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.