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…

And the winner is…

I’d somehow anticipated posting more in between the initial giveaway post and announcing the winner, but that didn’t happen… I’m happy to announce that Tanya, my awesome friend, will be the happy recipient of the hooded scarf. I’ll be dropping it in the mail to her this week. Even better, the charity she chose, The Moveable Feast, will be receiving a lovely donation that will help them continue to provide meals to people who are sick and need their support. Thanks Tanya!

A giveaway… of knitwear…

With the particularly terrible turn in the weather this morning, I was forced to consider my options for cold weather gear. I dug through the giant tub of things in my closet, searching for the one item I actually wanted. I’ve been wondering for a while about the best way to cull the herd, if you will, and move along some handknits to make room for the new. Looking at them again this morning, I realized that it had grown fairly urgent. Pre-dating my concern that my collection of hats and scarves and mittens (and gloves and cowls and leg warmers) had reached a critical mass was a blog posting by Stephanie Pearl-McPhee in which she raised some money for a charity by posting knitted items and having folks bid. They let her know how much they'd give to a charity in exchange for the knitted item. I’d like to do the same, giving back by giving hand-knitted goods.

I present to you the hooded scarf. It was a great idea, and I loved it for a few weeks after I made it, but I’ve found that I much prefer the hat and cowl that I made out of the same yarn (they all match my mittens). It's an alpaca and wool blend, and a very dark teal color.

If you, or someone you know, would like to sport this for the rest of our terrifying winter, and beyond, please fill out the form below in the next few days. If you submit the winning bid, I’ll let you know. At that point you can send me the receipt from the charity you've donated to, and I'll get the scarf to you.

The end of break

Amazing voicemails…

For the past several years, every time I’ve listened to my voicemail I’ve also resaved several messages that I just couldn’t bear to delete. Several of them feature one of my best friends singing customized songs for and about me. Many of them feature my hilarious mother. And none of them should ever disappear. When I got a new phone in the fall, I was initially worried that I would lose my precious voicemails. Once I realized that they were tied to my phone number, and not my phone, however, I could rest assured that they were safe. At least for now. I would occasionally worry that I’d push the wrong button and then hang up, losing my message forever, and wonder why there wasn’t a way to transfer these gems to a more permanent home. Apparently Google Voice offers better ways to manage your voicemails, but regular old cell service does not offer a particularly smooth or easy way to transfer voicemails to mp3 files or some format that another program can read. I finally found this page, which explains how to record your voicemails with reasonably high quality into mp3 or other audio format files, and did it this morning.

For your listening pleasure, I present this little treasure, recorded immediately following my mom's dissertation defense in 2010...

Chocolates, again!

Now that all of them have been shipped out, I wanted to share another fun holiday recipe. Last year, motivated by something I’d heard on The Splendid Table, I decided to make chocolate bark for some friends and family. This year I did it again. The recipe is included in last year’s post, and on the Splendid Table website. Last year’s flavors: Mexican hot chocolate, candy cane, fleur de sel, and gingerbread. This year I repeated the candy cane, gingerbread, and fleur de sel, but added cinnamon and ginger brown sugar flavors. They were all pretty delicious.

Enjoy!

The chocolate comes in giant bricks...

Then it is transformed into giant sheets!

 I stored each of the different kinds in a bag in the refrigerator.

And then I packaged them in little baggies in little boxes. 

 Martha Stewart, you have my number...

 

The knitting of 2012

2.16 miles of yarn =

3 cowls

3 pair of mittens

2 hats

2 scarves

1 afghan

2 pair of baby booties

2 baby sweaters

2 hot water bottle covers

2 candle sweaters

2 bangles

1 pair of fingerless gloves

The 2.16 miles of yarn is equivalent to 137,100 inches. Employing a now tried and true calculation, that’s about as many stitches, which would take approximately 685,500 seconds of knitting, or just over 190 hours of knitting this year. As with last year, most of my knitting was concentrated during breaks, during points of heightened travel (read: interviews), and around the holidays. Goals for next year include not trying to knit so many gifts that it becomes a chore and taking advantage of idle minutes with small projects!

And the CSA makes one more appearance, from the freezer…

So when I posted previously that the summer CSA was finally complete, I’d forgotten about one small remaining item. The corn. Toward the end of the summer I was getting lots of corn on the cob, and just couldn’t keep up with eating all of it. So I would boil it, cut it off the cob, and throw it in the freezer. When I finally took stock of what was in there, I realized that I had about 12 cups of frozen corn languishing in there, taking up valuable real estate as my winter-time, frozen CSA was about to begin. Someone brilliant (Lynn, for the record), sent me this recipe, and it was a wild, wild success. I doubled the recipe, in order to use a full 10 cups of frozen corn, leaving only a little bit still in my freezer. The soup was delicious, and the salsa/garnish was not only fantastic on the soup, but was also great with tortilla chips once I realized that I had more than I really needed for the soup. All of it was made with frozen corn, and was just summery enough to make me almost forget that it's really gross outside, and warm enough to keep me cozy when I had to brave the weather. Enjoy!

The giant vat of soup. I recommend an immersion blender!

The garnish. I think the only modification I made was adding avocado to taste (meaning as much as possible) rather than limiting myself to the recommended amount in the recipe.

Burn out

Cross-posted on Dose of Reality:

Between October 4 and December 14 I did fourteen residency interviews, although most of them were concentrated between October 27 and December 14, so all told I did an average of two interviews a week for seven weeks. I was home for 17 days during that period, spread out over the interview season.

Things that were wonderful about the interview trail:

• Catching up with friends in distant cities
• Enjoying cuisines that aren’t available in Ann Arbor
• Meeting so many delightful future colleagues/potential co-residents

Things that were terrible about the interview trail:

• Sleeping on floors, air mattresses, couches, and guest beds; thank you to everyone who hosted me, but the cumulative effect was rough
• Air travel
• Leaving Walter with every friend and relative I have in the greater Ann Arbor/Detroit area

I’m glad I did it, but I’m really glad I’m done. Now the excitement of making a rank list and holding my breath until March 15 when I find out where I’ll be heading for the next four years. Stay tuned!

Thanksgiving

This year, Thanksgiving was not only a time to reflect on how wonderful it is to spend time with my friends and family, but also a respite from the ridiculous interview season that has consumed most of October, November, and December. I had almost a full week at home over the holiday, and I made the most of it. This was the most delicious part of that week:

 To accommodate everyone, there are little sugar free and gluten-free versions of the pumpkin pie baking on the bottom rack. 

Yum!

Peach Cranberry Pie
adapted liberally from Mark Bittman’s How to Cook Everything

Two batches of pie crust
16 oz frozen peaches, thawed and drained
6-8 oz frozen cranberries, thawed, drained, and sliced lengthwise
3/4 cup sugar
1 tablespoon lemon juice
1/4 teaspoon ground cinnamon
1/8 teaspoon ground nutmeg
1 1/2 tablespoons cornstarch
Little bit of milk

Preheat the oven to 425F. Prebake the bottom crust (using a little more than half of your crust dough) for about 10 minutes with foil and pie weights (or dried beans, which is what I use) over it, and for another five minutes with the foil removed, or until it is very slightly brown. While this cools, mix the lemon juice with the peaches and cranberries. Increase the heat of the oven to 450F. Mix together the dry ingredients for the filling and toss the peaches and cranberries with this as well. Roll out the remaining pie dough, and cut it into strips a little less than an inch wide. Once the bottom crust is cool, pile the fruit filling into it. Lay four-five strips of crust across the top of the pie, and attach them to the bottom crust on one side. Starting at one side and working across the pie, weave the perpendicular strips across the pie, over and under the other strips. When it is all woven, press the edges of the strips into the bottom crust. It should look roughly like this when you’re done.

Brush the top crust with a little milk and sugar, and bake for 10 minutes at 450F. Reduce the heat to 350F and back for another 40-50 minutes, until the pie is golden. Let cool and serve warm or at room temperature.

In addition to eating, we also went to the parade, joined by Ash’s mom Cindy. The weather behaved so well that it was an ideal first parade year for her!

The Detroit Mounted Police

The clown fire brigade

Grover visits Detroit

Emergence of a rank list?

Cross-posted on Dose of Reality

At the beginning of the interview process, I had some sense of which programs would be at the top of my rank list*. I also had some ideas about which would be at the bottom. I'd set up a list for myself of programs likely to be in the top 5-6, and programs likely to be in the bottom 5-6, but the middle of the list was a bit of a mystery. Now that I'm through nine of my fifteen interviews, I'm getting a better sense of what I'm looking for in a program, although it's still difficult to make concrete pre-interview predictions. Some things I have learned:

• As promised by all of the residents and faculty I've talked to, interacting with current residents is really important. Not only do they have a completely unique, insider perspective on the programs, but their personalities and preferences seem to be the best indicators available of what kinds of applicants match at particular programs, and what sorts of people do well there.
• I'm really glad I'm not couples matching. Applicants who have a significant other (or anyone they want to match with, really, as there is no requirement that you be in any particular kind of relationship) who is also applying to residency this year can choose to link their match lists with that person's. The match algorithm then processes the two lists together so that if Applicant A only wanted to be at Program X if Applicant B were at Program Y, and Program Y isn't an option for that applicant, then the algorithm moves on and looks for a better match. This means that although OB/GYN isn't the most competitive specialty, those applicants who are couples matching with someone in a crazily competitive specialty have to apply and interview to many more programs. The travel is already wearing on me, and I can't imagine having to do more than I already am.
• The fit and feel of a program are much more obvious after an interview day than I'd expected. I know it sounds dubious, but you really can get a good sense of a program after an informal mixer/dinner with the residents and then an interview day. There are, I'm sure, lots of things that can't come out in that amount of time, or that are intentionally hidden away during interview days, but the personality of a program really does come out quite clearly in that brief interaction. 

I've definitely not finalized my list at this point, as there are still lots of interviews to come, but it's exciting to feel like I'm getting closer.



*For those of you confused about what a "rank list" is, I refer you to a post from May that describes a bit of the match process.

Catch up

Somehow it's been ten days since I last posted. I was home for a week over Thanksgiving, and thoroughly enjoyed the break from the travel. I'm back on the road again, and wanted to share some highlights from my interlude visiting Ruti in DC!

 She lives very, very near to the White House, and I realized that I'd never seen the front side of it. Here it is, in all it's glory!

 We tried a delicious soft-serve spot that starts with bars of frozen yogurt and actual fruits (or pumpkin, in my case) and then blends them into delicious soft-serve. I got the pumpkin spice flavor with chocolate ice cream - a perennial favorite for me, but new to the astonished gentleman behind the counter. It was amazing.

I went to the Renwick Gallery, the Smithsonian Museum of American Craft, and saw some of their permanent collection as well the 40 under 40 exhibit, which featured 40 works that had been created since the opening of the gallery 40 years ago. 

There were no pictures allowed in the special exhibition, but upstairs in the permanent collection I was particularly taken with this "Bureau of Beaurocracy."

On my way to the museum I stopped at the food trucks (below) just a block or so from Ruti's house. I did not get the most exotic tacos, but they were delicious (above).

We also went to an aerial yoga class, but mercifully there were no photos of that experience. Unlike the class we did last year, it was not explicitly directed toward producing impressive photos. Instead, it was focused on destroying one's triceps, and it did an admirable job of that. Thanks Ruti, for an amazing visit!!!

"I have always depended on the kindness of strangers"

Cross-posted on Dose of Reality

While I'm optimistic that the end of my interview trail will not parallel the end of Blanche from Streetcar Named Desire, I nonetheless feel that, at least right now, I am wholly dependent on the kindness of friends, family, and even some strangers. I'm writing this post from dearest Ruti's living room, having stayed with my sister last night and a gracious UM alum the night before*. In Boston I stayed with a med school classmate, and an old friend in Seattle. I've got friends lined up for many of the rest of my interviews as well, and I feel incredibly grateful at their willingness to pull out their air mattresses, unfold their couches, and make up their guest rooms for me. I'll be working to balance my karmic withdrawals by hosting some applicants interviewing at UM back in Ann Arbor. I can't say thank-you enough to all of these folks who have made the first half of the interview trail that much more hospitable. Don't hesitate to call if you find yourselves in Ann Arbor. Thanks!

*The Office of Alumni Relations runs an impressive hosting program that connects interviewing fourth years with UMMS alumni across the country. I've only used it once so far, but was thrilled with it. Yay for having a gigantic alumni network!

End of the CSA

My CSA this year caused more anxiety than last year. I think I was working so much last year that I got into the habit of cooking massive amounts of food on my limited days off, and eating salads at every possible juncture. This year felt much less organized, with rotations that were really radically different each month, and somewhat unpredictable. I wasn’t nearly as diligent about cooking regularly, and so I frequently had panicky moments until I figured out what to do with the massive lot of greens in my fridge. When I finally had some time at home a few weeks ago, I cleaned up my refrigerator and finally used the last of the CSA. (I will note that since it's very, very fresh when it comes to me, it's actually just fine to sit in the fridge for a week or two. Not ideal, but fine.) Some of it, okay, truthfully, massive volumes of it, became sautéed greens with a fried egg on top. But another large portion became this:

Eggplant + final tomatoes of summer + chick peas = delicious

There’s not much "recipe" to share, as I just roasted the eggplant in the oven and then warmed it on the burner with the tomatoes and chickpeas. I seasoned it with zahtar, which is a mixture of sesame seeds, coriander, sumac, thyme, cumin, and black pepper. The sumac adds a citrusy deliciousness to the whole thing, and I highly recommend it!

Time I got up to get to the airport in Boston: 3:15AM

Number of empty rows on each leg of my flight to Seattle: 10+

Number of screaming children traveling with me from Philadelphia to Seattle: 1

Cost of earplugs that I try to keep in my carry-on: $0.50

Value of laying down across three seats and sleeping for another four hours: Priceless

I have now forgiven US Airways for any past injustices, as I was on two very empty flights this morning, and I got to sleep for almost the entire flight from Boston to Philly, and then another few hours en route to Seattle. It was so incredibly nice to sleep a bit more since I needed to catch up after Boston evenings filled with a pre-interview mixer and a fabulous dinner with the most amazing out-of-town friends a girl could want, and mornings filled with interviews (starting at 6:45AM!) and flights (departing at 3:50AM!). My gracious host (a friend from med school) couldn’t have been kinder, but I didn’t spend nearly enough time in the bed she provided!

More voting!

That’s right folks, vote early, and vote often…

I wanted to share a few more links for those of  you looking for more information about local elections than I’d provided here. I did a lot of my own research during the primaries, and so didn’t have to do as much this time around, but here are a few organizations/news items that helped me out.

If you’re voting in person, print out a sample ballot to make notes to take with you! You’re allowed to take whatever notes you like into the polls with you, as long as they don’t look suspiciously like campaign materials – leave the buttons and yard signs in your car.

American Federation of Teachers (AFT) Michigan endorsements

AFT Michigan includes a link to local AFL-CIO endorsements

Ann Arbor News article about the school board candidates

Ann Arbor News article about the library bond proposal

Ann Arbor Journal article about the library board candidates

Have fun with your absentee ballot, or making notes to take with you in person on Tuesday, and remember to vote all the way to the end of your ballot!