The Most Wonderful Time of the Year

So, July 1 came and went with a minimum of fuss. For those not in the know, July 1 is the start of the new academic year in medical training, that day when all the fresh-faced young interns, who just spent the last 4 months (since Match Day) slacking on the beach, are suddenly tasked with Being A Doctor.

I vividly remember my July 1, walking toward the mirrored glass doors of the hospital in my new long white coat (freshly laundered: first, last, and only time it was actually white) and thinking, Who’s that doctor coming toward me so fast? and then realizing OH WAIT THAT’S ME.

My other big July 1 memory is when I was walking down one of the hallways and they announced over the loudspeakers “Rapid Response to the angio suite,” and some lady in street clothes grabbed me and was like “What does that mean?” and I, having just sat through hours of orientation, unthinkingly parroted “It means someone needs CPR,” and the lady just collapsed in from of me. Like she just fell to the floor in tears.

July 1, as an attending, is a little different. It’s more of the same old, same old over in clinic; we do have a fellow this year but she is off-cycle. But the other thing about July 1, or summer more generally, is that it’s application season! I read medical student applications last summer and probably will again, but in the meantime, am going through applications for the upcoming fellowship crop. And ye gods, they are making the SAME MISTAKES on their damn personal statements. I feel like I’m in Groundhog Day.

So, in the interests of trying to make things better for next year (sigh), here’s the Scrivener’s Top Five Tips for a Winning Application Essay.

Done! Done?

Today was my last day of fellowship. Fifteen years of blood, sweat, and many many tears, and just like that, poof, training is over. I’m an attending!

I feel ready, but also very not ready. I have a job I’m really excited about, but carries a lot more administrative responsibility so I’m terrified of screwing up. Maybe that’s why I’m hedging my bets, academically, and trying to continue clinical research. And also revising the Carrie Buck novel? In, you know, my copious amounts of spare time.  (Our research coordinator asked me the other day if I’m secretly taking Speed, because I will churn out papers overnight. No, Steph, I just have no life.)

I am also really sad about leaving my training program. There are issues with it, as with any large institution, but the people are generally well-meaning, smart, and I have learned a TON. There is also a sense of security when you’re in training, like there is always backup. Whereas as the attending, you ARE the backup. Although they asked me to stay, it wasn’t the best option in terms of the infrastructure I wanted/needed in a job, and they were aware of that. It also can be somewhat awkward to stay on after training, because there is a very real chance that you’ll never be considered a peer to the people who trained you. That’s especially true at a place as hierarchical as this.

So off I go, to a place where I know next to no one. I’ve done this enough times to know that I’ll be deeply homesick for the first year or so, but then I’ll find my book group, my writers’ group, my science society, and I’ll come to love my new city just as much as I do my current one.

So here we go:

Oops

TFW you go to revive a dormant paper for submission to Journal X, then log in to your account for Journal X to check formatting requirements … only to discover you submitted there last June and got rejected in 5 days.

This free photo lady has a really big head…

Doctors’ Day

So apparently today was National Doctors’ Day, which is just about the Hallmarkiest of holidays. Here’s how this doctor spent it:

Woke up before my alarm (for once!), had ample time to get ready, and yet … still forgot to pack my lunch.

Chatted with a coworker for almost an hour, catching up on all the gossip while I was gone on vacation.

Cleaned the dataset I’m using for my research project.  The last time I used this dataset, I worked in SPSS which is GUI/point-and-click but took me months (MONTHS!) to clean. This time I’m using Stata this time, which I freaking love — I consolidated and cleaned the data in a day and a half! I love you, Stata.

Found a pack of Skittles in my desk drawer. Lunch!

Went to our fellowship didactics — this week was DBS troubleshooting and an overview of the new Abbott/St Jude device, which was super helpful. It was just approved a few months ago; I haven’t had the chance to program it yet, so it was nice to get to play around with the programmer.

Half an hour at the gym to make up for the Skittles for lunch.

Finished reading What Happened. I found it slightly uneven — partly personal memoir (lots of playing with her granddaughter) and partly actual analysis of the wtf-ery created by James Comey et al., but the two parts never really came together in a cohesive way. I also felt there was a lot of I AM HISTORIC! FIRST WOMAN NOMINEE! Which is … true, but also totally erases a long history of women running for president. #stillwithher, though.

Cracked into a pint of Ben & Jerry’s, because.

Happy Doctors’ Day!

 

The Tenth Circle

I am currently house-hunting, in another state, which is a special kind of hell. The area where I’m looking is rapidly gentrifying (and I guess I’m about to contribute to that?) which means that it’s awash in fixer-uppers that have been fixer-upped with the trendiest possible design.

Jobs

I have a job.

Yay?

I mean, it’s great to be done with training (or almost done — six months to go!) I started on this journey a dozen years ago, in January 2006, when I began studying for the MCAT. It’s been a doozy of ups and downs along the way.

There has been nothing more doozy-ing than the academic medicine job market, let me tell you.

I had very specific goals in mind for a job. I had to have movement disorders. And I had to have narrative medicine. So what I did, in early 2017, was make a list of all the academic centers that had both.

It was a small list.

Then I reached out to them individually last spring, a sort of pre-application inquiry. Like, hey, are you hiring?

One place had just hired a movement specialist the year before, so no go. Lots of places were looking for more traditional research-oriented physicians, not educators, so no go. It was stressful and dispiriting. I ate a lot of cookies.

Slowly, though, better news started filtering through. I got interviews. (Fun fact: on faculty interviews, they pay for everything! It’s an actual recruitment!) Magically, somehow, I had two offers roll in at close to the same time.

I read Getting to Yes, which multiple people had recommended to me as a “how to negotiate” book. The biggest take-away I got from it was that negotiation is about finding out where your priorities align. As someone with an inherently relational worldview, this made a lot of sense.

 

In my heart, there was one place where I really, really wanted to be; they were the clear front-runners since the beginning of this process. They had an opening. They had a humanities center. They had a tenure pathway for clinician-educators. I knocked the job talk out of the park. (Detailed how-to-job-talk post later.) We found multiple (multiple!) areas of alignment. The details of the offer were basically crafted around using my strengths to fill their needs. Things were looking good. I was prepared to sign. I started looking at houses on Trulia.

Then.

Something deeply deeply shitty happened. I don’t want to get into specifics, but it was confirmation of a suspected terrible pattern of behavior. I tried to set it aside for a week, pretend it didn’t happen, but I couldn’t. It was a really big deal. It was a deal-breaker.

So, I cried a lot, and then took the other offer. Then I called people at the first place, and told them, and cried even more as soon as I hung up the phone. For days after, I kept having to run out of the shared fellows’ office at clinic and go hide in the stairwell so I could cry.

That was two weeks ago. I’m no longer crying every five minutes, but I still feel really, really sad about it, especially when I tell people where I’ll be headed. Because I want to be able to say, “I’m going to FirstPlace.” I’m trying to think about all the positive things about the place I’m actually going. There are plenty of positives!

But still.

I guess what I’m trying to say, for anyone looking for advice, is not to get emotionally attached to anything in this freakish environment known as academic medicine.

Who do you want to be when you grow up?

Earlier this week, I met the guy whose job I want to have in 20 years. Physician and scholar and novelist! The guy talks about getting medical humanities grants like ordering a salad at Chop’t: “So one of my colleagues had this idea and we got a grant and studied it.”

For the last several months, as I’ve been on the academic medicine job market (post on that struggle later, once I actually Have A Job), my attendings have asked me, “do you want to be like … Ned? Or Emerson? Or Lonely Tourist Charlotte Charles?” And I’ve always answered, “None of the above?” Not really, I pick a name usually at random. (But I’ll take Chuck’s dress sense any day.) But frankly, none of the career paths that my current attendings have, really fits with my goals and interests. They are great people, who clearly love what they do and are fun to work with, and I have learned a LOT from them, but what I want to do is pretty niche, and while I’ve had some excellent role models as a medical student and resident, there isn’t anyone here at my fellowship institution who does what I want to do.

There are times, intermittently, when I still feel I missed the mark and should have stuck with literature. Don’t get me wrong, I love taking care of patients. But I love it because I love their stories. I am doing NaNoWriMo this year, and I cannot wait for November 1.

A Play in Two Acts

ACT I

Interior: Clinic Room. Morning. 

ME
And how far did you get in school, sir?

PATIENT #1
Sixth grade. I had to quit because of the Depression.

 

ACT II

Interior Clinic Room. Afternoon

ME
Any family history of tremor?

PATIENT #2
No, but it’s just my parents, they were orphans. The rest of their families were killed in the Armenian genocide.

 

You forget, sometimes, how close some of the tragedies of the 20th century are.

Winning and losing

Today a 87 yo demented man who has called me “young lady” for the last year, ever since I told him he shouldn’t be driving, told me that he liked me and that now I was a “real doctor.” (I think he has just forgotten about the driving issue.)

And someone else hugged me because I reprogrammed their DBS to give them better tremor control with less speech impairment.

And then, just before I left work, I got to tell someone over the phone that their spouse had an incurable, progressive, inherited condition. They started crying. They were at work. Note to self: never ever ever do this over the phone ever again.

Poorly worded parallelisms

I got all excited to see that the promised immunotherapy for migraine was already being tested. But using a drug for metastatic breast cancer? That’s big guns…

Then I opened the email:

Headline writer FAIL.