Real Talk: The long white coat

As a medical student, I often yearned for the day when my short coat would be replaced with a long one, my name embroidered with an “M.D.” after it. I would gaze longingly at my residents and attendings adorned in their Capes of Knowledge, flitting about the hospital in their flowing white garment dispensing Ativan and reassurance like candy and wine. (Just kidding, candy is bad for you).
Well, I am half-an-intern-year wiser and I’m here to tell you: The Establishment has you duped. They have carefully cultivated this illustrious image of the Long White Coat (LWC), but what they aren't telling you is that it is not worth its weight in anything except maybe Robbins Pathology textbooks.

I know, I know, there are things people actually like about their LWCs. It’s a shining beacon of authority! (Especially the day after Laundry Day). It serves as an extra layer of protection from hospital subarctic temperatures and bloody vomit, sometimes simultaneously! It comes with pockets for carrying Very Important Stuff like energy bars, the purple book of wisdom, and an IV kit for mainlining caffeine!

The most tragic dupes of The Establishment are women, who have been brainwashed for years upon years by the fashion industry into being thankful for the pockets, since every other garment leaves them (us) deprived. It’s a massive conspiracy that’s been playing out for centuries! But that belongs in a separate article that I will never write because fashion is so far from being my thing.

Okay, so the benefits pretty much end there. Now for the drawbacks, with some suggestions sprinkled in:

The Coat Mass Index

• It is a couple feet longer than our student coats, which just means extra inches to iron (ha.) and keep clean. Ain’t nobody got time for that! Those are precious minutes that could be spent sleeping, or stealthily scarfing down lunch in the bathroom where no one can find you.
• Those extra inches also mean you keep rolling your chair over it, which means it gets dirty, which means you have to wash it again (maybe), which means you have to iron it again…you see where I’m going with this.
• More square inches = greater surface area to cover in miscellaneous fluids, including but not limited to: blood, emesis, printer ink, stray pen marks, etc. Cue vicious cycle yet again.
• New and improved length blocks universal scrub back pocket access! Making for awkward moments when you hike your coat up to fish out your phone.
• Extra length means the stethoscope in your pocket is now at perfect door-snagging length. Excess fabric is more than happy to co-snag with the stethoscope, making it difficult to maintain a semblance of dignity and authority while cursing at a door knob.
• Yes, they come with nice, roomy pockets. But as with any benefit offered to a capitalist society, you’re tempted to ‘make the most of them’ and stuff them chock full of Very Important Stuff, which makes for sad shoulders and a sad back.
• I hear the Pocket Capitalism Effect tapers off as you go up the ranks, since eventually you will be a bad-ass attending who only needs to carry around your brain and a pen to scrawl chicken-scratch on the souls of your minions.

Just for kicks, how cool would it be if white coats grew on their own? Lengthening by a percentage of your height per year of experience – eventually, they will all be like awkward, collared and buttoned, infected wedding dresses.

Fashion Commentary

• The fabric is hot. And I don’t mean the kind of hot that gets you all excited. I mean the kind of hot that gets you all disgustingly overheated and uncomfortable. You’d think they would have discovered a more breathable material by now. Can we get Under Armour on this?
• Also: Why aren't LWCs fluid resistant yet??
• Maybe instead of white, they should come in shades of body fluid, the ultimate camouflaging technique. I’m not entirely sure how this could best be engineered. A swatch for each type of fluid? A fancy cloth mosaic?
• The LWCs are inherently sexist! I’m sure this shocks exactly no one (see fashion industry mini-rant above).
• Guys don’t get a slimming band across the back. Why not? They have as much right to a tapered fit as the rest of us.
• Gals don’t get pocket-accessing side slits! I mean, it’s bad enough we usually get gypped on the pocket square footage front, but now we can’t even get to them!

 The [unwelcome] Genius Effect

• People think you actually know stuff. I mean, the coat even says “M.D.” on it. This is dangerous.
• It comes free with a 15th century pager. Run away! This is not a good deal! Silence your inner capitalist!

Cargo scrub pants are the great equalizer. Everyone should have to wear them all the time whenever they’re in the hospital. The end.  

BAU to the Rescue

"Things are not always what they seem; the first appearance deceives many; the intelligence of a few perceives what has been carefully hidden."

-Phaedrus

(spoken by Hotch in "Paradise," 4x04, Criminal Minds)

Most who know me know I am a loyal Criminal Minds fan. Every episode is book-ended by quotes. I don't believe they have ever repeated a quotee (apparently this is actually word) within or between episodes, but don't quote (ha) me on that. But I digress. 

In senior year of college, I began to struggle with blogging, especially as difficult things were going on at home, combined with the encroaching sadness of leaving college behind and separating from a lovely, if insular-to-college, community. So, I turned to my favorite TV show for inspiration -- I picked an arbitrary quote from one of the openings/closings to help me focus my thoughts whenever I struggled to write. And it worked!

When I started my med school blog, I felt I was 'better' than that. I could manage my own inspiration! I was in such an inspiration-rich environment, what could possibly be lacking? Quite a bit, apparently, the most significant of which was focus.

I changed blogs from college to medical school because I thought carrying the same one forward would encumber the process of identity growth. But I'm keeping the same blog for this transition, from medical school to residency, at least for now. Why?

a) I never quite gave it a fighting chance, and feel responsible for giving it another go.

b) Transition and growth is a gradual incline, not a stepwise leap from one standpoint to another.

c) Let's face it, it's kind of an awesome name. (That's not arrogance speaking -- I didn't come up with it!)

But I think it will take a different form. I hope it will.

In medical school, I shied away from expressing too much of myself or my opinions. My friends will probably scoff at this. I should clarify -- this was mostly true in public environments/forums, maybe not as much one-on-one. I don't think this was a new trend; I'm a somewhat conflict-averse person, though I've been known to pick my battles.

I also somehow became of the opinion that I was only worth taking seriously if I processed my experiences into story-form prose. I'm still struggling with this, but I'm starting to consider that to be false. And the duality of self gets tiring to maintain. The intention to maintain it here began to translate into maintaining it in person. And that really gets tiring.

It seems kind of goofy to think that writing this will somehow affect a significant change in behavior. But maybe I will at times be more successful in holding myself accountable. And hey, I'm kind of goofy at baseline -- who knew? (Spoiler: My sister definitely knows. Better than any other human being alive. This will probably make her feel validated in some way. Just for you, M.)

Identity.

I am a

-daughter

-sister

-cousin

-granddaughter

-friend

-learner

-educator

-mentee, and dare I say, mentor

-reader
-alien

-[select] TV show junkie

-coffee addict

-Bollywood fan (though the 90s make me cringe)

-PJ extraordinaire

---> Some will think this stands for pajamas. Others will say poor jokes. They would all be correct.

-writer

The list is both incomplete and in continuous flux. Now I am also a psychiatry resident, resolving to work harder to find a truer me even as I help patients do the same. And all this with the hope that I will come out a better care provider and individual for the effort.

(Leave more identities in the comments! Yours or mine. The more absurd the better, of course.) 

Mile markers

The purple of her hands taunted me with their frailty

Zip.

Zip. Zip.

Arun's hoodie engulfed me - just as well, since I was desperately trying to ignore the shrill noises of the highway. I chanced a peek forward, Ty was driving. When did he grow a foot? His toes still barely grazed the acceleration. My little guy.

Speedometer, 148mph. Gas, empty, full, running on empty. A stuttering hysterical laugh threatened to break free from my throat. Ty, driving? Ty, swerving. On a packed, deserted highway. Sports cars racing past us, chasing us. Glance out the window, nothing. Ty, underage, younger than age, shorter than height, running in the driver's seat.

Ty, sitting in the witness box. "Lighten your chest, son." "Not your son."

Ty, glaring insolently. "You will answer the question." "Fine. Lighten my chest." He let loose a lusty breath, a brazen smirk flitting across his face. "Yeah?" The cloud of air dissipated, no trace. 

Ty, poker-faced. "She was too much." "Too much?" "You heard me."

I was barely enough. A tease of a taste, inspiring a craving - a single pistachio, the early hours of a TV marathon. Nicknames sagging with the weight of nightmares and sanguine expectation.

Blink, and suddenly it's dad in the driver's seat. Ty's next to me in the backseat, yanking my ponytail while shoving his size 3 foot under my rib cage. The car rang with the impish cheer of his two-index-finger years, vibrated with the thrum of the highway.

Arun sized him up, ever the skeptic, then huffed out a rueful chuckle. "Harass me? If anything, I was the bad influence. I gave her the caffeine addiction, after all. And phone calls at 3 in the morning." "And then she screwed up."

"Yes?" His whisper fell heavy with rust and ashes. "Wish I could say yes. The only thing she did wrong was ask for too much. And I knocked her down for it. Repeatedly."

Because I had too much to give. It pounded through me, clawed out of me, innocence with wax fingers running from a frenzied blaze.

Adrenaline swept through my veins like chilled lava. My hand inched out from the sleeve, its destination left stranded as my grip collapsed. An origami kitten fluttered to the seat by Ty's foot, traces of red ink visible through the folds.

"She cared too much." Angel carded her fingers through her own hair, a distorted mirror of a taunting memory - an impertinent vision of thrones and grapes and a hand languidly soothing over my scalp. "I wrote her letters. I handed her my story, mystery, in a soundtrack. She listened to it, heard what I didn't even know was there. And I couldn't take it back. So I took me back instead."

Because I didn't belong, until you. You translated the crescendo of shadows into a symphony, and now without you, it's morphed into a chanting litany, static in my ear.

The car weaved through ghosts on the street, Dad at helm. Suddenly, gunshot, a red rose bloomed from his shoulder, proud green stem and prickly thorns. No bullet. Another pop, a bullet hole nowhere close to us, yet in the car seat next to Ty, next to me, no, Ty, no, wait…

If I closed my eyes, I could almost pretend it sounded like popcorn exploding in the microwave at movie night. Loud, irregular.

Mrs. Relnik's fingernails tapped a staccato rhythm against the rail. "She forged her mom's signature on a form once." "See, Your Honor, a bad--"

A distracted musing cut through his slow build. "She made a pop-up book about dinosaurs on long-lost planets. I framed one of the patterns she colored for me." "Framed, ma'am?" A stammer - he cut himself off in surprise.

I won a spelling bee for you. It's been my little secret.

Steady. If they would just steady, if the lurches would settle, if the bullets would stop whizzing, I could play the game. Massage the magic spot on my neck, vanish for a little while. Maybe a long one…

The knowledge lurked, crushing and panting, behind his languid gaze. "We could've been twins, you know? Should've been." "T--twins?"

Xavi's eyebrow quirked up even as his voice quieted to a murmur. "Well, different moms. Different birthdays. Minor details." He tossed out a nonchalant smirk.

The smirk was always your tell. Yours to show, mine to know, a bitter aftertaste in both our jugulars.

Ty, all trust and bristling energy, squirming to the tempo of the silencer. His earnest, naïve adoration drools a flood, painting a lake over the road. And the car grows gestures, beating through the sweat of vision.

"I guess...I guess it got too hard." "What did?"

She gave a helpless chuckle, a frantic hand wave with long, artists' fingers -- tried to encompass the words she couldn't lift, the milky threads of burning summer woven into a raging waterfall. "Everything. Phonecalls. Emails. Goodness, I make it sound like we broke up or something. Listen, I don't know, okay! Ask me anything else and I'll know. But if I knew this… well, you wouldn't have dragged me here if I knew." "Listen, Ms. Penny--"

And there was the haughty stare, relishing in delivering a challenge. "Penny to my friends. That's Penelope to you, sir. Why would I tell you anything worth sharing?"

The worst things about the desert are the mirages. A gleefully tempered tempest turned into a parched wasteland, turn of the hat. You put super glue on my idioms, until I sagged under the agony and tore through skin.

Floating an achingly idyllic path as Airplane Ty whizzes around the car, his lilt tripping over his tongue, undulating with eternity. The brakes suddenly hydroplane a powerful void, leaving behind lather and a choppy shore.

"Once in a dozen paces--" "--Excuse me?"

"You're excused." "That's not what I--"

"I know that's not what you. So what are you?" "This isn't about--"

"--Like hell it isn't!"

[AHEM]

"Ma'am, let me finish. Once in a dozen paces, and it wasn't enough. But you knead the dough and hope like hell [AHEM] it rises." "Yes, but--"

"I do believe I'm getting kicked out for impertinence. Just too bad, hm?"

The gavel banged onto its bed of petals, deep maroon pulsing with rusted hope.

Kick in the Pants

Med school started 'forreal forreal' yesterday, with Host Defenses and Infectious Diseases. So far, it is busting our chops big time. And it's barely been two days.

Exam day Tuesday didn't go quite as Ian had hoped. And tragically, this is Ian's new reality:

In other news, things I've learned so far:

The only way to get better is to get wayy worse first

And there is a profound revelation reflected in Ian's shaved head

(yes, his nose is actually that hooked. Peer closely the next time you see him; it'll creep him out)

This is kind of turning into the 'Ekta and Ian' show, isn't it? Only good things can come of it.

Don't Forget the Confetti

Today we are featuring some guest art by [drumrollllll] IAN P! Dutifully doodled on the last day of lectures before our long weekend, between the hours of 1000 and 1200. Make of that what you will.

Every exam day, Ian comes with high hopes -- of gifted A's, laptops in the air, and confetti:

 And tragically, every exam day, those hopes are dashed.

Hope springs eternal.

Dukes and Pirates

Signs my caffeine detox worked (AKA, ET on one cup of coffee today):

(Disclaimer: May also be signs of excessive studying and pod-induced claustrophobia. 

Read as: side effects of medical school. 

AMCAS should issue a warning label.)

 - I spontaneously start dancing in my seat like a jitterbug

(Please note, this is NOT me attempting to swing dance in my seat, which would have disastrous results, such as me falling out of my chair and suffering a traumatic brain injury after hitting my head on the corner of my bed, or perhaps more tragically, falling out of my chair and toppling my desk over, killing my cool stereo system in the process).

- I facilitate a rum-war between my Lego Jack Sparrow and my teddy finger puppet pirates

 

- I want to dunk Liz in a pit of green Nickelodeon goo to commemorate her birthday (HAPPY BARFDAY!)

- I work on a ridiculous blog entry instead of studying.

 

Ok, who am I kidding? That happens almost every time.

Exam-time Munchies

I know, I know, people get them all the time. But I don't get them barely ever.

Being hungry for a snack is so inconvenient when you don't have any good snacks at hand. Luckily, I remembered just in time that I still had some tortilla chips in my cabinet, and salsa in the fridge. Just in time for what, you ask? Some kind of colossal disaster, I'm sure, but luckily we will never have cause to find out, until the next time I have a salt-craving.

I'm waiting for my ghrelin to calm down and my leptin to kick in so that my stomach stops grumbling at me (and no, those are not monsters hiding in my closet; they are intestinal hormones! I bet whoever named them got a good chuckle out of it). I think if I were to name a hormone, I'd call it "savvy," for a multitude of reasons. Other suggestions?

You know what's awkward? When your stomach starts grumbling at you while you're trying to study in a quiet pod surrounded by other quietly studious people with tamer stomachs. My stomach has no sense of propriety. Granted, it is my stomach after all, but still! Poor excuse!

You know what's brilliant? Always over-estimating either how many chips or how much salsa you need to put on your plate at snack time. You leave yourself the perfect excuse to go back and fetch more of the other to make up the difference. *grin* Sometimes, eating junk food is totally worth it. Now if only I had some sharp cheddar cheese, or samosas, or chaat, or bhel puri…...

Instead, I am settling (not too much) for this, against the lovely backdrop that is the disaster zone otherwise known as my desk:

Isn't caffeine supposed to be an appetite suppressant? I guess it's busy enough keeping me awake and "focused" right now.

I suppose it's a good thing that now I can't stop thinking about renal clearance.

A derepressing (not depressing) December

aka How I Got My Brain Stuck in the Alphabet Soup Jar

...and valiantly strove to fish it back out before 12:30pm Monday desperately hoping something had stuck.

Well, except the torture is over, so I'm not actually hysterical and can look back on this weekend with a healthy dose of amusement and sarcasm. In that vein, I invite you to enjoy a photo-essay.

I spent my weekend drowning in a sickly colored stew of enzymes and mechanisms involved in DNA, RNA, and protein replication, repair, processing, etc., with a base of genetics and modes of inheritance, flavored with diseases and molecular bio techniques, with some drugs to taste. My white board at some point said at least part of it best:

 (Ignore the cute doodles, courtesy my friend TQ; if only they were that accurate).

Despite having yet to crack the spines of any of my borrowed CMB textbooks, I felt kind of like Oasis and Ender, crushed under the weight of all that knowledge and despair:

 Raja, on the other hand, looked positively gleeful and extraordinarily pudgy conquering my mountain of textbooks:

I would almost wish to share his sentiments, except it would probably involve an immensely high volume of sugar intake to reach his girth, which is his secret source of power.

Sunday night found me studying the drug list. And consequently musing on all sorts of toxic scenarios therein. In short, I was going a little crazy:

(For the uninitiated, α-amanitin is arguably the most deadly amatoxin, in this case found in Amanita phalloides, or the death cap mushroom. It inhibits RNA polymerase II, causing the cells in your liver to burst, leading to death within a little over a week.)

Luckily, I made it to and through Monday, arguably in one piece, and hung out with a lot of pretty cool people Monday night to glory in our post-exam-ness. And as soon as I got back:

Boy was I tired.

Hanging with Yorick

Laurel and I spent some quality time in the pods today getting inside my skull. And I mean that literally, not figuratively.

If my blog were an anatomy atlas, I would draw in a bunch of arrows and walk you through the million foramina, fossae, and fissures therein. Thankfully, for the sake of both your sanity and mine, it isn't. Quirky person that I am, though, I will walk you through our time of hardcore studying.

He started out by sampling my caramel macchiato - I'm sure (I hope) coffee-making techniques have advanced for the better since his heyday.

Sadly, between the two of us, we polished it off pretty quick.

It potentially wasn't our brightest idea to caffeinate him, though. Pretty soon, he dived auditory meatus-first into 21st century technology, commandeering Laurel's iPod and rocking out to Outkast...

...after which he proceeded to chat up a storm of bone dust, and showed me a pencil tattoo under his eye socket that read "infraorbital fossa."

At some point, we gave up on the pretense of studying and spend many precious moments staring creepily at Laurel, much to her chagrin. Or amusement. I'm still not sure which.

We were having such a swell time, we didn't even realize it was time for solemn farewells.

On the bright side, we had a jaw-droppingly amazing time. Being crazy creepers.

(Shout-outs to Laurel, Dr. Pumplin, and Shakespeare)

Anatomy of Stuffing

I got back home last night around 11:45pm after an afternoon/evening of studying that started around 2:30pm and existed to highly variable degrees of productivity (often at the zeroth one - and that should totally be an ordinal!). First order of business, use my $5 Amazon mp3 credit, expiring in 15 minutes. And I now have a brand new album to check out! (Thanks for the help, DTD =))

Maybe it was the late hour, maybe I was finally cracking, but as I aimlessly spun around in my chair, my eyes alighted on my stuffed animals and I found myself idly wondering what their abdominal anatomy looked like. Say what?? My anatomy vision didn't get me too far, though -- all that stuffing got in the way, especially with Raja. And Sly was just too small for me to imagine much of anything. I was trying to superimpose a liver, which would dominate his entire front and then some. Oops. Just for reference, pictures:

Sly's the impish/sleepy raccoon in the middle

And Raja is the ginormous tiger Erik is cuddling up to

Of course, the logical progression from trying to visualize Raja's intestinal structure was to Google stuffed animal anatomy! Of course. It took some digging (and I somehow managed to restrain myself for a whole 24 HOURS before more fully indulging my craziness), but I found something super-cool! This answers almost all of my unresolved, burning questions about the innards of my stuffed raccoon, though I think there may be no hope for Raja:

Okay, so he's made of gummy stuff, whatever that's made of, and not teddy bear stuffing, but close enough. And he's a bear, not a raccoon, but it works, somehow. And, talk about AWESOME. The digital artistry, the level of detail, just...wow. I am blown away.

And the artist, Jason Freeny, happened to have something that tied in semi-perfectly with what I've spent the last couple of hours tackling: the female reproductive system.

Okay, so this image jumps ahead a few months, but close enough. Umbilical cord! Hemostats! Fertilization! HUGE BRAIN! Oh, wait, that's exam 3. Let's not get ahead of ourselves here.

And this last one is especially for Kevin:

I shouldn't be allowed near my blog after, say, 8pm, because my mental processes start breaking down. Clearly.