HELP!

I'm having a quarter-life crisis trying to figure out what to specialize in. I have to turn in my elective choices for the end of 3rd year/4th year and that means I need a pretty solid idea of what I want to do for the rest of my life. Yikes! Only 11 months before I have to make my final decision--I didn't think it would come so fast. I feel like I pretty much enjoy everything in medicine (except maybe psychiatry) and so now more than ever I have no idea what I want to go into. I've put up a poll for everyone to put in their two-sense. I won't tell which way I'm leaning until after it closes.

For those not familiar with internal medicine, because I have a lot of people asking me what that is exactly, that includes the following: cardiology, nephrology, infectious disease, pulmonology, gastroenterology, rheumatology, endocrinology, allergy/immunology, and hematology/oncology. So basically everything between the neck and the hips.

To be continued...

Dermatology 101

Yesterday in neurology clinic:

Dr. Torres (the attending): "So what do you want to do with your life?"

Me: "Well, I have a top 5...it pretty much boils down to dermatology, neurology, family medicine, pediatrics, or endocrinology. Pretty broad, I know, but I think derm is definitely up there."

Dr. Torres: "Dermatology? Well, you have to be all posh for that. Wear high heels and have those Louis Vouitton purses."

Me: "huh, yeah. It's pretty competitive I hear."

Dr. Torres: "Yep, really. You have to have perfect skin too. I don't know about that for you. They're all about looking beautiful. So much of their practices are cosmetic, you know, so just keep your options open because you might not cut it."

Me: "well, I'm working really hard, you know, and I think I can do it. I've got good board scores and research so I hope that makes a difference too."

Dr. Torres: "Well, you know, you won't get into a top program or anything, but maybe somewhere in the midwest. Yeah, I bet there are some fat derms in the midwest. Gotta be."

I'm not even making this stuff up. Seriously? I know I'm pretty nerdy, and not exactly the most beautiful person you'll ever meet, and I struggle with Rosacea/acne, and I also know you can't take this stuff seriously, but you tell me, how would you feel if your superior talked to you like this? And she has to evaluate me! Um, I'm pretty sure I won't be applying for neurology in Tucson is all I have to say.

Scared of psychiatry? I was too.

Seriously, where does the time go? Today I just finished my very last day on my psych rotation. The shelf exam is Friday and then I get to start neurology! By no means am I planning on going into psychiatry, but I loved learning about it because it is:

a) so controversial
b) so prevalent
c) so gosh darn interesting
d) so heartbreaking
e) so challenging
f) so cushy (meaning, the work days are short and sweet)

I've never met more people scared of using psychiatric medications. I think it's natural to be scared of drugs that act primarily in the brain. Heck, I think it's natural to be scared of prescription drugs, period. And to be sure, a lot of the old drugs could kill you in overdose (although, most drugs can do that if you mix them right). Plus there is plenty of pop culture about "anti-psychotics" and "tranquilizers" and other things that will "fry your brain." The multi-billion dollar drug industry is also not really helping things with its pretty advertising followed by ads parading as "public service announcements" for lawyers who can get you compensation for drugs with "evil" side effects. Bottom line: it's confusing.

But if I learned anything on this rotation, and in med school in general, it's that prescription drugs are necessary--life-saving even--for many, many people. Even the psychiatric drugs. Especially the psychiatric drugs. If you've ever seen a child with severe ADHD, you realize that this disorder could literally sabotage his whole education and development if the proper treatment isn't started. For those who think medicating their kids is for the birds, "treatment" is not just drugs. Treatment for these kids is holisitc, or should be if the parents are on board. It includes not only a psychiatrist, but therapists, parenting classes, behavioral planning and changes in the home structure, dietary changes, and teachers. I'm all for alternate therapies including diet, exercise, and behavioral therapy, but sometimes it isn't enough, and the best thing a parent can do for their child is accept a diagnosis and work with the entire team to implement care on all levels--including drug therapy. I can't tell you how frustrating it is to work with parents and patients who put ultimatums on their treatment. For example, they'll say they'll do "anything" but try a stimulant for their child. Or, they'll allow an anti-depressant, but "no more than 10mg." Honestly, why do we even go to medical school if parents and patients are just going to tell us exactly how they want their child or themselves treated? And I'm not talking about advocacy. I think every patient and parent has a right to advocate for their child and for their own healthcare. Truly, studies show that when patients are in charge of their health, they are more compliant and heal faster. But advocating for yourself crosses a line at the point where the recommendation/opinion of the health care professional no longer matters.

I'll get off my soapbox. I just want people to really think before they judge about things like whether diagnoses such as ADHD even exist, or whether psych meds are a bunch of hooey. It's so easy to jump to conclusions and so hard to actually dig through the reserach. Guess what? Most good doctors have dug through the research.

So what have I learned? ADHD is real. So is depression, and anxiety, and psychosis, for that matter. When people suffer from psychiatric illness it is not their fault. People with depression can't just, "snap out of it." Drugs help--help a lot of people actually--and it isn't a sign of weakness if someone needs and anti-depressant or almost any other kind of psych drug. Also, psychotherapy works and it's also not a sign of weakness if you need to see a therapist. Or if you need to be hospitalized. Psych diseases are just like other medical problems, our culture has just bent them out of shape in weird ways so that we get scared when a family member or loved one has a diagnosable psych illness. So get the facts. Advocate. And don't be scared. Psychiatristis are some of the nicest people I have ever met.

San Diego

This is by far more pictures taken in one week than have been taken in the past 4 years of our relationship--so I hope you enjoy seeing, well, a lot of us. On the first night we ate at this quaint little restaurant called Prep Kitchen in La Jolla, which is what the fuzzy sign is attempting to say above...

Continuing our culinary tour we had brunch at the Hash House in downtown San Diego the next day. The line was about 1 1/2 hours long but sooooo worth it! Demonstrating my beautiful watermelon kiwi lemonade below:

Sunday we went to the Spreckel's organ concert at Balboa park. Here we are documenting the largest outdoor organ in the world. They even let us borrow big beach umbrellas for the concert. Only in San Diego...

We also did some cooking and made good use of the grill, outdoor jacuzzi, and gorgeous, beachfront, wrap-around porch. Here is our nod to California for Sunday dinner. Obviously there were avocados.

Boyd showing his extraordinary beach cruiser skills. All free with our rental! So Lily Allen...

Children's pool in La Jolla.

I actually had a dream that involved steps almost identical to these with Boyd on them about a month before our vacation. Creepy!

Somehow only Boyd was captured in a swimsuit appropriate to post here...!

Boyd showing off our sweet digs.

We won't brag too much about the just as sweet deal we got with it.

Clearly, the food itinerary must have been set by me. Oh man, this place was up there with finale in Boston. And if you havn't been there we pity you.

Boyd's first peek at Disneyland to round out the California experience. This is at California adventure.

Obligatory picture by the "L"

Proof that we actually went to the real thing too. And ate dole whips. Who's jealous now?

So even though we celebrated in full before I got my board scores, it turned out it was well deserved in the end. Since no one from med school reads our blog, I can proudly announce to my family (and the few friends that read our blog who I know won't spread it to the wrong people) that I scored a 245! Plenty high enough to be really competitive for any residency I could possibly dream up. Plastic surgery anyone? Just kidding.
Thanks everyone so much for all of your support and help during my studying. I couldn't have done it without you!

Mini Memoir: The Girl in the Mirror

When I was little I would watch my mother get ready for the day. I often perched on the cold marble of the bathroom sink and, although I swear I was better seen than heard, I’m sure my mom would describe me in perfect chatterbox form. I was really such a chatty Kathy growing up—everything from know-it-all status to a delinquent fondness for talking back--for which I was rewarded with many mouthfuls of Dial soap. To this day I can’t use Dial for that reason. But even if my mom may not remember these mornings in quite such an optimistic light, I really liked them. The steam would billow through the shower and create those condensation droplets on the marble and the mirror. Sometimes I would drag my finger through it and write her messages. I like to think they were clever little Haikus or limericks but I think the standard “I love you Mom” might have been the best I ever conjured up.

She always showered in the dark for some reason I’ll never quite understand—still does in fact—and then when she stepped out of the shower she used this Crabtree and Evelyn body powder called Summertime. It was in a granny shaker—really it was—all floral looking with loopy cursive. When I was a teenager I crinkled my nose at such a fluffy and functionless powder all wrapped up in old person’s wrapping. Now I think it’s beautiful. Isn’t that the way it always goes? Now I cherish things like the vintage rocking chair that I acquired a few years ago and that Boyd has been working on sanding for my birthday which was, wait, in February? That’s okay, I still love him. And part of me kind of loves the fact that it still isn’t finished. I can’t really say why. Now I’m debating whether we should really be re-staining it at all.

After the body powder came the round woven basket of makeup. Whenever she’d put on her blush I would get some too—that was probably my favorite part. She had that blush for I think about a decade. But seriously, do you ever run out of blush? I know I haven’t yet. Well the end of that blush was when I went in her bathroom around the age of 16 to try on all of her makeup before she came home from work. I think prom was about 2 weeks away and my cover girl just wasn’t cutting it. Her Clinique “Breathless Berry” was guaranteed to make me more beautiful than my cover girl cheekers, “pink.” Seriously? Don’t they pay someone to come up with names for make-up? Clearly not enough. Anyways, I fumbled with the breathless berry, and it came crashing down onto the whiter than white tile my mom swore was practical. And, of course, being more than 10 years old, the blush cake shattered into about a hundred pieces. Which I put back into the little snap case and quietly stowed away. I didn’t even have the guts to admit I had broken it when she came asking the next day.

Just the other day I noticed that whenever I look in a mirror I put my tongue just up to the insides of my lips to make them look fuller (I guess us Dahl girls weren’t exactly blessed with the Angelina Jolie lip pout) and I realized just how much I look like my mom. She actually does this little lip-plumping exercise too, although she'll probably deny it. People always said we were twin growing up, but I never saw it because, well, I have blond hair and she has dark brown hair. We obviously couldn't have looked alike. But we do, it’s undeniable. Now that I have just the finest of lines around the corners of my eyes and my baby fat is all but gone off my face I see it. I see the skin so white it’s almost translucent and the occasional tiny capillary running through it. I see the dark sun spots that so easily mark how old we are. I see the hazel eyes I used to think were an ugly pea green, all speckled and frog-like, now deep and earthy and prettily freckled. I see the lashes so long it looks like I’m wearing fake ones every time I put on mascara and know that mom blessed me with those beauties. And now when I get ready for the day, and fog up the mirror, and powder up, and put on a blush that’s actually my color, I see that I am beautiful, just like my mother is beautiful. And I thank my lucky stars that it was never on the outside that counted anyways.

Before and After

Before: 7:00am. Exactly 1 hour before I started I had Boyd take this picture of the smartest day of my life. So this test, in case you're not familiar, is the first part of 3 exams that you have to pass to become licensed to practice medicine in the United States. USMLE step 1 covers basic science, supposedly, but the truth is that every question is a mile long clinical vignette. The problem with step 1 is that you don't just have to pass it if you want to do something other than family medicine (which is great, don't get me wrong), but you really have to bring your "A" game to be considered for top specialties (read: anywhere in Boston, Seattle, Baltimore, New York, Chicago, or basically the whole state of California).

The other crazy thing is that you are timed (better pee fast!) for exactly 7 hours and 45 minutes. Only 45 minutes of that is break time. The rest is the test. No matter what you're doing, you're timed. And since you have to be fingerprinted, interrogated by the testing police, and ready to show your papers every time you enter and exit the room (not to mention you have to wrestle with the stupid locker that holds your pathetic morsel of a granola bar), you basically waste 5 mintues just getting out to take your break. Have you been adding this up? That's right--if you take a break every hour you have five, 5 minute breaks and a 20 minute lunch. But wait, subtract 5 from every break. Now you have a 5 minute lunch and a few other 5 minute breathers. Anyways, I just needed to rant about that. Because honestly, what's it to them if it's an 8 and half hour test with 90 minutes of break time?

Anyways, before this all got started I took this ridiculous picture where I look slightly delirious. That's what the medical licensing test will do to you I guess. I'm holding my "bible." First Aid. You basically have to memorize the 600 page book and you'll do great. Which was awesome. Blah. Hey, but look, I still had the frame of mind to put in earings that morning. Now that's truly a doctor for the 21st century.


After: 5:30pm. I think I've finally shed my slightly psychotic look from the morning. Boyd and I went out to one of my favorite Italian places in Tucson--Tavolinos--for dinner. And then where? To Borders of course. Now, unless you think we are completely crazy for going to a book store after my board exam, let me just say that I only came out with cheap beach reads. The exam went as well as a board exam can go, I think. There were definitely questions I think they pulled out of places where the sun don't shine, but I think I'm allowed to have a mild case of "stick-it-to-the-man-iosis" if you know what I mean. Tune in next time for coverage on our San Diego getaway where we got a screaming deal on our sweet beach house and I scored my very first Coach purse. Yep, Boyd loves me.

T minus 4 days

In just 4 short days we will be in sunny San Diego bliss. Check out where we're staying right here:

www.vrbo.com/39466