Game of Thrones, where justice is best served by not being served

I'm in the midst of Game of Thrones and it's a pretty rough struggle.  When I say "Game of Thrones"* I mean the books and when I say "struggle" I mean life struggle.  I'm literally 3000 pages in and, since I don't want to give anything away, I'm going to use an analogy to describe how I feel on a pretty regular basis.

Let's say you enter grade school as a transfer in the 3rd grade to a Finnish grade school (I'm specifying Finnish, not to distinguish a difference in the culture, but so you can get a feel for how fucking hard it is to keep the names straight).  You get there day one and you meet some people. Some seem cool and others seem like they are kind of a dick.  Some seem important, others are clearly in the shadows.  Time moves on and you realize that you really like some people, they are great and treat you well, and are well liked by all, and even their follies are the kind we all make.  Others are just cruel, evil, wanton destruction types.  They are the bigger, badder bullies and they do terrible things.  The kind of terrible things that you feel bad about, even if they weren't done to you.

But this is no matter, there are teachers out there who will right the wrongs, recognize the good, punish the bad, and expel the wicked.  Such is the way of life, in a just world.

That is not how things are going as you come to finish (get it?) 3rd grade. The bad kids seem to have curried favor with the teachers, the good kids have been put in a corner, and the best kid just got expelled (if you watch Game of Thrones, I think you know where we are).

Ok, well not how it was planned, but we have 3 more years till we graduate, plenty of time to make amends.  But fuck no, you get no such justice.  4th grade comes and the bullies have been promoted to hall patrol and given gold stars.  Your friends, the ones plainly seen as good by all (even the bullies see their good) are being expelled left and right.  On top of that, you are being forced into the same classrooms, and onto the same sports teams, as some of the bullies, and as you get to know them, instead of their crimes being punished, they are explaining them from their point of view and you are starting to side with them.  The truly good people are being expelled and the bad guys are seeming not so bad.

5th grade is upon us.  Really cutting it close on the justice being served side, especially since your expelled friends aren't making it back to this school system any time soon.  Probably time to start dolling out at least a little justice.  This will be a good year.  It must.  A small victory perhaps.  At least one punished bad guy...right?  No.  The rest of your friends are expelled.  Four remain and all four are in some stage where they are completely helpless to exact any revenge.  The bullies continue to rule and are relatively unopposed.

Admittedly, I have another year and a half to go, but a year is a long fucking time and you can't unexpel these people.  Also, I've become so calloused to the calamities that befall my friends, that nothing you can do to the true bullies will possibly be horrible enough to fulfill the revenge I want for my friends.

This book could be considered a deeply depressing lesson in actual life, but actual life is generally much more fair.  Fuck you Game of Thrones.

*Note: It's funny how the name "Game of Thrones" has stuck, which is a fantastic title; while the actual title of the series, "A Song of Fire and Ice", is completely lost.  Probably because if fucking sucks.

Oh great Loan Forgiveness

Oh great Loan Forgiveness, please look upon my weak soul, know that I have sinned, and forgive me for my past borrowances.

I am but a meek and mortal man; feeble and childlike in the face of the temptations of earth.  Most regularly, I would find myself tempted by the flesh and evil-delights of this world like food and wireless internet.  During my trite schooling, I was forced to borrow great sums of money from you, all so that I could shame my loathly self by paying for a bus when I could have walked in the rain or purchasing ice cream after my meal of rice and cheap meats.  Once...oh it's so hard to admit, I celebrated the termination of a semester by paying for alcohol at a bar.  Perhaps it was even more than once; I dare not think too deeply on such matters lest I should find myself gazing on my black soul.

And these transgressions; these pitiful displays of my beastial soul, have left me in oh such great debt to your kindness.  I find myself with much for you to forgive.  More than I can really think about.  Or later pay, which is kind of where you come in.

But oh there is more!  Whether it is my weak soul that sours my mind or a small and worthless mind that allows my soul to get so filthy, I cannot begin to know, but I do know that this weak mind is not allowing me to really get how these loans work.  I have oh so many loans, and all seem to be different, with many of your cryptic abbreviations.  Abbreviations that I am sure you will have explained to me in full whence this dreary life has ended and I am in your ultimate light.  And out of your debt.  But until that time occurs, I am greatly confused by them and when the grace period starts and ends and if something different needs to be done for my undergrad loans and why you randomly capitalize parts of loan names.

I have spent a great deal of time studying your parchments and texts and .gov pages, but to no avail.  Please, oh great Loan Forgiveness, send me one of your earthly priests who is wise in the ways of Perkins Loans and Grad PLUS to tell me what is best financially for my future.  Or possibly just go ahead and forgive them now and I'll be like, super grateful.  Either way oh great Loan Forgiveness.

Master meeter

Trying to meet up without a phone now is pretty mind blowing.  I know it's possible, because I'm old balls enough to have done it, but it's ridiculous.  It's like trying to masturbate without the internet.  It takes a lot longer, requires a lot of mental effort, and has several points where you almost give up, but it does work in the end albeit several shades more painful.

Misfits, but really, it all fits.

I watched the first 10 minutes of this show while on call and the resident I was with said, and I quote, "I have no idea what they are saying, this is stupid, let's go round".  That ended Misfits for me for 6 months.  Then, one day, my world was opened again on a whim to kill an hour.  Three days later I emerged having watched two twelve episode seasons.  I'm not confident I showered in that time.

When I describe this show to others, I say, "think of Heroes and Community mashed together, but better than both".  In the first episode a group of UK kids who are doing community service for minor offenses are caught in a storm and get special powers.  So did everyone else caught in the storm.  You end up with five fuck ups with "special power" (Ok, mutant powers. Give credit where credit is due, all of these shows are just reruns of X-Men*) who end up killing their probation worker and have to hide him.  Drama ensues.  Hilarity ensues.  Hilarious drama ensues.

This show has everything.  Absolutely everything.  It has moments that Breaking Bad and Dexter should be shown so they can understand how to build suspense.  "Oh, I see. Get the audience to believe what the characters believe.  Weird, who knew that would work."  There are stylized episodes that would make Community bow and say, "well done".  There's a Nazi episode, a cult episode, an episode where a guy has a power that makes him think he's in Grand Theft Auto that is so on point with Grand Theft Auto that you would believe the actor they got to play the GTA guy is the actual guy who did the stop-motion for the game.  And yes, of course it has a zombie episode.

It is also fucking hilarious.  The main guy, Nathan (Robert Sheehan of well, absolutely nothing) is one of the funniest on screen actors I have seen.  Remember when you were watching 2 Guys a Girl and a Pizza Place and you were like, "Wow, this show blows. Although...that one guy, he seems to have something special" and that guy turned out to be Ryan Reynolds (regardless of what you think of him now, admit he was good when you first saw him.  Admit it.  Now.  In writing.  Leave a comment.)?  This guy is like that.  His delivery is something special.

The directing is spectacular, the writing is amazing, the characters even better.  Even the theme song is a great Rapture song (Echoes, if you're looking for it) and they have some awesome music in their show.  Fuck, even the cinematography is top notch.

So please, get on hulu, spend 4 days and get caught up on all 3 seasons, and we can have a Misfits party before season 4 comes out.

*Note: And just like X-men and all of these shows, there is some awkward time traveling stuff.  I didn't say every episode was perfect, just that most were.

Bond. James Bond. James F. Bond? Ok maybe it's under something else.

The life of a secret agent is probably a lot more dealing with front desk clerks than shooting people.

"I believe there's a package for me under the name 'Frank Wilson'"
"Ok what kind of package?"
"Um, a package with some stuff in it.  It's under the name 'Frank Wilson', here's my ID and Passport"
"Great, thanks, what kind of package is it? Big? Small? Envelope?"
"Let's say smallish. Maybe heavy.  Or maybe it just has papers in it.  I'm not really sure."
"Who sent it?"
"Um, I'm not actually sure."
"Well what's the return address on it, that's what I'm really asking"
"I...don't really know."
"Well can you check a tracking number, or call the person who maybe sent it, or check an email?"
"No, not really, that was all destroyed."
"Ok, so smallish, maybe heavy package with an unknown return address and the name, 'Frank Wilson' on it.  I'll just go to the back and look through the 300 pieces of mail we receive a day at this depot and see if I can't find it.  Do you have 3 hours?  Also there is a guy in a suit standing behind you who keeps telling me to go ahead into the back, I think he wants to talk to you."

Orwellian anatomy: 198Four ligaments in the knee

I wish textbooks were as interesting as pleasure reading books.  Like I wish Orwell wrote my anatomy text.  It would be like, "the sun poured in through the window and landed gently on her scapula, which is attached to the Manubrium at the sternoclavicular joint, the subtlest of joints."

Step 18 of becoming a doctor, wade through the bullshit

I'm interviewing for residency right now and it's a bizarre process.  I'm applying into neurosurgery and surprise! it is a 7 year, "88" hours a week, 5am to 8pm on an easy day, work your ass off residency.  Turns out people want neurosurgeons to train kinda hard like.

So going through this interview process is a strange trip.  On the one hand, most good applicants get a program in their top 3 choices.  That's pretty comforting.  In fact, by far the most common scenario is to get your number 1 choice.  And more than that, most people like their home institution and their home institution has interviewed them for the 4 years of med school (particularly in neurosurgery where people start from day 1 walking around introducing themselves as, "Hi, I'm JohnI'mgoingtobeaneurosurgeon, what's your name?"), so it's sort of clear that it's a mutually beneficial situation and a bit of a lock.

However, there are political games galore, lying, applied game theory, and tons of horror stories of the "locks" at Home Institution University ending up at Third Best State School in the Region University.  So everyone gets very nervous, no matter how good an applicant and develops a self destructive habit like alcohol abuse or watching Whitney.

A common question at this point is, "well what's wrong with Third Best State School in the Region University, won't you still be a neurosurgeon".  Yes, and likely a well trained one.  Still, 7 years, working that hard with 7 to 21 other people (most programs take 1-3 residents a year) is just not a flippant choice.  It's like trying to pick the best prison for you.  Which penitentiary has the coolest inmates?  Who's the best Warden? Where do they give you the most time for arts and crafts, but still enough time to read?  How much outdoors time do you really get?  You can't switch residencies (or rarely) and you can't speed it up.  At the end of the day, we will all be rehabilitated and ready to re-enter society, but you still want the best prison possible.

Let the games begin!

Let's smoke pot and play computer games

There are some words that are just about impossible to say cooley (like, "cooley").

Try to talk about marijuana and sound cool.

"We are going to go smoke some pot".  Thanks for the update, Baby-boomer.  Let me know how groovy it is and if you guys are going to the Simon and Garfunkel concert later.

"Those guys are going to eat weed brownies".  I hope they get a glass of milk with those and don't stay up too late watching Animaniacs, they have a big homework assignment due at the end of the week.

Using a desktop is another one.

"Let me just write this down on my PC".  Oh right, take whatever time you need to write on your "Personal Computer".  Do you think you can get me a copy with your Dot Matrix Printer, or better yet, Fax it to me.

"I have a desktop".  Cool dude, can't wait to come over and play computer games.  Should I bring a joystick so we can both play Civilization or SimCity 2000?

I've just started saying, "I don't have a mac".  That basically answers people's questions.

So you want to get into med school...

I often get asked how med school and residency works.  It's not really clear or intuitive and most people get their information from extremely accurate TV shows like Grey's Anatomy and Scrubs.  As someone who finally understands it, and I can assure you I did not until probably this year, let me do a bit of explaining.

For pre-med, I've given a decent explanation here, so I'll leave it alone.  I'll move on to first year.  This year is all about minutia.  It has been said that you spend the first year learning a language, and that is more or less accurate.  Particularly first year, your life is to learn basic science, basic science related to medicine.  This is like getting hired as a lawyer and then being asked to spend a year learning how books get made.  You learn new fancy words, with no idea how to use them or what they really mean.  You hear about things that sound important, but don't really exist.  The kind of thing where your attending* sees primary syphilis and is like, "It does exist!", and he's been doing it since the pre-antibiotic era. You definitely learn a lot, but it's mostly useless or won't stick. The major utility of this year is to drink and hook up with your classmates.

The summer between 1st and 2nd year is the only summer med students get.  This is a hard concept to understand for the rest of the working world, who assumes school is school and schooooooooool's out.for.summa! It's not.  And most people work this summer, doing research.  Lawyers get paid around 30,000 for the summer.  We get paid around 3,000.  If you have a good grant.  Again, a good time to drink and sit by a pool and regret hooking up with your classmates.

Year 2.  This is pretty much the same, but they get your ready for the wards**.  You do things like see standardized patients; paid actors who pretend to be sick and then give you feedback afterward that is always the same, one good thing, one bad thing, and "how do you think it went?"  "I think it went about as well as it could go considering you aren't sick and I've seen you tending bar at The Back Saloon.  We were both there last night.  Didn't have a bum knee then, did you?".  We learn physical exam, interviewing skills, basically all of the stuff that teaches you how to diagnose the fact that you need to order a cat scan.

At the end of this year, you take Step 1. This is the MCAT for residencies and is a super painful test.  More about it here.

More on year 3 and 4.

*Note: An attending is the head doctor (Dr. Cox, if you will) who runs the show, makes final decisions, and pimps the shit out of you.
**Note: The wards is the name for actually being in the hospital.  Clinics is a synonym.

I'm like a super hero but without being super or a hero

In response to my recent post, truthfully, I've had to pull back on everything.  I'm basically hiding from the internet right now.  I have to apply for residencies which is, for all its other bullshit, still a job.  So posting poop jokes on twitter and the pictures of me in cat-face for the month of July are not cool, bro, not cool.

Privatize this, anonymize that, stop making up words like anonymize; life in the real world blows.  I realize the problem, you can't have doctors going around writing shit like I write, saying the shit I say, using the word "shit" so often.  It's unprofessional and makes people lose faith in doctors.  So I keep it anonymous.

Although in reality, I'm a work hard, play hard kind of person and I never mean anything but a joke.

I can complain about med school and make jokes about rectal exams being uncomfortable, but I don't dislike my patients and I don't dislike my work.  I'm ecstatic to be doing what I'm doing and take it very seriously.  That's why I write this.  It's an outlet for me to get all of the jokes out of my system before I walk into a manic patient's room, because when they start telling my team a 25 minute rambling story about a cat, going into exquisite detail about the cat, never letting focus get off the cat for more than a sentence, when they finally finish talking about the cat, if I don't have an outlet, then I feel it necessary to blurt out, "Sorry, you said you had a cat? Can you tell me more about that?".  That tends to make me unpopular with my colleagues (although super popular with the manic patients).  So I get the jokes out now.

A question that gets asked on interviews with a frequency high enough that I'm pretty sure it's  JCAHO* required interview question is, "how do you deal with stress? how do you relax?".  You have to say things like, "exercise" and "playing with underprivileged minority children", but even a legit real outlet, like writing a blog, is a huge no-no.  I took certain things off my application that were actually impressive and show me to be a well-rounded individual because you can google them.  Since this is just a job and they don't care how well-rounded I am, I'd rather them think I'm boring than think that I write the word "shit" so frequently.

I guess this is the duel-life I have signed up for, by day, mild mannered doctor, by night, slightly annoyed doctor, every month or so, when I have a free hour or so, dude who writes a shitty blog.

*note: JCAHO is the Joint Commission on Accreditation of Healthcare Organizations.  They are the standards committee that comes by once a year "without warning" and makes sure that people aren't like tossing needles into patients from a distance or letting patients just wee where they want.  They are sticklers for things like washing hands and not weeing wherever you want.  A real drag.  They would never sanction a question about the well-being of doctors because they would never care about the well-being of doctors.

5 years. Is anyone still reading this?

Holy shit, I've been doing this for 5 years.  Look at my first post, that was over 5 years ago and before I was even in med school.  I was applying to med school; a doe-eyed premed, full of hopes and dreams, and fresh out of college.  And look at me now, applying to residency, a weary-eyed soon-to-be doctor, filled with realities and not enough sleep for dreams, or fully coherent thoughts, still fresh out of college (right? right?!?! I can still party right? I'm cool, right? Say it!  Say it!!).  So let's highlight the differences between me now and me 5 years ago.

1) Let's start with the most pressing for any hopeful premeds.  Primary care blows.  I sort of figured I wanted to have a long-term relationship with my patients, doing primary care in an underserved area, stomping out diseases with a tongue depressor and deep thought.  I'm going to listen to my patient. Fucking listen to her. That's what I'm going to do, fuck yeah!

Primary care sucks.  I don't mean people who do primary care sucks, I mean the way primary care physicians are treated sucks.  Every specialty has it's own brand of suck, but something about primary care, particularly outpatient, feels like you are standing there in your white coat, trying to listen to your patient, acting dignified and thoughtful, like a good doctor should, while monkeys surround you and fling poop at your face and laugh at you.  Fifteen minute visits, gatekeeper status, hyper-specialized docs keeping you out of the loop are the poop on your face.  The insurance companies are doing the flinging.

All of the underserved, long-term relationship, sword of justice stuff is superfluous to my new found love of hyperspecialization.  Everyone with a brain tumor is under-served.  I still like all that stuff, it is just mostly irrelevant in my world, and takes a back seat until I can breathe on the other end of residency.

2) I have confidence.  As you can tell by my first post and the subsequent ones about interviews  that I wasn't really sure how this whole thing would go.  Med school has a 58% rejection rate the last time I checked.  Residency is virtually guaranteed.  I didn't know how I would do in med school, on my board exams, with extra-curriculars, etc.  I now trust in the system.  They let me in because they thought that I would be fine, and I was.  "Med school is the narrowest hoop, and once through that, you will do just fine and get a residency" that's the basic idea and it is pretty much true.

3) I have chest hair.

4) I am jaded. Not jaded, that's not quite right, hardened, calloused.  I try very hard not to be jaded, but hardened for sure.  I've watched people die, I've pumped on their chest while they die, I've had my patients die.  That's never great, but the weird thing is just how used to it you get.  Not to mention all of the gross shit I've done or seen or been asked to do and just been like, "yeah ok whatever".  As in "Stick my finger in that guy's butt? Yeah ok whatever."

Ways I am the same:
1) I still want to be a doctor.  I want to  be a totally different kind of doctor, but I love this profession so much.  We love to bitch about it and prove how much more hardcore we are than all the other professionals, but truthfully, we get paid a more than decent salary to go around thinking about how the body goes wrong and fixing people.  We can get jaded and bitch about the paperwork and the insurance companies (for good reason), but there are so many opportunities to more or less switch careers to teaching, or admin, or writing or even a different kind of doctor if it gets bad.  Worst comes to worst, it becomes like every other job, we do it for pay and can't wait to get home to our real passion.  Boo hoo for us.

2) I want a cat.  I wanted a cat then, I want a cat now, I still don't have a cat and probably will never get one.  Seems like a lot of work.  A tattoo is in the same boat.  The same boat as the cat.  Which makes it some sort of strange boat with a cat and a tattoo and wanted by me, but only, like, sorta.

I am NSFW

A bunch of my classmates were asked to write blogs about their experience at my med school.  I have no idea why I was not asked to do such a thing.  I mean, I already have a blog; I feel like I'm an obvious choice.  What could possibly make them not want me to do it?  Pricks.

I was once asked to start a twitter account for the school where they would live feed my tweets to the admissions page.  They pulled me down in a month.  Apparently, the word "fuck" is not exactly the message they wanted to send.  But that's a totally normal, med school reaction to finding out you have another write-up to do. "You have an incomplete write-up" "fuuuuuccckkk".  See?  Natural. "You are not allowed to write an official blog" "fuuuuuucccckkkk you".  Just trying to express thoughts in real time.

display('programming sucks')

I'm learning to program (again), which is a lot like trying to learn to live in a world with a different set of physical laws, holding nothing but wikipedia.  It's like appearing in a world, wearing normal clothes, and the sun is shining, and people are walking around looking normal, so you try to take a step. Error.  Area (muscle) non-real index.

So your leg doesn't move. So you look up muscle.  Then you realize you need to know more than muscle, so you go looking for other stuff that is often cool, but you have no idea if you need it or not.  So you look up cell, nerve, desire, will-power, gravity, lactic acid, exhaustion, coordination, balance, track and field, world records, and walk-a-thon.  You try again. Your leg picks up and you try to extend your leg to land the step. Error. Undefined function or method 'step' for input arguments of "walk".

I respect the shit out of people who spend they're lives recreating the world through a made up series of logical operators, while listening to techno and monstering red bull.

This is what I think about when I'm on a research month

You will be locked in the same place for the rest of your life.  If you leave, even for a short time, you will be accompanied by a guard and in shackles.  You will get around 15 minutes of outdoors time per day, most days, weather permitting.  Exactly twice per day, you will be fed the same food you are always fed with no variation.  You may have water when you need it.  You will receive special goods and services, but only upon witnessed and continued good behavior.  You will speak only when spoken to, and never too loudly.  You will be castrated.

FREE DOGS!!!

You can take my freedom, but you can't take the word Dong.

I was taking this test where we see standardized patients*, take a history and physical on them, then write the whole thing up, come up with a differential diagnosis, and order some fake tests.  It's a timed test for both the interview and the write-up, so you tend to rush through and not care much about spelling and whatnot.  Still, I finished one patient and had a bit of time to review my write up, at which point I found this:

"64 year old female complaining of left sided chest pain following exertion.  Patient was taking her dong for a walk when she began feeling chest pain."

Hahahahahahahahaha, dong, hahahahahah, no but seriously, delete.

*note: Standardized patients are actors paid to pretend to have certain diseases and to give us information only when we ask the right questions.  It's a bit like a LARPing in terms of realness, skill at acting, and awkwardness.  

Pimp my expensive education

There is a thing in medicine called, "pimping". Basically, pimping is when a higher up doctor puts a lower down doctor or medical student on the spot in front of the group and makes them answer a question about medicine.  The idea is to see what a young doctor knows about a subject that comes up on patient rounds regarding their disease.  Although sometimes it's about history.  Or trivia. Sports sometimes.  I once saw an attending pimp a patient.  No joke, the patient was a PhD in physics and he started asking him who discovered some string theory equation.  The guy was like, uh I don't know, but my ankle reallyl hurts.  He was then told to read more. Pimping is as old as medicine* (there is a story in the bible where Jesus, right before healing a sick man, asks one of his disciples to name the 4 kinds of gastric ulcers, then smotes him and tells him to read more.  I think it's in John somewhere) and has a lot of surrounding controversy.

The controversy exists because it sort of sucks to be made to look like an idiot in front of a bunch of people.  Generally, the term "unnecessary humiliation" gets thrown around in sensitivity meetings.  On the other side of the coin is that fact that frankly, you learn a lot from being pimped.  Once you get over the shear terror that is being asked a factual question in front of a bunch of people you don't really know who will judge and grade you based on your answer, you swallow your fear, take a small poop in your pants, and give an answer.  You will either surprise yourself with what you know, or get the answer wrong and be told the correct answer.  I know some of the most obscure facts in medicine because the emotion associated with the question burned the answer into my brain parts (but let's be clear, that emotion is fear).

A good pimper, one who asks relevant and useful questions (see this post about the difference) without adding too much visible weight to the answer, will teach you more than you can imagine.  In fact, once med students get over the sharp pain of being pimped, many will agree that a rotation without pimping is a decidedly dull one.  A lot of being a med student is scut work; a term that means "shit" work.  "Call this nursing home", "make sure that CT got done", "walk this patient down the hall"; those are things I am asked to do on a daily basis.  Only paying 70 grand a year, NBD.  So getting a little extra teaching in the form of a jeopardy (because you are in actual danger) style learn-a-thon is not that unpleasant.

*Note: I once looked up the origin to the use of the word, "pimping" in medicine.  It doesn't seem novel now, since MTV pimps everything that can be bejeweled, but it is listed in books and articles in the 70's.

I've seen the trifecta

My school health insurance requires that if you aren't going to use the school health insurance, that your alternate insurance plan has this stipulation, "My plan does cover me for Sports injuries, alcohol-related injuries or conditions, eating disorders." ...I'm offended by your accuracy.

Downer alert. My B.

People dying is sad.  That prolific statement is brought to you by my current rotation, Neurosurgery: "Where people die a lot."  Not the slogan of the national society, but certainly a reasonable runner-up option.

What I've discovered during my recent acclamation with death is that I find certain deaths more emotional and tragic than others.  This is another obvious statement, but instead of listing some criteria like "people with families" or "contributing members of society", I am basing this off of my emotional experience. I just sometimes walk away from a patient who died or is about to die, and find myself more moved than with a different patient.

The only variable I can seem to cite with some consistency is age.  Social status, family status, mechanism of injury, events leading up to death; all seem to not make a difference, but age fucks me up.  In particular, it's the 18-35 crowd that jerks my soul around.  There is something about seeing someone with the prime of their life torn from them that really gets me.

I realize this is very egocentric, I myself being in this age range, but I think there is more to it than that.  Older individuals have gotten to live an impressive amount of life.  From your 85 year old former paper editor, to your 55 year old father of 3, their death is sad without a doubt, but their life is established and in status quo.  A great place to be, but a plateaued place, at least from a year-to-year view.  But 18-35, that's when you are really setting up the rest of your life.  You are making the moves to get to that plateau.  You are starting college as a theater major; getting promoted to manager; knocking up that waitress; heroine binging your way onto a reality show.  You are a real fucking winner, and no one can tell you different.

Kids are obviously sad; there is so much life lost.  But when I was a kid, I wanted to grow up to be a fire-truck (Ding-ding!), now I want to grow up to be a doctor and I'm like 90% there.  If you robbed me of life when I was 8, then we can just build a new fire-engine.  If you rob me of my life when I'm 28, then we have just lost my realistic future as a physician (and my loans, see you in hell Sallie-Mae). 

People are in the active process of realizing their future.  It's not a pipe-dream anymore.  It might not be glamerous, it might be laying actual pipe, but it's an active, conscious persuit.  It can be painful, and full of introspective self-doubt, but at least it's not boring status quo, like 20 years from now, and it's not dinasaur catchering and wand-makering like 20 years ago.  It's like running a marathon and getting pulled at mile 16.  You'll never know if you could have made it.  And you won't care, you're dead.  But I will.  I care if you could have made it.  I wanted to see how you finished college.  Or even my Caesar salad.  I hear they were going to promote you to manager...

Anyway, back to work.

Oh also the scrubs on Ob/Gyn were awesome and I stole like 10 pairs

I loved my Ob/Gyn rotation, unlike approximately 103% of other med students.  It was the weirdest, most fun experience, top to bottom (pun intended).  Oh sure, there were the bad residents.  Well just one really.  She was actually the worst human being I've ever met, but she was so bad it was comical.  Plus she hated me, and since I didn't use the adverb "fucking", that means she didn't make my life any particular hell.  My love of that rotation can also be qualified with, "it was your first," making it new and exciting and fun.

Still, it was a cool trip down memory lane (you know, because I was born there.  The vagina that is.  I came out of a vagina).  There is some surgery, some primary care (find that combo in another specialty) and an interesting patient population.  But what really made that rotation for me was one single person.

The head of the department was probably the best teacher I've ever had.  He was this hilarious guy who just knew exactly how to give you information so it was useful, relevant, and interesting.

Those are all code words.  Useful means it had the number one most important feature, it would appear on our test.  I know this sounds shallow.  I'm supposed to be a medical student learning for the sake of learning.  Learning so I can be a better doctor.  Learning so I can help people.  That's the kind of bullshit that I said to get into med school. The truth is that I will never remember even a 20th of what I learned over my clerkship year, so the fact that it got me through my test is the most important feature by far.

That being said, relevant refers to its usefulness in the actual clinic, helping actual people, when it actually matters.  The kind of stuff you need to know as an Ob/Gyn resident.  There is a large overlap between useful and relevant, but not nearly big enough. A good teacher can differentiate the two.  A bad one pimps you on both indiscriminately, then tells you to read more.

Interesting means what it sounds like, but it also means that it had a chance of sticking beyond my 6 week rotation.  It didn't, but it had a chance.  This is a rare skill indeed.  Let me provide an example.

"Fetal heart monitors are sensitive, but not specific (useful).  They help us decide whether or not to perform a C-section (relevant).  This is bullshit forced down our throats by lawyers.  They have never been proven to do anything, but increase the rate of C-section.  We use them because we can be sued if we don't (interesting)."

See how that is a unique skill?

Medicine often laments that the most influential aspects of choosing a specialty are the residents and attendings you worked with during your clerkship; the most dynamic and least legit reasons to choose a specialty, but true nonetheless.  I'm not going into Ob/Gyn, but if I did, it would definitely be because of him.  And vagina.  J/k, just him.

Please don't take all of my hatred the wrong way

I realize that my post about my sub I makes me sound very bitter and begs the question, "why are you doing this?"  And also, "please don't go anywhere near me if I'm in the hospital."  Those are legit concerns.  But let me reassure you, that was me bitching about the amount of work I'm doing and the basic quality, not me bitching about my future work.  Let me shed a different light on it.

I fucking love the OR.  I really do.  I once heard this melodramatic, masturbatory statement, "If you can think of yourself doing anything besides surgery, surgery isn't for you".  The same thing is told to ninjas before they start their training, imagines brain surgeon.  Get over yourself.

But, it is a really brutal life during residency and if you don't love the OR, it's just not worth the pain.  I don't get to do much in the OR.  I regularly stare down a tiny hole, in which at best, I can see some fat for 5 hours, just so at the end of the case I can tie a few knots.  Most of which will be cut out because they aren't tight enough and that layer of fat needs to be tightly tied to that other layer of fat.  But two things.  One, it is worth it.  I love tying those knots and suctioning that blood and irrigating that wound enough that I'm willing to wait until I climb the ladder.  And two, the shit I'm watching, if I can see, is awesome.  Being a surgeon and being a med student interested in surgery are two totally different things.

No one likes watching someone else do something, particularly not the A-type* personalities that go into the surgical specialties.  You have to imagine yourself on the other side of the body, the dude with his hands inside the human.  The lady under the microscope.  Those are the people you have to want to be.  If you want that, and can deal with mostly watching for a few years, surgery is for you.

And it is for me.  I love it and it's worth all of the pain.

People often comment that I'm a masochist for doing what I'm doing.  No, I just find the pain to be less painful than others, so the pain to pleasure ratio is in my favor (I guess the same can be said for masochists, but let's not get into a philosophical argument about the true nature of pain and pleasure). I'm allowed to bitch about paying 70 grand a year to work over 100 hours doing virtually nothing.  I earned that right, and in turn, earn that right to be the one elbow deep in a person**. Plus, I dropped out of ninja school and don't know what else to do.

*note: The A stands for asshole.  ADHD. Arrogant.  Get me a thesaurus and look up Douche-bag. 
**note: I'm going into neurosurgery, if I'm elbow deep inside someone, something has gone terribly wrong.