Hurricane Jill

Let’s get this straight

Someone recently made a comment to me that’s been rattling around in my head these last couple weeks. It’s sort of like when someone gives you a backhanded compliment out of the blue, and a moment later you’re thinking “wait….what exactly did you mean by that?” Except it wasn’t a compliment, just a random observation/piece of advice for which I can’t fathom the reason.

The advice was not to concern myself so much with sucking up to my pharmacy colleagues, and to focus instead on making connections and impressing people within the neurosurgery field instead.

Now, part of this is entirely valid: I haven’t been doing enough networking in neurosurgery. I should be going to grand rounds, meeting the people who visit and getting to know them.

But my failure to do this is not at all an attempt to suck up to people in pharmacy. I am not trying to establish myself as part of the political scene in academic pharmacy. It might not be too difficult, given my credentials. But I’ve learned my lesson, and I’m very clear these days with my pharmacy colleagues that anything I do in pharmacy is either to meet basic needs for food, shelter and a good credit rating, or to pay for things that further my career in neurosurgery.

I did renew my board certification in pharmacotherapy. But that’s the kind of thing you don’t let slip away if you can at all avoid it, even if you leave the field entirely. It actually expired during internship, and the board contacted me to offer a one-year extension and an exception to their normal test registration deadline for recertification. So all I had to do was explain why I didn’t recertify when I was due (which was a very good excuse, you have to admit), pay some money, show up and pass.

So what was this comment about, really? The only thing that comes to mind is that people may think I’m avoiding a particular neurosurgeon because of a particular pharmacy colleague. It seems a bit far-fetched, but who knows? My behavior’s consistent with that, but the reason is very different.

To the extent that it’s even my business, what I know about the situation is third-hand at best, and I’ve seen enough of the world to know that it’s a story with at least two sides, probably three or four. I may nod and make sympathetic comments when my friends discuss it, but I’m also thinking to myself that there’s got to be more to the story, because it sounds to me like the typical way in which long distance relationships end. Or at least, the ones that were probably going to end at some point, anyway. But to say so out loud is just pouring salt in the wound.

I’d be willing to bet that some of my own relationship casualties are even more gruesome. The only difference is that mine were all among people I don’t have to deal with every day any more. So while I might be a little more guarded in getting to know the subject of this kind of gossip, it’s far from enough reason to avoid doing so. In other words, nice to meet you Kettle.

In reality, what I’m mainly concerned about is avoiding any special treatment, and avoiding any perception that I’m getting special treatment. My training depends on unvarnished feedback about my performance–being taken to task when my work is subpar, and praised when my work is good. This was the case on the November rotation, but in February I don’t think that was happening. So the real problem here is that while it’s best for me to avoid such a situation, I don’t actually want to discourage it, and in fact on some level would enjoy and appreciate it. It’s a situation that has no good solution, so I ignored it. I didn’t know what else to do. In fact, it may no longer even be an issue at this point.

Anyway, if that’s not what the remark was about, then I have absolutely no idea.

Edited 4/15/09

I forgot to mention in my previous post that the manner in which this opportunity came to me strongly suggests some behind the scenes phone calls. So whoever made them (as well as the ones that didn’t manifest in a job quite so fast), thank you.

Next

Good news: I have a job in neurosurgery.
Bad news: I have to move.

Good news: cost of living is cheap there.
Bad news: there’s a reason for that.

Good news: there’s great skiing nearby.
Bad news: it’s not within the hospital, which means I’ll probably never see it.

Good news: it’s closer to my family.
Bad news: it’s still too far away for that to make any difference.

Good news: there’s nothing to keep me here.
Bad news: there’s nothing to keep me here.

That’s the sum of what I know right now. The rest is a big question mark. Since the answers wouldn’t matter, I didn’t ask. My goal is to work hard, learn as much as possible and make the most of whatever opportunities exist wherever I am. There may not be many, but I’ve certainly done more with less in other situations. So we’ll see how it goes.

Update

For those of you who haven’t been following along in the comments section (which is where all the action has been these last two weeks), I am still looking for a job. I’ve applied to almost everything neurosurgery-related that’s out there right now (1 more app to send today).

But it’s an employer’s market right now, so I must keep my pharmacy overlords happy until I find a neurosurgery fellowship or PGY-2.

The rent, it burns…

Please help

I’m going to lay out my situation here, because it’s pretty dire. Obviously it could be worse. If there’s anything I’ve learned in life, it’s that it can always be worse. Nonetheless:

1. Didn’t match

2. Wasn’t able to find anything in the scramble (one program did offer me a spot, then dithered around about sending me a contract, and finally told me all their spots were gone). Then again, I’m not sure that’s the way to go, and I don’t want to sign a contract and then reneg.

I know, I know, this is a bad time to get all squeamish about screwing other people over to look out for #1. But there are just some things I can’t seem to make myself do. Like go into a field I find uninteresting, but that pays really well and is easier to get into. Trust me, I’m mentally cursing myself over my inability to get over this mental block. But honestly, in a choice between that and defaulting, I’m not sure which is worse.

3. My temp assignment ends Sunday, and there’s not much other temp work out there right now to take up the slack.

4. I am the only person in my family who’s even employed right now. My mom is retired and I’m paying some of her bills. Fortunately she’s no longer in the Medicare donut hole like last fall, but at some point this year she will be again. My dad lives in an assisted living home, which my brother pays for. However, he is a corporate attorney who was just laid off by his company. He was incredibly good at his job, and has in past saved his employers millions of dollars, so I’m sure they’ll be sorry next time they’re up against any attorney who actually knows his stuff. Nonetheless, he has no income and it’s a tough job market.

5. I have about three times the average student loan debt. Tulane’s student insurance was awful, so my medical expenses had to be included in my cost-of-attendance calculation. This is also why I was working as a pharmacist throughout the preclinical years, and why my finances (and my health) were in such dire straits by the end of 4th year. I had spent every cent I had trying to match in neurosurgery. I can live on a pittance of a salary, as long as I have good medical insurance, and can defer my loans. Otherwise my loan payments are in the range of 6-7K/month. I have zero consumer debt, just the student loans. But I can’t pay them on a primary care income. Period.

I don’t actually care about the money, where neurosurgery is concerned. I care a little bit, with regard to vascular surgery. Everything else just feels like prostitution; I’d be doing it for the money, and no amount of it would ever really be enough to compensate. It would a sad thing for my patients, and for medicine, if I went that route instead of doing something I love. And it would be utterly stupid to train in some field I don’t even like, that doesn’t even pay well enough for me to repay my loans.

6. For some reason, I’ve been completely unsuccessful at getting any kind of job in neurosurgery. I’m consistently told that my qualifications are excellent and that I’m a strong candidate whose application, though it does have blemishes, does not contain anything that should keep me from getting a position. And yet, time and time again I’m not the person chosen, and no one will give me anything more than platitudes when I ask for feedback about where I fall short in comparison. It just doesn’t ring true anymore. There’s something not right about it, I can feel it.

7. I am FAR less interested in my love life than I am in solving the above problems. Those things must be dealt with first. So don’t anyone talk to me about men right now.

——-

So that’s where things stand. I like to work hard, I’m easy to get along with, my neurosurgical operative skills are as good as they could be with the amount of experience I’ve had. I manage patients well. And I just want the opportunity to prove myself in neurosurgery, and no one will give me even the slightest chance.

This is just a bad dream, right?

It’s official. I should just go to sleep, and wake up again tomorrow. I’ve been awake since about 5am yesterday. And yet I’m not tired. Or if I am, I’m too numb to feel it.

Did I Match?

No, I did not. If someone out there knows why, please tell me.

Tick tock

Less than 48 hours till we find out if we matched. Options for how to spend the time:
a) drink heavily, do something stupid, worry about that instead
b) alternating Benadryl/Ambien till 9am monday.
c) curl up in the fetal position and moan
d) blog incessantly but don’t post any of it

D is clearly the most pathetic, so D it is.

Nerves

O-kay! The dread has officially set in. Today for the first time I felt a twinge or two in the pit of my stomach over the possibility of not matching.

Perhaps it was the kindly email from the NRMP titled “Scramble Advisory,” that did it. Even though I know everyone gets that email, and it means nothing at all about my own match results to have gotten it, it still sets off the fight-or-flight reaction. Reading it only made things worse. I sat there and considered the logistics of scrambling from my living room, and whether I would even want to take part in it at all. Why scramble into another internship that I’d most likely have to repeat the following year if I finally found a spot in next year’s match? Does that even make sense?

Instead, though, I reined in my thoughts and reminded myself how unlikely it is to fall entirely off a 15 program rank list, even as an independent applicant. Plus I’m not usually someone whose personality sabotages her application to that extent. So given the range of programs on my list, surely somebody ranked me in a position where I’ll match.

But the waiting. It’s getting to me.

Ranky rank

I decided to weigh things a bit differently this time around when it comes to my rank list. Last time, I ranked primarily on quality of program and research opportunities, and made small adjustments based on how much I liked everyone there.

This year, I grouped programs based on the following parameters, regardless of subspecialty:
Top Tier: Liked everyone I met
2nd Tier: Liked all the faculty and most of the residents
3rd Tier: Liked the key faculty and most of the residents
Bottom Tier: Bad vibe from a key faculty member, but liked all the residents
OTL: Bad vibe from key faculty, disliked one or more residents

I was fortunate this year in that most programs started out in tiers 1 and 2. So I subdivided 1 and 2 based on quality of operative experience, again without regard to subspecialty. This was based on breadth of operative training, and case volume vs number of trainees.

Again, I was fortunate to interview at several excellent programs which are largely indistinguishable using these criteria. So the next filter was based on quality of research opportunities at the program, the amount of time available for dedicated research, and how competitive I would be for faculty positions across the country (as opposed to internally, where they were all fairly equal) after training there. This narrowed it down to four programs, three neurosurgery programs and one vascular surgery program. All in locations that are pretty equally uncool.

So the last criteria was simply vascular vs neuro. And since all the extraneous considerations had already been applied, and I could see myself doing either one in 20 years, it was simply a matter of which one I enjoyed more on a day to day basis. So I ended up ranking two above and one below the vascular program.

My top three neurosurgery programs are all well-liked among the applicants I’ve met on the trail. The lowest ranked of the three, on my list, is more sought after by the other applicants than my number one, which is a reflection of the fact that most applicants in this tier are only faking their interest in research and academic neurosurgery. The highest ranked program on my list has an intimidatingly sophisticated level of research going on, making it more attractive to the hard-core academics on the trail. And there are some.

So it’s impossible to gauge how likely I am to match at either of those programs. Which means the possibility of matching at the vascular program is real, and I need to be sure that I won’t regret ranking it above neurosurgery programs where I’d also be pretty happy to match.

Of course, I could always end up falling entirely off my list again this year. In which case this post is just hubris, and I will look like a fool. But let’s hope that doesn’t happen.

Note: edited to correct the number of programs in my top group. I had let someone else’s opinion sway my assessment of a particular neurosurgery program when I initially wrote this. But I changed it back to my original order after thinking through step 3 (research time and quality) again.

Oh, you mean THAT rank list…

Forty eight hours until the rank list deadline. All my ranking posts are embargoed until then.

Why are they such jerks?

The following post was written on 4/2/08:

It’s part of the standard introductory small talk with an intern: “So, what are you going into?” Or some variation thereof. If they already know I’m a surgical intern, most will ask me if I’m a categorical surgery intern. Now, I do realize this is the diplomatic way of asking whether I’m a designated or undesignated prelim, but I let myself be flattered anyway. At least the answer isn’t obvious.

I always give the same reply: “I plan to go into neurosurgery, but I’m still looking for a PGY2 spot.” At which point, the other person will usually remark, “but you’re too nice to be a neurosurgeon!” And I will usually say one of three things, depending on my mood.

Most of the time, I’ll just thank them for the compliment and be done with it. If I’m feeling mischievous, though, I’ll say “You clearly don’t know me very well.”

Sometimes, though, and particularly when the other person has recently dealt with a less than friendly neurosurgery resident, I’ll remark “Well, from what I hear, they were all nice when they were interns.” And actually all of them still are, on a personal level.

The neurosurgery residents have a lot to get done, and every person between them and getting the job done is just another obstacle. So the way to get along with a neurosurgeon is simply to do your job. And if you can actually facilitate their work in any way, they’ll really like you. They still may not hang around and chat with you, but at least you’ll be spared their obvious contempt.

But when they do have time to talk, you’ll find that the manner in which they deal with people in the course of getting work done is not really how they are. People wonder how the orthopods can be so nice to work with and the neurosurgeons so…not. The residents are equally busy, and about equally smart and personable upon entry into the field. So why are they so different from R2 onward?

The reason is actually simple. In ortho, patients break things that are nearly 100% fixable. Often incredibly painful, but other than low back pain, rarely intractable. Neurosurgery is just the opposite. And few people, even in medicine, really understand what it’s about. I’ll confess, it still seems largely like voodoo, even to me. And I know that there’s science behind it.

So if you deal with colleagues all day who really have no clue about your field, at some level it stops mattering to you whether they understand or approve. And that comes across. In time, people forget that it’s just mental armor, and that the person underneath hasn’t changed.

I see it even now. Whenever the neurosurgery residents come to the ER to evaluate a patient I happen to be following, it takes them a second to remember that I’m someone they know and generally like. They’re so used to dealing with people who think they’re insensitive jerks. And they definitely can be. But even though people often take it personally, it rarely is intended that way.

Everyone else’s job, fundamentally, is to save the brain from the rest of the body’s dysfunction. In other words, to keep the heart pumping, so that blood gets to the brain. To keep the kidneys and liver and lungs working so that the blood that gets to the brain is full of oxygen and not toxins. When those organs stop working, and can’t be fixed quickly or well enough, the patient dies, and also looks dead. However, even if the patient looks dead, if the brain is alive and the problem can be fixed, the patient will live. So you always at least try.

But the neurosurgeon’s job, when called, is first to decide if the brain can be saved.

Only the neurosurgeons have to decide, in the ER, when the patient still looks alive to their family, whether they might in fact be better off dead. So you have to be able to say things to people that you know will devastate them. On some level, you have to be able to be a jerk. And not only that, but you have to be able to live with yourself despite it. But there’s more. Let’s say you did decide that this patient had a reasonable chance of meaningful recovery. You operated, and prevented the death that was rapidly approaching, but didn’t salvage any of the intellectual function that made the person who they were. That’s an outcome worse than death to many people, and you have to tell their family. Now you really feel like a jerk, and you still have to live with yourself. That’s a whole order of magnitude more crappiness than anyone else in the hospital ever has to dish out.

And over time, you find that if you’re known to be a jerk, fewer people hassle you, and you can get the job done more efficiently. And it’s not such a blow every time you have to tell a family news they don’t want to hear. From the neurosurgeon’s perspective, it’s an adaptive response.

Are there better ways to handle it? I’m sure there are. But empathy requires some time for reflection, and there really isn’t much of that in the junior years of a neurosurgery residency. And empathy makes the job harder, not easier, at a time when a lot of residents are already at the limits of what they can handle.

This is going to be ugly

I am currently adding up all the money I spent on interviews, in order to deduct it from my taxes.

A cursory scan of my bank statements is enough to tell me it’s a very large number. Especially since I had forgotten about the four interviews I did before application season even started.

People

It’s hard to believe I’m more than halfway through my interviews already. And while I do have some strong preferences already, I haven’t yet encountered a program I’d be reluctant to rank. Which is a far cry from last time around, where they comprised an alarming percentage of my rank list.

Also of note is that I’ve only been offered interviews at programs I didn’t apply to last time around. I guess no one wants to entertain the notion that their screening process isn’t perfect, or that applicants can change for the better. No doubt I would do the same thing, were the situation reversed. But that doesn’t make it any less foolish.

I’ve also identified a number of people I’d love to have as co-residents. Some people have fantasy football teams; I have a fantasy resident team, with residents at each PGY level. The only problem is that there are more residents than there are spots. But isn’t that always the way it is in neurosurgery?

Of course, I’m not going to share the names on my team here. But I might share it with one or two people. And I plan to keep the list somewhere permanent, so maybe in 20 years we’ll see how good I am at recognizing talent.

The other thing I wish for is some sort of anti-Couples Match. Seriously. There are people I really don’t want as co-residents, to the point that I would rather not match at a particular program than match with that person. It’s easy this year to avoid the ones from my own graduating class: I just didn’t apply to their program (although this was never the only reason). And it was easy to factor in my fellow interns when I applied for prelims. But we have no say over who we end up with in our own match year. And I suspect the only reason my anti-match list is so short this year is that I really don’t know many of the applicants well enough to have my own opinion, or to be privy to theirs.

I think it would be very enlightening for programs to ask this question. However, I can’t imagine a way to do so that wouldn’t be perverted by the gunners among us, and used to shoot down the people who are well-liked instead. But wouldn’t it be great, though, if it were possible?

Curse you, Emily Post

Alright, I’ve decided no more sleep today until I’m done writing thank you notes. I have 4 programs’ worth of them to write, and if I rack up any more before getting to it, I simply won’t be able to face the task at all.

Thank you notes are one of the few writing tasks I truly dislike. And ironically, it’s tougher the more I like the program I’ve interviewed at. Everything I write sounds either naive and flighty, or like damningly faint praise. And while gushing is not professional, the alternative risks being misinterpreted. And I’ve already not matched once, so it’s not like I can afford to be careless about it.

You can see the dilemma.

A few wedges, some awls, and the occasional razor blade

It was cloudy but not raining today as my plane touched down in Seattle. I could see my apartment building as we flew over it, and also my old apartment building downtown from when I lived here before. It’s out of my price range now.

Well, technically I could afford it these days, but I’m trying to keep a resident budget so I can pay for my interviews.

Anyway, Seattle was simply beautiful this morning. Not least because I get to sleep in my own bed after a week and a half away. (That’s the only downside of owning a tempur-pedic: even the high end hotels are no substitute. Well, that, and the fact that it’s a suffocating heat sink unless the room is very cold.)

The interviews themselves were interesting. Last time around I got the impression that it was only the top tier programs that had most of what I wanted in a residency. This year I’ve already seen three supposedly lesser programs that look, frankly, almost indistinguishable from top tier programs in terms of the training they provide. Reputation is the only thing that lags behind.

One of my interviewers took me to task for being too much myself and not acting fake and arrogant to impress people. I’m dead serious. He said that neurosurgeons like the fantasy that every applicant is super smart and not nerdy at all, and that by not playing this game, it makes people wonder what other parts of the game I’m not going to play. He then went on to talk about how sad it is when people pretend to be what they’re not, and end up unhappy in a field they’re not suited for. And I’m sitting there, thinking, “yeah, I never should have been a pharmacist.”

Of course, that interview started with him taking a moment to write his evaluation of the last interviewee, and me warning him that I can read upside down. He asked me when I learned to do that, and I said I didn’t know–I’ve just always been able to. He then asked me a bunch of random questions about how I do crosswords and whether I’m good at math, etc. It was by far my oddest interview to date.

As for the other applicants, they seem different than the kind I met on the trail last time around. More detail on this later.

The magic number

Sweet! Any other invites are just gravy from this point on.

Although with everyone going on more interviews, I’m willing to bet that any program not inviting more applicants than usual runs a higher than normal risk of going unmatched. Because what I’m seeing is a lot of high-end applicants simply hanging onto all their interviews, now that the season is long enough to schedule them all, rather than having to choose among programs with conflicting dates.

What goes around…

Just a quick note to anyone who’s here looking for post-interview program assessments. I’m not posting any, for now. The main reason is that, this year, I didn’t apply anywhere that I wouldn’t want to go. And I don’t want a program assessment that I’ve written in a spirit of fairness and balance to be interpreted as a negative opinion.

I’m heading out tomorrow for the midwestern round of interviews. After that is a last minute west coast trip (if I can get my coworker to trade night shifts with me), and then the driving tour of New York. The November schedule worked out pretty nicely.

There is no rhyme or reason thus far to my December schedule, and January is also very haphazard. Hopefully I’ll get a couple more interviews, and those two months will make a little more sense. If you have any good karma to send my way, these next few months, and particularly March 2009 would be an opportune time to do so.

20/20 foresight

The interview numbers keep inching upward, thankfully. I wonder how it works when you’re applying to two different specialties: do you need 10-15 of each, or is it the overall total that counts? The “Charting Outcomes” publication doesn’t really discuss the characteristics of successful applications where there are multiple specialties involved, except for the specialty of the program ranked #1, and contiguously ranked programs within that specialty. So if you alternate specialties, you only have data for your likelihood of matching in the first specialty you list, based on how many subsequent programs you list in that specialty before ranking one in another specialty.

Oh well. Operating in the dark, as usual.

My personal statement for the other specialty is, at best, only tangentially related to the specialty in question. Among other things, I talk about why I don’t have a tragic Katrina story to make everyone feel sorry for me. Still, I just know my readers are thinking, “what the hell does this have to do with anything?” for fully two thirds of it. Mostly because that’s what I think whenever I read it. But whatever, it’s an interesting story, and does illustrate the potential for good surgical judgment. So it’s not entirely out in left field.

Now, whether anyone will actually make that connection is a whole different story.

Hx of O.R. withdrawal, now presenting with same

Last night at Outside Hospital we had a patient who had to be emergently trached at the bedside. He also had a subdural hematoma, so we ended up sending him to Harborview. I was sad that we couldn’t operate on him ourselves, but it was a traumatic subdural, and obviously not his only problem, so he would undoubtedly be better off there.

I so wanted to send him with a sticky note, saying hi to whichever R2/R3 was on call for neurosurgery. Man, I’d be happy even to do some lowly burrholes right now. Instead I just sent along some propofol and ativan for the ambulance ride.

After all the drama was over, I went back down to the pharmacy and looked up his scan. It had been done about 2 hours prior to the transfer, and definitely looked like a subdural on the right, with either some subarachnoid or intraparenchymal bleeding in the left frontal region, right where the contracoup injury would be. It was hard to tell the difference on my crappy little computer screen. And it’s not like I have all kinds of time (or any, really) to be doing anything other than keep up with my medication management and distribution duties, anyway. But I like to look at the scans. And I like the double-take I get from the other physicians when I say anything halfway intelligent about them.

The standards, they’re so low it’s entertaining. If I don’t find a spot soon, I may actually need to repeat internship.

The green monster

Well, the network is still down (note how I managed not to put that in quotes). And will be, until tomorrow. But at least I got my snail mail delivered yesterday, so that’s good. We’ll see what happens today. Thank God for email, so I at least find out about it when people send me something and it gets returned.

The interview minus rejection count is holding fairly steady, with an approximately 1:1 ratio of interviews to rejections over the last couple of weeks. But I’ve still heard nothing from the vast majority of places. And pretty soon we’ll be entering the pocket veto stage, where not hearing anything is essentially a rejection.

I applied to an alternate field today. You’ll note that I said alternate, rather than backup. The reason I applied solely to neurosurgery the first time around was because there wasn’t anything else I wanted to do. I had toyed with the idea of applying to peds as a backup, but in the end I just couldn’t not be a surgeon. The only problem was that, although I enjoyed being in the OR, I wasn’t interested in the associated perioperative care for anything other than neurosurgery. And even in the OR, my interest in neurosurgery was on a whole different level than everything else. So there weren’t any other surgical fields that seemed like a reasonable choice. And, to be honest, no one thought I’d even need a backup.

This year is a different story. I know I need one, but I still think backups are just a bad idea in general. First of all, no program wants to be the one you didn’t really want to go to. And second of all, no one wants to end up doing something they didn’t really want to do. So it had to be something where there was a least some overlap between the two fields in how I might end up ranking them. And that’s a tall order, given how much I like neurosurgery.

But I did figure out something else I could see myself doing. The lifestyle is no friendlier, and it’s not any less competitive, so it’s not even a backup in the strictest sense of the word. It’s just something else that I like.

And you know how the dating game goes: the minute you find someone else who’s a realistic choice, the other guy decides he really did want you after all…

Today’s excuse

“Network problems,” that generic, catch-all, clearly-not-my-fault reason.

It’s at least semi-plausible: Tulane has had IT issues since before I even went there. In fact, during my first year, one of the guys in the med school’s IT department (actually I think he was the med school’s IT department), told me that there were two hacker gangs over at the uptown campus, and that each was trying to outdo the other and take control of Tulane’s system.

Who knows if that was true? But it made a colorful story, and certainly explained all the random email outages happening that year. It also didn’t help that most of the med school’s own IT people had been let go the prior year. So the department consisted of basically one person.

So, you know, even before the hurricane, it seemed like the only things holding Tulane together were shoestrings, chewing gum and determination. With a lot of help from Newton’s first law.

And it was really only the inertia of the system that the hurricane disrupted. Shoestrings, chewing gum and determination are remarkably hurricane-proof.

In any event, supposedly the network will be back up this afternoon. And our ERAS lady should know, since she’s married to one of the IT guys. But if it’s not, I’m sending those letters out myself.

House of mirrors

Well, my last letter is in, and now I’m just waiting for my school to upload it. Unfortunately the person who uploads the letters is out sick again today. I swear, she takes at least one day off every week, sometimes two, and somehow it’s always the day something of mine gets sent in. Which is yet another argument for having two people be responsible for uploading documents.

Anyway, the letter writer sent me a copy, although I didn’t ask for one. It was an eye opener.

Funny how things can appear so completely different from the outside looking in. No doubt I owe a few apologies.

I’ve known me longer than you have

There seems to be a pause these last few days, in the interview offers and rejections. I’ve received none of either since Tuesday. What does it mean? Does it mean anything at all? Did people take my last post seriously, and just not send me all the rejections I’d be getting otherwise?

I hope not, because despite my fragile ego, I’d rather know than wonder.

All 4 letters are finally in, and I’m expecting one more. Currently, all four are from neurosurgeons, but I’m going to replace one of them with a letter from a non-neurosurgeon.

Blasphemous, I know.

But one of the letters makes claims about my academic record that I’ve never made and that aren’t true. So although I have immense respect for the writer as a surgeon and educator, I have serious qualms about using the letter he wrote. And at least the new letter is also from a surgeon, so it might still get read.

Or it might not. In the end, my record is either good enough, or it’s not. If I didn’t think I had something to offer the field, and that I could and would finish the residency, regardless of what obstacles may arise, I wouldn’t have applied in the first place.

I don’t have time to waste like that anymore.

The count is +5

I think the rejections may start coming today, from the programs where I never had a chance in the first place. With three letters, my application is technically complete, even though there’s one more coming. But if the last letter won’t change a PD’s mind, then they might as well tell me now.

Which is fine. At the moment, I have five invites and no rejections, so I think my ego is sufficiently inflated that it can handle getting knocked around a bit. Last time, I had zero interviews at this point, so things are already going much better.

The lack of invitations should have been a clue that something was really wrong, last time. But people kept telling me to be patient, and not having been through the process before, I didn’t know what to expect. And then I got a few interviews from some really good places, and I figured everything must be OK. But it was just that my letters were so good (I was told time and time again how remarkably good they were), that some programs were willing to overlook the sucky (and incorrect) grades.

Anyway, the past is past, and there’s nothing I can do about it now. And I have a good feeling about this year.

Feedback

Ah, feedback. Not fun, but better than letting an error become a habit.

I do have a tendency to get defensive about things that really don’t deserve that much attention. However, as someone who’s always found it easy to figure other people out, and know where I stand with them and why, it’s very distressing for people to hold opinions of me that I don’t know the reason for, and therefore can’t address.

And apparently my personal statement is very dry. To which I say, better dry than crazy. Plus, that’s what happens to writing when it gets edited by large numbers of people. And mine has been edited by a small army.

Nonetheless, like George Michael, I apologize for boring you.

But seriously, consider the audience. For every resident and junior faculty who’d appreciate a shiny and entertaining personal statement, there’s a Chairman out there who’d consider it the sign of a ditzy dilettante, unsuitable for the serious reputation of their program. And if I can only show a single dimension of myself, then guess what? I’m going to play it safe.

If people want to see a more multi-faceted picture, they can always come here.

And speaking of feedback, I just got two interview invitations, both from programs that might actually be a good fit. Yay! Although you can never really tell until you visit. But it made my day. Particularly since it’s CNS week, and I really wasn’t expecting any.

Doesn’t add up

Wow, I seriously underestimated how uncomfortable I would feel at neurosurgery grand rounds. Which is surprising because I did expect to feel somewhat out of place. But I actually felt frankly unwelcome.

It’s hard to tell what that means, without context. But the context in my life at the moment is a deafening silence in response to all my requests for help and advice, from nearly all quarters. And no one seems able, or at least willing, to give me any real answer why.

Think about it from my perspective. I’m a pretty normal person–easy to get along with most of the time. I get irritated when people waste my time, but usually let it go unless it involves something important. I get angry when I feel I’ve been mistreated, but almost never act on it without thinking through the consequences first. So with that as background, I work toward my career goal, and along the way people are generally supportive and encouraging of my efforts.

Imagine waking up one day, having done nothing differently than the day before, and all of a sudden people are treating you like a leper. No one will come within 10 feet of you. But no one will acknowledge that, and everyone insists that this is normal behavior, and nothing has changed from the day before. But you can see with your own eyes that it has.

There are a few people who aren’t acting like that, so you ask one of them to find out what’s going on and tell you. But then that person, instead of telling you, starts treating you the same way. Everywhere you go, and with every person you meet, it’s always the same pattern. And no one will tell you why. Or they come up with reasons that are profoundly insufficient as an explanation.

How do you get to the bottom of something like this? Because I certainly can’t fix what I don’t know is wrong.

I mean really, did I kill someone in my sleep? Are Katrina and Rita and Ike just massive Poltergeists of my creation? Am I shedding Ebola virus? Seriously, what’s the deal?

I suppose it’s always possible that there’s a disconnect between reality and what my records say. But why wouldn’t someone be willing to point out whatever it is they find concerning, in that case, so that I can address it?

Or maybe no one can tell me because it’s not me that’s done something wrong, and it’s easier to exclude me than to address the real problem. I don’t know the answer, but I certainly can’t take any of these possibilities off the table with the information I currently have.

Learn, do, teach

Ugh.  There was a craniotomy today at Outside Hospital, and I missed it.  Mostly because of the nutcase factor–it would be a little odd to just show up for the case without ever having introduced myself to the surgeon or the patient.  It’s usually OK to meet the surgeon in the OR, if you’ve been taking care of the patient, or to meet the patient in pre-op, if you’re already working with the attending, but in this situation I knew neither of them.  So, just showing up would not be kosher. 

Where is it?!

Thursday, people. That’s when I get paid. But I certified it today.

This will not be my personal statement, however

I must be crazy.

Can you believe I actually miss being a surgery resident? What is wrong with me?

From a slacker perspective, how can anyone complain about being paid six figures to count by fives, answer crazy questions and check other people’s work? I did this for so many years, I hardly even have to think about it anymore. And yet, I can’t help thinking that if I’m going to stand for eight to twelve hours straight, I’d rather be a surgeon–even a resident at the bottom of the totem pole making 1/10th of my current hourly wage.

I realized this yesterday, as I was talking to the other pharmacist at the store where I was working. She had recently had an abdominal surgery, and was talking about how the recovery had gone. Up till that point, I had been wondering in the back of my mind whether I ought to just give up on the idea of continuing my residency. It’s certainly the path of least resistance. But then it hit me: any kind of surgery–even an abdominal operation, God help me–is more interesting than the study of medications and their storage, preparation, usage and effects. Although when it comes to abdominal operations, it is a fairly close call.

It’s not that I dislike my job, or anything. In fact, it seems that even retail pharmacists get breaks and lunches these days. So thus far, it certainly hasn’t been the hellish environment I remember. But it’s just a job. And I do know how to enjoy having time and money to spend. (I still don’t have any yet, because I had to mail my first paycheck to my bank, which only has one branch office. In Texas.) There are places I’d like to go, friends I’d like to see, things I’d like to buy.

But I don’t enjoy any of those things as much as like being in the O.R., fixing something that’s gone dreadfully wrong with someone’s body. Preferably their brain. Or spine.

Like I said, crazy.