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.