One of Those Days

Yesterday was one of them. You know the ones I am talking about. 

The days where nothing goes the way you want it to. Nothing you were planning to do or accomplish gets done, all of your plans fall through or don't work out, all this stuff just gets in the way of where you intended to go. And it feels really crappy. And maybe you end up crying a little in your car, by yourself, because you are overwhelmed by how much you feel like you are failing at everything and maybe you are now single again, and maybe this had not been the plan. And you just feel really alone. 

But then, something wonderful happened. All my girlfriends came over for dinner, in what turned out to be a serendipitously pre-arranged plan. And it is always so, so good to get together. But later on, after almost everyone had left, I had a moment where I just let myself feel what I was feeling and then be honest about it to someone else. And that someone else swooped in and picked me right up, and let me know that I am loved, despite how I may feel from time to time, in those lonely moments when things just don't seem that great. 

And that never would have happened if the whole entire day up until that point hadn't been sorta really shitty and hadn't left me feeling pretty vulnerable. And I would never have had that moment of profound gratitude that my friend gave me right when I needed it most. 

And then another something wonderful happened. I did something brave. I went out on a limb, I acted on an impulse. And I was almost immediately rewarded for it. I was up late; way too late for having clinic this morning, but I just hung onto that crappy day until the good way outweighed the bad. 

Leftover chocolate ganache pie from Southern Sweets Bakery - this was something wonderful too.

Randomly, I happened to read this today and damned if I didn't recognize a whole lot of myself in it - it was just the reminder I needed to take a deep breath and enjoy right now, right where I am (and just to be very clear, I have never thought I would die if I weren't married by 30. I still don't. I did, however, sort of assumed that I would be... and it's taken some adjusting to the idea that I won't.) 

And then I read this, from my sister: a promise of spontaneous, joyful uncertainty and breathless expectancy. I love every word of this. 

So, on this last night in April, which gives me exactly nine months left before the big 3-0, I am putting up this 30 Before 30 list, a very short-term bucket list of sorts, goals to aim for, ways I am going to pack as much life into my twenties as I possibly can during the last months of the decade. That works out to about one cool thing a week until my birthday. 

The list isn't finished yet... so help me out!! I am up for most anything, although keep in mind I do have a bit of a time commitment between now and then (most of third year of medical school.) Seriously, send me your suggestions - I would love to hear them. Yes, some of the items on the list are already checked off because I did them recently. What?? It's my list, so I make the rules. :) 

Romantic time with myself.  :)

Final thought for the night: I am listening to Bird by Bird, Anne Lamott's book on writing, on audiobook during my considerable commute these days, and in one of the first chapters she says something very lovely about writing that applies just as well to every other part of life, too. I am paraphrasing, but what she says, essentially, is that we should treat ourselves like a dear friend, and we should learn to be good, compassionate company for ourselves, as if we were someone we were fond of and wished to encourage. Good advice, I think.

It's My Color

A sure sign you might need to rethink your lip gloss impulse buying habit? Finding the same exact shade you just bought in a purse you haven't used in a while. I mean, just theoretically, of course...

On Surgery and Babies

I often have patients tell me "good luck!" as I say goodbye to them and start to leave the room.  "Good luck," as in, good luck with finishing medical school... and then residency... and then, you know, the whole being a doctor thing.

I always say thanks, and I always mean it.

I never don't feel like I need a whole lot of luck to get through this, or at the very least a little of some really good stuff.  This afternoon, a patient - an older woman - went on and on about how wonderful she thought it was that there were so many more women going into medicine nowadays.  And I totally agree with her, but I also think that a big part of the reason I feel like I need to rely so heavily on luck for this whole being a doctor thing is because I am a woman.  Not for the medicine part by itself, necessarily (although God knows I could use that too), but for the entirety, the wholeness, of my life.  To be a woman in medicine and to still have the life I want, or something like it.  I have so much to say about this subject that I could write forever about it, and probably will plenty of times, but tonight I am going to keep it short.

All I know is, I have been reading this excellent book, and it is just fascinating and pulls you right into the crazy intense world of pediatric heart surgery, and envelops you with a sense of the insanity of that life and the courage and singularity of purpose it requires to do that work (and thank God there are people out there who can do it)... but they are all men.

They do amazing, incredible, miraculous, insane work, and they have schedules to match.  Still, many of them have families.  And I can't help but wonder... is it any coincidence that none of them are women?  Just kidding, I don't wonder that.  At all.  It is obviously not a coincidence.  

Anyway, here is another fabulous Dr. Chen column from the NY Times Well Blog, expounding on the topic much more eloquently than I.  Enjoy.

The Plight of the Pregnant Surgeon

By PAULINE W. CHEN, M.D.

February 23, 2012

Admired as much for her sheer talent as for her humility, my surgical residency colleague became pregnant during her last year of training. At about the same time her baby was born, another colleague, also in his final year of training, broke his leg in a skiing accident. Both ended up taking a few weeks off from work, he for his accident and she for her maternity leave.

A couple of months later, after both had returned to work, we learned that our female colleague had been asked to make up the time lost on her maternity leave, while our male colleague had not. Outrage over this decision spread quickly among the ranks; in hallways and call rooms we residents huddled together to condemn the decision of our elders. Medical students reacted, too, choosing training positions not in surgery but in obstetrics and gynecology or internal medicine, specialties where they believed they could have “a life” while training.

Many years later, what remains surprising to me is that none of us, including the woman herself, ever seriously questioned the decision or the senior surgeons. Despite our railings, we accepted it because, as one female colleague trenchantly observed at the time, “this is the way it is with surgical training; you just don’t get pregnant.”

I remembered this incident when I read a study published this week in Archives of Surgery, the first large-scale examination of attitudes toward pregnant surgeons.

Researchers from the University of Maryland School of Medicine in Baltimore sent questionnaires to more than 5,000 female surgeons who were in various stages of their careers, asking them about attitudes toward pregnant surgeons. Roughly half of the women responded. A vast majority reported a significant stigma attached to being pregnant, particularly during training. While younger respondents felt significantly less stigma than those who had trained a generation or two earlier, a sizable majority of the young women — over two-thirds of them — still believed that being pregnant during training could negatively affect or even jeopardize a surgical career.

And although female surgeons tended to be more supportive of their pregnant colleagues than men, they were also capable of being just as dismissive as their male colleagues.

“There isn’t much ‘kind and gentle, warm and fuzzy’ going around,” said Dr. Patricia L. Turner, lead author, an associate professor of surgery at the University of Maryland and a director at the American College of Surgeons. “The fact was that everyone — man or woman — could be hard-core and difficult.”

While women now make up almost half of all medical school graduates, only 30 percent of surgeons-in-training are female, a discrepancy that may be related at least in part to the fact that the most intense period of surgical training, which sometimes stretches over an entire decade, correlates to a woman’s most fertile years, her 20s and 30s. “You cannot not look at the impact of such training on childbearing and career decisions,” Dr. Turner noted.

Many of the surgeons who responded to the 99-question survey inserted additional pages describing their experiences. “It was like there wasn’t enough room within the survey for them to tell their stories,” Dr. Turner said. Some respondents recalled being told outright that they would not be able to finish their training if they became pregnant. Others described watching pregnant colleagues quit under the stress.

Several respondents recounted the pressure to take off no more time than what was allotted annually for vacation. They would work right up until delivery, then return to work exactly three weeks later, fearful that an additional day off might cost them their job or reputation.

Although many women also wrote about what they deemed to be positive experiences, these were not recollections of festive baby showers and congratulatory cigars. One respondent, for example, wrote about hiding her pregnancy for several months before finally approaching the senior surgeon in charge of the residency program. His response was matter-of-fact; he would rearrange the on-call schedule and her schedule to make it possible for her to take time off to have her baby. “The fact that it was handled like a non-issue and without screaming, yelling or threatening to kick her out of the program was perceived by this surgeon as amazingly positive,” Dr. Turner said.

There have been official efforts in recent years to improve the work-life balance of surgeons-in-training. Residency programs across the country have been working to limit duty hours to no more than 80 a week; and the American Board of Surgery, the organization that defines surgical training standards, has made some of its requirements more flexible. Trainees now, for example, can apply to take up to six weeks off for maternity leave or medical reasons without penalty.

Still, it probably will not be until those in the youngest generation of surgeons become well established in their careers that significant changes will occur. “Thirty years ago, people didn’t have the words to say ‘work-life balance,’ let alone say it was a priority in their career,” Dr. Turner said. “But younger surgeons, female and male, aren’t afraid to articulate that that’s important to them.”

“We are going to have to figure out how to mesh our training with the dreams this generation has for the other parts of their lives,” Dr. Turner continued. “Especially if we still want the best people to keep going into surgery.”

Acro Yoga

My awesome friend Elena took me to an Acro-Yoga class yesterday, and it was incredible!!  I did this:

And this:

And this (minus the dreadlocks and bizarre outfit):

And this!!

I know!!  I never would have thought I could do something like that... I totally surprised myself.  And I am totally hooked.  :)  If you are a yogi, go out and find yourself an acro class immediately!

I Panicked

So.  As part of my current Ambulatory care rotation, there is also a Radiology course mixed on in, most of which we are supposed to do on our own/online, but we also have four Fridays of lectures, small groups, etc.  

This past Friday, as in two days ago, we were all assigned a radiology resident to shadow for the morning before returning to the main campus for lectures the rest of the day.  I had emailed my resident the day before, giving her a heads-up that I was coming, and when and where would she like me to meet her?  She wrote back, saying, okay, come to the Executive Park Hospital campus and I will meet you in the lobby at 8:30am.  So I wrote back, great, see you tomorrow at 8:30, and by the way, here is my phone number.

She didn't respond.

But no big deal, I had been to the Exec Park location before, so I thought I knew where I was going.  8:30.  Lobby.  Not a problem.  I even looked up "Emory Radiology" and looked up their different locations just to be sure.  Yep, same place I was thinking of.  

Ok, so Friday morning rolled around.  I drove to Executive Park and got there early, which never happens.  (It was like 3 minutes early, but whatever, it totally counts.)  I went into the lobby, and sat down to wait.  And wait.  Aaaaaand wait.  

It took a while before I started to get nervous, because residents are busy people, you know.  After I had been there for about half an hour, though, I started to worry.  What if this wasn't the right place?  45 minutes in, I was sure that it wasn't.  I was also sure that I had messed up.  Crap!!  The resident had probably waited for me in the place I was actually supposed to be, and I hadn't shown up, and I hadn't called to let her know because I didn't have her number, and I hadn't emailed because I didn't have a smart phone and basically no way to get in touch with her.  And I was definitely going to be in trouble, and I was obviously a terrible medical student.  

I went back to the parking lot to get my laptop out of my trunk and went to find a wireless location.  Signed into my email, to see if the resident had sent any message.  Nothing.  I was really sweating by now.  It was almost 10, and we were supposed to have spent close to four hours with our residents by the time we had to be back to Emory for lectures.

I finally decided that the morning was a lost cause, that I would just have to get in touch with the clerkship director and apologize, explain what had happened, and figure out a time for me to make it up.

But I also decided that I had HAD it with my inability to communicate like the rest of the medical world, and that the solution to this problem, in order to avoid ever messing up this way again, was to drive straight from Executive Park to the Verizon store.

And buy an iPhone.

I get that this was possibly not the most logical thought progression, but what can I say?  I panicked.

I even told the Verizon guy the whole story, who openly mocked me even as I handed him my credit card and paid lots and lot of money for this new phone.  "I am only doing this under duress," I told him.  "What, is there some dude in the parking lot with a knife who is threatening you to buy this phone?" he said.

When he asked me which smartphone I wanted and I answered the iPhone, he said, "Ok, now the thing about the iPhone that I have to tell you is that it is non-returnable.  Even if you change your mind about this phone five minutes after you walk out the door, it doesn't matter.  Can't bring it back."  I took a deep breath and said ok.  (Pay attention, kids, this is called foreshadowing.)

He proceeds to set the thing up for me.  I feel relief at the thought of never again being stranded without access to important email or Epocrates.  

Not five minutes after I bought the phone, but closer to ten minutes later, I was pulling into the parking deck on the main Emory campus, figuring I would be able to get a little studying in before lectures started, when I got my first-ever phone call on my brand-new phone.

It was my resident.

"Cathy??  Hi, this is Santhi!  I am SO sorry, my kid was sick this morning, and I just now got to work and realized that you were supposed to be with me and I just totally forgot to call you!!"

True story.  And when she said that, I mostly just felt enormous relief that I had been in the right place, after all, and that the miscommunication hadn't been my mistake.  A split second later, it dawned on me that I had just spent hundreds of dollars for no urgent reason whatsoever.  (Phone plus insurance = yikes.)

Of course, I immediately told a friend the story, proving yet again what a moron I am, and we both laughed so hard we were close to tears.  

I am not really at all sorry that it happened... the iPhone is really freaking cool.  Also, I can't tell you how many times a week I have felt like an idiot on the wards without a smartphone, so it will definitely make my life a lot easier.  Moral of the story is that, as a med student, you always have to assume that when something goes wrong, it is definitely your fault.  Sometimes, though, it is a really great surprise when it turns out that it's not. :)

~ ~ ~

And that, friends, is the story of how I finally got an iPhone.

"Dog"

Today, sitting on the patio at Victory Sandwich Bar, (a patio that is awesome because they let dogs sit there), and enjoying a fantastically perfect spring afternoon, my friends and I drank Jack and Coke slushies while Izzy made friends with everyone.  One of her new friends, after gushing about how cute she was, said, "She is such a perfect DOG.  She looks just like what you should see if you looked up 'dog' in the dictionary."

How to Pick a Specialty

(click on the cartoon to make it bigger)

Reflection

My preceptor for the afternoon was a female surgeon, obviously supremely competent and almost aggressively confident.  Her black pumps came to a sharp point at her toes and her black hair was pulled back into a no-nonsense ponytail.  As the medical student assigned to her for the day, and on only my third day of rotations, no less, I sensed right away that I could only hope to stay out of her way and not piss her off, at best.  But I needn’t have worried; she hardly seemed to register that I was even there.  This made for as close to the ideal fly-on-the-wall observation opportunity as I was likely to ever have. 

~ ~ ~

The patient was a gentleman who came in with his wife.  They were an extremely gracious, polite, and terrified-looking middle-aged couple.  The wife was slim and fragile; she wore a form-fitting, animal print sweater on top of slim-cut black pants.  Her jewelry looked heavy and expensive.  Her makeup was just slightly too enthusiastically applied; her heavy black eyeliner made her large eyes stand out even more, and meticulously applied lipstick tried hard to make her thin lips look fuller than they were.  He was soft-spoken and nervous, although he seemed like the kind of person who would not naturally experience nervousness often.  His impeccably ironed button-down was tucked into blue jeans that fell to spit-shined loafers and his thinning hair was parted deeply to the side and carefully combed.

The surgeon introduced herself, and the wife spoke first.  Her words rushed over each other.

“Thank you so much for seeing us, we are so glad to meet you.  We just have so many questions for you.  I have been doing some research online…” and she pulled out a stack of articles she’d printed off, all manner of information from all manner of sources that likely ran the gamut from reputable and reliable to the opposite of reputable and reliable.  She’d read everything she could find about her husband’s thyroid cancer.  She was as familiar with the basics of different treatment options as she was with the horror stories – the worst outcomes conceivable, both actual and imagined.  Her hands fluttered as she spoke, flipping through the deep pile.

The surgeon all but rolled her eyes as she opened the patient’s chart on the computer in the room.

“Alright, when do you want to schedule the surgery?”

“So, will you be the one doing the surgery?” the wife asked.  The surgeon nodded over her shoulder, saying yes without glancing up from the chart. 

“Oh, we have just been so worried ever since his biopsy came back positive.  We aren’t sleeping, we aren’t eating… it’s been two weeks, and both of us are losing weight…” the wife’s brow wrinkled and the already-red rims of her eyes now brimmed as she exchanged glances with her husband.

The surgeon spun around.

“What are you worried about?”  The question did not sound kind.

The patient and his wife both stopped, taken aback.  They looked at each other and then at her, expressions bewildered.  “Well…” he started, and paused for breath.

“It’s cancer, right?” his wife said, her voice betraying her confusion.

“Yeah, and we just take it out, and it’s fine,” the surgeon made no effort to slow down or modulate the tone of her voice, to accommodate for the fact that her patient and his wife had misunderstood the nature of his disease, to allay their worst fears or take the time to provide reassurance.

Such was the couple’s relief upon hearing for the first time that they didn’t need to worry and that everything would be alright that not even the surgeon’s bungled delivery could overshadow it.  She hardly spent five minutes with them, making sure to get consent for the surgery and a date agreed upon.  They both thanked her profusely as she shook their hands cursorily and walked out; they even thanked me, the silent bystander, smiling gratefully, tears in their eyes.

~ ~ ~

As I watched this scene unfold, cringing inwardly and feeling badly for this sweet couple and the brusque treatment they received at the hands of their surgeon during a very distressing time, I realized something else: it was entirely possible that the surgeon did not even realize what was going on. 

There was no extra reassurance that everything would, in fact, be all right.  There was no recognition that getting a positive biopsy report must have worried them, no validation that the word “cancer” carries frightening implications.  No comforting after what had obviously been a harrowing two weeks.

It might have been that the surgeon had had a bad day, or week, or year; doctors are human, after all.  It might have been that the surgeon did realize that this couple had simply not been well informed and that, for whatever reason, she just didn’t have the time or the patience or the emotional reserves to treat the case with the care it deserved.

But it might have been that she wasn’t just refusing to gently explain to her patient and his wife that the cancer was not life-threatening, that it was totally curable, but that they had been rightfully distraught by a scary-sounding diagnosis.  Indeed, it might have been that she noticed none of the subtext.

In the end, I am not sure that the reason matters.  It was a missed opportunity to really connect with and care for her patient.  She will no doubt be able to remove his cancer and help him make a full recovery.  But she will not play any part in his healing.

~ ~ ~

Easier said than done.  A truism in most circumstances, and I will humbly admit that it is almost certainly truer in this situation than many others.  Without a doubt, my current vantage point makes it much easier to see patient interactions with greater perspective.

In these first few weeks of clinical rotations, I have often made mental notes to myself regarding physician behavior.  Some of those notes have read like this: remember this!  DO THIS when you have patients of your own!  And some of them go something like this: do not EVER treat a patient this way.  Oh, and try not to let anyone else around you treat patients this way, either.

Hopefully, these observations will become valuable lessons.  Because if I don’t learn them, then my time and purpose in going to medical school will truly have been wasted, and the reasons will have nothing to do with whether or not I will be able to cure my patients’ medical ailments.

Housewares Fantasy Time

And the randomness this week continues.  Sorry, folks, the inspiration/energy to actually write or share anything interesting/meaningful has been lacking.  So instead, here are some more pictures! 

These are from a fun open house/open bar event a few weeks ago at Paris on Ponce.  It's sort of like an upscale flea market; they have tons of awesome stuff at tons of different booths, all housed in a big giant warehouse.  Sooo many gorgeous and totally unaffordable things, and so much fun to walk around and drool over/covet things for my future hypothetical home.  (Kinda like a real-life Pinterest!)

Ok, not housewares. But a really cool/weird paper dress and wig on a mannequin.

One of my small purchases! LOVE these.

Glowing goblets.

Love the colors and the geometric patterns on these throw pillows.

Bright happy colors. :)

Whimsical mini-terrariums.

I actually went back to buy this piece a week later, and it was (obviously) gone... sort of heartbreaking.

Eyeball!  For any future ophthalmologists out there...

Another purchase - antique pyrex bowls.

If I had [any] money, I could spend a lot of it in this place.  Maybe someday...

Random Monday Cuteness

...brought to you tonight by Izzy.

I realize that I *might* be sightly biased, but seriously, if there were such a thing as the Gerber baby of dogs, it would definitely be this pup.  Or at least the Baby Gap model of dogs, what with being a mutt and all.  ;)

My Sister

... is totally hilarious and really cute.  Go check out her blog!

Who, Me?

Oh, nothin'...  

Just hanging out on a Friday night -- a post-test Friday night -- by myself... cleaning, organizing, doing laundry, crafting a little, listening to old episodes of This American Life.

So exciting you can hardly stand it, I know.

What are you up to tonight?

I Am Not Ashamed

I will freely admit it: I LOVE Flo Rida.  

What??!  I don't even care.  I defy you to not want to get up and dance to any one of his songs--it is physically impossible not to.  This one is also my new go-to running song, and it's awesome.  You should try it.

Speaking of things you should try, OMG ROOSTER COOKIES.  I am seriously obsessed.  They are crazy-good, and I have no doubt they are also crazy-bad, if you know what I mean.  Apparently, according to their website, each cookie is almost half a pound.  I don't know why I am surprised by that... they have become my little (but actually really not little at all) treat recently, and I have been "treating" myself more and more often.  They might be the best cookies I have ever had... the chocolate chips are always a little melty-soft, the dough is slightly salty and crumbly, they are shaped like scoops of ice cream... I can't really explain or do justice to them here, but it's almost like they are too intense or something.  I mean, obviously not too intense for me not to eat entire half-pound cookies in the span of about three minutes at least two to three times a week, though.

There are a few different places to buy them around Atlanta, if you are local, or you can order them online if you are not.  Yep, they cost $2.50 a pop.  And they are SO WORTH IT.