A Bright Future in Scut

What a difference a week makes...last week, I was scutting twelve to fourteen hours a day, wondering if match day would ever come, and if my sub-internship would ever end.

This week, I'm on a very relaxed research schedule, waiting for Fed Ex to show up with my residency contract, and just generally enjoying life. Not that I don't recognize that internship is right around the corner and going to hit me like bricks in the face, but right now, I'm just happy.

Match day was good to me. It would probably be unwise to say here exactly where I'm headed. I will say when I told my old advisor where I'd matched, his first response was, "Wait. Say that again." I've gotten that reaction from quite a few people and it always cracks me up.

I don't anticipate getting an Ivy League attitude any time soon, but my dog is way out of control already. I caught him on ebay late last night pricing berets, cigarette holders, and a rollneck dog sweater. Oh well, I guess I'll let him enjoy it.

"Got a Job, Don't Know Where Yet"...Like the Title of a Bad Country Song

Got the official and cryptic National Residency Match Program Scrambler's Monday email yesterday. Nice subject line, by the way, if any NRMP people stumble on this post...keep the suspense up just a bit longer with that whole "Did You Match??" bit (and yeah, I did.)

Don't know too many other fields where it would be possible to say that you have a job but that you have no idea where yet. Not that it's a bad thing to know that my training is about to begin and my four year episode of hemmorhagic cash flow is about to end. Just a bit odd to still wonder where. Soon enough, I suppose.

My rotation mates and I were comparing notes the other day and are in agreement that four years is about the longest you can keep most of your stuff without it falling apart. Lab coats, case in point: you bleach them weekly for four years, and eventually, the thread starts to fail, the buttons fall off, and even the pockets separate from the main garment. (Pockets are a BIG DEAL, if you don't have them anymore.) My cell phone is currently missing four buttons on its dial pad, with a fifth and six ready to part company any day now. I could tell you a funny story about underwear waistband elastic giving out at an inopportune moment during interview season, but I'll save that for after the match is finalized, just in case...

I didn't enter medicine for the money, but it will be nice to have a paycheck again and be able to replace some of this stuff.

Things Looking Up and Geriatric Medicine

Got new residents for the March schedule. Things are much improved since then. Goes to prove, you can be reasonably competant AND reasonably happy. Life is so much better when you can smile openly and even ask the occasional stupid question with no fear of reprisal.

Due to the location of my current hospital, 80% of our patients are over 65. This means an intense learning experience in geriatric medicine, and all that entails.

In general, I like working with older patients. They are usually pretty calm and understanding about the fact that nobody is going to be able to snap their fingers and put them back to their 20 year old state of being, whereas of the 40-60 crowd many seem to think that is possible and should in fact be the standard of care. Even if they have been eating nothing but baloney sandwiches and twinkies for the past several decades.

One thing I have learned about working with older folks is that you have to learn to take some of the things they may tell you with a grain of salt, but also not completely ignore statements that may sound a little "off."

An example: a patient on my service, who I'll call Miss Liz for HIPPA purpuses. Miss Liz is sweet and generally pretty with it for eighty-nine. She has also been a nursing home resident for the last eight years and has not driven a car for the past twenty.

Yesterday, I went to see Miss Liz and she told me with much excitement how, the night before, she had been involved in a twenty-car pileup in a neighboring town. She proceeded to relate details about live chickens running across the highway and a very handsome state trooper that seemed to be interested in Miss Liz, in a romantic way.

OK, so it was pretty clear that this didn't happen, at least the night before. But one thing it did tell me was that Miss Liz had made a sharp downhill turn as far as mental status in the twelve hours since I'd seen her. And that is important! As it turned out, she'd been on a very strong antibiotic (levaquin) that does strange things cognitively to older people. I had to go through a whole song and dance with her attending to get it changed, but when he came and saw her and saw for himself how different she was, he agreed.

A less educationally poignant but pretty funny geriatric story about another patient on the floor, Miss Jane. At ninety-four, Miss Jane has some interesting habits, things that when she first arrived we attributed to possible alzheimers. First thing in the a.m., she liked for the nurses to do up her hair in pigtails. While being wheeled through the hospital for her various tests, she liked to grab the butts of the male doctors and shout "Yoohoo!" As it turned out, Miss Jane is not senile. She just figures she should enjoy every day to the max. More power to her.

God Bless the Surgical Interns

Two weeks into a four week medicine sub-internship. This is my last major hurdle towards graduation, and I’m excited about that, so I won’t waste a lot of time here on why the site of this rotation is not so hot for students, or why I would never choose to be a resident at this hospital.

Suffice it to say that too many of the parties involved have chosen misery as a lifestyle, and since in my view that IS a choice, I hold them responsible for their own despair and refuse to buy into it. Probably on some given day of my own residency I will myself be a miserable cur, but if I’m like this all the time, or I’m treating other people, i.e. med students, like crap, please just hunt me down and shoot me.

One bright spot that keeps me from focusing on this is the rapid approach of Match Day, less than two weeks away at this point. Sometime on March 15th I will receive an email alerting me to the location of my own indentured servitude. As I alluded to above, I’m going to try really hard to make residency a positive experience. I know it is possible because I’ve seen it done at other hospitals, and I’ve tried hard to assemble a rank list full of those places.

Another bright spot: the fact that although I am on a medicine service, for some reason almost all our interns will be going on to surgical programs. So, although they are under the dictum of the Medicine chiefs, they have amassed, through birth, exposure, or Gray’s Anatomy, enough Surgical Attitude to not take much shit when they have a say about it.

Case in point: the intern I was assigned to stand call with today. I showed up at seven with enough food and changes of scrubs for a hectic twenty-four hours. She had me round, write notes and orders, and then cut me loose. In her words, after a sixty hour week on a medicine service, I wasn’t going to absorb a whole lot following her around to check labs on a Saturday. (Also, although she was too polite to say it, I would probably have slowed her down in the process.)

How refreshing is that—the ability to call bullshit where it exists and send somebody home for a nice weekend?

Smallville

Ok, in case I haven't mentioned it, I picked a specialty--psychiatry. Have been on many, many residency interviews and think I know where I want to do my indentured servitude. Now all that remains is to see if my top choice wants me. Provided I don't change my mind in the next three weeks and screw everything up...

According to the explanations from the match people, over 90% of applicants get one of their top three picks. So I should be ok. As long there is a paycheck and dental insurance involved, I can make pretty much anything work.

As for the Smallville reference, I was watching because my go-to Thursday night show (My Name Is Earl) turned out to be a rerun. The Smallville episode was sort of a psychiatrist-to-be's nightmare: Clark is wrongly institutionalized by the Luthers. A very authentic looking psychiatrist tells him that he is actually a paranoid schizophrenic, and goes on to reference his belief in super powers, an alternate universe, and a conspiracy against him. (Didn't hurt that the guy they got to play this doctor is a dead ringer for one of my professors.)

So Clark goes through a whole hour of complications, such as his mother being brainwashed and married to Mr. Luther, a roommate at the hospital who thinks he is a superhero from Mars, and the threat of some sort of mind erasing treatment.

Needless to say, there were many glaring differences between the depiction of mental health care in this show and in reality. For one thing, Clark's room in the instituion was unrealistically big.

Seriously, I have no real worries about mistakenly 302-ing Superman. But it was scary...that is how it must actually seem to be psychotic.

High Class Problems and a Thousand Dollar Sandwich

Strange things happen: Got back Part Two of the licensing exams, and it would appear that I had one, singular eight hour stretch this past August where my operating IQ was substantially above its norm. (And then went back down to gutter level). Ten hours after the scores came back, my phone started ringing, and some of the residencies I'd applied to "just as a joke, to see if they really do read the applications," were calling to set up interviews. Bizzarro world does in fact exist.

All this has caused a good but stress inducing change in my world view. Where I'd been all set to hunker down at the first residency near a beach that appeared to want me, now I've got options to consider. But Ivy League or no, the beach is hard to let go...

This is a high class problem. I could just as easily be gearing up for a costly and alopecia inducing retake of Part II. So, what I'll probably do is get in my beater-mobile, check these places out, eat their free lunches, and then make some decisions. What I'm telling myself is, pick the place that is the best combination of good education and happy residents. What might happen on rank day is I give in, either to the temptation of going to a big name place that will make me miserable, or to the most laid back gig I can find. But hopefully, there IS a happy medium.

As for thousand dollar sandwiches...took the "Practical Exam" part of the licensing gauntlet today. Due to the confidentiality agreement we all had to sign, all I can tell you about the exam is that the lunch was decent...turkey club rollup sandwiches and, the bonus, canollies for dessert. Even just halfway through the day most of us were at the point of adrenaline fuelled giddiness, so when someone blurted out "best thousand dollar sandwich I ever had", we all started laughing hysterically.

No, it's not that funny, but neither is shelling out a grand for a test with a 97% pass rate. Can anybody say "Why Botha?" Let's just hope there's no reversal of fortune on my IQ upswing that puts me in the bummer 3%...