How do you know?

Perhaps the most common question I receive on this blog is a simple one: how did you know you should be a doctor? Well, I have written no less than 4 times on that subject, and posted a litany of reasons why to avoid medicine.

But the truth of the matter is that there is no way to know for sure. Is there any way to know for sure about any career decision until you've already made it? What I can tell you is this: all the reasons YOU think you would be a good doctor are bullshit. Total 100% crap. Because I had the same thoughts, and it just wasn't true.

I want to help people. I'm compassionate. I care. I had a grandfather who was really sick. Blah blah blah. This is all trite garbage, and doesn't cut to the heart of the matter.

In high school, I decided that I would consider being a doctor. Instantly, my teachers were enthusiastic. They thought I'd be an excellent doctor, as did a few college professors and a boss or two. What did they know? They didn't see my transcript. They didn't read my admissions essay. They knew nothing about my motivations.

In truth, being a good doctor is not one quality, but a myriad. It is compassion, but it's also conviction, empathy, faith, indignation, professionalism, perseverance, reverence, charity, dedication, hope, intelligence, skepticism, forgiveness, anger, and so much more. It is a whole subset of skills and traits that you don't know you have at the tender age of 18.

I realize now that all those encouraging words from my teachers and superiors, it was because they could see in me things that I could not see in myself. I wanted to become a doctor because I thought it would change me, make me different. They saw that the other than some coursework and a stethoscope, I didn't need to change a thing.

backup plans

When you talk to doctors from my generation, we all had backup plans. I was talking to a colleague, and her plan was to get a PhD in neuroscience. My plan was to work in pharmaceutical development. I was even looking at jobs with a few pharmaceutical corporations, back when my med school app process wasn't going so well. A friend of mine actually got a Pharm D. Another friend pondered social work.

The thing we all appreciated is that being a physician is a privilege and an honor. It's not something you deserve. There was no 'game' or 'trick' to getting into medical school. The entirety of medical school admission can be summed up in one question: why should we let you be a doctor?

Bachelor's in pre-med

I was reminiscing with a friend about the 'good old days' when we were both chemistry students. He's a chemistry professor now, and complains endlessly about pre-meds. He teaches one of those required pre-med courses.

Pre-meds (and medical students for that matter) are pretty high maintenance. 'Is that going to be on the test?' should be the pre-med motto. There's no learning for learning's sake: everything is goal directed. I need to ace biochem so I can rock the MCAT so I can get into Harvard Med so I can get a residency spot in derm so I can do cosmetic derm and rake in a seven figure salary. At no time is there any enjoyment of the process. It is facts and test material and hoops to jump through.

The pièce de résistance is that some schools offer a degree in pre-med. This is, in my opinion, ridiculous. When I was in college, I took all the tough science courses. I took all the sections for real science majors. This is because I wanted my degree to mean something, and feel like I'd accomplished something. I didn't want to spend four years earning a degree in 'pre' anything.

Learning about electron affinity, valence shells, and lattice structures may be entirely useless to me now, but that doesn't mean that it wasn't worth learning. Reading the Iliad was useless too, but I wouldn't give it up either.

EDIT 1/4/11
When I mention a degree in pre-med, I am referring specifically to a Bachelors in Pre-Medical Studies, which is an actual degree offered by some smaller colleges, but not at most universities.
I know that med school has a lot of requirements. I took them too. But part of life is enjoying the process. I enjoyed organic chem. It was fascinating. I took a geology class and loved it. I got a letter of recommendation from my Communications prof for one course that I got a B in. I took 3 or 4 classes that had nothing to do with my 'hard science' major because I wanted to learn. The point of education is to learn, not to earn a grade.
One of the hardest things to explain to pre-meds is that grades and MCATs aren't nearly as important as being a decent and honorable person. And if you can figure out how to convey that information truthfully to an interview committee, then there isn't a med school in the country that wouldn't accept you.

Match Day

Thursday (today) is the Match. Students found out on Monday whether they have a spot or not, and the unfortunate had to go through the Scramble on Tuesday and Wednesday, and today, everyone finds out their fate. It is a far more ominous day than any other day in medical school.

I have some patients who have children in medicine or are pre-meds, and they are pushing their kids towards subspecialty careers, which makes me sad as an internist. And the thing that I want to tell them so desperately is that there is no price tag on being happy with your job. I could've been paid far more than I'm earning now, but I love my current position, and I don't want more money. I'm happy now.

So, to all your MS4's out there, I hope you don't get what you want, but that you get what will make you happy. And those two may not be the same thing, but when it is, everything else falls into place.

The toll of medical school

My New Year's resolution this year was to get back to healthy living. I spend countless hours talking to people about improving diet and exercise, and ways to change lifestyle to improve health. And it's good advice, and some of my patients are quite successful. However, it's advice that I should probably heed.

Before I started my third year of medical school, I ate healthy. I bought fresh produce. Turkey was my favorite meat. I ran a few times a week. I worked out a lot. I was probably in the best shape of my life. Then came clinicals.

Since that fateful July 1st, my health has gone into a tailspin, because after a 30 hour call, I just didn't have the energy to do anything else, muchless exercise. And every year, I've gotten fatter and more complacent. So I have finally decided that it's time to change. And so I am returning to healthy living.

And I think to myself that medical school has taken a considerable toll on my life. I was physically great. I was mentally stable. I was doing quite well. And as much as I enjoy being a doctor now, it's with the knowledge that I spent so much time taking care of medicine that I forgot to take care of me.

Doctors say the darnedest things

When I was a student, we were encouraged to have a 'thick skin' because attendings, residents, interns, nurses, social workers, MA's, PT's, and custodians all tended to lash out verbally at medical students. And it didn't really matter how good you were, or nice, or helpful. Eventually, someone would chew you out for no reason other than you are a convenient person to yell at. People have more scruples about kicking a cat.

I remember the times this happened to me. I was publicly humiliated by one attending at a conference for asking the drug rep a question. One surgeon threatened to make me do M&M, since this patient's imminent death was all my fault. One day I was assigned to eight patients in the morning, and I couldn't see them all before rounds, and the resident told me that I was lazy and useless, and should seriously consider dropping out of medical school. I strongly recall one attending who spent 20 minutes on rounds screaming at one intern until she broke down crying.

So when I graduated medical school, I promised myself that I would not perpetuate this horrible rite of passage. I would be nice. And that's such a noble thing to say to oneself, but in reality, I was just as bad. As a resident, I made no less than two interns cry, and there are a few students who likely went home and blogged about what a jerk I was after getting dressed down by me.

The problem for me is that I expect a lot out of people. I expect 100% all the time. That is the effort that I gave as a student and resident. That is the level I want. But my 100% is not the same as other people's. And it's not like I had to miss my daughter's soccer game or my wife's birthday.

When I finished residency, I promised myself that I would try to be more understanding. Being nice is tough. When you're pissed off, it's hard to turn that into nice. But as long as you're willing to listen and try to understand, even the most withering criticisms can at least be constructive.

Pluripotent

Don't get me wrong. I never want to go through the hell of med school again. One of my friends was thinking about a second career in medicine, and I honestly think that if I had to go through medical school and residency again, I would quit. It's too hard to do twice.

But there are some things about medical school that I miss terribly, because it's stuff that I can't get back. I remember my first perfectly done suture. It was a vertical mattress, and the tails were just right. I remember following a running suture during a vascular surgery. Afterward, the surgeon told me that he'd never let a med student touch a vessel he was working on, but he trusted me. I miss the excitement of seeing my first trauma, a 20 yr old female MVA, no LOC, FAST scan negative, c-spine cleared. I miss the novel sense of horror upon seeing an apple core lesion on CT abdomen.

But most of all, I miss that moment in medical school when I was not an internist. I wasn't sure what I wanted to do, but I knew that I was capable of anything. It was entirely within my power to pick my medical specialty.

There was a very similar moment that occurred in college. I remember it exactly. It was 6:54 PM and I was getting out of chemistry lab. It was twilight, and as I walked home from lab, I stopped at one particular tree about 40 yards from the chem building. At that moment, I could be whatever I wanted to be in life. I could be a lawyer, doctor, investment banker, veterinarian, librarian, computer programmer... All my life and education had led me to that one point in time where I could choose, differentiate. I was a stem cell.

That is what I miss about medical school. I don't miss the studying or the work. I miss being pluripotent.

It gets easier... right?

I had the chance to talk to a budding medical student last week, and it's strange to see the medical student perspective again. When I was going to medical school, I had a very self-centered experience. That is to say, I did not notice a lot of what was going on around me because I was so focused on what I needed and wanted.

Now that I'm done with the medical education process, I find I have remarkably little sympathy for the plight of the medical student. Everything seemed so dramatic at the time, but the thing about medical education is that every subsequent year is worse. MS2 is worse than MS1. MS3 is worse than MS2. MS4, while easier from the education side, is far worse with interviews and rank lists and the Match. PGY1 is pure hell. Subsequent PGY's are painful for new and horrible reasons. Being an attending is a whole new basket of terrible issues.

So it's hard to be sympathetic when medical students complain about med school. It's like complaining to a major league baseball player that a 70 MPH fastball is hard to hit. Yes, it is, but if you want to go forward, it doesn't get any easier. In fact, it only gets worse.

Gunners

I have a friend in med school, and he is continually worried about gunners. He's started clinicals and doesn't want to be shown up or embarrassed on rounds. To me, it's quite amusing listening to students complain about gunners, because it's all perspective.

When I was on internal medicine as a student, there was another student on rotation who was always chipping in or talking about some obscure thing he'd been reading about. He knew MY patient's labs, just in case I didn't. It's not like he told me the lab values. He just got them so that if I should falter, he'd have them ready so that he could look good and I would look bad.

But looking back on my surgery rotation, I showed up earlier than everyone, did all my pre-rounding, and helped the interns with pre-rounding, and I volunteered for all the dull procedures. I wasn't trying to shine. In fact, I just wanted to do my time and be done with it, but because I put in the effort, I was always first in line. 'Hey, ifinding has scrubbed in on like five lap chole's this week. He should get to come in on the Whipple.'

I had no desire to do surgery. Scrubbing in on the Whipple was six hours of absolute torture. I wasn't trying to show off or make other students look bad. I just wanted to have a good experience. After the rotation, I found myself complaining about gunners, and one of my friends elbowed me, saying, 'Yah, takes one to know one!' I was shocked, but after a while, I saw it. I'm a gunner too. Being a gunner is all a matter of perspective. We're all gunners.

Countdown to July 1: MS3

Anyone familiar with the medical education process knows the significance of July 1st. It is the day that everyone moves up a peg. MS2's become MS3's. MS4's become PGY1's. PGY3's (or 4's or 5's) become attendings. There's a lot of significance wrapped up in July 1st.

Third year of medical school is a funny thing. It is an unpredictable experience. It is rough and wonderful and glorious and terrible. It is amazing and disturbing. And the thing about the third year of medical school is that it changes people. At the beginning, everyone starts bright eyed and eager, and by the end, students are profoundly different.

We all imagine that if we were in battle, we would be leading the charge, but what we may discover is that we are the ones hiding in foxholes, shitting ourselves. And that is what you find out about yourself in third year. You find out who you are. You discover if you are vengeful or vindictive, apathetic or aggressive, kind or cantankerous. Your own true nature is revealed.

There are many reasons for this. The MS3 is sleep deprived. He is rotating through different rotations and always a little disoriented. He has not eaten breakfast in 10 months. He has not seen the sun except through patient room windows. He has been constantly pimped about every piece of medical knowledge currently known.

Although we have been trying to change the process of medical education, the MS3 experience is still one of being crushed down, and then being rebuilt better than before: better, stronger, faster. However, that means that some soul crushing has to take place... As nice as it is to be done with the process and look back on MS3 with nostalgia, having your soul crushed is a uniquely painful experience.

Some words of advice to the new MS3:
-Take a shower, no matter what.
-Work hard, play hard.
-No one likes a kiss ass.
-Wear comfortable shoes.
-Your attending wants 3 things from you: honesty, enthusiasm, and diligence (if you have none of these qualities, learn to fake it).

The things you learn in med school

When we talk about medical school education, there's the actual didactic material, and then there's the 'hidden curriculum.' For those not familiar with education lingo, the hidden curriculum is a set of norms or values that are imparted to students unintentionally. It is not written down. It is not testable. It is simply something learned through the process of going to medical school.

In medical education, some examples of hidden curricula are that men shouldn't go into OB/GYN, or women shouldn't go into surgery. You should have no life other than medicine. Everything comes second to your medical responsibilities. Sleep is for the weak. There's no crying in medicine.

Sometimes, these lessons are reinforced though things like lectures on professionalism or the patient-physician relationship. Some schools even try to direct their hidden curricula, taking it into the open light, for better or for worse.

For me, I found my own hidden curriculum from medical school. In the process of going through school, I learned a lot of things that med school never intended to teach me, but they're some strong lessons for life:

The friends you make over a bottle of $200 scotch at 4 AM are probably some of the best friends you'll have.

Thanksgiving and Christmas are precious, and when you can't go home for your own family's holidays, then finding a family to take you in is invaluable.

Medical school is some of the hardest work you'll do. Work hard, but play hard too.

While there are many other such lessons, the one that stuck with me is that at some point in your schooling, you will find that you will have to choose to give everything to medicine, or hold back. And you will discover what kind of doctor you really are when you're faced with the hardest choices between what you want to do, and what other people need of you.

Humble Pie

I think that I'll try to post on a monthly basis. I know, I know, once a MONTH? But right now, that's as fast as I can go! And by the way, I'm taking down my old archives 2002-2004. Sorry! Maybe I'll put up some selected posts as a 'best of' kinda thing?

Every step in the medical education process is a humbling one. There's never a safe moment when medicine won't put you in your place. For me, the most humbling part of my medical education was the application process. I was waitlisted to some, rejected by most. My applicant year was extremely competitive, and some of my rejection letters acknowledged that in other years I would've been accepted, but for circumstance.

I lived in fear of my mailbox. I made a large pile of rejection letters on my desk. I was going to burn them once I got accepted, but after several months, my burning plan was lost in self-pity. Two schools were kind enough to reject me via postcard. I that that was the biggest slap in the face, that my rejection was not worth an envelope.

The interviews were even worse. One interviewer actually told me that I had no business applying to med school, and I shouldn't bother to pursue it any further. Another interview, I forgot my tie of all things. The interviewer took one look at me and didn't bother to listen to a word I said.

So, in early June while I was packing up my apartment and getting ready to move back home, I got an overnight express letter: 'Congratulations! Blah, blah, blah. Sign here!' One of my waitlist schools came through.

Now that I'm further along, it's easy to look back on those times with nostalgia, but it's awfully humbling to know that the only reason I got into medical school was because someone higher up on the list said 'No thanks, I can do better.' Thanks, dude. I really didn't want to move in with my mom.

A new paradigm?

A friend of mine once considered going to officer candidate school (OCS). Of course, he didn't realize this was for folks who want a commission in the armed services, and when we let him know, he reconsidered. However, I don't think that OCS is a bad thing. In fact, I think that things like OCS are quite useful sometimes.

One thing that I think medical school is lacking is training student doctors what it means to be a doctor. There is the education and interviewing and a lot of other aspects that go into medical education. However, I think that a lot of medical schools lack training in the professionalism and ethical behavior of being a doctor. Certainly every school teaches medical ethics, but it is in the safe environment of a classroom. It lacks the thing that OCS excels at: put someone in a real situation and watch them squirm.

An intern I was working with was managing a patient in the clinic, and I saw the patient on a sick visit, and one look at this poor patient was enough to admit him to the hospital. It was a judgment call, but one that the intern should have been able to make. Why didn't the intern admit?

I was the admitting resident and had 3 admissions from the clinic. None of the residents or attendings had contacted me to let me know. Two patients were having acute CHF exacerbations. One was an acute asthma exacerbation. After seeing these three patients, I transferred one on the cardiac stepdown unit, and one patient went to the ICU. Why didn't any of their doctors contact me about the acuity of their patients?

I think that medical school needs to teach doctors to make good decisions, because if you don't want to make good decisions, you shouldn't be a doctor. Being a doctor is all about making decisions. You may not make the right calls all the time, but you must continually question your decision making process, and evaluate yourself critically.

And after confronting all of the medical personnel mentioned above, several mentioned their poor decisions based on workload. They were too busy to do the right thing, and they all recognized that there was a right decision and a wrong one, and that they had not made the right call. But it took being confronted about it. I wasn't mean or rude. After all, in some cases, I was a resident questioning an attending. But if I didn't confront these folks, would they have learned?

I had a part time job once where my boss was a former marine. Let me tell you, having a marine for a boss is a mixed blessing. It turned a pretty easy job into a LOT of work. But the job had relatively little direct supervision. If I did a shitty job, no one would really know. But I always did my best.

My boss recognized me in a meeting, and I was completely stupefied. What had I done other than what was expected? And I realize now that what I had done was something quite simple, but something worth recognition. Without any desire for reward or recognition, with no one looking over my shoulder, I had done my best, because if I was going to do something, then it should be done right.

And I was talking to my boss about being a marine, and he told me that they teach marines something simple but profound. A marine should always do the right thing, even when no one is looking, because that is the best way to judge a man. And I agree. I think that if you can very accurately judge the character of a man by what he does when no one is looking, and by what he does when he is under pressure. Does he do what is right or what is easy?

I told my marine boss that I wanted to be a doctor, and he told me that I would be excellent. What did he know about being a doctor, I thought to myself. He told me that excellence is all about being excellent in all things. And if I can do a good job with essentially meaningless work, then how much better I would be at something where I can make a difference.

And I'll tell you right now, when I see students and residents, I let them know that you can know Robbins word for word, but that won't make you a good doctor. You measure a doctor by how he cares for his patients. And when I was a senior resident, the folks I came down hardest on weren't the ignorant, but on the lazy. I have no sympathy for laziness or arrogance. How can you ever look at yourself in the mirror if you don't do what is right when someone's life is in the balance?

If I could teach that to a medical student, just one, then that would be enough to change the world.

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.

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.

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.

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.

2003 in Review

First Quarter

After doing child psych, I was really conflicted. I loved working in the child and adolescent service, but it was so hard. Everyday, I'd come home emotionally drained. Eventually, I decided that I couldn't do child psych, because it got me so angry every day, so frustrated because most of the kids are the way they are because their parents abused them or mistreated them. It was emotionally too much, but I never wanted to be cold to that sort of human suffering. So in the end, child psych was not for me. But it was nothing but fun being on a rotation with M.

Then, OB/Gyn! It started off hellish, but after 4 weeks slaving through surgeries and countless pap and pelvics, I found out that I actually really like OB/Gyn. And I could never do it. Half the women told me to my face they'd never see a male OB/Gyn, and with malpractice costs it'd be a terrible idea. But if I was a woman, I'd do OB/Gyn in a minute.

Second Quarter

For Spring Break, I stayed in town and did nothing. I tried to upgrade my computer, but I ended up wasting a lot of money. Started surgery, and I really enjoyed working in the ER. I called a laundry list of people for the Baskin Robbins free scoop night and only managed to get two people. For free ice cream. How pitiful is that? Went to the museum with F to the museum, then Hooter's afterwards!

Started surgery with M! We were like ill-behaved children. It was the most fun I've had on a rotation in a long time. Then, vascular kicked my ass, and I have to say that no human should have to do that. Memorial Day came and went, and I did not have a date in the meantime. But at least I got to grill. I got drunk, again, in R's basement.

Third Quarter

I worked on my golf swing at the range, only to determine that I suck. Went on a canoe trip and ended up in the ER. My laundry sock streak ended. In the past 4 years, I've only lost 2 socks. The AC broke and we were very warm for a while. Went to the museum with I and R, and sushi! I started climbing again, after a 12 year hiatus. Bought gear, a Nalgene bottle, the works. Learned that I can apply a coat of Rain-X to a front windshield in about 3 minutes.

I went on several trips to look at knives, egged on by F. I finally broke down in December and bought a set of Henckels. I frequented the sauna for a month or two. I found out that my aunt has terminal cancer. I started getting into punk and emo music. I had the damnedest time writing my personal statement, which went through 3 revisions before coming out in its limp form. I had my standard Labor Day grillfest, with the standards in attendance. I spent two months trying to find a decent bowl of naeng-myun. I picked up a new laptop thanks to my old computer's uncanny ability to cease working. And I tried to quit smoking again, and I failed, again. I did go for 5 weeks without, but in the end, I broke down. And in September, I began my quest for apple cider. I changed my haircut, who's to say if that's for the better or worse, or if anyone even noticed. And I came upon the realization, as September came to a close, that I might have Seasonal Affective disorder.

Fourth Quarter

I went to a concert with D, I started cardiology, I bought canvas tote bags, because somewhere along the way, I picked up some eco-nerd into my persona. I discovered Starbucks, only to discover that I prefer a different local coffee house. It IS true then. Starbucks really is good for independent coffee houses by increasing the prospective market. I had my whole big deal about bill splitting, to the point where I treated about $400 worth of meals this year. I bought a new PDA because my old Handspring (wrought with all sorts of problems to begin with) shattered.

I tried to get drunk on Halloween to wash away my troubles, and I failed, and I ended up so depressed the following weekend that I formulated a plan to kill myself, and the only reason I didn't follow through was a pack of cigarettes and a holy day of obligation. In retrospect, I should've gone to the ER and had myself committed. I stopped eating for quite a while, and I lost around 15 lbs as a result. I found that I can actually starve myself down to 1000 kcal a day. I had to force myself to eat. My brake lines went out. Thankfully, I wasn't suicidal at the time. After several long talks with a few close friends, I managed to pull myself from the edge. I am pretty sure now that some component of this is seasonal affective disorder.

I took Step 2, and passed. I swore off drinking to get drunk. Never again. I made the switch from briefs to boxers. I went to visit my dying aunt. I came to the realization that when I climb with R, I always injure myself, and when I climb with I, I always strain something or work something till it's sore. I went with I and R to Thanksgiving at R's, which was the most educational Thanksgiving ever. Me and I had a slumber party. I was talking to some friends and telling them that according to her, I snore like a little boy. Then, silence. It took me 5 minutes to realize the obvious next question: why does she know how you snore? My aunt died. I feel happy about it, and I feel guilty for being happy. Happy that her suffering's over, but how could I feel right hoping that she would die sooner.

I started Neurology. I got to see so much of my college friends, they're such a welcome sight. I saw Handel's Messiah with D, which was an excellent performance. I ruined a sweater. I rediscovered the art of being a gentleman. I wrote a million Christmas cards. I got some touching cards in return. I went South for Christmas and that's pretty much a wrap on the year.

The most embarrassing moment of third year

I was thinking back on all the funny moments of my medical school clerkships, and the one that always sticks out is this one girl I saw on Peds. She was like 16. She had a rash on her right flank and abdomen, with itching, that had been there for a week. There was one spot that was big, and there were smaller lesions that followed skin lines. For all you medical students, say it with me: pitryiasis rosea. Anyway, she lifted up her shirt to expose her side and I got a pretty good look at the Herald spot. However, her mother, in the interest of furthering medical knowledge, was unsatisfied with this level of exposure. Perhaps she was a surgeon in a previous life, but she was determined to have complete exposure. So, she walked over and yanked her shirt up past her breast and pulled her shorts down to her pubic bone. And to the mom's credit, I visualized the entire extent and distribution of this girl's rash, from base of right breast to right inguinal region, extending along the back as well. I imagine that I probably turned some odd shade of purple, muttered something, and left.

You know what the scary thing about being a doctor is? You'll be sipping a mocha, and the guy at the table next to you, he clutches his chest and falls to the floor. Someone yells out to call 911 and asks for help, that's you. And when you're sitting on the porch and you see some guy fall off his bike and smack his head on concrete, and he needs help, that's you. And when you see a car swerve off the road and flip a few times, you gotta pull over, because that person needs you.

There's a nice feeling of anonymity before all of this med school stuff. I could watch an ambulance drive by with its lights going and think to myself how glad I was that it had nothing to do with me. I could see an accident and think, I'd better let the professionals handle this. The only problem with that attitude is that in a few months, I'll be the professional. And it'll be 3AM and I'll get a page from a nurse telling me that Mr. D in 5142-2 had a 30 second run of V Tach. And I can't walk away. That's a scary thought.

San Diego must be nice this time of year

I'm finally submitting my ERAS application. It took me long enough. I'm applying to an obscene number of programs, especially since I'm very much leaning towards staying right where I am. It was funny today. I had two different attendings tell me that they didn't even need to see my app. One attending asked when I was interviewing. I told him that I hadn't even submitted my application yet. He kind of laughed and said for me, it wasn't necessary.

I would like to stay here for residency. There are all sorts of reasons I shouldn't stay here. It's always a good idea to train at a different location so that you can see a variety of conditions and managements. It'd be nice to go to a program where I can get a nice fellowship and a good faculty position. It'd be nice to work at an institution that runs more efficiently. But what it boils down to for me is that if I stay here, I know it's going to be another 3 years where my romantic future will go bbbpllbffplt.

I'd like to believe that it wouldn't make a difference where I am. I'd like to believe in fate and destiny and finding that perfect person for you. Except I know that fate and destiny and all that stuff is bullshit. I know that if I plan on procreating, I have to go to the East or West Coast. But I can't stand the idea. I can't stand the thought that my ability to attract another human being is entirely dependent on geography.

You know, it's amazing just how low you can set your sights in life. I used to think that what I wanted was someone who was perfect for me, who could understand me, who loved me, who I could share my life with. At this point in my life, my romantic aspirations total to this: I'm looking for a girl who will let me feel her up occasionally.