On my way to study at the library, I stopped off at one of the local parks. The colors have been so beautiful, I couldn’t resist getting out my camera. Wisconsin, you’re going to break my heart when I leave.

(Taken through my sunglasses. I love the effect, but am irritated by the smudge at the bottom. Argh!)

All pictures can be seen here.

Corn maze outside of Waukesha, WI. It has truly been one of the most glorious autumns ever here. Warm weather, blue skies, vibrant colors.
All pictures can be found here.

I don’t know what all the fuss is about. You say it’s my birthday?
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My dinner tonight:
Roasted Vegetable Minestrone Soup with parmesan cheese
Pumpernickel toast
Milk
Oh my yumminess.

My study area at the public library. I haven’t studied at a library since med school. I was a little more productive there, though. Restudied the pituitary disorders and focused on the thyroid and my post-test scores were better. I need to complete all of endocrine tomorrow and make some headway through renal and pulmonary before my test on Tuesday. It’s times like this, when I realize how slow going this is, that I start really panicking about boards in a year (10 months). Right now, I’m able to put in 3-8 hours a day studying and I’m still making it only through 20 pages at a time. I’ve got 11 books to cover which average 80-100 pages each. When I take boards next year, I’ll be a fellow and won’t have the luxury of time off. Frightening. Here’s hoping for some retention.

Yes, I missed yesterday.

I’m supposed to be on vacation this week. My dad was going to come out, we were going to install new windows in my basement and paint the joints with sealant to help prevent some of the perpetual water problems. He called me from Nebraska to tell me that his Jeep had completely died. So much for the trip. Things happen and we’ve rescheduled the trip for later this month.

In any case, I have my internal medicine in-training exam (a mimic of the big boards that I’ll be taking in less than a year). I’ve never done very well on them, mostly because I’ve never gotten a chance to really study hard before taking them. So I’m trying to be good and study, but am failing miserably. Today I made it through 20 pages of endocrine – but I needed to get through at least double that. And when I took the “post-test”, I missed a lot of questions, so I have to go back and review hypopituitarism again.

I keep getting distracted by this picture:

Mt nephew turned one last week. I, of course, missed his birthday party,  but my sister finally updated her blog with pics of the festivities and the birthday boy. Footed pajamas kill me dead (must remember that for Christmas).

Oct. 5 Pic:

I love that its October and I still have raspberries!

Found during a midday walk. One has to wonder why the need for a tea party for a porcelain cat, but you have to admit, it’s a rather pretty setting.

It was general conference this weekend and for once, I had the whole weekend off. My bishop (equivalent of a priest or pastor) invites the ward (congregation/parish) to his house on Sunday morning for breakfast and lunch, in between the 2-2 hour blocks of talks. It’s one of my favorite traditions. His house is about 30 miles away from Milwaukee, in tree blanketed hills, so this time of year is just absolutely gorgeous. After the first block, we ate lunch and took a walk around the hills. For the first time in months, I could hear birds and squirrels and nothing else. I miss silence, sometimes.

All of the rest of the pictures can be found here on my facebook. I think you should be able to see it without being my friend or signing into fb.

Mt. Olympus hamburger: artichoke and spinach dip, feta cheese and a garlic mayo. Incredibly yum.

It’s October (how can it be October already??). I’m trying to resurrect this journal. I’ve had too many thoughts and emotions that have crowded my head that I have not been able to get down on paper; they fade in significance once words are applied. So I haven’t written. Maybe sometime soon I’ll be able to get them down. But for now, posting a photo a day seems like a good start into blogging again.

I just got home from a birthday dinner/movie, and I’m exhausted, so I’ll have to wait to upload the pics from night, but here’s some recent pictures from a very short visit to San Francisco. I went for a neurology conference; I’m not sure that the combined cost of the registration, air fare, hotel, transportation was really worth it for 3 days, but I did get to spend some time with my new boss, which was excellent. She’s as fabulous as I remember and we really connected. I also got fingerprinted for the FBI and the DOJ, so that the state of California will sometime in the next year grant me a license. All in all, it was a fulfilling trip.

I didn’t get a lot of time to see the city: I flew in Wednesday night, was in lectures most of Thursday and Friday, and then left Saturday morning. I had really wanted to explore the city, find neighborhoods where I wanted to live, but I guess that’ll have to wait for another visit. I did sneak away to go to a baseball game. The SF Giants were playing the Brewers; one of my friends had bought tickets and was not able to go. As I have not seen the Brewers play this year, I jumped at the chance. I couldn’t find anybody to go with me, and I was thoroughly annoyed with most of my colleagues by that point (I was annoyed with them before the trip, but that’s another story), so I went by myself: navigating the bus and subway system and sitting alone in a midst of orange, cheering for the team in blue. Brewers won, 3-1. I do like the stadium; I can see myself adopting the Giants for a few years.

I woke early the next day. My motel was just on the edge of Union Square, so I rode one of the streetcars to Fisherman’s Wharf and wandered around for a little while, before coming back for the long journey home.

I have 37 blog “drafts” that I have started and not finished over the last several months. I’ve been a really bad blogger. Since I was grumbling to my mom tonight that my sister does not post nearly often enough to her blog with pictures and stories about my darling nephew, I realized that I needed to recognize my kettle-blackness. Of course, my life doesn’t change nearly as much as my nephew’s who has gone from creeping to crawling in a matter of minutes, but still.

Gratuitous piccy of nephew:

His first steps! His red hair!

Of course, just when I think about crawling back to blogging, LJ (Livejournal)’s overlords start making bizarre decisions again that make Facebook’s privacy woes look like frolicking in dandelions. Oh LJ. I’m not sure I entirely understand the situation about the Facebook/Twitter crossposting and how exactly it works and really, why you would want to share comments. I already cross-post to LJ from my primary blog, which I’ve done for a year now because I had planned on moving it over to my private site and then friends-locking LJ (still will, eventually). I keep my blogs completely separate from Facebook. My privacy settings on Facebook are iron-clad: only friends can see personal information and even that is kept from groups that I don’t want to follow me. My boss friended me on FB a couple of weeks ago; you can bet that I made sure that he could not follow me here as this is a venue where I can express frustations in a HIPAA compliant manner. My blogs are not linked to my FB and they never will be. Consider your comments/posts safe.

If you are at first lonely, be patient. If you’ve not been alone much, or if when you were, you weren’t okay with it, then just wait. You’ll find it’s fine to be alone once you’re embracing it.
We could start with the acceptable places, the bathroom, the coffee shop, the library. Where you can stall and read the paper, where you can get your caffeine fix and sit and stay there. Where you can browse the stacks and smell the books. You’re not supposed to talk much anyway so it’s safe there.
There’s also the gym. If you’re shy you could hang out with yourself in mirrors, you could put headphones in .
And there’s public transportation, because we all gotta go places.
And there’s prayer and meditation. No one will think less if you’re hanging with your breath seeking peace and salvation.
Start simple. Things you may have previously avoided based on your avoid being alone principals.
The lunch counter. Where you will be surrounded by chow-downers. Employees who only have an hour and their spouses work across town and so they — like you — will be alone.
Resist the urge to hang out with your cell phone.
When you are comfortable with eat lunch and run, take yourself out for dinner. A restaurant with linen and silverware. You’re no less intriguing a person when you’re eating solo dessert to cleaning the whipped cream from the dish with your finger. In fact some people at full tables will wish they were where you were.
Go to the movies. Where it is dark and soothing. Alone in your seat amidst a fleeting community.
And then, take yourself out dancing to a club where no one knows you. Stand on the outside of the floor till the lights convince you more and more and the music shows you. Dance like no one’s watching…because, they’re probably not. And, if they are, assume it is with best of human intentions. The way bodies move genuinely to beats is, after all, gorgeous and affecting. Dance until you’re sweating, and beads of perspiration remind you of life’s best things, down your back like a brook of blessings.
Go to the woods alone, and the trees and squirrels will watch for you.
Go to an unfamiliar city, roam the streets, there’s always statues to talk to and benches made for sitting give strangers a shared existence if only for a minute and these moments can be so uplifting and the conversations you get in by sitting alone on benches might’ve never happened had you not been there by yourself
Society is afraid of alonedom, like lonely hearts are wasting away in basements, like people must have problems if, after a while, nobody is dating them. but lonely is a freedom that breaths easy and weightless and lonely is healing if you make it.
You could stand, swathed by groups and mobs or hold hands with your partner, look both further and farther for the endless quest for company. But no one’s in your head and by the time you translate your thoughts, some essence of them may be lost or perhaps it is just kept.
Perhaps in the interest of loving oneself, perhaps all those sappy slogans from preschool over to high school’s groaning were tokens for holding the lonely at bay. Cuz if you’re happy in your head than solitude is blessed and alone is okay.
It’s okay if no one believes like you. All experience is unique, no one has the same synapses, can’t think like you, for this be relieved, keeps things interesting, life’s magic things in reach.
And it doesn’t mean you’re not connected, that community’s not present, just take the perspective you get from being one person in one head and feel the effects of it. Take silence and respect it. if you have an art that needs a practice, stop neglecting it. if your family doesn’t get you, or religious sect is not meant for you, don’t obsess about it.
You could be in an instant surrounded if you needed it.
If your heart is bleeding make the best of it.
There is heat in freezing, be a testament.

How I spent my Saturday night (it took me two days to figure out how to download it off Facebook):

I’ve never seen a video of me dancing, and I’m glad to see that I don’t look nearly as clunky as I feel. I ain’t never going to make it to SYTYCD, but my moves aren’t half bad. 🙂

Ya’ll, I have missed this. Learning new dance steps, remembering old (it’s been a long, long time since I did the Lindy Hop, most only know the basic east coast swing; I kept switching back into the 6 count rhythm). A partner with a firm grip who knows how to lead. It brought back floods of memories of dancing in the smelly, hot and humid Navy Science building on Thursday evenings or the MAC on Saturday nights. My foot still remembers the feeling of hitting a nose during an unexpected flip (never again). I lust again for a comfortable pair of saddle shoes, brown and creamy white and a frilly, satiny red dress.

My partner invited me dancing on Saturday, as I will be visiting bjorks_defender for the weekend and he lives there and there’s a swing club. With a live band. So tempted. Soooo tempted.

So I have basement problems. Water coming into my basement problems.

I’ve known about this since 2008, when I first had water coming in through the windows, and then the floor drain stopped draining and it all backed up. I spent two days, pulling up glued carpet squares and cleaning and mopping floors (and putting my couch and washer/dryer up on cinder blocks). That summer, my church came over and dug a drain to help with some of the drainage and I bought new window well covers and caulked the windows and that seemed to take care of it for a while. Until the next big storm a year later, when it flooded again. My little portable sump pump tried its best to keep up with it and it wasn’t quite as bad. I had real hopes when in April, I got notification that I couldn’t use my plumping for two days because they were revising and rewiring the sewer system: I hoped that that would mean the end of backup problems.

But I started noticing more “leakage”, especially in the bathroom, and with less intense rainstorms. I was somewhat worried that my foundation floor had cracks and I wasn’t sure where the water was coming from. So, my dad and I pulled up the tile; the foundation floor looks fine, it’s leaking from the foundation “joints” where the walls and the floor meet. A big problem, one that to completely fix will require complete excavation of the foundation and the drain tiles. But I brainstormed with knowledgeable friends and came up with a few more reasonable suggestions to help alleviate some of the symptoms. And after I fixed some of the downspouts, things seemed better for a rain storm or two.

It rained hard a couple of weeks ago; and I had quite a bit of water collection. I moved up my plans to convince friends that they wanted to spend their afternoons shoving clay-based dirt to form a better gradient around the perimeter.

And then it rained again last night.

Some of you might have seen some of the pictures, especially this one:

I came home, after a 40 minute commute home, avoiding the flooded roads to find this:



I think it was about 8 inches deep at the location of the drain. I can’t know for certain, because I couldn’t check: the water was deep enough to submerge some electrical equipment that made stepping into the puddle somewhat dangerous. (I think my video cassette rewinder has seen its last day). It took about an hour for it to drain, leaving me with a mud/probable sewage covered floor.

Luckily, my church is still fantastic and I was able to call my home teacher who came over with a friend and we mopped and mopped and got it cleaned. It continued to rain off and on last night and I still had my leakage problems, but those feel almost manageable at this point.

I researched how to fix the problems all day today (thankfully a quiet day, as I didn’t want to deal with anything). It’s probably telling that all of the articles that discussed sanitary water backup in basements mentioned Milwaukee and its terrible sewer drain system. It’s unfortunately, however, a problem that I might not be able to fix; most solutions were to bother the officials until they redid the sewer system. Grrr. I could improve things and make flooding much less likely if I install a sump pump, which may not be too horribly expensive. I’m still exploring options and talking to people. I’ve got some numbers for a basement consultant and I’m going to talk to my real estate agent about people she might recommend; and how much of it I should try to get fixed before I try to sell it.

I’m lucky, there were 7 houses up north were the basements washed completely out and collapsed. And I was supposed to be on call last night, but switched at the last minute. Hooray for small graces.

I have pretty much made up my mind, that even after I finish training and am finally settled, that it’s going to be a long time before I buy a house again.

Oh, and it’s supposed to rain again tonight.

(more pics of the flood and Milwaukee can be found here)

Random thoughts for random people
1. Longest week ever. Seriously. I had heard tales and legends about the attending that I worked with, but since the first day had gone well and I had managed to keep her on task and we were done by 4:30, I thought that it was all exaggeration.

Oh silly mortal!

Hours of rounding. HOURS of telling and retelling families of what’s going on. None of my opinions mattered. She kept changing her mind as to what was going on. One minute she was harassing the primary teams about consulting us without a properly formulated question; the next, she was condescendingly putting me in my place for “refusing” a consult. I’ve never been so openly snarky before, because I was so tired and frustrated of the endless circles. And did I mention tired?

It also confirmed why specialists SHOULD NOT EVER try to do anything besides their specialty. Hello contributors to the rising cost of health care! Of course, I’m the one who getting the lectures from radiology as why a particular test wasn’t warranted; I knew that perfectly well, thank you, I just couldn’t convince my attending to listen to me. Ugh.

I get a new attending tomorrow, one who I’ve worked with before and adore.

2. I hate non-accidental trauma. Number 1 reason why I decided not to do peds. Heartbreaking.

3. I miss my friends who recently graduated. Some of them are still around for fellowships, but it’s not the same. One who moved accidentally called me on Thursday and I was so excited thinking she was in town. But she wasn’t. So instead I entertained myself looking at pictures from Neurobowl:
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One year from today, I will officially be finished with residency. Four years ago, I was an intern, freshly minted from medical school, nervous about prescribing tylenol to my patients without double checking their med list and past medical history and making sure that they were awake enough to take it without aspirating and are you sure they don’t have to be NPO in the morning???

Time flies, it’s true, but it also feels like I’ve been a resident forever. It’s been hard. There have been times, particularly my entire second year, where I wanted to quit. There were times when I was fighting depression and anxiety and hated my life, but I was too tired to do anything more than just sit on my couch. Times when I wanted to stage a mutiny. Times when the thought of dealing with particular patients would make me cry in frustration.

There have been patients who have died on my watch. Most died because of inevitability of mortality and their disease processes. There are a few who sit on my conscious, a worry that I might have through action or inaction contributed to their demise. I’ve fretted, I’ve worried. I’ve cried during rounds. I’ve told patients and family members about inescapable death and not cried. I’ve held hands with patients. I’ve stood in doors, impatient with the endless questioning, ready to move on to the next patient.

Over the last four years, I have had approximately 300 call nights, where I spent 24-30+ hours in the hospital. The majority of those, I had less than 4 hours of sleep. I can do 24 hours without a problem. It’s the remaining 6+ that kill me still. On call nights, I hate the pagers and I loath the ER. I think I always will.

I’ve written hundreds of histories, listened to a thousand stories of illness. I’ve auscultated over a thousand hearts and still could not tell you what a S3 gallop sounds like. I still hate gaping wounds and eye infections. I’m still terrible with names of muscles and their innervation, and well as anything related to heme-onc and rheumatology. I’m bad at daily studying (I still haven’t lost my natural tendency of procrastination), but love to find little bits of data and explore how to put a challenging puzzle together for a particular patient.

I’ve loved being a doctor. I’ve hated being a doctor. I’ve hated being a resident, treated like a high schooler, with the responsibilities of an adult. I’ve loved having support and backup in making decisions. I’m dreading the moment, a few years from now, when all decisions end with me.

One year more. Another year, another destiny, this never-ending road to Calvary. Or something like that. 😉

(And now off to study before bed… I’m trying to do better!)

For better or worse, I matched!

Chris called me at 5:50 this am (!!!) asking me where I had matched. As I had stayed up late and then tossed and turned for hours, I was pretty blurry eyed and groggy. But I logged on the computer and there were the results. No fanfare, no congratulatory email from the department (it was 4 in the morning pacific time, so I guess that’s not too surprising), just results that had probably been released at midnight. I was rather stunned to just see them there – the past few days, I had had the habit of clicking on the “match results” link to test if they were accidentally released, so I was used to the curse “please check again” webpage. I had promised Chris that he’d be the first to know–I think it dawned on him faster than me what the results were!

As always, my emotions are in turmoil. I’m super excited and ecstatic and happy, and then the other side of me is shell-shocked and grieving at the thought of moving and leaving behind this life that I’ve created here. I’m happy here, even with the crazy snow storms and muggy heat. I love my house, I love my friends, and the thought of leaving that terrifies me.

I’ve joked before that The Match is very much like a marriage ceremony, albeit a rather sadistic one (even in arranged marriages, you at least know the name of the person to whom you are vowing). By submitting the list, I tell whoever selects me, that for better or worse, I’m committed and that I’ll pick up my life and become theirs. I knew when I submitted the list that I would be leaving Milwaukee. As much as I’ve loved being here, this isn’t the place that I wanted for training. The program director belittles and torments when he’s not a in good mood, which is not something that I want to endure for two years. I wanted a place where I would have women mentors and colleagues, which I couldn’t get here. So I chose to go elsewhere, just like I chose to come here for residency, leaving my comfy life behind. I grieved then, and I’m grieving now, between the smiles of elation.

I submitted my match list last night, while I waited in my basement to see if a tornado would land on my house (it didn’t but it touched down a few miles southeast – first time I have heard the tornado sirens). I had submitted it last week, when I was “experimenting” with the site and discovered that contrary to the advertisement, you could not easily edit the list. In fact, in order to edit, I had to contact the match organization and demand that they delete the list and then start all over again.

I double and triple checked my rank order before submitting it last night, thereby sealing my fate. I then wrote my top 3 places last night, confirming that they had the necessary information to rank me, should they wish. The director of my top place emailed me back this morning stating that they had “ranked [me] quite high,” which could mean something or not. I hate that we have to use this stilted language to communicate, so we don’t break match rules.

So now begins the waiting game. Just one week, I keep reminding myself, but this week feels like it’s going to last an eternity.

I had not intended to take such a prolonged absence from my blog. Three months! I think it’s the longest break that I’ve had since starting my blog in 2003. The longer I was away, the harder it was to come back. I’ve missed writing, scribbling down my thoughts, but the longer I was away, the harder it was to actually write. Granted, it’s been a really busy three months – lots and lots of time in the hospital, my four precious days off a month being used to interview, too many 30 hour days – but every time I sat down to blog, I couldn’t get the words out. The first entry back had to be deep, ladled with meaning and symbolism that would make you all read and weep for my prolonged absence, because your life just had not been complete without my pithy remarks. This won’t be that kind of entry. I’m on vacation right now, visiting my parents and my mother was so excited when I opened up my computer, thinking that I might update. And who can deny their mom anything? So, Mom, this is for you.

When last we spoke, I had just started the whole interview process, I think, for neurocritical care fellowship. Yes, it’s still ongoing. You all were here for the drama of applying and then thinking that I had missed the deadline. Oh ho, foolish Julia! It took until April to even get an interview from a majority of the programs (and I just had another email this past week from a program who hadn’t said a thing until now), so it’s been a rather prolonged, drawn out process. I did take a couple of notes throughout my interviews, but as they dragged on (and on. And on. And on). I stopped doing that as much, which left most of the programs as a big fuzzy memory. Oops. It’s okay, all of the programs have wonderful relationships with neurosurgery, there’s plenty of teaching, all of the fellows are happy and there’s no more call and the water fountains stream golden honey. Or something like that.

I’ve completed all 11 (!!) of my interviews; I have a top choice (and a close second) and now am contacting programs declaring my everlasting love and asking if they will be mine. On June 22nd, my rank list is due and on June 29th, the arranged marriage match will be confirmed. In one month, I’ll know where I’ll be planting roots for two years.

And since I’ve been telling everybody, my first choice is San Francisco. So if in June, I mention that I’m headed to Atlanta, then you’ll know that things turned out really, really wrong (I didn’t even interview there!). I’ll be really, really happy when the whole thing is over.

I’ll let you know. 🙂

From fileg:

I love this band!

Have you seen their other music video?

Things I’m looking forward to this month:

1. Going to Michigan to see my friends Michelle and Kelly and their little family. Interviews #2 & 3 on Monday and Tuesday

2. Weekend trip and interview in Portland. I looked online and determined that it was roughly the same price to fly in Friday as it was to fly in Monday. I’ve never been to Portland and it’s been high on my list (along with Seattle and Vancouver) and I haven’t been on a vacation to just see a new place in a long time. I’m already drooling over the photographing potential. Mountains!

3. Following weekend in Boston, visiting Chris and Gretchen. I’m interviewing in Philadelphia, so it made a good excuse to jump over and see them. As I’m still waiting for the itinerary from Philly, I haven’t gotten tickets yet, which is making me anxious. Boston in late winter is probably not as awesome as Boston in the fall, but it’ll do. Any must see sights?

So for those who are keeping score at home, by the end of this month, I’ll have interviewed at 5 places (I may be able to squeeze one more in), I have 2 scheduled in April, 4 other programs have contacted me and stated that they “would decide soon” about interviews (that was about a month ago), and I haven’t heard anything from 3, including the program here (still!!!). Of the 6 unknowns, I really only want to interview at 2-3 (really only one, but the others I have to because of connections), so I should be able to squeeze them in. I do love when things start sliding into place.

Forgive me for my absence here during February. I actually had a pretty good month with weekends free and no call. I was doing palliative care consults in the hospital, which translates to lots of family meetings and talking about goals and how people want to spend their last days, weeks or months. As this is something that I need to perfect, as well as intrigues me (I don’t get excited about new techniques and drug trials, but talk to me about how we as doctors can communicate better with our patients and families and I’ll gab your ear off for hours), I found the month informative and moving rather depressing. I really do love it when the patients and the families work towards a “good death”: whether that means stopping the treatments and focusing on comfort or continuing to hold on for the next treatment, because life is what’s important to them, as long as we’re doing what the patient and family wants.

One of the residents died in a car crash earlier in the month too, which sent me reeling. We worked closely together, shared many a sleepless nights and many a crashing patient. It was only after her death that I realized that I didn’t know her at all and that we could have been really good friends outside of work. Her memorial was beautiful, full of hope and celebration, although I sobbed through most of it (especially when my neurosurgery boys gave their eulogies. I’ve never seen them cry before). She left a gaping hole and I think I’m still grieving.

Yeah, aren’t you glad you didn’t have to read a month of this pathos?