Finished!

Ah, now I can relax. I have finally sent my residency applications out.

The whole process felt like applying for medical school, but I was probably less drunk this time. I’ve discovered that it takes about three beers to say to myself: “Why NOT spend four years in Duluth?” As a result, I’ve applied to waaay too many programs.

Either way, it’s a relief to have it out of my hands. Whatever happens, happens. The only thing I need to do now is chase down a handful of people to finish writing my recommendations.

To be honest, I’m still kind of shocked that they let me into medical school.

Welcome to 666

Good news! As of July I am officially a fourth year medical student. Mostly this means I feel like slightly less of a dipshit. I learned a great lesson over third year, which I think is best expressed by Douglas Adams:

“There is a theory which states that if anybody ever discovers exactly what the Universe is for and why it is here, it will instantly disappear and be replaced by something even more bizarre and inexplicable.”

That also happens to be a great description of how medical school works. Now that I’m in my fourth and final year, I’m finally on to it. These days, I expect to be a moron.

I decided to kick off my fourth year with the sickest of the still-living in the medical intensive care unit. The unit happens to be on the 6^th floor of the hospital. On my first day I walked over to the row of charts and immediately noted that most of them were numbered starting 666. Heh.

I pulled a random chart and started reading. A little panic swept over me as I mentally ticked off the problems. The guy in 4 (666-4, that is) had been in the hospital for two months already, on a slow, and painful decline. He had AIDS, CMV colitis, MRSA meningitis, etc, etc. Staph-scalded-skin-syndrome for chrissake. The only unafflicted organs were his eyes, which tracked me around the room as I attempted to sort out his lines. “Hey…I don’t know if you can understand me...my name is Simone.” We’d put tubes in his body wherever we could find a spot. He couldn’t speak for himself, but his wife decided he’d be a Full Code. Apparently she was living with her boyfriend hours away from here, and had not come to see him. I don’t think she fully grasped the situation, but the law is the law. After a couple of days pumping drugs and fluids in him, his eyes stopped following me. The wife finally decided to withdraw care, but could we keep him alive until she came for a visit? We tried, but when I came in the next morning his room was empty. I asked if the wife had come. She never made it.

It’s been over two weeks now, and my panic has subsided. It’s been replaced with a feeling I don’t have words to describe. Maybe it’s just numb? Yesterday I coolly helped rid the unit of a body. First the nurses and I zipped it into a white body bag. Then we launched it onto a a large metal cart, one-two-THREE! Over the body went a rectangular box made out of white canvas. The whole ensemble resembled a large buffet, like what you might see at a wedding. As he got wheeled out of the room I wondered how many people would think that crab cakes were under there.

After that I sat down next to my intern, who happens to be mega cool. “Man, this kind of blows.” I announced.

“Yeah…how many people have died since we got here?” He began counting off on his fingers… “Let’s see…the guy in 4, the guy in 8..oh another went to comfort care. Oh, and the nines.”

So far, everyone that had gone into room 9 has died. But not before they spent a couple of days breathing on The Oscillator, which is basically a last-resort ventilator. It makes a machiney-death-rattle so loud you can hear it across the floor. It makes the patient shudder with each mechanical mini-breath. It makes me shudder when I hear it, but I can’t block it out.

Not that there aren’t any bright spots in the rotation. First of all, my friend Andy is working the ICU with me. Andy’s cool. He’s confident. He knows shit, a lot more shit than I do, which is actually kind of annoying to my puny ego. We have fun torturing the third year medical students (until they figure out that we actually have no power over them). It’s mean, but we have lots of pent-up rage from when we were picked on as third years.

This is a side note, but it just so happens that my ‘extra-small’ scrubs are humongous on me. I don’t get it, because yes I am kind of small but I’m not that small. Still, there is enough fabric in the ass of my scrub pants to fit a couple of basketballs under my butt. If I really really wanted to, I could pull the top of my pants up over my boobs and tie them close to my neck. That way I wouldn’t have to wear a shirt. Anyway, the enormity of my pants didn't escape Andy. “Hey MC Hammer!” There was no way I could argue with him. So I did the Hammer-dance. If I remember it correctly, it means pointing your toes outward and quickly scampering side to side, making your pants billow in the wind like sails. I have no idea what I look like while I do this, but the appalled look on Andy’s face probably meant I succeeded. I was just about to collapse into a fit of giggles when it hit me: Whoa! I’m in ICU! Suddenly I had to stop. It was as if I’d just Hammertimed right into the Grim Reaper’s icy breath. My giggles froze in my throat and I stood at solemn attention for the rest of rounds.

Sometimes people live. When that happens it’s fucking awesome. They come in like vegetables, and leave awake and talking like real people. I met a young woman with cystic fibrosis while she was sedated and on a ventilator. Something about her made me think about Sleeping Beauty. Each day I carefully listened to her lungs, praying for a change. I met her worried family one by one, as they each took turns at the bedside. When we were finally able to get the breathing tube out of her, I was ecstatic. When she could speak, I introduced myself jubilantly.

“Hi, I’m Simone!”
She glared at me. “I haaaaaate it heeeeere!”

Not that I blame her. Over the next hour or so she complained about the bed, the nurses, the ceiling, the air, her mom. But I just smiled. The bitchstorm was like Bach in my ears, a glorious sign of life. To celebrate I did a little victory booty-dance behind the nurses’ station. Take that, Grim Reaper …Well, for now anyway.

Poop

I’m 5 weeks in surgery rotation. It’s been amazing. I wake up some time around 4 am. Hit snooze, repeat. I stumble into the hospital and run up the stairs to the 8th floor. Then I race to the staff lounge in search of coffee. (I don’t know who it is, but some angel makes fresh coffee just before I get there at 5am. Whoever you are, I love you.) But just before I make it to the coffee maker my nostrils fill with the now all-too-familiar smell of shit. Not any old shit, but hospital shit.

Hospital poop is extra special because it is bursting with especially malevolent multi-drug resistant bugs. Superpoop, I think, and stick my nose in my coffee cup.

“Miss Jenkins, did you fart today?” I begin my pre-rounds on a 70-year old lady who had some pretty invasive abdominal surgery.

Miss Jenkins rolls her elderly eyes at me. “What? YOUNG LADY what in God’s name are you doing up at this hour?”

“Did you fart.” I don’t have the energy to explain. Might as well get to the point.

We stare at each other, determinedly. I will know about her bowel function. Then I will make my report to my intern at 6 am. Who’s going to report to the chief resident. Who will tell the attending. Who was going to ask her anyway. But in some insane world, knowing if Miss Jenkins farts before anyone else knows makes me a good medical student. I might even get a recommendation for Honors.

“Doc, have you lost your mind?” She peers at me.

I love Miss Jenkins. While she’s the one who just had some internal organs surgically removed, it’s my state of mind she’s worried about. She might have a point. I've been chronically exhausted. It's so bad I've been thinking about sleeping with all my patients. Literally. I think about crawling under the covers with them, the only place I might be able to hide from the rest of the surgery team and actually get some sleep.

“How ‘bout poop?” I scream, partly because she’s hard of hearing. Mostly because I'm trying to drown out my inner voice, which is mocking me. Either way, it doesn't help my case.

Yes she pooped and farted for chrissake. Good, I say, and I change the dressing on her wound, knowing that with every pee, poop, and fart she is that much closer to getting out of this stinky, super-bug infested place, the center of my world. I’m not very eloquent at 5am, so I don’t explain this very well. But it matters tremendously.

I used to imagine that the rest of our organs pretty much existed for the sake of the reproductive ones. To breed human life! Now I’m pretty sure that reproductive organs exist so we will never run out of poop factories.

Basically it required two and half years of medical school to truly appreciate crapping. I won’t bore you with all the details, but bottom line is: Want to know how well your body is working? Want to see the end result of a complex yet perfectly orchestrated effort between brainesophagusstomachpancreasgallbladdersmallnlargebowelsbloodmuscle, etc?

Just look in the toilet. And there it is, the final movement to a perfect symphony. What once was breakfast is now a poop. Maybe it’s obvious, but I bet you’ve never really thought about it: no matter what you put in, poop always comes out. Even computers can't do that. So next time, before you flush – take a moment. Congratulate your body on what it has created. Well done! Now you’re at least partly ready to attempt breeding.

Groundhogs and Desire

I took my Internal Med exam on the 21st, and after that I pretty much crumpled. I went home and zombied around my apartment. I had planned to do christmas shopping and clean up my place, but it just didn't happen. The last semester had been hellish in several ways and I just needed to stop and play Civilization for awhile. But that's in the past, and now I'm on a BREAK! YEEEEEE!

I used my first night of freedom to watch the movie Black Sheep with my friend Steve. If you haven't seen it yet, then I strongly encourage you to forget that this movie had ever been made. It was awful. Yes, I knew going in that it was about genetically-engineered flesh-eating sheep gone awry, and I had adjusted my (few) standards accordingly. But still. The sheep were the best actors by far. I'll just save you the trouble and tell you what happened at the end: after the obligatory blood-bath the sheep had lots of gas. Apparently this is a big problem if you've been feasting on human flesh. Anyway, after the sheep had eaten all the Japanese investors, they cornered our hero and the idiotic environmentalist girl. At this point I was convinced it was all over. Surely they would be eaten, too, or at least get turned into flesh-eating sheep themselves. But I was wrong. Our hero, thinking quickly, lit his zippo and threw it into their midst. Then the sheep blew up in a fiery fartstorm. The End.

The next morning I packed my things for the trip to my parents house, all the while fighting images from the night before. (Did they really need to show the sheep biting off the evil farmer's wiener?) Then I embarked on the five-hour drive to my mom's house. It was raining. Most of the drive looked like this:

But even more fuzzy because I still haven't replaced the glasses I lost two months ago.

Most people I know hate long drives by themselves, but I don't mind so much. I blare good music and I'm living in my fantasies, the world is whizzing by and I'm feeling all the possibilities of life ahead of me...and I love it. Sometimes I think it's when I'm happiest, when I'm in between places.

So I was feeling pretty good right before I realized I'd missed my exit like, half an hour ago. Dammit. Why do I always have to be such a space cadet?? I got off the next exit, re-routing and realizing that it would add another hour to my drive. The new-chosen road was irritatingly slow and winding with lots of stops and small towns.

And then, I saw The Sign. (It was at night and was freezing out and my fingers were getting numb so I didn't try to get a better picture. I know it looks funny, but it's real. Skeptical? Go ahead, mapquest it.):

Which way would you go?

So I stopped. I wondered why other drivers didn't stop to ponder this choice as well. Maybe to them it made perfect sense that paradise and primal human drives lie in one direction, while a weather-predicting groundhog lies in the other.

The only conclusion I could come to was this: don't get lost in Pennsylvania.

I headed toward the groundhog since that was closer to home, it was late and my mom was starting to get worried. I plan to come back and visit the other places later. I still haven't figured out what I'm going to do once I get there. Check out a diner? Eat an apple?

Anyone wanna come with me?

I am completely oblivious, and I waste heat

Today, I got home after my exam and found this stuck to my door:

This actually explains a lot. I mean, the fact that every day I’d come home and find my windows mysteriously shut. I’d just think, “heh, that’s weird..did I close them this morning??..did I do that in my sleep?...why is my fan on the floor? ” And then I'd stick my fan back in the window, feeling only somewhat creeped out. Then I would say to myself, “When you leave in the morning, remember that you left this window open! REMEMBER!” So that I could confirm my suspicions that I had an intruder. An intruder that likes stale, stinky air. But in the morning rush to get out of the house I would forget. Then I'd get home at the end of the day and the scenario would repeat.

Anyway, mystery solved. I don’t know what’s more disturbing: imagining my maintenance guy, Rick, being in my apartment, resentment growing with each window he had to slam down (and only now writing me a note threatening to kick me out of my apartment), or that fact that I hadn’t really noticed this whole time.

Go, Civic, GO!

Today I got my very first speeding ticket. I had no idea what a uniquely irritating experience this is until now.

My first reaction was to flee. Aaaack police! Hide! But just before my foot slammed on the gas and I went zooming off to Cortland, the good brains god gave me kicked in: Fool! You can’t hide in CORTLAND! Plus my gas tank was nearly empty. So I pulled over, wondering if there was a special way to do it that would make me seem extra-obedient.

I rolled down the window and flashed him my best good-citizen smile. Please be less than 95 ohpleaseohpleaseohpleaseohpleaseoh-

Officer: “You were going 86 in a 65.”

Phew!

Me: “Um, but-“

Officer: “You have something to say?”

I'm sorry, I was zoning out! I can't read the speed limit because I’m not wearing my glasses! I'm pregnant! I'm a doctor! I'm a pregnant doctor! Pleeeeeeease don’t give me a ticket!!!!

Me: “Oh, nothing. "

Officer, handing me ticket: “Here you go, you can handle this by mail.”

Me: “Thank you.” Fuck you.

I drove away disheartened. "Vroom. Vroom-vroom." Then I gave it up. It's no fun to pretend you're in NASCAR when you're only going 60.

Later on, my friend Andy scolded me:
“Why didn’t you just flash him your BOOBS?!”

Oh, yeah. Dammit.

You came!!!

You came!!!!

And, as promised, I will show you a couple of things that I’ve been hiding from you. Not that you were really missing much. But I'd still like to explain:

Writing has been different now. It’s harder. For various reasons, I’ve been having problems writing consistently. For one, 3rd year med school is remarkably demanding on my time. And I can’t drink as much as I used to. I mean, I can’t just go waltzing into a patient’s room and yell at them to lose some goddamn weight for chrissake. Not while I reek of vodka and cigs. It wouldn’t be right.

Not that thought and creativity were all in the bottle, but it sure helped. Plus, now that I’m all sober and responsible, life's a bit more boring.

Old Self:
“Wheeee! Fun!”

New Self:
I AM A ROBOT OF RESPONSIBILITY. PARDON ME, I MUST IRON THIS SHIRT, READ 2 CHAPTERS, PROGRAM MY COFFEE-MAKER TO BREW AT 4AM, AND BORE MYSELF TO SLEEP BEFORE 9PM. REEE! REEE! (those are robot noises)

And then there's the whole honesty thing. Not that I've been lying...but, the stuff that I needed to write was at a level of honesty that would have made me ridiculously vulnerable. It made me squeamish to share it with myself, in fact. But it was time. Time to open the closet (not the gay one, necessarily) and watch the skeletons parade out. And then stuff some choice ones back in.

The other problem with honesty is that it tends to hurt other people. Too bad, because the deep-down truth is actually pretty entertaining. A direct result from it being horribly offensive?

Plus, I was getting long-winded. So long-winded that I had trouble editing my own stuff, since it took so long to read. Yes, I'm aware that I should probably be on Ritalin, and right now I'm trying to see if I can get some shipped from Mexico or craigslist or something.

So there. Those are my excuses. And now, on to the excerpts, as I promised:

A conversation from my pediatrics rotation:

"Do you and the baby live her father?" I asked the baby's mother.
"He's a piece of shit."
"Uh. Okay..I'll just write down...uh... 'father uninvolved'"
"How about, 'father is an uninvolved piece of shit?"

From the first death on my OB/GYN rotation:

I followed the attending out of the room. As soon as we got out of the door, I
broke into a full run, out of labor and delivery, past the nursery, and into the
locker room. I was sobbing. Fuck.

I hunched over and said a prayer for the baby, the young mother. My mind turned to Eve and the Apple. Strange that men are considered the stronger sex, when it's the women that bear these bloody horrors. Alone.

I forced myself to snap out of it, attempting to make myself look like I hadn’t been crying. This is an impossible task. After I cry I get so red and puffy that I look like a giant hive with a face. When I came out, my attending gave me a pitying look and patted me on the back:

"Eetz good zat you should learn zis. Eetz not all happy-jollies, you know."

No. Eetz not.

And the first birth:

I stepped away from the table covered in blood and some other stuff that was probably baby-poop. I pulled off my gown carefully, and noticed the new father standing there. I asked him if it was a surprise. I was referring to the baby’s sex.

“Nah. I knew she was pregnant when I started dating her. The father’s a shithead. He abandoned her. But I’ve been there with her, I’ve stuck with her through this whole pregnancy. This is my daughter. ” And he stomped proudly out of the OR doors, a king exiting the throne-room.

Well, there are pieces of shit, and then there are some amazing boyfriends out there. A little confused about my question, but amazing nonetheless.

From The Boyfriend Box & the Pathophysiology of Love:

Final verse: we were living together. I found the letter to another girl. I kept it for myself, and bound it with a rubber band to the letters he'd written me, putting it right on top so it was the first thing I'd see. Chorus: anytime I was tempted to go back to him I'd look at all the letters again, cheating one first. The first 100 times the pain ripped through me like it was fresh, but I forced myself to look at it over and over again until I was sure I'd become numb. Maybe I overdid it. It took years before I stopped equating strength with being unfeeling.

I know. You've lived some version of this, too. Haven't we all?

....

Anyway, one new thing in the boyfriend box, one fresh ex to the list. It hit me that I have waaay more exes than I've had boyfriends. Guess it's just semantics, but it irritates me. Why should I be so stingy about the boyfriend title and not the ex? The ratio is off. Where's the pathology?

...

So I set out to draw the "pathophys" of love the way I'd been taught in class. Drawn partly from experience and partly from baffled observation. Honestly I'm kind of disappointed in it. Well, not totally. I AM proud of my Cycle of Neediness and Despair. It just irritates me that the only sure way to exit all this is by death.

....

Well, not necessarily a "best of" show here, but that's what I got. For now.