Snowed IN Rank list

I have been blog slacking…mostly because I have been living in my car for the last 3 weeks interviewing all over for my peds residency. Its been quite the ride. I loved some programs, hated some programs, had a fender bender, driven over 2500+ miles on my car and been in 10 states.I listened to 2/3rds of my Lord of the Rings on Audiobook unabridged that should indicate how much of my life has been in the car.  sigh. On top of that craziness in the middle I got a call from a top program that I had not heard from saying there was a computer glitch….I canceled an interview to fit them in.  I also bought a plane ticket so I could go from Texas to NC to VA to Ohio in less than 36 hours.

Now I am on Day 3 of being snowed in under two feet of snow at my Parents’ house in the Blue Ridge Mts. The valley roads are ok but for some gosh awful reason no snow plow has come up the mountain.  I missed Hopkins because of the snow.

I can honestly say I am ready to leave Wake Forest after interviewing all over. Its been a great, great home for college and medical school but I am ready for a change. And their peds program is just not global health minded.  Thats the main conclusion I have at this point. I have some favorite programs but not for the same reasons and its hard to shake out a rank list.  But here is my opinions….if you are curious….

I interviewed at the following: Wake, Emory, UVA, Duke, Vanderbilt in TN, Cincinnati Children’s (the late addition), Baylor in TX, Pittsburgh.And yes there are now to be LORD OF THE RINGS analogies mostly because I feel odd publishing my rank list on the internet…but if you try you can figure it out.

The Shire-beautiful facilities, familiar, nice people who mostly want to live in the shire forever.  q 4 call for 5 months. Good electronic medical records (EMR).  home  for me yet not home forever.

Helm’s Deep-Rural, mountains,  horses, close to parents, surprisingly nice global health program, not nice facilities, q4 call for 6 months. Close to wheelchair skiing. Would actually have to eat my ACC liver and be hated by my family to go (just kidding!).  crappy EMR (no notes). nice people.

Isengard-has hospital symbol that looks like Isengard. would seriously have to wear my black/gold tie-dye shirt every day of basketball season to not feel like a traitor and will be hated by all my friends from college (Not actually kidding)..  nice people, close to Rohan (parents’ home), close to the Shire. q3-4,no golden weekends (UGH!!). not nice facilities, hard to navigate on pony (or wheelchair).  Very controlled and structured global health program.  Did I mention I would have to sell my soul?

Minas Morgul: Cold, dark. Not terribly far from Rohan (6hrs) but have to go through the Morgul Vale roads (state just West of Rohan) to get there. People are super nice. Beautiful facilities, best advocacy program of anywhere.  Global health is not really set up but very open and int med program is set up. But would have to live in cold, dark city that I almost died in (fender bender).

Minas Tirth: FUN, FUN, warm city. although all the issues of a city, lots of traffic, expensive, occasional flying monster, etc.  nice people, amazing global health, HQ of the CDC, flexible first year elective, shift work (no call except in community hospital), incredibly diverse patient population.  Direct flight to parents’ city in Rohan. EMR!!!!!!! Big downside: two hospitals 15 mins away in city traffic regularly. Good friends live there!!!

Rivenedale: Close to mountains but fun city.  Cheaper than Minas Tirth.  A couple of friends live here too.  Q4 call for 8 mons BUT early check out system, go home by 2PM. AMAZING EMR!!!!!!!!!! (maybe better than the Shire in some ways).  Was interviewed by health commissioner of the state who is a pediatrician, a christian and really cool lady who told me about all the amazing advoacy opps in the area. Could have a second clinic that focused on refugees and international adoption as a second year.  Flexible not hugely structured but active global health program. CHRISTMAS BREAK!!!!! (unlike Edoras)

Edoras: The Golden Hall, ridiculously highly ranked pediatrics program (always in the top 3 in everything) but sort in the middle of no where. Would also require crossing the Morgul Vale (hard in the winter from the Rohan village my parents live in) and NO CHRISTMAS or NEW YEARS time off.  Global health program is FANTASTIC including 2-3 months of PAID TIME OVERSEAS!!, journal club, really active group. The head of the GH program interviewed me, super nice, worked with people I am working with in Kenya, and told me I could do my contunity clinic in a faith based clinic among the poor in the city.  Plus among the best pediatric training in the country and I think they liked me. Downside: In the airport they sell shirts that say Edoras: our cows are made for tipping and no Christmas/New Years with my family for 3 years.  No direct flights to Rohan.

Far, far, far away:  HUGE, SCARY, MASSIVE medical center that is bigger than the city the SHIRE is in.  But is home to the pediatric AIDS corp and have a global health residency that allows you to take an extra paid year to work with pediatric AIDS corp. Got to meet the guy who founded the AIDS corp and really enjoyed talking global health. Have dear, dear friends there and family a couple hours a way. But far, far, far from Rohan and the program is a little overwhelming by pony (wheelchair).  Super nice people though wish it was somewhere closer.

SO Current Rank list:

Fighting for 1 and 2-Edoras and Rivendale

3-Minas Tirth

4-6 Shire? Far, Far Away?  Helm’s Deep?

7-8 Isengard,  Minas Morgul

Thoughts?  (other than the fact that I am big nerd with this LOR stuff)

the uglies

everyone seems to like listening to my life stories. the little gimpy kid with the disease no one has ever heard of growing up and becoming a doctor has a nice ring to it.  the stuff on my resume makes me look smart, sane, mature.

but in reality most of it is a facade. none of it is untrue but putting it all in bullet points on a sheet of paper cuts out all the details.  no body likes the details.

the details are ugly. everyone wants to know how my surgery went. but everyone wants me to say it went great. everyone wants to know what being a disable medical student is like but everyone wants me to say its been swell.

I just had a surgery that was basically palliative care. it didn’t cure my disease it kept me from pulling my hair out because I can’t sit still because of the the pain. but the truth is yeah the actual four hours of the surgery went well but physical therapy is a bit of a disaster.  i have what appears to be a three to five year old flexion contracture that is not only tough as nails but if it doesn’t get better is going to wear the prosthesis down much faster than usual (which basically knocks off years of walking).  No one diagnosed this crucial fact…one has to wonder what role it played in the hip pain the first place. no one wants to hear from the little medical student that her transition from pediatric to adult medicine has been fraught with peril, that the adult orthopods are not only ignorant about her pediatric disease but too arrogant to admit it.  I suffer for it not them.

I am getting up at 5 AM, rounding on patients I do not know half the time, writing notes either observing (as in not touching) in the OR or occasionally interacting in clinic till 5PM when I go to PT and get pushed on till I finally get to go home by 6:30 and then repeat. today i repeated plus SWINE FLU.

then I try to prepare for things like my interview on Friday, fall asleep on my computer and then wake up in the middle of the night and worry about the flexion contracture that gives me muscle spasm cramps randomly and frequently that leave me begging for tramdol and has not moved a single degree in the last three weeks.

no one wants to hear that some times I come home and I cry with frustration and pain. no one wants to hear about how some days I absolutely hate my chosen profession not just because it has so few answers for me but because  no one have the balls to admit they have no answers.  Good gosh people just tell it like it is. do you think I somehow don’t know that it sucks?

no see that doesn’t sound all that inspirational now does it…

Circles…

I spent a good portion of this week figuratively and literally lying prostate on a table having my someone pull my body into various positions until with my teeth gritted and  tears stinging my eyes I said “I surrender”   My orthopod last week said my x-rays were perfect, my PT progress was not.  He lifted the precautions for PT which means we can attack the flexion contracture with full force.

And so we did and because scheduling PT is like scheduling meetings with Obama I had three days in a row. While it was exciting and somewhat luxurious to lay on my belly…  by the third night I was downing tramadol at 1 in the morning because the muscle spasms were bad enough to wake me from sleep. I have been down this road before…my connective tissue just gives up and hopes  I won’t notice.  Then I spend months fighting it back into submission.  Only to have it eventually give up again and we go back through this whole cycle of me laying prostate on a table for several months….

Then there was the scheduling mishap that landed me on a surgery rotation.  And here I was waking up at 5 AM from my muscle spasms disrupted sleep cursing myself for letting Student Services sign me up for Peds ENT.  Three hours later I was either in the OR a place that makes me feel cold, nauseous and bored or in ENT clinic having my attending yell at me in front of patients to hold my otoscope like I held my pencil…I explained I was HOLDING IT LIKE I HOLD MY PENCIL…it never occurs to him maybe I don’t hold my pencil like everyone else….and I have daily flashbacks to writing my name in Kindergarten over and over again. My teacher standing over me saying THAT IS NOT HOW YOU HOLD YOUR PENCIL. I remember looking at her and wanting desperately to please her but knowing fully well that I could not hold my pencil the way and form the letters.  Why couldn’t she just understand that this way was working for me….

So here I am in my last 6 mons of a doctorate program and am being yelled at for how I hold my pencil.   Oddly not much as changed in 20 years.

or the last 8…

On Thursday night and Friday morning I put on makeup, I styled my hair, I wore designer clothes….and went to my first peds interview here at home. I walked into my faculty interview and before I had barely sat my little spazzing butt in the chair Dr M looked me straight in the eye and said ” Amy, I am not going to interview you, I know you well and you will have no problem staying here, you fit in well here and we want you to stay. Now surely they are pros and cons for you staying in town  but just so you know if you rank us high, you will match here. Now what other schools are you applying to?”   I sat there in my smart suit a little stunned, I had prepared answers to all the usual questions.  I had not expected to be courted, to be wanted badly enough to not even be interviewed.  My chief resident interview strated similarly after we looked at cute pictures of his baby girl..”Amy, everyone knows you and likes you, we want you stay here so I am going to give you the 5 min speal about why you should.” And the 5 min speal was not some standard thing it was obvious that it had been well prepared with regards to me…these people know me well, they have had 8 years to study me.  And part of my wall melted a bit I walked out slightly intoxicated by the idea that it would be so very easy not to break the cycle and just stay here….

and here we are back to where I melted four years ago sitting in a Ruby Tuesday where my dad handed me a check of early inheritance.  And I dissolved into tears and called the med school admissions office the next morning to declare my intent.

so here I am laying prostate on a table with my teeth gritted and my eyes stinging wanting so badly to just say…STOP I have had enough but not wanting to appear…weak.

It is  so easy to just keep going, to just circle around and around and around…

The safe house….

Today I went to the peds surgery conference. Because yes I admit I wanted FREE LUNCH.

Well there is no such thing as a free lunch at least not when you are me.

The lecture was crowded. All the peds surgeons were there, all the residents more than half the peds residents and all the peds medical students and the entire Peds ED staff. It was so crowded there were people on the floor…

The topic was led by a Sr surgery resident and was on Peds tramua. It was well done. I was sitting there eating my potato salad and turkey sandwhich when all of the sudden JKP my peds surgery attending (FROM LAST APRIL FOR CRYING OUT LOUD) stops the resident looks around the room and say A. L. (my name), what are the five Ps of compartment syndrome.  THere are like 50 people (no lie) in the room including surely some of JKP’s current residents and students for him to torture.   I had a big bite of my free lunch in my mouth and half mouth half cough “Me??” like an idiot. “Yes you!” he says with his big grin, “you can phone a friend if you want.”  “Um how many Ps are there again?.. ” I am racking my brain I know all about compartment syndrome but I don’t know if I can describe with only P words.  I know the symptoms the treatment, the causes.
“UM umm.. pain, pulseless, pallor…”  Coldness, coldness I think but I can think of a P word for coldness.  “Um someone can get the other two. ” I mumble. Here I am a fourth year and am being pimped by an attending in front 50 people and I get it wrong…how humiliating.  Of course an eager third year gets the last two…”polikothermia (coldness) and parasthesia” some kid who probably knows endless acronyms and couldn’t actually talk to a real human being or even treat compartment syndrome… but as I began to think about it more I took the compliment.

As I left and wandered back to Peds Cards Clinic I realized something scary…

JKP likes me which may seem terribly contradictory because I really was a terrible surgery student not because I couldn’t suture quickly to save my life but because I lacked confidence. But the reason he likes me is because I wrote an essay about my last day as his student( http://wakeelf.livejournal.com/2008/09/23 ) . And because I spent time with little girl who was very, very terrified one Friday pre-operatively after I left the service (long story). He found out about this after a Mom told him on a follow up appt three months later.  He e-mailed me a thank you note.

For those of you outside of the profession if you get pimped (asked a question) in a room full of 50 other people by an attending currently not your own one of two things is true. 9/10 (in places not cut-throat) that attending thinks you are awesome (he might think this see above) or really smart (not true). For that attending to be in another specialty far, far from  yours of interest means he really, really  likes you if he actually knows your name. Or occasionally an attending will do it TRULY because he/she doesn’t like a student but its rare. So yes we humiliate people we like, as a weird medical compliment.. and you wonder why doctors are so messed up…

Here is the thing at my current academic home of 8 years.  Everyone knows my name. Not just JKP. But all the Deans, the head of my dept, the program directors.  I am never that kid they had on the service three years ago.  Its not because I am so great, its because I have been here forever and I am only the med studednt ever to go all four years here with a disability.  Generally I am well liked, well supported and safe. So safe, no one doubts rather I should be here, no one thinks twice about a doctor in a wheelchair or amplified stephscope in the peds cards clinic.

I have been scheduling interviews and dreaming of  moving on.  In my heart I know this is right. But today I realized its going to hurt. More than I realize. Because the outside is not safe.  Everyone does not know my name. Everyone does not respect me or my existence.  Out there there is no JKP or Dr. O or Dr. J to fight on my behalf or even cheer me on.

Outside I am still a questionable admission….outside I am chronically ill, pre-existing condition, idealist, non-conformist who came into medicine knowing who she was and had little interest in fitting into some medicine mold.

Am I ready for that? Am I ready to leave this safe harbor I have sailed in for 8 years?

Read the rest of this entry »

….all grown up.

Its been a while. I should probably write about my surgery and I will some time. It went well, recovering in Roanoke was fantastic. Now I am back in Wisnton and life is very well difficult.

DO you remember what you wanted to be when you were five? eight? fourteen? twenty?  I do. Teacher, writer, doctor, missionary (/doctor).  In academic international medicine I will get to be all four.  In six months I will have achieved the three out of the four and the fourth halfway on a shorterm basis. I”m a lucky (blessed) young woman.  Its not that I found my niche in the world, although I did.  Its not that i have some high and mighty calling or endless ambition. Nope that is not why I am lucky.

This weekend I am helping lead a retreat for young adults with disabilities and chronic illnesses. I just got the schedule. The theme of the weekend is WHEN I GROW UP.  We are asked as staff and campers to bring a COSTUME of what we want to be when we grow up for a special banquet.  There  is only one other disabled staff person who I have ever met working at this camp. She is very nice, smart and pretty. She lives in her parents’ basement and volunteers at the hospital where I learn medicine. So its the two of us plus 40-60 other 20 somethings/late teenagers with disabilities in a room dressed as our greatest ambition.   I am sure most everyone will bring something or make it at camp. I am sure nearly everyone will dress up for the big banquet.  I just have one question…one thing that makes me put my face in my hands and feel very alone and yet very lucky.  I won’t be wearing costume and honestly I might be the only one.

Today I went to my first physical therapist appt in Winston. It was a nightmare. They were unprepared, lost my transfer paperwork from Virginia, had not processed my insurance correctly. But what really got me was they did not understand how I could possibly have a full time job and be recovering from a hip replacement at 25.  They didn’t understand that I have to be in clinic at certain times.   It was odd to them I was not on medicaid and had complicated out of state insurance (because the blessed school’s policy will not cover birth defects). They looked at me like I had seven heads when I told them no I can’t be there at 10 in the morning or 1 in the afternoon I have a job.  and yes a disability.

You know for the last three weeks I lived like I am supposed to live according to my society. …in my parents’ basement.  I didn’t cook a single meal, my Mom did my laundry, my Mom picked up stuff I dropped so I would not have to struggle to not break hip precautions, my Mom or my friends drove me around for the first two weeks.  This is how most of my friends live (NOT ALL). Oddly enough we never had a single problem with my insurance, I got therapy for proper amt of time each week and everyone talked about how freaking inspirational I was.  Funny how well everyone plays around when you play the part they expect you to play.

Being the only one in a room full of disabled people ….its awkward.  I didn’t wake up one day and decide I am going to be the one disabled kid who moves out of their parents’ basement. I just grew up, went away to college, chose the career of my choice and lived my life.  I’m not a freak, I’m not a pioneer, I’m not anything particularly amazing. I am just a 25 yo almost doctor who happened to be born missing a few nucleotides.  My parents aren’t superheros, my doctors aren’t brilliant, we all just missed the memo about the whole disability checks, medicaid basement thing.

My life is difficult but it only compounded by a society that just can’t get over the fact that I became who i wanted to be when I grew up.  And not despite of my disability or because of my disability. But because that’s what I wanted and that’s what I worked for.

Today I heard the sound of a heart that was born backwards (transposition of the great vessels) but corrected almost normal state by human hands. Doctors’ hands.  Today I finally began to master heart murmurs and laughed with a little kindergarter and teased a young man with Downs’ Syndrome about his girl friend.  And I loved it.

so on Sunday I will put on my scrubs and my stethoscope and my white coat and my hospital ID badge with my name and date of graduation there in small block letters.  And no I don’t know what corny, inspirational thing I will tell these young adults this weekend other than this: I am so happy being a pediatrician, I don’t think I could ever do anything else.  And our social norms suck…ignore them.