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A fond farewell

I’m writing this now from San Francisco, sitting on an air mattress in my new apartment, with the dog curled in a packing blanket that I also used as a comforter last night. We’ve spent the past four days traveling across the country to arrive in our new home. Some highlights from our trip:

  • Our route took us through Michigan, Indiana, Illinois, Iowa, Nebraska, Wyoming, Utah, Nevada, and California. This totaled 2,358 miles over 35 hours of driving time.
  • The cats were supposed to be constrained by a pet barrier to the back few feet of the minivan we rented to make this journey. They figured out how to climb over it within minutes, and spent the remainder of the trip free-ranging throughout the van, in particular enjoying cuddling in Walter’s bed. You can see the barrier standing uselessly in the background of the photo…

  • We stopped in Des Moines, IA on the first night to see my grandmother (and accept her generous hospitality, having invited me, Mike, Lynn, the cats, and the dog to stay with her). I hadn’t seen her in years, and it was wonderful to catch up.
  • There are Whole Foods stores approximately every 9 hours along I-80. Lynn did a pretty incredible job finding places for us to eat along the way that would accommodate our various needs for tasty vegetarian and gluten-free food.
  • We had one pretty remarkable Google snafu that led us to an interesting off-roading experience in the minivan. We ultimately found the relaxing State Recreation Area we’d been looking for (about 12 miles up the highway), but only after about 40 minutes of harrowing round-trip craziness and then an easy jaunt down the interstate. We actually passed several ATVs, who looked at us with a level of incredulity I had not previously experienced.
The beautiful two-track road…
The van after our adventure…

For those of you who have been following me on the Dose of Reality site, thank you for your lovely support throughout the past eight years. I hope you’ll consider adding this link to your favorites, and continue to follow me through residency. For the rest of you, stay tuned for the further adventures of one Dr. Andrea in SF…

First bike ride of the year!

I spent the last week in San Francisco finding an amazing apartment (although I was not really responsible for the finding… credit where credit is due, Lynn) and noticing the cyclists there. As many of you know, there are hills in San Francisco, and they are not for the faint of heart. Or the faint of leg. Despite the fact that I have been trying to stay on the stationary trainer this winter, I was gripped with a sudden and gripping fear that I would arrive in SF and make a fool of myself on the hills. Arriving home in the 35F with sleet and rain, however, was not helpful. Finally, today was beautiful. It got up to almost 50F, it was sunny, and I got out my bike. I have many friends and colleagues who are much more intense cyclists than I, and even more who were industrious on those few very warm days we had earlier in the year. But today was the day for me, and it was glorious. Thank goodness I made my rank list in the winter!

And then we came to the end…

Believe it or not, my last real day of medical school was Friday. I finished all of my exams for OB/GYN Boot Camp (which was the most fabulous last rotation I could have imagined), and now I just have a month of vacation before I graduate. The phrase “and then we came to the end,” which I used to title this post, is the title of a book by Joshua Ferris that I read a number of years ago, courtesy of the free book room at Borders, if I’m remembering correctly, which chronicles the end of a company as employees are laid off, and moral falls. I keep thinking of it, in relation to medical school, because a few of the characters get a little crazy with the stress of the uncertainty of their fates. I suspect it’s clear why this seems to relevant to my life right now. Despite having checked a number of things off of my list over the past few days (i.e., finish exams, give conference presentation, buy chips and salsa so that Lynn does not go into withdrawal when she comes home today), everything still feels pretty up in the air. As annoying as I find the “Keep Calm & Carry On” memes, that is, in fact, the mantra I keep repeating to myself. Here is a paragraph I posted in 2007, as I was finishing my second year of medical school:

Remember riding on the merry-go-round at the playground when you were little. And you’d hold on so tightly as your parents or friends spun it as fast as they could run, terrified that you’d lose your grip and fly off into the hard ground. Remember how you smiled as you screamed, loving every minute of the terror. And then, remember how gentle it seemed as the merry-go-round slowed to a delicate spin, how calm you felt as your heart slowed, your eyes adjusted to the gently revolving world, no longer a blur. Finally, remember how unsteady your legs felt as you climbed back onto steady ground. Now imagine that the merry-go-round spun until you felt sick – that it wouldn’t stop even when you started crying instead of laughing.

It’s amazing how little has changed, how frequently over the past eight years I’ve felt like I was hanging on for dear life, just hoping it would all slow down soon. Despite the impressively high amplitude of fluctuations between the ebbs and the flows, I’ve loved it, and will certainly be a bit nostalgic as I walk across the stage in another month. For the next few weeks, however, I’ve got a lot of things to catch up on, so, much to my chagrin, I’ll keep calm, and carry on.

Matched… and then…

As some of you have heard, Match Day is over and I’ll be heading out to San Francisco to start my OB/GYN residency at UCSF in June. It’s hard to believe that the day is past, and no one really said what we could all anticipate after Match Day itself. Some had hinted that it was somewhat anticlimactic, but I didn’t find it to be that. Finding out where I would be living in just a few short months was nothing short of exhilarating, to say nothing of sharing it with so many important people in my life. Confirming that I’d be leaving the University of Michigan after 12 years here was monumental. What have been odd are the days that have followed. All at once I have nothing to do and so much to do. It’s too early to find an apartment, but too anxiety provoking not to peruse the SF Craigslistings; I don’t have any of the paperwork I need to sign yet, but I know that it’s coming and will need a quick turnaround; I don’t have the energy to really focus intensively on academic work, but there are so many things I’d like to get done before I graduate. I know it’s only been a few days, and it is all starting to settle into place, but I’m getting the sense that this is only a beginning.

Sometimes it’s hard

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.