Blog name and address change

Hey, in honor of all of the new ridiculous stories I'm going to have as a resident, I'm changing my blog name and address.  This matters because this blog will no longer exist under the old address/ name.  So:

old name - Almost a D.O.ctor; doctoralmost.blogspot.com

new name (!) - Practically a D.O.ctor, doctorpractice.blogspot.com

A friend suggested the clever name change to accompany the change in status.  I will really be practicing being a doctor now, in the sense that I will have to try to work out patient care on my own and in large part my attendings will exist as a safety net.  This is quite different from how you work as a medical student, where you have really no autonomy and there is always someone looking over your shoulder.

I will change the site name in about one week.  It doesn't look like there's a forwarding service that I can set up, so don't forget!

Residency training, day #1

Things I learned from my first day of residency training:

1. Lower your expectations.
2. Be on time.
3. Pay attention. 
[3a. If you're falling asleep, hold your breath until your brain thinks you're dying, freaks out, and floods your system with adrenaline.  Problem solved!  You are now awake, if twitchy and a little pale.]
4. Don't make excuses for your stupidity.
5. Don't harbor regrets for your stupidity.
6. I am probably as ill-prepared as I think I am, if not more.
7. Things will probably be okay anyway.

I'm doing a bit better spiritually/ emotionally, by the way.  It's incredible how the Lord comforts us in our struggles.  My attitude toward residency isn't settled yet, but it'll get there.

Wherever there is jealousy and selfish ambition, there you will find disorder and evil of every kind.

I wrote this a week or two ago, but followed the advice of a wise friend who suggested I wait and make sure I could handle this much transparency.  I'd be lying if I said this issue is closed, but I've already sat on this post in one form or another for months and I'm starting to feel like I'm hiding it.  That's not okay.  I don't want to give the false impression that this walk with Christ has no stumbles or sharp turns in it, and I don't like keeping secrets.  So here it is.

I often get the sense that real struggles with sin are not okay to talk about in a lot of church circles, but I don't currently have any thoughts on eschatology or the latest Joyce Meyer book, so this will have to do for discussion.  Let me start by saying that I'm still really ashamed of the content of this post, which is proof that this internal journey is nowhere near finished yet.  But it would be dishonest of me to pretend this isn't going on, and it's something that many, many doctors (Christian and not) have a hard time with, so it should be brought out into the light and examined with the eyes of truth. 

The real story of my winter and spring is not auditions, or rotations, or matching, or medicine.  Those things just form the backdrop for the action.  The real story of my past six months is how, for the first time since coming to know Christ several years ago, I fell unresisting into sin - the sin which some have said lies at the root of most other sins, pride.  I have almost no idea how to even talk about it.  It's so hard.  It came about so gradually at first, over years, that I didn't even notice it, and it started with something very simple and not wrong at all: I liked emergency medicine more than family medicine as a potential career.

You all know that for me, the FM/EM fight has been raging for years, and I always put it like this: I feel like FM has big strengths and undeniably lends itself to missions, but I just honestly like the ER so much.  And that sounds good.  But I didn't realise that other things were building up around that, things like: ER doctors get to tell cooler stories.  All family physicians get to do is drudgery, and they don't get any respect.  I would really like the flexibility that comes with shift work.  I don't have fun managing diabetes and such.  My feet hurt when I walk the floors on internal medicine.  I would hate to have to run a business so I'll never be a clinic doctor.

I have listened to so many incredible doctors warn about how obstacles to serving Christ creep in and take the form of our desires for comfort, stability, respect, and choice.  And you know what?  I still have let all of those things creep into my heart.  And I was so sure that everything was fine that I let it get worse.  By fourth year, my thoughts went more like this: yeah, I'm going to be an emergency doctor.  I'll do all the interesting stuff.  I will be the Christian who survives in a demanding secular environment.  I will be the spiritually sound one who still has the trendy job. 

Pastor Mark Driscoll did an interesting sermon series this year about identity, and he mentioned something that resonated like a bell for me: when you commit identity idolatry, that is, when you define yourself by something other than your relationship with Christ and put great worth in that identity, you eventually get extremely nervous.  This is because you can sense that whatever or whoever you have pinned your identity on is not reliable enough to keep you stable.  I recognise this in myself during audition season.  I had let my career become everything to me, the deepest part of my desires for my future and the center of my self-image; and the strain was starting to show.  My anxiety about matching into family medicine vs. emergency medicine was profound.  I probably cried about it 2-3 times a week for months.  It became very important to me that I match into an EM residency, although I still didn't realise why.  I just knew that I had to match into emergency medicine.  I had to.  That was all there was.

Except I didn't, did I?  I matched as a family medicine resident with a Christian residency program.  (How I was brought there when I was essentially running full tilt in the other direction is a whole other post.)

I wish I could tell you that I'm thrilled to start at this program.  I should be.  It is an incredible place, filled with deeply admirable people, and they deserve better than I am giving them.  And it is really sick that I can look at their graduating class and think, I really want to be like each of those people both as doctors and as Christians, and yet I feel shame when I tell people that I am going into family medicine. During my spring rotations I had to constantly interact with ER attendings and residents and a hot little knife of embarrassment jabbed me every time.

I haven't been able to pray with a whole heart since October or November.  I feel like I'm fleeing from the Word even as I seek it.  I have no peace about my immediate future even though it's settled now.  I am terrified that I am denying myself joy in the beginning of my residency.  I've admitted to myself that I crave recognition and am full of self-righteousness, that it's possible I never wanted EM for the right reasons, and that part of me wants to simply switch those terrible reasons over to my new field without working on my heart so that I can keep my pride.  There have been many layers to this repentance and each is more painful than the last, and I'm still not finished; at this point part of me doesn't even want to continue, which is why I persist in this spiritual listlessness.  I feel like a fraud and I feel an inch tall.  I wonder how the Lord could possibly use me for His purposes when I am such a sinner.  I wonder why on earth He would inflict me on such a good Christian ministry when I am anything but an asset to them right now.  And part of me can't help but repeat that maybe if I'd loved Him more, if I'd been a better Christian, I would be headed to work in an ER right now - which is totally theologically unsound.  The Lord doesn't work that way.  I know there is victory and freedom in Christ, and I have reveled in that in the past, but I am so far from that now.  And I worry that I don't know how to truly seek the ways of the Lord instead of the world.

So there you go.  I am lost and I feel like time is running out. I trust God's promise that He is with me always, even to the end of the age, but I also remember Jesus' clear warning that following him requires taking up your own cross - a metaphor for death to self and a call to sacrificial living.  My faith is small right now.  I'm glad all He asks is a mustard seed's worth. 

Probably no one will notice

So I graduated this last weekend.

I KNOW

Matt and me at prom - I mean, graduation.  It was awkward,
okay?  There were so many people STARING at us.  So we left a little room
for Jesus just in case anyone forgot we've been married for years.
For real, though, we were really happy in this picture.

I have wanted to be a doctor my entire life that I can remember.  There was possibly a preschool interlude where I wanted to be an astronaut or perhaps an elf, but ever since then it's been medicine all the way (well, and during middle school I really wanted to go to Hogwarts, but even then I figured I'd be a healer but WITH A WAND, you GUYS, it would be so cool.  Anyway).  It made graduating on Friday a really big deal for me.  And I had so much family there.  I think we were that annoying, enormous group that clogs up the hallways and where everyone overflows with pride all over the place.  It was wonderful.  I have received so much love and support from family and friends during school, and to have so many of them there, some from very far away indeed, to witness the ceremonial transition from student to professional was overwhelming for me.  The silly octagonal hat, the choking hood-scarf thing - I loved all of it.

So.  This was the first graduation ceremony that really mattered to me - and I tripped.  Twice.

It's my fault for being completely clumsy, and also for wearing tights with a pair of heels that I'd never done that with before.  I wasn't counting on the lack of friction between my foot and the shoe.  So walking into the auditorium, when all eyes were on us, I felt the shoe slip halfway off my foot midstep.  Everyone behind me tells me I did a good job of recovering, but I'm pretty sure I actually groaned and stumbled down the aisle much like a zombie with one foot and a moist, slippery stump where the other should be.  I made it to my seat without actually hitting the ground but it was a near thing.  It meant I spent all of the speeches in a cold sweat, picturing myself completely wiping out as I reached the front of the stage and possibly taking out one of my attendings as she prepared to hood me.  The crowd would make that dismayed, rumbling, "Whoooaaa nooo" that it always makes when someone does something irredeemably embarrassing.  I could see it, over and over.  Lord, please, no.  Please no.  My feet hurt a lot.  Please get me across that stage with a bit of decorum.  I'm going to pass out.

I am thrilled to report that I made it across the stage, receiving my professional hood and diploma without incident.  Instead, my shoe tripped me again as soon as I got behind the curtain.  I took them off completely at this point.  And so, as I got my official graduation picture, all hooded and proud, I was also barefoot.  (The picture is from the waist up, we're good).

I also walked back into the auditorium barefoot, shoes neatly hidden in the folds of my fancy robe.  And the things stayed off until it was time to walk out.  And so this is the first lesson I learned as a brand-new lady doctor: embarrassing things are going to happen all the time.  JUST FAKE IT.  NO ONE WILL NOTICE, PROBABLY.

PROBABLY.

Minor epiphany

I was in the middle of something that needs doing, but I just had an epiphany and I want to make sure I write it down somewhere, because it's important to me, and when things are important to me (and even when they're not), I write them down.

When I say I need to do work that matters, I just realised I mean I need my work to be irreplaceable to the people I'm working to help.  And I mean that in a very specific way.  I don't need to be the best (although I need to be my best, but that is obviously not the same thing); I don't need to do something new or unique.  But I need to work somewhere and with people who don't have other comparable options.  I don't want to be Dr. Zoe Almost on a list of 37 doctors you have access to who could provide the exact same service for you.  You don't need me around in that case.  No, I need the skills I'm learning to be used to plug a hole for people.  That means:

1. I need to serve in an area where there aren't many other doctors;

2. I need to serve a group of people that most doctors don't serve;

3. or both.

Listen, I still have no idea what this means in the practical sense.  Which maybe is okay for now?  It helps me to understand why I have no drive to be a doctor to nice suburban people, at any rate.  If there's one thing I hate seeing, it's waste; if there's one thing I hate being, it's superfluous.  And being yet another doctor available to people with lots of resources is a waste of what I'm learning that would render me redundant. 

Let's talk a bit about my brown privilege

[TL;DR: there are some undeniable perks to being brown.  Also, widespread initiatives to help those with need should not be race-based, but rather based on socioeconomic status, to keep selfish pigs like I was from taking advantage of the system.]

It took me a long time to even accept that I am, technically, a black American.  (Well.  Half-black, which technically makes me 'light-skinned' but I am not even going to go into unofficial black castes here today.  ANYWAY.)  It's such a big label; there's so much weight of racism and oppression and anger and race-based aspiration behind that.  Also, a lot of people think that label denotes being African-American, which I am not.  And yet, when it came time for college applications (of course), I saw the many opportunities that I could take advantage of for no better reason than because I was brown.  Would you like to be listed as a minority, or some such question.  Suddenly it made good financial sense to own my skin colour.  In my home state, when it comes to scholarship recognition, it's a rough crowd because there are a lot of Ph.D.s in that area which means a lot of good schools and kids who practice for their SATs and whatnot.  I was just another one of those kids.  Immigrant, educated parents who work hard, middle class.  And I'm smart, but not intellectually special - but certainly smart enough to notice that the bar for black people is set much lower than the race-blind bar, or even the Hispanic bar (I am half Colombian).  So I was suddenly not smart in the wider pool, nor even smart enough to count on my right side, but my left side - the black side - was top of the dogpile.  Yes, thank you, I would like to be listed as a minority in order to use this leg up that I really don't need because I'm not the person you were pityingly thinking of when you created this race-based legislation.

[I am well aware that the honourable thing to do would've been to not declare my minority status, but the truth is before I accepted Christ I was nothing if not a self-centered opportunist.  Being black had never worked for me before that point.  When it came to getting kickbacks from the government, however, suddenly racial identity had utility.  And man, did it have some serious utility.]  

That changed my entire life.  I was able to go to a private university tuition-free in a totally different part of the country, a place with a nearly 100% acceptance rate into medical school.  With odds like that, all I had to do was stay with the pack and I was basically in.  And once you're in medical school, barring a personal disaster you are definitely going to be a doctor. But it also changed me to click that box.  Suddenly I was black, or mixed, or Afro-Caribbean-white-Latina-with-some-indigenous-Colombian, or whatever.  I had this really confusing ethnic identity with all its baggage, and I didn't really want it, but once you pick it up you apparently can't put it down.  So instead I've sort of learned about this set of racial privileges that I have.

...That was probably a surprising statement to some of you.  But did you not think minorities have race-based privileges?  Totally do.

This is what I've found so far:

1. I am allowed to have a Voice.  This is actually backwards from how most people think it is.  Most people think it is still how it was fifty years ago, when a black person was denied a voice by dint of being black.  It is not that way anymore.  Now, white people are not allowed to have voices. What I mean by this is that those of Caucasian descent can't simply have something distinctive to say.  Have you noticed this?  It's especially true in areas concerning ethics, social justice, etc.  They can make small observations on things, but those observations always have to be bookended with, "but-I-am-drowning-in-invisible-white-privilege-so-I-can't-have-any-idea-what-I'm-talking-about-I'm-sorry-for-speaking-out-I-just-thought-maybe-I-noticed-something."  There's a fair amount of talk about how white people can't even have an accurate point of view on something because they are inescapably speaking from a place of privilege, which invalidates everything they say.  Sound familiar? 
   
   Sometimes white people who talk about social issues even get mad at other white people for daring to just say something.  They must be shamefaced about it.  They must internalise that they cannot possibly have a valid point of view, because they are white, and white existence is homogenous and vaguely oppressive.  I never have that problem.  My observations on the social issue of the day are always treated as legitimate.  It's the same with my personal experiences; my contributions to a conversation on racial or social issues are generally treated as somehow truer than a white person's, regardless of background.  In fact, I can literally (and yes, I mean literally) say any ridiculous thing I want, and I will only ever get so much criticism.  This is entirely because my skin is brown.  Here's an example.  White man goes on about hating black people?  He's a monster, but all the black people who go on rants about white people every day are normal and just acting out from the depths of their terrible oppression in our horrible capitalistic society.  Honestly, my pedigree makes me basically untouchable in a conversation if I want to be.  I'm a female double-minority first-generation immigrant.  This means I have the most legitimate point of view there is.  If I claim this label in a conversation with silly people, it's as though I just said, "Well, 2+2 = 4."  All argument stops.  Whatever I have just said is obviously now fact.
   
2. People think I'm awesome for doing normal things.   I mean, I'm black.  My life must have been hard, right?  And actually, there have been hard times, but not in any way that isn't true for all immigrants when they first get here, and later not in a way that can't happen to anyone.  I haven't faced any special pushback from The Man due to my race.  "But Zoe!  Stop being so insensitive!"  you say.  "There are many oppressed black people in our country!  Your experience is not the norm!"  No, it's not.  But there are also many oppressed white people in our country, and no one talks about them because they're meant to have some fancy white privilege (that somehow doesn't lift them out of poverty).
   I have graduated college and I will soon graduate medical school.  I'm pretty excited about that.  But some people, when they find out what I'm pursuing, get inordinately thrilled.  Not everyone can be a doctor.  I'm not disputing that.  So in the sense that I've done something unusual, people are right.  But let's consider my family situation, something that most people don't do.  My mother has two degrees in nursing.  My father has a Ph.D. in physics.   I am not even the first in my generation with multiple degrees; my cousin already beat me to that distinction.  The point I'm trying to make is that at this point I'm dynasty.  I have an educated family; this is normal for us.  Except apparently not, because my brownness means I must have overcome a ton of naysayers, so I'm extra impressive.  I get so many verbal accolades for my hard work, even though some of my white colleagues are the first people in their ENTIRE families to get ANY degree past high school, and yet they fought their way to the professional level.  Good thing their white privilege made it so easy for them, especially the ones who had to work a job in order to make it through medical school.
   
3. I have membership in the Black People Club.  I used to hate this, but I've learned to love it.  Want to know where something is in a hospital?  Don't ask a doctor or a nurse.  Ask a housekeeper or orderly or transport person.  Oh, except you can't, because most of them are black and you're not, so to a lot of them you don't count all the way as a person.  I do, though.  I'm brown.  All of the support staff in my hospital love me for NO other reason than that I'm the little black medical student.  I am every black person's sister or daughter.  They don't know, or care, that I don't have whatever experience we are meant to share that supposedly brings us super close and makes me worth helping.  They also don't know that many of the white doctors and students they don't greet or talk to much have a lot more in common with them than I do.
   
   I've always thought it was very interesting that black people and Latino people are allowed to be openly racially exclusive but Caucasian people cannot do the same without being labelled racist.  Consider the collective chummy media eye-roll when Beyonce said she makes music for black people.  Consider my first college roommate who told me she had to get away from all the "whiteness" on campus and be with "our people" sometimes - even though her father was a dean.  Now imagine if a white person had said those things.  Suddenly much more shocking to you, I'm guessing.

It's really sad that so many Caucasian people accept this assertion that they are less interesting and valuable - that their experiences are less notable or their conclusions less correct - because their skin is pale.  And it's also really sad that so many minority people in this country have internalised the language of racial isolation and race-based struggle on top of whatever personal hardships they may have.  Now everyone loses.

February #2: Falling Asleep Inappropriately, Or, Radiology

I see how we got here.  In reality all it took were a series of small, logical steps.  Radiologists need to be able to see details in the scans they review, so they darken the room.  They sit down while they work, so it makes sense to have good chairs.  Radiology doesn't require a lot of talking.  And why be cold when you can be warm?  Each piece by itself is perfectly normal.  Consider the sum total, however: a warm, dark, quiet room, where you sit unmoving in a plushy chair for hours.

In short, a nap room.  Except not.  Because you're meant to be working.  Except not, because you are sleeping.

This led to a lot of painful, violent struggles between me and my brain, where it was mashing the POWER button trying to shut me down while I desperately refused to let my background programs close.  Eyelids flickering madly, I always lost.

Brain: ENVIRONMENTAL PARAMETERS MET, INITIATING SLEEP MODE

Me: What?!  No, brain!  No!  Nuuuuuu...

-pause as I fall asleep-

-radiologist suddenly starts teaching-

Radiologist*: ...be worried, not that the mediastinum appears widened here.  But since we're talking about it, what are the main-

Brain: EMERGENCY REBOOT... ONLINE

Radiologist: -causes of a widened mediastinum on a radiograph?

Me: pbbbrthftuhwhat?!  The... of a widened... they are!  Aortic dissection?  And.  Pericardial effusion.  And pneumonia, possibly, in the right middle lobe or the lingula.

Oblivious Or Perhaps Just Kind Radiologist: Good.  Pleural effusion could maybe show up like that too, but it's less likely to be central.  But like I said, we don't see that here. 

I don't think I have ever instantly snapped from sleeping to being fully awake, in a total panic, and on the spot like that before.  It hurts on some connective tissue level.  And it happened almost every day.

Also, right around this time I failed to match into an osteopathic residency.  Not as dire as it sounds, don't worry.  More on that later.

*I made this line up completely.  I have no idea what he said to start the sentence, because I was asleep.  I'm glad I caught as much of his question as I did!

February #1: Ophthpththtpthtpphphththpth- Eyes

So this rotation introduced me to something special and wonderful.  No, not that the inner part of your eyelid and the clear top layer of your eyeball are actually all one continuous layer (although!  how cool is that?! And isn't that also kind of weird?  Because the inside of your eyelid is pink, but that outer part of your eyeball is clear.  And also it's weird that that layer, your conjunctiva, is not made of the same stuff as the clear part that you look through, your cornea.  Crazy.  Anyway).  No, gentle reader, this is the rotation where I learned why spring of fourth year is so vaunted.  It's because you do nothing.

Let me be clear that when I chose my rotations for the spring semester, I was not trying to choose easy rotations.  I wanted to use this time to try to learn about things I'd had very little exposure to.  I chose ophthalmology, radiology, HIV clinic, and anesthesiology.  Sounds legit, right?  Ha!  Wrong!  Because as I found out, once people know you're a fourth year student rather than a third year, they find any number of reasons to send you home early or have you not come in in the first place.  Real examples:

"It might snow today."

"You've been working hard."

"You've already seen this stuff a couple times and you seem to get it."

"Your head hurts; why would I make you work with a headache?"

"You have an appointment scheduled for late morning, so just take the whole morning off."

"If you came in you'd only be working for like two hours anyway."

"I'd like to stay home but I can't, so you do it."

"You're a fourth year."

I felt so weird arguing with people to let me stay and work.  After the first few times, it became easier to just go with it.  And I have discovered something wonderful: having a full life.  I read books.  I watch extra sermons.  I lead study groups for second year students.  I am helping my husband lead our Bible study group.  I exercise, cook, do laundry, talk to my husband, AND I sleep...  is this what all you people with lives get to do all the time?  Surely not; it's too awesome.  If it were possible for people to always live like this the secret would be out, right?  I also love working at medicine, but working all the time doesn't hold a candle to having a balanced, varied life that is full of different sorts of challenges and chances to enjoy people.  I had no idea.  I don't think I have ever had this before.

Despite everything I just said, I did go to work sometimes while I was on my ophthalmology rotation.  It was a whole new totally overwhelming world, actually, which made a two week rotation feel like those impossible multi-site tours people are always inflicting on themselves when they go to other countries.  You take a bunch of pictures of towns you don't catch the names to, you try unsuccessfully to learn a phrase in the local language, you try some weird foods that you're not sure you like, and then you go home.  It's experience with no context to ground it; fun, but with limited return on your investment.

Doctors don't generally learn much about eyes.  They're there.  You see through them.  Don't get stuff in them.  Sometimes they get dry.  You want the jelly part to stay inside.  Go see an eye doctor.  The end.  We learn a fair amount about what leads up to the eyes, i.e. how the brain manages vision and how damage to the brain/ nerves specifically affects sight in different ways, but that's not the same as understanding the eyes themselves.  Eyes are highly complex and fascinating.  They're also quite important in that eyes are the only place in the body where we can directly see blood vessels and nerves without doing surgery or something, because we can shine a light into the eye and see straight through to the back.  That means all diseases that affect blood vessels or nerves systemically (think diabetes, high blood pressure, high cholesterol, some infections, etc.) will show up visibly in the eye somehow.  This is in addition to all of the specific eye conditions that someone can have.  There is a ton of very specific tech and wordage surrounding this, and in two weeks all I got were some basic eye exam skills and a glimpse at a huge body of knowledge that I know nothing about.  I watched a lot of cataract surgeries.  I did not have to watch anyone get their eye surgically removed, and I will always be grateful for that, because ew.

Also I looked at peoples' irises under high magnification a lot.  I was meant to be contemplating the deep mysteries of the pathologic retina at the time, but irises are cooler to look at if you're not an ophthalmologist.  Did you know irises have kind of a black background, and the colour is actually a bunch of fibers radiating out from the pupil?  They stretch out almost flat when your pupils are small, and they curl up when your pupils are dilated.  And a lot of people have little spots of other colours in their irises that aren't visible normally.

Somewhere in there I made P. F. Chang's chicken lettuce wraps from scratch and got all my dry cleaning done and had some work done on my car.

You can tell this was an enormously productive rotation.

A Touch of Writer's Block

I have been trying to write about the Match, and identity, and accomplishment as an idol, and medicine as an idol, for about two months now.  Also my fear of the future and learning to let go of really big things and what it really means for Christ to be my portion.  And I can't get any of it down in words.  I don't know why.  Maybe I haven't finished wading through it all yet.  Anyway, I haven't let myself make any of my usual silly posts because I feel like I have some Really Important Stuff to get out first.  Vegetables before dessert, and all that.  But it just isn't happening right now. 

So, fine.  I give up for a while.

Coming up next, February #1: where I stare deeply into peoples' eyes for two weeks.  No, really.

In the meantime, enjoy this lovely little song.

Quick thoughts from the interview trail

This city is getting nicer and nicer, he said.  Take the area we're in right now.  It used to be a bunch of projects.  But they tore all that down about 10 years ago, and now there are all these nice bars and restaurants here.

I nodded, but all I could think was, Where did all those displaced people go? I didn't ask.  He wouldn't have known.  But it's interesting how once you decide to start seeing the poor in our country, your eyes are opened to a whole horrible world that most like to pretend doesn't exist.  That man probably didn't even realise he was talking about people's homes.  It was just a Bad Area that has now been magically transformed into a Good Area.  How wonderful.  How bloodless.

Changing subjects slightly.

Interviews are hard because all the talk is about how great the program is for you, how it will give you everything you want, how cushy it is, etc.  I'm not denying that comfy things are comfy, but it hits right at the heart of the self-centered mindset of the rich that we are meant to be so on guard against.  And I wonder how best to fight that mentality while continuing to aspire to the next step of my career.  And I wrestle with how deeply I can enter into this world of having everything I want while still counting it all as scubula. 

"More than that, I also consider everything to be a loss in view of the surpassing value of knowing Christ Jesus my Lord. Because of Him I have suffered the loss of all things and consider them filth, so that I may gain Christ."

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.

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.<sup>"

"</sup>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.}