In Kenya we had one ventilator:

We had to fight off the adult doctors for it. Every time one of our kids was crashing, we rushed up to the ICU and talked to my dear mentor and friend Dr. L  (med/peds) who ran the P, N, M, S, etc- ICU and figured out who needed the vent the most and who had the best possible outcome. Sometimes our kids won. Sometimes a premature a baby would win. Sometimes the big people won.  The decisions were daily, the stakes were high, people lived and died off our decisions. Sadly none of the children I saw ventilated  made it back to the floor or nursery.  We had very little.   In fact, I was there when the Haiti earthquake happened and we all watched the news and had ICU envy….the Haitian patients got flown to FL….we wondered where were these magic planes to the land of opportunity last week when the one ventilator ICUs of Haiti were deciding who lives and who dies and where were these magic plans for Kenya?

In the TCC, a step down ICU for children who have tracheotomies and/or are ventilator dependent we have infinite ventilators.  We have ventilators in the hallway, in the corner, we have back up ventilators.  We have BiPAP, CPAP, pressure control, volume control and I am fairly convinced that somewhere in the back closest somewhere we have ventilators that makes you fly.  I spent the first two weeks of my pulmonary month among  children who would never have even had a chance at THE ventilator, some who outside of the world of shiny ivory tower of the best pediatric care in the world would never have made it even in the West. But here they are still breathing, still hoping.

Some of these children melt my heart, one is 7 yo and lives at the Children’s hospital. He goes to school a few miles away every day on the bus, he is in the first grade, is crazy about trains, Star Wars and people.   He is abandoned and on chronic TPN (IV food)  so other homes for medically complex children won’t take him.  So he lives with us,  Child Life,  nursing assistants and the occasional on-call resident are his play mates. His nurses, teachers and fellow patients are his family.    I am broken for him. SO happy that we have the technology here that lets this beautiful soul grow up and learn how to read and go to the zoo and meet his first girlfriend. But my heart is so broken that as a society we have no place for him.  We saved him but we don’t want him.

I know about not being wanted…because you are different..my sweet babies in Romania have taught me about that.

There are some others like my friend.  A 29 yo math genius with a neuro-muscular disease who can talk by moving his eyebrows with stickers on them.   A much beloved boy with spinal bifida who loves sports and whose family is devoted to him.

But then there are others who I don’t know what we are fighting for….their lives are nothing but the sensation of pain and struggling to breath.  One baby has an inoperative congenital heart defect and is bleeding from her gut. We can’t do anything for her except keep her on a ventilator, we can’t make her better and her parents refuse to withdraw care.  Another had a devastating brain injury and has no higher brain function and limited brain stem function considering he is still on a ventilator.  He seizes, winches in pain and rarely opens his eyes.  Just because we can save them all…does it mean we should……

….am I too bold to suggest we should let children die…. and am I a terrible pediatrician….should I turn in my white coat and quit now….

what I learned from the ONE ventilator is that with technology comes great responsibility….in the states we don’t always remember this because we have so much technology that it seems like an unlimited resource. But we have other resources that can also be unlimited that we must not forget: suffering.  We doctors have a commitment to alleviating it.  There are many forms of suffering. There is physical pain, grief, hopelessness and anger.  Children dying is not something we talk about in America.  We have insulated our selves where technology can stop death,  we can beat death. But what if that is not the goal?  What if at the expense of saving ourselves, the parents, etc the pain of grief or loss or separation, we buy a child, an innocent child a life of nothing but pain?  Did we do the right thing?   And who did we do the right thing for??

We have a responsibility as pediatricians to our patients and sometimes I think as I get paged to the TCC at 2 in the morning for a seizure or child being coded or nearly coded. I sometimes wonder in these children who know nothing but physical pain that they are crying out, screaming,  begging, please let me go. Its ok, this is what should happen.  The best way to save me, to love me is to let me go to Jesus.

But I of course pull all stops. I race downstairs and hope to God that we can just make it till morning when the meeting of the minds can tweak the magical ventilators that make dead babies fly and beat death again.

…..after the crisises of the night are averted or as I get in my car post-call in the dark parking garage and have a chance to think I can’t help but wonder if the children we tweak and play with as our own lab of physiology would make the same choices for us if the situation was reversed.  And I wonder if the children we save that society doesn’t want would offer us the same gracious welcome to human family.

I shake it off and pull out into the sunshine and think about grateful African mamas hugging their dying babies who can’t be on the one ventilator but are so grateful for the palliative O2 and prayers w offer  and my Romanian babies reaching out from their cribs as I tidy up at the end of our play session.

And I know one thing for sure,  these children understand grace, mercy and loving thy neighbor far better than I do.  I seat at their feet and learn.  And yes I think in so  many ways I learn more from them than from all the ivory towers of medicine combined.

I am still that navybrat inside. I am still a homeless  nomad always in search of my next adventure. Or so I thought till I moved to the Midwest.  Yes my house was unpacked within 48 hours of hitting Ohio soil.  Yes by the time orientation started I had all my paperwork in to the state of ohio,  been to the grocery store and had house plants. I transplant well.  My family is still  like a moving machine.

But the difference is I am homesick. For first time in my 25 years of moving. I am truly homesick. Its not my parents, its not my school, its not even my friends that I miss. Its the sameness.  Its the culture. Its the manners: the thank you m’am, No Sir, hold the door open for a lady or a baby stroller every day occurrences that I have taken for granted.  Its the sunset over the mts in the summer all lavender and deep blue blending together. And its also the ability to get in my car and be at the ocean in 4 hours or with my grandparents in 4.5 or nearly all my best friends from college/high school and my family within 2-3.  Its the anticipation of basketball season even as early as July.  Its the accent, deep, slow and quick to laugh like a summer afternoon.  Its the people walking their dogs and waving at you while you water your plants. Its the neighbors who don’t need a reason to walk on over and shoot the breeze with when you get your mail. Its the check out lady at the grocery store who tells you about her dreams of becoming a famous artist while she rings up your ground turkey and bananas.

These things leave a hole deep down.  A hole that cannot be filled by amazing ice cream or my awesome, new friends who are just as nerdy and in love with pediatrics, global health and board games as I am or the best farmer’s market I have ever been too or a faith based pediatrics clinic that I get to be a real pediatrician one half day week for the next three years or my cute little emerging church…..

And I realize that I am no longer a nomad.  I have a home.   And its sort of rocks my world.  Because being a nomad is who I have been for 25 years.   I realize that for the better or for worse some time between 10th grade moving to Roanoke and May 17, 2010 graduating from Medical school.  Western NC/VA (very similar although unique in their own rights) became home.  Somehow the southern drawl, the BBQ, the outdoorsy, laid back, sweet tea, banjo music and James Taylor with a touch of class up Roanoke way has taken root and its not going to be able to weeded out by Ohio or probably anywhere else in the future.

It doesn’t mean that I am not glad to be here. That I don’t wake up and pinch myself that I get to learn pediatrics at one of the best (if not the best) children’s hospitals in the world.  Because I am still doing that.

It just means that when people ask me where I am from, for the first time in 25 years…I have an answer.   And it an answer that fills my heart with longing but also a sense of belonging, of being from…

And I think that doesn’t mean I won’t thrive anywhere, that I won’t thrive here, it just means I have a home.

and I didn’t know I needed one.  But I think perhaps I am a bit more whole now that I have one.

I love Wake Forest.  I have the t-shirt, the hat, the flag, the tie-dye!, the key chain, the bumper stickers and the license plate border.  My new car is gold and black.  I sing the fight song and the alma mater and I of course detest UNC and Duke with my soul.  And while Medical school was not always a bed of roses and rainbows especially in terms of gimpness…I stood up for Wake because I loved Wake. I was happy there. Whatever you do don’t mess with my Wake.

Then in a strange series of events I have been pursued and recruited by one of the best pediatric programs in the country (perhaps the world!) which is NOT Wake Forest. And I work here now (or at least orienting now, work on Monday.  The rose colored glasses have come off.

Here I am not a freak. I am not an exception.  I am not even a pioneer. I am number FOUR. I am the fourth resident with a major disability to come through the program.  After I matched I sent an e-mail explaining to the program directors and chiefs my story and what I would need.  They e-mailed me back thanking me but surprised of course whatever  I needed was mine to have.  Everything is accessible. There are  other disabled employees that I see every day working at the medical center. And there is another intern in my year who also has a milder connective tissue disease and disability.

Beyond gimp life, the culture here is ALL about collaboration.  I thought wake was team oriented then I came here where everything is about communal learning.  The culture is phenomenal both for us and our patients. They invented and are perfecting family centered rounds….its so great.  (we round in the room with the family participating).

And I have been a patient…yes already.  I was seen in the connective tissue transition clinic. It was the most enlightening doctor’s appointment I have had in a decade.

Its AMAZING. And I wonder why in the world did I put up with the crap I put up with at Wake…but I love Wake….::::trembling lip:::: I find myself looking back and thinking why oh why did I allow myself to go through the fiasco that was the ED (even the peds side) or the procedures curriculum or allow a gross HIPPA violation of my records to occur, or faculty to say rude things about my disability.  Why didn’t I stand up and say SHUT UP and let me learn.

I have no regrets. Not really. I love Wake but I now understand that my expectations for disabilitness and medical culture have been lower by medical school.   Wake has a loooong way to go.

But I still love Wake. But now that they don’t control my future.  You better believe that when I return in September as a guest lecturer I will be looking for ways to encourage them to keep going.

Now if I just get of my intense anxiety of not being smart enough to be here…life would be sweet.

For the first time (because I have been here since I left home at 17) I am transferring all my medical records, finding new doctors and making sure I have all the checks in the boxes before I transition up to my new place in the world.  Its a comedy of errors.  I e-mailed the peds ortho folks at Childrens about where to go as an adult with Skeletal Dysplasia (SD) fully expecting a list of adult doctors. Instead I got the clinical geneticist working me in next month to the TRANSITIONAL SD clinic that see adults with SD at Childrens. Initially it bothered me that I would go see the doctors at work considering what happened here. But I figured this was such a good thing…right I mean they know all about my disease unlike other adult docs and its one stop for ortho/rheum/general medicine/PT.  One of those cool, trendy, state of the art inter-disciplinary, holistic sort of places.

I have been going to the doctor and gathering records all week to fax to this new doc.  Today I nearly had a melt down.  I had made an eye appt a month ago…they are extremely hard to come by.  I get there and turns out instead of the resident clinic I have been placed in the optometrist clinic.   In theory most medical students can see the optometrist but  this medical student has connective tissue that makes a tissue thin retina that may  rip itself to shreds one of these days.   Tomorrow is my last day of school and I am leaving the country the day after graduation.  So for the first time in my life I flash my ID and say YOU HAVE TO FIX THIS RIGHT NOW.  And they do because I am almost a doctor and I looked like I was going to cry.  They put me into the walk in emergency clinic. I walked back to the waiting room wondering why am I so unglued?

I go up to medical records and am greeted by a somewhat bored and dour clerk who seems seriously put out about the fact I want four years of records copied and released to me.   Why does this all have to be so difficult?

I packed all evening filling my boxes with dishes, glasses, pictures and books and pondering.  I then went downstairs and while I was folding my favorite pair of fuzzy pink PJs pants I had a moment of shocking clarity.   I DON’T WANT TO BE A FREAK SHOW ANYMORE.   Yes my doctors here don’t know Kniest Syndrome from RA half the time and its great. Because they do know medical students and fractures and chronic pain. They don’t parade me in front of every student, resident and fellow in the tri-state area.  That’s what I remember about being a child and going to the doctor being a complete freak show.  (never mind that in Feb I lived the dream and worked for the freak show as a medical student).  I like the anonymity of just being a young adult patient. I like that internists are not squealing over some weird genetic disease. I like how we solve my problems as a team because I know more about my diagnosis than they do. I know that’s bizarre and ridicilous but its true.

But its time of course me to suck it up and be grateful that I have the chance to have access to such good care and know that while the medical education system makes me feel like a freak show as a patient it is how I got to this point as a doctor.

Its a give and take situation.

Because I am sort of a global health nut and because Dr. B who happens to run the medical school likes me I got asked to go to the OTHER GLOBAL HEALTH DAY and speak.  OTHER being code for where we raise money for the new global health program. It was in the medical school board room.  It should be noted that I had to ask directions to the medical school board room. It should also be noted that my two compatriots were in suits.

The table was set  formally. It had ALL THE DIFFERENT TYPES OF FORKS.  There were three.   3 forks!!! 3 forks to raise money for people with no forks.  It dripped of old south. We had sweet tea with lemon to drink, three courses, key-lime pie and a waiter for the main table who was quite sadly one of three African Americans in the whole room. There were name cards.  I set next to Dr. B at the head of the table.

Most of the attendees were older than my grandparents. . They were retired physicians, people with foundations to their names. And there was me staring down at my forks in my kanga wondering how bizarre life is.  And thinking that I felt more at home in a Masai hut made from cow dung and mud drinking chai with flies than I did in this room in the heart of  my school, in my country.

I spoke, sat down and pondered about trying to describe this scene  to the Kenyan mothers who had braided my hair and trusted me with their babies. What would I say?   Well a bunch of rich white people got together and ate too much so other rich white people could go and take care of babies.

They would stare and laugh. And say doctari nywara your country is a strange place with strange ways.

and I would say.

ndio ndio.

STOP. STOP. STOP.

For just a moment I would like to bask in the moment that I am done with school for all intensive purposes.  Other than three weeks of casual lectures. I am done with medical school.

No more exams, no more adult patients, no more surgery rotations!!!

and now that moment has passed. now we move on to whats really important when you graduate from medical school at 25…becoming an adult.

A real one.

I am bad at it.  For starters…life has been prolonged series of camping trips since well birth…  I go somewhere, I sleep there for a while then I move on. I don’t know what color I want my kitchen or what kind of slip covers I want or where one even really goes to furnish a house… When I imagined myself as a grown up…I imagined a small soviet bloc style apartment or small falling down African house/flat filled with a lot of ethnic art, books, photographs, doctor stuff and stock piled peanut butter in rubber maid containers next to the rubber maid containers of Gideon bibles (in a language that only i speak) and buttons that misguided yet well meaning churches send me and I use as coffee tables. Eventually there will be a husband and kids smooshed in the tiny, tiny flat  too.  I have no idea how to set up house in America especially as a doctor. Apparently doctors are very respectable and have color coordination and matching hand towels. Why didn’t they cover this in medical school?

Insurance…well I have been uninsurable off of my parents’ insurance up to this point. All I know is insurance companies hate me because I was born gimptastic.  There are now like mutliple plans that all cover me now because I have the title of doctor and I work at Childrens.  How do I choose? What’s the difference? Can I just barter brownies for hip x-rays? Is that an option?

Money…never had any of my own…ever.  What little I did have to my name I spend on plane tickets for “camping trips” and food. I have no idea what one does with money that does not go to eating…apparently  one goes to IKEA and buys sofa beds…thats what my Mom said to do.  Then there are taxes and my student loans according to my Dad eats up the rest of it.

Well I have been an adult now for four days. I think I am done. I am ready to retire.

1. I will be a DOCTOR. No really I will be a D O C T O R. Its not that I can sign all my own orders. Its I HAVE TO SIGN ALL MY OWN ORDERS. I am ultimately responsible for real live children. (ok so yeah I will have back up but seriously I am the person who gets called first….do I really know what to do when some kid is not breathing well or has a seizure or tries to die at 3 AM….)

2.  Every time someone in authority over me at school introduces me these days they say this is Amy she matched at a premier pediatrics program.  Every time they say that I think to my self…HOLY BANANAS.  I am going to be a D O C T O R at a place where all my peers are going to be ridiculously smart and probably know exactly what to do when a kid tries to die at 3 AM and they are on call.  They are also probably AOA (smart, smart med student honor society) and have cured some childhood disease to get in. Basically I am not the brightest crayon in the Wake Forest Box…but in the new box I am going to be surrounded by a LOT OF BRIGHT CRAYONS.

3.  I am a big crayon in the Wake Forest box.  I am not trying to sound arrogant but its true. Everyone knows me because I the only gimpy med student, because I have been here forever, because I give lectures about disability to all the underclassmen, Because I bring back cool pictures from far off lands, because the Dean of Academic Affairs and the Dean of the Faculty like me (because I am the only gimpy med student).  I am going to a place where I will be a very small, very dull crayon.

4. Everyone I regularly rely for support and spend time with is not coming with me and 90% of them won’t be here when I come back to visit. My friends are scattering to the four winds.  I am leaving my family behind as well.

5. I will not have a roommate next year barring divine intervention.  This will be a HUGE adjustment.

6. I am moving somewhere where it SNOWS and I have to get up at 5AM and scrape  my car.

7. I am going to be q 4-5 for 8 freaking months. Will my joints will handle this???  I have no idea. Honestly, what the heck was I thinking? Why could I not be content with some small peds program somewhere with 4-5 months of call as an intern. Why do I have to be so freaking Type A???

8.  Panic…panic…panic….

9. :::intense desire to hide in the tunnels under Wait Chapel and just not graduate:::

10.  Whats the dose of epineprine if my kid tries to die at 3 AM???

:::::Frantically searching for Pediatric Advanced Life Support Book:::

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)

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…

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…