karma...

...is a trip. One of the chiefs this year wanted to match at this institution for maternal fetal medicine (MFM), but did not match here even though she ranked it #1. Everyone said aloud, "how could this be? She did so well on the CREOG." It turns out that she has a reputation for being lazy. My experience of her is that she is quite hard working and considerate of the people she works with. But at some point, perhaps before I arrived here, she got the "lazy" label and has worn it for all 4 years.

This is a perfect example of how the gossip in this place can hurt people.

The irony is that this chief is one of the people who spreads bad gossip about other residents. And now, the gossip has come back to bite her in the butt.

delusions

It is my belief that most of us create our own personal mythologies, ways of looking at the world, that make us the hero in our own story. Most of the time this is probably harmless. But sometimes we need to keep our delusions to ourselves.

Last night over dinner one of my classmates told me that a chief who failed to match in gyn onc this year made up a ludicrous explanation why she didn't match, and is sharing it with everyone who will listen. She claims that Ob/Gyn as a specialty was so competitive during her class year that she could not successfully compete against the strong candidates her year applying for onc fellowships. However, the people in ob/gyn residency in the class years after her are dumber, so it will be easier for next year's candidates to match in gyn onc. This theory does a neat job of explaining her failure without her having to admit that maybe, she just wasn't good enough. It also explains how junior residents could possibly match in the coming years while she could not match her year.

Never mind that she didn't have any oncology research at the time of her application. Never mind that she alienated our gyn oncologist during her rotation with him and probably earned a lukewarm recommendation at best. Never mind that she has a personality disorder, a rotten bedside manner and performs the world's most sadistic pelvic exams. Never mind that she spits when she talks.

Initially I was a bit offended by her calling the junior residents stupid, but then I had to get some perspective. She went out for a competitive fellowship that only accepts something like 30 candidates nationwide per year. She failed, and she is unaccustomed to failure. Worse, her defeat was public. She had to find a reason other than the fact that she just plain ol' got beat.

So now, all is right in the world and she can sleep at night knowing that she is more deserving of a gyn onc fellowship than the junior residents who might match in gyn onc next year. Whatever.

more stuff

Last night there was a dinner for area Ob/Gyns that was free to the residents in the program. When asked if I was going to attend, what I really wanted to say was "no thanks, I already gave at the office". After working 14 hours the last thing I feel like doing is spending even more time with residents. To them, it's recreation; to me, its just more work.

A non-medicine friend of mine had the audacity to complain to me about working 60 hours last week. For all of you reading this who work 9-5, 9-6 or *gasp* 9-7, DO NOT complain to a medical resident about your work hours. I'm under too much stress, man. Saying that to me is like dangling meat in front of Old Yeller. I ripped into the poor guy like a first year med student dissecting a cadavar. The horror. The horror.

I'm having a decent time at the moment on my current service because the people I work with are not malignant. It's just myself and a chief resident. My chief recently landed a fellowship in Maternal Fetal Medicine so she's relaxed and easy to work with because she doesn't give a damn. She confided in me that she thinks our program director is a lunkhead who doesn't even try to advocate for residents. Naturally, I agree. When she was pregnant during her intern year, her baby wasn't growing properly and her doctor recommended bedrest. Our program director's idea of "bedrest" was making her slave every day in the clinic. Finally, after things got worse and she developed preeclampsia her doctor went to battle with the program director and got her two weeks of REAL bedrest, in bed. Her baby DOUBLED in size during that time. Her baby ended up doing well after birth (although she did have a rough start) but my chief hates our program director for jeopardizing the health of her unborn child.

I got a couple of things out of our conversation. First, not everyone is blind to the evil ways of our program director. He's a little guy who has found a niche for himself at this University and has been here for practically his entire career. He works himself to death to make himself indispensible to the program. A secretary confided in me that he hopes to be department chair one day. Of course he never will because he is just a generalist and doesn't have any fellowship training. So while the rest of us will move on to bigger and better things, he will still be here working too many hours and forcing pregnant residents to march around the hospital on swollen feet.

It kills me how an Ob/Gyn residency program can be so family un-friendly.

The second thing I realized after talking to my chief was that nearly every resident that I know of who has had a baby in this program has had IUGR (intrauterine growth restriction). In other words, their babies are puny. So apparently, I'm not the only stressed-out resident around. I would never have a baby in this residency program. Heaven only knows what my outcome would be.

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Earlier this week I did an abdominal myomectomy for a 40 year old attractive Trinidadian woman with uterine fibroids up to her diaphragm. She was slender woman but her fibroids were so big they made her belly poke out. While we were prepping (the patient was unconscious) the attending told us that the patient refused a hysterectomy because even though she was 40 she still wanted to be able to have children. She hadn't had any children yet. "And", said the attending in a loud conspiratorial whisper, "she's not married. She doesn't even have a boyfriend!"

My heart bled for her.

Mr. Sensitive Anesthesiologist said, "well, she probably can't get a man because her belly is so big. She looks pregnant!" At that moment I wished I had a rubber leg that could reach around the blue curtain to kick his ass.

As it turned out, she had 10 pedunculated fibroids, 5 of which were the size of canteloupes. All together they must have weighed at least 15 lbs. The surgery was long and she lost a huge amount of blood. Her starting hematocrit wasn't stellar because of her menorrhagia. I could tell that she would need a transfusion, but the anesthsiologist talked my attending out of it because she was a relatively young and healthy patient. He was hording blood like we wanted to take it out of his own body. My thought was, give a sister a break! Give her the blood!

The anesthesiologist finally relented and transfused her one unit in the PACU. Bastard.

When I rounded on her the next morning, I had the pleasure of telling her that she would indeed be able to have a baby if she became pregnant, albeit by cesarean section. As far as finding a suitable man is concerned, she's on her own.