Nurse

Last week I was accepting a transfer patient from a surgery service. The notes were terse, which is both good and bad, and there were abundant notes from consultants that were hard to decipher. But no summary note. No list of the patient's active problems. I couldn't even figure out why the patient was no longer a surgical candidate based on the notes that had been left in the chart.

So I called the resident. I had to dig a bit before I found an actual extension to call.

And he was very polite! Gave me a fabulous summary! Clarified everything!

And then he asked me if I was the patient's nurse.

I wasn't offended by this. As a medical student I know way WAY less about most things having to do with the nitty gritty of patient care than the nurses do. I rely on them to give me updates about my patients and to care for them. And frankly, I am lower on the totem pole than everyone in the hospital. Residents, nurses, nurses aids. Even the people who clean the toilet.

But I still tell the nurses what to do. It's been a weird transition for me since they know so much more than I do. It feels weird for ME to tell THEM what to do. But it is what it is. That's just how things work in the hospital.

And I do know some things better than they do. On occasion.

Well anyway, I wondered why this surgery resident had thought I was a nurse. So I asked him whether he'd thought that because I was female.

I immediately regretted my inquiry. He was embarrassed, and got kind of terse after that.

So I apologized and thanked him profusely for his help.

But truthfully? I think that WAS why he'd assumed that I was a nurse. It's weird. On one hand, I have enormous respect for the nurses. On the other, I want people to realize that I am (or will be) the DOCTOR. It feels disrespectful to the nurses in a way to feel that way, but when it comes down to it, as awesome and invaluable the nurses are, the doctor is fundamentally the "boss."

After all of this training? I want the respect of being the "boss." Not yet, but eventually. I want people to know that I'm the doctor. Not to assume that I'm the nurse because I'm the woman.

Is that incredibly snotty of me?

Complaining

People complain incessantly about the costs of health care. Justifiably, don't get me wrong. They'll say that the $1000 for the ER visit is "ridiculous" or that the $360 paid to the orthopedist is "insane."

So let me ask you, what DO YOU THINK the "right amount" is? And for simplicity's sake, let's make it this:

What do you think your annual gyn exam should cost you, the patient? What services should that cost include? How much should you pay each month for birth control pills?

There is no such thing as "free."

Scut

5 days down, 23 to go.

It really isn't so bad yet. I'm not carrying 6-8 patients yet (only 4 right now) though so we'll see how I feel when I have that many.

I actually (gasp!) kind of like it. I love being busy. I like thinking through the assessment and plan. I'm getting faster at data gathering and doing the patient interview.

Scut just doesn't bother me. The only thing I mind is chasing after people to make sure they do their jobs. Then I feel like a nag. But if you don't do it, the job doesn't get done and badness ensues. I had to nag the nurse of one of my patients 3 TIMES to collect the patient's urine and do legionella and pneumococcal urine antigens. 3!! And she still didn't do it.

Unf***ingbelievable.

And don't even tell me that she didn't do it because I nagged. She didn't do it because she didn't do it. Period. And the overnight nurse didn't do it either when the nightfloat person told her to do it either.

My real estate agent was commenting the other day that I had a very pessimistic view of how things worked. In my view, you assume that people are going to lose important paperwork. That the mortgage company will drop the ball and demand things of you at the last second, even if they've known for days that they need something from you. That they will blame you if you can't get that pdf file to them RIGHT THIS SECOND because you're on call at the hospital. As such, I make sure I am hyper-organized (esp for the mortgage) and that I take care of everything immediately as it comes up. And I send "helpful reminder" emails.

I.e. I nag people.

My agent wondered why I was like that.

I told her that me JOB was to nag people. That I spend all day at the hospital following up on things I've told people to do, and then tell them to do more things. And then I document them. My job is to get things done so that patients can leave the hospital before we make them sick (again). If you don't nag, patients don't leave and people die.

Badness.

Anyway, so far so good. My only complaint is that I feel tired when I get home. Very tired. With no escape. Intern year will be hard just because of that. It's hard knowing that you have so little time off and that there's nothing you can do about it. I think that's what's most oppressive about it.

Glass Half Empty, Glass Half Full

Half Empty: I know very little.
Half Full: I'm learning so much!

Half Empty: I didn't get dinner tonight.
Half Full: I didn't notice until just now.

Half Empty: I was on call tonight.
Half Full: I am home now.

So far so good

I've only had 2 patients so far this sub-i, but today I have long call so I'm sure that will change rather quickly.

The team seems nice! I still feel stupid.

I found out that I have the same resident a friend of mine did a few months back that she had a great time with. Well, great for a sub-i.

I suppose it would be poor form to reject his friend request on facebook. But then I won't be able to grouse!

My life is so difficult.

The countdown begins

28 days until I'm done with my Sub-I.

That's 4.667 six day call cycles, 2-3 overnights, and three days off.

My days should be typically 10-11 hours long. Except on Long Call days where they will be 12-16 hours long. Or so.

I'm really not looking forward to it, but at least it will be over in less than a month. Also, the fact that I like neurology and don't have to go into Internal Medicine as my backup will hopefully make me feel better about the whole process. Even though I'll still have to do an intern year of IM if I go into Neuro. (Just thought I'd head that one off since I know there are some know-it-alls out there.)

Internal Medicine -- consider yourself warned. If you want me, you'll have to prove that you (and everybody who practices you) don't suck. You are on notice.

Let the games begin.

Why I never go shopping with my friends

I don't like shopping all that much. I don't like having my friends check my body out when I try on new clothes, silently comparing theirs to mine. Later, commenting on how I need "more meat on my bones." Judging me for how I spend my money. Thus when I shop, I shop with my husband or myself. But never with my friends.

Back in 2004, I decided to break this rule. I went with my friend MG, who I used to work with. She was nice! It was fun! We went to MAC, which I'd never been to before. I purchased non-cheapo makeup for the first time in my life. Then we went to J Crew and I bought some shirts to wear at work in the summer. I hadn't gone shopping for summer clothes for at least 2 years, and it was time for some new stuff. I still have some of those clothes now.

Come to think of it, I have the makeup too. I suppose that's not very hygienic. Hm.

I think I spent $300 the whole day. Probably $40 on makeup (MAC is not cheap), and $260 on clothes.

My friend bought $100 of makeup.

When we returned to work on Monday, I caught her gossiping to the other women in the office about my extravagant tastes. About how much money I had spent. About how SHE had never spent so much on clothes in her entire life. How rich I must be.

And then she turned around and told the same thing to my face.

I'm not sure how, but I managed to bite my tongue about the fact that she'd just dropped $100 on makeup. And we won't even go into the thousands she spent on various alternative medical remedies and herbal supplements that had no scientific basis whatsoever.

I don't know. Is "trashy" the right word to describe what she did?

See, when it comes down to it, most people are assholes about how everyone else spends their money. As such, it's best for nobody ever to know. Particularly in med school when the majority of people are bankrolled by their parents, but feel the need to make snide comments regardless.

And this is why I prefer to shop by myself.

Stupid

Though I liked neuro, I feel like it gave me a complex. There's always something I miss. Some detail of the exam that would bring the whole picture together that the patient wouldn't comply with on my exam, or something they'd not tell me -- but then would tell the attending. I really tried to do a good job, and the residents were very patient with me. There was this one attending, though. I am sure that man thought I had to have been the stupidest person on the planet.

Things got particularly magnified when I had to present directly to him without going over the patient with the resident first, which happened with increasing frequency towards the end of the rotation. I guess on one hand it's like, "Yay! They think I'm competent enough to do this." But really I feel like they just didn't have or want to take the time.

Consequently I got the sarcastic grilling routine when I presented to this one attending. I tried to ignore it, but it made me feel incredibly stupid. I wanted to say, "You know what? It's true. I'm nowhere near the level of the JAR residents.... WHO HAVE THREE YEARS OF EXPERIENCE MORE THAN I DO." But of course you can't do anything at all in these situations except pretend you don't hear the sarcasm, and throw cheerfulness and happiness back in their faces.

The thing is, he was often right. I did miss things or misinterpret things on occasion. How else am I supposed to learn, though?

He'd walk into a patient's room after I did an exam with the attitude that he was going to have to show me all the things I screwed up. Yesterday he said, "Huh, I guess he IS a little weak on that side." I was like, "That's RIGHT motherfucker!" But then he proceeded to lambaste me about a teeny-tiny point of the exam that actually had nothing to do with the original question and that we'd been asked to address. Was that really necessary?

God. Is this what learning to be a doctor is all about? Feeling stupid all of the time? AM I really incompetent? I don't want to mess up and hurt my patients because I don't think to ask them something important or because I can't get their freaking brachioradialis reflex. And I know without close oversight (and probably even with) that will happen sooner or later.

I think about knowing even less when I return to clinics after PhD in 4 years and it makes me want to quit. I will have to go through all this AGAIN and more when I come back. I don't know if I'll be able to take this abuse and the feelings of inadequacy when I start residency at age 37. 37! The rest of my peers will have been attendings for at least 5 years at that point!

It's just too much.

They

"I've already answered these insulting questions 10 times!" my patient complained yesterday to me as I administered the Mental Status exam. "Why can't you people ever talk to each other!"

The rant had to have lasted for at least 5 minutes. I'd try to get a word in and he'd just cut me off again. I think he was just embarrassed about his deficits, but still. God I hate it when they complain about this. It's not like I'm going to say, "You know what? You're right. I don't REALLY need to see you. I think I'll go and have a coffee instead."

I want to say, "Well, the sooner you shut up and let me examine you, the sooner I'll be able to let you go back to sleep," but instead I sit there and wait until they're done with their bitching and try to remain cheerful and pleasant. Try not to rise to the bait.

This time it paid off. When I came in to see him this morning, he was pleasant. And he apologized for being rude to me the day before. He'd been tired and continually harassed, he told me. I know, I said. The hospital is not a place of rest.

Did you hear that, people? He APOLOGIZED. Better mark that one in your cynical record books.

See, because on one hand, certain types of patient interactions really grate on me. But then every so often you get a patient who really surprises you. Who is a really good human being. Who makes you smile. Who makes you happy to be there at 4AM helping them.

Well, maybe not at 4AM.

*****

Next door I heard one of the surgical interns twisting a patient's arm to go to physical therapy. He'd been refusing for some reason, probably in an attempt to assert himself. To take some control back that he'd relinquished by being in the hospital for so many days. The resident told him if he didn't go to PT that they'd send him to a nursing home. He didn't want that, did he? He wanted to go home, right? The resident dangled.

It seemed coercive and kind of mean. I'd heard the nursing staff and the PT staff talking with this patient before, nagging him, but not listening to him. Nobody ever asked him why he didn't want to go to PT, they just took the position that he was being obstinate and treated him like a 5 year old.

The thing is, I see that temptation in myself. To get coercive and confrontational with the patients when they don't want to comply with my exam. I see plenty of examples of this style in my superiors as well. It never works at getting the patient to do what you want them to do, but it can sure be cathartic. And then you get to go back to your peers and talk about that awful patient in room 375.

*****

An intern I know who is going into Radiology asked me what I was planning on going into. "I hope you're not planning on going into Internal Medicine," he said with disgust. "Stay AWAY. Do Radiology. Then you won't ever have to talk to patients again."

"But I like talking to patients," I protested.

"Ha," he snickered, "Don't worry, that will pass. You won't after intern year, I can assure you of that."

I wondered if that was true. He's not the only one who's told me that. Will I get sick of talking to patients? Will I really wish I'd gone into Radiology? Will I lose my patience? Become like that coercive surgical intern I heard next door today? Stop seeing and/or being able to elicit the positive things my patients have to offer?

I hope not, but it's a possibility. With the pressure to go fast, it's a real possibility.

I know this shouldn't bother me

But it does anyway.

I'm not the sort of person who is a big planner. Who gets into a tizzy because my shelf exam is the week right after my best friend's wedding in which I am the maid of honor. A) I don't have that many friends who have gotten married, and B) I pretty much blocked out all of the time during my clerkships under the assumption that I would never be available.

Ever.

It was that in accordance with my life policy of never having anything conflict with med school ever, I made no plans during my sub-i. Except the house buying shenanigans which we are (allegedly) taking care of tonight with a power of attorney.

Still, we received our site assignments 6 weeks ago or so, with the corresponding call schedules. I had everything mapped out. I knew when I had long call, when I had short call, what days I had off. Everything. I had even contacted my resident 1 week in advance (as recommended by the course director) to verify when and where we were supposed to meet.

And so it was that today I received an email stating that I was assigned to the resident that the other medical student had been assigned to on our site selection sheet. And he was assigned to mine. And there was no reply when I sent an email back asking whether maybe the assignments had been reversed.

Not that any of this really matters anyway in terms of my plans for the next month, it's the principle really. What's the point of sending our rotation assignments out early under the guise of allowing us to plan our lives during the sub-i month if you're just going to F with everything at the last minute and give your students a completely different schedule?

Like I said. Not that it matters. In fact this schedule might even be better. This resident is a man, while my original assignment was a woman. Historically this has worked out better for me, so really this is a good thing and I should be happy.

Yet, it still grates on me. Why can't people have their S*** TOGETHER???? I feel like I am being penalized for being on top of things and proactively doing what I've been told to do.

And yes, my paranoia streak is telling me that if I say anything at all that it will immediately be interpreted as, "Old MD Girl is being rigid and inflexible. She is not a team player."

Because people suck. That is exactly how people in authority respond when the pee-ons ask questions about possible errors having been made.

Such is my faith in humankind.

Limited? Perhaps.

Accurate? You bet your ass.

Miss.Mrs. Negativity

I've been ornery lately, no? I feel stressed out about the house, stressed out about my impending sub-i. Stressed out about still not knowing what I'm supposed to. About starting my PhD.

It's all built up and made me pissed off at everything.

So, a few positive things:

1. Look at the weather! Sunny and 78 today.
2. Only 3 days left of neuro. Then onto sub-i. Then PhD.
3. The house buying process is going. I think it will be fine in the end, even with all the stress. I was thinking on my walk home tonight that soon I'll be walking in the opposite direction to go home. And that years from now, my stay in the fortress will be a distant memory.
4. I have learned a lot since last year, in the last month even. Even though I feel like an idiot a lot of the time.
5. I have at least one perfectly good option for what to do with my life from a medical specialty standpoint.
6. I finished a book this weekend! That had nothing to do with medicine!
7. My hair has finally grown out and I like it!
8. Once PhD time starts, I'll probably have time to swim again.


Ahhhhhhhhh.....

Just typing this list made me feel more relaxed. I am smiling now. Promise.

Passive Aggressiveness

Is what I disliked about internal medicine the last time around, and is what I suspect will be the deal killer for that field for me.

So we get an email regarding the mandatory or else orientation for our sub-i today. Previously scheduled at 4:30 on Wednesday, I had planned my life this week around this. Making appointments, canceling others.

And now it seems that the orientation has been moved to 8AM that same day. Do we have any conflicts with that? Are we available?

Hmmm..... Surely she doesn't really mean that. Of course she realizes that we must have conflicts. We are all doing rotations now, aren't we? And no rotation ever starts later than 8AM.

What she really means to say is, "We have changed the meeting time. Mark your calendars and be there or else." But that would be too direct.

It's such bullshit. None of the other course directors operate under the assumption that their rotation is more important than and thus supersedes any other rotation. At least when the meeting was going to be at 4:30 there was a possibility that you'd already be done for the day for whatever rotation you were currently on. Even though that never actually happens.

Annoying.

What I wrote back was, "Not sure what your definition of 'available' is. I am doing a neuro externship right now, and usually we have conference at that time and see patients right after. It's probably ok if I miss conference, but I ought to ask first rather than just disappear."

Part of me worries that I will be flailed alive for insubordination, since I know the expected response was, "NO PROBLEM."

God I hate medical school sometimes.

HGTV

Do you ever watch HGTV? Those shows that teach you how to present your house to potential buyers? The hosts always get the sellers to completely depersonalize their houses. Remove all photographs. Paint the walls white. Make all the furniture beige. Remove all signs that actual people live in the space.

B.O.R.I.N.G.

But I suppose effective for the typical buyer.

I was reminded of this show when Luca and I were looking at a house in West Philly a few weeks ago. In the atrium were two antique signs:*

The sign for "Whites" pointed back out the front door.
The sign for "Coloreds" pointed into the house.

I thought it was pretty clever.

I chuckled a bit to myself at the thought of the HGTV ladies tackling THAT one.

Heehee.


*Not antique enough, unfortunately.

Stipend

I was talking with my mortgage officer about my stipend.

"Well we don't know if we can even *count* your income, since you're just a student," he told me.

"That's ironic," I said, "because my income is likely far more secure than anyone's that I know in the private sector these days, given the economy."

"But how long will you be able to get the money?" he asked, a note of anxiety in his voice.

"Until I finish my program. I've heard of people going for 10 years or more."

"BUT THEN WHAT????" he seemed concerned. Apparently he does not know how one becomes a doctor.

"Then I will be a resident and will make more money. Also, a very secure job." I said.

"BUT AFTER THAT, WHAT????"

"Um, I will be an attending physician, and make more money, still." I was confused. Does he think I am in medical school for my health?

Anyhow, it doesn't matter anyway because my husband has a decent salary and can pay the mortgage on his own, but it was just weird explaining the concepts of stipend, residency, and being an attending physician to this guy. Sometimes I assume everyone knows what doctors make, and what residency is (i.e. mostly guaranteed job/ slave labor).

Usually I guess I'm just used to people incorrectly assuming that doctors are rolling in money rather than the other way around.

Weekend

This is my last real full weekend before my sub-i starts a week from next Sunday. Then no more until late June.

:-(

But then the PhD starts. That, I expect, will be both good and bad. A mixture of release from not having to be on in the clinics at all times, and an Oh crap now I have to pick a mentor for real this time.

I have a couple of people in mind though. Given my apparent predilection for neurology, I probably ought to add some more to the short list.

Hopefully the sub-i will be as educational as this last block has been. Hopefully I like my team.

Hopefully I won't totally forget everything I learn next month, only to have to relearn it ALL 4 years from now.

I knew this would happen

That we'd end up closing during my sub-i. Buying the house, I mean. I've explained to my agent repeatedly that I am not available AT ALL between May 24 and June 21 and she seems to still think that I'll be able to run errands during that time.

"Can't you even get out for 30 minutes?" She'll ask me.

NO MOTHER-F***ER I CAN'T!!!

See, I know that it might in theory be possible on some day that I am on short call or post short to escape for 30 minutes. Can I guarantee it? Not even close. Can I ask for 30 minutes here and there? Not on your life.

What if I get an evil resident/attending? What if my resident agrees to let me sign my patients out to her and then disappears right at the moment of truth and I am stuck there? What if a patient of mine has a rapid response called 20 minutes before I planned to sneak out?

I can't plan for these things, so it's safest to assume that I will not be available at all that month. Why it is that people don't understand that "not available" means "not available." This happens all the time. Do they think I'm being difficult? Have they really never been in a situation where they literally had no control over their time at all and could not leave, even for important personal things?

My agent tonight said, "Well, this is important you know. It's not as though you're leaving for some frivolous reason. Buying a house is a big deal."

Yes thank you. I'm not allowed to have important things going on in my life other than medical school. Get it through your head, lady!

Anyway. One day I will be a big and important attending and I'll be able to leave if I have to.... say for the imminent death of an immediate relative (and ONLY once I am an attending and IF I have someone who can cover for me). Until then, the rest of you lay folks will just have to believe me when I say I can't just drop everything and leave.

Of all weird twists of fate

There are 4 second year med students on the neuro consult service and 3 residents. And me. So now I sometimes have one following ME around.

They look bored. I try to give them stuff to do that simultaneously keeps them entertained and helps get work done, but then they don't know what they're doing, or they drop the ball on something, so I basically have to do everything myself over again.

AND THEY SLOW ME DOWN SO MUCH.

Which wouldn't bother me, except they also act bored.

Part of me knows that I was probably something like this last year. But I know I never acted bored.

Maybe they're just not into neuro. That's just crazy! ;-)

Clearly

Residency is going to be a breeze. By the time *I* get there anyway.

This article in the NYTimes says so, so it must be true. Apparently, older people who are sleep deprived have fewer lapses in attention and doze off less often younger people who are similarly sleep deprived over a 26 hour period.

Hm. Well, here's hoping anyway!

I don't trust the mail

Last week, I saw two patients who had been going without their Parkinson's medicine for a week because of a snafu with their mail in pharmacy. Supposedly the next three months of pills were in the mail. But they had been for a week, and had still not arrived.

The patients were doing ok, but definitely had worse symptoms than usual from their disease.

It made me really happy that I've thus far refused to do mail in for my birth control pills.

Why would I throw all that money away, getting it at the pharmacy, you might ask?

#1 -- I can refill at the pharmacy every 21 days. This gives me a bit of a window, and I can build up a cushion in my supply in case I need to go 35 days some month because I am out of the country or forget to get more one month.

#2 -- The flier I got telling me how much money I'd save if I did mail-in said the following: "Get either a 28 day or a 90 day supply for X dollars!" But 28 x 3 = 84. So are they telling me that I'd be obliged to go without for 1 week every 90 days or pay out of pocket for another pack?

#3 -- I don't trust the mail.

We harangue our patients every day about medication compliance, but the truth is, even if you're perfect, you can still get screwed up by this system.

And god help you if you change insurances.

Home Inspection

We had the home inspection yesterday, and it went well. Nothing horribly unexpected, mostly just wear and tear that you'd expect on a 70 year old house. No deal breakers.

Though, there are a few things that we really ought to be able to get credit for on the price of the house. Hopefully the next round of negotiation will go smoothly. Keep your fingers crossed for me!

Neuro. And babies.

One of the things I like about neurology is that unlike in other specialties,* the residents allow you to interact with them as people. You can ask them questions when you don't understand and won't be treated with scorn. You can ask how they do things like balance their lives* and how they decided they wanted to do neuro. They'll actually give you a straight answer AND don't seem irritated.

In fact, one of the most useful conversations I had with a resident on this rotation was about the nuances of house buying and negotiation. Talking with her was what convinced me we were ready to make an offer.

The second most useful conversation was about childcare options.

It turns out, there is no extended hours daycare in West Philadelphia. That Penn daycare closes at 7 (which is considered very late), and that the other option closes at 6. And that it costs approximately $1200/month per child.

A babysitter (with similar hours) costs $2000/month if you pay her under the table. You pay more for babysitters who have impressive CVs, and about 30% more if you pay taxes on them.

An au pair costs less, but you have to have an extra room in your apartment/house. They are the most affordable alternative for people who need overnight coverage. The only downside is that you have to worry about them getting homesick and running away, abandoning your children in the middle of the day while you are at work.

And lo, I began to understand why people (residents) freak out about the cost of child care. Well, I actually understood before. But now I have concrete reasons.

Babies are expensive! If you don't have a stay at home spouse, I actually don't see how it is possible to have kids during residency. Unless you have a relative nearby who is willing to help. But frankly, I'd never feel comfortable asking my pushing-70 year old parents (one of whom can't walk so well) to come live in my house for a few years to take care of my kid(s). It seems like a lot to ask.

I know I'm not alone in this.

I will also say that I do NOT feel terribly sorry for attendings who actually make enough to pay for childcare. If they picked their specialty wisely. But then, most people don't become attendings until they are in their 30s. And if you took time off before med school you're talking mid-30s which gets kind of old if you've always expected to have a brood of 4.

I have never really wanted a brood of 4, so this is not an issue for me. And I thought about all of this in advance of medical school, so it doesn't come as a surprise. But it makes me wonder how many people really thought about this ahead of time. That they might have to have fewer children because they wouldn't be able to afford the children they wanted while they were in residency, and because after residency they'd be too old.

In my opinion, the solution is NOT to confront women (and it's always ONLY women) with this quandary at age 20, as a pre-med advisor at my old college used to routinely do with her female advisees. The solution is better daycare. Subsidized on site daycare. Flexible programs that do not engender bitterness among your co-residents for taking maternity leave. That sort of thing.

I think we're moving in that direction, but slowly. Very slowly. I almost feel like my situation is as close to ideal as possible: I have a non-doctor husband who makes enough money at his job that we'll be able to afford daycare or a babysitter. His hours will allow him to pick said theoretical child up in the evenings when I am on call during residency. Good thing I never really wanted 4 kids, otherwise we'd be screwed too.


* Such as medicine and ob/gyn
* Yes, all the neuro residents seem to have lives. With, like, kids and stuff.

Earth to me

It's been a stressful few months, what with me loathing my first two electives and trying to find a house. All things considered, I feel like I've been handling it pretty well. I'm still getting 7-8 hours of sleep a night, and have been sleeping like a rock. I haven't been exercising as much as I used to, but whatever. What's the point since sub-i month is coming up anyway.

But the thing is, I feel like I'm walking around in this fog all day. And when I leave the house in the morning, I have this neurotic feeling that I've forgotten something.

Something important.

You know. Like my pants.

And then I'll look down and see that I am not sans pants on my walk to school. However last week I did look down and notice I was wearing my brown shoes with my black pants.

What! It was dark. I was out of it. It was morning!

Oops.

I also feel markedly less self assured than I did this time last year on my Neuro rotation. Perhaps it's because I have *actual* responsibility now as opposed to last year. I even usually know the right answer. But the thing is, I say it in a way that makes me feel like I am guessing. I feel like I'm not my usual self. It's hard to describe. I'm just out of it.

So now I am forced to ask: WTF HAPPENED TO ME IN THE PAST 12 MONTHS TO SAP ME OF ALL MY CONFIDENCE? Wait nevermind. I know the answer to that one.

At least I can tell that I know more than the 2nd years. Thank goodness. If I know *enough* is the question. And the answer is: There is no such thing as enough.

Neuro

I remember one of the first times I thought I might like neurology last year. I was on the stroke service, and we were seeing a patient with multiple comorbidities who kept having TIAs.

One of the comorbidities was gout.

And he couldn't get colchicine because he had renal insufficiency. It was something like that anyway.

Rather than worry our pretty little heads about what to do about his gout (since figuring out how to keep him from having a stroke was a little higher on our list), we called a medicine consult.

It was awesome. Gout has got to be one of the most boring illnesses out there, and I didn't even have to think about it.

*****

So here I am a year later, and I still couldn't care less about gout. I still like neurology, and I even like the way that the neurologists talk to their patients. They are very concrete. It pleases me.

The only thing is I still have anxiety about how little I know, and feel not-confident about my assessments sometimes. I'll think, "This is a totally non-focal exam. This patient just has hyper[insert electrolyte of choice here]." But then I will doubt myself. Is that maybe a ptosis? A flattening of the nasolabial fold? Is that just weakness, or is that really dysmetria? I'm getting better though, and I like the definitiveness about it.

*****

As for "being able to see everything on CT or MRI anyway," what about Parkinson's? What about a polyneuropathy? What if you can see enhancement on MRI, but you still don't know what it is?

And it really doesn't bother me that a lot of the patients don't get better. I don't see it as all that different than half of the diseases Internal Medicine treats. Heart Failure, anyone? Diabetes? Lung Cancer? I think a lot of people feel uncomfortable with neuro problems and then decide on that basis that they hate it.

Anyway, just my two cents for today. I hope it continues on this well. Even my husband has noticed that I'm happier and more relaxed lately.

*****

The we are now to the counter of the counter of the counter offer. Still going strong.

*****

Tomorrow is my birthday. Wish me happy birthday!!!

House

Our offer is getting countered! Yay! They didn't reject it!

In other news, my husband has decided that I will be a neurologist. I think it was when I told him that my senior resident had to leave by 5:30 every day to pick his daughter up at daycare. Oh, and that he arrives at 8AM also. Of course this is the consult service.... so it's different inpatient.....

But still.

Thank you honey, for making these decisions for me. ;-)

In all truthfulness, I like it better than anything else I've done so far. I don't even mind reading about it.

The only thing I'm not fond of is when my attending pontificates at great length about herpes viruses. And I'm sitting there listening, and I'm pretty sure he's talking out his ass. Except that I don't know the literature very well, and I keep thinking, "I wish my husband were here so he could shut this guy up." But then I remember, he's the attending, and attendings never shut up.

We'll see. Outpatient is still not so exciting for me, but maybe it will get better when I do some myself.

This week

Went by really quickly. I really like my neurology elective, my only wish is that I got a little more variety in my patients. One more to work up/day might be nice too, though I think I'll try to spend more time in clinic next week, so maybe that won't be an issue afterall. My team is great though.

I also ran into a bunch of people from last year whom I hadn't seen in a while, which was nice. What a difference it makes to run into people you know!

Luca and I made an offer on a house last night. The sellers still haven't gotten back to us. Hopefully they won't completely reject it. They're asking way too much and we kind of low balled them. We'll have to see.

Of course as a result of my anxiety with the house thing, I awoke at 2:30AM and then lay there for 2 hours until I talked to Luca and he calmed me down. That's what husbands are for!

This weekend.... this weekend.... well, no house hunting at any rate! Maybe I can read some neurology and choose a topic for the CPC I have to give. Oh yeah, I have to give a 1 hour talk to some 2nd year med students rotating on the neuro service. I just hope my talk isn't incredibly boring to them. I have NO idea what it will be on at this point, though.

I've been thinking about my now self compared with my last year self. This time last year I was about to finish up my psych rotation. I had really enjoyed it. I was about to start neuro. I hadn't yet learned how to present effectively, and I'd just learned how to data gather. I guess I have learned a lot in the past year, even though sometimes it feels like I know nothing.

As for neuro, I have no idea whether I could do this. They all seem very happy and have nice lives though, and it must be nice getting to go through residency as a specialist. Specialist in 4 years..... something to think about.