It's been a while since I posted anything, but I figured I'd finish out intern year with a little something.........forgive me if I ramble. I may have had a glass of wine. Or two.

The amount of change that has occurred in my life over the past year has been rather striking. This time last year I was a newly minted doctor moving into a rented house with the man that everyone in my life presumed I would marry (including that particular man and myself). Residency has a funny way of clarifying your thought processes though, stripping away any unnecessary or difficult attachments. To survive emotionally you essentially develop a zero tolerance policy for bullshit in your personal life, since you're forced to deal with a fair amount at work 80 hours a week. As this happened in the first 6 months or so I pulled away from that relationship and eventually ended it, feeling very badly about doing so but so sure of my decision. For those of you who know him, he's still wonderful and I truly mourned the loss.

For the first time in my life I began to understand what it might be like to get divorced, splitting up furniture and pets, sharing rent on a house that I no longer lived in. I bought a house on my own, moved in on a day that I was post call, and sat in my new empty living room with my dog. I remember crying, having been awake for 40 hours, wondering how the hell I was going to handle it all on my own. And yet........a funny thing happened. I woke up every day, got dressed, and went to work. I saw horrible things and amazing things. There were days that I retreated alone, from frustration at the sometimes crazy nights, from sadness when a favorite patient died unexpectedly. There were good days too, when I did a procedure well, when I connected with a patient or their family and was able to help in some small way. If I'm being honest, the good days far outnumbered the bad. After a while, I forgot that I had once been somebody's almost wife and just became.......me.

Through it all I was learning and gaining confidence, not just as a physician, but as a person. Yes, I can work 90 hours a week in the MICU and still pay my bills on time and keep up with my friends and family. Yes, I can pronounce a patient that I cared about and go back to rounds and present without flinching. I can handle a code (even if my heart is racing the entire time and I feel like I may or may not pass out). I've been buoyed by amazing friendships, forged in the thick of internship, with wonderful women and a few guys who I connected with during the long hours of call. If there's one thing I've learned this year, it's to never underestimate the power of camaraderie. I certainly don't think being a resident is as stressful as being a soldier, but I think the bond that develops between us must be nearly as strong. My friends outside of residency have been amazing as well, I love you guys.

Another thing happened during the course of this year. For the first time in life I'm totally, unconditionally, comfortable with being alone. At the same time, I'm more optimistic about relationships than I ever have been. I'm assuming that this comes from having, finally, a well cemented sense of self. It's amazing how much easier (and more enjoyable) it is to love men when you don't necessarily need anything from them (but still want it).

It's been a good year. Three (maybe four counting fellowship) more to go.

Cheers,
Lauren

Home. Panda and I are well settled now. I eagerly await the day when I have more furniture, but for now everything is functional and I'm quite pleased with the little nest we have. I'd never really planned on buying a house by myself, but life is funny. I have to say I'm glad it worked out this way. The whole process was hectic, but like residency in general there's a certain satisfaction and confidence that stems from knowing that I can handle it.....Of course, like residency, a cute house is even better with friends in it :)

Changes

I love quotations, likely because I'm not clever or eloquent enough to come up with many of my own profound musings, let alone record them. Luckily, I don't really mind riding the literary coattails of others and occasionally co-opting their words to describe my feelings. Anyhow, I was browsing for a bit of wisdom tonight in a quote collection and found exactly what I needed.........

It takes a lot of courage to release the familiar and seemingly secure, to embrace the new. But there is no real security in what is no longer meaningful. There is more security in the adventurous and exciting, for in movement there is life, and in change there is power.
-Alan Cohen

The Luckiest Man (or woman)

It's a rather cliched tradition, but every year at Thanksgiving I try to write down or at least think about a few things that I am (of course) thankful for. This year seems particularly rich in experience to me, so here it goes (forgive the reference to Lou Gehrig in the title of this post, I am after all, a neurologist :).

1) The love of a close-knit family; three wonderful, intelligent siblings, parents who encourage me and are honest with me no matter what, and a whole host of lovely (and often entertaining) extended family members. There have been a few that have showed me how not to live my life, I am grateful for them as well.

2) An education that has allowed me to explore, both in my mind and sometimes literally, the far depths of the universe. I have held in my hands rocks that are 4 billion years old and I have cut through a persons skull and felt the pulsations of a living human brain. This education has led me to a profession that challenges me on a daily basis and one in which I get to witness both the worst and best expressions of humanity (sometimes all in the same day).

3) Travel, the chance to live in the country of my dear grandfather's birth, to walk amongst the remainders of history, to have my breath taken away by scenes so beautiful that only a poet(read, not me) could accurately describe.

4) True friendship, childhood camaraderie that has stood the test of time and other, more recently discovered kindred spirits. I have also had the honor of having a dog for the past decade that has been a better friend than I could ever have imagined. Also, a horse that taught me the meaning of grace and the joy of flying so fast across the ground that I thought we might momentarily break free of gravity.

5) Love, relationships that, while imperfect, have forced me to grow in ways that I never expected and to understand the power of quiet, enduring respect between two equals.

6) Darkness, inner rumblings and external events that have forged me in ways I would not have chosen at the time, but that I recognize the utility of now.

7) How to cook a meal, to draw, to tell a good story, to create something worthwhile for the enjoyment of others.

8) The power of compassion, the unrelenting importance of it, and the peace that comes with allowing the pursuit of it to guide my life.

9) Legs that will carry me, eyes that can see, and a mind that functions (most of the time).

I am indeed a lucky girl and, to quote Lou, that's something.

Wanderlust

It's fall here in Cleveland and the weather is admittedly taking a turn for the worse. There are some nice things about this, including it being much easier to stay inside all day at the hospital. The trees are beautiful, though not quite as stunning as in Virginia. That said, it's funny how little I miss VA. I spent the majority of my childhood there and feel I should have more attachment to it. I was very happy there most of the time and certainly was formed by the environment in Blacksburg, but I suppose I'm attached more to the people in my life than the places(my family moved to Nebraska years ago). This is healthy, of course, but when people ask me where I plan on practicing someday, VA is never on my list. I feel a twinge of disloyalty when I say this, but it is very concrete for me.

I suppose I view my relationship with the Commonwealth as one that was a great maturing experience with much joy and spare sorrows, but definitely one that has run it's course. I sense that something else is out there for me......

One of my favorite quotes;

Human nature will not flourish, any more than a potato, if it be planted and replanted too long for a series of generations in the same worn out soil. My children shall strike their roots in unaccustomed earth. -Nathaniel Hawthorne

things are a bit better now......a couple of ancedotes to share:

1) i was thrown out of a patient's room for the first time yesterday. i tried to explain the difference between an allergy and an adverse reaction and the patient told me i was insulting her intelligence. i wasn't, actually, but she very dramatically told me that the conversation was over and that i should leave. i almost felt bad about it, but then she threw my attending out later on that day and i realized that she was just a person that enjoyed conflict.....or had dreams of acting on broadway that were never realized.

2) it is possible to get a UTI from being so busy that you can't stop to pee for 12 hours, three days in a row. it is also possible, though not advisable, to treat said UTI with your dog's leftover antibiotics.

3) some patients will "play possum". that is, they pretend to be asleep and unarousable so that you will remove their restraints to examine them. after their limbs are free, they will open their eyes, promtly pull out all their lines, grab your stethoscope and proceed to beat you with it. this warning comes courtesy of a fellow resident of mine.

I went into the start of residency thinking the first few days would be the hardest, the most fearful. The first week was indeed overwhelming, a barrage of new protocols to follow, finding my way around one of the largest hospitals in the country, and learning a new computer system. All while trying to remember how to practice clinical medicine after a few cushy months of vacation. Luckily, the catecholamines carried me through and I felt as if residency was something that I could handle.

I wasn't prepared for the feelings that began to surface after the first two weeks, when the newness wore off and reality officially set in. When I realized that I had signed the next four years of my life away, sacrificing my freedom to travel, to attend weddings and graduations, to take my dogs to the dog park, to sleep. Being a medical student was easy, there was very little responsibility and ample time to read about interesting disorders. Fast forward a few months, as an intern, I am rushed, constantly making decisions that I have little confidence in and barely able to formulate a cohesive presentation in time for morning rounds because I am so busy answering the nurses questions on cross cover patients. I have never been prone to depression, but the past few days I think I'm beginning to understand what depression might feel like. Residency is like a cold, wet blanket. Uncomfortable, energy sapping, and obscuring my view of the outside world.

The irony, of course, is that I chose this! I happily applied to a specialty that is wrought with frustrations when I could have chosen a much easier path. I wanted this, over a career in radiology or derm, over a career in geology that would have been much easier, over a more traditional path....marriage at 25,kids shortly thereafter. I sped past a janitor in the hallway last night and was actually envious of him for a second, he at least, could afford to walk slowly down the hallway. He could daydream if he wanted.

I think it will get better. My senior residents say it does, so it must. I don't expect the frustrations to melt away, but I hope the despair fades sooner rather than later. I went into medicine partially to push myself, to add toughness and fortitude to my self definition. Let's just hope that I'm capable of absorbing what residency has to offer me.