The end

The 3rd year of medical school is OVER. Everyone says that it's the hardest year. Last year at this time, I refused to believe them. Now that it's over, I choose to believe them.

I spent the weekend celebrating the end of the hardest year. As soon as I've recovered from the celebration, I'll be back to post. Hopefully, tomorrow.

You wouldn't want to read anything I wrote right now anyway. Trust me. I can't really describe my heartburn, bloating, and headache in a way that will truly convey how fabulous my weekend was.

Let me just leave you with this...
If you're thinking about renting Margot at the Wedding, don't. It's not funny. Get Death at a Funeral instead.

Not that I'm counting

Today was my last day on the floor as a 3rd year med student.
In less than 48 hours, the exam will be over.
And I'll be a 4th year.

I don't want to throw around too much fancy medical jargon here, but 4th year is technically referred to as THE LAST YEAR OF MED SCHOOL.

Memories

I stole a dollop of someone else's shower gel tonight. Bath and Body Works Honeysuckle. It's the fragrance I wore in high school the year I dated my first real boyfriend, Steve. As scents have a way of evoking memories, this is taking me back to the days of groping each other in the front seat of a white Chevy Lumina while Steve panted in my ear, "Babe, you smell sooo good."

This convinced me that Honeysuckle shower gel was the nectar of the gods. It wasn't until years later that I realized I could have rolled in cat shit, and Steve would have made out with me in his car.

Because, to the heterosexual male, breasts always smell like honeysuckle.

Dirty, dirty squirrel

I decided to grab a little snack before call started tonight. I was walking through the hall of the desolate office building I now call home sweet home. I had my bookbag on my back, my white coat (complete with fresh coffee stains) over my arm, and a bowl of cereal in my hands. I was shoveling raisin bran crunch--you can actually live on that shit for weeks, by the way--into my mouth when the cleaning man nodded in my general direction and said hi.

I didn't want to be rude. But, my face stuffed with crunchy goodness (picture an emaciated squirrel in the middle of a nut famine at the moment the UN finally shows up with international acorn aid), I couldn't vocalize my, hi to you too, Mr. Clean. So, with my face hunched over my bowl, I sort of glanced at him over my glasses, licked some milk from my lips, and gave a little wave.

He recoiled a bit and made the oh that's just wrong face. You know, the face you make when you accidentally open up a spam email and find ugly people porn. That face. In fact, I think he may have thrown up in his mouth little.

As I walked away, I couldn't help but wonder what the hell had inspired his revulsion. And then, I realized what had happened there. A woman who hasn't showered in about 15 hours, a soggy piece of raisin bran crunch precariously perched on her chin and some milk on the end of her nose, just hit on him. Like a dirty squirrel.

Laughing

Today, I met a resident who, in a brief conversation, I learned is engaged to be married as soon as possible. That's what she said--as soon as possible. At first, I thought that maybe she was going to head to the altar after rounds. But, it turns out, as soon as possible actually means mid-July.

It also turns out that she has only known her until death do us partner for about 12 minutes. She reflexively started to defend her choice to enter into a lifelong commitment with someone she just met when I cut her off to reassure her.

"Look, you don't have to explain it to me," I said. "I dated a guy for years before I married him, and that turned out to be a complete and total disaster. You never know. It's all luck."

Shut up. It sounded reassuring in my head.

She replied, as though, with the voice of true love experience, she could somehow educate me, "I think that you just have to know what the deep cry of your soul is."

Okay, well, thank you for the tip. But, the thing is...my soul's not crying. My soul is laughing. Barefoot, spinning in circles on the beach with her arms flung out at her sides, singing along to this, laughing.

That said, I sincerely wish the engaged resident all the happiness and luck in the world. That her soul might laugh as well.

Travel log

This morning, there was no hot water in my bathroom. Braver women would have taken the ice cold shower. I, however, am not braver women. I was afraid my tiny tits were going to freeze off my chest.

Then, I could just imagine the call to maintenance...
I lost something in the shower drain and I was wondering if you could use that snake thingy to retrieve it.
What'd ya lose? A ring?
No. My nipples. Damn things froze right off.

And, you know, even if the maintenance guys were able to get them out of the drain, they would never really look right again.

So, paralyzed by fear and vanity, I didn't shower. I threw on some deodorant and called it clean enough. Sort of like camping. Without the s'mores and tent sex.

And what have we learned from this experience?
Camping without s'mores and tent sex is utterly pointless.
Don't bother.

New digs

It's a new month--a new rotation in a new town--and that was me you saw lugging groceries through the hospital tonight. I was headed to the second floor of an office building connected to the hospital. I've been assigned room #1 in a suite of five call rooms.

I get lost every time I go up there because it all looks exactly the same. Long, thin hallways. Beige walls, beige doors. No fake art or plastic fig trees with which to orient myself. The call suite is through the unmarked door across the hall from Quality Management. So...I'd be the chick wandering the halls of a medical office building after hours, dragging her granola bars, cereal, tea, and a gallon of milk, looking for Quality Management.

The other four call rooms aren't being used right now, so I've got the suite to myself. I can hear my mother now, WHAT? So you're staying all alone in some deserted office building? Is that even SAFE?

I don't know. I guess I'll find out.

My room is populated with leftover furniture. A chair that spent it's first twenty years in a waiting room--a Peds waiting room--it's coated with fruit juice stains and crushed up sugary bits; an end table that came with the chair; a ridiculously fancy, terribly outdated satin ottoman; the desk my friend Priscilla had in her bedroom when we were 12; and a twin bed with a plastic-lined mattress, in case I have an accident.

The worst thing about the place is the lighting. There are no lamps, just overhead fluorescent lights. And they buzz. Loudly. I may make a trip to Target tomorrow to buy a cheap desk lamp. Maybe I'll look for one with a ridiculous shade--something with sequins or feathers, perhaps--and then donate it to the room.

The suite doesn't get wireless, so right now I'm in the hospital cafeteria. The guy at the table next to me is reading this. Amazon says, "The author makes surrender to erotic romance suspense." Well, then. Good for you for having the balls to read that shit in public. Oh, and if I happen to see you wandering around my office building tonight, I'm going to mace your ass. No offense.

Living on the edge

The cable guy came to fix Graci's basic cable hook-up today. When he was done, she suddenly had 100 channels she doesn't pay for. She has butt-load of FREE CABLE now. She also seems to have a gas leak. So, if we fall asleep watching the Food Network, we'll probably die. My apartment has life-sustaining oxygen, but no TV.

Sometimes, you have to take a risk.

Powerless

Every morning, the students on my team ask, "How's your grandpa?"

The answer is that he is not good. He has no energy and his legs are very weak. While walking through the yard the other day, his legs gave out and he fell into a bush. His friend Steve, the big, strong police detective, was with him. He scooped him up and sat him on the porch swing. Then, Grandpa cried. Not because he was hurt, but because he is frustrated with his lack of energy, and he's scared that he's going to lose all his dignity.

The other day, Grandpa asked Steve if he could have an officer patrol the neighborhood at night. He and Grandma live on a quiet suburban street, but Grandpa said he's not strong enough to protect her should anything happen. Someone else will have to do that from now on.

In the middle of rounds last week, my grandma called with lab results. His primary care physician had ordered a little blood work. When it came back abnormal, he didn't know what to do with it. He said as much and referred him to a specialist. That appointment is on Monday, but he's going to see a different family doctor tomorrow--someone who will, hopefully, know how to interpret these results. Frankly, they aren't mysterious. He has cancer. His white blood cells are crowding out everything else in his bone marrow. He's terribly anemic, and he'd feel a hell of a lot better with a few units of red blood cells.

I spoke to Grandpa briefly this morning. I had just finished seeing my patients and had a few minutes before rounds started, so I called to check in. He said, "Well, we go to that new doctor tomorrow. I'm just hoping they can do something to get me half way back to normal. Just half way."

He sounded so incredibly sad. I found myself leaning into the wall as I listened to him, as if the weight of his sadness was falling on me. I am incredibly frustrated by knowing what to do without the power to do it. I can see the note I'd write if he was my patient. I know the few tests I'd order, and I know what I'd do for him to make him feel better.

He's not looking for a cure, just half way. I wish I could get him half way.

I guess I'll be studying that AGAIN

Don't you hate it when you get grilled on metabolic alkalosis in the middle of rounds and you miraculously can't answer a single question despite the fact that just this weekend you spent THREE FUCKING HOURS reading about the condition commonly referred to as metabolic alkalosis?

And then, you call radiology to schedule your own MRI because your doctor wants to make sure that ringing in your ear is a psych disorder and not a neurologic problem and suddenly you're convinced that just by scheduling the damn thing you may have somehow resigned yourself to a brain tumor that is, as we speak, feeding on the synapses where you could have sworn you stored all that shit on metabolic alkalosis.

Don't you hate that?

Yeah, me too.

The job

There are lots of times I sit down to write about work and end up never publishing the post. I struggle with how much to tell these stories because they are, at least in part, stories about patients. These are other people’s intimate moments. They may not be mine to tell. As a result, most of my really great days at work are not recorded here.

But, this time, I'm going to go ahead with a work story, mostly because I don't ever want to forget why I do this. This is a story about a patient named Jane and her partner, Anne. In telling it, with every word I write, I am asking myself, If these women ran across this post some day and saw themselves in it, would they be honored by what I wrote here? I hope so.


A little over a week ago, Jane came in with what looked like a hell of a sinus infection. When she came to the hospital, she thought she’d only be in a few days. But then, she got sicker. A lot sicker. Around this time, the medical student who was assigned to Jane’s case quit coming to work. He’s on a two to three day a week schedule now. More power to the turd for getting away with that shit.

On the first of many of Turd’s vacation days, I stole his patient. I was fascinated by the whole sicker for no reason thing she had going on. And, although this may sound a little strange, I also felt like someone was missing from Jane's case.

A few days earlier, during our morning rounds, Jane had a visitor—a woman who gave off odd vibes. She introduced herself as Jane’s good friend, but something about her smelled like an opportunistic jaded wannabe girlfriend. No one else smelled that, but I often have the most powerful nose in the room. I trust it because it’s big and usually right. As we walked out of her room that day, I thought, Jane is gay. She has a partner somewhere. We need to find her.

And so…when Turd quit coming to work, I stole Jane as my patient. On that first day, I had a long conversation with the infectious disease doctor. In discussing Jane with her, she suggested that I call someone who knew her well to try to get a very detailed history.

I hunted down Jane’s emergency contact form where I found the names of a couple of cousins and one local friend. I tried everyone on the list. Twice. I finally got a hold of cousin’s wife who gave me her husband’s work number. I explained to him who I was and that everyone’s vitals were stable. This is important when you call from the hospital. Until the person on the other end hears that no one is dying, he or she hears nothing else. I went on to explain that I needed some important information from whoever may know Jane best. He gave me the name of a boy she dated when she was 14—forty years ago. I was thinking, Dude, you’ve got to be fucking kidding me. But, I took a breath and said, "Okay…anyone else?"

He paused and said, "Well…there is a woman who she’s friends with. Her name is Anne."

I got the number, hung up with the cousin, and called Anne. I explained that no one was dying and then started asking questions. Does she swim in fresh water? Does she drink unpasteurized milk? Does she live with cats? Does she eat raw seafood? Does she breed mosquitoes? Or raise earthworms? Does she vacation in Sub-Saharan Africa? Does she spend her spare time tipping cows? Or licking bats?

As Anne answered my questions, I got the distinct impression that she was more than just a friend. I had avoided saying much about Jane’s condition. Anne wasn’t on the emergency contact form, and giving her information would have violated privacy laws. I knew what I was hearing, though. Finally, I said, "Anne, I have a 54 year old woman here with three cousins and a two friends. I feel like we’re missing someone."

Anne answered, "We’ve been together for 20 years. I’m just out of state right now because of a job."

"You’re the person I’ve been looking for for two days."

"Well, you found me," she said, "and I'm on my way." She was on the next flight.

I’m not going to go into the specifics of how all this happened—how Anne’s name ended up being left off of that emergency contact form. I will say this…when we institutionalize bigotry by writing it into law, it is not difficult for individuals (in this case, hospital employees) to exercise discrimination. If Anne and Jane had been married, even if separated by thousands of miles, Anne would have been on that form.

Because she wasn’t on the form and wasn’t getting information from anyone else, I told her I would meet her when she got here. At 8:30 that evening, long after the rest of the team had gone home, I drove back to the hospital to find Anne and introduce myself.

Anne and I met and spent awhile talking. Understandably, she had a lot of questions. Jane had been out of it since Anne arrived. She didn’t even know Anne was there. I explained to Anne that she needed to find the Durable Power of Attorney paperwork that she and Jane had completed. And, praying that such paperwork actually existed and that I wasn’t violating 746 privacy laws and flushing my career down the shitter by doing so, I went ahead and updated her on Jane’s condition. I answered all of her questions as best I could.

At 9:00, as Anne and I talked in the hall outside the ICU, Jane’s nurse ran out to say, "She’s awake." We all high-tailed to Jane’s room. Anne wanted to see her. I wanted to see Jane’s reaction, to reassure myself that I had found the right person.

When Anne walked into that room, Jane took a huge breath and smiled. Anne slid between the IV pole and the bed, leaned over the side rail, wrapped Jane in her arms, and began whispering in her ear.

I don’t know what she said. I can imagine. But, I will never forget the look on Jane’s face as Anne held her. I leaned against the wall of that ICU room and thought, This is it. And this…this is worth it.

The next day, as I walked down the hall towards the ICU, Anne stepped off the elevators, appropriate legal documents in hand. She smiled and said, "Thought I better bring these in. You know, so they don’t kick you out of med school." I thanked her for saving my skin and gave her the names of all the physicians she should ask to speak to.

"Now that you're all official," I said, "you should get your updates from someone besides the med student. You deserve better."

In truth, though, Anne still gets most of her updates from me. I wish I could say that all of her love has healed Jane. Unfortunately, she’s not quite there yet. What I can say is that I am absolutely privileged to have met these two women, to have been a small part of this amazing week.


I am incredibly lucky to have this job.
All the work…it’s worth it.

A close call

I just called Graci to tell her she had to drive across town on $4/gallon gas to come kill an insect. Quit rolling your eyes. The fucker had 15 PAIRS OF LEGS.

I could picture ALL 30 LEGS crawling into my mouth as I slept tonight. The creepy crawliness would surely wake me up, but not enough to expectorate the creature, just enough to freak out and choke on it. And, with the current status of my immune system, beaten down by all this work, I would surely catch aspiration pneumonia. Repeated bronchoscopies to try and remove the dead and rotting bug would fail to retrieve all 30 legs, some of which would remain a source of festering lung infection.

In short, I would be dead in a month.

I'm not an entomologist or a pulmonologist, but I'm pretty sure that if you asked those people, they would say that's how it goes when something with 15 PAIRS OF LEGS crawls around your bedroom at night.

Graci, you saved my life.

The women in this family...we come

The days all ran together, one into the other, this week. One week ago, it was Mother’s Day. It feels like it’s been a month.

On Tuesday night, my mom called to say that she was headed to my grandparents for the night. Grandma had called her in a bit of panic. At 6:00, Grandpa told her that he was going to bed and that she could wake him up Friday for his test (he had a CT scan scheduled).

Grandma was worried he was never going to wake up, that he was going to die that night, and she didn’t want to be alone in the house when that happened. So, she called my mom, and my mom called me. I didn't tell my mom I was coming because I didn't want to hear all the, "Oh, honey you don't have to do that" bullshit. But, I was packing before we even hung up. I drove to the turnpike, set the cruise control at 87 mph, and two hours later, I was standing at my grandma’s back door. My mom simply smiled and said, "I knew you'd come. I told your dad, She's on her way. He asked how I knew. I said, Because the women in this family...we come."

For the next few hours, Grandma and my mom and I sat in the in my grandma's living room, the garage light streaming through the windows. We talked about Grandpa and, well…shit, now I don’t really remember what else. We laughed a lot. We cried a little.

At about 11:30, three hours after her normal bedtime, Grandma went to bed. She had considered going to bed, tried to go to bed twice before then. She couldn’t stop talking, didn’t want to be alone in bed next to Grandpa with her thoughts. But, eventually, exhaustion took her.

My mom and I talked another hour, and then she went to sleep in the room she grew up in. I crawled under a throw blanket and lay down on the couch. I lay there and stared at the red leaves on the bush outside the living room window. I thought about how short this night was. Too short. I wanted to stop time right there. To lay on that couch with my grandparents and my mom sleeping down the hall. To make that quiet stillness hold us a while longer. Things were moving too fast.

Two hours later, my cell phone alarm went off, reminding me to drive back across the state and round on patients. My grandma was waiting for me when I woke up. She watched me gather my things, waited for me as I went to the bathroom to wet my hair, and then walked me to the back door. She apologized again for panicking when it seemed as though Grandpa was probably fine for now. And, she wanted to know if I thought she would be okay when he wasn’t.

She said, “I’ve been thinking about it, and I know I’ll be really sad for a really long time, probably forever. But, I think that I will be okay. You think I’ll be okay, right?”

“Yes. I think you’ll be okay,” I said. I was standing on her back steps, one step above her. I kissed the top of her head, something I’ve never done before. She walked me to my car, told me not to talk to strangers, and waved me off into the dark.

It was 4:00 in the morning by the time I left. I drove until 5:00, when the turnpike Starbucks open, and stopped for espresso. It did little to energize me. In fact, I’ve been exhausted since.


The story of the rest of the week, the week at work, will have to wait. It was incredibly infuriating and frustrating and amazing and rewarding—in short, it was completely draining. I hope to get to it tomorrow. No promises, though, okay?

A cowboy known for his discerning tastes

It's been quite the week. I plan to tell you all about it. Tomorrow.
Tonight, I had a couple of these with a few good friends...


According to the bottle, Buffalo Bill also loved Bass. Buffalo Bill won the Medal of Honor. I am working for Honors in Internal Medicine. To this end, I drink the pale ale of champions.

Lilacs, my favorite

I went home to see my grandpa. I'm too tired to talk about the day, except to say thank you to the friend who filled my bathroom with the smell of these...


A reminder that even as things end, we are in the midst of a beautiful spring.