Lately, work and career-planning has been chipping away at my soul and sucking my energy.

I can’t keep it straight - ampicillin in neonates should be q6h not q8h, and why am I looking at my wicked old NICU dosing card anyway? Get it straight. And, why am I only getting bloody taps (lumbar punctures, for those not in the know) in the last two weeks?  Jeez, Miranda.  And why won’t my letter writers get their letters in so I can start applying already for fellowship?  And why can’t attendings who I respect and desire feedback from give me the feedback I need to get better?  The devil is in the details, and either I am tired and missing all the details, or the details are not forthcoming.  All of these things are accumulating to make me feel like a mess of a resident, and maybe while I am meeting low-level competency expectations, I really do want to be a better doctor for my patients, I want to not be too tired to learn something new, and I want to be rid of this feeling of low-grade fury mixed with anxiety.

I don’t mind the intensity of the residency experience, but right now, after a shift in the ED that almost put me over the edge, I really, really, really wish I owned a piano so I can practice scales and do finger exercises or something so that I can focus all this detailed nervous attention and physical energy on something semi-productive.  Alternatively, I guess I could do a self-imposed Iron Chef session and try to do “Figs” in three main courses and a dessert in under 1 hour.  I need outlets, people!

Whoa, that was weird to write…”I’m a doctor.” Graduation was pretty nice — before we walked onto the stage, they entrusted us with the tremendous task of lining ourselves up semi-alphabetically according to a list of names posted on two columns in the basement of Masonic Hall. How many soon-to-be doctors does it take to alphabetize 150 soon-to-be-doctors? 150 of them! (silence as my joke drops to the floor.) After we were all anointed with our MD hoods and outfitted like 13th century barons, about 30 of us got up on stage to say the first line of the Oath in our “native” languages. I just loved butchering “I swear, to the best of my ability and judgment, to fulfill this covenant” in Cantonese.

The highlight of graduation for my dad probably wasn’t me graduating…it wasn’t even getting to shake Dean David Kessler’s hand (former head of the FDA)…it was meeting Kevin McCarthy, whom my dad immediately recognized from Invasion of the Body Snatchers and other random t.v. shows of the 60’s and 70’s. I guess Mr. McCarthy was there for his step-granddaughter, who was in my class. How my dad recognized him and proceeded to make a beeline towards this man who was sitting in the corner of the reception room is beyond me.

Sort of.  I mean, there will be other lectures and noon-time conferences and workshops and maybe even teach-ins to attend.  And I have the suspicion that I will be back in the classroom probably doing some teaching of some sort, too, but even so.  The last Powerpoint presentation for at least another 4 weeks was finished today, and I was so ready for it!  Lots of partying, packing and graduatin’ to do over the next several days.

Also, I am having two beauty issues.  (1) The mortarboard.  The flat hat thingy you’re supposed to wear at graduation. It smooshes my bangs down into my eyeballs.  I could cut my bangs short, but then I look like a third grader.  The last several graduations where I had to wear a mortarboard, this didn’t seem to be an issue because there was a frog attached to my first hat, and the International Space Station was affixed to the second, so the state of my bangs was a secondary issue.  This time, graduation appears to be a rather stiff, formal affair.  (2) The bites I got from the bed bugs in Guatemala are still as red and inflammed and itchy as ever.  I’ve been applying hydrocortisone like there’s a shortage at Walgreen’s.  But they’re still itchy and big and red.  How friggin’ long is this going to take?

I’ve been on laboratory medicine for the past two weeks, and discovered that, despite my immense senioritis at the moment, I really love microbes. They’re fascinatingly disgusting.

For example…someone found this in their poop and brought it to their doctor, who sent it to our lab. They likely had some poorly handled sushi or undercooked fish.

And just sitting in the cabinet was this, in a 20 oz. Sprite bottle. Apparently, the person either pooped it out or coughed it up into the most convenient container available to them.

But my favorite, I think, is syphilis. Truly great art and writing has come from this disease. Thomas Hardy and James Joyce, for example, had syphilis. And there’s this lovely gem about syphilis: Read the rest of this entry »

We gathered this morning at the conference center, and at 9 AM on the nose, with friends and family all around, they let us open our envelopes. Contrary to my fears that I matched at Disneyland or in forensic pathology, I matched at my first choice, and we’re going back to Boston! A lot of my classmates were lucky enough to match at their top choices, too, and there was much celebrating and happiness.  It’s a wonderful relief to know where I’ll be for the next three years, and I’m ready for the change. Of course, it’s 65 degrees and a sunny blue-sky day here in San Francisco, so it’s making it awfully hard for me to feel as excited as I should be to go back to Massachusetts.

Joe and I are watching Pulp Fiction right now, which isn’t exactly a celebration movie, but a little bit of stylized violence seems just as randomly appropriate at this moment as any other.

I had 3 anxiety match dreams last night:

(1) I opened my match letter, and it said I would be going to Stanford Lucille Packard Children’s Hospital for residency.  What the hell?  I didn’t even interview there.  Somehow, the match computers messed everyone up, and people were going places they hadn’t even heard of.  Likewise, programs were getting residents they hadn’t even interviewed.  This could actually happen.

(2) I opened my match letter, and it said Congratulations, you’re going to Disneyland!  I don’t want to go to Disneyland, I want to go to residency!

(3) I opened my match letter, and it said Dear Jesse-Miranda, we think it’d be better if you tried forensic pathology, since you got an M.S. in forensic medical sciences, so try out this one year pre-internship in pathology, and then re-apply for the match next year!  First of all, my name isn’t Jesse-Miranda.  Second of all, I don’t have an M.S. in forensic medical sciences.  Third, why is the match going all Crossing Jordan on me?

My very noble friend Carol, who is out saving lives in Malawi, sent me this study a long time ago, about which group of male doctors are more handsome and taller: surgeons (i.e. those who cut people) vs. physicians (i.e. internal medicine types.) The surgeons won.

Actually, they also had a “movie star doctor” group for comparison, which included the likes of George Clooney and Patrick Dempsey, and this was clearly the winningest group. But this study was flawed for various reasons:

1. They only had female raters for male doctors. Why not also have male raters for male doctors? C’mon, we’re all judges.

2. The average age of the physicians and surgeons who were judged in this beauty context was 50.6 years old, whereas those actors playing physicians are roughly a decade younger.

3. If they had included pediatricians in the physicians group, this would have likely boosted their average score. Pediatricians tend to be way hot.

4. However, if they had included dermatologists in the surgeons group (I don’t know if you’d include dermatologists in the category of “surgeon” — they do use tools to excise pre-cancerous moles, though), they would have won by a lot. Dermatologists for some strange reason, always have really excellent skin.

5. This study was done in Spain. I will automatically deduct points for any study on beauty that comes off as scientific from either Spain or Italy because those cultures are generally weird and obsessive about looks, food, and shoes.

6. Finally, this study was flawed because you really just shouldn’t be doing an Am-I-Hot-Or-Not study on doctors…it’s like watching snails in a 100m race or right-handed people cutting with lefty scissors. Dumb and irritating.

I’m doing a child abuse elective now, where I’m learning all the various ways to abuse children. No kidding. It’s the most depressing stuff ever, but the people who are involved in it are amazingly level-headed (the physicians and nurses and law enforcement, not the abusers). Whereas it takes all my acting skills and energy not to make faces and say biased things about the criminals like “I hope you catch the f#*$er and rip his balls off.”

I saw a child being interviewed today for a sexual molestation case. We sat behind a one-way mirror with the assistant district attorney, the police investigator, a nurse interviewer and another person who I think was from CPS. Her story made me think that the data we have on the rates of child abuse are probably low: it’s probably far more under-reported than we realize. If the child’s mom hadn’t believed their story, I don’t think they would have ever come to the attention of the city and health agencies. Poor kid.

For the last couple of hours, I’ve been reviewing cases of sexual abuse, and it’s exhausting and terrible. After looking at hundreds of awful pictures of bruises, cuts, tearing, scars, I think I need to go do something calming. I’m going to go make soup.

“An expense of ends to means is fate.” – Emerson

Drama plays an important role in every supposedly mild-mannered soul, so who else to turn to when in need of quotable philosophy to illuminate the drama except Ralph Waldo Emerson? (Sorry, folks. I veer towards Emerson, Thoreau and Whitman when I need that uplifting, American-way-of-thinking.)

In the last minutes leading up to the finalization of rank list decisions for the match, I decided I needed some edu-my-cation about issues regarding Fate. Let me believe that Fate will take care of it all! There are only two books in this household regarding Fate: the St. James edition of the Bible and The Conduct of Life by Emerson. Since I have no idea how to use the stupid Bible and all its parables and genealogy, I flipped to the only portion of Emerson’s book that I have read, i.e. the first chapter…the section I usually read before falling asleep and not reading the rest of the book for whatever class I’m taking at the moment. And in this rather promising chapter regarding all-too-powerful-Fate, Emerson finally decides:

Person makes event, and event person…[man] thinks his fate alien, because the copula is hidden. But the soul contains the event that shall befall it, for the event is only the actualization of its thoughts; and what we pray to ourselves for is always granted. The event is the print of your form. It fits you like your skin. What each does is proper to him. Events are the children of his body and mind.

Damnit! So, after a strong drink*, I decided to take fate (with a lower-case “f”) into my own hands and re-master my rank list in the way I wanted it to be…which is the only way I should ever have designed it. After re-reading the horrible woes of the imaginary match example that the NRMP provided for us, this confirmed my suspicion: just friggin’ rank the programs by where you want to go. Et fini.

Read the rest of this entry »

Today our rank lists for the match (a.k.a. The Match) are due, and typical me, I am flying full speed ahead into a zone of indecision.  And what happens when I don’t know the answer to something?  I call for a consult!  I call everyone I know who is important to me to make the decision for me.

That’s clearly not the solution, but I have 18 minutes until the rank lists close.  The alternative is to just let go of my fears and simply let the rank gods decide for me.  Oh oh oh, what to do, what to do….

Apparently, this is what I lack, and no amount of bone allograft or rod insertion will help the matter.

I’m on pediatric orthopedics right now, which is my very brief foray into the world of surgical sub-specialties. Orthopedics is already considered a sub-specialty of surgery, but to make it even more specialized (and better, in my opinion) they’ve created a specific orthopedic practice dedicated to the bony deformities of children.

I saw my first spine surgery yesterday. They were correcting a patient with scoliosis, who was pretty bent at the mid-chest. What are the problems with having scoliosis? None, really, except that you can’t stand completely straight, it might look ugly, and people with scoliosis have just a tad more musculoskeletal strain than the folks without scoliosis. In severe cases of extremely bent people (that’s a medical term) who continue to progress, you risk decreased lung capacity, and two-thirds of scoliosis presentations in childhood progress with further curving. I remember seeing an old lady walking down the street who’s entire torso was virtually parallel to the ground, and remember thinking, “dang, she looks uncomfortable.”

So the orthopedists were fixing this spine, and it took a whopping 10+ hours (it was a particularly bloody case). It was a long case, during which the surgeon did not sit down, pee, eat, or scratch his nose once. And it’s a gruesome procedure. To see the entire length of a person’s back sliced open, the spine dissected away from fascia and muscle, screws inserted into the spine, rods pushed into place, and the spine itself yanked into alignment, was an adventure in brutality, endurance, and danger. It is a friggin’ dangerous surgery because of the risk of paralysis — think of it as the X-games crossed with ultra-marathoning. The other miraculously crazy thing is to watch them squeeze off the spinous processes of the vertebrae with big bone scissors (they don’t call orthopedists “bone crushers” for nothing), macerate them into bits, and then sprinkle the bone bits back onto the spine like so many croutons on a salad. They hope to accomplish “fusion” with this task — the little bits of bone, combined with the fractured spine, will fuse and heal into one big, stable bone-and-metal-rod column to keep the patient erect.

Today in clinic, I saw a patient who had had that spine surgery to correct her scoliosis back in December, and she looked good. Remembering that bent lady I saw in the street, to me, this patient looked so much better off. Surgical fusion is probably the most dangerous surgery for what ends up being largely a cosmetic repair. But it takes cojones…and backbone…to take on the risk of such a procedure, on the part of both the orthopedist and the patient. Despite not peeing or eating or sitting for more than 10 hours, I felt really lucky to be able to witness that before I enter my relatively safer world of pediatrics. As much as I love the OR, I can’t handle the stress. If I can’t pee or eat or sit, I will do the obvious alternative, which is go home and pick a fight with Joe and suffer massive road rage. So I gotta get my fix of OR time in the next few weeks before I enter the slightly more risk-adverse world of peds. You hear that, Joe? I’m saving our marriage by going into pediatrics and I’ll be a better driver because of it.

Every time I see this picture from old anesthesia textbooks, I have to crack up:

It reminds me of those 19th century diagrams used to explain the protoscience of phrenology.

—

I bought a toilet plunger yesterday. Joe threw up on the old toilet plunger, so he threw it out. Which doesn’t exactly make sense, because toilet plungers deal with the Nasty Fluids of Life, and doesn’t vomit count as one of them? Anyway, I put the plunger on the conveyor belt at the check-out counter, and the cashier kept on making bad jokes about it. “Boy, sometimes your guests leave right away, but that there probably means you’ve got guests who won’t leave.” Hmm. Not that I’ve had to use the plunger recently, ahem, but it just seems like every time we lack a toilet plunger, something evil happens with the toilet. So we keep one around, like a talisman of sorts.

On the interview trail, I met another applicant, a really funny and nice guy, whose strategy was to interview in a different city every weekday. “I been on an airplane almost every day for the past two weeks.” He was also interviewing with a removable cast on his leg and crutches, due to some knee surgery, so in addition to probably getting a bit more fatigued than most on the hospital tours, I bet it definitely was a drag to get through airport security.

I’m supposed to be writing down my thoughts and impressions of each institution, but my notes aren’t particularly helpful. For example:

- ward mo 0 call c 1w night float …
- 2-14 pts/intern (winter hi) no cap …
- dating - ask questions!

Cryptic, but maybe reflective of how jumbled and chaotic this process is to me in my head. I’m also realizing I’m a terrible “business traveler”. Unpacking my little suitcase when I got home this morning, I pulled out:

• 1 rumpled suit swathed in 4 plastic dry cleaning bags, with two dirty socks tucked into the pockets
• a ripped quart-sized plastic bag with my less-than-3-oz bottles of toiletries, on which I had drawn a hammer and sickle
• a pair of rumpled jeans, sweatpants, several t-shirts, dress shirts, more socks, one sneaker (the other one was in my backpack)
• some pennies and nickels and wad of four one dollar bills
• cell phone charger (to a different cell phone, not my own, whoops)
• inside the sneaker: a pack of Skittles, half eaten, and some dirty underwear (why did I put the Skittles in there? I swear I’m not this disgusting in my non-travel life)
• some more knee-high socks, which I never used, but that were very neatly and carefully laid out in the hard-to-pack crevices of the suitcase.

This is not how I remembered my suitcase when I first opened it…maybe because Joe packed it for me, and he happens to be one of those people who can fold sofas into duffle bags. Along the way, I’ve lost:

• my laptop battery
• a hairbrush
• multiple mini tubes of toothpaste (I had to buy more toothpaste twice this week)
• a tube of chapstick and a bottle of contact solution (lost to the cause of Homeland Security, but you can probably find these items on the Homeland Airport Security Ebay Auction).

The NYTimes had an essay about young docs and med students who wear less than professional clothing. Flip flops in clinic! Skirts that are shorter than your white coat! Killer bacteria in long hair! The author then points out that there are studies showing that the white coat instills confidence in patients, too. I dunno: you could argue that the white coat is also a harbinger* carrier of bacteria, as your sleeve brushes up against one patient and then the next one; or think about the crumbs from a noon conference cookie sitting in a white coat pocket for months. White coats, if you look carefully, aren’t always so white. At least mine were never that way for long. Thankfully, pediatricians don’t always wear white coats, as that seems to instill more fear than confidence in their tiny patients. My not-so-white coat certainly scares me.

* new: whoops, so I realized I used the word “harbinger” incorrectly.  White coats are definitely not “harbingers of bacteria”, they are harbingers of illness and death, mwuh-ha-ha.  Or, harbingers of healing and health restored.  Take your pick.

Aaaarrrgh, the infamous DNR order (Do Not Resuscitate) and the dilemmas that surround them are explored in this well-written piece in the NYTimes.

I remember sitting in on a conversation with a family and our attending physician regarding the status of a critically ill patient in the ICU. One of the sons and his wife knew the end was near and wanted the best comfort care possible for his dad. The other son wanted to give his dad every fighting chance. The wife of the dying patient kind of had no opinion, I suppose, just from the shock of it all. My attending explained the pros and cons of CPR (mostly cons since CPR is not particularly effective in really sick patients), gave them his phone number, and suggested having another meeting to discuss comfort care and DNR orders the next day. And I remember the rah-rah-fight-for-life son saying, “well, we’re not having that conversation because you haven’t even talked about treating his main problem, his lungs.” Read the rest of this entry »

This morning, I stumbled out of bed to turn off the alarm (alarm clock is across the room, to allow for maximal effort in turning it off, and hence, getting up), and also had to fumble to turn on the heat. We are now starting to use heat again, finally!

Speaking of cold, I got my first interview. In a very, very cold location, very far, far up north! Yay snow! I checked the weather reports over there, and it reminded me: tucking in the t-shirt or undershirt helps keep the cold away. I never have to do that trick out here, but back home, you always, always, tuck the layer closest to your skin into your pants. Prevents updrafts.

My dean’s letter is also up for review, and I’m supposed to go pick it up and edit it for grammatical and spelling mistakes. I don’t know why I’m so nervous. It’s not like there are any surprises because I wrote the thing.

I also had a very bad dream last night, thanks to this tidbit on Boingboing. I dreamed that I was an intern, except that the hospital looked like my high school, and my attending was my old high school history teacher. And he was making us write epitaphs for all the patients, based on our admission history & exam. “Here lies Ms. Gregory, 54 years old, with a history of insulin-dependent diabetes, hypertension, and chronic atrial fibrillation, who died of a stroke. She screamed from the ED gurney, ‘and I have fibromyalgia, too, don’t forget!’ and told me how incompetent I was within minutes of her death.” We had to dictate them into the phone, and the guy at the other end of the phone would chisel them onto stone, and when the stone tablets came up for inspection, my high school history teacher yelled at me, because I didn’t know how to use the dictation system well enough, so the tablets all read “Here lies … hypertension … minutes of her death, end of dictation.”

I had the pleasure of reading some friends’ personal statements, and it’s funny how dramatically different the personalities come across in the different specialties. They are all very eloquent and beautiful writers, though, so it was very enjoyable.

For a friend who’s applying in orthopedic surgery, the gist of it was like: “Rawr, rawr! I like bones and tools! And joints! Joints are neat-o. And making that little girl walk again is a bonus, too. Swee-eet.”

For a friend who’s applying in psychiatry: “Putting a face on human suffering and insanity, and empathy empathy empathy and compassion and listening listening listening and humanity humanity humanity, oh the humanity! I am a great listener, and humans suffer and listening helps alleviate suffering.”

For a friend who’s applying in anesthesia: “Weee, putting people to sleep and bringing them back up is a trip, you should try it some time! Awesome chemicals! Awesome drugs! Oh, and knocking out the patient is a good way to help them deal with the stress of, you know, surgery n’ stuff. Did I mention that I’m really smart?”

And for dumbasses like me, who can’t write: “Kids become adults someday. But before they do that, they need to grow and pediatrians, like, help with that and all. Oh, and it takes a village and all that. P.S. Kids are CUTE cooo cooo cooo.”

I saw this article in the NYTimes about a county in Ohio where people were receiving angioplasties for blocked coronary arteries at a rate four times the national average. Which led the New York Times to ask the public this question: “Have you ever suspected that a physician had financial incentives for recommending a medical treatment to you?” To which there were over 200 responses, most of which went like this:

PAPI: Of course; One of my best friends works with a doctor who does unnecessay tests and procedures to elderly, dying patients and he makes a killing. Has like 3/4 houses in CA, 5 Porches and just about anything else you can imagine..

Yes, I’m spending the BEST 15 or so years of my life in school and medical training so I can have three to four houses in California and five fancy cars (at least, I think that is what this guy is trying to say). Oh boy. This Papi character has found me out — clearly, I’m only in it for the porches (and porch furniture).

For anyone who thinks that doctors are in it for the money — and by extension, that’s why your medical bills are so expensive — I want to set you straight. You are only partially correct. Some unknown fraction of physicians are “in it for the money” because doctors, for the most part, make a decent salary. A small proportion of them make mucho grande ridiculous bucks, a larger proportion make a comparatively decent living, and another proportion of them are working at rural clinics or inner-city hospitals where they’ll never lock their 1984 Volvo in case someone in that neighborhood wants to break the window to steal the basketball in the backseat. But I think the reason why we’re paying so much for health care is because the medical system is really flawed and reimbursements are inaccurately assessed; we need to pay a lot for some very crazy high-tech things and some things that are really important never get properly reimbursed. Also, the thing that people really don’t understand is that medical management is never perfect. We hope these four rather expensive medications will clear up your sinus allergies and breathing problems, but we never know until we try, and you’ve already tried all the cheap ones and said you don’t like them. We hope that removing these moles will have prevented skin cancer, but we can never be 100% sure, and stop going to tanning salons by the way. And just because they couldn’t find the source of your rectal bleeding until the second colonoscopy doesn’t necessarily mean they were trying to charge you for two colonoscopies. At least I hope it doesn’t mean that. At least I hope that those unethical doctors get found out and people stop going to them.

Also, I highly doubt that unethical practices constitute the bulk of what drives health care costs up (but I do wonder what proportion of unnecessary testing/procedures are done that do contribute to the rising cost of healthcare). Bah.

In any case, I think I’m in a decidedly rant-y mood right now because peds nephrology IS as scary as I imagined it to be, not only because I have no idea what is going on 100% of the time, but also because there is never a good time for me to ask my stupid-med-student questions. I’ve been writing them down and managing to find answers on the internet or in books at home about 50% of the time. Then I lie down on the floor for about an hour and get depressed about being the worst kind of med student there is in the entire world, which is the barnacle-kind of med student, which is all I can be on this rotation. Then I lose motivation for looking up my questions and fall asleep. And the cycle begins again — student-barnacle, tired feet, being confused for 8 hours, then going home, trying to learn, lying comatose on the floor until I get sleepy enough to go to bed. I’m cranky. I guess the only thing I like about it so far is seeing parents and their children together. And one kid, who named his stuffed monkey “Sydney Kidney.”

I tried doing my own head shot today with the camera’s auto-timer and needless to say, I’m not a very good photographer. We need to send ERAS, the Evil Residency Application System, a professional-looking photo of ourselves for identification purposes. Frankly, I think they just like to make sure we’re not scary looking so we don’t make all the patients cry when they first see us. It’s because medical people just become uglier after years and years of 80-hour work weeks, so they want them fresh-faced when they first get ‘em.

I also tried on my old med school interview suit, which my mom bought me at a Filene’s Basement sale and a.) the pants don’t fit since my waistline has since expanded b.) it was dusty and c.) it has shoulder pads that looked like epaulets. Hmm. Where am I supposed to buy a new suit that doesn’t make me look a hundred years old? Where does one buy suits? I know that Joe has purchased suits at Men’s Wearhouse, but I think “Men’s” is a clue that this is not the place for me.

Hmm. I start “pediatric nephrology” tomorrow which isT scary because I fear the kidney. All those electrolytes and fluids and such, I can’t remember if sodium goes in or out of the proximal tubule, and who knows what exactly which antibiotics are nephrotoxic? I fear the kidney and whole month of it, to boot.

Here are some fun pictures from the weekend:

Congratulations to Jason and Regan, who got married without telling anyone! Yes, getting married should involve getting crowned, too.

I finally bought myself a pediatric stethoscope! After all, I think I am joining the profession. You know, commit to commitment and all. They’re wee and cute, and after using the infant stethoscopes (which are even wee-er) all the time on NICU (each little pod baby had his or her own stethoscope attached to his/her isolette) I think I’m ready for the big jump from adult-sized stethoscope to child-sized one.

Last week, I had this sudden huge attack wave of fear about pediatrics — which most people equate with getting shots and getting plotted on the height-weight curve, then talking about rashes or the best insect repellent to take with you to camp. Not exactly jazzy medicine. That’s the thing about peds — kids, for the most part, are healthy. Shots and plots are part of being a healthy kid. And it’s kind of boring. But I like sick children. Sick children are…well, endearingly sick and have tumors or are too small or don’t have organs that function quite right. And can usually be brought back to health to live out good and fulfilling lives, eventually. But what if I’m not good enough to manage sick children? What if I’m headed down the track of becoming those cloyingly sweet pediatricians, those Bearer of Stickers and Cute Toys On My Stethoscope, and Orange Pedialyte Popsicles? (Which, by the way, are disgusting. Don’t try them. The blue ones are infinitely better.) I don’t think I have it in me to become one of those pediatricians. (insert guilt guilt guilt here. I’m not worthy. I’m not worthy.)

I started looking really hard at med-peds programs…which are residencies that get you ready for both adult internal medicine and pediatrics and are four years long. But those programs are few and far in between, and the most well-rounded and sough-after program in med-peds is a program that I was told to “not be surprised if you don’t get an interview there.” The next-best options aren’t all that attractive, since they are in locations that Joe would be relunctant to move to. So there you have it. I hate the idea of leaving the adult world behind, and I would gladly be a general internist…but never a general pediatrician. On the west coast, if you love both adults and children, there’s always the option of family practice, but I really like the hospital, and I want hospital-based training, which family medicine doesn’t quite prepare you for. I want the options afforded to pediatricians or internists that aren’t given to family practitioners. And I hate ob-gyn, which I’d have to do a little bit of in a family medicine residency.