Hurricane Jill

Everything’s better with a soundtrack

Yay! I finally got my iPod shuffle today. I had a huge list of cool electronic gadgets I wanted to buy with my pharmacist paycheck. But in the end I only got the iPod shuffle. And the only reason I could justify that was because my other iPod is too heavy to run with.

So now that I have it, and all my previous running injuries seem to have resolved, I can get started running again.

Because you really do feel great after a run, in a way that no other aerobic activity can match.

A sorry excuse

Yo, cold front!! What’s up with the D-minus attempt at snow? If you’re gonna snow, do it like you mean it.

Also, coming up in about two weeks: the Rank List Extravaganza. With an opening act by the Travel Awards. After which I attempt to distract myself by any means possible for 4-5 weeks. There’s likely to be some epically poor judgment involved, and poor judgment loves company. So buy your tickets now.

Child-wearing

Anyone else out there find it particularly ironic that the most compulsive and control freakish young adults in this entire country are at the mercy of a computer algorithm and the unpredictable ranking decisions of hundreds of other people and programs across the country for perhaps the most important decision of their careers?

It’s interesting to watch us all try to assign meaning to every little piece of information we glean from this process, in order to feel some sort of illusory control over our fate. Even when you absolutely know that you can’t rely on anything anyone says, you can’t help feeling relieved when a program you like says they like you too. And feeling a little miffed when you get a lukewarm reply or none at all from a place where you thought your interview went really well.

I say this as a habitually lukewarm-replier. Whatever other reasons there were (and I know there were others), I have no doubt that part of the reason I didn’t match last time was due to my own underwhelming show of interest in all but one of the programs I really liked. I failed to consider the fact that in a small field like this, programs are basically the children of their chairmen and PDs.

Every parent hopes their children are gifted, but every parent also knows that not every child can be. The difference is that some parents want you not to make exceptions for their gifted children, and to have the same behavioral expectations you would for an average child, and some parents want you to treat their average children as though they’re gifted. Speaking non-metaphorically, I am a child of the former type of parent, and children of the latter type annoy the hell out of me. (And in the case of gifted children whose parents have actually gotten the world to revolve around them, I am mostly just envious.)

So the expected amount of deference and praise varies widely, and I tend strongly towards not giving enough of it. I’m trying to correct that this time around, and be clear about my interest in particular programs. But quite frankly I don’t have it in me to be super enthusiastic and keep in close contact with every program where I’d be happy to match, so at some point, I just have to let my rank list do the talking.

Multi-party loop

I got nothin’ right now.

Not that my brain is empty–on the contrary, it’s a swirling mass of questions and plans and decision trees stretching out well past the horizon of my personal ability to predict anything in my life whatsoever.

The performing arts of medicine

Two topics today.  One was raised very eloquently by Dr. Alice: the pain of watching a patient you, yourself operated on suffer a complicated recovery.  The way a surgeon responds to this is one of several things I’ve noticed in surgery that tend to distinguish the excellent from the average.  The average group tends not to be bothered by complications, and to accept at face value the fact that some patients will have complications even when everything was done exactly right.  Another group, while perhaps seeming outwardly accepting of this, nonetheless at least ask themselves the question whether their operative technique was part of the cause.   And they don’t let the “statistical inevitability” of complications become an excuse not to keep looking for better techniques, or examining their own for mistakes.

For example, lately I’ve had a run of difficulty placing A-lines, and have had to place a bunch femorally.  And while it’s been nice to get more experience with femoral line placement, and I know that A-line placement is more a matter of zen and art than science, I can’t help thinking that it’s my technique at fault, and not dumb luck.  Even though I’ve placed them successfully on first attempt in hypotensive patients without a palpable pulse, I keep wondering if it’s something I’m doing wrong.  Likewise subclavian lines.  I’ve placed enough of them that statistically I should have dropped at least one lung by now, and yet that hasn’t happened.  Frankly, my most common complication is simply not finding the vein, because some of our critical care attendings make me use a placement method intended for people without a 3D mental image of the anatomy involved.  I have much better “luck” placing lines in the middle of the night when I can use my trusty HMI instead. (That’s Human Mental Image, for you unfortunate students who never had the opportunity to learn anatomy from Dr. Kirby.)

I heard a rumor…

Creepy, huh? I write about my own scare, and some other plane crashes. Happened last time, too. Although not quite so quickly. I’m just glad everyone survived.

I don’t see how people can do twenty interviews. I’m at thirteen right now, and the only thing keeping me going is my intense fear of not matching again. Which is probably ten times higher than that of any 4th year med student. Otherwise I’m running entirely on fumes.

It’s been a surprising few months, though. This field is like a small town. It makes me wonder if interview season is as much about learning all the gossip as it is about meeting this year’s crop of applicants.

Airline misadventures

If only I actually WERE a hurricane

Finally saw my Dean’s Letter. What a piece of fiction. I don’t mind the subjective nasty comments–anytime you take a stand, it’s going to piss somebody off. And I’ll accept being called on the carpet for my errors of knowledge and judgment. They happen, and I can only try my best.

What I do mind is the blatant fabrication of my supposed sins, and misrepresentation of the things I did do, and that fact that all these things are included as if they are proven facts, without also including my complete refutation of them, and description of what actually happened. –Not my perspective on what happened, but a number of simple facts that were left out, and which would have made it clear that my behavior was entirely unremarkable with respect to my peers, and not at all uncharacteristic of even an excellent student.

Don’t ask me to take character assassination in stride, to put it behind me and move on as if it’s deserved. I mind. I care about my professional image, and no one should have the right to lie about me and have it reported as the truth, to follow me my entire professional career.

If you don’t care, I won’t bother you with the explanation. But I care. And do you really want a resident who doesn’t?

Past lives

Wow. My college friends are slowly creeping onto Facebook. I can’t believe how many old friends I’ve found, that I haven’t heard from in ages.

Those are the people who knew me When. Back before I developed the mostly bulletproof professional facade that I now inhabit most of the time. Those people can tell you some interesting stories about me. But then again, I can tell you some stories about them that are at least as interesting as anything I ever did.

I have never been the craziest person in my group. Whatever the group norms are, I generally stay within them. But back then I hung around with some pretty wild people, none of whom were pre-med, and I definitely had more fun in college than the vast majority of physicians I know. In fact, I’m pretty sure that I could lead a totally joyless life for the remainder of my existence, and I would still have had more fun, over all, than most of my current colleagues. Frankly, it’s a miracle that I ever finished college.

To give you some idea, the latest friend I’ve run across was affectionately known to all of us as Dave From Hell. The name was so universally used that some people didn’t even know his real last name. He was in ROTC, and eventually became the Battalion Commander for the school, and went on to become a green beret/SEAL/whatever the elite combat group was for his branch of the service. That was the kind of guy he was. And he was a good friend of mine. We lost touch after he graduated, but apparently he is still in touch with some other good friends of mine that I didn’t lose touch with.

So lately, there’s been a parade of friends and exes, friends of exes, exes of friends, and assorted others from the complicated web of people I knew in college, showing up on Facebook. It’s kind of cool to get in touch with all of them again, and remember that medicine isn’t all there is to my life.

So demanding and high-maintenance

It occurred to me, belatedly, that some might misconstrue the title of my last post. Oh well. Nothing like the prospect of good gossip to reel in more readers.

So that was the looking-backward part of the new year. I think you have to look back a bit at what’s happened in order to know where you need to go from there. However, I’ve decided against making resolutions this year. Instead I have some goals. Here are the things I want from 2oo9:

1. More fun.
2. More friends.
3. More fitness.
4. More surgical training. Preferably of the neuro- variety, but Plan B is also acceptable.

That’s it. If any of those are involved, count me in.

2008, warts and all

1. What did you do in 2008 that you’d never done before?

• started an IV–yes, just a garden variety IV
• put in a chest tube, all by myself
• was primary surgeon on a craniotomy for subdural hematoma
• drove in a snowstorm

2. Did you keep your new year’s resolutions, and will you make more for next year?

Not as well as I’d have liked. I’ll probably make some more, and then not keep those well either.

3. Did anyone close to you give birth?

I don’t think so.

4. Did anyone close to you die?

Thankfully, no.

5. What countries did you visit?

Mexico.

6. What would you like to have in 2009 that you lacked in 2008?

A neurosurgery residency. (I know, totally out of left field, that one.)

7. What dates from 2008 will remain etched upon your memory, and why?

June 24, 2008. The day I finished internship.

8. What was your biggest achievement of the year?

Regaining my sense of humor.

9. What was your biggest failure?

Not finding a PGY-2 position in neurosurgery.

10. Did you suffer illness or injury?

I fell and bonked my head pretty badly back in March.

11. What was the best thing you bought?

New suitcases and a garment bag for interview season. Lame, I know.

12. Whose behavior merited celebration?

My parents, for finally taking real charge of their health (although it’s still a work in progress).

13. Whose behavior made you appalled and depressed?

Not many people this year. I suppose all the PD’s who interviewed me, and didn’t know a good thing when they saw it. Not really appalling, but certainly depressing.

14. Where did most of your money go?

Interviews.

15. What did you get really, really, really excited about?

The end of 2007.

16. What song will always remind you of 2008?

Hard to say, right now. I’ll have to get back to you in about 5-10 years.

17. Compared to this time last year, are you:a) happier or sadder? b) thinner or fatter? c) richer or poorer?

a) happier, b) about the same but flabbier, c) richer

18. What do you wish you’d done more of?

Exercise, socialize.

19. What do you wish you’d done less of?

Watch TV.

20. How will you be spending Christmas?

Working.

21. Did you fall in love in 2008?

The potential was there, but no.

22. How many one-night stands?

Zero.

23. What was your favorite TV program?

Burn Notice

24. Do you hate anyone now that you didn’t hate this time last year?

No. …wait, I take that back. There was one chief who would hound me to the point of absurdity, like he’d been told to find fault with me, and was duly obeying orders. The last straw was when, unannounced, he decided one day to round about 15 minutes earlier than the agreed-upon time (which was the difference between my having data and physical exams on the whole service, or just half of it), because the pharmacist had arrived early and he didn’t want to keep her waiting, and then totally ripped me a new one for not being fully prepared to present every patient. I subsequently learned that he had had a huge thing for the pharmacist in question and had asked her out once upon a time, and didn’t realize she had gotten engaged and married since the last time they were on service together. Bzzzt, fail!

I don’t generally revel in other people’s misfortune. But I tell this story because he continued to be such a huge jackass to me that he pretty much destroyed whatever human kindness I might naturally have felt for him.

25. What was the best book you read?

The Twilight series, recommended by a friend I met last time around on the trail.

26. What was your greatest musical discovery?

Jason Mraz’s latest album, We Sing. We Dance. We Steal Things. Is that a great name for an album, or what?

27. What did you want and get?

An entire rank list full of programs where I’d be happy to match.

28. What did you want and not get?

An actual residency position in neurosurgery.

29. What was your favorite film of this year?

Wanted. Simply awesome.

30. What did you do on your birthday, and how old were you?

Vacation, and none of your business.

31. What one thing would have made your year immeasurably more satisfying?

A boyfriend. Or, as we’ve been over multiple times here, a neurosurgery residency.

32. How would you describe your personal fashion concept in 2008?

White and ciel blue cotton, laundered by the hospital.

33. What kept you sane?

The finite nature of my indentured servitude on general surgery. And the fact that pharmacists get paid twice as well for half as much work.

34. Which celebrity/public figure did you fancy the most?

Oooo, tough one. Probably James McAvoy.

35. What political issue stirred you the most?.

The incompetence of Sarah Palin.

36. Who did you miss?

My cat, who died on January 2nd of 2007. I still miss her horribly.

37. Who was the best new person you met?

I met lots of great people. I can’t pick one.

38. Tell us a valuable life lesson you learned in 2008.

Wounds heal and scars fade, but truth is powerful and timeless.

39. Quote a song lyric that sums up your year.

“Let it go. Let it roll right off your shoulders.
Don’t you know? The hardest part is over.
Let it in, let your clarity define you in the end.
We will only just remember how it feels.

All lives are made
In these small hours
These little wonders
These twists and turns of fate.”