The lessons of 6th grade dance class

When I was in 6th grade, my mom sent me to take ballroom dancing classes. This was the height of social awkwardness. We learned a bunch of things, and one dance was of course the waltz. After learning box steps and twirls, it finally came time for dips. This was, for the most part, a splendid failure. It's asking a lot of a 12 year old boy to dip some poor girl who (thanks to earlier onset of puberty) likely outweighs him, and it's asking a lot of some poor girl to let herself be dipped. There were no casualties, thankfully. Just some bruised egos.

And part of when you see two good dancers is the realization that they can do these things with ease and grace, and part of that is the relationship between them: they trust each other. If they didn't, it wouldn't work. It'd be like dance class for 12 year olds.

And that was when I realized that part of the beauty of dancing is that trust. It's the flow between two people who know each other's movements, each other's thoughts. And that's what makes dancing beautiful. And that's true for life too. You have to trust people, and the most beautiful things in life come only with trust.

And I guess that's the take home lesson. You can't be a part of something beautiful without first putting your faith in someone else. You can't accomplish much of anything without trusting in someone.

I did manage one successful dip, and it should go without saying that to this day, I have a near photographic recall of the event, down to her forest green dress, plain satin white gloves, and braces.

Doctors and doormen

There's a certain je ne sais quoi of a good doctor. You know, ask a hundred people about doctors, and they'll tell you a hundred different qualities, but there's something that everyone wants out of a doctor, and it's stuff that keeps people coming back for more. And really, I'd like to think that's all I've got going for me.

I went into a residency interview and I flat out said, "I'm not the smartest candidate you'll interview, not by a longshot. I'm not the sharpest or the most qualified, but I'll be just as good a doctor if not better because if all you were looking for were the smartest and the sharpest, you wouldn't be interviewing me right now." There's truth to that. I think about my med school class, and I know who I think the exceptional ones are, and they weren't the smartest. They were the ones that patients love, because medicine is more about relating to people than treating disease.

I was telling a friend of mine a truth to medicine. Even an incompetent doctor can be loved by his patients if he's willing to stand up and fight for them. And I'm living proof. I have patients all the time in the hospital, and my pitch to them to follow up with me in clinic is about as negative as possible. I'm a first year. I'm in training. There are better, more qualified doctors that abound. They're under no obligation to establish care with me. But still, I've had patients that turned down my attendings to follow with me. I'm not incompetent. I think really it's just that people want to know that their doctor is someone that cares about them. I don't talk down. I talk with.

The reason I like medicine, the reason why I wake up every morning and go to the hospital is because I like working with people. I like helping people out. I like talking to people and getting to know their problems and how I can help. Diseases, treatments, procedures, it's all a means to an end. If there were no patients to care for, I'd rather be a doorman. This is in complete opposition to one or two friends I have that don't want to care for patients at all. And I'll admit, I don't get it. If you don't want to take care of patients, why bother?

To me, being a doorman has the same luxuries and benefits of medicine. It's all about knowing someone who at the end of the day is looking out for you.

Do you really want to be a doctor?

It takes a certain level of masochism to go into medicine. Something in your mind has to actually say that yes, I do think that getting the shit beat out of me on a regular basis sounds like a way to spend my life. Never in all my life have a felt stupider than when I'm taking care of patients. What's the patient's UA show? How do you explain this uric acid level? What are we doing for her renal failure? What medications do we have him on for blood pressure? What has her white count been doing for the past week?

I think that the great advantage attendings have over us lowly interns is that they can cherry pick. They can take aim at us from high above and we really have no recourse. It's wholly their right, since they take the heat if shit starts flying, but it certainly doesn't do much for the ego when your attending shoots a string of questions at you and the only one you can answer is that yes, she has been afebrile for the past 24 hours.

But it balances in ways. My senior has a habit of saying that I did a good job with this or that, and it's unbelievable, absolutely unbelievable how much I appreciate that. It's nice to have someone say, hey, good job, I think that's the right thing to do. One of my seniors questioned an order I wrote. I told him that the on call senior told me to do it and he laughed. He said to me that he knew it wasn't me. I was too smart to do something that dumb. I'm glad that others have such confidence in me, and I'm starting to think that I need to have some confidence in myself as well.

I'd love to talk to pre-meds in college. I'd love to tell them that this glorious career of medicine, it's not what they think. It's work, tough work. It's as blue collar as you can get for six figure salary. It's not noble. It's not honorable. It's work. And if that's your flavor then more power to you, but if I wanted to get some respect, I think that there are better ways.

I think the one beautiful thing about medicine is that despite what other people do to you, no matter how much the system beats you up and down, you can feel good about yourself if you can go home and say that you helped someone. You know, it's not often that you can go home, sip a beer, eat a pizza, and think to yourself that you made the last few hours of someone's life as pleasant and pain-free as medically possible.

A patient looked at me today and asked me what I would do in her shoes. I didn't have an answer. She wanted one but I didn't have one. What would I do? I dunno. Would I fight? Would I give up? I don't know. And sometimes, just knowing that this decision that she's been fighting with is a tough one, that's comforting to know. And so I can go home and sip on a beer and think that in spite of how lousy today was, I did okay.

Yes, I am a doctor

There's something very satisfying about making a decision, whether that's right or wrong. When I was on ICU call, we were getting killed one night, and my senior sent me to evaluate a patient while he tried to save some other guy's life. I saw the patient and this patient was not as stable as I'd been led to believe. So, I nearly wet myself. Here I am, 2 months into being a doc, and I'm presented with a crumping patient. I tried to do little things first, but it eventually boiled down to a serious intervention. And my senior was getting worked over, so he couldn't help me. So I made my call, stabilized the patient, and gave him a ring. And he was fine with it, and it was such a... relief to know that I could make that decision on my own.

Going to church

Church today was a funny event. My med school church, I sat in the old people section. There wasn't a person in my pew that was within 30 years of me. However, my new church here, I'm surrounded by young women. And I do mean surrounded. It's a tad awkward. And moreover, I've no clue how one goes about meeting people in church. Can you imagine a weirder setting to meet people?

I like my new church, despite the lack of kneeling. It's nice to be somewhere that people like to go to church, but the problem is that it's death trying to get a seat. I remember my college church and the nightmare that occurred when you got there late.

I miss my college church sometimes. The last year there, me and M would go together fairly regularly, and afterwards, we'd meet up with S and sometimes C and get something to eat. It was so very... social. It was pleasant, and I miss that sometimes. Going to church by yourself is a very hollow experience sometimes.

I still find myself in the very bizarre position of being the most... Catholic person I know at my age. That's not quite right. And I've had people heckle me over this, and it's somewhat funny, because I don't think of myself as that much of a die-hard Catholic. I just go to church and give God his props. I try to be good and do right. That's not exclusive to any religion or belief. It's just being a good person. I'd love to find someone that's in my boat, but it doesn't seem like many people are where I'm at, and that's sad, but that's life too.

I did have one funny moment today. I was planning on going to church straight from the hospital, so I was a little dressy for a weekend in the ICU. One of my patients told me I looked nice today, and I replied that I was going to church, and she asked me to pray for her. Is that what all this Catholic stuff is for? For interactions like that?

I had another funny moment today. I drove past a Burger King, and I remembered that in one of my aunt's more lucid moments, she wanted Burger King, so we went to BK after seeing her surgeon. I don't stomach Burger King much, but now I'm a little sad. I have to admit that I cried a little bit. Who'd have thought anyone could wax nostalgic over Burger King?

Strengths and weaknesses

I was talking with my senior resident that I'd like to go into academic medicine, but I'm not all that smart. His words: well, I'd take issue with that. You're pretty intelligent, and you could do academics.

That was kind of surprising, since I really didn't think I was making all that much of a positive impression. Also, his followup comment is that academic medicine is full of people that couldn't cut it in private practice, so he did manage to stick it to me. Ha ha ha. Seriously though, I'm not one who thinks much of myself. I just know that I have certain strengths and I have to play to them.

Knowing your strengths and weaknesses is something that is more powerful than you might imagine. And I'm not talking about that interview garbage. In interviews, everyone's weakness is "I try to take too much responsibility on myself," or crap like, "I work too damn hard!" That's all lies.

I do remember one interview I did for med school. The interviewer asked me what my weaknesses are. So, I told him that I'm not the smartest student he would interview, not even close. I'm nervous and get easily flustered. I have to remind myself to do the most basic things. I like a high level of supervision. I seek reassurance constantly. But here's the deal.

I got strengths. I'm conscientious. I do what I'm supposed to do. I try my hardest. I don't give up easily. I try to talk to my patients, get to know them, because when you care about a patient, your level of care goes up like a rocket. You actually give a damn about how things are going to turn out. I take my responsibilities seriously. I try to perfect everything I do. I try to understand what I'm doing rather than just blindly doing it. I have an inquisitive mind and I'm eager to learn and be taught.

My interviewer's reply was that they were looking for people who were eager and receptive, and had the qualities that make internal medicine doctors great, and those qualities aren't just smarts. The qualities of a good doctor are ubiquitous. People want a doctor who is dedicated, conscientious, caring, compassionate. That's what people want in a doctor, and that was what this program wanted in a resident.

So of course, I didn't rank their program.

Everyone's a critic

Everyone's a critic. I had a patient weaned and extubated because she was getting ready to self-extubate. I ran it past the attending, who sort of agreed, but was mixed in feeling afterwards. He wasn't critical, but I definitely got the vibe that maybe this was too soon. One of our consulting attendings wasn't quite as subtle. He upfront said to me that I had extubated too soon and would have to reintubate her. I won't go into specifics, but anyway, I was vindicated. She's doing fine and out of the ICU. The attending conceded, but the outcome's really not the question.

I'm a first year medicine resident. As such, I have NO clinical judgement. I don't have that gestalt that attendings use for diagnosis and treatment. That's the skill I'm supposed to garner from residency. Seeing as that's the case, there's just about no reason to suppose that I will make the right clinical decision. In fact, I'd bet against me on all questionable treatment decisions. Already, I've had several of my orders changed or otherwise D/C'ed because they were inappropriate or outright wrong.

The point is to learn, and some attendings are better teachers than others. One of my attendings told me that I did the wrong thing, period. And that wrong thing had the capability of jeopardizing one of my patients. I didn't get burned on it; the patient's doing fine. But he didn't get in my face about it. He showed me what to look for next time, who to talk to, what I should consider, and really who to trust.

Y'know, it's all about attitude. Some people honestly believe that criticizing and yelling is the best way to teach. I'm glad that most of these people don't go into internal medicine. Medicine's got all the passive aggressives. Like I was telling my medical student today: medicine's full of asses. All the jackasses become surgeons. All the smartasses go into internal medicine. The dumbasses? Well, someone's got to do psych I guess.

That being said, I think I should've gone into psychiatry.

How to wet your pants

If you ever want to experience the intense desire to wet yourself, here's how. Get in a room full of new interns to be, and have the person at the podium ask the following question: "Now, everyone here has put in a central line, right?" Your hand is the only one that doesn't go up. Panic, panic, panic, panic, panic, PANIC.

"Experience is a hard teacher because she gives the test first, the lesson afterwards." –Vernon Sanders Law

I was talking with a friend a little while back that my expectations for med school were just too high. "'How high?" he asked. "Did you think you'd be married by now?" I have to say that yes, I kind of did. That was unrealistic from the beginning, but it sort of speaks to the height that I was to fall over four years. And my friend did relay a simple truth. "I'm not sure why you thought med school would fix your problems. Med school's just an event. It doesn't change who you are."

But the real problem is that instead of making med school different from college, I sort of turned it into a repeat of the previous four years. It had the same crappy ups and downs, similar challenges, and similar results. And of course, similar regrets. Regrets like chasing after the wrong girl, like not studying harder, like making a boatload of friends but only trusting my high school ones, stuff like that.

There's a fantastic quote said by Franklin P Jones: "Experience is that marvelous thing that enables you to recognize a mistake when you make it again." So at least I'm walking away from med school with experience. I can say that much. And hopefully, next time I meet a girl that's my type and the world seems convinced I should try to go out with, I won't be a moron and chase after another girl for a year or two and fuck everything up in the process.

My life is one big regret

The problem with regrets is that they keep working backwards. I can regret eating an ice cream cone for dinner, but then it keeps working itself backwards, and eventually I end up regretting not staying in town for residency, regretting that whole sorrowful time during 2nd year, regretting 1st year and all those stupid attempts to change myself, regretting leaving my college friends and going to med school, regretting that whole sordid relationship mess, regretting going to the college I did, regretting moving to the Midwest in the first place... and it keeps going on and on, and eventually, I end up at the age of five, on a snowy hill in a park in the Northeast.

I was so happy. I had my Freezy Freakies with the jet airplanes on them. I ran everywhere; I was so eager to get there that I had to go as fast as I could. And I think to myself that the only regret of my life, the original regret from which they all stem, is one that I had no control over. I wish my parents had not gotten divorced. I wish that we were still a family. I wish that those winters sledding in the park were the rule and not the exception.

I wish that I never had any reason to move to the Midwest, and maybe worked up the courage to ask out that one girl in the row next to me who always was so flirty with me. Maybe we'd go out, and that would turn into something more, and maybe we'd end up married, have some kids, and live in Manhattan, and visit my parents every few weeks.

They'd go crazy over the grandchildren. My mom would be all over them, and my dad would try to teach them something far above their comprehension. And I wouldn't have to spend the rest of my life trying to figure out what a family is. I wouldn't have to spend the rest of my life trying to find intimacy with another human being.

The problem is that when you go that far back, you stand a good chance of entirely changing whom you'd become. I wouldn't be the same person that I am now. I wouldn't have all the close friends that I do. I wouldn't have a lot of things, but I think I'd trade it all. And I doubt any of you can understand how entirely scared I am to leave here. I don't want to move again. I don't want to leave anymore. This is the only home I have; I don't want to give it up.

And all I really want is someone to tell me that it'll all work out in the end. All this moving and worrying and new beginnings, it'll all come up roses. 'This is the second act. Second acts are always full of anguish and tribulation. But it'll all work out in the end.' That's all I'm asking for. It'll be nice to have a new city, new people, new surroundings. I can start fresh. But you see, I never wanted a fresh start. I appreciate it, but it was not what I wanted. I wanted another chance at an old start.

Realizations about my love life

I was reading through the archives on this site. I enjoy it because it comforts me with the realization that all my problems are not new or special, but in fact festering boils on my existence. It got me thinking that for once in my life, I'm thinking different. Oh the situation is unchanged, notwithstanding the crap that has happened in the interval between then and now, But I'm glad that my opinion on the matter has changed significantly.

Because it's one thing to be unlucky in love. I mean, man, I've struck out more times than should be allowed by law. It's quite another thing to abandon hope entirely. Because I've made a few realizations in my life, and they're stupid realizations, but just because they're stupid doesn't make them any less true.

(1) I can't love someone if I don't love myself. I don't mean that in a narcissistic way. I just mean that when it comes down to it, loving someone else requires you to believe yourself worthy of such an emotion.

And along that line, (2) Happiness is something from within, and I have to learn to be happy by myself if I want to be happy with others. Inner joy isn't supplied by others. It's something gained from within. Happiness based on other people isn't happiness. It's no different than drugs or alcohol. It's a temporary euphoria that is lost as quickly as it's gained.

(3) Part of learning to love myself is accepting who I am. This I am working on. I've been working on it for quite some time. A couple years back, I realized that I was trying to change who I was to accommodate the love interests in my life, and that was a flawed strategy. I need to be myself, and accept that I am the best at being who I am. And that means accepting that I'm a private person, that I have a hard time sharing. I'm a goody-goody Catholic boy who'll quite likely remain a virgin for a long, long time. I draw pleasure from small things. I am very nostalgic. I get great satisfaction by pleasing others. I am conscientious. I am full of quirks and foibles and little sharp edges, and that's who I am, and there's no reason to change that or modify it.

Once I learn to accept myself, and to love myself, then (4) quite simply, I deserve to love and to be loved. I am who I am, and that is the person who deserves to be loved, not someone else.

But just because I deserve to love and to be loved, (5) that doesn't mean that I have any control over who loves me. I've been chasing after eidolons, fantasies. I did not learn until recently that finding the right person is more than attraction. It is finding a person that complements me, that is the other half of my puzzle piece in life.

(6) Love is not trying to fill the emptiness in my life with someone else, but it's trying to find someone who'll want to help me fill those holes. Love is not a solution to anything; it's a partnership. I've always viewed my life as empty and lacking, and maybe it is, but I'm not looking for someone to shore up the gaps. I'm looking for someone to help me along.

But the thing that I really came to terms with is that looking for love, real love, is playing with fire. Because the truth to life is that (7) if you want to be loved, you must love. Love isn't a one way street. And I can't be loved without loving. I can't take without giving. I can't expect a person to love me and not to love her back.

I'm still sorting through these little realizations, but I feel like it's time for me to get back into the dating world. And it's not that I have any prospects that I'm working on. It'd be nice if something just fell into my lap (no pun intended), but I think that it's simply a change in my attitude.

So, the short of the story is that I think I'm ready to try to start dating again, and that I'm kind of glad that I've had all this time off from it, in spite of all the shit I had to wade through, because I had some lessons to learn, and learning those lessons was valuable, because learning to accept myself for who I am is probably much more valuable to my existence than some scattered dates that led nowhere and would've caused a lot of heartache.

Thank you

I guess now is a good a time as any to get this over with. I want to just thank some people, and by thank, of course I doubt any of them actually read this site, so I get to thank them in utter anonymity.

Thank you, M. I think that I've never met a person quite like you, and probably never will. You've no idea how much you inspired me to be a better student and a better doctor. You showed me that it's okay to hold myself to a higher standard that what was expected of me. You showed me that being a good doctor is not about smarts, but about heart. I remember when I first met you, I remember smoking outside school between classes. I remember it all, and I doubt that you'll ever comprehend how much I'm in your debt.

Thank you, S, for keeping me running even keel. You had such a fantastic way of putting things into perspective. You kept me from getting unbalanced and tripped up. You kept me pointed in the right direction at all times, as much as I wanted to go the other way. You made me realize that life is what you make of it, and that when all you get is lemons in life, you get to discover just how delicious lemonade is. You made me feel like I was a part of your family, and you made me feel at home. Thanks.

Thank you, R, for rejecting me, of all things. Thanks for making me look at myself in the mirror and see who I really am. You'll never know it, but over the past two years, I've grown by leaps and bounds, far surpassing the other nine years I've lived in the Midwest. You know, it's been a long, long time since I've felt like I'm not pretending. It's been a long time since I've been true to myself, and although you probably have no idea, you shook up my world and forced me to find myself. Thanks for only being a friend.

Thank you, F, for listening. Thanks for never blowing off my ravings and tirades and anger and desperation and sadness and self-loathing. Thanks for letting me be myself, and helping me along the way to discover just who I am. Thanks for always being the person to lean on when I needed a shoulder, and the helping hand when I needed a lift. Thanks for making me understand that it's not what's around you as much as what's in you.

Thank you, K, for being the most decent person I know. Thanks for showing me that there is refuge for the kind-hearted and compassionate. Thanks for making me realize that all the qualities I want in a doctor are things that you can't measure or quantify. Thanks for being a person that I admired, that I could call my friend.

Thank you to everyone that helped me along the way to get to this point in my life. I couldn't have done it without you. Everything I've done, I couldn't have done it without friends to lend a helping hand, an attentive ear, or a shoulder to lean on. There are some people who deserve all the thanks in the world, but I'd rather not thank everyone here.

What I really want to do is thank everyone who held me back, everyone who threw roadblocks in my way. I want to thank everyone who doubted, interfered, meddled, and made a mess of my life. I want to thank each and every one of you who made me contemplate suicide for the first time in nine years. I really, sincerely, want to thank you.

I'm not being sarcastic. You know when you're drowning, you've got to strip off your clothing so that you don't sink. When you're running low on fuel, you've got to pitch the dead weight so that you can go the distance. You know, it's like I've been climbing, and I'm halfway up a wall, there are only two directions to go. And as much as you tried to drag me down, I'm still going up. And knowing that you were there to hinder me, to hold me back, to make my life as hellish as possible, it makes reaching the finish line that much sweeter.

Seven facts about me everyone should know

(1) I do not give out compliments. I just don't. It's not that I'm trying to be rude, but I just don't see the need. Conversely, I cannot take a compliment. Whenever someone says something nice to me, I am the picture of awkward. This goes back to when I was 15 and I decided that I would stop using the word 'love' because I thought it was overused and lost all of its meaning and significance. Similarly, I think people pay each other compliments just to feel better, and not because it's true.

So, I decided back then that I wouldn't use love unless I meant it (I've since rescinded), and I also decided that I wouldn't compliment someone unless I meant it. So, believe me when I say that any compliment I pay, you have to amplify a bit. If I tell you that you look nice, you're fucking on fire you're so hot. If I say that you did a good job at something, then you blew the freakin' doors off of it. That's just me. I can't give a compliment.

(2) I have a rule for everything. I realized this when F pointed it out to me. I started to say something about the proper way to do something and he stopped me and ran back into the room saying, "Wait, wait, I want to hear the rule for this!" I realized then and there that my superego is the 600 lbs gorilla of my psyche. It extends far beyond rules of etiquette. I have rules for the proper way to read the newspaper, the proper way to store clothing, whether to recycle and what one should recycle, when to smoke, proper e-mail etiquette, how to read a poem, and other topics. In fact, I have an opinion on the proper way to do most anything. I have had to actively suppress this urge to give my opinion, especially when F gave me his business card and asked me what the rules of business cards were (his cards broke most all my rules).

(3) I completely hide my emotions. It is very difficult to get a read on me, not in some vague trivial sense, but I'm talking huge deals. Like I was suicidal for a day or two and no one even noticed. People piss me off to extraordinary lengths and have no clue. People accuse me of being angry when I'm tired, happy when I'm depressed, bitter when I'm remorseful. There are only about 5 people in the world who manage to see through my layers upon layers of defenses to who I am. Everyone else just sort of operates on the assumption that I'm this happy-go-lucky sort of individual. As an example, I have a friend who I was planning on cutting out of my life entirely. That person's saving grace was a Christmas card. I know someone else who will probably never know how much our friendship has meant to me, and I'm fine with that.

(4) It is remarkably difficult to get me angry. But once someone gets me mad, I stay mad. And I never let go of grudges. I mean, really, I was social with my ex and my friend who basically undercut me in order to go out with her. And this guy, I stuck with him when his previous girlfriend and him broke up. I was a good friend, and he royally screwed me over. But man, I was waving hello and inviting them to things. Getting on my shit list takes a lot of effort. It's one thing to annoy me or irritate me, but getting me angry, that takes work. In this world, there are only 2 people that I hate. And I dole out forgiveness like I'm gunning for sainthood. But once someone crosses the line, that's it.

The funny thing is that most people have no idea what will set me off because I don't show it. There are more than a few people in the last few years who have pissed me off to a major level and it's not like I ever did anything about it. It's difficult to know what will set me off because there's so very little that does.

But my opinion of people certainly brightens and dims without any indication. I have a friend who came up short on a bill, leaving me to pay an extra $10, and I don't think I'll ever confront that person, and I doubt I'll ever have a favorable opinion of that person like I did before. Another person, I confided some pretty serious shit to, and that person more or less blew me off. I didn't say anything, but I spent the better part of a month deciding whether I ever wanted to talk to that person ever again.

(5) I am angry with God. I was told this by a priest during my last confession which was over 5 years ago. I came to realize that this priest has a level of insight into the human soul that is unbelievable, because he was dead on. I am remarkably angry with God, because I feel like my life is without purpose. I feel like my entire life is spent pointlessly without any effect or repercussion on anyone, muchless humanity in general. It's a sobering realization to think that I could be erased from existence without so much as a hiccup. And the part that truly pissed me off was that in spite of this pointless meandering existence I lead, I'm not allowed to end my life. How wholly unfair. It's pretty much the only reason I haven't killed myself.

But I go to church like it's my job, and I do spend time in prayer. I feel very grateful for what God's given me. I'm remarkably fortunate. But still, it's hard to look at all this good fortune, knowing that most of it is stuff I could do without, and the stuff I do want in my life is all deficient.

(6) I am extremely paranoid. I honestly wouldn't be surprised if I had a psychotic break sometime soon. I have a lot of paranoid thoughts. I worry that someone may be following me, or that one of my friends is actually trying to betray me, or a girl I like is actually making fun of me behind my back. I worry endlessly about what people think of me. I spend a lot of time trying to rationalize away my paranoia, but the problem is that it's ended up being right a good number of times. Part of dispelling an irrational belief is realizing that it has no foundation in truth. It becomes exceptionally hard to dispel an irrational belief when your previous irrational beliefs (like that your girlfriend was cheating on you, that a girl you liked was mocking you behind your back, that one of your friends was just humoring you but actually resented you) have been proven to be true.

(7) I don't talk to anyone about what goes on in my life. Sometimes, I'll call S, or I'll track down F maybe, but otherwise, I keep everything to myself. I've become an intensely private person, because I've come to the realization that I'm not really sure I can trust anyone with my emotional wellbeing except for those with a decent track record. And this is rather amusing to me, in that ironic kind of amusing way, because I would love to share myself with another person. I would love to have someone I could really confide in. But honestly, most people wouldn't know what to do with me. I had a friend who honestly just avoided me for 2 months after I spilled some emotional baggage. I had another friend who offered me a terse e-mail whose content can be summed up with the words: so, are you better now?

Two things I have to do before I die

The thought occurred to me that I may be single for the rest of my life. This has actually been invaluable. I thought the whole point of being okay with myself was that this realization shouldn't scare me as much as it does. I have to admit, it scares the shit out of me, because it sort of infringes upon one of the two things I'd like to do before I die. We were talking one day about things that we'd like to do before we die, and when rubber met road, I decided that only two things are really critical. Everything else, like going to the Vatican, having children, all that stuff, it was a wash. There were only really two things that I thought I absolutely had to do before I died. And the sad fact is that I've made no progress on either front.

What are these two things? What the hell, I'm in a sharing mood. (1) I'd like to make a difference in someone's life, a real difference. Not some bettering the world bullshit. I'd like to have a situation where I made an honest to God difference. I can't say that's happened yet, and I doubt it'll happen any time soon. (2) I'd like to know what it's like to love someone with all your heart. Y'know, it'd be nice to have a girlfriend and all that jazz, or even to reproduce, but what I want is to know what it's like to really love someone. These are the only two things that I feel like I need to do before I die.

And I'm sure that some of my friends would say, "How can you say that you haven't made a difference?" Well, it's actually quite easy to say. And easier to believe. I really haven't. My life has been exquisitely selfish. I figure that one day, I'll take a bullet for someone, and that'll be that. As far as love, I've no fucking clue. I really have no idea what it is to love. It's an entirely meaningless word to me. I'd like to know what love is, not lust or crushes or infatuation or friendship or obsession or any of that shit. Balls to the wall 100% love. I haven't the faintest.

Awards and accolades

There was an awards ceremony at school. I went because one of the med school coordinators is changing job titles (a fun game at my school, as this has happened to just about all my favorite folks at school), and I was somewhat sad. As much as we butted heads, I really owe her a big debt of gratitude for her help with my personal statement.

I was thinking though about how it's been such a long time since I've won an award. I'd like to say that I'm envious of the award winners, but I'm not really. Awards don't mean that much to me. I can't take a compliment at all (I've been contemptibly rude upon receiving compliments before. Someone thanked me for doing something, and my reply was that an idiot could've done it). What's more, the work I do isn't anything I'm ever particularly proud of. The thing I do envy is that someone thought of those people for those awards. Y'know, there was some earnest appreciation going on, and it's always nice to be appreciated.

I don't think I'm appreciated at all, but then again, I don't do anything that deserves appreciation. So it all balances out. Well, maybe that's a lie. I did get a call a few days back, thanking me a gift I made, a very earnest thanks. And y'know, I have to admit, I felt a little pride. And maybe that's the thing. Whenever I used to win praise or awards, it was all stuff I was supposed to do. I was winning awards for doing what was expected of me. There's no pleasure in that. But that gift, I made it because I thought that we should have something to remember our times together. And to be thanked so earnestly for doing that, it's hard not to be a little proud.

I've only ever won one award or recognition that I was proud of. I won an award in 8th grade, and it wasn't for intellectual prowess or some ability or skill. It was the most coveted award the school bestowed for exemplifying everything the school stood for. It was an award for being a person the school could point to and say, "This boy here is the reason for our existence, to mold a youth into this kind of man." On that day, and on that day only, was the only time I've ever felt truly proud.

All nighter

I haven't pulled an all-nighter in years. Years I tell you. I can't remember if I did during 1st or 2nd year of med school, but I certainly did tonight. It was... fun. It's been a long time since I've had a good time like tonight, or today, or whatever. It's made me realize that you can come at the same problem from entirely different directions.

It's also made me realize what exactly constitutes a great friendship. Y'know, it's such a marvel when you figure out what it is that draws you to other people, and what draws them to you. You don't have to be false, or even try. You just are, and that's it. No pressure. No worrying. It is the ideal state of being. And it makes me wonder sometimes why I feel such a terrific need to torture myself over loneliness and crushes and past romances and all that other stuff, when I know, I know I have a legion of fantastic friends who are there for me when I start to falter.

And the best friendships, if one has to choose, should definitely involve a bottle of scotch.

The last day of ICU

Today was my last day of the ICU rotation. I have to say that I actually learned very little on my rotation. I learned how to write an ICU note. That was something. I learned that despite what everyone says, common things occur commonly.

Today was a very... stupid day. I caught five or six things today that were just silly. One patient had two H2 blockers. Another patient was on heparin and actively bleeding. Another patient had meds that the pharmacy didn't send up. One patient was NPO and getting scheduled insulin. It was just a string of stupidity today.

I greatly confused a nurse today. She needed a boost, but she walked right past me. If you've never met me, I'm a pretty big guy. So I stopped her and we boosted her patient, and that was that, but I think it's sort of... a sign of the times, y'know? I think that a lot of docs and students think they're too good for this sort of stuff.

It's like we were putting in a Cordis, and I can assist someone in a sterile field just as well as a nurse. It takes all of one hour to learn how to maintain a sterile field. And the nurse was surprised at me.

Maybe it's because my mom is a nurse, but whenever I work with nurses, I'm always on my best behavior. I realized one day that nursing is a really tough job, and I should try to be helpful if I can. I mean, why does some nurse need to waste time helping another nurse boost a patient when I can help? Why does a nurse need to stand around at a simple procedure when I can do the same thing?

I thought I was the only person that did this, but I discovered that M was also guilty of doing this stuff, and in fact did much more of it than I did. I think that's why I liked working on rotations with M. We both were eager to do things that had absolutely no teaching value, but were things that were... good-natured.

I thought about it a long time, and I used to think that a lot of my attendings liked me because I was a hard worker, but I discovered that this is not really the case. It's the willingness to do something that really has no value to me whatsoever. It's that I would talk to families of patients on my own. It's that I would stick around late and help out. It's that I wouldn't leave until I'd done what I said I would do. It's that I actually cared. It's that I'm still sad for the wife of a patient I saw who blamed herself for her husband's death. It's that I'm still angry about an aggressive workup on a brain dead patient.

I was thinking today about how devastating oncology was for my mental wellbeing. I was thinking that I'd said that I could never do it. I was thinking today that it's not only a field I could do, but one that I should consider. It's got a healthy amount of intellectual stimulation, but moreover, it and general medicine are two fields where your relationship with your patient can be more valuable than any treatment you have to offer. Y'know the truth of the matter is that I think I could be a decent oncologist. It's simply a matter of whether my heart could stand it.

Zebra hunting

One of my patients died. I was very... angry about it. Well, not angry. It was just that... we did a ton of workup and treatment on a guy that was toast. Y'know, it's very frustrating to be in a setting where we almost don't know when to stop. To me, my patient died at 6AM. The death certificate I'm sure will read sometime in the evening. The family was all torn up about it, and I guess I can understand. I'm torn up about it too.

Y'know, the one thing that I learned in medicine about life is that I'd like to die with a little dignity. I've seen too many people die too messy a death in the hospital. When I go out, I'd like it to be a little less nuts. Y'know, we spend our entire careers in medicine battling the inevitable.

Still, I went down to the coffee cart to try to get an espresso after work, to take the edge off the horrible taste in my mouth from knowing that my patient was alive yesterday and is dead today. I'm not sure if you've never been in medicine that you can really appreciate what it's like to know that someone in your care has done exceptionally badly, and is now dead. You detach yourself. You harp on little things.

It's impossible for me to concentrate, so I spent tonight playing America's Army. It's better than thinking about the whole situation and my aggravation with it. Y'know, the guy is dead, and we're still hunting zebras on him. And everyone feels comfortable with that, and that's the part that bothers me the most.

Y'know, I've greatly disliked my month in the ICU, because it has single-handedly gone against everything I've ever thought about medicine. We order million dollar workups on everyone that comes through the door. We order so many tests that tracking them all down is next to impossible. We order tests that take days to come back for questions on acute management. Everything in the ICU is a zebra. We spend no time with the patients. I've actually written a note on a patient, and only realized after rounds that I had not done a physical exam. We treat numbers almost exclusively.

I wish I was back on my sub-internship. I liked seeing my patients. I liked taking care of them. My ICU patients, a good number of them got better, but I certainly don't feel any better about it. And maybe that's because I really can't say for sure that we actually did anything to help them. I'm willing to bet that aside from the vent, they did it all themselves.

My resident couldn't believe I wanted to do general medicine, but the thought of doing critical care for a living makes me nauseous. Y'know, people talk about lifestyle and pay and all that stuff, but in the end, you have to do a job that at the end of the day, you can go home and sleep at night. I think about the ICU, and it makes me ill.

I have so many criticisms of my ICU experience that I wouldn't know where to start, but I guess in the end, my biggest problem with it is that you would think that the ICU is where you get the absolute best care in the hospital, and the truth of the matter is that if not for the nurses, I'd never admit anyone to the unit.

Pay it forward

Of all the things I learned from medical school, my best lesson was from M. She taught me something that was more valuable to me than all those lectures and attending rounds and didactics and whatever. I learned from M that it's one thing to meet the standards expected of you; but you've done nothing unless you've met the standards you expect from yourself.

It's not okay to do just enough. It's not okay to skate by. You must be the best that you can, because any less and you'll know in your heart that you came up short. It's why I end up doing a lot of things that I used to make fun of M about. I saw one of my patients this afternoon. I didn't have to. The nurse even looked at me funny. Why was I even there?

I was telling a friend of mine that I'd endeared myself to some of the nurses because I'd given away so many pens and goodies that I got from drug reps. He seemed intrigued by the idea, till I told him that I gave away the good pens, the metal ones. In the medical student world, nothing's better than those metal shaft drug pens. I have given nearly all of them away. He stopped listening to me at that point. He wasn't going to give away the metal ones.

I was dumbfounded. I paid nothing for it, and I could make someone's afternoon by just giving that person a pen. Think about that for a second. We live in a world where I can give someone a pen and make their day. What a simple gesture. There's a wonderful quote by Emerson: it is one of the most beautiful compensations of this life that no man can sincerely try to help another without helping himself.

I was leaving a conference, and the lunch had been picked over. K had come late and hadn't gotten a chance to eat anything. I had saved my sandwich for later, and I gave it to him. He thanked me profusely. Y'know, that's life right there. That's what life is all about. You share what you have. There's a passage in the Bible that I've always liked, Matthew 25:40. "Whatsoever you do for the least of my people, that you do unto me."

In my life, I've always done what I felt was right, not because I had to or because I thought it'd be good for me in the end. I've always tried to do what's right because it was the right thing to do. You know, life is full of uncertainty and doubt, but if you follow your heart, you'll never go astray, because the heart will never be wrong. I do what's right because I have the sincere belief that the only way to make this world a better place is to make it a better place, one day at a time.

So I lead my life the best way I can. I always act with the best intentions. I always try to be the best person I can be. Because while other people are content to sit on the sidelines and criticize the world, I want people to know that life is what you make of it, and that you can only reap what you've sown.

Responsibility

Y'know, normally, I am a bit of a social butterfly. I used to go to a lot of parties and such. Recently however, I've been very antisocial. Truth be told, I'm sick of dealing with other people. Honestly. Anyway, I mention this because tomorrow I'm going to a get together, and my heart is just not in it. I think to myself that I could just skip it and take a nap. And somehow, that sounds like a good idea. I'm not sure what's wrong with me lately. One of my housemates keeps asking me if I'm doing okay. I'm actually doing pretty well. I just don't feel very upbeat.

Maybe I'm not okay. That's a distinctive possibility. Maybe I'm depressed (unlikely) or despondent or something. Maybe being surrounded by all this death is jading me to existence. I don't know. All I know is that I could skip out on the festivities tomorrow and not feel bad about it.

The thought occurred to me that maybe this is not something I should frown upon. I've spent all this time getting back in touch with who I am. Why should I question now what I've spent so long reacclimating to? Maybe this is me. Maybe I really am a 'goes to the movies by himself' sort of person. I know that I'm getting back in touch with my utter preppiness. I'm dying to wear my new sports coat, or even the old one really.

You know, in the process of getting to know yourself, you end up doing things to test just who you really are. And a lot of it is simple self-indulgence. I don't feel like doing this, so I won't. I don't feel like getting out of bed, so I won't. Let it stew. Let it fester. Eventually, you discover what gets you, what moves you along.

The one thing that I learned about myself is that I place no value in praise. I've won my fair share of awards and recognition. Today my senior told me that he really appreciated that our lists were so up to date, and on all the services he'd been on, he'd never had a list so well done. I'm sure he meant it in a complimentary way. I couldn't have cared less. Why should I be praised for doing what I'm supposed to do? That's ridiculous. If I did something outstanding, then sure, I would like some thanks. But please, for doing what I'm supposed to do, I expect nothing. I've always believed that when someone trusts you to do something, that's sacred. That means you do it, and you do it right.

It's why I've never felt comfortable when attendings tell me that I'll make a good resident. Their opinion is based on the fact that I do what I'm expected to do? Would you congratulate your computer for not crashing? Would you reward your heart for beating? There shouldn't be a reward for doing what you're supposed to do. One of my friends in college was right about me. I'd make a terrible boss, because I expect things to be done, because it's what I'd expect from myself.

And I realized that to myself, I'll never be outstanding. Never. Every time I achieve something notable, I'll always know that it was simply what I should have done anyway. No matter what the world says, I always hold myself to a higher standard. And I think that something my mom told me when I was 12 is sort of the truth behind me. I got a C in one of my subjects, and my mom scolded me. I told her that I tried. And she looked me in the eye and I knew that she could see right through me. "The important thing is that you do your best." And that's the standard I've always held myself to.

Maybe that's why I'm so disappointed with myself sometimes. It's the knowledge that I have not done my best.

On a side note, I helped a couple ladies push their car into a parking lot today. I drove by them and I had to stop and turn around, because in my mind, I knew that if I drove away, I wouldn't be able to forgive myself. How could I call myself a God-fearing Catholic if I drove off without helping a couple women with a broken down car? Y'know, medical school has taught me one thing about life: if you don't walk the path, it doesn't matter that you know the way.

RRC in the ICU

The other student I'm with seems to be enjoying this rotation. I on the other hand am dying. It reminds me so much of my time on vascular surgery, the rotation that convinced me that I wanted nothing to do with surgery. It's criminal what we do to people. I can think of no greater humiliation than dying with a foley and a rectal tube, a decubitus sacral ulcer, and some med student breaking my ribs doing compressions while the intern warms up the defibrillator.

The ICU is not the real world. That is what bothers me the most about it. Everything that happens in the ICU is like medicine practiced on crystal meth. It's the last 30 seconds of a basketball game played for the whole game. It's a hockey game that's 60 minutes of power play. I can't get into it. I can't appreciate it.

I did the math and for an ICU rotation, the residents are actually doing pretty okay. It's not q3 overnight call. There's more than one intern covering a service. Caps are enforced. So when residents complain, I'm just not sympathetic anymore. Medicine isn't supposed to be easy. It's hard. And ICU is the hardest. At some point, you've got to say that there's a limit.

A lot of people in my class are going into radiology and emergency and other fields that are basically shift work, and it depresses me. Medicine should not be a job. It's a profession. Mechanic is a job. Electrician is a job. Plumber is a job. Medicine is a profession, and that means something. It's ridiculous to ask someone to work 80 hours a week, but life can be pretty ridiculous.

You do what you have to do. I've never left the building without updating my patients on the list. That's simply being responsible. Today, my senior told me to go home, and an hour later, I was still there. I could've just left, but I refuse to leave the hospital without doing what I was supposed to do. It's my responsibility, and if I expect to be taken seriously, I have to act serious.

My senior has been sending the interns home early recently, and while I'm sure I'd be thankful if I was an intern, I'd also resent it somewhat. When you're on a team, you work as a team. That's the way teams work. You don't see a pitcher in baseball happy to be taken out of the game.

It's tough to put into words what I'm trying to say, so I'll stop here, and note that I had a successful radial stick for ABG today. Nice.

Stuck in the hospital

Last month, one of the nurses took to calling me doctor. I informed her, on several different occasions, that I'm not a doctor yet. Her reply was that I would be soon enough, and she loved the startled, panicked look on my face when she called me doctor. After all, I'm not very used to it.

For those of you not in the field, being called 'doctor' by others must sound somewhat appealing, but anyone who's been in the hospital knows that the only time someone calls you doctor is when they want something from you.

I've learned that I can only be so upbeat. After doing two months of inpatient back to back, I'm pretty tapped. I just want to get done and go home. I can't be a gunner right now, as much as I'd like to. I'm too tired. I just wish this was all over, but what I've come to realize, to my horror, is that it'll never end until my retirement party. I didn't get home to 8 PM tonight. How nuts is that?

It's all about trust

I completed the nomination forms for graduation awards for clinical faculty and students. The docs that I nominated were folks who I thought deserved it, but my votes for students were not exactly predictable. I would guess that none of the people I voted for have any chance at winning. At the onset, I tried to come up with a set of qualities and traits to rank people, but in the end, it really just boiled down to trust. Do I trust this person?

On my sub-I, I consulted an attending whom I'd worked with before. I told him about the patient, and he took my presentation at face value. He didn't have to. I'm a student. As an attending, it's his right to talk to my attending, or my senior resident, or even my intern. He doesn't have to take my word for it. But he trusted that I was giving him the whole picture, and that I would follow up on what he had said. And that's something.

Attendings have the liberty of avoiding scut work in house, but they have to trust that the residents will get it done, and rely on the work of the residents to base all of their clinical decisions. That's a lot of trust. Some attendings don't trust the residents or students at all. I know several attendings who repeat the entire comprehensive physical exam on every patient they see. Some check all the labs themselves, not trusting that the numbers we've written in our notes.

Everything after trust can be worked on. You can teach a person knowledge and judgment and clinical skill. You can't teach someone to be trustworthy. And that's why I didn't vote for some of my classmates. When the rubber hits the road, I just don't trust that they'd get the job done.

As an example, on my sub-I, there were a couple personal emergencies, and as a result, I was the only person on my service. No senior. No interns. I had to work with an intern pulled from another service to emergency cover. As we rounded, it became plainly obvious that the lists for the patients were not up to date, and we were paralyzed because we were spending all our time figuring out what medications our patients were on. The 3rd year students are supposed to keep those lists up to date, but they hadn't been keeping up.

After rounds, I had a talk with my students. I was nice. I said that it's important for them to keep their patients' lists up to date to avoid what happened. And from that day, I watched the list. There's truly no better, objective measure of a medical student than asking him to do the most trivial task on a daily basis.

When someone follows through on that, you know that you've got a winner. Because that student has shown the desire to earn your trust. And if someone can be trusted with minor things, than perhaps he can be trusted with greater things. And when a student doesn't follow through on something as simple as updating a list, that tells you something too. If someone can't be trusted to do something as trivial as update a list, how can he be trusted with something major, like the lives of his patients?

One of my students, my gunner, she was great. I could ask her to do something, and I knew that she would do it. She called people. She got old records. She tracked down a patient's baseline creatinine. She got the name of a patient's psychiatrist, of all things. She's a 3rd year, and she's got a ways to go with history taking and that stuff, but you can learn that crap. You can't learn being trustworthy. If I was a resident, I'd take her as my intern any day of the week and twice on Sundays. If we were picking teams, she'd be my first pick.

My slacker, it got to the point where I just couldn't trust her to get the basic stuff done: writing notes, updating the list, checking the labs, stuff like that. I had to ask her every day if she even saw her patients. I blame myself to some extent. I should've corrected this behavior from the get-go. But the heart of the matter is simply that I couldn't trust her.

So I'm glad that some of my classmates are going into fields without direct patient care or are far removed from internal medicine. I'd rather work with people I trust. And that's how I voted for the graduation awards. Despite all the flourish and prose written to encompass the awards, to me it boiled down to this: who would I trust to care for me? And when presented with that question, the answers were quite simple.

Medicine treats disease. We do not 'help' anyone.

The ICU is not for me. I know that now. There's something so... unsatisfying about taking care of a patient for only a few days, and then turfing that patient to another service. One of my patients made it out of the ICU, despite our best efforts, and I can't help but wonder what will come of him. It's like another patient I have from last month. He's still in house, and I keep meaning to visit him, but I don't have the time. I wish I could see him. I feel like I should. And that's how I know I'm meant for primary care. Because the thought that I'm not going to follow a patient is sad.

On the slacking front, it's become next to impossible to slack. I'm trying to slack, but there is just so much work to do. I'm only following two patients, but it adds up with other patients. Find this lab. Write this order. Do this. It's making the interns' lives a little easier to have another set of eyes and ears to catch the little stuff that slips through, but this rotation is one of the busiest I've ever done.

And I know you're saying to yourself, it's the ICU, man, what did you expect? Well, honestly, I expected that I'd get to be a medical student again. Instead, this rotation is far more like a subinternship than my actual subinternship.

I keep seeing attendings that I've worked with before. Uniformly, I get the comment that I'll make an excellent resident and that they hope I stay. Y'know, everyone tells me that I'll be a great resident, but I know me. The aspect of medicine that I excel at is just the work. I work hard. That's all. I think I know less than most. I just try to keep at it. I try to move things along.

We had a lecture about goal-oriented care, and I thought it was pretty stupid, because it's something I think about every day. We do all these things to patients, and half the time, I question who we're really treating: the patient or ourselves. In the end, I applied to medical school thinking that I'd get to help people, but most of the time, we don't help too much. It's mostly trying to hold back the tide. And the only rewarding part of that is knowing that at least you tried.

I had a patient who was put into Hospice care, and I was glad. Glad that we avoided putting in a PEG tube, putting in a trach, and doing all those things that make me hate medicine every day. I had always thought that the role of medicine was to help people. It's only now that I understand that the role of medicine is not to help people but to treat disease, and that is not the same, not by a longshot.

Don't be single on Match Day

I RSVPed for my school's Match Day reception. Just me. That's flat out depressing. It's not that it's depressing that I'm single. Nah. The depressing part is that there really is no one in a 500 mile radius that could come to this deal who gives a rat's ass about where I go for residency. There's something infinitely disturbing about the thought that no one really cares where I do my training. Someone should care. Someone should want to be there. And I think ultimately this is what disturbs me the most about being single. There's no one to share things with. There's no one to share the good times with, or to weather the tough times with.

I'm sure my family is interested. But interested is a long way off from caring. It's not like where I go will affect them all that much. I'm not going to train near any of them, based on my rank list, so it's sort of a moot point where, really.

It just seems sort of unfair that one of the biggest decisions in my life should have so little impact on anyone else. To any other medical students reading this that are not 4th years, I'd suggest getting yourself a boyfriend or girlfriend to have for Match Day. And maybe you'll end up matching in a program so far away that you'll be forced to break up, and that's okay, because someone should view this decision as huge other than yourself.

When you're the only one who cares about where you match, the decision begins to seem as trivial as whether you super size your extra value meal or not. I was talking to my friends about Match Day, and someone mentioned that he'll be on the phone for a lot of Match Day, telling people where he's going. It dawned on me at that moment that I hadn't even thought about informing my family or friends. It's become meaningless to me, just another excuse to get out of a day of rotations.

Student evaluations

I'm not sure if I get to evaluate the students on my service. If I do, I'm going to be in a boatload of trouble. One of them will be incredibly easy to evaluate. She was a better student than me, and I'm the sub-intern. The other two students were fine. They did a good job. The last student... that's where the trouble lies. She did okay, but she didn't correct some things that I specifically asked her to correct. She didn't see her patients before rounds. She was late a lot. She didn't bother to attend rounds today. And our service is so light, I'm not sure how this is in any way excusable.

I thought a lot about what I did as a 3rd year student. I came in on my day off to personally calculate the QTc on one of my patients on a med that prolongs QT. The nursing staff was confused. Why wasn't I wearing a tie? I tracked down results of tests and curbsided attendings left and right. I often knew my patients much better than my interns. Not that I was showing them up. I just made their life a million times easier. I knew the labs. I knew the test results. I knew the schedule for the OR.

On the first full day of surgery, I didn't see all of my patients, and my resident asked me to present on one of the patients I hadn't seen. I told him that I had not seen the patient. "And...?" he said, expecting an excuse. I was late. I didn't know where she was. I couldn't find the chart. I didn't know what I was doing. I was tracking down another problem. Some sort of excuse.

My reply: "And it'll never happen again." And it never did. My resident was impressed by my response. Truth be told, all anyone looks for in a med student is effort, the willingness to do the work. One of my students didn't care at all for medicine, but I asked him to see his patients and write his notes on time, and he did. I asked him to list the meds for me. He did. He wasn't stellar, but he was earnest and put in the time. I can't ask for much more.

So my problem remains. I keep thinking that it's not my place to criticize. I think that I'm holding this one student to a standard that is too high. But the reality of the situation is that she did not put in the work. The bottom line is that I could not trust her.

Discarded dreams

I threw away my dream journal. That was an odd moment. The last few dreams in it were not dreams that I wanted to remember. Oh, they weren't nightmares or anything like that. They were dreams I had when I was feeling suicidal. I read through them again and I can feel the pain there. It's like an old wound, and you can run your fingers across the scar tissue, and the raw nerve endings fire up, and if you tweak it just right, you can feel the same pain all over again.

So I tossed my dream journal. I'd only been keeping it for a few years. Most of my other dreams are in my diary and stuff like that. I wish I remembered more of my dreams, because I'm sure there must be happy ones. Everyone has some happy dreams every now and then. I wish I could remember those.

Hospital codes are a spectator sport

I get left alone to fend for the service quite often. Granted, my team had good reasons not to be there in the afternoon, but I know that if I wasn't there, someone would have to stick around. In any case, I got some stuff done, and I'm feeling better about my eventual transition into residency.

But the thing about being in the hospital for a protracted period of time is that you realize a lot of people die in the hospital. I mean a lot. And it's from all sorts of reasons. There are ICU patients that just are straight up dying. But there are patients on the floors too that die for one reason or another. And it gets you down after a while.

And you can only care so much. It doesn't matter if you're a bleeding heart or you're stone cold, there's only so much you can care before you find yourself cracking jokes or simply blowing things off. It's self protection. You can only handle so much before you're overcome. The human creature was only designed to tolerate so much suffering. After a while, you compartmentalize and shield yourself to the horror of it all.

And in this respect, my life has come to mirror my hospital reality. I'm slowly but deliberately shielding myself from reality. I've adopted a policy of avoidance and ignorance. I've turned a blind eye to the world around me, because to look at it, to think about it, it'd be too much: too frustrating, too disappointing, too depressing. I'd rather not think about it at all.

But on the plus side, I've got a friend in the hospital, and M is cool beans. We've been hanging out a lot in house, and it's so much fun. You know, I realize now what people mean when they say that the other residents you work with are what define your residency experience. It's nice to have a friend in the hospital, if only to have someone to lean on.

We've had a storied history in the hospital. We took call a lot together on medicine. We were there when a classmate was diagnosed with a serious illness. We saw a lot of codes together. On surgery, we were always running around together. We were like peas in a pod. I think, of all the things I'll miss about medical school, I'll miss our time in the hospital, because she single-handedly made 3rd and 4th year of med school a fun time.

And I should note that it took my attending 3 weeks, but he finally noticed my tremor. I guess he did better than my neurology attendings who didn't notice at all. My tremor, if you're curious, is exacerbated by stress, fatigue, caffeine, and anxiety, to name a few things. However, I tend to mask with creative use of hands (pockets, behind back, pen twirling, etc).

My senior resident noticed on my 2nd day on service.

You'll probably never read this, but...

Hey, you'll probably never read this, but I think you're the coolest person I know. I think that you're amazing in ways that I can't ever capture in words. Your heart is always in the right place, and your tone is always gentle and compassionate. You've always got time for people who need you, and you've been an amazing friend to me. You think your life is a big jumble, but I look at what you've accomplished and think that I'd be lucky to be in your shoes. You'll probably never read this, and it's just as well, but I just wanted to say that I could spend the rest of my life looking, and I'd never find a person that's as wonderful as you. And one day, I'll tell you that.

Crushes have nothing to do with love

I've known a lot of girls in my lifetime, and I have gotten my silly heart hung up on a whole bunch of them. And it seems like all the girls in my life, the ones that matter anyway, have fallen into two columns.

There are girls that I've had sickening, maddening crushes on. They are attractive to me in every sense. In their presence, I feel woozy and trip over my words. I never know what to say or how to say it. I admire everything they do or say. I find myself mildly obsessed with their lives. This is, for the most part, entirely unhealthy.

Then there are girls I'm so comfortable with that it's like we were joined at the hip. We get along like milk and cookies. We talk every day as if we haven't spoken in 15 years. And uniformly, I've been entirely uninterested in these girls, save one. It's not that they are unattractive, and it's not that they haven't been interested in me. It's just that I had my mind on other things, I guess.

I often gripe that a lot of women I know are interested in everything about me, but not me. There is nothing so annoying as having a girl describe her ideal mate, and she describes you down to what color boxers you're wearing. But you know that if she was presented with the choice between you and being locked in a foot locker full of spiders, she'd have to think about it.

I've had a pretty pitiful love life, and I have a whole list of people and situations that I enjoy blaming. But maybe it's because I've been trying after the wrong girls all along. Maybe it's because the women that are right for me are not the ones that I've been chasing after. Maybe I'm just as guilty of chasing after something I don't really want. And maybe I need to rethink the last ten years of my life.

You can only apologize for being yourself once

I did my last serious interview. Now my rank list has been thrown into chaos, and I'm still trying to sort it all out. This last place was more cosmopolitan, and the people were super friendly. It felt really good. One thing though is that it's pretty far away from my med school friends. You'd think that'd be a minus, but for me, it's in the plus column.

It's not that my med school friends are bad or mean or evil. They're good people, fantastic people in fact. But here's the thing. When I came to medical school, I tried to be everything I thought I should be. I was cheerful, gregarious, and social, and the shame of it was that it wasn't me. It was some other guy entirely who made all those friends. He's the guy going to parties and such. Not me.

And of late, I've tried to be more like myself. I've tried to leave that guy in the past. I've been more true to myself than I have in years. But I can't help but feel a little phony. I can't stop thinking that when your friend only knows you for who you project yourself to be, who is that person really friends with?

So I've shown people a slice of the real me. That happy fellow was fine, but the guy who runs along the edge of depression, who has so many hobbies and interests to distract himself from thinking about the emptiness of his own life, he's a little scary. He's not as much fun.

I feel more like myself now. It's like I've been in a long sleep, and I'm just waking up and taking in a few deep breaths. And it's a little rough, has caused some issues, and stirred up some ripples. I've tried to smooth things out a little, but I find it hard to be apologetic when I'm being who I am.

I was talking with West Coast, and I said something like the problems in my life revolved around being lonely, and if I wasn't so lonely, my life would be falling into line. He didn't placate me. He just said no.

"That's a lie, and you know it. You could be fucking the hottest 24 year old girl in town, and you'd still be miserable. Because that's not your problem. It's a problem, but it's not yours. Maybe you hate your father for being emotionally distant. Maybe you resent your family. I don't know. You don't know either. It's something that you don't figure out until after years of therapy. But don't lie to yourself and think that the problems in your life will be solved by a girl."

And I loved him for saying it, because he was right, and he was unafraid to know me in that deep sense, in that way you know where your hand is, even if your eyes are closed. Proprioception, it's called, knowing where your hand is.

I'm not eager to leave my friends here. They're good people, and some of them are people that I'd like to know for the rest of my life. But it's an uncomfortable position I'm in. Because with most of my friends still, after 4 years, they just don't know who I am.

Cheesehead, she asked me, "Are you okay?" noticing that I looked pretty awful. I turned to her and gave her a choice: "Do you want the real answer, or the flippant one?" And that's the deal. So often, so many have chosen flippant.

The definition of lonely

I'll admit it right here, right now. I am lonely. I am lonely in a way that I can only describe as painfully so. I'm not lonely for company. I've got plenty of friends around. I'm lonely in that lonely way, when you see other people who've found one another, when you see a couple holding hands in the parking lot, when you hear the lilting laughter of a woman giggling at some remark, when you hold the door open for a girl wrapped in the coat of her boyfriend.

Loneliness is a terrible thing. It eats at you constantly. It reminds you that even unhappiness is better sometimes. It's like a sweater that itches, but you can't take it off. Loneliness is what drives a person to go through old letters from crushes and exes, neatly kept in file folders, letters still kept in their original envelopes. Loneliness is what makes you appreciate that a beautiful woman is more than skin deep. Loneliness is what reminds you that life is horrible and cruel because it gives you so much but never enough. Loneliness is what makes you realize that you are so very unhappy with who you are, not because there is anything wrong with you, but because the rest of the world has no appreciation for who you are. Loneliness is what tells you that the most beautiful object in creation is meaningless if you can't share it with someone else.

I am lonely. And with that, a healthy dose of despondent. I don't say depressed because I'm not depressed. I know depression. I could ramble on about depression for quite some time. Depression is not the same thing. Despondent is simply the lack of hope. It's the active realization that there is no hope for the future or the present. Despondency is what tells you that you should be depressed and you should consider putting a bullet in your brain. That's not depression. Depression is thinking that a bullet in your brain would be an improvement.

I think that people have no comprehension of me. I am some sort of enigma or puzzle that is entirely not worth unraveling. I am a Rubix cube that sits in the toy chest unsolved, and undeserving of such effort. I am a pair of white shoes the day after Labor Day. I am khakis at a semi-formal event. I am soft serve ice cream in the middle of winter. I have spent so much time in trying to sell a product that has no market. I'm trying to be a jelly donut, but I'm really a bowl of oatmeal.

And that's why I hate myself really. It's not that there's anything to hate. It's that what is there is so unwanted, that I too do not want it. It's that pecan roll whose only fault in life was being a pecan roll. And it sits, growing stale, in a case full of frosted cinnamon rolls, watching them snatched up with great pleasure. But that poor pecan roll just sits in the case and dries out. And how can it NOT hate itself? Why shouldn't it hate itself, for being something that is so unwanted?

Time to break out the ramen noodles

I'm not sure how it is that I've managed to spend so much money so quickly, but I wish that I was still getting parental money. I had no idea just how much I relied on that cash, and how painful it's been trying to operate without it. I still haven't gotten a loan check yet, which makes my situation just a little more... dire. I have bills to pay. I guess that other people got their loan check already, but I really need mine. This is especially troublesome since more than half of my loan check will go directly to my credit card company. They've got me behind the 8 ball, for sure.

And into this picture enters Spring Break. Somehow, in my... idiocy I thought that going somewhere on Spring Break would be pretty neat. And I can work it out. That's not as much of a problem as I'd like to think it is. It's just hard to look at my checking account, think about how I won't be able to write some checks that I need to, and tell myself that I can afford a Spring Break trip.

As much as I think I should leave my current location when school ends, I don't want to leave. And when I think about it, I can come up with a ton of reasons to stay, but none of them are very good. You know when you want to do something, you can come up with hundreds of perfectly acceptable rational reasons to do it, but none of those reasons are the truth. Truth is, the reason I want to stay here is for such a bad reason that I myself am surprised, and ashamed. Anyway, more interviews ahead. I canceled one today, so that gives me some free time at least. Catch up on some sleep. I'm tired of interviewing.

Prom was for losers anyway, speaks the voice of bitterness

For the first time in two years, a friend has achieved a level of correspondence deserving of a personal folder in my file cabinet. Only twelve others have achieved such a distinction, but paradoxically, I am out of contact with seven of those twelve. So, maybe this is a bad thing. I read through my favorite Christmas card ever, from a girl I used to know. She's got a special place in my heart because she was the only girl ever to actively pursue me. And for that, she gets all the props in the world.

I realized that I've never been invited to a white tie affair. Now, I've been invited to plenty of black tie events, but never white tie. Well, I've never actually been to a black tie event, but I've been invited. D was confused when I mentioned this. Y'know, formal events like the prom or other dances. I repeated my statement. I've never been to a black tie event.

I'm not sure if it's weird that I didn't go to prom. It was pretty much the most unappealing idea in high school. I hated my school. I hated all the popular kids in the school. I had no date. And going stag was akin to social suicide. And then, dancing? *shudder*.

Y'know, I spent so much of my life watching from the sidelines. I've watched other people get where they want in life, and I keep wondering when I get to start. Y'know, I'm not sure how many more weddings I can really attend and still care. I wish that for once, it was my turn. But it's not, and it won't be, especially since I've adopted my little laissez-faire policy on dating.

So whatever. I've conceded defeat in this stupid town. I've come upon the sad realization that I'm not going to find what I'm looking for in this city, or state, and I really should have pursued the coasts more vigorously. At least on the coasts, I've got a fighting chance. This whole Midwest thing, it's like living in a big tub of vanilla. And that's fine, if you're vanilla. But it's nothing but trouble if you're a praline.

There is a two year expiration date

I find myself in a very awkward position these days of wishing that I was in a relationship, but entirely unwilling to deal with potential rejection. I am, to put it in the vernacular, gun shy. And so, I'm not really sure what to make of all that. I mean, I'm sure there are positive steps that I can make, but right now, I'm not exactly the picture of confidence.

S is right to point out that I have exhausted my available options. I mean, I do know single women, but I've been relegated to Friendville, so it's not like I'm going anywhere. I find this quite ridiculous, but then again, I'm the one that's single. I'm supposed to find it ridiculous.

Of course, my mom is unusually eager about my prospects. For the past few years, she has been increasingly inquisitive about my romantic life. In college, my mom took the hard line opinion that I should not date because it would interfere with my studies. Well, it wasn't like I listened to her. Now that I've become a medical student, she seems convinced that I should be dating more. Well, I should be dating, period. 'More' would imply that I've been dating.

I had a funny discussion with my mom. I was showing her pictures on my computer. And whenever there was a girl in the picture, my mom would go, "Oh... is she married?" You can imagine the follow-ups that ensued. Anyway, I knew this was coming, but we eventually hit upon one friend of mine. I'll just quote the conversation.

mom: Oh, who is she?
me: That's ______, the friend of mine I told you about.
mom: [trying to ask casually, but this is like the fifth time she's asked this question] Is she seeing anyone?
me: I'm not sure. I don't think so.
mom: Oh, then you should ask her out.
me: I don't think that'd be a good idea.
mom: She sounds nice. And she's pretty. You should ask her out.
me: [laughing] well, I already did. That's why it's not a good idea.
mom: So what did-
me: The answer was no.
mom: Well, how long ago was that? [furrowed brow, analytical gaze]
me: Umm... a while? Like 2 years?
mom: Pfft, after 2 years, it's okay to ask again. It's so long ago, it's like you never asked.
me: ... Well, if she were interested, she'd have said something.
mom: Why would you think that? After two years, ask again.

I have come to realize three very important things. (1) I have absolutely no comprehension of the female mind. (2) My mom seems to have far more confidence in me than I do. (3) From now on, I should tell my mom that all my female friends are married or are nuns.

Less important, but also interesting, the following three items. (1) My mom seems to have this uncanny knack for picking up on girls that I have been interested in. It's not like I tell her anything, but she always manages to hit the mark. (2) My mom's questions have become interesting as well. At no time did she ask me if I knew any Korean girls. She didn't ask about the religion of any of the girls I know. She didn't come out and ask me about my romantic life, but tried to be subtle about it. Odd. (3) I didn't know that "No" had an expiration date.

Why I don't have a Christmas tree

Every year, I catch a lot of flack about Christmas, because I do not make a big fuss. I no longer buy a tree or wreath or any decorations. I don't even buy presents. This time I bought 5 presents. In 2002, I bought 3. I write my Christmas cards, but otherwise, that's pretty much it. People always seem surprised why I don't do more for Christmas. Well, what does any of it have to do with the birth of Jesus Christ? You know, it's tough to put up a tree and decorate it, knowing that it has no religious or spiritual significance whatsoever.

I just can't bring myself to do commercialized Christmas anymore. It's not what Christmas is about. To me, Christmas is a wonderful time of year, and it has nothing to do with presents or hot cocoa or a douglas fir or blinking lights. I think that the Charlie Brown Christmas special sums it up:

"And there were in the same country shepherds abiding in the field, keeping watch over their flock by night. And, lo, the angel of the Lord came upon them, and the glory of the Lord shone round about them: and they were sore afraid. And the angel said unto them, 'Fear not: for, behold, I bring you good tidings of great joy, which shall be to all people. For unto you is born this day in the city of David a Saviour, which is Christ the Lord.

"'And this shall be a sign unto you; Ye shall find the babe wrapped in swaddling clothes, lying in a manger.' And suddenly there was with the angel a multitude of the heavenly host praising God, and saying, 'Glory to God in the highest, and on earth peace, good will toward men.'"

"That's what Christmas is all about, Charlie Brown."
-Linus Van Pelt

Word, Linus. Word.