:***(

My stomach hurts and I feel nauseous. I’ve had the worst possible day.

I locked my car keys in the car this morning at 6 AM. On the second day of my super secret rotation down at Dupont Children’s Hospital that I’m forced to do during my vacation time between 3rd and 4th year because the registrar placed me in a required rotation during a key month for getting recommendations. As a result of my keys being locked in, I was late - which meant that I missed scrubbing in with the chief of Surgery. I did office hours instead, with this otologist I secretly idolize. He asked me today, “Do you think his tympanic membranes are abnormal or normal?” I replied, abnormal.  They were normal. The tympanic membranes looked huge to me!  Abnormally huge!   I burned up in shame and humiliation.

Then I got into a fight with my best friend who’s leaving the country because he wouldn’t give me ten minutes of his time to say goodbye on the phone because he was too busy saying goodbye to everyone else. I hate having to justify why I’m deserving of someone’s time. I hate even more when they try to justify why it’s okay that I didn’t get it.

I’m exhausted and tired and crying and it’s been a really long and disappointing day.

I’ve spent the past half hour wallowing in self-pity and looking at pictures of myself on Facebook and thinking, “Look at this poor girl.   Look at that smile - she has no clue.    No one likes her.    Not her car who sabotaged her today.   Not even her best friend.  And she can’t even recognize normal ears!”

 

The Bachelorette

Has anyone watched this show? My roommate got me hooked on it. Every Monday, we tune in - mostly to make fun of the pea-sized brain that the current Bachelorette has, and predict who we think she’ll choose. I don’t really understand why a girl has to be a Bachelor reject to become the Bachelorette. This is just like how bachelorette parties before weddings exist solely in response to the bachelor party. How many girls really want to go out and party it up and meet single men and strippers right before they get married? It’s like we do it to prove a point. We too can party it up like the boys can. I refuse to have a bachelorette party and wear a silly little veil and run around bars if/when I get married. A spa weekend might be more in line with something I’d like. I think it’s curious that guys view marriage as an end (which thus requires a last-bash bachelor party) whereas women tend to view marriage as a beginning.

Back to the Bachelorette…. She’s 26 years old, and the premise of the show is that she has to eliminate a guy each week, and at the end - choose one guy and marry him. Yes, marriage. One of the last 4 contestants remaining is a single father, whose ex-wife left him with his toddler son (who is adorable by the way). Though he’s the most feel-good of the guys (and the one my roommate is rooting for. We bet tickets to the organ concert), I am annoyed to no end by him. I cannot think of anything more irresponsible than picking a new mother for your 3 year old son off a game show. As if having your birth mother walk out on you isn’t bad enough.

The guy who was eliminated in today’s episode (Graham) is clearly the guy that the Bachelorette is going back to after the show is over. Even though he’s in his 20’s, he acts like he never left high school. Refusing to talk about his feelings, taking her to his high school gym to play basketball, getting her a sports jersey with his name on it for her to wear. Besides, his job is listed as “professional basketball player.” I’ve never seen him in the NBA. And I soured on him in the first episode when he stated that with his money, he wants “to start an organization for children with illnesses.” I could hear Zoolander echoing in my brain, “I want to start a school for kids that don’t read good.” The clincher was the elimination moment. They’re sitting outside by the limousine that’s going to whisk him away in his lonely rejection (aw poor baby, you’re riding in a limo back to the airport…), and the Bachelorette is crying and saying that he’s the one she was falling in love with but he wouldn’t let down his guard and let her in. Call me unromantic, but I couldn’t help but roll my eyes. And I outright laughed when he gave her a note that he says has all of the feelings that he can’t say out loud. He asks her to read it when she’s alone. Right. Because when we’re in our 20’s, we still write notes in teeny tiny writing to girls we like and fold them in half and give it to them at the most awkward time - cautioning, “READ IT ONLY WHEN YOU’RE ALONE.” I’m surprised he didn’t pass it to his friend to pass to her. I wouldn’t be shocked if at the bottom of the note, he wrote - PLEASE CHECK YES OR NO - with two boxes.

Besides, the Bachelorette is 26 years old and she comes onto this show to get married? I’m a year older than her. How come I’m not on the Bachelorette? Single female physician!

“It’s because you’re a minority. America hates minorities,” my roommate said.

“Yeah, you’re right.”

 

What Medicine Has Done To Me.

I found out recently that my friend’s cousin committed suicide at the age of 20. My friend was talking to me about it over AIM last night. He jumped off a building, 17 stories fast. Immediately - a list of questions populated quietly in my head, like a drop-down menu on a webpage. Was he showing any signs of depression? Did he seek psychiatric help prior to jumping? Any prior suicide attempts? Did he withdraw from his circle of friends? Start giving away his things? I didn’t ask any of these questions, but as my friend talked to me, I sought the answers in his words.

I had very little answers by the end of our conversation. His aunt, who practically raised him, saw him a few days beforehand and didn’t notice anything out of the ordinary. I wondered whether it was unintentional suicide and maybe he was on something when he jumped. It just didn’t make sense.

And then I realized that I’ve become…. this. This something. Not someone. This is what medicine has done to me. I can no longer simply feel the shock of a tragedy. I have to dissect it. Make it make sense. Somewhere along the way, I metamorphosized and didn’t even notice. Everyday, when patients come in, we break them down into signs and symptoms, lab values and test results, we ask them whether they feel this or that, for how long, how did it start, is it getting worse or better, and we put the clues together into an answer which we then present to the patient as a possible solution. Throughout third year, I’ve been trained to hear any two words (”Chest pain”, “shortness of breath” - fine, three words if you consider ‘of’ a word) and be able to tell you a differential list of things it could possibly be. And the list of questions I would ask to rule in or rule out the possibilities. I have statistical odds in my head linked to the age of the person. But nowhere in there is a sense of shock or sadness. Perhaps because I’ve already seen so much that it’s hard to be shocked by anything - besides when patients are actually nice.

I suppose on some level it’s good for physicians to be a bit removed. Too much emotion clouds your thoughts and chokes you, hobbling you so you can’t move forward. Paralyzes you with tears. But a small part of me can’t help but be a little afraid of how far this emotional distance extends into my life. Am I going to be incapable of feeling anything? Have I become, paradoxically, less human as a consequence of going through medical school?

My friend was telling me that he feels selfish. He has his board exams to take in a few weeks and he’s thankful for the shock and disbelief he’s experiencing because it allows him to focus on his studying. He talked to me a little about how I handled things when my grandmother passed away around this time last year when I was studying for the board exams also. I urged him to take a few days off and spend it with family.

“Susie, this is the most important test of my career.“

I heard bits of myself echoed in that statement. It was funny. This kid used to be a surfer in California. Most laid back guy at college.

This. Is medical school and what it does to you. And I found myself saying, with honesty and truth, thoughts about my grandmother’s death that I have deep inside that I had never voiced out loud, not even to myself.

“I’m only skipping one day of studying for the funeral. The viewing is on Friday but I think I’m not going to go,” he said.

I told him that I thought he should go. That though I was anxious about missing so many study days last year when our own family tragedy happened, I’m glad I missed those days. Because being there for family is so much more important that a higher grade on an exam. Do I secretly feel like I could’ve done better on my boards if things didn’t happen the way they did? Sure. I am a little uncomfortable with my board score. But that discomfort pales in comparison to the discomfort I would have felt if I hadn’t gone, if I wasn’t there for my dad, and if I wasn’t there for my grandmother. It’s tough to comfort yourself with, “Well, at least I scored 5 percentile points higher on my exam,” when you wake up in the morning and have a tough time facing yourself in the mirror. Though medical school forces you to value grades and points more than anything else (because despite it’s fuzzy wuzzy exterior - medical school and residencies are surprisingly unforgiving), the important things in life aren’t that. At the end of the day - at the end of your life, you need to be able to close your eyes and look back on things and think to yourself, “There is not one thing that I regret or am ashamed of.”

Okay, maybe there’s likely to be a few things I’ll be ashamed of. But I try to minimize those.

No one ever regrets a test grade. People do regret not being there for their loved ones.

As I urged my friend to go, I realized that I must sound hollow in his ears, the way other people’s advice sounded hollow to mine when I was going through the same thing. Med school has this way of putting the fear of God into people who are usually very down to earth and reasonable. Because med school is actually right and it’s hard to argue with someone who’s right. Your entire career does depend on this test score. Certain medical fields/specialties/residencies won’t even look at your application if you don’t make a cutoff. Dermatology, Otolaryngology, Plastics, Orthopedics, Opthalmology, Urology, Neurosurgery, just to name a few. The list goes on and on. The ones without a cutoff are the ones with lower base salaries. So I understand my friend’s anxiety.

But as I talked about it to him, I realized that I’m comfortable with the choices I made last year. And that I remain confident that I did the right thing. And at the end of the day, even if I become a doctor who can’t feel, doing the right thing is the most important.

“I’m living your life SusieD, just one year delayed. Will you tell me the conclusion of medical school when you get there so I get a preview?”

I didn’t have the heart to tell him that he’d become jaded during rotations and only honor a rotation that he hates. I told him I’d tell him later. But that he should take care of things at home first.

I hope he heard me.

In Memory of Armand.

 

To Frame Your Face. In parts.

I got new glasses today. My first pair of new glasses in over 7 years - new frame AND lenses. There’s nothing wrong with my old frames, but I wanted an extra pair - just in case. A cheap frame that I can bring travelling with me without having to worry about busting them. Besides, my prescription has jumped 2 diopters since my last pair of glasses and it was time for an update.

As I browsed the frames at the optician’s place I realized a few things:

1) I have serious commitment problems. Anything that requires me to stick with something for more than a year provokes an anxiety reaction in me. This includes a medical field choice for residency, and a pair of frames for my new glasses.

2) I couldn’t see jack. My pupils were dilated from the eye exam so everything was a blur.

I decided to come back later, so that I could see clearly before I made such a momentous decision and so that I could bring my mom. Whenever I feel anxious or indecisive, I rely on mom. Sad. And I could tell the optician thought so too when I came to pick up my glasses yesterday.

“Didn’t bring mom with you this time?” he joked. Ha.

So my mom didn’t like the frames I had picked out. We were choosing among the $40 frames, largely because of my habit of destroying everything I own. I tend to really use the things I have. Partly because I like convenience, and partly because I think things should be used for their intended purpose instead of being preserved so they ‘look nice.’ I’m not going to have plastic sheeting on my couches in the future. It’s not like I can take any of these material things with me when I die so I’m not sure what I’d be preserving it for.

I had picked out a rectangular frame. Because I’ve always had rectangular frames my entire life, so it felt comfortable. But also because I feel like rectangular frames are more serious. I have this fear that I come off frivolous, so I feel like I need a serious frame. My mom tsk tsk’ed and picked out a different one. “This one is more feminine,” she said. I looked at it dubiously. I still preferred my frame. The ones she chose reminded me a bit of Mimi from Drew Carey. But my mother’s never wrong about stuff like this. Whenever I go with my own choice, it’s not like the world implodes. But whenever I go with my mom’s choice, even against my own better judgement, people end up complimenting me on it. So I opted for the frames my mom liked.

I’ve had them for two days, and they’re already deformed. They came out originally all nice and symmetrical, but after 2 days of wear, they already sit crooked on the table. My ears are uneven, I can’t help it! And I have a terrible habit of pushing my glasses onto the top of my head in the middle of the day, so I can give my face a break, which also stretches the frames a bit.

It’s okay. They’re $40 frames. This is exactly why I got them.

Mimi.

 

Meets Expectations.

It’s been no secret that I’m generally frustrated with the seeming arbitrariness of third year evaluations.  Today, when I logged on to the registrar to view my transcript, this thought was only confirmed.

I received honors in my first major rotation.   I’d honored a bunch of minor ones that don’t count for much, but this was my first “real” honors.    Before I go into more detail, let me quote an email I wrote to my best friend Kenmore a few days ago, expressing my feelings about this whole grading system.

Even stranger is that the students who are honoring classes are students who suck as people.   As in - patients generally hate them, as do the other students on their team.  Obviously, I must be missing something, but if being like these jackasses is what it takes to receive ‘honors’, then screw it - it’s not worth it.   I’ve decided that third year grades are arbitrary and I have no control over them.

I am now a jackass by my own definition.   Of all things - I honored my Pediatrics rotation, which I hated and tried to scrape by with doing as little work as possible.   This reminds me of my consulting days, when paradoxically, about 2 months after I decided to try to underperform so I could get laid off and receive severance pay - I got recommended for early promotion instead.    Clearly, what I should do for every rotation is hate it and try to do as little work as possible.   I’m apparently at my best when I’m bitter and unmotivated.

You’d think that I would go into Pediatrics as a result.  Go where your strengths lie.   Do what you’re naturally good at.   I mean - that’s what I thought I was coming to med school for.   Either Pediatrics, Family Medicine (which I liked, but was ‘eh’ about), or OBGYN (which didn’t like me).    My entire CV looks like it’s aimed towards Pediatrics.   The thing is - I do like kids.   I like them a lot.  And kids seem to like me too.   Unfortunately, I don’t find pediatric diseases to be that fascinating or intellectually stimulating.   I was horribly bored on my Pediatrics rotation even though I loved the patients.   I would suffer through morning rounds and afternoon lectures so I could run to the floor and play with the kids after all my notes were written.   All that really says is that I am a kid.   Not that I should be a kids’ doctor.

I remain baffled by this.   This moment of undeserved accolades.   But I do have to admit that it’s nice to see that H on my transcript instead of the usual P (for pass).