Remediation

I've been preparing for my anatomy remediation exam these past couple of weeks. The material was actually easier (less boring) this time around because I was able to put it in physiologic context.  It still sucked having to memorize random useless shit:  "the plantaris m. is a vestigial structure" "septum transverserum becomes the liver and diaphram"

Is it necessary to use limited neural connections on these things?  I do understand the importance of having a strong anatomy foundation -like knowing the arcuate line- it would be disastrous to sew up the wrong layers- they showed us the photographs. But foundations are usually made of large bricks/slabs and mortar not itty-bitty pebbles. Jeez.

I met with the course director on Monday.  I had described him before as being funny, over-the-top and somewhat misogynistic ( I use that term carefully w/ the updated 2012 definition: entrenched prejudices against women.  I don't think he hates us).  He obviously had his favorites among the male students, rarely called on women and his anatomical examples were always skewed to more represent the masculine anatomy.

During our meeting though, he was really gentle, helpful and understanding. I had gone in with shaking knees and an underlying deep mortification with being in this situation (never again!)  but he put me at ease.  He made me feel as if this wasn't a great deal and even shared stories of his own graduate school struggles with failing a course.  He asked me how the other courses had gone and nodded knowingly when I confessed that I had a much easier time with physiology and immunology.  "You have an analytical mind" he told me. He even confessed that he was the same, liking concepts more than memorization and how ironic it was that he ended up an anatomy professor.

He then flipped open a manila file, riffled through the pages and began rattling off advice:

Know the anastomoses around the stomach
Know the course of the gonadal vessels
Understand straddle injuries, the cremasteric reflex, portal varices, I 8 10 eggs AT 12, water under the bridge, this is going to be leg and pelvis heavy, 2 radiology questions- think Dr. Y (I knew this meant one was an abdominal ultrasound), 6 cardiac, 2 lung, an adrenal, the unhappy triad, exceptions to para/sympathetic....

Realizing that he was looking at the exam questions, I started scribbling notes trying to keep up with his rapid fire proclamations then went home and studied specifics.

I sat for the exam this morning and he had been right: it was very leg and pelvis heavy. It was also foot heavy and neck heavy. I didn't do very well on it but I passed.

When I was notified about my medical school acceptance, the joy I felt far outweighed the relief. That was a great feeling. Because the powers that determine who gets invited for interview/acceptance are behind closed doors with ambiguous criteria (beyond grades/MCAT), it didn't feel like an anticipated failure, my fear of being denied. So the joy at hearing the "we want you" was pretty pure.

The joy I felt today having heard (read- I was notified via email) that I passed was pretty gritty. My fear of failure far outweighed the anticipation of the news. There has been times that life has been pretty tough: deciding to take both parents off life support (different times), grieving, recovering from an abusive relationship, feeling unlovable, getting laid off, the stress of living in a house I couldn't afford... etc etc. 

I'm pretty familiar with the grit life throws at you like rice at a wedding.  Today though, today, I felt a gritty joy. And it was fucking awesome.

Cheers.

Invisible

I've noticed a number of constants over the last few weeks of this course.  It took me a little while because our lecturers are fun. They joke with each other, poke fun at their favorite students and make a hard (boring) subject entertaining.

They also don't see the 40% of the class that carry two Xs.

None of the students pimped are women. Not ONCE have I heard a female name called out.  There's no negativity towards us; we're just ignored.

No examples in any of the pathological examples in lecture are female bodies.

And today during an embryology lecture on the face, the composite photo of variability examples consisted of:

Men                                                       Women
1. Harry Truman                                        1. Jennifer Lopez
2. Michael Jordan                                       2. little Pakistani girl
3.  A 40 something Asian Violinist               3. a perfectly symmetrical Asian teen model
4. Dwight Eisenhower                                4. A very young Sharon Stone
5.  A Caucasian Marine                              5. Tyra Banks
6.  Morgan Freeman
7. Geraldo Rivera

Seriously, am I reading too much into this? That the examples of 'variability' for us women are 4 western-world-idealized women and a child?

Friday Night, Weekend pre-Exam

Our first two exams menacingly loom over Monday morning.  I was managing just fine until this past Wednesday, when the lecturer piled 65 densely packed slides of intricate reaction mechanisms over 150 assigned pages of reading. Some of it was familiar; much was new minutiae. Ugh.

She repeated this distribution level both Thursday and today so I now have a mountain of new information to conquer before the weekend is out.

I'm in pretty good shape. I knew last week's material cold and have some familiarity with that of this week. I really feel for my classmates who don't have my chemistry background. They have a Herculean task. I think I'd rather steal the golden fleece, myself.

Anyway, I set up a study schedule and because I'm sacrificing my weekend to the (greater good?) of acing my first exams, I decided to treat myself to a pre-celebratory sushi dinner.

I walked down to the neighborhood sushi bar with my (amazing) Ipad full of notes and readings and snuggled into the banquette at a corner table overlooking the bustling bar.  Glass of wine in hand and saba sashimi on the way, I began to review ubiquitin modification in DNA repair. (awesome right? yawn.)

Losing myself in the notes, I didn't notice the couple next to me until the lady asked me what I was studying. I glanced down at my pad and then back to her smiling face and said. "Biology".

"Oh! Are you in nursing school?"

I smiled at her (I get that question a lot). I'm sometimes embarrassed to reveal that I'm in medical school; I don't want to EVER seem to be boasting and it's the type of confession that provokes preconceptions. Nonetheless...

"Medical. I'm at BCMS." (inner grin-thrilled at the self-reminder)

Gasp. Pause. Blurt.

"I've never seen a chubby med student before!" I could tell by her face, she was mortified at what slipped out.  I couldn't help my sharp shocked bark of laughter. Sometimes people just say the most awesome things.

"Oh. They make rare exceptions for really brilliant applicants." This was one of those rare times when my witty comeback didn't wait to 'come back' several hours after the fact.  Hee. She and her friend quickly settled their bill and I ordered a second glass of wine and some edamame.

I'm so glad I did! The next resident of the table turned out to be an adorable late seventies gentleman in a straw boater with a pale blue ribbon. He was unfamiliar with sushi but looking to be adventurous. We chatted; I gave him my recommendations and he told me about trying new things since his wife died.  I 'wasted' an hour of study time (totally worth it) meeting the character I hope I become when I grow up.

We left at the same time, hugged outside the restaurant and I turned to watch him stroll away, dapper with cane in hand.







 

Hometown Blues

The greater metropolitan population of my hometown is about 200,000.

There are over 90 bars, all of which serve the same house wine, domestic tap beer and have the same smoky dingy interior. There is one bookstore: Barnes and Noble- also the only free wifi location in town.

The male-female ratio is about 76:100.  Median income is 18,000 and 25% of the population lives in poverty.

The political tone is strongly republican and no one that I've talked to cares that the best gym at the local Y is men only.  After all, I'm such a feminist.

The average driver's age is 59.

There is a local racetrack and 2 movie theaters.  There are no art galleries.

A nurse on U8, one of the few who was interested in more than getting married and having babies, was after me for weeks to get together. Finally, we had a common day off and made plans.

I was thrilled to finally share conversation. She didn't show up. She sent me a text message the next morning telling me how sorry she was but a friend showed up in town unexpectedly.

Now, a week later, she acts as though we are best buddies, girl-flirting with me at work and constantly playing with my hair. I ignore it.  My resentment towards her is minor. Rather I resent that this stifling, backwaters town has so lowered my standards for friendship.  I miss my wonderful, interesting, reliable Seattlite friends.

She asked me if I was going to be sad on my last day next week and I laughed at her.

I hate this town and, now that my family is mostly gone, can hardly wait til I'm gone.

Neighbors

My neighbors are fighting again. They scream, swear and throw violent words at each other. It’s actually rather filmy. I’m listening to tranquil Leonard Cohen and eavesdropping on a explicit fight. The walls are thin; eavesdropping is inevitable.

Neighbors usually like me. I’m very quiet. I think about my relationships. They’ve all been boringly civilized. My last boyfriend and I broke up in a Vietnamese restaurant. Silent tears over a steaming bowl of pho and a hug at the end. He remains a friend.

I once dated someone who had abusive tendencies. It didn’t last long. Though it was, by far, my very worst breakup, I helped carry his boxes to the car. He drove away. I waved. We never spoke again. (best day of my life btw)

I’m not a screamer but it fascinates me when people react so strongly that they shout and scream and break things. They’re so very alive. I sometimes wonder what it would be like to lose that control. I just can't picture myself letting go like that.

Laziness and Loneliness

I'm lonely.

When I moved back from the west coast to my itty-bitty industrial town, my life changed completely. During the subsequent two years when my time was consumed with caring for my mother, my smart, stimulating and worldly friends across the continent dropped away. I just hadn't the time to nurture our relationships.

I'm trying to create new stimulating relationships but apparently I'm weird.

My nursing coworkers, the pinnacle of education in this working class town, are consumed entirely with creating and raising families, getting married or engaged. We're friendly enough at work but I so miss talking with people about things beyond our immediate sphere of family and work.

Those who read, read Twilight and the Hunger Games. They tease (not maliciously) me about the books that I bring in and I can't find any interest in the antics of Belle or Edward.

Growing up here, I was the lonely little girl in the tree with a book fantasizing about evading the trolls below. When I left at eighteen, I discovered a wonderful world full of fascinating curious people who read, traveled, explored cultures, food and art, fought for environmental preservation and human rights. They celebrated their own uniqueness and seemed to appreciate mine. I swore that I'd never return to this area.

Then dad got sick and mom got sick and I again was tethered.

I know that the end is in sight; I'll be leaving in a few months and re-entering a world of more curious people.

This last year has been brutal though. Those who have applied to medical school probably remember how demoralizing the process is. You basically rip your life and history apart, present the pieces to anonymous adcoms and wait for them to decide that you're lacking. With the deaths of my parents and my relocation thousands of miles and several time zones away from my friends, I lost all of my social and emotional support.

Every time that someone I work with asked why my applications were failing, I withered away a little more. Trying to explain the immense competition involved came across as just defensive and it showed in their expressions.

Emotionally, I'm hibernating now. The acceptance that I received validated me in a way that I could have never predicted. My intellectual loneliness isn't so severe now that I know that it's finite.

I don't feel defensive anymore when people insinuate that I'm lazy because I don't plan on working through medical school. I can just wait a few short, yet impossibly long, months and I'll be with folks who'll understand that I'm not lazy.

I'm grinning now in anticipation. I know that I'm leaving an intellectual desert to conquer an ocean of knowledge. It'll be hard, I know, but it'll never be as hard as the last few years of dehydration. It can't be.

Faces

Last night, one of our lovely confused LOLs grasped my cheeks with her hands and told me that seeing my face made her feel better.

Aw. Shucks.

Then she tried to bite my arm.

Wallet Blues

I lost my wallet last night. I spent the entire day looking for it.. under my bed, between books on the shelves, in the fridge, in the car; I tore my apartment apart searching. I drove to work hoping desperately that it would turn up in my locker or the unit lost and found.

Nope.

Sigh.

I immediately checked my balances online and.. whew.. everything was fine. So I called my banks and cancelled my cards. I drove to the DMV and applied for a new license. Then I stopped by the bank and withdrew enough money to last the next week.

Now, I'm at home and going through a bag of cards and letters that were sent to my mom during her hospital stay, a chore that I've procrastinated on for the last year. It makes me sad.

Between a letter from my grandmother and a card from an old neighbor is... baddam bam... my wallet.

ARGHHHHH!!

(I have NO IDEA how it ended up in this bag of letters which had been stowed deep into the recesses of my closet-- I'm blaming the cat.)

Sigh.

Oh and I just got rejected from Brown University SOM.

Book

I spent hours and hours writing my med school applications. Now that they're done, I'm at loose ends and am trying very hard not to obsess over my statuses. Watched pot and all that...

So I've spent the last few weeks maintaining that creative momentum and focusing it into a story.

I am writing an FBI/armed forces thriller. Ha ha ha ha! It's absolutely ridiculous but I'm having so much fun. I've done a lot of research and am surprised at how much I've learned.

I was never really interested in military history before. Now I have a new appreciation for what my grandfather must have experienced as a ranger in the 6th Battalion during WW2. How I wish now that I had the knowledge/interest to talk to him about his experiences before he died. I didn't even realize before the significance of his being a ranger, a member of the special forces. It's thrilling to have have a personal connection to something that is so romanticized now. I'm trying to balance the romance with reality in my story.

I've fleshed out the plot and have composed about 60 pages but the more I research, the more I have to add to my story. I know that I'll probably never finish it but the process is, so far, fantastic.

Settling In..

Well, I'm getting used to my new apartment. My neighbors are musicians. Yep. Alt Rock. Sigh. Toulouse is not amused.




I love it nonetheless. Here are the aforepromised photos.





There's been a delay on the house closing. Lawyers. Hopefully, we'll finally finalize it this week. In the meantime, I've been popping up there to check on it and take advantage of the laundry. Yesterday afternoon, I was vacuuming and heard "knock, knock, knock" on the door.

I opened it up and, lo and behold, there was the mayor of my small town holding a small ceramic bowl.

I invited Mr. B in and we chatted for a few minutes. Apparently, his son bought the house and the mayor was unaware of the delay in closing. He was wandering around the property last week, found my collection of wheat pennies in the garage and took them home. When he found out about the delay, he wanted to return the money. He was embarrassed. We walked through the house together and he mentioned some things that 'John-John' wanted to change and asked about the family. I had never really known him, his kids were older than me, but he was my brother's little league coach and shared booster club responsibilities with my mom and several aunts and uncles.

After he left, I burst out in laughter. I was robbed by my mayor! It struck me as incredibly ironic.

Work has been remarkably smooth. The nightmare patient that I had mentioned last time was only with us for a few days and since then, our census has been mostly comprised of easy ortho patients.

No more news on the medschool application front. I'm still 'under review' at all of the other schools. The waiting is impossible. BAH.

New Digs

I'm settling into my new apartment. It's a tiny studio in an old Victorian house with ceilings higher than the room is wide...

I'm using an old refurbished library study table for dining.

I last rented a mother-in-law basement apartment, draped in grapevines and filled with books, that I christened the li-burrow. I haven't yet thought of a clever name for this new place. I'll post some more photos when I finally organize the living/bedroom. It's filled with boxes now and not very inspirational.

We have a patient at work. I'm not able to express the turmoil that this patient throws the hospital into when (s)he is here. I've been on the unit for over a year an this is the second visit. It's an incredibly stressful time for nursing staff, manager and hospital administration. This patient only comes to our floor for reasons that I can't go into without violating HIPAA. I can only say that they're unique and awful. I'm not experienced or clever enough to adequately change the details and still portray the magnitude of this person's effect on us. We get extra staff and the nursing supervisor relocates her center of command to our floor for the duration of the patient's stay. It doesn't help with the stress levels of the nursing staff. My manager hand selects the staff assigned to the room. Though he picks his most reliable, most patient and most experienced, it's not an honor.

The last time, the patient stayed 2 months. I'm not looking forward to another two months of complete anxiety before every shift. Bah.

I received my first med school interview offer. I'm thrilled but my loneliness yesterday was amplified in my hunt for someone to share my excitement. I mentioned it to my coworkers but they were more concerned that this means I may not be there next year. My brother disapproves of my ambition (I'm too old) and my west coast friends couldn't talk last night.

I'm still excited though!!

Nighttime Serenade

Tonight, I stayed several hours past my shift end to sit with a confused elderly patient. "George" had a psych history and a broken hip. For various reasons, he had a triple lumen catheter and an order for TPN. Just before 2nd shift he pulled out his line and offered it to his nurse like a wedding ring, asking her to marry him.

I had worked with George before. He was unfailingly cheerful and absolutely adorable in his confusion. He was definitely one of my favorite patients. Because he was tugging on his foley and newly placed peripheral line, I volunteered to stay and guard his wandering hands.

He called me his little black Jewish kitty-cat and asked to pet my fur (I'm neither black nor Jewish) but happily acknowledged that I was a cat who didn't like to be petted and sang to me instead: "Kitty-Cat I Love You" to the tune of Bull Moose Jackson's big hit.

George didn't seem to have any short term memory; he constantly asked where he was, did his parents know he was there, why we had kidnapped him, when I was going to have my baby. (I'm not pregnant). *sigh*

Despite his misinterpretation of my physical homage to all things cheese (my little potbelly), we had a great time together telling stories and tearing pictures of cats out of the stack of magazines that someone had left him.

Outwardly, he and my mother were complete opposites. He was a tall black millwright and my mom was a tiny white schoolteacher. She died young and he had reached a blessed age. But their eyes were the same: brown and slightly bulging. He and my mom were both confused but so very loving and so happy to meet new faces.

It breaks my heart that he's transferring tomorrow to a university hospital for surgery and I won't be able to follow up on him.

Changes (and cleaning)

I know that I've been subtle about my frustrations with the folks at work. (tongue in cheek) A UA on the third shift has given her notice and I volunteered to step in. My manager is very thankful that I'm helping out and I'm really thankful that I get to work permanently with a stronger team.

I'm going to miss the greater opportunity to talk with patients during 2nd shift. I've found, though, the last few months I've been scrambling so much to do both the secretary's and aide's work I didn't have time to spend with patients anyway. I'll be glad to wear just one hat on this new shift.


On the cleaning note, I was out of town this weekend. I spent Saturday and Sunday up at my family's cabin. Coming home, I found my cat sitting on the window sill behind the kitchen sink watching the squirrels on the deck. Like she did all last winter...



As I turned to make a cup of tea, a mouse, A MOUSE!, ran across the stove and down into one of the burners. UGH! What's the point in having a pain-in-the-ass-she's-lucky-she's-so-cute cat if she doesn't mind roommates of the rodent extraction? I HATE rodents. Always have. I barely tolerate chipmunks and squirrels outside and the thought of them in my house makes my skin crawl. Their sharp pointy teeth that never stop growing are creepy. Besides, all of my work in Yellowstone has made me uber-aware of awful diseases (hantavirus, LCM etc) spread by little pointy toothed vermin.

I immediately pulled the stove out from the wall and, using a bottle of bleach, began scrubbing every surface I could reach. In my entire kitchen. For 3 hours. Then I went down to the 24hour drug store and bought a couple of traps. So far, I've only caught one and let it go across the street in the woods. My uncle mocks me for not killing them. He says that they'll just come back. But I can't rationalize killing something just because I hate them. Otherwise, all old drivers who go half the speed limit and don't use their turn signals...

Rejected and Dejected.

I received my first rejection today and to my first choice. It had been a shoot-for-the-moon dream but it still stings. I haven't heard anything positive yet. I'm trying very hard not to be pessimistic.

Choices

Finishing my stint on third shift this morning, I stepped into the clear cool air and watched the beautiful blushing sunrise. It was a serene moment after a long night and a tense early morning.

One of our patients had left AMA just after morning labs. Last week, high on cocaine, Russell** started a bar fight and injured his shoulder. Dr. Joe told him that the surgery would be delayed for several days to allow his body to metabolize the cocaine. Russ was not happy to be stuck in the hospital for a week and recompensed by abusing the nursing staff: dumping his urinal over his sheets and the floor, barking at us when we walked by and spitting at anyone who came into the room.

We, of course, avoided him as much as possible. Well, Dr. Joe neglected to mention to Russ that he would have to have another drug screen before the surgery. Apparently his visiting friends had decided to bring him more drugs instead of flowers. When the lab tech went in to draw his blood, he went a little nutso, pulled out his IV and, blood dripping down his elbow, stormed out of the room toward the nurses' station screaming about bovine stool and ordering us to procreate with ourselves. Thinking he was going to attack us, we called a security code.

After the grey coats wrestled him back to his room, Dr. Joe came up and told him that the surgery was, yet again, delayed. Russ decided that he didn't want the surgery and demanded to be allowed to leave. Dr. Joe, quite angry and quite willing, retrieved the AMA paperwork and Russ left.

I stopped by the grocery store for cat food on my way home. I settled in the express line as a heavyset young woman unloaded her cart of items with the corresponding WIC vouchers on the counter. I had the rest of the day off and so buried my natural impatience with a magazine.

I soon found myself eavesdropping on the transaction ahead of me. The woman, refusing to pay the 58c difference for a bunch of grapes, told the cashier to take some grapes out of the bunch. I watched as the scan was voided, grapes removed, rescanned, voided, grapes removed, rescanned, voided, grapes removed, rescanned, voided and then grapes added one by one until the weight matched the amount allowed by the WIC voucher. *sigh*.. "day off.. day off.. day off.. breathe.."

The cheese came next without issue. The juice wasn't juice but punch and not allowed under the rules of the program. Argument. Huffing. Return with Lemonade. Argument. Huffing. Apple Juice.

Finally, the cashier began scanning the non WIC items: HungryMan dinners, bagels, jars of baby food and beer. Total $21.53. Oh, only have $18.37.. Big eyes look at the cashier then move to me. I bury my face in the magazine. Hummm... Ok, take the baby food off.

I drove home judging her. I drank my black coffee and judged her. I thought about the choices that she could have made but didn't. I began to reflect on the decisions that I have made that could be better and I felt guilty. I could have had something other than that blueberry muffin this morning. I could have had tea instead of wine last weekend. I make awful decisions all the time: too much cheese, not enough greens, not enough water, reading trashy novels instead of literature, watching True Blood. I have a degree in chemistry and a passion for studying nutrition. I still make crappy lifestyle choices. I think most people do.

Lady, you're doing alright. Keep going to your classes at WIC and keep fighting for every grape. Please just don't do it in the express line. And don't date anyone with a gimpy shoulder; he's bad news.

Poison Ivy

I went hunting blackberries yesterday before work in the hills beyond my house. Through the misty rain, the sun had cast a mauve glimmer on gray shale and the birds' loud chatter drowned out any stray noises from civilization.




It was a much needed diversion into serenity. My hamster wheel had been spinning furiously and stepping off reminded me of the bigger picture. Attitudes at work drive me mad but it's only a brief interlude. It will only be at most 10 more months until I'm back to school (fingers crossed!).

So I walked in the woods with dew soaking my sneakers and breathed in the absence of people. Coming up over a knoll, the sun beamed through the trees and from across the meadow. There, I saw the bush. Enormous, succulent and inky berries glinted in the light.

I made my way forward and noticed the wide jade green leaves that surrounded the fruit. Poison Ivy. I stopped a moment and thought about the symbolism, the correlation with my work dissatisfaction and my ultimate goals. I couldn't help but laugh aloud, startling a small flock of goldfinches into flight.

I continued to the bush, thankful in many ways, that I don't react to urushiol and I picked the berries.


And I made a blackberry, ginger compote for my salmon.

My Narrow Room

In his sonnet, Nuns Fret Not at Their Convent's Narrow Room, Wordsworth describes the paradoxical liberation of having limits. The cells of a nun, though tiny, can still admit God just as the restrictive form of the sonnet can still accommodate the greatest imagination.

Likewise, my life started out at Versailles. I was overwhelmed with the need to open every door and look through every window. I traveled, wrote, acted, explored different careers and places to live. I studied poetry, literature, history, people and science. As I grew up, I gained the freedom to close doors behind me. I meandered through the palace, enjoying beautiful views and then fastening the windows.

I find myself at the end of a long winding corridor, looking into a small room. Of all the choices, careers and life paths, I chose medicine. This narrow chamber shines with light from a beautiful window and is large enough to fit and small enough to focus all the passion, curiosity and adventure I've found in life. I'm coming home to my narrow room and this blog is a chronicle of that journey.