Please shame yourself

I recently had the opportunity to talk to a few program directors and attendings who do candidate interviews both for fellowships and for residency positions, not to mention interviewing for faculty positions. And the question that I was most concerned about was the most infamous question in all of interviewing: what are your weaknesses?

This is the most patently ridiculous question that an interviewer could possibly ask, but I thought I might as well find out the motivation behind such a loaded question.

The answer almost uniformly was that it gives the candidate an opportunity to reveal some professional areas for growth. Another responded that it seemed like something valuable to learn about someone.

I read MB's post about it, and I have to say, I agree. It is such a ridiculously stupid question, because it is inviting a person at best to shame himself, and at worst to outright lie. The classic way to escape this question is to turn it into a strength: I'm too detail-oriented. I'm a workaholic. You get the idea, and if you've interviewed for med school, you've probably done this.

The people I talked to said this was a stupid answer, but hell, if everyone gives the same answer, then maybe people will stop asking it. But sometimes, I look at this question as a challenge. And the last time someone asked me this, my response was: 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.

Reproductive success

My dad, he recommended to me that I obtain some additional advanced degrees, to which my reply was ppppppppppppblt. I'm already an MD with a hardcore science BS. The only thing left is a PhD, and I'll be damned if I'm going to do that. I've already earned my stripes.

My mother is much more tactful when it comes to the topic of career advancement. She wants me to do endocrinology, not because it is a good field, and one that is in demand, but for office hours. "There's not much call, and not a lot of hospital work, so you just have clinic hours, and then, you can make your own schedule! You should do that! Plenty of time off for life!" This is my mom's way of saying that it will give me the chance to meet some woman and impregnate her, perhaps several times.

And then, I got the most bizarre phone call. As you may know, there's been cases of mumps in the Midwest, and my mom called me to try to force me to get another MMR vaccine, to which I said pppppppppblt. I already had more than my fair share. However, she was determined to convince me. Finally, in exasperation, she said, "Maybe if you were married already..." and then gave up, and let me (her son, the doctor) figure it out for myself.

I had to go home and figure out what she was talking about. Epididymoorchitis occurs in >30% of adult male cases and can cause sterility, but rarely. That's my mom, always looking out for her reproductive success.

See ya

I spent some time hanging out with WC, saying my good-byes. He starts his residency soon in another state, and chances are I won't see him again for at least a year, if not longer. We had a couple drinks and enjoyed our time, but it always hurts saying good-bye.

I've had to say good-bye more times than I care to recall. I've left more friends behind than I can count. I hate good-byes, because they're painful. Good-bye should be enjoyable, like the ending of a good movie, and as the credits roll, I get to enjoy the denouement, and close it off. Now it can come in a DVD and sit on my shelf. I have digested it.

Parting with friends, it's never like that. It's never the three act play. My friends always seem to part in the middle of Act 3. I never feel any closure, and that lingering sentiment is probably what inspires me to write bizarre letters to my friends every now and then, because I'd like to know how the story ends.

So good-bye, WC. Stay good.

None for me

People wanted to go see the DaVinci Code, but I told them to go without me. I've already decided that I will boycott this movie. I'm a pretty open-minded guy. After all, I saw "Dogma" and enjoyed it.

But this DaVinci Code shit is too much. And to pass it off as real? That's just offensive. To say that there is any truth to this is actually blasphemous.

If this was about the prophet Mohammad, Dan Brown would have a bounty for his head. As it stands, we Catholics are too guilt-ridden to go about trying to execute anyone. But this is one trend that I'll pass on.

flashbacks and old scars

While I was on call the other day, I had a flashback to a few years ago. It was winter during med school, and I was trying to quit smoking, and I had some stuff happen in my life, and I was thrown into a tailspin. I couldn't sleep and found myself in my church parking lot at 5AM, waiting for morning mass, smoking half a pack of cigarettes.

And I went home and put on my game face, and no one was the wiser. I was bordering on suicidal ideation, and to the rest of the world, it was just another day. No one saw any reason for concern, as I was torn about whether I should go to the ER to get a psych eval.

And eventually, one of my friends noticed, and let me unload on him, and it felt wonderful to have someone there. And it's not often in life you have good friends like that in life.

And it's wonderful to remember that time of horrible depression in my life, and realize that I don't feel like that anymore. And it may not seem like much, but there is something wonderful about enjoying life, and when there is no joy, life can be so very painful.

I was talking to a psychiatrist a while back, and she noted that there are warning phrases people say when confronted with the issue of their suicidality, and the one that concerned her was when people would say something to the effect of: the only reason I haven't killed myself is because it's a sin.

That took me aback when I heard it, because that was how I operated for years. Every day was pretty much a wash, and I'd come home and think, "This sure would be easier if I could just kill myself, and get the next 50 years of pain out of the way."

And it's interesting to look back on all that emotional trauma, and see that everything's healed up, and the scars don't even show. And sometimes, I hear this specious garbage that life's struggles are like the story of Job, and that there are tough times, but it'll all turn out well in the end.

To them I say bullshit. The story of Job ends with him having a new family, new fortunes, but what about his wife and children, everyone he loved, all dead? The lesson is that we do not know what is in store for us in life, and that we must fight, constantly and continuously, and in the end hope that we find meaning in the struggle itself.

And maybe one day we can run our fingers over the scars, remember that time, and see that it was the struggle that made us strong.

Choices

As criticized as the Matrix: Reloaded was, there was actually quite a bit that was very sharp. Talking to some philosophy folk, they actually saw a lot in this movie, and the input was nice.

But the one thing I liked in the movie was when the Oracle was talking with Neo. He asks her if he has to make a choice and she says no. "you didn't come here to make the choice, you've already made it. You're here to understand why you made it."

And for most of us in medicine, that's a mouthful. Because I know that I chose to go into medicine a long time ago, all the way back in high school. And now that I'm a doctor, I've been spending a lot of time trying to understand the why behind that. I thought I knew when I first made that choice, but I really didn't.

Because I'm lonely, and I have no life, and I am tired all the time, and I think to myself why in the world did I decide to do this? And if I couldn't answer that question, I'd have quit years ago.

And it's hard to realize that why I went into medicine, all the stuff I love about medicine, that was all there back in high school. Everything I love about medicine now was there, lingering in the shadows, and it's taken me nearly a decade to discover it.

Why I'm nice to nurses

I'm always very pleasant and friendly with the nursing staff, and try to remember as many names as I can. This is for the two simple reasons: (1) I like to be friendly, and (2) I can get more done if the nurses are on my side. I like to brag (and some attendings have noticed) that I can get a lot of work done without a ton of effort because nursing and support staff find me approachable. It's akin to knowing a guy in the mailroom of a big company.

But for all my bragging, I'm not that efficient, and every now and then, I find myself in a strange situation like my last post-call day. I was writing some orders before I went home at about 7AM, and I was sitting at the nurses station. The nurse across from me was pitching a fit, having a little rhetorical conversation.

nurse: This lady's anxious like anything, and crazy too. How am I supposed to keep her from flipping out with 1mg po ativan? What kind of a useless order is this? What useless resident wrote this order anyway? I mean, c'mon, what a pushover dose. I hate when residents do this. They dump this shit on us and don't give us anything to fix it with. Who did this anyway?
me: Umm... is that the lady in room 5? [nurse nods] That useless resident would be me.

But we worked things out, and it all turned out positively. And that's why it's good to be friends with the nurses. Because she could've just as easily tore me a new asshole.

Antalgic gait

I was out with West Coast a while back, shopping for boots of all things. I'm not a boot guy, and WC's response to this was that I am a boot guy, if I would give it a chance. And so I did. I bought boots over the weekend. They go above the ankle and are leather soled. They are fancy, and I could probably wear them with my suit and stuff.

And so, I decided to try them out. And for the first hour, they were nice. I felt large and in charge, with an extra 3/4" of lift to make me feel on top of the world. However, that hour came and went quickly, and then it was nothing but pain. I haven't worn dress shoes for a day of hospital work in months. I usually wear Skechers or some other pseudosneaker.

And by the end of the day, the intern, my attending, and the nursing staff were all wondering if I'd twisted my ankle, I looked so awkward. But it was all worth it in the end. I went to the golf course, switched into my new golf shoes, and I was hitting for distance. It felt good. High and straight, the perfect swing.

So maybe a little pain in the end pays off. Come to think of it, this is an apt metaphor for the entirety of residency.

Compliments come from the stranges places

"You seem like a really personable person. That's a great quality to have. Y'know, it takes someone that's sincere and honest to be a good doctor. I'll bet your patients love you. You're going to be a fantastic doctor once you're done."

Take a guess who told me this. Student? Colleague? Attending? Fellow? Nurse? All good guesses. And I'd love to hear it from any of them. But those guesses would all be wrong.

The correct answer is stripper.

A well-deserved day off

"Ifinding, what's up with your blog? After reading it, I wanna run out into traffic." This is the subtle way my friends tell me that I've been a tad morose in my blog. I've been working a lot of days straight. My last day off was 3 weeks ago. It's been dragging me down.

So, it feels nice to finally have a day off again. I feel better, like there's a little hope in the world. I'm tired, as I slept only about 4 hours, but it's a good kind of tired, the tired after having fun.

Still, though, I know that there's so much missing in my life. And maybe those things will work themselves out, but for now, I think I'm content with a day off, so I can feel like a human again.

All things being equal

When I wrote this post about deaths in the hospital, a fellow blogger pointed me to a short story called "Zanduce at Second." It's about a baseball player for the Orioles who has managed to kill eleven people with errant foul balls. There's a wonderful line in it: eleven [deaths] isn't really worse than one for me, because one was enough by itself. It doesn't double with two.

I had a patient who was terminally weaned today. The patient was old and had risk factors. The patient had significant, severe disease. By all accounts, it was this person's time. Compare this to this young lady that I was following earlier. She was 30 something, young, without medical problems, and generally well until a vessel in her brain decided to explode.

If you look at things objectively, you'd say the younger patient is far more tragic. She was young and in the prime of her life, leaving behind a family with children, and the children she could've had. Her life was cut 40 some years short. It's awful.

But the thing I've learned is that you can't quantify tragedy. There's no yardstick for it. This old patient and the young lady, one is not more tragic, not more sad. It's all tragedy, and that's something that can't be added or subtracted. In such unequal circumstances, there's always equality in sadness.

May angels lead you in

I was driving into work yesterday, and I was listening to Jimmy Eat World, and the song, "May Angels Lead You In" came on. It's a great song. And I was suddenly bawling, in the parking lot of the hospital. I had to sit in my car for a couple minutes to compose myself.

Maybe it's all the tragic cases I've been seeing lately, with patients dying left and right. And I can't help but remember my aunt. There's just so much death out there, and sometimes it catches up with you. And I'm normally very good at compartmentalizing my feelings, locking them up in a little box and putting that box in the back of the fridge.But not this time.

Sympathy can be a dangerous thing sometimes. Because there are so many tears to shed, and if I were to cry for every sad case, I'd have no tears left to shed.