Category: residency

Raft of Bitches

Published on by Mindy NLeave a comment

Scenario One:

“Okay, sir, I just want to let you know that you’ll be here for at least 4 hours while we repeat your cardiac enzymes. So here’s the remote and call button. Let us know if your pain comes back.”

“YOU MEAN I HAVE TO WAIT THREE HOURS TO SEE A DOCTOR?” He screams in frustration.

Scenario Two:

“So, how was Dr. N? Was she kind? Did she listen to you?” My attending and medical director asks a patient that I have seen multiple times and just recently updated on his negative work up in the ED.

“Who?” The patient answers quizzically.

“The young woman that came in. The one that just told you that your labs were fine and you were going home.”

“Oh, that young girl? I thought she was a nurse.”

Being in residency, I have attendings who can teach me how to perform a chest tube, illicit a history that can lead me to the right diagnoses, and to interpret lab results. But, my residency is staffed almost completely with older white males that illicit the image of a quintessential doctor in pateints’ minds. They don’t walk into rooms and immediately have to repeat themselves that they are the doctor and assuage worries that I’m “too young” or “too female” to take care of them. They don’t have to tiptoe the line between being seen as a leader or a bitch. They don’t have to be seen as deficient.

And it’s been lonely swimming in that ocean by myself. I’ve had to weather storm after storm by myself, sometimes I am able to swim to shore safely. And sometimes, it’s all I can do to keep my head above water. I have had to learn on the job on what to say to assuage those fears, maintain relationships with nurses when I have to ask for a lab to be drawn three times, and how to make myself look like a doctor. I have had to figure these things our on my own.

On those days that I can barely keep my head above water, I’ve looked around for someone who looks like me [female] to hold onto as a buoy or rock in that water. Unfortunately, I have been alone in that sea. Until, FeminEM and Fix 17.

I was a scared second year resident who had never even gone to a movie on my own. And I signed up to travel to New York City and attend a new conference about females in Emergency Medicine. I was ecstatic to find a group of women who might be experiencing the same things I had, who could relate and empathize, and, most importantly, who could guide me. I didn’t have to swim alone anymore.

I was anxious and nervous the entire month leading up to the conference. It was my first professional conference in which I was going to be an actual Emergency Medicine physician and not a med student “hoping to be” one. I was anxious that I was going to be seen as less than for just being a resident, from being from a community hospital in the Midwest, and for being alone. Why should these women want to help me or be friends with me if I couldn’t even get another person to come with me somewhere for a few days?

I couldn’t have been more wrong.

That first FIX changed my life. I cried, laughed, and loved in that theater. I learned that we had to stand on the shoulders of those that came before us to advance even more. I found mentors and women who had come before me willing and happy to share their experiences and insights. I was freely and happily given contact information along with a hug. And for the first time in the rough seas of residency, I had buoys to hold onto.

That feeling boosted for me another year. I went back to my home institution and promised that the other female residents had to come with me the next year. Every time a patient mistook me for a nurse, didn’t trust that I could be a doctor given the youthfulness of my face or the genitals between my legs, I was buoyed by those other swimmers. I knew I wasn’t alone. I knew that they might not physically be next to me, but they were definitely weathering those waters with me.

Day after day, I walked into that Emergency Department with my head held high (some days were easier than others to keep my head held high) and saw patients. I treated patients for a range of complaints ranging from the mundane to the more life-threatening. And before I knew it, it was September 2018 and FIX 18 was just around the corner. But this year, I was excited instead of afraid to be in that auditorium. 

This year, I cried, laughed, and loved in that theater, again. I felt the same sense of belonging and safety that I had felt the previous year. And most importantly, I had shared that with some of my co-residents that were female and also feeling like their head couldn’t stay above water. My buoys were now their buoys.

Or, more accurately, our buoys were a raft. Hearing the stories of these women (and a few men) made me realize that these women weren’t above me in the water like a buoy. They were still experiencing the same discrimination, fear, and uncertainty that I was feeling. They were next to me in the water. However, they were holding a hand out to let me know I wasn’t alone. 

As Dara Krass said, female otters, known as “bitches”, link together by holding hands to form a raft, which will always lovingly be known as a “raft of bitches”. These “rafts of bitches” allow otters to survive in the dangerous waters much easier than if they were to weather the waters alone. Just like us. 

Each of those speakers held out a hand to every audience member. Each participant held out a hand to the audience member next to them. Quickly, the FeminEM community became a “raft of bitches”. We were able to laugh, cry, and learn together. We were able to see how our unique circumstances and abilities made us valuable to that raft. We were able to support each other. We were able to allow those struggling to keep their head above water to rest for just a second. We were able to just be.

But most importantly, we learned that our raft always has room for one more. Since otters’ rafts grow by holding hands, there is always an open and waiting hand at either end of the raft. And when that hand finds another hand, the newly minted member also has an open and waiting hand. 

Last year, we stood on the shoulders of those before us. This year, we held their hand. What are we going to do next year?

Stolen Joy

Published on by Mindy NLeave a comment

30 years old.

Block 3 of my third year of residency.

According to Numerology, the number 3 has ” a powerful need to express feelings, ideas, and visions of the imagination”. And isn’t it beautiful that I felt the need to start blogging again? When the number 3 is repeating itself so much in my life right now.

I’m laying in my bed, and all I can think about is how much I was afraid to turn 30. Afraid to be a senior resident. Afraid to not live up to my own ideal of what I was supposed to be when I turned this milestone.

As a child, I had a clear vision. By 30, I would be a successful doctor, married to the love of my life, and mother to two cute but sassy children. I would be an attending, saving lives and taking names at work but starting to think of academia or administration. I would have a loving husband who also had a good job and had the same values as me. We would have one night a week carved out for “date night” in which we would go out to dinner or cuddle up on the couch and watch movies. I would have a house that had a big kitchen with an island in the middle. Seasonal flowers would constantly be on that island that over looked bowls of cereal. Happy memories to go with those two children who bounced off to preschool and elementary school. I would be the mom that had it together, remembering when the bake sale was and who had practice at what time. I would be an adult. A real adult. An “adultier adult”.

Instead, I’m a single woman who lives in a one bedroom apartment who is trying to find time between ER shifts to make sure my laundry is done. I have a cat who I’m still surprised to find her cat bowl empty sometimes. I swear I refill that thing at least three times a day! How can it be empty? I’m smelling scrubs before I put them on again to work. I’m the one eating cereal over the sink – not those two children.

Because of that beautiful daydream that has stuck in my head, and so closely tied to my 30th birthday – my summer was rough. Full of transitions. I transitioned from a junior resident who could always think “well there’s going to be someone more senior-y than me” to the senior resident. I transitioned from a young adult who could always think “well there’s going to be someone more adult-y than me” to the adult. And constantly seeing how different my real life was from my daydream.

Comparison-is-the-thief-of-joy-sized

Theodore Roosevelt said that “Comparison is the thief of joy”. And let me tell you, I lived in that comparison all summer. I bathed in the sadness that came with seeing how much I lacked in my life compared to that daydream. I sat rooted to the spot and watched the seconds count down to my birthday, each second like a timer on a bomb. Tick, tick, tick. With each second, I could feel myself become older. With each second, I could feel myself become sadder. With each second, I could feel myself become farther and farther from that daydream. So I sat some more. And let more seconds pass. And let more distance come between my current state and my daydream.

And then it happened. My birthday happened. Luckily, I was at work on trauma and had patients facing life and death to distract me. But I looked at the clock and it was already 1am. I had been 30 for a whole hour and nothing bad had happened. The bomb didn’t go off, the skies didn’t tear apart, no fire came raining down from heaven. I was still breathing, walking, and talking just like I had been an hour before. I hadn’t suddenly aged to a wrinkly, old woman who was unable to remember her name or what year it was. I hadn’t suddenly become less of a woman or a doctor. I hadn’t suddenly become anything. I was still me.

My celebration was quiet and uneventful; I went home and had a piece of the cake the ER nurses had been so kind to get me. My cat came up and cuddled up to me. And I went to sleep watching a murder documentary on Netflix. Like any other day.

So how had this “monumental” occasion, which had been the obsession of my mind, come and gone with not so much of a whisper?

How had I become an adult, a real adult, with no big consequential change?

Because I was still me. Turning 30 hadn’t really meant anything, really. True, it meant that I had been on this Earth for another year. But it didn’t change who I was or what was expected of me. The comparison between my real life and that daydream – the one I was sure everyone else could see and judge – had robbed me of celebrating. Of celebrating the joy of being another year older, wiser, and being the senior resident. My mother and father didn’t care that I didn’t have those children yet. In fact, their daydream of what my life was to be like by the time I was 30 was vastly different than the daydream I had. My attendings didn’t care that I was suddenly a senior resident. They just wanted to continue to see my grow and learn. My friends didn’t care that I didn’t have a husband who doted on me. They just wanted to see me happy. No one cared that I was an “adultier adult”. They just wanted to know that someone else was eating cereal over their sink too.

So I woke up the next day, I put on those scrubs (with the habitual sniff test), tied my shoes, and walked out the door. The sun was still shining, the heat was still unbearable, the hospital still smelled like antiseptic. Everything was the same.

My daydream is still what I want to have – I’m very much looking forward to wiping milk off of faces who are smiling at those seasonal flowers on that big kitchen island. But it doesn’t have to have a deadline. That daydream doesn’t become any less special or beautiful because it happened when I was a little older. Those children aren’t going to look at their mom and think “if only she had this when she was 30”. That husband isn’t going to be less because I found him later in life.

So maybe I did change when I turned 30. Maybe I did become an “adultier adult”. Or maybe I just learned that life doesn’t listen to deadlines. And my joy is too important to be stolen.

 

The Quiet Smile

Published on by Mindy NLeave a comment

As every EM resident, I LOVE outside rotations…..and by love, I mean we absolutely dread spending time out of the ER. It’s almost a constant reminder of why we picked the speciality that we did; I don’t want to manage high blood pressure long term, I don’t want to be in the OR where I have to worry about what I can and cannot touch, and I for sure don’t want to spend all day in clinic. However, some outside rotations are better than others. In surgery, I got to see and participate in the surgeries that I daily tell people they need in the ER. In cardio, I got to read EKGs until they became less scary and more routine. In anesthesia, I got to tube and tube and tube until I felt like I could take on any crashing patient. But then…..there are some rotations that just kill.

My program’s second year is very EM heavy and outside rotation light. I spent the beginning of my year in the ICU and then spent one month in a pediatric ER (so still very homey). Both of which were informative, useful, and full of valuable teaching moments. My predecessors have complained about the rotations that didn’t seem to fit those standards and our curriculum has been changed a lot to make sure that we spend time in ways that is beneficial to our education. Except for this one. And I’m just finishing week 1 out of 4 of this dreaded, spiteful rotation. And I’m about ready to jump ship and forget about being a doctor!

Let me preface that I had been warned about this physician by every single one of my co-residents. I have had experiences with him myself with phone calls in the middle of the night discussing a case in the ER. I have even seen patients cry after he has walked out of their room. I was prepared for this to be a tense month. I was prepared for his hearing impairment and need for me to shout (when he deems it appropriate for me to speak). Hell, I was even prepared to have to be silent for a month and just look pretty (which, happily, I have been told that I am a lot in the last few months). But I wasn’t prepared for what this rotation is actually like.

First, and the most bizarre thing that I have ever experienced, is how he is referred by all of his staff (clinic and surgery). He is referred to as “Doctor”. Not “Dr. [insert last name]”, “the doctor”, or even by his name. As in, “Let me see what Doctor wants”, “You can’t have certain foods here because Doctor is sensitive”, “Don’t speak when Doctor is speaking”. It’s like he’s this weird god-like figure in the people that surround him. They cater towards him like he can do no wrong. They contort themselves to make sure that he is happy at all times. Even hearing this behavior, witnessing it, I feel like I am some outsider that was allowed into a cult for a brief visit. I am as foreign to them as they are to me. I can answer their smiles with a smile of my own, but we both know they are as fake as the pedestal upon which he stands. As a physician, I cannot even fathom trying to make this kind of environment for myself. I am not a crazy god-like creature just because I went to school and learned some advanced biology. I am not a person to be tip toed around just because of some initials behind my name. ER is a team sport full of doctors, nurses, respiratory therapists, and emergency medicine technicians. We each have a skill and knowledge that is needed to make sure our patients get the best care. And that is the kind of environment that I want to practice medicine in. I don’t want to balance on a slippery pedestal built from my ego and hubris.

Secondly, he is just an asshole. I could try to sugarcoat it and talk about how he is just very blunt and rude. But let’s be straight, he’s just an asshat. He does not allow others to speak while he is speaking, thinking, or performing surgery. He does not call people by their names. He does not attempt to teach – he just boasts. In fact, I have been handed laminated newspaper articles praising him to read while he sees a patient. I have been asked, in front of patients who are there for a pre-op visit for the same procedure, to confirm that it was the best surgery I have ever seen. I have been prey to his endless rants about how incompetent our ER and the physicians who have welcomed me, loved me, taught me, and praised me, are. So with a silent mouth and a fake smile, I have nodded my head and felt a little piece of me die inside.

And I think that is the part that is bothering me the most – this requirement to be silent but still dying inside. Anyone who knows me can tell you that being quiet or being silent when I feel like injustices are being done are not my strong suit. As a child, most of my report cards had “exceeds expectations but could learn when it is appropriate to talk”. And my mother probably would have been happier if I hadn’t learned about feminism and social justice in 5th grade. I have always been the girl that is not afraid to speak or afraid to stand up for someone who cannot. Part of why I picked medicine as a career and emergency medicine as a specialty was because of that fact — I wanted to be a voice for people who do not have ready access to medicine. And in this rotation, I am expected to nail another board of praise to his pedestal. I am not expected to learn, to grow as a physician. I am expected to contort myself into this weird cult member for a month. I am not expected to see a patient or make a single clinical decision. I am expected to be a quiet smile in the back of the room.

Well, we’ll just see about that.

Match Day 2016

Published on by Mindy NLeave a comment

When I thought about re-starting a blog, I thought about the blog I had in medical school. It documented and chronicled the fear, anxiety, and feelings of being overwhelmed that myself and my peers were going through. But it all culminated in one day: Match Day 2016. The day that decided our futures — everything from what speciality we were going to pursue every day for the rest of our lives to where we would live. My relationship at the time was even hanging on what that meant. And it all culminated at 4:30am on February 8, 2016. With one email. That decided the rest of my life.

Spoiler alert: I got Emergency Medicine. And I moved to Michigan/Ohio.

Now, as a second year, I have settled into my position as a resident. I walk into the hospital with a smile on my face (most days at least) and a feeling of belonging. But there was still something missing. And that’s where this blog comes in – how to fill that creative space, how to process such a demanding time in my life, and how to coincide the need for social justice that has spurred me since I was in fifth grade.

Spoiler Alert: I got Emergency Medicine. And then….Michigan. What now?

So I thought I would post my blog about that first day when I found out where I was going to go. That first day when I realized I was actually going to be Dr. N. That first day that I started to think that about becoming that #torpedointoledo.

“For the last half of third year and for all of fourth year so far, I have focused on today. I have spent many nights, awake in my bed, tossing and turning, obsessing over getting an email at 4am stating if I can actually become an emergency medicine physician. I have cried over this day. I have worked my ass off working towards this day. I have put my all into making sure this day isn’t the absolute worst day of my life.

And now it’s here.

I thought I would be fine. Just a little anxious, like I always am, but able to function. I thought that after I got the email that I would be more excited (hopefully) than anything and ready to celebrate for the rest of the day. I thought it would be a happy day.

But then the day happened. And I knew my life would be forever different. I just wasn’t expecting how.

But let’s go back to how that day started: I fell asleep the night before, with the help of some sleep-inducing fun for the Superbowl, around 11pm. I had originally decided that I was going to tough it out and not sleep until I got that email, anytime between 4am-9am. But that fantastical idea, along with my roommates, mother, and a friend who was there for moral support, slowly faded into real dreams. And around 2am, I awoke with a start.

“Did I rank the right places?” “What if they don’t really like me?” “Do I really want to be an emergency medicine physician?”

All of a sudden, every single fear I have ever had during medical school came rushing back! Thankfully, my mother was sleeping next to me and was easily awoken by my rushed, panicked breathing. And for the next two hours, my mom tried to usher me back to sleep, hoping that I would relax. Sadly, for both of us, my breathing might have calmed, but my mind did not. I laid in my mother’s lap, while she stroked my hair, listening to Michael Scott orchestrate another “Conference Room Meeting” on “The Office” and trying to focus on his shenanigans. I hoped that Michael’s hilarious, delusional interactions with his co-workers would be comforting enough (since I can watch “The Office” all day every day) to distract me. However, even Michael couldn’t help me that morning. It seriously might have been the longest two hours of my life.

Around 4am, my heart skipped a beat and I sat up quickly. It was like my semi-unconscious body could tell time! I knew that the emails could have been sent out as early as 4am, but knowing my luck — and how tired I was–I knew the email would come later. But that didn’t stop me from opening my computer and my email. So while my mom laid next to me and my friend snored quietly at the foot of my bed, I logged into my email….and nothing. So I refreshed. Again, nothing. So I tried to focus my attention back on Michael, Dwight, Jim, and Pam. And I succeeded, for a whole two minutes and then hit refresh again. My entire being was focused on this little routine: hit refresh, register that there was no email yet, and then try to focus on “The Office”. Wash, rinse, repeat. Only it was refresh, nothing, “The Office.” For 45 whole minutes I repeated this routine (if I ever did this to my hair, it might be more than just a frizzy curly mess but that’s a whole different story). And suddenly: it was there! I hadn’t even opened the email before the shriek came out of my mouth. My mother and friend suddenly woke up and looked at me expectantly. My fingers were frozen, unable to actually click the message to see what it said, it was actually here! It took a few seconds for the immediate shock to wear off and my fingers to process functional movement again. There it was, in black and white, my future:

CONGRATULATIONS. Emergency Medicine. Promedica Monroe.

My eyes went straight to those words and I shrieked again. My mom grabbed my computer and then started laughing. My friend looked at me expectantly, and when she saw the joy in my eyes, jumped up and hugged me. My roommate in the next room peeked her head in and smiled. This was it! I had done it!

And then my next thought was “Ohhhhhhhh great, what the fuck do I do now?”

My entire life, all 27 years of it, had culminated in this moment. I had worked so hard for it, sacrificed friendships and relationships, gotten into massive amounts of debt, and it was finally here. It’s like when Olympic hopefuls who have spent countless hours reaching for that gold medal finally attain it or that actor finally wins an Oscar. Now what do you do?

And I think that was the hardest thing I’ve had to deal with. No one talks about this moment, or the many after, in which you sit there, basking in the glow of your achievement, and wonder what the next step is. As an overly ambitious young woman, my life is measured in working to achieve goals and achieving goals. However, previously, my goals were just stepping stones to another goal. First, I had to get into a good college, then it was perform well on the MCAT, etc etc. Each goal just got me another step closer to this goal. Even getting accepted into medical school was just a stepping stone. But this particular goal seemed more like a finish line than any of the previous achievements/goals. And even after a marathon runner finishes a race, even though it took them months to prepare and hours to complete, crosses that finish line and STOPS RUNNING. They put a very futuristic silver blanket on and collapse on the ground. But they stop running.

And I have stopped running.

And I keep wondering, “now what?”

-April 2016