Another Christmas Post

December 25, 2010

Once again I find myself in the semi-dark, sitting at the dining room table in my family’s house looking out over the lights of [the city]. Got some Christmas music going on Pandora, hot apple cider and warm slippers on my feet. It’s a peaceful place, and as I am sure you have all grown accustomed to, one suited to reflection.

The biggest thing on my horizon these days is figuring out the rank-order for the surgery residency programs I’ve interviewed at. I plan to interview at about 15 programs and in my head there are more or less two criteria; how good is this program/how good a fit is this program, and how difficult is it to get home from there. The ordering of these priorities is rather conflicting me at the moment. On the one hand I want to get the best surgical training I can, and enjoy the company of the half-dozen or so people I will be spending the next 5 years with . . . but on the other hand I realize my grandparents are not getting any younger and neither are my parents for that matter. And a lot can happen in five years. And on top of that, something like 80% of residents end up starting their practice within 100 miles of where they did their residency and I kind of like [my city], and yes the people who live in it (or at least come back to visit from time to time).

I anticipate my surgical residency to go for 5 years (possibly as many as 6 or 7 depending on whether I take time off to do research), working 80 hours a week for 48-50 weeks a year. As residents we are supposed to have 24 hours off every 7 days, averaged out over a few weeks. So I won’t exactly be rolling in the free time, and taking a plane flight home when you gotta be back in 36 hours is tricky.

And so the dilemma. I am not sure yet how these conflicting priorities are going to pan out. And despite all this premeditation, where I end up may well be completely random, as The Match works its algorithm and sticks me where it will.

Anyway. A few years back (on Christmas Eve if I do recall correctly) I had an entry talking about how I feel like medical school has changed me. If nothing else, I feel like I complain a lot more than I used to. I have struggled with this, trying to find a balance between getting stuff off of my chest/venting, and just being a whiny person losing his perspective. I chose this path intentionally; there was no coercion, no trickery. I knew it would be a lot of work, and I knew it would be stressful. I knew it would test me, and teach me about myself. Returning to home, I feel kind of like I am looking at an old photograph, or reading an old journal entry. It’s kind of like a window into the past a little bit, as if all the other stuff that has happened in my life away from here hadn’t occurred. It’s almost like a gauge, a marker that throws into relief how much I’ve changed, now that I am back in a place that has remained mostly the same in the seven and a half years since I’ve really lived here.

I think it’s telling, that in this context I feel more grouchier, more tired, and cynical and world weary than I remember. I snap at my parents more than I used to. What I perceive as personality flaws are more nettlesome. I look at my old bookshelves and I realize I’d forgotten how much I used to read. But I also feel a sense of pride, of accomplishment maybe even bordering on hubris. I find I still enjoy walking, and the lights of the city, talking with my parents and playing video games with my sister. I enjoy seeing my old friends.

Truly, I don’t know where this all is going. I suppose I already feel a bit uprooted, while I process all the changes from med school. And I worry a bit about how much more untethered from my proverbial roots I will become if I wind up somewhere else. But we’ve only got one life to lead and it’s almost always too short for anyone’s liking. And so why constrain myself to a certain geographical area, when there is so many more places of the country to explore? And when I may even find a better experience farther away, rather than close to home? Well, I suppose that’s the dilemma.

Anyhow, I wish all of you a Merry Christmas, and all the best in the new year.

Vacation . . . Kind of.

October 18, 2010

Got back a few weeks ago from 3 months of “sub-internships.” They are classes/rotations in which you are theoretically supposed to act as an intern (1st year resident). It’s a good way to start learning how to be a good intern, a chance to get involved in the nitty gritty parts of taking care of patients, and an opportunity to visit other programs to show them just how awesome you are and how they should take you on as an intern next year. On the other hand, the 80 hour work-week, not exactly respected among most surgical programs anyway, doesn’t extend to students. Together with the programs more or less wanting to see what you’re made of, they make it a point to work you HARD. But it’s over, I don’t think I hurt my chances at those programs, and I have four weeks off.

Or at least I did have 4 weeks off until yesterday, when I got antsy and scheduled a (relatively) low key 2-week pathology class for myself. On the other hand, got to play soccer and frisbee last week, and I’ve started fencing again.  Enjoying spending hours at a time reading, and yes, the occasional video game. Life could be a lot worse now.

I’ve also started to get invites to interview for residency positions. Together with the sub-internships, they have kind of made the whole future life in surgery thing a lot more real. Plus, the idea that I won’t have more than a week off at a time for a long long time. I know you guys out there in the working world are already aware of it, but man, it’s a scary thought . . .

Medicine isn’t as fulfilling day to day as one might think. I had an interesting conversations with the first year medical students that share the house with me. The hospital is one huge layer-cake of human suffering, with scores of rooms on each floor containing a person or two having the worst (or if not THE worst, at least in the bottom 5) day of their life, in a building 14 stories tall. At the end of a 14 hour day you’re tired and beat, spending the day helping patients get better, or at least trying to keep them from getting worse. They’re all having a shitty time of it, and almost to a man (or wo-man) they could probably benefit from someone sitting down and hanging out with them for a few minutes. On Scrubs, they have scenes from time to time where JD or whomever sits down exhausted at the end of their day, at the bedside of a patient, props their legs up on the bed, and just hangs out with the patient. They shoot the shit, or they just both fall asleep, with the patient reassured that they’re not alone.

But leaving the hospital after that 14 hour day, struggling to keep your and your team’s (and thus your patients’) heads above water, you know you COULD take another 5 or 10 minutes out of your spare time to spend with a patient. But usually you don’t. Because you’re tired, and in a hospital of over 800 patients, you can’t help everyone. So you go home.

The young ‘uns charge into medical school looking forward to spending time with their patients, eager to heal, and failing that, at least provide comfort. But sadly, there are so many people that could use your time, you’re overwhelmed so fast. My first and second year, I learned the limit of my intellect, of how much I can cram into my head in a given amount of time. And in my third and fourth year I learned the limit of my compassion and energy, where you must draw a line between being with someone who is suffering, and taking time for yourself.

On the other hand, babies get born, people make recoveries, and there are some positives to be found if only one cares to look for them. So my goal for the rest of my 4th year here, in the waning months of my time in medical school, is to get better at finding those positives 🙂

Oh Surgery

June 22, 2010

After finishing my Emergency Medicine rotation a few weeks ago, I had a bit of a revelation that surgery is where I want to take my medical career.  EM was a lot of fun, don’t get me wrong.  But I always disliked how we never really fixed the sick patients.  If they were alright, we sent them home.  If they were really sick, we just held onto them until one of the in-hospital services could pick them up.  On my last day, there was a gentleman who was really very sick; he came in right at the turn of the shift, and so he had two shifts of EM docs working on him at the same time for almost an hour and a half to get him “stabilized.”  But then off he went to the MICU (medical intensive care unit), never to be seen or heard from again.  They paged a code to the MICU later that night, and one of the residents wondered aloud if that was our guy.  Who knows?  I found that aspect to be a little disappointing.

There are plenty of procedures in EM (I like procedures), and the shift-work lifestyle can be pretty awesome.  All the people I had the chance to work with were all very nice.  But you always give up your sick patients – you never really “fix” anyone, and the procedures are hurried, slap-together affairs because there are the other 20,000 patients out there waiting to be seen.  Plus there are the classic “emergency room specials,” the savory personalities that pervade every EM waiting room.

I appreciate that in surgery there is sort of a credo of personal responsibility.  Your incision, your patient.  And especially in critical care/SICU type work, the buck stops with you.  Patient goes from ER to the floor, and then if they’re too sick, they go from the floor to the ICU.  But once there, you gotta fix ’em.  No where else to put them.  And so they either get better . . . or they don’t.  :shrug:  That sort of mentality appeals to me.  I also love the feeling of cutting the sick right out of someone.  Peri-umbilical pain that turned into excruciating right lower quadrant pain a few hours ago?  Nausea, vomiting, fever?  Sounds like appendicitis to me.  Come on up to my OR and we’ll cut the sick right outta you!  And the mix of technical proficiency and medical knowledge.  Oh man.  Get excited just writing about it, lol.

So yeah.  It’s going to be surgery.  Get worried because of the hours, and the fact that I might end up like some of the people who come out of the process burnt out, angry shells of human beings.  But for the chance to do what they do . . . I think it’s worth the gamble.  We shall see.

In other news, I’ve been studying for the Step 2CK the last few weeks.  Kinda ready to get this over with, and move on to my SICU rotation in July.  oo rah!

Emergency Rotation II

May 2, 2010

Just coming off the night shift at the emergency department.  First time I’ve ever tried drinking Rockstar, and I’m not gonna lie, that is some powerful stuff.

Did chest compressions on an elderly man last night.  He was old, and so I am pretty sure it was his ribs I could feel breaking and crunching while I was jamming on his chest.  He was coded for about 15 minutes before the attending called it off.  Old man with cancer, and I guess this was his time.  Surreal stripping off my gloves and walking out of the resus room, diving back into the bustle of the emergency department after being part of an unsuccessful effort to save a person’s life.  The intern told me that I had done good chest compressions.

Put sutures into another man’s head just before I left this morning.  It took a long time; he was very patient and I was very clumsy.  He was grateful for my second class work and that surprised me.

I did not fall asleep once during this shift.  I am bad at finding pedal pulses.  I helped cut the clothes off of four separate people.

There is no good breakfast food at home right now.  So after the shift ended, I walked to the starbucks by my house.  For about 5 seconds I stood mute at the counter because I couldn’t remember what it was I wanted to order.  I ate a bagel and sipped my hot chocolate by a window.  Watched people come and go for a little bit, with their kids going to volleyball tournaments.

I got up, came home, sat down and wrote this, and now I am going to go to bed.

Emergency Rotation

May 1, 2010

Fourth year is officially here!  Last week on the night before my last shelf exam, I closed my textbook and it felt like a million pounds just fell off my shoulders.

Since then I have done a few shifts in the Emergency Dept as a 4th year, and it’s been a totally different experience.  A lot more autonomy.  Last night I got to suture a girl’s hand closed after she fell on some glass.  And I diagnosed a nursemaid’s elbow the attending had missed.

All in all it was an awesome shift, and it helped restore a few of the soul-points I think I had hemorrhaged over the last several months of my third year.

Labor and Delivery

April 9, 2010

Gonna try something new; instead of long posts, gonna just toss out some random stuff in brief.  Here goes.

Spending a month on the labor and delivery service.  Got to deliver a placenta, and had a resident guide me through delivering a baby (her hands on top of mine for the most part).  Scrubbing into c-sections.  Neat watching the little babies come to life when they pop out of mom’s vagina or uterus or what have you.

Flip side is a lot of babies that are too young to be “viable.”  The cut off here is about at 23 weeks of gestation; after that time, they will try but before, no effort is taken.  It’s a little bizarre being in on the discussions of whether or not to stave off pre-term labor a little bit longer, give steroids, etc or whether it is better to advise to throw in the towel.

One of the residents here delivered twins at 21 weeks.  At that age they are considered non-viable; they may come out with heartbeats and breathing, but there is no way they will survive.  And so the twins were delivered and taken from the room; I guess it is sort of the policy of the service to not let the parents see them until all signs of life have stopped.  I wasn’t there personally, but I can see how that can shake one up.  I’ve observed a few dilation and curettage/evacuations here for therapeutic purposes.  Reassembling the little bits of fetus after sucking them out through a tube to make sure you got them all is a bit of an unnerving experience.  Yesterday a family wanted to see their evacuated 14 week old fetus.  The resident did her best to sort of assemble the parts into a form resembling that of a human being so the family could see on the plastic lid of the pathology container.  Think what you wish about abortion as a social issue, but when you get down to it, it’s a pretty grisly process.

Anyway.  That’s my brief update!  Hopefully more to come in a similar manner.

From the Archives: “For Good”

March 3, 2010

I wrote this just before I left the University of Washington, after spending four years there as an undergraduate.  It was there that I began to kick around the idea that perhaps life isn’t always about seeking happiness.  That perhaps the fullness of your life and your experience is what is more important.

Written Saturday, June 9th, 2007

For Good

This looks like it will be the last post I make in Washington for a long time.  We all graduated today in the cold and the wet; a perfect Seattle send-off for the class of 2007.  I won’t deny that going home to San Francisco is making me a little sad.  I suppose that whenever any chapter of your life comes to a close, that is to be expected.  All the same, knowing that I’m never going to be a college undergraduate again is a sobering thought, conjuring up images of middle age and laugh lines.  Everyone looks forward to college (or back upon it), saying that these will be (or have been) the best four years of their life, that this is the time when you will have the greatest freedom with the least responsibility.

For me, to a certain degree I came to the University of Washington with the (albeit embryonic) purpose of making it into medical school.  There was a point when I decided that was what I wanted to do, and that would be my top priority.  Social life, extra curricular activities, heck, even leaving the U-district were all generally subordinated to that purpose.  Reflecting now on that decision, I’m not unhappy that I made it . . . but I do wonder whether or not that was the best choice.  After all, you only get one life, and so it behooves us to make the most of it before it passes us by.

But that is not to say that I haven’t had good social outings, made good friends or had amazing experiences.  I have done all these things, and I know that I am happier for them.  We’ve played hide and go seek in the dark in the common room on L2, we’ve gone to Discovery Park and Gasworks, we’ve gone sailing, played sports, went to parties together.  We’ve laughed, cried, studied, worked, played, lived and loved protected and supported by each other’s friendship.  One would think that these memories would be enough to make one happy, and believe me they do . . . but in characteristic [me]-fashion, I wonder if it’s been enough.

College has really changed me, and I don’t really know if it’s been for the better or for the worse.  I got to strike out on my own, arriving in Seattle knowing nearly no one, and now I know I will drive home with tears in my eyes for the people that I will be leaving behind.  All I need to do is walk around campus, and the memories of times both good and bad come rushing back; I remember cuddling on a warm night over here, or dispiritedly sitting with my head in my hands on the bench over there.  This place and these people have been my world for the last four years.  This place has seen me both as the happiest man alive, as well as so low I thought no one here would care if I simply fell off the earth. The times I have spent here certainly have been ambiguous, but one thing is to be certain though; in the years that I have been here, I have lived.

Maybe that is all I can really ask of a place or time in my existence.  These years have probably seen the single most happy moments, as well as the most sustained sad times of my life.  I cannot leave here and say in full honesty that I have loved my years here, but maybe that is not entirely a bad thing.  Life after all is made up of both good and bad, and perhaps living means experiencing both and everything in between.  I’ve gotten the feeling that life is more than climbing into an Orgasmitron of perpetual bliss, and that the real living happens just as much while you are riding a high as you are while slogging it through a low.

If this is the case then, then my time living and learning here in Seattle has been well spent.  I would like to take a moment to thank you, UW for your acquaintance; for the people you have introduced to me, and the challenges and emotional blows you have dealt me.  These years have not been wanting for it’s ups and downs, and for that I think I should be grateful.

And thank you too, all the amazing people that I have been able to meet here, even if I’ve only known you for four weeks or the entire four years.  You, perhaps even more than the University have changed me as a person; you have taught me many lessons, many of which I suspect I won’t know I have learned or won’t fully appreciate until many years from now.  I cannot say that these four years have been the best of my life, but I can promise you that that I have certainly lived during them, and for that I am grateful.  Take care all of you, good luck, and best wishes to you all on whatever path it is you choose to walk.  I am so happy and privileged to have been able to meet you, and it is without reservation that I say I will shed tears for our parting on the drive home.

Life, I think, is not just all about the good times, it is about the bad times as well.  I have seen my fair share of both here, and so it is with a heavy heart that I walk away from the life I have lead at the University of Washington.

Cheers.

“It well may be
That we will never meet again
In this lifetime,
So let me say before we part
So much of me
Is made of what I learned from you
You’ll be with me
Like a handprint on my heart.
And now whatever way our stories end
I know you have re-written mine
By being my friend . . .

Who can say if I’ve been changed for the better?
But because I knew you
I have been changed for good.”

-Wicked

Free Association Post!

February 7, 2010

It has been a while since I’ve last posted. I’m having a hard time pinning down specific things to talk about, so I figured I’d just let fly with the gestalt in my head.

I’ve been thinking about some of the memorable patients I’ve met over the course of the year. Single, earthy, elderly grandfather taking care of his two grandchildren. The girl who shot herself in the head, and the doctor who told her family. The really nice guy with inoperable pancreatic cancer. The other really nice guy who had the courage to joke about having his leg amputated. The sister and her mentally retarded brother who live together with her boyfriend, somehow making things work. The little girl with leukemia that we tried to send home for her birthday, but came back the next day to stay for four months. The man who lived in utter squalor at home with terminal cancer, that we kept in the hospital for two days against his will. The cancer patient who tried to leave AMA, trying to curse the doctors through his trach tube. The man who asked me when I’d be a doctor, and if he could be my patient. The woman that I tried to “give homework” to overcome her agorophobia by driving her son to school . . . and she succeeded. The 23 year old girl with a rare and terminal liver cancer. The little girl that we coded for two hours. The little boy with prune belly syndrome who smiled all the time.

I’ve been thinking a lot about surgery lately. About making it my career. I figure for some people, working 40 hours sucks because it’s just a job, and they spend another 40 hours chasing their hobbies and their passions. But if surgery is my job, my passion and my hobby. . . maybe that’s not so bad. I was told I was a low-average applicant, and I will need to do some solid work in the next six months or so if I want a shot at a good surgical residency in California. I am thinking that perhaps if I do surgery, I won’t necessarily get what I want, but maybe I will get what I need.

I have spent the last two Saturdays at the student run clinic I used to help direct. It’s amazing how far I’ve come since I was there a year and a half ago.  It’s kinda awesome realizing I have something to offer/something to teach.

My parents bought me this huge (for me) full size bed that I am luxuriating in each night.

I have started fencing again each Monday. It’s been so long, but the joy in that activity is still there. After practice this week, I went to dinner with some of the fencers afterwards. We all turned out to be grad students in one discipline or another. Was great to relax and be socially awkward in front of people who couldn’t care less.

Advice to First Years

December 4, 2009

About six months ago, a good friend of mine was just starting as a first year at my medical school.  In an attempt to be a good friend/good third year, I thought I’d jot down a list of pithy tidbits of “wisdom” I had accumulated over my two years here.  Some of this is specific to my medical school, but I feel like a lot of it is generally applicable.  Enjoy.

1.  If you are scared, everyone else is scared too.  They just aren’t showing it.

2.  Don’t fall into the trap of not seeing past your own nose (to use the Marry Poppins term).  If you’re stressed, then everyone else is stressed too, and small gestures to acknowledge that and to help other people through difficult times will be incredibly appreciated.

3.  Nobody expects you to learn it all.  Learn what you can, and move on to your next task or else you will get bogged down and miss the big picture.

4.  Don’t worry if you can’t see a ‘big picture.’  I’m a third year, and I am only now just beginning to pull the pieces together.

5.  Do what you have to do to learn best.  If that means skipping all the lectures and learning from syllabi and recordings at home, do it.  If it means sleeping all day and studying all night, do that too.  You are responsible for your own education, so use or cast aside the tools the school gives you to achieve that end as you please.

6.  Get your hands on a copy of First Aid for the USMLE Step 1, and peruse it as you go through your classes.  One of my biggest regrets in my first two years was studying for my classes, and not for the boards.  No one cares what percent you get in your class (so long as you pass [my medical school is just a pass/fail system]), but a good number of people will care what score you get on the Step 1.  Also, some classes at [my medical school] are not the best organized, and First Aid can really help summarize complicated and badly taught concepts.  And finally, if it is in First Aid, you should know it.  Use First Aid to help you learn for your classes, but also use your classes to learn what is in First Aid.

6.5.  What will get you a good score in your class is not necessarily what will get you a good score on Step 1.

7.  Make sure you take some time for yourself.  Everyone says this, and it’s true.  I played frisbee almost every Friday for two years, and I think I am mentally and physically better for it.  Plus, no one cares how good you are, and it’s a good chance to hang out with your classmates while not in school.

8.  Medall [our med school listserv] is for important stuff (and ultimate frisbee emails).  Like a good surgeon, think twice, email once.  Cuz once it’s out there. . . it won’t be coming back.

9.  Take time to get to know your classmates.  Everyone has an amazing story, and everyone is worth taking some time to meet.  And so if a classmate is sitting alone during lunch or break or at a party, take some time to meander over and exchange a few words.

10.  As an addendum to 9, LOOK OUT FOR EACH OTHER.  Medical school is very hard on the self-confidence and self-esteem.  One never knows when a kind word or gesture can reach through someone’s funk to brighten a gloomy day.

11.  DO NOT BE AFRAID TO ASK FOR HELP.  Medical school is quite possibly one of the hardest things you will ever do, and I cannot express just how stupid it is to think you can do it by yourself.  It takes courage to admit you need help, and NOBODY will ever hesitate to lend you a hand, a set of notes, a sympathetic ear or a shoulder to cry on.

12.  And as a corollary of 11, never, Ever, EVER ignore someone’s request for help.  And remember, people can ask for help with more than just their voices.

13.  When the helicopters rumble overhead, I like to pause and think about the doctors in the hospital getting ready to receive their patient, and how someday that is going to be me.

14.  The lobster bisque isn’t bad at the cafeteria.  Italian wedding and the clam chowder aren’t bad either.  And make sure to get the extra bread that comes with the soups.

15.  Medical school will take you outside of your comfort zone.  Whether that is hemisecting your cadaver’s pelvis, feeling out of your intellectual depth, or trying to do a blood draw on an IV drug user, you will feel uncomfortable in medical school.  That is a good thing.  I think one can learn a lot about themselves when they are out of their comfort zone.

16.  There are some amazing views to be had from the 14th floor of the hospital.

17.  Don’t forget your big and great-big sibs.  They’ve been through this before, and will have lots of tips, tricks, and a healthy dose of perspective to offer you.

18. You came to medical school because you wanted to be a doctor, but that is easy to forget if all you do is study.  Take some time to volunteer your time at the student run clinics, and to remember the altruism that brought you here in the first place.

19.  Take some time to reflect once in a while.  I keep a blog for some stuff, and a written journal for others.  This is a crazy experience, and taking some time to think about it not only helps put it in perspective, but also helps you get the most out of your experiences here.

20.  There are a fair number of bull-crap classes and small group sessions in medical school.  Don’t let yourself get bogged down in worrying about them, but don’t let them upset you for wasting your time either.  There is usually a point to the maddness, even if it could be made in 5 minutes in a lecture, rather than an hour in a small group.

21.  Carm will always have candy and a kind word for you.

22.  Take some time to shadow in the hospital.  You will be shocked at how different it feels to be part of the medical institution now, rather than just volunteering at its fringes.

23.  If you go to lecture, I highly recommend having at least one scrabulous game with your classmates going during class time.

24.  If you have a significant other, don’t forget that because you are working your ass off chasing down your dream, you have less time to spend with your boyfriend or girlfriend.  Your medical school experience is a sacrifice for them too.

25.  If you can get involved with the trauma study later in your first year, do so.  It is a great chance to get a watered down idea of what call is like, and to see some of the ‘highlights’ of the Emergency Room.  Plus they give you money.

26.  Get a copy of BRS Physiology.  Physio is a huge and hugely important subject, and BRS Physo helps greatly to keep you oriented, and serves as a good place to get simple explanations of complicated topics.

27.  Consider getting a copy of Lipencott’s Illustrated Reviews: Biochemistry.  Biochem is very confusing, and if you are more of a self-studier, it can be very helpful.

28.  Take lots of pictures.

29. Once a month, all the stores in [my city] are open waaaay late, and there are tons of free samples, live music, art on display, etc.  It’s a fun little promenade and good chance to see what normal people do with their spare time.

30.  If you cannot be friends with everyone in your class, at least find it in yourself to be civil.  You never know when you might find that person in your next small group, doctoring group, or third year rotation.

31.  Never forget that it is an honor and a privilege to be doing what you are doing.  Things might get hard, but before you complain, you should ask yourself “Is there anything else in the whole wide world I would rather be doing at this moment?”

32.  Medical school is about helping each other out; it’s about kind words, nice gestures and shared notes.  There have been times beyond counting that my class has carried one another through rough patches.  Be loyal to your class, because you will be getting through medical school together.

33.  And finally, enjoy yourself.  You will be working very hard, but don’t forget you are living your dream.  You will belong to a group of amazing people working very hard to learn how to become a doctor.  How much cooler can it get?

Soul Points

November 26, 2009

It has been a while since my last post, but it’s my lunch break here at the psych clinic, my med-student colleague has left early, and my next patient isn’t supposed to show until 1pm.

Psychiatry is a funny clerkship (and a funny profession). Most other specialties in medicine focus on physical, quantifiable parameters of the body; your weight, your blood pressure, x-rays, sodium level, and so on. Psych on the other hand is much more interested in how you feel, think, and behave; qualitative things that require a certain rhetorical flair to portray fully. Psychiatrists need to think about how their patients make them feel. If the patient makes you feel sad, then it lends credence to the thought they are depressed. If they make you feel annoyed, then perhaps they are borderline. If you are entertained, perhaps they are slightly manic.

Psychiatrists have this uncanny ability to cut through a person’s outer layers (onions vs cakes anyone?) and seem like they are looking into your soul. Much like the Jedi, they can’t so much read minds as they can read emotions. This is unsettling enough watching your superiors use this power with patients, but it is truly disquieting when they turn that piercing gaze on you (think Frodo and the eye of Mordor). What this all means is that their critiques of your performance during the clerkship tend to be very incisive, and not a little bit painful. They seem to be able to find your insecurities and bring them to light, in an attempt to “fix” them. This is a painful thing for a student, knowing you are flawed, feeling shitty about it and trying to hide it, only to have your boss drag it out into the light and examine it under a microscope. People say that good critique is painful, and if it is one thing that these guys do, they seem to give good critique.

And so I get to what all this has to do with the title of my little entry (in a round about, or as we would say “circumferential,” manner). I’m not going to lie, I have had a couple of really crappy weeks during my first month of psychiatry. I think I was finally reaching that part of third year when, for want of a better phrase, I was running out of soul points.

What are soul points? Well, it’s kind of an extension of wins and losses. The way you get them is by doing good, self-affirming (or just fun) things. A patient tells you that you’re going to make a good doctor. Someone notices your hard work. You get in a good game of ultimate frisbee. You lose soul points when bad things happen; you watch the unsuccessful code of a 10 year old girl, or participate in another unsuccessful code of a 17 year old girl who shot herself in the head. When you worked for 2 months setting yourself the challenge to honor a clerkship, and don’t. When you have to help keep another human being in the hospital against their will . . . for their own good. When your supervising psychiatrist tells you that you that he thinks you have made one too many inappropriate comments during rounds. When the world singles out a vivacious person doing good work to get sick and die for no particular reason.

Talking about some of this with a fellow third year, I swear to god I nearly cried. Tears in my eyes and everything. That’s probably the closest I’ve come to crying in front of somebody in five or six years.

People generally say that third year and internship are the two hardest years of medical training. Those two years are long, and they nibble away at your soul-points without offering much time or many chances to replenish them. I think one starts to “burn out” when you run out of soul points to absorb the random shit flying at you. Once you run out, then it’s all body blows; you can’t muster the enthusiasm, optimism, idealism or any of that life-zest anymore because everything gets to you, and it beats you down.

I know soul-points is kinda a funny name for the concept, and truth be told it’s more or less just a sardonic nod to the elephant in the room. Rather than not give it a name, or give it a less melodramatic (and thus more credible) one, I feel like like this way there is some degree of acknowledgment both of the problem’s existence, as well as some degree of defiance; that is hasn’t gotten so bad as to sap all humor.

I’m feeling much more myself now than I was a week or two ago. But the point stands all the same; they weren’t kidding when they said third year was going to be hard.