Rank with the smell of self loathing and indecision

Originally written Feb 2009.  somewhat relevant to this time of year.

 

I am not sure anyone who is not in the 4th year of medicine or beyond can understand the stress of trying to rank a competetive specialty.  I recently  finished a massive interview schedule that had me making my way across this beautiful coutry of ours, meeting and greeting and interviewing and answering the same questions againg and again for different people and socializing.  Ohh the socializing.  I had nothing left near the end of it.  I could barely look myself in the mirror, let alone talk to some mindless fuck from another medical school who was gaming for my spot.  I dont give a shit what your house is like, I think your med school is shit.  I think the students there are fucks and I think you suck. 

If you can imagine constantly seeing the same people in each city at each airport and talking about the same thing for weeks, you can feel my pain.  To make things even more painful, most of these socials were alcohol free.  Yes, that was not a typo.  Only 2 of my socials included alcohol.  Like masterbating with a cheese grater, somewhat enjoyable, but mostly painful.

The best social was the one with the open bar.  Hallilulah.  However it was quite sadistic of this school.  I had no problems drinking in front of future staff/residents.  especially after the week I had.  especially when the beer was free.  however, many of the keeners were leaving entire pints of beer untouched after they vacated their seats.  what an insult.  dont order it if you are not going to drink it.  I understand you are nervous and want to make a good impression.  This is the most important interview of your short life.  but FUCK, brush your shoulders off and loosen that spine.  My interview was at 9:30 the next morning and I left at 2.  Feeling pretty good but still clear headed.  The residents on the other hand were not doing as well.  I guess an open bar is and open bar, especially when your staff is footing the bill.  They became a rather jolly bunch.

So after all this mayhem, the travel the interviews the (make it stop) socials, I am left at home exhausted and with an even larger debt.  Add to this, I now have to decide which one of these schools/cities is going to be my home for the next few  years.  I have been somewhat lucky in that I have a top 5.  and in that top 5 I have a definite top3.  however it is that top three that is killing my sleeping patterns.  This is where the stress i was talking about earlier comes in.  I try not to think about it.  I think I have it under control, but it gets me in my sleep.  I am never really asleep.  I have light sleep cycles and I dream extremely weird dreams in which i am a participant and an observer at the same time. Todays dream  involved me napping in a caravan(I dont own a caravan) in a deserted parking lot only to emerge from the van out the exit of my board exam.  the terror that I felt realizing that I had slept in a caravan while others wrote the exam.  What is this new form of crazy.  My bp was 118/82 today.  somewhat reasuring.  I will try to exercise tomorrow, maybe that will help clear my fuzzy fuzzy head.

AMS

 

Addendum:  I matched fine and I am now doing OBGYN at my #7 choice.  that is a long story and I will hopefully start writing on this blog again soon.

Lying 101

I have discussed lying on this blog numerous times and I feel that this subject is never fully covered in Medical School.  There are many steps I feel that need to be covered before you can fully appreciate the art of lying.  I may get shit on for this post (like many others) but let he/she who has not sinned cast the first stone!

here we go. Here are the steps I feel one has to complete in order to become good at telling the non-truth.

1. The first person you must learn to lie to is yourself.

In order to be a proficient lyer, you must first master the ability to lie to the most disbelieving person in your life,  Yourself.  This task may appear easy at first glance, but most take many years to learn to believe everything they tell themselves.  The brain is a tricky place to be, filled with endless background info on the lyer, and many ways to trip one self up.  once you have mastered this step, you can lie to just about anybody and makes the next step in the training quite simple.  but be careful, many of the assholes in your world that you dislike are people who are extremely good at one thing.

2. Any lie is believable as long as you think it is true.

Lying, especially when one tells a real dousie, can take a certain amount of self denial to pull off as genuine.  Espeicially if you are a person with a heavy conscience.  If you do not have a conscience (and are souless) then this step doesn’t apply to you.  You could care less if you are a good or bad lyer as whether the other person believes it or not does not matter to you.  However, for those of us with a soul, or remnants of one anyways, if you can convince yourself that the lie is somewhat true or necessary for the better good, then this makes the lie that much easier to portray by you, and hence, believable by others.

3. Once you tell a lie, you must stick with it until the end.

A ex-friend of mine who was a chronic lyer, once told me that no matter what happens after you tell a lie, you stick with it and deny the truth until you are blue in the face. no matter who finds out what.   now, he is an asshole and mows lawns for a living and lives with his mom.  however, he had a point.  commitment is key.  You may have a lie come back at you weeks/months/years after you released it.  if you are not careful it may bite you in the ass.  but no matter what happens, if you are a lyer, remain a lyer or you will have no credibility what so ever.

4. KISS

Complicated lies are for geniuses and movie characters.  they are nearly impossible to contain and keep up on.  if you are going to start a lie and keep it up for a while, keep it simple stupid or you may find yourself caught.

This is just a rough guide.  I am sure there are plenty of other tips out there.  remember lying is not for the weak at heart and will almost always end badly.  but for some of us, it is a way of life.

AMS

Dog Shit

Snow can be an inconvenience.  especially when you live somewhere where you have to shovel it.  I am not too upset about having to shovel it as I have a snow blower.  I also have friendly neighbours who have snowblowers as well.  Somehow it all gets done.  I also have a neighbour without a snowblower.

Some how this neighbour gets his driveway cleared.  Where would he stand and smoke if he didn’t have his step cleared.  As I was clearing my driveway last night, I look over and see said neighbour try to do the old fashioned driveway clear, put your car in reverse and crash through the wall of snow.  Due to poor public notice and city planning, our street has become very busy with the rushed building of a giant supermarket near the end of it.  As a result, his reverse car crash was halted mid way, ending in him being stuck on said pile of snow.  or maybe he was stuck on the snow i had been blowing into his driveway.  either way, one will never really know now will one.

Anyways, I see this guy get out and try pushing, then try reving the engine and spinning the wheels.  eventually resorting to shoveling the frozen heavy snow out from under his car.  all this time I just kept slowly driving my snow blower around my already cleared driveway, not offering to help him.  Am I an asshole?  Should i have rushed over to help get him out?  maybe.  But lets review this neighbour.

This neighbour has lived here about a year now.  in such time I have had the police called to my street to break up a fight which included a baseball bat and strange men being thrown onto my car while I watched from my window.  Countless nights of drunk people in my driveway.  A night in which i watched his 4 year old daughter out with drunk men at midnight running around his house and the countless days I return home from work only to find my lawn littered with garbage and cigarette butts from his busy day of hanging out on his steps with his other unemployed friends “working” the day away on his step.  But the best part of this neighbours contribution to our neighbourhood has been the addition of his new dog.

I was away for a month doing an elective and I returned home to find my lawn covered in dog shit.  I wondered how there could have been a large increase in stray dogs in the neighborhood to cause such an huge amount of crap to accumulate on my lawn.  So I ask my neighbors did they get a new dog.  “Why yes we did” they answer.  oh ok… well could you not let it crap on my lawn any more.  “sure” they answered.  the next day, more crap.  i go over again, the next day more crap.  finally I have to go over on christmas eve and ask them to stop letting their dog shit on my lawn before I call their landlord.  I have not found any since.  but seriously, who the fuck lets their dog shit on their neighbors lawn and let it build up.  once or twice may be unavoidable (at which point you would pick it up of course).  fucking trash.

anyways, fuck them and fuck their dog too and their piece of shit car that I left stuck in the snow.

AMS

Trains, Planes, and Automobiles

The thing about the matching service, is that it does not tell you the amount of travel you will be doing.  it does not discuss the different cities that you will be travelling through, and it does not give you a dollar amount for the insane attack on your bank account that will happen during this time.  I am starting to get very upset at the beating my credit card is taking.  especially disheartening is the cab rides.  very expensive.

what i do get is a very intense job interview with the new cities I am visiting.  some of them are too expensive to live in, some of them are too dirty, too large or to scary (druggies, thugs and punks).  I am getting a feel for the places I may be living for the next 5 years or more.  this is something I could never do over a phone or on the Internet.  I spent 5 hours walking around one of my possible future cities last weekend.  it was a real eye opener.

I have started compiling a list of places I will be considering and places I will not be considering.  My top three are in constant motion, but my bottom of my list is prety solid.  I will hopefully have a final list in a few days.  then all I can do is wait for the machine to decide my future.  kinda matrix like right?

AMS

Out With the Old, In With the New

Nothing says 4th year like an afternoon of doing nothing, and still not worrying about it.  As the Fake Doctor once said “Ah fourth year, where any evaluation will do.”    this is so true.  I have applied for residency, all of my references are in and I have basically graduated from medical school, all I need is the stamp on my diploma.  Why am I so sure?  because I am in 4th year.  It is a waste of money and resources for everyone involved but does allow us medical students time to sit on our asses and enjoy life before internship begins.

I am busy trying to clue of research projects I started a few years back, and organizing my interview process.  I am not sure how far away from home I want to go with my residency.  There is a part of me that wants to stay close to home.  but there is a loud voice in my head that is telling me to move far away and start new.  I just dont want to see my classmates any more.  I dont want to see the residents I worked with any more, and I am tired of hte staff as well.  but moving away is a huge ordeal and a giant pain in the ass.  so i am torn.

The stress of residency applications has made me very tired as well.  I dont sleep very muchg any more and I am very cranky.  I find i am constantly thinking about the program and where i want to end up.  I am worried that I will not rank properly and I will end up in a place i am not happy with.  then there is the ultimate fear of not being accepted anywhere. and having to do this all over again and do something i do not want to do.

Ahh 4th year, where your future is completely in someone elses hands.

it sucks

AMS

Today=frustrated

I am in a bad place the last few days/weeks.  Not sure why.  Just been a bad few days.  I think I have felt it coming on for a few weeks and have just been ignoring it.  I have feelings of anxiety and stress and depression.  They are not your usual feelings.  They are more stealth like in presentation.  I feel fine a lot of the time and life goes on, but I have just been realizeing that for the last 4 weeks I have done practically nothing.  the bare minimum.  it has started to show in my work at school and I have not picked up a book for that length of time.  My board exam is coming up soon and I am of course not ready.

I went to my GP for a refill on my Effexor the other day and before I knew what I was doing, I was asking for her to up my prescription.  Then I thought twice about it.  That voice in my head screaming, “HOW ARE YOU GOING TO GET OFF THESE MEDS IF YOU DON’T STOP TAKING THEM”  I figured I would be withdrawing from these meds soon.  however, I find myself becoming more and more dependent on them as time goes on.  I am going to be a doctor for fucks sake.  how can i take care of my patients if i cant even take care of myself.  it is frustrating.  Med school is stressful, but it is stressful for everyone the same.  how come I am bending and being this way.  I don’t see others feeling like this.

“I am just frustrated” I tell myself.  “things will always eventually get better”.

I guess

AMS

upset stomach, nausea vomiting diarrhea

I caught a bad case of hospital acquired gastroenteritis this week.  there is no way to easily describe this, except to stay that it was horrible.  the worst part was the nausea.  I hate nausea.  This is one of the main reasons i don’t drink a lot.  once i got old enough to get nauseated badly after drinking, I stopped doing it.  Yes, thats how much I hate nausea.

I made it though a lot of my clerkship without getting sick.  I had a few episode of post-call mania, that we easily treated with a shopping binge, but no real illness.  not until now.  4 days of this and I am finally better, but still weak.   I never had a fever, but got really weak (probably cause I didn’t eat for 4 days.).

I watched vantage point today.  I liked it, although I had it figured out in the first 15 minutes.  I think they were OK with people figuring it out though as the movie is told over and over again from different peoples views (vantages heh, get it.) sorry it has been a long weekend.  on a side note, Forrest Whittaker was totally wasted in this movie.

back to the grind stone, at least I wont be calling God on the old porcelain phone any more.

AMS

The Usual Please

This has been a bad week.  I have been faced with numerous tragedies in my clinical rotations.  Plus my academics have been their usual dismal selves.

I cant believe how badly some people treat their children.  I sit every day at the ward desk reading test results on my patients and my seat is a direct view into a room that holds what remains of a child who was shaken.  shaken so badly that he can no longer see, no longer hear and will not suck or eat.  CT shows a massive subdural hematoma.  Cerebral edema and midline shift.  Classic signs they tell me.  I feel anger every day when i see this family and what they have to go through because they trusted the care of their child with a baby sitter with a short fuse.  The rage the wells up inside of me when i think of what they are going through is unmeasurable.

As for me things are not as bad.  However, i have had a shitty day.  first my attending has given me a shitty review on my last report.  4 weeks we spent together and he could not say one thing positive about me.  only gave an avg rating with a short comment on “needs improvement with clinical knowledge”.  thats all!  loser.  4 weeks man, 4 weeks everyday, followed your ass around, listened to your lame stories, drank your coffee and not a signle positive strength you could think about?    Plus I have recieved my final exam mark.  I didnt fail, but i did not do stellar.  I am not sure how much marks are going to make a difference on my Residency applications.  I guess I should cross ENT off my list.

Fuck, wake me when March is over.

AMS

Anger is Everywhere

I am surrounded by anger all the time.  Mood swings from happy to destructive at the flip of a switch.  I don’t know what to do.  I am happy for most of the time (finally) and now she is just angry.  My rock is now my poison.  I don’t know what to do.  I miss the happiness.  I wish she was happier.

AMS

You Cant Push Me Down, I am Already on the Ground

One of those days, one of those weeks, one of the months.

Tired man.  I am tired.  I am sitting here the night before one of my oral exams and i just cant bring myself to read/study/look at anything tonight.  I am just  sitting here in my small paper littered pitiful excuse for an office with Avril Lavigne blasting (dont ask) wondering what the fuck is this all about.  My shrink says I should exercise (or something).  She says it will increase my concentration and help with my running destructive thoughts.  So I bought an exercise bike.  it looks great with my clothes hung on it.

I cant be bothered to do anything.  I am content to drink too much coffee and grind my teeth into non-existence.  I miss the sun.  this rotation does not allow for sunshine.  it is making me rethink my choice of specialty.  I know you should choose based on what you will love to do and what will make you happy, but fuck man, a guy has to see the sun once in a while or it is just fuckin depressing.  life is sad enough.  we should make every effort to enhance the natural happiness in it.

I just feel so low.  not depressed.  that is a different type of low.  I just feel worn down.  I am sure I am not the only clerk who feels low and worn down. Ass kicked i heard someone describe it the other day.  I am looking forward to Christmas.  although i am working along side attendings and residents, I am still a student and thus still get Christmas holidays.

This type of low does offer some protection.  I just couldn’t give a fuck anymore about what anyone says or thinks of me.  “Go ahead take your best shot!” I think to myself, “I am already on the ground, you cant knock me down any farther”.  Moody cranky resident and crack ho bitch resident?  I just don’t care.    you will not inflate your hollow shelled self esteem on me today.  I am rubber and you are glue baby.  seriously though, how sad is your life when you are that cranky that you have to take your problems out of those who are lower than you on the totem pole.  I am not scared of you, I am not intimidated or in awe of your power, i just feel sad for you and glad that I will never be like  you.  Maybe you need a hug.  come here Crack Ho Bitch Resident, virtual hug.  feel better?

I know I do.

AMS