Call me fickle, but I'm writing at Luminousheart.vox.com again. I wish I could be like normal people who just write on one blog for years.

Going to bed at 10 am.

I'm post-call again this morning, for the second time in four days. Since I'm going on vacation during the second half of the month, they have to cram in my requisite number of calls (five this month) into the rest of the time that I am here. We had a busy morning, including an emergent intubation in the ICU (which I got, yay!), so I was at work for 26 hours! (I love to complain about how many hours I work, can't you tell?) We all have our idiosyncrasies; one of the female senior residents loves comparing her looks to other girls. She's in her late thirties but looks younger. She is half Asian but dyes her hair platinum blond religiously. This morning she saw me and grabbed my shirt. "OH MY GOD, Sel, you look SOOOOOO EXHAUSTED." You might think she was concerned that I had a rough night on call or was being too overworked, but no, you could see it in her face: she looked happy, perhaps even thrilled that I looked so horrible. We had a morning conference with the chairman after that and I kept catching her catching sneak peeks at me. (Thinking to myself: Okay already, I know I look horrible; is it that shocking?)

I had a busy but satisfying call. One of my patients was only 16 years old and recently immigrated from Central America so she didn't speak a word of English. I was able to use my Spanish but more importantly, I was able to play a huge role as she was scared to tears about the upcoming operation. I was more connected to her than the surgical team was, which confirmed my understanding that an anesthesiologist does have power to impact patient's lives... no matter how our role is belittled by other physicians (especially surgeons).

The only unfortunate thing about being on call last night was that I missed Chris's birthday. He complained about it a lot, but more like a little child whining rather than really angry (I hope). I probably should have made more of an effort to switch my schedule (ie, trade call nights with someone else), and for that I feel guilty. I did, however, take him out to dinner the night before since I knew I wouldn't be there yesterday. That was nice. On the whole, however, something seems off about him ever since yesterday morning. When we talked on the phone he seemed distant and upset about something. He keeps denying that anything's wrong, but my intuition is usually right. I'm guessing that it's something that he doesn't want to admit to me, so maybe it involves money.

The Return of the Shopaholic

Two young men with jaw fractures after being struck by baseball hats, one young man newly blind and riddled with skull deformities after a gun shot wound to the temple: these were some of the wild and wooley characters making up my weekend call at the House of Doom. It was steadily busy for at least twelve hours without respite... but for the first time, I really enjoyed my call. I'm telling you, this anesthesia thing is growing on me. The only thing I missed was the first major snowfall of the season. I looked out longingly from the second floor hospital windows. When I left for home this morning, the snow turned to rain, and now there are sheets of treacherous black ice on the roads.

If there's one human behavior that has changed completely because of my work, it is my driving. Since my resolution to change last month, I have consistently remained a safe and boring driver. No longer am I the fastest driver on the roads as I used to be. In the operating room I don't see the ones who have died from car accidents-- those are for the emergency medicine residents to handle. But of those victims who have survived-- I see the worst of them, because they inevitably need surgery. And what I have seen has scarred me for life. I wouldn't say I'm now afraid of driving, but what I feel is close to that.

I slept for a few hours this morning after I got home. Then realized that I only have a dress for Saturday, and nothing else. (Thanks for reminding me, Lara, by asking if I had accessories yet!) So off I went shopping for a strapless bra at Victoria's Secret, bought eye shadow at Chanel (the saleswoman knew me by name though I hadn't visited since September; I was impressed), and engaged in a several hour quest for the perfect shoes. I ultimately settled on a lacy pair from Ann Taylor:

Not sure if these are "perfect." The material and color are similar to the top of my dress. But are these shoes too "black" for the dress? I have a back-up pair of pearly-colored shoes at home if a lighter color is the way to go.

For the sake of my bank account, I'll skip the search for new jewelry.

A new month (Or: a chance for a clean slate)

It's currently 18F/ negative 7C. With the wind chill, it feels more like 5F/negative 15C. The weather wasn't much better during the day. Despite that, we went off to search for our Christmas tree. Chris talked me out of going to a rural farm to pick out the tree. So we copped out and went to the local Mahoney's where they sold pre-cut trees. It wasn't a disappointing experience however, as they do try and recreate the farm look. There were endless rows of trees standing up tied to little poles to simulate the look of trees still rooted into the ground, and there were so many shapes and sizes to choose from. However, we were in danger of frostbite and in a sore mood from an argument earlier this morning so we quickly picked a cheaper and thinner tree than last year's beautiful fir. However, now that it's sitting in our living room, over six feet tall and adorned with lights and ornaments, one can't really tell a difference.

I'm on call tomorrow so this is the end of my weekend. I'm already looking forward to coming home Monday morning and going to sleep.

I've decided that it isn't possible to make up for a sleep deficit with only one good night of sleep. I slept for at least 10 hours last night but was still fatigued all day today and these tired, baggy eyes looked back at me through the mirror. (In fact, I now hate looking in the mirror as all I ever look is horrible these days and I can't figure out why!!) What I'm feeling no doubt is a chronic state of sleep deprivation. I'll be using my upcoming vacation to fully recuperate.

I only had one case today and the paramedic student needed one more intubation to graduate. Despite what I wrote yesterday about my selfish greediness because I still enjoy doing all these things myself, my sense of moral duty compelled me to offer him this intubation so he could graduate and go forth into the world. After all-- if I get into a life-threatening accident on the highway I would want the paramedics to be able to intubate me. Or if Chris or a family member had a cardiac arrest, I'd want the paramedics who rushed to our house, be able to intubate. I was mortified when the paramedic student told me he was only required to get 10 successful intubations to graduate. It took me at least 50 successful ones to feel really comfortable. It's November 30th, the end of the month, and the last day of this NaBloPoMo. So after tonight I will no longer feel compelled to write every day. It was a fun exercise while it lasted, but now I won't have to write sub-par stuff and can go back to writing only when I really have something meaningful to say.

Despite the long work hours, fatigue, and the worn, increasingly unattractive face that is my reflection in the mirror...

I'm starting to really like this practice of anesthesia. I no longer daydream about returning to internal medicine. That is progress. Even an intubation still excites me. I have now done approximately 102 successful intubations (remember when I couldn't even get my first one?). Sometimes I still get critiqued on my technique though. I think I still need so much more practice and experience. I admit that I feel selfish about intubations. I want to do them all the time. However, I often get medical students or other residents doing an anesthesia elective and they ask to join me on my cases, and they want to do my intubations. Even a paramedic student today asked if he could take my intubation. I don't know how to assert myself so I give it all up to them. I remember how I felt as a medical student when I wasn't given much of an opportunity to try intubating so I try to be generous to everyone now. But on Monday night when I was on call and had to intubate someone emergently in the ICU, I couldn't get it despite trying twice. My senior resident had to try. She got it easily. I think this means I still need the practice. Besides giving up my intubations to the med students, it's also tough to pay attention to what's going on in the case and try to teach a student at the same time, particularly this early on when I'm still learning the ropes too. Truthfully, my heart sinks everytime a student comes up to me and asks if they can join me on my case. I feel ashamed for having this feeling because a good resident should want to teach.

The only thing worse than having an overly long day at work,

is having an overly long day at work and coming home to find multiple piles of dog poop all over the cream-colored carpet in the bedroom.

Who says dogs can't have human emotions? My chihuahua is capable of a highly evolved form of emotion: GUILT.

I instantly knew something was up when I walked into the bedroom and found neither dog in sight. Usually, they are highly visible and come to greet me when I come home. This time they were hiding under the bed. It wasn't a matter of If they'd done something, it was a matter of WHERE they'd done it. I found my answer on the floor.

The funny thing is, I don't even punish them. I just say "bad! bad!" and they know.

I guess it could be worse. I could be a mother and come home after a long day at work and have to feed and bathe a HUMAN baby. That's got to be a lot harder.

You're so vain

I ran into UberMan's ex-best friend (The Iranian) yesterday. We talked about the nature of his friendship with UberMan and other people we knew in common.

He sat back, his legs crossed, arms flexed behind his head. "They were all like kids," he said. " I've been through so much in life. My level of understanding about life is beyond their comprehension."

We had done our internship at the same institution, albeit different years (he's ahead of me), which is why we had so many friends in common. Those who knew him, spoke of him with reverence. He had lived in several different countries, spoke an assortment of foreign languages, and could talk with intelligence about anything, according to these people: the same people he was now calling intellectually inferior.

"It's like trying to explain what an orgasm is to a seven year old," he pontificated. "Think about it. There is no way you can fully explain this experience to a child and have them understand you... because they haven't experienced it! That was the way I felt with UberMan and (our other friends). Still though, they were the closest friends I had at the time... and shaped my life."

Inside I was rolling my eyes.

I haven't been impressed. The more somebody advertises their greatness to me, the further they'll have to go to actually impress me. "Show, don't tell" is the motto for writing well. It's also a genuine way to live life.

I too have lived in a few different countries and at one point could speak five different languages. I've been through many unusual and rare experiences, some at a tender young age. The Iranian doesn't know that about me, since he talks a great deal more than he listens. Not only is he not a good listener, he's pompous, quick to dismiss others, and automatically thinks he's better than everyone else. I'm not impressed.

Do you know anyone like this?

On call; another 25 hour stretch at work. Someone said to me today that he's finished all his Christmas shopping. The television is playing Christmas commercials and the radio is playing Christmas music. I don't know why; I'm just not feeling it yet. We thought about going to the tree farms this past weekend to pick out, chop down, and bring home a tree like we did last year. But it just doesn't feel like it's Christmastime yet. Every time I've gone shopping this past month, I've been buying things for myself and not for others. I guess I have this long wishlist... and I've waited so long for some of these things. I have never had any credit card debt, and hope to never have any (since I have over $260,000 in medical school loans that I have to consider), but not having credit card debt means having to exercise delayed gratification: wait 'til the time's right, can't buy anything whenever I want, etc. I bought the dress at Lord and Taylor's this past weekend. It looks little different on me; since I'm not as tall as the model, the dress reaches down to my knees and doesn't look as much like a nightie. The top still feels a little bare though; that's the tricky thing about these work parties... I don't want my attendings seeing me with too much skin... Some people were talking about the annual parties of years past. Apparently the group of physicians we belong to has very deep pockets. In addition to the glamorous downtown hotel, one year they even hired the city's prestigious ballet corps to do an excerpt performance from The Nutcracker!

Confession, continued

I emailed both of my parents a copy of yesterday's newspaper article that Chris had been mentioned in. He was the assistant district attorney on a case involving a drunk driver who'd caused an accident last week. I'm starting to open up more to my parents about Chris. For many years, I had avoided the subject. They had disapproved of him on several levels, even without knowing the worst of our troubles (the drinking). Fortunately, they've come 'round and accepted him, coincidentally around the same time that he cleaned up his life completely, about a year and a half ago. Part of the reason that they began to accept him was that they started to see what other men were like, particularly the ones my younger sister was starting to date. They realized that Chris has a lot of wonderful qualities that are rare and difficult to find in other men. For some reason they also stopped complaining about his shortcomings (ie, lack of financial success) after I graduated from medical school. I think they felt more secure after I became a doctor and knew that I would be financially capable with or without him. They also saw how busy and demanding my life was, and grew to appreciate how difficult it would be to find another man who accepts my lifestyle and supports it as much as Chris does.

The need for approval and the fear of criticism are, I think, the fundamental reasons why I've been reluctant to share Chris with the other people in my life. He's far from perfect, as are many of us. Unlike the rest of us though, he doesn't strive as hard to hide his imperfections. He doesn't care as much about how he appears to other people or what other people think about him. This can be a good or bad thing.

I find that physicians can be the most critical and perfectionistic people in the world. This may be a gross generalization. However, our job demands it. Without obsessive compulsive, anal, and overly thorough habits, we could easily kill someone or effectively ruin their lives. We also got to each step of our journey by survival of the fittest-- competing with others and beating the losers out with our grades, scores, and performance. The final result is a group of people, physicians, many of whom I don't like very much but we share more in common with each other than with any other people. The reality is that I have tried to introduce Chris to other people in my life over the years; most of the people who've been happy for us and accepted us as a couple were non-physicians; most of the people who had something critical to say were physicians.

Take for example, the party on Friday night. My girl friend S, whom I had always thought to be a nice person, was laughing hysterically with the guy who'd been forced to take a drug test at work. They were laughing at the other guys in our class who were overweight and a little too much adipose tissue around the belly. And the next day, while talking on the phone, S sounded a little petulant: "You looked sooo thin last night," she said. (She hadn't seen me in normal clothes for a few months; I'm usually in baggy scrubs.) Since we've met a few months ago, she's expressed her insecurity about her weight to me numerous times, even though she's a thin, petite girl who's only heavier than me because she has (significantly) larger breasts and butt! She's even stopped taking her birth control pills recently (and swore them off forever) because she'll probably be thinner without them. I don't know if I've had any influence on this, but the point I'm trying to make is that weight and superficial appearances are very important to my classmates.

I felt bad when I realized they were making fun of the guys because Chris is far from perfect too. When I met him, he was tall and handsome (6'2", or 188 cm), with an athletic build... by no means overweight. Unfortunately, through the years he has gone the way of his genetic fate (his mom, for example, is terribly overweight). He has gained too much weight, and though he's not morbidly obese or disgusting or anything, he's like a lot of other Americans after they're no longer young spring chickens. This is despite trying numerous diets, starving himself, and exercising (we walked six miles together yesterday). Am I nervous about what my co-workers are going to say about him? Maybe. When some of my med school classmates met him a few years ago they said to me, "he looks like a meathead." Was I supposed to be insulted or take it gracefully? Meathead: big dumb jock, not smart. He's well-read and writes well and went to law school; doesn't that count for something? Maybe he looks like a meathead because he always dresses like a slob. He looks great in a suit, but outside of work, he always dresses a slob. I relate more to Sandra Oh's character in Gray's Anatomy: "My room might be a mess. My house might be a mess. But I never look like a mess." Maybe I care too much about what other people think. I'm not used to being criticized for my weight or my clothing; thinness always came easily to me, (like the majority of Asian women), and I always dressed to make a good first impression.

It hurts me to hear what other people think or might think about my boyfriend.

Last night, our class of residents had a small party in a high-rise apartment overlooking the river and the city skyline. The instant I walked in, I saw that the male residents had all brought their wives. Their first reaction to me was: "WHERE'S CHRIS?!" Apparently they had wanted to meet him, and found it unfathomable that I wouldn't bring him.

I think I have issues. Stuff I haven't admitted to anyone before. Perhaps by writing it here, I can some sense of it.

I am an intensely private person. The residents in my class know very little about me, despite having been "in the trenches" together for over four months. While S and I have talked on the phone several times a week since July, she still doesn't know where I went to college, or that I like to write, or what strange and interesting experiences I've had throughout my life. I'm okay with that. I don't know why I feel the need to keep my work world so separate from my private world, but that's how I roll.

Now to the crux of the matter: not only did I not feel the need to bring Chris to this party, I didn't want to either. Part of it is due to my private nature; part of it-- and this is something I've had to deal with for years-- is the lack of compatibility. Chris is older; I've always preferred older men. (He does look insanely young for his age, though; people are always guessing his age to be at least 10 years younger than he really is). I think younger women who date older men have this problem, you see: While she can often hang out with his friends (who are his age) without any problem, it's not so easy for him to hang out with her friends (who are her age).

Maybe my issues go back even further than this. For as long as I can remember, I had often dated guys who weren't very good for me. As a consequence, they would be banned from my life by my family or my friends... but I would continue to secretly date them. So since my teenage years, these relationships were shrouded with secrecy, guilt, and deception. Before Chris, I never really dated anyone I was so proud of that I made him a part of my public life.

And maybe that attitude towards relationships was a part of my life for so long that even now it affects the very positive relationship that I do have with Chris. My instinct is to keep him separate, to not share him with the people in the other spheres of my life.

Part of me feels that this is wrong and that I have to change. The prospect of the Christmas party in two weeks is looming. I will have to go, for political reasons, and I will bring Chris. I'll introduce him to everyone who's anyone in my career at this moment. I have to get over this complex I have... whatever it is. Why am I like this?!!

Do you think I'm utterly crazy now?

We're going to a big Christmas party in two weeks at a ritzy hotel downtown. You know what this means: a perfect reason to go dress shopping.

I haven't actually tried this one on; I found it on the Lord and Taylor website. What do you think? I have dark hair with a light complexion; I think I look better in black rather than white... but the prettiest dresses I've found so far are white!

I also entertained the idea of wearing a qipao, the traditional, form-fitting Chinese dress. I used to have a red one, but I don't know where it is now (I've moved too much over the last few years). This time around I'd want a black or a white one. The problem with the qipao, in my opinion, is that because it's so tight on top, it can be unforgiving to someone with a small bust size.

Happy Thanksgiving! While driving yesterday and today I saw not only heavier traffic but also a lot of accidents. Our cynical chairman said, "This is a big week for organ donations." He was joking, I think, but the point is: don't become one of the statistics. Drive without ego: go a little slower and safer than you normally would. I have to work tomorrow. Boo. I only have one minor case in the morning; in fact, there are only a handful of surgeries scheduled on our entire campus. However, I know better than to have hopes for an early finish. (See previous entry).

In the field of medicine, one should never get their hopes up. I woke up a little later today (5:02 am) and took my time coming to work. I thought that surely there would be no cases added today, the day before Thanksgiving. Of course I was wrong. Not only did I get a case, I probably got the sickest patient in the entire hospital. I had been placed on standby in the cardiac room, which is typically reserved for coronary bypass surgeries and other cases which are too advanced for my level of training (we don't do cardiac months until next year). The case was a frightening maelstrom and I basically felt like an idiot the whole time. Probably anyone at my level of training would have felt the same way.

Lately I've been getting panicky feelings every day, at the mere thought of an upcoming case. Stomach churning, heart racing, muscles tensing up. I'm not sure why. I think I may have lost some of my confidence after a few blunders this past week. Blunders in anesthesia means near-death misses for the patient.

Chris came home today with a bouquet of 11 roses. The 12th rose had fallen off on the ride home, so he'd placed it behind his ear. He'd also written a card for Thanksgiving and said he was thankful for having me in his life :-).

"'Cause I love the way you call me baby"

In anticipation of Thanksgiving on Thursday:

I was assigned to an empty OR tomorrow. If something emergent comes in, I'll be put to work... but if nothing comes in, I'll be able to go home early!

I have Thursday off from work. I can hardly believe it! Last year as a medicine intern, I worked all day on Thanksgiving.

Chris had already bought a turkey and all the trimmings. I caught him watching the food channel briefly tonight, gathering ideas for the dinner he's going to make. He's so cute.

Dangerous and frightening things can happen in anesthesia. A few of these happened today. I've felt restless and distraught about it ever since.

So I'll talk about lighter things instead.

I've been wearing the same perfume for nearly 10 years now: L'eau d'Issey, by Issey Miyake. I think it's certainly time to try something new.

What do you like? What do you wear? I tried on "Sheer Veil" by Vera Wang yesterday and liked it, but didn't commit to buying yet.

Despite having been together for eight years, this relationship is still hard work and goes through phases. I'm recognizing a pattern here: during the week, when we hardly see each other, I often miss him and have positive feelings about him. During the weekends, when we're together in the small apartment, 24 hours a day, I get irritated and easily critical of him. This wasn't always the case; when my schedule was a bit lighter in previous months, my weekends with him were the highlight of my week. Lately, I've been more exhausted and impatient. We argued off and on today, and the unhappiness culminated tonight when he left the house to run errands and then lost his wallet, which included not just ID and bank cards but also money, which for him has been in short supply lately. I would say that financial matters are the most frequent cause of our arguments. I'm naturally good with money (in the stereotypical Asian way) and he has virtually no ability to hang onto money, (in the stereotypical Irish way). It seems more than just an inability, it almost seems like a curse. Anything bad that could happen financially to him, happens. I've had to bail him out countless times in the past and it looks like I will have to now again (on account of the lost wallet). I need to be more patient and generous.

In other news, I saw my old apartment building on the news last night. I lived in this particular apartment building when I first graduated from college and didn't know any better. It was relatively inexpensive, but was located in a college student area (a different town from where I went to college) and was rowdy, over-populated, and unpredictable. Beer bottles would be thrown into the front door window; I became accustomed to the broken glass. When Chris would visit, he'd park his car on the street, only to find smashed sideview mirrors or dusty footprints on the hood of his car the next morning. Well, it was only a matter of time before that building showed up on the news. Apparently there was a party there this weekend that got out of control. People were fighting and congregating on the roof, which had no guardrails or other protective features. A college kid fell off that roof and died on the scene. It was surreal to see my old windows, staircases, etc on the news, but not too surprising. I see so much gore and horror at my job that few things really shock me anymore.

Our first trauma case arrived by helicopter: a man who had fallen off a tall ladder at work. He had blown pupils and needed a craniotomy to remove a subdural hematoma.

Our second trauma case also arrived by helicopter and was a large, morbidly obese, close to 400 pound man who'd had a head-on collision with another driver. The other driver was killed on the scene. When asking the patient when his last drink or meal had been, a crucial question for anesthesia, he admitted to drinking alcohol at 10:00 that morning. He said he only drinks one beer per day, but it hit me later, when the commotion had subsided: what was he doing, drinking at 10 in the morning? His drinking was probably more of a serious problem than he was willing to admit, and perhaps it had been the pivotal cause of death of the other driver in this accident. This bothered me a great deal.

However, he was critically unstable and needed my undivided attention. Because of his enormous size and obesity he might be difficult to intubate, so I was nervous and scared as I got ready to intubate... though I kept this fact to myself as the crowd of other physicians hovered around his bed and me. Also, because of the possibility of neck injury, he required in-line stabilization. This meant that we had to keep his neck absolutely still and straight during the intubation, which would make my ability to find and visualize his cords in what was already challenging anatomy, even more difficult. But find it I did, and I was able to intubate. I was so happy, but this was only the first out of many challenges that the patient presented throughout the four hour case, so I wasn't able to enjoy my victory for long. He had almost non-existent blood pressure; ten minutes after intubation, his blood pressure was 30 over 20... and remained quite low until he got an elephantine dose of vasopressors and fluid resuscitation.

Last night for the first time I really felt scared for the patient's safety because of our fatigue. Both the senior resident and I were extremely exhausted by our 18th hour or so of working. I could barely keep my eyes open, my legs hurt, and I was nursing a cold. Thankfully, the wave of action subsided by 1:30 in the morning and we were able to sleep until it was time to wake up and leave the hospital at 7. Luckily, I don't feel sick anymore and I was able to get another few hours of sleep this morning at home... but I'm still too wiped out to do anything else.

On call. Am on a quick bathroom break. Trauma case after trauma case. Have been working straight for 18 hours. May be coming down with a cold or flu. Want to collapse. Will write more later. 7 more hours to go.

I couldn't bear to look in the mirror today. I only saw a tired, haggard face that looked so bad I was sure it wasn't really me.

It took an hour and ten minutes to drive home today because of rush hour and rain, an unlucky combination. To make things worse, when I walked into the house I found dog diarrhea all over the carpet floor. Usually, the chihuahua is curled up in bed, in the exact position she was left that morning (she loves her beauty sleep and doesn't budge an inch). This time, she was nowhere to be found-- so she must have moved off-- very unusual for her. Ultimately, she was hiding under the bed. She knew she had done something wrong. Who said dogs don't have complex emotions? This chihuahua knows when to feel guilty :). It wasn't fear, because I don't exactly punish her when she poops in the house. But I do use my stern voice and tell her she was a bad girl.

Tomorrow is Friday but there's no rest for the weary. I'm on call, so I'll be there until Saturday. Basically I've been working straight for two weeks, and I'm about to collapse. Also, my attending tomorrow is the vice chairman and he's very difficult to please. Yesterday, I worked with him for several hours and at the end he showed a rare display of praise: Several phrases of compliments, and then "Dr Seldelaterre, you are to be commended." But it doesn't come easy, and you have to work super hard to get an ounce of this recognition.

I hope I survive until this weekend, and then I'll finally have Saturday and Sunday off, after I catch up on sleep.

The Straight and Narrow Path

Five minutes after I feel asleep last night, Chris barges into the room.

"Come look at the news!" he says.

I grumble incoherently (I get in a terrible mood when I'm woken up).

"There's an attending physician from (university where I did my internship last year) who got busted in a sex sting operation; he'd been soliciting a prostitute!"

Scandalous, but not enough to get me out of bed. "Find out the name!" I yell at him.

"Dr XYZ!" he reports back, "they're showing his face on TV!" "Oh my god!" I say. And then I couldn't go back to sleep, reminiscing about this attending. He'd been my attending for a few patients last year. Gruff personality, emotionless face, and not friendly at all. Who knew that he'd be interested in females and sex? I guess all men are interested in sex at a guttural level.

Truthfully, however, I felt a little guilty for being so intrigued by this scandal. I have known more than a few people through the years, people whom I've cared about, who had gotten themselves involved in scandal, and it is devastating. For example, I or other members of my family have been close to two different people who later went on to murder someone. One murdered his wife, the other murdered her husband. And I didn't even grow up in the ghetto; I grew up in sheltered, upper-middle class suburbia. But that was also the reason why the people I knew, and who got into trouble, attracted so much attention; they were white collar, high profile people. And one of them (not the murderer) was my father, who also was a physician, and who also drew media attention and lost so much after his scandal-- his career, our family life, and many friends (who probably weren't real friends to begin with).

However, that's all water under the bridge now, and it makes me all the more resolved to make my life with Chris a fresh start from all that happened in the past. A drama-free existence, a strong loving family (someday), and always walking the straight and narrow path.

The reason why I've been writing every day since November 1st is because, during a momentary lapse of judgment, I signed up for NaBloPoMo.

To write every day when I'd never written regularly in the past did seem daunting, but to me, nothing is ever downright impossible. Besides, I thought that I would never run out of things to write about. I see so much on a daily basis-- wild and wooley patients, surgeons with Axis I personality disorders, and fast-lane medicine at its best. It's not easy to write about, though, particularly at the end of the day when I'm tired.

I wasn't able to sleep yesterday when I came home from being on-call. Then, I had to stay up late and watch Desperate Housewives (my weekly guilty pleasure) (I've finally managed to force Chris into watching it with me), so I only got five and a half hours of sleep after that. I worked today, which was doubly hard knowing that most of America had the holiday off. It was a shorter day than usual because of the holiday, so I only had two cases (hysterectomies) and two pre-ops to do. Nevertheless, it was still an eleven hour work day.

The senior resident whom I was on call with Saturday never complains about the grueling schedules. She immigrated from an Eastern European country several years ago and spent years gearing up here (working in research labs, taking her standardized tests), before she could even apply to residencies: steps that Americans don't have to experience. Nevertheless, she is so appreciative of getting this residency, in a desired specialty, in a cosmopolitan US city, in a stepping stone to a future well-paying job... that nothing is worth complaining about.

I don't have the same appreciation. I complain every day, internally or to my closest friends in the program. I have to remember that I could have it much worse, but what should I use to remind myself? I don't have enough hardships anymore other than my job. I need some perspective, but my brain is too exhausted to get inspired. It's 8 pm now, maybe I'll head to bed so I can catch up on my sleep deficit.

23.5 hours down; 30 minutes to go and then I can leave The House of Doom and go home! I should be trying to sleep now on the lumpy hospital cot, but the anticipation of leaving is killing me. In fact, nothing happened after midnight, but my sleep was fragmented anyway, as it always is when you're on call and dreading the fact that your pager may go off or the overhead intercom may scream "anesthesia stat!"

90 minutes after I wrote my post of bliss and quiet at The House of Doom yesterday morning, I found out that a gunshot victim was coming up. The senior resident and I ran to one of the designated trauma operating rooms, and only 30 seconds later the patient was already being wheeled in.

As I stood over his head, placing monitors on him, he was crying in anguish and screaming "I can't breathe!" I held a facemask containing oxygen over his face and, although I myself was screaming with anxiety inside, I said to him in the most soothing voice I could, "this is oxygen, concentrate on taking nice, deep breaths, in and out..."

As with other traumas, there was so much going on, so many people in the room, and extremely high anxiety and stress in the air. Induction and intubation almost at once, the surgery resident is placing a chest tube, I'm placing an arterial line, the senior resident is placing a central line, the surgeons are already prepping and draping, blood transfusions are running, and the patient's vital signs are out of control.

Someday I'd like to get so good that I could remain absolutely calm in a crisis such as this. I am already starting to see that the measures of progress in anesthesia training is gaining the ability to handle more and more pressure and difficulty in less time and less stress.

The case ended in four hours; the patient is made it alright to the ICU; the source of bleeding was found in the liver, and part of his liver was removed. Damage to the stomach and diaphragm were also repaired. "What is going on out there that this guy was shot in broad daylight? They don't wait for nighttime anymore?" some people said. I wasn't complaining. Better in the daytime when I was still awake rather than at night when I was in the middle of sleeping.

Still, taking care of him was an immense responsibility and I thought alot about why people did this to each other. I wondered who did this to him, and if it was part of the ongoing gang wars that's tearing our city apart. He was only in his 20's.

My senior resident was complaining later on. "I never knew about black culture until I got here," she said. "These people are ANIMALS. Wild animals. They get pregnant at 16, they kill each other, and they have these dumb looks of wildness on their faces." She complained on and on about the patient population here.

Honestly, I came here for this kind of patient population. In college, most of my volunteer work was with underprivileged inner city kids. In medical school, all of my rotations were at inner-city hospitals with underprivileged, underserved patients. I am handling cases of intense complexity everyday because these patients are poor, don't see doctors until they're well advanced into their diseases, and are challenging to take care of. Call me crazy, but I like it.

There's more I'd like to say but there are only 10 minutes left before the new team comes to relieve us.... gotta run!

9:00 am, Saturday. I am at work, on my 24 hour call. When I walked in at 6:45 am, I found to my happy surprise that there was nothing scheduled on the O.R. board. And meanwhile, the pagers have been silent. I hope it stays this way, although I did sleep for nine hours last night and I'm refilled with energy.

My fellow resident who was subjected to a drug test and suspended for a week pending the results, is back. We were thrilled to see him. Unfortunately, he told me that he's been accepted to another residency program on the opposite coast. All along, he'd been secretly applying to transfer out. We'd suspected as much, since he was always traveling away for mysterious reasons, using the hospital fax machine, doing paperwork. We'd also wondered why his wife and kids were still on the other coast and didn't move here with him. I guess all along, he'd been looking for a back door exit.

I was both happy for him and sad as well. I immediately texted S, who'd left for the other coast on vacation yesterday. She immediately called me back (she secretly has a thing for him), and her reaction was the same. Shock, sadness, and happiness for him all mixed into one. I asked Chris why he thought we were so sad (after all, I wasn't really close to this guy). Chris quickly said, "Of course you're sad. You all started together. You were in the trenches together." It's a bit like Gray's Anatomy-- a small class of residents thrown into life changing experiences with one another. You take it for granted that you'll be together for these three years of hard work and long hours. You need each other.

But I think there's another reason for why we're sad. We all had the same reaction: "Hey, I want to leave too! And I'm being left behind." It's a malignant program, difficult, and the hours are back-breaking. I myself have entertained fantasies of applying for transfer to another place, but I've held back. The way I've always been is that, once I've chosen something, I don't change. I've seriously thought about leaving anesthesia and returning to internal medicine, but I hate the idea of turning back, or giving up.

Then the selfish thoughts sink in. I hope the adminstration finds another resident to transfer into our class from another program to take this guy's place. Because if we're down one person, we'll have to make up for it and do even more on-calls.

It's Friday and I got home early for a change (5:30 pm). I should be thrilled, but I'm on call tomorrow, so I'll be working for 24 hours. Saturdays are notoriously busy at our hospital so I'll probably be slaving away for much of those 24 hours. And Monday is a national holiday but I have to work then too.

I'll probably fall asleep tonight in a dead heap, early as usual. These days I'm so exhausted that my sleep is equivalent to a coma-- I don't even notice when Chris and the dogs come to bed a few hours later.

In the mornings now I find ice on my car and temperature in the upper 20's. I've unwrapped my black winter coat from last year's dry-cleaning bag, and turned on the heat in my apartment for the first time.

Time marches relentlessly on.

It will always catch up with you

My last case yesterday was an anal sphincter repair, hemorrhoidectomy, and other assorted buttock repairs for an extremely ancient old lady. After I wheeled her into the recovery unit, UberMan's Best Friend came up to me. "This is why you should never have anal sex," he whispered in my ear in front of my patient. "It will always catch up with you." He immediately placed his papers in front of my face to hide my uncontrollable giggling from the hapless patient, who was smiling at us, at ease and happy from the effects of happy anesthetic drugs well done.

Afterwards, Uberman's Best Friend took me aside. "I thought about you this past week," he said. "And about UberMan."

Essentially, he thought I had unresolved issues. That I wasn't sure if I had made the right decision. Perhaps he thought I had let the opportunity for True Love slip away. "Here is my advice to you, which you might disregard since I don't know your poor Fiance at all and what kind of a person he is," he said. "But I think you should never, ever, ever settle for someone and stay with them just because it seems the right thing to do."

UberMan had told me the same thing: that I was settling. But whereas a part of me thought he was right at one time, I don't think that way anymore. Something changed when Chris and I moved in together this past June at last, after five years of long distance. Something also changed when he learned about UberMan's interest. There was a lot of fixing to do in our relationship but we finally did it. And Chris has fixed a lot of other things in his life.

What piqued my interest in UberMan long ago was his complexity as a person. Chris is not complex at that level, but I have come to understand that this is something to be valued. He's a simple, solid, good guy... and in the end, I believe these traits are more important. No matter how intelligent, interesting, and complex UberMan was, in the end he still was a womanizer who had no qualms hitting on and trying to bed any number of married, engaged, or otherwise unavailable women.

I was so exhausted that I got off the wrong exit on the way home today. Sadly, this is not the first time it's happened over the last few months.

Despite all this, I've been feeling so good about my work this week-- as you know, my feelings towards my chosen field is something I've been battling with. I'm starting to really like what I do. I'm beginning to be able to handle more pressure and more difficulty with less trouble than before.

At the end of the day, my attending (trained at the General and known to be a tough guy) said, "I really like how you're doing. You're on top of things... you're fast... you think ahead..." "Wow, me?" I asked several times. "Yes, you!" "Wow, thank you. I really appreciate it." I was on cloud nine for the rest of the day.

But I'm still exhausted and I still came home late, with only 2 hours left in the day before I had to go to sleep again. I was lucky because Christopher was already home and cooking me one of my favorite dinners. He was in a good mood because he won a jury trial today against one of the best defense attornies in the area.

Slowing down and taking a deep breath

Boston drivers are notorious for being aggressive and insane. I didn't get my driver's license until I was 21-- and I got it in Boston, after learning how to drive in Boston. Knowing how dangerous Boston drivers are, it is therefore incredible that I'm still one of the fastest drivers on I-93 and I-95 in the mornings on the way to work.

I know it's reckless, but it was part of my whole lifestyle of rushing here to there, walking fast, being impatient with others, and stressing out about everything. It scared me to see the consequences of motor vehicle accidents, which I see first-hand quite often, in the operating room. Fractures, head injuries, flirtations with death. But it was never enough to change my ways.

It finally struck me this weekend though. I was driving with Chris, and he became visibly and vocally afraid for our lives. I've therefore made a conscientious effort to change this week, sticking to the slowest lanes and taking a relaxed pace. From this angle, I sometimes see the fast lanes, with the cars driving too fast, and jerks tailgating and cutting one another off. I feel glad that I'm no longer a part of that.

I still somehow managed to get to work early, as did S. We set up our rooms, met with our patients, put in an IV, and even had time to get breakfast together. We've decided to make it a habit, of getting there early enough so that we could have breakfast together before the surgeons get there.

The real highlight of my day was when my first patient admitted how scared she was that I was going to be responsible for her anesthesia during surgery. She said I looked too young to be a doctor, and that I looked like a college student. I tried to reassure her by letting her know that I was soon to turn 30. The other week a frail old lady said in front of the entire room, "You can't be a doctor! You look like a kid! I feel like I'm on an episode of Doogie Howser!"

I couldn't have been happier :-).

The Road Not Taken

It was my intention to never write about Uberman again. However, Lara's post about accidental run-ins made me think of him.

As if we needed yet another reminder of how small this world is-- Uberman used to have a particular best friend and they were inseparable. However, they had a falling-out for complex reasons, and no longer speak to each other. Strangely enough, this Best Friend is training in my field, in my program, a year ahead of me.

Seeing the Best Friend every now and again at the hospital is a complicated experience for me. He has similarites to Uberman so I can see why they gravitated towards one another. And Uberman had told me so many stories about him-- I have a sense of their history, of what was and what no longer is. When I see the Best Friend, I think about all this-- the past which seemed so magical the way Uberman had described it, until it all went bad of course. The bottom line is, everytime I see him, it reminds me of Uberman, and I hate that.

Last week we were killing time in the hospital and I showed Best Friend an old text message on my phone from Uberman. "Why did you save it?" he asked. I babbled something about how I never use the textmessaging option on my phone so I don't get very many. The few that I got were from Uberman or my dad, and I never bothered to erase them. I'm sure it all sounded ridiculous and perhaps there really was a more meaningful reason for saving it.

The text message was sent in June, and ran along the lines of: "Dear Little One, I care about you and love you, and hope to marry you one day. This will make you happy-- I'll be in charge of breakfast. :-)" (He knew how much I hated to cook). I told you that he was delusional-- falling in love without us even having had a real relationship, without even knowing each other very long.

Best Friend read it slowly, his eyes lingering over the words. "He really cared about you," he said with amazement. He continued to explain-- Uberman had never felt this way towards anyone else before, and Best Friend had known a lot of the girls Uberman had been through.

Sometimes in life you have to make a choice, I said. I too had felt that I had met, in Uberman, someone who could have really been The Perfect One For Me. But I also had a fiance whom I loved and would never want to hurt: a long-term relationship I did not want to destroy. And when the two found out about each other-- well, Uberman (in his often delusional state of mind), was all prepared for me to leave the fiance for him, and the fiance was so pissed off he was ready to let me go. I could literally have gone in either direction, and it was surprisingly and shamefully one of the most difficult decisions of my life. But I made my decision and I've stuck to it.

"Decisions aren't written in stone," said Uberman's former Best Friend, suggesting that perhaps, this story wasn't over yet.

But I am sure it is.

Apres le deluge

The storms ended overnight; by daybreak, it was as if they never happened. I woke up to cerulean blue skies, a golden sun, and brisk autumn air. We took the dogs for a long walk in the woods and I think everyone felt better afterwards. My afternoon was spent studying, eating, and watching "Fatal Attraction" for the first time.

Because of Daylight Savings Time, however, it became dark all of a sudden: 4:30 in the afternoon. I was driving along I-95 when it happened and I was both surprised and struck by a sense of sadness. I've grown to love the outdoors, and crave sunshine and blue skies, more so because my budding career has taken all that away from me. I wake up at 4:45 in the morning and leave for work when it's dark as night. I work in a sterile operating room all day long without any windows. When I leave the hospital in the evening it's dark as night again. My only glimpse of sunshine during the day is when I buy lunch in the cafeteria, but even that is deceptive since the windows are tinted and the outside world appears a perpetual shade of gray.


I had to talk myself out of the void by thinking about all the happiness that winter could bring: Thanksgiving, with all its food and love; picking out a Christmas tree at a rural farm next month; snow!!; Christmas, with all its gift-giving and re-uniting with family; Christopher's birthday; my birthday; warm sweaters and fuzzy socks; running inside from the cold and into a warm, heated house.

I had stopped shopping for a long time after I had started my anesthesia residency. It was a strange territory, never experienced before: to be so unattached from material desires and wants. A simple life. This is in large part due to anesthesia-- I work all days in pajamas! (Scrubs). I no longer have to buy new clothes every season. I no longer have to buy endless pairs of shoes. And who cares about handbags? I bring a large cotton tote to work, which I have to throw on the floor of the resident lounge anyways, stuffed with clothes, books, and overnight necessities (for when I'm on call).

But since I stepped into the stores again last night for the first time in so long... Now I can't stop! Tonight I again went shopping. Surprised to see all the Christmas trees and lights and decorations already up in the malls. Thinking that my presence there was justified because maybe I could do my Christmas shopping early this year and avoid the last-minute stress and pressure.

At least tomorrow will be sunny

It rained all day-- torrential downpours and gusty winds at 55 miles an hour. Chris and I were imprisoned at home. We quickly got on each others' last nerves. I learned that: our apartment is too small for the size of our (large) egos, arguments over finances will always threaten to erode our happiness with each other, we are most happy when we can be outdoors and physically active, and I get stressed out when I have nothing to do. Finally, we parted ways in the evening and I indulged in some retail therapy, which put me in a better mood.

I also received good news when the Chief Resident rang me up at home today to work out the details of my first holiday request. I was truly late, behind the eight ball, in sending out my requests. Almost all of my other peers had sent in requests months ago, and some have already taken their first 5 days of vacation (we get 15 days per academic year).

So as it stands, I will be on call December 13th, leave the hospital the morning of December 14th, and will not have to come back until December 26th! And somehow this only counts as 6 vacation days, since post-call days, weekends, and Christmas do not count against my vacation time. This will be a much-needed respite from the interminable grind of the past few months. I'll probably spend a few days recovering here, and then fly off to the Gulf Coast for a few days. Unfortunately, I'll have to fly back on Christmas as I have to report to work at 6 am the day after. Also, I'm being punished by having to work New Year's Eve as compensation. I'm certain that that we'll be busy that night-- with car accident, gunshot, and stabbing victims. I've become cynical. But I'm so happy about this upcoming vacation I'm not even going to worry about the negatives.

Post-call

My call night was uneventful until I was paged at 5 in the morning for a craniectomy. The nice thing about anesthesia is that at the end of my shift, the case was only two-thirds finished but someone else took over for me and I was able to go home. The unfortunate neurosurgeons were still plodding away.

Since I'd been away from the external world for 25 hours, I was unprepared when I stepped outside and met the first really cold day of the season. It was in the mid-40's--not cold at all by New England standards-- but we're just getting started. In a few months I'll be acclimated to single-digit temperatures.

When I got home, I slept for a few hours. Got up and am eating leftovers from the dinner Chris made two nights ago. Contemplating a shower and getting my day started. It's chilly in the apartment, and quiet-- the dogs and cat are fast asleep, accustomed as they are to being alone during the day.

It takes time to step away from our memories before we can fully understand them. Four months after internship, I'm now starting to make sense of it-- my life in the other city, apartment, hospital, and the friends whom I no longer keep in touch with but now miss dearly. The cold, quiet apartment today makes me remember my Night Float month last January, when I worked nights and slept during the day. It was a hard month, 84 hours of work per week, but I was happy. Actually, I was happy for most of my internship year. I don't think I'm as happy anymore now, in the new city, apartment, hospital, and field of anesthesia... but I don't know. Again, I think it'll take time before I can have perspective.

I've blogged for over four years now and have never been able to write more regularly than once or twice a week. Medical school, internship, and now residency keep me busy and I don't write unless I have something interesting to say. But these days, I'm trying to write more frequently to help me stay sane. They mentioned at the meeting on Monday that part of what makes anesthesia residency hard is that we're in the operating room without really talking to anyone all day long. The surgeons talk amongst themselves, and we usually end up listening to their conversation, but without participating. There are too many things going on in the anesthesia side that require constant vigilance. The constant stress and isolation are a few of the things that make me unhappy. I don't compensate for it when I come home; I'm too tired to talk much with Chris and I end up ignoring most of the phone calls I get from friends.

Anyway, I signed up for this NaBloPoMo, which I'd seen other bloggers do last year. You have to write a post every day for the month of November and maybe win a prize at the end. Get ready for a lot of complaining about residency, as that seems to be the only topic I can talk about every day ad nauseam.

Addiction

It's like I'm addicted to the stress. I don't know what I want: I complain when my job is overwhelming and tiring. But I'm bored and want to shoot myself when nothing's happening. Yesterday I was in the ambulatory surgery center giving anesthesia for eye cases (cataract removals). The patients have to stay awake and alert during these surgeries so we basically give no anesthesia, just some one-time, short-lived sedation, and monitoring their vital signs the rest of the time. I was sitting there, bored and ready to take one of the surgeon's tools and gouge my own eyes out. I actually began to miss and wish for one of my busier and more stressful days: The days when I'm running on pure adrenaline, my heart racing in the 120's.

I shouldn't be saying all that. I'm on call tonight. Sitting at the hospital; it's 9 pm right now and so far nothing's going on. I want to keep it that way! I'm tired and want to sleep. But 10 hours on the job remain, and anything can happen...

On the subject of addictions, my colleague who was forced to take the drug test has not been on the OR schedule all week. That means he has been asked not to come into work. We're worried and we want to know what's going on... we're all in the trenches together. However, none of us know. We suspect that the drug test results are still pending (I suppose it has to be a very specific test for Fentanyl, not just a general screen for opiates), and he is suspended until proven innocent. Scary times for all, because this could very well have happened to any of us. Seriously. You never know what will throw you off the deep edge...

Winter of my Reconstruction

Several nights ago there was a mandatory meeting for us residents. We were asked to openly discuss issues that bothered us about the program so that we could all work together towards making it better.

The meeting was held at a ritzy hotel downtown where we were filled to the brim with wine, multi-course meals, and delectable desserts. After eating, we had to express our opinions.

I couldn't help but think of the books I read in the past about people's experiences with cultural revolutions in Europe or Asia, where intellectuals were asked to express their ideas in front of the dominant political party, but then executed later for saying the wrong things. I think we all wanted to be honest on Monday evening, but I for one wasn't sure of what I could really say and to what extent they really desired our honesty. But there was safety in numbers and together we expressed some of our sorest contentions.

The most common theme in people's complaints was the amount of work and hours we are forced to do compared to other training programs out there. I don't think this will change despite our complaints, as there are no realistic solutions at this point. We're a busy hospital with a huge population of underserved, poor patients (making us busy all day), and these are the type of patients who also get involved in lots of violence and traumas which lead to busy on-calls for us at night. Well, I'm here now at this program because that's what I wanted before, an urban hospital, at a time when I was more idealistic and unafraid of hard work.

Sometimes I feel guilty for complaining about my life, because nobody put a gun to my head and said I had to be a doctor. Everyone knows what a doctor's lifestyle is, even the streety waiter whom I worked with at a restaurant all those years ago. At that time, I was dating a doctor (briefly), and my co-worker said to me, Forget about it, don't have a relationship with a doctor. I asked why, and he said, "He'll never have time for you." He said it like he knew from true personal experience although he had none. I guess people just know.

Now I'm the one who's actually a doctor and sure enough, I have no time for anyone I care about and love.

I'm tired of feeling tired all the time but even more than that, I'm tired of being so negative every day. That's what I've been reduced to these days, a ball of negativity.

Tomorrow is the first of November, which isn't symbolic of anything except that it's the first of something, and I'm aiming to change. To be more positive in all realms of my life. Sel de la Terre was the name of a restaurant Christopher introduced me to in our earlier days. It also means "salt of the earth," a Biblical expression for a good human being, through and through. I want that to be me.

Ten Little Indians...

A few weeks ago, I wrote about the incredible pressures we face on the job. Why, I lamented, do help and support not arrive until it's too late, ie, the anesthesiologist is found overdosed on fentanyl on a bathroom floor?

Despite my anguish over the last few months, I have survived surprisingly well compared to some of my other peers. One of them was involved in a horrifyingly bad incident with his patient in the operating room and ultimately, the patient died. There have been meetings already with the hospital attorney.

Another guy in my class has been mysteriously deteriorating, to the point that he was forced to be drug tested this morning. Apparently, some of his "symptoms," like disappearing between cases, falling asleep on the job and needing vigorous physical stimulation to wake up... can be signs of growing addiction to Fentanyl. So far, nothing has been proven yet, but he's a nice guy and I feel sorry for him. If the drug test is positive he will surely be asked to leave, most likely to rehab, and most likely never to return here or anesthesia in general.

I'm holding on tenaciously to the facets of my life outside of medicine: my fiance (hereby named Christopher), my dogs, my cat, my interests in friends, books, writing, and the outdoors. A doctor must fight every day for his/her right to a satisfying, normal life outside of the hospital; otherwise, the pressures of our job could very well subsume us.