Do the work

In some fields of medicine, it's all about skillz. Surgeons are all about skill. Radiologists are atuned to visual skill. Anesthesiologists have skills. Other fields of medicine, like internal medicine, don't have much in the way of procedural skill.

Medicine attracts detail-oriented perfectionists. It's all lists and tables and planning and proper medication selection. For lack of a better way to describe it, medicine attracts nerds. And it's because internal medicine is ultimately a specialty that demands planning.

And part of that is what attracts me to outpatient medicine. People think of planning when they think of placement, but the planning that intrigues me is stuff like what a patient needs over the next 3 years. This lady will need a pap and pelvic in 1 yr. This guy needs a colonoscopy in 10 years. This kid needs his cholesterol checked. This lady needs a glycohemoglobin every 3 months.

And it's funny to me that I still get a lot of pats on the back for doing nothing more than my job. It says so quite clearly in my contract what my job requirements are, and I've done them, and people think me a competent resident for it.

I have a very hard time taking a compliment from anyone, and part of it is because I don't feel that I've done anything worthy of praise. Y'know, all the time people are praised for doing their jobs. I don't get that. It's your job. It's what you're paid to do. Why should I take praise for doing my work? The way I grew up, I've always thought that praise is for exceptional work. When I do exceptional work, then I know enough to reward myself.

Diagnostic and Statistical Manual

When I did my psychiatry rotation in med school, the most valuable piece of advice I got from one of my attendings was while we were sitting in the conference room, talking about a tragic case of a little boy abused since the age of 5, neglected and physically assaulted, but thankfully no sexual abuse. He still carried horrible emotional scars despite being in a nurturing, safe environment at time of evaluation.

Me and the other medical student sat there flipping through the DSM, trying to pigeon hole this kid into a diagnosis. He lacked 1 criteria for post-traumatic stress disorder. He certainly lacked criteria for major depression. We presented the case to our attending over coffee. He watched us for about 5 minutes before becoming fed up.

"That book can't tell you anything about what your patient has. You're trying to diagnose with DSM, but it can't tell you that someone's depressed. It can't tell you someone is sick. It just tells you what to look for. Is that book going to offer any reassurance? 'You don't have PTSD because you don't have the necessary number of criteria met.' Ridiculous."

He took our DSM's away and asked us what this kid had. And that was when I realized the difference between cookbook medicine and clinical skill. After a certain amount of time, a doc's got to be able to look at someone and say, "You are sick." DSM is the psychiatric diagnostic equivalent of a Brother P Touch. Nice for labeling, but I wouldn't use it for much else.

A letter to an ex:

More in the series of painful letters never meant to be read by the intended recipient.

Ever since this all began, I've been in anguish. It's been torture for me to sit by while you sorted through your feelings, not saying no, but never really saying yes. But watching you tonight, watching you two pawing each other made me realize a lot of things.

I've been doing a lot of remembering, and really, I can't think of a time that you ever really opened up to me. I get all these cards and letters, but you never talk to me. You say things, but there's nothing behind it. I don't want your letters if you're not willing to share yourself with me. I've bared my soul to you. That's just not fair. I don't want your letters if you can't share with me who you are.

You say we're good friends, but I never see you, never talk to you. You're willing to hug everyone but I'm left standing around. I've never felt like a friend to you. I've always felt like an outsider, and it was stupid of me to think that I could have a relationship with you when you've never shown me a token of affection.

Half of my enjoyment of our relationship was finally feeling accepted by you, and that I was worthy of your affections, but that didn't last, did it. It was a battle just to see you, to hold your hand, to touch you. And now, it's like you're not in my life at all.

If you don't want to be friends, that's fine, but I don't like being treated like a second class friend, and that's how I've felt for a long time. You don't talk to me, you don't sit near me, you don't make eye contact, and I hate thinking that I have to compete for your friendship. That's not what being friends is about.

If this is how it's going to be, I'd rather never see you again. What's the point of this 'friendship' when we both know it's a joke. Let's call this what it is. You want to make this out to be all nice and pretty. Well, if this is friendship to you, I want no part of it.

And as far as our mutual friends go, you need not worry about me ruining your fun anymore. You can have them all. I've burnt longer bridges in my life.

A letter to a girl I knew:

More in the continuing series of painful letters never meant to be read.

Hey, I think it's great that we're friends and all, and I have a great time hanging out with you. But is that it? Call me crazy, but haven't we connected? Maybe just me... We could be like peas in a pod, but you're just not where I am. And I doubt you ever will be. And I've given up hoping. I think to myself that it'd be great or nice or special, but I'm thinking in that hazy dreamy way, the kind of thinking you do when it's raining outside, and you think of how you'd love to go outside and play, but if the rain stopped, you know you'd still be inside. It's not reality. It's not even a world of 'might have been's. It's all fantasy and conjecture. There's no truth to it.

I know that the proper course of action is bridge burning. It's the tried and true solution. And it wouldn't be because I hated you or resented you. It's be because every time I see you, I think, 'Maybe...' and every time I get a card or e-mail or phone call from you, I think, 'Maybe...' when there is no maybe, there is no possibility. There is no might. And the mind knows this, but the heart, it wants what it wants. And the only way to change its mind is to hate you, to resent you, to wish that I'd never met you. It's the only way to stop the wondering and the fantasies and the endless string of maybes. It's the easy way out, the model solution, but I can't bring myself to do it. And maybe I know that it'd be pointless. The maybes would still be there at night or in my dreams.

They wouldn't go anywhere. These feelings aren't the ones you can just chase off, because they're not lust or infatuation. It's not love either. I don't believe in love. You can't grasp it. You feel it like you smell cinnamon in an apple pie, and it blows away in the cold and wind. No, love is nothing to connection. Two people connecting, that's real. That's firm. You can't throw that away any more than you can throw away your parents.

So I guess it'll just be status quo, with me wondering if I'd ever had a chance, or if I was always out of focus. But I'm just festering, rotting away, waiting for something to happen when it never will. And I wonder what will happen when you finally find someone. Maybe that part of me will die, like I hope it will.

A letter to a once best friend:

Like I said previously, I thought I'd throw up some letters I've written here, letters that will never be sent to the desired recipient, but are interesting to read, in a jaded and painful way.

I can't believe you. Maybe you don't realize that you are the only friendship I have let survive in spite of betrayal. You say things like, "Does our friendship mean so little..." well maybe it would do you well to realize how close you were to not being a friend at all.

And you start off about her emotional state and whatever. What the hell am I supposed to do, huh? She was the one that rejected me. Somehow by listening to you, that's supposed to make everything better? I've tried to be the bigger person. I've tried to pretend that I was ready to move on, but guess what, I'm not. And if you think that I'm gonna feel sorry for her for rejecting me, and that 'my emotional state' isn't helping? Well, I don't give a damn.

I can't deal with other people's problems right now. I'm trying to piece together what's left of my life and trying to get back to even keel, and in case you haven't noticed, this isn't helping.

You can rush me all you want, and that's fine, but guess what, if I took what I've got on hand right now, I can come to pretty simple conclusions: you're a jerk and she's a bitch, and going behind my back was about the shittiest thing anyone's ever done to me. So there's your emotional resolution. So stop bothering me, leave me alone, and let me deal. I don't have time for your shit.