Discharge: Rants and Reflections of an Ob/Gyn Resident

Grey's Anatomy

2006-12-14T18:47:00.000-05:00

I recently sent my blog website to an old friend from college who encouraged me to write more. Therefore, I will try to write more frequently.

A nurse recently asked if residency was anything like Grey's Anatomy. Well, let's see. On Grey's Anatomy, an intern dates an attending. In my program, an attending dated TWO residents, both at the same time, without them knowing about each other. On Grey's Anatomy, residents date each other. In my program, two residents not only dated, but recently got married. It doesn't stop there. In my program a hoochie female resident gave a middle-aged, married attending a pair of boxer shorts for Christmas. In my program, two residents got caught doing the horizontal tango in the call rooms. Is my residency like Grey's Anatomy? I don't think so. No one could make this stuff up.

Now for some updates. The intern in a previous blog who was using booty calls as an anti-depressant is now a third year and happily MARRIED (to a different guy). Her classmates are terrified that she will have a baby during residency, and with good reason. Girlfriend is secretly working on that project as I type. Why the secrecy? No one wants their fellow resident to have a baby because it takes them out of work, thus increasing the workload for everyone else. Selfish? Probably. Let he who regularly works 30 hours straight cast the first stone.

My friend who was dating the guy who goes to the LI-BERRY instead of the library is still dating old dude. He now attends her family gatherings like Thanksgiving and Christmas. My friend says that he is super nice and treats her well, but she is still caught up on the class issue. I think she will end up marrying him. She could do a lot worse. She could be with one of my exes.

My Puerto Rican classmate (previously referred to as "PR") who was banging nurses in deserted stairwells is now married to another resident. He seems to worship the ground she walks on. He recently told me that all his beloved had to do to ensure his future happiness was to "stay blond". I'm not kidding. She's a nice girl but has some, er, psych issues. If you look up "bipolar" in DSMV-IV you'll see her picture. Girlfriend had to take time off a few months ago when she cracked up and was on suicide watch. But more importantly, she never changed her hair color.

Practically the day after I wrote my last entry my magnanimous boyfriend broke up with me. It was cool because I had already decided he was a Mr. Right Now and was wondering how I could unhitch him without hurting his feelings. I shouldn't have worried. He ended up dumping me for a surgeon which was astonishing because 1) what were the chances of him dating two black female doctors successively? and 2) ol' dude was dumb as a box of rocks. He was, however, incredibly good-looking.

Then lickety-split I started dating a wonderful man that a friend fixed me up with. He was significantly older and had a 12 year old son that he co-parented with his baby mama. He was smart, emotionally mature and kind. Within months, we were engaged. Then he broke the devastating news that he changed his mind about wanting more children. Since kids are one of the main reasons I want to get married, I knew we had to part ways. We had a painful, but civilized break-up.

That's the update. Perhaps not as entertaining as Grey's Anatomy, but it's all true.

Yesterday, I MATRICULATED to the LI-BERRY

2006-03-01T18:30:00.000-05:00

I had an interesting convo with a fellow sista resident the other day. It turns out that we are both dating men who are less educated than we are. Not coincidentally we are both committed to dating within the race in an area that does not accommodate our preference (i.e., more brothers dating/marrying interracially than not).

My friend's man wants to marry her, but she is held back by the class thing. Brotherman is not a college graduate, and he knows nothing of her Jack and Jill world. Furthermore, he fathered a child out of wedlock which some middle-class black folks still find less than ideal. And his baby mama is GHETTO. But the real kicker for my friend is his bad grammar. He says "you and I" when he should say "you and me" and he leaves the first "r" out of "library". For whatever reason this drives her bonkers. She says she just can't see herself waking up every morning with someone who says "LI-BERRY".

My sweetheart has some issues as well. He keeps misusing the words "matriculate" and "magnanimous". Example: "I matriculated across the room". And anything good is "magnanimous". This is like nails on a chalkboard for me. My constant prayer is that he refrain from using these words around my friends. My friend's approach is to constantly correct her man which irritates them both. He chooses not to change his language. My gut tells me not to even broach the subject with my guy. At least not yet.

And then, there is the issue of dealing with the male ego as female doctor. Part of the reason these men are attracted to us is because we are doctors. But it feels weird for us to be giving orders all day and come home to someone who is too stubborn or too insecure to accept even the smallest correction. It's like living a double life. I wonder if these men would be as defensive with us if they felt better about their own accomplishments.

I'll end here. I have to matriculate to work.

Nigerian Scams

2005-07-16T17:47:00.000-04:00

Today, during an orientation for my medical mission trip to Nigeria, we were warned against doing two things: giving money to people and falling in love. On a previous mission trip, a Nigerian woman managed to bilk a thousand dollars from the mission team with some sob story about her financial hardship. She took her story to all of the team members individually and received about $100 per person. No one on the team knew that the other team members had given so much money until they got back to the US. When you consider that the average yearly income in Nigeria is $350, this was a hugely successful scam.

Some American woman on the medical team apparently fell in love with a Nigerian man during a previous trip. The two of them made plans to marry. Luckily she found out he already had a wife and kids before she paid for him to come to the US. He was looking for a green card.

I think one has to be very, very careful about becoming romantically involved with someone who might be motivated by the possibility of US citizenship. Just ask Terri McMillan.

Timing is Everything

2005-07-15T12:36:00.000-04:00

This week's lesson: uncensored blabbing during sex can create problems. As my best friend recently instructed, "don't let 'I love you' prematurely slip. And if you can't think of a substitute phrase, do a search on the internet or something!"

I have heard a couple of amusing stories about bombs that were dropped in the heat of the moment. A friend of mine was having sex with her boyfriend while straddling him. In the middle of the act, she stopped abruptly and said, "Tyrone, where is this relationship going?" Poor Tyrone, who probably had diminished blood flow to the brain at that moment, blurted "um, toward marriage?" They were married 8 months later. Tyrone's only stipulation was that she hand him back his testicles long enough for him to pick the moment of his proposal.

A male friend recently told me that his ex-fiance proposed to him during sex. They ended up engaged even though he suspected the relationship was doomed. How can you possibly have an emotionally loaded conversation at that moment? One of my favorite lines from Sex in the City: "you're breaking up with me... while you're still inside of me?"

2005-07-13T11:37:00.000-04:00

When I first arrived back in Chicago a few days ago I did what I usually do. First stop is Harold's Chicken/Robinson's Ribs/BJ's Market (take your pick) where I acquire a good ol' South Side artery-cloggin'-myocardial-infarction-on-a-platter that is unavailable in New England. Then I plop down in front of my sister's TV (I don't have cable at home), watch music videos, lick the grease off my fingers and wonder why I am fatter than the video hos.

I watched Jessica Simpson, daughter of a Baptist minister, gyrate in front of a car in a string bikini. This in itself doesn't bother me. What's weird is all the publicity about her virginal pre-nuptual status and squeaky-clean image contrasted with her hoochie behavior after the ring. Now that she's having marital relations with her nobody husband it's suddenly okay for her to show the world her ass? God says it's ok to be a hooch as long as you're married but not before? Maybe I should ask her dad. "Excuse me Mr. Simpson, your daughter kinda looks like a slut. No no, don't thank me. Just thought you might want to know."

Don't misunderstand me. I don't have anything against the hoochie-mamas. Smoke 'em if you got 'em, I always say. Just don't wear me out talking about your purity while you do it. It irritates me.

After watching cable for a week I have guilty pleasures other than food. I like 50 cent. He has a face made for the inside of a paper bag but that body... oh yeah, I like the songs, too :)

I like BBC America. Hyacinth Bucket rules!

And then there's Snapped on Oxygen. 'Nuff said.

I still enjoy those birth shows on TLC, even though I do that stuff every day now. I still get all sentimental and misty-eyed when I watch. More confirmation that I chose the right medical specialty.

Sweet Home, Chicago

2005-07-11T13:37:00.000-04:00

My next few entries will not have as much residency stuff. I am on an elective rotation. For my elective I have chosen to go to West Africa for a couple of weeks with a medical mission team. The rest of my elective time will be spent doing research. My "research" includes a brief trip to Chicago to study the lakefront in July, daytime TV, and the anatomy of one particular male subject who I like very much.

Coming back to Chicago was interesting. So much has changed. They are building new houses in areas that used to be overrun with crack addicts and prostitutes. And they're asking 400K! The gentrification thing is out of control. I saw white people walking in areas of Woodlawn that still make me nervous.

I was also accosted by people running scams on 71st and Jeffrey. In Dominicks, a man approached and asked if I was paying for my groceries in cash. It turns out he wanted to find out if I had a link card. I didn't talk to him long enough to find out the specifics of his hustle, but I recognized it as such. When I walked out of a Walgreens in the same area, a woman on the street asked me for my receipt, presumably so she could shoplift items from the store.

I just don't remember things being so bad on 71st and Jeffrey. Does something about my appearance or carriage make me an obvious target, as a friend suggested? Or did things get worse during my 6 year absence?

sex, lies, and gonorrhea

2005-06-26T13:34:00.000-04:00

So, the other day I admitted a young black woman who presented to the emergency room with acute pelvic pain and cervical motion tenderness. She had pelvic inflammatory disease. As expected, the culture I took in the emergency room was positive for gonorrhea. Since I admitted her I decided I should be the one to break the news to her.

When I walked into her hospital room, her boyfriend was sitting at the bedside, holding her hand and looking soooo attentive. I felt like pointing at him and screeching like in Invasion of the Body Snatchers. Guilty! Ark! Ark! Ark! I kicked him out of her room (okay, I politely asked him to step outside) and told her she had the clap. In fact, her infection was so bad it landed her in the hospital for IV antibiotics and forced her to miss several days of work. "I don't understand," she said, looking genuinely puzzled. "My boyfriend and I have been together for 5 years, and I haven't slept with anyone else." I watched silently as the truth dawned on her. Her expression changed from confusion to hurt to rage in about 30 seconds.

"You can come in now," I told the boyfriend, sweetly.

love in the time of chlamydia

2005-06-21T15:01:00.000-04:00

Last weekend I went out for tapas and booze with the female residents in my class. We had a lot of fun. Three of us were single, and one was married. Our waiter was a hottie so the married resident (a.k.a FB: Future Breeder) got it in her head to fix A up with him. A is muslim and has every intention of marrying within her own ethnicity and faith, but I guess she has no objection to spending time with a hot waiter. The poor guy must have sensed something was up because he started looking flustered each time he approached our table.

As our friend K became more and more drunk, she began monopolizing the conversation with her single gyno-girl angst. She is upset because she is about to turn 30 (horrors!) with no marriage prospects. To make matters more complicated, she is Korean-American and has her heart set on marrying a Korean boy. Not Chinese, like her last two boyfriends, but Korean. She wants the comfort of being with someone who understands Korean language and culture.

Naturally FB, a Mexican girl married to a very cute and reasonably P.C. white boy, urged K to consider dating outside her race. I had to agree. While interracial dating is not my favorite personal pastime, it made sense for K to broaden her applicant pool. Either that or get her parents involved in helping her hook up with a nice Korean boy.

After we paid the check, three of us left and FB stayed behind to tell the waiter that A liked him. Five minutes later, she came running out of the restaurant, waiving a napkin and shouting "Success!! Success!!" James the hot waiter liked A as well and had written his number on a napkin for her.

A fine example of how the aggression of Ob/Gyn residents can be used for good instead of evil.

sexual healing

2005-06-17T13:34:00.000-04:00

One of the black female interns confided last night that she is severely depressed. Before residency, she was a cheerful, joy filled person. Then she entered this work environment where everything you do is criticized and people smile in your face while they stab you in the back. She has tried to throw herself in to her spiritual practice and she has seen a counselor, to no avail.

Her confessional was interrupted by a booty call: some guy she has known forever who refuses define their relationship (been there, done that, will never go back). He works the night shift at Target. He spends way too much time in her apartment while making no contribution to the rent. She even lets him drive her new car. When I asked her why she is doing this, she responded "my life is shit. Sex is all I have".

Sexual healing. Humph.

If you ask me, SSRIs (anti-depressants) are superior to booty calls. SSRIs will never leave you anxious about the status of your relationship. In fact, they will mellow your ass out for longer than the duration of an afterglow. SSRIs will never raid your refrigerator or ask to drive your car. SSRIs will never tell you that your breasts or butt is too small or that you need to hit the gym. SSRIs will never leave the toilet seat up in your own damn house. SSRIs will never give you a sexually transmitted infection.

However, my troubled intern friend feels there is a greater stigma in taking an antidepressant than allowing some good-for-nothing-but-sex Negro to pimp her ass. Go figure.

2005-06-14T12:36:00.000-04:00

I went to the gynecologist today for the first time in ages. Even though she was professional, sensitive and expert, I still felt somewhat violated when I got off the table. Note to self: learn to be as quick as possible with exams.

I have to schedule a baseline mammogram. Yikes!

Last night on Labor and Delivery, a short, swarthy, middle-aged man with an unidentifiable accent told me I had beautiful eyes. And, he said, he could say this because his wife wasn't around. The reason she wasn't around was because she was in recovery after having his baby! Eeeeooowww....

reunion

2005-06-05T09:35:00.000-04:00

I apologize, dear readers, for taking so long to update this blog. Much has happened but I have not had the energy to document mi vida loca.

I went to my college reunion last weekend and discovered two things: 1) everyone who showed up was successful and 2) everybody was FAT! Aging is a bitch.

It was weird to see people who were alcoholics, drug addicts and sex freaks in college come back our reunion as corporate whores and surburban housewives. It was weirder still to see that some of them had actually become parents. It was tempting to say to someone's 10 year old kid, "did you know that your mommy used to screw anything with legs and a vagina back in college? But of course, that was before she met your daddy."

Equally disturbing were the people who hadn't changed at all. Qualities that were cute and quirky at 17 often lose their charm at 37.

The Nut Whisperer

2005-02-11T10:49:00.000-05:00

The oncologist that I have been working with on my current rotation has a tendency to collect a lot of patients with psych issues. As someone who at one point wanted to be a psychiatrist, I think I have delt quite well with these people. I have a knack for figuring out what they need and giving it to them. 90% of the time they just want to be heard. If they have irrational fears, they don't want to be patted on the head and told not to worry. They want the opportunity to sit with a doctor and tell them how they just know that they are going to die tomorrow from a cancer they never even had. So I give them that opportunity. Once they have voiced their concerns, they are usually more receptive to gentle reassurance. This is what I have been doing for the past 6 weeks.

Yesterday, a 54 year old female pediatrician came to see the gyn oncologist. She had basically referred herself. She has an obsessive fear of ovarian cancer. She has no relatives with ovarian cancer, or cancer of any kind. She had no symptoms, and her Ca-125 (a marker for certain types of ovarian cancer) was normal. All she had was an ultrasound that showed a small, complex ovarian cyst.

Being in the medical field can easily turn you in to a hypochondriac. I think most doctors have had some experience, usually in medical school, of being completely convinced they have some horrible, rare disease. Too much information can be dangerous and burdensome when coupled with an obsessive mind. For example, when I recently felt some loss of sensation on my left toe, my first thought was that I am an undiagnosed diabetic. Then I came to my senses and bought a new pair of looser-fitting work shoes.

I sat and talked with the pediatrician for quite some time. Her husband had died 8 years earlier of a rare and gruesome disease, leaving her with a young son to raise alone. She started taking Prozac after his death. I listened to her vent her darkerst fears. I kept my demeanor serene and pleasant. I doubted that she had ovarian cancer, but I didn't share that. I simply told her that the gyn oncology attending was one of the best in the field, and she could trust his opinion.

After her physical examination, the pediatrician, the attending and I sat in his office to talk. My attending gave his usual speech about ovarian cancer. The pediatrician listened patiently. When her opportunity came to speak, she said with a grave look, "bottom line. I have a 12 year old son. All I ask is that I be alive for the next 10 years to see him into adulthood. That is my only concern."

I found this very touching.

In a private moment, my attending, who has 20 plus years of experience as a gynecologic oncologist, turned to me, a 2nd year resident and said, "So. What should I do?"

My response: "It's unlikely, but not impossible, that she has cancer. But she is not going to sleep at night until her ovaries are out. Take her to the OR."

He booked her for next month.

The oncologist shared with me that the pediatrician told him that I was an excellent resident. I thought this was particularly high praise coming from a fellow doctor.

karma...

2005-01-29T15:35:00.000-05:00

...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

2005-01-13T09:07:00.000-05:00

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

2005-01-12T09:54:00.000-05:00

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.

Tragedies

2004-12-22T18:01:00.000-05:00

Yesterday, I delivered the baby of a 28 year old Puerto Rican woman. When the baby arrived, the nurse exclaimed "it's a girl!" and tears rolled down the patient's cheeks. The nurse asked "those are tears of joy, right?" and the patient nodded yes, but her tears did not look happy. I asked her the gender of her two children at home and she told me she had two girls. She admitted she had been hoping for a boy. She was crying because the new baby was a girl.

She was reluctant to breastfeed after the delivery.

I have never understood how people could be so disappointed with the gender of their baby. I found this scenario tragic. I wondered how this kid would feel if she ever knew that her mother cried with disappointment when she was born.

Then again, you never know what people are going through. Perhaps the father of the baby (who was absent for the delivery) was putting pressure on the patient for a male child. Perhaps he was sexually abusing her other two girls and a third girl would mean more pain. Who knows what was behind those tears.

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A 34 year old woman on our service is dying of cervical cancer. I heard she missed her pap smears for only 6 years. She did have some mildly abnormal paps before but I mean, who knew? Now she is dying. She just told her two kids who are 8 and 10 years old.

During resident sign out when she was discussed, my chief resident said, "Jesus! I hope she doesn't die on our shift. That would really bum me out for the holidays."

I silently vowed to schedule my pap asap.

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I recently found out that one of my contemporaries, a black gay man in Chicago, died from AIDS. His death really shook me up. People are not supposed to die in their mid thirties. It's just wrong, so wrong. I had heard stories about this person engaging in risky sexual behavior in his youth (ex: sex in a Zayre parking lot, forest preserves and in the old IC station--now Metra--on 53rd). He got himself arrested once for indecent exposure during one of these episodes. I don't know. Let he who is without sin cast the first stone. Just about everyone has had some instance of sexual irresponsibility in their lives. I mean, when I think about the behavior I witnessed in college...Hello? AIDS and cervical cancer seem to me to be too steep a price to pay for having sex.

Depressing.

mean girls

2004-12-11T13:52:00.000-05:00

I just saw the movie Mean Girls, and realized I am living it.

Ob/Gyn programs tend to be small, intimate, and gossipy. The women (and men!) in this program have taken gossip to another level. I've even heard people who are friends talk about each other with astounding viciousness. The latest dish: the wife of a male resident is pregnant, and people are speculating that he is not the father. Riduculous, horrible, unfounded, and mean, mean, mean. To make matters worse, this particular resident has suffered a lot of abuse in this program from both residents and attendings primarily because he is different. He is Nigerian, speaks slowly and is sometimes difficult to understand. So despite the fact that he is well read and knowledgable, he is called stupid and slow because no one will take the time to listen to him. They will, however, take the time to talk about him.

Even the nurses and attendings gossip like junior high girls. I had one particularly difficult surgery with an attending, who sat down with me afterward and explained how I could improve my technique. I thought he was sweet until I heard that he had gone around telling the other attendings that I am surgically weak, based on that one case. Fortunately, this rumor has since died after my subsequent surgeries went well. Every time I saw the surprise on an attending's face that I did such a good job in the OR, I felt like spitting in the face of that gossipy attending. The Labor and Delivery nurses gossip as well. They talk about whichever resident is not in the room at the moment and try to draw other residents into the conversation. Dangerous, petty, and mean, mean, mean.

There are residents in the program who prey on your personal information like vultures. They will ask questions about your life outside of the program (the million dollar question always has to do with who you are dating/sexing) then they will practially run to tell someone else. The worst ones will actually swear secrecy ("I won't tell a soul, I promise") before they serve you up. After being pestered about my personal life, I actually made up some juicy info about a fictional boyfriend who was supposedly causing me torment, and told the class gossip, just to see what would happen. Sure enough, despite the fact that I swore her to secrecy, the info floated back to me in a matter of weeks. Hilarious!

Actually, I have the goods on most of my classmates for real. For whatever reason, people tend to pick my shoulder to cry on and my ear to bend about their problems. I have volumes of sensitive information about several people in my class. I keep my mouth shut because 1) it would be wrong to tell, and 2) who cares?

I guess if you spend every waking hour in the hospital, you need some kind of diversion. Some people turn to gossip. I content myself with sleep, long distance telephone conversations, and infrequent social activity as time permits. Not much of a life. I think the stress of residency brings out the bitch in everyone, when it's not making us crack under pressure. A few years ago before I got here, a resident who had an ill-fated affair with a divorced male attending (and naturally everyone knew about it because there are no secrets here) had a "nervous breakdown" and dropped out. At the University of Maryland there was an Ob/Gyn resident who committed suicide by jumping off the roof of the hospital. It's no wonder so many of us are popping Zoloft and Wellbutrin like tic tacs.

cruella deville

2004-11-23T06:34:00.000-05:00

I am really good to my patients. I am sensitive, sympathetic, and spend more time than most listening to them. But recently, for the first time, my well of compassion ran completely dry...

I had a scheduled C-section with a patient who I was warned was crazy. Having encountered difficult patients before, I thought nothing of it. This patient was a drug abusing alcoholic who had showed up on labor and delivery pregnant and drunk several times. Her own brother called DCFS on her ass. Since I once aspired to be a psychiatrist and have a lot sympathy for addicts, I wasn't bothered in the least by this informaiton. That is, until I finally met the patient.

A more annoying individual has never walked the face of the earth.

"A doctor once told me that since I had a C-section with my first baby, my bowels and bladder could be stuck together. Do you think my bowels and bladder are stuck together? Do you? Do you? Do you?" After hounding me with this question, she hounded the anesthesiologist, the nurse, and the medical student, then came back for me.

Now that she was on the brink of having her baby (along with certain DCFS involvement, given her history of substance abuse) she was full of irritatingly vocal remorse. "Oh!" she wailed loudly, "My poor baby. I hope my baby is okay because I love her so much. I love my little baby. Do you think my baby's okay? Do you? Do you? Do you?" She began to sob, sitting on the OR table while the anesthesiologist tried to do her spinal. "Oh!" she wailed. "I just love my little baby so much! So much!"

"Ma'am," said the exasperated anesthesiologist, "you have to try to sit still so that we can place your spinal." Thank God for the medical student, who walked over to the patient and held her hands. "There, there," she said. I leaned against the back wall of the OR and examined my cuticles.

It was the same thing during the procedure. Before we had even cut open her uterus she was sobbing and yelling, "is my baby okay? Why isn't she crying yet?" Since I was weilding the knife I decided to ignore her and focus on the task at hand. My chief resident, bless her heart, did her best to answer the patient's questions.

Contributing to my irritation was the fact that I had a bad cold. The definition of misery is wearing a mask during surgery while snot runs down your face and into your mouth. And you can't do a damn thing about it because your hands have to remain sterile. In my mind I muttered a string of Yosemite Sam expletives: "Yassafrackafrickamaka..."

Rounding on her post-op was a nightmare. She was attention-seeking and would make up problems. Even though I was certain she was full of crap, I couldn't ignore her complaints on the slim chance that she wasn't crying wolf. So my morning rounds were slowed down by orders for lab tests that all came back normal.

I bought myself flowers on the day she was discharged from the hospital.

People are still having sex

2004-11-19T19:35:00.000-05:00

It was inevitable. Lonely, horny, unhappy residents spending all their time in the hospital, no time for a social life...mayhem ensues.

A fellow second year resident, PR, confided that he is having an affair with a nurse. They hit it in a deserted stairwell after hours. Thing is, Nurse Comfort has a husband and two small children at home. PR tells me her marriage is on the rocks, which is not surprising given the fact that she's having sex with residents in stairwells. If girlfriend thinks she's got a golden parachute after she leaves her husband, she's mistaken. PR says that he's just in it for the sex and he's not trying to raise another man's kids.

PR is also having an affair with a chief resident. She's this miserable, desperate, depressed, moody person who pre-PR was always moaning about not having a man. She weighs about 400 lbs. PR makes a big show about telling me and others that he wouldn't touch her with a ten foot pole, but I am convinced he's touched her with something much shorter. Last night at a party, I playfully told PR that he couldn't keep a secret. Big Sybil overheard and said meaningfully, "oh, yes he can. Yes he can." I looked at the two of them, and I suddenly knew, beyond a doubt that they were lovers. Classmates and I had been speculating about the two of them for months. PR acts very casual around Big Sybill. Big Sybill on the other hands acts like a woman who would like to declare her love but can only hint at it. I feel sorry for her. It's humiliating to have sex with someone who won't claim you in public.

PR makes my classmate who sleeps with medical students look like the Pope.

disillusionment

2004-11-13T15:31:00.000-05:00

Where do I even begin?

It's been so long since my last blog, and so many noteworthy things happen to me on a daily basis that it's hard to know where to start in this posting. So I guess I'll start with my wonderful and much needed vacation to Miami last week. I stayed with a fellow resident in South Beach, aka Beautiful People Central, where the women are thin and the men are gay. I spent an entire week reading trashy novels on the beach and loving every minute of it. My friend is also a resident so she couldn't spend much hang time, which was fine. South Beach reminded me of L.A., and like L.A. I found it a pleasant place to visit but I could never think of living there. Too few black folks, not enough sista love and I don' t speak Spanish (yet).

It was a much needed mental break as well. I felt like I was buckling under the pressures of residency. Some days I thought I might actually break. Being in Miami gave me perspective. The politics of this program, the chatter, the gossip, don't amount to a hill of beans in the long run. I am going to finish the program, I am going to be an Ob/Gyn, and I am going to be doing exactly what I chose to do with my life, which is a luxury.

My classmates on the other hand are becoming very disillusioned with Ob. One who recently married told me that she would be perfectly happy not practicing medicine after graduation. This shocked me, because she seemed so passionate about the field when we started residency. I guess after a year and a half of getting the shit kicked out of her she is ready to throw in the towel. Her husband is a pediatrician so she'll probably kick back, push out a couple of rug rats and become a housewife like her mother. A very well educated housewife. She is committed to finishing the program only because she started it.

Another classmate has been whispering in my ear that she is sick and tired of this program. She is a crazy nut who is selfish, domineering and has the kind of bedside manner that will get her sued in practice because her patients dislike her. Like the Housewife, she also says that she does not want to practice Ob when she finishes. Unlike the Housewife, she doesn't have a husband-safety net. However, her parents are wealthy and overly indulgent so I am sure she will be able to find some way to occupy her time after graduation.

There is a lot to be sick and tired about in this program. We just got our holiday vacation schedule this year. We have only 5 days off for the holidays, when we used to have a week. Also, we have been assigned to work 36 hour shifts we get back from vacation. It is illegal to work 36 hours. The chief resident responsible for making the schedule caught me perusing it one day at work. She said to me in a stone-faced, menacing manner, "We are working 36 hour shifts because it was the only way to get adequate coverage. You are not to report that we are doing this. If you report it, we won't get time off for the holidays at all".

A threat. One of the few good things I used to be able to say about this program was that it at least attempted to respect the work hour restrictions.

******************************************************************

The other day, an attending was trying to communicate with a Spanish speaking post-op patient. Her English was limited, his Spanish is nonexistant and there was no translator in sight.

Attending: "Ma'am, no intercourse for 2 weeks"

Patient, confused: "Huh?"

Attending: "Um, no sex for two weeks"

Patient: "Huh?"

Attending: " Um, 'sexo'? With your boyfriend? No relations for two weeks.

Patient: "Huh?"

Attending, going for broke: "Uh.... NO FUCKIN'!"

Patient, smiling broadly: "Si. Okay!"

Doctor Love

2004-10-01T11:06:00.000-04:00

On a lighter note, a hot Emergency Medicine resident is giving me the eye.

I am probably the only woman in America who does not want to date or marry a doctor. First of all, it's hard enough having one doctor in a house, let alone two. Physicians work long hours. Like I mentioned earlier, someone has got to write out the bills and keep things reasonably organized and it ain't me.

Second, lets not forget my ridiculous and painful experiences with Sideshow Bob, the psychiatrist and Doctor Dick, the urologist. The names say it all.

I'd much rather date some Average Joe who is out there doing something not even remotely related to medicine, and who has his ego in check.

Goodbye, Mrs. W

2004-09-27T16:59:00.000-04:00

Did I say that I enjoyed gyn/onc? I spoke too soon.

Mrs. W is a fiesty, strong-willed 68 year old woman who reminded me of my own mother. She had an ovarian mass that we surgically removed. Unfortunately, we didn't help her at all. It turns out that Mrs. W has a metastatic GI cancer that is going to kill her in a few weeks.

I had grown to like Mrs. W during her hospital stay. I will never forget the day she got her prognosis. The gynecologic oncologist, the medical oncologist, the chief resident and I all crowded into a small room with Mrs. W and her daughter. With a flinty stare, Mrs. W asked the doctors to be complely straight with her about what was going on. They were. She seemed to take the news rather well, considering. Her daughter, however, fell to pieces. As my eyes welled up with tears, I fought hard not to follow suit. I was suddenly transported back to my father's losing battle with prostate cancer. At that moment, my professional veneer slipped and I was no longer a doctor. I was a daughter facing the loss of a parent. I hid behind the medical oncologist and stared my tears away.

After rounds I slipped away to my call room and cried like a baby.

The very next day, as if by magic, all five of Mrs. W's daughters appeared in her hospital room. They had come at a moment's notice from all over the country, leaving jobs, husbands and children behind. That morning, the mood in the room was surprisingly light. The daughers were cracking jokes and I could see they had inherited Mrs. W's sense of humor. I did see one daughter's face crumble once when she thought no one was looking, but she made a quick recovery. When I left the room, I noticed that one of the daughters had posted a hand-written note on the door:

"Outside this door we may fall apart. But inside these walls we will be a source of love, encouragement and support."

After that, Mrs. W was never alone for a single moment. Her daughters kept a bedside vigil, even spending the night in her room. They worked shifts. I would see a different daughter every morning and several of them in the afternoon. After my daily physical examination, a daughter would follow me outside of the room and ask questions. Sometimes the daughter would cry and I would struggle not to do the same.

Today, we discharged Mrs. W from the hospital. She wanted to die in her own home.

As strange as it may sound, there was beauty in this experience. As an Ob/Gyn resident I spend most of my time witnessing birth, not death. For me, the joy of delivery is being in the presence of family love as they welcome a new member. The way that Mrs. W's daughters surrounded her with love was as moving as watching new life enter the world. May we all be fortunate enough to die in the same way.

Goodbye, Mrs. W.

gyn/onc

2004-09-19T08:56:00.000-04:00

My current rotation is oncology. I thought I would really hate it, but truth is I love it. It's not nearly as depressing as I thought, and since the patients stay in the hospital for longer than 2 days we get to know them pretty well. They can be difficult and high maintenance at times, but if you had metastatic cancer you would be difficult, too.

One patient is this 68 year old woman with metastatic cancer and no one knows where the primary cancer is. The chemo won't start until they have some idea what they are treating so that they can choose the most effective agents. Until tumor cells are identified, she will just be waiting. She and her daughter are full of questions, and they ask the same questions every day.

Q: "What is the plan now?"
A: Same as yesterday.
Q: "What are we waiting for?"
A: The final pathology, same as yesterday.
Q:"Should we get a second opinion?"
A: If you like, but you might want to wait until there is enough information to give one. You don't have a first opinion yet.
Q: "When will I be able to go home?"
A: I don't know.

And so on.

I really like this patient. She reminds me of my mother. One of the residents on the service is named Watson, and she can't resist saying "Dr. Watson, I presume" when she sees him. My own dear mother would say something corny like that, as will I if I'm lucky enough to live as long.

It's fun dealing with older patients. Until this point, the vast majority of my patients have been reproductive aged women. Older women are cute. They are formal and polite and they love to talk. One of them insists on calling me "Brenda" (not my name) and after correcting her a few times, I stopped trying. It's kind of funny. She even introduced me to her husband as "my friend, Brenda" and I just smiled and shook the man's hand like that was what my mother named me. Hey, she's old and she has cancer. She has enough to think about without trying to remember all the resident's names.

Overall I enjoy the mature patients, but that is not to say there are not a couple of cranky old birds in the bunch. One surgical patient with vulvar carcinoma in situ took one look at me and insisted that residents not be involved in her surgery. My race paranoia flared, and I had a hunch what that request was about. I assured her that the attending doc would be doing her surgery. She then looked me in the eye with hostility and said emphatically, "GOOD!". Naturally the residents ended up doing it anyway. I told the attending doc about her request, and he said that because he was directing the whole thing it was the same as if he did it himself. It was a simple, partial, skinning vulvectomy, something that her husband could have done at home with a knife and a local anesthetic.

sex and the single resident

2004-09-11T11:16:00.000-04:00

I'm convinced that the real reason so many people get married during residency is not because they need companionship...they just need someone at home to write out the bills! I am late with the rent for the 100th time this year. It's not because of my bank account, it's because I can barely find the time to mail the stupid check.

Doctoring is a sexy profession. Booty is everywhere, especially for male residents. Unfortunately (or fortunately), it doesn't always feel this way because of our confinement to the hospital. My male classmates end up sighing wistfully over some cute unattainable intern like Charlie Brown's obsessive crush on the little red haired girl. Or they make lame attempts to hit on the handful of nurses who are under the age of 50 and single. They don't seem to lust after our clinic patients because 1) (hopefully) they realize that it would be highly unethical, 2) many of the clinic patients have multiple social issues, and 3) no one is quite as cute when you know they have chlamydia. One of my classmates confided that he cheated on his long term/long distance girlfriend with *gasp* a medical student, which is super inappropriate. But perhaps if more residents slept with the med students we would get fewer complaints from students about OB residents being so bitchy. Just kidding. Sort of.

The female residents who are not married are also quite vocal about their lonliness. More than a few have signed onto dating services on the internet. As a group they can be anal retentive which of course prompts my male classmates to speculate about how much more pleasant they might be if they were getting some. Sexist, but occasionally amusing depending on how much I like/dislike their target du jour.

I signed onto one of those dating sites a few months ago and met Jeff, a nutty pseudo-Rastafarian. He was reasonably intelligent, but a tad bit off the deep end on the afrocentric tip. We had a few dates then parted ways amicably. I abandoned that online stuff because even that took too much effort, and most dudes online seemed to have a hard time expressing themselves in writing. All I can say is "RIF": Reading Is Fundamental. From what I've seen that campaign needs to make a comeback.

I've been getting random collect calls on my voicemail from a local prison. Maybe it's a wrong number. Maybe the guy just likes my voice. The calls sound like this:

Recording: "You have a collect call from..."
brotha's voice: "Mookie" (more urgent) MOOKIE!!!!"

My future husband, perhaps. I wonder if Mookie can pay his bills on time.

2004-09-09T22:43:00.000-04:00

I had a good day today. I didn't screw up in the OR, my cases went well and my upper level residents behaved themselves.

diversity

2004-09-09T09:07:00.000-04:00

Last night the residents gathered for a retreat. An intern brought up the issue of the horrible attitudes some residents have toward our clinic population. No one really heard her comment. The chiefs immediately got defensive and nothing was accomplished. However, I'm really glad she voiced an observation that has been made by many, including myself. The truth is, the residents talk about our clinic patients as though they were something less than human at times. It's true that some of our patients can be challenging to deal with because of their social issues, but there is really no excuse for the racist and elitist culture that permeates this program. I have never been in an environment where such hateful, disrespectful speech is tolerated.

a night to remember

2004-08-30T13:50:00.000-04:00

This morning I dragged myself into work, dead tired from working an 18 hour shift on Sunday. Usually Sunday call is only from 6 am to 4 pm, but I worked 6 to midnight on labor and delivery (a busy, non-stop service) to cover D, one of my fellow residents, while he went to his sister's wedding. He came in at midnight to finish his shift, which ends at 8 am. I got up this morning at 5 am to round on my patients and work a full day as usual.

When I came in today an intern who I like and trust informed me that I was being bad-mouthed by a chief resident for helping my classmate. According to that chief, I should have worked 36 hours straight instead of going home at midnight when my classmate came back to finish his shift. She thought it was a bad idea to split the shift between two people. Something about continuity of care.

Never mind that 1) the idea to split the shift was D's and was approved by his chief resident on the service; 2) when D approached another classmate to help him that person flat out refused so I was his last hope, 3) with the new residecy work hour regulations a 36 hour shift is illegal, and 4) if I hadn't been kind enough to give up my freedom on a Sunday evening D would have been watching his sister's wedding on video. But somehow, in the twisted minds that I work with, my generous gesture is evidence of my laziness and lack of dedication.

All I can say is that it's a good thing I know Jesus.

****************************************************************

Last night, during my shift from hell, a Jamaican couple came in for delivery. The woman was 40 years old but had refused genetic testing for fetal anomalies. She did agree to an ultrasound during the pregnancy which suggested the baby had down syndrome. The couple refused further testing. The patient's husband, mother and sister were all gathered to welcome the newest family member. Their demeanor was pleasant and serene.

I was called into the room when the birth was imminent. As I was gowning myself, I was startled by the hands of the baby's grandmother tying my surgical gown at my back. I thanked her and she smiled at me. As the nurses rushed about the room to prepare for delivery, the words "downs", "meconium" and "pediatrician" swirled about, but the family seemed completely unfazed. The woman gave birth to an adorable baby girl with apgars of 9 and 9, a normal nasal bone (which was supposedly absent on ultrasound) and no obvious signs of downs. After examining her the pediatricians declared that she would be going to the regular newborn nursery (as opposed to special care) but would need further testing.

All the while, the family quietly celebrated. The father was beaming. The aunt dabbed tears from her eyes. They politely thanked everyone for their help.

When we left the room the nurse whirled on me in disgust. "What just happened in there? Don't they know that baby has downs? Why are we supporting their denial?"

The Indian Ob/Gyn attending turned to me and said, "well, the baby may or may not have downs, but now we know why it looked like the nasal bone was absent on ultrasound. Did you see the father's nose? He looks like a chimpanzee! When you look at him you can see how we evolved from apes!"

And while the doctor and nurses gossiped and speculated about what they had witnessed, a father, mother, aunt and grandmother who didn't give a damn about any of them celebrated the birth of a baby girl. Their love had made doctors, nurses, triple screens, amniocentesis and even the possibility of down syndrome completely irrelevant.

The beauty in those moments is what helps me to endure.