Wednesday, December 26

Other than this, Christmas matters not to me.

Mary's Song
by Luci Shaw

Blue homespun and the bend of my breast
keep warm this small hot naked star
fallen to my arms. (Rest …
you who have had so far to come.)

Now nearness satisfies
the body of God sweetly. Quiet he lies
whose vigor hurled a universe. He sleeps
whose eyelids have not closed before.

His breath (so slight it seems
no breath at all) once ruffled the dark deeps
to sprout a world. Charmed by doves’ voices,
the whisper of straw, he dreams,
hearing no music from his other spheres.

Breath, mouth, ears, eyes
he is curtailed who overflowed all skies,
all years. Older than eternity, now he
is new. Now native to earth as I am, nailed
to my poor planet, caught
that I might be free, blind in my womb
to know my darkness ended,
brought to this birth for me to be new-born,
and for him to see me mended
I must see him torn.

Wednesday, December 12

Failure. Pleasing others.

So I started this audition month by looking at a joint x-ray.  After about 30 seconds of confused contemplation, I finally gathered my courage and asked the resident, "Hey, where's the patella on that x-ray?"  As soon as the words left my mouth, my eyes made sense of the radial head.  Crap.  That's an elbow! Before she could start to say anything, I was shaking my head and saying, "Ooh.  I mean.  Never mind because that's not a knee that's an elbow and elbows don't have kneecaps.  Let's forget I said anything.  In fact, I was merely remarking on what a normal looking elbow that xray is showing."  She laughed at me. 

Apparently I began as I meant to go on.  I've missed IVs, messed up Foley catheters, placed endotracheal tubes in the esophagus, placed orogastric tubes in the lungs, had to rip out a few sutures, fumbled immobilisations... I'm such a klutz and it is beyond frustrating!  I am not super neurotic, but I'm certainly type A enough that I HATE doing stuff that I'm bad at - and at this stage of my training I'm bad at everything.  Still.  I've been trying my best to keep a good attitude about my failures, work hard, and ask thoughtful questions.  I may not be good at anything, but I swear I'm teachable! 

I have been struggling very much lately with wanting to please other humans.  This, I think, is the quintessential struggle of any Christian who is currently aspiring to some new position.  This morning I was reading the letter written by Jesus' brother, James; these passages in particular became my prayer today:

"For jealousy and selfishness are not God’s kind of wisdom. Such things are earthly, unspiritual, and demonic. For wherever there is jealousy and selfish ambition, there you will find disorder and evil of every kind. But the wisdom from above is first of all pure. It is also peace loving, gentle at all times, and willing to yield to others. It is full of mercy and good deeds. It shows no favoritism and is always sincere. And those who are peacemakers will plant seeds of peace and reap a harvest of righteousness."

"Don’t you realize that friendship with the world makes you an enemy of God? I say it again: If you want to be a friend of the world, you make yourself an enemy of God...  But he gives us even more grace to stand against such evil desires."

That last sentence is perhaps the most important.  Through the Holy Spirit, I am empowered to fix my eyes on my King, and to allow Him to set my goals and priorities.  I am glad to let Him.

Tuesday, December 4

On Catastrophes.

From my personal journal, edited slightly for anonymity.

This is actually my second time in the town where I'm currently rotating.  I guess it will always hold a little place in my heart because even if I successfully go on to do disaster work as my career, this town was the first place where I grabbed my work gloves and dug in to help other people whose lives had just been wrecked.  I showed up with a group a few days after the disaster to do general cleanup and hand out supplies.  I know now that I really should have found out where the medical tents run by the hospitals were and gone there to help, but I was uncertain enough of my skills that I didn't have the courage.  They could have used me.

Someone recently told me the area had been "totally cleaned up," so I was deeply surprised to see how destroyed it still looks.  There are a lot of new little houses, but nothing like the density of homes that was there before.  All the dead trees are still there.  There are still blue tarps around, for goodness' sake.  The two things that moved me most were seeing all the power/ telephone poles, which were all downed the last time I was here, and seeing how the foundation for one of the destroyed hospitals has been removed.  When I was here, everything was a flat, even layer of shredded insulation and fragments of levelled houses...  It was nightmarish.

Remembering back to how awful that whole scene was, for a moment today I couldn't help but wonder why I even want to go into disaster relief.  But part of the answer settled into me as I looked out over the scarred hillside this morning.  This, this brutality and overwhelming power, is how the world truly is.  And the way we deal with these crises - how we crumble, how we push back - is how we truly are.

Sunday, December 2

Carving your own way is not always fun

So here I am, at 5:30 on a Sunday morning, awake.  I have learned that one of the harder things about working in the ER is the shifting from days to nights and back again, generally with only 24 or 48 hours to do so.  I find myself frequently staying up for 24- 36 hours because I have things to do, or simply because my body has no idea what it needs.  I stare at the ceiling and rehearse interview questions a lot.

As a fourth year student, I'm in the phase of trying to get into residency, my required postgraduate training.  Generally, that takes this form:

- take Step/ Level 2 board exam during the summer
- apply to residency programs during the fall through a standardised system, the Electronic Residency Application Service, aka ERAS
- during autumn, spend time at various residency program locations for 2-4weeks at a time, trying to impress and hopefully scoring...
- interviews, which are how a program shows interest in an applicant after their ERAS application has been submitted
- during December/ January, students and residency programs create ranked lists of the programs/ students they would like, respectively.  So I might make a list that said my #1 choice was Program A, #2 is Program B, and so on.  At the same time, those programs are making lists that might say their #1 student pick is Jane, #2 is Zoe, #3 is Steven, etc.  All of these lists are fed into a computer that works through a matching algorithm, pairing students with residency programs according to their preferences.
- Match Day, the day when all successful matches are revealed, occurs in February for D.O.s and March for M.D.s.  Everyone hopes they received a match to a program, but as some fields are more competitive than others, there are invariably not enough spots in each area for all the people who want to do that work.  Hence the Scramble.
- the Scramble is something no one wants to do.  The day after Match Day, a list of unfilled residency spots is published, and it's a barely restrained free-for-all.  Think of tossing a pile of gold pieces into a crowd and saying, "Go!"  Yeah.

I just finished my third audition rotation: one family medicine, two emergency medicine.  I have one more ER audition and then I'm finished with this part and can get back to working/ learning without also feeling like I should be jockeying for a job.

The thing about this season is that it is insecurity-inducing and it impels you to contort yourself to please people.  You see how high-stakes this is, right?  Because you want to get a job, but you know you aren't that great as you are, so you start to compromise yourself in order to look more attractive to whichever program you are with at the time.  Which of course, is a futile goal, and one not pleasing to Christ.  My job isn't to please other humans.  My job is to do my best to please Him, every day.  Walking through this time has taught me a few very important things:


- not everyone at every site will like me, and there may be nothing I can do about it
- I most certainly will not like everyone I will have to work with
- pursuing Christ will make me enemies - the more openly I do it, the more enemies I make
- being a patient advocate will make me enemies - the more openly I do it, the more enemies I make
- a few doctors still think of women as not good physician material
- some programs will expect you to abandon your dignity and become a supplicant rather than an applicant who seeks to become an equal.  These programs will provide ample opportunities for you to play their stupid game
- we who seek to glorify the Lord are truly a remnant, a small band of rebels trying not to get shot down as we slip through and around the rigid expectations of others
- calling missions "international aid" or "providing care to those who are less fortunate" is a good way to keep from getting doors slammed in my face for now
- many people will want to compare notes with you endlessly - where you've been, how many programs you applied to, what your boards scores are, how many interviews you have.  It's easy to get obsessed with statistics and probabilities
- these people will not be inspired by you telling them you trust God to place you where you're meant to be.  They will look at you with pity.  They think stress is how you know you're doing it right


I can't even tell you what a weird process this has been.  The whole point of it is to prove how awesome you are and to get what you think you want for yourself, even if getting what you want means doing a bunch of stuff you hate and lying to people.  The pressure to conform is high and constant, and I've dealt with a lot of anxiety as I grapple with this system that I must survive in but still want to reject.  It is very hard to see an opportunity to impress or agree with someone who you know has power over you, and to count the cost and deem it too high, and to consciously allow the opportunity to pass.  There's no earthly reward for that kind of behaviour. 

I work to avoid straying from pleasing God to pleasing men because God has impressed something deeply on my soul.  It is not about getting into residency.  It is not about emergency medicine or family medicine.  It isn't even about being a doctor.  My purpose is to serve the King - to trust that He will let me know what my tasks are for that day, and to work at them diligently.  The tasks themselves are pretty much incidental.

Now how is that supposed to translate in an interview, hm?