quitters sometimes do win

The sun is once again shining, after months of darkness. I quit the first real job I've ever had. The etiologies were varied and complicated and many. It wasn't an easy decision. My gut had been telling me to quit since the day I started, but my head was reminding me I wasn't a quitter and I had worked exceedingly hard to put myself in this position. Many people would die to be where I was.

I was running along the Cherry Creek one evening when I finally let myself quit. I felt as though an elephant had been lifted off my shoulders. I could once again run fast and free. Many people have called me stupid. These are the people who choose security over passion; the people who are content with mediocrity, who are afraid of uncertainty and change. I am not.

I quit, if for no other reason, than on principle alone. I don't believe people should be treated the way a surgical intern is and continuing to submit myself to their torture methods is only condoning the process and allowing it to perpetuate. Cheers to happiness, health, freedom and sunshine. I'm back.

intern absurdity

I went to four years of medical school to tell people when they can eat. It's not rocket science. I'll even let you in on the secret so you don't have to go through the four years of hell, ahm I mean school, and $180,000 debt part. If a patient is farting and pooping it means his or her guts have woken up enough after surgery so that he or she can eat, hopefully without puking. That's it.

I am essentially a glorified secretary in a long white coat with MD on my name tag. I wander the hospital halls like a zombie, making phone calls, answering pages, writing notes, typing orders, dictating discharge summaries. I'm not really sure why they call it medicine because it's really only about 2.7% medicine, 97.3% crap. And I'm not so into the crap. I want to actually have to think. I want to apply the physiology I learned in school. I want to see it in action. I want to see that I've made a difference in someone's life. Thus far I have been so sleep-deprived and depressed that I don't think I've seen anything.

For those of you considering a medical career, consider this your fair warning...it's not what everyone on the outside thinks.

identity theft

I've been waiting my entire life to fit in and now that I finally do, I'm not so sure I like it. I can no longer tell someone I ran the Boston and expect them to look at me like I'm some sort of god, or better yet, say "what's that?" Instead I get, "Oh, what year? Yeah, that was my 11th Boston. The weather really sucked that year, didn't it? Hey, I'm doing this 50-mile trail run race this weekend...interested?" I no longer get looks of awe and "are you crazy" when I tell someone I went mountain biking for two hours in a hail storm yesterday. Instead I get, "Yeah, yesterday, I did this 12 hour adventure race and then, after grabbing a quick bite to eat, went out and rode for 3 hours in the moonlight with a few of my buddies."

On my way home after a long hike in Rocky Mountain National Park with my cousins yesterday, I decided to stop in Boulder to see if I could still sign up for the Bolder Boulder, a 10K running road race on Memorial Day and the largest of its kind in the nation. As I drove around town for 20 minutes looking for a place to park (which I never found), I was appalled at what I saw: 10 year-olds riding $2000 miniature road bikes to the candy store; every third car with a bike on the roof; beautifully sculpted bodies walking down the street in their chacos; people riding bikes everywhere you turn--serious racers out for their training rides, commuters, dads pulling their kids in buggies... Hey, wait a minute...that's my gig. You can't do that. The more I saw, the angrier I got and I finally had to leave without signing up for the race. Let them have their stupid race. I don't need 40,000 Sarah clones to run with. I can run my own 6.2 miles wherever I want.

I am officially, no longer, crazy Sarah. I am now completely ordinary, below average Sarah. Congratulations. You got what you wanted.

loss for words

I made it home. And I am already depressed.

Today was my first day back in the hospital and I am convinced that there is something seriously wrong with the way we practice medicine here. I never saw it before. I guess because that's all I ever knew. It took me over two hours to wade through the patient assigned to me's charts (yes, multiple--there's the nurses paper chart, the other paper chart, the computer program where you can access all the labs, x-rays, etc, the computer program where you can access the patient's past medical records that have been scanned in, the computer program where you can print a progress note for the patient and yet a different computer program where you can print the changeover sheet.) The patient is taking no fewer than 20 different medications and 10 additional prn (as needed) meds. She has been taken care of by probably 20 different doctors and at least as many different nurses. She has pneumonia and acute respiratory distress syndrome and congestive heart failure and chronic obstructive pulmonary disease and morbid obesity and obstructive sleep apnea and hypertension and acid reflux and pseudotumor and osteoarthritis and a brain aneurysm and bipolar disorder and chronic lower back pain and cellulitis of her right calf and a few other things not worth mentioning. A fancy machine is breathing for her and she is now developing bed sores. She has a tube in her nose that goes down to her stomach so she can receive liquified nasty tasting calories. Her potassium was a little low yesterday so we put some extra potassium in her feeds today. We give her a little of this, go up a little on the dosage of that, and continuing tweaking until she is just "perfect." We will continue to tweak her to perfection until she dies, likely right here in her ICU bed.

Yes, patients in Africa die too. But not like that.

Are we really doing what's best for our patients? Doing "no harm?" Somehow I don't think so.

oh, africa

Africa is kind of like medical school in that it is nearly impossible to describe to anyone who hasn't experienced it. After you've been here for a while, you eventually go from saying why, why, why to why not? Why wouldn't there be a man chasing a goat that is darting back and forth in the street, on your way to work? Why wouldn't there be a live chicken in the front seat of your taxi? Why wouldn't there be a man selling perfume out of a crate on the back of his bicycle at the hospital? Why wouldn't the bovie stop working in the middle of a mastectomy or flies be landing on the sterile field? Why wouldn't there be a viper in Dr. Daniel's house last night, "attacking my son"? (His wife killed it because he is afraid of snakes. Oh, by the way, I live right next to him in a duplex sort of thing. Good thing they have antivenom here at the hospital.) Why wouldn't our landrover get stuck in deep sand and we all have to get out and push for 50 meters? After a while, it somehow all just starts to become normal. You fall into the rhythm of craziness, and just have to say "Oh, Africa" and continue on with your day.

d-day

I wake up at 5:30 (T minus twelve and a half hours) to go for a run. The sunrise is hazy and the most distant mountains are obscured by dust in the air, but I can already tell it's going to be a hot day. The village is just waking up. Women are going to the well to pump water. The occasional child or chicken scurries across the road. My legs feel like lead, as they have for the past two weeks. I chalk it up to being anemic since I haven't had meat in 6 weeks and cut myself some slack.

I make myself a cup of instant coffee (I have been forced to become less of a coffee snob since coming here--it's instant or nothing) and head over to the hospital at 7:30 (10.5 hours to go).

This morning I get to go to Mora with Myra, the Canadian who, along with Dr. Ellen, built this hospital from nothing 18 years ago and who is the keeper of the money fridge (ie: accountant and administrator). In Mora, I buy some guava (new fruit of the week) at the market and get some quality people watching in, while she makes stops at the button store and the tailor. I'm convinced there is no better place in the world to people watch. I think I could have sat there all day without ever getting bored. Everyone and everything just seem more alive and vibrant here. I don't know how else to describe it.

When we get back to the hospital, I scrub in on a prostatectomy, sans the Davinci of course.

5:45 pm (T minus 15 minutes) I have been waiting for this moment for almost forever it seems. I'm sitting in Dr. Ellen's hot office staring at her computer screen, anxiously clicking refresh over and over again while my 270 classmates have gathered en mass several thousand miles away at this very same moment, our uncertain futures about to be decided for us.

General Surgery, U. of Colorado, Denver. Silence.........................................................................
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Damn. .......................................................................................................................................................
Colorado was 4th on my rank list but I somehow wasn't expecting it. Well, I guess if I can manage to elude the 37.5% attrition rate and enjoy the 300 days of sunshine a year, it might actually be okay. And there are mountains and biking and hiking and climbing and skiing galore. And the staff I interviewed with there were incredible. And it's not Indiana. And maybe, okay, it might just be alright. It might just be where I was meant to go after all. I trust that someone is looking out for me and my future.

So I send a few emails and make a few phone calls, shut down the computer, cover it with plastic, two towels and a sheet to fend off the dust, and while my classmates are all out drinking and celebrating together, I walk home in the moonlight alone. Somewhat anticlimactic if you ask me.

Ahh..........Colorado..........What color will I paint my walls?

Everyone--please let me know where you're going next year! I'm sad I missed out on all the excitement back home.

you know you're homesick when...

-You try to make cookies in a skillet over a gas stove.

-You bust out the make-up you had been wondering why you brought, and wear it to work just because it makes you feel more like at home.

-You fry yam cubes in cotton oil, top with tomatoes and pretend you're eating french fries and ketchup.

-You borrow a quality single speed Skylark for the day and pretend the huge springs under your seat are actually your rear suspension.

-You sing out loud to yourself because you haven't heard music in five weeks. The last song I listened to before I left home was Snow Patrol's "shut your eyes and think of somewhere, somewhere cold and caked in snow...", which now helps me make it through the days of 105F heat and sleepless, sweaty nights with no AC and no fan, only a wet shirt and frozen water bottle between my legs.

Several hours after doing laundry (and by laundry I mean washing every piece of clothing by hand, in a bucket, with blue powder that people here call soap but I'm not convinced actually cleans anything, and hanging my clothes on a clothesline in the bathroom), I find that several hundred mosquitoes have invaded the bathroom and I empty half a bottle of deet in the toilet, sink and air to scare them away enough that I can use it.

I'm tired of being the celebrity in town. I'm tired of people staring and staring... and staring. Maybe they're just curious, but where I come from that's impolite. I miss being able to run down the street and not have people stop what they're doing and come out of their houses to stare. I miss being able to sit in a coffee shop and read with twenty other people and still be alone. I miss the order, organization, precision and timeliness of the U.S. operating room. I miss feeling clean. I miss my garbage disposal and my jeans and tank tops and my yoga class and my $1500 bikes and my grocery store and my Starbucks and my air conditioning and my car (or the abstract idea of my car since I don't actually own one) and even my cell phone.

As much as I hate to admit it, I realize I have become yet another victim reliant on the many conveniences of the western world. I may not spend hours a day watching TV or surfing the internet, but I'm just as guilty as those who do.