Life is Hard.

I'm averaging 70-80 hours a week. I never see B. My patient who came in with abdominal pain reported child abuse and then I had to report it to CPS. Another patient had a very high ammonia overnight which we only found out about this morning, for various reasons. I've been exhausted for two months straight. I talked back to my very sweet attending on rounds today because I was so frustrated, and then he forgave me, which was really heaping coals of fire. I then sent him a letter of apology. I have three discharge summaries to dictate, it's nearly eleven, and I'll have to get up early. I've been reflecting on what I learned this year and I think I'm dumber and less knowledgeable than when I started. Nurses are grumpy and the hospital is full. Why is it that the less ill children seem to have the more demanding parents? It's a hospital, not the Hilton. The new interns are coming in July and I'll have to be a senior. I'm so tired, and everything that's been hard all along has become too hard all at once. Tears.

What It's Like to Be an Intern -- Or, I'm Back!!

I have missed this blog. And I simply cannot keep a diary online in my own name. So, in short, I came back! And it feels really, really nice to be back. But there's a small difference, which you might notice in the header. I'm no longer a future doctor lady, but an actual doctor. And that's a scary thought. And given that residency is the equivalent of two full-time jobs, I likely won't be able to write often, but I do want to write. It's been amazing. Very intense, very frightening and at times, incredibly sad, but amazing. It turns out that my dream program really was my dream program.

So how does intern year work? You rotate through various areas of the hospital for a month. Child neurology is two years of general pediatrics, one harrowing year of adult neurology, and then two years of being the child neurology "fellow", meaning senior resident who is called by everyone in the middle of the night for pediatric neurology consultation (ie is this child having a stroke?). Yes, children have strokes.

I am currently rotating through the emergency department. It varies from very slow to really quite insanely busy with a lot of very serious disease. In just day for example, we had one patient with newly diagnosed cancer and one baby with pyloric stenosis, a girl with ovarian torsion, four suicidal patients (boys and girls), and multiple appendicitis scares with a couple of true cases, multiple fractures, children with bad cuts needing stitching, some concussion, and one case of possible abuse. That does not include all the children with asthma attacks, bad viral illness, and croup. It was a busy night. But I have to say, putting a fingertip and nail bed back together is a pretty interesting skill to have :) I don't like as much the heartbreaking conversations with the suicidal patient and her family centered around her gender identity. What I told her is that obviously I can't decide who she is for her, but being true to her values and treating those around her with honesty and kindness will get her through the really tough times. But honestly, what do I know, especially at three in the morning? Luckily there are really great resources for her that will do her more good than I possibly can in the emergency department in the middle of the night.

One thing I really like about the new hospital system where I work is that people don't seem to be quite as sarcastic or angry, even to the medical students :) I appreciate that. I'm thinking maybe having all the children around help the culture -- most people don't want to curse in front of a four year old. The absolute cutest moment of my current rotation this far: I'm discharging a patient home with her parents and they tell her, "Ok, sweetie, say thank you!" And this three year old says "Thank you!" to me and to her nurse, since we were standing together. Then, as she reaches the door, she turns around, bats her eyelashes at me, and says, "Bye-bye, Dr. Nia!"

Melt, darn it.

It's Time to Move On.

In more ways than one, I have come to the end of this journey. Maybe I am a serial blogger -- I think a lot of people are. But I was looking over an old post about anonymity, and I think the time has come for me to write as myself. I no longer want to separate myself into a blogger-self, a medical self, etc. Online, I think the time has come to integrate. It's hard enough for people to keep up with each other at all, let alone multiple versions of each other. And that's the main reason I blog.

So, to make a long story short -- I matched. In my dream field. To my dream program. And for the rest, I will continue to blog, but as myself. When that blog is ready to launch, I will link it to my Facebook page.

Thank you so much for reading and for being present with me through the years. May your own paths take you to new and interesting vistas, and may we all keep in touch. By summer, I will be a doctor, and no longer a future doctor lady.

Nearly Match Week!

This is probably going to be my last post on this blog. I haven't posted since last July!! I think the issue is that although  I love blogging, I don't find weekly updates about my own life really compelling. So I may start another blog, but it will likely have different/more branched out content. Anyhow, here's what's been going on! I did 2 weeks in the adult ICU, as I posted. Then a month of NICU, a month of child neurology (when I fell in love with the field and decided I would apply in Child Neurology, a 5-year double board residency), a month of genetics, pediatric rheumatology, and a month of adult Medicine Sub-I (where you are supposed to function like an intern). The latter was at our county hospital, which was overwhelming. One dude came in with a CD4 count (a measure of how bad your AIDS is)  of 4. Normal is in the high hundreds. So from July - November, I was on service continuously.

Then, I spent two months interviewing with child neurology programs. I did take a week off for Christmas, but it was such a whirlwind it didn't feel like a real break. This usually included a two-day interview with both pediatrics and child neurology. I went to 20 programs all over the country!!! By the end of it, I was incredibly tired and had been sick twice :)

Next week is Match Week. On Monday, I find out whether I matched in the original algorithm, and on Friday, I find out where I'm going. I've been super nervous, but Match Week is finally almost here. And then, I'm going South to do an away rotation where B is currently working. So he can't come to Match Day, but my mom and dad will both be there. It's a highly emotional day and some people are really unhappy with what they get, so I'm glad my school's Match Day is so chill (breakfast and then everyone opens their envelopes at the same time when the clock strikes 9). Last year, two of my friends were very unhappy with their matches -- one in Emergency, one is Psychiatry. Both matched to good programs, but not their top choices.

Also, Dusky the still-beautiful cat is ill with a nasal cancer and has been placed on oral chemo and kittycat hospice. She is doing okay (eating, drinking, meowing, sleeping), but has about 2-3 months by the vet's estimate, less by my own. She's much more timid than she used to be and has lost 5 pounds, but I think she believes she just has a left-sided cold. The diagnosis is nasal lymphosarcoma. I've had her since I was a teenager and literally can't imagine life without her. Sigh. Poor wee cat.

From the ICU to the ICN: The Beginning of 4th Year!

I started fourth year in the ICU -- the adult ICU. I was rounding with the pulmonary service, and it was quite a shock to the system after a year in the research setting. Our team consisted of an attending, an R1 about to become an R2, an R1, and me (RX= Resident in year x). I learned an incredible amount in a very short time. I learned about ventilators, I learned about lung-disease, I learned about a different way of assessing acid-base status (instead of Henderson-Hasselbach, my attending was a fan of the Strong Ion approach). The chief resident asked me to identify Howell-Jolly bodies on someone's peripheral blood smear -- which I kind of did! I was able to look at cells under a microscope, at least, because of my research year :) So I had a lot of fun. But it's also tough -- long hours, a lot of feeling undereducated, and just complex issues that everyone else is comfortable with. However: they fed me lunch FOR FREE every day! Every. Day.

 Last night, the night before I started my sub-internship, I dreamed I was being asked a series of questions I couldn't answer. LOL. The subconscious mind is so ridiculous. Today was the first day of my sub-internship in the intensive care nursery. Very ill children and a very different way of doing things. I already have two patients, and I'm going to try to figure out how to present them tomorrow. I don't even know what to read tonight because there is so much. However, I really like the content -- the babies are adorable (of course) and the problems are really interesting. A lot of diseases of prematurity, and a lot of congenital malformation. And a free lunch (okay, so I am a little food-centric. Food keeps me from being hangry). My resident is really smart and really nice -- I hope this will be a good working relationship. I have to not bug her -- I tend to bug people when I'm excited. I ran into one of my students from the master's program on my rotation! She's in the year below me now, I think. Or maybe in my year? I'm all mixed up at this point. After a certain point in life, what you are doing matters more than how old you are.

I have a lot of work to do, but it's the good kind. The kind where if you work really hard, you might be able to reach your goal. I have an entire month of this, so I really hope to be somewhat competent by the end of it. I am so excited to be working in a field I think I want to do for the rest of my life. And on that note: the residency application program opened on Sunday! I registered and started entering my information. There is something so fresh and summative about putting everything career-related into one online application -- it's like looking at an updated CV. It sort of gives you the perspective to handle one challenging day.

In the meantime, I am determined to find time to write up the rheumatoid arthritis paper from the research year. My mentor has already asked me how the writing is going. It is not going. It is paused. Oops. I should probably un-pause it by the end of the week. In fact, I should write them both a detailed update with a timeline.

Rica: How are you doing with your intern year? Are you excited? Stressed? Overwhelmed? Send us a message from beyond the bar!
Che: When does your program start? Oh, wait, I can stalk your blog and find out!
Mom: Come back from NC and tell Dad to stop playing the video games we downloaded for him on his birthday. My brother and B are irrepressible. You gotta love em, though.

Hugs,
Nia

How Am I Going to Learn Enough?!

I am so frustrated right now. I've spent the past few days reading about ventilator management, lung volumes, and acute respiratory distress syndrome. We've covered congestive heart failure and why the traditional way of thinking about acid-base disorders is incomplete. However, for some reason I just can't get questions right when people ask me point blank. For instance, even though I read an article my preceptor suggested a few days ago, I just couldn't summarize it when he asked me to this morning. What has happened to my recall? In high school, that wouldn't have been a problem. In fact, I think memorizing medicine in general would have been easier in high school.

I'm quite sure the British system does have something over us -- they take kids right out of high school and teach them, so they still have the ability to stay up all night and study, or memorize things as soon as they read them. I don't know if my brain is aging or rusty, but it's just maddening to know that you can't recall something that you thought you knew. Today, at the end of the day, a neurologist was quizzing me about locations of strokes in the brain. I *knew* this stuff at the end of last year -- and now it's gone -- poof -- like the wind. F*%K. A great way to end the day, looking like an idiot in front of your senior resident. Terrific. I'm being quizzed about everything except the lung on this pulmonary rotation.

And here's the twenty-four million dollar question: If I don't have this stuff memorized now, when on earth am I going to have a chance to learn it? How am I ever going to become the type of doctor I want to be -- the kind that understands physiology, biochemistry, and disease? How many times a day can I feel like a complete idiot? When will I know how to manage patients on my own? What the hell is wrong with me? Seriously, just shoot me now.

The child upstairs is singing 'Colors of the Wind.' The most relevant line from that song:

You'll learn things you never knew you never knew.

It's clearly a song about med school.

Anyway, there has been another milestone in the process of becoming a doctor: I have my basic lifesaving skills card, and I actually performed my first real CPR during a Code Blue in the ICU on Friday. It's physically more demanding than I realized. He was in shock, of a type that has a very high mortality, so the prognosis was unfortunately grim from the start. Then I had to call the family to let them know that the patient had passed away. I was grateful that my resident trusted me to make the phone call myself.

You know, what they don't tell you about medicine is that it's not the long hours, the terrible things that happen, or the yuck factor that makes it difficult. For me, the long hours are fine as long as I have enough food; the patients are the brightest part of my day, even if things are taking a turn for the worse, because you can't just abandon people if things go to pot; and the yuck factor is negligent because I was fortunately given a strong stomach. It's the doctors. The residents sometimes, and the senior doctors often. Some of them have a gift for teaching students, but most do not. They personally resent the extra work teaching requires, no matter that they chose to remain in academics. A few seem to particularly enjoy humiliating medical students, especially if there's an audience or a competitive aspect involved (like grades).  I guess it does make them look smarter, but how are they going to feel when one of those junior doctors is the one taking care of them when they grow old? The Hippocratic oath involves promising to teach the next generation of doctors as though they are your own lineage, not as though you are shooting fish in a barrel, and I hope I remember that if/when I get to that stage in my career. Hazing went out with the baby boomers.

For this reason, I am dreading my presentation tomorrow. What should be an opportunity to present and learn something will instead become a who-can-take-turns-outshining-the-dumb-med-student session. Am I the only one surprised that many doctors are, to put it mildly, not very nice people?

Okay, done venting. Mom and Dad, it's still worth it. Make change from the inside, and all that.

I'm So Terrified.

Medicine is terrifying. On Monday, I officially begin the first rotation of my fourth year. I will be expected to know more than I did last year, to care for patients more fully, to have memorized a larger percentage of relevant facts. That is scary enough; but at least the damage I can do to my patients will be limited by the supervision of those above me. One thing that really scares me, though, is being expected to teach third years. I do not know enough to teach third years! I've been off the wards for an entire year. I have no idea what I'm going to do or how I'm going to learn the material I need to learn. This afternoon I am having a little attack of nerves that makes it hard to breathe, let alone study. I'm going to go home to my nice B and spread my books out on the dining room table and try to get some work done. It's just difficult to read and process information as though you have all the time in the world when you have a Clock O' Doom ticking in the back of your mind.

Change is Good. Change is Good. Change is Good.

"The old order changeth, yielding place to new

And God fulfills himself in many ways 

Lest one good custom should corrupt the world."

-- Lord Alfred Tennyson, The Passing of Arthur

Here I am, just before another corner. Friday was my last day in lab. On Thursday, my lab took me out to lunch at Pacific Catch at the corner of Lincoln and 9th, which was amazing. They gave me parting gifts -- a pediatric rheumatology textbook from my boss, a cute cardigan from our senior technician, and yummy hand lotion and tea infuser from my junior mentor. I brought them thank-you gifts, but was touched to receive things from them. I think the art of gift-giving is dying. It's sad. But that's another blog post. Anyway, with the lab folks, I really felt as though we had managed the true spirit of giving something you think the other person will like because you appreciate them and were thinking about them. One way to achieve this is to limit spending. Small consumables are more likely to make it into the "how thoughtful, I'll definitely use this," category.

Lab bench, all cleaned up before I leave for good.

The last few months of the research year are over. It's been fun. One highlight was a student conference at the Mayo Clinic -- technically it was free, but I have yet to be reimbursed :(. I roomed with a Pharmacy student, and we even went running by the river in Rochester.  We saw goslings! Rochester is a really cute little town. They are trying to encourage diversity, which means our waitress didn't know how to pronounce the eight very non-Christian names at our table, but actually cared about how to say them. The conference was interesting, but the food was unfortunately better than the content. You know there's something wrong when a poster you stumble across on your way to lunch is better than any of the day's speakers, keynote included. That said, there was some *amazing* student work presented. Out of three keynotes, the last was actually mind-blowing (pun intended) -- a neurosurgeon who has been part of a team that is inventing an implantable chip to measure neurotransmitter levels (like dopamine) in the brain, and then transmit the information to a computer. Amazing!! There will be so many applications for the technology.

Another random, cool event was my old high school best friend, Div, coming in from Dubai! She was visiting her brother on the peninsula and they all came up to the city for dinner, so B & I joined them. We ate at Udupi Palace, a South Indian restaurant. Delicious but precarious -- the dinner plates were literally too big for the tables, so the edges were hanging off the sides over our laps! Div is doing well, and unofficially planning a wedding! She's in banking, not a bio teacher as she originally planned, and I'm going to be a pediatrician, not a lawyer like I was thinking about in high school.

High school friends, 10 years later!

I'm trying to write a personal statement for residency. Meaning that I'm thinking about trying to write a personal statement about residency. It's much, much harder than I anticipated because I'm switching fields. All my research and volunteer work has been in aging/rheumatology up until now, and now I'm shifting gears entirely and working with kids and embryology. Somehow, I have to articulate my trajectory, the 'ah-ha' moments, and why I want to work with kids. I feel like there is an entire category of things -- exams, personal statements, impressing my supervisors -- that I'm no longer rocking. Nia needs her groove back. Ah, well. If you can't beat 'em, just keep plodding forward.

B is home from DC. People keep asking how married life is. It's awesome, because I'm rooming with my life partner. It's so worth it. It's something I'm grateful for every day. We celebrated our one year anniversary by running Bay to Breakers, which is a 12K (7.5 mile) race that starts down by the San Francisco Embarcadero and winds its way through the city and Golden Gate Park to end at Ocean Beach. It was on my bucket list, and B kindly agreed to run it with me. I was the 6202nd runner to cross the finish out of 23, 072, and the 1853/11,793 woman, at a pace of 10:22 minutes/mile (1 hour 17 minutes overall). Not too shabby. B was my coach and ran with me, instead of jetting on ahead. Nice B! Che and Rica did B2B as well, walking in costume (thousands of people dress up), and we all met up at the end for tacos!! Yum. Che was a naked lady and Rica was a superhero. My favorite costume was the guy who dressed up like he was riding an ostrich, with feet dangling on either side of the bird, so it looked like the ostrich was running the race. My least favorite costume was The Silver Surfer -- running behind his reflective outfit was like having a glaring mirror in my face for three sunny miles. I also enjoyed seeing the Salmon, who always run the race as a 'school,' backward from Ocean Beach to the Embarcadero (going upriver to spawn). I almost got a salmon high-five. The most popular costume was a pair, running as the Lorax and The Tree -- the tree was nearly 8 feet high!

I am going on vacation.

The next two weeks will be packed: Open House party this weekend with our friends & my parents' friends, etc, and then a week of very intense review/getting things done before my pulmonary rotation. The Open House will be a nice break from reality. We are sending the cat on vacation to my parents' for the party, because my mom wants to attend and she's allergic to the cat. My dad saw our place last week, took one look around at the mess, and said, "Well, since our friends (meaning real adults) are coming, you can host the party at our house if you want." Thanks, Dad. Thanks a lot. But then, he has many strengths beyond tact. I hope the weather is nice so we can go outside. I don't remember much clinical medicine, so I need to study like crazy. I bought and borrowed the books for my rotations, and they all weigh a ton. I really hope 4th year works. I am excited to study more focused areas of medicine than I did with my longitudinal clerkship. Also, wouldn't it be nice to have an MD?

Here's the To-Do:

Open House!
Study pulmonary medicine
Study neonatology
Study child neurology
Write personal statement for residency
Research rheumatoid arthritis paper
Write rheumatoid arthritis paper
Meet with pediatrics department chair/advisor
Come up with list of residencies to apply to
Get photo taken for residency
Ask research mentor for a recommendation letter

Busy = Happy.

Love,
Nia

Death on our Floor

Our lab is under quarantine. Someone in another lab on our floor died, so the whole floor has been cordoned off and we all have to take antibiotic prophylaxis. The poor guy. My boss called me at home to let me know. So I guess I work from home/library on Monday, until this is resolved. Good thing I didn't leave my workout clothes at work. And glad that all the medical students are required to have vaccinations. I'm afraid all my transfected cells will die, and that's a year's work. But that is nothing compared to what the guy's family must be feeling. Oh, I hope he didn't have any children. Or parents. Or a spouse. Or siblings. Anyway, my job now is go pick up my prescription and then text or e-mail my boss to let her know she can check me off the prophylaxis list.

P.S. I have edited this to remove any identifying details, and am not authorized to discuss them publicly, but I will update family in a private email.

Change is in the Air Again!

Okay, although I am totally overwhelmed, I need to write. So much has happened this month. Much of it has been very, very good and exciting. A lot of it is scary. And no, I'm not pregnant.

Basically, next month is the culmination of the research year. Some of you have already heard that my molecular biology project was going really slowly. However, the fellowship I'm on expects us to have a finished, completed project that we did ourselves at the end of the year. So around December/January, I panicked a little bit and tried to think of something I could do that piqued my interests, aligned with my abilities, and was feasible in a condensed time frame if I worked hard. The project I came up with looked at predictors of refractory disease in rheumatoid arthritis patients, which I was totally psyched about because it was clinical, had statistics, and dealt with both medicine and health disparities/epidemiology.

I've basically been working every day for a long time on this project, and I finally have results! I love my data. But they are alarming, showing differences in outcomes based on level of education when adjusted for medication use and other factors. I am beyond excited that it looks like we have some interesting data. I just sent the dataset to my mentor, so I'm just crossing my fingers that she doesn't run my numbers and get something totally different. That would be a minor tragedy. My big boss I think was a little skeptical at first, but she seemed pleased at my lab meeting today and had some great ideas for what to do next.

So next week I have to somehow do the following: Finish and practice my talk, actually do the 10-minute talk for a symposium, present my poster, finish my resume and personal summary form for the Dean's office to kickstart the residency application process, go to a 2-hour evening journal club (which curtails my ability to speak with my husband on the East Coast, sadness), finish additional data analysis for my presentation, work on a different poster for a different project I've been doing on the side, and pack for a 3-day conference the week after that. Oh, and remember to give my little boss a birthday present. Actually, when I write it all down it doesn't feel so bad anymore. Thank you, therapeutic blogging. I was sad to miss meeting up with my Auntie from India, who was only in town tonight, due to a confluence of work-related and traffic-related factors. But she got to hang out with my dad (she's dad's brother's wife).

In the next month, I have to finish all my research because then I'm back on the wards! Here's my 4th year clinical schedule:

2 weeks of adult pulmonary medicine
4 weeks of neonatal intensive care nursery
4 weeks of child neurology
4 weeks of pediatric genetics
4 weeks of child rheumatology
4 weeks of adult internal medicine
4 weeks for residency interviews + some vacation time (or time to mourn lack of interviews!)
4 weeks of To Be Determined + some vacation time
4 weeks pediatric infectious disease
4 weeks of end of year required curriculum

I am so excited about this. If I do apply in child neurology, I'd like to fit in some adult neurology somewhere. So little time, so much to learn. Many of my old classmates are graduating soon. I'm a little sad when I think of it, but I'm very, very glad that I took a research year. Although I've been in medical school so long (6 years next year!) that when I graduate, it will be quite a shock to my system. If I had gone straight through, which is a big if, I could have been a 2nd-year resident by now. Then again, hopefully the added maturity will be a good thing when I have an MD behind my hybrid name. I should blog about changing my name. Anyhow, I am also nervous/excited because I finally was able to arrange a meeting with the child neurology department chair, whom everyone literally raves about (Pediatric department chair: "I'd trust her with my life...in fact, I have").

In fun news, I'm also doing Bay to Breakers! So are three people from my lab, one of my old friends who is coming in from out of town, and B. I'm so pleased B agreed to be my running buddy. He usually tries to do shorter distances because he needs to be able to sprint for Ultimate, but he was really nice about the 12K. I'm told the entire first half of the race is uphill. Ick. But then, I was also told that it's so crowded that you are forced to walk at points.

For those who asked, B is doing well. He and the other employees got to take a big group photo with The Boss of the House that Shall Not Be Named. Pretty snazzy.

And, just in case you were wondering about my political views, you heard it here first:
Keep your MITTens off my kittens. No more drama. Vote Obama.

April Showers, a 12K, & The Match!

It has been raining a lot. My research facility is located on a hill, which means that you get pretty wet from rivulets and waterfalls as you climb up to work. I think we're getting all the downpour we missed out on this winter. I am lucky enough to own two beautiful umbrellas and good shoes, so I can actually enjoy the torrents. Usually with a hot cup of tea. I'm drinking way more tea than will be sustainable on the wards. Yes, it's almost that time -- the moment I go back to the clinical life! Yikes (Which end of the patient is up, again?). It seemed so far away all year, but now I'm only two months away.

Warming up before the race

On the Sunday after St. Patrick's Day, we ran a 12K (~7.5 miles) to benefit the Edgewood Children's Foundation called Emerald 12K Across the Bay. It was a beautiful run, staring at Fort Baker and climbing up the (steep!) hill to the Golden Gate Bridge, crossing the bridge, and then winding down past Chrissy Field and ending near Ghirardelli square. My dad walked the whole 7.5 miles!

Beautiful views of the bay the whole 7.5 miles

Post-race party with live band at Ghirardelli square

Free chocolate milk from the Nesquik rabbit

The weather was breezy, sunshiny, and cold in the morning but perfect for running. As I crossed the bridge, I saw huge, graceful pelicans fishing at the mouth of the bay. I could see Alcatraz like a jewel in the water. It was amazing. I've never run that far before. My time was 1:20:38, for a pace of 10:49/mile. Just for perspective, the winning female runner did it at 5:32/mile. She's a year older than I am!

Speaking of clinical life, the Match happened two weeks ago. The Match is a huge, nationwide event that occurs the third week of March. Medical school seniors crowd into a room, open tiny white envelopes, and find out which residency program they'll be working at for the next three (or four, or ten) years. My friends all matched! Most of them seemed very happy. E is doing internal medicine. CL is doing pediatrics, and had some great advice for me. Dee is doing internal medicine. T is going to LA to do psychiatry, which is great because his wife, K, was offered a teaching position down there (congrats you guys)! Maybe they'll go all Hollywood on me and start doctoring/teaching the stars? Mimi won her coveted dermatology spot, for those of you who were biting their fingernails. Many, many people are staying in or around the SF Bay Area, which means I might see them once every six months during their training...

The evening of Match Day, there was a class party at a cafe near the beach. I went even though I am no longer in their class, just to say congratulations. Unluckily, it was pouring rain (again). Luckily, it was indoors and we had seats by the fire. Butters brewed an awesome, hoppy beer and brought it! Dee baked a pie (her first! With homemade crust! It was delicious). There was wine and excitement and congratulations. I couldn't believe how grown-up everyone looked. I am so very proud of them and all the hard work they've invested. The matched folks graduate this May with MDs. Dear Lord, they are going to be doctors. Our 2013 graduation will be so lonely without them. Can you believe how time flies? And the handful of us that added a year are left to plunge into the breach.

A beautiful gel for Western blot, loaded and ready

Research is going...strangely. After working on a basic science project all year, I'm not sure if it's going to manifest itself or fall through. However, I've also just started a clinical project that might save my behind when the NIH people come after me for Results with a capital R. Crossed fingers. It's interesting work, looking at what types of people don't respond to treatment for rheumatoid arthritis and how their bones erode. It's actually great stuff. We'll see how it goes; the deadline is a conference coming up in May (and prior to that, an abstract due next week).  I can't believe how much molecular biology and statistics I've learned this year. I hope all the clinical info regarding patients is still in my head somewhere. Unfortunately, I've had no time at all to work on my master's thesis, and I'd love to edit it and submit it. My brain is going to explode one day, wait and see. It'll be interesting. Anyhow, this week I get to teach a high schooler volunteering at the lab. She's a bubbly senior, five foot nothing, long dark hair, wants to major in chemistry. Rock on, my little friend.

B continues to work at the pale house in a certain capital city that shall not be named on a public blog. He's coming home weekend after next, though. Yay! Maybe it'll stop raining enough for us to go hiking. It has occurred to me that it's very late and I should go to bed (this is laughable: by hospital standards it's not even the end of the day). But I am so very happy to get a chance to sleep that I should carpe noctem. Bonne nuit.

March Madness! Career and Gender Musings.

Spring is coming, slowly but surely, to the Bay Area. We have such odd seasons here, I have to say I miss the Philadelphia and DC areas with their stormy winters, lush green springs, humid summers, and crisp, vibrant autumns. But here, in California, in the Bay Area fog-basin, we have buds appearing on the flowering trees, days alternating between 45 and 65 degrees Farenheit, and the flu season finally seems to be tapering off. Influenza is nothing to sneer at, which is why they suggest that anyone is contact with the young, the sick, and elders (>65, although nowadays that doesn't seem very elderly!) receive a flu shot. I generally don't get it, because I tend not to get the flu, unless I know I'll be working with patients whose immune systems are more vulnerable (like the young and the old).

March 5th is our deadline to submit our 4th year schedule for consideration by our advisors. Here's what I'm hoping for:

Tentative Schedule for 4th Year: Each block is 4 weeks long. * = HARD, possibly with overnight call every 4th night.

Spring 2012:
Block 1: Finish Research (In year-long CTR pathway right now)
Block 2: 2 weeks' writing up paper; then 2 weeks' child abuse (if offered) or peds critical care, or other available elective.

Summer 2012:
Block 1: Child Neuro (2nd choice: peds genetics) *
Block 2: Peds Sub-internship *

Fall 2012:
Block 1: Peds Pulmonary *
Block 2: Genetics Clinic
Block 3: Away rotation or Bone Marrow Transplant or Medicine Sub-internship*
Block 4: Vacation (maybe with a narrative writing elective; this is interview time)

~Winter Break~  my last one ever!! Hopefully will go on interviews.

Winter 2013:
Block 1: EKG Interpretation or Medicine Sub-I
Block 2: Cardiology *
Block 3: ICU/NICU or NICN *

Spring 2013:
Block 1: Adolescent Med or Toxicology/Pharm (and/or some vacation)
Block 2: Mandatory end-of-school session
Graduation!


That's right! I'm going for either Child Neuro or Pediatrics +/- eventual fellowship (meaning a sub-specialty like endocrine or cardiology). Also interested in health policy/advocacy. I still have time to change my mind, but I don't think I will. I'm so excited about working with kids AND parents. I think we would be a better society if we listened to children and parents, encouraged them to contribute, and invested in them. Parts of the US really do not have a parent-friendly culture (though I hope celebrity babies will change this mindset), which causes people who happen to be parents to either feel very defensive and that they have to be aggressive advocates for children, or just plain unsupported.

However, I knew I was excited about this choice of fields when they had a Forum discussion on the radio about raising girls to be freer of gender stereotypes (are we STILL talking about pink Barbie/Disney princess dresses? Seriously?!) and I got so riled up I emailed them a comment. They had entirely failed to mention how playing sports has really changed the process of growing up female, and what Title IX (thank you, Congresswoman Patsy Mink) and the subsequent support for female athletes did for our society.

Here are some things that our parents did that rocked my world (and hopefully my brother's) and taught me to be a strong woman. Clearly, we still need to have this conversation. Sigh:

Seven Things My Parents Did Right (and So Can You):

1) Turn off the TV. Limit screen time on weekdays, and turn off the TV. This was a strong policy in our home. Weekdays were workdays, hence no TV. Have computers and TVs in public spaces in the home, not in bedrooms. Getting hooked on teen soaps exposes you not just to the twisted messages of these 20-year-old-playing-teen shows, it also exposes you to all the advertising aimed at the target audience. Tell kids to get outside: it saves their eyesight. The healthiest TV show is still less healthy than going out and living your own life! And then their friends will realize that not *everyone* watches these things, so you'll affect more than just your child! Summers were also more fun because TV was for summer.

2) Criticize Sex in Advertising. Avoid stores that use sexualization to sell stuff. Teach your kids the difference between sexualization and sexuality, and the difference between being admired and desired. Abercrombie & Fitch keeps getting into trouble for this stuff aimed at middle-schoolers. Call these stores names: gross, disgusting, and perverted. Show them the not-very-attractive board of managers and CEO.

3) Avoid Gendered Marketing. Avoid stores that have girl sections and boy sections: for example, substitute your local toy store for Toys 'R' Us, and buy things in unexpected places: a lot of hardware stores have toys. My mom hates TRU and loves the others. Bookstores are also great (although they are dying a slow and painful death). For older teens (driving age), tea and coffee culture is strong and can supplant alcohol (and caffeine is not as bad for teenagers as it was once thought). If you can tell what gender a toy is for (pink beach shovels?), don't buy it. Vote with your wallet and explain why.

4) Treat Kids Like Kids. If you have a girl, treat her like a kid; if you have a boy, treat him like a kid. Give him dolls and animals; give her a log cabin building set. Give them both art supplies. Teach the males how to cook and the girls how to repair things effectively. My brother and I had no concept of things we couldn't both do. Essentially, check your own gender bias at the door. If they have gender bias, remember it's a phase and do your best to be a countercultural rock. It's okay if they turn out different, as long as they understand whole hog what they're getting themselves into.

5) Keep Them Busy. Encourage alternative fun. Let them play sports, get creative, be involved in after school activities -- and, oh, yeah -- study! My dad enrolled me in baseball; my mom gave me a tool kit and indulged countless plays/art projects/choir performances. Let children derive their identity from their skill set, and/or being busy all the time. Not what they look like.

6) Know Their Friends. Make sure they are good friends. Know and care about their friends; invite them over. I remember my dad hosting (by himself) a crazy sleepover party for eight 10-year olds. That's dedication. Teach your kids to care for their friends; then they'll know if their friends don't care for them. If your kid needs helping choosing appropriate friends, teach them how to choose BEFORE they're 16 and sullen and think you're so lame. It will make a world of difference if they have peers they can really lean on in their high school years when things get rough.

7) Have a Career. Take it seriously. Take your kids to work (on acceptable days or weekends) so they can see how adults roll and what you're doing all day while they are at school.

I know each household is different and parents all have different values, but these worked for us. My brother is a very kind, respectful man; I am a very strong woman. We are both good at things that are not stereotypical (he's a great cook; I am good with science and machines). We are still close to each other and our parents. Yay!

What a Non-Catholic Can Learn from Observing Lent

A week ago was Ash Wednesday. I saw many people at work going about with a black ash cross on their forehead. Although I am not a Catholic by any stretch of the imagination, I have always respected Lent. I think it has a beautiful symbolism, in so far as my understanding goes. If you want to learn more generally about Lent, here's a good overview. The forty days of Lent (Sundays do not 'count' because Sundays are a celebration of salvation) mark a time of prayer, penance, and fasting (meaning a different diet, not total starvation) in preparation for the resurrection of Christ at Easter. Many people see the temporary sacrifices of Lent (chocolate, TV, internet) as another way to do penance, develop self-discipline, and remember the sacrifice of Christ -- for instance, this 25-item list put together by and for teenagers. Pretty impressive for high school students, right? One could argue it is artificial hardship, but I was thinking how valuable it could be for anyone, not just the Lent-observing Christian, to 'do without' for 44 days.

It seems this practice would bring us closer to those people who have less than we do, while reminding us that we have much more than we think. Especially during this Great Recession, I've been remembering the old saying, "Use it up, wear it out, make it do, or do without." Not that I live a deprived life -- we live in comparative luxury on our modest income (ie my research stipend and his intern stipend). But of course it's good to be careful and frugal with money, and to be thankful for what you have -- no matter how much it is.

The 44 days of Lent are also valuable to the non-Catholic as a dedicated time to learn a new habit. It takes people anywhere from 18 to 91 days (depending on the individual, the behavior being learned, and which study you read) to really establish a habit, but 44 days is a pretty solid amount of time to devote to a new practice. Check out this Slate article on one (Indian-American) woman's experiment with becoming a morning person. You could apply this to anything, from nagging your children/spouse/employees all the way to kicking a dependence on caffeine, alcohol, or cigarettes. Speaking of which, isn't it neat that our medical school's first-year syllabus requires that we attend an AA meeting if we've never been to one, so that we understand what it is we are recommending to patients?

So my Catholic neighbors and colleagues have inspired me to re-examine my own life. What do I indulge in? What could I do without? What would make me a better person?  I think as I get older (I'm now 27 years and 4 months old), I need to decide what my priorities are going to be. As a high school student, especially, I had this strange idea that I could do everything. I could act in plays, sing in a choir, choreograph dances, ride horses competitively, study hard, do research, volunteer, etc etc. And I could do it all, but I was perpetually exhausted, never saw my family or friends, and I think I averaged about 4-5 hours of sleep a night my junior and senior years. Obviously (in hindsight), that was not sustainable. However, we'll see if I've still got it (residency is coming)!

Our little older Siamese (she's 13) had a health scare this weekend: she chewed a bump off her shoulder which turned out to be benign (a self-operating cat! Dr. Cat, M.D!). But the reminder that she, like all of us, is mortal made me want more focus in my life. I am currently deciding on a specialty (almost there; really close to deciding), starting a marriage, and trying to find enough time for family and close friends. Given that I am in the medical field, I don't know how much room there will be for anything else. Maybe kids, someday? Running? Riding? Pets? I don't think I'll be choreographing another can-can anytime soon.

At this point, I want to devote more time to my career and calling -- to becoming a really good doctor. It takes way more time than I had anticipated. But not more time than it deserves. Because it's worse to be a lousy doctor than to not be one at all. I'm in a research lab at the moment, but the MD is the goal. I need to start thinking about my future patients: which skills do I need to acquire in order to be the doctor they would want? So until Easter, I am going to read one article or chapter every day that will make my sub-internships easier during fourth year and beyond. I am also going to spend ten minutes each morning in a lovely meditation taught to me by a friend who was also a minister a few years ago. It went something like this:

The Friend Map:
Picture a map of the United States or the globe in your mind. Picture everyone whom you carry in your heart -- friends, loved ones, colleagues, frienemies, or any other group -- as pinpoints on that map. Now scroll across the continent, sending a prayer/good wish for each person. This cultivates gratitude for their presence and a loving demeanor, both of which will strengthen your ability to weather storms. And who knows? They may sense that someone is thinking of them/praying for them.

Why This Blog Is Only Nominally Anonymous

I bumped into a couple of dear friends yesterday and had a surprise Valentine's Day 'date' with them. I was walking near their place, so I should have somewhat expected it, but it was still a wonderfully unexpected meeting. Over Thai iced tea (yum), I found out that one of them knew about this blog! I was so pleased (hello K if you read this)! It feels safe and warm to know that friends occasionally pop in.

As someone who keeps a blog for the primary purpose of keeping in touch with family and friends and reflecting on my personal life, it is important to specify what this blog is and what it isn't. Although I do not post my name, address, medical school, or other identifying information for the world to see (and Google), I am fully aware that someone who really wanted to know who I was could find out based on clues and the sieve-like nature of "secure" information online. The Dr. Lindeman case (read his interview about it on ScienceRoll) illustrated perfectly why blogging, especially blogging anonymously about controversial topics, can lead to trouble.

Essentially, he is a Yale-and-Columbia-trained pediatrician who blogged as "Dr. Flea" for a few years. He had a straight-talking approach to the medical world and his commentary was often somewhat controversial. A lawsuit was brought against him by the parents of a 12-year-old boy who died of diabetic ketoacidosis six weeks after an office visit where his diabetes went undiagnosed. Because his team did not think it was true malpractice, it went to trial. During the trial, Dr. Flea blogged about the case, the jury, the attorneys, and the defense strategy. The prosecuting attorney then found a comment that linked Dr. Flea to the person on trial! I wonder if the person who posted that comment had any idea how much trouble it would cause. Basically, the attorney unveiled Flea's real identity in court, and he settled the suit. This whole saga made the Boston Globe. I have no more knowledge of or connection to this case, as far as I know, than the information available online. I feel bad for everyone involved.

That said, I do believe that medical students, residents, and doctors have a unique view of society and should try to participate in conversations about topics important to them. It's just that in a shrinking world of increasing internet fluency, it's utterly naive to think that you can post opinions that will never be identified with you. This is why I rarely blog about patients, I don't publish scathing critical reviews of anything, and I assume that my boss's kids will one day print this out and hand it to her! This blog is not a forum for me to rant about medical school or to air personal vendettas against specific people (which I don't really have, anyhow). I write to create a place online where people can check in and perhaps find something to think or at least smile about. But I have no desire to be an infamously controversial blogger; blogging, like so many things in the context of medicine, may be best done in moderation.

With all this in mind, I have drafted the following pledge:

The Sane Blogger's Pledge

1) I will not write anything 'anonymously' that I would be ashamed to have attached to my name.
2) I will not disclose secrets that do not belong to me.
3) I will remember who I am in real life and not let my blog identity overwhelm it.
4) I will blog about my past and present while remembering that what I write may affect my future.
5) Uncharitable thoughts are no less uncharitable in written form.

Does this mean no hot-button issues? No, it just means that when I take a stand, I do so knowing that to most of the people who read this blog, to our circle of friends/family/colleagues, and to anyone who does enough hunting, I am not anonymous.

Which brings up another issue: should I just post my name as the author? Would you consider blogging under your real name? What do you guys think?

Yours online,
Nia

Choosing a Specialty

Lately, the most pressing questions in my professional life have been a) which medical field to go into and b) how to get myself published. Part (b) is a topic for another post, but the choice of specialty question has been plaguing me for a couple of weeks now.

So far, I've narrowed it down to a few fields I think I'd be most happy in. Here's the list, in no particular order, with the training required for each:

1. Neurology (adult): 1 year preliminary medicine + 3 years' neurology
2. Child neurology: 2 years preliminary pediatrics + 3 years' child neurology OR 3 years pediatrics + 3 yrs child neuro
3. Pediatric rehabilitation: Same as child neuro, but put "rehab" in place of "neuro"
4. Adult rehabilitation: Same as adult neuro, but put "rehab" in place of "neuro"
5. General pediatrics: 3 years of pediatrics

So I think I'd be happy in any of these fields. The problems I have with deciding are related mainly to i) competitiveness and ii) scheduling 4th year rotations so that I have a good chance of doing well and getting a recommendation in my chosen field. Basically, I have two available slots, and I was hoping for a 'warm-up' rotation so that I could really do well in my 2nd one. I want to step it up my fourth year!

In terms of competitiveness, neurology and adult rehabilitation are not that competitive, but the 1st year -- preliminary medicine -- is. This is because everyone matching into the more competitive fields of Radiology, Ophthalmology, Anesthesia, and Dermatology (the ROAD to the good life, we call it) has to first do a prelimininary medicine year. These are the students with honors across the board, Alpha Omega Alpha (medical honor society), and great board scores as well as research in their field.

Child neurology and pediatric rehabilitation are not supposed to be competitive, but they have very few spots available each year, and so it tends to be that either you get interviewed/ranked at many programs or nobody ranks you (this refers to a complicated process known as "The Match", in which programs interview selected students applying in their field, and both rank each other so that a computer algorithm can decide who goes where).

What all of this means for me is that I have to take a cold, hard look at my scores, grades, research, and qualifications so that I don't under- or oversell myself when trying to find a position for residency. My record is that I come from a very good school, but my Step I is unfortunately quite awful, my Step 2 is quite decent, my grades are solid but nothing special, my research experience is strong but not PhD level, and I won't be a member of AOA. I do have gumption and passion and lots to give in terms of intangibles, though!

The other issue, of course, is whether I'd like to work with children or adults more. This is a huge decision and is, I think, the biggest 'branch point' in the above decision-making. I have written out lists of pros and cons, I have flipped coins, I've asked friends/families/advisors. I get different answers depending on my mood, the person I'm speaking to, etc. My mother even wrote out a flow chart analysis thing (it's so nice to have an MBA Mom with a great deal of patience for my ridiculous anxiety). Right now, I'm favoring the kiddos. And their parents. I really like parents. Parents are adorable. But we'll see!

Yuletide in the Foggy City

Grateful for our tree

Christmas will always bring to mind the woman I saw in the Emergency Department last year. She was around forty, had epilepsy, and came in because she had "gone into convulsions" that morning. Her husband brought her in at 4 AM, explained that she had fallen out of bed and bitten her tongue, and then then had gone to work while she was treated. Although it was clearly painful to talk, she wanted to. She told me she had come to our hospital because when she went to the general hospital after a seizure, the staff assumed she was drunk or high because she was Black. "It hurt my pride when they treated me like that," she told me with a bleeding tongue, "I don't abuse my body with drugs or drinking." As she and I talked, it became clear that she had been off her seizure medications because she was saving up for Christmas. "I asked the kids if they wanted a tree or presents more, and of course they said presents. They've been good kids, so they'll get their toys. We'll just do without the tree this year, things have been rough with the money."

Stockings, candles in the grate, and apple pie for Santa

Stories like this always remind me to be thankful for how much we do have -- our health, each other, and more than enough money to live on. We had such a joyful and abundant Christmas, with both a tree and presents, and I only wish everyone could be as fortunate.

Card games around the table

Our traditions vary, but this year my whole family and B (B and I were at his parents' for Thanksgiving and my parents' for Christmas) played a board game around the dining table, Apples to Apples. My father won, which makes this the second year in a row he had won the Christmas game! Well done, Dad. We also spent Christmas Eve dinner together, and my dad had Tandoori chicken, palak paneer, and other delicious food for us to eat. Our Christmas Day brunch was tasty too (but then, I made it and I only made food I like!): whole wheat flapjacks (some with chocolate chips), chicken and beef sausage, garlic and cheddar home fries, and eggs with toast. We were all full on Christmas morning, although I did sneak back for an extra flapjack. We opened presents together in the living room, and it was just a lovely feeling to be together, with B there for the first time.

A thoroughly spoiled Samantha

Even Samantha, my American Girl doll from back when it was still The Pleasant Company and American Girl had not been sold to Mattel, had a new fancy purse and a plush Christmas mouse. After we had all opened our presents, we bundled up and went out to see the new Tin Tin. We used to read the Tin Tin comic books in India, so it was a fun treat. The movie was well made and the visual effects were beautiful. It was a very simple story, and family friendly. There was a camel that was so touchably fluffy with such long eyelashes that I wanted to take it home.

Family Movie

 

Laughter around the food table

We had a gathering in our home the night before New Year's Eve. We were joined by old family friends whom we've known for years. It was so nice to see them all again amid laughter and stories of 2011. We had food and friendship as we bid the old year good-bye. I'm glad to welcome 2012. I hope it will bring us luck. If you look in the middle of the food table behind the grapes, you will see a square gingerbread on a square plate. Here is my Pumpkin Gingerbread Recipe to keep you warm in the chill -- be careful not to over-bake, it is better moist and also better on the 3rd day.

Pumpkin Gingerbread

Pre-heat oven to 350. Take out two large mixing bowls. Into each, add the following:

Bowl 1:

2 cups brown sugar
1/2 cup honey
1/2 cup olive oil
4 eggs
2/3 cup water
1 can pumpkin
1 tbs powdered ginger
1 tbs cinnamon
1/2 tsp cloves
1 tsp pumpkin or allspice
Pinch nutmeg

Bowl 2:

1 cup white flour
2.5 cups whole wheat flour
1/2-1 tsp baking soda (depends on your baking conditions)
1/2 tsp baking powder
1 tsp salt

Mix each bowl separately and well. Fold dry ingredients into wet.
Mix just until evenly blended. Pour into 10x10 in pan or two 9" loaf pans.
Bake 1 hr at 350. Remove to cooling rack when a knife comes out clean. Serve on the 2nd or 3rd day, warmed, with ice cream or fruit.

There were so many parties and potlucks around the holidays, including for work. I am currently trying to decide between Neurology and Pediatrics for a career (potentially Child Neurology). The rules for how to apply to which are quite convoluted. I don't know what will happen, but I hope that it all somehow works out... I will let you know! I need to meet with advisors, write an appropriate resume, and try to get in touch with my former classmates (many of whom are graduating this year, meaning that they are applying to the residency Match right now). Isn't it strange that a computer algorithm determines your post-MD placement? It's a bit scary, but then everything worth doing is. I'll post about what happens.

Office potluck -- everyone digging in

There are so many projects I want to work on all at once. I don't know which to do first. There is the lab work, other work-related projects, career planning, household stuff, wedding wrap-up. It's all wonderful, though, in a sense. My mother was right: it is fun to be a grown-up.

Wet Malamute

We have finally gotten the rain we will need to prevent another big summer drought. As I write this, though, I have a grown-up dilemma: the next-door neighbor's dogs are locked out on their patio, it's pouring, and the younger of the two is chewing up and ripping apart their wooden window blinds trying to get into the house through the window. The neighbors have gone out, or else they aren't answering the doorbell. They've just moved here and I don't have their number. Should I leave them a note? I've told the dog, "No!" but that is all I can do without breaking into their yard (not a good idea with strange dogs). Poor, wet, angry doggies.

I Am Done with Step 2 CK!!

Simulated Exam Screen with Heart Mitral Valve (score95.com)

I haven't written in a very long while, because I was overwhelmed by that anxious, itchy feeling of not knowing how you've done on a very important exam. As you know already, I was wondering what would happen if I did very poorly or didn't pass. But last Wednesday I got my Step 2 CK (Clinical Knowledge) results back, and not only did I pass, I passed comfortably. No 'squeaking by' like with Step 1. What a wonderful Christmas present! And maybe I'll stop making careless mistakes in lab now. A huge weight has been lifted. I'm hungry again. I care about life again. And I'll start posting more frequently now that I have a little more time to devote to writing.

B and I went to LA this past weekend so he could visit old law school friends and I could take Step 2 CS (Clinical Skills). It's an in-person exam set in a simulated clinic. The exam was so odd. We were in a long hallway with over twenty doors, and standardized patients behind every door, and proctors in the hall, and buzzers and announcements going overhead. I felt under time pressure and could not do a lot of physical exam, sadly, so I hope that is okay in terms of whatever grading rubric they use. And it's a pass/fail exam, so I just hope I pass. I don't need a good score :) I am not allowed to say anything about the actual content of the exam, but it was just a weird experience. They are all actors. For one patient, I wasn't sure if he was "supposed" to be malingering -- that is, pretending to have symptoms for some other benefit. But he was an actor, which meant I was pretending to be concerned about his pretend symptoms while trying not to act as though I thought he was pretending to pretend. And they say it isn't an acting exam.

So, in a word: Phew!!

Gingerbread and Counting One's Blessings

Thanksgiving is almost here, and we have more than enough to be thankful for. B passed the California Bar Exam! He was enormously relieved, especially given that two of his twenty colleagues did not pass this time around. B will also be on the East Coast for a few months this spring for an internship, and then will be looking for work. Where he ends up will determine where I seek a residency next year.

Assuming I pass my own exam. Results haven’t arrived yet, so I feel a bit stuck in limbo right now. I keep playing the ‘what-if’ game – what if I failed? What on earth do I do then? What if I never graduate from medical school? Finally, I got so tired of this that I called my own bluff and started to compile a list of alternate careers I could do if medicine did not work out:

Clinical research director. High school teacher. Biostatistician. Medical transcriptionist. Policy analyst. Medical writer. Bench scientist/technician. Guidance counselor (ironic). Riding for the disabled instructor. Any other thoughts?

The clinical skills exam is coming up in mid-December, and I plan to start studying immediately after Thanksgiving break. We are going to his parents for Thanksgiving and mine for Christmas. Things at work are a bit hectic, as well – I feel guilty going anywhere for Thanksgiving because it puts a forced pause in an experiment where no pause should be, and my boss offered to feed my cells over the Thanksgiving weekend. Yuck. There’s nothing like knowing you are putting your boss out to take the fun out of a holiday. I am also hugely inexperienced and am dealing with quite a steep learning curve. I’m sure that I supply the more seasoned scientists with plenty of laughter over my naive mistakes. 

As you can probably tell, I am feeling all out of balance... plans I thought I had made so carefully to schedule things out this year have gone awry, and I just hope that somehow it will all work out. I am learning important things about myself, though – I do not think I want a wildly unpredictable career where I play five different roles and juggle far too many responsibilities. Although I doubt any medical career could ever be low-stress, I would like medium as opposed to very high stress on a daily basis. A little bit of time for family would be nice, as well. I think that this culture really does emphasize doing as much as you possibly can, and de-emphasizes things like family time, sleeping, and food. No wonder obesity has become a problem – poor, stressed-out working people have too little time to cook, so they simply eat processed foods or eat out all the time. And they are so busy working that they are never able to go for a walk. It's a double whammy.

Anyhow, one of the sovereign remedies for the blues is to think happy thoughts. Funny things qualify: the other day, the children who live above us were dancing around while it was raining out. Somehow, the rain amplified their footsteps until it sounded like an army was marching over our heads. Of course, they will now forever be known as the Storm Troopers.

Secondly, one of B's colleagues called Swarthmore College, our alma mater, a "potted Ivy." I thought this was both highly flattering and quite appropriate (but then, I'm biased. I loved Swarthmore).

Another form of happy thinking (appropriate for the upcoming season) is to list the stuff you are grateful for. So here goes... 

Things I am Grateful For: (Here are the ones I can think of right now, in no particular order)

Being happily and newly married.
All the wonderful people who came to our wedding/sent us love.
Living in the same town as my brother!
Having adorable parents fifteen minutes away.
Warm gingerbread with cold milk.
My thirteen-year-old cat, who is still pretty feisty.
The friends I've made in medical school, and the friends from college who stuck around.
Having a job with good colleagues.
A car, a roof over our heads, food, comfortable clothes, and some extra goodies.
Good in-laws. Seriously.

To facilitate putting the attitude of gratitude into practice, I just got one of my favorite things in the world: a new blank journal. It's been a year since I kept one. For $3.99, isn't it worth it to feel as though your life is, once again, a clean, fresh sheet of paper just waiting to be written on? The only feeling that tops it is when you've filled it.

Emerging from the Library

The Step 2 CK exam was yesterday. It was a long, grueling nine hours, and by the time it was over, I was so brain-dead that I have no idea whether I made it or not.  It felt terrible to leave the testing center thinking that I might have done badly after studying so hard. I did feel like I was catching up during my studying, but still. Not a great feeling. And there is quite a lot riding on this exam. It is sickening not to know if my career goals will come to pass. After imagining out every possible scenario and moping around for a bit, I decided that regardless of the outcome, it's going to be weeks until I find out. And regardless of the outcome, I did what I could in the time that I had. It is now in greater hands than mine. So in the meantime, I'll write a bit about what's going on now that the board exams are (for the moment) over.

The grass is greener on the other side.

Catfish the Siamese is home, after spending a little vacation at my parents' so that I could actually get some sleep (she enjoys parading across the bed and meowing for food at 5 am every morning). I went over to my parents' place to collect her right after the exam, and was able to spend a good long time with the family. B came with me, and my brother even stopped by. It was so nice to have an impromptu family gathering.  The weather has been trending towards chilly rain with a generous helping of clear, bright days.

This morning we went to the farmer's market -- there will be just one more next Sunday and then the harvest season will be over. Guess what has come into season whilst I was studying? Fuyu persimmons! We also found fresh cauliflower, tomatoes, onions, and apples. They were selling apple cider but we decided to pass this time around. It doesn't last as long in our house as the apples do! We sliced up our bell peppers onto whole wheat toast (B's home-baked bread) with mozzarella and tomato puree -- our marinara open-face sandwiches were delicious.

B making bread dough.

A golden loaf, fresh out of the oven.

The end product!

We also took a short journey to Golden Gate Park this afternoon to enjoy the November sunshine. There were so many families out walking or boating, and any number of ducks, seagulls, and flowers still in bloom.

A bright yellow blossom seems to say, "Cheer up, cheer up! Life is worth living!"

The moss, trees, bridges -- everything felt fresh and interesting. It was lovely to be outdoors instead of studying. The animals at the lake are used to people and will let you get pretty close, hoping to be fed.

Contented ducks.

The Canada geese were quite docile.

Sleek geese getting nervous before Thanksgiving.

We made friends with an elderly gentleman who was feeding the seagulls -- I was able to catch their excitement as they flew up to catch the breadcrumbs!

Free meals draw crowds.

Whee!

As we drove home, we were treated to a beautiful early sunset against the autumn clouds.

It didn't seem real to us, either.

Speaking of Thanksgiving, I saw an article in the September Education issue of the NY Times Magazine discussing the differencing between raising overachievers and raising children with "true grit" -- the strength of character to succeed in the face of adversity. It really spoke to what I've been thinking about lately and what my boss and I have discussed -- that life is not an IQ test, and that your drive, optimism, gratitude, social skills, curiosity, and sheer gumption will get you a lot farther in life than just intelligence ever could. It's called "What if the Secret to Success is Failure?" I think the title is misleading, though; it's more about whether character can be taught than whether failure is needed for success.

For someone in my particular position (that is, trying to learn a set of skills, earn a degree, and begin a profession), it was a very hopeful read. It's been a more difficult road than I anticipated, for a whole host of reasons, so it was nice to hear that continuing to strive for the goal is worth something in itself.

A red-eared slider at the lake. Slow and steady wins the race.