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MY BIRTHDAY:
I was born on December 28th and this past birthday I got a particularly special little treat: Josue. I get called down from rounding on my post-partum patients to see a newly arrived patient in triage who may be in labor. She's quite uncomfortable, speaks English with a Creole accent, and has had 1 other child. I examine her in triage and she is at 6cm, so she has 4 whole centimeters to go before she can begin attempting to push this kid out. So I declare her an admission and she is rolled to one of the labor rooms. I begin writing up all of her paperwork, including her orders and medical history, when one of the nurses yells "Dr. Torres, you need to check her again. She's REALLY uncomfortable." In my line of work interruptions are standard, but I was kind of annoyed at this interruption because I had checked her literally 20 minutes before and I knew she couldn't have reached 10 cm THAT fast. So I go into the room and, yes, she's writhing in the bed (also common in my line of work), so I put my glove on (only one because that's all you need to check a cervix) and as I ask her to let her legs relax to the sides, I see an infant's head coming out of her vagina! I cry out, "She's delivering! Get the attending! Break the bed!" and I deliver the baby with one glove on and one glove off... I asked the patient to please let the next doctor know during her labor that she tends to go FAST. Josue was the first baby I ever delivered on my birthday, I'm sure I'll never forget it. (On a side note, later that day I admitted a woman with my same last name and she was scheduled for a C-section, but I didn't get to be in on that delivery-- it would have been neat to deliver a child with my same surname on my birthday.)
MISC:
So I'm in triage and a woman comes in who is 24 years old and this is her 5th pregnancy, she has 4 children at home. She is accompanied by the father of her baby (FOB, as we say in the biz) and she's come to us fearing she's in labor too early. I rule her out for pre-term labor and, as is my custom, I complete my time with her by asking if there are any questions. She shakes her head but the Peanut Gallery in the corner pipes up and asks: "When can she get her tubes tied?" As my blood boils it takes every bit of will and strength in me not to smack this guy upside the head and tell him he's an arse, I decide to instead reply: "You realize you can actually get YOUR tubes tied, right?" He looked at me as if I had just proposed we chop off his willie. (Which I'm also certified to do, at least the foreskin.) He vigorously shook his head and said, "No way, no way am I doin' that!" Mind you not only did he ask when his baby momma could get her tubes tied but he also had just clearly explained to me that they did not want anymore children... However having his "tubes tied" was not going to work for that plan. So I explained that a vasectomy was much easier than a tubal ligation, that it's a matter of a doctor's visit for a man while a woman must undergo surgery in an operating room. As I'm explaining this, the woman is looking at me like, "wow, I had no idea!" and the guy is looking at me like, "Lady, you're wacked out of your mind if you think a knife is getting anywhere near my twig and berries!" At any rate, I think I at least educated the woman that birth control is not always only her responsibility, especially when it comes to permanent sterilization. (Keep in mind my reaction would have been quite different had SHE been the one asking about HER OWN tubal ligation.)
MORE STORIES TO COME THIS WEEK AS I AM O
We are now on two weeks of call schedule so that we can all have some holiday time to visit our families. I know I am MUCH looking forward to heading to FL to visit my parents over New Year's. This past weekend I went to New York City and tore up the town, which was fun and a much needed release. I will try to keep up with more stories, it's been tough because of the exhaustion catching up to me. In fact, this morning, after 8.5 hrs of sleep I STILL didn't want to get out of bed. My alarm went off and I thought, "Oh for the love of all that is holy..." I haven't had an alarm wake me up after 8 hrs of sleep since I was a teenager. However, as a result I was able to go to the DMV of Pennsylvania and make myself an official PA citizen... Maybe now they'll give me some heat in my apartment!
A young woman came into triage and from what I could tell she was in the middle-ish of her pregnancy. The RN tells me she has had no prenatal care such that I am hoping she had at least peed on a stick at one point. I start the interview and she says she's had some cramping, a common complaint in the Land of Triage. I ask her when her due date is, she doesn't know, I ask her when her last period was, she thinks it was March, maybe... Tough one. I then ask her why she hasn't seen a doctor yet and she tells me that she plans to give the baby up for adoption anyway so she didn't need prenatal care. Too much faulty logic in that statement to address, but you get the idea. Then she asks if we can induce her labor today so she could leave the baby here with our social worker... I'll admit, I'm thrown for a bit of a loop here because I can clearly see she is not full-term and then there's the question of my not being familiar with the plan of someone just "leaving a baby here for the social worker." But I'm new, so who knows... I tell her I have to figure out how far along she is first, then we can go from there. So I get the ultrasound and scan her belly, taking measurements of the fetus inside: length of the femur (thigh bone), circumference of the abdomen and head circumference and my calculations tell me she is about 27 weeks, or 7 months. At this news she starts to cry and I wonder what's wrong... Apparently she thought she could come in, have her labor induced and she could just have the baby and leave it at the hospital and finally be done being pregnant. Um, this is not how it works. We try and prevent women from going into labor at 7 months, much less induce them. I get the feeling that not only was this pregnancy not planned, but perhaps she found out late and couldn't get an abortion or maybe she doesn't believe in abortions and still did not want to raise this child so she was planning on just leaving it wherever she delivered. Needless to say she was distraught for many reasons I could not begin to understand because I had no idea what plan she had in her head or what ideas of pregnancy and giving birth she had. Mind you, she had had two previous children, so I know this process is not new to her, adding to my perplexed state. I try to sympathize and explain that even though she could not be delivered today because it was not safe for her or the baby, she should still seek prenatal care if only for the sake of her own health given all the tolls pregnancy can and does take on a woman's body. She said she would and she left teary-eyed but hopefully reassured. I don't know. The things I see and people I meet get stranger and stranger and just when I think I've heard it all, something like this comes along. When I told my 2nd yr resident about this patient she said, "Yeah, not surprised. You'll only see more of that, it doesn't even phase me anymore." But I want to be phased, I don't want to lose the shock of something like that because then I think you lose the ability to reach out to that person as well as the desire to help them. My point is I will see more of these things, but I want to be equally affected by them, not accustomed to them or "not phased" by them.
However, I live in the MICU now... more fun details on that to come.
Most days this week and last I have been so busy that I didn't get to each lunch any sooner than 9PM (yeah, when I was home.) I would have the floor nurses paging me about post-partum patients having fevers that I needed to assess but as I was in triage taking care of about a truckload of pregnant women who called each other and thought it would be fun to go into the hospital all at the same time, I couldn't get out of triage to see what might be the cause of said fevers. Meanwhile, my two seniors were in the main delivery room taking care of all 9 laboring women (no more beds than that), doing deliveries, doing C-sections, and running around like crazy people themselves. It has been sort of like one of those anxiety nightmares people have where you're the only clerk in the entire department store and everyone wants to make their purchases and get their returns refunded and problems fixed and appropriate sizes for the dressing room and all of a sudden a mob of angry customers is coming at you like a wave of fury, in which you ultimately drown and wake up in a pool of cold sweat. Yeah, it's been a lot like nightmares and pools of cold sweat. No one is meant to take care of as many people as each of us three residents were responsible for (I alone was responsible for 4 people in triage, the line of women waiting outside of it, and 30 people up in hospital beds on the inpatient floors.)
So how've you been?
The other night I had my first delivery flying solo: it was not the most pleasant experience, but I delivered the baby all by myself! I say it wasn't the most pleasant because this woman was screaming and groaning and not listening to instructions and the room was just filled with the air of insanity. She was going to push that baby out of her even if it meant busting her cervix wide open. Uncontrolled childbirth like that is dangerous, though she was luckily a >1 time mom and had no tears (as in "to tear a cloth") after the delivery. I was very flustered during the whole thing because she just wouldn't listen and yelled and screamed a lot. So much for epidurals. The night before last I delivered my second baby all by my lonesome and it was an 18 yr old who already had a 1 yr old at home but she kept screaming " I can't! I can't!" and she wouldn't push. Of course, I've heard women scream that before, but this woman really didn't WANT to push, as though staying in that state of baby's head in her vagina forever was a more pleasant option. Finally, after taking quite a stern tone of voice with her, she pushed and delivered her child. Now what amazed me most was not only the fact that she already had another child at home, but that her friend that was with her, who looked to be no more than 15, also had an 8-month old at home. These two girl-women were well on their way to having a full family, yet no life partner in sight and SOOOOO young!! It really amazes me every time I see it, and I seem to see it a lot where I'm working.
I think one of the other highlights of my month also happened this week when I rounded on a patient Friday morning. She was holding her newborn daughter and even though I had only asked, "And how's baby?", she went on and on about the child's feeding schedule for the past 24-hours in great detail. Then came the part when I asked about what kind of birth control she would like and she turned to me and said, "Oh that won't be necessary, this isn't going to happen again." Of course this isn't the first time I've heard a patient of mine say this and I am thinking, "Right, and in 9 months you'll be right back here," so I say to her: "I understand but even so you could still get pregnant even in these next few months and..." but she cut me off. She told me, "No, it really won't happen again," and as she's holding her newborn daughter and smiling at her she says, "See, sex before marriage is against my religion and I've learned my lesson." I think my jaw may have hit the floor at that point. Trying not to judge (and it's quite difficult sometimes) I tell her, "I can understand and respect that, but even so it is possible to be on birth control and still hold to your beliefs, if for no other reason that you are covered just in case..." But she did not want to hear any of it. Obviously I can't force birth control on anyone but I couldn't help walking out of that room thinking I had failed her in some way. I mean, there she was, holding her baby, telling me that she did not believe in sex before marriage and therefore did not want birth control... I have a hard time wrapping my head around something like that.
On a more positive note, I went kayaking today!! Yep, who knew that beyond the borders of Philadelphia you could actually do fun outdoorsy things! And next month we will be taking excursions apple/pumpkin-picking and horseback riding! These are things that are important if I am to keep my sanity.
Ugh, back to waking up at 4:30AM... but this time I may (or may not) have a better idea of what I'm doing.
So I'm constantly tired and the constant drill of working and sleeping and not doing anything else is starting to get to me. I think it's mainly the night schedule because I don't sleep much during the day. I try to get 6 hours, but it is usually interrupted by me waking up disoriented at 2PM thinking I'm late for work and didn't set my alarm, except these days my alarm is set for 4PM. I'm still shopping at CVS, but I branched out to the little 'Mom n Pop' store down the street for expensive poor quality bread and milk. The 1 or 2 hours I have awake must be spent showering or unwinding, no time for shopping or cooking. In my refrigerator there is said milk and bread, as well as left over rice, a red pepper that is surely spoiled, two containers of half-and-half cuz I can't be bothered to throw out the older one, and some thawed chicken that I hope to cook tomorrow. Oh yeah, and my standard PB&J. That's it. A fully-stocked frat guy fridge. Though I've been getting my vegetables at work -- corn that has been crushed and flattened and fried and topped with salt. This morning I was supposed to clean my apartment, but that's not going to happen either. In fact, my brain is shutting down, I must excuse myself.
So in the span of a week I have missed a GBS diagnosis, let a patient labor in triage in breech presentation, forgot to ask a C-section if she wanted a tubal and thus consent her for it (all that was missing in the end was documentation on the consent form, but still), and then didn't complete the orders for that admission which looked bad in front of my chief. I can't go into what all that stuff means, but it makes me look pretty incompetent and I've been beating myself up all week/weekend. I just hope somehow I'm able to shine tonight because I need something to go right for me and fast before I sink any further in the quicksand. My confidence is shattered and usually I'm pretty good about putting the pieces back together, but how do you take sawdust and remake the tree it once was?
More to come...
I finished medical school, that is completed my final rotation, earlier than most of my colleagues -- a week before Match. I wish I could say I finished happily, but nothing could be further from the truth. Essentially my last week was full of tension on my team, tension that ruptured my spirits on my last day when my intern threatened to have our senior resident fail me. They were lovely my final days of medical school! I was on my sub-internship where my responsibility was to perform at the level of an intern, since that is what I would be in a few months. The first three weeks went splendidly and our senior resident loved us ("us" being a fellow 4th year med student, also a dear friend of mine). He commended us on our progression through the rotation and then gave us the most gratifying compliment ever: he trusted us to manage patients on our own. (That's huge when you feel you know nothing.) We never anticipated the turn of events that occurred when our senior switched rotations (as scheduled) and we were working with a new senior for our last week. All I can say is that my fellow Sub-I and I soon learned that our new senior could not multi-task. As a result, a patient stayed an extra day in the hospital unnecessarily, our 2 interns had to do double the already heavy workload and they became angry with us because of it. We had done our work but our senior had failed to sign off on it, which meant the interns had to do it, and they took their anger of the extra work out on us. "S*** runs downhill" so the saying goes in medical hierarchy. So when my intern called me while I was waiting for my train to head out of town for my first weekend of freedom to tell me that if I didn't come back to admit new patients for the next two hours that she would have our previous senior fail me, a surge of a whole bunch of different feelings (most of them unpleasant) ripped through me. Needless to say my last day of medical school left me with a bitter sweet taste in my mouth.
With medical school rotations done and Match Day over, all there is left to do is graduate. Given that I had almost two months between Match Day and Commencement, and considering this would be the longest stint of free time I'd have until retirement (that is if I can pay off my debt), I traveled as much as my meager funds and credit cards would let me! First stop: Spain, specifically Sevilla for the Feria de Abril. Next stop: Cancun for a week of luxury at an all inclusive resort with my oldest and best friend. As we all know, what happens in Cancun stays in Cancun. Three days after my return I graduated!!! Among the stars who made it for the occasion: my grandma, my aunt Cheryl, my childhood babysitter and her son, and my childhood friends from Traverse City! (I appreciated everyone's effort to be there, of course!) Then the day after I graduated, the boiler on the roof of my building flooded and damaged the walls and hardwood floors of my condo! YEAH! I got to be homeless for a month and a half before I moved to an entirely new city! All the vacation time I took to de-stress... null and void. I can't even get into the chaos that was my life at that time, but I made it to Philadelphia, though not all of my belongings did, and I had a LOT of help from the bestest mom in the whole world in settling into my new city.
End dictation. For full details of patient's hospital stay please see the chart in medical records. This is Dr. Torres completing dictation for medical record number 9999999.
My next rotation is Night Float, which starts Sunday evening. That's basically the chaos I was dealing with last month, but during the nights this time. In theory, it's not supposed to be as chaotic, but we'll see about that. I anticipate spending a lot of time in triage, just like I do when I'm on call, and then a lot of rounding in the morning before morning report, only this time it will be at the END of my shift instead of at the beginning. All of the responsibilities are the same. I have yet to unpack boxes that are sitting in my hallway, and if that can be done before another month of constant fatigue begins, that would be spectacular! I still have my living room all a mess with papers strewn about, and I thought I would get them organized a bit this evening, but no. I was busy doing dishes, making dinner, opening new mail (to add to the present mess), and paying my bills. It's amazing how much harder paying bills becomes when you have an actual income, not sure how that works. Today someone told me that plumbers make more than doctors -- yeah, that was comforting. Not that pay should be based on level of education, but I DID go to school for a REALLY LONG TIME and worked REALLY HARD to get where I am! One of the residents told me that we get paid about $2 per patient... Uh huh, yep, it's all worth it! (I've had a glass of wine this evening, I'm sure that's what's talking right now.)
This weekend's goals: renew my driver's license, clean my apartment, hang up wall things, unpack from my recent vacation (oh yeah, forgot to mention I'm tripping over my suitcase in my bedroom still), and go out and have some fun at some point as long as I don't have to spend money... oh yeah, and go to the gym, if I can remember where it is.
I'm going to trot off to bed now, lay there reading some medicine stuff then read some fun Women's Health magazine stuff, then drift off to sleep and have lovely dreams about the hot guy I'm going to meet at some point here in Philadelphia... Hey, even over-worked residents have needs.
I'm having a hard time accepting the fact that I have to go back to Philadelphia. It really has felt like I'm home from having been on an away rotation. I guess I just need to jump back in the water without even thinking about it. What else makes it a bit trying is the fact that I'm still not fully unpacked/settled as well as that my apartment is a mess with piles of papers laying everywhere. I'm usually so tired and cramped for time that I can't address and take care of all the little loose ends that I still have from the move. The very thought makes me tighten up my back muscles, and I just got a massage to try to fix that! I really wouldn't be surprised if 4 years from now I had a lot less packing to do cuz I just never got everything UNpacked. I was going to tackle this when I got back on Sunday, but now something ELSE has come up that needs my immediate attention and, once again, this will just have to wait...
At least I still have time left to enjoy Chicago!!! Home, sweet home!
I'm very much enjoying my time off... no obligations, just doing whatever I feel like doing day-by-day. These days I feel like doing a whole lot of nothing, which is nice. I'm meeting up with people this weekend before I'm dragged back to Philadelphia Sunday morning. Ah well, at least I'll have some time to mourn Chicago and organize some things in my apartment before returning back to work Monday. I've been telling my cousins here how much I feel like I'm merely on an away rotation in Philly, which is true. I'm in a bit of denial about actually living there and beginning a new life there, can't imagine why! It's hard being in a new city, not knowing where to find things, not having people to explore the city with, etc etc. I'm sure if I just give it a bit more time, say 3.5 years, I'll get used to it and it won't be so bad. =)
Off to my massage appointment that I so desperately need and that I meant to get before I left for vacation, but alas, time did not allow for such luxuries. With as tight as my entire back is from stress, I think massages on a regular basis may be necessary in order to prevent injury! Darn...
Vacation, had to get away! I can hardly believe it myself, but they actually let me escape from their clutches! I’m travelling the country and so far I’ve been in a wedding in Washington state, toured the love Pike Place Market in Seattle, and now I’m in sweet home Chicago. I plan on taking this time to sit back, relax, and catch up on pieces of my life that have passed me by… certain loose ends I still need to tie, if you will. Like acquire renter’s insurance, for one thing (I think I finally appreciate how important insurance really is), as well as complete certain educational tasks my residency program has piled upon me. As if I had nothing else to do… I would LOVE to go to the beach while I’m home!!!
A few words thus far regarding residency: it’s still hard. And although I feel like I’m getting more and more into the groove of things, I’m still as green as Elfaba and it’s a fine balance to exert myself when I think I know what I’m talking about and play it cool when someone with less authority but more experience contradicts my thinking. It’s only around this time that I am really feeling less like a glorified medical student and more like a doctor that is actually responsible for people’s care and well-being. It’s a good thing, but the feelings of self confidence and overall adeptness become muddled when nurses, for example, contradict what I want to do for patients. Let me just say that I only have a couple of examples of me butting heads with any nurse and overall they and I are getting along famously. Afterall, I have a lot of respect for nurses given that my mom is a nurse and given that they have indeed ‘been in the biz’ quite a number of years more than I have, usually. There is a difference between nursing school and medical school, however, and sometimes it’s hard for me to remember that when discussing a patient’s care with someone who has been taking care of patients before I was ever a twinkle in anyone’s anything. Without further delay, here’s the story. For those of you who know me, you can appreciate my passion for health, well-being, and birth control. Try to imagine my dismay when one of my post-partum patients went home without birth control because a nurse essentially talked her out of it. First of all, in the post-partum period there are very limited options for women to use for birth control. The only sure way is abstinence (and we all know that's just not natural), then you have condoms (which have been known to fail every now and then), then you have birth control pills but not the combined pills, rather the progesterone-only pills that you have to take at the exact same time every day. There can be a bit of a compliance issue there. One other option is the Depo-Provera shot because it, too, contains only progesterone. We want to avoid adding any more estrogen to a woman's body in the post-partum period as it is due to its properties of blood clotting as well as the fact that a woman's hormones are already out of whack and trying to re-balance themselves as is. All in all, there are only two effective birth control options a woman can go home with after having a baby: the progesterone-only pill or the Depo shot. It was once thought that the Depo shot inhibited milk production by a breast-feeding woman, however research has shown that this is not the case. In fact, it's been shown to promote lactation (a good thing for breast-feeding women.) Unfortunately, on this fateful day my breast-feeding patient had the misfortune of being cared for by a nurse who subscribed to an older school of thinking. Essentially what happened was the nurse vehemently told me that she would not give a Depo shot to a breast-feeding woman because it inhibited milk production. I asked her to please do so anyway since that was the order written by another doctor and I felt the order was appropriate. The nurse responded by saying she would tell the patient it was not the best option for her and if the patient refused the shot, she wouldn't give it anyway. Ultimately the nurse told me, "I talked to the patient and she refused the shot so I'm not giving it to her." Well that's just great. Hey, how about if we doctors write down orders for medicines and you nurses just decide which ones you want to give and which ones you don't?! Well, I was obviously irked by this but silly me decided that the veteran nurse may know more than I do on this matter and fighting with her would accomplish nothing anyway, so the patient went home without birth control. However, I never "D/C'd" ("discontinued") the order so it was actually still a standing order. The nurse never documented anything regarding the discussion she had with the patient or the patient's refusal to accept the medication, so all the records show is that an order for a medication was written and it was never administered. NOT the best example of patient care. I went to my senior attending, the big boss of the program and he was none-too-pleased with what transpired, thanking me for coming forward with the matter. We both agreed the best way to proceed would be to provide educational nursing material to clarify this issue as opposed to disciplinary action by some administrative board because, really, she is a good nurse and a good team member. I have since switched rotations but I wonder if this nurse is still not giving the Depo shot to patients who are breast-feeding, despite what the literature says. I felt so caught between what I knew to be right and what I also knew to be the value of many years of experience that some possess and I clearly do not.
When in doubt, educate and be educated.
More meanderings to come...
So I'm excited about my new Peds friends! Lina and I are together in the NICU and she invited me out with another of her Peds friends and a Medicine intern friend of theirs. Lina is from Peru, Felipe is from Ecuador, and Ricardo is from Venezuela, so of course most of the night was spent speaking Spanish. I was SO ITCHING just to get out I didn't even care I only slept for 2 hours that night!! All work and no play makes Leah a crazy person, to be perfectly honest.
OK, wanted to write more, but gotta get to bed.... Despite what I said above, I actually love sleep.
Now comes the part where I contradict myself: I did something AMAZING today! I performed my first lumbar puncture (spinal tap) ever in my life on a patient that was only 26 weeks older than a sperm and an egg!!! My senior resident talked me through it, but I did it!!!!!!!!!! And it was a clean tap!!! That means there was no blood contamination, quite a difficult achievement in a squirming infant!!!!!! I impressed the socks off of my residents, it was spectacular!!!!! OB/Gyn intern rockin' the NICU!!!! My senior told me I had to bring in champagne for my 'champagne tap,' since it was the nice, clear liquid that cerebral spinal fluid is supposed to be. I doubt she was serious about the champagne, but she did stress sparkling grape juice quite a bit. I'll see if CVS is open when I leave in the morning... Not sure how impressed my OB/Gyn colleagues or attendings would be, but I am STOKED I had this opportunity and succeeded with flying colors!
Went grocery shopping at CVS again. Tomorrow I'll make the trek to Trader Joe's, today I just didn't have it in me. I had hoped to do a lot of decorating today, but I just can't seem to commit on where I want to hang everything. The things I do know where I want to hang are heavier than I want to deal with all by myself. Again, will need to recruit one of my local XY chromosomer friends to help out.
I've had time to reflect on my recent residency experiences and I gotta say, I've come a long way in just one month! I'm a bit sad that I've had to spend so much time away from L&D managing post partum patients and circumsizing wee wees that I didn't get as much baby-delivering in as I would have liked. I also didn't get as much O.R. time or training as I had hoped for. I am feeling more and more comfortable in my own "doctor" skin though, which is nice.
This past week I ran into a bit of a snaffoo with one of the nurses on the post partum floor and I had cause to notify the head honcho attending Dr. Beckmann (author of the main textbook for medical students doing their OB/Gyn rotation, I might add.) One of the patients had been prescribed a Depo Provera shot for birth control before she was to be discharged home and the nurse did not fulfill the order. In fact, she talked the patient OUT of having the shot entirely, then told me the patient refused the shot and therefore she wasn't going to administer it. OK, fine, but there's a few problems here... First, the order was never D/C'd ("discontinued") and the nurse never documented that the patient refused the shot. Second, she decided that since she had been doing this work for >20 years that she knew what was best for the patient, which I don't disagree with. I DO, however, disagree with basing your treatment of patients on anything less than scientific evidence. You see, she is under the impression from lactation consultants that Depo Provera reduces a woman's ability to breast feed her newborn. This, in fact, is not the case. She has it so stuck in her head, however, that no matter what evidence I bring forward, she's convinced she's right and she knows best. Let's keep one thing in mind that's very important: I do not for one second, at least not at this juncture in my career, presume to know more than the RN's who have been doing this for decades. But if I have research-based information that conflicts with an older way of thinking, I would appreciate an open-mind and for someone to hear me out. In the end, a written order was not executed by the nurse and my patient went home without birth control. This is unacceptable. Dr. Beckmann is going to have a chat with her, I suppose, but not in an administrative manner but rather in a "we're on the same team, let's do what's best for our patients" manner. I couldn't agree more and that is indeed how I tried to communicate with her, but she sees me as young, naive, and inexperienced. So I'm anxious to see where this goes and what comes of this. (As an aside, there are really only two forms of birth control we can give to women who have just had a baby, whether or not they're breast feeding: the Depo shot or the progesterone-only Mini Pill, which is a pill you have to take at exactly the same time every day. You can imagine this is not my preferred method of birth control to send young women with busy lives and a newborn home with.)
Things I have learned so far: If you screw up, don't make excuses but rather admit being wrong and put forth suggestions for how you will act differently in the future; don't piss off your chief; don't piss off your attendings; don't piss off the nursing staff (been able to avoid that so far); don't eat too much of the cafeteria food; DO thank your colleagues (that includes medical students); DO ask for help without reservation; have confidence in yourself -- you're probably on the right track.
My goals for this next month are: to read more, to practice surgery techniques more, to read more, to exercise more, to go out and have fun more. I think I will accomplish all of the above and more. *grin* Indeed, I will be treating myself to a full body massage at some point this week, as well as a mani-pedi sometime next week!
I'm off to take a bath now.... ah.....
They called my name in the fourth or fifth batch, my cue to step up to the front of the ballroom and retrieve the envelope that held my destiny for the next four years of my life. I had already had a mimosa to ring in Match Day so I walked up with confidence, feeling that I already knew what the piece of paper inside would tell me. As I opened the envelope and read what the NRMP so magically spat out for me, I learned the true meaning of "dumb struck." I would be spending the next four years of my life NOT in Chicago where my family, friends and my cozy home resided, but rather in Philadelphia, the City of Brotherly Love, also the city where no one I knew lived. An eternity passed before I was able to look up from that sheet of paper and see the microphone on the stage before me where I was to announce to the world my "overjoyment" of matching residency. I needed to do this quickly, like ripping off a Band-Aid. In a fog I walked up to the microphone and said, "Albert Einstein, Philadelphia, OB/Gyn," or at least I think that's what I said. It was all a blur, which I'm sure had nothing to do with the glass of merlot I was working on back at our table. I walked down from the stage into a group of my colleagues and mentors, all congratulating me and so excited for me and all I could do was smile, say thank you, and hurry back to my seat before the tears started to flow. Four years of medical school, not counting the 3 years of applying to get in, I had worked so hard through and now not only did I not match in Chicago but I get my 7th pick?! Inconceivable! The only positive side to this was that I was not doomed to my 8th and final program on my list. The walls were closing in around me and only by fixing my gaze on my cousin back at our table was I able to find my way there. I plopped down next to him but before I could even get out "I'm going to Philly" the tears welled up and it was all over. There would be no composure, no graceful acceptance of my fate. No, I was officially a wreck. I called my parents with the news-- they were surprised but very supportive and excited for me. I didn't see why. At this point the only thing to be done, really, was to continue taking advantage of the open bar. Over two thirds of my colleagues had yet to learn of their own fates, and as they yelled and cheered into the microphone one by one I felt like the only kid at the party that didn't get a cupcake. My closest friends all got within their top 3, so what was wrong with me? Why was I the deficient M4? I should mention that even if you do end up with one of your top 3 picks, that doesn't mean you're happy with where you end up. The Match is a mysterious, and often cruel, entity. Applicants submit a "rank list," a list of programs ranked in order of preferance, while specialty programs submit a list of applicant they would like to train for the next 'x' number of years. All of this information goes into a computer and on the third Thursday of March every year it spits out the results of its complicated algorithm and M4's across the nation are told where they will be training. If you don't like it, too bad. It's a lot like 'the draft' that way: you do not pass Go, you do not collect $200, you do not get another option. The other up shot of my fate, besides not being my last choice, was that I didn't have to "scramble." That's an entirely different process where if you do not Match, you have to run around trying to find a program that didn't fill all of its spots to take you in for your first year as a resident, and there's a good chance it won't be in the specialty you want to train in. (I didn't want to scramble which is why my last choice even ended up on the list -- it would have been better to match there than to scramble.)
The rest of Match Day was spent with friends drinking and regaling in who was going where and for what. I think at some point I was at a bowling alley, it's all a little fuzzy. By the end of the night, however, I was actually able to tell people where I was going for residency without beginning to cry -- a significant achievement considering how my day began. I should emphasize that it wasn't starting a new life in Philadelphia that jarred my system, but rather it was leaving my life in Chicago that had me so upset. I had to pick up and leave my family and friends -- an established support system that is so essential to journeys through medical school and residency. I had to leave my beautiful 2BR condo, a place I owned (with help from my parents) and that finally didn't feel like living in a dorm. I was also leaving a glorious and familiar city; residency is hard enough without having to navigate unfamiliar territory as well. Now I'm staring down the barrel of having to find someone to sublease my condo (the horror of a stranger living in my home!), finding a suitable place to live in Philadelphia that bears the absolute minimal resemblance to squalor as possible, and having to do all the packing and unpacking and loading and unloading that comes with the moving process. At least I know I'll be hiring movers: the days of carrying furniture up and down stairs are gone... I'm too old for this.
That wraps up Part One of my reminiscing... more to come....
Good night and fair thee well!
P.S.- a man approached me on the subway this evening saying, "Do you remember me?" Of course, I'm thinking, "Nice line and you're a bit too old for me, but thanks anyway," although I say, "You look familiar..." He says, "From the hospital," (I'm still perplexed) "You helped deliver my wife." I was so touched he was so happy to see me and approached me! He was very thankful for my caring for his wife and asked me some questions about neonatal jaundice that I happily explained. He and his wife are French and I guess there was a language barrier issue when they asked the pediatricians. It was touching to be approached by an almost complete stranger who was so thankful that, according to me, I was doing my job.
P.P.S- not sure why I put "P.S."... or subsequently "P.P.S."
