women in the United States use contraception.  Now, if a FP isn’t trained to provide their female patients with counseling on contraception, pregnancy options, and the such, where are these women expected to turn?  It is an equation that makes no sense at all and will lead to subpar care for many US women, especially poor women and those in underserved communities. 

Please do not change the requirements for family planning physicians.  Women count on their providers, and we as providers need to be trained in how to provide comprehensive reproductive health care.  If we’re not trained, then who will be?  It is your responsibility as an accrediting organization to look out for our best interests as future physicians and the best interests of our future patients. 

Thank you,

PAIT

 

I wrote my letter - now where is yours?

 

ACGME is debating cutting family planning training for family medicine residents.  They are accepting feedback through tomorrow.  Please speak up, and ask everyone you know passionate about this issue to do the same. 

Comments are being accepted at familymedicine@acgme.org.  Also, the Reproductive Health Access Project has an online campaign going here.  More information can be found here.

And tangentially related, what is going on in Kansas is disturbing.

Passing stones

I'm pretty sure I had my first kidney stone this weekend, which also means this weekend went nothing like it was planned.  The presentation was classic: sudden onset severe flank pain radiating into my pelvis, nausea without vomiting, clamminess without a fever, and urinary urgency.  Of course, the pain started on my way home from work on Friday night, right after all the doctors' offices and urgent care centers had closed, and right before the start of shabbat. 

 I went through the differential: kidney stones, pyelo, appendicitis, hemorrhagic ovarian cysts, ovarian torsion.. but was very aware that the pain was primarily flank pain.  I called my med school roommate to calm me down, talk through the differential, and come up with a plan.  800mg ibuprofen, hydrate as much as possible, use a heating pad, reevaluate in a few hours.  The pain escalated but the heating pad made it bearable.  Our shabbat dinner guests arrived.  One guest encouraged me to call my PCP to talk to the on-call doc.  It turns out my own doc was on-call, strongly felt that I was passing a stone, and advised I go to the ER for IV fluids, stronger pain meds, and a confirmatory CT scan. 

A friend drove me to the ER.  We waited an hour, in which the waiting room became increasingly filled with people who appeared to have all types of communicable germs.  I couldn't sit comfortably or stand in one place and so I paced in the corner.  I hadn't yet even been triaged.  I wished I wasn't such an honest person, knowing that had I reported my chief complaint as chest pain + SOB, I would have been seen immediately.  I freaked myself out about a CT, about exposing my ovaries to needless radiation.  And so after an hour I checked myself out of the que and we left, knowing that either it was a stone and would declare itself or something would get significantly worse and I would be back.

The next 24 hours were a slow mix of adjusting the heat pad, re-dosing on NSAIDs, drinking as much as I possibly could, peeing, sleeping, and trying to read a book.  Not how I had planned to spend shabbat.  My urine turned cloudy a few hours after the pain began- furthering my suspicious that it was a kidney stone.  And then, sometime last night, the pain stopped.  It has left my body sore and exhausted, wondering if maybe I made it all up?  That's the downside of not having a confirmatory scan or seeing a physical stone pass... now I always get to wonder if it was a stone or not.  Really, could I have imagined all of the last 36 hours?  And it is a pretty compelling story indeed...  But, the true question is, would I believe a patient that came in and told me all of this?