Sometimes it’s hard

Cross-posted on Dose of Reality

I’m in the midst of my emergency medicine rotation right now - my last real clinical rotation of medical school. I didn’t save it until the end intentionally, and I was a little worried about how burned out I’d be during a rotation that included night shifts and an unpredictable schedule. This turns out to have been justified. Now that I’m safely on the other side of a cluster of 3PM-midnight and 11PM-7AM shifts, I am feeling better, but the last few weeks have been really rough. The biggest challenge, however, has not been the schedule. The disaster that is my sleep schedule pales in comparison, as the most difficult aspect of this rotation has been the intimate partner violence. Little has made me feel more powerless than the women* who have been bruised and beaten by their partners. They come in to the emergency room because of pain that won’t go away, because of unborn babies that have them worried, and because of risks for disease they can’t ignore. They leave with medical assessment, reassurance, and treatment for these things, but to be honest, I’m not sure whether they really get what they need. I say I’m not sure, because I’m embarrassed that I’ve not taken the time to find out whether a social worker sees them, or whether they are given references for shelters or other resources. I’ve been too overwhelmed by assessments of the pain, ultrasounds of the babies, screening for disease risks, and, most of all, the management of my own emotions, to get much past the emergency care they ask for explicitly.

We talk about intimate partner violence during the pre-clinical years. We talk about the statistics, how many people are harmed by those closest to them in a given year, and we talk about the shelters and resources available locally. I seem to remember a panel discussion featuring survivors of intimate partner violence, and maybe a few healthcare providers who were some sort of experts in this area. We learn that we should ask every patient whether they feel safe at home. And I think most of us do it. I know I tried to include that as a part of the social histories I took during M3 year. And I don’t think a single patient told me “no” in response to that question all year. I’m certain some of them were lying, definitely to me, and maybe to themselves, but I nonetheless really didn’t confront this kind of violence directly. I do recall patients I saw in clinic who discussed their past or present violent situations either with me or with a previous provider who had documented it, but it was hard to connect the women I was seeing in clinic with what I knew to be going on at home.

The ER is different, and so much of what we see there has just happened and is written all over the faces of the patients who present there. I get the sense that for people who love emergency medicine, this is a big part of why. There is a rawness to the undifferentiated nature of many of the complaints in the ER that can be exciting; there is an adrenaline rush that goes with being the systematic hero, even when the heroic measures aren’t enough. But what do you do when the raw edges were supposed to be soft? And when there are no heroic measures? I’m not sure, and I’m still reeling a bit from having something revealed about the world that I’d really rather not know. What do you do when sometimes it’s hard?


*I know that men can also be victims of intimate partner violence, but the patients I’ve seen have all been women.

Waiting

Cross-posted on Dose of Reality

Today is the deadline for certifying rank lists. This blog is no stranger to talk of rank lists and matching, and I’m about ready for it to end. I talked about my list starting to emerge here, and if you need a refresher on how the whole match process works, check here. If you care to, you can also take a look back at my post about when my original med school class matched and graduated, not-so-optimistically titled “Moving on when everyone else is moving out.” I certified my rank list a couple of weeks ago, sitting with a coffee shop with Michelle, another fabulous MSTP, who helped me proof my list to make sure I wasn't accidentally ranking a program where I didn't interview, etc. A few of the highlights of this waiting game:

• I reviewed my list again today to make sure it was right. The application program (ERAS) and the ranking program (NRMP) don’t use the same program codes – that would be too easy – so I double checked and cross-referenced the codes when I made my list, and checked them for a third time today. I live in fear that I've accidentally left my favorite program off the list.
• Somehow this deadline is only the beginning of the waiting. Even though I feel like I've been waiting since December 14, when I finished my interviews, it will take the matching algorithm almost another month to grind through my list, and those of all of the other wishful applicants, and assign me a spot. March 15 feels so far away.
• I’m fairly certain that no matter where on my list of twelve I match, I will be happy and get great training. I think I’ll be taking the advice of one sage AMSA friend, and in the twelve days leading up to Match Day I’ll go in alphabetical order through my programs and share with you all of the things I love about each of them. We’ll call it the Twelve Days of Matchmas. I haven’t decided whether I want a partridge or not.

Melon Salad

Lynn and I went to Isalita for the first time right before she left. It was amazing, and I can’t wait to go back. We had a wonderful server, and the food was absolutely fantastic. One of the many delicious things I ate there was a melon salad that I tried to reproduce at home, with some moderate success.

Melon Salad   

Cantaloupe (the restaurant used a mix, but I didn’t have that)
Lime juice
Sunflower seeds (would have been better with the pepitas they used)
Cayenne pepper
Salt

Cut up as much cantaloupe (or other melons) as you like. I made one serving at a time to avoid spoilage. Sprinkle the sunflower seeds or pepitas, drizzle the lime juice, and dust the cayenne over it. Sprinkle it with a little salt and enjoy.

On the theme of orange foods, my brother felt that I should have something "aged" for my birthday this year (thanks a bunch, Jake). My gift included some delicious cheeses. Yum!

The babies...

To start off my return to the blog, here is a picture of Alex, attempting to stow away in Lynn's suitcase. (Little did he know that he would be safely in his kitty carrier on the plane!)

Also one of Walter, attempting to stow away in... well... nothing, really. Just in a blanket, as per  usual.

Just haven’t felt like sharing…

I apologize for the rather substantial gap in blog posting that’s happened over the past month. If you’d asked me a month ago whether I had anything to post about, I probably would have said yes, but now I feel like I’m just waiting for things to happen. Things I am waiting for:

1. Match Day – March 15
2. Lynn Returns – April 8
3. Graduation – May 17

Otherwise, I feel a bit like I’m treading water. Also, I turned 30, which I have mixed feelings about. Despite this, I continue to cook and knit, and learn things about clinical medicine, so stay tuned for more posts coming up soon…