Friday, December 30, 2016

6 Specialities in search of an intern

I don’t do well with time off. My last real vacation, before we started med school was a five day trip to Hawaii. It was beautiful. Swim up bars, blue sea, white sand and I spent most of it on the lanai finishing my health informatics thesis, which was for all intents and purposes already finished. OCPD at its finest.

Something about having time off, is that is gives me time to think about what I have been doing—where normally I’m so busy I don’t have time to think too hard. As third year is now 2/3rds of the way over, I feel mounting pressure to decide on a specialty.

I thought deciding that I wanted to go to medical school was the biggest decision I would ever make—but it turns out that we are not off the decision making hook. Now in addition to being asked if I am dating anyone when I return home for the holidays, I am asked about what kind of medicine I want to practice. What kind of doctor I want to become.

The answer is honestly—a good one. One that isn’t too burnt out or disillusioned. A doctor who cares, who is able to live comfortably. A doctor who does right by people and has good friends and colleagues by my side. Oh—and one who is competent…let’s hope that comes with time.

But when it comes down to the nitty gritty, the fact remains—we have to pick a specialty and therein lies the trouble. Everyone seems to have their own thoughts about what I should be doing. They mean well, but I’m the only one who can live my life.  Anesthesia makes a lot of money, but I worry its lonely. ER gets beat up by everyone in the hospital, pediatrics is way too stressful, IM rounds forever, surgeons seem too intense and psychiatrists never use their stethoscope. There is no one perfect specialty, but I'd like to get as close as possible to finding one. The thing is-- what makes medicine good, and fulfilling and meaningful, doesn't really have much to do with the chunk of it you pick. 

I am in search of a specialty that will make me ridiculously happy, but to be honest I’m not sure its possible to find one. Medical school doesn’t make me any more happy than I was before and although I don’t regret it, I think I had unrealistic expectations about what it would do for my life. Lo and behold, I’m still me. Still as happy as I was before, just more poor but with lots more friends by my side (care about you).

I think that’s one of the most important things about picking a specialty. Are you going to have good people with you? Will you be loved and supported? The rest is gravy. Remember the year after you finished college? It seemed like such a huge thing deciding what to do—but it all worked out right? After all, here you are.  

So friends, wherever you go, whatever it is you chose to do—know that we’re behind you, every step of the crazy, difficult, winding way.

Saturday, December 24, 2016

Stealing Jesus

The Baby Jesus has been stolen from numerous naivety scenes across the county this holiday season. In Boise, Idaho thieves snuck into a Rotary Club nativity in the middle of the night to remove the plastic baby. It was returned two days later when the culprits threw it out the window while driving by the nativity—which if you ask me is the ultimate Hail Mary.

NPR just featured a piece where a woman recounts stealing her sister’s nativity ornament with the words Peace on earth inscribed on it, inciting a ten year long family feud. Peace indeed.

Even our feline friends have been ousting the babe from its manager in the most adorable removal of the Christ child ever known. The old, if I fits I sits adage makes exception for no one.

Some curators of nativity scenes have even resorted to securing the Baby Jesus with a metal band bolted to the manger. Which seems kind of ironic, but a good solution none the less. And of course this being 2016, some plastic babies even have location trackers in them-- coining my favorite term of 2016-- "GPS Jesus."

But I can’t help but feeling like there is some kind of bigger metaphor here. The most important part of the holidays what ever one you choose to celebrate is too easily lost in politics, in spending money and in the stress that accompanies this time of year (bonus if you’re visiting family members who are Trump supporters). We are robbed of what this time of year is really all about-- remembering the light when it is dark. 

And as we get ready to say goodbye to what was one hell of a year, may we all try to do just a little bit better. So whatever religion you are or whatever weird family traditions you partake in, don’t let what can easily be a really stressful time of year get the best of you.

What matters is that we remember what matters. We’re going to need to try harder than we ever have in 2017 in order to protect our world, and to protect each other. We won’t be good friends, community members nor good citizens if we don’t remind ourselves what peace and love and joy feel like. So if you've stolen Jesus this holiday season--or had a plastic infant stolen from your yard, I hope the holiday spirit finds you, and puts you back where you belong. 

I hope you can take a moment to recharge this break. Take a walk in nature, donate money to your favorite charity, buy someone coffee (heck buy yourself coffee you look tired). 

So gentle reader, fill your glass with a beverage of your choosing. Let us cheers to being more present and less petty (although frankly some days go better than others). We will survive elections and exams alike. We will pick each other up, or sit with each other on the ground—whatever feels right. And at the end of the day, we will not rob ourselves of hope, even if we so often loose our way. Let us come back with renewed strength and energy and perseverance to put 2016 to bed and welcome in the hope that a new year always seems to bring.

Saturday, December 3, 2016

Where does the good go?

I took 9 days off over Thanksgiving break. While the rest of you were getting up at its-still-dark-out o’clock, I was snuggly, warm and fast asleep in my own bed.

I never thought that I would be so glad to return to the Boat House, but after almost three months away in Redding it was comforting to be among the familiar.

I sipped coffee in the mornings, and wine in the evenings. I answered emails, read two books, cooked dinner every night, saw a multitude of friends, had a dance party and hugged Roshelle whenever we passed each other in the hallway. Oh and Netflix….lots of Netflix.

The days passed quickly. Too quickly.

Nine days off was not enough to fill the deep void that being alone in Redding for three months has left. I didn’t realize that it would be so hard to be the only med student for miles around. I miss you guys. I knew not having you around me all of the time would be hard, but working with an extremely terrible attending who has a penchant for yelling and living with incredibly weird dental students makes things extra difficult.

Its hard to work at clinic all day and never once get told that I did a good job, or got a question right or showed empathy and understanding towards a patient. If this was KevinMD there would be a slew of comments that med students are too soft these days and we need to suck it up and we can’t expect a trophy for participating. Screw those people. They don’t know (or don’t remember) what it feels like to be a third year med student. I need to hear that I did at least one thing right every day. I just do—otherwise I go home and hate myself. And is it really that hard to be thrown a bone once and a while? We’re human and we’re trying. How about showing a little empathy to your med student every now and then.

And the thing is, we’re good. We’re so good. We want to help so badly. We care. We’re good people. We’re working as hard as we can.  That matters. The rest will come with time. Being made to feel like terrible incompetent idiots just doesn’t pay. It doesn’t make for better doctors, it makes for burned out students who lay in bed at night and question whether they should have gone to med school in the first place. It drives us to have a secret fantasy about working in a little shop that sells soap and other sundries (just me?). If we are not going to be reminded that we can do this and that we are going to be good doctors—then we need to remind each other- every day, all the time.

I am so lucky to have such wonderful, smart, caring and capable classmates. When in doubt think about graduation day—its going to be here sooner than you think. We’ll come out the other side of this academic war, perhaps a little worse for wear, but still awesome, still good.

So where does that good feeling go? It didn’t go anywhere.

You’ve always had it.

And all you need to do to feel it, is remember that its there.

And if you can’t find it, we’ll be there to help you look.

Wednesday, October 5, 2016


I have been 30 for exactly 13 days 7 hours and 56 minutes and 20, 21, 22 seconds. So naturally this makes me a bit of an expert on the topic. Lots of newly minted 30 year olds have written advice columns disseminating their wisdom to the masses. Adele even dropped a new album for her 30th (trust me, that was my back up plan too). But to be honest, I don’t really feel like I have very much knowledge to expound. In fact I swear I’m only 19. But looking at my recently renewed drivers license, courtesy of the Redding DVM (aka a slow moving government office full of white people) I see that I was born in 1986.

The world was a different place back then. Ronald Regan was president (thankfully I don’t remember that). And as is our purview, the US was involved in some war in a country most citizens couldn’t find on a map. Gas was cheap. The music was good. The clothes not so much.

I am reminded every day how much I don’t know, so it seems silly to want to give anyone any advice. Plus after reading some absolutely vomit inducing essay entitled Advice from 30-year-old me to 20-year old me which said, “You have very little responsibility [in your 20s’] so go and travel.” Yea, fuck you. You didn’t spend your 20s in med school you asshole. You can appreciate why I’m kind of turned off from the whole "go and find yourself" shit. Its so 1997.

But in my last 30 years on earth I have learned some stuff and made some pretty epic mistakes (both fashion wise, relationship wise and in the amount of vodka I thought I could drink). You should learn from my mistakes gentle reader. Trust me—parachute pants are not making a comeback and no tequila is never a good idea (except when it is—trust me, you’ll know). Also considering that someone in my Doctoring group (em…Daniel Hernandez) called 30 middle aged—I get to dole out unsolicited knowledge. So in lieu of inventing facebook, or going on a world tour or winning an Olympic gold medal (all things people younger than me have done), here is everything I know about life thus far.

1.     Spread good JuJu. Throw that shit around like glitter. Bring coffee, recycle, don’t be a jerk. In the words of Ram Das, we are all just walking each other home.
2.     Shut up, dance it out. Dancing is just good for you and I think we should do more of it. Grab your hair brush, put on One Direction and the rest will take care of itself (this may be where the tequila happens).
3.     Enjoy the simple things. For example, after a particularly awful winter quarter in grad school I spent the better part of winter break dressing my dog up in different outfits. Maybe you could read that book you’ve been wanting to pick up, or go out to eat with friends. Life is lived in moments, try to make them good ones.
4.     Say nice things (including to yourself). The “Doc 3 peer evaluations” although a stupid (and totally not anonymous exercise) may seem like a waste of time—but think of it as an opportunity to tell a classmate how much they are loved. Let’s remind each other that we can do this.
5.     Wear sunscreen. Just trust me.
6.     The hospital is sacred ground. This building has seen pain, sorrow, despair, joy, and hope in unparalleled proportions. We would do well to feel the earth under our clogs and remember this.
7.     Learn stuff. Push yourself to learn as much as you can every day. Maybe that means looking something up and maybe that means you learn how much amazing knowledge there is in the world and maybe that means you learn that a hot shower and a cold beer cure all manner of bad days.
8.     Stay humble. The best, smartest, most amazing teachers I have ever had are some of the most kind and humble people ever. I have asked some really dumb questions, like the time in grad school I asked what a p value was (let’s just say people in the epidemiology graduate group should probably know that). But the good ones never let on.
9.     We are all stardust. Our carbon has been around for eons and it just so happens that right now all of these atoms are perfectly arranged to make you. You little miracle.
10. When a kid hands you a toy phone you answer that shit.

There may be more things I know about life, but I’m 30 and starting to go senile so I can’t think of anymore. Thank you for making the first 13 days, 9 hours and 26 minutes of this decade so amazing. What do you say? Want to take this planet for a spin around the sun a couple more times? That’s what I thought. I’ll put the One Direction on.

Friday, September 30, 2016

The King and I

You ever see that movie with Colin Firth? You know the one where he yells swear words for a full minute? I’ll just leave it here. The King’s Speech is one of my favorites for a number of reasons. #1 Its British #2 Colin Firth will always be Mr. Darcy to me and #3 I like anything with Helena Bonham Carter in it. But I think perhaps the reason I found myself watching it on repeat while in Redding (okay, maybe I was a little lonely) was because the struggles of King George VI really hit home as a medical student.

King George had a stammer so severe his speeches were filled with painfully long pauses. One speech—perhaps his worst, the opening of Wembley Stadium—prompted him to seek help from a speech therapist Lionel Logue (played by the super talented Geoffrey Rush).

I really feel the King’s pain. We all know what its like to stand there stammering, trying to speak, trying to find the answer or have the courage to say something, or ask a question. Even harder still if an attending throws a line of questioning your way. I feel the fear. I feel the incompetence deep in my bones. 

But the thing with King George is that he didn’t run away from his speech problem. He didn’t run away when London was being bombed during the war either—and being King, he most certainly could have.

He stayed. He stayed and fought.

He did not deny the trouble he had with his speech. He recognized it. And he worked on it.

That's what we have to do too.

Watching the movie really highlights the incredible courage he had. In the face of overwhelming stress and challenges from his family, the country, the Nazi’s rising to power and his stammer—he worked to be better.

To be honest, I don’t much feel like embracing the things I am bad at most days. I’d rather people think I’m just naturally gifted. But we don’t learn via divine intervention (why isn't that a thing?) We learn by reading and studying and being wrong—and working on it.

So this is the part where I tell you to embrace the things you are bad at—and be happy about being wrong, and finding all of your shortcomings and lack of knowledge. I only threw up in my mouth a little bit from writing that.

Every time I get a question wrong I wish the earth would swallow me whole. I use how well rounds go as a sort of gauge regarding my self worth. I do that with other things to. How many carbs I ate, divided by the number of glasses of wine, multiplied by how many people yelled at me minus if someone said they liked my hair (bonus points if I actually brushed it).

But I don’t want to live like that. I want to start trying to be happy about getting things wrong—because then I have discovered something to learn (let’s just say I’m doing a lot of discovering about the kidney at the moment).

We don’t run.

We stay, we fight. Despite an imperfect system of evaluations (speaking of things I measure my self worth by), a method of teaching that doesn’t exactly lend itself well to learning (no, I don’t want to play stupid peds hematology jeopardy at 5pm on Friday anymore).

Sometimes my soul can’t take all of the things I don’t know or can’t do or do badly. But then I think of King George.

He was one of the most popular and most loved monarchs in Britian. He became a symbol of national resistance. He wasn’t perfect, he was human and others saw his humanity. They saw him recognize his shortcomings and work on them.

Showing those around you (especially other med students) that you don't know everything, gives other people permission to admit they don't know stuff either. Showing other people your vulnerabilities makes you more likable, more relatable, more like George. 

So the next time you wish the linoleum in the hospital would become a giant sinkhole because you didn’t know the mechanism of a drug, or forgot an acronym or couldn't remember a side effect. 

Remember the King. And know that you will be successful not in spite of your shortcomings, but because of them.

Monday, July 18, 2016

UC Davis Island

I was promised a “psych-ation.” You know, like the chillest, easiest rotation of all. I was expecting to wake up at a reasonable hour, have coffee, walk to the hospital, have more coffee, pretend to be a doctor, look busy typing on a computer and then leave for the day (also at a reasonable hour). Psych is supposed to be the Hawaiian vacation of rotations and after internal medicine I was looking for a break.

The trouble is, I wasn’t expecting the patients to have such complex social problems and for Sacramento to have so few resources. How can a hospital function when there is nowhere to send people. What’s a hospital to do with people who become stranded here. Survivors who have some how made it through the doors and past triage should no doubt be received into the arms of some kind of safety net, or options or something.

I know you know. I know you recognize that we don’t do enough in this country to help those who need it most. So I’ll spare you a boring paragraph about the budget, our politicians and our priorities.

Its just so hard to help people and I didn’t think it would be like that. Maybe that’s why I’m so tired at the end of the day. Not because I walked 10,000 steps because the psych work room is in the farthest possible reaches of the basement, but because I’m so defeated at notion that we are not going to be able to fix everything. Not because we can’t, but because we won’t.

I can come around to the fact that people have medical problems we can’t cure. I get that. People get sick sometimes and there is nothing we can do. But when there is a solution and we do nothing…well then now we have a problem.

I find myself running around the hospital getting people juice and crackers. Finding them a book or a DVD, offering patients in the ED showers or a phone or fetching clean clothes from upstairs.

You don’t have to do that,” an intern said to me, my hands full of graham crackers for our patient who has been in the ED for 6 days. 

But the thing is, that I feel compelled to bring people the little things we can do, because I know the big things, like finding them housing or getting them into a rehab center are much harder, next to impossible tasks. And honestly, sometimes we just discharge people to the street. There just aren’t places to send people and we can’t keep them. Its like catch and release. Treat em and street em.

I didn’t know psych-cation would be like this.

President Obama said it best on Seinfeld’s Comedians in Cars Getting Coffee, “bad stuff and stupid stuff is happening everyday.”

Truer words indeed Mr. President.

I think this is part of the reason doctors burn out. Who can stand working in a broken system for years on end? I bet it gets to you.

I suppose the only saving grace is that sometimes things go right. In spite of a complicated, stretched thin network of resources. People are helped. Its never as shiny and beautiful as I imagined. It’s a bus pass, or a train ticket, or some food. One patient who came in looking for help is now off drugs and has a sober living community to go to. Its a miracle, but not even close to how I thought those things are supposed to go. 

Anne Lamott, who's work was recently featured on Orange is the new Black says, “I wish grace and healing were more abracadabra kind of things. Also, that delicate silver bells would ring to announce grace's arrival. But no, it's clog and slog and scootch, on the floor, in the silence, in the dark.” 

I wish it was easier. I wish helping people took as much effort as raising a fruity drink with a tiny umbrella in it to my lips.

I know psych-ation isn’t real. But that's okay. What we're doing is real, and its hard and messy and complicated, but its honest and it means something.

And I bet you're already getting ready to it again tomorrow.

Sweet dreams friend.

Saturday, June 11, 2016

Say Anything

How many evaluations are there about you? Dozens? Hundreds maybe? Some are down on paper- hurriedly scribbled and passed into your hands. Most are no doubt floating around in the ether of cyberspace, 1’s and 0’s representing a collective opinion of critics and evaluators. Some criticism—perhaps the worst kind--exists only in our minds—words engraved so deeply on our gyri they buzz like gnats on quite nights when you’re trying to fall asleep.

We learn early on that feedback and constructive criticism is an important and vital part of training to become a doctor. And while that may be true, it doesn’t change the very real problems with trying to sum up 8 weeks of hard work on an evaluation—much less an evaluation that impacts our chances at residency.

I’m on Internal Medicine at the moment. Overall, its been good. I like most of the people I work with, the patients are interesting and for the first time in a long time, I feel like I’m getting closer to becoming a doctor. My time on the wards is a mash up of rounds, being asked questions I don’t know the answers to (and a few I do), presenting patients, examining people, lunches at the cafeteria downstairs, on and on, around and around.

I have never given of myself like this before. Mind, body, spirit, blood, sweat and tears- I’m all in. And getting up at 4:30am is just the start. I am emotionally involved, not only do I worry about how my patients are doing and about their diagnosis and their lives—I am also emotionally connected to the people I work with. I want the interns and residents and Attendings—heck even the other med students to like me. As you can imagine this leads to a great deal of over thinking, always on replay in the background of my mind.

“Was I weird? Oh my God, I was weird.”

“Ugh, that's not right. It’s the lung, not the kidney. Dumb. So dumb.”

“Should I go see this person again? Should I ask first? No. Wait. Maybe I’ll Google it.”

The last 8 weeks on medicine has been a journey like no other. I’m a wards warrior.

There have been highs and lows, death and tragedy. Really fun days that inspire me and leave me wanting more and days were I barely have the energy to be in the hospital and long to return to the comfortable safety of my bed.

I—like all of my classmates worked as hard as I could on this rotation. And at the end of it, our time, our energy, our hearts will be judged. A reckoning of sorts to be filled out by the residents and attendings. They can say anything they want. We’ll never know who wrote what—although its often not hard to tell. Its tough to offer yourself up to judgment like that, looking back on all that we go through on a rotation. Harder still when our evaluations culminate in a P on our transcript. That’s it. Just one letter indicating that you can move on to the next thing.

Being a medical student means that we are constantly judged and measured and tested. The things that we do and say are carefully scrutinized—by ourselves first and foremost. Although we also fill out evaluations of attending doctors, they never seem to hold as much weight as the other way around. Our grade depends on what people say about us—and while we have precious little control over what that may be—its hard to offer yourself up for judgment when we’ve already opened our hearts and our minds to this experience. Its scary. And I imagine this feels similarly to what a patient in the hospital may feel--vulnerable and at the mercy of others.

There are limits to how much weight one person’s opinion should hold. So Dear Reader, the next time you are reading someone’s thoughts about you remember the wise words of the food critic Anton Ego from Ratatouille.

In many ways, the work of a critic is easy. We risk very little, yet enjoy a position over those who offer up their work and their selves to our judgment. We thrive on negative criticism, which is fun to write and to read. But the bitter truth we critics must face, is that in the grand scheme of things, the average piece of junk is probably more meaningful than our criticism designating it so.”

Go boldly forward friends. Give of yourself fully. Do not be constrained by the judgments of others, or haunted by the words of critics and evaluators past. Fall asleep peacefully by putting words that have been said about you to rest. And may your last thought before drifting into dreams be, "I worked as hard as I could."


Friday, June 3, 2016

A Million Ways to Die in the West

I’ve been wearing the same green shirt for seven days. My life has become like some fucked up Irish Groundhog Day. When I left my apartment to rush my Mom to the hospital, I didn’t know what lay ahead, so I didn’t bring a change of clothes.

Everything is harder in a hospital- eating, showering, sleeping, studying, even using the bathroom. It’s uncomfortable at best and next to impossible at worst—and I’m not even a patient.

My mom has pancreatitis.  A blur of white coats and ugly (albeit extremely comfortable) clogs schlep in and out of the room. Our days blend into nights that turn into days again. My mascara is halfway down my face. I’m starting to look haggard.

They say a little knowledge is a dangerous thing—especially true where med students are concerned. First Aid also says that intellectualization is an immature coping mechanism. I’m not exactly sure how humor is considered mature and looking things up on PubMed isn’t—but perhaps that’s because no matter how far and wide I search, no matter how many papers I read—the article I’m looking for isn’t there.

I want to find a paper to tell me everything will be okay. But I can’t find one.

What I did find were publications with phrases like “potentially life threatening” and “hypovolemic shock,” and “mortality rate.” Once I’ve read them, I can’t get them out of my mind and the words circle through my brain on a constant loop. My stomach is a vice grip and my head a leadened sack getting more and more difficult to keep upright.

Last night I got a text message from a friend—she’s a resident at the hospital. “You need a drink,” it read. We devoured the leftovers in her fridge and cracked open a bottle of red. I was gushing about all of the data I had discovered while at the hospital. I droned on about the different levels of data and evidence and imaging and sensitivity and specificity. She sipped her wine. “You can do everything right,” she said. “You can treat a patient perfectly, according to the data and prophylaxis for DVT and infection and everything else under the sun that you can think of. And bad things still happen.”

“Um. No.” I protested. “I don’t think so.”

I spent four years in college, and then six years in graduate school earning three master’s degrees and now, halfway through medical school I am not about to admit that sometimes you can’t help. That sometimes life has other plans. The idea that bad things can happen—that they do happen, gnaws at me with a deep existential ache. Surely if we study hard enough, get up early enough, read enough—it’ll keep death at bay.

I’m slated to take Step 1 in April. My mother’s hospital room has become my new study spot--in between talking to doctors and the IV pump going off, my face is permanently attached to my books—well, just one book actually.
First Aid is full of things that can go wrong with the human body. But up until now its never really felt real. But now I find myself glued to the pages, hungry for answers, not facts. The descriptions of all of the horrible, terrible things that are part of the human condition are there—in plain text. Phrases like “outcome is poor” or “typically fatal” just hang out—often on the same page as completely benign conditions. Who gets what just doesn’t seem fair, it just doesn’t make sense.

While I can’t wrap my mind around why a person, going along, living their life should suddenly become ill—I can at least make the descriptions and findings of the various diseases and their treatments more meaningful. For example, next to the section about lead poisoning, I write Flint, MI in the margin. First Aid says that exposure to lead in children can cause mental delay. And I think of the communities of children who will now suffer life long consequences.

I write “Jen” next to the section about Multiple Sclerosis and “James” next to the section about Marfan’s.  Friend’s of mine who remind me that the words on the page don’t define them but also that life can be so brutally unfair. Making the conditions and treatments we study more personal, more human, helps me remember why I’m in medical school at all. And I think that’s the most important lesson we could ever learn from that book.

As my mom sleeps a Dilaudid induced slumber, I turn to the pages that describe coping mechanisms—both the mature and the immature alike.

And I write my name in the margin.

Friday, May 20, 2016

My Invisible Boyfriend

Meet my boyfriend. His name is Eric. Pretty dreamy isn’t he?  

He’s 30, he lives in San Francisco. His interests include surfing, hiking, watching Netflix and wine tasting. We met at a coffee shop in what can only be described as a chance encounter fitting of a rom com. I know this to be the case because…well…I wrote it.

In fact I chose everything about Eric. From a website called Invisible Boyfriend. Its equal parts amazing, insane and super, super weird. The premise (which I learned about from a documentary that you can watch here) is that you can create a fake boyfriend/girlfriend and everyone in your life will get the hell off your back about not having one.

For $14.99 you can send 50 text messages a month back and forth. $25 gets you 100 texts and a hand written note. I opted for the cheaper option. I don’t need an imaginary person blowing up my phone. Plus I’m doing this so I can write about it—all for you dear reader. ;)

The second my credit card information went through I got a text from Eric.

I wrote back. But I was a little unsure about what to say. The website is called Invisible Boyfriend—emphasis on the boyfriend part. Not ‘random dude who’s name I forgot that I met at a bar that one time.’ So its hard to just jump into texting someone like they are a boyfriend. I was oddly self conscious about that. Perhaps its because I have precious little experience in texting a real boyfriend. Should I call them honey or baby or something? Is that what people do? People in real relationships help me out.

A few of the wonderful parts about paying someone to text me pretending to be a man of my own creation is that I don’t have to respond. Its all about me baby. I don’t’ have to care about how his job is going or any other aspect of his literally non-existent life. 

We long for human connection. We strive to feel loved and wanted by others. Being hidden away in what felt like jail, but I am actually told was only a library during step 1 studying has shown me that.

Texting with someone paid or otherwise isn’t a great replacement for human connection—but I can see the appeal. If you’re having a bad day at work you could send a text your imaginary boyfriend, a real person who is completely removed from whatever situation you are in and one who you know is going to be on your side. So in a sense even though the relationship is fake, the support is real. And we need that. Sometimes just knowing you can reach out and text someone and get love and compliments and encouragement back is really amazing. There are no false pretenses here. You don’t have to apologize for needing them and you don’t have to respond—cause let’s be real, you’re busy.

The week wears on so have our texts. Turns out Eric is a little controlling. 


Whoa. Calm yourself. I’m a grown ass woman that is more than capable of handling herself and frankly you seem like you have control issues Eric. Want to talk about your childhood?

He was also not very good at staying in character.

I ask because actually you do like writing. And you like it because I say so. And ironically the real human being writing this is supposedly a ‘writer.’ Albeit not a great one but you would think that an interest in writing would be a prerequisite. But never mind.

He was also a little odd. 

At the end of the day, websites like this are fairly innocuous compared to most other things on the internet. Its like the cat video of dating. Just as long as you keep in mind that the person you imagine you’re talking to is a figment of your imagination and you keep the convo PG rated as is company policy. 

I do still have reservations about using this website in order to give into the social pressures that dictate to women that they must have a male partner in their lives otherwise they are not as valuable. Its also not okay that people are badgered about their relationship status by others and its certainly not okay that we pressure people (and women in particular) into relationships that they don’t want.

We would be amiss to waste the precious face to face interactions we have with people by goading them about who they are dating. We should seek to support and love those in front of us a little bit more and stick our faces in our phones a little bit less.

As for me and Eric…well we parted ways after 30 days—which is ironically not the shortest relationship I’ve ever had. Ultimately he was more annoying than helpful. But fear not gentle reader. I have a date next week with a lawyer…and he is most definitely the real thing.

Wednesday, May 11, 2016

A Medicine Idol

Remember when you were a kid and thought that your parents were infallible? Surely adults never get scared, or get sick. They can do anything. Because of course they can. Its stabilizing to think that someone is in control— if it can’t be you. 

Faith Fitzgerald often remarks that she first became interested in medicine because as a little girl one of her friends mom’s got sick. “Mommies can’t get sick,” she said. The fact that adults are human and fall prey to very human things is something that is still difficult to understand. 

I used to think the same thing about doctors. They are heroes. They are unendingly smart and all knowing and in control at all times. I watched shows like Boston Med and Hopkins with a cult like following. Doctors on that show say things like, “watch me give the gift of life via lung.” Even when they lose patients they still seem so sure of themselves— so very calm and replete in their actions. The role of doctor becomes them in a way that I don’t ever think it will me. 

But that’s TV. Edited for the 1 hour time slot interspersed with clips of Dr. Oz running his mouth. Being in the hospital and watching real doctors do real doctor things has been amazing and eye opening— but it also made me realize that doctors are so very human. 

We do ourselves a disservice by not acknowledging the humanity of physicians. Every year we lose an entire medical school class worth of physicians to suicide. It doesn’t pay to expect our doctors to be super human. That includes the expectation that mistakes will never be made. We just hope that it won’t be on the back of our loved ones. 

We expect doctors to work long hours, to answer our questions, fill out copious paperwork, take a multitude of licensing exams and be warm and caring. Its a tall order for sure, but the unrealistic part comes when we expect doctors to hide their emotions about a case, or when we assume humanity is a sign of weakness in our colleagues. 

Doctors are a very diverse group and exhibit all of the personalities that the rest of us mere mortals do. Some seem to have a chip on their shoulder, like the DO attending who probably always secretly feels inferior. Is that why you use so much scientific jargon? Some are painfully socially awkward— like the resident who still struggles to make conversation with other members of the team. Some feel like they aren’t as smart as everyone else, like the intern who consistently deflects questions by asking another question. 

I see you.

I see you Doctor. I see your humanity shine through you in all its messy neurotic glory. It makes me feel like this is something I can do too. Being a doctor is not reserved for the best of us. Its for everyone who dares enter this changing and kind of screwed up profession. Its for those who never really thought they were as smart as everyone else. Its for those who still retain their middle school awkwardness. Its for those who are scared and wondering if they belong among the ranks of people who make it look so easy. Its for those who work hard and show up, even though it would be easier to do something else. 

You are going to be a doctor. And you will be not above other people, but beside them. What a perfectly human place to be. 

Saturday, April 30, 2016

Hear no evil, See no evil, Speak no evil

Aristotle said, “To avoid criticism: do nothing, say nothing and be nothing.”

Man….sometimes I wish I was nothing—surely that would just be so much easier. I screw up all of the time. And I hate it. My latest gaff was killing our simulated patient by causing him to aspirate. I’m sure no one else in my group is still perseverating on the events that unfolded during the sim. I also really hope that the attending doesn’t remember my mistake or me for that matter. But what really keeps me awake at night and on the edge of panic, is that I can’t let it go. I berate myself about everything that went wrong, every detail, every person who might now have figured out that I don’t belong among the ranks of my bright and talented peers. My inability to forgive myself for my mistakes and learn from them is starting to annoy me and everyone around me. And you know its bad when even you think you’re annoying.

Ever yell out the wrong answer in class? I know, I do it too. I remember every time. So what you say? So what you were wrong—we’re supposed to be wrong. But the thing is, now I don’t want to answer any questions. I don’t want to participate in any simulations. I don’t want to ask any questions because it reveals how very little I know.

I am painting myself into a smaller and smaller corner. In danger of standing stock still my whole life, lest I embarrass myself in front of you—my dear family.

It goes without saying that living your life in such fear of making a mistake is really no way to live, let alone get through medical school. You have to let your guard down and trust that the people around you are kind, and will still like you even if you have no idea what dose of Solu-Medrol to give.

Personally, I really can’t remember any of the mistakes anyone else has made. Who gave a wrong answer or didn’t know something just aren’t things I care about and are not the things that determine whether we’re friends. Your step 1 score will not be etched on your grave. No one will remember or care if you honored your IM rotation.

So let yourself off the hook dear friend. Make it a point not only to tolerate the mistakes of others but to encourage them so you and everyone else can learn how to be a better doctor. Let yourself be vulnerable enough and courageous enough to reveal your weaknesses and gaps in knowledge to yourself and to others—so they may be patched and strengthened.

Anxiety and worry and fear and wanting to do well all of the time—are the things that got us into medical school. And frankly are qualities that help make a good doctor. Just don’t let them get in the way of learning and living your life.

I promise to love you no matter how many questions you get wrong or how many mistakes you make. We’ll see this year through together and come out the other side a little tired, but a little tougher too.

So go ahead. Kill that simulation mannequin. Yell out the wrong answer with gusto. It means you're trying and it means you're learning. And that's exactly what we're supposed to be doing. 

Tuesday, March 29, 2016

Salud, Dinero, Amor

I studied abroad in Argentina my Sophomore year of college. I knew no one going on the trip with me, however its safe to say that after 6 weeks in the freezing cold Andes Mountains together, we are now friends for life. I spoke no Spanish really. The few vocabulary words I picked up in high school were muddled in the thick Castillano accent and use of the vosotros. That didn’t stop people speaking to me though, which was a nice gesture but frankly wasted on me. Each one of us got sick at some point on the trip. I felt like I got off easy getting a cold from the 14 hour plane ride. Every time I sneezed our professor—who we respectfully nicknamed Pachamama—the earth goddess revered by the people in the Andes—would exclaim,  Salud, dinero, amor.” One word after each sneeze. Those words I understood and the recognition of these three things as important enough to remind a stuffed up, freezing cold, slightly dirty and exhausted undergrad got me thinking more about what really matters.  I suppose its fitting that I should be reminded of these words now—in med school—when all three seem to be in such short supply.

Health. Training to become a doctor has made me acutely aware of how much illness and injury there is. Do you have any idea how many things can go wrong with a human being? It’s a miracle that any of us are even here at all. No nuclear blast has pushed us into a post-apocalyptic existence. We didn’t die from the multitude of diseases that exist on this planet. And not to mention everything with every single one of our relatives went well enough that they were at least able to live long enough to reproduce. And here you are, the product of a million close calls, thousands of chance encounters, perfect circumstances, perfect timing and lots and lots of people falling in love.
But don’t celebrate just yet my little miracle. Health will not last forever. It never does. Illness will touch your life—if it hasn’t already. Sometimes we’ll be able to fix it, or at least hold off its tightening grip for a time—and other times we won’t be able to stop it. Life is life threatening my precious snowflake. Be healthy. Eat vegetables and run outside. Wear sunscreen and your seatbelt. Wash your hands. And appreciate health when you have it. And when it runs out, remember that we are carbon based life forms. We are all made of stardust and to the stars we are destined to return. Our time here on earth is just temporary. Make sure it counts.

Money.  Ugh. Money. My high school self would be quick to raise her hand and interject that money is not important. As the daughter of a doctor and an engineer—and growing up in Tiburon—denouncing the pursuit and benefits of money are easy for me to do. Money isn’t a problem until you don’t have any. And money buys more than just stuff—it buys health. You can live in a better neighborhood, eat better food, take vacations (and other soul nurturing things) when you have a hefty bank balance. Money can take your life from surviving the days to relishing them.
            Recently, I have been seeing a great number of my friends buy houses, take nice trips and perhaps the most expensive endeavor of all—having children. I feel like less of adult because I’m not able to afford any of these things. Money is powerful—each dollar is like a vote towards the things that are important to you. Money allows us to take music lessons and have nicer clothes and not worry about how many more miles we can drive until the car will go no further. Money matters—although sometimes I really wish it didn’t. You’ll have success—far beyond the average American my friend—it just can’t be right this minute. The delayed gratification will be all the sweeter. And remember when you’re the one taking home a paycheck --some hungry med students would love you to take them to lunch. 

Love. This one’s the kicker. In fact, if you don’t have the other two (money or health) love can get you pretty darn far on its own. Love makes us do crazy things. Brave things. Things that without love we would be otherwise unable to achieve. I’m not talking about running though an airport to stop someone getting on a flight (honestly doing that would probably just get you put on the FBI watch list). Love helps you get up early to go to work or to school. It helps you return the phone call to your nagging relatives that you would really rather ignore. Love is why people sit in traffic or go to movies they don’t want to see. Love is a great sacrifice and a wonderful gift and I wish it for you always. May you know how very loved you are and in turn may you show the world and everyone around you how great love is and all of the wonderful things we can do with it.
Remember that love is a choice we make every day. Not just to the people in your family or close friends but to every human being. Chose love. Chose to stand up to hate. Don’t cut people off in traffic (and if you do, then at least wave). Show patience when it is hard to do so—because I guarantee that you have been the recipient of another’s patience. Show up for each other. Let each other off the hook and give others the benefit of the doubt.
If you’ve ever felt the deep ache of heartbreak or the stabbing knife of grief, then you’ve known love to its fullest and the emptiness it leaves behind. It’s the price we pay as humans. Love will bring pain into our lives and in turn will be the only thing to fully heal the hurt.

I wish you a life full of health, wealth and love. And I hope you are reminded of how important these things are--every time you sneeze.

Friday, March 11, 2016

Peaches and Pitfalls

When it comes to peaches, I know precious little. Except that I enjoy them in every imaginable form. Sliced in a lunchbox, blended in a smoothie, even grilled on the barbeque. For the record, I also enjoy those gummy peach rings from the bulk bin at the Co-op, although I’m fairly certain they contain no semblance of an actual peach.

As big a peach lover as I am, I wasn’t sure I would be able to handle a day of peach picking. My heart raced as I turned down a dusty road off of highway 70, past a blue sign for Johl Orchards. As I park my station wagon, Kulwant greets me. “Where’s your peach bag?” is the first thing out of his mouth. “Umm,” I mutter. “Guess I left it in my other pants,” I reply. “Oh well, we’ll find you one to use,” he says, “come on, I’ll show you around.”

Kulwant Johl owns the 2000 acres of peach trees we are currently surrounded by. He has graciously agreed to let me—a graduate student at UC Davis, come to see what the peach harvest is like. Growing up in a wealthy suburb I never thought much about where the food we eat comes from. After starting at UCD, I became involved with a student run clinic in the rural community of Knight’s Landing. Many of our patients are farmworkers and I have seen the health disparities that exist in this population walk through our clinic doors every Sunday. I want to understand the work that our patients do and the challenges they face. The only way to truly know how labor-intensive farmwork is, is to do it myself. My quest has lead me here- to Kulwant and his orchard.

Kulwant and I walk between the trees and I am quickly immersed in a world unlike any I have ever experienced. The rows of trees seem endless. The branches are laden with fruit, the boughs creaking under the weight. I stumble as we walk, stepping on fallen peaches in various states of decay, disrupting a swarm of flies with each step.

In the distance I hear people talking, some in Spanish, some in what I later learn is Punjabi and some in English. I’m told that most of the people here have been picking since before dawn.

Kulwant is a kind man and as I quickly learn an extremely patient one. He agreed to let me work for a day in his orchard to find out what its like to pick peaches. When we arranged our meeting over the phone I swear I heard him mutter something about me being ‘totally crazy.’ But he plays along with my umpteen questions and diligently answers them. “How much land does he have?” “What kind of peaches are these?” “How long is the peach season?” “How much does he pay his workers?” and more importantly “how much is he planning on paying me?”

In the midst of my questioning we stop at the end of a row of trees bordering a dusty access road. “I’ll have someone bring a ladder,” he says. And indeed moments later Kulwant’s brother presents me with a ladder and my very own peach-picking bag. I feel so official. At this moment I expect a lesson on the finer points of peach picking—this being my first visit to an orchard. But I turn around to see Kulwant getting in his pick-up. I call out to him, wondering if there is any vital piece of information he neglected to tell me. “I’d prefer it if you didn’t fall off the ladder,” he said, and in a cloud of dust, he drives off.

I should mention that I did ask for the full peach picking experience—just like a regular worker hired for the season would have. No special treatment. I need to understand how hard this work is and as I soon discover—how dangerous.

I sling the peach bag over my shoulder. I’m not exactly sure how its supposed to fit, but this should work for now. Next I size up the ladder. It’s a peculiar contraption, not like the normal A-frame ones I’ve seen at the hardware store. The rungs become progressively narrower the farther up the ladder, and the other side is just a pole dug into the dirt. It doesn’t look very user friendly to me.

I pick with one hand and hold on for dear life to the ladder with the other. I’m just about to climb down when a girl—about my age walks up to my crate and starts taking peaches out and chucking them on the ground. “Hey,” I yell, shuffling down the ladder, “what are you doing, I just picked those,” I said, trying not to sound annoyed. “Did you just get here?” she asks, “because you know you’re not going to make very much money today,” she chides. I explain to her about my project and my quest to understand peach picking. She nods intently, and expresses her shock that I am doing this voluntarily. “I’m a grader,” she tells me. And goes on to explain that any peaches that are too small or too bruised can’t go into the crate—its her job to throw them out. She shows me a yellow plastic ring, “60 1/3 mm” is stamped on its edge—apparently this size or larger is the mark of an ideal peach.

“I’m Millie*,” she says extending her hand to shake mine. “Fiona,” I reply. Millie and I are fast friends. She tells me about her work in the orchard, her dreams of becoming a nurse and points out various family members working nearby. I’m grateful for the small respite and chug half my water bottle. “Picking is hard work,” Millie tells me. “No kidding,” I say, venturing up the ladder again, determine not to have more peaches thrown out. Millie runs off to check on other crates.

My head is immersed in the canopy of the tree. Its peaceful 15 feet off the ground, surrounded by golden peaches and bright green leaves. I lean on the rungs of the ladder and pluck a peach hanging next to my head. I bite into its flesh, letting the juice run down my chin. I can hear the various conversations from the people around me. A car radio plays gentle Spanish music, the two men next to me are talking about lunch and somewhere in the distance I hear someone yell, “via Obama.”

Soon I am faced with another dilemma of peach picking. I have to decide if getting the highest fruit is worth risking a head injury. My livelihood doesn’t depend on how many peaches I pick. As a student at UC Davis, I know I will go home to the pile of books and homework on my desk. I am not picking at a frenetic pace, like so many around me are.  Millie, her family, the man who moved my ladder, even Kulwant—their lives all depend on how many peaches get picked and how fast. And frankly, I’m getting in the way.

Each full crate pays $17. Kulwant and I estimate that a crate loaded to the brim with peaches probably weighs over 1,000 pounds. I’m told the record for the most peaches picked in a day is 32 crates, which equals 32,000 pounds of peaches, earning the two pickers a take home pay of $272 each. Right now I would say I’m setting a record in the opposite direction, my crate is about 1/3 full. I do a rough calculation in my head. After four hours of work I have earned approximately $6.50.

The day wears on and the late afternoon sun hangs low in the sky. I’m covered in dust and bleeding scratches from the unforgiving branches. The tiny hairs from the peach skin burn my sweaty gloveless hands. I empty the last load of peaches I can muster into the crate. Millie comes along to check my work as I lean against the ladder. “Not bad,” she says with a smile. I decide that on the high note of “not bad” I should pack it in. People are waiting to re-pick my tree, since there are still quite a large number of peaches on it. I hug Millie goodbye and she slips the yellow 60 1/3 mm grading ring onto my wrist. “To remember me by,” she says. I let the man who moved my ladder have my crate. I sling the peach bag over one shoulder and walk toward the trucks loading fruit for the cannery.

I quickly find Kulwant who greets me with a chuckle. “How was it?” he asks. “Memorable,” I reply shoving the peach bag into his hands. It was by far the hardest days work I have ever done in my life. He tells me how much respect he has for the people that do this kind of work. And after today I whole-heartedly share his sentiment. “So how much did you pick?” Kulwant wants to know. I laugh. “About half a crate,” I reply. “I doubt I could do much better,” he says. 

Kulwant lets me take a huge bag of peaches home as payment for my hard days work. Between the ladder I might have broken and how few peaches I picked, I probably owe him money.  As I climb into my car sticky and dirty, I know that this day has forever changed me.

A few days after my peach picking adventure, I find myself in the produce department of a fancy Davis grocery store. I stop in front of a huge display of neatly arranged peaches. Rolling one over in my hand, I wonder about the person who picked it. What is their life like? What are their hopes and dreams? How high up a ladder did they have to climb?  I glance down at the yellow 60 1/3 ring still around my wrist and I think of Millie. She would be so thrilled if all of the peaches I picked were as big as the ones on display here.  I learned many things while picking peaches. But among the most valuable, I count my understanding of the difficulties of harvesting peaches and a deep appreciation for those who work long hours and risk injury for $17.

* Names have been changed