Wright State University Boonshoft School of Medicine, commencement address, May 24, 2013

Good evening and congratulations to the Class of 2013!

I graduated medical school almost exactly ten years ago today (which sounds like a much longer span of time than it actually feels) so naturally when I started to write this address I thought back to my own med school commencement ceremony, or what little I remember of it.  Particularly I tried to recall the invited speaker we had that year and what pearls of wisdom he imparted, so that I could frankly plagiarize them and pass his pithy truths off as my own.

The problem is, I can’t remember anything he told us.

Our med school commencement speaker for 2003 was Jimmy Breslin, a reporter for the New York Post and certainly a more illustrious figure than I.  And he had a very well-written speech—I mean, probably he did, because again, I can’t remember—but all I really do recall is that he spoke a lot and he spoke for a long time.  And I remember thinking to myself, as I sat there in my academic regalia, sweating under the layers of polyester like one of those cook-in-the-bag microwave meals, that this man and his endless speech were the only things standing between me and my medical degree.

(He did eventually stop talking, by the way.)

I can’t convey to you what an honor it is to be invited to share this day with you all, which with the possible exception of this address, is likely one of the most important and memorable days of your life.  So when I sat down to write this speech, I had only two goals in mind.  First goal: to give you real advice that you can actually carry with you for the long road ahead.  And my second goal: keep it short.

Now, as a fourth year medical student, you probably already experienced the fact that the world is teeming with people all too eager to give you advice.  Much of the advice from senior doctors in particular will be strangely centered around when, how and if you should eat, sleep, and eliminate during residency.  (Clearly people have strong feelings about such things.)

But as a fairly junior attending physician myself, the idea of giving you all advice outside the realm of the purely practical does feel a little presumptuous.  The field of medicine is constantly changing—maybe now more than ever before—and I can’t pretend that I know what the future will look like any more than you can. Therefore, I only have one piece of advice, so as to make it easier for you to remember, and that is this:

Remember who you are in this moment.

And who, exactly, is that?  At this moment, you are a fourth year medical student, just minutes away from being granted your medical degree. You are proud, and you should be.  You are excited, and you should be. You are a little apprehensive about what comes next—intern year, residency, the hours, the new responsibility. That, you should be too, but I’ll not belabor the point—other than pregnancy, there’s no condition about which people like to recount horror stories more than medical residency.  Finally, and perhaps most importantly, you are still idealistic. I hope, at least, that even at the end of medical school you have retained the idealism that brought you into medicine in the first place.

And why did you go into medicine? I’m sure there are a host of different reasons, phrased in a number of different ways—but I think, and I hope, that it all boils down to this: you want to help make the world a better place, one patient at a time.  And right now, this seems like the most obvious thing in the world, the thing that has powered you through years and years of books and finals and 4:00am scut rounds done on no sleep and an empty stomach.  You’re doing all this not just for yourself, not solely for any kind of personal glory or reward, but to help other people.

Remember who you are in this moment.

Older doctors, particularly the more cynical ones, will speak of idealism as though it’s a bad thing, some sort of marker for naivite.  But I’m going to tell you this right now: idealism is never a bad thing.  And idealism seasoned with experience is maybe one of the very best characteristics a doctor can have.

Remember who you are in this moment.  A young doctor on the cusp of doing great things.  Some of these great things will be large acts, the majority of them will be small, but all of them will stem from who you are in this moment, who is someone with the energy, idealism and work ethic to make the world a better place.  With all the pomp and circumstance of this particular day and all those that preceded, it seems like the concept of service would be difficult to forget.  But believe me when I tell you that forgetting is the easiest thing in the world.  I have forgotten it many times myself.

Because there will come a night on call during internship when you’re going to feel beaten down and tired and regretful of having ever gone to medical school in the first place. And right when you manage to sit down, the first time that you’ll have had a chance to sit down all night, the charge nurse on that floor will yell at you for sitting in her special chair. And right then, you will forget who you are in this moment.

Or during residency, you’ll have a patient who will push all of your buttons.  And that patient will be loud and belligerent and unappreciative and will say things that make you feel inadequate even after the hours and hours of work you’ve put in trying to take care of him. That patient will make you angry, unsympathetic, and when that happens, you will forget who you are in this moment.

Or there there will come a time when you’re an attending, after you’ve been working late for the fourth evening in a row. This will be the one day that you have any hope of getting home to see your spouse and kids before bedtime, and right as you’re finishing up your dictations and ready to hit the door, an emergency case rolls in that no one can staff but you.  And that particular evening, you will forget who you are in this moment.

Cynicism is a protective adaptation.  It is a shell that doctors build around themselves after they feel that they’ve worked too hard, seen too much, been burned too many times.  It’s a way for doctors to broadcast to their colleagues and to the world at large that they’re so expert in the human condition that nothing surprises them anymore.

But don’t be that person.  Don’t be the cynic.  Be for the rest of your career as you are today, someone who doesn’t tuck your idealism away like an obsolete relic of your years in training, but proudly wears it on the lapel of your white coat. 

Be ready for everything you think you know now to change. Be open to new experiences. But always remember who you are in this moment.

Congratulations to the Wright State University Boonshoft School of Medicine Class of 2013.  Congratulations, doctors. May each of you have a long, fulfilling career filled with interesting patients, challenging days, and a lifetime of surprises. The rest of us have been waiting for you, and are so happy to have you join the team.

Now roll up your sleeves and get in here. We’ve got a lot of work to do.  

spotlight on specialties: anesthesiology

Sorry, I'm a little bit in remiss in that I didn't post this link up earlier, but here's a link to the AAMC article on the field of anesthesiology, for which I was interviewed along with a number of much more distinguished and accomplished colleagues. If you're interested in the field of anesthesiology, either as a potential career or if you just want to know what exactly it is we do all day, check it out.

An excerpt:

“Anesthesia is hands-on, fast-paced, and has tremendous capability to make a positive impact on our patients’ lives as anything else we do in the hospital,” says Dr. Au. “In my opinion, it's one of the most interesting, most exciting fields in medicine, and I firmly believe I have the best job in the world.”

I've said it before and I'll say it again here because it's appropriate: it's a difficult juggle to balance work and family, but it's all the more difficult because I do indeed love my job.  If I didn't love what I did at the hospital as much as I love what I do at home, my choices would perhaps be easier, though maybe not as satisfying.  So really, in the end we should be grateful for the difficult choices, and the chances we have to make them.

(And on an unrelated note: the above photo panel is from pictures I took with my phone during residency--isn't it amazing to see how far cell phone photography has come?  Wow! The future! hovercrafts that fold up into briefcases! And etcetera!)

great and lesser expectations

I had Cal three weeks after starting my training in anesthesia--a highly conspicuous move that I think indelibly branded me for the rest of my academic career as "that pregnant resident"--so I think it's fair to say that I have some insight into the assumptions that people tend to make about people mixing family with a career in medicine.

In most ways I imagine it's not unlike mixing family with any intense or high-powered careers--look at all talk that Marissa Mayer's pregnancy incited after she was named the new CEO of Yahoo. (Aside: I'm not saying that my career is anywhere near as high-powered as that of Marissa Mayer, just that the case is emblematic). Particularly in the field of anesthesia, where I'm in the room but often lurking in the background or behind a drape, I've heard a lot of conversations about medicine, other physicians, and things that fall in the rubric of "lifestyle choices"--conversations that maybe weren't meant for me to hear.  But as a result, and as a result of living my own life, I can say for sure that women in medicine (physicians in particular) who choose to have children during the most active parts of their careers suffer under what I'd describe as a handicap of perception.

Perception. Not an actual handicap, but one of perception. There's a Chinese saying that my dad always uses that roughly translates to, "When you're walking through someone else's pumpkin patch, don't bend over to tie your shoes." (OK, that's a very rough translation--I don't think the parable from which the saying was taken originated during a time when shoelaces were a particularly popular feature of Chinese footwear.) What it means is: if you're in a setting that breeds suspicion, try hard not to do suspicious-looking things, no matter how innocent they actually may be. Because you may be just tying your shoes in the middle of that pumpkin field, but a casual observer might be inclined to think you're actually stealing those pumpkins.

I think that in medicine (and perhaps in the working world in general but what the hell do I know, I've never had a real job doing anything else) people are quick to assume things about working mothers, not too many of them flattering. I'd like to say "working parents" because believe me, I'd love for us to get to a point where there is actual gender parity on the issue (to be fair, I do think that Joe and I do have gender parity when it comes to parenting, but...we do have to leave our household occasionally and interface with the world) in the year 2012, this is still more of an issue of perception for working mothers. The following is a list of some of the things that some people are quick to assume about women with children who work outside of the home.


1.) We don't work as hard.

2.) We complain when we do have to work as hard as everyone else.

3.) We want special favors and allowances in the workplace because having kids somehow entitles us to them.

4.) We are unreliable because something's going to come up with our kids and we're either going to leave our co-workers with the extra work, or sometimes leave our jobs entirely.

5.) We just don't care as much about our jobs as our counterparts.

5.) All this is somehow inevitable.


The problem with other people's perception, especially those colored by preconceived notions, is that there's very little that you can do about it.  It has very little to do with you, and sometimes even very little to do with reality itself.  And that perception can be insidious, like a Chinese finger trap--the harder you struggle against it, the tighter it binds you.  (Yes, again with the Chinese.  WE HAVE A RICH CULTURAL HISTORY, OK?  Actually I have no idea whether Chinese finger traps are actually Chinese, or just "Chinese," like fortune cookies or General Tso's chicken, but whatever, it's not germane to the metaphor.) You want for all the world to defy the lowered professional expectations that people have of you, to prove them wrong, but sometimes it feels that the harder you try, the more you're reinforcing them nonetheless.

So what I think a lot of female physicians with kids do--and what I know I certainly do--is overcompensate. You do it all and then some. You work even harder. You try to never complain about your schedule or your hours while you're at work. Not only do you not ask for special favors, you embrace situations that allow you to prove that fact. In other words, you try to work as much and as hard as everyone else, and then you go a little bit farther, just to make sure. You try to be above reproach.

Sometimes this works. Sometimes it doesn't.

I think often now about Michelle Obama, particularly during the president's first presidential campaign, and how hard she and her team had to work to control her image.  The reasons people might have a negative impression of her are perhaps multifactorial and not entirely flattering of a portion of the electorate, but there seemed a point where every little thing she did or said, no matter how innocent, was misconstrued as playing right into her detractors' expectations.  (The endearing but now notorious fist-bump comes to mind.)  Sometimes it feels that way to me too.  Representing not only myself, but working mothers in medicine as a group, I am very aware of trying to present myself, present all of us, in the best possible light.  Again, overcompensating.  I think this explains a lot of my personality at work, which I have often classified as "aggressively pleasant."  As in: I will be easy-going and pleasant to work with if it kills me.

Sometimes this gets pretty tiring.

I also will note that there's a segment of people who will respond to this blog entry with the opinion that I and others like me are far too sensitive about these issues, reading meaning into things that have no meaning, turning mountains into molehills.  I am perfectly fine with people responding however they want (as someone who has been writing online for more than a decade, I think that if it's your right to publish something online it's the right of your readers to respond, even if they disagree with you) but I also think that actually being a working parent in medicine, a working mother in particular, lends you a perspective that you don't have access to otherwise.  So saying that we're overly sensitive to the issue of low expectation or perception bias is, to me, a little like a straight person saying to a gay person that they're being too sensitive about homophobia, or a white person saying to a Latino that they're too sensitive about racism.  Or, maybe, like Mitt Romney condescendingly telling poor people that they just don't work hard enough.  If you don't know what you're talking about, sometimes it's best not to talk.

I would love to hear your own stories about whether or not you feel that working parents in medicine are stymied by lowered expectations or perception bias, and what you all do in your lives to roll with the punches.  Because though the natural (or perhaps easiest) reaction is, "Screw 'em! Who cares what people think?" (this is Joe's response, for example) the fact of it is--I do care.  I care what people think of me in my career.  I care not only about being a good doctor, I care about being perceived as a good doctor.  I care not only about having a good work ethic, but about having that work ethic be a key part of how people see me. I care.  Maybe not as much as when I was in training (when I wouldn't even have dared to write a blog entry like this at all, for fear that I'd be seen as "whining") but I still care a lot.  So until I stop caring, or society changes as I continue to hope it will, I guess I'll keep walking through this field, head up, eyes straight ahead, and try not to look like I'm stealing pumpkins.

life or something like it

OK, so let's talk about this:

Some of you may remember an Op-Ed in The New York Times this past summer, written by Dr. Karen Sibert, entitled "Don't Quit This Day Job." If you haven't read this piece already I strongly recommend that you do, because I think it can spark a lot of good dialogue on the topic of work-life balance in medicine and what it means, personally and on a systems level, to find that balance. I wrote a response to that Op-Ed here, and we all discussed and discussed and discussed that some more. In particular (I've been doing a bit of traveling and speaking this past year and as a result have had the pleasure of spending a lot of time with doctors in various stages of training--pre-meds, med students, residents, fellows, what have you), I find that young doctors are especially hungry for dialogue on this topic, which seems to be foremost on everybody's minds and yet often discussed furtively, behind closed doors.

Dr. Sibert has recently started blogging as well, and posted a piece today entitled, "Give yourself a break--don't have a baby during residency." An excerpt here:

Overheard in the OR—a surgery chief resident ruefully explaining to a senior surgeon why no intern or junior resident was available to scrub in on his case. “Everyone in our department is either pregnant or on maternity or paternity leave,” he said.

The senior surgeon just shook his head. 

From my vantage point as the anesthesiologist on the other side of the drapes, I thought to myself, “Really? What’s wrong with these people? What would give anyone the idea that residency is a good time to have a baby?” When I look back to what it was like to deal with pregnancy, give birth, and look after an infant, all I can say is that internship was easier. After all, as an intern—even in the bad old days—I had some nights off. 

Yet having a baby during residency is increasingly common among male and female residents alike. For women especially, it sounds perfectly awful. We’ve all heard the stories—pregnant residents struggling with nausea and fatigue during long nights on call, or vomiting into a trash bag in the operating room; new mothers trying to breast-pump in the hospital locker room during a half-hour lunch break. 

One possible response is to argue that senior physicians should be more sympathetic to pregnant and nursing residents, and give them longer lunch breaks. This would be in keeping with the kinder, gentler world of limited resident duty hours and mandated nap times. 

But it’s equally fair to consider that residency might be a bad time to have a baby.

Even with today’s work hour limits, residency training in any field involves stressful days at work, limited control over your schedule, and frequent nights on call. It’s hard to get nutritious meals on a regular schedule, even if a pregnant resident could stomach the food in her hospital cafeteria. Nor can she get enough rest. Anyone who’s been pregnant can recall moments of such profound fatigue that she would kill for an afternoon nap, and a resident can’t simply lie down when she feels like it. Can this be a healthy way to go through pregnancy?

(Read the full blog entry here.)

So, a little background to catch everyone up first, just to show that I have some perspective of which I speak on both sides of the "when to have kids" quandary.  I got pregnant with Cal the fall of my second year of Pediatrics residency.  I can't speak for every Pediatrics residency experience, but to be a resident at the Children's Hospital of New York was a very intense experience--lots of call, tons of ICU time, patients on the general wards that would have been on the unit in any other hospital, it was (and I think I can safely say this now) much more difficult than my anesthesia residency, even on the "best" months. Cal was born soon after I switched into Anesthesia residency, after which point I began in earnest the balancing act that is having a child during training.  (Because, you know, that's the real difficult part--not so much the pregnancy, but the part where you and your baby are actually in two separate places.)  I spent the entirety of my first trimester with Mack finishing up my Anesthesia residency, and he was born about five months into my first job out of training, when I was a junior junior junior (junior) attending.  Now I'm about three and a half years into my post-graduate career, working full-time and more or less settled in my current job situation, and as you know, our third child is due in July.

OK, so to sum: one pregnancy early in residency, one half-in-half-out-of residency pregnancy, and one pregnancy as an attending.

First things first: Dr. Sibert is right on a couple of points.  It is more difficult to have a baby during residency, for many of the reasons that she mentioned and more.  I can't argue that.  I lived it.  It's a daily challenge.

But here, now is a partial list of just a few other things that are also more difficult during residency: Being in a relationship.  Being a good partner to your spouse.  Spending time with your friends.  Calling your parents.  Keeping up with current events.  Making time for your hobbies and creative pursuits.  Studying for your boards.  Reading a book for fun.

I wouldn't tell you to not do those things either.

Right, so in part I jest, because obviously the choice to have a child during residency (and that is what we by and large have as privileged, educated ladies and gentlemen: a choice--that is, unless certain members of the Republican Party intelligentsia have their say) is obviously a huge one that should not be taken lightly.  Nor do I think it is one that people do take lightly, or look at as just another point on their "achievement checklist" (as per Dr. Sibert's blog entry):

In a way, the determination and single-mindedness of physicians may help to explain why they have children during residency. Having a baby becomes part of the achievement checklist. Finish college—check. Finish medical school—check. Score residency position of choice—check. Find life partner—check. A baby becomes the next item on the list, and residents often feel additional pressure from parents and in-laws who are anxious for grandchildren. For the young female resident who’s been a bridesmaid in her best friends’ weddings, it can be hard to watch them all start having babies without feeling the urge to have one of her own.

No, I don't think that it is a decision that people make on a whim, or a life milestone that people fall into secondary to intertia or because of societal expectations or because their parents are screaming for grandbabies.  Remember, these are people who to this point have been through between four to eight years (give or take--if we're talking about medical residents) of post-college education and training, who knew what they were getting into (med school isn't exactly something you end up doing by accident), knew that it was going to involve a lot of hard work, and make choices to live their lives outside the hospital a certain way. The life of a medical resident is not a "Cathy" cartoon, after all. (I'd say my life is closer to a Calvin and Hobbes strip, actually.)

Would I tell all med students to try to have baby during residency? No, of course not, that would be ridiculous. But equally ridiculous, in my mind, is the blanket statement that no one should have a baby during residency. These are individual choices that people have to make for themselves given their specific circumstances, where they are in their lives, where they're looking to be in the future--all with more nuance and interpersonal variability than can be covered with any overarching recommendation. What I would say on this issue is the same thing I tell people when they ask me if they should go into medicine in the first place.

"You can do it. But you have to want it."

You have to want it. It comes down to that. Very few things in medicine are easy--and if I may venture, very few parts of parenthood are easy.  (In most ways, like I said before, the pregnancy is the easiest part.  Never again will you be able to have this much control of your offspring, nor will they ever again be so portable!  But I digress.)  You have to know exactly what you're getting into, you have to know your own limitations and what you're going to have to do in order to make a more difficult than average situation work...and you have to want it.  But you can do it.  It can be great.  And you and your family can thrive.

Joe and I (and I say this just as a personal anecdote--everyone's situation is different) went through a kind of specific calculus when we decided to have kids during residency.  And our calculus, basically, was this: "What exactly do we do with our time when we're not at work?"  Well, we were medical residents living in Manhattan.  Obviously we worked long hours, and we not infrequently worked for 24 to 36 hours at a stretch.  We weren't big partyers, and since most of our friends were also medical residents (and therefore pretty busy as well), most of our free time we spent with each other.  We'd eat out, get coffee at the bookstore to read free books preview books that we intended to pay money for, go to the movies, occasionally splurge and go to a nice restaurant or go see a play. And this was fun, having that kind of relative free time, and a little teeny bit of disposable income.

But then came the next question, "Are we willing to give some of that up--have less free time to do adult things and spend more time doing baby things, as a family?"  Yes, we decided, we were.  Also we considered, "Are we making enough money to have a baby?" Yes, we decided. It would be tight, predominantly because of childcare costs, but we could make it on what amounted to a single salary after paying for a nanny.  "Do we have enough time between us to take care of a baby?"  Again, like with the financial resources, we would be tight, but we thought we could do it.  (It helped, I think, that we had a dog for a few years by this point--the juggling act of allocating time and responsibility for the care of another living thing was good training for us in terms of the childcare calculus.)   In other words, we went through the exact same decision method that most other couples go through when deciding to start a family.

And finally, the last question, "Do we really want to do this now, or do we want to wait until later?"  Later was, I think, kind of an indistinct entity.  When, exactly, is the best time to have a baby in your medical career?  Everyone has different opinions, but I will tell you this as someone who has basically tried it a lot of different ways: it's never a good time.  It's always going to be inconvenient.  There's always going to be something making it difficult, and there's always going to be conflicting demands on your time, attention, and resources.  With Mack, for example, I had just started my first job as an attending anesthesiologist, and Joe was a newly minted fellow who was taking call every single night, including weekends and holidays, for a year and a half straight.  Thing 3 is set to be born this July, and I don't think I can even anticipate what that's going to be like--three young kids at home, two parents working full-time, lots of expenses, both of us taking night call. Also, to be honest, I'm going to be seven years older this time around than when I had Cal, and I worried (and continue to worry) about the byproducts of my sad old aging eggs.  The "perfect time" to have a baby is a myth.  So you have to do your calculus.  You decide if and with whom and how you you're going to get there, and you decide how much you want it, and when.

Joe and I wanted it.  We wanted Cal, we wanted Mack, exactly when and where and how they came about.  They made things harder.  But they also made things better.

Now let's also talk about the fact (because in many ways having a child as a medical trainee is very different from having a child in any other professional context) that you have to want to be a good doctor too.  That's an important part of it, just as important as the other half.  As a trainee, especially, you have an awesome responsibility to your patients and the future of your medical practice, and you have to figure that into your plans as well.  You have to make time for your education, and having a lot of responsibility outside of your work does not excuse you from your responsibilities while you're there.  There's no half-assing this one--people in the hospital need you too.  You have to put in the time and you have to give that sweat and blood the same as everyone else--in some ways, you have to put in more than everyone else.  But that's part of knowing what you're getting into as well.  Like I said: you can do it.  But you have to want it.

I have seen the argument again and again that having a child during residency makes you a sub-par doctor and a sub-par parent.  I would beg to differ, of course, but how I'm doing on those two fronts is not really for me to judge.  My patients and my colleagues decide how good of a doctor I am.  My kids will decide how good of a set of parents Joe and I are--maybe not right now, because they are both young and therefore still think we are awesomesauce--but down the road, ten or twenty years from now, they'll be able to tell us.  Still, we try.  We knew what we were getting into and we work hard and we try to do our best.  And if I may say, I think we're actually doing pretty OK on both fronts.

On such weighty, personal topics, I would never tell people what to do purely based on my own experience.  (In fact, the only real advice that I can give unreservedly to all medical trainees is: learn at least a little Spanish, and buy some comfortable shoes.)  But I will gently remind you that no matter what stage of training you're in, medicine is just one part of your life, not your life in its entirety.  You'd be surprised how easy it is to forget that.

No doubt residency is hard.  Being a doctor is hard.  But know what you're getting into, get as much information as you can, and thus armed, decide: do I want to do this?  Am I equipped to do this?  Do I have the support to do this?  And then make your choices.  Reading opposing viewpoints is good.  Reading different people's experiences is good--it's largely why I wrote my book, and why I continue to keep this blog, year after year.  Talk it over with your partner, your friends, your colleagues, your mentors.  All these things will inform your choices.  Live your life in whatever configuration, in whatever order you choose to live it in.

And then let the rest of us know how you're doing it too.

(Edited to add: I would love to hear discussion on this issue from all sides, and I'll thank my excellent readers in advance for keeping things collegial--in particular towards Dr. Sibert, who I don't know in person but is obviously a professional colleague in the world of anesthesia. We don't all always agree, but how boring life would be if we did.)

tripping to the light linktastic

First off, you guys knew there was virtually no way that I couldn't respond to this Op-Ed in The New York Times from this weekend right?  In case you hadn't read it, a quick excerpt to whet your appetite:

Students who aspire to go to medical school should think about the consequences if they decide to work part time or leave clinical medicine. It’s fair to ask them — women especially — to consider the conflicting demands that medicine and parenthood make before they accept (and deny to others) sought-after positions in medical school and residency. They must understand that medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve.

I recently spoke with a college student who asked me if anesthesiology is a good field for women. She didn’t want to hear that my days are unpredictable because serious operations can take a long time and emergency surgery often needs to be done at night. What she really wanted to know was if my working life was consistent with her rosy vision of limited work hours and raising children. I doubt that she welcomed my parting advice: If you want to be a doctor, be a doctor.

(Italics and bold face I added for emphasis, but the words of the actual article are reproduced verbatim.)  So! Thoughts? I had a few. And I posted them here. I hope this doesn't count as some sort of cop-out substitute for an entry, but as both article probably highlight, the role of a physician parent is fairly busy, and there's only so much time in the day for writing, as much as I might love to do it.

For those somewhat less interested in the issue of out-of-home-working parenthood, here is a video from this weekend. As you can see, Cal went from being somewhat nervous in the water to staging his own underwater Cirque du Soleil.

And finally, remember to check out the awesome JetPens and book giveway in my guerilla marketing contest! Don't stress, your entry doesn't have to be anything XXX-treme, it could be as simple as starting a Twitter word-of-mouth campaign or sharing a link to the book on your Facebook page! Just e-mail me with a link to your entry to officially enter the contest! (This is just so I can keep track of everyone.) They're really good pens, guys. And it's a pretty decent book too, on an issue--the balance of medicine and parenthood--that clearly needs to be shared and discussed.

That about sums it up.  Hope you had a good Monday!

psychology today

You may have already seen this, but I have a new writing gig on Psychology Today, and as my first post, I put up a piece that I've been noodling around for a while, about work-life balance during residency.  If you haven't seen it yet, take a look.

It doesn't totally surprise me, though I guess I'd be lying if I didn't admit that it surprised me just a little, the reactions I got to the piece after I posted it.  There are some measured responses, some balanced responses, but also some responses that make me realize: wow, some people really feel a lot of generalized antipathy towards doctors.  And that makes me kind of sad, I guess.  I don't deny that it's a privilege to go to medical school, or that it's a privilege to take care of patients, but I wish...I don't know what I wish.  Maybe I just wish that criticisms lobbed towards doctors didn't automatically lead with the assumption that we are all terrible people with icy, cold hearts made of cash registers and human tears.  Or that we all drive Lexuses.

(And, for the record, though I feel partially like I'm losing ground by even bringing this up--neither Joe or I drive a Lexus.  I myself drive a Toyota Camary that we got from a used car dealer, whose cosmetic imperfections compel perfect strangers to stop me on the road in order to harangue me about body work.)

I put the piece up to talk about the fact that a profession born out of humanism sometimes fails to use humanistic principles in dealing with its own trainees--trainees who are largely idealistic and hardworking and wanting more than anything else to do good.  And yet many of the comments I got sort of went in another direction, almost like an airing of grievances about the whole of medical profession itself.  So.  Three things.

One: I'm really glad I wrote the book I did.  If for no other reason to humanize the practice of medicine to the outside, and to let people see what it's like, really like, to be a young medical trainee who, like all young medical trainees, got into this profession not for fame or fortune or the promise of a champagne fountain in their two-story foyer, but simply in the interest of trying to do her very best, for her patients and for her family.  Many, many of the people who have read my book already are involved in medicine in some way, but now, more than ever, I'm determined to bring it more to a non-medical audience.

Two: I have no problem with getting comments opposite to my own viewpoint (so long as they are not gratuitously vitriolic), because that's the value of having a system which encourages open discussion.  So I really hope that, for this piece and future pieces, that I get even more discussion, on all sides, and that the culture of those discussions is as well-conducted as the ones we've been able to have on this page.  Do you have any thoughts about the piece?  Why not weigh in?

Three: I'm delighted to have started writing online for Psychology Today, because I'm excited to bring the topics that I care about to a wider audience.  The focus of my column on PT is the human side of the medical profession, and I can already see that we're going to have a lot to talk about.  So what should I talk about next?  I have some ideas, but you guys tell me: what do you want to read about?

sink or swim

Hope you're having a good Memorial Day weekend, everyone.  As we enjoy our holiday, of course let's not forget our brave men and women in the armed forces, without whom this beautiful summer weekend with our families and loved ones would not be possible.

In the States, Memorial Day marks the official start of the summer season, and this makes me realize that the idea of summer, to someone in or recently departed from academic medicine, is very different from the idea of summer held by the rest of the population.  For most, summer means school's out.  Summer means vacation.  Summer means sunshine and barbecues and leisure.  But for the eight years that I was in academic medicine (I'm leaving out the year that I was a first-year med student, since first-years usually get their summers off, though they usually spend the time doing something unbearably earnest), summer meant one thing: new beginnings.

The Gregorian calendar begins in January, and most schools from elementary to university begin somewhere in the neighborhood of August/September.  But in medicine, the new year always begins towards the beginning of the summer.  One chapter ends, another chapter begins.

During the summer, usually on or close to July 1st, everyone in academic medicine moves up a peg.  Third year med students become Sub-Is.  Interns become residents.  Residents become new attendings.  New people come in to fill the spots vacated.  Everyone is in new roles, figuring out what they're supposed to be doing.  Want to know why the conventional wisdom is that you should never be admitted to a teaching hospital in July?  That's why.

Here's an excerpt from my book that I was thinking about today, and after the excerpt I'll tell you why.

A sub-internship, or “Sub-I” (as it is known to those of us who cannot get through a sentence without acronym or abbreviation) is basically the training bra of residency. It is a pre-requisite for graduation from medical school, consisting of a month where we assume the patient load and care responsibilities of a first-year resident (or “intern”), albeit with the increased supervision and support required by logic and law. It is a dress rehearsal for the real thing.

In one sense, being a Sub-I the logical progression from being a third year medical student. See one, do one, teach one is one oft repeated credo of academic medicine, and after a year of watching residents in action, it seems due time for us to start “doing” on our own. Sounds reasonable enough. However, the reality of the transition from third-year med student to Sub-I is more like being lifted dripping from a knee-deep wading pool in which beach balls and foam noodles lazily float, and thrown headfirst into the churning ocean, your only instructions being to keep your head above water and not die.

So.  Cal learned how to swim today.





He's going to be six in about two months, so he's definitely not, shall we say, precocious in his mastery of water survival tactics.  He had all the requisite skills to swim, but mostly he's just been kind of nervous around the water.  Didn't like to put his head in.  Didn't like to be in the pool without a flotation device.  Worried about getting water up his nose.  Worried about sinking.  I don't think he quite trusted, despite a number of increasingly scientific demonstrations about human tissue and buoyancy, that he would float.  Being a bit of a late swimmer myself, I remember that feeling well.  But I also knew from my own experience that all it would take was one moment--one leap of faith, or more accurately a second of forgetting his own doubt--for him to realize that yes, he was going to be OK in the water after all.

It's med school graduation season now, of course, and I hope it doesn't sound disingenuous (because it is quite simply the truth) that I often think about the crop of newly minted practitioners joining us in the real world.  And look, I don't have any good advice, I'm new enough at the game that I'm still trying to figure things out for myself.  But there's going to be a moment for all of you when you look up and realize that you're doing something that you didn't think you knew how to do.  That something you practiced and practiced and practiced somehow, likely while you weren't paying attention, became automatic.  That in the recesses of your brain, you actually knew something, remembered something, that will help an actual patient in your care.  It's that moment--the leap of faith, the forgetting of your doubt--that's going to make you realize something that you're only being told now and may not quite yet believe.

You're a doctor.

Welcome to the team.

on dreams

The night before I return to work after having been on vacation, I always have an anxiety dream about anesthesia.  It's something that I hoped I would outgrow, and I guess I have to some degree, since for the entire first six months of my anesthesia residency, I had anxiety dreams about anesthesia every single night.  Most of these dreams had to do with the standard things that residents are anxious about--I had dreams about machine malfunctions, patients sitting up on the table in the middle of surgery, leaking canisters of volatile anesthetics that rendered me unconscious before I could reach the machine to turn it off.  But some of the dreams I had early on were completely nonsensical, like the one where I was at an airport and I was called upon emergently to resuscitate a sea lion.  Why was I in an airport?  Why a sea lion?  If this implies anything unsound about my state of mind, please also remember that I also had a young infant at the time, and the very fact that I was even able to sleep deeply enough to dream was a triumph in and of itself.

So anyway, the dream I had Sunday night was that I had to put a thoracic epidural in my own grandmother.  To what purpose it was unclear, but I do remember having to sit her up on the OR table and prep her back with Betadine while explaining to her in Cantonese what I was doing.  Aside from the construct, it was actually a very realistic dream, and when I woke up, I had to orient myself for a few minutes to decide whether or not my work day had ended or whether it was just beginning.

What anxiety dreams do you have about medicine?  Have they changed over time?  I would like to think that they will, or that I might at least at some point in my life be able to go on vacation without having to count on one full night of tossing and turning and dreaming with a pulse-ox tone backbeat.  But it's been more than 15 years since I last took a math class, and I still regularly have dreams about showing up for the big calculus final having not attended a single lecture (it's always something where I forgot that I registered for the class, and didn't realize it until the Add/Drop period had ended), so I don't have real high hopes that my medicine anxiety dreams will ever fully go away.

first we work, then we play

There was a point when I was taking call this weekend when I realized it had probably been about three years or so since I had been up doing cases straight through the entire night. I distinctly remember those nights on call as the "team captain," (my role was exactly what you'd imagine it to be--in a medical context, that is), and I was convinced that the page operator had some sort of bug on me, because literally the second I would either sit down or go to the bathroom (perhaps that was redundant) one of my many pagers would go off. Which reminds me of a story that one of my parters at work told me about one of his senior residents during training who nipped across the street to get something to eat while on call, and some little kid at the restaurant looking up at him in awe, informing him that he had on "more pagers than Master P." Kids!  Kids and their rap music!

Anyway, I will post something more substantial later, but for now, this: do you like beer? Do you like Iowa City? Do you like drinking beer in Iowa City?  Then join me, won't you, for a little meet-up at the Sanctuary Restaurant and Pub at 8:30pm this Friday night!  I will be heading there after my reading at the Prairie Lights Bookstore, which will take place somewhere between 6:00 and 8:00pm.  Come and hang out with me afterwards, or it will be very embarrassing, just me sitting alone in a pub.  Also, beer gives me hiccups, like some kind of cartoon wino.  So sit with me and witness the magic!

acknowledgements

Although I do hope that many of you will eventually read my book, I labor under no misconception that everyone will. Therefore, there is one small excerpt from the acknowledgements page at the end of the book that I wanted to share here, because, quite simply, as many people as possible need to know about how important these people were and have been to me, and to the thousands of young doctors that preceded and followed.

...In medicine, role models are everything, and while I have had countless mentors that have made lasting impressions on me, I would like to single out three in particular: Dr. Steve Z. Miller, Dr. Glenda Garvey, and Dr. Ingrid Fitz-James. Every single day, I remember what you taught me, and whatever good I have accomplished as a doctor has simply been from doing exactly what you told me to.

Dr. Miller I've spoken about several times on this website, and thinking about him always makes me tear up just a little bit, because he was such a good man, with so much left to do in this life.  People say that things happen for a reason, but those of us in medicine see all too clearly that sometimes there just is no reason, sometimes senseless things happen to good people, young people, and the sense of waste is truly tragic. But in addition to his family and his gorgeous children, Dr. Miller achieved the truest type of immortality.  He is still practicing medicine today, through all of us that, whether we know it or not, will continue to channel his voice, his approach to patients, and his attention to the unspoken details.

(To learn more about the Steve Miller Medical Education Day at Columbia University, click here.)

Dr. Garvey is also no stranger to this blog.  I first talked about her very early on, because she's just that kind of doctor that inspires absolute idolism and devotion in medical students--especially young, idealistic lady med students like me.  The thing with Dr. Garvey was, my worship of her never waned, and in fact, only strengthened throughout the years.  She was quite simply one of the smartest people I'd ever met, and her ability to balance that keen intellect with such a sense of true warmth and caring and effortless grace is something that I wish I could emulate if only I knew how.

Some months after Dr. Garvey passed away, I got an e-mail from her family, telling me how much what I had written about her on my blog had meant to them, and had meant to her.  Which, at the time, felt almost embarrassing to me, that the public sum of my gratitude could be quantified only as a handful of skimpy blog entries and and, now, an acknowledgement in the back of a book.  But Dr. Garvey, as an Infectious Disease Specialist, would surely have appreciated that there's more; that what's visible pales in comparison to the what's unseen and intangible but nonetheless fills the spaces between.

(To learn more about the Glenda Garvey Teaching Academy, click here.)

Dr. Fitz-James is quite simply the woman who taught me how to be an anesthesiologist.  Period.  She was my "one-to-one" mentor when I first started training in anesthesia (all first-year anesthesia residents are thus closely supervised during the first few weeks of their training), and I have to admit, I was a little bit afraid of her.  She was so firey and intense, and she would look at you with these EYES that could on one hand indicate that you were brilliant and destined for success, or else that you were the biggest fuck-up that ever lived, and you might as well start packing your bags now because your career in anesthesia was going to be a short one.  She had this way of calling us all doctor ("Doctor Au...") in this dry, arch way that always left some doubt whether or not she was putting invisible air quotes around the honorific.  And damn it if you didn't try all the harder to show her you could live up to that expectation.

Dr. Fitz-James is so smart, and she cares so deeply, and her commitment to not just doing things, but doing things right, every single time, had a deep and lasting impact on me.  As an attending anesthesiologist, there is not a single day that passes that I am not doing things just the way Dr. Fitz-James taught me.  And thank goodness for that.

Did you or do you know Dr. Miller, Dr. Garvey, or Dr. Fitz-James?  What was their impact on you?  Or, for those who trained in other institutions, who inspired you, and how did they do it?  The comments section is open.

then and now

So!  Match Day!

Match Day, for those lucky enough to not know, is the day that fourth-year medical students across the country find out where they will be doing their residency training.  Our Match Day was--oh lord, could it have been?--EIGHT years ago.  I was much more awake that morning than most of my classmates, who had been up late partying the night before at "Super Night," our name for the big annual pre-Match bash at the med school.  I'm sure a similar tradition exists at medical schools around the country, and though regional differences surely exist, there is one commonality of which I'm almost certain: the involvement of booze.

I myself was still recovering from a bout of peritonitis when my acute appendicitis in February was misdiagnosed and I subsequently developed a small bowel obstruction and a perforated viscus (TRUE), and so during Super Night I was on Flagyl and couldn't drink anyway.  It was still fun though, and basically ensured that I was not hung over the following morning for Match Day, enabling me to recall each nerve-wracking minute in crystal-clear detail.

I'd heard that in the olden days, Columbia had a tradition of holding Match Day in a giant auditorium, where one by one, students from the fourth-year class were called up to a podium and handed an envelope with their match results, which they were then to open in front of everyone and read aloud, into a microphone.  Of course, not everyone always matches exactly where they want to match, so this ritual (thankfully) came to be regarded as somewhat inhumane, especially in the already high-pressure environment that is med school.

So by the time Joe and I were cycling through in 2003, they had reduced Match Day down to a reception at the faculty club, with a table full of labelled envelopes off to one side of the room.  People could take their envelopes and leave, or open their envelopes there with everyone else.  Within this group, there were people who would open their envelopes and cheer, others who would open their envelopes and start crying, and possibly some that would open their envelopes and promptly punch one of the poor waiters who was trying to pass out shrimp cocktails on toothpicks.  One hopes against that last option, for the waiter's sake.

I am telling you this because the fact of Match Day, and the ritual of Match Day, is one that makes you think that Match Day is probably one of the biggest days in your life.  And it really seems that way at the time.  Hell, Joe and I were getting married about a month afterward, and I think I had put in more time, energy, anxiety and thought into Match Day than I had about the wedding.  It was a big fucking deal, this feeling that the rest of your life was hiding inside this one thin envelope.  It was a big deal, but also...it wasn't.

It was eight years ago.  This is what I can tell you now.  I matched at my first choice program, which was in a Pediatrics residency at the Children's Hospital of New York at Columbia.  Eight years later, I'm not even in that field anymore.  Joe matched in his first choice program too for residency, but for his transitional year, he got his absolute last pick, a fact which deeply dismayed him.  Didn't matter.  He had a great year, got excellent training, and he still has many fond memories of that institution to this day.  We had friends that failed to match at all, and who instead scrambled into spots in other fields, or in cities they never dreamed of living.  They are all successful, happy, healthy, and practicing the kind of medicine they want to practice today.  They have significant others, spouses, children, and they are enjoying their lives in medicine just as much as their lives outside the hospital.  They are happy.  It all works out.

Most of you are probably pretty excited today.  Some of you maybe aren't.  Some of you are dealing with hard choices, and I know that talking about this now doesn't make those choices any easier.  But if you went to med school, I know you have a long memory, so I'll tell you this: some day in the future--five, eight, ten years from now, you're going to look back on this day, this Match Day.  Then you're going to look to the present, at the life you're leading now.  And you might not be where you thought you would be when you were a medical student.  Hell, look at me, I thought I was going to be a pediatrician in academia, and now I'm an anesthesiologist in private practice.  You can't find two more different fields.  I couldn't have predicted it.  But it all works out in the end.  It really does.  You'll find where you need to be, what you need to do, who to go there with, and you'll get there.

So congratulations to all the fourth year med students in the Class of 2011!  Can't wait for you guys to graduate and join the team!

Now on to what's next.

keeping it real

Hey, my book got a nice review from Kirkus!*  Thanks Kirkus! Though it seems the full review won't be available to non-subscribers until the book is actually released, here's a brief excerpt:

An account of medicine, marriage and motherhood, executed with style and enough humor to offset the not-always-happy endings for patients...An upbeat memoir by a woman still imbued with the idealism to serve, but also to be there for her husband and two sons.

I'm especially happy because it seems that the reviewer keyed into the one of the main things I want to get across, which is that I really tried hard to write a first-person medical memoir that was ultimately upbeat, and occasionally irreverent hopefully without tilting towards cynical. Lots of medical non-fiction I've read can either be academic and detached, bitterly humorous, or difficult to read because they're kind of ceaslessly grim. I tried, and hoped I succeeded (though you all can tell me in May, I guess) in writing an account of med school and residency that keeps in mind that I was a human being training in medicine, not that I was a medical trainee that just so happened to be a human being.

Anyway, thanks again to Kirkus for the lovely review!

(P.S. Yes, I know the cover image on the Kirkus site is still the original cover image. We are working on getting it updated to the new hotness.  Thanks!)

perspective

Were you on call this weekend? Me too!  Spring forward indeed.  (I would say something wittier here, but I'm tired.)

Very interesting feedback and discussion in response to the last entry, thanks everyone for weighing in.  I think that to generalize is to oversimplify, but I said this in the comments and I'll say it again here: I think the reason that the process of medical training is so stressful for people is because those who go into medicine in the first place usually try their hardest to do their best, no matter how difficult the circumstances. And it can be difficult for us when we feel like our best, for whatever reason, is not enough.  More than the fatigue or the workload or the ridiculous life-and-death stress of working in the hospital, far and away the hardest part for me was feeling like my best was not enough.  Of course, my efforts for the most part were "enough" (at least by most quantifiable metrics and some intangible ones), and though it never felt like enough, I tried my best, then as I do now. As we all do.

Watching the news reports and photos and video footage coming out of Japan these past few days has been incredibly sobering, and puts into perspective how uncertain life can be, and how much we have to be grateful for.  So let's keep up what we do, trying our hardest to do our best.  Here are some ways to help.

(Kyoto, Japan, 2002)

it gets better

The lowest point in my residency was in January of my intern year.  I was a Pediatrics resident back then, doing a month-long rotation on "Team 2," which is what we called the general inpatient pediatric team, with a focus on the patients on our liver transplant service.

It was a very long month.

I'd get to work at around 5:45 every morning to pre-round, and invariably leave after dark every night--not difficult, considering that, in January, it seemed like it started to get dark around 3:30pm every day.  I was there much later than that, of course--most nights I'd leave around 7:00pm, unless I was on call, in which case I'd leave at around 10:00am the following morning.  We'd have pre-rounds and then rounds, then attending rounds and work rounds, followed by teaching rounds and radiology rounds, with time at the end of the day for sign-out rounds.  Twice a week we'd have Grand Rounds and Chief of Service Rounds.  How we ever got anything done with all this rounding, I'll never know.  How I ever got to spend time with any patients in between all these rounds is even more of a mystery.  It just felt like a day of endless, endless scut.  Losing the forest for the trees.  It would be a day full of writing down numbers and pagers beeping and phone calls and faxes and entering computer orders, and not nearly enough time practicing medicine or spending time with patients.  And then I'd go home and collapse and wake up at 4:15 the next morning to go in and do it all again.

It was shortly after this that I decided to switch fields, to Anesthesia.

But this entry is not about me and my switching residencies (though this is easily the topic that I get the most e-mails about--I think I've addressed it a couple of times on this blog, but for the most fully fleshed out explanation of when and how and why I switched residencies, I'd recommend you check out the book, it's probably one of the sections I spent the most time editing in order to get the details right), it's about something else that I want to talk about, which is this: residency can be deeply depressing.

And let's get this straight.  I liked residency.  Really, I did.  Yes, it was hard, and yes, I was tired basically all the time, but I expected that, and now that it's over, most of my memories are affectionate.  Residency, like medical school, was full of stories, and many of them, in retrospect, are funny--not at the expense of patients, but at my own expense, because lord, how serious and inexperienced and bumblingly well-intentioned I was!  But that first January of my intern year, I was very close to being clinically depressed.  It just all felt so grim and featureless and endless, and I felt more and more like I was just some kind of task-programmed automaton, not like the doctor that I thought I was supposed to be at this point.

 I wanted to quit.  Not just quit being a Pediatrics resident, but quit medicine altogether.  I was unhappy.  I didn't like my life.  I wanted to be done.  I know that this comic was intended to be a joke, but there were time, real times, when I passed by a Gap or a Starbucks or whatever, saw that they were hiring, and seriously considered stopping by to fill out an application.  At least they don't make you take call at The Gap, folding chambray button-down shirts at 2:00am.

Now I'm going to tell you a secret.  Everyone who has been through a residency has felt this way at some point.  Everyone.

Maybe you're feeling this way right now.  So here's another secret.  There's more to life than this.  Even though it feels like residency is your life, it's not.  There's more to life.  There's more to you.  And it gets better.

It gets better.

There's this great line from "A League of Their Own," which I adapt and quote often. "[Medicine] is supposed to be hard. If it wasn't hard, everyone would do it. The hard...is what makes it great."  However, don't get me wrong, I don't equate suffering with nobility.  Suffering is just suffering.  All I'm saying is that it's hard, but there's more, and you deserve to experience all of it.  Don't let your residency consume you, and don't let it make you believe that there's nothing else, or that there are no other options.  There's always more.  There's always what's next.  And you know what?  If you're really unhappy, and you want to leave medicine, there's always that too.  It's OK.  There's no shame in changing your mind.  The shame is hating your life, really hating your life, and doing nothing about it.  Who wins in that situation?  Not you, not your patients.

It gets better.  I know it's winter, and winter for a resident is long (oh lord, it's so long, it feels like you'll never see the sun again) but it gets better.  Just remember that.  Remember that you're a person--an intelligent, good person with free will, not just a cog in a machine--and I swear to you, the rest will follow.

midnight snack

Look, first let's make it clear that Atlanta has really grown on me, OK?  First off, the weather is pretty nice here.  Second off, people are charming and say cute things.  Third off--well, today I was taking care of a patient who just so happened to be an "ambassador" (his word) for Chick-Fil-A, and he had such a nice time talking to me that he gave me a personal business card which could be redeemed for one free chicken sandwich.  Free Chick-Fil-A!  How was your day?

But one thing that drives me crazy about Atlanta is the restaurant hours.

OK, so forget the fact that no non-fast-food restaurants open before 10:00am, like, ever.*  I like to get an early start on my day but whatever, I can deal with having to stand outside a self-proclaimed brunch establishment at 9:00am on a Sunday morning waiting for them to wake up.  But what really kills me, especially in my line of work, is the fact that no restaurants stay open past 10:00pm.  It's ungodly.  Don't people get hungry at night down here?  More importantly, don't people want to make money selling food to people like me?

Back in New York (oh, not this again) I would often get off work late.  Obviously.  Being a resident means working weird hours, and by "weird hours" I mean all the hours.  Many days I'd get in before the sun rose and leave work at 10:00pm, midnight, sometimes 2:00am, knowing I'd have to be back in to work the next day.

After a certain point of the night (I'd put that cutoff at around 9:00pm I guess) there was really no point in me hurrying home anymore, since I knew everyone there was already asleep and therefore there was no one to see.  So sometimes, on my way back downtown, I'd stop for a very late dinner by myself.  And if this sounds pathetic, it absolutely is not--eating alone in restaurants is awesome.  You get to order whatever you want and you don't have to share it with (or feed it to) anyone, and you can eat your whole meal while reading a book or listening to "This American Life" on your iPod.  And for someone who always felt like she was at the beck an call for other people (kid, patients, attendings, spouse), these occasional late night dinners were the ultimate indulgence.

I don't know how your tastes run, but when I'm up late at night, especially after a long night at work with limited sustenance, my appetite runs towards the hot, the brothy, the spicy, the comforting.  Korean food was always a good default--relatively inexpensive, lots of food, and restaurants in Koreatown (the only redeeming feature of the Herald Square area, in my opinion--please don't counter with "Macy's," you'll just depress me) are open all night long.  And everyone goes there.  There were many nights that I'd be grabbing a quick late-night meal on my way home, past midnight at some Korean restaurant that I didn't even know the name of because nothing in the restaurant was written in English, and the restaurant would just be packed with people.  Old couples grimly gumming down their hot pots, not speaking to each other.  Masses of young teenagers oozing booze and karaoke.  Single people like myself at many of the smaller tables, sitting alone but looking utterly contented.  It was so busy and alive, even at that hour.  And that made the food taste really good.

You'll forgive me this lament because obviously we're happy in Atlanta and we love the people here, but that last part is the key to why I miss New York so much.  And it's not just because I'm a creature of habit, or because everyone I've ever known in my life up until this point is in New York.  No, it's because in New York, you don't ever feel like you're just you.  You always feel like you're part of something bigger.  And that's fun.

There's a Vietnamese pho place up the street from where we live now in Atlanta that has some decent food.  But when I drove past it tonight, at 10:00pm, it had long since closed.  The lights were off, the parking lot was empty.  So instead I came home and made some instant noodles and sat in my dark house eating them by myself.

It wasn't the best late-night dinner I've ever had.  But it was all right.

* I already know what you're going to say.  "Something something The Flying Biscuit."  Right?

Janus

We just found out yesterday that we got approved for our mortgage. So...yay! Hooray for debt!

No, but seriously, we are very happy. We've always been fiscally responsible and we haven't exactly been living in the fast lane, but still, when you have bank people going through your history with a fine-toothed comb, even the most conservative of spenders and savers tends to get a little damp-palmed. (I know that my personal financial history was just about as boring and by-the-rules as you could hope, but I kept getting paranoid that they were going to find out that someone had stolen my identity and had maxed out twenty credit cards that I didn't know I even had on jet ski equipment or something. SO MANY JET SKIS.) Anyway, we've been approved, so that's good.

Life has been very busy and exciting lately. Aside from this House Thing and the Book Thing various other Things, there's a lot going on and most of it's pretty good, but I'm going to hold onto some of these topics until they're a little more fleshed out. But for now, let me point you in two directions: forward and back.

FORWARD: Last week? Or maybe it was the week before, I can't even remember--I got an e-mail from the Hachette Speakers Bureau asking if I was interested in joining their roster of speakers. I said, huh? whuzza? snrf? which I'm sure was very impressive (my oratorical skills are unparalleled under any circumstances, certainly) because I don't know what a Speakers Bureau is and therefore didn't know what they were talking about. But after a very nice phone call from a guy named Blair, now I do.

The Hachette Speakers Bureau is an agency under the umbrella of the Hachette Book Group (of which Grand Central Publishing, my publisher, is one imprint) that basically manages certain authors for speaking events. After ascertaining that I was interested (I was) and after I filled out a survey about myself and topics that I can talk about at some length, and I now have a page on their speaker site and am available to come talk about stuff in your town. What kind of stuff? Well, you read this blog, right? You tell me. Want me to come to your med school/college/Rotary Club/quilting bee and talk about, oh, say, the changing role of social media in medicine? You should e-mail the Hachette Speakers Bureau and try to work something out! Or, you can e-mail me and I will forward the e-mail to them. Technology!

BACKWARD: You guys seem to enjoy the pictures from the Way Back Machine, so here's another one--actually a paired set, from December 31st, 2007.





Here's how I spent my New Year's Eve that year, setting up for a lap appy. Luckily I'm not much of a party person anyway so being in the OR was about as exciting as anything else I could have been doing.